TFDA November/December 2023 Issue by Florida Dental Association

today’s THE MEMBERSHIP ISSUE

A PUBLICATION OF THE FLORIDA DENTAL ASSOCIATION

Why FDA Membership Matters

Helping Members Succeed

Ensuring a Smooth Transition for Dental Practices

ADA Institute for Diversity in Leadership

Vol. 35, NO. 6 NOVEMBER/ DECEMBER 2023

contents NOVEMBER/DECEMBER 2023 floridadental.org

MEMBERSHIP ISSUE 18 A Recap of the 2023 ADA House of Delegates 27 Focused on the Mission of Helping Members Succeed 29 Why FDA Membership Matters

30 Key Things to Know Before Selling Your Practice 34 Ensuring a Smooth Transition for Dental Practices 38 The Transition Process 41 ADA Institute for Diversity in Leadership 42 2023-24 FDA President Dr. Beatriz E. Terry 46 Offering Your Patients a Customized Payment Plan 50 The Accidental Leader: Dr Rudy Liddell 53 Dental Lifeline Network — Changing Lives 55 FDC2024 Speaker: The Numbers Start The Story — The Ending is Up to You!

58 FDC2024 Speaker: Forensic Odontology 64 FDC2024 Speaker: 6 Critical Questions That Will Improve Team Effectiveness

68 Exhibit Marketplace 70 FDA Districts: Helping Members Succeed Throughout Florida! 72 So, You Think Your Water is Optimally Fluoridated? 76 Can You Name a Famous Figure Who Wore Partial Dentures?

IN EVERY ISSUE 2 Staff Roster 4 President’s Message 7 Did You Know? 9 Legislative 12 Preventive Action 16 Take The Lead 20 news@fda 23 In Memoriam 81 Diagnostic Discussion 88 Career Center 91 Advertising Index 92 Off the Cusp

Check out Today’s FDA online

Today’s FDA | 1

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

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.

EDITOR Dr. Hugh Wunderlich, CDE Palm Harbor

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

BOARD OF TRUSTEES PRESIDENT Dr. Beatriz Terry Miami

PRESIDENT-ELECT Dr. Jeffrey Ottley Milton

FIRST VICE PRESIDENT Dr. John Paul Lakeland

SECOND VICE PRESIDENT Dr. Dan Gesek Jacksonville

IMMEDIATE PAST PRESIDENT Dr. Gerald Bird Cocoa

SPEAKER OF THE HOUSE Dr. Don lIkka Leesburg

TREASURER Dr. Rodrigo Romano Miami

EXECUTIVE DIRECTOR Drew Eason, CAE Tallahassee

EXECUTIVE OFFICE Drew Eason • chief executive officer/executive director

deason@floridadental.org

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Greg Gruber • chief operating officer/chief financial officer

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Casey Stoutamire • chief legal officer

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Lianne Bell • leadership affairs manager

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Lywanda Tucker • peer review coordinator

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Breana Giblin • director of accounting

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Kaitlinn Sendar • fiscal services coordinator

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ACCOUNTING

TRUSTEES Dr. Tom Brown Orange Park

Dr. Christopher Bulnes Tampa

Dr. John Coroba Lake Mary

Dr. Bethany Douglas Jacksonville

COMMUNICATIONS AND PUBLICATIONS Renee Thompson • director of communications and marketing

rthompson@floridadental.org

Ext. 7118

Dr. Karen Glerum Boynton Beach

Dr. Fred Grassin Spring Hill

Jill Runyan • director of publications

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Dr. Reese Harrison Lynn Haven

Dr. Bertram Hughes Gainesville

AJ Gillis • graphic design coordinator

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ksimmons@floridadental.org

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Dr. Eddie Martin Pensacola

Dr. Richard Mufson Miami

Kelsey Simmons • communications and media coordinator

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Dr. John Pasqual Delray Beach

R. Jai Gillum • director of foundation affairs

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Dr. Enrique Muller Aventura

Kristin Badeau • foundation coordinator

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Madelyn Espinal • foundation assistant

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2 | November/December 2023

FDA FOUNDATION

FLORIDA DENTAL CONVENTION AND CONTINUING EDUCATION Crissy Tallman • director of conventions and continuing education

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Alyssa Bynum • FDC meeting assistant

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Brooke Martin • FDC marketing specialist

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Belle McCreless • FDC program coordinator

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Lisa O’Donnell • FDC program coordinator

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Deirdre Rhodes • FDC exhibits coordinator

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Joe Anne Hart • chief legislative officer

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Alexandra Abboud • governmental affairs liaison

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Jamie Graves • legislative assistant

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Larry Darnell • director of strategic initiatives and technology

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Charles Vilardebo • computer support technician

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Kerry Gómez-Ríos • director of member relations

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Megan Bakan • membership coordinator

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GOVERNMENTAL AFFAIRS

INFORMATION SYSTEMS

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FDA SERVICES | 545 John Knox Road, Ste. 201 • Tallahassee, FL 32303 • 800.877.7597 or 850.681.2996 Scott Ruthstrom • chief operating officer

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Carol Gaskins • commercial accounts manager

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Porschie Biggins • Central FL membership commercial account advisor

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Maria Brooks • South FL membership commercial account advisor

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Davis Perkins • Atlantic Coast membership commercial account advisor

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Today’s FDA | 3

The Importance of Membership By FDA President Beatriz E. Terry, DDS, MS

The Florida Dental Association (FDA) plays a crucial role in the development and advancement of dentistry. The FDA serves as a hub for networking, continuing education, advocacy and the exchange of ideas within our profession. Being a member of the FDA can significantly impact your career and professional growth. One of the most apparent advantages of joining the FDA is the opportunity to network with like-minded individuals. The FDA brings together general dentists and specialists, allowing us to build connections with our peers, mentors and experts. Networking opens doors to new career opportunities, collaborations and partnerships that may not have been possible otherwise. The FDA offers a wealth of resources for members to enhance their knowledge and skills. Membership includes access to workshops, seminars, webinars, conferences, publications and the annual Florida Dental Convention. Staying up-to-date with the latest trends and best practices can be a game changer in a competitive job market 4 | November/December 2023

like Florida. Members benefit from discounted rates, exclusive access to these educational resources and even free registration to our annual convention. Members also receive discounts on professional liability insurance and other insurance products offered through FDA Services. Being a part of the FDA can significantly boost your career development. The FDA offers continuing education such as Botox and aligner therapy, which can improve your qualifications and increase your earning potential. Moreover, the FDA can provide career guidance to help you navigate your professional journey more effectively. The FDA serves as an advocate for dentistry. Through its Governmental Affairs Office, the FDA works to influence policy, promote industry standards and protect the interests of its members. By joining, you can contribute to the collective voice of dentistry and play a role in shaping

president’s message its future. In addition, the FDA is an excellent source of dentistry-specific information and research. Members gain access to reports, studies and publications through the FDA and the American Dental Association that can provide valuable insights into market trends, innovations and emerging challenges. This knowledge can give you a competitive edge. Being a member of the FDA provides a sense of belonging to a community of individuals who share your interests and goals. This community can offer support during challenging times such as job searches, career transitions or professional setbacks like hurricane damage to your office. It’s a place to connect, share experiences and find encouragement. I recall making post-hurricane calls to our members and the sigh of relief on the other end of the call from a member in need. Membership in the FDA can enhance your professional credibility. It demonstrates your commitment to dentistry and willingness to adhere to industry standards. This can be particularly beneficial when seeking new job

Being a part of the FDA can significantly boost your career development. opportunities or new patients. In our rapidly changing and competitive job market, being a member of the FDA is more important than ever. Whether you’re a seasoned professional or just starting your career, joining the FDA can provide the support, knowledge and connections you need to succeed in dentistry. For members, you already know the value of membership. For those who haven’t joined yet — I hope that you’ll use this as the nudge to make it happen. FDA President Dr. Terry can be reached at bterry@bot.floridadental.org.

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

Today’s FDA | 5

6 | November/December 2023

did you know?

What Happens When You “Cash” a Virtual Credit Card? While they may seem convenient, when you “cash” these virtual credit cards, you are most likely charged a convenience fee (usually 3%), making your reimbursement from the plan much less.

By FDA Chief Legal Officer Casey Stoutamire

Did you know you do not have to accept an electronic payment or virtual credit card instead of a physical check or electronic fund transfer (EFT) from an insurance plan? In recent years, third party payers (insurance plans) have started paying health care providers using virtual credit cards. While they may seem convenient, when you “cash” these virtual credit cards, you are most likely charged a convenience fee (usually 3%), making your reimbursement from the plan much less. Although health care providers can request physical checks or EFT payments, many are unaware of this option. If you do not wish to be paid via virtual credit card, you must contact the plan and tell them to pay you via EFT or physical check.

In 2018, the Florida Dental Association’s (FDA) House of Delegates passed a resolution stating the FDA supports legislation to ensure third party payers cannot require a provider to accept an electronic payment or virtual credit card instead of a physical check; require the third party payer to inform providers they have the ability to choose whether to receive an electronic payment or physical check; and ensure the default payment method from a third party payer to a provider is a physical check. The FDA plans to file legislation again to address this issue during the 2024 Florida Legislative Session. If you receive pushback from a plan, please contact FDA Chief Legal Officer Casey Stoutamire at cstoutamire@floridadental.org.

Today’s FDA | 7

UNLOCK DENTAL BENEFITS Help patients access their full benefits through their dental insurance.

2024 DENTISTS’ DAY ON THE HILL TUESDAY, JAN. 30, 2024 MONDAY, JAN. 29 Legislative Briefing 6 PM at Hotel Duval Complimentary dinner to follow PRIOR AUTHORIZATION

TUESDAY, JAN. 30 DOWNCODING

BUNDLING

Capitol Visits Lunch Provided

CLAIMS

NON-COVERED SERVICES

G IS T E R F O

SCAN

VIRTUAL CREDIT CARD FEES

For more information, please2023 contact the FDA Governmental Affairs 8 | November/December Office at 850.224.1089 or gao@floridadental.org.

REGISTRATION OPEN: floridadental.org/ddoh

legislative

Unlocking Dental Benefits By FDA Chief Legislative Officer Joe Anne Hart

Dental offices accept dental insurance for many different reasons. Being an in-network provider allows patients to choose a dentist who will be covered by their plan and potentially reduce the amount of out-of-pocket expenses when dental care is provided. Participating as an in-network provider also allows dentists to build the volume of their patient base by accepting lower fees than their usual and customary fees. Dental insurance should be a win-win for the patient and the in-network provider; however, this is not the case. Dentists are challenged with denials and other administrative barriers

the plans they accept will honor their contract to cover services for their insured. Another issue creating challenges in dental offices is virtual credit card fees added to the receipt of payment for claims. Instead of asking dentists how they want to receive payment for claims, many dental insurance plans automatically pay claims through virtual credit cards, which reduces the amount being paid because a service fee is added to receive payment. Dentists have been told that they can opt out of the virtual credit card methodology and be paid by a check or electronic funds transfer. Still, after a period of time, they start receiving payments through virtual credit cards again. The FDA will pursue legislation to make this process an opt-in option instead of an opt-out option for dental offices.

When dental offices check to ensure that a patient is covered under their dental insurance plan before services are provided, claims must be honored and not denied by dental insurance plans.

that are time-consuming for staff to resolve, if resolved at all. At times, this interferes with the patient-doctor relationship when, after exhausting all attempts to collect payment from the dental plan, the dental office eventually seeks payment from the patient. The patient’s frustration is then directed towards the dentist and not his or her dental plan, which leaves the dentist looking like the bad guy (or gal) when it’s truly the dental plan. During the 2024 Florida Legislative Session, your Florida Dental Association (FDA) will pursue legislation addressing several dental insurance reform provisions, such as prior authorization and virtual credit card fees. When dental offices check to ensure that a patient is covered under a dental insurance plan before services are provided, claims must be honored and not denied by dental insurance plans. This is a practice that is happening daily and makes it difficult for dentists to be confident that

During session, your FDA will focus on helping patients unlock their full dental benefits under their dental insurance plans. Insurance should act as a financial safety net for patients by covering the costs of services and procedures provided by their dentist instead of shifting the cost to the patient and often to the dentist. As the FDA moves forward with this effort, we will need your help to provide real-life examples of how these policies affect your dental office. If you are experiencing any issues related to prior authorization denials or virtual credit card fees, please contact the Governmental Affairs Office at gao@floridadental.org. FDA Chief Legislative Officer Joe Anne Hart can be reached at jahart@floridadental.org.

Today’s FDA | 9

ARE YOU A MEMBER OF

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

.R Dr

a ir

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.

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A on - FD

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 Program Coordinator Belle McCreless at bmccreless@floridadental.org or 850.350.7106.

10 | November/December 2023

Advocacy is a Team Sport By FDA Governmental Affairs Office

We all know the saying, “There is no ‘I’ in team.” Instilled in us from childhood, this teaches us that one player cannot win team sports. Whether you play a sport or enjoy watching your favorite team, we can all agree that team sports require communication and collaboration. From the coaches down to the backup players, every person has a role to play. In many ways, advocacy is the same. We may not all have the same position, but we are striving to achieve the same goals: to protect patients and win for organized dentistry. As a Florida Dental Association (FDA) member, you are not alone in advocacy, just as players are not alone during a game. The Governmental Affairs Office (GAO) coaches the FDA’s advocacy team. Our job is to ensure that FDA members are informed and ready to advocate for dentistry. The plays created for session are part of our legislative agenda. Like any good coach, we take feedback and strategize with our players (you) to implement our game plan. Your job as a player is to help advance the FDA’s legislative agenda for the win. One member cannot take on advocacy alone. That is why we have teams of Legislative Contact Dentists (LCDs) who lead our grassroots advocacy efforts. But, just as in sports, we cannot keep the same players on the team. Members constantly ebb and flow with their advocacy involvement; that is why we strive to recruit new dentists to the LCD program. If you would like to help your team get to the finish line

Advocacy is a group effort and will take everyone playing their part to move our legislative agenda forward. — reach out to the GAO and learn more about becoming an LCD! Dentists’ Day on the Hill (DDOH) is the FDA’s championship game. Robust numbers of member engagement at DDOH show legislators that the profession truly cares about the state of oral health in Florida. The 2024 DDOH will take place on Tuesday, Jan. 30, 2024, with a legislative briefing the night before at Hotel Duval. While many of us may never get to experience going to the NFL Superbowl or NBA Finals, you can, in fact, attend your own association’s championship game by going to bit.ly/3LWhoU5 to register for DDOH! The FDA has a room block at Hotel Duval, so book your accommodations today before rooms are sold out. Advocacy is a group effort and it will take everyone playing their part to move our legislative agenda forward. We will need your help to stay in the game. If you are not currently involved with the FDA, we encourage you to call the GAO at 850.224.1089 or email us at gao@floridadental.org to find out how you can help us win during the 2024 Legislative Session. Go, Team FDA! Reprinted from the Sept. 23, 2023 issue of Capital Report. Today’s FDA | 11

Why Dental Practice Owners Should Consider Buying Employment Practices Liability Insurance By FDA Services Chief Operating Officer Scott Ruthstrom

As a dental practice owner, you know that your business is constantly exposed to risk. From malpractice claims to slip-and-fall accidents, many things can go wrong. Employment Practices Liability Insurance (EPLI) can cover risks you may not have considered. Employment-related issues can arise unexpectedly, exposing dental practice owners to costly legal battles, potential reputation damage and significant financial setbacks. To safeguard their practice and ensure smooth operations, dental practice owners should seriously consider purchasing EPLI for many reasons.

12 | November/December 2023

1. Protection Against Employee Claims Employee claims is one of the primary reasons for dental practice owners to invest in EPLI. These claims can include allegations of wrongful termination, discrimination, harassment, retaliation and other employmentrelated issues. No matter how well a dental practice is managed, disputes can arise. Having EPLI in place provides the necessary financial protection against these claims.

preventive action

Employee claims is one of the primary reasons for dental practice owners to invest in EPLI. EPLI is vital to protect dental practices from the potential legal and financial ramifications of employment-related claims.

2. Legal Costs and Defense Defending against employment-related lawsuits can be costly, even if the claims are ultimately dismissed. Legal expenses, attorney fees, court costs and settlements can add up quickly. These can significantly impact the financial stability of a dental practice. EPLI coverage ensures the practice has the financial means to defend itself in court and cover the expenses associated with these legal actions. 3. Peace of Mind EPLI provides dental practice owners peace of mind because they know they are protected against employment-related claims. With the assurance that their practice is backed by a reputable insurance policy, dental practice owners can focus on providing quality care to their patients and growing their business.

