2017 - May/June TFDA

Dentist of the Year Lease Negotiation Exhibitor Marketplace Cutting Edge

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ELIZABETH GESENHUES VOL. 29, NO. 3 • MAY/JUNE 2017

TRY MY AGENT “

FDAS and The Doctors Company have excellent support staff and outstanding customer service. They are always ready to answer any questions and concerns. Having retired after 28 years of active practice and becoming a full time faculty member, the Tribute award was a bonus that I will use for a nice vacation.

“

- George Kolos, D.M.D.

Make sure you REVIEW before you RENEW!

FDA Services Board of Directors, FDA Trustee, NOVA Southeastern Univeristy Assistant Professor

If it’s time to renew your professional liability policy, make sure you check out The Doctors Company for better rates and coverage options!

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contents 46 Dentist of the Year Dr. Elizabeth Gesenhues

news

literary

16

20 Letter to the Editor

news@fda

f e at u r e s 24 FLA-MOM 2017 - A Special Thank You to Our 2017 Benefactors

columns 3

Staff Roster

5

President’s Message

30 Leveling the Playing Field in Your Next Office Lease Negotiation

8

Legal Notes

13

Did You Know?

36

FDC2017 Speaker Preview — Ms. Helen Davis

15

Information Bytes

40 FDC2017 Speaker Preview — Mr. Don Yaeger

69

Diagnostic Discussion

42 Exhibitor Marketplace

80 Off the Cusp

28

FDAS Highlighted — Carrie Millar

46

Dentist of the Year: Dr. Elizabeth Gesenhues

52

A Table of Information on Drug-induced Osteonecrosis of the Jaws

58

Your Own Dojo

60 Cutting Edge

classifieds 74 Listings

67 How to Make a Difference with Dental Lifeline Network • Florida

Read this issue on our website at:

www.floridadental.org.

www.floridadental.org

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

May/June 2017

Today's FDA

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FLORIDA DENTAL ASSOCIATION

L A C LO Y L E V & LI

GATHER FOR FUN & CONTINUING EDUCATION IN YOUR DISTRICT. 2017 WCDDA ANNUAL SUMMER MEETING FRIDAY-SUNDAY, AUGUST 3-6, 2017 RITZ-CARLTON NAPLES Speakers: Jim Van Allen – The Energy Bus: Creating Positive Leaders; Dr. Roberta Pileggi – Management of Dental Trauma: An Interdisciplinary Approach; Dr. William Robinson – Medical Errors in Dentistry; Dr. Glori Enzor and Special Agent, Terry Thomas – Domestic Violence, www.wcdental.org • 813.654.2500 • kelsey@wcdental.org

MAY/JUNE 2017 VOL. 29, NO. 3

EDITOR Dr. John Paul, Lakeland, editor

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

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

2018 NWDDA ANNUAL MEETING

FRIDAY & SATURDAY, FEB. 2-3, 2018 THE GRAND SANDESTIN www.nwdda.org • 850.391.9310 • nwdda@nwdda.org

2018 ACDDA WINTER CONFERENCE

FRIDAY, FEB. 23, 2018 EMBASSY SUITES, WEST PALM BEACH • 561.968.7714 Wantwww.acdda.org free course tuition at FDC?” • acdda@aol.com

2018 CFDDA ANNUAL MEETING

FRIDAY & SATURDAY, MAY 4-5, 2018 HILTON DAYTONA BEACH RESORT Speakers: Dr. Gerard Kugel – Adhesive Dentistry & Bioactive Materials, The Dos and Don’ts of Porcelain Laminate Veneers; Dr. Howard Chasolen – The Seamless Integration of Aesthetics, Form, and Function: The Restorative/Periodontal Interface

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

WANT FREE COURSE TUITION AT FDC? Sign up to be an FDC speaker host!

For more information, go to www.floridadentalconvention.com/education/ speaker-host. *Only FDA and ADA members, FDA and ADA team members and ASDA students are eligible.

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

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

Periodical postage paid at Tallahassee, Fla. and additional entry offices. Copyright 2017 Florida Dental Association.

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

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

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

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

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

Advertising must be paid in advance.

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

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

FLORIDA DENTAL ASSOCIATION FOUNDATION

EXECUTIVE OFFICE

(FDAF)

Drew Eason, Executive Director deason@floridadental.org 850.350.7109

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

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

ACCOUNTING Jack Moore, Director of Accounting jmoore@floridadental.org 850.350.7137 Leona Boutwell, Finance Services Coordinator Accounts Receivable & Foundation lboutwell@floridadental.org 850.350.7138 Deanne Foy, Finance Services Coordinator Dues, PAC & Special Projects dfoy@floridadental.org 850.350.7165 Mitzi Rye, Fiscal Services Coordinator mrye@floridadental.org 850.350.7139 Stephanie Taylor, Membership Dues Coordinator staylor@floridadental.org 850.350.7119

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

Meghan Murphy, Program Coordinator mmurphy@floridadental.org 850.350.7161

FLORIDA DENTAL CONVENTION (FDC) Crissy Tallman, Director of Conventions and Continuing Education ctallman@floridadental.org 850.350.7105

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

Elizabeth Bassett, FDC Exhibits Planner ebassett@floridadental.org 850.350.7108

Debbie Lane, Assistant Manager – Service & Technology debbie.lane@fdaservices.com 850.350.7157

Brooke Martin, FDC Meeting Coordinator bmartin@floridadental.org 850.350.7103

Allen Johnson, Accounting Manager allen.johnson@fdaservices.com 850.350.7140

Jennifer Tedder, FDC Program Coordinator jtedder@floridadental.org 850.350.7106

Alex Kline, FDAS Marketing Coordinator arey@fdaservices.com 850.350.7166

GOVERNMENTAL AFFAIRS

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

Joe Anne Hart, Director of Governmental Affairs jahart@floridadental.org 850.350.7205 Alexandra Abboud, Governmental Affairs Coordinator aabboud@floridadental.org 850.350.7204 Casey Stoutamire, Director of Third Party Payer and Professional Affairs cstoutamire@floridadental.org 850.350.7202

INFORMATION SYSTEMS Larry Darnell, Director of Information Systems ldarnell@floridadental.org 850.350.7102 Rachel Burch, Computer Support Technician rburch@floridadental.org 850.350.7153

Tessa Daniels, Membership Services Representative tessa.daniels@fdaservices.com 850.350.7158 Liz Rich, Membership Services Representative liz.rich@fdaservices.com 850.350.7171

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

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

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

Mike Trout Director of Sales North Florida

Marcia Dutton, Receptionist marcia.dutton@fdaservices.com 850.350.7145

904.249.6985 Cell: 904.254.8927 mike.trout@fdaservices.com

Porschie Biggins, North Florida Membership Services Representative pbiggins@fdaservices.com 850-350-7149 Maria Brooks, SFDDA Membership Services Representative maria.brooks@fdaservices.com 850.350.7144 Eboni Nelson, CFDDA Membership Services Representative eboni.nelson@fdaservices.com 850.350.7151

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

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

Melissa Staggers, WCDDA Membership Services Representative melissa.staggers@fdaservices.com 850.350.7154

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

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

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

Christine Mortham, Membership Concierge cmortham@floridadental.org 850.350.7136

www.floridadental.org

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

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

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What is the FDA Mentorship Program?

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N M OW N EM R E TO BE EC W R R !

M D UI EN EN TI TO TI NG R. STS

mentorship program

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Who Participates?

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The mentors are FDA member dentists who volunteer their time and experience to provide professional guidance to dental students. All member dentists are encouraged to participate as mentors. A select number of dental students (depending on the number of mentors available) from each Florida dental school (LECOM, Nova and UFCD) will be able to participate as proteges.

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What Does It Involve?

The online mentoring program has been designed with the needs of the student and busy dentist in mind.

Connecting is easy: 1. Member dentists can volunteer by completing a quick and easy online form at floridadental.org/ mentors.

2. The protege will select a mentor from the bios available at floridadental.org.

3. The protege will contact the mentor directly via email.

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The Florida Dental Association (FDA) Mentorship Program was developed by the FDA Council on the New Dentist as a resource to help dental students gain a practical and professional perspective from established member dentists.

4. The mentor will contact the FDA Director of Member Relations, Kerry Gomez-Rios, to inform the FDA that he/she has accepted a protege.

If at any time a change in the mentor/protege relationship is needed, please contact Kerry GomezRios at membership@floridadental.org.

Questions?

For more information, contact Kerry Gomez-Rios at membership@floridadental.org.

hip gui ns

PRESIDENT’S MESSAGE BILL D'AIUTO, DDS

On the Shoulders of Giants Like most of the Florida Dental Association’s (FDA) presidents before me, we tend to start off our final “President’s Message” commenting on how fast the year has gone by or how we can’t believe it’s about to be over, etc. Well, it’s all true, and the reason is predominately twofold: The office of FDA president is packed full of scheduled events, assorted meetings, speeches to write and deliver, seemingly endless conference calls to chair, and politicians to contact and educate on the issues important to the dental profession — all while trying to practice dentistry in the way our patients have come to expect. What also tends to be disclosed is how much fun it is to be plugged into our members’ desires to forge an ever-broadening view of how they see the future of dentistry heading. Believe me — this makes time fly!

I’d like to share with you that I am writing this last presidential article for the third time now. My first endeavor was entitled, “The Name Means ‘of Help,’” as I have been consistently reminded by my friend and South Florida colleague, Dr. Carlos Sanchez, that in Italian, “D’Aiuto” means “of help.” He’s also forever reminding me that I pronounce my last name incorrectly, and he is profoundly accurate, but I had little to do with that — the pronuncia-

“

Leadership is not a popularity contest — leadership is action!

tion was Americanized 80 years ago! The second stab at this last message was entitled, “The Memoirs of a Parrot Head” — the reason I came to Florida in the first place. Yes, Jimmy Buffet had something to do with that … indirectly, of course.

However, this third and final rendition comes by current events and probably by fate itself.

Like many of you, I have been influenced by mentors throughout the years in and outside of

”

the profession who have changed the course of my track through dentistry and with it, life’s journey itself. It is with the recent passing of one of these mentors and giants in our association that I tossed the first two messages for a “Special Commemoration to All the Giants of this Profession” upon whose shoulders we stand. For to forget those who came before us to forge this proud profession is to forget who we are and why we are here in the first place.

I am speaking about the passing of my dear friend and mentor, Dr. Clifford Marks, a past president of the FDA and first American Dental Association (ADA) Trustee to the newly Please see PRESIDENT, 7

www.floridadental.org

May/June 2017

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benefit

NUMBER

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FLORIDA DENTAL CONVENTION GAYLORD PALMS RESORT & CONVENTION CENTER ORLANDO, FLORIDA SATURDAY, JUNE 24 • 12-1:30 PM

YOUR FDAS STAFF IS “HELPING MEMBERS SUCCEED” EVERYDAY!

PROFESSIONAL STAFF I help members succeed by providing exceptional customer service.

As a knowledgeable representative, I make informed suggestions about insurance options and services members may not be aware of. I like to give members the peace of mind that comes with knowing they have the insurance coverage needed to protect themselves and their businesses.

– Carol Gaskins, FDAS Assistant Membership Services Manager

Have a question about insurance?

800.877.7597 • 850.350.7159 • carol.gaskins@fdaservices.com www.fdaservices.com

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PRESIDENT from 5

formed 17th District of the ADA. In 2000, Cliff helped forge Florida’s identity as a single-state district within the ADA structure. We became the sixth state to be its own autonomous dental district. A heavy lift, to say the least, after many, many years of being a part of a multi-state district. Pulling away from a multi-state district to form our own identity came at a high price and required the calm and measured leadership style of a diplomat — that was the Dr. Marks that I knew. Perhaps, the greatest moment that I remember regarding Dr. Marks’ leadership strength was when he proposed that the FDA form its own PPO in 1992. Not 2002 or even 2012 — but 1992! He was that much ahead of the curve. At the December 1992 FDA House of Delegates, where the idea was formally proposed, members from around the state lined up like the Rolling Stones were in town to protest their outrage of such a proposal! Twenty-five years have passed and I often have wondered, “What if it had passed?” Clifford Marks knew what few ever realize. Leadership is not a popularity contest — leadership is action! Clifford’s proposal in 1992 signaled the dawning of a new day, and forecasted that a “meteor of change” was quickly approaching. Dr. Marks, thank you for taking the charge of leadership to heart and risking the slings and arrows of outrageous fortune on our behalf. I join the many members who knew you and grew under your tutelage and guidance to celebrate your life and contributions to our future. You will be missed, but your legacy lives on.

In 1988, I met an aging Dr. L.D. Pankey at his institute in Key Biscayne. He did not spend a long time with our C1 class, as his health was failing, but before he left us, he said something like this: To live a fulfilled life, you must like what you do, for if you don’t, you are a fool. If you like dentistry for the money and do not like helping people, you are an even bigger fool.

My greatest gift from the dental profession has come from helping people and putting their needs and desires first; when you do, all else will surely come. I challenge all of us to do the same.

It is on the shoulders of giants that we move forward. Please take the time to thank the giants in your life — those mentors who have impacted you.

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

www.floridadental.org

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Legal Notes

How Well Do You Know the Board of Dentistry Disciplinary Process? Part 4 Graham Nicol, Esq., HEALTH CARE RISK MANAGER, BOARD CERTIFIED SPECIALIST (HEALTH LAW)

STEP 6: The Investigative Process It’s during the investigative phase that doctors must especially be aware of their legal rights. Generally, you will be given notice of the investigation. You are entitled to a copy of the complaint.

TIP: Immediately request the complaint and all attachments in writing or else you will not get them.

First contact usually will be in the form of a letter or phone call from a Department of Health (DOH) investigator. It may imply that you must respond in writing to the investigator. It may ask that you contact the investigator by telephone to set up an interview time. More often, they will intentionally call you at the most inconvenient time or show up at the busiest time of the day and flash their badge to rattle your cage because someone who is upset is much more likely to incriminate themselves than a lawyer who deals with investigators every day.

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TIP: Some investigators may take the opposite strategy and convince you they’re your friend, that “it’s no big deal” or that they “just need to hear your side of the story in order to clear you.”

TIP: You are not legally required to respond to the investigator. You have the right, but not the duty, to submit a written response.

A response is not mandated.

TIP: Even though Florida law treats licensure discipline as “quasi-criminal,” investigators are under no obligation to tell you your rights. You have rights that you probably don’t even know about, but there is no right to a Miranda warning.

TIP: What you think is innocuous or meaningless may end up being critical. Remember, the DOH must prove every single element of the counts against you to prevail. If you give them records, you have made them admissible as evidence against you and have waived any right to object. If you acknowledge that you treated the patient, then the state no longer has to prove this element via a witness.

TIP: Under section 456.073(1), Fla. Stats., dentists have 20 days from the notice to submit a written response. Physicians have 45 days. A written response is crucial because it must be considered by the Probable Cause Panel (PCP) and will be one of your only opportunities to tell your side of the story.

TIP: Some investigators are more creative than others. For example, if you are told that you are not the “target” of the investigation, that they “just need a few records,” or they want to ask you “just a few simple questions to clear you,” then be on high alert.

If you volunteer answers, medical records or reimbursement information, you may have given away documents or damaging information that might otherwise have been protected. Once the information has been given away, you have waived any available objections. You do not want to obstruct justice, but at the same time, you want to force the government to prove the allegations against you.

TIP: Do not ask questions of or expect help from the investigator, the DOH or the Board of Dentistry (BOD). At this point, they are your adversaries, so go to your lawyer, not the government if you have questions. Only your lawyer is there to protect you — no one else.

TIP: Investigators go by all different types of titles. For example, they could call themselves auditors, surveyors, special agents, compliance officers, quality assurance investigators or medical malpractice investigators.

TIP: If their credentials use the word “integrity,” you are being investigated for fraud. If they carry a gun, you are being investigated for criminal activity, so guard against “civil forfeiture” of your assets.

www.floridadental.org

Legal Notes

TIP: Never write your own response to the investigator and never agree to an interview.

It’s always appropriate to politely decline any request for interviews until legal counsel has been consulted. The reason a police officer always asks, “Do you know why I pulled you over?” is to get you to make an admission or a declaration against interest.

In plain language, they want you to confess by responding, “Because I was speeding.”

Respond to a DOH investigator the same way you would respond to the police investigating you. You have the right to remain silent — and it’s usually the best strategy.

It is human nature to try to explain your side of the story when accused — do not fall for this trick and be extremely wary of talking to the investigator. DOH investigators are former law enforcement officers trained on how to get confessions. Some may appear friendly and reassuring. Others can be intimidating. Regardless, most have no medical background at all and will not understand you when you try to explain standard of care to them. Further, they have no authority to dismiss the case against you.

Most dentists are not trained advocates and therefore, will feel intimidated or lured in by the tone and manner of the investigator’s questioning. Nor will they know when an appropriate evidentiary objection should be made.

TIP: You want your lawyer to respond in writing. The response will be addressed to the investigator, but your lawyer is writing it to be read by the department’s attorneys and medical experts. While a verbal response (other than a confession) will probably not be written down by the investigator, your lawyer’s written response is the only thing that will travel with the investigator’s report and it is crucial to balance the investigator’s recommendation to the PCP. www.floridadental.org

TIP: The response should not try to blame someone else (unless you can prove it). Rather, the response should: q focus on factual errors and inconsistencies in the complaint. q be objective. q emphasize the training and credentials of the licensee. q recite an accurate chronology of events. q attach scientific literature and affidavits from fact or expert witnesses supporting your treatment. q lay the groundwork for challenging the discipline under either section 120.569 or section 120.57, Fla. Stats., and set out any mitigating factors.

Under Rule 64B5-13.005(2), Fla. Admin.

Code, the BOD must consider the following as aggravating or mitigating circumstances: q danger to the public q number of specific offenses q prior discipline q length of practice q actual damage caused and its reversibility q deterrent effect q effect on the licensee q rehabilitation efforts by the licensee q actual knowledge that it was a violation q attempts (or refusals) by the licensee to correct or stop the violation q any other aggravating or mitigating circumstances (e.g., health conditions, patient non-compliance, location of service and availability of equipment, etc.)

TIP: Section 456.073(10), Fla. Stats., gives your lawyer a second chance to respond in writing once the investigation is concluded, but he or she must ask for it. Always ask for it because your first response will only have the allegations in the Administrative Complaint (AC). In contrast, your second

response will include not only the AC, but also the investigator’s report as well as the expert witness opinions. This statute provides: Upon completion of the investigation and a recommendation by the department to find probable cause, and pursuant to a written request by the subject or the subject’s attorney, the department shall provide the subject an opportunity to inspect the investigative file or, at the subject’s expense, forward to the subject a copy of the investigative file. Notwithstanding s. 456.057, the subject may inspect or receive a copy of any expert witness report or patient record connected with the investigation if the subject agrees in writing to maintain the confidentiality of any information received under this subsection until 10 days after probable cause is found and to maintain the confidentiality of patient records pursuant to s. 456.057. The subject may file a written response to the information contained in the investigative file. Such response must be filed within 20 days of mailing by the department, unless an extension of time has been granted by the department.

Agency investigators also must follow procedural rules set forth in section 120.62, Fla. Stats.: Every person who responds to a request or demand by any agency or representative thereof for written data or an oral statement shall be entitled to a transcript or recording of his or her oral statement at no more than cost. Any person compelled to appear, or who appears voluntarily, before any presiding officer Please see LEGAL,10

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Legal Notes

LEGAL from 9

or agency in an investigation or in any agency proceeding has the right, at his or her own expense, to be accompanied, represented, and advised by counsel or by other qualified representatives.

TIP: At the Division of Administrative Hearings (DOAH) trial or a District Court of Appeal (DCA) appeal, your credibility as a witness can be impeached by “prior inconsistent statements.”

Before you testify at trial or on appeal, always review what you said during the investigatory phase so you don’t contradict yourself. Unless you have a fantastic memory while under stress, how can you do that effectively if you haven’t exercised your right to have a transcript?

TIP: Often, it is the coverup or the lie that will get you in far more trouble than the underlying charge against you. If you lie or alter your records, you should, at best, expect a count of fraudulent misrepresentation or a records violation; at worst, expect to be tried for perjury.

STEP 7: Subpoena Authority Sometimes the investigator or attorney prosecuting the disciplinary case will simply request production of records from the licensee via a letter. However, section 456.071, Fla. Stats., clearly gives the investigator general authority to subpoena your records and compel your testimony: For the purpose of any investigation or proceeding conducted by the department, the department shall have the power to administer oaths, take depositions, make inspections when authorized

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by statute, issue subpoenas which shall be supported by affidavit, serve subpoenas and other process, and compel the attendance of witnesses and the production of books, papers, documents and other evidence. The department shall exercise this power on its own initiative or whenever requested by a board or the probable cause panel of any board.

When the patient is the complainant, they usually sign an authorization to release records to the DOH, and if you don’t comply voluntarily, the DOH will then subpoena the records under section 456.071, Fla. Stats. But what happens if the patient has not signed an authorization to release records to the DOH because they are missing, uncooperative or dead? In that situation, the DOH can still get your medical records if the allegations concern improper prescribing, standard of care, fraudulent billing, kickbacks or patient-brokering, and they establish “reasonable cause” under section 456.057(8), Fla. Stats.: The department may obtain patient records pursuant to a subpoena without written authorization from the patient if the department and the probable cause panel of the appropriate board, if any, find reasonable cause to believe that a health care practitioner has excessively or inappropriately prescribed any controlled substance specified in chapter 893 in violation of this chapter or any professional practice act or that a health care practitioner has practiced his or her profession below that level of care, skill and treatment required as defined by this chapter or any professional practice act and also find that appropriate, reasonable attempts were made to obtain a patient release.

The department may obtain patient records, billing records, insurance information, provider contracts and all attachments thereto pursuant to a subpoena without written authorization from the patient if the department and probable cause panel of the appropriate board, if any, find reasonable cause to believe that a health care practitioner has submitted a claim, statement or bill using a billing code that would result in payment greater in amount than would be paid using a billing code that accurately describes the services performed, requested payment for services that were not performed by that health care practitioner, … received a kickback as defined in s. 456.054, (or) violated the patient brokering provisions of s. 817.505 …

Enforcement Under subsection 120.569(2)(k)(2), Fla. Stats., if you do not comply with a lawfully issued subpoena (e.g., you simply ignore it or indicate your refusal to comply with it), then the DOH may file a petition to enforce the subpoena in circuit court. If the court orders the subpoena is valid, then you are in contempt of court for not complying.

