2019 Dentists’ Day on are the Hill - March 11-12, The Boomers Coming! See 2019 Page- Page 34 2
VOL. 32, NO. 4 • MAY/JUNE • ELDER CARE ISSUE
What is the Elder Care Workgroup? Medications and Dental Care of Your Older Patients
A PUBLICATION OF THE FLORIDA DENTAL ASSOCIATION
2020 Legislative Wrap Staying Healthy in a Virtual World
Seniors Make Great Patients
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The The Boomers Boomers are are Coming! Coming!
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in every issue
Staying Healthy in a Viral World
3 Staff Roster 5 President's Message 8 Did You Know? 11 Info Bytes
42
24
Seniors Make Great Patients
28
Medications and Dental Care of Your Older Patients
Florida Board of Dentistry Meets Via Conference Call
20 news@fda 59 Diagnostic Discussion 62 Career Center 63 Advertising Index 64 Off the Cusp
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Marching Forward on Your Behalf
What is the Elder Care Workgroup?
14
32
23
Remembering Dr. Neil Powell
FDA Member Engagement High During March COVID-19 Reaction
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Hail and Farewell, Dr. Ethan Pansick!
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46 50
30
Avoiding Hiring Pitfalls
2020 Legislative Wrap
A PUBLICATION OF THE FLORIDA DENTAL ASSOCIATION
FDA Member Changes the Life of a Florida Senior
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The Boomers are Coming!
The Digital 3D Printed Denture
TODAY'S FDA ONLINE: floridadental.org
FLORIDA DENTAL ASSOCIATION MAY/JUNE 2020 VOL. 32, NO. 4
EDITOR Dr. John Paul, Lakeland, editor
STAFF
Award
2020
RECIPIENTS
PRESIDENT’S AWARD
Dr. Rudy Liddell, Brandon
DENTIST OF THE YEAR
Dr. Don Ilkka, Leesburg
J. LEON SCHWARTZ LIFETIME SERVICE AWARD
Jill Runyan, director of publications Jessica Lauria, publications and media coordinator AJ Gillis, 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
Dr. Bill D’Aiuto, New Smyrna Beach
LEADERSHIP AWARDS
PUBLISHING INFORMATION
NEW DENTAL LEADER
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.
Dr. Drew Johnson, Cocoa Dr. Jessica Stilley, New Port Richey
Dr. Michael Starr, Wellington
DENTAL TEAM MEMBER
Ms. Heather Lewis, Alachua
PUBLIC SERVICE AWARDS
Dr. Diane Ede-Nichols, Fort Lauderdale Dr. Reese Harrison, Lynn Haven Dr. John Penny, St. Petersburg Beach
HELPING MEMBERS SUCCEED TEAM IMPACT AWARD Ms. Carol Gaskins, Tallahassee
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 MAY/JUNE 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 CASEY STOUTAMIRE, Director of Third Party Payer and Professional Affairs cstoutamire@floridadental.org 850.350.7202 RENEE THOMPSON Director of Communications and Marketing rthompson@floridadental.org 850.350.7118 JUDY STONE, Leadership Affairs Manager jstone@floridadental.org 850.350.7123
BROOKE MARTIN, FDC Marketing Coordinator bmartin@floridadental.org 850.350.7103 DEIRDRE RHODES, FDC Exhibits Coordinator drhodes@floridadental.org 850.350.7108 EMILY SHIRLEY, FDC Program Coordinator eshirley@floridadental.org 850.350.7106 EMILY SOMERSET, FDC Meeting Assistant esomerset@floridadental.org 850.350.7162
GOVERNMENTAL AFFAIRS JOE ANNE HART Chief Legislative Officer jahart@floridadental.org 850.350.7205
LIANNE BELL, Leadership Concierge lbell@floridadental.org 850.350.7114
ALEXANDRA ABBOUD Governmental Affairs Liaison aabboud@floridadental.org 850.350.7204
ACCOUNTING
INFORMATION SYSTEMS
BREANA GIBLIN, Director of Accounting bgiblin@floridadental.org 850.350.7137
LARRY DARNELL Director of Information Systems ldarnell@floridadental.org 850.350.7102
LEONA BOUTWELL, Finance Services Coordinator Accounts Receivable & Foundation lboutwell@floridadental.org 850.350.7138 DEANNE FOY, Finance Services Coordinator Dues, PAC & Special Projects dfoy@floridadental.org 850.350.7165 ALLEN JOHNSON, Accounting Manager allen.johnson@fdaservices.com 850.350.7140 MITZI RYE, Fiscal Services Coordinator mrye@floridadental.org 850.350.7139 STEPHANIE TAYLOR, Membership Dues Coordinator staylor@floridadental.org 850.350.7119
FLORIDA DENTAL ASSOCIATION FOUNDATION (FDAF) R. JAI GILLUM, Director of Foundation Affairs rjaigillum@floridadental.org 850.350.7117 KRISTIN BADEAU, Foundation Coordinator kbadeau@floridadental.org 850.350.7161 KRISTEN RULE, Foundation Assistant krule@floridadental.org 850.350.7122
FLORIDA DENTAL CONVENTION (FDC) CRISSY TALLMAN Director of Conventions and Continuing Education ctallman@floridadental.org 850.350.7105
RACHEL STYS, Systems Administrator rstys@floridadental.org 850.350.7153
MEMBER RELATIONS KERRY GÓMEZ-RÍOS Director of Member Relations krios@floridadental.org 850.350.7121 MEGAN BAKAN Member Access Coordinator mbakan@floridadental.org 850.350.7100 JOSHUA BRASWELL Membership Coordinator jbraswell@floridadental.org 850.350.7110 CHRISTINE TROTTO Membership Concierge ctrotto@floridadental.org 850.350.7136
PUBLICATIONS JILL RUNYAN, Director of Publications jrunyan@floridadental.org 850.350.7113 AJ GILLIS, Graphic Design Coordinator agillis @floridadental.org 850.350.7112 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.
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FDA SERVICES 800.877.7597 or 850.681.2996 545 John Knox Road, Ste. 201 Tallahassee, FL 32303 Group & Individual Health • Medicare Supplement • Life Insurance Disability Income • Long-term Care • Annuities • Professional Liability Office Package • Workers’ Compensation • Auto • Boat
SCOTT RUTHSTROM Chief Operating Officer scott.ruthstrom@fdaservices.com 850.350.7146 CAROL GASKINS Commercial Accounts Manager carol.gaskins@fdaservices.com 850.350.7159 ALEX KLINE FDAS Marketing Coordinator arey@fdaservices.com 850.350.7166 MARCIA DUTTON Membership Services Assistant marcia.dutton@fdaservices.com 850.350.7145 PORSCHIE BIGGINS Central Florida Membership Commercial Account Advisor pbiggins@fdaservices.com 850-350-7149 MARIA BROOKS South Florida Membership Commercial Account Advisor maria.brooks@fdaservices.com 850.350.7144
CARRIE MILLAR Director of Insurance Operations carrie.millar@fdaservices.com 850.350.7155
YOUR RISK EXPERTS 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 877.843.0921 (toll free) Cell: 407.927.5472 dennis.head@fdaservices.com MIKE TROUT Director of Sales — North Florida
KELLY DEE Atlantic Coast Membership Commercial Account Advisor kelly.dee@fdaservices.com 850.350.7157
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
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 MAY/JUNE 2020
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TODAY'S FDA MAY/JUNE 2020
FLORIDADENTAL.ORG
leadership
ELDER CARE AND COVID-19 How ironic that this issue of Today’s FDA deals with elder care. We’re currently in the midst of the COVID-19 pandemic, which has been particularly cruel to our elder population. Statistically, the virus seems to affect older adults with one or more comorbidities in a much more dramatic fashion than younger, healthier adults. The last in-person meeting that I attended was the National Elder Care Advisory Committee (NECAC) meeting in Chicago in early March. We reviewed the 2019 symposium that addressed challenges associated with treating an elderly population, such as chronic disease, polypharmacy, navigating difficult treatment plans, collaborating with medical doctors, SDF use in geriatric patients and oral health literacy for an aging population. Although there will not be a stand-alone symposium in 2020, there will be an extremely robust Elder Care Track planned for the ADA/FDA meeting in Orlando in October 2020. The American Dental Association (ADA) Council on Dental Practice also supported the Dental Public Health Residents Research Program, which gives selected residents a chance to present research on topics ranging from the impact of tooth retention on overall health, teledentistry considerations when dealing with an aging population and prescribing protocols for our elderly patients.
PRESIDENT’S MESSAGE RUDY LIDDELL, DMD FDA PRESIDENT
Dr. Liddell can be reached at rliddell@ bot.floridadental.org.
I would like to thank all the members of Florida Dental Association for your continued support throughout these unprecedented times. Handling the closure of dental offices statewide due to a pandemic was not in the president’s handbook. With the help of a great team at headquarters, we have strived to keep everybody updated in real time on our website with regards to current restrictions, navigating through the financial issues and finally getting us back to work safely. I was proud to co-chair the task group that developed the ADA’s guidelines for reopening dental practices as well as serving on the Governor’s Re-open Florida Task Force. I’m looking forward to prosperous times on the other side of this pandemic. Good luck and stay safe!
FLORIDADENTAL.ORG
TODAY'S FDA MAY/JUNE 2020
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human relations
AVOIDING HIRING PITFALLS Hiring decisions affect and are affected by so many different factors and providing a detailed compendium on hiring practices is neither feasible nor practical. This article will provide you with a general overview of some of issues that should be considered in the hiring process.
Pre-hire Inquiries 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.
Employers subject to the various discrimination laws, i.e., those with 15 or more employees (20 for age discrimination), should take particular care during the hiring process. Certain areas of questioning or discussion either on the application or during the interview process can expose the employer to potential claims if the decision is to not hire the individual. Examples of topics of questions and discussions that should be avoided are: n decisions to have children n whether the applicant is pregnant n childcare issues n date of graduation from high school (can be used to extrapolate the applicant’s age) n religious observances n arrests (generally believed to have a disparate impact on minority applicants who are allegedly arrested more frequently) n convictions that bear no relation to the position requirements
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TODAY'S FDA MAY/JUNE 2020
n physical abilities (can generally describe the duties of the position and inquire if the person is able to perform those duties and meet the job requirements) n
the applicant’s nationality
n
gender non-conformity issues
You may be thinking these are obvious and you’d never ask such questions directly. However, to avoid accidentally venturing into questionable areas of inquiry, take care. A wise practice, particularly during the interview process, would be to create a list of jobrelated questions and stick to those.
