2013 - July/Aug TFDA

F l o r i da

D e n ta l

A sso c i at i o n

TODAY’S FDA

A View of The Profession What Stage of Your Dental Career Are You In? important news for fda members 2013 Legislative Wrap-Up VOL. 25, NO. 5 JULY/AUGUST 2013

New plans are coming Oct. 1, but find out now how to get your health plan.

Health care Reform and Subsidy Information Available A Member Benefit Since 1989 800.877.7597 insurance@fdaservices.com www.fdaservices.com

A wholly owned subsidiary of the Florida Dental Association

contents cover story

42

A View of The Profession

cover stories

literary

42 View of the Profession

67 Guest Editorial

46 What Stage of Your Dental Career Are You In?

78 Books on the Shelf

news

columns

12 House of Delegates

3

President’s Message

15 Board of Dentistry

5

news@fda

16 2013 Legislative Wrap-up

34 Diagnostic Discussion

57 Health Care Consumer Alert

80 Off the Cusp

features

classifieds

24 Drew Eason — The FDA’s New Executive Director

74 Listings

28 Celebrating Member Milestones 50 Awards 58 Make Certain Electronic Communications Ensure Patient Privacy 62 Pride in Excellence: Avoiding Burnout 70 FNDC2013 Photo Recap

Read this issue on our website at:

www.floridadental.org.

www.floridadental.org

* On page 26 of the “Reception Room” Issue, the article “10 Biggest Causes of Tooth Sensitivity” – incorrectly referred to Leslie Jeldin, DDS, as a spokeswoman for the American Dental Association.

It should be spokesman. We apologize for the error.

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

July/August 2013

Today's FDA

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florida dental assocIation July/August 2013 VOL. 25, NO. 5

editor Dr. John Paul, Lakeland, Editor

staff Jill Runyan, publications manager • Jessica Lauria, publications coordinator Lynne Knight, marketing coordinator

council on communications

NEDDA, JACKSONVILLE & CLAY COUNTY CE

Friday, Oct. 4, 2013 Deerwood Country Club Speaker: Dr. Gerard Lemongello – A Systematic Approach to Comprehensive Treatment Planning for Aesthetics and Function www.nedda.org • 904.737.7545 • ddeville@nedda.org

WCDDA Annual Meeting

Jan. 17, 2014 • St. Petersburg Hilton Bayfront www.wcdental.org • 813.654.2500 • wc.dental@gte.net

Miami Winter Meeting

Feb. 21-22, 2014 Jungle Island, Miami, FL Speaker: Dr. Jose-Luis Ruiz www.sfdda.org • 305.667.3647 • sfdda@sfdda.org

NWDDA Annual Meeting

Feb. 21-22, 2014 The Grand Sandestin Speakers: Dr. Alex Fleury – New Dimensions in Endodontics; Dr. Joe Steven Jr. – Efficient Dentistry www.nwdda.org • 850.391.9310 • nwdda@nwdda.org

CFDDA Annual Meeting

Friday, March 14, 2014 Continuing Education Session Weston Lake Mary Orlando North Speakers: Dr. John Burgess www.cfdda.org • 407.898.3481 lindaannelowell@gmail.com

CFDDA island getaway

April 24-27, 2014 Puerto Rico: Great Times, Great Profession “Let’s Make Memories”

ACDDA Winter Meeting

Friday, Feb. 28, 2014 Embassy Suites, West Palm Beach Speakers: Rita Zamora & Dr. Michael Ragan Marketing Your Dental Practice With Facebook & Social Media www.acdda.org • 561.968.7714 • acdda@aol.com

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Dr. Thomas Reinhart, Tampa, chairman Dr. Roger Robinson Jr., Jacksonville, vice chairman Dr. Richard Huot, Vero Beach • Dr. Scott Jackson, Ocala Dr. Marc Anthony Limosani, Miami • Dr. Jeff Ottley, Milton Dr. Jeannette Hall, Miami, trustee liaison • Dr. John Paul, editor

board of trustees Dr. Terry Buckenheimer, Tampa, president Dr. Richard Stevenson, Jacksonville, president-elect Dr. Ralph Attanasi, Delray Beach, first vice president Dr. William D'Aiuto, Longwood, second vice president Dr. Michael D. Eggnatz, Weston, secretary Dr. Kim Jernigan, Pensacola, immediate past president Drew Eason, Tallahassee, executive director Dr. David Boden, Port St. Lucie • Dr. Jorge Centurion, Miami Dr. Stephen Cochran, Jacksonville • Dr. Lee Cohen, Palm Beach Gardens Dr. Don Erbes, Gainesville • Dr. Don Ilkka, Leesburg • Dr. Jolene Paramore, Panama City Dr. Rudy Liddell, Brandon • Dr. Tom Ward, Miami Dr. Ethan Pansick, Delray Beach, speaker of the house Dr. Paul Miller, New Port Richey, treasurer • Dr. Bryan Marshall, Weekiwachee, treasurer-elect Dr. John Paul, Lakeland, editor

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

FDA membership dues include a $10 subscription to Today’s FDA. Non-member subscriptions are $150 per year; foreign, $188. Periodical postage paid at Tallahassee, Fla. and additional entry offices. Copyright 2013 Florida Dental Association.

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

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

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

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

FDA office numbers: 800.877.9922, 850. 681.3629; fax 850.201.5013; email address, fda@floridadental.org; website address, www.floridadental.org.

Advertising Information For display advertising information, contact: Jill Runyan at jihasz@floridadental.org or 800.877.9922, Ext. 7113 Advertising must be paid in advance.

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

www.floridadental.org

President’s message Terry Buckenheimer, DMD

Make the FDA an Organization Dentists Want to Belong to!

It was Saturday morning, June 15, and my time to address the House of Delegates was fast approaching. It has been quite a number of years leading up to this point!

From a Children’s Dental Health Month assignment through several committees, task forces, councils and boards to now this: president of the Florida Dental Association (FDA)! I have so much information in my head but never enough time to share it all. And when I do share, I can get a little carried away … just ask my colleagues in the Hillsborough County Dental Association (HCDA) and the West Coast District Dental Association (WCDDA). So what did I do? I purposely simplified my message so as not to bore anyone. “I’m excited to be here!” That’s a simple enough way to start off. Now just don’t blow it and get into all the details and please don’t get all “sappy.”

And you know what? I actually enjoyed being there in front of all of you promising to do my best for the organization this coming year. The KISS (Keep It Simple Stupid) method seems to work well for me, and of course, prayers are always essential.

So let’s use the “Build it and they will come” approach to managing our association this year. I have spent countless hours in membership activities over the years. Having served on the Councils of Membership at the WCDDA, FDA and American Dental Association (ADA) and as a chair at each of these levels, I’ve surveyed members, nonmembers and potential members, and analyzed the data and the results. I’ve developed strategies to address the declining membership market share and promoted an array of member benefits to show the “value” of membership. With the “MemberGet-A-Member” program of the ADA, you will receive an American Express gift card for $100 if the nonmember you contacted joins the tripartite. Now how great is that?

But will it work? It really depends on each one of us spreading the word to nonmembers and sharing the benefits of the FDA with them.

“

What does the FDA mean to each of you?

To me, it is a Family of Dedicated dentists who Aspire to be the best!

”

Please see President’s, 4

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grams. I encourage everyone to contribute to our Foundation, the charitable arm of the FDA.

president’s from 3

Let’s be proud of what we do and where we are. We have a strong organization thanks to the efforts of Mr. Dan Buker.

For 26 years, Dan has given his all as executive director of the FDA. We have dedicated staff in Tallahassee and in each of the components. We now have Mr. Drew Eason as our executive director. Drew’s experience and success while directing the Michigan Dental Association will serve us well for many years to come. We have had wonderful leaders over the years. Drs. Cesar Sabates and Kim Jernigan, we are so proud of you — Cesar as our first Hispanic president and Kim as our first female president. The Board of Trustees, the council members and the members of the Governmental Affairs Committee (GAC) have given an enormous amount of time to the FDA. Delegation members to the ADA not only give up time from their practices and families, but also spend countless hours preparing for each council and committee meeting.

Our Foundation, led by Dr. Jay Walton and directed by Rusty Payton and Stefanie Dedmon, is organizing out first Mission of Mercy (MOM) event on March 28-29, 2014 in the Tampa area. Drs. Nolan Allen and Leo Cullinan are co-chairs and working diligently to make this event a success and a demonstration of what the FDA and its Foundation can do for the citizens of Florida, especially those in need of dental services.

The MOM event is in addition to our Project: Dentists Care (PDC) clinics, Give Kids a Smile (GKAS) events, and our coordinated efforts with the Department of Children and Families (DCF) for foster children and our education pro-

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What does the FDA mean to each of you? To me, it is a Family of Dedicated dentists who Aspire to be the best! We are all in this together, to build the best organization we possibly can. I am here to serve you and this association. With your support and prayers, we will make the FDA an organization dentists want to belong to!

Dr. Buckenheimer is the FDA president. He can be reached at tlbdmd@aol.com.

I have had many friends and colleagues who have provided inspiration to me. Drs. Milton Wood, Joe Valenti, Sid Swindle, Bob Hart and many more have given me opportunities to grow and develop over the years. But two friends have meant so much to me for demonstrating courage in the face of insurmountable odds: Drs. Dan Bertoch and Ted Haeussner.

I dedicate this year of service to them!

www.floridadental.org

news

@fda

important news for FDA members

FDA Headquarters Announces New Hours The FDA now has new, expanded hours to serve you better. The new hours will be 8 a.m. ‑5 p.m. EDT, Monday through Friday. If the person you are trying to reach is unavailable, please press zero to reach the receptionist or dial 850.681.3629.

Are You Taking Advantage of Your Association’s Benefits?

As a member of the American Dental Association (ADA), Florida Dental Association (FDA) and your local district, are you taking advantage of all the benefits available to you? You probably understand that the association, through our lobbying and relationships with regulatory agencies, remains vigilant in protecting your ability to be successful in the dental profession. However, you may not be aware of the many benefits that can save you money and time. Please be sure you are taking advantage of the great resources and benefits provided to our members. Here is a general overview for you to consider and begin using today: FREE Online Continuing Education The FDA offers a great benefit just for its valued members — free, on-demand continuing education (CE). Through the FDA website, we offer a selection of previously recorded CE programs from the Florida National Dental Convention (FNDC), the FDA’s premier annual convention. Also available are free CE opportunities published through the www.floridadental.org

FDA’s bimonthly journal, Today’s FDA. Members can earn CE credit by viewing the “Diagnostic Discussion” article and diagnostic slides, and completing a quiz.

These resources are available 24 hours a day — CE when you need it at no cost to you, our member dentist.

Practice Made Perfect New Dentist Webinars — Our free educational webinars for FDA members provide new dentists (and more seasoned practitioners) with valuable practice management and marketing tools to help you increase your productivity, business and professional knowledge.

Florida National Dental Convention Members save up to $480 on registration at the largest dental convention in the Southeast. Did you attend this past June?

Make plans to attend FNDC2014 in Orlando, June 12-14, 2014.

ADA Contract Analysis Service — The ADA’s Contract Analysis Service analyzes third-party contracts, including contracts from managed care companies, to inform you in clear language about the provisions of the contracts so you can make informed decisions about the implications of participation. This service is available as a complimentary member benefit for FDA members.

Review, the dental profession demonstrates the appropriateness and quality of the care it renders. It provides an expert and credible system for resolving disagreements that cannot otherwise be resolved regarding patient complaints about clinical care. You hope you will never need it, but it’s there for you in case you do!

FDA Corporate Affiliate Program — Most dentists could pay their dues with their savings from using the services of the FDA’s Corporate Affiliation Program (CAP). FDA Services has added exciting new CAP members — now you can save 18-22 percent on dental supplies; receive considerable savings on new website design and hosting; and fantastic savings on your electronic claims processing.

Note: to access protected member benefits on the FDA website, please use your current email address on file with the FDA. The default is “Password1” (capital P, no spaces and the number 1.)

These are just a few of the benefits and resources that make your membership in the ADA, FDA and local district so valuable. If you have questions about your benefits, please contact your FDA Member Service Center at 800.877.9922. We can’t do it without your support!

FDA Peer Review/Patient Dispute Mediation Program — The Peer Review Program is only available to FDA members. Through the mechanism of Peer

Please see news, 6

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news@fda

news from 5

SmileFlorida.org Has Been Redirected to MouthHealthy. org.

On July 1, the Florida Dental Association’s (FDA) public website, SmileFlorida.org, was discontinued. In an effort to streamline the public’s experience and provide the most comprehensive and current oral health information, the FDA will direct the public to the American Dental Association’s (ADA) website, MouthHealthy.org. In addition to an impressive amount of detailed and thorough information, the website offers the option to view the entire site in Spanish.

Anything pertinent or specific to Florida on SmileFlorida.org has been transferred to the FDA’s main website where it can be accessed easily by the public.

FDA Services Presents Check to FDA at FNDC FDA Services (FDAS) exists to provide dentists throughout the state unparalleled insurance products and services dedicated to their profession. At the same time, by relying on FDAS to secure the insurance needs for your business and family, you are able to support the FDA, our parent company, with payments and reimbursements made throughout the year that support the efforts of organized dentistry, and help keep your dues to their lowest level possible.

On behalf of FDAS, its Board of Directors, and its dedicated staff, Dr. Paul Palo (FDAS Treasurer) and Dr. Steven Bryan (FDAS President) were pleased to present a check in the amount of

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$969,427, which represents the payments and reimbursements made to the Florida Dental Association for the 20122013 fiscal year.

Local Boy “Does Good” Samuel Dorn, DDS, has been awarded the Edgar D. Coolidge Award by the American Association of Endodontists (AAE). This accolade is the organization’s highest honor and lifetime achievement award.

Dorn currently serves as the chairman of the Department of Endodontics at The University of Texas Health Science Center at Houston (UTHealth) School of Dentistry. He also is a former president of AAE and has held several offices and committee chair positions within the organization. He lived and worked in Florida for three decades before going to the UTHealth School of Dentistry in 2009. His lengthy record of involvement includes terms as president of the South Florida District Dental Association and director and treasurer of the American Board of Endodontics.

Dorn holds the Frank B. Trice, DDS, Professorship in Endodontics at UTHealth and was the founding director of the postgraduate endodontics program at Nova Southeastern University College of Dental Medicine. He also served as a clinical professor at the University of Florida College of Dentistry and has authored numerous articles and textbook chapters.

Read Before You Sign Biomedical Waste Contracts Recently, the West Coast District Dental Association (WCDDA) and FDA have been made aware of some biomedical waste disposal contracts that have generated member complaints. According to one member, one of the waste disposal services is offering a six-year contract that allows them to increase rates whenever they want without giving the dentist the opportunity to cancel the contract.

As always, read all contracts before you sign them.

Resources for Oral Health Professionals Participating in the Electronic Health Record (EHR) Incentive Program Dentists and other oral health professionals are eligible to participate in the Medicaid Electronic Health Record (EHR) Incentive Program. Incentive payments can total $63,750 for professionals meeting Medicaid eligibility thresholds and demonstrating meaningful use of their certified technology.

But, it is recognized that oral health professionals have unique challenges in meeting the participation requirements for EHR Program. Visit the Health information Technology and Quality Improvement website at http://1.usa. gov/18pUf5J for best practices when attesting for meaningful use as an oral health professional. Also, check out the Agency for Health Care Administration’s (AHCA) webinar series on the EHR Incentive Program at Learning Opportunities, at http://bit.ly/13QAR08.

Have questions? Contact the AHCA at MedicaidHIT@AHCA.MyFlorida.com.

www.floridadental.org

news@fda

FDA Services Becomes a Progressive Auto Insurance Agency!

CMS Gives Florida Final Approval for Statewide Medicaid Managed Care

FDA Services Inc. (FDAS) is proud to announce that they have been appointed as an agent for Progressive Auto Insurance. FDAS strives to bring members the best value for their insurance dollars.

This appointment will benefit members by helping them secure a competitive option for their auto, boat, RV and personal umbrella insurance. Call FDA Services today to get a competitive quote at 800.877.7597.

On June 14, the Centers for Medicare and Medicaid Services (CMS) gave final approval to a plan to privatize Florida’s Medicaid system into managed care. The decision was expected, as federal officials had signaled their willingness to approve the plan in February, as long as the state made additional improvements. The approval comes at the end of a lengthy process that started when the Florida Legislature passed sweeping reform legislation in 2011 that allowed the state to expand a program that allows for-profit providers to determine the health care of Medicaid recipients. The privatization plan expands on a five-county pilot program begun under former Gov. Jeb Bush that has been rife with problems.

Gov. Rick Scott and other Republican lawmakers had repeatedly warned that Medicaid’s annual costs were consuming Florida’s budget and pushed for the waiver from federal rules on Medicaid in order to carry out the overhaul. However, critics worry for-profit providers are scrimping on patient care and denying medical services to increase profits. Eleven insurance companies responded to the Agency for Health Care Administration’s request for bids to participate in a statewide Medicaid managed-care program.

These bids embedded dental services into the medical contract, putting both services under one umbrella. The rollout for the Statewide Managed-care Program is scheduled to begin in October 2014.

PDC@FNDC Partners for Success!

This year at FNDC, Project: Dentists Care (PDC) was held for two days, June 13 and 14. Checkups and treatment for 65 foster children were provided from the Orlando area. This event s howcased three Florida mobile dental units: Orange County Health Department, Colgate and the Florida Baptist Convention. The units were housed inside the Exhibit Hall this year. The foundation again partnered with Community Based Care of Central Florida, Department of Children and Families, Florida Dental Association, and Florida Department of Health to provide this pro bono dental care.

Twenty dentists from all over the state, including outgoing FDA president, Dr. Kim Jernigan, donated their time to treat this large group of children and provided care valued at $28,109.