TIP: The prevailing party (you, if the subpoena is quashed; DOH, if it isn’t) is entitled to attorney fees and costs incurred in the circuit court litigation.

STEP 8: Challenging a DOH Subpoena Subsection 120.569(2)(k)(1), Fla. Stats., outlines the procedure to challenge subpoenas. This is done through filing a Motion to Quash or a Motion for Protective Order. Typical grounds for challenging a

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Legal Notes

subpoena are that the subpoena was not lawfully issued (e.g., it was not signed properly); it was not properly served (e.g., your employee lacked authority to accept service of process); it is being issued for an improper purpose (e.g., to harass or delay); it is unreasonably broad in scope; it requires the production of irrelevant material; it is filed for frivolous purposes; or, it needlessly increases the cost of litigation. You also may challenge a subpoena on U.S. Constitutional grounds as well as under Article I, section 12 (searches and seizures) and section 23 (right of privacy) of the Florida Constitution.

TIP: Before you provide anything to the government in response to a subpoena or a request for production, you should have your lawyer review both the subpoena and the records you intend to produce. Once materials are produced, you have waived your right to challenge the subpoena.

TIP: You may be asked to voluntarily sign an affidavit that the copies of the records you provided to the government are “true and accurate” or constitute “the complete” record.

Be on high alert, because chances are you did not personally make the copies. Your lowest paid staff person or the investigator probably made the copies and you may have casually observed that process. There is no Florida law requiring you to sign such an affidavit and many times records do not get fully copied. For example, is anyone other than yourself or your lawyer going to take the time to make sure any sticky notes are included; that both the front and back of the pages are copied; that the front and back of the folder is copied (if you use paper records), including any code or color that you may use to indicate a patient’s health or billing status; and, that everything is in order, numbered and labeled?

TIP: A subpoena duces tecum (i.e., a subpoena that demands production of document or materials in connection with the appearance of a witness or party at a deposition, hearing or trial) is not a substitute for an unlawful warrantless search and seizure (i.e., the government cannot serve the subpoena on you or your employee and immediately search and seize records). Dean v. State of Florida, 478 So. 2d 38 (1985).

TIP: Do not think that Florida records confidentiality law or federal HIPAA gives you any defense against a properly issued subpoena even if the patient hasn’t signed an authorization to disclose the records.

Health Insurance Portability and Accountability Act (HIPAA) provides exceptions to the confidentiality of identifiable health information for “health oversight activities.”

Pursuant to 45 C.F.R. §164.52(d), a covered entity must disclose protected health information to a health oversight agency like the DOH. TIP: If you performed the dental services in a hospital, the BOD is authorized to subpoena the records even if the patient hasn’t signed a release under section 395.3025(4)(e), Fla. Stats.

The next article in this series will discuss search warrants, civil forfeiture laws, a true story involving Dr. Louis Tsavaris and the various peer review privileges.

Graham Nicol is the FDA’s Chief Legal Counsel.

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

Expires 4/1/2019

DON’T MISS “YOU WANT ME TO SIGN WHAT?” AT THE 2017 FLORIDA DENTAL CONVENTION. PRESENTED BY MR. GRAHAM NICOL

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

THURSDAY, JUNE 22



2-4 PM

May/June 2017

Today's FDA

11

Ts M E f o Use sia e h t s e for An

ntistry airs ard of De o B a ssional Aff fe id r ro lo P F & e r e th on to arty Pay of Third P , FDA Lias r a k to k c Il e ir n o D Dr. D , FDA toutamire S y e s a C .

Ms

Did you know that under the current Florida Board of Dentistry (BOD) rules, a dentist cannot supervise an emergency medical technician (EMT)? Thus, an EMT cannot insert an IV in a dental office in a non-emergency situation. However, at its last meeting, the BOD Anesthesia Committee discussed the idea that some dentists are interested in using EMTs as dental assistants when performing sedation procedures. The committee and legal counsel for the BOD are researching this issue to see if the dental assisting rules can be modified to allow an EMT to use his/her training as an EMT while functioning as a dental assistant. And, as a reminder, if a dentist brings in a physician, another dentist or a nurse anesthetist to perform the anesthesia, the dentist also must have an anesthesia permit and pass a board inspection. If a physician

Dr. Ilkka

anesthesiologist comes into a dental office, the BOD rules require them to be responsible for the entire anesthesia procedure. In addition, the rules require the dentist to have three people to assist during the procedure. One of them must be designated for emergency procedures and a certified registered nurse anesthetist or a physician assistant can be one of the three team members.

To read a full copy of the BOD’s rules on anesthesia use in the dental office, please visit the BOD’s website at: http://floridasdentistry.gov/resources/.

Ms. Stoutamire

If you have any questions, please contact Director of Third Party Payer and Professional Affairs Casey Stoutamire, Esq. at 850.350.7202 or cstoutamire@floridadental.org, or FDA Liaison to the Board of Dentistry Dr. Don Ilkka at 353.787.4748 or donjilkkadds@aol.com.

U O Y D DI

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?

May/June 2017

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THINGS TO KNOW BEFORE YOU GO 1. WHERE TO PICK UP YOUR BADGE WHEN YOU ARRIVE •

•

WEDNESDAY, JUNE 21 — 4-9 p.m., Hotel lobby THURSDAY, JUNE 22 — 7 a.m-8 p.m., City Hall lobby FRIDAY, JUNE 23 — 7 a.m-6 p.m., City Hall lobby SATURDAY, JUNE 24 — 7 a.m.-3 p.m., City Hall lobby

6. PARKING AND SHUTTLES • Free parking and shuttle service to the Gaylord Palms Resort is available at a convenient, remote location.

THURSDAY, JUNE 22 — 7 a.m.-11 p.m.

FRIDAY, JUNE 23 — 7 a.m.-10 p.m.

SATURDAY, JUNE 24 — 7 a.m.-6 p.m.

Guest badges can be purchased on site for $20.

2. ROOM FINDER

Download the FDC Mobile App to find a current list of course and event room locations, as well as much more convention information.

• Search “FDC2017” in the iTunes or Google Play stores

• The remote parking location will be emailed to all registered attendees one week prior to the convention.

7. LUNCH VOUCHER • If you’ve purchased a morning and afternoon course, you will receive a $15 lunch voucher for Exhibit Hall concessions. The voucher can be used in $5 increments on any day of FDC.

to download.

3. VALIDATE YOUR PARKING • Validate your Gaylord Palms self-parking ticket when you spend more than $50 at a sit-down restaurant in the hotel (does not include Cocoa Bean or Marketplace). See your server to validate.

• Your lunch voucher will be automatically imbedded into your badge.

8. FOOD OPTIONS • Look for monitors located throughout the hotel and

convention center listing the available food options and wait times for each.

4. PLAY THE PHOTO SCAVENGER HUNT • Play the FDC Photo Scavenger Hunt for a chance to win a Visa gift card!

• To play, download the FDC mobile app, click

on “scavenger hunt,” and log in using your FDC registration information.

• The three players with the most points will win.

Points vary depending on the challenge.

5. EXHIBIT HALL HOURS • THURSDAY, JUNE 22 — 9 a.m.-6 p.m.

FRIDAY, JUNE 23 — 9 a.m.-6 p.m.

SATURDAY, JUNE 24 — 9 a.m.-2 p.m.

• On site, look inside the Official FDC Program for

special exhibitor coupons and show specials available only at FDC.

• There will be food and drink stations available all day in the Exhibit Hall as well as lunch from 11 a.m. to 2 p.m.

9. CE REPORTING • To receive one hour of CE credit, you must be present in a course a minimum of 50 of the 60 minutes.

•

Your CE certificate will be emailed to you on Monday, June 26th.

•

CE credit will be reported to CE Broker for all Florida licensed dentists and hygienists on July 22, 2017.

10. VISIT THE FDA MEMBER CENTER • Visit the FDA Member Center at Booth 715!

Learn about becoming an FDA member and the benefits it includes.

• Play the FDA Services “Crownopoly” game on Friday for a chance to win a variety of great prizes.

• Register to volunteer at the 2018 FLA-MOM in Fort Myers, Florida.

Information Bytes

How to:

Get Hacked, Get a Virus, Download Malware, Be Spammed and Have Your Identity Stolen

By Larry Darnell DIRECTOR OF INFORMATION SYSTEMS

1. Use simple, easy-to-guess passwords like “password,” your birthday, “1234,” and the like. If people want your information badly enough, they will get it anyway. Having complex passwords only makes it hard for you to get to your data.

2. Click on every link in emails. If it looks like it came from a friend, it must have.

If the link is not what you think it was, you can quickly close your browser.

No harm, no foul. That email that says you got the FedEx or UPS package tracking? Too legit to quit. Even your bank lets you know when there are issues with your account via email. I just solved my IRS issue that they emailed me about, too.

3. Give out your email to everyone who asks for it. It is the primary communication method. You are not worried about people getting your phone number so give them that, too. There are laws in place to stop people from calling you or spamming you.

4. Make sure you have up-to-date full bios on all social media platforms.

Birthday, place of birth, etc. While you are at it, keep that information on

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5.

6.

7.

8.

9.

your cell phone in the Notes app. It is good to have this personal information handy.

Do not worry about updating your computers, phones or tablets. This update stuff is just a scam to make you buy a new device anyway. The moment you update, you want it the way it used to be anyway. Who needs anti-virus programs? Just another scam to steal my money.

When installing stuff on any device, just let it install all the things it wants to. It might not work if you don’t.

You need that coupon printer to save money after all. Just click “Agree” to everything. Never read that fine print legal mumbo-jumbo. That stuff does not even matter.

Let your kids (any age, 1-91) have full access to your devices. They know more about technology than you do.

They would never download something they were not supposed to — you raised them to do better than that.

Connect to any and all public Wi-Fi. The ones at the airport are the best.

Everyone is doing it and you are saving data in the process. Even the grocery stores and convenience stores offer free Wi-Fi. It’s hard to beat free!

Don’t worry about those private texts, photos, videos and the like on your phone, tablet or computer. No one will ever see, read, watch or look at those.

What you do is personal, encrypted and secure. It disappears in a snap … or so they say.

10. There is no need to have a physical backup of anything. You have the cloud. The cloud is backing up 24/7 and you will always be able to access your data at any time and any place thanks to the cloud.

I would hope that you realize that the above is a satire. I hope you even viewed it as having comedic value. In fact, just about everything you see in those 10 items you should do the exact opposite of, or not do them at all. If you have ever gotten a virus, downloaded malware, been hacked or had your identity stolen, it makes you re-evaluate some things we take for granted. We have gotten way too loose with our private data, too predictable with passwords, and too trusting of the technology and those who can manipulate that technology. It is no surprise that these things happen to us.

In many cases, we have done it to ourselves.

Stop and think before you click that link.

Stop using that life password (the same one in some variation). Protect the most valuable asset you possess — your data — like your life depends upon it, because it may very well be the case.

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

May/June 2017

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

Florida Recognized for Fluoridation Efforts On Monday, April 24, Florida stood out at the Association of State and Territorial Dental Directors (ASTDD) Annual Business Meeting as a leader in the country for fluoridation systems that were started and for defending areas where cessation efforts took place. The ASTDD gave Florida communities and individuals the following awards:

50-year Awards water systems reaching 50 years of continuous water fluoridation:

• Daytona Beach • Melbourne • Sanford 2016 Community Initiative Awards communities that passed water fluoridation initiatives during the past calendar year:

• Lake City • Wellington • Flagler County

communities that defeated initiatives to discontinue community water fluoridation during the past year:

• Clearwater • Collier County • Perry

Today's FDA

deserving individuals and organizations:

• Dr. Johnny Johnson, American

• Mark Lander, Columbia County

Fluoridation Society

Florida, Department of Health

Professional Liability Insurance: Make Sure You Review Before You Renew!

If it’s time to renew your professional liability policy, make sure you check out The Doctors Company for better rates and coverage options! Get a quote, apply and bind 24/7. The online application lets you request a personalized quote by completing a simple form rather than an extensive application. Make sure you tell your colleagues in other states that the best dental professional liability carrier is now available in all states at competitive prices.

Go to http://bit.ly/2nEswr6 to complete the online professional liability application from The Doctors Company.

Flossing Made Easy

2016 Community Fluoridation Reaffirmation Awards

16

Letters of Recognition

May/June 2017

Like many people, the patients of Tavares dentist Dr. Tim Pruett rarely flossed. Flossing was painful, inconvenient, awkward and messy, they told him. So, Dr. Pruett, founder of a company called Flossolution, invented a product that combines both sonic power-flossing and toothbrushing on a single brush. “Our non-negotiables were that we needed to design a system that made flossing one-handed, eliminated the need to stick your hands in your mouth, controlled movement of the floss

both laterally and vertically, and couldn’t be stored away in a drawer and forgotten,” Pruett says. One version of his product, called Max, recently won bronze in the Best in Biz Awards’ Most Innovative Product of the Year in the health care category.

Introducing the FDA Fan Shop!

The FDA is excited to announce the creation of our official online store, FDA Fan Shop! Now members can order apparel and other merchandise featuring your favorite FDA family-logo (FDA, FDA Services and FDA Foundation) — including scrubs!

The store features top brands and quality apparel for all ages. As an added benefit, you can even personalize your apparel with your practice/specialty and your name for a small additional fee. Show your FDA member pride and order online at fanshop. floridadental.org.

Send Us Your Photos for Throwback Thursdays!

The FDA would love to showcase our members having fun at anything FDA-related to post to our social media for Throwback Thursdays (#TBT). Please send any photos from past events, meetings, etc. along with a caption to communications@floridadental.org for the chance to be posted on the FDA’s Facebook and Twitter accounts.

We look forward to seeing what you send in!

www.floridadental.org

LECOM Names New Dental School Dean

Dr. Bateman

On May 1, the Lake Erie College of Osteopathic Medicine (LECOM) named Mathew J. Bateman, Ph.D., D.H. Ed. as dean of its School of Dental Medicine.

Dr. Bateman joined LECOM in 2006 as a basic sciences faculty member, teaching in all disciplines of anatomy. In 2009, he earned his doctor of health education degree from A.T. Still University School of Health Management in Kirksville, Mo. Dr. Bateman has served as the college’s assistant dean of curriculum, evaluation and faculty and as the institutional director of planning, assessment, accreditation and research.

“Although [the college] initiated a national search for a new dean of the [dental school], it was apparent to the president and the board of trustees that Dr. Bateman’s unparalleled skills and expertise made him an ideal candidate to filled the role of dean,” said provost Silvia M. Ferretti, D.O., dean of academic affairs for LECOM.

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.

Paul Kramer, St. Augustine Anthony Lee, St. Augustine Daryl Smith, Jacksonville Patrick Trad, Jacksonville

Northwest District Dental Association LaToya Butler, Tallahassee Jerry James, Inlet Beach Gary Turnier, Crestview

Atlantic Coast District Dental Association Diego Dalla-Bona, Fort Lauderdale Valentina Espinosa, Fort Lauderdale Miguel Grillo, Wellington Caryn Kleiman, Hollywood Jared Shulman, Boca Raton

Central Florida District Dental Association Akmal Ahmed, Altamonte Springs Ximena Aldea, Orlando Mobeen Alvi, Orlando Lee Cote, Altamonte Springs Lan La, Gainesville Yaling Liu, Gainesville Linh Nguyen, Orlando Juan Pinzon, Orlando Margarita Romero Quevedo, Orlando Emily Schroeder, Satellite Beach

Northeast District Dental Association Amy Bouvier, Atlantic Beach Jessica Kraich, Fleming Island

South Florida District Dental Association Monica Agudelo, Tamarac Onize Aiyede, Miami Lakes Nerissa Aquino, Port Saint Lucie Shanna Bernkrant, North Miami Tommy Gaertner, Miami Alexandra Gordon, Aventura Patrick Lolo, Miami Sam Margulies, Aventura Samantha Rabor, Miami Andrew Stiles, Miami Tamarra Sweeting, Davie

West Coast District Dental Association Steven Leikin, Naples Christina Makram, Tampa James Park, Riverview Rosalyn Shkolnikov, Brandon Keyvan Tavakoli, Lutz Lorraine Tomlinson, Tampa

In Memoriam The FDA honors the memory and passing of the following members: Sterling L. Watson Quincy, FL Died: 4/9/2017 Age: 60

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Jocelyn Mendez Coconut Grove, FL Died: 4/24/2017 Age: 45

May/June 2017

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Members‘ Opinion

Letter to the Editor The Florida Dental Association (FDA) welcomes letters from readers on articles that have recently appeared in Today’s FDA (TFDA) and matters of general concern to Florida dentists. The FDA reserves the right to edit all communications and requires that all letters be signed. Letters must be no more than 550 words and may cite no more than five references. Brevity is appreciated. No illustrations will be accepted. You may submit your letter via email to tfdaeditor@floridadental.org, by fax to 850.561.0504 or by mail to Florida Dental Association, Attn: TFDA Editor, 1111. E Tennessee St., Tallahassee, FL 32308-6914. By sending a “Letter to the Editor,” the author acknowledges and agrees that the letter and all rights of the author in the letter become the property of the FDA. Letter writers are asked to disclose any personal or professional affiliations or conflicts of interest that readers may wish to take into consideration in assessing their stated opinions. The views expressed are those of the letter writer and do not necessarily reflect the opinion or official policy of the editor, staff, officials, Board of Trustees or members of the FDA.

Letter to the Editor

By Dr. C.J. Henley

In the March/April issue of Today’s FDA, a rebuttal of my article from the previous issue, “Midlevel Dental Provider,” was published in the form of a “Letter to the Editor.”

I want to thank Dr. Frank Catalanotto for his interest in my article and take a moment to address several of his points.

The first question I would ask an advocate of midlevel dental providers (MDPs) is: Who would you choose to receive your dental care from, or perhaps for your child?

Who would you want to manage a complication from a dental extraction or a root canal? My wife, Dr. Stephanie Henley (who is amazing), is an oral surgeon practicing in Jacksonville, Fla. She is on call at three major hospitals in our city. She is routinely called in for life-threatening complications from common dental procedures that trained dentists, endodontists, periodontists and — on several occasions — other oral surgeons don’t feel confident managing. I wonder, when a slew of lesser-trained prac-

20

Today's FDA

May/June 2017

titioners begin providing care in Florida, who will manage their complications? It should be noted that in many cases with severe dental infections, patients cannot pay for treatment. She provides lifesaving treatment to these patients at no cost to them, as do many oral surgeons in all our communities.

I agree with Dr. Catalanotto that philanthropy is not a system of care. However, I wholeheartedly disagree that philanthropy is demeaning to patients. This week we did pro-bono dental work for a 23-year-old woman who’s smile was ravaged by decay.

She literally wept when she looked in the mirror and saw her new smile. Did she find this demeaning? I think not. Or, simply ask any patients at any Mission of Mercy or Baptist Bus event if they felt that the help they received was degrading. I take offense to the statement that philanthropy is demeaning, as would the hundreds of doctors who participate in these programs.

I also would argue that Medicaid is a form of governmentally regulated philanthropy.

Aren’t those with more, giving to those

with less? Moreover, throughout the past five years, the University of Florida College of Dentistry received an average of $3.1 million annually in philanthropic gifts, and in 2015 health care institutions throughout the U.S. raised $9.6 billion from charitable donors.1 A substantial proportion of this total is given by individuals, many of whom are motivated by their experiences as patients. Institutions, physicians, dentists and the public benefit immeasurably from philanthropy.

Any preventable death in our health care system is a tragedy. The family of Deamonte Driver would certainly agree with this statement. However, and unfortunately, mortality is an issue in every specialty of medicine, including dentistry. I would argue that dentistry in the U.S. is safe. Not to be insensitive, but I wonder how statistically significant 60 to 100 deaths over a decade from dental-related issues is in a population of 318 million people? To put this in perspective: Per the National Oceanic and Atmospheric Administration, over the last decade, 304 people have died in the United States from lightning strikes.2 This, too, could be considered a preventable form of death. So, to be clear, in the U.S., someone is three times more likely to get struck by lightning than to die from a dental-related complication.

It also is important to highlight the substantial difference in education between MDPs and dentists. An MDP requires less than half the training as a dentist (three years as opposed to eight), whereas the medical equivalent of an MDP (such as a

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Members‘ Opinion nurse practitioner) requires seven years of training. It is my assertion that dental therapists with such a disparity in training dilutes our own education. Dr. Catalanotto also mentioned the decreased cost of education for MDPs. The out-of-state cost for attendance to the University of Minnesota’s program is almost $120,000.3 While he is correct that this is less than most dental schools, it is still expensive. And when you consider that the average salary of an MDP is roughly $68,000, the burden of debt to a new graduate is proportionally similiar to the educational debt/income ratio of a dental student.

I also take offense at the statement that we are (or in this case, I am) mindlessly following orders from the American Dental Association (ADA). I have had the good fortune to personally treat many of the patients we speak of. I spent the first years of my career treating underserved populations eight hours a day, six days a week. In that time frame, I performed more than 1,000 root canals on children who otherwise would have had their adult teeth extracted. Now I own my own practice and still provide pro-bono care as often as I possibly can. I feel that I am uniquely qualified to speak regarding the care for this patient population, as I have spent time on both sides of the fence.

I know many struggling young dentists who have recently started their own practices who would love to have their schedules filled with Medicaid patients. However, because Medicaid reimbursement rates are not even remotely close to UCR and the red tape to get reimbursement is a mile long, it is too much of a financial liability to attempt to treat this segment of patients. I know classmates who have worked for public health clinics in Florida for years with the promise that they would receive reimburse-

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ment for their dental education, only to learn in the end that the federal government couldn’t pay. If there is no money now to pay for dental care for the underserved, where will it come from to pay an MDP? Currently in Minnesota, MDPs only can practice in a federally designated health professional shortage area (HPSA). However, MDPs in Minnesota are under no obligation to provide care to underserved populations. I was curious to know what areas in Jacksonville were considered a HSPA (specifically referring to dental health providers). The location I found was in downtown Jacksonville.4 A quick Google Maps cross-reference showed that there were roughly 16 dentists located within two miles of that HPSA (my office is six miles from this area). Let’s get real. Where are MDPs going to work? Will they take jobs with the state, seeing a much higher volume of patients in remote locations, or will they work in private offices near their current homes, making better incomes? Ultimately, MDPs will choose higher paying jobs in better locations simply because the quality of their lives will be improved. I am not naive to the fact that MDPs could be profitable in a private practice setting. I understand that if I had five MDPs (the maximum allowable under Minnesota law) working under me and a full schedule, we could be extremely productive. However, dentistry — or health care for that matter — should not be treated as a commodity. Our goal as fully trained dentists should be providing excellent care to all patients.

