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TABLE OF CONTENTS The Florida Dentist’s Guide to

46

Peer Review

NOVEMBER/DECEMBER 2022 floridadental.org

MEMBERSHIP issue 8 | But We Agreed They Were Independent Contractors 27 | Massachusetts Ballot Question 2 Passed!

28 | Recap of the 2022 ADA House of Delegates 33 | ADA and FDA Principles of Ethics and Codes of Professional Conduct 35 | Stay Connected with the FDA 36 | West Palm Beach 2023 FLA-MOM FAQs 39 | What’s Your Why? 42 | FDA Foundation Grants Aid to 209 Florida Dentists 44 | Florida Dental Association By The Numbers!

46 | The Florida Dentist’s Guide to Peer Review 56 | So, You Want to Buy a New Computer?

58 | Go Back-to-school for Radiography Certification 60 | Highlighting FDA’s Event for Leaders Emerging Among Dentistry 62 | Employment Agreements/Contracts 64 | The Dentists Supply Company: Dental Supplies as a Member Benefit 66 | 2022 FDA President Dr. Jerry Bird 72 | FDC2023: A Look at What’s to Come at FDCC2023 with FDC General Chair Dr. Becky Warnken

7

74 | FDC2023 Speaker Preview: Your Patient, Your Duty

19

78 | FDC2023 Speaker Preview: Have You Noticed Changes in Your Coverage for Dental Billing?

80 | FDC2023 Speaker Preview: The 10 Financial Strategies to Succeed in Dentistry

IN EVERY ISSUE 2 Staff Roster

22 news@fda

4 Contributors

96 Diagnostic Discussion

7 President’s Message 13 Did You Know?

19 Legislative

100 Career Center

84 | FDC2023 Exhibit Hall 86 | Helping Members Succeed Throughout Florida!

CHECK OUT TODAY’S FDA ONLINE!

103 Advertising Index 104 Off the Cusp

20 Preventive Action

1 | TODAY'S FDA november/december 2022

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

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

COMMUNICATIONS AND MEDIA COORDINATOR Kelsey Simmons

GRAPHIC DESIGN COORDINATOR AJ Gillis

BOARD OF TRUSTEES PRESIDENT Dr. Gerald Bird • Cocoa

PRESIDENT-ELECT Dr. Beatriz Terry • Miami

SECRETARY Dr. Dan Gesek • Jacksonville

FIRST VICE PRESIDENT Dr. Jeffrey Ottley • Milton

IMMEDIATE PAST PRESIDENT Dr. Dave Boden • Port St. Lucie

SECOND VICE PRESIDENT Dr. John Paul • Lakeland

EXECUTIVE DIRECTOR Drew Eason, CAE • Tallahassee

Dr. Tom Brown • Orange Park | Dr. Christopher Bulnes • Tampa | Dr. John Coroba • Lake Mary | Dr. Bethany Douglas • Jacksonville Dr. Karen Glerum • Boynton Beach | Dr. Reese Harrison • Lynn Haven | Dr. Bertram Hughes • Gainesville | Dr. Mark Limosani • Weston Dr. Irene Marron-Tarrazzi • Miami | Dr. Eddie Martin • Pensacola | Dr. Paul Palo • Winter Haven | Dr. Mike Starr • Wellington Dr. Don lIkka • speaker of the house, Leesburg | Dr Rodrigo Romano • treasurer, Miami

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

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

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

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

deason@floridadental.org • Ext. 7109 ggruber@floridadental.org • Ext. 7111 cstoutamire@floridadental.org • Ext. 7202 lbell@floridadental.org • Ext. 7114 jstone@floridadental.org • Ext. 7123 ltucker@floridadental.org • Ext. 7143

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

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

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

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

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

2

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

FLORIDA DENTAL CONVENTION AND CONTINUING EDUCATION Crissy Tallman • director of conventions and continuing education Mackenzie Johnson • FDC meeting assistant Brooke Martin • FDC marketing specialist Isabelle McCreless • FDC program coordinator Lisa O’Donnell • FDC program coordinator Deirdre Rhodes • FDC exhibits coordinator

ctallman@floridadental.org • Ext. 7105 mjohnson@floridadental.org • Ext. 7162 bmartin@floridadental.org • Ext. 7103 imccreless@floridadental.org • Ext. 7106 lodonnell@floridadental.org • Ext. 7120 drhodes@floridadental.org • Ext. 7108

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

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

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

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

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

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

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

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

scott.ruthstrom@fdaservices.com • Ext. 7146 carrie.millar@fdaservices.com • Ext. 7155 carol.gaskins@fdaservices.com • Ext. 7159 marcia.dutton@fdaservices.com • Ext. 7148 porschie.biggins@fdaservices.com • Ext. 7149 maria.brooks@fdaservices.com • Ext. 7144 davis.perkins@fdaservices.com • Ext. 7145 melissa.staggers@fdaservices.com • Ext. 7154 dbasista@fdaservices.com • Ext. 7156 tessa.daniels@fdaservices.com • Ext. 7158 kelly.dee@fdaservices.com • Ext. 7157 liz.rich@fdaservices.com • Ext. 7171

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

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

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

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

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

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

3 | TODAY'S FDA november/december 2022

november/december 2022

GUEST CONTRIBUTORS

LARRY DARNELL, MBA, CAE

CASEY LYNN, DMD

DEBORAH S. MINNIS

FDA DIRECTOR OF INFORMATION SYSTEMS

cclynn09@gmail.com

AUSLEY MCMULLEN

Page 34

dminnis@ausley.com

ldarnell@floridadental.org

Page 8

Page 56

BRYAN T. MARSHALL, DDS, MBA

JOHN PAUL, DMD

ANGELA MCNEIGHT, DMD, MS

FDA SECOND VICE PRESIDENT

angela.mcneight@gmail.com

jpaul@bot.floridadental.org

Page 60

Page 28

JAMES R. PITTS, DMD

LARRY SANGRIK, DDS

james.pitts@jwcemail.com

ljsangrikdds@aol.com

MADISON SCHWARZ

Page 80

Page 74

btmarshall@msn.com Page 62

TDSC.COM Madison.Schwarz@tdsc.com Page 64

BECKY WARNKEN, DDS

CHRISTIN TAXIN ctaxin@links2success.biz Page 78

4

rwarnkendds@gmail.com Page 72

CONTRIBUTORS

INDRANEEL BHATTACHARYYA, DDS

SAJA ALRAMADHAN, BDS oralpath@dental.ufl.edu

oralpath@dental.ufl.edu

Page 96

Page 96

JOE ANNE HART

NADIM M. ISLAM, DDS

FDA PRESIDENT

FDA CHIEF LEGISLATIVE OFFICER

oralpath@dental.ufl.edu

gbird@floridadental.org 850.681.3629

Page 96

jahart@floridadental.org

Page 7

850.350.7205

CASEY STOUTAMIRE, ESQ.

RENEE THOMPSON

FDA DIRECTOR OF THIRD PARTY PAYER & PROFESSIONAL AFFAIRS

FDA DIRECTOR OF COMMUNICATIONS AND MARKETING

cstoutamire@floridadental.org

rthompson@floridadental.org

850.350.7202

850.350.7118

Page 13

Page 46

Page 19

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

5 | TODAY'S FDA november/december 2022

850.681.3629 Page 104

november/december 2022

JERRY BIRD, DDS

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

Join us at facebook.com/groups/floridadentalchatter.

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

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

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

Dr. Rudy Liddell FDAPAC Chair

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

— Dr. Rudy Liddell

6

president’s message

Why is Membership in the FDA Important?

By Jerry Bird, DMD, FDA President

Helping members succeed and supporting the health of the public are goals of the Florida Dental Association (FDA). As our professional organization, the FDA helps us from the beginning of our careers to the end and remains focused on our success as dentists and in our personal lives.

When I opened my practice in 1985, the FDA helped me navigate the business side of dentistry. I have gained many friends, colleagues and mentors through the FDA. But what does membership in an organization really mean? There are many organizations that we will join. Some we join to get something tangible in return. Organizations like AARP or clubs like Costco and Sam’s save us money by buying a membership; but that is about it.

There are other organizations that we join because they fulfill us in some way – our church or synagogue. We join a family or a group that supports what we believe. Maybe it’s a volunteer club like Rotary, Kiwanis, Moose or Junior League. We give money and participate in their activities, but it may just be for a time or a season in our lives.

Then there are organizations like the FDA that are there to help make the road easier for us and have tangible benefits that are worthwhile to our business and profession. This is where we, as professionals, can make a difference in our chosen field of dentistry. This is more than a commitment – this is our career. We invested a lot of time, energy and money into our education and made many sacrifices along the way. Now we are in a practice, and we would like it to be productive, fulfilling and have longevity. In addition, we may have a family and a home now, so there are more reasons to protect our investment.

As a dentist in Florida, you need to decide: Do I want to be a bystander, or do I want to be involved? Do I want to see what’s happening that can affect me, my profession and my family?

What are the new advances, how can I improve what I do and make it better? What are the threats that linger out there that could affect my practice? That’s why we as dentists organized into an association – many voices make the best decisions and make the biggest difference.

The FDA has an amazing team of professionals at the ready to help us navigate the challenges of practice. They help us in advocacy by supporting dental-friendly candidates and legislation, helping our patients get access to quality dental care, purchasing insurance products for our office and team members, providing us with the best continuing education at the best dental meeting ever – the Florida Dental Convention – and so much more. The FDA, together with the American Dental Association, delivers programs, services, and advocacy to maximize value and service at every level.

As a member dentist of the FDA, you are ensuring that your investment in your profession is protected. As dentists in Florida, our strength and voice make a difference in our profession and comes from the unity of our member dentists. Encourage your friends who are not members to join and remember to invite that new dentist who just moved into your community to a local meeting or to coffee. A personal ask is the best recruitment tool for membership. It takes all of us and we cannot do it without YOU! Join us today and let’s succeed together!

7 | TODAY'S FDA november/december 2022

But We Agreed They Were Independent Contractors

”

By Deborah Minnis

Many companies and individuals attempt to maintain flexibility in their work relationships by entering into independent contractor agreements. However, these agreements can create serious tax and employment problems for companies. The fact that the parties have agreed to an independent contractor arrangement, have acted on that agreement, and have signed a document titled “independent contractor agreement” is not binding on the Internal Revenue Service (IRS) or the agencies enforcing employment laws or the courts interpreting those laws.

Misclassifying an employee as an independent contractor can often result in unpleasant surprises for the company. By way of example, Company A terminates a contract with an individual working as an independent contractor. The disgruntled “independent contractor,” believing he/she was really treated as an employee, goes on the internet to the U.S. Department of Labor Division of Wages and Hours (USDOL) to complain. (This is the division that enforces the federal overtime laws.) Based on the information provided to them, the agents of the USDOL decide that the individual was really an employee and not an independent contractor, resulting in the company possibly ending up owing the person overtime pay for two to three years.

8

Misclassifying an employee as an independent contractor can often result in unpleasant surprises for the company.

”

human resources Three major areas where I most often see these types of issues are when former alleged independent contractors are audited by the IRS, have filed discrimination claims with the Equal Employment Opportunity Commission (EEOC), or have claimed overtime with the USDOL under the Fair Labor Standards Act (FLSA). The IRS, the EEOC and the USDOL each consider slightly different factors in determining the existence of an employer/employee relationship. Please see a brief overview of each.

IRS FACTORS: As a general rule, the IRS considers whether the company controls the method of work and not just the final outcome. The more control the company exercises over the method of the work, the more likely the relationship will be determined to be that of employer/employee.

The IRS considers several factors broken into three categories: (1) behavioral control; (2) financial control; and (3) type of relationship.

1. Behavioral Control a. Whether the company controls when and where the work is done. b. Whether the company controls what tools or equipment are used. c. Whether the company controls in what order and sequence the work is to be done. d. The degree of instruction provided by the company – the more detailed the instructions the more control is being exercised. e. Whether the company evaluates the individual on how the work is being performed, i.e., not just the end result. f. Whether the company provides training on how to do the job. This demonstrates that the business wants the job done in a particular way and is strong evidence of an employer/employee relationship.

2. Financial Control

c. Is there is an opportunity for profit or loss by the individual providing the service? d. Are the individual’s services generally available to the market? e. How is the individual compensated? Independent contractors have a flat fee versus employees, who are paid a regular amount based on an hourly, weekly or monthly pattern.

3. Type of Relationship a. Is there a written contract? However, note the IRS guidance specifically states that it is not required to follow the language in the contract. b. Does the individual receive benefits, i.e., insurance, pension, vacation, sick leave and disability benefits? c. How permanent is the relationship? If the relationship continues indefinitely, this indicates an employer/ employee relationship. d. Are the services provided a key activity of the business?

If so, the business is more likely to have the right to direct and control the person’s activities in how the services are performed.

FAIR LABOR STANDARDS ACT FACTORS: In its Fact Sheet #13, the USDOL sets out the factors it considers in determining what type of relationship exists. The following are among the factors considered: l The extent to which the services rendered are an integral part of the company’s business. l The permanency of the relationship. l The amount of the alleged contractor’s investment in facilities and equipment. l The nature and degree of control by the company. l The alleged contractor’s opportunity for profit and loss.

a. Does the individual have a significant investment in the equipment she/he uses? True independent contractors have a significant investment in equipment.

l The amount of initiative, judgment, or foresight in open market competition with others required for the success of the claimed independent contractor.

b. Are there unreimbursed expenses? Independent contractors have no unreimbursed expenses.

9 | TODAY'S FDA november/december 2022

t

10

human resources l The degree of independent business organization and operation engaged in by the claimed independent contractor.

While there is some overlap between these factors and the IRS factors, each agency has authority to interpret its factors independent of the others.

In addition, the USDOL factors used to determine the existence or non-existence of an employer/employee relationship are also regularly interpreted by the various federal and state courts.

The courts, in making their determinations on this issue, do not consider one factor over the others but have held that the total activity or situation controls. In its Fact Sheet #13, the USDOL also specifically states, among other factors not considered, the fact that the alleged independent contractor is licensed by state/local government does not have a bearing on its determination.

EEOC INDEPENDENT CONTRACTOR CHECKLIST: The EEOC administers most discrimination laws, such as Title VII, the Age Discrimination in Employment Act, the Pregnancy Discrimination Act, and the Americans with Disabilities Act. The EEOC considers the following factors: l

Does the company have the right to control when, where and how the work is performed?

l

Does the work require a high level of skill or expertise?

l

Does the company furnish the tools, materials and equipment that are used?

l

Is the work performed on the company’s premises?

l

Is there a continuing relationship between the company and the individual?

l

Does the company have the right to assign additional projects to the individual?

l

Does the company set the hours of work and the duration of the job?

l

Is the individual paid by the hour, week or month rather than an agreed upon cost for performing the particular job?

l

Does the individual hire and pay assistants?

l

Is the work performed by the individual a regular part of the company’s business?

l

Is the company in business?

l

Is the individual engaged in his/her own distinct occupation or business?

l

Does the company provide the individual benefits such as insurance, leave, or workers’ compensation?

l

Is the individual considered an employee for tax purposes?

l

Can the company discharge the individual?

l

What type of relationship do the company and the individual believe they are creating?

This is not an exhaustive list; the EEOC and the courts can consider other factors and circumstances they deem relevant to determine the issue. No one factor is controlling. Answering “yes” to some or all of these factors generally indicates that the individual is an employee and not an independent contractor.

CONCLUSION: In conclusion, my previous statement bears repeating: the fact that the parties have agreed to an independent contractor arrangement, have acted on that agreement, and have signed a document titled “independent contractor agreement” is not binding on the IRS or the agencies enforcing employment laws or the courts interpreting those laws. To the extent you currently have individuals you believe to be independent contractors, those agreements and your relationships with those individuals should be carefully reviewed. To the extent you are considering entering into such agreements or relationships in the future, you should carefully review and analyze the agreement and the specifics of the relationship before the provision of services begins.

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.

11 | TODAY'S FDA november/december 2022

OPIOIDS

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

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

DISCUSS Advantages and disadvantages of non-opioid alternatives.

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

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

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

Effective July 1, 2021.

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

NON-OPIOID ALTERNATIVES LAW:

Exclusive Member Benefit!

FOR THE LATEST ON OPIOIDS, GO TO:

FLORIDADENTAL.ORG/NYK

12

GO TO bit.ly/2KXvZ2h

did you know?

Dentists May Delegate Remedial Restorative Functions

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

Did you know that effective June 26, 2019, a dentist may delegate remedial restorative functions to a dental assistant or to a dental hygienist who has completed the mandatory training offered by an accredited dental or dental hygiene program?

What restorative functions are delegable? Look at the top of the following page for a current list.

What are the prerequisites for dental assistants as well as what training is required? Look on the following page for information.

What are the responsibilities of the delegating

dentist? Look on page 14 and 15 for a list.

t

”

The delegating and supervising dentist shall remain fully responsible for all delegated tasks and for ensuring that the dental assistant or dental hygienist meets the training requirements of this rule.

13 | TODAY'S FDA november/december 2022

did you know?

New! DENTISTS MAY DELEGATE REMEDIAL RESTORATIVE FUNCTIONS

What restorative functions are delegable?

All functions delegated shall be performed under direct supervision.

The delegating and supervising dentist shall remain fully responsible for all delegated tasks and for ensuring that the dental assistant or dental hygienist meets the training requirements of this rule.

After a dentist has prepared a tooth, a dentist may delegate to a dental assistant or hygienist the task of placing, packing and contouring amalgam and composite restorations, and the fitting and contouring of stainless steel crowns (tasks).

Does not include permanently cementing stainless steel crowns.

The tasks shall only be performed using a slow-speed handpiece and hand instruments.

FOR DENTAL ASSISTANTS What are the prerequisites?

States Department of Education (DOE) or shall have received formal training in expanded duties.

Never had a dental assisting license suspended or revoked in any jurisdiction.

Within 24 months prior to being admitted to the mandatory training course, the candidate must have documented proof of 2,400 hours of clinical work experience in either a dental office or as an educator of dental assisting.

The training program shall ensure that the candidate meets all the qualifications before accepting the candidate into the training program.

To be eligible to be admitted into the mandatory training course required by rule, a dental assistant (candidate) shall meet the following conditions: Be at least 18 years of age.

Be a high school graduate or have a High School Equivalency Certificate.

Have a current Basic Life Support for Healthcare Provider certificate.

Be a graduate of a dental assisting program that is accredited by a dental accrediting entity recognized by the United

What training is required?

The training course shall be offered by a dental or dental hygiene school or program that is accredited by a dental accrediting entity recognized by the United States DOE.

The training program shall verify competency by requiring an exit or final written examination and clinical examination that includes live patients.

The written portion of the examination shall include a section covering the Laws and Rules of Dentistry in Florida.

A passing score shall require a 75% or above on both the written and clinical examination, and the examinations shall not be weighted to achieve an overall score of 75% or better.

The clock hours dedicated to the exit or final written and clinical examination shall not count towards the required minimum 105 total clock hours required by the course.

At a minimum, the training shall include and contain the following: 105 clock hours, including a minimum of 10 hours dedicated to preclinical didactic hours (may be offered online).

• At the completion of the preclinical didactic hours, the course shall require the passing of an initial written examination prior to the clinical portion of the training. A passing score shall require a score of 75% or above.

A clinical portion consisting of a minimum of 70 hours dedicated to simulated lab, minimum of 25 hours dedicated to live patients.

A clinical and lab session for Amalgam Restorations Class I, II, and V, which shall include live patients.

A clinical and lab session for Composite Restorations Class I, II, III, and V, which shall include live patients.

A clinical and lab session to size, fit and contour, but not permanently cement, stainless steel crowns, which shall include live patients.

Upon the successful completion of the training course, a certificate of successful completion of the Restorative Function Course shall be issued. The delegating dentist shall ensure that a copy of this certificate is immediately available at the location where tasks are delegated, and the certificate shall be produced by the dentist when requested by the Board of Dentistry (BOD) office or any authorized inspector.

14

did you know?

Effective June 26, 2019, a dentist may delegate remedial restorative functions to a dental assistant or to a dental hygienist who has completed the mandatory training offered by an accredited dental or dental hygiene program.

What are the responsibilities of the delegating dentist?

