2007 MAY/JUNE wmdds bulletin

MAY/JUNE 2007 VOL. 39, NO. 5

Bulletin

d rvey n a Su e t le ism p om teer 12 c se olun age a Ple he V on p n t und i fo nd e s

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Editor

Bruce Weny

Asso ciate Editors

Jeff Smith Tom Herremans Mike Palaszek Tara Meachum Seth Vruggink Aric Smith Paul J. Karl

Adver tising Editor

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

West Michig an Dist ric t Dental S ocie ty Executive B oard 200 6 -2007 President John Frey President-Elect Amy De Young Vice President Doug Killian Secretary-Treasurer Douglas Klein Editor Bruce Weny Immediate Past Laura Fogle President Directors Joseph Kirkwood Seth Vruggink John Klooster Area Representatives Kent County Paul O’Grady Ionia-Montcalm Christopher Morgan County Mecosta County Margaret Gingrich Ottawa County Tyler Wolf MDA IV Dist ric t Trustees

Connie Verhagen Norman Palm

Big Rapids Dental Study Club Officers, 2006 -2007 President-Treasurer Erick Perroud Vice PresidentChrista Stern Secretary Hol lan d -Zeeland Dental S ocie ty Officers, 200 6 -2007 President Ryan Lebster Treasurer Robert Ankerman Secretary Caddie George Immediate Past Scott Nelson President Ioni a -Montcalm Dental Study Club Officers, 200 6 -2007 President-Secretary Lowell Swartz Vice PresidentKirk Faber Treasurer Kent Count y Dental S ocie ty Officers, 200 6 -2007 President Douglas Klein Vice President Brad Van Hoose Secretary Paul O’Grady Treasurer Brant Erbentraut West Michig an Dental Foundat ion Officers, 2006 -2007 President Tom Harmon Vice President Secretary Matt Gietzen Treasurer Carl Kruyswyk The Bulletin of the West Michigan Dental Society is published six times a year (Directory issue, Sept./Oct., Nov./Dec., Jan./Feb., Mar./Apr., and May/June). 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. © 2006-2007 West Michigan District Dental Society Bulletin

Contents President’s Message ........................................................................................................2 Editor’s Thoughts...........................................................................................................3 Trustee Report ................................................................................................................4 Evidence-Based Dentistry .............................................................................................6 Looking Ahead ...............................................................................................................9 Peters Announces Candidacy for MDA Speaker ........................................................10 MDA Annual Session Report ......................................................................................11 Volunteerism Survey ....................................................................................................12 Program Review ...........................................................................................................14 Toothsome Tales and Oral Oddities............................................................................16 Medical News: Antibiotic Resistance ..........................................................................18 GRDHS News ...............................................................................................................19 Financial News .............................................................................................................20 Classified Ads................................................................................................................22 Advertiser Index ...........................................................................................................23

About The Cover This issue of the Bulletin focuses on Evidence-Based Dentistry.

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 is published in September/October, November/December, January/February, March/April, May/June, and the fall directory 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 | MAY/JUNE 2007

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PRESIDENT’S MESSAGE

Valediction

By Dr. John Frey, WMDDS President

T

here’s a gazebo nestled in between the buildings of the small business development where my office is located here in Belmont. I understand the developers’ intentions by building it, but with only a cold cement floor and nowhere to sit, it’s very rarely used. That’s why I was surprised to see people in it the other day. A young child was playing there, running in between the posts and imagining something more than the stark structure standing there. An adult woman stood nearby, and my initial thought was, that woman is probably not that child’s mother. Leaning against a post, she was clearly not involved in the child’s playing, but nearby enough to keep the child from harm, like a babysitter.

I didn’t observe any conversation pass between them.

Now there are certainly times when I’m the sole adult around my kids, making sure they stay safe, perhaps not always interacting with them. I realized soon after becoming a father that I could never really babysit my own kids. I’m their dad. I care for my own kids all by myself from time to time. I knew that when I signed up for the job. But I do try to put the remote down every now and then and actually play with them. I try to imagine how they will remember me when they were still very young. I don’t babysit them. I’m part of their lives.

Our relationship to organized dentistry can be a lot like that, too. Do I merely exist alongside my profession, becoming involved only when something potentially harmful comes along? Or do I engage myself in its everyday activities? I can volunteer in any number of projects here for the WMDDS. I can serve on their committees or board, or support their local CE courses. I can involve myself in a nearby MDA Annual Session, or take a trip somewhere else in the US and organize a mini-vacation around an ADA Annual Session. Many of us

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have been asked to become involved, some have simply stepped forward. How will dentistry remember me when I’m gone?

So when my son came up to me on a warm Spring evening not too long ago, holding his new kite and wearing a hopeful expression on his face, it was an easy decision. As we were leaving the house, my wife shot me that “Don’t You Have A Column To Write?” Look, but I pressed on. The park was empty, and the evening was perfect. The warm wind carried the kite higher than either of us could remember, and we stayed until he was tired and asked to go. We rode our bikes home, quickly got ready for bed, and turned out the lights. I went downstairs in our now-quiet house, and sat at our desk.

I thought about this past year serving as your President of the WMDDS. I realized what an honor it was, and what an extraordinary accomplishment for the men and women that make up your board, volunteer on committees, serve as your trustees, to keep this amazing profession of ours relevant, vital. I thought about meeting my deadline for this column each time I had to write one, and the relief that our longsuffering editor Bruce must feel now that I’m done.

And in this tranquil, reflective frame of mind, I began to write.

The New Dentist Forum of the WMDDS would like to thank

Jim Ditta & Davis Lab For their very generous sponsorship of our recent Bowling Night held at Northfield Lanes.

We appreciate your continued support and involvement in the dental community here in West Michigan.

Thank You!

WEST MICHIGAN DISTRICT DENTAL SOCIETY | MAY/JUNE 2007

EDITOR’S THOUGHTS

Who is Number One?

By Dr. Bruce Weny, Editor

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n this Bulletin, Evidence-Based Dentistry is explored.

More and more emphasis is being put in this area. What does that do for the clinical judgment of the dentist?

What about patient concerns and circumstances? Will we have a world controlled by evidence-based science only? A world controlled by evidence-based science only would be difficult to treat everybody in. Our science comes up short in some areas, and we are left to our own devices. This is often called “grey area” treatment. Talk about grey area, occlusion, the very center of restorative dentistry, is right in the middle of this.

