2017 - July/Aug TFDA

FDA Foundation is a Force for Good FLA-MOM The Impact of Data Dental Lifeline Network Student Volunteers

EXCITING TIMES FOR THE FDA FOUNDATION

VOL. 29, NO. 5 • JULY/AUGUST 2017

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contents Dr. Natalie Carr Bustillo treats a pediatric patient at the 2017 FLA-MOM event.

news

columns

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news@fda

3

Staff Roster

18

Board of Dentistry

4

President’s Message

23

Member Speaks Out on Board of Dentistry

6

Legal Notes

30

Florida's Action for Dental Health: A Two-year Progress Report

11

Did You Know?

13

Information Bytes

65

Diagnostic Discussion

f e at u r e s 20 Meet the FDA's Dynamic Duo

80 Off the Cusp

23

Member Speaks Out on Board of Dentistry

28

The Black Box

33

The FDA Foundation is a Force for Good

classifieds

35

Create a Legacy for Oral Health in Florida

74 Listings

36

FLA-MOM

38

The Impact of Data

44 Duane's Story: A Follow-up from FLA-MOM 2014-Present 46

Dental Lifeline Network: Q&A with Dr. Michael Eggnatz

49

Fort Myers PDC Makes Impact on Patients and Volunteers

50 PDC: Looking for a Volunteer Home?

52

The Wildlife Student Dentist

53

GKAS Influenced My Career Goal

55 Save a Smile to Save a Child 56

Two Mountains

58

Comprehensive Corporate Dental Practices: Part 1

71

Basis for Dental Pain: A Review

72

FDC2017 Highlights

Read this issue on our website at:

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

July/August 2017

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FLORIDA DENTAL ASSOCIATION JULY/AUGUST 2017 VOL. 29, NO. 5

L A C O L Y L E V & LI

GATHER FOR FUN & CONTINUING EDUCATION IN YOUR DISTRICT. 2017 WCDDA ANNUAL SUMMER MEETING

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

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. Michael D. Eggnatz, Weston, president Dr. Jolene Paramore, Panama City, president-elect Dr. Rudy Liddell, Brandon, first vice president Dr. Andy Brown, Orange Park, second vice president Dr. Dave Boden, Port St. Lucie, secretary Dr. William D’Aiuto, Longwood, 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. Rick Mullens, Jacksonville • Dr. Beatriz Terry, Miami Dr. Stephen Zuknick, Brandon • Dr. Ethan Pansick, Delray Beach, speaker of the house Dr. Tim Marshall, Spring Hill, Treasurer • Dr. John Paul, Lakeland, editor

2018 NWDDA ANNUAL MEETING

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

2018 WCDDA ANNUAL MEETING

FRIDAY, FEB. 2, 2018 • CAMLS, TAMPA Speakers: Dr. Stanley Malamed, Emergency Medicine; Larry Guzzardo, Now what Do I Say?; Larry Guzzardo, Unravel the Mystery of Treatment Acceptance: A Dental Team’s Guide www.wcdental.org • 813.654.2500 • kelsey@wcdental.org

2018 ACDDA WINTER CONFERENCE FRIDAY, FEB. 23, 2018 EMBASSY SUITES, WEST PALM BEACH www.acdda.org • 561.968.7714 • acdda@aol.com

2018 CFDDA ANNUAL MEETING

FRIDAY & SATURDAY, MAY 4-5, 2018 HILTON DAYTONA BEACH RESORT Speakers: Dr. Howard Chasolen, The Seamless Integration of Aesthetics, Form, and Function: The Restorative/ Periodontal Interface; Dr. Gerard Kugel, Adhesive Dentistry & Bioactive Materials, The Dos and Don’ts of Porcelain Laminate Veneers www.cfdda .org • 407.898.3481 centraldistrictdental@yahoo.com

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

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

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

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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 Director of Insurance Operations carrie.millar@fdaservices.com 850.350.7155 Carol Gaskins, Assistant Sales & Service Manager carol.gaskins@fdaservices.com 850.350.7159

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

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

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July/August 2017

Today's FDA

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PRESIDENT’S MESSAGE MIKE EGGNATZ, DDS

By working together, we can influence the inevitable changes, meet the challenges before us and the FDA, and provide the best solutions for all Florida dentists and the public we serve.

The summer marks the transition from one Florida Dental Association (FDA) presidency to another, and it’s a time to reflect on the accomplishments we’ve made as an association this past year, as well as the goals we set to tackle the challenges ahead. As this new term begins, I want to thank you for the honor and privilege to serve as the FDA president, and express my pride in being an FDA member. Between the collaboration of the FDA’s professional staff, Board of Trustees (BOT), House of Delegates, council and committee members, and all our members, I am confident that the FDA will continue in its market share, advocacy and philanthropic success.

I want to thank Dr. Bill D’Aiuto for his outstanding leadership as president, which set a foundation for us to meet the many challenges we’ll face in the coming year.

Last year, he eloquently wrote, “Change is the only constant.” So, my question to you

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is: “How do we influence the change that is constantly upon us, both for the good of the individual and the good of the order?”

The answer is that we must identify the issues we face and prioritize our resources to effect the changes we seek at all levels of our profession. While the FDA is the center of the tripartite, which includes the American Dental Association (ADA) and your local district, the glue that binds us all together geographically and across all specialties and related dental entities is that we all hold a Florida license to practice dentistry in our great state. We must work together to keep dentistry a highly skilled and learned profession to help our members succeed in a demanding world.

The BOT workforce task groups are using their findings to advocate on behalf of our profession to challenge the concept of midlevel providers that outside groups are try-

ing to bring to Florida, and to promote the ADA model of community dental health coordinators (CDHCs) as team members to meet the dental needs of the public. We also are formulating the appropriate position on the large and complex issue of telehealth, which effects every part of your practice. In addition, we are tenaciously addressing the student debt crises in Florida by refocusing on the dental student loan repayment legislation, which provides state and local funding to encourage new graduates to practice in remote areas of need to help increase access to care for the public. These are only a few of the topics and issues the FDA is working hard to resolve to keep dentistry the learned profession it has become.

Another way we are helping members succeed is through FDA Services (FDAS), by providing our member dentists with a myriad of necessary services and products, which contribute to non-dues revenue that

www.floridadental.org

helps to reduce membership dues and support our association’s priorities.

The FDA Foundation, the philanthropic arm of the FDA, has three major programs in which members can get involved and give back to the community: the Florida Mission of Mercy (FLA-MOM), Dental Lifeline Network’s (DLN) Florida Donated Dental Services (DDS) and Project: Dentists Care clinics across the state. This issue of Today’s FDA features the Foundation and these wonderful and important programs, and will show you how to use your professional knowledge and skills to help those who are less fortunate in your local community and around the state. Our next FLA-MOM will be held March 9-10, 2018 in Fort Meyers, and I encourage you to volunteer — please go to www.flamom.org to register. Those who have participated in these philanthropic endeavors can attest that what you give is rewarded many times over by what you receive!

I can personally attest to that statement.

FDA Executive Director Drew Eason, the immediate past trustee, current trustee and I — along with many others in leadership — serve on the DLN’s national or state boards.

DLN is a charitable affiliate of the American Dental Association, which launched the Florida DDS program more than 30 years ago. Today, DDS operates in all 50 states.

DDS provides comprehensive dental care to people with disabilities or who are elderly or medically compromised, and have no other access to dental care. The Florida DDS program has helped more than 1,741 people receive more than $7.5 million in care through 421 volunteer dentists and 210 volunteer labs. I encourage each member to

profession.” I urged them to follow the lessons of L.D. Pankey who said, “To live a fulfilled life as a dentist, one must know yourself, know your patients, know your work and apply your knowledge.” I believe this is good advice for all of us, individually and collectively in the FDA. We must work collaboratively to keep the good profession that has been given to us. We must nourish it, improve it and protect it for the public trust we serve. treat just one patient a year. You will belong to something greater than yourself and contribute greatly to your local community.

We have a waiting list of those who need our care in all parts of the state, and now we have the funding to better coordinate that care to match our members with the patients in need.

I had the privilege of addressing the rising juniors at the University of Florida during their White Coat Ceremony on Father’s Day. My message to them was: “In order to be successful in dentistry and as a professional, one must invest time in relationships with your patients, colleagues and your

By working together, we can influence the inevitable changes, meet the challenges before us and the FDA, and provide the best solutions for all Florida dentists and the public we serve. I look forward to working with you, and I thank you for your trust in me and our leadership! If I have not met you yet, I look forward to doing so this year. You can contact me or the FDA to address your needs!

Dr. Eggnatz is the FDA President and can be reached at meggnatz@bot.floridadental.org.

Dr. Bill D’Aiuto presents Dr. Michael Eggnatz with an FDA Leadership Award at the Florida Dental Convention in June.

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July/August 2017

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Legal Notes

How Well Do You Know the Board of Dentistry Disciplinary Process? Part 5 Graham Nicol, Esq., HEALTH CARE RISK MANAGER, BOARD CERTIFIED SPECIALIST (HEALTH LAW)

This is Part 5 of a continuing series.

MFCU Search Warrants Licensure investigations will not involve search warrants. However, if you are being investigated for Medicaid reimbursement fraud, bribes, kickbacks or rebates for patient referrals, abuse or neglect of a child, or financial exploitation of an elderly patient, you probably will first learn of it when you’re served with a search warrant by the Florida Medicaid Fraud Control Unit (MFCU) or another governmental enforcement agency. Or, even worse, you will first find out when your credit card is denied or your checks start to bounce because of civil forfeiture (discussed below).

Under subsections 409.920(9)(a-c), Fla. Stats., MFCU performs both criminal and civil investigations of reimbursement fraud and criminal investigations regarding alleged patient abuse, neglect and exploitation. Section 466.028(1(t), Fla. Stats., makes fraud in the practice of dentistry a disciplinary violation. Section 825.103, Fla. Stats., makes it a crime to abuse, neglect or financially exploit a child or an elderly person (60 or over).

MFCU is a unit within the Florida Office of the Attorney General, which has been

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granted statutory authority to issue investigative subpoenas and search warrants to review provider records for evidence relating to Medicaid fraud and/or patient abuse. Under section 409.9205(1), Fla. Stats, MFCU investigators are active law enforcement. They carry guns, can execute search warrants and have authority to arrest you.

Often, they will coordinate searches with local law enforcement.

Under subsection 409.9205(10)(a), Fla. Stats., MFCU may enter upon the premises of any Medicaid-participating dentist to examine accounts and records that may be relevant in determining the existence of fraud in the Medicaid program. In addition, these powers may be used to investigate the alleged abuse or neglect of patients, or the alleged misappropriation of patients’ private funds.

You are required to make available any accounts or records that may be relevant in determining the existence of fraud in the Medicaid program, alleged abuse or neglect of patients, or alleged misappropriation of patients’ private funds.

TIP: However, the accounts or records of a non-Medicaid patient may not be reviewed by, or turned over to the attorney general, without the patient’s written consent. Additionally, the MFCU can subpoena witnesses or materials, including medical records relating to Medicaid recipients, within or outside the state, and through any duly designated employee; administer oaths and affirmations; and, collect evidence for possible use in either civil or criminal judicial proceedings.

Civil Forfeiture Laws If you are under criminal investigation (e.g., sex, drugs and fraud in dental practice — not rock and roll), your first notice may be when your bank tells you that your account was seized by the government. When the government shows up at your front door, they will take anything and everything that they think will prove that you are guilty of a crime, that is evidence of a crime or that is used “in furtherance of a crime.”

TIP: “In furtherance of a crime” means “civil forfeiture” applies and the government may take away your property before you have been found guilty of anything. You may lose your computers, paper records, cash, cellphone, car, bank accounts, maybe even your real estate. You have a very short time to challenge civil forfeiture and the burden is on you to do so.

TIP: You can get your property back if you can prove, for example, that you are innocent or that you did not know that the property taken was being used in furtherance of a crime.

TIP: If you can’t get your property back, maybe someone else can, so your business does not go into bankruptcy. For example, someone who is innocent and not under investigation but is a co-owner of the property taken can get it back. Think about what your partnership agreement says about ownership. Think about whether your car is titled in your name, jointly with your spouse or by your business.

What’s the Difference Between a Subpoena and a Search Warrant?

Subpoenas are issued by the MFCU or www.floridadental.org

Legal Notes DOH requiring you to appear at deposition or trial. Subpoenas that are “duces tecum” request you to produce documents or materials under your control or bring them to the deposition or trial. Subpoenas are issued by lawyers; search warrants are issued by a judge who is neutral and not in an adversarial relationship with the party getting served.

MFCU and DOH subpoenas are considered investigatory subpoenas, meaning that, because they are issued by an adversarial party, you may challenge them before you produce documents or materials. Subpoenas are less intrusive than a search warrant.

When you are served with a subpoena, law enforcement is not going to immediately go through your belongings and there is no threat or actual use of force. When you are served with a search warrant, they will immediately execute it and under section 933.15, Fla. Stats., you are subject to arrest for a misdemeanor if you refuse entry.

Under section 933.02, Fla. Stats., a judge issues a search warrant when an investigator files an affidavit (a written statement made under oath) saying that property has been used as a means to commit a crime. The affidavit asserts probable cause and will name and describe with particularity the person, place or thing to be searched. Under section 933.09, Fla. Stats., if the investigator is refused entry, she may lawfully break down the door or a window to gain access to the premises to execute the warrant. Depending on what the judge allows, under sections 933.10 and 101, Fla. Stats., the warrant may be served at night or on a Sunday when you are out of the office.

Warrants are issued in duplicate and you, as the subject of the investigation, or whoever is in charge of the premises, will get a copy.

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TIP: If no one is present when the warrant is executed, the investigator will simply leave it at the premises. All property removed will be noted on the inventory receipt and you will be given a copy. Hopefully, they will lock the place back up before they leave.

A Case Study: State v. Tsavaris, 394 So. 418 (Fla. 1981) One Monday morning after a patient’s death on Saturday night, the Hillsborough County Sheriff ’s Department showed up at Dr. Tsavaris’ office and proceeded to interview Ms. Carlton, Dr. Tsavaris’ part-time secretary.

The employee refused to give the detectives any of the records or information from the records, stating that this information was confidential and disclosure would be unethical.

Later that same morning, four detectives from the Sheriff ’s Department and an assistant state attorney went to Dr. Tsavaris’ office. They served two subpoenas duces tecum on Ms. Jones, Dr. Tsavaris’ full-time secretary. Each subpoena was addressed to “custodian of records, 4600 Habana Suite 28, Tampa, Fla. (Office of Dr. Louis Tsavaris)” and commanded the “custodian of records” to appear before the state attorney “instanter,” which is similar to a search warrant in that it demands the records be produced without time to talk to a lawyer. One subpoena demanded all medical records relating to the deceased patient.

The other demanded the custodian bring with her the doctor’s personal appointment book. Ms. Jones went with two detectives to the office of the state attorney and there turned over to the state attorney four sets of records from Dr. Tsavaris’ office. Personnel at the state attorney’s office made copies of those records and returned the originals to Ms. Jones.

At trial, Dr. Tsavaris argued that the state attorney had obtained the subpoenaed office

records in violation of his right to be free from unreasonable searches and seizures.

He further argued that the records should be suppressed because the subpoenas were defective and improperly served.

The Florida Supreme Court held that Dr. Tsavaris had no grounds to object to the defective process and determined that the duty rested on the employee, Ms. Jones, to object to the form of process served: “If a witness fails to object to the form or service of process, the witness waives any right to be heard at a later date on those matters.

Objections to the legality of a subpoena are personal and may be asserted or waived only by the person being searched or examined.” Thus, the doctor could not object to the subpoena service and process, even though it was his records that were taken.

TIP: Think carefully about your written records policy and under what circumstances employees must contact you before releasing records.

The court further ruled that the doctor could object on the grounds that his constitutional rights under the Fourth Amendment were violated. But it held that a subpoena “will not constitute an unreasonable search and seizure under the Fourth Amendment as long as the subpoena is properly limited in scope, relevant in purpose and specific in directive, so that compliance will not be unreasonably burdensome.” The court also noted that there was no objection made at the time of service that the subpoenas were overbroad or irrelevant.

The first employee responded properly, the second employee put the doctor in harm’s way.

TIP: Train your employees frequently on your record policy and enforce it strictly.

Please see LEGAL, 8 July/August 2017

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7

Legal Notes LEGAL from 7

What Should I Do if the Government Shows Up at My Office?

From the case study, we’ve learned that if you invite them in, you waive any objections to the search.

TIP: If they ask, “Do you mind if we come in to get out of the sun or to discuss this in private?” do not answer, “Yes,” or move out of the entryway. That is consent to conduct the search.

While you have more rights against “inspection” warrants in connection with OSHA (workplace safety, hazard communication, bloodborne pathogens), Office of Radiation Control (X-ray equipment inspection) or anesthesia permitting than you do against search warrants for criminal activity, best practice is to not invite them in unless you knew they were coming and have properly prepared.

TIP: If you refuse entry, the only time they can come in without a warrant is under “exigent circumstances,” meaning a grave emergency exists that makes a warrantless search imperative to the safety of police and the public. See, Riggs v. State, 918 So. 2d 274 (Fla. 2005). Exigent circumstances include the need to preserve life or render first aid, so if they enter your practice on a report of child or elder abuse and hear screaming coming from an operatory, a judge will probably rule it as entry under exigent circumstances.

TIP: Ask for their identification and credentials. Keep your copy of the warrant and keep records of who was there when they left and what they took. Don’t rely on the inventory receipt. Keep your own record.

If they don’t have a warrant, you (or your employees if you are not present) should

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politely refuse entry and call your lawyer at once.

Even if they have a warrant, ask if they can come back at a scheduled time or wait so you can have your lawyer present. If they decline — which they probably will — don’t refuse entry or you will be arrested for obstruction of justice.

Remain with the MFCU investigators and inform them that they may not review or remove any non-Medicaid patient records or files. You and your employees cannot be compelled to assist in the search. It is usually a good idea to send your employees home while the investigators conduct the search.

You are under no obligation to discuss any matters with law enforcement officials.

If your lawyer is present, let her do the talking. If you are alone, try to do the following: q Do not let them take original records.

They are entitled to copies of written records and should return the originals to you. q Object to seizures of anything outside the scope of the warrant. q Protect carefully any attorney-client or attorney-work product materials. q Keep your own inventory of seized property. Copy important documents. q Object to the seizure of essential records required for your business. Ask that the investigator obtain copies of any hard drives. Ask to have computer discs placed under seal pending review for privilege. q Do not obstruct justice by interfering with the search. Object, but do not resist. q Demand all interviews on premises stop immediately. Remember, employees have a right to speak only if they wish to speak. If you tell them not to speak, that is obstruction. However, you have the right to tell them they are

not required to speak and then inform the investigator of their decision. q You cannot be compelled to tell the location of documents. q After the search, debrief with your lawyer and tell your employees not to discuss the search among themselves or with anyone else. q Make sure you identify and protect potentially related documents that might have been missed in the investigiation. For example, if the MFCU took financial records but left chart notes, make sure you don’t lose the chart. It might be the only thing showing medical necessity for billed charges. Do not destroy related documents and make sure you don’t lose them.

STEP 9: Peer Review Protection From Dr. Tsavaris’ case study, we’ve seen that the ability of licensees to prevent investigation into, and to exclude evidence under procedural and substantive due process rights (Fourth and Fifth Amendment, Section I, Article 23 of the Florida Constitution, and statutory protections), is limited at best.

TIP: Under subsections 395.0193(14) and 395.0197(13), Fla. Stats., the state has the broadest possible authority to get records when the dental procedure took place in a hospital because hospitals must file reports of adverse incidents that become public record.

Likewise, if they are investigating an adverse anesthesia occurrence they will get any and all records.

TIP: Peer review records are non-discoverable, and even if they are found (usually by the patient disclosing them), they are non-admissible as evidence in civil or disciplinary litigation under sections 766.101, Fla. Stats., (civil litigation) and 466.022, Fla. Stats. (licensure discipline). Nor can peer review members or witnesses be compelled to give www.floridadental.org

Legal Notes testimony as to the peer review proceedings. This is another example of how the FDA Peer Review serves as effective risk management for members.

Why Are Peer Review Records Privileged?

The reason peer review records have significantly greater protection is found in subsection 766.101(7)(a), Fla. Stats.: “It is the intent of the Legislature to encourage medical review committees to contribute further to the quality of health care in this state by reviewing complaints against physicians in the manner described in this paragraph.”

In this context, “medical” includes “dental” and “physician” includes “dentist.”

The leading Florida case on peer review immunity, non-discoverability and inadmissibility as evidence is Cruger v. Love, 599 So.2d 111 (Fla 1992), where the Florida Supreme Court defined the scope of documents protected under the peer review privilege. First, it explained the rationale behind the privilege: The Florida Legislature enacted these peer review statutes in an effort to control the escalating cost of health care by encouraging self-regulation by the medical profession through peer review and evaluation. Holly v. Auld, 450 So.2d 217, 219-20 (Fla.1984) (interpreting former section 768.40(4), Florida Statutes, the predecessor to section 766.101). In order to make meaningful peer review possible, the legislature provided a guarantee of confidentiality for the peer review process. Holly, 450 So.2d at 220.

What Records Are Protected?

The scope of the privilege is made explicit in section 766.101(5), Fla. Stats., which states that: The investigations, proceedings and records of a (peer review) committee … shall not be subject to discovery www.floridadental.org

or introduction into evidence in any civil or administrative action against a provider of professional health services arising out of the matters which are the subject of evaluation and review by such committee, and no person who was in attendance at a meeting of such committee shall be permitted or required to testify in any such civil action as to any evidence or other matters produced or presented during the proceedings of such committee or as to any findings, recommendations, evaluations, opinions or other actions of such committee or any members thereof. (Emphasis added).

The Florida Supreme Court explained the reasoning behind the broad scope of privilege in Cruger: The scope of this statutory privilege is at issue here. The statutes do not define what constitutes records of a committee or board. Therefore, we must look to the legislative intent and policy behind the statutes to determine the extent of the privilege. We have previously held that “[t]he discovery privilege ... was clearly designed to provide that degree of confidentiality necessary for the full, frank medical peer evaluation which the legislature sought to encourage.”

Holly v. Auld, 450 So.2d at 220. Without the privilege, information necessary to the peer review process could not be obtained. Feldman v. Glucroft, 522 So.2d 798, 801 (Fla.1988). While we recognized in Holly that the discovery privilege would impinge upon the rights of litigants to obtain information helpful or even essential to their cases, we assumed that the legislature balanced that against the benefits offered by effective self-policing by the medical community.

The court ruled that the privilege provided by sections 766.101(5) and 395.011(9), Florida Statutes, protects any document

considered by the committee or board as part of its decision-making process. The policy of encouraging full candor in peer review proceedings is advanced only if all documents considered by the committee or board during the peer review or credentialing process are protected. Committee members and those providing information to the committee must be able to operate without fear of reprisal.

(Emphasis added, citations omitted.)

TIP: This statute does not, however, mean that the actual medical records themselves are protected. As we’ve seen in the Sheppard case,* records that are statutorily required to be made and maintained have no Fifth Amendment protection. Similarly, under section 766.101(5), Fla. Stats.: Information, documents or records otherwise available from original sources are not to be construed as immune from discovery or use in any such civil action merely because they were presented during proceedings of such committee, nor should any person who testifies before such committee or who is a member of such committee be prevented from testifying as to matters within his or her knowledge, but the said witness cannot be asked about his or her testimony before such a committee or opinions formed by him or her as a result of said committee hearings.