Ethics Hotline Available for FDA Members The ADA Ethics Hotline is a service available to members and is designed to assist new dentists and other members in managing ethical challenges that may arise in day-to-day practice. The Ethics Hotline is not a legal resource, but rather a service for helping resolve ethical dilemmas, much like an ethics consult service. Callers will be matched with a member of the ADA Council on Ethics, Bylaws and Judicial Affairs, who will arrange to call the member at a mutually agreeable time to discuss the dilemma and offer resources that may assist in resolving the dilemma. For more information, go to http://www.ada.org/8180. aspx.

ADA Offers Free Course on Becoming a Medicaid Provider The ADA wants you in a free course at Annual Session in New Orleans. Maintaining your Sanity and Practice Viability as a Medicaid Provider, will be Thursday, Oct. 31 from 11 a.m.-1:30 p.m.

Course Description: Despite misconceptions and fears associated with being a Medicaid provider, treating this population can be rewarding and contribute positively to your bottom line. Medicaid providers will share three effective practice models and opportunities/challenges regarding compliance, fraud, advocacy and more.

Please see news, 8

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news@ fda news from 7

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

Gonzalo Cortes, Coconut Creek Kali George, Tampa Mirela Giurgiu, Port Saint Lucie Ajay Joshi, Fort Lauderdale Steven Kline, Port St. Lucie Nancy Nguyen, Davie Jamily Pedro, Fort Lauderdale Raul Rangel, Coconut Creek Lindsey Reznik, Stuart Gladston Silva, Fort Lauderdale Zayde Toquica, Delray Beach Central Florida District Dental Association

Alesia Apana, Winter Park Woojn Cho, Oviedo Debbie Darius, Bronson Luis Garabis, Ponce Inlet Peter Kelly, Winter Park Amanda Lazo, Alachua Timothy Millward, Gainesville David Rogers, Melbourne Luis Rosario, Ocala Daniel Spagnoli, Titusville Marissa Whitehead, Winter Springs Ameer Zufari, Orlando Northeast District Dental Association

Paul Boldt, Jacksonville Nicholas Comerfond, Jacksonville Mark Dawley, Jacksonville Beach Melanie DeLoach, Jacksonville Eric DePetris, Middleburg 8

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Pierre Gosselin, Jacksonville LaChelle Hendley, Jacksonville Paul Kolodziej, Jacksonville Steven Mantegari, Jacksonville Jignesh Patel, Jacksonville Irivelisse Porter, Jacksonville Nicole Staman, Fleming Island Douglas Storch, Jacksonville Northwest District Dental Association

Ben Fishbein, Pensacola Tamara-Kay Tibby, Tallahassee South Florida District Dental Association

Alexandra Botero, Miami Adrian Correa, Miami Lissette de la Rua, Miami Lester Gil, Homestead Reydel Gonzalez, Hialeah Eduardo Martinez, Miami Nancy Medina, Miami Carlos Mercado, Hollywood Isabel Suate Pedroza, Miami Tessa Scott, Miami Gardens Tara Siegal, Miami German Ucros, Miramar Larry Vinuela, Miami Tosha Williams, Miami Gardens West Coast District Dental Association

Nicole Eastham, Naples Marian Gerges, Tampa Rebecca Lenard, Naples Sandy Lucceus, Bonita Springs Gabriela Marquez, Venice Stephen Ruso, Saint Petersburg Daniel Seger, Tampa Terrace Jennifer Senge, Naples

In Memoriam The FDA honors the memory and passing of the following members: Charles Crane Orlando, FL Died: Sept. 27, 2012 Age: 58 Raymond Hart Tallahassee, FL Died: May 9, 2013 Age: 87 Lawrence Armus Delray Beach, FL Died: April 27, 2013 Age: 81 Gary Trikardos Tallahassee, FL Died: May 11, 2013 Age: 67 Lucas Stevens Tallahassee, FL Died: May 20, 2013 Age: 55 William White Sanford, FL Died: May 23, 2013 Age: 91 Gerald Isbell Sun City Center, FL Died: June 23, 2013 Age: 83 Theodore Haeussner Orange Park, FL Died: July 8, 2013 Age: 64 Edward Ritter Winter Park, FL Died: July 11, 2013 Age: 76 www.floridadental.org

news@fda

In Memory of Dr. Ted Haeussner, Former FDA President When I recall Ted, however, it is not the

What a huge loss! Our friendship

a skill that, for

countless meetings that I remember. It is

emerged from Ted following me through

some, can be

the conversations about his passion for

the chairs leading to the FDA presidency.

learned and de-

kayaking and the round of “best ball”

It was a pleasure working with him on

veloped, but for

golf we played at Dr. Nolan Allen’s BOT

the critical issues we faced on an almost

others, it comes

retreat (now known as strategic plan-

daily basis. His input was always mea-

naturally and

ning), before it was politically incorrect

sured and focused, and I will truly miss

effortlessly. Dr.

to mix team-building fun with long

that. Ted and his wife, Kathy, made a

Ted Haeussner was a natural. I had

meetings. We shared a cart — with me

great team of their own, and she helped

the honor of serving with Ted on the

being possibly the worst golfer ever, and

Ted to his finish line with dignity and

Board of Trustees (BOT) and as a line

Ted most likely having the gangliest

grace. He was truly one of the most

officer for the Florida Dental Associa-

legs I’ve ever seen — but we planned

dedicated individuals to our great profes-

tion (FDA). Ted’s leadership was not

our presidencies while riding around in

sion that I have ever had the pleasure of

one of “kicking the can down the road

that cart trying to find my golf ball. It is

knowing, and dentistry is better because

or not making waves.” If there was an

in those situations that friendships are

of him. Rest in peace, good friend.

issue that concerned him, he would

forged.

Leadership is

Nolan W. Allen, DDS, FACD, FICD

go right at it. We did not always agree on issues, but Ted was consistently

You cannot describe Ted without using

fair, willing to listen to both sides and

the word “courage.” Despite fighting

never engaged in “dental politics.” If

cancer, he performed his role as president

you made your case, he was willing

of the FDA exceptionally, and kept a

to modify his position, but Ted was

positive and upbeat attitude throughout

equally skilled at guiding others to his

the next five years. It was my pleasure to

point of view. When Ted wished to

know and work with Ted. If I could tell

make a point, he would usually begin

him just one more thing it would simply

with, “Let’s sit down and …” so much

be, “Well done.”

FDA President 2007-2008

so, that at the beginning of meetings, some of us would guess at how many

Charles Hoffman, DMD, PhD, BA, MA

times he would use that phrase.

FDA President 2009-2010

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House of Delegates

House of Delegates

House of Delegates 2013 12 12 Today's Today's FDA FDAJuly/August July/August 2013 2013

www.floridadental.org www.floridadental.org

House of Delegates

By FDA Staff

On June 14 and 15, the Florida Dental Association (FDA) House of Delegates (HOD) met at the Gaylord Palms Resort and Convention Center in Kissimmee.

The HOD discussed many issues, including the following business.

Dr. Kim Jernigan, 2012-2013 FDA president, gave a review of her presidency. Dr. Jernigan discussed several accomplishments, including her promise to recruit 10 new members over the past year, and her attendance at the Washington Leadership Conference.

Election of Officers The following officers were elected and installed during the June HOD meeting.

President: Dr. Terry Buckenheimer

Dr. Terry Buckenheimer, 17th District Trustee, reported that the American Dental Association’s (ADA) continuing emphasis will be on membership and unity of organized dentistry. The ADA found the best way to recruit members is one-on-one and has restructured its recruitment and retention efforts to focus on the new “Member-Get-A-Member” program.

Dr. Buckenheimer gave his address as the FDA’s incoming president. An excerpt of his remarks can be found in the President’s Message on Page 3 of this issue of Today’s FDA.

Report of the ADA President Dr. Robert Faiella, ADA president, reported that the ADA’s primary focus is on the strategic plan, which will carefully consider Dr. Marko Vujicki’s economic analysis. Dr. Faiella also identified some game-changers, such as: consumerism and more active and informed patients accessing oral health services; the prevalence of onsite reviews or patient report cards; dental service corporations, anticipated to be 25 percent of the market share in several years; the shift of dentistry into a delivery of care and financing model similar to that of medicine, with its emphasis on quality outcomes and preventive care rather than reimbursement based on procedures.

www.floridadental.org

President-elect: Dr. Rick Stevenson First Vice president: Dr. Ralph Attanasi Second Vice president: Dr. Bill D’Aiuto Secretary: Dr. Mike Eggnatz Speaker of the House: Dr. Ethan Pansick

Elections Held Dr. Tim Marshall was elected as Treasurer-elect for the 2013-2014 fiscal year. Dr. Pansick was elected by acclamation as Speaker of the House. Dr. Suzi Thiemes-Heflin was elected as the ADA At-Large Alternate Delegate, to fill the remainder of Dr. Thad Morgan’s term.

Date of Next Meeting Dr. Ethan Pansick, Speaker of the House, announced that the next meeting of the HOD will be held Jan. 24-25, 2014 at the Tampa Airport Marriott Hotel.

July/August July/August 20132013 Today's Today's FDA FDA 13 13

mediation makes sense with the FDA Peer Review Mediation Program MEDIATION VS. LITIGATION The Peer Review Mediation Program settles disagreements between patients and dentists more economically and efficiently than the legal system and is available only to FDA members.

This program is free of charge.

Only cases involving problems with actual treatment and procedures are eligible for mediation.

Mediation takes place at the local level, so problems can be resolved more effectively.

For more information

about the FDA Peer Review Mediation Program 800.877.9922 • fda@floridadental.org www.floridadental.org/peer-review

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Cases not eligible for the program include: malpractice litigation; formal regulatory investigations; disputes over dental fees; treatment that occurred more than 12 months before the patient’s last appointment with the dentist; and cases involving dentists who are not FDA members.

www.floridadental.org

Board of Dentistry

Board of Dentistry Meets in Jacksonville

By FDA Staff

The Florida Board of Dentistry (BOD) met in Jacksonville on Friday, May 17.

All nine BOD members were present which included Dr. Dan Gesek, chairman; Dr. Robert Perdomo, vice chairman; Dr. William Kochenour; Dr. Carl Melzer; Dr. Carol Stevens; Dr. Joe Thomas; Dr. Wade Winker; hygienist Ms. Catherine Cabazon; and consumer member Ms. Elmira Gainey.

The Florida Dental Association (FDA) was represented by BOD-Liaison Dr. Don Erbes and lobbyists Ron Watson and Casey Stoutamire. Other FDA members in attendance included Drs. Rick Stevenson, Don Ilkka, Andy Brown, Barry Setzer, Gary Myers and others.

This was the final meeting for Dr. Erbes as the BOD-Liaison. He has served the FDA in this capacity with distinction for more than five years. Mr. Watson made this announcement to the BOD and introduced Dr. Ilkka as his replacement.

At this meeting there were two vacancies on the BOD. Also, this meeting was the last for Ms. Gainey, who has served the maximum10-year term limit.

Subsequently, on July 22, Gov. Rick Scott’s Appointments Office announced changes to the membership of the Board of Dentistry (BOD). Due to several resignations, as well as delayed appointments, there were five appointments announced with different expiration dates.

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• Present BOD Vice-chairman and FDA member, Dr. Robert Perdomo; term that expires on Oct. 31, 2016; • FDA member, Dr. Leonard Britten; term expires Oct. 31, 2015; • Ms. Angie Sissine, R.D.H, hygienist; term expires on Oct. 31, 2013; • Mr. Anthony Martini, consumer member; term expires on Oct. 31, 2014 • Mr. Timothy Pyle, consumer member; term expires Oct. 31, 2016 The BOD was presented with 14 disciplinary cases, two informal hearings and two voluntary relinquishments at this meeting. Cases included an anesthesia-related child death, controlled substance abuse and advertising violations, to name a few.

At the meeting, the BOD: v adopted proposed draft rules for changes to teaching permits, which included a new 30 hour continuing education (CE) requirement and also required passage of the laws and rules exam for new applicants. v addressed some rule clarifications in regards to dental anesthesia sedation permits by stating that the new airway management CE requirement does not begin until the 2014 licensure renewal cycle. v agreed to join the North East Regional Board’s (NERB) Board of Directors. v created a task force to study proper dental record keeping. v reviewed a draft BOD annual regulatory plan for 2013-2014, which details all rule proposals/changes and their status. v heard a presentation from the Florida State University College of Medicine on tobacco cessation and CE credits. v took no action or had any discussion on the FDA’s Restorative Functions Dental Auxiliaries proposals. v asked for more information on a Healthy Kids One More Foundation declaratory statement regarding providing services in schools without a dental van. v referred the FDA letter on only allowing non-sedated patients to receive local anesthesia from hygienists to the BOD Anesthesia Committee for discussion.

Additionally, the BOD announced a new website. It is designed to be more userfriendly and can be found at www.floridasdentistry.gov. This includes information on all the disciplinary cases mentioned above, as well as licensure renewal, applications, status, etc. To complement the new website, a Twitter account (@FLDentalBoard) was also established.

The BOD Anesthesia Committee has scheduled a conference call for June 18 at 6 p.m. The next full BOD meeting is scheduled for Friday, Aug. 23 at 7:30 a.m. in Orlando, at the Rosen Plaza Hotel on International Drive. The last remaining BOD meeting date for 2013 is Nov. 15 in Gainesville.

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2013 Legislative Wrap-up

By Joe Anne Hart,

FDA Director of Governmental Affairs

FDA Pushes Non-covered Services Legislation Until Final Day of Session The 2013 Legislature adjourned its legislative session around 7:15 p.m. on Friday, May 3, with one more health care bill waiting to be considered that contained an amendment to add the Florida Dental Association’s (FDA) supported legislation on non-covered services. Rep. Ron Renuart (R-Ponte Vedra Beach) filed an amendment that would prohibit insurance companies from dictating what dentists could charge for services not covered by the plan to CS/CS/HB 1159 by Rep. Marlene O’Toole (R-Lady Lake). After a brief recess of both the House and Senate chambers, representatives gathered on the House floor to present the compromise that was negotiated and agreed upon as the last bill to pass this session; unfortunately, the noncovered services legislation was not part of that compromised deal. Rep. Renuart 16

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did have an opportunity to present the amendment on the House floor, but had to withdraw it before the final vote was taken on CS/CS/HB 1159.

The FDA also filed several non-covered services amendments to an insurance industry bill. The bill contained legislation that was heavily supported by the insurance lobbyists and because the FDA filed amendments to add the non-covered services language to their bill, they refused to have their bill taken up on the House floor. The insurance lobbyists made it known that they were not happy with the FDA’s lobbyists for using their bill as a vehicle to push the non-covered services legislation. Ultimately, the efforts of the FDA to adopt non-covered services language to an insurance industry-backed bill defeated their legislation altogether.

The FDA thanks Rep. Renuart and Sen. Jack Latvala (R-Clearwater), who filed the Senate companion bill, SB 924, for their unwavering commitment to getting this legislation passed this year.

Sen. Latvala worked so tirelessly to get

this legislation to the finish line that he amended the substance of his bill onto CS/CS/SB 1016 by Sen. Alan Hays (R-Umatilla), CS/SB 1816 by Sen. Joe Negron (R-Palm City) and CS/ HB 7169 (the House health care bill), which Sen. Negron amended to include the language contained in CS/SB 1816.

All of these bills were passed off of the Senate floor and waited for action by the House. The House made a decision not to take up any of these bills at the end of session, which ultimately defeated these bills and our efforts to pass non-covered services this year.

The FDA would like to thank all of those dentists who contacted their legislators this session to encourage them to support the FDA bills on non-covered services.

Medical Malpractice Tort Reform Bill Passes/Major Victory After more than a decade of fighting the trial lawyers, a major medical malpractice, tort reform victory occurred during the 2013 session with the passage of SB 1792 by Senate Judiciary. As chair of the Senate Judiciary Committee, Sen. Tom Lee (R-Brandon) spearheaded this www.floridadental.org

legislation through the process. SB 1792 includes major changes that will be extremely helpful to the provider community in the event of a malpractice lawsuit.

The bill was effective July 1, 2013.

1. Dentist’s Constitutional Right to Counsel A recent Florida Supreme Court decision (Hasan v. Garvar, SC10-136), which involved dentists, had the effect of limiting and even prohibiting nondefendant health care providers from speaking to their attorney about nonprivileged information. The ruling stated that the state’s patient confidentiality statute prevented certain ex parte discussions between attorneys retained by a medical malpractice insurer and health care providers involved in a case. SB 1792 basically overturns that ruling and ensures that a health care practitioner has the right to consult with an attorney for the purposes of obtaining legal services if the practitioner is scheduled for a deposition, is called as a witness or receives formal/informal discovery requests. This provision was the centerpiece of the legislation and is a major victory for a provider’s constitutional right to counsel.

2. Subsequent Treating Practitioner/ Ex Parte Communications Florida law prohibited a non-party health care practitioner from disclosing a malpractice plaintiff’s medical history and condition to a defendant in a medical malpractice case without the plaintiff’s consent. SB 1792 addresses this unfairness by permitting prospective defendants or their counsel, after receiving a claimant’s notice of intent to initiate a medical malpractice lawsuit, to interview the claimant’s treating health care

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providers without the presence of the claimant or the claimant’s attorney, but only after providing notice. The bill requires 15 days’ notice to the plaintiff during the pre-suit process of such interviews and requires the plaintiff to set the interview time, date and location. After the suit is filed, the bill allows the defendant to interview the treating providers without notice to or the presence of the plaintiff or the plaintiff’s attorney.

