2016 - March/April TFDA

Patient Safety FDC2016 Speaker Previews Exhibit Marketplace When Things Go Sour

Dr. Reza Ardalan and his team prepare for their annual trip to the Florida Dental Convention.

Highlights  More than 100 lectures to choose from  30 hands-on workshops  Three mini-residences VOL. 28, NO. 2 •1 •MARCH-APRIL VOL. 28, NO. JANUARY/FEBRUARY 2016

 FREE keynote sessions

each morning for ALL attendees

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contents FDC Issue

news

columns

10

House of Delegates Announcement

3

Staff Roster

16

news@fda

5

President’s Message: Discover Orlando

21

Board of Dentistry

6

Legal Notes

13

Information Bytes

f e at u r e s 24

Patient Safety Challenges in General Dentistry

32

FDC2016 Speaker Preview — Dr. Jonathan A. Bregman

36

FDC2016 Speaker Preview — Mr. Tim Twigg

40 FDC2016 Speaker Preview — Dr. Darcy M. Benghenia

60 Diagnostic Discussion 92

Off the Cusp

classifieds 84 Listings

45 FDC2016 Speaker Preview — Mr. Lucas Boyce 50 Bring Your Superheroes to FDC 58

Exhibit Marketplace

68

A Two-stage Impression Technique for Making Edentulous Impressions of Maxillary Displaceable Fibrous Tissues

72

Net Worth Perspective

76

When Things Go Sour, Volunteer Dentists Transform a Life

80 Dr. Fred Costello Runs for Congress

Read this issue on our website at:

www.floridadental.org.

www.floridadental.org

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

March/April 2016

Today's FDA

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FLORIDA DENTAL ASSOCIATION MARCH/APRIL 2016 VOL. 28, NO. 2

L A C LO Y L E V I &L GATHER FOR FUN & CONTINUING EDUCATION IN YOUR DISTRICT. ACDDA 7TH ANNUAL CE CRUISE THURSDAY, APRIL 14, 2016 Cosumel, Mexico Call 561.968.7714 to register.

CFDDA ANNUAL MEETING

FRIDAY & SATURDAY, APRIL 14-16, 2016 Marriott Orlando World Center

Speaker: Drs. Jeffery Sevor and Lawrence Dario www.cfdda.org • 407.898.3481 centraldistrictdental@yahoo.com

SFDDA ANNUAL BUSINESS MEETING WEDNESDAY, APRIL 20, 2016

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

WCDDA SUMMER MEETING

Aug. 5-7, 2016 • The Ritz-Carlton, Naples Speakers: Dr. DeWitt Wilkerson – Integrative Dental Medicine / The Complete Health Dental Practice; Dr. David Seaman – Nutrition & Inflammation www.wcdental.org • 813.654.2500 • wc.dental@gte.net

WCDDA ANNUAL MEETING

FRIDAY, FEB. 3, 2017 • CAMLS, Tampa

Speakers: Dr. John Burgess — Dental Materials & Current Restorative Techniques; Dr. John Kalmar – Topic-TBD www.wcdental.org • 813.654.2500 • wc.dental@gte.net

NWDDA ANNUAL MEETING

Friday & Saturday, Feb. 17-18, 2017 The Grand Sandestin Speakers: Dr. Tarun Agarwal, Dr. John C. Flucke, Ms. Pamela Smith www.nwdda.org • 850.391.9310 • nwdda@nwdda.org

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

EDITOR Dr. John Paul, Lakeland, editor

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

BOARD OF TRUSTEES Dr. Ralph Attanasi, Delray Beach, president Dr. William D’Aiuto, Longwood, president-elect Dr. Michael D. Eggnatz, Weston, first vice president Dr. Jolene Paramore, Panama City, second vice president Dr. Rudy Liddell, Brandon, secretary Dr. Richard Stevenson, Jacksonville, immediate past president Drew Eason, Tallahassee, executive director Dr. James Antoon, Rockledge • Dr. Andrew Brown, Orange Park Dr. Jorge Centurion, Miami • Dr. Robert Churney, Clearwater Dr. Richard Huot, Vero Beach • Dr. George Kolos, Fort Lauderdale Dr. Jeffrey Ottley, Milton • Dr. Howard Pranikoff, Ormond Beach Dr. Barry Setzer, Jacksonville • Dr. Beatriz Terry, Miami Dr. Stephen Zuknick, Brandon Dr. Ethan Pansick, Delray Beach, speaker of the house Dr. Tim Marshall, Weekiwachee, treasurer • Dr. John Paul, Lakeland, editor

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

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

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

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

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

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

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

Advertising must be paid in advance.

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

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

FLORIDA DENTAL ASSOCIATION FOUNDATION

MEMBER RELATIONS

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(FDAF)

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

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

ACCOUNTING Jack Moore, Director of Accounting jmoore@floridadental.org 850.350.7137 Leona Boutwell, Finance Services Coordinator Accounts Receivable & Foundation lboutwell@floridadental.org 850.350.7138 Joyce Defibaugh, FDA Membership Dues Assistant jdefibaugh@floridadental.org 850.350.7116 Deanne Foy, Finance Services Coordinator Dues, PAC & Special Projects dfoy@floridadental.org 850.350.7165 Tammy McGhin, Payroll & Property Coordinator tmcghin@floridadental.org 850.350.7139 Stephanie Taylor, Membership Dues Coordinator staylor@floridadental.org 850.350.7119

Meghan Murphy, Program Coordinator mmurphy@floridadental.org 850.350.7161

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

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

800.877.7597 or 850.681.2996 1113 E. Tennessee St., Ste. 200 Tallahassee, FL 32308 Group & Individual Health • Medicare Supplement • Life Insurance Disability Income • Long-term Care • Annuities • Professional Liability Office Package • Workers’ Compensation • Auto • Boat Scott Ruthstrom, Chief Operating Officer scott.ruthstrom@fdaservices.com 850.350.7146 Carrie Millar, Agency Manager carrie.millar@fdaservices.com 850.350.7155

Debbie Lane, Assistant Membership Services Manager debbie.lane@fdaservices.com 850.350.7157

RISK EXPERTS Dan Zottoli

Allen Johnson, Support Services Supervisor allen.johnson@fdaservices.com 850.350.7140 Alex del Rey, FDAS Marketing Coordinator arey@fdaservices.com 850.350.7166 Angela Robinson, Customer Service Representative angela.robinson@fdaservices.com 850.350.7156

561.791.7744 Cell: 561.601.5363 dan.zottoli@fdaservices.com

Dennis Head Director of Sales Central Florida

Mike Trout Director of Sales North Florida

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

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

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

Porschie Biggins, North Florida Membership Services Representative pbiggins@fdaservices.com 850-350-7149

Jessica Lauria, Communications and Media Coordinator jlauria@floridadental.org 850.350.7115

Director of Sales Atlantic Coast

877.843.0921 (toll free) Cell: 407.927.5472 dennis.head@fdaservices.com

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

Eboni Nelson, Central Florida Membership Services Representative eboni.nelson@fdaservices.com 850.350.7151 Melissa Staggers, West Coast District Membership Services Representative melissa.staggers@fdaservices.com 850.350.7154

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INFORMATION SYSTEMS

Will Lewis, Information Systems Helpdesk Technician/ Database Administrator wlewis@floridadental.org 850.350.7153

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COMMUNICATIONS AND MARKETING

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

To contact an FDA Board member use the first letter of their first name, then their last name, followed by @bot.floridadental.org. For example, Dr. John Paul: jpaul@bot.floridadental.org.

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March/April 2016

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2016 FLORIDA DENTAL ASSOCIATION AWARDS YOU ARE INVITED TO THE 2016 FDA AWARDS LUNCHEON. SATURDAY, JUNE 18, 2016 12-1:30 P.M. Plan to attend this very special celebration luncheon honoring our FDA President, Dr. Ralph C. Attanasi Jr., as well as the 2016 award recipients, including the FDA Dentist of the Year.

FLORIDA DENTAL ASSOCIATION 2016 AWARD RECIPIENTS PRESIDENT’S AWARD Dr. Ralph C. Attanasi Jr. DENTAL TEAM MEMBER AWARD Mrs. Cheryl Lopez FDA DENTIST OF THE YEAR Dr. Andrew Brown FDA LEADERSHIP AWARDS Dr. Yvette Godet Dr. Steven Bryan

J. LEON SCHWARTZ LIFETIME SERVICE AWARD Dr. Nolan Allen NEW DENTAL LEADER AWARD Dr. Brittney Craig PRESIDENT'S CHOICE AWARD Dr. Ethan Pansick DANIEL J. BUKER SPECIAL RECOGNITION AWARD Mrs. Carrie Millar

FDA PUBLIC SERVICE AWARDS More Health Inc. Pinellas County Dental Association Mrs. Delores Barr Weaver

Tickets are $35 per person or purchase a table of 10 for $300 — available on your FDC2016 registration form.

@Ralph RALPH C. ATTANASI JR., DDS, MS

Discover Orlando:

The No. 1 Meeting Destination in the Country!

As many of you know, Orlando has been ranked as the No. 1 family destination in the world. It also is the first choice of meeting venues for professional associations. The Florida Dental Association (FDA) is holding its annual meeting, the Florida Dental Convention (FDC), at the Gaylord Palms Resort & Convention Center on June 16-18. Come join us at this spectacular venue that provides family fun, educational experiences and one-of-a-kind entertainment opportunities for all!

This year’s FDC program is aptly titled, “The Art of Modern Dentistry.” The practice of dentistry has evolved through the years, and now — more than ever — the mixture of science and artistic vision has become one. Our meeting will take each member of the dental team on a journey that will enhance how we do what we do so well. There are courses designed for the dentist, dental hygienist, dental assistant and office manager — what a terrific opportunity for team growth and bonding!

Our keynote speakers, The Madow Brothers, Dr. Mark Hyman and Mr. Lucas Boyce, will start each day and set the tone for the day’s courses at 8 a.m. After that, you will be energized and excited to pursue your interests with the courses you have selected. After your courses or between sessions, please visit our vendors in the Exhibit Hall to see the latest and greatest products and equipment. We have more than 350 vendors who will feature onsite booth specials that are sure to delight.

Remember that as an FDA member, pre-registration for our meeting is absolutely free and that there are 18 continuing education (CE) credits available to you at no cost just for being an FDA member! Just be sure to complete your pre-registration before May 31!

And, of course, in addition to the fabulous program that the FDA puts on, we have the world’s greatest theme parks just outside of the Gaylord Palms for the enjoyment of kids and adults alike!

Please join me in congratulating the FDC Committee Chair, Dr. Bert Hughes and this year’s Scientific Program Chair, Dr. Ross Enfinger, along with the entire FDA staff and volunteers who work tirelessly all year long to make this convention the huge success that it is!

See you in Orlando!

Dr. Attanasi is the FDA President. He can be reached at rattanasi@bot.floridadental.org.

Please folow us on Facebook and Twitter.

In addition to the wide array of CE opportunities, there are a myriad of events that provide entertainment and social networking for you and your entire family. Thursday night’s Sweet Success party in the Osceola C Ballroom will feature live karaoke with you as the star — feel free to sing in costume! Friday night’s Heroes and Villains party in the Atrium is family friendly — please bring costumes for your kids for this free event! And the fun doesn’t end there — the Friday night After Party at Wrecker’s starts at 10 p.m. DJ King will be spinning and everyone is welcome to enjoy drinks and dancing. The FDA Council on the New Dentist sponsors this event.

www.floridadental.org

March/April 2016

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Legal Notes

“What about the Children?! Won’t Somebody Please Think of the Children!?”

An Advanced Discussion on Florida Informed Consent Law, HIPAA Privacy Rights and Dentistry (Part Two) Graham Nicol, Esq., HEALTH CARE RISK MANAGER, BOARD CERTIFIED SPECIALIST (HEALTH LAW)

According to Wikipedia — everyone’s favorite reference — Helen Lovejoy is a fictional character from “The Simpsons” — everyone’s favorite television show. Her catchphrase is “What about the children?! Won’t somebody please think of the children!?”

While she meant it satirically, it is an effective reminder for dentists that Florida law treats children and many others differently when it comes to informed consent and records privacy. So, next time you are faced with determining who is the decision maker for purposes of federal HIPAA and Florida informed consent law, remember Helen Lovejoy and “think about the children!” and other patients who are treated differently under Florida law.

In addition to minor children, there are several other types of patients who are treated differently under Florida informed consent and federal records privacy laws.

Part One of this article, which appeared in the January/February issue of Today’s FDA, discusses pediatric patients, natural

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or adoptive parents, emancipated minors, the “both parents” rule, divorced parents who disagree regarding treatment or records privacy of their minor children, and the legal difference between parental responsibility and physical custody.

Part Two of this article discusses other exceptions to informed consent and records privacy law. It analyzes health care powers of attorney, what to do when the dental practice cannot locate the adoptive or natural parents of the minor patient and “substitute consent,” records privacy rights when the patient has deceased, and informed consent and privacy decision involving unemancipated minors in custodial settings.

Health Care Powers of Attorney HIPAA makes no change to the way in which an individual patient grants another person power of attorney over health care privacy or treatment decisions. Florida law on these issues is not pre-empted. It allows a patient to designate anyone who is legally competent as his or her legal representative to make informed consent decisions and to access protected health information (PHI) or otherwise exercise HIPAA privacy rights on behalf of the individual patient.

When presented with a health care power of attorney, the dentist/privacy official should first determine whether it is valid under Florida law.1 For comparison purposes, the following form is valid under Florida law:

Limited Health Care Power of Attorney2 KNOW ALL MEN BY THESE PRESENTS, that ___________ and ______________, (hereafter collectively referred to as Parents) are natural or adoptive parents of _______________________, an unemancipated minor (hereafter “Child”), and do hereby jointly nominate, constitute and appoint: _______________________________________ as their attorney in fact for the limited purpose of making health care decisions (including but not limited to providing informed consent for medical treatment, surgical and diagnostic procedures and records privacy decisions) on behalf of Child.

Parents do hereby jointly give and grant unto said attorney in fact full power and authority to do and perform every act necessary, requisite or proper to be done in and about the premises as fully as they might or could do were they personally present, with full power of substitution and revocation, hereby ratifying and confirming all that said attorney shall lawfully do or cause to be done by virtue hereof, with the following limitations:

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Legal Notes 1. This limited power of attorney shall be effective only if: a) Parents are unable to make health care decisions regarding Child; or b) neither parent can be immediately located by telephone at their places of residence or businesses, as follows: _______________________ 2. Parents fully understand that this designation will permit the attorney in fact to make health care treatment and informational privacy decisions on behalf of Child, and to provide, withhold, or withdraw consent on their behalf; to apply for public benefits to defray the cost of health care; and to authorize Child’s admission to or transfer from a health care facility.

3. If the attorney in fact is unwilling or unable to perform his or her duties, Parents designate as alternate attorney in fact: ______________________________________________ 4. This limited power of attorney is not intended to and shall not pre-empt the provisions of §§743.064 and 743.0645, Florida Statutes, pertaining to, respectively, consent for emergency care and other persons who may consent to medical care or treatment of a minor.

5. This limited power of attorney shall remain in full force and effect until revoked in writing, dated and signed by Parents.

6. A copy of this signed, dated power of attorney shall be as valid as the original.

IN WITNESS WHEREOF, the undersigned have issued this limited power of attorney, effective as of __________________. ____________________ _____________________ Signature of Parent Signature of Parent

On this _________ day of ____________, _________, before me personally appeared ______________ and ________________, to me personally known and known to me to be the persons described in and who executed the foregoing instrument and they duly acknowledged that they executed same. ______________________ Notary Public My Commission Expires: Second, the doctor/privacy official should review the wording. If the form is unclear, the privacy official should clarify it before accepting the patient. It should give the named representative clear-cut authority to make “health care decisions” or “treatment decisions” in lieu of the patient. Better yet, it will explicitly authorize the representative to make “records privacy” decisions on behalf of the patient. Even if the wording does not explicitly authorize privacy decisions, the representative should be given access to the entire medical record as necessary to make a fully informed decision to consent (or withhold) care.

Third, if the power of attorney limits the representative’s authority, the privacy official must implement procedures to honor those limits. For example, if it:

n has expired, then so has the right to provide informed consent and request an accounting of disclosures of PHI or otherwise exercise HIPAA rights. n gives authority to transfer a title or take out loans, that is not valid authority over health care decisions.3 n is specific to cancer treatment, then the representative lacks authority related to dental treatment or records.

Fourth, the following rules apply if the patient is an unemancipated minor (defined in Part One), even when the representative or guardian has a valid, properly worded, health care power of attorney: n The representative still cannot give informed consent, and therefore, has no decision-making authority under HIPAA, if the parents expressly object.

In these circumstances, the Covered Entity must follow the parents’ instructions. If this occurs, the privacy official must maintain documentation to comply with HIPAA. Thus, the parents’ objections should be followed and put in writing or otherwise documented in the chart. n The representative still cannot consent to treatment if the privacy official can locate the parents with “reasonable” efforts. Similarly, the representative is not the privacy decision maker if the parents can be located. Florida law, discussed immediately below, requires the doctor to document what efforts at locating the parents were made. This documentation should be retained under the six-year HIPAA records-retention rule, not the four-year minimum Florida rule on records retention.

Before providing medical care to an unemancipated minor, all Florida doctors must document “reasonable” attempts to Please see LEGAL, 8

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7

Legal Notes LEGAL from 7

It depends on where the child lives:

get permission from the parents or the representative “otherwise provided by law” (i.e., the custodian or guardian).4 Thus, before using or disclosing PHI in minors’ records, all Florida Covered Entities also must document “reasonable” attempts to get HIPAA privacy decisions from the parents, the custodian or the guardian, as required under Florida law.

n If the child is living in a foster home, the foster parents are the representatives with informed consent authority under Florida law.5 Because they are the decision-makers for treatment under Florida law, they are the decision-makers for privacy issues under federal law.

The privacy official should obtain a copy of the court order that gives the foster parents long-term custody over the child. Unless it says otherwise, the foster parents have “all the rights and duties of a natural parent” under Florida law, including the right and duty to provide the child with “ordinary medical (and) dental care.”6 n If the child is living in a DCF facility (e.g., abandoned and awaiting placement in a foster home or adoption), the DCF caseworker is the representative.

The privacy official should obtain a copy of the agency paperwork. Whoever brings the child to the appointment usually will bring it. It should give the custodian’s name and phone number as well as the Medicaid number if the child is eligible for benefits. n If the child is living in a DJJ facility (i.e., a juvenile delinquent), the facility administrator is the representative and the privacy official should retain documentation similar to DCF custody.

Florida does not objectively define or quantify what is a reasonable attempt. However, under HIPAA, “a good faith attempt” to get the representative’s signature is acceptable.

It is the minimum required for use and disclosure of PHI. But a good faith attempt is insufficient to comply with Florida law regarding informed consent and filing of claims/disclosure of records to insurers or managed-care organizations.

When assignment of benefits and disclosure of PHI to payers is involved — as is usually the case in most private practices — Florida law adds to HIPAA. It requires the privacy official to obtain the representative’s actual signature — not merely an acknowledgment of the Notice of Privacy Practices. Because the signature requirement is contrary to and more stringent than HIPAA, it continues to apply to all Florida Covered Entities.

Foster Parents, DCF and Juvenile Delinquents Occasionally, an unemancipated minor has no natural or adoptive parents with decision-making power. In these situations, a foster parent, the Florida Department of Children and Families (DCF), or the Florida Department of Juvenile Justice (DJJ) will be the privacy decision-maker.

Documentation of the custodian’s authority as decision-maker must be retained by the Covered Entity under HIPAA’s minimum six-year records retention rule, not Florida’s minimum four-year records retention rule.

Missing Decision-makers/ Substitute Consent When the parents cannot be located, there is no health care power of attorney, and the

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unemancipated minor is not a foster child or in custody of DJJ or DCF, the doctor/ privacy official should: n Document in the patient’s chart exactly what attempts were made to locate the lawful representative. n Verify that there is no notice from the parents in the file that indicates they are the only ones authorized to make decisions,7 and then n Contact any one of the following persons, in the order of priority listed, for treatment and records privacy decisions: n stepparent n grandparent n adult brother or sister n adult uncle or aunt In other words, if the parents of an unemancipated minor are nowhere to be found, Florida law on informed consent would still prefer an aunt or uncle over the age of 18 to make the treatment decision than the minor patient! As pointed out in Part One of this article, Florida law on informed consent is anachronistic and fails to recognize the seriousness of decisions that younger teenagers are faced with making every day in our modern culture.

Developmentally Disabled or Mentally Ill Adults, Guardians and Wards Another common situation where representatives other than the patient are the privacy and informed consent decisionmakers involves developmentally disabled or mentally incompetent adult patients with court-appointed guardians. Under these circumstances, the guardian is the legal representative under Florida law, and therefore, the privacy decision-maker under federal law.

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Legal Notes Florida has a “Bill of Rights” for persons who are developmentally disabled.”8 It provides that “all persons with developmental disabilities …”9 have “all the rights enjoyed by citizens of the state and the United States.”10 These rights specifically include the “right to consent to or refuse treatment”11 and therefore, presumably include federal privacy rights as well.

But under Florida law, the developmentally disabled person’s ability to exercise these rights is limited if a probate court has appointed a “guardian advocate”12 or some other type of guardian under the Florida Guardianship Law.13 In these circumstances, the representative — not the patient — is the decision-maker on privacy and informed consent issues and the doctor/privacy official should keep a copy of the court order for a minimum of six years under the HIPAA records retention rule, not four under Florida law.

If the adult patient is mentally ill (e.g., they have been “Baker-Acted”) the rules are different.14 These rules are not discussed because dentists in private practice normally will not treat these patients. Mentally ill patients usually will be institutionalized in a hospital or mental health setting. A doctor providing care in those settings should contact the custodial facility’s privacy official for documentation of representative authority.

Deceased Patients The last situation where someone other than the patient is the Florida legal representative (i.e., the HIPAA privacy decisionmaker) involves deceased patients. This discussion has no bearing on informed consent for medical care because a dead person (barring communication from beyond the

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grave!) cannot be consulted. It is not 100 percent accurate to say that “dead people in Florida have no rights.” Instead, the survivors and loved ones of the decedent are the decision-makers for records privacy but not necessarily, for example, decisions regarding burial or other disposition of the body, medical harvesting or organ donations.

Under Florida law, the executor of the deceased patient’s estate (also known as the “personal representative”) has authority to act as the decision-maker for informational privacy. Often, but not always, the executor will be the spouse of the deceased patient.

Also, the will’s designation of someone as the personal representative is not authoritative until the probate court enters an order appointing that person.

In these situations, the privacy official should obtain a copy of the probate court order (not the will). It should be retained under the HIPAA records retention rule (six years) not the Florida rule (four years).

Conclusion Health care law is always complicated and full of exceptions to the general rule — and even exceptions to the exceptions. But, a simple rule for dentists in Florida that will remind you of the general rule and the exceptions for informed consent and records privacy law is: “What about the children?! Won’t somebody please think of the children!?”

