2018 - Sept/Oct TFDA

FDAPAC-supported Candidates - Page 15

VOL. 30, NO. 6 • SEPTEMBER/OCTOBER 2018 • HR ISSUE

A PUBLICATION OF THE FLORIDA DENTAL ASSOCIATION

SHOULD YOU ALLOW PATIENTS TO RECORD DENTAL VISITS?

Required Posters for the Workplace New Rules and Limitations for Depreciation and Expensing

What Do Dental Hygiene Supervision Levels Mean?

MAKING YOUR OFFICE A FUN PLACE TO WORK

6 Mistakes Dentists Make When Hiring

The Dogtor Will See You Now — All About Therapy Dogs

We work for you.

“

For years I was overpaying on my malpractice insurance!

What a fool. The Doctor's Company and FDA Services reduced my premium, making

no-brainer

it a to be part of the ADA and FDA. I also buy supplies through FDASupplies.com at a lower cost than other suppliers.

- Dr. Athas Kometas

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Call us 800.877.7597 or visit fdaservices.com.

HELPING MEMBERS SUCCEED VOL. 30, NO. 6 • SEPTEMBER/OCTOBER 2018

A PUBLICATION OF THE FLORIDA DENTAL ASSOCIATION

in every issue 3

Staff Roster

5

President's Message

8

Human Relations

10 Did You Know?

12 Legislative Corner 17 Info Bytes 18 news@fda 34 Get Involved!

66 Compleat Dentistry 71 Diagnostic Discussion 76 Career Center 79 Advertising Index 80 Off the Cusp

15

FDAPAC-supported Candidates

22

Board of Dentistry

26

Should You Allow Patients to Record Dental Visits?

50

Top Tips to Effectively Manage Your Online Communities and Address Patient Comments

30

6 Mistakes Dentists Make When Hiring (and How to Avoid Them!)

36

New Rules and Limitations for Depreciation and Expensing Under the Tax Cuts and Jobs Act

38

What Do Dental Hygiene Supervision Levels Mean?

40

The Dogtor Will See You Now

46

54

How Servant Leadership is Critical to Your Dental Practice's Success

58

Keeping Your Patients With an In-Office Dental Membership Plan

60

Making Your Office a Fun Place to Work

64

Get the Hang of it! Required Posters for the Workplace

Dentists by the Numbers

TODAY'S FDA ONLINE: floridadental.org

FLORIDA DENTAL ASSOCIATION SEPTEMBER/OCTOBER 2018 VOL. 30, NO. 6

EDITOR Dr. John Paul, Lakeland, editor

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

BOARD OF TRUSTEES

FDA District Calendar

Dr. Jolene Paramore, Panama City, president Dr. Rudy Liddell, Brandon, president-elect Dr. Andy Brown, Orange Park, first vice president Dr. Dave Boden, Port St. Lucie, second vice president Dr. Gerald Bird, Cocoa, secretary Dr. Michael D. Eggnatz, Weston, immediate past president Drew Eason, CAE, Tallahassee, executive director Dr. Karen Glerum, Boynton Beach Dr. Jeannette Pena Hall, Miami • Dr. Bernard Kahn, Maitland Dr. George Kolos, Fort Lauderdale • Dr. Eddie Martin, Pensacola Dr. Jeffrey Ottley, Milton • Dr. Paul Palo, Winter Haven Dr. Howard Pranikoff, Ormond Beach • Dr. Rick Mullens, Jacksonville Dr. Beatriz Terry, Miami • Dr. Stephen Zuknick, Brandon Dr. Ethan Pansick, Delray Beach, speaker of the house Dr. Tim Marshall, Spring Hill, Treasurer • Dr. John Paul, Lakeland, editor

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

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

Periodical postage paid at Tallahassee, Fla. and additional entry offices. Copyright 2018 Florida Dental Association.

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

POSTMASTER: Please send form 3579 for returns and changes of address to Today’s FDA, 545 John Knox Road, Ste. 202, Tallahassee, Fla. 32303.

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

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

FDA office numbers: 800.877.9922, 850. 681.3629; fax 850.681.0116; 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.

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

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

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TODAY'S FDA

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WWW.FLORIDADENTAL.ORG

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

EXECUTIVE OFFICE DREW EASON, Executive Director deason@floridadental.org 850.350.7109 GREG GRUBER, Chief Operating Officer/ Chief Financial Officer ggruber@floridadental.org 850.350.7111 CASEY STOUTAMIRE, Director of Third Party Payer and Professional Affairs cstoutamire@floridadental.org 850.350.7202 JUDY STONE, Leadership Affairs Manager jstone@floridadental.org 850.350.7123 LIANNE BELL, Leadership Concierge lbell@floridadental.org 850.350.7114

ACCOUNTING BREANA GIBLIN, Director of Accounting bgiblin@floridadental.org 850.350.7137 LEONA BOUTWELL, Finance Services Coordinator Accounts Receivable & Foundation lboutwell@floridadental.org 850.350.7138 DEANNE FOY, Finance Services Coordinator Dues, PAC & Special Projects dfoy@floridadental.org 850.350.7165 JAMIE IDOL, Commissions Coordinator jamie.idol@fdaservices.com 850.350.7142 ALLEN JOHNSON, Accounting Manager allen.johnson@fdaservices.com 850.350.7140 MITZI RYE, Fiscal Services Coordinator mrye@floridadental.org 850.350.7139 STEPHANIE TAYLOR, Membership Dues Coordinator staylor@floridadental.org 850.350.7119

COMMUNICATIONS AND MARKETING JILL RUNYAN, Director of Communications jrunyan@floridadental.org 850.350.7113 LYNNE KNIGHT, Marketing Coordinator lknight@floridadental.org 850.350.7112 JESSICA LAURIA, Communications and Media Coordinator jlauria@floridadental.org 850.350.7115

FLORIDA DENTAL ASSOCIATION FOUNDATION (FDAF)

FLORIDA DENTAL CONVENTION (FDC) CRISSY TALLMAN, Director of Conventions and Continuing Education ctallman@floridadental.org 850.350.7105 KENLEE BRUGGEMANN, FDC Meeting Assistant kbruggemann@floridadental.org 850.350.7162 BROOKE MARTIN, FDC Marketing Coordinator bmartin@floridadental.org 850.350.7103 DEIRDRE RHODES, FDC Exhibits Planner drhodes@floridadental.org 850.350.7108 JENNIFER TEDDER, FDC Program Coordinator jtedder@floridadental.org 850.350.7106

GOVERNMENTAL AFFAIRS JOE ANNE HART, Chief Legislative Officer jahart@floridadental.org 850.350.7205 ALEXANDRA ABBOUD, Governmental Affairs Liaison aabboud@floridadental.org 850.350.7204 COURTNEY THOMAS, Governmental Affairs Legislative Assistant cthomas@floridadental.org 850.350.7203

INFORMATION SYSTEMS LARRY DARNELL, Director of Information Systems ldarnell@floridadental.org 850.350.7102 RACHEL BURCH, Computer Support Technician rburch@floridadental.org 850.350.7153

MEMBER RELATIONS KERRY GÓMEZ-RÍOS, Director of Member Relations krios@floridadental.org 850.350.7121 DESTINY SIMS, Member Access Coordinator dsims@floridadental.org 850.350.7100 ASHLEY MERRILL, Member Relations Coordinator amerrill@floridadental.org 850.350.7110 CHRISTINE TROTTO, Membership Concierge ctrotto@floridadental.org 850.350.7136

FDA SERVICES 800.877.7597 or 850.681.2996 545 John Knox Road, Ste. 201 Tallahassee, FL 32303 Group & Individual Health • Medicare Supplement • Life Insurance Disability Income • Long-term Care • Annuities • Professional Liability Office Package • Workers’ Compensation • Auto • Boat

SCOTT RUTHSTROM, Chief Operating Officer scott.ruthstrom@fdaservices.com 850.350.7146 CAROL GASKINS, Assistant Manager – Sales & Service carol.gaskins@fdaservices.com 850.350.7159 DEBBIE LANE, Assistant Manager – Service & Technology debbie.lane@fdaservices.com 850.350.7157 ALEX KLINE, FDAS Marketing Coordinator arey@fdaservices.com 850.350.7166 MARCIA DUTTON, Administrative Assistant marcia.dutton@fdaservices.com 850.350.7145 PORSCHIE BIGGINS, North Florida Membership Services Representative pbiggins@fdaservices.com 850-350-7149 MARIA BROOKS, SFDDA Membership Services Representative maria.brooks@fdaservices.com 850.350.7144 EBONI NELSON, CFDDA Membership Services Representative eboni.nelson@fdaservices.com 850.350.7151 MELISSA STAGGERS, WCDDA Membership Services Representative melissa.staggers@fdaservices.com 850.350.7154 TESSA DANIELS, Membership Services Representative tessa.daniels@fdaservices.com 850.350.7158 LIZ RICH, Membership Services Representative liz.rich@fdaservices.com 850.350.7171

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

YOUR RISK EXPERTS DAN ZOTTOLI, SBCS Director of Sales — Atlantic Coast 561.791.7744 Cell: 561.601.5363 dan.zottoli@fdaservices.com DENNIS HEAD, CIC Director of Sales — Central Florida 877.843.0921 (toll free) Cell: 407.927.5472 dennis.head@fdaservices.com MIKE TROUT Director of Sales — North Florida 904.249.6985 Cell: 904.254.8927 mike.trout@fdaservices.com JOSEPH PERRETTI, SBCS Director of Sales — South Florida 305.665.0455 Cell: 305.721.9196 joe.perretti@fdaservices.com RICK D’ANGELO, CIC Director of Sales — West Coast 813.475.6948 Cell: 813.267.2572 rick.dangelo@fdaservices.com

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.

R. JAI GILLUM, Director of Foundation Affairs rjaigillum@floridadental.org 850.350.7117 AUSTIN MOSER, Coordinator of Foundation Affairs amoser@floridadental.org 850.350.7161

WWW.FLORIDADENTAL.ORG

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

TODAY'S FDA SEPTEMBER/OCTOBER 2018

3

FDA Foundation Mission of Mercy Thank you

leadership

WHITE COATS, CODA, CMS AND DENTAL BENEFITS IN MEDICARE White Coat Ceremonies Hello again, Florida Dental Association (FDA) members! In the last few months, I’ve been honored to speak to the rising dental students at Nova Southeastern University College of Dental Medicine (NSU CDM) and the University of Florida College of Dentistry (UFCD) during their White Coat Ceremonies. NSU CDM Dean Dr. Linda Niessen and UFCD Dean Dr. Isabel Garcia were gracious hosts, and the FDA and I thank them for including us in their events. It was my pleasure to celebrate the students’ success, present them with cool blue, magnetic FDA pins and welcome them to the profession on behalf of the more than 8,000 FDA members. I was honored to pin Jacob Harrison, who is the grandson of past president, Jerry Harrison, and the son of Rex Harrison, a third-generation dentist at UFCD. One of the most impressive aspects of the White Coat Ceremony at both universities was the faculty’s support and interaction with the students. I was so happy to see the relationships between the D2s and their chosen faculty members presenting them their white coats at UFCD. Besides the big hugs and fist bumps, there were a lot of smiles! You could feel the genuine care the faculty has for the students and the respect the students have for their instructors. It was inspiring!

Nova’s ceremony was held at the end of the D1s’ orientation week. Before the ceremony, I

was able to interact with the students as they reflected on their new-found knowledge that the next four years would be very different from the last four years. After the faculty gave their presentations, there was a noticeable change in the students. In the presence of each other and their families, the D1s realized that the NSU CDM faculty was there to help them walk across that stage again in four years as a doctor. As the students made their oath, you could see that trust was building and bonds were forming — and it was “Fins up!”

PRESIDENT’S MESSAGE JOLENE PARAMORE, DMD FDA PRESIDENT

Dr. Paramore can be reached at jparamore@ bot.floridadental.org.

It was my goal to share with the students that they care for — and not just treat — all patients when they become a professional and wear the white coat. Tomorrow’s dentists need to know early on that they will be responsible for the profession’s reputation and their actions will delineate and define the profession for future generations. It was my duty to let them know we’re here for them and to let them stand on our shoulders, as those before us let us stand on theirs. I was proud to tell them the FDA is a group of ethical dentists who pledge to do no harm, respect the wants and needs of patients, do good, be fair and be truthful. So, welcome to all the D1s and D2s who got your white coats! We are here for you!

Alphabet Soup Dentistry and government are full of entities with alphabet soup names. CODA and SEE PAGE 7

WWW.FLORIDADENTAL.ORG

TODAY'S FDA SEPTEMBER/OCTOBER 2018

5

FDA - FDA and FMA Two-hour CE Course

leadership FROM PAGE 5

There is much discussion about what procedures might be covered, how much a dental benefit would cost the government to administer and what legislative changes would be needed to create a dental benefit. I believe it will ultimately come down to dollars and how much Congress values the oral health care of Medicare recipients — you know, follow the money. Florida delegation members will be debating the position and role of the ADA in the dental Medicare expansion movement at the ADA House of Delegates meeting on Oct. 19-22. If you have an opinion you would like to share, we’re all ears.

CMS are two that have the capability to change the practice of dentistry, so let’s focus on them. The Commission on Dental Accreditation (CODA) is an organization that approves educational standards and accredits dental educational programs, among other things. The Centers for Medicare and Medicaid Services (CMS, don’t ask me why it’s not CMMS) is a federal agency that administers the Medicare program and works with state governments to administer Medicaid, the Children’s Health Insurance Program (CHIP) and is responsible for health insurance portability (HIPAA) standards. (Wouldn’t you just love to work in the HIPAA standards department?)

Opt in to FDAPAC and ADPAC

This August, CODA commissioners voted on proposed changes to the dental hygiene educational standards. Those changes would have mandated teaching dental hygiene diagnosis and formulation of treatment plans in all CODA-accredited dental hygiene schools. The FDA’s leaders strongly believe diagnosis and treatment planning are under the sole purview of a dentist. The FDA and the Florida Delegation to the American Dental Association (ADA) each submitted comments to CODA, reinforcing that only a dentist determines the diagnosis and develops the treatment plan.

How much influence the dental profession will have in determining the end result of the dental benefits in Medicare discussions remains to be seen. Everyone will be receiving their dues statements for next year soon, so when you get yours, please use a little of your treasure to support the American Dental Political Action Committee (ADPAC) and FDA Political Action Committee (FDAPAC) by including both in your dues. Better yet, go to floridadental.org, pay your dues online and make an extra contribution to the PACs in gratitude for the opportunity dentistry affords you.

Many of you watched the video we sent in May, which encouraged our members to submit comments in opposition to the changes, and some of you took action. We appreciate all the members who did. The results are in: Together, we made a difference. CODA voted not to change the educational standards; diagnosis and treatment planning remain the responsibility of the doctor.

Nearly 90 percent of full dues paying members opt out of joining ADPAC, and I’ll guess that most of you think you support the PACs. If you’re unsure, our governmental affairs team will be happy to let you know. Please don’t “opt out” or have your bill payer cross off those items they don’t think are necessary.

Being a member of both PACs is important, now more than ever. Whether the ADPAC’s “One Voice United” is heard or ignored is up to us. Those who will make the decisions that affect the future of our profession know how to follow the money. Let’s keep it in both of their hands.

