2016 - Sept/Oct TFDA

Giving Offering Feedback Stress in the Dental Office Treating Anxious Patients Hobbies

How to get away from it all!

Relax in M near th aine e harb

— Dr. R or... ans

Tallah ey Boyd, assee

ch he bea t o t o G , e kids! with th r. Ransey Boyd —D

ssee Tallaha

autiful.

Make something be — Dr. Dan Henry,

Pensacola

hon arat y! m a o, Run rk Cit igo Roman o Y w in Ne Dr. Rodr mi a — th Mi

Sou

n sets

he su hile t

wine w Drink ! r, Setze ly a y r t I r a n i B — Dr. sonville

k Jac

—

Get some exercise — with friends and a little mud!

— Drs. Pete Lemieux, Bryant Anderson, Jorge Angulo, and Joseph Bongiorno (from left to right) VOL. 28, NO. 6 • SEPTEMBER/OCTOBER 2016

TRY MY AGENT “

Working with FDA Services made my transition to private practice as seamless as possible. They educated me on all aspects of insurance and allowed me to decide which coverages I felt necessary. Their agents and staff continue to help me to this day when a question arises!

“

MY AGENT DAN ZOTTOLI

- John P. Aylmer, DMD Dentists by the Sea, West Palm Beach, FL

800.877.7597 ∞ insurance@fdaservices.com ∞ www.fdaservices.com

contents Wellness Issue

news 12

news@fda

20 Board of Dentistry

66

Tough Mudder

68

Putting Down the Handpiece

71

It Was a Wednesday ...

72

Dental Manifestations of Methamphetamine Abuse: A Case Report

81

The Use of the State’s PDMP in a Dental Practice

82

Chiropractic

84

Three Ironies

f e at u r e s

literary

24

Three Questions Every Dentist Should Ask Before Giving

16

Letters to the Editor

28

Offering Feedback Helps Your Team and Practice Grow

88

Books on the Shelf

32

Three Reasons Why a Little Stress Can be Healthy

36

Stress in the Dental Office

38

Treating Anxious Patients

42 Dentistry as an Endurance Sport 45 Colleague Insurance 47

How to Keep Your Practice Healthy When You're Not

50 If I Can Do It, You Can Do It, Too! 52

Tennis and Life

56

Balance

58

Family, Dentistry and Photography

62

How I Became a Runner

64

Work Hard, Play Hard: How I Maintain My Work-life Balance

Read this issue on our website at:

www.floridadental.org.

www.floridadental.org

columns 3

Staff Roster

5

President’s Message

6

Legal Notes

11

Information Bytes

77

Diagnostic Discussion

96

Off the Cusp

classifieds 90 Listings

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

September/October 2016

Today's FDA

1

FLORIDA DENTAL ASSOCIATION

L A C LO Y L E V I &L

GATHER FOR FUN & CONTINUING EDUCATION IN YOUR DISTRICT. NEW! SFDDA CE DINNER MEETINGS

OCT. 5: SOUTH BROWARD, FORT LAUDERDALE Alex Zahn: Progressive Trends/Modern Dental Lab

OCT. 11: MIAMI DADE, CORAL GABLES NOV. 1: NORTH DADE/MIAMI BEACH, AVENTURA NOV. 2: SOUTH BROWARD, FORT LAUDERDALE Nelson Dellis: Memory Expert/Advice for Your Practice NOV. 9: MIAMI DADE, CORAL GABLES

www.sfdda.org • 305.667.3647 • sfdda@sfdda.org

SEPTEMBER/OCTOBER 2016 VOL. 28, NO. 6

EDITOR Dr. John Paul, Lakeland, editor

STAFF Jill Runyan, director of communications Jessica Lauria, communications and media coordinator Lynne Knight, marketing coordinator

BOARD OF TRUSTEES Dr. William D’Aiuto, Longwood, president Dr. Michael D. Eggnatz, Weston, president-elect Dr. Jolene Paramore, Panama City, first vice president Dr. Rudy Liddell, Brandon, second vice president Dr. Andy Brown, Orange Park, secretary Dr. Ralph Attanasi, Delray Beach, immediate past president Drew Eason, Tallahassee, executive director Dr. James Antoon, Rockledge • Dr. Steve Cochran, Jacksonville Dr. Richard Huot, Vero Beach • Dr. Jeannette Pena-Hall, Miami Dr. George Kolos, Fort Lauderdale • Dr. Jeffrey Ottley, Milton Dr. Paul Palo, Winter Haven • Dr. Howard Pranikoff, Ormond Beach Dr. Barry Setzer, Jacksonville • Dr. Beatriz Terry, Miami Dr. Stephen Zuknick, Brandon • Dr. Ethan Pansick, Delray Beach, speaker of the house Dr. Tim Marshall, Spring Hill, Treasurer • Dr. John Paul, Lakeland, editor

WCDDA ANNUAL MEETING

FRIDAY, FEB. 3, 2017 • CAMLS, TAMPA

Speakers: Dr. John Burgess – Dental Materials & Current Restorative Techniques; Dr. John Kalmar – You Make the Diagnosis www.wcdental.org • 813.654.2500 • kelsey@wcdental.org

NWDDA ANNUAL MEETING

FRIDAY & SATURDAY, FEB. 17-18, 2017 THE GRAND SANDESTIN Speakers: Dr. Tarun Agarwal, Dr. John C. Flucke, Ms. Pamela Smith www.nwdda.org • 850.391.9310 • nwdda@nwdda.org

ACDDA WINTER CONFERENCE FRIDAY, MARCH 10, 2017 Speaker: The Madow Brothers – ROCK Your Practice to the Top! ww.acdda.org • 561.968.7714 • acdda@aol.com

WCDDA PRESIDENT’S TRIP

FRIDAY, APRIL 28, 2017 DISNEY CRUISE • PORT CANAVERAL TO BAHAMAS

Six CE credits will be provided. www.wcdental.org • 813.654.2500 • kelsey@wcdental.org

CFDDA ANNUAL MEETING

MAY 11-13, 2017 • ROSEN SHINGLE CREEK, ORLANDO

Speakers: Friday – Dr. Steven Rasner; Saturday – Dr. Robert G. Ritter www.cfdda.org • 407.898.3481 centraldistrictdental@yahoo.com

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

FDA membership dues include a $10 subscription to Today’s FDA. Non-member subscriptions are $150 per year; foreign, $188.

Periodical postage paid at Tallahassee, Fla. and additional entry offices. Copyright 2016 Florida Dental Association.

All rights reserved. Today’s FDA is a refereed publication.

POSTMASTER: Please send form 3579 for returns and changes of address to Today’s FDA, 1111 E. Tennessee St., Tallahassee, Fla. 32308-6914.

EDITORIAL AND ADVERTISING POLICIES Editorial and advertising copy are carefully reviewed, but publication in this journal does not necessarily imply that the Florida Dental Association endorses any products or services that are advertised, unless the advertisement specifically says so. Similarly, views and conclusions expressed in editorials, commentaries and/or news columns or articles that are published in the journal are those of the authors and not necessarily those of the editors, staff, officials, Board of Trustees or members of the Florida Dental Association.

EDITORIAL CONTACT INFORMATION All Today’s FDA editorial correspondence should be sent to Dr. John Paul, Today’s FDA Editor, Florida Dental Association, 1111 E. Tennessee St., Tallahassee, Fla. 32308-6914.

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

ADVERTISING INFORMATION For display advertising information, contact: Jill Runyan at jrunyan@floridadental.org or 800.877.9922, Ext. 7113.

Advertising must be paid in advance.

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

For a complete listing: www.trumba.com/calendars/fda-member.

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www.floridadental.org

CONTACT THE FDA OFFICE 800.877.9922 or 850.681.3629 1111 E. Tennessee St. • Tallahassee, FL 32308 The last four digits of the telephone number are the extension for that staff member.

FLORIDA DENTAL ASSOCIATION FOUNDATION

EXECUTIVE OFFICE

(FDAF)

Drew Eason, Executive Director deason@floridadental.org 850.350.7109

R. Jai Gillum, Director of Foundation Affairs rjaigillum@floridadental.org 850.350.7117

Greg Gruber, Chief Operating Officer/ Chief Financial Officer ggruber@floridadental.org 850.350.7111 Graham Nicol, Chief Legal Officer gnicol@floridadental.org 850.350.7118 Judy Stone, Leadership Affairs Manager jstone@floridadental.org 850.350.7123 Alex Lewis, Leadership Concierge alewis@floridadental.org 850.350.7114

ACCOUNTING Jack Moore, Director of Accounting jmoore@floridadental.org 850.350.7137 Leona Boutwell, Finance Services Coordinator Accounts Receivable & Foundation lboutwell@floridadental.org 850.350.7138 Joyce Defibaugh, FDA Membership Dues Assistant jdefibaugh@floridadental.org 850.350.7116 Deanne Foy, Finance Services Coordinator Dues, PAC & Special Projects dfoy@floridadental.org 850.350.7165 Stephanie Taylor, Membership Dues Coordinator staylor@floridadental.org 850.350.7119

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

Meghan Murphy, Program Coordinator mmurphy@floridadental.org 850.350.7161

FLORIDA DENTAL CONVENTION (FDC) Crissy Tallman, Director of Conventions and Continuing Education ctallman@floridadental.org 850.350.7105 Elizabeth Bassett, FDC Exhibits Planner ebassett@floridadental.org 850.350.7108 Brooke Martin, FDC Meeting Coordinator bmartin@floridadental.org 850.350.7103 Jennifer Tedder, FDC Program Coordinator jtedder@floridadental.org 850.350.7106

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

INFORMATION SYSTEMS Larry Darnell, Director of Information Systems ldarnell@floridadental.org 850.350.7102 Will Lewis, Information Systems Helpdesk Technician/ Database Administrator wlewis@floridadental.org 850.350.7153

FDA SERVICES 800.877.7597 or 850.681.2996 1113 E. Tennessee St., Ste. 200 Tallahassee, FL 32308 Group & Individual Health • Medicare Supplement • Life Insurance Disability Income • Long-term Care • Annuities • Professional Liability Office Package • Workers’ Compensation • Auto • Boat Scott Ruthstrom, Chief Operating Officer scott.ruthstrom@fdaservices.com 850.350.7146 Carrie Millar, Agency Manager carrie.millar@fdaservices.com 850.350.7155 Carol Gaskins, Assistant Sales & Service Manager carol.gaskins@fdaservices.com 850.350.7159 Debbie Lane, Assistant Manager – Service & Technology debbie.lane@fdaservices.com 850.350.7157 Allen Johnson, Accounting Manager allen.johnson@fdaservices.com 850.350.7140

Tessa Daniels, Membership Services Representative tessa.daniels@fdaservices.com 850.350.7158 Liz Rich, Membership Services Representative liz.rich@fdaservices.com 850.350.7171 Suzy Illum, Director of Sales – Southern Expansion suzy.illum@fdaservices.com 850.350.7141

RISK EXPERTS

Alex del Rey, FDAS Marketing Coordinator arey@fdaservices.com 850.350.7166

Dan Zottoli Director of Sales Atlantic Coast

Angela Robinson, Insurance Clerk angela.robinson@fdaservices.com 850.350.7156

561.791.7744 Cell: 561.601.5363 dan.zottoli@fdaservices.com

Dennis Head

Jamie Idol, Commissions Coordinator jamie.idol@fdaservices.com 850.350.7142

Director of Sales Central Florida 877.843.0921 (toll free) Cell: 407.927.5472 dennis.head@fdaservices.com

Marcia Dutton, Receptionist marcia.dutton@fdaservices.com 850.350.7145 Porschie Biggins, North Florida Membership Services Representative pbiggins@fdaservices.com 850-350-7149

Mike Trout Director of Sales North Florida 904.249.6985 Cell: 904.254.8927 mike.trout@fdaservices.com

Maria Brooks, SFDDA Membership Services Representative maria.brooks@fdaservices.com 850.350.7144 Eboni Nelson, CFDDA Membership Services Representative eboni.nelson@fdaservices.com 850.350.7151 Melissa Staggers, WCDDA Membership Services Representative melissa.staggers@fdaservices.com 850.350.7154

Joseph Perretti Director of Sales South Florida 305.665.0455 Cell: 305.721.9196 joe.perretti@fdaservices.com

Rick D’Angelo Director of Sales West Coast 813.475.6948 Cell: 813.267.2572 rick.dangelo@fdaservices.com

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

Ashley Merrill, Member Relations Coordinator amerrill@floridadental.org 850.350.7110

Kaitlin Walker, Member Access Coordinator kwalker@floridadental.org 850.350.7100

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www.floridadental.org

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

For example, Dr. John Paul: jpaul@bot.floridadental.org.

September/October 2016

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PRESIDENT’S MESSAGE BILL D'AIUTO, DDS

Nearly 30 Percent of Florida Adults Report Life is Less Satisfying Due to Condition of Their Mouth and Teeth In a recent survey by the American Dental Association (ADA) Health Policy Institute, nearly 30 percent of Florida respondents shared that life is generally less satisfying due to the condition of their mouth and teeth.

n Two-thirds of adults shared they accept that as they grow old, they will lose some of their teeth. n About one in four adults say that the appearance of their mouth and teeth affects their ability to interview for a job.

The ADA’s Oral Health & Well-being in the United States report is a first-of-its-kind analysis to show how seriously oral health issues affect the lives of U.S. adults. It was developed following a survey of nearly 15,000 adults from every state, who were asked about their oral health and its impact on their physical, social and emotional well-being.

When we talk about oral health, particularly in the context of health care policy, it’s typically focused on the presence and severity of dental disease. While that is a critical health problem in our state, this survey shows an even broader toll that poor oral health takes on individuals’ physical and emotional well-being, as well as employment status.

The following are key findings on selfreported oral health status and dental care utilization among Florida adults, as of 2015. n More than one-third of adults experienced difficulty biting/chewing in the past year, and 27 percent experienced pain. Approximately 50 percent of lowincome adults reported these problems. n Thirty percent of adults avoid smiling and feel embarrassment due to the condition of their mouth and teeth, and one in four experience anxiety related to their oral condition. n Nearly 50 percent of low-income adults avoid smiling due to the condition of their mouth and teeth.

There are many facets to this issue. In Florida’s Medicaid program, adults typically are not covered for comprehensive and preventive dental benefits. Transportation barriers can limit patients’ ability to visit a dental office, particularly in rural areas.

A lack of education on nutrition and the importance of preventive care can lead to tooth decay, which can cause complicated and costly dental and health problems when left untreated.

www.floridadental.org

The Florida Dental Association (FDA) is working to combat these challenges at the state level, as we believe dental care isn’t a luxury available only to some Floridians. The FDA recently developed Florida’s

Action for Dental Health, a comprehensive effort to improve oral health in Florida by promoting attainable dental care, expanding opportunities for public health dentistry and collaborating to maximize the capacity of Florida’s dental workforce to serve Floridians.

A key success we’ve achieved is the graduation of Florida’s first community dental health coordinators. These graduates are dental professionals who received training to deliver oral health education, preventive services and assistance in navigating the health care system. Now they will work in their own communities and help bridge barriers to oral health care, such as poverty, geography, language, culture and a lack of understanding of oral hygiene.

The FDA will continue to advocate for dental health care and education for all Floridians. Everyone should have the opportunity to have good oral health. As a state, as employers and as individuals, we need to recognize that oral health is essential to overall health and quality of life, and promote more collaborative solutions for these issues.

Dr. D’Aiuto is the FDA President and can be reached at bdaiuto@bot.floridadental. org.

September/October 2016

Today's FDA

5

Legal Notes

Déjà vu Part Two: The Federal Government Has Changed How Much You Can Charge to Copy Records AGAIN Graham Nicol, Esq., HEALTH CARE RISK MANAGER, BOARD CERTIFIED SPECIALIST (HEALTH LAW)

The last “Legal Notes” column in the July/ August issue of Today’s FDA discussed the federal government’s interpretation of records copying charges. Doctors and their legal counsel were equally outraged by what was posted to the Office of Civil Rights’ (OCR) frequently asked questions (FAQ) website: Further, while the Privacy Rule permits the limited fee described above, covered entities should provide individuals who request access to their information with copies of their personal health information (PHI) free of charge. (Emphasis added.)

While covered entities should forgo fees for all individuals, not charging fees for access is particularly vital in cases where the financial situation of an individual requesting access would make it difficult or impossible for the individual to afford the fee.

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Today's FDA

September/October 2016

We will continue to monitor whether the fees that are being charged to individuals are creating barriers to this access, will take enforcement action where necessary, and will reassess as necessary the provisions in the Privacy Rule that permit these fees to be charged.

We note that as technology evolves and processes for converting and transferring files and formats become more automated, we expect labor costs to disappear or at least diminish in many cases. (Emphasis added.)

Fortunately, there was such an outcry against OCR pressuring doctors to provide electronic copies of electronic records for free that this has now been removed from the website. I suspect it probably still reflects the opinion of OCR. After all, they are meant to be watchdogs protecting patients’ rights to access their medical records. But I am glad they realized that language suggesting that covered entities provide electronic copies for free crossed the line and removed it from their website.

The new OCR FAQ site further clarifies that the $6.50 flat rate is one of three options available to covered entities, with average and actual costs being the other two. I still think it is unfair to smallbusiness owners. It places an unneces-

sary record-keeping burden on doctors to justify how they calculate average and actual costs. Further, OCR uses a standard of “reasonableness” for the calculation of wages paid to staff. This doesn’t give much concrete guidance and will always leave doctors with the anxiety that they have done the calculation wrong. Even with the new interpretation, I fear that doctors will simply take the easy route and just charge the $6.50 flat rate because they don’t want to calculate and document actual or average charges.

But if you know you’re going to lose money at the $6.50 flat rate, please realize there are other options. If the patient’s request is time-consuming or involves electronic formats or technology you are not familiar with, then decide for yourself whether using actual or average costs is justified.

So what is the step-by-step process for calculating average and actual expenses?

According to the revised FAQs: A covered entity may include reasonable labor costs associated only with the: (1) labor for copying the PHI requested by the individual, whether in paper or electronic form; and (2) labor to prepare an explanation or summary of the PHI, if the individual, in advance, both chooses to receive

www.floridadental.org

Legal Notes

an explanation or summary and agrees to the fee that may be charged.

Labor for copying only includes labor to create and deliver the electronic or paper copy in the form and format requested or agreed upon by the individual, once the PHI that is responsive to the request has been identified, retrieved or collected, compiled and/or collated, and is ready to be copied. For example, labor for copying may include labor associated with the following, as necessary to copy and deliver the PHI in the form and format and manner requested or agreed to by the individual: v photocopying paper PHI v scanning paper PHI into an electronic format v converting electronic information in one format to the format requested by or agreed to by the individual v transferring (e.g., uploading, downloading, attaching, burning) electronic PHI from a covered entity’s system to a web-based portal (where the PHI is not already maintained in or accessible through the portal), portable media, email, app, personal health recorder, or other manner of delivery of the PHI v creating and executing a mailing or email with the responsive PHI In contrast, labor for copying does not include labor costs associated with: v reviewing the request for access. v searching for, retrieving and otherwise preparing the responsive information for copying. This includes labor to locate the appropriate designated record sets about the individual, review the records to identify the PHI that is responsive to the request, ensure the information relates to the correct indi-

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vidual, and to segregate, collect, compile and otherwise prepare the responsive information for copying.

In addition, if an individual requests, covered entities should provide the individual with a breakdown of the charges for labor, supplies and postage, if applicable, that make up the total fee charged. We note that this information would likely be requested in any action taken by OCR in enforcing the individual right of access, so entities will benefit from having this information readily available.

In other words, if your practice intends to charge actual or average costs instead of the $6.50 flat rate, be prepared to produce documentation if a complaint is filed with OCR and retain that documentation for at least five years from the calculation. You also need to get the patient to agree to your records copying charge determined under the actual or average cost method before you charge them the fee.

More from the revised FAQs: In addition to being reasonable, the fee may include only certain labor, supply and postage costs that may apply in providing the individual with the copy in the form and format and manner requested or agreed to by the individual. The following methods may be used, as specified below, to calculate this fee. v Actual costs. A covered entity may calculate actual labor costs to fulfill the request, as long as the labor included is only for copying (and/or to create a summary or explanation if the individual chooses to receive a summary or explanation) and the labor rates used are

reasonable for such activity. (Emphasis in original.) The covered entity may add to the actual labor costs any applicable supply (e.g., paper, or CD or USB drive) or postage costs. Covered entities that charge individuals actual costs based on each individual access request still must be prepared to inform individuals in advance of the approximate fee that may be charged for providing the individual with a copy of her PHI. (Emphasis in original.) An example of an actual labor cost calculation would be to time how long it takes for the workforce member of the covered entity (or business associate) to make and send the copy in the form and format and manner requested or agreed to by the individual, and multiply the time by the reasonable hourly rate of the person copying and sending the PHI. What is reasonable for purposes of an hourly rate will vary depending on the level of skill needed to create and transmit the copy in the manner requested or agreed to by the individual (e.g., administrative level labor to make and mail a paper copy versus more technical skill needed to convert and transmit the PHI in a particular electronic format). v Average costs. In lieu of calculating labor costs individually for each request, a covered entity can develop a schedule of costs for labor based on average labor costs to fulfill standard types of access requests, as long as the types of labor costs included are the ones which the Privacy Rule permits to be included in a fee (e.g., labor costs for copying but not for search and retrieval) and are reasonable. (Emphasis in original.) Covered Please see LEGAL, 8

September/October 2016

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7

Legal Notes

LEGAL from 7

entities may add to that amount any applicable supply (e.g., paper, or CD or USB drive) or postage costs. v This standard rate can be calculated and charged as a per-page fee only in cases where the PHI requested is maintained in paper form and the individual requests a paper copy of the PHI or asks that the paper PHI be scanned into an electronic format. Per-page fees are not permitted for paper or electronic copies of PHI maintained electronically.

(Emphasis in original.) OCR is aware that per-page fees in many cases have become a proxy for fees charged for all types of access requests — whether electronic or paper — and that many states with authorized fee structures have not updated their laws to account for efficiencies that exist when generating copies of information maintained electronically. This practice has resulted in fees being charged to individuals for copies of their PHI that do not appropriately reflect the permitted labor costs associated with generating copies from information maintained in electronic form. There-

fore, OCR does not consider per-page fees for copies of PHI maintained electronically to be reasonable for purposes of 45 CFR 164.524(c)(4).

There is another circumstance when your practice may want to pay close attention instead of charging the flat rate. That’s when the request is coming from a lawyer’s office because the dental records are needed in a litigated case. Again, from the OCR FAQs: In contrast, third parties often will directly request PHI from a covered entity and submit a written HIPAA authorization from the individual (or rely on another permission in the Privacy Rule) for that disclosure. Where the third party is initiating a request for PHI on its own behalf, with the individual’s HIPAA authorization (or pursuant to another permissible disclosure provision in the Privacy Rule), the access fee limitations do not apply. However, as described above, where the third party is forwarding — on behalf and at the direction of the individual — the individual’s access request for a covered entity to direct a copy of the individual’s

PHI to the third party, the fee limitations apply.

When you get a subpoena or request from a lawyer to reproduce records, it often will attach the individual’s authorization. In these circumstances, you may be confused as to whether the request is coming from the third party or the patient. Here’s what OCR suggests you do: Where it is unclear to a covered entity, based on the form of a request sent by a third party, whether the request is an access request initiated by the individual or merely a HIPAA authorization by the individual to disclose PHI to the third party, the entity may clarify with the individual whether the request was a direction from the individual or a request from the third party. OCR is open to engaging with the community on ways that technology could easily convey this information.

The takeaway from all of this is that the federal government is now getting involved in the doctor-patient relationship and telling both you and your patients how much

What Florida Dentists Need to Know about Prescription, Controlled Substance and Pain Management Laws (LC01) Patient Abandonment (LC02) Take these courses online to earn free CE credit. For links, go to floridadental.org/members. FDA Members Only!

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Legal Notes

can be charged when copying records. Gone are the good old days when all your records were paper and you knew you could (if you wanted to) charge up to $1 per page because that’s what the county government charged you as a citizen to access public records.

Ironically, the federal government doesn’t follow the same rules when it comes to their electronic records as they want you to follow when it comes to your electronic records. For example, the federal government has a program called Public Access to Court Electronic Records (PACER).

For every electronic court records search conducted by the PACER Service Center, there is a flat-fee charge of “$30 per name or item searched.” So, that’s a flat fee from the government of $23.50 more that you as a

citizen pay than the $6.50 they want you as a covered entity to charge your patients.

As another example, when the PACER Service Center reproduces its electronic records on paper for you, the government will charge you a fee of 50 cents per page. But, as a covered entity, OCR warns you that, “per-page fees are not permitted for paper or electronic copies of PHI maintained electronically.” (Emphasis in original.)

If you as a citizen use the PACER Service Center, forget about getting a breakdown of the government’s charges for labor, supplies and postage that make up the total fee charged to you. But OCR tells you as a covered entity that, “if an individual requests, covered entities should provide the

88%

individual with a breakdown of the charges for labor, supplies and postage, if applicable, that make up the total fee charged.”

Two-year olds know the difference between “do what I say” and “do what I do.” How old do you have to be to get a job in the federal government?

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

Graham Nicol is the FDA’s Chief Legal Counsel.

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Information Bytes

My Name is Larry, and I am a Technology Addict

By Larry Darnell DIRECTOR OF INFORMATION SYSTEMS

Not that long ago, I went somewhere I couldn’t use any technology. I couldn’t use my phone or have any access to the internet.

No, I was not in jail or prison. I have to admit, it was the hardest thing to not be able to read any emails, check Facebook, take selfies, play mindless games or surf the web. I honestly have become so dependent on my vast array of technology that it is difficult to remember a time when I had none of it.

Even family dinners are different. We tend to gravitate to the technology. It’s hard to make a rule to not use technology when you are the prime user of it. Sort of like getting my kids to eat vegetables when I don’t. I’m pretty sure I have attention-deficit disorder and that is not helped by trying to multitask a conversation and technology at the same time. You’ll hear me say, “Huh?” “What did you say?” and “Come again?” pretty often. Go to any restaurant and look at any two people together and see how much time they spend on their technology and not on each other … surely, I am not alone in my bad habit.

I’m trying to think of the number of times I have truly gone unplugged from my technology. It hasn’t happened often. I bet you even take your phone or tablet to the bathroom, so don’t judge me. I thought technology was supposed to make life easier. However, with all of the tweets, likes, emojis and posts regularly happening, I’m not sure I have many moments to myself. I even wear it on my wrist now. It used to be that every ding, tone or noise would instantly make me pick up my phone or check my email (at any time of the day or night, by the way). Now, I get a couple of pulses on my wrist and I’m fully involved in looking at my techno watch.

