2014 - May/June TFDA

FLORIDA DENTAL ASSOCIATION

TODAY’S FDA

2014 AWARD WINNERS Non-covered Services Legislation Approved by the Legislature!

Dr. Paul Miller Named Dentist of the Year

VOL. 26, NO. 3 MAY/JUNE 2014

WE KNOW DENTISTS. WE KNOW SERVICE. For the last 10 years, I have worked with Dennis Head at FDAS for my insurance needs. His knowledge and skill provided us with the insurance coverage we needed for me personally and for our businesses. Dennis responded after just one phone call. Then he followed up to make sure we understood what coverage we had, and let us know it was in place. He asked the questions that I did not know to ask.

Dennis proves himself to be a valuable member of our team of advisors. I will continue to use Dennis and FDAS, and will refer him to all of my colleagues.

Don J. Ilkka, DDS Leesburg

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

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

Dr. Paul Miller: Dentist of the Year

news

literary

12 news@fda

30 Letter to the Editor

21 Non-covered Services Legislation

Approved by the Legislature!

columns

36 2014 Award Winners

3

Staff Roster

5

President’s Message

6

Legal Notes

18 Rebranding: The Art of Redefining Yourself

11

Information Bytes

22 CT-guided Implant Surgery

49 Diagnostic Discussion

26 Generous Dentists Offer Comprehensive

Care to Patients in Need

58 Dental Staff: Components

of Optimal Ultrasonic Therapy

31 Mission of Mercy (MOM) Event

80 Off the Cusp

features

52 “No Touch” Digital Restorations 54 The LANAP Protocol and Orthodontics 65 Sound Insurance Protection

for This Hurricane Season

classifieds 72 Listings

68 Dental Negligent Referrals 76 Introducing Sal La Mastra

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.

May/June 2014

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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!

Christine Mortham

Accelerate

YOUR PROFESSIONAL GROWTH 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

FEB. 20-21, 2015 • The Grand Sandestin www.nwdda.org • 850.391.9310 • nwdda@nwdda.org For a complete listing, go to www.floridadental.org/fda-master-calendar.aspx.

May/June 2014

EDITOR Dr. John Paul, Lakeland, editor

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

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

or 850.350.7136 cmortham@floridadental.org

Today's FDA

MAY/JUNE 2014 VOL. 26, NO. 3

BOARD OF TRUSTEES

800.877.9922

2

FLORIDA DENTAL ASSOCIATION

Dr. David Boden, Port St. Lucie • Dr. Jorge Centurion, Miami Dr. Stephen Cochran, Jacksonville • Dr. Richard Huot, Vero Beach Dr. Don Erbes, Gainesville • Dr. Don Ilkka, Leesburg • Dr. Jolene Paramore, Panama City Dr. Rudy Liddell, Brandon • Dr. Beatriz Terry, 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 bimonthly, 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 For display advertising information, contact: Jill Runyan at jrunyan@floridadental.org or 800.877.9922, Ext. 7113 Advertising must be paid in advance.

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

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 Drew Eason, Executive Director deason@floridadental.org 850.350.7109 Rusty Payton, Chief Operating Officer rpayton@floridadental.org 850.350.7117 Graham Nicol, Chief Legal Officer gnicol@floridadental.org 850.350.7118 Judy Stone, Leadership Affairs Manager jstone@floridadental.org 850.350.7123 Brooke Mills, Assistant to the Executive Director bmills@floridadental.org 850.350.7114

FLORIDA DENTAL HEALTH FOUNDATION (FDHF) Stefanie Dedmon, Coordinator of Foundation Affairs sdedmon@floridadental.org 850.350.7161

FLORIDA NATIONAL DENTAL CONVENTION (FNDC) Crissy Tallman, Director of Conventions and Continuing Education ctallman@floridadental.org 850.350.7105 Elizabeth Bassett, FNDC Exhibits Planner ebassett@floridadental.org 850.350.7108

ACCOUNTING

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

Jack Moore, Chief Financial Officer jmoore@floridadental.org 850.350.7137

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

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’ Compensat on • 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

Leona Boutwell, Bookkeeper – FDHF & A/R lboutwell@floridadental.org 850.350.7138

GOVERNMENTAL AFFAIRS

Deanne Foy, Bookkeeper – PAC & Special Projects dfoy@floridadental.org 850.350.7165

Joe Anne Hart, Director of Governmental Affairs jahart@floridadental.org 850.350.7205

Tammy McGhin, Payroll & Property Coordinator tmcghin@floridadental.org 850.350.7139

Alexandra Abboud, Governmental Affairs Coordinator aabboud@floridadental.org 850.350.7204

Mable Patterson, Bookkeeper – A/P mpatterson@floridadental.org 850.350.7104

Casey Stoutamire, Lobbyist cstoutamire@floridadental.org 850.350.7202

COMMUNICATIONS AND MARKETING

INFORMATION SYSTEMS

Jill Runyan, Director of Communications jrunyan@floridadental.org 850.350.7113

Larry Darnell, Director of Information Systems ldarnell@floridadental.org 850.350.7102

Marcia Dutton, Administrative Assistant marcia.dutton@fdaservices.com 850.350.7145

Lisa Cox, Database Administrator lcox@floridadental.org 850.350.7163

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

Lynne Knight, Marketing Coordinator lknight@floridadental.org 850.350.7112 Jessica Lauria, Publications Coordinator jlauria@floridadental.org 850.350.7115

Ron Idol, Network Systems Administrator ridol@floridadental.org 850.350.7153

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

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

Jamie Chason, Commissions Coordinator jamie.peddie@fdaservices.com 850.350.7142 Kristen Gray, Membership Services Representative kristen.grey@fdaservices.com 850.350.7171

JOE DUKES Northeast & Northwest Insurance Representative 850.350.7154 Cell: 850.766.9303 joe.dukes@fdaservices.com

JOSEPH PERRETTI South Florida District Insurance Representative 305.665.0455 Cell: 305.721.9196 joe.perretti@fdaservices.com

RICK D’ANGELO

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

West Coast District Insurance Representative

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

www.floridadental.org

DAN ZOTTOLI Atlantic Coast District Insurance Representative

May/June 2014

813.475.6948 Cell: 813.267.2572 rick.dangelo@fdaservices.com

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PRESIDENT’S MESSAGE TERRY BUCKENHEIMER, DMD

What a Year it has Been!

It’s hard to believe that this year is already coming to an end! We are in the final phase of preparation for the Florida National Dental Convention (FNDC) in June, and my last meeting as chairman of the Board of Trustees was on May 3.

We have had a remarkable year thanks to the passionate volunteers and the dedicated staff led by our executive director, Mr. Drew Eason. I won’t be able to provide all the details in this article, but I invite you to please come by the House of Delegates (HOD) on Friday, June 13 at 1 p.m. at FNDC. Whether you are a delegate, an alternate delegate, trustee, council member or member of the Florida Dental Association (FDA), I encourage you to come and listen. Highlights of what your FDA has accomplished will take center stage for 15-20 minutes. I hope you will be amazed at the progress of your organization and take with you a feeling of pride for being a member!

On Thursday, June 12 at FNDC, the “Sweet Success” program will honor all the 1,465 volunteers of the Florida Mission of Mercy (MOM) event. The MOM event was spectacular! Over the course of two days (March 28 and 29), 1,660 people were provided care and more than $1.14 million of dental care was donated. Media coverage included national and local TV, radio and press — what better way to make the public aware of

www.floridadental.org

“ ”

I hope you will be amazed at the progress of your organization and take with you a feeling of pride for being a member!

the FDA and its caring members? The Florida Dental Health Foundation was instrumental in providing the funds to carry out this MOM event, and Rusty Payton and Stefanie Dedmon were the driving force behind the scenes. Come and celebrate with many of the volunteers and show off your talents during karaoke. Last year this event was a blast!

On Saturday, June 14, I encourage you attend the Awards Luncheon at FNDC. There have been quite a few individuals who have contributed so much to the FDA this year. This issue of Today’s FDA provides an insight into some of the award winners, especially my friend

Paul Miller … the FDA’s Dentist of the Year! This luncheon will enable all FDA members, as well as the friends and family of the award winners, to properly recognize these important individuals.

The luncheon will directly follow the HOD, is reasonably priced and will be a fitting close to the meeting. I can’t wait to see the excitement generated during these special awards!

In this issue, you will see articles about technology. This July, we will be converting our software system to Aptify.

Through a very generous opportunity from the American Dental Association (ADA) and through the tireless efforts of the FDA’s Information Systems department, Larry Darnell, Ron Idol and Lisa Cox, we finally will be able to share information in a common database between all levels of the ADA. This should create member value and relevance, and keep our communications up-to-date.

What a year it has been! Thanks for your membership in this great organization.

Do all you can to protect this wonderful profession and may God bless!

Dr. Buckenheimer is the FDA president.

He can be reached at tlbdmd1@gmail.com.

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Legal Notes

Frequently Asked Questions About the Professionals Resource Network Graham Nicol, Esq.,

HEALTH CARE RISK MANAGER, BOARD CERTIFIED SPECIALIST (HEALTH LAW)

Dentistry can be a stressful profession.

Stress, substance abuse, or other physical or mental impairment may lead to a decline in professional competence. Substance abuse and professional competence are always concerns when protecting the public’s health, safety and welfare.

Therefore, section 456.076, Florida Statutes, requires treatment programs for impaired practitioners. The Department of Health (DOH) works with approved impaired practitioner programs as consultants. Dentists, dental hygienists or dental assistants who fall below professional standards of care due to substance abuse or other type of impairment may encounter the Professionals Resource Network (PRN), which is also known as Florida’s Impaired Practitioners Program.

The PRN and its medical director serve as the consultant to the DOH on matters relating to practitioner impairment.

The PRN also works closely with the

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DOH’s legal department in regard to impairment-related mitigation factors during disciplinary proceedings. Specifically, the PRN is involved in intervention, evaluating and treating a professional, continued care of impaired professionals by approved treatment providers, continued monitoring by the consultant of the care provided by approved treatment providers regarding the professionals under their care, and expulsion of professionals from the program. What follows is information from the Board of Dentistry (BOD) that answers the most frequently asked questions that members of the Florida Dental Association (FDA) have.

What is the PRN? The Professionals Resource Network Inc. (PRN) is a nationally recognized, legislatively enacted private nonprofit 501(c)(3) organization, that is widely cited as one of the premier programs for impaired health care professionals in the United States. The PRN program was originally created to serve physicians, and has grown to serve a wide range of health care professionals and other participants. It serves dentists, dental hygienists and dental assistants, as well as dental students and applicants for licensure.

What is the PRN’s mission statement?

The PRN has the ongoing mission to protect the health, safety and welfare of the public, while at the same time to support the integrity of the health care team and other professionals. Through a complex and comprehensive statewide system, the PRN has the ability for early identification, intervention and appropriate referral of all licensed health care professionals and other professionals who are affected with all impairment types, inclusive of those arising from physical conditions, mental/emotional problems and chemical dependency/abuse. When indicated, post-evaluation/ treatment and monitoring afford health care practitioners and other professionals the earliest and safest opportunity to reintegrate with the health care team while protecting both the confidentiality of the participant and the safety of the public.

Is it confidential?

The PRN is often an alternative to the DOH disciplinary process and is entirely confidential from the FDA. Most referrals to the PRN occur before there is any patient harm or violation of the Dental Practice Act. Dentists participating in the PRN do so voluntarily instead of being reported to or by DOH. This allows the PRN to maintain an individual’s confidentiality and limits the negative impact on his/her life. Confidentiality will be lost if there is a failure to progress in recovery or if sexual misconduct is alleged. www.floridadental.org

Legal Notes

The PRN and the public disciplinary process may run concurrently if there is patient harm and the licensee waives confidentiality, or a finding of probable cause is made. If there is an immediate and serious threat to the public due to a licensee’s impairment, an emergency suspension order may be issued by the secretary of the DOH, which is public record.

What is impairment?

Impairment is defined as the condition of being unable to perform one’s professional duties and responsibilities in a reasonable manner and consistent with professional standards. Cognitive function, judgment, reaction time and ability to handle stress are increasingly affected. As impairment progresses, the potential for compromised patient care increases.

Impairment may result from dependence or use of mind- or mood-altering substances; distorted thought processes resulting from mental illness or physical condition; or disruptive social tendencies.

What signs may indicate impairment?

Because professionals are human, compiling a complete and definitive list is impossible. Co-workers, friends and family members generally notice when “something is up.” Warning signs may include: v increased absenteeism that may be more pronounced following weekends, holidays or scheduled days off. v subtle changes in behavior or appearance that may increase in severity over time; job performance and progress notes deteriorate. v mood swings or personality changes. The socially outgoing individual may become withdrawn; a usually quiet individual may become talkative and gregarious; a calm and agreeable person may become argumentative and agitated. v disproportionately overreacting in response to situations that were handled appropriately in the past.

Co-workers and staff often feel frustrated and helpless. Staff morale and performance tend to deteriorate while the impaired professional becomes more impaired. Associated problems usually stay unresolved without effective intervention and treatment of impairment and its cause.

Does the PRN help with anything other than impairment?

Yes. The PRN plays a crucial role in providing confidential management and monitoring of HIV-infected health care workers. It also can assist dentists facing physical limitations, such as stroke, Parkinson’s, chronic pain, etc. or mental health issues like depression and anxiety, cognitive decline, etc. It also is sometimes used when sexual boundary violations occur. www.floridadental.org

What should I do if I suspect a professional is impaired?

Any person suspecting impairment of a professional’s ability to provide safe care may make a report to the PRN and/or the DOH. Referrals of individuals occur through various avenues, including: self, hospitals, group practices, individual partners and/or staff, patients, treatment providers, family, friends, pharmacies, other work settings, law enforcement, the DEA, the DOH (including licensure applicants referred for evaluation due to history of illness that may affect ability to practice) and the respective Boards. You may make a referral or seek a confidential consultation by calling the PRN at 800.888.8776.

How does the evaluation process work?

Upon referral of an individual with a suspected illness, and given sufficient evidence, the individual is required to undergo an independent evaluation with a Department Approved Provider (DAP) coordinated by the PRN. Such providers have been approved by the DOH due to their credentials, expertise in treating health care practitioners and the diverse services they offer. The PRN will offer the referred individual three options for evaluators based upon the suspected impairment, the intensity/severity of the situation and the geographical location.

Evaluations will vary from in-office assessments to inpatient evaluations. A second opinion evaluation by a DAP, and also coordinated by the PRN, is always allowed if the practitioner disagrees with Please see LEGAL, 9

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

During FNDC2014, Dentists, Hygienists, Assistants and Dental Students will be volunteering to provide pro bono treatment for a group of area foster children. Participants will receive continuing education credit for their efforts. 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. Come by and see your colleagues in action!

At press time, only a few volunteer time slots remained. You can check online by searching for keyword “PDC” during FNDC course selection. Thank you for supporting Project: Dentists Care and helping to make a child’s heart smile!

BUILDING PARTNERSHIPS TO BUILD HEALTHY SMILES

Legal Notes

LEGAL from 7

the original recommendations. The ultimate question to be answered by the evaluator is whether, in the evaluator’s expert opinion, the licensee is able to practice his or her profession with reasonable skill and safety.

How is treatment provided?

In those cases where there is a recommendation for treatment following evaluation, the PRN will again offer three options for a DAP. This selection will be based on the illness identified, the type of treatment needed, the intensity of treatment required and the geographic location. Treatment modalities will vary from office follow-up for medication management and/or therapy to extended residential treatment for several months.

What are the costs for PRN services?

The PRN is a nonprofit organization funded through a contract with the DOH to implement the statutorily mandated Impaired Practitioners Program (from licensure fees) and through charitable contributions. Participants are not charged for the PRN’s services. The program has no financial relationship with any evaluator, treatment provider or facilitator. The PRN does not provide medical services; therefore, participants pay directly to the providers.

Likewise, in the monitoring phase, the participant pays directly to the provider for urine toxicology screening, ongoing psychotherapy and the facilitator of the regional PRN group they attend as a requirement of their contract. When all other financial options have been exhausted, charitable treatment options, as well as a participant loan fund, are available for verified hardships.

Can a participant still practice?

Initially, the participant may be required to refrain from practice during evaluation and any resulting treatment. The participant may resume practice when given authorization to do so by the PRN. The approval for a return to practice is based upon recommendations from approved treatment providers in consultation with the PRN staff. Practice limitations are often required during the early phase of return to practice.

Does the PRN protect my license?

