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SUMMER 2008 VOL. 40, NO. 5

Bulletin

COMING TO A DENTAL OFFICE NEAR YOU


Contents Editor

Bruce Weny

Associate Editors

Jeff Smith Tara Meachum Seth Vruggink Aric Smith James Papp

Advertising Editor

Elaine Fleming Executive Secretary WMDDS 511-F Waters Building Grand Rapids, MI 49503 (616) 234-5605 efwmdds@aol.com

West Michigan District Dental Society Executive Board 2007-2008 President Doug Killian President-Elect Douglas Klein Vice President Seth Vruggink Secretary-Treasurer Ryan Lebster Immediate Past Amy De Young President Editor Bruce Weny Third year director Larissa Bishop Second year director Tyler Wolf First year director Christopher Morgan Area Representatives Kent County Ionia-Montcalm County Mecosta County Margaret Gingrich Ottawa County MDA IV District Trustees

President’s Message ...................................................................................................... 2 Editor’s Thoughts......................................................................................................... 4 Trustee Report .............................................................................................................. 6 Dental Amalgam Separators........................................................................................ 8 MDA Speaker of the House.........................................................................................10 What Is Depression? ....................................................................................................16 These Are A Few Of My Favorite Things....................................................................18 Program Review ...........................................................................................................20 Classified Ads................................................................................................................22

Connie Verhagen Norman Palm

Big Rapids Dental Study Club Officers, 2007-2008 President Erick Perroud Vice President Erick Perroud Secretary Christa Stern Treasurer Erick Perroud

Advertiser Index ...........................................................................................................23

Holland-Zeeland Dental Society Officers, 2007-2008 President Ryan Lebster Treasurer Robert Ankerman Secretary Immediate Past President

About the Cover

Ionia-Montcalm Dental Study Club Officers, 2007-2008 President-Secretary Lowell Swartz Vice PresidentKirkwood Faber Treasurer Kent County Dental Society Officers, 2007-2008 President Paul O’Grady Vice President Brad Van Hoose Secretary Brant Erbentraut Treasurer David Armbrecht West Michigan Dental Foundation Officers, 2007-2008 President Tom Harmon Vice President Don VanderLinde Secretary Matt Gietzen Treasurer Carl Kruyswyk The Bulletin of the West Michigan Dental Society is published six times a year (directory, holiday, winter, spring, and summer). The opinions expressed in The Bulletin are not necessarily the opinions of the West Michigan District Dental Society. Contributions to The Bulletin are welcome and should be addressed to The Bulletin Editor, 255 Washington SE, Grand Rapids, MI 49503. Requests for purchase of advertising space should be directed to the Advertising Editor, Elaine Fleming, (616) 234-5605. The deadline is the 1st of the month prior to publication. © 2007-2008 West Michigan District Dental Society Bulletin

Left: Solmetex Unit. Right: large and small versions of the Amalgam Collector Unit.

Mission Statement The Bulletin is the newsletter of the WMDDS and its mission is to inform the membership of upcoming and recent events, state & local issues related to dentistry, and as a forum for its officers, representatives, and members to discuss appropriate topics of interest to the membership. Communication & Advertising Policy The Bulletin will publish submitted articles from members and others that relate to the practice of dentistry, small business, social, or political issues affecting dentists, or other subjects of interest to the membership. All published items are subject to space restrictions and the community standards of the WMDDS. The editors reserve the right to reject any article or advertisement deemed inappropriate and to edit submissions as they see fit. Submission & Publication Policy: Articles and advertisements must be submitted no later than the 1st of the month preceding publication date. The Bulletin has six publications: the directory issue, fall issue, holiday issue, winter issue, spring issue, and summer issue. Direct submissions or correspondences to: Dr. Bruce Weny • 255 Washington SE • Grand Rapids, MI 49503 Phone: 616.451.2336 FAX 616.222.1345 • Email: Bweny@aol.com Include “Newsletter” in the subject line

WEST MICHIGAN DISTRICT DENTAL SOCIETY | SUMMER 2008

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PRESIDENT’S MESSAGE

And That’s What It’s All About By Dr. Amy De Young, WMDDS Immediate Past President

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ne recent evening, I was cleaning out some files in my office and ran across a folder that I keep little notes in. The notes have been written by me or my staff to remind us of the funny things that happen in the office. I had not seen this file for quite a while and took a moment to glance through it. One note in particular brought back a bright memory, and I would like to share the story with you. In early 2003, a five-year-old girl came to the office with many significant areas of decay. She was quite nervous about the proposed dental treatment, which consisted of several stainless steel crowns and some fillings. My staff and I tried to reassure her that we would take very good care of her and her teeth when she visited us for her dental treatment. The look on her face when she left our office after her initial visit was not what I would call a look of relaxation and confidence! I knew I would have my work cut out for me. The child returned a few weeks later for her first appointment. She was very apprehensive about the treatment that I was going to do, but was very good about climbing into the dental chair as long as she could have her doll with her. My assistant and I began her appointment and explained everything we were doing as we proceeded. She was a terrific patient and left with a new shiny silver crown and a little silver star in her teeth. I left the child in the play area with my assistant while I went to explain to her mother what I had done during the visit. Her mother and I returned to the play area to find the child in full dental regalia! In the play area, I have a dental chair that usually has a large stuffed bear sitting in it. The bear was on the floor and the little girl’s doll was seated in the chair. The child had asked my assistant if she could have something to fix her baby’s teeth. Maribeth gave her a little microbrush to

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use. That was not enough, though – she needed more things. Maribeth asked the child what she needed. Her reply was, “Stuff to put on a crown.” Maribeth gave her a bite stick, and our little patient went back to work on her doll. When her mother and I came into the room, I asked my little patient what she was working on. She flashed a big smile and announced that she was giving her baby two silver crowns and two silver stars. “Wow” I said, “that’s a lot of work!” Maribeth, my assistant (who was now my patient’s assistant for this procedure), asked the child how long all of that treatment would take. The child replied, “Ten hours. No, thirteen minutes.” A few minutes later, she was finished and headed to the prize basket. She fished out a prize for herself and another for her doll. Two weeks later she was back for more treatment. She came bounding back all smiles. Mom reported to me that she counts down the days to come back to the dentist, and she has to show her silver crown off to anyone and everyone. Her doll had stayed home this time because “she needed a nap.” Her mother told us that her doll needed a break from all of the dental treatment that the budding dentist had been subjecting her to. This story just makes me smile. It makes me feel like I made a real difference in this child’s life. I was able to take a situation that she was very concerned about and turn it into playtime … literally. Her family has since moved away. I wonder if she will continue with her fascination of dentistry. Maybe someday she will become a dentist. Maybe she will just never have a fear of dental treatment. If that is the case, I did make a difference in her life, and that makes me very happy. As I finish my “presidential year,” I realize that I have not had the time to enjoy some of the small pleasures that I get out of being a dentist. I am really looking forward to taking life a little slower and enjoying the moments that come along. I have been honored to serve as WMDDS President for the 2007-2008 year. Thank you for your support and kindness.