Shall not supervise more than four dental hygienists or dental assistants in combination who are simultaneously performing the tasks.

Shall ensure that the patient’s dental chart is annotated to reflect the initials of the dental assistant who performed the tasks.

Shall ensure that the patient’s dental chart reflects that the final restoration was verified by the delegating dentist and the result of the verification also shall be documented.

FOR DENTAL HYGIENISTS What are the prerequisites?

To be eligible to be admitted into the mandatory training course required by rule, a dental hygienist (candidate) shall meet the following conditions: Be at least 18 years of age.

Be a high school graduate or have a High School Equivalency Certificate.

Have a current Basic Life Support for Healthcare Provider certificate.

Have an active unrestricted dental hygiene license from any U.S. state or territory.

Never had a dental hygiene license suspended or revoked in any jurisdiction.

Within 24 months prior to being admitted to the mandatory training course, the candidate must have documented proof of 2,400 hours of clinical work experience in either: • a dental office • as an educator of dental hygiene • is a graduate of a dental hygiene program, accredited by a dental accrediting entity recognized by the United States DOE, within 24 months prior to being admitted to the mandatory training course.

• The training program shall ensure that the candidate meets all the qualifications before accepting the candidate into the training program.

What training is required?

The training course shall be offered by a dental or dental hygiene school or program that is accredited by a dental accrediting entity recognized by the United States DOE. At a minimum, the training shall include and contain the following: 85 clock hours, including a minimum of five hours dedicated to preclinical didactic hours (may be done online), and a clinical portion consisting of a minimum 55 hours dedicated to simulated lab and a minimum of 25 hours dedicated to live patients.

• At the completion of the preclinical didactic hours, the course shall require the passing of an initial written examination prior to the clinical portion of the training. A passing score shall require a score of 75% or above.

A clinical and lab session for Amalgam Restorations Class I, II, and V, which shall include live patients.

A clinical and lab session for Composite Restorations Class I, II, III, and V, which shall include live patients.

A clinical and lab session to size, fit and contour, but not permanently cement, stainless steel crowns, which shall include live patients.

The training program shall verify competency by requiring an exit or final written examination and clinical examination that includes live patients.

The written portion of the examination shall include a section covering the Laws and Rules of Dentistry in Florida.

A passing score shall require a 75% or above on both the written and clinical examination, and the examinations shall not be weighted to achieve an overall score of 75% or better.

The clock hours dedicated to the exit or final written and clinical examination shall not count towards the required minimum 85 total clock hours required by the course.

Upon the successful completion of the training course, a certificate of successful completion of the Restorative Function Course shall be issued. The delegating dentist shall ensure that a copy of this certificate is immediately available at the location where tasks are delegated, and the certificate shall be produced by the dentist when requested by the BOD office or any authorized inspector.

15 | TODAY'S FDA november/december 2022

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17 | TODAY'S FDA november/december 2022

IN THE KNOW

WITH GAO

Webinar series for FDA members to stay informed on legislative and political issues.

The Florida Dental Association’s Governmental Affairs Office (GAO) would like to invite you to join in on our listening sessions to learn about legislative issues that may have an impact on the dental profession, political issues that could affect the dental industry, and a number of other hot topics that may be of interest to you!

The listening sessions will be scheduled for mid-afternoon, 30-minutes long and will allow you to ask questions of the speakers. These sessions are meant to give you a quick update on issues and topics during your lunch hour, without interrupting the flow of your day.

POTENTIAL GUESTS: • • • • •

Elected officials (federal, state and local) Candidates running for office State agency and department heads FDA Members National dental leaders/experts

GOVERNMENTAL AFFAIRS TEAM:

JOE ANNE HART Chief Legislative Officer jahart@floridadental.org

ALEXANDRA ABBOUD Governmental Affairs Liason aabboud@floridadental.org

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JAMIE GRAVES Legislative Assistant jgraves@floridadental.org

legislative

Addressing the Dental Workforce Shortages

By Joe Anne Hart, Chief Legislative Officer

It is no secret, workforce has become an issue for many industries, including dentistry. Not only did the pandemic create a hesitancy for dental hygienists and dental assistants to come back to the dental office, but it also exposed other workplace dilemmas that will have to be addressed in order to drive and keep dental hygienists and dental assistants in the dental profession. The Florida Dental Association (FDA), through its Workforce Innovation Task Group, has been engaging with interested stakeholders on how to address this issue. The ideal solution would involve a quick fix to remedy the dental workforce issue, but because it is important to maintain the standards of educating and training qualified dental auxiliary, we must look to other options before compromising standards.

The American Dental Association’s (ADA) Health Policy Institute (HPI) recently released a report that took a deep dive into researching the parameters around the issues driving dental workforce shortages. In addition to concerns involving the pandemic, dental hygienists and dental assistants noted several issues they feel haven’t been sufficiently addressed within the dental workforce culture. Many have concerns about benefits and compensation packages and have expressed a desire for more inclusion in the dental office, to be seen as a part of the dental team. It is important for dentists to evaluate the status of the labor market in order to remain competitive. The pandemic

opened the doors for employees to demand more flexibility in their work schedules, heightened the desire for work-from-home options, negotiate for more compensation and paid-time-off, and the list goes on. Not all of these demands will be viable or met within the dental industry, but they can’t be ignored. The HPI report states that even if these demands are met, there will still be an ongoing dental workforce shortage that will take long-term solutions to adequately address. To access the HPI report titled “Dental Workforce Shortages: Data to Navigate Today’s Labor Market,” go to bit.ly/3D6XHFi. In the meantime, the FDA hosted a webinar on addressing the dental workforce shortages. Dr. James Younger, owner and creator of TempStars, is a practicing dentist in Canada, who has entered the market with a new spin on temporary staffing services.

As a dentist, he truly understands the unique challenges a dental office faces when dental auxiliary is not dependable. TempStars just may be a temporary solution that could help address the need now in dental offices as long-term solutions are implemented. To view the webinar about TempStars, go to bit.ly/3VMMWiK. The FDA’s Workforce Innovation Task Group will continue to meet to address the dental workforce issues and we would love to hear directly from you. If you have any information you would like to share, please contact Joe Anne Hart at jahart@floridadental. org.

19 | TODAY'S FDA november/december 2022

preventive action

Now is the Time to Make Sure You Are OSHA Compliant!

By Abyde

OSHA — just four letters, but a word that holds so much importance in health care. The four-letter acronym is short for Occupational Safety and Health Administration and was given life by the OSH Act of 1970, with the ultimate goal of reducing on the job injuries, illnesses and deaths across America. And, because we’re big believers in data and the occasional name drop, we will share this little tidbit: since the introduction of the OSH Act, workplace fatalities have been cut by more than 60%, and occupational injury and illness rates have declined by 40%.

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Now, we hope that your practice isn’t stuck in the Stone Age with some bulky paper binder that houses your OSHA program. We are here to tell you it’s time to dust it off and toss it in the dumpster. Between all the policies, forms and laws, there are more than 40 policies and procedures that are required for you to be compliant. While they are tedious and require a ton of knowledge to pull them together, OSHA is in place to promote a safe and healthful work environment — not to mention that state and federal regulations are always changing. And, when your focus should be on your patients, who really has time to keep up with that?

Did you also know that all employees should be completing training on an annual basis? From hazard communication to bloodborne pathogens and everything in between, there are more than a handful of topics that your employees should be knowledgeable and comfortable with to best perform their jobs. Unfortunately, it doesn’t seem like Netflix is adding OSHA training to their new releases anytime soon — although, we would probably give it five stars.

Even though we could chat about this for days, we will just leave you with this piece of advice. In addition to the rights you have as an individual employee, there also comes responsibilities in protecting yourself, your

co-workers, visitors and patients. Your workplace might have their own specific requirements, but general OSHA guidelines for employees include: Reading and following all health and safety postings.

Following safe work practices.

Helping to reduce work hazards.

Reporting all occupational injuries and illnesses.

Reporting hazardous conditions.

Cooperating during an OSHA inspection.

Exercising rights under the OSH Act in a responsible manner.

Whether you’re a newbie or an expert, Abyde is here to help you make sense of all the mumbo jumbo that comes along with OSHA. As your Crown Savings partner, it is our job and our passion to ensure you’re well equipped to take on any OSHA (and HIPAA!) challenge that comes your way. Since we’re all proud residents of the Sunshine State and never get the chance to truly embrace wearing the added layers of scarves and mittens in the winter, we do have some options for you to “bundle up” with our HIPAA and OSHA solutions – we encourage you to check them out!

Since the introduction of the OSH Act, workplace fatalities have been cut by more than 60%, and occupational injury and illness rates have declined by 40%.

21 | TODAY'S FDA november/december 2022

”

news@fda Get Your Squad Together And Volunteer at the 2023 Florida Mission of Mercy!

2023 DENTISTS’ DAY ON THE HILL Tuesday, March 28, 2023

FREEDOM TO SMILE! Monday, March 27, 2023

Tuesday, March 28, 2023

will meet withLegislative legislators policies Briefingand advocate forCapitol Visits that will help 6 p.m. at Hotel Duval Lunch provided better theComplimentary oral health of patients in the state. dinner to follow Register todayHotel at bit.ly/3hqDy4v to keep a healthy smile on all Room Block Hotel Duval - $209 a night Floridians’ faces!

Click here to reserve

Volunteer Registration is OPEN for the 2023 Florida Mission of Mercy (FLA-MOM)! FLA-MOM is a large-scale, two-day, professional dental clinic that provides care to any patient at no cost to them, with the goal of serving the under-served and uninsured in Florida – those who would otherwise go without care.

A legislative briefing will take place on Monday, March 27, at 6 p.m. at Hotel Duval with a complimentary buffet dinner to follow.

Click here or scan the code above to register If you plan on attending the briefing and dinner, please add both items during your registration.

For more information, please contact the FDA Governmental Affairs Office at 850.224.1089 or gao@floridaental.org.

The Atlantic Coast District Dental Association and the FDA Foundation will be hosting the 2023 FLA-MOM in West Palm Beach Feb. 24-25 at the Expo Center at the South Florida Fairgrounds. With a goal of treating 2,000 patients – we need You!

The FDA has a room block at Hotel Duval for $209 a night. To book your room, please call 850.224.6000 and reference “Florida Dentists’ Day on the Hill” or go to bit.ly/3fOi94X. Rooms for this event fill up quickly so reserve your room today!

Visit FLAMOM.org today and register to volunteer! Clinical volunteers including dentists of all specialties, dental hygienists and assistants, and medical professionals such as physicians, EMTs and nurses are needed. In addition, general volunteers are needed to assist with registration, clinic setup, data entry, escorting patients, translating and more.

Questions? Please email foundation@floridadental.org or call 800.877.9922.

Freedom to Smile — Register for the 2023 Dentists’ Day On The Hill!

Please note: Room reservations should only be made for yourself/ parties staying in the same room. Multiple rooms reserved under one name for any affiliate or district may be subject to cancellation by the FDA. Thank you for your cooperation.

Information regarding DDOH will be sent periodically to registrants throughout the year and up until the event. Register as soon as possible to receive timely information! If you have any questions, please contact Governmental Affairs Liaison Alexandra Abboud at 850.224.1089 or aabboud@floridadental.org.

Flood Insurance is Available!

All Floridians deserve the “Freedom to Smile!” It shouldn’t matter where you live or how much money you make, everyone deserves to receive quality dental care from a licensed dentist. As an FDA member, you know and can help ensure this by coming to Tallahassee to advocate for the FDA’s legislative priorities.

During the 2023 Dentists’ Day on the Hill (DDOH) on Tuesday, March 28, FDA members, along with spouses and dental students,

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FDA Services recommends that ALL dental practices carry a flood insurance policy, especially since this is NOT covered on an office insurance policy. Practices can write a policy with the national flood program or a private flood carrier. Keep in mind a standard 30-day waiting period applies. Call or text 850.681.2996 to get a quote today!

Get Ready for Stellar Education to Keep “Launching Dentistry Forward” at FDC2023!

Save the dates for FDC2023, June 29-July 1, at the Gaylord Palms Resort & Convention Center in Orlando where you can attend courses on the latest trends, technologies and techniques to keep “Launching Dentistry Forward.” Course highlights include Dawson Seminar 1, clear aligner therapy, platelet-rich fibrin therapy, crown lengthening, implant advancements, geriatric and special needs care, salivary diagnostics, and much more. Go to bit. ly/3UBXwaE to check out the full list of course offerings and their details. As always, FDA members can take advantage of free registration, free course options and discounted registration fees for team members. Go to to bit.ly/3UBXwaE to search all FDC2023 courses and speakers.

Captain Samira Meymand, DDS, MPH Captain Samira “Sam” Meymad serves as the Captain of 14th Dental Company, 4th Dental Battalion leading the dental readiness of Marines and Sailors along the East Coast.

Capt. Meymand quickly climbed the ranks of leadership, most recently to Captain in October 2022.

After completing her Oral and Maxillofacial surgery residency, Capt.

Meymand deployed on the USNS Comfort (TAH-10) Navy ship in 2009 where she performed oral surgery and even served as Chief of Oral Maxillofacial Surgery. She also served side-by-side with plastic surgeons assisting in cleft lip and palate treatment with Operation Smile.

With her most recent rank promotion, Capt. Meymand continues to look for opportunities to mentor sailors coming up through the ranks, as she knows the challenges and sacrifices that come with being a military officer, surgeon and mother.

Health Care Practice Stays Compliant with Coalition’s Included Employee Security Training Dental care may be the biggest concern and goal when it comes to a practice and the service it provides. But privacy and security are two of the biggest elements that help determine just how safe a company really is — for both patients and those who work there. New regulatory frameworks, including the General Data

The FDA House of Delegates Will Consider Bylaws Changes The Council on Ethics, Bylaws and Judicial Affairs will perform it’s annual review of the FDA bylaws and propose changes if necessary.

The Next House of Delegates Meeting Will be Held Jan. 21, 2023 at the Tampa Airport Marriott Hotel Protection Regulation (GDPR) and California Consumer Privacy Act require companies to adhere to high standards of data and privacy compliance. Many companies need guidance on how to comply, as well as insurance protection if an incident arises.

Following is an example of one company who turned to Coalition for coverage: number of employees: less than 25; company’s main duty: provides dental are for patients across two offices; and, highly regulated industry.

Under the heavy burden of increasing regulation and following a less than stellar claims experience with a traditional insurer after a previous data breach, a Michigan-based health care organization turned to Coalition for superior coverage and help with regulatory compliance both nationally and on a global scale. The organization was looking for an insurance policy that: provided broad coverage for privacy regulations including local, state, federal and foreign laws such as GDPR; included coverage for voluntary notification (which wasn’t covered in their last policy) with no caps on the number of individuals notified; and, went beyond just insurance — they needed help with compliance and cybersecurity to protect their patient data After reviewing options with their insurance broker, they chose Coalition. And, in addition to receiving superior coverage, they’ve re-written their security policies with help from Coalition’s Security Incident Response Team and are using Coalition’s included employee security training and simulated phishing emails with every single member of their staff.

Coalition’s included security tools can reduce an organization’s costs to detect, recover and contain a breach more than 40%, and are available to all policyholders at no additional cost.

23 | TODAY'S FDA november/december 2022

news@fda Welcome New FDA Members The following dentists recently joined the FDA. Their memberships allow them to develop a strong network of fellow professionals who understand the day-to-day triumphs and tribulations of practicing dentistry.

Central Florida District Dental Association

Dr. Woo Sang Hwang, Jacksonville

Dr. Andikan Akpabio, Jacksonville

Dr. Christopher Klekamp, Jacksonville Beach

Dr. Lara Bachour, The Villages

Dr. Stephanie Labib, Jacksonville

Dr. Anika Batta, Orlando

Dr. Hy Le, Jacksonville

Atlantic Coast District Dental Association

Dr. Alla Bizanti, Kissimmee

Dr. Kirkland Maples, Ponte Vedra

Dr. Alexandra Brown, Gainesville

Dr. Scott Poortinga, Jacksonville

Dr. Alejandro Baez Gutierrez, Davie

Dr. Cody Dazen, Gainesville

Dr. Loveena Rastogi, Jacksonville

Dr. Andre Barbisan de Souza, Boca Raton

Dr. Timothy DeSanto, Melbourne

Dr. Matthew Radwanski, Chalfont, PA

Dr. Beau Byers, Davie

Dr. Andra Hayward, Saint Cloud

Dr. George Rubin, Jacksonville

Dr. Hannah Houghtaling, Apopka

Dr. Tyler Sanders, Fernandina Beach

Dr. Alena Kvashenka, Tampa

Dr. Emory Spradlin, Saint Augustine

Dr. Inaia Leibovitch, Gainesville

Dr. Adam Tarboush, Orange Park

Dr. Danielle Lombardi, Orlando

Dr. Cole Washington, Fernandina Beach

Dr. Anna Katrina Canta, Sebring Dr. Alexander Cardounel, Plantation Dr. Saba Dolatshahi, Plantation Dr. Carlos Espinal Mercado, Jr., Dania Beach Dr. Vanessa Franks, Pompano Beach

Dr. Julianna Masabni, College Station, TX Dr. Alberto Noguera, Oviedo

Northwest District Dental Association

Dr. Shivani Rajkumar, Maitland

Dr. Jeremy Brown, Santa Rosa Beach

Dr. Laura Santos, Saint Cloud

Dr. Matthew McNally, Shalimar

Dr. Venkata Manda, Plantation

Dr. Vanessa Schussler da Silva, Gainesville

Dr. Dixie Mobley, Milton

Dr. Sheldon Sacks, Palm Beach Gardens

Dr. David Wertz, Milwaukee, WI

Dr. Aarti Parmar, Tallahassee

Dr. Nathaniel Soto Rosado, Sebastian

Dr. Karli Wilson, Gainesville

Dr. Jacob Zellner, Tallahassee

Northeast District Dental Association

South Florida District Dental Association

Dr. Elizabeth Amoff, Jacksonville

Dr. Guianella Cala Balmaseda, Miami

Dr. David Elsharouny, Jacksonville

Dr. Ana Blain Abdala, Miami

Dr. Lisset Garcia Alonso, West Palm Beach Dr. Mitchell Hong, Fort Lauderdale Dr. Lavina Jagtiani, Boca Raton Dr. Isha Khullar, Tamarac

Dr. Cao-Minh Tran, Boynton Beach Dr. Kevin Vernet, Delray Beach Dr. Michael Ybern, Miami

Welcome new members to the 24

Dr. Carlos Arango, Miami

Dr. Mayumi Harada Rodriguez, Davie

Dr. Aashin Gokal, Riverview

Dr. Elissabet Banega, Coral Gables

Dr. Alexandra Romero, Miami

Dr. Gregory Grabowski, Nokomis

Dr. Livet Boffil, Miami

Dr. Ramon Sanchez, Fort Lauderdale

Dr. Timothy Jernberg, Naples

Dr. Matthew Breglio, Miami

Dr. Justin Schneider, Miami

Dr. Michelle Jordan- Gonzalez, Tampa

Dr. Venus Salazar Castrillon, Miami

Dr. Sujit Shakya, Miami

Dr. Leigh Klein, Lakeland

Dr. Elizabet Cedeno, Miramar

Dr. Tejaswi Singana, Davie

Dr. Anyeley Lopez, Plantation

Dr. Francisco Chapman, Pembroke Pines

Dr. Yohanny Solorzano Monaca, Doral

Dr. Armando Lopez, Plantation

Dr. Dened Vega Delgado, Miami

Dr. Ana Martins Wright, Davie

Dr. Nicholas Lynch, Clearwater

Dr. Adrian Gonzalez, Miami

Dr. Irina Zarichny, Miami

Dr. Radhika Malhotra, Spring Hill

Dr. Angely Hernandez Jose, Miami

Dr. Karen Zapata, Davie

Dr. Angelica Machin Hernandez, Miami

Dr. Manelys Zapata, Hialeah

Dr. Fernando Martinez Escobar, Cape Coral

Dr. Ahmad Jumaa, Davie Dr. Franziska Klostermyer, Plantation Dr. Lieny Padron Giraldino, Davie Dr. Maria Zelaya Gomez, Miami Dr. Arash Goshtasby, Hollywood Dr. Grace Guzman Lavandera, Miami Dr. Megan Leyva, Miami Dr. Andrea Lima, Plantation Dr. Alexandra Martin, Miami Dr. Hajir Mohammed, Hialeah Dr. Yusmila Ochoa, Tampa Dr. Ana Karina Perez, Miami

Dr. Yuniesky Martinez Lopez, Naples

West Coast Dental Association Dr. Islam Abusalum, Tampa

Dr. Huda Niwash, Tampa

Dr. Elizabeth Alabi, Fort Myers

Dr. Andrew Pakchoian, Wesley ChapelDr. Rachel Patenaude, Brandon

Dr. Vladyslava Barylyak, Wesley Chapel

Dr. Heydi Perez Reyes, Fort Myers

Dr. Hunter Bennett, Bonita Springs

Dr. Dominik Rokita, Hudson

Dr. Jeffrey Bourne, Fort Myers

Dr. Albert Rophie, Bradenton

Dr. Yilian Laborde Chang, New Port Richey

Dr. Natalie Schmidt, Sarasota

Dr. Paige Collins, Venice

Dr. Michael Snyder, Dunedin

Dr. Taylor Dietl, Palm Harbor

Dr. Anabel Valdivia Del Campo, Naples

Dr. Michelle DiMonte, Bradenton Dr. Oghenerukevwe Erhenede, Tampa

Dr. Brittany Valledor, Bonita Springs

Dr. Ashley Eugenio, Tampa

Dr. Susana Barrios Pinera, Naples

Florida Dental Association!

