2015 - May/June TFDA

Dentist of the Year 2015 Award Winners FDC Speaker Previews Dental Coding Exhibit Marketplace

VOL. 27, NO. 4 • 2015 MAY/JUNE

Dr. Russell: Dentist of the Year

WE KNOW INSURANCE. WE KNOW DENTISTS. Call us today to speak to a licensed agent about your insurance needs.

“I cannot speak highly enough about the assistance given by Carrie Millar.

We were dealing with a LOT of changes with our health insurance needs this year, and her expertise and help in providing information about our options and the pros and cons of various plans was most greatly appreciated. Once our decision was made, she helped in completing the necessary paperwork and expediting the application process for our new plans. She made a process I dread every year so much easier. She is truly an outstanding representative for FDAS.”

— Barbara Campbell PHONE: 800.877.7597 EMAIL: insurance@fdaservices.com www.FDAServices.com

contents

40

Dr. David Russell: 2015 Dentist of the Year

news

literary

9

House of Delegates to Consider Bylaws Changes

69

Books on the Shelf

9

Next House of Delegates Meeting

77

Book Review

12

news@fda

columns f e at u r e s

3

Staff Roster

17

The Dangers of Missing Your Dental Office Lease Expiry Date

5

President’s Message

6

Legal Notes

19

Meeting Patients Where They Are: A Mobile-friendly Website

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Information Bytes

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Diagnostic Discussion

20 Create Your Hurricane Crisis Plan Now!

80 Off the Cusp

26

Letter to the Editor

30

FDC2015 Speaker Preview — Dr. Drake

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FDC2015 Speaker Preview — Ms. Banta

classifieds

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FDC2015 Speaker Preview — Dr. Levin

72 Listings

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2015 Award Winners

58

Disparities in Survival Patterns for Oral and Pharyngeal Cancer in Florida

62

Dental Coding Truths and Myths

66

Exhibit Marketplace

Read this issue on our website at:

www.floridadental.org.

www.floridadental.org

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

May/June 2015

Today's FDA

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FLORIDA DENTAL ASSOCIATION MAY/JUNE 2015 VOL. 27, NO. 4 EDITOR Dr. John Paul, Lakeland, editor

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

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

BOARD OF TRUSTEES

YOUR PROFESSIONAL GROWTH WCDDA 2015 SUMMER MEETING FRIDAY-SUNDAY, AUG. 7-9, 2015 The Ritz-Carlton, Naples

Speakers: Dr. Gerard Kuge & Dr. William Robinson www.wcdental.org • 813.654.2500 • wc.dental@gte.net

NEDDA PRESENTS TRIAGING THE OROFACIAL PAIN PATIENT Friday, Oct.30, 2015 Sheraton Jacksonville Hotel

Speakers: Dr. Henry Gemillion www.nedda.org • 904.737.7545 • ddeville@nedda.org

NWDDA 2016 ANNUAL MEETING

FRIDAY & SATURDAY, FEB. 19-20, 2016 The Grand Sandestin www.nwdda.org • 850.391.9310 • nwdda@nwdda.org

CFDDA ANNUAL MEETING

FRIDAY & SATURDAY, APRIL 15-16, 2016 Marriott Orlando World Center

www.cfdda.org • 407.898.3481 centraldistrictdental@yahoo.com For a complete listing, go to www.trumba.com/calendars/fda-member.

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Today's FDA

Dr. Richard Stevenson, Jacksonville, president Dr. Ralph Attanasi, Delray Beach, president-elect Dr. William D’Aiuto, Longwood, first vice president Dr. Michael D. Eggnatz, Weston, second vice president Dr. Jolene Paramore, Panama City, secretary Dr. Terry Buckenheimer, Tampa, immediate past president Drew Eason, Tallahassee, executive director Dr. James Antoon, Rockledge • Dr. David Boden, Port St. Lucie Dr. Jorge Centurion, Miami • Dr. Robert Churney, Clearwater Dr. Richard Huot, Vero Beach • Dr. Kim Jernigan, Pensacola Dr. Rudy Liddell, Brandon • Dr. Howard Pranikoff, Ormond Beach Dr. Barry Setzer, Jacksonville • Dr. Beatriz Terry, Miami Dr. Ethan Pansick, Delray Beach, speaker of the house Dr. Tim Marshall, Weekiwachee, treasurer • Dr. John Paul, Lakeland, editor

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

FDA membership dues include a $10 subscription to Today’s FDA. Non-member subscriptions are $150 per year; foreign, $188. Periodical postage paid at Tallahassee, Fla. and additional entry offices. Copyright 2015 Florida Dental Association.

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

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

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

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

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

ADVERTISING INFORMATION

LOOK FOR GREAT VALUES IN THE COUPON SECTION OF YOUR FDC PROGRAM! May/June 2015

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

Advertising must be paid in advance.

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

www.floridadental.org

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

FLORIDA DENTAL ASSOCIATION FOUNDATION

EXECUTIVE OFFICE Drew Eason, Executive Director deason@floridadental.org 850.350.7109 Greg Gruber, Chief Financial Officer ggruber@floridadental.org 850.350.7111 Graham Nicol, Chief Legal Officer gnicol@floridadental.org 850.350.7118 Judy Stone, Leadership Affairs Manager jstone@floridadental.org 850.350.7123 Blair Fowler, Assistant to the Executive Director bfowler@floridadental.org 850.350.7114

ACCOUNTING Jack Moore, Director of Accounting jmoore@floridadental.org 850.350.7137 Leona Boutwell, Finance Services Coordinator Accounts Receivable & Foundation lboutwell@floridadental.org 850.350.7138

(FDAF)

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

Health Gioia, Director of Foundation Affairs hgioia@floridadental.org 850.350.7117

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

Christine Mortham, Membership Concierge cmortham@floridadental.org 850.350.7136

Meghan Murphy, Program Coordinator mmurphy@floridadental.org 850.350.7161

FLORIDA DENTAL CONVENTION (FDC) Crissy Tallman, Director of Conventions and Continuing Education ctallman@floridadental.org 850.350.7105 Elizabeth Bassett, FDC Exhibits Planner ebassett@floridadental.org 850.350.7108 Ashley Liveoak, FDC Program Coordinator aliveoak@floridadental.org 850.350.7106 Brooke Mills, FDC Meeting Coordinator bmills@floridadental.org 850.350.7103

Joyce Defibaugh, FDA Membership Dues Assistant jdefibaugh@floridadental.org 850.350.7116

GOVERNMENTAL AFFAIRS

Deanne Foy, Finance Services Coordinator Dues, PAC & Special Projects dfoy@floridadental.org 850.350.7165

Joe Anne Hart, Director of Governmental Affairs jahart@floridadental.org 850.350.7205

Tammy McGhin, Payroll & Property Coordinator tmcghin@floridadental.org 850.350.7139

Alexandra Abboud, Governmental Affairs Coordinator aabboud@floridadental.org 850.350.7204

Mable Patterson, Accounts Payable Coordinator mpatterson@floridadental.org 850.350.7104

Casey Stoutamire, Lobbyist cstoutamire@floridadental.org 850.350.7202

Stephanie Taylor, FDA Membership Dues Assistant staylor@floridadental.org 850.350.7119

INFORMATION SYSTEMS

COMMUNICATIONS AND MARKETING Jill Runyan, Director of Communications jrunyan@floridadental.org 850.350.7113 Lynne Knight, Marketing Coordinator lknight@floridadental.org 850.350.7112 Jessica Lauria, Publications Coordinator jlauria@floridadental.org 850.350.7115

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

Larry Darnell, Director of Information Systems ldarnell@floridadental.org 850.350.7102 Will Lewis, Information Systems Helpdesk Technician/ Database Administrator wlewis@floridadental.org 850.350.7153

FDA SERVICES 800.877.7597 or 850.681.2996 1113 E. Tennessee St., Ste. 200 Tallahassee, FL 32308 Group & Individual Health • Medicare Supplement • Life Insurance Disability Income • Long-term Care • Annuities • Professional Liability Office Package • Workers’ Compensation • Auto • Boat Scott Ruthstrom, Chief Operating Officer scott.ruthstrom@fdaservices.com 850.350.7146 Carrie Millar, Agency Manager carrie.millar@fdaservices.com 850.350.7155 Carol Gaskins, Assistant Membership Manager carol.gaskins@fdaservices.com 850.350.7159 Debbie Lane, Assistant Membership Services Manager debbie.lane@fdaservices.com 850.350.7157 Allen Johnson, Support Services Supervisor allen.johnson@fdaservices.com 850.350.7140 Alex del Rey, FDAS Marketing Coordinator arey@fdaservices.com 850.350.7166 Angela Robinson, Customer Service Representative angela.robinson@fdaservices.com 850.350.7156 Jamie Idol, Commissions Coordinator jamie.idol@fdaservices.com 850.350.7142 Marcia Dutton, Administrative Assistant marcia.dutton@fdaservices.com 850.350.7145 Sarah Beall, Membership Services Representative sarah.beall@fdaservices.com 850.350.7171

Nicole White, Membership Services Representative nicole.white@fdaservices.com 850.350.7151 Pamela Monahan, Commissions Coordinator pamela.monahan@fdaservices.com 850.350.7141 Porschie Biggins, Membership Services Representative pbiggins@fdaservices.com 850-350-7149

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

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

Carrie Millar, FDAS Agency Manager Northeast & Northwest 850.350.7155 carrie.millar@fdaservices.com

Joseph Perretti Director of Sales South Florida

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

305.665.0455 Cell: 305.721.9196 joe.perretti@fdaservices.com

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

Director of Sales West Coast

Rick D’Angelo

813.475.6948 Cell: 813.267.2572 rick.dangelo@fdaservices.com

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

May/June 2015

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EXHIBIT HALL HOURS Thursday, June 11 Friday, June 12 Saturday, June 13

9 AM - 5:30 PM 9 AM - 6 PM 9 AM - 2 PM

DEDICATED EXHIBIT HALL HOURS Each day from 12-2 PM

W I SH

O Y

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JOIN US IN THE EXHIBIT HALL!

H E ERE R E !



BOOTHS 315 & 415

 Order ADA products.  Toss for a bottle of wine with FDAS. Visual Identity System  Meet your local FDAS insurance agent.

The ADA Signature  ADA Find A Dentist Photo Booth: get your photo taken to update your ADA web listing.  NEW DENTISTS (graduates after 2005) & DENTAL STUDENTS: The parent brand tickets signature isfor the most component pick up your complimentary drink Thevisible After Party of the brand identity system and serves as the foundation before 6 p.m. on Friday.for all other pieces of the visual identity system. The

American Dental Association

signature distinguishes the organization from other dental organizations through color, emphasis on the name of the organization and typography, and reinforces the brand positioning message.

MEMBER CENTER @ HELPING MEMBERS SUCCEED WITH THE POWER OF THREE! This year, FDA and ADA membership experts Signature will staff the Member Center together.

The signature is made up of two elements: the symbol Symbol Typography Signature Elements

and the typography. Since the acronym (ADA) exists for other organizations, the full name is emphasized in the signature. The two elements that comprise the signature complement each other visually while clearly identifying the organization.

•For Guidelines on using the symbol alone, see page 9.

•Never alter the spatial relationship between the symbol and typography.

& YOUR DISTRICT DENTAL ASSOCIATION

FDA Services is a major sponsor of the Florida Dental Convention

New Dentist activities at FDC2015 are supported by a grant from the American Dental Association.

Style

PRESIDENT’S MESSAGE RICK STEVENSON, DDS

The End of the Journey My journey as the Florida Dental Association’s (FDA) president has been a great ride. I’ve covered the state from corner to corner, coast to coast: from Jacksonville to Pensacola and down to Naples and Miami. I’ve also visited the following cities many times: Tampa, Orlando, Tallahassee, Gainesville, Delray Beach, Destin, Weston — and points in between! My journey even took me on trips out of state to Washington, D.C.; Montgomery, Ala.; and San Antonio, Texas.

I found a common theme everywhere I visited: great people with a desire to serve and protect their profession. Hospitality was ever-present. The FDA’s Board of Trustees (BOT) and staff have been working hard to make the FDA more relevant to our members. All of our districts and almost all of the affiliates throughout the state have adopted our new logo, making the FDA the first state dental association to implement a consistent single brand for the association and all its affiliated entities. In addition to a new mission statement, the strategic plan has been reworked into a functioning document that will help determine our future resolutions. If it doesn’t fit the strategic plan, then it isn’t necessary and shouldn’t be passed.

Using the American Dental Association’s Power of Three initiative, we’re putting what’s best for our members into the decisions we make. We’ve streamlined our bylaws to remove redundant and irrelevant actions from past years, and moved some material into the policy manual where it belongs. These moves will make the BOT and the House of Delegates more efficient and effective at making critical decisions. We’ve developed and introduced the Florida’s Action for Dental Health to the Florida Legislature; we now need to work hard to implement these actions.

As my journey comes to an end, I feel that the FDA is in good hands with its dedicated staff, volunteer line officers, trustees, and council and committee members. I want to thank them for their years of service and making my year as the FDA president a rewarding and enjoyable one. It’s the friendships made as a volunteer that makes this job rewarding and worth the effort. I look forward to my next journey as co-chair of our next Florida Mission of Mercy event in Jacksonville in April 2016.

“ ”

I found a common theme everywhere I visited: great people with a desire to serve and protect their profession.

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

www.floridadental.org

May/June 2015

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Legal Notes

I’ve Come Across Three Questions Lately ...

Graham Nicol, Esq., HEALTH CARE RISK MANAGER, BOARD CERTIFIED SPECIALIST (HEALTH LAW)

1) Does the U.S. Supreme Court hate dentists? 2) What’s the deal on cellphones in your practice? and, 3) You want me to sign what?

1) Does the U.S. Supreme Court hate dentists?

In the last few months, the U.S. Supreme Court has handed down two decisions affecting dentistry. First, in February, North Carolina State Board of Dental Examiners v. Federal Trade Commission reversed longheld beliefs that state dental boards were immune from antitrust liability under the “state action doctrine.”

The decision reasoned that because a majority of the board members were dentists actively practicing the very profession regulated by the board, the board therefore could not invoke state action antitrust immunity unless the state government actively supervised the board’s actions. In other words, dentists (and all other regulated professionals) cannot be trusted to put public safety concerns above their own financial interests! Regardless of whether you agree with that underlying hidden assumption,

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May/June 2015

professional boards with a controlling number of board members practicing the regulated profession must now be actively supervised by state governmental agencies if they want to avoid federal antitrust prosecution. But the real problem is — what does “active supervision” actually mean?

Three tests were put forward: state officials must “have and exercise power to review particular anticompetitive acts of private parties and disapprove those that fail to accord with state policy;” the state government is required “to review and approve interstitial policies made by the entity claiming immunity;” and, a state “supervisor must have the power to veto or modify particular decisions to ensure they accord with state policy.” Time will tell if dentists will no longer volunteer to serve on licensing boards, but the court’s decision is a shot across the bow for all professional regulatory bodies.

Second, in March, Armstrong v. Exceptional Child Care Center ruled that “neither the Constitution nor federal law authorizes doctors and other health care providers to go to court to enforce the law’s directive that the reimbursement rates set by states be ‘sufficient to enlist enough providers so that care and services are available’ to Medicaid recipients just as they are to the general population.” The case concerned two home health care providers who sued Idaho’s Medicaid program because reimbursement rates had been kept at 2006 levels despite proof that the cost of providing home

health care had increased, causing providers to lose money.

The court’s decision means if doctors believe Medicaid fees are too low, they can complain to the U.S. Department of Health and Human Services (HHS), but they cannot sue. According to the court, the federal law’s requirement that states maintain “sufficient” Medicaid reimbursement levels is “judicially unadministrable.” But what remedy can HHS realistically provide? The HHS secretary can withhold federal Medicaid funds “if a state does not comply with the law’s funding requirements.” In other words, because the state is not spending enough, the federal government can withdraw its share of the funding. This makes the problem worse, not better!

2) What’s the Deal on Cellphones in Your Practice?

First, as the employer, you have the right to adopt office policies that ensure productivity, workplace safety, etc. So, if you want to ban cellphones from the operatory (for infection control) or limit them to use only in employee break rooms when they are off the clock, you have lawful authority to do so. Just make sure to let your employees know beforehand and that the rule is applied fairly.

Many employees have a mistaken belief that they have a “right of privacy” to their personal effects, and there is some truth to that. The Fourth Amendment to the U.S. Constitution says, “The right of the people

www.floridadental.org

to be secure in their persons … and effects, against unreasonable searches and seizures, shall not be violated.” But, that generally applies to public employers, not private employers.

“

The Florida Constitution also establishes a citizen’s “right to be let alone and free from governmental intrusion into his private life.”

Again, it generally requires a “state actor” or a public employer for this Constitutional protection to be relevant. Certainly, your employees have a reasonable expectation of privacy that you, as their employer, will not monitor their personal cellphone usage (employer-provided cellphones are different), but they have no Constitutional right to access their personal cellphones on the worksite during working hours. It is a privilege, not a right, and there are valid business reasons why you may want to limit cellphone usage during work hours.

For example, Florida law prohibits the interception and disclosure of wire, oral or electronic communications without the consent of all parties to the communication. Just like you, as an employer, would not intercept or electronically eavesdrop on your employees’ personal conversations, so too, your employees should not use their cellphones to take photos, make videos or record conversations of patients without the patient’s consent.

Preventing employees from invading patients’ privacy is a legitimate workplace goal. Florida recognizes the following four types of “invasion of privacy” as legally actionable:

www.floridadental.org

Legal Notes

Many employees have a mistaken belief that they have a ‘right of privacy’ to their personal effects, and there is some truth to that.

1. Appropriation: unauthorized use of a person’s name or likeness to obtain some benefit.

2. Intrusion: physical or electronic intrusion into another’s private space.

3. Public disclosure of private facts: disclosing truthful private information that a reasonable person would find objectionable.

4. False light in the public eye: disclosing facts that place a person in a false light, even though the facts themselves may not be defamatory.

If this is starting to sound like what federal HIPAA and Florida records-confidentiality law expressly prohibit as improper “uses” or “disclosures” of “personal health information,” then you’ve got the point.

3) You Want Me to Sign What?

On Thursday, June 11, at the Florida Dental Convention (FDC), I will present a practice management course. The course provides an overview of indemnity, preferred provider organizations (PPOs), exclusive provider organizations (EPOs), prepaid limited health service organizations (PLHSOs) and health maintenance organizations (HMOs) providing dental benefits. It will go through standard contract language in participating provider agreements (PPAs) and explore some of the specific contract provisions that

”

may have unfavorable impact on dentists.

The course also will review the legal rights dentists have as both participating and nonparticipating doctors to obtain reimbursement for services.

A comprehensive manual, called “A Florida Dentist’s Handbook on Managedcare Contracts,” will be available to FDA members for free on the FDA’s website at www.floridadental.org on June 8. The handbook addresses basics, such as types of health care delivery systems, managed care models, reimbursement and participating providers’ risks. It also has a step-by-step guide on how to negotiate with managedcare organizations and doctors’ legal rights under discount medical plan organizations, insurance, and PPO, HMO and PLHSO contracts. Please download the materials and use them as a reference when evaluating PPAs.

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

Graham Nicol is the FDA’s Chief Legal Counsel.

May/June 2015

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Bylaws Notice

House of Delegates to Consider Bylaws Changes

Next HOD Meeting The secretary of the FDA announces that the HOD will meet Friday and Saturday, June 12-13, 2015, at the Gaylord Palms Hotel and Convention Center, in Orlando.

At its June 2015 meeting, the Florida Dental Association (FDA) House of Delegates (HOD) will be asked to consider rewriting the bylaws and creating efficiencies by moving some content to an FDA Workgroups Manual maintained by the Board of Trustees (BOT). Also, the HOD will be presented a resolution regarding dual-status membership dues.

According to the FDA’s Articles of Incorporation, the FDA bylaws may be changed as follows: • o by a two-thirds affirmative vote of the members of the HOD, provided the changes are sent in writing to the association’s membership postmarked at least 30 days in advance of that session of the HOD. • o or, at any session of the HOD, by a three-fourths affirmative vote of the members present and voting, providing the proposed changes have been presented in writing at a

The FDA encourages all members to seek information about these important matters from their component’s delegates to the HOD and trustees to the BOT.

previous meeting of the session and unanimous consent has been given to consider the The agenda for the HOD also will be available electronically at http://www.floridadental.org/members/about/leadership/houseof-delegates.

changes.