5. Protection Against Unfounded Claims Even if an employee’s claims are baseless, defending against them can be time-consuming and costly. EPLI can help dental practice owners address these false allegations without draining their resources. With appropriate coverage, the insurance company will assess the claim and provide support in resolving the matter efficiently. EPLI is vital to protect dental practices from the potential legal and financial ramifications of employment-related claims. In a world where litigation is increasingly common, investing in EPLI provides dental practices with the means to navigate the complexities of employment law confidently. FDAS Chief Operating Officer Scott Ruthstrom can be reached at scott.ruthstrom@fdaservices.com.

4. Protects Your Reputation An EPLI claim can damage a business’s reputation. Even if the dentist is ultimately successful in defending an EPLI claim, EPLI can help protect his or her reputation by providing access to legal counsel and other resources.

Contact FDAS For Your Insurance Needs! fdaservices.com | insurance@fdaservices.com | 800.877.7597 Today’s FDA | 13

Learn more about joining our dental network at

envolvedental.com

Proudly serving over 5.5 million Medicaid, Medicare, and Marketplace dental patients.

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Today’s FDA | 15

You’re Invited! 2024 Leaders Emerging Among Dentistry Program By FDA Leadership Development Committee Chair Angela McNeight, DMD

An organization’s success is primarily determined by the quality and effectiveness of its leadership. Whether it’s a local affiliate offering continuing education and mentorship, the Florida Dental Association (FDA) advocating for the profession of dentistry at the state capitol or within your dental office, we know that leadership matters.

is on delivering ideas and tools to help member dentists succeed in their leadership pursuits.

At the FDA, great leaders are developed through learned skills and practices. The Leadership Development Committee (LDC) is tasked with providing opportunities for our member dentists and dental students across the state to grow in their leadership.

We hope you will set aside some time to attend the 2024 LEAD program to continue your leadership journey and enjoy the community of like-minded colleagues and professionals.

Leaders Emerging Among Dentistry (LEAD) is an FDA program that provides participants with training to develop and enrich leadership and interpersonal skills. The focus

16 | November/December 2023

This year, LEAD will expand on this mission, offering more in-depth training and increased flexibility for attendees. Participants can choose to attend the morning seesion, the afternoon session or plan for the entire day and attend both.

Dr. Angela McNeight FDA LDC Chair Dr. Angela McNeight is an orthodontist in Melbourne and can be reached at angela.mcneight@gmail.com.

take the lead WHEN:

Friday, Jan. 19, 2024

WHERE:

Orlando Airport Marriott Lakeside 7499 August National Dr., Orlando

WHAT TO EXPECT Morning Session 9 a.m. - 2 p.m.

• Emotional Intelligence for Leadership Influence,

Bobi Seredich Take a deep dive into the soft skills all leaders need. The goal is to help participants harness the power of emotional intelligence and influence. Gain skills and knowledge on developing people, improving communication skills, empowering team members, managing pressure/change and building collaborative teams. Bobi is the founder of the Southwest Institute for Emotional Intelligence and managing partner of EQ Inspirations. With more than 23 years of experience, she will guide participants through a three-part interactive program to discover ways to create better self-awareness and influence across all levels of the organization. The morning session concludes with a networking lunch from 1 – 2 p.m.

Lunch 1 – 2 p.m.

The morning and afternoon sessions overlap with a shared networking lunch. This is an excellent opportunity to create new connections across the state with your colleagues and learn how you can become a leader in the FDA. Cost for lunch is $25.00 per attendee.

Afternoon Session 2 – 5 p.m.

The afternoon session begins with the networking lunch from 1 – 2 p.m.

• The Future of Dentistry, Marko Vujicic American Dental Association’s Chief Economist and Vice President, Dr. Marko Vujicic, will be covering the future of dentistry in Florida. From access to care to workforce shortages — what are the current trends and where are things going? What do the next FDA leaders need to know to ensure the FDA remains successful in our state?

• FDA House of Delegates Training Why do we have a House of Delegates (HOD)? The HOD is the largest leadership body in the FDA and is comprised of delegates from all parts of the state. This training will provide an overview of the House’s purpose and a mock session where delegates, or potential delegates, can practice their skills debating motions and voting.

Leadership Reception 5:30 – 6:30 p.m.

Optional networking reception, which will include the FDA’s HOD members, officers, trustees and others. Visit floridadental.org/lead for more information and to register for the 2024 LEAD program.

Sponsored by:

Today’s FDA | 17

ada hod

A Recap of the 2023 ADA House of Delegates By ADA 17th District Whip and FDA First Vice President John H. Paul, DMD

This past October, your Florida Delegation (the 17th) attended the American Dental Association (ADA) House of Delegates in Orlando for our most successful year in terms of politics. We submitted four resolutions for the betterment of the national association. ● Resolution #305 was to survey the membership concerning their desires regarding inclusion in Medicare. It was the House of Delegates’ (HOD) opinion that general membership would require some education to form an opinion to be surveyed and the resolution did not pass. ● Resolution #408 asked the proper ADA agency to investigate opportunities to increase interest and expand enrollment in allied dental careers. Resolution #408 was approved. ● Resolution #409 was a companion resolution to #408 to request that the Commission on Dental Accredi18 | November/December 2023

tation be translucent with the methodology for their current policies and to revise student-to-faculty ratios to allow for improvement in the number of allied dental professionals entering the workforce. Dr. Paul Miller was instrumental in writing and revising this resolution and secured the help of the 11th (Washington) in seeing the HOD approve this resolution. ● Resolution #210-S1 addressed the report of the ADA Task Force to eliminate barriers for underrepresented minorities, requesting that a diversity and inclusion officer be included to shepherd the efforts of the task force and the ADA. This resolution was defeated due to the cost of that position. The FDA has three members who served on ADA Reference Committees. It’s a big responsibility, and very few delegations have members on three committees.

4. ● Chair of the Dental Benefits, Practice and Related Matters Committee, Dr. Steve Zuknick. ● Business, Membership and Administrative Matters Committee member, Dr. Karen Glerum. ● Legislative, Health, Governance and Related Matters Committee member, Dr. Reese Harrison. The 17th was recognized in the HOD for having 100% participation in the American Denal Political Action Committee at the club level. It is important that our political action committee have the money to support our opinions in Washington, D.C. and everyone should consider contributing. At the close of this year’s HOD, Dr. Rudy Lidell announced his candidacy for President-elect of the ADA. He will spend the next year campaigning, and your support in this endeavor will be critical for his success.

5. Respectfully, Jp

Whip 17th District ADA John H. Paul DMD

Photos: 1. Your 17th Florida Delegation. 2. Left to right: Dr. Dan Gesek with incoming ADA President Dr. Linda Edgar and outgoing ADA President Dr. George Shepley. 3. Dr. Rudy Liddell entertaining in the suite. 4. FDA members being inducted into Pierre Fauchard Academy: Drs. Mark Limosani, James Vandenberghe, Zack Kalarickal ArNelle Wright, Donovan Essen, Tom Brown, Monique Belin, Jason Portnof and Millie Tannen. 5. Legislative reference committee member Dr. Reese Harrison, second from right.

Today’s FDA | 19

news@FDA

FDA Editor Dr. Hugh Wunderlich Recently Installed as the 2023-2024 AADEJ President The American Association of Dental Editors and Journalists (AADEJ) held its annual conference in Orlando at the beginning of October, where Dr. Hugh Wunderlich was installed as the 2023-24 AADEJ president. Congratulations, Dr. Wunderlich!

Biennium Reminder: Renew Your Dental License by February 28, 2024

Exciting News for Florida Dental Practices in 2024! We are pleased to announce that workers’ compensation rates are proposed to decrease once again for the upcoming year. At FDA Services (FDAS), we are committed to providing the best solutions for your insurance needs. That’s why we’re thrilled to remind you of our partnership with The Zenith, a leading provider of workers’ compensation coverage. When you choose to protect your team with FDAS and The Zenith, you not only get top-tier coverage, but you also enjoy an additional 25% upfront dividend, putting money back into your pocket. Our dedication to supporting organized dentistry within the workforce is unwavering, and we believe that by partnering with us you’re investing not only in the security of your employees but also in the future of your business. Contact us today to learn more about how we can help you save and support organized density. Call or text 800.877.7597 today!

Reminder: All Florida-licensed dentists must renew their dental license before midnight on Feb. 28, 2024. Visit CEBroker.com to review your current continuing education (CE) credits or self-report courses you may have completed. When you are ready to renew your dental license, visit flhealthsource.org. Do you still need CE hours to renew your license? The Florida Dental Association (FDA) offers free online courses exclusively for FDA members at floridadental.org/online-ce.

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 Dec. 31, 2023.

Enjoy Member-only Incentives on the 2023 Mercedes-Benz EQ Electric Lineup The vehicles are all-electric. The feeling is all-Mercedes. Introducing the EQ lineup. The craftsmanship, intelligence and performance you expect from a Mercedes-Benz vehicle is exactly what you get with the EQ lineup of vehicles. They continue the long legacy of excellence and push the level of commitment even further. Thanks to your FDA membership, you can even get savings starting at $5,001 off the all-electric vehicles in the EQ lineup. Go to bit.ly/3SxfMUR to save now. Disclaimer:

1Fleet incentives available only for qualified customers on certain MY23 Mercedes-Benz models. Not all engine variants are eligible for Fleet incentives. Please confirm with dealership if chosen vehicle is eligible for Fleet incentives at the time of purchase. Incentive must be used at time of purchase/lease. Incentives vary based on vehicle model as indicated. Eligible person must be the

20 | November/December 2023

ADA Ends Its Relationship With Overstocker The American Dental Association (ADA) recently announced that it has stopped accepting advertising from or doing business with liquidation company Overstocker.

This decision comes after multiple complaints from members about unfilled orders, unauthorized charges or poor customer service. ADA members are asked not to order from Overstocker and report any complaints to the Better Business Bureau or Federal Trade Commission. You can read more about this story by visiting ADA.org.

Dental Assistant Exam to be Offered in Spanish The Dental Assisting National Board will offer its Radiation Health and Safety exam in Spanish starting in January 2024, a move commended by the ADA Council on Dental Practice. “By offering the exam in Spanish, the workforce shortage will be reduced, and the diversity will reflect a diverse patient population,” said council Chair Dr. Jeffrey Ottley. To view the full story at ADA News go to bit.ly/3MDU3qD.

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. 20, 2024 at the Marriott Orlando Airport Lakeside

Florida Dentists Inducted Into the International College of Dentistry

Recently, a group of FDA member dentists were in attendance at the International College of Dentistry induction. Fellowship in the college is by invitation only and is granted in recognition of an individual dentist’s outstanding professional achievement, commendable service and dedication to the continued progress of dentistry for the benefit of humankind. The FDA sends congratulations to all of those who have been newly inducted and to the following FDA members: Drs. Natalie Carr Bustillo, Bradley Cherry, Thanhphuong Dinh, S. Donovan Essen, Curtis B. Hill, Jr., Craig Kara, Luis E. Martinez, Stephanie Mazariegos, Samira Meymand, Joseph Richardson and Samuel S. Wakim!

Where in the World is Today’s FDA? Thank you, Drs. Michaeal Cobbe and Farah Amin Cobbe, for taking Today’s FDA to the Godafoss waterfall in Akureyri, Iceland! Do you have vacation plans this winter? On your next trip, take a copy of Today’s FDA with you, take a photo and send it to jrunyan@floridadental.org to see it featured in an upcoming issue. Where will Today’s FDA venture next?

Today’s FDA | 21

news@FDA Learn more by visiting our virtual Member Center at floridadental.org

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.

Atlantic Coast District Dental Association

Dr. Monica Bursian Ortiz, Cape Canaveral

Dr. Jeffrey Abettan, Vero Beach

Dr. Caitlin Carmody, Gainesville

Dr. Jose Guedes Filho, St. Augustine

Dr. Stephanie Dye, Gainesville

Dr. Ronnie Israel, Vero Beach

Dr. Anika Gupta, Sanford

Dr. Payton Ledman, Jacksonville Beach

Dr. Omar Hernandez Linares, Kissimmee

Dr. Jason Lee, Jacksonville

Dr. Madison Huffman, Lake Mary

Dr. Samuel Posze, Jacksonville

Dr. Shelby King, Windermere

Dr. Eric Pressler, Jacksonville

Dr. Robert Mang, Oviedo

Dr. Jake Ryan, St. Augustine

Dr. Saloni Mehta, Gainesville

Dr. Emily Sklar, Lake City

Dr. Maha Muneer, Palm Coast

Dr. Cordaryl Whitehead, Jacksonville

Dr. Zunera Naeem, Port St. Lucie

Dr. Drew Wilburn, Interlachen

Dr. Gabriela Parpia, Sanford

Dr. Natalie Williams, Gainesville

Dr. Marc Al Khoury, Palm Beach Gardens Dr. Chelsea Dancek, Boynton Beach Dr. Carolina Heck, Deerfield Beach Dr. Taylor Micallef, Boca Raton Dr. Brittany Morgan, Pompano Beach Dr. Kevin Nguyen, West Palm Beach Dr. Andrew Peloquin, Boynton Beach Dr. Sandra Perez De La Cruz, Boston, MA Dr. Chloe Reyes, Marco Island Dr. Michelle Rousseau, Stuart Dr. Laury Rousseau, Pembroke Pines Dr. Furkat Sadykov, Boca Raton Dr. Enrique Santiago, Boca Raton Dr. Rachel Schapiro, Parkland Dr. Hannah Tremain, Fort Lauderdale Dr. Komal Virk, Fort Lauderdale Dr. Eric Waldman, Boca Raton Dr. Victoria Bejarano, Port Orange

Central Florida District Dental Association Dr. Avni Bhula, Gainesville

22 | November/December 2023

Dr. Liset Capote Victores, Kissimmee

Dr. Shyamaly Premaraj, Gainesville Dr. Kinnar Shah, Orlando Dr. Chetna Sharma, Orlando Dr. John Ulloa, Reddick Dr. Margi Vadaliya, Orlando Dr. Gelan Wang, Orlando Dr. Walker Wiggins, Gainesville

Dr. Madison Gatewood, Ponte Vedra Beach

Northwest District Dental Association Dr. Spencer Taylor, Milton

South Florida District Dental Association Dr. Carlos Almeda, Miami

Dr. Laura Zweifler, Lake Worth

Dr. Maria Altahona Sanchez, Weston

Northeast District Dental Association

Dr. Nina Azurin, Miami

Dr. Fatima Butt, Upper Darby, PA

Dr. Harrison Brandes, Weston

Dr. Grettel Apezpeguia, Miami Dr. Shoshana Barishansky, Miami Beach

in memoriam Dr. Cesar Carozzo, Miami Dr. Alexa Chaname, Miami Dr. Arletys Cuellar Suarez, Miami Dr. Elizabeth Diaz, Miami Dr. Yunior Diaz Sablon, Miramar

The FDA honors the memory and passing of the following members: John Balikowski Lakeland Died: 9/13/2023 Age: 85

Harold Brooks Vero Beach Died: 9/12/2023 Age: 79

Robert Clendenen Circleville, OH Died: 9/16/2023 Age: 100

Richard Rand Punta Gorda Died: 10/3/2023 Age: 76

Dr. Ethan Dunn, Miami Dr. David Escalante, Weston Dr. Laura Fernandez Gorrin, Hialeah Dr. Janisley Garcia Martinez, Miami Lakes Dr. Najwa Ghanem, Miami Dr. Gabriela Gil, Miami Dr. Andrea Gispert, West Park Dr. Jasmine Gonzalez, Hialeah Dr. Lilian Gonzalez, Pembroke Pines Dr. Maria Gonzalez Gilbert, Weston Dr. Tamara Insua, Miami Dr. Kenya Jimenez de Iorio, Miami Dr. Olesia Kesova, Hollywood Dr. Michelle Lavandero, Miami Dr. Harabel Liranza Pinon, Miami Dr. Claudia Lopez Hernandez, Biscayne Park Dr. Nicole Manfrini, Richmond, VA Dr. Claudio Marcantonio, Miami Dr. Arlety Mendez, Miami Gardens Dr. Roxana Millor Rosquet, Cutler Bay Dr. Lilliam Morales Rosell, Miami Dr. Ariana Murillo, Doral

