2014 - Sept/Oct TFDA

Support Candidates Work-life Balance Maternity Leave Cancer Women's Health Care

WOMEN IN DENTISTRY VOL. 26, NO. 6 • 2014 SEPT/OCTOBER

WE KNOW INSURANCE. WE KNOW DENTISTS. Through the years, transitioning throughout my dental career, Joseph has been there every step of the way. Especially with insurance, I always want to know the necessity and have the reason for acquiring specific types of insurances explained.

Joseph has always done a great job in doing that. He takes that quality time to go through everything and is always quick to respond.

— Timothy Chen, DMD, PA Tooth Tales, Miramar

CALL JOSEPH PERRETTI

A Member Benefit since 1989

DIRECTOR OF SALES – SOUTH FLORIDA 305.665.0455 • Cell: 305.721.9196 joe.perretti@fdaservices.com

Individual and group health • Disability income • Office overhead expense • Workers’ compensation Professional liability • Office package • Term life • Fidelity bonds • Long-term care • Boat • Auto

contents cover story

30

Maternity Leave for Practice Owners

news

literary

14

23

Letter to the Editor

67

Book Review

news@fda

20 Board of Dentistry 65 Supported Candidates: General Election

Nov. 4, 2014

columns f e at u r e s 10

Required Posters

25

Attaining Work-life Balance is Possible

27

Volunteer to Stay Relevant in Our Profession

30

Maternity Leave for Practice Owners

38

Public Awareness of Oral and Pharyngeal Cancer

42 Maintaing Your Dental Practice While Recovering

From Cancer 44 Maintaing Your Dental Practice

While Recovering From Cancer 54 Women’s Health Care Benefits Change

Under the Affordable Care Act 58

Excuse Me, I'm Talking Here!

Read this issue on our website at:

www.floridadental.org.

www.floridadental.org

3

Staff Roster

5

President’s Message

6

Legal Notes

13

Information Bytes

49

Diagnostic Discussion

76

Off the Cusp

classifieds 70 Listings On the cover: Top row, left to right: Drs. Brittany Craig, Yvette Godet, Eva Ackley and Irene Marron.

Middle photo: The West Coast District Dental Association’s first ever “Divas in Dentistry” event in Tampa at Neiman Marcus.

Bottom row, left to right: Drs. Shireen Dhanani, Geraldine Ferris, Betty Hughes and Tanya Orr.

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

September/October 2014

Today's FDA

1

FLORIDA DENTAL ASSOCIATION SEPTEMBER/OCTOBER 2014 VOL. 26, NO. 6 EDITOR Dr. John Paul, Lakeland, editor Dr. Jeannette Pena-Hall, guest editor

STAFF Jill Runyan, director of communications • Jessica Lauria, publications coordinator Lynne Knight, marketing coordinator

Accelerate

YOUR PROFESSIONAL GROWTH NEDDA FALL CE COURSE

FRIDAY, NOV. 7, 2014 SHERATON JACKSONVILLE HOTEL Speaker: Dr. Alfonso Pineryo www.nedda.org • 904.737.7545 • ddeville@nedda.org

WCDDA ANNUAL WINTER MEETING

FRIDAY, JAN. 16, 2015 HILTON ST. PETERSBURG BAYFRONT Speakers: Henry A. Gremillion, D.D.S.; Dave Weber www.wcdental.org • 813.654.2500 • wc.dental@gte.net

ACDDA ANNUAL WINTER MEETING

FRIDAY, FEB. 13, 2015 EMBASSY SUITES HOTEL, WEST PALM BEACH Speaker: Dr. Tyler Lasseigne — Cosmetic Dentistry www.acdda.org • 561.968.7714 • acdda@aol.com

SFDDA MIAMI WINTER MEETING

FRIDAY, FEB. 20, 2015 • JUNGLE ISLAND, MIAMI www.sfdda.org • 305.667.3647 • sfdda@sfdda.org

NWDDA 2015 ANNUAL MEETING

FRIDAY & SATURDAY, FEB. 20-21, 2015 THE GRAND SANDESTIN www.nwdda.org • 850.391.9310 • nwdda@nwdda.org

CFDDA ANNUAL MEETING

FRIDAY & SATURDAY, APRIL 24-25, 2015 www.cfdda.org • 407.898.3481 centraldistrictdental@yahoo.com

COUNCIL ON COMMUNICATIONS Dr. Thomas Reinhart, Tampa, chairman Dr. Roger Robinson Jr., Jacksonville, vice chairman Dr. Matt Henry, Vero Beach • Dr. Scott Jackson, Ocala Dr. Marc Anthony Limosani, Miami • Dr. Bill Marchi, Pensacola Dr. Jeannette Hall, Miami, trustee liaison • Dr. John Paul, editor

BOARD OF TRUSTEES Dr. Richard Stevenson, Jacksonville, president Dr. Ralph Attanasi, Delray Beach, president-elect Dr. William D’Aiuto, Longwood, first vice president Dr. Michael D. Eggnatz, Weston, second vice president Dr. Jolene Paramore, Panama City, secretary Dr. Terry Buckenheimer, Tampa, immediate past president Drew Eason, Tallahassee, executive director Dr. David Boden, Port St. Lucie • Dr. Jorge Centurion, Miami Dr. Stephen Cochran, Jacksonville • Dr. Richard Huot, Vero Beach Dr. Don Erbes, Gainesville • Dr. Don Ilkka, Leesburg • Dr. Jolene Paramore, Panama City Dr. Rudy Liddell, Brandon • Dr. Beatriz Terry, Miami Dr. Ethan Pansick, Delray Beach, speaker of the house Dr. Tim Marshall, Weekiwachee, treasurer • Dr. John Paul, Lakeland, editor

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

FDA membership dues include a $10 subscription to Today’s FDA. Non-member subscriptions are $150 per year; foreign, $188. Periodical postage paid at Tallahassee, Fla. and additional entry offices. Copyright 2014 Florida Dental Association.

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

POSTMASTER: Please send form 3579 for returns and changes of address to Today’s FDA, 1111 E. Tennessee St., Tallahassee, Fla. 32308-6914.

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.

For a complete listing, go to www.trumba.com/calendars/fda-member.

2

Today's FDA

September/October 2014

www.floridadental.org

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 Drew Eason, Executive Director deason@florid adental.org 850.350.7109 Graham Nicol, Chief Legal Officer gnicol@floridadental.org 850.350.7118 Judy Stone, Leadership Affairs Manager jstone@floridadental.org 850.350.7123 Brooke Mills, Assistant to the Executive Director bmills@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 Tammy McGhin, Payroll & Property Coordinator tmcghin@floridadental.org 850.350.7139 Mable Patterson, Accounts Payable Coordinator mpatterson@floridadental.org 850.350.7104

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

MEMBER RELATIONS

(FDAF)

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

Kaitlin Alford, Member Relations Assistant kalford@floridadental.org 850.350.7100

Stefanie Dedmon, Coordinator of Foundation Affairs sdedmon@floridadental.org 850.350.7161

Ashley Merrill, Membership Relations Assistant amerrill@floridadental.org 850.350.7110

Christine Mortham, Membership Concierge cmortham@floridadental.org 850.350.7136

FLORIDA DENTAL CONVENTION

FDA SERVICES

(FDC)

800.877.7597 or 850.681.2996 1113 E. Tennessee St., Ste. 200 Tallahassee, FL 32308

Crissy Tallman, Director of Conventions and Continuing Education ctallman@floridadental.org 850.350.7105 Elizabeth Bassett, FDC Exhibits Planner ebassett@floridadental.org 850.350.7108 Ashley Liveoak, FDC Meeting Assistant aliveoak@floridadental.org 850.350.7106 Mary Weldon, FDC Program Coordinator mweldon@floridadental.org 850.350.7103

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

INFORMATION SYSTEMS

Lynne Knight, Marketing Coordinator lknight@floridadental.org 850.350.7112

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

Jessica Lauria, Publications Coordinator jlauria@floridadental.org 850.350.7115

Lisa Cox, Database Administrator lcox@floridadental.org 850.350.7163

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 Membership Services Manager carol.gaskins@fdaservices.com 850.350.7159 Debbie Lane, Assistant Membership Services Manager debbie.lane@fdaservices.com 850.350.7157 Allen Johnson, Support Services Supervisor allen.johnson@fdaservices.com 850.350.7140 Angela Robinson, Customer Service Representative angela.robinson@fdaservices.com 850.350.7156 Jamie Idol, Commissions Coordinator jamie.idol@fdaservices.com 850.350.7142 Kristen Gray, Membership Services Representative kristen.gray@fdaservices.com 850.350.7171 Marcia Dutton, Administrative Assistant marcia.dutton@fdaservices.com 850.350.7145

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

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

Joe Dukes Director of Sales Northeast & Northwest 850.350.7154 Cell: 850.766.9303 joe.dukes@fdaservices.com Joseph Perretti Director of Sales South Florida

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

305.665.0455 Cell: 305.721.9196 joe.perretti@fdaservices.com

Nicole White, Membership Services Representative nicole.white@fdaservices.com 850.350.7151

Rick D’Angelo Director of Sales West Coast

Pamela Monahan, Commissions Coordinator pamela.monahan@fdaservices.com 850.350.7141

813.475.6948 Cell: 813.267.2572 rick.dangelo@fdaservices.com

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

September/October 2014

Today's FDA

3

F LO R I D A D E N TA L CO N V E N T I O N : T H E O F F I C I A L M E E T I N G O F T H E F D A

KEYNOTE SESSIONS UCHE ODIATU, DMD Living Your Dreams

SAVE THE DATE J U N E 1 1 -1 3 , 2 0 1 5

DAVE WEBER Overcoming Life’s Goliaths MORRIS MORRISON Lead-ur-ship Starts With You! Offering over 15 hours of FREE CE !

orlando,florida

I www.f l o r i d a d e n t a l co nve n t i o n .co m

PRESIDENT’S MESSAGE RICK STEVENSON, DDS

The Journey Continues As my journey continues, I am constantly reminded of why I continue to be a volunteer. It’s because of you — the people I have met, those whom I am going to meet and those that I serve. You cannot put a price on the amount of satisfaction gained through volunteering, whether it is in your dental society’s leadership, volunteer clinics, churches or civic organizations. I encourage everyone to get engaged in volunteering on as many levels as you feel comfortable. Your interests are being well-served by your volunteer leaders in the Florida Dental Association (FDA). They are a dedicated group who constantly are being challenged to keep dentistry and the way we practice the best profession out there.

We couldn’t do this without the help of our outstanding FDA staff. They are in the background working hard at making sure we are organized and ready for our meetings, making our arrangements both at home and at the American Dental Association’s (ADA) meeting and, of course, keeping an eye on any and all outside entities that may pose a threat to our practice. We thank them for all they do, and a special thanks goes out to one of our finest, Rusty Payton. Rusty has been a hard-working and dedicated employee of the FDA. It was a privilege, not just working with him, but calling him a true friend as well. Thank you, Rusty, for all your wonderful years of service and best of luck as you take over as the executive director of the Florida Home Builders Association — you deserve it. You may leave, but you will not be forgotten.

You may have noticed that we introduced our new logos to all our different FDA divisions, but we have not changed their function, just their names. Stay tuned for more positive changes to your FDA.

“

I encourage everyone to get engaged in volunteering on as many levels as you feel comfortable.

”

Dr. Stevenson is the FDA President. He can be reached at rstevenson@bot.floridadental. org.

www.floridadental.org

September/October 2014

Today's FDA

5

Legal Notes

Treating Patients With Dementia Graham Nicol, Esq., HEALTH CARE RISK MANAGER, BOARD CERTIFIED SPECIALIST (HEALTH LAW)

DESIGNATION OF HEALTH CARE SURROGATE Patient’s name and address: Smith, John Adam Sr.

Informed Consent and Dementia A member called about treating patients with dementia/Alzheimer’s disease and the difficulties that arise.

Specifically, she mentioned a patient who had lost a crown. The patient’s son drives her to appointments, but does not make decisions nor listen to treatment needs for her. The patient thought she had left the crown at the dental office and wanted it recemented. The doctor had noted in the chart that the patient had lost the crown. The patient was not happy, but of course, due to her mental state, she could not recollect what happened.

In addition, because her son was not involved in the health care decisions of his mother, he was unaware of what had transpired.

Is there a consent form for Florida Dental Association (FDA) members’ use when treating patients with dementia/Alzheimer’s disease?

Under Florida law, an adult (generally, anyone over 18) is presumed to have exclusive authority to make his or her own health care decisions, barring unusual circumstances not likely to be seen in dental practice. Authorization to treat is accomplished through the informed consent dialogue, and an informed consent form is not the best way for the doctor to address who is responsible for decision-making. But there are two forms that dentists should expect to see when treating an elderly patient suffering from dementia or any other patient who lacks the ability to decide on matters involving their health.

The first form usually is seen only when the elderly patient is an in-patient at a hospital, nursing home or hospice, and there is a medical diagnosis of dementia. It appears as follows:

6

Today's FDA

September/October 2014

1111 Adams St. Tallahassee, FL 32301 In the event that I have been determined to be incapacitated to provide informed consent for medical treatment and surgical and diagnostic procedures, I wish to designate as my surrogate for health care decisions: John Adam Smith Jr. 1111 Adams St. Tallahassee, FL 32301 Home Phone: 111.555.0140 Work Phone: 111.555.1851 Cell Phone: 111.555.7399 If my surrogate is unwilling or unable to perform their duties, I wish to designate as my alternate surrogate: Jason Adams 210 Auburn Lane Miami, FL 33010 Home Phone: 111.887.5741 Cell Phone: 111.663.3218 I fully understand that this designation will permit my designee to make health care decisions, except for anatomical gifts, unless I have executed an anatomical-gift declaration pursuant to law, and to provide, withhold or withdraw consent on my behalf; to apply for public benefits to defray the cost of health care; and to authorize my admission to or transfer from a health care facility.

I further affirm that this designation is not being made as a condition of treatment or admission to a health care facility.

www.floridadental.org

Legal Notes

I will notify and send a copy of this document to the following persons

Principal does hereby give and grant unto said attorney in fact full

other than my surrogate(s) so they may know who my surrogate(s) are:

power and authority to do and perform every act necessary, requisite

Melissa Sensen, Krueger Lane, Apt. 3, Tampa, FL, 32222.

or proper to be done in and about the premises as fully as they might or could do were they personally present, with full power of substitu-

Signature of Patient ____________________________________

tion and revocation, hereby ratifying and confirming all that said at-

Signature of Witness ___________________________________ torney shall lawfully do or cause to be done by virtue hereof, with the Signature of Witness ___________________________________

following limitations:

The health care surrogate designation must be signed by the patient. It

1. This limited power of attorney shall be effective upon execution by

also must be witnessed by two (2) separate individuals over the age of

Principal.

18, other than the surrogate(s) themselves. Most facilities use the front office staff or social workers as witnesses. A witness should be some-

2. Principal fully understands that this designation will permit their at-

one easily located in the event the designation is challenged. Note that

torney in fact to make health care decisions on behalf of Principal; to

the health care surrogate has authority to make medical decisions for

provide, withhold or withdraw consent on Principal’s behalf; to apply

the Alzheimer’s patient only so long as the patient is incapacitated.

for public benefits to defray the cost of health care; to authorize Prin-

For example, during moments of lucidity, the patient can withdraw

cipal’s admission to or transfer from a health care facility.

or change the health care surrogate. Note also that, unlike a durable limited power of attorney to provide medical consent (see below), the

3. If the attorney in fact is unwilling or unable to perform their duties,

health care surrogate designation form does not need to be notarized.

the Principal designates as alternate attorney in fact:

A durable limited power of attorney for medical decisions is far more

Jason Adams

common in the dental setting. It appears as follows:

210 Auburn Lane Miami, FL 33010

DURABLE LIMITED POWER OF ATTORNEY TO PROVIDE MEDICAL CONSENT KNOW ALL MEN BY THESE PRESENTS, that John L. Adams, Sr., a Florida resident domiciled at _________, hereafter “Principal,” does hereby nominate, constitute and appoint John S. Adams Jr. 1111 Adams St. Tallahassee, FL 32301 Home Phone: 111.555.0140 Work Phone: 111.555.1851 Cell Phone: 111.555.7399 as their attorney in fact for the limited purpose of making health care decisions (including, but not limited to those provided under Chapter 765, Florida Statutes, as well as providing informed consent for dental

Home Phone: 111.887.5741 Cell Phone: 111.663.3218 4. This durable power of attorney is not terminated by the subsequent incapacity of the Principal except as provided in Chapter 709, Florida Statutes.

