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Virginia Dental Association

THE VIRGINIA DENTAL ASSOCIATION

(VDA) / VIRGINIA DENTAL SERVICES

CORPORATION (VDSC) have partnered with B&B INSURANCE, ASSOCIATES, INC. to service all your insurance needs.

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Call our toll-free number between 8:30 am to 5:00 pm (MON-FRI). Simply dial 1-877-832-9113 for quick and efficient service. It's that easy! VDAINSURANCEINCLUDES Programs

Contacts

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Larry Bedsole Deedie Poteat Larry Bedsole Jr.

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Choice of individual auto, homeowner insurance, and umbrella coverage

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Choice of life insurance, estate planning, long term care, long term disability, and pensions

Larry Bedsole Larry Bedsole Jr.

TOLL FREE: 1-877-VDA-9113

FAX: 1-703-323-7169

For information on the wide variety of exciting products our association is offering, please call the VDSC Insurance Service Office at 1-877-832-9113.

B&B B&B Insurance Associates, Inc.

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Leslie S. Webb, Jr., D.D.S. Editor 1. Barry I. Einhorn 2. Sharon Covaney 3. Michael R, Hanley

Susan P. Lionberger Director of Publications ASSOCIATE EDITORS 4. Kathryn Finley-Parker 5. Lori Snidow 6. Robert G. Schuster

Terry D., Dickinson, DD.S. Business:Mana er "-""';;"'':--'

7. Mac Garri~~8 8. Scott Mc94,islbn School of DebJl~fr:Y James Revere

January-March 2003

Volume 80

Number 1

TABLE OF CONTENTS 4 5 6 9

Editorial Message From The President Guest Editorial and Letters To The Editor Oral Biopsies From Pediatric Patients: A Retrospective Analvsis'

13

Abstracts

18

VCU School of Dentistry Launches Clinical Simulation Carnpaiqn

20

Dr. Baxter Perkinson Donates Watercolors For Art Auction To Ber:lejfit Dental School

21

Virginia General Assembly 2003 Overview

23

HIPAA - Time Is Running Out

24

HIPAA News You Can Use

25

Avoiding Liability

26

PANDA

27 28

Membership Initiative Update OSHA, HIPAA and EPA Regulations

30

How To Protect Yourself From Identity Theft

31

VDSC News

31

Smiles In Spite Of Terror

32

VDANews

35 36 38 40 44 45

Reasons To Consider Estate Planning Outside Of Taxes

47 52

Medicaid DR News 2002 Northern Virginia MOM Project Continuing Education, Meetings and Events

Fluoride, Flossing & Folic Acid Campaign

Component and Speciality News

Classified Advertisements

COVER: Original Watercolor by Dr. Baxter Perkinson.

© 2003. All Rights Reserved. PUBLICATION TEMPLATE: C:\Change

THE VIRGINIA DENTAL JOURNAL (Periodical Permit #660-300, ISSN 00496472) is published quarterly (January:~cu;C9' April-June, July­

September, October-December) by the Virginia Dental Association. 7525 Staples Mill Road. Richmond, Virginia 23228, Telephone (804) 261-1610

SUBSCRIPTION RATES: Annual Members, $6.00. Others $12.00 in U.S., $24.00 Outside U.S. Single copy: $6.00..

Second class postage paid at Richmond, Virginia. Copyright Virginia Dental Association 1996

POSTMASTER: Send address changes to Virginia Dental Journal, 7525 Staples Mill Road, Richmond, VA 23228.

MANUSCRIPT AND COMMUNICATION for publications: Editor. 7525 Staples Mill Road. Richmond, VA 23228.

ADVERTISING COPY, insertion orders. contracts and related information: Business Manager, 7525 Staples Mill Road, Richmond, VA 23228


VIRGINIA JOURNAL EDITORIAL

BOARD

VDA COMMITTEE CHAIRMEN

Ralph L. Anderson James R. Batten Carl M. Block Cramer L. Boswell James H.Butler Gilbert L. Button B. Ellen Byrne Charles L. Cuttino III Frank H. Farrington Barry I. Griffin Jeffrey L. Hudgins Wallace L. Huff Lindsay M. Hunt, Jr. Thomas E. Koertge James R. Lance Daniel M. Laskin Karen S. McAndrew Travis T. Patterson III W. Baxter Perkinson, Jr. Lisa Samaha David Sarrett Harvey A. Schenkein James R. Schroeder Harlan A. Schufeldt John A. Svirsky Ronald L. Tankersley Douglas C. Wendt

Annual Meeting Andrew J. Zimmer

Infection Control & Environmental Safety Richard F. Roadcap

Budget & Financial Investments David R. Ferry

Institutional Affairs Elizabeth A. Bernhard

Caring Dentists Harry D.Simpson, Jr.

Legislative Dana H. Chamberlain

Communication & Information Technology Robert B. Hall, Jr.

Membership David B. Graham

Constitution & Bylaws Thomas S.Cooke '"

New Dentist Timothy J. Golian

Dental Benefits Programs Susan F. O'Connor

Nominating Thomas S.Cooke III

Dental Health & Public Information Samuel W.Galstan

Peer Review & Patient Relations Alan Robbins

Dental Practice Regulation J. TedSherwin

Planning David C. Anderson

Direct Reimbursement Theodore P.Cocoran

Search Committee for VA Board of Dentistry Thomas S.Cooke III

Ethics & Judicial Affairs Charles E. Gaskins III

VADPAC Gus C. Vlahos

Fellows Selection Donald L. Martin

FOUNDATIONS

Roger E. Wood

Relief Foundation

2003 ADA •1

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Virginia Dental Health Foundation Ralph L. Howell, Jr.

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Delegates:

144th~,.. Session, October 23-26,2003, San Francisco, CA

Anne C. Adams (200S)!,')!') M. Joan Gillespie (2003)" Ronald L. Tankersley (20g5)

Alternate Delegates:

Charles L. Cuttino III (2004)

Bruce R. Hutchison (2005)

Andrew J. Zimmer (2005)

Thomas S. Cooke III (2003) Rodney J. Klima (2004) Gus C. Vlahos (2004)

Bruce R. DeGinder (2004)

Kirk Norbo (2003)

Edward K. Weisberg (2004)

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Richard D. Barnes (2004)'; Ronald J. Hunt (2003)';;;>" William J. Viglione (2gg3)

2 Virginia Dental Journal

David C. Anderson (2004) Wallace L. Huff (2004) Leslie S. Webb, Jr. (2003)


Representing and serving member dentists by fostering quality oral health care and education.

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OFACERS

COUNCILORS

President: Rodney J. Klima, Burke President Elect: Bruce R. DeGinder, Williamsburg Immediate Past President: Thomas S. Cooke III, Sandston Secretary-Treasurer: Edward J. Weisburg, Norfolk Executive Director: Terry Dickinson, D.D.S. 7525 Staples Mill Road, Richmond, VA 23228

I II III IV V VI

EXECUTIVE COUNCIL

Includes officers and councilors listed and: William J. Viglione, Charlottesville - Chairman Mark A. Crabtree, Martinsville - Vice Chairman Benita A. Miller, Richmond M. Joan Gillespie, Alexandria Ralph L. Howell, Jr., Suffolk Ex Officio Members: Parliamentarian: James R. Lance, Richmond Editor: Leslie S. Webb, Jr., Richmond Speaker of the House: Bruce R. Hutchison, Centreville Dean, School of Dentistry: Ronald J. Hunt, Richmond

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James E. Krochmal, Norfolk McKinley L. Price, Newport News H. Reed Boyd III, Petersburg Anne C. Adams, Richmond Mark A. Crabtree, Martinsville Ronnie L. Brown, Abingdon VII Darwin J. King, Staunton VIII AI Rizkalla, Falls Church

VDASTAFF

Stephanie Arnold - Director of Outreach Programs Dr. Terry Dickinson - Executive Director Bonnie Anderson - Administrative Assistant Linda Gilliam - Director of Finance Susan Lionberger - Director of Events & Publications Samantha Paulson - Director of Marketing and Programs Leslie Pinkston - Dir. of Membership Recruitment & Retention Nicole Pugar - Director of Public Policy Barbara Rollins - Asst. Director of Outreach Programs

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SOCIETY

PRESIDENT

SECRETARY

PATIENT RELATIONS

Tidewater, I

Harvey H. Shiflett III 3145 VA Beach Blvd #104 Virginia Beach, VA 23452

Robert A. Candler 116 Janaf Office Bldg Norfolk, VA 23502

Carl Roy 2100 Lynnhaven PWky #200 Virginia Beach, VA 23456

Peninsula, \I

EricW. Boxx 11 3 Hampton Hwy Yorktown, VA 23693

Sharon K. Covaney 1313 Jamestown Rd. 205 Williamsburg, VA 23185

Kent Herring 122700 McManus Blvd #102B Newport News, VA 23602

Samuel W. Galstan 12290 Iron Bridge Road Chester, VA 23831

D. Kent Yandle 5716 Courthouse Road Prince George, VA 23875

C. Sharone Ward 12290 Ironbridge Road Chester, VA 23831

Richmond, IV

AI J. Stenger 7033 Jahnke Road Richmond, VA 23225

Kathryn Finley-Parker P.O. Box 15188 Richmond, VA 23227

Jerry L. Jenkins 400 Old Hundred Road Midlothian, VA 23114

Piedmont, V

Craig B. Dietrich P.O. Box 4402 Martinsville, VA 24115

Randy J. Norbo 1414 Franklin Rd, SW #3 Roanoke, VA 24016

Craig B Dietrich 604 E. Church Street Martinsville, VA 24112

Southwest, VI

Susan F. O'Connor P.O Box 1086 Galax, VA 24333

Joseph P. Schneider Route 1 Box 560 Cana, VA 24317

Paul T. Umstott 300 W Valley Street Abingdon, VA 24210

Shenandoah Valley, VII

C. Mac Garrison 129 University Blvd Suite 0 Harrisonburg, VA 22801

Robert B. Hall, Jr. (Treasurer) 130 W. Piccadilly St. Winchester, VA 24401

Alan Robbins P.O. Box 602 Timberville, VA 22853

Northern Virginia, VIII

Neil J. Small 9940 Main Street Fairfax. VA 22031

A. Garrett Gouldin 101 West Broad sr #601 Falls Church, VA 22046

Neil J. Small 9940 Main Street Fairfax, VA 22031

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Virginia Dental Journal

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EDITORIAL

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The Christmas and New Year holiday season gives us a wonderful opportunity to reflect on our many blessings and to visit and share with family and friends. The holidays pass quickly but at times seem like a marathon test of our endurance. Now we turn to focus our attention on the coming year. Our thoughts consider many realities: The economy is in a downturn. There is the possibility of war. Terror alerts continue. Airplane travel is more difficult. As dentists we have addi­ tional concerns. We must be ready for the new HIPAA regulations. A new CDT­ 4 dental code is to be used. The ADA claim form has been changed. Ergonom­ ics, OSHA, waste management, legislative and regulatory changes are still con­ tinuing factors in our lives. How can we cope with all the change and stress?

Leslie S. Webb, Jr. DDS

VA Dental Journal Editor

Somehow we manage, but it isn't always easy. It's nice to have help along the way. Family and friends are special. We are blessed to live in a country that provides freedom, has governmental stability and an extraordinary talented citi­ zenry. We are blessed to have received a great education that enables us to practice dentistry. We are also fortunate to have support from our colleagues, staff and our tripartite dental association. Many dentists give an amazing amount of their time and talent to help us in our profession by promoting fair legislation and regulatory reform, providing tools to help implement imposed requirements, maintaining dental codes, improving den­ tal education, upgrading our dental knowledge and promoting access to dentistry. Dentistry is not a sideline profession. We need the participation of all of us in this effort. The support services provided by our colleagues in local, Virginia and American Dental Associations are constantly making it a lot easier to cope with our practices. Your help is needed and appreciated. Get involved! Stay involved! Participate! You'll reap the benefits and help your profession.

4 Virginia Dental Journal


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MESSAGE FROM THE PRESIDENT

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We are all familiar with the adage that the one constant in life is change. Being one of the now graying group of dentists who graduated in the seventies, we have seen our share of changing times. First, there was the Great Society with the massive Federal financial help to dental schools to turn out more dentists. Then, in the eighties and early nineties there were concerns of oversupply of dentists and lack of business, and the closing of some of America's best dental schools. Today, our dental schools graduate a little over four dentists for every six who finished twenty years ago. These figures tell the tale. Not all of us will be able to sell and continue our practices when we retire because there Will not be enough buyers. We have seen some of our peers wind down, and when ready to retire, refer remaining patients to other dentists and close their own doors. But, most of us would like to maintain a busy practice, and when ready, bring in an associate dentist with a partnership or buyout agreement, or sell outright and leave, or sell and work as an associate. The dental consultant gurus certainly advise the course of working to sell your practice. What will it take to make these hopes a reality in today's dental world?

Rodney J. Klima, DDS

VDA President

A recent editorial by Dr. Robert Keim, a dental faculty member at the University of Southern California in the Journal of Clinical Orthodontics offers some valuable insight into this ques­ tion of practice transition. Dr. Keim relates the difficulties experienced by new practitioners, in this case finishing in his specialty program, of entering into practice. The graduating students are offered numerous opportunities to buy established practices but the transac­ tions are not being made, and upon graduation, his students are having to take part time positions, some outside of dentistry altogether, or accept positions in large dental clinics or with managed care organizations. According to Dr. Keim, "The profession is faced with an extreme generation gap. It is sometimes difficult for senior doctors who have done well over the years as a result of their own hard work and personal fiscal responsibility to recognize that today's young graduates have worked just as hard and are every bit as fiscally responsible, but are faced with a situation that is far different from what existed in the past." What is different from the past and is the root of the problem is that most dental students are carrying a very heavy debt load upon graduation. The average is well over one hundred thousand dollars. For a senior dentist to be successful in practice transition, any buy in or sale of practice agreement must be structured so that the new dentist can earn a comfort­ able living while being able to service their education debt loan, and at the same time, giving the senior dentist a fair price. Creative seller financing certainly comes to mind here as a start. We need to develop better ways to bring new dentists together with established practitio­ ners, perhaps through our mentorship program. In addition, we need to better educate our members on the predicament of the new dentist through continuing education offerings. Dr. Keim suggests a possible program in which an established dentist nearing retirement or desiring a partner provides some financial sponsorship of a dental student as a way of grooming a successor and potential buyer. I have read elsewhere that this type of arrange­ ment could be a legitimate business expense for the practice. We are Virginia, certainly not Southern California, but I believe our situation is roughly the same. In particular, our members in some of our beautiful small to medium sized cities and in our rural areas are fearful of not being able to sell their practices. While it is true that other demographic factors enter in to where our VCU School of Dentistry graduates locate, we need to be working to help bring our new graduates into the many wonderful practice buying opportunities which exist here in Virginia. Not only Will our member dentists benefit on both ends. but so will the patients they serve.

Virginia Dental Journal

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GUEST EDITORIAL

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speaey.ms to me that we have a debt to

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OUR DEBT By Richard D. Wilson, DDS Last Summer I was fishing on a colleague's 26' center console - beau­ tiful boat and expertly equipped. To­ ward evening, we pulled into his dock, cleaned our catch, and trudged up the hill to his waterfront cottage, lugging our coolers and rods. It had been a great day. As I loaded up my gear to drive home, we stood there and chatted about dental education. He made it abundantly clear that he had been embarrassed and demeaned as a dental student and that those un­ forgettable memories would prevent him for ever giving money to his dental school. As I drove home, I wondered about the faculty members who had "embar­ rassed and demeaned" my good friend. Were they retired by now? Had they been full-time or part-time? Had they been replaced by more student-friendly faculty? And, most importantly, why would they do that? I suspect that my colleague's unhappy memories are shared by many, includ­ ing me, frankly. And yet, I have to ask myself - what would I be doing today if I hadn't gone to dental school? I wondered about the life style of my friend and his family. The role of dental education in establishing that life style seemed to me to be very contributive.

Dental education is confronting grave problems. BUdgets are being cut --- not by 3 or 4%, but in a number of schools (ours for example) by 15-22%. Old labo­ ratory equipment remains in use; fac­ ulty compensation continues to be a factor in faculty recruitment/retirement; clinical facilities need to be brought up to date. Critical thinking seminars, so necessary in the development of stu­ dent judgment, are greatly enhanced by new (and expensive) electronic technol­ ogy methods. Innovative, patient-like manikins (also expensive) accelerate the clinical learning curve ofthe student -- an area that has concerned many. So it is clear that "keeping pace' issues have to be supplemented by "forging ahead" issues. If a school is concerned only about keeping pace it will shortly find itself to be a third tier school. Cre­ ativity and innovation in education re­ sult in a happy house for faculty, an exciting and challenging environment for the students and a more patient-care skilled graduate. Clearly, these are the hallmarks of a school judged to be among the best in dental education. The problems of dental education have to be accepted by the practicing den­ tist as being the problems of the entire profession. Only then will dental schools benefit from an authentic and productive professional partnership. We all have our favorites for contribu­ tions. I suggest we include our dental school among those favorites.

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zarre in the advertising world, and Peruse the classified section in "Health and Medical" to see what the demand (and supply) of assis­ tants and hygienists is in that area.

Imagine my surprise, chagrin, displea­ sure, amazement, bewilderment, and yes, outrage upon seeing the enclosed ad in the October 6th St. Paul Pioneer Press. Delta Dental of Minnesota ad­ vertising for a "Treatment Plan Analyst­ proficient with diagnostic radiograph in­ terpretation, and knowledge of clinical dentistry and treatment alternatives ... to provide dental opinion based on clini­ cal knowledge." Was this an opportunity for an experi­ enced dentist, perhaps wanting to scale back from clinical work? Perhaps a position for a dentist suffering from a disability no longer able to practice? Alas, it was for neither. It was an ad beckoning dental assistants or hygien­ ists to come and decide on a proper course of treatment for our patient's dental treatment! I don't know where each state's dental practice act stands on this position, but the last time I looked, most states require a D.D.S. or D.M.D. to interpret radiographs and of­ fer dental opinion or treatment. I read this ad aloud from the floor of the House of Delegates recently in New Orleans, and afterwards was ap­ proached by a number of dentists and lawyers representing state dental asso­ ciations, asking for copies of the ad. Apparently they want to try to prevent things like this happening in their states.

Dentists have vastly different life styles. Not everyone has a waterfront cottage with a 26' center console out front. Some are educating children, some are paying educational debt, and some are recovering from the stock market.

A debt, after all, has to be paid.

But --­

Dear Editor:

Candor compels us to admit that most of us are experiencing a reasonably acceptable level of financial satisfaction.

In this era of interstate travel. it has long I also hope that we as individual den­ been my habit upon arriving in different tists become pro-active, being our towns to:

patient's advocates on this issue, and 1) Check for people with my surname, contact our state boards letting them as chances are they are a relative, know how we feel about this practice. 2) Read Yellow Page ads for dentists If part of our job involves direct patient to see what is new, different, or bi­ care, surely part of it also involves help­

Perhaps it's time to subordinate bad memories and give serious thought to where we are and how we got here. It

6 Virginia Dental Journal

LETTERS TO

THE EDITOR

I hope that we, as state dental associa­ tions, and united, through the ADA, have the fortitude to challenge these third party payers on this issue. I urge indi­ vidual states to look into what third party payers are doing in this regard and to challenge them directly and through your State Board of Dental Examiners.


ing our patients overcome the obstacles that can either legally or illegally be put before them in getting proper dental treatment. Let them know what the in­ surance industry is up to. Grass roots politics doesn't start from the ADA level or even our state or local levels. It starts with individual dentists, and it involves all those dentist's patients. If enough voices speak up, surely a change can be affected.

course by her was given three years ago to Lions International, which I attended. In terms of personal value to me and all those there it was invaluable (priceless). It certainly reinforced the message about leadership and leaders- they help prepare us for that inevitable change that we face, not only as an individual den­ tist, but as a organization and profes­ sion. The VDA has set out to provide real value to its membership and they 'nailed' it on this weekend. The skills I learned over the weekend will not only Sincerely, help me in my role as a member of the David Lurye, DDS VDA, and as a member of the legisla­ Winter Park, CO tive committee, but in my role as a mem­ ber of my community and my practice. ~------_ ­ To the ones who chose not to attend­ you really missed a golden opportunity Dear Dr. Dickinson:

to learn something about yourself and your great profession. You never will I want to thank you and your staff for know the value that the VDA meetings organizing an exciting and informational and programs have if you never come to leadership event. This leadership con­ a meeting or program. It's your profes­ ference was my first and a great experi­ sion and it's not a spectator sport! ence for me as president-elect of my

component. Again, thank you for your Dr. Bill Pearlman work in creating a VDA in which I am Hampton, VA 23663 proud to be a member.