A more complicated rule would be, “What about the children; the natural and adoptive parents; the emancipated minors; the divorced parents who disagree; the health care powers of attorney; the foster parents; the missing decision-makers and substitute consent; the juvenile delinquents; the devel-

opmentally disabled or mentally ill adults; the guardians; and, the wards!?”

Thankfully, most situations encountered in a dental practice only involve children. But, be on the lookout for those exceptions!

(Endnotes) 1 Florida law also provides for health care surrogates and proxies (see chapter 765, Fla. Stats., health care advance directives) to make health care decisions as well as attorneys in fact. Surrogates and proxies are not often encountered in private practice, being more germane to hospital settings, and are therefore outside the scope of this article.

2 A health care power of attorney form is used when natural or adoptive parents authorize someone else to make health care decisions for their unemancipated minor children (e.g., grandparents while the parents are on vacation). To be valid under Florida law, the power of attorney form must substantially conform to the sample.

3 The rule for deceased patients is slightly different.

There, the representative of the estate has authority over the privacy of the deceased patient’s records unless the probate court rules otherwise.

4 See §743.0645(3), Fla. Stats.

5 §39.01(41), Fla. Stats.

6 Id. 7 §743.0645(2), Fla. Stats.

8 §393.13, Fla. Stats.

9 §393.13(3), Fla. Stats.

10 §393.13(2)(d)1, Fla. Stats.

11 §393.13(3)(h), Fla. Stats.

12 §393.12(2)(a), Fla. Stats.

13 §744.101, Fla. Stats., et. seq.

14 §394.459(3), Fla. Stats.

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

Graham Nicol is the FDA’s Chief Legal Counsel.

March/April 2016

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HOD Announcement

House of Delegates to Meet Pursuant to the bylaws of the Florida Dental Association (FDA), all FDA members are hereby notified of the upcoming meeting of the FDA House of Delegates (HOD). The HOD will hold its annual session Thursday, June 16 at 1 p.m. and Friday, June 17 at 9 a.m. The meeting will take place at the Gaylord Palms Resort & Convention Center, 6000 Osceola Parkway, Kissimmee, FL 34746. The FDA encourages all members to seek information about the meeting from their component’s delegates to the HOD and trustees to the FDA Board of Trustees.

Exhibit Hall Only Pass

benefit

NUMBER

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

PROFESSIONAL STAFF I HELP MEMBERS SUCCEED by working with the FDC Committee to plan a diverse learning experience at the Florida Dental Convention for everyone on your team.

LOOKING FOR NEW PRODUCTS AND SERVICES BUT SHORT ON TIME? FDC2016 OFFERS TWO “EXHIBIT HALL ONLY” PASSES FOR YOUR CONVENIENCE.  Three-day Pass: $75, available for non-FDA member dentists  Saturday-only Pass: $35, available for non-FDA member dentists and team members  FREE for FDA member dentists*

This pass does not allow you to attend CE courses or events. If you wish to upgrade your registration to attend courses or events, you may do so at the Onsite Registration Desk.

* FDA members should register as FDA/ADA members.

— Jennifer Tedder FDC Program Coordinator Interested in being a speaker at a future FDC? 800.877.9922 • 850.350.7106 • jtedder@floridadental.org www.floridadentalconvention.com

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

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Today's FDA

March/April 2016

Expires 4/1/2017

www.floridadental.org

CE in the hall THURSDAY, JUNE 16 CREATING THE ULTIMATE INTERNET PRESENCE EN11  9 AM-12 PM  CE CREDITS: 0 This lecture is fully sponsored by Advice Media.

UTILIZING E-FORCSE, THE STATE’S PRESCRIPTION DRUG MONITORING PROGRAM, IN A DENTAL PRACTICE EX21  9 AM-12 PM  CE CREDITS: 3 This lecture is fully sponsored by Florida PDMP Foundation.

NEW SOLUTIONS FOR THE MISSING TOOTH CONCEPT EX31  10 AM-12 PM  CE CREDITS: 2 This lecture is fully sponsored by VIAX Dental.

FRIDAY, JUNE 17

SATURDAY, JUNE 18

DENTAL LASERS IMPROVING CLINICAL OUTCOMES & GROWING PRACTICE REVENUES

PREVENTION TODAY: ARE WE DOING ALL WE CAN? ARE WE DOING IT CORRECTLY?

EX13  9 AM-12 PM  CE CREDITS: 3

EX15  9 AM-12 PM  CE CREDITS: 3

This lecture is fully sponsored by BIOLASE.

This lecture is fully sponsored by 3M Oral Care & Atlanta Dental Supply.

THE EPIDEMIC OF DENTAL EMBEZZLEMENT — DIAGNOSIS, TREATMENT & PREVENTION EN23  9 AM-12 PM  CE CREDITS: 0 This lecture is fully sponsored by Berryhill, Hoffman, Getsee & DeMeola, LLC.

GUIDED DENTAL IMPLANT SURGERY — A LIVE PATIENT PROCEDURE EX33  10 AM-12 PM  CE CREDITS: 2

BUYING AND SELLING A DENTAL PRACTICE: ENSURING A SUCCESSFUL TRANSITION

This lecture is fully sponsored by BioHorizons.

EN12  2-5 PM  CE CREDITS: 0

EN14  2-5 PM  CE CREDITS: 0

This lecture is fully sponsored by Wells Fargo.

TIPS & TECHNIQUES TO IMPROVE YOUR PRACTICE This lecture is fully sponsored by Henry Schein Dental.

WHAT IS YOUR OFFICE REALLY TELLING YOUR PATIENTS ABOUT YOU?

FINANCING MULTIPLE DENTAL OFFICES

EN22  2-5 PM  CE CREDITS: 0

This lecture is fully sponsored by Bank of America.

This lecture is fully sponsored by Pelton & Crane.

ONE-DAY DENTISTRY IS HERE — THE FUTURE IS NOW!

EN24  2-5 PM  CE CREDITS: 0

EX34  2-4 PM  CE CREDITS: 2

CONSIDERING PRACTICE OWNERSHIP? EN25  9 AM-12 PM  CE CREDITS: 0 This lecture is fully sponsored by Bank of America.

CONVERSION OF A CONVENTIONAL DENTURE TO A FIXED HYBRID — A LIVE PATIENT PROCEDURE EX35  10 AM-12 PM  CE CREDITS: 2 This lecture is fully sponsored by Knight Dental Group.

EXHIBIT HALL COURSES ARE FREE TO FDA & ADA MEMBER DENTISTS

This lecture is fully sponsored by Patterson Dental.

THANKS TO OUR SPONSORS!

Operatory sponsored by Patterson Dental.

Corporate Classroom sponsored by Henry Schein Dental.

A Leixir Lab Group Company

Information Bytes

Windows 10: Should I Upgrade?

By Larry Darnell DIRECTOR OF INFORMATION SYSTEMS

First things first: If you are still using Windows XP, I am squarely looking at you with the “don’t roll your eyes at me” face. Support for Windows XP ended some time ago and you are putting your business/personal data at great risk by continuing to use it — no matter the reason. If you are still using Windows Vista, I feel bad for you because computers do work better than that, so you need to consider getting a whole new computer — not just the operating system. Now, if you are using Windows 7 or 8, or even 8.1, you may be asking why you need to upgrade. I admit we hate change — especially change to our technology. However, there are compelling reasons to consider upgrading your computer operating system to Windows 10 … at least 120 of them. Microsoft has indicated that this summer they intend to charge $119 for Windows 10, but you can upgrade for FREE now. That sounds like 119 reasons per computer right there.

I hear you. “My printer may not work with Windows 10. My ancient version of Microsoft Word may not work either.” After spending a year working to upgrade various computer systems to Windows 10, we have not encountered a single hardware- or software-related issue. Oh, I am sure there may be some issues out there somewhere, but that is just not enough of a compelling reason not to upgrade at this point. You may say, “It’s so different, it will affect my productivity.” And that may be true at first, but face it — we are smart people.

We have learned to adapt to changes thrown at us, given time. I could pull out the typewriter or abacus to wax nostalgic, but I don’t want to use them for work now. It is a little known fact that since the last time you upgraded your computer system or its operating system, you have likely upgraded your phone or its operating system at least twice. Upgrading to Windows 10 clearly is your call, but one you need to make now.

“

Microsoft has indicated that this summer they intend to charge $119 for Windows 10, but you can upgrade for FREE now. That sounds like 119 reasons per computer right there.

”

For more information on how to upgrade to Windows 10 as well as other benefits to you and your office, please go to https://www.microsoft.com/en-us/windows/windows-10-upgrade.

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

www.floridadental.org

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YOU are YOUR COLLEAGUES ARE NUMBER “HELPING MEMBERS SUCCEED” EVERYDAY!

1

DEDICATED VOLUNTEERS HELP YOU SUCCEED By participating in the Florida Dental Association and the Northeast District Dental Association, I am trying to reach new dentists and help them feel welcome to the profession and the community.

My goal, as a member of the FDA Council of the New Dentist, is to help new dentists understand that the collegiality of our profession has been a cornerstone to its success and will be even more important in the future. We need to change the paradigm of seeing other local dentists and specialists as competitors and re-emphasize that relationships within the dental community are integral to one’s success. Our ultimate goal is to provide our community with the absolute best in dentistry and oral medicine.

C.J. Henley, DMD

— C. J. Henley, DMD Member, FDA Council on the New Dentist (DrHenley@HenleyandKelly.com)

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

JUNE 16-18, 2016

Hot topics!

REGISTER NOW!

 SPEAR Education Series

www.floridadentalconvention.com

 Forensic Dentistry  Dental Stem Cells  CAD/CAM  Modern Implant Dentistry  New Dentist Program

Gaylord Palms reseort & convention center



orlando,florida



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

FDC Recognized in Trade Show Executive Magazine!

The Florida Dental Convention (FDC) was named one of the “Fastest 50 Growing Shows in Attendance” for 2015 by Trade Show Executive magazine! FDC also received the “Next 50” recognition for growth in net square feet of exhibit space. In addition, FDC was the only dental meeting to receive either of these awards. We now are able to use the “Top 50” logo on our website and marketing materials — be on the lookout for this special recognition!

Give Kids A Smile Event in Pensacola

children, performed 184 dental sealants, and 100 dental exams and cleanings. In addition, 5-2-1-0 Let’s Go Northwest Florida! was there to educate children about healthy eating habits, and dental assisting students gave oral hygiene instructions to the children and their families.

Enforcement of the Medicare Part D Prescriber Enrollment Requirement Delayed The Centers for Medicare and Medicaid Services (CMS) has delayed enforcement of the Medicare Part D Prescriber Enrollment Requirements until Feb. 1, 2017. However, CMS strongly encourages prescribers of Part D drugs to submit their Medicare enrollment applications or opt-out affidavits to their Medicare Administrative Contractors before Aug. 1, 2016.

If you have any questions, please contact Casey Stoutamire in the Governmental Affairs Office at 850.224.1089 or cstoutamire@floridadental.org.

Have a Tough Patient Question? Ask Dr. John Paul!

On Feb. 26-27, Pensacola Kids Dentistry hosted a Give Kids A Smile event at Pensacola State College, where Dr. Allison Simmons, along with 14 others dentists and 60 dental assisting students, volunteered their time. They were able to treat 93

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Do your patients ever ask a question that you have a tough time answering? Most likely, you’re not the only one who has been asked that same question. Let Dr. John Paul help you frame a concise and effective response to your patients’ questions. Send your questions to Dr. Paul at jpaul@bot. floridadental.org, and we’ll post his answers on the FDA Blog, “An Early Bite with Dr. John Paul,” on Tuesdays.

Member Survey Coming in April A membership survey will be emailed to all members in early April. Please watch your in-box for the survey link. In order to provide the best service possible, we need to hear from you. A sample of nonmembers will be receiving the survey as well. The information will assist the Florida Dental Association leadership and staff in planning for future programs and services.

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

Atlantic Coast District Dental Association Karoline Asbell, Delray Beach Gloria Barredo, Jupiter Maria Garcia Sarria, North Bay Village Sandra Gomez, Fort Lauderdale Eric Gott, Wellington Andrew Lager, Jensen Beach Richard Mancuso, Deerfield Beach Brenda Schobert Capetillo, Hollywood Anthony Sconzo, Jupiter Robert Simon, Boca Raton Samantha Steiner, Coral Springs

Central Florida District Dental Association Tauseef Bhatti, Palatka Gary Cardoso, Plantation Jennifer Fraser, Lake Mary

www.floridadental.org

Katie Heald, Tavares Amit Kamat, Orlando Theodora Kompotiati, Gainesville Nhu Le, Kissimmee Song Mao, Miramar Jeffrey Molloy, Windermere Elana Oliver, Orlando Darshan Patel, Longwood Savanna Peterson, Plantation Jesse Rosario, Orlando Estela Truzman, Miami Travis Weeks, Winter Park

Northeast District Dental Association Barron Banks, Jacksonville Hiran Master, Jacksonville

Northwest District Dental Association Shawn Hanway, Tallahassee Alex Jeffrey, Niceville

South Florida District Dental Association Patrick Abuzeni, Miami Ariam Alvarez, Hialeah Raffaella Armstrong, Doral Vanessa Arzola Rivera, Miami Tiffany Brady, Miami Mauro Carballo, Miami Maribel Carbia, Miami Noslen De Lapuente, Fort Lauderdale Benita DeMirza, Miami Ricardo Dubois, Miami Lakes Flavia Goncalves, Sunny Isles Beach Amr Hassan, Miami Leyane Hernandez Nunez, Miami Flavio Kottar, Miami Liudmila Labrada, Weston

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Maria Lopez, Hialeah Jessica Macagno, Miami Jaime Marquez, Boca Raton Gianny Montenegro, Pembroke Pines Eric Murias, Miami Lakes Hansel Navarrete, Hollywood Sandy Pape, Key West David Peretz, Hollywood Alba Perez Carmona, Miami Tania Santos, Doral Yuchen Sheng, Hallandale Beach Rita Steiner, Miami Beach Maria Ucros, Doral Natalia Vazquez Marrero, Key West

West Coast District Dental Association Lorielle Alter, Tampa David Altman, Tampa Leanet Ascunce, Fort Myers Thomas Bevelock, Bradenton Dianelis Blanco, Naples Carol Bou-Sliman, Palm Harbor Robert Branstrator, Marco Island Anne Broderick, Estero Volha Budzinkski, New Port Richey LoanAnh Bui, Lakewood Ranch Guifang Cai, New Port Richey Juan Fabrega, Tampa Ryan Harris, Fort Myers Melita Islambasic, Tampa Bayonne Joseph, Fort Myers Frank A Kaman, Sarasota Konstantine Lagos, Winter Haven Andrew Langston, Nokomis Susana Martinez, Lakewood Ranch Bibek Nakarmi, New Port Richey Lisa Painter, Tampa Jose Peralta, Windermere

Diane Piper-Hilton, Saint Petersburg Eduard Pocola, Wesley Chapel Mary Prendiville, Tampa Amanda Rizner, Lakewood Ranch Manuel Rodriguez, Cape Coral Ahmed Saleh Kiwan, Fort Myers Sue Schlissel, Sarasota Christopher Shannon, Davenport Kenan Tarabishy, Wesley Chapel Mine Turhan, Bradenton

In Memoriam The FDA honors the memory and passing of the following members: Paul O. Austin Gulf Breeze, FL Died: 1/21/16 Age: 68 Marc H. Frankel Hollywood, FL Died: 1/24/16 Age: 54 Charles D. Hall Vero Beach, FL Died: 2/1/16 Age: 86 David H. Huang West Palm Beach, FL Died: 2/26/16 Age: 52

March/April 2016

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The Nation’s Largest Doctor-Owned Medical Malpractice Insurer

4 REASONS WHY YOU SHOULD HAVE THE DOCTORS COMPANY ON YOUR DENTAL TEAM 1. Florida Clout, National Perspective With an established team in Florida, The Doctors Company and the Florida Dental Association have the local expertise to meet your needs and the national insight to identify emerging threats and protect you with innovative solutions.

2. Our Defense Never Rests We are relentless in protecting your livelihood and reputation, beginning with the promise never to settle a claim without a member’s consent. If a claim is made against you, you’ll be backed by the nation’s top medical malpractice attorneys.

3. Discounts for FDA Dentists Florida Dental Association members enjoy 5 percent program discounts, and members may also qualify for discounts of up to 10 percent for remaining claims-free. New dentists receive a 80 percent discount, and part-time practice discounts of up to 75 percent are also available.

4. Unrivaled Financial Rewards The Tribute Plan® rewards your loyalty and your commitment to outstanding patient care and keeping claims low. No other Florida insurer offers a benefit of this magnitude.

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WAKE UP TO INSPIRATION! 8-9 AM  Pre-registration is FREE for all attendees.  $10 after May 31st.

AUDIENCE: Dentists, Dental Students, Assistants, Hygienists, Administrative Staff, Laboratory Technicians, Guests

THURSDAY, JUNE 16

FRIDAY, JUNE 17

SATURDAY, JUNE 18

THE MADOW BROTHERS ROCK Your Practice to the Top!(PM02)

DR. MARK HYMAN The Secret Sauce!

LUCAS BOYCE Living Proof (NC07)

Through music, comedy and videos, The Madow Brothers illustrate the triumphs and frustrations all dentists and team members experience on a daily basis. Laughing and learning together promotes teamwork and accomplishment, and The Madow Brothers are prepared to teach and entertain you in a way you have never experienced at a dental event! Dental teams will become educated with better communication skills and be more able to function as a true team and love their career. Come and learn how to identify the frustrations and pitfalls that can prevent dentists and team members from performing at the highest possible level.

The Hidden Ingredients of Highly Successful Teams (NC05) What is it that differentiates the top practices from the average? What is their “secret sauce?” — It’s the formula that leads to extraordinary production, collection, overhead control, team retention and FUN! Laugh and learn as we reveal the formula, discuss action steps and see your team re-engage and thrive today!

In this session, you’ll learn how to plan, implement and improvise when things go wrong. Review the art and science of optimal, comprehensive care. Dr. Hyman will discuss how to create experiences, not just transactions.

You’ll also have the chance to evaluate the quality of your leadership, doctor and teams.

Learn about Lucas’ journey to overcome significant obstacles to achieve three once-in-a-lifetime goals. Personal history or external conditions outside of our control don’t have to determine our future trajectory, success and/or fulfillment.

Lucas shares why our obstacles and limitations become irrelevant when we understand our life purpose and are willing to reach for something more. It doesn’t matter at what station of life we find ourselves, we are built for something more. We are meant to succeed. Lucas is living proof of this and shares his view on what it takes to overcome, stand up and stand out.

Board of Dentistry

Board of Dentistry Meets in Bradenton

By Casey Stoutamire FDA LOBBYIST

The Florida Board of Dentistry (BOD) met in Bradenton on Friday, Feb. 19. The Florida Dental Association (FDA) was represented

by FDA BOD Liaison Dr. Don Ilkka and FDA Lobbyist Casey Stoutamire. Other FDA members in attendance included Drs. Andy Brown and Bill D’Aiuto. Also, in attendance were third- and fourth-year students from the Lake Eerie College of Osteopathic Medicine (LECOM) School of Dental Medicine.

Eight out of 11 BOD members were present, which included Dr. Robert Perdomo, chair; Drs. Joe Calderone, Naved Fatmi, Bill Kochenour, Claudio Miro and T.J. Tejera; hygienist, Ms. Angie Sissine and consumer member, Mr. Tim Pyle. Dr. Joe Thomas, vice chair, and hygienist, Ms. Catherine Cabazon, were absent. This was Dr. Perdomo’s first meeting as chair.

The BOD heard an in-depth presentation on the U.S. Supreme Court ruling in the North Carolina State Board of Dental Examiners v. FTC. This ruling will change the way all regulatory boards operate in Florida, as well as around the country. However, several questions were left unanswered by the Supreme Court opinion and will have to be

www.floridadental.org

decided by the lower courts in the years to come. For example, the Supreme Court held that decisions of a board must include active supervision, but it did not define what active supervision is or is not. The Florida Office of the Attorney General basically recommended that in order to comply with this decision moving forward, all actions by the BOD, especially rulemaking, will be scrutinized by the board attorney, Mr. David Flynn, for anti-competitive implications, as well as by attorneys from the anti-trust division of the Attorney General’s office.

Furthermore, while the decision applies to all board action moving forward, it also could apply to rules already promulgated if someone brings a challenge based on anticompetitiveness. However, the most pressing issue is that BOD members now can be held personally liable under anti-trust lawsuits. At this time, Florida’s Division of Risk Management has stated that it will not cover defense costs, damages or attorney’s fees if a board member is sued in an anti-trust action, which means the BOD members are not protected by any sort of insurance policy. The Legislature would need to direct the Division of Risk Management or some other entity to indemnify all regulatory board members to ensure their personal assets are protected. The BOD approved a motion directing BOD Executive Director Ms. Jennifer Wenhold to send a letter to the governor, senate president and speaker of the House explaining the problem and encouraging the legislature to take action.

Next BOD meeting The next BOD meeting is scheduled for Friday, May 20, 2016, at 7:30 a.m. in Jacksonville at the Hyatt Regency Jacksonville.

Mr. Mark Whitten, Chief of Investigative Services, Division of Medical Quality Assurance for the Department of Health (DOH), discussed the coordination of investigations for complaints received regarding dental care in nursing homes, assisted living facilities and other settings regulated by the Agency for Healthcare Administration (AHCA). At the BOD’s request, the DOH and AHCA will make unannounced visits to these facilities to see what type of care is provided and to ensure quality standards. AHCA and DOH investigators will work together to inspect these types of facilities and if violations are found, AHCA will take appropriate action against the facility and the BOD will take appropriate action against the dentist or hygienist.

Mr. Flynn gave a rules report and a hearing was held on Rule 64B5-17.002, Written Dental Records: Minimum Content, Retention, which is now effective. Nova Southeastern University College of Dental Medicine (Nova) challenged this rule, specifically the removal of subsection (9) pro bono dental events. Nova’s attorney, Ms. Please see BOD, 22

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Board of Dentistry BOD from 21

Jennifer Garner, said their concern was that with this provision deleted, Nova would no longer be able to provide pro bono dental care. Mr. Flynn assured Ms. Garner this was not the case and that this section had no bearing on whether a provider could or could not provide free dental services. With the removal of subsection (9), records of treatment provided at a pro bono event will need to be kept for at least four years.

In addition, a Statement of Estimated Regulatory Cost (SERC) for Rule 64B514.010, Pediatric Conscious Sedation Requirements, was passed. All pediatric conscious sedation permit holders will be required to have a capnograph. This rule was approved at the November 2015 BOD

meeting, but the SERC was inadvertently left out. It is a formality for the rule-making process. The requirement for all conscious sedation and pediatric conscious sedation permit holders to have a capnograph will be effective around mid-April. The FDA will update its members when the final rule is published. Finally, Rule 64B5-9.011, Radiography Training for Dental Assistants, was modified to update the language so it reflects current language and training.