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Public Relations Dues Assessment Renewal The West Michigan District Dental Society Public Relations Committee and the Board of the West Michigan District Dental Society submit for your approval: The WMDDS Public Relations Committee requests a renewal of the yearly public relations dues assessment of $45 per year for 2009, 2010 and 2011. This is a renewal and will not increase your membership dues. The WMDDS has had a public relations dues assessment in place for at least 30 years. Approving this assessment will allow the committee to keep the WMDDS name before the public and to increase public awareness of the advantages of seeing a member dentist. The committee also strives to promote and improve oral health in our West Michigan communities. This proposal will be voted on by mail in late summer.

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EDITOR’S THOUGHTS

Community Dental Health Coordinator (CDHC) By Dr. Bruce Weny, WMDDS Editor

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hat it is: A three-year pilot project for mid-level dental personnel. Where it will start: Detroit. Where it came from: This proposal came from the American Dental Association. Purpose: To serve underserved populations – To reduce disparities in care in selected communities – The coordinator should increase access to dental care by a dentist, especially the number of Medicaid patients and underserved populations. For how long are the coordinators to work: There is a sunset date and geographic limitations. The program would last up to four years. The Michigan State Legislature will control this. They have to approve the program to make it part of the Public Health Code. Where will they work: They will be employed by federally qualified health clinics, the Indian Health Service, state or county or public health clinics, and private practitioners serving in dentally underserved areas. How it started: A committee that consisted of Dr. Perry Tuneburg as chairman, Dr. Amid Ismail from the University of Michigan, and some four other dentists were to define, develop, and evaluate a training and certification process for a community oral health aide. This was done in February of 2006. The ADA will oversee the development of the model as well as the implementation of all aspects of the project. Funding: The pilot program will cost some $300,000 for each coordinator for an urban area, a rural area, and a Native American setting. The money is to come from the ADA, national and local foundations, associations, government agencies, and corporations. The ADA has set aside some two

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million dollars for support of the program. Who can apply for the position: A high school graduate, a college student, a social worker, dental assistants, dental hygienists and dentists, as well as other health care providers. Stipulation to work as a coordinator: The person must come from the community from which they are to serve. They are to have the same cultural background. Training time: 18 months. Scope of services: Place temporary restorations (they are allowed to remove caries with hand instruments only and place glass ionomer temporary restorations), apply sealants, apply fluoride, triage patients, educate and motivate patients to see a dentist for continued care. The coordinator is to follow up with care, even making house calls. Why this came about: The Alaska dental nurse or dental health aide therapist could perform all of the above duties as well as extract teeth, “drill” caries, place restorations, and perform pulpotomies. The ADA felt that the Alaska model would jeopardize the care of a patient who often had compromised medical status or had various interactions to medications. Also, the Commission On Dental Accreditation (CODA) would not accredit the educational program. There was spirited debate in the House of Delegates of the Michigan Dental Association. This did pass. In four years we will see what this will bring to those in need as well as to our profession. In reflection, it is possible that this will lead to something very different, but better, which could only happen if we went down this road now. Funding and where those who need dental treatment will receive it are the real issues. If our profession does nothing, it will be done in time by either the Legislature of the State of Michigan or by Congress. All three presidential candidates have worked out state-controlled health care positions. In some states the physicians are required to see a certain number of underserved patients in order to retain their licenses. With dental school graduates having two- or three-hundredthousand dollars in debt, it is most likely they will want to practice in high-income areas to pay off this debt. If there were some debt relief as well as an income for these new dentists, it might mean two or three years of service in a clinic for the needy. Also, this could be a way for some dentists, who WEST MICHIGAN DISTRICT DENTAL SOCIETY | SUMMER 2008


EDITOR’S THOUGHTS

wish to retire but only work part time for a much smaller income and no administrative problems to deal with, to still stay active in dentistry. In Great Britain, the socialized dental program ran into a crisis when many of the dentists changed to private practice due to the low reimbursement from the state. Now, Britain

is importing dentists from South Africa and Poland to fill the spots. This program is just a beginning. Much more will be done by either our profession or by the politicians.

New Dentist Forum Annual Golf Outing Friday, August 1, 2008 Cedar Chase Golf Club 12:00 noon Shotgun start $90 per person Includes golf, dinner, on-course beverages, and prizes Look for your registration form in the mail For more information, contact Dr. Devin Norman 616.676.9177

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TRUSTEE REPORT

Actions of the House of Delegates April 19 By Dr. Norm Palm, MDA Trustee

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y best regards to you and your staff. I hope you will read closely the information in my report that concerns the House of Delegates actions. This was a very busy House with several important issues having important action taken by your MDA. My personal thanks to our West Michigan delegation members. Our West Michigan membership was well represented and in a conscientious manner by all that served on your behalf. I hope you were able to attend the Annual Session here in Grand Rapids. The attendance was excellent and our own Doug Killian, general chair of annual session, kept things running smoothly. Thanks, Doug, for your service. Before I talk about the House’s actions, I want to also update you on several Board of Trustees matters. The Board had a brief meeting during the MDA Annual session. We received an update on the new headquarters building planned for construction in Okemos. The architect, Neumann Smith, was present with some of the first drawings of the proposed building. We will be building a class A building, to use the builder’s nomenclature. This means no Taj Mahal, but a fitting structure for our caliber of organization that has a public profile as well as a mission to serve the membership. A two-story structure was decided upon in order to gain efficiencies for use of natural light as well as mechanicals for the 22,000 square feet to be built. There will be abundant parking on the west side of the building. The front of the building will face Okemos Road, with the MDA name marquee at the street level as well as on the building itself. It is planned that the Insurance and Financial Group will occupy the first floor and the MDA staff the second floor. There will be abundant con-

