2021 - July/August TFDA

2019 Dentists’ Day on the Hill Have - March 11-12, 2019 - Page Antibiotic Recommendations Changed — Page 342

VOL. 33, NO. 4 • JULY/AUGUST • CUTTING-EDGE ISSUE

A PUBLICATION OF THE FLORIDA DENTAL ASSOCIATION

3D Printing

Tongue and Lip Ties

Leveraging Your IT Provider

Saliva Analysis

Digital X-ray Hardware

The Emergence of Artificial Intelligence in Dental Care Delivery

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HELPING MEMBERS SUCCEED VOL. 33, NO. 4 • July/August 2021

in every issue 3 Staff Roster 5 President's Message 8 Did You Know?

11 Legislative Corner 14 Preventive Action 16 news@fda 69 Diagnostic Discussion 72 Career Center 75 Advertising Index 76 Off the Cusp

22

Florida Board of Dentistry Discusses Anesthesia and Lasers

24

Recruiting and Hiring: The Short Game

A PUBLICATION OF THE FLORIDA DENTAL ASSOCIATION

46

28

Tongue and Lip Ties

30

Saliva Analysis is a New Patient Engagement Tool

50

3D Printing

Should Digital X-ray Hardware Still be Bought or Should it be a Subscription?

34

Antibiotic Recommendations Have Changed

52

The Emergence of Artificial Intelligence in Dental Care Delivery

38

4 Ways You Should be Leveraging Your IT Provider in 2021

61

Air Force Veteran Can Eat More Comfortably

40

Developing a Growth Mindset Through the Introduction of Technology

62

FDC2021 Recap

42

A Modernized Patient Experience Increases Practice Revenue

TODAY'S FDA ONLINE: floridadental.org

American Sensor Tech

FLORIDA DENTAL ASSOCIATION JULY/AUGUST 2021 VOL. 33, NO. 4

EDITOR Dr. Hugh Wunderlich, Palm Harbor, editor

STAFF Jill Runyan, director of publications Jessica Lauria, communications and media coordinator Andrew Gillis, graphic design coordinator

BOARD OF TRUSTEES Dr. Dave Boden, Port St. Lucie, president Dr. Gerald Bird, Cocoa, president-elect Dr. Beatriz Terry, Miami, first vice president Dr. Jeffrey Ottley, Milton, second vice president Dr. John Paul, Lakeland, secretary Dr. Andy Brown, Orange Park, immediate past president Drew Eason, CAE, Tallahassee, executive director Dr. Christopher Bulnes, Tampa • Dr. Bethany Douglas, Jacksonville Dr. Dan Gesek, Jacksonville • Dr. Karen Glerum, Boynton Beach Dr. Reese Harrison, Lynn Haven • Dr. Bertram Hughes, Gainesville Dr. Bernard Kahn, Maitland • Dr. Gina Marcus, Coral Gables Dr. Irene Marron-Tarrazzi, Miami • Dr. Eddie Martin, Pensacola Dr. Paul Palo, Winter Haven • Dr. Mike Starr, Wellington Dr. Don Ilkka, Leesburg, speaker of the house Dr. Rodrigo Romano, Miami, treasurer • Dr. Hugh Wunderlich, Palm Habor, editor

PUBLISHING INFORMATION

Paragon Dental Practice Transitions

Today’s FDA (ISSN 1048-5317/USPS 004-666) is published bimonthly, plus one special issue, by the Florida Dental Association, 545 John Knox Road, Ste. 200, Tallahassee, Fla. 32303 .

FDA membership dues include a complimentary 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 2021 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, 545 John Knox Road, Ste. 200, Tallahassee, Fla. 32303.

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. Hugh Wunderlich, Today’s FDA Editor, Florida Dental Association, 545 John Knox Road, Ste. 200, Tallahassee, Fla. 32303.

FDA office numbers: 800.877.9922, 850.681.3629; fax 850.561.0504; email address, fda@floridadental.org; website address, floridadental.org.

ADVERTISING INFORMATION For display advertising information, contact: Deirdre Rhodes at rhodes@floridadental.org or 800.877.9922, Ext. 7108.

For career center advertising information, contact: Jessica Lauria at jlauria@floridadental.org or 800.877.9922, Ext. 7115.

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

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TODAY’S FDA JULY/AUGUST 2021

FLORIDADENTAL.ORG

CONTACT THE FDA OFFICE 800.877.9922 OR 850.681.3629 545 John Knox Road, Ste. 200 • Tallahassee, FL 32303

EXECUTIVE OFFICE DREW EASON, Chief Executive Officer/ Executive Director deason@floridadental.org 850.350.7109 GREG W. GRUBER, Chief Operating Officer/ Chief Financial Officer ggruber@floridadental.org 850.350.7111 CASEY STOUTAMIRE, Director of Third Party Payer and Professional Affairs cstoutamire@floridadental.org 850.350.7202

FLORIDA DENTAL CONVENTION AND CONTINUING EDUCATION

FDA SERVICES

CRISSY TALLMAN Director of Conventions and Continuing Education ctallman@floridadental.org 850.350.7105

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

BROOKE MARTIN, FDC Marketing Coordinator bmartin@floridadental.org 850.350.7103

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

LAVONNE PATOIR, FDC Meeting Assistant lpatoir@floridadental.org 850.350.7162

SCOTT RUTHSTROM Chief Operating Officer scott.ruthstrom@fdaservices.com 850.350.7146

JUDY STONE, Leadership Affairs Manager jstone@floridadental.org 850.350.7123

DEIRDRE RHODES, FDC Exhibits Coordinator drhodes@floridadental.org 850.350.7108

LIANNE BELL, Leadership Concierge lbell@floridadental.org 850.350.7114

EMILY SHIRLEY, FDC Program Coordinator eshirley@floridadental.org 850.350.7106

CAROL GASKINS Commercial Accounts Manager carol.gaskins@fdaservices.com 850.350.7159

ACCOUNTING

GOVERNMENTAL AFFAIRS

BREANA GIBLIN, Director of Accounting bgiblin@floridadental.org 850.350.7137

JOE ANNE HART Chief Legislative Officer jahart@floridadental.org 850.350.7205

MARCIA DUTTON Membership Services Assistant marcia.dutton@fdaservices.com 850.350.7145

LEONA BOUTWELL, Finance Services Coordinator Accounts Receivable & Foundation lboutwell@floridadental.org 850.350.7138 DEANNE FOY, Finance Services Coordinator Dues, PAC & Special Projects dfoy@floridadental.org 850.350.7165 JAMIE IDOL, FDAS Support Services Coordinator jamie.idol@fdaservices.com 850.350.7142 MITZI RYE, Fiscal Services Coordinator mrye@floridadental.org 850.350.7139 STEPHANIE TAYLOR, Membership Dues Coordinator staylor@floridadental.org 850.350.7119

COMMUNICATIONS AND PUBLICATIONS RENEE THOMPSON Director of Communications and Marketing rthompson@floridadental.org 850.350.7118 JILL RUNYAN, Director of Publications jrunyan@floridadental.org 850.350.7113 AJ GILLIS, Graphic Design Coordinator agillis@floridadental.org 850.350.7112 JESSICA LAURIA Communications and Media Coordinator jlauria@floridadental.org 850.350.7115

ALEXANDRA ABBOUD Governmental Affairs Liaison aabboud@floridadental.org 850.350.7204

INFORMATION SYSTEMS LARRY DARNELL Director of Information Systems ldarnell@floridadental.org 850.350.7102 RACHEL STYS, Systems Administrator rstys@floridadental.org 850.350.7153

MEMBER RELATIONS KERRY GÓMEZ-RÍOS Director of Member Relations krios@floridadental.org 850.350.7121 MEGAN BAKAN Member Access Coordinator mbakan@floridadental.org 850.350.7100 JOSHUA BRASWELL Membership Coordinator jbraswell@floridadental.org 850.350.7110 CHRISTINE TROTTO Membership Concierge ctrotto@floridadental.org 850.350.7136

PORSCHIE BIGGINS Central Florida Membership Commercial Account Advisor pbiggins@fdaservices.com 850.350.7149

877.843.0921 (toll free) Cell: 407.927.5472 dennis.head@fdaservices.com MIKE TROUT Director of Sales — North Florida

MELISSA STAGGERS West Coast Membership Commercial Account Advisor melissa.staggers@fdaservices.com 850.350.7154

RYAN WHITE Commercial Account Advisor ryan.white@fdaservices.com 850.350.7151

DAN ZOTTOLI, SBCS, DIF, LTCP Director of Sales — Atlantic Coast

DENNIS HEAD, CIC Director of Sales — Central Florida

KELLY DEE Atlantic Coast Membership Commercial Account Advisor kelly.dee@fd3aservices.com 850.350.7157

LIZ RICH Commercial Account Advisor liz.rich@fdaservices.com 850.350.7171

YOUR RISK EXPERTS

561.791.7744 Cell: 561.601.5363 dan.zottoli@fdaservices.com

MARIA BROOKS South Florida Membership Commercial Account Advisor maria.brooks@fdaservices.com 850.350.7144

TESSA DANIELS Commercial Account Advisor tessa.daniels@fdaservices.com 850.350.7158

CARRIE MILLAR Director of Insurance Operations carrie.millar@fdaservices.com 850.350.7155

Cell: 904.254.8927 mike.trout@fdaservices.com

JOSEPH PERRETTI, SBCS Director of Sales — South Florida 305.665.0455 Cell: 305.721.9196 joe.perretti@fdaservices.com RICK D’ANGELO, CIC Director of Sales — West Coast 813.475.6948 Cell: 813.267.2572 rick.dangelo@fdaservices.com

DAVIS PERKINS, Commercial Account Advisor davis.perkins@fdaservices.com 850.350.7145

FLORIDA DENTAL ASSOCIATION FOUNDATION R. JAI GILLUM, Director of Foundation Affairs rjaigillum@floridadental.org 850.350.7117 KRISTIN BADEAU, Foundation Coordinator kbadeau@floridadental.org 850.350.7161

FLORIDADENTAL.ORG

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

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. Hugh Wunderlich: hwunderlich@bot.floridadental.org.

TODAY’S FDA JULY/AUGUST 2021

3

JUNE 23-25, 2022

DENTISTRY& SYSTEMIC HEALTH:

MOUTH, MIND & BODY CONNECTION

GAYLORD PALMS RESORT & CONVENTION CENTER ORLANDO, FLORIDA FLORIDADENTALCONVENTION.COM

SAVE THE DATE! - JUNE 23-25, 2022

in the sulcus

FDA ON THE

EDGE

First off, as the newly minted president of your Florida Dental Association (FDA), I must beseech you to resist the temptation to first turn to the back page of this wonderful journal. Our Today’s FDA editors have been so creative and humorous writing “Off the Cusp” that countless FDA presidents have moaned and groaned that their column always relegated to second place! Anyway, a well-deserved kudos to Drs. John Paul and Hugh Wunderlich and crew for informing and entertaining us so well and helping scoop up so many writing and editorial awards year after year.

OK, now that you have read Hugh’s article (admit it), it is my turn. This issue’s theme is cutting-edge dentistry. In your office, in whatever practice mode you have chosen, this does not just apply to innovative technology. While all the new toys continue to provide us never-ending joy figuring out and applying technologies to patient care, there are other edges to keep sharp. The practice of dentistry can no longer succeed without paying attention to the business of dentistry and the regulation of our profession. I wish I could say we’re all as well-versed in the latter two as the former. In our complicated profes-

sion, just providing top-notch patient care consumes most of our time and energy.

The business of dentistry is no longer a solo pursuit. All of you successful doctors have adopted a team approach. You have carefully selected advisors to your team for accounting, financial planning, banking, insurance, legal, management, and more recently, even life coaching.

PRESIDENT’S MESSAGE DAVE BODEN, DDS, MS FDA PRESIDENT

Dr. Boden can be reached at dboden@bot.floridadental.org.

But there is one other team that can help coach you to success and keep you out of trouble: Team FDA. Our staff and those who volunteer their time are so good at what they do that their efforts often are incredibly quiet, but amazingly effective. Over the many years I’ve had the privilege to be in leadership roles, every year I feel like we are the Matrix’s hero, Mr. Anderson, calmly and acrobatically dodging potentially tragic bullets fired at us by outside influencers trying to damage our profession and delivery of care. And you probably never felt the regulatory or legislative bullets whizz by. That is how good your FDA staff, officers, trustees, delegates and council members are. That is why we win multiple awards from the American Dental Association every year.

SEE PAGE 7

FLORIDADENTAL.ORG

TODAY’S FDA JULY/AUGUST 2021

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in the sulcus

FROM PAGE 5

Florida is at the forefront of dentistry today. You can be proud of Drs. Andy Brown, Rudy Liddell, Jolene Paramore, and our executive director Drew Eason’s crew for how well they guided you past the worst of the legislative’s and pandemic’s effects over the past several years. I bet you didn’t even know the effects these “Mr./Ms. Andersons” had on your practices.

Where other associations foundered, yours thrived. We do that because your team anticipates, rapidly mobilizes, and always helps those who need it. It’s OK to celebrate our successes, laugh together, and have fun with our lives and profession. We win because we are positively relentless in our actions.

We cannot be Mr. Anderson without you. You are the FDA. We have so much more to do to plan for our profes sion’s future. Sound intriguing? Call us. We enjoy and value your thoughts. Be part of this winning team! Volunteer when you can and donate to our efforts. Please thank team members for how well they execute the game at the forefront for your patients, your practice, and the future of our amazing profession of dentistry. But don’t thank me. You are the star players. I’m just fortunate to be your coach for a year.

Helping Members Succeed Through Relentless Positive Action

FLORIDADENTAL.ORG

“

The business of dentistry is no longer a solo pursuit.

All of you successful doctors have adopted a team approach.

But there is one other team that can help coach you to success and keep you out of trouble: Team FDA.

”

TODAY’S FDA JULY/AUGUST 2021

7

BOD

DID YOU KNOW? HEALTH CARE CLINIC ESTABLISHMENT PERMITS CASEY STOUTAMIRE FDA DIRECTOR OF THIRD PARTY PAYER & PROFESSIONAL AFFAIRS

If you have any questions, please contact Director of Third Party Payer and Professional Affairs Casey Stoutamire, Esq. at cstoutamire@ floridadental.org or 850.350.7202.

A Health Care Clinic Establishment (HCCE) permit is required by law if you order prescription drugs for use in your office — unless you’re a solo practitioner. Solo practitioners are exempt from the requirement of purchasing an HCCE permit if the prescription drugs are purchased under his or her license. A prescription drug is anything that is not available over the counter, including oxygen and topical anesthetics. An HCCE permit is administered and issued by the Department of Business and Professional Regulation (DBPR). This permit is required to identify a “qualifying practitioner,” which is a licensed health care practitioner defined in s. 456.001 (this definition includes dentists), who will be the person legally responsible for the HCCE’s compliance with legal and regulatory requirements related to the purchase, recordkeeping, storage and handling of the prescription drugs. Identifying one person in the practice as a qualifying practitioner eliminates the need for each dentist in the practice to hold an HCCE permit in order to purchase and use prescription drugs in your office.

The law authorizes solo practitioners to be exempt from acquiring an HCCE permit and allows them to purchase their prescription drugs by using their corporate check.

The Florida Dental Association has been communicating with DBPR about the HCCE permit to help members understand how this permit is being implemented. In the meantime, if you have received any communications from any dental suppliers (i.e., Henry Schein), please be sure to send in your form indicating your appropriate status: either acknowledging that you have an HCCE permit or that you are in the process of applying for it, or you are exempt from the HCCE permit requirement because you are a solo practitioner.