The BOD unanimously approved a petition by the FDA Foundation to formally approve the Florida Mission of Mercy as a not-for-profit pro bono program under Rule 64B5-12.0185 so participating volunteers may receive continuing education (CE) credit. In addition, the BOD approved

a motion for Advanced Cardiac Life Support and Pediatric Advanced Life Support (ACLS/PALS) hours to be included as part of the 30 hours of CE required per biennium. Currently, the ACLS/PALS hours are in addition to the 30 required hours.

There were four disciplinary cases that dealt with failure to meet the standard of care and Medicaid fraud. If you have not yet attended a BOD meeting, it is suggested that you take the opportunity to attend and see the work of the BOD. It is much better to be a spectator than a participant in BOD disciplinary cases.

Congratulations, Florida Dental Convention!

The Florida Dental Convention (FDC) was named one of the “Fastest 50 Growing Shows in Attendance” for 2015, and “Next 50” recognition for growth in net square feet of exhibit space by Trade Show Executive magazine.

FDC was the only dental meeting to receive either of these awards!

FDC2016 will be held June 16-18 at the Gaylord Palms Resort & Convention Center in Orlando, FL. Register today at www.floridadentalconvention.com/registration.

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“

Dentists face many patient safety challenges in their practices, with risks appearing throughout the care process — from patient selection to complying with medical waste disposal laws.

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Safety

Patient Safety Challenges in General Dentistry

By David O. Hester, FASHRM, CPHRM, Director DEPARTMENT OF PATIENT SAFETY AND RISK MANAGEMENT, THE DOCTORS COMPANY

Dentists face many patient safety challenges in their practices, with risks appearing throughout the care process‑from patient selection to complying with medical waste disposal laws.

Here are some of the most frequent risk management issues dentists face, as well as steps you can take to reduce potential liability and improve patient safety in the office.

Infection Control Following these infection control practices vigilantly can reduce the chance that you, your staff or your patients will become infected: n Ensure that everyone follows universal precautions with every patient. n Wear your personal protective equipment. n Always wash your hands before donning gloves and again after removing them. Change gloves between patients. n When gloved, don’t touch noncritical patient care items with anything that is not barrier-protected or cleaned between patients. n Use any single-use disposable instrument only once, and then dispose of it properly. n Follow the manufacturer’s directions for autoclaving dental instruments. Perform biological monitoring and document the monitoring results. Store sterilized instruments in a clean, dry and protected environment. n Establish a dirty area for processing and cleaning instruments in preparation for autoclaving to avoid cross-contamination of clean and sterilized items. n Select appropriate devices that reduce risk of injury and contamination. n Manage occupational exposure to blood-borne pathogens, including post-exposure prophylaxis for work exposure to hepatitis B virus, hepatitis C virus and HIV. n Monitor dental unit water lines, biofilms and water quality. Consult with the manufacturer for their recommended frequency of monitoring.

Dental Histories Ask patients the right questions in the dental history. At a minimum, the questionnaire should include a patient’s appraisal of current health status, current medical treatment and medications, history of disease by system (with attention to congenital or valvular heart disease), and a history of high blood pressure, stroke, diabetes, thyroid function, bleeding disorders, malignancy, AIDS, chronic or acute infections, allergies and venereal disease. The questionnaire also should include the status of pregnancy and the existence of pacemakers, valvular replacements and prosthetic joints.

The dental history also should include information regarding previous dental work, radiographs, oral hygiene practice, oral habits, attitudes toward dentistry and the reason for the patient’s visit.

Identify high-risk patients, and place an alert in their dental records in a conspicuous location. High-risk patients include those on anticoagulants, immunosuppressants, bisphosphonates, and other treatments or medications for chronic medical conditions.

Patient Selection Selecting the right patient is imperative.

This is especially true for elective aesthetic procedures, which are the most frequent cause of litigation in general dentistry.

When interviewing a patient for an elective procedure, consider the individual’s chief complaint and concerns, expectations, aesthetic concerns and needs. For more on this topic, read our article, “Patient Selection for Elective Procedures,” which can be found online at bit.ly/1Um0bT8. Be especially cautious in planning treatments for patients who have unrealistic expectations and patients who demand an assurance or guarantee of results.

Compliance Follow state laws when purchasing, registering and maintaining radiology equipment. For example, you must comply with manufacturers’ recommendations on maintenance schedules and record keeping.

Please see SAFETY, 27

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www.pscsales.com PSC Group Team Members

Lamar Mann Equipment & Digital Technology Sales

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Julio Flores-New Equipment Sales & Service

Georgia Chiki Diane Sollaccio Equipment Sales & Technical Service Operations Manager Support

Professional Sales Consulting Group is a team of professionals that have over thirty five years of experience in the dental field. Whether your requirements are for equipment, products or service repair we stand ready to fulfill your needs.

PSC Group is your complete source for all aspects of growing your dental practice. We are your answer in handling all of the requirements to make your office run smoothly and efficiently.

PSC Group is your answer for all your equipment needs: chair & unit pkgs, cabinetry & digital technology.

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Safety SAFETY from 25

Employees who operate or work around radiological equipment must receive safety training. Additionally, dental offices generate medical waste, including sharps, pharmaceuticals and biohazardous materials. Medical waste disposal is governed by Florida law through the Occupational Safety and Health Administration (OSHA).

CDT 2016 Code Check App

iOS & Android

iOS

This handy, searchable app contains the new dental procedure codes, including 19 new codes and 12 revised codes. Features include: A complete listing of 2016 CDT Codes New and revised codes listed with tracked changes Searchable code number, keyword & category

When a general dentist ventures outside the scope of practice, complications may result in harm to the patient. A dentist should not attempt procedures that are beyond his or her education, experience and expertise. Patient injury can be prevented through referral, treatment selection, choice of technique and common sense.

Chairside Instructor App

Patient Mishaps

Updated to include video clips, Spanish text, WiFi printing, and ability to upload photos from your own camera roll. You also can draw on a picture, add a comment, email it to a patient, and save for future use.

Handle patient mishaps carefully. For example, if a patient inadvertently swallows part or all of a tooth, crown or dental instrument, inform the patient immediately, and refer him or her for a chest or gastrointestinal X-ray. Any abnormal results should be reviewed by the patient’s physician, and a follow-up appointment with the physician should be scheduled. Document the dental record with any treatments provided and all discussions of the event, treatment options and referrals for medical care.

Coordinate arrangements with the patient and the treating medical practitioner for medical care and X-rays. Communicate with the patient’s physician and maintain a dialogue with the patient.

Notify your patient safety risk manager.

Toothflix 2.0 App

iOS

Patient education! The app includes all 26 updated Toothflix 2.0 videos, intuitively arranged for quick access. Email videos to patients before or after a consult; mark your favorite videos or even the exact video clips you show most often.

Oral Pathologist App

iOS & Android

ADA Oral Pathologist is a chair-side reference to oral pathology conditions that can assist dentists with formulating diagnoses. Dr. Michael Kahn, of the Department of Oral and Maxillofacial Pathology at Tufts University School of Dental Medicine, wrote and developed content for the app. Search more than 200 conditions or by entering clinical observations.

Florida Dental Convention

iOS & Android

Scope of Practice

Everthing thing you need to know about the FDA's official annual meeting. Maps, course listings, speaker profiles, and scheduled events. Available before the convention at floridadentalconvention.com. Come for the CE. Stay for the fun! Available May 2016.

ADA ORDERING: iOS – Order from adacatalog.org, and then complete your download in the App Store. Android: Order from adacatalog.org, then complete your download from the Google Play store.

www.floridadental.org

The guidelines suggested here are not rules, do not constitute legal advice and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each health care provider in light of all circumstances prevailing in the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.

Reprinted with permission. ©2016 The Doctors Company (www.thedoctors.com).

Mr. Hester will be speaking at FDC2016, and is presenting three courses. His course, “What to Do if You are Sued for Malpractice,” will be on Friday, June 17 at 9:30 a.m. and is part of the New Dentist Program, “Success is your Future: The New Dentist Practical Guide for Success.” Also on Friday, he will present, “Prevention of Dental Errors,” at 2 p.m., with a repeat of the lecture on Saturday, June 18 at 2 p.m.

March/April 2016

Today's FDA

27

1

ONLINE CREDIT CARD PAYMENT

2

CREDIT CARD PAYMENT VIA PHONE OR MAIL

3

Visit floridadental.org/dues to pay your dues in full or set up a dues installment plan with a credit card.

LEGISLATIVE ADVOCACY The Florida Dental Association is a major leader in the health care advocacy arena. The FDA Governmental Affairs Office tracks and analyzes legislation affecting dentistry and health care in Florida.

FDA SERVICES INC. WE KNOW INSURANCE. WE KNOW DENTISTS. FDA SERVICES (FDAS) provides members with all of the insurance they need for their practice. Revenue from insurance sales goes directly toward helping FDA programs and lobbying efforts important to members.

Call the member relations team at 800.877.9922 to make a credit card payment in full over the phone or use the self-addressed blue envelope to submit your payment in full, or enroll in the dues installment plan by submitting your dues statement with your credit card information.

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EXCLUSIVE DEALS AND DISCOUNTS — FDA Services has researched and vetted business solutions so FDA members can take advantage of exclusive deals and discounts. Members who participate will save time, money and hassle, putting the focus back on patient care.

HAVE QUESTIONS ABOUT YOUR DUES STATEMENT? Go to www.floridadental.org/dues for answers to frequently asked questions!

NEED MORE HELP? Our FDA Member Relations Department is always ready to help with any questions.

Call 800.877.9922 or email membership@floridadental.org.

The FDA’s award-winning journal offers news, commentary, scientific studies and practice management articles.

The journal keeps members apprised of association news and the latest advances in the dental profession.

CONTINUING EDUCATION YOUR BEST SOURCE FOR CONTINUING EDUCATION! Look to the FDA for the best buy in continuing education in the Southeast: Florida Dental Convention, free online continuing education, and free webinars on practice and risk management.

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

Contact us at membership@floridadental.org or 800.877.9922.

THE FDA COUNCIL ON THE NEW DENTIST

PRESENTS

THE PARTY DOESN’T HAVE TO END! Join the “New Dentists” at Wreckers on Friday, June 17 at 10 PM-1 AM. Enjoy drinks, dancing and DJ King playing all your favorite hits.

Whether Whetheryou youare areaanew newdentist dentistor oraastudent studentdentist, dentist,this thisisisaamust musttake takeprogram. program.Come Comehear hearvarious variousspeakers speakersas as they theyteach teachyou youeverything everythingyou youneed needto toknow knowto tohit hitthe theground groundrunning. running.Jumpstart Jumpstartyour yourdental dentalcareer career with with these these pearls, pearls,designed designedjust justfor foryou, you,the thenew newand/or and/orup upand andcoming comingdentist. dentist.From Fromhiring hiringan anenergetic energeticteam teamto tocompletcompleting ingyour yourfirst firstbig bigcase, case,this thisday dayand andaahalf halfprogram programwill willprovide provideyou youwith withall allthe thetools toolsyou youneed needfor forsuccess. success.

C63 (APPLIESTO C63  CE CECREDITS: CREDITS:22(APPLIES TOSATURDAY SATURDAYONLY) ONLY) ADMINISTRATION ADMINISTRATION//ENRICHMENT ENRICHMENT//TREATMENT TREATMENTPLANNING PLANNING FRIDAY, FRIDAY,JUNE JUNE17TH 17TH  99AM-5 AM-5PM PM SATURDAY, SATURDAY,JUNE JUNE18TH 18TH  9:30 9:30AM-12 AM-12PM PM (GRADUATESOF AUDIENCE: AUDIENCE: DENTISTS DENTISTS(GRADUATES OF2006 2006OR ORLATER), LATER), DENTAL DENTALSTUDENTS STUDENTS

REGISTRATION REGISTRATIONCATEGORY CATEGORY

EARLY 4/4 REGULAR

REGULAR ONSITE 6/1

ONSITE 6/1

DENTIST DENTIST--FDA/ADA FDA/ADAMEMBER MEMBER

$99 $99

$99 $110

$110

NON-MEMBER NON-MEMBERDENTIST DENTIST

$99 $99

$99 $110

$110

FRIDAY, FRIDAY,JUNE JUNE17 17  99AM-5 AM-5PM PM 8-9 8-9AM AM HYMAN, HYMAN,DR. DR.MARK MARK

11:15 11:15AM-12 AM-12PM PM  TWIGG, TWIGG,MR. MR.TIM TIM

THE THESECRET SECRETSAUCE! SAUCE!THE THEHIDDEN HIDDENINGREDIENTS INGREDIENTSOF OFHIGHLY HIGHLY SUCCESSFUL NC05* SUCCESSFULTEAMS TEAMS NC05*

EMPLOYMENT EMPLOYMENTCOMPLIANCE COMPLIANCEFOR FORDENTISTS: DENTISTS: WHAT WHATYOU YOUDON’T DON’TKNOW KNOWCOULD COULDHURT HURTYOU YOU Hiring Hiringand andunderstanding understandingemployee employeemanagement managementcan canbe beoverwhelmoverwhelming. ing.An Anemployee employeelawsuit lawsuitcan canbe beemotionally emotionallydraining drainingand andfinancially financially devastating. devastating.Dealing Dealingwisely wiselyand andeffectively effectivelywith withcomplex complexemployment employment issues thethe most up up-to-date to date inforissuescan canbebeparticularly particularlychallenging. challenging.Learn Learn most inmation about labor compliance. formation about labor compliance.

SEE SEETHE THEFDC FDCREGISTRATION REGISTRATIONBROCHURE BROCHUREFOR FORAAFULL FULLDESCRIPTION. DESCRIPTION.

9:10-9:30 9:10-9:30AM AMMILLAR, MILLAR,MS. MS.CARRIE CARRIE THE THEFLORIDA FLORIDADENTIST DENTISTADVANTAGE ADVANTAGE Entering Enteringthe the“real “realworld” world”ofofdentistry dentistrycan canbe beaavery veryoverwhelming overwhelmingexexperience. perience.From Fromsigning signingcontracts contractstotochoosing choosingthe theright rightservice serviceprovidproviders, ers,this thissession sessionisissure suretoto“wow” “wow”you. you.Come Comelearn learnhow howtotohit hitthe theground ground running runningwhile whilesaving savingtime, time,headaches headachesand andmoney. money.

9:30-10 9:30-10AM AMHESTER, HESTER,MR. MR.DAVID DAVID WHATTO TODO DOIFIFYOU YOUARE ARESUED SUEDFOR FORMALPRACTICE? MALPRACTICE? WHAT Youcan canbe benamed namedininaasuit suitfor forany anynumber numberofofreasons reasonsregardless regardlessofof You whetherthe thesuit suithas hasmerit meritorornot. not. This This session sessionwill willdiscuss discussthe theinitial initial whether stepsyou youshould shouldtake takeininresponse responsetotothe theallegation allegationalong alongwith withrecomrecomsteps mendationsfor forpreparing preparingtotodefend defendthe thesuit. suit.InInaddition, addition,the thetheories theoriesofof mendations liabilityalong alongwith withthe thecomponents componentsofofthe thelegal legalsystem systemwill willbe bereviewed reviewed liability

10:05-10:35AM AM 10:05-10:35 ERICKSON,MR. MR.CHAD CHAD//SEIGEL, SEIGEL,MR. MR.DARREN DARREN ERICKSON, LEVERAGINGSOCIAL SOCIALMEDIA MEDIAAND ANDPROTECTING PROTECTINGYOUR YOURREPUTATION REPUTATION LEVERAGING Socialmedia, media,reviews reviewsand andSEO SEOdemonstrate demonstratethe thepower powerofofthe theInternet.

Internet.

Social Beaamedia mediagiant gianton onaastartup startupbudget. budget.Don’t Don’tfall fallprey preytotonegative negativeonline online Be reviews.Our Oursimple simplestrategies strategieswill willhelp helpyou youachieve achievepractice practicesuccess, success, reviews. communityprofessionalism professionalismand andmaintain maintainyour yourreputation. reputation. community

10:40-11:10AM AMCLAYTON, CLAYTON,MS. MS.ANGELA ANGELA 10:40-11:10 CHOOSINGTHE THECONSULTANT CONSULTANTTHAT’S THAT’SRIGHT RIGHTFOR FORYOU YOU CHOOSING businessfor forthe thefirst firsttime? time?We Wemust mustoften oftenrely relyon onprofessionals professionalstoto InInbusiness helpguide guideus usthrough throughthe themaze mazeofofdental dentalpractice practicelife. life.Come Comelearn learnkey key help principlesabout aboutwhat whattotolook lookfor forininaaconsultant. consultant.You Youwill willalso alsolearn learn principles whattotoexpect expectfrom fromtheir theirservices servicesas aswell wellas asunderstanding understandingthe theROI. ROI. what

30 Today's FDA

March/April 2016

2-2:50 2-2:50PM PM  URA, URA,MR. MR.EDMUND EDMUND COMPENSATION COMPENSATIONAND ANDPERFORMANCE PERFORMANCEMANAGEMENT MANAGEMENT Team Teammanagement managementisisone oneofofthe thekeys keysfor forpractice practicesuccess. success.OrganizaOrganization tiondesign, design,job jobdescriptions, descriptions,performance performancemanagement managementand andcompeticompetitive compensation compensation are are aa few few challenges challenges facing facing new new dentists. dentists. Learn Learn tive howtotoattract, attract,retain retainand andmotivate motivateyour yourteam teameffectively. effectively.You Youwill willalso also how learncurrent currentFlorida Floridacompensation compensationrates ratesininthe thedental dentalfield. field. learn

3-3:50PM PM  OWENS, OWENS,MS. MS.ALICIA ALICIA 3-3:50 THREEPILLARS PILLARSTO TOSUPPORT SUPPORTYOUR YOURPRACTICE PRACTICE THREE Goodbusiness businessmanagement, management,including includingsoftware softwareintegration, integration,will willlead lead Good greaterprofessional professionalsuccess. success.Learning Learningthe thethree threeimportant important pillars pillars totogreater practicesuccess successisiskey: key:optimizing optimizingpractice practicemanagement managementsoftware; software; ofofpractice trackingnumbers; numbers;and, and,the thedaily daily huddle. huddle. Learn Learn how how toto manage manage your your tracking practiceand andstay stayon ontop topofofyour yourpatients patientsneeds. needs. practice

4-5PM PM  JOYNER, JOYNER,MS. MS.STACY STACY//SPIWAK, SPIWAK,MS. MS.ERIN ERIN 4-5 10FINANCIAL FINANCIALSTEPS STEPSTO TOBUILDING BUILDINGAAPOLISHED POLISHEDPRACTICE PRACTICE 10 Buildingaapolished polishedpractice practicetakes takestime timeand andknowledge. knowledge.Understanding Understanding Building moneyand andits itsfinancial financialaccounting accountingcan canhelp helplead leadyou youtotolong-term long-termsucsucmoney cess.

Come explore the 10 key financial steps to building a career that cess. Come explore the 10 key financial steps to building a career that is fulfilling and ever lasting.

Learn about cash flow, embezzlement, is fulfilling and ever lasting. Learn about cash flow, embezzlement, payrolloptions, options,financially financiallysound soundequipment equipmentpurchases, purchases,and andso somuch much payroll more. more.

orlando,florida i www.floridadentalconvention.com

the new dentist guide for success The New Dentist Program is fully sponsored by

SATURDAY, JUNE 18  9:30 AM-12 PM 8-9 AM  BOYCE, MR. LUCAS LIVING PROOF  NC07* SEE THE FDC REGISTRATION BROCHURE FOR A FULL DESCRIPTION.

9:30-10:30 AM  RAWAL, DR. SUNDEEP I GOT MY FIRST LARGE PROSTHETIC CASE ... NOW WHAT? Complex therapy can sometimes be uncharted territory for the general restorative dentist, especially with the full arch rehabilitation. With dental implants and the use of technology, there can be confusion as to how best to approach cases from the start. This course is intended to demonstrate the diagnostic and clinical steps necessary to follow once patients have accepted complex treatment therapies.

COME FOR THE CE, STAY FOR THE FUN! Join us at the nightly social and alumni events to network and socialize with your fellow colleagues and friends after a day of learning & CE earning.

10:45-11:45 AM  MURPHY, DR. MARK IMPROVING CASE ACCEPTANCE, MOVING PAST INSURANCE ENTITLEMENT We live in a cynical time that rewards quick fixes, fast food, ATMs and instant everything. Taking time to help our patients WANT what we know they NEED, drives the economic and reward engine of our practice. Help more patients have better health, do more of the dentistry that fulfills and stimulates you, and be more successful in your practice. Mark provides an entertaining program full of useful tips and ideas that you can put to use right away. By utilizing excellent communication skills, patients will say yes more often to you and then to your treatment plans. He will demonstrate how to improve the educational value of the examination experience and overcome the insurance entitlement behavior that patients often exhibit.

* Keynote sessions must be registered for separately from C63.

ENHANCE YOUR LEARNING! Add “A Day in the Life of a Top Gun Dental Team,” (PM06) on Saturday, 2-5 PM to your course itinerary. Refer to the FDC Registration Brochure for a complete course description and pricing.

The official meeting of the florida dental association

THURSDAY  FDA Services Happy Hour, 5-6 PM  Sweet Success, 8-11 PM

FRIDAY  Gator Reception, 5-7 PM  Nova Southeastern University College of Dental Medicine: Alumni and Friends Reception, 5:30-8 PM  Ohio State University College of Dentistry Alumni Reception, 5:30-7:30 PM  ASDA Reception, 6-8 PM  Heroes & Villains, 7-10 PM  The After Party, 10 PM-1 AM

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speaker preview

The Oral Cancer Epidemic

By Dr. Jonathan A. Bregman

“

The dentist, along with the entire dental team, must continually make every effort to save lives through early detection, along with educating patients and our communities about the risk factors for oral cancer.

32 Today's FDA

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March/April 2016

More than 10 years ago, oral cancer had its place within the concerns of dental health care providers. But today, the incidence of new cases of oral cancer has exploded to levels never before imagined. s Why this increase? s How are both patients and dental practitioners at higher risk than ever before? s What oral cancer office protocols must be clarified to reflect today’s world?

The Changing Risk Factors for Oral Cancer At one time, oral cancer was a disease mostly limited to white men aged 45 and older who used tobacco and drank alcohol to excess (with a small number in that group due to family history). Today, the number of oral cancer cases include the aforementioned group plus an equal number of women and an even younger population overall. The increase in oral cancer cases now is considered a “disease” in epidemic proportions. Why has this epidemic occurred? The epidemic primarily is due to the human papilloma virus (HPV), a sexually transmitted virus that can be contracted through oral sex.

In 2007, The New England Journal of Medicine published a landmark study that clearly stated that there is a direct correlation between oral cancer and HPV even when individuals do not ever use tobacco or alcohol, and have no family history of the disease.

