2020 - March/April TFDA

2019 Dentists’ Day on the - March 11-12, - Page 2 Five-year Progress Report onHill Florida's Action for2019 Dental Health

VOL. 32, NO. 2 • MARCH/APRIL • AWARDS/LEGISLATIVE ISSUE

A PUBLICATION OF THE FLORIDA DENTAL ASSOCIATION

Clawback?

Please Explain!

ADA FDC 2020 2020 FDA Award Recipients

Your Patients & Cannabis 20 Years of Winners: Schwartz Awards & top Dentists

BABY GORILLA GETS DENTAL VISIT

MEET THE 2020 DENTIST OF THE YEAR DR. DON ILKKA SEE PAGE 44

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HELPING MEMBERS SUCCEED VOL. 32, NO. 2 • March/April 2020

A PUBLICATION OF THE FLORIDA DENTAL ASSOCIATION

Five-year Progress Report

VE-YEAR PROGRESS REPORT

in every issue 3 Staff Roster

22

Board of Dentistry Meets in Gainesville

11 Info Bytes

26

Clawback? Please Explain!

28 news@fda 44 Get Involved!

66 Compleat Dentistry 68 Diagnostic Discussion

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20 Years of Winners: 74 Career Center Schwartz Awards a’s Action for Dental Health is a comprehensive effort to improve & Top Dentists 78 Advertising he oral health and resulting Index overall health of all Floridians.

80 Off the Cusp

6 Why are Harassment Policies and Training Important?

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Florida's Action for Dental Health

Evidence-based Considerations for Patients Using Cannabis

56

Bottle Decay — In a Baby Gorilla?

60

36

2020 Award Recipients

44

ADA FDC 2020

52

5 President's Message 8 Did You Know?

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Dentist of the Year: Dr. Don Ilkka

Our Partners: The Dental Laboratory

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EPA Amalgam Recycling Rule

TODAY'S FDA ONLINE: floridadental.org

Paragon

FLORIDA DENTAL ASSOCIATION MARCH/APRIL 2020 VOL. 32, NO. 2

EDITOR Dr. John Paul, Lakeland, editor

STAFF Jill Runyan, director of publications Jessica Lauria, publications and media coordinator Lynne Knight, graphic design coordinator

BOARD OF TRUSTEES Dr. Rudy Liddell, Brandon, president Dr. Andy Brown, Orange Park, president-elect Dr. Dave Boden, Port St. Lucie, first vice president Dr. Gerald Bird, Cocoa, second vice president Dr. Beatriz Terry, Miami, secretary Dr. Jolene Paramore, Panama City, immediate past president Drew Eason, CAE, Tallahassee, executive director Dr. Dan Gesek, Jacksonville • Dr. Karen Glerum, Boynton Beach Dr. Jeannette Pena Hall, Miami • Dr. Bernard Kahn, Maitland Dr. Irene Marron-Tarrazzi, Miami Dade • Dr. Eddie Martin, Pensacola Dr. Rick Mullens, Jacksonville • Dr. Jeffrey Ottley, Milton • Dr. Paul Palo, Winter Haven Dr. Howard Pranikoff, Ormond Beach • Dr. Mike Starr, Wellington Dr. Stephen Zuknick, Brandon Dr. Ethan Pansick, Delray Beach, speaker of the house Dr. Rodrigo Romano, Miami, treasurer • Dr. John Paul, Lakeland, editor

American Sensor Tech

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

FDA membership dues include a $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 2020 Florida Dental Association.

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

POSTMASTER: Please send form 3579 for returns and changes of address to Today’s FDA, 545 John Knox Road, Ste. 200, Tallahassee, Fla. 32303.

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

EDITORIAL CONTACT INFORMATION All Today’s FDA editorial correspondence should be sent to Dr. John Paul, Today’s FDA Editor, Florida Dental Association, 545 John Knox Road, Ste 200, Tallahassee, Fla. 32303.

FDA office numbers: 800.877.9922, 850. 681.3629; fax 850.561.0504; email address, fda@floridadental.org; website address, floridadental.org.

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

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

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

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TODAY'S FDA

MARCH/APRIL 2020

FLORIDADENTAL.ORG

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

EXECUTIVE OFFICE DREW EASON, Executive Director deason@floridadental.org 850.350.7109 GREG GRUBER, Chief Operating Officer/ Chief Financial Officer ggruber@floridadental.org 850.350.7111

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

FDA SERVICES

EMILY SOMERSET, FDC Meeting Assistant esomerset@floridadental.org 850.350.7162

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

GOVERNMENTAL AFFAIRS

CASEY STOUTAMIRE, Director of Third Party Payer and Professional Affairs cstoutamire@floridadental.org 850.350.7202

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

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

ALEXANDRA ABBOUD Governmental Affairs Liaison aabboud@floridadental.org 850.350.7204

LIANNE BELL, Leadership Concierge lbell@floridadental.org 850.350.7114

ACCOUNTING BREANA GIBLIN, Director of Accounting bgiblin@floridadental.org 850.350.7137 LEONA BOUTWELL, Finance Services Coordinator Accounts Receivable & Foundation lboutwell@floridadental.org 850.350.7138

INFORMATION SYSTEMS

RACHEL STYS, Systems Administrator rstys@floridadental.org 850.350.7153

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

MEMBER RELATIONS

ALLEN JOHNSON, Accounting Manager allen.johnson@fdaservices.com 850.350.7140

MEGAN BAKAN Member Access Coordinator mbakan@floridadental.org 850.350.7100

FLORIDA DENTAL ASSOCIATION FOUNDATION (FDAF)

JOSHUA BRASWELL Membership Coordinator jbraswell@floridadental.org 850.350.7110 CHRISTINE TROTTO Membership Concierge ctrotto@floridadental.org 850.350.7136

R. JAI GILLUM, Director of Foundation Affairs rjaigillum@floridadental.org 850.350.7117

MARKETING AND COMMUNICATIONS

KRISTIN BADEAU, Foundation Coordinator kbadeau@floridadental.org 850.350.7161

RENEE THOMPSON Director of Marketing and Communications rthompson@floridadental.org 850.350.7118

KRISTEN RULE, Foundation Assistant krule@floridadental.org 850.350.7122

PUBLICATIONS

FLORIDA DENTAL CONVENTION (FDC)

JILL RUNYAN, Director of Publications jrunyan@floridadental.org 850.350.7113

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

LYNNE KNIGHT, Graphic Design Coordinator lknight@floridadental.org 850.350.7112

BROOKE MARTIN, FDC Marketing Coordinator bmartin@floridadental.org 850.350.7103 DEIRDRE RHODES, FDC Exhibits Coordinator drhodes@floridadental.org 850.350.7108

FLORIDADENTAL.ORG

CAROL GASKINS Commercial Accounts Manager carol.gaskins@fdaservices.com 850.350.7159 ALEX KLINE FDAS Marketing Coordinator arey@fdaservices.com 850.350.7166

KERRY GÓMEZ-RÍOS Director of Member Relations krios@floridadental.org 850.350.7121

STEPHANIE TAYLOR, Membership Dues Coordinator staylor@floridadental.org 850.350.7119

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

LARRY DARNELL Director of Information Systems ldarnell@floridadental.org 850.350.7102

DEANNE FOY, Finance Services Coordinator Dues, PAC & Special Projects dfoy@floridadental.org 850.350.7165

MITZI RYE, Fiscal Services Coordinator mrye@floridadental.org 850.350.7139

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

JESSICA LAURIA Publications and Media Coordinator jlauria@floridadental.org 850.350.7115

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

YOUR RISK EXPERTS

PORSCHIE BIGGINS Central Florida Membership Commercial Account Advisor pbiggins@fdaservices.com 850-350-7149

DAN ZOTTOLI, SBCS Director of Sales — Atlantic Coast 561.791.7744 Cell: 561.601.5363 dan.zottoli@fdaservices.com DENNIS HEAD, CIC Director of Sales — Central Florida

MARIA BROOKS South Florida Membership Commercial Account Advisor maria.brooks@fdaservices.com 850.350.7144 KELLY DEE Atlantic Coast Membership Commercial Account Advisor kelly.dee@fdaservices.com 850.350.7157

877.843.0921 (toll free) Cell: 407.927.5472 dennis.head@fdaservices.com MIKE TROUT Director of Sales — North Florida 904.249.6985 Cell: 904.254.8927 mike.trout@fdaservices.com

MARRISA LEE North Florida Membership Commercial Account Advisor marrisa.lee@fdaservices.com 850.350.7122

JOSEPH PERRETTI, SBCS Director of Sales — South Florida

MELISSA STAGGERS West Coast Membership Commercial Account Advisor melissa.staggers@fdaservices.com 850.350.7154 TESSA DANIELS Commercial Account Advisor tessa.daniels@fdaservices.com 850.350.7158

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

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

LIZ RICH Commercial Account Advisor liz.rich@fdaservices.com 850.350.7171 ARIEL WORD Commercial Account Advisor a.word@fdaservices.com 850.350.7151

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.

TODAY'S FDA MARCH/APRIL 2020

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FREE REGISTRATION FOR FDA MEMBERS

ADA/FDC Annual Meeting

A Little More Meeting to Love Join us as the FDA and ADA come together to host the ADA FDC Annual Meeting, October 15–18, in Orlando. Experience more opportunities for networking, camaraderie, and new learning experiences all under one roof. Make your plans now!

• FDA member dentists get the Standard Registration Package, which includes Tier 1 lectures (50% of lectures), for FREE. Don’t delay — this Early Bird pricing expires May 15 at 6 p.m. ET. • Dental team members can register for the Standard Registration Package for $85 during the Early Bird pricing period.

• Book your rooms at the FDA headquarters hotel, Hilton Orlando. FDA members are guaranteed access to the hotel room block until May 15 at 6 p.m. ET. • Join us for FDC’s Howl at the Moon Dueling Pianos event Friday night. Tickets are $15 for FDA members with a Standard Registration Package.

For more information, go to ADA.org/meeting.

ADA FDC 2020 is a joint meeting of the American Dental Association and Florida Dental Association. #ADAFDC HARNESS THE POWER OF CONNECTION

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leadership

HOW QUICKLY TIME GOES! I’ve always been warned that the year you serve as president of the Florida Dental Association (FDA) will pass in a blur. I’ve completed almost two-thirds of my term, and I’m a believer.

As I write this, I have a waterfront view from my room at The Grand Sandestin. Visiting the districts is one of the activities that I enjoy the most. It gives me the opportunity to visit new places and interact with the grassroots members. The Northwest District Dental Association (NWDDA) meeting is an awesome experience and I’ve enjoyed meeting new people and catching up with old friends. Big thanks to Dr. Brittany Craig, NWDDA Executive Director Angel Estep and of course, Dr. Jolene Paramore, who acted as my personal tour guide to show me the surrounding area, which is one of her stomping grounds.

The Governmental Action Committee is hard at work trying to secure funding for our legislative victories from last year, the Dental Student Repayment Program and Donated Dental Services Program. We had a Senate budget committee score those two bills for initial cost and according to their calculations, both can be funded for $773,000. We are pitching this to the Legislature hard this session. The FDA also is pushing for the reinstatement of the health access dental license, which gives out-of-state licensed dentists the opportunity to practice in Florida in rural and underserved areas. This has been in effect since 2008, but was recently repealed on Jan. 1, 2020. We are once again opposing the dental therapy bill, and I will be traveling to Tallahassee once again with many of my colleagues to oppose this bill.

PRESIDENT’S MESSAGE RUDY LIDDELL, DMD FDA PRESIDENT

Dr. Liddell can be reached at rliddell@ bot.floridadental.org.

One of the more rewarding things that I’ve done during my presidency is notifying the award winners of their selection by the Awards Committee. Ms. Heather Lewis will receive the Dental Team Member award, Dr. Mike Starr is the New Dental Leader and the three members who earned a Public Service Award were Drs. Diane Ede-Nichols, Reese Harrison and John Penny.

Drs. Drew Johnson and Jessica Stilley demonstrated the unique ability to motivate their colleagues and will receive Leadership Awards. Dr. Don Ilkka’s work on the Florida Mission of Mercy in Orlando earned him Dentist of the Year honors. The call that resonated the most was when I was able to call a long-term leader and my great friend, Dr. Bill D’Aiuto, to inform him that he had been voted to receive the J. Leon Schwartz Lifetime Service Award, the FDA’s highest honor.

Join in the recognition of your colleagues at the Awards Dinner on Friday, June 12 at the Gaylord Palms in Orlando. Tickets will be available in Spring 2020.

FLORIDADENTAL.ORG

TODAY'S FDA MARCH/APRIL 2020

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human relations

WHY ARE HARASSMENT POLICIES AND TRAINING IMPORTANT? Generally, employers are protected from lawsuits by employees for injuries that occur at work or while engaged in work activities under Florida’s Workers’ Compensation Law. Harassment claims are an exception to this rule.

Types of Potential Harassment Claims

DEBORAH S. MINNIS

Ms. Minnis practices labor and employment law at Ausley McMullen, and she also represents various local government bodies. She can be reached at dminnis@ausley.com.

This article is for informational purposes only and is not intended to be a substitute for professional legal advice.

If you have a specific concern or need legal advice regarding your dental practice, you should contact a qualified attorney.

1.

Employees can bring both statutory and common law harassment claims against employers. Statutory claims are those actions that are allowed based on laws enacted by either Congress or the Florida Legislature. Common law claims are those that have developed based on decisions by the Florida courts.

Several federal and state laws protect employees from being subjected to harassment/hostile work environment. Most people are familiar with Title VII, the federal law that prohibits discrimination based on race, sex, color, national origin and religion. Title VII also prohibits harassment or creating a hostile environment based on those protected categories.

In addition to Title VII, the federal Americans with Disabilities Act (ADA) and Age Discrimination in Employment Act (ADEA) prohibit discrimination and harassment or creating a hostile environment based on disability or age.

The Florida Civil Rights Act mirrors Title VII, the ADA and the ADEA. The laws referenced above apply to employers with at least 15 employees (20 employees for the ADEA), but the courts have recognized claims based on negligence under the common law that applies to all employers, including dental providers, without regard to the number of people employed by the practice.

Common law claims recognized by the courts are negligent hiring, negligent retention and negligent supervision.

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TODAY'S FDA

MARCH/APRIL 2020

Negligent hiring is found if the employer failed to conduct a proper investigation or review prior to hiring. With proper vetting, the employer would’ve been aware that the individual had engaged in inappropriate/ harassing behavior that would’ve made them inappropriate for the position. Based on this knowledge, the person would likely not have been hired and the harm to the complaining employee wouldn’t have occurred.

Negligent retention and negligent supervision occur after hiring. These claims are found where an individual engaged in behavior while employed that harmed an employee, the employer had prior knowledge of this type of behavior, and if the employer had taken appropriate action to terminate or to properly supervise the employee, the harm would not have occurred.

The common law claims are frequently brought in conjunction with federal and state discrimination claims where those laws are applicable.

Example of Potential Claim An employee who is an excellent hygienist makes stereotypical statements about the opposite gender consistently throughout the day. The comments are made in a joking manner, but are insulting and demeaning, and while not overtly sexual or requests for sexual favors, are made daily. There is no policy and the employees do not know how to report the behavior.

A new person is hired, and the offending employee is attracted to him/her. The comments escalate from stereotypical statements to mildly sexual comments, to explicitly sexual comments, finally culminating in the offending employee committing battery against FLORIDADENTAL.ORG

the other employee. In an attempt to get away, the other employee falls and breaks his/her arm. Under this scenario, the employee would likely file a claim under state and federal discrimination laws, as well as negligent hire, retention or supervision claims. For an employer with less than 15 employees, the person would likely file suit under one or all the common law negligence claims.

If the employer had a policy, its expectation to have a harassment-free workplace and its position on such behavior would have been clear. In addition, the other employees would have understood that they could’ve brought the behavior to the attention of management and how to do so. The employer would then have had an opportunity to take action to stop the behavior and potentially avoid its escalation.

How Can a Harassment Policy Help?

All employers can be held responsible for the actions of others, whether a supervisor, a fellow employee or a nonemployee, under either the federal and state discrimination laws, the common law negligence claims or both. Under the federal and state discrimination laws, an employer with 15 or more employees has an affirmative duty to prevent and/or cure harassment or a hostile environment in its workplace.

Having a clearly and properly disseminated anti-harassment policy and procedure for investigating these claims is an important part of the company’s defense for such claims of harassment or hostile environment.

Where an employer enacts, disseminates and actively enforces an anti-harassment policy, the courts have acknowledged this as a defense to harassment/hostile environment caused by co-workers and non-employees generally, and that caused by supervisors where no adverse FLORIDADENTAL.ORG

employment action has occurred. The defense to harassment/hostile environment caused by a supervisor where an adverse employment action has occurred requires more than enacting, disseminating and enforcing an anti-harassment policy, but having such a policy can provide employees a mechanism to report behavior of a supervisor and provide the employer an opportunity to stop the harassment before it escalates to the point that a suit is filed.