25 | TODAY'S FDA november/december 2022

In Memoriam The FDA honors the memory and passing of the following members: Marshall B. Berger

Robert E. Karol

Hollywood

Ponte Verdra Beach

Died: 9/21/2022

Died: 10/22/2022

Age: 86

Age: 68

Joseph J. Meyer

Thomas A. Parker

Saint Petersburg

Hollywood

Died: 9/12/2022

Died: 9/30/2022

Age: 74

Age: 89 Joe M. Wright Bradenton Died: 9/18/2022 Age: 90

FDA: Well-being program Tobacco Free Florida

26

Massachusetts Ballot Question 2

Passed!

The Florida Dental Association (FDA) is pleased to share excellent news about a major victory for dental patients and their families in Massachusetts. Massachusetts Ballot Question 2 — requiring most of the premium dollars collected by dental insurers to be spent on actual dental care — has passed overwhelmingly with 71% of the vote.

This decisive landmark victory means better dental benefits and better access to dental care for patients, period. It also means more families will be empowered to seek the dental care they need.

The FDA contributed $50,000 to the campaign; the American Dental Association (ADA), other state dental associations, dental specialty groups and individual dentists also contributed.

The passage of Question 2 ensures that what patients in Massachusetts pay in premiums ultimately goes to the actual care they receive, rather than to insurers’ bottom line. If dental insurance companies spend less than 83% of patient premiums on actual dental care, they must refund the difference to covered individuals and groups.

This sets an important precedent for dental care providers and their patients across the country. Despite dental insurers spending millions to defeat Question 2, ultimately voters considered the facts and supported these important consumer protections for dental patients and their families.

The ADA now hopes to work toward bringing these important reforms in dental insurance to other states throughout the country.

There is momentum and now is the time for dental care providers and their patients, as well as health care and consumer advocates across the nation, to work together to ensure that these important protections are implemented for dental patients and their families in every state.

The ADA is always a resource for dental providers in advocating for important insurance reforms to benefit dental patients and their families as well as the future generation of dental care providers to ensure better access to dental benefits and oral health care for everyone.

”

This decisive landmark victory means better dental benefits and better access to dental care for patients, period. It also means more families will be empowered to seek the dental care they need.

27 | TODAY'S FDA november/december 2022

ADA in Houston

Recap of the 2022

ADA House of Delegates

”

The 17th District Delegation attending the 158th ADA in Houston.

By John Paul, DMD, FDA Second Vice President

October 18 saw the close of the 158th American Dental Association (ADA) House of Delegates and the culmination of the presidency of Dr. Cesar Sabates, the first president of the ADA from the state of Florida.

The 17th District Delegation to the ADA (Florida is one of five single-state delegations) traveled to Houston for the meeting. Your delegation was successful in making and passing two resolutions: Resolution #517 closed a loophole allowing prospective members to receive services from the ADA. An important benefit when it took months to process an application, it was obsolete now that membership can be confirmed in less than a week. Some individuals were taking advantage of benefits without completing memberships, but the practice will now stop.

Important to all members of the ADA, Resolution #305 adopted as ADA policy that when third party payers (insurance companies) request any changes to existing contracts between dentists and the third

28

If a third party payer seeks to lease its network or start a new network, it should provide notice to the dentist 90 days in advance and obtain the dentist’s written consent to include the dentist in the new network.

”

Dr. Cesar Sabates addresses the 158th House of Delegates during the October ADA annual meeting in Houston, TX.*

party payer, it must be noticed at least 90 days before they are enacted and require the signature of the dentist to opt-in to agree to the new changes. Also, if a third party payer seeks to lease its network or start a new network, it should provide notice to the dentist 90 days in advance and obtain the dentist’s written consent to include the dentist in the new network.

While the resolution will not create a new law, it will set the standard for best practice and will serve as a guide for determining policy and future action.

The ADA House also voted in a new form of governance, the

Strategic Forecasting Committee. Florida’s Dr. Tom Brown was integral in developing this group and will serve on the committee during its inaugural year. This, coupled with a new view on accounting called Mission-based accounting where expenses are reported as they relate to programs of the ADA, should help the association direct its spending to programs members find most important and useful. *Photo by EZ Event Photography, courtesy ADA News. © 2022 American Dental Association.

No copyright information is necessary for photos printed for personal use.

If you have questions about what is permitted use, please contact Kelly Ganski, Editor, ADA News, ganskik@ada.org, 312.440.2792.

The ADA name should not be used in connection with a product or other commercial entity without specific, written permission from the ADA. Thank you for your cooperation.

29 | TODAY'S FDA november/december 2022

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31 | TODAY'S FDA november/december 2022

32

standard of conduct

ADA and FDA Principlesa of Ethics eb ot detcele evah I and Codes of Professional EHT FO REBMEConduct M DUORP ,NOITAICOSSA LATNED ADIROLF

Because the dental profession holds such a special position of trust within society, the profession makes a commitment to society that its members will adhere to high ethical standards of conduct. These standards are embodied in the American Dental Association (ADA) naciremA eht ot tnemtimmoc laudividni na setartsnomed hcihw and Florida Dental Association (FDA) Principles of Ethics and Codes of Professional Conduct (ADA & FDA Codes). The ADA & FDA Codes oC expression & scihtofEthefo selpicarising nirPfrom ’sn itaico ssA between latnethe D dental adiro lF dnand a la tneD are essentiallyead written obligations theoimplied contract profession society.

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Members of organized dentistry voluntarily agree to abide by the ADA & FDA Codes as a condition of membership; they recognize that continued public trust in the dental profession is based on the commitment of individual dentists to high ethical standards of conduct.

The full ADA code can be found online at bit.ly/3SJDWIu.

:OT WOV I

The code online .ssfull ecFDA orp gncan innbealfound p tne mtaaterfloridadental.org/coe. t eht fo rebmemThe larmain getdifference ni na sabetween elor sthe ’tntwo eitisathat p athe RFDA ONrequires OH for ymonotuA( .ytilaitnedfinoc ot thgir rieht ronoh lliw osla I members to participate in the peer review)process.

;lliks have tpedthree a dnmain a eg delwonk tnerruc gnisu ,mrah morf stneitap TCETORP The ADA & FDA Codes components: )ecnecfielamnoN( .tnemtaert ezimitpo ot slarrefer reporp gnidivorp dna

The Principles of Ethics — The Principles of Ethics are the aspirational goals and firm guideposts of the profession. They provide tnetepm oare c hmade guoup rhof t ,the egfive rafundamental l ta cilbuprinciples p eht dofnpatient a tneautonomy, itap ehtnonmaleficence, fo tfienebbeneficence, eht rof Tjustice CA and guidance and ) e c n e c fi e n e B ( . e r a c l a t n e d f o y r e v i l e d y l e m i t d na veracity.

.lla rof ssecca gnitomorp ,ecidujerp tuohtiw dna ssenriaf htiw erac REVILED

The Code of Professional Conduct — The Code of Professional Conduct is an expression of specific types of conduct that are )ecitsuJ( either required or prohibited. It’s a product of the ADA’s legislative system and all of its elements result from resolutions adopted by the ADA’s House of Delegates. )yticareV( .nac I sa yltsenoh dna ylraelc sa ETACINUMMOC Opinions are interpretations that apply the code to specific fact situations. They are ad.erThe ac Advisory htlaeh Opinions ruoy dn—aThe seAdvisory lpicnirp eseht gnidrager noissucsid nepo dna snoitseuq emoclew I

opted by the ADA’s Council on Ethics, Bylaws and Judicial Affairs to provide guidance to membership about how the Council might interpret the code in a disciplinary proceeding.

gro.latnedadirofl

Members, please consider displaying the poster, which was polybagged with this issue, in your office to reinforce to patients, staff scihte-fo-edoc/selpicnirp/tuoba/gro.ada and members of the public that you’re a dentist who is personally committed to exercising the ADA & FDA Codes. If you would like additional copies, please go to bit.ly/3TG70Rl, to print out the poster.

33 | TODAY'S FDA november/december 2022

I have elected to be a

HELPING MEMBERS SUCCEED

RENEW YOUR MEMBERSHIP FOR 2023 TODAY!

We have your back. Always.

Dr. Casey Lynn Chair, FDA Council on Membership Pediatric Dentist – Apollo Beach, FL

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

Mail: Return blue envelope with statement and payment.

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

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

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

34

membership

credit card you put on file. d forget it! Your membership will automatically renew each year

stay connected RUOY WENER with the PIHSREBMEM DEECCUS SREBMEM GNIPLEH

-RENEWAL:

rom a variety of monthly installment plans.

ENT PLAN:

ial 850.681.3629 to speak to our friendly membership team. urn blue envelope with statement and payment.

E EASY WAYS TO PAY:

nyL yworld esaCcan .rDbe a lonely place when you are isolated Thendental p i h s r e b m e M o liworking cnuoCdaily ADFin,arisingle ahC office. Leading from your colleaguesnand LF ,managing hcaeB oallo pA – tand sitnnavigating eD cirtaiadminefield eP a team, business of things outside of your control can be daunting sometimes! The good news is, the Florida Dental Association (FDA) can help with the day-to-day challenges as well as your overall career. Organized dentistry can be intimidating to those not involved, but the main thing we work on at the FDA is our members and how we can help them succeed. The FDA community is dedicated to helping our members in all aspects of dentistry.

The advocacy aspect of the FDA is one of the largest “silent” benefits our members have. Our team works tirelessly to make sure any legislative issues that can affect the dental profession are addressed, lobbied on and controlled before they affect members.

Each year, our team navigates the political world, and we make sure they advocate on your behalf!

isit floridadental.org/dues.

.syawlA .kcab ruoy evah eW

By Dr. Casey Lynn

3202 ROF !YADOT

I have been an FDA member since dental school, and proudly stay involved so I can have a seat at the table as a “younger” dentist.

It’s helped me stay connected, provided numerous opportuni-

:YAP OT SYAW YSAE EERHT

Dr. Casey Lynn Chair, FDA Council on Membership Pediatric Dentist – Apollo Beach, FL

ties to .sbetter eudmy /gcareer ro.land atfacilitated nedadtheirgrowth olf tiofsmy iVstartup : e n i l nO practice. All of which I feel are invaluable. For newer dentists, the career outlook is vastly different than our more seasoned memAre you looking to meet other dentists, build connections and . t n e m ya p d n a t n e m etIt’s atimperative s htiwthat epweoall lesupport vn e e uorganization lb nrutesoRwe:liaM bers. our open doors that can catapult your career? We have many netcan keep this amazing profession what it is, and work to make it working events designed to make this easy and fun. The FDA also an2 organization, we.0 make a significant .maeresources t pihstorehelp bm em ysucceed. ldneiOur rf ruo obetter t kaevery epsday.oAs t9 63.186 58 laiD :impact enohP provides numerous members on the future of our profession!

Member Benefits Guide is a one-stop shop to see everything the

EW YOUR BERSHIP 2023 AY!

We have your back. Always.

FDA has at your fingertips. If you have a question and can’t find For those looking to get a more in-depth look into what the FDA the answer online, call our headquarters in Tallahassee and our does, I recommend reaching out to any component of organized amazing team can connect you to the right resource! Some of the dentistry, as we are always looking for members who want to snalpintpublic nemlla tsni ylhtnom fo yteirav a morf esoohC biggest challenges facing our industry are not .discussed make a difference. For those who are not interested in dedicating forums. Difficult patients and a litigious world can lead to frivolous time or energy to the FDA, your membership has a powerful imcomplaints to the Board of Dentistry (BOD); as an FDA member, pact on what the organization can do for YOU and all our member Peer Review is available to help settle any issues before they get to dentists. Although many of us work in an isolated environment, the BOD — huge raa e y hbenefit caeforwany enpracticing er ylldentist. acitamotua lliw ihcan srhelp ebyou meconnect, m rumanage oY !tiyou tecareer groand f dTHRIVE. na ti teS the p FDA

:NALP TNEMYAP

:LAWENER-OTUA

Please contact me or anyone at the FDA if you have any questions .elif no tup uoy drac tiderc eht htiw or would like to get more involved.

35 | TODAY'S FDA november/december 2022

G MEMBERS SUCCEED

36

37 | TODAY'S FDA november/december 2022

VOLUNTEER FOR FLA-MOM 2023!

February 24-25, 2023 • West Palm Beach Expo Center at The South Florida Fairgrounds

THE FLORIDA MISSION OF MERCY

YOU CAN MAKE A DIFFERENCE!

Florida Mission of Mercy (FLA-MOM) is a large-scale, two-day, professional dental clinic that provides care to any patient at no cost, with the goal of serving the underserved and uninsured in Florida — those who would otherwise go without care.

Help us provide dental care to those in greatest need.

We need the following types of volunteers:  dentists, hygienists, dental assistants  dental lab technicians  physicians, nurses, EMTs

With a goal of treating 2,000 patients, FLA-MOM seeks to have a positive impact by providing important access to dental care.

 medical assessments of health history  vital signs  glucose testing  general community  patient and volunteer registration  patient escorts  interpreters  parking attendants and more!

Treatments offered at FLA-MOM include: cleanings, fillings, extractions, root canals, pediatric dentistry and limited dentures and partials.

SIGN UP TODAY AT FLAMOM.ORG 38

FDA Foundation

What’s Your Why? FDA Members Share Why They Give to the FDA Foundation

By FDA Foundation

“I volunteer [with the Florida Dental Association (FDA) Foundation] because the Florida Mission of Mercy (FLA-MOM) is a place where you use your greatest expertise and passion to provide the greatest gift to mankind,” shares Dr. Sam Elias, FDA member and FLA-MOM prosthodontics co-manager.

As the philanthropic arm of the FDA, the FDA Foundation brings member dentists together to provide dental care to the underserved and uninsured in Florida — those who would otherwise go without care.

With guidance from the FDA Foundation, members hearing the call to Give, Volunteer and Lead can best use their time and skills to provide quality dental care to those in need. FDA member donations, time and leadership help create the success of the FDA Foundation.

“I’m involved [in the FDA Foundation] to give back to those in need and to show that dental professionals have a giving heart!” said Dr. Terry Buckenheimer, FDA Foundation board treasurer and FLA-MOM consultant.

Give

Lead

Volunteer

Emerald Club Annual membership supports FDA Foundation programs.

•

Florida Mission of Mercy Annual two-day dental clinic with care provided at no cost for those in need.

•

FDA Foundation Board Serve on the Board of Directors or one of their committees.

Giving Tuesday Annual giving opportunity in November to support the FDA Foundation.

Donated Dental Services Provide care in your office for disabled, elderly or medically fragile patients who cannot afford treatment.

Florida Mission of Mercy Leadership Team

•

Planned Giving Pledge a donation in your estate plan or donate with an annual IRA distribution charitable donation.

•

•

• •

Volunteer to lead a committee or department on the FLA-MOM planning team.

Project: Dentists Care Volunteer at a local dental access clinic that provides preventive and restorative care.

•

FDA President Dr. Jerry Bird and his wife, Jerilyn, have been long-time FDA Foundation supporters and say, “Our why is to bless others!” The Birds have been involved in many FLA-MOM clinics and say that the clinic “is an amazing weekend spent blessing others and getting back more than you can imagine.”

“I volunteer at FLA-MOM because I am happy to use my skills and experience to help people that have difficulty affording dental care,” explains Dr. Julia German, who volunteers along with her husband, Dr. Igor German, and their two daughters. “I came to this country as a very poor immigrant from the former Union of Soviet Socialist Republics, and I had the privilege of studying at the University of Florida and learning my great profession.” t

39 | TODAY'S FDA november/december 2022

40

FDA Foundation Come and join the FDA Foundation with our call to action – Give, Volunteer and Lead – and discover your Why! As the philanthropic arm of the association, we are committed to promoting dental health for all Floridians, and our volunteers and donors help us make a difference in the lives of thousands of people each year. Former FDA Foundation president and longtime volunteer, Dr. Robert Payne, coined the phrase, “The FDA Foundation is the heart of the FDA.” Your support of the FDA Foundation is the beat that enables our “heart” to provide life-changing dental programs.

Please visit donate.floridadental.org to show your support today.

How Your Why Has an Impact in the Community 2022 Florida Mission of Mercy Patient Spotlight “First and foremost, I’d like to thank the staff and volunteers for their time, work and sincerity through the entire process. But even more than that, I’d like to thank them for fixing my smile, my oral health and restoring my confidence. I used to live every day in fear of judgment for my [previously] poor dental hygiene. It wasn’t only affecting me. I have three stepdaughters with beautiful smiles, and they were hiding their teeth in photos and at events because they’d watched me do it for so long. Now I’m not afraid to show them how to smile with their teeth and how beautiful it is. I no longer avoid talking, smiling or laughing so people won’t see my teeth. No longer will I have to stay up at night in throbbing pain due to tooth aches because I don’t have the insurance to take care of it. I feel like I didn’t just get my smile and confidence back, I got my life back. Thank you again.” – 2022 FLA-MOM patient

41 | TODAY'S FDA november/december 2022

FDA Foundation Grants Aid to 209 Florida Dentists

”

Thank you for your Recipients, including the dentist who gave the quote at the right, have been thanking the Florida Dental Association Foundation’s (FDAF) Emergency Disaster Assistance Program for grants that assist with immediate personal needs such as food, water, clothing, emergency shelter or medications.

quick assistance on

To date, in response to the impacts of Hurricane Ian, the FDAF has processed 209 applications for emergency disaster assistance and provided $313,500 in grant funds.

generosity of the

In addition to the negative effects of the storm — damage to practices and homes, loss of records and personal mementos, and more — it’s important to note the positive response.

Members of organized dentistry and others came together to offer support to Florida dentists hit by the hurricane through donations to the FDAF Emergency Disaster Assistance Program.

42

this matter.

I appreciate the FDA Foundation to support a member during this difficult time.

”

FDA Foundation Donations from individuals: $17,470

l

Louisiana Dental Association Foundation

Donations from FDA Components, other state dental associations and other entities: $149,000

l

Massachusetts Dental Society Foundation

l

Mississippi Dental Association

l

Alabama Dental Association Foundation

l

Missouri Dental Association Foundation

l

Arizona Dental Association

l

Missouri Dental Association

l

Atlantic Coast District Dental Association

l

Northeast District Dental Association

l

Brevard County Dental Association

l

New York State Dental Association

l

California Dental Association

l

Northeast Missouri Dental Society

l

Central Florida District Dental Association

l

Oklahoma Dental Relief & Disaster Grant Program

l

Florida Section – American College of Dentists

l

Pennsylvania Dental Foundation

l

Florida Section – International College of Dentists

l

South Carolina Dental Association

l

Henry Schein Cares

l

South Florida District Dental Association

l

Kansas Dental Charitable Foundation

l

Texas Dental Association

43 | TODAY'S FDA november/december 2022

florida dental association by the numbers!