When a committee decides where centric relation is, as is the case in our profession, where are the random controlled trials in this? Where are the meta analyses? We are at a stage in science where we have to have some elective standards so we are not talking past one another. Even at that, our very foundation in science is at times primitive. Still, many patients are helped by what we think we know and the treatments we employ.

Not all patients respond to our classic bite splints, CR-CO, neuro-muscular, long centric, balanced interferences cleared treatments. Some treatments remain outside of conventional therapy and they work. Why? Nature seems to work on a bell curve, be it broad or narrow. Our treatments are based on percentage of success, which means we are shooting for the center of the bell curve. The bell curve may be larger than our percentage of success, or the patient may present with several different bell curves that have to be successfully treated all at the same time. Good luck!!! Not only that, but because the human body is a dynamic system responding to a variety of stimuli, some good some not so good, to the point where it is different from day to day. Even bacteria can evade our most powerful antibiotics if given time. All of nature is like this.

WEST MICHIGAN DISTRICT DENTAL SOCIETY | MAY/JUNE 2007

Really, we labor in the grey area more than we admit, although we like to think that we are very logical and scientific. New ideas start out in the grey area until they are discredited or go mainstream.

Blame it all on quantum theory I guess. In the first two weeks of April 2007, both Newsweek and Time had articles on Albert Einstein. Of the two great pillars of modern physics, relativity and quantum theory (mechanics), Einstein did not trust in the later. He did believe in God, although not a personal one. He did believe that this God started the universe and all was pre-determined. “God does not roll dice when it comes to the universe,” he said. Quantum mechanics with its uncertainty equation was an enigma. Probability was the problem. Electrons cannot be measured in place, they move if you try. Therefore, there is only a probability of predicting their place in space. If thought is an electrochemical reaction, how could ideas (logic) come from electrons moving in a helter-skelter, at random pattern? How could anything of substance come from chaos? One the other hand, maybe that is how new ideas come about. Like a slot machine, our minds are continually trying new combinations until something comes up triple 7. Our experiences, our training, our genetics, and even the coffee we had in the morning and more all play a part.

We have to have some wiggle room here. How will our treatments play out in a court of law, or will insurance companies accept our treatments if only evidence-based treatments are accepted? The other part of the picture here is the doctor’s clinical judgment tempered by experience and patient concerns. As of this writing, both the insurance companies and the courts will allow, “What would a reasonable person do given these circumstances?” In short, you have to document in your records why you did what you did. What was the thought process behind your treatment? A suggestion here, don’t blame it on quantum mechanics. Even though we both know it’s true. That’s our secret.

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TRUSTEE REPORT

Be An Advocate … The ADA Leadership Conference 2007

By Dr. Norm Palm, MDA Trustee

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y report to you starts with a review of the Leadership Conference held in Washington, D.C., April 30 thru May 2. This was my first attendance at this conference that the ADA sponsors annually. The program is presented by the ADA’s Washington lobbying staff to update the membership on pending legislation that affects dentistry, and how to advocate for dentistry’s position on the issues. Despite some apparent friction between some of the Washington staff, the program successfully guided me towards some of the issues before us. As expected, the major thrust was all about access to care. The death of a twelve-yearold Maryland youth due to untreated dental infection earlier this year has lead to calls from legislators for improved dental care coverage for kids, something that the MDA has advocated since 1998 when Healthy Kids Dental was proposed and instituted in 2000 here in Michigan. As always, these types of programs are under-funded despite their success. Now, suddenly they seem more important to the political leaders in Washington, and more money is being shaken out to provide dental care for children.

ADA President Kathy Roth testified before Congress recently about poor funding for children’s dental care programs. She held up Michigan’s Healthy Kids as an example of success. This program is in more than fifty Michigan counties.

It uses Medicaid funding for kids’ care, but also uses Delta Dental as administrator and Delta fee profiles for reimbursement. It is an imperfect program, but it has good participation by dentists and patients, removing arcane Medicaid claims processing and the patient stigma of being “on Medicaid.” In 2003, the MDA House passed a resolution asking the state of

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Michigan to expand Healthy Kids to all Michigan counties. It has yet to happen.

The Children’s Dental Health Improvement Act of 2007 H.R. 1781/S. 739 is the major bill in Congress to increase Medicaid funding specifically for kids’ dental care. Sen. Jeff Bingaman of New Mexico is a co-sponsor of the bill and spoke to the Leadership Conference about the Bill. Too often the block of Medicaid dollars that go to the states gets used for medical care, and dental gets what’s left over. This bill specifies funds for children’s dental care that can’t be used for any other purpose.

The State Children’s Health Insurance Program (SCHIP) is a current funding program for Medicaid at the states’ level.

Here in Michigan, the program is My Child. SCHIP is up for renewal this year with, you guessed it, a purposed increase for dental Medicaid. I’d rather see Healthy Kids expanded here in Michigan.

FY 2008 Indian Health Service Dental Appropriation is intended to help fill some 130 vacancies in the Indian Health Service by starting a loan forgiveness program for new dentists who join the Service for a specified period of time. There is also increased funding for equipment, including modular dental units to replace aging units in remote clinic locations.

What can you do? Contact Representatives Vern Ehlers at www.house.gov/ehlers or Peter Hoekstra at www.hoekstra.house.gov and let them know you support legislation that helps kids get dental care. The ADA web site has recently expanded its advocacy section. Just go to ada.org.

Other things have been going on of course. Congratulations to Bill Wright of Jackson who was elected vice-president of the MDA by the House at Annual Session May 5. Sherrill Behnke of Okemos ran a competitive campaign, and our thanks to her for running for vice-president. I feel contested elections for MDA offices are important for the health of the Association. The delegates to the House deserve a choice in selecting the leadership for the MDA. Only contested elections can provide choices.

Deb Peters has announced her candidacy for the MDA’s Speaker of the House. Deb is experienced, capable, and energetic. She is a great candidate for Speaker, and she is from West Michigan. Please call Deb, let her know you support her candidacy. She will be a leader from West Michigan that we all can be proud of.