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Sincerely,

Michael A. Abbott, DDS

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To the Editor: Dear Fellow VDA members: I was fortunate to be able to attend the recent VDA Leadership Conference in Richmond. The first day of the confer­ ence was devoted to membership is­ sues (recruitment and retention) and our role in the legislative arena- which was of value and an excellent presentation by all presenters. On Saturday, there was a presentation that, in my opinion, changed how I viewed my role and re­ sponsibilities in this profession. Sheila Sheinberg, PhD, of Port Orchard, Wash­ ington, a nationally known organiza­ tionalleadership and management ex­ pert, gave a full-day self-evaluation course and presentation. That might sound boring, but it was anything but boring. It was in fact, one of the most exciting one-day events I have ever had the privilege to be a part of. A similar

Dear Dr. Webb: I enjoyed seeing you at the VDA meet­ ing in Norfolk. I appreciated you dis­ cussing with me the need to remem­ ber, Mr. Charles F. Suter, one of our few Honorary Members, with a memorial article. He died on December 3, 2001 and this has not been done until now. He was so helpful to all of us in the Dental As­ sociation for a lifetime. I am sure many of our members would appreciate this being done. Thank you for doing this and being so faithful in keeping the Virginia Dental Journal so well done over the years you have been the editor. Best Wishes, Thomas W. Peterson, DDS Chesapeake, VA

A MEMORIAL TO

CHARLES F. SUTER

An Honorary Member of the Virginia Dental Association Who was Charles F. Suter? He was "Mr. Insurance" for the VDA for many years. Charlie, as he was called, pioneered the insur­ ance coverage that our dental as­ sociation enjoyed. In 1971, the VDA and the ADA agreed to endorse the Profes­ sional Protector Plan of the liabil­ ity insurance. Charlie guided our association and encouraged members to be adequately in­ sured for our protection. He at­ tended the leadership meetings of the VDA as advisor. He always attended our VDA meetings to guide and advise members on in­ surance needs. Charlie was al­ ways available to extend a help­ ing hand in solving individual in­ surance problems. He was there for each of us. I first met Charlie in 1951 during my senior year in dental school when he lectured on the need to be properly insured. Overthe 50 years of my practice, we became good friends and I called upon his wisdom and counsel numerous times. Many heartwarming sto­ ries could be told by members about their relationship with Charles F. Suter. Charlie was a sincere, soft spo­ ken man, worked quietly,promptly and efficiently and was always a gentleman. Because of his dedi­ cated service, Charlie was elected an Honorary Member of the VDA. There has been few to receive this honor. Charlie told me that this was the greatest honor he had ever received. Thomas W. Peterson, DDS MCV School of Dentistry, Class of 1951

Virginia Dental Journal

7


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TO: All of the doctors and technicians that participated and completed the denture portion of the M.O.M. program of Northern Virginia Community College, November 1, 2 and 3, 2002. We thank you for all your efforts, coop­ eration and devotion to help the needy patients. It was quite an effort for the prosthetic department. Each of you had to supply your own tools, articulator, and other equipment. I compared it to al­ most having to supply the needs of a dental school. Above all you had to work and function in a strange setting as well as being on a very restricted schedule. You pro­ duced from start to finish 6 complete sets of dentures in 2 and 1/2 days, an immediate complete denture and sur­ gery, a rebase of a complete set of up­ per and lower dentures, and an imme­ diate transitional denture. You were also able to make several repairs to vari­ ous types of dentures.

All the above was accomplished with the generous help of Dr. Dave Vokins and some staff members from J-dent Dental Laboratory, 9653 Lee Highway, Suite 19-A, Fairfax, VA. They helped make base plates, donated all the sets of teeth used for the dentures processed and finished all the dentures and were terrific about deliveries to and from the laboratory. Several doctors volunteered and made adjustments to these dentures in their private offices for up to 2 weeks after their insertion. Our services were much more than 1 visit treatment and were multiple visits, and late hours devoted by all of the doc­ tors, technicians and assistants. The patients received a once in a lifetime treatment and were very appreciative.

again in the future. Thank you so much, Douglas C. Wendt, DDS MOM Section Leader, Prosthodontics

THE PROSTHODONTIC SECTION MOM PROJECT consisted of Dr. Charles Fletcher, Dr. Bruce Hutchison, Dr. Linwood Outen, Dr. Gary Arbuckle, Dr. Raymond Bond, Dr. Kenneth Haggerty, Dr. Brian Mahler, Dr. Mike O'Shea, Dr. AI Rizkalla, and Dr. Dou­ glas C. Wendt. Laboratory support came from Mr. Dave Vokins and 2 staff members from J-Dent Laboratory. Den­ tal staff and assistants were Ms. S.Y. Reese, Ms. Gunjan Harmini, Ms. Helen Vergnetti, and Ms. Marilyn Wild.

Dentistry has shown it's finest hour on what we can and will do for our less for­ tunate neighbors. My hat is off to all who participatedin the M.O.M. program, and look forward to working with you all

1,If§lrtl[(ll AMERICAN SOCIETY OF CLINICAL HYPNOSIS

www.asch.net or

630/980-4740 for more information

April 4-8, 2003 Alexandria, Virginia Hilton Alexandria Mark Center

8 Virginia Dental Journal

ASCH-ERF is an Academy of General Dentistry Approved PACE

Program Provider FAGD/MAGD Credit 3/04/2001 to 5/31/2005.


ORAL BIOPSIES FROM PEDIATRIC PATIENTS:

A RETROSPECTIVE ANALYSIS

Brian Brumbaugh DDS and James Burns DDS PhD

School of Dentistry, Medical College of Virginia, Virginia Commonwealth University

ABSTRACT

Purpose: The purpose of this study was to determine the relative occurrence of ora/lesions, biopsied within a popula­ tion of children, aged 0-12 years old. Additionally, the submitted clinical im­ pression for each biopsy was compared to the actual histopathologic diagnosis to determine the clinical accuracy of the contributor. Methods: A 5-year retrospective study of 1,644 lesions removed from children 0-12 years old was conducted. The ab­ normalities were ranked by frequency from most common to least common. The relative ranking was compared to previously reported studies. Clinical accuracy was analyzed by comparing the submitted "clinical impression" to the final histopathologic diagnosis. The clinical accuracy was calculated for the total 1,644 biopsies as well as for the top 10 most common lesions. Results: The mucocele, a submucosal accumulation of salivary secretions sometimes referred to as a mucous re­ tention phenomenon, was found to be the most commonly biopsied lesion in the 0-12 year old age group (25%). The second most commonly biopsied lesion at 11 % was dentigerous cyst, an odon­ togenic cyst that occurs in association with the crown of an unerupted tooth. The third most commonly biopsied le­ sion at 9% was the fibroma, a benign neoplasm of fibrous connective tissue. There was an overall accuracy rating of 49% for the clinician's "clinical impres­ sion" compared to the histopathologic diagnosis. There was a 72% accuracy level when only the ten most common lesions were analyzed.

Conclusions: Room for improvement exists with respect to clinical diagnos­ tic accuracy among health care profes­ sionals serving the pediatric population.

This can be accomplished by the clini­ cians being aware of the characteris­ tics of the more commonly occurring lesions.

The purpose of this study was to deter­ mine the most common biopsied oral lesions in children and secondarily to assess the accuracy of the practitio­ ners' clinical impression.

INTRODUCTION MATERIALS AND METHODS Epidemiologic information about oral lesions commonly found in children is sparse. Of the six most recent studies assessing biopsied lesions in children four were from foreign sources." More­ over, some of the information that is currently available in the literature is dated and decades old.':" Many oral lesions have a distinct predi­ lection for various age groups. As an example, squamous cell carcinoma occurs in patients with an average age of 60 years. Other predominately "older age group" lesions include lichen pla­ nus, lipoma, metastatic carcinoma, Paget's disease, epulis fissuratum and pemphigus. In pediatric patients, text­ books list candidiasis, hemangioma, lymphangioma, neuroectodermal tumor, and eruption cyst as primarily occurring in patients less than 12 years of age. 9 ,10 Clinicians find this type of information useful in establishing their differential diagnosis. For example, the differential diagnosis for a gingival mass on the al­ veolus in a 6-month-old is different than one in a 60-year-old: congenital epulus of the newborn versus peripheral ossi­ fying fibroma. The decision to biopsy a lesion is largely based on clinical impression. Studies on the accuracy of clinical impression and final diagnosis suggest a high rate of accuracy for common lesions, but a lesser rate for less common lesions. 11 It is important not only to compare 14 clinical impression with histopathologic diagnosis to assess accuracy, but also to gain practical information concerning differential diagnosis of clinically simi­ lar lesions.

The medical profession divides the pe­ diatric patient into four groups: infancy, toddlerhood, childhood, and adoles­ cence. Papalia defines infancy as birth to 1 year old, toddlerhood as 1 to 3 years old, childhood (early/late) as 3-6 and 6-12 years old, and adolescence as 12-18 years old." The principle pediatric subsets of interest in this study were infants, toddlers, and child­ hood, birth through age 12. The adoles­ cent age group was not analyzed in this study. The database used for this study was from the Department of Oral and Maxil­ lofacial Pathology, School of Dentistry at Virginia Commonwealth University (VCU) in Richmond, Virginia. This da­ tabase contains over 88,000 cases spanning the years of 1988-2001. Ap­ proximately 85% of the cases received by the VCU Oral Pathology Department are from Virginia sources. The majority of the remaining cases originate from neighboring states, therefore limiting this study to the Mid-Atlantic region. For this study, a computer analysis of nearly 43,000 cases acquired from April 1996 to April 2001 revealed 4,100 (9%) pediatric cases (ages 0-18 years). The 9% pediatric subset found in this study is similar to other studies of this nature.': 2 When this subset was further limited to patients aged 0-12 years 1,644 cases (4%) were found. This group was com­ parable to the overall database in that 86% of these biopsies were from Vir­ ginians. Additionally, the gender and race of the patients were analyzed. "Clinical impression" and "final diagnoVirginia Dental Journal

9


sis" of each oral lesion were tabulated and analyzed. "Clinical impression" was defined as the submitting clinician's ten­ tative or working diagnosis at the time of biopsy, while "final diagnosis" repre­ sented the final histopathologic name applied to the lesion after the pathologist's evaluation. An "oral" lesion was defined as a soft or hard tissue le­ sion found in or around the oral cavity. In some instances, when histologic ex­ amination was able to permit a more specific diagnostic term within a class of lesions, the clinical impression was considered correct if it fell within the more general classification. As an ex­ ample, a "clinical impression" of muco­ cele would be considered "accurate" for a histologic final diagnosis of mucous retention phenomenon, mucous reten­ tion cyst or chronic sialodenitis with ductal dilatation.

RESULTS In the 1,644 biopsied lesions from chil­ dren ages 0-12, there was nearly a 501 50 ratio of males/females (Table 1). The Caucasian, African-American, Asian and Hispanic distribution was analogous to the general population of Virginia (86% of the biopsies were from Virginia) (Table 1). The average age of the biopsied sub­ jects was 8.4 years (SD=3.23) (Table 2). As shown in Table 3, the mucocele rep­ resented the most frequently biopsied lesion at 25% (417/1644). Dentigerous cyst, fibroma, papilloma, odontoma, pyogenic granuloma, cyst, radicular cyst, ranula and periapical granuloma constituted the next nine most com­ monly biopsied lesions. The top 10 most frequently biopsied lesions comprised 68% (1113) of all the lesions. The accuracy of comparing the "clinical impression" to the "final diagnosis" was 49%. This rate was greatly improved when only the ten most common le­ sions were analyzed (72% correct).

DISCUSSION Private practitioners in Virginia submit­ ted the majority of biopsies in this study (86%), but the results were similar to previous studies on other populations. Skinner and Das both reported pediat­ 10 Virginia Dental Journal

ric biopsy percentages of 13% and 12%, respectively, with age groups of 0-20 years. 1, 2 Chen et ai, and Ulmansky et ai, found just 6% and 7%, respectively, of the total biopsied lesions in a 0-15 year old population" 5 In this study, the number of pediatric biopsies was 9% (4,100) for the 0-18 age group and 4% (1,644) forO-12 year olds in a database of 43,000. Table 2 notes 83 lesions from children less than one year of age, which differs from past studies showing fewer cases in the first year of life. This may be attributed by the fact that VCU has a very active pediatricdental residency pro­ gram. Table 2 also noted an increasing number of biopsies submitted in patients over one year of age, reflecting an in­ crease in trauma-related lesions (mu­ cocele), development lesions (dentiger­ ous cyst, odontoma) and reactive/inflam­ matory lesions (pyogenic granuloma, radicular cyst, periapical granuloma) as the child matures. These numbers are congruent with findings of past studies with similar distribution curves.!" Of the 1,644 lesions, mucocele (25%) was the most commonly biopsied le­ sion reported, followed by dentigerous cyst (11 %) and fibroma (9%). As shown in Table 3, the 10 most frequently biopsied lesions made up nearly 68% of the total. A strong working knowledge of these lesions, as well as knowing some important differential diagnostic features, is a key factor in successful clinical examinations. The mucocele, a submucosal accumu­ lation of salivary secretions sometimes referred to as a mucous retention phe­ nomenon, represented 25% of the sub­ missions. In a study by Das et ai, the occurrence of mucoceles was 12% in 0-20 year 01ds.2 Skinner, within the same age group, reported a 33% oc­ currence.' By comparison, Weir and Tay reported 8 and 9% overall percent­ age of mucoceles, respectively, in the general poputauon.":" In our study, the practitioners' clinical impression was correct 82% of the time. Significant in­ correct clinical impressions included fi­ broma (5%), focal inflammatory fibrous hyperplasia (3%) and hemangioma (2%). Characteristics to help differenti­ ate mucoceles from focal inflammatory fibrous hyperplasia, hemangioma, pyo­ genic granuloma and fibroma include

location (lower lip), gender (male), color (bluish) and being fluid-filled. The second most commonly biopsied lesion was dentigerous cyst (11%), an odontogenic cyst that occurs in asso­ ciation with the crown of an unerupted tooth. Keszler reported a 25% and Das reported a 5% occurrence.s" Again, as with mucoceles, a high percentage of clinicians (91%) correctly identify this lesion. A few misdiagnoses noted were ameloblastoma (2%) and actinomyco­ sis (1%). Dentigerous cyst has been reported as the most common odonto­ genic cyst':' in children and second behind radicular cyst within the general population.":" It should be noted that both the dentigerous cyst and the radicu­ lar cyst, the eighth most common le­ sion in this study, are commonly found in the second and third decades of life. 3 Fibroma, a proliferation of fibrous con­ nective tissue, was the third most com­ monly biopsied lesion in this study with 9%, similar in incidence to previous studies.":" Unlike mucocele and den­ tigerous cyst, the clinical diagnostic accuracy levels for fibroma was only 45%. This discrepancy may reflect the wide variety of clinical "look-a-likes" for the fibroma. In this study the more com­ mon incorrect clinical impressions were mucocele (37%), pyogenic granuloma (5%), and hemangioma, verruca vulgaris and lymphangioma at 1% each. Inter­ estingly, mucocele was the favorite mis­ diagnosis for a fibroma. Although the most common soft tissue neoplasm of the oral cavity, the fibroma is never fluid­ filled like a mucocele. Fibromas are generally pink except when friction causes white hyperkeratosis to appear, They are most commonly found on the buccal mucosa rather than the lower lip, as are mucoceles. The 49% "correct" clinical impression rate in this study was below that re­ ported by Jullien and Seoana"", which was limited to recognition of malignant and pre-malignant lesions. Jullien re­ ported a range of 79-83% in their can­ cer study, while Seoane reported 83­ 87% correct recognition of malignant versus non-malignant lesions. In this study, the "correct" clinical impression percentage increased to 72% when just the ten most commonly found lesions


were analyzed. We found that 68% of all the lesions fell in the top ten and most other lesions were found only once or twice. It stands to reason that if clini足 cians see many children in their prac足 tice, they should become very familiar with these common lesions.

Table 3: The 10 Most Frequently Biopsied Lesions in Patients Aged 0-12 "Clinical Impression"

If.

Mucocele

417

Dentigerious Cyst

186 Dental follicle, dentigerous cyst

Fibroma

155

Papilloma

104

Odontoma

98

Pyogenic Granuloma

Table 1: Demographic Distribution of 1,644 Pediatric Cases Gender: Male Female Race: Asian Black Caucasian Hispanic Other Unknown State: VA OH PA

NC GA AR WV SC Other

Number

833 811 Number

18

274

1318 25 4 5 Number

1416

46

37

37

21

16

14

12

39

Percent

Number

Less than 1 83

Correct Match

Mucous retention 82.2% phenomena, Chronic sialoadenitis/ductal dilatation, mucus retention, cyst 90.8%

Most Frequent

"Incorrect" Diagnosis

Focal inflammatory

fibrous hyperplasia,

Hemangioma,

Pyogenic granuloma,

Fibroma

Ameloblastoma

50.7 49.3 Percent

1.1 16.7 80.2 1.5 0.2 0.3

Focal inflammatory 44.5%

fibrous hyperplasia,

peripheral ossifying fibroma,

focal and epithelial hyperplasia

fibroma

Mucocele, pyogenic granuloma, hemangioma, verruca vulgaris

63.5%

Fibroma, mucocele,

pyogenic granuloma

Developing tooth, tooth Fragments, Odontoma

72.5%

Dentigerous cyst, dental follicle

81

Subacute inflamed granulation tissue, pyogenic granuloma

32.1%

Focal inflammatory

fibrous hyperplasia,

Peripheral ossifying

fibroma, peripheral

giant cell granuloma

Cyst

21

Lymphoepithelial cyst, 71.4% Granulation tissue, cyst of undetermined odontoma, origin, dentigerous cyst,

lipofibroma odontogenic keratocyst, radicular cyst

Radicular Cyst

18

Periapical granuloma, cyst of undetermined origin, radicular cyst

88.8%

Granulation tissue

Ranula

17

Chronic sialoadenitis/ducal Dilatation, ranula

88.2%

Fibrous hyperplasia

Periapical Granuloma

16

Radicular cyst, periapical granuloma

87.5%

Chronic pulpitis, Parulis

Totals:

1113/1644=68%

Verruca vulgaris,

Papilloma

Percent

86.1 2.8 2.3 2.3 1.3 1.0 0.9 0.7 2.6

Table 2: Age Distribution of 1,644 Pediatric Cases Age

"Correct" when histologically diagnosed as:

Percent

5.1

1

21

1.3

2

18

1.1

3

24

1.5

4

46

2.8

5

75

4.6

6

129

7.9

7

147

8.9

8

160

9.7

9

197

12.0

10

208

12.7

11

263

16.0

12

273

16.6

72% weighted

Virginia Dental Journal

11


REFERENCES

1. Skinner R, Davenport W, Weir J, Carr R: A survey of biopsied oral lesions in pedi­ atric dental patients. Pediatr Dent 8:163­ 167, 1986. 2. Das S, Das A: A review of pediatric oral biopsies from a surgical pathology ser­ vice in a dental school. Pediatr Denta 15:208-211,1993. 3. Keszler A, Gugliemotti MB, Dominquez FV: Oral pathology in children: frequency, distribution and clinical significance. Acta Odontol Latinoam 5:39-48, 1990. 4. Chen Y, Lin L, Haung H, Lin C, Yan Y: A retrospective study of oral and maxillofa­ cial biopsied lesions in a pediatric popu­ lation from southern Tiawan. Pediatr Dent 20:404-410, 1998. 5. Ulmansky M, Lustmann J. Balkin N: Tumors and tumor-like lesions of the oral cavity and related structures in Israeli chil­ dren. Int J of Oral Maxillofac Surg. 28:291­ 294, 1999. 6. Taiwo E, Salako N, Sote E: Distribution of oral tumors in Nigerian children based on biopsy materials examined over an 11­ year period. Community Dental Oral Epidemiol 18:200-203, 1990.

7. Bhaskar SN: Oral tumors of infancy and childhood. A survey of 294 cases. J. Pediatr 63:195-210, 1963. 8. Dehner LP: Tumors of the mandible and maxilla in children. Clinicopathologic study of 46 histologically benign lesions. Cancer 31:364-84, 1973. 9. McDonald J.S.: Tumors of the oral soft tissues and cysts of the bone. In Dentistry for the Child and Adolescent (7 t h ed.) McDonald & Avery, Philadelphia: CV Mosby Co., 2000, pp. 151-179. 10. Flaitz, C.M.: Oral pathologic conditions and soft tissue anomalies. In Infancy through Adolesence, (3rd ed.) Pinkham, Fields & McTigue, Philadelphia: WB Saunders Co., 1999, pp. 12-42. 11. Kuc I, Peters E: Comparison of clini­ cal and histologic diagnoses in periapi­ cal lesions. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 89:333-337, 2000. 12. Jullien J, Downer M, Speight P, Zakzewska J: Evaluation of health care workers' accuracy in recognizing oral can­ cer and pre-cancer. Inter Den Journ 46:334-339, 1996.

13. Seoane J, Varela-Centelles P, Gonzalez N, Aguado A, Esparaza G: As­ sessment of dental students' ability to rec­ ognize Precancerous lesions and condi­ tions. Euro J of Dent Educ 4:172-175, 1997. 14. Sadowski D, Kunzel C, Phelan J: Den­ tists' knowledge, case finding behavior, and confirmed diagnosis of oral cancer. J Cancer Educ 2:127-134, 1988. 15. Papalia D. & Olds, S.: A child's world: theories, issues, and methods for study­ ing it. In A Child's World, Infancy through Adolescence, (61h ed.) Papalia & Olds. New York: McGraw-Hili Co., 1993, pp. 7­ 47. 16. Weir J, Davenport W, Skinner R: A di­ agnostic and epidemiologic survey of 15,783 oral lesions. JADA 115:439-442, 1987. 17. Tay A: A 5-year study of oral biopsies in an oral surgical unit in Singapore: 1993­ 1997. Annals of the Academy of Medicine, Singapore 28:665-671, 1999. 18. Weir J, Smith C: A report and analysis of lesions submitted to the LSU oral bi­ opsy service during 1986. Louisiana Den­ tal Association Journal 46:6-10, 1987.

Mid-Atlantic Center February 14-16, 2003 Planning Optimum Dentistry­ for Advanced Dental Study Treatment Predictable Restorative Excellence Series The Mid-Atlantic Center for Advanced

John Cranham, DOS

Dental Study is a a multi-purpose education facility dedicated to the advancement of dentistry. We are proud to host leaders in dentistry, from around the world, to teach quality

February 14, 2003

Basic Photoshop/Powerpoint Presentations for Dental Professionals Harriet McCullough

dentistry to the dental team for the benefit of the patient Our facility also offers an extensive library for dental research and study. For more information on courses visit

March 28, 2003

Porcelain Veneers - A Hands On Program AvashiSadan, oMo Co-Hosted with the Seattle Study Club

www.mid-atlanticcenter.com or call us at 757.222.9843

March 29, 2003

Fabrication of Temporaries for DentalAssistants Karen McAndrew, ODS June 19-21, 2003

Esthetics in the Worldof Occlusion John Cranham, ODS and Buddy Shafer. COT Mid-Atlantic Center for Advanced Dental Study 1207 Volvo Parkway Chesapeake, VA 23320-7654 757222.9843 www.nJid-atlmlticcfnter.com

12 Virginia Dental Journal

October 17-18, 2003

Bonded Porcelain Restorations in the Anterior Dentition Pascal Magne, OrMed, Dent Co-Hosted with the Sesttle Study Club


ABSTRACTS Iii! [I~~~~~~~~~~~~~ The following abstracts were pro­ vided by the Department of Endo­ dontics at VCU School of Dentistry. We appreciate the contribution that these individuals have made to the Virginia Dental Journal.