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

6. A photocopy or electronically transmitted copy of this original power of attorney has the same effect as the original.

IN WITNESS WHEREOF, the undersigned has issued this durable limited power of attorney, effective as of the date set forth below. __________________________________________________ (Signature of Principal)

and/or medical treatment, surgical and diagnostic procedures) on behalf of Principal.

Please see LEGAL, 9

www.floridadental.org

September/October 2014

Today's FDA

7

Legal Notes

MAKING CHANGES? LEGAL from 7

LET US KNOW! MOVING?

Don’t miss out on any of your member benefits.

Contact the FDA with your new office address or email address.

John L. Adams Sr. 1111 Adams St., Tallahassee, FL 32301.

Sworn to (or affirmed) and subscribed before me this ___ day of ________, 2012, by John L. Adams Sr.

Remember to contact the Board of Dentistry directly about your move. Go to floridasdentistry.gov to make the change.

__________________________________________________

RETIRING?

Commission Expires: _______

We want to make sure you receive the forms for retired membership. You can save money! Contact us to find out more!

FOR STATUS OR ADDRESS CHANGES, CONTACT THE FLORIDA DENTAL ASSOCIATION. 800.877.9922 • fda@floridadental.org

Notary Public – State of Florida Print, type, or stamp commissioned name of notary public Personally known OR Produced Identification __________________________________________________ Type of Identification Provided Witness: ____________________________________________ (Print name and address) Witness: ____________________________________________ (Print name and address) Note that this form, unlike the health care surrogate designation, must be signed in front of a notary and attested to by the notary as well as two (2) witnesses.

For the convenience of FDA members, both of these forms will be posted on the FDA website, under the members-only section.

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

Graham Nicol is the FDA’s Chief Legal Counsel.

www.floridadental.org

September/October 2014

Today's FDA

9

Posters

Required Posters There are many federal and state laws that require dental offices, like other employers, to conspicuously post up to a dozen notices in locations accessible to employees. As a practicing dentist, it can be hard to keep up with all the rules and regulations — that’s where your membership works for you. The Florida Dental Association has done all the dirty work to provide our members access to free ways to comply — no need to spend hundreds of dollars to purchase forms from an outside group. Depending on the number of employees in your practice, you may need all or some of the following: Title

Notes

U.S. Fair Labor Standards Act (Federal Minimum Wage)

Required for: all employers.

U.S. Employee Polygraph Protection Act of 1988 (Lie Detectors)

Required for: all employers.

U.S. Job Safety and Health Protection (OSHA)

Required for: all employers.

How to obtain

Website

U.S. Department of Labor

http://www.dol.gov/whd/regs/ compliance/posters/flsa.htm

Frances Perkins Building 200 Constitution Ave., NW Washington, D.C. 20210 866.487.9243 U.S. Department of Labor Frances Perkins Building 200 Constitution Ave., NW Washington, D.C. 20210 866.487.9243

Revised in 2013; must be at least 8.5˝ x 14˝ in. with 10 point type; use high resolution download.

U.S. Department of Labor Occupational Safety & Health Administration

Required for: all employers.

U.S. Department of Labor

Revised in 2009; make sure to include the Genetic Information Nondiscrimination Act language.

Frances Perkins Building 200 Constitution Ave., NW Washington, D.C. 20210 800.397.6251

U.S. Uniformed Services Employment and Re-employment Rights Act (Military Service)

Required for: all employers.

U.S. Department of Labor

Florida Law Prohibits Discrimination (Florida Civil Rights Act)

Required for: Florida employers.

Prints on 11˝ x 17˝ paper; print both English and Spanish.

2009 Apalachee Parkway, Ste. 100 Tallahassee, FL 32301 800.342.8170

Florida Minimum Wage

Required for: Florida employers.

Florida Department of Economic Opportunity

10

Today's FDA

Frances Perkins Building 200 Constitution Ave., NW Washington, D.C. 20210 866.487.2365

September/October 2014

http://www.osha.gov/Publications/ poster.html

200 Constitution Ave., NW Washington, D.C. 20210 800.321.6742

U.S. Equal Employment Opportunity (EEOC)

Revised in 2014.

http://www.dol.gov/whd/regs/ compliance/posters/eppa.htm

Florida Commission on Human Relations

107 E. Madison St. Caldwell Building Tallahassee, FL 32399 850.245.7105

http://www.dol.gov/ofccp/regs/ compliance/posters/ofccpost.htm

http:// www.dol.gov/vets/programs/userra/USERRA_Private. pdf

http://fchr.state.fl.us/fchr/publications/discrimination_poster/discrimination_poster

http://www.floridajobs.org/business-growth-and-partnerships/ for-employers/display-postersand-required-notices

www.floridadental.org

Posters Title Florida “EEO is the Law” Poster Supplement

Florida Workers’ Compensation Works for You

Florida Re-employment Tax (formerly Unemployment Tax)

Notes Required for: Florida employers.

Prints on 8.5˝ x 14˝ paper.

Required for: Florida employers.

Scroll down to the “All-In-One Broken Arm Poster” link, which includes the anti-fraud program notice; prints on 11˝ x 17˝ paper; get sticker from your workers’ compensation carrier.

Required for: Florida employers.

Scroll down to form number RT-83.

Family and Medical Leave Act (FMLA)

Required for: employers with 50 employees or more.

Florida Child Labor Law

Required for: employers who employ children.

Scroll down to “Other Posters,” click on Florida Child Labor Employment Laws; prints on 8.5˝ x 14˝ paper.

How to obtain

Website

Florida Commission on Human Relations

http://fchr.state.fl.us/fchr/publications/discrimination_poster/eeoc_ supplement_poster_in_english

2009 Apalachee Parkway, Ste. 100 Tallahassee, FL 32301 800.342.8170 Florida Department of Financial Services

http://www.myfloridacfo.com/wc/ publications.html

Division of Workers’ Compensation 200 E. Gaines St. Tallahassee, FL 32399 800.742.2214 Florida Department of Revenue

http://dor.myflorida.com/dor/ forms/

Division of Workforce Services MSC 229 107 E. Madison St. Tallahassee, FL 32399 800.204.2418

U.S. Department of Labor Frances Perkins Building 200 Constitution Ave., NW Washington, D.C. 20210 866.487.9243

Florida Department of Business and Professional Regulation

http://www.dol.gov/whd/regs/ compliance/posters/fmla.htm

http://www.dol.gov/whd/regs/ compliance/posters/fmla.htm

1940 N. Monroe St. Tallahassee, FL 32399 800.226.2536

As health care professionals, many dentists prohibit smoking in their offices. The Florida Clean Indoor Air Act (Florida Statutes § 386.201 et seq.) allows employers to prohibit smoking within their facilities. Smoking can be restricted to designated areas outside the office. If you choose to implement a smoking prohibition, you may post a “non-smoking” notice, but it is not mandatory.

Federal and Florida employment law is complex and changing. For example, the U.S. National Labor Relations Board (NLRB) promulgated a rule in 2012 that most private employers would need to post a notice under the National Labor Relations Act. The rule was enjoined by a federal court, but you should routinely check http://www.nlrb.gov/poster to see if the law takes effect. Also, be aware that additional posting requirements may apply for federal contractors and companies that participate in the voluntary E-Verify program (electronic checking of immigration status and work eligibility). If you do, you can download the necessary posters at http://1.usa.gov/ VpCygU. This information can be found on our website at www.floridadental.org/posters.

www.floridadental.org

September/October 2014

Today's FDA

11

benefit

Helping Members Succeed

NUMBER

16

ON L I N E

CE

I’ve saved about $3,000 using the FDA’s free online CE. I would recommend it — absolutely! — Dr. Amy Counts

THESE COURSES NOW AVAILABLE Dr. Alan Fetner Hot Topics in Implant Dentistry (EL31)

Dr. Gary Wayne Expand Oral Surgery for the General Practitioner (EL27)

Dr. I. Bhattacharyya Autoimmune Diseases of the Oral Cavity (EL34)

Dr. Robert Marx

THE EASY WAY

Clearing the Fog on Different Types of Bone Grafting and Ridge Augmentation (EL26)

F R EE C E C RE D I T S FOR F DA M E M BE RS

The “New” Periodontal Disease: Inflammatory and Risky (EL22)

Dr. Samuel Low Go to www.floridadental.org.

Questions? Call 800.877.9922 * These courses expire on 1/30/2015.

Information Bytes

I Need a New Smartphone or Tablet …

What Should I Buy? Apple, Android or Windows?

By Larry Darnell DIRECTOR OF INFORMATION SYSTEMS

I’m asked this question quite often. I know what I like personally, but what works for me may not work for you. I usually tell people who ask me this question to look at what others are using and go to a store to try some out. It’s best to go in without any preconceived notions; don’t make snap decisions — do your research first. That $69 tablet sounds good, but it may not last or even do what you want. I suggest asking your children (unless they’re infants or toddlers) because they often know best when it comes to the technology and what works.

The answer to this question used to be simple: It was all about the apps (applications).

Each platform or operating system — Apple, Android or Windows — has their own specific set of apps, their own app store and limited cross-platform sharing of those applications. In my case, my family and I use the same platform because it is cost-effective and easier to work with and support. Therefore, if you are going to get a tablet, consider one that is using the same operating system as the smartphone you currently use.

Part of this question calls for you to educate yourself a little on the operating system a certain device uses. Suffice it to say, Microsoft and Apple promote theirs heavily, so you may already know that a Surface tablet and Windows phone are made by Microsoft, and the iPad and iPhone are made by Apple. Other manufacturers, such as Samsung, LG, Motorola and HTC, don’t advertise their operating system as much, but they are almost exclusively some type of Android device.

Each manufacturer will trumpet their features, but you have to determine if it’s something you need and will use. A cool feature is only cool if it does something you actually need. For instance, the camera quality on most smartphones or tablets pale in comparison to an actual camera but, most times, it is sufficient for what you need.

Shopping for a new smartphone or tablet can be like buying a new car; there are highend models, budget models and the ones in between. Generally speaking, you get what

www.floridadental.org

“ ”

A cool feature is only cool if it does something you actually need.

you pay for. Take one for a test drive.

Look at the features and see if it meets your needs. You’re not committing to something for the rest of your life. Ten years ago, these things didn’t exist and 10 years from now, you won’t be using what you choose today — so get what you want for now.

If you have questions about features, capabilities, jargon or the like, I’m a phone call or an email away and would love to help you if I can.

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

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

Editor’s notes: Dr. Donald Levenson accidentally wasn’t listed in “Member Milestones” in the July/August issue of Today’s FDA. He has reached the 60-year member milestone.

We apologize for this oversight and thank Dr. Levenson for his many years as a loyal FDA member!

Correction in July/August Issue of Today's FDA The House of Delegates article on page 19 of the July/August issue was incorrect with regard to a bylaws change. The article contained the original language from the agenda instead of the actual resolution adopted by the House. The House amended the bylaws to refer to “married” instead of “spousal” members, and replaced the term “recognized under federal law as husband and wife” with “recognized under federal law as married.” The FDA staff deeply regrets this error.

FDA Members to Attend UFCD Career Kickstarter Happy Hour Florida Dental Association (FDA) members are invited to attend the University of Florida College of Dentistry (UFCD) Career Kickstarter Happy Hour to meet with third- and fourth-year dental students in a casual and social environment.

The Career Kickstarter Happy Hour will be in Gainesville at The Swamp Room (upstairs) on Thursday, Oct. 16 at 6:30

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p.m. EDT. This event is organized so you, a dental professional, can discuss your real world environment and experiences with the dental students. Please plan on attending so you can lend your expertise and help ensure these dental students are more prepared to join our great profession! For more information, please contact Dr. Brett Zak at bzak24@gmail.com.

Understanding the Affordable Health Care Act Webinar Confused about how the Affordable Care Act (ACA) impacts you? It seems like provisions, regulations and deadlines change almost daily — join us for a webinar on Oct. 30 at 6:30 p.m. EDT to get the most up-to-date information.

Perfect for dentists and all dental team members, this webinar will cover how the ACA impacts your dental practice and individuals.

Participants will be able to: v understand the options and requirements for small groups under the ACA. v understand individual/family health insurance options and requirements under the ACA. v understand the two types of health care subsidies under the ACA and requirements to qualify for them. v understand how the ACA impacts dental insurance plans.

Board of Dentistry …

Did You Know?

It affects your practice every minute of every day. How much do you really know about the Board of Dentistry? For instance, did you know that BOD meetings are open to the public? What do Board members really do? What does the Professionals Resource Network do? How does the regulatory process work?

On any given day, the Florida Dental Association (FDA) receives calls regarding the Board of Dentistry (BOD) such as: v information about getting a dentist’s license suspended v appropriate information on the peer review process (if the doctor is a member) or the Board of Dentistry’s phone number if they are not v Florida laws and rules v mandatory courses for license renewal v how to collect patient records once a dentist/practice has moved or been sold v inquiries about a filed complaint on a specific license, etc.

Check out the BOD website at http:// floridasdentistry.gov for answers to these questions and other pertinent information.

Go to www.fdawebinar.org to attend this webinar.

www.floridadental.org

University Health Services’ New Dental Office Ready to Serve FSU Community

University Health Services at Florida State University proudly announces the opening of its new state-of-the-art dental office in the FSU Health and Wellness Center. This digital, chartless dental suite incorporates six contemporary open-bays in the operatory, complete with new technology. Pictured here, Sirona’s ORTHOPHOS XG 3D dental imaging system provides high-resolution digital images quickly and quietly while allowing for a comprehensive view of the entire jaw in a single scan.

Isabel Garcia, DDS, MPH, Named Dean of the University of Florida College of Dentistry Dr. Isabel Garcia, currently the deputy director of the National Institute of Dental and Craniofacial Research (NIDCR) — a part www.floridadental.org

of the National Institutes of Health — will officially begin her new job in February, when she will become the college’s seventh permanent dean.

help dental professionals stay current on dental coding. Don’t wait until it’s too late — allow time for staff training before the codes go into effect on Jan. 1, 2015.

Garcia’s career spans 34 years in public health, clinical practice, research, teaching and administration at the local, state and national levels. As deputy director of the NIDCR, she has shared responsibility for the oversight and management of programs and functions within the institute — which includes a staff of more than 400 scientists and administrators dedicated to research, training, science policy, health education, communications and financial management.

The new CDT 2015: Dental Procedure Codes is the only HIPAA-recognized code set for dentistry. Code changes include 15 new procedure codes, 52 revised procedure codes and five deleted procedure codes. It also comes with a searchable CD-ROM.

A fellow of the American College of Dentists, Garcia is a diplomate of the American Board of Dental Public Health, one of the nine specialties recognized by the American Dental Association, and is an active member of the American Dental Education Association, the International Association for Dental Research and the American Dental Association.

“The University of Florida, with its Health Science Center, is a powerhouse of talent, innovation and collaboration,” Garcia said. “It is a privilege to be joining such an exceptional team and supporting the visionary efforts of the entire university and its leaders.”

American Dental Association Releases CDT 2015 Codes

The CDT 2015 Companion: Help Guide and Training Manual educates staff on how to code dental office claims quickly and accurately, and successfully submit them for reimbursement. The Companion contains more than 150 coding questions and answers, 26 coding exercises, 15 quizzes and a continuing education (CE) test worth five CE credits.

The CDT Code Check app, which will be available Oct. 1 for iOS and Android mobile devices, will make CDT codes always accessible. The app will contain a searchable database of both the 2015 and 2014 CDT Codes; a list of new, revised and deleted codes with tracked changes; and a “favorites” section for storing your most frequently used codes.