If I didn’t know better, I would think technology has become my new drug. I can’t do without it, and go into withdrawals when I am unable to use it. What I have is good, but it is never enough — I need more, faster, newer technology. I’ve passed this culture on to my wife and children, and now I’m not only a technology addict, I’m a technology dealer, too.

When we focus on wellness, we tend to point the finger at everyone else. As it has become apparent to me, the proverb, “Physician, heal thyself,” applies to my use of technology. The

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“

I’ve passed this culture on to my wife and children, and now I’m not only a technology addict, I’m a technology dealer, too.

”

first step is becoming aware that there is a problem. I am a technology addict. Step two is doing something about it. I can’t quit technology cold turkey, and I’m sure you can’t either. However, decide to become more aware of your use of technology and look for ways to cut down and cut back.

Limit your use. Have a technology-free hour or evening. We are all on the path to recovery — some of us just haven’t started it yet.

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

September/October 2016

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*Please note that FDA members have their names listed in bold.

in 1979-1980. Our thoughts and prayers are with his family.

CFDDA Newsletter Recognized

EFSC Faculty Member Honored for His Service in the Air Force Reserve

The Central Florida District Dental Association’s (CFDDA) newsletter received the International College of Dentists Silver Scroll Division 2 Award for overall improvement in 2015! Please congratulate Dr. Ed Kennedy, the CFDDA newsletter editor, Dr. Gary Altschuler, acting editor (20142015) and the CFDDA executive director, Marlinda Fulton, for their extraordinary efforts! The award will be presented at the American Association of Dental Editors and Journalists’ annual meeting on Oct. 19, 2016 in Denver, Colo.

ADA Institute for Diversity in Leadership The American Dental Association’s Institute for Diversity in Leadership recently announced the class of 2016-2017, which includes Dr. Stephanie Mazariegos from Lithia, Fla. Congratulations, Dr. Mazariegos!

In Memory of FDA Past President Dr. Fred J. Ackel died on Aug. 9 in Fort Lauderdale. He graduated from Georgetown University School of Dentistry in 1954. He also was a midshipman in the U.S. Merchant Marines and a captain in the U.S. Air Force Reserve. Upon moving to Fort Lauderdale in 1956, he established his dental practice and he served the South Florida community for 43 years. He was a past president of the Florida Dental Association

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Dr. Dennis Connaughton, a dentist and professor of Dental Hygiene who has taught at Eastern Florida State College for 24 years, has received the Meritorious Service Medal for leadership and the Military Outstanding Volunteer Service Medal.

FDA Services’ Chief Operating Officer is Now For-profit Subsidiary Group Chair Scott Ruthstrom now serves as the chair of the For-Profit Subsidiary group meeting. This group meets each year and is made up of state dental association executive directors and the directors of state association for-profit subsidiaries. In this two to three year leadership commitment, Scott will chair the meetings, arrange for speakers, and be a resource of other states.

laws and rules governing sedation dentistry.

One of the most frequently asked question is about having a physician anesthesiologist (MDA) who performs sedation in a dentist’s office. According to the Florida Administrative Code 64B5-14.0032, if you have a physician anesthesiologist performing sedation in your office, you must notify the BOD and be inspected at the general sedation permit level.

Another question frequently asked is about the use of CRNAs. Rule 64B5-14.0038 Use of Qualified Anesthetist (CRNA) states that CRNAs may administer anesthetic to a patient under the direct supervision of the permit holder for the dental office only at the level of sedation of the permit holder.

Sedation Dentistry: A Letter from the BOD

Depending on the level of sedation that will be administered, the dentist must have the correct and valid permit along with the required office equipment and medical supplies. For Itinerate/Mobile Anesthesia, each location that sedation is performed must be reported to the BOD and properly inspected at the appropriate permit level.

As a requirement of the permit, an on-site inspection will be conducted by an inspector who also is a Florida-licensed dentist with previous sedation experience. The inspection will evaluate the facility, equipment and personnel. If a permit is issued, it must be renewed every two years and is valid only at the locations reported to the BOD.

The Florida Board of Dentistry (BOD) was established to ensure that every dentist and dental hygienist practicing in this state meets minimum requirements for safe practice. The purpose of this letter is to provide you with information regarding the

For the rules regulating your permit, go to Florida Administrative Rule Chapter 64B514. To learn more about the various permits for sedation dentistry call the BOD office at 850.245.4474. To report your locations or a

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change in location, email the BOD at info@ floridasdentistry.gov.

To receive updates on changes in the law and Board rules, reminders about legal requirements that impact your profession, simply subscribe to the BOD’s email service at http://floridasdentistry.gov/resources/. If you have any questions, please contact FDA Lobbyist Casey Stoutamire at 850.350.7202 or cstoutamire@floridadental.org.

Disclaimer: This material is from the Florida Board of Dentistry and is reprinted here for general reference purposes only and does not constitute legal advice.

Dentists should contact qualified legal counsel for legal advice. The Florida Dental Association (FDA) makes no representations or warranties about the information provided by the Board of Dentistry, which is independent of the FDA.

New Director of Foundation Affairs R. Jai Gillum is the new Director of Foundation Affairs for the Florida Dental Association Foundation. She received both her undergraduate degree and Master of Public Health degree from Florida A&M University. She most recently served as the Director of Income & Health Strategies for the United Way of the Big Bend. R. Jai developed a passion for dental health issues while on the State Oral Health Improvement Plan for Disadvantaged Persons Workgroup. She also has been affiliated with the Florida Commission on the Status of Women, Florida Healthy Kids Corporation (Ad Hoc Board Member) and

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the Tallahassee Community College Foundation Board of Directors. R. Jai is married to Tallahassee Mayor Andrew Gillum, and they have two children.

Florida Mission of Mercy Award

CDT 2017 Update CDT 2017: Dental Procedure Codes features 11 new codes, five revised codes and one deleted code. The manual builds on previous code sets with codes that fill documentation gaps, making it easier to code quickly and accurately. More detailed options for documentation also provide better protection from legal liability, as well as fewer rejected insurance claims. The Code on Dental Procedures and Nomenclature in CDT 2017 is the only HIPAA-recognized code set for dentistry. The availability of these tools allows time for staff training before the codes go into effect on Jan. 1, 2017.

CDT 2017 products can be pre-ordered at adacatalog.org or by calling the American Dental Association Member Service Center at 800.947.4746.

Join your colleagues on a CE Cruise to Alaska Enjoy a seven-night Alaskan cruise aboard the Celebrity Solstice, one of Celebrity’s premiere ships, on June 30-July 7, 2017. The Florida Dental Association has partnered with the Michigan Dental Association to bring you this great opportunity. Twelve hours of continuing education (CE) credit will be available for $499 while you enjoy the beautiful sites in Alaska. Go to http:// classictravelusa.com/mda for more information on how to sign up for the trip and get 12 hours of CE credit!

Please see NEWS, 14

The Florida Dental Association Foundation and Florida Mission of Mercy (FLA-MOM) Committee were recognized by the governor and the Florida Cabinet today for their contributions to improve the dental health of Floridians through ongoing FLA-MOM events.

Dr. Stevenson Receives Award

Dr. Rick Stevenson received the Governor's Veteran Service Award from Gov. Rick Scott during a ceremony in September.

FDC Committee Members

(L to R) Drs. Tricia Hess, Sandy Rosenberg, Yvette Godet and Bert Hughes enjoy a Gator football game this season at the University of Florida. Photo courtesy of Dr. Godet.

September/October 2016

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NEWS from 13

In Memoriam The FDA honors the memory and passing of the following members: Albert C. Fears Largo Died: 7/4/16 Age: 73

Harry W. Davis Tallahassee Died: 8/9/16 Age: 71

Eric Reum, Delray Beach Lana Riettie, Plantation Jeffrey Shiffman, Boynton Beach Marcela Solarte, Weston Keith Sonchaiwanich, Stuart Shelly Taylor, Lauderdale Lakes Linda Truong, Port St. Lucie Jacqueline Urcuyo, Fort Lauderdale Julia Zaslavsk, West Palm Beach William Zenga, Fort Lauderdale

Welcome New FDA Members

Central Florida District Dental Association

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

Anthony Azadi, Eustis Luisa Betancur, Ocala Raquel Blanco, Gainesville Frantz Brignol, Tavares Tirzah Brittlebank, Oviedo Jaime Cadena, Orlando Michael Caputo, Orlando Jeresia Choice, Orlando Joshua Cline, Clermont Andreea Cosma, Plantation Lauren Coughlin, Winter Springs Tamra Culp, Vero Beach Timothy Davidson, Longwood Gaurav Desai, Indianapolis Joel Eley, Melbourne Megan Gallagher, Daytona Beach Robert Gannon, Orlando Brent Golden, Orlando Alejandra Gonzalez, Palm Bay Selycette Hamner, Gainesville Omid Khezri, Titusville Rachel Killam, Gainesville Glenn Losasso, Indian Harbour Beach Ramzy Lotfi, Clermont Jessica McMann, Lake Mary Nikki Moshiri, Melbourne Stephen Obeng, Orlando Mairelys Onate, Gainesville Yesha Patel, Deltona Edina Penland, Sanford Marina Perez, Sanford Quyen Pham, Altamonte Springs Edward Pirie, Windermere Ryan Priemer, St. Cloud Vanessa Quintero, Windermere George Quintero, Windermere Derrick Rizziello, Lady Lake

Atlantic Coast District Dental Association Sana Abdel-Jabbar, Boca Raton Armand Asinmaz, Boca Raton John Aylmer, Delray Beach Clifford Bryan, Port St. Lucie Jenevieve Bunassar, Miami Tiffany Chin-You, Cooper City Yolanda Cintron, Fort Lauderdale Ryan Coello, Parkland Guillermo Cortes Morales, Davie Kelly Cundy, Fort Lauderdale Nathan Eberle, Weston Adriana Echenagucia, Fort Lauderdale Patrick Fitzgerald, West Palm Beach Shana Francois, Coconut Creek Eli Friedman, Plantation Mario Hernandez, Boynton Beach Thomas Hussey, Fort Lauderdale Serafeim Kallithrakas, Davie Elizabeth Kerr, Southwest Ranches Rose Le, Lake Worth Chau Leminh, Parkland Dianoris Lora, Palm Springs Farinaz Niroumand, Davie Margarita Ochoa, Coral Springs Sandra Ogando, Plantation Roshni Patel, Port St. Lucie Jose Porras, Davie

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Andrew Roman, Gainesville Priyanka Roperia, Lady Lake Claire Rosebrough, Gainesville Jairo Sanchez, Gainesville Kira Santos, Pembroke Pines Luciana Shaddox, Gainesville Earl Spader, Palm Coast Roger Thayer, Daytona Beach Ivy Tran, Orlando Ngoc Trang Truong, Gainesville Phuong Van, Port Orange Tim Van, Deland Nopparat Voaonsri, Orlando Clara Vu, Gainesville William Westberry, New Smyrna Beach Cara Wiewiora, Lake Mary Jessica Wyatt, Orlando Lina Yu, Orlando Gabrielle Zuzo, Canton

Northeast District Dental Association Leydi Barros, Jacksonville Cary Berdy, Jacksonville Timothy Bradberry, Jacksonville Bryan Bright, St. Johns Evan Busby, Erie Neha Chakravarti, Jacksonville Shruti Chopra, Ponte Vedra Joseph De Jesus, Jacksonville Akhil Dubey, Jacksonville Ricardo Fontoura, Atlantic Beach Francisco Gari, Jacksonville Michelle Goodman, Jacksonville Ryan Johnson, Jacksonville Beach Hyun Kang, Jacksonville Beach Jullia Kinser, Jacksonville John Landis, Gulf Breeze Annette Lorenzo Reyes, Jacksonville Nicolas Mabardi, Orange Park Abusad Mahmud, Gainesville Yunior Molina, Jacksonville Jennifer Perna, Jacksonville Beach Grettel Recillez-Lopez, Ponte Vedra Beach Yanisis Romero, Gainesville Kristofer Sears, Jacksonville Beach Juhi Soni, Jacksonville Jay St Charles, Lutz Jonathan Weiss, Gainesville

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Northwest District Dental Association Justin Buchanan, Crestview Jason Carter, Tallahassee Carl Graves, Belton Ana Monzin, Lakewood Ranch Jose Paiva, Destin Krista Parker, Panama City Jenna Pascoli, Panama City Joseph Rodriguez, Santa Rosa Beach Robert Rowell, Holt Kaycee Wilcox, Bonifay

South Florida District Dental Association Arnedith Adarmes, Miami Ahmad Sherriff Ali, Miami Yailen Alvarado, Hollywood Joseph Alvarez, Cutler Bay Jose Amador, Southwest Ranches Claudia Arias, Pembroke Pines Lara Bacchelli, Miami Beach Jorge Barona, Miami Yehuda Benjamin, Hollywood Joshua Blanton-Dickens, Doral Rene Cabrera, Miami Eileen Castro, Miami Ailin Chao, Miami Kristina Christoph, Southwest Ranches Florin Cicortas, Hollywood Ada Corugedo, Miami Javier Cutino, Miami Jany Diaz, Miami Angela DiPastina, Philadelphia Alexander Duque, Pembroke Pines Jonathan Echeverri, Miami Merisney Espinosa, Coral Gables Dario Ferrer Torres, Doral Maria Franco, Miami Rogelio Garrote, Miami Evelyn Gil, Doral Daniella Godoy, Davie Darlen Gonzalez, Miramar Vannette Guerra, Miami Russell Kotch, Pembroke Pines Vicente Lau, Miami Analidys Lemus, Miami Michael Marrocco, Miami Claudia Martinez, Miami Beach

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Katiuska McIntosh Falcon, Miramar Diana Morell, Miami Supriya Narang, Fort Lauderdale Marianelys Navarro Sanchez, Miramar Lorena Pell, Miami Mileidis Pena Marro, Miami Ann Pereira, Miami Laura Perez, Hialeah Silvina Rajschmir, Aventura Maria Elena Regalado, Miami Alice Reich, Plantation Avery Ruben, Cooper City Zeida Sacerio Brunet, Hialeah Jessica Tendero, Miami Lakes Ricardo Verne, Pembroke Pines Marilyn Yaber, South Miami Jose Yaber, South Miami

West Coast District Dental Association Jason Alter, St. Petersburg Clay Alviani, Tampa Sheno Bennett, Tamarac Fred Benzenhafer, St. Petersburg Igor Bilov, North Port Gibson Boswell, Tampa Kenton Brandimore, St. Petersburg Carina Canizares, St. Petersburg Carina Catipovic, Wesley Chapel Shweta Chapagain, Palm Harbor Eros Chaves, Seminole Stephanie Cole, Sarasota Sharon Colvin, Bradenton Jacqueline Dorociak, Sarasota Kelli Eberhardt, Bonita Springs Derek Espino, Tampa Maira Estrada, Lakeland Jennifer Fiorica, Tampa Charlotte Fowler, Lakewood Ranch Maria Garcia, Plantation John Girgis, Tampa Gabrielle Goodman, Tampa Brittany Guerrero, Tampa Cole Haggerty, St. Petersburg MHD Nadim Haidar, Orlando Beenabahen Harkhani, Fort Myers Kendrah Harper, Lakeland Annette Harriman, Sarasota Trevor Hart, Estero Johanna Hernandez, Miami

Helen Hoveida, Tampa Sorina Ilie, Naples Jacqueline Jakubiec, Tampa Sarah Johnson, Sarasota Yuriy Kuchmak, Bradenton Brandon Larkin, Clearwater Joana Lastres, Naples Vitaly Levintov, Land O’ Lakes Sadaf Mahdavieh, Valrico Julie Mancera-Loftin, Bonita Springs Brian Mannari, St. Petersburg Gjergj Mara, Palm Harbor Joseph Massey, Spring Hill Stephanie Mazariegos, St. Petersburg Nicholas Mickelson, Tampa Alicia Millan-Morales, Seminole Laura Munoz, St. Petersburg Tony Nader, Seminole Brittany Nalley, Palm Harbor Ashley Nati, Tampa Jimmy Orphee, Winter Haven Dharmendra Pansuriya, Sarasota Kelly Paula, Davie Samuel Pero, Lake Wales Elena Petrova, Sarasota Pete Pham, Tampa Emily Plaza, Coral Springs Jillian Porto, Sarasota Kampa Raju, Gainesville Navid Ramsi, Coral Springs Kirstin Rasmussen, Tampa Michelle Ringwald, Bradenton Jade Rivera, Spring Hill Roxann Russell Aves, Tampa Maksym Ruzanov, Sarasota Adam Scheurer, Fort Myers Courtney Schlenker, Seminole David Smith, Bradenton Gayathri Subbaraya, Lithia Kirsten Teresi, Pinellas Park Richard Thibodeau, Fort Myers Jonathan Van Dyke, Palm Harbor Brianne Wade, Land O’ Lakes Crystal Watters, Riverview Ariel Westervelt, Naples Karen Wilkinson, Fort Myers

September/October 2016

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Members‘ Opinion

Letters to the Editor The Florida Dental Association (FDA) welcomes letters from readers on articles that have recently appeared in Today’s FDA (TFDA) and matters of general concern to Florida dentists. The FDA reserves the right to edit all communications and requires that all letters be signed. Letters must be no more than 550 words and may cite no more than five references. Brevity is appreciated. No illustrations will be accepted. You may submit your letter via email to tfdaeditor@floridadental.org, by fax to 850.561.0504 or by mail to Florida Dental Association, Attn: TFDA Editor, 1111. E Tennessee St., Tallahassee, FL 32308-6914. By sending a “Letter to the Editor,” the author acknowledges and agrees that the letter and all

is to know a lot about marijuana based on their own personal use. If the dental community as a whole is against mid-level providers, then we should see the danger of a constitutional amendment empowering non-medically trained personnel in the direct care of patients.

rights of the author in the letter become the property of the FDA. Letter writers are asked to disclose any personal or professional affiliations or conflicts of interest that readers may wish to take into consideration in assessing their stated opinions. The views expressed are those of the letter writer and do not necessarily reflect the opinion or official policy of the editor, staff, officials, Board of Trustees or members of the FDA.

Letter to the Editor Dentists Should Stand with FMA

By Dr. David F. Sutton As fall approaches and the nastiness of the political season hits full force, it is easy to disengage entirely and ignore the other issues that are up for a vote. However, Florida voters will need to decide on some important issues that could potentially affect the Sunshine State in drastic ways. Specifically, Amendment 2 — the ballot initiative to legalize medical marijuana — requires a closer look.

There are many reasons to oppose this amendment. However, as dentists, the real danger is that this amendment goes around the medical community to constitutionally empower non-medically trained personnel to be involved in the direct care of patients, which creates a whole new model for dispensing medication without any say from the medical community.

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You would assume that this amendment means a doctor writes a prescription and patients go to the pharmacy to get it filled.

However, doctors cannot write a prescription for marijuana. Instead, the amendment would allow them to give a flimsy recommendation, which is not considered legitimate in the medical community. This is why in states with medical marijuana, like California, there are only unscrupulous doctors — referred to as “pot docs” — involved in recommending marijuana.

In addition, pharmacists are nowhere in this model. Instead, this amendment gives license to people with no medical training or clinical experience to perform the duties of a pharmacist. In states with medical marijuana, the pot industry affectionately refers to these people as “budtenders.” These are the men and women who dispense the marijuana in its many forms. Obviously, the term budtender is a play on the word bartender. This should give you a clue as to what their job is really about. They can’t give you advice on dosing or how to use marijuana safely. Their only requirement

Obviously, this sets a dangerous precedent.

It not only subverts our current health care model, but it also leaves open the possibility that other medical/dental treatments will be left up to a super majority. This may be why the Florida Medical Association (FMA) recently passed a resolution in opposition to Amendment 2. FMA CEO Tim Stapleton said, “There is nothing medical about this proposal, and the lack of scientific evidence that pot is helpful in treating medical conditions is far from conclusive.”

So I ask you: Who gets to set the standards and parameters of health care? Should it be a super majority? Or should it be health care providers in conjunction with the scientific community? I believe it should be the latter.

For that reason, I believe all dentists should stand with the FMA and oppose Amendment 2. A “No” vote protects the interests of both the general public and health care providers. I would hope you see it that way, too.

So, please, vote “No” on Amendment 2.

Dr. Sutton is a general dentist in Orlando and can be reached at dsutton181@msn.com.

www.floridadental.org

Members‘ Opinion

Letter to the Editor

By Dr. Stephen B. Hulen

To the Editor of Today’s FDA: This letter of concern is about the article, “DDS: Double Down Solution to Florida’s Access to Care,” which appeared in the May/June issue of Today’s FDA. In a side box, it stated there were “few to no volunteers in Highlands County” who participate in the Donated Dental Services (DDS) program. This negatively reflects on our county as if we are not involved in access-to-care issues.

The truth is, we’ve had the same type of program with Samaritan’s Touch since 2007, which predates the Florida DDS program, which started in 2013.* All patients are

screened for need (150 percent below the poverty level and no insurance), then given a period of time they are eligible before they would have to requalify. All treatment is coordinated by Samaritan’s Touch. The dentist sees the patient and decides to treat for emergencies or do Phase I treatment to rid the patient of active dental disease. They must seek care on their own for fixed or removable prosthetics.

Since 2010 until the end of August 2016, we have delivered approximately $430,000 of care to the dentally underserved in our county. This number represents only care done through the Samaritan’s Touch program and does not include pro bono care reported quarterly to Project: Dentists Care that has been done through Kid Dent of Highlands County.

Our local program is under a different group than DDS but seeks to serve the same population of the dentally underserved.

So, you can see that dentists of Highlands County have been actively trying to reach the underserved for years.

Thank you for listening to my concerns.

Yours Truly, Dr. Stephen B. Hulen *Editor’s note: The Florida DDS program began in 1997. The year 2013 in the article refers to when the Florida DDS program became fully funded, which allowed for a fulltime position with Dental Lifeline Network to coordinate the state.

FDA CHAT online member support NEW! Chat with FDA Member Relations staff and get answers fast.

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Board of Dentistry

Board of Dentistry Meets in Gainesville report unlicensed activity to 877.425.8852 or haltuta@flhealth.gov.

By Casey Stoutamire FDA LOBBYIST

The Florida Board of Dentistry (BOD) met in Gainesville on Friday, Aug. 26. The Florida Dental Association (FDA) was represented by FDA BOD Liaison Dr. Don Ilkka and FDA Lobbyist Casey Stoutamire. Governmental Affairs Coordinator Ms. Alexandra Abboud also was in attendance. Other FDA members in attendance included Drs. Charles Llano and Mark Romer.

Nine of the BOD members were present, which included: Dr. Robert Perdomo, chair; Dr. Joe Thomas, vice chair; Drs. Joe Calderone, Naved Fatmi, Bill Kochenour, Claudio Miro and T.J. Tejera; hygienist, Ms. Angie Sissine and consumer member, Mr. Tim Pyle. Ms. Cathy Cabanzon, hygienist, was absent. There is one consumer position open on the board that the governor has not yet filled.

Mr. Chilo Casas, Unlicensed Activity Liaison, Bureau of Enforcement at the Department of Health, made a presentation to the BOD on unlicensed activity around the state. Mr. Casas encouraged everyone to

Mr. David Flynn, BOD attorney, gave a rules report. There currently are seven rules open for development that deal with the edits to the licensure applications approved at the last BOD meeting. Mr. Flynn also told the BOD that because of the new requirements from the FTC v. North Caroline Board of Dentistry Supreme Court case, the promulgation of rules now will take longer to complete.

Several BOD members gave reports from meetings they attended on behalf of the BOD around the country. Dr. Miro attended the Commission on Dental Competency Assessments (CDCA) Steering Committee meeting in June. He also attended the Curriculum Integrated Format (CIF) Exam at the Nova Southeastern University College of Dental Medicine. He reported that all the examiners attended a three-hour calibration exercise on the day before the exam, and subsequently, the exam ran well.

Drs. Fatmi and Perdomo, along with Ms. Cabazon, attended the American Board of Dental Examiners (ADEX) House of Representatives meeting in August. For additional information, please refer to the report at the end of this article.

Since the last BOD meeting, Dr. Fatmi worked with Drs. Romer (LECOM School of Dental Medicine) and James Haddix

(University of Florida College of Dentistry) to update the continuing education guidebook, which is a list of all the remediation courses offered by each of the dental schools. The BOD uses this information during discipline cases that require the dentist to complete remediation before resuming his/her practice. A draft of the guidebook will be given to the BOD at the November meeting.

No action was taken on any of the rules approved at the Aug. 15 Council on Dental Hygiene conference call. Ms. Cabanzon asked prior to the BOD meeting that these items be tabled since she was absent from this BOD meeting.

There were three disciplinary cases and two voluntary relinquishments that dealt with failure to meet the standard of care and failure to keep proper dental records.

There also was a review of a recommended order from the Division of Administrative Hearings.

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

Ms. Stoutamire can be reached at 850.350.7202 or cstoutamire@floridadental. org.

The next BOD meeting is scheduled for Friday, Nov. 18 at 7:30 a.m. EST at the Marriott Miami Airport, 305.642.8200. The Anesthesia Committee will meet at the same location on Thursday, Nov. 17 at 1:30 p.m. EST. Also on Thursday, there will be a Dental Consultant/Inspector training at the same location at 8 a.m. EST. 20

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www.floridadental.org

Board of Dentistry

American Board of Dental Examiners (ADEX) Report Highlights The following are highlights of the 12th Annual ADEX House of Representatives: There were 50 out of 58 Jurisdiction, District Hygiene and District Consumer Representatives present.

2016-2017 Officers Were Elected: n Dr. Stanwood Kanna, HI, president n Dr. William Pappas, NV, vice president n Dr. Jeffery Hartsog, MS, secretary n Dr. Conrad “Chip” McVea III, LA, treasurer n Dr. Bruce Barrette, WI, remains as immediate past president

ADEX Board of Directors Elected: n District 5 – Dr. Eleanore Awadalla, OH n District 8 – Dr. David Perkins, CT (re-elected) n District 9 – Dr. Russell Chin, RI n District 10 – Dr. Mina Paul, MA

ADEX Board of Directors n Framework for a major review on the ADEX Bylaws announced. n ADEX Strategic Plan reviewed.

Changes to the ADEX Dental Examination: n Scoring — No changes. n Endodontics

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n Increased the allowable size of the posterior access opening for 2017. n Approved new prototype Aca- dental molar for use in examina- tion starting in 2018 or later de- pending on its availability. n Periodontics — No changes. The committee is working on developing a prototype patient-based periodontics exam that tests for the critical aspects of the National Occupational Analysis (NOA). n Restorative n Approved the indirect pulp cap protocol beginning in 2017. n In 2018, there will be one posterior composite restoration. n Prosthodontics — No change to current exam. Committee finalized new proposed criteria.