Dr. Kamila Rodriguez Rocha, Miami

Dr. Alyssa Manski, Tampa

Dr. Raymond Rophie, Miami

Dr. Brandon Martinez, Cape Coral

Dr. Alexander Sanchez, Hollywood

Dr. Yenisbel Martinez Perez, Riverview

Dr. German Santana, Jr., Hollywood

Dr. Maydelin Martinez-Blanco,

Dr. Leonardo Silva, Hialeah

Clearwater

Dr. Amanda Socarras, Miami Lakes

Dr. Maylen Mendez, Brandon

Dr. Michael Urbina, Doral

Dr. Christy Mikhael, Redington Shores

Dr. Maidelys Valdes, Hialeah

Dr. Osmar Morales Fernandez, Nokomis

West Coast Dental Association Dr. Yasmeen Abugharbiyeh, Valrico Dr. Saman Adibi, Lutz Dr. Lisandra Almarales Batista, North Fort Myers Dr. Sergio Baron, New Port Richey Dr. Danielle Durrett, Hudson Dr. Kara Eckstein, Naples Dr. Marco Geris, Palm Harbor Dr. Renee Gomez, Sebring Dr. Samantha Hanan, Sarasota Dr. Belal Heddaya, New Port Richey

Dr. Nidhi Patel, Bradenton Dr. Priya Patel, Estero Dr. Jon Petrie, St. Petersburg Dr. Jonathon Rivera, Port Saint Lucie Dr. Bader Saleh, Temple Terrace Dr. Jacob Smith, North Fort Myers Dr. Nicole Steliotes, St. Petersburg Dr. Huy Richard Truong, Tampa Dr. Tianna Wallick, Riverview Dr. Logan Webb, Lakewood Ranch Dr. Ashley White, Sebring Dr. Brooke Wilson, Tampa

Dr. Reynaldo Novoa, Miami Dr. Mayelin Ortega, Miami Dr. Veronica Pena, Pembroke Pines Dr. Giselle Pendas, Miami Dr. Elizabeth Perez Menedez, Miami Dr. Jessica Prado Rivas, Miramar Dr. Manuel Ramos, Miami Gardens Dr. Stephany Rodriguez, Miami

Today’s FDA | 23

MORE THAN $1 MILLION PAID TO FLORIDA DENTISTS

AN UNRIVALED MEMBER BENEFIT — A REMARKABLE MILESTONE Unlike commercial insurance companies, which look for ways to reward shareholders, The Doctors Company is dedicated to rewarding our members. Fifteen years ago, we created the Tribute® Plan, an unrivaled financial benefit that rewards you and your fellow dentists for your loyalty and dedication to superior patient care. As an organization committed to providing the best imaginable service, we are profoundly honored to have now attained an industry-leading achievement — the distribution of more than $150 million in Tribute Plan awards. While other insurers have attempted to follow our lead, The Doctors Company is by far the only dental malpractice insurer that celebrates the careers of dentists with rewards of this magnitude.

CALL FDA SERVICES AT 800.877.7597 OR VISIT FDASERVICES.COM TO LEARN MORE.

No other insurer pays

FLORIDA MILESTONES

$21M+

$1.3M

600 +

Tribute balance for Florida dentists

Tribute awards paid to date

Number of Tribute award recipients

LEARN MORE ABOUT TRIBUTE Visit thedoctors.com/tribute

Tribute Plan projections are not a forecast of future events or a guarantee of future balance amounts. For additional details, see thedoctors.com/tribute.

Dr. Rod olfo O

RENEW YOUR MEMBERSHIP FOR 2024 TODAY! THREE EASY WAYS TO PAY:

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membership

Focused on the Mission of Helping Members Succeed FOCUSED ON THE MISSION OF HELPING MEMBERS SUCCEED

The beauty of organized dentistry—at the component, state and national levels—is the opportunity for dentists of all practice modalities to speak with one voice, learn from each other and work together to further common interests. Please join us for another year by renewing your membership today!

The Florida Dental Association (FDA) is proud to be an extension of your team. You’re an expert in dentistry. We provide expertise in advocacy, insurance, finance, education and much more so you don’t have to go it alone. We’re well-positioned for the future which looks better when we’re working together. The beauty of organized dentistry — at the component, state and national levels — is the opportunity for dentists of all practice modalities to speak with one voice, learn from each other and work together to further common interests. There are lots of member resources on our website. We regularly send out email alerts and Today’s FDA is sent out six times a year. But sometimes it’s just easier to call! Whatever the question, we encourage you to reach out to your FDA to find the answer.

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General question? Need to update your contact information? Call the FDA main line at 850.681.3629 and a person will answer the phone during work hours!

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Third party payer issues? Call in-house expert Casey Stoutamire at 850.350.7202.

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membership@floridadental.org

850.681.3629 We’re well-positioned for the future which looks better when we’re working together.

Have a challenging patient? Peer Review can help avoid Board of Dentistry complaints and legal fees. Contact Lywanda Tucker at 850.350.7143.

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850.681.3629 The Florida Dental Association (FDA) is proud to be an extension of your team. You’re an expert in dentistry. We provide expertise in advocacy, insurance, finance, education and much more so you don’t have to go it alone. We’re well-positioned for the future which looks better when we’re working together.

Want to know more about what’s included with your membership? Ask the Membership team by calling 850.681.3629.

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FOCUSED ON THE MISSION OF Legislative questions or want to be more HELPING MEMBERS SUCCEED engaged with advocacy? Contact Joe Anne Hart at 850.350.7205. The Florida Dental Association (FDA) is proud

Please join us for another year by renewing your membership today!

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The Florida Dental Association (FDA) is proud 850.681.3629 to be an extension of your team. You’re an expert in dentistry. We provide expertise in advocacy, insurance, finance, education and much more so you don’t have to go it alone. We’re well-positioned for the future which looks better when we’re working together.

to be an extension of your team. You’re an in dentistry. providemore expertise in Wantexpert to volunteer orWe become involved? advocacy, insurance, finance, education and Ask Lianne Bell about the FDA’s Leaders Emerging much more so you don’t have to go it alone.

Please join us for another year by renewing your membership today!

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membership@floridadental.org The Florida Dental Association (FDA) is proud 850.681.3629 to be an extension of your team. You’re an expert in dentistry. We provide expertise in advocacy, insurance, finance, education and much more so you don’t have to go it alone.

Among Dentistry by calling 850.350.7114.

We’re well-positioned for the future which looks better when we’re working together.

We’re well-positioned for the future which looks better when onto we’re the working together. Challenges logging website or

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Communities of Interest? Larry Darnell can help The beauty of organized dentistry—at the if you call 850.350.7102. component, state and national levels—is

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the opportunity for dentists of all practice to speak one voice, learn of Wantmodalities to participate in with the Florida Mission from R. each and work together further call her Jaiother Gillum can share all thetodetails; Mercy? common interests. at 850.350.7117.

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Please join us for another year by renewing

Please join the FDA or renew your membership today at your membership today! floridadental.org/dues or by scanning the QR code below.

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Curious about CE or your 2024 licensure renewal? Contact Belle McCreless at 850.350.7106.

floridadental.org/dues membership@floridadental.org 850.681.3629

Today’s FDA | 27 floridadental.org/dues membership@floridadental.org

The Florida Dental Association presents

The NEW Communities of Interest provide opportunities for member involvement and engagement through an online platform. Share ideas, ask questions, provide feedback and network with your peers in private online communities that focus on:

∞ Dental Education and Licensure ∞ Dental Benefits and Care ∞ Membership and Leadership ∞ New Dentists Register now by scanning this QR code and get started today!

fda members

Why FDA Membership Matters Here’s what your colleagues are saying about why it’s important to be a member of the Florida Dental Association (FDA).

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“The FDA had supported my career from the beginning. Figuring out the ins-and-outs of insurance. Navigating how to purchase a practice. The mentors helped me make good decisions. I would not have known these people if I did not get involved early on in my career.” — Dr. Casey Lynn

floridadental.org/dues membership@floridadental.org 850.681.3629

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“The number one service that I utilize through the FDA is insurance. I have my workman’s comp policy through FDAS. They provide awesome benefits and discounts that no one else could match.” — Dr. Monique Belin

floridadental.org/dues membership@floridadental.org 850.681.3629

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“As a new dentist, I like that the FDA gives you insurance services. They really guide you to which insurances you need to have.” — Dr. Lorena Corzo

floridadental.org/dues membership@floridadental.org 850.681.3629

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“The way FDA supports me is through advocacy. Without them up in Tallahassee fighting for our ability to continue to practice in the way that best suits us and our patients helps me every single day.” — Dr. Michael Starr

floridadental.org/dues membership@floridadental.org 850.681.3629

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“There is absolutely no reason not to join the FDA. There is so much going on. There is so much to learn. There is so much to discuss.” “It is important to hear from you, because you are counted; we care about your thoughts because we care about what you can give … to our profession and our community.” — Dr. Rodolfo Olmos

floridadental.org/dues membership@floridadental.org 850.681.3629

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“You are putting your trust in a group that is going to protect this wonderful profession that we have. The stronger we are as a group the better we can protect our profession moving forward.” — Dr. Brandon Alegre

floridadental.org/dues membership@floridadental.org 850.681.3629

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“There are a million benefits to joining the FDA. There are discounts on certain products. There are services we can get, insurance, malpractice, advocacy and camaraderie. It’s like a family. You are never alone if you are a member of the FDA.” — Dr. Jessica Stilley-Mallah

floridadental.org/dues membership@floridadental.org 850.681.3629

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“The FDA has been intentional about bringing new voices and new faces to the table to allow our voices to be heard. Investing time and leadership skills in these new leaders. The FDA has been crucial in helping me advance and elevate as a dentist and as a person.” — Dr. ArNelle Wright

floridadental.org/dues membership@floridadental.org 850.681.3629

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MEMBERS SUCCEED “Through HELPING local meetings I have met a lot of great mentors. me out(FDA) at the beginning when TheThey Floridahelped Dental Association is proud to be an extension of your team. You’re an career out I had even more questions. It helped my expert in dentistry. We provide expertise in and made me feel like Ifinance, am supported.” advocacy, insurance, education and much more so you don’t have to go it alone. — Dr. Stephanie Mazariegos

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We’re well-positioned for the future which

looksFDA betterstaff whenis we’re working together. “The whole amazing. Anytime you call you are going to get an answer whether The beauty of organized dentistry—at the it is on insurcomponent, state and national levels—is ance, legal situations, etc., they are always helpful the opportunity for dentists of all practice and answer the phone away.” modalities to speak right with one voice, learn from each other and work together to further — Dr. Eddy Sedeno

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common interests.

Please join us for another year by renewing your membership today!

“The FDA can provide you with many opportunities, all the way from continuing education, networking opportunities, the ability to attend the FDA convention and advocacy.” — Dr. Melissa Sedeno

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Please for another by renewing today at Please join the FDAjoin orusrenew youryear membership your membership today! floridadental.org/dues or by scanning the QR code below.

Today’s FDA | 29 floridadental.org/dues membership@floridadental.org

Key Things to Know Before Selling Your Practice By Principal & Broker for Doctor’s Choice Practice Transitions Greg Jones

causing a decline and if the practice is healthy. If you depend upon every penny from the sale of your practice for retirement, this is easy to avoid. If you don’t mind taking less for your practice because you value your time off more than getting top dollar, that is fine. The overall goal is to try not to let collections drop by more than 10% as this is when banks start to waver.

Stop Taking Cash Taking cash is a gray area of discussion, but many business owners do so and do not reflect it in their financial statements. If you want to get paid on those cash collections, start reporting all income. I have never met a buyer (or lender) who will take the seller’s word for it. Brokers, buyers and lenders all base their evaluations on what is shown on your corporate tax return or Schedule C.

Control Your Overhead

Selling your dental practice is an enormous, life-changing decision from a professional, personal and financial perspective. Surprisingly, it is common for prospective sellers to not plan this process and their exit strategy. You would be astonished at how many dentists call and are ready to immediately bring their practice to market. Failing to plan is planning to fail. Following is a list of common pitfalls to avoid so you can make the sale of 30 | November/December 2023

your business as seamless, profitable and stress-free as possible.

Stay on the Throttle! When selling a practice, many doctors start working less as they get closer to retirement by taking more vacations and referring out procedures they once did but no longer want to do. Practice valuations are typically based on a weighted average of your last three years of collections, with the highest weight in the most recent year. Buyers and banks do not want to see a sudden drop in working days or collections as it makes them wonder what is

Whether you are considering a potential sale or not, when did you last do a health check on your practice expenses to ensure they aligned with market standards? You were not taught in dental school how to run a business, nor do many dentists take continuing education to further their knowledge on becoming more profitable. In this article you will find a list of the market norms for certain expenses in a dental practice relative to your collections. How does your practice measure those norms? Note that these metrics are a rule of thumb, and your overhead will vary based on your collections due to fixed expenses not increasing with collections.

selling your practice Whether you are considering a potential sale or not, when did you last do a health check on your practice expenses to ensure they aligned with market standards? ● Dental supplies: 6% to 8% ● Lab: 7% to 9% ● Rent or mortgage: 5% to 7% ● Marketing/advertising: 0.5% to 1.5% ● Office expenses: 0.5% to 1.5% ● Staffing and payroll: 20% to 25% Some of these expenses are easier to modify than others. Let’s use lab or supply costs, for example. You can change suppliers, labs or the products themselves tomorrow to potentially get a better fee schedule and increase profitability. While your rent or payroll cost is more of a process, the return could be more significant. When making changes, you must weigh a cost vs. benefit analysis for anything you are doing. Payroll and wages can be one of the most challenging overhead expenses to adjust. We will discuss more about how to cut costs pertaining to your rent expenses below.

Renegotiate Your Lease Landlords drool when they hear the word “dentist.” Why? Many dentists don’t like to relocate due to the extensive build-out cost. Therefore, you often see dentists in the same location for more than 30 years. On top of that, dentists have one of the lowest default rates (less than 1%) of any business in America. Are you negotiating your rental rate and terms every time you are due for renewal? Your rent is arguably the most negotiable expense in your

business. The standard base rent increase is 3% per year, and it compounds. After 10 years, you could pay more than $2,000 a month more than you started out paying. Does your space need new flooring, paint, ceiling tiles or baseboards? These are all things that could be negotiated into your next lease renewal as a “tenant improvement” cost for the landlord to cover. Another thing to remember if you plan to sell is that a buyer’s lender will require them to have at least a 10-year lease remaining through the existing term or through options to renew. A bank will not lend any buyer the money if that is not the case, as the lease term must match or exceed the length of the banknote, which is generally 10 years. Essentially, the bank wants to make sure the buyer pays back the note, and ensuring that the dentist has a place to do dentistry is a key component of being able to do that. Negotiating a lease is very delicate, and it is highly recommended that you enlist the help of an experienced real estate attorney.

Increasing Your Fees and Insurance Reimbursements Despite the obvious positive implications for practice profitability and value, many dentists are reluctant to raise fees in the years leading up to the sale of their dental practice. Most prospective sellers are

winding down their careers and thus believe themselves to be financially sound they are reluctant to “burden” their patients with fee increases. However, a dentist who has not raised fees for three years passes on a need for a 9% fee increase if the buyer is to make up that ground lost due to inflation alone. “Who cares what the former owner did or didn’t do with the fee schedule of the practice? The buyer can fix that problem!” Unfortunately, it’s not that simple. Even in instances where buyers increase fees as a necessary act to cover the ground lost by the seller to inflation, the mere act of increasing fees is often viewed by patients and staff of the practice as a negative rather than the appropriate market adjustment. As a result, buyers may see this as too much of an uphill battle to consider your practice a fit for them. Some sellers think that patients will leave if they increase fees. Less than 10% of patients will notice a fee increase from $650 to $710. The same fee increase made by the seller will result in less than 1% of the patients making an issue of the increase. In contrast, the same very reasonable and appropriate change made by the buyer typically creates a real sense of outrage and confusion for a majority of both the staff and patients of the practice. t Today’s FDA | 31

selling your practice Did you know that you can also renegotiate your insurance reimbursements/fee schedules? There are companies out there that can help you with this and most dentists are not aware that their insurance fee schedules are typically able to be negotiated every two years. There have been instances where doctors have increased their collections by more than $100,000 per year by utilizing someone to help them with these negotiations. Remember, you are doing the same amount of dentistry and have the exact same costs; therefore, this additional $100,000 becomes all profit. This becomes an immediate benefit for the business owner and it will increase your practice value by having higher collections and net earnings.