The FDA’s Peer Review program is extremely effective at ensuring your records will not be used against you in civil or administrative (licensure) litigation. * “Legal Notes: How Well Do You Know The Board of Dentistry Disciplinary Process? Part 3.”

Look for Part 6 in this series in the next issue of Today's FDA. Graham Nicol is the FDA’s Chief Legal Officer.

July/August 2017

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9

ine h c a M X-ray ion t a r t s i try Reg of Dentis ffairs fessional A ida Board r Pro to the Flo y Payer & n rt o a s P ia d L ir A h r of T kka, FD DA Directo F Dr. Don Il , e ir m ta Stou Ms. Casey

Did you know that you must register your X-ray machine with the Department of Health within 30 days after acquisition and before use? You also must designate someone to be responsible for radiation protection. The application for registration can be found online at http://bit.ly/2uK5R0e.

Rule 64E-5.511(2) printed below lists the fees and information about renewal of the application and inspection.

incorporated by reference and available from the internet at http://www.floridahealth.gov/radiation, or at https://bit.ly/2tlVSLL. 2. Designate an individual who will be responsible for radiation protection.

3. Prohibit any person who is not registered with the department as a provider of services as specified in (3), below, from furnishing radiation machine servicing or services to his radiation machine. (b) Registration fees are due within 30 days after acquiring a radiation machine. If the machine is acquired within 120 days before the Oct. 28 annual renewal date, the registration fee will be due on or before Oct. 28 and will be the annual renewal fee.

Otherwise, the renewal fee is due annually on or before Oct. 28. (c) An annual fee for the registration and inspection of radiation machines shall be paid according to the following schedule, please see below:

Dr. Ilkka

(2) Application and Fees for Registration of Radiation Machines. (a) Each person who acquires a radiation machine or an additional radiation machine shall: 1. Apply for registration of the radiation machine with the department within 30 days after acquisition and before use. Application for registration shall be on DH Form 1107, 09/14, “Radiation Machine Facility Registration,� which is herein Ms. Stoutamire

First Tube/Unit Each Additional Tube/Unit Medical or Chiropractic or Osteopathic

$145

$85

Veterinary One Tube $50 $34 Educational or Industrial $47 $23 Dental or Podiatry $31 $11 Medical Accelerator $258 $148 Non-medical Accelerator $81 $48

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

U O Y DID

www.floridadental.org

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IDA E FLOR

H OUT T B A N O MATI INFOR

TIST OF DEN D R A BO

July/August 2017

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Information Bytes

It’s Time for a New Do!

By Larry Darnell DIRECTOR OF INFORMATION SYSTEMS

Everyone gets that new summer hairdo. A new, sassier style or the cooler cut for those hot summer days. The Florida Dental Association’s (FDA) website, www.floridadental.org, received a “new do” this summer on July 12. We made the decision to align ourselves more closely to the American Dental Association by using their branded web templates for our website design. What does this mean for you? Same great content that we’ve had, but the look, feel and organization will be a little different.

We heard the issues members had with finding information on the website, so we condensed and streamlined the menu structure to make it more understandable and fully searchable. There also was a concern about website accessibility, so we made sure that every aspect of our website is fully compliant with W3C recommendations for accessibility.

The advantage of moving to the branded web templates is that every state dental association or society will have a similar look and feel. They refer to this as the “NFL model”— there are 32 different teams, but their websites share a style and structure. Already, the Northeast and Central District components here in Florida have done the same thing as we have. It will help solidify the “Power of Three” across the tripartite.

“

One website, one login and one password — to get all you need.

”

Another reason for this change is to have one place to find all the information relevant to our association. We have removed fdaleadership.org, which was a separate site that provided agendas and minutes for the Board of Trustees, committees and councils, and now have an entire section of the website exclusively devoted to leadership. One website, one login and one password — to get all you need.

So, you will receive the same great content, but with a website redesign to help you succeed.

Please check it out and provide feedback at newdo@floridadental.org.

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

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July/August 2017

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13

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

FDA Wins ”Association of the Year” Award

The Florida Dental Association (FDA) was awarded “Association of the Year” at the Florida Society of Association Executives Annual Conference in July. Congratulations to the Board of Trustees and staff for Helping Members Succeed!

Florida Dental Convention to combine with ADA Annual Session in 2020 To create more impactful dental meetings for attendees, guests and exhibitors, the FDA and the American Dental Association (ADA) are consolidating meetings in 2020.

“Because of the willingness to partner, several dental tradeshows will be combined,” states ADA President Dr. Gary Roberts.

“This approach makes great sense because it saves everyone time and money. Rather than wonder which meeting to attend or exhibit at, the choice is now easy!”

The ADA has a long-standing policy that encourages state and local societies to work with the ADA as meetings rotate around the country; and the ADA recently added another optional model to that policy that is

14

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July/August 2017

already showing positive results. The ADA also looks forward to successful meetings in 2017 and 2018 in Atlanta and Honolulu, working in collaboration with the Georgia and Hawaii Dental Associations.

The ADA and FDA will host a joint meeting together in Orlando from Oct. 15-18, 2020.

“The Florida Dental Association is thrilled to partner with the American Dental Association to host ADA 2020 in Orlando,” said Dr. Bill D’Aiuto, immediate past president of the FDA and practicing dentist in New Smyrna Beach. “This will be a great opportunity to shine a light on our state, and we look forward to working together to make this an impactful event.”

All organizations involved in these joint meetings ask exhibitors and sponsors to support all of their meetings, each and every year, recognizing their commitment and willingness to work together in the specific year(s) that the ADA holds its meeting in their area.

Dr. Irene Marron-Tarrazzi Receives “Woman to Watch” Award

The Lucy Hobbs Project is named after the first woman to earn a degree in dentistry in 1866. Her leadership, courage and success paved the way for other women.

ADA Vice President Dr. Irene Marron-Tarrazzi was awarded a “Woman to Watch.”

Dr. Marron-Tarrazzi defied the odds by becoming the youngest elected vice president of the ADA. A periodontist in private practice in Miami, she had been serving on the ADA New Dentist Committee while holding positions at the state and local levels. Dr. Marron-Tarrazzi initially received her DMD from Universidad Central de Venezuela in Caracas. Later, she received a master’s in science and a certificate in periodontology from the University of North Carolina – Chapel Hill. In 2003, she earned a DMD from Nova Southeastern University in Florida. She draws on her own story — one that encompasses success across two distinct cultures and languages — to inspire young women looking to pursue a career in dentistry and to encourage them to run for leadership roles at the national level.

Congratulations, Dr. Marron-Tarrazzi!

Dr. Johnny Johnson Receives Health Equity Heroes Award and Redirects it to the FDA Foundation

The Lucy Hobbs Project awarded six women — including three ADA leaders — as dentists who set new benchmarks in their profession at its annual celebration in April.

In May, DentaQuest named five health leaders the 2017 Health Equity Heroes, including American Dental Association members www.floridadental.org

Drs. Gary Schwarz, Richard Simpson and Johnny Johnson. The awards are given to people who are breaking down barriers and developing innovative programming to improve health outcomes and access to care for underserved populations.

Dr. Johnny Johnson, a pediatric dentist of Palm Harbor, Fla., was recognized for his work leading a comprehensive dental program for low-income community members.

Dr. Johnson organized a care program for socio-economically disadvantaged people in Pinellas County with cooperation from the Pinellas County Health Department, the Board of Pinellas County Commissioners and volunteer dentists, which has been operating since 2012. Patients receive radiographs, cleanings, extractions/restorations, treatment plans and often, Dr. Johnson said, “a new hope for a better life.”

Dr. Johnson also is president and founder (in 2014) of the American Fluoridation Society, which promotes the health and safety of community water fluoridation.

Each recipient of this award receives a $1,000 donation from DentaQuest’s Citizenship Fund toward a nonprofit that promotes health equity of his or her choice. Dr. Johnson generously redirected his award donation to the Florida Dental Association Foundation. The Foundation provides millions of dollars of life-changing dental care to those who are most in need through the generous contributions from our members.

We encourage our members to think about donating to the Foundation to continue making these programs possible.

Congratulations, Dr. Johnson, and thank you for your donation!

Crissy Tallman Elected to Florida Society of Association Executives Board FDA Director of Conventions and Continuing Education Crissy Tallman, CMP, CAE, was recently elected to the Florida Society of Association Executives’ Board of Directors as one of their directors at large. Her role will expose her to many talented people and associations — bringing that much more valuable knowledge to the FDA. She was installed at the 2017 Annual Conference at The Breakers Palm Beach in July. Congratulations, Crissy!

To achieve the CAE designation, Mr. Darnell successfully completed more than 100 hours of specialized professional development, passed a stringent examination in association management and pledged to uphold a code of ethics.

“The Florida Dental Association is proud of Larry’s accomplishment and ongoing commitment to strengthening this association,” said Drew Eason, executive director/CEO of the FDA. Mr. Darnell has been with the FDA for more than 20 years. He has a Bachelor of Science degree from Albany State University and Master of Business Administration degree from the University of North Alabama.

Postgraduate Students Present Table Clinics at FDC

Larry Darnell Receives CAE Certification The FDA is proud to announce that Director of Information Systems Larry Darnell recently received the Certified Association Executive (CAE®) certification, which is the highest professional credential in the association industry.

Dr. Anthony Wong, far left, and postgraduate students at FDC2017.

During FDC2017, dental postgraduate students presented table clinics on meticulously documented research they have performed. These table clinics have practical uses in the treatment of dental patients.

Please stop by next year at FDC2018, to learn more on researches for practical office use.

Please see NEWS, 17

www.floridadental.org

July/August 2017

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15

benefit

NUMBER

11

YOUR FDA FOUNDATION STAFF IS “HELPING MEMBERS SUCCEED” EVERYDAY!

PROFESSIONAL STAFF

THE OFFICIAL MEETING OF THE FDA

O Y U R E T G A AME V E LE

I help members succeed by making it easier to volunteer and provide pro bono services to patients in need.

I focus much of my energy on the Florida Mission of Mercy — organizing the myriad elements that help the event run smoothly for volunteers and patients. Not only do patients benefit, but their need for dental care is highlighted for lawmakers, the media and the public.

– Austin K. Moser, Coordinator of Foundation Affairs

Have a question about FDA Foundation?

800.877.7597 • 850.350.7161 • amoser@floridadental.org foundation.floridadental.org

Gaylord Palms Resort & Convention Center I Orlando, Florida

SAVE THE DATE

JUNE 21-23, 2018

REGISTRATION

OPENS MARCH 1ST

FLORIDADENTALCONVENTION.COM 16

Today's FDA

July/August 2017

www.floridadental.org

NEWS from 15

FDA Staff Receives New Titles The FDA has recently made a few title changes to better reflect the level of responsibility and leadership these outstanding women provide to help our members succeed. Congratulations on your well-deserved new titles!

• Carrie Millar is now the FDA Services Director of Insurance Operations • Joe Anne Hart is now the FDA Chief Legislative Officer • Alexandra Abboud is now the FDA Governmental Affairs Liaison

Former FDA Employee and NWDDA Executive Director Has Died Frances Dover died on Saturday, June 24, in Tallahassee. She was a former, longtime employee of the FDA, serving as receptionist/ office assistant for the Governmental Affairs Office for many years. In addition, Frances served as the Northwest District Dental Association’s executive director for more than 20 years. She was always friendly and a pleasure to work with.

In Memoriam The FDA honors the memory and passing of the following members: Sterling L. Watson Quincy, FL Died: 4/9/2017 Age: 60 Jocelyn Mendez Coconut Grove, FL Died: 4/24/2017 Age: 45

www.floridadental.org

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

Atlantic Coast District Dental Association Tomas Baez, Plantation Flora Bentsi-Enchill, Fort Myers Elzebir Castillo, Coral Springs Shiva Khatami, Fort Lauderdale Wesley Nelson, Fort Myers beach Jessica Rivas-Plata, Plantation William Seefried, Stuart

Central Florida District Dental Association Falastin Abu-Samn, Lake Mary Sapna Adappa, Daytona Beach Andreina Alarcon, Orlando Mikal Baaqee, Ocoee Elizabeta Cokovska, Winter Springs Christopher Connell, Gainesville Jomar Diaz Nicolas, Oviedo Nilofar Jamasi, Ocoee Mohammed Khattari, Orlando Cathleen Luong, Port Orange Francisca Montero, Kissimmee Jenny Narvaez, Kissimmee Ishbel Nieves, Leesburg Sara Nikfar, Orlando Rishit Patel, Clermont Jefferson Pecora, Palm Bay Auturo Perez, Daytona Beach Alyssa Pinnock, Orlando Elizabeth Stewart, Orlando Tej Vaidya, Orlando

Northeast District Dental Association Carlianette Baez Henry, Jacksonville William Cullen, Jacksonville Nguyen Do, Jacksonville Katherine Hicks, Jacksonville Beach Karen Hubbard, Jacksonville Christina Monford, Jacksonville

Northwest District Dental Association Sarah Howle, Pensacola

South Florida District Dental Association Martha De Laiglesia, Davie Malena Fernandez, Miami Augusto Figueiredo Neto, Miami Carmen Gonzalez, Miami Maria Guevara, Weston Yvania Jimenez, Miami Flor Luzardo, Miami Martha Maderal, Miami Lakes Aline Morin, Coral Springs Fredericka Salbo, Hollywood Debora Shapiro, Hollywood Ana Tellez, Miami

West Coast District Dental Association Alesia Apana, Tampa Patricia Bachmann, Naples Daryl Brito, Riverview Meghan Carter, Tampa Tirso Ignacio, Seminole Erika King, Tampa Robert Miller, Sarasota Nicole Mitchell, Tampa Karen Nagle, Sarasota Neal Patel, Tampa Rosalyn Shkolnikov, Brandon Igor Traktinskiy, Tampa

July/August 2017

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17

Board of Dentistry

Board of Dentistry Meets in Orlando

By Casey Stoutamire DIRECTOR OF THIRD PARTY PAYER AND PROFESSIONAL AFFAIRS

The Florida Board of Dentistry (BOD) met in Orlando on May 19. The Florida Dental Association (FDA) was represented by FDA BOD Liaison Dr. Don Ilkka and Director of Third Party Payer of Professional Affairs Casey Stoutamire. FDA Executive Director Drew Eason also was in attendance. Other FDA members in attendance included Drs. Jim

Horn on the Western Regional Examining

legislative ratification.

Board (WREB) dental licensure exam.

Florida is currently under contract with the

There was a discussion on whether teaching

Commission on Dental Competency As-

permit holders must comply with all con-

sessments (CDCA) to administer the ADEX

tinuing education (CE) requirements, as the

exam, so the WREB presentation was

rules are unclear. This issue is being sent to

purely educational at this time. Dr. Thomas

the Rules Committee for further discussion.

discussed the upcoming consolidation of National Boards Part I and II into the Inte-

The BOD denied a declaratory statement

grated National Board Dental Examination

regarding whether an endodontic residen-

(INBDE). The first graduating class to take

cy program fulfilled the requirements of

the INBDE instead of the separate Nation-

466.006(3)(b), Florida Statutes. This section

al Boards Part I and II will be the class of

of law requires a graduate from a dental

2022. Board counsel, Mr. David Flynn, is

school not accredited by the American

going to research whether the statute needs

Dental Association Commission on Dental

to be updated to reflect this change.

Accreditation (CODA) to submit proof of having successfully completed at least two

Due to legislation passed during the 2016

consecutive academic years at a full-time

Session, the BOD can set, by rule, minor

supplemental general dentistry program

violations, which gives the Department of

accredited by CODA before being approved

Stevens and Linda Trotter.

Health (DOH) the opportunity to use alter-

to take the dental licensure exam in Florida.

native dispute resolution remedies instead

This issue will now most likely be litigated.

Ten of the BOD members were present,

of official discipline. Mr. Flynn reaffirmed

Mr. Flynn advised the board on the statu-

with the BOD the substance of Rule 64B5-

tory construction of the law at issue in this

13.0045, Minor Violations, so that he could

case. His advice was that the plain meaning

certify to the legislature that the BOD was

of supplemental general dentistry program

complying with the law.

does not include specialty programs. This

Antoon, Andy Brown, Bob Churney, Mike Eggnatz, Larry Grayhills, Mel Kessler, Richard Mufson, Merlin Ohmer, Carol

which included: Dr. Joe Thomas, chair; Ms. Cathy Cabanzon, vice chair; Drs. Joe Calderone, Naved Fatmi, Bill Kochenour, Claudio Miro, Robert Perdomo and T.J. Tejera; hygienist, Ms. Angie Sissine; and,

also is the FDA’s position.

consumer member, Mr. Tim Pyle. Dr. Joe Thomas has officially ended his term with the Florida Board of Dentistry. The FDA thanks him for his service and wishes him

The BOD approved the application of

success at his future endeavors. There is one

silver diamine fluoride by a hygienist in a

At the request of the FDA, Florida Associa-

health access setting without supervision

tion of Periodontists (FAP) and the Florida

at its February board meeting. However,

Academy of General Dentistry (FLAGD),

the board did not make a determination if

the BOD held a public rule hearing on

consumer position open on the board that

the proposed amendments would require

Rules 64B5-16.006 and 16.007. The rules

the governor has not yet filled.

a Statement of Estimated Regulatory Costs

approved by the BOD in December 2016

(SERC). The board considered the econom-

proposed moving scaling and root planing

The BOD heard a presentation by Director

ic impact and determined that a SERC was

and the placement of medicaments by hy-

of Dental Exam Administration Dr. Bruce

not necessary and the rule will not need

gienists from indirect supervision to general

18

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July/August 2017

www.floridadental.org

Board of Dentistry

Next BOD Meeting The next BOD meeting is scheduled for Friday, Aug. 25, 2017 at 7:30 a.m.

EST at the Sheraton Tampa East, 813.371.5939. supervision. Those speaking in opposition to the change were: Drs. Don Ilkka (FDA), Merlin Ohmer (FLAGD), Richard Mufson (FSOMS), Bob Churney (FAP), Linda Trotter (FLAGD), Carol Stevens (representing herself as a former BOD member) and Matthew Hall (Dental Society of Greater Orlando). Please reach out to them and

thank them for their time and testimony in opposition to these rules. Those speaking Driscoli (Florida Allied Dental Educators) and Becky Smith (Florida Dental Hygiene Association). The BOD voted to uphold its original vote, which means that scaling and root planing and the placement of medicaments by hygienists will be moved to genthrough the regulatory process and will be reviewed by legislative committee.

meeting, it is suggested that you take the opportunity to attend and see the work of the BOD. It is much better to be a spectacases.

Director of Third Party Payer and Professional Affairs Casey Stoutamire, Esq., at

informal hearings not involving disputed

850.350.7202 or cstoutamire@floridadental.

issues of material fact and one voluntary

org.

NOW OPEN!

CALL FOR NOMINATIONS

www.floridadental.org

If you have not yet attended a BOD

If you have any questions, please contact

There were four disciplinary cases, two

GO TO floridadental.org/nominate for the FDA nomination form.

one patient death.

tor than a participant in BOD disciplinary

eral supervision. The rule is now moving

DEADLINE: All nominations must be received by Friday, Sept. 1, 2017.

meet the standard of care, substance abuse, failing to keep proper dental records and

in support of the changes were: Danielle

Nominations are reviewed by selected members of FDA leadership.

Recipients will be notified in December 2017 and can receive the physical award at the annual awards event, held in conjunction with the Florida Dental Convention in June.

relinquishments that dealt with failure to

2018 FDA AWARDS

AWARD CATEGORIES  Dental Team Member  FDA Public Service  New Dental Leader  FDA Leadership  FDA Dentist of the Year  J. Leon Schwartz Lifetime Service

July/August 2017

Today's FDA

19

FDA's Legal Team

Meet the FDA's Dynamic Duo

By Casey Stoutamire FDA DIRECTOR OF THIRD PARTY PAYER AND PROFESSIONAL AFFAIRS

“Why am I not getting reimbursed by XYZ insurance plan?” “Who do I call to make a complaint about XYZ insurance plan?” “I can’t believe XYZ insurance plan is no longer covering/reimbursing a build up for a crown!” “What is the FDA doing about insurance companies taking over my practice?”

The Florida Dental Association (FDA) is here to help! Recently, I

I look forward to working with you — and for you — on problems you are having with third-party payers in your practices! Feel free to reach out to me via email at cstoutamire@floridadental.org or on my direct line at 850.350.7202.

Ms. Casey Stoutamire, Esq., is the FDA’s Director of Third Party Payer and Professional Affairs. She graduated cum laude from Stetson University College of Law in 2009. She was a competitive gymnast for more than 15 years, and received numerous scholarship offers from various colleges and universities. As a neat party trick, she can still walk on her hands! Today, she enjoys running and cycling, spending time with family and friends, and kayaking with her dog, Gus.

became the FDA’s Director of Third Party Payer and Professional

Graham Nicol, Esq.

Affairs. That’s a fancy title, but what does it really mean for our

HEALTH CARE RISK MANAGER, BOARD CERTIFIED SPECIALIST (HEALTH LAW)

members? I am now your go-to resource on all things related to third-party payers in Florida — from private insurance plans to

I work alongside Casey as the FDA’s

worker’s compensation plans to Medicaid managed-care plans. I’m

Chief Legal Officer, and I love to talk

continuing to develop relationships with decision makers for vari-

with FDA members about any legal

ous insurance plans, Medicaid managed-care plans, the Agency for

and risk management areas other than

Health Care Administration (ACHA), Department of Health, Board

third-party reimbursement disputes,

of Dentistry (BOD) and other state and federal agencies regarding

which is Casey’s expertise. A few mem-

third-party payer issues. I can help you with things such as:

orable calls — all true! — over the years: q

q insurance and Medicaid managed-care plan reimbursement q contracting with insurance and Medicaid managed-care plans q filing complaints with the Office of Insurance Regulation and/or AHCA q general third-party payer questions q regulatory issues with the BOD For example, I recently was contacted by a member because one of the plans he was in-network with was no longer paying for code OHI 1330. I contacted the plan on the member’s behalf and within 24 hours, the plan had contacted the member and informed him they would be reprocessing all denials going back one year. Now, these results are a best-case scenario, but sometimes just having the FDA reach out to a decision maker at an insurance plan can bring an issue to their attention and for corrective action can be taken.

20

Today's FDA

July/August 2017

“I’m locking up for the night, it’s

dark and a disgruntled patient’s violent boyfriend is waiting for me in the parking lot. What should I do?” q “I’m remodeling my office. Is it OK for me to put carpeting in the operatories?” q “What can I do about the restaurant next door to me? It smells like three-week old garbage rotting in the sun and my patients are complaining.” q “Can I rinse out my gloves and reuse them? Also, I don’t want to buy a sharps container. Is it OK for me to use an empty coffee tin, put the lid on it and bury it in my backyard?” q “I saw one of my patients rear-end a car when leaving my parking lot. I have video of her doing it and can’t believe she just left the scene! What should I do?”

Please contact me at gnicol@floridadental.org or 800.877.9922.

www.floridadental.org

FDA's Legal Team

Sure, I can help you with routine questions about how long to keep medical records, etc., but unusual questions are what make my day!

Mr. Graham Nicol, B.C.S., is the FDA’s Chief Legal Officer. He graduated from the University of Florida and has practiced law for 30 years. He earned Florida Bar Board Certification as a specialist in health law in 1997 and is licensed as a health care risk manager.

