2017 - Jan/Feb TFDA

2017 Legislative Issues 2016-2018 Legislature Community Water Fluoridation Florida Medical Marijuana Law

VOL. 29, NO. 1 • JANUARY/FEBRUARY 2017

TRY MY AGENT “

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

“

- George Kolos, D.M.D. FDA Services Board of Directors, FDA Trustee, NOVA Southeastern Univeristy Assistant Professor

Call us at 800.877.7597 to get started with Professional Liability coverage from The Doctors Company!

contents LEGISLATIVE ISSUE

news

74

Drug-induced Gingival Overgrowth: What You Need to Know!

12

news@fda

76

Soldier Values for Citizen Dentists

30

The Florida Board of Dentistry —

78

You Are Such a Perfectionist, Part 2

More than Just Discipline

80 Mission Trip

f e at u r e s

literary

16

84

Book Reviews

88

Books on the Shelf

2017 Legislative Issues

20 2016-2018 Legislature 24

GAC, FDAPAC and LCD Members by Component

27

Capital Hill Club Thank You!

29

Show Us Your Smiles!

32

FDA Highlights Community Water Fluoridation

34

Florida Medical Marijuana Law Now Effective

3

Staff Roster

39

Serve First Solutions

5

President’s Message

41

Student Debt Management

6

Legal Notes

42 Dentistry Faces a New Economic Climate

11

Information Bytes

50 FDC2017 Speaker Preview — Bruce Christopher

69

Diagnostic Discussion

54 FDC2017 Speaker Preview — Laci L. Phillips

96

Off the Cusp

56

FDC2017 Speaker Preview — Dr. Tracy Shaw

58

FDC Exhibitor Marketplace

61

Dental Lifeline Network

63

Midlevel Dental Provider

Read this issue on our website at:

www.floridadental.org.

www.floridadental.org

columns

classifieds 90 Listings

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

January/February 2017

Today's FDA

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FLORIDA DENTAL ASSOCIATION

L A C LO Y L E V & LI

GATHER FOR FUN & CONTINUING EDUCATION IN YOUR DISTRICT. SFDDA SCIENCE, SOCIAL MEDIA & START UPS FRIDAY, FEB. 24, 2017 MARGARITAVILLE, HOLLYWOOD BEACH Speakers: Dr. Jean Wu; Jack Hadley; Industry experts www.sfdda.org • 305.667.3647 • sfdda@sfdda.org

NWDDA ANNUAL MEETING

JANUARY/FEBRUARY 2017 VOL. 29, NO. 1

EDITOR Dr. John Paul, Lakeland, editor

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

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

FRIDAY & SATURDAY, FEB. 17-18, 2017 THE GRAND SANDESTIN Speakers: Dr. Tarun Agarwal; Dr. John C. Flucke; Ms. Pamela Smith www.nwdda.org • 850.391.9310 • nwdda@nwdda.org

NEDDA SPRING MEETING FRIDAY, MARCH 3, 2017 MAGGIANO’S LITTLE ITALY, JACKSONVILLE Speakers: Dr. Thomas Yoon — Digital Dentistry; Dr. Hyung-Jun Kong — Prosthodontic Treatment Planning www.nedda.org • 904.737.7545 • ddeville@nedda.org

ACDDA WINTER CONFERENCE FRIDAY, MARCH 10, 2017 Speaker: The Madow Brothers – ROCK Your Practice to the Top! ww.acdda.org • 561.968.7714 • acdda@aol.com

WCDDA PRESIDENT’S TRIP FRIDAY, APRIL 28, 2017 DISNEY CRUISE • PORT CANAVERAL TO BAHAMAS Six CE credits will be provided. www.wcdental.org • 813.654.2500 • kelsey@wcdental.org

CFDDA ANNUAL MEETING MAY 11-13, 2017 • ROSEN SHINGLE CREEK, ORLANDO Speakers: Friday – Dr. Steven Rasner; Saturday – Dr. Robert G. Ritter www.cfdda.org • 407.898.3481 centraldistrictdental@yahoo.com

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

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

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

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

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

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

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

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

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

Advertising must be paid in advance.

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

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

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January/February 2017

www.floridadental.org

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

FLORIDA DENTAL ASSOCIATION FOUNDATION

EXECUTIVE OFFICE

(FDAF)

Drew Eason, Executive Director deason@floridadental.org 850.350.7109

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

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

ACCOUNTING Jack Moore, Director of Accounting jmoore@floridadental.org 850.350.7137 Leona Boutwell, Finance Services Coordinator Accounts Receivable & Foundation lboutwell@floridadental.org 850.350.7138 Joyce Defibaugh, FDA Membership Dues Assistant jdefibaugh@floridadental.org 850.350.7116 Deanne Foy, Finance Services Coordinator Dues, PAC & Special Projects dfoy@floridadental.org 850.350.7165 Mitzi Rye, Fiscal Services Coordinator mrye@floridadental.org 850.350.7139 Stephanie Taylor, Membership Dues Coordinator staylor@floridadental.org 850.350.7119

COMMUNICATIONS AND MARKETING

Meghan Murphy, Program Coordinator mmurphy@floridadental.org 850.350.7161

FLORIDA DENTAL CONVENTION (FDC) Crissy Tallman, Director of Conventions and Continuing Education ctallman@floridadental.org 850.350.7105 Elizabeth Bassett, FDC Exhibits Planner ebassett@floridadental.org 850.350.7108 Brooke Martin, FDC Meeting Coordinator bmartin@floridadental.org 850.350.7103 Jennifer Tedder, FDC Program Coordinator jtedder@floridadental.org 850.350.7106

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

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

INFORMATION SYSTEMS

Lynne Knight, Marketing Coordinator lknight@floridadental.org 850.350.7112

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

Jessica Lauria, Communications and Media Coordinator jlauria@floridadental.org 850.350.7115

Rachel Burch, Computer Support Technician rburch@floridadental.org 850.350.7153

FDA SERVICES 800.877.7597 or 850.681.2996 1113 E. Tennessee St., Ste. 200 Tallahassee, FL 32308 Group & Individual Health • Medicare Supplement • Life Insurance Disability Income • Long-term Care • Annuities • Professional Liability Office Package • Workers’ Compensation • Auto • Boat Scott Ruthstrom, Chief Operating Officer scott.ruthstrom@fdaservices.com 850.350.7146 Carrie Millar, Agency Manager carrie.millar@fdaservices.com 850.350.7155 Carol Gaskins, Assistant Sales & Service Manager carol.gaskins@fdaservices.com 850.350.7159 Debbie Lane, Assistant Manager – Service & Technology debbie.lane@fdaservices.com 850.350.7157

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

RISK EXPERTS Dan Zottoli Director of Sales Atlantic Coast

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

561.791.7744 Cell: 561.601.5363 dan.zottoli@fdaservices.com

Alex del Rey, FDAS Marketing Coordinator arey@fdaservices.com 850.350.7166

Dennis Head Director of Sales Central Florida

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

877.843.0921 (toll free) Cell: 407.927.5472 dennis.head@fdaservices.com

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

Mike Trout Director of Sales North Florida

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

904.249.6985 Cell: 904.254.8927 mike.trout@fdaservices.com

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

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

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

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

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

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

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

Christine Mortham, Membership Concierge cmortham@floridadental.org 850.350.7136

www.floridadental.org

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

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

January/February 2017

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What is the FDA Mentorship Program?

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N M OW N EM RE EW B TO E C R R !

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

mentorship program

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Who Participates?

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

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What Does It Involve?

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

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

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

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

rela t i o

ce cou n n da

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

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

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

Questions?

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

hip gui ns

PRESIDENT’S MESSAGE BILL D'AIUTO, DDS

Elections Are Over, But the Work Has Just Begun!

As we have seen in the past, presidential election years can be brutal not just for the candidates, but incredibly stressful events for the electorate — that’s us! As dental professionals who are entrusted with caring for the good of the public through advocacy and political action, we can ill afford to allow ourselves to become polarized in the dogma of either political party. We are the “Tooth Party.” We must be both progressive and conservative if we are to advance this great profession into the future. Progressive in that it is incumbent upon us to put forth the “next generation advocacy solutions” so that our state Legislature has the proper GPS coordinates to connect the dots from point A to point B to meet the ever-changing needs of the public and to elevate patient care. Conservative in that we must always remember why we are here and that, dear friends, is to protect the public trust.

The Florida Dental Association’s (FDA) public advocacy program, Florida’s Action for Dental Health, charts the path that will continue to lead the way into the future for greater access, utilization and availability of dental care.

As members of the FDA, we have a golden opportunity to positively influence the fu-

www.floridadental.org

ture of this caring profession by volunteering to be a legislative contact dentist (LCD).

Our LCD member dentists work closely with our Governmental Affairs Office to be trained as an advocate on dental issues that champion the initiatives that serve the best interests of our patients and profession.

If we are in the business of preserving and serving the public trust — and we are — then volunteering to advocate on behalf of the profession is in the best interest of both.

We not only have a golden opportunity, but also an ominous task in the upcoming 2017 Legislative Session because we have a new Legislature that we will need to educate on the issues important to our membership.

What is equally important is that we have new House and Senate leadership, which promises to bring a new set of challenges to our lobbying efforts. It’s been stated time and time again — and it’s true — that “all politics is local.” Volunteering to become an LCD is in no measure a minor role in the big picture of keeping dentistry a revered profession. Being an LCD not only keeps our advocacy alive beyond elections and legislative sessions, but also all year long as issues need to be introduced to our legislators for their proper education and illumination. By far, most legislators are

not dentists (news flash!), but they need to be enlightened to think as a dentist thinks when it comes to preserving the highest quality of care to the public that we both endeavor to serve.

So, what if you don’t know a legislator or have personal reservations about the possible commitment to becoming an LCD? A few great ways to find out what it’s all about is to contact the FDA’s Governmental Action Committee, or better yet, take part in Dentists’ Day on the Hill on April 4, 2017.

This “meeting of the minds” within the dental profession is preceded by a rally the evening before at the Aloft hotel in Tallahassee, where legislators and dental colleagues meet and collaborate on the important issues to the profession.

I invite you to plug in, turn on and be enlivened to the greater purpose for which you became a dentist. It will make all the difference to your day-to-day practice, I can assure you.

coach advise learn shadow

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

January/February 2017

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Legal Notes

How Well Do You Know the Board of Dentistry Discipline Process? Part 2 Graham Nicol, Esq., HEALTH CARE RISK MANAGER, BOARD CERTIFIED SPECIALIST (HEALTH LAW)

In Part 1, we looked at common misconceptions about Florida’s licensure discipline process.

Now let’s look at each step in the discipline process.

STEP ONE: Who Gets Licensure Complaints?

The Florida DOH, Division of Medical Quality Assurance (MQA), gets complaints against dentists and hygienists. In the 80s, the Department of Business and Professional Regulation did intake. Then it was the AHCA. Then in 1997, hospitals, clinical labs and ambulatory surgical centers stayed with AHCA, but individual licensees went to DOH. The DOH has grown dramatically since then. It now regulates more than 200 types of licensees in more than 40 health care professions. You might be surprised to learn there are nine different types of dental licensees: dental, dental hygienist, dental expert witness, dental laboratory, dental radiographer, dental residency permits, dental teaching permits, dental temporary certificates and dental health access licensees. Further, there are permits for anesthesia

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providers and dispensing practitioners. In this context, there is no practical difference between a permit and a license — both subject you to government regulations. The government regulates health care professionals more than any other profession except, perhaps, commercial airline pilots.

TIP: Judges ensure legal procedure is followed, the “finder of fact” plays an even more important role in determining the ultimate question — did you violate the rules or not (i.e., are the allegations against you true or false, are you “guilty” or “not guilty”)? In civil litigation, the judge watches over evidence and procedure, but does not make the findings of fact. That is left to the jury. Administrative law is completely different.

As a generalization in licensure discipline (unlike civil litigation), the DOH/MQA acts as both investigator and prosecutor, while the Florida BOD acts as judge and jury under informal hearings. This is because in informal hearings, you have admitted the facts and they are no longer an issue. But in formal hearings, the administrative law judge (ALJ) under the Division of Administrative Hearings (not DOH/BOD) acts as an unbiased, non-adversarial judge, but also serves as the finder of fact.

It is crucial to understand who will decide whether the allegations against you are true.

In civil and criminal litigation, it is the jury.

In informal administrative litigation, you already have admitted the allegations to the BOD; in formal hearings under administrative law, the ALJ serves as the finder of fact and it is extremely difficult for the DOH/ BOD to reverse those findings.

TIP: Whether your license is sanctioned depends to a large extent on who you have chosen to serve as the finder of fact. The first choice you make is whether you disagree with the facts; the second choice you make is who — between the DOH/BOD and an independent ALJ — do you want to decide the facts. Many a good dentist has been disciplined because they made uninformed choices on these two questions.

The BOD’s job is not to protect the individual patient; although, they often will require restitution to the patient as part of the licensure discipline. The BOD’s job is to protect public safety by ensuring “that every dentist or dental hygienist practicing in this state meets minimum requirements for safe practice.”

The board consists of 11 members appointed by the governor and confirmed by the Florida Senate. Seven of the board members are licensed dentists who actively practice dentistry, two are licensed dental hygienists and two are laypersons who have no experience in the profession. Each dentist who serves on the board must have at least five years of experience as a practicing dentist.

The board is a mix of general practice and specialties.

STEP TWO: Who May File a Complaint?

Anyone. Moreover, they are encouraged to file complaints. For example, section 456.068, Fla. Stats., mandates that AHCA establish a toll-free telephone number for reporting complaints. As another example, section 456.073(11), Fla. Stats., gives www.floridadental.org

Legal Notes

complainants “a privilege against civil immunity” with regard to complaints and information they provide to the MQA. Under section 456.073(12)(a), Fla. Stats., they lose the immunity only if the licensee complained against can prove they acted “in bad faith or with malice in providing such information.” This means that you, as the doctor complained against, must retain counsel and sue in circuit court to prove the complaint was filed with “intentional fraud or malice.”

TIP: Intentional fraud is different from acting in bad faith, but both terms are undefined by statute. Also, it is almost impossible for you to prove what was in the mind of the complainant and they will be sure to deny bad faith and malice. Also, the DOH may continue its investigation and prosecution even if you prevail in the civil suit. Further, if you lose the civil suit, then you owe the complainant court costs and reasonable attorney’s fees.

TIP: Don’t expect to avoid discipline by arguing the complainant had improper motives.

Disgruntled patients are obviously the most prolific source of serious “informed consent” and “standard of care” MQA complaints. But patients also routinely complain that the front office staff was rude, they were made to wait or they were charged too much.

TIP: Remember there is no financial cost and extremely low liability risk to the patient to file a complaint against you. Assume that if you practice long enough, you will have a complaint filed. Regardless of what you do or don’t do, some patients are beyond your control, unreasonable and vindictive. So, the important question is not who may file www.floridadental.org

a complaint. Rather, it is what complaints will the MQA act on? More on this later.

TIP: Assume that there are plaintiffs’ attorneys involved even if you don’t spot them.

Under s. 766.106, Fla. Stats., plaintiffs’ lawyers must file with the MQA in order to file in circuit court, so lawyers are a huge source of referrals to the DOH. TIP: Trial lawyers get calls from potential medical malpractice plaintiffs every single day. Within the first six minutes, a good lawyer already has decided to get a retainer agreement signed or to hang up on the caller as a literal waste of their time. Why six minutes? Because that is the smallest increment of time that gets billed or written off by the firm. The quickest way for a lawyer to get off the phone when the case is a “dog” — as opposed to a “drowning baby” — is to tell the caller, “I can’t help you. Call the Department of Health.” So, a lot of complaints (some serious, some frivolous) get filed with the MQA because of lawyers, and by now, everybody has at least one lawyer in the family.

On the other hand, if the lawyer wants the case, they will actively assist their client to file with the MQA. It is an inexpensive, yet effective, way to have the government gather the evidence they intend to use against you at trial.

“

Don’t be fooled by the nomenclature of informal hearings and expedited review ... the process is lengthy and during that time you are out of work.

”

Medical malpractice insurance companies are required to report settlements, as are self-insured dentists. If you have privileges or are on staff, hospitals are required to submit “adverse incident” or “Code 15” (within 15 days) and “Code 24” (within 24 hours)

Please see LEGAL, 8

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7

Legal Notes LEGAL from 7

reports, as well as medical staff sanctions.

Managed-care plans and health insurers may, but rarely do, file complaints. The DOH also investigates licensees on its own initiative, even though no complaint has been filed (more on Emergency Suspension Orders later). Each month, AHCA contacts the U.S. Department of Health and Human Services to determine who is in default of their student loan obligations, which is a disciplinary violation as well as a breach of contract liability. See, section 456.0721, Fla. Stats.

Self-reporting You might be surprised to learn that you are required to report yourself under five circumstances. First, you legally are required to notify your patient, in person, if an “adverse incident results in harm,” which may trigger a DOH complaint/litigation.

TIP: Section 456.0575, Fla. Stats, doesn’t define what “adverse incident” or “harm” means. Adverse incident is used in the hospital licensure act and mandates a written report to ACHA within 15 days. But what adverse incident means outside the hospital setting is undefined. The statute also says your “notification” is not an admission of liability and cannot be used as evidence against you. This statute first passed in 2003, but there is no case law construing it, which leads me to believe doctors are simply ignoring it and hoping they don’t get caught.

Second, section 466.028(1)(ii), Fla. Stats., makes it a disciplinary violation for you to fail to report to the BOD “in writing, and within 30 days if action has been taken against one’s license … in another state, territory or country.” Third, section 465.072(1) (x), Fla. Stats., requires you to report to the BOD “in writing, within 30 days after

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the licensee has been convicted, or found guilty of, or entered a plea of nolo contendere to, regardless of adjudication, a crime in any jurisdiction.” If the crime involves controlled substances or fraud, this typically further triggers an Emergency Suspension Order (ESO). This will be discussed in the third article in this series.

TIP: Very few things you do in your practice will get you in criminal trouble. It pays to know what they are and diligently avoid them. Controlled substances violations and fraud are felonies likely to be prosecuted and will result in a five-, 10- or 15-years prohibition on licensure.

TIP: Plea bargain felonies down to misdemeanors in order to avoid long-term prohibitions on licensure.

Fourth, Section 456.063(3), Fla. Stats., requires a licensee to report allegations of sexual misconduct to the DOH without regard to the practice setting where the alleged misconduct occurred. Note that the self-reporting obligation applies to mere allegations of sexual misconduct.

Fifth, section 456.059, Fla. Stats., requires dentists to report themselves to the Office of Insurance Regulation (OIR), which is under the Department of Financial Services, not the DOH, whenever there is “any claim or action for damages for personal injury alleged to have been caused by error, omission or negligence in the performance of such licensee’s professional services or based on” lack of informed consent.

Similarly, section 627.912(1)(f), Fla. Stats., requires dentists to report claims or actions if the insurer or the self-insured fund does not. These reports must be made within 30 days of a settlement if it includes a payment of $1 or more. Even if there was no money paid to the claimant in the settlement, the

licensee must still report to the OIR, which will report to the DOH, if the insurer paid $5,000 or more in defending you. Remember from earlier that the insurance company has two separate duties: to defend and to indemnify.

Similarly, claims and actions must be reported if there is an “entry of any judgment against (the dentist) for which all appeals as a matter of right have been exhausted or for which the time period for filing such an appeal has expired.” Note that the self-reporting obligation applies to any “claim” not just a lawsuit. In this context, “claim” means the receipt of a notice of intent to initiate litigation, a summons and complaint, or a written demand from a person or his or her legal representative stating an intention to pursue an action for damages.

TIP: Importantly, the FDA’s Peer Review process has been crafted so that patient mediation requests do not rise to the level of being reportable “claims.” More on how FDA Peer Review also avoids BOD discipline later.

Also, later we will discuss whether the Fifth Amendment’s privilege against self-incrimination applies to disciplinary cases.

The “Honor Code” Section 466.028(1)(f), Fla. Stats., makes it a disciplinary violation for you to fail to report to the DOH any other licensee who you either “know” or you have “reason to believe is clearly in violation” of BOD rules.

TIP: Many DOH complaints are filed by dentists who are your business competitors.

These don’t necessarily involve standard of care, informed consent or improper delegation; they involve advertising. Remember that complainants are generally immune from liability and that if you get your advertising wrong, the violation is literally memorialized in print for all the world to see. www.floridadental.org

Legal Notes TIP: As a licensee complained against, you have the right to get a copy of the complaint filed. But, realize that when another dentist or hygienist in the community is the one filing the complaint, they will typically file it anonymously to avoid potential loss of patient referrals or embarrassing social encounters.

The official DOH complaint form states that a signature is “required to file (a) complaint.” But the signature need not be the complainant’s proper name. I’ve seen complaints signed by what appeared to my untrained eye to be “Richard Nixon.”

TIP: If you are unsure about advertising your practice, call the FDA and ask for “The Dos and Don’ts of Dental Advertising.”

TIP: Earlier I wrote that you may have complaints filed against you that you don’t even know about. For example, if a complaint is dismissed for not being legally sufficient, then there is no investigation and no record created. Under section 456.073(1), the subject of the complaint has a right to a copy of the complaint, but only if it “resulted in the initiation of an investigation.”

STEP THREE: What Complaints Will the MQA Actually Investigate?

The DOH must investigate any written signed complaint that is “legally sufficient,” meaning it alleges ultimate facts that, if proven, would constitute a violation. Frivolous complaints that you were rude or made the patient wait will not be investigated. But the DOH may investigate written anonymous complaints and complaints from confidential informants if they are legally sufficient, the alleged violation is substantial and the DOH has reason to believe after preliminary inquiry that the allegations are true. That gives the DOH a lot of discretion.

TIP: Once the complaint has been filed, the person filing it cannot stop it, even if they request the DOH to cease the investigation and report that the matter has been settled amicably. Section 456.073(1), Fla. Stats. The DOH investigates individual complaints, not to redress wrongs suffered by a specific person, but rather to protect the safety of the public.

The DOH may start investigations even if there is no complaint filed. If the depart-

ment has “reasonable cause” to believe that a licensee or group of licensees is violating the law or disciplinary rules, they can initiate investigations on their own authority.

Again, there is broad discretion on what gets investigated.

Finally, under section 456.073(1), Fla. Stats., physicians, podiatrists and chiropractors will typically be investigated if a paid claim that exceeds $50,000 is reported within the previous six years. In contrast, under section 466.028(6), Fla. Stats., dentists will be investigated if a single paid claim exceeds $25,000, or there are three or more malpractice claims where indemnity has been paid (in any amount) in the previous five-year period.

The next article in this series will walk you through the timing of the investigation (i.e., statute of limitations and laches), your due process right to be notified, situations where you will not receive notice — an ESO — and how to respond to one.

Graham Nicol is the FDA’s Chief Legal Counsel.

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

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January/February 2017

Expires 4/1/2017

Today's FDA

9

Student loan refinancing for FDA members SoFi saves dentist borrowers an average of $870 a month1

Apply through SoFi.com/FloridaDental to get a $400 welcome bonus2 when you refinance your student loans.

Terms and Conditions Apply. SOFI RESERVES THE RIGHT TO MODIFY OR DISCONTINUE PRODUCTS AND BENEFITS AT ANY TIME WITHOUT NOTICE. See sofi.com/legal for a complete list of terms and conditions.

Current as of 12.1.16. SoFi loans are originated by SoFi Lending Corp (dba SoFi) California Finance Lender #6054612. NMLS #1121636. 1Monthly savings calculation is based on all SoFi members with a dental school degree who refinanced their student loans between 7/1/15 and 6/30/16. The calculation is derived by averaging the monthly savings of SoFi members with a dental school degree, which is calculated by taking the monthly student loan payments prior to refinancing minus the monthly student loan payments after refinancing with SoFi. SoFi’s monthly savings methodology for student loan refinancing assumes 1) members’ interest rates do not change over time (projections for variable rates are static at the time of the refinancing and do not reflect actual movement of rates in the future) 2) members make all payments on time. SoFi’s monthly savings methodology for student loan refinancing excludes refinancings in which 1) members elect a SoFi loan with a shorter term than their prior student loan term(s) 2) the term length of the SoFi member’s prior student loan(s) was shorter than 5 years or longer than 25 years 3) the SoFi member did not provide correct or complete information regarding his or her outstanding balance, loan type, APR, or current monthly payment. SoFi excludes the above refinancings in an effort to maximize transparency on how we calculate our monthly savings amount and to minimize the risk of member data error skewing the monthly savings amount. 2Payment will be issued electronically once you become a SoFi borrower; you have submitted a completed application with documents and your loan has been disbursed. Offer good for new customers only.

Information Bytes

The Clock Keeps Ticking ...

By Larry Darnell, MBA DIRECTOR OF INFORMATION SYSTEMS

Turn the clock back to 30 years ago when I was a struggling computer science major at Albany State College. I was slogging my way through Assembler, COBOL and Fortran classes, as I was missing significant class time while playing on my college tennis team. It was the greatest educational challenge I had faced. That was my junior year of college. That also was the last time I saw Assembler, COBOL or Fortran computer programming, too.

Fast-forward to 2014 as I am about to embark on an MBA program. My advisor asked me if I had ever used a “blackboard” system. “You mean with chalk and an eraser?” I responded. Obviously not. Blackboard is an electronic learning management system. Those did not even exist when I completed my undergraduate degree in 1987. For the briefest of moments, I stopped to consider how much technology had changed in the 30+ years since I graduated high school. I honestly was blown away. If I had “Rip Van Winkled” those 30+ years, I would not have believed it. However, because I was experiencing it live, the changes did not seem so dramatic.

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I examined the majority of my computer science degree coursework and evaluated how much it would help in my pursuit of my master’s degree. I noticed that on that level, I was woefully deficient. Very little of what I learned 30 years ago still even applied today, and if it did, it was so different that I am not sure it was helpful.

I just completed my master’s degree. So, what did I learn? Here are my seven takeaways: 1. I wrote more papers in a year and a half than I wrote in eight years of high school and college. (Computer science majors don’t write papers — we write programs!)

2. I was way more committed now than I was 30 years ago because I learned the value of learning along the way.

3. I discovered there is a great need to stay current with what you do know. We cannot rest on what we learned 30 years ago and think that will suffice.

4. We must all become lifelong learners of something. Find that something and devote yourself to it.

5. There is value in teamwork, but nobody does it like I do it.

6. There are new ways — even more efficient ways — of doing things, but the old-school concepts of determination and hard work never go out of style.