References: 1. http://givingusa.org/product/giving-usa2015-report-highlights 2. http://www.lightningsafety.noaa.gov/ fatalities.shtml 3. https://www.dentistry.umn.edu/sites/ dentistry.umn.edu/files/dt_class_of_2019_ cost_of_attendance.pdf 4. https://datawarehouse.hrsa.gov/tools/ analyzers/hpsafind.aspx 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 topics and 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.

TFDA is the the place where members are assured their voices can be heard. Given the subject matter of this letter, the editorial board offered Dr. Henley a bit of consideration on the usual 500 word limit expected of letters to the editor.

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

We can all agree that caring for our underserved populations is a problem. We can all agree that fixing the issue is critical to both our society and our professions. However, we should explore ways to use our existing infrastructure to provide care to all patients in need.

May/June 2017

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IS YOUR PRACTICE SECURE WHEN SEVERE WEATHER LOOMS?

What to look for in your Business Owner’s Policy: • Business Income Coverage • Off-premises Power • Updated Building Value

Check out “Hurricane Proof,” our 2017 Practice Readiness Guide.

It’s full of useful information that will help you make sure your practice is ready for any weather.

Read and Download: http://bit.ly/29nWaJU

CALL US AT 800.877.7597 FOR A FULL REVIEW OF YOUR BUSINESS OWNER’S POLICY.

PHONE: 800.877.7597 EMAIL: insurance@fdaservices.com

A SPECIAL THANK YOU TO OUR 2017 BENEFACTORS PRESENTING BENEFACTORS

PLATINUM BENEFACTORS DELORES BARR WEAVER FUND Sponsered by

COMMUNITY CARE FOUNDATION

Academy

GOLD BENEFACTORS DR. TERRY BUCKENHEIMER

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ASHLEY D. PACE CHARITABLE FUND EDWARD C. SHILS ENTREPRENEURIAL FUND

SILVER BENEFACTORS MR. THOMAS PACE JR. DR. GERALDINE FERRIS DR. MICHAEL PIKOS Reminders To All Health Clinic Patients MS. GLORIA HALL-WHITE Remember that one of our providers will continue to see patients during the traditional lunch hour.

Visits AGD FOUNDATION PROGRAMS & SERVICES

Health Department

are scheduled by appointment only. A limited number of visits each day are reserved for "work ins" so if you are sick and require a "work in" appointment, please call the clinic early in the morning and we will do our best to assign an appointment time that day.

Health & Elder Services Purpose Focusing on prevention and wellbeing through a variety of medical and educational programs, we guide our members to make choices that will enhance their quality of life and help them make healthy choices that are in their best interest.

Please bring the following items on every visit to the Health Department: N O R T H W E S T D I S T R I C T D E N TA L A S S O C I AT I O N • Driver’s License A COMPONENT OF THE AMERICAN & FLORIDA DENTAL ASSOCIATIONS • Tribal ID • Insurance Card • Medication List

We want all Tribal Members to feel their best so they can live life to its fullest.

BRONZE BENEFACTORS

Poarch Band of Creek Indians

These items are needed so that we may keep all your information and medications updated.

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PENSACOLA

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AMRICK INSURANCE ASSOCIATES Your Insurance Source

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A COMPONENT OF THE AMERICAN & FLORIDA DENTAL ASSOCIATIONS

A COMPONENT OF THE AMERICAN & FLORIDA DENTAL ASSOCIATIONS

A COMPONENT OF THE AMERICAN & FLORIDA DENTAL ASSOCIATIONS

A COMPONENT OF THE AMERICAN & FLORIDA DENTAL ASSOCIATIONS

Poarch Creek News

40

2017 Florida Mission of Mercy

Pale-Osten

The Florida Mission of Mercy is only possible with the generosity of our benefactors and volunteers.

During the 2017 FLA-MOM, held in Pensacola on March 24-25, more than 1,550 volunteers provided donated dental care valued at $1.5 million to more than 1,800 patients.

A SPECIAL THANK YOU TO OUR 2017 BENEFACTORS (cont.)

BRONZE BENEFACTORS Air Techniques Boo Weekly Charity Golf Escambia County Emergency Medical Services Florida Section of American College Dentists Key Analytics And Consulting Dr. Briano Allen Dr. James Antoon Dr. Beau Biggs Mr. Walter Biggs Jr. Dr. Andy Brown Dr. Steve Bryan Dr. James Callahan Dr. James Campbell

Dr. John Dozier Dr. Michael Eggnatz Dr. Robert Fish Dr. Scott Heitzmann Dr. Tricia Hess Dr. Cecilia Hines Dr. Kim Jernigan

Levin And Papantonio Family Foundation Picard-Dannheisser Foundation The Russenberger Foundation Salvation Army – Pensacola Smallwood Investments LLC Sultan Ms. Susan Kennedy Dr. Idalia Lastra Dr. Oscar Menendez Ms. Marjorie Moore Dr. Richard Mullens Dr. Jeffrey Ottley Dr. Jonathan Ottley

Dr. Jolene Paramore Dr. David Russell Dr. Barry Setzer Dr. Rick Stevenson Dr. Jay Walton Mr. Bill Young & Mrs. Judy Young

PATRONS Dr. Sol Brotman Dr. Thomas Brown Dr. Natalie Carr Bustillo Dr. Ron Caylor Dr. Steve Cochran Dr. Brittney Craig Dr. Bruce Gordy Dr. Nathan Hall Dr. Leanne Keough

Dr. Alana Keough-Humberson Leon County Dental Association Dr. Rudy Liddell Dr. James McCreary Ms. Donna Mair Dr. Tim Marshall Dr. Eddie Martin

Ms. Jane Merrill Dr. Beth Nixon Dr. Craig Oldham Dr. Charles Stavely Dr. Erin Sutton Dr. Greg Woodfin Florida Academy of Pediatric Dentistry

Florida Association of Orthodontists Florida Association of Periodontists Pinellas County Dental Association Upper Pinellas County Dental Association

CHAIR SPONSORS Dr. Nolan Allen Dr. Jamie Amir Dr. Ralph Attanasi & Dr. Ethan Pansick Dr. JP Bastien Mrs. Jerilyn Bird Dr. Leo Cullinan

Dr. Peggy Dennis Dr. Mark Denunzio Dr. Makeba Earst Mr. Drew Eason Dr. David Hanle Dr. James Hart Dr. Bert Hughes

Dr. Rick Huot Dr. Gregory Langston Dr. Demetrick LeCorn Dr. Allan Litvak Dr. Lindsay Maples Dr. Paul Marcus

Dr. Paul Miller Dr. Anissa Ottley Dr. Jared Ottley Dr. Bob Payne Dr. Thomas Reinhart Dr. Daniel Snead Dr. Cecil White

FRIENDS OF FLA-MOM Dr. Julie Bailey Dr. William Baldock Dr. Timothy Barber Dr. Bruce Buhrow Ms. Vicki Campbell Dr. Sebastian Castellano Dr. John Cordoba Dr. John Craig

Dr. Bill D’Aiuto Dr. Jim Dewine Dr. Yiqian Dong Dr. Suzanne Ebert Dr. Alan Fetner Ms. Sophia Freeman Dr. Chad Gehani Ms. Martha Gruesser

Dr. Scott Imray Ms. Joann Jones Dr. Bill Layman Mr. Christopher Lewis & Mrs. Yvonne Lewis Dr. Samira Meymand Dr. Robert Murrell Dr. Lee A. Niblock

Dr. Sandy Rosenberg Dr. Peter Scerbo Dr. Melissa Sedeno Dr. Kristin Shinnick Dr. Flavio Soares Ms. Susanne Timmons Ms. Sharon Winter

FLA-MOM LEADERSHIP A tremendous thank you to the amazing leaders who contributed their time and talents to make the 2017 Florida Mission of Mercy a great success!

2017 FLA-MOM LEADERSHIP

Dr. Rudy Liddell  Radiology Manager

Dr. Beau Biggs  2017 Local Co-chair

Dr. Oscar Menendez  Statewide Clinical Co-lead

Dr. Kim Jernigan  2017 Local Co-chair

Dr. Mike Mihalcik  Facilities Lead

Dr. Nolan Allen  Statewide Co-chair

Dr. Jolene Paramore  Fundraising Lead & Impact Study Lead

Dr. Leo Cullinan  Statewide Co-chair

Mr. Geoff Parsley  Central Supply Manager Dr. John Paul  Routing Co-manager

COMMITTEE CHAIRS

Dr. Mike Pikos  Oral Surgery Co-manager

Dr. Brandon Alegre  Patient Registration Entry/Line Manager

Dr. Jack Pruett  Local Clinical Co-liaison

Mr. Clay Archer  Data Services Lead

Dr. Allison Simmons  Pediatrics Co-manager

Dr. Rill Banks  Restorative Assistant

Dr. Neil Simmons  Pediatrics Co-manager

Dr. JP Bastien  Dental Triage Co-manager

Dr. Bruce Tandy  Patient Exit Manager

Dr. Jay Boatwright  Prosthodontics Manager

Ms. Susan Tandy  Hospitality Co-manager

Dr. Andy Brown  Impact Study Manager

Mr. Bob Vaningan  Hospitality Lead

Dr. Tom Brown  Endodontics Manager

Dr. Claudio Varella  Set Up/Tear Down Manager

Dr. Steve Bryan  Oral Surgery Co-manager

Mr. Jim Warr  Parking/Security Manager

Ms. Karen Buckenheimer  State Oral Health Education Lead

Dr. Cecil White  Patient Registration Lead

Dr. Chris Bulnes  Statewide Clinical Co-lead

Dr. David Williams  Hygiene Co-manager

Ms. Kelsey Bulnes  Patient Ambassador Co-manager

Dr. McClain Woolsey  Volunteer Registration Co-manager

Dr. Susan Byrne  Sterilization Manager

Dr. Steve Zuknick  Routing Co-manager

Ms. Pat Clay  Patient Ambassador Co-manager Dr. Flip Cox  Restorative Manager

STATEWIDE COMMITTEE

Ms. Linda Duff  Hygiene Assistant

Dr. Nolan Allen

Dr. Don Ilkka

Ms. Angel Estep  Patient Registration Data Entry Manager

Dr. James Antoon

Dr. Bernie Kahn

Dr. Monica Franklin  Hygiene Co-manager

Dr. Sol Brotman

Dr. Lee Anne Keough

Ms. Jennifer Guynn  Volunteer Committee Coordinator

Dr. Andy Brown

Dr. Rudy Liddell

Ms. Pam Harrod  Hospitality Co-manager

Dr. Terry Buckenheimer

Dr. Jolene Paramore

Ms. Linda Harvey  Volunteer Registration Co-manager

Dr. Leo Cullinan

Dr. Howard Pranikoff

Dr. Sam Desai

Dr. Barry Setzer

Dr. Dan Henry  Local Clinical Co-liaison Dr. Tricia Hess  Volunteer Recruitment Manager Dr. Cecilia Hines  Volunteer Lead Dr. Zack Kalarickal  Communications Lead Ms. Ann Kidwell  Food & Beverage Manager Dr. Steve Krist  Dental Triage Co-manager Dr. Larry Leventhal  Medical Triage Manager

STAFF Ms. R. Jai Gillum  FDA Foundation Director Ms. Megg Murphy  FLA-MOM Program Coordinator Ms. KC Lorenz  Foundation Assistant Mr. Drew Eason  FDA Executive Director Mr. Greg Gruber  Chief Financial Officer/Chief Operating Officer

FDAS Highlighted

Florida Agency Lights the Way for Dentists

By The Doctors Company

Carrie Millar is surrounded by 300 twinkling leis — and she knows that each of these lighted accessories represents an opportunity for her agency to be remembered. That brand recognition — or “opportunity to keep warm fuzzies about us” as Millar puts it — is especially important to surviving in a soft market.

Millar, agency manager at Florida Dental Association Services (FDAS), works with her colleagues to promote her agency and the services it offers to dentists at local meetings, tradeshows, student events and fundraisers. Millar plans to use the leis for an upcoming beach party and happy hour tied into the American Student Dental Association’s meeting in Orlando. “Warm fuzzies on the beach” sounds more like the name of a trendy cocktail than a dental malpractice insurance sales strategy, but it will likely get results.

For more than 25 years, FDAS has operated as a for-profit subsidiary and independent agency of the Florida Dental Association (FDA). The program began in 1989 and now insures more than 4,000 dentists across the state and is beginning to expand its programs in surrounding states. Millar started at FDAS in 2004 as an agent, then worked as assistant manager of special programs and moved to her current position as agency manager in 2011.

Carrie Millar was honored to be featured in The Doctors Company Agent’s Advocate newsletter. This quarterly publication is distributed electronically and in print nationwide to 10,000+ top professional liability leaders.

Millar received a bachelor’s degree in risk management and insurance from Florida State University (FSU) in 2003 and earned an MBA from FSU in 2008. In 2014, Millar earned her certified association executive certification from the American Society of Association Executives: The Center for Association Leadership.

A Trusted Advisor FDAS strives to be a trusted partner for dentists and is committed to providing excellent service for members of the FDA, reflected in the unique structure of the agency. FDAS reports to a board of dentists through the FDA, making staff keenly aware and connected to their customers. Revenue from insurance sales goes directly toward helping FDA programs and lobbying efforts that are important to members.

The board is comprised of 11 dentists and three student advisors, including two board members who graduated within the last decade to ensure the voices of younger professionals are heard. “It’s our goal to make sure the board is diversified so we have every voice at the table,” Millar said. “We have a different type of accountability to dentists because of our affiliation with the FDA. And the FDA is only going to sell dentists something that is in their best interest and has their backs.”

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FDAS Highlighted This accountability and commitment to superior service is at the heart of FDAS, fueling its mission to help members succeed. Millar said FDAS looks for the same commitment to customer service with its carriers, leading to strong partnerships between the agency and carriers like The Doctors Company — FDA’s exclusively endorsed professional liability carrier.

“We work to help dentists and have what they need in place. We want to make sure we are looked at as a trusted source,” Millar said, noting how the agency aims to connect with dental students before they graduate from dental school and educate them on professional liability insurance coverage and their options. The goal, she explained, is to get young dentists to join the FDA and sign their first policy at graduation with FDAS, providing options for every aspect of a dentist’s career and practice throughout their lifetime. FDAS also strives to be an expert in malpractice claims, tort reform, workers’ compensation, the Affordable Care Act — anything that could affect a doctor.

The agency also has student representatives on campus at the University of Florida, LECOM School of Dental Medicine and Nova Southeastern University to connect with dental students and be a resource for them before they graduate and begin practicing. “We make sure they have everything they need,” Millar said. “We have been really successful in being the whole insurance portfolio manager — we write about 1.75 policies for an insured — and we have a very high retention rate.”

Innovative Resources and Tools for Today’s Dentists In an effort to be the best resource for dentists, FDAS employs five agents located across the state to foster connections at a local level and be the agency’s eyes and ears in the regional dental community.

Millar said that a lot of what FDAS brings to the table are value adds for good service and extra resources. For instance, to offset the issue many dentists and dental students are facing coming out of school with a high debt ratio and pressure to go into corporate dentistry, FDAS partners with a lot of organizations to serve as a resource to help dentists find jobs.

“Our goal is to help dental students and new dentists have forms and find partners to get spots in private practices,” Millar said. “It’s our job to make sure there is a vehicle for them to pursue private practice and access these opportunities at networking events and meetings.”

“

We work to help dentists and have what they need in place.

We want to make sure we are looked at as a trusted source.

”

FDAS also has pushed for automated underwriting, electronic applications and electronic quotes for dentists, who Millar explained are fairly low-risk from an underwriting standpoint. “One of the bigger challenges we have faced is the younger generation wants things instantly. So, we really have been working with our insurance partners to have electronic application processes because we are no longer in a situation where paper and a waiting process is acceptable.” Millar also pointed out that The Doctors Company has been particularly vigilant in pursuing automated underwriting for dentists.

It’s this innovation and ability to create solutions for its members’ pain points that have propelled FDAS into the future.

Reprinted with permission from The Doctors Company. The Agent’s Advocate, March 2017.

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Lease Negotiation

Leveling the Playing Field in Your Next Office Lease Negotiation

By Ken Jorgenson CARR HEALTHCARE REALTY

The current commercial real estate market has been dramatically affected by the economy in the past several years. This has resulted in a favorable environment for tenants, as landlords are extremely motivated to attract new tenants and retain existing ones — especially high-quality tenants such as health care practices. Some of the current opportunities include reducing your monthly rent payment, upgrading your office’s appearance through an improvement allowance, as well as obtaining free rent and other favorable concessions.

One of the keys to a successful negotiation is to take advantage of the free services of a real estate broker or agent. This is important because most landlords are in the real estate business and typically have the upper hand when directly negotiating with tenants.

Additionally, the majority of landlords hire a real estate broker to represent their interests and provide expertise. Though dramatic concessions are available, a specific posture and negotiation strategy are paramount to achieve the best possible terms.

When the time comes to evaluate your current lease situation, you’ll need to consider the pros and cons of renewing the lease in your current location versus relocating to a new property. Since economics and concessions will have a dramatic impact on the decision, it is essential to understand all of your available options and implement a strategy to leverage them. It is critical to the success of your negotiation that your landlord knows that you have the option to relocate, which means that you need to begin negotiations well in advance of your lease’s expiration — ideally nine to 24 months before your current term ends.

“

Landlords know that without market knowledge, tenants have no baseline against which to compare a lease offer. Therefore, a landlord will most likely offer the highest lease terms that they believe an uninformed tenant will accept.

”

When you begin negotiations, you have two options available to you: You can work with the landlord’s agent and represent yourself, or you can hire a real estate broker. Here are some things you need to know if you choose to represent yourself in a lease negotiation.

Under state law, a real estate broker can enter into an agreement to serve clients as an agent. An agent is obligated to serve his or her client’s interests with the utmost good faith, loyalty and fidelity. Clearly, it is not practical for an agent to act with utmost loyalty to two parties on opposite sides of a transaction, meaning the landlord or landlord’s broker also should not represent your interests.

Please see LEASE, 33

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Lease Negotiation

LEASE from 31

Simply put, if you do not bring an agent into the negotiations, no one will be protecting your interests but yourself. If you deal directly with the landlord or landlord’s agent, it is crucial to remember that he or she is not legally or logically able to advocate on your behalf, so it is important to exercise discretion with the information you share with the landlord’s agent.

Even if your building’s ownership and management are pleasant to work with, respond to issues quickly and maintain the building well, their primary interest is maximizing profits.

Landlords know that without market knowledge, tenants have no baseline against which to compare a lease offer. Therefore, a landlord will most likely offer the highest lease terms that they believe an uninformed tenant will accept.

The only way to know if any offer is truly competitive is to compare it to the market. To do this you need to identify all the available properties that suit your needs, and then tour a significant number of them to determine which ones will be best suited for you and ensure that you don’t miss any opportunities.

You then need to negotiate with the landlord at each property to receive the best offers for a suitable space for your practice. These offers will include terms for the base lease rate and any increases in the lease rate, as well as concessions such as free rent and an improvement allowance. You’ll also need to know the lease terms and concession that new tenants in your current building are receiving from your landlord. At each step along the way, you’ll be dealing with a professional real estate broker who is hired to achieve the best possible terms for the landlord.

If this sounds daunting to handle yourself, you do have an alternative. You can hire an experienced real estate professional as your agent — to act on your behalf with your interests in mind. He or she can provide you with comparable properties’ lease rates, build-out allowances and other concessions, which then can be used as valuable leverage on your behalf in the negotiations with the landlord. Ideally, you should select an agent with experience representing health care practices because they will be able to achieve specific terms and concessions that generally aren’t available to other types of tenants. Your agent will handle all the research and communication with the landlords while maintaining a professional negotiating posture on your behalf.

Fortunately for you as a tenant, landlords and sellers have agreed to pay for an agent’s services on your behalf, so it costs you nothing. Commercial real estate is similarly structured to residential real estate. If you were to sell your home, you might list it with a broker and agree to pay a commission. The commission is split between the listing broker and the broker who brings the buyer. If the listing broker is able to find the buyer directly, then he or she would earn a double commission. The same kind of arrangement is made in the

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commercial real estate market, and you as a tenant or buyer have access to professional representation at the seller’s expense.

Most health care providers have plenty to do serving their patients and running a successful practice. Spending hours on end making sure your lease renewal is competitive and handled properly typically is not the best use of your time. Since professional representation does not cost you anything as a tenant, it makes a lot of sense to let a licensed real estate professional review your lease, represent your interests in your negotiations and help you capitalize on the current market conditions so you can achieve the best possible terms.

Carr Healthcare Realty is the nation’s leading provider of commercial real estate services for health care tenants and buyers. Every year, hundreds of dental, medical, veterinary and other health care practices trust Carr Healthcare Realty to help them achieve the most favorable terms on their lease and purchase negotiations. By not representing landlords or sellers, Carr Healthcare Realty is able to strongly advocate for health care providers and avoid conflicts of interest while saving their clients hundreds of thousands of dollars.

Carr Healthcare Realty’s team of experts can assist with all types of real estate transactions, including lease renewals, expansions, relocations, startup offices, purchases and practice transitions.

Visit www.carrhr.com to find an expert in your area to help with your commercial real estate needs.

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FDC2017 SPEAKER PREVIEW

Patient Engagement Tips to Grow Your Practice Using DISC

By Ms. Helen Davis

Did You Know?

According to British anthropologist Robin Dunbar, the average human being can only maintain a stable relationship with approximately 150 people. This is referred to as Dunbar’s Number. In short, this is the number of people you know on an interpersonal level and can reasonably predict how they will interact with others and respond to different situations.

What does this have to do with patient engagement? Everything. In a service-based industry where your team is engaging with dozens of different faces every day, it is simply impossible to remember everyone.

As a result, patients can feel unimportant, unappreciated and underwhelmed with your service.

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What Makes Great Service Great?

If you ask this same question of 10 different people, you will probably get a handful of different answers. Some patients prefer a hands-on and detailed approach that tells them which step to take next. Some patients will want to get to know you personally, while others will want to get in and get out with little social interaction. Great patient engagement looks and feels a little different for each patient.

With a little focus and effort, you can learn a quick and effective method to recognize a patient’s preferences and flex your behavior to match their expectations. Using the DISC acronym, your team can make quick and discrete notes about a patient’s preferences that will help them and other team members communicate with the patient more effectively.

What is DISC? DISC is an acronym used to identify four different behavioral styles: dominance, influence, steadiness and compliance. Understanding these four factors and which form of communication your patient prefers is vital to providing great customer service.