The PRN routinely supports participants in the program who are in compliance with the recommendations of the program in the evaluation, treatment and/ or monitoring phase. The PRN will work with hospitals, practice partners, insurance carriers, HMOs, disability carriers, the DEA, criminal courts, other state impairment pro-

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grams and other state licensing agencies; and offer support for participants if they are deemed impaired.

As consultant to the Department of Health and the Licensing Boards, the PRN supports compliant participants who have disciplinary investigations, complaints or action taken against their license. Participation in the PRN is often used as mitigation in disciplinary cases charging impairment and the PRN will speak in support of those in compliance at BOD meetings.

Do I need to self-report a DUI arrest to the Board of Dentistry?

Not the arrest, but section 456.072(1) (x), Florida Statutes, requires dentists and hygienists to report in writing within 30 days all convictions, guilty pleas and nolo contendere pleas, except for minor traffic violations not related to the use of drugs or alcohol. You must report misdemeanors, felonies, “driving while intoxicated” (DWI) and “driving under the influence” (DUI) even if they result in a suspended imposition of sentence.

You must report them even if they occurred out of state.

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.

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Information Bytes

Password Keepers

By Larry Darnell

FDA DIRECTOR OF INFORMATION SYSTEMS

What do 123456 and your birthday have in common? They might be your password … for everything. In this day and age of information technology, we are increasing the number and complexity of the systems we access, but we are not keeping up with the security measures necessary to provide basic protection. Just accessing the Florida Dental Association’s (FDA) website and the FDA Leadership site requires two passwords. Add in about another dozen — including email accounts, pin numbers for your debit cards, usernames for banking sites — and even the best memory gets stretched. So what do we do? We use one password or a variation on that one password. This is called a “life password” and if it can be figured out, anyone could have access to (or at least a higher probability of gaining access to) your critical data.

Many people use their web browser to remember passwords and login data. This works well for low-level security websites but it does not work with sites that are encrypted. It is also a potential vulnerability. Anyone who has access to your computer (directly or indirectly) has your passwords. www.floridadental.org

Some are turning to password keeper programs to manage this vital task. Password keepers are encrypted data vaults that keep your passwords accessible via either a master password or two-step verification. Think you don’t need this? Try accessing your usual websites when you are away from your computer. Yes, you need one. The best ones work across all platforms: PC, iOS, Android and Mac. Let me say, as far as password keepers go, you really do get what you pay for. There are free options out there; however, I have been using the program 1Password (https://agilebits.com/onepassword) for years and paid good money for it, but it has been a lifesaver.

A password keeper is a program that stores data in the cloud (on a server somewhere) that permits you to access that data if and only if you have the encrypted key. If the master password is 123456 or your birthday, do not bother with one.

The five basic password policies are this: First, change passwords frequently, every month if need be. Secondly, never give your passwords to anyone. Try telling your daughter to keep that bank pin a secret! Third, make your password something that no one could guess by using a mixture of letters, numbers, upper and lower case and even special characters.

Fourth, resist the temptation to use one password, or a variation, for everything.

Imagine if we had one key for everything we own. Lastly, realize that even the best

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Resist the temptation to use one password, or a variation, for everything.

Imagine if we had one key for everything we own.

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security can and will be compromised.

Keep an eye on your accounts and never assume you are safe.

I would recommend using a password keeper. For a current review of password keepers themselves, check out this website: http://online-password-managerreview.toptenreviews.com/.

Mr. Darnell is the FDA’s director of information systems and can be reached at 850.350.7102.

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news

@ fda

IMPORTANT NEWS FOR FDA MEMBERS

Attend ADA 28th New Dentist Conference Registration is now open for the 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, Missouri. The conference offers up to 14 hours of topnotch 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.

And don’t miss the hands-on endo and implant workshops at UMKC School of Dentistry. Geared to new dentists — those who earned a DDS or DMD 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.

More Title Changes for FDA Staff

Stone

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The Florida Dental Association (FDA) is pleased to announce title changes for two of its employees.

Judy Stone’s title has changed from Agency Relations Manager to Leadership Affairs Manager

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to better reflect what she does. Her role remains basically the same with a primary accountability being to manage the ongoing activities of the leadership bodies of Runyan the FDA (Board of Trustees, House of Delegates, ADA delegation, work with component societies, councils, etc.). In addition, Jill Runyan’s title has changed from Publications Manager to Director of Communications. Her previous title also didn’t reflect the diversity of her job — publications, e-newsletters, social media, support staff for the FDA Council on Communications, work with Moore Communications Group, etc.

Congratulations, ladies, and thank you for all you do!

New Appointment to the Board of Dentistry On Friday, March 28, Gov. Rick Scott appointed Dr. Tinerfe J. Tejera to the Board of Dentistry (BOD). Dr. Tejera’s term began March 28, 2014 and will end on Oct. 31, 2017. He is subject to confirmation by the Senate. FDA member Dr. Tejera succeeds Dr. Carol W. Stevens from Port Charlotte, also an FDA member, who has served on the BOD since March 10, 2010. Dr. Tejera is an oral maxillofacial surgeon out of Fort Myers. If you know Dr. Tejera, please reach out and congratulate him on his appointment! If you know Dr.

Stevens, please thank her for her service and commitment to organized dentistry throughout her tenure on the BOD!

HHS Secretary Appoints ADA Member Dr. Linda Niessen to Advisory Committee Health and Human Services (HHS) Secretary Kathleen Sebelius recently appointed ADA member Dr. Linda Niessen to the Advisory Committee on Training in Primary Care Medicine and Dentistry. Dr. Niessen is dean of the Nova Southeastern University (NSU) College of Dental Medicine in Fort Lauderdale, Fla. Her term on the committee runs through August 2016.

The advisory committee provides recommendations on policy and program development to HHS, and is responsible for submitting an annual report to the secretary and Congress concerning certain activities of the Public Health Service (PHS) Act. In addition, the committee develops, publishes and implements performance measures and evaluations of certain sections of the PHS Act. The Advisory Committee comprises of 17 members, including practicing health professionals engaged in training, leaders from health professional organizations, college faculty, and health professionals from public or private teaching hospitals or community-based settings.

Mouth Problem?

There’s an App for That!

The new American Dental Association www.floridadental.org

(ADA) Oral Pathologist app is a handy tool to aid dentists in the diagnosis of lesions, papules, nodules, ulcers, vesicles and many other oral pathology conditions. For chairside use with mobile devices, the ADA Oral Pathologist app was developed by Dr. Michael Kahn, chairman and tenured professor of the Department of Oral and Maxillofacial Pathology at Tufts University School of Dental Medicine.

App features: s access content anywhere (Internet not needed) s registration or subscriptions not required s compatible with Android or Apple s search for more than 200 oral pathology conditions by name, or perform searches by entering information such as gender, age, clinical site and clinical observations s includes suggestions for management The ADA Oral Pathologist app is available from the Apple Store or on Google Play for $59.99. For more information, visit success.ada.org/en/apps/.

Get Flood Insurance Before Hurricane Season Starts!

Flood insurance requires a 30-day waiting period before it can go into effect.

With hurricane season starting June 1, make sure to get yours in place this month! Call us at 800.877.7597 if you have any questions.

www.floridadental.org

Submit an Article for Today’s FDA! Do you have an article that you would like to share with the Florida Dental Association’s (FDA) members? Submit original articles for review and possible publication in Today’s FDA to communications@floridadental.org.

Send Us Your Pictures!

The Florida Dental Association (FDA) wants to see its members active in the dental community. Attending a dental meeting or event? If so, take a picture and email it to communications@floridadental.org to be featured in the FDA’s social media outlets. Please include the name of the event, names and any other information you would like our members to know.

Have a Question ...

Ask the Experts!

Stop by the Florida Dental Association’s (FDA) membership booth in the Exhibit Hall at FNDC and talk to different members of FDA staff to get the answers to any questions you’ve been wondering about — from legal to IT to legislative and more.

Stay tuned for the June News Bites for more information!

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

Atlantic Coast District Dental Association

Vigamy Arguello, Pompano Beach Steven Burman, West Palm Beach Ty Eriks, Fort Lauderdale Emilia Isaza, Lake Worth Randi Korn, Plantation Marina Nudel, Fort Lauderdale Krunal Patel, West Palm Beach Brian Rosenberg, Coral Springs Central Florida District Dental Association

Shiju Cherian, Lake Mary Rosana Nikfar, Orlando Joymarie Saavedra, Sanford Nicholas Tanturri, Daytona Beach Siennella Thomaszadeh, Palm Coast Nga Vu, Orlando Jeffrey Werblin, Leesburg Northeast District Dental Association

Naderge Chery, Jacksonville Alexander Fetner, Gainesville Jiangian Hu, Jacksonville Linda Johnson, Jacksonville Erin Sherrill, Jacksonville Lori Vespia, Ponte Vedra Beach South Florida District Dental Association

Anna Aller, Coral Gables Jean-Paul Chavez, Miami Ivette Coro, Miami Malaika Davidson, Miami Dorgis Garcia Lopez, Miami Daniel Guera, Miami Beach Katia Mattos, Hollywood

Please see NEWS, 15

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JOIN MORE THAN 6,000 DENTAL PROFESSIONALS AT FNDC2014!

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NEWS from 13

Sagar Mauskar, Miami Melissa Quintana, Miami Nadezda Selmic, Hallandale Elena Solis Gonzalez, Miami Claudia Urday, Miami Yeneir Urquiza, Miami Gardens Sergio Vega, Hialeah Stanley Zelman, Miami West Coast District Dental Association

Francisco Bezerra, Wesley Chapel Mitchell Edlund, Sarasota Richard Gyles, Clearwater Uday Mehta, Tampa Ruben Mesia, Tampa Victoria Rinando, Naples Deborah Ruddell, Fort Myers David Sherberg, St. Petersburg Fady Zaki, Lakewood Ranch

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Rebranding

Rebranding:

Art Redefining The

of

Yourself

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www.floridadental.org

Rebranding

By Moore Communications Group

Branding is a buzzword that is very familiar in the circles of public relations and advertising, but it’s also a term that’s gained momentum with the mass public over the last few years. Companies — big and small — are more accessible than ever before. The landscape of communications has drastically changed with the explosion of social media, and companies are continually challenged to stay fresh, active and engaged with their target audiences.

In business, the art of defining your identity is called branding. Too often, the word “brand” becomes synonymous with the concept of a company logo. However, a brand is much bigger than that.

It’s a philosophy and an attitude. It’s how you approach product development and what drives you to the next big idea.

Simply put, branding is storytelling. As storytellers, we have a responsibility to tell the kind of stories that speak out in our rapidly evolving world and re-establish our connection to the people we serve. The best stories get better through time — they are constantly refined to meet the growing expectations of the audience. The same applies to branding.

Why do companies rebrand? In general, there are five key catalysts that spur a rebrand:

Rebrands come in all sizes and shapes.

While some may include simple tweaks and fine-tuning, others include new logos, taglines, messaging and more. The overall goal for a rebrand is to reinvigorate your business from the ground up.

It’s changing the way you think about your business and personifying that to the public.

As the Florida Dental Association (FDA) works to strengthen and reinvigorate its organization, we are adding a new chapter to the story with a rebrand to include a revised logo, a fresh look and updated messaging. This rebrand will provide a new and unique visual identity for the FDA while focusing on relevancy in today’s market. Those attending the upcoming FNDC on June 12-14 in Orlando will have the opportunity to be a part of the unveiling. If you haven’t registered, we encourage you to do so and be part of the excitement!

We look forward to seeing the new idenity of FDA take shape and to further the great work of one of the countries’ premier dental associations.

“

The overall goal for a rebrand is to reinvigorate your business from the ground up.

”

The Moore Communications Group is a public relations firm with offices in Tallahassee, Washington D.C., Miami and New Orleans. They can be reached at 850.224.0714.

s company growth/expansion s targeting a new audience s release of a new line or product s relevancy to today’s market s negative public perception

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Non-covered Services

Non-covered Services Legislation Approved by the Legislature!

By Joe Anne Hart

FDA DIRECTOR OF GOVERNMENTAL AFFAIRS

The Florida Dental Association (FDA) understood the significant challenge that lay ahead when filing legislation that would be heavily opposed by the insurance industry. During the 2010 Legislative Session, the FDA knew the importance of educating its members on the unfair practice of insurance companies dictating charges for non-covered services. The FDA implemented a grassroots campaign that involved member dentists contacting their local representatives to encourage them to support the FDA’s legislation on this issue. During the 2011 Legislative Session, the FDA engaged membership by having dentists send personal postcards to all legislators asking them to co-sponsor the FDA-supported bills. It was clear during the 2013 Legislative Session that the bill sponsors who agreed to file the bills, Sen. Jack Latvala (R-Clearwater) and Rep. Ron “Doc”Renuart (R-Ponte Vedra Beach), were not going down without a fight. Sen. Latvala was so adamant to pass legislation on non-covered services that he got the language adopted onto four different bills that were all approved by the full Senate. In a last-ditch effort to get approval from the House, Rep. Renuart filed amendments to several different bills, including an insurance industry bill, to try to get the language to the finish line. On the last day of session, Rep. Renuart’s amendment was the last amendment discussed (but eventually withdrawn) on the last bill that was adopted before the Legislature adjourned.

From the beginning, there has been overwhelming support from the Senate, but it has been an uphill battle in the House of Representatives. The insurance industry has developed strong relationships with many of the House members and is able to influence their support despite the Senate’s position on these types of issues. As years passed and many other states were successful in their efforts, the FDA recognized the need for possible compromise language to lessen the opposition.

The National Conference of Insurance Legislators (NCOIL) developed model legislation that had been acceptable in 25 out of the 33 states passing legislation to stop this unfair practice. After continued roadblocks and resistance from the insurance industry, the FDA decided to model its legislation after NCOIL. Even this compromise initially was met with disagreement by the insurance plans. But with continued support from FDA volunteer leaders keeping this issue alive, the opposition from www.floridadental.org

the insurance plans was neutralized and the FDA garnered unanimous approval.

The next step will be for the legislation to be approved by the governor before it can become law. Should this legislation become law (SB 86), it will apply to contracts entered into or renewed on or after July 1, 2014.

So, you may ask — how does this legislation help me? Since Florida’s laws are silent on this issue, it has been very difficult to refer to a section in law that directs the spirit of fairness in contract provisions. Many instances have shown that dentists may not realize what a certain provision means in a contract, and once signed, they are bound by the terms of that contract. This new law will help address any future concerns that may be added to contracts of this nature.

The FDA thanks all of the volunteers who provided support and took time out of their practice to travel to Tallahassee and met with legislators on this issue to tell their personal stories. The FDA also appreciates all of the grassroots efforts that help get this legislation approved this session.

Ms. Hart can be reached at 850.350.7205 or jahart@floridadental.org.

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Technology

CT-guided Implant Surgery: You Have Nothing to Fear but Fear Itself!

By Jay B. Reznick, DMD, MD

Dentists can be a funny bunch. We all — for the most part — like new technology and gadgets, yet it is very difficult for some of us to change the way we do things, especially when it comes to our practices. Some of our colleagues would be satisfied if they could continue doing procedures and using clinical techniques just as they learned them in dental school. If they never had to learn anything new, they would be content.

A few years ago, along with many 21st century dentists, I witnessed history in the making — a true milestone in the practice of dentistry that represents only a tip of the iceberg of what is to come.

This event was the first live presenta-

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tion of the two most significant technological advances in dentistry since the first dental radiograph was taken in 1896 merging together. The first is the CEREC CAD/CAM system, which allows dentists to accurately scan a dental preparation and then create a restoration that is milled from a solid piece of ceramic or composite material. The second is the GALILEOS cone beam CT scanner. This revolution in implant dentistry transfers the image of the dental and soft tissue topography in and around an edentulous space into a 3-D radiograph of the patient’s jaws. This information is then used for the planning of dental implants. This is the next quantum leap in the evolution of CT-guided dental implantology.

It is my belief, that within five years, CT-guided implant surgery will become the standard of care (I hate using this term) for implantology. There already are a number of dental implant manufacturers who have embraced this technology and developed CT-guided surgical kits for their implant systems. There also are a number of fine software packages on the market that allow for CT-based implant planning and the manufacture of a guided surgical stent. So, for those of you who are not familiar with this technology, I will elaborate.

When I began practicing almost 20 years ago, implant surgeons would plan their dental implant placement from a study model and panoramic radiograph. We would lay a large flap to visualize the

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bony anatomy and place the implants to engage the greatest volume of bone.

Six months later, we would uncover the implants and send the patient to their restorative dentist and hope that the implant fixtures were positioned well enough to be restored. Sometimes they were. Sometimes they were not, in which case, the implant would be “buried” and never restored. Fortunately, today we are a little smarter. Implantology today is, at least theoretically, restoratively driven.