Even though small practices with fewer than 15 employees have no statutory affirmative obligation to maintain a workplace free from harassment, courts have allowed employees to sue their employers under general negligence laws for negligent hiring, negligent retention and negligent supervision based on the actions of other employees and supervisors. Having an anti-harassment policy will provide a way for employees to report behavior that could lead to an allegation of negligent hiring, negligent retention or negligent supervision, and give the employer an opportunity to deal with the behavior before such a claim is filed and/or provide a defense to show that it took action to stop the behavior in the event a claim is filed.

What Should the Policy Contain?

At a minimum, the policy should include: n a clear statement that the employer does not condone harassing behavior or behavior that creates a hostile work environment. n a definition of the behaviors and actions that are considered harassing or that create a hostile work environment.

provide for at least two management positions to which complaints can be made.) n an anti-retaliation provision. n that the investigation/complaint will be confidential to the extent feasible. n that substantiated harassment/hostile environment claims can result in discipline up to and including termination. n that supervisors are to report immediately to the appropriate person harassment observed or complaints of harassment brought to their attention.

Is Training Necessary?

Simply having a policy is not enough to support a defense. The policy must be disseminated and enforced. An important way to demonstrate that the policy is disseminated and enforced is to show that all employees receive training on its provisions. In addition, training on the policy offers more assurance that the employer will learn of inappropriate behavior before it becomes a claim.

The better practice is to hold separate harassment training annually, not just as a part of a general discussion in the employee manual. At a minimum, employees should be made aware of the existence of the policy and either be provided with a copy of the policy or told how they can access the policy (online, on the practice website, etc.). The training also should set out the procedure for reporting harassing behavior and should be conducted by someone who is familiar with the policy and investigation procedure and can knowledgably answer questions.

n a procedure to report alleged harassment or a hostile work environment.

(The reporting procedure should TODAY'S FDA MARCH/APRIL 2020

7

BOD

YOUR RESPONSE TO A NEGATIVE REVIEW COULD BE A HIPAA VIOLATION

DR. DON ILKKA FDA LIAISON TO THE FLORIDA BOARD OF DENTISTRY

CASEY STOUTAMIRE FDA DIRECTOR OF THIRD PARTY PAYER & PROFESSIONAL AFFAIRS

If you have any questions, please contact Director of Third Party Payer and Professional Affairs Casey Stoutamire, Esq. at cstoutamire@ floridadental.org or 850.350.7202, or FDA Liaison to the Florida Board of Dentistry Dr. Don Ilkka at donjilkkadds@aol.com or 352.787.4748.

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TODAY'S FDA

Did you know that your response to a negative review from a disgruntled patient or family member could be a HIPAA violation? There is no HIPAA exception that allows a health care provider to disclose a patient’s protected health information (PHI) in response to a negative review.

HIPAA generally prohibits dentists (and all health care providers) from using or disclosing a patient’s PHI without his/her consent. As a reminder, PHI includes information that “[r]elates to the past, present, or future physical or mental health or condition of an individual [or] the provision of health care to an individual, and … that [i]dentifies the individual, or [w]ith respect to which there is a reasonable basis to believe the information can be used to identify the individual.” (45 CFR 160.103) This means that posting any information that identifies someone as your patient violates HIPAA even if specific medical information is not posted or disclosed.

The next question is: How can I respond to a negative review? Our first advice is to just ignore it and try to generate more positive reviews to offset the negative one. In addition, you could reach out to the patient to try and resolve the problem. Usually when someone posts a negative review, they are frustrated and want their voice to be heard. If you can resolve the situation, you may be able to convince the patient to take down the negative review. And even if you cannot resolve the issue, ask the patient to give you a HIPAA-compliant authorization that would allow you to respond appropriately to the negative review.

Now, we know ignoring a post is not going to sit well with some of you! If you feel you absolutely must respond, it should be generic. Your response cannot even confirm that the patient received care at your office. Instead, you could describe your general practices and policies and then ask the disgruntled person to contact your office to discuss things further. It goes without saying, that if you do respond, take a deep breath before doing so to calm down, be polite, professional and sensitive to the disgruntled person’s perspective.

For more information on social media policies, please visit the American Dental Association Center for Professional Success at bit.ly/36x1rgq.

MARCH/APRIL 2020

FLORIDADENTAL.ORG

FDA Online Radiography Training Program

9

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

Effective July 1, 2019.

 OPIOIDS

Non-opioid Alternatives Law bit.ly/2KXvZ2h

HEALTH CARE PROVIDER CHECKLIST INFORM

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

 Non-opioid interventional procedures or

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

DISCUSS

 Advantages and disadvantages of non-opioid alternatives.

 Patient’s risk or history of controlled

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

DOCUMENT IN PATIENT’S RECORD

 Non-opioid alternatives considered.

Your

BACKSTAGE

PROVIDE

 “Alternatives to Opioids,” an educational

ALL ACCESS

ur FDA YoEXCLUSIVE

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

MEMBER BENEFIT

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

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GO TO

info bytes

THE NEED FOR

SPEED

Twenty-eight years ago, I worked for Florida State University and I remember when the campus IT gurus hooked us up to something called the “backbone” of the internet. I had the fastest internet connection I’d ever seen at 1 Mbps (1 megabit per second or 1,000 Kbps [kilobits per second]). Crazy thing is, there was nothing to do on the internet back in those days. I’d go home and use an old school dial-up modem at a “blazing” 14.4 Kbps speed to look at my five AOL emails. I was jealous of the connection I had at the office. My, how the tables have turned. In 2020, I have a faster internet connection at my home than I do at the office. The internet of things (IoT) means almost everything at my house is connected to the internet. Who knew that my blender would need to be connected to the internet one day?

Everything being connected to the internet (a tenet of IoT) requires a lot of speed and bandwidth to work.

This term bandwidth is like asking if the pipe is big enough for your data. In theory, more bandwidth equals more speed. Ever see the buffering delays? Yep, not enough bandwidth either coming or going. The same now applies to your office. Digital transformation has led to all things electronic: phone calls, practice management systems, cloud-based backups, Xrays or cone beam CT scans that need a lot of bandwidth to store, save or use, so you need to make sure your internet speed is sufficient for that need. That’s usually measured in megabits FLORIDADENTAL.ORG

per second (Mbps). At the office, my personal usage is 120 Mbps while at home it’s more than 300 Mbps. How do I know these numbers? I don’t just rely on what my internet provider says I have. Neither should you.

Most internet providers have tiers of bandwidth plans. Whether at home or office, the concepts are the same. I recommend you test out your bandwidth. In a web browser on a computer that is “hardwired” (physically connected) to the internet, go to speedtest.net.

Also test it with a device that uses Wi-Fi and see if it’s substantially different. You also can find speed test apps for phones and tablets, and internet providers may have their own incantation of a speed test. At home, my provider is Comcast and they insist I use their version. If the speed is substantially slower than the tier you’re paying for, there’s a problem.

For instance, my tier is 300 Mbps. One day, I checked the performance and it consistently was less than 100 Mbps. Not good. I called them, and sure enough, there was an unreported issue and they fixed it.

LARRY DARNELL, MBA, CAE FDA DIRECTOR OF INFORMATION SYSTEMS

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

Two years ago, I went to the Florida Dental Association’s (FDA) Governmental Affairs Office (GAO) and used their computers for a day. Their internet bandwidth was horrible.

I investigated it and found that their internet provider was limited by what they could bring SEE PAGE 12 TODAY'S FDA MARCH/APRIL 2020

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into that old downtown location. At one point, the internet cable was run through a gutter! Time for a change. We went to a different type of provider that uses a cable modem, so speed is no longer an issue. Problem solved. I’m sure you seldom think about the speed of your internet connection until you’ve used a faster one. It was that difference that tipped me off that something was wrong at GAO. For them it was “normal”— for me, it was unacceptable.

Here are three takeaways from this: q Find out what your internet speed is supposed to be.

Your provider needs to tell you the tier you should expect to be in. You’re looking for a number with Mbps behind it. q Test the speed over a series of days. If you use one day, some providers will say it varies based on usage. Try offpeak times, for example, when the office is closed. If you’re

not getting what you pay for, find out why. It could be the internet provider, your hardware, computer or network.

You pay for it, so you deserve an explanation. q Buy all the bandwidth you can afford. The need for bandwidth will keep growing and that growth will likely be exponential. We put a high-speed fiber connection here at the FDA that gives each person at least 120 Mbps, even in heavy usage. Our work is dependent on the internet now and that’s not likely to change. Why put in a two-lane dirt road when you’ll need an eight-lane superhighway soon?

Every two years I go back to my home internet provider and they upgrade my bandwidth for free. This year they did it without me asking!

Bottom line: Make sure you’re getting what you pay for when it comes to internet speed.

FDAS: Cyber Liability Coverage

YOUR DIGITAL PRACTICE FILES MAY BE AT RISK. In 2017, U.S. healthcare data breaches cost companies an average of

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You need CYBER liability coverage!

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FDAS stronly advises adding cyber coverage to your insurance portfolio becuase cyber attacks are a significant and expensive risk to dental offices today. don’t let cyber criminals jeopardize your practice.

FLORIDADENTAL.ORG

FIVE-YEAR PROGRESS REPORT

Florida’s Action for Dental Health is a comprehensive effort to improve the oral health and resulting overall health of all Floridians.

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LETTER FROM THE PRESIDENT

In 2014, the Florida Dental Association (FDA) launched Florida’s Action for Dental Health (FADH) to serve as a comprehensive, ongoing initiative to improve the oral health and resulting overall health of all Floridians. Since then, the FDA and its more than 8,000 member dentists have worked to implement the strategies outlined in this initiative. A healthy mouth is essential to a healthy body, and Florida dentists believe everyone — from pediatric to geriatric patients — deserves quality dental care.

As we reach this five-year milestone, we are pleased to share highlights of key successes and positive movement achieved to date through FADH. We also recognize and value the collaboration of stakeholders and partners in helping to drive these achievements.

We look forward to continuing to build these partnerships to grow the reach and impact of FADH, and we invite you to join us in this effort to promote oral health for all our citizens.

RUDOLPH T. LIDDELL, DMD President, Florida Dental Association

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FLORIDA DONATED DENTAL SERVICES PATIENT STORY

Joseph is a veteran and senior living in Fort Lauderdale. He served in the Army in the 1960s before going on to work as an auto mechanic for 45 years. Joseph was no longer able to work after developing high blood pressure, Type 2 diabetes and degenerative disc disease.

Unfortunately, Joseph’s dental health also was poor, and he didn’t have the financial ability to pay for dental treatment. He had three remaining teeth that were causing him pain when he ate, which then limited his diet.

The DDS program gave Joseph the opportunity to become a patient of a volunteer dentist and get the care he needed. Joseph’s remaining teeth were extracted, and he was fitted with a full upper denture and implant-retained lower denture with the help of a volunteer dental lab. Through DDS, Joseph’s dental health and smile were restored, which significantly improved his quality of life.

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OBJECTIVE 2: Collaborate to maximize the current dental workforce to serve Floridians with preventive and therapeutic dental care.

14,000+

DENTISTS WITH AN ACTIVE FLORIDA LICENSE

14,000+ DENTAL HYGIENISTS WITH AN ACTIVE FLORIDA LICENSE

16,000+ DENTAL ASSISTANTS IN FLORIDA

800+ REGISTERED DENTAL LABORATORIES IN FLORIDA

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Key Strategies: The FDA supported rules recently passed by the Florida Board of Dentistry to expand scope through restorative function dental auxiliaries.

As a result, dental hygienists and assistants will be trained to do more restorative care, which will support increased efficiencies in Florida dental offices.

The FDA supports reinstating the Health Access Dental License, which provides an opportunity for out-of-state licensed dentists to practice in Florida, specifically in underserved health access settings.

This license was repealed on Jan. 1, 2020.

Reinstating the Health Access Dental License will continue to allow dentists to provide dental care in rural and underserved areas.

The FDA also supports teledentistry as an opportunity to increase access to dental care in rural and underserved areas across the state. Teledentistry has been piloted in several Florida counties and helped increase access to dental care in these areas. Through teledentistry, dentists are able to remotely provide dental examinations to patients, while hygienists provide preventive services. For cases with severe and immediate needs, the dentist is able to make a referral for the patient to see a nearby dentist for restorative services.

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ACKNOWLEDGMENTS The FDA would like to thank our partners and stakeholder groups for their continuous collaboration in helping to improve access to oral health care for all Floridians.

The FDA would like to recognize the members of the Workforce Innovation Task Group for their work in driving FADH.

The FDA also would like to recognize the members of the Sub-Workgroup on Elder Care for their contributions to this effort.

Dr. Andrew Brown, Chair

Dr. Nolan Allen, Chair

Dr. Jim Antoon

Dr. Terry Buckenheimer

Dr. Terry Buckenheimer

Dr. Don Ilkka

Dr. Chris Bulnes

Mr. Bob Macdonald

Dr. Bill D’Aiuto

Dr. Cesar Sabates

Dr. George Kolos

Dr. Rick Stevenson

Dr. Jolene Paramore Dr. Mike Eggnatz, Consultant Dr. C.J. Henley, Consultant Dr. Rick Huot, Consultant Dr. Rudy Liddell, Consultant

CONTACT: Joe Anne Hart, Governmental Affairs Office jahart@floridadental.org deason@floridadental.org Drew Eason, MA. CAE, Executive Director 850.224.1089 118 E. Jefferson St., Tallahassee, FL 32301 dentalhealthfl.org floridadental.org

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FLORIDADENTAL.ORG

I3 Implant

BOD meeting

FLORIDA BOARD OF DENTISTRY MEETS IN GAINESVILLE

CASEY STOUTAMIRE FDA DIRECTOR OF THIRD PARTY PAYER & PROFESSIONAL AFFAIRS

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

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The Florida Board of Dentistry (BOD) met in Gainesville on Friday, Feb. 21, at 7:30 a.m. The FDA was represented by FDA BOD Liaison Dr. Don Ilkka and Director of Third Party Payer and Professional Affairs Casey Stoutamire. Other FDA members in attendance included Drs. Andy Brown, Jim Haddix and Doug Manning. Dental students from the University of Florida and dental hygiene students from Santa Fe Community College also were in attendance.

All the BOD members were present, which included: Dr. Naved Fatmi, chair; Dr. Nick White, vice chair; Drs. Matt Freedman, Nick Kavouklis, Claudio Miro and T.J. Tejera; hygiene members, Ms. Cathy Cabanzon and Ms. Karyn Hill; and, consumer member, Mr. Fabio Andrade. There is one dentist position and one consumer position open on the board that the governor has not yet filled.

Ms. Hill is the newest BOD member and this was her first meeting. The FDA congratulates her on her appointment and looks forward to working with her in the future.

Ms. Cabanzon provided a report of the Council on Hygiene conference call from Dec. 11. The council requested Dr. Tejera and the Anesthesia Committee review the training requirements for dental hygienists to administer nitrous oxide, as the council feels they are too rigorous for hygienists and are too costly. There also was a request for Dr. Kavouklis and the Dental Assisting Commit-

MARCH/APRIL 2020

tee to look at making the supervision level for assistants administering nitrous oxide consistent within all BOD rules since there is currently a conflict. The anesthesia rules propose that assistants, with proper training, can administer nitrous oxide under indirect supervision. Finally, per the council’s recommendation, the BOD approved the American Academy of Dental Hygiene as a board-approved continuing education (CE) provider.

Ms. Cabanzon also reported on the Rules Committee meeting held Feb. 20. In November, the governor directed all boards to do a comprehensive review of all rules. This comprehensive review will be an important focus for the committee and board for the upcoming year. There was discussion on Rule 64B5-0.010 Prescriptions for the Services of a Dental Hygienist. The board approved the verbiage below. Please note that statute referenced is for services in a licensed public and private health facilities, other public institutions of the state and federal government, public and private educational institutions, the home of a non-ambulatory patient; and, other places in accordance with the rules of the board.

(1) For the purposes of section 466.023(2)(d), F.S., aA dentist’s prescription for his patient of record for dental hygiene services in the setting outlined in 466.023(2)(d), F.S., shall contain the following information, within the record of the patient:

FLORIDADENTAL.ORG

The next BOD meeting is scheduled for Friday, May 15 at 7:30 a.m. EST in Tampa. (a) the patient’s name and address (b) the dentist’s name, business address and license number (c) the name, business address and professional license number of the dental hygienist who is being authorized to perform the service (d) a statement of the specific services authorized and the frequency of the services authorized (2) The prescribing dentist shall maintain an electronic or paper copy of the prescription within the patient’s dental record.

The committee discussed revising the information found in the rule on CE to simplify and clarify the process for granting CE for pro bono services. This will not affect the FDA’s Florida Mission of Mercy program. In addition, per the committee’s recommendation, the BOD approved the following language to be added to Rule 64B5-12.013 to comply with the Human Trafficking law passed during the last legislative session.