Recognizing the Four DISC Factors Dominance is a person’s need for getting results and having control, as well as their source of drive and ambition. “High D” people operate at a quick pace, and they prefer to get down to business quickly. They like bullet points and getting things done.

Whenever you are feeling self-motivated, driven to accomplish something or are anxious to get started, you are using your “D” factor.

Influence is a person’s need to express themselves, their preferred degree of communication and their source of persuasion. “High Is” like interaction with people, discussing just about anything and relationships. You’ll see them as talkative (perhaps jumping from topic to topic) as well as friendly and open. Whenever people feel enthusiastic, warm or trusting, they are using the “I” factor.

Steadiness is a person’s need for consistency and their source of thoughtfulness and strategy. Kindness, loyalty and being supportive are all “S” traits, as are calmness and careful listening. When you go out of your way to help someone, you are using your “S” factor.

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“With a little focus and effort, you can learn a quick and effective method to recognize a patient’s preferences and flex your behavior to match their expectations.”

Compliance is a person’s need for structure, planning and their source of organization.

“High Cs” prefer to follow rules and know what the format and expectations will be upfront. This makes them feel at ease. You might notice “High Cs” being careful and cautious, wanting to be accurate and tactful.

They like details, so please allow sufficient time for them to ask questions. When you become extremely focused on completing tasks, on time and within budget, you are using your “C” factor.

Communicating with Co-workers Using DISC Quick Tips to Adapt to Each DISC Factor: Once you identify a person’s preferences, you can quickly and easily communicate those preferences to co-workers by drawing attention to their tendencies. If you see someone who just wants results and wants you to get to the point, you can let others know they are “High D.” If they are talkative, label them “High I;” thoughtful and strategic, “High S;” or, organized and structured, “High C.” A patient can have more than one elevated or “high” factor score.

For instance, someone who is a “High DI” would be interested in results (High D) and other people’s opinions (High I). Take a personal approach and talk to them in a friendly manner. Tell them the course of action you recommend taking and when.

They are more concerned with the “what” than the “why.”

A “High SC” would be primarily concerned with making well thought out choices (High S) and taking an organized or planned approach (High C). Take a little more time to ask questions and make sure that they understand the “why.”

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Always remember to keep your elevated DISC factors and preferences in mind so that you can adjust and flex (dial up or dial down) your behaviors to match the patient’s preferences. When possible, try to maintain a mid- to high-level of influence (communication) and steadiness (thoughtfulness) to ensure the patient is aware of what you are doing and why. Influence and steadiness are the people-oriented factors, so remember to put the patient first and this will be relatively easy.

High D Pick up the pace if you are not yourself a “High D.” Try to be brief and to the point.

Keep on topic, then move to the next.

“High Ds” only like details that lead to a result they want, so take their lead on this.

Paint “the big picture” of what options are available to them and guide them to your suggested option. Demonstrate your practice’s results and talk about its competence in the marketplace.

High I Take on a more sociable, informal and relaxed style. Never be abrupt and make sure you begin with a little small talk to break the ice. Smile. Listen intently with open body language when they talk about how they feel. Ideally, interject humor and keep the conversation light. Flatter them and praise them about their accomplishments.

High S Be consistent, calm and patient. Do not interrupt. Be logical and systematic in your approach. Choose your words wisely — people who are a “High S” are great listeners. Take time to respond thoughtfully to their questions. Give them a bit more time than you might be used to (because of their heightened level of thoughtfulness).

High C Be prepared. Explain the process. Ask if they have any questions prior to starting and be prepared to respond with details.

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FDC2017 SPEAKER PREVIEW

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Hand them paperwork before, during and/ or after the visit to satisfy their need for details. Make sure the next steps and actions needed from the patient are crystal clear.

Why Does This Matter?

By implementing a “DISC culture” in your office and putting this DISC language into practice, it will allow your team to quickly

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and more efficiently function. Your patients will feel the improved customer service because your staff will be communicating within the patient’s comfort zone as opposed to their own. By improving customer service, you will limit attrition and increase repeat business and follow-up appointments.

Hellen Davis is the CEO of Indaba Global Coaching LLC and the creator of DISCflex™ DISC Assessments. She can be reached at info@indabaglobal.com.

Ms. Davis will be speaking at FDC2017 and presenting two courses on Thursday, June 22. Her first course, “Acquiring Great Phone Skills” will be at 9:30 a.m., and “Enhancing the Patient Experience” will be later that day at 2 p.m.

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FDC2017 SPEAKER PREVIEW

Achieving Greatness

By Don Yaeger

Association leaders and corporate executives have long recognized that great lessons — lessons in leadership, team building, handling adversity and managing success — can be learned from their peers in the world of sports.

This explains why some of the most sought-after public speakers at corporate events are sports greats: Miami Heat basketball coach Pat Riley, Duke basketball coach Mike Krzyewski, tennis legend Jimmy Connors and even Walter Bond. The lessons they teach and exhibit in their world translate perfectly into yours.

In my 20-plus years as a writer for Sports Illustrated and author of more than 20 books, I have been blessed to spend hours interviewing great winners like Riley, Krzyewski, Connors, basketball legend Michael Jordan and Hall of Fame running back Walter Payton.

Some of the best lessons I have learned, however, have come at the foot of the greatest winner of them all, former UCLA basketball coach John Wooden, winner of an unprecedented 10 NCAA championships.

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Until he passed away in 2010 at the age of 99, Wooden was an oft-tapped corporate consultant on the subject of leadership.

In the final year of his life, I was in Los Angeles to talk with Wooden about greatness and the traits of those who have achieved it.

One characteristic is that the truly “great” understand the value of association. They know they only can become great if they surround themselves with others who are headed in that direction.

Wooden, his mind sharp as any 30-year-old I have met, got a twinkle in his eyes that told me he had a story to share — one I would enjoy sharing with others.

“Many people, when they ask me about coaching great players, always ask me about my two most famous centers, Lew Alcindor (who became Kareem Abdul-Jabaar) and Bill Walton,” the coach said. “But one of the greatest I have ever coached is a player many wouldn’t suspect. It was Swen Nader.”

I think Coach enjoyed the look of surprise on my face. I remembered Nader, but just barely. What I remembered was that he was cut from his high school basketball team as a junior because, even at 6 feet 11 inches, he was too clumsy to offer the team any value.

He didn’t give up, though, and made a community college team. He became talented enough that several small colleges offered him scholarships.

At the time, UCLA and Wooden were in the middle of one of the most spectacular runs in all of sports, winning seven out of eight national championships. Alcindor had graduated, but Wooden had a new center, Walton, who he thought might be even better.

Nader’s community college coach asked Wooden to consider his player. “I was told he could, at the very least, be a great practice opponent for Walton,” Wooden recalled. “So I spoke with Swen. I was honest.

I told him he could go to a small school and play all the minutes he wanted, or he could come to UCLA, where he likely would never start a game, but where he could play against the best center in the country every day. That’s the best I could offer him.”

Nader didn’t flinch. He accepted the opportunity and, as Wooden had promised, he didn’t start a single game at UCLA. “Swen understood that to become the best he needed to associate himself with the best he could find,” Wooden said. “There was no better than Bill Walton.”

Or John Wooden.

When his three years at UCLA were complete, Nader had earned three championship rings playing as Walton’s backup.

Nader then made history when he became the first player selected in the first round of

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“I hope that each of you have identified those in your profession from whom you could learn, those who share your passion for greatness. ”

a professional basketball draft without ever starting a college game. He played 12 years professionally and now is vice president for Costco. His career “is absolutely and directly the result of having made the decision to associate myself with folks who were the very best,” Nader told me. “I learned that you are who you associate yourself with.”

Like Swen Nader, I hope that each of you have identified those in your profession from whom you could learn, those who share your passion for greatness. Then, while attending your state or national conferences, introduce yourself, spend time asking and learning what it is they do that makes them successful. These lessons often are transferable.

Then take the lessons home with you. Make your aspirations known to your staff and your colleagues because they want to associate themselves with greatness, too. You’ll be amazed how you surround yourself with those headed in the same direction.

At each of these steps, you’ll understand why John Wooden agreed that understanding the value of association is one of the most significant traits of greatness.

Don Yaeger is a motivational speaker, New York Times best-selling author and longtime associate editor of Sports Illustrated. He often speaks on the subject of greatness, taking lessons from the world of sports and translating them to business and professional audiences. He can be reached through his website, www.donyaeger.com.

Mr. Yaeger will be speaking at FDC2017 and presenting his keynote session, “What Makes the Great Ones Great,” on Saturday, June 24 at 8 a.m. Purchase Mr. Yaeger’s best-selling books before and after his keynote session on Saturday, June 24 during FDC. Books will be $20 each. Cash and checks will be accepted.

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EXHIBITOR MARKETPLACE Exhibitors as of May 8, 2017

#-

10 Foot Wave 3D Diagnostix Inc. 3M Oral Care

A-

A-dec A. Titan Instruments Accutron Inc. ACTEON North America ADS Florida | Henry Schein Professional Practice Transitions ADS Page Brown and Associates Advantage Technologies Advice Media AFTCO Air Techniques Inc. AMD Lasers Anutra Medical Inc. Argen Refining ArtCraft Dental Inc. ASAP Dental Care Aseptico Aspen Dental Atlanta Dental Supply Atlantic Dental / Brewer Design

B

These exhibitors have made a commitment to attend the FLORIDA DENTAL CONVENTION (FDC). Not only do these companies exhibit the latest in technology, materials and equipment, but many sponsor events and continuing education programs at the FDC. Look to see if your supplier is on the list. Make an effort to stop by their booth in the Exhibit Hall in June for exclusive show specials. Support these companies that support the Florida Dental Convention.

Bank of America Practice Solutions Banyan Baron Design Group Inc. BaseVac Bayshore Dental Studio Beaverstate Dental Systems Belmont Equipment Benco Dental Berryhill, Hoffman, Getsee & DeMeola LLC Bien-Air Dental Bioclear Matrix BioHorizons BIOLASE Biotec Inc. BirdEye Bisco Dental Products Black Tie Digital Marketing BQ Ergonomics LLC Brasseler USA Brewer Company

C

FDA SERVICES INC. IS A MAJOR SPONSOR OF THE FLORIDA DENTAL CONVENTION.

Exhibitors in blue are FDAS Crown Savings Merchants.

CareCredit Careington International Carestream Dental Carl Zeiss Meditec Inc. Carr Healthcare Realty Centura Pharmaceuticals Inc. Certol International Christian Dental Society Citibank Healthcare Practice Finance Classic Craft Dental Laboratory ClearCorrect Coast Dental Colgate

COLTENE Cool Jaw by Medico International Inc. Crest + Oral-B Curaprox USA CUTCO Cutlery

D

D&D Retail Dansereau Health Products Dear Doctor Inc. Demandforce DenMat Dental Care Alliance Dental Equipment Liquidators Inc. Dental HQ Dental Temps Staffing Solutions DentalEZ Integrated Solutions DentalOne Partners / DentalWORKS DentalPC DentaQuest DentaSpa Seminars Dentegra Insurance Company DentLight Dentsply Sirona Designs For Vision Inc. DEXIS Diatech Inc. Digital Doc LLC Digital Resource Doctor Multimedia Doctor’s Choice Companies Inc. Doctor.com Doctors Disability Specialists DoctorsInternet.com Doral Refining Corporation Doxa Dental Inc. Dr. Fuji / ACIGI Relaxation

E-F Easy Living Products Eclipse Loupes and Products Elevate Oral Care LLC Envolve Benefit Options ePracticeManager Essential Dental Systems Eternal Beauty LLC Expo Enterprise FDA Supplies / SourceOne Dental Inc. Feel Good Inc. Fidelity Bank First American Dental Finance First Citizens Bank First Home Bank Florida Academy of General Dentistry Florida Baptist Convention Florida Board of Dentistry Florida Combined Life Florida Dairy Farmers / Dairy Council of Florida Florida Dental Association Florida Dental Association Foundation Florida Dental Association Services Florida Probe & VoiceWorks Forest Dental Products Inc.

Fortress Insurance Company Fortune Management Fotona / Lasers4Dentistry Frontline Dental Supply Fuze Care System

G

Garfield Refining Company Garrison Dental Solutions GC America Inc. Geras Associates LLC GlaxoSmithKline Glidewell Dental Global Expo GPS Dental Lab Great Expressions Dental Centers Greater New York Dental Meeting Greenberg Dental & Orthodontics

H

Halyard Health Hawaiian Moon HealthLink / Clorox Heartland Dental Henry Schein Dental Henry Schein Practice Solutions HIOSSEN Hu-Friedy Manufacturing Co. LLC Hunza Dental

I

I.C. System Inc. Iconic Orange ICW International iMedicor Implant Direct Implant Educators Infinite Trading Inc. Insurance Credentialing Specialist integrated dental systems International Pemphigus & Pemphigoid Foundation Ivoclar Vivadent Inc.

J-K

Jive Communications Karl Schumacher Dental KaVo Kenwood / CGX Radios Kerr Kettenbach LP Knight Dental Group Komet USA Kulzer Kuraray America

L

La Visage Innovations Lares Research LECOM Lending Club Patient Solutions LIBERTY Dental Plan Lighthouse 360 Live Oak Bank LumaDent Inc.

M

MacPractice maxill MCNA Dental Plans Medidenta

Meisinger USA LLC MHM Services Inc. / Centurion Microcopy Microflex / Ansell Midmark Corporation Millennium Dental Technologies Inc. MIS Implants Technologies MMG Fusion Modular & Custom Cabinets Ltd. More Health Inc. My Computing RX Myofunctional Research Co.

N-O

National Dental Association Nature Hill NV Neoss New Image Dental Laboratory Nova Enterprises LLC Nova Innovations NSK America Corporation NSU — College of Dental Medicine Officite On the Map Marketing OraPharma Inc. Orascoptic Ortho-Tain / Healthy Start

P-QI

Pacific Dental Services Panoramic Corporation Patient News Patient Prism LLC Patterson Dental PDT Inc. / Paradise Dental Technologies Pelton & Crane PerioChip By Dexcel Technologies Ltd. PeriOptix Peter J. Freuler Jr., PA, CPA Philips Sonicare & Zoom Whitening Piezosurgery Incorporated Planmeca USA Inc. Porter Instrument Co. Inc. Power Dental USA Prestige Products Direct PrevMED PRO-Craft Dental Laboratory Inc. Professional Sales Associates Inc. Proma Inc. Prophy Magic Prophy Perfect / PHB ProtaPayTM Pulpdent Corporation QDP-Quality Dental Products

Shofu Dental Corporation Sierra Dental Products LLC SmileFaith Foundation Inc. Snap On Optics Solutionreach Sonendo Special Olympics Florida St. Renatus LLC Sterisil Inc. Straumann USA Summitt Dental Systems Sunrise Dental Equipment Inc. Sunset Dental Lab Sunshine Health Sunshine State Credit Superior Dental Design Services & Upholstery SurgiTel

T-U

TD Bank The Dental Assisting National Board The Doctors Company The Online Practice Thommen Medical Tokuyama Dental America TriNet HR III Inc. Tuttnauer USA U.S. Jaclean Inc. U.S. Navy Recruiting UF College of Dentistry Ultradent Products Inc. Ultralight Optics Inc. US Dental Transitions

V-W

Vatech America Vector Research & Development VIAX Dental Technologies Video Dental Concepts Vitalert Vitality Dental Arts VOCO America Inc. Walla International / Click Heaters Wand Dental Inc. (Milestone Scientific) Water Pik Inc. WEAVE Wells Fargo Practice Finance

X-Y-Z i

XPdent Corporation Zimmer Biomet Dental ZOLL Medical

R-S

Real Time CPAs Regions Bank RF America IDS Inc. RGP Dental Royal Dental Manufacturing Sage Dental Sakr Dental Arts Salvin Dental Specialties Inc. SciCan Inc. SDI (North America) Inc. SecureTip Serve First Solutions Inc. Shamrock Dental Co. Inc.

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Dentist Year:

2017

of the

Dr. Elizabeth

Gesenhues

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2017 Dentist of the Year

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2.

3.

4.

5. www.floridadental.org

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2017 Dentist of the Year Tell us about your family.

What is your dental philosophy?

Take care of the patient as if they were a family member.

Always look for new solutions to old problems, be a lifelong student and pursue continuing education, and be grateful we live in the USA.

I am one of nine children — I’m the oldest daughter and second child — and was born in post-war Munich, Germany. My parents immigrated to the U.S. in 1952, with my older brother and me. My father was a physician (general practitioner) in Louisville, Ohio and my mother was a homemaker.

My mother spoke little English when we arrived and I started school with German as my only language. My parents valued education above all else. I can still remember my mother repeating the phrase, “They can take everything away from you but what is in your head.” Seven of us received college degrees and five went on for further degrees. Their values of hard work and commitment to family, faith and community have guided me throughout the years.

How do you spend your leisure time?

I haven’t had that much leisure time!

However, I am a hobby beekeeper. I have several hives I keep in a hunting camp that borders the Favor Dykes State Park here and produces some of the best honey I’ve had. I enjoy walking my dogs on the beach every chance we get, exploring St. Augustine, its restaurants and its many treasures.

I love getting together with family and friends, whether it is here in St. Augustine or elsewhere. We have fun!

How did you end up in dentistry?

In a very roundabout way. My father was a small-town physician and I was strongly attracted to medicine, but had no desire to work as hard as he did. A relative in Germany asked why I didn’t consider dentistry. After getting over my revulsion at putting my fingers in someone’s mouth, I went and talked to my family dentist who I had always liked and admired, and he strongly encouraged it. In 1973, there were

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not that many women in dentistry, but I was accepted and started in 1974 at Case Western Reserve University. My educational experience was excellent, but I detested dentures (and wire bending). As a result, I pursued pediatric dentistry — which was as far from dentures as I could get, and I had no intention of bending wires. I was accepted in to a residency training program at The Children’s Hospital Medical Centre in Cincinnati, Ohio and again had an exceptional educational experience.

That sparked an interest in facial growth and development, which took me back to Germany where I earned a certificate in Dentofacial Orthopedics from the University of Cologne. I returned to the USA and received a Certificate in Orthodontics from the University of Florida. .

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

That was truly an obligatory thing. I joined the American Student Dental Association (ASDA) as a freshman, stayed in the American Dental Association (ADA) through my years in Germany, and joined the FDA when I became an orthodontic grad student at the University of Florida. Every dentist that I respected and admired during my early years in dentistry emphasized the importance of joining the ADA. There simply was no question about joining, regardless of debt and dues. In my early years in Jacksonville, I was asked to serve as an alternate delegate, and met up with Dr. Rick Stevenson on a Southwest Airlines flight to Tampa for an FDA House of Delegates meeting — and the rest is history!

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

Like many, my initial reaction to the people

www.floridadental.org

2017 Dentist of the Year in organized dentistry was they were a bunch of fat, balding old men who had no idea what it was like to start a practice in today’s environment (1991). Today, I am one of the fat, old people in there, but I sure hope I am not yet balding! And I have to say, the challenges mount, the solutions become more complicated, but if we want to have some control over our destiny, it will be through organized dentistry. For me, no matter what, I am a dentist before I am a specialist — and it is the profession of dentistry that has to survive despite the business of dentistry. This may be an unpopular opinion, but I did not sign up for this to be a used car salesman. I have seen enough in other countries to value our organization’s commitment to our patients and the dentists. We have been great supporters of prevention, a high ethical standard among dentists, continuing education, etc.

Can you make some predictions for dentistry?

We will see so many changes in the delivery of care, how it will be delivered, who will be delivering the care, etc., but the contact between doctor and patient will remain important.

What advice would you give to dental students?

New dentists?

Always remain a student! Never stop learning. And the best advice I received: “If you take care of the patient, the money will take care of itself.” When I first heard that, I did not believe it could be so simple, but it was good advice then and I think it remains good advice today.

How has dentistry changed since you began practicing?

What is better?

I don’t know where to start! Lasers, composites, ceramics, implants, indirect

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bonding, digital radiography, 3-D scanning and 3-D radiography, dental CT scans, heat sensitive wires in orthodontics, Invisalign.

When I started, we dealt primarily with two disease processes — decay and periodontal disease — and fluoride made real inroads on the decay issues. Today, we have an array of options to offer our patients in cosmetics, preventives, diagnostics, restorative care, surgical care. It is all better! It is wonderful to be able to tell a patient to give me time to think about this and let me talk to a few colleagues and then be able to offer them multiple options to address their concerns.

It is great! A challenge is corporate dentistry and its impact on the delivery of care, but I believe that they fill a niche and that good personal care will still be sought out.

Dr. Liz Gesenhues with her staff (l to r): Heather Foster, Dr. Liz, Blanca Campos and Megan Brueck.

What has been the most challenging aspect of your job? The most rewarding?

The most challenging has been running and managing the business. I was ill-equipped for that. The most rewarding aspect has been being able to practice dentistry the way I want to!

American College of Dentists Induction, with (l to r) Drs. Mary Hartigan, Rick Stevenson and Liz Gesenhues.

Photos:

1. Dr. Liz's took braces off her patient, Nick. L to r: Dr Chris Henry; long term employee, Blanca Campos; Nick; and Dr. Liz. 2. Dr. Liz's nephew, Zack's, bar mitzvah.

3. A hobby beekeeper.

4. Dr. Liz's two dogs, Oskar and Meier, going for a walk on St. Augustine Beach.

5. Barbara Brinkmann, Dr. Liz's cousin from Germany, and Dr. Liz eating homemade ice cream in Amish Country.

Dr. Liz Gesenhues with her nine brothers and sisters (top left going clockwise, from oldest to youngest). Bernard Gesenhues, Dr. Liz, Henry Gesenhues, Albert Gesenhues and Joseph Gesenhues, the bottom right is the youngest, Barbara Gesenhues Cabral, Hubert Gesenhues, Hedwig Gesenhues Demsey and at the bottom left is Dorothea Gesenhues Polster.

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HELP NEW PATIENTS FIND YOU. Courtesy of the www.floridadental.org

May/June 2017

Today's FDA

51

Osteonecrosis

A Table of Information on Drug-induced Osteonecrosis of the Jaws (DIONJ) A Summary of Almost Everything You May Have Wanted to Know, But Were Afraid to Ask

By Dr. Richard A. Mufson

Author comment/disclamier: The information contained within this article and associated table is intended for use as a reference and general “guideline.” It is not intended to be a specific recommended or definitive directive for prevention or treatment, nor as a standard of care. Varying clinical situations, clinical judgment on the part of the treating practitioner, and communication with other medical professionals involved in the care of a given patient, should be taken into consideration, and may result in differences in individual management or treatment plans to optimize patient care on a case-by-case basis. Most assuredly, new data and new drugs will come about that may modify and add to these guidelines.