7. Thirty years’ worth of experience is only valuable if you can apply it to life today.

“

My advisor asked me if I had ever used a “blackboard” system. “You mean with chalk and an eraser?” I responded. Obviously not.

”

Unlike my graduate work in obsolete computer programming languages, here’s hoping I haven’t seen the last of corporate governance, management policy or organizational behavior (courses I took on my MBA journey).

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

January/February 2017

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

West Pasco Dentists Help Treat Veterans

We Look Forward to Serving You in 2017!

Happy New Year! Renew your membership today and cross it off your to-do list. Visit www.floridadental.org/dues to submit a credit card payment in full or to select a monthly payment plan. (Your username is your ADA number.)

Additional ways to renew: g Phone: Call the member relations team at 800.877.9922 and make a payment in full with your credit card. (Please note: monthly payment plan enrollment cannot be accepted over the phone.) g Fax: Send in your credit card payment information to 850.561.0504. g USPS: Mail in your payment in full via check or credit card, or check the option for the credit card payment plan.

Questions or concerns? Contact the member relations team at 800.877.9922 or membership@floridadental.org. Thank you for the opportunity to serve you in 2017!

Become a Mentor!

Consider volunteering as a mentor to a Florida dental student in 2017. For more information, please visit www.floridadental.org/mentors. You will need your ADA number and password to login.

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January/February 2017

FDA Mobile App The Florida Dental Association (FDA) is considering the creation of a mobile app, and we would like our members to let us know what you would like to see included. What features would be most helpful?

Please email your suggestions to communications@floridadental.org.

Welcome New FDA Members

West Pasco Dentists and PHSC Dental Assisting Students proudly served the US Veterans who have served our nation!

On Friday, Oct. 28, 2016, the second annual “Stars, Stripes and Smiles” event was hosted in New Port Richey. The event provided $65,000 in urgent oral health care services to 71 U.S. military veterans who were ineligible for Veterans Affairs (VA) dental care, as veterans must be 100 percent disabled to qualify for VA dental benefits. The West Pasco Dental Association teamed up with U.S. Congressman Gus Bilirakis (R-FL), State Representative Danny Burgess (R-Dist 38), Pasco Hernando State College, and other community partners to combat the barriers to care and raise awareness of the significance of oral health in total health for veterans. Dr. Zack Kalarickal has been assisting Congressman Bilirakis and University of Pennsylvania Dean Emeritus Marjorie Jeffcoat to develop federal legislation to improve oral health for veterans, based on research demonstrating reduced total health care expenses through obtaining oral health care. The Florida Dental Association applauds the wonderful efforts of the West Pasco dentists to treat our veterans!

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 Maria Hernandez, Plantation Helena Hogan, Boynton Beach Steven Horwitz, Boca Raton Elizabeth Keith, West Palm Beach Paola Kesman, Coral Springs Viktor Kopynets, Boca Raton Tiffany Moncrieffe, Boca Raton Brent Popovich, Pompano Beach Jason Tenny, Port Saint Lucie Arghavan Welch, Palm Beach Gardens

Central Florida District Dental Association Fadi Aoun, Winter Springs Roberto Castilini, Orlando Patricia Mendez-Peralta, Orlando Hemita Patel Klose, Orlando Patricia Pereira, Gainesville Alexandros Tapper, Winter Garden

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Northeast District Dental Association Dillon Davis, Jacksonville Ian Farnham, Jacksonville Mary Kaye Jones, Jacksonville Nicholas Tawil, St. Augustine

Northwest District Dental Association John Miller, Lynn Haven

South Florida District Dental Association

COMING SOON!

Ileana Arias, Miami Lakes Michael Franco, Hialeah David Garazi, Davie Jayleen Joy, Miami Valentina Mata, Tamarac Milagros Mendoza, Miramar Juan Ojeda, Miramar

Look for more information in February!

Reynaldo Pita, Hialeah Safiya Smith, Miami Douglas Stokesberry, Miami Shores Tatiana Suarez, Miami Gabriela Vegas, Pembroke Pines

Jacob Pedraza, Land O’ lakes Robert Perlstein, St. James City Thomas Purcell, Bradenton Harry Richter, Tampa Alejandra Romero, Cape Coral Inessa Slipak, Osprey Wendy Terry, Seminole

West Coast District Dental Association Maria Brachowicz, Brandon Alexander Brao, Naples Andrew Brattain, Tampa Yarelis Cartagena Alejandro, Lakeland Sara Cervantes, Brandon Maridith De Jesus, Tampa Melissa Duston, Port Charlotte Robin Flicker, Plant City Muyeenul Hassan, Bradenton Leah Kanner, Tampa Aaron Memon, North Port Joshua Morrow, Fort Myers

In Memoriam The FDA honors the memory and passing of the following members: Solomon Lanster Miami Died: 11/8/2016 Age: 88

Jeffrey M. Hanley Gainesville Died:11/27/2016 Age: 47

Joseph Antonellis Orlando Died: 11/10/2016 Age: 86

MEN’S APPAREL

WOMEN’S APPAREL

YOUTH APPAREL

ACCESSORIES

SCRUBS

INFANT & TODDLER APPAREL

Top brands • Quality apparel for all ages • Online convenience Get ready for FDC! Wear your new FDA apparel or stop by the Fan shop onsite.

NEW YEAR INSURANCE CHECKLIST DO YOU HAVE THE INSURANCE YOU NEED FOR 2017?

Professional Liability Insurance Malpractice coverage for individuals, corporations or employees.

Workers’ Compensation Insurance Mandatory for all offices with four or more employees, but strongly recommended as protection for all dental offices.

Dental Office Policy Covers general liability, office furnishings, equipment, building, improvements to leased space and buildouts. Can include business income, accounts receivable and wind/hail coverage.

Commercial Umbrella/Excess Liability Provides coverage in the event of a catastrophic liability loss in excess of underlying policy limits. Can cover general liability, employer’s liability and commercial auto insurance liability.

Employment Practices Liability Responds to allegations of wrongful termination, failure to promote, harassment or discrimination.

Data Breach/Privacy Insurance Responds to risk involving personal health information.

Directors & Officers Liability coverage for allegations against the dental practice’s officers or board members.

Health Insurance PPO, POS, HMO and HSA plans for your practice. Also offers individual health insurance that can be set up via payroll deduct.

Office Overhead Protection to continue business operations should you become disabled.

Life Insurance To facilitate buy-sell agreements should a partner die, protect the practice, protect the family or replace the income derived from a key employee.

Disability Insurance Coverage to protect your loss of income due to a disability.

Long-Term Care Insurance This voluntary benefit for you and your employees covers costs of home care, assisted living and nursing home.

Bonds ERISA compliance for pension and profit-sharing plans.

Personal Auto Insurance & Umbrella Personal auto protection and excess liability protection.

P: 800.877.7597 | F: 850.681.9782 E: insurance@fdaservices.com

TRY YOUR AGENTS! YOUR FDA SERVICES INSURANCE EXPERTS

RICK D’ANGELO

DIRECTOR OF SALES, WEST COAST DISTRICT PHONE: 813.475.6948 | rick.dangelo@fdaservices.com

DENNIS HEAD

DIRECTOR OF SALES, CENTRAL FLORIDA DISTRICT PHONE: 877.843.0921 | dennis.head@fdaservices.com

MIKE TROUT

DIRECTOR OF SALES, NORTH FLORIDA DISTRUCTS PHONE: 904.249.6985 | mike.trout@fdaservices.com

JOSEPH PERRETTI

DIRECTOR OF SALES, SOUTH FLORIDA DISTRICT PHONE: 305.665.0455 | joe.perretti@fdaservices.com

DAN ZOTTOLI

DIRECTOR OF SALES, ATLANTIC COAST DISTRICT PHONE: 561.791.7744 | dan.zottoli@fdaservices.com

2017 Legislative Issues 16

By Joe Anne Hart FDA DIRECTOR OF GOVERNMENTAL AFFAIRS

Each new year brings on a sense of great expectation and the opportunity to set new goals and pursue new endeavors. As the Florida Dental Association (FDA) prepares for the 2017 Legislative Session, there is an expectation of pursuing legislative initiatives that will help reduce barriers and increase access to routine dental care, while maintaining high standards for dentistry and ensuring patient safety. The goals this session will be to help educate legislators on the FDA’s legislative priorities for organized dentistry, whether that position is in a supportive role or an opposition stance.

Many issues pursued in Tallahassee take several years to get passed and eventually approved by the governor.

Different tactics and strategies are used and applied each year to garner the desired results. During the 2017 Session, there will be a large number of legislators who are new to this process and novices on certain legislative issues. It is imperative that the FDA implements a solid educational campaign through its Legislative Contact Dentist (LCD) Program to ensure that every legislator has a local dental contact.

Here’s a look at some of the issues on the FDA’s legislative agenda: Community Dental Health Coordinator The FDA supports adding curriculum to existing dental hygiene and assisting programs to integrate community dental health coordinators (CDHCs) into the dental workforce. CDHCs have proven to benefit patients who struggle to find adequate access to routine dental care in their communities.

In 2004, the American Dental Association (ADA) convened a task group to look at ways to break through barriers that prevent people from accessing dental care

Today's FDA

January/February 2017

in rural and underserved areas. It was clear that people needed help navigating through the multi-layers of the health care system to access services. In October 2010, the first class of CDHC students completed their training and started working in these underserved areas. CDHCs are trained to interact, with cultural competence, in dental underserved communities where they work. They understand the people, language and barriers to oral health in those communities. They serve as “patient navigators” to individuals who struggle to find dental care or who may not be educated about the benefits of maintaining good oral hygiene.

CDHCs work under dentist supervision in clinics, schools and other health access settings with people of similar ethnic and cultural backgrounds. Additionally, CDHCs collect information to assist dentists in triaging patients; address social, environmental and other health literacy issues; and, provide dental health education to help people develop goals to enhance their oral health. CDHCs are trained to provide screenings, fluoride treatments, sealants, coronal polishing and X-rays.

Florida graduated its first class of CDHCs in 2016. Initial training took place at Mattia College in Miami, with final training being completed at Nova Southeastern University College of Dental Medicine in Fort Lauderdale. The FDA encourages support for additional schools to integrate this curriculum into their programs.

By providing this additional curriculum to existing programs, Florida will be able to expand opportunities for patients to receive routine dental care that may already be available in their communities.

Increase Access to Dental Care in Underserved Areas Every two years, dentists renew their license to practice, as well as provide information on a dental workforce survey administered through the Department of Health (DOH).

Based on information provided through the dental workforce survey, it is clear that Florida has a sufficient amount of dentists practicing in the state; however, there are several areas around the state that are considered underserved or dental shortage areas. www.floridadental.org

Legislative Issues

In the past, Florida implemented a program that would assist dentists in repaying their student loans if they agreed to practice full time in a health access setting as a Medicaid provider in an underserved area. This program was extremely successful in getting dentists in these dental shortage areas and provided the opportunity for the dentists to establish themselves in these rural communities to determine if they would stay and continue providing care. Unfortunately, due to budget shortfalls, the program went unfunded for a number of years and eventually was removed from statute in 2012.

Florida continues to struggle to encourage dentists to practice in underserved areas. Recent reports indicate that dental students are graduating with an average student loan debt of $250,000 from public dental schools and nearing $400,000 from private dental schools.

This substantial amount of debt typically dictates where dentists choose to practice after graduation in order to meet their financial obligations. Instead of dentists moving to overly saturated areas of the state, it would make sense to reinstate the dental student loan repayment program and incentivize dentists to practice in underserved areas where access to dental care is deficient. The return on the investment for the state would be significant by reducing the unnecessary use of hospital emergency rooms for access to dental care. Instead, patients would be able to establish a dental home and get routine preventive care and treatment at a much lesser cost than emergency room expenditures.

During the 2016 Legislative Session, legislation was unanimously approved by the Legislature that would have helped dentists pay back their student loan debt. Unfortunately, this legislation was vetoed by the governor. The legislation would have established dental care access accounts for eligible dentists who were able to secure local funds that would then be matched with state funds, while practicing in a dental health professional shortage area, medically underserved area or treating medically underserved populations.

The DOH would be authorized to establish no more than 10 new dental care access accounts per year. Eligible dentists participating in the program could receive matching funds of up to $100,000 per dentist per year for up to five years, if all requirements are met.

Dentists then would be able to use these funds for repayment of their student loans, investment in property, facilities or equipment needed to set up a dental practice. In order to remain eligible to receive funds from the dental care access accounts, dentists must agree to practice in an underserved area for at least two years. Oth-

erwise they would forfeit their eligibility and access to the funds in the dental care access account. Additionally, a dentist could access these funds if he/she shows a commitment to opening a private practice in one of the areas designated, maintain an active Medicaid provider agreement, enroll in one or more Medicaid managed-care plans and expend sufficient capital to make substantial progress in opening their own dental practice.

The FDA supports legislation that will increase access to dental care in underserved areas, which also addresses the financial constraints dentists face after dental school.

Donated Dental Services Program In 1997, the Florida Dental Lifeline Network and the South Florida District Dental Association established the Donated Dental Services (DDS) program, which eventually evolved into a statewide program supported by the FDA Foundation. The DDS program allows dentists and dental laboratories to provide free, comprehensive dental treatment to people with disabilities or who are elderly or medically fragile and cannot afford dental care.

Currently, 400 Florida dentists and 200 Florida dental labs participate in the DDS program. They have helped more than 1,511 patients in Florida with seriously neglected dental problems and have donated almost $5.8 million in dental services. These individuals would end up seeking dental care in the emergency room if it were not for the volunteers who provide their services for free through this program. Seeking dental care through an emergency room setting is cost-prohibitive and would not resolve the patient’s underlying issue. Nationwide, with more than 15,000 dentists and 3,600 dental labs, the program has provided $250 million worth of donated dental services.

The FDA supports state funding for two full-time coordinators and operating expenses for the DDS program through the Dental Lifeline Network at approximately $170,000, recurring annually.

Community Water Fluoridation Proclaimed as one of the 10 greatest public health achievements of the 20th century by the Centers for Disease Control and Prevention (CDC), community water fluoridation has proven to be one of the

Please see LEGISLATIVE, 19

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January/February 2017

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Registration now open: floridadental.org/ddoh

SHOW ME YOUR SMILE!

2017 Dentists’ Day on the Hill BRIEFING

LEGISLATIVE VISITS

Monday, April 3, 2017 Aloft Hotel, Tallahassee

Tuesday, April 4, 2017 Capitol in Tallahassee

G IN R R B OU E Y US O SP

SPONSORED BY

HOTEL ROOM BLOCK ALOFT HOTEL 200 N Monroe St. • Tallahassee, FL 32301 Phone: 850.513.0313 Room Block Deadline: March 3, 2017 (rate: $229 with complimentary parking)

For more information, please contact the FDA Governmental Affairs Office at 800.325.0051 or gao@floridadental.org.

Legislative Issues

LEGISLATIVE from 17

most efficient and safest ways to prevent dental decay, which is one of the most common childhood diseases. Studies show that for more than 70 years, community water fluoridation has resulted in a significant reduction of tooth decay amongst individuals of all ages, and especially those without access to regular dental care.

Fluoride is naturally occurring and is present in all water sources.

In Florida, about 77 percent of the population receives optimally fluoridated water. Community water fluoridation is simply the precise adjustment of the natural occurring fluoride to the level recommended for optimal dental health. The level of concentration, established by the U.S. Public Health Service, is currently set at 0.7 milligrams per liter. Besides the CDC, the public health benefits of water fluoridation are recognized by the ADA, the American Medical Association (AMA), the World Health Organization (WHO) and 125 other national and international organizations.

One argument against adding fluoride to the water supply is budgetary restraints. The average annual cost for a community to fluoridate its water system is estimated to range from approximately $0.50 a year per person in large communities to approximately $3 per person in small communities. Compared to the cost of dental treatment, community water fluoridation actually provides cost savings.

For most cities, every $1 invested in water fluoridation saves $43 in dental treatment costs. In fact, the average lifetime cost per person to fluoridate a water system is less than the cost of one dental filling.

While representatives from both sides of the fluoridation issue have expressed passionate views, the facts at hand are unequivocal. In 2012, 74.6 percent of the U.S. population on public water systems received optimally fluoridated water. Fluoridation has been thoroughly reviewed in the United States’ court system, and found to be a proper means of furthering public health and welfare. No court of last resort has ever determined fluoridation to be unlawful. The overwhelming weight of credible scientific evidence consistently indicates that fluoridation of community water supplies is the single most effective, safe and economical way to prevent dental decay among citizens, regardless of their age or socio-economic status.

www.floridadental.org

The FDA supports the optimization of fluoride levels in community water systems in Florida and encourages the state to dedicate $1 million in recurring general revenue to continue these efforts locally.

Maintain Educational Standards for Internationally Trained Dentists Current law requires that graduates of non-accredited dental schools complete a two-year supplemental general dentistry education program before taking the Florida licensure exam. The purpose of the supplemental education program is to: 1) ensure that internationally trained dentists attain the same knowledge and skills as graduates of accredited programs and 2) familiarize internationally trained dentists with the oral health care delivery system in the U.S., including the techniques, procedures and standards of oral health care.

In the past, there have been legislative efforts that tried to create a “back door” pathway to licensure in Florida for internationally trained dentists. There have been proposed changes to the current law that would provide exemptions for internationally trained dentists who agree to treat Medicaid recipients in exchange for bypassing the supplemental education requirement. The FDA believes that all Floridians should have access to the same standard of care regardless of economic status. These supplemental education programs are offered to ensure that a minimum standard of care for Floridians is consistently achieved for all dental licensees in the state.

The FDA supports maintaining the current supplemental education requirement for internationally trained dentists.

Joe Anne Hart is the FDA’s Director of Governmental Affairs and can be reached at jahart@floridadental.org. Please visit the FDA’s website at www.floridadental.org.

January/February 2017

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Legislature

2016-2018 Legislature Below is a list of senators and representatives who will serve in the 2016-2018 Florida Legislature. Legislators elected to the Senate during this election cycle will serve a four-year term, while the House members will serve a two-year term.

Senate District 1

Sen. Doug Broxson (R)

Gulf Breeze

District 2

Sen. George Gainer (R)

Panama City

District 3

Sen. Bill Montford (D)

Tallahassee District 4

Sen. Aaron Bean (R)

Jacksonville District 5

Sen. Rob Bradley (R)

Orange Park

District 6

Sen. Audrey Gibson (D)

Jacksonville District 7

Sen. Travis Hutson (R)

Palm Coast

District 8

Sen. Keith Perry (R)

Gainesville District 9

Sen. David Simmons (R)

Altamonte Springs

District 10

Sen. Wilton Simpson (R)

New Port Richey

District 11

Sen. Randolph Bracy (D)

Ocoee District 12

Sen. Dennis Baxley (R)

Ocala District 13

Sen. Linda Stewart (D)

Orlando District 14

Sen. Dorothy Hukill (R)

Port Orange

District 15

Sen. Victor Torres Jr. (D)

Orlando District 16

Sen. Jack Latvala (R)

Tampa District 17

Sen. Debbie Mayfield (R)

Vero Beach

District 18

Sen. Dana Young (R)

Tampa District 19

Sen. Darryl Rouson (D)

St. Petersburg

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January/February 2017

District 20

Sen. Tom Lee (R)

District 39 District 40

Sen. Bill Galvano (R)

Bradenton District 22

Sen. Kelli Stargel (R)

Lakeland District 23

Sen. Greg Steube (R)

Sarasota District 24

Sen. Jeff Brandes (R)

St. Petersburg

District 25

Sen. Joe Negron (R)

Stuart District 26

Sen. Denise Grimsley (R)

Sebring District 27

Sen. Lizbeth Benacquisto (R)

Fort Myers

District 28

Sen. Kathleen Passidomo (R)

Naples District 29

Sen. Kevin Rader (D)

Boca Raton

District 30

Sen. Bobby Powell (D)

West Palm Beach

District 31

Sen. Jeff Clemens (D)

Lake Worth

District 32

Sen. Lauren Book (D)

Plantation District 33

Sen. Perry Thurston Jr. (D)

Lauderhill District 34

Sen. Gary Farmer (D)

Fort Lauderdale

District 35

Sen. Oscar Braynon (D)

Miami Gardens

District 36

Sen. Rene Garcia (R)

Hialeah District 37

Sen. Jose Javier Rodriguez (D)

Miami District 38

Sen. Daphne Campbell (D)

Miami

Sen. Frank Artiles (R)

Miami

Brandon District 21

Sen. Anitere Flores (R)

Miami

House District 1

Rep. Clay Ingram (R)

Pensacola District 2

Rep. Frank White (R)

Pensacola District 3

Rep. Jayer Williamson (R)

Milton District 4

Rep. Mel Ponder (R)

Destin District 5

Rep. Brad Drake (R)

Marianna District 6

Rep. Jay Trumbull (R)

Panama City

District 7

Rep. Halsey Beshears (R)

Monticello District 8

Rep. Ramon Alexander (D)

Tallahassee District 9

Rep. Loranne Ausley (D)

Tallahassee District 10

Rep. Elizabeth Porter (R)

Lake City

District 11

Rep. Cord Byrd (R)

Jacksonville Beach

District 12

Rep. Clay Yarborough (R)

Jacksonville District 13

Rep. Tracie Davis (D)

Jacksonville District 14

Rep. Kimberley Daniels (D)

Jacksonville District 15

Rep. Jay Fant (R)

Jacksonville District 16

Rep. Jason Fischer (R)

Jacksonville District 17

Rep. Cyndi Stevenson (R)

St. Augustine

District 18

Rep. Travis Cummings (R)

Orange Park

www.floridadental.org

Legislature District 19

District 42

Rep. Mike La Rosa (R)

District 65

Rep. Chris Sprowls (R)

Palatka

St. Cloud

Tarpon Springs

District 20

District 43

Rep. John Cortes (D)

Rep. Bobby Payne (R)

District 66

Rep. Larry Ahern (R)

Gainesville

Kissimmee

St. Petersburg

District 21

District 44

District 67

Rep. Chris Latvala (R)

Rep. Clovis Watson Jr. (D) Rep. Chuck Clemons (R)

Rep. Eric Eisnaugle (R)

Newberry

Orlando

Largo

District 22

District 45

District 68

Rep. Ben Diamond (D)

Ocala

Ocoee

St. Petersburg

District 23

District 46

Rep. Charlie Stone (R)

Rep. Kamia Brown (D)

District 69

Rep. Kathleen Peters (R)

Ocala

Orlando

St. Petersburg

District 24

Rep. Paul Renner (R)

District 47

District 70

Rep. Wengay “Newt” Newton (D)

Palm Coast

Orlando

St. Petersburg

District 25

Rep. Tom Leek (R)

District 48

District 71

Rep. Jim Boyd (R)

Ormond Beach

Orlando

Bradenton

District 26

Rep. Patrick Henry (D)

District 49

District 72

Daytona Beach

Orlando

Sarasota

District 27

Rep. David Santiago (R)

District 50

District 73

Rep. Stan McClain (R)

Rep. Bruce Antone (D) Rep. Mike Miller (R) Rep. Amy Mercado (D) Rep. Carlos Guillermo Smith (D) Rep. Rene Plasencia (R)

Rep. Alexandra “Alex” Miller (R) Rep. Joe Gruters (R)

Deltona

Orlando

Sarasota

District 28

District 51

District 74

Rep. Jason Brodeur (R)

Rep. Tom Goodson (R)

Rep. Julio Gonzalez (R)

Sanford

Cocoa

Venice

District 29

District 52

District 75

Rep. Michael Grant (R)

Longwood

Melbourne

Port Charlotte

District 30

Rep. Ray Rodrigues (R)

Rep. Scott Plakon (R)

Rep. Thad Altman (R)

District 53

Rep. Randy Fine (R)

District 76

Maitland

Palm Bay

Estero

District 31

Rep. Jennifer Sullivan (R)

District 54

Rep. Erin Grall (R)

District 77

Rep. Dane Eagle (R)

Mount Dora

Vero Beach

Cape Coral

District 32

Rep. Larry Metz (R)

District 55

Rep. Cary Pigman (R)

Rep. Bob Cortes (R)

District 78

Rep. Heather Fitzenhagen (R)

Groveland

Sebring

Fort Myers

District 33

Rep. Don Hahnfeldt (R)

District 56

District 79

Rep. Matt Caldwell (R)

The Villages

Bartow

Lehigh Acres

District 34

Rep. Ralph Massullo Jr. (R)

District 57

District 80

Rep. Byron Donalds (R)

Rep. Ben Albritton (R) Rep. Jake Raburn (R)

Lecanto

Valrico

Naples

District 35

Rep. Blaise Ingoglia (R)

District 58

Rep. Dan Raulerson (R)

District 81

Rep. Joseph Abruzzo (D)

Spring Hill

Plant City

Boynton Beach

District 36

Rep. Amber Mariano (R)

District 59

Rep. Ross Spano (R)

District 82

Rep. MaryLynn Magar (R)

Hudson

Riverview

Hobe Sound

District 37

Rep. Richard Corcoran (R)

District 60

District 83

Rep. Gayle Harrell (R)

New Port Richey

Tampa

Stuart

District 38

Rep. Danny Burgess (R)

District 61

Rep. Jackie Toledo (R)

District 84

Rep. Larry Lee Jr. (D)

Zephyrhills

Tampa

Fort Pierce

District 39

District 62

District 85

Rep. Rick Roth (R)

Rep. Neil Combee (R)

Rep. Sean Shaw (D) Rep. Janet Cruz (D)

Auburndale

Tampa

Loxahatchee

District 40

District 63

District 86

Rep. Colleen Burton (R)

Rep. Shawn Harrison (R)

Rep. Matt Whillhite (D)

Lakeland

Tampa

Wellington

District 41

Rep. Sam Killebrew (R)

District 64

District 87

Rep. David Silvers (D)

Winter Haven

Tampa

West Palm Beach

Rep. James Grant (R)

Please see LEGISLATURE, 23

www.floridadental.org

January/February 2017

Today's FDA

21

Legislature LEGISLATURE from 21

District 110 Rep. Jose Oliva (R) Hialeah

District 88

Rep. Al Jacquet (D)

District 111 Rep. Bryan Avila (R)

Delray Beach

Hialeah

District 89

Rep. Bill Hager (R)

District 112 Rep. Nick Duran (D)

Boca Raton

Miami

District 90

Rep. Lori Berman (D)

District 113 Rep. David Richardson (D)

Boynton Beach

Miami

District 91

Rep. Emily Slosberg (D)

District 114 Rep. Daisy Baez (D)