Rule 64B5-12.013: 6. By January 1, 2021, each licensee shall complete a one-time board-approved, 1-hour continuing education course on human trafficking as outlined in 456.0341.

The course must address both sex trafficking and labor trafficking, how to identify individuals who may be victims of human trafficking, how to report cases of human trafficking, and resources available to victims.

Finally, a petition was brought forth to the Rules Committee to allow examiners affiliated with a dental school to be eligible to be an examiner if they were not examining at his/her own school. The committee proposed and the board approved a motion to repeal Rule 64B5-2.020, selection of examiners. The rationale is the rule is obsolete as the Commission on Dental Competency Assessments (CDCA), which administers the American Board of Dental Examiners exam in Florida, has its own processes and procedures for selection of examiners and the board is confident in how the CDCA handles that process.

FLORIDADENTAL.ORG

Ron Dilworth, investigative services administrator at the Department of Health (DOH), updated the board on the new Anesthesia and Sedation Permit Inspection process that started in October 2019. Inspections now are conducted through the DOH. There was a rigorous training program to calibrate the inspectors and they also hold weekly meetings.

Currently, there are two full-time inspectors, who are oral surgeons. There are four openings, but two positions are in the final stages of the hiring process. In 2019, there were a total of 433 inspections, with 116 of those between October and December. Since Jan. 1, there have been 103 inspections. The failure rate was 35%, but only two cases have been referred for disciplinary action. The others either were corrected before the follow-up visit or the dentist relinquished their permit. Dr. Tejera and the board thanked Mr. Dilworth and the inspectors on a job well done. This work will clear the backlog of inspections and bring the department current on inspections that need to occur moving forward and thus, protect the patients of Florida.

There were four disciplinary cases, three informal hearings, two determination of waivers and one voluntary relinquishment dealing with a patient death (the license was revoked), failing to meet the minimum standard of care and failing to keep adequate records. It is much better to be a spectator than a participant in BOD disciplinary cases.

Finally, Dr. Fatmi thanked Ms. Angie Sissine Brown, RDH for her service on the board. The FDA also would like to thank her for all her hard work! Ms. Jessica Sapp was named executive director of the BOD as Ms. Jennifer Wenhold is now the bureau chief for Health Care Practitioner Regulation at the DOH. The FDA congratulates them both on their new positions.

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FDAS: Employment Practices Liability Insurance

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WHY DO YOU NEED IT? Employment practices liability insurance (EPLI) is a type of liability insurance covering wrongful acts arising from the employment process. The most frequent types of claims covered under such policies include: wrongful termination, discrimination, sexual harassment and retaliation.

LEGAL COUNSEL “Litigation by employees has become a fact of doing business and even medical practitioners are not immune. The costs to defend your practice, even if successful, can be significant. Having a plan to manage these costs is a must.”

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overpayments

CLAWBACK? PLEASE EXPLAIN!

CASEY STOUTAMIRE FDA DIRECTOR OF THIRD PARTY PAYER & PROFESSIONAL AFFAIRS

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

Imagine this scenario, a patient comes into your office, you verify their insurance and complete the treatment. You are in network with their insurance plan, so you file the appropriate paperwork and receive the explanation of benefits form back, and you balance bill the patient or write off the appropriate amount. All is well. I know that almost never happens but stay with me. A couple months later, you notice another patient with that same plan has money deducted from their claim, but it was for treatment on the first patient in this scenario. Or you get a letter from the insurance plan that says they overpaid you for that patient’s treatment and now you owe them a sum of money. I’m sure you don’t have to imagine this scenario — you’ve probably dealt with something similar in your practice. You’re probably thinking, what is going on? Is it legal? And what can I do about it?

The scenario described above is a classic example of an insurer’s recovery of overpayment to providers (also known as a clawback). The bad news is that this is a term you agreed to in the contract with the plan. You should always check your signed agreements to determine how overpayments are handled by the plan. Out-of-network dentists are not contractually obligated to return overpayments to the insurance plan; however, it’s not uncommon for the plans to withhold future payments from dentists. If this happens, make sure to appeal the claim and notify the Florida Dental Association (FDA) so that

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we can help you fight the overpayment. Remember, the patient is ultimately responsible for payment to the dentist regardless of plan coverage and dentists are recommended to use their preferred collections methods in situations where the patient does not pay.

To compound the issue, Florida law allows an insurer to request a refund from an alleged overpayment from the provider 30 months after the payment was made. Twenty states have passed legislation limiting how far back a payer can recoup overpaid claims. The FDA has been educating legislators on this issue and would like to shorten the clawback period in the state to one year. However, you must remember, a law passed in Florida only applies to state regulated plans, which account for approximately 52% of your patients who have dental insurance. The other 48% have selffunded or other types of dental plans, which are exempt from state insurance statutes.

Usually, the alleged overpayment is due to the gap between when your patient is shown to be a beneficiary in an insurance plan’s system and when they are no longer eligible for coverage. Unfortunately, it’s common for a patient’s employer to fail to timely notify the insurance plan the patient’s benefits have been terminated, resulting in a refund request from the dental plan. Below are questions front office staff can ask patients regarding changes in their dental benefits coverage. (Thank you to my colleagues at the California Dental Association for sharing these tips!)

FLORIDADENTAL.ORG

1.

Since we last saw you, has your dental coverage changed?

o no longer at that employer

o shifted to part-time work

o leave of absence

o loss of job

a. If the patient answers no, the staff should go on to ask question 2. b. If the patient answers yes, the staff should ask, “How has the coverage changed?”

l Do you have a new dental plan? l Has your coverage changed?

Eligibility and coverage should be verified by the front desk through the payer’s online portal or by calling the toll-free number on the patient’s identification card.

2.

Since we last saw you, have there been any recent employment changes for the policyholder? l Have the staff listen for these key words from the patient:

l If any of the above employment changes have occurred, have the staff continue the questions.

3.

Did the employer provide you and/or the policyholder with paperwork stating how long the dental plan coverage will be in effect, or how it might affect the coverage due to this change? l

Explain how there can be a delay in reporting of eligibility from the employer to the plan and for the patient’s protection, you would like to get a copy of the paperwork they received from the employer to keep on file.

o laid off from job

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

2020 Florida Mission of Mercy Has Been Postponed The Florida Dental Association (FDA) Foundation has been actively monitoring the outbreak of illness caused by the new coronavirus (COVID-19). Out of abundance of caution for patients and volunteers, the April 24-25, 2020 Florida Mission of Mercy event will be postponed. At this time, a rescheduled date has not been determined. We will be sharing additional information and updates as they become available. If you have any questions, please contact the FDA Foundation at 850.681.3629.

Phishing Email Impersonates ADA President At least one American Dental Association (ADA) member has reported receiving a phishing email appearing to come from an address containing ADA President Chad P. Gehani’s name and including a link to “view member’s details.”

The email was not sent by Dr. Gehani.

A phishing email disguises itself as coming from a trustworthy source in an attempt to obtain sensitive information, such as usernames and passwords, by tricking the recipient into clicking on a link or opening a document and then providing sensitive information.

If recipients clicked the link and entered their username or password, they should change their password as soon as possible. If they use that same username

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and password combination for any other online account, they should change their passwords for those as well.

If members receive a suspicious email regarding their member information or dues payment and they are not sure if it is legitimate, they should contact their state association or call the ADA toll-free number to confirm or deny the authenticity of the email.

The Federal Trade Commission also recommends phishing victims forward phishing emails to spam@uce.gov and reportphishing@apwg.org and report the incident to the commission at FTC. gov/complaint.

The ADA Center for Professional Success offers several ways member dentists can protect themselves against cyberattacks. Steps include training staff on basic data security, backing up data regularly and keeping a copy off-site, being wary of attachments and web links included with suspicious emails, and maintaining cyber defenses such as antivirus and anti-malware software.

To learn more, visit success.ada.org. The ADA also offers a continuing education course on phishing at ebusiness.ada.org.

Other Scams Aimed at Dentists Recently, the FDA has been made aware of an increasing number of scams aimed at dentists. These scams can be by phone, email, text or fax. From the Drug Enforcement Administration supposedly suspending your license because of illicit drug sales unless you pay X dol-

lars, to the Department of Health or the Board of Dentistry taking action against you unless you pay them a fine — these all are scams.

These are simply scare tactics and they follow a simple formula, but people still fall for them. They scare you by threatening your professional or personal reputation and then comes the catch.

They want you to do something in response to that and it usually involves money. Please understand, if you receive any unsolicited threatening email, text, phone call or fax, do not be fooled into immediately responding in any way. It can appear to be very real. Take the time to independently call the agency these people are with to discover the truth if need be.

Responding to them in any way — even if you do not pay them — tells them you are paying attention and they may work to set you up for the next scam. Simply do not respond.

Volunteer at ADA FDC 2020 Mark your calendar! The ADA FDC 2020 Annual Meeting will be held Oct. 15-18 at the Orange County Convention Center in Orlando. This joint meeting of the ADA and FDA will bring you 300+ courses, 500+ exhibiting companies and endless networking opportunities. Learn more at ada.org/meeting. As an FDA member benefit, members can register for the Standard Registration Package for FREE, including Tier 1 lectures (50% of lectures) during the Early Bird Registration period. For more informatoin, go to ada.org/meeting. If you are inter-

FLORIDADENTAL.ORG

HOUSE OF DELEGATES TO CONSIDER BYLAWS CHANGE The June House of delegates will review a possible bylaws change regarding the process for FDA officer nominations and elections. ested in serving as an ADA FDC 2020 volunteer, please reach out to Dr. Bert Hughes at DrBertHughesADACLA@ gmail.com.

ADA Accelerator Series Aims to Speed Up Dentists’ Success In March, the ADA launched the ADA Accelerator Series, an “online, ondemand program specifically designed to provide information — from parental leave to financial support — that is tailored to the early-career dentist’s unique work-life balance needs.” The program’s goal is simple: position dentists for a faster road to success. To learn more about the ADA Acceleration Series, visit ADA.org/Accelerator.

All in the Family

The Ritota brothers, Drs. John and Ted, celebrate practicing dentistry together in Delray Beach for 40 years, with mom, Dolores, alongside them as their receptionist.

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 dayto-day triumphs and tribulations of Photo credit: Melissa Korman practicing dentistry.

Northeast District Dental Association Dr. Alexandro Ahmar, Jacksonville Dr. Matthew Smith, St. Johns

Northwest District Dental Association Dr. Sara Siddiqui, Tallahassee

South Florida District Dental Association Dr. Nicholas Castellanos, Miami Lakes Dr. Leticia de Lapeyra, Miami

Atlantic Coast District Dental Association

Dr. Yamel Maqueira Rodriquez, Miami

Dr. Robert Blashka, Boca Raton

Dr. Evan Rosen, Palmetto Bay

Dr. Shawn Briggs, Jupiter

Dr. Roymar Perez Otero, Miami Dr. Adriana Valery-Lara, Miami

Dr. Cristian Chinea Suarez, Port St. Lucie

West Coast Dental Association

Dr. Tara Humble, Palm Beach Gardens

Dr. Dayron Baez, Largo

Dr. Imari Morrison, Cooper City

Dr. Michael DeMarsh, Tampa

Central Florida District Dental Association Dr. Mounika Akula, Orlando Dr. Marielle Beauchamp, Port Orange

Dr. Matthew Keller, Bonita Springs Dr. Sean Matheny, Port Charlotte Dr. Stephanie Mazariegos, Riverview Dr. Jonathan Tanner, Clearwater

Dr. Stuart Beauchamp, Ormond Beach Dr. Rajendra Gohel, Gainesville Dr. Claudia Green, Ormond Beach Dr. Susana Hernandez, Summerfield Back row: Sofia, Dr. Ted, Dolores (mom), Dr. John and Luz; In front: Kim and Carine.

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FDA: The Doc

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Did you know FDA Services (FDAS) is overseen by a board of directors made up of Florida dentists who guide our mission to support FDA members throughout their dental careers?

Did you know FDAS specifically negotiated the FDA dental professional liability program with The Doctors Company to get FDA members the best coverage, rates and benefits possible?

Did you know revenue generated from FDAS insurance sales goes directly toward funding FDA programs and lobbying efforts that are important to members, as well as keeping member dues at their lowest possible level?

Did you know FDAS contributed more than $1.7 million to FDA dues reduction in 2019?

Getting your malpractice coverage through FDAS and our partners at The Doctors Company is a no-brainer. Members get expertly negotiated coverage while benefiting the FDA and keeping dues low!

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Award

2020

RECIPIENTS



PRESIDENT’S AWARD



Dr. Rudy Liddell  DENTIST

OF THE YEAR

Dr. Michael Starr 

J. LEON SCHWARTZ LIFETIME SERVICE AWARD



LEADERSHIP AWARDS

Dr. Drew Johnson Dr. Jessica Stilley

PUBLIC SERVICE AWARDS

Dr. Diane Ede-Nichols Dr. Reese Harrison Dr. John Penny

Dr. Bill D’Aiuto 

DENTAL TEAM MEMBER

Ms. Heather Lewis

Dr. Don Ilkka



NEW DENTAL LEADER



HELPING MEMBERS SUCCEED TEAM IMPACT AWARD Ms. Carol Gaskins

JOIN IN THE RECOGNITION OF YOUR COLLEAGUES AT THIS SPECIAL EVENT.

AWARDS DINNER Friday • June 12, 2020 • 6:30-10 PM Gaylord Palms Resort & Convention Center Orlando, Florida Cocktail Reception, Dinner & Dancing Individual tickets are $80 or a table for 10 is $750.

Please purchase your tickets by May 29.

To purchase tickets online, go to floridadental.org/awards or contact Emily Somerset at esomerset@floridadental.org or 850.681.3629.

2020

Award

Recipients 36

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PRESIDENT’S AWARD Dr. Rudy Liddell

Dr. Rudy Liddell was born and raised in Pittsburgh, Pa. and moved to Florida just prior to his senior year of high school. After attending the United States Military Academy for two years, he received an engineering degree from the University of South Florida (USF). Dr. Liddell then went on to attend dental school at the University of Florida College of Dentistry (UFCD) and graduated in 1982. He now practices in Brandon, Fla. in a small group practice with four other partners. Dr. Liddell has served at all levels of leadership in organized dentistry, beginning as a delegate to the Florida Dental Association (FDA) in 1998 and then serving as an officer for the Hillsborough County Dental Association (1999-2005), a line officer for the West Coast District Dental Association (WCDDA) from 2005-2010, and as an FDA officer since 2014. He is the 2019-2020 president of the FDA. Dr. Liddell also served on the FDA Board of Trustees (BOT) from 2010-2012 and is the current chair of the ADA Council on Dental Practice. Dr. Liddell also is the newly elected 17th District Trustee to the ADA BOT and will begin his service in this role in October 2020. Dr. Liddell has been married to his wife, Sherri, for 35 years and they have two sons, Michael, married to Ashley and living in Riverview, and Brian, who resides in Gainesville with his wife, Savannah.

DENTIST OF THE YEAR Dr. Don Ilkka

Dr. Don Ilkka was born in Detroit and raised on a small farm in Goodrich, Mich. He received his bachelor’s degree in 1978 from Michigan Technological University and his Doctor of Dental Surgery degree in 1982 from the University of Detroit. After graduating, Dr. Ilkka relocated to Leesburg, Fla. and opened his general dentistry practice where he still practices today. Dr. Ilkka has been a leader in organized dentistry, holding all the officer positions in the Lake County Dental Association as well as the Central Florida District Dental Association. He also served as a trustee for the FDA for 10 years and served on the FDA Services (FDAS) Board of Directors for four years. Dr. Ilkka is a founding member and the dental director at St. Luke’s Free Medical and Dental Clinic is Eustis, Fla. Most recently, Dr. Ilkka serves as the FDA Board of Dentistry (BOD) liaison. He attends all meetings and keeps the FDA informed and up to date on BOD happenings. Dr. Ilkka married his wife, Kathy, in May 1985 and they have three grown children: John, Jacob and Anna.

SEE PAGE 38

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J. LEON SCHWARTZ LIFETIME SERVICE AWARD Dr. Bill D’Aiuto

Dr. Bill D’Aiuto graduated from the Ohio State University College of Dentistry in 1981 and moved to Fort Myers, Fla. that same year. After a brief associateship, he realized the growth potential in the Orlando area and started his own private practice in restorative and cosmetic dentistry in 1982 in Longwood, Fla. Dr. D’Aiuto began his service to organized dentistry as chair of the FDA New Dentist Committee. In 1992, was named the ADA’s chair of the Mississippi, Alabama, Georgia and Florida New Dentist Committees. He served on the FDA House of Delegates (HOD) for more than 30 years. New dentist and student issues have been at the forefront of his dental career. Dr. D’Aiuto was instrumental in bringing the American Student Dental Association student vote to the ADA HOD as part of his 26 years serving Florida’s delegation to the ADA. Dr. D’Aiuto was chair of the Florida National Dental Congress and a past president of the FDA and the FDA Foundation. As the FDA’s appointee to the ADA Council on Dental Practice, he has seen firsthand the trends that face the dental profession. Dr. D’Aiuto has been honored for his service in dentistry and has received many awards, including the 1989 ADA Outstanding Young Dentist Leader Award and 1993 FDA Dentist of the Year.