WEST MICHIGAN DISTRICT DENTAL SOCIETY | MAY/JUNE 2007

TRUSTEE REPORT

What follows are just a few bullet points on random issues as I try to keep you informed: • ADA Council Appointments. As you know, Michigan and Wisconsin comprise the ninth district at the ADA. ADA council appointments from our district are shared on a rotating basis with both states. Ray Gist of Flint is currently our ADA trustee, and he makes nominations to the ADA Board to fill council positions. This year there are five nominations available for Michigan appointees. Deb Peters has served on Membership and will be going off that committee. Thanks, Deb, for your service. I’m happy to report that nominated for Dental Benefits and Programs will be Chris Smiley, and for Dental Education and Licensure Reggie VanderVeen has been nominated. Todd Christy, trustee from Lakeland Valley, will be nominated to Membership.

• Community Dental Health Coordinator (CDHC). At the ADA House last year, a workforce study was approved that included a new auxiliary, the CDHC. This will be a community based person to determine the need for dental care in a locale, design pathways locally to get patients treated, and complete temporary reversible care. The MDA has offered Michigan as a test site for a pilot program for the CDHC. The hygienists have voiced concerns, but have not opposed the proposed new auxiliary. However, the State has said that since the public health code has no definition of a CDHC and that auxiliary’s duties, the CDHC cannot provide patient care even in a pilot program. Stay tuned on this one.

• 2007 Dues Statement Blamed for Big Drop in Contributions.

The 2007 dues statement you received last November differed in layout from 2006. Contributions to DentalPac, ADPAC, and the Michigan Dental Foundation were clearly broken out from the dues amount. So far this is year, the MDF has suffered a 63% drop in contributions, DentalPac a 53% drop, and ADPAC a 62% drop. The MDF has already asked the MDA to change the 2008 dues statement back to the 2006 design.

• Cross-Over Procedures Squabble. The Michigan Dental Specialties Council has a task force with MDA and Board of Dentistry representation discussing how to handle the ethical issues of cross-over procedures. Cross-over procedures are ones that multiple specialists or generalists may WEST MICHIGAN DISTRICT DENTAL SOCIETY | MAY/JUNE 2007

provide on a competing basis. On questions of scope of practice, this group is asking that individual specialty societies make the determination of the appropriateness of the care in question, and not an MDA peer review committee as MDA has suggested.

• The Capital View Building Project is dead. The Boji Group found in their own due diligence period they could not construct the addition to their own building due to covenants in their mortgage and their inability to enter into a contract with the MDA on a fixed cost basis. None of this was foreseeable by the MDA, and the decision making on our end was solid. The Building Committee has moved on and is looking at possible new sites for the MDA headquarters both downtown and on a green site in the greater Lansing area.

Thanks for reading my report. Remember to be an advocate for your profession by letting your legislators know that dentistry is primary care, and dentistry counts.

Norm Palm Stsorminnorman@msn.com

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F E AT U R E A R T I C L E

Evidence-Based Dentistry

By Dr. Bruce Weny, Editor

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hat is evidenced-based dentistry, and where did it come from? How will this affect the way we as dentists practice dentistry? What are we to do to accomplish what evidenced-based dentistry mandates? What and how we will practice?

The Problem In a lecture given by Dr. Myer Leonard, chairman of the Oral Surgery Department of the University of Minnesota School of Dentistry at the Mid-Winter meeting in Chicago, he said that: “In the 1960s, most in medicine thought that someday we would understand everything about the human body. In the 1990s, a medical school dean said that the human body is not only: ‘queerer than we thought it may be; it is queerer than we can ever think.’”

In the 1970s, a vast amount of scientific research came on line. Medicine was swamped with the information. If you were five years out of medical school you were already outdated.

MEDLINE, one of several noted systemic review panels to index articles, reviews some 34,000 articles in the 4,000 journals a month. The problem is, this is a mere fraction of the 100,000 scientific journals currently being published. Medicine started to establish standards by which one could evaluate scientific studies.

Look up the Reader’s Digest Special Report, February 1997

by William Ecenbarger. This article set off a fire-storm with its conclusions about dentists. He went to 50 different dentists and got 50 different treatment plans. Some plans called for a few hundred dollars of treatment to several thousand dollars worth of treatment. Some of you may remember “Dr. Paul Revere’s” book in the late 1960s. This was his pen name as it was not known who he actually was, but he called dentistry on the carpet for much the same thing.

In truth, the vast majority of the treatment plans in Mr. Ecenbarger’s article could be justified, it was just a matter of how far the patient wanted to go. He did find that a patient was five times more likely to “require” restoration changes if they changed dentists. There were other problems as well.

There were nine variations in antibiotic and hygiene procedures. There was a whole variety of occlusal caries detection and treatment protocols. These included: visual inspection, explorer, radiographs, illumination, Fl remineralization, sealant, amalgams, or only composites. Every one of these

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protocols is valid, but the patient does not understand that.

We do a poor job of explaining ourselves.

The Need The need for some type of clearing house to find the best solution for a particular problem was evident. Evidence-based decision making is a process which involves scientific evidence, experience and judgment, clinical and patient circumstances, and patient preferences or values. Of these four elements, I will discuss scientific evidence. This is the one that we as practitioners know the least about.

Everyone knows that nobody can keep up with the enormous amount of material in medicine and dentistry. Yet everyone expects us to be up to date with all procedures and possible outcomes. The further away from an academic environment you are in years, the more out of touch you are. I know there are some exceptions. For most of us who are not used to using a computer or reading research journals, this will take some time to work out. It is a lot easier to go to a course and have someone tell us what to do then go out and do it! The problem is that in a few years that information will be outdated, and so will we. One should ask if what we are being taught in the post-degree educational environment is in fact evidenced based.

First Step Help is on the way. There are some five skills to be learned.

• Asking clinically relevant and focused questions.

• Conducting an efficient computerized search of the literature.

• Critically analyzing what you have found.

• Applying it to patient care.

• Evaluating outcome of care and the process.

I will address the first three skills.

There are four parts to a question.

• Problem or Patient Question.

• Intervention • Comparison of interventions.

• Outcome This is called “PICO.” The “problem” part is: What are the most important characteristics of this patient? This may involve WEST MICHIGAN DISTRICT DENTAL SOCIETY | MAY/JUNE 2007

F E AT U R E A R T I C L E

primary problem, disease, age, race gender, etc. The second part, or “intervention” is: What do you want to do for that patient, or what is the patient asking you to do? This may include a procedure, a product, a technique, a medication, a diagnostic test, etc. The third step is a “comparison.” What is the main alternative, comparable procedure or product, same procedure with an additional step, etc. “Outcome” is the last step in the question. What can I hope to accomplish? This could be to add longevity, durability, improve esthetics, decrease caries, eliminate symptoms etc.