To purchase any of the CDT coding products, please visit adacatalog.org or call the ADA Member Service Center at 800.947.4746.

The American Dental Association (ADA) announces the release of CDT 2015.

New books, training tools and an app

Please see NEWS, 16

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news@fda

NEWS from 15

Classified Advertising Online

Give Kids A Smile® Announces 2014 “Smile Champion” Awardees The ADA Foundation (ADAF) has announced the winners of the 2014 Smile Champion awards for Give Kids A Smile® (GKAS).

Cindy Hearn, Vice President, Branding & Communications for CareCredit, will receive the Steven W. Kess Give Kids A Smile® Corporate Volunteer Award. Dr. Michael Shreck will receive the Jeffrey Dalin, D.D.S. Give Kids A Smile® Volunteer Award. The awards presentation will take place during the ADA Foundation Give Kids A Smile® Gala, Oct. 10 at the San Antonio Marriott Rivercenter, San Antonio, during the American Dental Association’s (ADA) meeting, ADA 2014 — America’s Dental Meeting.

The Smile Champion awards are presented annually by the ADA Foundation.

The award recognizes the winners’ tireless efforts to expand the GKAS program to reach more underserved children across the country. Give Kids A Smile® is the American Dental Association’s signature national access-to-care program that provides free dental screenings, treatment and education to underserved children.

Since its founding more than 10 years ago, GKAS has provided dental services to more than 5 million children. Through its Give Kids A Smile® Fund, the ADA Foundation has provided financial support for the program totaling almost $1.4 since 2011.

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Are you looking for a job? Need to hire an associate or partner? Want to sell your equipment? Maybe you’re trying to sell your practice, or you’re in the market to buy one. No matter what your situation, the FDA’s online classified system has the solution for you.

This system provides our advertisers the opportunity to place, modify and pay for ads — wherever or whenever it’s convenient for you! Along with these options, you have the ability to personalize your ad with enhanced features to make your ad stand out.

All active ads in the system will be published in the upcoming issue of Today’s FDA, at no additional charge. That’s two ads for the price of one! Whether you are an FDA member or not, you have the capability to both place and search for classified ads in our system — guaranteeing maximum exposure!

Please visit www.floridadental.biz/ to get started today! If you have any questions, please contact Jessica Lauria at 850.350.7115 or jlauria@floridadental. org.

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

Atlantic Coast District Dental Association Alex Afsahi, Fort Lauderdale Andreina Avendano, Fort Lauderdale Brooke Berson, Philadelphia, PA Maria Boutsikos, Fort Lauderdale Diana Bronstein, Fort Lauderdale Juliana Chang, Fort Lauderdale Mikhail Daya, Fort Lauderdale J’Nelle Delica, Pompano Beach Kyle DeLuca, Sunrise Brittanie Dillon, Fort Lauderdale Robyn Gagnon, Boca Raton Michael Gertsen, Lighthouse Point Davode Gottardi, Pompano Beach Shirin Hamed, Fort Lauderdale Matthew Hooks, Stuart Bizu Irving, Port Saint Lucie Danielle Jaffe, Fort Lauderdale Lital Kathein, Fort Lauderdale Efthimios Koveos, Boca Raton Sara Lee, Fort Lauderdale Loan Leminh, West Palm Beach Fabiola Liendo, West Palm Beach Stephanie Maglio, Fort Lauderdale Mark Mays, Palm Beach Gardens Marc Mingel, Fort Lauderdale Mandana Mir Esmaili, Fort Lauderdale Eric Palacios, Fort Pierce Kinjal Patel, Leeds, AL Robert Perlstein, Deerfield Beach Lori Porras, Fort Lauderdale Jenan Shraiteh, Boca Raton Rafael Soltero, Weston Michael Starr, West Palm Beach Anne-Marie Umoren, Lake Worth

Central Florida District Dental Association Domenic Aloise, Ocala Valentina Ayala, Gainesville Maryam Bangash, Kissimmee

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news@fda

Sean Bannan, Daytona Beach Diego Baratelli, Ocala Kayanna Beckman, Gainesville Juliana Bermudez, Altamonte Springs David Boules, Palm Coast Daniel Branca, Gainesville Chelsea Brinkman, Gainesville Robert Brown III, Melbourne Miralys Chardon, Orlando Jesse Edwards, Orlando Christopher Ferreira, Orlando Daniel Garcia, Gainesville Jan Garcia, Gainesville Jessica Garcia, Gainesville Larissa Hanson, Daytona Beach Shores Tristan Hensley, Melbourne Ryan Holbrook, Daytona Beach Allison Johnston, Gainesville Ayala Justiniano, Orlando Rujuta Katkar, Gainesville Jimmy Lapnawan Jr., Gainesville Thao Le, Clermont Melvin Lopez, Micanopy Sidni Manne, Gainesville Kristina Marklin, Melbourne Thomas McPherson, Gainesville Nicholas Moore, Orlando Denise Hoang Ngo, Gainesville Christine Nguyen, Longwood Jessica Overmeyer, Orlando Frederick Palacios, Oviedo Darshan Panchal, Gainesville Ana Roca, Winter Park Nicole Sensabaugh, Gainesville Joseph Sorrentino II, Gainesville Kumar Sowmya, Merritt Island William Spencer, Gainesville David Sterrett, Orlando Leah Strange, Ocala Meagan Thomas, Gainesville James Troxler, Gainesville Natalia Valderrama, Melbourne Tracy VanDuyne, Gainesville

www.floridadental.org

Adam Walters, Gainesville Wendy Westberry, New Smyrna Beach

Northeast District Dental Association Danielle Antal, Jacksonville Steven Garrett, Fernandina Beach Paul Kanach, Jacksonville Jessica Kraich, Saint Augustine Sara Makary, Jacksonville Stacey Nedrud, Jacksonville Richard Ochsner, Jacksonville Kathleen Stevens, Yulee

Northwest District Dental Association Robert Abbiati, Panama City Marc Blackburn, Pensacola Jordan Harper, Niceville Victoria Jones, Tallahassee Jordan Rigsby, Tallahassee

South Florida District Dental Association Ariana Almasi, Miami Peggy Alvarez-Penebad, Miami Osbel Borges, Miami Alicia Cayon, Miami Kelly Chase, Weston Ning Chi, Davie Yoan Cortiza, Miami Daynet Fraga, Miami Magela Martinez, Miami Fabiane Ribeiro, Miami Alejandra Romero, Weston Saili Ruiz, Hialeah Harold Villegas, Miami

West Coast District Dental Association Jesse Alonso, Brandon Melissa Alvarado-Romero Pou, Bartow Tyler Branscombe, Sarasota Ivo Bushati, Saint Petersburg Kenia Campos, Naples Sean Coyle, Cape Coral Lauren Dupre, Saint Petersburg Andrew Haidet, Naples Elias Josephs, Fort Myers Ashley Keen, Sun City Center Keith Kiskaddon, Tarpon Springs Apolonio Lirio, Sarasota Deborah Lowry, Saint Petersburg Jennifer Meadows, Bonita Springs Lisa Nguyen, Winter Haven Shannon Novak, Cape Coral Minalben Patel, Fort Myers Ganesh Rajagopalan, Zephyrhills Luisa Rodriguez, Bradenton Billy Sams, Fort Myers Jong Um, Bonita Springs Karen Wasko, Naples Jennifer Waters, Bradenton Linda Yang, Safety Harbor

In Memoriam The FDA honors the memory and passing of the following members: George Williams Fort Lauderdale, FL Died: 3/19/14 Age: 84 Angelo Amato Orange Park, FL Died: 5/29/14 Age: 82

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Board

Board

Aug. 22, 2014

of

Dentistry

By Casey Stoutamire FDA LOBBYIST

The Florida Board of Dentistry (BOD) met in Orlando on Friday, Aug. 22. The Florida Dental Association (FDA) was represented by BOD liaison Dr. Don Ilkka and FDA lobbyist Casey Stoutamire. FDA President Dr. Rick Stevenson, Drs. Andy Brown, Richard Mufson, Oscar Morejon, Patty Dowling, Nicholas White, Reza Iranmanesh, Brian Coleman, Mark Falco and many others also attended.

All eleven board members were present: Dr. Joe Thomas, chairman; Dr. Robert Perdomo, vice-chairman; Drs. William Kochenour, T.J. Tejara, Dan Gesek, Wade Winker and Leonard Britten; hygienists, Ms. Catherine Cabazon and Ms. Angie Sissine; and consumer members, Mr. Tim Pyle and Mr. Anthony Martini.

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At the meeting, the BOD held a workshop to discuss the proposed changes to Rule 64B5-17.002, Written Dental Records, Minimum Content, Retention. The BOD voted to send this proposed rule back to the Dental Records Task Force for further discussion. Dr. Ilkka spoke on behalf of the FDA. He stated the FDA opposes sections 1(a) – 1(e) of the proposed rule per the House of Delegates resolution. Before the meeting, the FDA sent a letter of opposition to the BOD outlining its concerns. Dr. Mufson and lobbyist/attorney Mr. Mike Huey spoke on behalf of the Florida Society of Oral and Maxillofacial Surgeons (FSOMS) in opposition to the proposed rule change as well. Dr. Dowling (Florida Association of Endodontists), Dr. Morejon (Florida Association Periodontists), Dr. White (Florida Academy of Pediatric Dentistry) and Dr. Iranmanesh (Florida Prosthodontic Association) sat at the table with Dr. Mufson and Mr. Huey, but did not speak. Dr. Falco, president of the Central Florida Academy of General Dentistry (AGD), spoke on behalf of the AGD in opposition to changes to section 1(e). Many FDA members also attended the meeting to show their opposition to the proposed records rule. Their presence was duly noted by the BOD members and helped provide the needed support for sending this issue back to the Dental Records Task Force to be re-evaluated. The FDA would like to thank all of its members who attended the meeting! The FDA will continue to keep its members updated on this issue.

Ms. Cabazon, RDH, gave a report to the BOD on the Hygiene Council conference call that took place on July 9. First, the Hygiene Council adopted a motion to require that all dentists and dental hygienists complete a one hour Laws and Rules course every other biennium beginning in 2017. The BOD moved to send this proposal back to the Rules Committee for further discussion. Since the proposed rule created a requirement for dentists, the BOD clarified that the Hygiene Council is not authorized to unilaterally create new rules for dentists. Second, the Hygiene Council adopted a motion to www.floridadental.org

Board

clarify that a hygienist who is certified to administer local anesthesia shall not administer local anesthesia to patients sedated by general anesthesia, deep sedation, conscious sedation or pediatric conscious sedation. If a dentist has administered nitrous oxide to the patient, the certified dental hygienist may administer local anesthesia under the direct supervision of the treating dentist. Also, a patient who has been prescribed a medicinal drug by their licensed health care provider for the purposes of life functions may be administered local anesthesia by the certified dental hygienist under direct supervision of the supervising dentist. If the medicinal drug is prescribed or administered for the purpose of a dental procedure, which is intended to induce minimal sedation (anxiolytics), the hygienist may not administer local anesthesia to that patient. The BOD approved this proposed rule.

Next, the FDA submitted language to the BOD to clarify that a dental hygienist with an anesthesia certificate may only administer anesthesia to one patient at a time. The BOD sent this language to the Hygiene Council for further discussion and review. Subsequently, the Hygiene Council adopted a motion to allow a hygienist with an anesthesia certificate to pack and remove a retraction cord that contains vasoactive chemicals. The FDA opposed this proposed rule change and the BOD also rejected it.

Afterward, the Hygiene Council adopted a motion to allow dental hygienists to receive up to three hours of continuing education credit for practice management. The BOD approved this proposed rule. Next, the Hygiene Council adopted a motion to add language to the rule on dental charting that would allow dental hygienists collecting data for epidemiological surveys or oral health surveillance to use the data collection forms without identifying patient information or the name, license number and place of employment of the dental hygienists. The BOD attorney explained that this proposed rule language doesn’t change the requirements under the statute; the hygienist or dentist still must give the consent forms and the result forms to the patient, that are required by statute, whether they are doing charting or screening. The personal information of the hygienist would then be redacted when given to the organization doing the epidemiological survey and surveillance. The FDA asked the BOD also to redact the dentist’s identifying information on the form. The BOD approved this proposed rule, with the amendment requested by the FDA to redact the dentist’s identifying information.

Lastly, there were several other rule changes adopted by the Hygiene Council to align the rules with recent statutory changes. These all were approved by the BOD.

The next BOD meeting is scheduled for Friday, Nov. 21, 2014, at 7:30 a.m. EST at the Bonaventure Resort and Spa in Weston. The BOD proposed meeting dates for 2015 are Feb. 20, May 29, Aug. 21 and Nov. 20.

The BOD also dealt with 13 disciplinary cases and one voluntary relinquishment by a dental radiographer at this meeting. There were several below-standard-of-care cases and a few that dealt with substance abuse. If you have not yet attended a BOD meeting, it is suggested that you take the opportunity to attend and see the work of the BOD. It is much better to be a spectator than a participant in BOD disciplinary cases.

Ms. Stoutamire can be reached at 850.350.7202 or cstoutamire@floridadental.org.

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Visit www.FDAServices.com/CrownSavings for more information about CareCredit.

Letter to the Editor

Letter to the Editor Esteemed Colleagues, At this year’s Florida National Dental Convention (now named the Florida Dental Convention) I was given the greatest professional honor of my life. I was recognized by my peers as the Dentist of the Year.

If you were there, you saw me wearing 24 years’ worth of badges and ribbons from local, state and national meetings I’ve attended. No, I’m not a hoarder and I wasn’t trying to look silly. I wore them so I could tell everyone the reason I saved them.

Every meeting I’ve attended usually required weeks of preparation for legislative issues, background statements and resolutions. I often would look forward to the meeting with some trepidation and anxiety over the workload and time commitment that was required and even wonder why I was doing it. But as the council, Board of Trustees or House of Delegates meetings progressed, I became involved in the process with many other dedicated volunteer members as we debated all sides of an issue and came to a consensus on solutions that affect the Florida Dental Association (FDA), the profession and all of us in our everyday practices. The only mission was to preserve the doctorpatient relationship, serve the public and help make member-dentists successful in their public, professional and personal lives. www.floridadental.org

While driving home after each meeting experience, I would have some time to reflect with building pride on all that we had been able to accomplish. Once I was home, still wearing my badge and eager to get the suit off, I first would hang the badge — much like an earned athletic medal — on a dedicated hook in the corner of my closet as a tribute. Every day I see them there and it reminds me of my pride in our organization.

At one meeting a few years ago, while having cigars and drinks with these same great leaders, it came out that I had saved all my badges over the years. One of our colleagues and my mentor, the late Dr. Dan Burtoch sheepishly admitted he also had saved his. Maybe it was the alcohol, but soon after, a challenge was made that we both should wear all of our badges to see who had the most. The awards luncheon during FNDC seemed to be the perfect place and time to wear them to show my pride and to honor Dan’s challenge. I’m sure he also was wearing his.

While walking around that day, others confessed to me that they had saved many of their badges as well. Even our editor, Dr. John Paul, admitted his goal was to save enough to make a vest with them.

If you are aware of JP’s large frame, the good news is that he will be around for a long time serving for the association.

This lesson taught me that the real reason I saved the badges is that I am proud to be a member of organized dentistry. As you can see, it even says so on all of my badges. Maybe we need not feel embarrassed about that and come out of the

closet and spread the word. Then maybe others will want to be a part of the same movement.

Thank you all for your encouragement and inspiration to be the best representative I can be for the FDA. It has been an honor and a privilege.

Sincerely, Paul Miller, DDS Dr. Paul Miller is a general dentist in New Port Richey. He can be reached at molar01@msn.com.

Editor’s note: Views and conclusions expressed in all editorials, commentaries, columns or articles are those of the authors and not necessarily those of the editors, staff, officials, Board of Trustees or members of the Florida Dental Association. For full editorial policies, see page 2.

All editorials may be edited due to style and space limitations. Letters to the editor must be on 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.