Unfortunately, awareness of this epidemic “flies below the radar” of the majority of the general population. I feel that it is up to all of us as front-line dental health care providers to educate the population in our respective communities in addition to our direct patient population about HPV. I hope that the following statistics will help move you, your patients and your community to preventive action: s Once every 60 minutes, of every day, of every week, of every month, of every year, someone in our country dies as a result of oral cancer.1 s The five-year survival rate for oral cancer is at 50 percent. The reason for the very poor chance of survival is that two-thirds of all oral cancers are discovered at a late stage.2 Even worse, these terrible statistics have not changed in 40-50 years! s In summary, oral cancer is a known killer unless detected very early.

orlando,florida i www.floridadentalconvention.com

Establishing Oral Cancer Protocols/Educating Patients about HPV Because of the worrisome increase in oral cancers related to HPV in the last few years, it is important that we screen all patients for oral cancer beginning at age 16. However, education in our office and beyond about oral cancer must begin before age 16. The key point to remember is that the more oral/sexual contact an individual has, the greater the chance of getting oral cancer can be expected.

Every office has to make decisions about a number of issues related to oral cancer: s Will you put HPV status (positive or negative) as a question on your health history form? s Will the office create talking points so that everyone, including the business office team, can provide a consistent message to patients? s How will you establish a protocol to comfortably discuss HPV with the parents/guardians of young adults? (Teens are known to have more oral sex because they mistakenly believe that there is no risk in that activity.) s Will you provide literature about HPV? s Having written protocols or a flowchart is the best way to ensure that best practices are followed easily and seamlessly in every office. In that way, nothing is left to chance and no room for error is allowed.

Avoiding Malpractice Risk When dentists are asked why they don’t screen for oral cancer, many respond that it takes too much time. Actually, it does not take much time at all. More importantly, by not performing the oral cancer screening exam and using good record-keeping techniques, dentists are putting themselves at tremendous risk for malpractice claims.

Malpractice claims that result from dentists failing to detect oral cancer are skyrocketing.

I recently discussed this issue with a dental malpractice insurance carrier agent. The agent told me that there are more claims and complaints regarding the lack of detection and late detection of oral cancer than ever before. The agent said, “It’s becoming the biggest reason for malpractice lawsuits compared to other claims against dentists.”

So, the keys to reduce malpractice risk are: s Communicate the steps of the oral cancer detection screening examination with the patient. s Complete record keeping and note all areas examined. s If an area of concern is detected, follow the “two to three week waiting rule” after documenting the existing area visually and photographically. s Schedule a follow-up appointment (two to three weeks) to reassess the area of concern.

If the area remains, document as above with a specific list of information transmitted to specialist for possible biopsy through a HIPPA-secure portal.

The official meeting of the florida dental association

s If the patient does not return for follow up: s Call the patient. s Write in the patient chart the exact conversation with patient about importance of return visit. s Send letter stating concern about the specific area detected and the importance of follow up (one through regular mail and one through certified mail).

Enhanced Oral Cancer Detection Devices The first enhanced oral cancer detection devices used rinses and special lights.

Approximately 10 years ago, the advent of fluorescence technology was a big improvement for enhanced detection. Fluorescence really has changed everything. Using it, we can access so much more information by being able to see below the oral mucosal tissues. As fluorescence technologies have developed, they have continually enhanced the extent of early detection that can take place. In my estimation, I think that the advent of fluorescence technology makes a huge difference in our efforts to save lives through early detection.

Over the past 14+ years, the number of technologies for enhanced early oral cancer detection has grown from one to six — with the most recent rolled out in November 2015. The sophistication of these devices also has grown dramatically. The currently available technologies are: s ViziLite Plus – Denmat: rinse and light system s MicroluxDL – AdDent: rinse and light system Please see CANCER, 35

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THURSDAY, JUNE 16 • 8-11 PM OSCEOLA C BALLROOM We invite you to step out of your shower and into the spotlight centerstage, to jam with a live band and backup singers, who make even a novice sound like a Rock Star!

Dress as your favorite rock star and come enjoy the tasty desserts, fun entertainment and take a chance at stardom.

Everyone is invited. Badges are required for entry. Children under 12 years of age do not need a badge.

CANCER from 33

s VELscope Vx with imagining adapter – LED Dental: fluorescence technology, direct fluorescence s Identafi – DentalEz: white light and fluorescence technology, indirect fluorescence s OralID – Forward Science Technology: fluorescence technology, indirect fluorescence s BioScreen – AdDent: fluorescence technology, direct fluorescence Yes, the basic oral cancer screening examination is required as standard of care in dentistry.

Using the enhanced detection technologies is not a part of standard of care (required). That being said, I strongly feel that every dentist should learn about the six enhanced detection technologies available today so that they can make an educated decision about possibly incorporating one of them into your practice.

Summary The incidence of oral cancer is increasing every year. The issues that this epidemic brings are as wide ranging as changes in patient/community education, dental practice systems/ protocols, risk management and investigating new technologies for enhanced detection. The dentist, along with the entire dental team, must continually make every effort to save lives through early detection along with educating patients and our communities about the risk

benefit

NUMBER

factors for oral cancer. With everyone’s efforts, we can stop the growth of this terrible epidemic.

References 1. American Cancer Society. Cancer Facts & Figures 2015.

Atlanta: American Cancer Society; 2015.

2. oralcancerfoundation.org Dr. Bregman will be speaking at FDC2016, and presenting three courses on Saturday.

His lecture, “Enhanced Oral Cancer Detection: Guide Your Practice to Thrive While Saving Lives!” will be at 9 a.m.; his workshop, “Enhanced Oral Cancer: A Hands-on Experience,” will be at 1:30 p.m., followed by a repeat of the workshop at 3:30 p.m.

Helping Members Succeed It’s the best reason to join the FDA! PR is a very friendly, low-key, nonadversarial process that looks out for the best interests of the dentist and the patient.

— Dr. Edward Daniel

The Peer Review Mediation Program settles disagreements between patients and dentists more economically and efficiently than the legal system and is available only to FDA members.

This program is free of charge.

FOR MORE INFORMATION 800.877.9922 • fda@floridadental.org www.floridadental.org/peer-review

speaker preview

It Doesn’t Have to End in Disaster:

“

A Case for Employment Compliance

By Tim Twigg

It only takes one unhappy or disgruntled person to create a legal nightmare for you.

There’s no need to take this gamble. All it takes is awareness, commitment and action on your part.

”

36 Today's FDA

March/April 2016

You’ve heard the horror stories: Dentist terminates an employee and ends up in an unfair termination lawsuit. Dentist lays an employee off and ends up in front of the labor board fighting a claim of discrimination.

It doesn’t have to end this way. With a little awareness, commitment and action on your part, problems like these can be prevented and don’t have to end with you — the employer — in the middle of a legal battle.

Personnel issues are a major source of stress for most dentists. Without awareness, commitment and action, dealing wisely and legally with complex employment issues can be particularly challenging, emotionally draining, as well as potentially costly if mishandled.

Unfortunately, because they’re not dealing with employment issues properly, an increasing number of dentists are finding themselves in front of labor board hearings or on the receiving end of an employee lawsuit. Whether it is for unfair termination, mishandling pregnancy leave, not properly paying for overtime, or a sexual harassment or discrimination allegation, the penalties, fines and/or settlements can easily exceed $50,000.

From reviewing a possible termination, investigating a claim of harassment or discrimination, handling pay and overtime correctly, or properly dealing with the various types of leave, including pregnancy leave, employment compliance issues can be particularly challenging. Today, in our sometimes overregulated environment, the list of areas requiring careful consideration, support and assistance goes on and on.

While HR issues are a reality and will exist even in the best and most stable practices, the trick is not to let them interfere with your practice goals and patient care. Anything that distracts you from patient care and is not handled within 24 hours will have a negative effect on your productivity and profitability.

Prevention — which means that having your “HR house in order” — is the key.

orlando,florida i www.floridadentalconvention.com

Case in point: An employee (past or present) files a harassment claim against you. You have your HR house in order; thus, you have: s a comprehensive, up-to-date policy manual in place. s a correctly written anti-harassment policy in your policy manual. s a signed employee acknowledgement form and employment agreement. s an established protocol for investigating claims of harassment. s a system of taking claims seriously and investigating them. s a process of taking necessary and appropriate action to address the issue. s a paper trail (documentation) that illustrates the steps taken to correct the problem.

Result: you win! Why? According to a recent article in the Wall Street Journal, “… the employer must affirmatively show that (he/she) exercised reasonable efforts to prevent and eliminate the harassment (the efforts don’t have to be 100 percent successful).” And, “… (employees) often lost sexual harassment cases because their employer took appropriate remedial action or because the employee failed to take advantage of the employer’s harassment safeguards and procedures.”

Check in the square for you on both accounts!

Alternatively: One staff member is just not working out. You know that you have tried to make things work, but it’s just not a good fit. This employee may not be performing well, or patients may be complaining about his/her comments or attitude, or coworkers may be unhappy with him/her as well. You know it would be best for everyone involved if he/she was not there. But, you don’t have your HR house in order. How do you handle this delicate situation the right way? Are you on solid legal ground? Have you properly documented everything? Will you prevail in a lawsuit for wrongful termination, or some form of discrimination or breach of contract if you let the employee go?

Alternatively: Smack in the middle of a busy day, a staff member stops you and asks a question about some personnel issue. And you don’t have your HR house in order. Will you answer correctly? Will you remember the answer you gave to the last person who asked that question? Or, will you unknowingly create a crisis and the illusion of favoritism when you give a different response this time?

Do you really want to be dealing with staffing issues this way? Wouldn’t you prefer the luxury of saying, “Just check the manual, it’s in there,” or the confidence that comes from having your HR house in order?

Recognizing the importance of this facet (HR and employment compliance) of running a business, every “real” company has an HR department. Within these HR departments, you will find processes that ensure:

The official meeting of the florida dental association

s comprehensive job descriptions for each employee or position s standardized recruiting and hiring protocols s up-to-date policy manuals comprising applicable regulations s all of the necessary personnel forms to fulfill documentation needs and requirements s processes for managing performance and employee engagement When someone is hired at places like Microsoft, Colgate, Kraft, Henry Schein Dental, he/she meets with HR on their first day of employment to complete a series of required processes. Like those companies, your dental office will need to have all of these same components in place. The number of people you employ may be lower, your annual revenue may be lower, but the requirements and the risks of not handling HR correctly are the same.

In fact, the risks may be greater because dentists don’t take HR seriously: s There is little to no training in the area of employment compliance; thus, it is foreign, daunting and can be quite literally overwhelming. s Dentists are not big enough to afford a specially trained HR staff; thus, the task of employment compliance falls on your shoulders. s Dentists erroneously believe they’re too small to have deal with it. As a result, most dental offices are not handling HR correctly and are vulnerable to serious liability.

Please see COMPLIANCE, 39

March/April 2016

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HIGHLIGHTS

HANDS-ON INTRODUCTION TO CEREC CONCEPTS



MR03

FRIDAY-SATURDAY  JUNE 17 & 18  8 AM-5 PM BOTH DAYS  CE CREDITS: 16 AUDIENCE: DENTISTS, LABORATORY TECHNICIANS  ADHESIVE / ORTHODONTICS / AESTHETIC ATTENDANCE IS LIMITED TO 12.

REGISTRATION CATEGORY DR. ERNEST JOHNSON is a general dentist with a private practice in Phoenix, AZ and more than 20 years of clinical experience. He is a leader in CAD/CAM dentistry using the CEREC system from Sirona. Dr. Johnson participates in most of the CEREC courses held at the SPEAR Scottsdale Center Campus as a mentor and also leads the hands-on training for new Patterson CEREC specialists.

REGULAR

ONSITE 6/1

DENTIST – FDA/ADA MEMBER

$845

$925

NON-MEMBER DENTIST

$925

$995

LABORATORY TECHNICIAN

$845

$925

This mini-residency is fully sponsored by

This hands-on course will offer participants the opportunity to test drive the latest CEREC Omnicam with the new 4.4 software package using standard CEREC typodont. Participants will learn a variety of design modes and quadrant dentistry, as well as mill restorations created using CEREC technology. Some lecture/discussion time will be set aside regarding preparation design for quality CEREC restorations, advanced design tools and materials discussion; however, the goal is to allow participants to learn through planned activities on the machines available for this program.

Attendance is limited to 12.

Participant Requirements: Loupes are encouraged, but not required, heatless stone on a mandrel.

At the end of the workshop, participants will be able to: 

administer a CEREC case correctly.



acquire a quality scan with the Omnicam.



design at least a crown, onlay, and two adjacent restorations.



mill at least one restoration, possibly more.



learn CEREC preparation design.



review current materials available for chairside use with CEREC.

COMPLIANCE from 37

Today’s reality is that dentists are at greater risk of a labor-related claim or lawsuit than a malpractice lawsuit.

So how do you prevent HR issues from getting in the way of your patient focus? You follow the lead set by your corporate colleagues. It’s not necessary or practical for the majority of dental practices to have an HR department, but you can still have an HR program in place that establishes policies and protocols for your practice. There are several components of a good HR program. It must be meaningful, clear, comprehensive, equitable, easy to implement and affordable. The program should include guidelines for job descriptions, staff management, salary administration, personnel forms, and both hiring and separation issues.

A comprehensive dental office-specific personnel policy manual will help you: s avoid costly lawsuits and the stress of litigation. s assure compliance with state and federal employment regulations. s define rights and responsibilities of employer and employees. s decrease or minimize misunderstandings and reduce stress. s improve morale and job performance.

You might be asking, “Is this really necessary? I’ve gotten along OK so far.” Before you decide that you don’t need an HR program, ponder your level of liability as you consider these questions: s Do you have accurate, written job descriptions that comply with the Americans with Disabilities Act? s Are you an “at-will” employer? Does your “at-will” policy information appear in all the prescribed places in your policy manual? s Have you established a system of progressive discipline that negates your “at-will” status? s Are you confident about what steps to take when terminating an employee to prevent lawsuits or claims of discrimination and/or wrongful termination? s Do you know how to give or ask for references without fear of legal repercussions? s Do you have access to personal profiling tools and other hiring instruments that can give you insight into a candidate’s personality, trustworthiness and ability to handle the position in your practice? s Are you clear about “protected concerted activities” and your disciplinary options related to employee’s work-related posts on social media sites and/or discussing wages, benefits or working conditions?

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Your goal is to answer with a resounding “yes” to each of these questions. Don’t wait until you are faced with a difficult situation before you have to learn the hard way how to protect yourself from litigation.

You’ve no doubt heard the expression: An ounce of prevention is worth a pound of cure. This is so true with HR and employment compliance.

Summary It only takes one unhappy or disgruntled person to create a legal nightmare for you.

There’s no need to take this gamble. All it takes is awareness, commitment and action on your part. Once you have your HR house in order and have implemented a sound HR program in your practice, you also can feel good about knowing you are giving your staff every protection due to them under the law and every opportunity to be happy and successful in your practice. For yourself, you will be minimizing your risks and protecting your most valuable asset — your practice. You also will have given yourself the gift of peace of mind.

Mr. Twigg is the president of Bent Ericksen & Associates, and can be contacted at timtwigg@msn.com.

He will be speaking at FDC2016 on Friday, June 17. His lecture, “Employment Compliance for Dentists: What You Don’t Know Could Hurt You,” will be presented at 11:15 a.m.

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“

Dental Stem Cells and Their Applications

By Dr. Darcy M. Benghenia

How can these technologies easily be applied chairside in a typical dental office?

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The concept of regeneration has been in existence since ancient times. In the Greek myth of Prometheus, Zeus punishes the mischievous demigod for stealing fire and giving it to humans. For committing this crime, Zeus chains Prometheus to a remote mountaintop, where he is tortured by a giant eagle that descends every night from the sky to savagely peck and rip out his liver. By the next morning, his liver has regenerated itself, and the gruesome cycle is repeated — ad infinitum — for the unfortunate Prometheus.

Using stem cells to regenerate damaged or lost tissues and to therapeutically treat disease has gained increasing attention over the past several decades. In 2000, stem cells were discovered in the dental pulp of teeth, and it was recognized that having a relatively easyto-reach source of stem cells was a clear advantage over the more difficult to access bone marrow stem cells. This article discusses the dental stem cells (DSCs) isolated to date, their general properties and some of the applications of DSCs in the medical and dental fields.

Key Concepts of Adult Stem Cells in Tissue Engineering Tissue engineering is a multidisciplinary science that brings together biology, engineering and clinical science with the goal of regenerating diseased, damaged, or lost tissues and organs. Tissue engineered regenerative medicine (TERM) represents regenerative tissuebased treatments in medicine. In an idealized, simplified view, stem cells from the patient are harvested, expanded in culture, grafted onto a biocompatible scaffold, and re-implanted back into the patient to regenerate the desired cells and tissues.

There are three core principles of tissue engineering: identification and propagation of appropriate stem cells; utilization of growth factors that activate the stem cells to regenerate the desired cells and tissues; and, the development of biocompatible scaffolds on which to grow and transplant the stem cells. These three components are known as the tissue engineering triad.

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Adult stem cells, or postnatal stem cells, were first identified in the bone marrow, the sponge-like tissue found inside bones — also known as bone marrow mesenchymal stromal cells. Since their isolation, other sources of adult stem cells have been found in stem cell niches throughout the body. Developing tissues set aside life-long reservoirs of stem cells, which retain the capacity to self-renew, divide and create additional cells as needed. Adult stem cells are multipotent, meaning they are differentiated to a degree, but still able to change into many different types of cells and tissues. In addition to bone marrow mesenchymal stromal cells, other sources of adult stem cells include skin, adipose tissue, heart, brain and teeth.

Dental Stem Cells Isolated to Date and Their General Properties DSCs were first isolated from the dental pulp of extracted human third molars and from exfoliated human deciduous teeth. DSCs are derived from the ectomesenchyme, the so-called “fourth germ layer,” which interacts with the neural crest during development. Ectomesenchyme of the neural crest, along with a small contribution from mesenchyme proper, gives rise to all tooth and tooth-associated dental tissues, except enamel, which is derived from the ectodermal germ layer. Having ectomesenchymal, ectodermal and mesenchymal components, teeth go through many fascinating epithelial-mesenchymal interactions during development.

DSCs are able to differentiate into a number of distinct cell phenotypes, including odontogenic, osteogenic, adipogenic and neurogenic lineages. Like bone marrow mesenchymal stromal cells, DSCs are considered to be immunomodulatory and immunosuppressive.

Subsequent to the isolation of dental pulp stem cells and stem cells from human exfoliated deciduous teeth, several additional sources of DSCs have been located and characterized.

These include periodontal ligament stem cells (PDLSCs), stem cells from the apical papilla (SCAP), dental follicle stem cells (DFSCs) and gingival stem cells.

Medical and Dental Applications of Dental Stem Cells While there is undoubtedly a long way to go before treatments incorporating stem cells in the clinical setting become routine, there have been major strides in stem cell biology and TERM. The oral area offers a rich and versatile source of stem cells that potentially can be used in the treatment of many clinical conditions in dentistry and medicine.

DSCs are multipotent and able to differentiate into a wide array of cells and tissues, such as bone, cartilage, adipose tissue, dentin, dental pulp, periodontal ligament and gingiva.

Having an ectomesenchymal origin gives DSCs unique properties; for example, DSCs have an increased ability to differentiate into neurons. DSCs possess immunosuppressive-immunomodulatory properties, can be harvested from dental tissues that often are discarded in clinics and are able to be stored (banked) for long periods of time.

Numerous studies demonstrate the ability of DSCs to regenerate non-dental cells and tissues. In one study, stem cells from human exfoliated deciduous teeth transplanted into a completely resected adult rat spinal cord resulted in the recovery of hind limb locomotor functions. Dental pulp stem cells transplanted intracerebrally into a rat 24 hours following focal cerebral ischemia resulted in significant improvement in forelimb sensory and motor function. After myocardial infarction, dental pulp stem cells transplanted to the infarction zone in rats promoted cardiac repair and function, reducing the infarct size compared to controls. Gingival mesenchymal stromal cells intravenously injected in collagenassociated arthritic mice alleviated the associated symptoms of this condition. In other studies, pancreatic cells were generated using dental pulp stem cells; a cornea was reconstructed with tissue-engineered sheets composed of dental pulp stem cells.

In 2009, the first clinical trial involving the use of dental pulp stem cells for bone restoration in the mandible was carried out by d’Aquiono and his team. Seventeen patients who had four completely bony impacted third molars participated in the study. Upon extraction of the mandibular molars, dental pulp stem cells previously harvested from the extracted maxillary molars immediately were implanted into one of the areas where the mandibular molars had been removed. On the other side, a collagen sponge without dental pulp stem cells similarly was implanted to serve as the control. Three months post-surgery, the test site had a much higher level of cortical bone when compared to the control site. Upon Please see CELLS, 42

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histological analysis, the test sites were wellorganized, having good vascularization with typical lamellar architecture surrounding the Haversian channels.

Having the ability to regenerate a bony defect has clear implications in the field of implant dentistry and prosthodontic implant restoration. Bony defects that develop after tooth loss usually result in additional horizontal and vertical bone loss of the alveolar ridge. In 2010, the Academy of Osseointegration stated that the continued improvement of the dental implant success rate will require stem cell-based approaches.

One limitation of dental implants is that osseointegration to the bone does not provide the cushioning, shock-absorbing, and selfremodeling properties of the periodontal ligament (PDL). PDLSCs may be an ideal source for PDL regeneration, and the regeneration of entire roots. In 2006, Sonoyama accomplished this feat in swine, using stem cells from the apical papilla and periodontal ligament stem cells. After extracting a lower incisor, a root-shaped scaffold loaded with stem cells from the apical papilla was immediately implanted into the socket. After three months, the SCAP-PDLSC implant had formed a hard root structure containing newly formed dentin on the inside, with a PDL between the surrounding root structure and bone.

It is known that dental pulp has inherent limited regenerative and healing capabilities, particularly in teeth with immature apices. Regenerative endodontics expands on this concept by using tissue engineering to replace damaged or infected pulp with

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new, healthy pulp. In 2008, Prescott and his team seeded dental pulp stem cells on a collagen scaffold supplemented with the growth factor DMP-1 (dental matrix protein 1) and successfully regenerated pulp tissue. Dental pulp stem cellss, SCAP and stem cells from human exfoliated deciduous teeth form a pulp-dentin complex morphologically and histologically equivalent to normal pulp when grown in vitro. The first in vivo demonstration of pulp regeneration in a murine model was reported in 2010.

The ultimate goal of tissue engineering in dentistry is the regeneration of an entire tooth.

In 2011, Oshima reported generating a bioengineered “tooth unit” comprised of mature tooth, PDL and alveolar bone in a mouse using murine dental follicle stem cells. These cells were allowed to develop to the early bell stage in vitro, then inserted into a scaffold and transplanted to the mouse’s subrenal capsule for further development. This “tooth unit” was transplanted into an appropriately prepared hole in the mouse’s mandible. A tooth erupted into occlusion and displayed normal physiological tooth function such as mastication, PDL remodeling and responsiveness to noxious stimuli. It had normal blood supply and innervation.