He is married to Cynthia Jakeman, Esq., and they have a beloved daughter, Savannah, who is 23. A founding member of Canopy Roads Baptist Church, he once built a house by himself. He has zero chance of walking on his hands and, after two knee surgeries and gout, is just grateful when he can throw his leg over a motorcycle!

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July/August 2017

Today's FDA

21

Members‘ Opinion

Member Speaks Out on BOD The Law and Ethics of Over-delegation of Dental Hygiene Duties

Is it Unethical to Over Delegate Duties to Dental Hygienists?

By Dr. Dave Boden The Florida Board of Dentistry (BOD), with the urging of the Florida Dental Hygiene Association (FDHA), recently voted to expand the scope of practice of dental hygienists. The rules passed in December and upheld in a public rules hearing change the supervision level of scaling and root planing from indirect supervision to general supervision. There are both legal and — more importantly — ethical objections to this proposal.

Who sets the rules?

Dentistry is governed by Florida statutes passed by our legislature and by rules set by the executive branch of the Department of Health through the BOD. Both have the force of law, but statutes are superior to rules, and the latter cannot override the former.

How are ethics involved with the practice of dentistry?

Ethical behavior can best be defined as doing the right thing at the right time, independent of personal gain, even when no one is looking. Unlike a law, ethical behavior cannot be easily made clear by specific rules, but is rather a culture that supersedes rules. They are agreed upon principles to encourage honorable interactions between

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humans. In the case of dentistry, we assume the Hippocratic Oath when we receive our doctorate, and as American Dental Association (ADA) members, we voluntarily bind ourselves to the ADA Principles of Ethics and Code of Professional Conduct. We agree to this to prevent harm to our patients and promote honest, good and just interactions with them. Ethical principles and the law usually coincide because laws generally stem from an ethical culture. However, there are times when ethical principles are at odds with the law, and when that happens in American society, the American Medical Association (AMA) medical ethics state we must obey our democratically determined rules, but are obligated to work at changing those laws.

Laws determining levels of supervision in dentistry: Florida Statute 466.003 (8) “Direct supervision” means supervision whereby a dentist diagnoses the condition to be treated, a dentist authorizes the procedure to be performed, a dentist remains on the premises while the procedures are performed and a dentist approves the work performed before dismissal of the patient.

(9) “Indirect supervision” means supervision whereby a dentist authorizes the procedure and a dentist is on the premises while the procedures are performed.

(10) “General supervision” means supervision whereby a dentist authorizes the procedures that are being carried out, but need not be present when the authorized procedures are being performed. The

authorized procedures also may be performed at a place other than the dentist’s usual place of practice.

(11) “Irremediable tasks” are those intraoral treatment tasks that, when performed, are irreversible and create unalterable changes within the oral cavity or the contiguous structures or which cause an increased risk to the patient.

The administration of anesthetics other than topical anesthesia is considered to be an “irremediable task” for purposes of this chapter.

(12) “Remediable tasks” are those intraoral treatment tasks that are reversible and do not create unalterable changes within the oral cavity or the contiguous structures, and which do not cause an increased risk to the patient.

What the BOD has done On Dec. 22, 2016, in a BOD meeting held via conference call, the board voted to move periodontal scaling and root planing from indirect supervision to general supervision.

At the same time, they moved the period of time between doctor authorization for treatment from 13 months to 24 months.

This means someone two years out of high school could be authorized by the state to perform subgingival scaling and root planing unsupervised — for up to two years — and treatment could be delivered in a place other than the dentist’s usual place of practice. The Florida Dental Association (FDA) and Florida Association of Periodontists strenuously objected and the board

Please see OPINION, 24

July/August 2017

Today's FDA

23

Members‘ Opinion

OPINION from 23

held a public hearing on May 19, 2017 to reconsider. The BOD did not change its position.

During the phone meeting, I presented testimony, as a periodontist and career-long periodontal and hygiene educator, as to why this was unwise and prone to patient risk.

Furthermore, I testified that according to the ADA 2017 Code on Dental Procedures and Nomenclature (CDT) definitions: “Root Planing [is]: A definitive treatment procedure designed to REMOVE cementum and/or dentin that is rough, may be permeated by calculus, or contaminated with toxins or microorganisms” and “Scaling [is]: Removal of plaque, calculus and stain from teeth.”

Florida Statute 466.024 Delegation of duties; expanded functions.

(1) A dentist may not delegate irremediable tasks to a dental hygienist or dental assistant, except as provided by law. A dentist may delegate remediable tasks to a dental hygienist or dental assistant when such tasks pose no risk to the patient. A dentist may only delegate remediable tasks so defined by law or rule of the board.

Despite a board declaration to the contrary, root planing is, in fact, irremediable because tooth tissue is removed. Ask any of my dental students and they will state the same. Furthermore, it was pointed out in the meeting — and in writing — that there are risks to patients with root planing procedures. Removal of calcified body structures is hard tissue surgery, and unfortunately in many hands, inadvertent SOFT tissue surgery. In fact, when encountering

24

Today's FDA

July/August 2017

inflamed tissue (certainly an indication for root planing), it is all too easy to sever papillae, which requires closure by suture — something dental hygienists are not trained or licensed to perform, and certainly cannot be performed without a doctor present.

Furthermore, broken subgingival instruments happen often enough to require surgical removal — again, not within the scope of hygiene practice.

A member of the board declared: scaling and root planing was not an irremediable task; root planing was no different from scaling except by a small angulation stroke difference in the instrument; the strokes were light; and, that the ADA Code was out of date. It was clear this member had not done their homework, as I pointed out that the CDT was updated for 2017 in late 2016.

This member then proceeded to lecture me from a dental hygiene textbook. So, if root planing is no different than scaling, then why is root planing so much more expensive? My 32 years of teaching hygiene and periodontics to pre-doctoral dental students and post graduate residents, and 35 years of periodontal practice experience were dismissed out of hand by several board members.

So, to be clear: Root planing involves the irreversible removal of calculus, calculus buried in cementum, cementum and rough dentin. By definition, that makes it irremediable. State statute prohibits the delegation of irremediable tasks to a dental hygienist unless such tasks “… pose no risk to the patient.” Only remediable tasks may be delegated by rule of the board. It is plain to see that the BOD is violating the spirit of Florida law, if not the actual law.

Ethical concerns There are five ethical principles in the ADA Code and several more with the American College of Dentists (ACD), of which three apply in this BOD decision: nonmaleficence (do no harm), beneficence (do good) and veracity (truthfulness). It is clear that the treatment and maintenance of advanced periodontitis cases without close doctor supervision for up to 24 months, and the damage that can occur putting the patient at risk violates the tenant of nonmaleficence.

The BOD, by acquiescing to the dental hygiene society’s demand, in my opinion, is caving to a false principle of convenience for the hygienist and doctor of record, rather than of beneficence. According to the ACD, often considered “the conscience of dentistry,” the “dentist refrains from harming the patient by referring to those with specialized expertise when the dentist’s own skills are insufficient.” Thus, the BOD further violates the principle of beneficence by downgrading supervision in the delegation of duties to those of lesser training and expertise. After all, it is the patient’s safety and proper treatment, not operator convenience that is the guiding ethical principle.

Is the BOD being fully truthful and honest with the public they are entrusted to protect by weakening the standards of care for ordinary citizens of all economic backgrounds?

Furthermore, the board’s attempt to push this through without proper deliberation certainly violates the ethical principle of veracity.

Political Concerns The next question to be asked is: Why are they attempting this? The answer, I submit, is not so difficult to surmise. Under the false guise of increasing “access to care,” the

www.floridadental.org

Members‘ Opinion

sk ach a

se dvi

netw

nce coun da

l se

hip gui ns

Legal note: While the rule allows dentists to authorize up to 24 months, it does not mandate that you, as the dentist, do so. You are still the employer of your ancillary staff and can shorten the authorization. You can no longer expand it beyond 24 months. However, you still have authority to set the authorization for 13 months or six months, whatever period you think is appropriate from clinical and risk management points of view.

ills le

as de

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

mentorship program

co

Dr. Boden is the FDA secretary. He currently is a consultant for the FDA Governmental Affairs Committee, a fellow of the American College of Dentists and a regent for the International College of Dentists. He is a former FDA trustee and a past chair of the ADA Council on Ethics, Bylaws and Judicial Affairs. He is a graduate of the University of Michigan and has been in private general and periodontal practice for 35 years. His teaching experience includes the University of Michigan and currently Nova Southeastern University College of Dental Medicine.

The above opinions are his alone and not necessarily those of these institutions and organizations.

relat io

www.floridadental.org

Given our Hippocratic Oath, it is our duty to speak up.

ing i ork

It is for the reasons above that I STRONGLY recommend that you voice your concerns about this BOD behavior by going to http://floridasdentistry.gov/contact/. Failure

to hear our voices will result in a further degradation of dental care for Florida’s citizens.

gacy

FDHA is, yet again, relentlessly pushing the scope of their practice beyond the level of their training and expertise, with the goal of independent practice. They would argue that this will permit them to perform advanced periodontal treatment outside a dental office without the burden of a doctor’s direct or indirect supervision.

However, that will not be possible given that almost all true periodontitis cases requiring scaling and root planing of deep defects require administration of dental anesthetic, prohibited outside close supervision by a doctor, and often, prescription anxiolytics, which are illegal for hygienists to deliver — and for good reason, given the disparity of education in pharmacology of hygienists two years out of high school compared to eight years for a doctoral degree. Drugs are dangerous. My students know there is no such thing as a safe drug. Lack of knowledge with their interaction with the complexities of human biochemistry puts patients at risk when administered by auxiliaries who are minimally trained in pharmacology, and more so without the supervision of a doctor. Furthermore, a large proportion of patients with periodontal disease have complex medical conditions. Doctors know a lot can change in a periodontal patient’s medical history in 24 months, including modification of complex prescription protocols and changes in the fragility of health. Detection of the latter is far too often not verbalized by the patient, and detection requires close observation of a patient far beyond the training of a dental auxiliary.

Who Participates in the FDA Mentorship Program?

FDA member dentists volunteer their time and experience to provide professional guidance to dental students. A select number of dental students from each Florida dental school (LECOM, Nova and UFCD) will participate as protégés.

What Does It Involve?

Volunteering is easy: 1) Member dentists complete an online form at floridadental.org/ mentors; 2) The protégé selects a mentor from the bios available; 3) The protégé will contact the mentor via email; 4) The mentor contacts the FDA Director of Member Relations to inform the FDA that he/she has accepted a protégé.

Questions?

Contact Kerry Gómez-Ríos at membership@ floridadental.org.

July/August 2017

Today's FDA

25

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A Look Back ...

The Black Box Dedicated to Leonard I. Linkow (1926-2017), the dental implant pioneer who started my adventure.

By Dr. Lawrence B. Musser

I received a small, black box on my desk that was unceremoniously delivered by one of my staff. There was no bow or card attached to dazzle me. Of course, I thought the box must be from an admiring patient who was appreciative of what I had done to help them out of a tough spot in their life. It was not my birthday or Bosses’ Day, so I didn’t have a clue. The box opened easily, and inside was a lapel pin from the American Dental Association (ADA) announcing I was now a life member. This is a good thing, right? Although, maybe a little depressing to think it’s all you get for some 40 years of membership and service to the profession and community. I got over that thought and mused about the changes in my dental life from graduation day in 1973 to the paradigm shift of an oral surgery practice, prosthetic practice and dental lab working in harmony in the same building. I thought of my odyssey.

There have been changes that were tediously slow and then internet speed. No advertising was allowed in 1973. Now, we educate on TV and inform in some depth on the web. I’ve had success, and learned a lesson making a denture for my father. Failure stimulates the mind and propels us forward.

There was a quick three years of college on the fast track and early acceptance to dental school. I completed a three-year, low-tech oral surgery residence at Kansas City General Hospital and then moved to Lakeland, Fla. My certificate proclaimed I was an oral and maxillofacial surgeon. I was 27 years old.

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Today's FDA

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In school, I completed a paper on the current state of dental implants, which was not in much of a state at that time. I devoted a paragraph to fabricating a blade implant from pinkbase plate wax and casting it in the lab. No one knew what metal would be best for such a device. Implants were considered unprofessional at my Midwestern university, the University of Missouri-Kansas City (UMKC) School of Dentistry. Radical surgeons and some outrageous dentists in New York City were belittled by the faculty for their implant escapades.

Suddenly, the tide turned — an “implantologist,” Dr. Leonard Linkow, was invited to speak at UMKC. He gave a lecture on blade implants to a select few, including one of the brand new oral surgery residents: me!

As the youngest and most gullible first-year resident in oral surgery, I was selected to place a blade implant supervised by Dr. Linkow. The epinephrine of my success set in and I started talking about how wonderful these blade things were and how nice it would be to put four implants in the lower jaw so a patient could have fixed teeth. My father would have loved this, and it would have prevented him from removing his lower teeth at the dinner table.

Residency training did continue with its challenges. Opinions explode on impressionable gray matter. Orthognathic and TMJ surgery were in their infancy, and we tried to make dentures fit better with vestibuloplasties and skin grafts to the lower jaw. I left with the admonition to stay away from implants for now. There might be something coming from a Swedish guy named Branemark.

I joined Dr. Larry Cook’s conservative practice in Lakeland in 1976. My dental implant studies continued, and when ramus frame implants came along, my new partner, Dr. Harley Richards, and I did more than 100. It was a perfect answer for the lower denture. The first ramus frames were stainless steel. Later, we used Hilt Tatum’s titanium frames. We immediately loaded the implant with a removable denture that was held by friction to the bar around the arch. I did some subperiostial implants. Some of those implants remained in place for more than 30 years. One of my maxillary subperiostial implants deflected a .38 caliber bullet to prevent a suicide. I was speechless the moment my patient told her story, so I gave her a hug.

I had a lot of mentors. In St. Petersburg, Fla., Dr. Tatum created his own implant system and opened the window on the era of bone grafting the maxillary sinus and used various materials to encourage bone to grow. There were a lot of other mentors, including Dr. Carl Misch (1947-2017), who helped the world discover dental implants with the International Congress of Oral Implantologists.

www.floridadental.org

A Look Back ...

America’s implant companies began production of the basic “root form” implant around 1980. All dentists — regardless of training — were invited to try this technology with some disastrous results and some great successes.

Everyone followed the Branemark protocol — there was an arduous precession of surgery, waiting, more surgery and a “clip-on prosthesis.” We did hundreds of these and all our patients were grateful. They told me this was much better than their dentures, which made me happy. Finally, there was an answer to my dad’s denture problems, but he was gone in ‘76.

Fixed hybrid prosthetics evolved and my patients started to tell me that the teeth felt like their natural teeth. Humans can adapt and thrive with fixed teeth. Some patients have the feeling of natural teeth immediately, but most develop this with time. The fixed prosthetic teeth felt like their own teeth — and not just a better denture like the clip-on patients used to tell me. Amazing!

Twice a year for 20 years, we had Steri-Oss® (Nobel Biocare) speakers introduce dentists to the art of dental implantology. They brought slides and later, laptops. They were inspiring!

We assumed too much and only a few doctors sent us patients — and this was mainly single implants, not the truly needy edentulous or soon to be edentulous.

To be fair, it is hard to add something new if all is well. At that time, there was a steady flow of cosmetic dentistry. Why add implant dentistry? I remember one dentist telling me that he didn’t like to use the “I” word in his practice.

I now understand why the dentists didn’t refer patients for full mouth dental implant reconstruction. It was simple and I should have known. The patients who needed major implant reconstruction don’t go to the dentist.

I always thought the two-office implantology delivery system was a mistake. It is OK for a simple case, but it is usually too confusing and time-consuming for the patients. They lose interest or become overwhelmed with who is to do what, when and how much. I can’t tell you how many patients have expressed their frustration with this system. The professionals look silly.

Presently, at Florida Dental Implants, my implant coordinator and I look at the I-CAT scan with the patient. All options are discussed, along with fees and financing for complete treatment. They say, “Yes,” and they are in new teeth the next week. We call it “New Teeth Now.” This is the simple way it should be. The three surgeons at Florida Dental Implants do more zygoma implants than any practice in the world, according to Nobel Biocare. This allows us to treat atrophic maxillas or pneumatized sinuses without grafting. Our patients want their new teeth now.

We appeal to the underserved. Not the ADA’s definition, but still “underserved.” These patients have elected to not take care of their mouth because of fear and could not be reached

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in a conventional manner. Our media has reached the new “underserved.” It has given patients a new option to which they are entitled. It has been a message of renewed self-esteem, improved function and an end of dental fears forever.

Most of the patients who respond and come in for consults have teeth! They know their oral condition is terminal and can’t stand the thought of dentures. They responded to the media message of oral health in one day, while asleep.

Humans have a tenacious desire for teeth.

Natural teeth are the best and should be cared for, preserved, restored, cleaned and loved! We all agree on that. The underserved sometimes fall out of grace. We can give our patients a brand new set of fabulous white teeth that are fixed and never come out. We can do it in one day while under general anesthesia. Most people have little pain and take ibuprophen to manage this.

The teeth that go in on the day of surgery are acrylic and prefabricated. Patients wear these “test drive teeth” for six months, and then a final set of teeth are milled in zirconia. It has taken some time to make all this seamless, but it was worth the effort.

I have enjoyed my professional life, and have been blessed. I think I have continued to learn. Forty years is a long time to do anything, and I still want some more. What will be next?

Oh, by the way, have you given any thought to what you will write when your black box arrives?

Dr. Musser is an oral and maxillofacial surgeon and can be reached at lmusser@ mrllc.net.

July/August 2017

Today's FDA

29

Action for Dental Health

Florida’s Action for Dental Health Two-year Progress Report Florida’s Action for Dental Health (FADH) is a comprehensive effort developed by the Florida Dental Association (FDA) to improve the oral health and resulting overall health of all Floridians.

OBJECTIVE 1: Promote attainable dental care for the uninsured and underserved in Florida.

KEY STRATEGIES: Increase the effectiveness of the Medicaid dental program in providing preventive care and treatment.  When the FDA spoke with WFSU-FM about FADH in 2015, a caller raised concerns that some foster children in Florida could not get dental services through the Florida

FDA SUCCESSES 2017 FLORIDA MISSION OF MERCY IMPACT IN PENSACOLA  Patients treated: 1,767  Volunteers: 1,556  Value of care: $1.69 Million  Procedures: 12,058

2017 FLORIDA LEGISLATIVE SESSION PASSED AND SIGNED

BY THE GOVERNOR!  $200,000 to continue fluori-

dation efforts in 2017-2018.  $100,000 to support the

Donated Dental Services program

30

Today's FDA

July/August 2017

Department of Health (DOH). Within six months, the FDA and DOH collaborated and secured dental care services for foster children in eight counties.

Secure state funding for two coordinators to match special needs and medically compromised patients with volunteer dentists through Florida Donated Dental Services (DDS).  Since 1997, nearly 1,700 of Florida’s most vulnerable patients have received more than $6.9 million worth of donated dental treatment services.  In 2016, the Florida legislature appropriated $170,000 in the state’s budget for two full-time coordinators and operating expenses for DDS. Although the funds were vetoed by the governor, the FDA worked to educate the legislative and executive branches on the significant impact this program could have on reducing unnecessary costs to hospitals by providing dental care services at no charge to individuals who would otherwise end up seeking care in the emergency room.  During the 2017 Legislative Session, the legislature appropriated $100,000 to support the DDS program and the governor approved the funding in the state’s budget for fiscal year 2017-2018.

OBJECTIVE 2: Collaborate to maximize use and capacity of the current dental workforce to optimally serve Floridians with preventive and therapeutic dental care.

KEY STRATEGIES: Establish community dental health coordinator (CDHC) education programs at dental, dental assisting and dental hygiene schools in Florida, and incorporate CDHCs into the dental team.  Ten dental professionals from South Florida and Tampa graduated from Florida’s first CDHC program in 2016, where they received training to deliver oral health education, preventive services and assistance in navigating the health care system.

These CDHCs are now working in their own communities to help bridge barriers to oral health, such as poverty, geography, language and a lack of understanding of oral hygiene.

Support and expand the volunteer safety net programs, including the FDA-supported Project: Dentists Care (PDC) clinics and Florida Mission of Mercy (FLA-MOM) events.  The FDA Foundation’s 2014 and 2016 FLAMOM events provided more than 4,500 patients with more than 24,000 free dental treatment services worth $3.9 million.  In 2015-2016, the Foundation's PDC program provided more than 19,000 patients with more than $4.2 million worth of free dental care.

OBJECTIVE 3: Expand opportunities for public health dentistry to serve Floridians.

KEY STRATEGIES: Establish and adequately fund a dental student loan repayment program.  During the 2016 Legislative Session, the FDA successfully passed legislation to establish a dental student loan repayment program through dental care access accounts. Although the legislation did not become law, the FDA will continue its efforts to pursue legislative initiatives to support our focus on increasing access to dental care in rural and underserved areas.

Increase state supported funding for community water fluoridation.  Secured $200,000 to support community water fluoridation in communities throughout Florida. Water fluoridation is the most efficient, safe and cost-effective public health measure to prevent and repair tooth decay, as it reduces dental decay by 25-45 percent and provides $43 in savings in dental treatment for every $1 invested.

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Two-year Progress Report for Florida’s Action for Dental Health

ORAL HEALTH IN FLORIDA In 2014, more than 163,000 Floridians visited the emergency department for a dental-related issue at a cost of more than $234 million.1

CHILDREN’S ORAL HEALTH TOOTH DECAY is the most common chronic childhood disease

TOOTHACHES are the

5x

more common than asthma

reason children miss school.3

#1

30%

Only of children in Florida with Medicaid coverage visited a dentist in 2013, compared to a national average of 48%..4

20x

AND

Kids with TOOTH PAIN are

4x

30

vs.

%

FL

more common than diabetes in children.2

more likely to have a low GPA.3

48

%

U.S.

RURAL DENTAL HEALTH

vs.

700,000 Floridians live in Florida’s 30 rural counties.

RURAL

TOOTH DECAY is more prevalent in rural areas than in urban areas.

URBAN

More than

5

Rural communities have higher rates of seniors who experience tooth loss vs. urban communities.6

29 of Florida’s 30

rural counties

7

Key findings from a survey of nearly 15,000 Florida adults on their oral health. 8

30%

For nearly of adults , life is generally less satisfying due to the condition of their mouth and teeth.

1/3

MORE THAN of adults experienced , and 27% experienced pain.

1 in 4

experience anxiety related to their oral condition.

Two-thirds of adults shared they accept that as they grow old, they will lose some of their teeth.

2/3

50%

Nearly of low income adults avoid smiling due to the condition of their mouth and teeth

1 in 4 adults say that the appearance of their mouth and .