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ference room space on the first floor. Site work will begin soon and construction will start by August with occupancy sometime in the spring of 2009. At the summer Board meeting June 19 to 22, the Board will start a strategic planning process. You may receive an evaluation form in the mail asking you to rate the MDA on a number of topics. The hope is to tailor your MDA’s plans for the future around the needs that you see important to your practice and personal successes. Please take the time to fill out this questionnaire and return it to the MDA. The House voted Dr. Gary Jeffers vice-president. Gary will do an excellent job as he succeeds to the presidency in two years. Congratulations, Gary. West Michigan is behind you all the way. I want to express my thanks to Dr. Alan Jacobs for his service as Speaker of the House. Alan ran unsuccessfully for vice president. It is to his credit for running and giving the House a choice on its future leadership. I know the MDA will find ways to keep him active in our fold. Our own Dr .Deb Peters will be the next Speaker of the House. Deb ran an excellent campaign against Dr. Nick Fontana from Oakland. Deb, heart-felt congratulations to you for your win. You deserve all of our respect and admiration. I can’t let the thanks stop there. As I have said to others, Steve Dater was the leader the MDA needed at this time. His forthright manner and honest appraisals helped us get the building project finalized and become a soon to be seen reality. He will be staying on as immediate past president, as the House renewed that position. Thankfully, we will have a chance to hear Steve’s clarity on the issues for another year. In other action, the Board has elected Connie Verhagen treasurer. In addition, Connie has announced she is a candidate for vice president at the 2009 House. Connie has been a tireless worker for the MDA and a mentor to many, myself included. I first began working with her in the early 1990’s as member of the Health Hazard and Regulation Committee, which she chaired. Connie always impressed me with her knowledge, first about blood borne pathogens and then about amalgam in the waste water. She is never self-serving, but jokingly calls herself the Queen of Sludge. She deserves our enthusiastic support and will be an excellent MDA president. Lastly, I was elected secretary of the Board of Trustees. It will be a privilege to serve the Board in this capacity. WEST MICHIGAN DISTRICT DENTAL SOCIETY | SUMMER 2008


TRUSTEE REPORT

House of Delegates Actions Peer Review Fee Cases. In the past all fee issues brought to Peer Review went to the state committee for action. Now, the component/specialty peer review committee will review fee cases. Peer review only can judge the propriety of the fee, not the amount. A 1994 FTC advisory opinion protects members from sanction on a fee only dispute, e.g. a fee was too high but was charged for an appropriate procedure properly performed. However, a dentist can be sanctioned for fraudulent or abusive behavior in the context of a fee arrangement. Elimination of Nominating Speeches from the Floor of the House. This motion was defeated. MDA Campaign Rules Updated. Several minor changes in the candidate Forum conducted for the House in contested elections were approved. Candidates will answer 4-6 questions, the president-elect will serve as moderator, and a two-minute opening statement can be given by each candidate. Wastewater and the ADA’s Best Management Practices. The House approved: The MDA will introduce legislation that would require ISO 1143 compliant amalgam separators be installed in dental offices that remove and/or place amalgam prior to a defined date to be determined, provide a Michigan tax credit for dentists that have installed a separator within 12 months of the Act, or 12 months prior to the date of the Act preempt the local WWTP’s from enacting a more stringent local law than is approved by the Michigan DEQ. The MDA supports the Concept of Improving Access to Care. Passed with no comment. Alternate delegates may be appointed to MDA reference committees. MDA will pursue legislation to allow the State Board of Dentistry to have jurisdiction over non-licensed individuals. Problems with denturism and the Board has no authority as they are unlicensed. Code of Ethics proposal: Patient Care after Hours. This proposal required some minimum arrangements to handle after hours calls from patients of record. The House defeated the proposal. The Community Dental Health Coordinator. The House approved a proposal that will allow the MDA to seek legislation to amend a section of the public health code to allow for the recognition of this new auxiliary for the purposes of conducting a pilot study for the ADA in the inner city of Detroit. WEST MICHIGAN DISTRICT DENTAL SOCIETY | SUMMER 2008

The legislation will sunset the CDHC in four years from the date of enactment and also allow the Board of Dentistry to promulgate rules for the CDHC. Certainly the discussion of the CDHC issue was the most contentious of any matter before the House for several years. The CDHC will be able to treat class I periodontitis and also be allowed to remove caries with hand instruments and place glass inomer temporary restorations, both under limited supervision. The ADA already has selected Detroit for this pilot study of the effectiveness of the CDHC. Much was said and much more will be said until we know if this new auxiliary can help dentistry provide access to care for a whole group of people who are not getting any care with our current workforce model. Thanks for reading all this. I want you to know the issues that the MDA is paying attention. Some of them may seem mundane, but collectively what we do as a profession in a responsible manner will preserve the integrity of dentistry and protect the patients we serve. As always, contact me if you have questions or concerns.

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W H AT ’ S H O T

Dental Amalgam Separators By Dr. Bruce Weny

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n an effort to reduce mercury from the effluent of local wastewater treatment plants, the managers of these treatment plants are requiring dental offices to install amalgam separators in their offices. The ADA has looked at eleven units that claim to do the job. There are four types of separators on the market. 1. Sedimentation units: these units slow the wastewater flow down to allow the particles to settle out. 2. Filtration units: these units filter out course to fine, even to colloidal amalgam particles out. 3. Centrifuge units: these products use centrifugal force to draw out the amalgam particles. 4. Combination units: these separators use any combination of the above to remove amalgam and dissolved mercury particles. Factors to Consider Install the amalgam separator as near as possible to the vacuum pump to minimize the effect on vacuum pressure. The addition of a hose to an existing vacuum piping system may mean more bends or angles in the length of that hose, which can compromise vacuum. Also, the addition of more that four feet of new hose can weaken vacuum performance. If your office building has a basement level, consider putting the separator there. The basement location not only will conserve space, but also will provide enough space upstream of the vacuum system to collect flow. If you do not have a basement, space upstream will be limited if your existing systems are installed behind a closet or cabinet door or in a utility space. As a result, you may have to install chair side amalgam separators. Some of these units can be used just for the operatories that will be involved in amalgam removal. That might be more expensive if the plumbing will not provide for this. Most dental offices will probably put one separator in for the whole office. That means that hygiene prophy paste will be added to the sludge, requiring more frequent filter or canister changes. Many sewer districts require some way to access the effluent from the office vacuum pumps downstream from the separator. This is for water quality testing purposes. This could involve a simple tap opening, or as much as a man hole access outside to the sewer line.