Changes to the ADEX Dental Hygiene Examination: n The 2017 scoring changes will undergo an equating study before they are implemented. n The case selection will consist of one primary quadrant with six natural teeth and two posterior teeth in a secondary quadrant, all of which the candidate may use to select surfaces. n The 2018 examination will be stopped after pre-treatment if it is determined that an adequate number of points has not been accrued to pass the examination.

n A process for the submission of a second case selection is being investigated for implementation in 2018.

ADEX House of Representatives n Approved the Dental and Dental Hygiene Examinations as recommended by the Examination Committees and the Board of Directors.

Presentations to the House of Representatives: n Dr. Joseph Gambacorta, Assistant Dean of Clinical Affairs, University of Buffalo School of Dental Medicine n “The Role of the Patient Centered CIF in a National Exam for Dentistry” n Dr. David Perkins, Chair, The Commission on Dental Competency (COCA)

n “ADA Licensure Task Force — The Dental Examinations Are Not the Same” The 13th Annual ADEX House of Representatives Meeting is scheduled on Sunday, Aug. 13, 2017 at the Doubletree Hotel, Rosemont, Ill.

September/October 2016

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FLORI DA DENTAL CON VENT I O N: THE OF F I CI AL ME E T I NG OF THE F DA

GET CONNECTED: Team to Technology

SAVE THE DATE

JUNE 22-24, 2017

floridadentalconvention.com

G AY L O R D PA L M S R E S O R T & C O N V E N T I O N C E N T E R • O R L A N D O , F L O R I D A

REGARDING THIRD-PARTY PAYORS …

WHO SPEAKS FOR YOU?

WE DO! RECENT EXAMPLE: July Letters from Medicaid Managed Care Plan to Medicaid and Florida Healthy Kids Providers Restricting Patient Care    

dental sealants only on high-risk teeth age limit on permanent crowns immediate dentures no longer covered limited children’s X-rays

PLEASE REPORT PROBLEMS WITH THIRD-PARTY PAYORS TO THE FDA. WE CAN HELP!

FDA Members Send Copies of July Letters the FDA. FDA staff evaluates and determines that the plan is unlawfully restricting care.

FDA STAFF CONTACTS THE AGENCY FOR HEALTH CARE ADMINISTRATION (AHCA) ABOUT PLAN’S RESTRICTION OF CARE.

RESULT! AHCA TELLS PLAN IT CANNOT IMPLEMENT CHANGES THAT RESTRICT CARE TO MEDICAID RECIPIENTS.

HELPING MEMBERS SUCCEED

?

For additional information, contact Casey Stoutamire: 800.326.0051 • 850.224.1089 cstoutamire@floridadental.org

Giving

By Rebekah Sanderlin

Your heart is big, but your tax bill is bigger — or at least it feels that way every spring when you meet with your CPA. You want to give — your time, money and resources — but it sure would be nice if you could get a little credit for that generosity in the form of tax deductions.

So what’s a dentist to do?

Before you commit yourself, your staff, equipment or money to a cause, you’d probably like to know if that charitable contribution will be tax deductible.

Fair question. Unfortunately, as with most tax questions, the answer almost always is, “It depends.”

1. Can you claim a deduction if you give to an organization?

According to IRS.gov, “If your goal is a legitimate tax deduction, then you must be giving to a qualified organization. Also, you cannot deduct contributions made to specific individuals, political organizations and candidates.”

So, that check you wrote to help out your neighbor who was running for city council? Not deductible. Also not deductible: any money, goods or time you gave to help out a friend, relative or other person in need. Your big heart is admirable, but those donations won’t reduce your tax bill. Organizations should be able to tell you if donations to them qualify for tax deductions, but the IRS has a search tool to help you check (or double-check) for yourself. It can be found at https://www.irs.gov/charities-nonprofits/exempt-organizations-select-check.

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Three Giving

Questions Every Dentist Should Ask Before Giving

Also, if you received a benefit because of your contribution — such as tickets to a concert or game, or other goods and services — then you can only deduct the amount that exceeds the fair market value of the benefit you received.

If your donation meets the above requirements, make sure you keep a record or receipt of what you gave. According to the IRS, to deduct a monetary contribution, you must maintain a bank record, payroll deduction records or a written communication from the organization that contains the name of the organization, the date of the contribution and amount you gave.

Finally, if you want those donations to count, you have to do the necessary paperwork. To deduct a charitable contribution, you must file Form 1040 and itemize deductions on Schedule A, and there are some additional documentation requirements for certain types of gifts.

2. How much can you deduct?

According to Blake Riber, a senior accountant with Cornelius, Schou and Leone, a certified public accounting firm in Jacksonville, monetary contributions from a business are fully deductible up to 10 percent of the business’ taxable income. Monetary contributions made by a person are deduct-

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ible up to 50 percent of the individual’s adjusted gross income.

Make sense?

Now, it gets a little more complicated depending on how the business was established: LLCs, S-Corporations and Flow-through entities report charitable contributions at the partner level, Riber says.

Bottom line: Always consult a CPA or paid tax preparer to confirm your eligibility to claim a charitable contribution before you commit to or make that contribution.

3. How should you give?

You’ve probably already worked out in your head why you should give to a particular cause and determined which cause you’d like to help. Riber says that how you help that cause is important, too.

Monetary gift: This is the simplest and most effective way to contribute to a charity.

The amount of cash contributed to qualified charitable organizations is fully deductible.

Non-cash goods: This includes gifts of things like equipment, supplies, clothing, etc. You are able to deduct the cost of the item or the fair market value, whichever is less.

Employee time: Share the love — and the labor! If you pay your employees while they participate in qualified nonprofit activities, you can deduct the amount they were paid.

Unfortunately, Riber says that you cannot deduct the value of your own donated time, though.

Mileage: It may not seem like much, but it can add up. Better, it can be deducted.

Taxpayers can deduct 14 cents per mile for driving in the service of a charitable organization.

Appreciated assets: When you donate securities to a qualified charitable organization, you often can get a more advantageous deduction than you would from donating cash or other goods. Security donations can be deducted at their appreciated value and the donor isn’t subject to capital gains tax.

For example, a stock purchased for $10,000 that is now worth $20,000 provides a charitable deduction of $20,000.

However you decide to give and whomever you decide to give to, know that everything you give makes life a little better for the eventual recipients.

So, get to giving! Just make sure you keep your receipts!

Ms. Rebekah Sanderlin can be reached at rebekah.sanderlin@gmail.com.

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DONATE! To make a DONATION, go to www.floridadental.org/foundation, or become a SUSTAINING MEMBER by checking the FDAF box on your Annual Dues Statement.

Your donations support these programs: Florida Mission of Mercy, Project: Dentists Care, Donated Dental Services.

Florida solicitation information: the FDAF is registered with the Florida Department of Agriculture and Consumer Affairs (# CH2435). One hundred percent of charitable contributions are received by the FDAF. No portion of contributions are retained by a professional solicitor. A COPY OF THE OFFICIAL REGISTRATION AND FINANCIAL INFORMATION MAY BE OBTAINED FROM THE DIVISION OF CONSUMER SERVICES BY CALLING TOLL-FREE, (800) 435-7352, WITHIN THE STATE. REGISTRATION DOES NOT IMPLY ENDORSEMENT, APPROVAL, OR RECOMMENDATION BY THE STATE.

YOU are NUMBER

1

YOUR COLLEAGUES ARE “HELPING MEMBERS SUCCEED” EVERY DAY!

DEDICATED VOLUNTEERS HELP YOU SUCCEED Being a part of the Florida Dental Association and the South Florida District Dental Association allows me to learn from fellow dentists, be active in the community and feel supported in all aspects of my practice.

As the young member representative of the South Florida District Dental Association, my goal is to provide a gateway for young dentists to receive guidance, assistance and support for the transition from dental school to serving their community as a dental provider.

MONICA GONZALEZ, DMD

— Monica Gonzalez, DMD Young Member Representative, South Florida District Dental Association mgonzalezdmd@gmail.com

Interested in opportunities to get involved? Simply email the FDA’s Membership Concierge and she’ll put you in touch with your local dental society. Contact Christine Mortham at cmortham@floridadental.org.

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Feedback

Offering Feedback Helps Your Team and Practice Grow

By Sally McKenzie

Your team members crave feedback. They want to know what they’re doing right and where they can improve.

Without feedback from you, the practice CEO, they don’t have the direction they need to excel in their roles and ultimately help move the practice toward true success and profitability.

If you’re like most dentists, you probably don’t spend much time giving team members the feedback they need. That’s not why you became a dentist, after all. You’d rather focus

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Feedback

on dentistry, and trust your team members are doing their part to contribute. The problem is, if you’re not offering your team members direction, they’re likely not meeting their full potential — and that means your practice isn’t either.

A strong team doesn’t just develop on its own. It starts with hiring the right people for the right roles, and then providing them with the tools, training and feedback they need to succeed. Providing continual feedback is important to help your team members grow and motivate them to improve their performance. And giving feedback once or twice a year during performance reviews simply isn’t enough. Most dentists sit down with employees for a few minutes, tell them they’re doing a great job and then give them a little extra money in their paycheck. While you might think a small bump in pay will motivate team members to improve their performance, it won’t. Why should it? In their minds, if you’ve given them a raise, they must be doing something right.

When dentists don’t give continual feedback, not only does the practice suffer, but also the team morale. Team members want to feel like they can grow in their roles and truly contribute to practice success. If you never let them know when you’re happy with their performance or give them advice on how they can improve, they’ll likely feel a little lost — which could send them looking for another job and leave you with the headaches that come with staff turnover.

Rather than providing no feedback at all, some dentists drop subtle hints. Maybe they make passing comments during a staff meeting or post sticky notes with vague messages. This does nothing to address the issue and likely only leaves team members feeling confused.

Scheduling example Let’s say your schedule is a mess. Some days you find yourself running from patient to patient just trying to keep up, and other days there are gaping holes caused by last-minute cancellations and no-shows. Instead of talking with the scheduling coordinator about the importance of scheduling to keep you productive and developing a plan to reduce broken appointments, you mention in a team meeting that your schedule has been a little chaotic lately. While you might think this is enough to get the message across, it does nothing to tell the scheduling coordinator it’s time to make the necessary changes to get your schedule back on track.

The truth is that you need to provide constructive feedback every day. This will go a long way to help your team members improve performance and grow your bottom line. Team members will no longer have to guess how they’re doing or how they can improve. They’ll know, which will help them become more efficient members of your team.

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OK, so now you’re probably wondering when you should actually give this feedback. You can offer feedback at any time, but it’s most effective when the team member is engaged in the behavior you want to praise or correct.

See one of your team members providing excellent customer service to a nervous patient? Let the team member know you noticed and appreciate the extra effort.

Hear one of your team members be short with patients on the phone? Take that team member aside and discuss proper telephone techniques, and offer scripts and extra training if necessary.

It’s important to create an environment that encourages both positive feedback and constructive criticism. When employees receive feedback every day, they’ll understand how important their contributions are to the practice. Feedback will help them grow and develop, making them more efficient and confident in their roles. This will lead to a happier work environment and a more robust bottom line.

This article first ran on DrBiscuspid.com.

Reprinted with permission.

Sally McKenzie is the CEO of McKenzie Management, which offers educational and management products available at www. mckenziemgmt.com. She can be contacted at 877.777.6151 or at sallymck@mckenziemgmt.com.

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Stress

Three Reasons Why a Little Stress Can be Healthy 32

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Stress

By Jen Butler, MEd

Here’s the good news about stress. Small intervals of stress can sharpen your mind and generate health benefits. This is referred to as “acute” stress or eustress.

Endocrinologist Dr. Hans Selye was the first to identify and study stress in 1936, and he documented the different types of stressors and their manifestations. He and other researchers have since identified numerous positive effects on our physical, psychological and biological systems when under just the right amount of stress.

Here are three good reasons why a little stress can go a long way to benefit our overall health: u It can boost brain function. It turns out low-level stressors stimulate the production of brain chemicals called neurotrophins and strengthen the connections between neurons in the brain. u It can increase immunity. “Some kinds of stress — very short term, that last only a matter of minutes — actually redistribute cells in the bloodstream in a way that could be helpful,” said Suzanne Segerstrom, Ph.D., an associate professor of psychology at the University of Kentucky who has conducted studies on stress and the immune system. u It can increase resiliency. A large body of research on the science of resilience has found that learning to deal with stressful situations can make future situations easier to manage, according to the American Psychological Association.

All the experiences we have trigger a complex choreography of chemical reactions within us as our adrenal glands release a cascade of hormones, such as adrenaline and cortisol. Adrenaline increases our heart rate, which boosts our energy level; cortisol increases glucose to our bloodstream.

Bad news When we regularly experience frequent and prolonged stress without enough time to recover, our mental and physical health becomes compromised. This kind of stress is “chronic,” and it is bad news. We are not designed to withstand this overdrive of physiological arousal without paying the consequences to our overall health.

A number of studies have been conducted that look at the stress levels of dentists.

Overall, the studies show 82.7 to 86 percent of dentists experience chronic stress. Related studies reveal unsettling statistics that result from chronic stress among dentists, according to the American Dental Association’s (ADA) 2003 Dentist Well-being Survey, which came out in 2005, and a 2008 study in the British Dental Journal (June 2008, Vol. 204:11, p. E19). The latter study also found that 47 percent of dentists were somewhat happy to unhappy with little interest in life.

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Just as important as owning our strengths, we must admit to our weaknesses.

From here we can heal.

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The ADA discovered the following in its 2003 Dentist Well-being Survey: u 79.4 percent feel low in energy. u 55.8 percent blame themselves for things gone wrong. u 34.9 percent feel hopeless about the future.

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Stress

STRESS from 33

u 29.1 percent have no interest in things. u 23.5 percent have feelings of worthlessness. u 41.9 percent have difficulty concentrating and making decisions.

Of the survey respondents, 24 percent had indicators of diagnosable, moderate to severe depression even though almost half (47.5 percent) have ever been formally diagnosed with the condition. Other studies, such as a 2004 study in the Journal of the American Dental Association (June 2004, Vol. 135:6, pp 788-794), have found similar responses, such as that 34 percent of dentists frequently or always felt physically or emotionally exhausted.

Good news Disturbing statistics? Yes. So how does good news follow this?

Well, the good news is you have more control over chronic stress than you might think. Although you may feel lost, out of control or overwhelmed, along with the realization you are part of the status quo of dentists with chronic stress (just the thought of this is more stressful), you can regain control of your health.

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Stress is triggered by an experience. It is about the way dentists feel and think about their past, present and perceived future and, therefore, it is unique to each dentist. While a “one-size-fits-all” approach may work for the short term, a personalized stress management plan is needed to achieve effective, sustainable results to address the uniqueness of all our perspectives to life’s experiences. So, an effective and sustainable stress management plan is customized to meet the individual needs of each dentist, working from the inside out.

Nonetheless, the first step to go from stressed to stress-free is to acknowledge that you are experiencing chronic stress. Just as important as owning our strengths, we must admit to our weaknesses. From here we can heal.

Dentists experience so many negative emotions in their work that they forget that there is another way to feel. The following three easy-to-apply-everywhere steps will help dentists get to stress-less. u Add “yet” to the end of any sentence for an immediate paradigm shift.

The word “yet” is a powerful word in the English language. It provides hope when you feel stuck. It reminds us that options are still available even when we think we’ve thought of everything.

Most important, it allows us to forgive the past and focus on creating a new “normal.” u Commit to breathing more deeply.

Deep breathing is the No. 1 way to reduce stress. There’s not a study conducted that doesn’t support deep breathing as the go-to coping method. How a dentist breathes will make the difference, so be sure to inhale slowly through the nose and exhale out the mouth. Close your eyes when possible to reduce the amount of stimulus the brain receives. u Focus on one thing. More dentists will turn their life around when they focus on one thing, make changes, form new habits and then move onto the next thing. If a dentist has too many situation events to change at once, the task becomes too large and instead of forging ahead, it’s more common to avoid changes and settle for less. It doesn’t matter which situation a dentist decides to change first. It’s starting the process of change that makes the difference.

This article first ran on DrBiscuspid.com.

Reprinted with permission.

Jen Butler, MEd, is the CEO and founder of JB Partners and has been working in the area of stress management and resiliency training for more than 25 years. She can be contacted at jen@JenButlerPartners.com.

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Stress

Stress in the Dental Office

By Sharon Paul, LMHC, NCC

“

It is your interpretation of and your ability to deal with the event, not simply the event itself that determines whether you stay healthy or become sick.

”

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Stress is a natural part of life and affects people of all ages, genders and circumstances. By definition, stress is any uncomfortable emotional experience — feeling overwhelmed, tense, worried, frustrated or rundown — accompanied by predictable physiological changes. Stress can include any event or occurrence that we believe to be a threat to our coping skills or resources. Simply, we feel stressed when we think that things are out of control.

Many dentists thrive on the challenges and benefits of the profession. For others, circumstances change and life does not go according to plan. Over time, the risks consistently outweigh the rewards and the result is burnout, which can lead to doubts about one’s competence and value.

Symptoms of Stress When faced with a stressful event, we experience the physiological “fight-or-flight” response — increased heart rate, muscle tension and our attention is focused on the threat. This helps us to run faster, fight harder and survive life-threatening events.

Unfortunately, there also are negative consequences. In this state, we are excitable,

anxious and irritable. We find it difficult to execute precise, controlled skills and work effectively with others.

What Keeps Dentists from Addressing Their Stress Research indicates that 86 percent of dentists have moderate to severe stress; however, 74 percent refuse to seek professional support. In an attempt to reduce or control stress, they turn to what they know — unhealthy coping skills — such as substance abuse, avoidance, taking stress out on others, or working harder to accomplish unrealistic or poorly defined goals.

A familiar objection heard in your practice is “It’s just a small cavity. I’ll wait and see what happens.” We all know what happens.

The patient avoids treatment until they are in extreme pain, and the problem now is more invasive and requires more expensive treatment. Just like dentistry, it is important to address mental health issues when they are small and require small changes in lifestyle and the way we think.

The Professional Resource Network (PRN) is one of the two programs designated as a Florida Impaired Practitioners Program (the other being the Intervention Project for Nurses). However, most seek this service when things are no longer tolerable.

This usually is when symptoms have caused lives and relationships to fall apart. Take responsibility for your own mental health and find a way that works for you. Intervention should occur before things get out of control.

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Stress

Causes of Stress Most people experience some degree of stress in their jobs, and dentists and their staff are not immune. Most dentists believe that the cause of their problems is the lack of new patients, cancellations and team drama. Each independently is a problem; however, often not the real problem. It is your interpretation of and your ability to deal with the event, not simply the event itself that determines whether you stay healthy or become sick. n Perception of stress: The relentless pursuit of perfection is a major cause for stress and frustration for dentists. This is increased by the reality that despite all your efforts, time and neglect will destroy your “ideal” treatment. n Office organization: Dentists do most of their work sitting in awkward positions for extended hours. Procedures are both physically and mentally demanding, which results in physiological stress. Dentists who own their own practice feel the pressure of running a business as well as providing treatment — they may feel that they cannot be sick or take holidays. Those who work for a large practice feel pressured to see more patients and may feel that they do not have enough time to do the job right. n Fearful patients: Anxious patients may be uncooperative and require more treatment time, which results in increased stress for both the patient and the dentist. n Treatment: Many patients will not accept the “ideal” treatment plan due to financial constraints, poor insurance, dental anxiety or low appreciation of quality dental care. You keep trying harder and harder to satisfy patients — some of whom will never be satisfied.

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Managing Stress Stress can never be totally eliminated from our lives. However, it can be minimized to avoid the many stress-related physical and emotional problems it can cause. Fortunately, it is easy to learn simple techniques to better cope with stress. n Self-care: Exercise, get enough sleep and have better nutrition. Avoid stimulants (caffeine, chocolate, nicotine) and depressants (alcohol) to cope. n Positive self-talk: Be kind to yourself.

Be less critical and demanding of your efforts. n Laugh: Laughter — especially at oneself — not only releases tension, but also helps you to keep perspective. n Look for self-defeating beliefs: Do not compare or measure your reaction to others. Do not take responsibility for how others respond. n Seek comfortable, familiar surroundings: Spend time with the people you care about. n Talk to a friend/colleague: Share ideas, concerns, challenges and successes for the purpose of creating solutions. n Practice relaxation: Learn a formal technique, such as progressive muscle relaxation, meditation or yoga. Plan to do things each day that you enjoy: read a book, listen to music or dance. n Seek help: If you have concerns over stress-related illness, your reaction to stress interferes with enjoyment of a healthy life or when symptoms persist, it is advisable to seek the advice of a licensed mental health professional. Depending on your unique needs, learning style, preference of communication and commitment, there are numerous resources available to you. The only barrier is your willingness to take care of yourself.

*If you, or someone you know is in crisis, seek help immediately.

Contact the following organizations for 24-hour crisis services: National Suicide Prevention Lifeline 800.273.TALK (800.273.8255) CHILDHELP 800.4.A.Child (800.422.4453) CALL 211

Chronic stress can be treated with appropriate interventions, such as lifestyle and behavior changes, therapy and in some situations, medication. A licensed mental health professional can help you identify behaviors and situations that contribute to stress and help you reduce your symptoms by making changes to the things you can control.

Our perception of and reaction to stress is within our control, though stress itself may not be. We can manage stress more effectively if we understand how our perceptions and internal self-talk influence our reaction. We have the ability to learn coping skills, avoid disease, and live a long, healthy, happy and meaningful life.

Ms. Paul is a licensed mental health counselor and national certified counselor. She can be contacted at sharonlmhc@gmail.com.

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Anxious Patients

Treating Anxious Patients

By Dr. C.J. Henley

“

Steps should be taken to mitigate the stress in both the clinician and the patient, as the emotional states of both parties can be interdependent.

”

Treating anxious patients is nothing new to dentists. However, I have always been astonished by how much a patient’s anxiety affected me while treating them. Despite my best efforts, it is difficult to separate my anxiety from theirs when a patient is rude, short, squirming or crying while undergoing treatment. I believe that part of our humanity is in our ability to be empathetic.

Because of this, I would imagine (and hope) that many clinicians feel their own anxiety as they treat scared and fearful patients.

We need to have a strong understanding of what anxiety is, how a patient’s anxiety can affect us and the efficacy of our treatment, how it can affect our practice economically and how it can impact our own stress level.

Anxiety is defined as a feeling of worry, nervousness or unease, typically about an imminent event or something with an uncertain outcome. While anxiety is a normal and valuable emotion, with some dental patients, anxiety regarding dental procedures can become an excessive and persistent fear about routine procedures. As a result, many patients cope with this anxiety through avoidance behavior. Dental fear or phobia that leads to avoidance of treatment affects 5-10 percent of the population.1 Avoidance behavior can increase appointment cancellations, thus having a detrimental impact on production.

Nearly 60 percent of patients have moderate to severe anxiety about certain dental procedures and perhaps, more importantly, nearly all patients that proceed with treatment have low anxiety. In order for patients to accept treatment, they need to have little fear regarding the proposed treatment.2 This is essential to understand case acceptance in practice.

Assessing a patient’s anxiety level can help dentists understand how to present treatment to patients in an appropriate manner. Likewise, managing a patient’s anxiety can increase their trust and confidence in the practitioner. Trust and confidence in the dentist and his/her staff is critical. Patients who trust their dentist are more likely to be pleased with treatment, regardless of whether there were any complications.3 A study completed in 1981 investigated the effects of fear and anxiety on the productivity of dental practice. The findings showed that patients with significant fear required about 20 percent more chair time than patients with little fear. The time required to prepare the teeth basically was the same for both groups — as measured by drilling time — but the fear group

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Anxious Patients

was shown to have more frequent interruptions during treatment.4 This additional time required to manage an anxious patient ultimately results in increased stress and anxiety for the dentist as our schedule gets behind and productivity drops.

Since we work in a field that involves so many anxious patients, it is imperative that we spend time understanding how a patient’s anxiety can cause us to be anxious. Psychologists refer to this as mirroring. Mirroring is the behavior in which one person subconsciously imitates the gesture, speech pattern or attitude of another. In most situations, mirroring is a beneficial reaction that can help people relate to one another in social situations. However, in the situation of a nervous or frustrated patient, mirroring can be disastrous. It can be difficult to overcome our “pre-programmed” need to mirror others.

It is paramount that dentists focus on their own stress level during treatment; failure to do so can contribute to the patient’s anxiety. The inability to understand when a patient is suffering from severe anxiety before, during or after treatment, and failure to address the problem can allow the patient to incorrectly believe that chaos is about to unfold.

Two critical considerations must be addressed when treating patients with significant dental anxiety: 1. Remind patients that they are in control of the situation and/or symptoms.

2. Help patients interpret their symptoms as nervousness, or a normal and explainable physiologic change that should be present.

Helping patients with significant dental anxiety develop cognitive-behavioral measures, such as relaxation and cognitive-restructuring techniques, can help reduce a patient’s anxiety to a manageable level.5 Reducing a patient’s anxiety level can reduce the anxiety level of the dentists and ultimately, provide greater job satisfaction.6

References: 1. Freidson E., and Feldman, J The public looks at dental care. JADA 57(3):325-335, 1958.

2. Lalabonova CK, Impact Of Dental Anxiety On The Decision To Have Implant Treatment. Folia Med (Plovdiv). 2015 Apr-Jun; 57(2):116-21. doi: 10.1515/folmed-2015-0029.

3. Narby B, Hallberg U, Bagewitz IC, Soderfeldt B. Grounded theory on factors involved in the decision-making processes of patients treated with implant therapy. Int J Prosthodont. 2012 May-Jun; 25(3):270-8.

4. Filewich, RJ, Jackson E, and Shore H, (1981). Effects of dental fear on efficiency of routine dental procedures. Journal of Dental Research, 60 (A): Abstract #895.

5. Filewich RJ. Treatment of the agoraphobic dental patient. Dent Clin North Am. 1988 Oct; 32(4):723-33.

6. Giesen P, Haandrikman L, Broens S, Schreuder J, Mokkink H. Centrale Huisartsenposten: Wordt de huisarts er beter van? [GP cooperatives: does the general practitioner benefit from them?] Huisarts Wet 2000;43:508–10.

When we care about our patients and the quality of treatment we provide, dentistry can be both an extremely rewarding and stressful profession. Steps should be taken to mitigate the stress in both the clinician and the patient, as the emotional states of both parties can be interdependent. Taking the time to assess the anxiety level in patients and yourself can make a dental practice more productive, improve the satisfaction of patients and improve your quality of life.

Dr. Henley is a general dentist in Jacksonville and can be reached at DrHenley@HenleyandKelly.com.