Staying Modern with New Technology Bridging the gap between the boomer generation (typical seller) and the millennial generation (typical buyer) regarding office décor and equipment is a constant hurdle when selling a dental practice. The younger generations crave new technology, whether it is a new iPhone or a 3D printer; older generations could typically care less. A highly dated practice making $400,000 per year can be harder to sell than a modern practice making only $150,000 annually. The takeaway is that a buyer needs to understand that if you make $400,000 per year, as in the example above, you can afford to buy new equipment and renovate the office over time. As a seller, you must consider what buyers want and how to make your practice more appealing and valuable. I am not telling you to necessarily buy all new equipment for your office before putting your office on the market because you probably will not get a full return on this investment, but we can find a balance. Finding the balance may be new paint, baseboards, reupholstering dental chairs, artwork and so on. If you are more than three years from retirement, you may want to consider buying some new equipment. Think about it like this: you will get the benefit and joy from it, it is a tax write-off and it will increase your practice value.

The Potential Drawback of a C-Corp If you are registered as a C-Corp, you will want to have a plan of action with your accountant pertaining to the sale of your practice more so than other tax elections. One notable aspect of C-Corps is that they are subject to double taxation. The corporation pays taxes on its profits, and then shareholders also pay taxes on any dividends they receive from the corporation. This same principle could apply when you sell the business if certain items are not handled beforehand. We are not certified public accountants, nor do we give tax advice. Still, we recommend you consult with someone about any exit strategy to understand your tax liability, particularly if you are a C-Corp.

Transition Your Spouse Out of the Practice Having spouses working in the practice is common; however, when it comes time to sell, these family members can pose an issue from a transition standpoint. Almost always, your spouse will want to retire simultaneously with you. Having a selling doctor exit the practice along with, let’s say, an office manager makes a transition from the buy-side more difficult, which, in turn, may not give them the comfort they need to purchase the practice or it gives them a reason to offer less money. We suggest hiring a replacement six to 12 months before you and any team members retire. This gives a new team member time to be trained and create relationships with your patients. The other option is for the spouse to stay on post-sale for six to 12 months. Most sellers prefer to remedy the situtation before a sale.

Closing Thought You are in the office almost daily and probably don’t even walk through the front door. My best advice is to have three friends or family members do a walkthrough of your office and point out anything that looks like it needs updating. You can then decide if it would be a good investment and worthwhile to get these items replaced. Remember, your landlord may pay for it! Don’t get more than three opinions, or you will be updating your entire office. Principal and Broker for Director of Operations for Doctors’ Choice, Greg Jones, can be reached at greg.jones@doctors-choice.com. Today’s FDA | 33

practice transition

Ensuring a Smooth Transition for Dental Practices: Philosophy, Preparation and Integration By Suzanne Ebert, DMD

Dental practice transitions are complex endeavors requiring careful planning and consideration to ensure a smooth transition for the incoming doctor and the practice. In this article, we’ll explore the importance of aligning philosophies of care and share practical tips for a successful start in dental practice.

34 | November/December 2023

Aligning Philosophies of Care One of the fundamental aspects to consider in a dental practice transition is the alignment of philosophies of care between the incoming doctor and the existing practice owner. A shared dentistry philosophy encompasses practice pace, treatment approach and staff collabora-

One of the fundamental aspects to consider in a dental practice transition is the alignment of philosophies of care between the incoming doctor and the existing practice owner. tion. Having alignment on these elements is crucial for long-term success. While there’s no universal “right” or “wrong” philosophy of care, understanding your preferred practice style is essential for making informed decisions about your future career or retirement plan. Scenario: Mismatched Philosophies Consider the scenario of Dr. Aaron, who built a practice for more than 30 years based on intimate patient relationships and personalized care. When he decided to sell his practice to Dr. Brandon, the assumption was that Dr. Brandon would continue this philosophy. However, Dr. Brandon had a different strategy, emphasizing a fastpaced, high-volume practice. The result was disgruntled patients, staff turnover, negative feedback and the eventual closure of the practice. This situation could have been avoided through open dialogue and a comprehensive evaluation of the practice and its philosophies of care. Dr. Brandon should have asked more questions about the practice’s operations and considered a gradual transition to his style to minimize disruptions. Dr. Aaron should have had staff weigh in by interviewing the buyer to help identify the right person. After all, office staff will be working closely with the new doctor. Preparing for a Successful Start Whether you’re an incoming doctor or a practice owner, thorough preparation is critical to a successful transition once you align your care philosophy. Consider taking these steps to avoid common mistakes: • Build an Integration Plan The smoothest transitions are the result of careful planning. Work together to create an integration plan that outlines clear expectations. Discuss issues like punctuality, patient workload and decision-making processes. Prioritize tasks like credentialing and licensure. Be sure that the incoming doctor has enough patients, staff and supplies from day one.

• Get a Sneak Peek Have the incoming doctor shadow the office before his or her official start date. This allows for familiariztion with the practice’s flow, staff and routines. Encourage interactions with staff and organize team-building activities to foster relationships from day one. • Acknowledge the New Team Member Celebrate the new doctor’s arrival through professional photos, website updates and social media announcements. Inform patients well in advance about the change in their care provider to avoid surprises. • Involve the Dental Community Successful integration extends beyond the practice’s walls. Make introductions to specialists, referring physicians and patients. Get involved with local organizations and your district dental society to establish a strong presence in the community. Conclusion A smooth transition in dental practices requires careful consideration of philosophies of care, thorough preparation and open communication. By aligning philosophies, building integration plans, offering sneak peeks, acknowledging new team members and involving the community, incoming doctors and practice owners can ensure a successful start and long-term success. For more detailed guidance and a sample integration plan, download the ADA Practice Transitions’ ebook, Building an Integration Plan: Your Guide to Retaining Staff and Patients, at bit.ly/3Qvp8z9 for more advice and a free sample plan. Dr. Suzanne Ebert is the Vice President of Dental Professional Career Services at the American Dental Association and can be reached at eberts@ada.org.

Today’s FDA | 35

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practice transition

The Transition Process By Greg Auerbach, MBA, Henry Schein

Once the practice is evaluated, it is listed for sale with a written listing agreement. In Florida, it is required that anyone being paid to transact a business be a licensed Florida real estate broker. Florida establishes several types of representation and it’s important to understand what that means. Is there a fiduciary relationship (similar to an attorney) as opposed to just a representation of the “transaction?” Dual representation is not permitted in Florida, and commissions paid by both parties may cloud any representation or transactional advisory services. Once the practice is listed for sale, purchasers have the opportunity to establish themselves as a match. Lender “pre-qualification” is not a requisite, but knowing what you are looking for — procedure and payor mix, size, production/collections, facility, equipment and location — is essential. A more refined search allows for faster decision-making. The speed of decision-making has become essential in securing most practices.

Several articles, including some authored by me, provide an overview of the transition process. To bring the information up to date, let’s examine a few key points on value and process. For owners, there should be many up-front documents and data gath38 | November/December 2023

ering for evaluation. We require business tax returns and profit and loss statements, practice management (production, collection and demographic) reporting, leases, contracts and other items. Each is important to set an appropriate price and work through financing and agreements later — the more complete the information, the easier the entirety of the process.

As for practice price, the metrics have changed from historically published figures. Expect to pay 75% to 90% or more of last year’s gross collections. In some cases, practices can sell outside of that range, as there continue to be more purchasers than sellers, especially for quality practices. Remember, what exists at closing, not two or three years ago, is what is being purchased, which is why “averaging” previous years is not always relevant. Quality evaluators will look at the

As for practice price, the metrics have changed from historically published figures. Expect to pay 75% to 90% or more of last year’s gross collections. history to understand the makeup and trending of the practice but not to formally establish value. In making a purchase offer, it should include the important parts of the transaction, including the offer price, target closing date, due diligence period to review financials, equipment and patient records, restrictive covenant (enforceable in Florida) and any other particulars including real estate details (lease or purchase). It may also include a proposed allocation of the price.

Once the offer (Letter of Intent) is agreed upon, formally securing financing, completing due diligence and negotiating contracts begins. Expect anywhere from six to 12 weeks and, typically, any notice a purchaser needs to give to a current employer would be added to the target closing date. In this process, it is vital to have a lender, attorney and accountant who know dental practice transitions (and practices). The cost of not having qualified counsel can be significantly higher than having

them, and they should be productive participants in completing your transaction. Many details go into selling and or purchasing your dental practice. The biggest takeaway is not to go it alone. Knowledgeable advice and guidance are invaluable but remember that the ultimate decision is yours. Mr. Greg Auerbach is a transition specialist and consultant for Henry Schein and can be reached at Greg.Auerbach@henryschein.com.

Today’s FDA | 39

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ada.org/mercedes | 866.628.7232 1 Fleet incentives available only for qualified customers on certain MY23 Mercedes-Benz models. Not all engine variants are eligible for Fleet incentives. Please confirm with dealership if chosen vehicle is eligible for Fleet incentives at the time of purchase. Incentive must be used at time of purchase/lease. Incentives vary based on vehicle model as indicated. 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 Dec. 31, 2023.

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ADA Institute for Diversity in Leadership By Gabriela Asensi, DDS

My name is Gabriela Asensi. I’m originally from Venezuela but have lived in the USA for about 30 years. I am proud to be an American citizen since 2006. I went to dental school in Venezuela, and when I moved to the states, I became a pediatric dentist and went back to dental school to practice in Florida. I have been told that I am an example of persistence and leadership. Nobody teaches you how to be a good leader. I can tell you that leadership takes work. We know that when we decide to become dentists, we will lead a group of people to get together and inspire them toward a common goal: our patients’ oral health. As dentists, we have countless opportunities to lead teams at the clinical level and in the corporate or public health world, to name a few. I can tell you that if you are a female, immigrant and Hispanic dentist, it can be even more challenging because, traditionally, minorities have had fewer opportunities to become leaders. Our profession has come a long way, though. Nowadays, it is well-known that inclusion and diversity in a team make it more effective and productive. The American Dental Association (ADA) has led the way in including diverse groups in leadership roles. The Institute for Diversity in Leadership (IDL) was created about 20 years ago with the purpose of including traditionally underrepresented dentists in leadership roles. The IDL is, at least for me, one of the best-kept secrets of the ADA. I was fortunate enough to have the opportunity to know about the IDL through a friend of mine who

graduated with me from dental school and is very active in the dental political world. She indicated that the IDL existed, that she had gone through it, and that my experience as chief of the dental department at Nicklaus Children’s Hospital made me a great candidate for the IDL. My experience at the ADA’s IDL was eye-opening. Not only did I learn from experts in leadership about inspiring people to achieve a common goal, persuasion, cultural respect, negotiation skills and conflict resolution, but I also had to develop a project that was impactful in my community. I also mingled with incredible people from different cultures, backgrounds, countries and sexual orientations. In my case, I decided, after conversations with my tutor, Dr. Jane Grover, to promote the one-year-old visit among general dentists in my community. I contacted my local dental association in Miami to get the word out about a “Baby Day” in my pediatric dental office. I reached out to local daycares offering free dental screening for toddlers and complimentary breakfast for the mothers/caregivers. I invited children up to age two and local general dentists to model the knee-to-knee position to examine these generally uncooperative patients. The event was well received, and I was able to teach some of the general dentists in my area to feel comfortable around babies and toddlers. I am now a proud member of the IDL class of 2022. I highly recommend the opportunity to participate in the ADA’s IDL. Information about how to spend three paid weekends at the headquarters of the ADA in Chicago in an unparalleled immersion in the latest leadership knowledge and research is available online at bit.ly/3tTtJSN. Dr. Gabriela Asensi is a pediatric dentist in Miami Dade and can be reached at gasensi14@gmail.com.

Today’s FDA | 41

fda president

2023-2024 FDA President Dr. Beatriz E. Terry By FDA President Beatriz E. Terry, DDS, MS

1. I am the youngest of four siblings. My parents, Jose and Sylvia Terry, Cuban exiles, arrived in Miami in 1960 with my two older sisters escaping Fidel Castro’s communism. My brother and I were born in Miami. We were raised in Hialeah, where many Cubans settled and attended parochial schools. Our Catholic faith was deeply cemented into my life and still is today. We moved south to Westchester, where I attended St. Brendan High School, followed by Florida International University. I was very close to my maternal grandmother, Blanca Machado Marcovits. She lived with my family until I was 13 years old. She was my mentor, role model and chauffeur as my mom worked full time. She was the smartest person I knew, speaking five languages, born and raised in Austria-Hungary until moving to Cuba with her family as a young adult. She was a female business owner when women mostly stayed home. She widowed young in Cuba and 42 | November/December 2023

took over my grandfather’s pharmaceutical business in Hialeah and Bogota, Colombia, S.A., which she eventually sold. I met my future husband, Edy A. Guerra, D.D.S., through my brother during high school; however, we started dating after college and eventually married. We both attended Marquette University School of Dentistry in Milwaukee, WI. I graduated from Marquette with honors and was inducted into the Omicron Kappa Upsilon Dental Honor Society and Alpha Sigma Nu Honor Society and I later moved to St. Paul, MN where I attended a residency in periodontics and dental implant surgery at the University of Minnesota. We moved back to Miami following the completion of my residency and quickly began our family. We have three adult children, Isabel, Julian and Pablo and we are so proud of the adults they have become. They, too, are people of faith and are amazing citizens of the world. Our middle son, Julian, will be getting married in 2024, and we are thrilled to be moving into this next phase of our lives. Since moving back to Florida, I began a private periodontal practice and got very involved with organized dentistry as a member first and then as a leader. I’ve always had a desire to serve others, and leadership positions in various clubs during high school and college fulfilled that desire. It was a natural transition that I would continue along this track with dental clubs and associations as

a line officer and eventual leader of groups such as the the Florida Dental Association (FDA), Miami Dade Dental Society, the South Florida District Dental Association, the Florida Association of Periodontists and the CEOLA/HELO Hispanic Dental Association. I also serve on the Miami-Dade College Dental Hygiene Advisory Board and as an examiner for the Florida Dental Board. I have been a member of the American Dental Association (ADA) since dental school and I have served as a delegate and alternate delegate to the ADA since 2008. I have served on the Committee on Annual Meetings to the ADA and am a proud American Academy of Periodontology member and past state and regional liaison (2013-2015).

My goal as president this year is to grow our membership through educating our colleagues about all the important issues the FDA advocates for.

I have been honored to be nominated and inducted into the Pierre Fauchard Academy, the American College of Dentists and the International College of Dentists and have been awarded a Recognition Award and a Leadership Award from the FDA. Becoming president of the FDA is by far my greatest accomplishment! I feel at home here. I have made amazing friends throughout the state and can truly say I would spend my free time with any one of them. In fact, I do! I have traveled with numerous colleagues, and I have forged some lifelong friendships with FDA staff. We work together to better our great profession while being mindful of providing the best dental care possible to the citizens of our state. I most enjoy advocating for dent

7. Today’s FDA | 43

Came for the insurance ... Stayed to support my profession.

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Presidential Favorites

• Hobbies: tennis, fishing and snow skiing. • Favorite food: Florida stone crabs. • Fondest memory: completing my 34-day walk along

The Camino de Santiago from France to Spain in 2021.

8. tistry through the Governmental Affairs Committee and have created special relationships with past and present legislators. My goal as president this year is to grow our membership through educating our colleagues about all the important issues the FDA advocates for. Together, we are stronger in number and carry a louder voice.

Photos: 1. Dr. Terry with her family & significant others at FDC 2023 (l to r) Isabel, Julian & Pablo.

• Guilty pleasure: PIZZA and attending live concerts, where I spend a lot of money on great seats!

• Favorite sports teams: Miami Heat, Miami Dolphins and Auburn Tigers.

• Leisure activities: reading and boating. • Vacation destination: any place with a physical

component (need to work off the good food and drink), good food, culture, history and a comfortable bed; preferably surrounded by friends and family.

• Favorite book: Outlander by Diana Gabaldon. • Favorite flower: hydrangea. 3. Marrying Dr. Edy A. Guerra in Miami. • Dessert: bread pudding. 4. With FDA past-presidents and good friends (l to r) Drs. Dave Boden, Jerry Bird and Beatriz Terry. • Candy: dark chocolate. 5. With FDA Governmental Affairs committee members. • Drink: Macallan whisky. 6. Dr. Terry and her exceptional staff. 7. With her #1 organized dentistry mentor Dr. Idalia Lastra. • Movie: “Sound of Music.” 8. With her closest South Florida co-leaders (l to r) Drs. • Music: All genres — R&B, Country, Spanish Ballads, Beatriz Terry, Jeannette Pena Hall and Rodrigo Romano. 2. Celebrating Dr. Terry’s 3rd birthday with her siblings & dad in Hialeah.