Examples Examples of PICO questions would be: • In children with active tooth decay living in fluoridated areas (problem), does fluoride toothpaste (intervention), as compared to non-fluoride toothpaste (comparison), result in fewer cavities? (outcome) • In patients with destructive periodontal disease (problem), is guided tissue regeneration (intervention), as compared to open flap debridement (comparison), more effective in regenerating periodontal tissue? (outcome) To review, a format might be something like: • “For A”(Define Patient/Problem? Or Population), “Will” (X-Intervention), “Compared to” (Comparison/Intervention), “Result In” (Outcome-equal, increase, decrease, ‘more effective’ is not an acceptable outcome, more effective in what way?)

Step Two There are several web sites to go to: http://pubmed.gov; http://www.cochrane.org; Google: Evidence-Based Dentistry or The Journal of Evidence-Based Dental Practice; MEDLINE, which is part of the National Institutes of Health (NIH), www.ncbi.nlm.nih.gov; The Health Information Research Unit at McMaster University in Hamilton, Ontario, http://hiru.hirunet.mcmaster.ca, Centre for Evidence-Based Dentistry at Oxford University, United Kingdom www.ihs.ox.ax.uk/cebd; Medical search engines: CliniWeb International, www.ohsu.edu/cliniweb; Medical Matrix, http://www.medmatrix.org; and don’t over look our own JADA. WEST MICHIGAN DISTRICT DENTAL SOCIETY | MAY/JUNE 2007

Step Three Now that you have some information the next thing to ask is what is in front of you? There are levels of evidence. A hierarchy of evidence exists to guide clinical decision-making. The lowest is “in vitro” (test tube) research, next is “animal research”; then “ideas,” “editorials” and “opinions,” next up is “case reports,” then comes “case control studies” (eg., a study of people who smoke and get lung cancer, and people who smoke and do not get lung cancer), above that are “cohort studies” (a study of two groups, one group with the problem and one group without the problem), almost at the top is the “random controlled trials” (RCTs). If several RCTs are combined and studied in a “systematic study,” you will have the gold standard for information which is called “meta analysis.”

You can have systematic studies in cohort and case control studies, but a meta analysis trumps them all.

Why is one better than another? It looks like case control studies are much the same as cohort studies. What goes here?

Bias is what each study tries to eliminate, and the higher the study, the less the bias. The old maxim is: Just because it is published does not mean it is good. A key question to ask is: Would your patient have met the inclusion criteria for the study?

As Time Goes By Most dental students are trained under the auspices of the so-called master teacher or clinician. Unfortunately, dental academicians have yet to develop a formula for training socalled master clinicians. As a result, dental students are taught by several inconsistent and sometimes contradictory teachers, and are trained to search for expert opinions and learn from the clinical experiences they encounter.

Some dental schools in our area, University of Indiana and the University of Michigan, are developing problem or casebased learning programs. These programs focus largely on the didactic portion of the curriculum rather than on learning through the provision of dental care. Problem-based learning can ensure that evidence-based practice is followed when students and their tutors rely on quality systematic reviews of evidence or critical appraisal of relevant scientific studies. It will take time to put a cadre of instructors who are themselves trained in evidence-based decision making. As time goes by, this will happen and will be part of the future of dentistry.

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F E AT U R E A R T I C L E

References Jane L. Forest, MS, EdD, USC School of Dentistry, Enhancing Clinical Practice Through Evidence-Based Decision Making, ADA Annual Session, Las Vegas, October 19, 2006 Amid Ismail, BDS, MPH, DrPH, James Bader DDS, MPH, Evidence-Based Dentistry In Clinical Practice, JADA, Vol. 135, January, 2004 Susan E. Sutherland, DDS, Stephanie Walker, MA, MLS, Evidence-Based Dentistry; PART III. Searching for Answers to Clinical Questions; Finding E-vidence on the Internet, Journal of the Canadian Dental Association, June 2001, Vol. 67, No. 6

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WEST MICHIGAN DISTRICT DENTAL SOCIETY | MAY/JUNE 2007

LOOKING AHEAD

WMDDS Looks Ahead

By Dr. Amy De Young, WMDDS President-Elect

W

hat does the 2007–2008 year have in store for WMDDS members? A whole lot!!! This year marks the 75th anniversary of the West Michigan District Dental Society. The year starts with the dedication of “Steel Water.” The Fluoride Commemorative Sculpture will be showcased in front of the new JW Marriott Hotel in downtown Grand Rapids. This artwork will be viewed by millions who will pass through the main entrance of this luxurious hotel in the heart of our fine city. A celebratory luncheon will follow the dedication ceremony, which will take place in mid September. Watch your mail for details!

The Program Committee has arranged for three outstanding programs for the 2007–2008 year. In October, we welcome Dr. Michael Miller who will be presenting information on the latest and greatest in dental materials. Dr. Paul Homoly will be here in January, and Dr. Corky Willhite rounds out our terrific schedule with his program on cosmetic restorations in March of 2008.

The 2007–2008 term will end with a “BANG” as Grand Rapids will play host to the Michigan Dental Association Annual Session. Our own Steve Dater will culminate his year of service as President of the MDA with his version of the President’s Dinner Dance, which promises to bring a great deal of fun and excitement to all who are able to attend.

Several of our dedicated members will continue to chair and serve on our committees. However, new ideas, new thoughts, and new ways of looking at things are needed to keep our committees interesting and current. If you have any interest in becoming involved in the WMDDS, I would like to place you on a committee that you find interesting and rewarding. I am working on a committee structure where current committee members are mentoring newer members to develop an easier and more consistent system for maintaining our committees and their functions.

Your 2007–2008 dental society board is made up of a young and dynamic group of dentists who are ready and willing to serve! If you have any questions, concerns, or suggestions for the WMDDS, don’t hesitate to call me or any of our board members! Together, we will make this a year to remember!!!