Khongkhunthian P, Reichart PA. Aspergillosis of the maxillary sinus as a complication of overfilling root canal material into the sinus: report of two cases. Journal of Endodontics 2002;7:476-8 Aspergillosis of the maxillary sinus is a relatively rare disease in non­ immunocompromised patients. In re­ cent years a number of cases of as­ pergillosis of the maxillary sinus have been reported in association with over­ extension of root canals fillings with certain root canal cements. It has been suggested that zinc oxide-based root canal cements might promote the in­ fection with the Aspergillus species. In particular Aspergillus fumigatus has been found to be associated with the maxillary sinus infection. Radiographi­ cally the unique appearance of a dense opacity foreign body reaction in the maxillary sinus was considered a char­ acteristic finding in maxillary sinus as­ pergillosis. Because this association of overfilling of root canal cements and aspergillosis of the rnaxi'lary sinus is not too well known two cases are re­ ported here. Both were young healthy female patients with the characteristic findings of aspergillosis both radiographi­ cally and clinically. The first maxillary molar was involved in both cases. Pa­ tients were asymptomatic and the di­ agnosis was made accidentally. After surgical removal histologic samples from both patients revealed aspergillomas, associated with the over­ extended root canal cement. The mi­ croscopic findings in both cases re­ vealed the characteristic branching hy­ phae and conidophores typical of As­ pergillus. Overextension of root canal cements into the maxillary sinus must be avoided to prevent possible as­ pergillosis infection.

Dr. Anita Aminoshariae is a second year-postgraduate student in Endodontics at VCU School of Den­ tistry. She received her D.D.S. de­ gree from Case Western Reserve University in 1999. - - -

~-------

Marisa Gomes de Amorim Demarchi,

DDS and Elizabeth Francisco Loureiro

Sato, DDS, MSc, PhD

Leakage of Interim Post and Cores Used

During Laboratory Fabrication of Cus­

tom Posts.

Journal of Endodontics 2002; 28:328­

329

Once endodontic treatment is com­

pleted the decision of how to restore the

tooth must be addressed. Many times

this is accomplished with a post and

core prior to the placement of the crown.

The prefabricated post can be accom­

plished in one appointment. A cast post

and core must be sent to the lab, so

the tooth being restored will have a tem­

porary post and core for a period of time.

During this interim period bacterial leak­

age may occur along the temporary post

and core. This could result in failure of

the endodontic treatment if the seal of

the root canal obturating material is

compromised.

The purpose of this study was to com­

pare coronal microleakage under two

conditions. Group A which consisted

of 14 endodontically treated extracted

molars which were restored with a per­

manently cemented prefabricated post

and core. Group B consisted of 14 en­

dodontically treated extracted molars

restored with a temporary post and core.

The teeth in both groups were

thermocycled, immersed in black India

ink for one week and then decalcified.

The extent of the linear leakage of the

dye was then measured.

The average leakage in the distal-buc­

cal, mesio-buccal, and palatal roots was

2.00,2.44 and .22 mm respectively in

group A. Group B demonstrated aver­

age leakage values of 9.69, 10.81 and

11 .33mm for the same canals. There

was a statistically significant difference

(p<0.01) between group A and group B.

Failure of endodontic therapy as a re­

sult of coronal leakage can be a result

of reinfection of root canals by microor­ ganisms in a short amount of time. Anything the dentist can do to decrease the possibility of this reinfection in war­ ranted because the result of this rein­ fection may not be seen until after the definitive restoration in placed. Nonsur­ gical retreatment is then more difficult because the definitive restoration must be disassembled to regain access to the root canals. This study concluded that significantly less coronal microleakage is associated with imme­ diate post and core placement than when a temporary post and core must be used.

Dr. Matthew T. Ankrum is a second year graduate student in Endodon­ tics at MCVNCU School of Dentistry. He received his D.D.S. degree from West Virginia University. He is look­ ing forward to returning to his home­ town of, Blacksburg, VA after resi­ dency. -----~

Zinelis S, Magnissalis EA, Margelos J

Lambrianidis T

Clinical Relevance of Standardization

of Endodontic Files Dimensions Acc­

ording to the ISO 3630-1 Specificati­

on.

Journal of Endodontics 2002; 28:367­

370

A serious problem was identified in the

mid 1950's with regard to the lack of

standardization of endodontic instrum­

ents. In 1981, the specifications were

revised, including requirements for a

uniform file taper of 0.02mm per mm at

each diameter inspection point. Later,

in 1989, a second revision was made

on the design of cutting blades, the geo­

metry, and the angle of the tip. Despite

the development of standard specificat­

ions, wide variations are being observed

in the diameters of instruments of the

same nominal size within or between

different manufacturers. The tolerance

limit of ±0.02 mm for all diameters has

been identified as part of the problem.

The purpose of this study was to invest­

igate the dimensions of current comme­

rcially available files according to ISO

3630-1 requirements. Measurements

of instrument dimensions were con-

Virginia Dental Journal

13


ducted on stainless steel Hand K files (sizes 08-40), as well as on rotary-driven nickel titanium (NiTi) files (sizes 15-40), to determine the incidence and degree of deviation from ISO 3630-1, 1992 specification. In addition, the dimen­ sions of sets of Hand K files (sizes 08­ 25) were measured to identify discrep­ ancies in dimensions among instru­ ments within the same size per manu­ facturer. The percentage of difference in width were used to determine the gra­ dation from one size to the next. None of the files tested complied with the ISO nominal size. All files were within the ISO tolerance limits. How­ ever, under such tolerance limits, there is a high possibility of either sizes over­ lapping or of great differences between two sequential sizes. These results may explain the clinical difficulty found in negotiating narrow and curved canals and may establish the need for a more comprehensive approach on the evalu­ ation methods used in root canal instru­ ment dimension specifications. Dr. Steven A. Brofsky is a first year postgraduate student in endodontics at MCVNCU School of Dentistry. He received his D.M.D. degree from the University of Connecticut in 1997. Prior to the start of his residency, he spent five years as a dentist on ac­ tive dUty in the U.S. Navy.

by size. Large bundles contained 20 to 40 fibers, medium bundles had 10 to 15 fibers, and small bundles consisted of 3 to 5 fibers. Glass tubes with an inner diameter of 6.5 mm were used to simu­ late a uniform access for all samples. Before filling the tubes with the tempo­ rary material, the cotton bundles were placed against the inner tube wall to simulate cotton trapped against the access wall during placement. Each tube was then filled with a 3.5 mm thick layer of Cavit, which was condensed from both sides with a plugger. The cotton fibers spanned the entire depth of the temporary filling, allowing 2 to 4 mm of excess fiber length to remain on both sides of the filling. The negative controls were prepared in the same manner except that no cotton fiber bundles were incorporated into the fill­ ing material. All samples were cured for 1 hour in a 100% humidity environ­ ment, then submerged 3.5 mm in me­ thylene blue stain. The length of time for the stain to penetrate the entire thick­ ness of the filling was recorded in min­ utes. The average leakage times for each group were as follows: group 1 (large bundles), 1.08 min; group 2 (medium bundles), 2.36 min; group 3 (small bundles), 7.76 min; and group 4 (nega­ tive controls), no leakage was detected during the three week observation pe­ riod.

----~-~----

Newcomb BE, Clark SJ, and Eleazer PD. Degradation of the Sealing Properties of a Zinc Oxide-Calcium Sulfate-Based Temporary Filling Material by Entrapped Cotton Fibers. J Endod 2001; 27:789-790. Temporary restorations serve an impor­ tant function to prevent contamination of the root canal system between en­ dodontic and restorative appointments. The focus of this study was to deter­ mine the effect of entrapped cotton in the filling material and measure the ra­ pidity of leakage as the cotton fiber bundle was enlarged from a few strands to a larger number of cotton fibers. Seventy-five bundles of cotton were pre­ pared under magnification and grouped

14 Virginia Dental Journal

A layer of cotton placed in the pulp chamber is frequently used before the placement of a temporary restoration both after a pulpectomy, and following completion of non-surgical root canal therapy. The cotton barrier prevents temporary material from entering and blocking the root canal system, reduces the possibility of damage to the pulpal floor during re-entry, and guides the re­ storing dentist to the obturated canals. A major disadvantage of placing a cot­ ton barrier between the root canal sys­ tem and a temporary restoration is a potential decrease in the material thick­ ness required for strength, and to pre­ vent microleakage. With a thick layer of cotton, temporary fillings are fre­ quently thinner than the recommended 3.5 mm. The results of this study sug­ gest the presence of cotton under a tem­ porary restoration also provides an op­

portunity for fibers to be incorporated within the filling, and provides a path­ way for microleakage. With these two observations in mind, a practitioner who chooses to use cotton before placing a temporary restoration must use special care to compress the cotton into the pulp chamber and avoid trapping loose cotton fibers within the filling. Other­ wise, bacterial microleakage into the pulp chamber could occur within min­ utes. Dr. David B. Ferguson is a second year postgraduate student in endo­ dontics at MCVNCU School of Den­ tishy. He received his D.D.S. degree from the University of Missouri-Kan­ sas City School of Dentistry 1990. Dr. Ferguson completed a one-year AEGD with the U.S. Army Dental Corps in 1991, and remains on ac­ tive duty. ----

~-------

Barbizam JVB, Fariniuk LF, Marchesan MA, Pecora JD and Sousa-Neto MD. Effectiveness of Manual and Rotary In­ strumentation Techniques for Cleaning Flattened Root Canals. Journal of En­ dodontics May 2001; 28: 365-6 Various methods for cleaning and shap­ ing root canals have been proposed over the years. Nickel titanium rotary instru­ mentation has recently gained popular­ ity and has shown clinical success. Anatomic variations present different problems to the clinician. The purpose of this study was to evalu­ ate the cleaning of the apical third of flattened root canals by either Ni-Ti ro­ tary or hand K-file instrumentation when both were used in a crown down method. Twenty extracted human mandibular central incisors confirmed to have one root canal were used in this study. An access preparation was made and working length was established 0.5mm from the apical foramen. The teeth were then divided into two groups. Group1 (n=10) teeth were prepared with Profile 0.04 Ni-Ti files in a crown down fashion and group 2 (n=1 0) teeth were prepared with stainless steel K-files in a crown


down fashion. The apical third of each root then was sectioned and prepared for microscopic analysis. The total ca­ nal area and the areas with debris were recorded and the percentage of debris present was calculated. There was 19.4 ± 2.0% canal area with debris in the canals instrumented with rotary instrumentation. In the stainless steel hand file group the percentage was 7.2 ± 1.8%. This represents a statisti­ cally significant difference. Rotary instrumentation with Ni-Ti instru­ ments has a limited area of action. Due to the physical properties, Ni-Ti files cannot be pressed against the side of the root canal walls to increase effi­ ciency. A flattened root, such as the mandibular incisor, will not permit ma­ jor enlargement with out risk of lateral perforation. Stainless steel files can be used in a circumferential filing technique that can clean the walls more effectively. While both instrumentation techniques in this study left debris, the use of hand files left significantly less. Dr. Sean D Fessenden graduated from MCVNCU School of Dentistry in 1996. He is now a first year post­ graduate student in endodontics. -----~-----

Abramovitz I, Better H, Shacham A, Shlomi B, Metzger Z. Case Selection for Apical Surgery: A Retrospective Evaluation of Associated Factors and Rational. Journal of Endodontics July, 2002; 28:527-30. The reasons for apical surgery are clas­ sified as biological, technical or a com­ bination of the two. Biological reasons would include cases that did not respond to proper endodontic therapy like refrac­ tory lesions or cysts and technical rea­ sons would be blocked, calcified or transported segments as well as the presence of well-fitting crowns and post! cores. Another technical reason for apical surgery would be separated in­ struments and perforations that could not be retrieved or repaired respectively from an orthograde approach. However, with the development of dental operat­ ing microscopes, high intensity fiber optic illumination and ultrasonic micro-

instrumentation many cases that were traditionally sent for an apical surgery can be effectivelyretreatednonsurgically. In this retrospective study, 200 roots referred for apical surgery were ana­ lyzed. Radiographs of referred teeth were reviewed by an endodontist and an oral surgeon and the various param­ eters of the roots were noted. Factors evaluated were: type and quality of coro­ nal restoration (if present), type, quality and length of post (if present), quality of obturation, apical perforations, block­ ages and the existence of a periapical radiolucency among others. Roots with inadequate root canal treatment were then categorized as to the difficulty in providing nonsurgical retreatment. Roots having adequate root canal treat­ ment were defined as having persisting symptoms (sinus tracts, pain and sen­ sitivity) or had the treatment completed close to the time of the study and showed a reasonable chance of heal­ ing with further follow up. Of the 200 roots, 70% had crowns and 80 of those had posts. Thirty-two crowns had open margins and seven were open with no coronal restoration at all! Eighty-three percent of the 200 roots had either an inadequate root ca­ nal filling or no filling at all. Among the 63 roots with posts, 14% had posts longer than 5 mm, the rest were shorter than 5 mm or loosely fitting and were therefore considered a removable ob­ struction in the hands of a qualified, properly equipped endodontist. When all the factors were considered, the authors concluded that 45% of the 200 roots referredfor apical surgerywere justified. The remaining 55% were deemed manageable by nonsurgical root canal retreatment. The authors note a 91% success rate for failed cases retreated nonsurgically prior to surgery. Cases once routinely sent for apical surgery because of the presence of por­ celain crowns and/or posts should be evaluated for nonsurgical retreatment since use of the microscope often al­ lows access back into the canals with minimal sacrifice of the restoration. The prudent practitioner must continue to weight the risks of surgery (mandibular paresthesia, compromised esthetics, gingival scarring) versus the benefits of

nonsurgical retreatment. Dr. M. Scott Monts is a first year post­ graduate student in Endodontics at MCVNCU School of Dentistry. He re­ ceived his D.D.S. from Baylor Col­ lege of Dentistry in Dallas, Texas in 1999. He completed an A.E.G.D. with the US Navy Dental Corps in 2000 and served with the Marines in Twentynine Palms, California for two years. -----

~

- - - _.._ . -

_..

Keene JR, Kaltman Sl, Kaplan HM. Treatment of patients who have type 1 diabetes mellitus: Physiological mis­ conceptions and infusion pump therapy Journal of American Dental Association. August 2002; Vol. 133 NO.8. 1088­ 1092. The purpose of this article is to provide an overview on the emerging technol­ ogy of insulin infusion pump therapy; discuss advantages and disadvantages of this therapy; and inform dentists on potential emergencies that may occur as a result of this new biotechnology. Today, many patients with type 1 dia­ betes mellitus (insulin-dependent) are managing their condition with the aid of an insulin pump device. This is a beeper-size device that delivers insulin through a subcutaneous catheter. Clini­ cal studies have reported that insulin infusion pump therapy has significantly reduced long-term complications asso­ ciated with diabetes mellitus, including retinopathy, nephropathy and neuropa­ thy. In addition, this new technology has led to far greater blood-glucose con­ trol than in the past. Due to the increasing use of insulin pumps (over 200,000 in the U.S.), it is important that dental practitioners be familiar with how these devices function and understands their advantages and disadvantages. One of the greatest advantages reported by insulin pump users is flexibility of lifestyle. Use of the infusion pump eliminates the need for multiple daily insulin injections by delivering a basal rate of insulin that can be coordinated with the patients' daily lifestyles. A major risk of infusion pump Virginia Dental Journal

15


therapy is the development of hypergly­ cemia as a result of pump failure or a kink in the infusion line. Although these devices have built-in alarms to safeguard against kinks in the line, conditions of ketoacidosis can develop rather quickly since the pump is the sole source of insulin for these patients. If an office emergency occurs involving a diabetic patient receiving infusion pump therapy, the clinician needs to be able to quickly determine the nature of the emergency (hyperglycemia vs. hy­ poglycemia) and act accordingly. Since the majority of these cases will involve hypoglycemia, the clinician needs to know how to place the insulin pump on "suspend" mode. This will prevent fur­ ther infusion of insulin into the patient. A quick blood-glucose level check can be performed to verify the diagnosis. In situations involving an unconscious dia­ betic patient experiencing hypoglyce­ mia, the dentist should immediately suspend the flow of insulin and admin­ ister glucagon. As more patients with type 1 diabetes mellitus will be using insulin pump therapy in the future, it is essential that the dental practitioner be familiar with this biomedical technology to provide these patients with optimal care. The dental practitioner must know how to place the insulin pump on "suspend" mode and how to administer a bolus of insulin. This knowledge will allow the practitioner to address hypoglycemic and hyperglycemic emergencies that may arise while treating these patients.

refrigerant spray (RS) in eliciting a re­ sponse in human beings. Response time, different tooth groups, and whether and how the teeth were restored were compared. 15 subjects were selected. One ante­ rior, premolar and molar were selected from each quadrant for a total of 12 teeth. Carbon dioxide dry-ice sticks were pre­ pared using the Union Broach Corpora­ tion Odontotest plastic cylinder and compared to RS Hygenic Endo-lceO and applied with a #2 cotton pellet. It should be noted that a cotton applica­ tor tip was not used at it has been dem­ onstrated to be relatively less effective in a previous study by Jones in 1999. SUbjectswere blindfolded and one quad­ rant at a time was tested with one of the two test materials. Two to seven days later the contralateral side was tested with the other test material. Responses were noted as either yes or no and the elapsed time before a re­ sponse was noted.

Overall, CO dry ice and RS were equiva­ lent in prodocing a response regardless of tooth group or restoration category. However, RS was usuallyfaster than CO dry ice in eliciting a pulpal response. 11 is interesting to note that patients were unable to tell the difference between the two test materials. False positives were noted on endodontically treated teeth that had cast crown restorations. Ther­ mal transference might explain this anomaly.

Dr. Anthony S. Thomas is a second year postgraduate resident in Endo­ dontics at the MCVNCU School of Dentistry. He received his D.D.S. degree from MVCNCU School of Dentistry in 1998. He is currently on active duty as a dentist in the US Army.

New and revised publications!

L, \ Oral Health, Cancer Care, and You

L-{~ing

the Pieces Together

Dr. David L. Spencer is a first year postgraduate student in endodontics at MCVNCU School of Dentistry. He received his D.D.S. degree from the University of Nebraska Medical Cen­ ter College of Dentistry in 1996. ~---

Jones, VR, Rivera EM, & Walton RE. Comparison of Carbon Dioxide versus Refrigerant Spray to Determine Pulpal Responsiveness. Journal of Endodontics 2002;28:7, pp. 531-533

Over one-third of cancer patients have oral complications from cancer treatment.

Learn what you can do. To order free patient and professional materials, call 301-402-7364 or visit: www.nohic.nidcr.nih.gov National Institute of Dental andCraniofacial Research

The purpose of this article was to com­ pare the effectiveness of CO dry ice and 2

16 Virginia Dental Journal

I National Institutes of Health


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Virginia Dental Journal

17


VCU SCHOOL OF DENTISTRY LAUNCHES

CLINICAL SIMULATION CAMPAIGN

Heather M. Siegel, MPA To keep abreast of the instructional technology that students increasingly pursue, dental schools must continu­ ally reinvest in their clinical and preclini­ cal facilities. Dr. Ron Hunt, Dean of the VCU School of Dentistry, notes the school has been successful in finding the funding to maintain state-of-the-art clinical facilities for optimum patient care and instruction. However, he says the school lags behind many leading den­ tal schools in maintaining state-of-the­ art preclinical teaching facilities. To help it meet this critical need, the School of Dentistry has launched a $4 million capital campaign entitled: Clinical Simulation:Advancing Dental Education Through Innovative Technology. Dr. Jeff Levin, a generaldentistfrom Rich­ mond and an Adjunct Professor at the School, is chairman of the campaign. He is being assisted by a chair for each graduating dental class and a leader for each decade of dental graduates. At the school, campaign representatives include Dean Hunt, Dr. Jim Revere, Ex­ ecutive Associate Dean, and Ms. HeatherSiegel,Directorof Development. Educational Need The school's preclinical laboratories have received only minor renovations over the last 30 years, with no techno­ logical upgrade or integration. The equipment in the labs is older than most of the current students. While state-of­ the-art when built in 1970, these labo­ ratories are far from up-to-date by today's standards. Nor do they meet the needs of increasingly technologi­ cally oriented students. It will be diffi­ cult to maintain our position as a top dental school, selected for its educa­ tional opportunities, if we have outdated facilities. If the VCU School of Dentistry is to pro­ mote strong educational programs and recruit the best-qualified students, it must incorporate additional technologi­ cal advances into the DDS curriculum. The faculty is making great strides in 18 Virginia Dental Journal

enhancing its lectures and restructur­ ing its coursework to keep pace with the ever-changing environment of den­ tistry and education. Changes include interactive case-based computer pro­ grams, online coursework, online test­ ing and PowerPoint presentations. Leading dental schools have enhanced the preclinical education experience through simulation. Simulation labora­ tories allow first and second year den­ tal students to gain experience with "pa­ tients" from the beginning. These "pa­ tients" are just one element of a so­ phisticated simulation station. The sta­ tion is a replica operatory complete with a mannequin positioned like a reclining patient holding dentiforms in a simulated mouth. From their first days in class, students learn the proper operator-pa­ tient positioning while developing their hand-eye coordination skills. This pre­ clinical experience offers students a more realistic perspective from the start and eases the transition from laboratory to clinic. Simulation training allows stu­ dents to gain the critical thinking and decision-making skills needed for treat­ ment planning in preparation for treat­ ing patients. In addition, state-of-the­ art electronics promotes enhanced, individualized learning. The Challenge Ahead The School of Dentistry needs to use technology as a tool to improve its edu­ cational programs and better prepare tomorrow's dentists. So, the school has identifiedpreclinical laboratory reno­ vation as a top priority. A capital cam­ paign to raise funds to renovate the pre­ clinical laboratories will permit the in­ troduction of simulation experience to predoctoral education. This bold initia­ tive requiresextensive renovationsof the first- and second-year preclinical labs and surrounding areas. Over 4,500 square feet will be dedicated to a simu­ lation laboratory. This space will be home to 90-simulation stations, each complete with a mannequin, air/water syringe, suction, high and low speed

handpieces, dental light, networked computer stations, and high-speed Internet access. A second preclinical laboratory will be equipped with identical benches and electroniccapability, butwill not contain mannequin simulators. Multimedia Instructor Stations will be located in both the simulation labora­ tory and the preclinical laboratory for faculty members to utilize state-of-the­ art instructional technology. The edu­ cational opportunities from this location are limitless. The integration of tech­ nology into the classroom will be one of the most exciting components to the project. This technology also provides excellent opportunities for continuing education (CE) programs. Facultymem­ bers will be able to utilize audio and vi­ sual formats to facilitate student learn­ ing. Students will receive information and images from the instructor's sta­ tion at each of their workstations. From every station, students will be able to view videotapes, digitized radiographs, slides, and live images on their very own monitor screen. In addition to the patient-simulating mannequins and the instructional tech­ nology linking instructors with students, the school plans to purchase several 'virtual-reality' tooth preparation ma­ chines, called DentSim. Students us­ ing this ground-breaking technology will get immediate, direct feedback on how their tooth preparations compare to an ideal preparation. Why the Commitment of Alumni and Friends is Needed Even with the difficult budget cutbacks it is facing, the school must look for­ ward and prepare for the future. Tofulfill its higher purpose to "Enhance the qual­ ity of life through improved oral health" while being recognized as a top dental school nationally, the VCU School of Dentistry needs high quality facilities to match its excellence in teaching, pro­ motion of learning, and advancement of science and scholarship.