3. Expert Witnesses to be in Same Specialty The final provision is one that requires an expert witness testifying against a health care practitioner to be in the same specialty as the health care practitioner. Before this change, an expert witness could have been in a same or similar specialty and the courts had the broad authority to decide what constituted a similar specialty. SB 1792 corrects this problem by restricting the categories of experts who are qualified to testify by permitting only those providers in the same specialty as the provider against whom the testimony is being offered.

More Tort Reform Passes Regarding Scientific Testimony/Daubert Standard CS/HB 7015 by House Judiciary and championed by Rep. Steve Metz (RGroveland) passed after several years of attempts. This bill is another major victory over the trial lawyers in regard to how “scientific” testimony is allowed by experts in Florida courts. CS/HB 7015 changes the legal standard under which courts consider whether expert testimony will be admitted in a particular case.

Previously, Florida and many other states Please see legislative, 19

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Florida Trial Lawyers File Suits to Stop Major Tort Reform Legislation The Florida Justice Association, which represents the trial bar, has filed five separate lawsuits to challenge the recently passed tort reform legislation, which became effective on July 1. As a reminder, after more than a decade of fighting for these changes, a major medical malpractice reform victory occurred during the 2013 session with the passage of SB 1792. The bill contained three major issues helpful for providers; 1) Dentist’s Constitutional Right to Counsel, 2) Subsequent Treating Practitioner / Ex Parte Communications, and 3) Expert Witnesses must be in the Same Specialty.

On July 1, just hours after the changes took effect, attorneys filed five lawsuits challenging a key part of SB 1792, contending it violates the privacy rights of patients. The lawsuits were filed in both state and federal courts from Miami to Pensacola and raise state and federal constitutional issues regarding the ex parte communications aspect of the new law. The suits were filed on behalf of people who are considering whether to pursue malpractice cases. Each lawsuit basically argues that the new law could lead to the improper disclosure of personal health information to defense attorneys representing dentists or other health providers. A common thread in each lawsuit is the argument that the malpractice law violates privacy rights under the federal Health Insurance Portability Accountability Act of 1996, commonly known as HIPAA.

used the “Frye” standard for determining admissibility. The Frye standard considered whether the testimony was “generally accepted within the scientific community.” However, federal courts and some other states have moved to a stricter standard known as the “Daubert” standard for determining admissibility.

The Daubert standard requires a court to determine if: 1) the testimony is based on sufficient facts and data; 2) the testimony is the product of reliable principles and methods; and 3) the witness has applied the principles and methods reliably to the facts of the case. CS/HB 7015 rejects the old Frye standard and adopts the Daubert standard for use in Florida courts. The bill was effective July 1, 2013.

Massage Establishment Regulations Bill Includes Dentist Supervision CS/CS/CS/HB 7005 by the House Criminal Justice Subcommittee passed the Legislature. The intent of this bill is to address human trafficking and how massage establishments are sometimes used in this endeavor. This bill contains several issues regarding the regulation of massage establishments and prevents them from being used as a domicile. The section directly affecting dentistry states that massage establishments cannot be open from 12 p.m. until 5 a.m., unless they are a part of a hotel, bed and breakfast, health care clinic, timeshare, airport, pari-mutuel facility or unless the massage therapist is supervised by a list of health care practitioners, including dentists. The bill is effective Oct. 1, 2013.

CAT Fund Assessment Exemption Extension for Medical Malpractice Insurance Most lines of Florida insurance products are subject to yearly assessments for up to 30 years if the Florida Hurricane Catastrophe (CAT) Fund goes into a deficit after a major storm. These assessments are designed to repay the fund in the event of a deficit. Medical malpractice insurance is exempted from this assessment, but was scheduled to expire on May 31, 2013, unless re-enacted by the Legislature. At the start of session, several CAT Fund bills were filed that included language for a permanent exemption for medical malpractice insurance, but a compromise was agreed to that allowed for a three-year extension of the exemption. The FDA supported language that was amended into several other bills and the one that finally passed was CS/ CS/SB 468 by Sen. Dorothy L. Hukill (R-Port Orange), a bill dealing with property and casualty insurance rates, fees and forms. If there is a major storm within the next three years, this bill could potentially save you thousands of dollars in assessments against your medical malpractice insurance over a 30-year period! The bill was effective July 1, 2013.

Gov. Scott Approves $74 Billion State Budget On Monday, May 20, Governor Rick Scott signed into law SB 1500 — a $74 billion state budget for fiscal year 201314 and Florida’s largest budget in history.

Additionally, the governor executed vetoes that totaled approximately $368 million, which was twice as large as his vetoes from last year. The governor’s focus and priorities centered on funding for jobs and education. This year’s Please see legislative, 20

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budget includes a $480 million pay raise for teachers and $45.5 million for business incentives. This was the first time in six years that the state did not have to deal with a deficit. The budget went into effect on July 1, 2013.

The state’s budget maintained funding for the Medicaid adult dental program, which covers partial and full dentures, and emergency extractions. There were several other dental-related items approved in the budget, but later vetoed by the governor, which include the following: v $200,000 — Lake Wales Dental Clinic v $200,000 — Gadsden County, Mobile Health Unit (included dental services) v $250,000 — Florida Health Organization, Rural Health Disparities v $1,725,000 — Okaloosa County Health Department (included purchase of two mobile dental units) v $1,000,000 — Children’s Nutrition and Oral Health Program (under the Department of Agriculture)

Prescription Drug Monitoring Program Database Gets State Funding There were several bills filed this session that addressed the Prescription Drug Monitoring Program Database (PDMP), which was created several years ago in an attempt to curb doctor shopping for controlled substances in Florida. However, when the original law passed, no state funding was allowed to pay for the database and it has been operating on grants and donations. The present law also requires pharmacies to report any

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controlled substance prescriptions to the database within seven days of dispensing, but does not require any health care practitioners to review the database, as this is voluntary and subject to the health care provider’s professional discretion.

A Senate bill, by Sen. Denise Grimsley (R-Sebring), was supported by the FDA that contained several positive clarifications to the present law and directly targeted the problem of drug abuse and diversion by requiring all new patients at pain management clinics to be checked by the database prior to a controlled substance prescription. A House bill,

by Rep. Mike Fasano (R-New Port Richey), was very similar to the Senate version until it was amended to require every health care practitioner, including dentists, in Florida to mandatorily check the database prior to every controlled substance prescription or be subject to discipline by their respective boards.

The FDA worked very closely with Rep. Fasano, who eventually removed the mandatory requirement. In the waning hours of session, neither bill passed but a last‑second amendment was added to the final bill to pass the legislature this year (CS/CS/HB 1159), which allocates $500,000 in state funds to keep the da tabase operational for another year. The bill was effective upon becoming law.

Campaign Finance Reform Legislation Dictates Restructuring of PACs The House and Senate finally agreed upon a bill to change the structure for receiving campaign contributions. CS/ CS/CS/HB 569 by Rep. Robert Schenck (R-Spring Hill) will eliminate committees of continuous existence (CCEs) and increase the maximum contribution for candidates’ campaigns. This legislation decertifies all CCEs by Sept. 30,

2013, and modifies the current $500 per election individual limit on contributions to candidates as follows: $3,000 for statewide and Florida Supreme Court retention candidates; $1,000 for other candidates (which include House and Senate candidates). Additionally, the bill provides for unlimited contributions to political committees (PCs) supporting or opposing candidates, in lieu of the current $500/election limit. As for reporting, the bill increases the frequency of campaign finance reporting for candidates and committees (excluding political party committees), with monthly reports due before state candidate qualifying in June and post-qualifying reporting as follows: v Statewide Candidates and Non-local PCs/Electioneering Communication Organizations (ECOs)

v WEEKLY full reports of contributions and expenditures, from the end of qualifying to the FRIDAY prior to election.

v DAILY contribution only reports beginning on the 10th day before the general election and ending on either the MONDAY (ECOs) or THURSDAY (state- wide candidates and non-local PCs) before the general election. v Other Candidates and Local PCs ECOs BIWEEKLY, beginning on the 60th day before the primary election (FRIDAY) and continuing through the FRIDAY before the general election, with an additional report due on the 25th and 11th days before each election.

Unless otherwise noted, this bill becomes effective on Nov. 1, 2013.

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2013 Legislative Wrap-up Sovereign Immunity for Dentists When Patients Contribute Toward Lab Fees Legislation was filed this year to allow patients to voluntarily contribute toward their dental lab fees when receiving free dental care in a clinic served by volunteer dentists without jeopardizing sovereign immunity. CS/HB 1205 by Rep. MaryLynn Magar (R-Hobe Sound) and CS/ CS/SB 1016 by Sen. Hays would have clarified that donations toward dental lab fees are not considered compensation to the dentists. Normally, trial lawyers are routinely opposed to any type of legislation addressing sovereign immunity, but after reviewing the substance and intent of these bills, their position on these FDA-supported bills was neutral. Unfortunately, neither bill passed this session.

The FDA will seek this clarification during the next legislative session.

Bill Amending “Access to Health Care Act� Passed The Legislature passed CS/CS/HB 1093

by Rep. Matt Hudson (R-Naples), which makes changes to the Access to Health Care Act (Act). The Act provides, among other things, sovereign immunity to a health care provider who enters into a contract with a governmental contractor and provides volunteer, uncompensated health care services to low-income individuals as an agent of the state. A governmental contractor is defined as the Department of Health (DOH), a county health department, a special taxing district with health care responsibilities, or a hospital owned and operated by a governmental entity. The definition of a health care provider includes dentists.

Currently, a governmental contractor, who contracts with a health care provider, retains exclusive control and oversight over patient eligibility, referral determinations and patient care. Patient www.floridadental.org

selection and initial referral must be made solely by the governmental contractor and the health care provider must accept all referred patients. Patient care, including any follow-up or hospital care is subject to approval by the governmental contractor.

As originally filed, this bill would have removed the governmental contractor’s control and oversight and, instead, would have allowed the health care provider to determine patient eligibility, referrals and care. However, during the committee process, the bill was amended and now states the DOH shall adopt rules to give health care providers the greatest flexibility possible to treat patients, but the governmental contractor retains review and oversight authority of the patient eligibility and referral determination. This bill also requires DOH to provide an online listing of all providers volunteering under the Act, along with the number of hours and patient visits each provided. However, the funding appropriated for this listing was removed from the budget during budget conferences. Furthermore, the bill creates a continuing education credit for health care providers who provide services under the Act. Health care providers can earn one credit hour for every one hour volunteered up to a maximum of eight credit hours. Currently, dentists are allowed up to seven hours so this bill allows for one more credit hour to be counted toward the overall thirty hours required every two years. This bill became effective on July 1, 2013.

Grandfathering Clause for Internationally-trained Dental Students in Supplemental Programs During the 2012 session, the FDA supported legislation in SB 1040 that

codified in statute that graduates of non-accredited dental schools must take a two-year supplemental education program in general dentistry to be eligible for the dental licensure exam. When this legislation became effective, it was made known that there were individuals who would be negatively impacted by the immediate effective date of the legislation since they had already started their training in a specialty program.

A provision included in HB 463 by Rep. Jose Rodriguez (D-Miami) and SB 1130

by Sen. Rene Garcia (R-Hialeah) would have grandfathered in those internationally-trained dental students who were already enrolled in a specialty program for dental licensure and allow them to be eligible for licensure under the old law, prior to the passage of SB 1040 (March 23, 2012).

HB 463 passed off the House floor, but unfortunately, the Senate did not take up the bill (despite no opposition). As a result, the current law stands.

Public Records Exemption for Dental Workforce Survey This year, Sen. Garrett Richter (RNaples) filed SB 1066 and Rep. Alan Williams (D-Tallahassee) filed HB 1115 to provide a public records exemption for dentists and dental hygienists who complete the voluntary dental workforce survey during licensure renewal. The bill successfully passed through all committees on both the House and Senate and was ready for final passage on the House floor during the last week of session.

Unfortunately, due to a procedural move by the House Democrats to have all bills read in full on the House floor, SB 1066 did not get heard for final passage.

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2013 FDA Legislative Awards The FDA is pleased to recognize and honor certain members of the Legislature who provided continued support for the FDA’s legislative agenda throughout this year’s session.

Sen. Jack Latvala (R-Clearwater) and Rep. Ron Renuart (R-Ponte Vedra Beach) are the FDA’s 2013 Legislators of the Year.

Sen. Latvala has truly been an unwavering advocate for dental issues during his time in office. He championed this year’s legislation on non-covered services Sen. Latvala and worked tirelessly to get our language amended to any bill that was moving through the process.

This year, our non-covered services language passed four times off the Senate floor in four different bills. Sen. Latvala is no stranger to hard work. He served previously in the Senate from 1994 through 2002 and during that time, the FDA recognized him as Legislator of the Year from his efforts during the 1998 Legislative session. Sen. Latvala is a leader and will continue to serve as an important resource for organized dentistry.

Rep. Renuart

Rep. Renuart continues to be a strong health care provider in the House of Representatives.

As an osteopathic physician, he truly understands and

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appreciates the challenges dentists face daily with the insurance industry. As the House bill sponsor of non-covered services, Rep. Renuart was able to articulate the FDA’s position on creating fairness in the negotiating process and making it clear that discount plans are separately regulated from insurance plans. Rep. Renuart was also recognized last year with a Dr. Lewis Earle Legislative Award for his many years of support for FDA supported issues.

Rep. Elaine Schwartz (D-Hollywood)

Rep. Perry Thurston (D-Fort Lauderdale)

The FDA also recognizes legislators who have served over the years as dedicated dental advocates and who have gone above and beyond. The following legislators will receive the FDA’s 2013 Dr. Lewis Earle Legislative Service Award:

Sen. Andy Gardiner

The FDA recognizes Rep. Lori Berman (D-Boynton Beach) as the FDA’s 2013 Champion for Dentistry and Rep. Jose Rodriguez (D-Miami) as the FDA’s 2013 Freshman Legislator of the Year.

(R-Orlando)

Rep. Marti Coley (R-Marianna) Rep. Berman

Rep. Rodriguez

Ms. Hart is the FDA Director of Governmental Affairs. She can be reached at jahart@floridadental.org or 850.681.3629.

Rep. Steve Crisafulli (R-Merritt Island)

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Drew Eason

By FDA Staff

Please tell us about your family.

My wife Joanne and I met during our undergraduate work at Ferris State University in Big Rapids, Mich. I was the northern “country boy” and she was the city girl growing up near Detroit. This October we will be celebrating 24 years of marriage. Our twin sons, Alex and Michael, are starting college this fall in Michigan, but we are hoping they might consider transferring to Florida at some point!

What are your hobbies when you aren’t working?

My wife and I both enjoy being home. I like working in the yard and playing with the dog. I like to run as well. Our lives, up until now, have been focused on our kids and soccer. Now that they have graduated, we are going to learn how to play golf and get to know our new hometown and state.

What is your vision for the FDA?

As I write this, I’ve only been with the Florida Dental Association (FDA) for three weeks — so I hesitate to say too much until I’ve had a really good opportunity to evaluate where things stand. I do, however, think it is safe to say that my vision is for the FDA to have a growing market share in which members have no doubt on the return on their investment.

1.

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Drew Eason

drew from 25

What are the goals you would like to achieve in your first year at the FDA?

I am initially focusing on what the Board of Trustees has asked me to: u membership growth u strategic planning u organizational effectiveness We’re somewhat going back to the basics — which is good.

These are all areas of focus I have a lot of passion for. My hope is that after the first year, we’ll have a solid strategic plan, a stop in membership loss, and efficiency/customer service that the entire membership can be proud of and benefit from.

What are three things that have been drastically different going from Michigan to Florida?

u The heat and humidity — that’s an obvious one! u The size of the state — it is much more difficult to meet one-on-one with members here. In Michigan, I could meet with dentists in most of the state and be home in my own bed that night. Here, I look forward to finding new ways to connect with members. u There is much more diversity in Florida than in Michigan. I don’t see that as a problem, but rather a great opportunity for learning from a variety of perspectives.

Eason family portrait. Joanne and Drew with Alex (top left) and Michael (top right).

As someone told me at the Florida National Dental Convention, it feels like I’m drinking from a fire hose. There is a lot to learn, but I’m looking forward to working with the board, House of Delegates, staff, component staff and leaders, etc. in moving the FDA forward.

Mr. Drew Eason is the FDA’s new executive director. He can be reached at 850.350.7109 or deason@floridadental.org.

Photo:

1. Drew and Joanne attend the senior soccer game for Alex (left) and Michael (middle).

Drew and Joanne at Alex (left) and Michael’s (right) high school graduation.

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Member Milestones

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r e b m s e e M ileston M

The Florida Dental Association (FDA) would like to recognize its life members and those who have belonged to the association for 60, 50, 35 and 25 years. Each member listed below has been mailed a special membership pin. The FDA congratulates these members and thanks them for outstanding personal commitment to the association and the dental profession.

Life Members Frank M. Addabbo

Silas E. Daniel III

Harvey J. Barbag

Jose R. Davila

Ira F. Berger

Diana Davisson

Hector Bethart

James C. Dee

Terry C. Blanks Jr.

Robert E. Deery

David A. Bowles

Joseph W. Delucia

Charles M. Braverman

David Dempsey

Jerome A. Brown William R. Brueckheimer Jr.

John S. Cairns

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Phillip C. Crawford

Carl L. Daffin

Dennis S. Apfel

Donald I. Cadle Jr.

Gary G. Cook

Donald Curl

Stephen F. Anderson

George H. Burgess

Frank A. Colaizzi

Ronald N. Cummings

Nolan W. Allen

Mark J. Brunswick

Sidney H. Christie

Gregory T. Dickinson Roger A. Dunphy Robert A. Eckelson John P. Egitto Steven C. Ferber Jerry L. Finelli

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James N. Flach

Paul E. Klein

James L. Frazier

Kenneth H. Knopf

Alan G. Friedman

Roger H. Koslen

Craig E. Gassett

Kenneth M. Krat

Howell A. Goldberg

Gregg R. Kroen

Robert S. Goldie

Kenneth W. Langston

William Gonzalez Jr.