Boca Raton

District 92

Rep. Patricia Hawkins-Williams(D)

District 115 Rep. Michael Bileca (R)

Lauderdale Lakes

Miami

District 93

Rep. George Moraitis (R)

District 116 Rep. Jose Felix Diaz (R)

Fort Lauderdale

Miami

District 94

Rep. Bobby DuBose (D)

District 117 Rep. Kionne McGhee (D)

Fort Lauderdale

Miami

District 95

Rep. Barrington Russell (D)

District 118 Rep. Robert Asencio (D)

Fort Lauderdale

Miami

District 96

Rep. Kristin Jacobs (D)

District 119 Rep. Jeanette Nunez (R)

Coconut Creek

Miami

District 97

Rep. Jared Moskowitz (D)

District 120 Rep. Holly Raschein (R)

Coral Springs

District 98

Rep. Katie Edwards (D)

Sunrise District 99

Rep. Evan Jenne (D)

Hollywood District 100 Rep. Joe Geller (D)

Dania Beach

District 101 Rep. Shevrin Jones (D)

West Park

District 102 Rep. Sharon Pritchett (D)

Coral Gables

Key Largo

2016 Florida Congressional Members U.S. Senate Sen. Bill Nelson (D)

Hialeah District 104 Rep. Richard Stark (D) Weston District 105 Rep. Carlos Trujillo (R) Doral District 106 Rep. Bob Rommel (R) Naples District 107 Rep. Barbara Watson (D)

Miami Gardens

District 108 Rep. Roy Hardemon (D) Miami District 109 Rep. Cynthia Stafford (D)

Opa Locka

www.floridadental.org

Congressional District 9 Rep. Darren Soto (D) Congressional District 10 Rep. Val Demings (D) Congressional District 11 Rep. Daniel Webster (R) Congressional District 12 Rep. Gus Bilirakis (R) Congressional District 13 Rep. Charlie Crist (D) Congressional District 14 Rep. Kathy Castor (D) Congressional District 15 Rep. Dennis Ross (R) Congressional District 16 Rep. Vern Buchanan (R) Congressional District 17 Rep. Tom Rooney (R) Congressional District 18 Rep. Brian Mast (R) Congressional District 19 Rep. Francis Rooney (R) Congressional District 20 Rep. Alcee Hastings (D) Congressional District 21 Rep. Lois Frankel (D) Congressional District 22 Rep. Ted Deutch (D) Congressional District 23 Rep. Debbie Wasserman Schultz (D)

Sen. Marco Rubio (R)

Congressional District 25 Rep. Mario Diaz-Balart (R)

U.S. Representatives

Congressional District 26 Rep. Carlos Curbelo (R)

Congressional District 1 Rep. Matt Gaetz (R)

Congressional District 27 Rep. Ileana Ros-Lehtinen (R)

Miramar District 103 Rep. Manny Diaz Jr. (R)

Congressional District 8 Rep. Bill Posey (R)

Congressional District 2 Rep. Neal Dunn (R) Congressional District 3 Rep. Ted Yoho (R) Congressional District 4 Rep. John Rutherford (R) Congressional District 5 Rep. Al Lawson (D) Congressional District 6 Rep. Ron DeSantis (R) Congressional District 7 Rep. Stephanie Murphy (D)

January/February 2017

Today's FDA

23

GAC, FDAPAC, LCD

GAC, FDAPAC and LCD Members by Component Key GAC: Govermental Action Committee LCD: Legislative Contact Dentist FDAPAC: FDA Political

Action Committee

Atlantic Coast Dr. Ralph Attanasi, GAC Member, LCD Dr. David Boden, GAC Consultant,

FDAPAC Consultant, LCD

Dr. Michael Eggnatz, GAC Consultant,

FDAPAC Consultant, LCD

Dr. Rick Huot, FDAPAC Consultant Dr. Alana Keough, GAC Member Dr. Ethan Pansick, FDAPAC Member Dr. Andrew Adelson, LCD Dr. William Balanoff, LCD Dr. Susan Berlin, LCD Dr. Steven Bogdanoff, LCD Dr. Christopher Dermody, LCD Dr. F. Dermody, LCD Dr. Joseph Dermody, LCD Dr. Raymond Doremus, LCD Dr. Robert Eckelson, LCD Dr. Shawn Engebretsen, LCD Dr. Donovan Essen, LCD Dr. Mark Fedele, LCD Dr. Theodore Field, LCD

24

Today's FDA

January/February 2017

Dr. Alan Friedel, LCD

Dr. Daryl Askeland, LCD

Dr. Leonardo Frydman, LCD

Dr. Hal Coe Jr., LCD

Dr. Jeffrey Ganeles, LCD

Dr. Kenneth Cohrn, LCD

Dr. Robert Gehrig, LCD

Dr. Brian Coleman, LCD

Dr. Howell Goldberg, LCD

Dr. Mark Falco, LCD

Dr. Lee Hauer, LCD

Dr. Bruce Gordy, LCD

Dr. Teri-Ross Icyda, LCD

Dr. Lance Grenevicki, LCD

Dr. Brian Jacobus Jr., LCD

Dr. Robert Hawkins, LCD

Dr. Tory Lindh, LCD

Dr. Gary Herbeck, LCD

Dr. Hal Lippman, LCD

Dr. Curtis Hill Jr., LCD

Dr. Robert Bruce McDonald, LCD

Dr. Steven Hochfelder, LCD

Dr. Robert Newman, LCD

Dr. Bert Hughes, LCD

Dr. Thomas Plymale, LCD

Dr. Cletus Huhn, LCD

Dr. Douglas Starkey, LCD

Dr. Bernard Kahn, LCD

Dr. Jeffrey Stevens, LCD

Dr. Keith Kanter, LCD

Dr. Craig Stranigan, LCD

Dr. Lee Anne Keough, LCD

Dr. James Strawn, LCD

Dr. Tim Marshall, LCD

Dr. Paul Werner, LCD

Dr. Robert Matteson, LCD

Dr. Kerri White, LCD

Dr. Hutson McCorkle, LCD

Central Florida Dr. Gerald Bird, GAC Consultant, FDAPAC Chair, LCD Mrs. Jerilyn Bird, FDAPAC Member Dr. Dan Crofton, FDAPAC Consultant, LCD Dr. Bill D’Aiuto, GAC Chair, FDAPAC Consultant Dr. Don Ilkka, GAC BOD Liaison Dr. Jason Larkin, GAC Member Dr. Donald Thomas, FDAPAC Member

Dr. Patrick Mokris, LCD Dr. James Montgomery, LCD Dr. Oscar Morejon, LCD Dr. Robert Mount, LCD Dr. Larry Nissen, LCD Dr. Haraldo Otero-Flores, LCD Dr. Neil Powell, LCD Dr. Robbin Quaterman, LCD Dr. Naghman Qureshi, LCD Dr. Frank Reynolds, LCD Dr. Jeff Sevor, LCD Dr. Michael Simpson, LCD

www.floridadental.org

GAC, FDAPAC, LCD

Dr. Doyle Summerlin, LCD Dr. Dave Sutton, LCD Dr. Wade Townsend, LCD Dr. Anthony Wong, LCD Dr. Lisa Yurkiewicz, LCD

Northeast Dr. Andy Brown, GAC Consultant, LCD. Dr. Dan Gesek, GAC Member, FDAPAC Member Dr. Rick Stevenson, GAC Consultant,

FDAPAC Consultant, LCD

Dr. Robert Cowie, LCD Dr. Ian Dennis, LCD Dr. Ron Dixon, LCD

South Florida Dr. Irene Marron-Tarrazzi, GAC

Dr. Cesar Sabates, GAC Consultant, LCD Dr. Beatriz Terry, GAC Member, FDAPAC

Dr. Kevin Neal, LCD Dr. Claude Owens, LCD Dr. Linda Trotter, LCD Dr. George Van Etta, LCD Dr. George Weeks, LCD

Northwest Dr. David Hanle, LCD, FDAPAC Member Dr. Jolene Paramore, GAC Member, LCD Dr. Robert Payne, FDAPAC Member, LCD Dr. William Baldock, LCD Dr. Steven Bryan, LCD Dr. Darrh Bryant, LCD Dr. Howard Fisher, LCD Dr. Dan Henry, LCD Dr. Tricia Hess, LCD Dr. Kim Jernigan, LCD Dr. Jeff Ottley, LCD Dr. Marcus Paul, LCD Dr. James Walton, LCD

Consultant, LCD

Dr. Pedro Castro, LCD Dr. Faustino Garcia, LCD Dr. Joseph Gay, LCD Dr. Laurie Gordon-Brown, LCD Dr. Ignacio Iturralde, LCD Dr. Robert Johnson, LCD Dr. Melvin Kessler, LCD Dr. Carlos Sanchez, LCD

Dr. Thomas Klechak, LCD Dr. Orrin Mitchell, LCD

Consultant, FDAPAC Member, LCD

West Coast Dr. Doug Jungman, GAC Member, LCD Dr. Zack Kalarickal, GAC Consultant,

FDAPAC Consultant, LCD

Dr. Gregg Langston, FDAPAC Member Dr. Rudy Liddell, GAC Consultant, LCD Dr. Jeremy Albert, LCD Dr. Eva Ackley, LCD Dr. Rodney Ackley, LCD Dr. Amy Anderson, LCD Dr. Nolan Allen, LCD Dr. William Belton Jr., LCD Dr. Victoria Bong-Kruger, LCD Dr. Terry Buckenheimer, LCD Dr. Sandra Cahill, LCD Dr. Miguel Castro, LCD Dr. Wendy Churchill-Urrico, LCD Dr. David Clary, LCD Dr. Tim Conway, LCD Dr. Joseph Craig, LCD Dr. Sam Desai, LCD

Dr. Glori Enzor, LCD Dr. Tom Frankfurth, LCD Dr. Richard Garcia, LCD Dr. Fred Grassin, LCD Dr. Richard Greenspan, LCD Dr. Melissa Grimaudo, LCD Dr. James Holloway, LCD Dr. Betty Hughes, LCD Dr. Bradley Jergins, LCD Dr. Nilofer Khatri, LCD Dr. Robert Klement, LCD Dr. William Kochenour, LCD Dr. Charles Llano, LCD Dr. Janice Luke, LCD Dr. Mariela Lung, LCD Dr. Oscar Menendez, LCD Dr. Michael McNeill, LCD Dr. Paul Miller, LCD Dr. Craig Oldham, LCD Dr. James Oxer, LCD Dr. Paul Palo, LCD Dr. Mili Patel, LCD Dr. John Paul, LCD Dr. Robert Payne, LCD Dr. John Pelton, LCD Dr. Carmine Priore, LCD Dr. Michael Reynolds, LCD Dr. Kenneth Rogers, LCD Dr. Rose Rosanelli, LCD Dr. Anthony Schweiger, LCD Dr. Tina Thomas, LCD Dr. David Thompson, LCD Dr. Steven Tinsworth, LCD Dr. Angella Tomlinson, LCD Dr. Tim Verwest, LCD Dr. John Watters, LCD Dr. Sandra Worman, LCD

Dr. Ralf Zapata, LCD

www.floridadental.org

January/February 2017

Today's FDA

25

REGARDING THIRD-PARTY PAYERS …

WHO SPEAKS FOR YOU?

WE DO! RECENT EXAMPLE: July Letters from Medicaid Managed Care Plan to Medicaid and Florida Healthy Kids Providers Restricting Patient Care    

dental sealants only on high-risk teeth age limit on permanent crowns immediate dentures no longer covered limited children’s X-rays

PLEASE REPORT PROBLEMS WITH THIRD-PARTY PAYERS TO THE FDA. WE CAN HELP!

FDA Members Send Copies of July Letters to the FDA. FDA staff evaluates and determines that the plan is unlawfully restricting care.

FDA STAFF CONTACTS THE AGENCY FOR HEALTH CARE ADMINISTRATION (AHCA) ABOUT PLAN’S RESTRICTION OF CARE.

RESULT! AHCA TELLS PLAN IT CANNOT IMPLEMENT CHANGES THAT RESTRICT CARE TO MEDICAID RECIPIENTS.

HELPING MEMBERS SUCCEED

?

For additional information, contact Casey Stoutamire, Director of Third Party Payer & Professional Affairs: 800.326.0051 • 850.224.1089 cstoutamire@floridadental.org

Capital Hill Club

Thank You! A special thank you goes out to all Capital Hill Club members who provided additional support to pro-dental candidates this election cycle. Capital Hill Club members are dentists who agree to be solicited during an election year for a one-time $500 contribution to a pro-dental candidate. The following dentists provided Capital Hill Club support for the 2016 election cycle:

Mrs. Kathy Haeussner, wife of the late Dr. Ted Haeussner, also is a member of the 2016 Capital Hill Club. Mrs. Haeussner sent a $500 check and note to the FDA, reprinted above.

The FDA would like to thank Mrs. Haeussner for her generous donation and commitment to help organized dentistry in honor of her husband.

www.floridadental.org

Dr. Gerald Bird Dr. Andy Brown Dr. John Cordoba Dr. Marcos Diaz Dr. Mike Eggnatz Dr. Dan Gesek Dr. Rick Huot Dr. Zack Kalarickal Dr. George Kolos Dr. John Krueger Dr. Gregg Langston Dr. Rudy Liddell Dr. Irene Marron-Tarrazzi Dr. Tim Marshall Dr. Richard Mullens Dr. Jeff Ottley Dr. Jolene Paramore Dr. Robert Payne Dr. Carlos Sanchez Dr. Barry Setzer Dr. Rick Stevenson Dr. Beatriz Terry

January/February 2017

Today's FDA

27

Websites and Online Marketing Solutions for Dental Practices

90% of people don’t look past the first page of search results.

Will they find your website?

Don’t be invisible. Get a website engineered for search engine performance. With a team of experts on your side, more new patients will be just a click away.

Set your new website up by January 31st and get website hosting FREE until April. Call or click for details.

(877) 874-2457 • Officite.com/FreeHosting/TodaysFDA

OFC_TodaysFDA_fullpage_0117-0217.indd 1

12/1/16 8:27 AM

Dentists’ Day On The Hill

Us Your Smiles!

Registration for the 2017 DDOH is Now Open!

SHOW ME YOUR SMILE! The 2017 Dentists’ Day on the Hill theme is “Show Me Your Smile.” Good oral health care encourages healthy behaviors, and we need your help to get the word out.

• Highlight good oral health!

• Take a selfie with your best smile.

• Share on Facebook and Twitter.

Don’t forget to tag the Florida Dental Association on Facebook and to mention us on Twitter (@FDADental).

2017 Dentists’ Day on the Hill

The 2017 Dentists’ Day on the Hill (DDOH) will be a perfect time for dentists, dental students and spouses to travel to Tallahassee to advocate on behalf of organized dentistry. As we have demonstrated in the past, there is strength in numbers, and it shows our elected officials that we care about our patients and our profession. This year, the DDOH theme is “Show Me Your Smile.” Our profession allows us to be the gateway for our patient’s overall health. Good oral health care encourages healthy behaviors, a healthy attitude and healthy choices — and we need your help to get the word out!

Take a selfie or a group picture with your best smile, and share on Facebook and Twitter using #showmeyoursmile and #DDOH2017.

Don’t forget to tag the Florida Dental Association on Facebook and mention us on Twitter (@FDADental).

The 2017 DDOH is scheduled for Tuesday, April 4 in Tallahassee, with a legislative briefing at the Aloft Hotel on Monday, April 3 at 6:30 p.m. The Alliance of the FDA will host lunch for DDOH

E

LIK

#DDOH2017 #showmeyoursmile

www.floridadental.org

attendees who have registered. To register, go to www.floridadental. org/ddoh2017.

January/February 2017

Today's FDA

29

Board of Dentistry

The Florida Board of Dentistry – More Than Just Discipline

By Casey Stoutamire DIRECTOR OF THIRD PARTY PAYER AND PROFESSIONAL AFFAIRS

The Florida Board of Dentistry (BOD) was established to ensure that every dentist and dental hygienist practicing in Florida meet the minimum requirements for safe practice. The practice of these professions is a privilege, not a right.

“

The BOD staff and legal counsel are a vital component of the board’s ability to function as an autonomous and unbiased entity.

”

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So what is the function of the BOD? It may surprise you, but the BOD is responsible for more than just discipline. They promulgate rules covering licensure and the regulation of the dental profession. They also monitor dentists and dental hygienists in their service to the citizens of Florida. For example, they cover sedation permitting and inspections and dental laboratory registration — and you may remember the recent records rule revision. The BOD also plays a role in the state’s ever-changing health care environment. This is accomplished through communications and working with the public, legislature, dental colleges, the dental community and through taking active roles on national dental organizations.

The full BOD meets quarterly, but similar to the Legislature, the BOD has different committees and councils that meet in the interim to discuss and debate issues before sending them to the full BOD for a vote. The committees and councils include: the Anesthesia Committee, Rules Committee, Council on Dental Assisting, Council on Dental Hygiene, ADEX Committee, CDCA Committee and a board budget liaison. The councils and committees usually meet via conference call throughout the year. The Anesthesia Committee and Hygiene Council are by far the most active. The Anesthesia Committee has taken bold steps to ensure Florida is ahead of the curve and a leader in its anesthesia requirements in a dental office. Similarly, the Hygiene Council debates issues and makes recommendations to ensure dental hygienists are practicing to their full potential, taking into account their education and training. Many times these debates include scope of practice issues and the Florida Dental Association (FDA) participates in these debates to advocate FDA policy.

www.floridadental.org

Board of Dentistry

All BOD meetings and conference calls are open to the public and dentists are encouraged to attend. It can be an eye-opening experience! And remember, it is much better to be a spectator than a participant in BOD disciplinary cases. All meetings, times and locations are posted on the BOD website, www.floridadentistry.gov. This website is a wealth of information, as it also contains information on licensure and renewal, as well as resources on Florida statutes and rules specifically focused on the practice of dentistry.

The Board consists of 11 members appointed by the governor and confirmed by the Senate.

Seven members must be licensed dentists actively engaged in clinical practice; two members must be actively practicing dental hygienists; and, two members must be consumers employed in a field or occupation that is not related to the dental profession. The current members include: Dr. Robert Perdomo, chair; Dr. Joe Thomas, vice chair; Drs. Joe Calderone, Naved Fatmi, Bill Kochenour, Claudio Miro and T.J. Tejera; hygienists Ms. Cathy Cabanzon and Ms. Angie Sissine; and, consumer member, Mr. Tim Pyle. There is one consumer member position open on the BOD that the governor has not yet filled. To learn more about becoming a member of the board, visit the Governor’s Appointments Office website or email appointments@eog.myflorida.com.

The BOD staff and legal counsel are a vital component of the board’s ability to function as an autonomous and unbiased entity. The Department of Health, Division of Medical Quality Assurance serves as the principle administrative support unit for the BOD. The BOD is supported by a full-time professional staff based in Tallahassee, and its regulatory functions are funded in full by fees paid by the licensees. BOD Executive Director Ms. Jennifer Wenhold oversees the licensing of dentists, dental hygienists, dental labs and dental radiographers.

She also helps implement new legislation, oversees the budget, organizes board meetings and trains new board members. Program Operations Administrator Ms. Jessica Sapp also attends all board and committee meetings, prepares agendas and minutes, processes final orders, and corresponds with the public, licensees and applicants via phone and in writing.

Assistant Attorney General Mr. David Flynn serves as legal counsel to the BOD. The FDA thanks Ms. Wenhold, Ms. Sapp and Mr. Flynn for their hard work and willingness to work with FDA staff and volunteer dentists.

Dr. Don Ilkka serves as the full-time FDA liaison to the BOD. The FDA also is represented at all meetings and conference calls by Director of Third Party Payer and Professional Affairs Ms. Casey Stoutamire. The FDA’s Governmental Action Committee monitors all BOD activities and holds conference calls to discuss issues and strategies before each board meeting. Please feel free to contact Ms. Stoutamire at cstoutamire@floridadental.org or 850.224.1089 with any questions about the BOD and its work protecting the citizens of Florida.

www.floridadental.org

January/February 2017

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31

Fluoride is naturally present in all water.

Community water fluoridation is the precise adjustment of naturally occurring fluoride to the level for optimal dental health.

0.7

is the optimal fluoride level in community water.

PPM (parts per million)

That means 7/10ths of a part of fluoride is diluted in a million parts of water.

60 years+ of scientific evidence supports water fluoridation measure to prevent and repair tooth decay.

Visit floridafluoridation.org to learn more about how water fluoridation improves health in Florida communities.

Find how out ifwater Visit floridafluoridation.org to learn more about your community’s water is fluoridated. fluoridation improves Florida communities’ health and find out if your community’s water is fluoridated.

Drink to good health!

FDA Highlights

Community Water Fluoridation

On Dec. 12, 2016, the FDA rolled out its new fluoridation campaign to help educate policymakers and the public on the scientific benefits to oral health. Community water fluoridation has been one of the longstanding polices the FDA has supported. This important mineral provides beneficial oral health effects, and the FDA is working to increase its educational efforts regarding community water fluoridation. The goal is to provide a central location where not only oral health advocates, but also local government and the public can find scientific facts, recent news and research articles on fluoridation. The new fluoridation website, www.floridafluordation.org, will be the central hub for citizens to receive the unequivocal facts on fluoride. The new community water fluoridation infographic is located on the website, and FDA members are encouraged to print out this infographic and post it in your office to inform your patients on the benefits of fluoride. If you have an office website, and would like your patients to be educated on community water fluoridation, please post the FDA fluoridation website link. If you have any questions, or would like more information, please contact the Governmental Affairs Office at 850.224.1089 or gao@floridadental.org.

Drink to good health!

Reduces dental decay by 20–40%

Helps adults fight tooth decay that occurs as gums recede with age

www.floridadental.org

Recognized as one of the greatest public health achievements of the 20th century

WATER FLUORIDATION Helps prevent the loss of approximately 51 million school hours to dental disease

Helps prevent tooth decay - the most common chronic childhood disease

Provides $43 in savings for every $1 invested

January/February 2017

Today's FDA

33

Medical Marijuana

Florida Medical Marijuana Law Now Effective Graham Nicol, Esq., HEALTH CARE RISK MANAGER, BOARD CERTIFIED SPECIALIST (HEALTH LAW)

Amendment 2 as it was known at the ballot boxes in 2016, passed with 71 percent of the popular vote.

Amendment 2 — also known as the Florida Medical Marijuana Initiative — took effect on Tuesday, Jan. 3, 2017. It allows for medical marijuana usage for patients with certain health conditions, including the commonly diagnosed post-traumatic stress disorder (PTSD), who are prescribed medical marijuana by a licensed physician who has completed special training.

Medical marijuana has been in use in Florida since 2014 when Gov. Rick Scott signed into law the “Charlotte’s Web” legislation.

Charlotte’s Web refers to a low-THC strain of marijuana and authorized its usage for terminally ill patients and those suffering from chronic seizures and severe muscle spasms. Proponents of medical marijuana did not think the Charlotte’s Web law went far enough because it allowed only low-potency marijuana for only a small number of individuals. As a result, proponents tried a constitutional amendment in 2014, which

34

Today's FDA

January/February 2017

was defeated; but last year, Amendment 2 was passed and is now in effect.

Amendment 2 does not allow recreational marijuana use. And, while it is broader than Charlotte’s Web, it still remains pretty specific on what patients can get medical marijuana and how. In short, the person seeking marijuana must be a qualifying patient (or their caregiver), meaning that they have been diagnosed with a debilitating medical condition by a Florida physician. Only certain medical conditions qualify the patient for medical marijuana: cancer, epilepsy, glaucoma, HIV, AIDS, PTSD, ALS, Crohn’s disease, Parkinson’s and similar conditions.

Physicians will probably retain ultimate authority to decide whether the medical use of marijuana outweighs the potential health risks. Also, the patient will have to be issued a Department of Health (DOH) medical marijuana ID card and present it when they go to fill the prescription.

Whether in-person examinations will be required for medical marijuana scripts is a hot topic. It will see legislative discussion this year. Specifically, many are wondering about whether a telemedicine consult will constitute an examination sufficient to issue a prescription. The Florida Board of Medicine has proposed a rule requiring in-person examinations, but it remains to be seen what will happen to the rule proposal. It could be challenged as arbitrarily restricting prescribing practices in a misguided attempt to stop drug diversion.

Right now, the Florida Board of Medicine

prohibits physicians from prescribing controlled substances via telemedicine, except for psychiatric disorders; but that rule has only been in place for about two years and may well come under closer legislative and judicial scrutiny.

So, when will you start to see patients in your dental practice who are using medical marijuana? It will be a while. The Florida Legislature starts in March 2017 and the DOH still needs to engage in the administrative rule-making process to determine how medical marijuana will be distributed.

The DOH has until June 3, 2017 to promulgate rules. The DOH has until Oct. 3, 2017 to issue medical marijuana ID cards to qualified patients.

In addition to creating all kinds of clinical questions, Florida’s Medical Marijuana Initiative creates questions for Florida employers, including dentists. For example, can you fire an employee who uses medical marijuana after work hours but shows up under the influence during working hours?

Can you test for medical marijuana use if you’ve implemented a Florida-compliant Drug Free Workplace Program through your workers’ compensation insurer? If it’s legal under Florida law but illegal under federal law, which law controls? Does the Americans with Disabilities Act mandate employers to make reasonable accommodation of medical marijuana use on, for example, work breaks or at lunch-time if the underlying medical condition constitutes a protected disability? What does the Occuwww.floridadental.org

Medical Marijuana

pational Safety and Health Administration (OSHA) Act say about medical marijuana usage?

Right now, the language of Amendment 2 states that Florida employers are not obligated to make reasonable accommodations for on-site medical marijuana use in their places of employment. This is important to health care employers, many of whom have instituted no-smoking policies and would be very conflicted if they were forced to allow on-site marijuana use. I think this will likely remain the same because cases from other states that allow medical marijuana usage have concluded that employers are under no legal obligation to accommodate medical marijuana use, possession or impairment while the employee is at the workplace or on the job. But some states do explicitly prohibit discrimination in employment on the basis of having a medical marijuana ID card. Just be aware that this may change.

Right now, the Americans with Disabilities Act states that persons using illegal drugs are not qualified individuals with a disability. The Americans with Disabilities Act does not prohibit firing or not hiring an employee based on their medical marijuana use, provided that the adverse employment action is based solely on the medical marijuana use and not an underlying disability.