Dr. Jolene Paramore, FDA Secretary

NEW COURSE! Patient Abandonment At some time in their practice, all dentists will need to terminate a doctor/patient relationship. This Legal CE explains how to do so without violating Florida’s patient abandonment law. It covers the following topics: potential civil and disciplinary liability resulting

from improper termination

required content of patient termination letters required notice provisions

proper and improper reasons for termination

emergency treatment and continuing-care

warning signs indicating that the doctor is at risk

obligations other legal and ethical requirements

of abandoning a patient

Take this course online to earn free CE credit. For link, go to floridadental.org/members. FDA Members Only!

Expires 4/1/2016

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4/2/2015 9:19:35 A

benefit

Helping Members Succeed

NUMBER

16

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

Ms. Carrie Millar Affordable Care Act (EL42)

ON L I N E

CE TH E EASY WAY FREE C E C R ED I T S FOR FDA M EM B ERS

Ms. Amy Cober Help Your Patients Quit: Tobacco Treatment for the Dental Profession (EL43)

Dr. David Beach Root Canals Gone Wild: Overcoming Problems in Endodontics (EL44)

Ms. Jo-Anne Jones Whitening That Works! Exploring the Facts, the Fiction and the Evidence (EL45)

Dr. Daniel Ward Contemporary Restorative Trends: Hot Syncing Your Dental Knowledge (EL46)

Dr. William Moorhead Streamlined Success: How to Run a Highly Efficient, Highly Profitable Dental Practice (EL47)

24 HOURS a day • Free clinical & practice management CE Go to www.floridadental.org.

Click Convention & CE.

Motivate Your Team and Create Systems to Run a Streamlined Office (EL48)

Questions? Call 800.877.9922

Solving the Most Difficult Cases: A Step-by-Step Process to Achieve Predictable Esthetic Dentistry That Lasts! (EL50)

Dr. Brian Fuselier The Marriage of Sleep Apnea and Your TMJ Patients (EL49)

Dr. Glenn DuPont

Dr. George Kugel

EVERY ISSUE OF TODAY’S FDA Earn online CE credit by taking a quiz on Diagnostic Discussion.

Dos and Don’ts of Porcelain Laminate Veneers (EL51)

Mr. Sam Simos The Latest Trends In Dentistry: What Patients are Looking For and How You Can Deliver (EL53)

Dr. Alan Fetner The Anterior Single Tooth Implant …

Achieving the Optimum Esthetic Outcome (EL55)

Mr. Graham Nicol What Florida Dentists Need to Know about Prescription Controlled Substance and Pain Management Laws: An FDA Legal FAQ Guide (LC01) Patient Abandonment (LC02) * These courses expire on 1/30/2016.

TFDA_0615_onlineCE-full.indd 1

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Information Bytes

Spam, Phishing and Spoofing, Part 2: These Phish Bite Back!

By Larry Darnell DIRECTOR OF INFORMATION SYSTEMS

You may have heard the term “phishing” and thought it was just a recreational activity.

Not this one.

Perhaps you’ve received an email from your bank (or even a bank you do not use) saying you’re locked out of your account or that someone has been using your account fraudulently. The email has your bank logo; it looks official. They want you to click the link. It all looks legitimate, but it’s not — it’s a phishing attempt. You click the link and go to a website that looks similar to your bank, but in reality, is being used to collect your information so it can be used against you. In many cases, you don’t even have to type anything in; it will collect your information from your very own web browser.

Cue the National Security Agency and Edward Snowden. Phishing is a play on the word fishing because these fraudsters throw out the bait (an email) hoping you’ll open it, click on the link and provide some information — causing you to be caught like a fish. The crazy thing is, you would never

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“It’s better to slow down and use the most intelligent, adaptive technology we have available: our brains.” provide this information to some unknown person who just called you, right? However, because it all looks official, you do it.

These days, modern phishers have expanded their game to include pretending to be the Internal Revenue Service (IRS), law enforcement agencies and even delivery notices about packages from FedEx and UPS. Your best protection is to never open these emails. Do not click on a link you get in an email if you question it or doubt it at all. You usually can hover over the link and if something other than your bank’s website pops up, do not click it. Also, be especially wary of attachments. Even the best virus and malware protection can be defeated if you willingly open an attachment or click on a link. Maybe you only check your email on your smartphone or tablet, so you think you are safe. Guess what? They can get you there, too, and that will only get worse.

Perhaps you think your best defense is to be a Luddite and never use email at all.

This “modern” communication method is 40-something years old and shows no sign of going away. Rather, it’s better to slow down and use the most intelligent, adaptive technology we have available: our brains.

Think before clicking that link. Pick up the phone and call someone to ask about that attachment before you do some real damage. Question why the bank, IRS or law enforcement needs this information, and why would they send an email for something this important? Take a minute and ask yourself: What is the worst thing that can happen if I do this? Sounds like I am talking to my teenage daughters … if only they liked to fish.

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

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

FDA Cleans House at the ADA Membership Awards During the ADA Recruitment & Retention Conference in Chicago (April 16-18, 2015), the Florida Dental Association (FDA) was the hot topic of conversation due to its rapidly growing membership. The FDA was the recipient of six awards in the following categories for states with 3,501-7,500 members: s Greatest Nonmembers to Membership s Most Improved Active Member Retention Rate s Greatest Net Gain of New Dentists s Greatest Net Gain in Membership s Highest Percentage of Diverse Dentists to Membership s Highest Percentage of Women to Membership Congratulations to the FDA and local component leaders, volunteers, and staff for all of their efforts in making the Sunshine State shine again!

We’d also like to extend a big “Thank you!” to our members who have renewed their 2015 dues! Because of you, we are able to keep the voice of organized dentistry strong in Florida! If you haven’t renewed your membership yet, we’d like to add you to our success story by having you reinstate your membership at http://www.floridadental. org/dues or calling the member relations team at 800.877.9922. We need you, too!

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Introducing “Beyond the Bite”: The Official Blog of the Florida Dental Association As the FDA continues to work to empower members and further the influence and recognition of our organization, we are pleased to announce the launch of the official FDA blog: “Beyond the Bite.” The blog will provide you with information on industry trends, tips to strengthen your practice, FDA programs and events, best practices and other and resources.

From boosting your social media presence to building patient referrals to understanding insurance and regulatory changes, “Beyond the Bite” will cover a range of topics. Expertise will come from a variety of sources, including submissions from fellow FDA members, partners, other industry leaders and FDA staff. We welcome FDA members to share topics that they would like to see on the blog or to contribute a blog post!

If you have an idea for a post you would like to submit or see covered, please send a brief overview to Jill Runyan at jrunyan@ floridadental.org.

Part of Medicare Opt In/Opt Out Deadline Pushed Back The enforcement of the regulation requiring dentists who prescribe Medicare Part D covered drugs to Medicare beneficiaries has been pushed back to Jan. 2016. To ensure their patients with Medicare Part D continue to have their prescriptions covered, dentists need to take one of the following three actions: enroll in Medicare as a provider of covered services, as an ordering/ referring provider or opt out of Medicare.

A number of online resources, including a tutorial and information on Medicare Advantage plans, links to appropriate forms, sample affidavits, private contracts and Medicare contractor addresses can be found through the ADA’s Center for Professional Success by going to http://success. ada.org/en/practice/medicare/medicare.

There also is a separate FAQ on Medicare Advantage and Part D regulation. In addition, some key aspects of the impact of this regulation on Medicare Advantage participants remain unanswered. As the ADA and FDA get more information, we will update our members.

Claims Submission for Medical Plans with Embedded Dental Coverage Since the Affordable Care Act was passed, the number of medical plans offering embedded dental coverage has increased significantly. Even though these are medical plans, the plans still will accept dental claim forms and CDT procedure codes; however, there may be confusion as to where to send the dental claim.

Do you send the claims to the medical plan or is there a separate address for the dental benefits coverage? This is a relatively new concern that dentists have with these types of embedded plans.

Recently, a member dentist received a claim denial for a patient who had dental coverage through the patient’s medical plan. The dental office submitted the claim to the address for the medical plan that was printed on the patient’s ID card.

www.floridadental.org

The doctor was surprised when the explanation of benefits (EOB) statement arrived at his office indicating that the claim was denied because “dental was not covered.”

Upon investigation, it became apparent that the dental benefit coverage was provided by a different company (a company that was not providing the medical coverage).

Unfortunately, the address for dental claim submission was not on the patient’s ID card.

The dentist had to call a phone number provided on the ID card to obtain the information for the dental plan.

It is recommended that dental offices call the toll-free dental plan number to get information on the dental claim submission.

Oxycodone Overdose Deaths Drop with PDMP Deaths related to oxycodone overdose dropped 25 percent in Florida after the state adopted a Prescription Drug Monitoring Program (PDMP) to track controlled substance dispensing.

To determine the PDMP’s impact on Florida’s oxycodone-related deaths, which increased 118.3 percent from 2007 to 2010, researchers from the University of Florida examined the number of queries health care providers made for summaries of controlled substance prescriptions filled for individual patients, and also measured monthly counts of oxycodone deaths obtained from the Florida Medical Examiners Commission.

While the introduction of tamper-resistant oxycodone formulations, the closure of illegitimate pain management clinics, and other law enforcement, pharmaceutical, policy and public health actions all con-

www.floridadental.org

tributed to a decline in oxycodone-caused mortality starting in 2010, the investigators found Florida’s PDMP implementation directly produced an additional 25 percent decrease in oxycodone deaths.

In fact, oxycodone overdose deaths declined by 0.229 individuals per month for every system-wide increase of one PDMP query per health care provider.

“Pharmacists make up a very large proportion of health care professionals using the PDMP. We did not measure their specific contribution to the decline in overdoses, but they had an important role,” lead study author Chris Delcher, PhD, told Pharmacy Times in an email. “Currently, we are trying to understand how to improve coordination between prescribers and dispensers around the use of the PDMP.” Dr. Delcher, told Pharmacy Times the findings, which were published in Drug and Alcohol Dependence, have implications for national prescription drug abuse efforts, since 49 states currently have PDMPs of some kind.

“Each state is different, but we have provided some evidence that PDMPs can help prevent at least one major outcome of prescription drug abuse: overdoses,” Dr. Delcher said. “Our results provide empirical data for national policymakers trying to decide how to devote resources to this epidemic.”

In addition to accessing the PDMP, community pharmacists and pharmacies in Florida were required to develop policies and procedures to minimize dispensing

based on fraudulent prescriptions or invalid practitioner-patient relationships under the provisions of Florida HB 7095.

Pharmacists throughout the state also must report to law enforcement any individual who obtains or attempts to obtain a controlled substance through fraudulent methods, and failing to report is considered a first-degree misdemeanor.

FDA Member Dr. Randy Feldman Honored as Lightning Community Hero The Tampa Bay Lightning honored Dr. Randy Feldman as the 27th Lightning Community Hero of the season during a game in early February against the Los Angeles Kings. Dr. Feldman, who received a $50,000 donation from the Lightning Foundation and the Lightning Community Heroes program, is donating the money to More Health Inc., Voices for Children, Tampa Humane Society, St. Vincent House and FARA. Dr. Feldman’s chosen vocation can be summed up in one word: service. As a practicing orthodontist for more than 32 years, he has tallied almost of 18,000 hours working pro bono to alleviate crainiofacial, birth defects in more than 3,000 patients. Additionally, he has taken up leadership roles in supporting various nonprofit causes, including the Make-A-Wish Foundation® and 13 Ugly Men, a nonprofit organization aimed at hosting events to raise funds for local charities. Dr. Feldman is noted as playing an integral role in the campaign that resulted in Hillsborough County fluoridating its water supply in 1988.

Please see NEWS, 16 May/June 2015

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WORKERS’ COMPENSATION INSURANCE: LEGAL AND NECESSARY! • This past year, FDA Services has been informed of more than two dozen offices visited by Florida Department of Financial Services employees who were checking on workers' compensation compliance.

• Under Florida law, businesses with four or more employees must have coverage.

Penalties for non-compliance include fines and can go as far as stop work orders.

• Since the cost of workers’ comp. insurance is relatively low compared to other industries and provides important financial security, it should be one of the first purchases a dental office makes.

800.877.7597 insurance@fdaservices.com  www.fdaservices.com

PROTECTION

CALL TODAY TO DISCUSS A WORKERS’ COMP. POLICY!

He is the president of More Health Inc., a nonprofit 501(c) 3 organization that trains instructors to deliver engaging health education lessons to students. In conjunction with Dr. Feldman’s steady community involvement, he operates his own orthodontic practice, Feldman Orthodontics, with two locations in North and South Tampa.

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 Patrick Cello, Okeechobee Kelly Chioffe, Boca Raton Sharon Davis-Browne, North Palm Beach Michael Elliot, West Palm Beach Constantin Fiacos, Sunrise Mark Kubiliun, Jupiter Elizabeth Meyers, Delray Beach Stephan Porter, West Palm Beach Natalia Tsar, West Palm Beach

Carl Jones, Melbourne

Manijeh D’Amelio, Naples

Justin Kindler, Daytona Beach

Richard Furman, Sarasota

Angel Lopez Guzman, Oviedo

Arezou Garmestani, Lakeland

James Magee, Winter Springs

Phillip Goff, Port Richie

Joseph Orlando, Clermont

Luz Hernandez, Wesley Chapel

Caroline Pawlak, Deland

Zahida Iqbal, Oldsmar

Bradford Porter, Altamonte Springs

Danielle Kissel, St. Petersburg

Jeffrey Smith, Melrose

Filadelfo Larios, Naples

Leonel Torres, Deland

Erica McFarland, Tampa

Allyson Wolfersteig, Palm Coast

Ashley Millstein, Lakeland

Jung Xue, Ocala

Eunice Nieves, Tampa Jennifer Paulmino, Largo

Northeast District Dental Association Felipe Falcao, Jacksonville Matthew Oubre, Jacksonville Bharat Shah, Jacksonville Christine Trunk, Jacksonville

Northwest District Dental Association Chinara Garraway, Tallahassee Eve James, Quincy Angel Vasquez, Pensacola

South Florida District Dental Association Ramzi Al-Hashimi, North Miami Beach

Central Florida District Dental Association

Martin Fernandez – Feo, Miami

James Baker, Altamonte Springs Andrea Cunningham, Palm Bay Mary Gharagozloo, Orlando

Today's FDA

May/June 2015

Samuel Rosenfeld, Sarasota David Tarnowski, Pinellas Park

Brian Leeson, Jacksonville

Christina Tseng, Port St. Lucie

Edwin Acosta, Clermont

16

Lauris Johnson, Orlando

West Coast District Dental Association

Maximillian Iurcovich, Melbourne

NEWS from 13

Isabel Cancino Badias, Miami Adela Haratz, Aventura Hakan Kinaci, Pembroke Pines Raquel Pino, Miami Judex Ramirez, Miami Lakes Anurupa Singh Roy, Coral Springs

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

Geoffrey Banga Richard Saal Ponte Vedra Beach Pensacola Died: 2/1/15 Died: 2/28/15 Age: 39 Age: 82 Alan Marder Naples Died: 3/18/15 Age: 67 Louis Pasetti Tampa Died: 2/10/15 Age: 98

John Stanton New Smyrna Beach Died: 2/1/15 Age: 93 H. Todd Lake Mary Died: 1/26/15 Age: 78

www.floridadental.org

Office Lease Negotiations

The Dangers of Missing Your Dental Office Lease Expiry Date Alain Sabbah PARTNER AT CIRRUS CONSULTING GROUP DENTAL OFFICE LEASE NEGOTIATORS

Have you ever considered what happens when you miss your dental office lease renewal deadline or expiry date? Timing is crucial, and letting your lease expire without a proper renewal plan can lead to a significantly negative financial hit to your occupancy costs, and to your dental practice’s overall value.

Critical Dates to be Aware of in Your Dental Office Lease Expiration Date The expiration date is a critical date to be aware of in your lease agreement. Being mindful of this date with the ability to negotiate your lease terms far in advance of its expiry will work to your advantage. The length of most lease terms is typically five or 10 years.

“Option to Extend” Expiration Date The “option to extend” or “renewal” expiration date is the last day you can exercise your option to extend the office lease term.

Dental professionals benefit from negotiating options into their leases because it provides flexibility for their practices in the www.floridadental.org

future. Landlords view these “options” as the sole benefit of the tenant, and therefore, often place limitations as to when they can be used with deadlines.

Why You Should Never Miss Your Renewal or Expiry Date Month-to-month Tenancy If you accidentally miss your dental office lease expiry date, you become a month-tomonth, or “overholding,” tenant. This means that you’ve lost one of the most important protections that an office lease agreement offers any practice: long-term security in your practice location. The last thing you want is to be relocated from your current practice, forced to rebuild it elsewhere, incurring hundreds of thousands of dollars in moving expenses along the way.

At this point, technically speaking, both you and the landlord have the right to terminate the lease by providing only 30 days’ advanced written notice to the other party.

Imagine getting notice that your landlord has terminated the lease and is kicking you out of the building, and you have only 30 days to relocate? This is a harsh reality that thousands of dental professionals face every year.

Your Monthly Rent, Doubled!

Allowing your lease to expire without a preplanned renegotiation or renewal strategy also may lead to a significantly negative financial hit. Many lease agreements state that as soon as you go past your expiry

date, the landlord has the right to charge you twice the normal monthly rent for each month past the expiry. That rental hike is enough to put any dentist out of business.

We advise you to check the overholding clause in your lease as soon as possible to ensure that you’re aware of what your penalty rent would be.

How to Avoid These Costly Leasing Mistakes?

Never miss an expiry or renewal date again!

Review your lease and identify your expiry date and option to renew deadline. If you have 24 months or less remaining on your dental office lease, begin to prepare your negotiation strategy now, leveraging the remaining time you have left to structure your lease properly.

Your landlord knows very little about the business of dentistry, but what they do know is that the closer they get you to the end of your term, the less time and leverage you have to negotiate a good deal with your landlord. Achieving a good lease with fair and affordable financial terms requires extensive research, preparation and a strong negotiation strategy — so, don’t wait. Be proactive and track your office lease dates!

Alain Sabbah can be reached at 1.800.459.3413 or asabbah@cirrusconsultinggroup.com. For more information about Cirrus, visit them online: www.cirrusconsultinggroup.com.

May/June 2015

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Website

Meeting Patients Where They Are: A Mobile-friendly Website Darren Allen MOORE COMMUNICATIONS GROUP

Mobile responsiveness has quickly shifted from “nice to have” to a “must have” for any company that wants to boast a successful website. According to Nielsen, mobile web adoption is growing eight times faster than web adoption did in the early 1990s and early 2000s. Google says 90 percent of people move between mobile devices to accomplish a goal, whether it’s on smart phones, PCs, tablets or TVs. And, while this is a very critical reason to have a mobile-responsive website, the stakes have gotten higher. As of April 21, Google expanded the use of mobile-friendliness as a ranking signal.

Google has long used a complex algorithm to determine where websites will be listed upon entering certain search criteria. Now, websites that aren’t easy to use on mobile devices will find themselves losing site rankings to their competition. Here’s why that should matter to practices large and small:

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“

The numbers don’t lie. Today’s website users are increasingly consuming web content through a variety of mobile devices.

”

• It allows you to provide the best user experience for your patients and potential patients. Jordan Frank at Seer Interactive, a leading Search Engine Optimization firm based in Philadelphia, shared with me why Google favors mobile devices so heavily. “Google aims to provide the most relevant and quality content to their users. Period. In an effort to make sure that every mobile user has a great mobile experience, Google’s mobile update will significantly affect mobile searches across the globe, and should be addressed.”

Google’s goal to provide the best experience possible for its users should be your practice’s goal as well. A smart practice strives to meet users where

they are, and the numbers tell us that’s increasingly on mobile devices, such as tablets and phones.

• It can turn your potential patients into loyalists. Users today expect to see a mobile site outperform the traditional desktop website, and the branding to be just as consistent and appealing. If they don’t receive this experience, they will move on. In fact, Google reports that 41 percent of users have turned to a competitor’s site after a bad mobile experience and 61 percent have a better opinion of brands when they offer a good mobile experience.

The numbers don’t lie. Today’s website users are increasingly consuming web content through a variety of mobile devices. Practices that don’t already have a great mobile experience for patients need to quickly change that, or risk getting left behind.

Darren Allen is the Director of Digital at Moore Communications Group. With his trademark energy and understanding of the ever-changing online environment, Darren leverages more than 15 years of digital design experience on behalf of clients. He can be reached at darrena@moorecommgroup.com or on Twitter @DigitalDarrenA. * Note: Officite, an FDAS Crown Savings Merchant, can assist with mobile-friendly websites and can be reached at 877.235.1525 or www.Officite.com/TodaysFDA. May/June 2015

Today's FDA

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FDA Services

Your Hurricane Crisis Plan FDA Services

Create

Now!