Eric J. Lebowitz

Roger A. Grace

Julian C. Leichter

Roy L. Greenberg

Robert J. Lev

Theodore Haeussner

Steven Lieber

John Hamman Jr.

Barry Lipton

Marc W. Heft

Charles D. Llano

Dan B. Henry

Stephen H. Loftis

Donald W. Hermann

William E. Lovett Jr.

Stephen B. Hulen

Michael T. Maccaro

Stephen H. Jensen

Bruce M. Mahaffey

Randy P. Jones

Alan M. Marder

Richard W. Joseph

Barry I. Matza

Richard M. Kanter

Richard Mautner

Lazarus N. Kavouklis

Donald B. McLendon

Henry P. Kellum

Sandra L. Mercier

Raymond A. Kenzik

Michael J. Mihalcik

Bernard E. Keough

David A. Moore

Keith S. Kilgallen

Jeannie H. Moran

Frederic G. Kirsch

Samuel Mozes

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Member Milestones

Lawrence B. Musser

Roger R. Stewart

Bert F. Erwin

Cletus F. Huhn

William H. Myones

Mitchell M. Strumpf

Hadley H. Hasemeier

Richard A. Johnson

Van A. Nelimark

Marvin Susskind

Samuel G. Kohlenberg

Norton Klotz

Wayne P. Newman

Jefferson W. Swindle

Lester S. Page

Robert E. Marks

Michael D. Odland

Edwin J. Szczepanik

John H. Ross

Bill L. McClanahan

James A. Padgett

Kamilla L. Sztanko

Anthony J. Schweiger

Robert W. McFadden Jr.

Michael C. Parker

Lee Tatro

George W. Starks

Robert Arnold McGee

James C. Pettigrew Jr.

Thomas J. Thacker

Roger K. Stockton

Philip P. McManus Jr.

Frank C. Pettinato

Richard N. Thomas

Edward R. Swan

G. Mark Morgan Jr.

Gabriel E. Pichardo

Charles A. Tomeo

Robert C. Tesher

William M. Nevans

George K. Pollock

Philip L. Topcik

Melvin L. Toothman

John E. Palsgrove

Raymond L. Pollock

William H. Truax II

John O. Parrish

William Porcell

Alan G. Wasserman

James A. Pickle

James R. Quick

Edwin H. Wasserman

Robert C. Ratcliff

Mark Webman

Donald A. Ray

Edward J. Weiss

Seth H. Rieback

Todd J. Wiener

Ernest J. Riggs

George M. Womble

Charles M. Robbins

Thomas C. Worcester

Jeffrey B. Rosenberg

Davis V. Yates

Richard L. Rush

Alexander Yewtuck

Charles D. Russo

Thomas F. Yoho

Leslie T. Schwarz

Joseph W. Zaffater Jr.

Barry P. Setzer

Jan L. Ziegler

Edward B. Sevetz Jr.

Neal B. Ziegler

Bruce Shaw

John D. Zongker

Charles I. Shofnos

Richard J. Zullo

Steven T. Short Robert J. Sims Jr. Alan L. Sizemore Edward J. Smith Thomas S. Smith Jr. T. Douglas Splane Noel Spurlock Stephen E. Stein Robert C. Stephens Jeffrey A. Stevens Richard A. Stevenson

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50-Year Members David J. Badat Louis H. Beall Jr. Robert P. Beem William H. Blanch James D. Booth James K. Brandt Jack H. Brenner Sam B. Carico Edd C. Chittum Walter A. Conner Thomas B. Cornell Richard W. Ehlers

60-Year Members Robert E. Ashmore Edwin J. Bard Lloyd L. Branch Charles R. Capehart Ernest R. Cervis

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Member Milestones

Thomas J. Dahlan

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Gresham L. Yeager Henry F. Young Danilo Zucchelli Edward W. Zwicker

35-Year Members

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25-Year Members Jose Abadin Suzanne Abergel-Nahon Hazel L. Abramson Douglas M. Adel Darrell R. Alford Marla J. Allen Atm N. Amin Pat Ardoin Mark A. Barber Antonio Barcia Harold L. Beddall Joseph Belotto Wayne L. Berry Andre J. Berube Thomas J. Boland Robert D. Burkhart Jr. Mary Anne Butler Robert J. Carey J. Edward Carroll Joseph J. Ceravolo Jr. John Cervenka Timothy B. Chatterley Robert B. Churney

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Gregory Lawrence

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Diagnostic Discussion

Diagnostic Discussion

By Dr. Nadim Islam

A 76-year-old retired health care professional was referred by a prosthodontist for comprehensive treatment.

He presented to Dr. Robert J. Miller, a periodontist in Plantation, Fla., with several badly broken-down teeth and restorations. After careful evaluation, the conclusion was that neglect and lack of routine dental care was the primary etiology of his dental and periodontal problems (Fig. 1). The patient also reported that it had been more than 10 years since he last had dental treatment.

Dr. Miller’s treatment plan consisted of caries control, improving oral hygiene and fabricating a processed provisional to improve esthetics. Subsequently, an implant in the upper left posterior quadrant was removed with a simultaneous lateral wall sinus graft. Tooth No. 5 was extracted with socket regeneration. The procedures went well and the patient was seen for a follow-up a week later. He reported significant mouth pain, irritability and no desire to eat or drink fluids. The patient reported sores throughout the hard palate (Fig. 2). These acute symptoms continued for seven to 10 days. A telephone consultation was initiated by Dr. Miller with the University of Florida College of Dentistry, Oral and Maxillofacial Biopsy Service. Based on the history and clinical presentation, an appropriate treatment plan was developed. The patient returned for a follow-up exam two weeks later and reported feeling much better. Clinical examination confirmed a wellhealed area with significant resolution of the ulcers and eruptions (Fig. 3).

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

A. Aphthous stomatitis B. Erythema multiforme (EM) C. Necrotizing sialometaplasia (NS) D. Primary herpetic stomatitis E. Recurrent or secondary herpetic stomatitis

Continuing Education Opportunity You can now earn continuing education credit for reading Diagnostic Discussion articles! Visit the FDA website at www.floridadental.org and click “Online Education” under the “Benefits and Resources” tab for this free, members-only benefit. You will be given the opportunity to review this column and its accompanying photos, and will be asked to answer five additional questions. If you have questions about this opportunity, email Publications Manager Jill Runyan at jihasz@floridadental.org or call 800.877.9922.

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Diagnostic Discussion

Fig. 1

Fig. 2 Please see diagnostic, 36

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Diagnostic Discussion

diagnostic from 35

Diagnostic Discussion A). Aphthous stomatitis Incorrect. An excellent choice, though! Aphthous ulcers can be seen over a large area and may lead to intense pain.

However, these are generally noted on mobile mucosa except when the patient is immunosuppressed or has other underlying risk factors. The usual locations are labial and buccal mucosa, tongue and floor of the mouth, and almost never involve the hard palate or the gingiva, which has predominantly bound or attached mucosa. Just as in our case, aphthae may be numerous but typically do not tend to involve all the areas mentioned above during a single occurrence. These are painful lesions, and pain is a salient feature usually unrelated to the size of the lesions. Also, most importantly, these lesions typically are seen in children and young adults and are less common in individuals older than 40. Aphthous ulcers are typically surrounded by a red halo which was not particularly visible in our case. There are two types: major aphthae and the minor form. The major form has been known to cause significant weight loss due to the inability of patients to eat or drink over the period these lesions persist. Aphthae are commonly associated with patients reporting a history of allergies, hematologic abnormalities, infections, nutritional deficiencies, trauma and stress. Patients with AIDS tend to exhibit a higher frequency of severe and unusual aphthous stomatitis. Smoking has been associated with increased keratinization of the oral mucosa, resulting in lowered incidence of aphthous stomatitis in smokers. The recurrence of aphthous ulcers is highly variable, with some patients reporting frequent outbreaks of ulcers, whereas some individuals have less than one per year.

B) Erythema Multiforme (EM) Incorrect. Good guess, especially when considering a previous dental procedure. Erythema multiforme (EM) is characterized by a recurrent pattern of oral ulceration with erythema.

Importantly, about 50 percent of cases have skin manifestations that range from flat, round and dusky-red lesions, with target or bull’s-eye lesions on the extremities. Our case did not

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have any skin lesions. Patients often complain of a mouth full of ulcers; however, the lesions occur predominantly on the moveable mucosa and do not commonly affect the gingiva or the hard palate. The lesions are very painful and they appear suddenly. EM is often misdiagnosed or difficult to diagnose due to its extremely variable clinical presentation. The classical characteristics of EM include: red maculae; papules/nodules; vesicles/bulla; persistent or recurrent oral ulcers and areas of necrosis; and, of course, multiple combinations of these lesions occur routinely. The outbreaks may resemble primary herpes; 15-30 percent of cases of EM follow a herpetic infection. EM is a non-specific entity and may resemble lichenoid drug eruptions. Also, lesions in chronic EM tend to eventually heal, only to recur again, unlike those in lichenoid drug reactions that wax and wane but almost never show complete resolution.

EM has a wide spectrum of clinical manifestations with mild ulcerations involving only the oral mucosa. In its most severe form, it diffuses sloughing and ulceration of the entire skin and mucosal surfaces may be seen. EM typically affects young adults in their 20s or 30s. Men are affected more frequently than women. The disease is frequently self-limiting, lasting a few weeks with a variable pattern of recurrence. Oral lesions almost begin as erythematous patches that eventually break down into large, shallow ulcerations with irregular borders. An important clinical sign is involvement of multiple areas, unlike this case in which only the palate was involved. Hemorrhagic crusting of the vermilion zone of the lips, another important clinical sign, was absent in our case.

C) Necrotizing sialometaplasia (NS) Incorrect, but it’s a good consideration, especially in scenarios where therapeutic interventions involving local anesthetic injections have been used. This entity is thought to be an uncommon, locally-destructive, inflammatory condition of the salivary glands. This is seen most frequently in the palatal salivary glands and generally is seen on the posterior palate.

The clinical presentation, initially, is a non-ulcerated swelling, often associated with pain or paresthesia. However, within two to three weeks, necrotic tissue sloughs out, leaving a crater-like ulcer that can range from less than 1 cm to more than 5 cm in diameter. This was the difference in our case, as the lesions started almost immediately after the procedure and kept on appearing until the end of first week.

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Diagnostic Discussion

A strong male predilection for this entity did match our case.

The general belief is that it is the result of ischemia of the salivary tissue, which leads to local infarction and subsequent sloughing. The significance of this lesion lies in the fact that it mimics a malignant process, both clinically and microscopically. However, this entity is generally not a diffuse process, as was noted in our patient, but focal in its presentation. A biopsy is mandatory to confirm this diagnosis and to rule out a squamous cell carcinoma or a salivary malignancy such as a mucoepidermoid carcinoma. There have been instances where, due to lack of proper diagnosis, these have been misdiagnosed as squamous cell carcinoma or mucoepidermoid carcinoma due to the pseudoepitheliomatous hyperplasia noted microscopically.

After a biopsy and the proven diagnosis has been rendered, no specific treatment is recommended and most lesions will heal by secondary intention over a six- to eight-week period.

D) Primary Herpetic Stomatitis Incorrect. The most prevalent pattern for primary herpetic infection is acute gingivostomatitis, seen in more than 90 percent of the cases. This condition usually affects children and young adults. It may present with an abrupt onset along with numerous constitutional symptoms, including lymphadenopathy, fever, anorexia, irritability and oral lesions. Both the movable mucosa (non-keratinized) and attached mucosa (keratinized) are affected. Importantly, the gingival tissues are involved in all cases and appear enlarged, painful and extremely erythematous. Identification of the gingival involvement often plays a crucial role in diagnosis of this condition. Our case did not involve the multiple sites usually affected in primary herpes, especially the free gingiva, but was mostly limited to the attached palatal mucosa. However, gingival involvement may range from very subtle to distinctive erosions and is usually seen along the facial free gingival margin. Initially, numerous small vesicles develop which rapidly form small ulcers. Adjacent ulcers often coalesce to form large, shallow, irregular ulcerations that are typically covered by a necrotic membrane. The lesions on the lip may extend beyond the vermilion border and involve the perioral skin. In some adults, the primary herpetic infection may cause pharyngotonsillitis with appearance of vesicles and ulcers on the tonsils and posterior pharynx. Auto-inoculation of fingers, eyes and genital areas is possible and should be prevented. The infection usually resolves in five to seven days;

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afterward, the virus is taken up by the sensory nerves and transported to the trigeminal ganglion. The virus remains at this site in a latent state and may produce secondary lesions periodically by traveling back and forth to the peripheral skin or mucosa.

E) Secondary or Recurrent Herpetic Stomatitis Correct. Bull’s-eye! Great guess! Recurrent or secondary herpetic lesions almost always involve the bound-down or keratinized mucosa and rarely involve non-keratinized tissues (except in immunosuppressed patients). Typically, they are seen on the skin of the lips (herpes labialis) or intraorally on the hard palate or attached gingivae. Due to their posterior palate/pharyngeal location, it is also referred to as clinically similar to pharyngotonsillitis — especially when seen in adult patients with no previous history of lesions. They are rarely ever widespread and generally spare the marginal gingiva as seen in our case. The systemic symptoms such as fever, malaise or lymphadenopathy seen with the primary form is also generally absent, but the patient’s complaint of irritability, loss of appetite and malaise may have been due to viral reactivation. Once the herpes simplex virus reaches the ganglion, it remains latent until a change in the host immune environment occurs. The virus may be triggered by various factors, such as fever (fever blisters), common cold, trauma, dental procedures, UV exposure, etc. The herpes virus then travels to the tissue through the axons of the nerve network to produce vesicles and ulcerations.

By the time the patient reported the soreness, the lesions had erupted significantly. If it is perceived or detected early, antiviral medications can be used effectively. In early cases, within the first 48 hours of the prodrome, acyclovir suspension is prescribed for a rinse and swallow dosage that may accelerate resolution. This is usually prescribed as five times a day for five days (for children, 15 mg/kg of body weight, up to an adult maximum dosage of 200 mg per day). Acyclovir in any other form is poorly absorbed and is less effective than the other antiviral agents available. Valacyclovir at the dose of 1 g twice a day and famciclovir at 500 mg twice a day are found to be effective. In addition, rinsing with a mixture of diphenhydramine (Benadryl) with Kaopectate or Maalox, or rinsing with 0.5 to 1.0

Please see discussion, 39

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Diagnostic Discussion

diagnostic from 37

percent dyclonine hydrochloride, is useful in controlling pain and discomfort. A soft and semi-solid diet with plenty of fluids is also recommended to prevent dehydration and compensate for reduced dietary intake.

Dr. Miller treated the patient and prescribed valacyclovir 2g initially, then followed by another 2 g after 12 hours. To prevent a future dental visit-related recurrence, we recommended that our patient take a prophylactic dosage of 2 g of valacyclovir at 12 hour intervals on the day of the surgery and 1 g twice a day after 24 hours. We also suggest antifungals in our patient if there is any perception of superadded fungal manifestations.

The patient was seen for a follow-up one week later and significant resolution was noted (Fig. 3).

Birek C, Ficarra G. The diagnosis and management of oral herpes simplex infection. Curr Infect Dis Rep. 2006; 8(3): 181-8.

El Hayderi L, Raty L, Failla V, Caucanas M, Paurobally D, Nikkels AF. Severe herpes simplex virus type-I infections after dental procedures. Med Oral Patol Oral Cir Bucal. 2011 Jan 1; 16(1):e15-8.

Laiskonis A, Thune T, Neldam S, Hiltunen-Back E. Valacyclovir in the treatment of facial herpes simplex virus infection. J Infect Dis. 2002; 15; 186 Suppl 1:S66-70.

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

Dr. Islam

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

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

Fig 3: Significant resolution of the soreness and ulcerated areas was noted.

Dr. Bhattacharyya

References: Chauvin PJ, Ajar AH. Acute herpetic gingivostomatitis in adults: a review of 13 cases, including diagnosis and management. J Can Dent Assoc. 2002; 68:247-51.

Westley S, Seymour R, Staines K. Recurrent intra-oral herpes simplex 1 infection. Dent Update. 2011 Jul-Aug; 38(6): 368-70, 372-4.

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

Dr. Cohen

Neville D, Allen B. Oral and maxillofacial pathology. 3rd edition. Saunders; 2009

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A View of the Profession

A View of the Profession: From Student to Dentist to Seasoned Veteran — A 25-year Perspective

By Leeanna H. Bartlett, BA, Med; Yashashri Urankar, BDS, MPH; and Gina Rinehart, BS

Documenting and comparing the attitudes and viewpoints of dental professionals at critical points in their professional life is one tool that can be used to facilitate improvements in the dental education process and in the field of dentistry itself. This paper will provide data from the Texas A&M University System Health Science Center Baylor College of Dentistry Class of 1985 extracted from three separate surveys of class members. The first survey was done during their senior year of dental school; the second survey was done 10 years after dental school graduation; the third survey was done 25 years following graduation.

Every profession brings with it a list of pros and cons. The American Dental Association (ADA), on its website, describes dentistry as a dynamic profession that provides its practitioners a world of varied and exciting professional opportunities1. However, Rada and Johnson-Leong, in a 2004 article, state that dentists view dentistry as more stressful than other occupations2. Logan et al. report that more than half of the dentists they surveyed are happy with their profession as a whole, but are dissatisfied with the level of stress it entails3. DePaola, in 2008, points out the positives in dentistry and dental education, while 42

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conceding that it is imperative that we take the long view in efforts to revitalize the profession so that dentistry is a respected member of the overall health care team4.