That makes sense, since the goal of tooth replacement therapy with dental implants is to give the patient a functional and esthetic prosthesis to restore their chewing function and self-confidence.

However, most dentists today still use a stone model and panoramic radiograph to design the surgical stent. Sometimes at surgery, it is discovered that the implants cannot be placed where desired, and so the implant position or angulation is “adjusted” to try to accommodate. Other times, the postoperative radiograph reveals that the actual implant placement was less than ideal.

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3-D CT-guided dental implant surgery virtually eliminates these problems.

This technology allows patients to have a true restoratively-driven implant treatment. We start with the restoring dentist creating the ideal prosthesis for the edentulous site, and then a radiographic template is made for the CT scan. Knowing the size and position of the ideal restoration, the implant surgeon uses a 3-D radiograph of the jaws to plan the implant placement sites, taking into account the bone volume and anatomy at each site, as well as the position of the prosthesis. If there is a bone deficiency requiring grafting, or if an angled abutment will be needed, this information is known before surgery and adjustments are made accordingly. This is all done in “virtual reality” on the computer screen using the patient’s actual data. Then, all this treatment planning data is used to create a custom surgical guide that accurately transfers the treatment plan from the computer screen to the patient’s mouth. And if that’s not enough, the implant placement is so accurate, that

the surgical guide can be used to create a master model that is used to design an abutment and restoration that are placed at surgery, with very little or no adjustment. Not only that, but this technique allows the surgery to be performed through a very small incision, in half the time of traditional implant surgery. In addition, the patient usually has a faster and more comfortable recovery, even when multiple implants are placed.

So, with all these benefits, why is it that CT-guided implant surgery is not the “norm” today? I think that it goes back to the first paragraph of this article. Most dentists are afraid of learning a new way of doing something, especially when it is so revolutionary that it completely changes our concepts and workflow in a particular clinical discipline. But I want to tell you not to fear the future. Embrace it. This technology, even though it seems very complicated, will actually make your life easier and your patients happier. CT-guided implant Please see CT, 25

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Technology

CT from 23

surgery allows us to get the best results, while improving the experience for our patients. We are starting with the ideal final result, and working backward to get there. This technology facilitates more accurate treatment planning and implant placement, leading to fewer complications and an overall greater implant success rate.

Like any other innovation, in order to be adopted by the masses, it needs to be easy to use. Given that this technology evolved from the medical-grade CT scanner, most of the earlier implant planning software programs required the dentist to be both a radiologist and a computer engineer. They also required the data from the CT scan to be put on a CD to then be imported into the implant planning program. This usually took a significant amount of time, which more than offset the time saved by using a CT-guided surgical stent. As a result, very few practitioners adopted this technology. The development of cone beam CT scanners brought this technology into the hands of dentistry and into our offices. Dental manufacturers began making the scanners more user-friendly, and the developers of dental implant planning software have followed suit.

A few of the systems available today make the workflow of implant planning and manufacture of the surgical guide a

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smooth, seamless process. In my practice, implant planning is done immediately after the patient is scanned. The patient participates in the process, is educated about implant dentistry and can see firsthand if there is bone deficiency or pathology that will need to be addressed.

The entire process, from opening the scan to planning the implants and ordering the surgical guide takes just a few minutes.

More and more implant manufacturers are seeing the writing on the wall and developing CT-guided surgical kits for their implant systems. The smart implant companies are committed to being “open source,” meaning that they are cooperating with a variety of software and surgical guide manufacturers, so that the practitioner can choose their favorite implant system and surgical planning software and use CT-guided technology to provide tooth replacement therapy to their patients. I am certain, that within a few years, all of the major implant systems will have this capability.

Once you have started using CT-guided technology, you will not want to do it the “old-fashioned way” again. You will be convinced by the accuracy and precision of treatment planning and implant placement, the reduced surgical time, the ease of restoration and the increased case acceptance. The biggest hurdle is to convince yourself that it’s no

different than making the switch from a typewriter to a word processor. Sure, it was a little intimidating at first, but once you got the hang of it, you were correcting, deleting and reformatting like a pro. The same thing goes for the switch from mallet and chisel to the high-speed handpiece for exodontia. It seemed like a radical change, but would you go back to your typewriter or chisels? Change is a good thing, especially when it improves the quality of your practice, and gives your patients a better experience and a better result. It’s pretty cool, too!

This article was originally published in the November 2009 issue of Dentaltown Magazine. It has been reprinted with permission of Dentaltown and the author, Dr. Jay Reznick.

Dr. Reznick is the director of the Southern California Center for Oral and Facial Surgery in Tarzana, Calif. and a diplomate of the American Board of Oral and Maxillofacial Surgery. His special clinical interests are in the areas of facial trauma, jaw and oral pathology, dental implantology, sleep disorders medicine, laser surgery and jaw deformities. He also has expertise in the integration of digital photography and 3-D imaging in clinical practice. He can be reached at jreznick@sccofs.com.

Sirona Dental is an exhibitor at FNDC14; visit them at booth #604 in the Exhibit Hall.

Author’s Bio

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Florida Donated Dental Services

Generous Dentists Offer Comprehensive Care to Patients in Need

By Dental Lifeline Network ● Florida

Fifty-five-year-old Boyd, a resident of St. Cloud, has suffered vision problems since birth and is legally blind. He is unable to read but enjoys listening to TV, especially the NASCAR races, with Chewy, his three-year-old Chihuahua.

Boyd was in desperate need of dental care, including 10 extractions to eliminate his painful periodontal disease and

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frequent abscesses. As a young adult he was able to work, repairing vehicle transmissions and installing concrete, until his deteriorating vision prevented further employment. Now, he is financially dependent on social security disability insurance, food stamps and Medicaid. Boyd could not afford the extensive dental treatment he needed and Medicaid does not cover dental therapies for adults.

Thanks to the overwhelming generosity of Dental Lifeline Network ● Florida volunteer Patrick Mokris, DMD of Kissimmee, Boyd was relieved of his pain. Boyd received the comprehensive treatment he needed. Now he lives without the pain of dental disease, with new dentures and a new smile. Dental Lifeline’s Florida Donated Dental Services (DDS) program often is the last resort for vulnerable people who have no access to care.

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Florida Donated Dental Services

Boyd (center), a resident of St. Cloud who is legally blind, received comprehensive dental care due to a generous donation from Patrick Mokris, DMD, (right) and dental assistant Dawn Middleton through Florida Donated Dental Services (DDS), a program of Dental Lifeline Network ● Florida, and the Florida Dental Association.

“My treatment with DDS was excellent,” said Boyd. “They asked me what was the first thing I’d do. I got me a great big apple and ate it — it was delicious! I just keep smiling. It’s nice to walk up to someone and grin!”

Boyd is one of thousands of Floridians with disabilities or who are elderly or medically fragile and cannot afford treatment. Patients who qualify as medically fragile are those who need a clean bill of oral health to receive chemotherapy for cancer or autoimmune diseases, an organ transplant, dialysis, cardiac surgery or those who have crippling arthritis and need a joint replacement.

Dr. Mokris, who treated Boyd, is a one of 396 Florida DDS volunteers. In addition, 196 Florida dental laboratories and several labs from outside the state donate their services. Through Florida DDS, nearly 1,300 people have received $4.7 million in donated treatment since Dental Lifeline Network ● Florida was founded in 1997 in conjunction with the South Florida District Dental Association (SFDDA). This year, the Florida Dental Health Foundation has granted funding that enabled DLN to hire a full-time program coordinator.

Volunteer today!

DDS volunteer dentists are needed throughout the state and volunteering is easy!

Most volunteers treat one or two patients per year. Dentists review the patient profile in advance, choose to see or decline any patient, and determine the treatment plan. As

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a volunteer, you see patients in your own office, on your own schedule and never pay lab costs. Florida DDS Program Coordinator Megan Gallagher screens patients to determine eligibility, handles the paperwork, serves as liaison between the dental practice staff and the patient, and arranges for assistance from specialists and laboratories. To volunteer, please contact Megan Gallagher at mgallagher@ DentalLifeline.org or 850.577.1466. For more information, visit http://dentallifeline.org/florida/.

Dental Lifeline Network ● Florida is part of the national Dental Lifeline Network organization, a charitable affiliate of the American Dental Association. Dental Lifeline Network serves patients in all 50 states and the District of Columbia through more than 15,000 volunteer dentists and 3,600 laboratories.

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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

Anal

Loca thetic

lgesics

al anescs

Letter to the Editor - MOM Event

Letter to the Editor Dr. Terry Buckenheimer

PRESIDENT, FLORIDA DENTAL ASSOCIATION; FLORIDA MISSION OF MERCY VOLUNTEER

Dear Editor, As president of the Florida Dental Association (FDA), I am extremely proud of the incredible support by the hundreds of dentists and more than 1,300 other volunteers who made the Mission of Mercy (MOM) a success. During this two-day event at the Florida State Fairgrounds, 1,660 dental patients were treated, 8,017 procedures were performed and more than $1.1 million worth of donated dental care was provided for free. The event provided even more significant cost-savings to the community by saving these patients from costly hospital emergency room visits due to dental pain.

The MOM highlights the need for appropriate funding for adult dental care in the Medicaid system. Florida has more than enough dentists to meet the needs of the state.

It is a matter of funding, not workforce.

Beyond large-scale events like this, the FDA hopes to raise awareness of the importance of prevention. The most tried and true methods to promoting dental health are brushing and flossing twice a day and regular dental visits. Waiting until there is a problem results in costly procedures and even trips to the emergency room. The FDA hopes that raising awareness of and helping address this issue has a lasting impact on people’s lives.

Thank you again to the many volunteers and our gracious sponsors. I was truly honored to be able to be a part of helping our fellow man.

Dr. Buckenheimer is the FDA president. He can be reached at tlbdmd1@gmail.com.

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 topics 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.

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Photos by Dr. Larry Lieberman and Jill Runyan

Mission of Mercy (MOM) Event

“

Photos by Dr. Larry Lieberman and Jill Runyan

Mission of Mercy (MOM) Event

”

Photos by Dr. Larry Lieberman and Jill Runyan

2014 Award Winners

s t n

e i ip

c e R d r a

Aw

Plan to attend the Awards Luncheon on June 14th, at the Florida National Dental Convention that will recognize and honor the 2014 award recipients.

For more information contact Ashley Liveoak at aliveoak@floridadental.org.

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Dentist of the Year Dr. Paul Miller Dr. Paul Miller has served as president and treasurer of his affiliate and component dental associations. After a severe motorcycle accident that left him injured and a friend mortally wounded, he did not go into hiding and instead dedicated himself to his role as treasurer through Dr. Buckenheimer’s term as FDA president. He also accepted a position on the ADA Council on Member Insurance and Retirement Programs at Dr. Buckenheimer’s recommendation.

He has a heart of gold and is a dear friend who can be called on at any time for ideas, recommendations and advice. He has a sense of humor, and passion and dedication to the profession, especially its financial well-being. He and his wife, Peggy, enjoy family vacations with their four children: Adam, 27; Elise, 25; Erin, 22; and Austin, 19. Dr. Miller also enjoys snow skiing, boating, motorcycles, triathlons, running, traveling and attending all kinds of sporting events.

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2014 Award Winners Leon Schwartz Lifetime Service Award Dr. James Walton Dr. James Walton is a true professional.

He is constantly giving of himself and his skills. He is an excellent leader and innovator. He leads by example and never asks anyone to do something that he wouldn’t do himself. He served a doubleterm as president of the Florida Dental Health Foundation (FDHF) because he was so dedicated to its mission, and he shared a common vision with all of the members of the board.

In addition, he is on the Council on Governmental Affairs and an ADPAC board member, and has served on the ADA delegation for many years. He is unselfish and always giving back to the profession and the community. His interests are hunting, traveling, golf and community service. The FDA is proud to present this special award to such a great individual.

Leadership Award Dr. Richard Stevenson Dr. Richard Stevenson is the ultimate “go-to” person. He is a leader by example in the Northeast District Dental Association (NEDDA), as a line officer for the FDA and as a delegate to the ADA. He offers to attend the Florida Board of Dentistry meetings, serves as the FDA representative to the Oral Health Florida Coalition, and fills in for Dr. Buckenheimer at any meeting of the FDA when he has a conflict with his duties as an ADA trustee. Dr. Stevenson is the FDA president-elect and an FDA Services board member. He is a great person to rely on when in need and is described as trustworthy, dedicated, loyal and dependable.

Leadership Award Dr. David Boden Dr. David Boden is a thoughtful leader and natural spokesman. He is able to quickly analyze an issue or problem and effectively communicate his position in a convincing fashion. His leadership role in the fight for community water fluoridation and his natural fit into his liaison

role with the Department of Health has improved the image of the FDA. He also is the FDA trustee from the Atlantic Coast District Dental Association (ACDDA), the chairman of the ADA Council on Ethics, Bylaws and Judicial Affairs, and is an alternate delegate to the ADA.

Leadership Award Dr. Sam Desai Dr. Sudhanshu “Sam” Desai embraces his diversity and shares it with the West Coast District Dental Association (WCDDA). He is the president of the WCDDA and has a passion for organized dentistry.

He is enthusiastic about his culture and his family, and he expresses that eagerness by making all of his colleagues in the WCDDA feel like family: including them in cultural celebrations, dinners, sharing gifts, and providing a unique and inclusive style of leadership. His willingness to serve, combined with his use of cultural diversity, sets an example of how to be inclusive.

Leadership Award Dr. Jolene Paramore Dr. Jolene Paramore is organized like no other. She is knowledgeable about every aspect of organized dentistry from the budget to efficiencies in our legislative efforts. She quickly analyzes what is best for the FDA and is not afraid to lead the way to a better organization. Dr. Paramore is an ADA delegation chairwoman, FDA trustee from the Northwest District Dental Association (NWDDA) and organized the formation of the “Budgeteer Network” within the ADA House of Delegates. She is a skillful communicator and an excellent leader by example.

Special Recognition Dr. Nolan Allen Dr. Nolan Allen was the inspiration behind the Florida Mission of Mercy (MOM) event. He attended and volunteered at several MOMs programs around the country and brought back a passionate desire to serve the community. His friendship with Dr. Terry Buckenheimer, Please see AWARDS, 38

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2014 Award Winners AWARDS from 39

Special Recognition

and their passion to serve others, led to a presentation to the Florida Dental Health Foundation (FDHF) board for funding — and the rest is history.

Dr. Cesar Sabates

Dr. Allen is an FDHF board member, FLA-MOM co-chairman, ADA delegate and Council on Access, Prevention and Interprofessional Relations (CAPIR) consultant. He is a pastpresident of the FDA as well as the West Coast District Dental Association (WCDDA), and was an ADA CAPIR council member. He is caring, giving of himself to others and unselfish. It gives the FDA great pride to acknowledge a tremendous leader and a compassionate friend with this special recognition.

Special Recognition Dr. Leo Cullinan Dr. Leo Cullinan has a passion to serve those in need, which led to the formation of the Dental Outreach of Collier County in Naples and the Access to Care Committee of the West Coast District Dental Association (WCDDA). The decision to present the MOM project to the Florida Dental Health Foundation (FDHF) board for funding created a need for a strong and organized leader to help Dr. Nolan Allen, as well as someone who also would be willing to serve on the board as well. Dr. Cullinan was a natural fit, has performed absolute miracles in preparing for the event and spent countless hours going over every detail.

Past leadership roles include president of the WCDDA as well as the Collier County Dental Association. His tireless pursuit of perfection, attention to detail, passion for service to others, and ability to communicate deep emotions and feelings in a meaningful way make him well-deserving of this award.

Dr. Cesar Sabates has a passion for dentistry and our organization. He currently serves as an ADA delegate, is a member of ADA Council on Access, Prevention, and Interprofessional Relations (CAPIR), and also has served as president of the South Florida District Dental Association (SFDDA). Most past-presidents of the FDA are ready to pack up their gavel and go into retirement or a life where different interests are pursued.

Not Dr. Sabates. He continues to serve on the Executive Director Review Committee, the Governmental Affairs Committee, and most importantly, the FDA Audit Committee, where he is willing to lend his expertise in budgetary matters on a consultant level. He has a true enthusiasm for our organization and a willingness to serve in any capacity. If you know Dr. Sabates, you know that as dedicated as he is to dentistry, his family comes first. The FDA is indeed fortunate to have an individual of this caliber on our team.