So, last but not least, let’s talk about CMS. For the last few years, the ADA has worked hard to overturn the CMS ruling requiring dentists to enroll as Medicare providers for our patients to get prescription drug coverage (Part D). We finally won. It’s a great victory for you, the profession and the ADA. You do not have to sign up for something you won’t use.

Until the next message, I remain yours in the bond,

Now, a large coalition of well-meaning stakeholder groups are advocating for a dental benefit in Medicare. Without a doubt, there is need for more oral health care for many of our elders.

Florida has the largest number of Medicare recipients in the U.S., so we definitely know the need for elder care.

WWW.FLORIDADENTAL.ORG

TODAY'S FDA SEPTEMBER/OCTOBER 2018

7

human relations

YOU WANT TO BRING YOUR WHAT TO WORK? DEBORAH S. MINNIS

LABOR AND EMPLOYMENT LAW, AUSLEY MCMULLEN

She can be reached at dminnis@ausley.com.

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

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

Requests to bring service and comfort animals to work have become quite popular. Such requests are covered under the employment provision, Title I, of the Americans with Disabilities Act (AwDA), applicable to all employers, including health care providers, with 15 or more employees for each working day in 20 or more calendar weeks in the current or preceding calendar year. The federal government and private membership clubs are the only exceptions.

These rules apply to employee matters only, not to accommodating patients and members of the public who come onto your premises, for which a different AwDA definition of service animals applies.

What is a Service Animal?

For purposes of employment, service animals are animals trained to perform specific tasks for a disabled person, and comfort animals provide emotional support.

Things to Know When Hiring With very limited exceptions, pre-offer medical inquiries are prohibited under the AwDA. Below are examples of things you should not ask.

When disabilities are not obvious: v if the person has any illnesses v if the person has any conditions

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v about medications v about prior workers’ compensation claims When disabilities are obvious or disclosed by the applicant (includes applicants who have a service animal or identify as needing a service or comfort animal): v specifics regarding the person’s disability, i.e., type or severity of the disability v about specific accommodations that will be needed v about medications v about prior workers’ compensation claims v if the disability will interfere with the ability to do the job Permitted inquiries are questions concerning the person’s ability to perform the essential job duties, which should be asked of all applicants.

If the individual is not offered the position, the reason(s) for non-hire should be documented and should relate to the person’s ability to perform or not perform the essential duties of the position and not be based on the identified or suspected need for a service animal.

Things to Know Relating to Requests by Existing Employees Employers cannot automatically refuse to allow service/comfort animals at work, and employees are not automatically entitled to bring service/comfort animals to work. A request to WWW.FLORIDADENTAL.ORG

bring a service/comfort animal to work should be treated the same as any other request for an accommodation. In addition, the employer and employee must engage in an interactive process to determine if the request is reasonable. The OSHA requirement to provide a safe workplace is not a defense for failing to engage in the interactive process.

The overall purpose of this interactive process is to work with the employee to find a reasonable accommodation. The determination of whether this accommodation is reasonable cannot be based on conjecture or assumptions. The employer can offer to try the accommodation on a temporary basis to determine if it is workable.

During the interactive process, these are things the employer can do: v ask the employee to provide documentation to establish the disability and how the animal assists the person in performing the essential job duties or provides support if the animal is a comfort animal. v request documentation about the animal’s training. v discuss areas where the animal is not permitted to go, for example, sterile/surgical areas. v discuss ways to deal with co-workers who are allergic to or afraid of animals. v discuss other possible accommodations.

WWW.FLORIDADENTAL.ORG

v consider whether allowing the service/comfort animal would create an undue hardship on the operation of the employer’s business as a whole. If so, it: v must pose significant difficulty to the business’ operation. v must be unduly costly. v must be substantially disruptive to the business’ operation. v would fundamentally alter the nature of the business’ operation. v must be more than a mere inconvenience. v consider whether allowing the service/comfort animal would pose a direct threat to the health or safety of the employee, his/her coworkers or patients. If so: v there must be a significant risk that cannot be eliminated or reduced. v it must be based on medical judgment that relies on the most current medical knowledge or best objective evidence. v it must be an individualized assessment.

Always document any denial of a request to use a service/ comfort animal, along with any offers of accommodations. If unsure, seek assistance before you act.

TODAY'S FDA SEPTEMBER/OCTOBER 2018

9

DID YOU KNOW

BOD

INFORMATION ABOUT THE FLORIDA BOARD OF DENTISTRY

ARE YOU REGISTERED WITH THE DOH? Did you know that you must indicate with the Florida Board of Dentistry (BOD) if you are registered with the U.S. Drug Enforcement Administration (DEA)? This is how the BOD will track if you are required to take the opioid continuing education (CE) course mandated by HB 21. As a reminder, each prescribing practitioner who is registered with the DEA is required to take a boardapproved CE course by Jan. 31, 2019.

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

To indicate if you are registered with the DEA: 1. Visit flhealthsource.gov/mqa-services.

2. Do you already have an account? a. Click “Yes” and log in using your MQA Online Services user ID and password (this is what you used when you renewed your license during the last biennium). b. Click “No” and follow the instructions provided to complete your one-time account registration.

3. Once logged in: a. Go to the “Manage My License” section.

MS. CASEY STOUTAMIRE FDA DIRECTOR OF THIRD PARTY PAYER & PROFESSIONAL AFFAIRS

b. Select “Add/Change DEA Registration” in the drop-down list and follow the instructions to indicate if you hold a current DEA registration. i. If you are using the DEA registration of an institution or supervisor, and do not have an individual DEA registration: • indicate that you are NOT registered with the DEA. ii. If you hold a current individual DEA registration: • you MUST provide your DEA number. iii. If you do not have a current individual DEA registration:

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

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TODAY'S FDA

• indicate that you are NOT registered with the DEA.

SEPTEMBER/OCTOBER 2018

WWW.FLORIDADENTAL.ORG

The Doctors Company

legislative corner

WHO’S ON YOUR TEAM?

JOE ANNE HART FDA CHIEF LEGISLATIVE OFFICER

Ms. Hart can be reached at jahart@floridadental.org.

Are you ready for some football? Yes, it’s that time of year again. College football teams and the National Football League are gearing up to pack stadiums with fans who want to see their team win. Teams are successful in games based on their defensive and offensive tactics. The coaches are developing game plans to anticipate what the other team will do and make sure that everyone on the team is covering their assigned position. This can be a winning formula and an effective strategy to achieve their goal.

The dental workforce team consists of the dentist, dental hygienist, dental assistant, dental lab technician (either in-office or separate dental lab office) and the front desk staff. Every position is important and vital to ensuring that the patient wins. From the greeting at the front desk to the interpersonal skills of the hygienist or assistant to the outcome of the dental visit, all components are significant in providing the patient with a great experience.

Well, there is another dental team member that can be included in this dental equation — the community dental health coordinator.

Who is a community dental health coordinator and why would I want this person on my team? Good question! A community dental coordinator is a case manager, community health worker and a patient navigator with a dental background, such as a dental hygienist or dental assistant, who is equipped with the skills and knowledge to help patients access dental care already available in their community. With these additional skills, a community dental health coordinator can help direct individuals to establish dental homes and access routine dental care instead of using

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the emergency department for dental-related issues. Community dental health coordinators typically are recruited from similar communities in which they plan to serve, such as rural and underserved areas. Recruiting community dental health coordinators with this background helps patients feel connected with their dental professional team and helps to remove language and cultural barriers that sometimes hinder access to care in these communities.

Community dental health coordinators also can provide oral education and administer preventive services as allowed in their scope of practice, which gives the patient direct access to preventive care and reinforces the importance of good oral health. As Florida’s advocate for oral health, the Florida Dental Association believes that community dental health coordinators are great additions to the dental team and can be key in providing offensive measures to prevent dental disease, as well as being a defensive blocker — reducing further dental decay.

The American Dental Association (ADA) launched this initiative in 2006 and it has proven valuable in many states — including Florida — that have incorporated community dental health coordinators into their dental workforce. We all want to be a part of a winning team, so check out the benefits of adding a community dental health coordinator to your team. For more information on community dental health coordinators, you can visit bit.ly/2EcUFy8.

WWW.FLORIDADENTAL.ORG

FDA - 2019 Dentists' Day on the Hill

floridadental.org/ddoh

Superior

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WWW.FLORIDADENTAL.ORG

FDAPAC-SUPPORTED CANDIDATES Supported Candidates For the 2018 election cycle, the 20 even-numbered Senate Districts and all 120 House Districts are up for election. Several legislators and candidates have already been elected into office as of the June 22 qualifying deadline and the Aug. 28 primary election. The following individuals listed below do not have to run in the Nov. 6 general election:

Senate District 6

Sen. Audrey Gibson (D) Jacksonville

District 32 Sen. Lauren Book (D) Plantation District 38 Sen.-elect Jason Pizzo (D) Miami

House

District 81 Rep.-elect Tina Polsky (D) Boca Raton District 88 Rep. Al Jacquet (D) West Palm Beach District 90 Rep.-elect Joe Casello (D)

Boynton Beach District 91 Rep. Emily Slosberg (D) Delray Beach District 92 Rep. Patricia Williams (D)

Lauderdale Lakes

District 2

Rep.-elect Alex Andrade (R) Gulf Breeze

District 94 Rep. Bobby DuBose (D)

Fort Lauderdale

District 5

Rep. Brad Drake (R) DeFuniak Springs

District 7

Rep. Halsey Beshears (R) Monticello

District 95 Rep.-elect Anika Omphroy (D)

Lauderdale Lakes

District 8

Rep. Ramon Alexander (D) Tallahassee

District 96 Rep. Kristin Jacobs (D) Coconut Creek

District 9

Rep. Loranne Ausley (D) Tallahassee

District 97

District 13 Rep. Tracie Davis (D) Jacksonville District 14 Rep. Kim Daniels (D) Jacksonville District 18 Rep. Travis Cummings (R) Orange Park District 20 Rep. Clovis Watson Jr. (D) Gainesville

Rep. Jared Moskowitz (D) Coral Springs

District 99 Rep. Evan Jenne (D) Hollywood District 100 Rep. Joe Geller (D) Dania Beach District 101 Rep. Shevrin Jones (D) West Park

District 41 Rep. Sam Killebrew (R) Winter Haven

District 102 Rep. Sharon Pritchett (D)

Miami Gardens

District 43 Rep. John Cortes (D) Kissimmee

District 104 Rep. Richard Stark (D) Weston

District 45 Rep. Kamia Brown (D) Ocoee District 56 Rep.-elect Melony Bell (R) Bartow

District 107 Rep. Barbara Watson (D)

Miami Gardens

District 68 Rep. Ben Diamond (D) St. Petersburg

District 109 Rep.-elect. James Bush (D) Miami

District 70 Rep. Wengay Newton (D)

St. Petersburg

District 110 Rep. Jose Oliva (R) Hialeah District 117 Rep. Kionne McGhee (D) Cutler Bay

District 75 Rep. Michael Grant (R) Port Charlotte WWW.FLORIDADENTAL.ORG

TODAY'S FDA SEPTEMBER/OCTOBER 2018

15

ADS

info bytes

Use a VPN to Connect the WAN to Your LAN with Wi-Fi Say what? Have you ever noticed how the technology field is filled with acronyms?

However, I imagine it’s not any different than any other profession. Let’s break down what the title means. VPN stands for virtual private network. To fully understand what it is, we have to define a broader term: the internet. The internet is global computer network that allows disparate types of devices to communicate with one another using standardized communication protocols. A great portion of this communication occurs over open (public) networks, or what is called a wide area network (WAN).

The internet is just a huge WAN. A local area network (LAN) is usually in one physical location, like your office. If you wanted to connect to your office from home, it’s often easy to do.

Most of that communication is unsecure and can be intercepted or viewed by the curious or those with nefarious intent. A VPN allows you to use the WAN to securely connect you to your LAN. In other words, a VPN allows you to create a secure, encrypted tunnel on the internet to another computer that can decrypt and decipher the information it receives. The VPN allows you to be a virtual part of your local network, thus the name.

A VPN also is helpful with the advance of WiFi. (Yikes, another acronym!) Wi-Fi just means a wireless internet connection. Many times, Wi-Fi is semi-secure, but a lot of places offer free open, public or unsecure access to Wi-Fi. Recently while traveling through the UK and Ireland, many places offered free Wi-Fi access.

Those who offer that Wi-Fi can see what you

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are doing as well as anyone else who is on the same Wi-Fi network with you. That may not be a concern until your identity is stolen. So, when traveling, I used a VPN. In practice, a VPN is a piece of software or an app that runs on a computer, smartphone or tablet that creates the secure, encrypted tunnel for your communications to pass through. The best VPNs do require you to pay for the service.

There are a lot of different ones out there, but I use ExpressVPN because it supports all the devices I use.

LARRY DARNELL, MBA, CAE FDA DIRECTOR OF INFORMATION SYSTEMS

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

Five things to know about VPNs:

1.

2.

3.

If you travel and do any kind of work or financial stuff remotely, use a VPN to secure your communications.

Home users can use VPNs as well — it’s not just for travel, and home networks are the easiest to exploit.

While there are free VPNs, the ones that work the best cost something. A VPN is easy enough for a novice to set up and use but paying for it guarantees support and hand-holding if needed.

4.

VPNs do not make you completely anonymous. It does secure communications, but I would not recommend you flout laws by downloading copyrighted music or videos either.

5.

VPNs do not protect you from viruses or malware either, so take appropriate precautions there as well.

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news@fda UPDATES FOR MEMBERS *Please note that FDA members have their names listed in bold.

Continuing Education Course on Prescribing Controlled Substances

Storm Proof your Practice with the FDAS 2018 Hurricane Guide

The Florida Board of Dentistry (BOD) is aware of controlled substances continuing education (CE) courses being offered that have not been approved by the BOD and will not meet the requirement of HB 21, the new law on prescribing controlled substances.

Some of the courses may even appear in CE Broker. The law was very specific as to who can provide this CE course.

To ensure you are taking the appropriate board-approved course, courses should be searched at bit.ly/2oDHTTg. It’s important to know that the required controlled substance course taken by a provider not authorized by law will not be accepted.

As we move into the fall months, hurricane season is in full swing and, as Floridians, we all know how important it is to be prepared for a big storm. As you go through your checklist at home, don’t forget that preparing your practice is just as important! The FDAS 2018 Hurricane Guide, Storm Proof, is a useful tool that can help you prioritize your preparedness tasks. From stocking the essential items to physically protecting your dental office to making sure you have an effective business continuity/disaster plan in place, Storm Proof has the information to help you get it done!

As required by the Legislature under Section 456.0201, Florida Statutes, each dentist who is registered with the United States Drug Enforcement Administration is required to take a two-hour board-approved CE course by Jan. 31, 2019 and at each subsequent renewal.

This course is included in your 30-hour requirement. More information about this new law can be found at flhealthsource.gov/FloridaTakeControl. If you have any questions, please contact the BOD at info@FloridasDentistry.gov.

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The FDC2019 room block at the Gaylord Palms is now open. Reserve your room for the discounted rate of $199, including FREE self-parking. Make your reservation early so you don’t miss out on staying in the middle of the action.