This is most likely a throwback to my childhood “arts and crafts,” filling some inner need to occasionally just “create stuff ” — especially stuff with a lot of fancy lines and

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colors. In truth, this mini-project simply had very much to do with the important reason of “need.”

I have received quite a number of phone calls and emails in recent years from dental colleagues asking questions such as, “Can I place an implant when my patient is taking Fosamax?” Or, “How long should I ask his/her physician to discontinue the medication?” “How about Aredia and Zometa?” “Will a CTX test help?” “How do I write the prescription, and how do I interpret the results?” “Can I do regular dental treatment?” “How about orthodontic treatment?” “What about these newer drugs, Reclast, Prolia and XGEVA? How are they different?” “How long does it take before the risk of necrosis begins?” And on and on.

Often with the phone still in my ear, I have provided answers to such questions — especially on the newer medications and time frames for “drug holidays” — by opening an adjacent desk drawer, reaching for and then rifling through several pages of handwritten notes from lectures I had attended that covered the most recent updates on drug-induced osteonecrosis of the jaws (DIONJ). The lectures were given by Dr. Robert Marx, professor and chair of the Division of Oral and Maxillofacial Surgery at the University of Miami, whom many or most oral surgeons regard as the go-to “guru” and leading source of knowledge on this and other clinical issues affecting bone.

An interesting idea then occurred to me. Rather than randomly thumbing through pages of handwritten notes with questionable legibility and organization at best, I thought, “What if the information could be organized, collated and logically placed in a colorful and easy-to-reference table?”

And so, with the help of those same handwritten notes, lecture slides of my own, and additional vetting and editing provided by Dr. Marx, I created what I felt would be a user-friendly “DIONJ At-a-Glance Table,” with the hope that others may find it helpful and useful. In all honesty, much of the motivation for this also began with my basic need to keep the information straight and available for my own eyes and mind.

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Osteonecrosis I feel the need to share an important point: By the very nature of periodic changes, which may inherently occur within any such area of science, this document should be considered “fluid” and subject to future modifications as new information may emerge.

Other Background Information I would not, in my wildest imagination, attempt to cover the full scope of information pertaining to DIONJ in an article such as this. My limited purpose was to organize and format the table of information. However, I felt that a few supplemental points would provide an additional helpful perspective.

DIONJ is a condition that impacts all dentists and dental patients, and the clinical concerns of which are far from being limited to one specialty group or another. As we know by now, ever-increasing numbers of patients come into our offices with seemingly longer lists of medications, many of which have challenged our treatment planning strategies over the years. A notable example would be the varied groups of blood thinners currently on the market and in use today.

However, it would appear that this one unique group of medications that induce bone necrosis in our patients undoubtedly has resulted in a greater level of consternation, befuddlement and questions for those of us who practice dentistry on a daily basis.

Although all the medications share a common thread of providing significant help in the prevention of health and life-endangering skeletal fractures in at-risk osteoporotic patients, and in the prevention of bone metastasis in cancer patients, they also share another common thread — interference in some form with alveolar bone turnover, remodeling and healing.

Additional challenges have emerged due to an increase in the number and categories of such medications surfacing in recent years, with differing dosages, timing, routes of administration, and variable time frames relative to (a) when the risk of necrosis begins and (b) halflives of the medications within bone. These variables may in turn affect the time frame of a recommended “drug holiday.”

As a net result, our ability to maintain a clear and concise vision or “handle” on how to clinically manage patients taking these medications has seemed elusive at best, and quite challenging in terms of having the most relevant information organized and available to us literally at our fingertips.

A number of changes also have occurred, as information, data and general knowledge have progressively evolved. The very name of the condition, since it first became apparent, has undergone important changes. As newer medications have emerged — such as Prolia, XGEVA and antiangiogenic drugs, which have resulted in the same/similar problem of bone necrosis, but are not members of the bisphosphonate group — the name, “bisphosphonate-related …” has since been changed to “drug-related ONJ.”

brother, sister or cousin) to the condition, but rather represent the direct cause-andeffect agents of bone necrosis via their toxic and killing effects on osteoclasts. Therefore, a change in the name reflecting this also has been made (by Dr. Marx and others), to “drug-induced ONJ.” Finally, I wish to thank the one individual who has provided virtually all of the information I am currently sharing with you: Dr. Robert Marx. Many — or most — of us have long considered Dr. Marx a mentor, leading clinician, researcher, and a uniquely gifted educator and communicator of information, and we are incredibly thankful for the many pearls he has given our profession throughout the years.

These have included, but are certainly not limited to, his groundbreaking research and journal articles in the mid-1980s on radiation-induced bone necrosis and the role of hyperbaric oxygen, followed by other major contributions in our understanding of pathology, bone grafting and reconstruction of the face and jaws, and in the development and use of adjuncts such as platelet rich plasma, bone marrow aspirate, bone-morphogenetic protein and others.

I sincerely hope you find this information useful, and would invite you to offer any feedback or questions on any aspect of what appears in this article or DIONJ table (please see following two pages for table).

Find a printable pdf of the DIONJ chart at http://bit.ly/2pkInAC. Dr. Mufson is an oral and maxillofacial surgeon in North Miami Beach and the editor of the South Florida District Dental Association Newsletter, and may be contacted at 305.935.7501 or MufsonOralSurg@aol.com.

The case also has been made by Dr. Marx and others that the term “drug-related …” is a misnomer, given the fact that the drugs in question are not merely “related” (as would be a

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Drug Induced Osteonecrosis of the Jaws (DIONJ) Medication

Drug Class

Used to Treat

Dosage

(left) Risk Begins at:

Fosamax1 oral osteoporosis 10 mg/day po, or (alendronate) bisphosphonate* 70 mg po/week 2.5 – 3 years

Actonel oral osteoporosis 5 mg/day po, 3 yrs (risedronate) bisphosphonate or 35 mg/wk; (lower dose, risk, or 150 mg/mo case #’s/incidence)

Boniva oral osteoporosis 150 mg/mo 3 yrs (ibandronate) bisphosphonate (lower dose, risk, case #’s/incidence)

Reclast IV osteoporosis 5 mg IV/yr sharp increase (Zometa) bisphosphonate after 4th dose

Prolia2 RANKL inhibitor** osteoporosis 60 mg sub-cu/6 mo 5th dose nd (denosumab) (2 dose if after Reclast)

XGEVA2 RANKL inhibitor Ca - mets 120 mg sub-cu/mo 2nd dose st (denosumab) (1 dose if after Reclast)

Avastin antiangiogenic lung, prostate 500 mg/2 wks insufficient (bevacizumab) Ca cases/data (?)

Sutent antiangiogenic kidney 25 mg/day insufficient (sunitinib) Ca cases/data (?)

Zometa3 IV breast, prostate, lung 4 mg/mo IV after 4th dose (Zolendronic acid) bisphosphonate Ca, multiple myeloma (also Pagets)

Aredia3 IV breast Ca 90 mg/mo IV after 8th dose (Pamidronate) bisphosphonate multiple myeloma (also Pagets)

DIONJ defined: Exposed non-healing bone in mandible or maxilla persisting > 8 wks, in absence of any other systemic drug known to cause ONJ and/or Hx of local RAD Tx to jaws.

*Bisphosphonates - half life in bone = 11+ years **RANKL Inhibitors - half life = 26 days (easier to treat/debride sooner) 1 – Oral bisphosphonates – drug holiday of 9 months prior to an invasive oral surgery + 3 months after surgery 2 – RANKL inhibitors: drug holiday of 3 months prior to an invasive oral surgery + 3 months after surgery 3 – IV Bisphosphonates: drug holidays - not practical 4 – CTX – helpful with osteoporosis, but not useful in Ca pts (readings too high), or Hx of steroids, or methotrexate (readings too low) Comorbidities: steroids, chemotherapy, diabetes, smoking, obesity (do not cause ONJ, but result in earlier, more severe, more extensive occurrence) Other bisphosphonates (not known to cause ONJ) – Clodronate (osteoporosis), Etidronate/Tilidronate (Paget’s)

Information courtesy of Robert Marx, DDS / Table, Graphics by Richard Mufson, DDS ; February, 2017 2.

3.

Drug Induced Osteonecrosis of the Jaws (DIONJ) CTX Test Helpful4?

Mechanism of Action

Prevention or Drug Holiday (+ add 3 mo’s after Tx)

Yes 9 month (empiric) drug holiday++ Osteoclast death at bone sites mostly, or sooner (3 mo? 6 mo?) per CTX > 150 pg/ml lesser effect on precursor inhibition; and death in marrow

Yes same as above++ same as above

same as above Yes same as above++ Yes

9 month drug holiday after last dose++ 3 months before next doset

same as for Zometa below

(or request until clinical healing occurs)

Yes 3 months++ after last injection2

Osteoclast inhibition, death in bone, marrow blood, tissue spaces, and at resorption site

Prevention: No (prior to therapy) remove unsalvageable teeth, prophy, treat caries, periodontitis + defer start of therapy No x 2 months

Osteoclast death (both Zometa, Aredia)

3 months++ after last injection2 same as above

Prevention: see below

No 3 months (?)

Blocks action of vascular growth factor (VEGF)

No 3 months (?)

Blocks action of multiple GF’s (VEGF, PDGF, TGF-b, etc.)

No

During therapy: Avoid invasive dental Tx (ext’s, perio surg, implants); RCTx if needed, amputate crown, supragingival scaling, splint mobile teeth. If ext’s are unavoidable – provide consent/inc risks

“Non-Invasive Dental Tx (not involving bone/bone healing) – is safe at all times” (restorations, crowns, bridges, dentures, endodontic therapy, non-osseous periodontal surgery).

CTX : < 100 pg/ml - high risk 101-150 pg/ml – moderate risk > 151 pg/ml – little or no risk

Writing the Rx: “Morning fasting C-Terminal Telopeptide (CTX) bone turnover marker” Dx = Osteonecrosis (M87.10) Please FAX result to: [fax number] Please report results in pg/ml

Tx of Exposed Bone in IV Bisphos: - Avoid debridement, smooth sharp edges, PCN (or Levaquin, Zithromax, Doxycycline); add Flagyl 500 t Reclast – may also consider CTX x 10 days in refractory cases, 6-9 months after dose/injection - if surgery unavoidable - perform alveolectomy or continuity resection ++ Avoid debridement, other surg Tx without drug holiday, smooth sharp edges, Tx w/ Pen VK or Doxycycline and Peridex - Adult Orthodontics in Bisphosphonate and Denosumab pts – “teeth will not move.”

- Ineffective therapies in DIONJ: clindamycin, HBO, Laser, Ozone - Antibiotic of choice in DIONJ – PCN/Amox or (if PCN allergic), Doxycycline x months needed; if Zithromax or Levaquin - no longer than 1-2 weeks.

Information courtesy of Robert Marx, DDS / Table, Graphics - Richard Mufson, DDS ; February, 2017

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Compleat Dentistry

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

By Dr. Edward Hopwood

“

Everything there has a reason to be there, and the reason is to pursue mastery.

”

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Steven Pressfield, in his remarkable group of books, talks about “turning pro.” Basically, he says that if you are going to take yourself seriously, put in your 10,000 hours and plan to do great work, and if you plan to be an outlier, then you need to start acting like a professional. He speaks about the demeanor professionals have when approaching their work. They are serious, focused and diligent. They put in their time every day and work hard, and they don’t fool around when they are working. Only when they stop working for the day do they do other things for the rest of the day. Now, Pressfield is talking to writers, and that group is notoriously known to procrastinate and approach their work less than seriously.

Fortunately for us as dentists, we show up each day at the same time and we face people who expect us to be professionals. Our patients and staff expect us to focus and complete the task at hand. We work hard, four days a week. But I find Pressfield’s message especially enjoyable because he talks about using the professional mindset to position ourselves to achieve peak performance. He compares excellent writers to professional golfers who truly work hard every day to hone their craft. This is easy to contrast with average golfers who approach the sport with the hobbyist’s mindset and will never hope to turn pro.

As part of the professional mindset, Pressfield recommends that we set up our own territory or space to do our work. This is how he describes Arnold Schwarzenegger when he goes to the gym; he is in his own territory where he has spent years claiming it as his own. This is like a karate master in his dojo. The dojo is a place where a karate master works and trains, where he pushes himself further and becomes a pro in an environment that is uniquely adapted to train a karate master. The dojo often is deceptively sparse with the intent focused on getting better at karate. If you see a TV in a dojo, then you are not working with a professional. Likewise, there are no Keurig machines or magazines. Everything there has a reason to be there, and the reason is to pursue mastery.

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Compleat Dentistry

The thing I love about this analogy is that we are uniquely able to create our own dojo. We can create an office where we pursue mastery of our profession. We can set it up so that everything there helps us to pursue dental mastery. And then we can turn pro and begin to work. We can show up on time. We can dedicate our days to improving our skills. Then, we can go home and do other things. So many other people have to work in an office; we can work in our own dojo. Remember, Malcom Gladwell spoke about 10,000 hours, but often it’s overlooked that he was speaking of deliberate, focused practice. A dojo is where we perform deliberate practice (if we elect to turn pro).

I often speak to our residents about transitioning into private practice. One of the important things first discussed is their vision for their ideal office and how it would feel to be in their dream office. Where would the office be located? What size staff would support the office?

Would there be other dentists in the office? And then we set out to find the type of situation in which they could develop into their dream practice. When they tell me about an opportunity they have found, the next question I ask is, “Is it your dream office?” And if not, “Can you make it into your dream office?” Because if it is not their dream office and they can’t see making it into their dream office, then they need to keep looking.

One of the most enjoyable aspects of my career in dentistry has been the development of my dojo. It’s not done yet, and we are always working to improve it and bring it closer to my vision. But, it is getting much closer, and it is certainly a comfortable environment for me and my staff to pursue mastery of our individual fields. And when the environment supports it, pursuing mastery is a comfortable endeavor. The environment frees us up to focus on our jobs, and then we can make great strides in our development.

I will never forget the first time I walked into my dojo. It wasn’t mine yet; it belonged to Dr. Pete Crawford. I was lucky — a friend introduced me to Pete, who was a great dentist for a long time in our area and was ready to retire. Fortunately for me, Pete agreed to sell me his dojo. He had spent years working hard and becoming the best dentist he could be. He had made his office and refined it so that it was a great place to work. Pete’s wife, Jan, had done a fantastic job decorating the office and designing it perfectly. I could pick up where he left off and turn it into my dream practice. Pete turned out to be a great friend and has always been willing to help me in any way he could. This turned out to be a pleasant surprise for both of us — a 17-year friendship between two people who were at very different stages of their careers. I began my career by standing on the shoulders of a giant.

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Now, there are some who say that the young generation of dentists are not going to buy practices. They have too much debt. Banks won’t lend them the money. They are not interested in putting in the effort to run a practice. But my experience with our residents has taught me the exact opposite.

They are more than willing to put in the effort. Banks will lend them the money.

And, the best way out of their debt is to become practice owners. My experience has been that they are ready, willing and capable — they can’t wait to begin making their own dojo.

This makes me think about the future, and when I am ready to retire. My dojo will be so much further along. It should be almost perfect by that point. I hope I will be able to do what Pete did and transition my dojo to a young dentist who will then go about making it his or her own. They will build upon two generations of dentists’ efforts to make it the best place they could, and they will turn pro and pursue mastery. And my patients will benefit from that. No corporation will be able to buy it, no matter how much money they offer, because a corporation has no business in a dojo.

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

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Cutting Edge

Cutting The Department of Cariology and Restorative Dentistry is on the Forefront of Innovation

“

The day is surely coming … when we will be engaged in practicing preventive, rather than reparative, dentistry. When we will so understand the etiology and pathology of dental caries that we will be able to combat its destructive effects.

”

— G.V. Black, DDS, 1926

Edge

By Michelle Solomon

Dr. Audrey Levitt Galka, chair of the Department of Cariology and Restorative Dentistry at Nova Southeastern University College of Dental Medicine (NSU CDM), will be the first to tell you that the days of “drill and fill” dentistry are numbered, and that G.V. Black, the father of modern dentistry, would be pleased to know that the day he spoke of in his famous quote has arrived. When students of the cariology and restorative dentistry department head out into the world as professionals, Dr. Galka hopes they keep five important letters in mind during their day-to-day practice: ICCMS™.

“This is the new model that we are using to train future dentists,” said Dr. Galka about the International Caries Classification and Management System™ (ICCMS™) that has become the overarching philosophy and mission of the department.

In June 2013, Dr. Galka headed to King’s College London Dental Institute as part of the ICCMS™ Implementation Workshop. When she returned, she set out to put a process in place at NSU. “We’ve had cariology here for 14 ½ years, and the philosophy of minimally invasive dentistry, including caries risk assessment, is reinforced by our faculty members. But now, we will have a formal ICCMS™ pathway,” she said.

The ICCMS™ concept uses a standardized system in a prevention-oriented approach.

“ICCMS™ classifies the stages of severity of the caries process — which is the decay — and

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Cutting Edge the activity status of lesions. This relates directly to whether and how to treat,” Dr. Galka explained. “Today, the evidence supports that if we get to the lesion early, using preventive strategies and motivational training for patient compliance, we can reverse the caries process.”

The protocol calls for a comprehensive management plan that first assesses the patient’s risk for caries. “Students are taught to evaluate the patient’s history, X-rays and clinical examinations to determine whether the patient is low, moderate or high risk, and to stage caries severity and lesion activity. The diagnosis governs the clinical treatments, which include an individualized preventive treatment plan (based on risk level) and nonsurgical or surgical care for individual lesions,” Dr. Galka said. The emphasis is on prevention and minimally invasive dentistry. A coded system ranks caries severity beginning at zero, with six being the most severe.

For patients with early stage caries, students are taught that they should work with the patient for a remineralizing plan and monitor these lesions over time before resorting to an irreversible surgical procedure. For moderate and severe caries, minimally invasive restorations are recommended. “The department supports the philosophy that controlling the caries process and preservation of tooth tissue are paramount,” Dr. Galka said.

Goodbye, Explorer Dr. Galka supports the view that traditional use of the dental explorer for caries detection be replaced with the less-invasive visual assessment model. She explained that if “You take that explorer and you have the initial stage caries — that white spot lesion — or the start of chalkiness, you can actually cavitate the tooth with the explorer.” Dr. Galka added that it is challenging to get buy-in from dentists and faculty members who have been using the explorer instrument as their right-hand man for 40 years. “We’re in the process of ensuring that all our faculty members are trained to use the ICCMS™ survey,” she said.

CDM student Zohaib Munaf observes CDM student Francesca Pietri.

“NSU has a rigorous cariology preclinic and clinical component, and we are excited about this initiative,” said Dr. Evren Kilinc, a cariology content expert. The treatment plans created by the students trained in the classification will result in a more comprehensive caries diagnosis. “They will become more attuned to looking at these initial active lesions and taking all the necessary steps to try to remineralize these early lesions, before intervening with surgical care,” Dr. Galka said.

Dr. Amir N. Farhangpour, predoctoral director and restorative director of the NSU clinic, said the ICCMS™ creates a common language between students, faculty members and patients. “It provides a guideline of what stages we should be looking for,” he explained. “It makes sure that we are looking at the entire picture and not just one tooth. Let me simplify it. In years past, if we saw a small spot, we treated it in the same way we would treat a large, active lesion. Now, we say, ‘Let’s see if we can give this a second chance with our preventive approach.’”

CDM student Giovanni Gonzalez listens to Stanley Hack, CDM professor.

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Cutting Edge EDGE from 61

Minimally Invasive Strategy

"We broke the silos when we created the Integrated Restorative Dental Sciences course," said Audrey Galka, CDM professor, with CDM students (left to right) Narges Atabakhsh, Shayan Azimi, Renatta Griffith, Dayron Baes, Sean Cinkilic and Denae Britsch.

Students working in the clinic are taught to look at the caries risk of the patient to develop an individual preventive treatment plan and to make decisions about borderline lesions.

“That’s where that minimally invasive strategy comes in. We say, let’s prescribe fluoride to stop the progression of the lesion.

It may need a restoration many years down the road, or maybe never,” said Dr. Farhangpour. When surgical intervention is indicated, students are taught to follow the principles of minimally invasive dentistry and make every attempt to be conservative in tooth preparation.

Both Drs. Galka and Farhangpour agree that the key for their students to decide on restoration is if the tooth is cavitated and there is a break in the integrity of the enamel. “What we’re teaching our students is the rationale linking the diagnosis to treatment,” said Dr. Farhangpour. “Hopefully, with future dentists learning this protocol, the restoration of cavities — previously the mainstay of general dentistry — will one day become part of a complete, patient-centered preventive model.”

However, Dr. Farhangpour does point out that NSU has no shortage of patients in need of restorative care. “Our students get a great deal of experience in a wide variety of restorative procedures, placing quality restorations with state-of-the-art restorative materials,” he added.

(From left to right) Khalid Motlaq, a CDM postgraduate resident; Luana Oliveira Haas, faculty of the Postgraduate Operative Dentistry Program; and, Thani Alsharari and Najat Aldossarry, both CDM postgraduate residents, observe Aryia Amini, CDM professor, as he examines a patient's records in the Postgraduate Operative Dentistry Clinic.

Integrated Study Students in their first year of dental school also are introduced to a course that has them hitting the ground running.

“We broke the silos when we created the integrated restorative dental sciences course. This was an interdepartmental initiative where we combined dental anatomy, occlusion, cariology, operative, biomaterials, fixed prosthodontics and case-based treatment planning as a super course,” said Dr. Galka. “The students are not just treating a tooth. On Day One, we show that we are treating the overall well-being of a patient. It’s all tied together, which lends itself to the clinic, which is built on a comprehensive care clinic model.”

Amr Azhari, CDM postgraduate resident, Luana Oliveira Haas, faculty of the Postgraduate Operative Dentistry Program, Vera Lulaj, DDS and Raul Astorga, dental assistant, discuss what to do for their patient.

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Zohaib Munaf, president of the class of 2018, said the course almost immediately had him immersed. “It was fast-paced because of all the dental topics rolled into one. It really showed me what I would do in my practice,” he explained. Enrolled in the course for three semesters, he said it showed him how www.floridadental.org

Cutting Edge to “look at a patient as more than just a restoration. I’m not just going to do a composite treatment. It’s a different way of looking at the whole oral cavity and seeing what other issues may be present or how you can resolve any other concerns.”