WEST MICHIGAN DISTRICT DENTAL SOCIETY | MAY/JUNE 2007

2007-2008 WMDDS Board of Directors Dr. Amy DeYoung President Phone – (616) 447-7900 Email – AKidsDDS@aol.com Dr. Doug Killian President-Elect Dr. Doug Klein Vice President Dr. Joe Kirkwood Secretary-Treasurer Dr. John Frey Immediate Past President Dr. Seth Vruggink 3rd Year Director Dr. John Klooster 2nd Year Director Dr. Larissa Bishop 1st Year Director Dr. Margaret Gingrich Mecosta County Representative Dr. Chris Morgan Ionia/Montcalm Representative Dr. Tyler Wolf Ottawa County Representative Dr. Paul O’Grady Kent County Representative Dr. Bruce Weny Editor Dr. Norm Palm MDA Trustee Dr. Connie Verhagen MDA Trustee Elaine Fleming Executive Secretary

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MDA NEWS

Peters Announces Candidacy for MDA Speaker Submitted by Dr. Chris Smiley

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ith a great deal of enthusiasm, former WMDDS together on the southeast side of Grand Rapids. She also held president Deb Peters announced her candidacy a faculty position as an instructor of head and neck anatomy for the office of Speaker of the Michigan Dental and clinical dental hygiene at Kalamazoo Valley Community Association’s House of Delegates. Not since Gene Bonofiglo in College prior to starting their family. the 1980’s has a West Michigan member The Peters have two children, held this statewide post.

Madison and Kyle, ages 10 and 8.

Deb’s history with the MDA House Maddy enjoys playing soccer yearbegan as a student delegate and continround for the Kentwood Falcons. Kyle ued as a member of the delegation from loves Legos and playing guitar. Both the West Michigan District since 1997. children are active in Scouts, so Deb On the national level she has served on and Dan serve as leaders for Cub Scouts the MDA’s delegation to the ADA and Girl Scouts.

House since 1999. Through participaDeb notes that she “greatly enjoys tion in both the MDA and ADA houses, her time serving organized dentistry on she has fostered an expertise in parliathe local, state, and national levels,” and mentary procedure and a love for the feels that she has more to give. It’s eviprocess. Deb’s service to our profession dent that her experience and enthusiconfirms her ability to act as a presiding asm for the dental profession and our officer and consensus builder. We know Association will make her a fitting her as a Past President of our compochoice to serve as our next Speaker of nent, but you may not be aware that she the MDA’s House of Delegates.

Deb Peters, a Speaker for the House of Delegates was Chair of the MDA’s Special The campaign will require Deb to Committee on the New Dentist or that she currently serves as visit component societies around the state, culminating with Chair of the ADA’s Council on Membership. an election next April at the 2008 MDA Annual Session in Deb was a practicing dental hygienist prior to returning to Grand Rapids. If you have any suggestions or would simply dental school. She and her husband Dan are 1993 graduates of like to offer her a word of encouragement, you can contact the University of Michigan School of Dentistry and practice her at DebPeters@SmileMichigan.com.

Volunteerism Survey – See Page 12 The staff members of the WMDDS Bulletin have decided to survey the membership to see how many dentists in the West Michigan area donate their own time and resources for the benefit of those who are underserved. Included in this issue of the Bulletin (on page 12) is a short survey requesting any information that you can share with us regarding your efforts or the efforts of others you know who have volunteered to serve those less fortunate. While we would appreciate you providing your name and a way to contact you (in case we have more questions or need more details), your anonymity will be protected if you wish. The information from this

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survey will be used so we can identify and visit the clinics in our area that provide dental care to the needy, as well as get an accurate idea of how much free or reduced fee dentistry is provided in offices by our membership. Ultimately this information will be published in the Bulletin. There are probably many of you out there who would like to volunteer but simply don’t know where to start or who to contact.

Participation in this survey will help us to get this information to you.

Please retur n the sur vey ASAP to Dr. Tar a Mea chum Fax to: 616.754.0519 Mail to: 117 West Cass Street, Greenville, MI 48838 WEST MICHIGAN DISTRICT DENTAL SOCIETY | MAY/JUNE 2007

MDA ANNUAL SESSION

West Michigan Delegation Shines at Annual Session

By Dr. Chris Smiley

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he 2007 Michigan Dental Association’s Annual Session was held May 2nd through May 5th at Cobo Hall in Detroit Michigan. The West Michigan District Dental Society was represented by delegates Sam Bander, Brian Cilla, Amy DeYoung, John Frey, Matt Gietzen, Doug Killian, Greg Oppenhuizen, Deb Peters, Chris Smiley, and Bruce Weny. Alternates Delegates included Kathy Eisin, Laura Fogle, Margaret Gingrich, Jim Hur, Joe Kirkwood, Doug Klein, Ryan Lebster, Brad VanHoose and Seth Vruggink.

Our delegation deliberated over several issues including revision of the MDA’s position statement on access to care through the State of Michigan’s Dental Medicaid Program and ethical concerns on how members should provide “after hours coverage” for patients in need of emergency care.

WMDDS’ Margaret Gingrich spoke eloquently in testimony before the House of Delegates raising concerns about a resolution that could impact her ability to purchase prescription medication in bulk for distribution on mission trips.

Delegation Chairman John Frey noted “It was great seeing our delegates and alternates share time on the floor of the House.

Everybody worked well together, and individual expertise was expressed effectively by our delegation.”

Beyond conducting the business of the House, those attending had several opportunities to enjoy Detroit, including

Sam Bander instructs Delegation members Doug Killian, Laura Fogle, Matt Gietzen and Margaret Gingrich on how to load up on caffeine to stay sharp on the floor of the House of Delegates.

WEST MICHIGAN DISTRICT DENTAL SOCIETY | MAY/JUNE 2007

Delegate Greg Oppenhuizen shares the Cinco de Mayo spirit at the West Michigan Fiesta hospitality suite!

the Dental Foundation Golf Outing and an evening at a Detroit Symphony Pops concert. WMDDS President Amy DeYoung worked with 3rd year WMDDS Director, Dr. Joe Kirkwood, and WMDDS Executive Secretary Elaine Fleming to successfully organize a “Mexican Fiesta” theme at our hospitality suite. The fajita buffet proved popular as the suite was filled to the brim with dentists from throughout the state!

Excitement at the meeting also included the election of our own Steve Dater as this year’s President of the Michigan Dental Association. In his inaugural address, Steve challenged all members of our Association to become involved in the grassroots political process and to contribute to the Dental PAC of Michigan.