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now you know INFORMATION FROM THE FDA GO TO SUMMARY All health care providers must include non-opioid alternatives for pain and pain management in their discussions with patients before providing anesthesia, or prescribing, ordering, dispensing or administering a schedule II controlled substance for the treatment of pain.

Effective July 1, 2019.

 OPIOIDS

Non-opioid Alternatives Law bit.ly/2KXvZ2h

HEALTH CARE PROVIDER CHECKLIST INFORM

 Non-opioid alternatives for pain treatment, which may include non-opioid medicinal drugs or drug products are available.

 Non-opioid interventional procedures or

treatments, which may include: acupuncture, chiropractic treatments, massage, physical or occupational therapy, or other appropriate therapy are available.

DISCUSS

 Advantages and disadvantages of non-opioid alternatives.

 Patient’s risk or history of controlled

substance abuse or misuse, and patient’s personal preferences.

DOCUMENT IN PATIENT’S RECORD

 Non-opioid alternatives considered.

Your

BACKSTAGE

PROVIDE

 “Alternatives to Opioids,” an educational

ALL ACCESS

ur FDA YoEXCLUSIVE

information pamphlet created by the Florida Department of Health (required, available at bit.ly/2KXvZ2h). Also, a checklist and poster.

MEMBER BENEFIT

For the latest on opioids, go to: floridadental.org/nyk FLORIDADENTAL.ORG

GO TO TODAY’S FDA JULY/AUGUST 2021

9

ARE YOU A MEMBER OF FDAPAC CENTURY CLUB? Join now: floridadental.org/centuryclub A portion of your required dues is transferred to the Florida Dental Association Political Action Committee (FDAPAC). FDAPAC provides campaign contributions to dental-friendly candidates.

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

Dr. Rudy Liddell FDAPAC Chair

FDA Foundation: Amazon Smile Foundation: Amazon Smile Foundation: Amzon Smile

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legislative corner

2021 LEGISLATIVE WRAP-UP COVID-19 took center stage this year as the Florida Legislature convened for the 2021 Legislative Session. Despite meeting during a pandemic, the Legislature was able to adjourn on time and passed the state’s largest budget totaling $101.5 billion.

On June 2, Gov. Ron DeSantis signed SB 2500 into law, which authorizes the state’s budget for fiscal year 2021-2022. For the first time, the Florida Dental Association (FDA) was successful in securing state funding to support the FDA Foundation’s 2022 Florida Mission of Mercy dental clinic held in Tallahassee at $225,000. The FDA also pursued state funding to implement the Dental Student Loan Repayment Program and Donated Dental Services program at $773,000. Unfortunately, funding was not allocated for these

programs even though legislation passed in 2019 to authorize them.

The Legislature addressed many issues related to COVID-19, as well as other substantive issues that may impact dentistry. For a comprehensive report on the 2021 Legislative Session, read the “Sine Die” edition of Capital Report, available at bit.ly/359y44F.

COVID-19 Liability Protection for Dentists

JOE ANNE HART FDA CHIEF LEGISLATIVE OFFICER

For additional information on legislative issues, you can reach Joe Anne Hart at jahart@floridadental.org or 850.350.7205.

SB 72 provides civil liability protections for health care providers (including dentists), individuals, businesses, governmental entities and other organizations against COVID19-related claims.

SEE PAGE 13

Want to Get Involved in Grassroots Advocacy?

Become a Legislative Contact Dentist!

Constituent dentists best influence the legislative and regulatory branches about issues that directly impact their professional lives. Organized dentistry’s political success depends directly on the leadership and strength of the legislative contact dentist (LCD) teams statewide. Currently, not all legislators in the state have an LCD and we need at least one for each legislator. If a legislator does not have an LCD, he or she may look to outside groups for information about dental issues, which may be contrary to FDA policy. If you have any questions or would like more information on the LCD Program, please contact Governmental Affairs Liaison Alexandra Abboud at 850.224.1089 or aabboud@floridadental.org.

FLORIDADENTAL.ORG

TODAY’S FDA JULY/AUGUST 2021

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REGISTRATION OPEN! 2022 DENTISTS’ DAY ON THE HILL register now at floridadental.org/ddoh.

Tuesday, Feb. 1, 2022 Tallahassee Hotel Duval room block reserved, go to bit.ly/3w7iKk8.

FROM PAGE 11

legislative corner

Protecting Consumers Against Pandemic Fraud HB 9 will protect consumers from pandemic-related fraud by making it a third-degree felony to knowingly disseminate false or misleading information related to the availability of personal protective equipment in any marketing or advertising material.

Prohibition on Vaccine Passports SB 2006 prohibits businesses, governmental entities and educational institutions from requiring documentation certifying COVID-19 vaccination. If violated, a fine could be issued not to exceed $5,000 per violation. This section of law will not apply to a health care provider as defined in s. 768.38 (which includes dentists); a provider licensed or certified under s.

393.17, part III or chapter 401, or part IV of chapter 468; or a provider with an active health care clinic exemption under s.

400.0035.

2021 Legislative Awards To say that the 2021 Florida Legislative Session was unusual would be an understatement, but even with the restrictions and limitations placed on the Capitol, several individuals were able to provide strong support for the FDA’s legislative agenda.

Whether it was advocating for funding for FLA-MOM or ensuring dentists were protected from frivolous lawsuits relating to COVID-19, these individuals stepped up to help guide these important initiatives to the finish line.

FDA’s 2021 Legislator of the Year

Nonopioid Alternatives SB 530 revises current law relating to nonopioid alternatives and will now allow for health care providers to give their patient a pamphlet in an electronic format instead of requiring it to solely be a printed document.

Sen. Aaron Bean (R-Jacksonville)

FDA’s 2021 Champions of Dentistry

Clawback Proposal The FDA filed legislation for the first time to address the issue involving the time frame insurance plans use to recover overpayments. SB 1386 and HB 1109 would have shortened the clawback period from 30 months to 12 months in which an insurer could recover an overpayment. Unfortunately, the bills were not heard this year.

Dental Therapy

Sen. Loranne Ausley (D-Tallahassee)

Jimmy Patronis (Florida Chief Financial Officer)

Legislation was filed for the fourth year to authorize dental therapy in Florida. The FDA opposed this legislation. SB 604 and HB 961 failed to be considered and died.

WREB HB 497 and SB 1366 attempted to add the Western Regional Examining Board (WREB) exam to Florida’s dental licensure process. The FDA opposed this legislation. The bills did not get final approval and died.

Rep. Allison Tant (D-Tallahassee)

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preventive action

4

TIPS

TO MAXIMIZE YOUR DISABILITY INSURANCE BENEFITS

Dentists understand the importance of purchasing a quality disability income insurance policy, but are you ensuring you receive every dollar you’re eligible for? Not having enough disability income or saving a few bucks by passing on available options and riders can make a tremendous financial difference. Should you fall victim to an accident or an extended illness, be sure you have your financial well-being fully protected.

SCOTT RUTHSTROM FDA SERVICES CHIEF OPERATING OFFICER

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

1. Max out the total monthly amount you can financially qualify for. Typically, disability insurance (DI) benefits are calculated as a percentage of your total gross income. One hundred percent of total gross income replacement is not available, so having the maximum benefit you are eligible for will help ensure that, in the event of a disability, you can maintain a lifestyle post-disability that is comparable to your pre-disability lifestyle. Even if you max out your benefits with one insurance company, you may be able to buy additional benefits through a second or even a third policy (depending on the amount of coverage in place already and your annual gross income).

2. Make sure your DI policy can grow with you. Many carriers offer options/riders that allow you to increase your monthly benefit without having to retake medical exams or physicals; you only have to prove you qualify financially.

3. The fact is, one in three dentists will have a disability over the course of his or her career. A dollar today is not what a dollar will be worth five, 10 or 20 years from now. A “cost-of-living

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TODAY’S FDA JULY/AUGUST 2021

FLORIDADENTAL.ORG

adjustment” rider (COLA) is a great way to ensure your DI policy will be able to keep up with inflation. The COLA rider will adjust the monthly benefit each year while on a claim.

4. Since most disabilities are temporary in nature, purchasing a “residual disability” rider is vital. This rider is designed to help offset the loss of income when returning to work following rehabilitation or recovery, as it could take months or even years to return to pre-disability income levels.

Call or text FDA Services at 850.681.2996 for a disability insurance quote or visit fdaservices.com/disability for more information.

FDA Services is a wholly owned subsidiary of the Florida Dental Association. We strive to be the source for information about insurance for our member dentists. Revenue from insurance sales goes directly toward helping FDA programs and lobbying efforts that are important to members, and to keep dues at their lowest possible level.

FLORIDADENTAL.ORG

“

Typically, disability insurance benefits are calculated as 55-60% of your total gross income.

”

TODAY’S FDA JULY/AUGUST 2021

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updates for members • Converted Highest Number of Diverse Dentists

*PLEASE NOTE THAT FDA MEMBERS HAVE THEIR NAMES LISTED IN BOLD.

to Membership

Thank You for Attending FDC2021!

• Converted Highest Number of Nonmember Women Dentists to Membership

• National Signing Day – Class of 2020 (80% or greater of applications signed)

• LECOM School of Dental Medicine • NOVA Southeastern University College of Dental Medicine • University of Florida College of Dentistry ADA Acts to Help Practices Manage Staffing Challenges

The FDA Committee on Conventions and Continuing Education relax after a successful meeting.

From the Florida Dental Association (FDA) Committee on Conventions and Continuing Education (CE) and staff, we hope you and your team enjoyed discovering the “Pathways to Success” at the 2021 Florida Dental Convention (FDC)! You can use your Registration ID to access your FDC2021 CE certificate at floridadental.org/convention-ce/convention/attend/ education. CE credits were awarded for attendees who stayed in the course a minimum of 50 of the 60 minutes. Please note that partial credits were added to CE certificates by July 24. If you believe your credits are inaccurate, please contact Brooke Martin at bmartin@floridadental.org or 850.350.7103. Full and partial credit were reported to CE Broker by July 24.

2020 ADA Membership Awards The FDA was recognized in the 2020 American Dental Association (ADA) Membership Awards for states in our size category. The FDA won the following awards:

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TODAY’S FDA JULY/AUGUST 2021

A May survey by the ADA Health Policy Institute found more than 80% of dentists who are hiring dental hygienists and assistants have found recruitment very or extremely challenging, and recruitment of associate dentists, dental assistants, hygienists and administrative staff is higher for all four positions than in October 2020, ADA News reports. Dr. Allison House, chair of the Council on Dental Practice’s subcommittee on practice management, said the pandemic has complicated training of staff, but some issues like the shortage of hygienists predate the pandemic. Dr. Duc “Duke” M. Ho, chair of the ADA Council on Dental Practice, says the ADA is coordinating with the American Dental Assistants Association and American Dental Hygienists’ Association on solutions. Meanwhile, the ADA has created resources for dental practices that are seeking staff, including promotional materials at bit.ly/3x2WERb, and information on managing a dental team at bit.ly/362tQfJ. Read the ADA News article at bit.ly/3hnQ3KA.

FLORIDADENTAL.ORG

CDCA and WREB Merger

single exam will simplify the licensure process for candidates, state boards and dental education programs.

For questions contact Alex Vandiver at avandiver@cdcaexams. org or Beth Cole at bcole@wreb.org.

Southern States Symposium & Expo

The Commission on Dental Competency Assessment (CDCA) and the Western Regional Examining Board (WREB), the two leading dental competency assessment organizations in the United States, are pleased to announce their intention to combine into one organization to further serve the oral health professions. A memorandum of understanding was signed on June 15, 2021, outlining the intent of the merger. The new entity will be known as CDCA-WREB. Together, the merged entity will administer the ADEX exams, which are accepted in 49 states, the District of Columbia, Jamaica and Puerto Rico as the basis for initial licensure for dentists and dental hygienists.

The existing Boards of Directors of CDCA and WREB will combine to provide governance oversight to the combined entity with equal representation from both boards. The transition to fully operationalize the merger is expected to be ongoing throughout 2022. During this year, the combined organization will implement best practices from both organizations to create new processes to better serve all key constituencies. The combined organization intends to administer both the ADEX exam and the current WREB exam throughout 2022 and will begin to administer only the ADEX exam at all locations for the class of 2023. CDCA-WREB will maintain two offices to best serve schools and candidates throughout North America.

Exams will be administered in manikin-, patient- and computer-based objective structured clinical examination formats that satisfy state board requirements. There is already considerable overlap. Many states by law recognize both the WREB and CDCA administered examinations as the basis for licensure and many examiners serve both organizations. Combination is a logical next step for both agencies. The merged entity will be able to further devote its time, effort and resources to the continued development of the exams it administers. Having a

FDA President Dr. Dave Boden and Florida Dental Lab Association President Dory Sartoris attend the 2021 Southern States Symposium and Expo in June.

“Chew on This!” Public Speaking Best Practices for Dentists

Do you ever wonder how to improve your public speaking technique? Well, wonder no more! In her “Chew on This!” interview, FDA member Dr. Jacinta Watkins-Lamontagne shares some tips and suggestions that are easy to employ whether you’re giving a speech, presenting at a local club meeting or leading a morning huddle.

Watch Dr. Watkins-Lamontagne’s interview with FDA Executive Director Drew Eason at bit.ly/2Tbp7Wc and tune in regularly to see what’s next. By taking advantage of a complimentary subscription to the FDA’s blog, “Beyond the Bite,” at blog.floridadental.org, you’ll receive email notices with new posts and be entered into a monthly drawing for a $10 Starbucks gift card!