Special Postgraduate Program With the many complex restorative cases at NSU, and a desire to be at the forefront of operative dentistry, the Department of Cariology and Restorative Dentistry developed and implemented a postgraduate program in operative dentistry in 2011. Currently, NSU is one of only six operative dentistry postgraduate programs in the country, with Dr. Ariya Amini serving as the interim director.

Dr. Luana Oliveira Haas, former director of the postgraduate program in operative dentistry, found it intriguing when she came to the United States from Brazil and discovered that operative dentistry was not considered a specialty as it is in other countries. “While operative is learned in dental school, the difference is that you learn only the basic concepts.

If you attend a postgraduate program that focuses on operative, you will learn different techniques, improve skills and have a different approach to your patients because you are more highly trained,” she said.

Currently, the program — with its first-entering class in July 2011 — is competitive, with 50 to 70 applicants vying for only four available positions. The training program awards a Master of Science degree and a certificate in operative dentistry upon completion.

“We teach many of the general dentistry concepts at an advanced level where they may have cases that are more complicated,” Haas stated. Students practice both cosmetic dentistry, such as working with porcelain veneers, composite restorations and prosthetic procedures, as well as fixed partial dentures. “The clinic aspect is the strongest portion of the program, and we have a large pool of patients, so our students are exposed to many different cases,” she said.

Additionally, a major focus of the postgraduate operative specialty program aligns with the predoctoral program, with an emphasis on a patient-centered prevention model. Recently, the Academy of Operative Dentistry requested that the American Dental Association’s Council on Dental Education and Licensure recognize operative dentistry as a special interest area in general dentistry. “If this proposal gets final approval, operative dentistry will be even more important in terms of recognition,” Haas said.

Amr A. Azhari, a graduate in the two-year program, said an additional year may be used to complete the research thesis. He had his pick of other operative dentistry programs, including the University of Michigan and Indiana University, but “chose NSU because their program has three components that are treated equally: research, clinical and teaching.”

Azhari was one of the students who was sponsored in the operative dentistry program as part of the Department of Medical and Health programs of the Saudi Arabian Cultural Mission. In his role as a faculty member at King Abdulaziz University in Jeddah, Saudi Arabia, Azhari said the government would have him return to his country with his skills to teach others, in addition to having his own clinical practice.

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CDM student Tyler Frey receives up-close instruction from CDM professor Edward A . Fellows, DDS.

The opportunity to have a large patient pool in which students are encouraged to be more productive seeing patients three times a week, and as many as eight patients per day, is another difference between NSU’s program and others similar programs, Azhari added. “Some cases are simple and some are complex. We are lucky to have experienced faculty members working with us. This program is really one of the toughest programs I’ve ever worked in. It’s good, because it gives you the opportunity to learn under pressure.”

Reprinted with permission. Story courtesy Nova Southeastern University College of Dental Medicine.

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FDA Services welcomes our new 2017-2018 Student Advisors!

Thank you for volunteering to provide the insights and perspective we need to serve the next generation of Florida dentists.

CHRIS NAGLIERI

MICHELLE BARGFREDE

SABLE MUNTEAN

Nova Southeastern University College of Dental Medicine

University of Florida College of Dentistry

LECOM School of Dental Medicine

Visit www.fdaservices.com to learn more about our products and services.

YOU are NUMBER

1

YOUR COLLEAGUES ARE “HELPING MEMBERS SUCCEED” EVERY DAY!

DEDICATED VOLUNTEERS HELP YOU SUCCEED Taking the time to help others is just something that comes naturally to members of our profession. It is one of the many aspects of dentistry that makes me proud of and willing to try to help support our profession in any way I can. After buying my practice, I was fortunate to have fantastic role models in the Clay County Dental Society, Jacksonville Dental Society, and Northeast District Dental Association to encourage me to get involved. I currently serve as an FDA delegate from my district as well as our district’s representative on the Council for Dental Education and Licensure. I’ve also had the privilege of serving as the Endodontics Department Manager for the Mission of Mercy events in Jacksonville and Pensacola, both truly unforgettable experiences.

The FDA has supported me through the process of buying a practice, as well as providing benefits that save me money running my practice day to day. I would encourage every member of our profession to support TOM BROWN, DMD, MS organized dentistry financially, but the greatest reward comes with taking the next step and finding ways to ORANGE PARK ENDODONTICS donate your time in some way to any of the wonderful things the FDA does.

— Tom Brown, DMD, MS tbrowndmd@gmail.com Interested in opportunities to get involved? Simply email the FDA’s Membership Concierge and she’ll put you in touch with your local dental society. Contact Christine Mortham at cmortham@floridadental.org.

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Dental Lifeline

How to Make a Difference with Dental Lifeline Network • Florida

Edward, or “Eddie” to his family, is a 42-year-old U.S. Air Force veteran from Tampa. He served for five years before suffering a traumatic brain injury that prevented him from continuing. Eddie suffers from dementia, migraines, bipolar disorder and TMJ because of his injury.

In addition to his medical conditions, Eddie also needed new dentures for which he had no means to pay. In order to qualify for Veteran Administration dental benefits, an individual must have a 100 percent service-connected disability, have been a prisoner of war or have developed a dental condition during Dental assistant Sarah, Edward their service. He joined a and Dr. Terry Buckenheimer vocational schooling program for human services, but he felt he could not enjoy everyday life things because of his dental condition. Eddie had nowhere to turn.

How DDS Helped Dental Lifeline Network • Florida (DLN) and the Donated Dental Services (DDS) program volunteers agreed to help Eddie restore his oral health. DLN national board member Dr. Terry Buckenheimer stepped up and developed a treatment plan for Eddie. Volunteer dental lab, Florida Laboratories, agreed to provide new dentures, too. “Despite his illnesses, Eddie had a terrific outlook on life. He knew that the treatment my staff and I were providing was going to work perfectly for him,” said Dr. Buckenheimer. Because of the generosity of DDS volunteers, Eddie’s life was changed forever. Eddie’s wife shared her words of gratitude after his treatment, “We are just so thankful for this! Dr. Buckenheimer has been wonderful and we are over the moon.”

How to Get Involved

Volunteer Today!

Donate Connect With Us Don’t miss our updates on Dental Lifeline Network and its Donated Dental Services (DDS) program! Sign up today at www.DentalLifeline. org/Newsletter-signup and follow us on social media. Go to www.DentalLifeline.org for more information.

You can make a difference, too, by volunteering with DLN. Take it from seasoned volunteer, Dr. Terry Buckenheimer, “Being a volunteer for the DDS program is an incredibly satisfying experience! My entire staff gets the opportunity to give back in a way that feels natural to them.” www.floridadental.org

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By Drs. Liya Davidova, Second-year Resident in Oral and Maxillofacial Pathology, Indraneel Bhattacharyya, Nadim M. Islam and Donald Cohen

A 65-year-old male presented to Dr. Alan Fetner, of Fetner and Hartigan Periodontics in Jacksonville, Fla., with a white linear lesion measuring approximately 1.5 x 0.4 cm on the right lateral border of the tongue (Fig. 1). In addition, faint erythematous areas were seen in the immediate vicinity of the white lesion. His chief complaint was increased sensitivity of teeth. The lesion was completely asymptomatic and had been present for an unknown duration. Clinical examination failed to reveal any source of trauma or friction to this site; though, it was possible the patient could be rubbing his tongue against the right mandibular molars. His medical history was significant for immune suppression, acid reflux, regular use of a CPAP device, mitral valve prolapse and shingles about eight years ago. He agreed to an incisional biopsy, which was performed by Dr. Fetner under local anesthesia, and the tissue was submitted to the University of Florida College of Dentistry Oral Pathology Biopsy Service. Microscopic examination revealed hyperkeratosis with frayed and shaggy keratin layers and papillary acanthosis (Fig. 2).

Bacterial colonies were seen adherent to the keratin. No candidal organisms were noted. Ballooning koilocyte-like cells were noted in the spinous layers. The nuclei of these cells exhibited a homogenous ground-glass appearance with margination of the chromatin material around the nuclei (Fig. 3). Occasionally, intranuclear inclusions were noted.

Fig. 1

Fig. 2

Question: What is the most likely diagnosis?

A. Frictional keratosis B. Hyperplastic candidiasis C. Oral lichenoid lesion D. Idiopathic leukoplakia E. Oral hairy leukoplakia

Please see DIAGNOSTIC, 70

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Fig. 3

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Diagnostic

DIAGNOSTIC from 69

Diagnostic Discussion A. Frictional keratosis Incorrect — excellent choice! Based on the location and clinical presentation, this was one of our primary choices as well.

Frictional keratosis (tongue chewing or morsicatio linguarum) on the lateral borders of the tongue occurs because of trauma to the tongue from biting by the posterior teeth, or due to irritation from poorly fitting or poorly polished dental appliances. This common lesion frequently presents as an irregular, rough, white plaque on the lateral tongue, alveolar and buccal mucosa. This lesion quickly resolves with a change of habit or removal of the source of irritation (e.g., adjustment of sharp cuspal edges, polishing of rough restorations, fabrication of better fitting restorations). In this case, however, careful evaluation failed to reveal any evidence of trauma, which prompted an incisional biopsy due to the presence of a white lesion in a high-risk location.

In addition, microscopic examination also revealed certain characteristic features such as superficial serum pooling seen with chewing trauma.

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B. Hyperplastic candidiasis Incorrect — great choice! Candidiasis closely resembles leukoplakia and often causes proliferation of both the keratin layer and the epithelial spinous layer; therefore, resulting in a thickened, raised and rough appearance. No candida was found in this specimen. The lateral border of the tongue is a common site for candidal infection-related hyperplasia. However, isolated or unilateral candida hyperplasia is less common and typically tends to be slightly symptomatic. Symptoms such as burning or discomfort usually are present, unlike in this situation where no symptoms were noted. Unlike many of the entities discussed here, candida-associated lesions usually can be wiped off, which was not the case here.

However, hyperplastic candidiasis usually cannot be wiped off. Candidal hyperplasia should always be included in the differential diagnosis of white lesions on the oral mucosa. Candidiasis, including pseudomembranous, erythematous, hyperplastic and mucocutaneous variants, may be seen in the oral mucosa. Immature or impaired immunity predisposes patients to candidiasis; thus, bimodal age distribution is observed for this condition. Infants and older adults are most commonly affected. However, this condition can be seen in any age group and mainly affects populations that have local or systemic predisposing factors. Local pre-

disposing factors include: reduced salivary flow; dental prosthesis (e.g., full and partial dentures); smoking; and, topical corticosteroids. Systemic factors consist of: prolonged use of systemic antibiotics; endocrine disorders (diabetes, Cushing’s syndrome); immunosuppression (chemotherapy, HIV, AIDS, systemic corticosteroids); nutritional deficiencies (e.g., iron); and, congenital conditions (e.g., DiGeorge syndrome).

Candidiasis usually is easily treatable with antifungal agents such as fluconazole, clotrimazole and nystatin. Itraconazole, posaconazole and voriconazole are second-line antifungal agents. Refractory cases of oral candidiasis may be treated with amphotericin B. C. Oral lichenoid lesion Incorrect — great choice! These are generally white lesions that may present on any oral mucosal surface often accompanied with white striations. No such striations were evident in this case. In addition, the patient did not have other lesions on any other areas of the oral cavity, which would lead us away from this diagnosis. Usually lichenoid lesions are not isolated. Oral lichenoid lesions (OLLs) may occur because of contact with a variety of topical agents, including dental materials (e.g., amalgam, ceramics, composite) and flavoring agents (e.g., cinnamon). OLLs most commonly present on the buccal mucosa and lateral surface of the tongue, but also may present on the gingiva, lips, floor of the mouth

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Diagnostic

and palate. Unlike oral hairy leukoplakia, OLL can present as white patches, striated, plaque, reticular, erosive or ulcerated lesions. These lesions completely or partially resolve after the replacement of restorations (whenever possible) or upon discontinuation of the product containing the offending agent. No new restorations were reported and the patient had these restorations years before the lesion started. The absence of any relevant history of contact stomatitis and no striations could not support this diagnosis.

However, as mentioned above, lichenoid lesions may present with a myriad of clinical presentation, it is important to consider this entity, in the differential diagnosis of white lesions on the tongue. Isolated white lesions on the high-risk locations such as this should be viewed with caution and biopsied to rule out premalignant alterations.

D. Idiopathic leukoplakia Incorrect â&#x20AC;&#x201D; great choice! Idiopathic leukoplakia (IL) is another condition that presents as a white hyperkeratotic patch.

The leukoplakia is considered idiopathic only after causes such as tobacco use, trauma from sharp cusps, friction, chemical injury and candidiasis are excluded. All these causes could be ruled out in this case.

IL has a predilection for the tongue and also is seen on gingiva. It is seen more commonly in females. IL must be distinguished from frictional keratosis because it has a greater tendency for malignant transformation.

Due to the premalignant nature of this lesion, biopsy is necessary. Obtaining detailed

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contributory history, such as medications, systemic diseases and social habits, becomes pertinent, since IL is mainly a diagnosis of exclusion. Dysplasia and/or atypia may or may not be present. The presence of dysplasia in biopsies of IL are more common in lesions from high-risk location such as ventral and lateral tongue or floor of the mouth. The microscopic features seen here (described above in case history) were not supportive of the diagnosis of IL. E. Oral hairy leukoplakia Correct! Oral hairy leukoplakia (OHL) is an Epstein-Barr virus (EBV) -induced hyperkeratotic lesion of the lateral tongue most often seen in HIV-infected patients.

An in situ hybridization staining for EBV was performed on the tissue and revealed numerous positive nuclei within the epithelium, especially in the koilocytic cells. It is strongly related to immune suppression and has been reported with other situations, such as organ transplantation. In this case, the patient had been diagnosed with HIV many years ago and had a generally well-controlled disease until recently. It most commonly affects males. OHL typically presents a painless, non-removable white linear or plaque-like lesion with a corrugated surface. The distinguishing feature of this lesion is the formation of white vertical lines and groves that run perpendicular to the long axis of tongue. The presentation of the lesion in our patient is not a typical one; however, the clinical history is consistent with the OHL diagnosis. Most HIV-infected

individuals do not have AIDS at the time of diagnosis of OHL, but may develop AIDS later. Even though OHL is most likely to occur in HIV-positive patients, this lesion also may develop in HIV-negative immunocompromised patients (e.g., organ transplant recipients, cancer patients on immunosuppressive therapies, patients receiving high-dose corticosteroids). The accurate diagnosis of OHL is clinically relevant since this lesion might be the predictor of the HIV progression, as well as an indicator of therapeutic failure or non-adherence to the antiretroviral regimen by the patient. OHL itself does not require treatment and usually resolves with highly active antiretroviral therapy. The lifespan of patients on newer therapies has dramatically increased over the last few decades. It is important to consider this entity in the differential diagnosis for white lesions on the lateral border of the tongue, especially when trauma, candida, contact reactions, etc. have been ruled out.

Though the incidence of OHL has significantly gone down due to the advent of new drug therapies, OHL should remain in the differential diagnosis for white lesions of the tongue.

References: Vale, D. A., Martins, F. M., Silva, P. H., Ortega, K. L. (2016). Retrospective analysis of the clinical behavior of oral hairy leukoplaPlease see DIAGNOSTIC, 72

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Diagnostic DIAGNOSTIC from 71

kia in 215 HIV-seropositive patients. Brazilian Oral Research, 30(1), e118. Epub Nov. 28, 2016. https://dx-doi-org.lp.hscl.ufl.edu/10.1590/1807-3107bor-2016.vol30.0118 Centers for Disease Control and Prevention 1993 revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults. MMWR 1992;41:RR-17 Kreuter, A., & Wieland, U. (2011). Oral hairy leukoplakia: a clinical indicator of immunosuppression. CMAJ: Canadian Medical Association Journal, 183(8), 932. http://doi. org/10.1503/cmaj.100841

Dr. Bhattacharyya

Muller, S. (2017). Oral lichenoid lesions: distinguishing the benign from the deadly.

Modern Pathology, 30, S54-S67.

Scully, C. & Felix, D.H (2005). Oral medicine — update for the dental practitioner: Oral white patches. British Dental Journal, 199(9), 565–572.

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

Dr. Islam

and challenging oral diseases.

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

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

Dr. Cohen

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

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 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 www.ada.org/goto/cerp.

This course will expire 06/01/2018.

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www.floridadental.org

C lassified A dvertising

Opportunities

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Today's FDA

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

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

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

Issue

Extracted Date

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

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

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

May/June 2017

General Dentist Ocala Area. Christie Dental is a multispecialty group practice, founded in 1999. Since our founding, we’ve used our core values of fiscal, social, and ethical excellence to guide us. Today, our group is a PPO/ Fee for Service dental group practice with 13 locations serving communities across central Florida. We are firm believers that the practice of dentistry must always be based on the doctor-patient partnership. That means that our behavior must demonstrate a conviction of honesty and the utmost integrity. Dentists are given full clinical autonomy so they can work with patients in choosing the best course of action for treatment and prevention. Doctors are supported with a network of resources and support, including mentor programs, leadership opportunities, continuing education and even a clear path to ownership.

New dentists are able to shadow camaraderie and collaborative environment. Social responsibility is one of Christie Dental’s core values. Whether it is partnering with the Brevard County Schools Supply Zone, anticipating in the Making Strides against Breast Cancer Walk, or sponsoring the local little league team, or being involved with Reach Out and Read book drives, we are proud to support the Marion, Brevard and Osceola communities.

Christie Dental is proud to provide a competitive compensation package, including comprehensive health benefits (Health, Vision, Dental), Life Insurance, Long Term Disability, Professional Liability Insurance, a 401(k) program with employer matching, and established mentor programs and leadership opportunities. For more information, please contact Kate Anderson at 781-213-3312 or email kateanderson@amdpi.com Required Skills: DMD/ DDS, FL State Dental License.

Oral Surgeon Brevard County. Christie Dental is a multi-specialty dental group with 13 practice locations in the Brevard and Ocala Florida area. Christie Dental offers individuals and families a full range of dental care, including general dentistry, hygiene and specialty care, such as pedodontics, oral surgery, endodontics, orthodontics, and periodontics. We currently have a wonderful opportunity for an Oral Surgeon to join our team in our Merritt Island and Palm Bay specialty practices, on a parttime basis. This is an opportunity that provides a high number of referrals from inside and outside the Christie Dental group. For more information, please contact Kate Anderson at 781-213-3312 or email kateanderson@amdpi. com. Required Skills: DDS/ DMD, FL State Dental License or Eligibility.

General Dentist. We currently have an opportunity for a Part-time General Dentist at our Sebastian location.

(Fridays, plus Every other Saturday. 2nd Day of Dentistry flexible). Christie Dental is a multispecialty group practice, founded in 1999. Since our founding, we’ve used our core values of fiscal, social, and ethical excellence to guide us. Today, our group is a PPO/ Fee for service dental group practice with 13 locations serving communities across central Florida. We are firm believers that the practice of dentistry must always be based on the doctorpatient partnership. That means that our behavior must demonstrate a conviction of honesty and the utmost integrity. Dentists are given full clinical autonomy so they can work with patients in choosing the best course of action for treatment and prevention. Doctors are supported with a network of resources and support, including mentor programs, leadership opportunities, continuing education and even a clear path to ownership. New dentists are able to shadow and learn from experienced professionals in their field, and seasoned professionals appreciate the camaraderie and collaborative environment. Social responsibility is one of Christie Dental’s core values. whether it is partnering with the Brevard County Schools Supply Zone, participating in the Making Strides against Brest Cancer Walk, sponsoring the local little league team, or being involved with Reach Out and Read book drives, we are proud to support the Marion, Brevard

www.floridadental.org

and Osceola communities. Christie Dental is proud to provide a competitive compensation package, including comprehensive health benefits (Health, Vision, Dental), Life Insurance, Long Term Disability, Professional Liability Insurance, a 401(k) program with employer matching, and established mentor programs and leadership opportunities.

In addition, employees have access to: Ownership Potential; Wellness Program; Consumer Goods Discounts (Verizon, Dell, AT&T, and Working Advantage); Continuing education Allowance; Sign-On Bonus (Select Locations).

For more information, please contact Kate Anderson at 781-213-3312 or email kateanderson@amdpi.com.

Required Skills: DDS/DMD, FL State Dental License or Eligibility.

Dentist Opportunity (Full-Time) - Bonita Springs, FL Come lead our terrific dental team in Bonita Springs, FL! Dr. Raul Rangel, Fort Myers Clinical Partner, is seeking a full-time Senior Dentist or Associate to lead our established, digital practice in Bonita Springs, FL located at: 25195 Chambers of Commerce Dr. Bonita Springs, FL 34135.

Enjoy a rewarding career with a full office staff (including Hygienist), a strong schedule and the ability to focus on quality patient care. Compensation: High Compensation Opportunity: Potential Annual Earnings of 200K+.

Benefits/Perks: Practice Leadership: Clinical Freedom and Treatment Autonomy; Patient Focus: Established and Growing Patient Foundation; Multi-Specialty Office/Digital; Partnership Model – Investment Opportunities/Long Term Doctor Career Path; Full Benefits Offered – Health care & Dental Benefits, 401K, Short Term/Long Term Disability, Time Off; Malpractice Coverage Assistance; Continuing Education Support: Internal & External Advanced Training, Paid ADA & State Society Dues; Group Practice Camaraderie– Technique Development Assistance, Study Clubs, Chairside Mentoring, GEDC University Courses.

Please view our Doctor Career Path video: http://www. screencast.com/t/M3xWM5CYN. Hannan Ayad| Clinical Recruiter | Great Expressions Dental Centers PSC-North | 29777 Telegraph Road. Suite 3000| Southfield, MI 48034 USA phone 248-598-7256 |Ext. 71178| fax 248-430-5528 | web www.greatexpressions.com. “Look for the Smile Above Our Name!” Must have a DDS/DMD from an accredited University and active State Dental Board license Apply Here. PI97800578. http://www.Click2apply.net/ ngy2stxtrw7bdfdd.