Service Award Dr. Richard C. Mullens Dr. Richard Mullens is a firm believer in service above self. He has served the Northeast District Dental Association (NEDDA) for more than 16 years as treasurer. He tirelessly works to help the underserved and received the FDA Special Service Award in 2006, as well as the ADA Recognition for Special Service to the Underserved Award in 2007 for his dedication. He has been a delegate to the FDA House of Delegates since 1996. Dr. Mullens is described as invaluable, compassionate, charitable, dedicated, spiritual and humble.

Service Award Dr. Johnny Johnson Jr. Dr. Johnny Johnson has become the community water fluoridation expert in Florida. He travels around the state “debunking” all the false claims of the anti-fluoridation groups and presents an enormous amount of science that allows the benefits of community water fluori-

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2014 Award Winners dation. Many of his activities are self-funded. His role in the reversal of Pinellas County’s decision to end community water fluoridation brought national attention to the battle for fluoridation. He is now running for county commissioner of Pinellas County due to his recognition for doing what is right for the citizens. He is a member of the Pinellas County Oral Health Coalition and is a fluoridation advocate. He is passionate in his research to substantiate his belief in community water fluoridation, ethical and always does what is right for the public.

Service Award Dr. Richard Huot Dr. Richard Huot has been instrumental in keeping the leadership of Florida educated on national issues about dentistry. He single-handedly arranged for a community dental health coordinator to have her sabbatical here in Florida at the Treasure Coast Community Health Center. Through his efforts, we were able to witness how this type of position can increase the use of dental services for those less fortunate by helping them navigate through the public health delivery system.

Dr. Huot is a trustee from the Atlantic Coast District Dental Association (ACDDA), a member of the FDA’s Council on Communications, an ADA delegate and a member of the ADA Council on Government Affairs. He is a past-president of the Maine Dental Association and member of the ADPAC board.

He is described as a hard worker who learns from experience and is able to distinguish best practices. He has experienced dentistry from all angles: private practice, public health, the military and practice consulting.

Service Award Dr. Bertram Hughes Dr. Bertram Hughes takes his role as chairman of the FNDC committee with the utmost sincerity. He analyzes meetings around the country to determine what would work best in Florida at FNDC. His innovative ideas and commitment to success has caused an increase in attendance and a substantial increase in the profit-

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ability of our meeting. He devotes countless hours to contract negotiations with speakers and vendors and works efficiently with our FNDC staff. In addition, Dr. Hughes is an ADA alternate delegate and has several leadership roles in the National Dental Association. He is dedicated, innovative and tireless in his efforts.

Service Award Dr. Gerald Bird Dr. Gerald Bird not only serves as the chairman of FLADPAC, which is almost a full-time job in itself, but he also serves on the ADPAC board. He is the expert on legislative issues and the inner-workings of the election process. He is a tremendous fundraiser during the election cycle and is a constant force in choosing candidates who show concerns for our dental issues. Dr. Bird is politically astute and a strong advocate of the dental profession.

Daniel J. Buker Special Recognition Award Stefanie Dedmon Ms. Stefanie Dedmon is one of the most “dive right in and get it done” employees that the FDA has. She is willing to do what it takes to get a job done and help out in other departments when needed.

She is unselfish, caring and thoughtful.

Stefanie is the coordinator of foundation affairs for the Florida Dental Health Foundation (FDHF), and in the past was an administrative assistant to the Agency Relations and Legal departments, as well as the executive director. She recently took on the planning of the Mission of Mercy (MOM) project that took place in Tampa in March. No one had planned such an event in Florida before and she is a huge part of its success.

Stefanie graduated fro m the University of Central Florida with a degree in Hospitality Management. She is currently working on her master’ s degree in leadership while still working full time. She enjoys traveling, college football — especially SEC teams whose colors are orange and blue — and is very active in her church.

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Dentist of the Year

Over the years, Dr. Miller has appeared at typically stale House of Delegates meetings as a sheriff, pirate and/or a KISS rock star.

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Dentist of the Year

It’s Miller Time ...

The Champagne of Dental Leaders

By Dr. Hugh Wunderlich

This year, the Florida Dental Association (FDA) is honored to present its annual Dentist of the Year Award to Dr. Paul R. Miller. The presentation will take place at the FDA Awards Luncheon at the Florida National Dental Convention on Saturday, June 14, 2014. Dr. Miller will be returning the “FDA checkbook” as he retires from five years’ of service as FDA Treasurer. The 11:30 a.m. ceremony promises to be especially effervescent, as our native Wisconsin honoree is well-known for his zest for life and “case” of costumes and characters. Not unlike a bottle of Milwaukee’s Best, Dr. Miller overflows and bubbles with energy. “Paul is not afraid to make sport of himself and turn a dry dental meeting into something memorable,” says FDA President Dr. Terry Buckenheimer. Over the years, Dr. Miller has appeared at typically stale House of Delegates (HOD) meetings as a sheriff, pirate and/or a KISS rock star. Not just a party hat; oh, no … we are talking full Wyatt Earp moustache, scar face and/or Gene Simmons’s tongue. Not only does Milwaukee bottle the champagne of beers, but it also brews some distinct dental leaders.

In 1977, Dr. Miller graduated from the University of Wisconsin; then the Marquette University School of Dentistry and later settled on the west coast of Florida. Dr. Miller is a general dentist in New Port Richey and was fortunate to be surrounded by some of the FDA’s finest elder leaders, residing right in the West Pasco area. Sometime in 1988, Dr. Niles Kinnunen was working on the West Coast District Dental Association’s (WCDDA) annual session and reached out to Dr. Miller. “Paul, would you help me put together this year’s meeting?” he asked. Now, WCDDA is no small district — it’s larger than 23 states. At that time, no committees or extensive staff was available. So, the burden of the meeting fell on the upcoming president of the component, and the entire knowledge base for the meeting fit in a cardboard box in the trunk of a car. There was so much to learn. I think all of our FDA leaders got their start this way — late-night phone calls from a mentor or colleague: “Have you ever considered serving on …” or “I want you to be the next …” and the “It’s only two extra meetings year.”

When it’s time to relax, one beer stands clear.

If you’ve got the time, we’ve got the beer.

Miller Time.

The Champagne of Leaders.

Dr. Miller quickly found his niche in the FDA and applied his math and finance background to budget matters (a burden most dentists would love to avoid). Everyone Please see MILLER, 45

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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. Order your tickets before May 30. For more information, contact Ashley Liveoak at aliveoak@floridadental.org.

PRESIDENT’S AWARD Dr. Terry L. Buckenheimer DENTIST OF THE YEAR Dr. Paul Miller J. LEON SCHWARTZ LIFETIME SERVICE AWARD Dr. James Walton III

SPECIAL RECOGNITION AWARDS Dr. Nolan W. Allen Dr. Leo Cullinan Ms. Stefanie Dedmon Dr. Cesar R. Sabates

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

Dentist of the Year

Dr. Miller with his staff. From left to right: Krissy Vien, Jessica Reuter, Dr. Miller, Tanya Rossow, Michelle Durivou and Anna Arnold.

MILLER from 43

is aware of the obvious budget, finance and audit meetings in his job description, but we are quick to forget the hours necessary to review spreadsheets line by line … dollar by dollar. Dr. Miller also was one of the early “budgeteers” on the 17th District Delegation to the ADA. This “budget badge of honor” was attached to the members of the ADA delegation that had an affinity to review the ADA budget that is measured in pounds, not pages (a job other delegates would easily give up). The “budgeteers” have been so effective on reviewing the ADA budget that any Florida delegate at any ADA function is assumed to have the same fiscal “brand” of responsibility.

Attending some of these meetings might mean several consecutive days out of the office. There is a lot of time away from your office, home and family that gets filled with dark rooms and PowerPoints. Chrissy Vien, Dr. Miller’s office manager, says of his time away, “Yes, it’s hard when he is busy with so many dental functions and away from the office, but the entire staff is happy to pitch in and minimize the impact on the patients. All the patients love him, so it makes the time away easy.” All this time away from home only works with the support of an understanding spouse and family.

Fortunately, Paul and Peggy Miller have balanced their 32 years of marriage with family time and reared four children: Adam, Elise, Erin and Austin. All of the children are excellent snow skiers, mariners and attended the University of Central Florida. On the southwest corner of their bedroom closet wall is a large nail. Curiously, Dr. Miller has placed every neck lanyard from every dental meeting he has ever attended for the FDA on this nail. At last count, this nail strains from 80 lanyards (give or take a few).

This seems to be a visible reminder of the Sisyphean burden that is embraced by our leadership.

In 1981, there was a popular beer jingle that ran on television. It showed two ski patrolmen at the top of a snowy mountain finishing some sort of difficult task that has them exhausted. Time for one last run before dark; cue the music — it’s Miller Time. They swish down the mountain, throwing up wakes of white powder, carving a path in and out long shadowed trees. The exhaustive efforts of the day are trailing behind them, and they soon will be refreshed with a cold beer and enjoy life. That’s Paul Miller; that’s Miller Time. This has become an adjective in our lexicon since then. It’s a difficult task, done well, with style and then capped off with something to savor life. I think Dr. Miller does just that.

Come to the FDA Awards Luncheon in June and celebrate life with Dr. Paul Miller and all the other recipients.

Dr. Wunderlich has a general practice in Palm Harbor and can be reached at htwdds@gmail.com.

Photo caption on page 42: Dr. Miller and family, from left to right, Austin, 20; Adam, 28; wife Peggy; Erin, 22; Elise, 25 and Dr. Miller. www.floridadental.org

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May/June 2014

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Diagnostic Discussion

Diagnostic Discussion

By Drs. Indraneel Bhattacharyya and Nadim Islam

A 44-year-old female was referred to Dr. Daniel Lauer, a periodontist in Palm Beach Gardens, Fla., for evaluation of a mildly symptomatic lesion on the palate (Fig. 1) by her dentist, Dr. Jimmy Chen, also of Palm Beach Gardens. The patient reported a history of food-related trauma to her palate four to six weeks before the lesion appeared. She complained of mild irritation in the area, especially on food consumption. Her medical history was non-contributory and she reports no prior history of similar lesions.

She is a non-smoker. The lesion appeared slightly “bumpy” on the surface and was slightly reddish- to flesh-colored. It measured approximately 1 x 0.4 cm and was roughly rectangular in shape. Slight erythema was noted around the lesion. The lesion was entirely excised and submitted to the University of Florida College of Dentistry Oral Pathology Biopsy Service. The biopsy showed a papillary proliferation of epithelium with significantly thickened keratin with elongated rete ridges and foamy cells in the connective tissue (Fig. 2).

Fig. 1

Question: Which of the following is the most likely diagnosis?

A. Verrucous Leukoplakia B. Verruca Vulgaris C. Condyloma Acuminatum (venereal wart) D. Focal Epithelial Hyperplasia (Heck’s Disease) E. Verruciform Xanthoma Fig. 2

Please see DIAGNOSTIC, 50

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Diagnostic Discussion DIAGNOSTIC from 49

Diagnostic Discussion A. Verrucous Leukoplakia Incorrect. An excellent choice! This entity is a definite possibility given the history of trauma. These lesions are a variation of the standard “leukoplakia,” or white patch, and are typically covered by a significantly thickened, somewhat “bumpy” or verrucoid layer of ortho- or parakeratin. The most important distinction from this case is the color of the lesion; verrucous or verrucoid leukoplakia tends to be white in color due to the thick keratin layer, and not mucosal or normal colored or reddish as seen here.

Clinically, these lesions feel “bumpy” on palpation and appear white like other leukoplakic lesions. Verrucous leukoplakia tends to be premalignant in nature and may be reactive, typically associated with chronic trauma. Traumatic verrucous keratosis is often seen on the mandibular retromolar pad areas and on the edentulous alveolar ridge, either where the soft tissue bears the brunt of mastication or under a denture. In this case, there was a history of trauma, making this a very possible consideration in the differential diagnosis. Generally, verrucous leukoplakia is seen in an older age group and is usually completely asymptomatic. Microscopically, though the thickened keratin layer is seen in both verrucous leukoplakia and the actual diagnostic entity, foamy macrophages are not seen with verrucous leukoplakia. When seen on high-risk locations, verrucous leukoplakias are worrisome and usually the recommended therapy is complete excision with close clinical follow-up.

B. Verruca Vulgaris Incorrect. Again a very good guess!

Verrucas are benign, hyperplastic growths of surface epithelium associ-

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ated with the human papilloma virus (HPV). Verruca vulgaris is associated with HPV, HPV-2, HPV-4 and HPV40. However, verrucas are typically small lesions measuring less than 1 cm in size, and oral lesions almost always appear to be intensely white with finger-like projections rising above the surrounding mucosa. In addition, verruca vulgaris is typically pedunculated and not sessile, as seen here. Verruca vulgaris is contagious and can spread to other parts of a person’s skin or mucous membranes by way of autoinoculation. It is uncommon on the oral mucosa but extremely common on the skin. These are frequently seen in children on the skin of the hands.

The oral lesions are usually located on the vermillion border of the lips, labial mucosa or anterior tongue. They present as painless, raised papillary lesions and may occur in clusters, especially on the skin. Sites of abrasion on the skin, such as elbows or knees, often are affected.

The recommended treatment for oral lesions is surgical excision. The majority of the skin lesions disappear spontaneously within two years, especially in children.

C. Condyloma Acuminatum (venereal wart) Incorrect. Excellent guess! Condylomas are papillary growths that can occur anywhere on the oral mucosa. As in this case, they can be sessile with short fronds, or blunted or short elevations somewhat similar to the present case.

Condylomas are larger than verruca and average about 1.5-2 cm. These are usually reported in young individuals less than 25 years of age, but people of all ages are susceptible. Typically, it appears as a sessile, pink, well-demarcated, nontender exophytic mass with short blunted surface projections. Condylomas, also called venereal warts, are one of the most common sexually transmitted diseases (STDs), representing about 20 percent of all STDs reported in clinics. These are most often found on the external genitalia, and are seen in the oral mucosa of sexually active individuals. Oral lesions

are mostly reported on the lingual frenum, soft palate and the labial mucosa, supposedly related to sites of abrasion during oro-genital contact. Most importantly, condylomas are typically clustered with multiple lesions or multifocal distribution, though isolated and solitary lesions are occasionally noted. These are associated with human papilloma virus (HPV) subtypes 2, 6, 11, 53 and 54, and are usually detected in the lesion.

The virus infects the epithelial cells, multiplies and induces the epithelium to proliferate. Oral lesions as large as 3-4 cm have been reported. They are usually treated by conservative surgical excision.

Laser ablation also has been used, but this treatment has raised questions as to the airborne spread of HPV through the aerosolized microdroplets created by the vaporization of lesional tissues. Even after excision they have been known to recur in crops. Another important distinction point between this entity and the correct diagnosis is microscopic. The presence of foamy macrophages rules out the diagnosis of condylomas.

D. Focal Epithelial Hyperplasia (Heck’s Disease) Incorrect. Though these are papillary lesions, focal epithelial hyperplasia (FEH), also known as Heck’s Disease, are classically multifocal papillary lesions. This is an uncommon disease affecting the oral mucosa and associated with HPV-13 (rarely HPV-32). These are often reported in children of Native American, Eskimo or African descent.

Since it is almost always reported in childhood, and typically resolves and spontaneously regresses as the child ages, this diagnosis should not be considered for isolated papillary lesions in adults without additional history. Rare but usually persistent cases of FEH have been reported in young and middle aged adults. It appears as multiple soft, nontender, flattened or rounded mucosal or normal colored papules, which are usually clustered. Lesions typically occur www.floridadental.org

Diagnostic Discussion on the labial, buccal and lingual mucosa.

They also may be scattered, pale and rarely white. Individual lesions are small, discrete and well-demarcated, but they frequently cluster so closely together that the entire area takes on a cobblestone or fissured appearance. Spontaneous regression of lesions has been reported after months or years, and is inferred from the rarity of the disease in adults. Microscopic examination of the lesion, similar to the other entities discussed here, does not exhibit foamy macrophages.

Conservative surgical incision may be performed for diagnosis or aesthetic purposes, or for lesion subjected to recurrent trauma.

E. Verruciform Xanthoma Correct! Verruciform xanthomas are relatively uncommon lesions of the oral mucosa. They occur most frequently on the gingivae, especially the marginal gingiva, the alveolar mucosa and the palate, but can be found on any masticatory surface. They are most common in Caucasians in the age group of this patient (40-60 years of age). A strong female predilection is reported, which is supported in this case. They also have been described on the skin, esophagus and genitalia, although this lesion is much more common in the mouth.

Unlike other papillary growths, it is not associated with HPV. Only rare examples of multiple lesions have been reported.