Next year’s state meeting will be held in Grand Rapids April 16–19, 2008 and will include a “President’s Dinner” to honor Steve for his years of service to organized dentistry. Please mark your calendars now and plan to join the fun and take advantage of all the great CE offerings right here in our own back yard!

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Volunteerism Survey Hi Everyone, We, the editorial committee of the WMDDS, are trying to figure out how much charity dentistry there is in West Michigan. We are compiling information not just for an article in the next Bulletin, but also as a resource base for dentists in the area. Maybe this information will even reach the Grand Rapids Press. Please give us a few minutes of your time to fill this out and either fax or send it in. We would appreciate it if for each program you list below you could include a contact name and number if possible.

1) What do you do through your office throughout the year? (ie, our staff picks one case per year to treat at no charge to the patient)

__________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ 2) What do you do in your office through established programs throughout the year? (Adult Dental Services, DDS, etc.)

__________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ 3) What programs outside of the office do you participate in? (Miles of Smiles, Mel Trotter, Clinica Santa Maria, etc)

__________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ 4) Are there other ways in which you donate your time or services either locally, nationally, or internationally?

__________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ 5) If you have any information to add or would like to possibly be contacted regarding charity dentistry, please list your name and phone number below and we will contact you.

__________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ Please fax to 616-754-0519, or mail to: Dr. Tara Meachum, 117 West Cass Street, Greenville, MI 48838

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WEST MICHIGAN DISTRICT DENTAL SOCIETY | M AY/JUNE 2007

PROGRAM REVIEW

System Meltdown: The Hidden Signals Submitted by Dr. Tara Meachum

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on’t you hate it when half of your staff are ISFJ’s and the other half are ENTJ’s, and all you want to do is focus on dentistry? Those of you who attended the Sally McKenzie (an ESTJ) Management course entitled “System Meltdown: The Hidden Signals” probably understood that. Sally McKenzie has been in dentistry for 40 years. She began as an assistant when she was 16 years old, and has been in business since 1980. Her business centers on helping dental offices run smoothly by keeping their systems in check. She has a realistic and refreshing approach, and appreciates the fact that all offices are not created equal. Not everyone wants to create a group practice or become a multimillion dollar production machine. If you make a conscious decision to be a solo practitioner (or any other philosophy you have), you have to accept the consequences. “If it’s OK with you, then it’s OK … but no whining!” was a common mantra that ran throughout her presentation. She realizes that what seems broken to one dentist may not be to another dentist.

McKenzie Management has many ideas on how to work smarter, not harder. One of the most important pieces of information Sally imparted was to measure any changes that are made. You have to know if the change had a positive or negative effect on the practice. You can’t always go with a gut feeling if you want to be successful. You should measure performance on both the norms for the industry and your expectations. Most practices measure collection ratio, accounts receivable, production, and number of new patients, but there are many more.

Sally advises continually monitoring your systems. You may make a change and see that it has a positive effect on your practice, but you must still measure that change. Five or ten years down the road, both the types of patients in your practice and the economy will most likely change, and you may need to change your system to accommodate that.

The number one reason systems break down is because the front office staff members have no training. Dentists seem to put up with mediocrity from business administrators and they don’t from any other staff member. Hygienists come to

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your office already professionally trained, and you work side by side with your assistants.

To improve productivity in your front office, consider this: it takes an average of 10 minutes total to check a patient in and out. If you have 35 patients a day, that equals 350 minutes per day tied up with this task alone. This should equal just over half of an employee’s work day. For example, one person can process 22-24 patients per day. Sally also recommends that you have a financial coordinator and a scheduling coordinator in the front office. The patient will stop at both positions upon exiting. This prevents the employees from overlapping jobs. Each staff member should be responsible for very specific tasks. If more than one person is doing the same thing, the right hand doesn’t know what the left hand is doing. They spend unnecessary time asking where their co-worker left off, which tasks need to still be performed, and which tasks need to be completed.

To increase your collections, it’s important to add value to your services so your patients understand what their money is going toward.

It’s imperative to use the patient’s name and embellish the services performed. For example, “Mrs. Jones, Dr. Smith performed fillings on two teeth that involved five surfaces plus medications and anesthetic. That will be $226. Will you be paying by cash, check, or bank card?” Never ask yes or no questions. Ask questions that elicit the answers you want to hear. Also, make it easy for your patients to pay you. Have a sign that says “Make checks payable to…” and have a swiper for credit cards. When you send out statements, include a return envelope, itemize services for 60 days (not “balance forward”), and have a specific due date on them. Sally also advises offering your patients Care Credit to give them an option to extend their payments.

Many dentists prefer to block schedule. In order to be successful at this, you must schedule for reality, not your vision.

Don’t consistently get patients in for crown and bridge appointments in two to three days while fillings are being scheduled out four to five months. This leads to poor customer service.

WEST MICHIGAN DISTRICT DENTAL SOCIETY | MAY/JUNE 2007

PROGRAM REVIEW

Dr. Karen O’Rourke and Dr. Bruce Weny

A tip for improving your hygiene department is to stop pre-scheduling appointments. This leads to an average of 1.3 openings per day as opposed to 0.5 broken appointment/no shows per day per hygienist.

Aside from systems management, Sally spoke about personality traits and how certain traits are better suited for certain positions. People are either extroverts (E) or introverts (I), sensing (S) or intuitive (N), thinking (T) or feeling (F),

and judging (J) or perceiving (P). Sally recommends giving all staff members and potential employees the Keirsey Temperament Sorter Test found in the book Please Understand Me by David Keirsey. Knowing which categories your employees fall under will help you to understand their inherent strengths and weaknesses. For example, ISFJ’s will walk on hot coals to avoid confrontation and ESTJ’s have poor listening skills and no patience. Do you really want an ISFJ responsible for making delinquent phone calls? That staff member may be better suited for a different position.

Sally opened up about her troublesome personal life growing up. She made an impassioned speech about getting help going for therapy to “fix your brain.” If something is wrong with any other organ in our body, we’re quick to repair it, but not our brains. Many professionals are bipolar or depressed, and all of these dysfunctional traits make us feel bad. If we want to be successful, we need to have enough confidence in ourselves to sell our treatment. If we don’t break this vicious cycle, we will pass it on to our children.