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Balance

Attaining Work-life Balance is Possible

By Dr. Beatriz Terry

“Good morning good citizens of the world, wake up, overachieve and conquer!

I luv ya!”

This is the text message I send every morning at 8 a.m. to my three children, ages 16, 18 and 20. Thanks to my Reminders app, I get a daily message: Send daily encouragement to my kids. What would I do in a world without technology? Forget a lot, that’s what I’d do.

Dealing with my practice and family life has never been easy to balance, but it’s not impossible. I’m constantly making to-do lists and updating my smartphone calendar to avoid missing a dental study club meeting or a parent-teacher conference. Even with all of that, I occasionally miss something or arrive late somewhere, but I don’t beat myself up over it.

Wikipedia defines work-life balance as “a concept including proper prioritizing between work (career and ambition) and lifestyle (health, pleasure, leisure, family and spiritual development/meditation).”

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I define it quite similarly, except I would add that it’s a concept that requires both physical and mental energy. The ability to balance work and lifestyle is not that difficult, but some women believe that it can be. I constantly get friends and colleagues who ask, “How do you manage all that you do? You are like the Energizer™ bunny; you keep going and going …” While I appreciate the compliment, I sometimes think it’s a cop-out to avoid involvement in numerous extracurricular (work or home) activities. For example, I have moms who refuse to participate in dental continuing education because family commitments take up all their time; moms who don’t participate in family events because they are too busy running their dental practice; overweight colleagues who can’t work out or get into shape because their offices and/or families take up all their free time. To them I say, “Really?” How do I, and numerous other women, manage to run successful practices, participate in organized dentistry, hold leadership positions, spend qual-

ity time and vacations with our spouses and children and stay in shape? We do it with sacrifice and commitment in both our personal and professional lives. We organize our work and personal schedule in a way that allows for a lot to get done.

It’s challenging, but not unattainable.

I would be lying if I told you that my “balance” doesn’t become lopsided at times. Even though I love my profession, my family and my “me” time, I sometimes get overwhelmed with everything I’m involved in and realize that moderation is the key to success. When I feel like I’m burning out, I take a step back and slow down. I might pick up the phone and call a female colleague to vent over the issues women-dentists face. It’s a great support group, pick-me-up kind of pep talk that re-energizes me until the next near meltdown.

Dr. Beatriz Terry is a periodontist in Miami. She can be reached at ubetdds@ aol.com.

“

We organize our work and personal schedule in a way that allows for a lot to get done.

It’s challenging but not unattainable.

September/October 2014

”

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Volunteer

Volunteer to Stay Relevant in Our Profession

By Dr. Robin Nguyen

Dentistry is at a crossroad. As a new dentist coming from a previous generation of dentists, I am privy to the changes that are happening, both good and bad. The demand to enter dentistry as a profession has grown tremendously in the last few decades, as apparent by the increase in number of students in each dental class and the increase in number of new dental schools nationwide. One of the main reasons for this shift in demand is the enticing lifestyle balance that the profession brings. It is no wonder that more women are entering dentistry every year. With all the current changes, it is an even more pivotal time for women dentists to get involved.

I agree that being involved in organized dentistry may not be for everyone. I certainly did not aspire to be active in organized dentistry as a dental student, much less hold any sort of leadership role.

The opportunity, for lack of a better word, sort of fell into my lap. My initial volunteer position was as an American Student Dental Association (ASDA) representa-

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tive for my school at the state dental association. I was pretty intimidated, surrounded by so many leaders and staff advocating for dentistry-related issues that I could barely comprehend at that stage in my career. Fortunately, these “volunteer leaders” were not as intimidating as I had envisioned. Instead, they were a great group of people with good intentions and passion to ensure that dentistry will be a great profession for future generations.

These mentors that I have met helped shape me into the person that I am today.

I currently am involved with the Subcouncil on the New Dentist at the Florida Dental Association (FDA). This position enables me to provide constant feedback on issues that affect the new dentists, from licensure to student loan repayment.

Being a woman dentist in private practice also gives me a unique perspective. I see the challenges we face in the workforce, such as work-life balance and maternity leave. As more women dentists enter the workforce, we all will face the same challenges in our career. Our dental association is there to help us succeed in reaching our professional goals, but it also is up to us to steer it in the right direction.

Being involved in organized dentistry has really given me a better understanding of what the association does for our

“

We can choose to ride the wave on the coattails of others deciding how our profession should be, or we can choose to lead the way and shape our own future.

”

Please see VOLUNTEER, 27

September/October 2014

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Check us out!

CMYK / .eps

Facebook “f ” Logo

Florida Dental Association

CMYK / .eps

@FDADental

Volunteer

have far reaching effects on our profession as a whole in the future.

VOLUNTEER from 25

members. Aside from the obvious dental conventions and continuing education courses, our association provides great resources to meet our members’ needs.

More importantly, the intangible value of peer review and advocacy done on our behalf are immeasurable. Some recent advocacy efforts include: legislation on non-covered services, lobbying efforts to help reduce the interest rate on education loans and transparency for Medicaid Recovery Audit Contractor (RAC) audits.

Though some of these issues may not affect everyone at this particular time, they

benefit

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Time is invaluable. We all have our commitments to our practice, our patients and our families, but we all should have commitment to our profession, too.

The landscape of dentistry is changing. We can choose to ride the wave on the coattails of others deciding how our profession should be, or we can choose to lead the way and shape our own future.

We are fortunate to be in the position to still have that choice, but if we don’t take action now, our future will be decided for us. I am a new dentist with student

loans. I have obligations and priorities to my family. I choose to be involved and volunteer my time in organized dentistry because I choose to be relevant. What is your choice?

Dr. Nguyen is an endodontist and practices in Clearwater and Trinity. She can be reached at robinmaianh.nguyen@gmail. com.

Helping Members Succeed Receiving a clear, concise explanation of the terms of a provider contract may help you avoid unpleasant surprises.

The ADA provides a Contract Analysis Service to members free of charge.

This service informs members, in clear language, about the provisions of their contracts so they can make informed decisions about their participation. Send your unsigned third-party contract (i.e., from managed care companies) to the FDA. We will forward it to the ADA for analysis.

FOR MORE INFORMATION 800.877.9922 • fda@floridadental.org www.floridadental.org/contract-analysis

www.floridadental.org

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Maternity

Maternity

Leave

Practice Owners for

Maternity

By Dr. Gina Marcus

The day I found out I was pregnant with my first child, I was overwhelmed with emotions.

Questions like, “Will I be ready?” and “What will I do with my patients and staff?” immediately filled my mind. I spent the next month trying to figure it out, because like most dentists — and especially practice owners — I’m a planner. There was only one problem … no amount of planning could prepare me for the complications I was about to experience.

At 11 weeks pregnant, I was diagnosed with complete placenta previa, a condition in which the placenta lies low in the uterus and completely covers the cervix. I was checked every two weeks for improvements, which never came. Because of this, I didn’t even announce my pregnancy to my team until I was at 16 weeks.

The excitement was immediately followed up with questions: How long will you be out on maternity leave? Will we still get paid? Will my hours be cut? What will we be doing while you are out? What will the schedule look like? Then I thought … maternity leave? Am I even entitled to this? I own my practice; if I’m not here producing, then who will be? Can I afford to have someone fill in?

I needed to have a real plan in place, and I needed to have answers right away. But how do I plan when my pregnancy complications weren’t going away? My doctor immediately scheduled the C-section for 37 weeks. My complications actually helped me focus on creating my materni-

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ty plan. It was pretty simple: my goal was to work until 36 weeks, giving me one week off before the baby, and then return to work three weeks after giving birth.

Total estimated time off: four weeks.

I got lucky — my sister-in-law Dania Melnick, DMD, had recently moved back to Miami and wanted to join me in the practice part-time, as she had two small children of her own. This was a great relief and impeccable timing! She was the perfect addition: someone I already knew, but more importantly, trusted and respected as both a person and dentist.

We discussed that we would cover each other during my current and any future pregnancies, vacations and vice versa. For this pregnancy, we specifically discussed that she would cover me to help the patients with basic needs, such as hygiene checks, Invisalign aligner changes and any emergencies so no one fell behind on recare. The plan also was to complete all crown bridge work by 34 weeks so no one would be in provisionals during my absence.

On the morning of Friday, Feb. 15, 2008, I began hemorrhaging. I was taken via fire rescue to Jackson Memorial Hospital in Miami. En route to the hospital, I made several phone calls. I had an entire day packed with patients, so naturally my first call was to see if Dr. Melnick could cover the patients. She was not scheduled for that day, but thankfully jumped right in without any hesitation.

“

Life is what happens while you are busy making other plans.

– John Lennon

”

I lost a significant amount of blood and my baby had stopped moving. I was hooked up to monitors in the labor and delivery unit as I was in active labor at just 27 weeks. Before I knew it, Benjamin Please see MATERNITY, 32

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Maternity MATERNITY from 31

was delivered by emergency C-section that afternoon.

Benjamin was immediately rushed to the NICU, intubated and hooked up to all types of monitors in the incubator. I was not able to hold my child because of his fragile condition. I reluctantly went home when I was discharged the following Monday. Walking out of the hospital without my baby was never in my plans, but knowing that Benjamin was receiving the best care possible, I tried to get settled with the nurses encouraging me to take care of myself so I could heal from the trauma and the C-section. They would say things like, “Get yourself well so when Benjamin goes home, you can care for him in the way that you want to.” I knew that this was wise. I knew that if I could be strong for Benji, he would somehow know this and follow suit.

Upon my arrival home, I started to think, “My baby was born premature weighing in at less than two lbs. and my plans for the office were scrapped. What am I going to do now?” and “Payroll is on Wednesday, today is Monday, no one was trained to do this!” I quickly made a plan for payroll.

My sister jumped on the first flight to Miami from San Francisco and arrived the day after Benji was born. She stayed with me during my recovery and drove me around where necessary. She drove me to the office that Wednesday to complete payroll. When we left the office we went straight to see Benjamin at the hospital.

When we arrived home from my first outing since being discharged, I was exhausted. Maybe it was delirium, but I started to again make plans for what I was going to do with my practice while Benji www.floridadental.org

was busy fighting for his survival day by day in the NICU. Was I going to close up shop, sell the practice or just take more time off? Another plan was created: I was going back to work as soon as sitting was comfortable enough to work for a few hours at a time.

Total maternity leave thus far: three business days.

I went back to work full time 10 days post-partum C-section. I know, I know — I’m crazy! I didn’t feel that I needed more time off at that point. Instead, I would take some time when Benji was ready to come home and I could better devote my time to him versus now, when he was hooked up to monitors in the NICU. I also knew that if I focused my time on my practice and my patients, I would be distracted from wondering whether or not my child would survive today. And that’s what I did.

Total maternity leave thus far: six business days.

My patient care coordinator scheduled my patients in two-hour blocks, leaving time in between for me to go visit Benji at the hospital, eat, write clinical notes and pump my milk privately in my office. Looking back, I have no idea how I did it. Once I began this routine, I never stopped to think about it.

Thirteen long weeks later, my son was discharged. He was still in a fragile state and required treatment and follow-up with several specialists: nephrologist, neurologist, ophthalmologist, cardiologist and pulmonologist. He was on several medications and had an apnea monitor.

We had to take his blood pressure four times a day, etc. I devoted Thursdays to going to the doctors with Benji so I could

have some semblance of order in my life and at the office. I decided the best thing for my baby was to have him in the office with me so I could check on him as much as I wanted, give him his medications and take him to doctor appointments. I had my son with a nurse in the office with me for the next six months.

Total maternity leave: six business days.

After this whirlwind of a year, I ran the numbers for year-end to determine what effect my “maternity leave” had on the practice. I noted that roughly 20 percent of patients fell behind on recare, which also caused a delay in patient’s seeking and completing restorative treatment.

Working part time for roughly eight months, even with Dr. Melnick building her side of the practice, made a considerable dip in the year-end production and collections. The practice was down 15 percent from the previous year. WHOAH! That was an eye-opener!

Why wasn’t I practicing what I was preaching? I don’t mean getting my teeth cleaned regularly, but a Practice Maintenance and Prevention Plan (PMPP).

I spent hours working on the practice so I could make changes in the practice.

Reinvesting in the practice — to make procedures go smoother, with less stress, more cost effective while maintaining and even improving the level of quality — seemed to be a reasonable beginning to my PMPP. Other changes included iTero to make crown, bridge, implant and Invisalign procedures become more costand time-effective. I hired an additional clinical assistant to manage both doctors’ schedules. As soon as the practice looked busier, it got busier! “If you build it, they will come!” (“Field of Dreams,” 1989) Please see MATERNITY, 34

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Maternity MATERNITY from 33

Fast forward three years to when I started planning for child number two. This time I would have a well-executed plan. I made a list of all the things that didn’t get done the first time and worked through the list (see page 35).

Because of what happened with my first pregnancy, my second pregnancy was automatically labeled high risk. I kept telling myself that despite what had happened last time, this time would be easier.

At the 11-week screening appointment, I was diagnosed with vasa previa, a condition in which blood vessels within the placenta or the umbilical cord are trapped between the fetus and the opening to the birth canal. It’s a rare condition and is more dangerous than complete placenta previa. I was monitored closely and my condition required that a home health care nurse come to the office once a week to give me steroid injections to prevent premature labor. My patients were scheduled around the nurse’s schedule so it didn’t interrupt the daily flow. I had already put my PMPP into place.

At 32 weeks, my water broke. This time, I was prepared and so was my practice.

I delivered my second son, Jordan. As premature as he was, he weighed five pounds and was much further along in his development, especially his lungs. I was told from the beginning, he would only need to stay in the NICU for 14 days. I knew this was my time to heal and get organized.

After only 10 days, Jordan was ready to come home and would be discharged at 11 a.m. That morning, I was at work, with my first patient since having the baby, for an emergency patient who broke a veneer. I quickly called the patient to meet me at the office earlier and was 34

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able to see and treat her successfully, and arrive at the hospital on time for Jordan’s discharge.

Total days maternity leave thus far: six business days.

I was going to do things differently this time. I took two weeks off from the office and hired a night nurse to do the overnight responsibilities so I could go back to work well-rested. With Jordan, I was able to nurse him when I was home and I pumped when I could not be with him.

I went back to work incrementally over a four-week period. My time off only totaled two weeks, but I did take my time coming back to full time.

Total days maternity leave: 16 business days.

When I was asked to write this article about how to prepare a dental practice for maternity leave, I chuckled because I didn’t take as much time off as originally planned, but thought it was certainly important and necessary for practice owners to have a plan.

The importance of a dependable support system from my team, friends and family is paramount. I am so blessed, grateful and appreciative of all of the people in my life, especially my husband Ilan, my sister-in-law Dania, my staff, and those not named who have either helped with the practice or in raising our children so I can achieve my goals while maintaining a healthy balance between my practice, personal and family life. The old adage “It takes a village to raise a child” * could not hold more truth.

Things to plan:

patients to know that you will not be present for their hygiene checks or Invisalign aligner changes, but that you have confidence that the doctor covering for you will assist them with the same level of quality and customer service that they are accustomed to and that their treatment will be uninterrupted. m Order supplies. Determine which items do not need to be ordered and only order necessary items. Get on a schedule for ordering every two to three weeks to avoid excess shipping expenses. Make a list of the necessary and frequently ordered items and look for deals on purchasing larger quantities. Everything else could be ordered less often or until necessary. m Arrange for payroll. Start with a service or bookkeeper before or early on in the pregnancy so this is well-established and any kinks can be ironed out while you are still available. m Plan for the end of pregnancy. Finish up any restorative work minimally two weeks before the scheduled leave time so patients are not in provisionals during your absence. m Determine who will fill in for you.

This doctor can oversee hygiene and Invisalign recare visits and be available for tasks needing direct and indirect supervision so the hygiene department can continue while you are out.

Clearly discuss whether the doctor will continue the restorative treatment plan while you are out or if patients will be scheduled upon your return.