OVERALL MEMBERSHIP .1%

.4%% 4%

.1% 73% 70

2% 2%

5.1% 6%

7% 11%

4%

12%

5% 2%

66%

BOARD OF TRUSTEES 6% PEDIATRIC

AF

ENDODONTICS

15% 12%

WH

IC AN

ITE

GENERAL

47%

AVERAGE AGE - 54 MEDIAN AGE - 54

28

PERIODONTICS HIS P

12%

ORTHODONTICS & DENTOFACIAL ORTHOPEDICS

N

9%

AN AMERICA RIC

AVERAGE YEARS IN PRACTICE

ORAL & MAXILLOFACIAL SURGERY

HOUSE OF DELEGATES 54%

73 %

8%

7%

6%

3%

OTHER

21

3%

44

3%

4%

7%

7%

11%

13%

NEED HELP WITH PATIENT COMPLAINTS? The Peer Review program is designed to help Florida Dental Association member dentists.

Avoid costly legal fees, malpractice suits and Board of Dentistry complaints by using this free service exclusively for members.

Learn more online at FloridaDental.org/PeerReview or by contacting FDA Peer Review Coordinator Lywanda Tucker at 850.350.7143 or ltucker@floridadental.org

45 | TODAY'S FDA november/december 2022

The Florida Dentist’s Guide to

Peer Review

”

By Renee Thompson, Director of Communications and Marketing

The Peer Review program is designed to help Florida Dental Association (FDA) member dentists avoid costly legal fees, malpractice suits and Board of Dentistry complaints.

Designed to assist members with resolution of patient disputes before they become lawsuits or complaints to the Florida Board of Dentistry (BOD), the FDA’s Peer Review program is an incredible member benefit that’s both free and confidential. The process can be initiated by a patient or an FDA member dentist.

FDA’s peer review coordinator, Lywanda Tucker, works with both the patient and the dentist to negotiate a compromise when there are differences in opinion about the care provided. If she is unable to successfully find a compromise, the case will be referred to the appropriate component peer review chair (a volunteer dentist) for additional mediation or a formal review.

The peer review process is not designed to handle every type of situation or problem that may arise between dentists and patients. Only cases involving problems with actual dental treatment and procedures are eligible. Cases not qualified for peer review include: those already in malpractice litigation; those already being investigated by the BOD; disputes that are only about dental fees; treatment that occurred more than 12 months before the

Thank you so much for your professionalism and handling of my recent peer review case. I greatly appreciate your responsiveness and patience while achieving an amicable result for all parties.

— Florida Dentist

”

patient’s last appointment; and cases involving nonmember dentists. The current peer review system is also not intended to handle a complaint initiated by one dentist against another.

Why Start with Mediation?

Mediation is the initial step in peer review and is one of the most important steps in the process. During mediation, the disputing parties, with the assistance of Ms. Tucker as a mediator, identify disputed issues, discuss alternative ways to resolve the issues, and

46

peer review potentially reach a settlement that is satisfactory to both parties.

If mediation is successful, cases are concluded at that stage and do not need to proceed on to formal peer review.

The crux of the mediator’s work is to help the parties think through the issues and generate ideas for resolving the dispute.

Ms. Tucker begins by gathering information about the dispute and asking each party to explain what the dispute is about in his or her own terms and hears each party’s initial position on the matter. Sometimes, it seems patients just want to be heard.

Even if there are differences in the versions of the events, it is not always necessary to resolve them. Ms. Tucker focuses more on finding out what needs each party wants to satisfy and how to best resolve the dispute. Ms. Tucker’s experience, dental knowledge and personality aid in problem-solving and finding compromise.

In fact, Ms. Tucker has more than 16 years of dentistry experience in varying positions including work at periodontal, general and orthodontic offices. She has been a chairside assistant, a treatment coordinator and a member of the front office staff.

This training and experience are of great benefit and allow her to properly conduct mediation as an impartial — but knowledgeable — third party. She works to establish communication, build trust and resolve problems expeditiously. Mediation can result in resolution of many cases initiated in the peer review system and can be a very valuable tool in resolving dental disputes.

A Brief History Peer review provides an impartial, easily accessible and generally expedient means for resolving misunderstandings regarding dental treatment. It benefits the patient and the dentist; however, it hasn’t always been in existence.

The American Dental Association (ADA) first established policy on peer review in 1970, with the adoption of the statement on Dental Society Review Committees. That statement outlined the purpose and functions of review committees and clearly specified that such committees were to be established for prepayment programs. Other committees, such as patient grievance, patient relations or patient counseling, dealt with disputes between patients and dentists.

FDA’s Peer Review Program:

 Maintains high dental standards.  Aids in mediation efforts.  Meets the needs of the public regarding the

quality and appropriateness of dental care.

 Assists parties in avoiding litigation.

Since its establishment in 1970, the peer review program has grown and changed through adoption of policies:

 1971 — peer review committees got the right to review radiographs and other treatment records.

 1972 — third parties were encouraged to use the peer review process.

 1973 — constituent societies were urged to seek statutory ex-

emption from civil damage liability for peer review committee members.

 1975 — the prerogative and duty of the dental profession to

conduct all necessary review of dental services through its established mechanisms, including peer review was acknowledged.

 1977 — the responsibilities for grievance and peer review

committees were combined under the auspices of a single “peer review committee.”

 1979 — constituent societies were urged to cooperate in the resolution of inter-jurisdictional cases.

 1980 — the Bylaws definition of member in good standing

was amended to include, among other things, cooperation with dental society peer review bodies.

 1987 — policies were revised to reflect the current practices in peer review and the changing nature of the various relationships that exist in the delivery of dental care.

Most of the remaining peer review policies were modified where necessary and incorporated into a statement, “Guidelines on the Structure, Functions and Limitations of the Peer Review Process.” t

47 | TODAY'S FDA november/december 2022

peer review For questions or additional information, please visit FloridaDental.org/PeerReview or contact Peer Review Coordinator Lywanda Tucker at 850.350.7143 or ltucker@floridadental.org.

That statement was revised and adopted in 1992, by the ADA House of Delegates.

Peer review continues to grow, change and improve. For example, in Florida, there was a shift to moving administrative duties to the FDA’s headquarters rather than at each of the components.

This was done, in part, to ensure consistency in intake of cases throughout the state. Having a qualified and trained staff person dedicated to peer review will benefit all members. And, parts of the process remain consistent with prior systems so cases will still be referred to the appropriate component peer review chairs as appropriate and necessary.

In all, peer review is a valuable tool to help FDA member dentists succeed.

Section 466.022(1), Florida Statutes, states (among other things) that “a professional organization or association of dentists which sponsors, sanctions, or otherwise operates or participates in peer review activities is hereby afforded the same privileges and immunities afforded to any member of a duly constituted medical review committee by s. 766.101(3).”

Section 766.101(3)(a), Florida Statutes, provides that “[t]here shall be no monetary liability on the part of, and no cause of action for damages shall arise against, any member of a duly appointed medical review committee, or any health care provider furnishing any information, including information concerning the prescribing of substances listed in s. 893.03(2), to such committee, or any person, including any person acting as a witness, incident reporter to, or investigator for, a medical review committee, for any act or proceeding undertaken or performed within the scope of the functions of any such committee if the committee member or health care provider acts without intentional fraud.” These statutory protections are intended to encourage good faith participation in the peer review process without fear of liability.

However, it is important to remember that records generated in the peer review process may be subject to disclosure in response to a subpoena or other legal process, and the original records (patient’s chart and dental records) and underlying facts of a matter submitted to peer review are almost always discoverable.

48

Peer Review Cards to Give to Patients Dentists are encouraged to have this card handy for front desk staff to give to patients who may be good candidates for Peer Review. Cut out these 10; print more at bit.ly/3UWTMRe.

Peer Review Coordinator Lywanda Tucker 850.350.7143 or ltucker@floridadental.org

One of the goals of Florida Dental Association (FDA) member dentists is to provide you – the patient – with personalized attention and the high-quality dental care. But, sometimes problems occur. If you cannot satisfactorily resolve an issue or believe your dentist has not provided the best quality care possible, thereCoordinator are options. YouLywanda may have the dispute Peer Review Tucker mediated through FDA’s Peer Review Program.

850.350.7143 or the ltucker@floridadental.org

One of the goa dentists is to attention and problems occ or believe y care possible mediated

One of the goals of Florida Dental Association (FDA) member dentists is to provide you – the patient – with personalized attention and the high-quality dental care. But, sometimes problems occur. If you cannot satisfactorily resolve an issue or believe your dentist has not provided the best quality care possible, thereCoordinator are options. You may have the dispute Peer Review Lywanda Tucker mediated through FDA’s Peer Review Program.

850.350.7143 or the ltucker@floridadental.org

850.350.7143 or ltucker@floridadental.org

One of of the the goals goals of of Florida Florida Dental Dental Association Association (FDA) (FDA) member member One dentists is is to to provide provide you you –– the the patient patient –– with with personalized personalized dentists attention and and the the high-quality high-quality dental dental care. care. But, But, sometimes sometimes attention problems occur. If you cannot satisfactorily resolve an issue or believe believe your your dentist dentist has has not not provided provided the the best best quality quality or care possible, thereCoordinator are options. options. You You may have have the the dispute care possible, there are may dispute Peer Review Lywanda Tucker mediated through the FDA’s Peer Review Program.

850.350.7143 or ltucker@floridadental.org

One of the goa dentists is to attention and problems occ or believe y care possible mediated

One of the goals of Florida Dental Association (FDA) member dentists is to provide you – the patient – with personalized attention and the high-quality dental care. But, sometimes problems occur. If you cannot satisfactorily resolve an issue or believe your dentist has not provided the best quality Peer Review Tucker care possible, thereCoordinator are options. YouLywanda may have the dispute mediated through the FDA’s Peer Review Program.

850.350.7143 or ltucker@floridadental.org

One of the goals of Florida Dental Association (FDA) member dentists is is to to provide provide you you –– the the patient patient –– with with personalized personalized dentists attention and the high-quality dental care. But, sometimes problems occur. occur. IfIf you you cannot cannot satisfactorily satisfactorily resolve resolve an an issue issue problems or believe believe your your dentist dentist has has not not provided provided the the best best quality quality or care possible, thereCoordinator are options. YouLywanda may have the dispute Peer Review Tucker mediated through the FDA’s Peer Review Program. mediated through the FDA’s Peer Review Program.

850.350.7143 or ltucker@floridadental.org

One of the goa dentists is to attention and problems occ or believe y care possible mediated

One of the goals of Florida Dental Association (FDA) member dentists is to provide you – the patient – with personalized attention and the high-quality dental care. But, sometimes problems occur. If you cannot satisfactorily resolve an issue or believe your dentist has not provided the best quality care possible, thereCoordinator are options. You may have the dispute Peer Review Lywanda Tucker mediated through FDA’s Peer Review Program.

850.350.7143 or the ltucker@floridadental.org

850.350.7143 or ltucker@floridadental.org

One of of the the goals goals of of Florida Florida Dental Dental Association Association (FDA) (FDA) member member One dentists is is to to provide provide you you –– the the patient patient –– with with personalized personalized dentists attention and and the the high-quality high-quality dental dental care. care. But, But, sometimes sometimes attention problems occur. occur. IfIf you you cannot cannot satisfactorily satisfactorily resolve resolve an an issue issue problems or believe your dentist has not provided the best quality care possible, thereCoordinator are options. options. You You may have have the the dispute care possible, there are may dispute Peer Review Lywanda Tucker mediated through through the FDA’s Peer Peer Review Review Program.

Program. mediated FDA’s 850.350.7143 orthe ltucker@floridadental.org

One of the goa dentists is to attention and problems occ or believe y care possible mediated

One of the goals of Florida Dental Association (FDA) member dentists is to provide you – the patient – with personalized attention and the high-quality dental care. But, sometimes problems occur. If you cannot satisfactorily resolve an issue or believe your dentist has not provided the best quality care possible, thereCoordinator are options. You may have the dispute Peer Review Lywanda Tucker mediated through FDA’s Peer Review Program.

850.350.7143 or the ltucker@floridadental.org

One of the goals of Florida Dental Association (FDA) member dentists is to provide you – the patient – with personalized attention and the high-quality dental care. But, sometimes problems occur. If you cannot satisfactorily resolve an issue or believe your dentist has not provided the best quality care possible, thereCoordinator are options. You may have the dispute Peer Review Lywanda Tucker mediated through FDA’s Peer Review Program.

850.350.7143 or the ltucker@floridadental.org

850.350.7143 or ltucker@floridadental.org

850.350.7143 or ltucker@floridadental.org

49 | TODAY'S FDA november/december 2022

peer review

One of the goals of Florida Dental Association (FDA) member dentists is to provide you – the patient – with personalized attention and the high-quality dental care. But, sometimes problems occur. If you cannot satisfactorily resolve an issue or believe your dentist has not provided the best quality care possible, there are options. You may have the dispute mediated through the FDA’s Peer Review Program.

One of the goals of Florida Dental Association (FDA) member dentists is to provide you – the patient – with personalized attention and the high-quality dental care. But, sometimes problems occur. If you cannot satisfactorily resolve an issue or believe your dentist has not provided the best quality care possible, there are options. You may have the dispute Peer Review Coordinator Lywanda Tucker mediated through the FDA’s Peer Review Program.

850.350.7143 or ltucker@floridadental.org

One of the goal dentists is to p attention and t problems occu or believe you care possible, Peer Revi mediated 850.350.7

One of of the the goals goals of of Florida Florida Dental Dental Association Association (FDA) (FDA) member member One dentists is is to to provide provide you you –– the the patient patient –– with with personalized personalized dentists attention and and the the high-quality high-quality dental dental care. care. But, But, sometimes sometimes attention problems occur.

If you cannot satisfactorily resolve an issue issue problems occur. If you cannot satisfactorily resolve an or believe believe your your dentist dentist has has not not provided provided the the best best quality quality or care possible, possible, there there are are options. options. You You may may have have the the dispute dispute care mediated through through the the FDA’s FDA’s Peer Peer Review Review Program.

Program. mediated

One of of the the goals goals of of Florida Florida Dental Dental Association Association (FDA) (FDA) member member One dentists is is to to provide provide you you –– the the patient patient –– with with personalized personalized dentists attention and and the the high-quality high-quality dental dental care. care. But, But, sometimes sometimes attention problems occur. occur. IfIf you you cannot cannot satisfactorily satisfactorily resolve resolve an an issue issue problems or believe believe your your dentist dentist has has not not provided provided the the best best quality quality or care possible, there are options. options. You You may have have the the dispute care possible, there are may dispute Peer Review Coordinator Lywanda Tucker mediated through through the the FDA’s FDA’s Peer Peer Review Review Program.

Program. mediated

850.350.7143 or ltucker@floridadental.org

One of the goal dentists is to p attention and t problems occu or believe you care possible, Peer Revi mediated 850.350.7

One of of the the goals goals of of Florida Florida Dental Dental Association Association (FDA) (FDA) member member One dentists is is to to provide provide you you –– the the patient patient –– with with personalized personalized dentists attention and and the the high-quality high-quality dental dental care. care. But, But, sometimes sometimes attention problems occur. occur. IfIf you you cannot cannot satisfactorily satisfactorily resolve resolve an an issue issue problems or believe believe your your dentist dentist has has not not provided provided the the best best quality quality or care possible, possible, there there are are options. options. You You may may have have the the dispute dispute care mediated through through the the FDA’s FDA’s Peer Peer Review Review Program.

Program. mediated

One of of the the goals goals of of Florida Florida Dental Dental Association Association (FDA) (FDA) member member One dentists is is to to provide provide you you –– the the patient patient –– with with personalized personalized dentists attention and and the the high-quality high-quality dental dental care. care. But, But, sometimes sometimes attention problems occur. occur. IfIf you you cannot cannot satisfactorily satisfactorily resolve resolve an an issue issue problems or believe believe your your dentist dentist has has not not provided provided the the best best quality quality or care possible, there are options. options. You You may have have the the dispute Peer Review Coordinator Lywanda Tucker care possible, there are may dispute mediated through through the the FDA’s FDA’s Peer Peer Review Review Program.

Program. mediated

850.350.7143 or ltucker@floridadental.org

One of the goal dentists is to p attention and t problems occu or believe you care possible, Peer Revi mediated 850.350.7

One of of the the goals goals of of Florida Florida Dental Dental Association Association (FDA) (FDA) member member One dentists is is to to provide provide you you –– the the patient patient –– with with personalized personalized dentists attention and and the the high-quality high-quality dental dental care. care. But, But, sometimes sometimes attention problems occur. occur. IfIf you you cannot cannot satisfactorily satisfactorily resolve resolve an an issue issue problems or believe believe your your dentist dentist has has not not provided provided the the best best quality quality or care possible, possible, there there are are options. options. You You may may have have the the dispute dispute care mediated through through the the FDA’s FDA’s Peer Peer Review Review Program.

Program. mediated

One of of the the goals goals of of Florida Florida Dental Dental Association Association (FDA) (FDA) member member One dentists is is to to provide provide you you –– the the patient patient –– with with personalized personalized dentists attention and and the the high-quality high-quality dental dental care. care. But, But, sometimes sometimes attention problems occur. occur. IfIf you you cannot cannot satisfactorily satisfactorily resolve resolve an an issue issue problems or believe believe your your dentist dentist has has not not provided provided the the best best quality quality or care possible, there are options. options. You You may have have the the dispute care possible, there are may dispute Peer Review Coordinator Lywanda Tucker mediated through through the FDA’s Peer Peer Review Review Program.

Program. mediated FDA’s 850.350.7143 or the ltucker@floridadental.org

One of the goal dentists is to p attention and t problems occu or believe you care possible, Peer Revi mediated 850.350.7

One of the goals of Florida Dental Association (FDA) member dentists is to provide you – the patient – with personalized attention and the high-quality dental care. But, sometimes problems occur. If you cannot satisfactorily resolve an issue or believe your dentist has not provided the best quality care possible, there are options. You may have the dispute mediated through the FDA’s Peer Review Program.

One of the goals of Florida Dental Association (FDA) member dentists is to provide you – the patient – with personalized attention and the high-quality dental care. But, sometimes problems occur. If you cannot satisfactorily resolve an issue or believe your dentist has not provided the best quality care possible, there are options. You may have the dispute mediated through the FDA’s Peer Review Program.

50

peer review

Peer Review Case Studies Case Study #1:

Case Study #3:

A patient called and wanted to file a complaint against a dentist he saw in 2021 to have a crown replaced that fell off a front tooth.

Patient was told the crown could not be saved and it would have to be replaced with a new crown. According to the patient, the tooth was filed down too much when being prepped for the first crown and a new crown. The permanent crown later fell off again and this time there was not enough tooth left for another crown.

The tooth had to be extracted. The patient went to another dentist and had treatment and wanted to receive a refund from the previous dentist.

A patient called and stated she went to a dentist to have two lower implants placed for permanent dentures. According to the patient, the implants were causing her a lot of discomfort and the permanent dentures would not fit. The patient went for a second opinion and was told that one of the implants had not been placed directly in the bone; it was in the gum and had to be extracted.

Peer Review Results: The case was forwarded to the peer review chair dentist for the patient’s area since the case was not able to be resolved with simple mediation. Upon full review of all records and talking to both the patient and the treating dentist, the case was closed.

The treating dentist had done everything within the standard of care and the patient was looking for a refund since he needed to have additional treatment for the tooth. Case Closed!

Case Study #2: A patient called to file a complaint about an FDA member dentist whom she said had done a filing for her that later came out. The patient stated she’d already spoken to the dentist about a refund, and he agreed to refund her, but she wanted to file a complaint about the amount to be refunded. The patient sent in her statement from the dental office.

Peer Review Results: Peer Review Coordinator Lywanda Tucker called and spoke with the treating dentist about the patient’s complaint. He agreed to refund the patient and wanted to know the amount to refund her. After looking over the patient’s statement the dentist agreed to refund her the amount she paid out of pocket as well as her insurance. Case Closed!

Peer Review Results: Peer Review Coordinator Lywanda Tucker called and spoke with the treating dentist to discuss the complaint and he agreed to refund the patient. No need for a more formal complaint with the Florida Board of Dentistry or a lawsuit. Case Closed!