By Carrie Millar, MBA, CAE

FDA SERVICES AGENCY MANAGER

Life in sunny Florida can have many benefits; relatively warm weather year-round and access to beautiful beaches are just two upsides of living and practicing in this state. However, there also are some downsides, the worst being hurricanes.

These destructive, swirling storms come barreling toward the peninsula almost every year and, although storms can vary in intensity, they always bring some sort of damage with them.

Is your practice prepared to handle the chaos that comes after a big storm? In a state where hurricanes are a normal part of life, it’s vital to have a hurricane/crisis plan ready for your practice in the event of an emergency. Not every plan is the same, but there are several hallmarks of an ideal strategy to keep in mind while crafting your readiness plan.

Decide when your practice will close and reopen.

Will your closing coincide with county schools and/or other government entities? Have a policy in place and be sure that both your employees and patients are aware of that policy.

Notify patients and staff if you need to close/reopen.

Keep updated emergency contact lists and create a notification system that can be used in any emergency scenario.

Make sure your practice can afford a couple days of closure.

Keep an emergency fund to help your practice survive in case you need to be closed for several days after a storm hits. Business income insurance and off-premises power failure coverage also will help with the costs, but they often have a 72-hour waiting period.

Please see HURRICANE, 23

“

Communicate annually with your insurance agent to review your coverage details.

Being prepared can make a difference.

”

HURRICANE SEASON WOULD YOUR PRACTICE PREVAIL? 5 Lessons learned from Superstorm Sandy Small business owners affected by Hurricane Sandy learned some hard lessons about what’s necessary to bounce back from a disaster.

What did the brutal storm teach us and how can your practice be prepared for major hurricanes in the future?

1

EXPECT THE UNEXPECTED

2

STORM TIME = DOWN TIME

Accept extreme weather as the new reality and have disaster preparation and business continuity plans ready before the weatherman’s forecast.

How long can your practice last with doors closed? Keep an emergency fund to help your practice survive a couple days of business closures.

5

3 4

PROTECT YOUR DATA Back up your data regularly and keep important documents in a weather-proof safe. Also keep copies of important records at a secure offsite location.

MAKE A BACKUP PLAN

Your business continuity plan should include details such as practice location alternatives, out-of-region backup suppliers and employee emergency contacts.

MAKE SURE YOU’RE COVERED Communicate with your insurance agent annually to reveiw your coverage details. Ask about additional coverages that may be right for your practice. Being prepared can make the difference.

Call us at 800.877.7597 or email insurance@fdaservices.com today to speak to a licensed agent about your practice’s hurricane protection coverage.

FDA Services

HURRICANE from 21

RISK EXPERTS Protect your data!

Back up your practice’s data regularly and keep important documents in a weatherproof safe. Also, keep copies of important records, such as employee, vendor and client contact information, collected and backed up at a secure offsite location.

Update your inventory list.

Make sure you have an updated list of all the major assets in your practice, or even better, take a video of all the items. This is a great way to make sure you can account for all items in the event of a loss.

Make sure you’re covered!

Communicate annually with your insurance agent to review your coverage details. Ask about any additional coverage that may be right for your practice. Being prepared can make a difference.

Key Coverages to Have for Hurricane Season

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

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

Carrie Millar, FDAS Agency Manager Northeast & Northwest 850.350.7155 carrie.millar@fdaservices.com

Wind/Hail Coverage: Make sure that your policy has coverage for physical damage caused from wind; often there is a separate deductible for this coverage.

Joseph Perretti

Business Income and Extra Expense: This coverage pays for your practice’s missed income when there is physical damage to your building. It also pays for temporary office space in the event of a larger damage amount.

305.665.0455 Cell: 305.721.9196 joe.perretti@fdaservices.com

Off-premises Power/Utility Services: In the event that you do not have any physical damage, you may still have to close your practice because of interruption of communication, power or water services. This coverage will help recoup some of that lost income.

Flood Insurance: We recommend that all business owners consider purchasing this coverage to have complete coverage for any water damage. While wind driven rain is covered by wind insurance, rising water is not.

This article was prepared by FDA Services. FDA Services’ experienced staff is ready to get to work for you. If you feel you need a review of your current insurance policies — call us at 800.877.7597 or email insurance@fdaservices.com.

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

Director of Sales South Florida

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

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

THINGS TO KNOW BEFORE YOU GO …



NEW! Automatic CE Verification



Where to Pick Up Your Badge When You Arrive

CE Verification is automatically provided for all attendees. Your badge is now your course ticket! To receive CE credit for course attendance, you must scan your badge upon entering and exiting a course and be present in a course a minimum of 50 of the 60 minutes to receive one hour of CE credit. The system will calculate and record the amount of time you are present in a course and award the credit appropriately. After the event your CEU certificate will be emailed to you. Course attendance will be submitted automatically to CE Broker on your behalf no later than June 30, 2015.

When arriving to the Gaylord Palms Resort & Convention Center, you may pick up your badge in the hotel lobby from 4-9 p.m. Wednesday and Thursday, or in the City Hall lobby, daily from 7 a.m. to 5 p.m. If you need to add courses or register additional people you can do that at onsite registration in the City Hall lobby.

NEW! Badges must be worn to all courses and events. Don’t forget that guests, spouses and children over 12 who will be attending events with you need to be registered to obtain a badge.



Room Finder



Exhibit Hall Hours & Info

Download the FDC Mobile App! There you will find the most current list of course and event room locations, as well as much more convention information. Visit www. floridadentalconvention.com and download it today! In addition, there will be a large display with room names, as well as digital signage directing you to room locations.

THURSDAY, JUNE 11 — 9 a.m.- 5:30 p.m.  FRIDAY, JUNE 12 — 9 a.m.- 6 p.m.  SATURDAY, JUNE 13 — 9 a.m.- 2 p.m.

Great products, new innovations, cutting edge technology … make sure you visit our exhibit hall, with over 300 exhibitors offering products and services to help your practice excel. Also, enjoy a leisurely lunch in the back of the Exhibit Hall with your colleagues. Short on time? Be sure to schedule your one-on-one appointment with the exhibitors you want to see while at FDC2015. The deadline to make appointments is Friday, June 5th.

NEW! Once you’re onsite, look inside the Official FDC Program for special Exhibitor coupons and offers available only at FDC.



Parking & Shuttles



Food Options

Parking is free to attendees staying at the Gaylord Palms Resort & Convention Center. If you are driving in or staying at an off-site property, self-parking is $18 per day and valet is $26 per day at the Gaylord Palms. Parking onsite is very limited for non-hotel guests. Free parking is available at ESPN’s Wide World of Sports. Free shuttle service from ESPN’s Wide World of Sports to the Gaylord Palms begins Thursday, June 11th at 7 a.m. and continues through Saturday, June 13th at 6 p.m.

We have worked with the Gaylord Palms Resort and Convention Center to ensure you have ample food outlets during the convention. In the Exhibit Hall you’ll find drink and snack stations available all day as well as lunch from 11 a.m.-2 p.m. An additional grab n’ go location will be available in the atrium, as well as additional restaurants open during peak lunch and dinner hours. Look for monitors located throughout the hotel and convention center listing the available food options and wait times for each.

Letter to the Editor

Mid-level Providers

By Dr. Edward Hopwood

Recently, I attended a meeting where we discussed the

“

assault on our profession’s standard of care by what I will refer

If we use the skills and talents it took us eight years of schooling to acquire, then there is no way someone with a two-year degree can provide the same safety, efficacy and quality of care we do.

”

to as “lower-tier” providers. Currently, there’s a lot of politicking going on about mid-level providers and how they will be used to improve access to care. There also is a concern about hygienists seeking clinical independence from dentists — not to mention the latest Facebook firestorm about independent “shopping mall” whitening. Everywhere we turn, it seems these “lower-tier” providers are threatening to erode the dentist’s wellearned role as leader of the dental team.

My favorite example is the home orthodontics kit — a company will send you everything you need to make impressions at home. Then, snap some photos with your cell phone, send in these materials and — voilà! —you will receive a series of trays that can be used to align your teeth. No need to worry, all the movement is worked out on a computer. Just switch the trays out

26

Today's FDA

May/June 2015

when prescribed, and you can do your own orthodontics at no cost!

The home orthodontics kit sounds like it should be ordered from the back of Mad Magazine. But it is not really so different from what our colleagues are doing after taking a weekend certification course.

After the impressions are made, very little thought goes into the process — the computer does the movement, the trays are delivered to the patients by an assistant and some sort of movement is accomplished.

Sure, the company sends a neat cartoon video, but how many of these “recreational” orthodontists even watch the video? How many take the time to make mid-course corrections?

As a profession, how do we withstand this assault on our professional ethics and standard of care from “lower-tier” providers? We need to raise our standard of care and use everything we learned from our training every time we treat patients. If we use the skills and talents it took us eight years of schooling to acquire, then there is no way someone with a two-year degree can provide the same safety, efficacy and quality of care we do. We cannot afford to simply do a filling. We need to use all of our knowledge and expertise: to select the most

www.floridadental.org

Letter to the Editor

appropriate material for that particular

and to be compensated fairly for what you

We can all agree that it takes much more

situation; eliminate interferences so that the

do.” Our profession’s long-standing and

than eight years of training to master the

filling will last; help eliminate the bacterial

proven commitment to patient safety is

dental profession. It takes many years of

etiology; and, to layer appropriate levels of

being threatened by “lower-tier” provid-

deliberate practice — long after graduation

resin to enhance the aesthetic result. Then

ers, but really it is under siege because

— in order to become a master (due respect

we must take the time to explain to the

we are allowing them to threaten us. We

to Malcolm Gladwell). If we all set out to be

patient what all of that means.

have accepted a general simplification of

the best we are capable of being, “lower-

many of our procedures, often at a cost of

tier” providers wouldn’t ever enter into the

One of my favorite authors, Seth Godin,

quality and durability. When we allow the

discussion.

addressed this issue in his blog. He wrote,

procedures to be simplified and we accept

“The proven way to add value [is to] do

a lower level of quality and durability, then

Dr. Hopwood is a restorative dentist in

extremely difficult work … If you do some-

these procedures can and should be done by

Clearwater and can be reached at edward-

thing that’s valued but scarce because it’s

those who are less educated.

hopwood@gmail.com.

difficult, you’re more likely to be in demand

www.floridadental.org

May/June 2015

Today's FDA

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SAVE THE DATE J U N E 1 1 -1 3 , 2 0 1 5 Register by May 29th to receive regular course pricing!

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FDC2015 Speaker Preview

Decisions, Decisions

By Dr. Richard B. Drake

Some of us have quite large social circles; others, not so large. I’m sure you have some friends or colleagues, however, that you keep in touch with on a semi-routine basis.

That’s the way it was with Mark. We met to catch up every couple of weeks or so. Lunch was usually at a hamburger joint, and we exchanged pleasantries and then got right into our routine. Burger bite, fry dipped in ketchup, then taking turns telling our woes. Mark would tell me how rough his week was, how tough business was; I would see his bet, and then raise him with a staff problem; he would see me and raise again with a flat tire. You get the picture.

Somehow, some way, our meetings had become — unintentionally on both of our parts — a tug-of-war to bring each other down. I can’t blame Mark; I was just as much to blame. I distinctly remember as I sat there that day hearing a voice scream into my head, “What are you doing? Why are you engaging in this downward spiral of negativity?” I thank God every day for that epiphany, which at this point occurred more than 10 years ago.

I made a decision right there that I would not engage anyone or anything that brought negativity into my life anymore.

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Today's FDA

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The change didn’t happen overnight; in fact, it took about a year or so. But I started to change and my friends followed suit.

The moment I heard a negative comment, I would immediately change the subject.

Mark would bait me with a sad story about an ailing parent, and man, my natural instinct was to want to tell my story about my mom’s struggle with cancer and her death. But instead, I took a deep breath and consciously redirected the conversation. I chose my words carefully, first to acknowledge his feelings of grief and then to bring in something positive. In this case, I chose to praise the wonderful people at hospice, and then ask Mark if he had ever thought about volunteering for something like that to help other people. My pattern of acknowledging the other’s feelings, bringing up something positive and then asking a question completely changed the tone of all of my conversations with all of my friends, in a positive and nurturing way.

But what in the world does this have to do with practicing dental sleep medicine? I’m not exactly sure I can put it into words, but I think it has a lot to do with it.

Patients who have sleep-disordered breathing have a decreased quality of life. Many of them want to tell you their woes (some want to tell us about all their problems!). If

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FDC2015 Speaker Preview

you understand what it is that you do, what you can help fix and believe in what you do, then you can learn to be more efficient at how to pick out specific problems that you can help change. I sit in with other dentists all the time as we consult and coach, and the tendency for most dentists is to listen to everything and not focus on the specific problems that they can fix. The result is vagueness, a sort of fog, an atmosphere where neither the patient nor the doctor really knows what was said or what can be done about it. It’s no wonder patients don’t choose to engage in your services and therapy. I remember telling a dentist and his entire staff one day, “As sleep dentists, we fix airways. We help keep them open, help people sleep better, oxygenate better and feel better. We mitigate other health risks by doing this, and we help patients to live longer, healthier and happier lives.

Get that through your head!”

Leave no doubt. Tell your patients, “You have a disease and it is slowly sucking the life out of you. Choose to feel better and have more energy. Choose to engage life with more enjoyment and be around longer to enjoy your grandchildren.” You get the picture. Tie in the patient’s chief complaint to how you can help make a change. More patients will say yes, and you will create that elusive win-win situation we all seek.

Dr. Drake is a professor at the University of Texas Health Science Center in dental sleep medicine, and is co-founder of Dental Sleep Solutions Franchising, LLC. He can be reached at richard@dentalsleepsolutions.com.

He is a speaker at FDC2015 and will be presenting two courses on Saturday, June 13. His lecture, “Dentists Saving Lives by Treating Sleep” is at 9:30 a.m., and his workshop, “Dental Devices for Sleep” is at 2 p.m.

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Tie in the patient’s chief complaint to how you can help make a change. More patients will say yes, and you will create that elusive win-win situation we all seek.

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FDC2015 Speaker Preview

Keys to Successful Collections

By Lois J. Banta

Collecting past due monies is more challenging today than ever — especially in the dental field. We’ve all heard the excuses: “I forgot my checkbook.” “I never carry a credit card.” “Why can’t you bill me like you used to?”

In actuality, we’ve done it to ourselves by allowing our patients to pay whenever they want to. We send three “We really mean it — this is your final notice!” statements and then never take action! Below are three steps necessary for effective, efficient collections. q Always, always, always inform your patients of your fees and financial policy before doing any dental treatment. q Make financial arrangements before treatment starts. q Follow through with whatever you promise — whether it’s collecting a past due balance, following up on an insurance claim or answering questions that are important to them. Otherwise, your patients will feel like they’re not being taken care of, and that they’re not understood or respected. With the proper information, they can make the right decisions about the proper treatment and payment options.

I recommend outlining the treatment plan and setting goals for your patients in writing. Use easy to understand terms, not

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complicated dental terminology. Develop a treatment plan that encompasses the entire process, and make sure to include a disclaimer statement at the bottom of the treatment plan that allows for unexpected changes in treatment. In addition, always have the patient sign a consent form allowing you to treat them and a truth in lending agreement explaining fees and payment options.

Changing how and when you accept payment from your patients is one of the most challenging situations for a dental practice. If your patients have been allowed to pay from a statement for 20 years and you suddenly change the rules, you will be met with serious objections! First of all, be excited about the change! When you are confident, your patients don’t have as much of an opportunity to object. For example: “Mrs. Jones, your fee for today is $700.

We estimate your insurance will pay $500, leaving $200 as your estimated portion.

How would you like to pay today: cash, check or credit card?” Mrs. Jones may reply, “Just send me a statement like always.” Your reply: “Actually, we are so excited — our accountant was just in and set up new payment guidelines. We now can take payment right here in this office by cash, check or credit card. Which would you prefer?”

If Mrs. Jones becomes upset, simply state that she couldn’t possibly have known about the change in policy and offer to send a courtesy statement with her with an en-

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FDC2015 Speaker Preview

velope and stamp included. Ask Mrs. Jones to put that payment in the mail as soon as she gets home and you will follow up in five days if not received. This is a simple solution to alleviate any adverse responses to your change, and now Mrs. Jones knows about your new guidelines for the next appointment!

When tracking past due payments, it’s important to remember to be consistent.

I firmly believe in the “four notice rule,” which is three past due payment notices before collection action is taken.

Four Notice Rule q First, send the current statement. q Then, send a 30-days past due notice as a gentle reminder. Calling the patient at this time is up to you. However, I believe in giving them the benefit of the doubt at this point, and I don’t call on the first past due notice. q If no response, send the second, 60-days past due notice and follow up with a phone call to the patient. q If still no response, send the third and final past due notice in the form of a 90day reply. After a set time, take collection action after that third and final past due notice.

Remember, we lose credibility when we repeatedly send final notices and never take any final action. Not only is this unproductive, it can get you in legal trouble in the Unites States. According to the Fair Debt Collection Practices Act, which can be found at www.ftc.gov/os/statutes/fdcpa/ fdcpact.htm (state laws may differ slightly), sending more than one final notice is considered harassment and the patient can take the dental practice to court! Another great collection resource is to look online for the state law rules at the Florida Attorney Gen-

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eral’s office at www.myfloridalegal.com. This website dedicated to informing you about Florida’s laws in reference to collections, NSF checks, small claims court, etc.

Whatever the policies are in your dental practice, be certain to put them in writing and always follow through. Fifty percent of our patients listen with their ears, and the other 50 percent “listen” with their eyes.

Most patients need to see something in writing before it becomes believable. Keep track of how many notices are sent to each patient and write detailed notes regarding conversations about collection attempts and promises made. Never write your collection notes in your progress and treatment notes.

It can be perceived by the courts that you were only interested in the patient’s money.

Always keep a separate record of collection calls and notices sent. Print monthly reports to keep track of payments received and notices sent to patients. And remember, for legal purposes, it didn’t happen unless you write it down.

Lois Banta is CEO and President and Founder of Banta Consulting Inc. She can be reached at 816.847.2055 or lois@bantaconsulting.com.

Ms. Banta is a speaker at FDC2015, and will be presenting four courses. On Thursday, June 11, “Dealing with Difficult Patients” is at 9:30 a.m. and “High-impact Communications” is at 2 p.m. On Friday, June 12, “Total Team Concept for Effective Scheduling” is at 9:30 a.m. and “Insurance Strategies that Work” is at 2 p.m.

“

Changing how and when you accept payment from your patients is one of the most challenging situations for a dental practice.

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WE’RE BACK!

Jacksonville April 20-23, 2016 VOLUNTEER REGISTRATION LAUNCHES AT FDC2015!

Come join us & share your talents. Help create healthier smiles for those in need.

For more information, or to volunteer: www.floridadental.org/foundation

800.877.9922 foundation@floridadental.org In my entire career, I’ve never done something as impactful and special as FLA-MOM. Very cool.

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FDC2015 Speaker Preview

The Nine Areas of Expertise – No.1: Production

By Dr. Roger P. Levin

In consulting relationships with more than 25,000 dental practices since its founding in 1985, Levin Group has developed a high level of knowledge and skill in all areas of practice management and marketing, which we refer to as “The Nine Areas of Expertise:” 1. Production 2. Collections 3. Team Building 4. Scripting 5. Case Acceptance 6. New Patient Experience 7. Hygiene 8. Scheduling 9. Marketing This article discusses the first area of expertise — practice production — in-depth, and what dentists can do to increase it in the current economic environment.

The Challenging New Dental Economy The first step toward increasing production is to analyze the reasons your practice revenues are declining, flat or growing too slowly. If you went into practice before 2008, you know firsthand that the game changed for dental practices that year. What I have called the “Eight Permanent Game Changers” — with the Great Recession foremost — posed serious challenges for

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dentists across the country. According to the Levin Group Data Center™, three out of every four practices have experienced production declines in the past six years.

The dental economy, once predictably rewarding (and forgiving, for dentists who lacked business skills), has changed dramatically and permanently. Faced with realworld challenges, dentists now must learn how to run their practices as real-world businesses, and production is the most critical skill that must be developed.

A Multi-pronged Approach to Increasing Production Except for the collections process, which comes after the fact, all the areas of expertise have a direct bearing on practice production, which should be targeted at a 15 percent increase per year. The most successful growth strategies, therefore, depend on the smooth orchestration of skills in every aspect of practice operation. This means that, as each new system goes online, there will be a synergistic effect, and growth can become exponential once your overall improvements reach critical mass.

The following steps, though arranged in logical order, are not meant to be pursued like numbered instructions. In reality, you and your staff will be moving back and forth between these areas as you progress toward your goals.