Pre-hire Investigations/ Credit Checks The title may give the impression that its provisions apply only in situations relating to applications for credit, loans, mortgages, etc., but the Fair Credit Reporting Act (FCRA) also applies to consumer reports obtained from a consumer reporting agency and used in the employment dete rmination process. There are two types of consumer reports, a general consumer report and an investigative consumer report. Generally, a consumer report is defined as a communication obtained from a consumer reporting agency, whether oral or written, that provides information relating to an individual’s consumer credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics or mode of living. An inves-
FLORIDADENTAL.ORG
tigative consumer report is a consumer report where the information relating to the individual’s general reputation, consumer characteristics, personal characteristics or mode of living is obtained by interviews with neighbors, friends or associates. Before obtaining either type of consumer report, all employers must provide written notice to the individual that a consumer report may be obtained. This notice must be in writing and must be the only item contained in the document. In addition, the employer must have a signed authorization from the individual agreeing to the procurement of the consumer report. If the requested report is to be an investigative report, the notice must contain a statement advising the individual of the right to request additional disclosures detailing the nature and scope of the investigative report. If requested by the individual, the employer must provide a written copy of the summary of consumer rights under the FCRA. If an adverse employment decision is based in whole or in part on any information contained in a consumer report, whether a general report or investigative report, the individual must be provided detailed information on which the decision was based and a written copy of the summary of consumer rights under the FCRA. Willful violation of the provisions of the FCRA can result in liability for actual damages suffered by the individual with awards ranging from a minimum of $100 to a maximum of $1,000. The individual also can be awarded punitive damages and attorney’s fees. FLORIDADENTAL.ORG
Social Media Screening
Summary
Many employers conduct social media screening to gather additional information on potential employees. No laws or rules prohibit this, but care should be exercised if this screening process is used. If social media screening is used for one applicant, it must be done for all applicants. Be aware that if a third-party entity is hired to conduct a social media review, the FCRA will likely apply.
Deciding on the right person to become a part of your team is an important decision. As with all important decisions relating to your practice, you should document the reason for your decision. The types of documentation that should be maintained are:
More importantly, posts on social media platforms frequently contain information relating to areas of inquiry that could expose the employer to liability under the various discrimination laws as discussed above. An example would be noticing several posts by the individual of pictures of the individual holding drinks or attending parties. If the person is not hired, they can attempt to bring a claim under the Americans with Disabilities Act that the potential employer perceived them to be disabled, perhaps suffering from alcoholism, and did not hire them for that reason. Even if the employer does not have enough employees to be covered by discrimination laws, information contained in the individual’s social media posts still has the potential to subject all employers to liability. For example, in a claim for negligent hire, one element of the cause of action is that the employer had knowledge of the perpetrator’s propensity for certain inappropriate behavior but hired them anyway. Such knowledge could have been gained in reviewing the individual’s social media posts.
n interview questions, if any n any notes of the hiring authority made upon reviewing applications or during interviews n any scores or rankings, if such systems are used n any applications or resumes submitted n any test scores if tests are used n documentation of notices required under the FCRA, if consumer reports are used n other documentation obtained during the selection process It’s recommended that this documentation be maintained for a minimum of four years. As noted above, there are pitfalls that must be avoid during the hiring process. In the event you cannot avoid allegations of discrimination, negligence or violation of the FCRA, having proper documentation of the hiring process can be offered to defend and support your decision and your hiring process.
TODAY'S FDA MAY/JUNE 2020
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BOD
CHANGES TO ANESTHESIA RULES Did you know that the Florida Board of Dentistry (BOD) recently made changes to the Anesthesia Rules? The new rules went into effect on March 10, 2020. Below is a list of the changes, but please note, while this list is extensive, it is not meant to be exhaustive. Please make sure to read the rules in their entirety. The new, updated rules can be found at bit.ly/3a2Sk8p. n Require the team approach for all types of sedation, which includes the operating dentist, a person responsible for monitoring the patient and a person to assist the operating dentist.
DR. DON ILKKA FDA LIAISON TO THE FLORIDA BOARD OF DENTISTRY
n Clarify that a dentist utilizing general anesthesia, deep sedation, moderate sedation or pediatric moderate sedation in the dental office may only have one patient at a time induced. A second patient shall not be induced until the first patient is awake, alert, conscious, spontaneously breathing, has stable vital signs, is under the care of a responsible adult and that portion of the procedure required in the participation of the dentist is complete. In an office setting where two or more permit holders are present simultaneously, each may sedate one patient provided that the office has the necessary staff and equipment for each sedated patient. n Effective March 1, 2022: n General Anesthesia Permit Holder: If treating a patient under the age of 7, a dentist utilizing any level of sedation must be currently trained in pediatric advanced life support (PALS). n Moderate Sedation Permit Holder: If treating a patient under the age of 7, a dentist utilizing moderate sedation must be currently trained in PALS.
CASEY STOUTAMIRE FDA DIRECTOR OF THIRD PARTY PAYER & PROFESSIONAL AFFAIRS
n However, if the intent for administering nitrous is for mild sedation, then PALS is not required if treating a patient under 7. n Routine inspections shall be conducted at a minimum of every three years. And any additional location shall be subject to a routine inspection no later than one year from the date the location was added. n During the initial inspection, a dental procedure utilizing general anesthesia/deep sedation, moderate sedation and pediatric moderate sedation must be observed and evaluated.
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 Don.ilkka.dds@gmail.com or 352.787.4748.
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n The only time demonstration of placement of an intravenous catheter is required is upon initial inspection for general anesthesia and moderate sedation permit holders. This is NOT a requirement for pediatric moderate sedation permit holders. n All rooms where sedation is being performed must accommodate the patient on a table or in an operating chair and permit an operating team consisting of at least three individuals to freely move about the patient. An operating table or chair which permits the patient to be positioned so the operating team can maintain the airway quickly alter patient position in an emergency and provide a firm platform for the management of CPR.
TODAY'S FDA MAY/JUNE 2020
FLORIDADENTAL.ORG
n The anesthesia record must include the duration of the procedure, including the start and finish time of the procedure. n Clarification on the definition of a physician anesthesiologist
of clinical training was dedicated to hands-on simulated training in emergency airway management of the compromised airway;
n Nitrous change n Any physician licensed pursuant to Chapter 458 n Must have a dental nitrous-oxide delivery system with or 459, F.S., who is currently board certified or board fail-safe features and a 30% minimum oxygen flow. eligible by the American Board of Anesthesiology or Previously this was a 25% minimum oxygen flow. the American Osteopathic Board of Anesthesiology, or currently holds anesthesia clinical privileges in a n Dental assistants and dental hygienists may monitor hospital or ambulatory surgical facility licensed nitrous-oxide inhalation analgesia under the indirect pursuant to Chapter 395 and such privileges are supervision of a dentist if the dental assistant or commensurate with the anesthesia being provided dental hygienist has complied with the training in a dental office (e.g., pediatric anesthesia privileges requirements in paragraph 64B5-14.003(4)(b), F.A.C., if pediatric patients are being treated in the dental and has completed, at a minimum, a two-day course office). is credentialed to administer anesthesia in of training as described in the American Dental a hospital or ambulatory surgical facility licensed Association’s “Guidelines for Teaching Pain pursuant to Chapter 395, F.S Control and Sedation to Dentists and Dental Students� or its equivalent. After the dentist has n Applying for a pediatric moderate sedation permit: induced a patient and established the maintenance 3) Pediatric Moderate Sedation Permit. level, the assistant or hygienist may monitor the (a) To be eligible for a permit to authorize the use of pe administration of the nitrous-oxide oxygen making diatric moderate sedation at a specified practice location only diminishing adjustments during this adminisor locations on an outpatient basis for dental patients, the tration and turning it off at the completion of the dentist shall comply with Rules 64B5-14.0025, F.A.C., and: dental procedure.
FDA Online Radiography Training Program
1. Complete formal training in the use of pediatric moderate sedation through a Commission on Dental Accreditation accredited dental school or program;, or through an accredited teaching hospital, or through an accredited pediatric residency program. Clinical training must take place at the accredited dental school or accredited teaching hospital and, 2. Is certified by the institution where the formal training was received to be competent in the administration of pediatric moderate sedation and is competent to handle all emergencies relating to pediatric moderate sedation. (b) This certification shall specify the type, the number of hours, the number of patients treated and the length of training. The minimum number of didactic hours shall be sixty (60), which must include four (4) hours of airway management. Clinical training shall include personal administration for at least twenty (20) patients including supervised training, management of sedation, clinical experience and demonstrated competence in airway management of the compromised airway. The program must certify that three (3) hours FLORIDADENTAL.ORG
n Reminders: n No dentist licensed in this state shall administer or employ the use of general anesthesia, deep sedation, moderate sedation, and pediatric moderate sedation until they have obtained a permit as required by the provision of this chapter, unless specifically authorized otherwise by this chapter. The permit requirements of this chapter do not apply when treating patients at hospitals or ambulatory surgery centers licensed pursuant to Chapter 395, F.S n No dentist shall administer, supervise or permit another health care practitioner, as defined in Section 456.001, F.S., or perform the administration of general anesthesia, deep sedation, moderate sedation or pediatric moderate sedation in a dental office for dental patients, unless such dentist possesses a permit issued by the Board. A permit is required even when another health care practitioner, as defined in Section 456.001, F.S., administers general anesthesia, deep sedation, moderate sedation, or pediatric moderate sedation in a dental office for a dental patient. SEE PAGE 10 TODAY'S FDA MAY/JUNE 2020
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BOD
American Sensor Tech
FROM PAGE 9
The dentist holding such a permit shall be subject to review and such permit must be renewed biennially. Each dentist in a practice who performs the administration of general anesthesia, deep sedation, moderate sedation or pediatric moderate sedation shall each possess an individual permit. Nothing in this paragraph shall be construed to prohibit administration of anesthetics as part of a program authorized by Rule 64B5-14.003, F.A.C., for training in the anesthetic being administered, or pursuant to a demonstration for inspectors pursuant to Rule 64B5-14.007, F.A.C. n Itinerate physician anesthesiologist n As long as the permit holder’s dental office meets the supply, equipment, and facility requirements as mandated in Rule 64B5-14.008, F.A.C., nothing in the rules shall be interpreted to prevent a physician anesthesiologist from utilizing their non-fixed mobile equipment when providing anesthesia services in the permit holder’s dental office.