Smooth Jazz, Rock & Roll, coffeehouse.

• Artist: Van Morrison. • Pets: I love dogs. I have two Australian Labradoodles, Fudge, 15 years old and Valentina, five years old.

Today’s FDA | 45

Offering Your Patients a Customized Payment Plan By Bento

More and more dental practices are recognizing the advantage of launching their own membership plans — a strategy proven to enhance patient loyalty and increase recurring revenue.

However, delving into this endeavor may unveil complexities beyond your initial perception. Instead of simply bundling services, there are numerous crucial factors to consider:

• Tailor Plans to Meet Your Patients Unique Needs Patient needs vary across different locations, with each dental practice catering to a specific demographic. 46 | November/December 2023

For instance, some dental practices primarily serve uninsured patients, requiring membership plans that include essential dental treatments. Conversely, practices located in areas with a higher demand for major treatments like crowns and implants should design plans that align with these needs. Offering customized plans that truly address your target market’s specific requirements is crucial.

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• Have a Comprehensive Plan for Your Membership Plan Administration You will need an established system to manage the plans, enrollments and utilizations. The system should enable you to easily update your plan offerings, enroll patients and track the status and usage of the plans. You can either set up your internal practice management system, which involves additional programming, or explore membership plan software platforms equipped with built-in features that enable you to create and administer flexible plans while minimizing manual tasks for your office staff.

• Prioritize Marketing Strategies Effective marketing plays a significant role in the success of dental membership plans. It connects your services with the right audiences, driving growth and ensuring a sustainable source of recurring revenue. To excel in this aspect, you will need to:

Offering customized plans that truly address your target market’s specific requirements is crucial.

Bento is an innovative dental membership plan solution that provides dental practices with a comprehensive, end-to-end solution, seamlessly handling all aspects of dental membership plans, from plan customization and launch to administration and marketing. As the only solution of its kind endorsed by the American Dental Association (AND the Florida Dental Association), Bento will be an ideal choice for you to achieve success in every facet of your dental membership plan business. Learn more at bento.net/in-office-plan.

1. Identify your target audience: Define your ideal customer base by analyzing your patient database, including their demographics and behaviors. 2. Select appropriate marketing channels based on the characteristics of your customer base. For example, if the majority of your patients are less tech-savvy, offline marketing such as in-office promotions and mailing, will be more effective than digital channels. 3. Constantly analyze and optimize your campaigns by evaluating the key metrics and outcomes. Align with your team: Ensure your entire staff is aligned with your marketing goals and encourage them to participate in sales efforts. You can designate an in-house marketing expert responsible for crafting strategies and executing campaigns or take advantage of marketing support offered by membership plan platforms.

Today’s FDA | 47

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The Accidental Leader Dr. Rudy Liddell Announces His Candidacy for President-elect of the ADA By West Coast District Dental Association

me at a meeting and said, ‘You come to all the meetings anyway. Do you have any interest in running for a position?’ And so, I tried.” Read his professional bio in the sidebar, and you’ll note that Dr. Liddell worked his way up through leadership positions at every level — Hillsborough County Dental Association (HCDA), West Coast District Dental Association (WCDDA), FDA and ADA. For all the titles, accomplishments and experience gained along the way, Dr. Liddell remains approachable, easy-going and encouraging. As the 17th District Trustee on the ADA’s Board of Trustees, Dr. Liddell is particularly interested in meeting and talking with new and young doctors in Florida and encouraging them to explore opportunities.

Dr. Rudy Liddell, one of our Florida Dental Association (FDA) members and a leader in organized dentistry at the local, state and national level, confirmed his intent to run for President-elect of the American Dental Association (ADA) on the closing day of SmileCon, the ADA’s annual session. Over the next year, he will campaign throughout the country in hopes of being elected to the position next fall. Those who know him locally are not surprised that his work and dedication would lead him to this moment. However, if you ask Dr. Liddell, he did not start out this way. “I call myself The ‘Accidental Leader,’” said Dr. Liddell in his characteristic humble tone, his eyes smiling as he spoke. “Some have the ambition to be in leadership positions at a young age. I never did. Someone approached 50 | November/December 2023

“We all give back in different ways. Some teach, some run study clubs, some volunteer and some give their time to leadership in our associations,” said Dr. Liddell. His advice for a resident or new member looking to identify ways to get involved is to start local. Show up at your local meeting and network with colleagues in your immediate area. “When I started, I felt like a little fish in a big pond,” said Dr. Liddell, “and then when you know everyone local, you move up to the next level and the next. It’s the same thing each time — little fish, big pond — but you keep building your network.” He recalls a moment when he was walking through the halls at the 2022 ADA annual session in Houston with his wife, Sherri, and their sons. “One of them said to me, ‘Dad, you know everyone.’ I love that, and I love the fact that I have a network of friends that stretches coast to coast.”

Dr. Liddell is particularly proud of the challenging time through which he led the FDA. During his term as president of the FDA, COVID shut down our dental practices. Dr. Liddell was selected to be part of the ADA task force that, in record time, developed the “Back to Work Toolkit” with policies and training to handle workforce issues, equipment needs and safety practices. Dr. Liddell also served on Governor Ron DeSantis’ Re-Open Florida Task Force. He was the only doctor in the group invited due to the work done with the ADA to get dental practices open again. Another issue Dr. Liddell tackled during COVID became a lasting change in policy in our state: the way dental licenses are issued. “During COVID, the schools shut down, and our doctors could not do their live exam, so they, in turn, could not obtain their license.” With a team of lobbyists, Dr. Liddell petitioned Governor DeSantis to suspend the requirement of a live patient exam as an emergency order. Post-COVID, that decision eventually led to advocating for the elimination of the live exam requirement altogether. “Florida is a good example of how associations should be run,” said Dr. Liddell, “We have people working together toward the same goals.” Identifying and developing leaders is key.

Dr. Rudy Liddell Bio Dr. Rudy Liddell, originally from Pittsburgh, Pennslyvania, moved to Florida during high school. He studied engineering at the United States Military Academy and the University of South Florida before attending dental school at the University of Florida, graduating in 1982. Dr. Liddell practices dentistry in Brandon as part of a small group with four partners. Throughout his career, Dr. Liddell has held leadership positions in organized dentistry. He started as a delegate to the FDA in 1998 and went on to serve as an officer for the HCDA (19992005), the WCDDA (2005-2010), and a trustee to the FDA (2010-2014). He also served as an officer for the FDA (2014-2021). Dr. Liddell’s involvement extended to national dental organizations as he chaired the FDA’s Council on Financial Affairs from 2012-2015 and the ADA’s Council on Dental Practice from 2019-2020. He currently serves as the 17th District Trustee on the ADA’s Board of Trustees. Dr. Liddell has been married to his wife, Sherri, for 38 years. They have two sons, Michael and Brian, who are both married and living in different states.

“People are usually passionate at the start. Over time, as they grow into the role, diplomacy grows. Your ability to collaborate with others, lean on others and delegate,” Dr. Liddell explains, adding, “The magic is transferring your passion to someone else, and they don’t even realize it happened.” Sometimes, doctors express interest and ask for ways they can help and volunteer. Others, like Dr. Liddell when he was first getting involved, must be asked. A servant-leader himself, Dr. Liddell knows, “When you ask people to do things, they are usually happy to help because they see how hard you work and that you wouldn’t ask them to do anything you wouldn’t do yourself.” Hard work is nothing Dr. Liddell shies away from. In the coming year, as he campaigns for the highest position in our organization, he will find his calendar full. He’s excited and ready. If you would like to help his campaign, donations can be made by scanning the QR code to the right.

Dr. Liddell can be reached at a2thgator@aol.com. Reprinted with permission from the West Coast District Dental Association. Today’s FDA | 51

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donated dental

Dental Lifeline Network – Changing Lives had broken and he had only four teeth remaining. Eating was challenging, and he was often in pain. Unfortunately, Donaldo was unable to afford the care he needed to address his deteriorating dental health. Retiring from a dental equipment repair technician career, he and his wife now rely on a small Social Security benefit. Their limited income is fully allocated to monthly expenses, leaving Donaldo with no means to cover the necessary dental care he required.

(L to r): Dental team: Laura, Maureen, Dr. Eggnatz, Donaldo, Ursula and Ayli. By Dental Lifeline Network

Dental and oral health care is not always easily accessible to those who face health challenges or disabilities. Dental Lifeline Network • Florida’s Donated Dental Services (DDS) program helps these individuals who are unable to afford treatment receive the dental health care they need. Since the program’s inception in 1997, Florida volunteer dentists and laboratories have donated more than $11.2 million in comprehensive treatment to almost 2,200 patients. The DDS program rehabilitates and transforms the oral health of patients like Donaldo, 82, who lives with his wife in Broward County. Donaldo has faced multiple health challenges through the years, including suffering a stroke and receiving three heart stents. In addition, he has glaucoma, hearing challenges and orthopedic problems with his knees and back. Unfortunately, his dental health was also a concern; his teeth were decayed, many

Fortunately, a team of DDS volunteers came together to help: a general dentist, oral surgeon and endodontist. Dr. Michael Eggnatz, in collaboration with two volunteer labs, contributed a six-unit bridge, an upper partial denture, and a lower implant retained denture. These remarkable volunteers gave Donaldo invaluable donated treatments that significantly changed his life. “We are and will be eternally grateful for the care provided on our behalf by all of the participating members of Dental Lifeline Network Florida!” said Donaldo’s wife about his experience in the DDS program. “Because of your generosity, my husband’s life has changed dramatically. Thanks to your donation, he has a new lease on life. He is able to eat and looks 10 years younger!” More than 500 patients are on the Florida waitlist and in desperate need of care. Will you help one? Visit WhyIDental.org to learn more about the program, become a volunteer, and help those who otherwise will be unable to access dental care. DLN makes volunteering easy. Sign up today by scanning the QR code below.

Today’s FDA | 53

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The Numbers Start The Story — The Ending is Up to You! By Laci Phillips Newland

Our passion for this industry reaches all levels of dental practice. We coach teams to reach new all-time levels of success in an environment that thrives on team cohesiveness rooted in solid business systems. Each unique opportunity to work with amazing dental teams starts with the “Number Story.” The numbers tell us where we are and then give us the vehicle to measure the success of the plans in place. There are basic numbers each practice should monitor, but there are also numbers to watch that can vary between practices and should be relative to key goals the practice is working on for that time. We call these Key Performance Indicators (KPIs). We dutifully gather

our KPIs each month, each quarter and each year. We put them in our tracking documents and send them for everyone to review. Wikipedia defines KPIs as follows: KPIs are financial and non-financial metrics used to help an organization define and measure progress toward organizational goals. For us, KPIs will tell us how we compare to the goals we set for ourselves. They help us measure the past periods’ performance to celebrate our victory or analyze our det Today’s FDA | 55

fdc2024 speaker

By using your practice management software to track your acceptance rate, you are monitoring your leading indicators. By using your software efficiently, you will be able to capture your KPIs, making tracking and analyzing easier and increasing productivity.

feat. Either way, we need to track them, we need to discuss them and then we need to act on them. The bottom line: our KPIs are essential and we need to understand them. The one bad thing about most KPIs is you can keep them the same; they reflect the past. Most KPIs are considered “lagging” indicators; a key ingredient to success is having leading indicators in place. The first step in doing this is to understand the difference between lagging indicators and leading indicators. Here is an example unrelated to dentistry. For many of us, a personal goal is weight loss. A clear “lagging” indicator that is easy to measure is when you step on a scale and have your answer. Your weight is your “lagging” indicator. However, how do you reach your goal? For weight loss, there are two “leading” indicators.

ing toward our goals and warning signs that things are heading in the wrong direction. A few samples of analysis results:

• Lagging indicator: Outstanding receivables are steadily increasing. • An indicator to look at time of service collection procedures or healthy financial arrangements.

• Lagging indicator: Overall production and production per patient are down slightly. • It could be an indicator to review diagnosis proce-

Keeping track of your weight, calorie intake and burned calories gives you a balanced KPIs worksheet and increases your odds of success.

dures, treatment presentations, patient acceptance rates or new patient trends. Lagging indicators always start the story, but trends and changes tell you where to look. Leading indicators, on the other hand, change quickly and are generally seen as a precursor to the direction something is going. Leading indicators are often related to activities undertaken by the team, like exercising and eating in our weight loss example. Your leading measurements/activities should always align with your strategy and goals and be reviewed frequently, if not daily.

Breaking it down in our world …

Some examples could be:

1. Calorie Intake 2. Calories Burned

Lagging indicators are always easier to track and are backward-focused, measuring data already captured in your practice management software. Simple ones we look at every month are our net productions, net collections, percent of write-offs or outstanding receivables, to name a few. Tracking can indicate how well we are track-

56 | November/December 2023

• Verbal skill training. • number of calls/communications to overdue patients per day. • number of calls to patients with outstanding treatment per day.

• Asking for referrals from existing patients. • New marketing plans. • Utilizing the tools available to you. Once you understand the leading and lagging indicators, you can start working with the solid base of reliable data available to you through your practice management software. Tracking the number of calls made to overdue patients daily may sound difficult and time-consuming unless you have an amazing phone system that will track your calls and your actions from each call. The same can be true of outstanding treatment plans. By using your practice management software to track your acceptance rate, you are monitoring your leading indicators. Your software will also give you easy access to the lists you need to generate reminders, customize newsletters and data for due and overdue patients.

Our practice management systems and our teams give us many numbers to track. By using your software efficiently, you will be able to capture your KPIs, making tracking and analyzing easier and increasing productivity. The key to this is understanding the numbers, acting on the results and ultimately effecting change. Ms. Phillips Newland earned her bachelor’s degree in communications and is the founding partner of Practice Dynamics and can be reached at laci.phillips@practicedynamics.net. Ms. Phillips Newland will offer the courses “Metrics and Goals – The Numbers Start the Story!” on June 21 and “Your Patients’ Expectations: Ditch the Rose-Colored Glasses,” and “Constantly Plugged In and Desperately Seeking Balance” on June 22 during the 2024 Florida Dental Convention. Learn more about her course offerings at floridadentalconvention.com.

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Today’s FDA | 57

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Forensic Odontology By Diplomate of the American Board of Forensic Odontology, Anthony R. Cardoza, DDS

tional option for postmortem identification. DNA is also now utilized, but due to its high cost and the extensive time required for analysis, it is used sparingly or when no other option exists. Other forms of postmortem identification include visual, personal effects, fingerprints, scars, marks, tattoos and medical radiographs. Forensic dental identification has been successful because of the nature of human dentition. Enamel is the hardest substance in the body and the only exposed portion of the skeletal system (Figs. 1 & 2). Teeth are very resistant to thermal damage, blunt force trauma and the dentition remains stable during tissue decomposition. In addition, the dentition is unique to a specific individual.

The field of forensic odontology is an area of dentistry concerned with the application of law in both criminal and civil proceedings. Forensic odontology has two primary disciplines: postmortem identification and bite mark (pattern injury) analysis. Forensic odontologists also assist authorities with multiple fatality incidents, age determination based on tooth development, recognition of child abuse/intimate partner violence and participate in civil proceedings as a expert witnesses.

Dental Identification As forensic dental identification specialists, we are typically the last conven58 | November/December 2023

This includes not only the morphology of the coronal portion of the tooth but also the morphology of the roots, the pulpal chamber and their relationship to their surrounding structures (i.e., sinus proximity, mandibular canal proximity, interproximal bony trabecular patterns, etc.). Following the natural dentition, if you add manufactured dental restorations, the unique combination for any individual can factor into the millions. There are numerous important reasons for identifying the deceased. A legal certification of death is necessary to consummate legal matters such as life insurance, wills, etc. There are family and personal reasons as well (closure). In criminal investigations, it is essential to estab-

lish the victim’s identity to proceed with the criminal investigation and to identify the suspect. In a fire, for instance, the bodies are often burned beyond visual recognition (Fig. 3). Personal effects are also destroyed or lost. Even if the personal effects are recovered, they may not be considered reliable due to the typical calamity surrounding a fire. A forensic anthropologist will examine the remains of the skeletal system and can then determine the age, race and sex of the victim. Positive identification is best performed by examination of the surviving dentition by the forensic odontologist. Even the dental remains may be destroyed in a fire where the temperatures may be very high (1000°C). Crowns may fracture or explode, leaving only the roots. The bone may also be completely consumed, leaving only scattered roots with no bony sockets for reference. Forensic dental identification is most often accomplished by the comparison of the radiographs of the teeth of the decedent (postmortem) (Fig. 4) with the dental radiographs obtained from the dentist of the suspected victim (antemortem) (Fig. 5). Ideally, the antemortem radiographs furnished should be the original full mouth series. Often, this is not the case. Children’s radiographs are typically bitewings only unless they also have orthodontic records. Often duplicate radiographs, not the originals, are sent and have been either poorly duplicated and/or are not labeled right and left for orientation. In addition, the antemortem radiographic image may be of poor quality due to improper operator technique

Fig. 1

Fig. 2

Fig. 3 Fig. 4

t Today’s FDA | 59

fdc2024 speaker Forensic odontology is an exciting field where dental health care professionals can utilize their skills and training for a field beyond dentistry.

submitted. This allows the forensic dentist to verify any dental treatment performed after the radiograph date. It is important for practicing dentists to keep complete patient records on file and continually update them, including the radiographs. One of your records may be needed for a postmortem dental identification.