To complete this important and ambi­ tious renovation project, the School of Dentistry needs the help of the school's loyal alumni and friends. Gifts of any size are welcome, but a number of nam­ ing opportunities have been identified for donors making significant gifts to the project. Naming Opportunities Simulation Laboratory $500,000 Preclinical Laboratory $250,000 Clinic Lab (Jr. & Sr.) $100,000 Instructor Multimedia Station $75,000 (two) Conf.lEvaluation Room $50,000 Simulation Support Lab $50,000 Simulation Dispensary $20,000 Simulation Lab Stations $10,000 each Preclinical Lab Stations $5,000 each

economy and current rate of return on investments. The Medical College of Virginia Foundation is skilled in admin­ istering such opportunities. For more information please contact: Ms. Heather Siegel, Dir.of Development, VCU School of Dentistry P.O. Box 980566, Richmond, VA 23298 Phone: (804) 828-4516 Fax: (804) 828-6072 Email: hmsiegel@vcu.edu

Sketches of what VCU School of Dentistry envisions for the Clinical Stimulation Lab.

Recognition Levels Founders' Club $25,000 and above ($5,000 per year for five years) Benefactors' Club $10,000-$24,999 ($2,000 per year for five years) MCV Campus Society $5,000-$9,999 ($1,000 per year for five years) Dental School Society $2,500-$4,999 ($500 per year for five years) Friends of the School $1,000-$2,499 ($200 per year for five years)

Double Decker CE Program

in conjunction with an

Art Auction to Benefit the VCU School of Dentistry

Friday, March 21, 2003

Mev Alumni

9:00 a.m. - Noon: HIPAA Update

Gifts of $5,000 or higher will be listed on a special donor recognition wall at the entrance to the Simulation Labora­ tory. There are numerous ways to make a contribution to the VCU School of Den­ tistry Clinical Simulation Campaign. All gifts make a difference regardless of the amount, but it is your participation that matters most. A gift paid by check is the simplest and most common contri­ bution that can be donated today. For greater gift potential, you are encour­ aged to pledge your support over a five­ year period. Gifts of appreciated stocks or bonds from your portfolio to the school are another option. This alternative may give you an opportunity to make a ma­ jor gift and receive key tax advantages. Donors may also remember the School of Dentistry in their wills by specifying a dollar amount or percentage of their estate in a Charitable Bequest. Life Income Gifts are a sound opportunity, considering the volatility of today's

House

MCV Campus - Richmond, VA

Dr. Russ Bogacki

Assistant Professor, General Practice - VCU School of Dentistry

Dr. Shantaram Rangappa

Assistant Professor, Internal Medicine - VCU School of Medicine

1:00 p.m. - 4:00 p.m.: Perkinson's Pearls

Dr. Baxter Perkinson

Private General Dental Practice, Richmond

Clinical Professor, General Practice, VCU

Registration fees: HIPAA Update Perkinson's Pearls

DDS $109 DDS $109

Staff $ 79 Staff $ 79

All day: both courses

DDS $169

Staff $115

Add $20 for late registration after March 7, 2003 All proceeds will benefit the Clinical Simulation Campaign for the School of Dentistry. I I

II II

Contact: Ms. Martha Clements Director of CE, VCU School of Dentistry P.O. Box 980566, Richmond, VA 23298-0566 Phone: (804) 828-0869; Fax: (804) 828-6072; email: mcclemen@vcu.edu Virginia Dental Journal

19


DR. BAXTER PERKINSON DONATES WATERCOLORS FOR

ART AUCTION TO BENEFIT DENTAL SCHOOL

Dr. Baxter Perkinson, general dentist and noted watercolorist from Richmond, is developing a se­ ries of framed, original watercolor paintings to ben­ efit the VCU School of Dentistry's Clinical Simula­ tion campaign to renovate its preclinicallaborato­ ries. The paintings will be auctioned at a gala ben­ efit auction on Friday, March 21 ,2003. The entire purchase price of the paintings will go to the school. In the past, Dr. Perkinson has donated his artwork to benefit auctions for a number of University and community causes. Dr. Perkinson has been look­ ing for a good opportunity to conduct a similar auc­ tion to benefit his alma mater, the VCU School of Dentistry. He paints a wide variety of subjects, so the auction will feature something for everyone. Examples of his work are depicted on the cover of this issue of the Journal and with this article.

This watercolor is just one of

=--__ ;. many beautiful pieces of origi­ '-­

The benefit art auction will be held at the Virginia Crossings Resort and Conference Center in north Richmond, just off 1-95 and 1-295. The artwork will be available for viewing at 6:00 p.m. At this time, a generous buffet will be available. The auction will begin at 7:00 p.m. An open bar will be available throughout the evening. All alumni and friends of the VCU School of Dentistry are invited. Further information on the auction is provided in the an­ nouncement on the following page.

nal artwork by Dr. Baxter Perkinson you can bid on at the VCU School of Dentistry ....... Art Auction on March 21.

Art Auction to Benefit the VCU School of Dentistry

Featuring the sale of

original watercolor paintings

by Baxter Perkinson, DDS

In conjunction with the art auction event, the School of Dentistry is hosting a day of continuing educa­ tion at the school for dentists and staff. The morn­ ing session will be a HIPAA update provided by Dr. Russ Bogacki, Assistant Professor of General Prac­ tice Dentistry at VCU and Dr. Shantaram Rangappa, Assistant Professor of Internal Medicine at VCU. The afternoon session will feature Dr. Perkinson in one of his popular "Perkinson's Pearls" updates. Both sessions are designed to provide up-to-date information for clinical practice. Further informa­ tion is provided in the announcement of the CE program on this page.

Virginia Crossings Resort & Conference Center North Richmond, near 1-95 and 1-295

Dr. Perkinson has remained very active with his alma mater. He is a Clinical Professor at the school, serving on the part-time faculty since 1971. In 1996, he was appointed as a member of the Board of Visitors of VCU. He became Vice Rector in 1999 and Rector in 2002. He also is a member of the VCU Health Systems Board of Directors and a member of the School of Dentistry Board of Advi­ sors. He is a popular lecturer, speaking on restor­ ative dentistry and dental practice management

All proceeds will benefit the Clinical Simulation

Campaign for the School of Dentistry.

(See page 18-19 for more information.)

I'IL

throughout the United States and Canada.

l1======================~

20 Virginia Dental Journal

Friday, March 21, 2003 Viewing begins at 6:00 p.m. Auction begins at 7:00 p.m. $50 per person Hors d'oeuvres & beverages provided.

Contact: Ms. Heather Siegel Director of Development, VCU School of Dentistry P.O. Box 980566, Richmond, VA 23298-0566 (804) 828-4516; Fax: (804) 828-6072 email: hmsiegel@vcu.edu


VIRGINIA GENERAL ASSEMBLY 2003 OVERVIEW

II

II

Chuck Duvall, VDA Lobbyist POLITICAL OVERVIEW

The 2003 Session of the Virginia General Assembly will set the stage for the 2003 General Elections to be held next November. All 140 seats of the Virginia General As­ sembly will be up for election. Since the Republicans control both Houses of the Legislature (House: 65 Republicans/34 Democrats/1 Independents; and Senate: 23 Re­ publicans/17 Democrats), they're going to want to make certain they give Democratic Governor Mark Warner very little on which to build democratic success in November while working with the Governor to produce a balanced budget. Voters in the Commonwealth re­ cently approved two bond pack­ ages: one for education and one for parks. While agreeing to supply over one billion dollars in bonds for these projects, voters were ada­ mant in rejecting referenda calling for sales tax increases for transpor­ tation in Northern Virginia and Tide­ water. Citizens let it be known that they are in no mood for new taxes.

some unspent balances; and, cut and combined certain programs to balance the budget. With regard to Medicaid, the Gov­ ernor suggested reduction of gen­ eral fund support for various pro­ grams including (funds are in mil­ lions): • Freezing rates for inpatient/outpa­ tient hospitals, nursing facilities and health maintenance organi­ zations: $61 million • Implementing drug relating sav­ ings strategies: $14.8 million • Eliminating the expansion of Med­ icaid coverage to include sub­ stance abuse services: $1.3 mil­ lion • Reducing inpatient/outpatienthos­ pital payments: $2.6 million • Revising the outpatient rehabilita­ tion reimbursement methodol­ ogy: $3 million At this time no reductions are pro­ posed for dental service reimburse­ ment rates.

Statewide Issues

VDA has indicated it will not oppose such legislation as long as it does not go beyond the gathering of the information as outlined above. Dental Hygiene

Dental Hygienists want to make a change in the prescription drug stat­ utes to allow them to apply topical drugs (Schedule 6 Drugs) under general supervision (as opposed to direct supervision) of dentists. This legislation is a follow up to the gen­ eral supervision legislation passed last year. This proposal has been thoroughly reviewed by VDA. As long as it re­ mains in the form which VDA has approved, there will be no objec­ tions to its passage. Volunteer Dental Services

Last year Delegate Jackie Stump (Democrat - Buchanan), had legis­ lation passed to allow dentists or dental hygienists who do not pres­ ently practice in Virginia, but do hold a valid license or certificate to prac­ tice elsewhere, to participate in free health care clinics in underserved areas in the Commonwealth.

VDAISSUES

The budget will be the main focus of the 2003 General Assembly Ses­ sion. More appropriately the deficit that exists in the current budget will be the major focus. During the 2002 Session, the General Assem­ bly made over $3.5 billion in cuts in a $50 million biennial budget. As we approach the 2003 Session, the Governor has made some $800 million in additional cuts; he has es­ calated some fees; used funds from the rainy day fund; captured

Reporting

As a consequence of the passage of the new definition of dentistry, oral maxillofacial surgeons performing certain cosmetic procedures certi­ fied by the Board of Dentistry will be required to file reports with the Virginia Health Information (VHI) similar to those presently being filed by plastic surgeons. The legisla­ tion will be part of the Joint Com­ mission on Health Care package.

This legislation is applicable to only those organizations that have no paid staff. Because the VDA's MOM Projects receive some ad­ ministrative assistance from the VDA, there was a concern that the statue, as it exists, would not be applicable to the MOM Projects. Clarifying language will be intro­ duced in this next session. Delegate Winsome Sears (R-Nor­ folk) is introducing legislation that will provide a new disciplinary tool Virginia Dental Journal

21


for the Board of Health Professions: A "confidential consent agreement." This will enable all Health Regula­ tory Boards to use this tool in cases of minor misconduct that does not cause severe patient injury and where the conduct of the health care provider is not likely to be re­ petitive. This language tracks the private letter of reprimand that is a disciplinary tool for attorneys at present. For oral maxilliofacial sur­ geons who have hospital privileges, the bill will advance the reporting date that the hospital has to tell the Health Professions Board of Ad­ verse Disciplinary Action, l.e., an OMS has had his privileges sus­ pended by a Peer Review. The re­ port would have to be made to the Department of Health Professions within 30 days thereafter and the appeals process would be running simultaneously.

Obviously, by the time you receive this information the 2003 Session of the General Assembly will be in full swing. Other bills not mentioned in this outline will have been intro­ duced.

VADPAC NEEDS

YOUR SUPPORT

If you do not take responsibility for your profession and the laws that govern its conduct, others will!

We encourage you to call VDA if you see legislation of concern. You can review all legislation introduced line http:// by going on leg1.state.va.us.

Active VADPAC $75

Commonwealth Club $200

Governor's Club $550

Apollonia Club $1,000

In closing, don't forget that 2003 is an election year. VADPAC needs your support. If you haven't partici­ pated to date, please do so. The future of dentistry and your ability to continue to provide appropriate services to your patients depend upon your active participation in all facets of dentistry including VADPAC.

Please become a member of VADPACtoday. If you are a cur­ rent member, please consider a higher contribution level. For more information, contact Nicole Pugar at 800-552-3886.

71 st Annual Nation's Capital Dental Meeting MARCH

27-29,2003· WASHINGTON CONVENTION CENTER

HIGHLIGHTS • Cherry Blossom Season

• Dental Technician Program

• Washington D.C. Tours

• Lunch and Learn

• National Zoo Tour

• Table Clinics

• Keynote and President's Reception

• Hygiene Program

• Dental Team Luncheon

FEATURED CLINICIANS Suzanne Boswell

Barry Freydberg, DD.S.

John Molinari, D.D.S.

PRACTICE MANAGEMENT

HI·TECH

ALLERGIES

Jeff Brucia, 0.0.5.

Lorraine Hollett and Patrick Wahl, D.MD.

JohnWest, 0.0.5.,

M.S.D., P.S.

Gerard Chiche, D.D.S.

PRACTICE MANAGEMENT

CROWN AND BRIDGE

Robert Convissar, 0.0.5,

Samuel Low, 0.0.5.,

M.S., M.Ed.

THE TOTAL ENDO

EXPERIENCE

LASER USE IN DENTISTRY

PERIODONTICS

COMPREHENSIVE CARE

Richard DeFilippo, D.M.D.

Stanley Malamed, D.D.S.

Richard Wynn, Ph.D.

MYOFASCIAL PAIN TREATMENT

LOCAL ANESTHESIA

PHARMACOLOGY/HERBS

ADHESIVE DENTISTRY

Robert Winter, 0.0.5.

Carl Misch, B.S., D.D.S.,

MD.S,

For a preliminary program, complete and return to: DC Dental Society, 502 C Street, NE Washington, DC 20002-5810 202-547-7613 Fa~: 202-546-1482 NAME ADDRESS

IMPLANTS

CITY

Don't miss this opportunity to visit the Nation's Capitall Join friends and colleagues at the 2003 Nation's Capital Dental Meeting and take advantage of all this capital city has to offerl

For further information, or to register online, visit our website at www.dcdental.org

22 Virginia Dental Journal

STATE

ZIP

No Registration fee for ADA memberdentists!


HIPAA - TIME IS RUNNING OUT

II]

Nicole Pugar, Director of Public Policy Are You Compliant with Federal HIPAA Regulations and Virginia Health Care Privacy Regula­ tions?

• Developing extensive policies and procedures to be adopted to ensure the protection of health information privacy.

HIPAA Privacy Kit. The Privacy Kit, which includes many sample forms you can use in your office, is avail­ able through the ADA catalog.

Deadline for Compliance with HIPAA Regulations: April 13, 2003

• Recognition of new patient rights under federal law, including the right to access health informa­ tion; the right to an accounting of certain disclosures of health information; the right to request corrections or amendments to their records and the right to re­ quest restrictions on disclosures of patient health information.

When developing a compliance plan, dental offices should also en­ sure that they are compliant with state regulations. To assist you with your efforts to be compliant with both state and federal regulations, The VDA has retained the legal firm of Troutman and Sanders to de­ velop guidelines that will ensure all dentists are compliant with existing laws in the Code of Virginia that regulate the privacy of health care records as well as federal HIPAA regulations.

The Health Insurance Portability and Accountability Act (HIPAA) is a federal regulation that governs how health care providers are able to use and to disclose patients' confi­ dential health information. HIPAA, attempts to eliminate inappropriate uses and disclosures of sensitive information, while at the same time, attempts to achieve some unifor­ mity throughout the country regard­ ing health record confidentiality.

• Appointing a privacy officer who will lead the HIPAA privacy com­ pliance program for the healthcare provider.

With the deadline for compliance with HIPAA regulations just six short weeks away, it is essential that your office determine if you are a cov­ ered entity and thus required to be compliant with the privacy stan­ dards. If you are a covered entity, you should develop a compliance plan, and beginning to implement your privacy policy. If you are un­ able to determine if you are required to comply with the regulations or have any questions about the regu­ lations, please contact Nicole Pugar at the VDA at (804) 261- 1610 or pugar@vadental.org.

• Creating a lengthy written notice describing all the ways in which the health care provider may use or disclose a patient's health in­ formation, known as the provider's notice of privacy prac­ tices.

Who is required to comply with the regulations? HIPAA applies to all health care pro­ viders, regardless of size, if they perform any financial or administra­ tive transactions electronically. HIPAA requires that health care pro­ viders implement certain specific steps in order to achieve compli­ ance, including:

• Developing and implementing contract and amendment lan­ guage for HIPAA compliance by health care vendors working on your behalf, also known as "busi­ ness associates."

• Establishing a reporting and re­ sponse system for privacy vio­ lations. • Developing a policy for the dis­ cipline of HIPAA privacy viola­ tions by employees, agents and contractors.

Developing a Compliance Plan To assist you with your efforts to be compliant with the federal regula­ tions, the ADA has developed a

While Courts of law often uphold the higher level of law (usually federal law) over state or local laws, Health and Human Services, the Department overseeing HI PAA regulations has stated that state law will preempt the federal HIPAA regulations if the state law is more stringent that HIPAA regulations. Determining which law prevails is referred to as a "pre-emption analysis." Troutamn and Sanders, LLP has examined existing state regulations and has completed an Pre-Emption Analysis of the Virginia Code. This HIPAA pre-emption analysis compares and contrasts the legal obligations imposed by the HIPAA privacy rule with Virginia laws governing health care providers on confidential ity. This HIPAA pre-emption analysis determines whether HI PAA's privacy regulations are contrary to Virginia law. Whenever possible, Troutman Sanders attempted to resolve federal and state obligations in a manner that allows Virginia Dental Journal

23


the health care provider to comply with both obligations. The HIPAA pre-emption analysis provides guidance for health care providers on what actions they need to take to be compliant from the pre­ emption perspective. The analysis currently can be found on Troutman and Sander's website at www.troutmansanders.com/ hipaa/pre-emption.asp. Although there are some instances in which Virginia law is more stringent than federal law, generally speaking Vir­ ginia law is only more stringent in situations where testimony about an individual's healthcare records must be given in a court of law or when a subpoena is issued. The firm will however be working with the VDA to develop a resource guide that will help members incorporate compliance with all state regula­ tions into their plans for HIPAA com­ pliance. The resource guide will in­ clude an index of all Virginia stat­ utes that regulate an individual's healthcare privacy rights. The VDA will correspond with members when a final resource guide be­ comes available. Because situations will arise that HIPAA regulations do not address, it is likely that the regulations will change to some degree as they are implemented. However, this is not to say that they will be changing drastically. It is thus essential that all covered entities develop a plan that will ensure they are compliant with the regulations. Becoming HIPAA complaint is not a matter of protecting the office from potential penalties for noncompliance but protection of your patient's privacy. Remember, we all have the poten­ tial to be a patient and all would want our own privacy to be protected.

[I

HIPAA NEWS YOU CAN USE IIL~~~~~~~~~~~~~~~~~~~~~~~~ I~

~

FREQUENTLY ASKED

QUESTIONS

The following questions and an­ swers were obtained from a website that provides information about HIPAA compliance. The site contains an area where individuals can post questions and interact with others who have questions about HIPAA regulations. Users can re­ quest email notification when new questions and answers are posted. To access this site go to http:// www.hipaacomplete.com. Q: Under HIPAA, am I able to send a FAX with patient medical infor­ mation to another provider's of­ fice? A: The HIPAA Privacy Rule due to go into effect in April of 2003, specifically permits physicians and other healthcare providers to disclose patient health infor­ mation to another health care provider for treatment purposes. This can be done by fax or other means, as long as, reasonable safeguards are in place to pro­ tect the privacy of that informa­ tion.

An example of reasonable safe­ guards for faxing would include the following: 1) the sender of the fax confirms that the fax number that was pro­ vided is valid and correct for the facility 2) the fax machine is located in a secure location to prevent unau­ thorized vlewlnq or access Q: Under HIPAA, are healthcare providers (e.g. physician offices, dentist offices) allowed to use patient sign-in sheets or call out

24 Virginia Dental Journal

patient names in waiting rooms? A: YES. Covered Entities such as physician offices and labs may use patient Sign-in sheets or call out patient names in waiting rooms, so long as the infor­ mation disclosed is appropriately limited. The Privacy Rule explicitly permits certain "incidental disclosures" that occur as long as the disclosure is within the "minimum necessary" standard and reasonable and ap­ propriate safeguards have been applied. For example, a sign-in sheet may not display medical information that is not necessary for signing in (e.g. the medical problem). Q: Under HIPAA, do doctor offices, clinics, hospitals and other cov­ ered entities need to monitor their business associates? k The answer is NO. The privacy rule REQUIRES covered entities to enter into written contracts which protect the privacy of pro­ tected health information; but covered entities are not required to monitor or oversee the means by which their business associ­ ates carry out privacy safe­ guards or the extent to which the business associate abides by the privacy requirements of the con­ tract.

In other words, the act of maintain­ ing a written contract with a busi­ ness associate is sufficient. It is, however, important that written con­ tracts with business associates have specific verbiage required by HIPAA, otherwise the covered en­ tity may face liability and penalties, even if the business associate is the violating entity.