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BACK UP MY SMARTPHONE? HOW DO I PUT IT IN REVERSE? That’s something I’ve heard quite a few
ferent things you adapted to throughout your
times when people try to relate tech terms to
life. You’ve proven you can learn new things
familiar practices. Technology has moved in
before and there is no reason you can’t now.
leaps and bounds and it may seem to have
It starts with your attitude. There are benefits
passed you by. We no longer have the luxury
of learning new technology, new commu-
of ignoring how to use certain technology
nication vehicles and more ways to stay in
like the internet, email, smartphones, ATMs
touch while keeping yourself informed as
or those fancy TV remotes. As you get older,
well. If you approach it with a problem-solver
maybe you think you don’t need the ability to
attitude and believe you can do it, you will.
use different kinds of technology. However, we’ve certainly seen how technology has bullied its way into our everyday lives, especially during the last few months. So, what are you to do? Like many of us, we may look to our children or grandchildren to teach us some things about technology. Whether it’s how to use Facebook, Instagram, Twitter, FaceTime or Snapchat, we never thought we’d need to use it — yet here we are using it just to stay in touch. This past week, I had a lengthy call with my 83-year-old mother trying to explain to her how to get her church services on her smartphone without needing a Facebook account to use it. If you suggested that to me 20 years ago, I would have thought that was stranger than fiction. Let me provide you with a few things to keep in mind when it comes to trying to adopt new (or new-to-you) technology.
LARRY DARNELL, MBA, CAE FDA DIRECTOR OF INFORMATION SYSTEMS
Mr. Darnell can be reached at ldarnell@floridadental.org.
Next, you need to find some source experts — someone who can teach you about this newer technology. I regularly have older adults call on me to assist them with their technology challenges. You also can seek out classes that local community colleges and extension programs offer. I see many senior adults taking classes at our local library. Many of these are free. I encouraged my 65-year-old brother to take smartphone classes at the Apple store (in part so he would quit calling me). Education is powerful. Let me throw a quick word of caution in here, too. Technology opens doors where you can be taken advantage of much easier. That’s why my mom abandoned Facebook. She “didn’t want to fool with that nonsense,” as she put it. But there are precautions you can take to keep yourself safe. This is where I mention trusted internet sites, and it’s hard to know what some of those truly are these
First, you shouldn’t be afraid to try new things. Look back and realize the many difSEE PAGE 13 FLORIDADENTAL.ORG
TODAY'S FDA MAY/JUNE 2020
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FROM PAGE 11
“
days. One site you can rely on for information is the AARP. There’s a great deal of information about computer courses and helpful tips specific to Florida on their website, which can be found at bit.ly/2wUpwBf. You also can check out seniorliving.org/tech. Both AARP and Senior Living obviously cater to the needs of seniors. Another issue that occasionally arises is the need for remote support of your computer. This involves somebody connecting remotely to your computer, tablet or phone using some software. This happens when they can’t physically have access
Caution: Always make 100% sure you know who you are giving access to and why.
”
to your equipment. Most computer support professionals use software like LogMeIn Rescue Assist, Splashtop SOS or FixMe. IT. The technician sends you an email with a link. You click on it and provide the technician a code, and then they have remote control of your computer. Caution: Always make 100% sure you know who you are giving access to and why. This is designed for one-time access, otherwise the risk is too great. You also need to be extremely careful when giving any outsiders access to systems with HIPAA-protected information on it. In those situations, you would need a business associate
Aftco
agreement to protect you and your information. Technology opens a whole new world that doesn’t even involve leaving your house. You just have to try, experiment and have fun with it. Will you be frustrated at some point? Sure. We all are at some point, but don’t let it beat you. Technology is still here to serve our needs, not the other way around. The information, connectivity and opportunities technology offers are too great to let a bad experience stop you.
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FDAS: Cyber Liability Coverage
DENTISTS’ DAY ON THE HILL
to all the members, students and spouses who met with legislators in Tallahassee.
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FDA: Radiography
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updates for members
*PLEASE NOTE THAT FDA MEMBERS HAVE THEIR NAMES LISTED IN BOLD.
CE Courses for Your Personal and Professional Growth The Florida Dental Association (FDA) and the Committee on Conventions and Continuing Education is offering FDA member dentists many online continuing education (CE) opportunities during these uncertain times due to COVID19. These courses will assist you in your personal and professional growth, as well as aid you in completing the CE requirements needed for license renewal this upcoming biennium. n FDC2019 Course Recordings: Take advantage of 30+ course recordings from the 2019 Florida Dental Convention at the convenience of your home or office. Visit floridadental. org/online-ce to access these courses. n Today’s FDA (TFDA) “Diagnostic Discussions”: Earn up to seven hours of CE by reading the popular TFDA “Diagnostic Discussion” articles. Visit floridadental.org/onlinece to access these articles. n COVID-19 Webinars: These ondemand webinars will provide tips and tricks to ensure your personal and professional success during the COVID-19 pandemic. Visit bit. ly/2SL4k8u to access the webinars.
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TODAY'S FDA MAY/JUNE 2020
n New Mandatory Courses: It’s now required that dentists complete a two-hour opioid prescribing course each biennium and complete a onehour human trafficking course by Jan. 1, 2021. The FDA offers these courses at a discounted rate for member dentists at floridadental. org/online-ce.
ADA FDC Annual Meeting Postpones Registration The American Dental Association (ADA) and FDA have postponed registration for the ADA FDC Annual Meeting from April 22 to early summer, in light of the COVID-19 pandemic. The meeting is still planned for Oct. 15-18 in Orlando. The ADA will continue to follow evolving advice from the U.S. Department of State and Centers for Disease Control and Prevention regarding public gatherings, but it is hopeful dentists will be able to gather again as a community at ADA FDC 2020. For the latest ADA FDC 2020 updates, please visit ADA. org/meeting.
The Doctors Company COVID-19 Resources
pany’s (TDC) COVID-19 Resource Center for Healthcare Professionals contains a wealth of information regarding the malpractice provider’s response to the COVID-19 crisis. The Resource Center is updated regularly with new articles and releases that can help health care providers tailor their responses to the pandemic confidently. Explore TDC’s COVID-19 Resource Center at bit.ly/35FJPPW.
2020 Hurricane Season Began June 1: Don’t Forget to Prepare! With our collective focus directed toward the COVID-19 pandemic, it’s easy to forget about important tasks like annual hurricane season preparation. Hurricane season began June 1 — don’t delay in reviewing your storm readiness plan and ensuring you have the right coverages in place to protect your practice. Creating an airtight plan will give you the peace of mind to focus your attention on other challenges your dental practice may face in the coming months. Visit bit.ly/35TgGB3 to review FDA Services’ Hurricane Guide, “Storm Proof,” which is full of helpful resources that will help you prepare for this year’s hurricane season.
Looking for COVID-19 risk management resources from a trusted professional liability ally? The Doctors Com-
FLORIDADENTAL.ORG
The Women Behind the Masks
Wishing Lynne Knight a Fond Farewell
The personal protective equipment (PPE) shortage during the pandemic inspired Dr. Queanh Phan and her mother, Thuy Vo, to make washable face masks and face shields to supply to their community. Soon after they began, they faced the challenge of fabric shortages, which hindered their production. Luckily, Dr. Phan’s DR. QUEANH PHAN staff stepped up to the plate and provided generous donations of fabric, elastic bands and textiles from their circle of family, friends and community. The mother and daughter duo sewed 600 washable face masks and face shields, and have donated these PPE to doctors’ offices, dental colleagues, family, friends and nursing homes. They plan to continue producing the masks and face shields, and believe that by working together, their communities and nation will get through this difficult time.
FDA Marketing Coordinator Lynne Knight celebrated her 25th anniversary with the association on Jan. 3 and after much thought, has decided it’s time to move on to enjoy retirement. The next chapter in her life will be centered around just that — many more chapters! Lynne completed her first novel and now is planning her second one. She’ll continue to write poetry, which has been published all over the country, and create art. She’s a dedicated and hardworking employee who seamlessly worked with several departments and turned rough ideas into compelling pieces.
JUDY STONE
FLORIDADENTAL.ORG
A few months ago, FDA Leadership Affairs Manager Judy Stone revived her sewing hobby simply because of the joy it brought her. It proved to be good timing, since the COVID-19 pandemic began only a few short weeks later. When she saw there was such a need for masks, Judy said “it was a nobrainer” that she would put her skills to use. Her sister-in-law, a nurse for 40 years in Miami, provided Judy with the mask guidelines and she got right to work. As of the beginning of May, Judy has made roughly 80 masks, and has generously provided them to family, friends, FDA co-workers, her husband’s co-workers at the Capitol, the elderly, etc. She plans to continue as long as there is a need!
We’ll miss Lynne and her creative flair, but will be reminded of her every day when we see her two paintings in the FDA’s lobby. Lynne has been an integral part of the FDA for more than 25 years and will be greatly missed. We wish her a relaxing and happy retirement!
New FDA Team Member in Publications Department Please welcome Andrew “AJ” Gillis to the FDA as the new graphic design coordinator. AJ comes to the FDA from the University of Florida (UF) with a degree in advertising and worked for the last five years as the assistant to the creative director at the UF College of Education. We’re happy to have AJ join Team FDA! He can be reached at agillis@floridadental. org.
SEE PAGE 22
TODAY'S FDA MAY/JUNE 2020
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Northwest District Dental Association
FROM PAGE 21
Veterans Health Heroes Request for Nominations The Florida Department of Health (DOH) Division of Medical Quality Assurance is accepting nominations for licensed health care practitioners to be profiled in the 2020 Veteran Health Heroes publication. The criteria for nominees are as follows: n Either currently serving or has been honorably discharged from a branch of the United States Armed Forces, or is a current or previous practioner in the Commissioned Corps of the U.S. Public Health Service n Active, clear health care practitioner license issued by the Florida DOH (nominee may either be currently practicing or retired from his/her health care profession) n No applicable disciplinary actions to the nominee’s license n Must not have been featured in a previous Veteran Health Heroes publication Any licensed health care practitioner who meets the criteria is eligible for nomination. (The licensee may or may not be a member of one of our regulatory boards.) The deadline for nomination submission is July 3, 2020. Submissions should include the full name of the nominee along with their honorifics, biography (maximum of 750 words) and a clear photo for the publications. For more information, contact Denise Simpson at denise.simpson@flhealth.gov.