Bite Mark Analysis

Fig. 5

Fig. 6 (cone cuts, overlapping interproximals, elongation/foreshortening, etc.) or poor processing (contrast, burned images, etc.). When poor antemortem radiographs are compared to an ideal postmortem radiograph, the two may appear inconsistent. This could seriously hamper the identification effort. In forensic dental identification, we stress that good quality, properly mounted and labeled original antemortem radiographs be sent for comparison. In addition, copies of the victim’s dental treatment progress notes should be 60 | November/December 2023

The study of bite marks involves the analysis of teeth contacting another object or medium. Thus, bite mark analysis is a type of forensic pattern analysis similar to tool mark analysis. Unlike dental identification, which is a quantitative analysis, bite mark analysis relies on the odontologist’s interpretation of the pattern; therefore, bite mark analysis is primarily subjective. For this reason, bite mark opinions, though based on scientific methods and principles, can be highly variable based on the individual’s interpretation of the pattern injury, resulting in experts often giving different levels of opinion on the same pattern injury. The consequence we see today is that bite mark analysis has become highly controversial, and in the United States there have been 38 exonerations by DNA testing of individuals after they had been previously charged or convicted where these charges or convictions had been based partially on faulty bite mark evidence. The study of bite mark analysis involves comparing the patterned injury or bite mark to the suspect biters’ dentition. The classic appearance of a bite mark is two semicircular or ovoid arches that oppose each other with a central ecchymosis (Fig. 6). The bite mark pattern is photographed from multiple angles with a scale present for reference. In addition, the bite mark is swabbed for possible suspect DNA. It is necessary to take full arch dental impressions of both the maxillary and mandibular arches on the biter. In addition, complete dental charting of all the present, missing and restored teeth, including

charting anomalies such as fractures, spaces, rotations, etc., wax bites and intraoral photography. If the accused suspect biter is in jail, collecting these records will require a court order, and the individual has the right to have his attorney present (note: the biter could also be the victim who bit their attacker in self-defense). Once all the records are collected on the bite mark and the suspect biter, the odontologist can complete his analysis. The analysis compares the bite mark photo, which has been digitally resized to life-size 1:1 proportion to an overlay of the incisal/occlusal edges of the suspect biters’ teeth. This is accomplished by creating a digital hollow volume overlay of the dental models by scanning the models, using a flatbed scanner, into the computer (Fig. 7). Then, with photographic software, the incisal edge overlay can be inverted and superimposed onto the bite mark pattern photo for comparison and analysis (Fig. 8). Finally, the odontologist will submit his report to the entity that retained him. In this report, the odontologist will list all his steps to complete the analysis and formulate an opinion. The range of opinions includes: can include biter in a pool of suspect biters, cannot include biter in a pool of suspect biters; exclusion (did not make the bite); and inconclusive (not enough data or poor-quality data to formulate an opinion). Forensic odontology is an exciting field where dental health care professionals can utilize their skills and training for a field beyond dentistry. Choosing a career path as a forensic odontologist or forensic dental autopsy technician (the auxiliary’s role in forensic dentistry) should not be viewed as a hobby but, in fact, a second career in addition to your primary career in the field of dentistry. The hours can be long and the monetary return low or non-existent, but the personal reward and satisfaction can be significant. Dr. Anthony Cardoza earned his dental degree from Northwestern University Dental School in 1985. Dr Cardoza is a Fellow of the American Academy of Forensic Sciences (AAFS), a member of the American Society of Forensic Odontology (ASFO), and a Diplomate of the American Board of Forensic Odontology (ABFO). Dr. Cardoza is the Chief Forensic Odontologist for the San Diego and Imperial Counties of California. Dr. Cardoza maintains a private

Fig. 7

Fig. 8 practice in San Diego County, California and can be reached at Openwide@arcdds.sdcoxmail.com. Dr. Cardoza will offer the courses “Twenty-First Century Laser-Assisted Dentistry” on June 21, “Dispelling the “CSI Effect” Myth – An Overview of Contemporary Forensic Dentistry,” and “Twenty-First Century LaserAssisted Dentistry Workshop” on June 22 during the 2024 Florida Dental Convention. Learn more about his course offerings at floridadentalconvention.com. Today’s FDA | 61

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6 Critical Questions That Will Improve Team Effectiveness By Debra Engelhardt-Nash

At the heart of a great dental practice is having exceptional clinical skills and the ability to deliver outstanding care; however, 85% of the time with patients is spent communicating with them, and 15% of the time with them is spent in clinical application.1 Enhancing Communication Skills One thing is the clinical ability to treat the patient; another skill is to communicate effectively. If we don’t communicate effectively from the beginning of patient engagement, we may never reach treatment acceptance and delivery of our care. Most people who call your office have already decided to choose your practice. It becomes the team’s responsibility to validate they made the right decision during the first 64 | November/December 2023

moments of contacting the office. Talking to someone on the phone is the FIRST opportunity to set the office apart and give them the right impression of the quality of care and patient experience they will receive.

Question One Award-winning storyteller and motivational speaker Kelly Swanson said, “Nobody Notices Normal.” Steer away from the standard phone call describing office policies and regulations and asking patients about their insurance coverage. These conversations should happen after you have impressed the patient with your customer ser-

vice proficiency. Patients tend to be more compliant with your office standards when they feel they will be treated well. Avoid making your office rules the focal point of the patient introduction. Replace the questions “What insurance do you have?” or “Do you have a dental emergency?” with Question 1: “What Inspired You to Call?” Initiating the first conversation with this question will immediately set your office apart from other practices and allow the patient to tell you what motivated them to seek your care. This question also leads the conversation into describing why your practice is right for them. “Based on what you’re looking for, I understand why you would choose us.” Informing patients how your practice delivers care and the atmosphere provided to the patients makes the office distinctive within minutes of contact.

Question Two We must gather important information from the patient so we can begin establishing their records. Some practices launch into questions regarding personal details before establishing rapport or gaining patients’ permission. As a courtesy to patients and to demonstrate your sensitivity to asking them to divulge personal information, it is an extra touch to ask their permission. Question 2: “May I Ask You A Few Questions?” This minimizes the patients’ perception that you are asking scripted questions to complete a form.

Question Three All team members have the responsibility to create a perception of quality. This happens when team members find opportunities to validate the practice and endorse the doctor. The team has several opportunities to tell their story of how the office and the doctor are exceptional. Before the receptionist/business coordinator ends the phone call with the new patient, they should share their endorsement of the office. Question 3: “May I tell you a little more about our practice?” Provide statements such as “The doctor has a great chairside manner” or “We will give you all the time you need to help you make the right choices for your care.” These comments help the patient feel comforted that they are in the right place for dental care. The dental auxiliary can also endorse the doctor and the standard of care provided by the office by telling

Dental professionals who excel in communication foster trust, alleviate patient anxiety and contribute to the success of their practices. the patient their “story.” Why do they work there? What about the office makes them proud? How do they feel as a member of the team? These comments establish trust and rapport with the patient and endorse the doctor and the practice. These remarks must be authentic, not scripted or contrived. This extra step in the patient process only takes a few extra moments but makes a significant difference in communicating well with patients. Presenting treatment to patients can be challenging. The doctor’s comprehensive treatment plan should be presented after the consultation, diagnostic information gathered and the clinical examination is performed. Rather than listing what the patient’s needs are, prior to presenting a written treatment plan, ask the patient this critical question:

Question Four “Would you allow me to tell you what I would like to do?” This question provides the opportunity to present the patient with the doctor’s plan for ideal care. The treatment discussion should be done with great sensitivity, incorporating all aspects of excellent communication — body language, tone of voice, pace and wording. This is not a rushed conversation. It is important to be an intentional listener and convey total engagement. Sitting at eye level, leaning slightly forward, demonstrates, “You have my attention.” The decision to accept treatment is the responsibility of the clinical team, not the financial team. They are responsible for negotiating payment terms AFTER the patient and the doctor have agreed on the treatment plan. Avoid giving the patient a “list” of what they “need” and dismissing them too soon to discuss financial arranget Today’s FDA | 65

fdc2024 speaker ments with a team member. Speak to the patient, not to the paper. How much dentistry has been planned but not completed by patients of record? Improving communication skills in the hygiene department will have a dramatic effect on increasing practice productivity. Establishing a way to initiate a conversation with patients about their incomplete treatment plans can boost profitability. Based on past discussions, it should never be assumed the patient isn’t interested in or can’t afford their treatment. If the office stops talking about incomplete treatment based on assumptions, the patient will never prioritize the unmet treatment needs.

Question Five “Tell me what has prevented you from moving forward with your care?” The hygienist needs time to have this conversation with patients of record. It should happen at the beginning of the hygiene appointment. Here is an example of how this conversation would flow:

• “In reviewing your records today, we noticed there is work that the doctor has recommended that has yet to be completed.

• Tell me (or help me understand) what has prevented you from having this done?”

The patient will probably bring up the following reasons: too expensive. • It’s not bothering me. • It’s I don’t have time. • Working on communicating with the patients to address these objections will ease the conversation. Here are some examples:

• “If cost is a factor, think what it would have cost you

if we had done it at the time the doctor first recommended this treatment and think what it might cost you if we wait. It will never cost you less than now. If we can find a way to help this be affordable for you, what other concerns do you have?”

66 | November/December 2023

• “Our goal is to help you avoid having any dental

discomfort or unplanned dental problems. If you wait until it bothers you, it will be a more significant and costly treatment.”

• “If time is a major concern, it would be best to take

care of this now, before it becomes a more significant problem requiring more appointments.”

It is also important to remember why that patient is coming to their hygiene visit. Be careful that it doesn’t become too “social.” Sometimes, we become so friendly with the patient we forget to talk about dentistry. Excellent communication will be a balance of relationship-building and clinical conversation. Communicating financially with the patient requires confidence and skill and the art of negotiation is needed. Patients are not interested in how your financial protocols serve YOU. They are interested in how your financial protocols serve THEM. The office’s financial standards should be friendly to the patient and healthy for the practice. Written protocols should be established and used as a guideline for financial discussions.

Question Six Posting or presenting them in writing diminishes the ability to negotiate your preferred payment options with patients. If the office has several options but has one they like, that is the option that should be presented first. Please wait for the patient to respond to whether that option will work for them; if not, propose the next preferred choice. If none of your options suit the patient, ask Question 6: “Tell me, what you do have in mind?” If their preferences do not work with your office protocols, find an affordable solution that will work for the practice and the patient. This is a two-way conversation. When you begin the financial conversation, avoid the statement, “We require.” Replace it with, “Most of our patients prefer to take care of their charges …” and describe your preferred payment method. Allow the patient to respond. Working in an atmosphere of financial discomfort is not conducive to patient or practice

satisfaction. The team presenting financial protocols and negotiating payment terms must be thoughtful, professional and comfortable with their skills. Mastering the art of communication is critical for every member of the team. A tiny shift in the approach can change the conversation. Dental professionals who excel in communication foster trust, alleviate patient anxiety and contribute to the success of their practices. The team can improve patient outcomes and increase practice productivity by asking the right questions, actively listening and expressing empathy. Providing exceptional dentistry requires skill that is learned and constantly honed. Natural abilities are trained to provide fine work for patients. Providing excellent communication is also a skill that is learned and honed. Natural abilities are tuned to give the patient an exceptional experience. The combination of both creates

an outstanding practice that is patient care-driven and guaranteed to be highly successful. Ms. Englehardt-Nash earned her bachelor’s degree from the University of California at Long Beach. She is a board member of the American Academy of Dental Practice Administration and vice president of the American Academy of Dental Management Consultants. Ms. Englehardt-Nash is a founding member of the Academy of Dental Management Consultants. She can be reached at debraengelhardtnash@gmail.com. Ms. Englehardt-Nash will offer the courses “Communication Skills for the Dental Team” and “The Five Secrets of Success” on June 22 during the 2024 Florida Dental Convention. Learn more about her course offerings at floridadentalconvention.com.

Reference 1. Waylean, A. The importance of communication in dentistry: Dental Update dental-update.co.uk Vol 44/Issue 8: 09/2017; 774-780.

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HALYARD

DOCTOR’S CHOICE PRACTICE TRANSITIONS

HAWAIIAN MOON

DOCTORSINTERNET

HENRY SCHEIN DENTAL PRACTICE TRANSITIONS

DORAL REFINING CORPORATION DPC TECHNOLOGY

HIOSSEN IMPLANTS

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HUFRIEDY GROUP

DREVE AMERICA

HUMANA

DSX

HUNTINGTON PRACTICE FINANCE

EASSIST DENTAL SOLUTIONS

ICORECONNECT INC.

EKOS DENTAL GROUP

IMPLADENT LTD.

ELEVATE ORAL CARE

IMPLANT EDUCATORS

ELITE PAYMENT GROUP

IMPLANT SEMINARS

EPDENT AMERICA INC.

ITX PROS

EPROMPT

JMU DENTAL INC.

FIRST CITIZENS BANK

KERR DENTAL

EXHIBITORS AS OF 11/2/2023 KETTENBACH LP

SIZEMORE & ASSOCIATES, CPA’S LLC

KOMET USA

SMILE DESIGN DENTISTRY

KWIKLY DENTAL STAFFING

SNAP ON OPTICS

L-Q

SOLMETEX

Exhibit Hall Hours & Events

SOLUTIONREACH

Times are subject to change

LARES RESEARCH LEGALLY MINE LLC. LIBERTY DENTAL PLAN LUMADENT INC. MEDILOUPES MEGAGEN AMERICA MEISINGER USA MIDWEST DENTAL ARTS MODERN DOC MEDIA MOMNT MYOFUNCTIONAL RESEARCH CO. MYRIAD CAPITAL NADAPAYMENTS NEOCIS NEW TEETH NOW NEXHEALTH NSK AMERICA OOMA INC. OPAL REEF JEWELRY ORASCOPTIC PEARL PERIO PROTECT PHILIPS SONICARE AND ZOOM! WHITENING PLANMECA PORTER INSTRUMENT POWER DENTAL GROUP PROFESSIONAL SALES ASSOCIATES INC. PROMA INC. PROVIDE INC. Q-OPTICS & QUALITY ASPIRATORS

R-Z

SOUTHEAST DENTAL TRANSITIONS SOUTHERN DENTAL REFINING STELLALIFE STRAUMANN GROUP STRAUSS DIAMOND INSTRUMENTS INC. STREAMHEALTH SUMMIT HANDPIECE EXPRESS SUNBIT SUNCOAST CREDIT UNION SUNRISE DENTAL EQUIPMENT INC. SUPERIOR DENTAL & SURGICAL MANUFACTURING

THURSDAY, JUNE 20 11 AM-6 PM Exhibit Hall Open to Attendees 11 AM-2 PM Lunch available to purchase 4-6 PM Welcome Cocktail Reception

SUPERIOR DENTAL DESIGN & UPHOLSTERY SUPERMOUTH SURGITEL TD BANK TEMPMEE THE ARGEN CORPORATION THE DAWSON ACADEMY THE DOCTORS COMPANY THE TRANSITION GROUP LLC TOKUYAMA DENTAL AMERICA ULTRADENT PRODUCTS INC.