To make your hotel reservation, go to bit.ly/2LZLYut or contact the hotel directly at 407.586.2000.

CFDDA Newsletter Received ICD Outstanding Cover Award

Go to bit.ly/2Nuuhoz to read the FDAS 2018 Hurricane Guide, Storm Proof, and make sure your practice is ready for hurricane season!

Save the Date for FDC2019!

Mark your calendar for the 2019 Florida Dental Convention (FDC), which will be held on June 27-29! FDC2019 will offer more than 120 lecture and hands-on courses, 300+ leading dental exhibitors and nightly social events. The 2019 dates do NOT conflict with Father’s Day! Go to vimeo.com/282896626 to see what to expect at FDC2019!

SEPTEMBER/OCTOBER 2018

The Central Florida District Dental Association (CFDDA) Newsletter was selected to receive the International College of Dentists (ICD) Outstanding Cover, Division 2 Award for the Winter 2017 issue! Congratulations, CFDDA!

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Congratulations Dr. Ebert!

Dr. Suzanne Ebert has resigned her positions as the Northeast District Dental Association trustee and alternate delegate to the American Dental Association (ADA), and has accepted a position in the new ADA Practice Transitions department. We appreciate the time and service she dedicated to these roles and wish her the best in her new position at the ADA. Congratulations, Dr. Ebert!

Today’s FDA Online Did you know that Today’s FDA is on our website? Make sure to check out the online version at floridadental.org/ member-center/member-resources/publications.

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 Samarah Al-Jamali, Sunrise Tina Amir, Plantation Emily Andrade, Coconut Creek Bethany Beniek, Jensen Beach Alyssa Benitez, Jupiter Maria Bernard Flores, Lake Worth Kathryn Champion, Deerfield Beach Rajvinder Dulay, Tamarac Scott Elliott, Port St. Lucie Peter Fereg, Jupiter Nigel Grandison, Plantation Steven Haas, Davie David Hatch, Plantation Eric Jimenez, Davie Latoya Joseph, Port St. lucie Cintia Kopecny, Deerfield Beach

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Joan La Salvia, Coral Springs Dorotie Lacroze, Coconut Creek Junaid Lakhani, Tamarac Minou Luo, Delray Beach Jordan Ma, Sebastian Leila Macario, Sunrise Kyle Maras, Palm Beach Gardens Brianna Mastrianni, Tequesta Jamar Mckay, Pompano Beach Peter Montini, Palm Beach Gardens Camilo Moynelo Coll, Palm Beach Gardens Chi Nguyen, Port St. Lucie Stephen Norton, Boynton Beach Pratik Patel, Coral Springs Ngoc Pham, Lake Worth Quynh Nhu Pham, Boca Raton Andrea Rodriguez, Lauderhill Emilio Rodriguez Acosta, Plantation Luis Sanchez Cardenas, Coral Springs Wolf Schwartz, Boca Raton Colby Sowers, Riviera Beach Ari Tow, Boynton Beach Wei Yin Vuong, Stuart

Central Florida District Dental Association Jeffrey Allen, Merritt island Naveen Allin, Gainesville Andres Alvarez, Gainesville Siraj Asadi, Orlando Brittany Baker, Winter Park Michelle Bargfrede, Gainesville Austin Belknap, Bradenton Adam Best, Sanford Danielle Brambila, Apopka Christian Cain, Gainesville Steven Calhoun, Winter Park Sumera Chohan, Orlando Richard Collier, Altamonte Springs Eduardo Cortes Contreras, Orlando Michael Davis, Groveland Kimberly Dennis, Gainesville Tara Derakhshandeh, Palm Bay Daili Diaz, Gainesville Domenic Digioia, Gainesville Kaitlin Donovan, Rockledge Kristen Dreyer, St. Cloud Stefhany Duque Rosas, Ocala Mona Durani, Melbourne Kelsey Ebach, Gainesville Anthony Farmer, Gainesville Elizabeth Gause, Gainesville Natalie Hage, Crestview

In Memoriam The FDA honors the memory and passing of the following members:

Ernesto Arill Miami, FL Died: 7/27/18 Age: 83

James T. Yang Plantation, FL Died: 8/2/18 Age: 58

George W. Starks Casselberry, FL Died: 7/29/18 Age: 94

William S. Wells Naples, FL Died: 8/3/2018 Age: 84

Ronald W. Ridge Seguin, TX Died: 8/22/18 Age: 90 Dustin Hickman, Winter Park Nicole Hovencamp, Port Orange Kassandra Ingram, New Smyrna Beach Tanya Jadhav, Altamonte Springs Melissa Jones, Oviedo Katherine Kapernaros, Gainesville Garrett Kever, St. Cloud Madeline King, Orlando Claire Krueger, St. Petersburg John Ledford, Gainesville Holly Malinoski, Gainesville Danielle Miller, Gainesville Natalia Morales, Orlando Gina Najafi, Gainesville Camha Nguyen, Orlando HongAn Nguyen, Gainesville Magda Pacheco, Orlando Miten Patel, Orlando Nathan Reuter, Gainesville Sonia Rivero, Lady Lake Luis Rodriguez, Ocala Whitney Schaff, Gainesville Priya Shah, Oviedo Sara Shah, Winter Park Mena Shenouda, Orlando Ethan Silverman, Melbourne Derek Stallard, Davie Faraz Tartibi, Oviedo SEE PAGE 20

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FROM PAGE 19 Stephanie Thomas, Miramar Travis Trapp, Gainesville Gabriela Vila, Sunrise Tina Vo, Orlando William Waggener, Merritt Island Mark Wells, St. Cloud Jeffrey Westra, Gainesville Ryan Whelen, Satellite Beach Christina Yidi, Miami Sharon Zachariah, Orlando

Northeast District Dental Association Michael Aaro, Jacksonville Nikolas Amini, Jacksonville Kehinde Ayoola, Jacksonville Royce Barlow, St. Augustine Erica Bockhorst, Jacksonville Clayton Celander, St. Augustine Catherine Chiafair, Ponte Vedra Beach Yevah Cueto, Jacksonville Jennifer Dolan, Jacksonville Rajvi Doshi, Jacksonville Thomas Fredal, Jacksonville Bennett Galperin, Jacksonville Veena Gosai, Jacksonville Kyle Houston, Orange Park Sarah Hutson, Interlachen Sebastian Isaza, Belleview Mary Keezel, Cape Coral Alina Lenz, Ponte Vedra Andrew Mancia, Miami John Mazzuoccolo, Orange Park Alexander McClure, Jacksonville Hoang Nguyen, Palatka Chin Park, Jacksonville Alyssha Powers, Jacksonville Phillip Robbins, Gainesville Tatiana Rocha, Jacksonville Katherine Sage, Jacksonville Daniella Sousou, Fleming Island Jenna Starkey, Jacksonville Duy Truong, Jacksonville Amy Valenti, Jacksonville Sarah Veazey, Atlantic Beach

Northwest District Dental Association Emillie Brandt, Eglin AFB Hieu Chau, Pensacola

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Wesley Dent, Lynn Haven Sunny Desai, Pensacola Tauland Kruja, Pensacola Sean Lindsay, Port St. Joe Michael Love, Eglin AFB Neila Nicholson, Milton Youla Noumeh, Destin Heather Perez, Freeport Ramin Rajaee, Crestview Markus Richard, Estero Christopher Roane, Tallahassee Haley Schmitt, Tallahassee Jean Shin, Crestview Mina Sidhom, Gulf Breeze Andrew Webster, Milton

South Florida District Dental Association Jose Abrahantes, Miami Licerba Alvarez Campos, Hialeah Lisandra Amador, Hialeah Raisa Arana, Miami Reshma Baddaloo, Miami Yoxari Batista Mendez, Miami Deeva Bhatt, Cooper City Alberto Blackwood, Miami Gardens Carlos Chirino, Miami Lorena Corzo, Hallandale Beach Angelica Cruanas Morales, Hialeah Yanet Cruz Carmona, Miami Ana De Feria, Miami Katherine Dearmas, Miami Nicholas DeVilliers, Miami Alina Diaz, Hialeah Orlando Diaz Valle, Miami Tyler Dolphin, Miami Ivonne Duarte, Coral Gables Julia E, Miami Eliseo Fiffe, Greenacres Salome Fraga, Miami Sanaz Ghiassi, Davie Resid Goljo, Miami Jovani Gonzalez, Miramar Giovanni Gonzalez, Coral Gables Lysette Gonzalez Perez, Miami Ela Gozlan, Pembroke Pines Alex Gruenberg, Miami Heilyn Hernandez, Hialeah Quan Huynh, Davie Andreina Jativa Garcia, Miami Shores Jonathan Journo, Miami Beach Baha Kablawi, Miramar Mohammad Hadi Kamalpour-Ansari, Davie

SEPTEMBER/OCTOBER 2018

Sara Karim, Pembroke Pines Monika Kunder, Miami Catherine Lopez, Hialeah Alberto Lopez De Castro Bolufer, Doral Leilani Lorenzo, Pompano Beach David Luther, Davie Tijerino Mauricio, Miami Beach Eric Meyer, Davie Marlene Moreira, Miami Erin Muro, Miami Michelle Nguyen, Davie Jose Novoa, Miami Mario Onate Hernandez, Hialeah Deanna Pandolfo, Davie Lorena Pell, Miami Maria Petroche, Davie Dustin Pfundheller, Altoona Tuvy Phan, Miami Loines Pina, Miramar Ricardo Polanco, West Miami Jose Ramirez, Miami Azany Reyes, Miami Alexander Rodriguez Castillo, North Bay Village Justin Ross, Homestead Katrina Sanchelima, Miami Marlie Sanchez, Miami Springs Jordan Siegel, Miami Shaun Smith, Coral Springs Emilia Smith-Alvarez, Key Biscayne Maurice Srour, Miami Ellie Suzuki, Miami Beach Naghmeh Taherian, Davie Lauren Tink, Hollywood Brian Tran, Hollywood Lauren Tuckman, Miami Angela Urruchi, Sunny Isles Beach Omar Vasquez, Miami Lesly Viera, Pembroke Pines Jonathan Wechter, Miami Lorena Wilkins, Pembroke Pines Erick Yglesias Ruiz, Miami

West Coast District Dental Association Andrea Ackley, Sarasota Andres Alberto, Ellenton Abdullah Allawnha, St. Petersburg Anamevys Alonso, Palmetto Glenda Arrabal Morejon, Port Richey Demyana Azer, Trinity Rocio Barocio Torano, Tampa Ana Beyra, Fort Myers Robert Bonser, St. Petersburg WWW.FLORIDADENTAL.ORG

Amanda Boodhoo, Tampa Maria Brown, Seminole Amelia Caceres Tejada, Cape Coral Yuna Choi, Fort Myers Daniel Cocris, Cape Coral Matthew Conley, Labelle Ana Cosma, Tampa Aida Davoodi Kermani, Safety Harbor Dana DeLosa, Boca Raton Marshal Earnest, Venice Jordan Eckardt, Miami Justin Elikofer, Bradenton Andrew Falestiny, Bradenton Garrett Folks, Sarasota Paul Francisco, Odessa Nicholas Gable, Winter Haven Brett Goldstein, Fort Myers Mary Hand, Naples Sean Hatch, Lakeland Rosa Hernandez, Gainesville Binh Ho, Tampa Hetty Hong, Plant City Jose Horak, St. Petersburg Korey Hurley, St. Petersburg Kurtis Hussey, Naples Elizabeth Irons, Seminole

James Ittel, Venice Simona Ivanov, St. Petersburg Miguel Jusino Perez, Naples Joseph Kase, Oldsmar Kelly Kidwell, Tampa Laura Koberda, St. Petersburg Mary Labance, Pinellas Park Allison Leedy, Lakeland Landon Lowell, Naples Meaghan Lutes, Sumterville Sara Maltese, St. Petersburg Virginia McKenzie Melmed, Tampa Camille Medina, Tampa Taylor Minkus, Defuniak Springs Marjan Mirkheshti, Lakewood Ranch Michael Moraguez, St. Petersburg Yuliet Moreno Montiel, Sarasota Amanda Mullersman, St. Petersburg Evan Murrell, Clearwater Robert Musselman, Tampa Kelli Orcutt, Davie Maitry Patel, Tampa Jeffrey Perez, Port Charlotte Tyler Phillips, Fort Myers Logan Poff, Punta Gorda Kaylee Pollitt, Bradenton

Christopher Ramke, Crestview Scott Roemer, Sarasota Brandy Rubinski, Lakewood Ranch Rafaella Sampaio, Fort Myers Jon-Michael Scalercio, Bradenton Jonathan Scott, Lakeland William Scott, North Redington Beach Sirirat Seebunpang, Fort Lauderdale Ruchi Shukla, Brandon Nancy Singh, Brandon Jim Singletary, Tampa Dorian Solomon, Bonita Springs Zinnia Sotolongo, Miami Dylan Tagg, Naples Kimberly Tran-Nguyen, Riverview Timothy Turner, Sebring Yasodhara Vadlamudi, Lakeland Dana Verdecchia, Fort Myers Thomas Veronee, Lake Placid Mateo Vidales, North Port Sabina Vlaeva, St. Petersburg Sherry Walters, Bradenton Matthew Williams, Fort Myers Mohamed Youssef, Davie Alexandra Zabala, Fort Myers

THE FDA WELL-BEING COMMITTEE OFFERS YOU CONFIDENTIAL, PROFESSIONAL ASSISTANCE Alcoholism and drug addiction can touch any of us. ADA statistics have shown that almost 20 percent of all dentists will have problems with drugs or alcohol sometime during their careers!

The FDA Well-Being Committee is a group of dental professionals with personal experience with these problems who can give complete confidential assistance to members of the profession, their staff and spouses.

FDA Well-Being Committee

FDA - Professional Staff

For more information and/or help, contact Dr. Barton Blumberg anonymously at 352-446-7910.

(Private Cell #)

PROBLEMS

WITH DRUGS OR ALCOHOL? WWW.FLORIDADENTAL.ORG

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BOD meeting

BOARD OF DENTISTRY M E E T S I N TA M PA

MS. CASEY STOUTAMIRE FDA DIRECTOR OF THIRD PARTY PAYER & PROFESSIONAL AFFAIRS

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

The Florida Board of Dentistry (BOD) met in Tampa on Friday, Aug. 24. The Florida Dental Association (FDA) was represented by FDA BOD Liaison Dr. Don Ilkka and Director of Third Party Payer of Professional Affairs Casey Stoutamire. Other FDA members in attendance included Drs. Andy Brown, Leonard Britten and Bill Kochenour. Students from Nova Southeastern University College of Dental Medicine and LECOM School of Dental Medicine also were in attendance with Lake Eerie College of Osteopathic Medicine (LECOM) Assistant Dean of Education Dr. Marc Ottenga.

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

The FDA’s petition for variance for its online radiography course was approved. Dr. Bob

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Coleman from Michigan, who was instrumental in developing this course, was present at the meeting and did a great job addressing the BOD’s concerns. Please watch for more information coming soon on this new benefit for FDA members!