SOURCES: 1. U.S. Health and Human Services, Agency for Healthcare Research and Quality. http://www.ahrq.gov/ 2. www.mychildrensteeth.org/assets/2/7/ECCstats.pdf 3. www.ncbi.nlm.nih.gov/pmc/articles/PMC3482021/ 4. Florida’s Oral Health Care System. American Dental Association Health Policy Institute. www.ada.org/en/science-research/health-policy-institute/oralhealth-care-system/Florida-facts 5. Rural Assistance Center. Available at www.raconline.org/states/florida

6. Rural Healthy People 2010. Volume 1. The Texas A&M University System Health Science Center, School of Rural Public Health, Southwest Rural Health Research Center. Available at sph.tamhsc.edu/srhrc/docs/rhp-2010volume1.pdf 7. Health Resources and Services Administration, Health Provider Shortage Areas. datawarehouse.hrsa.gov/tools/analyzers/HpsaFind.aspx 8. Oral Health & Well-Being in Florida. American Dental Association Health Policy Institute. www.ada.org/en/science-research/health-policy-institute/ oral-health-and-well-being/Florida-facts

A SPECIAL THANK YOU TO HENRY SCHEIN CARES 2017 FLA-MOM PRESENTING BENEFACTOR

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

As a resident of Pensacola, Florida, I am very proud of the impact that the Florida Mission of Mercy made in the northwest Florida area this year. The free two-day dental clinic for the needy in the area had a huge impact by treating almost 1,800 patients. The most amazing part of the event for me was to see 1,500 volunteers who gave up their weekend to help others. As a member of Henry Schein Dental, I am very proud to be part of a company that contributes our time, talent, and treasure to “Doing Well by Doing Good.”

— Eric Blay Regional Manager AL & NW FL, Henry Schein Dental

FDA Foundation

The FDA Foundation is a Force for Good

By Dr. Robert Payne, FDA FOUNDATION PRESIDENT

These are exciting times at the Florida Dental Association Foundation (FDA Foundation), the philanthropic arm of the FDA! It is my desire to move the Foundation from an organization that dentists know little about to an energetic, vital, conspicuous and indispensable part of the FDA. At our last strategic planning meeting, the Foundation came away re-energized and refocused, and decided that our signature event would be the Florida Mission of Mercy (FLA-MOM). In the last four years, we’ve had a FLA-MOM event in Tampa, Jacksonville and Pensacola. All three were tremendously successful — from the fundraising for the events to the number of people treated to the value of donated care to the fellowship of the volunteer dentists, staff and all who helped with the events. Thank you all.

The Foundation has other programs that are under its purview. The Florida Donated Dental Services program is part of the Dental Lifeline Network, a multistate initiative of volunteer dentists and dental labs. A patient is matched to a volunteer dentist who restores the patient’s dental health, while a network of volunteer dental labs provides the prosthetic services. During the 2017 Legislative Session, the FDA secured $100,000 in the state’s budget, which was approved by the governor, to cover funding for staff and operating expenses.

Project: Dentists Care (PDC) is the other program the Foundation supports. PDC is a network of volunteer clinics throughout the state that provide free or reduced-cost treatment to those in need. We offer $50k in grants to these clinics to help and encourage them.

The Foundation also encourages our members to participate in volunteer activities at local, state and national levels — from local charities to Give Kids A Smile events, and even foreign mission trips. The Foundation also provides disaster relief for dentists in need throughout our state. This is an organization committed to improving access to care and improving the oral health of all Floridians.

I am excited about the future of the Foundation. My wish is that all the dentists in Florida will embrace and take ownership of our Foundation, and experience the joy of giving back. I hope every dentist will participate in some capacity — serving and giving to help others less fortunate. We encourage you to share your volunteer experience with us and to inspire others to support our Foundation and become an Emerald Club member.

Together, let’s make our Foundation a force for good in Florida.

Dr. Payne is president of the Florida Dental Association Foundation, and is a general dentist in Marianna. He can be reached at paynless@embarqmail.com.

www.floridadental.org

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BECOME A HEALTH-ENHANCER SMILE-RESTORER ESTEEM-BUILDER DIFFERENCE-MAKER LEGACY-CREATOR LIFE-CHANGER

Visit emeraldclub.floridadental.org to learn more and join the FDA Foundation’s Emerald Club.

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 IN-FORMATION 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.

Emerald Club

CREATE A LEGACY FOR ORAL HEALTH IN FLORIDA Join the FDA Foundation’s Emerald Club As leaders and champions for organized dentistry, every member of the Florida Dental Association (FDA) has a passion and drive to promote oral health in Florida.

Unfortunately, there is a critical need in our state to improve oral health. Every day, thousands of Floridians are experiencing severe dental pain and infection that is affecting their health, their self-esteem and their quality of life — from their ability to find employment to their ability to speak or chew properly.

Many of you have seen in your own practice or volunteer efforts the effect that a lack of dental care can have on a person’s mouth and overall well-being. It’s devastating.

The FDA Foundation serves as a catalyst for uniting volunteers and organizations to make a difference through better oral health.

From supporting Florida Donated Dental Services and statewide Project: Dentists Care clinics, and efforts to leading the annual Florida Mission of Mercy two-day dental care events, the FDA Foundation provides millions of dollars of life-changing dental care to those who are most in need.

www.floridadental.org

These efforts are making a difference by restoring smiles, providing critical oral health education, building self-esteem and the confidence to find employment, and changing people’s lives by improving their overall health and quality of life.

As Florida’s advocate for oral health, the FDA and the FDA Foundation also work collaboratively to champion policies to make oral health achievable for all Floridians. Our efforts provide tangible faces, stories and numbers to illustrate the significant need for better oral health programs and policies, which we highlight in engagement with statewide elected officials and media outlets.

But to continue to build on these efforts and make an impact, the FDA Foundation needs the support and charitable giving of our members. This month, we are launching the Emerald Club to recognize members who support the FDA Foundation and its efforts through sustaining membership and charitable contribution.

“

The FDA Foundation serves as a catalyst for uniting volunteers and organizations to make a difference through better oral health.

”

We invite you to become a part of the Emerald Club and create a legacy for oral health in Florida. For more information on the Emerald Club and the FDA Foundation’s efforts to change lives through oral health, please visit www.emeraldclub. floridadental.org.

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Mission of Mercy

By Dr. Leo Cullinan, FLA-MOM STATEWIDE COMMITTEE CO-CHAIR

The Florida Mission of Mercy (FLA-MOM), the signature program of the Florida Dental Association Foundation (FDA Foundation), is an annual, two-day event with a large-scale dental clinic that provides oral health care at no cost to patients of all ages who otherwise cannot afford or access care. Nationwide since 2003, MOM clinics have provided nearly $163 million in dental services to more than 249,000 patients. Since its 2014 inception in Florida with events in Tampa, Jacksonville and most recently, Pensacola, more than 5,471 dental and general volunteers have provided more than $5.59 million in free care to 6,227 patients.

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www.floridadental.org

Mission of Mercy

Dr. Terry Buckenheimer has always espoused the belief that it is important to be part of something that is bigger than we are.

It is this enduring theme that Terry championed amongst his fellow board members within the FDA Foundation for many years.

The result in 2014 was the FLA-MOM. The FLA-MOM story is unusual in that it has a beginning, a fantastic story line with colorful, passionate characters and impactful chapters to an endless series of books chronicling how we’re making a difference in the lives of so many people. It’s about vision, inspiration, an evolving organization and process, with short- and long-term goals, and a call to action.

A FLA-MOM Statewide Committee was formed to pursue two parallel tracks. One track includes short-term/event-focused goals, including: 1. relieve pain for as many patients as possible.

2. have outstanding, first-class events with the highest standards of organization and care.

3. raise awareness of need and existing resources vis-à-vis the FDA, the Foundation, local nonprofits, Project: Dentists Care clinics, media outlets, etc.

www.floridadental.org

4. develop strategic relationships with community partners and corporate sponsors to help those in need.

5. promote positive and professional goodwill within our professional circles, our communities and across the state.

6. encourage all Florida dentists to support organized dentistry through membership in the FDA with enthusiastic support for the FDA Foundation, the philanthropic arm of the FDA. 7. develop systems and best practices for the FLA-MOM program to establish a knowledge base and organizational structure to ensure successful events.

8. hold yearly events throughout the state in each of the FDA’s districts.

The second track includes long-term goals: 1. Foster “higher level” discussions and planning to: a. raise awareness of the access-to-care problem. b. bring professionals from within and outside organized dentistry together with legislators and community partners across the state to develop a more permanent solution to the access-to-care issue and maximize resources.

c. develop the means (medium) to educate and encourage our colleagues to embrace the “service component” of access to care throughout the year. d. assess the viability of purchasing our own equipment. e. leverage FLA-MOM fundraising activities to support other important Foundation programs. f. develop and mentor our “pool” of FLA-MOM leaders to sustain and expand the program.

We invite you to become involved in this great program — to be a part of the story. A call to action goes out to all FDA member dentists across the state to sign up for our next FLA-MOM event at the Lee County Civic Center in North Fort Myers on March 9-10, 2018, and encourage non-members to join us to support great programs like the FLA-MOM. For more information, go to www.flamom. org or contact any one of our FLA-MOM Statewide Committee Co-chairs: Dr. Nolan Allen, nwa@ij.net; Dr. Leo Cullinan, lrcullinan@comcast.net; or, Dr. Andy Brown, abrown@bot.floridadental.org.

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The Impact of Data

Impact Study

Impact Study

By Dr. Jolene Paramore, FDA PRESIDENT-ELECT

The Florida Mission of Mercy (FLA-MOM) is a charitable community service project of the Florida Dental Association Foundation (FDA Foundation), serving thousands of Floridians in need of dental care. It also is a bright light revealing the oral health status of those who attend, a beacon to guide state legislators and other community leaders to a better awareness of the importance of oral health. How do we keep people focused on our light? How can we leverage our volunteers’ efforts for a more long-term effect?

Our answer is the FLA-MOM Impact Study. In a first-of-its-kind scientific study, demographic and health characteristic data was gathered at the 2016 FLA-MOM in Jacksonville and again at the 2017 FLA-MOM in Pensacola. It will be used to strategically plan for and sustain future FLA-MOM clinics and aid in modeling emergency department (ED) dental referral programs.

Knowledge is needed to effect real and lasting change in the oral health of our citizens. Through collection and effective dissemination of the data, “after-MOM” efforts will help guide communities toward more definitive and long-term solutions to achieve oral health equity for citizens underserved by the present system.

The Impact Study initially focuses on the effect of a FLA-MOM on ED use for dental problems. Between 2005-2014, dental-related ED visits increased by 44 percent! A total of 163,906 ED visits, which represents more than $234 million in charges, occurred in Florida in 2014 alone. A patient generally leaves the ED with an antibiotic and pain medication along with instructions to go see a dentist. Since the data shows the majority of FLA-MOM patients are living at or below 250 percent of the Federal Poverty Level (FPL), options for care are limited, often due to finances.

The exposure of the FLA-MOM Impact Study data to the Jacksonville hospitals, as well as the media associated with the event, has increased the level of interest in the dental needs of a population that has been largely ignored until the last few years. There has been an increase in the number of organizations wishing to find ways to deliver dental care in conjunction with their medical outreach events. The Impact Study results thus far have resulted in multiple opportunities that will benefit our community for years to come.

A local hospital involved in the FLA-MOM event purchased a three-operatory dental bus to use within the community. Armed with the 2016 FLA-MOM data from the ZIP codes that have the highest use of the ED for dental problems, health inequities can begin to be addressed that keep residents from a dental home.

Twenty-seven percent of patients from the 2016 FLA-MOM event reported a visit to an ED. This is consistent with data from a local federally qualified health center (FQHC). Pre-FLAMOM, 25-40 percent of the FQHC’s patients sought care at an ED. After the FLA-MOM, the FQHC “patients seeking care at an ED” percentage has fallen to 13-18 percent. In addition, the FQHC has seen a 20-30 percent increase in patients seeking emergency care since the FLA-MOM. The dental director attributes this to the increased awareness of the need for definitive dental care for those living at or below the FPL.

www.floridadental.org

Since March 2016, the Sulzbacher Clinic in Jacksonville has worked with Veterans Affairs, a local hospital and a local cancer center to deliver dental care to their target populations. Because of these collaborations, more patients are being treated and the community at large is becoming more informed on the effects of oral health on overall health and well-being.

Currently, dental students from the University of Florida College of Dentistry on their extramural rotation are involved in assessment of disabled children and adults to determine their dental needs and options for obtaining the necessary care. Patients who may be able to be treated in an outpatient setting may be referred to the FQHC for definitive care.

Motivated Foundation FLA-MOM volunteers, armed with data from the Impact Study, have the power to build the “after-MOM” effect by engaging local stakeholder groups and other interested entities.

It is obvious to those who are tracking these numbers and seeing these collaborative efforts come to fruition that the effects of the FLA-MOM extend far beyond the two-day event. The study provides a framework for forward thinkers to use the data to formulate a model for delivery of care that makes sense for hospitals and patients alike.

Some say knowledge is power, but only if action accompanies knowledge. By itself, knowledge is just power waiting to be unleashed. We know there are volunteers among Today’s FDA readers who care deeply about changing the oral health landscape for the better. What action will you take to help us effect real change?

Dr. Paramore is the FDA President-elect and the FDA Foundation FLA-MOM Impact Study Lead, and can be reached at jparamore@bot.floridadental.org.

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THREE SUCCESSFUL YEARS FLA-MOM STATEWIDE IMPACT! 2017 PENSACOLA • 2016 JACKSONVILLE • 2014 TAMPA

PATIENTS TREATED PENSACOLA: 1,767 JACKSONVILLE: 2,800 TAMPA: 1,660 TOTAL: 6,227

VOLUNTEERS PENSACOLA: 1,556 JACKSONVILLE: 2,465 TAMPA: 1,450 TOTAL: 5,471

VALUE OF CARE PENSACOLA: $1.69 MILLION JACKSONVILLE: $2.75 MILLION TAMPA: $1.15 MILLION TOTAL: $5.59 MILLION

PROCEDURES PENSACOLA: 12,058 JACKSONVILLE: 16,228 TAMPA: 8,017 TOTAL: 36,303

2018 FLORIDA MISSION OF MERCY MARCH 9-10, 2018



FORT MYERS, FLORIDA

REGISTER TO VOLUNTEER AT WWW.FLAMOM.ORG 800.877.9922 • FLAMOM@FLORIDADENTAL.ORG

A SPECIAL THANK YOU TO DENTAL PC 2017 FLA-MOM PRESENTING BENEFACTOR

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

A SPECIAL THANK YOU TO THE SCHOOL DISTRICT OF ESCAMBIA COUNTY 2017 FLA-MOM PRESENTING BENEFACTOR

Thank you to Woodham Middle School for hosting the 2017 FLA-MOM!

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

WOODHAM MIDDLE SCHOOL • PENSACOLA

Friday, March 24

Woodham Gym tranforms into dental clinic.

Wednesday, March 22

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Duane's Story

Duane’s Story: A Follow-up from FLA-MOM 2014-Present

“

Today, Duane continues to enjoy excellent health and is proud to tell everyone who compliments him on his great smile that he was fortunate to receive his excellent dental care at the inaugural FLA-MOM event. He states that people take him more seriously now, and therefore, he has been given more opportunities and increased responsibilities at the job he was able to secure after the FLA-MOM. He says that it is all related to his positive attitude and the confidence he gained since his dental treatment. “Nobody ever gave me a chance because of the way I looked,” he says, “but now I am able to communicate so much better with the people I come into contact with at work.

They trust me more now and know that I am a self-starter, so they leave me alone to complete my work more efficiently and effectively.”

Nobody ever gave me a chance because of the way I looked.

By Dr. Nolan Allen, FLA-MOM STATEWIDE COMMITTEE CO-CHAIR

”

You may recall Duane Wagner’s story, which began in March 2014 at the Florida Dental Association Foundation’s (FDA Foundation) inaugural Florida Mission of Mercy (FLAMOM) event in Tampa. Duane had volunteered to work all day to assist in setting up our 100-chair clinic, and he was a whirlwind of both energy and enthusiasm in getting the job done on time. He knew that the faster he got the job done, the more likely he would be the first patient to receive treatment the following day. He was the first volunteer there on setup day and the last to leave that night.

Duane got his wish the next morning when he was the first patient to be treated, and his case proceeded like clockwork. After 20 extractions and the placement of an immediate maxillary complete denture and a mandibular removable partial denture, Duane left the clinic floor showing off his beautiful new smile to everyone in his path while saying, “I feel great!”

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Duane is looking forward to volunteering next March 8 to set up for the 2018 FLAMOM at the Lee County Civic Center in North Fort Myers. Please consider joining Duane for the event on March 9-10, 2018 — and encourage non-FDA members to join us in our efforts — as we strive to provide free oral health care for as many as 2,000 patients who otherwise cannot afford or access care.

For more information, go to www.flamom. org or contact any one of our FLA-MOM Statewide Committee Co-chairs: Dr. Nolan Allen, nwa@ij.net; Dr. Leo Cullinan, lrcullinan@comcast.net; or, Dr. Andy Brown, abrown@bot.floridadental.org.

www.floridadental.org

Dental Lifeline

Dental Lifeline Network: Q&A with Dr. Michael Eggnatz

BY DENTAL LIFELINE NETWORK

Dr. Michael Eggnatz has been a volunteer for Dental Lifeline Network’s (DLN) Florida Donated Dental Services (DDS) program since 1997. He not only volunteers with the program, but also serves as the DLN • FL treasurer/secretary. Dr. Eggnatz received the Florida Dental Association’s (FDA) Leadership Award in June, and the newly installed FDA president exudes what it means to be a dedicated dental professional with a compassion for others.

DLN took some time to sit down with Dr. Eggnatz and get his perspective on what it means to be a volunteer for DDS.

Q: What is your experience with DLN and the DDS program like?

A: My experience with DLN and DDS has been extremely rewarding, personally and professionally. Knowing that you are helping patients who have no means to afford necessary care is a great feeling.

Q: Why is the DDS program important to you?

A: The appreciation level of the patients we treat is extremely high and very sincere. I often hear of people who are involved in mission trips abroad, taking care of people in other countries. I think that is wonderful, but I also think there is a tremendous need here at home in my own community.

Q: How long have you been involved with DDS? Why do you continue to be involved?

Q: Why do you think DDS is important for other dentists/labs to take part in?

A: It is important for programs like DDS to exist because they serve multiple purposes. First, is the obvious needed treatment for the patients. Second, the ability to demonstrate to the legislature the value of the work that we are providing for this population, will hopefully prove the need for additional state and private funding for additional care.

Q: Why is it especially important for programs like DDS to exist?

A: I feel I can more effectively and comprehensively treat more people with my own staff and laboratories than I could in any other location. I find helping these patients, who don’t qualify for any other assistance, to be extremely satisfying, in part, because many of them tell me no one has ever treated them with the dignity and respect that they have received in my office. I find them to be amongst my most appreciative patients in my practice.

Q: What is the DDS experience like for your entire staff?

A: Giving people the dignity and respect they normally do not receive is a gift for our office to share with each other. My staff has had the opportunity to share the joy of giving care to our DDS patients.

They see, feel and hear the appreciation of these patients and they play a vital role in our patients feeling they are being treated with the respect and integrity I referenced above. This brings our entire staff together for a great cause and our office is better for it.

A: I have been involved with DDS/DLN for 20 years and have enjoyed every moment of it.

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www.floridadental.org

Dental Lifeline

Dr. Eggnatz pictured with his staff and a recent DDS patient.

Q: What would you say to another dentist, who is on the fence about volunteering for DDS?

tients express their gratitude. After experiencing that, they will want to be involved on a more constant basis.

A: I believe if other dentists experienced the joy of the sincere appreciation these patients express after treatment, then more dentists would volunteer their services more often. I would challenge any dentist who is on the fence about volunteering for DDS to move forward and experience the same rewarding feeling when these pa-

The ability to change people’s lives, doing what we know how to do every day, becomes a reward in itself. This program has become one of the most unexpectedly fulfilling experiences of my career.

www.floridadental.org

July/August 2017

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Project: Dentists Care

Fort Myers PDC Makes Impact on Patients and Volunteers

By Dr. Bill Truax

In 1996, former Florida Dental Association (FDA) member, Dr. Hal Haering, and I started Project: Dentists Care (PDC) in Fort Myers. After three relocations, the Fort Myers PDC now is housed in my office building — with 1,000 sq. ft. and four operatories.

Scope of Treatment Seventy-five percent of our patient procedures are extractions. For the most part, these are difficult surgical procedures. We also perform white and silver fillings — from one surface to five surface fillings with multiple pins. Specialists perform some surgery, and endodontic and prosthodontic procedures in their offices for us.

Funding A $10,000 grant from the FDA Foundation enabled us to pay for most of our remodeling expenses when we converted a law practice into a dental office. The remaining remodeling funds were donated by the Rotary Club. Private donations have been wonderful — amounting to more than $40,000. The Lee County Health Department, United Way and Lee Hospital also have helped.

Patients Fort Myers’ PDC is the only place to get a tooth pulled for free in Lee County. We see many emergency-room patients who have been given antibiotics and pain pills at the hospital, but still need an extraction. At the clinic, we see anyone — for free — who makes less than 200 percent of the poverty level.

A Legacy Dentistry has been good to me. I started in this building in 1976.

My son graduated from the University of Florida in 2008. Since then, he and several of his colleagues have given many hours to PDC. We now have more than 50 dentists volunteering for fourhour clinics held three days a week. www.floridadental.org

Giving Back “To whom much is given, much is expected.” We, as dentists, have the responsibility to give back to the community. In Lee County, I am the only advocate for indigent dental health. It gives me great satisfaction to have this honor. We welcome all dentists as volunteers, even if they have no Florida license. If a dentist holds a valid license from another state, we can get them a charity license to work at the clinic.

The clinic is located at 2051 McGregor Blvd. in downtown Fort Myers, close to the Edison home. Dr. Truax can be contacted at 239.470.1302.

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Project: Dentists Care

LOOKING FOR A VOLUNTEER HOME? THESE CLINICS ARE LOOKING FOR YOU! AS PART OF THE PDC NETWORK, THEY PROVIDE A SAFETY NET OF PREVENTIVE AND RESTORATIVE DENTAL CARE TO THOSE IN GREATEST NEED. Project: Dentists Care Inc. (PDC) is a nonprofit, charitable organization formed in 1993. Many FDA members volunteer their time and services with PDC organizations to provide oral health care to the underserved.

Last year, PDC affiliates reported that more than 19,000 patients received $4.2 million in donated dental care. In order to provide this kind of care, many PDC clinics rely greatly on volunteers. Below is a list of PDC clinics throughout the state of Florida that are currently in need of volunteers.

The mission of PDC is to establish dental-access programs statewide. Patients who receive services under PDC are typically low-income individuals who don’t qualify for public assistance but have the greatest unmet needs. Each PDC chapter is registered with the Florida Department of Agriculture and Consumer Services (Solicitation of Contributions) and tax-exempt under section 501(c)(3) of the IRS code. Besides providing dental care to underserved population groups, member and associate organizations provide valuable data on the pro bono and reduced-fee services they provide. This assists the FDA in presenting a more complete picture of the community service provided by volunteer dentists working in the private and nonprofit sectors.

ACORN DENTAL CLINIC

CITY RESCUE MISSION

Address: 23320 N. State Rd. 235, Brooker, FL 32622 (outside of Gainesville) Contact Name: Laurie Jennings Contact Phone Number: 352.485.2772, Ext. 16 Contact email address: ljennings@acornclinic.org Clinic/Program hours: Monday-Thursday, 8 a.m.-4 p.m.; Friday 8 a.m.-12 p.m.

Website: www.acornclinic.org

Address: 426 McDuff Ave. S., Jacksonville, FL 32254 Contact Name: Kim Kilby Contact Phone Number: 904.421.5140 Contact email address: kkilby@crmjax.org Clinic/Program hours: Tuesday, Thursday and Friday 8 a.m.-5 p.m.