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FDC2015 Speaker Preview 1. Attracting New Patients You can’t grow your practice without new patients who: q make up for the inevitable attrition in your patient base due to relocation and other causes. q typically represent higher per-patient production than existing patients. q broaden your captive audience for elective services. q increase the potential number of patient referrals you generate annually.

In the new dental economy, competition for these patients has increased, with more new dentists graduating from dental schools, more doctors postponing retirement and more dental support organizations marketing actively.

You’ll need a marketing program to bring in new patients. Start with multiple internal marketing strategies — Levin Group recommends that our clients use 15 ongoing strategies — that encourage current patients to refer family members, friends, etc. This word-of-mouth advertising can be powerfully persuasive. The target: 40-60 percent of patients making at least one referral per year.

Once you have a full internal marketing program in place, you may want to consider implementing some external marketing, but keep in mind that it’s costlier and, because you’ll be facing a lot of competition for the attention of prospective patients who’ve never heard of your practice, response levels will probably be low.

2. Reactivating Patients Many patients who stop coming in are not dissatisfied … they’re just trying to save money or don’t believe they need routine care. A high proportion of inactive patients can be persuaded to schedule an appointment if you use excellent scripting, a

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methodical calls-emails-letters communication process, and perhaps an incentive (e.g., a free comprehensive exam). It will be easier and less costly to reactivate a former patient than to bring in a new one. Most practices that follow our recommendations reactivate 60+ percent of their inactive patients within 90 days.

3. Comprehensive Exams and Treatment Plans You should give comprehensive annual examinations to all patients and then develop equally comprehensive treatment plans. Perform a Five Phase Exam™, which includes: q periodontal exam q tooth-by-tooth exam q cosmetic exam q implant exam q occlusal exam Based on your observations, you then should develop a prioritized comprehensive treatment plan that lists everything from more immediate needs to longer-range possibilities. This plan — modified periodically as conditions change — will serve as an ongoing reference and motivator for both you and your patients.

4. Benefit-oriented Case Presentations One of the most striking changes made by dentists who are successfully increasing production and turning their practices around is their approach to consults. Seeing that the old, clinical take-it-or-leave-it approach was resulting in dismal acceptance rates, they have shifted from informing to influencing and from education to motivation.

“

If you and your team commit to increasing production, your efforts will be rewarded and your practice will move steadily toward fulfilling its true potential.

”

Rather than overwhelming patients with technical details, you will find much greater Please see EXPERTISE, 39

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MAKING CHANGES? LET US KNOW!

2015 FLORIDA DENTAL ASSOCIATION

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It is really rare to see customer service anymore, so you are very much appreciated. Thank you for all that you do!

— Dr. Rebecca Benedict

Get to Know Your Membership Concierge Ms. Mortham advised me to be part of the Association so, together with other members, we can voice what is needed for all dentists and make Florida Dental Association become a stronger organization. Christine even wrote a personal note to thank me for working with her. Furthermore, Christine took an extra step by making the membership payment easier for my accounts payable supervisor in the office. That is top-notch customer service! — Dr. James T. Yang

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Are you taking advantage of all the benefits the FDA and ADA offer? As your Membership Concierge, Christine gives her undivided attention to FDA members and future members alike. She has a wealth of information and can help direct you to the path of success. Call her with your questions!

800.877.9922 or 850.350.7136  cmortham@floridadental.org

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FDC2015 Speaker Preview EXPERTISE from 37

success by helping them understand how they will benefit from treatment. In addition to feeling and looking much better, their overall health will be improved thanks to better oral health. It makes much more sense to prevent rather than repair problems.

Along with this kind of value building, you also should be sure to present more than just single-tooth cases. If multi-tooth approaches make sense, and if you think the benefits of elective procedures might be appreciated by patients, present them. Even if they want to take time to “think about it,” the seed has been planted. In today’s economy, patients are taking longer to make decisions regarding larger cases and elective treatments.

You know the value of the care you can provide. By sharing that appreciation with patients, you’ll be serving them well and increasing production. Aim for a 90 percent case acceptance rate of all cases, not just single-tooth cases.

5. Follow Up As suggested above, patients may not accept treatment when you first present it.

In the new dental economy, many people are obliged to think twice about accepting treatment if they have to pay for it out of pocket. Give them time to think about it and talk it over with their spouse, but don’t let it drop entirely. You, the hygienist or perhaps even another member of your staff can “remind” them of the option without applying pressure. By following up like this, you ultimately will close many more cases.

6. Payment Options Beyond having a well-thought-out approach to dental insurance, you should

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be prepared to help patients handle fees that will not be covered by insurance. To encourage case acceptance (and thereby increase production), your objective is to make treatment affordable. Offer a range of payment options: discounts for upfront payment-in-full; half upfront, half on completion; major credit cards; and, financing by a reputable outside company. Be aware that many patients will be hesitant to say they need such help, so offer it to everyone.

7. Hygiene Production The hygiene department is an area of expertise in its own right, but belongs in any discussion of total practice production. In a well-managed general practice, hygienists account for 25 percent of total production.

Clearly, you need to ensure that all related systems allow for the maximum performance of this profit center within your practice.

In addition to actual hygiene production, this department also serves as the gateway to doctor production. It provides continuity in relationships with patients — making more future doctor production possible.

8. Scheduling When some doctors think about increasing production, they believe it will necessitate working longer hours, raising their fees or some other radical change. In many such cases, revamping the scheduling system will increase the practice’s production capacity significantly without expanding hours.

An efficient schedule enables the doctor and team to see the maximum amount of patients per day. Without such a schedule in place, practices will never be able to reach their full production potential.

Dentists should consider replacing their schedules every three to five years to ensure the highest levels of efficiency and production.

9. Delegation By the same token that you should prepare your scheduling system for increased production, you also should begin minimizing non-productive activities for your practice’s primary producer — namely, you.

Delegate all routine, non-clinical tasks to staff. By distributing these responsibilities, you’ll not only be taking a major step in team building and stress reduction, but you also will be freeing up your personal time for doing what you love: producing dentistry. Your target is to spend 98 percent of your time chairside.

Conclusion Begin making improvements and developing your expertise in production using the above steps and you quickly will see quantifiable growth. The effects will be incremental at first, but if you and your team commit to increasing production, your efforts will be rewarded and your practice will move steadily toward fulfilling its true potential.

Reprinted with permission from Levin Group Inc. Dr. Levin is the founder and CEO of Levin Group Inc. and can be reached at rlevin@ levingroup.com.

He is a speaker at FDC2015 and will be presenting two courses on Friday, June 12.

He will be presenting “Nine Essentials of a Successful Practice” at 9:30 a.m. and “Set Your Practice on Fire!” at 2 p.m.

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Dr. Russell

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Dr. Russell

By Jessica Lauria PUBLICATIONS COORDINATOR

From the Oklahoma fields to the Florida beaches, Dr. David Russell has left a trail of success. What hasn’t this man accomplished? He attended the University of Alabama (UA) School of Dentistry for his dental degree, and subsequently enlisted in the U.S. Air Force as a dental officer. When his commitment with the Air Force was fulfilled, he proceeded to further his studies once again at the UA School of Dentistry and specialized in pediatric dentistry. The UA School of Dentistry was like a second home, as he became a professor and chair of the Department of Pediatric Dentistry. He was a part of a respected faculty and took pride in educating and preparing many young men and women to become successful members of the dental profession. Many of his students have served in high offices in various state and speciality dental associations, as well as the American Dental Association (ADA). In conjunction with being a professor, he was an international lecturer, and a co-editor and contributing author in Sidney B. Finn’s “Clinical Pedodontics” — one of the most widely used textbooks on the subject in dental education.

Dr. Russell is a member of numerous dental organizations and is impressively licensed in five different states. He is an active volunteer, with a remarkable ability to balance his many commitments with his duties at his practice in Fort Walton Beach. Currently, he is the Florida Dental Association (FDA) Foundation president, a member of the FDA Committee on Conventions and Continuing Education, and a member of the Northwest Delegation to the FDA House of Delegates. In the past, he’s had the great fortune to participate in numerous committees for all levels of organized dentistry.

A dedicated and humble man, Dr. Russell is an inspiration to all he encounters. He truly is deserving of this great honor, and the FDA is proud to call him one of our own.

1. Please tell us about your family and where you grew up.

My parents worked hard and provided a great start for me and my brother. With my parents’ love and guidance, I began a wonderful and storybook life. Our home was a small, rural community in southwest Oklahoma. The major business and economic influence was agriculture — the town was surrounded by thousands of acres of flat, but beautiful cotton and

wheat fields. I made most of my spending money and funds for college by working in those fields.

My wife Jane is the most beautiful and fun lady that I have ever met; she has been my friend, soulmate and wife for 47 years. We have two sons, Lee and Blake, and a grandson, Caden Matthew — who is a pistol and delight for us all. I’m very proud of my family. We’ve had many good times and we’ll have many more. Someone is always there to deflate any fat head I may acquire (i.e., Dentist of the Year) or to raise my spirts when needed. I love and respect them all.

2. How did you choose dentistry as a career?

I guess you could say that I was destined to be a dentist. My mom was a dental assistant for as long as I can remember: all of my childhood, throughout college and dental school, and beyond. I had an opportunity to live and breathe all aspects of a dental career through the mentorship of Dr. James H. Hollomon, a rural small-town dentist who was a prominent citizen and a pillar of the community. I spent many hours with Dr. Hollomon observing, listening and learning about the profession. My career in the dental profession has been educational, interesting, enjoyable and rewarding beyond belief. I attribute every fun moment to Please see RUSSELL, 42

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Dr. Russell RUSSELL from 41

At A Glance Born: n Nov. 22, 1936 in Frederick, Okla.

Education: n University of Oklahoma, 1955-56 n Abilene Christian College, 1956-58, B.S. in Zoology n University of Alabama School of Dentistry, 1958-62, DMD n University of Alabama Graduate School, 1964-67, M.S. in Dental Science (pediatric dentistry)

Honors/Awards: n Hatton Award, presented by International Association of Dental Research n Outstanding Thesis Award, presented American Academy of Pedodontics

Boards passed: n Florida, Oklahoma, Texas, Mississippi and Alabama

Professional organizations: n ADA, FDA, NWDDA, OkaloosaWalton Dental Society, American Academy of Pediatric Dentistry, Southeastern Society of Pediatric Dentistry, Florida Academy of Pediatric Dentistry, American College of Dentists

Military/Academic Experience: n 1962-64, Captain/Dental Officer, U.S. Air Force in Tripoli, Libya n 1969-84, Assistant, Associate and Full professor and chair of Department of Pediatric Dentistry, University of Alabama School of Dentistry.

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the great people, including my family, my staff, my colleagues, my friends and my patients.

It’s been a great journey.

3. What advice would you give to dental students?

New dentists?

It’s often said that advice is worth what one pays for it. That being said, I would advise preprofessional students to decide as early as possible the academic/career direction they wish to travel, and seek out a quality mentor to help them. Once a career/educational direction is determined, focus on goals, work hard and persevere. Be flexible. The road is tough, and may contain a few potholes. You may not be accepted to a professional school on your initial application, or you may not be accepted to your school of choice, etc. These are just bumps in the road if you really wants a specific future.

I essentially would give the same advice to new dentists. The dentist first must decide what kind of career in dentistry they wish to pursue: practice, academics/teaching, military, public health, etc. Where do they want to live, what kind of lifestyle do they want to have and what assets are available to provide the things that will make them happy?

4. Why should dentists be a member of the FDA? How has it helped you/your career?

I have been a proud, dues-paying, appreciative ADA member for about 56 years. I’ve been an FDA member for 30 years, and prior to that, an Alabama Dental Association member for around 26 years. I believe the most important aspect of our memberships in organized dentistry is the relationships with each other as individuals that comprise the various organizations. Surely, we all know that the most important part of our lives includes the people — family, friends, neighbors, coworkers, colleagues. Members of organizations function as a team focused on the same goals. They are more effective and more successful than when trying to do the same thing alone. We need to work together, play together and celebrate our successes together. If we do not follow those principles, the successes we seek for our profession will become fewer, occur less frequently, and the dental profession and the people it serves will suffer.

My professional memberships have helped me by protecting the important and necessary qualities of excellence. I’ve benefitted greatly by my association with other dental professionals on both a social and professional level. I believe that quality individuals seek out other people with similar traits, desires and wishes to better accomplish their goals and share their lives.

5. You’re the FDA Foundation president — what is the Foundation and how does it benefit members and the FDA? It is an unbelievable honor for me to have the opportunity to serve as the FDA Foundation president. It’s a multi-faceted, involved and often time-consuming activity. The individuals who serve on our board are the stars of our society. They give graciously of their time, intellect, emotions and wealth to manage and support the charitable arm of the FDA.

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Dr. Russell

In our lives, the one thing we cannot create, accumulate, acquire, buy or even borrow is time. We have a limited amount of time for sleep, work, family and our own interests. Therefore, an individual’s time is a precious commodity.

By volunteering for the Foundation for more than a decade, Dr. Russell has chosen to sacrifice his valuable time in support of the charitable endeavors of organized dentistry.

”

It is my pleasure, on behalf of the staff and Board of Directors, to express our deepest gratitude to Dr. Russell for his years of volunteerism and service to the Foundation. We are so pleased that the FDA is giving special recognition to a man who inspires us all. ­— Heather Gioia, Director of Foundation Affairs

The Foundation is an organization supported primarily by sustaining members. The Foundation raises money to support worthwhile dental activities within Florida, including: student scholarships for members of the dental team; funds to help members in disaster and relief situations; support of dental health education programs and materials; and, clinical dental care support for Florida citizens in need. A recent important milestone was the Florida Mission of Mercy (FLA-MOM) event held in Tampa in 2014. Several hundred dental volunteers from throughout the state, representing all members of the dental team, gathered at the Florida State Fairgrounds, with an assembled dental clinic of more than 100 dental chairs/units to provide dental care to more than 1,500 patients who were in need.

The second FLA-MOM is being planned, and will be held in Jacksonville in April 2016. The individuals involved are working hard and making great progress. I’m very proud of them and I ask each FDA member throughout the state to make a commitment to volunteer for onsite participation, financial support or both.

preventive care, the importance of good oral health to good general health, and more emphasis on cosmetic treatment.

6. You’re also on the FDC Committee. Why should members attend the convention and how does bringing their staff benefit their workplace?

Photos:

I’ve served on the FDC Committee long enough that they should be charging me rent! It’s been a pleasure for me to be able to work each year with the staff and committee members to plan, manage and execute the FDC, which is one of the finest dental meetings in the U.S. The FDC has provided a quality event each year where attendees have the opportunity to interact professionally with colleagues, attend quality continuing education courses, while simultaneously providing support for the FDA. It’s a win-win for all.

Dental staff members are an important and indispensable part of the team. In every activity, the weakest link often determines the ultimate level of the group’s success. Dental practices are no exception. The same opportunities for learning through formal courses and interaction with other attendees are available for all dental team members. In addition, bonding opportunities occur for attendees within their office staff as well as staff from other practices. There is value there for everyone.

7. How has dentistry changed since you began practicing?

What is better?

In clinical practice, I think most would agree that the quality of the equipment and materials has improved. From a personnel aspect, there are far more female dentists than existed in my first year in dental school in 1958. Also, many members of the dental team have expanded their contributions in patient care. Philosophically, more emphasis is placed on www.floridadental.org

Government control and regulation is much more prolific in our profession. Use of gloves, masks and other protective wear is common; one-use, throw-away materials used in treatment, including needles, are the standard; control of where and how one practices dentistry, including the level of remuneration for providers is already present or on the horizon.

1. Dr. Russell and his new bride, Jane. His lucky day.

2. Jane and David - Happy times!

3. Proud father with sons, (right to left) Blake, Dr. Russell and Lee. 4. With the kids in Costa Rica. Long days, hard work, hot jungle, great satisfaction.

5. Considering another career?

6. Right to left: Drs. Watson, Russell, Trawick, Pruett, Fisher, Futrell, Henry & Perrett. The Dan Henry gang at work and play.

7. Drs. Russell and Fisher. The rewards of volunteerism.

Dr. Russell is a pediatric dentist in Fort Walton Beach and can be reached at dlrfwb@hotmail.com.

Ms. Lauria is the FDA Publications Coordinator and can be reached at jlauria@floridadental.org or 850.350.7115.

May/June 2015

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43

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2015 Awards

Dentist of the Year David Russell, DMD Dr. David Russell is a life member of the American Dental Association (ADA) and Florida Dental Association (FDA), and has been an FDA member since 1985. He is the Northwest District Dental Association (NWDDA) Delegate to the FDA, a member on the Florida Dental Convention (FDC) com1. mittee, and a member of the FDAF from 2001-2015. He currently is the FDAF president. He was on the FLADPAC board from 2001-2009 and the DENTPAC committee from 2001-2004.

Dr. Russell has been an ADA member for more than 30 years, and a FDA member for more than 25 years. He has been a pediatric dentist for 30 years in Fort Walton Beach and an instructor at the University of Alabama at Birmingham prior to private practice. He has tirelessly served the FDA

46

Today's FDA

May/June 2015

for more than a decade, representing the NWDDA and the FDA with a smile on his face and great story for anyone who will listen. His commitment to the FDC over the last decade has helped grow our annual meeting to one of the best in the country.

He is known as personable, dedicated and humble.

Schwartz Lifetime Service Donald Clay Erbes, DDS Dr. Don Erbes has held leadership positions at all levels, including officer positions at the Central Florida Distric Dental Association (CFDDA), Central District Delegate to the FDA, FDA Trustee, Alternate Delegate to the ADA, and president and Peer Review chair of the Alachua County Dental Society. He won the 2013 Distinguished Service Award for excellence in clinical dentistry and

Distinguished Dental Service to Alachua County. He has been active as an instructor at University of Florida College of Dentistry (UFCD), and received the 1992 Award for Excellence in Teaching and Service for 10 years. He has received several awards from the FDA, including the 2006 FDA Leadership Award, the 2011 FDA Service Award and was selected as the FDA Dentist of the Year in 2012. Dr. Erbes was an ADA Grassroots Action Team co-leader with his wife Joy. Their teamwork won the annual award for best U.S. Congressional Legislative Action team in 1997.

Leadership Award Andrew Brown, DDS, MS Dr. Andrew Brown is an FDA trustee, ADA Council on Dental Practice member, National Association of Dental Labs liaison for the ADA, ADA delegate, FDA Governmental Action Committee (GAC) member, FDA

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4

4.

2015 Awards Council on Dental Health member and the Peer Review chair for Clay County. He is a past president of the Clay County Dental Society, past Northeast District Dental Association (NEDDA) delegate, NEDDA ethics chair and FDA Council on Ethics, Bylaws and Judicial Affairs member. He is extremely dedicated to organized dentistry at all levels and is the current co-chair of the 2016 FLA-MOM event. He says his greatest achievement to date is that he raised three children who are out of the house and gainfully employed! Dr. Brown is described as dedicated, reliable and hard-working — making him an excellent co-chair for the upcoming FLA-MOM event.

Leadership Award Beatriz E. Terry, DDS, MS Dr. Beatriz Terry holds several leadership positions: FDA Trustee; GAC Representative; 17th District Alternate Delegate for the ADA; Florida Dental Association Political Action Committee (FDAPAC) consultant; Legislative Contact Dentist; Florida Dental Board Examiner; Miami Dade College School of Dental Hygiene Advisory Board member; and, South Florida District Dental Association (SFDDA) Foundation President. She also is the immediate past president of the Florida Association of Periodontists, as well as past president of the SFDDA, Miami Dade Dental Society and the Ceola-Helo Hispanic Dental Association. She served on the FDC Committee and was the program chair in 2008, and was the FDAPAC Delegate to the HOD. Dr. Terry is described as dedicated, determined and committed.

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Leadership Award Stephen J. Zuknick, DMD Dr. Stephen Zuknick is an ADA House of Delegate (HOD) Alternate Delegate, FDA Board of Trustees Alternate Trustee, FDA Council on Membership BOT liaison and FDA HOD Alternate Delegate for HCDA/West Coast District District Dental Association (WCDDA). In the past, he was a member of the ADA Council on Membership, ADA Committee on the New Dentist, ADA Council on Access, Prevention and Interprofessional Relations (ex officio), and ADA Council on Annual Sessions (ex officio). In addition, he served on the FDA Sub-council on the New Dentist and was the Council on Communications chair, as well as the WCDDA editor.

Dr. Zuknick is a natural leader and mentor to many young dentists and dental students.

His passion is assisting new dentists, as he has served on the committee at the state and national level for many years. He is always available and has valuable insights into many facets of organized dentistry.