SEE PAGE 18

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updates for members FROM PAGE 17

Central Florida District Dental Association

Dr. Shawn Mullen, Freeport

Dr. Manual Cano Morejon, Apopka

Dr. Jeremiah Patrick, Fort Walton Beach

Welcome New FDA Members

Dr. Anabel Casado, Orlando

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

Dr. Keren Castellucci, Winter Springs

Atlantic Coast District Dental Association Dr. Tina Akhavan, Palm Beach Gardens Dr. Kayla Bateman Etman, Delray Beach Dr. Sofia Blackmore, Plantation Dr. Fahra Dawood, Davie Dr. Charles Deutsch, Boynton Beach Dr. Joshua Etman, Delray Beach Dr. Paula Giraldo, Port St. Lucie Dr. Michael Hennessy, Delray Beach Dr. Sergio Jacas, Fort Lauderdale

Dr. Judy Delgado, Tavares Dr. Debbie Desravines, Maitland Dr. Kristina Galligan, Palm Bay Dr. Clayton Hamrick, Gainesville

Dr. Marilyn Amaral, Miami

Dr. Thomas Harter, Ocala

Dr. Yudit Berrio Rey, Miami

Dr. Sadesh Kumar, Melbourne

Dr. Julio Cervantes, Weston

Dr. Georgeana Lewis, Deland

Dr. Zachary Danowit, Coconut Creek

Dr. Ralph Luckett, New Smyrna Beach

Dr. Zuhdiyah Darojat, Plantation

Dr. William Martin, Gainesville

Dr. Ana Fernandez, Hialeah

Dr. Jonathan Montoya, Gainesville

Dr. Olufunke Gbadamosi, New York

Dr. Pooja Patel, Orlando

Dr. Reinol Gonzalez, Davie

Dr. Kevin Powers, Daytona Beach

Dr. Yaima Gonzalez Farinas, South Miami

Dr. Will Ratliff, Gainesville Dr. Yanerkys Rivera-Perez, South Miami

Dr. Gisele Oliveira, Lighthouse Point

Dr. German Obando, St. Augustine

Dr. Amber Rowe, Orange City

Dr. Justin Page, Jacksonville

Dr. Irwine Sainvil, Coral Springs Dr. Nadia Shadani, Fort Pierce

Dr. Nodesh Shyamsunder, Jacksonville Beach

Dr. Kayla Tommie, Sunrise

Dr. Cynthia Skigen, Jacksonville

Dr. Heghine Tovmasyan, Boca Raton

Northwest District Dental Association Dr. Nathan Chu, Tallahassee Dr. Yoo Jin Chung, Pittsburgh Dr. Terry Mick, Quincy

TODAY’S FDA JULY/AUGUST 2021

South Florida District Dental Association

Dr. Carlos Gurreonero, Orlando

Dr. Elizabeth Lenchner, Fort Lauderdale

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Dr. Ronald Willis, Tallahassee

Dr. Liliana Alvarez Mesa, Miami Springs

Northeast District Dental Association

Dr. Brianna Webb, Vero Beach

Dr. Amar Patel, Tallahassee

Dr. Taylor Hammock, Palmetto Bay Dr. Mario Hernandez, Miami Dr. Rizwan Lalani, Miramar Dr. Greidy Lazo Neyra, Miami Dr. Malena Lemus Ramos, Hialeah Dr. Ehab Musharbash, Miami Dr. Ly Nguyen, Miramar Dr. Sami Sheikh, Miami Dr. Andreina Vitto, Miami

West Coast Dental Association Dr. Angela Boehler, Port Charlotte Dr. Cynthia Connor, Naples Dr. Ryan Cyriac, Tampa Dr. Janet De Vaul, St. Petersburg

FLORIDADENTAL.ORG

Dr. Erin Dougherty, St. Petersburg Dr. Fatima Farrokhrooz, Tampa Dr. John Foster, Avon Park Dr. Hugo Galdos Santalo, Naples Dr. Jon Gesicki, Punta Gorda Dr. Yuliya Kovalova, North Port Dr. Frank Laga, Winter Haven Dr. Megan Laga, Lakeland Dr. Rose Le, Lakewood Ranch Dr. Eberechukwu Njoku, Odessa Dr. Edgar Ortiz Pimentel, Davenport Dr. Gerard Scannell, Largo Dr. Ryan Serra, Holmes Beach Dr. James Skvor, Naples Dr. Eric Strouse, Odessa Dr. Michael Thomas, St. Petersburg Dr. Conor Wierus, Fort Myers

In Memoriam The FDA honors the memory and passing of the following members: Dr. Carroll Johnston Clearwater, FL Died: 06/02/2021 Age: 91 Dr. Paul Sidlo Tampa, FL Died: 05/05/2021 Age: 89

Dr. Sasha Winderbaum, Lake Wales Dr. Jerry Zimring, Sarasota

FDA: Well-being program Tobacco Free Florida

FLORIDADENTAL.ORG

TODAY’S FDA JULY/AUGUST 2021

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Dr. Bryan Griffith FDAS Customer Since 2000

“FDA Services has provided me coverage for my entire 18 years of practice. Great customer service with people who care about my practice and personal well-being. Thank you, Rick, for your dedication to dentistry.”

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Drs. Griffith and Mullens trust FDAS with their OFFICE INSURANCE COVERAGE!

“Prompt, knowledgeable, friendly service. I had a burning question over the weekend and my Jacksonville representative, Mike Trout, was kind enough to respond without waiting until Monday. Best decision I have ever made with regard to my insurance needs was to work with FDA Services.”

Dr. Richard Mullens FDAS Customer Since 2017

21

BOD

FLORIDA BOARD OF DENTISTRY DISCUSSES ANESTHESIA AND LASERS The Florida Board of Dentistry (BOD) met in Orlando on Friday, May 21, at 7:30 a.m. The Florida Dental Association (FDA) was represented by FDA BOD Liaison Dr. Joe Calderone and Director of Third Party Payer and Professional Affairs Casey Stoutamire. Other FDA members in attendance included Drs. Dave Boden, Andy Brown, Walt Colon and Roger Robinson.

The BOD members present included: Dr. Nick White, chair; Mr. Fabio Andrade (consumer member), vice chair; Drs. Christine Bojaxhi, Tom McCawley, Claudio Miro, Jose Mellado, Brad Cherry and T.J. Tejera; hygiene members, Ms. Angela Johnson and Ms. Karyn Hill. There is one consumer position open on the board that the governor has not yet filled.

BOD Executive Director Ms. Jessica Sapp updated the board on legislation affecting the practice of dentistry that passed during the 2021 Legislative Session. She also mentioned that neither the dental therapy legislation nor legislation that would allow the Western Regional Examining Board exam to be accepted for licensure in the state passed this Session.

During the Anesthesia Inspection Report, the anesthesia inspectors requested the Anesthesia Committee look at the amount of epinephrine needed in the dental office. Right now, the rule is an “adequate amount.” This objective standard is causing some confusion and leading to

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The next BOD meeting is scheduled for Friday, Aug. 13 at 7:30 a.m. EDT in Maitland at the Sheraton Orlando North. different inspectors requiring dentists to

2017; when weighing the safety of the public

have different amounts upon inspection. Dr.

(including cost) with the efficacy, the FDA

Tejera, chair of the Anesthesia Committee,

is opposed to the use of lasers by hygienists

stated he would hold a meeting sometime

for this purpose. Thank you to Drs. Calde-

during the summer to discuss this issue. The

rone and Brown and Mrs. Angie Brown for

FDA will continue to monitor and update its

testifying. They did a fantastic job present-

members accordingly.

ing the FDA’s position. Dr. Calderone and

At its November 2020 meeting, the board heard a revised proposal from the Council on Dental Hygiene to allow hygienists to use a laser while performing their remediable tasks, which died on a 4-4 vote. After this vote, the Florida Dental Hygienists’ Association requested the BOD revisit this rule and hold a workshop on the issue. After its May

Mrs. Brown also gave a historical perspective, as they were both BOD members when this issue first arose. Thank you also to the Florida Association of Periodontists and its president, Dr. Colon, and the Florida Society of Oral and Maxillofacial Surgeons and its

FDA DIRECTOR OF THIRD PARTY PAYER & PROFESSIONAL AFFAIRS

president, Dr. Brett Laggan, for joining with the FDA to oppose this issue.

meeting, the BOD held this rules workshop.

There were five disciplinary cases, one in-

After much discussion and testimony, the

formal hearing, one determination of waiver

board adjourned without moving forward

and two voluntary relinquishments dealing

with the rule. In addition, the BOD attor-

with failing to meet the minimum standard

ney said, on the record, this is not a Federal

of care and failing to keep adequate records.

Trade Commission issue. All BOD members

If you have not yet attended a BOD meeting,

indicated they would revisit the topic if, and

it is suggested that you take the opportunity

when, there is evidence to support the use of

to attend and see the work of the BOD. It is

lasers by hygienists for bacterial reduction.

much better to be a spectator than a par-

This also has been the FDA’s position since

ticipant in BOD disciplinary cases.

FLORIDADENTAL.ORG

CASEY STOUTAMIRE

If you have any questions, please contact Director of Third Party Payer and Professional Affairs Casey Stoutamire, Esq. at cstoutamire@floridadental.org or 850.350.7202.

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RECRUITING AND HIRING: THE SHORT GAME Prior to the pandemic, we were experiencing a tight labor market. This was a result of an expanding economy and fewer available workers for the number of job openings. Now, because of the pandemic, the labor market is even tighter — especially in dentistry — but for various reasons. Some of these include: 1. Many have chosen to retire.

2. Many have chosen new or different career paths, given potential risk factors of working in a dental office environment.

3. Many are needed at home for childcare, home schooling and/or caregiving.

4. Many have chosen to delay reentering the workforce due to underlying

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health conditions, or stimulus checks or extended unemployment benefits.

5. Many dental assisting and hygiene schools closed and have yet to reopen, thus graduating fewer students.

6. Many of the testing options for licensing and certification were postponed or suspended, meaning smaller numbers of qualified candidates.

Given these factors, it is no wonder that the pool of available candidates is quite small and causing a lot of frustration for many dentists.

When it comes to recruiting and hiring there is a “short game” and a “long game.” The short game is doing whatever you can now to fill the openings. The

long game is: 1) focusing on developing quality employees, and 2) putting conscious effort into employee engagement and creating the type of organizational culture that supports long-term retention, thus reducing the need to recruit.

Here we will focus on the short game; next issue we will look at the long game.

Most employers want some “silver bullet,” or guaranteed, fool-proof set of tactics for recruiting and hiring. Unfortunately, such a thing does not exist.

There are some basic principles that can help your recruiting and hiring success.

One rule of thumb: Hire first for the things you cannot teach or train.

You cannot teach attitude and personality. Attitude and personality are things FLORIDADENTAL.ORG

recruiting and hiring that all of us, including your patients, experience when we interact with others. You can’t teach it. You can’t train it. So, you look for these things first. Experience can be gained by working with you and skills can mostly be taught and/or trained, so they are next in line for consideration.

To set the stage for more effective recruiting and hiring, make sure you clearly define the job. Have an accurate, up-to-date and concise job description. This should truly delineate the duties, responsibilities, requirements and expectations of the job. A comprehensive job description acts as a form of communication that supports performance and accountability — it is the recipe for success in that position. It can provide a road map for training and onboarding. It should be focused and clear — don’t make assumptions about people’s knowledge of the job.

Use all the common sources for finding candidates, such as: Indeed, Dental Post, Zip Recruiter, employment agencies, Craigslist, etc. Don’t forget to contact and network with schools or professional organizations in your area, and especially internally with your existing (good) employees and patients who might know of someone looking for a job or a career change.

Once you have a candidate pool (large or small), engage in applicant screening. The primary purpose of screening is to quickly assess who stays in the running. Eliminate those who, for whatever reason, are not going to be moved forward in the process. It’s far easier to eliminate at this stage and saves you time in the long run.

Screening is done via a phone call (with or without Zoom) and lasts only a few minutes.

Ask each person the same relevant two to three questions and evaluate whether you like them (attitude and personality), can commuFLORIDADENTAL.ORG

nicate well with them and you want to learn more about them. Anyone who passes the screening “test” is then asked to complete and sign an application (if that hasn’t been done yet) and moves on to an actual interview.

When interviewing: n Prepare by reviewing the application and developing questions (i.e., don’t shoot from the hip!).

TIM TWIGG, PRESIDENT

n Avoid yes/no questions. n Ensure that 60% of the questions you ask are behavioral-based questions. n Focus on “fit” over experience. n Interview multiple times with multiple people (ideally). n Avoid snap judgments, biases and stereotyping. n Allow the candidate to do most of the talking.

BENT ERICKSEN & ASSOCIATES

Mr. Twigg is the president of Bent Ericksen & Associates, the dental industry’s “go-to” resource for human resources and employment compliance.

To receive a complimentary copy of the company’s quarterly newsletter or to learn more, contact them at 800.679.2760 or at bentericksen.com.

For the top one or two candidates, create opportunities to “unmask” them to get a deeper idea of what they’re like. This could be something like taking them to lunch, which affords an opportunity to “see” and experience this person and how he or she interacts with servers (respectfully or not) and other people. This might prove to be the best $25 you ever spend!

Incorporating the following rounds out the recruiting and hiring process: skills assessments, job match personality assessments, and reference and background checking — all of which are valuable components to increase success and minimize risks.

Hopefully, this information and these suggestions will lead to greater success moving forward as we begin to put COVID-19 in the rearview mirror.

TODAY’S FDA JULY/AUGUST 2021

25

Rethink your dental career with Sage.

Interested in selling your practice? Looking for an exit strategy?

Have you ever thought about what life would be like with the support of a dental organization? Are you ready to maximize your earning potential and not have to worry about the day-to-day responsibilities of running your practice? Consider Sage when answering these questions:

Sage Dental

• Sage dentists earn 55% more than the national average.

• Full-time general dentistry providers earn well over $420,000 annually.

• Sage practices are experiencing 107% patient volume compared to pre-pandemic levels*.

If you are at a stage in your career where you’re looking to develop a transition or exit strategy, we want to speak to you. Not all DSOs are created equal. At Sage, you have the freedom to practice dentistry the way you feel is best for your patients with the support of a large organization making it possible. Unlike other large DSO groups, Sage Dental: • Values and supports its team members • Provides skilled leadership • Delivers best-in-class training and mentorship • Offers advanced clinical technology and cutting-edge artificial intelligence applications Sage does all of this so you can continue providing the best patient care your way.

We’re looking for dental pros like you. It’s time you were treated— and paid— like the pro you are.

Interested? Let’s talk. Call or visit us online today.

Aleksander Popovic | (561) 944-6956 | APopovic@mysagedental.com

Wealth Creation

Where do you want to be?

At Sage, our job is to make you successful.

As you look to join a larger group, develop an exit strategy, or sell your practice, which team do you want to play for?

Clinical Autonomy

Balanced Lifestyle

Career Development

Complete Practice Administration

tongue and lip ties

Tongue Lip Ties

d n a 28

You hear it from parents all the time: “My kid is the pickiest eater,” “We tried to breastfeed, but gave up after a month of issues,” “He’s been in speech therapy for four years.”

Many of these complaints fall on deaf ears.

The basis for many of these growth and development woes we hear about stem from a functional issue in the mouth, mostly due to restrictions of the tongue and/or lips. If the tongue cannot rest in the palate, which is the normal resting position, you’ll see constricted upper arches and airways as well.

As experts of oral health, dentists should be on the forefront of addressing these issues.

Unfortunately, tethered oral tissues (TOTs) training is absent in most dental school curriculums. The subject isn’t taught even in pediatric residencies, and if it is, proper diagnosis and treatment is not.

Many of the above issues stem from TOTs, namely tongue and/or lip ties. Parents often turn to their pediatricians for advice on these issues and are told there are no “tongue ties” present or the child will grow out of it. Pediatricians unfortunately also lack the formal education needed to properly identify functional issues in the mouth. Many are only concerned if the patient can’t stick their tongue “out,” but posterior lift/function is a huge part of normal tongue function. This can be disheartening because as one “issue” passes, another can occur. Even adults with TOTs are affected as they typically have sleep, breathing, head and neck tension issues.

The good news is, with the right questions and some simple exam techniques, we all can start to identify issues early on and help many patients thrive!

It’s estimated that up to 30% of the population has some sort of functional restriction in the mouth. New, higher level research is being done to turn the “fad” of tongue ties into a legitimate issue that all dental and medical providers can learn about. Great educational resources are becoming more available to people all over. Dr. Richard Baxter, a pediatFLORIDADENTAL.ORG

ric dentist who runs the Alabama Tongue Tie Center, and Dr. Soroush Zaghi, an ENT who runs the Breathe Institute, are leading the way in both research and education. As more is done to investigate TOTs, more providers can understand what to look for and how to properly treat these issues. Releasing these tissues can be easily done with numerous instruments, although soft-tissue lasers allow for quicker, cleaner and better healing than many other options. It’s important to understand that these procedures release the tissues, but without proper function, many patients will still struggle. The procedure needs to be done with a team to help with this. For infants and moms struggling with breastfeeding, working with lactation consultants and body workers is crucial. For adolescents with speech and/or feeding issues, speech language pathologists help support the healing process and teach the patient proper function. Even adults with issues need support around their surgery, which is typically done with the help of a myofunctional therapist and body worker.

DR. CASEY LYNN

Dr. Lynn is a pediatric dentist in Apollo Beach, Fla. and can be reached at cclynn09@gmail. com.