Website: www.crmjax.org

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www.floridadental.org

Project: Dentists Care MISSION SMILES MOBILE DENTAL TRUCK

PROJECT DENTISTS CARE OF SOUTHWEST FLORIDA

Address: 801 E. Hillsborough Ave., Tampa, FL 33604 Contact Name: Kathy McGartland, RDH, Program Manager Contact Phone Number: (office) 813.236.6237, (cell) 813.601.3783 Contact email address: kathy@missionsmiles.org Clinic/Program hours: One to two clinics per month on Saturdays in Hillsborough County, two clinics per year in Pinellas County.

Website: www.missiontampa.org Needs: dentists, hygienists, dental assistants

Address: 2051 McGregor Blvd., Fort Myers, FL 33901 Contact Name: Dr. Bill Truax Contact Phone Number: 239.470.1302 Contact email address: commandercavity@comcast.net Clinic/Program hours: Wednesday, 5-9 p.m.; Friday, 8 a.m.-12 p.m.; Saturday, 8 a.m.-12 p.m.

Website: www.projectdentistscare.org

VIM/HANDS CLINIC NEIGHBORHOOD HEALTH CLINIC Address: 121 Goodlette Rd. N., Naples, FL 34102 Contact: Laurie Heaver Phone: 239.529.2255 Email: dental@neighborhoodhealthclinic.org Clinic Hours: Monday, Tuesday, Thursday and Friday, 9:30 a.m.-5 p.m.

Every other Wednesday, 9:30 a.m.-5 p.m. and every other Saturday, 8:30 a.m.-12 p.m.

Website: www.neighborhoodhealthclinic.org

OSCEOLA CHRISTIAN MINISTRY CENTER Address: 700 Union St., Kissimmee, FL 34741 Contact: Roberta Warden-Miller Phone: 407.847.0234 Email: bobwar38@gmail.com Clinic Hours: Usually Friday mornings, 8:30 a.m.-12 p.m., but other days can be scheduled.

Address: 3855 S U.S. Hwy 1, Ste. B, Fort Pierce, FL 34982 Contact Name: Kelly Collins Contact Phone Number: 772.429.4380 Contact email address: kelly.collins@handsofslc.org Clinic/Program hours: Monday-Friday, 9 a.m.-5 p.m.

Website: www.handsofslc.org

WILDFLOWER CLINIC Address: 268 Herbert St., St. Augustine, FL 32084 Contact Name: Marian Patrick Contact Phone Number: 904.829.1962 Contact email address: volunteers@goodsamstaug.org Clinic/Program hours: Monday and Tuesday, 8:30 a.m-4:30 p.m.

Wednesday, 8 a.m.-4 p.m.

Thursday, 8:30 a.m.-4 p.m.

Friday, 8 a.m.-4:30 p.m.

Dental clinics for extractions, fillings and cleanings are held Mondays, Wednesdays and Fridays.

Website: www.goodsamstaug.org

DENTAL LIFELINE NETWORK • FLORIDA DONATED DENTAL SERVICES (DDS) PROGRAM Address: 1113 E. Tennessee St., Ste. 300, Tallahassee, FL 32303 Contact Name: Megan Manor, Florida Donated Dental Services (DDS) Program Coordinator Contact Phone Number: 877.224.3969 • Contact email address: mmanor@dentallifeline.org Clinic/Program hours: Contact for additional information.

Website: www.dentallifeline.org/our-volunteers/volunteer-now or www.dentallifeline.org/florida DDS volunteers provide comprehensive dental treatment to people with disabilities or who are elderly or medically fragile, and have no other way to get help. Volunteering though DDS is easy — patients are prescreened, you review the patient profile in advance, determine your own treatment plan, see patients in your own office, never pay lab costs and no extra paperwork. Volunteers currently are needed throughout the state of Florida. DDS is supported by the FDA Foundation. www.floridadental.org

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LECOM Volunteer

By Sable Muntean, LECOM

The Wildlife Student Dentist

It’s Saturday morning and I am on my couch eating breakfast when I come across a TV show called “The Wildlife Docs,” filmed at Busch Gardens in Tampa. I see the veterinarians working on a gorilla and providing it with its routine physical. As the show continues, they mention that because a lot of animals are like humans, they bring in “human doctors,” such as gynecologists and, you guessed it — DENTISTS! At that moment, the camera pans out to show Dr. William Geyer, the dentist who treats the animals at Busch Gardens. Wow! I assumed that he needs to be local, so I began my detective work to find him and learned that he practices in Lutz, Fla., so I sent him an email.

As the new president of LECOM’s chapter of the American Student Dental Association (ASDA), I wanted to come up with some out-of-the-box speakers to bring in for our Dinner and Dentistry meetings, and who better than a dentist who works on animals? Dr. Geyer promptly responded to my email and the date was set for him to present at our meeting.

During his presentation, he mentioned that he soon had to pay a visit to “Lana the Lesser Bush Baby” who had generalized chronic severe periodontitis. He showed us pictures of this adorable animal that could fit in the palm of a hand and had the biggest eyes for such a small creature. At the end of the evening, I asked Dr. Geyer if I could join him at Busch Gardens the weekend he was working on her and to my joy, he said, “Of course!”

On Sunday, Sept. 4, 2016, I met with Dr. Geyer, and headed over to meet Lana. As the staff brought her in, she was in a little, dark crate and all you could see were her big eyes. Lana was due for a cleaning and was so small that the nitrous mask was too big for her, so we needed to alternate between sedating her with it, cleaning her teeth and putting it back on for a few seconds. We knew she was waking up when her little tongue would stick out, which you can imagine was adorable. After her cleaning, we applied fluoride varnish and she was good to go until her next cleaning in three months.

You would think she would be brushing and flossing in the meantime, right?!

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On Aug. 24, 2016, the “wildlife dentist” came to our ASDA meeting, joined by a huge crowd of students who could not wait to hear about what his life entails. He practices general dentistry every week, and on weekends, he comes into the amusement park to see his more “furry” patients as needed. Dr. Geyer immediately captured the audience’s attention with his genuine demeanor, kind introduction in which he related himself to us as students, and stunning pictures and stories with the various animals he works with.

I literally said, “Lions and tigers and bears, oh my!” as he has worked on them all. From root canals to simple cleanings to extractions to fillings — he has done it all. I was simply amazed at the humility he had with being able to have such an opportunity as a dentist.

“Lana the Lesser Bush Baby” is about to be treated for generalized chronic severe periodontitis.

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www.floridadental.org

Nova Volunteer

By Victoria Gandarillas, Nova

Early on, my contribution included setting up for the event, greeting children and parents, helping with face painting, coloring and giving away prizes. Once I became a part of the College of Dental Medicine Class of 2018, I was that much closer to fulfilling my dream of becoming a dentist, and my volunteer efforts and commitment to GKAS flourished during my first three years of dental school. I was given executive roles to help plan the annual events, as well as the kickoff event we hosted in 2016, organize roles for volunteers and participate in providing preventive dental services to the children. Now as a fourth-year student, I have the privilege

This year, we have a strong-willed GKAS executive board of students who have started planning for the months leading up to this fun-filled community service event. So far during the summer term, we have put in many hours of hard work and commitment to meet and organize this year’s theme; plan recruiting efforts for local schools and Boys and Girls Club programs; design flyers to network within the area and through social media; recruit dental students to help coordinate GKAS efforts; communicate with sponsors; and, reach out to volunteers from local Pre-Dental Societies.

With our hard work and dedication, we hope we can provide free pediatric dental services to more than 300 children for the 2018 GKAS event. Nova looks forward to this event every year and we are fortunate to gain many volunteers not only within our dental program, but also through the interprofessional programs of pharmacy, optometry and osteopathic medicine that teach the children the importance of body wellness. As a community event, our dental program is continuously open to the volunteer efforts of local dentists as well as local pre-dental students.

GKAS is a truly rewarding event, and I invite students and dentists to reach out to their local dental school to become involved and experience the wonderful efforts that go toward creating this special day. Although a lot of hard work and planning goes into making this grand, special day once a year, the rewarding experiences and memories last a lifetime.

Over the years, GKAS has not only allowed my volunteer experience to grow, but also has influenced my career goal of becoming a pediatric dentist. Being involved with GKAS has sparked my passion and filled a place in my heart for what I feel is my true calling to the community and my future.

Victoria Gandarillas is a Nova Southeastern University College of Dentistry DMD candidate, Class of 2018, and can be reached at vg291@mynsu.nova.edu.

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July/August 2017

GKAS Influenced My Career Goal

I aspired to become a dentist from the very beginning of my undergraduate career at Nova Southeastern University, and I knew that I wanted to contribute to the community through any volunteer efforts I could. During my freshman year, I became involved with the College of Dental Medicine through their undergraduate Pre-Dental Society, which gave me the opportunity to volunteer at Nova’s biggest volunteer event, Give Kids A Smile (GKAS). As a schoolwide event, hundreds of students, faculty and staff volunteer their time and efforts to provide free comprehensive pediatric dental services to underserved children and special needs patients in the South Florida community.

to be a co-director and the honor of joining the American Dental Association Foundation’s continuing efforts in celebrating its 16th anniversary of the GKAS program in February 2018.

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LECOM Volunteer LECOM from 52

After cleaning up post-treatment, the veterinarian said that “Mikey the Red Kangaroo,” who tends to be the more jovial one of the bunch at Busch Gardens, was not as gregarious with his kangaroo friends and the park visitors as he tends to be. Since Dr. Geyer was there, she asked if he could stay to take a look at his teeth, just in case there was something going on intra-orally that was causing the problem. Before Dr. Geyer could answer, I turned and gave him a huge smile that obviously read, “Please say yes because I cannot contain the excitement in me any longer.” Once Mikey was sedated, he was brought over to the examination room and was more massive than I would have imagined. I had the opportunity to pet him and take a picture, and I just kept praying he was not going to wake up and start hopping around. We took a look inside his mouth, and he definitely lacked anterior guidance, but overall was in good oral

health. Since there was nothing unexpected intra- or extra-orally, Mikey was kept by the veterinarians to do blood work and take radiographs to figure out what was wrong, and we left the premises.

I never thought that one morning of flipping through channels would lead to the experiences I have had and the relationship I have built with Dr. Geyer, and ultimately writing this article, but I encourage anyone to branch out and learn about the multitude of opportunities there are as a dentist — and even a dental student!

Sable Muntean is a LECOM School of Dental Medicine DMD and MHSA Candidate, Class of 2018, and can be reached at Sable.Muntean@dmd.lecom.edu.

“Mikey the Red Kangaroo,” is anesthesized to receive a dental exam at Busch Gardens as Sable Muntean observes.

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2.

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3.

UF Volunteer

By Taylor Rae Vracar, UF

$160.

On Oct. 14, 2012, a fire was set in my heart when a man named Missionary Sam traveled from Southeast Asia to share his story with my church in Gainesville, Fla. His story went something like this: I grew up in a culture where kids with bad karma were sent to be part of the child slavery industry. It’s not illegal — it’s the norm where I’m from. When I got older, I realized that I didn’t agree with that system. I wanted to find a way to stop it.

I traveled to one of the brothels down the street from my house to see how it all worked. When I arrived, I saw a man sitting on a cardboard box. He asked me how I heard about their business and what I was interested in. He said he could sell me a “fresh” girl for the low price of $160 and she would be mine to keep.

When I handed over the money, he jumped off the box, picked it up, and under it was a shivering, petrified 6-year-old girl who was given to me to do whatever I wished with her. All I wanted to do was clobber the guy, but I knew that wouldn’t solve the problem. That was the moment I dedicated my life to fighting for a solution.

Missionary Sam then went on to share about the organization he created, called Life for the Innocent (LFTI). Their mission is to rescue, restore and renew children affected by human trafficking. These children have been used as a commodity

I knew I had to get involved. I found myself dreaming about how I could support LFTI with my future practice, but being so busy in dental school, I figured I’d just hang tight until I graduated. It’s not like I had any sort of money to give to the organization now. But all I kept hearing in my head and my heart was, “Why do you have to wait until you have a paycheck to support this organization? Why don’t you do something now, Taylor?”

So, in 2015, I organized a 5K race in my hometown of Venice, Fla., where I hope to return to work after graduating from dental school. With absolutely no experience in organizing an event like this, my expectations weren’t very high for this race. I guess when dollar signs are placed on the lives of innocent children, though, it can fire up a community to take a stand.

Nearly 300 participants came to support this cause, and we were able to raise more than $8,000 for LFTI — allowing more than 50 children to be rescued! My mind was blown at the support of the community!

Since the 5K, I have gone through training with LFTI to become the Florida ambassador for the organization. I am currently applying to orthodontic residency programs and hope to own a private practice in the future. On behalf of every patient that I treat, my desire is to take a portion of money right off the top of whatever would go into my pocket to rescue a child from a life of slavery.

I desire nothing more than to “save a smile to save a child” — one patient at a time.

Taylor Rae Vracar is a University of Florida College of Dentistry DMD candidate, Class of 2018, and can be reached at tcapasso@dental. ufl.edu.

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Save a Smile to Save a Child

What if I told you that was all it took to literally save a child’s life?

When I heard it, I couldn’t empty my pockets fast enough.

for sex, labor and even organ harvesting. After rescuing these children, LFTI provides housing, education, food, clothing and medical attention for eight months to rehabilitate the children. Perhaps the best part is that after they are rehabilitated, LFTI has a waiting list of vetted Christian families eager to adopt these precious children and provide them with a new life!

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Compleat Dentistry

Two Mountains 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

Graduating from dental school is kind of like being dropped on the beach in the picture shown on the right. The young dentist stands on the beach and tries to decide where to go next, and there are three paths that our young dentist can follow if he or she wants to move forward.

And no one wants to move backward at that stage of their career.

The first path is to climb the mountain on the left. I call this the “Mountain of Higher Production.” This is the path of “more.” To climb the “Mountain of Higher Production,” you need to take classes that improve your efficiency, then get faster and produce more. Any equipment you purchase is designed to make you work faster or cheaper.

Success on that path is measured in terms of production (often, gross production rather than net production). This is an exhilarating climb as there are always new challenges, and you can always produce more next year. I once spoke with a dentist

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on that mountain and he bragged about how he was so efficient, he had someone to put on his gloves for him, that way he could get going more quickly.

But, when we look at the mountain on the left, there are some concerns that become evident.

First, there is no top to that mountain. If we make the mistake of trying to primarily pursue more, then there is no limit to how much more we can get. That’s why there are offices where solo general practitioners are producing $3.5 million per year. And that is one of the great challenges of using production as a yardstick for success —there will always be someone who produces more, and there is always another year around the corner where we’ll have to work to outdo our accomplishments from the previous year.

Second, as we look up the mountain on the left, we can see that it gets dark and stormy at a certain elevation. This represents the dark struggles that we encounter as we pursue higher production. You see, you can produce more year after year up until a certain point, but after

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Compleat Dentistry

that, measuring professional success in terms of production causes deep, internal stresses. And often, these stresses overlap into our personal lives, which may lead to alcohol or substance abuse, divorce, imprudent financial decisions or other destructive tendencies. The pursuit of “more” causes us to lose balance and focus only on increasing our production.

The other alternative is to climb the mountain on the right. I call that the “Mountain of Compleat Dentistry.” Note that we still have hard work to climb it. But, if we elect to climb it, then we can get over the top of the mountain and descend into a valley where the sun is shining. To climb the “Mountain of Compleat Dentistry,” we need to take classes that not only improve our technical ability, but also our people skills and our financial management.

These are the classes offered by Pankey, Dawson, Schuster, Kois, Spear and so many others.

(A special shout out to Dr. Lee Ann Brady for reuniting with the Pankey Institute — I am sure this is a sign of great things to come. If you have been thinking about taking one of their classes, now is a great time.)

The mountain on the right is the mountain of better, not more; slower, not faster; less gross production, but more net collections. Success is measured not in efficiency, but in effectiveness. It is a path of continuous improvement, with the understanding that perfection is not possible — but we try to become the best we can be. The climb is no easier than that of the other mountain. There are times where we may lose our way in the clouds, but they are not storm clouds and we can get through them if we keep on climbing. Although that mountain has been climbed by many others, there is no path — we must blaze our own trail.

But, if we pursue effectiveness, part of the journey is to remain balanced in our lives. We do not need to keep pushing professional success at the cost of our personal relationships or our own health. Climbing the mountain on the right involves making sure our life stays in balance. Our practice and professional life is part of who we are, not all of who we are.

“

Although that mountain has been climbed by many others, there is no path — we must blaze our own trail.

”

I must admit, it took my friend Brian Beirl to show me that there is another path. And, it is perhaps the saddest path of all. It’s the path of the dentist who does not climb any mountain.

Instead, they take the easy road right up the middle of the valley between the mountains.

That path is not very steep, and the dentist who takes that path does not push very hard and does not climb very high. Their goals are determined by other people and they only do what they are told. They complete the bare minimum of continuing education and do not progress to their fullest potential. But they can never get very far because the valley is created by a glacier, and if they follow the path up the middle, they will arrive at an impassible ice wall.

Sure, it is hard work to climb either of the mountains, but if you are just starting your career, why not make it a journey? That sure beats the alternative of banging into an ice wall. And if you are going to climb a mountain, best to be sure you choose the right one.

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

www.floridadental.org

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Comprehensive Corporate

Comprehensive Corporate Dental Practice: Part 1 A Contemporary Analysis Driven by Porter’s Five Forces

By S. Donovan Essen, DDS, MBA

Introduction In 1979, the Harvard Business Review published Michael Porter’s article, “How Competitive Forces Shape Strategy.”

Porter’s Five Forces has become the gold standard for strategy and business modeling, and it often drives and designs frameworks for competitive advantage.

According to the Harvard Business Review, Porter’s Five Forces have shaped a generation of academic research and Dr. Essen business practice.1 For decades, physicians and hospitals have recognized the need for best business practices in large corporate settings, while concurrently ensuring patient-centered care. As health care undergoes a period of distinct disruption, dentists should be aware of similar phenomena headed for their market segment. Dentists are critical health care providers, and must acknowledge and embrace change. According to J. Blaes, one-third of dentists are searching for a new business model to increase profits and productivity. The long-term outlook for dental practices has become much brighter, but only for those who change the way they do business. Doctors who quickly adapt to the new market conditions by replacing their outdated systems will be the ones who enjoy the highest levels of success.2 Porter’s business model offers a strategy for change based upon solid and proven academic theory. The Five Forces Model (Fig. 1) includes: 1) Threat of New Entrants; 2) Threat of Substitute Products or Services; 3) Bargaining Power of Suppliers; 4) Bargaining Power of Buyers; and, 5) Rivalry Among Existing Competitors. Using these Five Forces, this article will offer a compelling argument for how dentist owned comprehensive corporate dental practices (CCDPs) can create a powerful and sustainable market strategy. Using Porter’s strategy, this treatise proposes a corporate model of large group

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dental affiliations inclusive of all dental disciplines under one roof, much like many present day dental schools.

Fig. 1 - Porter‘s Five Forces

Threat of New Entrants The threat of new entrants to the dental field is viewed by many as a narrow door consisting of dental school admission and graduation, followed by licensure by state or regional dental boards of examiners. After a dental student obtains state or regional licensing, the common route to practice is to open a new practice, purchase an existing practice or enter an associateship. But this paradigm has shifted. Many states and regions no longer require that licensed doctors own practices, and instead have established statutes that allow non-dentist entities such as dental service organizations (DSOs) to own and manage dental offices. The Threat of New Entrants is multifaceted and as suggested by Porter, consists of eight distinct segments.

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Comprehensive Corporate 4. Capital Requirements

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1. Supply-Side Economy of Scale It is obvious that firms that produce larger volumes can supply products at lower costs. This is because they can spread fixed costs over more units, employ more efficient technology or command better terms from suppliers.1 DSOs , because of their large size, are able to exploit economies of scale. These organizations are creating successful models that are directly challenging solo practitioners and small groups. It seems logical then, that CCDPs can own better technology, command better supplier contracts and create a more efficient value chain than previous and accepted archetypes. Current trends indicate that solo practitioners cannot give customers the best value for their money, commonly referred to as being the bestcost provider, and so must seek brand differentiation to justify fees.

CCDPs have distinct leverage by being able to exploit economies of scale.

2. Demand-side Benefits of Scale

Costs of dental education continue to rise,4 and setting up private practice can exceed $500,000.5 Assuming that the new entrant will be able to finance their fledgling business, large financial obligations make it extremely hard to realize net profits or retained earnings for many years. As the cost of goods sold and fixed costs continue to rise, it can be challenging for a new dentist to retire debt in a timely manner. Capital requirements deter new entrants from competing with established companies. This author believes that because of staggering capital requirements for new entrants, dentists should feel compelled to begin CCDPs to preserve the future of the profession and maintain the integrity and quality of patient care.

5. Incumbency Advantages Porter suggests that large companies may not always have a strategic advantage and that incumbency may provide an edge. He states, Regardless of size, incumbents may have cost or quality advantages not available to potential rivals. These advantages can stem from such sources a proprietary technology, preferential access to the best raw material sources, preemption of the most favorable geographic locations, established brand identities or cumulative experience that has allowed incumbents to learn

By Michelle how to produce more efficiently. Entrants try to bypass such Solomon 1 advantages.

This force arises when a customer’s willingness to pay for a company’s product increases with the number of buyers who patronize the company.1 For years, dentists have relied on “word-of-mouth” referrals, yellow pages and print media limiting their consumer network and market segment. The dentist’s local community brand reputation dictated his volume of business and referrals. This hometeam advantage has eroded because marketing has expanded to social and online media, internet advertising and mass mail. Business can now reach an unlimited number of customers in an extremely short time. Brands can be established at lightning speed — stunning entrenched solo and small group practices. When large groups of customers begin to trust branded company stores, traditional dental practices lose market share.

Porter’s statement has merit because established dental practices often have the best locations, understand local culture, have a welltrained and loyal staff, employ the most competent lab technicians and possess tacit knowledge that large entrants may not possess.

Many large corporations purchase and absorb established private practices to acquire and maintain market leverage.

3. Customer Switching Cost

6. Unequal Access to Distribution Channels

This is a simple concept: If it costs a lot to switch dentists, patients will most likely stay with their existing provider. But today’s price-conscious consumer has little brand loyalty and costs of switching practitioners are insignificant. Fees for transferring to another dentist are nominal, as in most states, records are the patients’ property and offices can only collect token fees for duplication and transmission.3 If a best-cost provider enters the market, it is certain that most customers will switch if there are few sunk costs with their existing provider. If a customer already is with a best-cost provider, there is low motivation to switch. Once a consumer has identified the greatest value, they usually remain loyal until another product of similar quality and lower price appears. Best-cost providers are difficult to dislodge.

To distribute goods, dental offices must have access to third-party payers, conveniently accessible facilities, efficient suppliers, skilled practitioners and staff, and engage in multifaceted brand awareness campaigns to build consumer interest, generate appointments, schedule treatment and establish loyalty. Insurance and union contracts may be exclusive or have narrow windows of enrollment time that severely limit a new entrant’s ability to distribute their service within those segments. Because of these disparities, businesses may not be able to expediently produce positive net operating income.

Unequal access creates a potential incumbent advantage.

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Please see CORPORATE, 62

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Comprehensive Corporate CORPORATE from 60

7. Restrictive Government Policy Historically, state and regional dental licensure has been the hurdle most dentists have had to deal with to gain practice privileges.6 For many years, this issue has been challenged and litigated based upon free trade laws. Many states countered free trade arguments by defending their entrance requirements with patient protection claims.

Today, access to care has moved to the forefront of the health care industry and many governmental bodies are now relaxing requirements for state and regional licensing to meet the needs of equal access.