Ms. Sissine updated the BOD on the status of the restorative function dental auxiliary (RFDA) proposals discussed by the Rules Committee at its meeting on Thursday, Aug. 23. The committee has reviewed the FDA’s RFDA proposal from 2011 in an effort to allow dental hygienists and assistants to receive additional training to provide restorative functions.

The committee reviewed draft language, which the FDA supports, and will hold a conference call in September or early October to finalize the rule language before sending the proposal to the Hygiene Council for its review. The proposal is on track to be voted upon by the full BOD at its November meeting.

Dr. Miro reported on the Anesthesia Committee’s in-person meeting on Aug. 23. The committee is working through edits to Rule 64B5-14: Anesthesia. There still are several

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issues outstanding and the committee anticipates meeting via conference call before the November meeting. Some of the items discussed were the age of a child (is it 7, 9 or 13); should a permit holder treating a child be required to take the Pediatric Advanced Life Support (PALS) certification course, and if so, how often; should offices of permit holders be inspected every three years instead of every five years; and, should moderate sedation permit holders be required to show they can insert an IV during their inspection.

Ms. Cabazon presented draft language passed by the Hygiene Council in June for Rules 64B5-16.006: Tasks Delegable to a Dental Hygienist and 16.001, Definitions of Remediable Tasks and Supervision Levels. The council attempted to revise and reorder the language to make it easier to understand. Ultimately, the BOD passed a motion directing Mr. David Flynn, BOD counsel, to draft the language so that the remediable tasks are aligned by supervision level rather than education (which is similar to how the current language reads). There also was discussion on taking gingival curettage out of the rule as a remediable task, but since that language is still in the Florida statutes, the BOD left it in the rule even though it was stated on the record that this is no longer taught in dental hygiene programs.

The BOD continued its discussion on the recent opioid legislation signed by the governor, House Bill (HB) 21, and its implications for dentistry and the BOD moving forward. Informed Inc. was approved as a provider of the mandatory continuing education (CE) course. As a reminder, teaching permit holders will be required to take the two-hour CE course on opioids and they now are able to track their CE using CE Broker. The BOD will be doing a complete rewrite of Rule 64B5-17.0045: Standards for the Use of Controlled Substances for Treatment of Pain. There was a multi-board meeting of the boards of medicine, dentistry, nursing, osteopathic medicine, pharmacy and podiatric medicine on June 21 where draft language was proposed. The multi-board group will meet again on Sept. 21 to finalize the rule language. Mr. Flynn presented

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The next BOD meeting is scheduled for Friday, Nov.16, 2018, at 7:30 a.m. EST in Lake Mary. the draft language to the BOD for its review and asked that the members become familiar with the language, as he would like the full BOD to hold a conference call before its November meeting to approve the language. BOD Executive Director Ms. Jennifer Wenhold reminded the BOD that the Department of Health recently rolled out a website dedicated to HB 21 and its impact on providers. You can visit it by going to flhealthsource.gov/FloridaTakeControl.

There were seven disciplinary cases, one informal hearing not involving disputed issues of material facts, one determination of waiver, one recommended order and one voluntary relinquishment that dealt with fraudulently accessing opioid medications, failing to meet the minimum standard of care and Medicaid fraud. If you have not yet attended a BOD meeting, it is suggested that you take the opportunity to attend and see the work of the BOD. It is much better to be a spectator than a participant in BOD disciplinary cases.

And last, but certainly not least, Dr. Bill Kochenour was recognized for his service on the BOD. The FDA thanks him for his years of hard work serving the citizens of Florida and wishes him well in his future endeavors!

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FDA Services Crown Savings Solutions

RECENT THREAT TO FLORIDA DENTISTS ...

If you are a Florida Dental Association (FDA) member, you may have received the following email from us in July 2018, warning of a possibly malicious spam email targeting Florida dentists. Emails like this can put your practice files at risk!

]

NOT an Official BOD Complaint!

]

Many members have notified the FDA that they have received spam email indicating that a complaint against them has been initiated from the following email address: “reportmydr.org�. Additionally, the FDA reached out to the Florida Board of Dentistry (BOD) to confirm that this is NOT an official complaint by the BOD and should be deleted. If you received an email from this email address indicating a complaint has been filed, it is NOT an official complaint and should be deleted.

YOUR DIGITAL PRACTICE FILES MAY BE AT RISK. FDAS Strongly Advises Adding Cyber coverage to your insurance profolio.

The Doctors Company includes $50K in Cyberguard coverage on all malpractice policies because it’s a real risk. You can upgrade to $1 million in coverage starting at $50 per month with Cyberguard Plus.

Call us at 800.877.7597 to discuss your practice’s cyber liability coverage.

hipaa compliance

?

SHOULD YOU ALLOW PATIENTS TO RECORD DENTAL VISITS

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BY RICH CAHILL, VICE PRESIDENT AND ASSOCIATE GENERAL COUNSEL, THE DOCTORS COMPANY

“Doctor, can I record our conversation today?”

Have you ever heard this question from a patient or a patient’s family member? Or, have you ever been worried a patient might record the visit without asking permission? As smartphones have become ubiquitous — giving patients a video and audio recorder that’s always at hand — the question of whether these devices should be allowed in the dental office setting is becoming increasingly more common.

Patients: To Record or Not to Record?

The issue of allowing patients to record their appointments requires balancing potential privacy and liability risks with the potential benefits of improved patient recollection of instructions and treatment adherence. Patient pamphlets and other educational materials handed out at office visits often are lost or forgotten, and patients forget or inaccurately remember a significant portion of information shared at doctor visits. Patients who have a better and more complete understanding of their condition and the treatment plan are more likely to be actively engaged and involved in their dental care.

Despite these potential benefits, it’s typically not the best course to allow patients to record the appointment. The recording devices could be disruptive and potentially intimidating to dentists and staff. In addition, these recordings — unlike the electronic dental record — can be altered or manipulated to create an inaccurate portrayal of what actually occurred. The recordings also can be easily streamed or posted online, raising the issue of patient and staff privacy and HIPAA compliance.

If a patient records a visit without the doctor’s permission, that can result in a loss of trust, which is the basis of a strong dentist-patient relationship. Only about a dozen states nationwide prohibit electronic recordings done without the explicit consent of all participants in the encounter. It’s important to know the specific laws concerning recordings in the jurisdiction where you practice. Regardless, it’s recommended that patients be advised unequivocally that digital recordings by handheld devices such as smartphones are prohibited on the premises in order to protect the privacy of other patients and staff in compliance with federal and state privacy laws.

Post this notice clearly on your practice website, in the conditions of treatment signed by the patient at the outset of the relationship and as office signage near the reception window. Suspected violations should be handled immediately. If this policy is violated, meet with the patient in a confidential setting to discuss the issue and reiterate the office policy. Depending on the circumstances and the status of the patient’s current episode of care, advise the patient that further violations may result in termination of the dentist-patient relationship.

If patients ask to record the visit, encourage them instead to take notes or to have a trusted family member or friend join them for the office visit to help take notes, remember information and ask questions.

Reprinted with permission by The Doctors Company. For more patient safety articles and practice tips, visit thedoctors. com/patientsafety.

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

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Officite

NEW FDA MEMBER BENEFIT! FDA Career Center

careers.floridadental.org

FDA - Career Center

Job Seekers

 FREE and confidential résumé postings email notifications when new jobs  Automatic match your criteria  Save up to 100 jobs to a folder in your account  Upload up to five career-related documents  Access to our diverse suite of career resources

Employers

 Targeted advertising exposure  Easy online job listing management  Résumé search included with job posting email notifications when job  Automatic seekers match your criteria  Member discounts available

Mentorship WHAT IS THE FDA MENTORSHIP PROGRAM? The Florida Dental Association (FDA) Mentorship Program was developed by the FDA Council on the New Dentist as a resource to help dental students gain a practical and professional perspective of dentistry from established member dentists in an effort to facilitate the transition from dental student to practicing dentist.

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

HOW CAN I BECOME MENTOR? Volunteering is easy! Complete and submit a profile by visiting careers.floridadental.org/ementor.

For additional information, please contact Kerry Gómez-Ríos at membership@floridadental.org.

6 hiring staff

TONYA LANTHIER

Ms. Lanthier is the founder and CEO of DentalPost, a tool to help dental professionals connect and make better job choices and hiring decisions by using data. For more information, go to dentalpost .net or contact her at tonyardh@dentalpost.net.

MISTAKES DENTISTS MAKE WHEN HIRING (AND HOW TO AVOID THEM!) Remember the class you took in dental school all about interviewing and hiring terrific team members? No? Of course not! Chances are, there wasn’t one. It’s no wonder that dental teams are frustrated with the process of interviewing and hiring.

Just like prepping a crown, there is a process to hiring that — if done correctly — will yield a great fit, but if not, you will lose time and money and a bit of your sanity in the process. Here are six mistakes dentists make while hiring and a few tips on how to avoid them.

Not Asking the Same Questions

Originally published by Dentistry Today and can be found at bit.ly/2lYQ7nx. Reprinted with permission.

1

Oftentimes, we go into an interview with the plan to “feel the candidate out.” We chat, ask about past experience and school, maybe jot down a few notes and that’s it. Doctors and office managers base their hiring decision on how they “felt” about the candidate. In this case, there is no real metric by which to compare competitors.

This laissez-faire approach will not land you the best fit.

What happens if you like two candidates equally? What if you and your office manager disagree? Without a standardized way to compare candidates, you will not get the most out of your hire. Instead, go into the interview with a standard set of questions each interviewee is asked. Our suggestions are as follows:

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s What type of culture do you think you fit best in? s What does your ideal work place look like? What did you not like about your last job?

the best ways to make culture and core values front and center is to build the job description around your culture and value needs.

s What core values are most important to you? s What do you like about our practice, and why do you want to work here? s What do you think you could bring to our practice, and how could you add value?

With a standard set of questions, you can easily compare each candidate’s responses. Your assessment will be more balanced and based on measurable data rather than emotion.

2

Ignoring Culture Fit and Core Values

Another major mistake is ignoring culture fit and core values.

These two areas supersede skill in any hiring process. Skills can be taught, but culture and values are fixed. If you don’t have candidates who fit with your practice’s culture or values, it does not matter how good they are at dentistry. Eventually, cultural or value disagreements end employer/ employee relationships.

How do you assess a candidate’s cultural preferences and core values? Start by knowing what your values and culture include.

Make sure you have a list of company values, and then ask candidates specific questions about how they relate.

For example, one of your core values may be that patient and team needs come before the individual employee’s needs. Ask candidates how they would feel about covering for a team member on a pre-planned day off. If they share the value of putting patient and team needs before their own, they will let you know they would happily step in. If not, they may ask more questions or try and offer alternate solutions.

In the same way, know your culture. If you are a fast-paced office that requires team members to be proactive, a candidate who loves stability and routine may not be the best fit. One of

3

Excluding Key People from the Process

One of your greatest hiring assets is your tribe — your team of highly motivated employees who already embrace your values and culture. Instead of a closed-door interview, bring in the experts.

Have your team prepare questions that focus on what they need in a new tribe member. Make sure you choose tribe members who will be key to the new candidate’s success in the potential role. Give your team members time to provide feedback after the interview and weigh their opinions heavily in your hiring decision.

4

Monopolizing the Conversation

One of the greatest mistakes is spending 70 percent of the interview (or more!) talking and only 30 percent listening. If you take up most of the conversational space, you miss out on relevant information from the candidate. When interviewing, try and stick to a 50/50 conversational ratio. Your interviews will be much more successful if you remind yourself that listening is more important than speaking.

5

Not Knowing the Answers You Want You have your set of questions, you have your tribe on hand to ask them, you are prepared to listen as much as you contribute to the conversation — you are going SEE PAGE 33

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31

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hiring staff

Skills can be taught, but culture and values are fixed.

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“ ”

to nail this interview! Well, not quite yet. There is one more thing you need to consider before the interview.

What is it you want to hear from an ideal candidate?

If you ask, “What did you not like about your last job?” and candidates reply, “Nothing at all! I absolutely loved my last job!” did you get the information you needed? Do you really want to know about their last job?

Or do you want to know something about a culture or values system they did not work well within? If you get an answer that does not truly answer your question, you need to dig a little deeper. Be prepared with a followup like: “Can you tell me about a job experience that wasn’t a good fit? What was it about that job that didn’t work for you?”

Ignoring Body Language

6

A second part of this scenario is ignoring the body language of the candidate. We all know how much body language (like eye contact, proximity, posture, touch, breathing and perspiration) plays a role in communication. An interview is an excellent place to evaluate how candidates handle a stressful situation.

Do they carry themselves with confidence? Do they smile? Are they eyeing the door wanting to escape? These cues tell you something about how they could potentially communicate nonverbally with patients. If you are not comfortable with the way they present themselves, your patients won’t be comfortable either.

Final Thoughts There is a difference between hiring an employee and building a team. When you set out to build your dream dental team, take time to consider how you will set up an interview experience to deliver the best possible outcome. For more tips on hiring, check out the information provided on DentalPost, where we help dental

professionals connect and create teams who excel.

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new rules

New Rules and Limitations for Depreciation and Expensing Under the Tax Cuts and Jobs Act With the passage of the Tax Cuts and Jobs Act (TCJA), most businesses will experience a change to their taxes in the upcoming filing season. While most changes are prospective and go into effect in 2018, certain changes to depreciation are retrospective and apply to the current filing season. For these reasons, it’s important to understand the changes to depreciation and how it can impact your business now and in future years.

Businesses Can Immediately Expense More Under the New Law Section 179 is an election made by the business to expense the total cost of qualifying property in the year placed in service.

Examples of property that qualify for this election are tangible property, off-the-shelf computer software, certain building improvements and “qualified real property” purchased for the use in an active trade or business.

to a building that is nonresidential real property. Examples include: n security systems

n roofs

n fire protection and alarm systems

n ventilation n HVAC

Improvements do not qualify if they are attributable to the enlargement of the building, the installation of any elevator or escalator, or any improvements or changes to the internal structural framework of the building.

First-year Bonus Depreciation

The TCJA increased the maximum Section 179 deduction from $510,000 to $1 million. The annual limitation on total qualifying property placed in service is increased to $2.5 million, where the deduction allowed is reduced $1 for every $1 over $2.5 million. This change should provide more taxpayers immediate expensing.

Bonus depreciation allows taxpayers to deduct half of the cost of qualified property in the first year and the remaining cost over the recovery period. The new law increases the bonus depreciation percentage from 50 to 100 percent for qualified property acquired and placed in service after Sept. 27, 2017 and before Jan. 1, 2023. This change provides taxpayers an opportunity to immediately expense eligible property acquired after Sept. 27, 2017 — a retroactive change to consider when finalizing the 2017 income tax returns.

The new law also expands the definition of Section 179 property to allow the taxpayer to elect to include “qualified improvement property,” which means any interior improvement

The definition of property eligible for 100 percent bonus depreciation expands to include “used property” acquired and placed in service after Sept. 27, 2017. Used property qualifies:

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Automobiles can be complicated, as there are three distinguishable categories for tax purposes: “passenger (luxury) automobiles” are automobiles weighing less than 6,000 lbs; “vans, light trucks or SUVs” are automobiles built on a truck chassis and weighing less than 6,000 lbs; and, “utility vehicles” are automobiles weighing more than 6,000 lbs. Understanding the category of the automobile will allow you to determine the limitation on depreciation for each year.