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YOUR DEDICATION TO MAKING A DIFFERENCE IN YOUR COMMUNITY SHOULDN’T GO UNRECOGNIZED! REQUEST YOUR FREE FDA MEMBERSHIP CERTIFICATE! ■

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FLORIDA DENTAL ASSOCIATION

C. William D’Aiuto, DDS 2016 Florida’s Advocate for Oral Health CENTRAL FLORIDA

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CALL FOR NOMINATIONS Nominations are reviewed by selected members of FDA leadership.

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DEADLINE: All nominations must be received by Friday, Oct. 28, 2016.

GO TO www.floridadental.org/nominate for the FDA nomination form. www.floridadental.org

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Endurance

Dentistry as an

Endurance Sport

By Kerry K. Carney, DDS, CDE

What if we thought of our professional lives as an endurance sport instead of a business career? What if the goal was to stay mentally and physically strong and healthy? What if our primary driver was to remain happy and to continue to enjoy helping our patients achieve and maintain oral health over the decades that span the course of a career in dentistry?

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Many practice management courses spend a lot of time trying various strategies to maximize production: the shortest possible time to return on investment, the most efficient scheduling to meet production goals, how to the minimize nonproductive downtime. If the office is open, it should be producing at maximal potential. Time is money and overhead is high, so increasing speed and proficiency is an obvious goal in order to achieve success.

If monetary success is the measure, then we run, run, run (or, as my husband likes to say, “Work, work only!�).

When I was in dental school, one of our clinical instructors advised us to never continuously run our practices at 80 miles an hour. He said we would need to be able to accelerate our speed when necessary but we needed to maintain a sustainable pace, one that would not wear us out. I was reminded of that advice when I was doing some physical therapy recently.

For a career in dentistry to be experienced as an endurance sport, we need to look at all the pieces that go into that sport and how we can train to excel in that sport. A day in the office requires physical fitness. Dentistry has habitual positions that can lead to stress on some parts of our bodies and weaken others.

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Endurance

In the first half of the century, the dentist’s habitual position was standing; now the seated position usually is preferred. An occupational hazard then was varicose veins; now it is hemorrhoids. We all have taken ergonomic classes that reinforce the need for good posture and healthy body mechanics. However, it only takes the restoration of the distal aspect of an upper third molar in a patient with restricted opening to know that the dentist will assume whatever contorted position necessary to complete the procedure.

We buy the aids — head-mounted lights, stools with armrests and loupes for improved vision — but if dentistry is an endurance sport, we need to think about how to strengthen the muscles that are not engaged in that habitual position. We need to learn how to stretch and lengthen those muscles that are always flexed in the dentist’s habitual work position.

In dental school, we spend a lot of time on head and neck anatomy, but recently I have had to spend a lot of time understanding the workings of the muscles of the back, legs and body core. I have learned that the health of the psoas muscle is critical in those who — like dentists — sit for a living. If dentistry is an endurance sport, we should dedicate time to understand our muscular-skeletal interactions and train to keep our bodies fit and ready for the fatiguing, straining rigors of everyday practice.

The nutritional aspect of training for an endurance sport has to be considered as well. In dental school, we learned basics about nutrition and its effects on the dentition. But what about the nutritional guidelines for dentist athletes? Maybe we should have spent some time studying what we should eat. What individualized diet would provide us the appropriate quantity and quality of calories for our level of activity? When and what should we eat to stay alert and relaxed? Caffeinated afternoon pick-me-ups are probably not be the best answer for endurance training.

Every sport has a psychological aspect. Psychology for the dentist athlete is complicated.

The dentist needs the ability to focus on the fine motor skills for performing surgical and therapeutic interventions, but everyday dentistry requires a lot more than that. The dentist needs the kind of team training to be able to work smoothly and efficiently with office staff and colleagues.

As dentist athletes, we have the added complication of patient interaction to consider in our mental training. In order to be able to endure and be happy, we have to learn how to compartmentalize some aspects of our interactions with patients and staff. Our patients trust us to care for them. We must be able to empathize with our patients. Even when our patients are transported to us on vehicles of pain and fear, we cannot get wound up in psychodramas of their own making.

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Some people are natural athletes and some are natural psychosocial athletes. For some of us, the psychological aspects of dentistry are what trip us up, burn us out and cause us to have a short and/or unhappy career in dentistry. This psychosocial component of training is frequently undervalued, overlooked and underdeveloped. We need to train for a mental fitness that can sustain us along the emotional and psychological obstacle course that must be negotiated day after day.

Every training program has to incorporate rest and relaxation, and dentistry as an endurance sport is no different. It is too easy to think we are indispensable and irreplaceable. The dentist athlete needs to build into the training schedule time to sleep, rest, relax and recreate.

A career in dentistry is not a sprint. Dentistry is surely an endurance sport and one that is practiced not in loneliness, like the long-distance runner, but with companions and friends. It is a veritable steeplechase day after day. With some luck and effective training, it is an endurance sport we should look forward to enjoy every day for the long haul.

Reprinted with permission from the California Dental Association, copyright July 2016.

Dr. Carney is the editor-in-chief of the Journal of the California Dental Association.

September/October 2016

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LIMITED-TIME OFFER

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For a limited time, take advantage of a 3% interest rate for the first three years on an acquisition loan. Enjoy a fixed payment and a low rate at the same time.1 The promotional rate is available on three loan offer options2 — see your practice specialist for details. You’ll also get a competitive rate through maturity, and you’ll know the rate up front.

Acquire a practice • Up to 100% financing for practice purchases • Terms up to 15 years • Promotional period: August 10 to October 31, 2016 • Applications must be submitted by October 31, 2016 and close by January 31, 2017 We’re committed to building a long-term relationship to support your business.

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Your local dental financing experts Jonathan Burns 614.309.7611 jonathan.burns@bankofamerica.com

Jason Nunez 614.804.0627 jason.nunez@bankofamerica.com

Practice Solutions All programs subject to credit approval and loan amounts are subject to creditworthiness. Some restrictions may apply. The term, amount, interest rate and repayment schedule for your loan, and any product features, including interest rate locks, may vary depending on your creditworthiness and on the type, amount and collateral for your loan. Bank of America may prohibit use of an account to pay off or pay down another Bank of America account.

2 Promotional rate available only with a prepayment fee. One of three prepayment fees will be required, depending on the option you choose.

Bank of America is a registered trademark of Bank of America Corporation. Bank of America Practice Solutions is a division of Bank of America, N.A. ©2016 Bank of America Corporation. ARN7HHG7 | 07-2016 | SHEET-06-16-0458.E 1

Insurance

Colleague Insurance

By Dr. Hugh Wunderlich

How about some great insurance that no amount of money can buy? Got a good neighbor? Are you in good hands? Got that someone on your side? Think that gecko can save you 15 percent on your dental practice? n Car insurance 3 n Fire insurance 3 n Liability insurance 3 n Life of your dental practice insurance 3 Life of your dental practice insurance? Guess what? You already have it. You are a member of the Florida Dental Association (FDA) — that means you are covered.

In the past five years, I have known four dental colleagues who have died when their dental practice normally would be young, vibrant and growing. In each case, organized dentistry had a hand in the health of the practice. Sometimes the aid was small: we provided food, and helped staff and family grieve. Other times the assistance was great. Dental volunteers came in to keep the practice alive until it could be sold for fair value and not a fire sale. Now that is a real “name your own price tool.” Sorry, Flo.

“

We are 7,000 member-dentists strong who form the best benefit to the wellness of your practice you may never need.

”

By comparison, I shared this story with a physician friend of mine. I had to tell him the story twice — he couldn’t believe the concept. Sadly, he suggested his “colleagues” would not rally into any kind of support group, but rather to something far, far less than that.

I’ve never been more proud to be an FDA member than to see this “insurance” play out at all levels. The American Dental Association helped expedite an existing life insurance policy. The local affiliate provided volunteers to assist the spouse in maintaining value. The component coordinated and scheduled the volunteers to console staff and keep a pulse of patients flowing. I know that because of our assistance, the practice avoided mayhem and sold for a number closer to its actual value.

We don’t have a blimp, a blanket or beagle. But we are 7,000 member-dentists strong who form the best benefit to the wellness of your practice you may never need.

Dr. Wunderlich is a general dentist in Palm Harbor and can be reached at Dr1Dcyber@gmail. com.

www.floridadental.org

September/October 2016

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INTRODUCING A FAST AND CONVENIENT WAY TO BUY LIFE INSURANCE

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FDAS

How to Keep Your Practice Healthy When You’re Not

By FDA Services

While no one expects to get sick or injured, it is important for a healthy practice to have a plan in place in case it happens. This plan should have three types of insurance included: office overhead insurance, locum tenens coverage and life insurance.

Office Overhead Insurance Office overhead or disability overhead insurance often is overlooked in today’s market. A lot of people are not familiar with it, and are unsure how it works. A disability overhead policy is a great tool to secure your business in the event of an unexpected disability. From dental school on, it is seared in your brain to get a personal disability policy; as a practice owner, the same emphasis should be put on disability overhead insurance.

If you become disabled, a disability overhead policy will start to pay benefits in as little as 30 days. You also can qualify for up to $50k a month of benefits based on your monthly business expenses, rather than your personal income. It also is much cheaper than personal disability insurance, because the benefit periods are shorter. You can select a benefit period of 12, 18 or 24 months. The reason for the shorter benefit periods is that this policy is designed to help you to keep the doors open. It allows you to pay key employees and keep a

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revenue stream flowing in. It also helps pay important bills, such as rent, bank notes, utilities, etc. It gives you the time needed to figure out if you are going to sell the practice or come back to work.

Don’t overlook this important coverage. It can be the difference between keeping the practice going or closing your doors without a chance to sell and make a profit.

RISK EXPERTS Dan Zottoli Director of Sales Atlantic Coast 561.791.7744 Cell: 561.601.5363 dan.zottoli@fdaservices.com

Dennis Head Director of Sales Central Florida 877.843.0921 (toll free) Cell: 407.927.5472 dennis.head@fdaservices.com

Mike Trout

Locum Tenens

Director of Sales North Florida

What about having another dentist see your patients while you are out of the office?

There is professional liability insurance coverage for that via locum tenens — and you want to make sure your professional liability carrier offers this coverage. By definition, the Latin phrase locum tenens means “one who holds the place of.” For our purposes, it refers to a dentist who temporarily replaces another dentist. A locum tenens cannot be used as additional help, such as opening another office or lending an extra hand.

A locum tenens must always be used as a replacement for one dentist.

904.249.6985 Cell: 904.254.8927 mike.trout@fdaservices.com

The Doctors Company, the Florida Dental Association’s endorsed professional liability provider, makes it easy to extend coverage to locum tenens in the short term and does not require advanced notification or an application if the event is shorter than 30 days.

Please see HEALTHY, 49

Joseph Perretti Director of Sales South Florida 305.665.0455 Cell: 305.721.9196 joe.perretti@fdaservices.com

Rick D’Angelo Director of Sales West Coast 813.475.6948 Cell: 813.267.2572 rick.dangelo@fdaservices.com

About FDA Services Inc. FDA Services (FDAS) is the wholly owned, for-profit insurance agency of the Florida Dental Association. FDAS is a full-service insurance agency and takes pride in managing the insurance portfolios of each and every client. Last year alone, FDAS contributed more than $1,000,000 to the FDA to help reduce membership dues.

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FDAS HEALTHY from 47

Ways to Get Involved 1.

Become a Legislative Contact Dentist.

2.

Support pro-dental candidates through the FDAPAC.

3.

4.

Attend Dentists' Day on the Hill.

Offer pro bono care through the FDA Foundation: PDC, DDS, and FLA-MOM.

5.

Serve on an FDA or district council.

6.

Volunteer for Peer Review in your district.

7.

8.

Write articles for Today's FDA.

9.

10.

Visit a school during Children's Dental Health Month.

Volunteer for Give Kids a Smile.

Train as an FDA spokesperson.

HELPING MEMBERS SUCCEED QUESTIONS ABOUT YOUR MEMBER BENEFITS? Find more information at www.floridadental.org.

Contact us at membership@floridadental.org or 800.877.9922.

When selecting a locum tenens, it is essential that you meet the following requirements: m To qualify for coverage, a locum tenens must be the equivalent specialty and have training, education, certification and credentialing equal to the person that he or she replaces. m Each named insured automatically qualifies to have a locum tenens serve in his or her place for up to 30 days per year. If special circumstances make additional days necessary, please contact your agent in advance and we will work with you to find a solution. m Keep complete records of locum tenens use for events that occurred when the locum tenens provided coverage.

Your premium dollars pay for locum tenens claims. Selecting a quality locum tenens will help you maintain a good insurance loss history. Also, remember that if your locum tenens provides his or her own malpractice policy, coverage from your policy is not needed or provided (although you are covered for allegations of negligent hiring of such locum tenens).

It is paramount for the hiring dentist or entity to review or develop procedures and policies for selecting appropriate locum tenens and to ensure that necessary records are maintained.

Life Insurance Life insurance is not a conversation that many dentists are comfortable discussing. We never know when the end will come, but life insurance can protect your office through these hard times. In addition to grieving, your family or practice partners will have to deal with the additional business expenses during the transition.

We strongly recommend every practice owner or partner have a life insurance policy for the sole purpose of assisting the practice to stay financially healthy.

Term life insurance can be affordable, with premiums as little as $15 a month. You can pick the term and amount of benefit from five to 35 years with benefits as high as $3 million. There are even carriers where you can apply and get an answer within an hour and a policy issued that same day.

Don’t wait — make sure you’re covered today. You work hard, and it’s important that you have a plan in place to keep your practice healthy.

Co-authored by Rick D’Angelo, Joe Perretti and Carrie Millar with FDA Services. FDA Services is the wholly owned insurance agency of the Florida Dental Association. Please call us today if we can assist with any of your insurance needs at 800.877.7597.

Hobbies

2.

“

Believe it or not, by taking care of me FIRST, I’m able to have more energy and be more present.

1.

50

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Hobbies

By Joe Anne Hart DIRECTOR OF GOVERNMENTAL AFFAIRS

In order to take care of others, you must first take care of yourself!

If you are a frequent flyer like me, you could probably recite this announcement without any help, “… in the event of an emergency, please put on your oxygen mask before assisting others.”

This is such a profound statement, right?

There is something to the notion that we must ensure our health is properly functioning before we can try to help someone else.

It’s challenging to create a work-life balance.

Many of us struggle with trying to juggle a full-time job, stay involved with our families, attend work-related meetings, participate on evening conference calls, volunteer for our community events ... Whew, this is exhausting just listing out all of the things many of us do! We try so hard to please everyone else and take care of others’ “needs” — which many times are “wants” — without thinking of ourselves. That’s what we do and for many of us, this is our daily routine.

But, regardless of the nonstop drum beat we try to maintain, we still need to make time for ourselves.

Here are a few tips to help get you on your way: Identify the time of day you could dedicate 30 minutes to an hour to work out.

Some people find that if they work out in the morning before their family is up, it gives them the best opportunity to have an uninterrupted workout. However, there are people who are not morning people and

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feel more comfortable exercising in the late afternoon or early evening.

Schedule your workout time as an appointment on your calendar. You will be amazed how this one little thing can make a big difference in your commitment to work out.

You value your time, so when you schedule an appointment for a meeting or a conference call, you feel obligated to make sure you are on time and that you don’t miss it.

Well, that’s the same concept with scheduling your workouts. It will help you value the time you have set aside for yourself and give you more of an incentive to make sure you don’t miss it.

Determine if you are into group fitness programs or you are better off solo. Everyone is different. Some people like the competitiveness and encouragement of exercising with a group of people. It helps motivate them to take their workout to the next level.

However, there are people out there that just want to be by themselves, zone out and focus on their personal workout without any interactions with other people. Either way works — you just need to find out which method works best for you.

Traditional gyms are not for everyone. As you may know, there are a lot of new and different programs that promote healthy living. Whether it’s the traditional gym setting, or something like these new programs that promote high intensity interval training or heavy weight training — before you commit — go through a trial period and assess if this is the right program for you. And more importantly, make sure you get approval from your physician before starting any exercise regimen that may be out of the ordinary for you and challenge muscles you haven’t used since you were a kid!

Diet and nutrition is important. I am not a dietician or a nutritionist, but I can tell you that exercise and healthy eating go hand-

in-hand. With age comes the slowing of our metabolism, and we immediately realize that we can’t eat the way we ate in our 20s and still maintain a healthy weight. If you are concerned about any hereditary conditions that you may have, make sure you discuss this with your doctor and incorporate healthy food options into your diet. You will be surprised how your eating habits can impact your energy levels and ultimately your overall health.

So, you may be wondering why I’m giving advice on work-life balance. In addition to working as a full-time lobbyist for the Florida Dental Association, I’m also a fitness instructor and a mom (in addition to many other things I’m involved in). I believe that I’m able to be as involved as I am because I’m committed to taking care of myself FIRST. Believe it or not, by taking care of me FIRST, I’m able to have more energy and be more present.

I’m proud to see that my son has taken on the same mindset of being active. He has qualified and participated in the Junior Olympics twice in long-distance races. He’s on his middle school cross country and track teams. He also plays the saxophone and is an honor roll student in his Magnet Program. I think he’s learning early the importance of work-life balance — and so can you!

Photos: 1. Nela Diaz, Joe Anne Hart and Isabella McElroy prepare to team teach a Les Mills BodyCombat class.

2. Joe Anne’s son, Campbell, racing to the finish line during the 2015 Junior Olympics in Norfolk, Va. Ms. Hart is the FDA Director of Governmental Affairs and can be reached at jahart@ floridadental.org or 850.350.7205.

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Hobbies

Tennis and Life 2.

“

A routine regimen of physical activity enhances your overall wellness, which benefits your family, dental practice, and your own mental and physical health.

1.

52

Today's FDA

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Hobbies

By Dr. Steve Cochran

My life has always been a balance of setting personal goals and achieving them. Ambition is a part of my DNA. In college and dental school, I always managed to make time for myself. Running was my outlet and exercise. Tailgating and weekends were my fun. It was a pretty simple recipe because there wasn’t much to think about other than myself.

After I completed my pediatric dentistry residency program in 1993, I was eager to begin my career and fortunate enough to become an associate with Dr. Barry Setzer in Jacksonville. My wife, Amy, and I married and were excited to build our new life in Florida. I jumped right in with a splash and immediately joined the American Dental Association (ADA), Florida Dental Association (FDA), Northeast District Dental Association (NEDDA) and the Jacksonville Dental Society (JDS), as well as several organizations related to my specialty. After all, if one dental organization was good for my career, five would be better — and a smattering of evening study clubs couldn’t hurt!

Over the next few years, I saw my budding practice take off and I was hooked. I loved what I was doing and I was thrilled to be affiliated with an awesome pediatric dental practice. My wife and I were blessed with three beautiful daughters. Life was good!

I started to understand that giving was just as important as receiving. I began to volunteer and serve on various leadership

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levels within the JDS, NEDDA, FDA and the Florida Academy of Pediatric Dentistry.

I was truly honored to be included with the dentists whom I admired — how could I resist? In an attempt at being fair to each of our daughters, I coached each of their soccer teams. Next on the agenda was the buy-in and partnership of our practice. The few hours left in my schedule were filled with meetings with attorneys and accountants. The word “No” was not part of my vocabulary. Each of my commitments was exactly the thing I wanted to do, but life was starting to feel like more of a marathon than a dance. And although life was much, much busier, it still was quite good.

What a humbling experience! I was barely able to hit the ball over the net and I was dizzy from the physical exertion. This was supposed to be fun? My wife and I joined a mixed doubles team on Friday nights and I started to notice a little bit of improvement.

We even won a few matches. The pro suggested I come out to one of his men’s night tennis clinics. The thought of showcasing my budding skill set in a group of my peers sounded embarrassing, but the burgers and beer had me at “Hello.” After several nudges from my wife and daughters, I decided to go for it. It was the missing piece of my puzzle.

I began weekly clinics and joined several tennis leagues throughout Jacksonville.

As time went on, besides my faith, family and work, I rarely engaged in a personal fitness regimen or socialized with anyone outside of my profession. There didn’t seem to be time for anything that was optional.

And with so many commitments and people counting on me, the niceties of life were left on the proverbial back burner.

My “Aha!” moment happened while I was driving home from work one day. I looked in the mirror and barely recognized the face staring back at me. I was tired, overweight and stressed. I came home and shared the discovery with my wife. She was not as surprised as I was. She hinted that exercise and male bonding might do the trick. Her prescription for me was to get out, make some friends, be a little selfish and have FUN. It truly was a revelation, and I was uncomfortable with the idea of being selfish. It sounded so wrong and yet, I knew she was right. My wife grew up playing tennis and played quite often. She suggested that I take a lesson with our local pro. It sounded crazy and completely out of my comfort zone.

One week later, one stop at Dick’s Sporting Goods and one bottle of Gatorade, and I was on the courts.

Because of my leap into the unknown world of tennis, I lost weight, found an outlet for my stress and made a great group of friends.

My wife, daughters and I now travel to a major professional tennis tournament each year. It’s become one of the favorite family vacations. As an extra bonus, it’s brought positive energy to me and my practice each morning. A routine regimen of physical activity enhances your overall wellness, which benefits your family, dental practice, and your own mental and physical health.

Maybe I’ll see you on the courts one day.

Photos: 1. A day of tennis with (l to r) David Sheffield, his Clemson buddy, Dr. Cochran and Shawn Vernon.

2. Dr. Cochran and tennis partner Shawn Vernon.

Dr. Cochran is a pediatric dentist in Jacksonville and can be reached at stephencochran1@me.com.

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VOLUNTEER TO BECOME AN EXAMINER FOR THE ADEX DENTAL LICENSURE EXAM IN FLORIDA ARE YOU: • actively engaged in the practice of dentistry in Florida for five years; • interested in continuing dental education; • and, not connected in any way with any medical or dental college?

CROWN SAVINGS FDA Services has researched and vetted business solutions for FDA members. Currently, you could save, on average, up to $28,924 in a year if you took advantage of all the exclusive deals and discounts offered.

IF YOU ANSWERED YES!

Contact the Board of Dentistry office at 850.245.4474 and tell them you want to volunteer as an examiner for the Florida dental licensure exam.

CONTINUING EDUCATION FDA online continuing education is FREE. One member saved $3,000 by taking FDA courses. Your completed courses are automatically reported to CE Broker. It's available 24/7 and it's members only!

THE COMMISSION ON DENTAL COMPETENCY ASSESSMENTS USES THE LIST FROM THE BOARD OF DENTISTRY TO FORM A POOL OF ELIGIBLE EXAMINERS.

NEW GRAD INSURANCE All new dental graduates who become members of the Florida Dental Association (FDA) and practice in Florida will have their first year of PROFESSIONAL LIABILITY INSURANCE from The Doctors Company reimbursed by their FDA colleagues.

IF SELECTED TO SERVE AS AN EXAMINER, you must attend every session of the pre-examination standardization exercise conducted by the Commission on Dental Competency Assessments..

4

PEER REVIEW The Peer Review Mediation Program settles disagreements between patients and dentists more economically and efficiently than the legal system and is available only to FDA members. With legal fees averaging $300 per hour, this FREE member-only service will save you time, money and worry.

EXAMINERS MAY SERVE FOR FOUR CONSECUTIVE YEARS.

FDC 2017

FDC 2017

?

For additional information, contact Casey Stoutamire: 800.326.0051 • 850.224.1089 cstoutamire@floridadental.org

Save the date — June 22-24, 2017 — for the Florida Dental Convention. Anyone can pre-register, but only FDA members pre-register for FREE, and FDA members also can earn up to 18 hours of FREE CE credits.

HELPING MEMBERS SUCCEED QUESTIONS ABOUT YOUR MEMBER BENEFITS? Find more information at www.floridadental.org.

HELPING MEMBERS SUCCEED

Contact us at membership@floridadental.org or 800.877.9922.

Hobbies

Balance

3.

“

1.

For me, activities that require eye-hand manipulation are the most relaxing and rewarding.

Woodworking is at the top of the list.

2.

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Hobbies

By Dan B. Henry DDS, FACD, FICD, FPFA FDA PAST PRESIDENT

Let’s face it: As dentists, we have been given an enormous blessing along with a great responsibility for what we do in this profession!

The downside to this is stress, worry and sometimes burnout. This can — and often does — affect one’s health, happiness and relationships. When boiled down to the basics, these three things are core to our existence! Because health, happiness and relationships are critical to life, how dentists integrate what we do as professionals into an overall “life plan” will determine if balance is obtained or if a trip down the preverbal rabbit hole awaits!

Over the years, I have developed multiple interests outside of dentistry. It’s beneficial that these interests involve skill sets that are both associated with and dissimilar to the practice of dentistry. A few areas that interest me are photography, art, and wood, metal or ceramic creations.

In his philosophy for dentistry, Dr. L.D. Pankey included the idea for a “Cross of Life.” Simply stated, all humans participate in four basic activities throughout their lives: work, play, love and worship. These four activities are part of being human, and are participated in at various levels throughout one’s life. Problems develop when one or more of these activities are pursued disproportionately, which brings a state of imbalance to the “Cross of Life” that Dr. Pankey refers to. We all know people who work too much or play too much, love too much or worship the wrong things in excess.

Furthermore, endeavors that involve participating in all four arms of the “Cross of Life” at the same time are, according to Dr. Pankey, best for centering the individual into a balanced existence. A great example of a balanced existence would be a dental mission trip, which involves work, play, love and worship all at the same time.

For me, activities that require eye-hand manipulation are the most relaxing and rewarding. Woodworking is at the top of the list, followed by photography — both in and out of the office. Shooting and reloading bring a dedication to accuracy, which relaxes me as well. In addition, my wife and I bought a farm a few years back and now live there full time. I have become involved with beekeeping, and find that the bees really keep me! I find the work around the farm physically and mentally rewarding.

My favorite poet, Carl Sandburg wrote about happiness in his poem of the same name. He writes: I asked the professors who teach the meaning of life to tell me what is happiness.

And I went to the famous executives who boss the work of thousands of men.

They all shook their heads and gave me a smile as though I was trying to fool with them And then one Sunday afternoon I wandered out along the Des Plaines River And I saw a crowd of Hungarians under the trees with their women and children and a keg of beer and an accordion.

What Mr. Sandburg is saying with this elegant little poem, is that happiness is all around if we look to everyday relationships and activities that bring us joy!

Photos: 1. Front doors to the Henry house, which are built out of figured Spanish Cedar from Peru.

2. A dinning room cabinet built out of Jatoba from Brazil with a top of purple heart from Brazil.

3. A bath sink/lavatory built out of figured nogal from Brazil.

Dr. Henry is an FDA past president. He is a general dentist in Pensacola and can be reached at golddoc@bellsouth.net. www.floridadental.org

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Hobbies

Family, Dentistry and Photography

3.