LEADERSHIP AWARD Dr. Drew Johnson

Dr. Drew Johnson was born and raised in Rockledge, Fla. He is a graduate of the University of Florida, the Virginia Commonwealth University School of Dentistry and the University of Cincinnati Medical Center Division of Oral and Maxillofacial Surgery. Dr. Johnson is board certified by the American Board of Oral and Maxillofacial Surgery and has been in private practice in Cocoa, Fla. since 1995. Dr. Johnson is a past president of the Brevard County Dental Society and has served as a delegate to the FDA HOD since 2004. He began his service on the FDA Delegation to the ADA in 2019. Dr. Johnson has served on the FDA Council on Ethics, Bylaws and Judicial Affairs since 2014 and was elected chair of this council in 2016. During his time as chair, the council has been instrumental in leading the FDA as it updates its bylaws and manuals. His leadership as chair on the FDA’s council led to his selection to serve on the ADA Council on Ethics, Bylaws and Judicial Affairs in 2018. Dr. Johnson and his wife, Jill, have two daughters: Emily, a USF graduate and teacher in Tampa, and Elizabeth, a college sophomore and volleyball player at Keene State College in Keene, N.H.

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LEADERSHIP AWARD Dr. Jessica Stilley

Dr. Jessica Stilley received her dental degree from UFCD in 2005 and her periodontal certificate from the Ohio State University in 2008. She has been practicing in Hillsborough and Pasco counties since 2008 with her partner, Dr. Steven Lieber, and now their associate, Dr. Camille Medina. Her involvement in leadership began in 2009 when she joined the executive council of the West Pasco Dental Association and has grown over the years to include involvement in WCDDA, FDA, ADA, Florida Association of Periodontists (FAP) and American Association of Periodontists. She believes in the value of organized dentistry and how it bolsters the profession.

Some of her many leadership positions include co-chair for the WCDDA delegation to the FDA, member of the ADA Council on Dental Benefits in 2019, officer on the FAP Executive Council and anesthesia inspector for the Florida BOD since 2016. When not practicing or volunteering in dentistry, she enjoys spending time with her husband, Michael, and their son, Trent.

NEW DENTAL LEADER Dr. Michael Starr

Dr. Michael Starr was born and raised in Wellington, Fla. He is a graduate of the University of Notre Dame and earned his Doctorate in Dental Medicine from Nova Southeastern University in 2014. He currently practices general dentistry with his father, Dr. Christopher Starr, in his hometown. Dr. Starr has vivid memories as a child of his father attending dental meetings and now considers it a great honor to be a part of the tradition and legacy of organized dentistry. Dr. Starr is a past chair of the FDA Council on the New Dentist, past president of the Central Palm Beach County Dental Association, and a current FDA Trustee from the Atlantic Coast District Dental Association. Outside of dentistry, he enjoys golfing, boating and spending time with his wife, Emily, and their dog, Colt.

DENTAL TEAM MEMBER Ms. Heather Lewis

Ms. Heather Lewis graduated from Santa Fe College in 2001 with an associate degree in dental hygiene. She has worked in clinical hygiene at the Alachua County Organization for Rural Needs (ACORN) Dental Clinic as the outreach program coordinator since 2002. The clinic’s “Tooth Fairy” program consists of providing children in rural and underserved communities with dental education through a fun and interactive program. In addition to her service to those in need, Ms. Lewis has worked with Dr. Yvette Godet in her private practice since 2010. Ms. Lewis enjoys nature and traveling with her husband and two sons.

SEE PAGE 40

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PUBLIC SERVICE AWARD Dr. Diane Ede-Nichols

Dr. Diane Ede-Nichols attended the University of Miami, receiving a Bachelor of Science in medical technology. She graduated from Fairleigh Dickinson University College of Dental Medicine with a Doctorate in Dental Medicine and was inducted into the Omicron Kappa Upsilon Honor Society. Dr. Ede-Nichols has dedicated her life to teaching and treating special needs patients and underserved populations. She has organized and participated in 26 international dental mission trips to five countries outside the U.S., providing access to oral health care to more than 10,000 people worldwide. Some of her many achievements include creating a didactic and clinical geriatric dental program for pre- and post-doctoral dental students. She also has created programs for educating pre- and post-doctoral U.S. and international dental students on the care of persons with disabilities. Dr. Ede-Nichols is currently a professor and chair for community and public health sciences at Nova Southeastern University College of Dental Medicine with a dual appointment in public health at the College of Osteopathic Medicine.

PUBLIC SERVICE AWARD Dr. Reese Harrison

Dr. Reese Harrison grew up in Lynn Haven, Fla. He attended University of Florida and earned his bachelor’s degree in zoology and went on to receive his dental degree. Dr. Harrison married his high school sweetheart, Mara, while in dental school. Immediately upon graduation, they moved back home, and Dr. Harrison started practicing general dentistry in the area.

Following Hurricane Michael’s devastation to the Panama City and Lynn Haven area in October 2018, his office was forced to close for five months. During this time, he and Mara founded Hope Panhandle, a not-for-profit organization dedicated solely to Hurricane Michael relief. The foundation quickly grew and has served thousands of people and secured more than $1 million in grants and donations to assist in rebuilding homes in the area as well as meeting the immediate needs of those displaced by the storm. They were even featured on NBC’s “The Today Show.”

With Dr. and Mrs. Harrison at the helm, Hope Panhandle continues to help all the affected areas in the rebuilding process and promises to assist in the recovery for as long as they are needed.

Dr. Harrison and Mara have three daughters, and the eldest is in her third year at UF now.

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PUBLIC SERVICE AWARD Dr. John Penny

Dr. John Penny was born in Lake Charles, La. and grew up in Madeira and Redington beaches in Florida. He attended USF and graduated from the Medical College of Virginia in Richmond in 1975. Dr. Penny worked in general dentistry in Colonial Heights, Va. before deciding to move back home to Florida where he opened a practice in St. Pete Beach in 1977. In addition to running a successful dental practice for more than 45 years, Dr. Penny has remained an active part of his St. Pete community including serving and giving his time in the St. Petersburg Dental Clinic, the Metro Wellness and Community Centers, the FDA Foundation, Veterans of South Pinellas County, the Coast Guard Foundation and Shriners Club to name a few. In 1985, Dr. Penny married his wife, Ann, who is a registered nurse. They have three children, Alexia, John Michael and Jacqueline. Their daughter, Alexia, lives in Virginia with her two sons: Hayes, 6, and Harry, 2. Their son lives in St. Pete and is a firefighter/medic. He and his wife are expecting their first baby. Their daughter, Jacqueline, also lives in Florida and is a dental hygienist and an award-winning equestrian.

HELPING MEMBERS SUCCEED TEAM IMPACT AWARD Ms. Carol Gaskins

Ms. Carol Gaskins began working at the FDA in 2002 as an insurance customer service representative. She has held several positions of increasing responsibility at FDAS throughout her 17-year career, including her current position as the commercial accounts manager. In her current role, Ms. Gaskins has contributed to overall company growth and high retention ratio by assisting members to review, effectively adjust and maintain their insurance portfolios at the highest level. She’s also helped implement several communication and retention programs to better serve FDA members. In her free time, Ms. Gaskins loves spending time with her friends and family. She also volunteers at various community events such the Second Harvest of the Big Bend and managing high school sports events and tournaments.

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THE OFFICIAL BEYOND THE BITE QUIZ (check all that apply):  1. Are you creative?  2. Are you well-informed?  3. Do you have opinions that need a place to be heard (or, actually, to be read)?  4. Can you write a “Hemingway” sentence (short, pithy, a complete thought)?  5. Do you have a funny bone begging for exercise?  6. Perhaps, you write dental haikus?  7. Can you tell a great story?  8. Are you the go-to expert on an issue?  9. Did you check any of the above boxes?

(If you did, you should write for Beyond the Bite! Send your ideas, how-tos, opinions, tall tales, poems and funny stories to FDA Director of Publications Jill Runyan at jrunyan@floridadental.org.

beyond the bite THE OFFICIAL BLOG OF THE FDA You can find Beyond the Bite at blog.floridadental.org

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Docor's Choie

2.

1.

DENTIST OF THE YEAR: DR. DON ILKKA 44

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4.

4.

3.

5.

Tell us about your family and how you spend your leisure time.

I was raised on a small farm in Goodrich, Mich. I received my undergraduate degree from Michigan Technological University, where people who really want to experience winter and snow go to school — the average snowfall is 370-400 in. each winter! I graduated from the University of Detroit School of Dentistry and relocated to Central Florida. I married my wife, Kathy, in 1985 and we have three children: John, Jacob and Anna.

My leisure time is spent reading (mostly nonfiction), woodworking in my shop and puttering around my 5 acres on my tractor. You can take the boy off the farm, but you can’t take the farm out of the boy.

How did you end up in dentistry?

Being born with both a cleft lip and palate, you can imagine I spent a lot of time in the offices of many medical and dental specialists. I had my last surgical palatal revision done when I was 29 years old. I was intrigued by the processes and the results. I knew that I wanted to be a dentist when I left home to go to college. I also knew that the competition for seats then was fierce, so I’d need a backup just in case I didn’t get into dental school. I studied for a biology and electrical SEE PAGE 46 FLORIDADENTAL.ORG

“

One th ing tha t I am m proud o o f a c c o mplishin st my pro fession g in is build openin ing and g the S t. Luke’s Medica F l and D ental C ree Eustis, linic in Fla., no w in its year of 11th servic County e to the Lake commu Anothe nity. r is that FDA Fo in 2012 un , th the Hum dation awarde e d me anita in Florid rian of the Ye ar a for m at St. Lu y work ke’s.

”

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lake at auna and s e th f insula o 1. View Upper Pen ’s n a ig h ic is Camp in M a goes to refresh h Ilkk where Dr. g soul. n a mornin o y th a K d an 2. Dr. Ilkka inac Island. ack walk on M nschied d Jo Espe n a a k k Il 3. John evada. hiking in N at.

Babs the c d n a a k k Il d 4. Anna oeppen an K n e e ll o with C enter 5. Dr. Ilkka t the World Trade C aa Jacob Ilkk n. tio subway sta

keep up with the changes in the profession. Organized dentistry helps members hone their technical skills by offering continuing education courses, and at a reasonable cost.

It keeps members current on the political front, including changes in rules and statutes that we practice under. It provides those of us who practice solo in our own little bubbles the opportunity to network with our peers. Frankly, it makes members and me better dentists.

What are your predictions for dentistry?

I participate in the American College Ethics Day at the University of Florida each year. Something that always impresses me is the quality of the students studying to be dentists. It reassures me that the new dentists entering our profession are well-rounded and well-trained individuals.

Dentistry has some major hurdles in front of it politically. My predictions for dentistry are that it will provide a rewarding pathway for many dentists in the future, but they’ll need to be active in the profession and organized dentistry to protect their profession.

What advice would you give to dental students? New dentists?

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engineering degree at Michigan Tech. I was accepted at Purdue for a master’s degree in electrical engineering but took the seat at the University of Detroit to go into dentistry when it was offered.

How did you get involved in the Florida Dental Association (FDA)?

I bought my practice in Leesburg, Fla. in July 1983. One of my colleagues, Dr. Gary Christensen, invited me to the local Lake County Dental Association (LCDA) meeting. That’s where it all began. I served in all the LCDA officer positions, then went on to serve in the Central District Dental Association (CFDDA) officer positions, then finally as the CFDDA president in 1999-2000. From there, I went on to the FDA Board of Trustees.

How has your involvement in organized dentistry influenced your own practice and commitment?

My advice to dental students: Get as much exposure to all facets of dentistry you can while in school. Determine which areas interest you the most. Then model your professional practice in those areas only. You don’t need to be the super dentist and do everything. If you are going to do it, do it to the highest standards and do it well. Refer out the other procedures you don’t enjoy doing. That way, you eliminate the stress involved with doing something that may not turn out the best. You’ll go home every night from the office with few, if any, worries. You’ll live longer.

To new dentists: Get involved in organized dentistry. Pay attention to the communications the FDA sends to you — read them all. Do not practice in a bubble. Be involved with your community. Work in the free clinics in your area — GIVE BACK! Most of all, as Dr. Wade Rucker told me many years ago, just take care of your patients, and they’ll take care of you! No truer words were ever spoken.

Being involved in organized dentistry is the only way to

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2019 Florida Mission of Mercy in Orlando (L-R) Drs. Jim Antoon, Andy Brown, Don Ilkka and Jerry Bird.

Why is being a legislative contact dentist (LCD) so important and vital to legislative advocacy?

One of the tools that organized dentistry uses is the LCD. It’s crucial that the legislators know and personally hear from our profession on a regular basis. The personal touch with either the legislator or their staff is the most efficient way to communicate. If you get out there and knock on doors or wave signs on street corners during election time, that’s remembered. When you do get that time with the legislator, they’re listening to you on a different level.

What is a political action committee (PAC) and what is its relevance to organized dentistry?

A PAC is a way to bring the power of many into one and focus it from a financial standpoint. It allows organized dentistry to bring together the financial contributions of members to one point and focus the message we’re trying to move forward with some financial clout.

Are there any dentists serving in the state House or Senate?

Should there be?

There are presently no dentists serving in the Florida House or Senate. Yes, there should be a dentist there. My good friend Dr. Alan Hays served in both the state House and Senate and told me many times how he would get many calls and emails for his opinion on dental issues in front of the House and Senate.

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Part of the FLA-MOM inventory crew. (L-R) John Ilkka; Drs. Don Ilkka, Curtis Hill, Howard Pranikoff, Bernie Kahn; Nate Germino.

His opinion counted; he was the expert and they trusted his input. Presently, we’re at a disadvantage without a dentist in the Florida Legislature.

What made you want to become involved in the FDA’s grassroots/ political advocacy?

As the present Board of Dentistry (BOD) liaison, I function most of the time one on one with the members of the BOD. They’re an intensely well-versed, dedicated group of individuals. They’re charged with protecting the citizens of Florida, and they’re committed to that charge. I saw my predecessor, Dr. Don Erbes, work with them for many years.

When he came to me to ask me to replace him, I thought, yes, I could do it. Decisions haven’t always gone as we’d like them to, but it’s always been extremely rewarding.

While there are many FDA members, there are not as many involved in advocacy. Why do you think it’s important that number increases?

There does need to be a dedicated outreach to members to get them more involved politically. We need a member(s) to step up and run for the House or Senate seats. We need stronger PAC participation. We always need LCDs. In my opinion, members unfortunately just don’t have an appreciation for what it takes politically to protect their profession. They need to step up, educate themselves by reading the communications sent by the FDA, financially support the PAC and visit with their representatives in their home districts.

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#ADAFDC2020

ADA FDC 2020 DR. JOLENE PARAMORE

Dr. Paramore is the FDC 2020 Committee Chair and can be reached at drparamore@gmail. com.

Join us for the first-ever joint meeting of the American Dental Association (ADA) and a state dental association right in our backyard! Florida is once again leading the way, this time with a new concept in meetings: Combining all the benefits of a national meeting with the Florida Dental Convention (FDC), the fastest-growing state dental meeting, results in an attendee experience sure to please! The place to be Oct. 15-18 is in Orlando at the Orange County Convention Center for ADA FDC 2020, the joint meeting of the ADA and Florida Dental Association (FDA). As a benefit of this combined meeting, FDA members who are early birds and register at ada.org/meeting will get a special deal on registration pricing! Take advantage of the free registration you are used to at FDC plus Tier 1 lecture courses (50% of lectures) for free! As an extra bonus, access to the Exhibit Hall and both morning keynote sessions are included in the Standard Registration Package.

As a member benefit, FDA member dentists are the only attendees able to register for the ADA FDC 2020 Standard Registration Package for FREE! FDC negotiated this fantastic opportunity for all FDA members, but you must act quickly once registration opens to take advantage of this offer. Look for more information about early bird registration — coming soon — to ensure you get the courses you want, as the free courses are first come, first reserved. Once Early Bird registration closes on May 15 at 6 p.m. ET, the Standard Registration Package will increase to $125 for FDA members, but free courses will still be available while they last, so don’t delay.

When it comes to courses, we have an incredible lineup for you! Starting on Wednesday with the Sleep Summit and Elder Care Immersion and continuing through Sunday morning with more than 200 lectures and 50 workshops, there is something for everyone. ADA FDC 2020 offers 10 tracks designed for dentists, including: diagnosis and treatment planning, elder care, endodontics, implants, oral-systemic connection, oropharyngeal cancer, pediatrics and periodontics. The Digital Future of Dentistry and the ADA Practice Excellence Theater will showcase the most current trends in our profession.

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“We need you, your team, spouses and guests to help us show the rest of the nation our Florida hospitality!”