The greatest allowable depreciation deduction is: n $10,000 for the first year ($18,000 if bonus depreciation is elected) n $16,000 for the second year n $9,600 for the third year n $5,760 for each later taxable year in the recovery period n if the taxpayer did not use the property at any time before acquiring it. n if the taxpayer did not acquire the property from a related party or controlled group. n the cost of the used property eligible for bonus depreciation should not include any carryover basis of the property, for example in a like-kind exchange.

Changes to Depreciation Limitation on Luxury Automobiles Purchasing and deducting the cost of a vehicle becomes a little more attractive to businesses with the passage of the TCJA. While there are still limits on depreciation that can be claimed for business-related vehicles each year, the TCJA raised the depreciation limits to provide taxpayers larger annual deductions for automobiles placed in service after Dec. 31, 2017.

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Acquisition of a Business The increased bonus depreciation has increased buyers’ incentive to structure their acquisition of a business with substantial tangible assets as an asset purchase as opposed to a stock purchase. This makes the buyer both more interested in structuring the transaction as an asset purchase and places even more emphasis than before on negotiating the purchase price allocation. The revisions for depreciation have placed a significant spotlight on the allocation provision to tangible property qualifying for bonus depreciation, as both the sellers and buyers have significant interest in the allocation.

DEBIE LEONARD TAX SERVICES DEPARTMENT DIRECTOR, SHAREHOLDER EMERITUS, THOMAS HOWELL FERGUSON P.A. CPAS

Ms. Leonard can be reached at DLeonard@thf-cpa.com.

Conclusion Depreciation can be a complex concept for most taxpayers, especially if the goal is to maximize deductions. The TCJA has introduced many taxpayer-friendly provisions, some of which can be applied immediately. Please consult with your tax advisor or do not hesitate to reach out to us for assistance.

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supervision levels

WHAT DO DENTAL HYGIENE SUPERVISION LEVELS MEAN?

MS. CASEY STOUTAMIRE FDA DIRECTOR OF THIRD PARTY PAYER & PROFESSIONAL AFFAIRS

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

Endnotes 1

Rule 64B5-16.006(3)(l), F.A.C.

2

Rule 64B5-16.007(3)(c), F.A.C.

3

Rule 64B5-16.006(2)(m), F.A.C.

4

Rule 64B5-16.001(4), F.A.C.

5

Rule 64B5-16.001(5), F.A.C.

6

Rule 64B5-16.001(6)-(7), F.A.C.

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In case you missed it, in the past year, the Florida Board of Dentistry (BOD) made changes to dental hygiene supervision levels for a few remediable tasks. Today, a dental hygienist who has received formal training can place subgingival resorbable chlorhexidine, doxycycline hyclate or minocycline hydrochloride under general supervision (a change from indirect supervision).1 In addition, by virtue of their training and licensure, dental hygienists are now authorized to perform — without additional training — root planing under general supervision (a change from indirect supervision).2 Lastly, a dental hygienist who has received formal training can now use adjunctive oral cancer screening medical devices approved by the U.S. Food and Drug Administration under indirect supervision.3 The question I always get asked is: What do those supervision levels mean? The answer can be found in Rule 64B5-16.001, F.A.C. But before I get to that, let me take a step back.

What is a remediable task? Well, you guessed it — that’s defined in Rule 64B5-16.001 as well!

Remediable tasks are those intra-oral tasks that do not create unalterable changes in the oral cavity or contiguous structures, are reversible and do not expose a patient to increased risks.

The use of a laser or laser device of any type is not a remediable task. Furthermore, a dentist may only delegate a remediable task to hygienists and assistants if they pose no increased risk to the patient and the training and supervision requirements found in Rule 64B5-16 are met.

Thus, the dentist is the captain of the team and it is up to him/her to delegate a remedi-

SEPTEMBER/OCTOBER 2018

able task; just because the rule allows a task to be delegated does not mean the dentist must always delegate that task.

Now, onto what the supervision levels mean.

There are three levels of supervision in Florida: direct, indirect and general. All three supervision levels require a licensed dentist to examine the patient, diagnose a condition to be treated and authorize the procedure to be performed. The difference lies in whether the dentist must be on the premises when the procedures are being performed and if the dentist must approve the work performed on the patient before they leave the office.

Direct supervision requires a licensed dentist to examine the patient, diagnose a condition to be treated, authorize the procedure to be performed, be on the premises while the procedure is performed and approve the work performed prior to the patient’s departure from the premises.4 Indirect supervision requires a licensed dentist to examine the patient, diagnose a condition to be treated, authorize the procedure to be performed and be on the premises while the procedure is performed. But, the dentist does not have to approve the work before the patient leaves the office.5 General supervision requires a licensed dentist to examine the patient, diagnose a condition to be treated and authorize the procedure to be performed. The dentist neither has to be in the office nor approve the work on the patient. However, any authorization for remediable tasks to be performed under WWW.FLORIDADENTAL.ORG

general supervision is valid for a maximum of 24 months; after which, no further treatment under general supervision can be performed without another clinical exam by a Florida-licensed dentist.6 A full list of tasks delegable to dental assistants and hygienists and under which supervision level they must be performed can be found in Rules 64B5-16.005 and 64B5-16.006, F.A.C. To read the text of all rules referenced in this article, please visit www.floridasdentistry.gov/resources, click on Florida Statues and Administrative Codes and then 64B5 Board of Dentistry under the Florida Administrative Codes tab.

“

The dentist is the captain of the team and it is up to him/her to delegate a remediable task; just because the rule allows a task to be delegated does not mean the dentist must always delegate that task.

�

US Dental Transitions

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therapy dogs

THE DOGTOR WILL SEE YOU NOW THERAPY DOGS PROVIDE PAWSITIVE INTERACTIONS FOR ANXIOUS DENTAL PATIENTS

D

ental anxiety is prevalent and can range from minor to severe: Some patients express feelings of unease, some need medication or anesthesia to complete their dental treatment, and others experience an intense, unreasonable fear that can be so strong it prevents them from receiving routine dental care. Dental fear is a significant barrier to dental care, and is associated with the avoidance of dental treatment, resulting in poor oral health and related quality of life. While there are many ways to deal with anxiety and provide distractions during appointments/ procedures, the most successful and beneficial method is including animal-assisted interventions (AAI). AAI is an umbrella term that describes the use of various species of animals in diverse manners that are beneficial to humans, which includes animal-assisted therapy (AAT), education and activities. AAT is the intervention between therapy animals and humans, with the goal of providing comfort, relieving stress and bringing joy. AAT became popular in the 1960s, and according to the American Ken-

nel Club, significant advances in the field of AAT and the use of therapy dogs have been made since the 1980s.

Interest in these interventions has greatly increased during the last few decades, and today, their value is widely acknowledged. Therapy animals are brought into many settings, such as foster homes, homeless shelters, schools and universities, places struck by natural disaster or other traumatic events, and within various areas of health care, such as nursing homes, hospitals, rehabilitation facilities and mental health institutions. More recently, dental practices have been incorporating the use of AAT to help ease the fear and anxiety that some patients experience during dental procedures.

A substantial amount of research has been conducted that proves animals — particularly dogs — have multiple positive effects on humans’ health and well-being. Numerous stud-

ies have shown that animals can improve our mood and morale, lessen our stress and generally increase our quality of life. According to “Animal-Assisted Therapy: Health and

Medical Issues Today,” some mental health professionals reported, “The evidence is overwhelming, and study after study supports the findings that animals, especially dogs, make us happier, healthier and more sociable.”

Studies have shown that there can be a decrease in pain perception during AAT, especially with children, and that physically touching an animal decreases blood pressure, heart rate, anxiety and stress. AAT can increase the release of endorphins, which helps the body relax, and provides much-needed stress relief.

Simply petting a dog raises levels of serotonin, the neurotransmitter associated with feelings of happiness and well-being, and improves one’s mood. Interaction with an animal can help foster trust and cognitive functioning, and shifts the focus off the patients’ symptoms by distracting them from their current situation and helping them relax to improve their overall well-being.

Many different animals are used as therapy for humans, such as dogs, cats, guinea pigs, rabbits and horses. However, the most common therapy animal is a dog. Many people can easily connect with dogs and feel the love that they provide, which can be therapeutic.

Dogs have provided therapy to humans since the beginning of their domestication. As our best friends, they’ve given us comfort, support, loyalty, companionship, affection and unconditional love. The bond between a human and a dog is extraordinary, so it’s no surprise that dogs are the most popular animal when it comes to animal therapy. One thing all dogs have in common is the ability to evoke strong, positive emotions in humans. According to the American Veterinary Medical Association, “The human-animal bond is a mutually beneficial and dynamic relationship between people and animals that is influenced by behaviors that are essential to the health and well-being of both.” The American Dental Association Center for Professional Success reported that a National Institutes for Health study found that

being in the presence of a companion animal is associated with improvements in mental, social and physiologic health status. Benefits from therapy dogs exceed those from spending time with a friendly human volunteer and can continue beyond the time of the dog encounter.

Although dogs provide unconditional love, not all dogs are a good fit for therapy work. A therapy dog can be any size and breed, but the most important characteristic is temperament.

They must be friendly, patient, confident, gentle and at ease in all situations. They must be properly socialized, well-behaved and enjoy human contact. While incorporating a therapy dog into a dental office is a wonderful idea, dentists should not just bring in their own pet for an afternoon. Therapy dogs are socialized in a variety of situations that a regular pet would never encounter — such as strange, loud noises and the use of a dental drill or other dental equipment — and are trained to react calmly in such situations.

JESSICA LAURIA FDA COMMUNICATIONS AND MEDIA COORDINATOR

Ms. Lauria and can be reached at jlauria@floridadental.org or 850.350.7115.

References: Available upon request.

What is the Difference Between a Therapy Dog and a Service Dog? It may seem like a therapy dog and a service dog are the same thing, but they are very different and not meant to be interchangeable. A therapy dog generally doesn’t have any special training and is not trained to perform specific tasks. Therapy dogs typically work in animalassisted programs and therapy. Their goal is to sense negative emotions and provide people with love, comfort and therapeutic contact, usually in a clinical setting, and to improve their physical, social, emotional and/or cognitive functioning.

Since therapy dogs aren’t limited to working with people with disabilities, they aren’t covered under any specific federal laws, so permission needs to be given from each place that a therapy dog is to be taken. Many places welcome therapy dogs if the dog is trained and obedient, does not pose a threat to others, can SEE PAGE 42

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41

therapy dogs

Benefits: decreases stress and anxiety

provides comfort and produces an automatic relaxation response initiates feelings of calmness

stabilizes blood pressure, lowers heart rate and slows breathing

increases endorphins, oxytocin, prolactin and dopamine — the hormones associated with blood pressure regulation, pain relief, stress relief and joy

raises levels of serotonin, the neurotransmitter associated with feelings of happiness and well-being

influences one’s mood and improves overall well-being

bridges communication gaps and improves cognitive function

improves cardiovascular health and reduces the risk of heart disease, heart attacks and stroke provides distraction from the current situation diminishes overall physical pain

FROM PAGE 41

benefit those present at the facility and does not adversely affect the facility’s operations.

A service dog, however, is covered by federal law and has full public access rights. A service dog is trained to complete specific tasks that provide help to individuals with disabilities that address the disability and assist with life functions. The role of an emotional support dog often is confused with the

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purpose of therapy dogs. An emotional support dog is intended to accompany and comfort someone dealing with anxiety or depression. Animals in both of these categories are daily companions that live with the individual; therapy animals are accompanied by their handler, who may or may not be the owner, and are used for the role they can play in counseling and/or clinical settings.

There are many programs and organizations — both nationwide and locally — for the handler and potential therapy dog to join. These programs are put in place to evaluate the dog and ensure it meets the criteria of therapy work, such as being friendly, well-behaved, with a handler who always has full control of the dog, etc. Organized therapy dog groups provide educational material to volunteers, screen volunteers and dogs, and provide liability insurance for the dog and handler when volunteering in a therapy setting.

Things to Consider Before Incorporating Therapy Dogs in Your Practice Many considerations must be thoroughly examined before implementing AAT in a dental practice.

First, educating the dental team about the uses, benefits and research on AAT is essential. Many dental professionals know a limited amount of information about animal therapy and educating them will increase their support and approval.

Everyone should have input on whether incorporating a therapy dog into the practice is appropriate and practical. An assessment can be done to make sure the specific population could benefit from AAT. You need to be aware of the potential problems as well as the benefits. Some health care providers are hesitant to use AAT. They feel that fear and anxiety could increase when someone is not comfortable with animals, such as larger breed dogs. Patients may not want an animal in their room because of their fears. Some of the common concerns are allergies, cultural beliefs, infection and liability. Moreover, a person’s attitude and culture may not approve or accept animals as complementary therapy. For instance, Middle Eastern and Southeast Asian cultures consider dogs unclean or a nuisance, so animal therapy would not be an option for patients who hold these beliefs. Therefore, cultural beliefs need to be considered before implementing AAT. Not everyone has had pleasant experiences with dogs — knowledge of patients’ and staff ’s experience with animals is essential in assessing whether the introduction of a dog might be disruptive, unsettling, frightening or harmful.

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Skepticism of incorporating a therapy dog can revolve around fear of animal diseases being transmitted to humans, so you must consider the infection control guidelines and potential health risks. Ensuring that the dog has an up-to-date vaccination record and is bathed within 24 hours of the visit decreases that risk. You also can avoid this problem by only bringing the dog in during “clean procedures” — cleanings and simple restorations — and not in a sterile environment where surgical procedures are done. However, most restorative procedures have been shown to deliver the most potent dental-anxiety triggers, which would mean the addition of a therapy dog for these procedures would pose issues, but potentially have profound benefits.

Animal bites and scratches also pose a hazard, which is why it is crucial that therapy dogs have proper temperaments and dispositions. Therapy dogs are certified only if they meet proper behavioral requirements. It’s not safe to claim that therapy dogs do not bite, because any animal can bite regardless of training. Rather, it’s preferred to reassure a patient that the dog is certified. Another concern is the liability of having an animal in a health care facility. Most animal therapy organizations, such as Alliance of Therapy Dogs, Pet Partners and Therapy Dogs International, provide testing, registration, support and insurance for members who volunteer with therapy dogs. While this provides you with basic coverage for accidents that may occur while AAT is provided, it’s also recommended that you seek additional insurance to limit your risk and liability. If appropriate measures, cautions, rules and regulations are followed, the use of animal therapy should not affect the liability risk or the transmission of diseases in a dental practice. Following these steps will help incorporate AAT into the mainstream of health care.

Establish a written therapy animal visitation policy, which covers: Health: The dog must receive an annual health screening by a veterinarian; not currently be taking any antibiotics, immunosuppressive drugs or antifungal medications, and have no stitches or staples present; and, not showing any signs of illness, including vomiting, diarrhea, coughing, etc.

Documentation: A copy of an annual full physical exam by a veterinarian, up-to-date vaccination record (including rabies vaccination) and negative fecal parasite test must be kept on file.

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Grooming: The dog is bathed within 24 hours of the visit and is thoroughly groomed, including nails, teeth, eyes and ears.