4.

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In dentistry, we are always learning and striving to be better. Photography is no different — it provides another creative outlet for me to keep pushing myself to do better.

1.

2.

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Hobbies

Two more kids later, and I still enjoy being

just getting as low to the ground as possible

behind the lens. I love taking pictures of

to get the best shot. In dentistry, we are

I have three

my children — that’s mainly what I do with

always learning and striving to be better.

true loves in my

my hobby. My youngest daughter is only

Photography is no different — it provides

life: my family,

18 months old, and as soon as I point the

another creative outlet for me to keep push-

dentistry and

camera at her, she smiles a goofy grin and

ing myself to improve.

photography. My

says, “Cheese!” My son won’t make eye con-

family is by far

tact with the camera for anything. Taking

My oldest daughter is now in the second

the most impor-

pictures of these kids can be challenging,

grade and she loves to use my old camera to

tant thing to me.

but so rewarding.

see what she can create. I envision a future

By Dr. Ransey Boyd

I have an amaz-

of the two of us heading out on an adven-

ing husband of nine years and three beauti-

I also love to travel, and photography re-

ture together to share love, photos and who

ful children, ages seven, five and 18 months.

ally goes hand in hand with this. Since I’ve

knows — maybe some talk about teeth.

Second is dentistry. Oh, dentistry, how I

had my camera, we’ve traveled to Ireland,

love you! I know, it’s strange, but that’s just

Maine, Montana and Yellowstone National

Photos:

how it is. The third thing that really lights

Park in Wyoming. I’ve taken these amazing

1. During a trip in 2010 to Kenmore,

my fire is photography. I don’t claim to be

opportunities to step beyond my comfort

Ireland, the Blue Door.

great or to have some amazing talent — it’s

zone and teach myself landscape photog-

2. The Bellagio ceiling, Las Vegas, Nev.

only a hobby for me. It started as a way for

raphy. It’s been a little more challenging to

3. Dr. Boyd’s son, Everett, on the beach.

me to document my kids’ childhoods. My

master, given that I’m not around beautiful

4. Everett’s after bath surprise.

oldest daughter was six months old when I

views every day. But, I am learning and I

purchased my first DSLR camera. I began

will continue to try until I get it.

to read, read and read some more on how

and can be reached at ranseyboyd@yahoo.

to use it. I read books, scoured the internet

It’s been incredibly rewarding to take

and talked to anyone I could find who could

something that is fairly unfamiliar and

tell me about f-stops, aperture and ISO.

complicated, and teach myself how to use

Soon enough, it all began to make sense.

and understand it. Photography is some-

I wasn’t setting the camera on auto and

thing that has become part of me. It has

letting it do everything for me anymore.

become a way for me to take my mind off

I actually was controlling the camera and

of the chaos of life. It gets me outside and

surprisingly, with some success.

moving around, whether it is on a hike or

www.floridadental.org

Dr. Boyd is a general dentist in Tallahassee com.

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benefit

NUMBER

Helping Members Succeed Other HIPAA products cost more than $400 and don’t comply with Florida law!

Florida and HIPAA Compliant Forms As an FDA member, you now have access to forms that comply with both federal HIPAA and Florida confidentiality law. All of the documents are available on the FDA website and are free of charge to members only. They are uploaded as Microsoft Word documents, so that you may add your practice information to them.

LINK TO THE FORMS: www.floridadental.org/members/member-resource FOR MORE INFORMATION 800.877.9922 • fda@floridadental.org • www.floridadental.org

SAVE THE DATE! MARCH 24-25, 2017

VOLUNTEER! PENSACOLA, FLA. WOODHAM MIDDLE SCHOOL

ROOM BLOCK: SPRINGHILL SUITES-PENSACOLA 487 Creighton Road  Pensacola, FL  $115.00 to 125.00/night 1.5 miles from Woodham Middle School  Call 888.236.2427 and request the “FDAF Mission of Mercy Block.”

SIGN UP AT WWW.FLAMOM.ORG. QUESTIONS? 800.877.9922 OR FLAMOM@FLORIDADENTAL.ORG

ALL U.S. LICENSED DENTISTS MAY PROVIDE CARE IF REGISTERED BY JAN. 15, 2017.

Licensed dentists and hygienists do NOT need their own malpractice insurance to practice at the FLA-MOM. The FDAF’s insurance through The Doctors Company will cover licensed dentists and licensed hygienists at FLA-MOM.

Hobbies

How I Became a Runner 2.

“

It is my natural relaxant that helps clear my head and envision certain goals that I need to accomplish.

1.

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Hobbies

By Dr. Rodrigo Romano

In August 2009, my primary care doctor told me that I had high triglycerides and my body mass-to-height ratio was not healthy. His initial treatment was to place me on statins. I went home depressed. I was only 34 years old; my birthday was in a couple of weeks and my chances of heart complications were high.

That year, I had the most amazing birthday. I invited all my friends and family to my home and made “Caja China.” For those who are not familiar with this, a well-marinated pig is placed in a wooden roasting box on top of charcoal and cooked over a slow heat for eight hours. Yes, it is finger-licking good. This was my way to say goodbye to my 35 years as a carnivore and initiate my journey into the unknown world of vegetarianism.

Two of my high school friends were instrumental to my new life. Paul gave me a book to read, “The China Study,” and Ernie invited me to join his running team, SoleRunners. During the first month of my new way of life, I was going crazy — especially, when I attended our local society meetings and the great aroma of a well-seared churrasco (grilled meat) overtook the air. But, since I was never a runner, I was not going to start at this point of my life. My follow-up appointment was all I needed to prove I was headed in the right direction with my new nutrition without yet exercising.

The next thing I knew, I lost 25 lbs. in one month. But I wasn’t feeling great. So, after my second invitation to join the SoleRunners, I began to run. The team was made up of many people, all shapes and sizes, who were energetic and caring. On my first day, the coach said, “Ok, we will take a two-mile run to the Biltmore Hotel and back.” I thought, “How easy ... it’s only two miles.” But, I was mistaken. I barely ran three blocks when my heart started pounding like two African drums. “Walk two minutes, run one minute,” the coach advised me.

After seven years, I continue to be a pescatarian and running has become part of my life. My running gear travels with me everywhere. It is my natural relaxant that helps clear my head and envision certain goals that I need to accomplish. So far, I have completed three full marathons, more than 30 half marathons, 25 5K runs and 15 10K runs. Once you have experienced the “runner’s high,” you will understand why it is so difficult to stop doing this amazing sport. So, get out and run!

Photos: 1. Dr. Romano takes time to celebrate after the New York City Marathon on Nov. 3, 2013.

2. Dr. Romano completing the New York City Full Marathon on Nov. 3, 2013 Dr. Romano is a periodontist in Miami and is on the FDA Board of Trustees. He can be reached at rromano@bot.floridadental.org.

www.floridadental.org

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Hobbies

Work Hard, Play Hard: How I Maintain My Work-life Balance 2.

“

My newer passions have been to cultivate my foodie taste buds and travel the world.

1.

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By Dr. Barry P. Setzer

The key to my professional success has been my ability to maintain a strong work-life balance. I work hard so I can play hard, and I play hard so I can work hard. Although this sounds like a simple concept, it actually requires a lot of dedication and willpower to break away from the confines of the office and just unwind! Throughout the years, I’ve developed an avid routine of working out and watching Gator football (preferably at Florida Field), as well as a passion for fine dining and traveling. These activities keep me active, healthy and constantly smiling!

I didn’t start working out until I turned 60. Before then, I typically came home from work, ate dinner and went straight to the couch. My waistline was a constantly expanding entity, and I generally felt stressed. On my 60th birthday, I decided enough was enough, and got a gym membership and a trainer. I’m now pushing 70 and train at least three times a week, including Fridays with my wife, and have never felt better. I encourage all my colleagues to regularly work out if they aren’t already. You’ll have so much more energy for your patients and all the extra-curricular things you love to do, I promise!

Attending sporting events, especially Gator football games, has been a regular routine of mine since I was a student at the University of Florida. I remember studying hard all week, then laying down the books on Saturday and not looking at them again until Sunday morning. Twenty-four hours of thinking about nothing else but football; this became — and has remained — one of my most joyful stress relievers, even if the Gators aren’t having a great season. I always look forward to Saturdays in the fall, and I love spending quality time with my wife and friends down in Gainesville.

My newer passions have been to cultivate my foodie taste buds and travel the world. Every time I step into a gourmet restaurant or visit a gorgeous place, I feel extremely grateful. It took me many, many years to finally be in a position to explore the amazing fruits of this world, so perhaps that’s what has made my journey even sweeter.

Believe it or not, I didn’t take my first two-week vacation until I was 50 years old! Nowadays, my wife and I travel twice a year for at least two weeks at a time, sometimes even three. I usually find that it takes at least a week and a half to stop thinking about the office and be totally “free,” but when the stress disappears, it’s the best feeling ever.

When you take the time to cultivate healthy routines and unique passions, I’ve found that you’re not only enriching your life and (hopefully) the lives of those around you, but you’re also recharging your mental and physical batteries to become a better professional — both inside and outside of the office. Work hard, play hard … that’s my motto!

Photos: 1. Dr. Setzer at The Treasury in Petra, Jordan.

2. Dr. and Mrs. Setzer in Burj Khalifa, Dubai, UAE. Dr. Setzer is an FDA Trustee and can be reached at bsetzer@bot.florida.org.

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Hobbies

Tough Mudder 2.

“

The part of me that doesn't like to be left out, likes challenges, my ego and curiosity — all took over and I signed up, too.

1.

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www.floridadental.org

Hobbies

By Dr. Jorge Angulo

Is it possible I’m crazy? If you ask my two assistants they’ll agree that not only is it possible, but I’m definitely out of my mind.

Around fall 2011, my friend and fellow Florida Dental Association (FDA) member, Dr. Pete Lemieux, told me he signed up for something called a Warrior Dash held early in 2012, and he had put together a small group to join him.

He asked if I was interested, so I checked out the Warrior Dash website. I thought it looked different and certainly more interesting than a typical 5K road race. So, I signed up for my first obstacle course race (OCR), which is more commonly known as mud racing.

Warrior Dash sounded a little scary. I actually remember “training” for the Warrior Dash. My assistants would ask me from time to time if I felt prepared. Nothing spectacular went into getting ready for this race — some jogging, pushups, maybe dips.

On the big day, I drove out to the middle of nowhere, which is where these events usually are held. It didn’t take long before I was covered in mud and having the time of my life. I can’t recall the details of that first race, but I do remember that several of us crossed the finish line and immediately wanted to go do it all over again.

The post-race atmosphere also is special; there usually is a festival feel to it. At this Warrior Dash, I enjoyed getting to know Dr. Kathryn Miller and her then-fiance, Dave. On a beautiful, sunny February day in Florida, covered in dry mud, we solved the world’s problems over craft beers. A few www.floridadental.org

years later, Dr. Miller joined my practice.

I’m grateful that the OCR experience impacted my practice in such an unexpected and delightful way.

Shortly after that first Warrior Dash, some of the members of our team started talking about doing a Tough Mudder. Again, I went to the website to do some research. The website explained that the Tough Mudder was 10-12 miles long. I hadn’t run 10 miles since I was on a cross country team as a freshman in high school. There’s a good reason for that: Running is dreadfully boring to me. The running alone seemed like the biggest obstacle. But, there were 20 obstacles. There was one named “Electroshock Therapy.” In this obstacle, a patch of hanging live wires shock you a few times as you run through it. Another not-so-inviting obstacle was the “Arctic Enema” — also known as large dumpsters filled with ice water. You jump in and maneuver your way across as fast as possible. They definitely have a sense of humor. All the obstacles are cruel, challenging and creatively named.

Based on the description of the Tough Mudder, they could have just renamed it “Worst Day Ever.” Running 12 miles, getting electrocuted, 40-degree ice baths, mud, climbing and crawling through swampy Florida woods just seemed like a bad idea.

But as we got closer to the day of the race, more and more friends signed up. The part of me that doesn’t like to be left out, likes challenges, my ego and curiosity — all took over and I signed up, too.

It was November 2012 and we dressed up like superheroes. I chose The Greatest American hero, a long-forgotten superhero from a cheesy 80s TV show. If I had been alone, the Tough Mudder would have been a nightmare. However, there were moments when others inspired me and kept me going.

I won’t lie: Getting shocked and experiencing the ice bath were miserable. Yet, they were mere footnotes on what was another fantastic day. Few times in my life has a cold beer tasted so good and felt so well-earned.

It reminded me of the inmates at Shawshank sharing a case on the roof of the prison.

Since then I’ve done two more Tough Mudders and countless other mud runs. I’ve dragged my wife to a few. Her first OCR was a date. She hates to admit that she loved it.

You might be asking yourself why on earth would someone be drawn to the misery of a mud run? What’s the point? For me, it’s an opportunity to spend time with friends.

It keeps me eating clean and prevents me from getting out of shape. OCRs let me be a child all over again. You forget about the practice overhead, filling gaps in the schedule or some open contact that’s trapping food on Mrs. Shreveport. All those things vanish once I’m covered in sunscreen, mud and sweat.

If you agree with my assistants and think I’m nuts, you’d be surprised to learn that this is the fastest growing sport in the world. If you have any interest in testing your mettle, join us Nov. 5 at the Central Florida Tough Mudder in Palm Bay. But beware — you might become an OCR junkie, too.

Photos: 1. Drs. Jorge Angulo, Luis Acosta and Pete Lemieux enjoy post-event sunshine and beers.

2. Dr. Joseph Bongiorno, Kendale Angulo, Dr. Jorge Angulo, and his daughter Regan Angulo try to keep warm after a Warrior Dash.

Dr. Angulo is a general dentist in Orlando and can be reached at drjangulo@yahoo.com.

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A Time for Change

Putting Down the Handpiece

“

At 51 years old, I was not too old to try something new. I felt excited at the opportunity to learn and be challenged.

”

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By Dr. BettyJo Costantino

My love of dentistry began when I was 16 years old. I worked for a dentist in the position that once was commonly referred to as “rover” — I was the girl who filed the charts, called patients and often administered Seconal to those awaiting a third-molar extraction. And when the dental assistant had to go home sick one day … well, you guessed it: I was elected as a fill in.

Up until that point, I had managed not to see the inside of a person’s mouth, and had no idea how I would react to the sight of blood. It wasn’t long into the procedure that I realized how fascinated I was — I was hooked! After high school, I was on a fast track to graduate with a biology degree. I couldn’t wait to be in dental school, and I worked weekends and evenings at a dental office throughout college.

I was so excited to be accepted into my first choice of dental schools, the Medical University of South Carolina. It was a dream come true. It was a major challenge, but I truly loved being there. My favorite part probably was the relationships I made with the other students as we forged our way through often unfamiliar territory.

After graduating from dental school, I headed into a hospital-based residency program in Boston where I learned about acute trauma and how to deal with acute infection. I also learned how to survive on little sleep. This training came in handy when I had my eldest son! I practiced in the Boston area for two years before settling in New Jersey. I joined a nice practice and worked as an associate for eight years until the dentist retired. By that time, I had two young sons and wasn’t interested in being a practice owner.

For the next eight years I practiced with a friend in a neighboring town. I enjoyed this time in practice as I spent weeks at the Pankey Institute getting my advanced training in occlusion and TMD dysfunction. My interest was piqued, and once I completed the core curriculum, I joined a Pankey study group.

In 2008, I decided to open my own practice. Since my youngest child was in high school I felt that the timing was right. There was much to learn about the business world and managing a practice. What a different world this was from working for someone else!

www.floridadental.org

A Time for Change

Things were going well when my back started to give me trouble off and on. In 2013, it became harder and harder to get through longer procedures and I was in constant pain. I was worried about the future, as I felt my issues with my back were going to be worse the longer I practiced. I prayed for an answer, not really knowing what would happen.

Over the next few months, my back got a little better and I continued to pray for a long-term solution. My prayers were answered in an unpredictable way one Sunday at church. A gentleman who I hardly knew came up to me and told me about his son who had met a nice young lady and he thought they were going to get engaged.

He reported to me that he had prayed along with his wife that their son would fall in love and marry. I was intrigued, but wondered why he was telling me this story. Then he dropped the bomb on me: His son’s future wife was a dentist and wanted to purchase a practice in the area! Wow, what a surprise! As it turned out, this lovely, accomplished young dentist purchased my practice and I worked for her for nine months as we transitioned the practice.

After leaving the practice, my husband and I sold our home and moved to Maryland. For the first three months after I left the office, I missed my patients and my team who I had worked with so closely. The amazing thing that happened was that my back started feeling better, and at the fifth-month mark completely stopped hurting. I was amazed.

I began looking for a part-time position in dentistry in my area in Maryland. I was surprised to learn that most of the dentists in the area we moved to were not busy enough for themselves and no one was looking for an associate. I then began to contemplate a longer commute to find a position.

Around this time, I heard from a representative from a company from which I purchased some health and wellness products. We exchanged pleasantries, and she was surprised to learn about my situation. I agreed to meet with her to learn about an income opportunity with her company.

After this meeting, I decided to make a change. At 51 years old, I was not too old to try something new. I felt excited at the opportunity to learn and be challenged. I now help people look and feel better in a different way than in dentistry, and my back is a lot happier! I teach and train people how to have a different life and turn expenses into income. I can work part time, from home or wherever I happen to be. I am blessed to be part of a network of inspirational people who share a common goal and want a different life.

I am so grateful for my career in dentistry. I am grateful for all my patients, co-workers, colleagues and team members. The initial transition was difficult, but having a new mountain to climb made all the difference. And having more time with my family and a new business to focus on was priceless.

Dr. Costantino can be reached at bettyjosimas@gmail.com.

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benefit

NUMBER

11

YOUR FLORIDA DENTAL CONVENTION STAFF IS “HELPING MEMBERS SUCCEED” EVERYDAY!

PROFESSIONAL STAFF I HELP MEMBERS SUCCEED BY making sure reports for our FDA Political Action Committee are accurate and filed on time. This ensures that we can provide support to pro-dental candidates and further FDA legislative goals.

— Deanne Foy Finance Services Coordinator

Have a question about FDAPAC financials?

800.877.9922 • 850.350.7165 • dfoy@floridadental.org www.floridadental.org

TIME FOR A CHANGE?

WHAT ARE THE MOST FREQUENT/MOST SERIOUS DISCIPLINARY VIOLATIONS? Practicing below the standard of care is number one. Failing to maintain adequate patient records is the second most frequent violation. It is mandatory that the board suspend or revoke your license for improper delegation and felonies under Chapter 409 (Medicaid fraud), Chapter 817 (fraudulent practices) or Chapter 893, F.S., (drug abuse prevention and control).

WHAT IS THE STANDARD OF CARE? It is what would pass as acceptable treatment among your peers. It is not perfection, but if you fall below what a reasonable doctor would have done in the same situation, you may be liable for malpractice and disciplined. Board of Dentistry rules and Florida legislation also set forth minimum standards of care (e.g., failing to have an automatic external defibrillator in your office or not properly reporting “adverse occurrences”).

WHAT SHOULD I KNOW ABOUT PATIENT RECORDS? A dentist must maintain written dental records for at least four years from the date the patient was last examined or treated. Usually, these dates coincide but not always (e.g. missed appointment and emergencies). Dental records include your day-to-day patient appointments. But, note that seven years is typically the statute of repose on malpractice liability, so keep them at least that long. Also, note that participating provider agreements and hospital privileges may contractually require longer retention periods.

If you decide to destroy records of patients who are no longer active, you should refer to your written policy on records retention and management. You may destroy old records in any manner that protects patient confidentiality. If you hire a shredding company, please remember to have them sign a Business Associate agreement. Don’t throw them in the garbage or a dumpster that is publicly accessible.

When a patient asks for records, you must provide copies of all reports and records including X-rays in a timely manner, with due regard for the patient’s health needs.

Keep your ADA and FDA member profile up to date with any changes!

Call the FDA at 800.877.9922 or email us at fda@floridadental.org.

Ready to retire as an FDA privileged member?

Stay active and take advantage of special membership incentives — you’ve earned it!

Contact us to find out if you are eligible for retired membership. * Florida licensed dentists: Don’t forget to notify the Florida Board of Dentistry with your new information by going to floridasdentistry.gov or calling 850.488.0595.

WHAT SHOULD I KNOW ABOUT “PATIENT ABANDONMENT” AND TERMINATING THE DOCTOR/PATIENT RELATIONSHIP? Improperly terminating the doctor/patient relationship is commonly known as “patient abandonment.” If the patient suffers harm because of how you or your employees terminated the relationship, you may be held liable.

Make it your written office policy to send patients leaving your practice a written notice or confirmation that your office is no longer treating them as a patient of record.

Don’t make the letter effective “immediately.” Immediate termination doesn’t give the patient enough time to locate another doctor. Remember that you remain legally and ethically responsible for providing emergency care. Don’t deny it with a poorly-worded notification letter that might be admissible as evidence against you.

WHO DO I CALL IF I SEE UNLICENSED PRACTICE OF DENTISTRY OCCURRING? Call the Unlicensed Activity Unit (ULA) hotline of the Department of Health at 1-877-HALT-ULA (1.877.425.8852) or visit their website (floridahealth.gov/ licensing-and-regulation/enforcement/report-unlicensed-activity). Unlicensed practice is a felony in Florida and should be reported immediately.

These legal questions and answers are provided by Graham Nicol Esq., FDA Chief Legal Counsel, Health Care Risk Manager, and Florida Bar Association Board Certified Specialist in Health Law.

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www.floridadental.org

Addiction

It Was a Wednesday ...

By Dr. Alan Mead

It was a Wednesday. And like many of my days back then, I was in withdrawal from opiates.

And unlike what you’ve probably seen in movies and on TV, I was dealing with it — just like I always did. I was at work ... seeing patients.

It was like having the flu. My body ached.

I had a runny nose and serious diarrhea. I was grumpy and irritable — the exact opposite of the way taking a handful of pills made me feel. I had come to realize that I was taking so much of my drug of choice, hydrocodone, that I couldn’t reliably keep it around. I had a lot of ways to get it, but none of them would keep me supplied enough to avoid withdrawal every couple of days.

This is what life had become. I had just turned 30 and I was a young practice owner.

I was a newlywed and my wife knew nothing about my drug habit. She knew that my behavior was becoming more and more bizarre, but she didn’t know about the drugs.

She knew that I seemed to nod off in public all the time — or when I was driving. I had everyone believing that I was narcoleptic or I had blood pressure problems. She knew that my mood was either bordering on manic or angry and irritable. There was no middle ground with me.

www.floridadental.org

Occasionally, I would have a moment of clarity where I understood that my life had become crazy and out of control. I think I realized that the problem I had with drugs wasn’t something that I could fix on my own. I knew that instinctively for all the times I had tried. I can’t even count the number of times I would get a bottle of pills and measure out smaller and smaller doses so that I wouldn’t be sick from quitting. I had no idea that the real problem I had lay with the fact that I had no skills at coping with life outside of drugs and alcohol. I had lost the ability to live life on life’s terms and my understanding of reality was distorted.

So, I thought if I could just stop using the drugs, I would be able to pull it together.

Except, I did stop using the drugs every time I ran out. And, I was still broken.

The day that my family intervened was that Wednesday. They finally had figured out what I had been up to for the last few years and they were going to confront me. What they didn’t realize is that I would occasionally have that moment of clarity between handfuls of pills. I would realize that what I was doing was dangerous. It was unethical.

And it was unlike the person that I really was.

So, when my family and friends came to do their intervention, I was ready to stop. Not consciously, but the table was definitely set.

Since I had always used drugs alone, I had never been honest with anyone about what I was doing. Once I knew that everyone else understood what was going on, I gave up the fight.

The next day was Thursday. I woke up in a treatment center. It was the first day in a long time that my entire existence wasn’t focused on getting and using drugs. In fact, it was the first day clean in a 14-plus-year adventure I call my recovery. And it’s still going strong. However, it’s not always that simple. People are complicated, and dentists ... they’re even more complicated! The statistics say that upward of 10 percent of people will struggle with chemical dependence in some form throughout their life. I think it might even be higher for dentists.

What should you do if you’re having trouble with drugs and alcohol, or you know someone having trouble? Let them know that you support them. If they’re a dentist, offer them this resource: the Professionals Resource Network (http://www.flprn.org).

It’s the program that Florida uses to help licensed health care professionals get help while protecting their license to practice.

It’s an invaluable resource that can help a dentist, hygienist or dental assistant get the help they need without jeopardizing their career.

Addiction is a tough problem, but it isn’t an impossible problem. I’m living proof.

Dr. Mead is a general dentist is Saginaw, Mich. He has lectured extensively in Michigan and across the country on various topics including social media for dentists, medical marijuana and addiction. He is the chair of the Michigan Dental Association’s Care and Well-being Committee, which helps dentists and dental teams with addiction and mental health issues. He also is the co-host of the Dental Hacks podcast. Dr. Mead can be reached at alan@meadfamilydental.com.

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Methamphetamine Abuse

Dental Manifestations of Methamphetamine Abuse: A Case Report

By John R. Antonelli, DDS, MS

Methamphetamine — meth for short — is classified by the Food and Drug Administration as a Schedule II stimulant drug; it has a high potential for abuse.

Meth only is available through a prescription that cannot be refilled. Although it can be prescribed by a physician, its medical uses are limited, and the doses prescribed are much lower than those typically abused.

Meth is a white powder that can be made into a pill or a shiny rock (called crystal meth). The powder can be snorted into the nose, smoked, swallowed, or dissolved easily in water or alcohol and injected. Meth is a highly addictive sympathomimetic central nervous system (CNS) stimulant. Smoking or injecting the drug rapidly delivers it to the brain, where it produces an immediate, intense euphoria. The high can last four to 12 hours after which time, users often take repeated doses in a “binge-and-crash” pattern.

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Meth causes the release of the neurotransmitter dopamine at the synaptic cleft, which results in high levels of dopamine in the brain. Dopamine is involved in the experience of pleasure, reward, motivation and motor function. Meth’s ability to release dopamine rapidly produces the euphoric “rush” that many users experience; it also blocks its re-uptake. Subsequent depletion of the available neurotransmitter leads to rapid tolerance and withdrawal.

The long-term effects of meth abuse include: severe psychological or physical dependence, rise in both systolic and diastolic blood pressure, hypertension, weight loss, anxiety, confusion, insomnia, mood disturbances and violent behavior. Sometimes symptoms of paranoia, visual and auditory hallucinations, and delusions (e.g., a sensation of insects crawling under the skin) are seen.