Challenges of Dental Stem Cell-based Tissue Engineering One of the major questions that has to be answered regarding dental stem cell-based tissue engineering is: “How can these technologies easily be applied chairside in a typical dental office?” Clinical realization of individualized stem cell-based treatments includes overcoming the difficulty of rapidly and inexpensively expanding the numbers of the DSCs to be used in vitro. Additionally, the availability of donor pulp tissues is decreased in the aged populations who need these regenerative therapies the most. Lastly — and most importantly — various types of mesenchymal stem cells found in the body are becoming increasingly accepted as important contributors to tumor development and cancer progression. Additional randomized, controlled clinical trials of longer duration are necessary to determine whether or not cell-based tissue engineering offers long-term benefits to patients.

References: 1. Langer R, Vacanti JP. 1993. Tissue Engineering. Science. 260: 920-926.

2. Alsberg E, Hill EE, Mooney DJ. 2001. Craniofacial tissue engineering. Crit Rev Oral Biol Med. 12 (1): 64-75.

3. Friedenstein AJ, Piatetsky S II, Petrakova KV. 1966. Osteogenesis in transplants of bone marrow cells. J Embryol Exp Morphol. 16 (3): 381-390.

4. Gronthos S, Mankani M, Brahim J, Robey PG, Shi S. 2000. Postnatal human dental pulp stem cells (DPSCs) in vitro and in vivo. Proc Natl Acad Sci USA. 97(25): 13625-13630.

5. Miura M, Gronthos S, Zhao M, Lu B, Fisher L, Robey P, Shi S. 2003. SHED: Stem cells from human exfoliated deciduous teeth. Proc Natl Acad Sci USA. 100(10): 5807-5812.

6. Rasmusson I, Ringden O, Sundberg B, Le Blanc K. 2003. Mesenchymal stem cells inhibit formation of cytotoxic T lymphocytes, but not activated cytotoxic T lymphocytes or natural killer cells. Transplantation.

76(8):1208-1213.

7. Seo BM, Miura M, Gronthos S, Bartold PM, Batouli S, Brahim J, et al. 2004. Investigation of multipotent postnatal stem cells from human periodontal ligament. Lancet 364: 149-155.

8. Sonoyama W, Liu Y, Fang D, Yamaza T, Seo BM, Zhang C, et al. 2006. Mesenchymal stem cell-mediated functional tooth regeneration in swine. PLoS 1:e79.

orlando,florida i www.floridadentalconvention.com

9. Morsczeck C, Gotz W, Schierholtz J, Zeilhofer F, Kuhn U, Mohl C, et al. 2005. Isolation of precursor cells (PCs) from human dental follicle of wisdom teeth. Matrix Biol 24: 155-165.

10. Zhang Q, Su WR, Shi SH, Wilder-Smith P, Xiang AP, Wong A, et al. 2009. Mesenchymal stem cells derived from human gingiva are capable of immunomodulatory functions and ameliorate inflammation-related tissue destruction in experimental colitis. J Immunol 183:7787-7798.

11. Sakai K, Yamamoto A, Matsubara K, Nakamura S, Namse M, Yamagata M, et al. 2012. Human dental pulp-derived stem cells promote locomotor recovery after complete transection of the rat spinal cord by multiple neuro-regenerative mechanisms. J Clin Invest 122:80-90.

12. Leong W, Henshall T, Arthur A, Kremer K, Lewis M, Helps S, Field J, et al. 2012. Human adult DPSCs enhance poststroke functional recovery through non-neural replacement mechanisms. Stem Cells Trans Med 1:177-187.

13. Gandia C, Arminan A, Garcia-Verdugo J, Lledo E, et al. 2007. Human dental pulp stem cells improve left ventricular function, induce angiogenesis, and decrease infarct size in rats with acute myocardial infarction.

Stem Cells 26:3.

14. Chen M, Su W, Lin X, Guo Z, Wang J, Zhang Q, Brand D, Ryffel B, Huang J, Lin Z, He X, Le A, Zheng S. 2010. Adoptive transfer of human gingiva-derived mesenchymal stem cells ameliorates collagen-induced arthritis via suppression of Th1 and Th17 cells and enhancement of regulatory T-cell differentiation. Arthritis and Rheu; 65:1181-1193.

15. Ishkitiev N, Yaegaki K, Kozhuharove A, Tanaka T, Okada M, Mitev V, Fukuda M, Imai T. 2013. Pancreatic differentiation of human dental pulp stem cells. Regen Med; 8:597-612.

16. d’Aquino R, De Rosa A, Lanza V, et al. 2009. Human mandible bone defect repair by the grafting of dental pulp stem/progenitor cells and collagen sponge biocomplexes. Eur Cell Mater.18:75–83.

benefit

Membership NUMBER Concierge

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Thanks, Christine. You are a very welcoming member of the FDA and made me feel happy to become associated with it. If there is anything I can do to help the FDA, please do not hesitate to ask.

— Dr. Bob Finkelstein Hi Christine, Thank you so much!

CHRISTINE I told the Dr., “I LOVE THE FDA!!”

MORTHAM — Bibiana Escobar Billing Coordinator, Santos Dental Care

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OUR MEMBERS!

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800.877.9922 or 850.350.7136 cmortham@floridadental.org

17. Oshima M, Mizuno M, Imamura A, Ogawa M, Yusakawa M, Yamazaki H, et al. 2011. Functional tooth regeneration using a bioengineered tooth unit as a mature organ replacement therapy. PLoS One; 6:e21531.

18. Cuiffo B, Karnoub A. 2012. Mesenchymal cells in tumor development: emerging roles and concepts. Cell Adh Mig; 6:3 (220-230).

Dr. Benghenia is the dental director for Dimensions Family Health and Wellness Center. She can be reached at drdarcydds@ yahoo.com. She will be speaking at FDC2016 and presenting her course, “Dental Stem Cells and Their Applications,” on Thursday, June 16 at 2 p.m.

FDC2016 Needs Speaker Hosts ARE YOU INTERESTED IN SPENDING TIME WITH AN EXPERT IN YOUR FIELD AND RECEIVING FREE CE CREDITS? WHO:

FDA and ADA member dentists FDA and ADA team section members ASDA students

HOW:

Host an FDC speaker

FDA/ADA members and their teams have the opportunity to host the speaker of their choice at the 2016 Florida Dental Convention.

Get to know an expert in your field and learn from them in a personal setting not available anywhere else. Be an FDC host and you will receive free tuition to the speaker’s lecture course. Duties include introducing the speaker and making announcements, passing out and collecting surveys, and assisting the speaker if necessary. You also will receive a lunch voucher for Exhibit Hall concessions — all while performing an invaluable service for the FDA! Sign up online to host your favorite speaker at www. floridadentalconvention.com/education/speaker-host.

Questions? Call 800.877.9922, Ext. 7106.

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HIGHLIGHTS

DR. FRANKLIN DOLWICK received his dental degree from the University of Kentucky and his PhD and certification in oral and maxillofacial surgery from the Medical College of Virginia. Dr. Dolwick is chairman of the Department of Oral and Maxillofacial Surgery at the University of Florida College of Dentistry, and was appointed as the Parker E. Mahan Facial Pain Endowed Professor in 2013. He serves as a member of the Craniofacial Cleft-Palate Team. Dr. Dolwick has published more than 100 papers and coauthored four books.

DR. HENRY A. GREMILLION attended Louisiana State University School of Dentistry and completed a fellowship in Craniofacial Pain and Dysfunction at the University of Florida College of Dentistry (UFCD). In 2008, he became dean of Louisiana State University School of Dentistry.

He has served as a consultant in the field of temporomandibular disorders and orofacial pain for the U.S. Army, Navy and Air Force, the ADA Council on Dental Practice, and the Comprehensive Dentistry Program at UFCD.

HEAD AND NECK ANATOMY: CLINICAL APPLICATION AND DISSECTION WORKSHOP

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MR02

FRIDAY-SATURDAY  JUNE 17 & 18  8 AM-5 PM BOTH DAYS  CE CREDITS: 16 AUDIENCE: DENTISTS  TEMPOROMANDIBULAR JOINT DISORDER / ANATOMY  ATTENDANCE IS LIMITED TO 24.

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This two-day program is designed to provide the participant with a detailed anatomical review of the dynamic masticatory system. Day one will consist of lecture and discussion with specific practical clinical application. Areas of special emphasis include: osteology, the oral cavity, nasal cavity, salivary glands, musculature and the temporomandibular joint. Day two will be a detailed dissection of the superficial structures of the face, the masticatory musculature and the temporomandibular joint.

Relationships to routine dental assessment and clinical procedures will be highlighted. Participants will work in two-member groups during the dissection portion, each group dissecting half of a provided cadaver specimen. Basic dissection instruments will be provided. It is strongly suggested that each workshop participant bring a head and neck anatomy atlas/text, and surgical instruments if desired.

Attendance is limited to 24.

Participant Requirements: Anatomy atlas; protective eye wear; magnifying eye wear (if desired); clinic/ laboratory jacket; preferred dissection instruments (optional).

At the end of the workshop, participants will be able to:      

review the basic anatomical relationships that are key to a detailed examination of the dental patient. discuss temporomandibular joint health and pathofunction. understand various subgroups of masticatory muscle disorders. review anatomical factors relating to vascular pain that may mimic odontogenic or temporomandibular-related conditions. gain insight relating to salivary gland origins of orofacial pain. review basic principles of diagnostic and treatment anesthetic procedures.

speaker preview

Living Proof: From Foster Care to the White House and NBA

By FDA Staff

Lucas Boyce has experienced many things the average person wouldn’t encounter. Throughout his ups and downs, he has remained positive — and used that positivity to propel him to a brighter future.

He wrote about his experiences and how he persevered in his book, “Living Proof: From Foster Care to the White House and the NBA,” published in 2011. His goal is to reach those who feel there is no hope due to their circumstances, and remind them to never give up.

His message to everyone — you are in control of your own future.

1. What obstacles have you overcome and how have they helped shape your life?

We all go through a lot of storms in life and experience trauma in some form or another. My earliest storm took place before I was born. I came into our world about six weeks premature and weighed about four pounds — with drugs in my system. Also, my mama couldn’t take care of me, so I was separated from her at birth and sent to foster care. I didn’t know my birth parents or whether they were alive or gone — it was that snowstorm that preceded the first spring of my life.

2. What can dentists take away from your experiences?

In some way, every dentist shares my story. They’ve all been in a room with a patient who was in a lot of pain, and they had the cure and did their best to take the pain away. Every dentist has been like my mom. In so many ways, she provided help — just as dentists do.

3. Tell us about your chance encounter with President George W. Bush and what transpired afterward.

I had the opportunity to participate in a meet-and-greet with President Bush on the South Lawn at the White House on March 25, 2002. It was only about six months after 9/11. I told him I was praying for him and that the cause was just. He took a photo with me and the next day asked my boss about my story. Then he asked my boss, “What can we do for him?

Let’s bring him on board.” He is responsible for my first job out of college — I was a staff

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“

Be kind, be loving, be humble.

Oh, and of course — never give up.

”

assistant on his re-election campaign for president.

4. It has been said you have one of the most unusual paths to working in the NBA. Can you tell us how that happened?

My path to the NBA began one summer night in 2007, if I recall correctly. My boss, Kevin Sullivan, asked me to give his friend Joel Glass and family a White House tour.

Joel was the Communications Manager for the NBA’s Orlando Magic. That tour ultimately led to my position in the front office of the NBA’s Orlando Magic: at the end Please see PROOF, 47

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Sit down and relax!

Win a bottle of wine from FDAS.

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Use the ADA Find-ADentist Photo Booth to update your web listing. Take home your photo on a flash drive.

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of the tour, Joel asked for my business card and resumé because the Magic were looking for good candidates in Orlando.

They did call me and I agreed to interview with them. It turned out I wasn’t the right fit for that particular position. I thought I had blown my chance to work for the NBA at that point. But two weeks later, I was promoted to Associate Director at the White House, overseeing the southwest region of the country. It was a position that gave me a lot more experience in my career and also enabled me to fly aboard Air Force One. Then, in April of the following year, the Magic called again and asked if I’d be interested in a new position within a newly created department focused on diversity and inclusion. Knowing the current administration was in its final year, it seemed like a good time to start transitioning, so I agreed to interview again. Over the

benefit

next few months, I went through three rounds of interviews and ultimately was selected for my first job with the Orlando Magic and

by Spring 2008, I was working in their front office.

5. What’s the best piece of advice you’d give on fulfilling lifelong dreams?

Think right, be right, do right — “wash, rinse, repeat.” Be kind, be loving, be humble. Oh, and of course — never give up. Always be willing to be wrong and start all over again. You can overcome seemingly insurmountable obstacles. I am “Living Proof!”

Mr. Boyce is the Senior Strategist for Media and Engagement to the Chairman of the Republican National Committee and can be reached at www.LucasDanielBoyce.com. He will be speaking at FDC2016, and his lecture, “Living Proof,” will be the keynote session on Saturday, June 18 at 8 a.m.

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THE PERFECT WAY TO LET YOUR PATIENTS KNOW YOU ARE A MEMBER

MEMBER IN GOOD STANDING

FLORIDA DENTAL ASSOCIATION

Ralph C. Attanasi Jr., DDS 2016 Florida’s Advocate for Oral Health ATLANTIC COAST D I S T R I C T D E N TA L A S S O C I AT I O N A COMPONENT OF THE AMERICAN & FLORIDA DENTAL ASSOCIATIONS

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HIGHLIGHTS

INTRODUCTION TO MODERN IMPLANT DENTISTRY: FROM SITE PRESERVATION TO SINGLE CROWNS — MINI-RESIDENCY

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MR01

JUNE 16-18  THURSDAY AND FRIDAY: 9 AM-5 PM  SATURDAY: 9 AM-12 PM  CE CREDITS: 17 AUDIENCE: DENTISTS  IMPLANTS  ATTENDANCE IS LIMITED TO 30.

DR. RODRIGO NEIVA earned his certificate and master’s degree in periodontics from the University of Michigan School of Dentistry. He also is a diplomate of the American Board of Periodontology and the International Congress of Oral Implantology. He serves as the director of the Graduate Program in Periodontics at the University of Florida College of Dentistry. He is active in clinical research related to bone and soft tissue augmentation, as well as novel techniques of implant therapy. He also has published various scientific papers and text book chapters in the periodontics and oral implantology fields.

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This mini-residency is fully sponsored by

Recent advances in implant dentistry allow for simplified treatment protocols, which results in reduced chairtime and patient discomfort. However, high levels of success and predictability in implant dentistry still are dependent on case selection, treatment planning and optimal clinical practice. Many patients are contraindicated for simplified treatment protocols due to anatomical and health limitations or other reasons. It is important to identify these patients, but also to be prepared to treat those who could benefit from simplified treatment protocols and to provide realistic treatment expectations.

This mini-residency is designed for dentists who want to be introduced to modern implant dentistry, as well as clinicians who want to update their knowledge in this field. This didactic and hands-on program emphasizes treatment planning, case selection, implant placement protocol and restorative techniques. Attendance is limited to 30.

Participant Requirements: Encouraged to bring loupes or eye protection.

At the end of the mini-residency, participants will be able to: 

understand both the surgical and restorative phases of implant therapy.



learn or improve implant knowledge and skills to advance toward more complex cases.



combine both didactic and hands-on instruction.

y Frida 016 7, 2 1 e Jun 0 PM 7-1 rium t A l Hote

HEROES & VILLAINS is a family-friendly event featuring entertainment and performances for all ages! We hope you’ll join us! Everyone is invited and tickets are FREE – request your ticket when you register. Name badges will be required for entry for all attendees. Children under 12 years of age do not need a badge.

FDC2016

Bring Your Whole Team to FDC!

FDC2016

Bring

Your Superheroes to FDC

“

FDC is more than just CE and organized dentistry meetings. It’s also a great opportunity to see old friends and make new ones.

”

Please see SUPERHEROES, 52

FDC2016 SUPERHEROES from 51

Dr. Ardalan and his team treat their biggest fans.

Dr. Ardalan and his team developing their gameplan for FDC2016.

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FDC2016

A Q&A With Dr. Reza Ardalan 1. How long have you been going to the Florida Dental Convention (FDC)? Have you always brought your team?

I’ve been attending the FDC since it was the FNDC (Florida National Dental Convention)! In fact, I used to attend as a dental student and always enjoyed the experience. I continued attending when I opened my practice in 2006 and have been bringing my team along ever since.

2. What are the benefits of having your team attend the convention with you?

There are a ton of benefits to bringing my team along. First and foremost, they get excellent continuing education (CE). Since we are a pediatric dental office, we mostly focus on the practice management, customer service and communication courses.

FDC provides world-class speakers right in our own backyard. Second, it allows our team to really bond with each other outside of an office setting. We love to have fun, and traveling to FDC as a team gives us another opportunity to learn about each other and learn skills that will translate into better teamwork in the office. We actually spend the Monday following FDC discussing everything we learned. It’s critical to take that information and determine how to implement the suggestions in your office.

3. What would you say to dentists who are considering taking their team? Why is it important?

I’d say, “Do it!” There is a tremendous value in bringing your team to FDC above and beyond simply getting great CE. Speaking for myself, I view it as a reward for all the hard work my team puts in day in and day out. We all stay at the Gaylord Palms, spend time socially and have at least one group dinner. They understand that I appreciate them as valuable team members, and that shows up in their energy and positive attitudes back in the office. Plus, we pride ourselves in being a progressive office that tries to raise the bar when it comes to providing great pediatric dental care. Offering my team an opportunity to better themselves speaks volumes for my practice and allows us to continue providing a unique experience.

4. What is your favorite part about attending FDC? Wow, that is a great question because there are so many things that I enjoy! My favorite part is probably reconnecting with colleagues. FDC is more than just CE and organized dentistry meetings. It’s also a great opportunity to see old friends and make new ones. The social events make it easy to run into people and have a great time!

Photo caption from page 42: Dr. Ardalan and his superhero team, seated left to right: Maci Driscoll, Ashley Smith, Kim Soricelli. Standing left to right: Maira Mendez, Ashley Wood, Kelly Rivera, Kimberly Ardalan, Dr. Reza Ardalan, Morgen Lozoya, Yani Velasquez, Tiffany Waller.

Dr. Ardalan is a pediatric dentist in Port St. Lucie and can be reached at info@ardalandental.com.

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COME FOR THE CE.

STAY FOR THE FUN! WE UNDERSTAND you have many options for dental education. The FDC strives to offer you a wide range of topics that address current best practices and challenges while providing you with opportunities to network with colleagues and have fun with your family. Dollar-for-dollar, FDC2016 is a great value for your money. After a day of learning skills you can implement in the office on Monday, join your colleagues and friends at one of the many FUN evening events or enjoy all the Gaylord Palms has to offer!

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Diagnostic

Diagnostic Discussion

By Drs. Don Cohen and Brian Mannari

A 52-year-old female was referred to Dr. Brian Mannari, an oral and maxillofacial surgeon in St. Petersburg, Fla. by a local general dentist for non-resolving left facial paresthesia and dysesthesia involving the mandibular division of trigeminal nerve.

The patient wears a complete maxillary prosthesis and partial mandibular prosthesis. It was reported that the patient initially presented to the referring general dentist’s office with the chief complaint of recent onset of left facial paresthesia. Tooth No. 21 was noted by the general dentist to exhibit periapical radiolucency in close proximity to the mental foramen. Tooth No. 21 was extracted and the patient underwent a course of antibiotic therapy. Once it was determined the neurosensory deficit was persistent beyond the time of extraction, the patient was referred to Dr. Mannari for further evaluation.

Neurosensory testing was performed during the initial consultation appointment, which revealed paresthesia and dysesthesia (more specifically allodynia and hyperalgesia). Affected areas were left of the midline, extending from the lower lip and oral commissure to the labiomental region and inferior border. Clinical exam revealed a fluctuant, dome-shaped purple elevation on the posterior left mandibular alveolar crest (Fig. 1).

This initially was believed to be a pigmented macule. The lesion was estimated to be about the size of a quarter. No drainage or signs of infection were observed.

Her past medical history includes significant gestational diabetes and a 1PPD, 30-year history of tobacco abuse. She recently complained of night sweats and generalized lethargy.

Relevant family history includes her mother was diagnosed with lymphoma and sister was diagnosed with breast carcinoma.

An orthopantogram revealed irregular trabecular pattern of the bone in the posterior left mandible with faint, indistinct saucerization of the superior alveolar crest (Fig. 2a, arrow) and expansion of the inferior alveolar canal (Fig. 2a, yellow lines). A CBCT was obtained and revealed perforations of the lingual cortices in the area of the mandibular body, with impingement on the inferior alveolar nerve (Fig. 2b, arrow). Also noted were multiple radiolucencies involving the anterior and posterior mandible on the left side, including the mental foramen area (Fig. 3). Dr. Mannari believed this to represent a non-healing extraction site, accompanied by an erosive process of the body of the mandible.

An incisional biopsy of the posterior left mandible was performed under local anesthesia.

Soft tissue specimens obtained were friable, fatty and lobulated, and blue-gray in color. Dr. Mannari submitted the excised tissue to the University of Florida College of Dentistry Oral and Maxillofacial Biopsy Service in Gainesville. Microscopic examination revealed multiple sections of a specimen composed of sheets of atypical round cells. The atypical cells are large and have prominent nucleoli and clumped chromatin. Numerous mitotic figures, including atypical mitotic figures, are seen scattered throughout. There are some scattered small lymphocytes in the background (Fig. 4).

At follow-up, the patient reports worsening dyspnea, shortness of breath and labored breathing. She exhibits progressing abdominal distension, accompanied by pedal and lower extremity edema. Patient was instructed to proceed to the emergency department.

Question: Based on the clinical, radiographic and microscopic features pictured or described above, and the brief medical history, what is the most likely diagnosis?

A. Lymphoma B. Metastatic carcinoma C. Periapical cyst/granuloma/abscess D. Osteomyelitis E. Squamous cell carcinoma

Please see DIAGNOSTIC, 62

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Diagnostic

A. B.

Fig. 1: Clinical photo demonstrates a pigmented fluctuant mass of the left side of the posterior mandible. This initially was felt to represent a non-healing extraction site.

Fig. 3: Also noted on the CBCT were multiple ill-defined radiolucencies involving the anterior and posterior mandible on the left side.

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Fig. 2a: An orthopantogram reveals a small saucer-shaped erosion of the superior alveolar crest in the left posterior mandible (arrow) and marked widening of the inferior alveolar canal (yellow lines).

Fig. 2b: A CBCT revealed perforations of the lingual cortices in the area of the mandibular body, with impingement on the inferior alveolar nerve (arrow).

Fig. 4: Higher power photomicrograph (40x) showing sheets of atypical round cells infiltrating throughout the surrounding loose fibrous connective tissue. The atypical cells are large and have prominent nucleoli and clumped chromatin.