FRIDAY, JUNE 21 8:45 AM-6 PM Exhibit Hall Open to Attendees 11 AM-2 PM Lunch available to purchase 3-5:45 PM Puppy Cuddle Break

ULTRALIGHT OPTICS VAKKER DENTAL INC. VALUMAX PROTECTIVE APPAREL INC. VATECH AMERICA VECTOR RESEARCH & DEVELOPMENT VIDEO DENTAL CONCEPTS VIZISITES VOCO AMERICA INC. WALMART HEALTH

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ZIMVIE

SATURDAY, JUNE 22 9 AM-2 PM Exhibit Hall Open to Attendees 11 AM-2 PM Lunch available to purchase

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FDA districts

Helping Members Succeed Throughout Florida! ATLANTIC COAST DISTRICT DENTAL ASSOCIATION Counties: Broward, Indian River, Martin, Okeechobee, Palm Beach, St. Lucie

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Kathy Corrado Executive Director k.corrado@acdda.org 561.968.7714 acdda.org 10380 SW Village Center, #408 Port St. Lucie FL 34987

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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 19, 2024. 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.” ACDDA 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

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Marlinda Fulton Executive Director cfdental@cfdda.org 407.898.3481 cfdda.org 800 N. Mills Ave. Orlando FL 32803

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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. Save the dates, May 3-4, 2024, and come to 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, Putn am, St. Johns, Suwannee, Taylor, Union

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Debbie DeVille Executive Director ddeville@nedda.org 904.737.7545 nedda.org 3733 University Blvd. W, Ste. #212 D Jacksonville FL 32217 The Northeast District Dental Association (NEDDA) focuses on the best ways to help members succeed by offering CE courses that meet licensure requirements at a reduced rate and automatically reporting course attendance to CE Broker. Additionally, these courses provide networking opportunities with colleagues and dental vendors. Members receive NEDDA’s monthly e-newsletter, which includes local, state and national information to keep members informed of the latest information, CE offerings, classifieds and more! Join or renew today! 70 | November/December 2023

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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

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Angel Henry Executive Director nwdda@nwdda.org 850.391.9310 nwdda.org 2910 Kerry Forest Parkway, D4-309 Tallahassee FL 32309

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The Northwest District Dental Association (NWDDA) prodcues even more benefits for success! The NWDDA Annual Meeting, Feb. 2-3, 2024, at The Henderson Beach Resort & Spa in Destin, offers CE courses at a 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

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Yolanda Marrero Executive Director ymarrero.sfdda@gmail.com 305.667.3647 sfdda.org 420 S. Dixie Highway, Ste. 2-E Coral Gables FL 33146

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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

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Lissette Zuknick Executive Director lissette@wcdental.org 813.654.2500 wcdental.org 1114 Kyle Wood Lane Brandon FL 33511

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Unlock member success with the West Coast District Dental Association (WCDDA)! Experience top-notch Continuing Education (CE) courses, connect with dental vendors, engage with local dental professionals, and network with dental assisting and hygiene students at the WCDDA 2024 Annual Meeting on March 1 in Tampa. Don’t miss out on the President’s Trip to Napa Valley April 18-21, and the WCDDA Summer Meeting at The Ritz-Carlton, Naples, scheduled for Aug. 23-25, 2024. Visit wcdental.org for details. If you’re not already a member, seize the opportunity and join WCDDA today to be part of a vibrant dental community dedicated to excellence and advancement!

Today’s FDA | 71

fluoridation

SO, YOU THINK YOUR WATER IS OPTIMALLY FLUORIDATED? By President of the American Fluoridation Society and ADA Delegate Dr. Johnny Johnson

My fellow colleagues, can you imagine using a carpule of local anesthetic that has been watered down to an ineffective level? Wouldn’t this make you angry? It absolutely would! Well, that is what’s happening to the current state of community water fluoridation (CWF) in Florida. More than 3.5 million Floridians who are on community water fluoridation in their communities are receiving suboptimal levels of fluoride (less than 0.7 ppm). Some are not receiving fluoridated water at all! In fact, of our 78.5% community water systems with CWF, nearly 25% of those are not receiving optimally fluoridated water. As dentists who care about their patients, are you angry yet? Cavities are the number one most common chronic disease of adults and children in the U.S. and worldwide. They are more common than asthma, obesity or diabetes and are an infectious and transmissible disease. Community water fluoridation is the greatest tool in our toolbox to prevent cavities by at least 25% for adults and children over their lifetimes. It provides everyone in our communities with the right amount of fluoride to prevent cavities without a single change in their daily behavior. While fluoridated toothpaste, mouth rinses and professionally applied varnishes help to reduce cavities,

72 | November/December 2023

The residents that live on these water systems are our patients. We need to fight for their dental health because we have access to knowledge and resources that they sometimes do not. there is still no replacement for CWF. CWF provides an additional 25% cavity reduction above and beyond the aforementioned topical fluorides. However, these types of products are complimentary and additive in their benefits. It’s like the invention of air bags in our cars; when air bags came out, we did not stop wearing seatbelts. Both provide greater benefits than either one alone; the same can be said of topical fluorides in combination with CWF. So, why are there families in our state living on suboptimal community water fluoridation systems? There are several reasons, but none of them are acceptable. The Florida Department of Health’s Public Health Dental Program oversees the fluoridation programs in water facilities around the state. They are aware of this problem and are working to fix it, but they can only provide technical assistance and education to the water plant facilities. They do not have the authority to enforce these facilities to deliver CWF at the optimal level. We, the dental providers, must take action to correct this by educating our local officials. The private dental sector along, with our community partners, must advocate for optimal CWF levels immediately. An extremely helpful report is available from the Centers for Disease Control and Prevention’s public-facing fluoridation website, My Water’s Fluoride. By selecting “Florida,” you can access each county’s public water systems reports. From there, select the specific local community water system you are interested in, and you can see the monthly fluoride levels by year for that community. Armed with these reports and working in conjunction with your local health department, you can meet with your local elected officials to discuss these suboptimal levels. Typically, the local city or county commissions have no clue that the fluoride in their water systems is

below the adequate level for dental health. You need to be the voice to expose that and help enact change. Meeting with local officials and advocating for optimal CWF levels may be uncomfortable for some the first time you do it. However, you are not alone. The American Fluoridation Society (AFS) and the FDA are here to help coach and guide you through the advocacy process. Moreover, advocating for fluoridation, a tool we dentists know a lot about, is very simple. You wouldn’t need anyone to guide you on how to approach your supplier of anesthetic if you found that they were giving you suboptimal levels, would you? The same can be said of the approach taken regarding CWF. The residents that live on these water systems are our patients. We need to fight for their dental health because we have access to knowledge and resources that they sometimes do not. Florida is not alone in this problem. In fact, more than 16% of our water systems nationwide are not fluoridated at an adequate level. We are, however, the first state in the country to lead this national effort to correct suboptimal fluoridation levels. The national goal for Healthy People 2030 for optimally fluoridated water is 77.1%. All we need to do is to optimize our current systems to meet this goal. With your help, we will meet and exceed this goal well in advance of 2030. Dentists are the oral health care leaders in the field. As leaders, we need to become educated on our local CWF levels so that we can help inform and guide elected officials. If we start to act, other community partners will follow suit, and soon, this task will not fall only on our shoulders. But it starts with us, so get involved! For more information, you can reach Dr. Johnson at drjohnny@americanfluoridationsociety.org. Today’s FDA | 73

HOW MUCH ASSURANCE do you have in your malpractice insurance?

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*Non-members pay $385.

dentures

Can You Name a Famous Figure Who Wore Partial Dentures? By Christine W. Chu, D.D.S., F.A.C.P. , Mea A. Weinberg DMD, MSD, RPh and Stuart L. Segelnick, DDS, MS

Fig. 1: Photo credit: Museum at the Royal College of Surgeons of England.

Partial dentures are not uncommon among famous figures; one notable example was Sir Winston Churchill. The British leader suffered from dental issues from his youth. His frontal image reveals a loss of vertical dimension, which affected his facial proportions and esthetic appearance 1. Churchill had difficulty pronouncing the letter “s” and he worked hard to overcome his speech difficulties with a speech therapist and practice.2 Even though Churchill believed that he had conquered his speech problem, he thought the British people liked his lisp, so he found a dentist to incorporate his natural lisp in his dentures.3 The first dentures made for him were when he was about 65 years of age. Dr. Wilfred Fish was his dentist, whom he admired, and Derek Cudlipp was the dental technician who made him three sets of dentures. In 2010, Nigel Cudlipp, the technician’s son, sold his set of Churchill’s dentures for £15,000 (about $24,000 in 2023) at an auction. 76 | November/December 2023

Churchill dentures were made of gold metal alloy and porcelain (Fig. 1). Whether gold was ever Dr. Chu considered the “gold standard” for partial dentures deserves discussion. One main advantage of gold alloy in Dr. Weinberg framework fan would be the flexibility given to the clasp; this allowed for adjustments with a lowered risk of Dr. Segelnick clasp breakage. Another advantage would be favorable wear on opposing teeth.4 This is important in Churchill’s case since he had metal on the occlusal surfaces of his prosthesis. The disadvantage of gold alloy in comparison to base metals is that the flexibility of gold is not favorable in rigid areas, where base metal has an advantage due to higher strength. Another disadvantage of gold is the increased weight and bulk required compared to base metal, which is thinner and less bulky.4 Modern-day materials and fabrication methods for partial dentures are quite different from Churchill’s time. Alternatives to metal alloy frameworks are high-performance polymers. The framework materials of non-metal clasp dentures (NMCD) 5 are bulkier than base metal alloy

Fig. 2: The design of Churchill’s dentures

Notes:

1. Kennedy Classification: IV 2. Major Connector: U-shape 3. Guide Planes: • #4 Mesial • #6 Mesial and Distal • #11 Mesial and Distal • #14 Mesial 4. Bracing Arm: #14 Lingual 5. Direct Retention: • #11 circumferential clasp, MB 0.01” • #14 circumferential clasp, DB 0.01” 6. Metal Lingual and Occlusal: #5,7-10, 12 and 13 7. Porcelain Facings: #7, 8, 9, 10, 12 and 13 8. All Gold: #5 9. Unable to determine the amount of missing posterior teeth based on removable prosthesis.

framework. Long-term data still needs to be included for a recommendation of NMCD over traditional metal frameworks.6 Along with incorporating computeraided-design (CAD) and computer-aided-manufacturing technology(CAM), RPD fabrication can now be performed in a combination of traditional and digital methods or as a fully digital workflow. However, the indication for fully digital fabrication is limited to tooth-borne prosthesis cases.7 It is said that one set of Churchill’s dentures was specially designed to be “loose-fitting” on the palate so that he could retain his famous lisp. This was accomplished with air escaping through the space between the major connector and the anterior palatal mucosa.8 The design of Churchill’s dentures is shown in Fig. 2. Winston Churchill’s denture design had differences and similarities to dentures fabricated today. The main differences are the material, fit and lack of rest seats — similarities in the use of metal occluding surfaces in patients with space limitations. The cast circumferential clasp and undercut location are consistent with what we use today. To view the article in its entirety, please go to bit.ly/3sKwbuW.

Questions should be sent to Dr. Christine Chu at cchu@tamu.edu.

References:

1. Turrell AJW. Clinical assessment of vertical dimension. 1972. J Prosthet Dent. 2006; 96(2):79-83. 2. https://www.express.co.uk/finance/retirement/35572/ Winston-Churchill-His-dentist-s-finest-hour. (Accessed online August 17, 2023). 3. https://www.speechbuddy.com/blog/speech-disorders/winston-churchills-dentures (Accessed online August 17, 2023) 4. Bange, A, et.al. Gold alloy cast to base metal removable partial denture frameworks. J Prosthet Dent. 1994;72:137-40. 5. Kim J. Revisiting the Removable Partial Denture. Dent Clin North Am. 2019;63(2):263-278. 6. Pereira A, et.al. Accuracy of CAD-CAM systems for removable partial denture framework fabrication: A systematic review. J Prosthet Dent. 2021;125:241-248. 7. Fueki K, et.al. A systematic review of digital removable partial dentures. Part I: Clinical evidence, digital impression, and maxillomandibular relationship record. J Prosthodont Res. 2022;66(1): 40-52. 8. Goodacre Charles J, et. Al. CAD/CAM fabricated complete dentures: concepts and clinical methods of obtaining required morphological data. J Prosthet Dent. 2012;107: 34-46.

Today’s FDA | 77

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Today’s FDA | 79

Practice Consolidation Is Cresting It’s Time to Understand the Value of Your Practice Silent Partners Buy Part of Your Practice

Six or More Choices in Partnership

Dozens of Invisible Dental Support Organization (IDSO) silent partners are paying record values for partial interests in Endodontic practices advised by LPS. Endo-only IDSOs compete fiercely with the multi-specialty and Specialty Surgical Trifecta IDSOs, driving up values. You should understand all of your options.

LPS clients have 6 to 10+ qualified bidders. LPS completed over $500 million of transactions for dentists of all types, in the last 12 months. LPS’ size enables our clients to achieve record values that the little advisors cannot match. Multiple Endodontic clients have achieved values of over 3x collections.

IDSOs purchase 51% to 90% of practices for cash now at low tax rates. Doctors retain ownership and have significant upside in the equity value. Some LPS clients have achieved 3x to 7x equity returns in only three to five years.

Your Value in Today’s Consolidation Frenzy

Long-Term Wealth Building Partnership Doctors continue to lead their practice with their brand, team and strategy for years or decades. Practices benefit from the resources of a larger, silent partner, but are not micromanaged or homogenized. IDSO partnership is not a short-term transition strategy, but rather a long-term wealth building partnership. Some happy LPS Endodontic clients are under 35! 80 | November/December 2023

Great practices with at least $1.4 million in collections have many options today. You should understand the value of your practice in an LPS-advised process. Doctors who deal directly with IDSOs often leave millions on the table and do not get to consider ALL of their options. Contact us to schedule a confidential, no obligation discussion to learn the value of your practice; you might be surprised at today’s values! 877-557-5119 FindMyIDSO.com FLDental@LargePracticeSales.com

diagnostic discussion

Diagnostic Quiz By Resident Oral & Maxillofacial Pathology Dr. Shamim Neduvanchery and University of Florida College of Dentistry professors Drs. Neel Bhattacharyya and Dr. Nadim M. Islam

A 58-year-old male was presented to Dr. James Barton, an oral and maxillofacial surgeon in Council Bluffs, Iowa. On clinical evaluation, a painful ulcer was noted on the posterior mandibular gingival mucosa near teeth #30 and #31. The lesion extended from the molar area up to the retromolar pad. The ulceration was covered by yellowish fibrinous exudate and the tissue presented with an irregular rolled-out border and an erythematous halo around the lesion was seen. As reported by the patient, the lesion was present for three months and was painful. The medical history reported that the patient was diagnosed with histoplasmosis of the abdominal cavity a few years back. The clinical impression was suspicious for a malignant salivary gland neoplasm. Dr. Barton performed an incisional biopsy and submitted the tissue for histopathologic examination and interpretation.

Fig. 1A: Scattered epithelioid macrophages, admixed with inflammatory infiltrate, containing lymphocytes, plasma cells and multiple round “dot-like” organisms of Histoplasma capsulatum (shown with arrows).

Question:

Based on the clinical presentation and background, what is the most likely diagnosis? A. Malignant salivary gland neoplasm B. Squamous cell carcinoma C. Lymphoma D. Traumatic ulcerative granuloma with stromal eosinophilia (TUGSE) E. Histoplasmosis

t Fig. 1B: GMS stain shows Histoplasma capsulatum spores shown with arrows in another area in the same biopsy with an admixture of epithelioid and foamy histiocytes. Today’s FDA | 81

diagnostic discussion

A. Malignant Salivary Gland Neoplasm Incorrect, but it does make a reasonable differential diagnosis. Malignant salivary gland tumors most frequently originate in the palatal mucosa. Mucoepidermoid carcinoma and adenoid cystic carcinoma (ACC) are the predominant malignant tumors arising in salivary glands. They can affect individuals across a broad age range, from the third to the seventh decade of life. Both of these tumors may present as elevated areas with painful ulcerations, although pain tends to be a more common symptom in ACC. Like many other malignant growths, these lesions can exhibit erosion and, in some cases, perforation of the underlying bone. It’s worth noting that the alveolar gingiva lacks minor salivary glands and is unlikely to be the primary site of origin for such neoplasms unless it is invaded by a salivary gland adenocarcinoma originating from adjacent regions, like the palate or buccal mucosa. In most instances, these malignancies initially present as a mass rather than an ulcer, with ulceration potentially developing in later stages. In this case, the lesion initially appeared as a painful ulcer rather than a mass. Furthermore, the histological features were not in agreement with a diagnosis of a salivary neoplasm.