FDC values the many team members who seek to expand their expertise at our meeting. For ADA FDC 2020, special tracks for dental administration, dental assisting and dental hygiene team members were developed to provide knowledge they can use as soon as they return to the office. For only an $85 registration fee, your team members can register for the Standard Registration Package and choose from more than 85 free lectures.

As a partner in ADA FDC 2020, FDC is responsible for coordinating speaker hosts and hospitality volunteers. Volunteer shifts vary from two to four hours and there are many perks available for volunteering. We need you, your team, spouses and guests to help us show the rest of the nation our Florida hospitality! There are many opportunities to choose from — visit floridadentalconvention.com for more information.

FDC could not host a meeting without the fun you’ve come to know and love! The fun starts on Thursday, Oct. 15 with “Night at Universal’s Islands of Adventure.” ADA FDC 2020 attendees will have exclusive access to Universal’s Islands of Adventure from 7:30-11 p.m. to enjoy the rides and entertainment. Adult tickets are $85, children ages 3-18 are $70 and children under 3 are complimentary.

Fire up your Friday morning and become a rock star with Marvelless Mark at the free keynote session, “Rock Star Results: Electrify you Career, Connections and Goals,” from 7:45-8:45 a.m. After your classes, join your colleagues at “Beer Tasting in Paradise” benefiting the FDA Foundation (FDAF) at The Pub Orlando from 5-7 p.m. Sample beer from five of Florida’s finest craft breweries while supporting the FDAF mission of promoting oral health for all Floridians. Thanks to the event’s generous sponsors, FDA Services and The Doctors Company, the entire $20 ticket price goes directly to FDAF! The Friday night ADA FDC 2020 fun finale will be Dueling Pianos at Howl at the Moon Orlando from 8-11 p.m.

The party atmosphere you experience during Dueling Pianos at FDC will be cranked up a notch with the high-energy live music show centered around dance hits and party anthems that will get you dancing in no time. Tickets are $15 for FDA members and $20 for non-FDA members.

ADA FDC 2020 at the Orange County Convention Center is the place to be Oct. 15-18! Make plans to join us for continuing education and endless networking and fun for you and your team. See you there!

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Bank of America and the Bank of America logo are registered trademarks of Bank of America Corporation. Bank of America Practice Solutions is a division of Bank of America, N.A. ©2019 Bank of America Corporation. ARKJGMF3 | 07/2019 | AD-06-19-0424 1

Easyrefine

cannabis

Evidence-based Considerations for Patients Using Cannabis Cannabis is one of the most commonly used recreational drugs in the United States.

Because of hastily enacted policy changes, legalization and rapid growth in the cannabis industry, oral health professionals should become knowledgeable about patient management strategies and assessments of marijuana users and the potential effects of cannabis use on oral health, including dental care considerations for oral health professionals.

JAANA GOLD, DDS, MPH, PHD, CPH

Dr. Gold is adjunct clinical associate professor in the Department of Community Dentistry and Behavioral Science, University of Florida College of Dentistry. She also is an associate professor in the Department of Public Health, A.T. Still University, College of Graduate Health Studies, Kirksville, Mo. She can be reached at jgold@dental.ufl.edu.

Reprinted with permission from the Journal of the Michigan Dental Association, September 2019 issue.

References available upon request.

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Cannabis is one of the most commonly used recreational drugs in the United States.1,2 It is extracted from the plant Cannabis sativa and contains about 104 different compounds3 called cannabinoids, which are able to stimulate the body’s endocannabinoid system.4-7 In the United States, cannabis-derived products are consumed in many ways for medical and recreational purposes, such as smoking, vaporizing the product or inhaling, eating food products or drinking beverages.8 Smoking marijuana is the most common use of cannabis.7 Two of the most widely studied phytocannabinoids are Δ9-tetrahydrocannabinol (THC) and cannabidiol (CBD). THC is the most psychoactive component of cannabis and is associated with the euphoria. It affects most of the body, especially the cardiovascular, respiratory and immune systems.7 Conversely, CBD lacks the cannabis-like intoxicating properties of THC and is considered nonpsychoactive.8 Because it is non-psychotropic, it can be administered in high doses without psychological side effects. CBD may prove to

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be an option for managing anxiety, insomnia and chronic pain; however, without sufficient high-quality evidence in human studies we can’t pinpoint effective doses. For patients with childhood epilepsy, CBD also has been shown to reduce the number of seizures, and in some cases, it has been reported to stop them altogether.9 The U.S. Food and Drug Administration (USFDA) classifies cannabis as a Schedule I substance drug,10 but pharmaceutical-grade cannabinoids are scheduled separately from cannabis. This designation has limited public research on marijuana over the years. What has been published in the past concerning the impact of marijuana use may be less relevant because the potency of commercially available marijuana has greatly increased.

Cannabinoid medicines include dronabinol (Schedule II drug), nabilone (Schedule III drug), nabiximols, and phytocannabinoid-dense botanicals or medical cannabis.11 The US-FDA has approved three (synthetic) THC drugs, Marinol and Syndros (dronabinol) and Cesamet (nabilone), intended to suppress nausea and vomiting arising from chemotherapy.

According to a recent survey, the primary use of cannabis in the United States is recreational (89.5% of adult cannabis users), but 10.5% reported using it for medical purposes and 36.1% reported mixed use.11 Research also suggests marijuana use is widespread among adolescents and young adults.1 Because marijuana use can have permanent effects on the developing brain,13,14 this widespread use is a concern for those under the age of 25. Another concern is the development of a potential drug dependency.15

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With medical use of cannabis, pain management is the main reason it is prescribed to patients. In 2017, an expert panel reviewed the health effects of cannabis and concluded there was moderate evidence for the effects of cannabis use on impairment in the cognitive domains of learning, memory and attention.8 The panel also reported there was conclusive evidence that cannabis or cannabinoids were effective for the treatment of chronic pain in adults and as an antiemetic for chemotherapy-induced nausea and vomiting.8 Cannabis use can increase the risk of short-term adverse effects, such as confusion, dizziness, dry mouth, fatigue, hallucination and nausea.16 Acute adverse effects also may include anxiety and panic attacks.11,17 Smoked cannabis contains many of the same carcinogens as tobacco smoke, and an association with lung cancer has been suggested.11 In addition, THC may decrease host resistance to bacterial and viral infections.18,19 Thus, smoking cannabis may lead to chronic inflammation of the oral mucosa.5 Limited and conflicting data exists regarding the causal relationship of cannabis in the development of head and neck cancers.20 A meta-analysis and systematic review by de Carvalho et al.21 found no association between lifetime marijuana use and head and neck cancers. The current dental literature in this area is limited, but it suggests that marijuana users may experience oral conditions such as xerostomia, periodontal diseases, caries, oral human papillomavirus infections and oral cancer.22 Further, smoking and chewing cannabis may cause changes in the oral epithelium, including leukoedema and hyperkeratosis.22, 23 In a review by Veersteeg et al.,7 xerostomia increased caries and gingivitis in cannabis users and increased in the prevalence and density of Candida albicans. Drug addiction and the use of multiple substances (e.g., alcohol, tobacco, methadone or morphine) have shown to be associated with poor dental health.24 However, the current article focuses solely on the effects of cannabis and not on other illicit drugs that patients may be using in combination.

Currently, 33 states and the District of Columbia have legalized marijuana for medical use, and 10 states and the District of Columbia have legalized its recreational use.

However, the legalization map is changing fast.25 Because of hastily enacted policy changes, legalization and rapid growth in the cannabis industry, oral health professionals should become knowledgeable about patient management strategies and assessments of marijuana users and the potential effects of its use on oral health. The following is a short discussion of the current evidence on the effect of cannabis use on oral health and includes suggestions for oral health professionals.

Evidence on Cannabis and its Oral Health Effects Overall, the literature on cannabis and oral health effects is scarce, and most studies are lacking in quality. Several studies are limited by confounding factors, such as lifestyle issues or other substance or tobacco use. Few existing studies have focused on periodontal diseases.

“

If a patient arrives for dental treatment under the influence, the dental experience may trigger acute psychosocial symptoms, anxiety and paranoia, making patient management challenging.

�

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cannabis

Clinical Considerations When Caring for Cannabis Users n Provide a comprehensive oral examination and include questions about cannabis use in a thorough dental and medical history. n Provide minimally necessary care for patients under the influence of cannabis at the time of care. Patient management may be complicated by increased patient anxiety and paranoia while under the influence. n If you question whether a patient under the influence can provide informed consent for care, consider waiting two to three hours for acute intoxication to subside. n Take appropriate clinical precautions to address issues with patient bleeding and local anesthetic needs when caring for patients under the influence of cannabis. Avoid anesthetics with epinephrine, which may prolong tachycardia already induced by cannabis. Advise the patient that post-operative pain management medications also may be less effective. n Provide home care instruction with suitable adjuncts to address periodontal concerns and caries risk. n THC-containing products tend to increase appetite. Encourage healthy, nutritious snacks over sweet, cariogenic snacks. n Employ preventive measures, such as topical fluorides and other strategies, to reduce caries risk. n Address xerostomia by recommending appropriate products such as xylitol-containing gum and lozenges, while avoiding alcohol-containing products, and emphasize that patients drink water rather than sugary beverages, fruit juice or sports drinks. n Patients should be encouraged to have regular dental visits due to heightened risk and the need for periodic assessment.

FROM PAGE 53

A study by Thomson et al.26 concluded that cannabis smoking was a risk factor for periodontal disease, independent of tobacco use. Meier et al.27 studied the same population as that of Thomson et al.26 and concluded that cannabis users had poorer periodontal health. They also suggested that cannabis users brushed and flossed less and drank more alcohol, which

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confounded their results.27 A cross-sectional study by Shariff et al.28 suggested that frequent cannabis use was associated with deeper probing depths, more clinical attachment loss and higher odds of having severe periodontitis. Ortiz et al.29 also found that marijuana users were more likely to have severe periodontitis, while a systematic review and meta-analysis by Chisini et al.30 found the use of cannabis was associated with a higher prevalence of periodontitis, regardless of tobacco use.

However, a cross-sectional study by Lopez and Baelum31 is the only study that found no associations between marijuana use and increased risk of periodontal disease. Participants in that study were high school students aged between 12 and 21 years; thus, they were substantially younger than participants in other studies.31 Jamieson et al.32 also studied young adults and found an elevated risk of periodontal disease associated with tobacco use; however, petrol snifďŹ ng was a confounding factor of the study.

Various published reviews claim negative oral health effects of cannabis use; however, after critical review it can be noted that many reviews do not cite original studies, or the original studies do not provide quality data. Further, some reviews are based on case reports, which provide limited evidence. As such, oral health professionals should evaluate the literature carefully and give more credence to valid and critically appraised literature.

THC has parasympatholytic properties leading to a decreased saliva secretion; thus, smoking cannabis can produce clinical symptoms of xerostomia. A review by Whiting et al.16 stated that common adverse events of cannabis and cannabinoids use included dry mouth. A retrospective study found that four of 29 (14%) patients who smoked synthetic cannabinoids reported dry mouth.34 However, in this study the sample size is small. Sexton et al.35 reported the most common acute effect of cannabis use was dry mouth. Overall, studies on xerostomia also are limited or of poor quality. Overall, the body of evidence suggests that that patients using cannabis have dry mouth and may be at risk for caries and periodontal diseases.

Studies assessing the effect of cannabis use on caries are sparse.

Ditmeyer et al.36 found tobacco and marijuana use significantly affected the dental health status of Nevada adolescents.

However, oral hygiene habits may have confounded their results. In a cross-sectional study by Gupta et al.,37 drug users, including marijuana users, had poorer oral hygiene and periodontal health and higher caries treatment needs than nondrug users. The poor oral hygiene was probably related to poor FLORIDADENTAL.ORG

hygiene practices and low socioeconomic status. No quality studies on the effect of cannabis use on caries were found.

because the alcohol can exacerbate the dry-mouth condition experienced by cannabis users.

As stated previously, because of limitations in previous studies, the true risk factor of cannabis use is unknown. The common confounding factor of poor oral hygiene habits in consumers of cannabis and other drugs is difficult to overcome. Therefore, even if there is an increased risk of periodontal disease from cannabis use, clinicians should be aware that this risk may arise from multiple associated factors. Further, many studies investigating this outcome are cross-sectional, so causal relationships cannot be determined. Since cannabis use has been a socially stigmatized behavior, self-reported data of cannabis use may provide biased results. Another shortcoming of existing literature is that measurement of cannabis use varies between studies, which makes comparisons difficult and limits conclusions.

Because of the association of cannabis use and dry mouth, appropriate caries prevention, risk assessments and treatment protocols need to be completed by oral health professionals when treating patients who use cannabis. Since THC-containing products tend to increase appetite, clinicians also should consider providing proper nutritional counseling, such as healthy snacking tips for these patients. The American Dental Association (ADA) provides tips for healthy snacking at mouthhealthy. org/en/nutrition/food-tips.

Research also has suggested that the multi-systemic effects of cannabinoids and their pharmacological interactions with anesthetic agents may lead to serious consequences.38 However, there is limited evidence between marijuana smoking use and acute myocardial infarction,8 and definitive conclusions about the effects of marijuana smoking on cardiovascular events cannot be made.39 Thus, there is a vital need for research investigating the effects of marijuana use on the cardiovascular system and the effect of dental anesthesia on patients using cannabis.

Overall, there is low quality and sparse evidence on the effect of cannabis use on oral health, especially related to caries, periodontal disease and oral cancer. Additional research is necessary to provide solid evidence of the negative effects of cannabis use on oral health.

Clinical Management Behavioral management is an integral component in the successful treatment of dental patients; therefore, it is important that clinicians are aware of potential psychosocial and cardiovascular effects of cannabis. If a patient arrives for dental treatment under the influence, the dental experience may trigger acute psychosocial symptoms, anxiety and paranoia, making patient management challenging.5,33,40 Dental procedures requiring anesthetics also can be problematic because epinephrine may prolong tachycardia already induced by cannabis.5,40 Therefore, using local anesthetics containing epinephrine with patients under the influence of marijuana may have serious health consequences.33 Further, alcohol-containing mouth rinses should be avoided FLORIDADENTAL.ORG

Patients who smoke marijuana also are at risk for any smokingrelated ailments typically associated with tobacco smoking.

Therefore, clinicians should further consider providing referral of cannabis users to the appropriate counseling services or professionals for cessation counseling.

Providing dental treatment for a patient who is under the influence of cannabis may depend on whether he or she can provide informed consent for the treatment.41 Therefore, dental professionals need to be aware of legal implications regarding the validity of informed consent of patients under the influence. The implications of treatment consent are especially important with irreversible procedures.40 Denying treatment to the patient who is under the influence can be regarded as a safe practice. In addition to the potential negative effects of administering epinephrine to a patient who is under the influence, dentists can refuse to treat the intoxicated patient and should consider postponing nonemergency treatment for at least 24 hours.40 If the situation is an emergency and treatment cannot wait without causing further harm, dental treatment should be provided, but the best practice is to do the least amount possible.41 Fortunately, the effects of acute intoxication usually subside within two to three hours, so clinicians should keep this in mind when planning the dental treatment.

The American Dental Association (ADA) recommends that clinicians complete a comprehensive oral examination, including questions about cannabis use.40 The ADA also recommends regular dental visits, healthy and nutritious snacks, preventive care, treatment for xerostomia and avoidance of alcohol-containing products.40 Oral health professionals, including dentists in their expanded role as oral physicians, need to stay up to date regarding cannabis and its legal status, therapeutic potential, and effects on the body and oral health to provide the best patient care possible.

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bottle decay

Bottle Decay— In a Baby Gorilla

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DR. BARRY SETZER

Dr. Setzer is a pediatric dentist in Jacksonville and can be reached at barry.setzer@ me.com. Dr. Setzer would like to acknowledge his daughter, Dena Setzer, as his personal editor.

Photos: 1. Gandai under sedation by Dr. Persky.

2. Broken decayed teeth with exposed dental pulps.

3. Tooth sockets after extractions 4. Dr. Setzer with Irma Negron, his assistant and at the end of procedure.

In early October 2019, I received a call from Dr. Meredith Persky, a veterinarian at the Jacksonville Zoo and Gardens. She was concerned that the zoo’s 1-year-old female gorilla, Gandai, may have a dental problem because she had stopped feeding normally. After reviewing pictures of Gandai’s mouth, I determined that her two upper incisors were severely decayed and needed immediate treatment. The next day, my assistant, Irma Negron, and wife, Ellen (my photographer), paid her a visit at the zoo.

Upon my arrival, I learned the unfortunate history concerning Gandai’s mother, Kumbuka: She had two babies prior to Gandai, both of whom succumbed to death related to improper handling by Kumbuka. To prevent another death, Gandai was removed from her mother’s care soon after birth and — for the next year — had been bottle-fed a standard gorilla formula via a human “gorilla surrogate.”

1.

2.