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DO NOT USE BLEACH or other chlorine-containing solutions to clean the lines. They can remobilize bound mercury and release it into the waste stream, thereby compromising the efficacy of your separator. The Big Problem It can happen. While you are working on a patient, suddenly the vacuum s-l-o-w-l-y loses power because the canister or filter in the basement has become full. Collected amalgam has to be removed from every unit; but what varies is how and when. It is important to understand the maintenance schedule of each unit. Some units may require a change out every two or three months. Other units have change outs every two to five years, but require weekly draining. Some units have audio alarms and others have transparent housings so one can see how full the canister is. Once the canister or filter is full, the waste amalgam sludge needs to be sent to the reclaimer/recycler for disposal, and a receipt kept for your records. The ADA recommends that: 1. Offices with four or more chairs should consider central, not chairside, units. 2. Offices that perform more that forty or more amalgamrelated activities per week might need a unit with a larger storage capacity. 3. Some units require a power supply and others do not. 4. The space available is critical to maintenance and inspection. 5. There will be a need to know maximum flow rate. 6. What kind of warning system does the separator have? Two Separating Systems Here is a brief review of the two systems that were present at the Chicago Midwinter Meeting in February 2008. The “Hg 5” Series by SolmeteX (800-216-5505) has as its features: 1. Type: Filter 2. Cost: $750 plus cost for installation of at or under $150. Services up to 10 chairs. 3. Ongoing cost: $285 for one filter and recycle processing included, OR WEST MICHIGAN DISTRICT DENTAL SOCIETY | SUMMER 2008


W H AT ’ S H O T

4. 5. 6. 7. 8. 9.

$170 per filter from the manufacturer plus $240 for five filters from the recycle company. Filters last from six to nine months. Needs: Works best if installed at the vacuum pump. MUST have spare filters on hand. Maintenance: Change filter when full. Very simple and quick change over. It would take one minute or less. Disposal Needs: Filters are to be sent to a recycler for amalgam wastes. You will need to keep a copy for your records. Warning when to change: Visual, the case is transparent. Has greater that 99% efficiency.

The “Amalgam Collector” by R&D (800-816-4995) has as its features: 1. Type: Sedimentation 2. Cost: $825 for four operatories to $1250 for five to twelve operatories all without cuspidors. Installation costs at or under $150. 3. Ongoing costs: $120 for recycle bucket. It may take more than one of the canisters to fill a sludge bucket. 4. To fill a canister takes from two to five years. 5. Needs: Once a week on a Monday morning, someone needs to drain off the liquid in the canister. This takes about one minute. There is an automatic system that does the same thing eight hours after the system is turned off. It costs $375 and requires a 110 outlet. 6. Maintenance: When the canister is full or before, one must clean out the canister into the sludge bucket. The canister can be reused. 7. Warning when to change: Visual, the case is transparent. 8. Has greater that 99% efficiency.

of Environmental Quality and the Michigan Legislature to allow for a more realistic goal for Mercury concentrations. My thanks to: SolmeteX 50 Bearfoot Road Northborough, MA 01532 800-216-5505 R&D Services Seattle, WA 98103 800-816-4995 www.The AmalgamCollector ADA Professional Product Review FALL 2007 Editor: David C.Sarrett DMD, MS ppreditor@ada.org

Two recyclers, Amalgaway of Indiana (800-267-1467), and Maguire & Strickland of Minneapolis (800-486-2858) can receive the sludge. Prices quoted were from Maguire & Strickland. For more information on other separators and recyclers, contact the ADA. One of the problems we face here in West Michigan is that some of the wastewater disposal managers want the dental effluent to have a concentration less than that of the community water supply. The MDA is working with the Department

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MDA SPEAKER OF THE HOUSE

With Sincere Gratitude By Deb Peters, DDS

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ell, the process is finally over. A year after Vander Kolk was West Michigan president when Dan and I announcing my intention to run for Speaker of were senior dental students. We were interested in settling in the House of the Michigan Dental Association, I West Michigan and John invited us to attend a West Michigan was elected as your Speaker on April 19th. I owe a special CE course. This was the first time that we were welcomed as thank you and congratulations for a campaign well run to my colleagues into the profession. A small thing, but this gesture opponent, Nick Fontana. Nick made an admirable run at the really stuck with us. Chris Smiley and Erick Rupprecht were position and taught me a lot along the way. He was respectful two of the first colleagues to welcome us to the profession while campaigning and most when we settled over here. gracious in defeat. They pushed, prodded, and The position of Speaker is encouraged us to get involved one that I’ve coveted for quite in organized dentistry. John a while now. While being Marshall was just ahead of me involved in the House of as I went through the chairs in Delegates for many years, I’ve West Michigan District. John learned to appreciate the most set a wonderful example of important work that the how to do the important work House does and I’m excited to of local president. There are facilitate productive meetings countless others that have in the future. taught me by example, but One of the great things space does not allow me to about being very involved in mention them all. You know organized dentistry is the who you are, and I thank you. ability to learn from others. As I sincerely hope that as I said above, even during time goes by, I’ll be able to the campaign process, I was pass down to others valuable learning from my opponent lessons that I’ve learned as a as well as both candidates that member of organized denwere running for vice-president MDA President Joanne Dawley (left) congratulates Deb Peters on her election tistry. I encourage each and as we traveled around the to MDA Speaker of the House. every one of you to make it a state drumming up support. personal mission to touch The opportunity to discuss important issues with so many those that come up behind us. Whether it is getting to know a colleagues around the state proved most valuable. dental student, inviting a new colleague out for a cup of cofAs an active member, I’ve been blessed over the years to fee, or teaching a new associate what dentistry is like in the have those that have come before me share their knowledge “real world,” our mentoring makes a world of difference. with me. In the West Michigan District in particular, we have Particularly for the good of organized dentistry and ultimateso many leaders that have always been there for me. Some of ly the public which we serve, please reach out and get somethese leaders are obvious to so many of us. Leaders such as one else involved. The work of the ADA, MDA, and WMDDS Gene Bonofiglio, Arnie Baker, Larry Marcotte, and Steve Dater is truly important. We are members of the best profession on have risen to the presidency of the MDA and are fountains of the planet. Let’s work together to keep it that way. knowledge for those that have and will follow them. Others are perhaps not quite as well known, but their leadership and willingness to teach me is very much appreciated. John