B. Squamous Cell Carcinoma While the choice is certainly plausible, it’s not the correct diagnosis. Squamous cell carcinoma (SCC) is a significant concern when dealing with non-healing oral ulcers, especially in older adults. Intraoral ulcers on the gingiva are less common than in other oral sites, such as the lateral aspects of the tongue, the ventral tongue and the floor of the mouth. Squamous cell carcinoma is notorious for its ability to mimic various conditions, exhibiting diverse clinical presentations such as swelling, hardening (induration), erosion and, notably, surface ulceration. However, in most cases, SCC initially presents as an asymptomatic 82 | November/December 2023

lesion characterized by white (leukoplakia) or red (erythroplakia) changes in the surrounding oral mucosa. In contrast, the ulcerated lesion in our case was painful and lacked the characteristic hardening (induration). Moreover, the histological features were non-diagnostic for a SCC. However, it is prudent to consider SCC as a potential diagnosis when dealing with non-healing ulcers in elderly individuals. Therefore, performing a biopsy is essential to exclude the possibility of this grave disease.

C. Lymphoma Incorrect, but a thoughtful assumption. Lymphoma, mostly non-Hodgkin’s type, can manifest clinically with symptoms such as redness, swelling and even the development of ulcers similar to the present case. This condition can affect various oral tissues, including the vestibule, palate and non-healing extraction sites. Among the different types of non-Hodgkin’s lymphoma, Diffuse Large B-cell Lymphoma (DLBCL) is the most common. It mainly affects males and the incidence increases with age, with an average age of around 60. Unfortunately, the occurrence of lymphomas has been steadily rising, making it the second most frequently encountered intraoral malignancy after squamous cell carcinoma. Lymphomas are fast-growing tumors and typically manifest as a swiftly growing lump in the soft tissues or a destructive condition within the bone with mild pain, which can be confused with pains of pulpal or periodontal origin. Unlike our patient, most individuals with DLBCL don’t experience significant pain. Night sweats, fever, itching and general lethargy could be frequent indicators of B-cell lymphoma in certain patients, and these symptoms are vital for making the diagnosis. Our patient reported no ongoing weight loss, fever or fatigue.

D. TUGSE Incorrect, but a possible option. Traumatic ulcerative granuloma with stromal eosinophilia (TUGSE) is an infrequent, non-malignant and self-resolving ulcerative condition. It most commonly occurs on the tongue, often originating from physical injury as the primary cause. TUGSE typically presents as an ulcer characterized by ar-

eas of erythema surrounding a central removable, yellow fibrinopurulent yellowish membrane, often resembling granulation or scar tissue. In most instances, this type of lesion tends to resolve on its own or after eliminating potential sources of minor trauma, such as dentures, for a few weeks. However, in our case, there is no documented history of injury or local irritation to explain the ulcer. Furthermore, the ulcer is shallow and has an irregular border with a rolled margin. It was associated with significant pain and has persisted for a period exceeding eight weeks. Additionally, the histologic features of TUGSE were absent.

E. Histoplasmosis Correct. Histoplasmosis is a rare infection that can affect the oral cavity and is typically associated with a disseminated infection caused by Histoplasma capsulatum (H. capsulatum). This fungal organism can exist in two different forms: spores and hyphae. This infection tends to occur in individuals who have disseminated disease, with older adults and those who have compromised immune systems being particularly susceptible. Individuals with compromised immune systems are the most vulnerable to this infection. Based on the patient’s previous history, age and the presence of a necrotic and painful ulcer on the gingiva and alveolar mucosa, histoplasmosis was one of the primary clinical considerations. The clinical presentation of histoplasmosis can vary, with manifestations that include ulcers, elevated granulomatous masses, and verrucous or thickened plaque-like lesions. Regional lymphadenopathy is often associated with the oral manifestations. The causative organism is most frequently found in soil contaminated with bird or bat droppings, and this is the primary cause of the infection, particularly in endemic regions such as those drained by the Ohio and Mississippi Rivers in the United States. The fungus thrives in warm and humid environments, and the infection typically occurs through the inhalation of fungal spores. The course of histoplasmosis depends on various factors, such as the individual’s immune status, the quantity of

inhaled infectious spores, and potentially the specific strain of H. capsulatum. Healthy individuals or those who inhale only a small number of spores are often asymptomatic, as their immune system effectively clears the spores, or the spore count is insufficient to induce symptoms. However, mild, flu-like symptoms can manifest. In severe cases, particularly in immunocompromised patients, symptoms can be life-threatening in disseminated conditions. Disseminated histoplasmosis can affect multiple organs, including the lungs, upper aerodigestive tract and the oral cavity. The most commonly affected intraoral sites are the tongue, palate and buccal mucosa. Oral lesions usually indicate the presence of disseminated disease and significant immunosuppression. The microscopic examination of the biopsy tissue unveiled a notable increase in histiocytes accompanied by the presence of plasma cells and neutrophils. Additionally, numerous sparsely distributed fungal organisms were observed, visible as multiple round structures in the image (Fig. 1A and 1B). Applying staining techniques, including periodic acid Schiff and Grocott’s methenamine silver, verified the existence of the fungal organism (Fig. 1A and 1B). It is of utmost importance to make an accurate diagnosis since there is a likelihood of a misdiagnosis of the condition as squamous cell carcinoma. This misapprehension could result in unnecessary resection and significant morbidity, highlighting the importance of a precise diagnosis.

References: 1. Folk GA, Nelson BL. Oral Histoplasmosis. Head Neck Pathol. 2017;11(4):513-516. 2. Akin L, Herford AS, Cicciù M. Oral presentation of disseminated histoplasmosis: a case report and literature review. J Oral Maxillofac Surg. 2011;69(2):535-541 3. Antonello VS, Zaltron VF, Vial M, Oliveira FM, Severo LC. Oropharyngeal histoplasmosis: report of eleven cases and review of the literature. Rev Soc Bras Med Trop. 2011;44(1):26-29. 4. Muñante-Cárdenas JL, de Assis AF, Olate S, Lyrio MC, de Moraes M. Treating oral histoplasmosis in an immunocompetent patient. J Am Dent Assoc. 2009 Nov;140(11):1373-6. 5. Viswanathan S, Chawla N, D’Cruz A, Kane SV. Head and neck histoplasmosis--a nightmare for clinicians and pathologists! Experience at a tertiary referral cancer center. Head Neck Pathol. 2007 Dec;1(2):169-72. 6. Narayana N, Gifford R, Giannini P, Casey J. Oral histoplasmosis: an unusual presentation. Head Neck. 2009 Feb;31(2):274-7.

t Today’s FDA | 83

diagnostic discussion 7. Dogenski, Letícia Copatti, et al. “Uncommon Case of Histoplasmosis with Oral Manifestation: A Case Report of Diagnosis in a South American Patient.” International Journal of Surgery Case Reports, vol. 93, Apr. 2022, p. 106920,. 8. M.A. Almeida, F. Almeida-Silva, A.J. Guimarães, R. Almeida-Paesa, R.M. Zancopé-Oliveira; The occurrence of histoplasmosis in Brazil: a systematic review Int. J. Infect. Dis., 86 (2019), pp. 147-156. 9. Momesso, G. A. C., Polo, T. O. B., Lima, V. N. D., Sousa, C. A. D., Soubhia, A. M. P., Jardim, E. G., & Faverani, L. P. (2017). Histoplasmose oral. Revista Brasileira de Terapia Intensiva, 29, 394-396. 10. Francesconi, Carlos, et al. “Chronic Disseminated Histoplasmosis with Lesions Restricted to the Mouth: Case Report.” Revista Do Instituto de Medicina Tropical de Sao Paulo,vol. 48, no. 2, 1 Apr. 2006, pp. 113–116.

Dr. Bhattacharyya

Dr. Islam

Diagnostic Discussion is contributed by University of Florida College of Dentistry professors, Drs. Indraneel Bhattacharyya and Nadim Islam 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 16,000 specimens the service receives every year from all over the United States.

84 | November/December 2023

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 and Islam and can be reached at oralpath@dental.ufl.edu. Conflict of Interest Disclosure: None reported for Drs. Bhattacharyya and Islam. 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.

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career center

FDA’s 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! Interim Services. General Dentist Will Travel Anywhere in Florida. Sick Leave, maternity leave, vacation or death, I will cover your practice so that production continues while you are out. Experienced in covering general dentists, pedodontists and orthodontists. Please call or text Robert Zoch, DDS, MAGD at 512-517-2826 or email: drzoch@yahoo. com. Visit careers.floridadental.org/ jobs/19173179.

Associate to Partner Position in Central Florida, Winter Park. We are seeking a motivated and outgoing periodontist to join our team as an associate with the expectation to transition to partnership. 4 days per week. The fee-for-service, 1 doctor practice has sustained growth year over year with a large, established referral base. We have always operated as a 2 doctor practice but with some unexpected health issues of one of the partners, we are currently a 1 doctor practice. We are involved in local dental societies and multiple study clubs and have excellent relationships with referring offices. There is a good mixture of dental implant and periodontal procedures allowing a good variety of patient care. Our office is located in the heart of Winter Park and provides one location central to all surrounding Orlando cities. A great opportunity to live in one of Florida’s best locations. Well-regarded, established, and highly successful periodontal surgical practice with large referral base and a 77-year history of successful 88 | November/December 2023

outcomes. 4 hygienists, 5 assistants and 5 administrative positions. The recently remodeled building is equipped with 10 operatories, LANAP and new CBCT machine. Please email inquiries to Scott. Cohen@periodoctors.com. Visit careers.floridadental.org/ jobs/19255472/.

Dental Office for Lease, Fort Lauderdale. Fort Lauderdale Downtown prime location, great visibility, excellent demographics. Charming stand alone building ~1200 sq. ft. with three treatment rooms set up (plumbed for 4), private parking. It has served as an endodontic practice for the past two decades. Availability: May 2024. Gross $50/ PSF. Photos, floor plan and more details upon request. Please email inquiries to soniapenadmd@gmail.com. Visit careers.floridadental.org/ jobs/19347305/.

General Dentist, Naples. Job Summary. This position will provide comprehensive dental care to patients in a primary health care delivery system. The dentist assumes the responsibility of providing the best care possible for all of patients. Provide preventive and restorative treatments for problems affecting the mouth and teeth. High moral character, ethics, and conduct are mandatory. Responsibilities and Standards: Perform oral examinations of hard and soft tissue while working with patients to maintain and restore quality health to everything within the mouth. Examine teeth and

diagnose patients’ dental conditions by using tools such as x-rays, dental instruments, and other diagnostic procedures. Clean, restore, extract, and perform oral replace teeth, using rotary and hand instruments, dental appliances, medications, and/or surgical equipment. Evaluate the current health and condition of the patient’s teeth to determine diagnosis of dental condition, if any. Completes treatment planned procedures that are agreed upon by patient and parent/ guardian, such as restoring teeth affected by decay and treating gum disease. Perform Dentistry services, including the diagnosis and treatment of diseases, injuries, and malformations of teeth, gums, and related oral structures. Consults with the patients and advises them of their dental status, prescribes the treatment required, provides risks and alternatives. Perform oral cancer examinations, take and interpret radiographs and provides limited prosthodontic services. Provide dental services at any and/or all HCN dental facilities as necessary to meet department needs. Supervise and evaluate dental students and residents during their rotations at HCN’s dental facilities as agreed upon with the AEGD Director. Performs other related duties as indicated or when requested by a supervisor. Job Specifications: This position requires a high degree of responsibility, excellent interpersonal skills, organizational ability, problem-solving skills, and written communication skills. Position requires the ability to work independently and within a team to meet goals. Position requires the ability to

In In Memoriam Memoriam The FDA honors the memory and passing of the following members: the following Post an ad onpassing the FDAofCareer Centermembers: and it will be published in our journal, Today’s FDA, at no additional cost. The FDA honors the memory and Visit the FDA’s Career Center at careers.floridadental.org.

GET GETFREE FREECOURSE COURSETUITION TUITION Nelson FDA Castellano Robert Ettleman Gilbert Principe Today’s is bimonthly, therefore, the basic text of all active ads will be extracted from the Career Center on AT FDC2023! Nelson Castellano Robert Ettleman Gilbert Principe AT FDC2023! Longwood Tampa Tampa roughlyTampa the 5th of every other month (e.g., Jan. 5 for the Jan/Feb issue, March 5 for the March/April issue. etc.). Longwood Tampa Volunteer to be an FDC Speaker Host.

Died: 2/12/2023 1/23/2023 to be an FDC 1/12/2023 Please Ads for theDied: Nov/Dec issue mustDied: be Age: placed no later than Nov. 1. Volunteer Died:note: 2/12/2023 Died: 1/23/2023 Speaker Host. 80 Died: 1/12/2023

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Age: 69 Age: 69

Michael Chanatry Wendell Hall Michael Chanatry Wendell interact with all departments and allHall levJacksonville Tampa Jacksonville Tampa to elsDied: of staff effectively. May be required Died: 2/12/2023 2/12/2023 Died: 2/12/2023 Died:the 2/12/2023 perform duties of other employees, Age: 88 Age: 72 Age: 88 Age: 72 including supervisors/managers, in their absence. be required to perform Charles Infante Silas May Daniel Charles Infante Silas Daniel Plantation dutiesSeminole and responsibilities not listed Plantation Seminole Died: 2/15/2023 Died: 1/10/2023 on a temporary in this description, or Died: 2/15/2023 Died: 1/10/2023 Age: 92 Age:basis. 74 Experience: Education/ long-term Age: 92 Age: 74 Training Level: Board Certified/Board Eligible Preferred. Graduation from an accredited school of dentistry (DMD or DDS). Must maintain required CE credits to maintain licensure. Licenses & Certifi-

Age: 80

Edward Stokes EdwardPossession Stokes of a current Florida cations: Died: 1/11/2023 Seeking Qualified Dental Died: 1/11/2023 license to 76 practice dentistry. Currentprovide an invaluable service to the Florida Dental Age: Volunteers Age: 76 Radiographer? Volunteers provide an invaluable service to the Florida Dental CPR Certification in Basic Life Support Convention. Speaker Hosts will be responsible for introducing Convention. Speaker Hosts willyour be responsible for introducing Train dental assistants to DEA License. AEGD or GPR the certification speaker, making announcements in front of the course, the speaker, making announcements in front of the course, expose the and collecting surveys,radiographs and contacting using convention preferred. Communicationpassing Skills:out Strong passing out and collecting surveys, and contacting convention staff if AV assistance is needed. verbal and written communication staff if AV skills. assistance isFDA’s needed.MyDentalRadiography online Volunteering has its perks! course Bi-lingual in Spanish/ English and/or CreVolunteering has its perks! that combines self-paced • All Speaker Hosts receive a $20 lunch voucher for Exhibit Hall • All Speaker Hosts receive a $20 lunch forproof Exhibit of Hall learning withvoucher clinical ole/English preferred. Technology Skills: concessions. concessions. Understanding of and ability to use Elec- Hosts receive competency. Tucker • Lecture Speaker free course Call tuitionLywanda for the hosted • Lecture Speaker Hosts receive free course tuition for the hosted course. tronic Dental Record. Experience with at 850.350.7143 for details or visit course. Denticon system preferred.Volunteer Visit careers. today at education.floridadentalconvention.com mydentalradiography.com/FDA to Volunteer today at education.floridadentalconvention.com floridadental.org/jobs/19259123/. create a supervising dentist ac-

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off the cusp By FDA Editor Hugh Wunderlich, DDS, CE

I am from Ohio. We have a tendency to overcook our hamburgers. Our football teams run the football - a lot. Three yards and a cloud of dust is a "winning" play. "Only three things can happen when you throw the football and two of them are bad" — Woody Hayes. So, when this broken mesial marginal ridge presents to my office, I am thinking about decision-making, principles-autonomy, nonmaleficence and beneficence ... and then perhaps punting on third down ... just to be safe.

The chief complaint of this 32-year-old female was associated with an asymptomatic broken mesial wall of No. 15. The periapical was unremarkable. She has no history of bruxism, clenching or crepitus. She wears an Essix retainer for her Class I occlusion. She requests a second opinion about the proposed treatment.

If you know the words to "Carmen Ohio," you are suggesting a 2 or 3-surface direct composite. With her history of moderate to large composites, I could go as far as a gold onlay if the clinical crown height is adequate. Now open the QR code for the proposed treatment plan.

Without further comment, I would love to hear your e-thoughts about their proposed plan. Please email your comments to hwunderlich@bot.floridadental.org. I have been guilty of undertreating a tooth, but it likely was a desiccated maxillary first bicuspid. Then again, nobody got Salmonella at my barbeques. But I sure do wish we would at least throw to a tight-end downfield just once.

FDA Editor Dr. Hugh Wunderlich can be reached at hwunderlich@bot.floridadental.org

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