While medical marijuana is now legal in Florida, it still remains illegal under federal law and therefore, outside the scope of protection of the Americans with Disabilities Act. Just be aware that this might change. I think Florida dentists will probably be allowed to prohibit employees from smoking or consuming medical marijuana in the workplace or from working while under

www.floridadental.org

the influence. But I would advise dentists to wait until the DOH issues administrative rules and there is some case law before implementing such a policy.

Right now, Florida employers are under no obligation to accommodate an employee’s off-duty use of medical marijuana. Just be aware that this might change. I think a court construing the Americans with Disabilities Act will hold that employers must allow off-duty use of medical marijuana (compared to use during working hours) as a reasonable accommodation since the diagnoses that allow a Florida citizen to get a medical marijuana card are all serious medical conditions that would appear prima facie to be disabling because they seriously limit essential life functions.

Complicating matters further, Florida dentists need to know that there are safety concerns associated with employees who use medical marijuana off-duty or on-duty. Right now, the federal OSHA Act has a “general housekeeping” rule that obligates employers to maintain their worksites “free from recognized hazards” — and impairment during working hours would be a recognized hazard. Just be aware that this might change. I think the OSHA rules will see litigation just like the Americans with Disabilities Act rules. Hopefully, the courts will recognize that, at least in the context of medical professionals, safety concerns should take precedence over an individual’s right to use medical marijuana.

Another complication making it prudent for Florida dentists to wait for more guidance is drug testing and zero-tolerance policies. If you have worked with your workers’ compensation carrier to implement drug

testing and zero-tolerance policies, right now you can refuse to hire or fire an employee simply for failing a marijuana test regardless of whether the marijuana was obtained legally with a medical marijuana ID car or illegally. Just be aware that this might change.

Unlike blood alcohol tests, marijuana tests do not necessarily show impairment at the time of testing because THC can stay in the person’s fatty tissue for weeks. Some of the other states that allow medical marijuana protect users by requiring employers to prove evidence of impairment in addition to a positive test result. I think Florida might go the same way and if DOH rules or case law require impairment in addition to a positive test result, then you will need to learn how to detect signs of impairment and properly document your investigation with witness statements and other findings. Or, maybe someone will come up with a THC test that shows impairment levels at the time of testing.

As of Jan. 3, 2017, not much has changed for Florida employers with regard to medical marijuana usage. Just be aware that a lot will probably change in the next six months, when the Florida DOH promulgates its rules, and over the next several years as courts decide on legal challenges under the Americans with Disabilities Act, OSHA and even Florida’s Drug Free Workplace legislation. The Florida Dental Association will continue to keep you updated as the rules for employers regarding medical marijuana use undergo significant change.

Graham Nicol is the FDA’s Chief Legal Counsel.

January/February 2017

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35

DONATE! To make a DONATION, go to www.floridadental.org/foundation, or become a SUSTAINING MEMBER by checking the FDAF box on your Annual Dues Statement.

Your donations support these programs: Florida Mission of Mercy, Project: Dentists Care, Donated Dental Services.

Contributions to the FDA Foundation may be tax deductible. All contributions, including those to named funds, are considered unrestricted unless a specific purpose is designated by the donor. The organization is located at 1111 E. Tennessee St., Tallahassee, FL 32308. A COPY OF THE OFFICIAL REGISTRATION AND FINANCIAL INFORMATION MAY BE OBTAINED FROM THE DIVISION OF CONSUMER SERVICES BY CALLING TOLL-FREE WITHIN THE STATE: 1-800-HELP-FLA OR VIA THE INTERNET AT WWW.800HELPFLA.COM. REGISTRATION DOES NOT IMPLY ENDORSEMENT, APPROVAL, OR RECOMMENDATION BY THE STATE. SPONSOR’S REGISTRATION NUMBER IS CH2435. NO CONTRIBUTIONS ARE RETAINED BY PROFESSIONAL SOLICITORS THEREFORE 100% OF ALL CONTRIBUTIONS ARE RECEIVED BY FDAF.

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Payment Processing

Serve First Solutions

By Scott Ruthstrom FDAS CHIEF OPERATING OFFICER

Most people would assume processing credit cards payments at your dental practice is a moderately straightforward procedure, but if you don’t know what to look for in a processor, you might get stuck in an expensive contract that is difficult to revoke. The truth is, merchant accounts come with a wide array of advantages and downsides that can affect your practice. Some useful services include health care billing tools, online marketing and virtual terminals for your office. However, there also are some potential disadvantages like high fees, concealed charges and poor customer support.

Most practices accept all major bankcard credit cards, including private labeled cards, such as CareCredit. Generally, health care credit cards are processed at a variable rate via an online portal. These card transactions are not to be confused with your bankcard transactions (Visa, MasterCard, American Express and Discover). Private label card transactions are independent from bankcard transactions, but in some instances, the health care credit card companies bundle their services with bankcard processing.

You may want to consider keeping your core bankcard payment processor separate from your health care credit provider, as this will circumvent hidden fees and nontransparent reporting.

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When it comes to selecting the right credit card processing company, it is wise to avoid pricing gimmicks. Therefore, it is necessary to bypass all pricing tiers and promotional rates outside of the interchange pass-through method. It is undisputable that tiers usually appear more simplistic than interchange fees in their naming, such as “Qualified,” “Mid-qualified” and “Non-qualified.” While this may seem easier to understand, it does not provide a great deal of information to understand what you are actually paying for and why. A traditional three-tier pricing schedule can become a four-tier, five-tier or even a six-tier pricing schedule. Unfortunately, the misperception is deliberate in most situations and can cost you money.

To help avoid traps, FDA Services has named Serve First Solutions as the exclusive payment provider for the Florida Dental Association (FDA). As a new Crown Savings vendor, Serve First Solutions will help FDA members save significant money on merchant processing while providing unrivaled customer service. Their exclusive method of pricing is interchange pass-through. Interchange pass-through efficiently passes through fees the bankcard associations charge for processing a transaction. The exact interchange fee is set by the bankcard associations; it usually is stated as a percentage of the total bill, plus a flat per transaction rate. To learn more and find out how much you could be saving, contact Serve First Solutions at 214.402.7589 or FDA@Serve-First.com, or visit them at www.Serve-First.com.

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

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

Mike Trout Director of Sales North Florida 904.249.6985 Cell: 904.254.8927 mike.trout@fdaservices.com

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

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

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

Mr. Ruthstrom can be reached at scott.ruthstrom@fdaservices.com or 800.877.7597.

January/February 2017

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Plan to attend this very special celebration honoring our FDA President, Dr. Bill D’Aiuto, as well as the 2017 award recipients, including the FDA Dentist of the Year.

Debt

Student Debt Management

By Joanna Borissova

Before entering the dental profession, I personally did not investigate the financial considerations that an average student must undertake. My hopes were to merely get accepted to a dental school so that I can gain an unparalleled skillset for my future career. However, my hopes have definitively expanded since then. As many professionals and indebted students like myself can relate, my current hopes also include financial freedom.

According to the American Dental Education Association, the average dental student will graduate with approximately $255,000 of student loan debt. This hefty amount may be contributed to by the rising costs of attendance and the declining support from state subsidies.

Furthermore, graduate students must apply for financial aid at the price of high interest rates. Many students’ hands are tied as they strive to reach their dream career. Simply put, without accepting financial aid from the Department of Education, practicing dentistry will be far from a realistic goal. As a result, many students and recent graduates may feel discouraged about their future as student debt accrues while in school. In 2011, the Budget Control Act eliminated subsidized loans for graduate students. Thus, borrowers have no option but to face the Direct Unsubsidized interest rates of 5.31 percent and Direct PLUS Loans interest of 6.31 percent. Some may even decide to delay post-graduate education in an effort to stabilize debts. Others have to postpone becoming business owners. Despite the concerning burden, efforts have been made to alleviate the substantial student loans and we have the option to take the matter in our own hands.

rate will decrease by 0.25 percent. DRB may be among many banks than can offer guidance for the newly graduated dentist to start managing debt.

Indeed, it is overwhelming to juggle graduation, securing an associate position, applying for residencies and obtaining licensure.

However, financial freedom should take precedence for the indebted students.

One of the most meaningful quotes that has resonated with me thus far in my dental education is, “Never pay interest on a depreciating asset,” by Dr. L.D. Pankey. Luckily, dental professionals do not have any depreciating assets when considering the level of education, vast skillset and professionalism earned upon graduation. The only interest that we pay is for a blissful future, rendered by the advocacy of our profession as we control our financial freedom.

Though dental school provides us with the vital skills to become excellent clinicians, there are a lot of real world lessons that have to be learned outside of school. Debt management is one of these topics. We must know that controlling debt is within range and the steps to financial freedom are solely dependent on proactivity by participating in organized dentistry. For instance, the American Student Dental Association has high hopes for their F-4 Student Debt policy to grow. One of the goals of F-4 is to encourage state legislatures to offer loan forgiveness options to students and residents that desire to practice in underserved areas. Furthermore, there are loan refinancing options that many students and graduating dentists should begin to consider. For instance, the American Dental Association (ADA) began to advocate Darien Rowayton Bank’s (DRB) new student refinancing loan program in 2015. Now, ADA members have the opportunity to refinance up to 100 percent of their federal student loans at lower interest rates (i.e., 4.45-6.15 percent). When it comes down to crunching numbers, these interest rates seem more competitive than the ones offered by the Federal Reserve. Additionally, if monthly electronic fund transfers are made, then the fixed

References:

www.floridadental.org

January/February 2017

http://success.ada.org/en/practice-management/ finances/national-and-state-loan-repayment-programs http://www.ada.org/en/member-center/ada-fornew-dentists/manage-my-debt?source=VanityURL http://www.asdanet.org/_AboutPage_wAdd.aspx?id=1558#F-4 https://student.drbank.com/

Ms. Borissova is a University of Florida College of Dentistry DMD candidate, Class of 2019.

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New Economic Climate

Dentistry Faces a New Economic Climate

By Richard Gawel

“

It’s teaching them the operations part of dentistry, said Huot. The younger dentists are learning that not only do they have to act like businesspeople, but they’re learning from somebody who already knows how to do it.

”

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There once was a time when a single practitioner could hang up a shingle and drill-and-fill the local community all the way to a successful career. But, of course, the profession has evolved. Factors like the Great Recession, dental service organizations (DSOs), the Affordable Care Act (ACA), student debt and digital technology all have affected today’s practices.

“What I’m trying to do for boomers, millennials, and Generation Xers is to say that no matter what, the way you were taught dentistry and the way you’re going to practice dentistry in the future has completely changed,” said Dr. Rick Huot, founder of Beachside Dental Consultants.

Recent Grads and DSOs For example, average earnings for general practitioners have dropped from the profession’s inflation-adjusted peak of $219,378 in 2005 to $183,885 in 2014. The recession and the subsequent drop in demand for dental care drove much of this decline, but it also was influenced by a competitive increase in the number of practicing dentists. And the cost of equipment isn’t getting better, either.

“The increase in overhead has got to go up, because the toys aren’t getting any smaller,” said Huot. “If you want a CAD/CAM, if you want the latest and greatest software, if you want lasers, and you have $400,000 in student loans, you aren’t doing it on your dime. The bank isn’t financing you for that.”

As a result, many dental school students who graduate with significant debt aren’t opting to launch and operate their own practices — or buy a retiring dentist’s practice. Instead, they’re joining established practices as associates. Often, they’re even accepting positions at corporate DSOs. “In Florida after 2008, what I found was that the only people who were buying practices were the large DSOs,” said Huot. “I got a chance to see how they operated and how they were doing it, and it was very obvious. They were looking for practices that grossed a million dollars. Who else is going to buy them?”

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New Economic Climate

These corporate practices come with pros and cons. On the one hand, dentists who work for them don’t have stakes in the ownership, though employee stock option plans may be available. Young dentists, then, can focus on learning the clinical and the management sides of the profession without the pressure of being a business owner.

“It’s teaching them the operations part of dentistry,” said Huot. “The younger dentists are learning that not only do they have to act like businesspeople, but they’re learning from somebody who already knows how to do it.”

Also, many DSOs provide opportunities and support for continuing education. It’s not just travel to regional and national conferences, either. Some larger organizations bring wellknown experts into their offices to instruct their employees in new procedures and technologies right on-site.

On the downside, though, salaries at DSOs may depend on bonuses, which are calculated via spreadsheets that include both fixed and variable costs related to performance. While practice owners would be familiar with those figures due to the daily tasks of running a business, employees might not know what they’re looking at.

“If younger dentists aren’t astute and can’t read spreadsheets, they would not understand what’s on them,” said Huot.

Plus, dentists at these practices often are in charge of their treatment plans. Yet there still may be pressure to perform. There wouldn’t be any quotas to meet. “You will not find a written record of that,” Huot said. Such goals may be implied, though, along with parameters for when certain procedures should be performed.

However, the emerging DSO model may see some evolution of its own. Huot believes that the millennial generation of dentists may be more entrepreneurial and more collaborative than their predecessors. So just because they don’t open up their own individual offices, that doesn’t mean they’re going to join or stick with a corporate group either.

“While they’re still in school, a bunch of them will decide that maybe they should own a cluster of practices,” said Huot. “Or you could potentially have four or five classmates who spread out and all work for these companies, and then they come back and say, ‘Wait a minute. We can do this together as a group.’”

Patient Payments and Records Regardless of the type of practice, dentists are seeing changes in how they’re getting paid. Even after insurance coverage — and especially in cases when there isn’t insurance at all — patients are putting treatment on their credit cards. Or, they’re skipping treatment or getting limited procedures that don’t get the job finished.

“For example, they won’t go for a crown.

They’ll say, ‘Just fix it, doc, and I’ll wait to get a crown later.’ And they’re putting things off,” Huot said. “Orthodontists would tell you that families were getting ortho for their first and second kids when the economy was doing better, but not for their third or fourth kids.”

Huot also notes that parents are waiting longer to make appointments, and emergencies are cropping up, even though most of dentistry is preventable. As a result, dental hygienists are seeing their booking totals decreasing. The hygiene schools are still producing students, though, who now may be having trouble finding work.

Meanwhile, some practices are using inhouse financing systems or discount plans to help patients afford care. Medicaid and Medicare also are growing options for many patients. Due to the reimbursement levels that the federal government provides, however, many dentists aren’t participating in these programs.

Please see ECONOMIC, 45

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New Economic Climate

ECONOMIC from 43

“In California, 65 percent of children qualify for Medicaid. Some states reimburse at a better level than others,” Huot said. “Florida compensates its dentists about 30 cents on the dollar, which is very, very difficult. It’s difficult to make that work even on volume.”

Federally qualified health centers are providing a safety net for these patients, segmenting the population into “haves” and “have-nots,” Huot said. The “haves” can afford to pay for treatment out of pocket or get Medicaid and Medicare to cover it. Then there are the people who are stuck in between.

“Everything else that you hear is about the middle class in this country, with insurance companies providing less coverage, and some plans even dropping out,” Huot said. “And that was one of the unintended consequences of the Affordable Care Act. Some plans did drop out.”

Also in the wake of the ACA, integrated electronic health records have dramatically changed dentistry, with great variations. Many older practices still use hard copies of records on paper, some have begun the migration to digital data and others are all online.

In fact, thanks to partnerships between the major software providers and dental schools, all dental students now are familiar with paperless recordkeeping. Yet the electronic frontier carries its own host of dangers for practice owners and patients alike.

“You’ve got two things going,” Huot said. “You’ve got hacker problems, and you’ve got HIPAA violations.”

Many physicians have launched patient portals where their patients can access their medical information securely and confidentially while satisfying HIPAA regulations. Huot believes that similar systems will emerge in dentistry. Still, many small practices don’t have the firewall muscle to protect these records yet.

What’s Next?

It’s a new landscape for dentists who are now looking to retire and sell their practices. Instead of a fresh-faced kid just out of school, it may be a corporation on the other side of the table. Technology may need an expensive overhaul, with an eye on new regulations. And patients themselves may have trouble paying. But Huot is hopeful about the state of oral health in the country.

“I think as a whole it’s getting better. When you look at older adults, they have retained their teeth for far longer than just a generation ago. On the pediatric side, we are making inroads. We don’t see as much rampant decay as we used to see. Some of it might be better nutrition. Some of it might be fewer sugary snacks,” Huot said.

“All that is going to increase our health.

And because of the Medicaid system and because there’s a large population that’s qualified for that, some of them are actually getting the treatment done,” Huot said.

“And once you find that patients are done, then it’s not as bad.”

Dentistry Faces a New Economic Climate, Reprinted with permission of Dentistry Today, ©2016 Dentistry Today.

“I would venture to guess that there are several practices still working in Windows XP. Microsoft will tell you that they can’t support it, nor is it secure. So all those people are potentially targets for hacking,” Huot said.

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January/February 2017

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800.877.9922 * THE ONLY NUMBER YOU NEED!

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FDC2017 SPEAKER PREVIEW

Bambi vs. Godzilla:

How to Deal with Difficult People

By Bruce Christopher

Difficult people are everywhere!

They can be our co-workers, customers, supervisors, neighbors and even family members. Difficult personality types can drain us of our energy and move us from a positive position to a negative state of mind very quickly. Many of us would like to avoid interacting with difficult people, or even worse, we can’t help but react to them with frustration and defensiveness.

Imagine this scenario: You are sitting in a dental office reception room calmly waiting for your appointment. Then, a well-dressed, professional-looking man walks into the waiting area, strolls up to the to the receptionist and says, “Good afternoon, my name is Mr. Jones. I am here for my three o’clock appointment.” The receptionist warmly greets him and looks down into her scheduling book. She turns the page, looks up and says, “Mr. Jones, I can see here that your appointment is for next Thursday at three o’clock, not today.”

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“What!” he explodes, “Do you think I’m incompetent and don’t know how to read a calendar! What is your name, young lady?

I’m going to talk to the doctor about you and your employment!”

attempts to solve problems as an adult. He probably explodes in the other relationships in his life as well — he explodes at his kids, his wife and his co-workers. He has become an Exploder.

I asked an audience in one of my corporate seminars why there are difficult people, and why do they do what they do? With quick wit, a woman exclaimed, “Because they are evil!” Though it may feel that way sometimes, in actuality, difficult people do what they do for a strategic reason.

The first rule of thumb to realize when encountering a difficult person is to understand that they are not evil; they are simply displaying their primary defense mechanism and their unconscious strategy to get their needs met. It is unconscious because most often, the individual is blind to their own behavior. You may recall talking to an exploder in your life and pointing out to them that they are yelling at you. “I am not yelling!” they may shout as their volume escalates even more.

Think about the dental office story. Why would this man explode in front of the receptionist in this manner? Because more likely than not, she is going to try to fit him into the schedule that day. You see, difficult people do what they do not because they are evil, but because it works.

It is a strategy of problem-solving that they learned in childhood and carried into their adult relationships. Much of our personality development is a result of how we learned to handle conflict as children.

In our preceding example, Mr. Jones most likely figured out as a child, that a way to handle conflict and get his needs met is by throwing a temper tantrum. His behavior in the dental office is a microcosm of how he

How do we deal with these difficult personality types? Can we change them? The answer to the second question is no. You cannot change someone else. In fact, the more you try to change them, the more resistant they will become to your efforts.

Though you cannot change difficult people, you can deal with them by employing the technique of what I call the “Surprise Effect.” The Surprise Effect means four things: You do the exact opposite of what people expect you to do.

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You take control of your own responses.

You are proactive with people and not reactive.

You interrupt frustrating and dysfunctional patterns of behavior in relationships.

This works because most interpersonal interactions have an expected routine or outcome. For example, the expected outcome of anger is defensiveness. If someone explodes at me with anger, you can pretty much expect that I will become defensive and may even explode back.

On the flip side, what if instead of buying into the expected argument, I could rescript my own responses and do something totally unexpected and unanticipated? That would result in a different outcome!

In my seminar, I ask a volunteer from the audience to help me demonstrate the power of the Surprise Effect. I ask my helper to stand facing me with about two feet distance between us. We put both our hands up, palms facing forward and on the count of three, we apply pressure on each other’s hands, trying to cause the other to lose their balance. However, these directions are a setup from me. Instead of pushing back on my “opponent” as he or she expects, I do the opposite by pulling my hands back at the last moment. The result is invariably that the other person falls forward, losing their balance while I stay centered, balanced and empowered. I have surprised them by doing the exact opposite of what they have expected me to do.

Great communicators intuitively know how to do this. Instead of buying into the ex-

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“Much of our personality development is a result of how we learned to handle conflict as children.” pected routine or outcome, they change the rules of the game by employing the Surprise Effect. If you can do it, the Surprise Effect allows you to stay centered and balanced, while your antagonist will lose center and balance.

For example, during a planning meeting you are giving a presentation about current trends in your industry. Right in the middle of your speech, one of your competitors yells out, “You know, you are really full of s@*%!” What would you do or say? For most of us, the expected response might be to become defensive, or worse yet, maybe even reactive and yell back, “Well, you are, too, buddy!”

But imagine using a Surprise Effect to do the exact opposite of what your rival expects you to do — perhaps you could use humor and say, “That is an amazing insight, most people take months to reach that conclusion. You came to it in only 45 minutes.”

This actually is a true story. It worked wonderfully; everyone laughed and the dialogue opened up to a more receptive audience.

The Surprise Effect shows us that we cannot change or control other people, but we can change and control our responses in any difficult situation. It helps us to see that we can interrupt the pattern of expected outcomes that difficult personality types are often counting upon.

There are six basic difficult personality types that I talk about in my seminar. Remember, that these personality types are really defense mechanisms that the individual developed in childhood as a way to deal with conflict or get their needs met. Let me briefly introduce them to you.

First, are the Tanks and Exploders. These are the intimidating and aggressive personality types who use power to demand that their needs be met. Exploders often believe that no one will listen to them unless they blow up!

Second, are the Snipers. These people use sarcastic and cutting jokes to distract attention from their own feelings of insecurity or incompetence onto to a more likely target.

They use humor to get in a dig at someone else.

Please see DIFFICULT, 52

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FDC2017 SPEAKER PREVIEW DIFFICULT from 51

Next, are the Know-it-alls. They believe that “to be right is to be liked,” so they use intellectualism to impress others and gain status.

They tend to be group dominators and may grasp for the spotlight in staff meetings.

Then come the Wet Blankets and Fire Hosers. These are the complainers and chronically pessimistic/negative individuals in our personal and professional lives. They tend to be missionaries of misery and like to point out to others how bad things can get around here. They often feel powerless to do anything about it, so they tend to complain and throw a “wet blanket” on new and good ideas.

Fifth on the list are the Super Agreeable Charmers. They are socially seductive and charming, yet tend to be super unreliable.

Because of their high need for approval and fear of rejection, they tend to become accommodating and often may overextend themselves trying to meet other people’s needs. But in the process they may begin to “drop the ball” on personal and professional commitments, and will attempt to use social charm as a way to distract attention away from the broken promise.

Finally, are the Clams and Indecisives.

They tend to clam up in the face of risk. In the sense that they are perfectionists and fear failure, their strategy is to lay back and remain indecisive in the hope that someone else will take the risk and decide for them.

It is essential to note that these are simple defense mechanisms that people use in a pressure situation. We all can be found in each of these defensive strategies to some degree. When the pressure is on, some of us clam up, some of us explode and some of us try to charm our way out. Many of us

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have a primary style in which we are most comfortable, and this integrates into our personality and becomes a way we handle conflict as an adult.

I encourage the people in my seminar to come up with a “behavioral map” that they can use whenever they encounter a difficult personality type. Your “map” can include two columns for each of the six difficult personalities. Take six pieces of paper, label each sheet of paper at the top with the six personality types outlined in this article.

Draw a line down the middle of each sheet; label the left-hand column, “What I Should Not Do,” and label the right-hand column, “Surprise Effects.”

It is possible to restructure interpersonal events by being prepared with a Surprise Effect. For example, a few years ago I was living in an apartment complex and I had recently taken up a new hobby of boating.

So I purchased a boat. While having no place to store my boat, I asked the management of the apartment complex if I could temporarily take up two parking spaces to pull in my boat until I found adequate space. “No problem,” they said.

One night while parking my boat, a car squeals into the lot and an irate gentleman begins to explode at me, “I can’t believe you are taking up two spaces! You know, we pay rent here, too!”

I remembered my training on the Surprise Effect; I calmly waited until he was finished and then I surprised him by saying, “Sir, you are absolutely right.”

The change that came over his face was amazing! “I am?” he said. “Yes,” I continued, “I realize that you pay rent here, too, and that there are too few spaces. But I want

you to know that I got permission from the management to do this and that it is a very temporary situation.” At the end of our brief conversation, he literally said, “Well ... OK. I’ll watch the boat for you.”

In less than two minutes, he went from being my antagonist to being my ally and protecting my property! Why did this happen? Because I surprised him by doing the exact opposite of what he expected me to do. He was anticipating my defensiveness and anger, while instead I listened and acknowledged his feelings of frustration.

I didn’t try to change him or talk him out of his anger, but rather, I controlled and changed my own responses.

There are many Surprise Effects you can employ in any situation, and with all of the six basic difficult personality types. I encourage you to have fun and think up two or three effective Surprise Effects that you can apply with the difficult people you interact with in your personal and professional life.

To jump-start your thinking in the right direction, can you pick out the best course of action using a Surprise Effect for each of the four scenarios below?

What Would You Do?

1. You are a customer service representative for ABC Company Inc. During an appointment, one of your clients angrily explodes at you. To diffuse his anger, you should: a) explode back. b) tell him that what he is saying is so important that you’d like to get a notebook and take down all his concerns. c) explain your side of the story. d) cry and show how much his anger hurts you.

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FDC2017 SPEAKER PREVIEW 2. During a staff meeting, one of your colleagues tells a joke about you to the rest of the group. They all laugh, but you feel cut down and hurt. You should: a) laugh and pretend that it didn’t hurt at all. b) tell a joke back on that person. c) look directly at that person and say in a loud voice, “Stop it!” d) get her alone and ask if she really feels that way about you.

3. After working all day long, then cooking and serving dinner, you ask dad and kids to help out by cleaning the dishes. They promise to help, but night after night your request goes unheeded. You feel angry, frustrated and resentful. You should: a) immediately start to nag. b) throw away all the dishes (except your own place setting) and cheerfully let them eat off paper plates with plastic utensils. c) threaten to leave the family unless they buckle down and help. d) ground the kids and give your husband the “cold shoulder.”

4. You are at work and you notice the company “Wet Blanket” coming toward you. She corners you and says, “Things are so bad around here! The morale stinks!