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Mark Your Calendar! WMDDS Continuing Education Lineup for 2008–2009 October 24, 2008 Dr. Gregory Lutke The Digital Patient Consultation January 16, 2009 Zonya Foco Excelling at Your Career Without Undermining Your Health March 20, 2009 Dr. Michael Sesemann Oral Art and Design: The Synergy of Esthetics and Function October 16, 2009 Dr. Witt Wilkerson All seminars will be held at Frederik Meijer Gardens & Sculpture Park. Registration forms will be mailed two months prior to each seminar and will be available on our webpage at www.wmdds.org

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Do You Need A Change of Heart? WANTED: Dentists and Hygienists to volunteer 3–4 hours on any Monday through Friday morning or afternoon, June 12 through August 6, 2008, to provide restorative and preventive treatment to underserved population in Grand Rapids. Community Dental Health Outreach is sponsored by the Grand Rapids Dental Hygienists’ Society and West Michigan Dental Foundation in partnership with Mel Trotter Ministries’ dental clinic. Benefits include a “happy heart” and grateful clients. Call JoAnne Hodder, RDH, BS, 616-453-6220, to volunteer.

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WEST MICHIGAN DISTRICT DENTAL SOCIETY | SUMMER 2008

Hours: M–F 9:30am – 6pm Sat. 10am – 4pm

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HEALTH & WELL BEING

What Is Depression? This article is from the Depression and Bipolar Support Alliance, a non-profit organization that works to help people suffering from depression.

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epression is a treatable medical illness marked by changes in mood, thoughts, energy, and behavior that affects more than 23 million adult Americans each year. It is the most common serious brain disease in the United States. Depresssion is more than the inevitable sadness or disappointment that accompanies life’s ups and downs. It is a combination of five or more recognizable symptoms that are strikingly distinct from a person’s normal range of feelings and behavior. These depressive symptoms persist for more than two weeks and interfere with daily individual and family functioning. Depression involves the whole body, but researchers have detected it in the brain through modern imaging techniques. People with depression have an imbalance of certain brain chemicals known as neurotransmitters. This imbalance produces serious and persistent physical symptoms such as changes in sleep, appetite and energy; cognitive losses such as slowed thinking and indecisiveness; and discernible feelings like irritability, hopelessness and guilt. Major depression is characterized by a single depressive episode that may recur during a person’s lifetime. Although distressing life events can trigger a depression, not all stressful events lead to depression, nor are all depressive episodes preceded by a stressful event. Symptoms of Depression Experiencing five or more of the following symptoms each day during a two-week period or symptoms interfering with work or family activities can indicate the presence of clinical depression: • Prolonged sadness or unexplained crying spells • Significant changes in appetite, sleep patterns • Irritability, anger, worry, agitation, anxiety • Pessimism, indifference • Loss of energy, persistent tiredness • Feelings of guilt, worthlessness • Inability to concentrate, indecisiveness • Inability to take pleasure in former interests, social withdrawal

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• Unexplained aches and pains • Recurring thoughts of death and suicide Who Gets Depression? • Fifty percent of all patients experience a depressive episode between the ages of 20 and 50. The average age of onset is about 40, although many people experience their first episode in their late teens or early adulthood (15-30), or even younger. (National Institute of Mental Health, 1998) • As many as one in 33 children and one in eight adolescents have clinical depression. (Center for Mental Health Services, U.S. Dept. of Health and Human Services, 1996) • People with depression are four times as likely to develop a heart attack than those without a history of the illness. After a heart attack they are at a significantly increased risk of death or second heart attack. (National Institute of Mental Health, 1998) Research has shown major depression often co-occurs with other illnesses: • 25% of cancer patients • 10 – 27% of post-stroke patients • 50 – 75% of eating disorder patients (anorexia and bulimia) • 27% of individuals with substance abuse disorders (both alcohol and other substances) (above: National Institute of Mental Health, 1999) • 8.5 – 27% of persons with diabetes. (Rosen and Amador, 1996) Depression and the Elderly • About six million people are affected by late life depression, but only 10% ever receive treatment. (Brown University Long Term Care Quarterly, 1997) • Fifteen to 20% of US families are caring for an older relative. A survey of these adult caregivers found that 58% showed clinically significant depressive symptoms. (Family Caregiver Alliance, 1997) Women and Depression • Women experience depression at twice the rate of men. This 2:1 ratio exists regardless of racial or ethnic background or economic status. The lifetime prevalence of major WEST MICHIGAN DISTRICT DENTAL SOCIETY | SUMMER 2008


HEALTH & WELL BEING

depression is 20-26% for women and 8-12% for men. (Journal of the American Medical Association, 1996) • Postpartum mood changes can range from transient “blues” immediately following childbirth to an episode of major depression and even to severe, incapacitating, psychotic depression. Studies suggest that women who experience major depression after childbirth very often have had prior depressive episodes even though they may not have been diagnosed or treated. (National Institute of Mental Health, 1999) • Depression may increase a woman’s risk for broken bones. The hip bone mineral density of women with a history of major depression was found to be 10-15% lower than normal for their age – so low that their risk of hip fracture increased by 40% over ten years. (National Institute of Mental Health, 1999) Economic Impact of Depression • Major depression is the leading cause of disability worldwide among persons five and older. (World Health Organization, “Global Burden of Disease,” 1996) • Depression’s annual toll on U.S. businesses amounts to about $70 billion in medical expenditures, lost productivity and other costs. Depression accounts for close to $12 billion in lost workdays each year. Additionally, more than $11 billion in other costs accrue from decreased productivity due to symptoms that sap energy, affect work habits, cause problems with concentration, memory, and decisionmaking. (The Wall Street Journal, 2001, National Institute of Mental Health, 1999) • Depression ranks among the top three workplace issues, following only family crisis and stress. (Employee Assistance Professionals Association Survey, 1996)