Based on these details and the pictures I saw, I strongly suspected Gandai had developed nursing-bottle tooth decay. Since gorillas erupt their teeth much earlier than humans, her teeth had been exposed to the bottle from a very early age. Her decayed upper incisors looked exactly like those of a human baby, only bigger.

Dr. Persky sedated Gandai for treatment. Oral examination revealed that her upper primary central incisors were broken to the gum line, with the dental pulps exposed and protruding from the broken teeth. Although we didn’t note any other tooth decay, we had no choice but to extract her upper incisors. We knew this wouldn’t pose a problem, however, since Gandai’s permanent teeth would be erupting sooner than human teeth.

3.

I followed up with Dr. Persky a few days after surgery, and she informed me that our patient was doing great. Gandai was eating and behaving like normal — a true dental miracle!

4.

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dental laboratory

OUR PARTNERS: THE DENTAL LABORATORY It should go without saying that as dentists, we understand the crucial role that the dental laboratory plays in our daily success and our ability to properly care for our patients. Even if you are a periodontist, endodontist or oral surgeon, without a quality restoration, your work will likely experience complications or failure. I believe we all enjoy the satisfaction that occurs when the dental laboratory provides us with exactly what we wanted. The appointment is efficient. Patient satisfaction is high, and the procedure is profitable. And when the lab provides a poor product, we get wasted time, frustration, patient dissatisfaction and lost revenue. Again, whether we realize it or not, the dental laboratory can be a key factor in the financial profitability of our businesses.

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The dental laboratory industry in the United States is undergoing tremendous change. At one time, there were more than 14,000 dental laboratories in the United States. Today, there are close to 6,000. Larger laboratories with high volume are taking over, and most states have little to no regulation on the operations or training within a lab. Managers in these facilities often aren’t dental technicians, just supervisors assessing production. Again, continuing education or certification requirements, such as the certified dental technician (CDT), are non-existent in most states.

About 40% of finished dental lab restorations in the United States are made in a foreign dental laboratory. They are subject to Food and Drug Administration regulation, however, less than 1% of devices are inspected before they come into the U.S. Please understand that if you think that state or federal rules and regulations are in some way ensuring the quality of a dental restoration or the materials it’s made from, you’re likely mistaken. It’s up to us.

DR. C. SCOTT SCHMITT

Dr. Schmitt has a private practice limited to prosthodontics in Altamonte Springs.

We must ask ourselves, “Are we happy with this state of affairs?” Is it professionally rewarding and financially profitable to practice dentistry with substandard laboratory support and/or materials of unknown content? Is this how we should treat our patients, or how we would like to be treated ourselves? I sincerely hope the answer is “No.” If so, there are things we can do as a profession to help maintain or improve the integrity of our laboratory relationships and support.

I encourage you to make the decision to improve the current relationship you have with your laboratories. Provide them with good impressions and other diagnostic materials, communicate specifically about the outcomes you expect and treat them as a colleague who can make your day go well. Further, support legislation that increases the minimum training requirements needed to operate a dental laboratory and/or employ a minimum of one CDT. Florida is ahead of the curve, already requiring full disclosure of where a dental appliance or restoration was made and the materials it was made from. However, transparency and disclosure are hot topics in our society today, and discerning patients would appreciate understanding this information for something that may become a permanent part of their body. This last point has been suggested by the National Association of Dental Laboratories, as part of their “What’s in Your Mouth?” Campaign. Learn more at dentallabs.org.

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compleat dentistry

THE FINALE This issue of Today’s FDA (TFDA) makes it five years since I started writing this column — and it will be my last one. This column has brought me great pleasure over the past five years, and I’ve enjoyed all the feedback and support you’ve provided. Thank you for reading. I hope my column has made you think, and I hope you continue to go out there and try to be the best dentist you can be. Our profession was built on men and women who simply did their best, day after day, and I am proud to be a dentist.

DR. EDWARD HOPWOOD

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

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.

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When I first considered becoming a dentist, I was dissuaded by the adults I knew because they felt that the insurance industry was too big of a threat to the profession. Then 10 years later, when I needed to decide if I was going to apply to dental school or medical school, the biggest threat to the profession was socialized medicine. Currently, the biggest threat to the profession is conglomeratization, by which I mean large corporations gobbling up small practices. This is ironic, because it’s a capitalist threat that’s similar to the earlier socialist threat.

But recently, I have been thinking: What do we mean by a “threat to the profession”? Certainly, we don’t mean that the profession will cease to exist. People will always have teeth and they’ll always want to maintain them. Surely, our profession isn’t imminently going to be taken over by computers; we aren’t destined to be replaced like scriveners. While it’s not an existential threat, it’s certainly a threat that we all feel. And when we feel threatened, we tend to fear that our existence is threatened. But when we think about it, the only threat is to the way we’ve always done things.

Somehow, the dental profession has persisted despite threats from insurance, socialization and conglomeratization. And somehow, I believe that the profession will continue to persist. Becoming a professional involves a higher calling — one that involves putting our patients above profits. A calling that involves pushing ourselves to be the best we can be, not because it will make us more money, but because our patients deserve for us to be our best. And when corporations try to wring profits out of us and interfere with our professional duty, then we’ll have no choice but to resist.

We must resist their interference, lest we find ourselves in the same boat as so many of our physician brethren.

You see, there is a reason why we all went into dentistry and we need to remember why we chose our profession. And the why was not for money, nor was it for lifestyle. Rather, it was because we were called to our profession and we rose to the calling. The dental schools are admitting the best and brightest students and they’re turning them into professionals who heard the calling and are interested in becoming their best. Those who join the corporate world last an average of less than three years before they have to break out because they come to learn that there is more to this great profession than closing margins and production.

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“

I believe that mastery is simply something we aspire to rather than a finish line we cross.

So, they seek out advanced training, but so many of the great teachers have themselves been bought out and now serve a corporate master. Kudos to Pankey for being one of the last ones standing on its own — they have led us through so many “threats” over the years. But it’s imperative for those of us with experience to help these bright, young minds get started in the profession and show them that there is a way to own a practice, pay off loans and set off on a path to mastery — all the while providing their patients with great care.

When we speak of mastery, we’re often criticized as though it is some impossible ideal to live up to. But the more I strive for it, the more I realize that mastery is not some ideal that is “out there.” Rather, it’s an internal ideal that we each can strive for and may be quite variable among individuals. Only the most insecure of us criticize the others; far better for us to respect each other’s journey and encourage each other along the way.

I believe that mastery is simply something we aspire to rather than a finish line we cross.

I hope my column has served to encourage you, my colleagues.

I hope that you’ll continue to push yourself further down your own path towards mastery. I know that our patients and profession will be better for it. And, while the pursuit of mastery is a noble goal, perhaps there is a higher goal, and that is balance. Because it’s no good to seek professional mastery and ignore personal mastery. A professional who has sought

FLORIDADENTAL.ORG

”

excellence and pushed themselves but ignored their family and personal relationships is just as incomplete as a drone who punches a corporate timeclock. So, good luck on your journey.

I hope I’ve helped you along your way.

Please allow me to thank the following: n Our Lord, by whose grace we are allowed to glimpse perfection. n The dentists who came before me, who have made the profession so respected. n My colleagues who are working so hard to preserve that respect. n My editor, Dr. John Paul, for knowing what I meant to say and keeping me from saying what I didn’t. n The crew at TFDA, especially Jill Runyan and Jessica Lauria, for turning a non-descript Word document into something that looks like it would be great to read. n My family, for inspiring me and encouraging me. n My wife, Carly, for being a perfect partner on our journey.

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DRS. SAJA ALRAMADHAN*, NEEL BHATTACHARYYA, DONALD M. COHEN AND NADIM M. ISLAM

A 70-year-old healthy Caucasian male presented to Dr. George Weeks, a general dentist practicing in Macclenny, with a chief complaint of severe pain in the lower left jaw that started six days earlier. The pain significantly impaired the patient’s ability to function and carry out normal day-to-day activities. He reported intense pain even upon biting into soft bread. Upon examination, pain and sensitivity to percussion was noted in teeth Nos. 20-24. However, upon careful examination, no obvious pathology, such as decay or bone loss, was evident. Importantly, multiple skin lesions were noted on the left side of the face and on the chin area with occasional scab formation (Figs. 1a-c). He reported intermittent pain in his ears as well as swelling on the left side that could be “nodes” according to the patient. Small shallow, ulcerative lesions also were seen on the left side of his tongue (Fig. 2a-b). His physician prescribed azithromycin, which did not alleviate his symptoms. The patient was a smoker who reports smoking small cigars for many years. He was on diclofenac, dorzolamide and Losartan medications for management of pain, glaucoma and high blood pressure, respectively.

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

A. Pemphigus vulgaris B. Erysipelas C. Erythema multiforme D. Trigeminal neuralgia E. Herpes zoster (shingles)

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Fig. 1a: Skin lesions

Fig. 2a: Tongue lesions

Fig. 1b

Fig. 2b

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diagnostics FROM PAGE 69

Diagnostic Discussion A. Pemphigus Vulgaris Incorrect. Pemphigus vulgaris (PV) is an uncommon immunobullous disease and is one among the four-pemphigus variants that can affect oral mucosa in addition to pemphigus vegetans, which is considered an extremely rare condition. PV is an important condition because, if untreated, it often results in the patient’s death (60-90%), mainly as a result of infections and electrolyte imbalances.

PV typically affects adults, with an average age of 50 years, with no sex predilection. Rare cases have been reported in childhood. PV is mostly seen in persons of Mediterranean, South Asian or Jewish heritage. Patients usually present with recalcitrant oral mucosal lesions. Clinical examination shows superficial, ragged erosions and ulcerations distributed along the oral mucosa, unlike the present case where the ulcerations were distributed unilaterally. More than 50% of the patients have oral mucosal lesions that precede the onset of cutaneous lesions, sometimes by more than one year. Unlike cicatricial pemphigoid, the ocular lesions of pemphigus typically do not cause scarring and symblepharon (conjunctival adhesions) formation. A positive Nikolsky sign is a characteristic feature of PV, in which a bulla can be induced when a firm, lateral pressure is exerted.

A biopsy of perilesional mucosa shows an intraepithelial separation, which occurs just above the basal cell layer of the epithelium, sometimes leaving only the basal layer arranged to resemble a “row of tombstones.” The cells of the spinous layer of the surface epithelium typically exhibit “acantholysis” with “ballooning degeneration” almost pleomorphic-looking cells termed “Tzanck cells.” Direct immunofluorescence is required for confirmation of the diagnosis.

B. Erysipelas Incorrect. Erysipelas, also known as St. Anthony’s fire, is a superficial skin infection, caused almost exclusively by beta-hemolytic streptococcus. The infection rapidly spreads through the lymphatic channels, which become filled with fibrin, leukocytes and streptococci. Classic facial erysipelas

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is rare and often confused with facial cellulitis from dental infections. Erysipelas tends to occur primarily in young or elderly patients who are immunocompromised or alcoholic.

Furthermore, patients who have areas of chronic lymphedema or large surgical scars also are at risk to develop the disease.

The infection commonly affects the skin on the lower legs, particularly in areas affected by tinea pedis (athlete’s foot). It also may affect the face, arm and upper thigh. The prevalence of the facial erysipelas increased during winter and spring seasons, whereas summer is the peak period of involvement of the lower extremities.

Face lesions usually appear on the cheeks, eyelids and bridge of the nose, and results in a butterfly-shaped lesion that may resemble lupus erythematosus, unlike the present case in which lesions are distributed unilaterally. Eyelid involvement may result in edema and swelling that mimic angioedema.

The affected area is painful, bright red, well-circumscribed, swollen, indurated and warm to the touch. Usually the affected skin will demonstrate a surface texture that resembles an orange peel, a feature not seen in the present case. Influenza-like symptoms and lymphadenopathy often are present. Diagnostic confirmation is difficult because cultures usually aren’t beneficial. Standard dosages of oral or intravenous penicillin are the treatment of choice. A rapid regression is noted within 48 hours. Neglected cases may lead to serious complications, such as abscess formation, gangrene, necrotizing fasciitis and toxic shock syndrome with possible multiple organ failure. Prophylaxis with oral penicillin for cases with multiple recurrences is recommended.

C. Erythema multiforme (EM) Incorrect. Erythema multiforme (EM) is a blistering and ulcerative mucocutaneous condition of uncertain etiopathogenesis. It may represent an immunologically mediated process, which is triggered in about 50% of the cases via medications or preceding herpes simplex infection, especially in young adults.

EM presents with a wide spectrum of clinical manifestations ranging from ulcerations to diffuse sloughing and erosions. It’s more common in young adults in their 20s or 30s with men being affected more frequently than women. EM is usually self-limiting, lasting two to six weeks. Erythematous skin lesions may develop in about 50% of cases with flat, round and dusky-red concentric circular erythematous rings resembling a “target or bull’s-eye.” Oral lesions begin as erythematous patches that ulcerate and evolve into large, shallow erosions and ulcerations with irregular borders. Hemorrhagic crusting of the vermilion zone of lips is common.

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The histologic features and direct immunofluorescence antibody studies of EM are non-specific, and the diagnosis often is based on the clinical presentation and the exclusion of other vesiculobullous disorders. Management with topical or systemic corticosteroids, especially in the early stages of the disease along with anti-viral therapy such as valacyclovir, results in rapid and striking resolution of lesions.

D. Trigeminal neuralgia (TN) Incorrect, but excellent guess! Unlike this case, trigeminal neuralgia (TN) doesn’t present with blisters and ulcerations.

TN is a unilateral disorder characterized by brief but recurrent electric shock-like pain with a sudden onset and termination.

TN is limited to the distribution of one or more divisions of the trigeminal nerve. TN is most common in patients over 50 years of age with female predilection. It’s the most common recognizable facial pain and has been shown to affect the patient’s quality of life in an extreme manner. TN may be idiopathic, but multiple etiological factors have been associated with it, including nerve dysfunction due to vascular compression, tumorigenesis, degenerative processes of aging, head injury or inflammation of nerve within its myelin sheath.

Common involvement of the lower two branches of the trigeminal nerve mostly results in a toothache-like pain with continuous aching or burning sensation.​This invariably results in many patients being subjected to unnecessary irreversible dental treatment. The diagnosis of TN is mainly based on clinical signs and symptoms. Pharmacotherapy such as carbamazepine and oxcarbazepine are the first line of treatment for TN. Surgical intervention for vascular decompression should be considered when the medications are ineffective or intolerable.

E. Herpes zoster (shingles) Correct! Herpes zoster (HZ), or shingles, is due to reactivation of Varicella-zoster virus (VZV) that spreads along the distribution of the affected sensory nerve. Primary infection with VZV causes chickenpox, after which the virus becomes latent in the dorsal root ganglia.

HZ occurs during the lifetime of approximately one in three individuals and the incidence increases after 50 years of age.

Additional risk factors for HZ include immunosuppression, HIV infection, treatment with cytotoxic or immunosuppressive drugs, UV radiation, malignancy, alcohol abuse, stress and dental treatments.

The clinical features of HZ can be grouped into three phases: prodrome, acute phase and the chronic phase. The prodrome phase or the stage of initial viral replication, an inflammatory reaction (ganglionitis) develops, which is responsible for the prodromal pain and manifests as burning, tingling, itching, dull, prickly or knife-like pain, and may be accompanied by fever, malaise and headache. The acute phase begins one to four days after the prodrome, in which the affected areas develop clusters of 1-4 mm vesicles with an erythematous base. The lesions tend to follow the path of the affected nerve and terminate at the midline. Within three to four days, the vesicles become pustular and rupture to form shallow ulcerations. These lesions are contagious until they crust after seven to 10 days.

Healing with scarring, hypopigmentation or hyperpigmentation is not uncommon. Pulpitis, pulpal necrosis, pulpal calcification or root resorption may be seen in teeth of the affected areas. In addition, significant osteonecrosis with tooth loss has been reported. Ocular involvement is present in approximately 10-25% of cases and can cause permanent blindness. Lesions on the tip of the nose, known as Hutchinson’s sign, indicate involvement of the nasociliary branch of the trigeminal nerve and consequently increases the risk for severe ocular infection.

Reactivation of VZV in the geniculate ganglion, will result in Ramsay Hunt syndrome. This is characterized by cutaneous lesions of the external auditory canal and involvement of the ipsilateral facial and auditory nerves. Patients may present with facial paralysis, hearing deficits and vertigo. Furthermore, some patients may develop a “loss of taste” in the anterior twothirds of the tongue.

The chronic phase (postherpetic neuralgia), develops in about 15% of patients and is characterized by persistent pain after resolution of the rash. The pain has been described as burning, throbbing, aching, itching or stabbing, often exaggerated by light stroking or contact with clothing. Most of these neurological symptoms resolve within one year, with 50% of patients experiencing resolution after two months. Rare cases may last up to 20 years, and patients have been known to take their own lives because of the extreme pain.

In immunocompromised patients, the symptoms often are severe. However, immunocompromised status does not appear to increase the risk for postherpetic neuralgia.