Case Study #4: A patient called and stated that she went in for treatment, but had a lot of discomfort and temporary crowns keep breaking. The patient went to another dentist to have a second opinion and decided to have treatment with him. The previous dentist refunded the patient the amount she paid for the permanent crowns but, the patient wanted more to cover the expenses she’d accrued with the current dentist.

Peer Review Results: After speaking with the dentist about the complaint, Peer Review Coordinator Lywanda Tucker determined that the dentist had already refunded the patient. The patient understood, but was insisting that she should have received more from the treating dentist. Ms. Tucker forwarded the case to the peer review chair doctor for the patient’s area. After looking over the records and speaking to both the patient and the dentist, the peer review chair doctor decided that the refund the patient received was sufficient for what she had paid out. Case Closed!

51 | TODAY'S FDA november/december 2022

peer review

Peer Review is Simple

By Hugh Wunderlich, DDS, CDE, FDA Editor

The Florida Dental Association (FDA) basically provides you with a liaison to navigate the process. It’s fair. It’s free and it’s the finest FDA benefit. Oh, not a member of the FDA? The next three pages give you some insight to the legal morass you might be facing. I mean it’s only your license! Join the FDA. We are here to help YOU succeed!

Division of Medical Quality Assurance Enforcement Process Citation Issued

Non Disputed Final Order

Disputed

Complaint

Department

Mediation

Complaint Closed

Investigation Probable Cause

Prosecution Attorney Review

Findings:

Formal Hearing Before DOAH (Contest Charges)

Informal Hearing Before Board (No Dispute)

State Surgeon General Review and Signature

Case Disposition No Probable Cause Found

Probable Cause Found

Dismissal/ Closure

Administrative Complaint Filed With Department of Health

Compliance Management (CMU) Courts of Appeal Confidential Public

Appeal Procedures To District Courts of Appeal

Prosecution

Draft Emergency Action

Mediation

State Surgeon General Boards

Closure/Referral to other agencies as Non-Jurisdictional OR Closure as legally Non-sufficient Receipt and Analysis

Consumer Services (CSU) Investigative Services (ISU) Prosecution Services (PSU)

Compliance Monitoring

Final Order Imposing Discipline Filed with Department of Health

Hearing Waived Before Board (No Dispute) Election of Rights by License

Settlement by Licensee to Board for Approval

Full Board Action and Disposition Settlement Rejected

Revised 11/2019

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peer review A Quick Guide to the MQA Disciplinary Process Probable Cause Panels The division of Medical Quality Assurance’s (MQA) Bureau of Enforcement fields and investigates complaints against health care practitioners and facilities/establishments regulated by the Florida Department of Health.

The path of a complaint:

• • •

•

Consumer Services Unit (CSU): Where the complaint process begins.

Investigative Services Unit (ISU). Legally sufficient complaints are forwarded here.

Prosecution Services Unit (PSU). Conducts legal review of ISU-generated investigative reports.

Probable Cause Panel. Determines what becomes of the case.

Cases are ultimately decided by a Probable Cause Panel (PCP). It is not bound to go along with the recommendation PSU attorneys give upon legal review. *456.073(2) & 456.073(4), Florida Statutes A Probable Cause Panel…

• • •

reviews all evidence and information gathered during the investigation. is made up of 2 or 3 board members – usually 1 or 2 licensed health care professionals and a consumer member. (*A consumer member represents the public interest. He or she does not necessarily have specialized medical knowledge/training and does not practice medicine.) can feature different members from meeting to meeting.

The PCP will issue one of the following recommendations: (1) Escalation to the Formal Administrative Complaint phase. (2) Closure, with a letter of guidance (3) Dismissal.

FAST FACTS Florida Statutes outline the parameters by which probable cause panels operate, especially its strict disclosure policy. (Example: The only time a case will be made public is if an administrative complaint is approved by the PCP – 10 days after such a finding.) *456.073(10)

1

True or False?: The person(s) whose complaint initiated an investigation of a health care professional is given unlimited access to the PCP and its conducting of official business.

2

True or False?: The licensee whom the complaint was filed against has the overriding expectation of confidentiality.

Answer: False. Even the complainant in the case is not privy to what happens at PCP meetings. Furthermore, he or she cannot sit in on PCP discussions, receive transcripts of the proceedingsor obtain copies of the case evidence presented. *456.073(9)(a),(b), and (c)

Answer: True. If a case is closed without an administrative complaint being issued – either with a letter of guidance or a regular dismissal ‒ no one gets to know anything about it, including who was on the PCP or what the alleged violation was. That is, unless, the licensee waives his/her right, in writing, to keep everything confidential. *456.073(10)

53 | TODAY'S FDA november/december 2022

peer review A Quick Guide to the MQA Disciplinary Process Discretionary Emergency Orders – 3 Things to Know

1

The Emergency Action process is applicable to any licensed Florida health care professional who poses an immediate, serious danger to the public health, safety or welfare. *456.073(8); 120.60(6), Florida Statutes • •

What that means: Immediacy is necessary. If an incident occurred too long ago to be considered immediate anymore, it will not qualify for Emergency Action. (Determination of “too long ago” is made on a case-by-case basis.)

The allegation(s) need to rise to a sufficient level of seriousness to warrant the emergency order.

Emergency Restriction Orders (EROs) and Emergency Suspension Orders (ESOs) are exclusively issued by the State Surgeon General. As with Probable Cause Panels, the Surgeon General can either accept or disregard the preceding investigation-based recommendation made by Prosecution Services Unit attorneys.

2

In addition to immediacy, the DOH is only permitted to use the “least restrictive means” to stop the danger. *120.60(6)(b)

What that means: The Emergency Action must be in line with what danger is posed to the public – whether it be just a portion, or, the public as a whole. (Example: If a male licensee accused of sexual misconduct against females will only be restricted to not treating females.)

The distinction between orders: • ESOs – For licensees deemed to be a threat to the public at large • EROs – For licensees considered a threat to a segment of the population

The Emergency Order process is carried out without a hearing. Restricting someone’s right to work without the benefit of a hearing, the balancing act dictated by appellate law calls for it be done by the least restrictive means.

3

An ESO or ERO is not considered final agency action.

•

•

What that means: Orders can be appealed within 30 days of issuance. The appeal can play out while the normal disciplinary process – toward administrative complaint and regular prosecution – runs its course. *120.60(6)(c) The accused health care practitioner is entitled to a hearing before final action is taken by a regulatory board or by the Department of Health. He or she can request an expedited full evidentiary hearing, which requires the presentation of evidence that is admissible in court and witnesses to testify to prove the alleged violation.

•

Complaints have to be filed within 20 days of an ERO/ESO – *Rule 28-106.501(3), Florida Administrative Code.

The violation posing the public danger must be a viable charge listed under the Practice Acts or the rules regulating the Department of Health, including: commission of crimes; violations of standards of care; drug use Page 1 / impairment; drug diversion; sexual misconduct; and student loan defaults.

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55 | TODAY'S FDA november/december 2022

By Larry Darnell, Director of Information Systems

”

So, You Want to Buy a New Computer?

I hear you. You are a dentist — a highly educated professional who works with a lot of technology day in and day out at your practice. So buying a new computer/laptop should be easy for you, right?

Despite what

I just participated in Amazon Prime Days. It is like Black Friday sales a month early. You know what I never buy on like Black Friday or Amazon Prime Days? Computers/laptops. Why? For the most part, retailers will put models andseems features on ridiculous sales that have almost none of the features you really want or need. However, who can turn down light-speed a $300 laptop though, right?

development,

I call this time of the year silly season for technology because you have people who want a new “something”, and you mostly have retailers who want to sell you the technology they cannot sell at other times of the year. It isnewer a match made in technology heaven.

is not

always better.

Let me ask you a few questions and provide you with some suggestions that can help you make wise purchases (or even no purchase) at this time of year.

No need for the

First, who is this computer/laptop for? Will it need to be mobile — like travel with you? That rules out a desktop. In pricy fact, I will say there are very few specific cases where a desktop is going to be the best option because laptops and even tablets are just as powerful as desktops these days.

upgrade.

Next, are you tied to a particular brand or maker of a device? If you are an Apple user (like an iPhone), MacBooks and iPads make great options to buy. Why? Because information can so easily be shared between them with built-in apps.

56

”

technology Likewise, if you are an Android or Google user, there are options that work well in that arena, too. I would caution you to steer clear of a Chromebook unless you only want it for limited Internet access. Chromebooks are single-purpose laptops with limited power and functionality but are also very cheap.

On occasion, a Microsoft Surface might be a good option no matter the phone you use because it is like a hybrid laptop/ tablet that works on the familiar Microsoft Windows operating system. Familiar is good.

The other thing you will notice is a dizzying array of features, acronyms, and letter/number combinations. Here is an actual advertisement on Amazon for a $650 laptop: 2022 Newest HP 17.3” HD+ Display Laptop, 11th Gen Intel Core i3-1115G4 (Up to 4.1GHz, Beat i5-1030G7), 16GB DDR4 RAM, 1TB PCIe SSD, Bluetooth, HDMI, Webcam, Windows 11, Silver, w/ 3in1 Accessories.

Let’s break that down. Intel Core I3 is an older and slower processor (even an 11th generation one); you want I5, I7 or I9, the higher the number the better. 17.3-inch screen means it could be monstrously heavy for a laptop. Check the weight if you want it to be portable.

16GB of RAM should be a standard today. You might get by with 8 or 12, but you will want more in a laptop than that. RAM is where the work on a computer can bog down. A 1 Terabyte (TB) SSD is a solid-state drive which is really good. The drive is where you store your applications and data. 1 TB is 1024 GB (Gigabytes). Most of your cheaper models will push a 256 GB SSD which is NEVER enough.

If you are buying a desktop/laptop, you want Windows 11.

Most of the other features listed come standard on just about anything you buy. You definitely want to pay attention to the number and types of ports like USB, HDMI and other video ports. In my opinion, this laptop is worth $400 not $650.

If you are wanting to purchase a desktop or laptop, here are some suggestions to follow.

1.

Go look at what you are interested in at a store locally. Want to buy a computer/tablet/laptop/phone, you name it? Go get the look and feel at the store. You do not have to buy it there. Anytime I go to a city with an Apple store, I go in and put my hands on all the test models. Best Buy and club warehouses have the ability for you to test out anything, so do it. Find what you like.

Make a note of it and the features. Take a picture of the specs with your fancy phone…that’s what it’s for. Then shop around both in stores and on the Internet paying close attention to get the specs and features you want for the price you want too.

2.

Is the extended warranty or Geek Squad stuff worth it? Probably not, but it depends on your level of expertise. I get AppleCare on my phone because a lot of bad things can happen with a phone. My laptops? Never.

3.

If you are shopping online, make sure it is with a reputable retailer. On Amazon, look at the stars, read a few customer reviews and be careful of some 3rd party resellers. Doing so might save you some headaches later.

4.

Despite what seems like light-speed development, newer is not always better. Case in point, except for the camera, an iPhone 13 is just like an iPhone 14. No need for the pricy upgrade. Wait for the iPhone 16 to get more value for your money.

5.

I also tend not to purchase really off-brand of technology.

Generic may work for groceries but it’s not as helpful with technology. It really comes down to service and support after you have made the purchase. The off-brands may not provide you with the best options here. Sometimes you really do get what you paid for.

6.

Be critical of those things that are put on sale at the high-pressure times of the year. The only exception I might make to that is back-to-school sales because good deals can be found then, but they are usually found at office supply stores not big box retailers or online.

7.

Most computer people like me will also never buy from certain manufacturers. Often that is based on personal experience.

I have a list just like that. I do not care if they are giving them away, I am not taking it. Making the wrong decision can have long-term consequences so do some research. Be patient.

What seems like the best deal today will likely be available again.

Happy computer/laptop shopping. As a guy who just properly disposed of 15 years’ worth of old computers/laptops, it pays to pay more, take your time, and get what you want/need the first time.

57 | TODAY'S FDA november/december 2022

Go Back-to-school for Radiography

Certification

Education opens so many doors and can help people grow personally, in their careers and in their earning capacities.

Dental assistants can join the back-to-school movement by seeking certification in radiography. The easiest way to become certified to expose radiographs is to take the Florida Dental Association’s (FDA) online radiography training course.

Why is it easy? l It’s completely online! You can study at your conveC A L L I N G nience, at home or in the office, on a desktop, tablet or smartphone, any time, any day, and for as long as you want. l No travel, no classroom, no health risks. l Enroll at any time and work at your own pace.

purchase and assign vouchers to staff members. The dental assistant who is to take the training receives a “welcome” e-mail and can create an account and get started learning right away.

About the course The training consists of nine modules, each with a quiz to test the student’s learning in preparation for the final test.

The final test covers the online course material and must be passed. Multiple retries are permitted. After the test is A L L D E N T A L A S S I S T A N T S passed, the dental assistant must expose a series of full-mouth radiographs, including four bitewings, with no more than five retakes permitted. The radiograph exposures must be under the direct supervision of the dentist.

Final steps

When the online coursework is complete, the test is passed and the full-mouth radiographs have been taken and approved, the supervising dentist logs back F O R Y O U R D E N TA L T E A M into his or her account and signs l Once you’ve earned your FDA off on the student’s certification. A cerradiography certificate, you simply tificate of completion is produced, which apply to the state of Florida for your can be printed. The dental assistant then applies license. Once licensed, you will have new skills to the state of Florida to be licensed to take radiographs. to contribute to your team, greater job satisfaction and Once the state approves the application, radiographs can be more diverse tasks. exposed under the general supervision of a dentist. l It’s affordable for your employer. Online tuition is only $285 for FDA member dentists.

TRAINED How to get started RAPHY? A dentist who wishes to make the FDA’s radiography training available to employees first needs to create an account at O FIXmydentalradiography.com/FDA THAT. and complete a short tu-

This training is also available to dentists who are not members of the FDA. The cost for non-member dentists is $385 per voucher. This is still another way that FDA members receive value for their membership.

torial that explains the supervising dentists’ responsibilities.

By state law, only dentists without any current or historical For more information about the radiography program, licensing actions are allowed to be supervising dentists for contact the FDA at 850.350.7114 and speak with Lywanda this training. When the tutorial is completed, the supervisTucker or email her at ltucker@floridadental.org. ing dentist is assigned an identificationHow’s number and this for an can amazing back-to-school experience for your staff? No travel. No time away from work. They train

RADIOGRAPHY TRAINING THAT MAKES BACK TO SCHOOL COOL AGAIN online, at their own pace. The Florida Dental Association (FDA) Online Radiography Training Program provides your team the formal training they need, with the professional development they want. Enrich career paths while contributing

58 a vital service to your patients and dental team. It’s the most convenient and economical way to get the radiography training required by Florida law. It’s affordably priced, too — just $285 per student* for FDA members!

C A L L I N G

A L L

D E N T A L

A S S I S T A N T S

F O R Y O U R D E N TA L T E A M

RADIOGRAPHY TRAINING THAT MAKES BACK TO SCHOOL COOL AGAIN How’s this for an amazing back-to-school experience for your staff? No travel. No time away from work. They train online, at their own pace. The Florida Dental Association (FDA) Online Radiography Training Program provides your team the formal training they need, with the professional development they want. Enrich career paths while contributing a vital service to your patients and dental team. It’s the most convenient and economical way to get the radiography training required by Florida law. It’s affordably priced, too — just $285 per student* for FDA members!

*Non-members pay $385.

59 | TODAY'S FDA november/december 2022

LEADERS EMERGING AMONG DENTISTRY

LEAD JAN. 20, 2023 • TAMPA, FLORIDA

An organization’s ability to thrive is largely determined by the quality and effectiveness of its leadership.

Great leaders can create tremendous success, but leadership skills don’t always come naturally.

At the Florida Dental Association we believe that great leaders are developed through learned skills and practices. LEAD, Leaders Emerging Among Dentistry, is an FDA program that provides participants with training to enhance leadership and interpersonal skills as well as a backstage pass to FDA offerings and experiences. LEAD features speakers from around the country with a focus on providing ideas and tools to help member dentists succeed in their leadership pursuits.

LEARN MORE AND REGISTER AT FLORIDADENTAL.ORG/LEAD

Highlighting FDA’s Event for Leaders Emerging Among Dentistry

By Angela McNeight, DMD, MS, Leadership Development Committee Chair

The Leadership Development Committee of the Florida Dental Association (FDA) is excited to announce its annual Leaders Emerging Among Dentistry (LEAD) event taking place Friday, Jan. 20, 2023, at the Tampa Airport Marriott. This half-day program, from 1-5 p.m., provides leadership training to enhance your abilities and interpersonal skills to help you become a stronger leader in your practice and your community. The first half of the program will focus on discovering your communica-

60

lead event

tion style and conflict resolution through interactive leadership coaching by renown leadership consultant, Velma Knowles.

She will provide a new perspective on your communication style and give tools to adapt your style for greater connection, leading to greater team collaboration and increase in employee morale. The second half of the LEAD event will include interactive, round-table discussions focused on real-life leadership challenges and current trends in the dental landscape. The day will also be sprinkled with informational presentations on FDA governance, advocacy and Foundation programs to share what is being done at all levels of the organization.

So, you’ve been to leadership events before and you’ve received training on some of the above-mentioned topics, and you may be thinking … why should I go to this particular event? What makes this event different? While all methods of self-improvement should be applauded, the fact remains that leaders change over time. As you grow in your practice and become more confident in your leadership skills, it is important to re-evaluate your strengths and receive additional training on areas of your skill set that may be a struggle. As much as leaders change, teams and their needs change as well. The challenges dentists face today are different than the challenges faced even a few years ago. Through the self-reflection and goal-setting portions of this event, you will receive tangible skills that you can incorporate into your day-to-day life. Investing time in yourself will bring invaluable insight to your interactions with your team, your community and your colleagues. After the event, attendees have the opportunity to attend a leadership reception with FDA House of Delegates members to network and learn more about the behind-the-scenes of the FDA. If you are looking to get more involved in dental leadership, become a more effective leader, or just learn more about organized dentistry, this is the event for you. LEAD is a free event for FDA member dentists as well as Florida dental students. The FDA has a limited number of grants available to assist with travel costs. For more information, access to the hotel room block, and to register, please visit floridadental.org/lead.

”

Registration is limited to the first 50 registrants.

If you are looking to get more involved in dental leadership, become a more effective leader, or just learn more about organized dentistry, this is the event for you.

61 | TODAY'S FDA november/december 2022

Employment

Agreements/Contracts reasonable about to whom you send you lab cases. Many times, there will be a daily minimum guarantee as well. Sometimes that guarantee go es away after 90 days. You may be able to negotiate this, but keep in mind that you will have to be able to earn your keep and if you are consistently producing less than your minimum, you will probably be looking for another job.

By Tim Marshall, DDS, MBA

You’ve successfully graduated and passed your boards – what’s next? For many of you, it’s getting that first job out of dental school. Almost all those jobs will involve an employment agreement of some kind. The first question that should come to mind is – “What should I expect?” In truth, most employment contracts are 90% boilerplate – meaning it is standard wording that will appear in every contract. The major elements are as follows:

Notice – Usually the contracts require a 30-day notice. Trying to negotiate a lesser time frame will raise alarm bells for the employer. Remember that if you decide to leave, the employer will need time to find a replacement and you should allow time to finish your cases.

Restrictive Covenant – Basically this will have two elements: time and distance. The typical time is two years, the distance will vary depending on the practice location. If you are in a high-density urban area, it could be one to three miles; if you are in a suburban area, it could be three to five miles. This is something that you may be able to negotiate a bit, but you will have something in place.

Non-Solicitation – This is an absolute. No negotiation here.

Basically, it says that you cannot solicit staff nor patients directly if you leave the practice.

Benefits – Things like insurance (health, malpractice, life, disability), continuing education, paid rime off, etc. Keep in mind that if your employer is supplying malpractice, when you leave, you will be responsible for purchasing “tail” insurance. Although you may be tempted to try to negotiate here, many of the benefits are covered by federal regulations (ERISA) and, as such, must be the same for everyone. Doesn’t hurt to ask, but don’t be disappointed if there is no room here for negotiation Compensation – This is the most important part. Usually, it is a percentage of collection calculated on a monthly basis. Many also include a deduction for lab fees incurred. An example would be 30% collection, less 30% lab fees. The reason for the lab fees is to ensure that you have some skin in the game and won’t be un-

62

Attorneys – Many of you will want an attorney to look over the contract before signing. There are two important things to note.