Dr. Jacinta Watkins, Pensacola
South Florida District Dental Association Dr. Alex Aleman, Pembroke Pines Dr. Maxwell Cardenas, Miami Dr. Juan Cobo, Hollywood Dr. Brigitte Corredor Marquez, Miami Dr. Yinet Garcia de Castro, Miami Dr. Shelly Levin-Rubin, Delray Beach Dr. Julieta Morales, Miami Dr. Catherine Paez, Miami Beach Dr. Maria Roman, Hialeah Dr. Leili Zamini, Miami
West Coast Dental Association Dr. Ilmary Arce Febles, Naples
Dr. Ana-Maria Grama, Riverview Dr. Vera Lee, Lithia Dr. Sneha Patel, Tampa Dr. James Sorrento, Apollo Beach Dr. Alexander Ziegler, Wesley Chapel
Welcome New FDA Members These dentists recently joined the FDA. Their membership allows them to develop a strong network of fellow professionals who understand the day-to-day triumphs and tribulations of practicing dentistry.
Atlantic Coast District Dental Association Dr. Zoey Gutierrez, Vero Beach Dr. Jovanna Lacayo, Miami Dr. Toni Marie Small, West Palm Beach
Central Florida District Dental Association Dr. Shauna Pittman, Melbourne
Northeast District Dental Association Dr. Jason Allen, Jacksonville
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guest editorial
Remembering Dr. Neil Powell Florida Dental Association (FDA) Past President (1980-1981), Dr. Neil Powell, of Orlando, passed away April 22 from complications from the coronavirus. He was 93. We mourn the loss of a great friend to dentistry and we celebrate a life lived well. Dr. Powell was a boater, an outdoorsman, a ballroom dancer, a drummer and a pedodontist. He served as a local mayor, a panelist on a weekly talk show and he was active in the Kiwanis Club. He was a husband (twice) and was a father. And, when I was growing up, he was my dentist. His office smelled like a dental office ought to (that’d be eugenol). He used a belt-driven handpiece and would snap his fingers when he wanted his assistant to push the button on the X-ray machine. After our appointments, he’d give us some sugarless candy. Back in those days, all kids got cavities (even, or maybe especially, orthodontists’ kids). I can clearly remember my last visit as a patient to his office just before I headed off to dental school. I was 22, and a young mother in the waiting room asked me which of the kids playing on the floor was mine. “None of them,” I said, “I’m here to get my own teeth cleaned.” On the way out the door, Dr. Powell told me, “John, when you get out there, they’re going to try to change out these fillings [composite was new on the scene], but don’t be in a hurry to do that — these are good fillings.” And he was FLORIDADENTAL.ORG
right. I still have every amalgam filling he ever placed in my teeth (there’s 10 in all), and so does my brother. When Tom Brokaw talks about the greatest generation of Americans, he means the men and women who grew up fighting World War II. Dr Powell was part of that, and he also was part of what I think of as the greatest generation in dentistry. He held the tradition of giving back to the profession and the philosophy of leaving a place in better shape than you found it. He served as president of the Orange County Dental Association (now the Dental Society of Greater Orlando), Florida Society of Dentistry for Children, Central Florida District Dental Association, and of course, the FDA. He was charter member of the Southeastern Society of Pedodontics and established the Orange County Dental Research Clinic that treats lowincome patients for free. In addition, he cochaired the successful campaign to fluoridate water in Orlando, and in retirement, he started a club for retired dentists that draws as many to meetings as the club for active dentists. All of us who practice in Florida should give thanks and appreciation for everything his generation did over many long years to make this great profession what it is.
DR. JOHN BEATTIE
Dr. Beattie is an orthodontist in Orlando and can be reached at jrbeattie2@aol.com. Editor’s note: Views and conclusions expressed in all editorials, commentaries, columns or articles are those of the authors and not necessarily those of the editors, staff, officials, Board of Trustees or members of the Florida Dental Association. For full editorial policies, see page 2. All editorials may be edited due to style and space limitations. Letters to the editor must be on topic and typically a maximum of 500 words. Submissions must not create a personal attack on any individual. All letters are subject to editorial control. The editorial board reserves the right to limit the number of submissions by an individual.
He’ll be remembered by many for his colorful sport coats and for his dedication to our profession. As for me, when you’ve known and admired someone all your life, you know you’re going to miss them when they’re gone. But I’ll always have a reminder of Dr. Powell every time I floss my teeth — those old 50-year-old amalgams in my molars. TODAY'S FDA MAY/JUNE 2020
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BOD meeting
FLORIDA BOARD OF DENTISTRY MEETS VIA CONFERENCE CALL The Florida Board of Dentistry (BOD) met via conference all on Friday, May 8, at 8 a.m. The BOD had to cancel its in-person meeting due to the COVID-19 pandemic, but still had to meet to conduct the necessary business of the board. However, the agenda was much lighter than if the BOD met in person. The Florida Dental Association (FDA) was represented by FDA BOD Liaison Dr. Don Ilkka and Director of Third Party Payer of Professional Affairs Casey Stoutamire. Another FDA member, Dr. Andy Brown, also was on the call. All the BOD members were present, which included: Dr. Naved Fatmi, chair; Dr. Nick White, CASEY STOUTAMIRE FDA DIRECTOR OF THIRD PARTY PAYER & PROFESSIONAL AFFAIRS
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. On April 27, the BOD held an emergency call to discuss the status of the administration of the dental licensure exam. Per Florida statute, the licensure exam must include a live-patient portion. However, representatives and students from Nova Southeastern University and University of Florida dental schools asked the BOD about the possibility of a one-time exemption to the live-patient component. Instead, students could take the new ADEX manikin exam administered by the
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.
Commission on Dental Competency Assessments (CDCA). This format uses the CompeDont™ DTX, a new manikin tooth technology developed by the CDCA and Acadental Inc. However, the BOD cannot suspend or change statute and thus, any exemption from the live-patient requirement on the licensure exam would require an executive order by the governor. To date, that has not happened. After much discussion, the BOD did pass the following motion: The BOD generally supports an executive order that would waive the live-patient requirement for the dental and hygiene exams during the COVID-19 pandemic. And the BOD supports the ADEX version for the non-live patient exam. On its May 8 call, the BOD did not take any new action on the above licensure exam issue. It did hear from many students and faculty from the three dental schools asking for guidance. However, the BOD took the only action it could on its April 27 call and now the final decision will be made by the governor.
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The next BOD meeting is scheduled for Friday, Aug. 21 at 7:30 a.m. EDT in Tampa. Mr. David Flynn, board counsel, updated the members on the
and one voluntary relinquishment dealing with failing to meet
status of several rule changes moving through the regulatory
the minimum standard of care and failing to keep adequate
process. As a reminder, the recently updated anesthesia rules
records. If you have not yet attended a BOD meeting, it is
are now effective. To read a summary of those changes as well
suggested that you take the opportunity to attend and see the
as the rules in their entirety, please visit bit.ly/3fF0CqZ.
work of the BOD. It is much better to be a spectator than a participant in BOD disciplinary cases.
There were two disciplinary cases, one informal hearing (hygiene license was revoked), one determination of waiver,
Your
BACKSTAGE
ALL ACCESS
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FDAS: Partnership
DID YOU KNOW... 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!
Call or text us at 850.681.2996 to learn more and apply or visit bit.ly/tdcquote to get an instant quote.
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THE TRIBUTE PLAN A decade ago, The Doctors Company created the Tribute® Plan to reward members for their loyalty and for their commitment to superior patient care. Their commitment to members is undeniable: They have paid more than $85 million to retiring doctors to date.
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TRUST YOUR COLLEAGUES WITH THE RIGHT CHOICE FOR COVERAGE “For years I was overpaying on my malpractice insurance! What a fool, The Doctors Company and FDA Services reduced my premium, making it a no-brainer to be part of the ADA and FDA.” — Dr. Athas Kometas
PARTNERSHIP
elder care
MARCHING FORWARD ON YOUR BEHALF
“
I know that what we experience in Florida when treating the elderly has a direct application to the rest of the nation.
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Violeta, Margarita and Estela were three sisters living together in Miami. They were intelligent women, all retired and filled with fascinating stories. It was my good fortune they chose my office as their dental home. I’ve always enjoyed treating a more mature population and was blessed with nurturing grandparents who had a significant impact on my life. All my elderly patients reminded me of the relationship I shared with my grandparents before they passed. Violeta, Margarita and Estela were not delicate flowers content to sit on the front porch in rocking chairs as their days passed. I often saw them out on the weekends and for example, when I asked them what they were doing in Home Depot, they would look at me like that puppy who’s not so smart and say, “Good doctor, why does anyone come to Home Depot? We have a leaky faucet.” Being older than their dentist was not the same as being too old to keep up their home. I had the privilege of being a part of these three sisters’ lives for many years. I told Violeta that on her 100th birthday I would come to her house to celebrate this milestone with her. So, when that day came, I left the office, stopped at the florist and bought some roses. When I arrived at her house, no one was home. I left the flowers and a card on the front doorstep. Later that evening I received a phone call from my dear Violeta. She asked me, “Doctor, were those your flowers? Thank you for remembering me on this special day.” I couldn’t help myself and I just had to ask, “Violeta, what does a 100-year-old do on her birthday that she is not home?” In her always sweet, loving and often witty voice she replied, “My dear doctor, I was celebrating, of course! My sisters, several friends and I went to the casino. We ate lunch and had a wonderful day. Thank you again for thinking of me and for your beautiful flowers. I look forward to seeing you soon.” I know that Violeta is only one of many experienced souls that call Florida home. I also know that not all of them are able to have the same doctor-patient relationship in a solid dental home that Violeta, her sisters and I enjoyed. That’s why I continue to treat the elderly. This life experience is in part why I was selected to chair the Elder Care Workgroup at the American Dental Association (ADA). I know that what we experience in Florida when treating the elderly has a direct application to the rest of the nation. As colleagues, sharing this knowledge and experience as we collaborate and inspire one another is why I feel honored to serve as your ADA trustee.