Quote was adapted by Hilary Clinton from an African proverb for her book titled, “It Takes a Village: And Other Lessons Children Teach Us,” published in 1996.

m Prepare the patients. Be up front and honest with them. It is important for www.floridadental.org

Maternity

Treatment and Patient Care Protocols Treatment and patient care protocols must be consistent to your every day practices. Take the time to train the entire team early on and again closer to the time of maternity leave. Review the following points: m How emergency patients will be handled: Create a decision tree that is easy to follow and in a centralized location in the office where everyone can easily access it for reference. m How referrals will be determined: Protocols must be in place for this so the team is clear who your patients will be referred to and why. m New patients: Make a protocol for how the new patient experience will flow. m Training on current and new equipment and caring for the physical plant: This is a good idea to review periodically with the entire team. Along with this, goes training on how to troubleshoot problems and who to call when it cannot be handled by the team. All team members need to know how to turn all equipment on and off every day and where emergency cut-off valves for water are, etc. m Have a cheat sheet: Phone numbers are needed for equipment repairs, hand piece repairs, the computer IT company, X-ray sensor customer service, practice management software customer service, dental laboratories, dental supply company local representatives, phone company, any utility company the office uses, landlord, plumber, parking attendant, building engineer or maintenance personnel and all team members, including doctors. Keep copies in several areas around the practice for easy access. m Who will pay bills: This is where a bookkeeper is extremely valuable. You are entrusting them to access to your bank accounts. I am (like most of you) a control freak, so I chose not to add my bookkeeper as a signer on my accounts, but in a larger practice this may be a necessity and already in place.

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Dr. Marcus enjoying time with her family. From left to right, husband, Dr. Ilan Melnick, Dr. Gina Marcus, and sons Benjamin and Jordan Melnick.

m Who will be responsible for doing the associate’s payroll: If it’s based on a percentage of their collections, this can be a complicated process that must be explained to the bookkeeper to avoid mistakes in calculations while you are out. m Team member issues: Appoint someone who is fair to handle any team member issues that may arise in your absence. A protocol for discipline must be clearly in place and enforced at all times; a comprehensive office manual will make this an easier task. Review office manual and policies before maternity leave. m Coordinators: The patient care coordinator or treatment coordinator will handle any and all patient issues and the billing and/or insurance coordinator will handle any billing issues. Again, take the time to review the office protocols with these individuals so everyone feels comfortable handling these sensitive issues appropriately.

Dr. Marcus is a general dentist and practices in Coral Gables. She can be reached at 305.466.6655 or ginamarcusdmd@gmail.com.

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benefit

Helping Members Succeed

NUMBER

1

Managed-care provider denies Medicaid patient’s surgery: “It’s crazy that the FDA has to get involved in this, ... but thanks to you (FDA lobbyist, Casey Stoutamire), I just completed the child’s surgery — multiple draining abscessed teeth.”

— Afsoon Elmore, DDS

Who Speaks for You? WE DO! 2014 FDA LEGISLATIVE SUCCESSES PROHIBITING UNFAIR CHARGES FOR NON-COVERED SERVICES (SIGNED BY THE GOVERNOR) CS/CS/HB 31 by Rep. Ron Renuart

CS/SB 86 by Sen. Jack Latvala

The FDA passed legislation that stops insurance companies from setting charges for services not covered by dental plans (non-covered services). Some insurance companies were strong-arming dentists to sign contracts and agree to steep discounts on non-covered services. Dentists did not have the option to negotiate and were presented with contracts on a take-it or leave-it basis — potentially resulting in the dentist not being highlighted in the insurance network provider directory as an available provider. If you have questions about a new contract, contact the FDA. We will forward your unsigned contract to the ADA’s contract analysis service on your behalf.

SOVEREIGN IMMUNITY FOR DENTISTS (SIGNED BY THE GOVERNOR) HB 97 by Rep. MaryLynn Magar

CS/SB 142 by Sen. Alan Hays

For many years, dentists volunteering their services in Volunteer Health Care Provider Program (VHCPP) clinics have been paying for their patients’ dental laboratory fees out of their own pockets in order to maintain their sovereign immunity. The FDA passed legislation that would allow a patient, or a parent or guardian of the patient, to voluntarily contribute to the dental laboratory expenses associated with the care of the patient. Under this provision, this contribution would not be considered compensation for the services and thus the shield of sovereign immunity would not be compromised.

DENTAL WORKFORCE SURVEY (PUBLIC RECORDS EXEMPTION) (SIGNED BY THE GOVERNOR) HB 457 by Rep. Gayle Harrell

SB 520 by Sen. Garrett Richter

The FDA passed legislation that provides a public records exemption for the personal identifying information of dentists and dental hygienists taking a voluntary workforce survey (included as a part of licensure renewal). This information now is protected for dentists and dental hygienists, as it is for physicians.

Support the FDA’s advocacy efforts and keep our presence in the legislature strong! RENEW YOUR MEMBERSHIP. Dues statements will be mailed in mid-November — or you may pay online at floridadental.org/dues.

Questions about memberhip? Contact 800.877.9922 or email membership@floridadental.org Questions about legislation or to volunteer?

Contact 800.326.0051 or gao@floridadental.org

Cancer

Public Awareness of Oral and Pharyngeal Cancer: What Can a Dentist Do?

BY HENRIETTA LOGAN, PHD

Over the past several decades, public health researchers have become increasingly alarmed by the patterns in oral and pharyngeal cancer (OPC) incidence and mortality1-5. More and younger Caucasian men are affected; African-American men are dying at twice the rate of Caucasian men; and, the overall survival rate is showing little improvement. These trends have not gone unnoticed in Florida. In 2008, with the support of the Florida Dental Association (FDA), our research group at the University of Florida was awarded a National Institute of Health (NIH) supported Center Grant entitled the Southeast Center for Research to Reduce Disparities in Oral Health (SCRRDOH).

The purpose of the initial funding to SCRRDOH was to study OPC awareness within a geographic region of Florida disproportionately high in incidence and prevalence and with relatively poor survival rates. The region for study was rural northern Florida; more than 2,800 individuals participated in this research.

Our collaboration with the FDA yielded more than 40 publications and several

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more are in process. In a series of brief articles, we will provide an overview of what we found about the current state of OPC. The complete collection of articles is available under the research tab on our website at http://take-the-bite.dental.ufl.edu/.

At the onset, we found two myths about OPC and the public that were common among the public health community and other health professionals: (1) The public is aware and knowledgeable about OPC and its cause, and (2) Overall, the public isn’t concerned about the disease, leading many individuals to make unwise decisions about how to protect themselves from OPC6. Thus, we sought to either confirm or deny the presence of these beliefs within the target communities.

Knowledge about OPC Our first series of studies was aimed at understanding what the public knew about OPC. In a telephone survey of 2,393 individuals residing in rural north Florida, we found that only 12 percent endorsed knowing “a lot” about OPC even though 91 percent had heard of OPC7. Higher education levels and health literacy were related to more OPC knowledge. Among women, Caucasians had more knowledge than AfricanAmericans (OR = 1.9). Among African-American participants, men had more knowledge than females (OR = 1.7). Knowledge that excessive sun exposure is a risk factor for OPC was lower among this sample than for earlier studies using urban samples.

Greater concern about OPC was associated with lower education levels, lower health literacy and lower financial status. An unanticipated finding was that those who selfreport as African-American were more concerned about OPC than their Caucasian rural counterparts. Overall, we found that rural adults are increasingly aware of OPC, but actual knowledge about the disease, including signs, symptoms and risk factors, is low. It is of note that other investigators have reported rural residents are less likely to use sun protection, making the association between sun exposure and lip cancer a relevant topic for patient counseling8, 9. Our findings were corroborated in a 2014 report from a national survey10. In that study, Luryi and colleagues reported that awareness of OPC may be increasing but knowledge of specific risk factors including sun exposure and human papillomavirus (HPV) is low. In their study, few people correctly identified symptoms of red or white sores that do not heal, sore throats, swelling or lumps as related to OPC.

Awareness of and Receipt of OPC Examinations We then expanded our survey to examine the knowledge about and prevalence of OPC screenings among our cohort in rural north Florida11. Awareness of OPC visual and www.floridadental.org

Anal

Local thetic

lgesics

l anescs

Cancer tactile examinations (46 percent) and lifetime receipt (46 percent) were higher in this study than reported in earlier statewide studies12. Anticipated racial/ethnic differences in knowledge of the existence of OPC examinations were diminished when adjusted for levels of health literacy and socioeconomic status. That is, those with low levels of health literacy and of low education and low income were least likely to know about OPC examinations, regardless of race or ethnicity. This pattern was not seen with the actual receipt of the examination.

We used two strategies to obtain information about receipt of OPC examinations. First, we asked the question, Have you ever had an OPC examination? Then we described the examination. Only 19 percent of the respondents were aware of their examination, whereas an additional 27 percent reported having the examination when a description was provided, suggesting a lack of communication between many caregivers and rural patients6. The main predictors of those having had an OPC examination in their life was: being older, Caucasian, better educated and having a dentist of record. For those who had had an OPC examination in the past year, the main predictors were: being Caucasian, having a higher education and having a dentist of record. When AfricanAmericans did receive an OPC examination, it was more likely to be in a non-dental setting, such as a public health medical clinic. We also found that our participants were unsure if dentists performed OPC examinations13. The majority of respondents stated that no one had ever suggested they have an oral cancer exam. Some respondents stated they thought their dentist or dental hygienist might have performed the OPC examination, but most were unsure if they had received such an examination. As one woman said, “I’m not sure; I’ve had dental work done, and you know they never tell me.” One man stated, “This is my first time hearing about it,” and others echoed this statement. These themes were present in all focus groups. When asked if they had any idea what an oral cancer exam would be like, respondents discussed a number of ideas but ultimately the resounding response to this line of inquiry was, “I don’t know.” The take-home message from this research is that many more people have heard of OPC examinations than have had them. In addition, limited access to dentists may be holding back earlier detection of OPC, as we found a main predictor of receiving an OPC examination is having a dentist of record.

Digging Deeper: Barriers to Getting an OPC Examination Using focus group methodology, our group attempted to dig deeper into the barriers to getting an OPC examination experienced by our cohort in rural north Florida. Again we found that among low income minority participants, the foremost barrier to getting an oral cancer screening was the lack of knowledge about OPC and about the symptoms of OPC. Additional barriers included fear and lack of resources to pay for the examination14. An unanticipated barrier was the participants’ belief that if OPC were important, there would be a lot more conversation about it from important people in their lives, such as doctors or family members.

“

Dentists can offer hope that through early detection, the outcomes for those diagnosed with OPC are more positive than for those who delay examinations.

”

In a later survey of a larger group of participants15, we found that low knowledge, lack of resources and fear of hearing negative results emerged as barriers to OPC screening, Please see AWARENESS, 41

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One million reasons to call FDA Services

800.877.7597

Dr. Paul Palo, FDAS treasurer (left) and Scott Ruthstrom, FDAS Chief Operating Officer (right) present Dr. Terry Buckenheimer, FDA president, with a check for $1,014,770 at the annual convention in June. Revenue generated from FDAS insurance sales goes directly toward helping fund FDA programs and lobbying efforts that are important to members, and to keep member dues at their lowest possible level.

Cancer AWARENESS from 39

with the latter two barriers being the most dominant predictors. Of note, participants also reported that a recommendation from their provider (dentist or physician) was most likely to increase their intentions to get an OPC screening, whereas encountering financial barriers was most likely to decrease their intentions to get an OPC screening15.

The Myths Our overall findings substantially “bust” the two most common myths. We found that: (1) the public knows very little about OPC, either generally or specifically about signs and symptoms of OPC; and, (2) the actions taken by most members of the public are based on the notion that if the disease were important, dentists or doctors would have talked to them about it. For those members of the public who do have knowledge about OPC and its risk factors, the concern is high and the desire for a cancer screening is present, especially for individuals self-identifying as African-American. For those individuals with low discretionary resources to manage the threat of OPC, the tendency may be to avoid learning potentially-threatening information about the disease16.

Dentists should be aware that people who deny being concerned about OPC may in reality be very concerned and would respond positively to hearing about and receiving an OPC examination.

Take-Home Message The take-home message from this research is that the dentist and his or her staff need to inform patients and the public about the signs and symptoms and provide current knowledge of the etiology of OPC. Dentists can offer hope that through early detection, the outcomes for those diagnosed with OPC are more positive than for those who delay examinations.

Colleagues, please create a buzz in your community that makes OPC germane to patients, other health care workers and those in the community who do not routinely see a dentist. It matters!

In upcoming issues of Today’s FDA, Dr. Henrietta Logan will provide current data on trends in the incidence of oral and pharyngeal cancer. Results will show a dramatic increase in incidence for pharyngeal cancer among Caucasian men between the ages of 45-64, which is accompanied by an increasing percentage of late-stage diagnosis of those tumors. Similarities and differences by geographic regions of Florida (north, central and south) also will be discussed.

The final article in the series examines survival from oral and pharyngeal cancer and finds significantly different patterns by geographic regions. Implications for the dentist in practice will be discussed.

Materials for patients and health professionals on oral and pharyngeal cancer can be found by clicking the resources tab on our website: [http://take-the-bite.dental.ufl.edu/].

www.floridadental.org

This work was funded by a grant from the National Institute of Dental and Craniofacial Research (1U54DEO19261) with additional financial support by the Department of Community Dentistry and Behavioral Science at the University of Florida.

Dr. Logan is a professor emeritus at the University of Florida College of Dentistry Department of Behavioral Science and Community Dentistry. She can be reached at 352.273.5965 or HLOGAN@dental.ufl. edu.

References 1. Gayar OH, Ruterbusch JJ, Elshaikh M, et al. Oropharyngeal Carcinoma in Young Adults An Alarming National Trend. Otolaryngology-Head and Neck Surgery 2014;150(4):594-601.

2. Goodwin WJ, Thomas GR, Parker DF, et al. Unequal burden of head and neck cancer in the United States. Head Neck 2008;30(3):358-71.

3. Jemal A, Siegel R, Ward E, et al. Cancer statistics, 2007.

CA Cancer J Clin 2007;57(1):43-66.

4. Shiboski CH, Schmidt BL, Jordan RC. Racial disparity in stage at diagnosis and survival among adults with oral cancer in the US. Community Dent Oral Epidemiol 2007;35(3):233-40.

5. Silverman S. Demographics and occurrence of oral and pharyngeal cancers - The outcomes, the trends, the challenge. J Am Dent Assoc 2001;132:7S-11S. 6. Choi Y, Dodd V, Watson J, et al. Perspectives of African Americans and dentists concerning dentist-patient communication on oral cancer screening. Patient Educ Couns 2008;71(1):41-51.

7. Riley JL, Pomery EA, Dodd VJ, et al. Disparities in Knowledge of Mouth or Throat Cancer Among Rural Floridians. J Rural Health 2013;29(3):294-303.

8. Kearney GD, Lea CS, Balanay J, et al. Assessment of sun safety behavior among farmers attending a regional farm show in North Carolina. J Agromedicine 2013;18(1):65-73.

9. Blair A, Zahm SH, Pearce NE, Heineman EF, Fraumeni JF Jr. Clues to cancer etiology from studies of farmers.

Scand J Work Environ Health 1992;18(4):209-15.

10. Luryi AL, Yarbrough WG, Niccolai LM, et al. Public Awareness of Head and Neck Cancers: A Cross-Sectional Survey. JAMA Otolaryngol Head Neck Surg 2014.

11. Riley JL, 3rd, Dodd VJ, Muller KE, Guo Y, Logan HL. Psychosocial factors associated with mouth and throat cancer examinations in rural Florida. Am J Public Health 2012;102(2):e7-14.

12. Tomar SL, Logan HL. Florida adults’ oral cancer knowledge and examination experiences. J Public Health Dent 2005;65(4):221-30.

13. Dodd VJ, Watson JM, Choi Y, Tomar SL, Logan HL. Oral cancer in African Americans: addressing health disparities. Am J Health Behav 2008;32(6):684-92.