President’s Award Richard A . Stevenson, DDS Dr. Rick Stevenson served in the U.S. Air Force for two years before establishing his general dentistry practice in Jacksonville, Fla. He has been an FDA member

since 1979 and has been in practice for 36 years. In addition to becoming the FDA president in June 2014, Dr. Stevenson serves on the Florida Dental Association Foundation (FDAF) Board of Directors, FDAPAC Board of Directors and is a member of the Florida Delegation to the ADA. He is the past president of the Florida Academy of Dental Practice Administration, a past president of the NEDDA, a consultant to the FDA GAC, a liaison to the Leadership Development Committee and a representative to the Council on Dental Health. As if that is not enough, Dr. Stevenson has a passion for the underserved in Florida, as he is co-chair with Dr. Andy Brown for the next FLA-MOM event, to be held in Jacksonville in April 2016. Dr. Stevenson holds memberships in the American College of Dentists, the Pierre Fauchard Academy, the Woehler Research Group and the International College of Dentists. Dr. Stevenson has been married to his wife Marilynn for 44 years this May, and has a daughter, a son and a granddaughter.

Special Recognition Charles Llano, DDS Dr. Charles Llano is a member of the Florida State Board of Dentistry Anesthesia Committee, a Delegate to the American Dental Society of Anesthesiology, attending staff at the Lakeland Regional Medical Center, and is a Central Florida Cleft Palate Team dentist (Florida Children’s Medical Services).

Dr. Llano was a U.S. Public Health Services dental officer from 1974-1976, and Please see AWARDS, 48 May/June 2015

Today's FDA

47

2015 Awards AWARDS from 47

Special Recognition

in the Ready Reserve until 1998. He is a past president of the Polk County Dental Association and the WCDDA, as well as the Florida Dental Society of Anesthesiology. He was a reference committee chair to the FDA HOD and has served on the FDA Board of Trustees (BOT) from 2002-2008.

He was an At-large Alternate Delegate to the 17th District ADA Delegation for eight years and served on the Committee to the Florida National Dental Convention in 2010. Dr. Llano and his wife Tracy, a dental hygienist, have three adult children: ages 41, 36 and 20.

Gregory Archambault, DMD

Special Recognition Don Ilkka, DDS Dr. Don Ilkka is the 17th District Representative to the ADA Council on Ethics, Bylaws and Judicial Affairs; the FDA Liaison to the Florida Board of Dentistry (BOD); and an FDA Audit Committee member. He has held all chair positions in the Central Florida District Dental Association (CFDDA) as well as the Lake County Dental Association. He was an FDA Alternate Trustee for two years, as well as an FDA trustee for 12 years, and served on the ADA Delegation.

His dedication to the profession is demonstrated by his service on the FDA BOT and FDA Services Board of Directors, as well as serving as the liaison to the BOD. He also provides dedicated service to his patients while simultaneously providing free care to the less fortunate in Lake County at the St. Luke’s Dental and Medical Clinic he founded and manages.

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Dr. Gregory Archambault is the president of Clay County Dental Care Inc. Dr. Archambault developed the concept of, and worked to start, the Clay County dental clinic to address access to care for county residents after the public health care clinic closed. He was the driving force in fundraising, and likewise encouraging his fellow practitioners and dental suppliers to share in his vision. Dr. Archambault spends countless hours in the clinic, volunteering his time to children and adults who need dental services. Dr. Archambault has served on the Clay County YMCA Board of Directors and as an FDA Alternate Delegate.

He was awarded the Health Department Volunteer of the Year in 2007 and Rotary Citizen of the Year in 2009.

Special Recognition Robert Hayling, DDS Dr. Robert Hayling has dedicated his entire life to serving his country, dentistry and the civil rights movement. His life was shaped by segregation, but he triumphed as a leader of the national civil rights movement. Because of his efforts to integrate St. Augustine businesses, he sometimes is called the Father of the Civil Rights movement in St. Augustine, and also the Father of the 1964 Civil Rights Act.

Dr. Hayling grew up in Tallahassee and went on to graduate from Florida A&M University before he enlisted in the Air Force in 1951. He went to officer’s candidate school and was commissioned a second lieutenant. Dr. Hayling earned his dental degree from Meharry Medical College School of Dentistry in Nashville, Tenn. After he graduated, he moved to St. Augustine, where he reopened the practice of Dr. Rudolph Gordon.

He demonstrated with Dr. Martin Luther King Jr. and many other well-known activists, to desegregate St. Augustine. He was a victim of violence at the hands of the Ku Klux Klan and segregationists on many occasions.

He is a career-long supporter of organized dentistry. Dr. Hayling was the first African American in Florida to become member of the district, state and national components of the ADA. He says, “I always wanted to be a dentist (or a veterinarian). I enjoyed every minute of it, and it provided a good life for my wife and family.”

Daniel J. Buker Special Recognition Crissy Tallman, CMP, CAE Crissy Tallman is the FDA’s Director of Conventions and Continuing Education and has been with the association for five years.

With 16 years of experience in the association industry, she combines a sharp eye for detail with imagination and creativity. She is someone with a “can do” attitude. She has worked with

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2015 Awards leaders like Dr. Bert Hughes to make our meeting grow in a time where most meetings are shrinking. She is someone who not only understands the FDA mission of Helping Members Succeed – but she works hard every day to fulfill that mission. Crissy has been and continues to be a great member benefit! Crissy is married to John Tallman, who works as a law enforcement officer, and has a three-year-old son named Kenneth.

Service Award Suzanne Ebert, DMD Dr. Suzanne Ebert is the NEDDA’s secretary and editor. She is the FDA Council on Dental Health vice chair and is the dental director of Sulzbacher Center. In her three years as the dental director, Dr. Ebert has become a voice for the underserved in the Jacksonville area by increasing access to care for people living below the poverty level, as well as children in the community and homeless vets. She is the Give Kids a Smile Liaison for the Jacksonville Dental Society. In addition, she is on the Adjunct Faculty at the UFCD where she provides clinical instruction and mentoring to UFCD senior dental students.

Service Award Robert Ettleman, DDS Dr. Robert Ettleman is the chair and founder of Gulf Coast Dental Outreach.

After being forced to retire from clinical dental practice due to Parkinson’s disease, he focused his energy on starting the Gulf Coast Dental Outreach.

This outreach program enables low-income adult patients to receive dental care at a low cost. It benefits those who may be going through difficult financial circumstances or who are unemployed. Dr. Ettleman remains active in the patients’ treatment despite his medical condition. When asked what his greatest achievement is, he says, “Not letting Parkinson’s disease define me in what I cannot physically do, but allowing me to explore alternative roles in dentistry.” He is full of determination and integrity, and is committed to helping the community. Since its inception, the Gulf Coast Dental Outreach has logged 5,300 patient visits, valued at $2,315,000.

Service Award John Krueger, DDS Dr. John Krueger has been on the FNDC (FDC) Committee since 2008, and was program chair for FNDC2014, which was a great success. He is on the WCDDA Continuing Education (CE) Committee and is chair of the Winter

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Meeting’s table clinics. In the past, he has served as program chair for the Pinellas County Dental Association, Upper Pinellas County Dental Association (UPCDA) and Hillsborough County Dental Association (HCDA) CE programs; a Dental Explorers Program advisor; UPCDA past president and council member; and an HOD Alternate Delegate. He was a volunteer dentist at the 2014 FLA-MOM event, Gulf Coast Dental Outreach and the Homeless Emergency Project dental clinic, among others.

He states that his most notable personal achievement is raising two children who will graduate from college and be productive members of society. Professionally, FNDC2014’s success was a great achievement — both financially and in attendance.

Service Award James Strawn, DDS Dr. James Strawn is the dental director of the Health Access Network of St. Lucie County (HANDS). He is a past president of the Treasure Coast Dental Society (TCDS), as well as a past Project: Dentists Care (PDC) coordinator of the TCDS. Dr. Strawn proposed and oversaw the establishment of the adult dental clinic at the HANDS medical facility located in Fort Pierce, Fla., and had it certified as a PDC program in 2012. Dr. Strawn not only recruits fellow dentists in the area to volunteer there, but he does so himself at least twice a month. With the assistance of six volunteer colleagues, the HANDS adult dental clinic has treated more than 1,000 patients and provided more than $300,000 in free dental care. Dr. Strawn is a community service oriented, altruistic and passionate person.

May/June 2015

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49

Diagnostic

Diagnostic Discussion

Fig. 1

By Drs. Nadim Islam and Indraneel Bhattacharyya

A young male presented with an anterior maxillary gingival lesion of at least 10 years duration in the area of teeth Nos. 9 and 10 (Fig. 1, blue arrows). The lesion was asymptomatic and presented as a pink to white, slightly raised, dome-shape but with a faint papillary or verruciform surface.

Clinical examination and palpation did not elicit any additional information. The patient was seen at the Oral Pathology Clinic

by Dr. Indraeel Bhattacharyya, Associate Professor, Division of Oral and Maxillofacial Pathology, and an excisional biopsy was

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performed. The excised tissue was submitted to the University of Florida College of Dentistry Oral Pathology Biopsy Service for histopathologic examination. The hematoxylin and eosin stained sections revealed a nodular fibrous proliferation surfaced by keratinized epithelium. The surface epithelium had a slightly papillary architecture with elongated, thin and spiked rete ridges. The most conspicuous feature was the presence of numerous stellate-shaped, multinuclear and dendritic fibroblasts scattered within the dense fibrous connective tissue stroma.

The lesion has not recurred since.

Question: What is the most likely diagnosis?

A. Papilloma B. Parulis C. Peripheral Ossifying Fibroma D. Pyogenic Granuloma E. Giant Cell Fibroma

Please see DIAGNOSTIC, 54

May/June 2015

Today's FDA

53

Diagnostic

DIAGNOSTIC from 53

Diagnostic Discussion A. Papilloma Incorrect, but an excellent choice. Papillomas tend to have a papillary/verruciform surface just as we saw in this lesion.

Microscopically, papillomas exhibit papil-

since they arise from the periodontal at-

lary proliferations of keratinized stratified

tachment tissue, and rarely are seen on the

squamous epithelium with a small fibro-

attached gingiva as a stand-alone lesion. The

vascular connective tissue core. Associated

most significant difference is the presence

bacterial colonization with trauma and viral

of calcifications noted in a cellular stroma

cytopathic effects may be noted in the epi-

when compared to the current lesion. POFs

thelium. Treatment of papillomas include

are associated with chronic irritation from

conservative surgical excision, including the

calculus, an ill-fitting crown and/or trauma.

base of the lesion to prevent recurrence.

Clinically, they strongly resemble pyogenic granulomas. POFs are more common in

However, the entire lesion usually consists

B. Parulis

of epithelium with finger-like fronds and a

children and young adults, with the peak

Incorrect. A good choice, but parulis

substantial fibrous component is not seen,

incidence in 10-19 years old, and typically

usually is associated with a symptomatic

as was noted in this lesion. A papilloma is a

appear as red/pink sessile or pedunculated

tooth or a dental inflammatory process.

benign proliferation of stratified squamous

growths on the anterior maxillary gingiva.

These lesions are associated with a draining

epithelium and is thought to be caused due

The main differentiating factor is the pres-

sinus tract from a local acute inflammatory

to an infection by human papilloma virus

ence of dystrophic calcification or actual

process usually of either pulpal or peri-

(HPV). It is believed that there are, at pres-

bone or osteoid in POFs. Also, POFs have

odontal origin. A parulis represents a mass

ent, more than 80 known HPV subtypes.

a modest recurrence rate, possibly due to

of subacutely inflamed granulation tissue

The viral subtypes HPV-6 and HPV-11

their origin from deeper tissues (periodon-

at the distal opening of an intraoral sinus

have been identified in up to 50 percent of

tal ligament or periosteum). POF is treated

tract. In addition, a draining abscess usually

oral papillomas. It also is seen in younger

by simple excision down to the periosteum

is mildly symptomatic, but here the patient

people, but mostly diagnosed in people 30-

to prevent recurrence. In addition, any cal-

was totally asymptomatic. A parulis appears

50 years of age with an almost equal male/

culus or local irritant also must be removed.

angry red, swollen and more like a pyogenic

female predilection. It presents as a soft,

granuloma than a cyst. Dental abscesses

D. Pyogenic Granuloma

painless, generally pedunculated, exophytic

also may channelize through the overlying

Incorrect. Great choice! Pyogenic granulo-

lesion with a stalk. Several finger-like sur-

skin and drain via a cutaneous sinus tract.

mas (PGs) are considered to be an exuber-

face projections that impart a “cauliflower�

Infections associated with maxillary anteri-

ant healing response most often caused by

or wart-like appearance can be seen with

or teeth typically drain through the lingual

chronic irritation or trauma. The nodular

this entity. It may be white, slightly red or

cortical plate. A long standing parulis may

fibrous presentation, long duration without

normal in color, and is usually seen on the

become fibrosed and resemble an organized

any noticeable increase in size and the lack

tongue, soft palate or the vestibule. It also

pyogenic granulomas or fibroma. There was

of local irritation detract from a diagnosis

may be seen on the gingiva, though less

no evidence of any adjacent tooth involve-

of PGs. In addition, 95 percent of PGs are

likely. The lesions present commonly as

ment/ailment in our patient.

ulcerated and covered by a whitish-yellow

solitary or stand-alone and may grow to

fibrino-purulent exudate, which was

the size of about 0.5 cm. It may be difficult

C. Peripheral Ossifying Fibroma

absent in this situation. The name pyo-

to distinguish this lesion clinically from

Incorrect. Good selection! Peripheral

genic granuloma is incorrect because these

the verruca vulgaris, a condyloma acumi-

ossifying fibromas (POFs) are common

lesions are not full of pus (pyogenic) nor

natum or even a verrucous carcinoma. The

hyperplastic growths that only occur on

true granulomas. They actually are com-

above mentioned lesions may be included

the gingiva. But typically, POFs are noted

posed of vascular granulation tissue. About

in the differential diagnosis of a papilloma.

on the marginal and/or interdental gingiva

54

Today's FDA

May/June 2015

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Diagnostic

75 percent of PGs occur on the gingiva,

E. Giant Cell Fibroma

are not distinct or characteristic to warrant

possibly related to chronic irritation from

Correct! The clinical presentation, es-

separate classification. However, most

calculus or trauma. They usually appear as

pecially the location (anterior maxillary

current pathology literature and text-

red/pink exophytic growths that vary in size

facial gingiva), papillary surface, nodular

books identifies these lesions as separate,

from a few millimeters to several centime-

architecture and microscopic features all

unique entities. These present clinically as

ters. These lesions are much more common

are highly supportive of this diagnosis.

an asymptomatic sessile or pedunculated

in females and often are associated with

Giant cell fibroma (GCF) was first identi-

nodule, usually less than 1 cm in size. The

hormonal changes as noted with puberty

fied by Weathers and Callihan in 1974 as

surface of the mass often appears papillary;

and pregnancy. Elevated levels of estrogen

a distinct entity within previously identi-

therefore, it is not unusual for the clinician

(which enhance production of vascular

fied fibroma-like lesions. This was called

to call these clinically a papilloma. This is

endothelial growth factor) and/or proges-

the giant cell fibroma specifically due to

consistent with the presentation in our case.

terone produce vascular effects and prob-

the presence of stellate-shaped, sometimes

Nearly 50 percent of all GCF cases occur on

ably augment the healing response to injury

multinucleated giant cells in the superficial

the anterior gingiva. The tongue and palate

or chronic irritation. Since these lesions

stroma seen on histological examination.

remain the second most common sites.

are common during the second and early

The GCF has more or less an equal sex

An entity clinically and microscopically

third trimesters of pregnancy, they often are

distribution with most lesions seen among

similar to the GCF is noted on the man-

called pregnancy tumors. They can occur at

those 20 years of age and older, and occurs

dibular lingual gingiva of teeth Nos. 22 and

any age but are most common in children

commonly in Caucasians. There has been

27. These are called “retrocuspid papilla.”

and young adults. PGs are treated by surgi-

some ambiguity and discussion, as well

The retrocuspid papilla more commonly

cal excision down to the base. A recurrence

as disputes, among authors as to the need

is seen in younger individuals, and tends

rate of 10-15 percent is noted, possibly

for GCF classification as a separate entity

to regress and disappear spontaneously

related to incomplete removal and/or failure

from the more common soft tissue fibroma.

with increasing age. The GCF microscopi-

to remove the causative irritant. Removal

These arguments are based on the fact that

cally presents as a nodular mass of loose

during pregnancy often is associated with

stellate and multinucleated cells are found

fibrous connective tissue. The hallmark

increased likelihood of recurrence. These

at various stages of maturation of the lesion

lesions often regress post-partum.

and that most other histological features

benefit

NUMBER

16

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www.floridadental.org TFDA_0615_DiagnosticDiscussionCE.indd 1

May/June 2015

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55

4/2/2015 9:18:34 AM

Diagnostic

Fig. 2

DIAGNOSTIC from 55

is the presence of numerous large, stellate fibroblasts within the superficial connective

fibroma: A clinicopathological study.

originate from the

J Oral Maxillofac Pathol. 2012 Sep;

more than 10,000

16(3):359-62.

specimens the service receives every

4. Bakos LH, The giant cell fibroma: a

tissue (Fig. 2, blue arrows). A conservative

review of 116 cases. Ann Dent. 1992

year from all over

surgical excision is the best management

Summer; 51(1):32-5.

the United States.

strategy. Recurrence is rare and there is no Diagnostic Discus-

malignant potential.

sion is contributed

Dr. Islam

Clinicians are invited to submit

Useful references:

by UFCD profes-

cases from their own

1. Vergotine RJ. A giant cell fibroma and

sors, Drs. Indraneel

practices. Cases may

focal fibrous hyperplasia in a young

Bhattacharyya,

be used in the “Di-

child: a case report. Case Rep Dent.

Nadim Islam and

agnostic Discussion,”

2012; 2012:370242.

Don Cohen, and

with credit given to

provides insight and

the submitter.

2. Kuo RC, Wang YP, Chen HM, Sun A, Liu BY, Kuo YS. Clinicopathological

Dr. Bhattacharyya

feedback on com-

study of oral giant cell fibromas. J For-

mon, important, new and challenging oral

mos Med Assoc. 2009 Sep; 108(9):725-

diseases.

3. Sabarinath B, Sivaramakrishnan M, Sivapathasundharam B. Giant cell

Today's FDA

Drs. Bhattacharyya, Islam and Cohen

can be reached at ibhattacharyya@dental.ufl.

9.

56

Dr. Cohen

May/June 2015

The dental professors operate a large, multi-

edu, MIslam@dental.ufl.edu and dcohen@

state biopsy service. The column’s case studies

dental.ufl.edu, respectively.

www.floridadental.org

FRIDAY, JUNE 12 7-10 PM • ATRIUM

A close encounter with island culture is a family-friendly event featuring entertainment and performances for all ages! There will be Caribbean themed food, steel drum band entertainment, rush out parades, wire writing, face painting and more.

Tropical attire is encouraged. We hope you’ll join us! Everyone is invited and tickets are FREE – request your ticket when you register.

Name badges will be required for entry for all attendees. Children under 12 years of age do not need a badge.

Cancer

Disparities in Survival Patterns for Oral and Pharyngeal Cancer in Florida: Can We Do Anything about It?

By Henrietta L. Logan, PhD; Yi Guo, PhD; and John Marks, DHSc

Dr. Logan

Dr. Guo

This is the third and final article in our series about oral and pharyngeal cancer (OPC) in Florida1, 2 for Today’s FDA. This article adds to the literature by examining and reporting on survival rates of OPC by geographic regions in Florida and identifies a group with poor survival.

We also highlight the results of a targeted media campaign that was designed to increase OPC examinations among the group with the poorest OPC survival.

Based on the outcome of our media campaign, we also propose important changes in the way we disseminate and structure oral health information to “at-risk” groups.

Five-year survival data of OPC reveals overall disease-specific survival rates of less than 60 percent; those individuals who do survive often endure major functional, cosmetic and psychological burden due to a dysfunctional ability to speak, swallow, breathe and chew.

Seventy-five percent of all OPCs begin in the oral cavity. According to the National Cancer Institute’s Surveillance, Epidemiology, and Ends Results (SEER) program, 30 percent of oral cancers originate in the tongue; 17 percent in the lip; and 14 percent in the floor of

Dr. Marks

58

Today's FDA

May/June 2015

the mouth.3 In Florida between 2001 and 2010, the percentage of oral cancers originating in the tongue was 30 percent; the percentage originating in the lip was 9 percent; and the percentage in the floor of mouth was 14 percent. For pharyngeal cancer in Florida (2001-2010) the percentage originating in the base of tongue was 27 percent, and in tonsils was 31 percent. From 2007-2011, Florida’s rate of oral cavity and pharynx cancers was 14.29 percent higher than the national average.4 We further analyzed Florida cancer data by geographic regions in Florida, using pre-existing geographic regions (north, central and south) established by the Florida Agency for Health Care Administration (AHCA).5 Our goal was to determine if geographic differences in survival existed for oral cancer and separately for pharyngeal cancer.