When a proper assessment is done with a clean surgery and the correct support is provided, fixing TOTs issues can be life-changing! Helping a patient speak more clearly, eat without struggles and sleep more peacefully is extremely rewarding — and with a little more training, all dentists can start asking the right questions and helping more patients daily!

-

Image shows a Kotlow Class IV lip tie. Functional restriction of the upper lip in breastfeeding infants can lead to a poor seal while feeding, causing an increase in gas intake and excessive reflux/gassiness. Upon release, the upper lip can flange over the breast or bottle, and allow for proper seal while feeding.

TODAY’S FDA JULY/AUGUST 2021

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3D PRINTING

Me: “Computer.”

Computer: “Yes, Dr. Ferguson?”

Me: “Please fabricate upper and lower dentures for Mrs. Smith, a temporary crown for Mx.* Jones and an occlusal guard for Mr. Johnson.”

Computer:“Yes, Dr. Ferguson.”

DR. KATHERINE FERGUSON FERGUSON Dr. Ferguson is a general dentist in

Dr. Ferguson a general Davie, Fla. andis can be reached at dentist in Davie, Fla. and drkferguson@aol.com. can be reached at drkferguson@aol.com.

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We haven’t yet arrived at what will surely be the magical place of computers making our lives that easy, but we are inching closer to it. 3D printing is a step in that direction.

Now that we’ve fully incorporated 3D printing into our practice, our office is cleaner since there’s little need for messy powders for mixing alginate or stone. We now store diagnostic models in a digital format instead of stone on a shelf, and are only 3D printing them as needed.

They’re trimmed digitally and can be reprinted; no more stone models that are over-trimmed or accidently dropped, fractured or missing necessary information. We rarely use stock impression trays. Instead, we can now 3D print custom trays for any application we wish.

Our staff is more fulfilled and more efficient, operating machines that were the stuff of science fiction movies only a few short years ago. Gone *gender-neutral courtesy title

FLORIDADENTAL.ORG

3D printing printing are the days of waiting insufferable amounts of time for a third party to deliver aligners to begin (or continue) orthodontic aligner treatment, especially when we determine additional aligners are needed after a patient has inevitably lost or damaged their current aligner. We now have all the steps for orthodontic aligner treatment readily accessible and changeable at any time for a fraction of the cost of third-party providers.

Our profits have increased because our overhead has decreased. Less money is spent on lab bills for temporary crowns, immediate dentures, custom impression trays, orthodontic aligners, clear orthodontic retainers, surgical guides, immediate screw-retained prostheses for All-on-X full-arch implant cases and occlusal guards.

Case acceptance has increased with our ability to deliver quickly and more efficiently than what used to have to come from a professional lab. Our patients have been impressed with the quick turnaround time for orthodontic aligners and occlusal guards as well as the speed in which they can be scheduled for implant placement (anything from a simple, single implant to an All-onX case) simply because we are fabricating what we need in-house. We can fabricate temporary crowns in any design we’d like, including the possibility of designing multiple aesthetic options for the patient to try on as potential prototypes of the final prosthesis — all at little cost.

To fully master the ins and outs of 3D printing, perfect workflows for our practice and completely employ 3D printing for diagnostics, restorative, surgical and orthodontic applications, it took a couple of years and cost a few thousand dollars — not unlike the path we pursued to fully incorporate CBCT imaging into our diagnostic skill set.

3D printed provisional hybrid

3D printed surgical guide being used

We didn’t do all of it at once. Just like any newly attained technology, incorporating and mastering just one aspect takes far less time and money to get started. A beginner course lasting one day or one weekend, some 3D printing filament or resin and a good beginner-friendly 3D printer with some low-cost software will run about $1,500-8,000 depending on whether you train your staff right away and how fancy you want your first 3D printer to be.

It’s best to fully learn, incorporate and, ideally, delegate just one aspect before moving to another application. Once you and your staff are fully comfortable with one application, move on to the next. Anyone new to 3D printing should adopt this approach — choose what you’ll find most helpful in your office.

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3D printed bite splints before removing supports

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FDC2021 Course Recordings PEOPLE.

PURPOSE.

PASSION.

PATHWAYS TO SUCCESS

Couldn’t make it in person to the 2021 Florida Dental Convention? Want your team to listen to courses they couldn’t attend? FDC2021 offers course recordings for you to purchase!

Listen to the FDC2021 courses at the convenience of your home or office with these MP4 audio recordings!

Course recordings are $20 each, or purchase all 75+ recorded sessions for $299.

Purchase your course recordings today at education.floridadentalconvention.com.

Your

BACKSTAGE

ALL ACCESS

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TODAY’S FDA JULY/AUGUST 2021

FLORIDADENTAL.ORG

3D printing

FROM PAGE 31

Do you most desire to have less mess in the lab from various powders for alginates and stone models? Would decreasing your lab bills be most beneficial to you at this time? Would you most appreciate an increase in the turnaround time for patients who need a custom temp crown/bridge or occlusal guard? Would you, your staff and your patients benefit from the ability to schedule the surgery for implant placement using a surgical guide within a day or so instead of a couple of weeks? Are you in need for a workaround on those occasions you procrastinated or your staff can’t get a case to the lab in a timely fashion?

3D printed temporary crowns for cosmetic evaluation

Once you have decided what you’d most enjoy being able to do, learn that application first. Take a course for that task.

These courses often can be taken in person or remotely. If you aren’t comfortable with all things digital yet, take a course that will support you after the course is completed or send your most technologically savvy staff member for the training instead.

As dentists, we have an independent mindset. Each day, we are presented with scenarios that are tackled by this headstrong attitude and determination to solve problems. 3D printing in our office has freed us from relying completely on a professional lab for fabrication of surgical guides to place implants in the ideal position to support our designed prosthesis. No longer are we at the mercy of the lab delivery times to schedule our patients for procedures that require temps (crowns, bridges, or even temp immediate dentures). No longer do we wait weeks for orthodontic aligners or flat plane occlusal guards.

No longer do we pay high lab fees for items we can now make ourselves whenever we’d like them.

Adding 3D printing to our office has given us freedom from the restraints of paying and waiting for others to do for us what we are able to do for ourselves. We can now make what we want when we want — and so can you.

FLORIDADENTAL.ORG

Models for clear aligner production

Various 3D printed appliances

TODAY’S FDA JULY/AUGUST 2021

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Antibiotic Recommendations Have Changed antibiotics

Many years ago, at a church retreat breakout session, a young mother shared a horrifying experience. She was extremely sick for a long time, and it was so bad that she was writing farewell letters to her young children. She was finally diagnosed and successfully treated for a Clostridium difficile (C. diff) infection.

My cousin recently had a C. diff infection. It was horrible. She was incredibly sick for eight weeks and could not venture far from the bathroom.

A man I knew well passed away due to complications from C. diff. He had a problematic tooth and was given a script from a dentist for clindamycin. His wife recently told me, “My husband died of a toothache.”

C. diff infection can cause prolonged, severe and possibly fatal diarrhea. Over the last decade, C. diff incidence rate has increased. New strains have emerged that are more dangerous. It causes 29,000 deaths a year.1 Antibiotics are the most important modifiable risk factor for the infection. Surprisingly, even single doses, such as for premed, have been associated with an increased risk of the infection.2 Clindamycin carries the highest risk of C. diff infection compared to other antibiotics2 — four or more times higher risk. All antibiotics increase the risk of C. diff, but clindamycin is by far the most dangerous.

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The U.S. Food and Drug Administration (US-FDA) long ago gave clindamycin a black box warning for Clostridium difficile infection.3 Clindamycin is the only antibiotic that has such a warning concerning C. diff infection. Black box warnings are required by the US-FDA for drugs that carry a significant risk of serious or life-threatening adverse effects. It’s the strongest warning the US-FDA requires.

The American Dental Association Council of Scientific Affairs now recommends azithromycin for penicillin-allergic patients presenting with dental infection.4 Azithromycin is the primary alternative replacing clindamycin.

The American Association of Orthopedic Surgeons no longer recommends clindamycin for premed in penicillin-allergic patients.5 They now recommend 2 g cephalexin, or 500 mg azithromycin or clarithromycin, in that order.

The American Association of Endodontists now recommends azithromycin in cases where response to penicillin is inadequate and as the first choice in penicillin-allergic people.6 Azithromycin replaces clindamycin.

From the American Heart Association, “Clindamycin is no longer recommended for antibiotic prophylaxis for a dental procedure.” 7 An Illinois dental malpractice case was settled in 2011 for $1.25 million. The plaintiff survived but suffered a C. diff infection that caused damage requiring multiple surgeries to correct. The dentist had prescribed clindamycin for a sore, recently crowned tooth, no evidence of infection present.

I urge you to limit the use of antibiotics, follow antibiotic stewardship principles and stay away from clindamycin — even as a premed.

There are safer drugs available.

Please share this information with others.

“

The American Dental Association Council of Scientific Affairs now recommends azithromycin for penicillin-allergic patients presenting with dental infection.4

”

FLORIDADENTAL.ORG

DR. WALTER (BEAU) BIGGS

Dr. Biggs is a general dentist in Pensacola and can be reached at beaubiggs@gmail.com.

REFERENCES 1. Lessa FC, Mu Y, Bamberg WM, Beldavs ZG, Dumyati GK, Dunn JR, et al. Burden of Clostridium diffficil infection in the United states. N Engl J Med 2015;372:825-34.

2. Kane S. Which Antibiotics Are Most Associated With Causing Clostridium difficile Diarrhea? Pharmacy Times. 2017-03-14 12:30:20.

3. Clyndamycin [package insert].

Morgantown, WV: Mylan Pharmaceuticals Inc: 2013.

4. Lockhart PB, Tampi MP, Abt E, Aminoshariae A, Durkin D, Fouad AF, Gopal P, Hatten BW, Kennedy E, Lang M, Patton LL, Thomas T, Suda KJ, Pilcher L, Urquhart O, O’Brien KK, Carrasco-Labra A. Evidence-based clinical practice guideline on antibiotic use for the urgent management of pulpal- and periapical-related dental pain and intraoral swelling. A report from the American Dental Association. JADA; November 2019 Volume 150, Issue 11, Pages 906–921.e12 5. Wynn RL, Meiller TF, Crossley HL. Drug Information Handbook for Dentistry, 26th Edition 2021: 40.

6. Fouad AF. https://www.aae.org/ specalty/2019/12/02/new-antibioticguidelines-is-there-anything-trulynovel/ 7. Wilson WR, Gewitz M, Lockhart PB, et al. AHA Scientific Statement.

Circulation. 2021; 143:e973

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Design Ergonomics Inc.

The Paragon Program

4 technology

Ways You Should be Leveraging Your Information Technology Provider in 2021

So, you made (or are planning to make) big investments in technology.

Now, how do you get the most out of them? Most practices have an information techonology (IT) provider but only the top offices leverage that relationship to make sure their tech is streamlined, safe and reliable. Let’s review four ways you can lean on that relationship to improve your practice workflow and keep your data safe.

Planning/Quarterly Business Reviews You should meet with your IT provider on a regular basis to review these items and plan for upcoming changes. We do quarterly busiCLAY ARCHER ness reviews (QBRs) with this rough schedule. During our Q1 and Q3 PRESIDENT AND CEO, DPC TECHNOLOGY reviews, we sit down with the doctor(s) and review the health of the Mr. Archer can be reached at system, budget for any upcoming changes, and identify any deficien904.443.0095 or carcher@ cies in training, hardware or policies. Your IT provider should have dpctechnology.com. experience with many other practices, so they can share compatibility, reliability and workflow issues that can save time, aggravation and money when it comes to new tech. Reviewing these new purchases and creating a budget before they are purchased will make implementation much smoother and save money.

Staff Training One of our quarterly meetings (Q2) is a staff “lunch and learn” where we discuss what the risks are to the practice and how the team can safely use the computers. The biggest threat to the practice is still employee (including the doctor) misuse of the computers. Spelling out what the risks are and how to avoid them is the most important thing your IT provider can do for the safety of the practice.

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HIPAA HITECH/ Compliance Your IT provider should have tools that automate most of this process. We meet annually (Q4) with your compliance officer, compile the reports and update the Health Information Technology for Economic and Clinical Health Act (HITECH) portion of your HIPAA manual.

Security Unfortunately, there is no silver bullet that will protect you 100% against cyberattacks.

But if you do nothing, you will be a target.

Health care (dentistry specifically) was a major target in 2020 and I would assume that trend will continue. These are the four major areas you should be working on with your IT provider.

this list on an annual basis (at least) is a great way to keep everyone on the same page.

• •

Implement network security protocols (Wi-Fi passwords, etc.)

Browser filters (in-office rules — NO PERSONAL SITES ON WORK COMPUTERS)

• • • • • • •

Implement user accounts (so you know who is on what machine) Data encryption (email accounts, hard drives, etc.)

Two-factor authentication (Office 365, social media accounts, etc.)

Off-site backup/disaster recovery Endpoint security Enterprise firewall Password management

1. Adopt policies.

If you do not spell out what your team members can and can’t do, how can you expect them to know? Polices need to address topics such as acceptable internet use, acceptable device and machine uses, physical security and location of devices and machines, and contingency planning. Every policy should have accompanying procedures that detail what must occur. Your IT provider should be able to help you create these and they should be reviewed annually as a part of your QBR process.

2. Have preventive measures (layered security).

This list is intended to be used in a discussion with your IT provider. It is not intended to drive the decision on what tools are used to achieve the goal. A good relationship with your IT provider should look like a good relationship with a patient. The patient does not choose the brand and type of implant, they trust the professional to use the tool that will lead to the desired outcome. Auditing FLORIDADENTAL.ORG

3. Develop an incident response plan.

An incident response plan should spell out who does what if something happens. It is much more effective to tell one individual to dial 911 than is to yell, “Someone dial 911!”

By defining roles, you will minimize the confusion during a difficult time.

4. Review security with your IT provider.

This should be an ongoing discussion that you have with your IT provider. Taking a few minutes each quarter to review weaknesses and plan for changes will greatly reduce the risk of a breach or random attack.

That is all there is to it. This quarterly cadence keeps everyone on the same page and greatly reduces risk in the practice. Most IT providers would be happy to help with all these items for little or no extra charge to your practice. An ounce of prevention is certainly worth a pound of cure!

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new technology

DEVELOPING A GROWTH MINDSET THROUGH THE INTRODUCTION OF TECHNOLOGY Disruption and innovation are two concepts that appear to be more evident today. The idea of hopping into a car with a stranger or sleeping in someone else’s home for a few nights would have seemed ludicrous in the not-too-distant past. As humans, these advancements in informatics have pushed our boundaries in terms of what we believe to be possible in our everyday lives. It’s clear that the modern-day office demonstrates little resemblance to that of our dental founding fathers.

We can all agree that embracing new technology in our practices is a bittersweet process. Oftentimes, we are enamored by a new piece of equipment that we were introduced to at a conference. We take the plunge only to be left with a slight sense of buyer’s remorse as we walk away from the booth with our receipt in hand. Weeks later, the product is delivered to the office, and then comes the test. Are we committed enough to the growth of our practice to overcome the resistance and growing pains that come with change? What makes or breaks this integration progress is a practice culture that embraces improvement.

DR. MARK A. LIMOSANI, DMD, MSC, FRCD

Dr. Limosani is an endodontist in Weston, Fla. and a Diplomate of the American Board of Endodontics. He can be reached at malimosani@westonendocare. com or 954.800.3453.

The endodontic specialty has been at the forefront of innovation. From the integration of the dental operating microscope to the use of apex locators, there are countless ways root canal therapy looks nothing like it did in the past. Staying at the cutting edge has required a true paradigm shift regarding some principles upon which the specialty was built.