Meth is known to cause increased physical and sexual endurance; increased sexual encounters. Sharing of injection equipment among meth users might be responsible for their increased risk for contracting HIV/AIDS and/or hepatitis B and C. Meth acts on alpha adrenergic receptors of the salivary gland vasculature to produce vasoconstriction and reduced salivary flow. Increased motor activity leads to excessive chewing, grinding and clenching. Prolonged highs lead to extended periods without brushing and ingestion of sugary foods and beverages. Users are reported to crave sugar and they typically drink large quantities of non-diet soft drinks high in carbohydrates.

Typical dental findings include an unaccountable and accelerated caries rate. The acidic nature of the ingredients used to produce meth has been implicated as a causative factor in caries and tooth wear seen in patients.1,2 Meth can contain phosphoric, sulfuric or muriatic acid. Smoking meth can expose teeth to acid, which could contribute to enamel erosion.

Navarro et al3 found high levels of methylenedioxymethamphetamine (MDMA or ecstasy) in the saliva of users, which they associated with a decrease in salivary pH (from neutral 7.4 to acidic 6.9). If the critical pH at which enamel demineralizes is 5.5, then the salivary pH change that occurs after ingestion of MDMA is insufficient to induce demineralization and caries formation. Some of the other ingredients used to make meth include: ephedrine, pseudoephedrine (in over-the-counter cold medications), hydroiodic acid, ammonia, paint

www.floridadental.org

Methamphetamine Abuse

thinner, ether, cleaning fluids and lithium (from car batteries). Readily available ingredients and ease of production have led to the exponential growth of makeshift labs throughout the country, especially in rural areas (Fig. 1).

Typical Dental Findings Meth users exhibit a distinctive pattern of caries on the buccal smooth surfaces of posterior teeth and interproximal surfaces of anterior teeth, as well as excessive tooth wear (Fig. 2).

The latter results from increased incidences of bruxism. Users may be hyperactive during times of intense drug use. As the drug wears off, users begin “tweaking,” a feeling characterized by restless anxiety, irritability, fatigue and dysphoria.4 During this time, abusers have a tendency to brux and clench, which contribute further to attrition.5

Case Report: Diagnostic Data

Fig. 2: A photograph of meth mouth — oral signs and symptoms associated with long-term methamphetamine abuse includes rampant caries, tooth wear and pain.

A 22-year-old Caucasian female patient was examined at our university with the chief complaint that, “All my teeth are rotten and they all hurt.” Her past medical history was non-contributory. She had not been to a dentist since childhood, when her only dental procedures were prophylaxes. She was a frequent methamphetamine user from age 16 to age 21.

Her method of delivery was primarily nasal. She smoked tobacco since age 14 and currently smoked, approximately one-half pack per day.

Please see METHAMPHETAMINE, 74

Fig. 3: The meth mouth caries pattern distinctly involves buccal smooth surfaces and anterior interproximal areas.

Fig. 1: Number of U.S. methamphetamine lab incidents in 2014 from National Clandestine Laboratory Database. Total number was 9,338.

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Fig. 4: Bitewing radiographs show the aftermath of reduced salivary flow and how it has deprived the oral environment of saliva’s buffering capacity to counteract acidity and prevent demineralization of enamel.

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Methamphetamine Abuse

METHAMPHETAMINE from 73

Odontological examination revealed rampant caries on buccal smooth surfaces of posterior teeth, fractured teeth, and extensive Class II and III lesions in posterior and anterior teeth, respectively (Figs. 3 and 4). Moderate to severe generalized gingivitis was diagnosed, and isolated pocket depths (with minimal bone loss) in the 4-5 mm range were detected secondary to inflammation (Fig. 5). The patient was diagnosed with severe generalized gingivitis and localized moderate periodontitis. Nine teeth exhibited periapical pathology. The patient exhibited Class III malocclusion (Fig. 6).

Restorative Phase Care

Fig. 5: Localized pocket depths of 4-5 mm mark the beginning of periodontitis in this 22-year-old female patient.

Fig. 6: Use of disclosing tablets reveals proof of lack of plaque control as areas of plaque biofilm on enamel stain red at the level of the gingival margins. Fractured teeth (Nos. 18, 19 and 30) are another long-term effect of meth use.

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Goals of treatment included: (1) eliminating dental pain; (2) reducing periodontal inflammation; (3) arresting rampant caries; and, (4) speaking with the patient about referral to a smoking cessation program.

The patient was offered a “treatment plan to health,� or disease-control plan option.

The plan consists of: n scaling and root planing all four quadrants. n prescribing chlorhexidine gluconate to reduce gingival inflammation. n excavating all caries by quadrant and restoring with resin-modified glass ionomer restorations. n prescribing high strength fluoride toothpaste and gel (with 5,000 ppm fluoride) with a custom tray for home application to enhance remineralization and diminish sensitivity of teeth. n extracting all non-strategic and nonrestorable teeth. n performing endodontic therapy when pulpal exposure occurs during excavation of a restorable and strategic tooth, and when pain persists following excavation of a tooth that is restorable and strategic. www.floridadental.org

Methamphetamine Abuse

Definitive Phase Care

The Dentist’s Role

Definitive restorations will be considered once the patient is free of pain and in good health, and there is objective evidence of motivation to practice good oral hygiene. The decision to proceed with definitive care will be based on: (1) plaque index scores as helpful indicators of patient compliance and success with daily home care procedures; (2) bleeding points indices to provide an evaluation of gingival inflammation around each tooth; (3) reduction of probing depths; and, (4) willingness to adhere to a two-month maintenance schedule during the first year. Orthodontic treatment and/or orthognathic surgery will be considered to correct the Class III malocclusion only if there is evidence of (1) abandonment of drug use, and (2) sustained, increased levels of compliance with oral hygiene recommendations.

Dentists might be the first front-line health care providers to recognize the signs and symptoms of meth abuse. Treatment for meth abuse often comes too late, with treatment options involving extractions that lead to what one report called, “a young generation of denture wearers.”8 It is important to recognize that the effects of meth abuse on a patient’s oral health involves a “triad” of (1) xerostomia secondary to sympathetic CNS activation; (2) rampant caries caused by a high intake of sugar in the relative absence of saliva; and (3) bruxism resulting from hyperactivity.

Dental Considerations The American Dental Association recommends completing a comprehensive oral examination that includes a thorough dental and medical history, including questions about illicit drug use. If a patient confirms meth abuse, then encourage him/her to consider consulting with both their physician and a substance abuse rehabilitation facility. Dentists should consider the potential for meth abuse in patients who report xerostomia, unexplained rampant caries and accelerated tooth wear from bruxism.6 Practitioners should educate patients about the profound negative effects meth can have on their general and oral health.

The issue of confidentiality becomes the dentist’s dilemma when a minor is involved. Requirements for parental notification vary among states; therefore, the dentist’s decision to breach confidentiality and disclose information must be made in conformity with state legal requirements.

Dentists should encourage the patient to consume water or artificially sweetened foods and beverages instead of sugar-containing beverages. It is best to avoid opioid analgesics or other potentially addictive substances considered for the dental treatment of meth users. Be cautious when administering sedatives, general anesthesia and nitrous oxide; when prescribing narcotics because of potential drug interaction or possible CNS depression to minimize potential ventilator depression; and, when administering local anesthetics (especially those containing a vasoconstrictor). Meth is structurally related to epinephrine and will cause a rise in both systolic and diastolic blood pressure. Whenever possible, all elective dental treatment should be postponed if the patient is suspected of actively using meth. Duration of meth can be eight to 12 hours, and up to 24 hours in cases of heavy use. During this time, local anesthetic without a vasoconstrictor should be used. The use of a vasoconstrictor in local anesthesia should be avoided for 24 hours following the last meth use. Although meth may be only 75 percent eliminated after 24 hours, there is evidence suggesting that the cardiovascular and clinical effects cease before the drug has been fully eliminated.7 Efforts should be made to keep prescription pads locked and prevent altering prescriptions.

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Reference List 1. American Dental Association. Methamphetamine use and oral health [patient education handout]. JADA. 2005; 136:1491.

2. Jones KD Jr. Viewpoint: spotting meth mouth. American Dental Association web site. August 18, 2005. Available at: http://www.ada.org/prof/resources/pubs/adanews/adanewsarticle.asp?articleid=1517. Accessed Feb. 22, 2007.

3. Navarro M, Pichini S, Farre M et al. Usefulness of Saliva for Measurement of 3,4-Methylenedioxymethamphetamine and Its Metabolites: Correlation with Plasma Drug Concentrations and Effect of Salivary pH. Clin Chem. 2001; 47(10):1788-1795.

4. Lineberry TW, Bostwick JM. Methamphetamine Abuse: A Perfect Storm of Complications. Mayo Clin Proc. 2006; 81(1):77-84.

5. Curtis EK. Meth mouth: A review of methamphetamine abuse and its oral manifestations. Gen Dent. 2006; 54(2):125-129.

6. ADA warns of amphetamine’s effect on oral health. Available at: http://www.ada.org/public/media/releases/0508 release01.asp. Accessed Sept. 5, 2005.

7. Newton TF, De La Garza R, Kalechstein AD, Nestor L. Cocaine and methamphetamine produce different patterns of subjective and cardiovascular effects. Pharmacol Biochem Behav. 2005; 82:90-97.

8. Kinkead LD et al. Deseret Morning News. June 12, 2005. Available at: http//deseretnews.com/dn/ view/0,1249,600140819,00.html. Accessed Feb. 22, 2007.

Dr. Antonelli is a professor in the Department of Prosthodontics and the Director of Fixed Prosthodontics Courses at Nova Southeastern University College of Dental Medicine, as well as an adjunct professor at The University of Tennessee Health Science Center College of Dentistry. He can be reached at antonell@nova.edu.

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Diagnostic

A. B.

By Drs. Nadim M. Islam and Neel Bhattacharyya

A 69-year-old male was referred for evaluation of an intrabony entity suspected to be a cystic lesion that was noted by his dentist on a routine dental exam. The patient promptly reported at Citrus Oral and Maxillofacial Surgery in Crystal River, Fla. The patient presented to Dr. Robert L. Brockett with previous details as noted by his dentist. The patient was a normal, healthy male with good health parameters. A comprehensive oral examination, which included thorough evaluation of the radiographs, was performed. The patient generally was asymptomatic and no soft tissue involvement was noted. Extraoral examination was within normal limits and the TMJ exam revealed slight subtle crepitus of the bilateral joints. The neck showed full range of motion, with no submandibular or cervical lymphadenopathy. Intraoral exam revealed normal oropharyngeal area with good oral hygiene. The dental exam showed missing teeth Nos. 1, 14, 16, 17 and 32. There was mild to moderate gingival recession noted on teeth Nos. 7, 8 and 9 with Class I mobility and Class 0.5 mobility on tooth No. 10. Bony expansion of maxilla on the right was not present. A 3-D image from June 2016 demonstrated a large, well-defined radiolucent mass in endodontically treated tooth No. 7 (Fig. 1). The treatment plan included, among other things, an excisional/incisional biopsy in the area of tooth No. 7 to explore the radiolucent area with possible apicoectomy of tooth No. 7. The patient was anxious; therefore, the treatment was planned under general anesthesia. All pertinent risks, benefits and alternatives of anesthesia and surgery were explained and all questions were answered. All previous radiographs were requested from the office of the referring dentist, Dr. Ronald Fagan’s, office. The previous periapical radiograph (Fig. 2) did reveal a smaller radiolucent area that probably initiated the endodontic treatment. Informed consent was obtained and the patient was instructed to be NPO six to eight hours prior to the procedure and was to be accompanied before, during and after the procedure the biopsy was performed to include most of the involved area and the cyst-like presentation was curetted down to the bone. The lesion seemingly involved the apex of tooth No. 7 that was root-canal filled. The tissue was submitted to the University of Florida College of Dentistry Oral and Maxillofacial Pathology Biopsy Service for evaluation. The patient tolerated the procedure well and was happy with the way the treatment had progressed.

Fig. 1

Fig. 2

Question: Which of the following is the most likely diagnosis given the clinical, microscopic and radiographic features?

A. Periapical/dental abscess B. Periapical cyst/granuloma C. Incisive canal cyst (Nasopalatine duct cyst) D. Nasolabial cyst E. Odontogenic keratocyst www.floridadental.org

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DIAGNOSTIC from 77

Diagnostic Discussion A. Periapical/dental abscess Incorrect. Expression of yellow puslike material during surgery and history of prior similar swelling that eventually subsided without treatment are all indicative of a draining periapical/periodontal abscess. However, abscesses frequently are extremely painful and the patient usually will provide a history of dental pain and/ or drainage. In this case, since a significant swelling was noted with possible expansion of soft and hard tissue, pain or symptoms would be expected. Moreover, abscesses tend to form either a small parulis or gum boil-like area to drain, or larger and more diffuse swelling may be seen — unlike the presentation here, which was discrete. Also, clinical examination frequently will reveal one or more adjacent teeth with caries or periodontal disease, or some obvious sources of dental infection. Additionally, with an abscess of this size, constitutional symptoms such as fever, malaise, lymphadenopathy, etc. also may be seen; such symptoms were absent in this case.

B. Periapical cyst /periapical granuloma Incorrect, but an important entity to consider in the clinical and radiographic differential diagnosis along with periapical granuloma. Most of the lesions are asymptomatic, but involved teeth can develop pain and sensitivity. These lesions represent up to 75 percent of periapical inflammatory

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conditions and more than half of these are associated with failure of response to conservative endodontic therapy. The involved teeth are invariably non-vital and do not respond to pulp testing. Most lesions are discovered on routine radiographic examination. A radiolucency of variable size may be seen and may result in root resorption.

Clinically, periapical cysts are indistinguishable from periapical granulomas. Loss of the lamina dura along the adjacent root, and a radiolucency encircling the affected tooth apex are typical findings. In rare instances, lesions can grow to large sizes and may be destructive. The histologic features consist of inflamed granulation or fibrous connective tissue lined by non-keratinized stratified squamous epithelium. Presence of respiratory epithelium and mucous cells is highly unusual.

In periapical granulomas, the presentation is identical to those seen in periapical cysts.

Microscopic features include inflamed granulation and/or fibrous connective tissue. Aggregates of cholesterol clefts with associated multinucleated giant cells may be present.

C. Incisive canal cyst (Nasopalatine duct cyst) Incorrect. Nasopalatine duct cysts (also called incisive canal cysts) are the most common non-odontogenic cyst of the oral cavity, occurring in up to 1 percent of the population. The cyst is believed to arise from remnants of the nasopalatine duct.

The nasopalatine duct is an embryologic structure that connects oral and nasal cavities in the area of the incisive canal. This diagnosis should always be considered for

lesions in the anterior maxilla, especially when pulp testing is equivocal. The most common presenting symptoms include swelling of the anterior palate, drainage and pain. Many lesions are asymptomatic and are discovered on routine radiographic examination. Radiographs usually demonstrate a well-circumscribed (occasionally resembling an “inverted pear”) radiolucency in or near the midline of the anterior maxilla between and apical to the central incisor teeth. It may be difficult to distinguish a small nasopalatine duct cyst from a large incisive foramen. It’s generally accepted that a diameter of 6 mm (about the size of a pencil eraser) is the upper limit of normal size for the incisive foramen (most cysts range from 1-2.5 cm in diameter). The microscopic features of the nasopalatine duct cyst are unique enough, along with the clinical features such as location and radiographic presentation, to distinguish it from other radiolucent entities. The microscopic features consist of an epithelium-lined cavity where the epithelial lining usually is of stratified squamous epithelium or pseudostratified columnar epithelium in origin.

The fibrous connective tissue wall usually exhibits numerous prominent nerves and thick-walled blood vessels, which are considered to be the normal contents of the incisive canal. Nasopalatine duct cysts are treated by surgical enucleation. They exhibit a low rate of recurrence.

D. Nasolabial cyst Incorrect. Nasolabial cysts are rare developmental cysts that occur in the upper lip lateral to the midline. These cysts most likely arise from cystic degeneration of epithelial remnants entrapped along the

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Diagnostic

line of fusion of the maxillary, medial nasal and lateral nasal processes. Therefore, may represent a “fissural” cyst. In addition, the possibility that these may develop from misplaced epithelium of the nasolacrimal duct also has been proposed. They present as a swelling of the upper lip lateral to the midline, resulting in elevation of the ala of the nose. Usually there is obliteration of the mucobuccal fold. Importantly, since these cysts arise completely within soft tissues, there are no radiographic features.

Microscopically, nasolabial cysts are lined by pseudostratified columnar ciliated epithelium and are supported by a fibrous connective tissue wall. They are treated by complete surgical excision via an intraoral approach.

E. Odontogenic keratocyst (OKC) Correct! The odontogenic keratocysts (OKC) may destroy bone and appear completely radiolucent, and do not cause expansion of the cortex when small. The recent World Health Organization nomenclature is keratocystic odontogenic tumor (KCOT).

The presentation was not supportive of this diagnosis; therefore, the top clinicradiographic differential was an apical cyst.

A large majority of OKCs are seen in the 10- to 40-year-old age group and involve the mandible with a marked tendency to involve the posterior body and ascending ramus. OKCs usually cause obvious bone expansion and present as well-defined radiolucencies with smooth and corticated

margins. However, large lesions of the mandible typically exhibit a multilocular “soap bubble” appearance. One-third of the cases are associated with an unerupted/impacted tooth.

The radiographic and clinical presentation, though highly suggestive sometimes, are not always diagnostic. OKCs may radiographically resemble other entities including dentigerous cysts and ameloblastomas.

The odd and mild presentation in our case was clinically misleading. The presence of multiple OKCs should be viewed with caution and the patient should be evaluated for the Nevoid basal cell carcinoma syndrome (Gorlin-Goltz syndrome), especially when such diagnosis is rendered in a patient Please see DIAGNOSTIC, 80

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DIAGNOSTIC from 79

References:

under the age of 20. Microscopically, OKCs typically show a thin, friable wall with an epithelial lining composed of a uniform six- to eight-cells thick layer of stratified squamous epithelium. The luminal surface exhibits a thin layer of corrugated or wavy parakeratin.

Characteristically, the basal epithelial layer exhibits a palisaded layer of cuboidal or columnar epithelial cells with hyperchromatic nuclei (Fig. 3).

Bhagavandas Rai, H. S. Charan Babu, Milind Joshi. A radiolucent lesion crossing the midline in maxilla: a rare presentation of odontogenic keratocyst in young patient. J Maxillofac Oral Surg. 2010 Mar; 9(1): 102–104 K. Priya, P. Karthikeyan, V. Nirmal Coumare. Odontogenic Keratocyst: A Case Series of five Patients. Indian J Otolaryngol Head Neck Surg. 2014 Jan; 66(1): 17–21 D S MacDonald-Jankowski. Keratocystic odontogenic tumour: systematic review Dentomaxillofac Radiol. 2011 Jan; 40(1): 1–23.

Javad Yazdani, Shiva Solahaye Kahnamouii. Developmental Odontogenic Cysts of Jaws: A Clinical Study of 245 Cases. J Dent Res Dent Clin Dent Prospects. 2009 Spring; 3(2): 64–66.

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

Dr. Bhattacharyya

Fig. 3

Most OKCs are treated by enucleation and curettage. In contrast to other odontogenic cysts, OKCs often tend to recur after treatment.

This mostly is due to the thin, friable lining and wall of the cyst and secondly due to the presence of “satellite cysts or cystlets” within the wall of the cyst. Often during removal of the lesion, remnants of the original cyst that were not removed at the time of the operation may give rise to a “new” cyst. Several reports indicate a recurrence rate of approximately 30 percent for the intraosseous variant. A significant number of recurrences may not be manifested until 10 or more years after the original surgical procedure. Hence, longterm clinical and radiologic follow-up is mandatory. Therefore, it is prudent for the clinician to be sentient of this entity even while evaluating radiolucencies in locations such as our case.

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

Clinicians are invited to submit cases from their own practices. Cases may be used in the “Diagnostic Discussion,” with credit given to the submitter.

Dr. Islam

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

Dr. Cohen

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PDMP

Use of the State’s PDMP in a Dental Practice

By Robert M. Macdonald, MS and Daniel Gesek, DMD

In order to curb prescription drug fraud, abuse and diversion, the Florida Legislature established a prescription drug monitoring program Macdonald (PDMP). The Florida PDMP is a web-based program that facilitates the collection, storage, maintenance and analysis of controlled substances dispensGesek ing data. The state’s program is managed by Department of Health staff and operates under the name E-FORCSE – Electronic Florida Online Reporting of Controlled Substance Evaluation.

The law requires any dispenser (e.g., pharmacy, dispensing pharmacist or dispensing practitioner) to enter the following into the E-FORCSE database within seven days: m name of the prescribing practitioner and his or her DEA and National Provider Identification numbers m date of the prescription m name, address and birthdate of person receiving the prescription m name of the controlled substance, its drug code, quantity and strength

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The information in the database is available to all Florida-licensed health care practitioners, who register at no cost to access the patient information as part of their routine practice management protocol. This includes physicians, dentists, osteopaths, pharmacists, podiatrists, ARNPs, physician assistants and optometrists.

Dentists who register to use the PDMP database can: review a Patient Advisory Report to prevent duplicate prescribing of controlled substances; identify potential interactions and prevent adverse drug events; and, detect if a patient received multiple prescription for the same drugs from multiple health care practitioners. E-FORCSE’s goal for practitioners is to: reduce the rate of inappropriate use of prescription drugs; reduce the quantity of controlled substances obtained by individuals who attempt to engage in fraud and deceit; increase coordination between practitioners, dispensers and the state relative to the prescribing of prescription drugs; and, involvement of all stakeholders to improve the general health of Florida citizens.

As of the first quarter of 2016, 35,700 (or 23 percent) of all licensed health care practitioners had registered to use the E-FORCSE database to check patient controlled-substance histories. Of those total PDMP users, 876 (or 2.4 percent) were dentists. Dentists registered to use E-FORCSE represent about 6.7 percent of all licensees in the profession.

To register to use E-FORCSE, go to http:// www.hidesigns.com/flpdmp/practitionerpharmacist/. Make sure to review the Training Guide for Florida Practitioners and Pharmacists before you register, then follow the directions on the screen. You will be contacted by email once the request is approved. For further information about accessing E-FORCSE, contact 877.719.3120.

Since the PDMP database became fully operational in September 2011, more than 28,000 practitioners made nearly 26 million queries for information about patient’s controlled drug use. The E-FORCSE staff receives about three million queries per month. Of those dentists registered to use the system, 60 percent have made 19,900 queries. Counties with more than 1,000 dental queries are Duval (2,772); Pinellas (1,558); Escambia (1,449); and, Hillsborough (1,110).

Bob Macdonald is executive director of Florida’s Prescription Drug Monitoring Program Foundation. He was formerly the Director of Dental Care and Health at the Florida Dental Association and director of development and administration for the Florida Dental Health Foundation. Dr. Gesek is a member of the FDA and Florida Society of Oral and Maxillofacial Surgeons and formerly the chair of the Florida State Board of Dentistry. He serves as a director on the PDMP Foundation board.

m date the prescription was dispensed m method of payment for the prescription m address of the dispensing pharmacy or practitioner Failure to report the dispensing of the controlled substance into the database within the time period is a first-degree misdemeanor.

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Chiropractic

Chiropractic this brief article. Just as every person on the planet with teeth should have a wellness exam done by a dentist; it would benefit our population greatly to have a wellness exam done by a corrective chiropractor. What separates corrective chiropractors is that we measure the alignment to see the progress we have made by x-raying the patient at certain intervals while undergoing care. While some chiropractors choose to limit their practice to the relief of symptoms, I believe that chiropractic best serves humanity though lifetime wellness care.

By Dr. James Ryan Fenn

As a chiropractic practitioner, we see patients for just about every type of complaint you can imagine — ­from migraine headaches to gastrointestinal problems, we have conducted chiropractic adjustments on patients with all types of ailments. My youngest patient was three hours old, and my oldest was one hundred and four! I would never be so bold to say we have seen it all for fear of what strange case might walk through the door. We have had success — and dare I say miracles — happen over the years. We have had patients who have been told there is no hope and no help for their conditions, but under our care, they get well and thrive in our office. Cases that respond to care are extremely rewarding and inspiring, the best testimonials for chiropractic are the ones from the patients who maintain regular chiropractic care their whole lives and have no major health issues.

Dentistry has done an amazing job educating the public about the benefits of asymptomatic wellness care for their teeth. This is something that chiropractors can learn from and what I hope to accomplish with

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The basic premise of chiropractic is that the brain runs every organ, tissue, and cell of the body through the nervous system. When the spine is in its anatomic normal position, straight from the front and 45 degrees curved from the side, there is no pressure on the nervous system and the body will function and heal as it was designed to do. If the position of the spine differs from this normal, or subluxates, it puts pressure on the nervous system and the signal is diminished causing a dysfunction of the body and over time can lead to disease. The problem we have as wellness chiropractors is that subluxation is often asymptomatic. This is an easy concept for dentistry to accept because they have done an amazing job of teaching patients not to wait until there is pain to get their teeth checked. I encourage everyone to get a spinal check-up regardless of symptoms or age.

There are multitudes of chemical, physical, and emotional stresses that cause spinal misalignment. Many of these stresses run rampant in the dental profession. First of all is the position that a dentist must be in to work on the patient. Leaning over and performing intricate work for hours on end over many years is not kind to your spine and can cause Forward Head Syndrome. This incorrect head position leads to improper spinal function. For every inch of forward head posture, it can increase the weight of the head on the spine by 10 pounds. The head in forward posture can add up to 30 pounds of abnormal leverage on the cervical spine which causes early spinal degeneration. Forward head posture results in a loss of vital capacity. Lung capacity is depleted by as much as 30 percent. Loss of lung capacity leads to heart and blood vascular problems. The entire gastrointestinal system is affected, particularly the large intestine. Loss of good bowel peristaltic function and evacuation is common. Freedom of motion in the first four cervical vertebrae is lost. This area is a major source of stimuli that causes production of endorphins. As a result of this loss of endorphins (hormones that reduce pain and affect emotions), many otherwise non-painful sensations are experienced as pain. Forward head posture causes loss of healthy spine-body motion.1 Just as dentist would, we rely on x-rays to not only screen for pathology of fracture but, to measure for misalignments. This allows us to recommend an accurate treatment plan for correction. This includes a series of corrective adjustments and a prescription of specific home care over a period of time that can range from one month to years. Most corrective care plans are 6 to 18 months. By definition, when the spine is close to its anatomic normal, the patient is healthier. Because stresses in life subluxate us, there is maintenance care to keep the corrected alignment, which includes regular adjustments and home care. This

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Chiropractic

corrective technique is what allows us to see the tough cases get results and keep our well patients well. If you have never been checked by a corrective chiropractor, I encourage you to do so as your wellness and the wellness of your practice may depend on it.