An immune dysfunction has also been postulated for the etiology. Unlike xanthomas of the skin, verruciform xanthomas appear to have no association with diabetes, hyperlipidemia, or any other

metabolic or systemic disease. The key to the diagnosis is recognizing the papillary surface that is characteristic of these lesions. These lesions also can be umbilicated with a cratered center but they usually are papillary within the depressed center very similar to this case. They also have a characteristic white, yellowwhite, or reddish-orange color (seen in the present case). This color is thought to reflect collections of large numbers of lipid-laden or foamy macrophages (Fig. 2) found ubiquitously in this lesion.

Hyperkeratosis, elongated rete ridges and collections of these foamy macrophages are all required for the histologic diagnosis of this lesion. The papillary surface (verrucous) and presence of abundant lipid-containing foam cells (xanthoma) give this lesion its name. The lesions are totally innocuous and are thought to be associated with trauma and/or chronic irritation, which was part of the history in this case. They are treated by simple excision and usually do not recur.

Dr. Islam

Dr. Bhattacharyya

Useful References 1. Allen CM, Kapoor N. Verruciform xanthoma in a bone marrow transplant recipient.

Oral Surg Oral Med Oral Pathol. 1993 May; 75(5):591-4.

2. Hu JA, Li Y, Li SVerruciform xanthoma of the oral cavity: clinicopathological study relating to pathogenesis. APMIS. 2005 Sep; 113(9):629-34.

3. Philipsen HP, Reichart PA, Takata T, Ogawa I.Verruciform xanthoma--biological profile of 282 oral lesions based on a literature survey with nine new cases from Japan. Oral Oncol.

2003 Jun; 39(4):325-36.

4. Nowparast B, Howell FV, Rick GM.Verruciform xanthoma. A clinicopathologic review and report of fifty-four cases.Oral Surg Oral Med Oral Pathol. 1981 Jun; 51(6):619-25.

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 own Dr. Cohen 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.

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.

www.floridadental.org

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Technology

“No Touch” Digital Restorations

By Dr. Todd Ehrlich

John comes into the dentist’s office for the third time and sits in the same seat he did a few days ago. His bite is just about there. Just about there. He felt like it was perfect last time, but a few days of eating his favorite hard cereal told him otherwise. His bite still wasn’t exactly right, and it pained him more to actually make another appointment with his dentist. Surely, the dentist and staff are tired of seeing him and think of him as a pest, but he needs just a “titch” off. Just a “titch,” and this time he knows the exact spot. He’ll be in and out in minutes this time.

Fig. 1

As dental professionals, we always have the best intention to get the “bite” right with any restoration, but it does not always ideally happen. How many hours of appointments and patient time have been lost for this very reason? What about the lost confidence of patients as they try to hold on a little longer with their high occlusion and see if it will “settle?” John’s situation is lived out through every dental practice.

Placing a newly made restoration in harmony with a patient’s functional occlusion takes experience and skill. With higher levels of technology, this is becoming easier. The new CEREC software platform now allows a clinician to not only see the maximum intercuspation position of upper and lower jaws, but now can analyze functional movements of the mandible.

Fig. 2

The process begins by taking a digital impression of the upper and lower arches with the newly released Omnicam. This optical scanner works like an intraoral video camera that builds a 3-D model (Fig.1). A third imaging is completed with the patient in a maximum intercuspation position, and this will relate the upper and lower teeth later (Fig.2). All of the imaging can be completed before anesthetic has taken effect (this can also be done by auxiliary team members in most states). Three digital models now have been completed (upper, lower and buccal for articulation), and all prior to the preparation of the teeth. To make things as streamlined as possible, the software allows you to cut out teeth that will soon be prepared (Fig. 3). This leaves the majority of the arch or quadrant intact, but digital voids that will be filled in with the prepared teeth data of the digital impression.

Fig. 3

The patient’s tooth is prepared and isolated for imaging. Typically, the final digital impression only takes about 20-30 seconds because the prepared tooth is the only area to be imaged (Fig. 4). The remaining models were already taken prior to preparation, as mentioned earlier.

Fig. 4

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Technology

Proceeding through the software, the margins are marked and a mathematical calculation of dental anatomy is proposed. This is a 3-D shape based on the adjacent teeth (Fig. 5). The centric occlusion is displayed with its intensity color indicators. According to clinical judgment, this surface can be adjusted easily. This has been available in the CEREC program for many years, but now it allows for functional movement of the mandible. The movement of the lower jaw starts with the designations of standard articulator values, such as the sagittal and Bennett Angles (Fig. 6). These values can be customized for the patient with true mounting of stone models and proper face-bow transfer. The distance between temporomandibular joints also can be measured with 3-D cone beam X-rays. However, if simple restorations are being completed, average articulator settings for the mandibular movement parameters are sufficient.

The movement of the mandible can be visualized as a true animation as it goes through working, balancing and protrusive movements. The animation repeats until it is turned off by the user (Fig. 7). Once the animation is stopped, another indicator can be used to map out any potential interference on the proposed surface (Fig. 8). These are designated in different color schemes so the user can know which direction of mandibular movement causes the mark. Simple design tools are used to adjust those prior to milling the ceramic. The restoration is milled and bonded into position. No adjustment to the occlusion was necessary.

Outside of digital dentistry, many single unit restorations are never completed with full-arch physical impressions and face-bow transfers. Triple tray impression techniques are very popular because of the ease of use, but they do not address lateral and anterior/posterior movements. In contrast, CEREC digital scans can be easily completed with the Omnicam, and the clinician may be more likely to use the articulation feature to deliver “no touch” restorations.

Fig. 5

Fig. 6

Fig. 7

These “no touch” restorations make it efficient for the dental procedure to be completed, and the patients appreciate the attention to detail. John would especially like not needing another embarrassing trip to his dentist for an additional bite adjustment.

Dr. Todd Ehrlich has a family and cosmetic practice in Bee Cave, Texas, a suburb of Austin. He is an advanced CEREC trainer for Patterson and a CEREC trainer through the International Society of Computerized Dentistry. He can be reached at drehrlich@cerecology.com.

Fig. 8

Patterson Dental is an exhibitor at FNDC14; visit them at booth #603 in the Exhibit Hall. www.floridadental.org

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Technology

The LANAP Protocol and Orthodontics: Offering Patients Hope Through Collaborative Treatment Plans

“

For about one-third of the price, patients can keep their teeth intact and enjoy a quicker recovery period with little pain through LANAP and orthodontic treatment.

”

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By Todd McCracken, DDS, MALD

For even the most “hopeless” cases of periodontal disease, the (Laser-assisted New Attachment Procedure) LANAP® protocol can be a life-changing treatment option. Over the past 12 years using the LANAP treatment, I’ve had countless patients walk through my practice’s doors ready to face the dreaded decision of pulling most or all of their teeth, or succumb to traditional gum surgery, only to be surprised and grateful when they learn that there is an alternative. I don’t view the LANAP protocol as a last-resort judgment; I see it as a firstline of defense to help save teeth, spare patients from pain and, ultimately, give them something to smile about.

The LANAP protocol is nothing like traditional gum disease treatment. It’s less invasive, more comfortable and offers faster recovery with significantly less pain. In traditional surgery, we know that a scalpel is used to peel the gum tissue back to sanitize the periodontal pocket and shrink the pocket depth by cutting away the infected tissue.

Reattaching the gum tissue to the root surface of the tooth often requires bone grafting as well. Hearing the details of this procedure can make any patient

cringe — and candidly, many of them suffer in silence for years just to avoid the conventional approach to treatment.

The LANAP protocol, on the other hand, doesn’t require the use of scalpels or sutures. Instead, it uses innovative laser technology with the PerioLase® MVP-7™, which operates on a wavelength that can differentiate between the healthy gum tissue and diseased tissue, allowing selective removal of the harmful bacteria responsible for gum disease.

I’ve been working with the LANAP protocol for more than a decade now, and I am thrilled to have recently joined forces with orthodontists to create even more positive outcomes for periodontal disease patients. It’s no surprise that gum disease can make teeth quite mobile and using orthodontics can provide a great deal of control to hold teeth in firmly, giving gums the opportunity to heal around ideally placed teeth. I believe that the combination of the LANAP protocol and orthodontics is a truly innovative concept, and my recent patient story is a testament to its success.

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Technology

Case Study A 42-year-old female patient recently came to my practice for a “second opinion.” A long-time gum disease sufferer with advanced periodontal disease, she’d been told by countless dental professionals for nearly two decades that there was simply no way to save her teeth — they’d have to be pulled. The patient, distraught, put surgery off for years due to fear and uncertainty.

Although her condition was late-stage and complex, including several supererupted teeth, I felt the LANAP protocol was still a viable option for her. After a complete periodontal work-up and consultation with an orthodontist, we proceeded to perform the treatment and followed up just a few days later with orthodontic procedures — which helped push her loose teeth back into place and begin the healing process. Much to her amazement, the patient’s recovery time after the LANAP procedure was very brief and adding brackets took very little time. The patient, finally free from pain, will complete this unique collaborative treatment plan within two to three years.

While the final results aren’t instant, her

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outcome truly is a 180-degree difference from her original prognosis. Most importantly, she is now pain free and has kept most of her natural dentition.

The concept of a “collaborative treatment plan” isn’t common practice yet, but it should be. In fact, most dental professionals won’t consider adding orthodontic brackets to their periodontal patients until the first year post-periodontal surgery has passed. Many clinicians view the combination of periodontology and orthodontics as a potential complication, mostly due to the concern that the orthodontic brackets may pull out loose teeth.

In comparison, for my patient, we added her braces just days after procedure — ultimately “splinting” the teeth with more control and precision than could be achieved without orthodonture. I firmly believe that brackets should be placed quickly and used for controlled stabilization. Brackets and wires in conjunction with the LANAP protocol may be viewed as an atypical protocol, but this unexpected treatment combination has already proven itself to be an innova-

tive new standard in enhancing patient outcomes — even in the most challenging, hard-to-treat cases.

Financial implications are a significant factor for patients to consider. Many unknowing, desperate sufferers immediately turn to dental implants, which involve extensive costs and procedures. For about one-third of the price, patients can keep their teeth intact and enjoy a quicker recovery period with little pain through LANAP and orthodontic treatment.

Dr. Todd McCracken has been in private practice since 1997. He received the honor of Master from the Academy of Laser Dentistry and is a frequent lecturer and teacher at Millennium Dental Technologies, the Institute for Advanced Laser Dentistry, Baylor Dental School and the University of Texas Health Science Center at San Antonio. He is a certified trainer for the LANAP® protocol. Dr. McCracken has also served as a clinical consultant to several dental manufacturers to help develop new products and technologies. He can be reached at lasersmiledr@verizon.net.

Millenium Dental Technologies Inc. is an exhibitor at FNDC14; visit them at booth #1118 in the Exhibit Hall.

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FDA leaders are energized.

Volunteer dentists are willing.

Support is growing.

Florida is ready!

The Florida Dental Health Foundation is preparing to make a quantum leap in fundraising — a yearlong campaign to build a new Foundation. A drawing of chance will anchor this campaign. The Grand Prize will be a minimum of $10,000.

Look for more information at the FDA Member Benefits Center (Booth 421) at FNDC2014 and in the next issue of Today’s FDA. Our new logo will be revealed at FNDC2014.

But, it’s not just a new logo (although we really like our new family of logos), but an energized foundation ready to build on the successes of Florida Mission of Mercy, Project: Dentists Care and Give Kids a Smile. A successful campaign will lead to a healthier, smiling Florida.

YOU COULD WIN $10,000!

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Building a New Foundation A YEARLONG CAPITAL CAMPAIGN

Dental Staff

Components of The use of proper technique during ultrasonic therapy may help prevent overinstrumentation and encourage positive outcomes.

BY KATHLEEN O. HODGES, RDH, MS

In today’s sophisticated practice settings, ultrasonic instrumentation is routinely incorporated unless contraindications prevail. Its use in oral prophylaxis, nonsurgical periodontal therapy and periodontal maintenance provides many potential advantages (Table 1). Like hand instrumentation, however, the risk of overinstrumentation is possible with ultrasonic technology1–10. Overinstrumentation is a clinician-created or iatrogenic problem stemming from the use of improper technique or debriding more than is necessary to encourage healing of adjacent tissues. Overinstrumentation can include creating root defects, leaving roughness and removing unnecessary tooth structure — each of which may encourage biofilm accumulation and tooth sensitivity11. A smooth root or implant surface reduces the likelihood that plaque biofilms will reattach and, thus, may decrease the risk of periodontal diseases, peri-mucositis, and periimplantitis.

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The goal of debridement is to remove plaque biofilms, their byproducts, their retentive factors and calculus embedded cementum to create a biologically acceptable root surface conducive to optimal healing, while preventing unnecessary loss of tooth surface. As such, the point of overinstrumentation may be different for each patient. During nonsurgical periodontal therapy, the patient’s response to individualized therapy is evaluated throughout multiple appointments and at the re-evaluation visit. At these times, additional instrumentation may be indicated due to tactile interpretation, bleeding points, visible inflammation or endoscopic observation of calculus. This therapy is justified and is not considered overinstrumentation.

Relevant Research Researchers continue to investigate the causes of root defects, roughness and unnecessary tooth surface removal with mechanical root debridement. In regard to root defects, power setting, load of

Table 1.

Potential Advantages of Ultrasonic Instrumentation

• improved patient comfort eliminates the need for • instrument sharpening • ability to use multiple tip surfaces reduced risk of musculoskeletal • injuries requires only minimal lateral • pressure • presence of water lavage • improved access to furcations

1,11

the ultrasonic insert/tip (UIT) on the tooth, and the cross-sectional shape of UITs may affect dentin defects with both magnetostrictive and piezoelectric ultrasonic technology12. Casarin et al.1 found that hand and ultrasonic instrumentation produced the same level of defect depths, regardless of power settings. As both power and manual instrumentation create alterations in the dentin surfaces under the best of conditions1, optimal outcomes are achieved by using proper instrumentation technique. www.floridadental.org

Dental Staff

The amount of root roughness remaining after instrumentation also has been examined. Singh et al.8 concluded that manual and ultrasonic instrumentation methods were equal in debridement efficacy, while other studies revealed that ultrasonic instrumentation left a smoother surface than curets3,5,7. Marda et al.5 found that magnetostrictive inserts created reduced root surface roughness, less root surface removal, and better efficiency of calculus removal than a rotary bur or curets.

Yousefimanesh et al.10 concluded that the exertion of different lateral forces in both magnetostrictive and piezoelectric devices caused similar effects on tooth surfaces. In this in vitro study, root surface roughness was the same after both types of ultrasonic technology were used, though the piezoelectric device produced the least roughness when 200 g of pressure was applied10. When piezoelectric, magnetostrictive and curet instrumentation was compared, each removed approximately the same amount of calculus7. Instrumentation with curets, however, produced the roughest surface7.

Kawashima et al.3 reported that ultrasonic instrumentation methods produced a smoother surface than the curet, and that there was a difference in root surface roughness after two different piezoelectric tips were used.

Results of such studies are not directly comparable, however, due to the various methodologies employed. Clinicians are encouraged, nevertheless, to heed recommendations regarding prevention of overinstrumentation due to its negative effects on clinical outcomes.

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Additional research has been performed on the effect of coated UITs designed for root surfaces and implants. Vastardis et al.13 found that diamond-coated UITs left a rougher root surface and removed more root surface compared to hand instruments and a non-diamond-coated UIT, with the non-diamond-coated UIT producing the smoothest root surface. In a study by Ribeiro et al.14, results showed that a sonic diamond-coated tip and a standard UIT produced more roughness than a curet. The use of diamond-coated UITs without an endoscope or outside

of surgical intervention is not recommended because of the likelihood for overinstrumentation. Additional studies evaluating which coatings produce the least amount of roughness after instrumentation are ongoing.

In regard to root surface removal, Mishra and Prakash6 compared laser therapy to ultrasonic and hand instrumentation using extracted teeth. Ultrasonic instrumentation yielded surfaces devoid of deposits and root surfaces that were Please see THERAPY, 60

Table 2. Review of Ultrasonic Technology and Proper Technique Factor

Piezoelectric

Magnetostrictive

Power setting

Low with thin inserts (except in the presence of tenacious calculus when thin insert ned for use on medium to high power are indicated); low to medium with standard inserts

Low with thin inserts (except in the presence of tenacious calculus when thin tips designed for use on medium to high power are indicated); low to medium with standard inserts

Average frequency

29,000 cps to 35,000 cps

Auto-tuned: 25,000 cps or 30,000 cps Manually tuned: frequency can be changed

Tip angulation to surface

0°

0° to 15°

Active tip area

2.3 mm to 3.5 mm

4.3 mm (depends on frequency)

Adapted surfaces of tip

Lateral sides

Back and lateral sides

Tip motion

Three-dimensional elliptical*

Three-dimensional elliptical*

Exposure time

Movement at all times

Movement at all times

Lateral pressure

Light

Light

Tip wear

Refer to manufacturer’s recommendations

Refer to manufacturer’s recommendations

*The pattern of the oscillating tip seem to be influenced by tip geometry.