From a diagnosis and treatment planning perspective, cone beam computed tomography has completely revolutionized our approach to endodontic challenges. Our ability to have a more nuanced understanding of radiolucent findings suggestive of pathology coupled with our ability to better visualize the possible etiology related to these findings has allowed for more predictable outcomes and a smoother, more patient-centered process. Nowadays, it’s not uncommon to offer selective non-surgical revised treatment on a specific offending root rather than disassembling the entirety of the prothesis. Treatment approaches such as static or dynamically guided access have allowed for more targeted access preparations that result in a more conservative treatment with minimal tooth structure loss. A combined approach of enhanced imaging with a mindset of tooth structure preservation appears to be setting the specialty up for more robust, long-term results.

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The dental operating microscope with co-observer optics is the focal point of a modern endodontic office.

Disinfection of the internal component of the tooth has always been top of mind for clinicians practicing endodontics. Unfortunately, in the past, this goal was sometimes accomplished at the expense of removing sound tooth structure. Advancements in rotary file design and metallurgy have allowed for clinicians to create a pathway to the apex of the tooth while also minimizing collateral damage.

Innovation oftentimes comes from looking at a challenge with a unique perspective. In 2016, early adopters of a new technology called the Gentle Wave Procedure® opened their minds to an alternative approach to root canal therapy. The use of multi-sonic energy and dynamic fluid movement in a closed loop system has allowed for more thorough disinfection with minimal tooth structure loss. This new paradigm shift of dentin preservation combined with more effective approach to root canal disinfection has allowed for endodontic therapy to become more convenient and predictable with less complications and post-operative discomfort.

One saying that rings true to this discussion is “In order to go there, you need to grow there.” I would encourage anyone willing to invigorate and energize their practice to invest and commit to new technologies and adopt a different approach to treatment while ensuring these advancements are rooted in sound science.

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Advancements in technology have allowed for a more thorough result with less removal of healthy tooth structure in endodontics.

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“ ”“ ”

A M A od Mo er de niz rni ed ze P d Pat atien ient tEExp xpe erieri necn ece IncInc re rea as se es s Pr Pra ac cti tic ce e Re Re ve ve nue nu

e

marketing

As dentists work to modernize the patient experience with these website features, it’s important to remember to market these unique attributes on social media, ads and email.

Ensuring that patients can communicate with the office when they want to is key to generating new appointments.

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WHITEBOARD MARKETING

Dental patients today are increasingly accustomed to being online 24 hours a day, seven days a week. The internet allows consumers to be instantly connected to anything they need conveniently at their fingertips. Making it easy for patients to schedule an appointment, complete forms, chat and even pay bills online is the new normal.

Dentists must modernize the patient experience by including these important digital elements to convert new patients and keep current patients coming back.

“Patients want the ability to communicate and take actions when it’s easiest for them, whether they are online at 8 a.m. or 11 p.m.,” said Sean White, CEO of Whiteboard Marketing. “Our clients who provide that experience on their websites see an increase in new patient appointments, bills paid and patient forms submitted prior to a visit.”

The most important features to add to every practice website include online scheduling, submittable patient forms, live website chat, dental membership plans and online bill pay.

Online Scheduling Giving current and prospective patients the opportunity to schedule a hygiene visit at their convenience is a guaranteed conversion opportunity, according to Kristi Simone, CMO of Whiteboard Marketing. Many patient management systems provide fully integrated online scheduling that syncs directly to a patient chart after the front desk staff accepts it. Not only does online schedul-

ing help patients schedule on their time, but this feature also simplifies work for the front desk team by eliminating time spent on the phone.

“For those patients who schedule online, we do recommend that the office sends a follow-up email with the appointment date and time and a link to required patient forms,” Simone said. “A follow-up email and/or phone call will help reduce cancellations or no-shows, so it’s important that practices have a set follow-up process in place.”

Online Patient Forms As patients and consumers rely on the internet for their communication, fillable online forms allow patients to complete and submit health information prior to their appointments. This modern feature is convenient for the patient and the front desk team. Many practice management systems directly sync to the patient’s chart, so the front desk team doesn’t have to manually enter the information.

Live Website Chat Every practice receives phone calls before, during and after the workday.

Ensuring that patients can communicate with the office when they want to is key to generating new appointments.

“Even when your office is closed, patients want to get answers to their questions,” White said. “Dentists who add live website chat are providing patients one more opportunity to choose their practice.”

There is a difference between live chat and chatbots. Chatbots are not live but can provide automated answers to patients’ questions if dentists provide

the answers in the system. Live chat is operated 24 hours a day with real people responding.

“Consumers today are conditioned to expect an immediate response,” White added. “That’s why we recommend a live chat feature with people on the other end of the chat line who can communicate in real time.”

Dental Membership Plan Making dental care affordable for patients who don’t have insurance helps to increase new patient acquisition and treatment acceptance rates. Whether a practice created its own dental membership plan or implements an organized platform, these plans help patients pay for their treatment.

According to Simone, patient membership plans are especially successful for practices that are trying to get out of insurance networks and move toward fee-for-service.

Online Bill Pay Practices that make it easier for patients to pay their bills see an increase in collections. While the best time to collect payment is at the time of service or checkout, the reality is not so clear-cut.

Providing patients with the opportunity to pay with the click of a button is easy, fast and the new normal of today’s consumer behavior.

Setting up online bill pay is relatively easy and can be done by contacting the practice’s merchant services provider. Once the payment link is set up, the dentist will need to send that link to their marketing partner or website manager to add the link to the practice website.

SEE PAGE 45

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43

FDA: Radiography

AMATEUR PHOTOGRAPHY IS GREAT FOR VACATIONS AMATEUR PHOTOGRAPHY (JUST NOT GREAT RADIOGRAPHY) IS GREAT FORFORVACATIONS (JUST NOT GREAT FOR RADIOGRAPHY)

Amateur radiography has no place in your practice. Don’t expect professional results without professional training.

Be sure your dental assistants have the training and certification required by Florida law before they expose their first Amateur radiography no place in your(FDA) practice.

Don’t expect professional results what without training. radiograph.

The Floridahas Dental Association Online Radiography program delivers yourprofessional assistants need and Be sureyou your dental assistants have theNo training required Florida before theyconvenience expose their and first keeps in compliance with the law. travel.and Nocertification time away from work.byThey trainlaw online, at their radiograph.

Florida Dental (FDA) It’s Online Radiography delivers what at their own The pace.

You sign off Association on their success. affordable too! Justprogram $285 per student for your FDA assistants members.need and keeps you in compliance with the law. No travel. No time away from work. They train online, at their convenience and Bring teamsign to off visitonustheir at success. booth #917 at the Florida June 24-26.

They’ll have at theiryour own entire pace. You It’s affordable too! JustDental $285 Convention per student for FDA members. the chance to win a free voucher for radiography training or an instant camera! You can also learn more at Bring your entire team to visit us at booth #917 at the Florida Dental Convention June 24-26. They’ll have MyDentalRadiography.com/fda. the chance to win a free voucher for radiography training or an instant camera! You can also learn more at MyDentalRadiography.com/fda.

PRINT AD_0291_ Radiography_Target dental staff_D_3_instant camera.indd 1

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marketing

FROM PAGE 43

As dentists work to modernize the patient experience with these website features, it’s important to remember to market these unique attributes on social media, ads and email. For example, dentists can send an email to recall patients to schedule online at their convenience, advertise on Facebook that the practice offers online scheduling or send an email to overdue patients to “click here” to pay their bill online.

Ultimately, adding features like online scheduling and online patient forms to a website will help dentists provide an

experience that prospective and current patients expect, while generating new patients and increased revenue.

Whiteboard Marketing is a dental practice marketing firm in Dublin, Ohio that partners with dentists nationwide to develop and implement practice marketing strategies that increase new patient acquisition and build brand awareness.

Visit whiteboard-mktg.com for more information.

Subscribe to our blog.

Get entered into a monthly drawing for a $10 Starbucks gift card.

beyond the bite THE OFFICIAL BLOG OF THE FDA

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saliva

SALIVA ANALYSIS IS A NEW PATIENT ENGAGEMENT TOOL

CHELSEA ANDERSON, RDH

Empowering patients to engage in their oral health care can be a constant challenge for dental professionals. Some patients are fearful of procedures, some want you to make all the decisions, and some just want to get in and out and not come back. Or, if insurance doesn’t cover it, they’re not interested to learn how it may help them.

Ms. Anderson can be reached at Saliva analysis screening technology can provide information you andersonc@arkrayusa.com.

didn’t previously have and can amp up your conversation to deliver oral health and hygiene education backed by objective measurements. It may just keep your patients coming back for more.

What Does Chairside Saliva Screening Look Like Today?

A few available tests can identify specific pathogens that cause disease, are considered diagnostic and are more expensive to

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administer as you must send the sample out to a lab for analysis. Saliva screening tools differ in that they are quick and easy to use and typically cost much less to implement. One saliva analysis system uses dual wavelength reflectance spectrometry to measure key saliva biomarkers through a chemical reaction on the test pad, which eliminates culturing of bacteria for days to get numbers or sending samples off to a lab. Other saliva tests measure the pH of saliva to determine if the oral cavity is acidic or salivary flow to determine hyposalivation. Saliva screening test results are tools that can be used to complement a clinical assessment of your patient to provide more information to support suggesting new oral hygiene habits, products or treatments.

The most comprehensive chairside saliva screening measures the presence of biomarkers in three key areas of tooth health, gum health and oral cleanliness, providing results for levels of cariogenic bacteria, acidity, buffer capacity, blood, leukocyte, protein and ammonia. These results can indicate a higher or lower risk for developing caries and gum disease, which can support the discussion with your patients on what their oral health looks like today and where you are encouraging them to take it.

FLORIDADENTAL.ORG

Can a Saliva Screening be Beneficial for My Practice?

Dr. Brian Nový, noted saliva lecturer, CAMBRA president and chief dental officer for the state of Massachusetts, added chairside saliva screening to his practice a few years ago and finds it beneficial for both the team and patients.

Team Benefits m Quick, easy procedure doesn’t interrupt current hygienist’s routine and supports clinical case presentation. m Customizable report fields to create a unique, patientcentered report card that clearly explains the issue and staff recommendations. m SillHa Results Advisor provides insight to potential causes and recommendations that support the conversation with patients. m Tracks progress over time so that everyone can see what is working and how health is improving.

Patient Benefits m Objective, visual evidence to help understand what the clinician is telling them about disease risk. m A report card just for them that clearly explains the issue and the recommendations. m Develops trust in their provider that what they are recommending has some basis. m Tracking patient results over time motivates them to continue behavioral changes to see improved outcomes.

“

Another office is using saliva analysis for a different audience and finds similar benefits. Dr. Boyd Simkins, a pediatric dentist in Utah, states that saliva analysis has changed the conversation with parents of his pediatric patients. He feels he is no longer saying the same things over and over to glazed-eyed parents about brushing and flossing, and no more sugar. Now, he discusses outcomes and progress as the numbers are changing. Discussions are more meaningful with a saliva screening analysis to show how their child is responding to treatment.

Dr. Simkins believes it is a valuable addition to his practice.

A saliva screening tool can change and add impact to your preventive care routines. Empowering your staff with this simple method to have deeper and more meaningful conversations to engage patients can be the boost a practice needs to make a great comeback after a year of uncertainties and smarter patients.

SillHa Oral Wellness System with mySaliva software provides your staff a quick and easy method to add saliva analysis to your preventive care initiatives. The instrument is compact to fit in your operatory or your lab. The mySaliva software provides an intuitive interface that delivers results in five minutes, presenting in a visual range of zero to 100 and offers customizable fields to individualize comments for each patient to show potential causes and recommendations. The ARKRAY USA SillHa team will work with your staff to implement SillHa into your practice to make it flow smoothly from start to finish, discussing all aspects with each of your staff to ensure their needs and concerns are addressed.

References 1. OralDNA® testing by Oral DNA Labs.

2. BokaFlo™ by BOKA Sciences, Inc. 3. SillHa Oral Wellness System by ARKRAY USA.

A saliva screening tool can change and add impact to your preventive care routines.

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digital x-rays

SHOULD DIGITAL X-RAY HARDWARE STILL BE BOUGHT OR SHOULD IT BE A SUBSCRIPTION?

Purchasing digital X-ray equipment, such as digital X-ray sensors, has long been the standard of practice since the first digital X-ray sensors came on the market in 1999.

The concept was that these expensive devices were to be purchased much like how a dental chair or air compressor would be. As digital has been more integrated into the practice of dentistry and the life span of these devices has been seen to be only a few years due to the nature and frequency of their use, the method of how digital X-ray sensors are purchased has begun to shift.

Many dentists have purchased sensors at prices exceeding $10,000 and have carried care plans that can cost as much as $125 a month to get an extended warranty that, although expensive, still did not cover some of the most common reasons the sensors failed.

These expensive warranties do not cover bite damage or other accidental damage. Instead, they only offered a reduced replacement price in the inevitable event that their sensor failed due to bite pressure or damage on the cables and sensors. With these high costs of ownership and ongoing support costs, dentists are still facing surprise expenses in excess of $7,000 when the sensor would fail and the warranty would not cover a replacement.

Looking at digital X-rays as a business solution, it’s clear that dentists are not seeking to own digital X-ray sensors. Instead, they’re simply seeking to have a solution that provides the necessary equipment to take digital X-rays in their office. This is different from other products, such as a home or car, where the customer wants to own the product and possibly resell it or pass it on. The person purchasing a car is not just buying a method of transportation; they are purchasing something they want to own, something they are likely emotionally invested in, in one way or another. Digital X-rays are not like this —

FLORIDADENTAL.ORG

sensors are simply a means to having quality X-ray images to diagnose their patients’ oral health.

Considering this new view of what the end goal is, it makes much more sense to rent a sensor in the same way someone would rent office space or internet usage. Products like the Jazz sensor and the Aurora VIP have decided to respond to this demand by offering digital X-ray sensors with short, one-year contracts that allow dentists to pay less than $160 a month per sensor to rent for as long as the office needs it. The cost of renting a sensor is just a bit more than what many customers are paying for support on the sensors they purchased.

Renting sensors allows the office a huge amount of flexibility to respond to either increased or decreased need in their practice. If the practice is growing and adding providers, for an additional $160 a month, they can add another sensor with a simple phone call and an overnight shipment. If the office is slowing down or being sold to another dentist, a contract can simply be ended or transferred to a new owner with incredible ease. Computer systems, digital X-ray sensors and other high-tech equipment depreciate quickly in value so there is no equity to be gained in purchasing digital X-ray equipment.

It’s hard to tell what dentists may decide in the future, but with the many sensor rental pros, it’s likely that many will begin to go this route. It will allow them to write off a simple monthly expense and not tie up credit or have debt hanging over their head from multiple equipment finance loans. The future of dental offices may see more equipment with short life spans and low equity values shifting to a rental or subscription model from the more typical financed equipment purchasing decisions of the past.

SHAWN HALL, CEO SODIUM SYSTEMS LLC

Mr. Hall can be reached at Shawn@sodiumdental.com.

“

Renting sensors allows the office a huge amount of flexibility to respond to either increased or decreased need in their practice.

”

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artifical intelligence

The Emergence of Artificial Intelligence in Dental Care Delivery

AI and machine-learning technology is here to improve our clinical intelligence in the delivery of care, improve practice profitability and identify efficiencies in a standardized manner to advance the delivery of care to our patients.