Diet: The dog isn’t fed a raw protein diet or raw treats, as raw protein diets lead to increased infectious agent transmission between animals and humans.

Handlers: The handler doesn’t have symptoms of respiratory illness, or have nausea, vomiting or diarrhea; has had appropriate vaccinations (such as flu) and a health screening; and, has not had any unusual stress-inducing incidents that would prevent them from concentrating on being fully engaged during the visit with their therapy dog.

Other protocols include keeping the dog on a leash, providing bathroom breaks and quiet time, as well as restrictions for intact females — they can’t be in heat or nursing puppies.

Identify the logistics: Will there be certain days and times a therapy dog visits, or will it only be brought in as needed?

This will determine when to schedule those patients who would benefit from the interaction on those established days/ times.

Determine where you will obtain a therapy dog. Is it your dog that you’ll get certified, or from an organization that has volunteers who bring in therapy dogs? Who is the contact person in your office for the animal therapy program who will oversee facilitating visits?

Conclusion A therapy dog’s role is to distract patients, pull their focus away from dentistry, and provide a calm and positive energy that brightens up not only the patients, but also staff. The positive impact that therapy dogs have had on patients’ dental experiences cannot be overstated. Incorporating a therapy dog to combat patients’ dental anxiety is a safe, effective and inexpensive approach that has profound potential for improving oral health.

There’s always challenges with any new change or implementation, and any disinterest health care professionals may have in AAT can be a major obstacle to the growth of the field. However, not only overcoming these challenges, but also considering all opinions and standpoints will help make incorporating a therapy dog go smoothly. Remember, not all patients will benefit from AAT, but those who have the potential to benefit should have the opportunity.

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FDA Services The Zenith

Doctor's Choice

20-30 (562)

31-40 (2,044)

Other (39) Native Hawaiian or Other Pacific Islander (4)

41-50 (2,345)

American Indian (16) African-American (458)

51-60 (2,632)

Asian (558) Latino (1642)

61 & older (5,904)

Caucasian (7,179) 1000

2000

3000

4000

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ASSOCIATE (936)

NON-OWNER (712)

INDEPENDENT CONTRACTOR (425)

$100,000 $50,000 0

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OWNER

Seattle Study Club

TOP TIPS TO EFFECTIVELY MANAGE YOUR ONLINE COMMUNITIES AND ADDRESS PATIENT COMMENTS THE MOORE AGENCY

Building an online community is a great way to create and maintain a dialogue with your patients in between dental visits. Whether it’s a blog, Facebook page, Twitter or Instagram account, creating and managing an online community for yourself and/or your practice can be one of the most important things you do. In addition to providing updates and

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information with your patient community, it helps ensure you stay top of mind and your patients keep coming back.

An online community can accomplish several things: n gain interest from current and prospective patients n provide support to patients beyond the office visit

WWW.FLORIDADENTAL.ORG

online communities n increase awareness of new and existing products and services

Tools We Love

n highlight involvement with community and charitable efforts

These resources can help you manage your online community, depending on the social platform(s) you are on:

n gather feedback on ways to improve your practice or a specific product or service

n Twitter: TweetDeck (tweetdeck.twitter.com)

Online community management ensures the dialogue is productive for you and your patients. It’s easy for patients or followers to take topics to a negative place or use the dialogue as an opportunity to issue a complaint. While the temptation may be to simply delete the post or respond tersely, the fact is that the rest of the online community is “watching” your actions. It’s critical to show poise, professionalism and respect to every post. It’s also important to take the time to think through the question and frame the answer in a way that will prevent additional follow-up questions or a potentially negative response. While you can’t control every comment from followers, your response may help prevent negative feedback.

For community management to be effective, your posts need to be frequent (ideally two to four per week on one platform) and you should aim to respond to comments and posts within 12 hours if possible. With the social nature of platforms like Facebook, it’s important to demonstrate to your entire audience that they are valued.

2. are some best practices by social platform for 3.

Here responding to comments/feedback: n

Facebook: Check wall posts, tags/mentions, notifications and photo comments two to three times a day. TIP: “Like” and engage with positive comments to keep them at the top of relevancy.

n Twitter: Due to Twitter’s real-time nature, aim to respond to @mentions within one to two hours if received during business hours. n Instagram: Check photo comments two to three times a day.

This shows your followers that you value their questions and comments, and are addressing them or thanking them for their loyalty.

WWW.FLORIDADENTAL.ORG

n Facebook and Instagram: Facebook Business Manager (business.facebook.com) n LinkedIn: Hootsuite (hootsuite.com)

To ensure that all posts and responses are consistent and onbrand, create a social response plan, which may include the following: n

Overall message tone: Is it more professional and polished, or more friendly and informal? Can you inject light humor in your posts, or should you keep them mostly straightforward?

n

Hide or remove comments with inappropriate language, threats, HIPAA compromises (such as photos where individuals’ faces are shared without consent), or negative mentions of a specific doctor.

n

In situations where the negative comment warrants a response, consider a direct message to that user. Only take this step if you think the communication will be productive.

n Always respond to positive comments, even with a simple “Thank you!” or “You’re welcome!” n Respond to neutral comments that are unlikely to turn into negative conversation. n Identify potentially sensitive questions or comments and determine the best course of response. These may include patient complaints and questions on cost, billing or office policies. In some cases, your legal team may want to review sample responses. Planning for potential scenarios in advance will help you address them more quickly and effectively.

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FDAS - Crown Savings

PSC Group, Inc.

servant leadership

HOW SERVANT LEADERSHIP IS CRITICAL TO YOUR DENTAL PRACTICE’S SUCCESS

“

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It is a terrible thing to look over your shoulder when you are trying to lead — and find no one there.

– Franklin D. Roosevelt.

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”

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Leadership: This is a word that we most often associate with specific character traits, such as charisma, intelligence, extraversion, integrity, creativity and self-confidence. Certainly, these attributes are helpful for leaders, but are predetermined personality traits really the key to being a good leader? Most evidence would suggest not. 1 Leading my dental team often is the hardest part of my day. In my office, different personalities, different genders, different cultures and different skill sets are on a collision course every day. As the leader, it’s my job to create a harmonious team that will function flawlessly and seamlessly every day.

Leadership often is confused with dictatorship. When a leader acts as dictator, they feel empowered because they appear to have control. In reality, the team’s identity, confidence, openness and support are suppressed. Often, employees will hold back ideas or opinions because they may feel that their contributions aren’t valued and only the dictator’s ideas are heard instead of the team’s. In a dental office, this can impair the dentist’s ability to attract the best and brightest team members. Are you frustrated with your staff turnover or the quality of staff available for hire? If so, then reflect on your leadership style.

In comparison, “the servant-leader shares power, puts the needs of others first, and helps people develop and perform as highly as possible.”2 Servant leadership inverts the “power pyramid,” placing the dental team at the top of the pyramid. Instead of the team working to serve the doctor, the doctor exists to serve the team. When leaders shift their mindset and serve first, they encourage team members to offer their ideas in an open environment, which results in higher performance and engaged, fulfilled employees. The servantleader philosophy is at the core of who we are as dentists. After all, at the heart of dentistry is our service to our patients and community.

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While the servant-leadership philosophy is employee-centric and the goal is to foster innovation and new ideas, it doesn’t mean that your team can run unchecked. Employees who aren’t eager to be coached, are unreceptive to constructive criticism or disruptive to the team should be fired. It’s that simple. Good leaders address problematic employees head on. Holding on to an employee who disrupts the cohesion of the rest of the team is far costlier in the long term. The cost will add up in time spent repeatedly counseling the employee, apologizing to patients, reorganizing office teams to minimize the disruption of the “bad apple,” etc.

Certainly, firing an employee is never fun and can be emotionally draining for both parties.

However, anyone who does not share your vision should be removed from the team. You will be a better leader for making the right decision in the end.

Our ability to lead our teams is perhaps the most critical to our success in our practices, but many of us rarely spend time to develop this skill. For most of us, leadership is a skill that takes investment, directed effort and practice to develop. Unfortunately, few of us have the innate ability to lead or the predetermined personality traits previously mentioned.

As of this writing, there are more than 29,000 books that can be purchased on Amazon regarding this subject. Conversely, I find that there’s a significant lack of dental continuing education (CE) on leadership. Yet, if you look at the business world, almost all conferences for major corporations focus on leadership skills. Most dental CE courses are focused on how to produce more now by adding any number of procedures to your practice and how, by doing so, you can improve your bottom line.

While I am aware that dentistry is a business and our bottom line is one measuring stick of our success, I believe that at the core of every successful dental office is a good leader, and that good leadership will do more to improve a bottom line than anything else.

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DR. CJ HENLEY

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

References: 1. Judge T.A., C. A. (2004).

Intelligence and leadership: A quantitative review and test of theoretical propositions. J Applied Psychol, 89: 542–552.

2. Servant Leadership Institute. (2018). Retrieved from https://www.servantleadershipinstitute.com/.

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Quick Email Tips 5 to Keep You Out of Trouble 1.

Never assume that an email is from whom it says it is from. Email can be — and is — easily “spoofed.” A spoof is an email that looks like it came from someone you likely know.

2.

Never blindly click links in any email. No matter if it is from someone you know, your bank, Apple, UPS, FedEx or even your system administrator, you can hover over the link and likely see it is not what it seems to be. If you have a question, call the person or use a separate method to communicate with a company to verify before taking any action. Attachments also can be corrupted, so be extremely cautious of those as well.

3.

Never send information like passwords, your Social Security number, bank information or any other personal data via email. You don’t know who sees it on the other end and potentially while in transit. Unencrypted email is easy to access, even without your email being hacked. Suffice it to say, your email can be “overheard” — similar to someone standing at your door while you are on the phone.

4.

Be extremely cautious when using “Reply All” and forwarding email strings. There may be conversations in the thread that others don’t need to see or may be proprietary. It also may have unintended consequences for other users who use “Reply All” back and didn’t notice all the people on the email.

5.

Often, email can carry a certain tone even if you didn’t mean for it to, so take great consideration before clicking send. It is the same as what you say out loud — once it’s out there, you can’t take it back — and in electronic form, it lives forever.

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dental plans

KEEPING YOUR PATIENTS WITH AN IN-OFFICE DENTAL MEMBERSHIP PLAN Today’s delivery of dental care and payments is changing rapidly. More and more patients are concerned with the lack of dental benefits within their “dental insurance” and their household annual dental expenditure. All the while, Baby Boomers are retiring without a dental benefit in their future. Implementing an in-office dental membership plan is a way for dentists to address these concerns. I’ll highlight an alternative to a traditional payment method and provide personal insight and guidance for an in-office dental membership plan.

DR. CHRISTOPHER BULNES

Dr. Bulnes is a general dentist in Tampa and can be reached at 813.259.9000 or trimile26@ gmail.com.

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Traditional dental offices offer fee-for-service, accept “dental insurance” or a combination of both to provide care and receive payment.

With the diminishing amount of dental benefits contained within “dental insurance” and/ or the loss of dental benefits due to retirement or other factors, dental offices are faced with a conundrum. An in-office dental membership plan may enhance the doctor/patient relationship by providing a membership-based fee schedule to alleviate the patients’ financial concerns. For example, the in-office dental membership plan can cost the patient $500 annually, which can include two comprehensive exams, two cleanings and bitewing X-rays. As an additional membership benefit, the patients can receive 15 percent off all other services.

This is a customizable example of how a basic in-office dental membership plan can be structured. Each dental office operates differently, carries different overhead expenses and the

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figures should be adjusted accordingly. Think of an in-office dental membership plan as a Costco or Sam’s Club membership.

In my experience over the years, patients have expressed concerns with the loss of their dental benefits due to retirement or overall economic strain to afford a dental benefit or even dental care. This led me to develop my own in-office dental membership plan and my goal was two-fold: Provide my existing patient base with an alternative benefit model and retain existing patients. I used my existing fee schedule, the guidance of the Florida Dental Association and a consultation with my attorney. After evaluating my existing fee schedule and office financials, I weighed the pros and cons.

The pros: The office can achieve a high patient retention and allow the participating patients to market the membership plan to their friends and family. The con: Convert the fee schedule from the existing patient base to an internal discounted dental pan, which in the short term reduces income. The membership plan is not something I market to the public, it’s purely an internal marketing campaign and member-

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ship program, and no additional expenses are incurred for the internal plan.

The American Dental Association’s Council on Dental Benefit Programs developed a toolkit to help member dentists implement their own in-office dental plan, which can be found at bit.ly/2Q59fyb. An alternative option is to use the services of Quality Dental Plan (qualitydentalplan.com), Kleer (kleer. com) and Simple Dental Plans (simple.us) to help implement and market your plan. Nevertheless, consultation with an atWWW.FLORIDADENTAL.ORG

torney is highly encouraged in order to be in legal compliance with state laws and rules pertaining to dentistry and the ability to market this product to the public.

If you have questions, please don’t hesitate to contact my office at 813.259.9000 or trimile26@gmail.com.

You also can contact FDA Director of Third Party Payer and Professional Affairs Casey Stoutamire, Esq. at cstoutamire@ floridadental.org or 850.350.7202.

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human resources

MAKING YOUR OFFICE A FUN PLACE TO WORK AND OTHER TIPS TO KEEP GOOD EMPLOYEES

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One of the most significant challenges for a dental office is to find and retain talented team members and keep them happy. There are a lot of books and managerial courses that are strictly on this subject. In large firms, it’s handled by several people. In the private dental practice, it essentially falls on the dentist and any team member delegated to help with this.

Every book or article I’ve read about job happiness states that money is only part of the equation to retain team members. Sure, you must pay a living wage and be competitive — that’s a given. We also pay for half of their health insurance and have a retirement plan. These are both important to our employees.

DR. LARRY SUTTON

Dr. Sutton is a general dentist in Ocala and can be reached at drsutton@suttondentistry.com.

After that, it comes down to making the office a fun place to work. We’re the ones who are in the practice every day. I’ve found that if we’re having fun, it’s contagious and most patients come along for the ride. (There’s always that one stick-in-the-mud, but hopefully, it’s the exception.)

Valuable employees are constantly told and shown how important they are, because it’s true.

Many of us have many team members who have worked with us 10 years and beyond. They are just as much the face of the practice as the dentist. Because of this, keeping our culture — great customer service in a fun atmosphere — is important.

That said, we truly seem to handle a fair amount of decisions together. When you have team members who have worked with you for a decade or more, it’s “our practice.” I certainly feel that way. We’ve collectively invested our time — human capital, if you will — to make our office a fun place to work.

Any practice’s life will have times where it experiences changes in personnel. There’s no way around it. Moving, marriage and pregnancy, underperformance, a change in careers — these are just some factors that affect personnel.

One rule that’s just common sense is to treat your employees like you want to be treated. I think being courteous and nice goes a long way in life. Every so often I try to do a few fun things with my staff. We’ve taken advantage of the Central District Dental Association’s meetings many times. If it’s a fun location, I tell staff to bring their families. We’ll meet one night for a meal. Other than that, have fun and check out a class if it interests you.

It’s a sad reality that we also must sometimes deal with an employee who is not fitting in or doing their fair share. I usually know about both through observations and staff either hinting or stating the obvious. They truly want the best for the office and our patients, and this is one more example of how they care. Letting someone go is one of the toughest things I have to do. That said, after it happens, more than one team member will say it was about time or wonder what took me so long.