All everyone does is complain, complain, complain!” You should: a) say, “It’s not so bad, cheer up!” b) say, “You might be right, why don’t you come up with some ideas and proposals about what we can do about it and let’s bring them to our supervisor.” c) say, “Well, things may be bad, but I’m going to have a great day anyway!” d) say, “Oh, I am so sorry for you. Tell me more about your feelings and how I can help you.”

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Answers for the scenarios:

1. The Exploding Client: b The best surprise effect in this situation is b.

Exploders are used to having people either explode back, defend or crumble in the face of their emotional outbursts. Exploders explode because they believe no one will listen to them unless they emotionally escalate.

Therefore, taking a notebook to write down all of their concerns is a surprise effect for them — having someone write down everything that is bothering you is the ultimate in attention. And it interrupts the pattern — how can someone explode when you are taking notes on them?

2. The Sniping Colleague: d The best surprise effect in this situation is d. Snipers use humor to get in a dig at someone else. This is an indirect and passive-aggressive way to deflect attention from themselves and onto another. The best way to smoke out a Sniper is to remove them from their cover, which in this case is the group of people in the staff meeting, and ask them direct questions. You can ask her a direct question like this while alone with her: “Mary, you told a joke about me in the staff meeting and everyone laughed, but I sensed a dig there. Do you really feel this way about me?” Of course she will say no, or that it was just a joke and you are being too sensitive. This line of questioning is uncomfortable for a Sniper because it is too direct and puts the spotlight on them. Most often, the Sniper will think twice about taking a shot at you again, because you may have another one-on-one conversation with them, which they hate.

3. The Lazy Family: b The best surprise effect for the lazy family is b. Most of the time, we become angry with people because we can’t get them to do what

we want them to do — even if we are right!

In this scene, mom has a reasonable request for help, but dad and kids are resisting her.

She may resort to nagging, threats or punishment, but these strategies tend to create more resistance. An effective surprise may be to disengage from trying to change them, and simply allow them to eat off paper plates and use plastic utensils, while mom continues to eat with the fine china. This is a true story from Dr. Harriet Learner’s book, “The Dance of Anger,” which actually results in the family getting the message in a fun and creative manner.

4. The Company Wet Blanket: b The best surprise effect for the Wet Blanket is b. Wet Blankets are complainers and pessimists who are used to people trying to talk them out of their misery or cheer them up. Unfortunately, it doesn’t work. Complainers complain because they typically feel powerless to do anything about it.

Empowering them by moving them toward solution-seeking behavior can help them to do more while complaining less. However, most Wet Blankets will not do the project, they would rather complain, yet they are unlikely to wet blanket you again; because you are going to move them toward solutions and they don’t want to go there!

Bruce Christopher will be speaking at FDC2017 and presenting three courses on Thursday, June 22. His keynote, “Are We Having Fun, Yet? Humor and Peak Performance in the Dental Practice” will be held on at 8 a.m. “Bambi vs. Godzilla: How to Deal with Difficult People” will be held at 10 a.m., and “The Psychology of Success: Secrets the Superstars Know” will be held at 2 pm.

For more information about Bruce Christopher’s seminars please visit his website at www.bcseminars.com or contact him at 952.988.9466.

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FDC2017 SPEAKER PREVIEW

Building the Brand

By Laci L. Phillips

Branding just might be my favorite thing right now. It’s fun, it’s intriguing and it’s absolutely a necessity. A brand is who you are — it’s the image and the feeling that’s left when you are not in front of your audience. Do you have a brand? Is it clear, defined and relevant? Is it you?

Think of some of your favorite brands now. How about Starbucks? Did you just smell coffee? What brand do you think of when I say, “Just do it”? And what about if I sing, “Chicken parm, you taste so good”? Our favorite brands evoke smell, sounds, touch and even feelings. Now think of businesses you have had a bad experience with. What does seeing or hearing their brand bring to mind?

What makes a brand?

Your brand can be any of the above or it can be several of them all at once. What is most important about your brand is that it matches your vision, your mission and your goals. All three of those elements walk hand in hand with your brand.

It’s important to remember your brand in everything you do. Integration includes your logo, your colors and your mission up to how you answer the phones, greet patients and perform dentistry. Integration also includes how you will use your brand. Here are a few items you should be using in your dental practice:

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“In the end, your brand should fit your vision, your mission and your goals.”

Business Cards: Every team member should have a business card with your practice name and logo. It is important to carry business cards with you everywhere you go.

You never know when or where someone will ask you what you do.

Stationary: This should be a no-brainer.

Make sure your digital stationary is reflective of your brand as well.

Two-pocket Folders: If you provide educational materials, treatment plans or any take-home items to your patients, they should be in a professional two-pocket folder with your name and logo. Are you a specialty practice that relies on the referral from dentists you’ve partnered with?

Each of those offices also should have your professional pocket folders to hand to their patients.

Pens: Do you have pens in your office? Every pen in your practice should be your pen — with your name, logo and in your colors.

When a patient is at the business office to pay for services, they should have an abundance of your pens to pay you with. And let them take them! Consumers love pens, they carry them around. Now you have your brand advocates sharing your brand outside of your practice.

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Mouse Pads: If you have computers, we are guessing you have mouse pads. Are they cute ones with your kids or your dog? Every mouse pad is a direct reflection of your practice.

Make them yours — your logo, your name, your brand. And when they get frayed and dirty, throw them away and replace them with new beautiful ones.

Lab Jackets/Uniforms: This is a big one. Does your business team look like they can step into the clinical area at any time? Does your clinical team match each other? How your team looks and how they present themselves says something about you. Is this what you want your patients to see? The business team should be in business attire, or slacks, a nice blouse and a jacket with your practice name. The clinical team should have matching, clean and ironed scrubs. When you travel for continuing education with your team, it is a great reflection for the entire team to be dressed the same. We’ve seen some great offices have matching T-shirts with the practice’s name and tagline or all wearing nice polo shirts. All team members should have appropriate hair and makeup, and of course, never open-toed shoes.

Your brand is Who You Are. Be true and be consistent. In the end, your brand should fit your vision, your mission and your goals. You can’t be all things to all people, but you should be what you promise to yourself, your team and your patients. Now, let your brand open the door to your entire marketing campaign.

Ms. Laci Phillips will be speaking at FDC2017 and presenting four courses. “Communications, Coding and Collections: The Three C’s to a Profitable Practice” will be held on Friday, June 23 at 9 a.m. and “Systems, Teams and Technology” will be held later that day at 2 p.m. On Saturday, June 24, “Dynamic Branding and Marketing: Bringing Your Story to Life” will be held at 9:30 a.m. and “Your Practice Through the Patients Eyes, It’s Not Just About Dentistry” will be held later that day at 2 p.m. She can be reached at laci.phillips@practicedynamics.net.

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The Benefits of Adding Botulinum Toxin and Dermal Fillers to Your Dental Practice

By Dr. Tracy Shaw

When I graduated from dental school, the notion of dentists doing facial aesthetics was still in its infancy. Buzz words like “smile design” and “total facial aesthetics” circulated, helping build the concept. I remember thinking to myself, “How can you have a ‘perfect’ smile if the rest of the picture doesn’t match?” The way I saw it, the rest of the picture includes how the lips frame the smile, how the eyes light up when laughing and everything in between. At this point, I realized that a great smile is about so much more than just teeth.

Dentistry today continues to evolve. What our patients come to us for is changing.

Facial injectables are a part of that change, allowing us to treat our patients’ aesthetic needs more comprehensively beyond their teeth and gums.

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Think about the fantastic full-mouth reconstruction you worked on for many months to perfect. Your patient feels better about themselves, smiles bigger and prouder, and their self-confidence is boosted.

But, as the saying goes, aesthetics begets aesthetics. Now your patient notices that their lips look wrinkled and uneven. They may see an angry, furrowed brow through tired eyes looking back at them in the mirror when, in reality, they are anything but that. This is where botulinum toxin and dermal filler treatments come in.

By offering this new paradigm in our practices, we’re able to tap into our creative outlets and reverse the signs of aging, bringing back symmetry and harmony to our patients’ faces and smiles. Deflated lips with peri-oral volume loss and downturned corners of the mouth? Carefully placed dermal filler can rehydrate and fill the lips, soften fine lines and upright corners of the mouth.

Tired, wrinkled eyes? Properly placed botulinum toxin can eliminate crow’s feet and lift the brows for a brighter, more refreshed appearance. Gummy smile? Botulinum toxin can predictably lessen the strength of the lip’s levator muscle, lowering the lip to minimize the excessive gummy display.

I have been providing treatments such as these in our practice for the last six years, and have seen the benefits for our patients and our practice firsthand. On a personal note, I simply love doing it. I get great satisfaction in feeling like I have met or exceeded a patient’s expectations and helped to restore their self-image. I also enjoy how it breaks up the routine of everyday dentistry, by providing a welcome challenge and immediate gratification for both the patient and me. As dentists, we are artistically inclined by nature. Aside from doing a beautiful Class IV, much of the artistry in what we do is handled by our laboratories.

Facial injectables put the creativity back in our hands. They allow us to treat a multitude of aesthetic and functional issues, and their presence creates an excitement in the practice for both our patients and our staff. My practice has directly benefitted from offering these treatments to existing patients who appreciate the convenience of pairing it with their regular re-care and the comprehensive outcomes they achieve.

Furthermore, patients who initially present for facial aesthetic treatment often find their way over to the dental side of the practice.

There is a learning curve involved, but it’s not too steep. There are no big-ticket items that you need to purchase, only the

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investments of time, proper training and practice. By taking introductory courses in botulinum toxin and dermal fillers — such as those being offered at the Florida Dental Convention in June — you can acquire the necessary tools to incorporate these exciting, fun and profitable treatments into your practice model.

“Dentistry today continues to evolve. What our patients come to us for is changing.”

Dr. Tracy Shaw is a cosmetic and reconstructive dentist in Miami Beach. She will be speaking at FDC2017 and presenting two courses. “Botulinum Toxin: How & Why to Incorporate it into Your Dental Practice” will be held on Friday, June 23 at 8 a.m., and “Dermal Fillers: How and Why to Incorporate it into Your Dental Practice” will be held on Saturday, June 24 at 8 a.m. She can be reached at info@theshawdentalcenter.com.

FDA CHAT online member support NEW! Chat with FDA Member Relations staff and get answers fast.

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EXHIBITOR MARKETPLACE Exhibitors as of Jan. 20, 2017

#3D Diagnostix Inc. 3M Oral Care

AA-dec A. Titan Instruments A/R Consulting Inc. DBA Dental PC Accutron Inc. ACTEON North America ADS Florida | Henry Schein Professional Practice Transitions Advantage Technologies Advice Media Air Techniques Inc. AMD Lasers Anutra Medical Inc. Argen Refining Aseptico Aspen Dental Atlanta Dental Supply Atlantic Dental / Brewer Design

B

These exhibitors have made a commitment to attend the FLORIDA DENTAL CONVENTION (FDC). Not only do these companies exhibit the latest in technology, materials and equipment, but many sponsor events and continuing education programs at the FDC. Take a minute to see if your supplier is on the list. Make an effort to stop by their booth in the Exhibit Hall in June for show specials. Please support those entities that help make the FDC a rewarding member benefit.

Bank of America Practice Solutions Banyan Bayshore Dental Studio Belmont Equipment Benco Dental Berryhill, Hoffman, Getsee & DeMeola LLC Bien-Air Dental Bioclear Matrix BioHorizons BIOLASE Biotec Inc. Bisco Dental Products BQ Ergonomics LLC Brasseler USA

C CareCredit Carestream Dental Carr Healthcare Realty Centura Pharmaceuticals Inc. Certol International Citibank Healthcare Practice Finance Classic Craft Dental Laboratory ClearCorrect Coast Dental Colgate COLTENE Convergent Dental Inc.

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

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

E-F Eclipse Loupes and Products Elevate Oral Care LLC Envolve Benefit Options Essential Dental Systems FDA Supplies / SourceOne Dental Inc. Fidelity Bank First Citizens Bank Florida Combined Life Florida Dairy Farmers / Dairy Council of Florida Florida Dental Association Florida Dental Association Foundation Florida Dental Association Services Forest Dental Products Inc. Fortress Insurance Company Fortune Management Fotona / Lasers4Dentistry Fuze Care System

G Garfield Refining Company Garrison Dental Solutions GC America Inc. GlaxoSmithKline Great Expressions Dental Centers Greenberg Dental & Orthodontics

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

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

K Karl Schumacher Dental KaVo Kerr Kettenbach LP Knight Dental Group Kuraray America

L Lares Research Lending Club Patient Solutions LIBERTY Dental Plan Lighthouse 360 Live Oak Bank LumaDent Inc.

M MacPractice Medidenta Meisinger USA LLC Microcopy Microflex / Ansell Midmark Corporation Millennium Dental Technologies Inc. MIS Implants Technologies Modular & Custom Cabinets Ltd. My Computing RX Myofunctional Research Co.

N-O Nature Hill NV New Image Dental Laboratory Nova Innovations NSK America Corporation Officite On the Map Marketing OraPharma Inc. Orascoptic Ortho-Tain / Healthy Start

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

R-S RGP Dental Royal Dental Manufacturing Sage Dental Salvin Dental Specialties Inc. SciCan Inc. SDI (North America) Inc. Serve First Solutions Inc. Shamrock Dental Co. Inc. Shofu Dental Corporation Snap On Optics Solutionreach Sunrise Dental Equipment Inc. Sunset Dental Lab Sunshine Health Sunshine State Credit Superior Dental Design Services & Upholstery SurgiTel

T-U The Doctors Company The Online Practice Thommen Medical Tokuyama Dental America Ultradent Products Inc. Ultralight Optics Inc.

EXHIBIT HALL HOURS THURSDAY • JUNE 22, 2017 9 a.m. – 6 p.m.

FRIDAY • JUNE 23, 2017 9 a.m. – 6 p.m.

SATURDAY • JUNE 24, 2017 9 a.m. – 2 p.m.

CHILDREN UNDER 12: Unless attending an educational session, children under 12 do not need to be registered and do not require a badge. Children are only allowed in the Exhibit Hall if accompanied by a registered parent or guardian. Infant strollers and carriages are not allowed in the Exhibit Hall, unless medically necessary. For the safety and convenience of others, the use of baby carriers is strongly encouraged.

V-W Vatech America VIAX Dental Technologies Video Dental Concepts VOCO America Inc. Walla International / Click Heaters Wand Dental Inc. (Milestone Scientific) Water Pik Inc. WEAVE Wells Fargo Practice Finance

Exhibitors in blue are FDAS Crown Savings Merchants.

X-Y-Z i XPdent Corporation Zimmer Biomet Dental ZOLL Medical

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Donated Dental Services (DDS) and a team of volunteers came to Denny’s rescue repairing his dentures and providing restorative treatment. The impact on Denny’s life has been tremendous, he now works part time as a care giver for a man with Down-syndrome, helping with his daily care needs. Also after his dental treatment was completed, he was inducted into the Iowa Rock-n-Roll Hall of Fame with his band, Street Band.

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Midlevel Provider

Midlevel Dental Provider

By Dr. C.J. Henley

The call for a midlevel dental provider1 (MDP) in dentistry has grown in the past few years.

Organizations like Pew Charitable Trusts and The W.K. Kellogg Foundation have been some of the most outspoken advocates of the development and implementation of the MDP. In a recent report, the Pew Center states, “State leaders, dentists, public health advocates and other stakeholders should be heartened to know that expanding the dental team is an effective strategy to improve access to care, but they cannot overlook the importance of setting adequate Medicaid reimbursement rates.”2 Often, the need for the MDP is propagated on the basis that there is an acute need for dentists in the United States. According to a study recently published by the American Dental Association (ADA), the population of dentists in the U.S. will steadily grow through 2035.3 Indicating that, as the population in the U.S. grows, so will the number of dentists. However, this is in stark contrast with a report published by the Health Resources and Services Administration that estimates it would take a net increase of nearly 9,500 providers to address the unmet need today.4

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Studies that highlight Alaska as a success story for the implementation and use of MDPs offer more support. There was — and is —little doubt that there is a need to improve the access to dental care in Alaska.

This is based on the fact that Alaska has the largest landmass in the U.S., but as of 2014 there were only 736,732 residents and more than 14 percent of Alaskans are American Indian/Alaska Natives. There are roughly 215 villages spread throughout Alaska.

Often, these remote locations are only accessible by boat, bush plane or snowmobile.

Many of these communities have no on-site dental services. For these reasons, MDPs have been successful at helping promote dental care in underserved areas such as remote Alaskan villages.5 It is difficult to use Alaska as an “apples-to-apples” comparison to what is going on elsewhere in the U.S. due to the geographic uniqueness of the state.

It’s interesting that the push to introduce the MDP has gained so much traction, when attempting to improve our existing system would logically seem to be the simplest path to improving access to dental care. I reached out to Pew and asked them just that. Why is there such an emphasis on the MDP as opposed to improving Medicaid reimbursement? John Grant, director of Pew’s dental campaign, stated, “For dental policy, we work in states on proven, cost-effective solutions that improve access to dental care.”

Often, the MDP is compared to a physician assistant (PA) or a nurse practitioner (NP).

But, is that really a fair comparison? If the ultimate goal of the MDP is to provide care to the underserved, then the comparison to the PA or the NP cannot be made. A study published in 1997 stated that of the total NPs practicing in the U.S., 85 percent were located in metropolitan counties.6 How is this geographic distribution of NPs serving any benefit to underserved populations in rural areas? A 2009 RAND study found that in Massachusetts, visits to NPs and PAs cost 20 to 35 percent less than visits to physicians.7 However, many of the costs in dentistry are fixed, such as rent, staff, restorative materials and sterilization costs.

With states such as Florida, Medicaid reimbursements hover around 35 percent of the usual and customary rate. With reimbursements at this rate, it will still be difficult to generate enough revenue to sustain a viable practice.

In a recent study published by the ADA’s Health Policy Institute, it was noted that in 2007, the Texas Medicaid program increased dental reimbursement by more than 50 percent, implemented loan forgiveness programs for dentists who agreed to practice in underserved areas and allocated more funds to dental clinics in underserved communities. By 2010, dental care among Medicaid-enrolled children in Texas had increased so much that it exceeded the rate among children with commercial dental insurance.8 The Affordable Care Act made dental care for children an “essential health benefit” so Please see MIDLEVEL, 65

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it is easier for children to obtain Medicaid coverage. However, Ron Waters, a contributor of Forbes.com, recently wrote an article entitled, “Ow! If You Think the U.S. Medical Care System is Broken, Take a Look at Dental Care.” In his article, he stated that in the U.S., Medicare provides health care to almost all elderly people in the country, but it specifically excludes dental care. Seniors may buy their own private dental insurance, but only 12 percent do so and less than half of Medicare recipients saw a dentist in the past year. So, the question stands, how can we improve the issue of access to dental care in the U.S.?

I don’t think that any dentist would deny that as health care providers, we have an obligation to help care for our underserved populations. Fortunately, programs like Give Kids A Smile and the Mission of Mercy have helped thousands find desperately needed oral health care. However, as amazing as these programs are, they are just scratching the surface of what the U.S. needs in order to help patients who need dental care the most. An often cited story tied to the access-to-care issue is the story of Deamonte Driver — a young man who died from a dental abscess in 2007.

Deamonte’s death and the ultimate cost of his care, which totaled more than $250,000,9 underscore our country’s issues with access to dental care and the cost to our communities for failing to treat dental problems in a timely manner.

The vast majority of dentists cite the reason for not taking Medicaid because the reimbursements are too low, and the patients’ likelihood to no-show appointments.10 According to the ADA, making Medicaid reimbursement rates for dental care closer

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to commercial dental insurance levels, in conjunction with other reforms, could increase provider participation and access to dental care for Medicaid enrollees. In order to close the gap in dental care utilization between low-income and high-income adults, policy makers can look to the success stories and “promising practices” of states, such as Texas, in considering reforms to their Medicaid program.11 It also is imperative not to understate the difference between lack of access to care versus under-utilization. I worked for a dental service group that provided Medicaid dental services to children in need in Florida for nearly three years. While many of the patients were grateful, it also was clear that many parents and caregivers were not educated about the importance of oral health care for themselves and their dependents. It is possible that a lack of education with respect to dietary considerations, oral hygiene and failure to understand the importance of good dental care are at the crux of the problem.

I am not enthralled by the idea of dentistry following the current model of medicine in the U.S. I believe that what makes our profession so great is our ability to own our own businesses, control the quality of care that we provide and spend time with our patients. I worry that if we introduce MDPs, dental practices will become “mills” and if anyone has been in a physician’s office recently knows that the larger the practice, the more likely you are to be “just a number.” Moreover, I hate the idea of legislators who are not dentists advocating for MDPs when they are not on the frontline of dentistry every day and don’t understand how a private practice functions. I fail to understand how the introduction of the MDP in the continental U.S. truly is going to have

a significant impact on access to care. I would encourage our legislators to increase Medicaid reimbursements and eliminate the “red tape” associated with becoming a provider. Lastly, we can all help solve the problem today by regularly treating a limited number of patients in need in our offices.

In my practice, we make it a point to extract teeth, place fillings and fabricate partials for patients who typically could not afford the care. We ask only for them to “pay what they can, when they can.” Protecting our profession starts with each one of us, in our communities, helping the people who need it the most – and not with legislators in Tallahassee and Washington, D.C.

Endnotes: 1. It should be noted that depending on the state, various names have been developed to describe the MDP such as Advanced Dental Therapist (ADT), Dental Therapist (DT), and Advanced Dental Hygiene Practitioner (ADHP) with varying scopes of practice, however for this discussion all variants will be grouped as a MDP. 2. The Pew Center on the States. It Takes a Team; How New Dental Providers can benefit patients and practices.

Washington, DC: The Pew Center, 2010.

3. Bradley Munson, B.A.; Marko Vujicic, Ph.D. Number of Practicing Dentists per Capita in the United States Will Grow Steadily. Washington, DC: American Dental Association, 2016.

4. A Report from Chairman Bernard Sanders Subcommittee on Primary Health and Aging U.S. Senate Committee on Health, Education, Labor & Pensions February 29, 2012.

5. Shoffstall-Cone, Sarah, Williard, Mary; Alaska Dental Health Aide Program. Int J Circumpolar Health 2013, 72: 21198.

6. Lin, Ge, Burns Patricia, Nochajski Thomas. The Geographic Distribution of Nurse Practitioners in the United States. Applied Geographic Studies, Vol. 1, No. 4, 287–30, 1997.

7. Rand Corporation Policy Brief. Controlling Health Care Spending in Massachusetts. 2009.

8. Kamyar Nasseh, Ph.D.; Marko Vujicic, Ph.D.; Cassandra Yarbrough, M.P.P. A Ten-Year, State-by-State, Analysis of Medicaid Fee-for-Service Reimbursement Rates for Dental Care Services. Washington, DC: American Dental Association, 2014.

9. Otto, Mary. For Want of a Dentist. Washington Post.

February, 28, 2007.

10. Galewitz, Phil. Medicaid Patients Struggle to Get Dental Care. USA Today. February, 15, 2015.

11. Nasseh, Kamyar Ph.D.; Vujicic, Marko Ph.D.; Yarbrough, Cassandra M.P.P. A Ten-Year, State-by-State, Analysis of Medicaid Fee-for-Service Reimbursement Rates for Dental Care Services. Washington, DC: American Dental Association, 2014.

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

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benefit

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Helping Members Succeed Resources to help you communicate with all of your patients

SECTION 1557 OF THE AFFORDABLE CARE ACT FOR FLORIDA DENTISTS Section 1557 is the civil rights provision of the Federal Affordable Care Act (ACA) of 2010.

Section 1557 prohibits discrimination on the grounds of race, color, national origin, sex, age or disability in certain health programs and activities. Find more information about complying with Section 1557 and available translation services on the FDA website.

LINK TO INFORMATION ON SECTION 1557: www.floridadental.org/1557 FOR MORE INFORMATION 800.877.9922 • fda@floridadental.org • www.floridadental.org

YOU are NUMBER

1

JARED YOUNG, DMD Dr. Jared Young with his wife, Dr. Catherine Young, and their adorable 19-month-old son, Mason Matthew Young.

YOUR COLLEAGUES ARE “HELPING MEMBERS SUCCEED” EVERY DAY!

DEDICATED VOLUNTEERS HELP YOU SUCCEED My experience with organized dentistry has helped fuel my spirit for what I do. It truly does help empower the people that share my profession. I began volunteering in leadership in dental school. I started as the Legislative Chair at my local chapter, then the National level, with annual Dentist Day on the Hill trips to Washington and Tallahassee. By my fourth year, I was a National ASDA Trustee, representing dental students in five states and Puerto Rico. I also was honored to be on an ADA committee and attend meetings on the top floor of the ADA Headquarters in Chicago. Recenty I have been most involved at the local level, as President of the Broward County Dental Association. Local affiliate meetings are a perfect opportunity to meet and interact with colleagues, and learn the special talents of the other dental professionals in your area. Volunteering may be a misnomer, as I was always asked to do the next thing, the next step on the ladder. It's a special camaraderie. I'm looking forward to the upcoming years and hoping for a continued strong, majority membership in organized dentistry. The profession has treated me well, and I take pride in returning the favor.

— Jared Young, DMD President, Broward County Dental Association jaredyoungdmd@gmail.com

Interested in opportunities to get involved? Simply email the FDA’s Membership Concierge and she’ll put you in touch with your local dental society. Contact Christine Mortham at cmortham@floridadental.org.

benefit

NUMBER

Helping Members Succeed Other HIPAA products cost more than $400 and don’t comply with Florida law!

Florida and HIPAA Compliant Forms As an FDA member, you now have access to forms that comply with both federal HIPAA and Florida confidentiality law. All of the documents are available on the FDA website and are free of charge to members only. They are uploaded as Microsoft Word documents, so that you may add your practice information to them.

LINK TO THE FORMS: www.floridadental.org/members/member-resource FOR MORE INFORMATION 800.877.9922 • fda@floridadental.org • www.floridadental.org

By Drs. Molly Housley Smith, Indraneel Bhattacharyya and Nadim M. Islam

A 27-year-old Asian male presented to Dr. Michael Hashemian, an oral and maxillofacial surgeon of the Dentofacial and Cosmetic Surgery Institute in Spring Hill, Fla. for evaluation of a swelling on the right side of his face. He was referred to Dr. Hashemian by his general dentist, Dr. Petra Lee of Brooksville, Fla. who noted the swelling about one-and-a-half months earlier. The patient reports he felt the swelling increasing in size about five days prior to being seen in Dr. Hashemian’s office. During examination, the soft tissue mass was found to be approximately 3 x 3 cm in size over the right pre-auricular region (Figs. 1 and 2). The lesion was firm to palpation, but mobile. Medical history was unremarkable, and the patient was not on any medications and had no known drug allergies. There was no history of tobacco or alcohol use. The patient experienced mild pain and denied any associated fever, chills, weight change, weakness and fatigue. No paresthesia or facial weakness was present. The overlying skin was non-ulcerated and unremarkable.