Sally spoke on ways to prevent meltdowns in all areas of office management such as: production, accounts receivable, scheduling, hygiene department, staffing issues, recall, and insurance. The aforementioned ideas are just the tip of the iceberg. McKenzie Management offers additional reading topics and other services at www.mckenziemgmt.com.

Future MDA Annual Session Dates Mark Your Calendars!

2008 April 16 –19 Grand Rapids

2009 April 22 – 25 Lansing

WEST MICHIGAN DISTRICT DENTAL SOCIETY | MAY/JUNE 2007

2010 April 21 – 24 Detroit 15

T O O T H S O M E TA L E S A N D O R A L O D D I T I E S

Tongue In Cheek Dental History Excerpts from the book Toothsome Tales and Oral Oddities, by James Wynbrandt

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ooth pain and the consequent seeking for some remedy for the pain has put our species on a quest for thousands of years. The Romans experimented with pain eradication sometimes with lethal results. One recommended method called for bringing pressure to the great carotid arteries in the neck, thereby diminishing the blood flow and inducing unconsciousness, a technique later used successfully by “Mr. Spock” on Star Trek. However unfortunate for the Romans, some of their patients’ minds ceased to function altogether. Maybe this lead to “up-front money” before treatment.

Galen killed pain during extractions by applying picked root of pyrethrum, or chrysanthemum, to the teeth and gum.

The corrosive concoction destroyed and loosened the periodontal membrane and attachment fibers holding the tooth in place as well as deadening pain. Its power was such that the neighboring teeth were shielded by a coating of wax to prevent unnecessary tooth loss. This was the first attempt at loss control and risk management. Galen reported he could perform extractions using his bare fingers following the application. This medication had some power; one could even clean drains with this, a possible spin-off use and all natural as well. Galen stopped using his fingers as his finger tips were gone after several extractions. No doubt expendable assistants were used for this procedure.

Mandrake was one of the empire’s primary painkillers, and was the main ingredient of a nerve-deadening soporific, or sleep inducing medication, that was popular during the reign of Nero. Pliny, the archivist of misinformation, wrote that mandrake grew in both male and female varieties, which lead to erroneous assertions that carried forward after the fall of Rome. The medieval mandrake hunters were warned against the terrible scream the plants would make when picked. It was advised that to capture the mandrake, hunters should “Stuff their ears with good bees’ wax, sift the earth around the mandrake and then attach a long piece of string to a dog’s tail. See that this dog is either ailing or at the most very small and worthless. Then tie the other end of the string to the mandrake and give a sharp kick to the dog. As the creature jumps forward, the root will give its dreadful cry and the dog instead of a man will go mad or drop dead. This lasted only until they ran out of dogs stupid enough to do this.

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As Europe awoke from its medieval slumber, new methods of sensory deprivation were developed. In 1220 Hugo de Lucca introduced “spongia somnifera” or sleep sponges.

Soaking sponges in a concentrated solution of opium, hemlock, henbane, mandragora, lettuce seeds, and other powerful additives, then drying them in the sun to prepare them. When it came to inducing anesthesia, the sponges were soaked in hot water and applied to the nostrils. When it was time to resuscitate the patient a sponge or cotton lint soaked in vinegar was substituted. Guy de Chauliac and other surgeons of the era used these sponges.

During the same age, anesthetics progressed from natural substances to man-made chemicals with the discovery of ether. Among those credited with first identifying ether are the twelfth-century Arabian chemist Yeber and the monk and alchemist Raymond Lullus (1235-1315), both of whom presumably stumbled upon it while trying to turn base metal into gold. Lullus recognized its anesthetic properties, calling it “ sweet vitriol.” The rest of the world remained ignorant of its potential in pain management consequently suffering centuries of needless suffering.

Paracelsus discovered the properties of ether independently in the early 1500’s. Reportedly he had mixed sulfuric acid with alcohol and was heating the mixture when a whiff of the resulting gas wafted his way, semi sedating him and giving him the sudden realization of its potential. He later experimented on chickens and found it could induce sleep. Still the medical and dental communities ignored the promising palliative treatment. One wonders, given the explosive nature of ether, how he managed not blow the place up.

The medieval world had another shot at putting ether to work when Valerius Cordus independently discovered it yet again in 1542. Finally, an English chemist dubbed it “ether” in 1730.

Why were either’s beneficial properties overlooked for so long? Some might suggest those inflicting pain had little vested interest in its reduction. Even after either’s widespread acceptance in the late nineteenth century, some physicians opposed its use, contending the sensation of pain was a requirement for the body to survive an operation. “Here, let me cut you open and remove part of you with no pain killer and this will make you a better person and a stronger patient.” How long would that survive today? What a practice builder! You know, WEST MICHIGAN DISTRICT DENTAL SOCIETY | MAY/JUNE 2007

T O O T H S O M E TA L E S A N D O R A L O D D I T I E S

it was not so long ago that local anesthetic was not used for routine operative dentistry. That would not go over at all today!

With no other anesthetics in the R&D pipeline, the use of cold to deaden nerves was reintroduced early in the 1600’s but for all the opium, ether, sponges and ice eliminating the horrific pain of an extraction remained beyond the reach of dentistry.

There was the occasional flash from the pain-fighting front, but little of substance. In 1774 Franz Anton Mesmer, an Austrian physician, introduced magnetic cures, known as Mesmerisms, into medicine. Magnets were already popular in quack remedies. Mesmer believed the true source of magnetism’s therapeutic power came from within the individual. His techniques were meant to harness that inner human force. He achieved admirable success treating what we would term psy-

chosomatic illness, but his acclaim alarmed other physicians.

A committee formed by University of Vienna to investigate his methods and recommended a cessation of his “fraudulent practice.” Little did they know this treatment would be resurrected by the shoe industry in the United States in the 1990’s.

Do you remember magnets being promoted to help arthritis etc? They were put in shoes and used in wraps around the knees. Wow! Have we progressed!

Hounded from his home country, Mesmer moved to Paris, published “Memoir on the Discovery of Animal Magnetism,” and opened a clinic in the Hotel Bullion on Rue Montmartre.

The results of Mesmerism’s use for pain relief during dental procedures were less that encouraging. A commission formed by the French government ultimately discredited him.

You’ve got bigger things on your mind than banking. We don’t.

51 ionia avenue sw grand rapids, mi 49503 616.454.0156 tboh.com

WEST MICHIGAN DISTRICT DENTAL SOCIETY | MAY/JUNE 2007

person to person

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MEDICAL NEWS

Antibiotic Resistance: Are Macrolides Next?