~I

AVOIDING LIABILITY Nicole Pugar, Director of Public Policy

I

The Posters You Really Need To Post Have you received countless calls from companies claiming they are able to protect you as an employer by providing you with all of the posters you need to avoid being held in viola­ tion of state and federal employer regulations? Do you know that you can obtain the same posters they are trying to sell you from various state and federal agencies free of charge? While you may have to make one or two additional phone calls to obtain the posters, by doing so you can avoid being taken advantage of by the same companies that claim they are trying to protect you. According to the Virginia Department of Labor and Industry the following is a comprehensive list of all posters you are required by law to post as an employer. Posting all of the publications listed below will ensure you are in compliance with all federal and state labor regulations that you, as an employer, are required to post to ensure your employees are aware of their rights. Should you have any questions about this list, please con­ tact Nicole Pugar at the VDA at (804) 261-1610. To obtain any of the following posters, please contact the agency listed below the description of each publication. STATE POSTERS REQUIRED

1. Occupational Safety and Health Poster needed: "Job Safety and Health Protection" This poster advises employees of their rights and re­ sponsibilities under Virginia's Occupational Safety and Health laws. Employers are subject to a citation and possible fine if this poster is not displayed. To obtain this publication contact: Virginia Dept of Labor and Industry Powers - Taylor Building, 13 South Thirteenth St Richmond, VA 23219 (804) 786-8011 2. Unemployment Insurance Poster needed: "Notice to Workers (VEC- B 29)" This poster advises employees on when they are eli­ gible for unemployment insurance benefits. This poster must be posted by every employer subject to the em­ ployment insurance law. To obtain this publication contact: Virginia Employment Commission Client Relations Department PO. Box 1358 Richmond, VA 23211 (804) 786-4359

3. Worker's Compensation Insurance Poster needed: "Worker's Compensation and Instruc­ tions to Employers and Employees (Form 1)" This poster advises employers and employees of their rights and responsibilities under the Virginia Workers' Compensation Law in case of injury or occupational dis­ ease. This poster must be posted by every employer within the operation of the Virginia Workers' Compensa­ tion Act. To obtain this publication contact:

Workers' Compensation Commission

1000 DMV Drive

Richmond, VA 23220

(804) 367- 8699

FEDERAL POSTERS REQUIRED

1. Fair Labor Standards Act Poster needed: "Your Rights under the Fair Labor Standards Act (WH Publication 1088)" This poster sets forth the federal minimum wage and the payment of time and a half for overtime hours for covered and non-exempt employees. The poster summarizes regulations governing the employment of minors under the age of 18. To obtain this publication contact:

Employment Standards Administration

Wage and Hour Division

U.S. Department of Labor

400 N. Eighth Street

Room 7000

Richmond, VA 23240

(804) 771-2995 2. Equal Employment Opportunity Poster needed: "Equal Employment Opportunity is the Law (GPO: 920-752)" Advises employees of their rights under Title VII of the Civil Rights Act of 1964 as amended, the Age Discrimina­ tion in Employment Act of 1967, as amended, the Equal Pay Act of 1963, as amended and other EEO Laws. This poster should be posted by all employers of 15 or more. To obtain this publication contact:

Equal Employment Opportunity Commission

U.S. Department of Labor

360 West Broad Street

Suite 229

Richmond, VA 23230

(804) 771- 2692 (800) 669-1000

Virginia Dental Journal

25


3. Family and Medical Leave Act Poster needed: "Your Rights under the Family and Medi­ cal leave Act of 1993" (WH Publication 142) This poster advises covered employees that they may be eligible for up to 12 weeks of unpaid job - protected leave for certain family and medical reasons. To obtain this poster contact: Employment Standards Administration Wage and Hour Division U.S. Department of Labor