DR. CESAR SABATES
Dr. Sabates can be reached at sabatesc@ada.org. To assist in his campaign, please contact Dr. Mike Eggnatz, campaign manager, at dreggnatz@gmail.com. Campaign contributions can be made at Cesar2020.com or by check payable to Cesar R. Sabates Campaign Fund, and sent to 747 Ponce De Leon Blvd., Ste. 609, Coral Gables, FL 33134.
Florida dentists have a unique role in advancing our profession and healing our patients. Driven by our collective vision and marching forward on your behalf, I would be honored to serve you as the next president-elect of the ADA. Help me to become the first Floridan ever behind the president’s podium at the ADA. Join me in Orlando in October for this election at ADA FDC 2020. Your support is essential for victory, so please contact me and my campaign team about ensuring an exceptional future for dentistry together!
Dr. Cesar R. Sabates, ADA 17th District Trustee FLORIDADENTAL.ORG
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elder care
WHAT IS THE ELDER CARE WORKGROUP? In 2018, the American Dental Association (ADA) House of Delegates (HOD) directed the ADA president to appoint an ad hoc committee with relevant expertise to review and recommend updates to the ADA’s current policies, including the creation of a plan, timeline and comprehensive strategy to address elder care, including Medicare. The Elder Care Workgroup (ECW) consists of 14 ADA volunteer leaders with subject matter expertise from a variety of backgrounds, which includes Florida Trustee Dr. Cesar Sabates as chair. They have completed an extensive, broad-based, two-year mandate to search out the best solutions to the structural limitations of our complex health care delivery system and our societal priorities in America today. DR. MIKE EGGNATZ
Dr. Eggnatz can be reached at dreggnatz@gmail.com.
The ECW meetings were conducted via conference calls (before Zoom was fashionable) and in person. The first in-person meeting was June 1-2, 2019, the second was Oct. 5-6, 2019, and the third was March 28-29, 2020 via Zoom due to the emerging pandemic. A perceptive and early judgement call made by Dr. Sabates made it among the first in-person ADA meetings to be substituted by Zoom conference call. Florida has an exceptionally high stake in this matter. It’s the third largest state in the nation and has a population of 21 million people, with 21% of its residents age 65 or older. This group will grow nationally by nine percentage points from 2016 to 2060, making it the fastest-growing age group. By 2035, the number of seniors in the United States over 65 will be greater than the number of people under 18. The 2019 ADA HOD reauthorized the ECW to report to the 2020 HOD with a recommended Comprehensive Strategic Elder Care Policy. The ECW took the first comprehensive review of existing, and often conflicting, ADA policy dating back to 1979 with a deep dive into the existing barriers to care for all underserved groups and potential solutions to address those barriers. Since resources are finite, we wrestled with difficult questions, such as: Which cohorts are most in need of dental care? Is the criteria age, income or medical conditions? Should it be limited to the elderly? How many people need this care? Are there other cohorts who need similar considerations? What level of care could or should be given? Who should deliver the care and where? What vehicles (mechanisms) are at our disposal to deliver that care? What is the most efficient
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and cost-effective method to deliver that care? How should resources be allocated and by whom? How should that care be financed and by whom? Ironically, the current pandemic has publicly illuminated the health care disparities in our underserved communities economically and geographically, which has mirrored many of the ECW findings. It has exposed the extremes of inequity, access and politics across our country that has no easy or inexpensive solutions. The ECW recommendations will be presented for consideration and debate to the ADA HOD in October 2020, where we hope to elect Dr. Sabates as the next ADA President-elect. Among his many positive attributes, his inclusive leadership style on complicated and controversial subjects like elder care and Medicare in dentistry is vital for this position. Please support his campaign. If elected, he will be the first president-elect from Florida and will showcase our state on a national level.
FLORIDADENTAL.ORG
“
Florida has a population of 21 million people, with 21% of its residents age 65 or older.
�
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32
33
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Number of Persons 65+ 1900 to 2060 (numbers in millions)
98.2
100 MILLION 82.3
80 56.4
60
47.8
40
35 25.5
20 0
9
3.1
4.9
1900
1920
1940
16.2 1960
1980
2000
2015
2020
2040
2060
Source: U.S. Census Bureau, Population Estimates and Projections Percent distribution of total population
1987 to 2030
1.2 1.5
2.3 3.1 3.9
1.7 1.8
2.0 1.9
2.7 3.5
2.4 4.2
3.5
4.2
2.1 1.9
3.0 5.7
2.5 2.8 4.2 6.0
5.7 6.0
58.8
58.8
61.2
58.7
55.5
KEY 85 years or over 80–84 years 75–79 years 70–74 years 65–69 years 29.2
27.4
25.2
24.1
23.5
20–64 years Under 20 years
1987
2000
2010
2020
2030
Source: Social Security Administration
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Boomers bring change!
Of course, you have been treating boomers for a long time. But now, they are likely to make up a larger percentage of your practice. As they age, they will bring new challenges to you and your staff. ENDENTULISM RATE DECLINES IN U.S. 18.9%
4.9%
2.6%
1957-1958
2009-2012
2050
COMMON AILMENTS OLDER ADULTS EXPERIENCE
* *
Source: International & American Associations for Dental Research.
* * *
Your senior patients no longer expect to lose all of their teeth as they age. INDEPENDENCE & MOBILITY ADULTS AGE 65 AND OVER
5% INSTITUTIONALIZED
5% HOMEBOUND 17% MAJOR LIMITATION IN MOBILITY
* * *
Hearing loss Cataracts and refractive errors Back and neck pain Osteoarthritis Chronic obstructive pulmonary disease Diabetes Depression Dementia
Source: World Health Organization
(due to a chronic condition)
FLORIDA RESIDENTS
70% INDEPENDENT
(65 years and older population)
* Source: doi.org/10.14219/jada.archive.2007.0357
*
Sumter County had the highest percentage of residents aged 65 and older at 55.6%. Highlands and Palm Beach counties had the highest median ages at about 75 years. The U.S. median age is 73.2 years.
Source: 5-year estimates from the 2014-2018 American Community Survey, US. Census Bureau,census.gov/ newsroom/press-releases/2019/acs-5-year.html
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In treating common ailments, your senior patients may be taking medications that can affect oral health. XEROSTOMIA
* *
Affects 30% of patients who are 65 years old and older and up to 40% of those older than age 80. Dry mouth effects can lead to other ailments such as mucositis, caries, cracked lips and fissured tongue.
ROOT CARIES
*
About 50% of elderly individuals who are older than age 75 have root caries affecting at least one tooth and increased gingival recession that exposes root surfaces, as well as increased use of medications that produce xerostomia.
*
Of patients ages 75 to 84, 10% are affected by secondary coronal caries, likely because of the prevalence of restorations in these individuals.
PERIODONTAL DISEASE
* *
17.2% of seniors 65 and over have periodontal disease. 10.58% seniors 65 and over have moderate or severe periodontal disease.
Source:nidcr.nih.gov/health-info/for-older-adults
ORAL CANDIDIASIS
* *
The prevalence in hospital or institutional settings varies from 13 to 47% of elderly persons. Local factors include wearing dentures, impaired salivary gland function and poor oral health. Systemic factors include antibiotics and some other drugs, malnutrition, diabetes, immunosuppression and malignancies.
Geriatr Psychol Neuropsychiatr Vieil. 2011 Mar;9(1):21-8. doi: 10.1684/pnv.2011.0259 (French)
SENIORS ALSO HAVE A HIGHER RATE OF ORAL CANCER.
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Docor's Choie
SENIORS
We all have grandfathers, grandmothers, aunts, uncles, cousins and close relatives that we would consider “senior citizens.” Without a doubt, in most cases if you could provide dental services to your senior relatives at no or little cost to them, you would. The truth is that this population segment is the second most underserved part of the population, second only to infants up to 2 years of age. Eight years ago, we started a mobile business to take dental care into assisted living facilities and nursing homes to treat the seniors that were not getting any structured dental care. It’s been a chalDR. DON ILKKA
Dr. Ilkka is a general dentist in Leesburg, Fla. and can be reached at donjilkkadds@aol. com.
lenge. I didn’t know that you couldn’t just walk into a facility and announce you were there to see the residents and provide them dental care. It doesn’t work that way. As a company, we had to be invited into the facility, similar to the purveyor that sells them bananas. In private practice, our patients seek us out. In the business of bringing dental care to seniors in extended care facilities, we needed to sell ourselves to the administration first in order to be invited in to work there. Due to HIPAA, we’re not able to contact the resident or their power of attorney directly. Another interesting fact about senior care facilities is that the administration changes on a regular basis. It’s not uncommon to have the administration change three to four times a year. The nursing staff who we directly interact with also has a very high rate of turnover. This can interrupt the patient flow that we’ve already established. Aside from the frustrations mentioned, providing care to the residents is always a challenge as well. Our model is to take portable equipment into the facilities’ building and set up a dental operatory. This can be done in an empty resident room, the hair salon or the
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pub — yes, the pub. All our appointments are confirmed the day before with the facility, the resident and the power of attorney if needed. We work with a somewhat unique audience. They might have died during the night. Sometimes the resident decides for one reason or another they do not want to see the dentist. They may not want to get out of bed, or they may just not want to leave their chair. I cannot remember a day when the previously set schedule was the schedule that we worked. The one thing I will stress is that with all the craziness associated with the care of these seniors, the resulting interactions for the most part have been some of the most rewarding of my career. They tell the best stories! Some of their history is astounding. One of my patients was a driver for Gen. Dwight Eisenhower early in World War II, another worked on the atomic bomb. If you are a history nut like me, this is all great stuff! Working in my personal office, the average age of my patients is 70 years old. For 37 years, that average age hasn’t changed much. Seniors make great patients. They listen to what you say. They ask great questions. They are rarely late for appointments and miss appointments even more rarely. Best of all, they pay their bills on time. Seniors as a group are easy patients to work on. They have high expectations, but they can articulate them well and are not afraid to tell you if you are failing to achieve them. They love appointments first thing in the morning if possible, or the first appointment after lunch. I always give myself 10 extra minutes with them, as they love it when we spend a few minutes talking, especially if it’s about their grandkids or even my children, which they always ask about. Building that relationship with them is key as they are the world’s best referral source. If they like you, they tell all their neighbors, all their bridge, bowling, golf, choir and other friends about you. Unfortunately, the opposite is true as well. If they don’t like you, they tell everyone about that! Senior patients need more breaks to relax their jaws than younger individuals do. For large cases, schedule in time to give them a couple breaks. This makes them more comfortable and makes your life easier by not being stressed about running behind.