Panoramic and CT imaging showed no bony abnormalities and were non-contributory. The lesion was excised via an extraoral approach (Figs. 3 and 4), and the entire lesion was submitted to the University of Florida Oral Pathology Biopsy Service.

Fig. 1

Fig. 3

Fig. 2

Question: Which of the following is the most likely diagnosis?

A. Epidermoid cyst (sebaceous cyst) B. Lipoma C. Hodgkin’s lymphoma D. Branchial cleft cyst E. Pleomorphic adenoma (benign mixed tumor) Fig. 4 Please see DIAGNOSTIC, 70

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January/February 2017

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69

Diagnostic

B. Hodgkin’s lymphoma

studies, chest radiographs, and possible

Incorrect. This condition usually does not

lymphangiography, bone marrow biopsies,

affect the preauricular nodes and rarely

gallium scans, splenectomies or exploratory

occurs within the substance of the parotid

laparotomies. The prognosis for Hodgkin’s

gland, involving intraparotid lymph nodes.

lymphoma depends on the staging; howev-

A. Epidermoid cyst (often mistakenly termed sebaceous cyst)

In addition, the nodes usually affected by

er, treatment and prognosis of this disorder

Hodgkin’s disease tend to be fixed, hard and

have been touted as one of the few success

Incorrect. Excellent choice! These cysts

immobile as opposed to this mass. Howev-

stories in cancer treatment over the past 30

are commonly found on the facial skin in

er, it is important to consider this condition,

years.

young individuals but typically present as

since the lesion affects young patients in

nodular and fluctuant (cystic) lesions that

this patient’s age group and also is often

C. Lipoma

may be secondarily infected. They may be

seen in the head and neck. A single node

Incorrect. Good choice! Lipoma is a great

solid to palpation only rarely, when fibrosis

affected by Hodgkin’s disease also is unusual

consideration in the differential diagnoses;

or a dense foreign body reaction is present.

as in this case. Hodgkin’s lymphoma is a

however, these lesions typically feel soft and

These lesions may rapidly grow in size,

malignant lymphoproliferative disorder,

“squishy” to palpation and rarely are firm.

especially if the lining ruptures, causing an

characterized by the proliferation of mono-

In addition, it is unusual for a patient to

inflammatory reaction. The epidermoid

nuclear Hodgkin and multinucleated Hod-

report a rapid increase in size of a lipoma

cyst accounts for approximately 80 per-

gkin Reed-Sternberg cells. It demonstrates a

as was seen in this case. The head and neck

cent of follicular cysts of the skin. They are

bimodal age distribution with the first peak

is a common site for this benign lesion,

common in the acne-prone areas of the

observed between the ages of 15 and 35,

and therefore, an important inclusion in

head, neck and back in older adults and

and the second peak after age 50. A male

the short list. Another reason lipoma may

are more common in men. Epidermoid

predominance is noted. It most common-

be considered in this case is the yellow hue

cysts are common keratin-filled lesions that

ly affects the cervical and supraclavicular

seen in the clinical presentation, which is

arise from the hair follicle, especially after

nodes, and presents as an enlarging discrete

common to lipomas. One of the detractors

inflammation, for instance, with trauma fol-

non-tender firm to hard mass, involving a

from this diagnosis is the fact that lipomas

lowing shaving. They may occasionally arise

node group. While the mass may be mobile

are rare in young individuals, especially

after traumatic implantation of epithelium,

in the early stages, it becomes fixed to the

before the age of 40. These benign soft-tis-

such as after penetrating trauma. Epider-

surrounding tissues over time. Intraoral

sue tumors are composed of fat in varying

moid cysts often are mistakenly termed

involvement is rare. Other accompanying

proportions. They are the most common

sebaceous cyst, which are not derived from

signs or symptoms may be present, which

soft-tissue tumors and mainly affect the

the hair follicle. Also, epidermoid cysts

may contribute to a poorer prognosis.

trunk and extremities, or the buccal mucosa

often are referred to as epidermal inclusion

These include weight loss, night sweats,

or buccal vestibule when found intraorally.

cysts, and they also can develop in the

fever and pruritus (itching). Patients who

Lipomas are most common in patients who

oral cavity. The epidermoid cyst is treated

are suspected to have Hodgkin’s lympho-

are older than 40 years of age and have no

by conservative excision with low rates of

ma have extensive clinical workups, which

sex predilection. Occasionally, they may

recurrence.

include careful medical history, physical

appear yellow; however, deeper tumors may

examination, magnetic resonance imaging,

not impart this yellow hue. They present

computed tomography scans, hematologic

as soft, smooth-surfaced masses that may

DIAGNOSTIC from 69

Diagnostic Discussion

70

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January/February 2017

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Diagnostic

be either sessile or pedunculated. Histo-

of 10-40 years. Patients occasionally may

pleomorphic adenomas present in young to

pathologically, the tumor demonstrates

experience pain due to secondary infection.

middle-aged patients with a slight female

a well-circumscribed mass of mature

Microscopically, the cyst demonstrates

predominance.

adipocytes with a possible thin fibrous

stratified squamous epithelium or respi-

capsule. Lipomas rarely contain cartilage or

ratory epithelium. Surrounding the lining

Clinically, pleomorphic adenoma appears

bone and can show up as an opacity within

epithelium are large aggregates of lymphoid

as a firm, slow-growing, typically painless

soft tissue upon radiographic examination

tissue, often with follicular architecture.

mass. When in soft tissues, the tumor usual-

if hard tissue is present. Prognosis after

Rare instances of malignant transformation

ly is movable in early stages; however, when

conservative local excision is excellent, and

have been reported. Fine needle aspiration

present on the hard palate, this is not the

recurrence is rare.

may be of help in establishing a diagnosis

case because of the tightly bound nature of

prior to treatment, and treatment is conser-

the tissue in that location. Although usually

vative surgical excision.

painless, the patient may present with pain

D. Branchial cleft cyst Incorrect. While this is a good consid-

E. Pleomorphic adenoma (benign mixed tumor)

eration because of the age of the patient, branchial cleft cysts are usually soft and

Correct! The clinical findings are compat-

fluctuant to palpation (similar to epider-

ible with a benign salivary gland tumor,

moid cysts), unlike this lesion which was

in this case a pleomorphic adenoma (also

firm to palpation. Additionally, around 95 percent of these cysts arise from the second pharyngeal arch in the upper lateral neck,

parotid gland. It accounts for 60-70 percent

branchial cleft close to the parotid gland.

of parotid tumors. When seen intraorally,

Branchial cleft cysts are developmental cysts derived from branchial arch remnants, young adults with an average age range

benefit

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ONLINE CE: THE EASY WAY

adenoma is the most common salivary gland tumor, most often presenting in the

while only 1 percent arise from the first

which are typically found in children to

known as a mixed tumor). Pleomorphic

if the lesion has been traumatized. Due to the indolent growth of this tumor, some patients may even wait years to seek medical attention. On rare occasions, the tumor may present bilaterally.

Microscopically, pleomorphic adenomas characteristically are composed of a mixture of elements. Cells present usually are of glandular and myoepithelial origin, and

the most common location is the palate,

Please see DIAGNOSTIC, 72

followed by the upper lip and buccal mucosa. The age range is wide; however, most

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“DIAGNOSTIC DISCUSSION”

Visit the FDC & CE page on the FDA website and click the “Online CE” button 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.

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71

Diagnostic

DIAGNOSTIC from 71

may be present within a myxoid stroma.

The tumor typically is well-circumscribed or encapsulated. Keratin, chondroid or osteoid material, or fat may be present within these tumors.

ly; however, the surgical approach depends on the tumor site. When the tumor occurs in the deep lobe of the parotid, a total parotidectomy with preservation of the facial nerve when possible is usually indicated.

If present within the superficial lobe of the parotid, superficial parotidectomy with preservation of the facial nerve is sufficient.

Because of the potential for incomplete removal or seeding of the tumor, local curettage is not indicated. When present on the palate, complete excision down to periosteum is necessary.

Prognosis is excellent when the tumor is adequately excised. A recurrence rate for pleomorphic adenomas of the parotid of 1-4 percent has been reported. Those that recur usually are due to multi-centricity or intraoperative tumor spillage (seeding).

Radiotherapy has been used as a post-operative therapy in patients whose tumor has been seeded. A higher percentage of patients with recurrences have been reported to be of younger age and female. A small percentage (3-4 percent) of pleomorphic adenomas may undergo malignant transformation, a risk that increases with duration of the tumor.

Today's FDA

ryya, Islam,

Zhan KY, Khaja SF, Flack AB, Day TA.

Cohen and Smith

Benign Parotid Tumors. Otolaryngol Clin

can be reached at

North Am. 2016 Apr; 49(2):327-42.

ibhattacharyya@ dental.ufl.edu,

Abu-Ghanem Y, Mizrachi A, Popovtzer

MIslam@dental.

A, Abu-Ghanem N, Feinmesser R. Recur-

Pleomorphic adenomas are treated surgical-

72

Drs. Bhattacha-

References

January/February 2017

rent pleomorphic adenoma of the parotid

Dr. Bhattacharyya

gland: Institutional experience and review

dental.ufl.edu,

114(6):714-718.

respectively.

Kerawala C, Brennan PA, Cascarini L, God-

Conflict of Interest

den D, Coombes D, McCaul J. Management

Disclosure: None

of tumour spillage during parotid surgery lofac Surg. 2014 Jan; 52(1):3-6.

reported for Drs. Dr. Islam

The Florida Den-

UFCD professors, Drs. Don Cohen, Indraneel

tal Association is

Bhattacharyya, and Nadim Islam provide

an ADA CERP

insight and feedback on common, important,

Recognized Pro-

new and challenging oral diseases.

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.

Bhattacharyya, Cohen and Islam.

Diagnostic Discussion is contributed by

The dental professors operate a large, multi-

hen@dental.ufl. edu, mhousely@

of the literature. J Surg Oncol. 2016 Nov;

for pleomorphic adenoma. Br J Oral Maxil-

ufl.edu and dco-

vider. ADA CERP Dr. Cohen

is a service of the American Dental Association to as-

sist dental professionals in identifying quality providers of continuing dental education.

ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry. Concerns or complaints about a CE provider may be directed to the provider or to ADA CERP at www.ada.org/goto/cerp.

This course will expire 02/01/2018.

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Gingival Overgrowth

Drug-induced Gingival Overgrowth: What You Need to Know!

By Dr. Douglas Fabiani

“

It is important to emphasize strict oral hygiene habits and it is recommended that an affected patient who cannot alter the medication should receive a three-month periodontal recall.

”

Over the past few years, I’ve noticed that I have been treating more and more patients who take medications that cause gingival overgrowth.

Some of these are new patients and they were not aware their medications could cause this problem. Some had been under treatment by their prior dentist for periodontal disease and managed according to the usual periodontal protocols, but the patient was unaware it was due to a medication. The more I saw these patients, the more I scratched my head. Why didn’t someone inform them of this side effect? I get it — during our daily care and management of our patients, it’s difficult to stop and really think about these adverse “outside-the-box” effects that our patients can experience. The goal of this article is to make you and your hygienist aware of these various medications that cause gingival overgrowth and treatment recommendations.

The three main classes of drugs that induce gingival overgrowth are anticonvulsants, immunosuppressants and antihypertensives (calcium channel blockers). As we have been told since our first day in the clinics

74

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January/February 2017

in dental school: It is vitally important to review the patient’s medical history, and these medications specifically need to be reviewed with the patient. It’s not fully understood why these medications cause gingival overgrowth. Research suggests they have a similar mechanism of action where they inhibit intracellular calcium ion influx.

The action of these drugs on calcium and sodium ion flux may prove to be the key in understanding why three dissimilar drugs have a common side effect upon a secondary target issue, such as gingival connective tissue.1,2,4,5 Another suggestion for the cause is the fibroblasts. It is thought that certain patients have fibroblasts that have a susceptibility to the drug. This could explain why some are affected and others are not.2

The Medications Calcium Channel Blockers These are common antihypertensive drugs used in the elderly population with patients who experience angina or peripheral vascular disease.

Immunosuppressants Patients with autoimmune diseases are a group who frequently takes these drugs.

Transplant patients typically take them for anti-rejection.

Anticonvulsants These anticonvulsants are used to treat a variety of seizure disorders.

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Gingival Overgrowth Medications that cause gingival overgrowth (trade name is listed to the right): Antihypertensives Nifedipine Adalat, Nifecard, Procardia, Tenif Diltiazem Cardizem, Dilacor, Diltiamax, Tiazac Amlodipine Lotrel, Norvasc Nitrendipine Baypress Felodipine Plendil Nicardipine Cardene Manidipine Manyper Nimodipine Nymalize Nisoldipine Sular Verapamil Covera-HS, Calan, Verelan

Immunosuppresants Cyclosporine Neoral, Sandimmune, Restasis Tacrolimus Protopic, Prograf, Hecoria Sirolimus Rapamune

Anitconvulsants Phenytoin Dilantin, Phenytek Sodium Valproate Depakote, Depakene, Stavzor Phenobarbitone Phenobarbital, Luminal, Epinil, Epigard, Donnatal Vigabatrin Sabril Primidone Mysoline Mephenytoin Mesantoin Ethotoin Peganone Ethosuximide Zarontin

Tear out the chart on the following page to keep as a reference for you and your hygienist.

The Treatment The signs of growth occur one to three months after initiation of the treatment with the associated medication.1,2 Management of the overgrowth proves to be more difficult because the plaque becomes trapped under the enlarged tissue. The severity of the overgrowth correlates well

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with poor plaque control by the patient.3 So, it is important to emphasize strict oral hygiene habits and it is recommended that an affected patient who cannot alter the medication should receive a three-month periodontal recall. It’s ideal to consult with the treating physician to change or discontinue a medication. If any drug substitution is attempted, it is important to allow six to 12 months to elapse between discontinuation of the offending drug and the possible resolution of gingival enlargement before

a decision to implement surgical treatment is made.1,6 Chlorhexidine gluconate and professional cleanings can decrease the rate and the degree at which recurrence occurs.

The final option is surgery. Those include scalpel gingivectomy, periodontal flap surgery, electrosurgery and laser excision.1 This is an aggressive measure and needs to be understood that recurrence is extremely common if the patient is still on the offending medication.

Final Thought The key is first to identify the patients on these medications and then discuss and educate these patients in order to lower their risk factors for the severity of this condition.

References 1. Bharti V., Bansal C. Drug-induced Gingival Overgrowth: The Nemesis of Gingival Unraveled. J Indian Soc Periodontol. 2013 Mar-Apr; 17(2): 182-187 2. Dongari-Bagtzoglou A., Cutler C. Drug-Associated Gingival Enlargement. J Periodontol 2004;75: 1424-1431 3. Thompson A., Herman W., Konzelman J., Collins M. Treating Patients with Drug-Induced Gingival Overgrowth. Journal of Dental Hygiene, Vol. 78, No4, Fall 2004 4. Seymour RA, Ellis JS, Thomason JM. Risk factors for drug-induced gingival overgrowth. J Clin Periodontol 2000; 27:217-23.

5. Dongari A, Mcdonnell HT, Langlais RP. Drug-induced gingival overgrowth. Oral Surg med Oral Pathol. 1993; 76:543-8.

6. Camargo PM, Melnick PR, Pirih FQ, Lagos R, Takei HH. Treatment of drug-induced gingival enlargement: Aesthetic and functional considerations. Periodontol 2000. 2001; 27:131-8.

Dr. Fabiani is a general dentist in Sarasota and can be reached at dfabiani@hotmail. com.

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Military Dentist

Soldier Values for Citizen Dentists

By Dr. Jose Peralta

“

“Loyalty, Duty, Respect, Selfless Service, Honor, Integrity and Personal Courage.” It’s easy to read the Army Values and believe you could apply them to everyday life, but could you really apply these to your dental practice?

If you have a team who also has your values of mission and vision, and will give you 110 percent, you can hyper-focus on your dentistry and patient-relationship building.

”

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I currently practice at Premier Community HealthCare Group (PCHG), a non-profit federally qualified health center that sees uninsured and Medicaid patients. PCHG is located in Pasco County, which has about 200,000 people at or below 200 percent of the poverty line. I have practiced in all types of dentistry — private, group, corporate, hospital, Army — and this is the happiest and best setting I’ve been in. Many, if not all of our patients, have very few options of where to go to obtain quality care. We are a high-volume, large practice with multiple offices and looking to grow in 2017. As the dental director and associate chief medical officer at a company that handles such a high volume of patients, I truly believe that there is no better way to manage a large team than by applying the Army Values. Not only establishing them, but also having the team educated on living and breathing those values. It is crucial in the office environment that you establish your values (the Army values are a good place to start) and build a team to carry out your mission and vision.

Once you hire your staff and they are trained, do you instill values like these in the office environment? Do you have a true chain of command or are you a do-it-all micro-manager?

The Army functions with a chain of command of officers and enlisted soldiers. Officers are college graduates and enlisted typically do not have college degrees, but do have a lot of Army skills learned through Army schools and training. When in a command position, officers (i.e., dentists) always have a senior enlisted (i.e., office manager), who will carry out the orders at hand. Under the senior enlisted is the junior enlisted (i.e., lead assistant) who keep the wheels rolling in the (dental) office. Defining roles and responsibilities in a setting allows you to let your team grow in their position and let you focus on yours. I recognize that it may vary in a one-doctor and four-chair practice, and a multi-doctor, 10+ chair practice with a lot of support staff.

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Military Dentist

Army mass casualty/ triage exercise.

Nevertheless, a chain of command needs to be established, job descriptions need to be written and meetings need to be held. I do not consider meetings as down time. It’s where ideas are brought forward, pros and cons are weighed and orders (mission) are given. Then you have to wait for it … wait for it … GET OUT OF THE WAY! Although this method sounds “hands-off,” I make myself available to my team when they need guidance. My immediate team — Anabel, Zenaida, Cesar, Nicole and Susan — has 24/7 direct line to me and access to my personal and work schedules. These meetings are not always warm and fuzzy. People are held accountable, including me (yes, I’ve been called out at times).

At first glance, the similarities amongst the two line of businesses may not be apparent, but structurally they can be managed the same. In fact, dentistry actually is easier to practice on soldiers because: 1) There is no money being exchanged; 2) Almost always, they are healthy and access to medical records are just a click away; and, 3) Soldier patients are extremely eager to get their work done because it can hold them back on promotions or deployments.

Most practices — outside of the military — have enormous challenges trying to dance around these three issues, but by using values and chains in command, you can overcome them.

If you have a team who also has your values of mission and vision, and will give you 110 percent, you can hyper-focus on your dentistry and patient-relationship building. This is a benefit not only to the office work ethic, but also results in increased revenue, production, office morale and less malpractice errors. One day during a deployment, we were inundated with dental emergencies and most of them were soldiers showing all the signs and symptoms of bruxing (which you can imagine with the stress they endure). I went over to one of the assistants and said, “I need to deliver these nightgaurds (with a crappy suckdown

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machine and no heat trimming knife) by COB (close of business).” He looked at me and in a position of attention said, “Too easy, sir. It will be done.” He spoke with this passion and sense of security that I had no option but to step back, get out of his way, let him work and worry about other tasks at hand. Can you say that about your team?

Soldiers are a different breed of men and women. They have a get-it-done, do-whatI-am-told-and-do-it-right mentality. Why? Because they trust their superiors and believe in the mission — can your staff say that about you?

Apart from soldier performance and brotherhood, the Army also values family very highly. They have a department that is in charge of calling your loved ones when you are deployed and hold yellow ribbon events, which are strongly suggested to attend, pre- and post-deployments. These events are meant to increase morale and bring the family closer. I used this idea and hold two events a year with our dental team and their families. We get together in a social environment, and I typically leave the activity and venue up to a team vote. In May of 2016 we had a barbecue at a beachfront park, followed in November by an afternoon of bowling and walking around at Disney Springs.

Does my team believe in my Army Values of “Loyalty, Duty, Respect, Selfless Service, Honor, Integrity and Personal Courage”?

You can bet they do! Does your team believe in yours?

Dr. Peralta is the associate chief medical/ dental director at Premier Community HealthCare Group Inc. He can be reached at JPeralta@HCNetwork.org.

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Compleat Dentistry

You Are Such a Perfectionist, Part 2

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

“

By Dr. Edward Hopwood

Early in our careers, we tend to work hard on the little details of

Edwin Land of Polaroid talked about the intersection of the humanities and science. I like that intersection.

There’s something magical about that place.

– Steve Jobs

our profession in the vain quest that we may achieve perfection.

But, as we get better and better at the little details, we then come to realize that there are many more details that go into doing our jobs well. And then we come to recognize that we are not pursuing perfection. What we are actually pursuing is mastery.

Mastery is different than perfection. Daniel Pink describes mastery as an asymptote. Now, those of you who are like me and can’t remember high school algebra (or don’t have a middle schooler who is taking algebra) may like to look at the picture below:

”

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Compleat Dentistry

So, you see a solid line which curves, and gets closer to the dotted

In Japan, they recognize that we can never reach the dotted line.

line, but never quite touches the dotted line. And if we are pursuing

There is an entire aesthetic dedicated to enjoying the imperfection, a

mastery, then we are on the solid line; as we get better and better, we

concept called wabi sabi. Wabi sabi is a celebration of the imperfec-

get closer and closer to the dotted line.

tion or the inability to touch the dotted line. It often can be observed in nature as things fade or erode away. A worn-down bench that has

This description of mastery is comforting. We all are somewhere on

provided a resting place for many years and has developed a patina

the solid line, and it doesn’t matter where we are compared to oth-

is a great example of wabi sabi. A Pottery Barn attempt to duplicate

ers. No matter where we are on the line, we can always improve and

that patina clearly is not.

get better — closer to the dotted line. Once we recognize that it is impossible to reach the dotted line, then we can be comfortable with

Wabi sabi often is related to the tea ceremony that is highly ritu-

our imperfections. Finally, if we recognize that we are on this curve

alized, regimented and consistent — but never perfect. There are

that will never touch the line, we can plot a course for continual

tea masters who have dedicated their lives to the tea ceremony and

growth and improvement to get closer and closer to the line.

never achieved perfection. I really enjoy the irony in the fact that the same culture that taught the world methods of consistency in manufacturing also recognizes that they cannot brew a perfect cup of tea.

WHAT’S YOUR STATUS?

So, then, what is the dotted line? Well, the dotted line is perfection.

And the further we move out to the right-hand side of the curve, the closer we are to perfection. Even though we can’t touch it, we can get closer. For some people, the closer they get, the more they want to push themselves to learn more, get better and see glimpses of the perfection. The glimpses of perfection become addictive and they

AS LIFE EVENTS OCCUR, don’t forget to notify the FDA of any changes to your contact information.

keep moving further and further out along that curve, pursuing

READY TO RETIRE or have questions about your membership status?Contact the FDA Member Relations department to learn about retired membership or eligibility for other membership incentives.

In dentistry, perfection is so much more than closed margins

CALL OR EMAIL the FDA at 800.877.9922 or fda @floridadental.org

article. Steve Jobs was quite correct in saying that there is something

* Florida licensed dentists must notify the Florida BOD with any new information. Go to floridasdentistry.gov or call 850.488.0595

mastery all the way.

or painless injections or perfect impressions or centric relation or financial stability or fancy offices. It is more than science and mechanics; it includes art and the humanities. It involves that intersection that Edwin Land spoke about at the beginning of this magical about that place. Some of us call it divine.

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

www.floridadental.org

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Mission Trip

“

By Paula Cohen

You have not lived today until you have done something for someone who can never repay you. ~John Bunyan

”

Left to right: Paula Cohen and Dr. Robert Payne.

Dr. Robert Payne was a huge asset this year, especially since we didn’t have an oral surgeon. We met at the 2016 Florida Mission of Mercy where he helped students from Nova, LECOM and UF treat patients. Knowing we were short one faculty member, I approached him about coming with us in a few months and he immediately said yes! His years of surgical experience in the mission field and his amazing ability to teach was so evident — we were blessed to have him in Guatemala this year.

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In August, I went on my third dental mission trip through the University of Florida College of Dentistry’s (UFCD) chapter of the Christian Dental Society (CDS) to Palin, Guatemala.

I never would have imagined how much this trip would change my life, but looking back I am so grateful I was selected as a freshman to be a CDS trip leader! Here are some photos capturing this year’s trip and the wonderful people who served.

yrnes s rew B Dr. D ne twice a e o has g ental, thre ental d -d e D r C p F a as a U wice as an s e tim dt mem nt an stude g faculty h the in it d atten is great w and e ts ber. H ics patien be tr o pedia y willing t em th all t t e o t g is all to b f o o ag in! g aga smilin

ns of eratio from n e g ( Three aders trip le rielle Platt , S D C ) ): Gab h (’18 L to R lsey Ebac r e K (’19), l and Taylo e (’17). ae Mich (’18) and m cted r ele Vraca ders are s d a an Trip le first year o to ir w e t h t n in go o e they y ll a r typic rips befo ew t the n three te so that ors. t a gradu have men rs leade

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Mission Trip ok CD D3s to day p Some UF tu se r u o ng f oral time duri o s d re hund to make s. We g a b goodie hygiene ing care d vi ro p p ended u tients! st 800 pa for almo d e d lu c t in Treatmen h fluoride it w s ie proph tions, n, extrac applicatio e fluoride in m silver dia ve and n, operati applicatio ls. rtia acrylic pa

cerFort is a Mr. Ken nician h c te b tified la r membe and staff e took a H .

D C at UF to teach week off how to students , quality d o o g make r artials fo p c li ry c a lin. a P f o ple the peo artials p e n o Twenty ede and d were ma s! y a d r fou livered in

familiar ee some s e w e r a Every ye are regulars at th up. t o e s h e w s w face here hurch w volunVerbos C n is one of the had ma and I’ve This wo church ow e n th k t a to teers etting ege of g s. Her the privil e last three trip th I wish her over incredible, but is better r ry e life sto met und to take e v a h we could ces since I had tan rs ago circums two yea . 23-26 l infeca ic p out Nos a ri er evere pe n gave h due to s year, Ke l is fu th ti t u u a B e tion. ith a b r smile w artial! p back he c de acryli handma

Dr. Cara H on this tr ill went ip as a UFCD s tud has retu ent and rned as an attendin g facult y membe r for thre e years. Y ou know th may not is, but s he also spe ak ish, so s s Spanhe was kind enough to triage an help with d screen ing for our patients !