400 N. Eighth Street, Room 7000

Richmond, VA 23240

(804) 771-2995

~III

II

PANDA

~]

~~~~~~~~~~~~~~~~~~~ Samantha Paulson, Director of Marketing &

Programs

The Virginia Dental Association is an active partner in the Pre­

vent Abuse and Neglect through Dental Awareness Program

(PANDA). The mission of the PANDA program is to create an

atmosphere of understanding in dentistry and other profes­

sional communities which will result in the prevention of abuse

and neglect through early identification and appropriate inter­

vention for those who have been abused or neglected.

In VA, a child dies from abuse or neglect every 12 days.

4. Employee Polygraph Protection Act Poster needed: "Notice Employee Polygraph Protection Act (WH Publication 1462)"

You Can Help Prevent Child Abuse and Neglect

A child may be helpless, but you are not. Here are the five

"R's" of preventing child abuse and neglect:

This poster advises covered private employees of the prohibition of lie detector tests during pre­ employmentscreening or during the course of their em­ ployment. The set of posters includes those for the pro­ hibitions, exemptions, and examinee's rights where poly­ graph tests are permitted and the penalty imposed for violation.

Reach Out

Anything you do to support kids and parents can help re­

duce the stress that often leads to abuse and neglect.

To obtain this poster contact: Employment Standards Administration Wage & Hour Division U.S. Department of Labor

400 N. Eighth Street, Room 7000

Richmond, VA 23240

(804) 771-2995

GLOVES:

Remember the Risk Factors

Child abuse and neglect occur in all segments of our soci­

ety, but the risk factors are greater in families where par­

ents:

• Seem to be having economic, housing, or personal prob­ lems. • Are isolated from their families or communities. • Have difficulty controlling anger or stress. • Are dealing with physical or mental health issues. • Had a painful childhood. Adults who were mistreated as children may unintentionally continue the pattern of abuse with their own children. • Abuse alcohol or drugs. • Are inexperienced with children or have unrealistic ex­ pectations of what a child can do.

POLYMER GEL

when you purchase RelyAld'''' products, you receive the highest quality and service Combmmg the best In deSIgn with the highes; quality materials. RelyAid's full Ime ol gloves oiler ease of mobili­ ty and excellent gripping in a vanety of dental environ­ ments. All RclyAld gloves arc tested under the most strin­ gent condinons 10 ensure ronsisrern product qualuy V·ic are pleased to announce the adduion of RelyAid soh ear loop bee masks to our gro\\lng line of products

\11",,1

These hlgh-qualrT\- masks arc fiberglass-free and fluid

L,l,TEX POWDERED POWDER-FREE

:'.1TRlLE SOFT EAR LOOP FACE MASKS

n-ststaru and available in iwo colors Since 1~)q(l. lntcrnauonai Manufacumnc Group.

Inc. has conmbiucd over 'j, 1,500,000 to dental soctctics and associauons Please call lor lree samples todav I H00771MI2

~

IMG hdw,I.. J",,"""'

CAI-,-P

International Manufacturing Group. Inc.

10170 Croydon Way, Suite 1

Sacramento, CA 95827

All RIIlAIIl PROD\'{ IS \H1 ["DORSI D B\ 1111

26 Virginia Dental Journal

VDSC

Raise the Issue

By educating yourself and others you can help your commu­

nity prevent child abuse and neglect from happening in the

first place.

Recognize the Warning Signs The behavior of children may signal abuse or neglect long before any change in physical appearance. Some of the signs may include: • Nervousness around adults. • Aggression toward adults or other children. • Inability to stay awake or to concentrate for extended periods. • Sudden, dramatic changes in personality or activities. • Frequent or unexplained bruises or injuries. • Poor hygiene or dress that is inappropriate for the weather. Report suspected Abuse or Neglect. If you suspect abuse or neglect, report it. Call the VA Child Protective Services Hotline, 800-552-7096.


[II

MEMBERSHIP INITIATIVE UPDATE

I~

Dr. David Graham The Tripartite Membership Initiative is underway and we need your help! Field representatives are being recruited to meet one on one with prospective new members and extend an invitation to become a part of the VDA Please con­ tact Leslie Pinkston at the VDA office or your component leader of the initia­ tive to volunteer. Prospect cards will provide contact in­ formation including prospective mem­ bers names, age, gender, dental school, and year of graduation. They will also record information including date of con­ tact, and previous membership status. Gaining this and other information is an important first step in the initiative. Its use will help field representatives identify the specific membership ben­ efits prospective members value,

be accessed through (ADAorg) under" Dental Society Resources". The entire ADA staff is committed to the success of the initiative. To help you, staff at the national, state and local levels are avail­ able to assist you and to provide addi­ tional information and resources. Con­ tact the ADA by phone (800-232-1382 or 800-621-8099), bye-mail through the website, or by mail at 211 East Chicago Avenue, Chicago, IL 60611. or Leslie Pinkston at the VDA office. With your continued support, the ADA, as well as the VDA and local compo­ nent organizations, can become a stron­ gervoice forthe dentalprofession.Thank you for making the commitment to the Tripartite Membership Initiative.

The ADA has developed excellent writ­ ten materials to support the initiative. A field representative resource manual provides coaching on listening skills, sample dialogues, messages for spe­ cific target groups, as well as informa­ tion on how to join the ADA It will serve as a basic reference on ADA policies and procedures and will provide mem­ bership marketing suggestions and as­ sist in recruitment efforts. Meeting one on one with colleagues when recruiting can be an intimidating experience. The manual helps to develop the most ef­ fective way for you to demonstrate your views on the value of membership in organized dentistry as well as provide an opportunity for a potential member to share his/her views with you. An excellent brochure for prospective members has been developed. It em­ phasizes taking control of the profes­ sion with ADA membership and high­ lights the ADA advocacy roles. It out­ lines the value of membership as well as the importance of being a part of the professional community and extends a sincere invitation to join. A section of the ADA website provides initiative support and updates. It can

Dr. Terry Dickinson, Executive Director of the Virginia Dental A~­ sociation, pinning former President George Bush with the VDA s 'Make A Difference' pin designed by Dr. BUd (Pin) Zimmer. Dr. Dickinson presented former President Bush with the Missions of Mercy (MOM) pin at the recent ADA meeting in New Orleans."

Virginia Dental Journal

27


~I

OSHA, HIPAA AND EPA REGULATIONS

II]

Samantha Paulson, Director of Marketing and Programs WHAT DO I NEED TO KNOW AS A DENTIST? Three of the major Federal regula­ tory agencies affecting the dental industry are the Occupational Safety and Health Administration (OSHA), US Department of Health and Human Services (DHHS) and the Environmental Protection Agency (EPA). OSHA's main func­ tion is the protection of workers while on the job. The EPA is con­ cerned with pollution control and managing hazardous waste and DHHS regulates and enforces the new Health Insurance Portability and Accountability Act (HIPAA). All of these agencies impact the den­ tal profession. Under OSHA regulations, any in­ dustry that has personnel with oc­ cupational exposure to bloodborne pathogens and hazardous materi­ als must annually train their work­ ers on these dangers. This train­ ing consists of two elements, both of which need to be addressed.

written documentation of training in their personnel file.

eters, blood pressure equip­ ment • elemental mercury

Under EPA regulations, any busi­ ness that generates hazardous These wastes under EPA (RCRA) waste has a "Cradle to Grave" re­ regulation must be identified and sponsibility, meaning the business recycled at state-licensed facilities. is liable for this waste from creation Paper-trail recording of the waste to recycle or disposal. Generation, recycling is imperative in the man­ storage and disposal of hazardous agement of the "Cradle to Grave" waste are regulated under EPA's responsibility. Resource Conservation and Re­ covery Act (RCRA). Infectious OSHA training must be performed waste management is controlled at on any employee that has occupa­ the state level by individual state tional exposure to hazardous or bio­ regulations. hazardous material. HIPAA is the latest in regulatory compliance affecting any healthcare provider and any other person or organization who fur­ nishes, bills, or is paid for healthcare in the normal course of business. The regulation mandates employee training and awareness for proper management of all per­ sonal information and protection of all health information that identifies the individual.

HIPAA training must be performed on all employees as described above The regulations which need to be managed for total compliance can be complicated and time consum­ ing. The Virginia Dental Services Corporation has recently endorsed Healthcare Compliance Service or

HCS. HCS will provide all services nec­

The first area deals with the Bloodborne Pathogen Standard, (29 Code of Federal Regulations 1910.1030) and the second ele­ ment of OSHA training is the Haz­ ard Communication Standard (29 Code of Federal Regulations 1910.1200). This is also referred to as "Worker Right-To-Know." This area looks at chemical and other physical hazards in the workplace. Both the Bloodborne Pathogen Standard and the Hazard Commu­ nication Standard require a written plan that is also reviewed during the annual OSHA training. All employ­ ees are to be trained annually with 28 Virginia Dental Journal

Dental establishments for the most part recognize "red bag" waste and dispose of it accordingly but man­ agement of hazardous waste, OSHA or HIPAAcompliance can be more complicated. Hazardous wastes from the dental practice that should be managed include but are not limited to: • photo chemical waste • lead and lead foil found in x-ray film, aprons and lead lined boxes • waste vacuum pump filters containing amalgam particulate • chairside vacuum traps • mercury found in thermom­

essary to ensure total compliance as described above with VDA mem­ ber discount pricing. They are a na­ tionwide full service company pro­ viding waste management and compliance services to the healthcare industry. For more infor­ mation contact Samantha Paulson at the VDA Central Office at 800­ 552-3886 or see the full page ad located in this issue of the Virginia Dental Journal.


DENTX[g~~RVICES

LJL J------Corporation-

PRESENTS

HEALTHCARE

COMPLIANCE SERVICE

Waste Compliance Service plus

OSHA/Bloodborne Pathogen and HIPAA

Compliance Training

How would you like to pick and choose what services you want,

When you want it, and at your convenience 'from one source?

Healthcare Compliance Service is a nationwide full service company

recently endorsed by the VDA providing waste management and

compliance services for the healthcare industry

We specialize in hazardous and bio-hazardous waste removal service

as well as OSHA and HIPAA compliance training programs

• • • • • • • •

New Photo Chemical Filtration Units with waste removal Lead and Lead Foil waste removal service Amalgam Filter and Trap waste removal service Mercury waste removal service New ISO approved Mercury/Amalgam Filtration Units Bio-Hazard Sharps removal service OSHA/Bloodborne Pathogen Training HIPAA compliance training Finally, one easy method for total compliance from one source. For more information or to order choose 'from below:

E-mail: HCSTODAY@CS.COM Phone: 610-518-5299

Website: WWW.HCSTODAYCOM Fax: 610-518-2995 Virginia Dental Journal

29


[I\

HOW TO PROTECT YOURSELF FROM IDENTITY THEFT

II]

MBNA

A recent report by the General Account­ ing Office of the United States Congress shows that incidents of identity theft have increased dramatically over the last few years. What is identity theft, and how can you prevent it? Identity theft is commonly defined as securing another person's personal in­ formation-such as Social Security number, date of birth, mother's maiden name-and then using that information to fraudulently establish credit. The U.S. Congress and many states have enacted laws that specifically criminalize identity theft, but no single database exists to track the crime. Re­ gardless. most experts agree that it is increasing. One credit reporting agency reported a 53 percent increase from July 1999 through June 2000. Another mea­ sure of its increase can be seen in credit card fraud losses. MasterCard and Visa reported $700 million in total fraud losses in 1996 and $1 billion in 2000, an in­ crease of approximately 45 percent. Financial institutions aren't the only ones being victimized. Identity theft can cause substantial harm to the lives of consumers, economically and emotion­ ally. Even though MBNA (the credit card company that issues the Virginia Den­ tal Association MasterCard or Visa) does not hold victims liable for fraudu­ lent debts, victims often feel personally violated. In addition, victims often expe­ rience identity theft-related problems such as bounced checks, loan denials, and debt collection harassment.

MBNA works hard to prevent identity theft. Unlike other issuers, MBNA credit analysts will call applicants to ask about any accounts showing on their credit report, or to investigate an application that has discrepancies with the infor­ mation contained on an applicant's credit report. In addition, MBNA's other ongoing efforts to reduce fraud include Neural Network Technology. which mea­ sures fraud risk, including the likelihood that fraudulent activity is taking place on a specified account, an advanced au­ thorization system that enables Fraud Detection analysts to review geographi­

For more information on the Virginia Dental Association MasterCard or Visa, or to apply, call 1-800-457-3714

LINKING PAYROLL & ACCOUNTING

SAVES TIME & MONEY

Paychex Every business owner knows that time is money, and the drive to increase effi­ ciency relates directly to a business's bottom line. One way to gain valuable time is to shorten the process of enter­ ing your payroll data into your general ledger.

The Paychex General Ledger Report­ ing Service posts your payroll informa­ tion, via the Internet, directly to a vari­ ety of leading accounting software pack­ ages, including AccPac®, Creative So­ lutions Accountinq''", M.Y.O.B.®, Peachtree", and Oulckbooks", speed­ ing the process and reducing the pos­ sibility of errors. For other programs, Paychex can provide a generic import file, to use as is or to modify using a file How can you avoid becoming a vic­ editor. Paychex can also generate a tim? Ask periodically for a copy of your report for manual posting to a general credit report and review it for accounts ledger. that might have been fraudulently opened. If you're traveling,have your mail The General Ledger Reporting Service held at the post office. Don't discuss accommodates both cash and accrual personal information in areas where it accounting methods, and lets you au­ can be overheard, and maintain careful thorize direct, online access for your records of your banking and financial ac­ accountant, bookkeeper or financial counts. advisor.

30 Virginia Dental Journal

cal location, full merchant description, and personal information on transac­ tions, and a delivery management sys­ tem that enables risky transactions to be reviewed seconds after they occur. Fraud scores and potential fraudulent transactions are forwarded to specially educated representatives, who review these accounts and call the Customer. Accounts are monitored throughout the day, seven days a week.

The service allows you to have a file automatically waiting for you after each payroll run, or to create a file or journal report representing up to fifteen months of historical data. Like other Paychex Online Services, the General Ledger Reporting Service is convenient, flexible, and secure. Visit the Paychex Web site at www.paychex.com to see an online demonstration, sample reports, and the list of specific software versions avail­ able for import. You can also verify sys­ tem requirements. For more information about Paychex and special pricing for Virginia Den­ tal Association members, call 1-800­ PAYCHEX (729-2439) and mention code number 5648.


[II

GOOD NEWS FROM THE VDSC

II]

I I

LifeServers, Inc. would like to thank the following den­ tists who have supported the Virginia Dental Services Corporation by implementing Automated External Defibriliators(AED's) in their dental offices.

During 2002, the VDSC provided the VDA with a total of $152,066 in the form of sponsorships, endorsements, and remunerations. This calculates to $64.22 per VDA mem­ ber. VDSC funded projects include:

Dr. Seth Anderson

Dr. Barry Argentar

Dr. Thomas Baxter

Dr. Carl Block

Dr. Paul Callahan

Dr. Donald Cooke

Dr. Charles Deustch

Dr. Richard Fisher

Dr. Thornton Jett

Drs. Kangur and Wilhelm

Dr. Curtis Killar

Drs. Link, Jacobs and Link

Drs. Mayer and Levy

Dr. Edward O'Keefe

Dr. Robert Simmons

Dr. Sebastiana Gagliano Springmann

Dr. Matthew Storm

Dr. Richard Tami

VDA Management Fee

VDA 2002 Annual Meeting CE ... MAJOR SPONSOR!

Virginia Dental Health Foundation M.O.M. Project Video

2002/2003 VDA Membership Directory Print and Website

Dr. Samuel D. Harris National Museum of Dentistry

VDA Grassroots Membership Initiative

Give Kids a Smile

2002 Component Revenue Sharing

plus an end-of-year bonus!

We anticipate this amount to grow significantly over the years as our members understand that their participation in the VDSC sponsored programs will not only benefit them with excellent products, but will also profit their component and the VDA as well. Listed below are the endorsed products and services. Please support our efforts on your behalf to allow the Association to continue to provide the benefits necessary to constantly maintain and grow our membership.

For more information on how to incorporate and AED in your dental office, please contact LifeServers, I~; I at (804)364-1047. ~

FOR YOUR DENTAL PRACTICE Malpractice Insurance/GE Medical Protective Co. B&B Insurance Associates, 877-832-9113 Practice & Equipment Financing Services Sky Financial Solutions, 800-340-7460 Payroll Services Paychex, 800-729-2439 Waste Compliance Services Healthcare Compliance Service, 610-518-5299 Automated External Defibrillators LifeServers, 866-543-3500 Gloves International Manufacturing Group, 800-775-6412 Collections I.C. System, 800-279-3511 Electronic Claims Processing WebMd, 888-309-9784

FOR YOUR PRACTICE AND YOUR FAMILY Life, Health, and Disability Insurance B&B Insurance Associates, 877-832-9113 Financial Planning Mercer Advisors, 800-462-1580 Automobile Rental Hertz, 800-654-2200, CDP# 1220431 Credit Card MBNA, 800-457-3714

[II

SMILES IN SPITE OF TERROR

II]

The Hebrew University Hadassah School of Dental Medicine in Jerusalem, Israel, founded by the Alpha Omega Frater­ nity, works in conjunction with volunteers to provide dental treatment to victims of terror attacks. This past year they held the "Smiles in Spite of Terror" program to treat victims of the July 31 81 attack at the Hebrew University campus on Mt. Scopus as well as 60 other victims from terrorist attacks. Many of those who were wounded suffered from multiple and multifaceted trauma that included, in many cases, oral and facial injuries. Patients received full treatment free of charge including restoration work for tooth and mouth injuries in­ curred in the attack. Others received conservative treatment. Dentists from abroad come to Israel as volunteers and col­ laborate with Hadassah dentists to treat patients injured in the terrorist attacks. Dr. Jeffrey Levin, a general dentist from Richmond, Virginia participated in the "Smiles in Spite of Terror" program from December 18, 2002 through December 30,2002. "It was a very rewarding experience," said Dr. Levin. "The patients were most appreciative. I recommend that other dentists consider contributing either their time or finan­ cial resources to this most worthwhile project." For more information call Dr. Jeffrey Levin at 804-288-4115.

Virginia Dental Journal

31


I~

VDA NEWS

[II VDAAWARDS

SCIENCE FAIR PRIZES

NEW MEMBER OF

THE VDA STAFF

Evan Crawford recieved the $50 state award and the $500 Dr. Bennett A. Malbon grand prize for his state science fair project "Design and Construction of an Atomic-Resolution Scanning Tunnel­ ing Microscope. Evan would like to thank everyone at the VDA for his award prizes and plans to use the money for college costs.

On November 18, 2002, Stephanie Arnold became the new Donated Den­ tal Services (DDS) Project Coordinator. Stephanie is a native of Northern Vir­ ginia, and has lived in the Richmond area for two years. Stephanie gradu­ ated from George Mason University in August 2000 with a BS in Criminal Jus­ tice and a Minor in Psychology. While going to school, she was the Office Manager at GMU in the Student Activi­ Science Fair Winner, Evan Crawford, poses for ties department. Stephanie was mar­ a photo with Dr, Tom Cooke and Dr. Tim Russell. ried in 1996 and is now the mother of a five year old son and three year old daughter. Upon moving to the Rich­ VDA MEMBERSHIP & LEADERSHIP CONFERENCE

mond area, she and her husband NOVEMBER 15-16,2002

bought a house in Mechanicsville. Prior to working at the VDA, Stephanie was Higher Purpose

A community of professionals advanc­ a Social Worker at another non-profit, ing dentistry and serving the people of where she worked with formerly home­ less individuals in a permanent support­ Virginia

ive housing setting. Stephanie states, Values

"I have been very fortunate to find an­ Having integrity and compassion

other job where I have the opportunity Fostering social responsibility

to work with the underprivileged and Embracing diversity

help provide them with services that otherwise they would not be able to Vision

obtain. It is refreshing to see on a day­ Empowering the dental community

to-day basis the number of dentists and through innovation, diversity and

laboratories who are willing to help service

these people be able to smile again."

Mark Your Calendar! Leading the VDA is hard work! Speaker, Dr, Sheila Sheinberg, tries to help VDA Presi­ dent, Dr. Rod Klima, relax,

2003 VDA Annual Meeting September 10 - 14, 2003 Richmond, Virginia

Strength in numbers! Two speakers from the ADA encouraged each VDA member to recruit just one person to increase VDA membership.

.:. Over 100 exhibit booths .:. VDA Golf Tournament, VDA Party & President's Party .:. Continuing Education ­ Practice Management, Pediat­ ric Dentistry, Ethics, Starting Up A Practice, Crown & Bridge, Ad­ hesive Dentistry, Financial Is­ sues, Hygiene, and much more!

I

32 Virginia Dental Journal

Look for more information in the next issue of the VA Dental Journal!


PUBLICATION OF

CANDIDATE INFORMATION

IN THE VA DENTAL

JOURNAL

Nominations for the elective offices of the Virginia Dental Association may be made either by a Component President on behalf of the Component he/she rep­ resents, or by obtaining signatures from a minimum of twenty-five members of the Association. These nominations should be directed to Dr. Edward J. Weisberg, Secretary/Treasurer. The fol­ lowing positions are up for election at the 2003 Annual Meeting in Richmond: President-Elect; Secretary-Trea­ surer; VDA Executive Council (at­ large) two positions (2 year terms), two ADA Delegate positions (3 year term), and four ADA Alternate Delegate po­ sitions (2 year term). All candidates must have submitted their CVs, picture (black & white head shot preferred), and biographical infor­ mation to the attention of Dr. Leslie S. Webb, Jr., Editor, at the VDA Central Office (7525 Staples Mill Rd, Richmond, VA 23228) no later than March 14, 2003, for publication in the April-May­ June issue of the VA Dental Journal. Forms of submission of Candidate In­ formation have been mailed to all VDA Component Society Presidents. Candidates for the office of President­ Elect and Secretary/Treasurer of the Association will be allowed a maximum of 500 words. Candidates for all other offices will be allowed a maximum of 250 words. Candidates are asked to limit their biographical information to major accomplishments, but to include such pertinent data as education, mem­ berships, honors, positions of leader­ ship held in the ADA, VDA and Compo­ nent Societies, and community leader­ ship activities. Due to space limita­ tions, the VDA Journal Editor will re­ serve the right to condense biographi­ cal information, if necessary. Should you have any questions regard­ ing the VA Dental Journal criteria, please contact Dr. Les Webb at (804­ 282-9781). If additional Journal submis­ sion forms are needed, please contact Susan Lionberger at (804) 261-1610 or lionberger@vadental.org.

VDA AWARD NOMINATIONS

JOCELYN LANCE ­

PRESIDENT OF THE

ALLIANCE OF THE ADA

Mrs. Jocelyn Lance was installed as President of the Alliance of the Ameri­ can Dental Association during the or­ ganizations' recent convention in New Orleans. Former President of the Alliance of the VDA, Mrs. Lance has held various elected and appointed positions in her national, state, and local dental alli­ ances. She presently serves as Com­ mittee Clerk at the Senate of VA during the legislative session. She is an Honorary member of the VDA, and she has received the AADA Thelma Neff Award and the ADA's Grassroots Program Award of Excellence. Mrs. Lance is married to Dr. James Lance, a clinical professor of Endodon­ tics at the VCU School of Dentistry.

THANK YOU The VDA would like to thank Dr. Gra­ ham Gardner. Dr. Gardner was kind enough to join the ASDA Representa­ tives from the VCU School of Dentistry for lunch in November. He explained to the students why he was involved in organized dentistry and what it meant to him. He was also an "ear" to hear what the students wants and needs were at this time and how the VDA could help them. Thank You Dr. Gardner!

The Virginia Dental Association has four main awards, which are presented at the Annual Session of the VDA. In or­ der to choose those who are most de­ serving of these honors, we would like to ask foryour help in identifying poten­ tial recipients. Nominations for awards may be made to the Awards Subcom­ mittee by individual members of the VDA or by components. Please submit nomi­ nations to the VDA central office in care of the VDA Awards Subcommittee by April 30, 2003. Dental Team Member Award The nomi­ nee must be a dental team member of a VDA dentist. This award may be pre­ sented to multiple recipients only when worthy candidates are recognized. The nominee(s) should demonstrate that she/he holds the profession of dentistry in highest regard, promotes the inter­ est and betterment of the profession through the team concept of dentistry and has five or more years of experi­ ence in the dental field. Emanuel W. Michaels Distinguished Dentist Award This award is presented to a member dentist who has demon­ strated outstanding service, leadership and dedication to the profession of den­ tistry and for the improvement of the health of the citizens of Virginia. This award is presented only when a worthy candidate is recognized by the Presi­ dent and approved by the Awards Com­ mittee. New Dentist Award This award is pre­ sented yearly to a VDA member who has been in practice ten years or less. This award is only presented when a worthy candidate is recognized. The nominee must have demonstrated lead­ ership qualities through service to den­ tistry. Special Service Award This award is presented to a non-dentist who has demonstrated outstanding service, sup­ port and dedication to the profession of dentistry. This award is presented when a worthy candidate is recognized.

Virginia Dental Journal

33


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REASONS TO CONSIDER ESTATE PLANNING OUTSIDE OF TAXES

David S. Lionberger, Esquire - Christian & Barton, LLP, Richmond, VA Tax planning is an important reason to undertake estate planning. How­ ever, there are numerous non-tax reasons why any individual, particu­ larly parents and business owners should plan and prepare their es­ tate and affairs. Broadly speaking, estate planning means considering and communi­ cating what you want to happen to your children and assets during life and after death. Passing away in­ testate - without a will - means state law controls what happens to your children and assets, rather than your wishes. For example, if mar­ ried at the time of your passing in­ testate, your surviving spouse may get all of your assets. However, laws of states differ and may divide your assets between your surviving spouse and children. In either case it is unlikely that the result under state law will match your individual preferences for how your assets are to be handled, including consider­ ations such as: exactly who will be your beneficiaries and get what as­ sets, whether assets pass to ben­ eficiaries outright or in trust, whether there are any restrictions on access to or use of the assets by beneficia­ ries, and when a beneficiary ulti­ mately receives an assets (if ever). Further, a will or trust can provide for custody and care of your chil­ dren in the event that both parents of the children pass away, provid­ ing critical guidance to the children and others as to your wishes for their future and care. Any charitable do­ nations you would like to be made out of your assets will not take place if you pass away intestate. Whether by will or by trust, charitable contri­ butions not only can support your preferred charities, but can incor­ porate your beneficiaries or others into the decision-making process to sustain their connection with you as well as the charity.

Divorce, dealings with and protect­ ing assets from creditors and (both yours as well as your beneficiary's), remarriages, investment assistance, and controlling the use of your as­ sets by your beneficiaries can be critical issues that trust and estate planning can address. These goals can be met through a will that directs your executor and beneficiaries as to the disposition of your assets. A trust, rather than outright transfers by gift or intestate succession, also is often used as a vehicle for ensur­ ing your preferences for the use and transfer of your assets are ad­ dressed. The trust can shelter the assets from claims by a creditor, ex­ spouse, children or other third party against your beneficiary. The trust is also a good vehicle to ensure that your assets are competently in­ vested and kept. Further, the trust can be used to establish incentives to your beneficiaries to encourage or reward activities that you would like to promote. The trust can be structured to provide a source of sup­ port and care for grandchildren simi­ lar to its uses with respect to chil­ dren. In addition, trusts are often used to accomplish charitable gifts in support of your favored charities while continuing to address the needs of your beneficiaries as you may direct. Providing a source of education funds, and an incentive to your ben­ eficiaries to further their education, is also a common reason to consider and establish a trust or address such issues in your estate planning. Fur­ ther, recent legislation under sec­ tions 529 and 2503 of the Internal Revenue Code have significantly increased the flexibility, benefits and wisdom of planning to address ever­ increasing educational expenses. Business owners, including medical professionals, have critical needs for

trust and estate planning to address the continuity and succession of their businesses. In addition to taxes, is­ sues including control of the busi­ ness, participation and compensa­ tion to family members (or lack thereof) and the interests of part­ ners, members or co-shareholders of the business all are important and should be addressed. Even the simple use of a revocable trust to avoid probate can save a certain amount of time and difficulty by reducing or eliminating the need to probate a will. In addition, unlike wills, trusts are private documents that may not need to be filed with a court or opened to public inspection. This alone can help to protect you and your beneficiaries attempts by credi­ tors and other parties to learn private financial and other information. Some may also question the need for estate planning in light of recent discussions regarding the repeal of estate taxes. However, under cur­ rent law the estate tax is only re­ pealed for a single year (2010), and returns in 2011. Discussion of a permanent estate tax repeal has taken place, but no one can predict whether the estate tax will in fact be repealed for that year or any year thereafter. In addition, gift taxes re­ main in effect and have not been the subject of repeal discussions. Minimizing estate taxes is important, but critical issues and concerns apart from estate taxes exist that should be addressed through proper estate planning. From con­ trolling the disposition and use of assets to caring for children or grandchildren to facilitating chari­ table giving, estate planning ad­ dresses important parts of providing for your loved ones and assets in addition to controlling taxes.

Virginia Dental Journal

35


[II The conclusions presented in the fol­ lowing article do not necessarily repre­ sent the views of the Virginia Dental As­ sociation, particularly concerning the managed care issues. However, the Vir­ ginia Dental Association believes that improvements have been made in the area of the dental Medicaid issues through the efforts of the Dental Medic­ aid Coalition. We wish to express our appreciation to the dental members of the coalition and to Dr. Steve Riggs and Jim Cohen of DMAS for their efforts to reform this system. A special thanks goes to Mr. Pat Finnerty, Director of Medicaid Services, for his untiring ef­ forts in support of our suggested changes. Only through conversations such as this will changes occur in a system that, in the past, has been inef­ fective at serving a population most in need. Because of our hope for a better future for those most in need, we ask each of you to consider becoming a part of our 'Take5' program. You should have received information on this program by letter and we encourage you to become part of the solution to this most press­ ing issue. Background:

MEDICAID ing provider issues and assisting in the resolution of issues leading to improve­ ment in the dental program. ImprovementslAccomplishments: Reimbursement: Low reimbursement was an obvious barrier to dentist participation. The Vir­ ginia General Assembly appropriated additional funding to DMAS in 1998 and 2000 to provide increased reimburse­ ment to participating dentists and help attract new network dentists.

The increased reimbursement, espe­ cially in 1998, resulted in a 6.5% in­ crease of newly enrolled dentists. The VDA, with DAC support was very instru­ mental in helping recruit new dentists and publishing the new reimbursement rates and other patient information in their newsletter to its member dentists. DMAS complied with the 1999 Virginia General Assembly directive to develop a plan including costs necessary to in­ crease reimbursement rates to the 85 th percentile of charges using commer­ cially available charge data. DMAS pre­ sented this data, in its Annual Report on Medicaid Dental Access and Reim­ bursement, to the Governor, the Chair­ persons of the Senate Finance Com­ mittee and the House Appropriations Committee of the Virginia General As­ sembly.

The Department of Medical Assistance Services (DMAS) formed a Dental Advi­ sory Committee (DAC) in the spring of 1998. The purpose of the committee was to work with representatives of the dental community, to expand the avail­ ability and delivery of dental services to pediatric Medicaid clients (under age 21), to streamline administrative pro­ cesses, and remove impediments to the efficient delivery of dental services and reimbursement.

Although the 2000 Virginia General As­ sembly did not provide enough funding to raise rates to the 85 th percentile of charges, additional funds were appro­ priated to provide for a 10% increase in dental service rates.

The committee membership was based on recommendations from the Virginia Dental Association, Virginia Society of Pediatric Dentists, Virginia Orthodontic Society, Medical College of Virginia-Vir­ ginia Commonwealth University School of Dentistry, Department of Health and other interested groups. The DAC has met quarterly since its inception and its input has been instrumental in address­

Broken Appointments: Broken appointments have been another barrier to Medicaid provider participation. The DAC approved a letter that was developed by DMAS that will be sent to clients if a dental provider notifies DMAS of clients needing intervention/education about the importance of keeping sched­ uled dental appointments. DMAS also emphasized that dentists should follow

36 Virginia Dental Journal

I~ their usual office policy/protocol regard­ ing broken dental appointments for pa­ tients. Dentists may refuse to see a client who breaks appointments as long as it is consistent with the enforcement of office policy/protocols for all patients. In addition, it was emphasized that it is permissible for providers to schedule appointments in blocks of time by limit­ ing appointments to a specific time and day of the week in their efforts to con­ trol broken appointments and reduce lost chair-time. Providers may also limit the number of new clients they are will­ ing to see. HMO Contractural Issues: Several contractual issues that were creating problems for dentists who par­ ticipated with lor were considering par­ ticipation with HMOs (Trigon, Sentara, Virginia Premier, Southern Health, Unicare) who administer Medicaid den­ tal plans, were resolved.

• HMO dental provider contracts can­ not have language requiring dentists that participate in their Medicaid net­ work to also participate in other plans that the HMO administers. • Payment for approved orthodontic cases through HMOs must be con­ sistent with the quarterly billing and reimbursement cycle used in the tra­ ditional Fee-for-Service Medicaid plan. • DMAS is now reviewing all HMO/Den­ tal vendor contracts used for prospec­ tive network dentists to ensure that they conform to established contrac­ tual requirements between DMAS and its HMO plans. • DMAS coverage policy is being moni­ tored on an on-going basis to ensure HMO dental plans cover at a minimum all services covered under the tradi­ tional Fee-for-Service plan. • Any previous prior approval for a ser­ vice is to be honored by the current plan in which the client is enrolled for clients who may have switched be­ tween different HMO plans or tradi­ tional Medicaid. This applies to any treatment that was initially prior ap­ proved (e.g.) orthodontia by either an