One is that the contract will be weighted in favor of the employer.

The reason for this is that all you have to lose is your job; your employer could, in theory, lose the practice. So, please remember that when your attorney tells you that the contract is not in your favor. Second, it is important that if you use an attorney you choose someone who has experience in health care employment agreements. An attorney that does real estate closings and wills is not a good choice. Ask the FDA for help and guidance with this.

In order to have a good experience after signing on, it is vitally important to keep the lines of communication open. Be sure to ask whom you speak with if you have any questions and/or problems.

Everyone involved wants the experience to be a positive one, so open and constructive communication is vital. Almost all problems are the result of misunderstandings or miscommunication.

Being aware of that will make your first employment experience a positive one.

Bryan T. Marshall, DDS, MBA is currently the CEO of Pioneer Dental Services based in Denver, CO. He has served as Chief Dental Officer for several Regional DSO’s throughout the United States. Dr. Marshall also served as a past FDA treasure. He can be reached at btmarshall@msn.com.

63 | TODAY'S FDA november/december 2022

tdsc

The Dentists Supply Company: Dental Supplies as a Member Benefit

Monitoring Your Supply Overhead

By Madison Schwarz, MBA

When the Florida Dental Association (FDA) was looking for innovative ways to help its members be more competitive and efficient in the business side of dentistry, they found TDSC. com. The FDA’s group purchasing partnership provides members with dental practices of every size competitive prices on supplies from leading brands. Additionally, TDSC.com equips its shoppers with:

Each and every day, shoppers at TDSC.com can save 24% on supplies; however, members of the Florida Dental Association save an additional 7% more on average, equating to greater than 31% savings on supply spends. Additional benefits to members of organized dentistry include: l Competitive pricing on dental supplies. l Free shipping on orders more than $99.

l Savings guides that act as your own personal formulary.

l Next day delivery on over 95% of in-stock items*.

l A dental supply overhead calculator to help you stick to your budget.

l Commitment to supporting state dental associations.

l Ability to create shopping lists and save favorite items. l An educational blog to keep shoppers up to date on trends and best practices.

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Why Shop at TDSC.com?

Florida dentists and their staffs can save time by shopping at their convenience 24/7 with TDSC.com and there is no need to negotiate. TDSC.com offers supplies at competitive prices to all dental practices – large or small. New dentists can take advantage of great prices, even if they’ve just opened their practice.

Supply pricing can be confusing. We practice price transparency so it’s easy to see the price you’ll pay with TDSC.com.

TDSC.com offers additional savings opportunities for all customers throughout the year with promotional events.

Whether it’s a Flash Deal or Sitewide Event, dental practices will have the option to save even more. Sign-up for our emails to learn about all the promotional events when you create an account.

TDSC.com makes it easy to buy dental supplies online and receive them quickly, too. With next-day delivery* on leading brands, you can feel confident in knowing your products will arrive fast!

Visit TDSC.com to see for yourself!

Our wide selection of products is consistently growing. TDSC. com has recently added a larger variety of lasers, sterilizers and scanners, making our equipment and technology offering larger than ever before! TDSC.com is an authorized source for the

best, top-quality dental supplies you love from brands you trust including: l

3M ESPE

l

Fluoridex

l

Cranberry

l

GC America

l

Clinician’s Choice

l

Henry Schein Inc.

l

Colgate

l

Kerr Corporation

l

DenMat

l

Ortho Technology

l

Dentsply Sirona

l

Plasdent Corp

When you shop with TDSC.com, you can be sure you’re purchasing only top-quality dental brands at the best prices.

TDSC.com’s knowledgeable customer care team offers product information and shopper support before, during and after the sale. Want to learn more? Give us a call at 888.253.1223 or send an email to support@tdsc.com.

Disclaimer: Exclusions apply. Next-day delivery is provided for over 95% of line items, dependent on inventory levels and time of order placement. Orders may ship from separate locations and may arrive at different times. Please refer to product detail pages for delivery estimates and exclusions. See tdsc.com/disclaimers for details.

”

Supply pricing can be confusing.

We practice price transparency so it’s easy to see the price you’ll pay with TDSC.com.

65 | TODAY'S FDA november/december 2022

fda president

2022 FDA President

Dr. Jerry Bird

Dr. Bird was born in Chicago, IL while his dad was going to chiropractic school. The Bird family migrated in the early years to Holland, Mich. and Platte, S.D. The family eventually settled in Marne, Mich. to be close to relatives. Dr. Bird is the eldest and has a sister, Carol, in Michigan, a brother, Keith, in Georgia and his youngest sister, Teresa, in North Carolina.

While in 6th grade, Dr. Bird knew he wanted to be a dentist. Once in dental school, he fell in love with oral surgery. Dr. and Mrs. Bird married in 1984, and moved from Michigan to Florida in 1985, where they built a thriving oral surgery practice. They have two children, Kevin (34), a surgical nurse who lives in Naperville, IL with his wife, Taylor, and their son Carter. Stephanie (32) works at Lockheed and lives in Denver with her soon-to-be fiancé, Anthony.

The Bird family is a sports family. Running, soccer, basketball, cycling and triathlons were all part of busy weekends. The kids went to many dental meetings with mom and dad and, probably like your kids, they began to think the meeting hotel was THEIR hotel. In his spare time, Dr. Bird was an assistant varsity men’s soccer coach at Holy Trinity Academy in Melbourne for several years and still attends games.

1.

66

Dr. Bird has been involved in the Brevard County Dental Society, Central District Dental Society, the Florida Dental Association

His goal for the Florida Dental Association is to be a unified force for the dental profession. The FDA already is the “Go To” place for all things dental.

2.

3.

4.

Photos: 1. Dr. and Mrs. Bird in D.C. at Dentist and Student Lobby Day. 2. Dr. Bird with grandson Carter.

3. Mrs. Bird, Florida State Representative Tyler Sirois and Dr. Bird.

4. Drs. Matt Sheldon, Jerry Bird and Jim Antoon.

5. Dr. Bird sporting his Michigan gear.

6. Dr. Bird, Mrs. Bird and their surgical assistants (l to r) Shelley, Ashley and Ellery 7. Dr. Bryan Bergens, Past Central Florida Distrist Dental Association (CFDDA) President, Marlinda Fulton, executive director for the CFDDA, and Dr. Bird celebrate 100 years of association excellence!

8. At Ironman Alaska this summer - Dr. and Mrs. Bird with their daughter, Stephanie, after she finished Ironman Alaska, and her beau, Anthony.

9. Kevin (son), Carter (grandson), Taylor (daughter-in-love).

1.

67 | TODAY'S FDA november/december 2022

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7.

6.

(FDA) and American Dental Association (ADA) since 1985. He has always thought it was important to give back to the profession to make it better for those who will come after him. His most loved arena is legislative, and his favorite job has been chair of ADPAC. He had a great legislative mentor, Dr. Robert Downey, who taught him much of what he knows. In their early office years, a team member’s dad who was their friend, realtor and part-time babysitter became a congressman. The rest is history.

Dr. and Mrs. Bird have been vegetarians since 1983, and they love Mexican food. They also love Michigan football and Tom Brady.

His favorite guilty pleasure is a Ghirardelli dark chocolate brownie with vanilla ice cream topped with whipped cream. Anything chocolate is #1. Although Jerry is not a fan of candy, many of his Board of Trustee friends like to share their chocolate buckeyes with him at meetings. Hmmm? But he really loves his University of Michigan Wolverines.

Dr. Bird loves to dance. 70’s and 80’s songs are favorites. He needs a new hip from the cycling accident, but once he gets the new total hip in December, watch out ... he will be back on the dance floor!

Dr. Bird loves his family, his profession, dogs, babies, all of his patients and many friends. His favorite drink of choice is water, and it is with him everywhere he goes. His favorite movie is “Shawshank Redemption,” which he has watched at least 10 times and lives the “Get busy living or get busy dying” quote every day. His goal for the FDA is to be a unified force for the dental profession.

The FDA already is the “Go To” place for all things dental. During the COVID-10 pandemic, the FDA was a leader in getting the latest information. Whether providing the safest conditions for patients and teams, helping dentists secure Paycheck Protection Program loans, and grants, the FDA had us covered. Now it is hurricane season, and the FDA is checking on us and making sure we are ready. The FDA is an amazing organization!

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3202CDF W EIV ERP REKAEPS

A LOOK AT WHAT’S TO COME AT FDC2023 WITH FDC GENERAL CHAIR, DR. BECKY WARNKEN

By Becky Warnken, DDS

Q.

As the new General Chair of Convention and Continuing Education (C-CCE), what can we expect for you to bring to the Florida Dental Convention (FDC)?

A.

First, I want to say that I am beyond excited to be the new C-CCE General Chair. During my six years on the committee, I have served in every aspect on the committee. I know how much this group pours into FDC every year, and we cannot wait to continue to showcase the innovation this group delivers each year. While education is – and will always be – our focus, we will also continue to offer new events for the whole dental team, as well as the dental family. I want your experience at FDC year after year to be the cutting-edge dental meeting you have come to expect, with a few surprises here and there to keep you guessing “what’s next?!”

I, myself, am a practicing dentist in a multispecialty office with a diverse team and a young family. I intend to continue to bring this unique perspective to C-CCE, pushing the envelope on our events and FDC to continue to expand our offerings to fit every aspect of your team, family, and practice! I intend for FDC to continue to be the premier educational AND fun meeting for our Florida dentists and beyond!

Q. A.

What do you look forward to most in attending FDC?

I absolutely love the energy and comradery of FDC. There is nothing like it. Everyone who attends is excited about dentistry, ready to gain skills, learn something new, and continue to serve their patients better when they return home. The speakers

are top notch; the vendors are excited to meet, connect and help attendees accomplish their goals; and the attendees are all eager to learn. “Come for the CE, stay for the fun” isn’t just something we say – it truly happens every day of FDC!

Q.

We know there are many outlets to get your continuing education. Why would you recommend your colleague get continuing education (CE) at FDC?

A.

There is nowhere else in Florida that you can get all that FDC offers: 130+ amazing courses to choose from, education for you AND your team, top-notch social events for all attendees, and an incredible resort for your family to enjoy, all at an affordable price with FREE registration for FDA members!

Beyond the obvious, the FDC Scientific Program is phenomenal.

There are 90+ distinguished speakers — experts in their fields who offer everything from advanced dentistry and hands-on workshops to communication and administrative courses. Bring your team and learn cutting- edge skills that can be implemented in your dental office on Monday morning.

Q.

Why do you choose to bring your team to FDC and what type of skills/knowledge have they brought back to the office?

A.

My team attends FDC because there is something in the program for every single one of them. My business assistants have gained communication and conflict management skills. My hygiene team has gained knowledge in everything from instrumentation and ergonomics for more efficient calculus removal

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My team attends FDC because there is something in the program for every single one of them.

to oral pathology to additional adjuncts for disease management. My clinical team has learned 3D printing applications for the general practice, tips and tricks for efficiency throughout their day, better lab case management, and implant pieces and parts to name a few! They also rave year after year about the Friday night party and are very much already looking forward to the “Out of this World” theme this year!

Q. A.

What kind of perks can FDA members expect to receive at FDC?

First and foremost, FDA members receive free registration and CE. All members receive free pre-registration, up to 19 CE courses for free, and discounted course fees with pre-registration.

”

There are also motivational keynotes on Thursday and Friday that are FREE for all attendees during pre-registration.

You can also discover and test drive the latest products, services and dental technologies from 300+ industry leading exhibitors in the FDC Exhibit Hall. Access to the Exhibit Hall is included in FDA members’ FREE pre-registration.

And, of course: Come for the CE, Stay for the Fun! There are endless opportunities to connect with colleagues, make new friends and enjoy your time during FDC. Enjoy alumni receptions, specialty meetings, family-friendly social events and all the fun Gaylord Palms has to offer all under one roof. As always, the legendary FDC Thursday and Friday parties are included for free in your registration.

The 2023 Florida Dental Convention will be held June 29-July 1 at the Gaylord Palms Resort and Convention Center in Orlando. You can view courses and make your hotel reservation at floridadentalconvention.com. Registration opens March 1.

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YOUR PATIENT, YOUR DUTY: Legal Issues Surrounding Medical Emergency Preparedness

By Larry Sangrik, DDS

Following continuing education programs, participants often come forward and ask a question about which everyone is wondering but too timid to ask publicly. When I speak on medical emergency preparedness, the question is, “What must I do to legally protect my office from litigation after a medical emergency?” While the question is a mere 15 words, the answer is far more complex.

Is There Really a Problem?

The dental profession has no mechanism to track or quantify medical events occurring during dental treatment. Regardless, there are five risk factors that point to medical emergencies during dental treatment increasing in frequency, intensity and diversity.

5. Dropped Dental Devices: While foreign objects blocking the airway have always been a concern to the dental profession, the increased reliance on dental implants, many with small instrumentation or components, only serves to heighten this issue.

The public does not expect the typical dental office to be a “mini emergency room;” nor does it expect that a typical dentist be capable of all the services a paramedic could offer.

However, a 2019 white paper published by the American Association of Dental Boards found that patients expect a dental office to serve as a “first responder to the level to which they are trained.”

Contained within these ten words are two important concepts. l First Responder: The public identified six tenets that they felt were important for a dental office to function as an adequately prepared first responder.

1. Demographics: As the baby boomer generation continues to age, the percentage of the general population in the upper age brackets continues to increase. Aged patients have an increased risk for undiagnosed or under-diagnosed medical problems.

l Dentist training: The dentist needs to periodically train to respond to a wide array of medical problems beyond basic CPR.

2. Complex Medical Histories: Paradoxically, improvements in medical care mean that today’s dentist is faced with patients who have far more complex medical conditions than our predecessors. Patients that in past generations were homebound (or dead) are now able to live full, active lives, including receiving dental care.

l Staff Training: The dentist should see that the entire staff has been trained to assist the doctor in the management of a medical emergency. l Mock Drills: The dental team should practice together responding to various medical situations they may encounter. l Emergency Manual: Because medical emergencies are relatively infrequent, the dental team should have a quick reference manual with signs/symptoms and response algorithms for a variety of medical situations.

3. Increase Sophistication: As dental treatment becomes more complex, appointments are becoming longer with an increased emphasis on surgical treatment.

4. Use of Sedation: Today’s dental patient expects not only clinical excellence but also freedom from both pain and anxiety during treatment. Dentists are responding by offering wider ranges of sedation during treatment.

l Medications: The office should stock emergency medications as recommended by the American Dental Association (ADA).

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There is such a need for pediatric OSA services that once you overcome your reservations and start having these conversations, your program will grow with very little work from you!

l Emergency Equipment: The office should stock and maintain basic equipment to manage a medical emergency, specifically the ability to deliver oxygen to both a breathing patient needing supplemental oxygen and a non-breathing patient.

• To the level to which they have been trained. The public

cares little about what local community standards are. Instead, they tend to focus on what is being taught in dental school, residencies and continuing education courses.

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that, they will likely look at the areas outlined earlier.

So When Does Malpractice Occur?

For malpractice to have occurred the plaintiff’s attorney must prove four things. If the defense can trip up the plaintiff’s case in any one area, it is like the baseball player who fails to touch second base. The batter may have hit a home run, but no run is scored.

The four pillars of a dental malpractice case are:

What’s Expected of Dental Offices

1. Duty: The dentist has an obligation to the patient.

Many dental offices feel they have a legally defensible position against malpractice litigation if they merely fulfill the requirements of their state dental board. Unfortunately, this leads to a false sense of security.

2. Breach: The dentist failed to fulfill that obligation to the patient.

For example, many dental boards require that dentists and dental team members maintain basic life support skills. Other boards require that dental offices stock an automated external defibrillator (AED). While neglecting a dental board’s mandate is inherently negligent, fulfilling the mandate does not imply that a dental office has met the standard of care.

The legal system has long established that it is impossible for the law to cover every possible situation. Consequently, the courts instruct juries to follow a legal doctrine of the reasonable man standard.

As it pertains to medical emergencies during dental care, the jury seeks to determine what a reasonable dentist would do in a similar situation. They will pay little, if any, consideration to what the colleagues of a dentist are doing.

Instead, they will define a reasonable dentist’s response as being what he/she should have done in the situation ... and to answer

3. Damage: The patient suffered an adverse consequence.

4. Cause: The breach of duty was the direct reason for the damage suffered by the patient.

One More Legal Principle One area in which dentists can find themselves in trouble is the legal principle of mitigation of damage. In short, in any situation, the involved parties have a mutual obligation to not make the situation worse than it would normally be.

Imagine a driver gets confused at an intersection, makes an illegal turn and causes a collision with another car. The driver of the second car, the victim, who was not wearing a seat belt in a state with a seat belt mandate, sustains a fractured pelvis and a concussion from his head hitting the windshield. Who pays for the victim’s medical expenses?

Clearly, the driver that caused the accident is financially responsible for the fractured pelvis and any other negative consequences

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such as loss of mobility. However, concussion is a different situation. The concussion was caused by the victim hitting his head against the windshield. The victim, merely by following the law and wearing a seat belt, could have avoided hitting his head.

Consequently, the victim, while not being responsible for the accident as a whole, is responsible for the portion of the accident that he made worse.

Putting it All Together...

Let’s take the following hypothetical situation and examine the dentist’s responsibilities. A patient presents for a standard preventive maintenance appointment in the hygiene department.

During the prophylaxis, the patient begins having chest pains.

The dentist comes to the treatment room, assesses the situation and directs that EMS is called. After reviewing the patient’s medical history, he administers aspirin. However, because the office only has supplemental oxygen for a non-breathing patient, no oxygen is available.

After 20 minutes, a reasonable response time, EMS arrives, administers oxygen and begins transport to a hospital. While transferring the patient to the ambulance, the patient goes into full cardiac arrest. The paramedics attempt to defibrillate the patient, but he ultimately dies.

Will there be litigation? Probably. Plaintiffs usually consult an attorney if something unusual has a serious negative outcome.

Now it becomes the plaintiff’s attorney’s to prove the four pillars of a malpractice case.

Damage is self-evident. The patient died.

Did the dentist have a duty to the patient? In a jury trial, a jury will likely conclude that, “Yes,” there was a duty. The dental team should respond as a properly prepared first responder.

Did the dental team breach that duty? Despite doing most things right (promptly calling EMS and administering aspirin) the dental team did not have equipment to oxygenate the patient while waiting for EMS. Consequently, there was a breach.

That’s three of four. The case now hinges on causation.

Did the dentist cause the heart attack? It will be almost impossible to prove that the dental treatment was the direct cause of the patient’s myocardial infarction. Consequently, it would superficially appear that the case lacks causation and the dental office did not commit malpractice.

However, the plaintiff’s attorney will likely use the concept of mitigation of damage to prove the case. Did the dentist’s failure

FDC2023 SPEAKER PREVIEW to oxygenate the patient make the patient’s existing heart attack worse and directly cause the patient’s death?

This is a far simpler challenge for the plaintiff’s attorney to prove.

If it can be shown that providing supplemental oxygen while waiting for EMS could have made the heart attack survivable, then the dentist is responsible for the difference between the competing scenarios. Unfortunately, this difference is the difference between life and death.

In all likelihood, the dentist’s malpractice carrier will seek to avoid going to trial and attempt to protect the dentist’s dental license and personal financial assets.

Back to Our Original Question...

Legally speaking, how can a dentist best prepare a dental office for a medical emergency?

The ADA recommends following the six principles sited earlier.

1. Dentists should periodically take medical emergency courses beyond CPR. Every two years is a reasonable interval.

2. Dentists should train their staffs to assist the dentist in responding to a medical emergency in a coordinated manner.

3. Dental teams should periodically practice responding to a variety of medical scenarios.

4. Dental offices should have a quick reference manual available featuring signs/symptoms and a series of response algorithms to medical events a dentist is likely to encounter.

5. At minimum, dental offices should stock the seven emergency medications recommended by the ADA. 6. Dental offices should maintain basic medical emergency equipment with an emphasis on supplemental oxygen.