For oral cancer, we found the survival rate for the southern region was higher than the northern region: hazard ratio, or HR, (south vs. north) = 0.83, p=0.002; and the survival rate also was higher for central Florida compared to northern Florida HR (central vs. north) = 0.88, p=0.027. In short, people with oral cancer survived a shorter time in northern Florida than in central or southern Florida.

For pharyngeal cancer, we found the survival rate was higher for the southern region than the northern region HR (south vs. north) = 0.81, p<0.001; and the survival rate also was higher for the central region than the southern HR (central vs. south) = 0.87, p=0.008.

That is, the probability of survival from pharyngeal cancer was significantly lower for the northern region compared to the central and southern regions for both oral and pharyngeal cancer.

We extended the survival data analysis to determine factors that might be contributing to this regional difference. Overall, we found

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Cancer

that African-American men were significantly more likely to be diagnosed at a later stage, contributing to poorer survival rates.

Moreover, there were twice as many African-American men with OPC in the northern geographic region than the other two regions.

We concluded that late-stage diagnosis largely contributed to the differences in five-year survival by geographic region and that the effect was strong among African-American men.

We extensively studied the reasons for a late-stage OPC diagnosis, knowing that the OPC diagnosis relies on patient presentation and a dentist’s visual and tactile examination of the oral and neck structures with biopsy confirmation.6 The reasons for a late-stage diagnosis as cited in the literature were varied.7-9 They ranged from the lack of examinations for OPC,10 the quality of dental training about OPC examinations,11 the public’s lack of awareness of the disease,12-15 patient’s fear of results of a dental examination,15, 16 and access to17 and the lack of discretionary resources to pay for the examination by a dentist.18 We, however, concluded that a major reason AfricanAmerican men did not seek OPC examinations was that the health messages about OPC lacked relevancy for them.

Based on this body of work, we initiated a media campaign to promote OPC examinations. Our media campaign used posters in local businesses, brochures, church handheld fans and magnets on the side of cars or trucks. We chose these modes for delivering the information based on input from individuals residing in these communities where survival from OPC was most problematic. The messages were highly tailored for African-American men and were developed in conjunction with local community members. Greater detail about this media campaign can be found in two of our publications13, 19 and on our website at http://take-the-bite.dental.ufl.edu/ resources/media-campaign/.

The media campaign’s overall purpose was to test whether targeted messages for a specific group were effective in increasing examinations for OPC,19 and if so, what about the targeting made the message successful. It is of note that few, if any, studies in this field have tried to figure out what the critical ingredients are in an effective health message. Thus, our work was at the cutting edge.

Our study as reported in the American Journal of Public Health used two waves of telephone surveys of individuals residing in 36 rural census tracts in northern Florida (N=806).19 The second survey

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occurred after our media campaign. Our hypothesis was that raising concern about OPC among individuals who had never had an OPC examination would result in a greater likelihood of receiving a firsttime OPC examination following the media campaign. Key findings of this study were: (1) seeing more modes of message delivery (message exposure) corresponded with heightened concern about the disease (OPC), particularly among African-American participants; (2) men who reported heightened concern about OPC were more likely to receive an OPC examination for the first time; and, (3) again, among men, more message exposure was associated with a higher probability of getting a first-time OPC examination. This relationship was partially mediated (caused) by increased concern about OPC. The take-home message from this study for dentists is that health messages have to be relevant to the intended audience, and that relevance only can be judged through the eyes of that audience. This lesson seems simple and believable, but how often do we, as professionals, ask the “audience” whether a message is applicable to their understanding and feelings about the disease? We suspect the target audience is rarely consulted. For the individual dentist, knowing the circumstances of your group of patients and your community could facilitate drawing new “at-risk” patients to healthier lifestyles through effective interactions with you.

The principles we identified through our media campaign are broadly applicable and also can be applied to stemming the tide of OPC across Florida in the group of younger men.20, 21 However, the question is, are the existing messages about OPC relevant to this younger “at-risk” group? Is the mode/method used to deliver that message appropriate for the younger adult? Take a look at the materials for yourself on OPC and human papilloma virus (HPV) and ask how “relevant” are these messages to those children who should be vaccinated against HPV, their parents and to those younger adults who should be examined for early stage lesions6? At the very least, the individual dentist can choose the message’s mode of delivery more effectively, so it fits the use patterns of the younger adult and tailor the message so it is relevant to the “at-risk” younger individual.

We sincerely hope that this series of articles has been helpful in understanding OPC in Florida and in understanding potential Please see CANCER, 61

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Cancer

CANCER from 59

9. Gomez I, Seoane J, Varela-Centelles P, Diz P, Takkouche B. Is diagnostic delay related to advanced-stage oral cancer? A meta-

strategies for mitigating the negative outcomes of OPC. We can, however, do much more. OPC has few strong champions. Scarcely anyone is at the public health table seeking resources to combat this disease. OPC is an orphan cancer, not totally owned by the dental or medical professions. By further embracing the dental profession’s obligation to improve survival of OPC through promoting prevention and OPC examinations at every opportunity, with every group, and in every venue, much more progress could be made in fighting this disease.

We shall forever be grateful to the Florida Dental Association and its members for their support and encouragement of this work.

Thank you.

References 1. Logan H. Public Awareness of Oral and Pharyngeal Cancer: What Can a Dentist Do? Todays FDA 2014; 26(6):38-41.

2. Logan HL, Guo,Y.,Marks,J.G. What a dentist should know about oral and pharyngeal cancer in Florida. Today’s FDA 2015(January/ February):56-59.

3. Centers for Disease Control and Prevention HPV- Associated oropharyngeal cancer rates by state. Atlanta, GA.: 2014. “http:// www.cdc.gov/cancer/hpv/statistics/state/oropharyngeal.htm.” Accessed September 23 2014.

4. National Cancer Institute State cancer profiles: Florida. 2015. “http://statecancerprofiles.cancer.gov/quick-profiles/index. php?statename=florida.” Accessed February 9 2015.

5. Logan HL, Guo Y, Dodd VJ, Seleski CE, Catalanotto F. Demographic and practice characteristics of Medicaid-participating dentists. J Public Health Dent 2014; 74(2):139-46.

6. Messadi DV, Wilder-Smith P, Wolinsky L. Improving Oral Cancer Survival: The Role of Dental Providers. Journal of the California Dental Association 2009; 37(11):789-98.

7. Foundation OC Oral cancer facts:Rates of ocurrence in the United States. 2014. “http://www.oralcancerfoundation.org/facts/.”

Accessed Feburary 9 2015.

8. American Cancer Society Survival rates for oral cavity and oropharyngeal cancer by stage. 2014. “http://www.cancer.org/cancer/

analysis. Eur J Oral Sci 2009; 117(5):541-6.

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

11. Clark NP, Marks JG, Sandow PR, Seleski CE, Logan HL. Comparative Effectiveness of Instructional Methods: Oral and Pharyngeal Cancer Examination. J Dent Educ 2014; 78(4):622-29.

12. Riley JL, Pomery EA, Dodd VJ, et al. Disparities in knowledge of mouth or throat cancer among rural Floridians. J Rural Health 2013; 29(3):294-303.

13. Logan HL, Shepperd JA, Pomery E, et al. Increasing Screening Intentions for Oral and Pharyngeal Cancer. Ann Behav Med 2013; 46(1):96-106.

14. Howell JL, Shepperd JA, Logan HL. Barriers to oral cancer screening: A focus group study of rural Black American adults.

Psychooncology 2013; 22(6):1306-11.

15. Panzarella V, Pizzo G, Calvino F, et al. Diagnostic delay in oral squamous cell carcinoma: the role of cognitive and psychological variables. In J Oral Sci 2014; 6(1):39-45.

16. Shepperd JA, Howell JL, Logan H. A survey of barriers to screening for oral cancer among rural Black Americans. Psychooncology 2014; 23(3):276-82.

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

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

19. Logan H, Guo Y, Emanuel A, et al. Determinants of First Time Cancer Examinations in a Rural Community: A Mechanism for Behavior Change Journal of American Public Health Association 2015; 105(7).

20. Guo Y, McGorray SP, Riggs CE, Jr., Logan HL. Racial disparity in oral and pharyngeal cancer in Florida in 1991-2008: mixed trends in stage of diagnosis. Community Dent Oral Epidemiol 2013; 41(2):110-19.

21. McGorray SP, Guo Y, Logan H. Trends in incidence of oral and pharyngeal carcinoma in Florida: 1981-2008. J Public Health Dent 2012; 72(1):68-74.

oralcavityandoropharyngealcancer/detailedguide/oral-cavity-andoropharyngeal-cancer-survival-rates.” Accessed February 9 2015.

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Dental Staff

Dental Coding Truths and Myths

By Patti DiGangi, RDH, BS

“ ”

As dental hygienists, we know there are gaps in the codes.

Not everything is a prophylaxis or perio maintenance.

As a futurist, I see the day coming soon when there is a profession of dental coders, or of a dental specialty within the medical coding world. That day has not arrived yet, which means dental hygienists, who often prefer to take a hands-off approach, need to step up and truly learn about coding.

What we think we know about coding often affects the care we offer. This carries risk — risk to patients’ health, risk for the practice, risk to your license and the risk of being unprepared in a rapidly changing world.

Dental hygiene is the backbone of many practices, with much of the diagnosis and treatment planning happening during hygiene appointments. Insurance carriers and the Affordable Care Act (ACA) are driving value-based care. Part of the ACA is aimed at improving the quality, efficiency and overall value of health care. Reimbursements will be tied to outcomes in the future. Many dental hygienists balk at offering a wider variety of preventive services that insurance won’t cover. The truth of the matter is, unless you’re holding a policy in your hand, understand how to read it and know what care has been rendered to date, there is no way to know what is or isn’t covered (no matter what your computer might say, it is only a guesstimate).

Kelly’s Dental-medical Necessity Let’s look at Kelly’s case history to illustrate. Kelly is exhibiting signs of a caries infection and oral cancer risk, but for this exercise, we will hone in on her periodontal

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condition. How should her care be coded?

The answer depends on her dental-medical necessity. The basis of all coding, including periodontal care, should be dental-medical necessity — a term and thought process that’s not well-known in dentistry. But as a dental hygienist, you do know and probably document it daily. There are many legal (and other) definitions; yet it simply requires documenting the reason a procedure is needed.

Kelly’s Background Kelly is a 20-year-old college student who is away from home for the first time. Her medical history includes taking Yaz® and multivitamins, and there is a chance she may be pregnant. She noticed some white spots on her teeth and bleeding gums, and mentioned she started drinking energy drinks to help get schoolwork done. She did admit to adding vodka to the energy drink on the weekend, as well as a few cigarettes and some “vaping.” Kelly has been your patient since childhood. She has no previous history of periodontal disease or cavities documented. Kelly’s first words to you are, “No, I am not flossing. Don’t yell at me.”

Kelly is a patient of record and scheduled for a periodic exam. She presents with some obvious signs of periodontal and health changes. In order to diagnose Kelly’s periodontal status, data collection includes full periodontal probing. The eternal question — is D0180 a code for periodontal probing? The answer is no. This code was established to indicate the extra time and effort needed for evaluating a patient’s periodontal condition to establish the most

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Dental Staff accurate diagnosis, and includes using a risk assessment.

significant diagnostic information should not be withheld from pregnant women.

You might have something like this listed in your notes: s spontaneous tissue hemorrhage, blunted papillae, bad taste and odor s severe inflammation with marked redness, edema, enlargement, spontaneous bleeding and ulceration

This position was further supported by the American College of Obstetricians and Gynecologists in their 2013 opinion paper, “Oral Health During Pregnancy and Through the Lifespan.” Based on Kelly’s medical condition, periodontal charting and possible pregnancy, the minimum radiographic images required are D0277: vertical bitewing images and D0220: single periapical image, Nos. 14 and 15. Similar to changing the procedure expected for the exam/evaluation, many practices might not consider taking radiographs at eight months. However, Kelly’s presenting condition warranted a change in the diagnostic protocols.

These satisfy Kelly’s dental-medical necessity for D0180: comprehensive periodontal evaluation – new or established. As mentioned, dental hygienists often know the dental-medical necessity, but it isn’t recorded into the insurance documentation.

The periodontal condition for Kelly shows: s generalized 4 mm pocketing with gingival tissues appearing 1+ mm enlarged and hemorrhagic s Nos. 14 and 15 area 5 mm with exudate present s using the Loe & Silness Gingival Index: moderate inflammation generalized with severe inflammation on Nos. 14 and 15 s no recession, fremitus or furcation is noted

Radiographs and Pregnancy Kelly stated she might be pregnant, which traditionally has meant no X-rays. But that is based on old information. More recent research says that leaving dental disease, particularly periodontal disease, untreated during pregnancy can lead to problems for both the mother and fetus. The American Dental Association (ADA) recommends that every precaution be taken to minimize radiation exposure to the pregnant patient. The estimated fetal doses from typical radiographic examinations support the conclusion that fetal risks are minimal.

Radiologic examinations that may provide

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Bone Height and Diagnosis Bone height must be evaluated to determine if there is loss. A normal measurement from the alveolar crest to the cementoenamel junction (CEJ) is 1.5-2 mm. By comparing the current radiographic images to a set of bitewing radiographs taken on Kelly eight months earlier, it’s clearly noticeable that there is 2 mm of bone loss between Nos. 14 and 15. This is critical in making her diagnosis. It is not based on pocket depth only.

Kelly’s periodontal diagnosis is: s plaque-induced gingival disease modified by systemic factors – pregnancy s Nos. 14 and 15 chronic periodontitis with 2 mm bone loss

Codes and Coverage: Not the Same Thing Now, view Kelly’s preliminary treatment plan in the sidebar to the right. How many of you already think insurance won’t cover all of it? This is probably not accurate because a clear dental-medical necessity has been established, as well as a clear diagnosis. Often, these steps are skipped or not documented.

Kelly’s Preliminary Treatment Plan s D0180: comprehensive periodontal evaluation – new or established s D0277: vertical bitewing images s D0220: single periapical image Nos. 14 and 15 s D4342: periodontal scaling and root planing – one to three teeth per quadrant, Nos. 14 and 15 s D4921: gingival irrigation, per quadrant s D1110: prophylaxis – adult s D1206: topical application of fluoride varnish s D1310: nutritional counseling for control of dental disease s D1320: tobacco counseling for the control and prevention of oral disease s D1330: oral hygiene instructions

We aren’t talking about coverage here; we’re talking about codes. A code’s existence doesn’t mean a patient has coverage under a policy. Yet, without a code, no coverage can be offered. This is where the confusion lies.

Codes and coverage are related, but are not the same. It’s the practice’s obligation to use the code that most accurately describes the procedure.

The coding truths and myths for Kelly’s treatment plan include the following considerations: s Anesthetic: Though a code exists for anesthetic and Kelly certainly wants to have it, there is no code listed. At the beginning of the periodontics section of the Current Dental Terminology (CDT) book, it states, “Local anesthesia usually is considered to be a part of periodonPlease see CODING, 64

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Dental Staff CODING from 63

tal procedures.” This was reconsidered by the Code Maintenance Committee for CDT 2015. The committee believes the rationale submitted to support this action did not add clarity or improve understanding of the current code, and declined to make the change (DentalCodeology: CDT 2015 Shifts). s Laser curettage: Codes are procedure-based rather than product- or instrument-based, e.g., nonsurgical periodontal therapy. For example, there is not a different code for using an ultrasonic scaler versus hand instruments.

The same is true of laser therapy. In earlier CDT versions, there was a code for curettage. Based on the “American Academy of Periodontology Statement Regarding Gingival Curettage,” the procedure code was removed (AAP 2002). There is no universal agreement on this position. For CDT 2015, the committee continued to vote no for a variety of laser-assisted periodontal therapy submissions. The rationale was that since lasers are used in conjunction with other procedures, they could not identify how the submissions were different from procedures reported under current codes. s D4341/2 and D1110 on the same day: There are no restrictions on quadrant/ isolated nonsurgical care and prophylaxis that would preclude use with any other procedures. There is nothing in CDT coding that states D4341/2 and D1110 cannot be billed on the same day.

Again, coding and coverage are not the same. It’s the practice’s obligation to use the code that most accurately describes the procedure.

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s Gingival irrigation: Kelly was diagnosed with Nos. 14 and 15 chronic periodontitis with 2 mm bone loss.

Gingival irrigation is a service many dental hygienists provide when treating periodontal disease. The Codes Maintenance Committee (CMC) discussed adding a code for CDT 2014 even though it has not been supported in the past. Some CMC members questioned the clinical efficacy of a onetime gingival irrigation. In this case, practitioners made a difference. In 2012, insurance carrier records show that gingival irrigation was submitted more than 500,000 times as D4999: unspecified periodontal procedure. Therefore, a new code — D4921: gingival irrigation per quadrant — was added to CDT 2014 and now is available for practices using this therapy.

In our case study, this should be documented and submitted for Kelly. s D1330 oral hygiene instructions: We know Kelly needs to clean her interdental spaces to prevent, manage and heal her periodontal disease. Kelly stated at the beginning of her appointment — and her behavior has consistently maintained — that she does not want to and will not floss.

We could continue to harangue, beg and reprimand her behavior; however, it may be time for new ideas. With ever-changing and improved technology, we can offer new options. CURAPROX, a Swiss-owned company, is now entering the U.S. CURAPROX products have been created and developed in Switzerland, and offer a new generation of interdental brushes that respect the papilla (which floss cannot) and are equally suited to young and elderly patients and less skilled individuals.

However, handing Kelly a “one-size-fitsall” interdental brush isn’t a great solution.

Different interdental spaces need different brushes. CURAPROX includes an innovative probe that helps measure the space to help in selecting the correct size for each interdental space. Does this take time?

Absolutely. Can an office be compensated for this time and expertise?

Standards of Clinical Practice list the professional roles of dental hygienists as clinician, advocate, administrator/manager, researcher and educator. When questioned, a majority of dental hygienists say the most important part of the care they offer is patient education. Yet oral hygiene instructions often are not documented or coded.

Why don’t dental hygienists code D1330?

Because we think there isn’t benefit coverage. The AAP says it this way: “The treatment plan should be developed according to professional standards, not according to the provisions of the contract.” Clinicians don’t know what a policy covers. Whether a practice chooses to charge a fee is a practice management choice.

Mark Rubin, JD, legal counsel for the ADA, further responded in 2006, “Knowingly alternating the D1110 and D4910 to maximize insurance benefits would constitute fraud. We must code for the procedure being performed. By doing otherwise, the attorney general could make a convincing case for prosecution.” Nothing has changed since these 2006 answers in regard to alternating D1110 with D4910; they cannot be alternated.

One option comes from Dr. Charles Blair, one of dentistry’s leading authorities on practice profitability, fee analysis, insurance coding strategies and overhead control, and

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Dental Staff author of “Coding with Confidence 2015” (a book I highly recommend). He offers a strategy for managing this sticky issue. A narrative can be added to a claim form that states, “If periodontal maintenance (D4910) is not available for reimbursement, please provide the alternative benefit of (D1110) prophylaxis.” This is different than changing the code. As noted above, purposely changing a code can be considered fraud.

Reducing your risk Electronic health records (EHRs) will require the use of uniform health information standards, including a common language.

The current standard language for dentistry is the CDT. This system is generally thought to only be used for efficient dental claims processing. Though the CDT is for dental claims processing, it isn’t only for that purpose. Another purpose for the CDT is to be used as a standard language to populate EHRs. In addition, diagnostic vocabulary designed for EHR is needed. Though not completely decided as yet, the ADA is in support of the Systematized Nomenclature for Dentistry (SNODENT). Others would prefer what is used commonly in medical – the ICD-9 or the upcoming ICD-10 coding systems for diagnosis. Those decisions will come sooner rather than later; yet this isn’t the time to wait. Structured data use can start now by making optimal use of CDT codes whether there is coverage or fee involved.

As dental hygienists, we know there are gaps in the codes. Not everything is a prophylaxis or perio maintenance. Scaling and root planing language is outdated and harkens back to a 1950s periodontal philosophy. This gap and the quickly approaching EHRs are the reasons for the DentalCodeology book series. Kelly’s case

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Coding Kelly’s follow-up care involves the following considerations: D4910: Kelly’s periodontal diagnosis was plaque-induced gingival disease modified by systemic factors — pregnancy, and Nos. 14 and 15 chronic adult periodontitis with 2 mm bone loss. All the words of the long definition for D4910 are important for a successful submission: “… instituted following periodontal therapy and continues at varying intervals, determined by clinical evaluation of the dentist for the life of the dentition or any implant replacement …” So, yes, Kelly qualifies under D4910. (Further discussion that Kelly’s state of oral health is not stable on recall can be found in the book “More than Pocket Change” at DentalCodeology.com.)