Currently with unemployment low, it’s a challenge to find new team members. Many employers have seen prospective employees not show up for interviews. Another surprise is someone accepting a job and then not showing up for their first day of work. Because of this, treat your superstar team members like gold. I’ll continue to try my best as well.

Photo: Dr. Sutton and his team enjoy some holiday fun!

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compleat dentistry

5 STEPS FOR A GREAT TEAM! Leading a successful team is one of the greatest challenges of running a dental practice. The young dentists I speak with often are intimidated by leading a team, and the older dentists often just ignore the team, which makes everyone in the office miserable. Finding and keeping great staff members is a challenge.

DR. EDWARD HOPWOOD

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

Compleat dentistry is a slower-paced, deliberate style of dentistry, espoused

by Pankey, Dawson and so many others, in which the dentist knows the patient well, knows the work, knows their own abilities and limitations, and uses this knowledge to take care of the patients who trust them with their care.

The world will change, but the principles of compleat dentistry will remain the foundation of an exceptional practice. The spelling is an homage to Isaak Walton, whose book, “The Compleat Angler,” was about so much more than fishing.

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When I first started out, I looked for courses on team development. It was so disappointing to sit in a lecture (with my team) and hear the speaker exclaim, “Doctors, quit being so cheap — everyone in the office deserves a raise!” Then all the staff would clap, and the doctors would squirm. Or, there’s the slick-suit guy who recommends that you rent a limo, take a ride to the nearest shopping mall and hand out $500 to each team member with the instructions that they have to buy something for themselves and bring back any money they don’t spend. Or, I’d hear the stories about someone who took their entire office to Hawaii or on a cruise … only to hear the follow-up story where one of their team members quit once the cruise was over.

Now, I’m not opposed to paying our team members well. Nor am I opposed to nice gifts.

But the problem with these type of gifts is that we are looking to build a great team and keep them together for many years. The limo with the $500 for the shopping mall is great, but then what are you going to do next year? And the year after? Eventually, you’ll have a hard time finding enough unicorns to pull a golden chariot to the Mercedes dealership where each person gets $50k to spend on any car. To me,

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pay is something you earn, and gifts are heartfelt things I pick out for my staff – I show them I care by what I pick, not by how much I spend.

Throwing money at someone is not a gift.

But then the question remains: How do you build and maintain a great team?

Well, to me, I think it’s valuable to recall Maslow’s Hierarchy of Needs, which is a pyramid of human needs laid out. Our basic needs are at the bottom and once we are stable on the bottom level, then we can begin working on the second level, then the third and so on.

The bottom two levels (physiological and safety needs) represent basic needs like food, water, clothing and shelter. Fortunately, in our society, it’s relatively easy for all mentally rational people to form a nice base for their pyramid.

When we look at the pyramid, we tend to think about where we stand, how far we are progressing and what we need to accomplish to advance to the next level. When it comes to team development, we need to remember that our team members also are trying to establish their own pyramids and climb to the next level.

Anyone who works in a dental office will have their basic needs met and has a firm foundation on their physiological and safety needs.

The next two levels (love/belonging and esteem) are psychological needs and these represent the greatest opportunity we have to offer our team members. The well-run dental office can be a place where the employees can climb to higher levels on this hierarchy — a place where they can develop into better people.

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We’re often working to improve our progress on this hierarchy and we can encourage our co-workers to do the same.

Relationships often are complicated, and the same is true for those working in a dental office. We have the incredible ability to make our offices a place where there are loving relationships between team members and with our patients. The sort of love the Greeks would describe as philos (and certainly not eros!) is evident in our office. It makes me smile when I watch our patients interacting with our staff, each genuinely concerned about the other. While our office team can be accurately compared to a family (for better or worse), there is no doubt that each member feels a sense of belonging to a special group.

We all know that we’ll be there for any team member when they need it. Providing an environment where a team member can find love and belonging is a huge help in their personal development.

As for the next level, esteem, we work with people who have as little as 0-2 years of education after high school. Unfortunately, in a society where everyone seems to go to college, this lack of education often leaves our employees with low self-esteem.

This is where the dentist has the chance to encourage our employees to develop their talents and use them to their fullest WWW.FLORIDADENTAL.ORG

extent, thus building their self-esteem. My assistants know they have special talents they love to use — one shines at lab work, the other excels at new patient exams. One enjoys chairside assisting, the other loves fabricating provisionals. For the hygienists, scaling is a small part of a job that involves patient education and establishing and maintaining health. My office manager has a chance to shine when interacting with phone calls and challenging personalities. She has a great foundation in running a small business.

If we build a solid enough foundation, then we are free to pursue the ultimate goal of self-actualization and the selffulfillment that comes along with it. This requires a balanced foundation that is more than could be provided by a work environment alone. But I think there is a tremendous opportunity to facilitate and enable the personal development of our employees. The absolute best thing I can reward my team members with is a place to develop into the best people they can be, a place where their personal development is encouraged. And what will I offer them next year? A chance to further develop their pyramids. That’s certainly much better than anything they could buy at a shopping mall.

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BY DRS. JASBIR UPADHYAYA*, FARAJ ALOTAIBY*, DONALD M. COHEN, NEEL BHATTACHARYYA AND NADIM M. ISLAM

A 97-year-old female visited her dentist for annual follow-up appointment of oral lichen planus. Upon seeing a pebbly and papillary-looking lesion in the mid-palate, he referred the patient for evaluation to Dr. Alan Fetner, a periodontist in Jacksonville, Fla. The lesion presented with a red and white pebbly and papillomatous surface (Fig. 1). The patient had no symptoms and was unsure of its duration. She was partially edentulous with a few teeth in the upper jaw. Her medical history was significant for hypertension, a massive stroke three years ago, idiopathic thrombocytopenic purpura, oral lichen planus, a joint replacement and glaucoma. At the time of presentation, her medications included losartan, ranitidine, tramadol, aspirin and latanoprost eye drops for glaucoma. An incisional biopsy was performed by Dr. Fetner and the tissue was submitted to the University of Florida College of Dentistry Oral Pathology Biopsy Service for histopathologic examination and interpretation.

Question: Based on the clinical findings, what is the most likely diagnosis?

Fig. 1a: Clinical presentation of the papillary lesion on the hard palate. The patient has only a few teeth in the upper jaw.

Fig. 1b: A closer view clearly demonstrates a pinkish, normal appearing mucosa-colored papillary lesion with focal areas of redness and erythema. The lesion is well-demarcated from the surrounding mucosa.

A. Inflammatory Papillary Hyperplasia B. Squamous Papilloma/Papillomatosis C. Granulomatous Condition D. Darier Disease E. Verrucous Carcinoma

SEE PAGE 72 WWW.FLORIDADENTAL.ORG

Fig. 2: Histologic presentation of the lesion demonstrating an epithelial neoplastic process exhibiting a deceptively benign appearance. The rete ridges are broad-based with pushing margins into the underlying connective tissue. An intense inflammatory infiltrate (shown with yellow arrows) is seen immediately subjacent to the rete ridges. This presentation is characteristic of verrucous carcinoma.

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diagnostics FROM PAGE 71

Diagnostic Discussion A. Inflammatory Papillary Hyperplasia Incorrect, but an excellent choice. The location and the localized papillary clinical presentation raise the possibility of a reactive hyperplastic epithelial or connective tissue process with papillary/verrucoid appearance. Inflammatory papillary hyperplasia (IPH) most often presents in the hard palate (as noticed in our patient) under dentures worn 24 hours a day without proper cleaning. IPH is a reactive response to a local irritant and usually is reported to develop beneath dentures that are either ill-fitting, have poor denture hygiene or are worn 24 hours a day. Since it occurs at any age and with equal gender distribution, this condition cannot be excluded based on the age and gender of the patient or on the clinical presentation of a white to red, pebbly lesion. Approximately 20 percent of denture wearers who wear them 24 hours a day have IPH. Candidal infection has been implicated in IPH, and the hard palate is the most common location. Less frequently, IPH also can be seen in dentate patients, especially in people who are mouth breathers or have a high vaulted palate. IPH typically is asymptomatic — as in our patient — and the mucosa has an erythematous and pebbly or papillary surface just as is seen in this patient (Fig. 1b). Removal of the denture may allow the erythema and edema to subside and the tissues may resume a normal appearance. However, the histology of the lesion was not compatible with IPH. But, the keratotic surface of the lesion demonstrated candidal colonization as typically is seen with IPH.

B. Squamous Papilloma/Papillomatosis Incorrect, but a reasonable thought. The papillary clinical appearance of the lesion also raises the possibility of a papilloma. This is a benign proliferation of stratified squamous epithelium, presumably induced by human papilloma virus (HPV). Of the many (>70) HPV subtypes, HPV-6 and HPV11 have been identified in up to 50 percent of oral papillomas.

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These often are seen in individuals 30-50 years old and appear with equal frequency in both men and women. The sites of predilection include the soft palate, tongue and lips. Squamous papilloma is a soft, painless, usually pedunculated exophytic growth with numerous fingerlike surface projections that impart a “cauliflower” or wart-like appearance. Depending on the amount of surface keratinization, the lesion may be white, slightly red or normal in color. These lesions usually are solitary and typically enlarge rapidly to a maximum size of about 0.5 cm, which is very much unlike in our patient where the lesion presents as a diffuse papillary mass and not as an isolated lesion (Fig. 1). Squamous papillomas are difficult to clinically distinguish from verruca vulgaris (the prototypical virally induced papilloma), condyloma acuminatum and multifocal epithelial hyperplasia. Squamous papillomas are treated by conservative surgical excision, including the base of the lesion, and recurrence is unlikely. Frequently, papillomas have been left untreated for years without any signs of enlargement or malignant transformation.

Extensive coalescing papillary lesions representing papillomatosis of the oral mucosa may be seen in a few skin disorders and syndromic conditions, like nevus unius lateris, acanthosis nigricans, focal dermal hypoplasia syndrome and Down syndrome. Our patient, however, did not exhibit generalized papillary lesions in other parts of the oral cavity or on the skin.

Therefore, the possibility of florid papillomatosis is ruled out.

C. Granulomatous Condition Incorrect, but a good guess. The clinical presentation of a rough and papillary surface raises the possibility of some type of granulomatous condition. Numerous etiologies can lead to granulomatous diseases manifesting in the oral cavity, most of which are rare occurrences. These include infectious diseases such as deep fungal and bacterial infections (TB, histoplasmosis), immune-mediated conditions such as chronic granulomatous disease, Crohn’s disease and sarcoidosis, foreign bodyinduced granulomas and rare conditions of unknown etiology such as Wegener’s granulomatosis.

The patient’s past medical history being negative for immunemediated conditions, except lichen planus, rules out the WWW.FLORIDADENTAL.ORG

possibility of chronic granulomatous disease, Crohn’s and Wegener’s. The clinical presentation also rules out Wegener’s since the latter occurs more often on the gingiva with the appearance of “strawberry” gingivitis. And, oral lichen planus does not present as a granulomatous condition. The patient is not immunocompromised and there is no history of persistent coughing, fever and weight loss, which rules out the possibility of TB. Most oral lesions of histoplasmosis occur with a disseminated form of the disease. The patient did not present with any indications of a disseminated disease. Also, histology of the biopsied tissue was not compatible with any infectious process (Fig. 2). Foreign body granuloma cannot be ruled out based on clinical findings and medical history. The histology of the lesional tissue, however, is negative for any type of granulomatous condition afflicting the mouth (Fig. 2).

D. Darier Disease Incorrect, but a good differential. Darier disease (DD), also known as keratosis follicularis or dyskeratosis follicularis, is a rare autosomal dominant genodermatosis. It’s caused by mutations of the ATP2A2 gene, which encodes a sarcoplasmic reticulum calcium pump. It’s clinically manifested by hyperkeratotic papules primarily affecting the seborrheic areas on the head, neck and thorax, with less frequent involvement of the oral mucosa. The oral lesions usually are asymptomatic and discovered on routine dental examination. Patients present with numerous erythematous, often pruritic, papules on the skin of trunk and scalp that develop during the first or second decade of life. Oral lesions are seen in 15-50 percent of cases.

These consist of multiple, normal-colored or white papules that typically are seen on the hard palate and alveolar mucosa.

If numerous enough to be confluent, these lesions result in a cobblestone mucosal appearance, as seen in our patient. If the palatal lesions are prominent, the condition may resemble IPH or nicotine stomatitis. Patients with DD may exhibit pits and keratosis on the palms and soles. The nails may show longitudinal ridges or painful slits. The lesion seen in our patient somewhat had the cobblestone architecture, but no skin lesions, palmoplantar keratosis or nail lesions were reported.

Treatment of DD depends on the severity of the disease. Photosensitive patients should use sunscreen and minimize exposure to hot environments. Keratolytic agents may be applied to the lesions in relatively mild cases. Systemic retinoids often are beneficial for more severely affected patients.

E. Verrucous Carcinoma Correct. Verrucous carcinoma (VC) is an extremely low-grade variant of the more common squamous cell carcinoma (SCC).

It’s associated with chronic use of chewing tobacco or snuff, typically arising in locations where tobacco is habitually held, such as the labial/buccal vestibule. It’s important to remember that in chewing tobacco users, a regular SCC is much more likely to develop than this low-grade variant. VC predominantly occurs in men older than 55 years of age, which is unlike this case. The most common sites include the mandibular vestibule, the buccal mucosa and the hard palate. It’s usually extensive at the time of diagnosis and may be present for two to three years before initial presentation and diagnosis. The lesions typically are diffuse, well-demarcated, painless, thick plaques with prominent papillary or warty architecture, just as presented in this patient. Metastasis is extremely rare and the lesions are treated by surgical excision without radical neck dissection. The prognosis is excellent with 90 percent of patients being disease-free after five years. Radiotherapy is not indicated.

Microscopically, VC exhibits a deceptively benign microscopic appearance. Histopathologic examination of the biopsied lesional tissue revealed a malignant neoplasm arising from the surface epithelium exhibiting deep parakeratin clefting. This atypical epithelium invaded the underlying connective tissue with broad-pushing, large arborizing and bulbous rete ridges, which is very much characteristic of VC (Fig. 2). An intense inflammatory cell infiltrate was noted in the subjacent connective tissue (Fig. 2, shown with yellow arrows). An adequate incisional biopsy or multiple deep biopsies may be required for the diagnosis of VC. Adequate sampling also is necessary because conventional SCC develops concurrently within up to

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

FROM PAGE 73

20 percent of VCs. Appropriate treatment comprises of surgical excision, but as for SCC, extensive surgery typically isn’t required.

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

DR. BHATTACHARYYA

References: Walvekar RP, Chaukar DA, Deshpande MS, et al. Verrucous carcinoma of the oral cavity: a clinical and pathological study of 101 cases. Oral Oncol 45:47-51, 2009 Rekha KP, Angadi PV. Verrucous carcinoma of the oral cavity: a clinic-pathologic appraisal of 133 cases in Indians. Oral Maxillofac Surg 14:211-218, 2010 Addante RR, McKenna SJ. Verrucous carcinoma. Oral Maxillofac Surg Clin North Am 18:513-519, 2006

DR. COHEN

Bouquet JE. Oral verrucous carcinoma – incidence in two U.S. populations. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 86:318-324, 1998

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

DR. ISLAM

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

The Florida Dental Association is an ADA CERP Recognized Provider. ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry. Concerns or complaints about a CE provider may be directed to the provider or to ADA CERP at www.ada. org/goto/cerp.