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Diagnostic

DIAGNOSTIC from 61

Diagnostic Discussion A. Lymphoma Correct! Lymphomas consist of a large group of malignancies that arise from white blood cells. Almost 85-90 percent arise from B-cells, as did this tumor whose exact diagnosis was diffuse large B-cell NonHodgkin’s lymphoma (DLBCL). As the name implies, the tumor consisted of sheets of large atypical B lymphocytes recapitulating a stage of normal lymphocytic maturation. This tumor is classified as peripheral B-cell neoplasm and is composed of mature lymphocytes. DLBCL actually is the most common Non-Hodgkin’s Lymphoma (NHL) and about 25,000 new cases are diagnosed in the U.S. each year. It represents a heterogeneous group of lymphomas that can be subclassified as to location (bone in this case) association with viruses (EBvirus, HHV-8), morphology (centroblastic, immunoblastic, anaplastic), etc. For this discussion, we will consider these lesions as one large group. Unfortunately, the incidence of lymphomas is increasing each year, and they now comprise the second most common malignancy found in the oral cavity after squamous cell carcinoma.

DLBCL most commonly affects middleaged males with an average age of 60.They can occur anywhere in the body, but have a predilection for the lymphoid tissues that make up Waldeyer’s Ring, including the tonsils, adenoids, posterior tongue and oropharynx. These are aggressive neoplasms and usually present as a rapidly enlarging mass in the soft tissues or as a vaguely

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painful destructive process within the bone.

About 40 percent of these lesions do not arise in lymph nodes (extra nodal) and only about 3-5 percent arise in bone. Most of the primary bone lesions are low grade, low stage and have a favorable prognosis.

Due to the pain, they often are mistaken for a toothache, which is why we present this case for your consideration. Radiographically, they can cause very subtle changes in the bone, especially early in the process, compounding the easy confusion with a toothache. Eventually, however, they appear as ill-defined destructive radiolucencies.

When they occur in the mandible, they often present as did this patient with numb chin syndrome or paresthesia of the lip and chin area. This is due to the infiltration of the malignant cells into the nerve itself.

Paresthesia is a serious sign and usually is found in association with malignances, aggressive tumors like an ameloblastoma or with serious infections, such as osteomyelitis. While most patients with DLBCL have no symptoms, this patient presented with the classic disease-related symptoms seen in many patients with B-cell lymphomas: fatigue and most importantly, night sweats. Night sweats, fever, itching and the aforementioned fatigue are common signs of B-cell lymphoma and these signs are important clues to this diagnosis. Another important clinical clue is the presence of a fluctuant (often rubbery) purple mass.

Lymphomas and salivary gland tumors often have this purple surface discoloration, as will vascular lesions and peripheral giant cell granulomas.

These tumors rapidly can be fatal if untreated, and will expand the bone and quickly erode through the cortex and present as a soft tissue mass as seen in this patient.

Staging is important in prognosis, with an early-stage patient doing better. This patient would most likely be in stage 3 or 4, with widely disseminated disease judging from her worsening symptoms of dyspnea and abdominal distension. The good news is that combination intensive chemotherapy can put most of these patients into remission and cure almost 50 percent. Recently developed monoclonal antibodies to Bcell surface markers, such as Rituximab, improve both the initial response and final outcome with little additional side effects.

However, patients must be healthy enough to withstand the highly toxic chemotherapy.

B. Metastatic Carcinoma Incorrect. Metastatic carcinoma (MC) is an entity that should be included in the differential diagnosis for this case. MC is the most common form of malignancy found within bone — far outstripping the incidence of primary bone cancers such as osteogenic and chondroblastic sarcomas.

MC primarily is a disease of the middleaged, which makes this patient a prime candidate. The mandible (usually posterior) is the most common site for metastasis to the jaws, making up more than 80 percent of jaw metastasis. While jaw metastasis may be small and relatively unnoticeable, most present as ill-defined radiolucencies that destroy the cortex just as in this case.

Metastases to the jaw can mimic inflammatory disease and often are diagnosed late in the course of the disease when the teeth become loose. Most importantly, jaw metastasis often causes numbness and paresthesia — an important finding seen in this patient. Also, approximately 15-20 percent of patients dying of MC will have jaw mets. Therefore, although metastases are an uncommon occurrence, they must

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Diagnostic

still be considered in the differential diagnosis. Biopsy is essential for diagnosis and the findings of an atypical diffuse round cell infiltrate as seen here would be compatible with a metastatic lesion. Only after careful study and extensive immunohistochemical staining of the round cell infiltrate was a different diagnosis discovered. Many clinicians discard suspected inflammatory tissue only to see the lesion recur and grow quickly. This could lead to fatal delays in treatment. If tissue is removed, it should be sent for microscopic examination to ensure the safety of the patient.

C. Periapical Granuloma/ Cyst or Abscess Incorrect, but since common things happen more frequently, this is not an entirely bad thought! A periapical granuloma (PG) or cyst would appear as an apical boney destructive radiolucency and would cause pain, but not paresthesia. Also, in most cases, a PG would cause far less extensive bone destruction and be better delineated radiographically. The one exception might be if an Actinomyces species got into the wound — this might cause the extensive and even multifocal bone loss seen here.

benefit

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ONLINE CE: THE EASY WAY

Also, while there can be multiple PGs, they almost always are associated with the periapex of a non-vital tooth and few teeth are present here. Finally, the PG would have a mixed inflammatory infiltrate composed mainly of lymphocytes and plasma cells, and perhaps neutrophils, but not the bizarre atypical round cells seen here.

D. Osteomyelitis Incorrect — but an answer with some merit! Osteomyelitis (OM) is an acute or chronic inflammatory process of bone marrow or cortex. A wide age range of patients are affected, but there is a strong male predominance. Most cases involve the mandible. In this case, the patient had extensive bone loss and signs such as chronic pain and paresthesia, which mimics extensive inflammation of the bone as seen in OM. Also, there is a ragged, ill-defined radiolucency present just as we would see with chronic OM. There also is a history of recent tooth extraction — a common precursor for OM. Obviously, the histologic findings in this case would preclude a diagnosis of OM, as the inflammatory infiltrate is made up of large atypical cells and does not contain the

requisite inflammatory cells: lymphocytes, plasma cells and often neutrophils, which characterize an OM. E. Squamous Cell Carcinoma Incorrect. Gingival squamous cell carcinoma (SCC) makes up between 10-30 percent of all oral cancers, depending on the study population. It is a disease of the elderly with an average age of 72 at the time of diagnosis. The mandible is the most common location, which is the site of origin 72 percent of the time. Just as in this case, it does favor the posterior mandible. Gingival carcinomas often mimic benign conditions such as pyogenic granulomas, granulation tissue, gingivitis and periodontal disease.

These lesions most often appear red in color, just as seen in our patient and in most inflammatory lesions. An SCC — especially if diagnosed late in the course of the disease — can cause extensive bone loss and appear radiographically as an ill-defined radiolucency just as seen in this patient. Most importantly, SCC or any malignancy often will cause paresthesia and dysesthesia if it affects Please see DIAGNOSTIC, 64

EARN FREE CE CREDIT TO RENEW YOUR LICENSE!

“DIAGNOSTIC DISCUSSION”

Visit the FDC & CE page on the FDA website and click the “Online CE” button for this free, members-only benefit. You will be given the opportunity to review this column and its accompanying photos, and will be asked to answer five additional questions.

Questions? Contact FDC Meeting Coordinator, Brooke Martin at bmartin@floridadental.org or 800.877.9922. * These courses expire on 4/28/2017.

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Diagnostic

DIAGNOSTIC from 63

Some useful references:

the posterior mandible. Usually, but not always, an SCC will show more surface change, but many gingival carcinomas are discovered only after a tooth is extracted in the area, which allows explosive growth of the lesion. Of course, the histologic findings would be unusual for a squamous cell as the infiltrate was composed of large atypical round cells, not polygonal — often keratinizing squamous cells that would be found in most carcinomas.

Dr. Cohen

Clinicians must increase their awareness of important diagnostic signs such as paresthesia, night sweats, fever and prolonged fatigue — recognizing these signs can lead to early diagnosis and improved prognosis in patients with lymphomas. Any lesion that does not respond to conservative therapy should be biopsied and the tissue submitted for microscopic examination to ensure arriving at the correct diagnosis.

Dr. Bhattacharyya

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1. Kumar V, Abbass AK, and Aster JC. Disorders of White Cells. Robbins and Cotran Pathologic Basis of Disease 9th ed. Philadelphia, Elsevier; 2015p.

586-597.

2. Neville BW, Damm DD, Allen CM, and CHI A. Oral and Maxillofacial Pathology, 3rd ed. Philadelphia Elsevier; 2015 p. 447-449.

3. Gurbaxani s, Anastasi J and Hyjek E. Difffuse large B-cell lymphoma – More than a diffuse collection of large B-Cells. Arch Pathol Lab Med. July 2009; (133)1121-1134.

4. Swerdlow SH et al eds. WHO Classification of Tumours of Hematopoietic and Lymphoid tissues.

4th ed, Lyon International Agency for Cancer Research; 2008; p 233-237.

5. Gatter K and Pezzella F. Diffuse Large B-cell lymphomas. Diagnostic Histopathology 2009p 69-81.

6. Friedberg JW and Fisher RI. Diffuse Large BCell Lymphoma. Hematology/oncology Clinics of North America 22(5); Oct 2008 p 941-52 (20040 10, 311-318

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

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

Clinicians are invited to submit cases from their own practices.

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

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

* Florida licensed dentists: Don’t forget to notify the Florida Board of Dentistry with your new information by going to floridasdentistry.gov or calling 850.488.0595.

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Impression Technique

A Two-stage Impression Technique for Making Edentulous Impressions of Maxillary Displaceable Fibrous Tissues

By John R. Antonelli, DDS, MS; Stanley L. Hack, BDS; Michael Georgescu, DMD; and Karina Leiva Lopez

A displaceable (flabby) maxillary ridge usually is detected in a patient who wears a maxillary complete denture opposed by natural mandibular anterior teeth — the combination syndrome. The syndrome also could occur in patients who have worn maxillary and mandibular complete dentures for many years,1 and consists of severe maxillary anterior ridge resorption combined with hypertrophic changes in the residual ridge tissues. In 1972, E. Kelly2 described the changes caused by a mandibular removable partial denture opposing a maxillary complete denture and coined the term, “combination syndrome,” which consisted of: 1) loss of alveolar bone from the premaxilla; 2) overgrowth of the tuberosities; 3) reactive papillary hyperplasia of the hard palate; 4) super-eruption of the mandibular anterior teeth in a labio-incisal direction; and, 5) loss of bone support under Kennedy class I removable partial denture bases. Displaceable tissues replace alveolar bone and also can be found

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in the mandibular alveolar ridge. Accompanying the changes is a loss of vertical dimension of occlusion and forward movement of the mandible to produce the classic prognathic chin.

Soft tissues that are displaced during impression-making will return to their original form, which could diminish retention and stability and, ultimately, dislodge an overlying denture.

One approach to the management of the flabby ridge involves surgical excision of fibrous tissues prior to conventional denture construction. This approach could produce a firmer denture-bearing area, with improved stability of the prosthesis. Ridge augmentation by grafting is an option that could produce further resorption or rejection of graft material.3 When little alveolar bone remains, surgical excision of hyperplastic ridge tissue could result in loss of sulcular depth, border seal and, subsequently, retention.4 It might be prudent to preserve displaceable tissue to obtain some retention, albeit inferior.

Implant-retained prostheses might offer a solution to the problems of stability and retention.

There is a lack of scientific evidence pointing to the superiority of one technique over the other.5 The general health, dental history and motivation of the patient must be considered before recommending preprosthetic surgery. In some situations, surgery is mandatory to achieve a successful outcome. In others, the surgery is optional. When faced with the cost, time and inconvenience of undergoing preprosthetic surgery, some patients may decline.

However, all patients who could potentially benefit from surgery should be given the option, as this is a vital component of the informed consent process.

I’ve outlined an impression technique that uses basic principles of complete denture construction without recourse to surgically invasive procedures. A mucostatic impression technique is described as one that records undisplaced denture bearing tissues at rest, and aims to achieve support from the other firm tissue areas of the arch to maximize retention.

It has been said that this technique results in uneven distribution of occlusal forces under the denture base, whereas a mucocompressive technique distributes forces more evenly.6 The same authors claim that there is no evidence to show the superiority of one technique over the other. The window technique employed here was described by Watson.7 It uses materials with which the general dentist is already familiar. A rigid custom tray, with an opening over the flabby tissues, is used to produce a composite mucocompressive impression of rigid tissues and mucostatic impression of flabby tissues.

www.floridadental.org

Impression Technique

Fig. 1: The area of displaceable anterior ridge Fig. 2: A window over displaceable tissue was cut in crest tissue is outlined in the photograph of a rigid custom tray. the edentulous maxilla.

Fig. 4: The completed polysulfide impresFig. 5: While the final impression was seated sion. Excess impression material was removed fully in the patient’s mouth, ultra-low viscosfrom the window area. ity vinyl polysiloxane impression material was syringed into the tray window over displaceable ridge tissues.

Fig. 3: The custom tray was border molded with green stick compound. The intaglio surfaces of the tray were coated with a thin layer of polysulfide tray adhesive.

Fig. 6: The composite, mucostatic-mucocompressive final maxillary impression.

The following steps are used:

Fig. 7: Pumice weakens the set plaster and facilitates separation of the master cast after pouring.

Fig. 8: Land areas of the master cast have been trimmed. The sides of the cast should be perpendicular to the base.

1. Make a preliminary impression with low viscosity irreversible hydrocolloid (Jeltrate Regular Set, Dentsply International, West Perth, WA) to ensure minimum tissue displacement. It is recommended to use a rigid, metal edentulous impression tray to maximize accuracy in the preliminary impression. Pour the impression in vacuum-mixed Type III dental stone.

2. Identify all displaceable tissue areas intraorally; outline them on the preliminary cast (Fig. 1).

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3. Fabricate a custom tray. Insert the tray intraorally and trim any overextended peripheral areas to within 2 to 3 mm of the mucobuccal folds, muscle attachments and frena.

4. Cut a window in the tray in the region of displaceable tissues (Fig. 2).

5. Border mold the tray with green stick compound to provide a satisfactory peripheral seal (Fig. 3). When this step is overlooked, prospects for optimal denture retention are reduced.

6. Make a final polysulfide impression.

Once polymerized, use a scalpel blade to trim all impression material that flowed into the window area of the tray (Fig. 4).

7. Apply a compatible vinyl polysiloxane (VPS) adhesive to the borders of the tray window. Replace the tray intraorally and syringe extra low viscosity VPS material into the window area to capture a mucostatic impression of all displaceable tissues (Fig. 5).

8. Once polymerized, remove the impression from the patient’s mouth (Fig. 6).

9. Box the final impression in a patty of plaster and pumice (1:1 mixture by volume of plaster of Paris and flour of pumice) to preserve the extension and thickness of the recorded borders (Fig. 7).

10. Pour the final impression in vacuummixed Type III dental stone to create the master cast (Fig. 8).

11. Make occlusion rims to register maxillomandibular relationships. Complete a facebow transfer to relate the maxillary plane to the condylar axis of a semiad-

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justable articulator. Guide the patient into a centric relation bite registration, use the bite record to relate maxillary and mandibular casts, set anterior teeth aesthetically and build a waxed denture with a suitable occlusal scheme with balancing contacts.

No final impression should be made before returning soft tissues to a state of health.8 Regardless of the impression technique employed, dentists should consider alternative impression procedures for impressing unsupported, flabby tissue on the ridge crest.9

Reference List 1. Grant AA, Heath JR, McCord JF (1994) Complete Prosthodontics: Problems, Diagnosis and Management. Mosby-Year Book Europe Limited, London, UK. 2. Kelly E. Changes caused by a mandibular removable partial denture opposing a maxillary complete denture. J Prosthet Dent.

1972; 27(2):140-150.

7. Watson RM. Impression Technique for Maxillary Fibrous Ridge. Br Dent J. 1970; 128:552.

8. Antonelli, JR, Panno, FV, Witko, AJ. Inflammatory Papillary Hyperplasia: supraperiosteal excision by the bladeloop technique. General Dentistry. 1998; 46(4):390-397.

9. Massad JJ, Cagna DR. Vinyl Polysiloxane Impression Material in Removable Prosthodontics Part 1: Impressions. Compendium Cont Ed Dent. 2007; 28(8):452-460.

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

3. Bindhoo YA, Thirumurthy VR, Kurien A. Complete Mucostatic Impression: A New Attempt. J Prosthodont. 2012; 21:209-214.

Drs. Hack and Georgescu are assistant professors in the Department of Cariology and Restorative Dentistry at Nova Southeastern University College of Dental Medicine, and can be reached at shack@nova.edu and georgescu@nova.edu, respectively.

4. Zarb G, Hobkirk, JA, Eckert SE, Jacob RF (2013) Prosthodontic Treatment for Edentulous Patients: Complete Dentures and Implant- Supported Prostheses, 13th ed.

Elsevier, MO.

Ms. Lopez is a D3 dental student at Nova Southeastern University College of Dental Medicine and can be reached at kl973@nova. edu.

5. Crawford RWI, Walmsley AD. A review of prosthodontic management of fibrous ridges. Br Dent J. 2005; 199(11):715-719.

6. Lynch CD, Allen PF. Management of the flabby ridge: using contemporary materials to solve an old problem. Br Dent J. 2006; 200(5):258-261.

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Compleat Dentistry

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

By Dr. Edward Hopwood

I came across an article with yet another respected advisor, offering free (!) advice on how to plan for retirement, and it finally pushed me over the edge. I carefully read the article on his opinion of the retirement plan options — conveniently grouped into silver, gold and platinum. The push was no surprise, offering tax-deferred savings in excess of $100,000 using a safe harbor 401k and a cash balance plan. Of course, this plan also generates the most expensive fees, requiring an actuary to do the math — platinum, indeed, but for whom?

I tore out the page and stuffed it into my work bag. After a few weeks, I usually throw it away and forget about it. But this one was different (though I have read so many before with the exact same message). This particular article made me recognize a powerful message for my colleagues. The problem is not with the author or the ubiquitous financial advisors like him, the problem is with his perspective. If we recognize this, we can avoid falling into their trap.

Too often, we think of retirement accounts as a category unto themselves. Money should be put there and we should save it for retirement. We should save enough so that we can retire and live on the money in the account. But, the true picture is more complicated than that.

I propose that we should think of retirement accounts as a portion of our total net worth.

When the perspective shifts to the retirement account as a part of a bigger picture, we can make more intelligent decisions. In fact, the decisions become easy.

For example, most financial advisors will recommend a portfolio based on a mix of stocks and bonds, with bond proportion increasing as we age. One rule of thumb is the percent of bonds should be equal to your age, i.e., a 30-year-old dentist should have 30 percent in bonds. The challenge in today’s world is that safe bonds are returning low yields (10-year U.S. Treasury at 2.056 percent), so we have people looking to increase the yield by buying

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riskier bonds (10-year Colombian at 3.1 percent). So these financial advisors are advising our 30-year-old dentists to commit a proportion of their retirement fund to a yield of 2-3 percent.

If we zoom out a little bit and take the net worth perspective, it is readily apparent to any 30-year-old dentist that the consolidated interest rate on graduate student loans taken after July 1, 2006 is now 6.80 percent (www.direct.ed.gov/calc.html). It just takes a little bit of common sense to understand that the 30-year-old dentist can double or triple their yield simply by prepaying their student loans. I would propose that any money put into a retirement plan and invested in bonds should instead be invested in prepaying student loans. Note: I am saying that if you have an extra $40,000 to invest, and 30 percent of that investment ($12,000) was earmarked for bonds, it would be far superior to take that $12,000 and pay it towards your student loans. This payment should be over and above your normal payment. The best part of it is the return is a guaranteed return, not relying on third-world governments to repay it.

But what about compound interest? Isn’t that the modern miracle that was the most amazing thing that Einstein ever discovered? Well, I am a big fan of compound interest, but there are two corollaries to all the eye-popping charts the advisors show you: s Compound interest works against you when you are paying interest.

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Compleat Dentistry

s The higher the interest rate, the more amazing the compound interest — so go for the higher rate. I assure you, the growth charts on 2.056 percent interest rates are not that impressive. (And Einstein didn’t discover compound interest.)

Now, I don’t believe that financial advisors are bad people — that would be insulting to us all because everyone is related to a financial advisor. I am saying that they are trying to make a living by providing a service. The service is never free and their incentive is to make money.

Therefore, they are proponents of plans that will generate the fees in which they make their living. It is our responsibility to recognize their perspective and to maintain ours, and filter their advice into the context of our overall financial picture.

As for where my financial plan fits in to the silver, gold, or platinum category ... Well, this advisor called one component of my plan a “fool’s gold” plan. The other tax-advantaged components of my plan were not even listed in any of his categories. Why? Because they don’t generate large fees. But, they are just as simple as the example listed above. It just takes a net worth perspective.

If we are able to maintain the net worth perspective, then we can run a practice with sound finances, and we will be able to free ourselves from the pressures of daily or weekly production goals. This will free us up to treat our patients without any financial pressure. Our patients quickly recognize when they are working with someone who is not financially struggling, and they can be comfortable that the treatment plan presented is one that puts their interests first — which is exactly the way the doctorpatient relationship should work.

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

NEW DENTAL GRADUATES GET THE GIFT OF COVERAGE All new dental graduates who become FDA members and practice in Florida will have their first year of professional liability coverage from The Doctors Comany completely paid for by their FDA colleagues!

CALL US AT 800.877.7597 TO LEARN MORE AND ENROLL

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Dental Lifeline

When Things Go Sour, Volunteer Dentists Transform a Life

Left to right: Carlos Verde of VerDent Labs, Dr. Karen Coello, Rona and Dr. Carlos Coello

If life hands you lemons, maybe your name is Rona.

Rona’s had a rough stretch, but this 72-year-old, Boca Raton assistant teacher of children with autism found a way to make lemonade. Diagnosed with Stage 4 non-Hodgkin’s lymphoma in 2011, Rona received intense chemotherapy treatments.

The chemo resulted in a side effect called xerostomia, which halts saliva production and caused her teeth to fall out. Rona began to lose her ability to speak clearly and she feared losing the work she loves.

Fortunately, some powerful helpers lined up at Rona’s lemonade stand. Unable to afford the dental treatment she desperately needed, Rona relentlessly applied for help for two years. She was turned down repeatedly by her own insurance company and 30 other agencies, but was referred to Florida Donated Dental Services (DDS). A program of Dental Lifeline Network • Florida,

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Rona with Dr. Thomas Copulos

DDS operates in partnership with the Florida Dental Association Foundation. A large and highly skilled team of DDS volunteers guided Rona through a year of dental treatment that changed her life.