8. Expected Retaliation How potential entrants believe incumbents may react also influences decisions to enter or stay out of an industry. If reaction is vigorous and protracted, the profit potential of industry participation can fall below the cost of capital.1 Rivals through various channels may begin signaling false or misleading data or aggressive defensive strategies to discourage competition. Incumbent warnings

may include how vigorously they will defend their market share.

One method employed by incumbents is promotional price reductions, which may elicit destructive price wars. Many practices have experienced price wars via television ads, direct mail, digital media blitzes and promotions. It is becoming increasingly difficult for new entrants to respond to hostile pricing strategies. Price wars can cause irreversible brand dilution, resulting in long-term negative earnings and limited survival.

Conclusion Porter’s Five Forces is a credible and timeless model for businesses to use to thrive in an increasingly competitive global market. This portion of a two-part article outlines how the threat of new entrants can be managed and integrated into CCDPs. Part 2 will appear in the Sept/Oct issue of Today’s FDA and will discuss the remaining four forces and how they can contribute to the success of large group dental practices.

Works Cited 1. Porter, Michael E. The Five Competitive Forces That Shape Strategy. Harvard Business Review. [Online] January 2008. http://hbr.org/2008/01/the-five-competitive-forces-that-shape-strategy/ar/1.

2. Blaes, J. Solid Recovery Offset by Outdated Systems. Dental Economics. [Online] November 2013. http://levingroup.com/pdf/desurvey/2013/Nov_DE_LGsurvey2.pdf.

3. Affairs, Council on Dental Practice and Legal. American Dental Association: Dental Records. laneykay.com. [Online] 2007. http://www.laneykay.com/dentalpractice_dental_records.pdf.

4. Force, ADEA Presidential Task. A Report of The ADEA Presidential Task Force on the Cost of Higher Education and Student Borrowing. American Dental Educators Association. [Online] 2013. http://www.adea.org/uploadedFiles/ ADEA/Content_Conversion_Final/publications/ADEACBExecSummary.pdf.

5. Khan, M.S. Starting a dental practice – How can you afford it? Dentistry IQ. [Online] September 8, 2014. http://www.dentistryiq.com/articles/2014/09/starting-a-dental-practice-how-can-you-afford-it.html.

6. Obtaining Licensure. American Student Dental Association. [Online] August 2015. http://www.asdanet.org/licensure/.

Dr. Essen is President of the Treasure Coast Dental Society, Delegate to the FDA HOD and to the Atlantic Coast District Dental Society.

He Serves on the FDA Leadership Development Committee. He is a former faculty member of Nova Southeastern University College of Dental Medicine, Indian River Community College and Westchester Medical Center. He received his DDS from Northwestern University and MBA in International Business from Florida Atlantic University.

He is the Director of Implant and Cosmetic dentistry at his practice in Palm City, Fla. Dr. Essen can be reached at dressen@essendentistry. com or 772.287.6717.

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By Drs. Jasbir Upadhyaya*; Neel Bhattacharyya; Nadim M. Islam; and, Donald M. Cohen

A 68-year-old male was referred to Dr. John Hardeman, director of the Oral and Maxillofacial Surgery Residency Program at the University of Florida College of Dentistry. He presented for evaluation of white lesions, which were present on the gingiva, buccal and alveolar mucosa for six months (Figs. 1a-b). The patient reported occasional tingling and burning, but denied any other symptoms like dysphagia, dysphonia, trismus or facial swelling because of the lesions. Multiple flat-appearing viral papillomas also were noted on his lower lip (Fig. 1b). His medical history was significant for myocardial infarction, angina, hypertension, obstructive sleep apnea and anxiety. His social history included use of smokeless tobacco (snuff) for 30 years, which he quit one year ago, and consumption of six beers a day. Intraoral examination revealed poor oral hygiene, with grossly carious and multiple fractured teeth. His medication history comprised of alprazolam, amlodipine, aspirin, atorvastatin, carvedilol, lisinopril, ezetimibe, ranolazine and Brilinta. A biopsy of the white lesions was performed, and then based upon the diagnosis, complete ablation of the lesions was planned. This was accomplished under general anesthesia in the operating room. The biopsy results were negative for dysplasia or malignancy, but revealed significant verrucoid hyperkeratosis. At the four-week follow-up, he presented with recurrent lesions, with generalized leukoplakia in buccal vestibule and gingival tissues, and minimal improvement (Figs. 2a-b).

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

A). Smokeless tobacco keratosis B). White sponge nevus C). Chemical burn D). Candidiasis E). Proliferative verrucous leukoplakia

Fig. 1a: Initial presentation of proliferative verrucous leukoplakia.

Homogenous or thick leukoplakia seen on the gingiva and in mandibular vestibule extending to the buccal mucosa.

Fig. 1b: Initial presentation of proliferative verrucous leukoplakia.

Thick leukoplakia on anterior mandibular gingiva extending to the mandibular vestibule. Also seen are viral papillomas on the patient’s lower lip (blue arrows). The teeth display extrinsic staining and attrition of the incisal edges.

Fig. 2a: Recurrent proliferative verrucous leukoplakia. The image represents recurrent leukoplakic lesions seen four weeks after treatment with laser ablation.

The lesions appear more exophytic and warty than the ones present before treatment. Also seen are numerous grossly carious and stained teeth.

Fig. 2b: Recurrent proliferative verrucous leukoplakia. Thick verrucoid leukoplakic lesions extending to the buccal mucosa four weeks’ post-laser ablation treatment.

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Diagnostic Discussion A. Smokeless tobacco keratosis Incorrect, but an excellent choice. The lesions associated with smokeless tobacco use often are white and show a change in oral mucosal texture that may vary from wrinkled to leathery to deeply furrowed and somewhat similar to what was initially seen in our patient (Fig. 1a). Placement of smokeless tobacco produces a characteristic thickened white or gray plaque in the mucosa, which comes in direct contact with snuff or chewing tobacco. This is unlike the lesions seen in our patient, which appear more generalized on the buccal and alveolar mucosa, and the gingiva rather than being confined to any specific area (Figs. 1a-b).

Stretching of the mucosa often reveals a distinct “pouch” caused by flaccidity around chronic tobacco placement, which was not seen in this patient. The mucosa appears rippled in a fashion that resembles the sand on a beach after an ebbing tide. Induration, ulceration and pain usually are not associated with this lesion. Dental caries, localized or generalized wear of occlusal and incisal surfaces, and brown-black extrinsic tooth staining have been associated with longterm use of smokeless tobacco, just as seen in this patient (Fig. 2a).

The three main types of smokeless tobacco used in the United States include chewing tobacco, dry snuff and moist snuff. Chewing tobacco often is used by men in conjunction with outdoor activities. In Asian countries, smokeless tobacco is combined in a quid with betel leaves, slaked lime and areca nuts. Moist snuff, also known as snus in Sweden, has dramatically gained popularity in the United States over the past two decades. It is composed of finely ground tobacco, which is placed in the oral cavity,

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most often between the buccal vestibular mucosa and gingiva. Fermentation of moist snuff tends to give its unique flavor, but also enhances the cancer-inducing by-products like tobacco-specific N-nitrosamines and certain nitrites. Dry snuff primarily is used by women in the southern United States.

Oral use of snuff is colloquially referred to as “snuff dipping.” Smokeless tobacco keratosis usually develops within one to five years of use. The development of smokeless tobacco keratosis lesions is influenced most strongly by habit duration, early onset of use, total hours of daily use, amount of tobacco used daily and number of sites used for tobacco placement.

The clinical appearance of smokless tobacco keratosis is diagnostic and this condition has a low malignant transformation potential. Biopsy is needed only for severe or atypical lesions, i.e., those demonstrating intense whiteness, a granular or verruciform clinical appearance, ulceration, mass formation, induration or hemorrhage. Habit cessation leads to a normal mucosa — usually within two weeks — in majority of the lesions. Lesions that persist longer than six weeks should be biopsied and considered to be true idiopathic (premalignant) leukoplakia. This contrasts with the lesions seen here, which were noted initially after one year of quitting snuff use and reappeared four weeks after treatment with laser ablation (Figs. 2a-b).

B. White sponge nevus Incorrect — a good entity to include in the differential diagnosis, but a very rare condition. White sponge nevus (WSN) lesions usually appear at birth or in early childhood; however, sometimes the condition develops during adolescence.

This is unlike our patient who reported appearance of lesions in late adulthood.

Clinically, the lesions present as bilaterally symmetric, thickened, white, velvety or corrugated, diffuse smooth plaques that

predominantly affect the buccal mucosa.

The affected mucosa appears folded with a soft or spongy texture and a peculiar white opalescent hue. Other less common intraoral sites of involvement include the tongue, labial mucosa, soft palate, alveolar mucosa and floor of the mouth. Our patient had leukoplakic lesions on the gingiva, which extended to the vestibule area. WSN is a relatively rare hereditary condition that has an autosomal dominant pattern of inheritance. It also is known as Cannon’s disease, and familial white folded dysplasia. A defect in the normal keratinization process of the oral mucosal epithelium results in this disorder. Mutation of the genes responsible for production of cytokeratins, CK4 and CK13, which are specifically expressed in the spinous cell layer of oral epithelium, are responsible for WSN. WSN often is mistaken for leukoplakia, with a concern that it is pre-malignant because of the dramatic white, rough, thickened appearance it imparts to the buccal mucosa. Therefore, it is important that the condition be distinguished from other lesions that present as diffuse white plaques to avoid unnecessary treatment. The diagnosis of WSN usually is based on its distinctive clinical appearance and history. A positive family history and histopathological features can distinguish WSN from other similar looking lesions.

Since this is an asymptomatic disorder, no treatment is required. Thus, the main features that differentiate lesions in our patient are the bilateral thick, diffuse white lesions, usually of buccal mucosa, at birth or during childhood in WSN. Whereas, the lesions in our patient — which were noticed in late adulthood — involved the gingiva, vestibule, buccal and alveolar mucosa.

C. Chemical burn Incorrect, but a good guess. The lesions associated with chemical burns usually exhibit sloughing within a few days of the injurious contact, and the area subjacent to the slough appears erythematous/necrotic www.floridadental.org

Diagnostic and typically is associated with significant pain and discomfort. None of these features were seen in this case. The lesions resolve completely in two weeks following discontinuation of the product. The patient had no history of a harsh chemical use; he denied use of any alcohol-containing mouthwash or medication, or any recent visit to the dentist. Unlike lesions associated with chemical burn, which often can be painful, our patient did not report any pain or discomfort except mild tingling and burning.

In addition, lesions associated with chemical burns neither persist for six months nor recur post operatively/ laser ablation.

Chemical burn of the oral mucosa is not uncommon and may result from contact with several potentially caustic materials that are used with various dental restorative procedures. Some examples include silver nitrate, formocresol, sodium hypochlorite, dental cavity varnishes and acid-etch materials. Silver nitrate remains a popular treatment for aphthous ulcerations because the chemical cautery provides relief by destroying the nerve endings. Alcohol-containing mouthwashes, hydrogen peroxide, over-the-counter toothache remedies like eugenol-containing products, and garlic cloves also can cause chemical burns.

Tooth-whitening products that contain hydrogen peroxide have been shown to create mucosal necrosis. Concentrations of hydrogen peroxide at 3 percent or greater are associated most often with adverse reactions.

Medications like aspirin, bisphosphonates and a few psychoactive drugs are potentially caustic. Aspirin is one of the more frequent causes of medication-induced burn of oral mucosa. This often is seen when the patient places the medication adjacent to a painful tooth to provide quick relief. With short exposure of all these chemicals, the affected mucosa exhibits a superficial white, wrinkled appearance, just as is seen in our patient.

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D. Candidiasis Incorrect, but a strong consideration in the differential diagnosis. Oral candidiasis may present either as white lesions or erythematous lesions. The variants of candidiasis — which present as white plaques — include pseudomembranous, hyperplastic (also known as candidal leukoplakia) and mucocutaneous. Pseudomembranous candidiasis, commonly known as thrush, presents as confluent adherent white plaques that resemble cottage cheese or curdled milk.

The lesions are present on the tongue, buccal mucosa, palate and oropharynx. The white plaques can be easily wiped off with a gauze, thus leaving behind an erythematous surface. The patients are usually asymptomatic. A mild burning oral sensation may be described by symptomatic patients, as was reported by our patient, but his lesions were non-removable. Pseudomembranous candidiasis is more commonly found in patients who are immunocompromised or are exposed to broad-spectrum antibiotics.

Hyperplastic candidiasis presents as slightly elevated, non-removable white plaques most commonly on the buccal mucosa and labial commissure. The lesions may be nodular or speckled in appearance. Such lesions may have an increased frequency of epithelial dysplasia. However, candidiasis rarely persists in the same location for months unless the patient is a smoker and receives no treatment. These lesions do not recur as was noted in our patient.

Mucocutaneous candidiasis is a heterogeneous disorder that presents with chronic oral, skin and nail lesions with a poor response to topical antifungal agents, and often is related to immune dysfunction.

Skin and nail abnormalities were not noted in our patient. However, candidiasis often may present as red or erythematous lesions.

Candida is commonly present in normal oral flora of healthy individuals. A variety of local and systemic factors lead to its overgrowth when it becomes a pathogen and the condition is known as candidiasis. Some of these factors include denture use, corticosteroid inhalers, xerostomia, immunosuppressed states and endocrine disorders like diabetes, systemic chemotherapy, radiation therapy and broad-spectrum antimicrobials. A diagnosis of oral candidiasis generally can be made with a thorough medical history and physical examination. Treatment comprises of elimination of underlying factors, and/or topical or systemic antifungals.

E. Proliferative verrucous leukoplakia Correct. Proliferative verrucous leukoplakia (PVL) is an aggressive form of leukoplakia that has a high risk of malignant transformation. It was first described in 1985 by Hansen et al. as a distinct form of leukoplakia, which has a high recurrence rate. PVL primarily is seen in older females, with an average age of 62 years at the time of diagnosis, who have minimal association with tobacco use. Etiology of this condition is unknown. The lesion begins as a simple white plaque that is indistinguishable from conventional leukoplakia. Over time, the lesion spreads locally or to other sites to become multifocal and proliferative. Typically, multiple sites like the buccal mucosa and palate are affected, but gingiva is one of the most frequently involved site as seen in our patient (Figs. 1a-b). In late PVL, the lesions become exophytic and wart-like, display areas of erythematous change within white patches, and have the appearance of verrucous or nodular leukoplakia. These lesions gradually progress to either verrucous carcinoma or squamous cell carcinoma, often within eight years of initial PVL diagnosis. Thus, PVL constitutes a continuum of hyperkeratotic lesions, ranging from a simple hyperkeratosis at one end to invasive Please see DIAGNOSTIC, 68

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Diagnostic DIAGNOSTIC from 67

squamous cell carcinoma at the other. These lesions tend to be slow-growing, persistent and resistant to all therapeutic procedures, including conservative treatment, laser therapy, surgical excision and radio-chemotherapy. Some of the important factors that may indicate a higher rate of malignant transformation include the presence of a lesion in a non-smoker, occurrence in females, erythematous or red component, thick lesions, presence of pain, presence of dysplasia and persistence over long periods of time. Early diagnosis of PVL is complicated by the fact that many of the morphologic features associated with progression to malignancy are absent in these lesions.

Because of the lack of specific histologic criteria, the diagnosis is based on histopathologic and clinical features and behavior.

Thus, the diagnosis often is made retrospectively after a significantly long follow-up period. The clinical presentation of white lesions in this case, along with the patient’s age, non-smoker history and high recurrent potential are all diagnostic of PVL. Careful examination of the oral cavity is essential when a white lesion is noted. Due to the high malignant transformation potential of PVL, early recognition, close clinical follow-up and multiple biopsies are essential for proper management. The biopsy should be taken from the clinically most severe areas. Surgical removal usually is done by excision, electrocautery, cryosurgery or laser ablation. Long-term follow-up is crucial, as recurrences may develop as seen in our patient (Figs. 2a-b). In our patient, the remarkable rapidity of the recurrence is unprecedented, and highlights the fact that PVL — especially those involving extensive areas — should be watched closely and the patient should be placed on close clinical follow-up, sometimes even monthly.

The Florida Dental

References:

1) Hansen, L.S., Olson, J.A. and Silverman, S., Jr. Proliferative verrucous leukoplakia. A long-term study of thirty patients. Oral Surg Oral Med Oral Pathol 60, 285-298 (1985).

2) Barnes, L., Evenson, J., Reichart, P. and Sidransky, D. World Health Organization Classification of Tumors. Pathology and Genetics of Head and Neck Tumors. Lyon: IARC Press (2005).

3) Neville, B.W., Damm, D.D., Allen, C.M. and Chi, A.C. Oral and Maxillofacial pathology. Elsevier 4th edition, p. 358 (2016).

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Abstract

Basis for Dental Pain: A Review

By Ernest A. Lado Jr., DDS; Robert M. Caudle, Ph.D., John H. Hardeman DDS, MD; and, Matthew J. Dennis, DDS

Abstract Identification and diagnosis of dental pain can be elusive. The nomenclature currently used to define various conditions can be confusing and often does not clarify the root cause of the pain. This article reviews the symptomatology patients report with dental pain and correlates the character of pain to biological principles of the involved tissues. Applying this knowledge should allow a better understanding of the cause and source of dental pain, and ultimately, result in reliable diagnosis and treatment.

Summary: Diagnosis of a toothache requires a greater understanding of the bio-physiology of dental pain than simply plugging diagnostic findings into a table. An in-depth understanding of the process that results in pain is needed not only to derive a diagnosis, but also to appreciate the process so that false-positive and negative tests can be recognized and considered when making a diagnosis.

The diagnosis of a toothache is based not only on history and symptoms, but also is dependent on changes that occur over time. Timely testing should be included to reproduce the chief complaint to enhance the accuracy of the diagnosis.

To read the full article, please go to http://bit.ly/2ujzTMf. Dr. Lado is an associate professor in the oral and maxillofacial surgery department at the University of Florida College of Dentistry (UFCD), and can be reached at ELADO@dental.ufl.edu. Dr. Caudle is a professor in the oral and maxillofacial surgery in the neuroscience division at UFCD. Dr. Hardeman is a clinical assistant professor and is the program director for the oral and maxillofacial surgery residency at UF/Shands. Dr. Dennis is a clinical professor in the oral and maxillofacial surgery department at UFCD.

Pain Scale

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The 2017 Florida Dental Convention (FDC), “Get Connected: Team to Technology,” was held June 22-24 at the Gaylord Palms Resort and Convention Center in Orlando. More than 7,000 dental professionals, including more than 1,500 Florida Dental Association members, came together for abundant learning, networking and buying opportunities. Each year, FDC is a memorable event — and 2017 was no exception! With more than 130 lecture and hands-on courses, nightly family-friendly social events and a vibrant Exhibit Hall filled with nearly 350 leading dental vendors, FDC2017 offered something for every attendee! Plan to join us for FDC2018, “Elevate your Game,” on June 21-23. These dates do not conflict with Father’s Day weekend! Go to floridadentalconvention.com/hotel to make your hotel room reservation at the Gaylord Palms today!

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Reimbursement, Paid ADA & State Society Dues; Group Practice camaraderie – Technique Development assistance, Study Clubs, Chairside Mentoring, GEDC University Courses.

Please view our Doctor Career Path video: http://www. screencast.com/t/M3xWM5CYN. Please apply via this ad for consideration, Molly McVay | Sr. Clinical Recruiter | Great Expressions Dental Centers PSC-North | 29777 Telegraph Road.

Suite 3000| Southfield, MI 48034 USA phone 248-430-5555 |Ext. 72467| fax 248-686-0170 | web www.greatexpressions.com. Must have a DDS/DMD from an accredited University and active State Dental Board license. Apply Here. PI98525286. http:// www.Click2apply.net/z45vyqrdxx4f3tj2.

Pediatric Dentist (3-5 days per/wk)-Bradenton, FL. Join our terrific Dental Team in Bradenton, FL as a lead Pediatric Dentist! Dr. Rick Woodward, Clinical Partner, is seeking a (3-5 days/wk) Pediatric Dentist in our highly productive Lakewood Ranch dental practice located at: 11215 SR 70 East Bradenton, Florida 34202. Enjoy a rewarding long term career path with dedicated staff in this productive practice environment with an established patient base! Compensation: High Income Opportunity: Potential Earnings of 500K+; Potential Sign on Bonus or Relocation assistance possible! Benefits/Perks: Practice Leadership: Clinical Freedom and Treatment Autonomy; Patient Focus: Established and Growing Patient Foundation; MultiSpecialty Practices with Dedicated Staffs; Partnership Model – Long Term Doctor Career Path/Investment Opportunities; Full Benefits –Healthcare & Dental Benefits, 401K, Short Term/Long Term Disability, Time Off; Malpractice Coverage Assistance; Continued Education Support: Internal & External advance training, Paid ADA & State Society Dues, Study Clubs and GEDC University Courses; Group Practice Camaraderie – Technique Development Assistance Available, Chairside Mentoring. Please view our Doctor Career Path video: http:// www.screencast.com/t/M3xWM5CYN. Please apply via this ad for consideration, 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. Apply Here. PI98524795. http://www.Click2apply.net/ wfbnq7sghm5tkwv5.

Dentist Opportunity (Full-Time)-Fort Lauderdale, FL. Come lead our terrific dental team in our Fort Lauderdale/Coral Ridge, FL practice! Dr. Dustin Haller and Dr. Raul Rangel are seeking a full-time Associate or Senior Dentist to lead our Coral Ridge, FL practice located at 1201 N Federal Highway Suite 2D Fort Lauderdale, Florida 33304. Enjoy a rewarding role with a dedicated staff and a strong patient base! High Compensation Opportunity: Six-Figures vs. Percent of Production; Benefits/ Perks: Practice Leadership: Clinical Freedom and Treatment Autonomy; Patient Focus: Established and Growing Patient Foundation; Digital, Solo Setting; Partnership Model – Doctor Career Path/Investment Opportunities; Full Benefits Offered – Healthcare & Dental Benefits, 401K, Short Term/Long Term Disability, Time Off; Malpractice Coverage Assistance; Continued Education Reimbursement, Paid ADA & State Society Dues; Group Practice Camaraderie – 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 both the role and Great Expressions! For More Information, Please Contact: Ross Shoemaker, MBA | Doctor Recruiting Manager | Great Expressions Dental Centers 770 Roswell Road, Roswell, GA 30076 USA phone 678-836-2226 | ext 72226 | fax 678-836-2144 |web www.greatexpressions.com. email Ross.

Shoemaker@greatexpressions.com. “Look for the Smile Above Our Name!” Apply Here. PI98419678. http://www.Click2apply. net/p4rvvrw9vv8kp5sm.

Dentist Opportunity (Full-Time) - Saginaw, TX. Come lead our terrific dental team in Saginaw! Dr. Rick Woodward, Texas Clinical Partner, is seeking a full-time Senior Dentist or Associate to lead our established, digital practice in Saginaw, TX located at: 1453 N Saginaw Blvd, Suite 150 Saginaw, TX 76179 Enjoy a rewarding career with a full office staff (including Hygienist), a strong schedule and the ability to focus on quality patient care. Compensation: High Compensation Opportunity: Potential Annual Earnings of 200K+; Benefits/Perks: Practice Leadership: Clinical Freedom and Treatment Autonomy; Patient Focus: Established and Growing Patient Foundation; Multi-Specialty Office/Digital; Partnership Model – Investment

Please see CLASSIFIEDS, 76

July/August 2017

Today's FDA

75

Your Classified Ad Reaches More Than 8,000 Readers!