14. Howell JL, Shepperd JA, Logan HL. Barriers to oral cancer screening: A focus group study of rural Black American adults. Psychooncology 2013;22(6):1306-11.

15. Shepperd JA, Howell JL, Logan H. A survey of barriers to screening for oral cancer among rural Black Americans.

Psychooncology 2014;23(3):276-82.

16. Howell JL, Crosier BS, Shepperd JA. Does lacking threat-management resources increase information avoidance? A multi-sample, multi-method investigation. Journal of Research in Personality 2014;50:102-09.

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Maintaining

Maintaing

Your

Dental Practice While Recovering

from Cancer

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Maintaining

By Cindy C. Moore, DMD, PA

I’ve been practicing general dentistry in Panama City since I graduated from the University of Florida College of Dentistry in 1980. I’ve been in solo practice for the majority of the past 34 years, with the exception of taking on a temporary dentist associate prior to and after having my two children. The pregnancies allowed me to plan for being away from the practice with nine months of notice! As many dentist-moms do, I prepaid some expenses and planned savings to cover later expenses, so being out wasn’t disastrous to my business. One of the benefits of having an associate or group practice is that we can cover each other in times of need.

These times of need usually come in the form of health issues and generally are the only times a solo practitioner needs help to keep patients properly treated and business steady (in order to pay staff and other constant expenses). For women dentists, childbirth is typically the main time to get another practitioner involved. However, for both male and female dentists, having unexpected health issues that last longer than a few weeks changes the needs and “plans” and often the outcome. Extensive health problems, such as heart attack, surgery or cancer, require more time off for recovery.

In these cases, it is ideal if there is an agreement already established between groups of dentists to “cover” for each other. They can do this by volunteering to take emergencies for the practice, or by covering a day or two a week so the regular patients are cared for and hygienists can continue to routinely see patients. Many dentists take a day or two off a week and can use that time to help out a colleague. I was blessed to be able to cover another dentist’s practice while he was out of town to plan his cancer surgery and therapy. I later took on his patient emergencies while he was out for the actual surgery and recovery. Without this kind of help, when the therapy takes weeks or months of time, practices could be lost. I have seen this type of goodwill from dentists in our Northwest District Dental Association (NWDDA) many times over the years, and experienced it firsthand in 1998.

Please see MAINTAINING, 47

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Maintaining

MAINTAINING from 45

In my particular case, after 18 years’ of practice, I was diagnosed with breast cancer. I took a week off to have diagnostic tests, a biopsy and oncology consults. A few weeks later, a second surgery followed for a lumpectomy as well as lymph node removal for evaluation. Thankfully, the cancer was fully removed and the nodes were clear. I chose to have chemotherapy on Friday mornings every three weeks for six infusions. I rested through Monday, and worked Tuesday through Friday (except for the infusion Fridays).

Radiation therapy followed, which consisted of 33 treatments over 50 days, Monday through Friday. I continued to work during this period and arranged to have the radiation treatment at 8:30 a.m. Afterward, I went home to sleep until noon (due to cumulative effects of therapy), and then worked from 1-5 p.m. My patient time was reduced during this seven-month period, but not to an extreme. I was able to survive the disease and keep my practice. I had a wonderful group of specialists who took on emergencies in their areas of expertise and a few general practitioners who also saw patients during my reduced schedule. Patients were very understanding and worked with my staff to keep me busy when I could work. They put off non-critical treatment until I could better take care of their needs.

I was well for seven years, but in 2005 the cancer returned. This time, in addition to the chemotherapy I had a more extensive measure taken: a double mastectomy. At an older age, the chemotherapy took a bigger toll on me. I had six infusions (every three weeks) on Fridays, but found I had to take an extra day off each time to regain strength. By the last infusion, I needed a week off. Afterward, I was blessed to be able to work three to three and a half days a week. Again, I had a team of specialists and general dentists to help as needed, this time for a longer duration. Prior to reconstruction, I needed to heal for a year due to the previous radiation. The recovery time from this surgery resulted in being out for a month.

A positive takeaway from my experience is that I’ve been able to help many patients who are facing breast cancer — or other cancers — to understand the process and to have someone to talk to that “has been there.” I think that being able to relate to someone you trust, such as your dentist, can be a powerful reassurance during difficult times. It helps to humanize you and patients can see that you connect with them on the same level. This has been a bonus for me these last nine years.

I have been blessed to survive cancer twice and to be able to thrive in my practice despite the difficulties. If it weren’t for my colleagues, the outcome might have been different. I hope that you never have to face any health issues, but I urge you to establish a reciprocal agreement with a few of your colleagues should you ever need help.

“

I’ve been able to help many patients who are facing breast cancer — or other cancers — to understand the process and to have someone to talk to that ‘has been there.’

”

Dr. Moore is a general dentist and practices in Panama City. She can be reached at 850.215.1353 or drdenccm@knology.net.

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Diagnostic

Diagnostic Discussion

By Drs. Nadim Islam and Indranell Bhqattacharyya

A 77-year-old male presented to Dr. Rui Fernandes at the University of Florida College of Dentistry (UFCD) Oral and Maxillofacial Surgery Department in Jacksonville, Fla. for evaluation of bilateral/diffuse tongue masses. He presented with an enlarged tongue lesion on the right and left lateral borders of the tongue (Fig. 1-A) and several erythematous macular lesions on the scalp (Fig. 1-B). No biopsy was previously performed, and the patient said none of the oral health care providers he visited had mentioned anything about this tongue lesion. The patient complained about pain and tenderness of the left and right side of the tongue. The obvious observation was of trauma. However, on examination Dr. Fernandes noted a uniform enlargement of most areas of the tongue with significant crenated areas due to the closure pressure from the patient’s dentition. Also seen were whitish plaque-like areas, especially around a large concavity on the left lateral border of the tongue. The clinician decided to perform two biopsies, one each from the anterior and posterior aspect of the tongue.

The tissue was submitted by Dr. Fernandes to the UFCD Oral and Maxillofacial Pathology Biopsy Service. The biopsy showed superficial parakeratinized stratified squamous epithelium and subjacent well-vascularized, hyalinized connective tissue. The most conspicuous aspect of the specimen was the presence of several foci of large aggregates of eosinophilic, amorphous material within the superficial and deeper connective tissues especially infiltrating skeletal muscle bundles and noted around neurovascular bundles as well (Fig. 2, marked with arrows).

Figs. 1A, 1B, 1C

Fig. 2

Question: Based on the clinical presentation/images and microscopic findings, what is the most likely cause for the macroglaossia (tongue enlargement)?

A. Edentulism-related Muscular Hypertrophy B. Vascular Malformation/Lymphangioma C. Myxedema of Hypothyroidism D. Angioedema E. Amyloidosis

Please see QUIZ, 50

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Fig. 3

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Diagnostic DISCUSSION from 49

Diagnostic Discussion A. Edentulism-related Muscular Hypertrophy Incorrect. This is the most common cause of acquired macroglossia. However, it is almost never this extensive and painful. It also usually is self-limiting and not so progressive. The surface of the tongue is usually more normal appearing although the tongue may be considerably enlarged. The obvious thing here is that the patient is dentate.

B. Vascular Malformation/Lymphangioma Incorrect. Intra-oral vascular malformation (VM) occurs most frequently on the tongue, lips and buccal mucosa. Unlike hemangiomas, they are not proliferations of endothelial cells but are made up of dilated vascular channels. They can contain any type of vessel from capillaries to lymph channels to arteries and veins. They are usually darker in color than hemangiomas — appearing bluer, dark red or black. They can appear as pigmented macules or as nodular growths. Interestingly, they all may not appear pigmented. These lesions, unlike hemangiomas, often persist into adulthood and grow at the same rate as the patient (i.e., no growth spurt is noted). Because they are sometimes poorly circumscribed, may involve bone and/or contain large arteries or A-V shunts, these lesions frequently recur and can cause life-threatening hemorrhage. They have a predilection for young females, so any pigmented soft tissue or vascular bone lesion in this group should be viewed with suspicion. For boney lesions, it’s always important to aspirate before attempting surgery. Vascular malformations that contain lymphatics also are notoriously difficult to treat and often require multiple surgeries for complete removal. Besides color, the best way to identify a soft tissue vascular lesion is to compress the lesion with a glass slide or test tube (diascopy). Most vascular lesions in the oral cavity, especially those seen in adults, actually represent vascular malformations.

Lymphangiomas, on the other hand, are usually congenital malformations or present in childhood. This is one of the most common causes of macroglossia (congenital). They frequently swell, especially if traumatized or infected, and often respond to antibiotic therapy. However, most importantly, these lesions are usually associated with tremendous papillary/vesicular (bubbly and clear) or hemorrhagic overgrowths of the surface mucosa and are rarely discovered in the elderly.

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C. Myxedema of Hypothyroidism Incorrect. This often causes significant enlargement of the tongue with exophytic masses, and these may be painful as they rub along the teeth/denture. Though rare, this is an established cause of acquired macroglossia. However, myxedema almost always is associated with systemic findings such as a slowing of physical and mental activity and cold intolerance. Hair changes also are frequently noted. The histologic features include accumulation of ground substance (glycosamininoglycans) and resultant tissue edema. This patient showed no signs of hypothyroidism and the histologic features were not that of excess tissue fluid or edema.

D. Angioedema Incorrect. This entity has been associated with acquired macroglossia but is always of acute onset and short duration (one to two days) unlike the present case. It has been reported in association with drug use and occurs shortly after ingestion of the offending drug or certain foods. Angioedema appears as a soft diffuse swelling of the lips, periorbital region or face. It only occasionally involves the tongue and never for a protracted period of time. Minor trauma or heredity can also play a role in its etiology.

E. Amyloidosis Correct! Amyloidosis represents a heterogeneous group of conditions characterized by the deposition of an extracellular proteinaceous material called amyloid. This deposition may be associated with diseases such as multiple myeloma, rheumatoid arthritis or chronic infections including tuberculosis. Amyloidosis may be of two types. Organ-limited amyloidosis has rarely been reported in the oral soft tissues. The second type is systemic amyloidosis, which may be in several forms, such as primary (myeloma-associated), secondary (hemodialysis-associated) and heredofamilial. The primary and myeloma-associated forms of amyloidosis usually affect older adults (average age 65 years), like our 77-year-old patient. The initial signs and symptoms may be nonspecific. Eventually mucocutaneous lesions and macroglossia develop as a result of the deposition of the amyloid protein. Fatigue, weight loss paresthesia, hoarseness of voice, edema and so forth may be the first indications of the disease. Except for the edema, most of the above were absent in the present case.

If present, skin lesions appear as smooth-surfaced, firm, waxy papules and plaques. Macroglossia has been reported in 12-40 percent of these patients and presents as diffuse or nodular enlargement of the tongue just as noted here. Sometimes oral amyloid nodules show ulceration and submucosal hemorrhage

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Diagnostic overlying the lesions. Biopsy of the rectal mucosa gingiva and labial salivary gland can be used to confirm the diagnosis. The clinical features — massive nodular and diffuse enlargement of the tongue with continued growth for no apparent reason — noted in cases with a history of renal dialysis would be supportive of a hemodialysis-associated amyloidosis.

The histologic finding of a hyalinized (pink), well-vascularized connective tissue mass is compatible with amyloid deposits, which almost always appear as pink nodules on routine staining. The pink material in our sections was confirmed as amyloid with a Congo red stain, which is specific for amyloid. Amyloid is a distinctive, pathologic proteinaceous substance deposited intercellularly in localized areas (in single organ or tissue) or systemically in various tissues and organs. All types of amyloid stain a distinctive pink to red color with the Congo/red stain due to its distinctive physical structure composed for non-branching fibrils in a ß-pleated sheet configuration. Under polarized light, it exhibits the classic “apple-green” birefringence (Fig. 3) as was noted in our sections, thereby confirming the diagnosis. The patient was diagnosed with multiple myeloma and is presently undergoing chemotherapy. The latest clinical presentation is seen in Fig. 1-C as provided by Dr. Fernandes just before the article went to print. We are thankful to him for sharing this interesting case.

Sadek I, Mauermann ML, Hayman SR, et al. Primary systemic amyloidosis presenting with asymmetric multiple mononeuropathies. J Clin Oncol 2010; 28(25): e429–32.

Do Amaral B, Coelho T, Sousa A, et al. Usefulness of labial salivary gland biopsyin familial amyloid polyneuropathy Portuguese type. Amyloid 2009; 16: 232–8.

Reinish EI, Raviv M, Srolovitz H, Gornitsky M. Tongue, primary amyloidosis, and multiple myeloma. Oral Surg Oral Med Oral Pathol. 1994 Feb; 77(2):121-5.

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

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

Dr. Islam

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

References: Van Munster BC, Baas MC. A 77-year-old female with macroglossia.

Neth J Med. 2011 Mar; 69(3):136, 140.

Serdar A, Basak D, Sercan G, et al. Solitary amyloid tumor of the tongue base. Int J Otolaryngol 2009; 2009: 515068.

Elad S, Czerninski R, Fischman S, et al. Exceptional oral manifestations of amyloid light chain protein (AL) systemic amyloidosis. Amyloid 2010; 17:27–31.

Dr. Cohen

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Health Care

Women’s Health Care Benefits Change Under the Affordable Care Act

By Carrie Millar, MBA, CAE FDA SERVICES AGENCY MANAGER

This is a general overview of the health care reform law as it relates to the small business dental practice market. It does NOT attempt to cover the law’s provisions and should not be used as legal advice for implementation activities. It reflects the current benefit coverage under the Affordable Care Act (ACA) as this article goes to print, but is subject to change.

When the Affordable Care Act (ACA) was signed into law in 2011, it brought about many provisions that specifically affect women’s health care benefits. These include additional preventive and wellness services at zero co-pays, mandatory maternity benefits and a new premium rating structure.

About FDA Services Inc. FDA Services (FDAS) is the wholly owned, for-profit insurance agency of the Florida Dental Association. FDAS is a full-service insurance agency and takes pride in managing the insurance portfolios of each and every client. Last year alone, FDAS contributed more than $1,000,000 to the FDA to help reduce membership dues.

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Preventive and Wellness Services Starting Aug. 1, 2012, all non-grandfathered health insurance plans at renewal must include additional women’s preventive and wellness services with no cost sharing to the patient. These include well-woman visits, breast feeding support (which normally means an electronic breast pump at no co-pay) and HPV screening. The full list is in table 1. It should be noted that recently the Supreme Court overturned the requirement to provide contraception for certain employers based on religious beliefs, but in general does not impact small employer group plans or individual health insurance.

Maternity As of January 2014, all ACA-compatible health insurance plans are required to cover 10 Essential Health Benefit categories (EHBs); this includes maternity coverage. This means that all nongrandfathered plans, starting Jan. 1, must include maternity benefits at the benchmark level of benefits set by each state.

In the past, maternity coverage was very hard to find on the individual health insurance market and the benefits were minimal. Only group health insurance was a viable option and plans could be very expensive. Now maternity is automatically included on all ACA-compatible plans.

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

Joe Dukes Director of Sales Northeast & Northwest 850.350.7154 Cell: 850.766.9303 joe.dukes@fdaservices.com

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

New Rating Structure Another change to women’s health insurance under the ACA is the inability to charge a different price based on gender.

All ACA-compatible plans are only allowed to use geographic location, age (no more than three times the youngest to oldest) and tobacco use as rating factors.

This has lead to a significant premium decrease for females under 40, but we have seen rates increasing for females over 50.