Dr. Sangrik will be offering the courses “Impact of Personality on Patient Behavior Deep Dive,” “Medical Emergencies in the Dental Office: Why CPR is Not Enough” and “Understanding Dental Fear: Successfully Treating the Apprehensive Patient” at the 2023 Florida Dental Convention. Learn more about Dr. Sangrik’s FDC2023 courses at floridadentalconvention.com.

This article is for informational purposes only and is not intended to be a substitute for professional legal advice. If you have a specific concern or need legal advice regarding your dental practice, you should contact a qualified attorney.

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HAVE YOU NOTICED CHANGES IN YOUR COVERAGE FOR DENTAL BILLING?

By Christine Taxin, Adjunct Professor,

(CBCT), we must learn how to use them to back our treatment up.

New York University School of Dentistry

If you are using the updated 2023 coding book by the American Dental Association (ADA), the dental diagnostic codes are in the book. The big problem is never being trained officially to use them correctly.

Third party payer policy changes happen all the time since they are running a business and not practicing on a real patient. The company feels it is up to the purchaser of the policy to understand what is covered and why.

1. How to choose the diagnosis we are performing for the work we are billing.

Many plans have what is called Integrated Benefits for Hygiene Visits. What these do for patients with systemic issues such as diabetes, kidney, arthritis and many more medical conditions allows them to have four covered visits with many codes that are not normally covered on the six-month visits since they have a

2. How to communicate with the medical provider what his diagnosis is for treatment of the patient.

3. How to put them together for both dental extra benefits and medical benefits for patients who are not covered in dental or who have no benefits for a treatment such as bone grafts that are no longer covered in dental.

medical condition, and they need to stay in remission. I use the word remission since hygiene is about stemming the infection of the oral cavity, so the patients’ medical condition does not have other infections traveling through the body.

We have said for years that patients who have a diagnosed condition need to stay as healthy as they can since their body is already compromised. This was a hard lesson that the world was told for the past three years during the COVID-19 pandemic. What happens when a patient has a compromised system? They are not able to fight back as hard as needed since they’re already fighting.

This has changed the entire way we have traditionally diagnosed patients for treatment, the treatment plans we offer and why learning how to use diagnostic codes is necessary.

An example many of the dental plans that have added to the extra visits are all patients that have a medical diagnosis, and then we must add our diagnosis to have the patient covered.

We must learn that a periapical radiography (PA) alone is a diagnostic tool, so it must be documented ordered and then what was seen on that x-ray that is causing a problem. Very few dentists take this step, and with the many changes in codes for different types of x-rays from PA to cone beam computed tomography

Let’s give you an example of how to bill for a bone graft for a patient who is diabetic.

21210 – Graft, bone; nasal, maxillary, or malar areas (includes obtaining graft). The physician utilizes a bone graft to augment or aid in the healing of the nasal, maxillary, or malar regions.

Under general anesthesia, the physician obtains bone grafts from the patient’s rib, skull, or hip. An incision is made over the defective area, and the physician plants the graft into the appropriate region. Wires, plates, or screws may be used to hold the graft to the recipient site. All incisions are closed.

Lesson 1. If you do not use the bone from the patient, then you must use a modifier to show the insurance company you are purchasing bone. Use modifier 52 which states you are not utilizing the patient’s bone.

Lesson 2. Put the lab bill on the claim for the purchase of the bone.

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We must learn that a PA alone is a diagnostic tool, so it must be documented ordered and then what was seen on that x-ray that is causing a problem.

Your diagnostic codes are going to depend on the patient’s medical history and the primary medical doctor who is treating this patient. The medical issues can come from the following areas in the example provided below:

E13.638 – Other specified diabetes mellitus with other oral complications E11.630 – Type 2 diabetes mellitus with periodontal disease We then also need to learn how to ask the provider what treatment is being provided for this patient so we can add that.

This patient is using insulin (Z79.4) adverse effect, which is a side effect of a substance correctly prescribed and administered.

The nature of the adverse effect (e.g., dizziness, hives) would be coded before the T code.

T38.3X1A – Poisoning by insulin and oral hypoglycemic [antidiabetic] drugs, accidental (unintentional), initial encounter.

After you choose these codes, which are only able to grow the medical doctor’s code, you have given the medical plan the reason why you are performing treatment on any patient with these conditions.

”

Notice that many of your patients have diabetes and one of the biggest reasons systemic issues are used is that the patient’s saliva is not healthy and continues to infect the patients’ body. That is the big reason dental added the additional hygiene visits and why you can do work to help the atrophy, decay or other issues in the oral cavity including oral cancer screenings.

In hopes you want to continue to grow your practice both for the benefit of the patients, but also to the benefit of your financial ability to continue your journey without wondering how to cover your overhead and pay everyone in your office.

P.S: The use of AI is helping staff use treatment plans better and provide the information needed for both dental and medical for payments. Don’t let them use it to ask for overpayments; you use it to protect your office.

Ms. Taxin is the founder and president of Links2Scuccess and Dental Medical Billing University. She will be offering the course “Dental to Medical Billing Deep Dive,” on Friday, June 30, 8 a.m. - 12 p.m. at the 2023 Florida Dental Convention. Learn more about Ms. Taxin’s FDC2023 courses at the 2023 Florida Dental Convention at floridadentalconvention.com.

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THE 10 FINANCIAL STRATEGIES TO SUCCEED IN DENTISTRY we deserve it. There is always a tug of war between our current desires and our future needs. Most of the time, the current desires win. One way to help prevent this is to visualize your future self. What will your financial situation be like in 15-20 years if you keep doing what you are now? In the fourth strategy, I will show

By James R. Pitts, DMD

As dentists we are blessed with having a great profession. There is no other career I know of where you can be your own boss, work in the manner that you choose and create a great life for your family.

Dentists also have an opportunity to earn a tremendous amount of money by working as hard as they choose.

Over the course of an average 35-year career, a dentist can easily collect over $30,000,000 in his or her office. Many dentists will do far more than this.

how dentists can provide for their future without sacrificing their present.

3.

Maximize the Collections in Your Dental Practice. By working at an increased level, you create more production and collection. Most dentists are working at close to half their possible capacity. The problem is we don’t usually know how to fix our issues. Some type of change is needed. This change could be in your facility, your staff, your skills, or even in yourself. Many times, in a dentist’s career, they will reach a point where the practice hits a plateau. The dentist feels like they are working as hard as they can, in their current office, with the staff they have and the systems in place.

A dentist can also easily average $250,000 - $350,000 in take home pay yearly. Why is it then that only about 10% of dentists can afford to retire and stay at the same standard of living? It’s not that we don’t make enough money. As the saying goes, we don’t plan to fail. We just fail to plan.

In this article, I will share 10 financial strategies to help dentists reach their goals. By using these proven, highly effective strategies, we can move confidently towards becoming financially independent.

Develop a Written Financial Action Plan. Create this plan as early as possible and don’t stop. Having a written plan that spells out exactly what you will accomplish and how you will do it, greatly increases the chances of success. Keep the plan in various places where you can easily see it every day. By constantly reminding yourself of your objectives, success comes more easily. If you need help in creating a plan, work with a financial professional. It will be money well spent.

It feels like they have hit a wall. Usually, a fundamental change is needed. Typically, the dentist will need help making these changes. Consultants that help with practice management issues are not inexpensive. They are however, worth every penny if they can facilitate the needed change.

4.

Invest Automatically. This is a key to becoming wealthy.

Your financial life should run on systems, just like your dental practice. By scheduling saving and investing to occur automatically every month, you are accomplishing many great objectives. First, the money goes directly from your business account to your investments. It doesn’t get sent home where it will be spent. The prescribed funds go automatically into the investments every month. By doing this, you are dollar cost averaging into the market. When the market is down, you are buying in more shares with the money. When the market is up, you are buying less shares with the same amount of money. By using this principal, you are being smart without having to try.

Live Below Your Means. Human nature causes us to try to live at or above our means. When we first start our careers, we have to be more frugal with our spending. We typically aren’t making as much money, so we don’t get into as much trouble.

As we earn more, we justify the increased spending by saying

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It’s not that we don’t make enough money.

As the saying goes, we don’t plan to fail.

We just fail to plan.

By saving and investing automatically over the years, you will create wealth. The money will arrive exactly where it should be, and you won’t ever miss it.

5.

Always Have Your Money Working. As dentists, we work hard for our money. It should work as hard for us. No one can effectively time the market. In order to do so, one must be right twice. Once when you take the money out of the market and then again when you put the money back in. This is impossible.

However, by developing a sound investment strategy and a good long-term plan, and by keeping your money invested, you can benefit from good markets and rebounds in bad markets.

Studies show us that the best days in the market usually occur right after the worst days. By keeping your money invested, you won’t be tempted to pull the funds out at the worst time. Most dentists tend to hoard cash in their business accounts, all the while earning next to nothing from their bank. While it is prudent to keep an emergency amount of cash on hand to take care of any unforeseen events, most dentists have way too much cash on hand. They never realize the lost opportunity of having that money working for them. With inflation running high, money in the bank could be losing up to 8-9% in spending power.

6.

Rebalance Your Portfolio Quarterly or Yearly. This is how the principal works. For example, initially your investment portfolio is created with a 60% stocks and 40% bonds asset mix, based on your particular risk tolerance. Then, over the course of a year, if stocks do well, by the end of the year your portfolio would look like 70% stocks and 30% bonds. In order to rebalance to your original asset allocation model, you would sell some stocks that have appreciated and buy some bonds that are lower. By doing this, you are returning to your original 60/40 model. More importantly, you are selling high and buying low

”

which is the smart way to invest. Having your portfolio rebalanced automatically ensures it will happen.

7.

Reduce Your Taxes Constantly. The effect that taxes have on the ability to build wealth is enormous. By regularly participating in pretax retirement plans in your dental practice one can save a tremendous amount on taxes. Money is saved pre-tax and grows tax deferred within the plan. Retirement plans come in many types and sizes. Examples can include 401k plans, SIMPLE plans and SEPs. Consult with a financial professional to help evaluate which plan is right for your dental practice. Also, knowing which type of investments to hold in various types of accounts is important. For example, in non-qualified accounts where you are taxed yearly on any gains it is vital to hold appropriate investments. Possibilities could include municipal bonds that give fed tax free income, growth stocks that you want to hold for a long time and dividend producing stocks. Furthermore, working with a dental specific Certified Public Account (CPA) is very important. The CPA can help save you on taxes every year. One of the biggest tax issues that can occur is when a dental practice is sold. It is extremely important to structure the sale properly. This is very complicated topic which should be dealt with in another article.

8.

Working with A Financial Professional to Help You Optimize Your Outcome. Studies show that people who work with a financial advisor can potentially improve up to 2-3% better annually in investment performance over those who don’t. Sometimes getting advice when facing various financial and business issues can help dentists avoid mistakes. Find an advisor who has knowledge and experience with dental practices. By sharing ideas and befitting from experience, you can shorten the learning curve significantly.

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THE PERFECT GIFT! Two Deals to Make the Holidays Truly Memorable.

This holiday season, you could find yourself celebrating behind the wheel of a Mercedes-Benz. That’s because they’re offering you a special deal on either a 2022 GLC SUV or a 2022 C-Class Sedan just for being a member of the Florida Dental Association.

Right now, you can get $750* toward your down payment or cash due at signing when you purchase a 2022 GLC SUV, or $500* toward a 2022 C-Class Sedan.

That’s two amazing deals on two amazing vehicles. Yup, this will be one holiday season you’ll definitely remember.

ada.org/mercedes | 866.628.7232 * Fleet incentives available only for qualified customers on certain MY22 Mercedes-Benz models. Incentive must be used at time of purchase/ lease. Eligible person must be the buyer/co-buyer or lessee/co-lessee. Star AccessSM incentives cannot be used in conjunction with Diplomat, European Delivery, Special Demos, Certificate Programs, Mercedes-Benz Incentive Bonus Cash and other Fleet programs, or non-U.S. specification vehicles. Incentive amounts are subject to change on a monthly basis and should be confirmed with your dealer at the time of transaction. Amount of actual savings may vary depending on model selected. Offer expires Jan. 4, 2023.

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9.

Reverts to strategy 1, Review and Adjust Your Financial Action Plan Periodically. Even a well thought out plan needs evaluation and adjustments occasionally. Time, changing issues in dental practices and circumstances of life will dictate periodic adjustments. As the saying goes, most plans don’t survive first boots on the ground. Communication and flexibility help you to continue to benefit from the plan and move towards the ultimate goal of financial independence.

10.

Maintain Your Focus on Your Long-Range Goals. We are bombarded everyday with news, noise in the media and meaningless babble. Markets will go up and down, but the prudent dentist knows to filter out most of the daily noise. Over time, a well thought out and followed plan increases the chances of success. The daily rantings and ravings of media announcers and daily market moves don’t mean much in the long term.

Keep your focus on what’s important in your life. Your family, faith, long-term goals and your dental practice should be the focus. By maintaining this focus, you move confidently in the direction of your dreams.

Dr. James Pitts II, is a licensed financial advisor, registered investment advisor representative, professional financial strategist, and a dental consultant connection. He will be offering the following two courses “Your Best Year Ever!,” on Friday, June 30, 2:00 - 4:00 p.m. and “The Long and Winding Road: A Dentist’s Guide to Financial Independence” on Saturday, July 1, 9:00 a.m - 12:00 p.m at the 2023 Florida Dental Convention. Learn more about Dr. Pitts course being offered at the 2023 Florida Dental Convention beginning January 2023 at floridadentalconvention.com.

Read, Learn and Earn!

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

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

83 | TODAY'S FDA november/december 2022

2023 FLORIDA DENTAL CONVENTION • JUNE 29-JULY 1 • GAYLORD PALMS RESORT • ORLANDO

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EXHIBITORS IN PINK ARE FDAS CROWN SAVINGS MERCHANTS.

FDA districts

HELPING MEMBERS SUCCEED THROUGHOUT FLORIDA! ATLANTIC COAST DISTRICT DENTAL ASSOCIATION Counties: Broward, Indian River, Martin, Okeechobee, Palm Beach, St. Lucie Kathy Corrado l Executive Director l k.corrado@acdda.org l 561.968.7714 l acdda.org 10380 SW Village Center, #408 l Port St. Lucie l FL 34987

The Atlantic Coast District Dental Association (ACDDA) delivers even more benefits for success! The ACDDA offers continuing education (CE) to members during their annual conference, which will be held Friday, April 28, 2023. Affiliates provide local meetings and events throughout the year that offer the opportunity to obtain additional CE credits. Bonus: Three meetings are included in your membership dues!

The ACDDA works hard to keep its members informed by providing member-only access to special events, access to multiple social media platforms and exclusive publications, such as the ACDDA quarterly newsletter, “The Explorer.” CFDDA members, take advantage of your membership today! If you aren’t a member, don’t wait another day to join and don’t miss out on exciting and fresh ideas, events and socials to keep you up to date.

CENTRAL FLORIDA DISTRICT DENTAL ASSOCIATION Counties: Alachua, Brevard, Flagler, Gilchrist, Lake, Levy, Marion, Orange, Osceola, Seminole, Sumter, Volusia Marlinda Fulton l Executive Director l cfdental@cfdda.org l 407.898.3481 l cfdda.org 800 N. Mills Ave. l Orlando l FL 32803

Team up with Central Florida District Dental Association (CFDDA) and they will help you find more ways to succeed! Each year, the CFDDA’s Annual Meeting offers continuing education units (8-12 CEUs) at no cost to CFDDA members and their teams. Join us May 5-6, 2023 at Hammock Beach Resort in Palm Coast to stay current with your CE requirements. Your course attendance is uploaded to CE Broker for you.

Join the CFDDA today and gain member-only access to special events, social media content and exclusive publications!

NORTHEAST DISTRICT DENTAL ASSCIATION Counties: Baker, Bradford, Clay, Columbia, Dixie, Duval, Hamilton, Lafayette, Madison, Nassau, Putnam, St. Johns, Suwannee, Taylor, Union Debbie DeVille l Executive Director l ddeville@nedda.org l 904.737.7545 l nedda.org 3733 University Blvd. W, Ste. #212 D l Jacksonville l FL 32217

The Northeast District Dental Association (NEDDA) focuses on the best ways to help members succeed! The NEDDA offers high-quality CE courses that fulfill licensure requirements at a reduced rate with automatic reporting of course attendance to CE Broker.

Become a NEDDA member and gain member-only access to special events such as “cocktails and conversation” on Thursday, Feb. 2, 2023 from 5:30-7:30 p.m. at the Epping Forest Yacht & Country club and network with fellow colleagues. Check out our monthly e-newsletter and more!

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NORTHWEST DISTRICT DENTAL ASSOCIATION Counties: Bay, Calhoun, Escambia, Franklin, Gadsden, Gulf, Holmes, Jackson, Jefferson, Leon, Liberty, Okaloosa, Santa Rosa, Wakulla, Walton, Washington Angel Henry l Executive Director l nwdda@nwdda.org l 850.391.9310 l nwdda.org 2910 Kerry Forest Parkway, D4-309 l Tallahassee l FL 32309

The Northwest District Dental Association (NWDDA) prodcues even more benefits for success! The NWDDA Annual Meeting, Feb. 3-4, 2023 at The Henderson Beach Resort & Spa in Destin, offers up to 12 hours of CE at reduced cost to NWDDA members, including all current Florida-mandated courses. And, it is FREE to new members! Course attendance is automatically reported to CE Broker for you.

If you are a member, remember to take advantage of your member-only access to special events, social media content and exclusive publications. If you aren’t a member, join today to take full advantage of everything the NWDDA has to offer!

SOUTH FLORIDA DISTRICT DENTAL ASSOCIATION Counties: Miami-Dade, Monroe, South Broward Yolanda Marrero l Executive Director l ymarrero.sfdda@gmail.com l 305.667.3647 l sfdda.org 420 S. Dixie Highway, Ste. 2-E l Coral Gables l FL 33146

The South Florida District Dental Association (SFDDA) gets creative providing members more ways to succeed! Check out SFDDA’s “Ain’t That the Tooth” podcast where you get a glimpse into members’ lives and their perspectives on dentistry and other topics.

Make sure you are a member of SFDDA and interact with your colleagues at 15 different affiliate CE dinner meetings throughout the year, which are included with your membership. Receive high-quality CE courses that fulfill licensure requirements at a reduced rate with automatic reporting of course attendance to CE Broker.

Members may also register to access the SFDDA’s dental professional placement service at no cost.

WEST COAST DISTRICT DENTAL ASSOCIATION Counties: Charlotte, Citrus, Collier, DeSoto, Glades, Hardee, Hendry, Hernando, Highlands, Hillsborough, Lee, Manatee, Pasco, Pinellas, Polk, Sarasota Lissette Zuknick l Executive Director l lissette@wcdental.org l 813.654.2500 l wcdental.org 1114 Kyle Wood Lane l Brandon l FL 33511

Let the West Coast District Dental Association (WCDDA) help you attain member success! Receive high-quality CE courses, meet with dental vendors, network with local dental colleagues and meet dental assisting and hygiene students, while attending the WCDDA 2023 Annual Meeting, Feb. 3 in Tampa.

As a WCDDA member, you can help promote local dental health, support preventive dental education and disaster relief for colleagues through the WCDDA Fund. You will also have member-only access to special events, social media content and exclusive publications. If you aren’t a member, join today!

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Read, Learn and Earn!

By Drs. Saja A Alramadhan*, Neel Bhattacharyya and Nadim M. Islam

A 17-year-old Hispanic female presented to Dr. Deck Couch, a Periodontist in Florida, with a chief complaint of swollen gums that interfered with eating. The patient appeared completely healthy with no complaints of spontaneous hemoror bleeding upon brushing. Clinicalfor examination revealed a generalized and diffuse gingival hyperplasia Visit rhage floridadental.org/online-ce this FREE, MEMBERS-ONLY BENEFIT. You willinvolving be given the both maxillary and mandibular quadrants, especially in the anterior facial aspects (Fig. 1, A-B). The gingiva was swollen opportunity to review the “Diagnostic Discussion” and its accompanying photos. Answer five and erythematous. Bone loss was not evident in the panoramic radiograph. The patient was completely asymptomatic. multiple choiceprocedure questions to earn for one hour reason of CE.(Fig. 2), however, 14 days later the gingival overgrowth A gingivectomy was performed a cosmetic recurred (Fig. 3, A-B). Dr. Couch performed an incisional biopsy. This was then submitted to the University of Florida Oral Pathology Laboratory biopsy service for microscopic examination.