HMO or the traditional Medicaid Fee for Service.

Claim Forms/Processing (Traditional Fee for Service): The new Medicaid Management Infor­ mation System (1\11 1\11 IS), when it is op­ erational (expected by 2003), will sim­ plify provider billing for clients in the tra­ ditional Fee-for-Service plan. Quadrant coding will no longer be nec­ essary for such services as scaling/root planing, space maintainers, etc. A single ADA approved claim form is planned for use in requesting a prior approval or submitting a claim for pay­ ment and the most current COT dental provider coding system will be utilized in processing claims. These planned changes in claims pro­ cessing are consistent with the prac­ tices of most commercial dental plans and should greatly reduce any unnec­ essary claims billing/payment problems currently being experienced, especially by some of the lower volume Medicaid providers.

Prior Approval (Preauthorization)­ Clients Under Age 21: DMAS has eliminated the dental prior approval (PA) process for most dental procedures listed in Appendix C of the Medicaid Dental manual. With the ex­ ception of full-banded comprehensive orthodontic treatment, dentists no longer need to receive a prior approval for such planned services as surgical extractions, root canal treatment, pros­ thetic services, sedation and space maintainers, etc. The provider now has the option to per­ form the planned services previously requiring PA and bill in the same man­ ner used in urgent/emergent situations. A letter was sent to all the participating dentists in Medicaid notifying them of this change. The pended claims process is being ex­ panded to include these planned ser­ vices. The provider may perform and bill for these planned services by re­ questing "Individual Consideration" (IC) and provide appropriate justification on or attached to the claim. As a general rule, the same documentation to sup­

port a pretreatment request should be sent with the c1aim(s). Prior to payment, the dental consult will review the claim(s). Providers may still request PA for planned treatment if they feel there may be some questions of coverage/eligibil­ ity for the service. Providers are encour­ aged to request PA for procedures that involve costs such as lab fees that the provider is responsible for paying if there is a possibility the service may be de­ nied. Providers are also encouraged to call the DMAS dental consultant prior to treatment if they have questions re­ garding coverage for specific patients or specific procedures. DMAS encourages the use of the ex­ panded pended claims process. Past experience in reviewing claims and sup­ porting documentation submitted for services requiring PA in urgent\emergent situations has been favorably received by providers and generally results in a timely and agreeable coverage and pay­ ment decision.

Electronic Claims: DMAS recognizes the advantages of electronic claims submission and will be promoting this technology as a way to further reduce administrative costs and optimize dental business opera­ tions. DMAS encourages the use of Internet technology and other electronic services providers who are able to inter­ face with DMAS and other insurance companies to exchange financial trans­ actions such as claims, remittances and electronic funds transfer. Provider Workshops/Dental Society Meetings: DMAS provider training staff conducted one dental provider workshop last year and other DMAS staff participated in several statewide dental meetings to encourage participation and provide in­ formation on the Medicaid program and the new Family Access to Medical In­ surance Security program (FAMIS) for enrollees under age 18 (not eligible for Medicaid benefits). The holding of ad­ ditional workshops and participation in additional meetings will be discussed with the DAC.

Closing/Future Meetings: DMAS appreciates the input, support and recommendations of the DAC and looks forward to continuing to meet with the committee as this has been very beneficial in identifying and addressing the needs of the dental community in helping reduce barriers to provider par­ ticipation and enhancing access to care. Plans and discussions for future DAC meetings will likely focus on resolution of any outstanding concerns and adher­ ence to DMAS's 3-Year Plan with the Center for Medicare and Medicaid Ser­ vices (CMS). This plan encompasses issues such as outreach/administrative case management for children, ad­ equacyof reimbursement rates, increas­ ing provider participation and client uti­ lization and improved claims process­ ing and reporting. Dentists should contact DMAS or the current DAC members listed below with any questions they may have about the Medicaid or FAMIS programs. For those dentists actively participating or have recently enrolled, thank you for your services and support. For dentists who are unsure about participating with DMAS, we urge you to give the program a chance.

DENTAL ADVISORY COMMITTEE Thomas Spillers, D.D.S.

Phone - 897-8600

Email: spillers@erols.com

Karen Day, D.D.S.

Virginia Department of Health

Phone - 786-3556 Fax - 371-4004 Email: kday@vdh.state.va.us Frank Farrington, D.D.S. Phone - 828-1790 Fax - 828-4913 Email: fhfarrin@vcu.edu Fred C. Hamer, Jr., D.DS. Phone - 804-296-0188 Email: fchjr@yahoo.com Vicki Tibbs, D.D.S. Phone - 932-4537 Fax - 932-4888 Email: vltdds@nni.com Joe A. Paget, Jr., D.D.S. Phone - 540-951-91 00 Fax - 540-953-3148 Email: JPTarhee/@aol.com

Virginia Dental Journal

37


CarlO. Atkins, Jr., D.D.S. Phone - 741-2226 Fax - 741-6751 Email: CarlADDS@aol.com Ms Woody Hanes Virginia AHEC Program Director Phone - 804-828-7639 Fax - 804-828-5160 Email: wbhanes@hsc.vcu.edu

DMASSTAFF Jim Cohen Dir., Division of Program Operations Phone - 786-8098 Fax - 225-4393 Email: jcohen@dmas.state.va.us Sally Rice D.P. User Liaison Division of Program Operations Phone - 786-9490 Fax - 225-4393 Email: srice@dmas.state.va.us

R. Neal Graham Executive Director VA Primary Care Association, Inc. Phone - 804-378-8801 Fax - 804-379-6593 Email: ngraham@vpca.com

Stephen Riggs, D.D.S. Dental Consultant Phone - 786-6635 Fax - 786-0414 Email: sriggs@dmas.state.va.us

Chuck Duvall Lindl Corporation Phone - 644-7884 Fax - 644-7886 Email: lindlcorp@aol.com

Cheryl Roberts Director, Division of Managed Care Phone - 786-6147 Fax - 786-5799 Email: croberts@dmas.state.va.us

Terry D. Dickinson, D.D.S. Executive Director - VDA Phone-261-1610 Fax-261-1660 Email: dickinson@vadental.org

Chris Owens Maternal and Child Health Coordinator Phone - 786-0342 Email: cowens@dmas.state.va.us

DR NEWS

The Virginia Dental Associa足 tion would like to thank the fol足 lowing member dentists for providing Direct Reimburse足 ment leads in 2002: Dr. Dennis Cleckner

Dr. Bruce Cook

Dr. David Fitzgerald

Dr. Bill Higinbotham, Jr.

Dr. Michael Link

Dr. Kirk Norbo

Dr. Peter McDonald

Dr. James Muehleck

Dr. James Schroeder

Dr. Harvey Shiflet

Dr. Gerald Smith

Dr. Henry Stewart

Dr. David Swett

Dr. Stephen Tuttle

Nicole Pupar Director of Public Policy - VDA Phone - 261-161 0 Fax - 261-1660 Email: Pugar@vadental.org

Dr. Milton Parker of Alexandria,VA Who won a digital camera by completing the

Virginia Dental Association

Journal Readership Survey Thank you to everyone who participated in our survey. Your opinions will help us continue to improve the Journal to better fit your specific interests.

ole

38 Virginia Dental Journal

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Virginia Dental Journal

39


2002 NORTHERN VA MOM PROJECT

I~

M.O.M. Makes First Showing in Northern Virginia The Virginia Dental Health Foundation (VDHF) and the Campbell Hoffman Foun­ dation co-hosted Mission of Mercy (M.O.M.) VI, the first Northern Virginia M.O.M. project on November 1-3, 2002. The clinic was held in the School of Dental Hygiene at the Annandale Campus of the Northern Virginia Community College. The Department of Social Services for Alexandria, Arlington, Fairfax, Prince Will­ iam, and Loudon counties pre-selected 800 patients to receive dental treatment. Over 270 dental volunteers provided these underserved and uninsured individuals with dental care they could not otherwise afford. During the three-day clinic 704 patients received 228 cleanings, 411 restorations, 365 extractions, 4 complete dentures, 8 denture repairs, and 30 root canals (a remarkable amount of work to be accomplished in 23 hours!). The value of these free dental services was esti­ mated at $131,651. A generous grant from the Virginia Health Care Foundation provided equipment for Northern Va M.O.M. 2002, Wise M.O.M. 2002, and Eastern Shore M.O.M. 2002. Ellen Flanagan of the Northern VA Dental Soci­ ety holds a little one while the baby's mom gets dental treatment.

INTERESTED IN

VOLUNTEERING AT

AN UPCOMING VDA

M.O.M. PRO~JECT? Visit the VDA website,

www.vadental.org, to regis­

ter on-line or call Barbara

Rollins at 804-261-161 O.

March 29-30, 2003

Eastern Shore

This little girl is all smiles after her procedure,

July 25-27, 2003

Wise County

,.<: If I close my eyes tight, maybe it won't hurt as much!

STUFFED ANIMALS

NEEDED!

Ms. Harris is all smiles after Dr. Douglas Wendt took care of her! Dr. Bruce Hutchison looks up quickly from a procedure to have his photo taken,

40 Virginia Dental Journal

The M.O.M. Project would like to give

each child a stuffed animal after their

procedure. If you have any gently

used stuffed animals you would like

I to donate, please contact Barbara

Rollins at the VDA at 804-261-161 O.


I I

Making A Difference!

I

I

The VDA thanks the following volunteers for their participation at the NOVA MOM Project.

I

I Anna Abel Ruth Abraham HamidAhmadi Maryann Ahmadi Doug Alcorn Patty Alfaro Jackie Aloezos I Jacqueline Alvarez Dave Anderson Holly Anderson Cassandra Andrews Gary Arbuckle Robert Argentieri Audra Arraya Marielena Arroyo-Pratt TamikaAtkins Jacqueline Atkinson Kathy Ax Mana Badipour Sue Badri Denise Bagayoko Gary Banaji Bob Barnes Ahmnon Barnett Patrick Barney Miriam Barton Tyshia Bastidas Alonzo Bell Anne Bell Jim Bell Annie Bennier Catherine Berard Scott Berman Dianne Bissett Marissa Bluemenbaum Irma Bobyak John Bohm Raymond Bond Jennifer Bradley Kristen Brafford Tawney Bridges Carol Brooks Nicole Brothers Lynn Browder Lynn Browder Kendra Brown Michelle Brown Katrina Burton Sabine Burton Diana Campbell Sandy Caouette Margo Carlotta Kim Carroll Jeff Cassady Steven Castro Candace Chandler Maria Chelpon(sp) Diana Chevalier JeongChoe Christie Choi Rhonda Clare Lorraine Cocolis Peter Cocolis Sandra Coggins Sandy Coggins

Tara Coughlan Colleen Crampsie Sally Crampsie Liz Cristofano Caitlin Crowder Cathy Crowder Yani Cruz Mary Jo D'Alessia Sara D'Andrea Karen Day Jayne Delaney Amira Dellawar DeniaDiaz Cherryl Dickinson Terry Dickinson Kathleen Dillon Greg DiRenzo Patrick Dolan Steve Dorsch William Dougherty Mickey Dowty Christianne Drago James Dryden Teresa Duncan Virginia Duncan Melissa Dunn Bonnie Dunnure Lynn Durdon Chuck Duval Raymonia Eddleton Wallace Edens Nastaran Ejtemai Lucinda Ellington Laura Emerson Robin Erskine Michael Fabio Carla Faris Laleh Fazli Marianne Feeney Bette Ann Felber Melvin Felber Charles Ferrara Carol Finnerty Patrick Finnerty Katherine Fischer Ellen Flannagan Ginger Fleming Charles Fletcher Tara Ford Debbie Foster Cristina Fought Ana Fraga Joe Frangipane John Friedman Cindy Funes Christina Gaffos Missy Gainor Allen Garai Graham Gardner James Geren Paul Gibberman Heather Gibson Andrew Gilfillan Linda Gill Joan Gillespie

Colleen Golenoe Jean Goodwin Mark Gordon Mike Gorman Stuart Graves Richard Green Cathy Griffanti Meredith Griffanti Lonny Grimmer David Groy TamiGruber Jim Gyuricza Kenneth Haggerty Peggy Hambert Josh Hamilton Sue Hamilton Gunjan Harmani Ronald Hauptman Yvette Healey Dolores Hedgepeth Regina Hersh Wendy Hicks Jessica Hopkins David Hughes Bob Hulshouser Maureen Hunt Bruce Hutchison Nicholas Ilchyshyn Joan Isenberg Jinan Jaff Keneice Johnson Amanda Justus-Gunn Neda Kalantar Sima Kalantarian Celine Karapetian Christine Karapetian Gregory Kayes Jeremy Kayes Rebecca Kayes Stanley Kayes Linda Keene Daniel Kelliher J.J. Kelliher Sean Kelliher Jennifer Kennedy Carol Klima Katie Klima Michelle Klima Rodney Klima Christine Kontny Mai Koussa Stacey Kralik Nick Krasnow Peter Kunec Michael Kuzmik Kimberly LaForest Kathy Lawrence Randolph Lazear Victoria Lazear Sue Leathers Edwin Lee David Leekoff Lori Leekoff Mark Leekoff Gary Leff

Larry Leonard Paul Levine Robert Levine David Lewis Deanna Uebhart Bonnie Lilley Jane Lindsey Thomas Lindsey Cheryl Lobo Maureen Locke Sharon Logue Brian Love Melanie Love EmilyLu Cynthia Luck Kin Lui LylyLui Pat Lupo AndyMa Patricia MacDougall Vivian Mack NiddaMahr Anna Manilla Daniel Manilla Dominic Manilla Ron Manilla Diana Marchibroda Melanie Marcotte Marlena Marin Lilsy Marionna Marianne Martinez Abby Mashalian Kathy Matias Karen Mayes Michael McCann Michelle McCullough Cathy McLoughlin Scott McQuiston Maira Menendez Nissa Mikkelson FayesMiles Jan Miller Jaquelyn Minter Mina Modaresi Lorenzo Modeste Zehara Mohammed HamanyMol Lynn Moseley Veldon Moser Dorothy Moss Susan Murphy Kurt Muse Hiroko Nagao SamirNaik Amir Naiminejad Patricia Navar Stephanie Neuman Umeki Newcomb An Nguyen Gregory Nosal PaulOlenyn Marita Orton Alex Osinovsky Helen Otero David Palmieri

Nancy Parilak JohnPash Stanley Patch Bhavik Patel Corey Paz Jenny Pedemonte Luis Pedemonte David Peete John Pellegrin Jackie Perry Tina Perry AnhPham ChuongPhan Evelyn Phan Faline Phucas-Garfall Michael Piccinino Bryan Pinkston Leslie Pinkston Marvin Pizer Crystal Potter Nicole Pugar KennethQiu Tiffany Quander Cameron Quayle Karin Quiroga Catherine Ramirez Sandra Ramirez RiazRayak Cheryl Reid Danielle Rhoades Linda Riffle AI Rizkalla Sharon Robinson LupitaRoca Diana Rock Susana Rodriguez Barbara Rollins Noel Root Steve Rosenblum Ed Ross Colleen Rossmeissl Karen Rubino Richard Rubino Veronica Rubio Kendall Russell Jannette Sado Saghi Saghafi Iris Sayasithsena Karen Seliguini Mary Semancik Vicki Sempter SelinaSeo Jeanne Serreyn Forough Seyedzosoghi Sherry Sharit Kimberly Silloway Angie Silva Heather Simmons Julie Simms Ellen Simpler Misty Sissom Neil Small Cynthia Smart Doreen Smith Emily Smith

Karl Smith Peter Smith Sara Smith Jung Song CindySopho Iris Soyiothorne BeBe Soyishsena Christopher Spagna Marianne Spagna Richard Spagna Joyce Spieler Carl Steger Richard Stone Zachary Strauss Jason Straw Rosa Sundquist Miranda Swaim Asifa Taria Elizabeth Tarpley Daniel Theberge Lori Thombs Ben Thornal Sossane Tokhi Yicel Toribio Tram Tran TuyetTran Carla Valle Jody Van ison- Taylor Claudia Velasco Helen Vergnetti Diane Vernem Dave Votkins Kimberly Ann Walker Richard Waxler Jeffrey Weaver Mary Weeks Regina Weems Chrissy Wells JoAnn Wells Douglas Wendt Melanie Wexel Erin Williams Jonathan Williams Keith Williams Lois Wilson Harold Wittman Megan Wood Roger Wood Jane Woods Carrie Wordell Pedram Yaghami Mujtaba Yahya Lita Yescas Brenda Young CathyYun TaraZier PaulZimmet

Virginia Dental Journal

I I I

41


Thank you to the following individuals & companies for donations to the Virginia Dental Health Foundation in 2002: Donated Dental Services Program Alliance of the VDA Lynk Systems, Inc. Mission of Mercy Project Bailey Enterprises Paul H. Banditt, Inc. Dr. Donna Burns Drs. Bussey, Mayo, & Archer, Ltd . Dr. Thomas W. Butterfoss Dr. Gilbert Button Dr. Jerry G. Caravas Carytown Cleaners Dr. Karen Cole Dr. David Crouse Delta Dental Plan of Virginia Dr. Harry A. Dunlevy Chuck & Linda Duvall Eckerd Drugs Dr. Gisela K. Fashing Drs. Gregg, Howard, & Boyle Dr. James Harrison Dr. Faryl Hart Gene W. Hirschfield School of Dental Hygiene Hu-Friedy Manufacturing Company

International Manufacturing Group, Inc. Dr. H. Phillip Johnson Dr. Marvin Kaplan Dr. Claire Kaugars Dr. Christopher Todd Long Dr. Robert Loving Dr. Stanley J. Mason Dr. James T. McClung Jr. Dr. Stephanie M. Meader Dr. Christine Ottersburg Patterson Dental Supply, Inc. Dr. Anthony Peluso Pepsi Pfizer, Inc. Pizza Hut Premier Dental Procter & Gamble Dr. Allen D. Schultz Dr. Harold Smith Southern Anesthesia and Surgical Southwest Virginia Dental Society Subway Sullivan Schein Dental VCU Division of Dental Hygiene Virginia Association of Orthodontists Virginia Dental Lab, Inc.

Virginia Department of Health Virginia Society of Oral and Maxiliofacie I Surgeons Ultradent Mr. Devon B. Wright Young Dental Manufacturing

VDHF Dr. Randy Adams Dr. CarlO. Atkins Jr. Dr. Joseph M. Doherty Dr. Ronald G. Downey Dr. R. Benjamin Ellis Dr. Michael R. Hanley Dr. Ralph L. Howell Jr. Dr. Ralph L. Howell Sr. Dr. Beth F. Ledwith Dr. Mark S. Levin Dr. Wendy Moore Dr. Douglas S. Price Jr. Dr. Mark G. Reitz Dr. Michael A. Rossetti Drs. Soderquist & Weis, P.C. Dr. Harold D. Taylor Dr. Jonathan Wong

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42 Virginia Dental Journal

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43


I~

CONTINUING EDUCATION

[I FEBRUARY 2003 February 20 Richmond (4) Dr. Richard D. Wilson

MAY 2003

April 25 Northern VA (8) Dr. Alan Fetner Waterford at Fair Oaks

May 2 VSOMS Implant Seminar Sheraton Park South

Everyday Ethical Scenarios That Trouble Spe­ cialists and General Dentists Capital Club, Richmond VA

April 25 Tidewater (1) Dr. Christopher A. Hooper

February 21

Holiday Inn Greenbrier, Chesapeake

Contemporary Functional Esthetics VCU School of Dentistry

Endodontics for the Real World: From Prob­ lems to Perfection Component CE Programs, For registration information, contact the appropriate person below:

February 28

Component I (Tidewater) Component II (Peninsula) Component III (Southside) Component IV (Richmond) Component V (Piedmont) Component VI (Southwest) Component VII (Shenandoah) Component VIII (Northern VA)

VCU School of Dentistry

Modern Dental Materials: A Practical Review for the Restorative Dentist

February 28 Northern VA (8) Drs. Pantera & Garlapo Fairview Marriott

Virginia Donne (Executive Secretary)

Kathy Harris (Executive Secretary)

Dr. Samuel Galstan (President)

Linda Simon (Executive Secretary)

Ann Gillespie (Executive Secretary)

Sonya Ferris (Executive Secretary)

Patricia Fuller (Executive Secretary)

Susann W. Hamilton (Executive Director)

(757) 491-4626 (757) 565-6564 (804) 796-1915 (804) 379-2534 (540) 732-3789 (276) 628-4934 (804) 985-1939 (703) 642-5297

VAGD Programs - please contact Frances Kimbrough (Executive Secretary) at 804-320-8803. VCU School of Dentistry - please contact Martha Clements at 804-828-0869. www.dentistry.vcu.edu/ce/courses.shtml

MARCH 2003

JLC;U School of Medicine (Anatomy Dept) - please contact Dr. Hugo Seibel at 804-828-9791.

March 8 - 15

VAE - please contact Dr. Timothy J. Golian at 703-273-8798.

VCU School of Dentistry Royal Caribbean Cruise - Navigator of the Seas

VSOMS and VAO· please contact Nicole Pugar at 804-261-1610.

Oral Pathology For The Fun Of It

March 21 VCU School of Dentistry Dr. Russ Bogacki & Dr. Shantaram Rangappa

CONTIIlJING EDUCATION RECOGNITION PROGIW.I

The VDA is recognized as a certified sponsor of continuing dental education by both the ADA CERP and the Academy of General Dentistry.

HIPAA Update MCV Alumni House (morning)

March 21 VCU School of Dentistry Dr. Baxter Perkinson

Perkinson's Pearls MCV Alumni House (afternoon)

March 21 Peninsula (2) Dr. Robert A. Lowe

[II

MEETINGS & EVENTS

March 29-30, 2003 MOM Project - Eastern Shore June 19-22, 2003 VSOMS Annual Meeting Courtyard Marriott - Virginia Beach, VA

Predictable Techniques For Total Esthetics

March 28 Richmond (4) Dr. Gerald Kugel

Restorative and Cosmetic Dentistry - All Day Program

APRIL 2003 April 17 Richmond (4) Dr. Tom Waldrop Periodontics Today - Trends & Techniques Capital Club (Dinner meeting)

44 Virginia Dental Journal

June 26-29, 2003 VDA June Committee Meetings The Cavalier Hotel - VA Beach, VA June 29..July 2, 2003 VAO Annual Meeting Greenbrier Resort, White Sulfur Springs WV July 25 - 27, 2003 MOM Project - Wise County Sept. 10-14, 2003 VDA Annual Meeting Marriott - Richmond, VA

October 23 - 26, 2003 ADA Annual Session San Francisco, CA June 24-27, 2004 VDA June Committee Meetings The Cavalier Hotel - VA Beach, VA Sept. 8-12, 2004 VDA Annual Meeting Waterside Marriott - Norfolk, VA Sept. 14-18, 2005 VDA Annual Meeting Marriott - Richmond, VA September 13-17, 2006 VDA Annual Meeting Hotel Roanoke & Conference Center

II]


II

FLOURIDE, FLOSSING & FOLIC ACID CAMPAIGN A COLLABORATIVE EFFORT BY

THE VDA AND THE VA CHAPTER

MARCH OF DIMES

Folic Acid Awareness

Research has demonstrated that con­ sumption of folic acid before conception and during the early months of preg­ nancy can reduce the risk of birth de­ fects associated with the brain and spi­ nal cord, neural tube defects (NTD's), by as much as 50-70%. Because of the strong scientific evidence, the March of Dimes, in accordance with the rec­ ommendations of the U.S. Public Health Service and the Institute of Medicine advises all women who can become pregnant to consume a multivitamin containing 400 micrograms of folic acid daily as part of a healthy diet including food with adequate folic acid.

Even with the national folic acid cam­ paign to increase awareness, many health care providers are not aware of the recommended amount folic acid for women in childbearing years. Many more do not advise women unless they request specific information. Survey information reported that women who currently do not take a multivitamin or supplement of folic acid would be more likely to do so if advised by their physi­ cian or other health care provider. The Virginia Council of Folic Acid has identified dentists and dental hygienists as those who during the biennial dental exam could take the opportunity to in­ form women of child bearing age about the need to take a folic acid supplement. Moreover, dentists and dental hygien­ ists often have established rapport with their patients that can result in an edu­ cational moment. Dentists and dental

II

hygienists are in a unique position to educate their patients about how to pre­ vent I\JTDs. The Folic Acid Council of Virginia encourages dentists and den­ tal hygienists to educate all women of childbearing age of the importance of consuming folic acid to promote healthy babies in Virginia.

RESOURCES March of Dimes

(www.modimes.org)

National Center of Birth Defects

and Developmental Disabilities

(www.cdc.gov/mcbdddlfolicacid)

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Virginia Dental Journal

45


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46 Virginia Dental Journal


[II

COMPONENT NEWS

[

Component I Tidewater

Dr. Barry Einhorn, Editor New Year's greeting from Tidewater (South Hampton Roads to you purists). Although we are actually in the middle of our program year we are energized for a final sprint to the finish of another exciting year in our cherished profes­ sion. We are proud to report that we had an­ other excellent response to the United Way campaign in our community. Den­ tists have been at the head of the class amongst professions for a long time. This year special thanks go to Dr. Mike Morgan and his fine committee. On November 15th we held an outstand­ ing continuing education program fea­ turing MCV's one and only Dr. John Sivirsky. He presented a full day which included "Aids, OSHA, and Infectious Diseases for the 21 st Century. In the af­ ternoon John's topic was "Oral Pathol­ ogy- Cases Only a Mother Could Love". Guess what, his Mom was present to hear him! Our next continuing ed program will be held on April 25, 2003. The speaker will be Dr. Christopher A. Hooper. His topic will be "Contemporary Functional Esthetics" Please call Ginnie Donne for further information. Dr. Anthony Peluso is again heading up this year's Dental Health month pro­ gram. In cooperation with the ADA we will be implementing the "Give Kids a Smile" program by examining kids at the ODU Hygiene clinic from 9 AM to 1 PM on Saturday February 15th . Finally we are grieved at the loss of Ada Michaels, beloved wife and partner of Dr. Manny Michaels. Ada was a warm friend to everyone with whom she came in contact. She is sorely missed.

I hope you have a mild winter and that there will be only Peace this spring.

disclosure to our patients rather than banning the use of the material. Thanks for representing our profession.

Component II Peninsula

After over 2 years of preparation, the Peninsula Christian Free Clinic in down­ town Newport News is scheduled to open January 9, 2003 and will be open on Thursday evenings from 6-8:30 to serve the needs of the less fortunate. The dental community is proud to offer this service and thankful for those who made it possible.

Dr. Sharon Covaney, Editor I hope everyone had a wonderful and safe holiday season. Unfortunately it has been a little while since component 2 has shared its happenings. I was pregnant and if any of you have been pregnant or had wives that have been pregnant, you can vouch forthe memory lapse that accompanies being pregnant and ie, missing the deadline for the last article. I am back now and pleased to catch you up! I'd like to share with you some of the exciting CE we were fortunate enough to experience last year. Last Septem­ ber, Dr. Kevin McCowan, a general sur­ geon in Newport News, discussed his real life experience with the tragedy of 9/11. In October 2002, Dr. C. Benson Clark shared his vast experience and knowledge with implants by discussing "Contemporary Occlusal Concepts in Implant Reconstruction". Finally, in November, Dr. Carol Brooks shared some tips to help our patients who don't floss with her lecture entitled" Improv­ ing Oral Health: Current Practices in Antiseptic Rinse Use". Upcoming CE for 2003 seems just as exciting as 2002. Dr. Ron Tankersley will be discussing "Ethics"in January and 2 of our own board members Drs. Link and Watkins will be updating us on Board issues helpful to us all. Fi­ nally, on March 21 an all-day CE course will be offered entitled "PredictableTech­ niques For Total Esthetics" by Dr. Rob­ ert A. Lowe. Our component would like to thank Dr. Fabienne Morgan for her work on H.R.4163, the Mercury in Dental Filling Disclosure and Prohibition Act. Dr. Morgan along with Dr. Terry Dickinson made a positive impact on Congress­ woman Jo Ann Davis who will support

Many "CONGRATS" to extend through­ out our component for their accomplish­ ments this past year. Congratulations on a successful campaign goes out to Drs. Bruce DeGinder (VDA President­ Elect), Richard Barnes (AIt. ADA Del­ egate) and Ron Tankersley (ADA Del­ egate). Congratulations to Dr.Jon Piche for representing the PDS as president this past year. Dr. Piche did an excel­ lent job and Dr. Eric Boxx has now stepped up to the plate-good luck Dr. Boxx on a successful year as well. Fi­ nally, congratulations to our new mem­ bers Drs. Jeff Booth, Heather Zak­ Ramsay and Michelle Galloway. I hope every one had a nice holiday sea­ son and best wishes for a great 2003!

Component III Southside

Dr. Mike Hanley, Editor Happy New Year from Southside! I had a very nice Christmas season, hope you did as well. I'll bet our office is not alone in being glad that non-stop seasonal music for a month straight is too much. Dr. Sam Galston is getting us ready for Give Kids A Smile day. I'll report on how that went next time. The ADA meeting in New Orleans was great. The VDA hosted a very nice re­ ception for new Alliance President, Virginia Dental Journal

47


Jocelyn Lance. All the continuing edu­ cation and exhibits make for a great value for your dues money.... Already made reservations for San Francisco 2003. Seems we have a "National Star" in our component. At the ADA meeting in New Orleans, none other than David Ellis won the golf contest on the exhibition floor. While the rest of us were attending classes, participating in workshops, and having the vendors show us the latest materials and equipment so that we might return to our practices and pro­ vide a higher level of service to our pa­ tients, Dr. Ellis was seen employing various wigs, fake moustaches, and numerous clothing changes to continu­ ously qualify for the finals for 3 straight days. It paid off, though, with one lucky.... I mean, smooth ... swing, he walked away with the giant check you saw in the ADA News, and the self pro­ claimed title of "Best Golfer in the ADA". Component IV Richmond

Dr. Kit Finley-Parker, Editor Happy New Year from the Richmond Dental Society! We hope that all is well with Virginia dentists thus far in 2003. We had a very busy and productive end of the year. Dr. Robert Penterson was elected at our November Monthly Membership Meet­ ing to the Board of Directors of the Rich­ mond Dental Society for a three-year term. Dr. Mike Dishman was the speaker at this meeting and he gave a very infor­ mative presentation on "Current Trends in Vital Bleaching." Our component lost four of its members in 2002, Dr. Sam Silberman, Dr. William Callaham, Dr. Mark Barban and Dr. Anthony Kell. All four of these men contributed so much to our association and to the dental pro­ fession. We are so fortunate to have had them as members of our compo­ nent. Dr. Frank Farrington, Chairman 48 Virginia Dental Journal

Members of Component III enjoy the nightlife on Bourbon Street in New Orleans during the ADA Annual Session.

of Pediatric Dentistry at the VCU School of Dentistry, was awarded The Community Service Award by the VDA for exhibiting a high level of professional achievement and leadership skills and for creating a significant impact on the community through his accomplish­ ments and volunteer activity. Dr. Gary Hartwell, Chairman of Endo­ dontics at VCU School of Dentistry, was elected to serve as the Board President of The American Board of Endodontics for 2003-2004. Richmond is looking forward to hosting the 2003 Annual Virginia Dental Asso­ ciation meeting in September! Dr.Anne Adams will be the Local Arrangements Chair, Dr. Norman Marks will Chair the Continuing Education Committee, Dr. Charlie Cuttino will Chair the Host Com­ mittee, Dr. Elizabeth Reynolds will be Social Chair and Dr. Kate Roberts will Chair the Exhibits Committee. Dr. Kate Roberts and her Dental Health, Public Information and Community In­ volvement Committee are also gearing up for an active February with Children's Dental Health Month. Her Committee is working closely with Dr. Roger Wood and Dr. Raymonia Eddleton who are co­ chairing "Give Kids A Smile Day" for the RDS. The RDS plans to work very hard on February 21 to make this day a huge success. The January Monthly Meeting of the RDS had Mr. David Avert, COT of Drake Precision Dental Laboratory, speak on "Clinically Proven Advancements In Esthetic Dentistry-Eliminating The Con­ fusion." Dr. John Syvirsky gave an all

day continuing education program in January entitled "Oral Pathology for the Joy of 1t. ..You are the Object of My Infection." John's presentation was as entertaining as it was informative. Dr. Richard Wilson will speak at our February 20, 2003 Monthly Membership Meeting on "Everyday Ethical Scenarios that Trouble the Specialists and Gen­ eral Dentists." Component IV wants to wish all of you a Healthy and Prosperous New Year! Component V Piedmont

Dr. Lori Snidow, Editor No News To Report

Component VI Southwest

Dr. Robert G. Schuster, Editor No News To Report


Component VII Shenandoah Valley

Dr. Mac Garrison, Editor No News To Report

Component VIII

Northern Virginia

Dr. Scott McQuiston, Editor Congratulations to Dr. Frank Samaha who (at age 75!) made a hole in one at the Fairfax National Course in Centerville on October 25,2002. It was a 155 yard, par 3 and he used his 5 wood.

[I

ALLIANCE NEWS

II

Barbara Yandle, President The Virginia Alliance opened the new year by once again assisting the VDA with its annual Legislative Day at the General Assembly. On Friday, January 24 th Alliance members helped to deliver dental care kitsto all legislatorsand aides. The Executive Board of the Virginia Alli­ ance held its annual mid-winter meet­ ing on Saturday, January 25 th at the Sheraton Park South to begin planning fo r the state meeting to be held in Rich­ mond in September. We welcomed to the Board Jackie Farley from Roanoke. Jackie is the new President of the Alli­ ance of the Roanoke Valley Dental So­ ciety. Jackie's efforts in Roanoke were recognized at the AADA Annual Meet­ ing in New Orleans where the Roanoke Alliance was the recipient of a Member­ ship Award. The Executive Board wishes to thank two Virginia Alliance members for their time and service in serving on the AADA (national) Board. Nan Cook just completed her term as our District 2 Trustee which serves the states of Virginia. West Virginia, Penn­ sylvania, and Maryland, as well as U.S. Territories in the Caribbean. Our new

District 2 Trustee is Maureen Zish from Pennsylvania. Sandy Parks has also just completed her term as AADA Comp­ troller. Her replacement is Connie Slyby from Indiana. Nan and Sandy have both demonstrated Leadership at its Best, and we are both proud and grateful for their efforts. Virginia is still well repre­ sented on the AADA Board, as Jocelyn Lance from Richmond is currently our national President! Jocelyn's installa­ tion in New Orleans was a memorable occasion, and the VDAlAVDA spon­ sored reception held that evening was a first-class affair. We are not only proud to call Jocelyn one of our own, but more importantly, we are proud that our orga­ nization has been placed under her most capable leadership. Our Alliance is truly privileged to have her represent all of us as we strive to support the val­ ues and goals of the organized dental profession.

www.alliance.org or call AADA Cen­ tral Office toll free at 800.621.8099, Ext. 2865.

As an organized Alliance, we have three component Alliance organizations in Virginia: Roanoke Valley; Richmond; and Southside. Members-at-Iarge are also a part of our State and National organization and are recipients of both our state "Dental Dominion" newsletter and our national "Key" newsletter. Please contact our Vice-President for Membership, Mrs. Shirley S. Meade (13004 Chipstead Road, Chester, VA 23831 Phone 804.796.2002) for more in­ formation. Please feel free to give us a call and find out more about the Alliance!

[11

VSOMS NEWS

Dr. James Nelson, President

I~

ATTENTION

Coming up soon will be our annual AADA Leadership Conference to be held March 5-8 in Lincoln, Nebraska. The Conference offers valuable leadership information in such areas as Oral Health Education and Legislative matters. The ADA's Jon Holtzee, Director of State Government Affairs, will be delivering a legislative update, and Oral Health Edu­ cation Day will offer lots of "hands on" activities as well as Member Project Displays and a panel discussion work­ shop. In addition, there are lots of fun activities planned for attendees starting with a Wild West Welcome Dinner and concluding with Jocelyn Lance's Presi­ dential Gala. All of this will take place at the Embassy Suites Hotel in Lincoln. The members of the Virginia Alliance always enjoy a good time at Leadership Conference, so I encourage you to join in on the fun. AADA has established a Leadership Conference Grantto encour­ age AADA members of new dentists (no more than 10 years in practice) and spouses of ASDA members to attend Leadership Conference. The grant awards complimentary, non-transferable tickets to all activities at Conference and reimburses up to $600 for transporta­ tion and lodging. One grant is avail­ able in each of AADA's 10 Districts. If interested in applying for this grant, please contact me as soon as possible. For more information regarding the ac­ tivities to take place in Lincoln, go to

MARK YOUR CALENDARS Date Change for Implant Seminar

The 2003 VSOMS Implant Seminar, originally scheduled to be held, Friday February 21 ,2003 has been resched­ uled for Friday, May 2, 2003. The Semi­ nar will be held at the Sheraton Park South, Richmond. Additional information and registration materials for the semi­ nar will be forthcoming.

[II

VAO NEWS

I~

Dr. Steve Hearne, Past President The Virginia Association of Orthodon­ tist and its board of directors are ex­ cited about the I\lew Year and all the beneficial changes on the horizon. The board has been working on a number of directives; orthodontist qualifications for licensure by credential, better partici­ pation by our members in the Medicaid program, obtaining information for our members regarding HIPPA, and the de­ velopment of our website, lNWW.vao.com. As in the past many of our VAO mem­ bers are active in local and regional den­ tal politics. Dr. Penny Lampros is on the editorial board of the SAO, Dr. John Goodloe is serving as the Component Director of the SAO, Dr. Steven Garrett Virginia Dental Journal

49


was elected First Senior Director of the SAO and is in line for the presidency, and of course Dr. Rod Klima is our VDA president. We should all give them a big "thank you" for their extra efforts for our benefit. The VAO membership is looking forward to our annual meeting this year, June 30-July 2,2003, at the Greenbrier Re­ sorts, in West Virginia. VAO president Dr. Bill Dabney, is planning a super meeting, at this five star resort. The VAO family was saddened this past year with the passing of one of our truly great members, Dr. Orrin Clifton of Roanoke. All friends and colleagues that had the pleasure of knowing him will miss Orrin.

~I

PUBLIC HEALTH NOTES

II]

Dr. Karen C. Day Dir. Division of Dental Health The Division of Dental Health is survey­ ing the teeth of school children in four Virginia counties to determine the ef­ fectiveness of the topical fluoride rinse program. Currently 49,000 children in more than 200 schools in communities without access to water fluoridation "swish away decay" for one minute once a week to prevent cavities. Although the Center for Disease Control and Preven­ tion (CDC) recommends the program for non-fluoridated communities, the level of effectiveness in Virginia children is not documented. Approximately 2,000 children with parental permission in Amelia, Buckingham, Cumberland, and Halifax County schools will be ex­ amined. While two counties have chil­ dren who have participated in the pro­ gram long enough to see some results, a long-term study in two counties will be conducted over the next five years. The children will receive toothbrushes and oral hygiene education in addition to the dental examination. We know that determining the fluoride concentration of a patient's primary drinking water is especially important in non-fluoridated areas priorto prescrib­ ing fluoride supplements. Effective July of 2002, a fee of $15 is now in effect from the Division of Consolidated Labo­

50 Virginia Dental Journal

ratory Services for the fluoride test kit (1-866-493-1 087.)

VAE ~I~~~~~~~~~~~~~II]

ship in OKU. Wittlinger currently serves as ADEA Vice President for Students and is an Orthodontic resident at the NYU College of Dentistry.

Dr. Frank R. Portell, President No News To Report

~II

SCHOOL OF DENTISTRY

II]