Periodontists (Part-Time) - Austin, TX. Great Expressions Dental Centers has select part-time opportunities for Periodontists to join our established practices located in Austin, TX! Compensation: High Compensation: Competitive daily rate vs percent of production. Benefits/ Perks: Leader in the practice: Clinical Freedom and Treatment Autonomy; Patient Focus: Established and Growing Patient Foundation; Multi-Specialty Office; Doctor Career Path – Partnership/Investment Opportunities; Malpractice Coverage Assistance; Continued Education Reimbursement, Paid ADA & State Society Dues; Mentorship – Study Clubs, Chairside Mentoring, GEDC University Courses. Please view our Doctor Career Path video: http://www.screencast.com/t/M3xWM5CYN. Please apply via this ad for consideration! Hannan Ayad| Clinical Recruiter | Great Expressions Dental Centers PSC-North | 29777 Telegraph Road. Suite 3000| Southfield, MI 48034 USA phone 248-598-7256 |Ext. 71178| fax 248430-5528 | web www.greatexpressions.com. “Look for the Smile Above Our Name!” Must have a DDS/DMD from an accredited University and active State Dental Board license, Periodontists Dental License and certifications.

Apply Here. PI97817566. http://www.Click2apply.net/ ztkzh3bfww3pn39n.

Pediatric Dentist (Full-Time) Fort Myers, FL. Join our terrific Dental Team in Florida as a lead Pediatric Dentist!

Dr. Raul Rangel, Clinical Partner, is seeking a full time Pediatric Dentist in our highly productive dental practices located at: 5100 S. Cleveland Avenue, Fort Myers, Florida 33907. Enjoy a rewarding long term career path with dedicated staff in this productive practice environment with

www.floridadental.org

an established patient base! Compensation: High Income Opportunity: Competitive six figure base vs percent of production; Possible sign on bonus or relocation assistance.

Benefits/Perks: Practice Leadership - Clinical Freedom and Treatment Autonomy; Patient Focus - Established and Growing Patient Foundation; Multi-Specialty Practices with Dedicated Staffs; Partnership Model - Long Term Doctor Career Path/Investment Opportunities; Full Benefits - Health care & Dental Benefits, 401K, Short Term/Long Term Disability, Time Off; Malpractice Coverage Assistance; Continued Education Support: Internal & External advance training, Paid ADA & State Society Dues, Study Clubs and GEDC University Courses; Group Practice Camaraderie - Technique Development Assistance Available, Chairside Mentoring. Please view our Doctor Career Path video: http://www.screencast.com/t/ M3xWM5CYN. Please apply via this ad for consideration.

Hannan Ayad| Clinical Recruiter | Great Expressions Dental Centers PSC-North | 29777 Telegraph Road. Suite 3000| Southfield, MI 48034 USA phone 248-598-7256 |Ext. 71178| fax 248-430-5528 | web www.greatexpressions.com.

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

Apply Here. PI97817008. http://www.Click2apply.net/ ypv4k933fzdgvwft.

Dentist (Sept Start) - Bradenton, FL. Join our terrific dental team in Sarasota and Bradenton, FL as a lead Dentist! Dr. Rick Woodward, Clinical Partner is seeking a full-time Senior Dentist or Associate to join our team in September 2017! Enjoy a rewarding long term career path with a dedicated staff in this productive practice environment with an established patient base! Compensation: High Compensation Opportunity: Potential Earnings of 200K+.

Benefits/Perks: Practice Leadership: Clinical Freedom and Treatment Autonomy; Patient Focus: Established and Growing Patient Foundation; Multi-Specialty Office/ Digital; Partnership Model – Investment Opportunities/ Long term Doctor Career Path; Full Benefits Offered – Health care & Dental Benefits, 401K, Short Term/ Long Term Disability, Time Off; Malpractice Coverage Assistance; Continued Education Support: Internal & External advance training, Paid ADA & State Society Dues, Study Clubs and GEDC University Courses; Group Practice Camaraderie – Technique Development Assistance available! Please view our Doctor Career Path video: http:// www.screencast.com/t/M3xWM5CYN. Please apply via this ad for consideration, Molly McVay | Sr. Clinical Recruiter | Great Expressions Dental Centers PSC-North | 29777 Telegraph Road. Suite 3000| Southfield, MI 48034 USA phone 248-430-5555 |Ext. 72467| fax 248-686-0170 | web www.greatexpressions.com. Must have a DDS/DMD from an accredited University and active State Dental Board license. Apply Here. PI97610775. http://www.Click2apply. net/dr2y9mmtxdrs2r24.

Part Time (Temp) Dentist Opportunities - Tampa, FL. Join our terrific dental team in Florida as a Temp or Part-Time Dentist! Dr. Rick Woodward, Clinical Partner has select Temp and Part-Time Senior Dentist or Associate positions for our Tampa, FL dental practices. Enjoy a rewarding career path with a dedicated staff in this highly productive practice environment with an established patient base!

Compensation: Extremely High Production Opportunities: High Daily Rate vs. Competitive Percent of Production!

Benefits/Perks: Practice Leadership: Clinical Freedom and Treatment Autonomy; Patient Focus: Established and Growing Patient Foundation; Multi-Specialty Offices/ Digital; Partnership Model – Investment Opportunities/ Long term Doctor Career Path; Malpractice Coverage Assistance; Continued Education Support: Internal & External advance training, Paid ADA & State Society Dues, Study Clubs and GEDC University Courses; Group Practice Camaraderie – Technique Development Assistance available! Please view our Doctor Career Path video: http:// www.screencast.com/t/M3xWM5CYN. Please apply via this ad for consideration, Molly McVay | Sr. Clinical

Recruiter | Great Expressions Dental Centers PSC-North | 29777 Telegraph Road. Suite 3000| Southfield, MI 48034 USA phone 248-430-5555 |Ext. 72467| fax 248-686-0170 | web www.greatexpressions.com. Must have a DDS/DMD from an accredited University and active State Dental Board license. Apply Here: http://www.Click2apply.net/ twpc6np952n5nnf4. PI97542773.

Implant and Periodontal Services. If you would like to provide in-office implant and periodontal treatment to your patients, please feel free to contact for additional information. YourPerio@gmail.com.

Pediatric Dentists. Full-Time! Opportunities in Winter Park, FL, Orange City, FL, and Ocala, FL. Formed in 1991, Dental Care Alliance is a Dental Support Organization with over 200 affiliated dental practices in 13 states. Specialized career paths and practice support solutions for Pediatric dentists committed to making kids smile! Work with a great team that places quality of care at the top of their list.

Our large well established Main Street Pediatric Specialty practice enjoys a high level of success and it is a result of just the right combination of excellent staff, marketing plan and a practice philosophy of patient first. It has taken years of development of systems and practices that have elevated us to where they are today and that is being ready to add an additional pediatric dentist to our top-notch team. Offering: Generous guarantee salary with production based bonus; Full schedule from day one; State of the art facilities with top of the line equipment; Excellent benefits package; Great Earnings Opportunity! The successful candidate will be a licensed DMD or DDS and must have completed Pediatric Dentist Residency and should be licensed or qualified to obtain license in the FL. Experienced Specialists or New Licensees are welcome! Interested Pediatric dentists should respond with resume/cv to bames@dentalcarealliance.com.

Learn more @ www.dentalcarealliance.com.

Endodontist (2-5 days/wk) - Tampa, FL. Dr. Rick Woodward, Clinical Partner has select opportunities for an Endodontist (2-5 days/wk) to join our established and highly productive dental group in Tampa Bay, FL: Our specialists have the clinical freedom and autonomy enjoyed in a traditional private practice without the additional financial or administrative burdens associated with practice management. When considering a career with GEDC, specialists can expect: Compensation: High Income Opportunity: Competitive Six Figure Annual Base Salary vs. a Competitive Percent of Production!

Benefits/Perks: Leader in the practice: Clinical Freedom and Treatment Autonomy; Patient Focus: Established and Growing Patient Foundation; Multi-Specialty and Digital offices; Doctor Career Path – Partnership/Investment Opportunity available! Full Benefits Offered – Health care & Dental Benefits, 401K, Short Term/Long Term Disability, Time Off; Malpractice Coverage Assistance; Continued Education Reimbursement, Paid ADA & State Society Dues; Mentorship – Study Clubs, Chairside Mentoring, GEDC University Courses. *Please view our Doctor Career Path video: http://www.screencast.com/t/M3xWM5CYN. Please apply via this ad for consideration! Molly McVay | Sr. Clinical Recruiter | Great Expressions Dental Centers PSC-North | 29777 Telegraph Road. Suite 3000| Southfield, MI 48034 USA phone 248-430-5555 |Ext. 72467| fax 248686-0170 | web www.greatexpressions.com. “Look for the Smile Above Our Name!” Must have a DDS/DMD from an accredited University and active State Dental Board license, Endodontic Dental License and certification.

Apply Here. PI97621584. http://www.Click2apply.net/ zphyk89yzndsjztf.

General Dentist @pearly white smiles. Need a General Dentist ASAP. PT/FT in Parkland/Pembroke Pines. Please send resume to: Pearlydentist@hotmail.com.

Please see CLASSIFIEDS, 76

May/June 2017

Today's FDA

75

Your Classified Ad Reaches Over 8,000 Readers!

CLASSIFIEDS from 75 Dentist needed. We are a high end private group practice in need of an experienced general dentist who is ready to join our team in Jupiter and North Palm Beach. We are a ffs restorative group concentrating on crown and bridge, implant placement and restorations, and endo. If you have at least 3 years of experience and are looking for a stable high income position, please send your resume to: doccasel@aol.com.

General Dentist Opportunity. Experienced general dentist needed. Must be very good at molar endodontics, oral surgery, crown and bridge. Excellent at diagnosing and presenting treatment plans. Experience in providing implant treatment helpful but not necessary. Primarily Fee for Service practice. Well compensated on a commission basis. Hours to include evenings. Full or Part time positions. We are a growing practice with an established patient base and a constant flow of new patients (averaging over 150+ per month!). When becoming an associate with our practice, you can expect FULL clinical autonomy and freedom from Medicaid and most PPOs allowing for great earning potential. Most importantly, you can focus on what matters most: patient care, while maintaining an exceptional work-life balance. We will provide the managerial, the marketing, and the technical administrative expertise; you provide the talent & passion for your craft.

Whether you’re interested in a single day or considering several, please send your CV/resume to ladonna. langstraat@emergencydental.com today so we can discuss this opportunity with you. We look forward to hearing from you!

General Dentist needed in Fort Walton beach. We are looking for a compassionate, upbeat general dentist for our dental practice in Fort Walton Beach. Your daily procedures will include restoration (fillings), crown and bridge and core build-ups (veneers, onlays, inlays), extractions, removable prosthodontics, and providing comprehensive treatment plans. Requirements: Complete comprehensive full mouth exams and diagnose dental conditions; Assess treatment planning options and discuss with patient; Educate patients on oral health; Carry out agreed clinical treatments; Maintain patients’ medical records; Assist in the recruitment, training, and management of staff; Keep abreast of new developments in dentistry through structured continuing professional developments.

Minimum Education and Experience: Must be a DDS or DMD from an accredited school. niceocclusion@gmail. com.

General Dentists Opportunities. Full-Time Associate Dentist opportunities available in FL! Associate roles available in our affiliated practices in Sarasota, Orlando, and Ocala. State of the art practice facilities. Strong commitment to long-term dental care for the whole family!

Be chair side and make money from day one. Highly trained and dedicated staff to support you. No Day-to-Day headaches of Managing a Practice. Excellent compensation pkg. with performance based incentives. Well-established and growing patient base. Benefits Package for FT Associates: Company paid professional liability insurance; DCA sponsored continuing education; Medical Insurance Dental Plan Life Insurance Vision Insurance; Long Term Disability Section 125 - Flexible Spending Account; 401K; DCA Voluntary Supplemental Insurance Products.

Requirements: 2+ years’ experience required; Licensed to practice dentistry in the State of FL. Experienced dentists should email resume to bames@dentalcarealliance.com.

General Dentist Wanted. General Dentistry Practice seeks a F/T Associate to work in our state of the art office.

Generous compensation. Bilingual a plus. Please email resume to Novasouth01@aol.com or fax to (561)424-2098.

76

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May/June 2017

Endodontist Opportunity (1 day/week) - Treasure Coast + WPB, FL. Come join our South Florida specialty team as a part-time (1 day/week) Endodontist in the Treasure Coast and West Palm Beach, FL! Aggressive compensation package (production based percent), dedicated staff, consistent schedule with a strong referral network of local offices. Compensation: Percentage of Production.

Benefits/Perks: Leaders in the practice: Clinical Freedom and Treatment Autonomy for Every Doctor; Patient Focus: Established and Growing Patient Foundation; Multi-Specialty Office Setting(s); Malpractice Coverage Assistance. Please view our Doctor Career Path video: http://www.screencast.com/t/M3xWM5CYN. Apply via this ad to learn more about Great Expressions! For More Information, Please Contact: Ross Shoemaker, MBA | Doctor Recruiting Manager | Great Expressions Dental Centers 770 Holcomb Bridge Road, Roswell, GA 30076 USA phone 678-836-2226 | ext 72226 | fax 770-242-3251 |web www.greatexpressions.com email Ross.Shoemaker@ greatexpressions.com. “Look for the Smile Above Our Name!” Apply Here. PI97620384. http://www.Click2apply. net/rycrprsbj7yczd6g.

Dentist Opportunities - Jacksonville, FL. Come lead our terrific dental team in Jacksonville, FL as a lead Dentist! Dr. Rick Woodward, Clinical Partner, has select full-time and part-time opportunities for a Senior Dentist or Associate in our busy Jacksonville, FL dental practices! Enjoy a rewarding long term career path with dedicated staff in this productive practice environment with an established patient base! Compensation: High Compensation Opportunity: Potential Earnings of 200K+. Benefits/Perks: Practice Leadership: Clinical Freedom and Treatment Autonomy; Patient Focus: Established and Growing Patient Foundation; Multi-Specialty Office/Digital; Partnership Model – Investment Opportunities/Long term Doctor Career Path; Full Benefits Offered – Health care & Dental Benefits, 401K, Short Term/Long Term Disability, Time Off; Malpractice Coverage Assistance; Continued Education Support: Internal & External advance training, Paid ADA & State Society Dues, Study Clubs and GEDC University Courses; Group Practice Camaraderie – Technique Development Assistance available! Please view our Doctor Career Path video: http://www.screencast.com/t/ M3xWM5CYN. Please apply via this ad for consideration, Molly McVay | Sr. Clinical Recruiter | Great Expressions Dental Centers PSC-North | 29777 Telegraph Road. Suite 3000| Southfield, MI 48034 USA phone 248-430-5555 |Ext. 72467| fax 248-686-0170 | web www.greatexpressions.com.

Must have a DDS/DMD from an accredited University and active State Dental Board license. Apply Here. PI97242091.

General Dentist - Panama City Beach. I’d like to add a General Dentist to our staff. We have a very clean, modern practice with 7 operatories, digital X-rays-digital notes are in the works. My marketing plan has us seeing over 7 new patients daily, we need help! I can help cover the cost of your liability insurance up to $2,500, no restrictive covenant or contract, just a friendly agreement to partner with our team. *Health coverage, retirement plan, 2 weeks’ vacation.

We’re closed major holidays.* Implant experience a plus.

Feel free to email me for more information, I can usually get some time to talk on the phone if given a little advance notice. molarpirate@gmail.com.

General Dentist wanted for busy, state of the art restorative practice in Delray Beach/Boynton Beach. FT/PT, completely PPO/FFS. Outstanding opportunity for growth, immediate start for right person. Send CV to radami@ ymail.com.

Part-Time (2+ days) Endodontist - Fort Myers, FL. Come lead our specialty team as a part-time Endodontist in Fort Myers, FL! Great Expressions Dental Centers has a current, select opening for a part-time (2-3 days/week) Endodontist to join our Fort Myers, FL multi-specialty practice in Page Field. We offer an aggressive compensation package, dedicated staff, consistent schedule with a strong referral network of local offices. Compensation: Six Figure Annual Base vs. Competitive Percent of Production! Attractive

Sign-on or Relocation possible as well. Benefits/Perks: Leader in the practice: Clinical Freedom and Treatment Autonomy; Patient Focus: Established and Growing Patient Foundation; Multi-Specialty office; Doctor Career Path – Partnership/Investment Opportunities; Full Benefits Offered – Health care & Dental Benefits, 401K, Short Term/ Long Term Disability, Time Off; Malpractice Coverage Assistance; Continued Education Reimbursement, Paid ADA & State Society Dues; Mentorship – Study Clubs, Chairside Mentoring, GEDC University Courses.

Please view our Doctor Career Path video: http://www. screencast.com/t/M3xWM5CYN. Please apply via this ad for consideration! Hannan Ayad| Clinical Recruiter | Great Expressions Dental Centers PSC-North | 29777 Telegraph Road. Suite 3000| Southfield, MI 48034 USA phone 248-598-7256 |Ext. 71178| fax 248-430-5528 | web www.greatexpressions.com. “Look for the Smile Above Our Name!” Must have a DDS/DMD from an accredited University and active State Dental Board license, Endodontist Dental License and certifications. Apply Here.

PI97670316.

Great New Opportunity. We have a fantastic opportunity for a motivated General Dentist like you. Our practice has grown exponentially over the past five years requiring the construction of a brand new state of the art facility which we just moved into this month. With our ever-growing patient base and massive influx of new patients the sky is the limit with your income. Let us take care of all the business aspects so you can focus on patient care and enjoy spending all your free time in one of the most beautiful areas of Florida. Come and see what we are all about and you will fall in love with the practice and the things that the Panhandle has to offer. We look forward to meeting you and discussing your great future with us, e-mail Dr. Anish Patel at Smilemaker80@gmail.com or call on my cell phone at (727) 418-2987.

Oral & Maxillofacial Surgeon Opening (Full Time) Tampa, FL. Come lead our specialty team as a full time Oral & Maxillofacial Surgeon in Tampa, FL! Our Tampa Clinical team has a current, select opening for a full-time (5 days/week) Oral & Maxillofacial Surgeon in Tampa, FL. Aggressive compensation package (avg. $150k/month in production), full/dedicated/trained staff, consistent schedule with a strong referral network of 30 local offices.

Compensation: High Compensation Opportunity: SixFigure Draw vs. Percent of Production; **Attractive SignOn or Relocation possible as well ($$$)! Benefits/Perks: Practice Leadership: Clinical Freedom and Treatment Autonomy; Patient Focus: Established and Growing Patient Foundation; Multi-Specialty Office Setting; Partnership Model – Long Term Doctor Career Path/Investment Opportunities; Full Benefits Offered (w/full time schedule) – Health care & Dental Benefits, 401K, Short Term/ Long Term Disability, Time Off; Malpractice Coverage Assistance; Continued Education Reimbursement, Paid ADA & State Society Dues; Group Practice Camaraderie – Technique Development Assistance, Study Clubs, Chairside Mentoring, GEDC University Courses. Please view our Doctor Career Path video: http://www.screencast.com/t/ M3xWM5CYN. Apply via this ad to learn more about Great Expressions! For More Information, Please Contact: Ross Shoemaker, MBA | Doctor Recruiting Manager | Great Expressions Dental Centers 770 Holcomb Bridge Road, Roswell, GA 30076 USA phone 678-836-2226 | ext 72226 | fax 770-242-3251 |web www.greatexpressions.com email Ross.Shoemaker@greatexpressions.com. “Look for the Smile Above Our Name!” Apply Here. PI97600096. http:// www.Click2apply.net/9sxcrshtzhdkzhs3.

General Dentist Wanted (West Palm Beach). Busy Dental Office is looking for an Associate (PT/FT) who is comfortable treating young children (New grads welcome.)

Medicaid provider is a plus. You will work in a private practice with experienced and supportive staff and friendly office environment where you can provide quality care to patients. We offer competitive compensation. Please send your resume to drleminh1@firstcaredental.net.

www.floridadental.org

Your Classified Ad Reaches Over 8,000 Readers!

Endodontist (full-time) - Tampa, FL Dr. Rick Woodward, Clinical Partner is seeking an Endodontist to join our established and highly productive dental group in Tampa Bay, FL: Our specialists have the clinical freedom and autonomy enjoyed in a traditional private practice without the additional financial or administrative burdens associated with practice management. When considering a career with GEDC, specialists can expect: Compensation: High Income Opportunity: Competitive Six Figure Annual Base Salary vs. a Competitive Percent of Production!

Attractive Sign-on or Relocation possible as well! Benefits/ Perks: Leader in the practice: Clinical Freedom and Treatment Autonomy; Patient Focus: Established and Growing Patient Foundation; Multi-Specialty and Digital offices; Doctor Career Path – Partnership/Investment Opportunity available! Full Benefits Offered – Health care & Dental Benefits, 401K, Short Term/Long Term Disability, Time Off; Malpractice Coverage Assistance; Continued Education Reimbursement, Paid ADA & State Society Dues; Mentorship – Study Clubs, Chairside Mentoring, GEDC University Courses. *Please view our Doctor Career Path video: http://www.screencast.com/t/M3xWM5CYN. Please apply via this ad for consideration! Molly McVay | Sr. Clinical Recruiter | Great Expressions Dental Centers PSC-North | 29777 Telegraph Road. Suite 3000| Southfield, MI 48034 USA phone 248-430-5555 |Ext. 72467| fax 248686-0170 | web www.greatexpressions.com. “Look for the Smile Above Our Name!” Must have a DDS/DMD from an accredited University and active State Dental Board license, Endodontic Dental License and certification. Apply Here.

PI97191706.

General Dentist - Associate (Spring Hill/Brooksville).

FULL/PART-TIME GENERAL DENTIST: Family Dentistry of Hernando. Founded in 1987, Family Dentistry of Hernando is an established group practice with two offices conveniently located in Spring Hill and Brooksville, Florida, two of the fastest growing areas in the state. We are seeking a full or part-time general dentist to join our thriving practice. We provide our patients a complete range of dental services including general dentistry, cosmetic dentistry, endodontic services, restorative and periodontal dentistry and oral surgery. Close to Tampa, St. Petersburg, and some of the best beaches, sports, dining and leisure activities in Florida, our doctors enjoy a professional practice experience with an experienced support staff in a multicultural and growing community with room for personal and professional growth. Our highly valued associates enjoy excellent compensation commensurate with their experience in the field. Required Credentials: Spring Hill/ Brooksville; DDS/DMD Florida State Dental License; DEA Number; Professional Liability Insurance. Come grow with us! For more information on this position, contact us at: (352) 596-7388. www.familydentistryhc.com.

Pediatric Dentist Opportunity: St. Augustine, FL. Join our terrific Dental Team in Florida as a lead Pediatric Dentist!