Reference: 1 Kapandji, Phys of Joints, V.3 Photo: (l to r) Dr. Fenn with the family’s ball of fur, Teddy, his wife, Jeannette and their son, Ryland.

Dr. James Ryan Fenn is a doctor of chiropractic and has been serving Tallahassee since 2000, where he truly has a passion for his community. His heart is catered towards families and he has a special place in his heart designated to those with autism. With his son, Ryland’s, diagnosis in 2004, Dr. Fenn comes from a place of understanding and proactive care. He also is the host of the “Fenn-onminal Health” radio show on Freedom 93.3 FM in Tallahassee, Saturdays at 2:30 p.m.

“

For every inch of forward head posture, it can increase the weight of the head on the spine by 10 pounds.

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Compleat Dentistry

Three Ironies Compleat dentistry is a slower-paced, deliberate style of dentistry, espoused by Pankey, Dawson and so many others, in which the dentist knows the patient well, knows the work, knows their own abilities and limitations, and uses this knowledge to take care of the patients who trust them with their care. The world will change, but the principles of compleat dentistry will remain the foundation of an exceptional practice. The spelling is an homage to Isaak Walton, whose book, “The Compleat Angler,” was about so much more than fishing.

By Dr. Edward Hopwood

The ironic part was that everyone called him Steve Barclay.

That wasn’t his birth name, but Steve Barclay was who he became. When it was time to pursue a career, his parents recommended a safe career: banking. It was a good job that guaranteed a middle-class lifestyle, a predictable future and a pension. He took the job and his parents were proud. He was transferred far away from his home in England to various posts in the West Indies.

He joined the country club, was given the three-month holidays that were customary for someone of his position and lived a good life. Unfortunately, the schooling in the West Indies was not so good, so he shipped his four daughters off to boarding school in England and missed out on half of their formative years, but it was better for them to get a good education. And when

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it was time to retire, he took his pension and left the bank after a successful career: a lifetime of service in a good, safe job.

After retirement, he spoke to my father (and his son-in-law) and told him how he wished he had never pursued banking; his true love was the sea and he had hoped to become a sailor. But, he had followed his parents’ recommendation and taken the safer route. This was a course that was followed by countless others of his generation — take a safe job, work for a corporation, get a house in the suburbs, have two children, a Chevrolet, a dog, etc. Work for 45 years and retire with a full pension, and maybe even a gold watch.

I never knew Steve Barclay, but his life and his message often resonate with me today. As a parent, I want what is best for my children and I want to prepare them for the world in the best way possible. But today’s world is so different from the one in which my grandfather lived. There has been a massive paradigm shift. Jobs that once were considered safe are no longer so safe.

Nobody expects to work 45 years for the

same company, get a gold watch and start drawing a pension. Any job that doesn’t require a passionate worker will either be outsourced or replaced with a computer.

My wife and I have an account with a bank in Utah, even though I have never been to Utah — and even if I were to visit Utah — I certainly wouldn’t stop by the bank to meet the people who are holding our money. In fact, I have never interacted with a human from that bank. The computers I interact with are as efficient as Steve Barclay. However, when it comes to important banking, I have a local bank that is full of passionate bankers who enjoy their work — unlike my grandfather, they have pursued their true calling. I can count on them for creative ways to help me accomplish my goals.

And, as Seth Godin points out, our school system is set up to churn out workers who are primed for the safe jobs. Our schools are set up to train people to follow the rules, answer the questions, do well on the SATs and go to college. There is one right answer that can be bubbled in with a No. 2 pencil. But the world has changed, so if we want the right answer to fill in a bubble, we can just ask our phones. Everyone with a smartphone has access to the right answer — what we really need are people who know what to do with the right answer.

But, our schools are still set up to have our children regurgitate the right answer.

www.floridadental.org

Compleat Dentistry

So, the second irony is the fact that the safest jobs for my children are exactly the opposite of the safe jobs for their great grandparents. A career spent following the rules for a large corporation will certainly be a dead end. The safe jobs for my children are those where they gain a certain level of education as a prerequisite, then they launch out into the world and follow their passion, and bring that passion to wherever it is they choose to work. The safe jobs are those that pursue mastery of the field, where they become an indispensable part of whatever career they choose. And a career cannot be safe unless there is that passion driving them towards mastery.

And this is where compleat dentistry comes into the equation. You see, compleat dentistry is not just about centric relation or facebows — it’s much more than that. The compleat dentists are on the path to mastery, following the passion that drove them into dental school and got them through the rigors of becoming dentists. But the degree was simply access to the launchpad.

It was the keys to the rocket. The journey begins after the keys are turned. My column is dedicated to those who have turned the keys and pushed the ignition button, but it’s also dedicated to those who are stuck on the launchpad, too afraid to take the next step.

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If you have read this far (thank you!) — then I promised a third irony: The powers that be tell us that our profession is headed in the exact opposite direction from the rest of the world. They claim that the safest path for a young dentist is to join a corporation and pay down debt. The safest path for a retiring dentist is to sell to a corporation. But I believe these “safe” solutions simply are applying an antiquated industrialist mindset to a field where it never worked.

Some people will read this and believe that I am opposed to corporations. Others think that I am afraid of being taken over by corporations, so I am a dinosaur clinging to a lost cause. This couldn’t be farther from the truth. I just don’t see how the current crop of dental corporations is any different than the previous ones that have applied economy of scale, or six sigma, or some other business concept du jour and then failed. They failed because they have suppressed their employees’ paths to mastery. It remains to be seen whether or not the challenges facing young dentists can be best solved by a corporation or a private practice. But either way, I know that the safest way forward is to turn the keys and light the fires.

Dr. Hopwood is a restorative dentist in Clearwater and can be reached at edwardhopwood@gmail.com.

“

Everyone with a smartphone has access to the right answer – what we really need are people who know what to do with the right answer.

”

September/October 2016

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Dental Lifeline

Dental Lifeline Network is a national organization providing access to comprehensive dental care for society’s most vulnerable people with disabilities or who are elderly or medically fragile and have no other way to get help. Nationally, DDS has 15,000 volunteer dentists and 3,700 volunteer labs.

Dental Lifeline Network • Florida has helped 1,656 people

and generated $6.8 million in donated services.

Join us:

Purchase DentaCheques

Volunteer

$ coupon $ To save money and make a difference purchase a DentaCheques book. www.DentaCheques.org

Please visit www.DentalLifeline.org/Volunteer

Or contact:

Connect with us

Megan Manor 850.577.1466 or mmanor@DentalLifeline.org

Donate

Facebook, Twitter, LinkedIn, Email

Visit: www.DentalLifeline.org/Donate

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September/October 2016

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87

Books on the Shelf

Books on the Shelf Books Available for Review If you are interested in reviewing one of the books listed here, please contact Director of Communications Jill Runyan by email at jrunyan@floridadental.org or by mail at 1111 E. Tennessee St., Tallahassee, FL 32308.

Authors should review their books within four to six weeks and are given the books they review.

2013 QDT, Quintessence of Dental Technology, Vol. 36 Edited by: Sillas Duarte, DDS, MS, Ph.D. 216 pages Published in 2013 by Quintessence Publishing Price: $128 2016 QDT, Quintessence of Dental Technology, Vol. 39 Edited by: Sillas Duarte, DDS, MS, Ph.D. 224 pages Published in 2016 by Quintessence Publishing Price: $132 3-D Imaging in Dentistry: From Multiplanar Cephalometry to Guided Navigation in Implantology By: Giovanna Perrotti, Tiziano Testori and Massimiliano Politi 560 pages Published in 2016 by Quintessence Publishing Price: $210 Aligner Orthodontics: Diagnostics, Biomechanics, Planning, and Treatment By: Werner Schupp and Julia Haubrich 368 pages Published in 2016 by Quintessence Publishing Price: $228

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Today's FDA

September/October 2016

At the Forefront: Illustrated Topics in Dental Research and Clinical Practice By: Hiromasa Yoshie, DDS, Ph.D. 108 pages Published in 2012 by Quintessence Publishing Price: $98

Evidence-based Dentistry for the Dental Hygienist By: Julie Frantsve-Hawley, RDH, Ph.D. 376 pages Published in 2014 by Quintessence Publishing Price: $56

Best Practices in Endodontics: A Desk Reference By: Richard Schwartz, DDS and Venkat Canakapalli, BDS, MDS 368 pages Published in 2015 by Quintessence Publishing Price: $134

Foundations of Dental Technology: Anatomy and Physiology By: Arnold Hohmann and Werner Hielscher 300 pages Published in 2014 by Quintessence Publishing Price: $98

Ceramics in Dentistry: Principles and Practice By: J. Robert Kelly, DDS, MS, DMedSc 128 pages Published in 2016 by Quintessence Publishing Price: $39

Medical Emergencies in the Dental Practice By: Orrett E. Ogle, DDS; Harry Dym, DDS; and Robert J. Weinstock, DDS 200 pages Published in 2015 by Quintessence Publishing Price: $69

Color Atlas of Fixed Prosthodontics: Vol. 1 By: Yoshiyuki Hagiwara 196 pages Published in 2013 by Quintessence Publishing Price: $120

Medical Microbiology and Immunology for Dentistry By: Nejat Duzgunes 306 pages Published in 2015 by Quintessence Publishing Price: $118

Development of the Human Dentition By: Franz P.G.M. van der Linden, DDS, Ph.D. 240 pages Published in 2016 by Quintessence Publishing Price: $99

Oral Implantology Review: A Study Guide By: Louie Al-Faraje, DDS 232 pages Published in 2016 by Quintessence Publishing Price: $108

Endodontics Review: A Study Guide By: Brooke Blicher, Rebekah Lucier Pryles and Jarshen Lin 264 pages Published in 2016 by Quintessence Publishing Price: $68

Oral Implantology Surgical Procedures Checklist By: Louie Al-Faraje, DDS 92 pages Published in 2013 by Quintessence Publishing Price: $68

www.floridadental.org

Books on the Shelf Oral Implants: Bioactivating Concepts Edited by: Drs. Rolf Ewers and Thomas Lambrecht 536 pages Published in 2013 by Quintessence Publishing Price: $328 Orofacial Pain and Headache, Second Edition By: Yair Sharav, DMD, MS and Rafael Benoliel, BDS 664 pages Published in 2015 by Quintessence Publishing Price: $168 Orofacial Pain: Guidelines for Assessment, Diagnosis, and Management By: Reny de Leeuw, DDS, Ph.D., MPH and Gary D. Klasser, DMD 312 pages Published in 2013 by Quintessence Publishing Price: $48 Periodontal Review: A Study Guide By: Deborah A. Termeie, DDS 296 pages Published in 2013 by Quintessence Publishing Price: $68 Principles of Design and Fabrication in Prosthodontics By: Arnold Hohmann and Werner Hielscher 408 pages Published in 2016 by Quintessence Publishing Price: $128 Promoting the Oral Health of Children: Theory and Practice, Second Edition By: Aubrey Sheiham, Samuel Jorge Moyses, Richard G. Watt, Marcelo Bonecker 450 pages Published in 2014 by Quintessence Publishing Price: $110

www.floridadental.org

Reintervention in Endodontics By: Mario Luis Zuolo, Daniel Kherlakian, Jose Eduardo de Mello Jr., Maria Cristina Coelho de Carvalho and Maria Ines Ranazzi Cabral Fagundes 332 pages Published 2014 by Quintessence Publishing Price: $180 Sinus Floor Elevation: Avoiding Pitfalls Using Cone-Beam CT By: Dr. Yasuhiro Nosaka 120 pages Published 2014 by Quintessence Publishing Price: $120 Smile! Your Guide to Esthetic Dental Treatment By: Douglas A. Terry, DDS 54 pages Published 2014 by Quintessence Publishing Price: $29.50 Success Strategies for the Aesthetic Dental Practice By: Linda Greenwall and Cathy Jameson 312 pages Published 2012 by Quintessence Publishing Price: $98 Summitt’s Fundamentals of Operative Dentistry: A Contemporary Approach, Fourth Edition By: Thomas J. Hilton, DMD, MS; Jack L. Ferracane, Ph.D.; and James C. Broome, DDS, MS 612 pages Published in 2013 by Quintessence Publishing Price: $128 Surgical Design for Dental Reconstruction with Implants: A New Paradigm By: Martin Chin 256 pages Published in 2015 by Quintessence Publishing Price: $172

The Alexander Discipline, Vol. 3: Unusual and Difficult Cases By: R.G. “Wick” Alexander, DDS, MSD 192 pages Published in 2016 by Quintessence Publishing Price: $176 The Biomechanical Foundation of Clinical Orthodontics By: Charles J. Burstone, DDS, MS and Kwangchul Choy, DDS, MS, Ph.D. 608 pages Published in 2015 by Quintessence Publishing Price: $180 The Oral-Systemic Health Connection: A Guide to Patient Care By: Michael Glick, DMD 312 pages Published in 2014 by Quintessence Publishing Price: $118 Treatment Planning for Traumatized Teeth, Second Edition By: Mitsuhiro Tsukiboshi, DDS, Ph.D. 240 Pages Published in 2012 by Quintessence Publishing Price: $82 What’s in Your Mouth?

What’s in Your Child’s Mouth?

By: Douglas A. Terry, DDS 66 pages Published in 2013 by Quintessence Publishing Price: $29.50 What’s in Your Mouth?

Your Guide to a Lifelong Smile By: Douglas A. Terry, DDS 48 pages Published in 2014 by Quintessence Publishing Price: $29.50 Zygomatic Implants: The Anatomy Guided Approach Edited by: Carlos Aparicio 280 pages Published in 2012 by Quintessence Publishing Price: $168

September/October 2016

Today's FDA

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C lassified A dvertising

Opportunities

90

Today's FDA

The FDA’s online classified system 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!

As an added benefit, we will continue to publish the basic text of paid, online classified ads in Today’s FDA, at no additional cost to you. All ads posted to the online classified system will be published during the contracted time frame for which you have posted your online classified advertisement.

Today’s FDA is published bimonthly; therefore, all active ads online will be extracted from the system on roughly the following dates of each year:

Issue

Extracted Date

Jan/Feb March/April May/June July/Aug Sept/Oct Nov/Dec

Jan. 15 March 15 May 15 July 15 Sept. 15 Nov. 15

Please visit the FDA’s classified website at www. floridadental.co/classifieds.

September/October 2016

Endodontist Opportunities — Tampa, FL. Great Expressions Dental Centers has select openings for Endodontists to join our Tampa, FL practices. Our specialists have the clinical freedom and autonomy enjoyed in a traditional private practice without the additional financial or administrative burdens associated with practice management. When considering a career with GEDC, specialists can expect: Compensation: Six Figure Annual Base vs.

Percent of Production! Attractive Sign-on or Relocation possible as well. Please apply via this ad for consideration! Stacey Bruwer, M.A. | Clinical Recruiter | Great Expressions Dental Centers, 29777 Telegraph Road, Suite 3000 | Southfield, MI 48034, phone 248-237-6853 |Ext. 72468| fax 248-686-0118 | web www. greatexpressions.com. “Look for the Smile Above Our Name!” Apply Here: http://www.

Click2apply.net/f7h36ppyyv.

Dentist Opening — Land O Lakes, FL. Compensation: Competitive Six Figure Annual Draw with Percent of Production; Sign-on Bonus or Relocation Assistance possible.Benefits/ Perks: Leader in the practice: Clinical Freedom and Treatment Autonomy; Patient Focus: Established and Growing Patient Foundation; Multi-Specialty office; Doctor Career Path – Partnership/Investment Opportunities; Full Benefits Offered – Healthcare and Dental Benefits, 401K, Short Term/Long Term Disability, Time Off; Malpractice Coverage Assistance. Please apply via this ad for consideration. Stacey Bruwer, M.A. | Clinical Recruiter | Great Expressions Dental Centers, 29777 Telegraph Road, Suite 3000 | Southfield, MI 48034, phone 248-237-6853 |Ext. 72468| fax 248-686-0118 | web www.greatexpressions.com.

“Look for the Smile Above Our Name!” Apply Here: http://www.Click2apply.net/zhw4vmz9nn.

Associate position available. F/T General/ Cosmetic Dentist wanted in our friendly, upscale practice located in Palm Beach County. Minimum of 1 year experience required. Bilingual is a plus. Offering excellent commission with no capitation. Please email or fax resume to kathiecperfectsmiledentistry@ gmail.com, 561-424-2098.

Full Time General Dentist. We are a privately owned, well established family practice located in Plantation Florida for over 30 years. We are fully digital as well as paperless. We provide a variety of services in addition to general dentistry, including Invisalign, Implants and cosmetic dentistry. We are looking for an associate to replace one of the retiring partners, excellent production and path to partnership.

Please send CV to pdapl@pdapl.net.

www.floridadental.org

ORLANDO — PRIVATE FFS/PPO OFFICE — General Dentist. An Excellent opportunity to join a Private Established Dental Office in Orlando, providing excellent patient care with the latest State-of-the-Art technology including Digital x-rays, Intraoral Camera, Cerec, Laser, Invisalign. Doing ALL aspects of dentistry including Ortho, Cosmetic, Surgery and Dental Implants. 100% PPO/FFS. (No HMO/ No Medicaid). We offer superior quality and excellent patient care, provide attention to details and our patients love us. Great compensation, with a huge potential for the right person, in addition to the on-the-job experience and mentoring. if you have GPR-AEGD Residency it is a plus. Please Fax 407-327-1018 OR email: Doctor@NewSmileDentistry.Net. Pediatric Dentist. Since 1997, Christie Dental has grown from our first location in Merritt Island, FL to 17 locations from coast to coast in Central Florida. We are a community based, multispecialty group committed to the traditional doctor-patient relationship and providing the highest quality care and service to our patients.

Our mission is to be Florida’s premier dental provider of choice through fiscal, social and ethical excellence. This is a part time position working 2 days a week and can be a great supplement to an existing schedule and may offer future growth opportunity. Christie Dental primarily a fee-for-service and PPO provider.

Interested candidates, please contact Kate Anderson: kateanderson@amdpi.com or 781213-3312. https://www.christiedental.com/.

Full-Time Dentist Opportunity — Coral Springs, FL. We have an excellent opportunity to lead our team as the full time Dentist in our multispecialty, Coral Springs, FL office! Great Expressions Dental Centers has an immediate, select opening for a full-time General Dentist w/1+ years’ experience to join our established multispecialty, digital Coral Springs, FL practice located at 1881 N University Dr #208, Coral Springs, FL 330713! Enjoy a rewarding career with a full office staff (including HYG), a strong schedule and the ability to focus on quality patient care. Compensation: * Compensation — Six-Figure Draw vs. Percent of Production. Apply Here: http://www.Click2apply.net/mfn3gpk83w.

Associate Dentist Opportunity — Tampa, FL. Great Expressions Dental Centers has an immediate opening for a full-time General Dentist to join our Carrollwood Commons and Pinellas Park, FL practices. Enjoy a rewarding role with a dedicated and experienced staff!

Compensation: Competitive Six Figure Annual Draw with Percent of Production; Sign-on Bonus or Relocation Assistance possible. Benefits/Perks: Leader in the practice: Clinical Freedom and Treatment Autonomy. Patient Focus: Established and Growing Patient Foundation. Please apply via this ad for consideration, Stacey Bruwer, M.A. | Clinical Recruiter | Great Expressions Dental Centers, 29777 Telegraph Road, Suite 3000 | Southfield, MI 48034, phone 248-2376853 |Ext. 72468| fax 248-686-0118 | web www. greatexpressions.com. “Look for the Smile Above Our Name!” Apply Here: http://www.

Click2apply.net/7bjbvdwvsj.

Dentist Part Time New Smyrna Beach Need an associate for a busy 20-year-old hometown dental practice in beautiful New Smyrna Beach. This is not “corporate dentistry” but an opportunity to truly care for your patients. Brand new office building with 6 operatories fully digital (Eaglesoft) state of the art equipment. Can start 2-3 days per week and get 30-33% of your net production. 386.314.9366.

Pediatric Dentist (Full-time) — Jacksonville, FL. Great Expressions Dental Centers has a full-time opening for Pediatric Dentist to join our team in Jacksonville, FL. We are looking for a motivated and qualified pediatric specialist to join and lead our 20 plus practices spread across the Jacksonville, FL area. Job Requirements: Must have a DDS/DMD from an accredited University and active State Dental Board license, Pediatric Dental License and certifications. Please apply via this ad for consideration, Molly McVay | Clinical Recruiter | Great Expressions Dental Centers, PSC-North | 29777 Telegraph Road.

Suite 3000| Southfield, MI 48034 USA, phone 248-430-5555 |Ext. 72467| fax 248-686-0170 | web www.greatexpressions.com. Apply Here: http://www.Click2apply.net/nsmz8g5gvs.

Master Tech, C.D.T. relocating to central Florida/ Orlando area. Seeking in house CandB/some removable has own dental lab equipment. Over 30 + years’ experience. Email me: almeldental@ att.net.

Pediatric Dentist Opportunity (3+ days) — Broward/Dade, FL. Great Expressions Dental Centers has a current, select opening for a parttime (3 days/week) Pediatric Dentist to join our multi-specialty, growing Broward, Palm Beach and Miami-Dade county practice(s).

Dedicated staff, consistent schedule with a strong referral network of several local offices.

Compensation: Compensation — Draw vs.

Percent of Production. Benefits/Perks: Leaders in the practice: Clinical Freedom and Treatment Autonomy for Every Doctor. Patient Focus: Established and Growing Patient Foundation; Multi-Specialty office(s); Doctor Career Path – Partnership/Investment Opportunities; Malpractice Coverage Assistance; Continued Education Reimbursement, Paid ADA and State Society Dues. Please view our Doctor Career Path video: http://www.screencast. com/t/M3xWM5CYN. Apply Here: http://www.

Click2Apply.net/mz7s7hrx8c.

Dentist (Full-Time) Opportunity — The Villages, FL. Great Expressions Dental Centers has an immediate opening for a full-time General Dentist to join one of our Central, FL practice in The Villages. Enjoy a rewarding role with a dedicated and experienced staff! Compensation: Competitive Six Figure Annual Draw with Percent of Production; Sign-on Bonus or Relocation Assistance possible. Benefits/Perks: Leader in the practice: Clinical Freedom and Treatment Autonomy; Patient Focus: Established and Growing Patient Foundation. Please apply via this ad for consideration, Stacey Bruwer, M.A. | Clinical Recruiter | Great Expressions Dental Centers, 29777 Telegraph Road, Suite 3000 | Southfield, MI 48034, phone 248-2376853 |Ext. 72468| fax 248-686-0118 | web www. greatexpressions.com. “Look for the Smile Above Our Name!” Apply Here: http://www.

Click2apply.net/h4p8bxsfdd.

Full Time Dentist Opportunity: Stuart, FL. Great Expressions Dental Centers has an immediate, select opening for a full-time General Dentist to join our established, high production, digital Stuart, FL multi-specialty practice! Enjoy a rewarding career with a full office staff (including HYG), a strong schedule and the ability to focus on quality patient care. Compensation: Compensation — Six-Figure Draw vs. Percent of Production. Apply via this ad to learn more about Great Expressions! For More Information, Please Contact: Ross Shoemaker, MBA | Doctor Recruiting Manager | Great Expressions Dental Centers, Practice Support Center — South | 1560 Oakbrook Drive, Norcross, GA 30093 USA, phone 678-836-2226 | ext 72226 | fax 770-2423251 |web www.greatexpressions.com. email Ross.Shoemaker@greatexpressions.com. “Look for the Smile Above Our Name!” Apply Here: http://www.Click2apply.net/gdt8pzsbr7.

Please see CLASSIFIEDS, 92 www.floridadental.org

September/October 2016

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91

Your Classified Ad Reaches 7,000 Readers!

CLASSIFIEDS from 91 Associate Dentist (Full-Time) Opportunity Land O’ Lakes, FL. Great Expressions Dental Centers has an immediate opening for a fulltime General Dentist to join our Land O’ Lakes, FL practice (located at 2091 Collier Parkway).

Enjoy a rewarding role with a dedicated and experienced staff! Compensation: Competitive Six Figure Annual Draw with Percent of Production; Sign-on Bonus or Relocation Assistance possible. Benefits/Perks: • Leader in the practice: Clinical Freedom and Treatment Autonomy; Patient Focus: Established and Growing Patient Foundation; Multi-Specialty office; Doctor Career Path – Partnership / Investment Opportunities; Full Benefits Offered – Healthcare and Dental Benefits, 401K, Short Term / Long Term Disability, Time Off; Malpractice Coverage Assistance. Apply Here: http://www.Click2apply.net/4jh25498xv.

Dentist (Full-Time) Opportunity — The Villages, FL. Great Expressions Dental Centers has an immediate opening for a full-time General Dentist to join one of our Central, FL practice in The Villages. Enjoy a rewarding role with a dedicated and experienced staff! Compensation: Competitive Six Figure Annual Draw with Percent of Production; Sign-on Bonus or Relocation Assistance possible. Benefits/Perks: Leader in the practice: Clinical Freedom and Treatment Autonomy; Patient Focus: Established and Growing Patient Foundation. Please apply via this ad for consideration, Stacey Bruwer, M.A. | Clinical Recruiter | Great Expressions Dental Centers, 29777 Telegraph Road, Suite 3000 | Southfield, MI 48034, phone 248-2376853 |Ext. 72468| fax 248-686-0118 | web www. greatexpressions.com. “Look for the Smile Above Our Name!” Apply Here: http://www.

Click2apply.net/whxvw345y6.

Dentist (Full-Time) — Fort Myers, FL. Great Expressions Dental Centers has an immediate opening for a full-time General Dentist to join one of our Fort Myers, FL practice. Enjoy a rewarding role with a dedicated and experienced staff! Compensation: Competitive Six Figure Annual Draw with Percent of Production; Signon Bonus or Relocation Assistance possible.

Benefits/Perks: • Leader in the practice: Clinical Freedom and Treatment Autonomy; Patient Focus: Established and Growing Patient Foundation; Multi-Specialty office; Doctor Career Path – Partnership/Investment Opportunities; Full Benefits Offered – Healthcare and Dental Benefits, 401K, Short Term/ Long Term Disability, Time Off; Malpractice Coverage Assistance; Continued Education Reimbursement, Paid ADA and State Society Dues. Apply Here: http://www.Click2Apply.net/ kgnhfvqzfq.