The key to the success of Rona’s care was Dr. Thomas Copulos, a DDS volunteer periodontist who devised the treatment plan, which included extracting 25 of Rona’s teeth and placing eight implants to anchor full upper and lower dentures. Two general dentists, Drs. Karen and Carlos Coello, were described as the “captains of the ship” by Florida DDS Coordinator Megan Manor who recruited all of the volunteers and facilitated the case. Sharing the responsibilities, Drs. Coello fitted Rona with full sets of immediate dentures donated by Androu Dental Lab, and a full set of implant dentures provided by VerDent Dental Laboratory. Both labs are among the 216 that volunteer for Florida DDS. Rona’s case also involved two manufacturers that donate materials to the DDS program.

Straumann donated two bone grafts, eight implants, and at least 20 implant parts used to anchor the dentures. DENTSPLY International contributed teeth for full upper and lower dentures.

DDS changes lives every day. This case was very complex and unusual for DDS, but noteworthy. Many generous volunteers and material donations were involved in rebuilding Rona’s mouth with implant dentures. Dr. Karen, speaking for both Coellos, commented that what Rona has overcome is truly amazing and they were happy to help.

With the help of Florida DDS and its volunteers, Rona’s life turned from lemons to lemonade. She is ecstatic with her new teeth and smile, and her cancer is in remission. www.floridadental.org

Dental Lifeline

To the volunteer dentists: “You exceeded my every expectation and managed to get me through the entire year process with the least pain possible and wonderful explanations about every procedure. We need more people like you in this world who are willing to give of themselves and take lessons on the trials many people endure because they are unable to afford help. I want to thank you for putting a smile on this grateful woman’s face and being the wonderful dentists you are.”

— Rona, DDS patient

To DDS: “Having my teeth fall out, along with nausea, baldness and the complete feeling of helplessness from the cancer left me utterly devastated. Then you came along. You put me in touch with the most marvelous dentists. The chills from that phone call still reverberate when I think back.

“I am almost myself again, but most importantly, I can smile when I go into work and have my colleagues, family, friends and students smile back at me. Thank you from the bottom of my heart for giving me life once again.”

— Rona, DDS patient “We were more than happy to help Rona. She went through chemo and really struggled with cancer. When you hear someone go through that, survive it and have another issue as a result — you would like to do whatever you can. The staff felt a sense of pride that they had contributed.

“If you want to work with patients who are appreciative of what you can provide to their overall health and feel the rewards, it’s worth becoming involved. I think DDS is successful because it took not just me as a surgeon — it involved general dentists, labs, Straumann and DENTSPLY International. The team, together, made it happen.”

— Dr. Thomas Copulos, DDS volunteer periodontist

www.floridadental.org

Volunteer Now! Join Florida’s 396 DDS volunteer dentists to help vulnerable people who have no access to dental care. Hundreds of people are on waiting lists and more volunteers are needed statewide — especially in north Florida and the Panhandle. You can treat one patient per year or as many as you choose.

Your DDS coordinator ensures that patients arrive on time for appointments, arranges for assistance from specialists and laboratories, and serves as the liaison between your staff and the patient to facilitate everything.

Volunteering is easy. Your staff will love the experience! n Patients are prescreened. n You review the patient profile in advance and choose to see or decline any patient. n You determine your own treatment plan. n You see patients in your office on your schedule. n You never pay lab costs. n You and your staff have no extra paperwork.

Volunteers say they never expected how much their staff appreciates the DDS experience.

Staff members celebrate the success of patients and value the teamwork they provide with their dentists.

To volunteer, contact Florida DDS Coordinator Megan Manor at 850.577.1466 or mmanor@DentalLifeline.org, or go to http://dentallifeline.org/florida/ for more information.

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DONATE!

Your donations support these programs: Florida Mission of Mercy, Project: Dentists Care, Donated Dental Services To make a donation, go to www.floridadental.org/foundation

Costello

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Dr. Costello believes this is the time to “Stand Up For America!”

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Costello

There are many issues at the state and federal levels that threaten the autonomy of practicing dentistry. Outside forces constantly are introducing legislation and proposals that attempt to over-regulate and undermine the dental profession. It is paramount to have someone willing to represent your concerns and interests. That someone is one of the Florida Dental Association’s (FDA) very own — Dr. Fred Costello!

Dr. Costello was born and raised in Orlando. After graduating from the University of Iowa College of Dentistry, he served as a captain in the United States Air Force. He later moved to Ormond Beach in 1977, where he still practices comprehensive and cosmetic dentistry. Among other recognitions, Dr. Costello was honored with the designations of Master of the Academy of General Dentistry and Fellow of the American College of Dentists.

Dr. Costello and his wife, Linda, have been married 42 years and have three children and six grandchildren. Dr. Costello considers it an honor to have served his community as mayor of Ormond Beach from 2002-2010, as well as his current position serving as a state representative. During the 2011 Legislative Session, Rep. Costello was honored by the FDA as the “Freshman Legislator of the Year” for his outstanding role during his first term in the state House.

Although legislation failed to pass this year by Rep. Costello on direct primary care (legislation to allow patients to sign an agreement directly with a health care provider — eliminating the insurance companies), he did play a vital role to assure that the scope of practice for hygienists was not expanded while finding a way to approve payment for their services when provided in health access settings. In addition, he especially is proud of his role in eliminating the $428 million required local effort school property tax included by Gov. Rick Scott in his initial budget proposal.

Dr. Costello will continue to work on issues impacting dentists, such as elimination of the medical device tax, improving Medicaid reimbursement, and protecting dentists against problematic balanced billing and non-covered services legislation. In addition, he will fight for America’s Judeo-Christian values, enhanced national security based upon peace through strength, limited federal government through restoration of states’ rights and attacking out of control federal spending — resulting in a balanced federal budget.

Dr. Costello believes Florida is in great shape, but Washington is broken. He believes this is the time to “Stand Up For America,” and has decided to run for U. S. Congress, District 6!

Photos: 1. Dr. Costello and his wife, Linda, with their six grandchildren.

2. Dr. Costello speaking on the Florida House floor.

3. Dr. Costello, wife, Linda, and one of their granddaughters participating in a Religious Freedom rally.

For more information, please go to ADA.org/ADPAC. www.floridadental.org

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C lassified A dvertising

Opportunities

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Today's FDA

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

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

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

Issue

Extracted Date

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

Jan. 15 March 15 May 1* July 15 Sept. 15 Nov. 15

* The May/June issue is scheduled to be mailed out two weeks earlier than normal to reach members before the annual Florida Dental Convention.

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

March/April 2016

Seeking PT or FT Endodontist. We are seeking a PT or FT provider to work in our established multi-specialty practice located in Jacksonville, FL. Offering Health benefits, malpractice coverage, CE reimbursements, competitive salary plus % of production in an established up to date practice!

Provider can expect a highly productive patient load, a welcoming staff, and a long term career path with potential partnership opportunity. Please call for more details: 248.430.5555 or email Molly McVay at molly.mcvay@greatexpressions.com. https://careersclinical-greatexpressions.icims.com/ jobs/5822/full-time-endodontist-opportunity--jacksonville%2c-fl/job.

Pediatric Dentist-Melbourne, FL. Since 1997, Christie Dental has grown from our first location in Merritt Island, FL to 17 locations from coast to coast in Central Florida. We are a community based, multi-specialty group committed to the traditional doctor-patient relationship and providing the highest quality care and service to our patients. Our mission is to be Florida’s premier dental provider of choice through fiscal, social and ethical excellence. We’re interested in speaking with Pediatric Dentists to join our team in Melbourne. This is a part time position working 2 days a week and can be a great supplement to an existing schedule and may offer future growth opportunity. We also have the ability to combine a second location for a full time schedule. Christie Dental is primarily a fee-for-service and PPO provider. Interested candidates, please contact kateanderson@amdpi.com or 781.213.3312. http:// www.christiedental.com/.

Dentist. True Health community health center has an immediate full time position for a general dentist in East Orlando, FL. Must be licensed in the state of Florida and have a valid DEA license.

Must provide both pediatric comprehensive and adult emergency services. 36 hours a week will be devoted to comprehensive pediatric care (patients up to age 21). 4 hours a week are for adult emergency care (extractions and fillings only).

This clinic has 3 operatories with 2 ½ experienced full time dental assistants, phosphor plate x-ray system, and electronic dental records. The office was opened in 2012 and has up to date dental equipment and instruments. The office is located at 11881-A East Colonial Drive Orlando, FL 32807.

Hours are Monday-Friday, no weekends. Applicant must have at least 2 years of clinical experience and be able to work in a fast-paced environment.

BENEFITS INCLUDE: COMPETITIVE SALARY; POTENTIAL TO APPLY FOR LOAN REPAYMENT ($60K for every 2 years served); Incentive bonus BASED ON PRODUCTIVITY; 5.5 WEEKS PAID TIME OFF, WITH CASH OUT option; 40 hours paid annually for CE time and monetary reimbursement for CE; Paid dental license renewal, DEA renewal, and monetary reimbursement towards professional dues; Medical insurance (base plan fully paid by employer for employee); 403B retirement plan; Life insurance; Malpractice insurance provided through the Federal Tort Claims Act. hr@mytruehealth.org.

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General Dentist Opportunities - Jacksonville, FL. Great Expressions Dental Centers has select openings for General Dentists to join our Jacksonville, FL dental team! For more than 35 years, Great Expressions Dental Centers has been exceeding patients’ expectations offering general dentistry, endodontic, periodontic, oral and maxillofacial surgery, orthodontic, and pediatric dentistry services in a comfortable, friendly environment. We are always looking for motivated and qualified dental professionals and with over 250 dental centers in ten states, the opportunities are unlimited.

Compensation: Six Figure Annual Draw vs.

Percent of Production! Attractive Sign-on or Relocation possible as well. Benefits/Perks: Leaders in the practice: Clinical Freedom and Treatment Autonomy.

Patient Focus: Established and Growing Patient Foundation. Multi-Specialty office. Doctor Career Path – Partnership/Investment Opportunities. Full Benefits Offered – Healthcare & Dental Benefits, 401K, Short Term/Long Term Disability, Time Off. Malpractice Coverage Assistance. Continued Education Reimbursement, Paid ADA & State Society Dues. Mentorship – Study Clubs, Chairside Mentoring, GEDC University Courses. Please view our Doctor Career Path video: http://www. screencast.com/t/M3xWM5CYN. Please apply via this ad for consideration! Molly McVay | Clinical Recruiter | Great Expressions Dental Centers PSC-North | 29777 Telegraph Road. Suite 3000| Southfield, MI 48034 USA phone 248.430.5555 |Ext. 72467| fax 248.686.0170 | web www. greatexpressions.com. Must have a DDS/DMD from an accredited University and active State Dental Board license.

Comprehensive HIPAA Compliance Program.

Federal Law requires all dentists to be HIPAA/ HITECH Compliant. Contact us to schedule your Comprehensive HIPAA Compliance Program.

Program includes: Team member training, Onsite Risk Analysis, IT Assessment, External Vulnerability Scan, Internal Vulnerability scan and Level 2 and 3 reporting, Security Officer training. 844-DKCARR1 – 844.352.2771 or email: info@dkcarr.com.

HIPAA COMPLIANCE . Federal Law requires all dentists to be HIPAA/HITECH Compliant.

Contact us to schedule your Comprehensive HIPAA Compliance Program. Program includes: Team member training, Onsite Risk Analysis, IT Assessment, External Vulnerability Scan, Internal Vulnerability scan and Level 2 and 3 reporting, Security Officer training. 844-DKCARR1 – 844.352.2771 or email: info@dkcarr.com.

Enthusiastic Dentist Wanted! We are looking for a FT General Dentist to team up with us in our Palm Harbor practice. Our clinic is very clean, completely renovated, 3,600 sq feet with great lighting, new equipment in 8 OP with digital X-rays. Our practice is located on the main highway with easy access for our patients plus loads of parking. Guaranteed daily rate with monthly profit sharing, we pay your malpractice insurance, provide health insurance and paid vacation. Financials can be discussed at length in person. *Partnership is available.* mioconnor@ aspendental.com.

ENDODONTIST-TAMPA BAY AREA. Quality associate needed for busy, modern endodontic office. New graduates encouraged to apply. Send CV to julieh@aeoftb.com.

General Dentist Opportunity In West Orlando.

West Orlando Dental practice needing a FT General Dentist. We have a lab in the practice with a FT lab tech, 3 DAs and a hygienist. Our clinic is completely remodeled with new equipment, very clean with great lighting, 7 operatories and digital X-rays. This practice is located on the corner of an intersection within a large, nearly new shopping center.

Great traffic flow with ample parking. We have a guaranteed daily rate with monthly profit sharing.

We pay $2,500 of your malpractice insurance. We also provide health insurance, 401K w/match, paid CEs and paid vacation. *relocation assistance is considered.* Must be a dentist with a DDS or DMD degree and no issues with license or insurance problems. mioconnor@aspendental.com.

ENDODONTIST FULL TIME OR PART TIME - Treasure Coast, Florida Endodontist position available to join multi-specialty established practice.

State of the art equipment (microscope, endoscope, CBCT). Great opportunity for a person of high integrity and strong work ethic. Our patients are the highest priority. Two locations on the Treasure Coast (Stuart and Port St. Lucie, FL). Great support staff. Send resume to tjmelching@gmail.com.

Dentist to provide oral care to patients including oral exams, diagnosis, treatment planning and various procedures. Require Doctor of Dental Surgery degree and license to practice Dentistry in Florida. Work location - Riverview, Florida. Submit resume to Great Expressions Dental Centers at kristy.loomis@greatexpressions.com.

Comprehensive Dentist - Key West. Opportunity for a full or part time comprehensive general dentist in a well-established, busy old town Key West practice. Open for associate, buy-in or buy out. Well-equipped office. Primarily fee for service office. Please respond to kwfdentaljob@gmail.com.

General Dentist - Bonita Springs, FL Come lead our Bonita Springs, FL team as a full time Dentist in a highly productive practice! Great Expressions Dental Centers has an immediate, select opening for a full-time General Dentist to join our Bonita Springs, FL office (located: 25195 Chamber of Commerce Drive, Bonita Springs)! Enjoy a rewarding role with a dedicated staff with a great patient base! Compensation: Compensation - Six-Figure Draw and Percent of Production. Attractive Sign-on or Relocation possible as well! Benefits/Perks: Leaders in the practice: Clinical Freedom and Treatment Autonomy. Patient Focus: Established and Growing Patient Foundation. Multi-Specialty office.

Doctor Career Path – Partnership/Investment Opportunities. Full Benefits Offered – Healthcare & Dental Benefits, 401K, Short Term/Long Term Disability, Time Off. Malpractice Coverage Assistance. Continued Education Reimbursement, Paid ADA & State Society Dues. Mentorship – Study Clubs, Chairside Mentoring, GEDC University Courses. Please view our Doctor Career Path video: http://www.screencast.com/t/M3xWM5CYN. Apply via this ad or contact Stacey Bruwer at 248.237.6853 Apply Here http://www.Click2Apply. net/y8sxppw9mt.

General Dentist. DENTIST. General Dentist and Endodontist P/T for Aventura practice. Per diem guarantee plus commission. Excellent opportunity to add additional income in a FFS/PPO practice.

Top notch equipment and friendly staff. E mail resume to grwez1@gmail.com.

General Dentist Opening - Pinellas County, FL Great Expressions Dental Centers has an immediate opening for a full-time General Dentist to join one of our Tampa, FL practices in Pinellas County, FL. Enjoy a rewarding role with a dedicated and experienced staff! Compensation: Competitive Six Figure Annual Draw with Percent of Production.

Sign-on Bonus or Relocation Assistance possible.

Benefits/Perks: Leader in the practice: Clinical Freedom and Treatment Autonomy. Patient Focus: Established and Growing Patient Foundation.

Multi-Specialty office. Doctor Career Path – Partnership/Investment Opportunities. Full Benefits Offered – Healthcare & Dental Benefits, 401K, Short Term/Long Term Disability, Time Off. Malpractice Coverage Assistance. Continued Education Reimbursement, Paid ADA & State Society Dues.

Mentorship – Study Clubs, Chairside Mentoring, GEDC University Courses. Please view our Doctor Career Path video: http://www.screencast. com/t/M3xWM5CYN. Please apply via this ad for consideration, Molly McVay | Clinical Recruiter | Great Expressions Dental Centers PSC-North | 29777 Telegraph Road. Suite 3000| Southfield, MI 48034 USA phone 248.430.5555 |Ext. 72467| fax 248.686.0170 | web www.greatexpressions.com.

“Look for the Smile Above Our Name!” Must have a DDS/DMD from an accredited University and active State Dental Board license. Apply Here http:// www.Click2Apply.net/bx8smgb5t7.

Please see CLASSIFIEDS, 86

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March/April 2016

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Your Classified Ad Reaches 7,000 Readers!

CLASSIFIEDS from 85 Expanding Practice Seeking New Dentist.

Tallahassee, Florida dental practice seeking a motivated, full-time associate dentist to join this established, general family practice that offers services in general dentistry, oral surgery, pediatric dentistry, endodontics, and periodontics. The practice is fully computerized with digital x-ray units, a digital panorex, digital radiography, Dentrix practice management software, intraoral cameras and more. The practice boasts a predominately fee-for-service/PPO patient base, turnkey facility, quality staff, and low overhead with consistent annual revenue of more than 2.5 million. The practice is currently located in Midtown Tallahassee, but is building a new state-of-the-art 6,800 squarefoot office building off Capital Circle NE with plans to relocate summer 2016. The new facility will feature 16 operatories and a low monthly rental rate.

For more information on this opportunity, please send a copy of your current CV to ccouch41@ gmail.com and/or chaneychip@yahoo.com or call 850.509.3789.

Dentist Needed- Fort Myers, FL. Come lead our Fort Myers, FL office as a full time Dentist in a high production practice! Great Expressions Dental Centers has an immediate, select opening for a full-time General Dentist to join our Fort Myers, FL office! Enjoy a rewarding role with a dedicated, fully trained staff with a great patient base! Compensation: Six Figure Annual Draw vs. Percent of Production! Attractive Sign-on or Relocation possible as well! Benefits/Perks: Leaders in the practice: Clinical Freedom and Treatment Autonomy for Every Doctor. Patient Focus: Established and Growing Patient Foundation.

Multi-Specialty office. Doctor Career Path – Partnership/Investment Opportunities. Full Benefits Offered – Healthcare & Dental Benefits, 401K, Short Term/Long Term Disability, Time Off. Malpractice Coverage Assistance. Continued Education Reimbursement, Paid ADA & State Society Dues.

Mentorship – Study Clubs, Chairside Mentoring, GEDC University Courses. Please view our Doctor Career Path video: http://www.screencast.com/t/ M3xWM5CYN. Apply via this ad to learn more about Great Expressions! For More Information, Please Contact: Stacey Bruwer at 248.237.6853.

Part Time Endodontist - Estero Area. Wonderful part time opportunity to work at a private dental practice located in a growing area. We provide all resources necessary for patient care. Excellent, trained staff and state of the art equipment. diana@ collieroralsurgery.com.

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General Dentist Opening - Stuart, FL Come join be a clinical leader at our Stuart, FL practice! Great Expressions Dental Centers has an immediate, select opening for a full-time General Dentist to work in our multi-specialty Stuart office (located: 6035 SE Federal Highway Stuart, Florida 34997).

Enjoy a rewarding career with a dedicated staff of dental professionals and a strong patient base!

Compensation: Six-Figure Draw vs. Percent of Production. **Attractive Sign-on or Relocation possible as well ($$$)! Benefits/Perks: Leaders in the practice: Clinical Freedom and Treatment Autonomy for Every Doctor. Patient Focus: Established and Growing Patient Foundation.

Multi-Specialty office. Doctor Career Path – Partnership/Investment Opportunities. Full Benefits Offered – Healthcare & Dental Benefits, 401K, Short Term/Long Term Disability, Time Off. Malpractice Coverage Assistance. Continued Education Reimbursement, Paid ADA & State Society Dues. Mentorship – Study Clubs, Chairside Mentoring, GEDC University Courses. Please view our Doctor Career Path video: http://www. screencast.com/t/M3xWM5CYN. Apply via this ad to learn more about Great Expressions! For More Information, Please Contact: Ross Shoemaker, MBA | Doctor Recruiting Manager | Great Expressions Dental Centers Practice Support Center - South | 1560 Oakbrook Drive, Norcross, GA 30093 USA phone 678.836.2226 | ext 72226 | fax 770.242.3251 |web www.greatexpressions.com. email Ross.

Shoemaker@greatexpressions.com. “Look for the Smile Above Our Name!” Apply Here http://www.

Click2Apply.net/svszwpwrcz.

Associate Dentist Opportunity - South Miami, FL (Cutler Bay). Come lead our team of dental professionals in our Cutler Bay office in Miami, FL as our solo full time Dentist! Great Expressions Dental Centers has an immediate (March 1st), select opening for a full-time General Dentist to join our established/high production Cutler Bay practice in South Miami, FL! Enjoy a rewarding career with a full office staff and a strong patient base! Compensation: Compensation - SixFigure Draw vs. Percent of Production Benefits/ Perks: Leaders in the Practice: Clinical Freedom and Treatment Autonomy for Every Doctor.

Patient Focus: Established and Growing Patient Foundation. Multi-Specialty office. Doctor Career Path – Partnership/Investment Opportunities. Full Benefits Offered – Healthcare & Dental Benefits, 401K, Short Term/Long Term Disability, Time Off. Malpractice Coverage Assistance. Continued Education Reimbursement, Paid ADA & State Society Dues. Mentorship – Study Clubs, Chairside Mentoring, GEDC University Courses. Please view our Doctor Career Path video: http://www. screencast.com/t/M3xWM5CYN. Apply via this ad to learn more about Great Expressions! For More Information, Please Contact: Ross Shoemaker, MBA | Doctor Recruiting Manager | Great Expressions Dental Centers Practice Support Center - South | 1560 Oakbrook Drive, Norcross, GA 30093 USA phone 678.836.2226 | ext 72226 | fax 770.242.3251 |web www.greatexpressions.com. email Ross.

Shoemaker@greatexpressions.com. “Look for the Smile Above Our Name!” Apply Here http://www.

Click2Apply.net/j2c3t7668y.

Part-time Orthodontist - Page Field, FL. Great Expressions Dental Centers is seeking a parttime Orthodontist to work in our Page Field, FL practice (located at 5100 S. Cleveland Avenue, Units 315 & 316). Our Orthodontists have the clinical freedom and autonomy enjoyed in a traditional private practice without the additional financial or administrative burdens associated with practice management. Orthodontists can expect an attractive annual base vs. allocated collections percent, malpractice coverage, a stable patient base, trained Orthodontic staff, local referring network of 8 practices and long-term practice or regional career growth with possible investment opportunity.

We do it all for you. You became a dentist to help people. It’s your profession and your passion. But the demands of owning and managing an office are not only financially taxing but time consuming.