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Dental Staff THERAPY from 59

essentially unchanged6. Hand instrumentation removed more root surface than other methods; however, the surfaces were smooth6. The laser provided similar outcomes in calculus removal as both ultrasonic and hand instrumentation, but it also caused greater loss of tooth surface and left more surface roughness than the other techniques. Santos et al.7 demonstrated that curets removed more root surface tissue than an ultrasonic device. These data support the benefits of ultrasonic devices in removing the least amount of root surface while achieving the desired clinical outcome.

Dental hygienists must understand the five aspects of quality ultrasonic therapy in order to prevent overinstrumentation.

These factors include: power setting, tip angulation, lateral pressure, exposure time and tip wear (Table 2). The interaction of one or more of these factors results in the increased probability of overinstrumentation.

Power Setting Augmenting the power setting increases the distance the active tip travels across the tooth from top to bottom of the stroke (Fig. 1) — though not necessarily in a linear fashion4. This movement creates a 3-D “chipping” of the tip against the surface, often referred to as displacement amplitude. High-power settings and long strokes remove more calculus4,

but also increase the probability of patient discomfort and overinstrumentation.

Low-power settings may create a better relationship between deposit removal, minimal loss of dentin and surface roughness4.

The UIT should be tuned and the Fig. 2. The correct tip angulation for an ultrasonic insert/tip is 0o to 15o. Only the power setting increased as needed, terminal millimeters should touch the tooth. depending on the deposit’s tenactween the active tip and the root surface, ity. The use of low power with the greater the energy output and chance thin tips, however, can easily burnish of overinstrumentation1. The active tip calculus to a smooth veneer, making it to tooth angle should be maintained at almost impossible to remove. Therefore, 15 degrees or less (Fig. 2). To prevent thin UITs should not be used to remove severe root damage, piezoelectric units heavy or tenacious calculus unless they should be used at close to zero degree are intended for use at high-power levels angulation11,16. and have the ability to break deposits cleanly from the root surface15. When In addition to tip angulation, adapting high-power settings are implemented, the terminal 2 mm to 4 mm is essential adequate pain control is essential to sucbecause this is the active tip area (Fig. 3). cessful instrumentation15.

The precise recommendation for active tip adaptation depends on the type of Power (length of stroke) and frequency technology and the unit (refer to the (speed) are distinct aspects of ultrasonic manufacturer’s instructions for informainstrumentation that work together tion on the active tip area). when the energy is activated on a tooth.

Frequency is how fast the tip moves across the surface in cycles per second, and it can be adjusted only with a manual-tuned unit. This adjustment allows the practitioner to balance the power and frequency for maximum effectiveness and comfort.

Tip Angulation

Incorrect application of the tip during instrumentation may cause undesirable surface alterations.

Tip angulation must be mentally visualized because of the inability to use direct vision with subgingival debridement without an endoscope, and due to tip size Fig. 1. As the power settings of an obstructing the view of angulaultrasonic instrument are increased (A to C), tion. The greater the angle bethe length of the stroke also grows.

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Correct adaptation of the tip also is crucial. With magnetostrictive inserts, although all sides of the tip are active, the lateral surfaces or back should be adapted because they generate the least amount of energy, which helps prevent overinstrumentation. Adapting the point of an insert to a root surface devoid of calculus may cause striations in the root structure or overinstrumentation.

The lateral sides of piezoelectric tips are the most effective. Though each mechanism requires adaptation of the lateral sides, the manner of movement — both loaded and unloaded — results in an elliptical motion. Oscillation patterns are not dependent on whether the unit

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Dental Staff tuning and instrumentation technique are correct, and the likelihood of iatrogenic damage also should be reduced.

Tip Wear Tip wear may affect the performance of UITs by Fig. 3. In A, too much of the tip is adapted reducing their displace(more than 4 mm). In B, less of the tip is adpated 19 (about 2.5 mm), which is the active part of the instrument. ment amplitude . With a magnetostrictive insert, uses piezoelectricity or magnetostriction; wear is evaluated by instead, power setting and shape/design examining the stack and working ends of the UIT influence the patterns17,18. for damage. With both piezoelectric and magnetostrictive instruments, the length Lateral Pressure of the working end also is assessed.

Calculus removal is less effective when Shortening of the working end reduces strong lateral pressure is used. Strong efficiency, lengthens instrumentation lateral pressure interferes with the free time, creates the need to use increased movement of the tip to fracture depospower settings, and raises the risk for tip its, and it can diminish the activation. fracture. Unfortunately, a 1 mm loss of Only light lateral pressure is needed; just the working end length results in 25 perenough to balance the instrument and cent less efficiency. A 2 mm loss results in let it work independently. Grasp pressure 50 percent less efficiency, at which point may also be related to root roughness/ tip replacement is indicated19. Efficiency defects11. Heavy pressure causes the tip guides are available from manufacturers to create roughness and remove more to objectively assess tip wear. structure than necessary. An extraoral grasp with thin inserts is recommended, Clinicians should use UITs that work which helps maintain a light hold on the at optimal levels and have not outlived instrument and balance on the fulcrum. their usefulness. A recent study found The majority of patients who do not that significantly more root surface begin therapy with sensitivity should not roughness was found when worn UITs develop it post-treatment when a light were implemented versus new UITs, and touch is used. the roughness change was dependent on

Exposure Time The longer the UIT’s exposure time on a specific area, the greater the risk of negative effects. To avoid this pitfall, clinicians must keep the UIT moving at all times. The moving strokes should overlap and be multidirectional. Patients who are not indicated for pain control should not feel sensitivity while the UIT is moved constantly over the surface if

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angle of application and power setting20.

Arabaci et al.20 concluded that tip wear is just as important as other factors in preventing surface roughness.

Conclusion A review of the literature assessing the use of power-driven and hand-delivered instrumentation reveals similar clinical outcomes21. Just as with hand instrumentation, clinicians may overtreat roots

with ultrasonic therapy. In addition to causing iatrogenic problems with the tooth, overinstrumentation can lead to discomfort and sensitivity, as well as loss of efficiency20 during care. The manufacturer’s instructions for proper use of the unit should always be followed. Patients’ verbal and nonverbal cues, such as grimaces, may indicate pain.

In the future, UITs with different materials might be recommended depending on the status of the root surface. For example, Rühling et al.22 found that a Teflon-coated sonic tip removed less root surface than a curet or traditional UITs, and might be an alternative for periodontal maintenance patients. In the study, a curet and a conventional sonic scaler insert removed the most root surface compared to a piezoelectric tip22.

As use of the dental endoscope grows in conventional therapy, clinicians will be able to assess the factors of optimal instrumentation while analyzing the deposit removal effectiveness, and more in vivo research will be conducted.

Analysis of the risk of overinstrumentation with ultrasonic therapy is difficult but necessary. The occurrence of overinstrumentation can be prevented using the best practices recommended by researchers, manufacturers and clinicians. By adhering to the recommendations regarding the key factors of quality ultrasonic instrumentation, clinicians can provide both effective and safe care to their patients.

Reprinted with permission from Dimensions of Dental Hygiene. Hodges K. Components of optimal ultrasonic therapy. Dimensions of Dental Hygiene. 2014; 12(1):22–27.

Please see THERAPY, 63

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Dental Staff THERAPY from 61

Kathleen O. Hodges, RDH, MS, is a professor emerita in the Department of Dental Hygiene at Idaho State University in Pocatello. She has 34 years of experience in dental hygiene education, including clinical teaching and administration. Hodges works in private practice and is a member and delegate for the American Dental Hygienists’ Association. She also is a board member for the Western Society of Periodontology and a Dimensions of Dental Hygiene Editorial Advisory Board member.

References

1. Casarin RC, Ribeiro FV, Sallum AW, Sallum EA, Nociti-Jr FH, Casati MZ. Root surface defect produced by hand instruments and ultrasonic scaler with different power settings: an in vitro study. Braz Dent J. 2009; 20:58–63.

2. Dahiya P, Kamal R, Gupta R, Pandit N. Comparative evaluation of hand and power-driven instruments on root surface characteristics: A scanning electron microscopy study.

Contemp Clin Dent. 2011; 2:79-83.

3. Kawashima H, Sato S, Kishida M, Ito K. A comparison of root surface instrumentation using two piezoelectric ultrasonic scalers and a hand scaler in vivo. J Periodontal Res. 2007; 42:90–95.

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4. Lampe Bless K, Sener B, Dual J, Attin T, Schmidlin PR. Cleaning ability and induced dentin loss of a magnetostrictive ultrasonic instrument at different power settings. Clin Oral Investig. 2011; 15:241–248.

5. Marda P, Prakash S, Devaraj CG, Vastardis S. A comparison of root surface instrumentation using manual, ultrasonic and rotary instruments: an in vitro study using scanning electron microscopy. Indian J Dent Res. 2012; 23:164–170.

6. Mishra MK, Prakash S. A comparative scanning electron microscopy study between hand instrument, ultrasonic scaling and erbium doped:Yttrium aluminum garnet laser on root surface: A morphological and thermal analysis. Contemp Clin Dent. 2013; 4:198–205.

7. Santos FA, Pochapski MT, Leal PC, Gimenes-Sakima PP, Marcantonio E Jr. Comparative study on the effect of ultrasonic instruments on the root surface in vivo. Clin Oral Investig. 2008; 12:143–150.

8. Singh S, Uppoor A, Navak D. A comparative evaluation of the efficacy of manual, magnetostrictive and piezoelectric ultrasonic instruments—an in vitro profilometric and SEM study. J Appl Oral Sci. 2012; 20:21–26.

9. Solís Moreno C, Santos A, Nart J, Levi P, Velásquez A, Sanz Moliner J. Evaluation of root surface microtopography following the use of four instrumentation systems by confocal microscopy and scanning electron microscopy: an in vitro study. J Periodontal Res. 2012; 47:608–615.

10. Yousefimanesh H, Robati M, Kadkhodazadeh M, Molla R. A comparison of magnetostrictive and piezoelectric ultrasonic scaling devices: an in vitro study. J Periodontal Implant Sci. 2012; 42:243–247.

11. Arabaci T, Cicek Y, Canakci C. Sonic and ultrasonic scalers in periodontal treatment: a review. Int J Dent Hyg. 2007; 5:2–12.

12. Lea SC, Felver B, Landini G, Walmsley AD. Ultrasonic scaler oscillations and tooth-surface defects. J Dent Res. 2009; 88:229–234.

13. Vastardis S, Yukna RA, Rice DA, Mercante D. Root surface removal and resultant surface texture with diamondcoated ultrasonic inserts: an in vitro and SEM study. J Clin Periodontol. 2005; 32:467–473.

14. Ribeiro FV, Casarin RC, Nociti Júnior FH, Sallum EA, Sallum AW, Casati MZ. Comparative in vitro study of root roughness after instrumentation with ultrasonic and diamond tip sonic scaler. J Appl Oral Sci. 2006; 14:124–129.

15. Pattison AM. Keys to effective calculus removal. Dimensions of Dental Hygiene. 2011; 9(10):50–53.

16. Flemmig TF, Petersilka GJ, Mehl A, Hickel R, Klaiber B. The effect of working parameters on root substance removal using a piezoelectric ultrasonic scaler in vitro. J Clin Periodontol. 1998; 25:158–163.

17. Lea SC, Felver B, Landini G, Walmsley AD. Threedimensional analyses of ultrasonic scaler oscillations. J Clin Periodontol. 2009; 36:44–50.

18. Lea SC, Landini G. Reconstruction of dental ultrasonic scaler 3D vibration patterns from phase-related data. Med Eng Phys. 2010; 32:673–677.

19. Lea SC, Landini G, Walmsley AD. The effect of wear on ultrasonic scaler tip displacement amplitude. J Clin Periodontol. 2006; 33:37–41.

20. Arabaci T, Cicek Y, Dilsiz A, Erdogan IY, Kose O, Kizilda IA. Influence of tip wear of piezoelectric ultrasonic scalers on root surface roughness at different working parameters. A profilometric and atomic force microscopy study. Int J Dent Hyg. 2013; 11:69–74.

21. Walmsley AD, Lea SC, Landini G, Moses AJ. Advances in power driven pocket/root instrumentation. J Clin Periodontol. 2008; 35(Suppl 8): 22–28.

22. Rühling A, Bernhardt O, Kocher T. Subgingival debridement with a teflon-coated sonic scaler insert in comparison to conventional instruments and assessment of substance removal on extracted teeth. Quintessence Int. 2005;36: 446–452.

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Dennis Head graduated from Florida State University with a degree in Risk Management and Insurance in 2004. While in school, he interned at FDA Services and was offered the position of Central Florida District Representative in his hometown of Orlando. Dennis has been assisting members of the Florida Dental Association in the Central 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. Dennis is married with two children and lives in the Orlando area. He enjoys spending time with his family and friends, playing sports and being active in his community.

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FDA Insurance

Sound Insurance Protection for This Hurricane Season

By Scott Ruthstrom

FDAS CHIEF OPERATING OFFICER

The warmer months are now upon us, which also means we are entering the Florida hurricane season. Sure, we have been fortunate with a decade of relatively Ruthstrom quiet activity, but do you remember back to the slew of storms that belted Florida in 2004 and 2005? It’s only a matter of time until Florida is back in Mother Nature’s crosshairs again. I say this only to be sure our members are not complacent when it comes to properly protecting their dental practice from the potential effects of hurricane storm damage.

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 $1,000,000 to the FDA to help reduce membership dues.

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Storm losses can come in many different forms, ranging from catastrophic total losses to the inability to open up for business due to a long-term power outage in your community. Any damage sustained could be financially devastating if not properly insured. Remember, there is a major difference between having insurance and being insured.

into your office and let them provide an unbiased evaluation of your insurance portfolio. Find out for yourself what sets us apart.

Mr. Ruthstrom can be reached at scott. ruthstrom@fdaservices.com or 850.350.7146.

RISK EXPERTS We are proud that more than 2,000 offices trust FDA Services (FDAS) for the proper placement of their office insurance policies. In order to get the most comprehensive and cost-effective policies for our members, FDAS has appointments with many nationally respected commercial insurance carriers, such as The Hartford and Liberty Mutual.

As a benefit of your FDA membership, FDAS provides member access to a dedicated insurance representative in each of the six district dental associations.

Unlike your typical commissioned independent insurance agent, FDAS’ agents spend all of their time consulting with dentists and are true dental risk experts.

If you want the peace of mind that you are well-prepared for this storm season, invite our dedicated insurance specialist

DAN ZOTTOLI Atlantic Coast District Insurance Representative 561.791.7744 Cell: 561.601.5363 dan.zottoli@fdaservices.com

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Referrals

Dental Negligent Referrals

By Greg Abramson, JD, CPHRM, PATIENT SAFETY RISK MANAGER, THE DOCTORS COMPANY

Patient referral and negligent referral can be a frustrating or confusing experience in a dental practice. The patient referral for specialized or higher level of care usually results in a good, quality patient outcome. Claims involving patient referrals are relatively few. However, a patient may allege more than a failure to refer or a delay in diagnosis resulting from a lack of referral. A patient may allege that they not only received substandard care from the dentist to whom they were referred, but also the referral itself was negligent, creating liability exposure for dentists who refer care outside their background, experience or training. These two areas of risk exposure remind us that the question the prudent practitioner asks: Is this patient’s condition within my clinical competence?

Most claims involving the failure to, or delay in, referral for either evaluation or treatment, involve treatment performed by specialists. The most common referrals are for oral surgery, periodontal disease, implants and orthodontia.

If a treatment or procedure is one the average, reasonable general dentist would refer to a specialist, communication (informed consent) and documentation should reflect that the risks, benefits and alternatives (referral to a specialist) were discussed with the patient, and the 68

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“

In the event of a claim, the documentation is the best evidence.

The dental record must document the referral process — the evaluation, treatment and discussions with the patient that resulted in the referral.

”

patient made an informed decision. The risk exposure is that the dentist will be judged against the specialist’s standard of care.