Histopathologically, the active vesicles of HZ exhibit Tzanck cells. These cells are not specific for HZ; they’re also seen

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diagnostics FROM PAGE 71

in herpes simplex infection (HSV) and pemphigus as mentioned earlier. Diagnosis of HZ is mostly based on the clinical presentation. Additional laboratory testing may be necessary for atypical cases or to exclude zosteriform recurrent HSV infection.

Antiviral medications, such as acyclovir, valacyclovir and famciclovir, have been found to be effective for mucocutaneous lesions and alleviate pain during the acute phase. These medications are most effective if initiated within 72 hours after development of the first vesicle. Combination therapy with antipruritic, analgesics, tricyclic antidepressants, antiepileptics or systemic corticosteroids may provide additional pain control.

Skin lesions should be kept dry, clean and, if possible, covered to prevent secondary infection; antibiotics may be administered to treat such secondary infections. Referral to an ophthalmologist for cases with ocular involvement is necessary.

Considering the serious complications of this disease including the postherpetic neuralgia, which is difficult to treat, the emphasis should be placed on HZ prevention. A HZ vaccine, Shingrix, was approved by the Food and Drug Administration in October 2017. It’s the preferred vaccine over Zostavax for healthy adults 50 years and older. In clinical trials, a two-dose of Shingrix vaccine has been proven to be effective up to 90% in preventing HZ and postherpetic neuralgia, with tremendous decreased morbidity among those who do develop the disease.

References: Arduino, Paolo G., et al. “Long‐term evaluation of pemphigus vulgaris: A retrospective consideration of 98 patients treated in an oral medicine unit in north‐west Italy.” Journal of Oral Pathology & Medicine, vol. 48, no. 5, 2019, pp. 406-412.

Bindra, Ashish. “Etiopathogenesis of Trigeminal Neuralgia.” Handbook of Trigeminal Neuralgia, 2019, pp. 23-29.

Feller, L et al. “Postherpetic Neuralgia and Trigeminal Neuralgia.” Pain research and treatment vol. 2017 (2017): 1681765. doi:10.1155/2017/1681765 Gilden, D et al. “Review: The neurobiology of varicella zoster virus infection.” Neuropathology and applied neurobiology vol. 37,5 (2011): 441-63. doi:10.1111/j.1365-2990.2011.01167.x Lerch, Marianne, et al. “Current Perspectives on Erythema Multiforme.”

Clinical Reviews in Allergy & Immunology, vol. 54, no. 1, 2018, pp. 177-184.

Santos, M.M et al. “Trigeminal neuralgia: Literature review” (2013). Journal of Morphological Sciences. 30. 1-5.

Stulberg DL, Penrod MA, Blatny RA. Common bacterial skin infections. Am Fam Physician. 2002;66:119-24.

Surya, Varun et al. “Childhood Pemphigus Vulgaris: Report of Two Cases with Emphasis on Diagnostic Approach.” Contemporary clinical dentistry vol. 9,Suppl 2 (2018): S373-S376. doi:10.4103/ccd.ccd_461_18 Xu, Hong-Hui et al. “Mucous membrane pemphigoid.” Dental clinics of North America vol. 57,4 (2013): 611-30. doi:10.1016/j.cden.2013.07.003 Yavuz, İbrahim H., et al. “Erythema Multiforme; Sixty Six Case Series with Review of Literature.” Eastern Journal of Medicine, vol. 23, no. 4, 2018, pp.

308-312.

Diagnostic Discussion is contributed

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

The dental professors operate a large, DR. BHATTACHARYYA multi-state biopsy service. The column’s

case studies originate from the more than 12,000 specimens the service receives every year from all over the United States.

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

DR. COHEN

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

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

The Florida Dental Association is an ADA CERP Recognized Provider. ADA CERP is a service of the American Dental DR. ISLAM Association to assist dental professionals in identifying quality providers of continuing dental education.

ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry. Concerns or complaints about a CE provider may be directed to the provider or to ADA CERP at ada.org/ goto/cerp. *Resident in oral and maxillofacial pathology at the University of Florida College of Dentistry.

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

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Card Connect

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

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

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

Associate Dentist – Lake Mary. Overview: Let us allow you to do what you do best by doing the dentistry that you diagnose while exploring future partnership opportunities. We follow through on our promise to clinicians with our culture of patient centric care, our abilit y to deliver comprehensive integrated care, and our ability to support modern dentistry. PDS supported owner dentists know that being backed by the country’s leading dental support organization allows them to focus on providing patient centric and clinically excellent care. Benefits: Competitive Compensation and Benefit Package; Modern offices equipped with the latest dental technology; Malpractice Insurance; Healthcare Benefits (Medical, Prescription Drugs, Dental and Vision); 401(k) Savings Plan. The average full-time PDS-supported Dentist earns $160,000 - $390,000. Testimonial from Dr. Callaway-Nelson: “Partnering with PDS has given me the opportunity to realize my dream of practice ownership. I am able to do the dentistry that I love.” Pacific Dental Services is an equal opportunity employer and does not discriminate against any employee or applicant for employment based on race, color, religion, national origin, age, gender, sex, ancestry, citizenship status, mental or physical disability, genetic information, sexual orientation, veteran status, or military status. Apply here: bit.ly/2TA3RXt. 2020 Graduating Dentist – Ocala. Overview: You’ve invested the time to become a great dentist, now let us help you take your career further with clinical mentorship in one of the best practice models in modern dentistry. Being a PDS supported clinician means you will be dedicated to patient centric care and the pursuit of clinical excellence creating patients for life. You will have access to modern dental technology, a trained support staff, and an office that genuinely cares about the patients within the local community. Benefits: Competitive Compensation and Benefit Package; Mentorship to increase clinical speed; Malpractice Insurance; Healthcare Benefits (Medical, Prescription Drugs, Dental and Vision); 401(k) Savings Plan. The average full-time PDSsupported Dentist earns $160,000 - $390,000. Pacific Dental Services is an equal opportunity employer and

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does not discriminate against any employee or applicant for employment based on race, color, religion, national origin, age, gender, sex, ancestry, citizenship status, mental or physical disability, genetic information, sexual orientation, veteran status, or military status. Apply here: bit.ly/3aGIw4C. Periodontist. Periodontist wanted to join a multispecialty practice in Broward County. Equity position available. Please contact us at 954-474-9660.

Pediatric Dentist. Healthcare Network (HCN) is seeking a Board Certified Pediatric Dentist to join our team. HCN is a Federally Qualified Health Center located in Collier County on the beautiful Gulf Coast of Florida. HCN has been providing primary care to underserved patients for over 40 years. We provide comprehensive, integrated primary care to more than 50,000 patients at 21 clinic sites throughout the county with more than 75 practitioners. Services include pediatrics, family and internal medicine, an HIV/AIDS treatment program, geriatrics, women’s care, dental, and integrated behavioral health. We are accredited by the Association for Accreditation of Ambulatory Care (AAAHC) and are certified by AAAHC as a medical and dental home. This is an exciting opportunity to teach and mentor students and residents as part of our Pediatric Dental program. Healthcare Network offers our care team members a competitive wage, comprehensive benefit package and the opportunity to serve in a mission-minded organization.

For more information on our community organization, visit our website at www.healthcareswfl.org. Job Summary: This position will provide comprehensive Pediatric Dental care to patients in a primary health care delivery system. The Pediatric Dentist assumes the responsibility of providing the best care possible for all of patients. Provide preventive and restorative treatments for problems affecting the mouth and teeth. High moral character, ethics, and conduct are mandatory. This position has a teaching opportunity as an important component of our Pediatric Dental Program. Responsibilities and Standards: Perform oral examinations of hard and soft tissue while working with patients to maintain and restore quality health to everything within the mouth; Examine teeth and di-

agnose patients’ dental conditions by using tools such as x-rays, dental instruments, and other diagnostic procedures; Clean, restore, extract, and replace teeth, using rotary and hand instruments, dental appliances, medications, and/or surgical equipment; Evaluate the current health and condition of the patient’s teeth to determine diagnosis of dental condition, if any; Completes treatment planned procedures that are agreed upon by patient and parent/guardian, such as restoring teeth affected by decay and treating gum disease; Perform pediatric dentistry services, including the diagnosis and treatment of diseases, injuries, and malformations of teeth, gums, and related oral structures; Consults with the patient, parent and/ or guardian and advises them of their dental status, prescribes the treatment needed, provides risks, benefits and alternatives; Perform oral cancer examinations, take and interpret radiographs; Provide dental services at any and/or all HCN dental facilities as necessary to meet department needs; Supervise and evaluate dental students and residents during their rotations at HCN’s dental facilities; Performs other related duties as indicated or when requested by a supervisor. Job Specifications: This position requires a high degree of responsibility, excellent interpersonal skills, organizational ability, problem-solving skills, and written communication skills. Position requires the ability to work independently and within a team to meet goals. Position requires the ability to interact with all departments and all levels of staff effectively. May be required to perform the duties of other employees, including supervisors/managers, in their absence. May be required to perform duties and responsibilities not listed in this description, on a temporary or long-term basis. NOTES: 3 openings.

Go to careers.floridadental.org/jobs/13416840.

Treatment Coordinator – Orlando. Description: Now is the time to join Doctor Phillips Modern Dentistry.

You will have opportunities to learn new skills from our team of experienced professionals. If you’re ready to take your career to the next level and gain valuable experience, apply today! Overview: Do you love working with patients to make sure they can get the treatment they need within their financial means? Are you great at helping patients understand their options

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and why the treatment is important to their health and well-being? Are you looking for a challenge and the chance to be part of a true team environment where you can constantly learn and grow? If so, now is the time to join us as a benefits coordinator. Responsibilities: Gain a financial commitment from the patient; Understanding of general dental operations and patient flow issues; Utilize tools, skills, and talents to assist patients in making the best possible decision for their unique wants and needs; remembering that the most important choice the patient will make is getting started with treatment; Coordinate fees and insurance benefits for patients visiting general practitioners; Utilize available financial options to give patients choices for how they can pay; Professionally overcome the common patient objections/rejections; Maintain accurate patient financial paperwork and adherence to the office manager’s financial arrangement parameters; Properly use patient account software and maintain accuracy in records related to patient financials; Obtain necessary insurance approvals in a timely manner; Partner with the Specialty BC, when appropriate, to complete patient care; Help in exceeding patient expectations in order to achieve the Perfect Patient Experience®. Qualifications: High school diploma or general education degree (GED) and one or more years of previous experience as a treatment coordinator in a dental practice is preferred; Ability to understand insurance plans is preferred; Knowledge of Microsoft and QSI software applications is preferred. Benefits: Medical, dental and vision insurance; Paid time off; Tuition Reimbursement; Childcare assistance; 401K; Paid time to volunteer in your local community. Pacific Dental Services is an equal opportunity employer and does not discriminate against any employee or applicant for employment based on race, color, religion, national origin, age, gender, sex, ancestry, citizenship status, mental or physical disability, genetic information, sexual orientation, veteran status, or military status.

Apply here: bit.ly/3cHphtm.

Clinical Assistant/Associate Professor. The University of Florida-College of Dentistry is seeking applications for a clinical track faculty position in the Department of Oral and Maxillofacial Surgery (OMFS) at the Assistant/Associate Professor rank.

The University of Florida College of Dentistry (UFCD) is one of the leading dental schools in the United States devoted to improving and promoting oral health throughout Florida, the nation and worldwide through excellence in teaching, research, patient care and service. The faculty member will be responsible for teaching within the Student Oral Surgery Clinic at the pre-doctoral (DMD) level, will have the opportunity for participation in intramural faculty practice, excellence in academic pursuits and service, and some limited participation in the development of departmental research and/or other scholarly activities. Salary and rank commensurate with credentials and experience. The University of Florida, a member of the AAU, is the largest and most comprehensive public university in the state of Florida, with large undergraduate, graduate, and postgraduate educational programs. The UF Health Science Center and its six colleges (Dentistry, Medicine, Nursing, Pharmacy,

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Public Health and Health Professions, Veterinary Medicine) are co-located on the Gainesville campus, with additional teaching, research, and patient care sites across Florida, and internationally. The University of Florida is an Equal Opportunity Employer dedicated to building a broadly diverse and inclusive faculty and staff. The University of Florida invites all qualified applicants to apply. The University of Florida is a public institution and subject to all requirements under Florida Sunshine and Public Records laws. The review of applications will begin immediately and will continue until the position is filled. To apply, please go to https://jobs.ufl.edu and search for requisition number 58224. Applicants should attach a curriculum vitae, a cover letter describing their interest in the position, and a list of three references for consideration. For more information about the University of Florida College of Dentistry, visit: www.dental.ufl.edu.

The position requires a DDS, DMD or equivalent degree. Candidates must have minimum of three years of general dentistry experience with an emphasis on medical management and surgical extractions.

Private practice and/or hospital experience preferred.

Florida Dental License preferred.

I’m available for Part time General Dentist/ Locum Tenens. I’m available for Part time/Locum Tenens, South West Florida but will travel for right employment. Newly retired but looking to stay in the game.

Resume upon request. Please contact to discuss. Go to careers.floridadental.org/jobs/13407312.

Associate Dentist – Orlando. Description. Now is the time to join a fast growing organization. You will have opportunities to learn new skills from our team of experienced professionals. If you’re ready to take your career to the next level and gain valuable experience, apply today! Overview: Let us allow you to do what you do best by doing the dentistry that you diagnose while exploring future partnership opportunities. We follow through on our promise to clinicians with our culture of patient centric care, our ability to deliver comprehensive integrated care, and our ability to support modern dentistry. PDS supported owner dentists know that being backed by the country’s leading dental support organization allows them to focus on providing patient centric and clinically excellent care. Benefits: Competitive Compensation and Benefit Package; Modern offices equipped with the latest dental technology; Malpractice Insurance; Healthcare Benefits (Medical, Prescription Drugs, Dental and Vision); 401(k) Savings Plan. The average full-time PDS-supported Dentist earns $160,000 $390,000. Testimonial from Dr. Callaway-Nelson: “Partnering with PDS has given me the opportunity to realize my dream of practice ownership. I am able to do the dentistry that I love.” Pacific Dental Services is an equal opportunity employer and does not discriminate against any employee or applicant for employment based on race, color, religion, national origin, age, gender, sex, ancestry, citizenship status, mental or physical disability, genetic information, sexual orientation, veteran status, or military status.

Apply here: bit.ly/39EBWvo.

General Dentist – Port Orange. Now is the time to join the Port Orange Modern Dentistry. You will have opportunities to learn new skills from our team of experienced professionals. If you’re ready to take your career to the next level and gain valuable experience, apply today! Overview: Let us allow you to do what you do best by doing the dentistry that you diagnose while exploring future partnership opportunities. We follow through on our promise to clinicians with our culture of patient centric care, our ability to deliver comprehensive integrated care, and our ability to support modern dentistry. PDS supported owner dentists know that being backed by the country’s leading dental support organization allows them to focus on providing patient centric and clinically excellent care. Benefits: Competitive Compensation and Benefit Package; Modern offices equipped with the latest dental technology; Malpractice Insurance; Healthcare Benefits (Medical, Prescription Drugs, Dental and Vision); 401(k) Savings Plan. The average full-time PDS-supported Dentist earns $160,000 - $390,000. Apply today. Apply now or contact a recruiter anytime. We’d love to chat, get to know you and share more about us. Testimonial from Dr. Callaway-Nelson: “Partnering with PDS has given me the opportunity to realize my dream of practice ownership. I am able to do the dentistry that I love.” Pacific Dental Services is an equal opportunity employer and does not discriminate against any employee or applicant for employment based on race, color, religion, national origin, age, gender, sex, ancestry, citizenship status, mental or physical disability, genetic information, sexual orientation, veteran status, or military status. Apply here: bit.ly/3342Qdk. Part-time Dentist – Lake Mary. Come join a thriving private, general dental practice looking for a parttime dentist in Lake Mary, FL. We have an amazing staff where you can practice quality dentistry and treat your patients like friends and family. We practice holistic/biological dentistry (we even place ceramic implants), treat sleep apnea, and all general dental needs from children to adults. We take out of network insurance. A competitive compensation package is offered. Please call 407-221-8655 for more information.

Associate Dentist – Jupiter. Dental Care Alliance is a Dental Support Organization that was established in 1991 to provide comprehensive dental care to patients in 19 States. All DCA offices pride themselves on satisfying patient needs, providing high quality general and specialty dental services, and offering patient comfort that is second to none. DCA believes in providing a positive professional experience so that your goals can be achieved. We are one of the nation’s largest and most successful dental practice management companies because we understand that when you succeed, we succeed. Outstanding Associate Opportunity for an experienced General Dentist to join one of our highly successful affiliated practices in Jupiter, FL. Strong commitment to long-term dental care for the whole family. Be chair side and make money from day one; Highly trained

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career center FROM PAGE 75 and dedicated staff to support you; No Day-to-Day headaches of Managing a Practice; Excellent compensation pkg. with performance based incentives; Well-established and growing patient base. Full Time Dentist Benefits Package: Company paid professional liability insurance; DCA sponsored continuing education; Medical Insurance; Dental Plan; Life Insurance; Vision Insurance; Long Term Disability; Section 125 - Flexible Spending Account; 401K; EAP Program; DCA Voluntary Supplemental Insurance Products.