Dr. Rick Woodward, Clinical Partner, is seeking a full time Pediatric Dentist in our highly productive dental practices located in: (Jacksonville and St. Augustine, FL). Enjoy a rewarding long term career path with dedicated staff in this productive practice environment with an established patient base! Compensation: High Income Opportunity: Potential Earnings of 600K+. Benefits/Perks: Practice Leadership: Clinical Freedom and Treatment Autonomy; Patient Focus: Established and Growing Patient Foundation; Multi-Specialty Practices with Dedicated Staffs; Partnership Model – Long Term Doctor Career Path/ Investment Opportunities; Full Benefits –Health care & Dental Benefits, 401K, Short Term/Long Term Disability, Time Off; Malpractice Coverage Assistance; Continued Education Support: Internal & External advance training, Paid ADA & State Society Dues, Study Clubs and GEDC University Courses; Group Practice Camaraderie – Technique Development Assistance Available, Chairside Mentoring. Please view our Doctor Career Path video: http://www.screencast.com/t/M3xWM5CYN

www.floridadental.org

Please apply via this ad for consideration, Molly McVay | Sr. Clinical Recruiter | Great Expressions Dental Centers PSCNorth | 29777 Telegraph Road. Suite 3000| Southfield, MI 48034 USA phone 248-430-5555 |Ext. 72467| fax 248-6860170 | web www.greatexpressions.com. Must have a DDS/ DMD from an accredited University and active State Dental Board license, Pediatric Dental License and certifications.

Apply Here. PI97202619.

General Dentist and Specialist Openings for Multiple Offices in South and Central Florida. Sage Dental currently has opportunities for qualified General Dentists & Specialists at our South and Central Florida practices.

Sage Dental offers you: Excellent Earning Potential; Ability to Focus on Patient Care; State-of-the-Art Facilities; Quality of Life. Apply today! Contact: Bradford Cabibi - Doctor Recruitment. Email: bcabibi@mysagedental. com; careers@mysagedental.com. website: http://www. mysagedental.com/; https://www.mysagedental.com/ career-opportunities/. Phone: 561-999-9650 Ext. 6146, Fax: 561-526-2576.

Dentist (Full-Time) - Seminole County, FL. Join our terrific dental team in Seminole County, FL! Dr. Rick Woodward, Clinical Partner, is seeking a full time Senior Dentist or Associate for our busy practice in Central Florida! Enjoy a rewarding role with a dedicated and experienced staff in this productive practice with an established patient base! Compensation: High Compensation Opportunity: Potential Earnings of 200K+; Possible Sign on Bonus *for provider who can start immediately. Benefits/Perks: Practice Leadership: Clinical Freedom and Treatment Autonomy; Patient Focus: Established and Growing Patient Foundation; Solo Practice; Partnership Model – Investment Opportunities/Doctor Career Path; Full Benefits Offered – Health care & Dental Benefits, 401K, Short Term/ Long Term Disability, Time Off; Malpractice Coverage Assistance; Continued Education Reimbursement, Paid ADA & State Society Dues; Group Practice Camaraderie – Technique Development assistance, Study Clubs, Chairside Mentoring, GEDC University Courses. Please view our Doctor Career Path video: http://www.screencast.com/t/ M3xWM5CYN. Please apply via this ad for consideration, Molly McVay | Sr. Clinical Recruiter | Great Expressions Dental Centers PSC-North | 29777 Telegraph Road. Suite 3000| Southfield, MI 48034 USA phone 248-430-5555 |Ext. 72467| fax 248-686-0170 | web www.greatexpressions.com.

Must have a DDS/DMD from an accredited University and active State Dental Board license. Apply Here. PI97202334. http://www.Click2apply.net/vm7g2v8qq7k97kw3.

Dentist (July Opening) - Zephyrhills, FL Join our terrific dental team in Zephyrhills, FL as a lead dentist!

Dr. Rick Woodward, Clinical Partner, is seeking a full-time Senior Dentist or associate for our busy Florida dental practice located: (7950 Gall Boulevard Zephyrhills, Florida 33541). Enjoy a rewarding career with a full office staff (including Hygienist) along with a highly productive office schedule and the ability to focus on quality patient care.

Compensation: Competitive Compensation: Six Figure Annual Draw vs. Percent of Production! Benefits/Perks: Practice Leadership: Clinical Freedom and Treatment Autonomy; Patient Focus: Established and Growing Patient Foundation; Multi-Specialty office/Digital; Partnership Model – Investment Opportunities/Doctor Career Path; Full Benefits Offered – Health care & Dental Benefits, 401K, Short Term/Long Term Disability, Time Off; Malpractice Coverage Assistance; Continued Education Reimbursement, Paid ADA & State Society Dues; Group Practice Camaraderie – Study Clubs, Chairside Mentoring, GEDC University Courses. **Please view our Doctor Career Path video: http://www.screencast.com/t/M3xWM5CYN. Please apply via this ad for consideration, Molly McVay | Sr. Clinical Recruiter | Great Expressions Dental Centers PSCNorth | 29777 Telegraph Road. Suite 3000| Southfield, MI 48034 USA phone 248-430-5555 |Ext. 72467| fax 248-6860170 | web www.greatexpressions.com. “Look for the Smile Above Our Name!” Apply Here. PI97480005. http://www.

Click2apply.net/4cmckqy78m6vbbmw.

GENERAL DENTIST OPPORTUNITY. Full time General Dentist needed for a 100% fee for service private practice on the beautiful space coast in Rockledge, FL (just south of Cocoa Beach and Merritt Island & minutes from Melbourne, Viera & Satellite Beach). Our modern, state-of-the-art practice is located in a free-standing building, is digital & paperless. The ideal candidate must be capable of both simple and surgical extractions, molar endo and be proficient in all other areas of general dentistry. Compensation is commission based with a guaranteed minimum. You would be joining a well-trained, experienced, highly motivated team. Please send your CV and contact info to molardoc2@gmail.com. All inquiries will be strictly confidential. We look forward to hearing from you.

General Dentist Opening (May Start) - Fort Myers, FL Come lead our Page Field team in Fort Myers, FL! Great Expressions Dental Centers has a great opportunity for a full-time General Dentist to join our Page Field practice located: 5100 S. Cleveland Avenue, #315 Fort Myers, FL 33907. Enjoy a rewarding role in a brand new digital facility with a dedicated and experienced staff with in house specialists. Compensation: Competitive Compensation: 150K Base vs. Percent of Production! Signon Bonus (Up to $10,000) possible as well! Benefits/Perks: Leader in the practice: Clinical Freedom and Treatment Autonomy; Patient Focus: Established and Growing Patient Foundation; Multi-Specialty Office; Doctor Career Path – Partnership/Investment Opportunities; Full Benefits Offered – Health care & Dental Benefits, 401K, Short Term/ Long Term Disability, Time Off; Malpractice Coverage Assistance; Continued Education Reimbursement, Paid ADA & State Society Dues; Mentorship – Study Clubs, Chairside Mentoring, GEDC University Courses.

Please view our Doctor Career Path video: http://www. screencast.com/t/M3xWM5CYN. Please apply via this ad for consideration, Hannan Ayad| Clinical Recruiter | Great Expressions Dental Centers PSC-North | 29777 Telegraph Road. Suite 3000| Southfield, MI 48034 USA phone 248-598-7256 |Ext. 71178| fax 248-430-5528 | web www.greatexpressions.com. “Look for the Smile Above Our Name!” Apply Here. PI97242831. http://www.Click2apply. net/7hmpymy93jz5drj7.

Periodontist. Group Periodontal Practice with offices in West Palm Beach and Wellington, Florida looking for parttime associate with possible partnership opportunity. Please email CV to: LCOTHERMAN@FLIPDI.COM. Opportunity in Naples. Private Dental Practice in affluent North Naples is looking to share my office space/operatories part time with an established dentist. Great opportunity for the experienced professional who is looking to slow down and work less days per week. Please email rhowardnaples@ yahoo.com for details. Thank you.

General dentist wanted. Well established, state-of-the-art private dental practice in West Palm Beach - Lake Worth area is looking for a full time general dentist who is caring, personable, motivated and skilled to join our growing team.

This is a PPO/FFS digital office with existing patient base.

Applicant should have at least 3 years of experience and be proficient in all aspects of dentistry including crowns, bridges, dentures, implant restorations, endo, basic oral surgery, and Invisalign. Excellent compensation based on commission. Please submit a C.V. and letter of interest to be considered for this unique opportunity! kromreydmd@ gmail.com.

Please see CLASSIFIEDS, 78

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Today's FDA

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Your Classified Ad Reaches Over 8,000 Readers!

CLASSIFIEDS from 77 Dentist Needed - Pinellas County, FL Great Expressions Dental Centers has an immediate opening for a full-time General Dentist to join our established practice in Pinellas County, FL! Enjoy a rewarding career with a full office staff (including Hygienist), a strong schedule and the ability to focus on quality patient care. Compensation: Competitive Compensation: Six Figure Annual Draw vs. Percent of Production! Benefits/Perks: Leader in the practice: Clinical Freedom and Treatment Autonomy; Patient Focus: Established and Growing Patient Foundation; Multi-Specialty office; Doctor Career Path – Partnership/ Investment Opportunities; Full Benefits Offered – Health care & Dental Benefits, 401K, Short Term/Long Term Disability, Time Off; Malpractice Coverage Assistance; Continued Education Reimbursement, Paid ADA & State Society Dues; Mentorship – Study Clubs, Chairside Mentoring, GEDC University Courses; Please view our Doctor Career Path video: http://www.screencast.com/t/ M3xWM5CYN. Please apply via this ad for consideration, Molly McVay| Sr. Clinical Recruiter | Great Expressions Dental Centers PSC-North | 29777 Telegraph Road. Suite 3000| Southfield, MI 48034 USA phone 248-430-5555 |Ext. 72467| fax 248-686-0170 | web www.greatexpressions. com. “Look for the Smile Above Our Name!” Apply Here.

PI97333709.

Endodontist needed. Dr. Gloria Barredo is seeking an experienced Florida licensed Endodontist, to work two or more days per month. We are a private, modern dental office, equipped with the latest technology including CT Scan. Our staff is fully trained in assisting you and your needs. This is a great opportunity for anyone who is seeking to add an extra day to their week, days and hours are flexible. Compensation will be discussed in detail upon your phone interview. We look forward to hearing from you! 561.741.8008.

Full Time Dentist Opportunity: Jensen + Port St. Lucie, FL. Great Expressions Dental Centers has an immediate, select opening for a full-time (5 days/split offices) General Dentist to join both our established, high production, Jensen and Port St. Lucie practice(s)! Enjoy a rewarding career with a full office staff (including HYG), a strong schedule and the ability to focus on quality patient care. Compensation: Six-Figure Draw vs. Percent of Production. Benefits/Perks: Leaders in the Practice: Clinical Freedom and Treatment Autonomy for Every Doctor; Patient Focus: Established and Growing Patient Foundation; Multi-Specialty office(s); Doctor Career Path – Partnership/Investment Opportunities; Full Benefits Offered – Health care & Dental Benefits, 401K, Short Term/Long Term Disability, Time Off; Malpractice Coverage Assistance; Continued Education Reimbursement, Paid ADA & State Society Dues; Mentorship – Study Clubs, Chairside Mentoring, GEDC University Courses. Please view our Doctor Career Path video: http://www.screencast.com/t/M3xWM5CYN. Apply via this ad to learn more about Great Expressions! For More Information, Please Contact: Ross Shoemaker, MBA | Doctor Recruiting Manager | Great Expressions Dental Centers 770 Holcomb Bridge Roswell, Norcross, GA 30076 USA phone 678-836-2226 | ext 72226 | fax 770-242-3251 |web www.greatexpressions.com email Ross.Shoemaker@ greatexpressions.com. “Look for the Smile Above Our Name!” Apply Here. PI97319409. http://www.Click2apply. net/v62m746q5hyrrbdj.

General Dentist Wanted. Established dental office is seeking an ongoing relationship with a well-rounded dentist. We are looking for someone who can fill in for the owner/dentist during vacations and CE courses with advance notice. Great compensation and excellent supportive staff. Compensation 45% of production or a fixed amount that can be discussed.

Looking for someone as soon as the end of April, with additional dates throughout the year. If you are ready to join our friendly and supportive team, please contact us at info@crosscitydental.com with a brief history of your training and experience.

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Dental Hygienist. Are you looking for an enjoyable position where you will be well trained, appreciated and fairly compensated? If so, we are the practice for you. We have a beautiful modern office, a wonderful patient population, an enthusiastic team, and a sincere dentist dedicated to quality care. Previous dental office experience would be helpful, but a great attitude and a strong work ethic are our first priorities. We are growing and need to expand our hygiene department. We are currently seeking a permanent, part-time hygienist for 1 day a week (Thursday); could lead to additional days, if you desire. We’d love for you to contact us and discuss your interest, and then possibly join us for a few hours and see if becoming a member on our team would be mutually beneficial. Please respond to lakemarydmd@gmail.com.

General Dentist. Palm Beach County General Dentist. Can be recent graduate. Several offices, one of which requires a Medicaid Provider number. Guaranteed per diem with percentage of net revenues. Lab on premises. Excellent opportunity. Palm Beach County facilities. 305.661.3819.

Dental Recovery Solutions Group. DRS-360 specializes in SHORT SALES. If you are upside-down in your dental practice and are hemorrhaging cash, please contact us for a Free Consultation at: 844-377-3601 or by email: info@drs360.com. Nationwide.

Part-Time (2+ days) Endodontist - Fort Myers, FL. Come lead our specialty team as a part-time Endodontist in Fort Myers, FL! Great Expressions Dental Centers has a current, select opening for a part-time (2-3 days/week) Endodontist to join our Fort Myers, FL multi-specialty practice in Page Field. We offer an aggressive compensation package, dedicated staff, consistent schedule with a strong referral network of local offices. Compensation: Six Figure Annual Base vs. Competitive Percent of Production! Attractive Sign-on or Relocation possible as well. Benefits/Perks: Leader in the practice: Clinical Freedom and Treatment Autonomy; Patient Focus: Established and Growing Patient Foundation; Multi-Specialty office; Doctor Career Path – Partnership/Investment Opportunities; Full Benefits Offered – Health care & Dental Benefits, 401K, Short Term/ Long Term Disability, Time Off; Malpractice Coverage Assistance; Continued Education Reimbursement, Paid ADA & State Society Dues; Mentorship – Study Clubs, Chairside Mentoring, GEDC University Courses.

Please view our Doctor Career Path video: http://www. screencast.com/t/M3xWM5CYN. Please apply via this ad for consideration! Hannan Ayad| Clinical Recruiter | Great Expressions Dental Centers PSC-North | 29777 Telegraph Road. Suite 3000| Southfield, MI 48034 USA phone 248-598-7256 |Ext. 71178| fax 248-430-5528 | web www.greatexpressions.com. “Look for the Smile Above Our Name!” Must have a DDS/DMD from an accredited University and active State Dental Board license, Endodontist Dental License and certifications.

Apply Here. PI97181698. http://www.Click2apply. net/3tnmxvmrznmpx5m4.

General Dentist. Associate needed in central Florida. New grads welcome. Associate to partner path with an 18+ year GP that is focused on comprehensive patient centered care.

8 ops with 2 hygienists, 3-4 fully trained dental assistants, superb front office, fee for service. Come join us and have a ball taking care of people with a MAGD mentor that loves to teach. 863.465.2037.

Dentist Needed (Full-Time) - Tampa, FL. Great Expressions Dental Centers has an immediate opening for a full-time General Dentist to join our Tampa, FL practice. Enjoy a rewarding career with a full office staff (including Hygienist), a strong schedule and the ability to focus on quality patient care. Compensation: Competitive Compensation: Six Figure Annual Draw vs. Percent of Production. Benefits/Perks: Leader in the practice: Clinical Freedom and Treatment Autonomy; Patient Focus: Established and Growing Patient Foundation; Multi-Specialty office; Doctor Career Path – Partnership/ Investment Opportunities; Full Benefits Offered – Health care & Dental Benefits, 401K, Short Term/Long Term Disability, Time Off; Malpractice Coverage Assistance; Continued Education Reimbursement, Paid ADA & State Society Dues; Mentorship – Study Clubs, Chairside Mentoring, GEDC University Courses. Please view our Doctor Career Path video: http://www.screencast.com/t/ M3xWM5CYN. Please apply via this ad for consideration, Molly McVay | Sr. Clinical Recruiter | Great Expressions Dental Centers PSC-North | 29777 Telegraph Road. Suite 3000| Southfield, MI 48034 USA phone 248-430-5555 |Ext. 72467| fax 248-686-0170 | web www.greatexpressions. com. “Look for the Smile Above Our Name!” Must have a DDS/DMD from an accredited University and active State Dental Board license. Apply Here. PI97202463. http://www.

Click2apply.net/wn336w2j8bx267jz.

General Dentist Opportunity — Sarasota, FL. If you're looking to make your professional mark on a community, this is your chance. Build valuable relationships with patients and get involved with the greater community while providing top-notch dental care. Our talented and dedicated support team will work alongside you to help ensure your success. You'll enjoy the following: Base salary with performance incentives to earn more; Sign-on bonus of $5000; Relocation package; Full time benefits include CE allowance, professional liability, 401K and group health/wellness plans; Practice 4-5 days per week with family friendly days/hours. Candidates must be licensed to practice in the State of Florida with no board reprimands or issues, have a valid DEA license, NPI number and current CPR certification. Send resume to areimiller@dentalpartners.com or call 321-574-8003 for a confidential review of the opportunity. www.dental-partners.com.

General Dentist — Port Charlotte, FL. If you're looking to make your professional mark on a community, this is your chance. Build valuable relationships with patients and get involved with the greater community while providing top-notch dental care. Our talented and dedicated support team will work alongside you to help ensure your success. You'll enjoy the following: Base salary with performance incentives to earn more; Sign-on bonus of $5000; Relocation package; Full time benefits include CE allowance, professional liability, 401K and group health/ wellness plans; Practice 4-5 days per week with family friendly days/hours. Candidates must be licensed to practice in the State of Florida with no board reprimands or issues, have a valid DEA license, NPI number and current CPR certification. Send resume to areimiller@dentalpartners.com or call 321-574-8003 for a confidential review of the opportunity. www.dental-partners.com.

Looking for dentist. DENTIST to perform EXAMS for Private Practice patients. Part-time or Full-time (benefits).

Daily guarantee. “Bankers hours.” The perfect job for a licensed semi-retired or new graduate or physically limited Dentist. No stress, over-head, or office responsibilities.

POSITION ALSO AVAILABLE FOR DENTIST WHO PERFORMS MOST PROCEDURES--GREAT PAY! Call 321 945 9545 or fax resume to 407 302 9799.

www.floridadental.org

PENSACOLA, FL-General Dentist Opportunity. * Well established Private Practice.* Fully equipped operatories and modern office. State of the art technology including digital x-rays, intraoral camera, laser, invisalign. Generous percentage of collections offered in addition to on the job experience and mentoring. Email resume to jennyk@emeraldcoastsmiles.com or fax to (850)478-6205.

For Sale/Lease General Dentistry Practice â&#x20AC;&#x201D; Quincy, FL. Profitable, efficient general dentistry practice in an historic town just twenty-five minutes from Tallahassee, Florida. The practice is walk in ready and averages two new patients weekly without any marketing. There are 5 operatories, collections over $500K/yr on 25hrs/week, FFS/PPO. There is definite room for growth. Great long-term staff. The practice was owned and operated by the same dentist since 1984. The office space is just shy of 3,000 square feet on a .38-acre lot on Hwy 90, and includes a spacious paved parking lot to accommodate the patients. The practice is modern, computerized and equipped with digital X-rays and a Kodak 9000 3D CBCT/Panorex. Buyer has opportunity of walking into a ready-made practice with collections over $500,000, a full team in place and a spacious building that can accommodate at least two doctors. Asking $860,000 for building, equipment and practice. Can separate out practice and guarantee property sale later. Contact Karen Watson for more information at 850-524-7358.

Office for sale in Panama City, FL. For sale, Panama City, FL. 1933 sq ft. Stand alone building.

4 equipped ops with room for 2 more ops; Lab, etc. Plenty of parking. Superb location in professional office park on major street on best side of town. Does not include practice, already sold that when dentist recently retired. 850-271-5612.

Office space. Beautiful medical office space available in Jupiter, Florida. The Office is 3600 square feet in Park Plaza 658 W Indiantown Rd. Suite 212. For pictures and more information please go to loopnet.com.

www.floridadental.org

May/June 2017

Today's FDA

79

OFF THE CUSP

JOHN PAUL, DMD, EDITOR

Living the Dream

“

We don’t ignore the cold hard facts about keeping the doors open.

We try to look at failure as an opportunity to learn how to succeed.

”

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Some of y’all know I am a bit of a gym rat.

When I was younger, I chased the 500 lb. bench press and spent about 10 hours a week slinging steel. The gym regulars get to be a little community and if you’re at a gym in Polk County, it’s not just a bunch of muscle heads. There are lots of elder aunts and uncles who are trying to keep their health.

One of those ladies — every time you spoke to her and asked how she was — always replied, “GREAT!” This lady moved slowly, she spoke slowly and her hair was often disheveled. Nothing about her suggested the answer should be so enthusiastic, so I asked her one day why she always answered, “GREAT!” She told me, “Every day you’re alive, you have some difficulty, some joy.” She chose to focus on the joy while she worked through the necessities of everyday life. When she answered, “GREAT!” she was reminding herself that she was on the right path.

When people ask me, “How are you?” I used to answer, “I am well.” This is a grammatically appropriate response that confuses the modern speakers of texted English/ emoji. Lately I have been telling people, “I am living the dream.” It makes most people laugh, so I keep doing it. When I gave that response to my physician the other day, her reply was, ‘I know, me too.” She said “I

always wanted to be a doctor and have a family and I do.” Dr. Vugman is an oncologist — there is no way her days are easy.

All day long she gives difficult diagnoses and dispenses poisons designed to “kill just those parts of you we don’t like.” I am convinced that she will never let me out of our annual visit because she likes to remind herself that she’s got one in the win column.

And, she is living her own dream.

I started telling folks I was living the dream during some tough times in my practice.

My consultant used to tell me, “You fake it till you make it.” On paper, the business may look kind of rough, but you get to choose your attitude every day, and the attitude here is great. We’ve got good people to work with and lots of nice folks to work for. I’m doing a job it seems I was designed to do. We don’t ignore the cold hard facts about keeping the doors open. We try to look at failure as an opportunity to learn how to succeed. I remember back when I used to work mowing lawns and loading trucks, and I realize that I really am living my dream.

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

H Y O P U P R A H FDC

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THURSDAY, JUNE 22 M 5-6 PM WRECKERS SPORTS BAR Dentists and spouses welcome Presented by