The survey design contained open-ended statements, and data was individually collected to ensure that results reflected personal opinions rather than a group consensus.

Studies illustrating how dentists regard their profession are typically one-time, cross-sectional assessments of the attitudes of practicing dentists. This paper presents the results of a 25-year longitudinal study comprised of surveys of the same group of individuals at three interval points; namely, during the last year of dental school (1985), 10 years following dental school graduation (1995), and 25 years after dental school graduation (2010). These results will not only assess attitudes toward the profession of dentistry but will also reveal the way in which experience in the field may have changed those attitudes.

In 1995, the same survey questions were sent to the same 1985 Baylor College of Dentistry graduates. Contact was made with 118 of the original 133 class members, and 86 questionnaires were completed and returned. This resulted in a 73 percent rate of response.

Methodology

In all three surveys, there was no attempt to contact a subsample of nonresponders by phone to determine if bias exists between the responder and non-responder groups. It is possible that there is some degree of response bias in the surveys, but the amount is unknown.

During their fourth year of dental school, in 1985, all 133 students at Baylor College of Dentistry were surveyed in order to provide a personal assessment of the field they had chosen to enter. They were asked a number of questions to assess their view of the dental profession.

They were specifically asked to identify what they believed to be the greatest advantage and also what they considered to be the greatest disadvantage of practicing dentistry. The answers to these questions are the focal point of this paper.

The year 2010 marked the 25th anniversary of dental school graduation for the class of 1985. The same survey was again mailed to the members of this class.

After two mailings, 84 members of the class were located, and 50 responded to the survey, resulting in a response rate of approximately 60 percent.

A summary of the sample and results is as follows: m 1985 survey: 133 responses out of 133 contacted = 100 percent return rate

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A View of the Profession

m 1995 survey: 86 responses out of 118 contacted = 73 percent return rate m 2010 survey: 50 responses out of 84 contacted = 60 percent return rate.

Results The advantages cited in all three surveys are listed in Table 1. Independence had been the answer most often given in 1985 and 1995 to the question, “What is the greatest advantage of practicing dentistry?” and that remained the top answer in 2010 as well. “Freedom” and “flexibility” were two words commonly used when describing this advantage of independence. Following that pattern, all three surveys show that the second most frequently mentioned advantage of being a dental practitioner was the opportunity it affords to be of service to others. A large majority of the 2010 respondents report being involved in

Respondents’ perceived advantages of practicing dentistry were grouped under these six categories: independence, income, enjoyment, service, undecided and none. Perceived disadvantages of practicing dentistry were classified under these six categories: stress and negativism, government/insurance regulations, risk of disease, office management responsibility, expenses and competition, and undecided/none.

Table 1 Year Adv 1985

60.0%

1995

Percent

2010

40.0%

20.0%

some form of community outreach activity. Almost one-third of the respondents cited economic rewards and enjoyment as advantages in 2010, but only seven reported either of these as the primary advantage of practicing dentistry. Two members of the Class of 1985 have left the practice of dentistry and are engaged in another profession, but no one stated that dentistry has no advantages.

Table 2 lists the perceived disadvantages of practicing dentistry. As senior dental students, the respondents viewed emotional and psychological stress as the greatest disadvantage of being a dentist followed by the financial concerns inherent in running a business.

Ten years after graduation, these dentists still listed emotional stress as the greatest disadvantage, but also expressed concern in the areas of expenses/competition, government and insurance regulation, office management duties, and risk of disease. In 2010, stress was replaced by office management responsibilities as the number one perceived disadvantage of practicing dentistry. It was followed closely by emotional and psychological stress and the intrusion of government and insurance companies into the profession. The percentage of respondents who did not list a disadvantage rose slightly with each survey.

Discussion None

Undecided

Service Aspect

Enjoyment

Income

Independence

0.0%

Dental professionals, whether at the student level or 10 years into practice or 25 years after graduation, all view independence as the greatest advantage of being a dentist. There was a significant decline in the number of respondents who ranked Please see profession, 44

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A View of the Profession profession from 43

it number one in 1985, but this reversed itself in 2010. Since independence is obviously perceived to be the greatest advantage of the profession at all three data collection points, the change depicted in Table 1 may reflect a changing interpretation of the definition of independence.

Responses from students in 1985 made frequent use of phrases such as “being the boss,” “having control,” and “making the decisions.” Ten years later, the respondents still valued independence but were less descriptive when discussing it.

They again became more verbal when affirming the importance of independence in 2010, using phrases such as “flexibility in scheduling,” “designing the practice,” and “freedom to balance work and fam-

ily.” Perhaps students have a simplistic view of independence as a byproduct of graduation, but realize after several years of practice that it is a relative term that is dependent on a number of variables such as competent office staff, a stable economy and the dentist’s own health.

Then, after having been in the profession for 25 years, respondents may have developed a more pragmatic understanding of the term independence and a recognition of its relationship to all facets of the practitioners’ personal and professional lives.

The service aspect was the second most commonly mentioned advantage of practicing dentistry in all three surveys.

The fact that the profession affords an opportunity to help others was appar-

Table 2 Year Disadv 1985

60.0%

1995

Percent

2010

40.0%

20.0%

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no response

Disadvantages

Undecided/None

Expenses/Competition

Office Managementt

Risk of Disease

Govt/insurance

Stress

0.0%

ently a significant motivator for students to enter the field, and it remained an important part of their professional life as practicing dentists. In 2010, 84 percent of the respondents report being involved in some form of community service.

Enjoyment and income were mentioned as perceived advantages of practicing dentistry in all three surveys, but no more than 11 percent of the respondents listed either of these as the most important advantage.

Table 2 shows the perceived disadvantages of practicing dentistry as reported in the three surveys. Nearly six out of 10 dental students perceived emotional and psychological stress as the greatest disadvantage of dentistry. This stress was specifically identified as being caused by dealing with patients’ pain, fear, apathy and negative view of dentists. Emotional and psychological stress was also deemed the greatest disadvantage of dentistry in 1995 although by a much smaller number of respondents. Any explanation of this change is speculative, but perhaps 10 years of practice has enabled the dentists to better deal with these stressors and maybe the public’s perception of dentistry has improved. The most common answer to the question, “What is the greatest disadvantage of practicing dentistry?” changed in 2010 from emotional stress to office management responsibilities. The emergence of new clinical techniques and dental materials, the increase in third-party payers, more stringent infection control requirements, increased litigation concerns, and the technology explosion have all contributed to the overall complexity of dental practice administration. Not only must the practicing dentist employ team members who have expertise in all of these areas, but he or she must also keep abreast of the rapidly developing new knowledge and innovation in the field. www.floridadental.org

A View of the Profession The expense of establishing and maintaining a dental practice was the second most often mentioned disadvantage of practicing dentistry in both 1985 and 1995, while emotional and psychological stress took the number two spot in 2010.

By this time, practitioners were rather settled and satisfied in their particular practice environment although high overhead and low insurance reimbursement rates were still concerns. The intrusion of government and insurance companies into the profession was not even on the radar of dental students in 1985. However, it became a concern in 1995, and the concern grew in 2010.

Respondents expressed a strong belief that dentists should govern themselves as reflected in this response: “Only we know what is best for our patients and our profession. We cannot allow government entities or insurance companies to dictate care. All dental school graduates, all dentists must help steer this ship.”

Implications Comparing the attitudes of the Baylor College of Dentistry Class of 1985 toward the dental profession over a 25-year period of time has been a fascinating undertaking that has produced some interesting data.

Independence was viewed as the greatest advantage of practicing dentistry in all three surveys although there was a significant decline in the number giving this response in 1995. It may be that the pursuit of independence is delayed during the first few years after graduation as the new dentist tries to find his or her professional niche and deal with all the issues that go along with doing so. Students might benefit from more exposure to various practice situations through courses or opportunities such as Baylor’s Community Preceptorship Program. www.floridadental.org

This allows fourth year dental students to spend one to two weeks in a private dental office or a public health dental clinic to observe and/or treat patients in the “real world.” The service aspect of being a dentist was a strong motivator for entering the profession and remained important to the practicing dentists.

A majority of the respondents in 1995 reported involvement in community service, and this attitude of giving back to the community was even more apparent in 2010. Continuing to include outreach activities in the dental school curriculum will expose students to various underserved populations and show them ways in which they can help meet their dental needs.

As senior dental students, an overwhelming majority of the 1985 class members viewed emotional and psychological stress as the greatest disadvantage of practicing dentistry. This may be due in part to the stressful nature of navigating through four years of dental school, but comments also suggest that respondents focused on the negative facets of the profession while neglecting to consider its positive aspects. The cost of establishing and maintaining a dental practice along with the competitive nature of the profession were considered to be important disadvantages of dentistry, and the respondents in 2010 saw the greatest disadvantage of the profession as office management responsibilities. Additional stress management techniques, business administration, personnel management, and effective communication skills should be offered to both dental students and practicing dentists through the dental school curriculum and continuing education courses. The responses from all three surveys indicate an ongoing need for more information in these areas.

Such factors as incorrect contact information, number of class members who may be deceased or in ill health, the number who may have retired, and the element of disinterest over such a long period of time could have severely limited the rate of response to the most recent survey. We were pleased to find not only that most of the members of the 1985 class are still engaged in the practice of dentistry, but also that they seem to view the profession in an overall positive light and are eager to talk about it.

References 1. American Dental Association. Education and Careers. Available at: http://ada.org/education. aspx 2. Rada R, Johnson-Leong C. Oral health: Stress, Burnout, Anxiety and Depression Among Dentists. J Am Dent Assoc 2004; 135 (6): 788-794. [Medline] 3. Logan HL, Muller, PJ, Berst MR, Yeaney DW. Contributors to Dentists’ Job Satisfaction and Quality of Life. J Am Coll Dent 1997; 64 (4):39-43.

4. DePaola DP. The Revitalization of U.S. Dental Education. J Dent Educ 2008; 72 (2 Suppl): 28-42.

Ms. Bartlett is in the Public Health Sciences Department, TX A&M HSC Baylor College of Dentistry. Dr. Urankar is in the Public Health Sciences Department, TX A&M HSC Baylor College of Dentistry.

Ms. Rinehart is a dental student, TX A&M HSC Baylor College of Dentistry.

Originally printed in the Texas Dental Journal: Tex Dent J 2012: 129(11): 11811187. Reprinted with permission. © 2012 Texas Dental Association.

This article has been peer reviewed.

The authors have no declared potential conflicts of financial interest, relationships and/ or affiliations relevant to the subject matter or materials discussed in the manuscript.

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Stages of Dentistry

?

What Stage

Your Dental Career Of

AreYou In

By FDA Staff

Brand New Dentist (0-3 years) Stefani Allison, DMD Practicing one year

Q. Where do you see your career taking you in the next five years?

A. I hope to see myself as a partner in a dental practice in the next five years. I also would like to join a nonprofit group that offers medical, dental and psychological services to underserved areas/countries.

Q. What is your dental philosophy?

A. Treat every patient as you would your family member. Be patient, kind, under-

Q. If you could start dental school

standing and truthful with each person — staff members as well as patients. And always maintain the utmost integrity and ethical standards.

A. Orthodontics.

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

A. The most challenging aspect is trying to understand different personalities and

all over and pick a different specialty, what would it be?

Q. What piece of advice would you

most want to ask of an experienced dentist?

A. How do you manage to incorporate the ever-changing philosophies, materials and new technologies into your practice?

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to be assertive when you need to be. The most rewarding part of the job is when a patient enjoys coming into to the office and is no longer fearful/scared of the dental experience.

Dr. Allison attended Midwestern University in Glendale, Ariz. and graduated in 2012.

She practices general dentistry in Winter Haven, Fla. and can be reached at snra1125@ yahoo.com.

www.floridadental.org

?

Stages of Dentistry

Mid-Career Dentist (3-10 years) Melissa M. Grimaudo, DMD Practicing seven years

Q. If you could start dental school all over and pick a different specialty, what would it be?

A. The first couple of years of practice

I wondered about this. I thought about periodontics or orthodontics, but now I really don’t think I would change anything. I love general dentistry. I get to do what I like to do, then refer the rest out. There is so much more to learn after dental school and general dentistry has so much to offer. I have taken advanced courses in esthetics and cosmetic dentistry, occlusion, TMJ and sleep apnea, among others.

I enjoy being the “general contractor” and formulating the plan with the patient. I value our relationship with the specialists we work with and always have a team approach when developing treatment plans. In some ways, it is more challenging to be the general dentist than to practice specialty care. We value the long-term relationship we have with our patients. I think I would really miss that if I were a specialist.

Q. What piece of advice have you carried with you throughout your career?

A. Listen to the patient.

Q. Where do you see your career taking you in the next five years?

A. My husband (also a dentist) and I

started our own practice about four years ago, and I see us continuing to grow our practice. I’d also like to increase our

www.floridadental.org

knowledge through additional continuing education (CE) courses.

Q. What is your dental philosophy?

A. Treat people how I want to be

treated. Listen. Find the cause of the problem, don’t just treat the symptoms.

Educate and inform the patients. Use the best techniques, materials and tools available.

Q. What has been the most challenging aspect of your job?

The most rewarding?

A.The most challenging aspect is being

a perfectionist. I think most dentists would say that they are perfectionists and it’s just impossible sometimes. We are dealing with individuals and the human body. I always do the very best I can and at the end of the day that lets me sleep well.

Everyone always says that the staff is the hardest part. Finding the right mix of people is key, and we have been blessed with great people that work with us and make it fun to come into work every day. I think running the business side of it is more challenging, considering the business-world knowledge you have to have as well as the time it takes! Owning and running a practice could be a whole separate career from being a dentist.

Sometimes I wish I could clone myself and have one of me be a dentist and the other one run the office.

The most rewarding aspect is the patients. It’s all worth it when a patient posts on Facebook that they are ecstatic with their new veneers, or a patient tells us how we changed her life by treating her TMJ. It’s wonderful when a patient who has been afraid of the dentist for years actually enjoys coming to our of-

fice. It’s very rewarding when you know you were able to change someone’s life with your care, and I value my relationships with the patients.

Dr. Grimaudo attended the University of Florida College of Dentistry and graduated in 2006. She practices general dentistry in Land O’ Lakes with her husband, Joseph N. Grimaudo, DMD. She can be reached at mgrimaudo@gmail.com.

Established Dentist (More than 10 years) Andrew B. Brown, DDS, MS Practicing almost 30 years

Q. If you could start dental school

all over and pick a different specialty, what would it be?

A. I really enjoyed all aspects of dentistry while going through school, but loved spending time in the orthodontic clinic the most as I shadowed the residents. They were having more “fun.” The patient population is young for the most part, the treatment plans are all over the map, growth and development knowledge was paramount, and you had a broad spectrum and number of patients (and parents) you got to know over short periods of time.

That being said, many of those same attributes extend to pediatric dentistry as well, and looking back, had I made that choice at the time, I could have incorporated many of those same things into what I do today. Regardless, orthodontics is what I chose, and I wouldn’t hesitate to do it again as my first choice to this day.

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Stages of Dentistry

“ ”

stages from 47

Q. What is your dental philosophy?

A. My philosophy is simple in working

with patients and/or parents: m Listen to the patient’s concerns, and communicate all aspects of the patient’s problem list. m Talk with the patients’ other treating professionals about any aspects that may need clarification. m Educate them about options for care, the short- and long-term aspects of each, and help them come to a decision on their treatment plan.

It is essential that the patient and/or parent understands what they are about to undertake from all dental aspects, including the costs, and buy into the process. Orthodontics does involve a lot of cooperation on the patient’s part to achieve most goals, and as in most things, education and communication are the key.

Q. What has been the most

challenging aspect of your job?

The most rewarding?

A. The most challenging part of the job

is finding the right people for your office team who complement each other. After that, it’s keeping them up to date on all aspects of patient care, as well as dental and technological advancements, and techniques for running a successful practice and business. Maintaining employee morale so they want to continue working in your office can be a difficult task as well; everyone wants to feel appreciated and be given the latitude to improve their skill levels and succeed in their own niche. Being the boss who is able to balance all of that can be a tough job.

www.floridadental.org

It is essential that the patient and/or parent understands what they are about to undertake from all dental aspects, including the costs, and buy into the process.

The most rewarding aspect is having found that balance, it makes a wonderful environment at work and makes it a pleasure to spend the day there, despite whatever level of patient care is going on. It cannot be stressed enough that the same balance and level of satisfaction among the office team is very apparent to the patients and parents, and makes their experience enjoyable as well.

Q. What is one piece of advice you

would offer to new dentists?

A. The biggest key I teach the residents

I work with is that you cannot be an island unto yourself. Dentistry is more complex today than ever. Treatment modalities, materials, delivery systems and insurance companies all continue to morph at an accelerated pace. Early in your career, you need to reach out and establish a mentor(s) in your specialty, or even with other specialty providers, as well as with other professionals, and form a good bond with your colleagues.

Dental schools do a good job trying to prepare you for your career, but the time is much too short to teach all the above, let alone how to “run a business.” The mentors and other professional col-

leagues can help guide you to a much smoother transition into your professional and business life, and they will help complement and complete the lifelong education it takes to be a good caregiver and business owner.

Q. Where do you see your career taking you in the next five years?

A. Thirty years of orthodontic practice

is staring me in the face this year. I still love getting out of bed to go to work to do what I do every day. That being said, I would consider doing a little more teaching in the future as I look for an associate. I also look forward to being a mentor, perhaps for my son who just graduated dental school himself and is deciding on his own professional course.

Dentistry continues to be a profession I love, and I will support its concepts throughout my life.

Dr. Brown attended the University of North Carolina at Chapel Hill and graduated in 1984. He is an orthodontist and has his own practice with offices in Orange Park and Fleming Island, Fla. He can be reached at ddsbrown@bellsouth.net.