• The suicide rate for older adults is more than 50% higher than the rate for the nation as a whole. Up to two-thirds of older adult suicides are attributed to untreated or misdiagnosed depression. (American Society on Aging, 1998) • Untreated depression is the number one risk for suicide among youth. Suicide is the third leading cause of death in 15- to 24-year-olds and the fourth leading cause of death in 10- to 14-year-olds. Young males age 15 to 24 are at highest risk for suicide, with a ratio of males to females at 7:1. (American Association of Suicidology, 1996) • The death rate from suicide (11.3 per 100,000 population) remains higher than the death rate for chronic liver disease, Alzheimer’s, homicide, arteriosclerosis or hypertension. (Deaths: Final Data for 1998, Center for Disease Control) Getting Treatment for Depression Up to 80% of those treated for depression show an improvement in their symptoms generally within four to six weeks of beginning medication, psychotherapy, attending support groups or a combination of these treatments. (National Institute of Health, 1998) Despite its high treatment success rate, nearly two out of three people suffering with depression do not actively seek nor receive proper treatment. For those who wish to learn more about depression, here are some websites that have additional reading material: www.pbs.org/secondopinion/episodes/suicide/index.html www.pbs.org/secondopinion/episodes/depression/index.html

Depression and Suicide • Depression is the cause of over two-thirds of the 30,000 reported suicides in the U.S. each year. (White House Conference on Mental Health, 1999) • For every two homicides committed in the United States, there are three suicides. WEST MICHIGAN DISTRICT DENTAL SOCIETY | SUMMER 2008

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POTPOURRI

These Are A Few Of My Favorite Things By Bruce Warber, DDS, MA, FAGD, BVD, BFD

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s I was waiting at the airport returning from a hunting trip with Fast Eddy Herremans, I started thinking of some of the more interesting innovations in dentistry. When P. T. Barnum said there is a sucker born every minute, he must have had more than a few dentists in his circle of friends. The first of my favorites list would be the Caridex machine. For a mere $3,500 in 1980’s dollars you could remove the last bit of decay from your preparations in about ten minutes. The fact that your could do this in about 30 seconds with #4 round bur probably explains why this device wound up on the secondary market about three days after it was purchased. Today, it would just be marketed on E-Bay. Another short-lived favorite was the identification decal you could bond on the buccal of child’s first permanent molar so they could be returned if abducted by a roving band of gypsies. In retrospect, I would have let them keep my kids. It would have served them right (Ransom of Red Chief anyone?) In the 1950’s and air abrasive unit was developed for preparing teeth for routine fillings. It didn’t last long, but as my friend Bill Avery says, “It’s hard to sink a melon in a punch bowl.” (Actually, he didn’t say melon, but that will do in polite

company.) Forty years later, guess what pops up?” You got it, the prep jet. For just $9,000 you too can drill a small hole in tooth enamel to start your preparation. Now, I know any dentist can do the same thing with a #330 bur for a buck-and-ahalf, but hey, what’s nine grand and a pile of beach sand in your nose? Now, we come to my real favorites: lasers and CAD-CAM machines. Once I put a Water-Lase, Cerac, Microscope, T-Scan, Prep-Jet, optical scanning device for virtual impressions, intra-ral camera, and what not in my operatory, where the heck do I go? Tell you what; you take this stuff and I’ll take the $250,000 and buy a Caterpillar and XTO stock and see you in five years. I’ll be smiling and you’ll be living in a van down by the river. I’m certainly not recommending copper band compound impressions, gold foil condensers, pinledge preparations, or plaster denture impressions. I’ll leave those to the dentistry’s version of Civil War reinactors. But I wonder if the Scottsdale Center offers a course in cost-benefit analysis? Would like an I-Cat with that hamburer , doctor? If you would like to e-mail Bruce with any comments, forget it! He doesn’t have e-mail.

Mark Your Calendar West Michigan District Dental Society Holiday Dinner and Awards Night Thursday, December 11, 2008 Kent Country Club in Grand Rapids WMDDS Spring Social Event Friday, March 6, 2009 Wine Tasting & Delicious Food Location: The Photography Room … A Gallery of Fine Art 15 Ionia Avenue SW - Downtown Grand Rapids

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WEST MICHIGAN DISTRICT DENTAL SOCIETY | SUMMER 2008


WEST MICHIGAN DISTRICT DENTAL SOCIETY | SUMMER 2008

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PROGRAM REVIEW

Ultimate Esthetics with Freehand Composite By Dr. Seth Vruggink

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t was one of the very few sunny and warm days in currently being done with porcelain when it comes to esthetics. March, and yet 250 West Michigan dentists and dental Venturing away from theory and into technique will be difteam members spent their Friday at Frederik Meijer ficult, but a few simple points can be made without the help Gardens & Sculpture Park stuffing their brains with useful of slides and video. First, understanding the difference pearls from Corky Willhite, DDS. between composites types is of great importance. What follows Dr. Willhite began his session by making the claim that is a grand oversimplification. Microfills should be used in composite, when used correctly, is not inferior to porcelain as esthetic areas to replace enamel. Hybrids should be used in an esthetic option (including veneers). He spent the remainder high wear areas to replace dentin or unseen enamel. of the day providing research, Microhybrids and Nanofills are techniques, and strategies that truly Hybrids and should not indeed supported his claim. It be used to replace enamel to will be difficult to relay much of achieve “Ultimate Esthetics.” the information that was preOnly pure Microfill composites sented, as a great deal of the are highly polishable and most valuable lessons were very translucent. All others will lose visual in nature. There were, their polish and translucency however, many pieces of this over time. large pie that anyone can make Dr. Willhite is a proponent of use of daily. using a layering technique inDr. Willhite began by tearing volving both composite types to down the traditional concerns achieve the ultimate esthetic regarding composite as a restoraresults. He has broken this techtive material. He addressed connique down into twelve (yes, I cerns of wear by citing in vivo said twelve) simple steps. He studies rather than the bench Dr. Corky Willhite and Dr. Seth Vruggink. referred to this as a “cookbook top tests that have been accepted technique with infinite flexibility,” as the norm. According to his evaluation of in vivo research, meaning not every restoration requires every step. Instead, composite wear is only slightly more than that of enamel. We experience will guide the practitioner to choose the appropriare talking about a few microns per year. He also defended the ate steps. In no way can each be explained completely here, fracture resistance of composite, citing several studies that put however, some tidbits can be mentioned. composite at or above the fracture resistance of feldspathic Take Shade – Always take the shade first, before enamel porcelain. Finally, he addressed the common concern of mardehydration occurs. Stick with that shade for both the dentin ginal integrity over time. Dr. Willhite stated his belief that a and enamel layers of the restoration rather than trying to long bevel margin on enamel is the most resistant of all build to an outer shade. This will be the most predictable. margin types to secondary decay. Moisture Control – Compliant patients with healthy tissue It is Dr. Willhite’s belief that conserving tooth structure is are the key (Uh-oh). becoming more important to our patients. With this in mind, Preparation – Accept in cases of severe staining or moving he believes composite should be stepping to the forefront for teeth lingualy, this should be minimal. Microscopically roughen several indications. These include diastema closures, enamel the tooth and include pumice and interproximal strips. defects, color change, and full laminate veneers among many Etch and Adhesive – Etch 60 seconds for unprepped enamel others. With proper training and practice, he believes that and 15 seconds for dentin. Dr. Wilhite stresses using the adhedentists can accomplish nearly everything with composite that is sive that works best for you.