Ms. Millar can be reached at 850.350.7155 or carrie.millar@fdaservices.com. www.floridadental.org

Health Care

Table 1

Type of Preventive Service

HHS Guideline for Health Insurance Coverage

Frequency

well-woman visits

well-woman preventive care visit annually for adult women to obtain the recommended preventive services that are age and developmentally appropriate, including preconception care and many services necessary for prenatal care. This well-woman visit should, where appropriate, include other preventive services listed in this set of guidelines, as well as others referenced in section 2713

screening for gestational diabetes

screening for gestational diabetes in pregnant women between 24 and 28 weeks of gestation and at the first prenatal visit for pregnant women identified to be at high risk for diabetes

human papillomavirus testing (HPV)

high-risk human papillomavirus DNA testing in women with normal cytology results

screening should begin at 30 years of age and should occur no more frequently than every three years

counseling for sexually transmitted infections

counseling on sexually transmitted infections for all sexually active women

annually

counseling and screening for human virus/immunodeficiency (HIV)

counseling and screening for HIV for all sexually active women

annually

contraceptive methods and counseling

all Food and Drug Administration approved contraceptive methods, sterilization procedures, and patient education and counseling for all women with reproductive capacity

as prescribed

breastfeeding support, supplies, and counseling

comprehensive lactation support and counseling by a trained provider during pregnancy and/ or in the postpartum period, and costs for renting breastfeeding equipment

in conjunction with each birth

screening and counseling for interpersonal and domestic violence

screening and counseling for interpersonal and domestic violence

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annually, although HHS recognizes that several visits may be needed to obtain all necessary recommended preventive services, depending on a woman’s health status, health needs, and other risk factors.

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GET TO KNOW DAN ZOTTOLI Having grown up in South Florida, Dan moved back to his hometown following his graduation from Florida State University in December 2005.

Armed with a degree in Risk Management/Insurance from one of the most prestigious programs in the United States, Dan has been assisting members of the Florida Dental Association in the Atlantic Coast District since January 2006.

Dan came to FDA Services with an extensive insurance background.

He has been licensed since he was 18 years old and has worked in the financial services sector since then, even while attending school full time.

With more than 10 years of insurance experience, Dan is well-versed in all lines of insurance coverage and is often able to help his clients save on their annual premiums.

Dan is married with one child and resides in Royal Palm Beach. In his spare time, he enjoys spending time with his family and friends and playing ice hockey.

DAN ZOTTOLI DIRECTOR OF SALES ATLANTIC COAST 561.791.7744 • Cell: 561.601.5363 dan.zottoli@fdaservices.com

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Dental Staff

Excuse Me,

I’m

Talking

Here!

Dental Staff

By Jen Butler, MEd, PhD, BCC

Obviously when you’ve been doing something like talking for as long as you have, of course you’ve got to be good at it. It’s a no brainer. It’s talking. You do it every day, with hundreds of people. You can probably talk a person’s ear off.

Reality check: There is a significant difference between talking and communicating. Just because you know how to do something, doesn’t mean you do it effectively. Talking takes little effort, has few boundaries and no pretense. Communication comes with intention, has definable standards and makes all the difference in any relationship.

Hygienists think they communicate every day and yet when asked, “What is the most challenging thing about dentistry?” many of them say, “Team communication!” Communication is a complex and delicate process. To say one communicates with others and then still complains about the level of miscommunication says something about the kind of communication occurring and its effectiveness. Also, when a dental team is dysfunctional, it’s often due to the level of acceptable communication between team members.

Don’t fall into the trap of settling for less than optimal communication. There are ways to learn communication techniques around common issues that better the team, improve patient care and make the work environment pleasurable for everyone.

How Does Communication with the Doctor Work in Different Offices?

Working in a variety of offices requires a registered dental hygienist (RDH) to be highly versatile in his or her communication styles. Some doctors are direct and assertive, others passive and introspective, and still others are quiet and noncommunicative.

An RDH has to be able to navigate through a multitude of conversations with their clinical partner in order to offer comprehensive and exceptional patient care. It’s not always easy, but it is always necessary.

To be versatile in communication, do the following: n Be mindful of body language. Crossed arms, looking away, pace of speech and tone of voice offer some insight as to the intention and meaning of a message.

Don’t only rely on that. Read on … n Ask questions first. Misunderstandings and miscommunication happen when people assume they know what someone’s intentions are and refrain from asking follow-up questions. If you want to know what someone means by their remarks, body language or tone, ask. So not to offend, start your questions with, “I’m curious ...” or “What do you mean by ...” n Don’t be offended by “why.” Doctors ask themselves “why” all day long. It’s their go-to tool for problem solving. It’s no wonder when they ask “why” questions of their team. The word “why” as a question requires a person to justify. For

example, “Why did you think that patient needed scaling and root planning (SRP)?”

Or, “Why did you tell the front desk to put that patient on your schedule?” Even in the sweetest and softest of tones, the message puts the listener on the defensive. With most doctors being analytical thinkers, when they ask “why,” it’s more about problem solving and seeking to understand than wanting to offend.

How Do You Deal with Passive-aggressive Co-workers?

People that rely on passive-aggressive communication do so because they don’t know any better. They may have formed habits of how to speak to others from early in their childhood. So rest assured, it has nothing to do with you. This doesn’t always make it easy to talk with someone that is passive-aggressive, so keep the following in mind: n Stay calm. Passive-aggressiveness comes from fear. Fear of conflict, fear of not being liked, fear of change, challenge, showing weakness, and on and on.

Considering the person you are dealing with is fearful, it’s important not to overreact as it perpetuates the behavior. Stay calm and before you respond, take a deep breath, tell yourself to relax and think about what you want out of the conversation. n Stick to facts. Focus on facts, not feelings. Facts include all of those elements of a situation that are trackable, observable and measurable. Even though your feelings are important, they are not always relevant.

Please see STAFF, 60

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Dental Staff

“

Don’t fall into the trap of settling for less than optimal communication. There are ways to learn communication techniques around common issues that better the team, improve patient care and make the work environment pleasurable for everyone.

STAFF from 59

n Resist temptation. If a co-worker jumped off a bridge would you follow them? The sounds of all our moms’ voices are ringing in our heads. Resist temptation to mirror poor communication habits. Instead, smile, show empathy, ask questions and state what you want and what you don’t. It sounds like this: “Co-worker, I want us to figure out a way to take our lunches while covering the phones. I don’t want to upset you or disrupt the entire schedule.”

How Do You Deal with Gossip?

Gossip is a bad habit that can be highly destructive to dental teams. Through

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”

gossip, teams become fractured, people are singled out and ultimately, communication breaks down. In a dental office, every team member has an important and specific role. When one feels out of place, there is much more lost than relationships. It comes directly down to patient care. n Refuse to be drawn in. If a team member begins to gossip, immediately excuse yourself from the situation. Even listening to the gossip validates the person’s behavior. n Confront the gossiper. Often people don’t realize what they are doing is gossip, so it’s important to let them know.

It can sound as easy as, “Co-worker, did

you know that when you talk like that it sounds gossipy?” Or try, “Co­-worker, I’m sure you wouldn’t like it if X talked about you like that. Let’s change the subject.” n Deal with the issue, not the person.

If the bad habit continues, it must be addressed. Gossip harms more teams than anything else. When you approach your co-worker, be sure to make it about the behavior and not about the person.

Say, “Co-worker, today when you talked about X, it made me [insert emotion or thought]. In order for our team to function at its best, it’s important we address issues up front. How can you talk to X directly?”

How Do You Approach the Doctor with a Concern?

There are going to be issues that come up between the hygienist and doctor. That’s normal for two people working together.

What’s imperative is that the concern doesn’t turn into something greater, like a problem or rift. Address it early so you can keep it small and manageable. n Think it through. There are several questions that are important to think through before you approach the doctor with concerns. Some are: Why is this a concern? Why bring it up now? What do you want to happen? What don’t you want to happen? How does this relate to the dental practice team or the patients?

Set parameters. The most productive conversations are ones with parameters. For example, set time limits on the length of the conversation. What happens if you get

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Dental Staff

off track or interrupted? If all parties felt great after having the conversation, what would be addressed or satisfied, and what does the follow-up look like? n Resolve one at a time. Dumping everything out onto the table makes it difficult to focus and problem solve because the sheer mass of emotions attached to each concern often is too much to manage.

Keep everything focused by discussing and finding solutions to one concern at a time.

How Do You Settle a Conflict?

When people work together, there is going to be conflict. And as some would be surprised, conflict is extremely healthy in any kind of relationship. Our relationships actually deepen as a result of conflict, if handled correctly. n Name the problem. Consider this: What we often think is the problem is actually not. The problem is typically a bit deeper. When you fix the right problem, everything else falls away. n Acknowledge personal contributions.

Conflict occurs between two or more people, which means that somehow, you are part of the issue. Before approaching someone to settle any conflict, be sure you know what role you’ve played, what you need to change and possibly what you might need to apologize for.

without outcomes really is just a gripefest and a waste of energy.

How Do You Work with a Friend?

One of the best things about a dental office is the kind of people that work there. It’s no wonder team members often start out friendly and turn into friends.

As great as it can be to work with people you’re close to, there are cautionary lines to remember. n Set boundaries. Clear, defined and unconditional boundaries are necessary for friends to work well together. For example: what to do Monday morning if a weekend spat occurs, don’t show favoritism (what you do for your friend you do for all your teammates), etc. n Hang with others. When at work, associate with other co­workers more than each other. It builds overall team bonds, shows others you are committed to the team as a whole and gives you the necessary break every friendship needs to be successful. n Stay professional. How you act, treat, communicate and partner with other teammates is the same consideration you show your friend. Under no circumstances should any personal interactions happen that wouldn’t happen with everyone. If professional lines are crossed, it’s time to go back to the first point and set boundaries.

How Do You Work with Someone You Don’t Like?

It’s normal to have varying levels of like and dislike with the people you work with. How you manage it and work together in spite of it is the key. n Know why. When you know why, you can do something about it. Not doing something about it isn’t an option. n Consider the whole person. Every person has something that isn’t a likable element of their character. Every person.

To not like someone based on a select few traits is highly judgmental and narrowedminded. Dental teams are most successful when they can articulate everyone’s strengths and navigate everyone’s weaknesses. n Move on. If there is someone who really pushes your buttons, find a way to get over it. It’s not for you to fix them or help them change. You not liking them is your issue, not theirs.

Reprinted with permission of Dentaltown Magazine, Dentaltown.com and author, Jen Butler.

Jen Butler, MEd, PhD, BCC has been working in the area of stress management and resiliency coaching for more than 20 years. She can be reached at 623.776.6715.

n Know what you want (what you really, really want). Looking to resolve conflict without a clear direction of what your ideal outcome is wastes precious office time. Having a resolution conversation

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Book Review

Book Review

Layers: An Atlas of Composite Resin Stratification Authors: Drs. Jordi Manauta and Anna Salat Published by Quintessence Reviewed by Dr. Harvey Barbag

The authors’ goal is to present a dissection of the physical elements of a tooth that result in what we call “natural,” for the purpose of suggesting how a clinician might approach the restoration of a tooth. This text would most benefit the practitioner early in his/her career who is striving for esthetic excellence in restoring teeth with composite resin. The authors don’t highlight one particular resin system, although one is mentioned.

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The first chapter is a presentation of the basics of color: hue, chroma and value.

The effect of light temperature and the flash considerations for photography are discussed. The two subsequent chapters highlight the uniqueness of dentin and enamel, important differences when considering the need for layering restorative material to achieve a natural appearance.

Suggestions are made for the type of composite (dentin or enamel shades) and general hue range of shades needed in a layering/stratifying technique. Through a series of photographs, the authors demonstrate examples of the layers needed to build a tooth mesio-distally, cervicoincisally and bucco-palatally. Although artfully and skillfully done, application is limited to Class IV restorations, as most daily treatment is applied to teeth with sufficient tooth structure upon which to build the restoration.

Restoration considerations of posterior teeth also are presented. Staining of occlusal grooves for a natural appearance is pictured. The chapter “Pathologic Phenomena” has suggestions for internal staining of cavities to reproduce a discoloration shared by an adjacent tooth.

Instrumentation for shaping surface topography and polishing restorations is covered in Chapter 10. Chapter 11 demonstrates, more than most other chapters, the use of pink and red resins designed to simulate the gingivae and alveolar mucosa. This aspect of esthetic restoration

of a tooth that has lost soft tissue, and where soft tissue surgical procedures are impractical or not desired, has progressed significantly. The reader will appreciate the need for spending considerable time to accomplish a natural blending from composite to the gingival margin.

The authors advise the clinician to create his/her own shade tabs from the materials used in their own practice. They suggest that these tabs be made in several thicknesses, with some thin enough to be translucent. Some instruction is given in how to create these tabs in Chapter 12.

One point discussed, which I believe is important, is the need for the practitioner to experiment with the shades and stains/ tints that already are available.

This book is not a “cookbook” of how to layer composite resin to achieve natural and blended restorations. Through photographic presentations, the authors demonstrate the process of building opaque and translucent layers. At best, it serves as an encouragement to think about layering. The photography is excellent, but some subtle differences in tooth color are not always appreciated. I feel it is important to stress that this is not a “how-to” book.

The reviewer claims no financial interest with the publication.

Dr. Barbag is a general dentist and has a practice in Boca Raton. He can be reached at hjbdent@gmail.com.

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B e Tre a t e d L i k e R o y a l t y

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C lassified A dvertising

Opportunities

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The FDA’s online classified system allows you to 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!

The FDA online classified ad model is for “paid online advertising.” Effectively, the advertising rate you pay will entitle you to online classified ads with increased exposure. As an added benefit, we will continue to publish the “basic text” format of paid, online classified ads in our bimonthly printed journal, 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.

Our magazine is published bimonthly, and therefore, all ads currently online will be extracted from the system on roughly the following dates of each year: Jan. 15, March 15, May 15, July 15, Sept. 15, Nov. 15. The ads extracted at this time will then be published in the following month’s issue of Today’s FDA. Please view the classified advertising portion of our website at http://www.floridadental.biz/.

Today's FDA

September/October 2014

ANNOUNCING: Hands On Extraction Classes.

Remove Teeth on Live Patients, including impacted wisdom teeth, and receive 40 hours of AGD PACE accepted CE Credit. Learn how to remove teeth and handle complications. Learn how to elevate flaps and suture properly. Classes July 27-31, Sept.

26/27, Oct. 24-30, and January 17-22, 2015. For more information contact Dr. Tommy Murph: 843.488.4357, drtommymurph@yahoo.com.

A blockbuster opportunity. Full or part time for General Dentists, Endodontists, Orthodontists, Pedodontists, Periodontists, and Oral Surgeons.

Generous compensation with unlimited potential.

Guaranteed referrals. Join our group specialty care practice with a significant general dental component. Established in 1975 in Aventura, Coral Springs, Delray Beach, Boynton Beach, Stuart, Ft. Pierce and Melbourne. Call: Kelly Oliver 954.461.0172. Fax resume to: 954.678.9539. Email: careers@dentaland.net.

Need an Associate? Need a job? There’s no fee for finding you a job! Call Doctors Choice Companies.

Sandy Harris: 561.744.2783 sandy@doctorschoice1. net.

Part-time Dentist. Private practice in Sun City Center needs licensed part time general dentist with strength in endodontic and restorative dentistry.

Must have excellent communication skills with comprehensive approach to dentistry. Please send us your resume via fax to 813.655.9945.

Position Desired: Specialist, Part-Time permanent. johnmaria7@yahoo.com Board certified endodontist with many years of private practice experience and an active Florida license is looking for an endodontic position. If you’re interested, contact me at rcttoday@gmail. com.

Endodontist with many years of private practice experience available to perform endodontic treatment in your office on a fee for service production basis. Materials, equipment, staff, scheduling, and billing to be provided by practice. If interested, email rctqday@gmail.com.

Seeking a General Dentist for a Partnership.

Great location in the Pembroke Pines area. Great opportunity for part ownership. Please inquire within. camellanmg07@gmail.com.

Dentist Opportunities. Dental Partners is one of the fastest growing family dental practice groups in the Southeast. We give you the ability to focus on patient care while earning a base of $125K-$200K and the opportunity to earn more based on production. Benefits package of medical/vision/ life/FSA, 401K, professional liability and yearly CE allowance. Relocation and student loan repayment assistance program may be available. Email resume to areimiller@dental-partners.com or call Ashley Reimiller, Director of People Development 321.574.8003.

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General Dentist Needed, Boca Raton. If you love dentistry, have excellent chair-side and communication skills, and want to surround yourself with talented staff, we invite you to join our busy, state-of-the-art, paperless, practice.