CLASSIFIEDS from 75 Opportunities/Long Term Doctor Career Path; Full Benefits Offered – Healthcare & Dental Benefits, 401K, Short Term/Long Term Disability, Time Off; Malpractice Coverage Assistance; Continuing Education Support: Internal & External Advanced Training, Paid ADA & State Society Dues; Group Practice Camaraderie– Technique Development Assistance, Study Clubs, Chairside Mentoring, GEDC University Courses; Please view our Doctor Career Path video: http://www.screencast.com/t/ M3xWM5CYN. Hannan Ayad| Clinical Recruiter | Great Expressions Dental Centers PSC-North | 29777 Telegraph Road.

Suite 3000| Southfield, MI 48034 USA phone 248-598-7256 |Ext. 71178| fax 248-430-5528 | web www.greatexpressions.com.

“Look for the Smile Above Our Name!” Must have a DDS/DMD from an accredited University and active State Dental Board license. Apply Here. PI98420779. http://www.Click2apply.net/ tsd9qtc6zfyjpz53.

Oral Surgeon (Part-Time) Fort Myers. Join our established and highly productive dental team (2-3 days per week) as a Part-time Oral & Maxillofacial Surgeon in our attractive multispecialty practices located at: 10580 Colonial Boulevard, Unit 103 Fort Myers, Florida 33913; 25195 Chamber of Commerce Drive Bonita Springs, Florida 34135. High Compensation Opportunity: Offering 40% of production vs salary of $2,000 per day; Production range of $7,000 - $10,000 per day; Benefits/Perks: Practice Leadership: Clinical Freedom and Treatment Autonomy; Patient Focus: Established and Growing Patient Foundation; Multi-Specialty Office Setting; Partnership Model – Long Term Doctor Career Path/ Investment Opportunities; Malpractice Coverage Assistance; Continued Education Reimbursement, Paid ADA & State Society Dues; Group Practice Camaraderie– Technique Development Assistance, Study Clubs, Chairside Mentoring, GEDC University Courses. Please view our Doctor Career Path video: http://www.screencast.com/t/M3xWM5CYN. For More Information, Please Contact: Apply via this ad to learn more about Great Expressions! Hannan Ayad| Clinical Recruiter | Great Expressions Dental Centers PSC-North | 29777 Telegraph Road. Suite 3000| Southfield, MI 48034 USA phone 248-5987256 |Ext. 71178| fax 248-430-5528 | web www.greatexpressions. com. Must have a DDS/DMD from an accredited University and active State Dental Board license, Oral Maxillofacial Surgeon License and certifications. Apply Here. PI98188777. http://www.

Click2apply.net/gxrhbb85nqyj3tck.

Dentist (Jammes Rd.) - Jacksonville, FL. Come lead our team in Jacksonville, FL! Great Expressions Dental Centers has an immediate, select opening for a full-time Senior Dentist or Associate to join our Jammes dental practice located: 5218 Jammes Road, Suite D Jacksonville, Florida 32210. Enjoy a rewarding role with a dedicated staff in this productive neighborhood practice with an established patient base!

Compensation: High Compensation: Potential Earnings of 200K +; 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 – Healthcare & 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 PSCNorth | 29777 Telegraph Road. Suite 3000| Southfield, MI 48034 USA phone 248-430-5555 |Ext. 72467| fax 248-686-0170 | web www.greatexpressions.com. Must have a DDS/DMD from an accredited University and active State Dental Board license. Apply Here. PI98420934. http://www.Click2apply. net/322ckp422v9frbmz.

General Dentist - Destin/Niceville, FL Area - $20,000 Sign on Bonus. At Heartland Dental, we are committed to supporting dentists as they provide high-quality, lifetime patient care in a state of the art environment. Our goal is simple – advance the financial and professional growth of supported dentists by providing the strongest non-clinical dental support model in the country. Why join our Heartland Dental supported office at Okaloosa Family Dental? Enjoy the broad support and stability of the largest DSO, and of one of the fastest growing companies in the country, with the freedom to diagnose and treatment plan

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your own cases, choose your own materials and labs, all while using the latest technology and enjoying the opportunity to provide direct leadership to your team. Receive superior nonclinical administrative support in areas including marketing, human resources, accounting, credentialing, procurement, information technology and more. Partner with non-clinical field support to advance you and your team’s success. Benefit from our existing relationships with suppliers, vendors and insurance companies. About Niceville, Florida: Known for its nice people, nice food and you’re guaranteed to have a nice time! The friendly city of Niceville, Florida is found in the northwest Florida panhandle between Pensacola and Panama City. Niceville is adjacent to a number of beaches, including the white sand beaches of Destin, Florida just a 20-minute drive via the Mid-Bay Bridge. Among other things, there are a number of different attractions within the greater Niceville area! Runners, cyclists, fishers, hikers, golf aficionados, and families alike enjoy the beautiful tropical landscape offered by this wonderful city in the sunshine state. Niceville has amazing city specific dining options like Boathouse Oyster Bar and Grill.

If you want to enjoy the culture and arts of Niceville, you can visit the Mattie Kelly Arts Center or the Destin History and Fishing Museum. Explore contemporary fashion, antiques and much more fun at the Destin Commons and Sexton’s Seafood Market Transport throughout the city of Niceville was designed to be easy as everything in the business district is built around the city’s main passageway John Sims Parkway; State road 20.

Professional Development; Unparalleled continuing education!

More than 200 hours of courses exclusive to Heartland Dental supported offices, putting you on the path to dominating your market as a definitive industry leader. Personal and professional development, offering professional mentorship, skill development and strategies to become an effective leader. If your career ambitions include leadership and further advancement, Heartland Dental’s network of supported locations is expected to double in size within the next five to seven years, and new opportunities will be created to support that growth.

Total Rewards: Guaranteed base pay or personal collections; whichever is greater; Opportunity for quarterly bonus; Paid time off – up to 2 weeks and 6 Holidays; Comprehensive insurance program; Retirement savings plans. Visit us at www.heartland. com to learn more about how Heartland Dental can support your professional goals. Responsibilities: As a supported Dentist with Heartland Dental, you will be the leader of your practice.

You will manage the dental office team, mediate any conflicts that arise and promote a positive and team-oriented work environment where high-quality patient care is the number one priority. Additional responsibilities of the Dentist include: Conducting morning meetings with the dental office staff to ensure that everyone is on the same page regarding the day’s schedule, procedures and patient load; Supporting office staff with assessing P&L reports; Improving your clinical skills and acumen through participation in continuing education and training opportunities offered by Heartland Dental; Doctor mentoring program. Qualifications: As a supported Dentist, you must have a strong work ethic, an outgoing and personable chair-side manner and the desire to improve within the dental field. You must also be flexible and open to new ways of doing things and able to lead and manage a team. Educational requirements of the Dentist – General Dental Doctor – DDS/ DMD include: DMD or DDS degree; Current dental license in state of hire; Ability to travel overnight to training sessions once a month during your first year of employment. https:// jobs.heartland.com/job/HEDEUS5587/General-Dentist-DestinNiceville-Ft-Walton-20-000-Sign-on-Bonus.

Dentist (Part-Time) - Land O’ Lakes, FL. Great Expressions Dental Centers has an immediate opportunity for a Senior Dentist or Associate to work part-time 2 days/week (Fridays and Saturdays) in our very productive Land O’ Lakes, FL practice located: 2091 Collier Parkway Land O’ Lakes, Florida 34639. Enjoy a rewarding role with a great team in place in this beautiful facility with an established patient base!

Compensation: Very competitive compensation model with a 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 248-430-5555 |Ext. 72467| fax 248-686-0170 | web www.greatexpressions.com. Must have a DDS/DMD from an accredited University and active State Dental Board license. Apply Here. PI98433842. http:// www.Click2apply.net/xkmn78wr8xpz4zwk.

Pediatric/General Dentists Needed. Tebo Dental is unique because of our family-oriented environment in which our patients and team remain our #1 priority. We are looking for pediatric and general dentists, new graduates and seasoned professionals, to join our growing team. We have four practices located just north of Atlanta, Georgia and have part-time and full-time opportunities available immediately. You can expect to receive hands-on mentorship and training, a stable patient base, long-term career growth, and the latest technology. To apply, please contact us at 770-925-3300 ext.318 or email your CV to HR@TeboDental.com. What you can expect: Generous signing bonus; Competitive compensation; Health & Dental insurance; Long-term disability; Paid holidays; Paid CE days; Paid vacation days; 401(k) with match; LifeTime Fitness partnership with subsidy. https://www.tebodental.com/.

Dentist (5 Days/wk) - Jacksonville, FL. Great Expressions Dental Centers has an immediate opening for a Senior Dentist or Associate to work full-time (Monday - Friday) starting August 2017 and lead our great team in Jacksonville, FL! Enjoy a rewarding role with a dedicated and experienced staff in this productive practice with an established patient base!

Compensation: High Compensation Opportunity: Potential Earnings of 200K+; Benefits/Perks: Practice Leadership: Clinical Freedom and Treatment Autonomy; Patient Focus: Established and Growing Patient Foundation; Solo Practice; Partnership Model – Investment Opportunities/Doctor Career Path; Full Benefits Offered – Healthcare & Dental Benefits, 401K, Short Term/Long Term Disability, Time Off; Malpractice Coverage Assistance; Continued Education Reimbursement, Paid ADA & State Society Dues; Group Practice camaraderie – Technique Development assistance, Study Clubs, Chairside Mentoring, GEDC University Courses. Please view our Doctor Career Path video: http://www.screencast.com/t/M3xWM5CYN. Please apply via this ad for consideration, Molly McVay | Sr. Clinical Recruiter | Great Expressions Dental Centers PSC-North | 29777 Telegraph Road. Suite 3000| Southfield, MI 48034 USA phone 248-430-5555 |Ext. 72467| fax 248-686-0170 | web www.greatexpressions.com. Must have a DDS/DMD from an accredited University and active State Dental Board license.

Apply Here. PI98003232.

Associate General Dentist. Growing practice in Southwest Florida seeking Associate General Dentist with option to buy.

Modern, paperless office utilizing Eaglesoft, digital X-Ray, laser.

All fee for service and PPO. Experienced, friendly staff. Position available immediately. Call (941)204-3121 for information.

Resume may be sent to vimac44@gmail.com.

Pediatric Dentist (Full - Time) Fort Myers, FL. Join our terrific Dental Team in Florida as a lead Pediatric Dentist! Dr. Raul Rangel, Clinical Partner, is seeking a full time Pediatric Dentist in our highly productive dental practices located at: 5100 S. Cleveland Avenue, Fort Myers, Florida 33907. Enjoy a rewarding long term career path with dedicated staff in this productive practice environment with an established patient base!

Compensation: High Income Opportunity: 200k Salary with potential earnings of 300k plus a year; Possible sign on bonus or relocation assistance; Benefits/Perks: Practice Leadership - Clinical Freedom and Treatment Autonomy; Patient Focus Established and Growing Patient Foundation; Multi-Specialty Practices with Dedicated Staffs; Partnership Model - Long Term Doctor Career Path/Investment Opportunities; Full Benefits - Healthcare & Dental Benefits, 401K, Short Term/Long Term Disability, Time Off; Malpractice Coverage Assistance; Continued Education Support: Internal & External advance training, Paid ADA & State Society Dues, Study Clubs and GEDC University Courses; Group Practice Camaraderie - Technique Development Assistance Available, Chairside Mentoring. Please view our Doctor Career Path video: http:// www.screencast.com/t/M3xWM5CYN. Please apply via this ad for consideration, Hannan Ayad| Clinical Recruiter | Great Expressions Dental Centers PSC-North | 29777 Telegraph Road.

Suite 3000| Southfield, MI 48034 USA phone 248-598-7256 |Ext. 71178| fax 248-430-5528 | web www.greatexpressions.com.

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

www.floridadental.org

Your Classified Ad Reaches More Than 8,000 Readers!

PI98188417. http://www.Click2apply.net/czgzj7nfx739cd5h.

Motivated General Dentist Needed to Run a Practice - Destin Area. Perfect opportunity for the right person. I need a general dentist to take my position for at least a year. It is a million-dollar practice that is built on sound dental and ethical guidelines. Everything is done in house except molar endo and implant placement (at least at the moment). The patient base is made up of a wonderful community of loyal people that respond to honesty and sound dentistry. Pay scale will be incredible.

The space is shared with another dentist, which allows for lower overhead, which in turn will represent a higher take home for the incoming dentist. I am attached to my practice and I’m looking for a specific type of person. Motivated, gregarious and efficient with time. All the pieces are here, just need to show up and do the dental. No business management is needed. No new dentists please, must have minimum 3 years’ experience and be confident with their skills. Mediocre dentistry has no place here. 4 days, 8-5. 2 hyg ops, 2 general ops. 6 full time staff members. This could easily turn into a longer tenure or buy out if things progress smoothly. If you don’t know Destin, google it.

It is paradise. Email me directly with a resume and what you are looking for. mgrimesdmd@gmail.com.

Part-Time Opportunity Naples, Florida. Our general practice is seeking a progressive, part-time associate to join our team. Our goal is to provide state-of-the-art, comprehensive dentistry in a warm, caring environment. We strive to build individual relationships with our patients. Please contact: cosmeticdentistryofnaples1@gmail.com for details.

Pediatric Dentist – Orlando Pediatric Dental Group is growing and we are looking to add a full-time Pediatric Dentist to our team. We are a private group owned and operated by 2 Board Certified Pediatric Dentists, and have 3 locations in the Orlando area. All of our locations are modern with digital records and x-rays. Services include in-office sedation and general anesthesia at several local hospitals. We offer a competitive compensation package, and an environment tailored to foster professional growth. New grads welcome, hospital based residency graduates preferred. Our pediatric dentists are happy to help ease your transition from residency into practice. Come live in Orlando, one of the best cities to live in Florida! Please visit www. pediatricdentalgroupflorida.com to learn more about our practice. Interested candidates please contact Jocelyn at 321720-2402 or Jocelyn.Espejo@pdgorlando.com to learn more about the opportunity.

Dentist. Seeking part time general dentist for flexible hours in well-established office. A great team is in place waiting for you.

Outstanding opportunity for someone to practice as a semiretired dentist or young associate willing to grow. Whether one day or full time, send an email to mjallen9875@gmail.com to discuss your options.

Endodontist Opportunity (1 day/week) - Treasure Coast + WPB, FL. Come join our South Florida specialty team as a part-time (1 day/week) Endodontist in the Treasure Coast and West Palm Beach, FL! Aggressive compensation package (production based percent), dedicated staff, consistent schedule with a strong referral network of local offices. Compensation: Percentage of Production; Benefits/Perks: Leaders in the practice: Clinical Freedom and Treatment Autonomy for Every Doctor; Patient Focus: Established and Growing Patient Foundation; Multi-Specialty Office Setting(s); Malpractice Coverage Assistance. Please view our Doctor Career Path video: http://www.screencast.com/t/M3xWM5CYN. Apply via this ad to learn more about Great Expressions! For More Information, Please Contact: Ross Shoemaker, MBA | Doctor Recruiting Manager | Great Expressions Dental Centers 770 Holcomb Bridge Road, Roswell, GA 30076 USA phone 678-836-2226 | ext 72226 | fax 770-242-3251 |web www.greatexpressions.com email Ross.Shoemaker@greatexpressions.com. “Look for the Smile Above Our Name!” Apply Here: http://www.Click2apply. net/3cbsvs4xmgbr75g2. PI98180275.

Associate Dentist (West Palm Beach - FL) Well established Private Practice is looking to add an additional Associate (PT/ FT) who enjoys treating children. Medicaid provider is a plus.

You will work with experienced, supportive staff and in a friendly office environment where you can provide quality care to patients. New grads are welcome: we will provide on the job training. We offer competitive compensation. Please send your resume to drleminh1@firstcaredental.net.

www.floridadental.org

GENERAL DENTIST - HELP A CHILD SMILE (GEORGIA) Dentists needed in Georgia! Help A Child Smile is a mobile dental program that provides oral health care to children across the state. Our mission is to enhance the quality of life for children by providing a positive dental experience in the school/ mobile setting. We are seeking part-time and full-time dentists to join our team. We offer a competitive salary including a GUARANTEED DAILY BASE PAY. We have a large patient base and experienced staff to get the job done. Absolutely NO OVERHEAD! Contact Sebrona Rhodes today at srhodes@hcsga. com, 770-760-7900 ext 42194, or 470-925-8438. Georgia dental license required.

General Dentist. Looking for a general dentist for a multispecialty practice located in Miami, Florida near FIU University.

This Doctor needs to be friendly and well-rounded in treatment planning and most important well communication with our patients. Needs to be bilingual (Spanish/English) if you do not speak Spanish please do not apply. jensanchez1218@gmail.com.

General Dentist Opportunity-Tally. Modern dental practice, PPO/FFS needing to add a General Dentist. Our office is very clean with great lighting, updated equipment, 7 OP and digital x-rays. Implant experience is a plus but by no means required. Partnership a high probability if there’s interest. I’m able to provide health insurance, paid vacation and retirement plan is available through Prudential. Your daily procedures will include restoration, crown and bridge and core build-ups (veneers, onlays, inlays), extractions, removable pros, and providing comprehensive treatment plans. Requirements: Complete comprehensive full mouth exams and diagnose dental conditions; Assess treatment planning options and discuss with patient; Educate patients on oral health; Carry out agreed clinical treatments; Assist in the recruitment, training, and management of staff; Keep abreast of new developments in dentistry through structured continuing professional developments. Minimum Education and Experience: Must be a DDS or DMD from an accredited school. *relocation assistance available. * Part-Time (2+ days) Endodontist - Fort Myers, FL. Come lead our specialty team as a part-time Endodontist in Fort Myers, FL! Great Expressions Dental Centers has a current, select opening for a part-time (2-3 days/week) Endodontist to join our Fort Myers, FL multi-specialty practice in Page Field. We offer an aggressive compensation package, dedicated staff, consistent schedule with a strong referral network of local offices.

Compensation: Six Figure Annual Base vs. Competitive Percent of Production! Attractive Sign-on or Relocation possible as well; Benefits/Perks: Leader in the practice: Clinical Freedom and Treatment Autonomy; Patient Focus: Established and Growing Patient Foundation; Multi-Specialty office; Doctor Career Path – Partnership/Investment Opportunities; Full Benefits Offered – Healthcare & Dental Benefits, 401K, Short Term/Long Term Disability, Time Off; Malpractice Coverage Assistance; Continued Education Reimbursement, Paid ADA & State Society Dues; Mentorship – Study Clubs, Chairside Mentoring, GEDC University Courses. Please view our Doctor Career Path video: http://www.screencast.com/t/M3xWM5CYN. Please apply via this ad for consideration! Hannan Ayad| Clinical Recruiter | Great Expressions Dental Centers PSC-North | 29777 Telegraph Road. Suite 3000| Southfield, MI 48034 USA phone 248-598-7256 |Ext. 71178| fax 248-430-5528 | web www. greatexpressions.com. “Look for the Smile Above Our Name!”

Must have a DDS/DMD from an accredited University and active State Dental Board license, Endodontist Dental License and certifications. Apply Here. PI97670316.

FLORIDA—Dentist. Dentist wanted who enjoys treating children. Well established non-corporate group practice. Mon. Fri. $180,000 - $220,000 guaranteed salary plus bonus program, sign-on bonus, 3-week paid vacation, paid holidays, CE and health insurance. Email resume to: hr.cobbedental2@verizon.net or call: (727) 446-3259.

General Dentist. Caring GP wanted for busy family fee for service practice in Lake Placid, FL. 8 ops, 3 Hygienists, 3 expanded duties assistants. Full time with partnership opportunities. 401K retirement, established staff and patient base. Pay commensurate with production, 33% of collections. jeodmd@htn.net. www.sunshinefamilydentistry.com. 863-4145779.

Dentist (Full-Time) - Lakewood Ranch, FL. Join our terrific dental team in Sarasota and Lakewood Ranch, FL as a lead Dentist! Dr. Rick Woodward, Clinical Partner is seeking a full-time Senior Dentist or Associate to join our team in September 2017! Enjoy a rewarding long term career path with a dedicated staff in this productive practice environment with an established patient base! Compensation: High Compensation Opportunity: Potential Earnings of 200K+; Benefits/Perks: Practice Leadership: Clinical Freedom and Treatment Autonomy; Patient Focus: Established and Growing Patient Foundation; Multi-Specialty Office/Digital; Partnership Model – Investment Opportunities/Long term Doctor Career Path; Full Benefits Offered – Healthcare & Dental Benefits, 401K, Short Term/Long Term Disability, Time Off; Malpractice Coverage Assistance; Continued Education Support: Internal & External advance training, Paid ADA & State Society Dues, Study Clubs and GEDC University Courses; Group Practice Camaraderie – Technique Development Assistance available! Please view our Doctor Career Path video: http://www.screencast.com/t/ M3xWM5CYN. Please apply via this ad for consideration, Molly McVay | Sr. Clinical Recruiter | Great Expressions Dental Centers PSC-North | 29777 Telegraph Road. Suite 3000| Southfield, MI 48034 USA phone 248-430-5555 |Ext. 72467| fax 248-686-0170 | web www.greatexpressions.com. Please note: The Requirements preview below had invalid markup and has been repaired. The original code can still be seen with the toggle view button. Must have a DDS/DMD from an accredited University and active State Dental Board license. Apply Here. PI97610775. http://www.Click2apply.net/dr2y9mmtxdrs2r24.

Dentist (2 days/wk) - St. Augustine, FL. Great Expressions Dental Centers has an immediate opportunity for a Senior Dentist or Associate to work part-time 2 days/week in our very busy St. Augustine, FL practice located: 9B St Johns Medical Park Drive St. Augustine, Florida 32086. Enjoy a rewarding role with a great team in place in this beautiful facility with an established patient base! Compensation: Very competitive compensation model with a 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 248-430-5555 |Ext. 72467| fax 248-686-0170 | web www.greatexpressions.com. “Look for the Smile Above Our Name!” Apply Here. PI98001665. http://www.Click2apply.net/ qb3rrfrr4q2c84x2.

Family Dentist Full Time Associate Titusville. Ready to practice dentistry without the hassles of practice ownership or corporate interference? We are a busy, low stress, family dental office focused on exceptional patient care. We are looking for a caring and energetic dentist to join Dr. Michele Zrallack and our experienced staff. We are a digital, paperless, and modern office located in Titusville and are privately owned and worked.

We offer a full range of preventative, restorative and cosmetic services for adults and children. We provide services to many families so ability to have a calm presence and patience with children is a must as well as proper communication with the parents. Surgical and simple extractions are a must. Two years’ minimum experience is preferred but Dr. Zrallack is willing to mentor candidates with the proper attitude and work ethics. Compensation is production based allowing great earning potential for motivated individuals. Send CV/ Resume to zrallack@bellsouth.net or call our office at 321267-7970. Requirements: Current, valid Florida Dental License; Other certifications required by state to include CPR and DEA; DDS/DMD from an accredited dental education Program. Responsibilities: Provide diagnosis of patient’s dental status utilizing accepted clinical and radiological techniques; Assess treatment options and discuss with patient; Provide comprehensive professional dental treatment to address the oral health needs of the patient; Provide routine recall exams, simple and surgical extraction, restorations, prosthetic services and root canals; Maintain patients’ medical records. Benefits:

Please see CLASSIFIEDS, 78

July/August 2017

Today's FDA

77

Your Classified Ad Reaches More Than 8,000 Readers!