~~~~~~~~~~~~~~

Dr. James Revere Executive Associate Dean SCHOOL EVENTS Best of Dentistry

The School of Dentistry held its "Best of Dentistry Dinner" on the evening of Friday, November 1, 2002, at the Vir­ ginia Crossings Conference Center. The event honored alumni, dentists, and or­ ganizations that have provided outstand­ ing leadership and service to the School. Dean Ron Hunt presented the awards. Dr. Thomas Cooke, Dr. Terry Dickinson, and the VDA were commended for the Mission of Mercy project that allowed VCU School of Dentistry students, staff, and faculty to participate in an outreach program providing dental care to underserved populations. Drs. Cooke and Rod Klima accepted the award on behalf of the VDA.

Dr. Wittlinger accepts his award for outstand­ ing student leadership

Dr. Richard Wilson was recognized for outstanding leadership, dedication, and service to the dental education commu­ nity.

Dr. Ron Hunts gives Dr. Richard Wilson his award.

Dr. Richard Wood and Dr. James Lance were recognized for their outstanding service as adjunct faculty members. Lance and Wood have been adjunct fac­ ulty members in the Department of En­ dodontics since 1970 and1980, respec­ tively.

Dr. Klima and Dr. Cooke accept an award on behalf of the VDA for the VDA MOM Project.

Dr. Eric Wittlinger was recognized for outstanding student leadership in his role with the American Dental Educa­ tion Association (ADEA). During den­ tal school, Wittlinger distinguished him­ self as an outstanding student. He also won numerous awards, including the Edmond 1. Glenn Award and member­

Dr. Richard Wood accepts his award.


a former faculty member in the Depart­ ment of General Practice, for authoring the original CD on morphology of adult dentition. FACULTY NEWS

Dr. James Lance is awarded for his outstand­ ing service as an adjunct faculty member.

Dr. Michael Dishman was honored for his dedication and outstanding service to the School of Dentistry as a full-time faculty member.

Dr. Jeff Rogers, an Assistant Profes­ sor of Periodontics and an Affiliate As­ sistant Professor in the Philips Institute, won funding for his research grant, "An­ tibiotic resistance in the oral strepto­ cocci," a study of antibiotic resistance in dental plaque bacteria. Rogers also was honored with a National Institutes of Health Student Loan Repayment Award. The award is highly competitive and helps doctoral recipients reduce loan commitments accrued during prepara­ tion for academic careers in the biomedi­ cal sciences. Rogers serves as Direc­ tor of Postdoctoral Research in the De­ partment of Periodontics. He mentored six Graduate Periodontics residents, including three who received the recently established Master of Science in Den­ tistry degree.

Dr. Michael Dishman proudly shows off his award.

United by excellence ... linked by pride

Dental assistant-. greatly increase the efficiency of the dentist in the delivery of quality oral health care and are valuable members of the dental cane team. Even though dental assistants deserve continual recognition for their numerous contributions, a special week has been designated to commend this member of the dental team.

March 2-8, 2003

Dr. Jeff Rogers

Drs. Hall, Perkinson, and Wilson at the School of Dentistry "Best of Dentistry Dinner."

CORRECTION In the last issue of the VDA Journal, I reported that Dr. Lou Abbey and Dr. Russ Bogacki received recognition from the American Dental Education Association's Section on Dental Informatics for their work in the educa­ tional CD-ROM category. This is true; however, credit should also be given to staff at VCU's Academic Technology, Instructional Development Center for their significant role in developing both of these CD-ROMs. In addition, credit should be given to Dr. Linda Baughan,

Dr. Gary Hartwell, Chair of the Depart­ ment of Endodontics, was elected President of the American Board of En­ dodontics for 2003-04 and is serving his second three-year term on the Board. In addition, Hartwell was inducted as a Fellow of the Virginia Dental Associa­ tion during its 2002 annual meeting.

has been designated hy the American Dental Assistants Association. along with the American Dental Association, the Canadian Dental ASSOCIation and the Canadiun Dental Assistants' Associat ion. as IhlO PlO\'fect tl111C to acknowJellge and recognize the versatik-. multitulcntcc] member or' vour denul team - your Dental A.'slslanl.

MARK YOUR CALENDAR VCU Dental Alumni Reunion Weekend April 25-27, 2003, at the Omni Richmond Hotel. Alumni being honored are those who graduated in a year ending with a "3" or an "8".

Flus Ine~:;.'X19<~ I"; wrurnuteci tlV 1he American Dental Asvoconoo s. Council on Dental Practice In cooperation wl111 nI('~ Arnenr.an Lenta' Assrstann. AsS()CI31Ior Crucaoo IL. the Canarnan [lental Assoctauon and the CanacJlan Dental AS~>lst£Wll~, ASSoCiatiun. Ottawa Ontar«

Virginia Dental Journal

51


classified ads Classified advertising rates are $40 for up to 30 words. Addi­ tional words .25 each. The classified advertisement will be in the VDA Journal and on the VDA Website - www.vadental.org. It will remain in the Journal for one issue and on the website for a quarter (3 months) unless renewed. All advertisements must be prepaid and cannot be accepted by phone. Faxed advertise­ ments must include credit card information. Checks should be payable to the Virginia Dental Association. The closing dates for all copy will be the 1st of January, April, July, October. After the deadline closes, the Journal cannot cancel previously ordered ads. This deadline is firm. As a membership service, ads are restricted to VDA and ADA members unless employment or con­ tinuing education related. Advertising copy must be typewritten and sent to: Journal & Website Classified Department, Virginia Dental Association, 7525 Staples Mill Rd., Richmond, VA 23228 or fax (804) 261-1660. The Virginia Dental Association reserves the right to edit copy or reject any classified ad and does not assume liability for the contents of classified advertising.

FULL TIME DENTISTS

Two Full Time Dentist Needed - School Based Dental Pro­

gram. Eastern Shore Rural Health. Contact Jeanette Edwards

at P.O. Box 1039, Nassawadox, VA 23417.

PRACTICES FOR SALE

Charlottesville: #7062 Gross $190,826, 4 days, 3 ops with

room for expansion in future, 1250 sq. ft. office space, lo­

cated in beautiful residential area near UVA. Doctor's offices,

potential unlimited.

Williamsburg: #7008, Gross $228,334; 4.5 days, 3

operatories; 1200 sq. ft. office space, assistant, receptionist

condo office for sale with practice in professional park. Excel­

lent potential.

Winchester Area: #7042, Gross $237,949; 4.5 days

3 operatories; 1200 sq. ft. office space, assistant, hygienist

(pt), receptionist, Excellent potential, close to D.C.

Tappahannock Area: #7077, Gross $265, 089; 3 days

2 operatories; 850 sq. ft. office space, assistant (pt), recep­

tionist (pt), Boat, sail, and grow with the beautiful people in

the Northern Neck., Room for expansion.

Southwestern Virginia: #7051, Gross $457,878; 3.5 days, 4

operatories; 1400 sq. ft. office space, 2 assistants, hygien­

ist, receptionist, Excellent potential, near major university.

Richmond: #7006, Gross $130,976; 4 days, 3 operatories;

750 sq. ft. office space, assistant (pt), receptionist (pt)

Excellent merger opportunity.

Front Royal Area: #7046, Gross $234,204; 4 days

5 operatories; 1750 sq. ft. office space, assistant, reception­

ist, Immaculate office, excellent potential, and Wonderful

small-town atmosphere, yet one hour from D.C.

Danville Area: #7018, Gross $292,117; 3.5 days, 4

operatories; 2150 sq. ft. office space, assistant (ft), assistant

(pt), office manager; Beautiful office, large lot, computer sys­

tem, Excellent potential.

All practices listed above have 100% financing available.

For more information on any practice listed above, call Pro­

fessional Practice Consultants, Ltd. Dr. Jim Howard @ 910­

523-1430

52 Virginia Dental Journal

ASSOCIATEPOSITION NEAR HARRISONBURG, VA General dentist needed for an associate position leading to buy-out of busy, progressive practice located in the beautiful Shenandoah Valley. Excellent opportunity; 22 year old family practice in fast growing local community. Great earning po­ tential. Contact Thomas M. LaTouche, DDS, 4167 E. Point Road, Elkton, VA 22827 or email mosestom@shentel.net.

PRACTICE FOR SALE - HAMPTON, VA

Established 33+ years, located near LAFB, Ft. Monroe. Seil­

ing land, building, equipment, patient records, "staff." Prac­

tice currently active. Owner will finance. Contact 757-851­

6187.

DENTAL LAB

Complete equipped lab, set up and ready for use. Located in

Ashland, Virginia. Available for immediate rent. Call 804·

798-2776 - Dr. Louis Korpics.

CAREER OPPORTUNITIES Outstanding career opportunities in Virginia providing ongo­ ing professional development, financial advancement and more. Positions also available in FL, GA, IN, MI, MD and PA. For more information, contact Jeff Dreels at 941-955-3150 or fax CV to 941-330-1731 or e-mail to dreelsj@dentalcarealliance.com

FLEXIBLE, LOW STRESS LIFESTYLE

Work when and where you choose without obligation. Excel­

lent Compensation. Nation's most experienced LOCUM TEN­

ENS (Temporary Professional) SERVICE for Dentists. Con­

tact FOREST IRONS & ASSOCIATES, INC. 800-433-2603 www.

torsstirons.com

ASSOCIATENEEDED???

Contact National Dental - our service will give you access to

over 1500 dentists who are seeking positions. For more

information, contact a placement specialist at 888-876-6372.

DENTIST - #X3137 Part-time, 24 hrs/week, M-F. No Benefits. $35.00/hr - $45.00hr. Provide dental services for patients of Health Dept. incl. oral exam, restorations, sealants, extraction, preventive dentistry. Knowledge of pediatric dentistry. Assist in providing educa­ tional services to developmental staff, school/students. Skill in clinical services & delivery of care to children. Current State of VA Dental License required, Open until filled. Send re­ sume to: VBDPH, 4452 Corporation Lane, Va. Beach, VA 23462. EEO/AAlH/Employer. Contact Human Resources: 757-518-2688.


What's So Special About Partials FroID Virginia Dental Laboratories?

1

Integrity. Virginia Dental Laboratory uses

• Vitallium® Alloy-the only partial denture alloy that is processed under the same quality control conditions as orthopedic implant alloy-with over 50 years of patient success.

2

Accuracy. Our entire procedure for construct­

• ing Vitallium Partial Dentures is quality-con­ trolled to achieve the utmost accuracy. This accuracy means faster delivery of the restoration; reduced chairtime and greater patient satisfaction.

Quality. Our partial denture restorations begin • with quality raw materials such as Vitallium® Alloy. Vitallium Alloy® is totally biocompatible. It is nickel- and beryllium-free. Its surface won't tarnish, dull or corrode in the oral cavity or in the body.

3

4

Experience. The exceptional skills, quality

5

Commitment. Virginia Dental Laboratories is

• craftsmanship, and proven techniques of Virginia Dental Laboratories come only as the result of years of experience, painstaking effort and a deep commitment to integrity.

• dedicated to providing you and your patients with the highest quality partial dentures available. We believe that the combination of our quality raw mate­ rials, such as Vitallium Alloy; our skilled technicians; our unequaled experience and our steadfast dedication specially qualify us to satisfy the needs of you and your patients. For special treatment on your next partial denture case, please contact Virginia Dental Laboratories!

We are happy to survey, design and estimate from your diagnostic casts at no obligation to you! Contact us today!

Since /932

irginia Dental Laboratories, Inc. 130 W. York Street Norfolk. Virginia 23510

1-800-870-4614 © 1992 Ausienal. Inc. All Rights Reserved. Vitalliurn ' trademark licensed to Austcnal.Jnc. by Pfizer Inc.


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Virginia Dental Journal