Part time or full time. Compensation: $600/day minimum, depending on qualifications, plus high percentage of collections. Call 954.703.9309 or email smilesofboca@aol.com.

Florida – Orlando/Daytona/Jacksonville/Tampa/S. Fla. General Dentist and Specialists. http://www. greenbergdental.com. andy@katsur.com.

3-4 Days FFS office. 3-Day week, same comp. as 5 days! South Central FL practice, 45 min from Wellington, 1 hr from Plantation. Amazing staff and patients. Great opportunity for Good Doc. Must do: Molar RCT, Dentures and extractions. Well above average take home. kurthausy@hotmail.com.

Pedo/Ortho office wants General or Specialist dentist. PEDO/ORTHO office looking for some great help. Possibility for General Dentist, Pediatric Dentist, or maybe even Orthodontist. Pay, hours, and arrangement TBD. gentledentalman@yahoo. com.

We are an exceptional multi-specialty group practice composing like-minded dentist, orthodontist, oral surgeons, denturist and ceramist. We offer a phenomenal opportunity both financially and professionally! For recent and new graduates, we will remove all financial pressure. We are willing invest the time, effort and resources to mentor and train you which will fast track your career goals and financial compensation. Many offices promote the possibility of making significant compensation, we GUARANTEE it in writing! Doctors right now are making $1,000+ a day. panhandledentist@yahoo. com, 850.450.8935.

General Dentist. Dynamic Dental Health Associates of FL and Dynamic Dental Partners Group (DDPG), a new private fee-for service group, is growing and expanding rapidly. Top Compensation, daily guarantee, health insurance, modern facilities with latest technology, great patient flow, no administrative headaches and professional mgmt. We also buy dental practices and create exit/transition strategies for solo and group practices. If interested in selling your practice, please email Dr. Alex Giannini at agiannini@ ddpgroups.com. If interested in an Associate Dentist position, please email your CV to Jeff Hokamp at jhokamp@ddpgroups.com or call 941.312.7838.

Current openings in Sarasota ($3K Signing Bonus), Bradenton ($3K Signing Bonus), Port Charlotte ($3K Signing Bonus), North Port, St. Petersburg and Gainesville. Future openings in Tampa/Clearwater, Ocala, Ft. Myers and Umatilla, FL. Please don’t hesitate to send your CV if interested in other areas in FL.

General Dentist. Smile Design Dentistry is seeking experienced general dentists working 4-5 days per week at our offices in Spring Hill and in the Villages. Our dentists have the clinical freedom and autonomy enjoyed in a traditional private practice without the additional financial or administrative burdens associated with practice management.

SDD offers a daily guaranty, stable and growing patient base, PPO and FFS based patients, and we offer medical and other benefits. Email spatel@ thesmiledesign.com or call 813.765.0879 for more information.

A traditional fee for service general practice seeking full or part time associates. Seven locations on Florida’s West Coast including Tampa, Clearwater, St. Petersburg, Port Richey and Bradenton. Immediate income, paid vacation, health insurance, 401k, flexible days. Established in 1981. NO CAPITATION. Please contact Carolyn Mallory 727.461.9149, Fax 727.446.8382 or www.

FloridaDentalCenters.com.

Seeking a motivated associate. Ad updated JULY 11th 2014 — High-end multidisciplinary team seeking a motivated associate. The center is located in an upscale area near Gulf Stream Plaza. Approximately one mile from the ocean.

The practice recently underwent a modern and technological renovation. Please visit us online at www.ThePremierSmile.com. Our team coordinates and provides continuing education courses i.e.

Invisalign, dental implants, cosmetics, sedation, and prosth. We employ a wonderful and highly trained staff that focuses on providing high quality care in a state of the art environment. We will provide the practice support needed for your success.

Partnership opportunities are available. Please email CV to Howard Corbeau: howardcorbeau@gmail. com or fax to 888.800.4955.

Experienced General Dentist Needed Full time.

Experienced General Dentist Needed for fast growing practice in New Port Richey, Florida.

Guaranteed salary plus percentage. Medical and malpractice paid for you. High-tech office with experienced staff. No nights or weekends. Excellent opportunity for experienced clinician. Please email resume (vjmnlm@gate.net) or fax (727.945.9661).

Immediate opening.

Great Opportunity for General Dentist. Come join our growing team at Dental Associates of Florida!

Our dentists have the clinical freedom enjoyed in a traditional private practice without the additional financial or administrative burdens associated with practice management. Our administrative team handles staffing, human resources, purchasing, financials and marketing so you can focus on patient care. Dentists can expect generous production based earnings and a stable patient base with long term career growth potential! We currently have openings at the following locations Lakeland, Tampa, and Clearwater. tinadaop@gmail.com.

General Dentist Position Tampa Bay. Looking to hire enthusiastic dentist, FT/PT. Flexible hours w/ well-trained staff. State-of-the-art facility, fully computerized. High income potential doing what you enjoy. Call 813.885.3900 or Fax resume 813.8865559. New grads welcome to inquire.

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Looking For Associate Destin, FL. By way of introduction, my name is Dr. Olivier Broutin and I practice in the Destin area. We’re looking for a doctor to work in our practice. We have a thriving practice and we need help! We are creating a great opportunity for someone who wants to treat people. We’ll handle the marketing, new pt generating and management hassle. We offer great income potential, excellent working conditions and training. We have all the latest high tech equipment, including CEREC and CBCT. We think we have it all! If you would be interested please email us your resume to OBDMD1@gmail.com.

Part Time Dentist in Crystal River, FL. Christie Dental is looking for a Part Time Dentist for our office in beautiful Crystal River Florida. The position would be 2 to 3 days a week including 2 Saturdays a month. We offer an excellent compensation package. Apply today for this dynamic opportunity! Email your C.V. to Sarah Bolduc at sbolduc@amdpi.com or call her at 781.213.3318.

Come join our growing team at Dental Associates of Florida! Our dentists have the clinical freedom enjoyed in a traditional private practice without the additional financial or administrative burdens associated with practice management. Our administrative team handles staffing, human resources, purchasing, financials and marketing so you can focus on patient care. Dentists can expect generous production based earnings and a stable patient base with long term career growth potential!

We currently have openings in Hillsborough, Polk and Hernando County. tinadaop@gmail.com.

ASSOCIATE DENTIST WANTED in Fort Lauderdale Dental Practice. State-of-the-art, FFS/ PPO dental practice is looking for an associate dentist to be part of team committed to quality dental care for our patients. Outgoing personality, proficiency in all aspects of General and Cosmetic dentistry, and desire to work in upbeat office are a necessity. Must be comfortable treating children.

Excellent earning potential at this office. AEGD or GPR residency required. Please contact Arelis at 954.523.6525.

Oral surgeon wanted. Longstanding oral surgery practice with excellent reputation seeks associate leading to partnership in Southwest Florida coastal community on the Gulf of Mexico. Great school systems in family oriented community with a large network of referral dentists. All phases of oral surgery available to BCBE surgeon. Contact gatormom143@me.com.

Endodontic Position Available. Florida, Tampa Bay Area — Full time endodontist wanted to join established multi-specialty practice. Great opportunity for a self-starter to build a career practice with the possibility of a future partnership.

Close to the beaches, excellent leisure activities available, and three pro sports teams in the area.

Salary, bonus, 401K. Please call 727.460.8268.

Please see CLASSIFIEDS, 72

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Your Classified Ad Reaches 7,000 Readers!

CLASSIFIEDS from 71 Full time Dentist Position in Ocala, FL. Christie Dental is a multi-specialty group practice with locations throughout central Florida. We are looking for a Full Time General Dentist for our office in beautiful Ocala, Florida. Ocala is known for its numerous equestrian venues including the Ocala Equestrian Complex which hosts major competitions. It located near Silver Springs which is a nature theme park that has one of the biggest artesian springs in the world. There are many places to hike and fish as well. If you are interested in being able to enjoy the traditional doctor patient relationship in a team environment with professional and clinical support to best service your patients this is the opportunity for you. We offer an excellent compensation package. Apply today for this dynamic opportunity! Email your C.V. to Sarah Bolduc at sbolduc@amdpi.com or call her at 781.213.3318. Check out our websites www. christiedental.com and www.amdpi.com.

Associateship Leading to Ownership. I am looking for the right candidate as an associate for my wellestablished pediatric dental practice who wants to become a practice owner in 2 years. Hours would include Mondays, Fridays, and one Saturday per month. Please reply to this ad ONLY if practice ownership is in your short-term plans. babytth@ aol.com.

ASSOCIATE LEADING TO PARTNERSHIP — BRADENTON, FLORIDA. Well-established high quality, fee for service, restorative/prosthodontic and aesthetic practice looking for a highly skilled and motivated associate. Excellent opportunity for the right person. scarlett@zkjvdental.com.

For Sale/Lease For sale ... Iluma vision 3D cone beam CT scanner.

Link to brochure is http://bit.ly/1lRDwIT. State of the art scanner renders fantastic high resolution images, sure to impress. Included computer and dual monitors flawlessly match providing end user with all control necessary for diagnosis and treatment planning. My loss, your gain! Expanding practice, new practitioner needs operatory that scanner is occupying. eric@ofsctallahassee.com.

Beautiful Lakefront Property. Brandon, FL. Beautiful 2000 sf lakefront office space available for custom build out. Adjacent to Endodontist. Ideal for Oral Surgeon or Periodontist. Contact Julie 813.654.3636 or julieh@aeoftb.com.

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Immokalee Rd, 2 mi W to US41 and 2 mi E to I-75. Main access to (5) major, N-S routes. The site is enclosed by (16) major hi-residential subdivisions. Yr. 2014, (2) major developers permitting new projects. “Great partnership facility/Major residential area.” frengel2@comcast.net, for listing package, email.

BRAND NEW MEDICAL RETAIL FRONTING W. HILLSBOROUGH AVE. Under Construction — Brand new 2 Story Office/Medical Retail Building. Downstairs — 3,300 sq. ft. total that can be divided into two units. Upstairs — (3) Three 1,100 sq. ft. Executive Office Suites. Frontage on W. Hillsborough Ave. Average traffic counts 55,000+/ day. Largest LED display sign on W. Hillsborough Ave. Built with SIPS panels to save you 50% on electric. Pavilion, Future Nature Trails. katie@ tlhuntinc.com.

Fully equipped active dental office with 8 operatories, 4 bathrooms, 2 business offices, and a 4 room private suite. Great for group or solo practice.

Near a hospital in a well maintained business park with a large parking area. Dentist retiring and moving out of state. Price includes all equipment. wmartin9@tampabay.rr.com.

For sale: Medical Business Office in Prime Location.

532virginia@gmail.com.

University Health Park (website: universityhealthpark.net) is a $15,000,000 80,000 square foot “one stop shop” medical office park with 3,000 patient/week patient flow. We have need for the following: general dentist/pediatric dentist/endodontist/periodontist/prosthodontist/ oral surgeon/orthodontist. A large $300 million development (including Starbucks, Dunkin Donuts, Culvers, Tire Kingdom, Firehouse Subs) and 200 acres of homes are being built all around us. We have office space ranging from 1,200 to 6,000 square feet. Some of the suites have equity options.

Please call Don Harvey, MD if interested at cell 941.724.3259.

Buyers and Sellers. We have over 100 Florida dental practice opportunities; and the perfect buyer for your practice. Call Doctor’s Choice Companies today! Kenny Jones at 561.746.2102 or info@ doctorschoice1.net. Website: doctorschoice1.net.

Private practice for sale in sunny South Florida!

Owner moving out of state. 4 ops with potential for fifth. PPO/FFS in busy shopping plaza. Email sellingdr@hotmail.com with inquiries. Price under negotiations. Sale confidential to staff.

Fort Myers, FL – 6 Ops-1,600 Square Foot OfficeWell-Established Practice. The local community is family friendly and filled with activities and amenities. The nearby white sandy beaches offer swimming, boating, fishing and much more!

Please contact: Henry Schein Professional Practice Transitions, Heather Brown-Licensed Sales Associate. Cell: 727.844.8588. Email: Heather.

Brown2@henryschein.com.

Practice Sale Tampa, FL. **PEDODONTIST PRACTICE SALE!!!!** 3,000 sq/ft space. 6 Ops incl 2 Quiet rooms. Equipment includes intra oral Cameras, Digital X-rays, Panographic X-ray unit, Digital Panoramic unit, Lasers, Nitrous and I.V. Sedation System. Family friendly community within minutes of Raymond James Stadium and Busch Gardens. #FL104. Please contact: Henry Schein Professional Practice Transitions, Heather BrownLicensed Sales Associate. Cell: 727.844.8588. Email: Heather.Brown2@henryschein.com.

For sale: Miami area. Active, well established oral and maxillofacial surgery practice. Full scope, excellent referral base, facility (digital), staff, opportunity. Can accommodate one or two surgeons. Contact: professional practice planners – 412.673.3144, stanpoll@aol.com.

FLORIDA – MIAMI. Well established, mature, full scope. Excellent staff, facility, referral base, opportunity. Can accommodate one or two talented surgeons. Contact: Professional Practice Planners – 412.673.3144, 412.621.2882 (after hours) or Email: Stanpoll@aol.com.

Sarasota, FL – The #1 Beach Destination the USA! Established 30 year old practice with $302,000 Gross and 95% collection rate. 3 day hygiene program with 1200 active patients — 25% PPO. 1100 sq. ft. business condo unit also for sale. Owner retiring.

Contact Dr. Rotole at: rotoleswimsgood@verizon. net or 941.922.0111.

Sublease office in Boca. Dental office space available to sub lease in Boca Raton, Fl. Great for an Oral surgeon, periodontist, or general dentist. rctnow@ gmail.com.

WANTED: Endo/Ortho to Share Space. Excellent downtown Miami location on Brickell, near arena.

Looking for endo or ortho to share space. Two plumbed/equipped ops, newly renovated, with valet parking. drmiller@webperio.com.

Beautiful Clearwater. General practice, FFS, well established. Owner retiring for health reasons.

All equipment new 2007. Must see to appreciate.

Extraordinary. Telephone 727.488.0215 for additional information. www.dentistrytampabay. com.

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OFF THE CUSP

JOHN PAUL, DMD, EDITOR

When Did This Happen?

“

It’s what you learn after you know everything that makes all the difference.

— John Wooden, basketball coach

”

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When this page is blank, the challenge it presents is daunting. It has been even more so because all year I knew this issue — the “women’s issue” — was coming.

I wasn’t even sure I had the credibility to write something for this issue. A thumbnail sketch of what I know about a woman’s approach to dentistry can literally fit on my thumbnail.

The more I pondered, the more I realized the importance of this issue for men as well as women. I found I have some credibility. Other than me, all the members of my family are female. My wife, two daughters, and even the dog and cat are all ladies. Except for me, everyone who works in my office — assistant, hygienist, office manager — all ladies. (I remember one assistant who asked me, “Did anyone in dental school ever tell you that for the rest of your life you would be working with only women?”) Sixty-five percent of my patients are women. At the home office in Tallahassee, except for me, every member of the Communications

Department — all of the fairer sex. My accountant, my investment counselor, my practice consultant: all women.

I’m completely surrounded, and I’m uplifted by these facts. The help they give me to be a better dentist, better editor, better father, and better man is appreciated and necessary. I couldn’t do it alone, and I hope I am returning the kindness equally.

When I was younger, I believed myself to be the master of my domain, a benevolent dictator who ruled all that I could see with a Star 435 SWL scepter. Experience has taught me that this is not my reality.

They say wisdom comes from experience and experience comes from surviving bad decisions. With this issue and many more like it, I hope we can take some of the bruises out of experience for both our male and female members.

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

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Important Health Insurance Deadlines NOV. 15, 2014- FEB. 15, 2015 OPEN ENROLLMENT FOR INDIVIDUAL HEALTH INSURANCE ON AND OFF EXCHANGE (no prior insurance required and pre-existing conditions waived)

JAN. 1, 2015 DEADLINE TO HAVE INSURANCE IN PLACE (to avoid individual mandate tax penalty for 2015)

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