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2013 Award Winners

By FDA Staff

The following awards were presented at the Florida National Dental Convention (FNDC) in June. The next time you see one of these Florida Dental Association (FDA) members or staff, please take a moment and congratulate them.

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Special Recognition Award

Dr. Philip Glatstein Dr. Phillip Glatstein has spent nearly a lifetime in service to the profession of dentistry and is very involved at the local level. He has been active in the Community Smiles Program in MiamiDade County and is chairman of the Restorative Dentistry Group of the Dade County Dental Research Clinic.

He’s had his dental practice in Miami since 1954. He is a fellow of the American and International College of Dentists and holds several professional committee memberships. He is in demand as a lecturer and consultant on subjects ranging from infection control to restorative dentistry.

www.floridadental.org www.floridadental.org

Award Winners

Daniel J. Buker Special Recognition Award

Special Recognition Award

Ron Idol

Dr. Iris Torres-Rivera

Ron Idol has been with the FDA since 2002. He has worked many long hours, weekends and after hours to ensure that all the FDA’s computer systems are functioning. This includes 60 desktop computers, 10 laptops and nine tablets. Some of us can barely handle one. He also completed a major overhaul of the FDA phone system, instituted new antivirus technology to improve the stability of every computer at the FDA, and stays on top of new technology and advancements for the betterment of the FDA. He does all this with a great team-first attitude. Just ask any staff member who has needed his assistance (and they all have) how helpful and patient he is through a technical challenge.

Dr. Iris TorresRivera practices general dentistry in Coral Gables.

She volunteers her time as a member of the Coral Gables Woman’s Club to the May Van Sickle Children’s Dental Clinic, so underprivileged children in the community can receive expert dental care. Dr. Torres-Rivera spends countless hours promoting the annual fundraising event that brings in the funds needed to give these underserved children the dental exams and treatment that they need.

This is a special year in that this award has been renamed to honor our retiring executive director, Mr. Daniel J. Buker.

Special Recognition Award

Dr. Robert Payne Dr. Robert Payne has served FDA agencies for many years, including DENTPAC, the Council on Communications, the Committee to Develop Access to Care and the ACHA Medicaid Advisory Council, among others. He has been active with the Florida Dental Health Foundation since 2004 and currently is vice president. He served as a Northwest Delegate since 2002, and on the Council on Dental Health since 2005.

Dr. Payne volunteers many hours of his personal time treating underserved children.

He holds an annual Give Kids a Smile event by opening his office on a Saturday to treat needy children with his son, Matt, who is also a dentist. Last year he served as spokesman for the Florida Dental Health Foundation during the Project: Dentists Care event at FNDC. He was involved with the mobile dental unit at Dentists’ Day on the Hill this past April, and also regularly donates his services to the Florida Baptist Convention’s Mobile Dental Care Unit.

www.floridadental.org www.floridadental.org

In addition to her dental practice, she has held other positions, including director of the South Dade Community Health Center and the Borinquen Health Center in Miami. She has always been a part of organized dentistry, holding memberships in the FDA, ADA, South Florida District Dental Association and Miami-Dade Dental Society, and is a fellow of the Academy of General Dentistry.

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Award Winners House, others look up to him. He also has served as an officer of the Florida Society of Orthodontists, as well as held office with the Northwest District from 2002-2006.

awards from 51

Service Award

Dr. Rudy Liddell Dr. Rudy Liddell is currently serving as the chairman for the FDA Financial Affairs Committee, a trustee to the FDA, and is a delegate to the ADA House of Delegates. He has served as a delegate to the FDA House of Delegates, co-chair for the West Coast District Dental Association, and president of the Hillsborough County Dental Association. Dr. Liddell is a fellow of the American College of Dentists, Pierre Fauchard Academy, International College of Dentists, and the Florida Academy of Practice Administration.

Rudy is tirelessly dedicated to organized dentistry and always there to help get the job done. He has a keen mind for numbers and business. On the other hand, he truly “has never met a stranger!”

Service Award

Dr. Randy Rigsby Dr. Randy Rigsby has been a member of the FDA for more than 30 years and has served in the FDA House of Delegates since 2002. He has served on the Credentials Committee and a number of Reference Committees, and when it comes to matters of the

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Service Award

Dr. Alfred H. Underwood Dr. Alfred H. Underwood has been an FDA member for 55 years. To give you an idea of how far back his membership goes, he received his dental degree at Emory University School of Dentistry when it was at the University of Miami! After graduating, he set up a general dentistry practice in Miami. Dr. Underwood has been active in the Miami Winter Meeting for 35 years and is past president of the Academy of General Dentistry and past treasurer of the Florida Academy of General Dentistry, of which he has been a member for 20 years.

He is currently a 5-year board member as well as a past president of Community Smiles. Community Smiles was established in 1946 as the Dade County Dental Research Clinic. Its founding premise, which continues today, is to provide professional dental care for the low-income community. The volunteer dentists, hygienists and dental assistants who provide service to Community Smiles on a daily basis, were recognized in July 2011. Dr. Underwood was acknowledged for having served the community for fifty years!

Leadership Award

Dr. Jorge R. Centurion Dr. Jorge R. Centurion has been active not only as a member, but has held office in most of the organizations in which he participates. This is a true sign of a leader. Dr. Centurion currently serves as a trustee of the FDA and is a member of the American Academy of Periodontics. He has also been active in the local affiliates, including the Riviera Dental Study Club and the Dade Dental Study Club.

In addition, Dr. Centurion has served in the dental education arena. He has instructed at the Miami Children’s Hospital, the University of Florida College of Dentistry, and was a visiting instructor at the University of Miami. He has authored numerous professional presentations for the various dental societies, study clubs, the Miami Winter Meeting and other professional associations. He has given lectures at the local, national and international level.

www.floridadental.org

Award Winners Leadership Award

Dentist of the Year

Dr. John Paul

Dr. Idalia Lastra

Dr. John Paul, “JP,” serves as the editor of Today’s FDA, the whip to the ADA Delegation, the 17th District representative to the ADA Council on Communications, and on the West Coast District Dental Association Program Committee. He has held positions as chairman of the Subcouncil on the New Dentist, FDA trustee, and has been president of the Polk County and West Coast District Dental associations.

JP has always been the first to volunteer for a job in organized dentistry. He has an uncanny ability to understand the many facets of organized dentistry and be able to refine it for those he leads. However, he is not afraid to tell it as he sees it. With JP, what you see is what you get.

Schwartz Lifetime Achievement Award

Dr. Howard Fisher The Schwartz Lifetime Achievement Award is given to members of our profession who have dedicated a lifetime of outstanding service throughout their distinctive career in dentistry. Dr. Howard Fisher, the recipient of this year’s award has been a member of the FDA, the ADA, and his district and affiliate dental societies for more than 35 years. During this time, he has been very active in all organizations. He has been a member of the FDA Legislative Action Committee, which is now the Governmental Action Committee, for more than 10 years. He has participated in the FDA House of Delegates since 2003, and has served on the Florida Delegation to the ADA since 1998, as well as numerous other task groups and committees.

Dr. Fisher has maintained a private practice in oral and maxillofacial surgery since 1977. He is a fellow of the American Association of Oral and Maxillofacial Surgeons and the Florida Society of Oral and Maxillofacial Surgeons.

Dr. Idalia Lastra, the FDA Dentist of the Year, has been a member of the FDA and ADA for more than 30 years, with service on the Board of Trustees for five years and the Florida Delegation for 15 years. She has been a member of the Florida Dental Health Foundation since 1994 and served as the treasurer from 2005-2009.

She also has held leadership positions as president of the Greater Miami Dental Society, the South Florida Academy of Orthodontics, and the Dade County Dental Research Clinic.

She has maintained a private practice in orthodontics in Miami since 1980. She lectures on the subject of orthodontics and currently serves in academic positions for the Miami Children’s Hospital, the Miami Children’s Craniofacial Team, and is a Courtesy Clinical Associate Professor at the University of Florida School of Dentistry. She has held leadership positions with the Florida Academy of Dental Practice Administrators, the American College of Dentists Florida Section, and is a member of the American Association of Orthodontists and the Southern Association of Orthodontists.

She served on the board of directors for the Archdiocesan Education Foundation from 1991 until its closing year in 2000.

She currently serves a variety of other community organizations, including the Kiwanis Club of Key Biscayne, and the Serra Club of Miami.

www.floridadental.org

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Howgo goHRA HRA Works Works How Employee Buys Health Insurance Employee Buys Health Insurance

Insurance Insurance Company Company

Employee Submits a Recurring Claim to goHRA Employee Submits a Recurring Claim to goHRA

goHRA Notifies Employer goHRA Notifies Employer of of Amount Reimburse thethe Amount to to Reimburse

Employer EmployerReimburses Reimburses Employee Tax-Free Payroll Employee Tax-Free in in Payroll

A Member Benefit Since 1989 A wholly owned subsidiary of the Florida Dental Association

800.877.7597 • insurance@fdaservices.com www.fdaservices.com

Health Care Consumer Alert

Health Care Consumer Alert As we approach the first ACA open enrollment period, beginning Oct. 1 for a Jan. 1, 2014 effective date, our professional advice is to proceed cautiously.

Before making any changes to your individual or small group health plan, or before considering purchasing a new plan, make sure your agent demonstrates a thorough and complete grasp of the nuances and complexities of the ACA.

By Scott Ruthstrom,

Chief Operating Officer, FDA Services Inc.

Beginning in 2014, all Americans will have to prove they have health insurance or else pay a tax penalty at the end of the year. While the tax penalty is minimal for 2014, it increases substantially in 2015 and 2016. With so many entering the health insurance marketplace, individuals should trust only the advice of a health agent who clearly comprehends the Affordable Care Act (ACA) law, and who can help navigate the various channels available to secure their proper health plan.

Full implementation of the Patient Protection and Affordable Care Act (ACA) is approaching quickly. So fast, in fact, that I liken it to a runaway freight train. Agents and brokers digest various aspects of the law in frightfully different ways. Some stay up to date with each new rule and clarification handed down on a near-daily basis by the Health and Human Services Department, while unfortunately, the majority of the agent community does not — leaving many agents thoroughly confused and only partially informed.

www.floridadental.org

Each week, I participate in webinars presented by the major health insurance companies that are geared toward agents and brokers. To their credit, these carriers excel in educating agents and in providing updated ACA information, but from the questions I hear being asked from the agent community, most agents remain woefully inadequate in their understanding of how ACA will affect their clients.

Rest assured, however, FDA Services (FDAS) is ready to counter their lack of understanding.

FDAS is taking the ACA head-on; in fact, we see this as a prime opportunity to continue serving as a valuable resource to our members. We resolve to guide our existing clients through this unprecedented transition, to weigh all of their options (including being an agent for the individual federal exchange) and we look forward to becoming a trusted resource for new clients. Our experienced staff stands ready to work for you. If you need a review of your current insurance policies, call FDA Services at 800.877.7597 or email insurance@fdaservices.com.

Mr. Ruthstrom can be reached at scott. ruthstrom@fdaservices.com.

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Electronic Communications

By Julie Song, MPH

Patient Safety/Risk Management Account Executive, The Doctors Company

Emailing and texting are efficient, convenient and direct methods to communicate in the dental and health care world, but they can be fraught with inadvertent security breaches. When emailing or texting replaces direct consultations and

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communication with dental colleagues, the dental provider must take steps to ensure the emails and texts are secure. Without appropriate safeguards, these types of communication can lead to violations of the Health Insurance Portability and Accountability Act (HIPAA).

Health care providers are smartphone “superusers.� According to Manhattan Research, more than 81 percent of health care providers use a smartphone to communicate and access health information. The attractions are obvious: texting and emailing reduces the time spent waiting for colleagues to call back and may expedite dental care by allowing necessary patient data to be sent and received quickly.

www.floridadental.org www.floridadental.org

Electronic Communications

Safeguard Against HIPAA Violations The very convenience that makes electronic communications so inviting may create privacy and security violations if messages containing protected health information (PHI) are not properly safeguarded. Electronic messages among dental colleagues should be encrypted and exchanged in a closed, secure network.

www.floridadental.org www.floridadental.org

However, according to a member survey conducted by the College of Healthcare Information Management Executives, 57.6 percent of those surveyed did not use encryption software. The underlying reasons for poor compliance with encryption could be due to lack of technical knowledge or to avoid the inconvenience of sending a message to someone who may not be able to unencrypt it.

With penalties starting at $50,000 per HIPAA violation, safeguarding electronic messages should be of utmost priority. In addition to encrypting the messages, consider installing auto-lock and remote wiping programs on smartphones. Auto-lock will lock the device when it is not in use, and requires a password to unlock it. This feature Please see communications, 61

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59 59

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“

needs to be activated in the settings of the smartphone by activating the “screen lock” feature so that the phone will automatically lock after the phone has been inactive for a designated period of time. Remote wiping programs can erase data, texts and email remotely should the phone be compromised. Depending on the type of smartphone, there are different remote wiping applications that either come with the phone or can be downloaded. Both types of safeguards provide additional protection if a device is lost or stolen.

Ensure Accuracy to Avoid Liability Concerns A cavalier attitude when composing an electronic message can pose a legal risk.

The informal nature of some messages may at times lead to using shorthand, which can increase miscommunication.

Additionally, deleted messages are never fully deleted, as metadata (the “data behind the data”) is also producible in a lawsuit. It’s important to ensure accuracy — particularly with consultations, personal health information or any other important text communication.

Finally, electronic messages cannot substitute for a dialogue with a colleague concerning a patient. If there is a critical matter or any doubt about the communication, pick up the phone.

Use Available Safeguards In some cases, an electronic record vendor may offer a secure email network option to clients. If this is the case, be certain that the email recipient is also www.floridadental.org

Electronic Communications

The very convenience that makes electronic communications so inviting may create privacy and security violations if messages containing protected health information (PHI) are not properly safeguarded.

using encryption in response to your messages. Be aware that some vendor contracts attempt to shift liability risks resulting from faulty software design or decision support data onto the provider.

The contract may also give rights to the vendor to use patient or provider data.

Take Steps to Protect Your Practice Consider the following steps to safeguard your practice: s Enable encryption on your electronic devices. s Have a texting policy that outlines the acceptable types of text communication and situations when a phone call is warranted. s Report any incidents of lost devices or data breaches to the practice’s privacy officer. s Install auto-lock and remote wiping programs to prevent lost devices from becoming data breaches. s Know your recipient, and doublecheck the “send” field to prevent sending confidential information to the wrong person.

”

s Ensure the metadata retention policy of the device is consistent with the dental record retention policy, and/ or in accordance with a legal preservation order. s Ensure that your system has a secure method to verify provider authorization. s When conducting your HIPAA risk analysis, include text message content and capability.

More information on e-communications risks can be found at bit.ly/WuEqj3.

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. © 2013 The Doctors Company (www.thedoctors.com).

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Pride in

Excellence:

Avoiding

Burnout

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Dental Staff

By Tammy L. Carullo, RDH, PC, PS

When you take pride in what you do and have a strong work ethic, you already have many of the tools needed to avoid clinical burnout. Yet, many hygienists find themselves smack dab in the middle of a rather deep complacency rut. They simply go through the motions of “a day in the life of a dental hygienist.” How do you escape this fate? Generally, you begin by determining what a strong work ethic is and then establishing where yours fits into the mix. Being proud of what you do to such a degree that you care about the outcome is the very gist of pride in excellence. If you don’t care about what you are doing, are you going to put your heart and soul into doing the absolute best job possible? No. You would be amazed — or perhaps not — at the number of hygienists in private practice who simply don’t get it! They don’t understand that the stress, depression and even physical symptoms weighing them down can be attributed largely to the fact that their work ethic has dipped below the line of acceptability.

While you cannot force someone else to care, you do have control over yourself. The knowledge and clinical skills required to do a superb job really do matter. Confidence is not a bad thing; it’s necessary for acknowledging your role in the oral health care chain. The role of dental hygiene is one of developing trust with the patient. But it’s also one of being an educator. As we become more involved with the various links that exist between oral health, systemic disease, medications and nutritional components, this role expands to unlimited options.

Evaluate your own position with regard to your work ethic. Would you classify yourself as a hard worker who puts the patients and the practice ahead of the individual?

The objective is to have our positive attributes outweigh the negatives.

Our patients deserve nothing less than our wholehearted effort. I know it isn’t easy to stay motivated and positive when faced with the same old procedures and the same old four walls on a daily basis. Many hygienists — whether they have been in the field for 30 years or three years — find themselves in this precarious position at least once in their career. Even though you may fall into a slump from time to time, it’s important to realize that becoming complacent is a far more serious issue. Once enveloped by the doldrums of clinical hygiene, it doesn’t take very long to slip into one of these vast ruts. Once there, it can be virtually impossible to climb back out. Some hygienists just give up. They quit the profession because they’ve lost their fire, their interest and their focus. Others simply go through the motions.

When you graduated from dental hygiene school, did you have every intention of remaining on the cutting edge? Absolutely! That answer is a no-brainer! No one

“

Being proud of what you do to such a degree that you care about the outcome is the very gist of pride in excellence.

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graduates from hygiene school and goes through the rigorous and stressful board examinations only to say, “Well, that ought to do for eight years or so.” Each graduate enters the world of private practice with dreams and visions of maintaining that fresh and vital feeling of importance. But when faced with the sometimes cold, hard reality of private practice, filled with time restraints, difficult patients and team-related obstacles, the dreams and visions can turn a bit cloudy. In fact, 12 percent of newly graduated hygienists quit the profession within two years of graduation. Burnout often can be avoided by not allowing the doldrums to take root. If you happen to be a veteran, figure out the best and quickest way to keep yourself off this destructive path. Eight steps to avoiding clinical burnout follow.