MAKE GREAT PATIENTS
“
Seniors make great patients. They listen to what you say. They ask great questions. They are rarely late for appointments and miss appointments even more rarely.
Seniors are a loyal patient base and a pleasure to see on a daily basis.
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Henry Schein
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medications
Medications and Dental Care of Your Older Patients
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Forty percent of older adults have not seen a dentist in the last year. Nineteen percent no longer have their natural teeth; of those with teeth, about 19% have untreated tooth decay and more than 70% have periodontal disease.
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Approximately 49 million Americans are 65 and older and that population will grow to 98 million in 2060. On average, a 65-year-old can expect to live another 19 years. Older adults are disproportionately affected by chronic conditions including diabetes, arthritis and heart disease, with 90% having one and 70% two or more. Multiple chronic diseases account for two-thirds of all health care costs and 93% of Medicare spending. The leading cause of death among older adults in the U.S. is chronic diseases.
PAMELA J. SIMS, PHARM.D., PH.D.
Dr. Sims recently retired as a professor in the Department of Pharmaceutical, Social and Administrative Sciences at Samford University McWhorter School of Pharmacy. She can be reached at pjsims@bellsouth.net.
Forty percent of older adults have not seen a dentist in the last year. Nineteen percent no longer have their natural teeth; of those with teeth, about 19% have untreated tooth decay and more than 70% have periodontal disease. This decline in oral health may require more aggressive dental procedures causing the patient to receive medications to control pain and provide sedation during the procedure, as well as manage infection and control pain following the procedure. Age-related changes in the GI tract may cause absorption of many medications to occur more slowly, delaying the onset of action and diminishing the peak effect. Using rapid-release oral formulations such as gel caps or oral disintegrating/dissolving tablets (ODTs), which deliver the drug transmucosally, can speed absorption resulting in a more rapid and increased effect. This can be particularly beneficial in providing mild or moderate sedation during a dental procedure and in managing pain. A reduction in the function of Cytochrome P450 enzymes, liver enzymes essential for the metabolism of many dental medications, causes the elderly to experience increased and prolonged effects of many medications compared to younger adults. Fat represents a greater percentage of body composition (even without weight gain), which can prolong the effects of many dental drugs. As a result, doses may need to be decreased and dosing intervals may need to be prolonged to provide safe treatment, especially during sedation, management of procedure-associated nausea or for pain management. Age-related reduced renal function may require the modification of doses of penicillin or cephalosporin antibiotics and NSAIDs. Diabetes is a primary factor for increased risk of infection and poor healing. Diabetics with certain cardiac risk factors for infective endocarditis or artificial joints should receive antibiotic prophylaxis for invasive procedures. NSAIDs should be avoided in patients in kidney failure or with a kidney transplant as well as patients taking ACE inhibitors (-pril drugs) or angiotensin receptor blockers (-sartan drugs) for hypertension or antiplatelet or anticoagulant medications. Because opioids are metabolized by the liver, they should be avoided or used cautiously in patients with liver disease or liver transplant. Tramadol and meperidine
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should be avoided in patients taking the selective serotonin reuptake inhibitors (SSRI) antidepressants. Patients with respiratory conditions like asthma or COPD should be carefully monitored during sedations for respiratory depression and nonopioid analgesics should be used, if possible, for pain management. If opioids are required, lower doses should be used.
In general, when caring for older adults, a good rule regarding medications is “start low and go slow.”
For patients taking beta-blockers (-olol drugs) for hypertension or arrhythmias, or antidepressants that block the reuptake of norepinephrine, it’s important to avoid vasoconstrictors in local anesthetics or use low concentrations (1:200) of epinephrine in the local anesthetic in small volumes to avoid increasing the patient’s blood pressure. For patients taking Selegeline for Parkinson’s disease or older phenothiazine antiemetics or antipsychotics, vasoconstrictors should be avoided during local anesthesia. For patients being treated for osteopenia or osteoporosis with antiresorptive medications like bisphosphonates or Denosumab, dental care should focus on good oral health by extracting failing teeth, assuring that removable dental appliances fit properly and treating periodontal disease early in therapy. With these dental conditions, the risk of osteonecrotic changes in the bone increases dramatically after the first two years of antiresorptive therapy. For older adults who take several different medications, it’s best to avoid administering or prescribing additional medications that can interact with the ones the patient is currently taking. The antibiotics Clarithromycin and Erythromycin and the antifungal Fluconazole are of particular concern. These anti-infective medications can prolong and increase the effects of other medications that are metabolized by the liver. For patients taking medications that cause sedation (i.e., skeletal muscle relaxants, opioids, phenothiazine antiemetics or antipsychotics, or anticonvulsants), patients should be carefully monitored for over-sedation and respiratory depression during dental sedations. For those same patients, pain management should employ nonopioid analgesia when possible. If opioids are required, lower doses should be used, and patients counseled regarding the risk of additive sedation and respiratory depression.
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donated dental services
FDA MEMBER CHANGES THE LIFE OF A FLORIDA SENIOR While researching online, Patrick found DLN and through the Donated Dental Services (DDS) Program was connected with Florida Dental Association member Dr. Marissa Whitehead. She extracted 23 broken teeth and donated a permanent set of upper and lower dentures. DENTAL LIFELINE NETWORK • DONATED DENTAL SERVICES
Our nation’s 65 and over population makes up a large part of our society — and a large part of our most vulnerable. Due to low income and often no coverage for dental care, many can’t afford treatment. Dental Lifeline Network (DLN) strives to close the gap by providing dental care to the elderly like Patrick. Patrick is a U.S. Army Reserve veteran who lives in Osceola County. After being discharged, he worked for a large telephone and mobile company in New York. Later, he moved to Florida to enjoy a warmer climate and spend time with his four children and five grandchildren. One of Patrick’s highlights is walking one of his granddaughters to school every day. Unfortunately, Patrick has multiple health issues, including blindness in his right eye, a deviated septum in his nose and coronary artery disease. Not too long ago, he had a triple heart bypass procedure. His insurance did not include dental coverage; his teeth were in bad condition and he only had three healthy teeth left. Every time Patrick ate, he felt pain while trying to chew. He survives on Social Security and a small pension and had no way to pay for the dental care he desperately needed.
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WHY THE DDS PROGRAM IS IMPORTANT TO DR. MARISSA WHITEHEAD After getting her dental degree in Fort Lauderdale, Dr. Whitehead elected to do a general practice residency in South Carolina and gained extensive experience in emergencies and treating medically compromised patients. She volunteers once a year with the Florida Mission of Mercy, but Dr. Whitehead wanted to do more with her skills to help people both physically and emotionally. “I don’t think that solely providing services to those in exchange for monetary fees is my true purpose. I enjoy being able to provide free care when I can!” said Dr. Whitehead. Dr. Whitehead loves being a part of the DDS program because she has the chance to see an entire case start to finish with the same patient. This program is important to her because of the immediate direct aid she can provide to someone truly in need in her community. “Being able to see Patrick’s condition improve along the way until it was finally complete was quite rewarding. Patrick was a wonderful man and was grateful for the help I provided,” said Dr. Whitehead.
FLORIDADENTAL.ORG
Dr. Marissa Whitehead with DDS patient Patrick.
Patrick was extremely appreciative of the dental care he received through the DDS program. “Working with Dr. Whitehead has been nothing short of spectacular. She is professional, thorough, knowledgeable and courteous. Since she is fantastic at making one feel at ease and answering all questions, I think that she deserves the highest possible ranking one can give. An AAA+! I appreciate the time and effort she has spent seeing me through every step along the way,” said Patrick.
FLORIDADENTAL.ORG
Dental Lifeline Network • Florida is part of a national organization, Dental Lifeline Network (DLN) and a strategic partner of the American Dental Association. More than 16,000 volunteer dentists and 3,500 laboratories participate in DLN’s DDS programs nationwide. For more information, visit DentalLifeline.org/Florida.
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digital 3D
THE DIGITAL 3D PRINTED DENTURE BENEFITS FOR CLINICIANS, LABS AND PATIENTS Additive (3D printing) manufacturing processes have become popular in the dental industry due to improvements of the CAD/ CAM software and hardware available, as well as the development of exciting new materials for many dental applications. I’ll outline the process and key benefits of producing a 3D printed denture.
JAMIE STOVER, CDT
Jamie Stover is the Senior Manager of Dental Lab Applications at Carbon and can be reached at jstover@carbon3d.com.
In mid-2019 Dentsply and Carbon announced the Lucitone Digital Print (LDP) denture, which is the first Food and Drug Administration-cleared, high impact and highly aesthetic 3D printed denture solution available on the market. Fabricated exclusively on Carbon 3D printers from a printable resin version of Lucitone 199, the LDP denture includes strong, aesthetic carded teeth (based on the popular IPN Portrait line of denture teeth) specifically designed for the digital design-print process. Converting Lucitone 199 to a printable resin had a positive side effect that Dentsply refers to as “BAM” — or body activated material — characteristics, meaning that when in the patient’s mouth and at body temperature, the LDP denture strength doubles to almost 3000 J/m2.
Benefits of Printed Dentures for Labs, Clinicians and Patients Printed denture fabrication brings many benefits at a critical time, as our industry faces a staggering shortage of dental lab technicians experienced with removable dentures.
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Printed denture production allows labs to transition these highly experienced technicians out of production roles at the bench and into roles as digital denture designers and quality control managers, digital removable consultants to assist clinicians with digital IQ and chairside technical consultants. And most importantly, as educators and trainers for the next generation of technicians with little or no practical removable knowledge or experience. A digital denture refers to the way the lab fabricates the denture and does not mean that a dentist is required to use an intraoral scanner to capture the impression digitally. Clinically, the impression and record gathering process doesn’t change, and a clinician can take a traditional polyvinyl siloxane impression and follow their normal denture protocol for capturing and sending denture records, such as using a bite block to record midline and vertical dimension of occlusion, for the lab. In the lab, impressions and bite records are scanned and converted to digital files, which are then imported into denture design software. The digital denture is designed and a monolithic try-in is printed and sent to the clinician/patient for approval. If no changes are required, the final design file is sent to the Carbon printer and the final denture base is printed. After post-processing and assembly is completed, the finished denture is delivered (Figs. 1-4).