Dr. Brio nL orthodo ong is an nti faculty m st and adjunct e UFCD. In mber at Guatem ala, he put dow n and wire the brackets s, and h elped students d our two o fillings using portable u Last yea r, we als nits. o starte using sil d ve fluoride r diamine on pedia tric patients w childho ith early od carie s and followe du of them p with a few th very pro is year with mising re sults!

FDA Fou nd Presiden ation Vice t Dr. Ro bert Payne p lay his famo ed one of us bible trivia games w it group! H h this year’s e candy fo even brought r the win n team! H is love a ing nd passion for serv ing both here an da radiated broad just from him all learn . ed more We about the FDA Fo what it m undation and eans to b servant leader fr e a om his shining example .

Thank you to our family, friends and mentors who continue to make this trip possible! I’ve had many incredible experiences as a dental student, but few compare to the joy I’ve received from serving with classmates and mentors to give back to the people of Palin.

Whether it’s locally with the FDA Foundation or abroad on a trip, I know all of us have the passion to help those in need, and we’re grateful for a profession and an association that makes that possible!

Ms. Cohen is a D4 at the University of Florida College of Dentistry and can be reached at PCohen@dental.ufl.edu. www.floridadental.org

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Creating and implementing strategy for the good of patients and dentists in Florida is a very important role for the volunteer leader. I help leaders succeed by making sure that meeting logistics and materials are handled for the Board of Trustees, House of Delegates, and Florida Delegation to the ADA. With the behind-the-scenes work done, FDA’s leadership can simply focus on the goals of organized dentistry.

— Judy Stone, BME, MS Leadership Affairs Manager Have a question about leadership?

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Contact us at membership@floridadental.org or 800.877.9922.

Book Reviews

Book Reviews scribe the treatment procedure sequences, and at times with mid-treatment photographs.

Chapter 1 is titled “Combining Orthodontic and Restorative Therapy in Complex Cases.”

This first chapter involved treatment and diagnosis contributions by four dentists and a dental laboratory technician. Treatment spanned more than three years, during which time the lead author discussed the need to assess the progress. Orthodontic and implant therapy are described and photographed in preparation of the restorative phases.

Interdisciplinary Treatment Planning: Comprehensive Case Studies, Vol. II Edited by Michael Cohen, DDS, MSD Published by Quintessence Reviewed by Dr. Harvey Barbag

Throughout this text, the authors thoroughly discussed the data gathered and provided a multi-specialist diagnosis of the subjective and objective points of data, and the options for treatment to achieve an optimal result. Each author presents the patients’ complaints and goals, the results of the examinations, including photographs and radiographs, and consultation opinions of specialists where deemed appropriate.

Each chapter is a case study of one or more patients with unique functional, anatomic and aesthetic variations. Before-and-after treatment records are presented to allow the reader to follow to the end of treatment how the decisions and treatment provided reached the desired goals. The authors de-

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Chapter 2 presents two cases where the first patient presented with periodontal and aesthetic issues, which resulted in fullmouth reconstruction. The second patient presented with severe erosion and attrition, which resulted in vertical collapse.

Chapter 3 addresses a case where maxillary teeth are structurally weak and orthodontic extrusive treatment is applied to create bone and soft tissue in preparation for implant reconstruction.

Chapter 6 presents the procedure of autotransplantation of a mandibular second premolar into the site of an immediately extracted maxillary central incisor for a 10-year-old patient.

Chapter 7 applies orthodontic treatment to minimize prosthetic reconstruction for a worn dentition.

Chapter 8 describes a biometric evaluation (Drs. Chu and Tarnow) of maxillary anterior teeth where implant and periodontal treatment is necessary to restore a missing central incisor and abnormal gingival heights.

Chapter 9 demonstrates endodontic retreatment success to save compromised anterior teeth.

Chapter 10 addresses a case in which the patient presented with moderate to advanced periodontitis, peri-implantitis and a failing fixed maxillary splint.

Chapter 11 treats a patient with a gummy smile, excessive anterior display and disproportionate tooth size.

Chapter 4 focuses on aesthetic considerations of papillae positioning in the anterior segment when restoration with adjacent implants is planned. Three cases are compared in regard to timing of implant placement: immediate, early (eight weeks’ post-extraction) and sequenced.

Chapter 12 concerns a patient with amelogenisis imperfecta in a 13-year-old. Six specialists were involved in this interdisciplinary treatment that spanned more than 10 years.

Chapter 5 treats three patients with an anterior dilemma with pink and white porcelain. Digital smile design is discussed.

Chapter 13 presents a patient treated with implant-supported upper and lower fixed-removable full arch appliances.

Pre-surgical planning and prosthetic interim procedures are discussed. www.floridadental.org

Book Reviews

Chapter 14 is a case in which a patient had experienced two previous reconstruction failures and accepted an implant-engineered solution.

a conservative approach to the highest of standards.

Chapter 15 is a surgically driven case where previously placed implants resulted in an aesthetic problem. Surgical and prosthetic treatment resulted in a major improvement.

Chapter 16 treats teeth Nos. 9 and 10 with a combination of tissue grafting, root contouring and implant placement. The effect of root position on gingival crest position and changes possible are well-documented photographically.

Inspiration: People, Teeth and Restorations

By Luiz Narciso Baratieri Published by Quintessence

Chapter 17 presents a Class III orthognathic case.

Chapter 18 presents a patient with attrition-related cosmetic compromise.

Treatment planning was adapted as the case proceeded.

Chapter 19 addresses a deep bite situation and involved orthodontic and implant treatment.

In conclusion, this book makes a case for thorough diagnosis and the importance of multiple-specialty involvement.

The reviewer claims no financial interest with the publication.

Dr. Barbag has a reconstructive and cosmetic dentistry practice in Boca Raton.

www.floridadental.org

Reviewed by Dr. Debora G. De Farias

In 1946 in Italy, Pope Pius XII gave a speech directed at dentists, and in my opinion, gave the best definition of dentistry: “Dentistry is a profession that demands from those who dedicate themselves to it, the aesthetic eye of an artist, the manual dexterity of a surgeon, the scientific knowledge of a doctor and the patience of a monk.” Almost 70 years later, Luiz Narciso Baratieri has proven that Pope Pius XII was absolutely right in his affirmation with his book, “Inspiration: People, Teeth and Restorations.”

This book is not only a beautiful book, it goes beyond natural beauty, science and skills, integrating all those components to restore teeth, restore smiles — and I would say to change lives. Patients’ lives are improved because they can have a confident, healthy, natural, beautiful and functional smile. In addition, health professionals’ lives also are improved because the book inspires all of us (and it gives us a step-bystep guide) on how to restore dentition in

In the words of Professor Richard Simonsen, who wrote the Foreword, “Every student needs this book to understand the underlying makeup of the layered structures of the teeth. Every dentist needs this book as an educational tool, or just as an incredible book, for patients to view in the reception area. Every educator needs this book to study the techniques that Professor Baratieri uses in his artistic and unusual revelation of the natural beauty of tooth structure and form. Everyone in the dental professional will find something to enjoy and learn from this book. It is a work of art, indeed.”

The book is structured in three parts that are truly comprehensive and interconnected to the human being as a whole.

The first part addresses optical behaviors of teeth and dental materials, in addition to how light reacts and interacts with different oral structures. It is a review of dental anatomy and dental histology directly applied to clinical restorative dentistry.

The second part is a brief guide on computer-aided design and computer-assisted manufacture (CAD/CAM) technology, and a review of dental materials that are available today to manufacture indirect dental restorations.

The third part is a gradual presentation of clinical cases, from the most conservative dental treatment options to full-arch reconstructions. It includes tooth whitenPlease see REVIEWS, 86

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Book Reviews

One of the greatest challenges we face as restorative clinicians, both prosthodontists and general dentists, is in managing the soft tissue or “pink” frame. I was pleased with the inclusion of procedures that are performed by the oral surgeon, periodontist and the orthodontist, and their impact on the final successes or failures of our restorations. By using a team approach, we all win — especially the patient.

BOOKS from 85

ing, anterior and posterior bonded resin composite restorations, laminate porcelain veneers and all-ceramic crowns. The book concludes with oral rehabilitations with fixed partial dentures, dental implants and more complex clinical situations.

The beauty of this book is that it provides the readers with a comprehensive presentation of dazzling photographs, proper diagnosis of tooth conditions and sequence of treatment plans for restorative dentistry.

The literature is a practical update, and it is useful in a daily routine of a clinical dental office. It emphasizes layered structures of teeth and restorative techniques of how to meet the challenge of mimicking natural dentition by blending art and dental science.

In conclusion of this brief review, I will reiterate the words of the author: “Nothing that cannot be comprehended can be reproduced.” As a general and restorative dentist, I am honored and thankful for the opportunity to comprehend more about different approaches to restore natural dentition, and for the opportunity to learn from such a valuable book. It is my hope that this review will serve as an encouragement to other dentists and dental professionals — regardless of their dental specialties — to have this book at hand and be inspired once again to do their best work in dentistry.

The reviewer claims no financial interest with the publication.

Dr. De Farias is a general dentist in Ponte Vedra Beach.

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Soft Tissue Management: The Restorative Perspective — Putting Concepts into Practice

By Dr. Ariel J. Raigrodski Published by Quintessence Reviewed by Dr. David Clary

“Soft Tissue Management: The Restorative Perspective — Putting Concepts into Practice” is an excellent publication from Quintessence books. This book is written by Dr. Ariel J. Raigrodski and nine other clinicians from the University of Washington School of Dentistry. Their backgrounds are not only prosthodontics and restorative dentistry, but also oral surgery, periodontics and orthodontics. This 209-page book has 779 illustrations and the quality of the images is outstanding. A plethora of current references are given at the end of each chapter. For example, Chapter One has 248 of them!

For example, implant dentistry is a prosthodontic discipline that has a surgical component. Implant placement must be restoratively driven. Surgical placement either makes the final implant restoration a success or a failure. Patients do not want implants, they want restorations that allow proper aesthetics, phonetics, comfort, function and longevity. I was extremely pleased that the “PDP method” to increase the soft tissue thickness by Fu et al. was discussed.

The implant POSITION (more palatal and apical), implant DIAMETER (smaller or platform switched) and the PROSTHETIC design (concave subgingival contours) all effect the final restoration. Only the final “P” that promotes soft management is under the control of the restoring clinician.

“That is where the bone is” is not acceptable in determining implant position.

The layout of this publication is incredibly reader-friendly. The eight chapters are extremely detailed and include an excellent review of the fundamental concepts of periodontal tissues in Chapter One. The following chapters present preparation

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Book Reviews

design, provisional restorations, impression making/dental laboratory procedures, cement/screw retained implant restorations and delivery procedures. The summaries at the end of each chapter highlight the most important concepts. All of these procedures impact the final result. Due to the detailed nature of the information presented, concentration is needed to fully comprehend the concepts. This is not a book to be read while watching the Gators or Seminoles on a Saturday afternoon, but requires concentration and attention to gain the most knowledge.

I found the information practical and useful. This compelling clinical monograph outlines how to manage the soft tissue in a practical manner, whether providing patients with tooth-borne or implant-supported restorations. The author provides well-illustrated, step-by-step instructions for each stage of therapy so that restorative dentists can understand how to manage the soft tissue frame, minimize trauma, and ensure a healthy and aesthetic treatment outcome.

Multiple cases are followed throughout the book, with individual chapters focusing on those portions of the case that illustrate the concepts elucidated in the chapter. Credit is given to the clinicians and technicians that contributed to the excellent and successful restorative outcomes.

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I was disappointed that Dr. Wadhwani (also on the University of Washington School of Dentistry faculty) was not given any mention, as he is one of the most respected clinicians/researchers regarding residual excess cement (REC), a common complication of cement-retained prostheses. REC has been linked to peri-implant disease.

I believe that with new abutment designs that cement-retained implant restorations will become much less prevalent and REC will be a thing of the past. For those that are interested, I would refer you to Wadhwani, C. et al., J Prosthet Dent. 2012 Mar; 107(3):151-7.

Although many of the concepts and information is important to all team members, it may be it too great of depth and detail for most team members who are not dentists.

By carefully selecting and extracting information, our dental assistants and hygienists can gain knowledge that will be extremely beneficial to our patients. There is a onepage section on oral hygiene that addresses maintenance issues, again with many good references. I personally will share this with my hygienists.

and technological innovations and developments. I believe that there will be future revisions as our knowledge improves. To “stay on top of our game,” we all have to be continuous students.

The goal of this publication is to “provide a better understanding of the soft tissue-restorative interface and its influence on the final restorative result.” Without a doubt, this goal was reached and even exceeded.

I wholeheartedly would recommend this publication to all of the Florida Dental Association’s members who are seeking to exceed our patients’ expectations with restorations that minimize trauma and insure a healthy and aesthetic treatment outcome.

And we also must share this information with our lab technicians, our often underappreciated colleagues who allow us to deliver both aesthetic and functional restorations.

The reviewer claims no financial interest with the publication.

Dr. Clary is a prosthodontist in Naples.

Without a doubt, this is a timely publication that will stand the test of time. Dentistry, and specifically implant dentistry, will continue to evolve due to future material

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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 Director of Communications Jill Runyan by email at jrunyan@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.

2016 QDT, Quintessence of Dental Technology, Vol. 39 Edited by: Sillas Duarte, DDS, MS, Ph.D. 224 pages Published in 2016 by Quintessence Publishing Price: $132 3-D Imaging in Dentistry: From Multiplanar Cephalometry to Guided Navigation in Implantology By: Giovanna Perrotti, Tiziano Testori and Massimiliano Politi 560 pages Published in 2016 by Quintessence Publishing Price: $210 At the Forefront: Illustrated Topics in Dental Research and Clinical Practice By: Hiromasa Yoshie, DDS, Ph.D. 108 pages Published in 2012 by Quintessence Publishing Price: $98

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Ceramics in Dentistry: Principles and Practice By: J. Robert Kelly, DDS, MS, DMedSc 128 pages Published in 2016 by Quintessence Publishing Price: $39 Clinical Photography in Dentistry: A New Perspective By: Peter Sheridan 232 pages Published 2016 by Quintessence Publishing Price: $106 Color Atlas of Fixed Prosthodontics: Vol. 1 By: Yoshiyuki Hagiwara 196 pages Published in 2013 by Quintessence Publishing Price: $120 Development of the Human Dentition By: Franz P.G.M. van der Linden, DDS, Ph.D. 240 pages Published in 2016 by Quintessence Publishing Price: $99 Endodontics Review: A Study Guide By: Brooke Blicher, Rebekah Lucier Pryles and Jarshen Lin 264 pages Published in 2016 by Quintessence Publishing Price: $68 Foundations of Dental Technology: Anatomy and Physiology By: Arnold Hohmann and Werner Hielscher 300 pages Published in 2014 by Quintessence Publishing Price: $98

Fundamentals of Implant Dentistry, Vol. II: Surgical Principles By: Peter K. Moy, Alessandro Pozzi and John Beumer III 448 pages Published in 2016 by Quintessence Publishing Price: $168 Oral Implantology Review: A Study Guide By: Louie Al-Faraje, DDS 232 pages Published in 2016 by Quintessence Publishing Price: $108 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 and Headache, Second Edition By: Yair Sharav, DMD, MS and Rafael Benoliel, BDS 664 pages Published in 2015 by Quintessence Publishing Price: $168

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Books on the Shelf

Orofacial Pain: Guidelines for Assessment, Diagnosis, and Management By: Reny de Leeuw, DDS, Ph.D., MPH and Gary D. Klasser, DMD 312 pages Published in 2013 by Quintessence Publishing Price: $48 Periodontal Review: A Study Guide By: Deborah A. Termeie, DDS 296 pages Published 2013 by Quintessence Publishing Price: $68 Principles of Design and Fabrication in Prosthodontics By: Arnold Hohmann and Werner Hielscher 408 pages Published 2016 by Quintessence Publishing Price: $128 Promoting the Oral Health of Children: Theory and Practice, Second Edition By: Aubrey Sheiham, Samuel Jorge Moyses, Richard G. Watt, Marcelo Bonecker 450 pages Published 2014 by Quintessence Publishing Price: $110 Reintervention in Endodontics By: Mario Luis Zuolo, Daniel Kherlakian, Jose Eduardo de Mello Jr., Maria Cristina Coelho de Carvalho and Maria Ines Ranazzi Cabral Fagundes 332 pages Published 2014 by Quintessence Publishing Price: $180 Smile! Your Guide to Esthetic Dental Treatment By: Douglas A. Terry, DDS 54 pages Published 2014 by Quintessence Publishing Price: $29.50

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Success Strategies for the Aesthetic Dental Practice By: Linda Greenwall and Cathy Jameson 312 pages Published 2012 by Quintessence Publishing Price: $98

The Oral-Systemic Health Connection: A Guide to Patient Care By: Michael Glick, DMD 312 pages Published in 2014 by Quintessence Publishing Price: $118

Successful Local Anesthesia for Restorative Dentistry and Endodontics, Second Edition By: Al Reader, John Nusstein and Melissa Drum 240 pages Published 2016 by Quintessence Publishing Price: $88

Treatment Planning for Traumatized Teeth, Second Edition By: Mitsuhiro Tsukiboshi, DDS, Ph.D. 240 Pages Published in 2012 by Quintessence Publishing Price: $82

Summitt’s Fundamentals of Operative Dentistry: A Contemporary Approach, Fourth Edition By: Thomas J. Hilton, DMD, MS; Jack L. Ferracane, Ph.D.; and James C. Broome, DDS, MS 612 pages Published in 2013 by Quintessence Publishing Price: $128 Surgical Design for Dental Reconstruction with Implants: A New Paradigm By: Martin Chin 256 pages Published in 2015 by Quintessence Publishing Price: $172 The Biomechanical Foundation of Clinical Orthodontics By: Charles J. Burstone, DDS, MS and Kwangchul Choy, DDS, MS, Ph.D. 608 pages Published in 2015 by Quintessence Publishing Price: $180

What’s in Your Mouth? What’s in Your Child’s Mouth?

By: Douglas A. Terry, DDS 66 pages Published in 2013 by Quintessence Publishing Price: $29.50 What’s in Your Mouth? Your Guide to a Lifelong Smile By: Douglas A. Terry, DDS 48 pages Published in 2014 by Quintessence Publishing Price: $29.50 Zygomatic Implants: The Anatomy Guided Approach Edited by: Carlos Aparicio 280 pages Published in 2012 by Quintessence Publishing Price: $168

The Ceramic Works: Dental Laboratory Clinical Atlas By: Hitoshi Aoshima 104 pages Published in 2016 by Quintessence Publishing Price: $82

January/February 2017

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

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

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

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Oral and Maxillofacial Surgeon Opportunity: Broward + Palm Beach County Come lead our specialty team as a full time Oral & Maxillofacial Surgeon in Broward/Palm Beach! Great Expressions Dental Centers has a current, select opening for a full-time (5 days/week) Oral & Maxillofacial Surgeon! Aggressive compensation package (avg. $100k/month in production), full/dedicated staff, consistent office schedule with a strong referral network of local offices. Compensation: Six-Figure Draw vs. Percent of Production. Benefits/Perks: Leaders in the practice: Clinical Freedom and Treatment Autonomy for Every Doctor; Patient Focus: Established and Growing Patient Foundation; Multi-Specialty Office Setting; Doctor Career Path – Partnership/Investment Opportunities; Full Benefits Offered – Health care & Dental Benefits, 401K, Short Term/Long Term Disability, Time Off; Malpractice Coverage Assistance; Continued Education Reimbursement, Paid ADA & State Society Dues; Mentorship – Study Clubs, Chairside Mentoring, GEDC University Courses. Please view our Doctor Career Path video: http://www. screencast.com/t/M3xWM5CYN. Apply via this ad to learn more about Great Expressions! For More Information, Please Contact: Ross Shoemaker, MBA | Doctor Recruiting Manager | Great Expressions Dental Centers 770 Holcomb Bridge Road, Roswell, GA 30076 USA phone 678-836-2226 | ext 72226 | fax 770-242-3251 |web www.greatexpressions. com email Ross.Shoemaker@greatexpressions.com.

“Look for the Smile Above Our Name!” Apply Here http://www.Click2apply.net/rfz9zwv5cd.

General Dentist-Tallahassee, FL. A Tallahassee, Florida dental practice seeking a motivated, FT associate dentist to join this well established, family practice that offers services in general dentistry, oral surgery, pediatrics, endodontics, & periodontics.

Fully computerized with digital radiography, Dentrix management software, intraoral cameras & more. The practice boasts a predominately fee-forservice/PPO patient base, turnkey facility, quality staff, & low overhead with consistent annual revenue of more than 2.5 million. Conveniently located in NE Tallahassee in a new state-of-the-art 6,800 square-foot office building, featuring 16 operatories with a lab. Partnership/Investment opportunities

www.floridadental.org

with earning potential of $250-$500K. Please send a copy of your current CV to chipchaney53@gmail. com or call 850.933.1002. Tallahassee was recently ranked the All American City in the US. Dentist Opening — North Tampa, FL. Great Expressions Dental Centers has an immediate opening for a full-time General Dentist to join our North Tampa practice. Enjoy a rewarding career with a full office staff (including Hygienist), a strong schedule and the ability to focus on quality patient care. Enjoy a rewarding role with a dedicated and experienced staff! Compensation: Competitive Six Figure Annual Draw vs. Percent of Production.

Please apply via this ad for consideration, Stacey Bruwer, M.A. | Clinical Recruiter | Great Expressions Dental Centers 29777 Telegraph Road, Suite 3000 | Southfield, MI 48034 phone 248-2376853 |Ext. 72468| fax 248-686-0118 | web www. greatexpressions.com. “Look for the Smile Above Our Name!” Apply Here: http://www.Click2apply. net/ydty82t23g.

General Dentist — Jacksonville, FL Great Expressions Dental Centers has select part-time and full-time General Dentist opportunities (2-5 days/week) to work in our established and updated practices located in Jacksonville, FL. Enjoy a rewarding long term career path with a dedicated (trained) staff with an established patient base!

Compensation: Competitive Six Figure Draw with Percent of Production; Sign-on Bonus or Relocation Assistance possible as well! Benefits/Perks: • Leader in the practice: Clinical Freedom and Treatment Autonomy; Patient Focus: Established and Growing Patient Foundation; Digital Office; Doctor Career Path – Partnership/Investment Opportunities; Full Benefits Offered – Health care & Dental Benefits, 401K, Short Term/Long Term Disability, Time Off; Malpractice Coverage Assistance; Continued Education Reimbursement, Paid ADA & State Society Dues; Mentorship – Study Clubs, Chairside Mentoring, GEDC University Courses. Please view our Doctor Career Path video: http://www. screencast.com/t/M3xWM5CYN. Please apply via this ad for consideration, Molly McVay | Sr. Clinical Recruiter | Great Expressions Dental Centers PSC-North | 29777 Telegraph Road. Suite 3000| Southfield, MI 48034 USA phone 248-4305555 |Ext. 72467| fax 248-686-0170 | web www. greatexpressions.com. “Look for the Smile Above Our Name!” Job Requirements: Must have a DDS/ DMD from an accredited University and active State Dental Board license. Apply Here: http://www.

Click2apply.net/cfnrq928zh.

Endodontist Opportunity (Part Time) — Treasure Coast + WPB, FL Come join our South Florida specialty team as a part-time (8 days/month) Endodontist in the Treasure Coast and West Palm Beach, FL! Benefits/Perks: Leaders in the practice: Clinical Freedom and Treatment Autonomy for Every Doctor; Patient Focus: Established and Growing Patient Foundation; Multi-Specialty Office Setting(s). Please view our Doctor Career Path video: http://www.screencast.com/t/M3xWM5CYN. Apply via this ad to learn more about Great Expressions! For More Information, Please Contact: Ross Shoemaker, MBA | Doctor Recruiting Manager

www.floridadental.org

| Great Expressions Dental Centers 770 Holcomb Bridge Road, Roswell, GA 30076 USA phone 678836-2226 | ext 72226 | fax 770-242-3251 |web www. greatexpressions.com email Ross.Shoemaker@ greatexpressions.com. “Look for the Smile Above Our Name!” Apply Here: http://www.Click2apply. net/gq8d8f83yc.

Dentist (Full-Time) Opening — Tampa, FL. Great Expressions Dental Centers has an immediate opening for a full-time General Dentist to join our Tampa practice. Enjoy a rewarding career with a full office staff (including Hygienist), a strong schedule and the ability to focus on quality patient care. Enjoy a rewarding role with a dedicated and experienced staff! Compensation: Competitive Six Figure Annual Draw vs. Percent of Production.

Please view our Doctor Career Path video: http:// www.screencast.com/t/M3xWM5CYN. Please apply via this ad for consideration, Stacey Bruwer, M.A. | Clinical Recruiter | Great Expressions Dental Centers 29777 Telegraph Road, Suite 3000 | Southfield, MI 48034 phone 248-2376853 |Ext. 72468| fax 248-686-0118 | web www. greatexpressions.com. “Look for the Smile Above Our Name!” Apply Here: http://www.Click2apply. net/z3k7b684vk.

Dentist Opportunity (Full-time) — Pembroke Pines, FL Dentist Opportunity (Full-time) — Pembroke Pines, FL Come be a clinical leader for our Pembroke Pines, FL dental team! Great Expressions Dental Centers has an immediate, select opening for a full-time (5 days/week) General Dentist to join our established, high production, digital, multi-specialty practice in the heart of Pembroke Pines, FL: 140 S. University Drive Pembroke Pines, Florida 33025. Compensation: Six Figure Draw vs. Percent of Production. Benefits/Perks: Leaders in the practice: Clinical Freedom and Treatment Autonomy for Every Doctor; Patient Focus: Established and Growing Patient Foundation; Multi-Specialty Practice Setting with 20 chairs; Doctor Career Path – Partnership/Investment Opportunities; Full Benefits Offered – Health care & Dental Benefits, 401K, Short Term/Long Term Disability, Time Off; Malpractice Coverage Assistance; Continued Education Reimbursement, Paid ADA & State Society Dues; Mentorship – Study Clubs, Chairside Mentoring, GEDC University Courses. Please view our Doctor Career Path video: http://www.screencast.com/t/M3xWM5CYN. Apply via this ad to learn more about Great Expressions!