Case Study1 A 49-year-old man reported a mass under his tongue during a routine prophylaxis visit, which his general dentist evaluated as a canker sore. Six months later, a biopsy done elsewhere led to a diagnosis of Stage IV squamous cell carcinoma. Extensive surgery and radiation treatment followed. The patient alleged both dental negligence and failure to refer to a specialist. The defendant dentist claimed the patient had been told to fol-

low up with his primary care physician (PCP) or an oral surgeon.

There was no documentation of a formal referral to a specialist or PCP, nor was there documentation to support one.

This result may have been avoided or the impact lessened if the dentist had documented his observation that testing would lower the suspicion of cancer, or if there had been a documented referral and follow-up of the referral.

There are times that local specialists are unavailable or the patient refuses to seek care that is far away. If you undertake a course of treatment that is outside your background, training or experience, there may be increased risk of injury to the patient that would not be present if the treatment were undertaken by a specialist. In addition, the patient cannot waive your negligence. The best practice would be to stand your ground and not let the patient push you into practice beyond your clinical comfort level. The best course of action is to explain to the patient that the referral is for their benefit and in their best interest. If no treatment is provided and there is a higher likelihood of an adverse outcome or serious disability or death, the more effort you may wish to spend helping the patient get the specialty care needed.

Your documentation needs to explicitly outline your discussions and counseling with the patient and if necessary, the patient’s informed refusal of other care.

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Referrals

You may want to consider terminating the patient from your practice if the patient will not follow your recommended treatment plan.

The American Dental Association (ADA) General Guidelines for Referring Dental Patients notes: “In some situations, a dentist could be held legally responsible for treatment performed by specialist or consulting dentists. Therefore, referring dentists should independently assess the qualifications of participating specialist or consulting dentists as it relates to specific patient needs.” Simply stated, a patient referral is negligent if made to a dentist whom you know to lack skill or judgment, whether that lack of skill is due to lack of training, carelessness or impairment.

Keep in mind that your first duty is to protect your patients. If you note a pattern of poor care provided by a dentist to whom you have previously made referrals, you are obligated professionally to exercise due care and avoid that provider for future referrals. A reasonable guide when making referrals is to ask yourself, “Would I consent to be treated by the dentist I am recommending?”

Communication Effective communication between both dentist and patient — and dentist and specialist — is the key to a successful referral. The best practice is to explain the need for the referral for a particular treatment or condition and that you will remain their dentist for all other dental care. Second, select a specialist based upon the patient’s needs and communicate to the patient why you recommend

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the particular specialist for the patient.

Third, you need to decide what level of involvement is needed for this patient in facilitating the referral. Do you provide contact information only? If you have the ability to do so, you may consider contacting the specialist on your patient’s behalf and setting up the appointment.

Finally, you will want to advise the patient of what to expect from the specialist and the treatment, and reassure the patient that you will remain in contact with both patient and specialist to assure the best possible outcome.

For dentist and specialist communication, a written referral is the best practice for avoiding problems. A referral letter should contain the following: w patient demographics and identification w evaluation and treatment completed to date w copies of diagnostics performed, including information as to when collected w diagnosis and prognosis w desired evaluation/care the specialist is requested to complete w your plan for after-care following the specialist’s intervention w a request for a consultation report and on-going status reports

Tracking Having a process to track patient referrals and returns will help enhance patient care. The process should be separate from the patient’s record so that it is centralized and uniform. It should cover the time frame from referral to specialist to return to you, and provide a

method for reminders or tasks to move the process along or document why it has not progressed. If the referral is not being completed in a timely manner, the process should include a method to contact patient and specialist as needed and facilitate.

Documentation In the event of a claim, the documentation is the best evidence. The dental record must document the referral process — the evaluation, treatment and discussions with the patient that resulted in the referral. Copies of written communications, and evidence of any oral communications, including phones calls and messages with both patient and specialist, must be kept in the patient record. Documentation of patient refusal or non-compliance must be in the record as well, as all evidence of efforts to overcome the refusal or non-compliance.

Finally, if it all falls apart and you cannot move the patient to seek a specialist, you must document your decision not to treat the patient further. This decision is followed by a properly handled termination of the dentist/patient relationship.

Reference: 1. Medical Malpractice Verdicts, Settlements & Experts; Lewis Laska, Editor, 901 Church St., Nashville, TN 372033411, 800.298.6288.

Greg Abramson, JD, CPHRM, is the Patient Safety Risk Manager, The Doctors Company.

May/June 2014

Today's FDA

69

Opportunities

C lassified A dvertising

ANNOUNCING: Hands-on Extraction Classes. Remove Teeth on Live Patients, including impacted wisdom teeth, and receive 40 hours of AGD PACE accepted CE Credit.

Learn how to remove teeth and handle complications.

The FDA’s online classified system allows you to place, modify and pay for your ads online, 24-hours a day. Our intent is to provide our advertisers with increased flexibility and enhanced

Learn how to elevate flaps and suture properly. Classes March 21-26, July 27-31, Sept. 26/27, Oct. 24-30, and January 2015. For more information contact Dr. Tommy Murph: 843.488.4357, drtommymurph@yahoo.com.

Great Expressions has a neighborhood practice in Jensen Beach, FL and we have a full-time Pediatric Dentist

options to personalize and draw attention to

position available. Our specialists have the clinical

your online classified ads!

practice without the additional financial or administrative

freedom and autonomy enjoyed in a traditional private burdens associated with practice management. When

The FDA online classified ad model is for “paid

considering a career with GEDC, dental professionals can expect unlimited production based earnings,

online advertising.” Effectively, the advertising

malpractice coverage, a stable patient base, covered lab

rate you pay will entitle you to online classified

regional career growth. To learn more please call Ross

ads with increased exposure. As an added benefit, we will continue to publish the “basic text” format of paid, online classified ads in our bimonthly printed journal, Today’s FDA, at no

costs, training opportunities, and long-term practice or Shoemaker @ 678.836.2226 or visit us on the web at https://careersclinical-greatexpressions.icims.com/.

FLORIDA – DENTIST. Fine opportunity. General Dentist who enjoys treating children for group practice with offices in north Clearwater, New Port Richey and Spring Hill; $160,000-$200,000 plus bonuses, three weeks’

additional cost to you. All ads posted to the

paid vacation, eight paid holidays and health insurance.

online classified system will be published during

727.446.3259.

the contracted time frame for which you have posted your online classified advertisement.

CE expense. Fax resume to: 727.785.8485 or call:

FLORIDA – DENTIST. Tampa Bay. General Dentist desired by group practice with offices in Clearwater, New Port Richey and Spring Hill. Base salary $160,000$200,000 plus bonuses. Three weeks’ paid vacation,

Our magazine is published bimonthly, and

8 paid holidays and health insurance. CE expense.

therefore, all ads currently online will be

727.446.3259.

No Capitation. Fax resume to: 727.446.3359 or call:

extracted from the system on roughly the

ORTHODONTIST SEEKING Position FT/PT or Locum

following dates of each year: Jan. 15, March 15,

tenens. Certified specialist. AAO, ADA member. Mature

May 15, July 15, Sept. 15, Nov. 15. The ads ex-

Personable, Hard-working team player. Great liking for

judgment. Communicative and organizational skills.

tracted at this time will then be published in the

people. Like responsibility. Experienced working with

following month’s issue of Today’s FDA.

dependable. Willing to travel. Available immediately.

diverse cultures and various professional groups. Totally Contact: johnmaria7@yahoo.com, Tel: 305.801.7537.

Please view the classified advertising portion

FLORIDA – A blockbuster opportunity. Full or part time

of our website at http://www.floridadental.biz/.

Pedodontists, Periodontists, and Oral Surgeons.

for General Dentists, Endodontists, Orthodontists, Generous compensation with unlimited potential.

Guaranteed referrals. Join our group specialty care practice with a significant general dental component.

Established in 1975 in Aventura, Coral Springs, Delray Beach, Boynton Beach, Stuart, Ft. Pierce and Melbourne.

Call: Dr. Feingold at 561.665.0991. Email: careers@ dentaland.net.

72 Today's FDA May/June 2014

www.floridadental.org

Need an Associate? Need a job? There’s no fee for

General Dentist in Port St. Lucie Needed. Great

We are an exceptional multi-specialty group practice

finding you a job! Call Doctors Choice Companies.

Expressions Dental Centers has a current opening for

composing like-minded dentist, orthodontist, oral

Sandy Harris 561.744.2783, sandy@doctorschoice1.

a part-time, 2-3 day/week, General Dentist in Port St.

surgeons, denturist and ceramist. We offer a phenomenal

net.

Lucie, FL. Our dentists have the clinical freedom and

opportunity both financially and professionally! For recent

autonomy enjoyed in a traditional private practice

and new graduates, we will remove all financial pressure.

without the additional financial or administrative burdens

We are willing invest the time, effort and resources to

associated with practice management. When considering

mentor and train you which will fast track your career

a career with GEDC, Dentists can expect unlimited

goals and financial compensation. Many offices promote

production based earnings, benefits, malpractice

the possibility of making significant compensation,

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

we GUARANTEE it in writing! Doctors right now are

or regional career growth. To learn more please call Ross

making $1,000+ a day. panhandledentist@yahoo.com,

Shoemaker @ 678.836.2226 or visit us on the web at

850.450.8935.

Dentist Opportunities. Dental Partners is one of the fastest growing family dental practice groups in the Southeast. We give you the ability to focus on patient care while earning a base of $125K-$200K and the opportunity to earn more based on production. Benefits package of medical/vision/life/FSA, 401K, professional liability and yearly CE allowance. Relocation and student loan repayment assistance program may be available.

Email resume to areimiller@dental-partners.com or

https://careersclinical-greatexpressions.icims.com/.

General Dentist. Dynamic Dental Health Associates,

call Ashley Reimiller, Director of People Development

One of a Kind Opportunity. Please contact Cindy

a new private fee-for-service group, is growing and

321.574.8003.

Pritchett/Patterson Dental for ALL the information about

expanding statewide in particular Jacksonville, Orlando,

several unique private solo practice opportunities in the

St. Petersburg, Sarasota, Port Charlotte and Fort Myers.

Orlando area. (We respect all confidentiality requests.)

Top Compensation, daily guarantee, health insurance,

352.339.5326.

modern facilities with latest technology, great patient flow,

General Dentist Needed, Boca Raton. If you love dentistry, have excellent chair-side and communication skills, and want to surround yourself with talented staff, we invite you to join our busy, state-of-the-art, paperless,

Associate Dentist (Orlando). Looking for Part-

practice. Part time or full time. Compensation: $600/

time Associate Dentist for Orlando, Florida area

day minimum, depending on qualifications, plus high

Requirements: Must have DDS or DMD Degree from

percentage of collections. Call 954.703.9309 or email

Accredited Dental School; License to practice in the State

smilesofboca@aol.com.

of Florida and meet applicable State requirements; 2

POSITION OFFERED: Florida – Orlando/Daytona/ Jacksonville/Tampa/S. Fla. andy@katsur.com.

3-4 Days FFS office. South Central FL practice, 45 min from Wellington, 1 hr from Plantation, non-East coast feel. Amazing staff and patients. Great opportunity for Good Doc. Must do: Molar RCT, Dentures and extractions. Well above average take home. kurthausy@ hotmail.com.

Great Expressions Dental Centers has a current opening for a full-time General Dentist in Ft. Myers, FL. Our

years or more experience; Bilingual (Spanish) a plus. djunca23@aol.com.

Brand New Office Space in Medical Office Building.

With $50,000-$100,000 in improvements. FT Dentist Required. Moving from another premises this is ideal for you. Pinellas Park is just outside of Tampa. Address 8200-66St North Pinellas Park, Florida. mitraezzati@ hotmail.com.

no administrative headaches and professional mgmt.

We also buy dental practices and create exit/transition strategies for solo and group practices. If interested in selling your practice, please email Dr. Alex Giannini at agiannini@ddpgroups.com. If interested in an Associate Dentist position please email your CV to jhokamp@ ddpgroups.com or call 941.312.7838. Current openings in Sarasota and Port Charlotte. However, please don’t hesitate to send your CV if interested in other areas.

General Dentist. Smile Design Dentistry is seeking experienced general dentists working 4-5 days per week at our offices in Spring Hill and in the Villages.

Our dentists have the clinical freedom and autonomy enjoyed in a traditional private practice without the

General Dentist for busy offices in Palm Beach County.

additional financial or administrative burdens associated

Laboratory on premises. zufi@comcast.net.

with practice management. SDD offers a daily guaranty, stable and growing patient base, PPO and FFS based

dentists have the clinical freedom and autonomy enjoyed

Porcelain/Crown and Bridge Technician Manager.

patients, and we offer medical and other benefits. Email

in a traditional private practice without the additional

Management Position! Porcelain/Crown and Bridge

spatel@thesmiledesign.com or call 813.765.0879 for

financial or administrative burdens associated with

Technician to manage small lab in Florida and help bring

more information.

practice management. When considering a career with

it to the next level. Must be a CDT and have experience

GEDC, Dentists can expect unlimited production based

in all areas of fixed prosthetics including implant

CHRISTIE DENTAL! Christie Dental is a multi-specialty

earnings, full benefits, malpractice coverage, a stable

technology. Competitive salary and profit sharing plus

dental group with approximately 55 dentists and specialty

patient base, and long-term practice or regional career

other benefits. Email or fax resume to 866.728.4579.

doctors in nearly 20 practice locations in the Brevard,

growth. To learn more please call Ross Shoemaker

Please put “LM-FDA” in subject/memo field in order to

Ocala and Orlando, Florida markets. Christie Dental

@ 678.836.2226 or visit us on the web at https://

be considered.

offers individuals and families a full range of dental

careersclinical-greatexpressions.icims.com/.

care, including general dentistry, hygiene and specialty Dentist wanted for Boynton Beach Office. Upscale

care, such as pedodontics, oral surgery, endodontics,

ASSOCIATE LEADING TO PARTNERSHIP – BRADENTON,

General Dentistry Practice seeks a full time associate

orthodontics and periodontics. We currently have a

FLORIDA. Well-established high quality, fee for service,

with at least one year of experience to work in our state

wonderful opportunity for an Oral Surgeon to join our

restorative/prosthodontic and esthetic practice looking

of the art Boynton Beach Office. Saturdays are a must.

team in the Melbourne area 3 days/week. We offer a

for a highly skilled and motivated associate. Excellent

No HMO’s or capitation. Offering excellent commission.

comprehensive compensation and benefits package

opportunity for the right person scarlett@zkjvdental.com.

Please email or fax resume to 561.424.2098.

which includes medical, life, disability and professional

Pedo/Ortho OFFICE wants General or Specialist dentist.

PEDO/ORTHO office looking for some great help.

liability insurances, flexible spending and 401(K) with employer match! pschwartz@amdpi.com.

Possibility for General Dentist, Pediatric Dentist, or maybe even Orthodontist. Pay, hours, and arrangement TBD. gentledentalman@yahoo.com.

Please see CLASSIFIEDS, 74

www.floridadental.org

May/June 2014

Today's FDA

73

Your Classified Ad Reaches 7,000 Readers!

Endodontist needed, part time. Part time endodontist

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

needed immediately at Arlington Dental Center.

Established 30 year old practice with $302,000 Gross

Dental associate. Full time dental associate in Fort

Our aging endodontist is moving towards retirement

and 95% collection rate. Solid 3 day hygiene program

Walton Beach/Destin area. Busy, 25+yr, 2 dr. general

and we need a supplementary endodontist now.

with 1200 active patients – 25% PPO. 1100 sq. ft.

practice. 1 dr. is retiring. Opportunity to be immediately

Compensation good. Will discuss. Call Ben Bradberry at

business condo unit also for sale. Owner retiring.

successful with option to buy in/buy out. Guaranteed

904.537.6290, or email me at benbradberry@aol.com

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

CLASSIFIEDS from 73

base salary. Tremendous earning potential for motivated individual. Wonderful area to work/live. Contact Lisa at

Seeking a motivated associate. High-end

941.256.6903.

multidisciplinary team seeking a motivated associate.

CENTRAL FLORIDA PEDO PRACTICE. Central Florida

The center is located in an upscale area near Gulf

Medicaid Based Pedo Practice. 9 Operatories in 3,800

Great Full Time Dentist Opportunity in Dunnellon. We

Stream Plaza. Approximately one mile from the

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

are currently seeking a General Dentist who appreciates

ocean. The practice recently underwent a modern and

Michael Finnan at 561.722.0787.

the professional, financial and administrative benefits of

technological renovation. Please visit us online at www.

group practice to join our team. Our doctors are offered

ThePremierSmile.com. Our team coordinates and

a generous compensation and benefit package. We are

provides continuing education courses i.e. Invisalign,

actively seeking full-time Dentists for our friendly practice

dental implants, cosmetics, sedation, and prosth.

in Dunnellon, FL! Dunnellon is a wonderful community in

We employ a wonderful and highly trained staff that

which to live and practice. Email CV to sbolduc@amdpi.

focuses on providing high quality care in a state of the

com.

art environment. We will provide the practice support

Associate/Partner/Sale. General Dental Practice has been

needed for your success. Partnership opportunities Excellent Opportunity in Titusville. We are currently

in existence for 26 years in a highly desirable location.

are available. Please email CV to Howard Corbeau:

seeking a Full-Time General Dentist for our Titusville

Amelia Island, Florida located in Northeast Florida.

howardcorbeau@gmail.com or fax to 888.800.4955.