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

Contact FDC Marketing Coordinator Brooke Martin A. Chronic hyperplastic gingivitis at bmartin@floridadental.org or 800.877.9922.

B. Orofacial granulomatosis C. Drug-induced gingival overgrowth D. Plasma cell gingivitis E. Leukemia-associated gingival hyperplasia

Fig. 1 (A-B): Diffuse gingival erythema with significant overgrowth.

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Fig. 2: Appearance immediately after gingivectomy.

Fig. 3 (A-B): Relapse of gingival overgrowth two weeks postoperatively. t

97 | TODAY'S FDA november/december 2022

quiz A. Chronic hyperplastic gingivitis Incorrect. Chronic hyperplastic gingivitis occurs from persistent and long-term gingivitis due to lack of proper oral hygiene, which leads to the accumulation of dental plaque and calculus; however, many other factors can affect the gingiva’s susceptibility to the oral flora. Gingivitis could be due to hormonal (puberty, pregnancy and oral contraceptive), stress, substance abuse, poor nutrition and medications. Establishing an effective oral hygiene regimen should be the goal for these patients. In our case, the oral hygiene appeared to be fair.

Incorrect. Orofacial granulomatosis (OFG) is an uncommon entity where oral lesions characterized by persistent and/or recurrent lip enlargement, oral ulcers, and other orofacial features such as mucosal tags, gingival enlargement, and fissured tongue may be noted. The etiology of this rare but perplexing condition is unknown. There is a slight female predominance. Most authorities believe an abnormal immune reaction is the root cause. Before calling it OFG, we need to exclude other granulomatous lesions such as chronic granulomatous disease, foreign body reactions and allergies. Typically, biopsy of these lesions reveals lymphoedema and non-caseating granulomatous inflammation, these features were not seen in the biopsied specimen of the present case. The enlargement of the lips is the most common presenting complaint. Local causes of OFG can be an allergic reaction to cosmetics, foods, flavorings, oral hygiene products (e.g., toothpaste, mouth rinses), and dental restorative materials.

Incorrect. Gingival overgrowth is a well-documented side effect associated mainly with several medications. The pathogenesis of drug-induced gingival overgrowth is uncertain, and there appear to be no unifying theories that link the three main categories of drugs such as Phenytoin sodium (anticonvulsants), cyclosporine (immunosuppressive), and nifedipine (antihypertensive). Up to 50% of individuals receiving phenytoin exhibit gingival overgrowth. Phenytoin induced overgrowth tends to respond well to good oral hygiene practices and responds directly to improvements in oral plaque levels.

Calcium channel blockers especially nifedipine, may also induce gingival enlargement in a certain group of patients. Drug-induced gingival hyperplasia may regress after discontinuation of the offending medication(s) or substitution of one medication for another in the same class by the attending physician. However, the patient in the present case reported no medications.

D. Plasma cell gingivitis

B. Orofacial granulomatosis

C. Drug-induced gingival overgrowth

Cyclosporine is a widely used immunosuppressive drug used to prevent organ rejection in solid organ transplant patients and has gingival overgrowth induction effect.

Incorrect. Plasma cell gingivitis typically presents with a rapid onset of sore gingiva that may be intensified by spicy or hot foods. The entire free and attached gingiva demonstrates diffuse enlargement with bright erythema and loss of normal stippling.

Erythematous areas may extend onto the palate, tongue or buccal mucosa. Plasma cell gingivitis is most often the result of contact stomatitis associated with food flavoring agents, toothpaste and preservatives. One of the more common offenders is cinnamon where the patient displays a hypersensitivity reaction to usually cinnamon-flavored candies, foods or chewing gum.

Microscopically, large numbers of plasma cells are noted in the gingival tissue biopsy which was not noted in our case. The best way to treat plasma cell gingivitis is to prevent its occurrence, hence a careful and complete dietary history is essential. Allergy testing may be helpful along with an elimination diet. Topical corticosteroids have been used in some cases with success.

E. Leukemia-associated gingival hyperplasia Correct. A very important diagnostic consideration when evaluating patients with generalized or localized gingival hyperplasia with episodes of bleeding. However, in the present case, no spontaneous gingival bleeding was reported and the patient appeared otherwise healthy. The clinical signs and symptoms such as anemia and infections seen in leukemia are related to the marked reduction in normal white and red blood cells. The patient may also present with a fever associated with an infection which is often the initial presenting sign.

Commonly reported oral manifestations of leukemia include a diffuse, edematous, boggy and nontender gingival enlargement with unusual ulcerations that tends to bleed either spontaneously or on provocation. The gingival tissue is most severely

98

affected than any other oral mucosal tissue mainly due to the large numbers of bacterial flora normally present around teeth.

Although gingival involvement has been reported in all variants of leukemia, it is most commonly seen with acute myeloid leukemia. Petechial hemorrhages of the posterior hard and/or soft palate may be also observed. Differentiating leukemic infiltration from inflammatory and reactive conditions can be challenging.

However, a comprehensive clinical evaluation is important. Dental clinicians should be aware of the oral manifestations that may be the first, earliest or only indication of leukemia. Moreover, they are often the first sign of relapse from remission achieved through chemotherapy. Awareness of oral manifestations ultimately helps dentists to facilitate early diagnosis and timely referral to a hematologist for appropriate treatment, thereby helping to reduce disease-related morbidity and mortality. A confirmatory diagnosis is usually made by testing patient’s blood and bone marrow. Remission of leukemic gingival overgrowth is expected after chemotherapy along with corresponding normal peripheral blood values. However, remission depends in part on the patient’s oral hygiene status because higher levels of dental plaque are directly proportional to an increase in gingival hyperplasia induced by systemic diseases. Thus, to ensure successful remission of gingival hyperplasia, plaque control with dental prophylaxis is recommended.

Reference: Neville, BW, et al. Oral and Maxillofacial Pathology. Elsevier, 2016.

Lourenço SV, Lobo AZC, Boggio P, Fezzi F, Sebastião A, Nico MMS. Gingival Manifestations of Orofacial Granulomatosis. Arch Dermatol.

2008;144(12):1627–1630. doi:10.1001/archderm.144.12.1627 Tungare S, Paranjpe AG. Drug Induced Gingival Overgrowth. [Updated 2022 Sep 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/ books/NBK538518/

Agrawal AA. Gingival enlargements: Differential diagnosis and review of literature. World J Clin Cases. 2015;3(9):779-788. doi:10.12998/wjcc. v3.i9.779 Ellegaard B, Bergmann OJ, Ellegaard J. Effect of plaque removal on patients with acute leukemia. Journal of Oral Pathology & Medicine: Official Publication of the International Association of Oral Pathologists and the American Academy of Oral Pathology. 1989 Jan;18(1):54-58. DOI: 10.1111/j.1600-0714.1989.tb00734.x.

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

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

The column’s case studies originate from the more than 14,000 specimens the service receives every year from all over the United States.

Clinicians are invited to submit cases from their own practices.

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

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

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

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

Barros P, Islam MN, Fitzpatrick SG, Cohen DM, Bhattacharyya I, Alramadhan SA. Essentials of oral manifestations of leukemia for the dental practitioner. Gen Dent. 2022;70(2):33-36.

Negi BS, Kumar NR, Haris PS, Yogesh JA, Vijayalakshmi C, James J. Plasma-Cell Gingivitis a Challenge to the Oral Physician. Contemp Clin Dent.

2019;10(3):565-570. doi:10.4103/ccd.ccd_776_18 López-Valverde N, López-Valverde A, Gómez-de Diego R, Ramírez JM, Flores-Fraile J, Muriel-Fernández J. Gingival hyperplasia as an early manifestation of acute myeloid leukemia. A retrospective review. J Clin Exp Dent. 2019;11(12):e1139-e1142. Published 2019 Dec. 1. doi:10.4317/ jced.56214

99 | TODAY'S FDA november/december 2022

Career Center

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

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

Today’s FDA is bimonthly; therefore, the basic text of all active ads will be extracted from the Career Center on roughly the 5th of every other month (e.g., Jan. 5 for the Jan/Feb issue, March 5 for the March/April issue, etc). Please note: Ads for the Nov/Dec issue must be placed no later than Nov. 1.

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well as a digital scanner. Looking for someone that has a wide range of skills, is tech savvy is a good communicator and has an interest in learning/ CE. Potential for long term relationship as an associate with ownership opportunity for the right candidate.

Recent grads welcome to apply and compensation is commensurate with experience. Please email CV to eck91dmd@gmail.com . 4-6 months dental employment. Florida Dental License. Must be proficient in most areas of GP practice and willing to learn new skills/CE. Proficient with computers. Visit careers.floridadental. org/jobs/17663123/.

General Dentist. Privately-owned, not a corporate practice! PPO and Fee for Service office only. We do not accept HMO or Medicaid. Located in west-side Jacksonville, we are seeking an experienced general dentist for our patient focused family practice. Our three highly productive general dentists are supported by a caring hygiene

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department, committed clinical staff, and superb front office team, and are looking for a fourth general dentist interested in full-time association. We also have a part-time endodontist on staff, minimizing external referrals.

Our practice is equipped with brandnew equipment and state-of-the-art technology. We have an on-site lab technician for customized chair-side staining, Eaglesoft Software, digital x-rays, conebeam, Cerec, and an endodontic microscope. This opportunity is perfect for a general dentist to expand on their clinical skills in all aspects of comprehensive dentistry including crown & bridge, removable prosthesis, restorative, oral surgery, endo and implants- all while reaching their highest earning potential! Starting base salary is negotiable but will increase annually with tenure. Pay will also include a bonus based off percent of monthly collections, which will also increase with tenure. I am looking for someone that is looking to grow as a dentist, learn new technology, hav-

career center ing dialogue about proper treatment planning and patient interaction strategies. You can also learn how to run a successful practice without having to deal with the headaches of paying bills and managing employees. DMD or DDS from accredited dental school, Valid state dental license, Ability to maintain state required insurance coverage, Excellent people and clinical skills, Commitment to maintaining open line of communication with owner. Visit careers.floridadental.org/ jobs/17663371/.

Practice for Sale by Owner, Pensacola, Fl. Well established 38 year general dentistry practice in Pensacola, Fl. Close to the beautiful beaches of the Gulf of Mexico, voted one of the top beaches in Florida. Also home of the Blue Angels at PNS NAS. Home of the 2019 NCAA II Football Champions University of West Florida. A vibrant downtown that was voted “top 10 great streets in America”. 5 Ops in a nice professional office park building with a loyal patient base. Chartless, digital radiographs, digital scanner, CBCT, and laser with gross collections over $1M with close to 38% Net. Turnkey opportunity with real estate available for sale or lease. Motivated seller with flexible post sale transition. Visit careers.floridadental.org/ jobs/17577038/.

Associate Positions Available Now, Panama City. Bay Dental Center and Dr John Collias encourage you to call if you are interested in a position with maximum growth potential. We are located in Panama City on the Bay. We are currently in the process of opening two additional locations between Panama City and Destin. My

Cell phone is 850-501-0761 (Dr. John Collias). Visit careers.floridadental. org/jobs/17585923/.

Seeking Qualified Dental Radiographer?

Dentist, The Villages. Established multi office, private practice is looking for a full-time associate dentist to provide quality comprehensive general dental services, someone who is an excellent communicator, and is compassionate with patients. Our dentists have clinical freedom in their treatment plans, and mentoring is available on the job for newer graduates. We offer employee or independent contractor arrangements with competitive per diem or percentage of production-based compensation.

Four day a week work schedules are available. Our experienced team of doctors, hygienists, assistants and administrative staff strive to make every patient feel comfortable and confident that their dental care needs are being met with the highest standard of treatment. They are loved by our patients, who truly appreciate them. Our North Central Florida offices are in a fast growing, treatment compliant, tight knit community and our reputation is top notch. We are serious about what we do, care about our employees, and are looking for the same commitment from others. If you are looking for a new chapter in your dental career, with massive opportunities, and think you could be a great fit don’t hesitate to contact us. DMD or DDS required.

Visit careers.floridadental.org/ jobs/17567273/.

nity to buy into our thriving practice.

We are proud of our excellent patient base, superb staff and latest equipment. Our practice is fee-for-service, accepting only out of network benefits from PPO plans. Full-time candidates can expect to work four days a week.

Good communication skills and three years experience are required to have basic skills mastered so that advanced dentistry can be learned and applied.

Please send resumes to timtiralosi@ tiralosidental.com or call/text us at 321.320.3128. Visit careers.floridadental.org/jobs/17495779/.

Dentist, Lake Mary. Come grow with us! Our high-end practice in Lake Mary, FL is looking for a full-time/parttime associate. After two years, the right candidate will have the opportu-

Practice in HIGH & DRY Florida! Fee For Service in North Central Florida.

Are you tired of evacuating for hurricanes? Tap into the market of CASH PAYING retirees of The Villages, Del

Train your dental assistants to expose radiographs using the FDA’s MyDentalRadiography online course that combines self-paced learning with clinical proof of competency. Call Lywanda Tucker at 850-350-7143 for details or visit mydentalradiography.com/FDA to create a supervising dentist account and complete the necessary tutorial on how the program works.

101 | TODAY'S FDA november/december 2022

career center Webb, and Stonecrest 55+ communities, many who have relocated from coastal Florida. There is also an untapped population of hundreds of young families moving into new homes in the immediate area! The only other dentist in the immediate vicinity is a Heartland office. Two fully equipped operatories are in free-standing 950 sq. ft. building built in 2008 plumbed for three operatories.

It is situated on one beautiful acre of land on busy US 301 just north of THE VILLAGES. Practice grossed 150K taking no insurance at 30% overhead in 2021 on 20-25 patients/week with dentist doing all hygiene. 4-5 internally referred new patients per week are being referred to a colleague. All surgery, endo, and pedo have been referred out. Immediate two full days of hygiene are scheduled and will keep the buyer busy with a loyal patient base. Modern chartless office is equipped with digital sensors and Patterson Fuse cloud-based software.

There is plenty of room to expand existing building or even build a new office and then rent the current space.

Please message me for more pics or to arrange a visit. Office is a 1 hour commute from either North Orlando/ Winter Garden/Clermont or Gainesville, 1.5 hours from Tampa. It is an easy drive off of I-75 Exit 341 or off the Turnpike on US 301. $450k includes practice and building/property. I will consider owner financing with adequate down payment. Visit careers. floridadental.org/jobs/13686503/.

General Dentist, Lake Wales.

Opportunity to work in high quality, ethical digital practice. Minimum five years experience, short term part time with unlimited growth potential.

Highly experienced and talented team with awesome reputation. License to practice in Florida. Visit careers. floridadental.org/jobs/17715632/general-dentist.

General Dentist, Naples. Naples Family Dentist, a private, non-corporate, practice in North Naples is looking for a Part-Time General Dentist to join our team of awesome dental professionals! This is a great opportunity for a Dentist who wants to work part time without all of the responsibilities of practice ownership. Compensation is based on experience and collections and can be discussed with Dr. Mabe in person. Please submit your CV or Resume for review to Smile@naplesfamilydentist.com. We look forward to meeting you and welcoming you to our team! Learn more about our practice at www.naplesfamilydentist. com. Visit careers.floridadental.org/ jobs/17733586/.

Experienced General Dentist, Palm Beach Gardens. This is a rare opportunity to be mentored by a doctor with internationally recognized credentials in cosmetic dentistry, full mouth reconstruction, dental implant surgery & sedation. Senior doctor is preparing to reduce his busy schedule allowing a new doctor to grow into a leadership role. Qualified doctor should be capable of producing at least $1M-

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$1.5M their first year in our practice.

Seeking a highly experienced general dentist looking for a long-term opportunity to join an extremely productive cosmetic & restorative practice in Palm Beach Gardens. Strictly fee for service.

No HMO’s or PPO’s. Our impeccable reputation for exceptional care has been well known in our community for 35 years. Integrity & good interpersonal skills are a big part of our culture where open and honest communication with patients and team is a top priority. Our state of the art facility is fully equipped with advanced technologies including CBCT scans. Our highly trained team maintains very organized systems that are proven to be very efficient & effective, allowing our doctors to focus on delivering quality dentistry. You will have the opportunity to perform all forms of dentistry including crown & bridge work, cosmetics, complete smile makeovers, endodontics, implant surgery as well as full mouth reconstruction at fees that are commensurate with the quality work you provide. Must have a minimum of 5 years clinical experience delivering quality dentistry. Proficiency in molar endo preferred. Cosmetic training through a recognized cosmetic dentistry institute is preferred.

Applicant must be personable with excellent communication skills. Position involves excellent compensation package + bonus package based on production with a guaranteed daily base salary. Medical insurance is included. Visit careers.floridadental.org/ jobs/17779424/.

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Today’s FDA (ISSN 1048-5317/USPS 004-666) is published bimonthly by the Florida Dental Association (FDA), 545 John Knox Road, Ste. 200, Tallahassee, FL 32303. FDA membership dues include a complimentary subscription to Today’s FDA. Nonmember subscriptions are $150 per year; foreign, $188. Periodical postage paid at Tallahassee, FL and additional entry offices. Copyright 2022 Florida Dental Association. All rights reserved. Today’s FDA is a refereed publication.

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103 | TODAY'S FDA november/december 2022

off the cusp

Peer Review is Paintball All Grown Up

By Hugh Wunderlich, DDS, CDE, FDA Editor

If you think about it, your whole life is a series of disputes that are settled in increasingly complex ways. When I was a young kid in Ohio, we would settle our differences with the “did so … did not … did so … did not” method. The kid to say it last won.

This technique had its limitations, so we advanced to “army.”

Later forms of this game used hand-propelled dirt clods that exploded on the loser. If the dirt was dry, it would never leave a mark until a bruise developed three days later.

Naturally, we elevated the game to BB guns with two limitations: an eight-pump maximum and no shooting in the head. However, when your opponent wears two pairs of jeans and his older brother’s band jacket, the game once again was reduced to “did so … did not.”

From this, I believe, was born paintball and …

Peer review, in its simplest form, is a mechanism by which the dental profession demonstrates the appropriateness and quality of the case it renders. It provides an expert and credible system for resolving disagreements that cannot otherwise be resolved regarding patient complaints about clinical care.

It is the dental “did not … did so” method. Ideally, both patient and doctor win, especially if you can avoid the Florida Board of Dentistry (BOD) and/or civil litigation. Trust me, trial attorneys do not always play fair. I learned this in …

Paintball has only two rules. If you are within 5 feet of your cornered cowering targets, you yell, “surrender, surrender!” They are “dead” for that game. When you are hit with paint on any part of the body, you are dead. On this day at a Bay area paintball park, my dental staff was assaulting a fortress defended by (oh, joy!)

trial attorneys. Each team member had been issued a protective mask and a semi-automatic paintball gun. Our mission was to capture a flag held in a plywood “Alamo” guarded by an equally equipped league of lawyers.

As we approached the fort quietly, I spied a gun barrel protruding about 6 inches off the ground. That meant some attorney would be on his belly and unaware of my stealthy flanking maneuver. I stood over him and yelled, “surrender, surrender!”

Failing to do so, I had no choice. I fired six rounds from 6 feet into his best side. Startled and stung, he spun to his feet. Looking down at his paint-free chest, he whined, “Hey, I have to see the paint to be dead!” His legal-esque argument had reduced the game to “did not … did so.” If only we had …

The Peer Review Manual of the Florida Dental Association (FDA) establishes a reference for resolving the most commonly encountered problems of patient complaints. A separate publication, the Ethics Manual, sets forth minimum acceptable procedures to safeguard rights of members accused of unethical conduct.

Peer review is intended to be a membership benefit. It is not intended to be an adversarial process. It is designed to preserve the doctor/patient relationship and resolve disputes that already have occurred, so patients do not file malpractice lawsuits or BOD complaints against members. The BOD is limited by the law when dealing with discipline cases.

I doubt the sum of dues paid to the FDA over a career would approach the cost of one litigation loss.

I believe peer review to be the best benefit in organized dentistry.

Without peer review all you have is, “did so … did not … did so … did not.”

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105 | TODAY'S FDA november/december 2022

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