1 month vacation allowance; No nights or weekends; Sign on bonus; Excellent experienced staff.

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

PI97943663.

Orthodontist (Great Income) - Fort Myers, FL. Great Expressions Dental Centers has a select opportunity for a fulltime Orthodontist to join our dental practices in Fort Myers and Cape Coral, FL! 5100 S. Cleveland Avenue, #315 Fort Myers, Florida 33907; 1127 Del Prado Blvd S., Suite D and E Cape Coral, Florida 33990. Our specialists have the clinical freedom and autonomy enjoyed in a traditional private practice without the additional financial or administrative burdens associated with practice management. When considering a career with GEDC, specialists can expect: Compensation: High Income Opportunity: $1200 Daily Rate vs. a Competitive percent of Allocated Cash Collections! Attractive 10K Sign-on possible as well! Benefits/Perks: Practice Leadership: Clinical Freedom and Treatment Autonomy; Patient Focus: Established and Growing Patient Foundation; Multi-Specialty and Digital offices; Doctor Career Path – Partnership/Investment Opportunity available!

Full Benefits Offered – Healthcare & Dental Benefits, 401K, Short Term/Long Term Disability, Time Off; Malpractice Coverage Assistance; Continued Education Reimbursement, Paid ADA & State Society Dues; Mentorship – Study Clubs, Chairside Mentoring, GEDC University Courses. *Please view our Doctor Career Path video: http://www.screencast.com/t/ M3xWM5CYN. Please apply via this ad for consideration!

Hannan Ayad| Clinical Recruiter | Great Expressions Dental Centers PSC-North | 29777 Telegraph Road. Suite 3000| Southfield, MI 48034 USA phone 248-598-7256 |Ext. 71178| fax 248-430-5528 | web www.greatexpressions.com. Must have a DDS/DMD from an accredited University and active State Dental Board license, Orthodontist Dental License and certifications. Apply Here. PI97982913.

Pediatric Dentist (Full - Time) Fort Myers, FL. Join our terrific Dental Team in Florida as a lead Pediatric Dentist! Dr. Raul Rangel, Clinical Partner, is seeking a full time Pediatric Dentist in our highly productive dental practices located at: 5100 S. Cleveland Avenue, Fort Myers, Florida 33907. Enjoy a rewarding long term career path with dedicated staff in this productive practice environment with an established patient base!

Compensation: High Income Opportunity: 200k Salary with potential earnings of 300k plus a year; Possible sign on bonus or relocation assistance; Benefits/Perks: Practice Leadership - Clinical Freedom and Treatment Autonomy; Patient Focus Established and Growing Patient Foundation; Multi-Specialty Practices with Dedicated Staffs; Partnership Model - Long Term Doctor Career Path/Investment Opportunities; Full Benefits - Healthcare & Dental Benefits, 401K, Short Term/Long Term Disability, Time Off; Malpractice Coverage Assistance; Continued Education Support: Internal & External advance training, Paid ADA & State Society Dues, Study Clubs and GEDC University Courses; Group Practice Camaraderie - Technique Development Assistance Available, Chairside Mentoring. Please view our Doctor Career Path video: http:// www.screencast.com/t/M3xWM5CYN. Please apply via this ad for consideration, Hannan Ayad| Clinical Recruiter | Great Expressions Dental Centers PSC-North | 29777 Telegraph Road.

Suite 3000| Southfield, MI 48034 USA phone 248-598-7256 |Ext. 71178| fax 248-430-5528 | web www.greatexpressions.com.

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

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

Placement Service. ASSOCIATE PLACEMENT SERVICES Statewide Opportunities. Need an Associate? General Dentist or Specialist? Call Melanie Aranda 561-310-0599, e-mail: melanie. aranda@doctors-choice.com (If you need a job, it’s at no charge).

Part Time (Temp) Dentist Opportunities - Tampa, FL. Join our terrific dental team in Florida as a Temp or Part-Time Dentist!

Dr. Rick Woodward, Clinical Partner has select Temp and PartTime Senior Dentist or Associate positions for our Tampa, FL dental practices. Enjoy a rewarding career path with a dedicated staff in this highly productive practice environment with an established patient base! Compensation: Extremely High Production Opportunities: High Daily Rate vs. Competitive Percent of Production! Benefits/Perks: Practice Leadership: Clinical Freedom and Treatment Autonomy; Patient Focus: Established and Growing Patient Foundation; Multi-Specialty Offices/Digital; Partnership Model – Investment Opportunities/ Long term Doctor Career Path; Malpractice Coverage Assistance; Continued Education Support: Internal & External advance training, Paid ADA & State Society Dues, Study Clubs and GEDC University Courses; Group Practice Camaraderie – Technique Development Assistance available! Please view our Doctor Career Path video: http://www.screencast.com/t/ M3xWM5CYN. Please apply via this ad for consideration, Molly McVay | Sr. Clinical Recruiter | Great Expressions Dental Centers PSC-North | 29777 Telegraph Road. Suite 3000| Southfield, MI 48034 USA phone 248-430-5555 |Ext. 72467| fax 248-686-0170 | web www.greatexpressions.com Must have a DDS/DMD from an accredited University and active State Dental Board license. Apply Here. PI97542773.

CLASSIFIEDS from 77

Seeking Dentist to Join Growing Practice in Tallahassee, Florida.

A Tallahassee, Florida practice seeking a motivated, full-time associate dentist to join this established team that offers services in general dentistry, oral surgery, cosmetic dentistry, pediatric dentistry, endodontics, and periodontics. The practice is fully computerized with digital x-ray units, a digital panorex, digital radiography, Dentrix practice management software, intramural cameras, state-of-the-art water filtration system and more. The practice boasts a predominately fee-for-service/PPO patient base, turnkey facility, quality staff, and low overhead with an annual revenue of more than 3 million. The practice is in a new, conveniently located building with 16 operatories. For more information on this opportunity, send a copy of your current CV to ccouch41@gmail.com and or call Dr. Cory Couch at (850) 509-3789.

Dentist (Pedo emphasis) Fort Myers, FL. Join our terrific Dental Team in Florida as a lead General Dentist providing care to children ages 1-12! Dr. Raul Rangel, Clinical Partner, is seeking a full-time Dentist treating kids 4 days per week to work in our specialty practice located at: 5100 S. Cleveland Avenue, Fort Myers, Florida 33907. Enjoy a rewarding long term career path with dedicated staff in this productive practice environment with an established patient base! Compensation: High Income Opportunity: $175,000 Salary with potential earnings of $300,000 plus a year; Possible sign on bonus or relocation assistance; Benefits/Perks: Practice Leadership Clinical Freedom and Treatment Autonomy; Patient Focus - Established and Growing Patient Foundation; Multi-Specialty Practices with Dedicated Staffs; Partnership Model - Long Term Doctor Career Path/Investment Opportunities; Full Benefits - Healthcare & Dental Benefits, 401K, Short Term/Long Term Disability, Time Off; Malpractice Coverage Assistance; Continued Education Support: Internal & External advance training, Paid ADA & State Society Dues, Study Clubs and GEDC University Courses; Group Practice Camaraderie - Technique Development Assistance Available, Chairside Mentoring. Please view our Doctor Career Path video: http:// www.screencast.com/t/M3xWM5CYN. Please apply via this ad for consideration, Hannan Ayad| Clinical Recruiter | Great Expressions Dental Centers PSC-North | 29777 Telegraph Road.

Suite 3000| Southfield, MI 48034 USA phone 248-598-7256 |Ext. 71178| fax 248-430-5528 | web www.greatexpressions.com.

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Offered – Healthcare & Dental Benefits, 401K, Short Term/Long Term Disability, Time Off; Malpractice Coverage Assistance; Continuing Education Support: Internal & External Advanced Training, Paid ADA & State Society Dues; Group Practice Camaraderie– Technique Development Assistance, Study Clubs, Chairside Mentoring, GEDC University Courses. Please view our Doctor Career Path video: http://www.screencast.com/t/ M3xWM5CYN. Hannan Ayad| Clinical Recruiter | Great Expressions Dental Centers PSC-North | 29777 Telegraph Road.

Suite 3000| Southfield, MI 48034 USA phone 248-598-7256 |Ext. 71178| fax 248-430-5528 | web www.greatexpressions.com “Look for the Smile Above Our Name!” Must have a DDS/DMD from an accredited University and active State Dental Board license. Apply Here. PI97882201.

Dentist Opportunity- Dallas (Cockrell Hill), TX. Join our terrific dental team in Cockrell Hill, TX as a lead Dentist! Our Dallas clinical leadership team is seeking a full-time Senior Dentist or Associate for our busy Texas dental practice located at: 2425 S Cockrell Hill Rd STE A, Dallas, TX 75211. Enjoy a rewarding long term career path with a dedicated staff in this productive practice with an established patient base!

Compensation: High Compensation Opportunity: Potential Earnings of 200K+; Benefits/Perks: Practice Leadership: Clinical Freedom and Treatment Autonomy; Patient Focus: Established and Growing Patient Foundation; Multi-Specialty Office/ Digital; Partnership Model – Investment Opportunities/Long term Doctor Career Path; Full Benefits Offered – Healthcare & Dental Benefits, 401K, Short Term/Long Term Disability, Time Off; Malpractice Coverage Assistance; Continued Education Support: Internal & External advance training, Paid ADA & State Society Dues, Study Clubs and GEDC University Courses; Group Practice Camaraderie – Technique Development Assistance available! Please view our Doctor Career Path video: http://www.screencast.com/t/M3xWM5CYN. Please apply via this ad for consideration, Hannan Ayad| Clinical Recruiter | Great Expressions Dental Centers PSC-North | 29777 Telegraph Road. Suite 3000| Southfield, MI 48034 USA phone 248-5987256 |Ext. 71178| fax 248-430-5528 | web www.greatexpressions. com. “Look for the Smile Above Our Name!” Must have a DDS/ DMD from an accredited University and active State Dental Board license. Apply Here. PI97882964. http://www.Click2apply. net/wvxrvtjk7323j93z.

General Dentist. General Dentist needed for new offices in Tampa area, Florida. We are seeking a Dentist that is motivated and will provide the highest level of care to our patients.

Excellent communication skills, great chair side manner and high work ethics are required. We are a new office offering an excellent opportunity for growth and earning potential for the motivated individual. We offer health insurance and 401K. Please reply to this posting with your CV/resume. shooo1@ aol.com.

Dentist Opportunity Dallas (High Point), TX. Come lead our terrific dental team in High Point! Dr. Rick Woodward, Dallas Clinical Partner, is seeking a full-time Senior Dentist or Associate to lead our established, practice in Dallas, TX located at: 12101 Greenville Avenue, Suite 101 Dallas, Texas 75243. Enjoy a rewarding career with a full office staff (including Hygienist), a strong schedule and the ability to focus on quality patient care. Compensation: High Compensation Opportunity: Potential Annual Earnings of 200K+; Benefits/Perks: Practice Leadership: Clinical Freedom and Treatment Autonomy; Patient Focus: Established and Growing Patient Foundation; Multi-Specialty Office/Digital; Partnership Model – Investment Opportunities/Long Term Doctor Career Path; Full Benefits Offered – Healthcare & Dental Benefits, 401K, Short Term/Long Term Disability, Time Off; Malpractice Coverage Assistance; Continuing Education Support: Internal & External Advanced Training, Paid ADA & State Society Dues. Group Practice Camaraderie– Technique Development Assistance, Study Clubs, Chairside Mentoring, GEDC University Courses. Please view our Doctor Career Path video: http://www.screencast.com/t/ M3xWM5CYN. Hannan Ayad| Clinical Recruiter | Great Expressions Dental Centers PSC-North | 29777 Telegraph Road.

Suite 3000| Southfield, MI 48034 USA phone 248-598-7256 |Ext. 71178| fax 248-430-5528 | web www.greatexpressions.com.

“Look for the Smile Above Our Name!” Must have a DDS/DMD from an accredited University and active State Dental Board license. Apply Here. PI97880998.

Dentist Opportunity (Full-Time) - Saginaw, TX. Come lead our terrific dental team in Saginaw! Dr. Rick Woodward, Texas Clinical Partner, is seeking a full-time Senior Dentist or Associate to lead our established, digital practice in Saginaw, TX located at: 1453 N Saginaw Blvd, Suite 150 Saginaw, TX 76179. Enjoy a rewarding career with a full office staff (including Hygienist), a strong schedule and the ability to focus on quality patient care. Compensation: High Compensation Opportunity: Potential Annual Earnings of 200K+; Benefits/Perks: Practice Leadership: Clinical Freedom and Treatment Autonomy; Patient Focus: Established and Growing Patient Foundation; Multi-Specialty Office/Digital; Partnership Model – Investment Opportunities/Long Term Doctor Career Path; Full Benefits

Periodontist (2 days/week) - Austin, TX. Great Expressions Dental Centers has select part-time opportunities for Periodontists to join our established practices located in Austin, TX! Compensation: High Compensation: Competitive daily rate vs percent of production; Benefits/Perks: Leader in the practice: Clinical Freedom and Treatment Autonomy; Patient Focus: Established and Growing Patient Foundation; MultiSpecialty Office; Doctor Career Path – Partnership/Investment Opportunities; Malpractice Coverage Assistance; Continued Education Reimbursement, Paid ADA & State Society Dues; Mentorship – Study Clubs, Chairside Mentoring, GEDC University Courses. Please view our Doctor Career Path video: http://www.screencast.com/t/M3xWM5CYN. Please apply via

www.floridadental.org

Your Classified Ad Reaches More Than 8,000 Readers! this ad for consideration! Hannan Ayad| Clinical Recruiter | Great Expressions Dental Centers PSC-North | 29777 Telegraph Road. Suite 3000| Southfield, MI 48034 USA phone 248-5987256 |Ext. 71178| fax 248-430-5528 | web www.greatexpressions. com. “Look for the Smile Above Our Name!” Must have a DDS/ DMD from an accredited University and active State Dental Board license, Periodontists Dental License and certifications.

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

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

FLORIDA—Dentist. The Villages, FL. Two Part-time positions available (1). Pedo exams only. Daily guarantee. Ideal position for semi-retired or new grad. (2). Adult work. Must be experienced in all phases. Unlimited earning potential. BUSY PRIVATE PRACTICES. Fax: (407) 302-9799. Phone: (321) 9459545. Email: FLDentalServices@aol.com.

General Dentist -- Port Charlotte, FL. If you’re looking to make your professional mark on a community, this is your chance.

Build valuable relationships with patients and get involved with the greater community while providing top-notch dental care.

Our talented and dedicated support team will work alongside you to help ensure your success. You’ll enjoy the following: Base salary with performance incentives to earn more; Sign-on bonus of $5000; Relocation package; Full time benefits include CE allowance, professional liability, 401K and group health/ wellness plans; Practice 4-5 days per week with family friendly days/hours. Candidates must be licensed to practice in the State of Florida with no board reprimands or issues, have a valid DEA license, NPI number and current CPR certification. Send resume to areimiller@dental-partners.com or call 321-574-8003 for a confidential review of the opportunity. www.dental-partners. com. http://newton.newtonsoftware.com/career/CareerHome. action?clientId=8a7882605a5f23cc015a628846e83cf8.

General Dentist Opportunity -- Sarasota, FL If you’re looking to make your professional mark on a community, this is your chance. Build valuable relationships with patients and get involved with the greater community while providing top-notch dental care. Our talented and dedicated support team will work alongside you to help ensure your success.

You’ll enjoy the following: Base salary with performance incentives to earn more; Sign-on bonus of $5000; Relocation package; Full time benefits include CE allowance, professional liability, 401K and group health/wellness plans; Practice 4-5 days per week with family friendly days/hours. Candidates must be licensed to practice in the State of Florida with no board reprimands or issues, have a valid DEA license, NPI number and current CPR certification. Send resume to

areimiller@dental-partners.com or call 321-574-8003 for a confidential review of the opportunity. www.dental-partners. com. http://newton.newtonsoftware.com/career/CareerHome. action?clientId=8a7882605a5f23cc015a628846e83cf8.

General Dentist Ocala Area. Christie Dental is a multispecialty group practice, founded in 1999. Since our founding, we’ve used our core values of fiscal, social, and ethical excellence to guide us. Today, our group is a PPO/Fee for Service dental group practice with 13 locations serving communities across central Florida. We are firm believers that the practice of dentistry must always be based on the doctor-patient partnership. That means that our behavior must demonstrate a conviction of honesty and the utmost integrity. Dentists are given full clinical autonomy so they can work with patients in choosing the best course of action for treatment and prevention. Doctors are supported with a network of resources and support, including mentor programs, leadership opportunities, continuing education and even a clear path to ownership. New dentists are able to shadow camaraderie and collaborative environment. Social responsibility is one of Christie Dental’s core values. Whether it is partnering with the Brevard County Schools Supply Zone, anticipating in the Making Strides against Breast Cancer Walk, or sponsoring the local little league team, or being involved with Reach Out and Read book drives, we are proud to support the Marion, Brevard and Osceola communities. Christie Dental is proud to provide a competitive compensation package, including comprehensive health benefits (Health, Vision, Dental), Life Insurance, Long Term Disability, Professional Liability Insurance, a 401(k) program with employer matching, and established mentor programs and leadership opportunities. For more information, please contact Kate Anderson at 781-213-3312 or email kateanderson@amdpi.com. Required Skills: DMD/DDS, FL State Dental License.

Oral Surgeon Brevard County. Christie Dental is a multispecialty dental group with 13 practice locations in the Brevard and Ocala Florida area. Christie Dental offers individuals and families a full range of dental care, including general dentistry, hygiene and specialty care, such as pedodontics, oral surgery, endodontics, orthodontics, and periodontics. We currently have a wonderful opportunity for an Oral Surgeon to join our team in our Merritt Island and Palm Bay specialty practices, on a parttime basis. This is an opportunity that provides a high number of referrals from inside and outside the Christie Dental group.

For more information, please contact Kate Anderson at 781213-3312 or email kateanderson@amdpi.com. Required Skills: DDS/ DMD, FL State Dental License or Eligibility.

General Dentist. We currently have an opportunity for a Parttime General Dentist at our Sebastian location. (Fridays, plus Every other Saturday. 2nd Day of Dentistry flexible). Christie Dental is a multispecialty group practice, founded in 1999.

Since our founding, we’ve used our core values of fiscal, social, and ethical excellence to guide us. Today, our group is a PPO/ Fee for service dental group practice with 13 locations serving communities across central Florida. We are firm believers

that the practice of dentistry must always be based on the doctor-patient partnership. That means that our behavior must demonstrate a conviction of honesty and the utmost integrity. Dentists are given full clinical autonomy so they can work with patients in choosing the best course of action for treatment and prevention. Doctors are supported with a network of resources and support, including mentor programs, leadership opportunities, continuing education and even a clear path to ownership. New dentists are able to shadow and learn from experienced professionals in their field, and seasoned professionals appreciate the camaraderie and collaborative environment. Social responsibility is one of Christie Dental’s core values. whether it is partnering with the Brevard County Schools Supply Zone, participating in the Making Strides against Brest Cancer Walk, sponsoring the local little league team, or being involved with Reach Out and Read book drives, we are proud to support the Marion, Brevard and Osceola communities. Christie Dental is proud to provide a competitive compensation package, including comprehensive health benefits (Health, Vision, Dental), Life Insurance, Long Term Disability, Professional Liability Insurance, a 401(k) program with employer matching, and established mentor programs and leadership opportunities. In addition, employees have access to: Ownership Potential; Wellness Program; Consumer Goods Discounts (Verizon, Dell, AT&T, and Working Advantage); Continuing education Allowance; Sign-On Bonus (Select Locations). For more information, please contact Kate Anderson at 781-213-3312 or email kateanderson@amdpi.com. Required Skills: DDS/DMD, FL State Dental License or Eligibility.

For Sale/Lease Office for sale in Panama City, FL. For sale, Panama City, FL. 1933 sqft. Stand-alone building. 4 equipped ops with room for 2 more ops; Lab, etc. Plenty of parking. Superb location in professional office park on major street on best side of town.

Does not include practice, already sold that when dentist recently retired. 850-271-5612.

Practices for Sale. Buyers and Sellers: We have over 101 Florida dental practice opportunities; and maybe the perfect buyer for your practice. Call or e-mail Doctor’s Choice today! 561-7462102 or info@doctors-choice.com.

Space for Rent/Share. New State-of-the-art Dental Office, with CBCT and Nomad. Ideal for a satellite office for a pediatric dentist (pediatrician’s office next door), endodontist, prosthodontist or general dentist with practice limited to pedo or Oral Surgery. Fast growing area in East Bradenton/Lakewood Ranch. Email attierentals@gmail.com or call Patricia (941)7209747

Where in the World?

Dr. Howard Pranikoff took his March/April issue of Today’s FDA to Tel Aviv University (TAU) where the bougainvilleas were in full bloom (left). He also visted the TAU Senate building with friends (above).

OFF THE CUSP

JOHN PAUL, DMD, EDITOR

The Trouble with Statistics My mechanic has a sign in his shop that he likes to point to when I’ve been pestering him while he works on my truck. “Labor $30 an hour, $40 if you watch, $60 if you help.” Lately I’ve been thinking about getting one of these signs for myself. It seems like a lot of folks want to tell me how dentistry could be done better.

Insurance companies believe they know what my services should cost, though they have never asked how I provide those services or what my patients expect. To the best of my knowledge, no insurance company actually provides care — only “benefits.”

Other groups propose that dentists are overtrained for most of what they do and lesser trained individuals would suffice. To some extent, I concur. Every time I vacuum the office, make the coffee or fix the toilet, I do not need my degree. I do, however, own a small business and those jobs are just as important to my success as a perfectly executed restoration. Even small jobs should be done well and from time to time, I am the one who does them.

When it comes to practicing dentistry, I disagree wholeheartedly. Only in hindsight can you say that a particular procedure was easy. Every patient we treat is like that starfish on the beach* — what we do matters to them. There may be statistics that “simple

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“

We do not lack for dental care — we have a lack of care for dentistry.

”

fillings and extractions” can be done with limited training. When the unexpected occurs, and that simple procedure now requires eight years of college and dental school, and several years of experience to be brought chairside immediately — that wisdom must be on the shelf, ready to use. The patient bears the ultimate consequence for everything we do. It won’t be enough to tell the patient, “So sorry, but your experience fell outside of the bell curve.”

We all want our patients to be healthy.

Education about prevention is a key part of every practice I know. Many hear the message, but few heed the call. Dental school taught us that we see about 40 percent of the dental need. There are many who will not come to our office until they are driven by unbearable pain, and still others who

will not come for any reason. Increasing the number of practitioners will not improve the dental health of these folks. We do not lack for dental care — we have a lack of care for dentistry.

Improving the oral health of the nation suffers from a fundamental lack of understanding of the problem. Until dentists are overwhelmed and unable to serve the demand for care, more providers are not the answer. Dentists must provide proper services and education, the government should provide for those who cannot help themselves and patients (parents) must take responsibility for preventing what they can.

As dentists, we try to address the third leg of this stool with education, but you can’t force the public to brush their teeth or floss or keep soda out of their babies’ bottles. *After a big storm, a boy was walking down the beach picking up starfish and throwing them back into the ocean. A man pointed out to him that there were thousands of starfish on the beach, all that he could throw back would make no difference. As the boy threw the starfish into the ocean he said, “It made a difference to this one!”

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

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