For More Information, Please Contact: Ross Shoemaker, MBA | Doctor Recruiting Manager | Great Expressions Dental Centers 770 Holcomb Bridge Road Roswell, GA 30076 USA phone 678836-2226 | ext 72226 | fax 770-242-3251 |web www. greatexpressions.com. “Look for the Smile Above Our Name!” Must have a DDS/DMD from an accredited University and active State Dental Board license. Apply Here: http://www.Click2apply.net/ yf3f6pzh66.

Full Time Dentist Opportunity: Jensen + Port St. Lucie, FL. Great Expressions Dental Centers has an immediate, select opening for a full-time (5 days/split offices) General Dentist to join both our established, high production, Jensen and Port St.

Lucie practice(s)! Enjoy a rewarding career with a full office staff (including HYG), a strong schedule and the ability to focus on quality patient care.

Compensation: Six-Figure Draw vs. Percent of Production. Benefits/Perks: Leaders in the Practice: Clinical Freedom and Treatment Autonomy for Every Doctor; Patient Focus: Established and Growing Patient Foundation; Multi-Specialty office(s); Doctor Career Path – Partnership/ Investment Opportunities; Full Benefits Offered – Health care & Dental Benefits, 401K, Short Term/ Long Term Disability, Time Off; Malpractice Coverage Assistance; Continued Education Reimbursement, Paid ADA & State Society Dues; Mentorship – Study Clubs, Chairside Mentoring, GEDC University Courses. Please view our Doctor Career Path video: http://www.screencast.com/t/ M3xWM5CYN. Apply via this ad to learn more about Great Expressions! For More Information, Please Contact: Ross Shoemaker, MBA | Doctor Recruiting Manager | Great Expressions Dental Centers 770 Holcomb Bridge Roswell, Norcross, GA 30076 USA phone 678-836-2226 | ext 72226 | fax 770-242-3251 |web www.greatexpressions. com email Ross.Shoemaker@greatexpressions.com.

“Look for the Smile Above Our Name!” Apply Here: http://www.Click2apply.net/62xfdv9g8f.

Dentist (Full-Time) Opportunity — The Villages, FL Great Expressions Dental Centers has an immediate opening for a full-time Associate Dentist to join our solo, practice in The Villages, FL! The office is located at 11962 County Rd 101, Ste 304 and is golf cart accessible! Benefits/Perks: Leader in the practice: Clinical Freedom and Treatment Autonomy; Patient Focus: Established and Growing Patient Foundation; Malpractice Coverage Assistance. *Please view our Doctor Career Path video: http://www.screencast.com/t/M3xWM5CYN Stacey Bruwer, M.A. | Clinical Recruiter | Great Expressions Dental Centers 29777 Telegraph Road, Suite 3000 | Southfield, MI 48034 phone 248-2376853 |Ext. 72468| fax 248-686-0118 | web www. greatexpressions.com. “Look for the Smile Above Our Name!” Apply Here: http://www.Click2apply. net/tksps37z62.

General Dentist Wanted Southeast Florida practice looking for full time general dentist. Long term commitment in very busy private practice. Would like dentist who will do General Dentistry/ Restorative/Cosmetic/Implants/Extractions/Some Endo. Excellent working conditions. Please send resume to RRRdentist@aol.com.

Pediatric Dentist Opportunity: St. Augustine, FL Great Expressions Dental Centers has select Pediatric Dentist opportunities (2-5 days/wk) in our highly productive dental practices located in: Jacksonville and St. Augustine, FL. We are looking for a motivated and qualified pediatric specialist to join and lead our 20 plus practices spread across the Jacksonville, FL area! Please apply via this ad for consideration, Molly McVay | Sr. Clinical Recruiter | Great Expressions Dental Centers PSC-North | 29777 Telegraph Road. Suite 3000| Southfield, MI 48034 USA phone 248-430-5555 |Ext. 72467|

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Your Classified Ad Reaches 7,000 Readers!

CLASSIFIEDS from 91 fax 248-686-0170 | web www.greatexpressions. com. Job Requirements: Must have a DDS/DMD from an accredited University and active State Dental Board License, Pediatric Dental License and certifications. Apply Here: http://www.Click2apply. net/5hzt77ghnr.

Endodontist Opportunity (2-5 days/wk) Great Expressions Dental Centers is seeking an Endodontist (2-5 days/week) to join our established and highly productive dental practices located in Jacksonville/St. Augustine, FL: 548 W Twincourt Trail, St Augustine, FL 32095; 751 Oak Street, Suite 601 Jacksonville, Florida 32204; 14286 Beach Boulevard, Suite 23 Jacksonville, Florida 32250. *Please view our Doctor Career Path video: http:// www.screencast.com/t/M3xWM5CYN. Molly McVay | Sr. Clinical Recruiter | Great Expressions Dental Centers PSC-North | 29777 Telegraph Road. Suite 3000| Southfield, MI 48034 USA phone 248-430-5555 |Ext. 72467| fax 248-686-0170 | web www.greatexpressions.com. “Look for the Smile Above Our Name!” Endodontic Dental License and certification. Apply Here: http://www.Click2apply. net/sz65z8n9d5.

New Listing — Ormond Beach, Florida Immediate opening. Our client is searching for a full time (MTh) General Dentist to work in their FFS private practice. Guaranteed base salary, plus commission.

Qualified candidates will have at least 3 years’ experience with general clinical competence and a great client rapport. Freedom to do their own dentistry while having the comradery and business guidance of supporting doctors. Excellent long term opportunity for the right candidate. Please contact Eric DeVriese at Eric@RealTimeCPAs.com for consideration.

ORLANDO — PRIVATE FFS/PPO OFFICE — General Dentist Full Time. An Excellent opportunity to join an Upscale Private Established Dental Office Near Downtown Orlando, providing excellent patient care with the latest State-of-theArt technology including Digital X-rays, Intraoral Camera, Cerec, Laser, Invisalign. Doing ALL aspects of dentistry including Ortho, Cosmetic, Surgery and Dental Implants. 100% PPO/FFS. (No HMO/ No Medicaid). We offer superior quality and excellent patient care, provide attention to details and our patients love us. Great compensation, with a huge potential for the right person in addition to the onthe-job experience and mentoring. If you have GPRAEGD Residency, it is a Plus ... Please Fax 407-3271018 OR e-mail: Doctor@NewSmileDentistry.Net. Full-Time General Dentist Opportunity-Central FL Excellent opportunity! Our office is expanding to a second location. PPO and FFS only. 4 days per week. Quality oriented practice focused on excellent patient care. We are located approximately 1-hour drive from Tampa, Orlando, and Gainesville in Bushnell, FL. A minimum of 2 years’ experience as a general dentist is desired. Commission based compensation with guaranteed minimum. Please email CV or resume to tearsasmith@bushnelldental. com.

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Dentist (1 day/wk) — St. Augustine, FL Great Expressions Dental Centers has an immediate opportunity for a General Dentist to work part-time 1 day/week (Fridays) in our highly productive Twincourt Trail practice located: 548 W Twincourt Trail St. Augustine, Florida 32095.

Enjoy a rewarding role with a dedicated staff in this beautiful facility with an established patient base! Compensation: Competitive compensation with Percent of Production! Benefits/Perks: Leader in the practice: Clinical Freedom and Treatment Autonomy; Patient Focus: Established and Growing Patient Foundation; Digital Office, Two Cerec Machines, One Cone Beam, and Great Location!

Doctor Career Path – Partnership/Investment Opportunities; Malpractice Coverage Assistance; Continued Education Reimbursement, Paid ADA & State Society Dues; Mentorship – Study Clubs, Chairside Mentoring, GEDC University Courses.

Please view our Doctor Career Path video: http:// www.screencast.com/t/M3xWM5CYN. Please apply via this ad for consideration, Molly McVay | Sr. Clinical Recruiter | Great Expressions Dental Centers PSC-North | 29777 Telegraph Road. Suite 3000| Southfield, MI 48034 USA phone 248-4305555 |Ext. 72467| fax 248-686-0170 | web www. greatexpressions.com. “Look for the Smile Above Our Name!” Must have a DDS/DMD from an accredited University and active State Dental Board license. Apply Here: http://www.Click2apply.net/ ngvxj9wp73.

Dentist. Jacksonville clinic is seeking a Dentist for the Jacksonville Florida office. The applying provider must be credentialed in Medicaid or be willing to apply, be licensed in the state of Florida, must have malpractice insurance, must not have any convictions in lawsuits within the last two years, no suspension of license within the past five years. The hours of operation are Tuesday – Friday, 8am until completion (normally about 4pm). You choose your scheduled days! Please send email to staffing@1daydenturejax.com, fax resume to 904503-2915 or call 904-683-0415.

Immediate Opening Emergency Dental Care has immediate openings for full time or part time dentists to join our team. Busy, fee for service office located in Altamonte Springs. Our office does it all, endo, prosthetics fixed and removable, extractions, etc. Experienced staff and business team allows for our dentists to focus on patient care while the administrative team handles the rest.

Competitive Compensation!! If you are interested in supplementing your income by working 1 day a week or enjoying a full time schedule by working just 3 days per week, contact us today, we are excited to hear from you. 641.780.4962.

Dentist Opportunity: Coconut Creek + Coral Springs, FL Come be a clinical leader for our Coconut Creek, FL dental team! Great Expressions Dental Centers has an immediate, select opening for a part-time (possible full time w/second location) General Dentist to join our established, high production, multi-specialty practice in Coconut Creek, FL located at: 4660 W. Hillsboro Boulevard, Suite 7 Coconut Creek, Florida 33073!

Compensation: Draw vs. Percent of Production.

Benefits/Perks: Leaders in the practice: Clinical Freedom and Treatment Autonomy for Every Doctor; Patient Focus: Established and Growing Patient Foundation; Multi-Specialty Practice Setting; Doctor Career Path – Partnership/ Investment Opportunities; Malpractice Coverage Assistance; Continued Education Reimbursement, Paid ADA & State Society Dues. Apply Here: http:// www.Click2apply.net/fhjm6hpbqc.

FFS Practice Seeking Full-Time Associate General Dentist This outstanding Full-Time associate opportunity is in a semi-rural, Fee-For-Service practice, which is busy and growing. Located in Eustis, Florida, the office is a state-of-the-art facility, equipped with modern technology — Cerec Omnicam and milling unit, soft tissue laser, DEXIS digital sensors, digital pano, digital ceph, several digital cameras, etc. Our focus is on providing the patient with an outstanding dental experience. The right candidate should have a great attitude and possess strong verbal communication skills, and be comfortable using computers. This position has excellent earning potential and the opportunity for mentorship. Please email resume to: mjackson@ jacksondentistry.com.

Dentist Opportunity — New Port Richey, FL Family Dental Practice looking for a full-time general dentist to lead our established solo practice. The office is fully staffed with a hygienist. Schedule: M-F 8:00am-5:00pm, 1 Sat/Month. Apply via this ad. Apply Here: http://www.Click2apply.net/ rq9xng9zkc.

Chapel Location Manager NorthStar Memorial Group is seeking a Chapel Location Manager for Southpark Funeral Home in Pearland, TX. This position will be responsible for directing and leading funeral home operations including selecting, training, and motivating location staff to assure delivery of service is above and beyond client expectations. Responsibilities: Develop and maintain community connections to establish a community referral network; Ensure facilities and equipment are clean, well maintained and in safe working order; 5+ years of experience in related field; 2+ years of experience management or leadership experience, funeral profession preferred.

For more information regarding this opportunity email nsmgrecruiting@nsmg.com or click the apply link. Apply Here: http://www.Click2apply.net/ yxw93xg2r5.

Oral Surgeon Opportunity (Full-Time) — Tampa, FL. Come join our Oral Surgeon Dental team! Great Expressions Dental Centers has a current opening for a full-time Oral Surgeon to join our Tampa, FL practices. This is a High production opportunity in established and fully equipped practices! Our Specialists have the clinical freedom and autonomy enjoyed in a traditional private practice without the additional financial or administrative burdens associated with practice management. Specialists can expect unlimited production based earnings (+$150k/production monthly), full benefits (such as medical, dental, 401k, continuing education), paid time off, malpractice coverage, a stable patient base with full clinical staff in place, a 20+ general practice referral network and long-term practice or regional career growth with possible investment

www.floridadental.org

Your Classified Ad Reaches 7,000 Readers! opportunity. Relocation or sign-on bonus possible as well! **Please watch more about our Doctor Career Path (http://www.screencast.com/t/ M3xWM5CYN) and apply via this ad to join our team! Stacey Bruwer, M.A. | Clinical Recruiter | Great Expressions Dental Centers 29777 Telegraph Road, Suite 3000 | Southfield, MI 48034 phone 248237-6853 |Ext. 72468| fax 248-686-0118 | web www. greatexpressions.com. “Look for the Smile Above Our Name!” Must have a DDS/DMD from an accredited University and active State Dental Board License, Oral Maxillofacial Surgeon License and certification. Apply Here: http://www.Click2apply. net/4h44m6dpbq.

Endodontist Opportunities — Tampa, FL Come lead our specialty team as a full-time Endodontist in Tampa! Great Expressions Dental Centers has a current, select opening for a full-time (4-5 days/ week) Endodontist to join our Tampa, FL multispecialty practice(s). Aggressive compensation package, dedicated staff, consistent schedule with a strong referral network of 25+ local offices. Compensation: Six Figure Annual Base vs. Percent of Production! Attractive Sign-on or Relocation possible as well. Benefits/Perks: Leader in the practice: Clinical Freedom and Treatment Autonomy; Patient Focus: Established and Growing Patient Foundation; Multi-Specialty office; Doctor Career Path – Partnership/Investment Opportunities; Full Benefits Offered – Health care & Dental Benefits, 401K, Short Term/Long Term Disability, Time Off; Malpractice Coverage Assistance; Continued Education Reimbursement, Paid ADA & State Society Dues; Mentorship – Study Clubs, Chairside Mentoring, GEDC University Courses. Please view our Doctor Career Path video: http://www.screencast.com/t/M3xWM5CYN. Please apply via this ad for consideration!

Stacey Bruwer, M.A. | Clinical Recruiter | Great Expressions Dental Centers 29777 Telegraph Road, Suite 3000 | Southfield, MI 48034 phone 248-2376853 |Ext. 72468| fax 248-686-0118 | web www. greatexpressions.com. “Look for the Smile Above Our Name!” Apply Here: http://www.Click2apply. net/m25q6csxbd.

Dentist (Full-Time) Opportunity — Tampa, FL. Great Expressions Dental Centers has an immediate opening for a full-time General Dentist to join our Tampa MLK practice located at (825 W. Dr. Martin Luther King Jr Blvd). Enjoy a rewarding career with a full office staff (including Hygienist), a strong schedule and the ability to focus on quality patient care. Enjoy a rewarding role with a dedicated and experienced staff! Compensation: Competitive Six Figure Annual Draw with Percent of Production.

Please apply via this ad for consideration, Stacey Bruwer, M.A. | Clinical Recruiter | Great Expressions Dental Centers 29777 Telegraph Road, Suite 3000 | Southfield, MI 48034 phone 248-2376853 |Ext. 72468| fax 248-686-0118 | web www. greatexpressions.com. “Look for the Smile Above Our Name!” Apply Here: http://www.Click2apply. net/pw8fmwyzzn.

www.floridadental.org

Dentist Opportunity — Lake Mary, FL Great Expressions Dental Centers has an immediate opening for a full-time General Dentist to join our Lake Mary practice. Enjoy a rewarding career with a full office staff (including Hygienist), a strong schedule and the ability to focus on quality patient care. Enjoy a rewarding role with a dedicated and experienced staff! Compensation: Competitive Six Figure Annual Draw with Percent of Production.

Please apply via this ad for consideration, Stacey Bruwer, M.A. | Clinical Recruiter | Great Expressions Dental Centers 29777 Telegraph Road, Suite 3000 | Southfield, MI 48034 phone 248-2376853 |Ext. 72468| fax 248-686-0118 | web www. greatexpressions.com. “Look for the Smile Above Our Name!” Apply Here: http://www.Click2apply. net/rq93wtbm7b.

Dentist (2 days/wk) Opportunity — Tampa, FL Great Expressions Dental Centers has an immediate opening for a part-time General Dentist to join our Carrollwood Commons (15148 N. Dale Mabry Highway), FL practice. Enjoy a rewarding career with a full office staff (including Hygienist), a strong schedule and the ability to focus on quality patient care. Compensation: Competitive Six Figure Annual Draw with Percent of Production; Sign-on Bonus or Relocation Assistance possible. Please apply via this ad for consideration, Stacey Bruwer, M.A. | Clinical Recruiter | Great Expressions Dental Centers 29777 Telegraph Road, Suite 3000 | Southfield, MI 48034 phone 248-237-6853 |Ext. 72468| fax 248-686-0118 | web www.greatexpressions.com. “Look for the Smile Above Our Name!” Apply Here: http://www.

Click2apply.net/rpvy6dbgx7.

Oral Surgeon Part Time Central Florida Pacific Dental Services® (PDS) supported offices have an opening for an oral surgeon to work part time in Central Florida; Clermont area. Oral Surgeons working in a PDS supported office have the luxury of focusing 100% of their time on patient care; leaving the non-clinical aspects to the office staff.

Excellent income potential and a comfortable practice environment, all within state-of-the-art facilities. Job requirements: Dental degree from an accredited University — DMD/DDS, OS residency certificate, an active State Dental Board license and IV sedation or GA permit required. For information contact Deb Packard 417 850 3322 or packardd@ pacden.com.

Part Time Endodontist Central Florida Pacific Dental Services supported Owner Doctor’s in Central Florida have an opening for an endodontist to work part-time; 3-6 days per month.

Endodontists can expect to focus on patient care and clinical excellence while leaving non-clinical aspects to the office staff. Offer includes; excellent income potential all in a comfortable working environment and state-of-the-art facilities.

Flexible independent contractor status. For more information, contact Deb Packard 417 850 3322 or email at packardd@pacden.com. Job requirements: Dental degree from an accredited University — DMD/DDS, Endo residency certificate and an active State Dental Board license

Full-Time Atlanta Endodontist Pacific Dental Services supported Owner Doctor’s in Atlanta have an opening for an endodontist to work full time. Endodontists can expect to focus on patient care and clinical excellence while leaving nonclinical aspects to the office staff. Offer includes; excellent income potential all in a comfortable working environment and state-of-the-art facilities.

Flexible independent contractor status. For more information, contact Deb Packard 417 850 3322 or email at packardd@pacden.com. Job requirements: Dental degree from an accredited University – DMD/DDS, Endo residency certificate and an active State Dental Board license.

Pediatric Dentist (Full-time) — Jacksonville, FL Great Expressions Dental Centers has a select full-time opening for Pediatric Dentist to join our team in Jacksonville, FL. For more than 35 years, Great Expressions Dental Centers has been exceeding patients’ expectations offering general dentistry, endodontic, periodontic, oral and maxillofacial surgery, orthodontic, and pediatric dentistry services in a comfortable, friendly environment. We are looking for a motivated and qualified pediatric specialist to join and lead our 20 plus practices spread across the Jacksonville, FL area! Compensation: Unlimited earnings with a competitive six figure base and percent of production! Attractive relocation or sign-on bonus possible as well. Benefits/Perks: Large, Internal Network of Referring Dentists; Leaders in the Practice: Clinical Freedom and Treatment Autonomy; Patient Focus: Established and Growing Patient Foundation; Multi-Specialty Practices with Dedicated Staffs; Hygiene/Fully Digital Offices; Doctor Career Path – Partnership/ Investment Opportunities; Full Benefits – Health care & Dental Benefits, 401K, Short Term/Long Term Disability, Time Off; Malpractice Coverage Assistance; Continued Education Reimbursement, Invisalign Training, Whitening Opportunity, Paid ADA & State Society Dues; Mentorship – Study Clubs, Chairside Mentoring, GEDC University Courses. Please view our Doctor Career Path video: http://www.screencast.com/t/M3xWM5CYN. Job Requirements: Must have a DDS/DMD from an accredited University and active State Dental Board license, Pediatric Dental License and certifications.

Please apply via this ad for consideration, Molly McVay | Sr. Clinical Recruiter | Great Expressions Dental Centers PSC-North | 29777 Telegraph Road.

Suite 3000| Southfield, MI 48034 USA phone 248430-5555 |Ext. 72467| fax 248-686-0170 | web www. greatexpressions.com. Apply Here: http://www.

Click2apply.net/yncr6y7gmf.

General Dentist Wanted (Palm Beach County).

Established Cosmetic/General Dentist Office seeking a F/T Associate to work in our state-of-theart office. Offering excellent commission. Bilingual, English/Spanish, required. Please email resume to flakat123@yahoo.com or Fax it to (561)424-2098.

Please see CLASSIFIEDS, 95

January/February 2017

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benefit

NUMBER

14

Helping Members Succeed How are you managing your managed-care contracts?

Banish the confusion with this definitive reference for Florida dentists.

A FREE BENEFIT AVAILABLE ONLY TO FDA MEMBERS A thoroughly researched and referenced handbook written clearly in an easy-to-follow format.

Written by Graham Nicol, Esq., Health Care Risk Manager, Board Certified Specialist (Health Law) and the FDA’s Chief Legal Counsel

Go to floridadental.org/signwhat Questions? Call 800.877.9922

to e M t n a W u t?

Yo a h W Sign ook Handbracts ’s t s i t Cont da Den A Florianaged-care on M Law) (Health ol, Esq., ham Nic fied Specialist ra G y B erti Board C anager, AW Risk M re a ALTH L C h ON HE Healt ATION IC L B IAL PU OFFIC ION’S OCIAT S S A L DENTA ORIDA THE FL

INSIDE: Chapter 1: Chapter 2: Chapter 3: Chapter 4: Chapter 5: Chapter 6: Chapter 7:

The Basics: Types of Health Care Delivery Systems The Basics: Types of MCO Models The Basics: Types of Reimbursement Methods MCOs & Other Types of Risk How to Negotiate with MCOs Step by Step Your Rights under Florida DMPO Contracts Your Rights under Florida Health Insurance & PPO Contracts Chapter 8: Your Rights under Florida HMO Contracts Chapter 9: Your Rights under PLHSO Contracts Chapter 10: Fighting Back

ARE YOU AN FDA MEMBER? PRE-REGISTER FOR FREE TO ATTEND THIS COURSE AT THE 2017 FLORIDA DENTAL CONVENTION. PRESENTED BY MR. GRAHAM NICOL  YOU WANT ME TO SIGN WHAT? THURSDAY, JUNE 22  2-4 PM  REGISTRATION OPENS MARCH 1, 2017

Your Classified Ad Reaches 7,000 Readers!

CLASSIFIEDS from 93

General Dentist. Immediate need for associate dentist to replace retiring dentist in family practice for 35 years. Hours and compensation negotiable.

Located in Belleview, FL just south of Ocala. Please fax resume or contact information to 352-307-7774.

Funeral Director/Embalmer NorthStar Memorial Group is seeking a Funeral Director/Embalmer for Levitt-Weinstein Chapel in N. Miami Beach, FL. This position manages all phases of the funeral arrangement including the removal of the deceased, selecting and setting up funeral services to final disposition, as well as, embalming, removals and transfers, cosmetology, dressing, hairstyling and any other preparation required for the deceased.

The successful candidate will have strong planning, organizational and time management skills and a current license in the applicable state. Conduct funeral and memorial ceremonies in a professional and caring manner; Carry out funeral services from retrieval of the deceased to final disposition; Assist in the maintenance of the facilities, grounds and vehicles; Ensure that all federal, state and local regulations related to the funeral industry are followed; Prepare the memorial area for the

www.floridadental.org

family before the services start; Ensure that flowers and other memorabilia are returned to the family after services; Maintain reverence and respect for the deceased at all times; Train all staff and strictly enforce all logging, identification, casketing and cremation procedures; Complete embalming, disinfecting, dressing, preparing and casketing the deceased using appropriate precautions and OSHA standards in a manner that honors the deceased.

Job Requirements: Current license or certification if required by state regulations; 1+ years of funeral industry experience; Professional communication skills; Experience handling sensitive situations in a professional manner; Understanding of the services and products available; Knowledge of current federal, state and local regulations related to the funeral industry. Apply Here:http://www.

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Beautiful office and practice for sale. Fort Lauderdale general practice 12-year-old free standing building on busy road with great signage 5 ops doctor wants to retire 2400 sq ft beautiful interior terrific opportunity for a doctor who does all facets of dentistry no HMOs lots of parking call 954-260-4924 or e mail sandsurf1@bellsouth.net.

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January/February 2017

Today's FDA

95

OFF THE CUSP

JOHN PAUL, DMD, EDITOR

Nose to the Grindstone, Shoulder to the Wheel Unless you live completely off the grid, there is someone you used to completely respect who has posted something on social media that made you think are they incredible fools, no better than common jerks or still looking for that sarcasm font. This is not a story about any of those people.

My friend Kevin does not have a Facebook account, but his wife does, and she proceeds to throw him under the bus on a daily — if not hourly — basis. She loves him as dearly as he loves her, and nothing she posts is meant to shame, just a comment on the wonder that is her husband. He willfully commits all acts attributed to him. Nearly everything he does is good for a giggle.

Most recently, he was taken to task for his sartorial splendor. The dinner was at some fancy restaurant and he was wearing a polyester shirt — if not actually from the 70s, then styled as if it were. The maître d’ was thoughtful enough to supply a tie and a jacket. The tie had a large white polka-dot on a purple field and, by report, the jacket was a brown herringbone. He was perusing a menu wearing his wife’s reading glasses when the photo was made. The portrait of self-confidence, he was completely comfortable that he was where he wanted to be, doing what he wanted to do and sharing his time with his friends. He garnered many likes and comments, though I am sure he neither knows nor cares.

If you only saw Kevin on Facebook, you might think him a screwball. I’ve known him a lot longer than there has been an interweb and sometimes I think that. He is, however, full of surprises and sometimes quite deep. Whether he intended it or not, he is the reason I have carried a card of quotes in my wallet for 25 years. A portable version of a poster I first saw in his office. It describes exactly how I believe each of us comes to success through failure. Thanks, Kevin.

“Nothing in the world can take the place of persistence.

Talent will not; nothing is more common than unsuccessful men with talent.

Genius will not; unrewarded genius is almost a proverb.

Education will not; the world is full of educated derelicts.

Persistence and determination alone are omnipotent.” — Calvin Coolidge

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

96

Today's FDA

January/February 2017

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