Do Not Isolate Yourself The worst thing you can do is withdraw more deeply into a shell, cutting yourself off from the rest of the hygienists in your profession who could offer you solace and inspiration. Membership in the American Dental Hygienists Association (ADHA) is alarmingly low. I frequently hear, “I don’t join because it costs a lot of money. Besides, what has it done for me lately?”

The ADHA does not knock on your door to help you personally with your specific problems. If every hygienist were to have this somewhat selfish mindset, preceptorship would be accepted nationally. The ADHA functions to act for the majority, as well as to benefit patients.

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Others desire isolation due to skepticism about sharing information with other dental professionals. Maybe they are afraid of competition, that someone will steal some secret way of applying sealants or billing patients. Regardless, dental societies, study clubs, associations, components, meetings, conferences and continuing education (CE) classes all are great mechanisms for bringing the dental community closer together, allowing us to learn from one another about how to better treat patients.

Stay Current With the High-tech Evolution It is reasonable to predict that dentistry soon will resemble a scene from Star Trek. With equipment advancements such as digital radiography, networking intraoral cameras, lasers, ultrasonic scalers and Perioscopy, as well as new equipment and instruments (with more curvatures than you can imagine) for the hygiene operatory, all sorts of new and improved methods and materials are designed to make our jobs easier and the outcome of each case more successful.

Learn as a Group Hygienists frequently attend CE courses alone, without the doctors or other staff members. Many of these programs, though, offer great insights on how to apply clinical knowledge for improved patient care from each staff member. The obstacles facing the front office and the clinical staff still exist. Many misunderstandings from either side result in “they said, we said” issues that truly create havoc for the practice. It is crucial that the team present a united front for pa-

tients, developing a sense of continuity, organization and maximum efficiency. If only one member of the team attends a seminar, vital information frequently is lost in the attempted implementation of an idea.

Agree That You Do Not Know Everything

This is a tough one! After all, no one wants to admit a lack of knowledge about the profession, indicating that you are less than perfect. Opening your mind to absorb information — whether it’s new or a reminder of old — is guaranteed to help you stay far away from complacency.

Commit to Change

Change can be scary. It’s human nature to become comfortable, and it alarms us to even contemplate stepping out of that comfort zone. But we are talking about our jobs and responsibilities. We need to make the changes that need to be made.

We need to always advance and maintain up-to-date clinical abilities and knowledge. After all, if you undergo knee surgery, would you want the doctor to have only the knowledge that he graduated with? Or would you be more comfortable with someone who is able to provide you with even better services, minimizing your discomfort and scarring, and maximizing the end result? Our patients are no different. They want and demand that we remain one step ahead of the game. It is not acceptable for a patient to ask you a question regarding the new water laser system that is out and for you to reply, “What water laser system?”

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Dental Staff

Read Dental Publications

Part of staying current is reading your dental publications, such as RDH, Journal of Practical Hygiene, and Access.

Information that you can read and apply immediately to private practice is your lifeline to avoiding burnout and complacency.

Take CE Courses

Do it even if you have fulfilled your requirements. I have heard so many times, “I really want to go to that seminar, but I have already received all of my credits.”

So what? The more the merrier! Whenever I hear this, I cringe; it’s rationalizing in its most deceptive form. It says to me and every other professional who is truly

committed that the only reason that these people attend seminars is because they have to. If it was not required, how many hygienists would actually go to CE courses?

Observe a Specialty Practice in Full Swing

This is really one for the books! Unfortunately, when I suggested this to a room of 120 hygienists, I got a resounding, “Are you crazy?” What better forum for keeping up-to-date than spending a day observing a periodontal practice, perio surgery, or a biopsy sent to an oral surgeon, or even an endodontic procedure? The more well-rounded you are, the harder it will be to replace you. The

more value you can provide, the higher chance you have of avoiding burnout (and, perhaps, preceptorship).

Take pride in the services you offer your patients; it will go a long way toward helping you steer clear of burnout. If you care about what you do, your patients will, too.

Reprinted courtesy of RDH magazine Tammy L. Carullo, RDH, PC, PS, is CEO of Practice by Design Inc. She can be contacted at jtncar@redrose.net or 717.867.5325. For more information about her company, visit www.practicebydesign.com.

Guest Editorial

Guest Editorial

By Dr. Rick Huot

Pretend that you are traveling in a time machine, and you programmed the craft to bring you back in American history to a time that looked just like what any dental school class of 2013 graduate is facing.

The ship stops and you run to the nearest library — remember, the Internet only exists in the Department of Defense research labs, and is classified — and you start reading what is happening in the world, from both an economic and demographic view. Trouble in the Middle East is brewing and our enemies are emboldened as they perceive that the United States is not the economic power it once was after a decade of war, and inflation is rearing its ugly head.

After a period of pent-up demand for dental services from the prior decade, the dental education community is starting to rapidly take advantage of government aid to expand their schools so that more graduates can set up practice in areas that have had difficult access and patients can enjoy the benefits of dental care.

But the economy comes crashing down, and some states (Illinois, New York and California) have an excess of 400 freshly minted graduates; many of them applying to general practice and specialty residencies to delay entering the job market.

Those who weren’t fortunate enough to get accepted into a program get hired by large group practices as dental hygienists with a base salary of $400 to $500 a day, and see “overflow” and emergency

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Many of us have walked the steps you are about to take, and we’ll be there to help you along the way.

”

patients to build their patient base. Many get discouraged initially, but are mortified at the costs of starting a practice from scratch, or even attempting to purchase an existing one. Turnover and barriers to movement make it even harder on these new graduates, and many veteran dentists already are complaining about the “busyness problem.” Many leave the profession altogether.

Sound familiar? It should be. These are the situations that I and many other graduates of the early 80s faced, with different conditions, but similar outcomes.

My personal story had a great outcome, as I was commissioned into the Air Force, and sent immediately overseas to a remote assignment one hour south of Seoul and just five minutes air time from the grandfather of the current North Korean dictator.

I was surrounded by a very talented and experienced bunch of mentors weaning me off my dental school days, as my student loans were deferred during my days on active duty. Three years later, the prime interest rate had been cut in half, and the Reagan economy was sending patients to me in my hometown.

The point of this story is this: You will find success in your dental career and there will be many rewarding moments, with the required bumps and valleys along the way.

Don’t lose faith, enjoy the wonderful moments associated with graduation with family and friends, and just remember this: Many of us have walked the steps you are about to take, and we’ll be there to help you along the way.

Congratulations!

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

All editorials may be edited due to style and space limitations. Letters to the editor must be on topic and a maximum of 500 words. Submissions must not create a personal attack on any individual. All letters are subject to editorial control. The editorial board reserves the right to limit the number of submissions by an individual.

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SAVE the date!

FLA-MOM’s first event DETAILS COMING SOON AT WWW.FDHF.INFO

Providing Free Dental Services for the Underserved

Who: Members of the Florida Dental Association

and Florida Dental Health Foundation When: March 28-29, 2014 Where: Florida State Fairgrounds in Tampa, FL

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FNDC2013

With more than 6,000 people registered, FNDC2013 attendance is trending upward! This year, the official meeting of the Florida Dental Association (FDA) attracted more attendees than in the previous four years.

FNDC2013 was mix of association governance, continuing education, a bustling Exhibit Hall and plenty of opportunities to socialize. The FDA presidency was passed from Dr. Kim Jernigan to Dr. Terry Buckenheimer. We said farewell to retiring Executive Director (ED) Dan Buker after 26 years of service and welcomed Drew Eason as the new ED. Attendees proved adept at karaoke, dowsing Foundation volunteers in the Silly Splash during Midway Madness and making par at the FDAS putting green in the Exhibit Hall.

Noted keynote speakers jumpstarted each day at 8 a.m. and Project: Dentists Care volunteers kept three dental clinics on wheels busy treating area foster children in the Exhibit Hall. Look for more photos online at http://bit.ly/17flsl2. *Photo credits: UCF student, Paula Livingston Please see fndc2013, 72

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C lassified a dvertising

Opportunities

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

The FDA online classified ad model is for “paid online advertising.” Effectively, the advertising rate you pay will entitle you to online classified ads with increased exposure. As an added benefit, we will continue to publish the “basic text” format of paid, online classified ads in our bimonthly printed journal, Today’s FDA, at no additional cost to you. All ads posted to the online classified system will be published during the contracted time frame for which you have posted your online classified advertisement.

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

74 Today's FDA July/August 2013

Workshops. ANNOUNCING Fall Conference: Pharmacology & Medical Emergencies. Amelia Island Plantation Conference “Drugs in Dentistry” & “Handson Medical Emergencies.” Speakers: Richard Wynn of U. of MD Author of “Drug Information Handbook in Dentistry.” Cindy Biron Leiseca, RDH, EMT. See link http://www.dhmethed.com/id26.html.

Workshops. ANNOUNCING Perio Instrumentation Hands-on for DH Clinician. 8 hour workshop: One on one instruction in periodontal instrumentation at Amelia Island “Boot Camp for Dental Hygienists.” See link http://www.dhmethed.com/category/RDH2.html.

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

Generous compensation with unlimited potential.

Guaranteed referrals. Join our group specialty care practice with a significant general dental component.

Established in 1975 in Aventura, Coral Springs, Delray Beach, Boynton Beach, Stuart, Ft. Pierce and Melbourne. Call: Dr. Feingold at 561.665.0991.

Email: drfeingold@dentaland.net.

ORTHODONTIST Position Desired. In house or orthodontic office. FT, PT. Locum tenens. AAO, ADA member. Experienced, Mature judgment. Skilled in business, organizational, management. Clinic, private, or corporate. Innovative multiple technics. Personable.

Presentable. Flexible. Salary open. Willing to travel. Tel: 305.801.7537; email: johnmaria7@yahoo.com.

PERIODONTIST FT/PT — Over 25 years of experience in periodontal and implant therapy; in both GP and multidisciplinary settings. I am also the former head of the Periodontal Division at a major dental school, and have published over 15 journal entries. My CV and references are available upon request. Email: periodontaljob@gmail.com.

A GREAT OPPOTUNITY IN TAMPA BAY AREA. Assoc. General Dentist desired by group practice w/ ofcs in Clearwater, New Port Richey & Spring Hill. $160K-$200K 3 wks pd vacation, 8 pd holidays & health ins., C.E. expense. No capitation. FAX RESUME TO 727.446.3359 or CALL 727.446.3259.

FINE OPPORTUNITY. Gen. Dentist who enjoys treating children for group practice w/ofcs. in Clearwater, New Port Richey & Spring Hill. $160K - $200K + bonuses, 3 wks pd vacation, 8 pd holidays & health ins. FAX resume to 727.785.8485 or CALL 727.446.3259.

General Dentist Needed, Boca Raton. If you love dentistry, have excellent chair-side and communication skills, and want to surround yourself with talented staff, we invite you to join our busy, state-of-theart, paperless, practice. Compensation: $600/ day, depending on qualifications, plus percentage of collections. Partnership available. Email: smilesofboca@aol.com.

www.floridadental.org

DAILY/WEEKLY/MONTHLY. Fill-in as needed for private FFS Owner Dentist. A few days to a month at a time. Easy-going moderate production South Florida location. 3 years Exp req’d. MUST do: All extractions, Dentures, Molar RCT. 954.557.2901.

Temporary to Permanent position. One year contract available during Sabbatical for owner Dentist. Full time moderate production, 3 to 4 days a week. Drive is central to many south Florida locations, zip 33440.

MUST do Molar RCT, Extractions, Dentures. Dr. Hausy, 954.557.2901; kurthausy@hotmail.com.

Wonderful Opportunities with a growing company. Full time with Benefits-Health, Life, Vacation and Holiday, 200 Hours of CE, 401K. State of the Art Practices and well trained team. These opportunities are throughout Florida. Please contact 904.545.6789 or 317.560.0901. Email: cstarnes@heartlanddentalcare. com, sasmith@heartlanddentalcare.com.

Seeking Dentist for Beautiful Central Florida.

FLORIDA — A unique multi-doctor private office seeks experienced dentist with partnership potential to join a rapidly growing practice in beautiful Central Florida. Highly trained staff, all management systems in place, and a 100 percent fee-for-service policy. The right candidate will be involved in post-graduate or continuing education and have strong interpersonal skills. Serious inquiries should be emailed to professionaldentist@yahoo.com.

Spodak Dental Group is hiring! We are excited to announce that the Spodak Dental Group is looking for either a GP with significant prosthetic background or a Prosthodontist to join our Delray Beach office on a full time basis. Our office has OMFS, Perio, Endo, and full production ceramic lab on premise. Fantastic opportunity to join with a rapidly expanding practice.

Must be proficient in general restorative and advanced crown and bridge reconstructive cases. Must have a passion to provide the absolute best care for our family of patients. Office is mostly fee-for-service with some PPO participation. Full time position Monday through Friday. Please send your resume to careers@ spodakdental.com. All communication will be held strictly confidential.

General Dentist needed for Bradenton/Sarasota area.

Must live in area. Associate position with option to buy in. Must have at least 5 years’ experience, corporate dental experience and Invisalgn a plus. Must have good patient rapport to encourage patient compliance.

Please send resume or contact information to: acn. dds@gmail.com.

Dental Associate Wanted for busy expanding general dental practice. Excellent salary & percentage PT/FT position, at least 3 years’ experience required. Good oral surgery skills a plus. om.swilliamsdds@aol.com.

ASSOCIATE NEEDED FOR SOUTH FLORIDA EXCLUSIVE PRACTICE. High-end multidisciplinary team seeking a motivated associate. The center is located in an upscale area near Gulf Stream Plaza. Approximately one mile from the ocean.

The practice recently underwent a modern and technological renovation. Please visit us online at www.

ThePremierSmile.com. Our team coordinates and provides continuing education courses i.e. Invisalign, dental implants, cosmetics, sedation, and prosth.

We employ a wonderful and highly trained staff that focuses on providing high quality care in a state of the art environment. We will provide the practice support needed for your success. Partnership opportunities are available. Please email CV to: info@ThePremierSmile. com or fax to 888.800.4955.

Palencia Dental, located in one of NE Florida’s premier neighborhoods has an opportunity for an associate to join our growing private practice — no HMO’s. If you have a passion for learning all aspects of dentistry, have great communication skills and excellent patient rapport. Please contact us at liz@palenciadental.com.

GENERAL DENTIST. DENTAL AMERICAN GROUP has a part-time opportunity to join our general practice in the Miami-Dade and Broward County area. English and Spanish REQUIRED. Compensation based on commission. Email: mago440@bellsouth.net or CALL 305.915.2953.

ORTHODONTIST. DENTAL AMERICAN GROUP has a part-time opportunity to join our general practice in the Miami-Dade and Broward County area. Compensation based on commission. Email: mago440@bellsouth.net or CALL 305.915.2953.

Full Time Associate wanted. Upscale General Dentistry Practice seeks a full time associate with at least one year experience to work in our Lake Worth Office. Excellent commission structure. Please email to flakat123@yahoo.com or fax resume to 561.424.2098.

Outstanding Associate Opportunity for an experienced General Dentist to join our highly successful affiliated practice in Central Florida. Be chair side and make money from day one. Highly trained and dedicated staff to support you. No Day-to-Day headaches of Managing a Practice. Guaranteed base salary, with additional performance incentives based on production. DCA believes in providing a positive professional experience so that your goals can be achieved. Our doctors, whose expertise includes endodontics, implantology, periodontics, oral surgery and the most advanced cosmetic procedures are part of an ongoing mentoring program. You would be given an opportunity to learn, earn a great income, and at the same time develop new clinical skills. dreelsj@ dentalcarealliance.com.

Skilled and Kind Dentists. Klement Family Dental Care is looking for superb dentists to help our practice grow!

We are seeking dentists with 2+ years’ experience who are passionate about patient care and are looking to continue to improve their clinical skills. Those who are capable of 1 appointment Endo, Post, and Crown Prep are preferred. Currently, our hours are Monday through Thursday, 7am-7pm, Friday 7am-6pm and Saturday 8am-5pm. We are looking for dentists who are willing and able to work within that schedule, with preference given to those candidates who are willing to work 2 or more Saturdays per month. careers@klementdental. com.

Tired of Corporate Dentistry? Here’s your chance to work your way into your own practice. Thriving office, latest equipment, room to expand, high growth Bradenton/Lakewood Ranch area. Great staff support, friendly atmosphere. Must be willing to live in area and have 5 years’ experience. Send resume and questions to: acn.dds@gmail.com.

Associate Dentist. Outstanding Associate Opportunity for an experienced General Dentist to join one of our highly successful affiliated practices in Florida. State of the art practice facilities. Strong commitment to long-term dental care. Be chair side and make money from Day One. Highly trained and dedicated staff to support you. No Day-to-Day headaches of Managing a Practice. Guaranteed base salary, with additional performance incentives based on production.

Well-established and growing patient base. Dental Care Alliance and its affiliate owners offer excellent career opportunities, with outstanding incentives and rewarding compensation package. Doctors join us at all different point in their careers — straight out of school, a residency or a specialty program, moving from another town or state, filling in extra days while building a private practice, leaving private practice or moving from other dental companies. dreelsj@ dentalcarealliance.com.

General Dentist Needed. As a dentist with Aspen Dental, you can expect to see a steady flow of new patients every day that are ready to get their smile back. Your daily procedures will include restoration (fillings), crown and bridge and core build-ups (veneers, onlays, inlays), extractions, removable prosthodontics, and providing comprehensive treatment plans. And at the end of the day we know that you’ll find your career is truly rewarding. What We Offer: Aggressive Compensation Package; Premium Benefits Package; Relocation Assistance; State-of-theArt Practices. mjarvis@aspendental.com.