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As oral health specialists, our role as dentists is to use scientific principles, clinical acumen, and technical expertise to prevent, diagnose, and care for patients with oral disease or injury, and to help maintain and improve their oral health throughout their lifetime.1 Dentistry’s understanding of the etiology of oral diseases, as well as the techniques and interventions available for their management, continues to evolve. Simultaneously, the expansion of information related to collection of patient metrics, advanced treatment protocols, and the influence of oral-systemic disease relationships has implications for both patients and providers, particularly in the complexity of treatment options and the difficulty patients face in accepting treatment.

Artificial intelligence (AI) approaches are currently at the frontier for health care in medical imaging, therapeutic intervention, and drug design and manufacturing. The global health care market for AI is increasing at a rate of 44.9% and is expected to reach $45.2 billion by 2026,2 with growing adoption of AI health care imaging, diagnostics and operational support projected at the highest growth rate. Can AI offer a breakthrough in advancing prevention through risk assessment, predicting diagnoses through radiographic visualization of diseases to enhance treatment planning and case acceptance, and demonstrably improve the delivery and outcomes of dental care?

In this review, the ambition of AI and computer visualization in transforming dentistry will be described, and current applications of models in the management of both clinical treatment and dental practice will be discussed.

Implications of AI on Health Information Management Health care, as an industry, is based upon a knowledge-driven economy, and clinicians FLORIDADENTAL.ORG

are acutely aware of the challenges in assimilating new information to improve their understanding and patient care. In 1950, the time to double medical knowledge was considered to be 50 years; in 1980, seven years; and in 2010, three and a half years. Today it is projected to take just 73 days.3 The dental profession is certainly no exception to the challenges of health information management.4 Successful prevention strategies depend upon knowledge of disease causation, progression dynamics, and early detection and treatment, all challenged by access to data and inherent constraints (missing, unstructured, or non-standardized patient information).5,7 The adoption and expansion of electronic health records has dramatically increased the quantity of clinical data available for our clinical treatment decisions. In addition, the implementation of data analytics to gain insights beyond human capabilities across large data sets has created unique opportunities to predict disease occurrence, reduce inefficiencies, and advance patient care.6 Predictive analytics linking data from dental and medical records, claims, and patient-reported sources will define the data elements to allow recognition of patterns within the disease process, leading to opportunities for earlier identification of known risk indicators, and timing of treatment.

Consider for a moment the knowledge and clinical expertise required to manage each patient individually. Providers and staff must acquire information from the medical and dental history, interpret the possible influence of medical conditions and current medications, record quantitative dental examination metrics and radiographic imaging, and abide by protocols to store and share the information securely.4,7 Once done, dental professionals must render a diagnosis and offer recommendations for treatment in a manner to allow informed consent by the patient. As an additional challenge, the medical

ROBERT A. FAIELLA, DMD, MMSC, MBA

Dr. Faiella is the chief dental officer for Overjet Inc. He is a past-president of the American Dental Association, serves as director of the American Board of Periodontology, and as treasurer of the American College of Dentists.

SHAJU PUTHUSSERY, MS

Mr. Puthussery serves as chief operating officer at Overjet Inc., an AI-driven enterprise applying artificial intelligence and machine learning to dentistry.

He has held several senior level leadership positions, as chief information officer at P&R Dental Strategies, chief analytics officer at DentaQuest, and chief technology officer and cofounder of his own technology firm at P&R Technologies.

Reprinted with permission from the Journal of the Michigan Dental Association, April 2021 issue.

References available upon request.

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artifical intelligence FROM PAGE 53

information, test results, and medications may change during the course of treatment. Consultations with medical colleagues may be necessary, as patients become more acutely aware of the connection between oral health and their overall health.

Over the course of a year, millions of data points are collected from thousands of patients seen by multiple providers, and in many cases, over multiple locations. The data collected is primarily used at the point of service for the patient, but it is rarely reviewed independently when the patient is not present for care.

An important element in the implementation of analytics at scale is to make it actionable.6 Systems that identify patients in need, while also making predictions available with minimal disruption to the existing workflows in the office, increase the ability for providers to take action in treatment decisions at the point of care. The system must both inform the provider and educate the patient regarding the recommendation for treatment with objective reason. By allowing this level of access to information, AI technology can empower providers to identify needs for confirmation and discussion with each patient we serve.8

Expanding Digital Dentistry to Include Predictive Diagnostic Support Dentistry is currently experiencing significant changes in the management and delivery of treatment due to the extensive introduction and expansion of digital capabilities. Most dentists are currently embracing digital workflows at some level, from submission of insurance claims with digital attachments, to treatment delivery through digital impressions connecting CT imaging, to CAD/CAM prosthesis fabrication by digital printing.9 The expanded computational speed and storage capacity required for these workflows also would allow AI algorithms to analyze radiographic images and unstructured patient data (such as digital images including intraoral photos and digital impression files and electronic record notes and claim narratives) in order to aggregate all practice data to improve our clinical cognition at scale.

Currently available AI models are expected to support providers with diagnostic accuracy for confirmation and interpretation to the patient in the delivery of care,8,10 and can accurately identify dental anatomy (tooth numbers, bone levels, enamel surfaces), oral diseases (caries, periodontitis, lesions and end-

Fig. 1: AI machine learning prediction pathway to determine the necessity of treatment with high-level accuracy.

Analyze and identify Anatomy, disease and past treatment

Dental Image

Al Engine

g

All images by permission from Overjet, Inc. (Cambridge, Mass.)

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g

Recommended Necessary Treatments

Qualify Disease and quality of past treatments

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odontic obturations) and quality of restorations (open margins, marginal over-extensions) from dental radiographs (both digital and scanned). In addition, incorporation of additional digital data, seamlessly extracted from practice management software, can then be combined with known dental procedure code parameters and guidelines to identify clinically appropriate treatments, and presented to the clinician at the point of care. This digitally enhanced process would allow for improved efficiencies in diagnosis, treatment decisions, workflow and ultimately, better treatment outcomes.11 For example, findings of bone loss for specific teeth greater than 2.0 mm12,13,14 and probing depth greater than 4 mm, as well as the presence of root surface calculus, can be presented on annotated images relevant to the site in question.

A dashboard also will present a timeline over the past 18 to 24 months, noting all dental procedures for each visit for the patient to determine if there has been a periodontal charting or comprehensive examination within that time frame. In addition, annotated radiographic images identifying the teeth exceeding criteria for bone loss, carious lesions, overextended restorative margins and indications for crowns (such as a missing cusp, the size and condition of an existing restoration, and the percentage of the clinical crown that is decayed, missing or filled) are presented. The indication for appropriate treatment can be reviewed and presented to the patient during the appointment, allowing the provider to toggle the annotations on and off to demonstrate the objective findings to the patient and inform them of the need for treatment.

Case acceptance has traditionally been based upon the trust between the patient and provider.15 The use of technology to provide objective findings at scale across the entire database of the practice shifts the treatment acceptance from “trust” to “trust with verification” by demonstration of need, while educating the patient with reason.16 This allows use of the AI model to determine indication for treatment, such as all the patients in the practice who have indications for SRP due to bone loss of 3 mm with four or more teeth in a quadrant, or the presence of caries. The ability for patients to visualize, recognize and understand objective indications for treatment, with interpretation by the clinician, gives them more control in making the right decision for their condition.

A Treatment Planning Process Based Upon Stratified Risk Health care systems have generally used simple decision trees or logistic regression models to determine risk levels. This is in part due to time constraints at the point of care.17 Identified risk has included those patients with comorbidities such as smoking, diabetes, atherosclerotic cardiovascular disease, and other systemic diseases known to have shared risk factors with oral diseases. Health care organizations that currently use analytic systems have focused on identifying the algorithm that can best stratify data in near-real time, allowing actionable use for patient care.18 The use of current AI systems in dentistry to identify dental disease can enable the clinician to determine treatment needs, SEE PAGE 56

Fig. 2: The left panel demonstrates prediction of enamel and caries extent beyond the DEJ, and the right panel exhibits machine leaning identification of endodontic obturation in the development of modules for clinical use.

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artifical intelligence FROM PAGE 55

but stratification of risk requires segmentation of patients by defined comorbidities that may influence the prevalence and severity of disease progression, as well as response to treatment protocols. Self-reported patient indicators identified by natural language processing models from the electronic health record within the practice can identify risk factors such as diabetes, smoking, frequency of maintenance appointments, and current medications.19,20 The ability to identify such predefined criteria can allow the clinician to stratify patients with a specific diagnosis into high-, intermediate-, and low-risk groups for dental disease development or progression, and can be a powerful predictor of treatment success. This approach for patient cohort stratification to guide prevention of highly prevalent chronic diseases is meant to improve outcomes and increase the cost-effective use of health care resources.21

Improving Payer-provider Alignment Through Better Code Identification and Submission Many health care insurers are currently placing AI into action.22 Using AI in claim life-cycle management between provider and payer systems improves payment accuracy, thereby reducing claim denials and cost through reduction of

administrative overhead. One of the key initiatives from the payer community is in intelligent claims automation, which distinguishes between processing speed for pre-authorization and post-treatment claims for automatic adjudication. A preauthorization process provides a confirmation that the patient is a covered enrollee, and the payer agrees with the provider’s recommended treatment before the treatment is performed.

This process of automation eliminates delays in approval and improves speed of treatment and payments to providers.

Patient eligibility verification through AI-automated workflow also improves efficiency and increases the provider-payer interaction experience with speed and convenience.23 Improving quality of care through standardization of treatment protocols is a priority for every dental office. AI-assisted diagnostic support will analyze, identify, and recommend treatment options, to increase the accuracy of disease detection, and improve patient outcomes. Artificial intelligence can also analyze insurance claim rejection reasons, collection performance, and dental treatment coding profiles in dental office operations, as well as encode and verify insurance processing guidelines prior to claim submission. This process will reduce errors in claim submission and increase adjudication decisionmaking based on real-time insights from dental office data with sustained information accuracy. For example, AI-assisted agents in the dental office can verify requirements for document attachments to insurance submissions proactively.

Fig. 3: As compared to the original image (left), highly accurate unassisted prediction of caries by Al is presented on the right.

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Considering the sea of information within our control, the challenge we face today is to establish interoperability across electronic medical records (EMR) systems to create a cohesive, holistic view of the patient health history.24 Social determinants of health (SDOH) are the conditions within the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, quality of life, risks, and outcomes. Incorporating SDOH indicators (such as economic stability and education) into overall health care delivery will produce potentially better outcomes.25 Artificial intelligence and machine-learning solutions can identify and analyze the SDOH factors that impact a patient’s health by mining these data from dental and medical EHR notes and facilitate stratification of risk.26

The Ability to Monitor Treatment Effectiveness and Outcomes The process of assessing risk for dental diseases, such as periodontal disease and caries, has been less quantitative and more qualitative in current provider-payer systems. The advent of AI to analyze and quantify patient risk factors from dental imaging, along with qualitative SDOH factors from patient behavioral questions, will make this process more quantitative and real-time. Incorporating stratified risk levels proactively in the management of patient care will enable dentists and hygienists to intervene in real time, implement early preventive measures

and improve treatment outcomes over time. For example, if the patient has diabetes and is a smoker, and has evidence of bone loss and/or radiographic root calculus, the provider may modify treatment options, which could include increased maintenance intervals, periodontal intervention or smoking cessation methods.

It is common for dentists to defer specific treatments at the patient’s request and observe progression over time, but without objective metrics combined with stratified risk the timing of appropriate treatment may pass. AI-powered metrics offer the ability to identify disease progression over time.27 The appropriate documentation of treatment deferred or refused by the patient allows the clinician to escalate the urgency for care and provides for an appropriate record of lagging patient compliance.

The use of AI technology also allows improved data-based oversight in the administrative management of the practice.28 Current dashboard configurations available can provide realtime key performance indicator (KPI) metrics,19 such as production year-to-date, collection ratio, active patients, and new patients month-to-date. In addition, the software can aggregate data to track the number of patients within the practice with indications for a certain procedure identified objectively by the software.

SEE PAGE 59

Fig. 4: A clinical intelligence dashboard demonstrating real-time caries, bone loss measurements, and calculus, with findings listed on the right that may be toggled on or off for clinical review or patient demonstration.

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FDAS: Bank of America

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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

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BankBank of America Practice Solutions may prohibit use of an account to pay off or pay down another Bank of America account. Sponsorship of endorser’s products and services is not an expressed opinion or approval by the Bank. All promotional and marketing materials are Bank of America Practice Solutions property and, as such, cannot be changed, altered or modified, orally or in writing. All questions regarding these materials should be directed or referred to a Bank of America Practice Solutions Sales Associate.

Bank of America and the Bank of America logo are registered trademarks of Bank of America Corporation. Bank of America Practice Solutions is a division of Bank of America, N.A. ©2020 Bank of America Corporation | MAP3322432 | 11/2020

FROM PAGE 57

artifical intelligence

Dentists also must assume responsibility for the management of the practice as well as measures of quality control among the providers. Maintaining the standard of care, and mandated regulatory compliance, demands careful oversight.

The implementation of chart audits, the time required for review, and the scope of the work is beyond the capability of most practice administrators to assure identification of missed treatment needs (such as indications for SRP or early carious lesions), documentation (appropriate radiograph and charting intervals), and disrupted treatment workflows, as well as compliance with office protocols that may be overlooked in the context of a busy practice. How can we improve the process for the benefit of our patients and improve treatment efficiencies?

our profession comply with the legal, ethical and regulatory oversight of AI-based information are currently being addressed by the ADA and will continue to evolve as AI applications continue throughout the dental industry.

Challenges and Perspectives for the Future

In 2001, the Institute of Medicine defined the six aims for high-quality care: safety, effectiveness, efficiency, equity, timeliness and patient-centeredness. Simply expecting providers to keep pace with the expansion of the knowledge base alone will not improve the quality of care. A learning health care system is one in which “science, informatics, incentives, and culture are aligned for continuous improvement and innovation, with best-practices seamlessly embedded in the care process …” and developed through the adoption of process improvements over time.32

The adoption and implementation of AI within the dental profession is poised to be a transformative technology in dental care delivery. That said, it will not be without the perspectives and challenges that come with innovation and will require our focused attention as applications for use continue to evolve.

Technical challenges will arise as data attributes, formats and transfer speeds evolve. The ethics revolving around data privacy, the evolving assurance of data security in transit and at rest, and the exclusion of bias in the data used in the development of the algorithms will demand the attention of the health care informatics community as we broadly embrace artificial intelligence.29 In addition, the introduction of clinical AI-based solutions by the dental education community will be critical to foster the required digital literacy needed in the future dental workforce.8,30 The American Dental Association (ADA) is an approved Standards Developing Organization, with authority to propose standards for the profession. The Standards Committee on Dental Informatics develops standards and technical reports for electronic health records, interoperability across technology platforms, secure storage and transmission of patient data and digital images, and dental education and research systems.

The Standards Committee on Dental Products addresses dental materials, digital devices, equipment and oral hygiene products.31 The skill sets, techniques and best practices to help

FLORIDADENTAL.ORG

The Case for a Continuously Learning Health Care System in Dentistry The aggregation of practice data allows for efficiencies in practice management, scheduling staff, reviewing practice goals and streamlining patient treatment. By using the insights gained, the ability to perform a needs assessment to maintain a standard with performance benchmarks for quality metrics of care encourages the development of a continuously learning environment within the practice.

AI and machine-learning technology is here to improve our clinical intelligence in the delivery of care, improve practice profitability, and identify efficiencies in a standardized manner to advance the delivery of care to our patients. It is likely that AI will transform all major verticals of the estimated $130 billion dental industry, including dental practices, payers, manufacturers, distributors and laboratories.