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WEST MICHIGAN DISTRICT DENTAL SOCIETY | SUMMER 2008


PROGRAM REVIEW

Pink Opaque – This is a material only available through Cosmodent and should only be used as a wash to increase the value of a tooth. Squinting at the tooth in comparison to the adjacent teeth can help determine whether the value needs to increase. Build “Support” – This is where the hybrid composite can be used to replace dentin in Class III and IV restorations. This layer should be no thicker than 0.5mm. Block Color – Defects can be further blocked with thin layers of opaquer. Enhance Color – Using tints, subtle color enhancements can be made to match adjacent tooth characteristics. Build “Enamel” – Microfil composites are used to sculpt final contours including inner-sculpting for any developmental lobes. Final Cure – Coating the tooth with glycerin gel (KY Jelly works great) eliminates the air-inhibited layer. Contouring – Removing surface defects and creating ideal contours are of utmost importance in the esthetics composite restorations. Polishing – This step should be very quick when contouring is correct. Dr. Willhite suggests using Cosmodent’s Flexidisks, Flexistrips, and Enamelize (aluminum oxide paste) on a Flexibuff disk.

importance of educating patients on not using teeth as tools to cut thread, fishing line or finger nails as this will shorten the life span of any esthetic dentistry. He emphasized the use of night time appliances to protect your hard work from annoying chips and fractures. Dr. Willhite is a true believer in the value of composite in promoting conservative dentistry. He has successfully used composite bonding on canines as a conservative method of restoring anterior guidance for young patients who are horizontal bruxers. It is his contention that replacing composite bonding every couple of years is better for the patient than many of the more involved restorative approaches that must be used later in life. Even building up worn posterior cusps with bonded composite can be accomplished with no irreversible change to tooth structure. Again, it is his belief that patients are shifting their choices away from solely longevity and toward conservative care. It is difficult to summarize a very visual and jam-packed lecture into brief black and white print. This article falls well short of delivering the many of the day’s messages. If, however, conservative and reversible dentistry is where patient demand is headed, Dr. Willhite’s courses are going to be of great value to anyone choosing to attend.

Are you still there? It is important to understand that not all restorations will require each and every step, nor will every step help every restoration. For instance, a Class IV fracture will need opaquer 99% of the time to block out the fracture line, but should rarely or never need the pink opaquer step. Most restorations will rarely need enhanced color through tints. It is only through practice and experience that these choices can be made quickly. It is Dr. Willhite’s belief that the contouring step is where most practitioners make mistakes that compromise esthetics. He suggests making study models of patients in our practices with great smiles to examine natural contours. Using the incisal view of teeth to establish definitive natural line angles will greatly improve esthetic results. Other tidbits of useful information included using scratchfree instruments to place composite and wiping them with alcohol-soaked gauze to remove debris. He also stressed the WEST MICHIGAN DISTRICT DENTAL SOCIETY | SUMMER 2008

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CLASSIFIED ADS

The classified ad rate is $10.00 up to and including 30 words; additional words 15¢ each. Space permitting, WMDDS members may place ads free of charge as a membership service. Ads should be submitted in writing and sent with payment to Elaine Fleming, WMDDS, 511-F Waters Building, Grand Rapids, MI 49503. Telephone numbers and hyphenations count as two words, abbreviations count as one word. Ads received after the first of the month prior to publication may appear in the following issue. Grand Rapids – Our very busy, well established general practice has an immediate opening for a full- or parttime dentist. Our stand-alone facility has eight operatories and a fully staffed denture laboratory. This is an excellent opportunity to practice in a diversified and growing practice. Salary based on percentage of production for an experienced, self-motivated individual. 150k to 200K annually. Please email: grandvalleydental@sbcglobal.net or call Pam at 616.245.2767. Storage Space for Lease – Safe, secure, 24/7 access. Ideal for records, models, or just stuff you need to store. Located in the basement at 1151 East Paris Ave. Contact Dr. Sam Bander at 616.949.5980 or drsam@sbcglobal.net for more information. Dental Practice For Sale – Jenison, Michigan. Established and growing dental practice on major Jenison traffic route. Great income potential. Call for details 616.245.2767 or cell 616.485.1348. Half of Building (2,424 Square Feet) for Lease. Other half is a full-service dental laboratory. Two year old building, excellent for a dental practice. Great location in Kentwood on the corner of Breton and 32nd Street. If interested please call 447.0190. Established Dentist with an Existing Office in Grand Rapids Wants to Buy – in or partner with another dentist. Open to all options. Please contact P.O. Box 141661, Grand Rapids, MI, 49514-1661.

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Grandville: 2000+ sq. ft. office space available for lease in exclusive professional office building. Other tenants include endodontist, family dentist, pediatric dentist, oral surgeon and orthodontist. Building partnership buy-in also possible as investment. Call 616.531.6377 or 616.531.1260.

For Lease – 1,500 sq. ft. (approx.) dental office suite with three operatories in newer (5-year-old) building. Beautiful water views. Located on Forest Hill Avenue south of Burton. Convenient, highly visible location. For more information, please call Janie at 616.942.3343.

Wanted – Kavo handpiece motors – new or used. I am looking to obtain one or more Kavo 182 slow-speed motors. If you have an old one available for sale, please call John Hanks, DDS, at 364.7039.