Dentist Position Available at the Healthcare Network of Southwest Florida. This position will provide comprehensive dental care to patients in a primary health care delivery system. The dentist assumes the responsibility of providing the best care possible for all of our patients. High moral character, ethics, and conduct are mandatory. Please visit our website for more information: www.healthcareswfl.org.

Please see classifieds, 76

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Your Classified Ad Reaches 7,000 Readers! classifieds from 75

For Sale/Lease

General Dentist. GREAT EXPRESSIONS DENTAL CENTERS is a patient-focused organization that operates a neighborhood practice in Ft Myers and we have a full-time Associate Dentist position available.

Our dentists and specialists have the clinical freedom and autonomy enjoyed in a traditional private practice without the additional financial or administrative burdens associated with practice management. When considering a career with GEDC, dental professionals can expect unlimited production based earnings, a solid benefits package, a stable patient base, training opportunities, and long-term practice or regional career growth. To learn more please call Ross Shoemaker @ 678.836.2226 or visit us on the web at www.greatexpressions.com.

General Dentist. GREAT EXPRESSIONS DENTAL CENTERS is a patient-focused organization that operates a neighborhood practice in Jacksonville and we have a full-time Associate Dentist position available.

Our dentists and specialists have the clinical freedom and autonomy enjoyed in a traditional private practice without the additional financial or administrative burdens associated with practice management. When considering a career with GEDC, dental professionals can expect unlimited production based earnings, a solid benefits package, a stable patient base, training opportunities, and long-term practice or regional career growth. To learn more please call Ross Shoemaker @ 678.836.2226 or visit us on the web at www.greatexpressions.com.

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

Sandy Harris 561.744.2783, sandy@doctorschoice1. net.

Are you looking for the right place to practice dentistry?

A rewarding place to grow your skills and advance your career? We are an established practice in Jacksonville and understand the balance that makes a dental practice succeed and at the same time be a great place to work. We seek a dentist — experienced or new — to join our team and take ownership of the patients and their dental treatment. We seek candidates who maintain the highest standards, understand professionalism and take pride in their work. Our team has over 50 years combined dental experience and knowledge. Our facility houses leading-edge tools and ample space to grow. Our patient base is strong, and we see growth opportunities. The perfect candidate can join an established team who is anxious to assist you with the current schedule and help promote and grow your dentistry. Please forward your CV to be considered for this position. resume@pamskaffdds.com.

Looking for a great dentist with a great attitude!

Enchanting Dentistry, a rapidly growing Practice with excellent opportunities, has one full-time position available for an experienced dentist with a winner's attitude. The culture is one of continuous improvement, ownership, service, and most importantly, fun teamwork. To learn more about how you can join our practice, send your current resume and a professional photo to middnet@yahoo.com or fax to 954.693.877

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Large Office for Specialty Practice. Large 6 op practice for sale to specialist. No patient records included.

5 rooms fully equipped with Adec and x-ray units.

Lease transferable. Office located in middle of Boca Raton, Florida. Please call 646.642.2747 or email lamloann@gmail.com.

Dental Office. Free standing dental office for sale in South Tampa, Palma Ceia Area. Very desirable area. Three operatories. For more information call: 813.760.9521.

Turnkey Office — Furnished and Equipped. Turnkey office with beautiful furnishings, high-end finishes and modern equipment ... all included in the price.

Great area and the busiest road in SWFL. Fitted for 6 operatories, 1 of which is fully equipped with chair and supporting equipment. Lab, Data vacuum all in place.

Move in to an existing practice with 3-4 days’ worth of appointments. Seller Financing/Lease also negotiable. info@adampalmer.net.

Move-in Ready Dental Suite. For Rent. This is a proven successful Dental Location on busy Clark Road (38,500 cars/day) in Sarasota, Florida. The previous tenant was so successful during their 11 year stay that they are now buying a building. wrasmussen2250@ gmail.com.

Turn Key Dental Office. For Rent. South Palm Beach County, Florida, east of 1-95. Beautifully built out dental office for lease in a lovely one story professional building. Plumbing and electrical for 3 opts. are in. Office includes lab, private office, 2 restrooms, business office, reception room, ample parking, 1,172 square feet at $13.00 per square foot. For further information call 561.582.3383 or email sanco3@aol. com or eyecare@eyecaredoctors.com.

PROFESSIONAL OFFICE BUILDING. Professional office building, near hospital, I-95, Aventura, divided into 2 separate interconnecting suites. 21 parking spaces, large operating room meeting all requirements for sterile environment, 2 recovery rooms, and two operatories. Ideal for any surgical or multispecialty group practice. Full OMFS instrumentation, compressors, digital x-ray, computers, etc., and central anesthesia monitoring available for sale with building.

Refer: MLS listing A1756292. a87938@mindspring. com.

Florida, Key West — Live and practice dentistry in paradise! Well-established, four-operatory dental practice with 1,850-square-foot, stand-alone building for sale. Great office layout, high quality staff, room for growth. Great opportunity! Call 305.394.2874 for details.

Naples FL Dental Practice For Sale On Best Offer. $165,000.00 (NEGOTIABLE) LIMITED TIME. ABSOLUTELY REDUCED PRICE FOR IMMEDIATE SALE. 3 OPS, IN THE MOST EXCLUSIVE HIGH-END AREA IN NAPLES. View website for more details: www.

NaplesFloridaDentalPracticeForSale.com. Email: NaplesFloridaDental@Yahoo.com.

Pembroke Pines — #FL501. 12 year old practice in high traffic area. Beautiful office w/good exposure and ample parking. Practice is equipped w/ Dentrix, Digital Intraoral, Pan and Lasers. 8 days of hygiene. Averaging 35 new patients per month. Michael.Finnan@ henryschein.com.

Lake County — #FL503. Central Florida Medicaid based Pedo practice. 9 Operatories in 3800 SF office. 2012 Gross receipts $1.2M+. Owner retiring.

Michael.Finnan@henryschein.com.

BUSINESS OPPORTUNITY: Beautiful Sanibel Island Practice For Sale. Popular, established dental practice for sale on Sanibel Island. Relaxed atmosphere, loyal patients, low overhead with high profitability. No welfare or insurance headaches. Modern equipment includes digital x-rays. Affordably priced to provide excellent immediate income. Owner is retiring after 16 wonderful years practicing on Sanibel. Email hgoblue1@msn.com for complete details.

Pompano —#FL504. Small Office in nice professional building on US 1 central Pompano. Great potential as a “start-up” practice! michael.finnan@henryschein. com.

BUSINESS OPPORTUNITY: associate leading to equity position. Brand new, high tech, beautiful office, for comprehensive care practice to enjoy, in Boynton Beach. Please call to explore 561.271.8454.

Bradenton. 20 year active practice, 6 ops., family practice owner retiring after 46 years. Phone: 941.400.4855.

Proven successful dental office space for sale or lease in booming Fleming Island, Florida. Free standing, street side, brick building in the" Professional Center" located between Pace Island and Eagle Harbor communities. All hook ups, some equipment, and all cabinetry in place to enable a quick start up.

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

PEDIATRIC DENTIST OPPORTUNITY. Pediatric Dentist needed in Highland County. Well established general practice that does lots of pedo, 4ops +, computerized.

Located in “The Heartland” of Central FL. Contact Dr. Jerry Pyser 954.830.3147.

South Miami Dental Office. South Miami Dental office for sale as a physical entity. Doctors are relocating and will take patient base only. Turn-key, older practice in nice shape. 2 new ops. Has 6 plumbed, and equipped rooms with x-rays. Has pano with digital conversion Denoptics. 2 other rooms are plumbed and can be equipped. Call 305.282.5296 for info. Asking price is negotiable.

www.floridadental.org

The FDA will, at no charge, forward an unsigned contract on your behalf to the ADA’s Contract Analysis Service.

Call the FDA – 800.877.9922.

before you sign ...

The ADA provides a Contract Analysis Service to members free of charge through their state dental society. This service offers analysis of third-party contracts (i.e., from managed care companies) and informs members in clear language about the provisions of the contracts so they can make informed decisions about the implications of participation.

For more information about Contract Analysis, go to http://www.floridadental.org/contract-analysis.

W. DAVID GRIGGS, D.D.S., Inc.

THE TRANSITION GROUP

Practice Sale / Associate Buy-In / Mergers Practice Appraisals / Transition Planning “I have completed three successful practice transitions with Dr. David Griggs, and I couldn't be happier with the service he provides. Although I'm not his only client, the amazing amount of attention and diligence he provides sure makes me feel like I am. I couldn't imagine ever working with another broker!”

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Visit Our Website for Practice Opportunities 30 Years Experience Over 2,000 Transitions Author of National Best-Seller: “Successful Practice Transitions” 105 Harrison Avenue Belleair Beach, Florida 33786 Phone: 727.593.5852 Fax: 727.593.9937 E-mail: clientservices@thetransitiongroup.com www.thetransitiongroup.com

www.floridadental.org

Griggs Practice Transitions, LLC - Licensed Real Estate Broker

July/August 2013

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Books on the Shelf

Books on the Shelf Books Available for Review If you are interested in reviewing one of the books listed here, please contact Publications Manager Jill Runyan by email at jihasz@floridadental.org or by mail at 1111 E. Tennessee St., Tallahassee, FL 32308.

Authors should review their books within four to six weeks and are given the books they review.

Books on the Shelf: 2010 QDT, Quintessence Publishing of Dental Technology Edited by: Sillas Duarte, DDS, MS, PhD 224 pages Published in 2010 by Quintessence Publishing Price: $84 2012 QDT, Quintessence of Dental Technology, Vol. 35 Edited by: Sillas Duarte, DDS, MS, PhD 236 pages Published in 2012 by Quintessence Publishing Price: $118 2013 QDT, Quintessence of Dental Technology, Vol. 36 Edited by: Sillas Duarte, DDS, MS, PhD 216 pages Published in 2013 by Quintessence Publishing Price: $128

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Advanced Immediate Loading By: Georgios E. Ramanos DDS, PhD, Prof Dr med dent 192 pages Published in 2012 by Quintessence Publishing Price: $148 Advances in Restorative Dentistry By: Drs. Adrian Lussi and Markus Schaffner 272 pages Published in 2012 by Quintessence Publishing Price: $138 At the Forefront: Illustrated Topics in Dental Research and Clinical Practice By: Hiromasa Yoshie, DDS, PhD 108 pages Published in 2012 by Quintessence Publishing Price: $98 Atlas of Cone Beam Imaging for Dental Applications, Second Edition By: Dale A. Miles, DDS, MS 408 pages Published in 2012 by Quintessence Publishing Price: $142 Atlas of Dental Rehabilitation Techniques By: Drs. Romeo Pascetta and Davide Dainese 416 pages Published in 2013 by Quintessence Publishing Price: $298 Controversial Issues in Implant Dentistry Edited by: Prof. Hernandez Alfaro, MD, DDS, PhD, FEBOMS 264 pages Published in 2013 by Quintessence Publishing Price: $168

Dental Materials and Their Selection By: William J. O’Brien, PhD, FADM 425 pages Published in 2008 by Quintessence Publishing Price: $68 Early-Age Orthodontic Treatment By: Aliakbar Bahreman, DDS, MS 436 pages Published in 2013 by Quintessence Publishing Price: $142 Esthetic and Restorative Dentistry: Material Selection and Technique, Second Edition By: Douglas A. Terry, DDS and Willi Geller, MDT 752 Pages Published in 2013 by Quintessence Publishing Price: $318 Implant Therapy: The Integrated Treatment, Volume 1 By: Dr. Mauro Merli 792 pages Published in 2013 by Quintessence Publishing Price: $360 Inspiration: People, Teeth and Restorations By: Luis Narciso Baratieri, DDS, PhD, MS 482 pages Published in 2012 by Quintessence Publishing Price: $228 ITI Treatment Guide, Volume 6 Edited by: Stephen Chen, MDSc, PhD; Daniel Buser, DDS; and Daniel Wismeijer, DDS, PhD 266 pages Published in 2013 by Quintessence Publishing Price: $98

www.floridadental.org

Books on the Shelf

Lingual Orthodontics By: Giuseppe Scuzzo and Kyoto Takemoto 885 pages Published in 2010 by Quintessence Publishing Price: $230 One Stroke, Two Survivors By: Berenice Kleiman, with comments by Herb Kleiman 208 pages Published in 2006 by Cleveland Clinic Press Price: $24.95 Oral Implantology Surgical Procedures Checklist By: Louie Al-Faraje, DDS 92 pages Published in 2013 by Quintessence Publishing Price: $68 Oral Implants: Bioactivating Concepts Edited by: Drs. Rolf Ewers and Thomas Lambrecht 536 pages Published in 2013 by Quintessence Publishing Price: $328 Orofacial Pain: Guidelines for Assessment, Diagnosis, and Management By: Reny de Leeuw, DDS, PhD, MPH and Gary D. Klasser, DMD 312 pages Published in 2013 by Quintessence Publishing Price: $48

www.floridadental.org

Peri-Implant Tissue Remodeling: Scientific Backgroung & Clinical Implications By: Luigi Canullo, DDS, PhD; Roberto Cocchetto, DDS, MD; and Ignazio Loi, DDS, MD 188 pages Published 2012 by Quintessence Publishing Price: $170 Periodontal Review: A Study Guide By: Deborah A. Termeie, DDS 296 pages Published 2013 by Quintessence Publishing Price: $68 Success Strategies for the Aesthetic Dental Practice By: Linda Greenwall, BDS, MGDS RCS, MSc, MRD RCS, FFGDP and Cathy Jameson, PhD, MA, BS 176 pages Published in 2012 by Quintessence Publishing Price: $98

Tooth Whitening Indications and Outcomes of Nightguard Vital Bleaching By: Van B. Haywood, DMD 152 pages Published in 2007 by Quintessence Publishing Price: $98 Treatment of TMDs: Bridging the Gap Between Advances in Research and Clinical Patient Management By: Charles S. Greene, DDS and Daniel M. Laskin, DDS, MS 216 pages Published in 2013 by Quintessence Publishing Price $108 Treatment Planning for Traumatized Teeth, Second Edition By: Mitsuhiro Tukiboshi, DDS, PhD 240 pages Published in 2012 by Quintessence Publishing Price: $82

The Art of Detailing: The Philosophy Behind Excellence Edited by: Rafi Romano, DMD, MSc 360 pages Published in 2013 by Quintessence Publishing Price: $240

What to Do For Healthy Teeth (This book is geared toward patients.)

By: Drs. Sadie S. Mestman and Ariella D. Herman 197 pages Published in 2004 by Institute for Healthcare Advancement Price: $12.95

The Magical Toothfairies: The Secret of the Magic Dust By: Henry Olberg 38 pages Published in 2012 by Quintessence Publishing Price: $18.99

Zygomatic Implants: The Anatomy-Guided Approach By: Carlos Aparicio, MD, DDS, MSc, DLT 254 Pages Published in 2012 by Quintessence Publishing Price: $168

July/August 2013

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OFF the cusp John Paul, dmd, Editor

The World is a Stage Do you ever consider the stage of your career? In the constant quest to be helpful to our members by cataloging the information we give them into more useful packets (with more of their good stuff and less of someone else’s good stuff), the current best practice is to divide by career stage.

When I started out, the division was simple: there were only three stages. The first was dental student, which meant no one was too interested in you because you had yet to prove that you could graduate, pass the board exam and do the job. The other two were practicing dentist and retired dentist, and retired might mean retired from life as often as retired from the art of healing. There was some concern that if you had just begun to practice, you would need to “build up your speed.” If your hair had started to turn gray, you might be interested in taking on an associate or selling your practice outright. Otherwise, everyone did the same thing, all the time, because that’s what dentists do did.

When I was 40, during one of our back porch chats my father said, “Son, I wish

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you were 13 again.” I told him that even I knew I was a jerk when I was 13 and wondered what would make him say something like that. He looked at me kind of sideways and said, “When you were 13, you knew everything, and I’ve got a couple of questions I’d like to have answered.” One question I wish I had asked my father before he passed: “Was there ever a time when you looked in the mirror and saw an old man?”

Gray hair or not, beard or not, I see a guy who’s about 35 looking back at me each morning. Maybe it’s because I’ve worn the flat-top since college. Maybe it’s because I need the glasses I now wear, but that’s how I feel. Old enough to know better, but young enough to still get anything done. I will celebrate 24 years of practice in one location this Labor Day, which should make me about 55. I’ve been involved in the leadership of the Florida Dental Association for nearly 19 years — that should put me closer to 60. I’ve been married to my first and only wife for eight years and we have a 5-year-old and a brand new baby. That should make me about 29. Neither of my children are about to start college, so

I must be considerably younger than our new executive director, Drew.

On any given day, I’m trying to build up my speed so I can get more done. I look for ways to get more patients into my office. I ponder new materials and techniques that may be better for my patients, and I wonder if I should practice as a sole proprietor or look to some type of group model. I wonder if I should start offering child care in my office. If you are confused about what stage you are, then you are in the same boat I am.

The good news is, no one will ask you to declare a stage. If you like one stage today, you can claim a different one tomorrow. You’re as old as you feel. As long as you are in the dental club, the world’s a stage and you are welcome to play upon it.

(Apologies to Bill Shakespeare, thanks to Bill Paul.)

Dr. Paul is the editor of Today's FDA. He can be reached at jpdentz@aol.com.

www.floridadental.org

30 MINUTE WEBINARS PRESENTED BY FDA SERVICES WednesDAY, AUG. 14, 2013 1 PM EST/NOON CST

WednesDAY, SEPT. 11, 2013 1 PM EST/NOON CST

Health Care Reform Update Impact of Health Care Reform on You and Your Practice We will discuss what the exchanges are shaping up to look like, what options a small dental practice will have, and the options available for individual/family coverage. We are striving to keep our members informed about all the different changes as we approach 2014. Presented by FDA Services.

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