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Today's FDA

September/October 2016

Endodontist (2-5 days/week) — Jacksonville, FL. Great Expressions Dental Centers has an immediate Endodontist Opportunity (2-5 days/week) to join our established and highly productive practices located in Jacksonville, FL! Our specialists have the clinical freedom and autonomy enjoyed in a traditional private practice without the additional financial or administrative burdens associated with practice management. When considering a career with GEDC, specialists can expect: Compensation: Six Figure Annual Base vs. Percent of Production! Attractive Sign-on or Relocation possible as well. Benefits/Perks: Leader in the practice: Clinical Freedom and Treatment Autonomy; Patient Focus: Established and Growing Patient Foundation; Multi-Specialty office; Doctor Career Path – Partnership/ Investment Opportunities; Full Benefits Offered – Healthcare and Dental Benefits, 401K, Short Term/Long Term Disability, Time Off; Malpractice Coverage Assistance; Continued Education Reimbursement, Paid ADA and State Society Dues; Mentorship – Study Clubs, Chairside Mentoring, GEDC University Courses. *Please view our Doctor Career Path video: http://www.screencast.com/t/M3xWM5CYN. Please apply via this ad for consideration! Molly McVay | Clinical Recruiter | Great Expressions Dental Centers, PSC-North | 29777 Telegraph Road. Suite 3000| Southfield, MI 48034 USA, phone 248-430-5555 |Ext. 72467| fax 248686-0170 | web www.greatexpressions.com.

Must have a DDS/DMD from an accredited University and active State Dental Board license, Endodontic Dental License and certifications.

Apply Here: http://www.Click2Apply.net/ jvhdh5vfrb.

General Dentist. We are seeking for a motivated, energetic, bilingual, family oriented Dentist that is willing to work in a fast pace environment.

We have two locations. Recent Graduates are Welcomed. We can offer both part-time and full time position as long as the office flows efficient. oviedodentalcenter@gmail.com.

GENERAL DENTIST – needed for PRIVATE PRACTICE IN DILLARD, GEORGIA — We need a General Practice Dentist for established private comprehensive family practice in the beautiful Georgia mountain area. Clinical autonomy, great compensation, and great team for excellent support. Practice perfect for a GP who is looking for great buy in/transition opportunity, as well as the new grad. All are welcome to apply including NEW GRADS. To be considered, please send CV to dmahiring3@ yahoo.com.

General Dentist — Tallahassee, FL — $10,000 Sign on Bonus! Heartland Dental supported offices are looking for outgoing and positive Dentists that are seeking career satisfaction and continuing education opportunities. There are 100 reasons to join Heartland Dental, Discover Yours! http://jobs.heartland.com/job/GeneralDentist-Tallahassee--FL-$10-000-Sign-onBonus/J3K82B6PQ91KD1N7Q8L. General Dentist — Jacksonville, FL Great Expressions Dental Centers has an immediate, select opening for a full-time General Dentist to join one of our established and highly productive practices located in Jacksonville, FL. Benefits/ Perks: Leader in the practice: Clinical Freedom and Treatment Autonomy; Patient Focus: Established and Growing Patient Foundation; Digital Office; Doctor Career Path – Partnership/ Investment Opportunities. Molly McVay | Clinical Recruiter | Great Expressions Dental Centers, PSC-North | 29777 Telegraph Road.

Suite 3000| Southfield, MI 48034 USA, phone 248-430-5555 |Ext. 72467| fax 248-686-0170.

Must have a DDS/DMD from an accredited University and active State Dental Board license. *1-2 years+ of experience is desired but will consider a new graduate doctor. Apply Here: http://www.Click2Apply.net/srb3h23z7b.

Oral Surgeon — Tampa, FL. Great Expressions Dental Centers has a current opening for a full-time Oral Surgeon to join our Tampa, FL practices. Our Specialists have the clinical freedom and autonomy enjoyed in a traditional private practice without the additional financial or administrative burdens associated with practice management. Specialists can expect unlimited production based earnings, full benefits (such as medical, dental, 401k, continuing education), paid time off, malpractice coverage, a stable patient base with full clinical staff in place, a 20+ general practice referral network and long-term practice or regional career growth with possible investment opportunity. Job Requirement: Must have a DDS/DMD from an accredited University and active State Dental Board license. *Oral Maxillofacial Surgeon License and certification.

Apply Here: http://www.Click2apply. net/7xm3ykyh28.

Dentist position in FFS office — available now.

3 days a week solo Doc position available temp, or temp to perm. Must do Molar Root Canal and 90% of extractions. Cosmetic and Invisalign a plus, as well as Spanish speaking. Office is well managed, you only need to step in and do Dentistry in the relaxed and cordial small town environment. Commute is 45-60 min. from Fort Lauderdale zone, about an hour from West Palm. 954.557.2901.

www.floridadental.org

Your Classified Ad Reaches 7,000 Readers!

General Dentist for a Flourishing Practice. We are a flourishing practice in St. Augustine that is looking to add another full time dentist to our team. We are growing with a solid flow of both new and existing patients and thus are looking to bring another doctor on board to support our community. We offer a daily guarantee with profit sharing opportunity, malpractice insurance assistance, paid CEUs, paid time off, 401(k) with a match, as well as dental, health and vision insurance. Our office has an onsite lab with full time lab technician, is exceptionally clean and modern with great lighting with a phenomenal front office team. 315.706.4661.

Full Time General Dentist — Beautiful Space Coast of Brevard County, Melbourne, FL. Dental Partners in Melbourne, FL has a full time General Dentist opportunity available. This position gives you the opportunity to provide patients with excellent dental care while building important relationships. Full time position with family friendly days and hours. Talented and dedicated support team. Competitive base salary with performance incentives to earn much more. Sign-on bonus, relocation and student loan repayment assistance of up to $20,000 available for this location. Modern, updated office, digital X-rays. Full benefits to include medical, vision, dental, life, 401K with company match, FSA, professional liability insurance and CE allowance. Candidate must be licensed in the State of Florida with no license issues or board reprimands. Valid DEA license. Please visit our website at www.dental-partners.com.

Pediatric Dentist Consultant. The Arc of Florida is seeking a pediatric dental consultant to review proposed dental treatment plans for individuals with intellectual and/or developmental disabilities. The Arc of Florida operates a statewide dental treatment network using community based dentists. Reimbursement would be made for each plan reviewed. Ask for Kathy Clinton or Deborah Linton. 800.226.1155. http://www.arcflorida.org/dental/.

Pediatric Dentist — Tampa, FL. Great Expressions Dental Centers has an immediate, 3-5 days/week, Pediatric Dentist opportunity in Northeast Tampa, FL. For more than 35 years, Great Expressions Dental Centers has been exceeding patients’ expectations offering general dentistry, endodontic, periodontic, oral and maxillofacial surgery, orthodontic, and pediatric dentistry services in a comfortable, friendly environment. The Pediatric Dentist would receive referrals from our 20+ General Practice offices in the Metro-Tampa, FL area!

Compensation: Unlimited Earnings via an Attractive Base vs. Percent of Production!

Relocation or Sign-On Bonus possible! Benefits/ Perks: • Large, Internal Network of Referring General Dentists; Leaders in the Practice: Clinical Freedom and Treatment Autonomy; Patient Focus: Established and Growing Patient Foundation; Multi-Specialty Practices with Dedicated Staffs; Doctor Career Path – Partnership/Investment Opportunities; • Full Benefits – Healthcare and Dental Benefits, 401K, Short Term/Long Term Disability, Time Off; Malpractice Coverage Assistance; Continued Education Reimbursement, Invisalign Training, Whitening Opportunity, Paid ADA and State Society Dues; Mentorship – Study Clubs, Chairside Mentoring, GEDC University Courses.

Please view our Doctor Career Path video: http://www.screencast.com/t/M3xWM5CYN. Please apply via this ad for consideration or via contact information below: Stacey Bruwer, M.A. | Clinical Recruiter | Great Expressions Dental Centers, 29777 Telegraph Road, Suite 3000 | Southfield, MI 48034, phone 248-2376853 |Ext. 72468| fax 248-686-0118 | web www. greatexpressions.com. “Look for the Smile Above Our Name!” Apply Here: http://www.

Click2Apply.net/v28rmypckv.

General Dentist part time position. Have opening for one day one week two days next week alternating plus fill in 3 weeks in summer 3-4 day weeks. Looking for experienced dentist who can do most procedures including extractions, root canals, and dentures.

386.562.4522.

Dentist for our Productive Melbourne Fl Office!

Christie Dental is currently seeking a full time Dentist for our doctor owned group practice in Melbourne, FL. Tired of HMO’s? Christie is primarily fee for service and PPO. Our doctors are offered a generous compensation and benefit package. Future ownership is available and encouraged. We are looking for a Dentist for 3 to 5 days a week! Email your C.V. today to sahildebrand@amdpi.com or call 781-213-3318.

2 day/wk General Dentist Opportunity — Tampa, FL Benefits/Perks: Leaders in the practice: Clinical Freedom and Treatment Autonomy for Every Doctor; Patient Focus: Established and Growing Patient Foundation; Multi-doctor office; Doctor Career Path – Partnership / Investment Opportunities; Malpractice Coverage Assistance; Continued Education Reimbursement, Paid ADA and State Society Dues; Mentorship – Study Clubs, Chairside Mentoring, GEDC University Courses.

Please view our Doctor Career Path video: http://www.screencast.com/t/M3xWM5CYN. Please apply via this ad for consideration!

Stacey Bruwer, M.A. | Clinical Recruiter | Great Expressions Dental Centers, 29777 Telegraph Road, Suite 3000 | Southfield, MI 48034, phone 248-237-6853 |Ext. 72468| fax 248-686-0118 | web www.greatexpressions.com. Apply Here: http://www.Click2Apply.net/3fbt23435y.

Part-time Dentist (Monument) — Jacksonville, FL Great Expressions Dental Centers has an immediate opening for a Part-Time 2 day/ week General Dentist to join our Jacksonville, FL (Monument) practice located: (2771-21 Monument Rd. Jacksonville, FL 32225). Enjoy a rewarding role with a dedicated staff in this beautifully updated facility with an established patient base! Benefits/Perks: Leaders in the practice: Clinical Freedom and Treatment Autonomy for Every Doctor; Patient Focus: Established and Growing Patient Foundation; Multi-doctor office; Doctor Career Path – Partnership/Investment Opportunities; Malpractice Coverage Assistance; Continued Education Reimbursement, Paid ADA and State Society Dues; Mentorship – Study Clubs, Chairside Mentoring, GEDC University Courses. Apply Here: https://careersclinicalgreatexpressions.icims.com/jobs/5323/generaldentist-opportunities---jacksonville%252c-fl/ login.

Dental Assistant. SOMI DENTAL GROUP is looking for an outgoing, motivated, Part time DA with (ideally) 2 years of experience! Motivated applicants please don’t hesitate to apply! Dr. Lopez doesn’t mind training the right candidate.

Dr. Lopez is passionate about the dental field and is seeking an individual equally as passionate about creating the perfect dental experience for his patients. SOMI DENTAL is a startup office, offering quality service in the Heart of South Miami. Seeking employees who are passionate about the field and who are interested in growing within the company! Need Radiology Cert and must be EFDA. START DATE: Aug. 25th, 2016.

Tue: 7:30am – 6:30pm; Thur: 8:00am – 7:00pm; Fri: 2:00pm – 6:30pm; Sat: 8:00am – 4:30pm.

305.338.8876.

Please see CLASSIFIEDS, 94

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September/October 2016

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Your Classified Ad Reaches 7,000 Readers!

CLASSIFIEDS from 93 Endodontist Opportunities — Tampa, FL. Great Expressions Dental Centers has select openings for Endodontists to join our Tampa, FL practices. Our specialists have the clinical freedom and autonomy enjoyed in a traditional private practice without the additional financial or administrative burdens associated with practice management. When considering a career with GEDC, specialists can expect: Compensation: Six Figure Annual Base vs.

Percent of Production! Attractive Sign-on or Relocation possible as well. Benefits/Perks: Leader in the practice: Clinical Freedom and Treatment Autonomy; Patient Focus: Established and Growing Patient Foundation; Multi-Specialty office; Doctor Career Path – Partnership/Investment Opportunities; Full Benefits Offered – Healthcare and Dental Benefits, 401K, Short Term / Long Term Disability, Time Off; Malpractice Coverage Assistance; Continued Education Reimbursement, Paid ADA and State Society Dues; Mentorship – Study Clubs, Chairside Mentoring, GEDC University Courses. Please view our Doctor Career Path video: http://www. screencast.com/t/M3xWM5CYN. Please apply via this ad for consideration! Stacey Bruwer, M.A. | Clinical Recruiter | Great Expressions Dental Centers. 29777 Telegraph Road, Suite 3000 | Southfield, MI 48034, phone 248-2376853 |Ext. 72468| fax 248-686-0118 | web www. greatexpressions.com. “Look for the Smile Above Our Name!” Apply Here: http://www.

Click2Apply.net/wnjgk9hg3w.

Dentist (Full-Time) — Tampa, FL Great Expressions Dental Centers has an immediate opening for a full-time General Dentist to join one of our Tampa, FL practices. Enjoy a rewarding role with a dedicated and experienced staff! Compensation: Competitive Six Figure Annual Draw with Percent of Production; Signon Bonus or Relocation Assistance possible.

Please view our Doctor Career Path video: http://www.screencast.com/t/M3xWM5CYN. Please apply via this ad for consideration, Stacey Bruwer, M.A. | Clinical Recruiter | Great Expressions Dental Centers, 29777 Telegraph Road, Suite 3000 | Southfield, MI 48034, phone 248-237-6853 |Ext. 72468| fax 248-686-0118 | web www.greatexpressions.com. “Look for the Smile Above Our Name!” Apply here: http:// www.Click2Apply.net/4cptx7npxr.

General Dentist Associate. ESCAPE THE HEAT OF FLORIDA TO THE BEAUTIFUL GEORGIA MOUNTAINS — THIS OWNER DOC DID GENERAL DENTIST – needed for PRIVATE PRACTICE IN DILLARD, GEORGIA — We need a General Practice Dentist for established private comprehensive family practice in the beautiful Georgia mountain area. Practice

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attracts many patients from North Carolina too. Clinical autonomy, great compensation, and great team for excellent support. Practice perfect for a GP who is looking for great buy in/transition opportunity, as well as the new grad. All are welcome to apply including NEW GRADS. To be considered, please send CV to dmahiring3@yahoo.com.

For Sale/Lease Office for sale in Panama City, FL. For sale, Panama City, FL. 1933 sqft. Stand alone building.

4 equipped ops with room for 2 more ops; Lab, etc. Plenty of parking. Superb location in professional office park on major street on best side of town. Does not include practice, already sold that when dentist recently retired. 850-2715612.

INTRAORAL X-RAY SENSOR REPAIR We specialize in repairing Kodak/Carestream, Dexis Platinum, Gendex GXS 700 and Schick CDR sensors. Repair and save thousands over replacement cost. We also buy and sell dental sensors. www.RepairSensor.com/919-924-8559.

Turn Key Dental Office Leesburg, Florida.

Motivated Owner — offered at 2012 appraised value $595,000. 3,742 Sq Ft office condo, Fully equipped and designed for Pediatric or Ortho Dental practice with 9 chairs, patient exam room, X-ray, on deck area, tray prep area, 1 quiet room with reception and children friendly waiting area. Central located in Lake County and the City of Leesburg, Florida with 6 lane US Hwy 441 exposure just North of Leesburg Airport.

Lake County 2015 Population – 325,875, Persons under 18 years of age – 64,523. Contact Greg Nacke for a private showing 352-455-1168 or greg@exitrealtytricounty.com.

Tremendous Opportunity East Fort Lauderdale.

Specialty: General Practice. Opportunity Type: Practice for Sale. Number of Operatories: 4. One Year Gross: 1,100,000.00. Great Opportunity: This well-established practice is located in East Fort Lauderdale. It is an incredibly busy PPO/ FFS practice with a great portfolio of clientele.

The office is freshly remodeled, modern, with a spa-like atmosphere. Digital X-Rays, Open Dental Software, 2 Hygienists, Sterilization Room, Consultation Room, plenty of parking.

Call or email for more information. Contact: 954-895-4398, email: ft.lauderdalepractice4sale@ gmail.com.

General Dental Practice. Destin, Florida.

General practice available. 2400 sq ft bldg. 6 ops.

Beautiful location on Emerald Coast. Contact for specifics. hpk32541@gmail.com.

Office Equipment For Sale in Boca Raton FL. Four fully equipped Op’s for sale; including: Pelton Crane chairs; 4 x-ray machines; 4 Pelton Crane overhead track lights; 4 rear-delivery dental units; dentist and assistant chairs; full cabinetry and more... Priced to sell. Contact Courtney info@levinedentist.com.

DENTAL OFFICE — WELLINGTON–LAKE WORTH FLORIDA. Three fully equipped dental operatories available to lease within an existing beautiful free standing medical/dental building within an existing high quality 2000 sq.ft. Dental office. Digital xrays, modern equip. Perfect situation for new graduate start up practice or existing relocating doctor to south Florida. Great opportunity for space sharing and reduced costs from owning your own facility and overhead.

Call now to discuss this great situation for the right doctor. Available immediately. Call 561670-4037.

2,000 Sq Ft Medical Office in Tallahassee, FL. Motivated Owner. $195,000 — Appraised at $257,000 in August 2012. 1,977 Sq Ft; 6 Offices.

In the medical district and walking distance from Capital Regional Medical Center. New roof and other repairs completed; Large 19x12 lobby, huge 17.5x9 receptionist space; 5 office spaces and a break room downstairs; 24x24 open floor space area upstairs. Equipment not included.

Call Stephen Kreider at Pro Players Realty 850.366.8886.

CENTRAL FLORIDA — PRACTICE FOR SALE Well established, profitable general practice for sale. Located on Merritt Island in a Pride designed dental office. The doctor is retiring but is available for a smooth transition or longer, as desired. Facility has four operatories with space available for another, as well as, adjoining rental space for expansion. Income is approximately $800,000 per year. The practice currently refers out most speciality production — endo, perio, implants and oral surgery. Inquire at marycon4t@gmail.com.

FLORIDA — SPECIALTY DENTAL PRACTICE SPACE FOR LEASE Located in The Villages, Florida; Beautiful, completely built-out dental space with 6 operatories, fully furnished with modern digital equipment (can be purchased), 2,200 sq. ft. turn-key facility located in the heart of The Villages, a large senior retirement community in central Florida; golf cartaccessible; adjacent to a general dental practice.

Contact: Mike Pederson-Grizzard Commercial Real Estate Group, (352) 408-0190. http://www. loopnet.com/Listing/19603384/11938-CR-101Suite-130-The-Villages-FL/.

www.floridadental.org

Statement of Ownership 1. Publication Title

Statement of Ownership, Management, and Circulation (All Periodicals Publications Except Requester Publications)

Today's FDA 4. Issue Frequency

2. Publication Number

1 0

4 8

_

5

3 1 7

5. Number of Issues Published Annually

bimonthly + Reception Room Issue

6 + 1 special issue

7. Complete Mailing Address of Known Office of Publication (Not printer) (Street, city, county, state, and ZIP+4 ®)

3. Filing Date

9/22/2016

13. Publication Title

Sept/Oct 2016

15. Extent and Nature of Circulation

Average No. Copies No. Copies of Single Each Issue During Issue Published Preceding 12 Months Nearest to Filing Date

6. Annual Subscription Price

$150/yr

a. Total Number of Copies (Net press run)

Contact Person

Jill Runyan

(1) Mailed Outside-County Paid Subscriptions Stated on PS Form 3541 (Include paid distribution above nominal rate, advertiser’s proof copies, and exchange copies)

Telephone (Include area code)

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

14. Issue Date for Circulation Data Below

Today's FDA

8. Complete Mailing Address of Headquarters or General Business Office of Publisher (Not printer)

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

b. Paid Circulation (By Mail and Outside the Mail)

John Paul, DMD 1111 E. Tennessee St., Tallahassee, FL 32308-6914

Jill Runyan 1111 E. Tennessee St., Tallahassee, FL 32308-6914 10. Owner (Do not leave blank. If the publication is owned by a corporation, give the name and address of the corporation immediately followed by the names and addresses of all stockholders owning or holding 1 percent or more of the total amount of stock. If not owned by a corporation, give the names and addresses of the individual owners. If owned by a partnership or other unincorporated firm, give its name and address as well as those of each individual owner. If the publication is published by a nonprofit organization, give its name and address.)

Full Name Complete Mailing Address

Florida Dental Association

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

11. Known Bondholders, Mortgagees, and Other Security Holders Owning or Holding 1 Percent or More of Total Amount of Bonds, Mortgages, or None Other Securities. If none, check box Full Name

7900

100

100

(3)

0

0

(4)

Paid Distribution by Other Classes of Mail Through the USPS (e.g., First-Class Mail®)

0

0

c. Total Paid Distribution [Sum of 15b (1), (2), (3), and (4)]

7614

8000

d. Free or (1) Free or Nominal Rate Outside-County Copies included on PS Form 3541 Nominal Rate Distribution (2) Free or Nominal Rate In-County Copies Included on PS Form 3541 (By Mail and Free or Nominal Rate Copies Mailed at Other Classes Through the USPS Outside (3) (e.g., First-Class Mail) the Mail)

0

0

0

0

Editor (Name and complete mailing address)

Managing Editor (Name and complete mailing address)

8300

Paid Distribution Outside the Mails Including Sales Through Dealers and Carriers, Street Vendors, Counter Sales, and Other Paid Distribution Outside USPS®

9. Full Names and Complete Mailing Addresses of Publisher, Editor, and Managing Editor (Do not leave blank) Publisher (Name and complete mailing address)

Florida Dental Association 1111 E. Tennessee St., Tallahassee, FL 32308-6914

Mailed In-County Paid Subscriptions Stated on PS Form 3541 (Include paid (2) distribution above nominal rate, advertiser’s proof copies, and exchange copies)

8320 7514

(4)

0

Free or Nominal Rate Distribution Outside the Mail (Carriers or other means)

0

115

115

115

115

f. Total Distribution (Sum of 15c and 15e)

7729

8115

g. Copies not Distributed (See Instructions to Publishers #4 (page #3))

200

200

h. Total (Sum of 15f and g)

7929

8315

i. Percent Paid (15c divided by 15f times 100)

98.51 %

98.58 %

e. Total Free or Nominal Rate Distribution (Sum of 15d (1), (2), (3) and (4))

* If you are claiming electronic copies, go to line 16 on page 3. If you are not claiming electronic copies, skip to line 17 on page 3.

Complete Mailing Address

Statement of Ownership, Management, and Circulation (All Periodicals Publications Except Requester Publications) 16. Electronic Copy Circulation

12. Tax Status (For completion by nonprofit organizations authorized to mail at nonprofit rates) (Check one) The purpose, function, and nonprofit status of this organization and the exempt status for federal income tax purposes: Has Not Changed During Preceding 12 Months Has Changed During Preceding 12 Months (Publisher must submit explanation of change with this statement) PS Form 3526, July 2014 [Page 1 of 4 (see instructions page 4)] PSN: 7530-01-000-9931

PRIVACY NOTICE: See our privacy policy on www.usps.com.

Average No. Copies Each Issue During Preceding 12 Months

No. Copies of Single Issue Published Nearest to Filing Date

a. Paid Electronic Copies

0

b. Total Paid Print Copies (Line 15c) + Paid Electronic Copies (Line 16a)

7614

c. Total Print Distribution (Line 15f) + Paid Electronic Copies (Line 16a)

7729

8115

98.51%

98.58%

d. Percent Paid (Both Print & Electronic Copies) (16b divided by 16c Í 100) PS Form 3526, July 2014 (Page 2 of 4)

x

0

8000

I certify that 50% of all my distributed copies (electronic and print) are paid above a nominal price.

17. Publication of Statement of Ownership

x If the publication is a general publication, publication of this statement is required. Will be printed

Publication not required.

Sept/Oct 2016 in the ________________________ issue of this publication.

18. Signature and Title of Editor, Publisher, Business Manager, or Owner

Date

9/22/2016 I certify that all information furnished on this form is true and complete. I understand that anyone who furnishes false or misleading information on this form or who omits material or information requested on the form may be subject to criminal sanctions (including fines and imprisonment) and/or civil sanctions (including civil penalties).

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OFF THE CUSP

JOHN PAUL, DMD, EDITOR

Group Therapy There was a class at the Medical University of South Carolina (MUSC) that was supposed to teach you how to deal with patients’ minds while trying to get to their teeth. That’s the only formal psychology course I ever took and it was taught by the folks who ran the suicide prevention hotline. All I remember from that course is that you were supposed to look into the other person’s face and say, “What I hear you saying is …”

“

How many of us ever think about treating the anxiety with a referral rather than a prescription?

”

That was the formal course. When I met my wife (a practicing mental health professional) I entered into an ongoing — now 15-year — course on practical psychology. The second question I asked her was, “Can you turn it off or do you psychoanalyze people all the time?”

Her answer was, “Should I be psychoanalyzing you?” Lesson No. 1: If you want to find out something about someone else, answer a question with a question.

Lesson No. 2 was much more important. It seems there actually are very few different personal problems, and to some extent, we all have them. It really has more to do with how much the problem controls your life. There is no specific dental anxiety — you have anxiety. Some people just feel it is OK to express that anxiety in the dental office, so they save it up for their every three-year visit, but it’s also how they approach some of their other problems. How many of us ever think about treating the anxiety with a referral rather than a prescription?

It turns out, that in the early stages of a problem, the answer can be pretty simple: find some friends and talk it out. Some of your friends likely have enjoyed the same experience that troubles you. It helps if they know you well enough to know when to listen and when to refill their drink because you are on a rant. We actually have an irregular group with regular meetings. The Brown Tooth Society convenes any time two or more of us are in the same place. It’s open to all, but like any good speakeasy, you have to know where to find it or who is in the know so you can get an invite. Along with talk therapy, we tend to enjoy some other, less professional therapies — but we are professional doctors. We’ll work on your problems and if you stay up late enough, we’ll solve the problems of the world. Maybe next time we’ll think to have someone take notes so we can remember the answers.

Dr. Paul is the editor of Today's FDA. He can be reached at jpaul@bot.floridadental.org.

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www.floridadental.org

Rewarding the practice of good dentistry...

The Tribute® Plan is an unrivaled financial benefit that rewards dentists for their loyalty to The Doctors Company and for their dedication to superior patient care.

No other Florida insurer offers a benefit of this magnitude. For more information on the Tribute Plan and professional liability coverage from The Doctors Company, contact us at 800.877.7597.

37,000

NUMBER OF MEMBERS WHO HAVE ALREADY QUALIFIED FOR A TRIBUTE AWARD

TRIBUTE PLAN HIGHLIGHTS ®

TRY OUR INSTANT QUOTER ONLINE AT FDASERVICES.COM

4,800

10567_2016_TributePlan_FDA_Infographic_051916.indd 1

AMOUNT IN TRIBUTE ACCOUNTS OF QUALIFIED MEMBERS

4.3

AMOUNT EARMARKED FOR FLORIDA DENTISTS

5/19/16 1:55 PM