D1110: What if Kelly comes back for her three-month appointment and is not pregnant and her periodontal condition is stabilized? Can she go back to D1110? The ADA has added a Q&A, and says this is a matter of clinical judgment. It is appropriately reported as D4910, but if the treating dentist determines that Kelly can be treated with routine prophylaxis, D1110 may be appropriate. D1110 can be used for Kelly, but later she cannot go back to D4910 without a new diagnosis and treatment of an active periodontal infection with bone loss.

Alternating D4910 and D1110: Follow-up care for a patient like Kelly who has received active periodontal therapy can receive the D4910 code. A carrier can only say what is covered under a policy. This does not mean this is the correct coding. Back in 2006, a dentist from the ADA Dental Benefits office said, “D1110 and D4910 are not interchangeable and should not be alternated. The dentist must make the diagnosis, but then the proper code for the procedure provided needs to be used. It does appear that you could choose one code or the other, based on the diagnosis, but it would never be appropriate to alternate them.” is one of the five cases introduced in the book, “More than Pocket Change.” Kelly’s story continues in “Jump Start Diagnostic Coding.” We will see more of Kelly and the other cases as the series moves forward.

Change is not coming; change is here. The DentalCodeology book series comes in bite-sized units that are easy to read and help busy people prepare for the transition to profitably.

Reprinted with permission by DentalIQ.com.

Patti DiGangi, RDH, BS, is a certified Health Information Technology trainer and holds publishing and speaking licenses with the American Dental Association for Current Dental Terminology and SNODENT Coding.

She is the author of the DentalCodeology, series of bite-sized books for busy people. She can be reached at info@pdigangi.com.

For this and any code listed in this article, Current Dental Terminology© 2015 & Systematized Nomenclature of Dentistry © 2015 American Dental Association. All rights reserved.

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Exhibitors as of 4/27/15

EXHIBIT HALL HOURS Thursday, June 11 Friday, June 12 Saturday, June 13

9 AM - 5:30 PM 9 AM - 6 PM 9 AM - 2 PM

DEDICATED EXHIBIT HALL HOURS: How many times have you felt torn between going to the Exhibit Hall and attending our invaluable CE sessions? To ease that dilemma, we’ve added dedicated Exhibit Hall hours each day from 12-2 p.m. During this time no educational sessions will take place.

Start making a list now of what you need in your office and be sure to buy from the exhibitors at FDC who support your association!

CHILDREN UNDER 12: Unless attending an educational session, children under 12 do not need to be registered and will not receive a badge.

Children are only allowed in the Exhibit Hall if accompanied by a registered parent or guardian. Infant strollers and carriages are not allowed in the Exhibit Hall. For the safety and convenience of others, the use of baby carriers is strongly encouraged.

EXHIBITORS IN BLUE ARE FDAS CROWN SAVINGS MERCHANTS.

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3D Diagnostix Inc. 3M ESPE

AA-dec A. Titan Instruments Accutron Inc. ADAKO USA ADA Members Retirement Program ADS Florida | Henry Schein Transitions Advantage Technologies Inc. AFTCO Air Techniques Inc. AMD LASERS American Dental Association Artistic Dental Lab Ascentium Capital LLC Aseptico Inc. Aspen Dental Atlanta Dental Supply Atlantic Dental Solutions/ Brewer Company

B Bank of America Practice Solutions Belmont Equipment Benco Dental Berryhill, Hoffman, Getsee & DeMeola, LLC Best Instruments USA Bien Air Dental Bio-Flex / BFI Products Inc. Bioclear Matrix Systems BioHorizons BIOLASE Biotec Inc. Bisco Dental Products BQ Ergonomics LLC Brasseler USA Bright House Networks Business Solutions

C Capital Preservation Services / Ameritas CareCredit Careington International Carestream Dental Centrix Inc.

Christian Dental Society Cigna Dental Citi Healthcare Practice Finance Classic Craft Dental Laboratory ClearCorrect CliniPix Inc Clorox / HealthLink Coast Dental Colgate Coltene Convergent Dental Inc. Conversion Whale Cool Jaw by Medico International Crest Oral-B Crown Depot Dental Lab CUTCO Cutlery

D Darby Dental Supply daVinci Dental Studios Delta Dental Insurance Company Demandforce Inc. DenMat LLC Dental Access Mobile Clinics LLC Dental Care Alliance Dental Dealer Solutions Dental Health & Wellness Dental Lifeline Network – Florida Dental Medical Sales Dental PC Dental Sleep Solutions Dental Staffing Solutions Dental USA Inc. DentalEZ DentalMarketing.net DentalVibe DentaQuest Dentegra Insurance Company DENTSPLY Caulk DENTSPLY Implants DENTSPLY International DENTSPLY Maillefer DENTSPLY Professional DENTSPLY Raintree Essix DENTSPLY Rinn DENTSPLY Tulsa Dental Specialties Designs For Vision Inc DEXIS Digital X-Ray

Digital Doc LLC Disability Insurance Law Group Doctor’s Choice Companies Inc. Doctors’ Disability Specialists DoctorsInternet.com Doral Refining Corporation Doxa Dental Inc. Dynamic Dental Partners Group

E-F Enovative Technologies Essential Dental Systems Find My Weakness First Citizens Bank Florida Academy of General Dentistry Florida Baptist Convention Florida Combined Life Florida Dental Anesthesia Services Florida Dental Association Florida Dental Association Services Forest Dental Products Inc. Fortress Insurance Company Fortune Management of Florida Fotona LLC

G Garfield Refining Company Garrison Dental Solutions GC America Inc. Gendex Dental Systems GerMedUSA / AllSurg Inc. GlaxoSmithKline GLO Science Professional Global Precision Guided Surgery Good On Ya Great Expressions Dental Centers Greater New York Dental Meeting

H Hager Worldwide Halyard Health (formerly Kimberly-Clark) Hawaiian Moon Hayes Handpiece Repair Healthcare Professional Funding Healthmate International LLC Hearst Digital Marketing Services Heartland Dental

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Henry Schein Dental Henry Schein Practice Solutions Heraeus Kulzer Hiossen Inc. Hu-Friedy

I-JICW International IDS / Genoray iMedicor Implant Educators Inada Massage Chairs Infinite Therapeutics Infinite Trading Inc. Insurance Credentialing Specialist iSocial Reviews Ivoclar Vivadent Inc. Joissu Products Inc.

K Karl Schumacher Dental KaVo Kenwood / CGX Radios Kerr Corporation Kettenbach LP Keystone Dental Inc. Knight Dental Group, CDL, DAMAS KOMET USA Kuraray America Inc.

L Lares Research Laxmi Dental Lab USA LECOM School of Dental Medicine Lending Club Patient Solutions Lexicomp / Wolters Kluwer LIBERTY Dental Plan Lighthouse 360 LoupeCam速 by VizVocus Inc. LumaDent Inc.

M MacPractice

Magnified Video Devices Inc. MANI Inc. Maxill MCNA Dental MedDent Supplies Medidenta Meisinger USA LLC Mercedes-Benz USA LLC Meta Biomed Inc. Microcopy Midmark Corporation Milestone Scientific Millennium Dental Technologies Inc. Modular & Custom Cabinets Ltd.

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More Health Inc. Myofunctional Research Co.

N-O NeobiotechUSA Nova Southeastern University College of Dental Medicine NSK Dental LLC Office Depot Business Solutions Officite OneMind Health Oppenheimer OraBrite OraPharma Inc. Orascoptic Osada Inc. Otto Trading Inc.

P-Q Pacific Dental Services Paragon Management Associates Inc. Patterson Dental Pelton & Crane PeriOptix, a DenMat Company Philips Sonicare & Zoom Whitening Piper Education & Research Center Planmeca USA Inc. Plinth Distribution PNC Bank Porter Instrument Co. Inc. Preat Corporation Prexion Inc. Prime Supply Corp.

ProAct Health Solutions Inc. Professional Sales & Consulting Group Inc. Professional Sales Associates Inc. Proma Inc. Propel Orthodontics Prophy Magic Prophy Perfect ProSites Protected Trust Pulpdent Corporation Inc. Quintessence Publishing Co. Inc.

R RealTime CPAs Regions Bank RGP Inc. Rose Micro Solutions Royal Dental Manufacturing Inc.

S Sage Dental Santech Solution Inc.

SciCan Inc. SDI (North America) Inc. SecureTip Sesame Communications Shamrock Dental Co. Inc. SharperPractice Shochet Law Group / The Dental Law Firm PA Shofu Dental Corporation Sierra Dental Products LLC Sirona Dental Smile Brands Inc. SmileFaith Foundation Snap on Optics Social Dental Solutionreach Square Inc. SS White Dental Straumann USA LLC Sun Dental Labs Sunrise Dental Equipment Inc. Sunset Dental Lab Sunshine Health Superior Dental Design Services & Upholstery SurgiTel | General Scientific Corp

T-U TD Bank TeleVox The Doctors Company Transworld Systems Inc. U.S. Air Force Recruiting U.S. Army Healthcare Recruiting U.S. Navy Recruiting Ultradent Products Inc. Ultralight Optics Inc. University of Florida College of Dentistry

V-W Vatech America Video Dental Concepts Vitamix VOCO America Inc. WEAVE Webco Dental & Medical Supplies Wells Fargo Practice Finance WePayAnywhere White Towel Services Inc.

MAKE AN APPOINTMENT! Get twice the amount of business done in half the time by scheduling one-onone sessions with the exhibitors that you want to see at FDC2015. Appointments will range from 10-15 minutes so you can maximize your time and have specialized attention for your business needs! Attendees will be able to search for products, find the company they would like to meet with at the trade-show and request an appointment with that company.

Once appointments are confirmed, you can print your schedule of appointments or access them on the FDC mobile app. Appointments will fill up quickly, so request your appointment time before you leave for FDC. As an added bonus, attendees who complete six or more appointments over the three days will be entered to win one of five $200 American Express gift cards.

X-Y-Z XPdent Corp Yodle Zimmer Dental

FDA SERVICES INC. IS A MAJOR SPONSOR OF THE FLORIDA DENTAL CONVENTION.

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VISIT US AT FDC 2015 BOOTH 415 (MEMBER CENTER)

YOU COULD WIN A BOTTLE OF WINE!

WE KNOW INSURANCE. WE KNOW DENTISTS. Is your agent an expert in dental practices?

We are, and have been for the past 25 years!

FDA Services puts your interests first because we work for you, our member dentists. We are one of your most valuable member benefits!

Group & Individual Health • Medicare Supplement • Life Insurance • Disability Income • Long-term Care

YOUR RISK EXPERTS A MEMBER BENEFIT SINCE 1989

Books on the Shelf

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

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

Books on the Shelf: 2010 QDT, Quintessence Publishing of Dental Technology Edited by: Sillas Duarte, DDS, MS, PhD 224 pages Published in 2010 by Quintessence Publishing Price: $84 2012 QDT, Quintessence of Dental Technology, Vol. 35 Edited by: Sillas Duarte, DDS, MS, PhD 236 pages Published in 2012 by Quintessence Publishing Price: $118 2013 QDT, Quintessence of Dental Technology, Vol. 36 Edited by: Sillas Duarte, DDS, MS, PhD 216 pages Published in 2013 by Quintessence Publishing Price: $128 2014 QDT, Quintessence of Dental Technology, Vol. 37 Edited by: Sillas Duarte Jr., DDS, MS, PhD 212 pages Published in 2014 by Quintessence Publishing Price: $128

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At the Forefront: Illustrated Topics in Dental Research and Clinical Practice By: Hiromasa Yoshie, DDS, PhD 108 pages Published in 2012 by Quintessence Publishing Price: $98 Color Atlas of Fixed Prosthodontics: Vol. 1 By: Yoshiyuki Hagiwara 196 pages Published in 2013 by Quintessence Publishing Price: $120 Controversial Issues in Implant Dentistry Edited by: Prof. Hernandez Alfaro, MD, DDS, PhD, FEBOMS 264 pages Published in 2013 by Quintessence Publishing Price: $168 Dancing Hands By: Herluf Skovsgaard, DDS 296 pages Published in 2013 by Quintessence Publishing Price: $198 Dental Materials and Their Selection By: William J. Oâ&#x20AC;&#x2122;Brien, PhD, FADM 425 pages Published in 2008 by Quintessence Publishing Price: $68 Evidence-based Dentistry for the Dental Hygienist By: Julie Frantsve-Hawley, RDH, PhD 376 pages Published in 2014 by Quintessence Publishing Price: $56 Foundations of Dental Technology: Anatomy and Physiology By: Arnold Hohmann and Werner Hielscher 300 pages Published in 2014 by Quintessence Publishing Price: $98

Fundamentals of Implant Dentistry, Vol. 1: Prosthodontic Principles By: Josh Beumer III, DDS, MS; Robert F. Faulkner, DDS, MS; Kumar C. Shah, BDS, MS; and Peter K. Moy, DMD 456 pages Published in 2015 by Quintessence Publishing Price: $168 Immediate Dentoalveolar Restoration: Immediately Loaded Implants in Compromised Sockets By: Jose Carlos Martins da Rosa 372 pages Published in 2014 by Quintessence Publishing Price: $228 Inspiration: People, Teeth and Restorations By: Luis Narciso Baratieri, DDS, PhD, MS 482 pages Published in 2012 by Quintessence Publishing Price: $228 Lingual Orthodontics By: Giuseppe Scuzzo and Kyoto Takemoto 885 pages Published in 2010 by Quintessence Publishing Price: $230 Mini-implants: The Orthodontics of the Future By: Skander Ellouze and Francois Darque 278 pages Published in 2015 by Quintessence Publishing Price: $189 One Stroke, Two Survivors By: Berenice Kleiman, with comments by Herb Kleiman 208 pages Published in 2006 by Cleveland Clinic Press Price: $24.95 Oral Implantology Surgical Procedures Checklist By: Louie Al-Faraje, DDS 92 pages Published in 2013 by Quintessence Publishing Price: $68

May/June 2015

Today's FDA

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C lassified A dvertising

Opportunities

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

The FDA online classified ad model is for “paid online advertising.” Effectively, the advertising rate you pay will entitle you to online classified ads with increased exposure. As an added benefit, we will continue to publish the “basic text” format of paid, online classified ads in our bimonthly printed journal, Today’s FDA, at no additional cost to you.

All ads posted to the online classified system will be published during the contracted time frame for which you have posted your online classified advertisement.

Our magazine is published bimonthly, and therefore, all ads currently online will be extracted from the system on roughly the following dates of each year: Jan. 15, March 15, May 1, July 15, Sept. 15, Nov. 15. The ads extracted at this time will then be published in the following month’s issue of Today’s FDA.

ANNOUNCING: Hands On Extraction, Immediate Denture, Mini-Implant Classes. Hands On CE May 2223, 2015 Orlando. Learn extraction techniques, elevating flaps, using instruments properly, immediate dentures, mini-implants and more. Live Patient Course June 28July 3. Alaskan Cruise August 7-14. drtommymurph@ yahoo.com. www.weteachextractions.com.

A blockbuster opportunity. Full or part time for General Dentists, Endodontists, Orthodontists, Pedodontists, Periodontists, and Oral Surgeons. Generous compensation with unlimited potential. Guaranteed referrals. Join our group specialty care practice with a significant general dental component. Established in 1975 in Aventura, Coral Springs, Delray Beach, Boynton Beach, Stuart, Ft. Pierce and Melbourne. Call: Kelly Oliver 954.461.0172. Fax resume to: 954.678.9539. Email: careers@dentaland.net.

POSITION DESIRED: ORTHODONTIST – Seeking FT/PT locum tenens position (temporary professional).

Member of ADA, AAO, Certified, licensed specialist.

Experienced, personable, good sense of humor, managerial, and organizational skills, can consult, treat your patients in your office. Successful in drawing patients; experienced in young patients starting at 7 yrs. Willing to travel. Per diem open. Please contact: johnmaria7@yahoo.com, or call 305.932.3584.

General Dentist Opening – Southeast Florida. Great Expressions Dental Centers has a current opening for a full-time General Dentist in Miami-Dade/ Broward County in South FL. Our dentists have the clinical freedom and autonomy enjoyed in a traditional private practice without the additional financial or administrative burdens associated with practice management. When considering a career with GEDC, Dentists can expect unlimited production based earnings, full benefits (such as medical, dental, 401k, continuing education), paid time off, malpractice coverage, a stable patient base, and longterm practice or regional career growth with possible investment opportunity. **Please watch more about our Doctor Career Path (http://www.screencast.com/t/ M3xWM5CYN) and apply via this ad! Apply Here: http://www.Click2Apply.net/ppc7td8.

POSITION DESIRED: Associate Dentist. I am a fourth year dental student graduating on June 2015, and will be practicing general dentistry. I am looking for an associate position in South Florida. I have passed my boards and I am applying for my FL license. Please contact me to andreamazate@hotmail.com or 719.930.3776 for more information.

Great Opportunity. Excellent location. Dentist wanted for direct partnership or Buy-in. Please email Resume and Written statement as to why you would be great for this position. Email: bluebellino012@gmail.com.

Please view the classified advertising portion of our website at http://www.floridadental.biz/.

Today's FDA

May/June 2015

www.floridadental.org

Palm Beach Gardens Office – Dentist Opening. Great Expressions Dental Centers has a current opening for a full time (5 days) General Dentist in our busy, high production, multi-specialty Palm Beach Gardens office in Palm Beach Gardens, FL office. Our dentists have the clinical freedom and autonomy enjoyed in a traditional private practice without the additional financial or administrative burdens associated with practice management. Relocation or sign-on bonus possible as well! **Please watch more about our Doctor Career Path (http://www.screencast.com/t/M3xWM5CYN) and apply via this ad to join our team! Ross Shoemaker, MBA | Lead Clinical Recruiter | Great Expressions Dental Centers Practice Support Center - South | 1560 Oakbrook Drive, Norcross, GA 30093 USA. phone 678.836.2226 | ext 72226 | fax 770.242.3251 |web www.greatexpressions. com. Apply Here: http://www.Click2Apply.net/9ggz3bp.

Dentist Needed – Fort Myers, FL. Great Expressions Dental Centers has a current opening for a full time General Dentist in our busy, solo Fort Myers, FL practice.

Our dentists have the clinical freedom and autonomy enjoyed in a traditional private practice without the additional financial or administrative burdens associated with practice management. Dentists can expect unlimited production based earnings, full benefits (such as medical, dental, 401k, continuing education), paid time off, malpractice coverage, a stable patient base with full office staff, and long-term practice or regional career growth with possible investment opportunity. **Please watch more about our Doctor Career Path (http://www. screencast.com/t/M3xWM5CYN) and apply via this ad and come join our team! Apply Here: http://www.

Click2Apply.net/kd8vysj.

Pediatric Dentist Opening – Miami. Great Expressions Dental Centers has a current opening for a part-time Pediatric Dentist to join our Miami, FL practice. Our Specialists have the clinical freedom and autonomy enjoyed in a traditional private practice without the additional financial or administrative burdens associated with practice management. Specialists can expect unlimited production based earnings vs. a base, benefits, continuing education reimbursement, paid time off, malpractice coverage assistance, stable patient base with full office staff in place, trained dental staff, and long-term practice or regional career growth with possible investment opportunity. **Watch more about our Doctor Career Path (http://www.screencast.com/t/ M3xWM5CYN) Apply Here: http://www.Click2Apply. net/m32q4yh.

Experienced General Dentist Needed Full time.

Experienced General Dentist Needed for fast growing practice in New Port Richey, Florida. Guaranteed salary plus percentage. Medical and mal-practice paid for you. High-tech office with experienced staff. No nights or week-ends. Excellent opportunity for experienced clinician. Please email resume (vjmnlm@gate.net) or fax (727.945.9661). Immediate opening.

Looking For Associate Destin, FL. By way of introduction, my name is Dr. Olivier Broutin and I practice in the Destin area. We’re looking for a doctor to work in our practice. We have a thriving practice and we need help! We are creating a great opportunity for someone who wants to treat people. We’ll handle the marketing, new pt generating and management hassle.

We offer great income potential, excellent working conditions and training. We have all the latest high tech equipment, including CEREC and CBCT. We think we have it all! If you would be interested please email us your resume to OBDMD1@gmail.com.

www.floridadental.org

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

Non-profit clinic in Stuart for low income and Medicaid patients needs licensed part-time general dentist with strength in extractions and restorative dentistry. Salaried position 2-3 days per week. Please send your resume to ccccenter@bellsouth.net or fax to 844.269.6899.