The enhancement of our capacity to analyze patient needs objectively for continuous quality improvement will only expand in the coming years and will provide digital frameworks in the transformation of dental care delivery. Most importantly, the ability to enhance the patient experience by providing timely treatment, engaging their understanding of treatment recommendations with reason, and improving their outcomes over time with objective metrics provides a patient-centric environment to advance patient health status and enhance the trust that is central to the delivery of care.

TODAY’S FDA JULY/AUGUST 2021

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YOU EARNED IT,

FLORIDA DENTAL SCHOOL GRADS!

FDAS: The Gift of Coverage

THE FDA HAS YOU COVERED.

THE GIFT OF COVERAGE Practice in Florida and your FDA colleagues will reimburse your first year of malpractice insurance.

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dental lifeline

AIR FORCE VETERAN CAN EAT MORE COMFORTABLY DENTAL LIFELINE NETWORK • FLORIDA

Eating is an essential everyday necessity and there comes a sense of appreciation for being able to eat comfortably. Unfortunately, for many people like Vincent, an 85-year-old Air Force veteran, difficulty in eating became a part of his daily life.

Vincent wanted to be an air police officer while in the military, but after taking a personal assessment it turned out he was better suited for accounting. Although he was hesitant, he decided to give it a try and enjoyed being an accountant for more than 60 years. He currently lives with his daughter and granddaughter in Kissimmee and has seven children and 23 grandchildren.

He suffered multiple health issues throughout his life, including heart attacks, strokes and a total stomach resection.

Currently, he has a pacemaker/defibrillator and suffers from skin cancer, kidney disease, rheumatoid arthritis and vertigo.

Unfortunately, he is unable to work due to his health and relies on his Social Security Disability benefit.

Several holes in Vincent’s dentures made it exceedingly difficult and uncomfortable for him to eat. Although dental treatment seemed far beyond his reach, he was referred to Dental Lifeline Network’s Donated Dental Services (DDS) program and was matched with Dr. Stanley Asensio. He was then fitted for dentures that were generously donated by Reggie Dental Lab in Orlando.

After the completion of his treatment, Vincent expressed appreciation for his team of volunteers: “Thank you very much

Dr. Stanley Asensio and staff with DDS patient Vincent.

for your help. It is so nice to be able to eat and smile again.

They were so wonderful.”

“We have completed Vincent’s treatment, and all went very well. I think we all made a new friend. I had a wonderful time getting to know him and listening to his military experience and stories. Thank you for the opportunity to help him,” said Dr. Asensio, DDS volunteer.

By volunteering for the DDS program, you can help provide people and veterans like Vincent with the ability to eat again.

To volunteer or support Dental Lifeline Network: Volunteer: WillYouSeeOne.org FLORIDADENTAL.ORG

• Donate: DentalLifeline.org

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fdc2022

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FDC2021 RECAP

The 2021 Florida Dental Convention (FDC), “Pathways to Success: People. Purpose. Passion,” was held June 24-26 at the Gaylord Palms Resort & Convention Center in Orlando. After a year apart, FDC2021 was an unforgettable event where dental professionals from across Florida and the country were able to gather again to learn, discover and connect. More than 6,600 dental professionals, including 1,400 Florida Dental Association (FDA) members, safely came together for learning, networking and buying opportunities.

This year featured more than 130 courses ranging from lectures to hands-on workshops and mini-residencies, including: Dawson Seminar 2, Botox, sleep dentistry, homeopathic trends and courses for the entire dental team. The Exhibit Hall buzzed each day with attendees learning about the latest technologies and buying products from 225+ leading dental vendors.

Each day also included exciting family-friendly social events! On Thursday, attendees had the opportunity to mingle with exhibitors during the cocktail reception in the Exhibit Hall, followed by a night of fun with their peers at Dueling Pianos featuring Howl2Go Dueling Pianos. On Friday, FDA members honored their fellow colleagues at the annual Awards Luncheon, including Dentist of the Year, Dr. Rudy Liddell, and J. Leon Schwartz Lifetime Service Award recipient, Dr. Cesar Sabates. Friday evening, attendees fell down the rabbit hole at the Wonderland Party featuring live music, a teacup carnival ride and fun for the entire family. It was a can’t-miss event!

Plan to join us June 23-25, 2022, for the 2022 Florida Dental Convention. As always, FDC2022 will feature free registration for FDA members, exceptional education courses and a bustling Exhibit Hall all under one roof at the Gaylord Palms in Orlando. Registration will open March 2022.

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Henry Schein Professional Practice Transitions

Doctor's Choice

DRS. SHAWKI S. ABED*, AUSTIN N. BELKNAP, INDRANEEL BHATTACHARYYA, DONALD M. COHEN AND NADIM M. ISLAM

A 51-year-old female presented to Dr. Peter Drews, at Drews Dental Services, in Lewiston, Maine for evaluation of a painless sessile growth on her soft palate. The patient’s past and present medical history was non-contributory except for social smoking history. The patient reported that the mass had been present for an unknown duration and recently had enlarged in size. Clinically, this well-defined, mucosal-colored nodule measured approximately 0.4 x 0.4 cm as seen in Fig. 1. No radiographic changes were noted. Dr. Drews performed an excisional biopsy, and the tissue was submitted to the Oral Pathology Biopsy Service at the University of Florida.

Fig. 1: Well-defined, nodular lesion of the soft palate. The overlying mucosa is slightly erythematous.

Question: Based on the given history and the clinical image, what is the most likely diagnosis?

SEE PAGE 70

A. Papilloma B. Mucocele C. Focal Fibrous Hyperplasia (fibroma) D. Minor Salivary Gland Tumor E. Traumatic Neuroma

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diagnostics FROM PAGE 69

Diagnostic Discussion A. Papilloma Incorrect. Papillomas develop as single lesions, similar to our case, but tend to be pedunculated and clinically appear exophytic with prominent finger-like projections. Papillomas are the most common benign epithelial proliferation in the oral cavity. Characteristically, these exophytic benign lesions appear as numerous finger-like projections arising above the mucosa. Papillomas have been reported to measure on average 0.5 cm in size and are frequently described as “cauliflowerlike.” Typically, papillomas are chalk white or mucosa-colored and can appear on any oral surface, with a predilection for the tongue, lips and palate. The etiological factor of papillomas are the low-risk types of human papilloma virus with an extremely low reported virulence and infectivity rate. The treatment for papillomas is conservative surgical excision at the base of the lesion. Current literature has found no reports of recurrence and malignant transformation.

B. Mucocele Incorrect, but a great differential due to the site for a superficial mucocele of the palate. However, there is no report of fluctuation of size, which is general the clinical characteristic of mucoceles. A mucocele is a common entity that develops due to accumulation of spilled mucin into the surrounding soft tissue after the rupture of a salivary gland duct. They arise within a few days after minor trauma. The lower lip is the most common site, followed by the floor of the mouth, ventral tongue and palate. Clinically, these appear as a painless, domeshaped, soft and fluctuant mass, with a variation in color from translucent to bluish white, depending on the depth of the lesion. Mucoceles are reported more commonly in children and young adults but have been reported over a wide age range.

The treatment for mucoceles to minimize recurrence is an excisional biopsy with removal of any adjacent minor salivary glands that are considered as feeder glands to the lesion. The excised tissue should be submitted for microscopic evaluation to rule out the possibility of a salivary gland tumor.

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C. Focal Fibrous Hyperplasia (Fibroma) Incorrect. These well-known reactive lesions are seen in trauma-prone areas, unlike our case. Fibromas are the most common reactive lesions of the oral cavity and are found most frequently in areas subjected to trauma, such as the buccal mucosa along the line of occlusion, the labial mucosa and the tongue. Fibromas are not necessarily “tumors” and are not true neoplasms, but most likely represent a fibrous hyperplasia secondary to chronic trauma. Most fibromas are sessile, smooth-surfaced nodules that can sometimes be pedunculated. They range in size from miniscule lesions that are only a couple of millimeters in diameter to large masses that are several centimeters across. While they are submucosal masses, they most often are traumatized and are covered by a white hyperkeratinized mucosal surface. Treatment is conservative surgical excision and recurrence is extremely rare.

D. Minor salivary gland tumor Incorrect — great guess! This is an important consideration in this case given the age of the patient and the location. The most common site for minor salivary gland tumors is the palate with 42-54% of all cases found at this location. Minor salivary gland tumors represent a heterogeneous group of neoplasms, with a broad range of histological types and growth patterns. They can appear at any age; the maximum incidence is within the fourth decade of life for benign lesions and within the fifth decade for malignant tumors. Characteristically, these lesions have been reported to be more frequent in women. The etiopathogenesis of minor salivary gland tumors remains unclear.

The most frequent benign minor salivary gland tumor is pleomorphic adenoma (PA). This benign tumor clinically appears as a uniform, well-delineated, smooth and mucosal-colored nodular tumor. These benign lesions tend to be insidious and slow-growing, with an average course of multiple years prior to the patient seeking a diagnosis. PA is great consideration, but the main difference is location of the lesion. The most common location for PAs is the parotid gland, with 33-41% found in the minor salivary glands.

E. Traumatic Neuroma Correct! Traumatic neuromas are not considered true neoplasms, but reactive proliferations of neural tissue after transection or other damage of a nerve bundle. Hence, the other name for a traumatic neuroma is Amputation Neuroma. Clini-

FLORIDADENTAL.ORG

cally, the lesion appears as a nonulcerated nodule where the overlying oral mucosa is typically smooth-surfaced. Although pain has been traditionally considered a hallmark of this lesion, studies indicate that only one-fourth to one-third of oral traumatic neuromas are painful. The range of symptomatic pain varies from mild tenderness/burning to severe radiating pain. This entity can develop in any oral location but is most commonly found at the mental foramen area, the tongue and the lower lip. Microscopically, as seen in Fig. 2, this benign reactive process is predominately composed of haphazardly arranged nerve fibers of variable sizes. These nerve fibers are composed of axons surrounded by perineurium. The stroma can be fibrous or myxoid. The treatment of choice for the patient with a traumatic neuroma is surgical excision, including a small portion of the involved proximal nerve bundle, and most lesions do not recur.

Diagnostic Discussion is contributed

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

The dental professors operate a large, DR. BHATTACHARYYA multi-state biopsy service. The column’s case studies originate from the more than 12,000 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. COHEN

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

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

Fig. 2: Microscopic examination shows a haphazard proliferation of mature, myelinated and unmyelinated nerve bundles within a fibrous connective tissue stroma that ranges from densely collagenized to myxomatous in nature.

References: Baurmash HD: Mucoceles and ranulas, J Oral Maxillofac Surg 61:369– 378, 2003.

Eveson JW: Superficial mucoceles: pitfall in clinical and microscopic diagnosis, Oral Surg Oral Med Oral Pathol 66:318–322, 1988.

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

Ellies M, Schaffranietz F, Arglebe C, et al: Tumor of the salivary glands in childhood and adolescence, J Oral Maxillofac Surg 64:1049–1058, 2006.

Neville BW, Damm DD, Allen CM, Chi AC. Oral and maxillofacial pathology. Fourth edition. ed. St. Louis, Missouri: Elsevier, 2016.

Vora AR, Loescher AR, Craig GT, et al: A light microscopical study on the structure of traumatic neuromas of the human lingual nerve, Oral Surg Oral Med Oral Pathol Oral Radiol Endod 99:395–403, 2005.

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

Post an ad on the FDA Career Center and it will be published in our journal, Today’s FDA, at no additional cost! Today’s FDA is bimonthly; therefore the basic text of all active ads will be extracted from the Career Center on roughly the 10th of every other month (e.g., Jan. 10 for the Jan/Feb issue, March 10 for the March/April issue, etc). Please note: Ads for the Nov/Dec issue must be received no later than Nov. 1.

Please visit the FDA’s Career Center at careers.floridadental.org.

Clinical Supervisor, Health Sciences – Dental Hygiene. Miami Dade College, Medical Campus is looking for a highly motivated individual for the Clinical Supervisor, Health Sciences – Dental Hygiene position. This position is responsible for the management of clinical operations of the On-Campus Clinic. Duties and Responsibilities: Participates in the development and implementation of College policies, procedures and guidelines. Provides clinically related training for employees and supervises OSHA compliance. Identifies resources necessary for the successful operation of a Clinic. Examines and reviews records of all new and returning patients, and gives referrals when required. Manages clinical emergencies that may arise as result of treatment of patients in the clinic. Assists clinical instructors in the instruction and evaluation of students in all clinical courses. Consults with students and instructors regarding patients’ medical histories, examinations and treatment. Reviews health histories of all students working in the clinic. Participates in the development and implementation of clinical curricula in order to meet accreditation standards. Reviews current literature for information on risk management. Supervises management of the clinic’s inventory and maintenance of the clinic equipment. Assists in the supervision of clinic staff and participates in faculty meetings. Assists in the Self-study for re-accreditation of the program and supervises students in the Dental Hygiene Clinic. Doctorate degree in General Dentistry and a current license to practice in the State of Florida, with a minimum of three (3) years prior clinical experience. NOTES: Additional Salary Information: Medical, Dental, Vision, 403B, Retirement Plan, Paid Vacation, Tuition Reimbursement, and more. Visit https://careers.floridadental.org/ jobs/15085313.

Associate Dentist — Panama City. Stamps Family Dentistry is currently searching for an associate dentist to join our team in Panama City, Florida! Currently a solo practice, Dr. Stamps purchased the practice in 2016 but it has been an existing practice for over 30 years. We just moved into a new space in 2019 with all-new ADEC equipment, CEREC omnicam, Digital radiography/ pan. The office has 6 ops, 3 doctor and 3 hygiene with space to expand to a minimum of 10 ops as we continue to grow.

Currently refer out molar endo, implant placement and some extractions. We are in network with 4 PPO insurance companies and the rest are FFS. We have 40-60 new patients a month and our hygiene schedule is booked out 2 months minimum with no advertising. We have an outstanding office staff who are extremely efficient and effective at collecting payments as well as

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insurance filing. Competitive pay offered for the right candidate.

Prefer at least 1 year experience but will consider new grads as well! Visit https://careers.floridadental.org/jobs/15016564.

General Dentist — Crystal River. General Dentist needed for busy, established, privately-owned, state-of-the-art general dental practice. Our computerized practice offers Dental Implants, same-day CEREC Crowns, Digital X-rays, Cone Beam Technology, experienced staff and in-house specialty care. Florida Dental License. Full-time preferred, but will consider part-time. Visit https://careers.floridadental.org/jobs/15016310.

Seeking General Dentist for Maternity Coverage — Riverview.

We are looking for a general dentist for temporary maternity leave coverage starting in September for 4-6 weeks. Job duties can range from solely doing hygiene checks and comprehensive/limited exams, to emergency/palliative treatment to routine treatment such as crown/bridge, fillings and extractions. Job duties will depend on the candidate. Position is full time 4 days a week, 8-5 with an hour lunch break. Potential part-time associateship can be considered and negotiated depending on how maternity coverage goes. Active dental license in good standing, professional liability insurance are necessary. In person “get to know each other” interview is necessary. Paid working interview is necessary. Excellent bedside manner and communication skills with patients and staff are necessary. “Real world” dental experience preferred. Please message me for details regarding compensation and more information about our office. Visit https://careers.floridadental.org/jobs/15001750.