FLORIDADENTAL.ORG
Figs. 1-4: Images show the design and fabrication of an LDP denture.
Fig. 1
Many Carbon labs report that the LDP denture fits more accurately than the traditional packed, acrylic denture and that the try-in step has proven unnecessary, so they are proceeding directly to the final denture. Nakanishi Dental Lab in Bellevue, Wash. is one such lab. Director of Operations Megan Nakanishi says, “The Lucitone Print Denture has proven to be so accurate that we now give our dental clients the option to skip the try-in step and proceed directly to the final denture delivery. This eliminates costly chair time for the clinician and an extra appointment for the patients, which they absolutely love.� Another massive benefit of LDP dentures is that the final design file can be stored by the lab so that in the event a denture is lost or needs to be replaced for any reason, there is no need to start over with a new impression and bite records. The lab accesses the design file, reprints the base, assembles a new final denture and delivers it. If the tissue changes substantially between the time the first and second denture are fabricated, the dentist can simply take a wash impression with the new denture in place and the lab can scan it, combine the data with the existing designed denture file, and reprint a new denture that fits the tissue perfectly.
Fig. 2
Fig. 3 Fig. 5: A finished LDP denture is polished and ready for delivery.
The digital revolution of our industry continues to provide exciting new ways for clinicians and dental lab technicians to collaborate more efficiently while providing patients with next-generation removable prostheses and restorations that improve lives. LDP dentures are a prime example of a powerful new application with positive impacts for clinicians, labs and patients. Fig. 4 FLORIDADENTAL.ORG
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Card Connect
DRS. ABDULAZIZ M. BANASSER*, NEEL BHATTACHARYYA, DONALD M. COHEN, AND NADIM M. ISLAM
A 57-year-old African American female presented to Dr. Dennis Connaughton of Eastern Florida State dental clinics for routine dental care when he noted a significant zone of “loss of pigmentation” on the upper lip (Fig. 1). The patient stated that the depigmented zone was slowly enlarging in size over the past 8 months on her upper lip. Recently the lesion had become aesthetically disconcerting and was clearly visible. The area was completely asymptomatic and did not bother the patient. She also had irregular melanotic macule-like lesions of the lower lip. She reported that there weren’t any other lesions elsewhere on her skin. Clinically, the lesion appeared as semi-circular depigmented macule 13 mm in greatest dimension involving the mucosa and outer aspect of the upper lip and was visible when she closed her lips in a normal position. The patient’s medical history was significant for systemic lupus erythematosus that was diagnosed 30 years ago. In addition, she had a history of hypertension and sinus allergies. She was on multiple medications, including prednisone, sertraline, losartan and amlodipine, as well as supplemental vitamins. Clinical assessment of the patient’s head and neck region didn’t reveal any similar manifestations.
Question: Based on the clinical findings, what is the most likely diagnosis? A. Post Inflammatory Hypopigmentation B. Idiopathic Guttate Hypomelanosis C. Vitiligo D. Sarcoidosis E. Discoid Lupus Erythematosus Fig. 1 SEE PAGE 60 FLORIDADENTAL.ORG
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diagnostics FROM PAGE 59
Diagnostic Discussion A. Post Inflammatory Hypopigmentation Incorrect, but a great consideration. According to the patient’s history, no major inflammatory or traumatic event has been reported regarding the affected area, which rules out this entity. Post inflammatory hypopigmentation (PIH) is a fairly common cause of acquired hypopigmented skin lesions. PIH is considered a sequelae of cutaneous inflammation, injury or dermatological treatment. Severity and distribution of the depigmentation is proportionate to the degree of inflammation. Major traumas such as thermal burns and freezing also have been linked to the development of depigmented macules. PIH is known to be more frequent and evident in darkskinned patients due to the color contrast with their normal skin. The condition can be temporary, where the affected area reverts back to its normal color once inflammation is controlled. However, it can be permanent if complete destruction of melanocytes occurs during the inflammatory event, such as second- or third-degree burns.
B. Idiopathic Guttate Hypomelanosis Incorrect, but a good guess! This condition rarely affects dark-skinned individuals. Idiopathic guttate hypomelanosis (IGH) is an asymptomatic benign skin condition that clinically manifests as diffuse hypopigmented macules or spots. These macules vary in size from 1-10 mm. This condition is most commonly seen in fair-skinned individuals. The etiology of this condition is still unclear. Several theories have been proposed, including it’s a normal aging process, or it occurs as a result of chronic cumulative sun exposure or as a result of continuous microtraumas to the skin. These lesions are reported to be seen more frequently in females, some studies related this prevalence to report bias due to higher cosmetic concerns in females compared to males. Contrary to the presentation of our patient, IGH lesions usually consist of multiple small-sized macules. IGH is a benign condition that harbors no malignant transformation potentiality. IGH lesions do not remit on their own, multiple methods of interventions have been used mainly for cosmetic reasons.
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C. Vitiligo Incorrect, but a great choice and essential addition to the differential diagnosis. Vitiligo is one of the most common causes of hypopigmentation. Depigmentation of vitiligo affects both skin and the mucosa and carries a big impact on quality of life. It has been reported that this condition affects 1-2% of the world’s population. Vitiligo is caused by disorder in the immune system in which the melanocytes of the epidermis are targeted by CD8 T-cells, leading to apoptosis of melanocytes and consequently depigmentation of the area. Clinically, patients with vitiligo show multiple defined hypopigmented patches of different shapes and dimensions, increasing in size and number with time. The condition is usually acquired in young patients. Studies reported 30% of patients acquire the disease before the age of 20, 14% before the age of 10, incidence decreases by aging with less than 10% by the age of 42 years. That fact makes it unlikely for our case to be categorized as vitiligo owing to the age of the patient when the symptoms first appeared. Oral involvement in vitiligo is not uncommon. Lips, labial mucosa, gingiva and buccal mucosa have been reported to be involved in cases of vitiligo. However, it is highly unlikely for oral lesions to be the solitary clinical presentation of vitiligo.
D. Sarcoidosis Incorrect, but an important consideration in the differential diagnosis given the race of the patient. However, solitary areas of hypopigmentation are rare especially in the skin of the head and neck without any other cutaneous involvement. Sarcoidosis is a multisystemic disorder that may affect almost any organ and system; therefore, it results in various clinical manifestations. Cutaneous sarcoidosis occurs in up to one-third of patients with systemic sarcoidosis. It has been reported in the United States that sarcoidosis is more common in African Americans. Skin lesions of cutaneous sarcoidosis show different variations that range from irregular hypopigmented shiny macules to nodules and papules. Unlike our case, skin lesions of sarcoidosis mostly affect limbs and trunk area. Another point of difference to our case is the distribution of the skin lesions, studies have shown that cutaneous manifestations of sarcoidosis often are extensive and florid, not solitary as in our patient.
E. Discoid Lupus Erythematosus Correct! Discoid lupus erythematosus (DLE) is the most common lesion seen in chronic cutaneous lupus erythematosus (CCLE). CCLE is a chronic autoimmune disorder associated with a variety of cutaneous manifestations in the setting FLORIDADENTAL.ORG
of systemic lupus. Frequently, lupus erythematosus can cause depigmented lesions of the skin. The presence of hypopigmentation is an important sign of this condition and patients often complain of expanding or enlarging depigmented zones, especially on sun-exposed areas. CCLE can occur in patients in both the presence or absence of systemic lupus erythematosus. Multiple theories have been advanced to explain the development of lupus, including genetic susceptibility, immune system damage and autoimmune induction. Lupus exhibits a strong female predilection specifically in the fourth and fifth decades of life. Discoid lupus lesions can be either generalized or localized, with the localized variant being reported to affect the head and neck area more commonly. It’s not uncommon for these lesions to affect mucosal sites, including genital, nasal, oral mucosa and lips. Clinically, discoid lupus lesions appear as well-demarcated erythematous macules, which subsequently can develop into indurated zones and transform into plaque-like areas. With time, these lesions become gradually more atrophic and exhibit depigmented centers and hyperpigmented peripheries. Physical trauma and sun exposure have been reported to further exacerbate the lesions. When these lesions affect the buccal mucosa, they can mimic lichen planus. However, the characteristic Wickham striae aren’t seen in lesions associated with lupus. Studies have shown that sun protection and smoking cessation are a successful management for DLE lesions. However, a systemic approach might be considered in refractory lesions. Squamous cell carcinoma of the skin has been reported in patients with lupus, including on the lips and the intraoral mucosa.
Related references: Vachiramon, V. and Thadanipon, K., 2011. Postinflammatory hypopigmentation. Clinical and Experimental Dermatology, 36(7), pp.708-714. Oakley, A., 2020. Idiopathic Guttate Hypomelanosis | Dermnet NZ. [online] Dermnetnz.org. Available at: <https://dermnetnz.org/topics/idiopathicguttate-hypomelanosis/> [Accessed 21 March 2020]. Brown F, Crane JS. Idiopathic Guttate Hypomelanosis. [Updated 2020 Jan 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan Aocd.org. 2020. Idiopathic Guttate Hypomelanosis - American Osteopathic College Of Dermatology (AOCD). [online] Available at: <https://www.aocd. org/page/IdiopathicGuttateH> [Accessed 21 March 2020]. Nagarajan, A, Masthan M, Sankar L, Narayanasamy A, Elumalai R, 2015. Oral manifestations of vitiligo. Ind J Dermatol, 60(1), p.103. Jacyk W,1999. Cutaneous sarcoidosis in black South Africans. Int J Dermatol, 38(11), pp.841-845.
Okon L and Werth V, 2013. Cutaneous lupus erythematosus: Diagnosis and treatment. Best Practice & Research Clinical Rheumatology, 27(3), pp.391404. Company-Quiroga J, Alique-García S, Romero-Maté A. Current Insights Into The Management Of Discoid Lupus Erythematosus. Clin Cosmet Investig Dermatol. 2019;12:721–732. Published 2019 Oct 3. doi:10.2147/CCID. S184824
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.
Kubba A, Patel A, Kubba R, 2013. Clinicopathological correlation of acquired hypopigmentary disorders. Indian J of Derm, Venereol, and Leprology, 79(3), p.376.