Dent-X 9000 Automatic X-ray Film Processor complete with installation operation and maintenance manual. The processor includes approximately 200 #2 bitewing films and approximately 30 mounts (bwx/fmx) 7 snapa-rays, 25 Stabes, 25 Panoramic films and Kodak roller transport cleanup film. We are asking $250 O.B.O. Milestone Scientific “The Wand” dental product along with 11 disposable anaesthetic handpieces. We are asking $100 O.B.O. Coming June ’08 we will have 2 MCC lower cupboards w/2 sinks each, 1 Coachman dental chair and 3 G.E. x-ray heads. Please contact us at Chambers Dental Excellence – 949.4650 or chambersdental@sbcglobal.net.

Office Space for Lease – Great location! 2426 Burton St. SE, 915 sq. ft., 3 operatories, lab, private office, reception, business office, basement. Contact Dr. Sam Bander at 616.949.5980 or email at drsam@sbcglobal.net Space for Lease – Holland (great north side neighborhood location). Previous tenant was a family practice dentist. High visibility sign available. Building interior is ready for equipment installation. Three ops and small lab. Owner is willing to adapt building to needs. Call 616.245.9098 or 800.669.0717. Dentist Needed – to provide services on state-of-the-art Mobile Dental Unit. Mobile Unit provides comprehensive dental services at schools throughout Ottawa County (Grand Haven, Holland, etc.) Dentist needed 1–2 days/week beginning immediately. Competitive wage. Please send resume to: Dental Program, Ottawa County Health Department, 12251 James Street, Suite 400, Holland, MI 49424.

Kentwood, Muskegon, Fowlerville – We have three practices for sale. These opportunities are excellent starters and satellite offices. Kentwood and Fowlerville have buildings also for purchase. Starting gross of $470,000 to $600,000. Financing and working capital available. Contact Dr. Jim David, Henry Schein PPT Sales at 586.530.0800 or daviddental@comcast.net. For Sale – 1998 Gendex GX-Pan, $4500. Also available: 1970 Moss Lateral Ceph. Make offer. Call 538.5920 Mon.–Thurs.

WEST MICHIGAN DISTRICT DENTAL SOCIETY | SPRING 2008


CLASSIFIED ADS

Dental Equipment Sale – Five operatories of dental equipment for sale. 5 Dental Ez chairs, 4 Pelton Crane Track lights, one chair mounted light, 3 Forest over the patient dental units, 2 assistant dental carts, 5 Telecam Intra Oral Cameras & 5 wall mounted Mitsubishi TV’s, photo printer, 5 assistant stools, 5 operator stools, 2 SS White x-ray machines, 2 rear delivery units, all other operatory cabinetry, vacuum pump, compressor, reception room furniture, 5 business office chairs, doctors office and business office desk/bookshelf cabinetry, conference table, 2 large patient records file cabinets, and more! Call 887.7389. West Michigan: Associate Wanted with Transition to Partner – Very busy, modern practice with eleven operatories and three full-time hygienists, seeking ambitious dentist who is committed to serving the general dentistry needs of our surrounding rural community. Our practice is located in an attractive lakeside village with a municipal airport. We are looking for a general dentist with some experience to work 2–3 days a week to start. Transition to 4–5 days per week as senior partner shifts towards retirement. Contact draper@pathwaynet.com or wjwinget@hotmail.com with resumé and contact information. Associate/Partnership – Great opportunity for a full / part time general dentist. Profitable, fee for service office. This is a well established family practice. Excellent location in Spring Lake/ Grand Haven area. Call 616.842.1562 or e-mail dmirwin@chartermi.net.

West Michigan Lakeshore – Our very busy, well established family/esthetic practice has an opening for a full-time associate dentist. Great buy-in opportunity. Facility located in a small town near the lakeshore. Has 6+ operatories and long term devoted staff members. This is an excellent opportunity to benefit from the advantages of a group practice, learn from us and have management input. Contact Elaine Fleming at 616.234.5605 for info. Would Like to Find in 2008 – A retiring dentist or a partner in the Grand Rapids area. I have had lots of experience. Please call Dr. Doug Martin 616-975-0464. Dental Office Suite/Three Operatories for Lease – Desirable SE Grand Rapids location. Some shared space (reception room, lab, etc.) with two other general dentists. Great opportunity for general, specialty, or start-up. Excellent terms. Call 616.949.8990. Dental Office for Lease – Sparta, MI. Outgoing dentist: “I am building my own building after amassing a fortune, over 3 million.” 616-874-4192, Drguyandcarol@aol.com. Floor plan and pictures available.

ADVERTISER INDEX

The Bulletin wishes to thank our valued advertisers who support organized dentistry by helping to defray the cost of printing and mailing. Advertising in the Bulletin is seen by over 90% of the dentists in the West Michigan District. This includes five of the fastest growing counties in the state: Kent, Ottawa, Ionia, Montcalm and Mecosta. For information on advertising rates, call Elaine Fleming, WMDDS Executive Secretary at 234-5605. Target your Market – advertise in the Bulletin! Centric Laboratories............outside back cover Davis Dental Laboratory................inside front cover Founders Bank & Trust.......................3 Henry Schein.....................................13 MDA IFG...........................................19 National City Bank ...........................11 Professional Solutions.......................14 ProNational...............inside back cover Prudential Financial..........................24 Scrubs for Success .............................15

For Lease – Desirable SE Grand Rapids location. Some shared space (reception room, lab, etc.) with two other general dentists. Great opportunity for general, specialty, or start-up. Excellent terms. Call 616.949.8990.

WEST MICHIGAN DISTRICT DENTAL SOCIETY | SUMMER 2008

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The West Michigan District Dental Society was saddened by the passing of our colleagues: Dr. Harold Steele II, March 27, 2008 Dr. Donald Hallas, March 31, 2008 Dr. Jay Tinholt, April 17, 2008 Dr. Richard Wierenga II, April 28, 2008 Dr. Orren A. Bolt, May 16, 2008 Those wishing to make a memorial donation to the West Michigan Dental Foundation in memory of these dentists should contact Elaine Fleming at the WMDDS office at 616.234.5605, or checks may be sent made payable to: West Michigan Dental Foundation 161 Ottawa Avenue NW, Suite 511-F Grand Rapids, Michigan 49503

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WEST MICHIGAN DISTRICT DENTAL SOCIETY | SUMMER 2008


WEST MICHIGAN DENTAL SOCIETY 511-F Waters Building Grand Rapids, MI 49503

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2008 SUMMER wmdds bulletin:layout2005