Which is why Great Expressions Dental Centers is built on a provider-first philosophy. The highest standards. Our National Doctor Panel has set standards for clinical excellence, including clinical protocols, sterilization, materials, standards of care, quality assurance, charts and charting, consent forms and many other items that have allowed us to become the gold standard in the industry. Focus solely on a steady flow of patients. With GEDC you don’t need to worry about overseeing the business aspects of the office, such as malpractice insurance, employee insurance, payroll, marketing/advertising and the litany of other concerns that go along with owning your practice. Instead, focus on being the clinical leader within your office. **Please watch more about our Doctor Career Path and apply via this ad! Stacey Bruwer, M.A. | Clinical Recruiter | Great Expressions Dental Centers PSC-North | 300 East Long Lake Rd Suite 311| Bloomfield Hills, MI 48304 USA phone 248.237.6853 |Ext. 72468| fax 248.686.0118 | web www.greatexpressions. com. “Look for the Smile Above Our Name!” Job Requirements: Must have a DDS/DMD from an accredited University and active State Dental Board license. Orthodontist License and Certifications.

Endodontist Opening- Jacksonville, FL. Great Expressions Dental Centers has a current opening for an Endodontist (3-4 days/week) to work in our Jacksonville, FL practices located in St. Augustine, Riverside and San Pablo, FL. Our specialists have the clinical freedom and autonomy enjoyed in a traditional private practice without the additional financial or administrative burdens associated with practice management. When considering a career with GEDC, specialists can expect unlimited production based earnings with a competitive base, benefits, malpractice coverage, a stable patient base, long-term practice or regional career growth and a local referring network of 20 practices. Relocation or sign-on bonus possible as well! We do it all for you. You became a dentist to help people. It’s your profession and your passion. But the demands of owning and managing an office are not only financially taxing but time consuming. Which is why Great Expressions Dental Centers is built on a provider-first philosophy. The highest standards.

Our National Doctor Panel has set standards for clinical excellence, including clinical protocols, sterilization, materials, standards of care, quality assurance, charts and charting, consent forms and

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many other items that have allowed us to become the gold standard in the industry. Focus solely on a steady flow of patients. With GEDC you don’t need to worry about overseeing the business aspects of the office, such as malpractice insurance, employee insurance, payroll, marketing/advertising and the litany of other concerns that go along with owning your practice. Instead, focus on being the clinical leader within your office. Work/Life balance. We believe in the importance of a work/life balance. So we make every effort to ensure you have time for family, friends and vacations (you know, that thing called a “personal life”). **Please watch more about our Doctor Career Path and apply via this ad! Molly McVay | Clinical Recruiter | Great Expressions Dental Centers PSC-North | 300 East Long Lake Rd Suite 311| Bloomfield Hills, MI 48304 USA phone 248.430.5555 |Ext. 72467| fax 248.686.0170 | web www.greatexpressions.com. “Look for the Smile Above Our Name!” Job Requirements: Must have a DDS/DMD from an accredited University and active State Dental Board license. Endodontist Dental License and certification. Apply Here: http:// www.Click2Apply.net/wkwxkk4f4h.

Pediatric Dentist Opening. We are looking for a caring, compassionate pediatric dentist for a part time or full time position in a busy dental office in the Melbourne/Palm bay area. Flexible schedule with excellent pay. If interested, please call Dr. Assaf 407.928.9996 General Dentist Opening - (Downtown) Tampa, FL. Come lead our Downtown Tampa, FL team as a full time General Dentist! Great Expressions Dental Centers has an immediate opening for a full-time General Dentist to join our Downtown Tampa, FL practice (1006 N. Florida Avenue Tampa, Florida 33602). Enjoy a rewarding role with a dedicated and experienced staff! Compensation: Competitive Six Figure Annual Draw with Percent of Production Sign-on Bonus or Relocation Assistance possible.

Benefits/Perks: Leader in the practice: Clinical Freedom and Treatment Autonomy. Patient Focus: Established and Growing Patient Foundation.

Multi-Specialty office. Doctor Career Path – Partnership/Investment Opportunities. Full Benefits Offered – Healthcare & Dental Benefits, 401K, Short Term/Long Term Disability, Time Off. Malpractice Coverage Assistance. Continued Education Reimbursement, Paid ADA & State Society Dues.

Mentorship – Study Clubs, Chairside Mentoring, GEDC University Courses. Please view our Doctor Career Path video: http://www.screencast. com/t/M3xWM5CYN. Please apply via this ad for consideration, Molly McVay | Clinical Recruiter | Great Expressions Dental Centers PSC-North | 300 East Long Lake Rd Suite 311| Bloomfield Hills, MI 48304 USA phone 248.430.5555 |Ext. 72467| fax 248.686.0170 | web www.greatexpressions.com.

“Look for the Smile Above Our Name!” Must have a DDS/DMD from an accredited University and active State Dental Board license.

P/T General/Cosmetic Dentist Wanted. Associate General Dentist wanted in our upscale practice located in Boynton Beach, FL. Minimum of 1 year experience required. Saturday’s are a must. No HMO’s. Offering excellent commission. Please email or fax resume to Flakat123@yahoo.com, 561.424.2098.

Locum tenens or regular one day a week part time position wanted. Looking for one day a week regular or fill in for illness or vacation position in the Largo to New Port Richey area. I have over forty years’ experience and perform all phases of general dentistry including molar endo. No third molar impactions or perio surgery. Available any day but Thursday. Contact me at wrhdds@aol.com.

Dentist: Consulting firm seeking Practice Transition Consultant nationwide. Immediate need in southern and central Florida. Full training and support.

Unlimited earning potential. careers@paragon. us.com. 866.898.1867.

An exceptional opportunity for the right pediatric dentist. As a fellow dentist, I understand the anxieties of paying off large student loan debt upon finishing school. I also understand the desire to find a practice that you can call home, with support and camaraderie from a partner that, together, you can positively impact patients’ lives. As I see it, there are a few options for how your professional future may unveil itself. Will you be an associate in a big business dental company with high volume and low quality? Will you take on more even more debt and open your own practice from scratch with no patient data base or any idea on how to run a successful business? Or will you join in a private practice that can offer you an existing patient flow with a long term, collaborative partnership and quality of life? I am an established, Board Certified Orthodontist seeking a compassionate Pediatric Dentist to join my privately owned, high quality practice with the ability to become a full partner with 1.5 years. With my 23 years’ experience, I have cultivated a community based, nurturing atmosphere with an exceptional talent for early treatment. I am certain that the pairing of what already exists here with the right pediatric dentist would be a recipe for success for us both. This is your opportunity to elevate yourself above your student loans and to own the practice of your dreams while residing in beautiful, South Floridian paradise! braces53@yahoo.com.

ASSOCIATE DENTIST – FULL TIME. PRIVATE PRACTICE DENTAL OFFICE. General Dentist needed for our private practice located in New Port Richey, FL. We are seeking a caring and compassionate dentist who is looking for a long term opportunity. Ideal candidate has a passion for dentistry and patient care, has a willingness to learn and adapt with our practice and understands the importance of a patient-centered office. We are a PPO/FFS Privately Owned dental office. No HMOs or Medicaid. To be considered: Current Florida Dental License. Compassion. Ability to connect with the families and provide excellent service.

Outstanding communication and customer service.

A professional presence and excellent clinical skills and chair-side manner. Some perks include: Medical Benefits. Guarantee pay plus bonus on production.

3 weeks paid vacation. CE allowance. If you are an experienced professional interested in joining a team invested in providing remarkable service to the community then we want to know you. APPLY ONLINE: https://www.appone.com/MainInfoReq. asp?R_ID=1181322.

FLORIDA - Orlando/Daytona Beach/Jacksonville/ Tampa/Sarasota regions: Join our 60 office group practice. Flexible schedule. Top salaries. Training and mentoring for new/recent graduates. Both General Dentists & all Specialists needed. Fully digital offices. Call Dr. Andrew Greenberg 407.772.5120 (confidential), fax CV to 407.786.8763, visit www.greenbergdental.com or e-mail to drgreenberg@greenbergdental.com.

General Dentist Opportunity in Tampa, FL. Coast Dental has an opportunity for a General Dentist in our Tampa, Florida practice. We take care of the administrative burden so you can focus on the dentistry. Sound familiar? Yes, we do that (and do it well), but so does every other group practice. So what else? Here are just few things that separate us from the competition: real clinical autonomy (from implants to invisible braces), private practice environment (most practices have one general dentist, meaning ‘your’ patients, ‘your’ diagnosing, and ‘your’ treatment), favorable schedules (8-12 patients/day) giving you time to build a connection with your patients, agreements that are easy to understand and fair, extremely desirable locations, and a path to equity ownership, to name a few. nina. voelker@coastdental.com.

Please see CLASSIFIEDS, 89

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CE VERIFICATION MADE EASY NO NEED TO WORRY ABOUT CEU CODES ANYMORE! CE verification is now automatically provided for all attendees. To receive CE credit for course attendance (except for NC and EN courses): ■ Attendees must scan their badge upon entry and upon exiting the course.

■ The system then will calculate the amount of time an attendee was present and award the credit appropriately.

■ Attendees must be present in a course a minimum of 50 of the 60 minutes to receive one hour of CE credit.

NO MORE STANDING IN LINE! Attendees will be emailed their CE certificate automatically on June 20, 2016.

NEED A PRINTED CE CERTIFICATE? Print a certificate at any time after the end of the course from CE stations. The CE stations are located:

Two Hotel Options!

GAYLORD PALMS RESORT & CONVENTION CENTER

HOST HOTEL: The FDC room rate at the Gaylord Palms Resort & Convention Center is $190 per night and includes free self-parking. Enjoy the convenience of staying where all the action is! Don’t risk losing the chance to secure a room — book as soon as possible.

Call 407.586.2000 to make your reservation at the Gaylord Palms.

SPRINGHILL SUITES MARRIOTT

■ In the Exhibit Hall through Saturday at 2 p.m.; ■ On the classroom level on Saturday after 2 p.m.; ■ Or, can be printed for free at home or the office.

CE certificates can be accessed online for free at www.floridadentalconvention.com until Sept. 1, 2016. After that date, there is a fee to obtain a CE certificate.

SUBMITTED AUTOMATICALLY TO CE BROKER. All verified course attendance (for Florida licensed dentists and hygienists) will be submitted to CE Broker on your behalf no later than July 16, 2016.

Your CE certificate will list all purchased courses; however, credit will not be reported to CE Broker for NC and EN course codes. Each state varies on what is accepted for CE and those courses can be selfreported to CE Broker after the event, should your organizing Board of Dentistry accept those courses.

QUESTIONS? Contact Brooke Martin, FDA meeting coordinator at 850.350.7103 or bmartin@floridadental.org.

ON A BUDGET? FDC2016 offers a budget-friendly room rate at the Springhill Suites Marriott conveniently located three miles from the Gaylord Palms Resort & Convention Center. Shuttle service to the Gaylord Palms is not available. The rate is $119 per night and parking is $4 per night. Call 407.938.9001 to make your reservation at the Springhill Suites.

You also may visit www.floridadentalconvention.com/hotel to make your reservations online.

CLASSIFIEDS from 87 General Dentist Opportunity in Orlando, FL. Coast Dental has an opportunity for a General Dentist in our Orlando, Florida practice. We take care of the administrative burden so you can focus on the dentistry. Sound familiar? Yes, we do that (and do it well), but so does every other group practice. So what else? Here are just few things that separate us from the competition: real clinical autonomy (from implants to invisible braces), private practice environment (most practices have one general dentist, meaning ‘your’ patients, ‘your’ diagnosing, and ‘your’ treatment), favorable schedules (8-12 patients/day) giving you time to build a connection with your patients, agreements that are easy to understand and fair, extremely desirable locations, and a path to equity ownership, to name a few. nina. voelker@coastdental.com

For Sale/Lease Brandon office. Brandon dental office and building for sale in a highly visible area, one block from hospital. 3 ops and 1 plumbed. Newly remodeled with a high traffic location. Owner retiring.

Excellent opportunity for the right person. Contact Donna at 813.689.6491 bafdental@gmail.com.

Brandon, Fl. FOR LEASE Beautiful 2000 sf lakefront office space available for custom build out.

Adjacent to Endodontist. Ideal for Oral Surgeon or Periodontist. Contact Julie at 813.654.3636 or julieh@aeoftb.com.

Move in ready Health Care Professional suite Medical/Dental/Optometrist/Podiatrist/ Chiropractor/etc. Location: East Fort Lauderdale, Broward County, Fl. 2480 East Commercial Blvd.

Fort Lauderdale Florida 33308 Penthouse Suite 2ed Floor. Contact Information: Barry Kligerman tel # 954.854.8153 or E- Mail barrykligerman@ gmail.com. Benefits: 1. Move in ready Health Care Professional suite Medical/Dental/Optometrist/ Podiatrist/Chiropractor/etc. 2. $500,000 in leasehold improvements in place: Medical/Dental Cabinets in all treatment rooms, sterilization, business area, reception, storage, and laboratory. 3. 3,000 Sq. Ft. designed for flow as 2 separate offices or one large office. May have existing Endodontist dental specialist stay, renting at $2,463 for smaller suite to off set rent. 4. Plumbing with 14 sinks with central shut off solenoid valve. 5. Electrical Wiring to 5 treatment X- ray rooms. 6. Reception desk for 4 team member’s work stations. Marble floors. 8.

Vinyl wall paper scratch/dirt resistant. 9. Private Elevator opens directly into Health Care Provider Suite. 10. Doctor’s Private Entrance. 11. Doctor’s Private Restroom. 12. Doctor’s Private Parking.

13. Private Consultation/Business Area separate from reception and doctors office. 14. Doctor and Staff Lunch Room/Meeting Room, seats 10. 15 .Prestigious Medical location between US 1 and A1A on E. Commercial Blvd, attracts patients from all of Broward County. 16. Adjacent to Galt

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Ocean Mile upscale Oceanfront Condominiums.

17. Adjacent to Intracoastal Waterway upscale waterfront homes, yacht club, boating capital, Bahia Mar, Hyatt Regency Pier Sixty-Six, Venice of America, and Florida’s Gold Coast. 18. Nearby upscale Communities: Victoria Park, Colee Hammock, Rio Vista, Sailboat Bend, The Isles, Las Olas Isles, Coral Ridge Country Club, Coral Ridge, Bayview Drive, Middle River Drive, Imperial Point, Sea Ranch Lakes, Harbor Isles.

19. Located in Building with a Proven History of Rapid Professional Growth. 20. Proximity to three major acclaimed hospitals: Holly Cross Hospital 1 miles; Imperial Point Hospital 3 miles; Broward County Hospital 7 miles. 21. Dental Laboratory in building whose owner provides personal service to patients. 22. Excellent Signage facing high traffic volume Commercial Blvd. when traveling both East and West. 23. Current owner willing to sell used dental equipment. 24. Landlord pays county taxes, property insurance, maintenance and repairs, pest control, elevator maintenance, air conditioning maintenance. 25. Tenants pays utilities and janitorial. 26. For 2,500 Sq. Ft. – $5,500 a month. 27.

For 3,000 Sq Ft. – &7,600 a month.

Office for sale in Panama City, FL. For sale, Panama City, FL. 1933 sqft. Stand alone building. 4 equipped ops with room for 2 more ops; Lab, etc. Plenty of parking. Superb location in professional office park on major street on best side of town. Does not include practice, already sold that when dentist recently retired. JohnMcw2@bellsouth.net.

DENTAL OFFICE EQUIPMENT FOR SALE. LIKE NEW DENTAL EQUIPMENT FOR SALE. GO TO http://dentalequipmentbrevardfl.weebly.com/ TO VIEW ITEMS. FOR SALE BY OWNER DENTIST. KODAK/CARESTREAM & SCHICK INTRAORAL X-RAY SENSOR REPAIR Specialize in repairing Schick CDR & Kodak/Carestream RVG 5100 & 6100 dental X-Ray sensors. Repair & save $1,000’s over replacement cost. We purchase old/broken sensors. www.RepairSensor.com/919.924.8559.

GENDEX & DEXIS INTRAORAL X-RAY SENSOR REPAIR. We specialize in repairing Gendex & Dexis dental X-Ray sensors. Repair & save thousands over replacement cost. www.RepairSensor. com/919.924.8559.

Specialty Dental Practice Space for Lease in The Villages, FL Great opportunity in The Villages for a dental specialist - Endodontist, Periodontist, Orthodontist, or Surgeon. Beautiful, completely built-out dental space with 6 operatories fully furnished with modern digital equipment (can be purchased), 2200 sq ft turn-key facility located in the heart of The Villages, a large senior retirement community in central Florida; golf cart-accessible. Owner has an established family/ general dental practice next door. Contact: Mike Pederson-Grizzard Commercial Real Estate Group at 352.408.0190. http://www.loopnet.com/ Listing/19603384/11938-CR-101-Suite-130-TheVillages-FL/.

Equipped Dental Office for LEASE. End unit in professional center..900 sf. business office, waiting room, 3 operatories, 4th used for storage, laboratory, one bathroom, private office with exit door.

EQUIPPED. Email best way to communicate....

DDDOCTORRR@aol.com.

Practice in Paradise. Only full time periodontalimplant practice in Key West. Three operatories with spectacular views of the Gulf of Mexico and equipped with ADEC chairs and delivery systems and digital X-ray. There is a small lab, private office and sterilization center. Practice is strictly fee for service with highly skilled referral base. Enjoy working, playing and living in paradise all year round. msgordondmd@gmail.com.

Established Footprint Oral/Maxillofacial Practices For Sale in Gross Income 2015 $1,586,974 *Annualized Jan-Aug $1,190,231. Asking Price $ 1,089,000. 1 Oral Maxillofacial practice available with 2 satellite offices: Open since 1991 this Oral & Maxillofacial Surgery practice is situated in a busy, populated shopping center that is in excellent condition. Now available for purchase, it is located in a highly desirable area in a professional medical space. Inside this 1500 sq. ft. practice you will find a spacious reception area (seats 4), 1 surgery suite, 3 consultation rooms, 2 private offices. This main office is close by to 5 to 6 miles of the Atlantic Ocean beaches. This first satellite office that is also available is centered in a professional medical building surrounded by a lush environment of palm trees. This practice is 1800sq. ft. and located in the second-most populous county in Florida, this desirable space comes with a spacious reception area (seats 4), 1 surgery suite, 3 consultation rooms, 1 private office, with a large window that provides a wonderful view, and 1 utility closet. This second satellite office that is as well available is in a professional medical building right across the way from water’s edge. This 2000 sq. ft. practice, located in Monroe County, Florida in a professional medical building, is surrounded by backcountry fishing, reef and wreck fishing, as well as offshore deep sea fishing. It comes with a reception area (seats 4), 2 surgery suites, 4 consultation rooms, 1 private office, and 1 lounge area. The practice is well kept up and has great visibility and accessibility. 100% Financing Available. Call ProMed Financial for more information! 888.277.6633 or Email maryann@ promed-financial.com. (Ref# D150).

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benefit

NUMBER

Helping Members Succeed The more that you read, the more things you will know.

The more that you learn, the more places you’ll go.

— Dr. Seuss, from “I Can Read With My Eyes Shut!”

BEYOND THE !

W E N

THE OFFICIAL BLOG OF THE FLORIDA DENTAL ASSOCIATION

 Industry trends, tips to strengthen your practice, FDA programs, and more.  Resources to support your professional growth and your practice’s success.  Posts from FDA leadership and staff, your local dental leaders, and YOU! FOR MORE INFORMATION 800.877.9922 • jrunyan@floridadental.org

www.floridadental.org/blog

benefit

Helping Members Succeed

NUMBER

14

How are you managing your managed-care contracts?

Banish the confusion with this definitive reference for Florida dentists.

A FREE BENEFIT AVAILABLE ONLY TO FDA MEMBERS A thoroughly researched and referenced handbook written clearly in an easy-to-follow format.

Written by Graham Nicol, Esq., Health Care Risk Manager, Board Certified Specialist (Health Law) and the FDA’s Chief Legal Counsel

o t e M t n a W ? t You a h Sign W k ndboots a H ’s t c tis Contra da Den A Florianaged-care on M Law) (Health ol, Esq., ham Nic fied Specialist

By Gra ti er oard C ager, B isk Man H LAW Care R h HEALT lt ea H N ON ICATIO L B U P ICIAL ’S OFF IATION ASSOC L A T N DE ORIDA THE FL

INSIDE: Chapter 1: The Basics: Types of Health Care Delivery Systems

Go to floridadental.org/signwhat

Questions? Call 800.877.9922

Chapter 2: The Basics: Types of MCO Models Chapter 3: The Basics: Types of Reimbursement Methods Chapter 4: MCOs & Other Types of Risk Chapter 5: How to Negotiate with MCOs Step by Step Chapter 6: Your Rights under Florida DMPO Contracts Chapter 7: Your Rights under Florida Health Insurance & PPO Contracts Chapter 8: Your Rights under Florida HMO Contracts Chapter 9: Your Rights under PLHSO Contracts Chapter 10: Fighting Back

OFF THE CUSP

JOHN PAUL, DMD, EDITOR

The Hard Part Always is “The Show” When you went to dental school, did it ever occur to you that the easy part of the rest of your life might be performing the feats of dentistry? My instructors made it seem that we would always be striving to measure up to the legend of GV Black and that there is a functionally significant difference between a 6 degree and a 7 degree taper. To be honest, I still do hear my instructors whispering in my ear, and I set out to do work that would earn me an A in school at every service, but it’s not the hard part of my day.

My boyhood friend and mentor, Dr. Paul Saari, was the first to let me in on the secret. I was visiting him during my senior year in dental school when he told me, “Dentistry is the easy part. The hard part is the show.” There are few, if any, patients who care that you’ve had a long day. I offer as evidence the number who think the ideal time for their appointment is 4:45. They don’t care that you are understaffed or overstaffed or under-busy and rightly so. They are actually paying you for your time and skills — not a product you keep on the shelf in the back. They expect a cheerful, clear eyed, steady handed doctor and staff. They have come to recline in your chair and the show must go on.

I’ve found there also is more than just the show Dr. Saari mentioned. My first name may be doctor, but on any given day, I am also the director of HR, the HIPAA enforcer, the chairman of infection control, creative writer, junior lawyer, day care provider, equipment technician, electrician, plumber and janitor, not to mention uncompensated tax collector for the federal government. I have no question why many of us are turning to DMOs and large multi-doctor practices. It has nothing to do with student loans (ADA research supports that statement). The dream of a turnkey practice where you only have to be a dentist sounds like greener grass some days.

Fortunately, I am a stoic and I understand life without struggle is life without meaning. There always will be days when some grass looks greener, but when you stand in that other pasture, you can see you may be standing in something other than grass. I smile, because I know that all pastures have smelly stuff you’re standing in and the grass can’t get greener without it. I also smile because I know that in my pasture, when the day seems long and the patients are staying away in droves, I can walk up to the front desk and tell them, “Call me if you need me, but I am taking my kids to the park.”

Dr. Paul is the editor of Today's FDA. He can be reached at jpaul@bot.floridadental.org.

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HAPPY HOUR Join us for Happy Hour at FDC 2016 The drinks are on us, so sit back, relax and enjoy the company.

Thursday, June 16 5-6 PM Wreckers Sports Bar Dentists and spouses welcome

Presented by