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career center The FDA’s online Career Center allows you to conveniently browse, place, modify and pay for your ads online, 24 hours a day. Our intent is to provide our advertisers with increased flexibility and enhanced options to personalize and draw attention to your online classified ads! Post an ad on the FDA Career Center and it will be published in our journal, Today’s FDA, at no additional cost! Today’s FDA is bimonthly; therefore the basic text of all active ads will be extracted from the Career Center on roughly the 10th of every other month (e.g., Jan. 10 for the Jan/Feb issue, March 10 for the March/April issue, etc). Please note: Ads for the Nov/Dec issue must be received no later than Nov. 1. Please visit the FDA’s Career Center at careers.floridadental.org.
Pediatric Dentist – Naples. Healthcare Network is seeking a Pediatric Dentist to join our team. Since 1977, our private non-profit Federally Qualified Health Centers have broken barriers to provide healthcare to our neighbors in need. Today, we proudly serve as a medical and dental home to approximately 50,000 patients throughout Collier County! As a patient-centered medical home, Healthcare Network is a resource for prevention, wellness and quality healthcare. Committed to treating the whole person in both mind and body throughout the life cycle our services include family care, children’s care, HIV/AIDS treatment, senior care, women’s care, dental care, pharmacy 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. Healthcare Network is accredited by AAAHC and certified as a Federally Qualified Health Center by HRSA. 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. Experience: Education/Training Level: Graduation from an accredited school of dentistry (DMD or DDS), Must maintain required CE credits to maintain licensure, Experience with nitrous oxide, oral sedation, IV sedation and/or general anesthesia preferred. Licenses & Certifications: Possession of a current Florida license to practice dentistry, Board Eligible/Board Certified in Dentistry, Board Certification in Pediatric Dentistry (or in current Residency for), Current CPR Certification in Basic Life Support, DEA License, Additional Certifications such as MPH, Ortho, Oral Pathology preferred. Communication Skills: Strong verbal and written communication skills, Bi-lingual in Spanish/ English and/or Creole/English preferred. Technology Skills: Understanding of and ability to use Electronic Dental Record, Experience with Denticon system preferred. NOTES: 3 openings. For more information, go to careers.floridadental.org/ jobs/13580647/pediatric-dentist. OFFICE FOR LEASE - Maitland. TURNKEY OPPORTUNITY. 1120 SQFT DENTAL OFFICE in Maitland area conveniently located on North Maitland Ave in a Medical/Dental/ Professional office complex. Walking distance to City center, Sun Rail station, and Restaurants. 4 operatory rooms. 3 rooms equipped with dental chairs and cabinets. Private Doctor’s office with private restroom, Break room, sterilization /Lab, attractive furnished waiting area, Plenty of parking space. Perfect for General Practice, Oral Surgery,Endo, Perio, and Prostho .Visit our site, mainland-dental.com You can email us at maitlandoffice1@gmail.com or 407-739-1910 for showing arrangement. Pediatric Dentist – North Miami Beach. Looking to hire a highly motivated pediatric dentist. Very relaxed and flexible environment. Dentist will be treating all the pediatric patients of the office. For more information, go to careers.floridadental.org/ jobs/13557008/pediatric-dentist. Coastal Central FL Practice for Sale or Partnership – Orlando. New to the market is an excellent general practice for sale in Coastal Central Florida. The current doctor has practiced in the community for over twenty years. They are looking to continue the growth of the practice by bringing on a partner or affiliating with a group. The growth is clearly shown with over 4,000 active patients and 65 new patients per
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month! Additionally, the real estate is for sale of the 2,400 square foot, free standing building. To learn more about this top-notch Floridian practice, read below: 6 fully equipped operatories, Massive expansion opportunity for an additional 6 ops, Collections over $2.2 million, Adjusted EBITDA $500,000, Real estate opportunity. Ready to learn more and review the prospectus? Contact Kaile Vierstra with Professional Transition Strategies via email: kaile@professionaltransition.com or give us a call: 719-306-8385. We look forward to hearing from you! Practice For Sale In Palm Beach County. Beautiful setup for all phases of multispecialty care. High tech all aspects. New network with upgraded workstations including Practice Management and Imaging. Four rooms for patient education and treatment. Upgraded amenities for desired patient experience. Motivated seller to ensure a smooth transition for buyer. For more information, go to careers.floridadental.org/ jobs/13541071/practice-for-sale-in-palm-beach-county. Pediatric Dentist – Naples. Healthcare Network is seeking a Pediatric Dentist to join our team. Since 1977, our private non-profit Federally Qualified Health Centers have broken barriers to provide healthcare to our neighbors in need. Today, we proudly serve as a medical and dental home to approximately 50,000 patients throughout Collier County! As a patient-centered medical home, Healthcare Network is a resource for prevention, wellness and quality healthcare. Committed to treating the whole person in both mind and body throughout the life cycle our services include family care, children’s care, HIV/AIDS treatment, senior care, women’s care, dental care, pharmacy 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. Healthcare Network is accredited by AAAHC and certified as a Federally Qualified Health Center by HRSA. 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 diagnose 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
FLORIDADENTAL.ORG
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. Experience: Education/Training Level: Graduation from an accredited school of dentistry (DMD or DDS), Must maintain required CE credits to maintain licensure, Experience with nitrous oxide, oral sedation, IV sedation and/or general anesthesia preferred. Licenses & Certifications: Possession of a current Florida license to practice dentistry, Board Eligible/Board Certified in Dentistry, Board Certification in Pediatric Dentistry (or in current Residency for), Current CPR Certification in Basic Life Support, DEA License, Additional Certifications such as MPH, Ortho, Oral Pathology preferred. Communication Skills: Strong verbal and written communication skills, Bi-lingual in Spanish/ English and/or Creole/English preferred. Technology Skills: Understanding of and ability to use Electronic Dental Record, Experience with Denticon system preferred. For more information, go to careers.floridadental.org/jobs/13535067/ pediatric-dentist. Part-time Dentist – Lake Mary. Come join a thriving private, general dental practice looking for a part-time to potentially, full-time 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 407-340-2768 for more information.
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Dental Faculty (Dentist) (195 Contract Days). Eastern Florida State College is currently seeking applications for a full-time Dental Faculty (Dentist) for both the Dental Assisting and Dental Hygiene programs on the Cocoa Campus in Cocoa, Florida, starting August 2020. This is a tenure track position. The following minimum qualifications for this position must be met before any applicant will be considered: Doctor of Dental Surgery (DDS) or Doctor of Dental Medicine (DMD) from a regionally accredited institution. Current Florida Dental license. Current Basic Life Support Provider (CPR/AED) certification. Certified in Nitrous Oxide Administration. Six years of current Dental experience. Previous teaching experience preferred. Valid Florida Motor Vehicle Operator’s license required. Reasonable accommodations may be made to individuals with disabilities unable to obtain a driver’s license. In such cases, a valid Florida I.D. is required. This position will require successful fingerprinting and the candidate chosen will be required to pay the associated fee (currently $37.25). This fingerprinting fee ($37.25) is non-refundable. Understanding of and commitment to Equal Access/Equal Opportunity. Official transcripts of all collegiate work will be required to be considered beyond the application phase. * High school or GED diplomas or transcripts or official transcripts of all collegiate work (as appropriate for the position) must be sent directly from the attended institution to the Human Resources Office. All foreign degrees must have a course-by-course official evaluation and translation sent to the Human Resources Office directly from an evaluation company affiliated with the National Association of Credential Evaluation Services, Inc. NOTES: Additional Salary Information: Full-time employees of Eastern Florida State College receive fringe benefits including health insurance and a retirement plan. Applications will be accepted from April 29, 2020, through May 31, 2020; however, the College reserves the right to extend or conclude searches without notice. Applications must be submitted prior to 5:00 p.m. on the closing day. Please complete an employment application at: easternflorida.edu/administrationdepartments/human-resources/employment-needs-opportunities/employmentopportunities.cfm
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TODAY'S FDA MAY/JUNE 2020
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off the cusp
I’M NOT OLD, I’VE JUST BEEN AROUND FOR A WHILE JOHN PAUL, DMD FDA EDITOR
Dr. Paul can be reached at jpaul@bot.floridadental.org
If we’re lucky, we all get older. I’m not saying I’m coming along willingly, but it seems to beat the alternative. I have two sisters born two and four years after me, but I contend that I’m younger. I remind them — often — that I cannot be older than them because I don’t have kids who can drive, Grandma. Those two beautiful children in the photo on this page are 6 and 12, and that definitely provides a different perspective on this journey around the sun. While many of my friends are taking trips and trying to figure out what to do with their child’s empty room, I’m surrounded by Barbie dolls and building swing sets. So, despite the gray in my beard, I’m obviously younger than my friends as well. We all practice in Florida, and I more specifically in Polk County. This means that like that boy in “The Sixth Sense,” I see old people. I see some folks whose bodies are treating them quite poorly, some who have decided they are near the end and should behave in certain ways, and some who just happen to be high mileage. Practicing geriatric dentistry used to mean you made a lot
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of dentures. Now it more likely means you are a learned chemist because, by volume, your patients put more pills in their mouth at breakfast than bacon and eggs. They stand a greater chance than ever to have most if not all of their teeth. Because they worked hard and saved their money to retire in Florida, they’re also just as likely to be asking you about veneers as they are dentures. When I first started practicing, patients asked me if I was old enough to be a dentist. My usual reply was, “No, but the state of Florida gave me a license, so I’m gonna do it anyway.” Nobody asks me that anymore. The gray creeping into my beard suggests the salad days of my youth are behind me, but I don’t feel it yet. If I could ask my dad one question, I’d want to know if he ever looked in the mirror and saw an old man looking back. The face I see is older, but certainly not old. I’m not so vain as to dye my beard, but I’m holding an ace up my sleeve. Clean shaven, I look about 10 years younger and I keep a set of clippers and a razor near that lying mirror.
P.S.: As I write this, we’re in the middle of a government-imposed, six-week vacation due to the coronavirus pandemic. When this is over, and we come back to some form of normal dental practice, one thing we should bring forward is that our older patients are a bit more susceptible to most of the communicable diseases floating through our airspace. They trust us not only to provide high quality dental care, but also to do it in a manner that keeps them safe from harm. That’s a trust we honored when we took the difficult measure of complying with the governor’s order to close our practices to nearly all the things we do to provide for our families because we couldn’t protect our patients. It’s a trust we’ll have to continue to earn as we find how to best practice in the post-crisis era.
JOHN PAUL, DMD, EDITOR, TODAY'S FDA
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