6 Operatory Asset Sale Only — Martin County. A 6 operatory, 1900 square foot space in Jensen Beach is available. This would be an asset only sale- No patients. Sale would include workstation computers (excluding server), recently upholstered chairs, digital sensors, Panoramic Machine, compressor, vacuum, some small equipment, instruments and some supplies. It is located in a busy Publix shopping center. This is an opportunity for an existing office to expand or a dentist wanting to own a practice with little upfront cost. Buyer would assume current lease$4400/month-includes fees and taxes. Buyer could potentially start seeing patients day one, just from walk in traffic. Asking $50,000. Visit https://careers.floridadental.org/jobs/14981693.

Seeking General Practitioner — Fort Myers. Associate Dentist Part Time in Private Practice, Fort Myers FL. Part- time Associate Dentist position available, located in the beautiful southwest Florida beachside community of Fort Myers on the coast of the Gulf of Mexico. Close communities include Bonita Springs,

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Naples, Sanibel Island, and Captiva Island. Ideal candidate would be preferably an experienced dentist (though we are welcome to new graduates as well). Opportunities available in oral surgery, selective implant placement, some endo, kids twelve and over, and all phases of general dentistry - whatever you feel comfortable doing. You can make good money depending on how much you want to work. A one-two day workweek, initially, offering 32% of billings. This practice prefers a W-2 classification.

Practitioner pays 33% of all lab bills. Long established private practice with consistent growth and collections providing excellent potential for a great candidate. The office is freestanding and is almost ten years old and is located across the street from the largest park in Fort Myers called Lakes Park. We have about 6,500 square foot office space that includes 14 dental chairs - 10 of which can be ops and two private doctor offices. The office is fully digital including Itero scanners, intraoral x-rays, and cone beam technology. We are fully engaged with an active social media presence on Facebook and Instagram. Work with a welltrained staff of ten and come down and enjoy the ocean! There are many longstanding patient relationships, providing wonderful opportunities for a rewarding work experience. We look forward to meeting you! Visit https://careers.floridadental.org/ jobs/14960539.

Clinical Assistant Professor — IL College of Dental Medicine.

[This is a shortened version of the classified ad. Visit the website for the full text.] The Clinical Assistant Professor Faculty should have earned a DDS/DMD degree, having a minimum of five (5) years’ experience in general dentistry. S/he should be a person committed to educating and empowering students with a wide range of clinical and academic abilities. The Clinical Assistant Professor Faculty must be eligible for and obtain licensure in the state of Illinois. Reporting to the Associate Dean for Clinical Sciences, the Clinical Faculty will: Work directly with students in the patient clinic, supervising all areas of general dentistry. Interact positively with students, treating all students as future colleagues.

Demonstrate dental procedures on patients to students as needed. Be competent treating patient in all areas of general dentistry.

Be a positive role model for students in professionalism. Have strong clinical experience in the use of CAD/CAM dentistry and lasers, being competent in training pre-doctoral students in these technologies. Be an example of an active life-long learner in dentistry, through learning and mentoring new techniques, emerging technologies, new materials and treatment protocols as needed by the college. Adopt different teaching techniques and styles to meet the needs of individual students. Be willing to serve on committees within the college or university. Interact professionally with all faculty and staff, treating all faculty and staff with respect and collegiality. Be timely in completing all notes and codes in patient charts. Evaluate students in a timely manner (daily, quarterly or weekly) as required by the college.

Meet with the Associate Dean for Clinical Sciences, the Clinical Faculty for reviews. Be competent in the use of the college’s patient digital record keeping system. Work professionally with specialists, mentoring to students the ideal of a positive working relationship of a general dentist with dental specialists. Be a positive influence on the MWU CDMI program. Be willing to mentor students in small groups on projects or special needs, as requested by the college. Be willing to work as a member of a team of faculty, accepting calibration of college protocols as necessary in the college teaching environment. Assume other responsibilities as needed, at the request of the clinical dean.

Applicants may send inquiries to Rebecca Siscel, DDS: Associate Dean of Clinical Education of the Dental Institute Midwestern University Illinois at rsisce@midwestern.edu. Visit https://careers. floridadental.org/jobs/14853396.

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Clinical Assistant Professor, Pediatric Dentist — College of Dental Medicine Illinois. [This is a shortened version of the classified ad. Visit the website for the full text.] The CDMI curriculum comprises integrated oral health science and basic sciences emphasizing knowledge, skills and values in clinical general dentistry, including specific disciplines of dentistry (e.g., Pediatrics, Oral and Maxillofacial Surgery, Prosthodontics, Periodontics, etc.) as required for pre-doctoral education in general comprehensive dentistry. The Pediatric Clinical Assistant Professor is responsible for Pediatric Dentistry instruction of predoctoral students, direct provision of patient care, didactic instruction of predoctoral students, contribution to the development of the CDMI curriculum and, as assigned, faculty calibration. The Full-time Pediatric Clinical Assistant Professor reports to the Assistant / Associate Dean, Clinical Education. The Full-time Pediatric Clinical Assistant Professor will be expected to serve as the CDMI content expert for the Pediatric curriculum and will work closely with the Assistant / Associate Dean for Academic Affairs and appropriate committees. The Full-time Pediatric Clinical Assistant Professor interacts significantly with the Assistant / Associate Dean for Academic Affairs, Assistant / Associate Dean for Preclinical Education and the Assistant / Associate Dean for Clinical Education. The Pediatric Dentist must communicate effectively with all CDMI General Practice Faculty and support staff. The Full-time Pediatric Clinical Assistant Professor must interact with all faculty, students and staff in a humanistic and professional manner consistent with the CDMI Professional Standards and all applicable Midwestern University policies. Applicants may send inquiries to Rebecca Siscel, DDS: Associate Dean of Clinical Education of the Dental Institute Midwestern University Illinois at rsisce@midwestern.edu.

Visit https://careers.floridadental.org/jobs/14853417.

RDH needed — Ormond Beach. Progressive dental office in need of full time or part time Registered Dental Hygienist. Must be committed to educating and advocating for their patients while providing the treatment they need and deserve. Must be people-oriented, experienced in periodontal care, and dedicated to detail and follow-up. We provide continuing education opportunities as well as leadership training to help you grow personally and professionally. Great compensation and benefits. For a challenging career opportunity, please email your resume to: johanna@saradeandental.com. RDH with at least 1 year experience. Visit https://careers.floridadental.org/jobs/14775726.

GENERAL DENTIST — Crestview. Looking for a well-established dental practice in sunny, no income tax Florida? Look no further!

Practice is located adjacent to busy FL Hwy 85 and 3 blocks north of FL Hwy 90 in the heart of the rapidly growing Community of Crestview. Crestview is located approximately 25 miles north of the white sand beaches of the Gulf of Mexico and a comfortable distance from hurricanes. The city features many amenities in addition to Universities and numerous high quality local schools. Eglin Air Force base is nearby. The Dental Office is a generous 2400 Sqft. Including: large waiting room, large reception and record area, large private office with 3/4 bath, washer and dryer, large laboratory area, kitchen and five operatories. Digital radiographs including Planmeca ProMax 2D unit. Experienced staff includes: 2 Dental Hygienists, 2 Certified Expanded Functions Dental Assistants, 1 Receptionist (also RDA), and 1 Office Manager. Opportunity for energetic dentist as: A. Associate B. Purchase Practice C. Purchase office complex, including 2 revenue generating office spaces. Revenue is upwards of 1 million dollars per year, with a four-day work week. Experienced practitioner could move to next level! Practice has been

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in the same location for over 40 years. Google rates practice 4.4 of 5. Facebook rates practice 5.0 of 5. Please contact: Michelle 850-682-4516 or Richie 850-585-5432. MUST HAVE CURRENT ACTIVE FLORIDA DENTAL LICENSE. Visit https://careers.floridadental.org/jobs/14735502.

Dentist — Miami. We are looking for a dentist looking for a private practice that focuses on relationships and long-term health.

Why working with us makes sense: 1) We offer one dental home with all dental specialties within our practices. Collaborate with specialties and colleagues to deliver the best care. We believe and implement in best-in-class dentistry. 2) Ample time is given to every patient during their visit. Our patients leave extremely satisfied and their experience means everything to us and our team. 3) Sign-on bonus. 4) Partnership opportunity after 1 year.

Medical/ Dental/ Vision. AFLAC HII. Life Insurance. FSA or HRA. Long/Short Term Disability. Student Loan Refinancing. Malpractice Insurance. NO Lab fees. 401(K) Plan & Match. Come join our dental family! NOTES: 2 openings. Employer will assist with relocation costs. Additional Salary Information: $15,000 Signing Bonus. Visit https://careers.floridadental.org/jobs/14722206.

Belleview/The Villages Fee-For-Service General Practice with Real Estate. 10-year General Dental Practice centrally located among several 55+ communities. Modern free-standing building with two operatories, plumbed for 3, on 1 acre of land on busy US 301. New AdventHealth ER and Publix are being built in immediate vicinity. Chartless office is equipped with new Patterson Fuse cloud-based software and digital sensors. This would be a great open slate for a mid-career practitioner looking for quality of life or a young dentist wanting low overhead to develop into the dream practice. May consider associate or selling real estate without practice. Picture gallery at: bit.ly/2Sy9aZF. $500k includes practice and real estate. Visit https://careers.floridadental. org/jobs/13686503.

Endodontist — Tampa. Overview: You’ve invested the time to become a great endodontist, now let us help you take your career further with more opportunity, excellent leadership and one of the best practice models in modern dentistry. As an endodontist working in an office supported by Pacific Dental Services®, you can rely on a great number of referrals as you will be providing PDS®-supported owner dentists the ability to provide excellent and comprehensive care under one roof. You will have the autonomy to provide your patients the care they deserve and provide you with the opportunity to earn excellent income and have a balanced lifestyle without the worries of running a practice. The Opportunity: You became a dentist to provide excellent patient care and an endodontist to have a career that will serve you for a lifetime. As a PDS-supported endodontist, you have the opportunity to work full-time or part-time, fantastic income opportunities and you’ll work with an organization that cares about their people, their patients and their community. You won’t have to spend your time navigating practice administra-

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tion, scheduling, or any other administrative tasks. Instead you’ll, set your hours and focus on your patients and your well-being.

The Future: As an endodontist you will receive ongoing training to keep you informed and utilizing the latest technologies and dentistry practices. PDS is one of the fastest growing companies in the US which means we will need excellent specialists like you to continue our clinical excellence in the future. Pacific Dental Services is an Equal Opportunity Employer. We celebrate diversity and are united in our mission to create healthier and happier team members. Apply here: https://bit.ly/3xDU2cK. Pediatric Dentist. Overview: You’ve dedicated your career as a dentist to helping children have happy, healthy smiles. Now let us help you take your career further with more opportunity, excellent leadership and one of the best practice models in modern dentistry. Join our practice today and join an office where you will have the autonomy to provide your patients the care they deserve. You’ll also have the opportunity to earn excellent income and have a balanced lifestyle without the worries of running a practice. The Opportunity: You became a dentist to provide excellent care in pediatric dentistry and have a career that will serve you for a lifetime. With our practice you will have balanced lifestyle, fantastic income opportunities and you’ll work for an office that cares about their people, the children they care for and their community. Our practice is an office supported by Pacific Dental Services®, which means you won’t have to spend your career navigating practice administration and instead you’ll focus on your patients and your well-being. Add on excellent benefits, including malpractice insurance, medical, dental and vision insurance, retirement plans and much more and you’ll feel well taken care of throughout your career. The Future: As a pediatric dentist, you will receive ongoing training to keep you informed and utilizing the latest technologies and dentistry practices. If you are interested in a path to ownership, our proven model will provide you with the training needed to become an owner of your own office or offices. PDS® is one of the fastest growing companies in the US which means we will need excellent dentists like you to continue to provide clinical excellence in the future. Pacific Dental Services is an Equal Opportunity Employer. We celebrate diversity and are united in our mission to create healthier and happier team members. Apply here: https:// bit.ly/36B3z8y.

General Dentist. Overview: up to $10,000 sign on bonus*. Let us allow you to do what you do best by doing the dentistry that you diagnose while exploring future partnership opportunities.

We follow through on our promise to clinicians with our culture of patient centric care, our ability to deliver comprehensive integrated care, and our ability to support modern dentistry. PDS supported owner dentists know that being backed by the country’s leading dental support organization allows them to focus on providing patient centric and clinically excellent care. Benefits: Competitive Compensation and Benefit Package; Modern offices equipped with the latest dental technology; Malpractice Insurance; Healthcare Benefits (Medical, Prescription Drugs, Dental and Vision); 401(k) Savings Plan. The average full-time PDSsupported Dentist earns $160,000 - $390,000. Testimonial from Dr. Callaway-Nelson: “Partnering with PDS has given me the opportunity to realize my dream of practice ownership. I am able to do the dentistry that I love.” Pacific Dental Services is an Equal Opportunity Employer. We celebrate diversity and are united in our mission to create healthier and happier team members. Apply here: https://bit.ly/3wEQ5mN.

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HARK

off the cusp

When I do count the clock that tells the time,

And see the brave day sunk in hideous night; When I behold the violet past prime, And sable curls, all silvered o’er with white; HUGH WUNDERLICH, DDS, CDE FDA EDITOR

When lofty trees I see barren of leaves ...

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

I am the new/old editor of the Florida Dental Association. Since Shakespeare is unavailable, you get me.

But maybe a little of the bard might engilden these editorials. Men at times are masters of their own fates.

Fusty in yond I had this job 20 years ago for 10 years.

Some might suggest my style is dated and I might be slow to embrace new technology and new media. I doth not understand wherefore those gents might balk so. You Banbury cheese! I can evolve with the most wondrous of those folk. I shall try to capture the essence of a topic and fancy the format to catcheth thine eye. Is this too Elizabethan for you? Maybe you should have listened to your English lit teacher in high school. The time of life is short and my topics shall enlighten in a pleasing embrace. However, I hail from the Midwest, and we tend to overcook our burgers and brew. I hath moved my operatory belt-driven handpiece to the lab. I am sick when I look upon my pager. Z.O.E. is not mine own primary impression material; tis mine own primary dental assistant, Zoë.

I still use my own porcelain glazing oven, but only to toast my Bagel Bites. All that glitters is not gold. My gold crowns art nay longer “cast by men,” ‘tis now “milled by mice.” I bethink my X-ray equipment only tooketh pictures in one dimension. But I doth yearn for the muse of a rack of radiographs being dunked in dip tanks: bludda-bloop … bludda-bloop. Verily, I do not miss the smell ’r thy drippy mess. My darkroom

is anon a “red-light district” for dental supplies. ‘Tis a winged cupid-painted blind. Goodbye, pegboard; holla, server in the cloud. The valiant never taste of death but once: begone mine own operatory lighting, ‘tis now a Batman battery belt that shines best upon thee. Now is the winter of our discontent. Life is so much easier but ‘twas more elegant. Consider, how the “Hokey Pokey“ would sound if written by Shakespeare: The “Hokey Pokey“ O proud left foot, that ventures quick within Then soon upon a backward journey lithe.

Anon, once more the gesture, then begin: Command sinistral pedestal to writhe.

Commence thou then the fervid Hokey-Poke, A mad gyration, hips in wanton swirl.

To spin! A wilde release from Heavens yoke.

Blessed dervish! Surely canst go, girl.

The Hoke, the poke banish now thy doubt Verily, I say, tis what its all about.

All joking aside, I’m looking forward to enhancing our publications. While I take a fun approach, our publications are an important member benefit. I am interested in new perspectives and want to represent all generations of dentistry. Whether you are a dental student, new dentist, mid-career or retiring — I want to hear from you! Let me know what you’d like to see in our publications!

To me, fair friend you can never be old. Apologies to William Shakespeare and Jeff Brechlin.

Hugh Wunderlich

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