General Dentist Associate with option to buy in, needed for nice practice F/T or P/T. Offices available in Naples, Port St. Lucie or Coral Springs. Please email: pbfloridadentist01@aol.com.

ENDODONTIST – Part Time Ocala, FL. Christie Dental is a multi-specialty dental group with approximately 55 dentists and specialty doctors in nearly 20 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 part time opportunity for an Endodontist to join our team in the Ocala, FL one day per week. This is a great opportunity to supplement your schedule with proven patient demand and referrals. If interested, contact Kate Anderson: kateanderson@amdpi. com or 781.213.3312.

GENERAL DENTIST – TAMPA/ CLEARWATER. Looking to hire enthusiastic dentist FT/PT. Flexible hours w/well-trained staff. State-of-the-art facility, fully computerized. High income potential doing what you enjoy. Fax resume 813.886.5559.

Compassionate dentist needed July and August providing services and supervising students from UF at private, non-profit ACORN Dental Clinic near Gainesville. Please contact Laurie at 352.485.2772, X 16 for details. Fun place to work! We provide Liability Insurance as well.

Endodontic Position available. Established Endodontic office in need of FT/PT Associate with Buy-in opportunity. Tampa area. Please send CV to chris@ cpendo.com or fax to 813.374.9048.

General Dentist. Dynamic Dental Health Associates of FL and Dynamic Dental Partners Group (DDPG), a new private fee-for service group, is growing and expanding rapidly. Top Compensation, daily guarantee, health insurance, modern facilities with latest technology, great patient flow, no administrative headaches and professional mgmt. We also buy dental practices and create exit/transition strategies for solo and group practices. If interested in selling your practice, please email Dr. Alex Giannini at agiannini@ddpgroups. com or call 941.893.3999. If interested in a general Dentist position, please email your CV to Jeff Hokamp at jhokamp@ddpgroups.com or call 941.312.7838.

Current openings in Sarasota (F/T and P/T), Gainesville, Jacksonville and St. Petersburg. We are offering a $5,000 signing bonus ($2,500 at start and $2,500 after 6 months) for the F/T positions. Please don’t hesitate to send your CV if interested in other areas in FL.

Associate Dentist Wanted. Associate Dentist FT/PT wanted for busy Dental Office in West Palm Beach. We are seeking a caring Pediatric or General Dentist who is comfortable treating children. We are a family-oriented private practice with experienced staff and friendly office environment. We offer competitive compensation. Please send your resume to drleminh@firstcaredental.net.

General Dentist and Specialist Openings for Multiple Offices. General Dentists and Specialists. Grow with us: Large intimate group practice seeks experienced, highly-productive General Dentists and Specialists for busy growing general and multi-specialty practices.

Gentle Dental Group operates 29 large, well-established practices in Broward, Palm Beach, Dade, and the Treasure Coast with new practices on the horizon in the Orlando Market. Our beautiful and modern facilities are in premium locations and state-of-the-art equipment and digital X-rays with a supportive staff and professional management team. Cash, private, and insurance. Highest compensation in industry. Full schedules, excellent benefits, malpractice insurance reimbursement, and CE. www.GentleDentalGroup.com. Call Bradford Cabibi, Doctor Recruiter: 561.999.9650 ext. 6146. Fax or email CV to: 561.526.2576 or bcabibi@gentledentalgroup.com.

PT/FT General Dentist Melbourne, FL. Part time or Full time opportunity available for a General Dentist to practice 2-5 days per week at our office in Melbourne, FL on the beautiful Space Coast of Florida. Qualified and supportive team members and modern updated offices.

We offer competitive compensation and full and part time benefits packages. Submit resume to areimiller@dentalpartners.com for consideration.

DENTIST. We are seeking a long term associateship with future partnership in our new office. Lady Lake/The Villages is occupied predominantly of senior citizens, therefore, experience in crowns/bridges, extractions/ dentures is needed, and knowledge of placing and restoring implants is a plus. Digital, paperless. Well trained staff. 2-3 days to start. Competitive salary/ commission. Dentalcare2015@yahoo.com.

Part-time Orthodontic associateship in high-end general dental/prosthodontic office in central Tampa. 2 days per month with potential for growth. Robust in-house referral system. Modern office with cone beam CT, intraoral scanner, and in-house lab. Generous compensation based in percent of collections. Orthodontist would have the opportunity to work with a multidisciplinary team. Please email CV, cover letter, and three professional references. dentalFLA@gmail.com.

Associate Dentist Wanted in Beautiful Apollo Beach! We are a family practice located in APOLLO BEACH FL, 15 mins south of TAMPA in Hillsborough County. Our great team focuses on an outstanding patient experience and convenient patient hours. This is a terrific opportunity for a patient focused, versatile, team oriented Associate Dentist! We are an outstanding practice looking for a terrific Associate Dentist! Be a dentist that will have clinical freedom and autonomy enjoyed in our traditional private practice without the financial or administrative burdens associated with practice management. Must Have great communication/people skills; Perform general dentistry, composite fillings, crown/bridge, dentures/ partials, preventive care, surgical extractions, implant restores, and dental emergencies. Earn GREAT pay treating patients on their time!! On your time off enjoy the beautiful Tampa Bay area! Apply! https://www. appone.com/MainInfoReq.asp?R_ID=989207.

Established growing general dental practice with solid patient base is looking for full time General Dentist to join our team. We offer a competitive compensation and benefits package. Potential signing bonus for the right candidate. Please email resume to JRoseDMD@yahoo. com.

Please see CLASSIFIEDS, 74

May/June 2015

Today's FDA

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Your Classified Ad Reaches 7,000 Readers!

CLASSIFIEDS from 73 General Dentist Needed for Ocala, FL. We are currently seeking a General Dentist who appreciates the professional, financial and administrative benefits of group practice to join our Ocala, FL team. Our doctors are offered a generous compensation and benefit package including: medical, professional liability, life and disability insurance; a 401(k) plan with employer match; and other benefits. sbolduc@amdpi.com.

Oral Surgery opportunity! Christie Dental is a multispecialty dental group with approximately 55 dentists and specialty doctors in nearly 20 practice locations in the Brevard and Ocala Florida area. We currently have a wonderful opportunity for an Oral Surgeon to join our team in the Space Coast area, on a full or part-time basis. This is an opportunity which provides a high number of referrals from inside and outside the Christie Dental group, and offers excellent paraprofessional support. We offer a comprehensive compensation and benefits package which includes medical, life, disability and professional liability insurances, flexible spending and 401(K) with employer match! Be a part of our outstanding team and be well-positioned to receive referrals from our general dentists. To learn more about American Dental Partners and Christie Dental please visit us at www.amdpi.com and www.christiedental. com. Interested candidates should email their CV to pschwartz@amdpi.com.

You must look into this Opportunity! It’s one of a kind!!

By way of introduction, my name is Dr. Anish Patel, and I practice in Panama City, FL. I am creating a great opportunity for someone who wants to treat people. I will handle the marketing, new patient generating and management hassle. We offer great income potential and great working conditions. I think we have it all, please email us at 10Xdoctor@gmail.com for more information.

P.S. If you are the first to refer someone who I hire, I will gladly pay you a $1,000.00 finder’s fee, please email 10Xdoctor@gmail.com or fax 850.763.0087; your name, your email address, prospective Doctor Name and Prospective Doctor Phone number.

Rewarding Associate Position. General, Implant and Cosmetic practice offers rewarding Associate position in amazing work environment. Spacious office located in Central Florida, near several retiree communities and family homes. I am searching for someone who is detail oriented, strives for quality dentistry and has professional attitude. We have an excellent reputation in our community and our work speaks for itself. Email resume to davenportcareer@gmail.com.

Position available for part time general dentist with room to grow. Looking to fill Fridays and Saturdays for the moment. Well trained staff and great atmosphere to work in. Great opportunity to grow clinically and professionally. Practice focuses on high quality restorative dentistry, including chair side CAD/CAM. Practice also offers implants, third molar surgery, ortho, endo, and perio. Compensation to be discussed. rovidental@yahoo.com.

Pediatric dentist needed. Pediatric Dentist needed for busy practice in beautiful Lakeland , FL. All experience levels will be considered! Dr. must be comfortable and confident in treating children of all ages with a great chair-side manner. Long term opportunity!

Must have Active FL license. Please send resume childrenandteendentalgroup@gmail.com.

74

Today's FDA

May/June 2015

General Dentist Associate Position Available In Orlando – Lake Nona Area! Seeking an experienced highly motivated associate with exceptional clinical and communication skills. Must be a goal oriented selfmanaged leader who loves to learn. We are looking for a long term candidate to work with our exceptional dental team. Practice is completely computerized and paperless with equipment such as Cerec and Galileos CT Scan, laser, digital X-rays and intraoral cameras. identistry@ gmail.com.

For Sale/Lease KODAK AND CARESTREAM INTRAORAL X-RAY SENSOR REPAIR. We specialize in repairing Kodak and Carestream RVG 5100 and 6100 dental X-Ray sensors.

Repair and save thousands over replacement cost. www.

KodakDentalSensorRepair.com/919.924.8559.

Dental office for sale, lease, or lease/purchase. Excellent opportunity at minimal expense. Centrally located in an attractive 10 unit condominium complex with two general dentistry practices, a chiropractic office, and other professional businesses. Fully furnished/equipped for the practice of dentistry. 3 operatories wired/plumbed for water, suction, compressed air and nitrous oxide/ oxygen. Suitable for general dentistry, periodontics, endodontics, prosthodontics or oral surgery. A) Purchase includes all equipment/furnishings. B) 3 Year Lease includes use of all equipment/furnishings. C) Lease/ purchase: to be consummated anytime during 3 year period for appraised value at that time. Photos, inventory of equipment/furnishings and floor plan available.

Contact Dr. Roger Lee 941.349.1352, royroddyboy@ gmail.com.

Naples office, SALE OR LEASE. teedup2@aol.com.

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

Website: doctorschoice1.net.

Bradenton/Anna Maria Island Beaches; General and Cosmetic Practice. 1600 Sqft bldg in park like setting with great traffic view. Five digital ops; paperless; Dentrix, DexIs and Panorex. Strictly fee for service; 500,000.00 plus in production with 96% collection. 32 hr work week w/6 weeks’ vacation/yr. Building FOR SALE with new roof and 2 new AC units. For detailed practice info VISIT and REGISTER: dentaldirectsales.com.

Owner is retiring and moving.

Tampa – #FL161. Tampa – General 4 Op, 1,200 Sq Ft Office, GR $488,000, great location, high visibilityMotivated Seller!! Tampa is a vibrant city. Residents can experience a large range of great amenities, year round!

Please contact: Henry Schein Professional Practice Transitions’ Consultant: Heather Brown-Licensed Sales Associate, Cell: 727.844.8588, Email: Heather.Brown2@ henryschein.com.

Largo – #FL108. Largo – 3 Ops-1,200 Square Foot Office – Expandable Office Space Available!! Largo is centrally located under 15 minutes from Clearwater Beach and 30 from Tampa. Local beaches provide activities such as fishing, boating, swimming, kayaking, and more.

Tampa Bay offers amenities such as the Hard Rock Cafe and Casino and unlimited restaurants and night life venues. Please Contact: Henry Schein Professional Practice Transitions, Heather Brown-Licensed Sales Associate, Cell: 727.844.8588, Email: Heather.Brown2@ henryschein.com. #FL108.

Orlando – #FL112. 5 Ops – Well-Established Practice – Dr. willing to stay on as associate! Orlando has unlimited recreation, a variety of restaurants, golf courses, professional sporting events, festivals, and spas.

We are also less than 2 hours from either coast offering swimming, fishing, boating, and more. Please contact: Henry Schein Professional Practice Transitions: Heather Brown-Licensed Sales Associate, Cell: 727.844.8588, Email: Heather.Brown2@henryschein.com. #FL112.

Clearwater – #FL110. Clearwater, FL – 7 Op General Practice – Updated Equipment and All New ComputersGR $820,000, 3,800 Sq. Ft. Office Space-Real Estate Included! Clearwater is known for its award-winning amenities. The city offers world-class entertainment.

Please contact: Henry Schein Professional Practice Transitions: Heather Brown-Licensed Sales Associate, Cell: 727.844.8588, Email: Heather.Brown2@ henryschein.com. #FL110.

7 Ops 2,000 Sq Ft Office – VERY MOTIVATED SELLER!! #FL111. Ocala, FL. Our city is an equestrian lover’s dream! The area boasts 70,000 acres of thoroughbred breeding and training farms! Our city also offers unique attractions, outdoor adventure, championship golf, and rich arts and culture. Please contact: Henry Schein Professional Practice Transitions, Heather Brown-Licensed Sales Associate, 727.844.8588 or Heather.Brown2@henryschein.com.

Jacksonville – Established Oral Surgery practice – FL #162. 6 Op + 2 Recovery areas, 3,700+ Sq Ft – Great Visibility!! GR $650,000. Jacksonville has plenty to do for all ages and interests!! Please contact: Henry Schein Professional Practice Transitions, Heather BrownLicensed Sales Associate -Cell: 727.844.8588 #FL162.

Tampa, FL – #FL163. Tampa, FL – the city offers unique and exciting recreation for all ages and interests and an exciting nightlife. A diverse selection of great restaurants and some of the state’s best attractions. We are also within 30 minutes of the Gulf! Please contact: Henry Schein Professional Practice Transitions, Heather BrownLicensed Sales Associate, Cell: 727-844-8588, Email: Heather.Brown2@henryschein.com. #FL163.

ORTHODONTIC PRACTICE for SALE in Broward County. RARE FIND! VERY profitable, FFS, modern, well-established practice with ENORMOUS potential and GREAT reputation. Fantastic opportunity to live your dream and be your own boss. Email your resume/ CV with references to DRMNDDS@aol.com. Serious inquiries only! NO BROKERS, please! Must be able to obtain own financing. Seller is willing to stay if desired.

www.floridadental.org

Helping Members Succeed

benefit

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

Florida and HIPAA Compliant Forms for 2013 Omnibus Rule As an FDA member, you now have access to forms that comply with both federal HIPAA and Florida confidentiality law. All of the documents are available on the FDA website and are free of charge to members only. They are uploaded as Microsoft Word documents, so that you may add your practice information to them.

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

MEET RELIABLE MERCHANTS AND

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WIN AMAZING PRIZES! Find out more when you play

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COLLECT THE GEMS

BO VISIT O TO TH 41 PLA 5 Y

Friday, June 12th, 11 a.m. - 2 p.m. at the Florida Dental Convention Visit the Crown Savings merchants in the Member Benefits Center to play for a chance to win a variety of great prizes.

Prize drawing every half hour!

The first drawing will be held at 11:30 a.m. and the final drawing will be held at 2 p.m. . *You must be present to play and win.

*Only registered FDA attendees are eligible to play “Collect the Gems”

4/2/2015 9:17:32 A

THE AFTER PARTY! The party doesn’t have to end!

Join the “New Dentists” at “The After Party” in Wreckers on Friday, 10 PM-1 AM. Enjoy drinks, dancing and DJ King playing all your party favorites.

SPONSORED BY New Dentist activities at FDC2015 are supported by a grant from the American Dental Association.

New Dentists and dental students can pick up their complimentary drink tickets at the FDA Membership Booth (#315) before 6 p.m. Friday.

You are a “New Dentist” if you have graduated since 2005.

Book Review

Book Review from 1983, with many illustrated cases showing complications from that concept.

Of the complications and failures discussed, probably 60 percent are related to this type of prosthesis. Single implant complications, as well as complications in the aesthetic zone other than implant placement complications, are not well-covered.

Atlas of Complications and Failures in Implant Dentistry, Guidelines for a Therapeutic Approach

By Luigi Galasso and Gian Antonio Favero Published by Quintessence

Reviewed by Dr. Merrill Grant

Like many books published by Quintessence, this is a high quality and amply illustrated book. Overall, as an atlas, it was a good book and easy to read. It primarily presents a historical perspective of cases done with machined titanium implants with external hex attachments. Implant basics are richly discussed, and the role of the patient in care and maintenance of implant restorations is examined as well. Many of the cases demonstrate the older approach of multiple implants supporting screw-retained prostheses. The authors begin by reviewing the early Branemark “Toronto bridge” concept

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There were many problem-specific examples of how a situation was resolved, although in many cases, not rectified. There was more emphasis on problems created by poor planning and less emphasis on treatment planning to avoid these complications.

Because of the older machined surface implant designs, there were many examples of a screw loosening or breaking, implant thread stripping, implants breaking and complications related to the external hex that we don’t often see today due to newer implant designs and surface treatments.

There was an excellent discussion on asymmetric loading of the remaining implants following the loss of a single implant under an implant-supported prosthesis. Many of the complications discussed revolved around long distal cantilevers that were common in early Branemark prostheses.

There are several examples of complications arising from the old concept of placing the implants “where the bone is.”

This book is educational from the historical perspective of problems that arose before better protocols were developed. It has nice illustrations and discussions on the perils of poor placement.

Soft tissue complications, biotypes or the importance of attached tissues around implants were not discussed. There is no real discussion of aesthetic complications and defects in the aesthetic zone due to the preponderance of cases with implant supported, screw-retained overdentures.

Anthony Sclar’s book, “Soft Tissue and Esthetic Considerations in Implant Therapy,” also published by Quintessence, pre-dates this book by a decade but provides a more modem approach to — and understanding of — the role of soft tissue and implant complications and failures.

This would be an excellent book for prosthodontists interested in the history of Branemark implants and the related prostheses. Rather appropriately, the introduction was written by P. I. Branemark. This book would not be appropriate for or of interest to the dental team. The concept of over-engineering cases and placing as many implants as possible to restore a case is being replaced today with the “All-on-Four” concept, which would eliminate many of the complications presented.

While I found it to be an entertaining read, I don’t think the information presented would benefit my fellow dentists as much as some of the other books on the same topic by the same publisher.

The reviewer claims no financial interest with the publication.

Dr. Grant is a general dentist in Satellite Beach and can be reached at drmerrillgrant@cfl.rr.com

May/June 2015

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benefit

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11

YOUR FDA STAFF IS “HELPING MEMBERS SUCCEED” EVERYDAY!

PROFESSIONAL STAFF I HELP MEMBERS SUCCEED by being a reliable source of information and making sure that your requests are fulfilled.

Call me about member benefits, applications, yearly dues and retirement. Stop by the Member Center @ FDC2015 with your questions!

—Ashley Merrill Member Relations Coodinator QUESTIONS ABOUT YOUR MEMBERSHIP? 800.877.9922 or 850.350.7110 amerrill@floridadental.org

®

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OFF THE CUSP

JOHN PAUL, DMD, EDITOR

Onesies, Safety Pins and Medicare Applications ...

Have I told you I have two beautiful young daughters? I think everyone should have children, or at least live with a few. They teach you things you would not otherwise know. Recently I found out what a “onesie” is for. In my naïve youth, I assumed this was a nearly disposable garment — easy to apply, help keep the child warm and possibly enhance their cuteness. We have lots of pink ones, one that says, “I’m cute, Mom’s cute, Dad’s lucky,” and several with flamingoes (an inside joke; buy me a cold drink and ask about it).

While these obvious things are true for the onesie, it serves a critical purpose. The onesie keeps the diaper secured to the child.

A properly secured diaper keeps the toxic waste the child produces contained until it can be rendered safe by a large number of baby wipes and scented plastic bags. Otherwise, the contents will be spread about your living space as the child rips the diaper from her body with dramatic flair and marvels at her achievement. While she has learned to defeat the adhesive tabs, she has not learned to unsnap the onesie. Perhaps if we had learned a lesson from our parents, we would still be using safety pins, which have to be as hard to learn as the snaps.

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Today's FDA

May/June 2015

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Perhaps like the safety pins, any one of those other numbers could have effectively served the purpose and prevented an unwelcome experience.

”

I wonder if this lesson can be applied to Medicare applications? By virtue of misreading some of the instructions, I think I have filled out every application form, nearly 100 pages of information. I have never knowingly treated a Medicare patient, but I live in Polk County. Doing business means your customers meet the age requirement, and I’d rather not have them in a dither because the drug store won’t give them their antibiotics, nor do I want the Medicare police going through my records to determine if I incorrectly charged for a service they have decided to cover. I will never get

back those hours of my life to spend with my children so the Medicare folks can issue me a number to identify me as worthy to provide them information (they don’t care if I see covered patients and hope I won’t take their money).

They require your National Provider Identifier number, your Drug Enforcement Administration number and your dental license number. Since Medicare is not going to start covering adult dental services in any meaningful way, this seems like just another piece of information that will be a “Gotcha!” when someone transcribes it incorrectly and you land in court for fraud. Perhaps like the safety pins, any one of those other numbers could have effectively served the purpose and prevented an unwelcome experience.

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

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