1 - 2 years dental experience; Licensed to practice dentistry in the State of Florida. Go to careers.floridadental.org/jobs/13392734.

Endodontist – Tampa. Description. Now is the time to join a fast growing organization. You will have opportunities to learn new skills from our team of experienced professionals. If you’re ready to take your career to the next level and gain valuable experience, apply today! Overview: You’ve invested the time to become a great endodontist, now let us help you take your career further with more opportunity, excellent leadership and one of the best practice models in modern dentistry. As an endodontist working in an office supported by Pacific Dental Services®, you can rely on a great number of referrals as you will be providing PDS®-supported owner dentists the ability to provide excellent and comprehensive care under one roof. You will have the autonomy to provide your patients the care they deserve and provide you with the opportunity to earn excellent income and have a balanced lifestyle without the worries of running a practice. The Opportunity: You became a dentist to provide excellent patient care and an endodontist to have a career that will serve you for a lifetime. As a PDS-supported endodontist, you have the opportunity to work full-time or part-time, fantastic income opportunities and you’ll work with an organization that cares about their people, their patients and their community. You won’t have to spend your time navigating practice administration, scheduling, or any other administrative tasks. Instead you’ll, set your hours and focus on your patients and your well-being. The Future: As an endodontist you will receive ongoing training to keep you informed and utilizing the latest technologies and dentistry practices. PDS is one of the fastest growing companies in the US which means we will need excellent specialists like you to continue our clinical excellence in the future. Pacific Dental Services is an equal opportunity employer and does not discriminate against any employee or applicant for employment based on race, color, religion, national origin, age, gender, sex, ancestry, citizenship status, mental or physical disability, genetic information, sexual orientation, veteran status, or military status. Apply here: bit.ly/38BKz8H. Dentist – North Florida. Description: This position is for dentists in the North Florida (Jacksonville, Gaines-

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ville, and Tallahassee) areas to provide treatment to residents in jails and prisons. We provide portable military equipment, an assistant, and all supplies. We are looking for someone 2-6 days per month. This position is perfect for a dentist that is just getting started that has some extra availability. It is also great for a retired dentist. It is a different day every day breaking up the regular routine of a traditional private practice.

These patients need our help, and are appreciative of the work we do. Daily Responsibilities: Meet dental assistant at the facility; Some travel may be required depending on location; Treat residents according to schedule provided; Assistant will set up and break down equipment in clinic area; Assistant will take instruments back to office for sterilization; Write progress notes on each patient seen; Services provided include exams, digital x-rays, fillings, and extractions.

Qualifications: Active Florida dental license, Current medical malpractice insurance policy. Benefits: Flexible schedule; Visits are scheduled according to your availability; No overhead costs associated with traditional dental offices. About Our Company: We are a portable dental practice that has been servicing nursing homes and jails since 2009. Our mission is to provide a convenient way to improve oral healthcare to those who have difficulty getting to a dental office.

We provide portable military equipment, an assistant, supplies, and are seeking compassionate dentists to provide the treatment these patients deserve. NOTES: 3 openings. Additional Salary Information: Per deim rate is based on experience. Go to careers.floridadental.org/jobs/13378015.

Dental Assistant – Melbourne. Overview: Responsibilities: Perform functions in accordance with the applicable state’s Dental Auxiliaries Table of Permitted Duties; Actively participate in the Perfect Patient Experience by striving to keep your patients focused on optimal treatment while attending to their individual needs and concerns; Escort patients to/ from the front desk and introduce them to other team members as appropriate. Maintain a clean, sterile, and cheerful environment; Record patient charting and all of the dentist’s notes in the digital patient chart as directed by the dentist; Maintain strict compliance with State, Federal, and other regulations, (e.g., OSHA, WC, Dental Board, HIPAA, ADA, DOL, HR policies and practices). Qualifications: Necessary industry certifications and education; Possess outstanding time management, communication, and technical skills; Can-do attitude, a proactive nature, a strong sense of ownership and integrity and a desire to continue to learn and grow; Demonstrate knowledge of dental terminology, instruments and equipment. Benefits: Medical, dental and vision insurance; Continuing Education (CE Units); Paid time off; Tuition Reimbursement; Child care assistance; 401K; Paid time to volunteer in your local community. Pacific Dental Services is an equal opportunity employer and does not

discriminate against any employee or applicant for employment based on race, color, religion, national origin, age, gender, sex, ancestry, citizenship status, mental or physical disability, genetic information, sexual orientation, veteran status, or military status.

Apply here: bit.ly/2TC1GTx. Associate Dentist – Lake Nona. Now is the time to join Nona dentists. You will have opportunities to learn new skills from our team of experienced professionals. If you’re ready to take your career to the next level and gain valuable experience, apply today! Overview: Let us allow you to do what you do best by doing the dentistry that you diagnose while exploring future partnership opportunities. We follow through on our promise to clinicians with our culture of patient centric care, our ability to deliver comprehensive integrated care, and our ability to support modern dentistry. PDS supported owner dentists know that being backed by the country’s leading dental support organization allows them to focus on providing patient centric and clinically excellent care.

Benefits: Competitive Compensation and Benefit Package; Modern offices equipped with the latest dental technology; Malpractice Insurance; Healthcare Benefits (Medical, Prescription Drugs, Dental and Vision); 401(k) Savings Plan. The average full-time PDSsupported Dentist earns $160,000 - $390,000. Apply today. Apply now or contact a recruiter anytime.

We’d love to chat, get to know you and share more about us. Testimonial from Dr. Callaway-Nelson: “Partnering with PDS has given me the opportunity to realize my dream of practice ownership. I am able to do the dentistry that I love.” Pacific Dental Services is an equal opportunity employer and does not discriminate against any employee or applicant for employment based on race, color, religion, national origin, age, gender, sex, ancestry, citizenship status, mental or physical disability, genetic information, sexual orientation, veteran status, or military status.

Apply here: bit.ly/2TyoBim. Registered Dental Hygienist – Winter Park. Description: Now is the time to join Dentists of Winter Park.

You will have opportunities to learn new skills from our team of experienced professionals. If you’re ready to take your career to the next level and gain valuable experience, apply today! Overview: Are you ready to take your career as a hygienist further than you ever thought possible? Do you get excited about working closely with dentists and dental staff to provide the best care that will keep your patients healthy and happy? If the answer is yes, then joining our practice as a hygienist is for you. This collaborative and wellsupported office will help you grow your skills as a hygienist while providing a rewarding and exciting career. About the opportunity: If you care about your career as much as you care about your patients, join our practice, an office supported by Pacific Dental

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Services®, and build relationships that will keep patients coming back for years to come. As a hygienist, you are a vital part of patient care. As such, you deserve to work for a practice that cares about their employees as much as they care about their patients.

You will receive ongoing technical training, have access to the latest technology, and have a balanced lifestyle that leaves you feeling ready to greet each new opportunity with a smile. Add on competitive compensation and benefits, including healthcare, dental and vision insurance, paid time off, retirement savings plans, child care assistance, and the fact that PDS® is one of the fastest growing companies in the US, and you’ll wonder why you didn’t find us sooner!

About you: As a registered dental hygienist with our team, you need to have a current state license. You will have a desire to always be learning and want to stay on top of the latest technology. You should also have outstanding time management and communication skills. To excel, you’ll bring a can-do attitude, a strong desire to treat and educate your patients, and a strong sense of ownership and integrity. Apply Today.

Ready to get started? We are too! Apply today! Pacific Dental Services is an equal opportunity employer and does not discriminate against any employee or applicant for employment based on race, color, religion, national origin, age, gender, sex, ancestry, citizenship status, mental or physical disability, genetic information, sexual orientation, veteran status, or military status. Apply here: bit.ly/3cLbsKo. Great Opportunity in Delray Beach Fl. Ideal dental specialty office available. 6 schools within one mile.

Pedodontist in building. Located in professional district. 1616 sf available second floor. Monthly rent $4477.99 (includes base rent, 7% sales tax, cam). Minimum 5 year lease. Dr’s looking to relocate in Delray Beach, Florida. Graduates starting new practice. Go to careers.floridadental.org/jobs/13320315.

Operations Manager – Miami. Overview: As an Operations Manager at Pacific Dental Services, you’ll have the opportunity to build a promising career—and a bright future. At Pacific Dental Services, we’ll help you take your drive and dedication as far as you want to go. When you join us as an Operations Manager/ Trainee, you’ll have the tools and resources you need to build a rewarding career. That support starts with a carefully designed training program including unique online components and valuable mentorship.

And as you build your future with us, you’ll discover additional opportunities for continued education and training, helping you attain your professional goals.

In this entrepreneurial role, you’ll use your teambuilding skills to help us establish a new, state-of-theart office. If you’re looking for an opportunity to enjoy both professional excellence and a balanced lifestyle, join us at Pacific Dental Services. Responsibilities: Achieve financial performance and revenue growth

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goals while supporting our culture and mission; Act as an expert in the local market, employing best practices for patient acquisition and retention; Provide direct individual and team leadership to achieve success in an entrepreneurial environment. Preferred background: Bachelor’s degree; 5 years of relevant work experience, or equivalent; Coursework or on-the-job training in the fields of dentistry, business or training; Strong retail management and leadership skills; Experience leading a team, mentoring and coaching subordinates. A life of service is the highest calling, and we live it every day. Join us as an Operations Manager/Trainee at Pacific Dental Services and help us improve the quality of life for millions of people. Pacific Dental Services is an equal opportunity employer and does not discriminate against any employee or applicant for employment based on race, color, religion, national origin, age, gender, sex, ancestry, citizenship status, mental or physical disability, genetic information, sexual orientation, veteran status, or military status. Apply here: bit.ly/2vUOUX9.

Endodontic Associate - Tampa Bay Area. Well established, busy endodontic group practice seeking energetic, quality endodontist. Modern office with latest technology including microscopes, digital radiography, CBCT, and experienced support staff. Excellent earning potential and benefits. Recent graduates encouraged to apply. Go to careers.floridadental.org/ jobs/13306718.

Associate Dentist – Fort Myers. Dental Care Alliance is a Dental Support Organization that was established in 1991 to provide comprehensive dental care to patients in 19 States. All DCA offices pride themselves on satisfying patient needs, providing high quality general and specialty dental services, and offering patient comfort that is second to none. DCA believes in providing a positive professional experience so that your goals can be achieved. We are one of the nation’s largest and most successful dental practice management companies because we understand that when you succeed, we succeed. Outstanding Associate Opportunity for an experienced General Dentist to join one of our highly successful affiliated practices in Ft. Myers, FL. Strong commitment to long-term dental care for the whole family. Be chair side and make money from day one; Highly trained and dedicated staff to support you; No Day-to-Day headaches of Managing a Practice; Excellent compensation pkg. with performance based incentives; Well-established and growing patient base. Full Time Dentist Benefits Package: Company paid professional liability insurance; DCA sponsored continuing education; Medical Insurance; Dental Plan; Life Insurance; Vision Insurance; Long Term Disability; Section 125 - Flexible Spending Account; 401K EAP Program; DCA Voluntary Supplemental Insurance Products.

1 - 2 years dental experience; Licensed to practice

dentistry in the State of Florida. Go to careers.floridadental.org/jobs/13307036.

Associate Dentist – Mount Dora: Description: Now is the time to join Mount Dora Modern Dentistry. You will have opportunities to learn new skills from our team of experienced professionals. If you're ready to take your career to the next level and gain valuable experience, apply today! Overview: Let us allow you to do what you do best by doing the dentistry that you diagnose while exploring future partnership opportunities. We follow through on our promise to clinicians with our culture of patient centric care, our ability to deliver comprehensive integrated care, and our ability to support modern dentistry. PDS supported owner dentists know that being backed by the country's leading dental support organization allows them to focus on providing patient centric and clinically excellent care. Benefits: Competitive Compensation and Benefit Package; Modern offices equipped with the latest dental technology; Malpractice Insurance; Healthcare Benefits (Medical, Prescription Drugs, Dental and Vision); 401(k) Savings Plan. The average full-time PDS-supported Dentist earns $160,000 - $390,000. Testimonial from Dr. Callaway-Nelson: “Partnering with PDS has given me the opportunity to realize my dream of practice ownership. I am able to do the dentistry that I love.” Dr. Callaway-Nelson Pacific Dental Services is an equal opportunity employer and does not discriminate against any employee or applicant for employment based on race, color, religion, national origin, age, gender, sex, ancestry, citizenship status, mental or physical disability, genetic information, sexual orientation, veteran status, or military status. Apply here: bit.ly/2Q1goRR. Dentist Needed – West Palm Beach. Job Descirption: Well-established private practice seeking an Associate Dentist (2 to 4 days/week) who enjoys treating children. You will work with experienced, supportive staff in a friendly, non-corporate environment where you can enjoy the traditional doctorpatient relationships. We will train the right candidate.

This is a great opportunity for a general dentist who wants to focus on pediatric dentistry. We offer competitive daily guarantee. Go to careers.floridadental. org/jobs/13439074.

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We are pleased to announce...

Kevin W. Snyder, D.D.S. has acquired the practice of Marshall S. Bailey, D.M.D. St. Augustine, Florida Maria-Marcia A. Carvalho, D.D.S. has acquired the practice of Steven Jakubaitis, D.M.D. Port Charlotte, Florida Call today for a FREE MARKET VALUE ANALYSIS ($5,000 value)

We are pleased to have represented all parties in these transitions.

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Practice Sales & Purchases Over $3.2 Billion

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off the cusp

JOHN PAUL, DMD FDA EDITOR

Dr. Paul can be reached at jpaul@bot.floridadental.org.

*An ode to Jimmy Buffet.

VAMPIRES, MUMMIES AND THE HOLY GHOST … THESE ARE THE THINGS THAT TERRIFY ME THE MOST* If you go out in the woods today, be very careful. Anywhere outside in Florida could be the home of the dreaded copper-headed water rattler. The sneakiest snake that ever snucked. It can spit venom 30 feet, even from its tail. It can bite onto its tail and roll at 30 mph to chase down its victims. Chuck Norris was bitten by one once, and after five days of agony, the snake died. But, you aren’t Chuck Norris. This was the dreaded fear of my childhood playing outside in Florida. I know some of you have chills right now because you feared the copper-headed water rattler, too.

We know there is no such thing. Yes, there are many snakes in Florida and a lot of them are venomous. Any body of water in Florida bigger than a red Solo cup has an alligator living in it. These are all things that might cross our paths one day, some of us more likely than others. I found an alligator in my parking lot one afternoon, Dr. Cesar Sabates had one in his swimming pool. They deserve caution and respect, but not fear that keeps you from going outside.

Just this morning, I heard that foreign nationals from Europe won’t be allowed to fly into the U.S. for the next 30 days and the NBA has suspended the 2020 season. Colleges will be conducting classes over the internet. The latest catchphrase is “in an overabundance of caution …” You cannot buy hand sanitizer, Clorox wipes or toilet paper at the store. Interesting though, right next to the empty spot on the shelf where hand sanitizer would be, there is more bar soap — in every odor — than you could ever want. We have been told to wash our hands with soap and water, so we are buying hand sanitizer and toilet paper.

all of this commotion. People are scared and others are fanning the fire. A patient yesterday asked with true concern, “If I get this, it’s a death sentence, right?” We have a long history of educating our patients and now is not the time to change our tactics. Please read your emails. The FDA will do our best to keep you updated with real information from the Centers for Disease Control and Prevention (CDC) and the Department of Health. We’ll also try to interpret it, so you’ll know what is expected of a dentist. I don’t think many of you are infectious disease specialists, but we deal with this kind of disease every day. Clean offices and clean hands are not new concepts for dentists. Giving patients and staff permission to stay home when they are sick also isn’t a new idea for dentists. Support each other. Take reasonable precautions and use that overabundance of caution if you think you might be infectious or you are old enough to have used a rotary phone or you have another condition that might make you more susceptible to contracting the disease and suffering a more serious outcome.

This won’t show up on your desk for about three weeks and we are being told this will be worse before it gets better. My wife says you hope for a miracle and prepare for the current situation. Maybe this will all be over and you’ll have a vague memory of what lead me to write this. If not, even with a wider spread of the virus, this will still be good advice.

Stay tuned to your emails and if you think you missed something or want to revisit a topic, check in at floridadental.org.

I want the Florida Dental Association (FDA) and all its members to be a voice of reason in JOHN PAUL, DMD, EDITOR, TODAY'S FDA

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All new dental school graduates who become FDA members and practice in Florida will have their first year of professional liability coverage from The Doctors Company completely reimbursed by their FDA colleagues!