We practice all aspects of dentistry. I am currently

850.218.6789 or email. Glfletcher2113@att.net.

location. We are looking for a Dentist that appreciates

a generous compensation and benefit package. Apply

General practice in nice professional building on US1 central Pompano. Great potential as a “startup” practice! Gross Rev. $160K. Contact Michael Finnan at 561.722.0787.

expanding my office from 4 to 7 operatories. Pay based

the professional, financial and administrative benefits of group practice to join our team. Our doctors are offered

CENTRAL POMPANO GENERAL PRACTICE. Small

For Sale/Lease

on production vs per diem. Please email or fax resume with contact information to rootdoc57@aol.com or 904.261.8181.

today for this great opportunity send resume to sbolduc@

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

amdpi.com.

Limited time. Absolutely reduced price for immediate

BUSINESS OPPORTUNITY: BUY IN TO THIS BEAUTIFUL

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

HIGH TECH PRACTICE. silberpeter1@gmail.com.

Associate. Full time position available in the Richmond, VA area. Commission or salary with benefits. Will mentor new graduate on Implant, Invisalign, and Cosmetic Dentistry. Email resume to sengddswp@yahoo.com.

A traditional fee for service general practice seeking full or part time associates. Seven locations on Florida’s West Coast including Tampa, Clearwater, St. Petersburg, Port Richey and Bradenton. Immediate income, paid vacation, health insurance, 401k, flexible days. Established in 1981. NO CAPITATION. Please contact Carolyn Mallory 727.461.9149, Fax 727.446.8382 or www.

FloridaDentalCenters.com.

Naples. No active patients; must hire your own staff, and do marketing for new patients. View website for more details. www.NaplesFloridaDentalPracticeForSale.com.

Email: NaplesFloridaDental@yahoo.com.

Pediatric dentist looking to purchase a pediatric dental practice, preferably in the following counties: St. Johns, Flagler, or Volusia. However, I am open to all locations throughout the state. If you are interested in selling

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

your pediatric dental practice, contact Candace at

Sarasota, University Health Park “one stop shop” health

candieapple8@hotmail.com or call 386.316.8021.

care campus, universityhealthpark.net, massive signage directly on corner of future stoplight, 40,000 cars/day visibility, 3,000 patients/week presently flow through campus, fully built out suite, affluent area, perfect for dentist, orthodontist, endodontist, prosthedontist, etc., 15 minutes from #1 ranked beach in USA, Sarasota #1

Buyers and Sellers. We have over 100 Florida dental practice opportunities; and the perfect buyer for your practice. Call Doctor’s Choice Companies today! Kenny Jones at 561.746.2102, or info@doctorschoice1.net.

Website: doctorschoice1.net.

General Dentist and Endodontist. Solo GP DDS seeking

midsized city in US for arts and culture. Call Don Harvey

Office Space to Share. Seeking to Lease a 4 chair

General dentist and Endodontist. A great opportunity

MD at 941.724.3259.

dental office for 3 days a week: Thursdays, Fridays

for the right individual! Expanding FFS quality office with 3 locations looking to hire an associate. General DDS Part Time with Full Time Potential. Endodontist 1-2 days/ month part time schedule. DDS with Endo skills would be ideal. High end Cosmetic, C & B, implants. Low volume

Beautiful Lakefront Property. Beautiful 2000 sf lakefront office space available for custom build out. Adjacent to Endodontist. Ideal for Oral Surgeon or Periodontist.

Contact Julie 813.654.3636 or julieh@aeoftb.com.

and Saturdays. The office is state of the art and great location. Excellent for an established Dentist who may want to relocate to another area and start building patients or bring their own. Monthly Lease is $3500 and includes electrical, water and 1 employee. Supplies

high quality patients with NO PPO or HMOs. Ft Myers,

Immokalee Rd, 2 mi W to US41 & 2 mi E to I-75. Main

expenses to be shared 50%. If interested, please reply to

Naples, Sanibel. drembos@aol.com.

access to (5) major, N-S routes. The site is enclosed

rafael11545@gmail.com.

General Dentist Position Available. 16 year Established private practice. Full time or part time. Benefits. Very busy.

Daily new patients. Prime location. Great opportunity for right person. Must be proficient in Diagnosis and Tx

by (16) major hi-residential sub-divisions. Yr. 2014, (2) major developers permitting new projects. “Great partnership facility/Major residential area.” frengel2@ comcast.net for listing package, email.

planning. Experienced only (3 years min). All phases of

Specialist to share office space. Periodontist seeking

general Dentistry (High Prosthodontics and Implants).

dental specialist to share office space in Southwest

Unlimited earning potential. The Villages, FL. Fax

Broward. Flexible schedule available. Please email info

resume: 407.302.9799 or email to: fldentalservices@

to: lindamyo@yahoo.com.

aol.com.

74

Today's FDA

May/June 2014

www.floridadental.org

WE KNOW HEALTH INSURANCE. WE KNOW DENTISTS. HELP IS HERE! Got questions? Get answers.

The health insurance marketplace can be confusing.

We’re here to help you get the health care plan you need.

Did you know you can no longer be denied coverage because of existing health problems?

Your Risk Experts 800.877.7597

A Member Benefit Since 1989

insurance@fdaservices.com • www.fdaservices.com

ON L I N E

CE

NEW THIS MONTH! DR. I. BHATTACHARYYA Autoimmune Diseases of the Oral Cavity (EL34) Expires 1/30/2015

T H E EA S Y WAY FLO RIDA DEN TAL ASSO C IATION

FREE CE CR ED I T S FOR FDA M E M B ERS 24 HOURS a day • Free clinical & practice management CE Go to www.floridadental.org.

Click Benefits & Resources.

Questions? Call 800.877.9922

DR. TED MALAHIAS Celiac Disease: A Review of This Emerging Disease and Its Dental Implications (EL32) Expires 1/30/2015 EVERY ISSUE OF TODAY’S FDA Earn online CE credit by taking a quiz on ”Diagnostic Discussion.”

Introducing ...

By Jessica Lauria

PUBLICATIONS COORDINATOR

What do you get when you take a dental student and add in a passion for politics and a desire to influence the millennial generation to make educated decisions? A young man destined to be a natural leader within organized dentistry. Articulate and knowledgeable, Salvator La Mastra has authored a book and made dozens of appearances on Fox News — all while attending dental school.

A D3 at LECOM, La Mastra has already made a name for himself, and it doesn’t even have a “Dr.” in front of it (yet).

Q. A.

Tell us a little about yourself. Where you grew up, family, school, interests?

I grew up in Dallas, Texas and spent my childhood attending Trinity Christian Academy. I went to Baylor University and received a Bachelor of Science degree in biology with a minor in chemistry.

Growing up in Dallas was an amazing experience, but the short time I’ve spent here in Florida has already made it a hard decision whether to return to Texas once dental school is finished.

Q. A.

What inspired you to write your book, “2012 for Twentysomethings: A Young Voter’s Guide to the 2012 Elections”?

My interest in politics escalated during the 2010 midterm elections. I developed a passion for seeking out nonpartisan, unbiased information to help inform my peers after realizing that no

76

Today's FDA

May/June 2014

www.floridadental.org

Introducing ...

relevant source of this type of information existed for young voters. This discovery eventually led to my book, “2012 for Twentysomethings: A Young Voter’s Guide to the 2012 Elections.” My hope for this book was to help educate my peers about the issues facing the United States for the 2012 presidential and congressional elections, and increase the number of thoughtful, educated and influential young voters. My goal is not to create Democrat or Republican voters, but educated voters — voters who choose based on their beliefs and not because of their age, race, class, job, sexual orientation or parents’ political affiliation. I hope this will be the first of many books aimed at educating, influencing and challenging my peers.

Q. A.

You are a regular correspondent for Fox News. How did you get the opportunity?

Through promoting my book and appearing on Fox News, I was continuingly asked to come back and comment on current events. This eventually turned into more frequent requests to appear and comment on current events related to the youth vote and millennials. Through doing this, I have set myself up as a millennial and youth vote expert. People are tired of hearing the ‘old dogs’ comment on the attitudes and mindsets of the millennial generation, the most powerful voting bloc in the country, which has opened up an amazing door for me.

Q. A.

How do you hope to influence the dental profession?

Right now, the main focus as a dental student is drawing continuing focus on the student debt crisis and cost of education. These are major issues that are going to severely affect the next generation of dentists. There are other important issues, such as licensure and midlevel providers, which also will affect our careers in the long run.

I hope to be able to be a positive advocate for the dental profession in educating the public on these issues, and lobbying for bills in the state I eventually practice in and at the federal level.

“

Right now, the main focus as a dental student is drawing continuing focus on the student debt crisis and cost of education.

”

Q. A.

Do you have any mentors? What is the most valuable advice you have received?

I have had many influential mentors throughout my life, but when it comes to dentistry I take an “all the above” approach. I believe right now as a dental student, it is important to soak up every piece of information and advice thrown your way. Every dentist you meet has a different way of doing something; being able to incorporate the best of all their techniques and what works best for you is what I believe makes you the best and most confident dental practitioner. I work closely with Dr. Richard Stanley, and he has illustrated this valuable point to me by showing me his constant drive and passion for learning and improving himself. He’s spent countless hours in continuing education (CE) courses so he can provide the best care to his patients, and is an excellent example to other dental students and me.

Ms. Lauria can be reached at 850.350.7115 or jlauria@floridadental.org.

www.floridadental.org

May/June 2014

Today's FDA

77

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 this 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.

1 Tooth Fairy Keepsake Boxes 3M ESPE

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

B Bank of America Practice Solutions Bankers Healthcare Group Inc. Bayshore Dental Studio Belmont Equipment

Benco Dental Best Instruments USA Inc. Bien-Air Dental Bioclear Matrix BioHorizons Implant Systems BIOLASE Biotec Bisco Dental Products BQ Ergonomics LLC Brasseler USA Bright House Networks Business Solutions Bright Now! Dental/Smile Brands Inc. BrushOnSmile

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

D Darby Dental Supply Delta Dental Insurance Company Demandforce DenMat LLC Dental Access Mobile Clinics LLC Dental Care Alliance Dental Equipment Liquidators Inc. Dental Health & Wellness Dental Lifeline Network – Florida Dental PC Dental Practice MLS Inc. Dental Pros Dental Sleep Solutions Dental Staffing Solutions Dental USA Inc. DentalEZ Group DentalVibe DentaQuest DENTCA Inc. Dentegra Insurance Company Dentistry That Cares Inc. DENTSPLY Caulk DENTSPLY Implants DENTSPLY International DENTSPLY Maillefer DENTSPLY Professional DENTSPLY Raintree Essix DENTSPLY Rinn DENTSPLY Tulsa Dental Specialties Denttio-CamSight Designs For Vision Inc. DEXIS Digital X-ray DigiDent Dental Art Technology Digital Doc LLC Doctor’s Choice Companies Inc.

Doral Refining Corporation DoWell Dental Products Doxa Dental Inc. Dynamic Dental Partners Group

E Ecolife Innovations efDA Training LLC Essential Dental Systems EvoraPro-Oragenics

F Fidelity Bank First Citizens Bank Florida Academy of General Dentistry Florida Baptist Convention Florida Capital Bank Florida Combined Life Florida Dental Association Services Flossolution Forest Dental Products Inc. Fortress Insurance Company Fortune Management of Florida

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

H H2Ocean Inc. Hager Worldwide Hawaiian Moon Hayes Handpiece Repair Healthcare Professional Funding HealthLink/Clorox Heartland Dental Henry Schein Dental Henry Schein Practice Management Solutions Heraeus Kulzer Hiossen Inc. Hu-Friedy

I i-CAT Imaging Sciences ICW International IDS / Genoray Implant Educators Inada Massage Chairs Infinite Therapeutics Infinite Trading Inc Instrumentarium / Soredex Insurance Credentialing Specialist Intra-Lock International Isolite Systems Ivoclar Vivadent Inc.

K KaVo Kenwood/CGX Radios

As of May 7, 2014 Kerr Corporation Kettenbach LP Kimberly-Clark Healthcare Knight Dental Group, CDL, DAMAS Knotty Floss LLC KOMET USA Kuraray America Inc.

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

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

N Nevin Labs New York Life Newman & Marquez P.A. Nobel Biocare NOMAD / Aribex Nova Southeastern University College of Dental Medicine NSK Dental, LLC

O OCO Biomedical Office Depot Officite Onpharma Inc. OralID / CytID OraPharma Inc. Orascoptic Oraspa™ Inc. Otto Trading Inc.

P Paragon Dental Transitions Parexton Web Design 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 & Consulting Group

Professional Sales Associates Inc. Proma Propel Orthodontics Prophy Magic Prophy Perfect Protected Trust Pulpdent Corporation

Q QSI Dental Quantitative Sciences

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

V Vatech America Video Dental Concepts Vitamix VOCO America Inc.

W Wells Fargo Practice Finance Wolters Kluwer Health/Lexicomp

XYZ Xlear / Spry Yodle Zimmer Dental

S Sales & Marketing Technologies Schumacher Dental Instruments SciCan Inc. SDI (North America) Inc. Sesame Communications Shamrock Dental Co. Inc. SharperPractice Shochet Law Group/The Dental Law Firm PA Shofu Dental Corporation Sierra Dental Products Sinsational Smile Inc. Sirona Dental Smile Reminder Snap On Optics StarDental Sterisil Inc. Straumann USA Sun Dental Labs Sunrise Dental Equipment Sunset Dental Lab Sunshine Health SunTrust Superior Dental Design & Upholstery SurgiTel/General Scientific Corp

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

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

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OFF THE CUSP JOHN PAUL, DMD, EDITOR

Sounds Like …?

I forgot to pack my headset for the gym yesterday, so I spent an hour on the elliptical machine trying to read the closed captions on the TV screens and being assaulted by some atonal noise experiment that Sirius radio calls music, being played at a level that probably garners an OSHA requirement for the staff to wear hearing protection. All the while, I was jealous of the rest of the gym rats who remembered their headsets and thinking: 1) Why don’t you just leave? (I never came up with a good answer for that one); and 2) Since everyone in this gym, except for me and the manager, is wearing a headset and listening to their own private pleasure, why don’t they just turn the radio OFF? Surely, they are compelled to pay for the privilege of playing music; they could probably save the cost of someone’s membership each year by not annoying the exercise junkies from the time they arrive until the time they can block out everyone else’s entertainment.

There is no way to please everyone when choosing music. About 10 years ago, I got tired of listening to complaints about the music in our office. I wanted to listen to Jimmy Buffet, but there’s at least one song on every album you can’t play in front of your mother — not good for business. Staff wanted to listen to country, also not good for dental busi-

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Today's FDA

May/June 2014

“

I wanted to listen to Jimmy Buffet, but there’s at least one song on every album you can’t play in front of your mother — not good for business.

”

ness. Lite jazz seemed like an obvious choice, but it was apparently so bad for business that the radio station closed down. One day I just turned the music off. Prior to that day the only comment I ever heard about the background music was, “Could you change the station?” In 10 years, I have not had a single patient comment that there was no music. Many patients bring their own devices and turn them up so loud I can hear the lyrics over the sweet sound of my high speed banishing caries from their mouths. My wife prefers AC/DC and Rob Zombie.

Graham Nicol, Esq., a great legal mind and the only one we love because he is ours, recently provided us with an article reinforcing my opinion. It seems our government has decreed anyone with more office space than the inside of a phone booth must pay a royalty for the privilege of listening to the work of recording artists in our place of business.

I am sure brother Nicol’s legal opinion is absolutely correct, but I think we might consider a different tactic. Rather than charge dentists to play their music, recording artists should pay us to not play their music. What super cool rock star who is drinking Dom and having the brown M&Ms picked from his bowl wants to be known as the king of dentist office music? I looked it up, and the only place cool is mentioned with dentistry is “cool mint flavor.”

As times are getting tougher and patients are staying away in droves, helping recording artists manage their image could become an important additional revenue stream for us all.

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

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