*Residents in Oral and Maxillofacial Pathology University of Florida College of Dentistry

The dental professors operate a large, multi-state biopsy service.

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

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REQUIRED STATEMENT OF OWNERSHIP FOR TODAY'S FDA

career center

The FDA’s online Career Center allows you to conveniently browse, place, modify and pay for your ads online, 24 hours a day.

Our intent is to provide our advertisers with increased flexibility and enhanced options to personalize and draw attention to your online classified ads!

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

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

EXTRACTED DATE

JAN/FEB MARCH/APRIL MAY/JUNE

JAN. 10 MARCH 10 MAY 10

JULY/AUG SEPT/OCT NOV/DEC

JULY 10 SEPT. 10 NOV. 10

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

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General Dentist. Rare Opportunity: Rock Star Dentist needed for an opening at our location in central Ocala, FL. If dentistry is your passion and patient care is your love, join a growing organization that is setting the standard in today’s dentistry.

Enjoy working as the sole practitioner in a modern completely digital, state-of-the-art, PPO/FFS practice; where our focus is to provide patients with the “Wow” experience.

We are actively involved in helping not only our community, but also we participate in a volunteer program that travels abroad. Diagnosis and treatment planning are critical to the health and wellbeing of our patients.

Experience complex treatment planning with a team of doctors’ approach, where you have the option to collaborate with our doctors and specialists leading to the best treatment plan. Dare to be exceptional, Join the Narducci Dental Group Team. ndg@ narduccidental.com.

LOCUM TENENS GENERAL DENTIST OPPORTUNITY: Spring Hill, FL -- The Gentle Dentist. If you’re looking to make your professional mark on a community, this is your chance. Build valuable relationships with patients and get involved with the greater community of Spring Hill, FL while providing top-notch dental care. Our talented and dedicated support team will work alongside you to help ensure your success.

You’ll enjoy the following: Daily base rate; Practice 2 - 5 days per week; Potential to become permanent opportunity. Candidates must be licensed to practice in the State of Florida with no board reprimands or issues and have a valid DEA license.

Prefer 3+ years of general dentistry experience. Apply via this posting or send resume to kschmidt@dental-partners.com. www. puredentalbrands.com.

SEPTEMBER/OCTOBER 2018

General Dentist -- Spring Hill, FL Part Time.

If you’re looking to make your professional mark on a community, this is your chance. Build valuable relationships with patients and get involved with the greater community of Spring Hill, FL while providing top-notch dental care. Our talented and dedicated support team will work alongside you to help ensure your success. You’ll enjoy the following: Base salary with performance incentives to earn more; Sign-on bonus of $3000; Practice part time, 1-2 days per week with family friendly days/ hours (Fridays and one other day if desired); Part time benefits package to include 401K and CE allowance. Apply via this posting or send resume to abrooker@dental-partners. com. www.puredentalbrands.com.

Dentist – Sebastian. At Christie Dental, we are firm believers that the practice of dentistry must always be based on the doctor-patient partnership. That means that our behavior must demonstrate a conviction of honesty and the utmost integrity.

We currently have a fantastic opportunity at our Sebastian practice where we have a strong patient base! If you’re someone who is passionate about providing quality care, and driven by opportunities for leadership and continued learning – Christie Dental may be the perfect fit for you to grow your career. Christie Dental is proud to provide a competitive compensation and benefits package which includes Health, Vision and Dental Insurance; Life, Long Term Disability and Professional Liability Insurance; 401(k) program with employer matching; Mentor programs and leadership opportunities; Ownership potential. pschwartz@amdpi. com.

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General Dentist. Full-Time Associate Dentist needed for a well-established non-corporate practice located in a growing area of Brevard County Florida. Our office is a state of the art facility Specializing in the care of patients. Our office is equipped with a surgical suite to facilitate Implant restorations including Zygomatic implants, and Full mouth implant restoration. We have IV sedation and general Anesthesia for the comfort of our patients. Our practice prides ourselves in the best quality of care for our patients.

Competitive Salary based on Experience will be offered. Sign on bonus upon hire. Send Resumes to SadeshDMD@gmail.com.

Lead Dentist Opportunity. Are you a talented and experienced Dentist seeking a rewarding full-time opportunity in Southwest, FL? Come join our dental team at Great Expressions Dental Centers and be able to focus on providing high quality patient care. *Select opportunities in Fort Myers, Cape Coral and Bonita Springs* Compensation: Competitive (above market) compensation model: Call for details. Our Average General Dentist Earns over $225,000 annually!

Benefits/Perks: Practice Leadership: Clinical Freedom and Treatment Autonomy; Patient Focus: Established and Growing Patient Foundation; Single Doctor and Multi Doctor practices with access to specialists; Partnership Model – Investment Opportunities/ Doctor Career Path; Full Benefits Offered – Healthcare & Dental Benefits, 401K, Short Term/Long Term Disability, Time Off; Malpractice Coverage Assistance; Continued Education Reimbursement, Paid ADA & State Society Dues. Join our team committed to making healthier lives one smile at a time! Hannan Ayad| Doctor Recruiter | Great Expressions Dental Centers phone 248598-7256 |Ext. 71178| fax 248-430-5528 | web www.greatexpressions.com. “Look for the Smile Above Our Name!” Must have a DDS/DMD from an accredited University and active State Dental Board license.

Associate Dentist. Advanced Dental Care of Sarasota proudly provides high-quality dentistry with compassionate, gentle treatment to meet the dental needs of families throughout the local community. Our dentists in Sarasota perform a full range of dental care services, from preventative care to specialized treatments, for adults and children from the age of 12. Outstanding Associate Opportunity for an experienced General Dentist to join one of our highly successful affiliated practices in the Sarasota, FL area. Strong commitment to long-term dental care for the whole family!

Be chairside and make money from day one. Highly trained and dedicated staff to support you. No Day-to-Day headaches of Managing a Practice. Excellent compensation pkg. with performance-based incentives. Well-established and growing patient base. 4-day work week. Full Time Dentist Benefits Package: Company paid professional liability insurance; DCA sponsored continuing education; Medical Insurance; Dental Plan; Life Insurance; Vision Insurance; Long Term Disability; Section 125 - Flexible Spending Account; 401K; EAP Program; DCA Voluntary Supplemental Insurance Products. Qualifications: 2 years dental experience; Licensed to practice dentistry in the State you will be working in. 4-day work week. Learn more @ www. dentalcarealliance.com.

Lead Dentist - (5 Days) - Tampa, FL (East Busch). Are you an experienced, Tampa, FL Dentist seeking a busy office where you can focus on providing excellent patient care? We have a wonderful opportunity for a talented General Dentist, 5 days/week to lead our long-term, neighborhood dental practice in Tampa, FL! Office Details: 5101 E. Busch Boulevard, Tampa, FL 33617 (East Busch). Seeking a 2-4 year (Preferred) Experienced General Dentist with Strong Focus on Quality Patient Care. Fully-Digital Practice. Multi-Specialty Setting: Periodon-

tist and Pediatric Dentist 1 day/week each.

5 Operatories. Experienced Office Staff incl.

Office Manager in Practice Last 10 years.

Average Monthly Production $50,000 -$60,000 w/ Established Patient Base!

High Compensation Opportunity: Strong Six Figure Annual Amount vs. Percent of Production. Benefits/Perks: Full Benefits Offered – Healthcare & Dental Benefits, 401K, Short Term/Long Term Disability, Time Off; Clinical Freedom and Treatment Autonomy; Patient Focus: Established and Growing Patient Foundation; Partnership Model – Doctor Care Path/Investment Opportunities; Malpractice Coverage Assistance; Paid ADA & State Society Dues; Continued Education Reimbursement/Support. For more information, please contact: Hannan Ayad| Doctor Recruiter | Great Expressions Dental Centers phone 248-598-7256 |Ext. 71178| fax 248-430-5528 | web www.greatexpressions.com. Must have a DDS/DMD from an accredited University and active/clear State Dental Board license.

General dentist needed Tallahassee, Florida.

High quality private dental practice seeking a full-time associate. Our three doctors have an excellent practice with an exceptional staff and state of the art equipment.

We are seeking a doctor with experience in all phases of dentistry. Our mission is to provide the highest quality care for each patient. Our professional staff is dedicated to our philosophy of quality care and team work. We do not participate in capitation plans. The doctors are experienced in all phases of general dentistry with an emphasis on implant placement and restoration and aesthetic procedures. They will provide an excellent mentor-ship opportunity. We are located in beautiful Tallahassee Florida.

Tallahassee has a plethora of cultural opportunities with two major universities and a very large community college. It is located a short distance to the Gulf of Mexico. We offer benefits including health, professional SEE PAGE 78

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career center FROM PAGE 77

liability and disability insurance. We also provide a 401k plan. We pay your continuing education expenses and professional dues. Please fax or mail your resume to: (850)386-8181. Drs. Chichetti, Torgerson and Hartley, 1305 Thomaswood Drive, Tallahassee, Florida 32308. Tallahasseedentists. net. General Dentist with current Florida License. Experience preferred but will consider recent graduate who is a team player.

Must be available for 4.5-day workweek.

General Dentist Naples FL. Our newly established, general practice is seeking a progressive, part-time associate to join our team in the growth of this young practice.

Our goal is to provide state-of-the-art, comprehensive dentistry in a warm, caring environment. We strive to build individual relationships with our patients, with the focus of optimal dental fitness being an integral part of overall health. For details, please contact: Matlor6191@gmail.com.

Pediatric Dentist -Tampa, FL. Available Fall 2018. Position availability -- Fall 2018. Private Pediatric dental practice - Non-corporate. Two office locations in the Tampa bay area. Newly renovated office has 15 chairs and is 5 days a week. 2nd office has 7 chairs and is a currently 2 days per week, with potential for growth. The ideal candidate I am seeking is full time, 5 days per week and will work at both office locations. PPO insurance and fee-for-service patients in both practices, no government plans or HMO plans. High-income potential, guaranteed $250K ++ in the first year with our compensation structure and patient volume. Both

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offices have digital radiographs and digital charting. In office IV-sedation provided on a regular basis with a certified Pediatric Anesthesiologist group. Fully trained and certified pediatric dental staff in place.

Orthodontic treatment is provided in both locations by an orthodontist in our practice. Full autonomy over treatment plans.

Position is available starting Fall of 2018.

Must have a current Florida dental license, previous experience in private practice is preferred but not necessary. Must be a certified pediatric dentist. Candidate should have excellent communication skills and enjoy a fast pace, fun work environment.

We are now interviewing qualified candidates, if interested please email current CV to: sugarbugdude@gmail.com. We look forward to speaking further about this amazing opportunity with you. Kind Regards. CV to -- sugarbugdude@gmail.com.

General Dentist Opening - South Florida and Orlando Markets. Looking for an opportunity with a successful and growing company? Sage Dental currently has opportunities for qualified General Dentists & Specialists at our South and Central Florida practices. Sage Dental offers you: Excellent Earning Potential – Sage Dental operates more efficiently and we share the results with our doctors through a higher compensation model. Ability to Focus on Patient Care – By delegating all the management and administrative stresses to us, our doctors can focus on providing the best patient care possible. State-of-theArt Facilities – Our dentists enjoy working in state-of-the-art facilities with the latest

SEPTEMBER/OCTOBER 2018

dental technology and equipment. Quality of Life – Since you don’t have to worry about insurance claims, payroll, staffing, accounting and marketing, you have the time to enjoy everything Florida life has to offer, including our many golf courses and beautiful beaches. If you are ready to take the next step in your career as a General Dentist or Specialist and want a position with excellent earning potential, Sage Dental has what you are looking for. Apply today! Contact: Bradford Cabibi - Doctor Recruitment. Email: bcabibi@mysagedental. com; careers@mysagedental.com. website: http://www.mysagedental.com/; https:// www.mysagedental.com/career-opportunities/. Phone: 561-999-9650 Ext. 6146, Fax: 561-526-2576.

ASSOCIATE PLACEMENT SERVICES. Need an Associate? Need a job? General Dentist or Specialist? Call Melanie Aranda 561-3100599 @ Doctor’s Choice e-mail: melanie. aranda@doctors-choice.com.

Certified Dental Assistant. Looking to add a valued team member to our already amazing staff. We are a family-oriented practice Located in Sarasota, Florida, looking for a compatible, hard-working dental assistant to become a part of our family. Must have Dental Assistant Certification. Full time opening and our hours are Monday - Thursday, 8:00 AM to 5:00 PM. Benefits available.

Please send resume to ilovemydentistsarasota@gmail.com.

WWW.FLORIDADENTAL.ORG

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off the cusp

WHAT KEEPS ME AWAKE AT NIGHT

JOHN PAUL, DMD

TODAY’S FDA EDITOR

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

Recently, your Florida Dental Association (FDA) Board of Trustees gathered for a deep think session and 1 question we were asked to answer in 1 sentence was, “What keeps you awake at night?” 1 sentence, really? Have I mentioned that I have 2 young daughters?

A better question would be how do I sleep at night? At least that answer is simple — exhaustion.

The constant negative messages from the mainstream media (pick your source, I’m playing equal opportunity offender here) would be enough to keep most folks awake.

Then I remember what I always tell my wife.

The purpose of the news is not necessarily to tell you things you need to know, but to sell advertising and keep you from changing the channel so their advertising space makes them more money. Thank goodness the remote has an off switch.

Running your own business can definitely keep you awake. There is this benefit — you can pretend that you run your own little kingdom and that you will never be blindsided by a pink slip. You can, however, go bankrupt, get blindsided by an employee’s resignation and spend countless hours making sure you conform to the neverending government regulations. Not running your own business can keep you awake, too. Pressure to do procedures you hate, work hours you don’t necessarily want in a location that may not be

your favorite. So, dentistry isn’t easy. I knew the job was dangerous when I took it.

The answer I gave might surprise you — “Unopened mail.” A concern one might expect from your editor. Recently, when HB21 (see paragraph No. 3, neverending government regulation) passed into our lives, we at the FDA went to great lengths to let our members know what was coming, when it would go into effect and what each dentist would be required to do. We sent letters, we sent emails, we wrote about it in this magazine and on social media. The day after this went into effect we started receiving messages to the tune of: How could you let this happen? Who was asleep in Tallahassee?

What am I gonna have to do now? These folks didn’t open their mail.

If you’re reading this, I know I am preaching to the choir. I am asking you for a bit of help. I’m sure you each know someone who doesn’t read their mail. Have a chat with them and ask them to start. If they won’t block email from the FDA, I’ll promise to keep it to a minimum. Second, since you have my back all the time, I’d like to do something nice for you. If there is something you would like to see but haven’t, drop me a line, give me a suggestion. We read all the mail we get and the only judgement we place on it is, “Will it help our members succeed?”

JOHN PAUL, DMD, EDITOR, TODAY'S FDA

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