By Kristi L. Koenig, MD, FACEP Sourced from Journal Watch, Emergency Medicine, March 30, 2007, Massachusetts Medical Society

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hort courses of azithromycin and clarithromycin led to increases in the proportion of macrolide-resistant streptococci in healthy adults.

Growing antibiotic resistance is a major public health concern, but few studies have demonstrated a causal relation between antibiotic exposure and resistance in individual patients. In a double-blind, placebo-controlled study, researchers randomized 224 healthy adults to receive azithromycin (500 mg once daily for 3 days), clarithromycin (500 mg twice daily for 7 days), or placebo and measured macrolide resistance in oral streptococcal flora before and after treatment.

The proportion of macrolide-resistant streptococci increased significantly in both antibiotic groups compared with the placebo group, and this difference persisted for six months. Resistance was highest on day 8 (the day after treatment) in the clarithromycin group (mean increase, 50%) and on day 4 in the azithromycin group (mean increase, 53%). Use of clarithromycin, but not azithromycin, was associated with selection for the erm(B) gene, which confers high-level macrolide resistance and resistance to other antibiotic classes.

An editorialist reminds us that the potential for penicillin allergy makes macrolides a popular antibiotic choice, and that increased macrolide resistance will further limit effective treatment options for patients who truly need antibiotics.

Comment: We are already seeing methicillin-resistant (and even vancomycin-resistant) Staphylococcal aureus run rampant. Are macrolides next? These data should frighten you enough to redouble your efforts to avoid overprescribing antibiotics.

Citations Malhotra-Kumar S et al. Effect of azithromycin and clarithromycin therapy on pharyngeal carriage of macrolideresistant streptococci in healthy volunteers: A randomised, double-blind, placebo-controlled study. Lancet 2007 Feb 10; 369:482-90. [Medline速 abstract] Dancer SJ. Attention prescribers: Be careful with antibiotics. Lancet 2007 Feb 10; 369:442-3. [Medline速 abstract]

New Dentist Forum Golf Outing Friday, August 2, 2007 Cedar Chase Golf Club 12:00 noon shotgun start For more details, contact Dr. Devin Norman at 616.676.9177 18

WEST MICHIGAN DISTRICT DENTAL SOCIETY | MAY/JUNE 2007

GRDHS NEWS

GRDHS Receives MDA Public Service Award

By JoAnne Hodder, RDH, BS

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he Michigan Dental Association presented its Public Health Outreach program. The Grand Rapids Dental Hygienists’ Service Award at the President’s Dinner held at the Society provides the leadership and organizational skills for Detroit Marriott Hotel, program set up and follow up, on Friday, May 4, to the Grand as well as recruitment of volunRapids Dental Hygienists’ Society teer dentists, hygienists, and for its Community Dental Health assistants. The West Michigan Dental Foundation provides the Outreach Project at Mel Trotter funding through a grant to purMinistries’ Dental Clinic. chase supplies. The Mel Trotter GRDHS President Sara Rydman, Ministries provides the inand CDHO Chair JoAnne house dental clinic, their perHodder, accepted the award on sonnel, and access to the underbehalf of the Society. These are served population through their JoAnne’s remarks that evening: residents and community serv“One morning last January, I ices. This is truly “a mission in watched Good Morning America our own backyard.” as Diane Sawyer interviewed the Each of us in our own right 16 women representatives and senators in our Nation’s con- CDHO Chair JoAnne Hodder (left), and GRDHS President Sara can make a difference, but all of gress. Diane asked them what Rydman (right), accept the MDA Public Service Award presented to the us working together have made a change in the dental health of they hoped to accomplish, and Grand Rapids Dental Hygienists’ Society these clients. one of the senators replied.

We are humbled by this award, and gratefully share it with “Each us here can make a difference. All of us together can our partners in dentistry, the West Michigan Dental make a change.”

Foundation, and Mel Trotter Ministries. Thank you.

That embodies the whole concept of the Community Dental

Letter to the Editor Dear Editor: My sincere thanks to the following persons who donated not only their time, but drove the miles to take part in the West Michigan Dental Foundation Tuition Grant Applicants’ interview process: Dr. Pete Garchow, Dr. Matt Gietzen, Carol Klein, R.N., Dr. Devin Norman, Dr. Greg Oppenhuizen, and Dr. Erick Rupprecht.

With a record number of dental, dental hygiene, and dental assisting students making application for grants this year, it goes without saying that the volunteer spirit of these current and former WMDF Board members is greatly appreciated. It takes some time and a bit of effort, but this interview process is not only beneficial to the students and enjoyable for the interviewers, but gives all of those participating a small glimpse of the bright future for the dental community in West Michigan.

Rosemary Jeruzal WMDF Tuition Grants Committee

WEST MICHIGAN DISTRICT DENTAL SOCIETY | MAY/JUNE 2007

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FINANCIAL NEWS

Are You Prepared for the Retirement Red Zone?

By Douglas A. Kliewer, Prudential Financial Planning Services

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f a secure retirement is your highest financial goal, understanding the potential pitfalls should be one of your greatest concerns.

Retirement planning is an emotional subject. Many people fear they are not saving enough. Others are confused about their investment options or unsure if their savings are invested aggressively enough. Still others may be saving and investing wisely, but are concerned they simply started too late. But for everyone, there is a ten-year period of time – five years before and five years after retirement – that is especially critical.

Prudential Financial has dubbed this time period the Retirement Red ZoneSM, and has issued a recent research study bearing the same name.

Retirement planning is all about managing risks – such as the risk of inflation eroding retirement savings, the risk of a market downturn depleting needed assets, the risk of a major illness or disability, or longevity risk – the risk of outliving your retirement assets. The Retirement Red Zone is a particularly important time when it comes to managing risks, because, for many, it’s the time they can least afford them. It’s also especially significant for women, who tend to have fewer retirement resources of their own, and who are more likely to be on their own at some point in their retirement years.

Key Retirement Red Zone survey findings include: • 63 percent of participants were not aware of the long-term impact of investment losses experienced in the Retirement Red Zone.

• If faced with an investment loss just before or early in retirement, 41 percent said that they would expect to keep working or return to work.

• Nearly seven in ten said they needed to rethink how conservatively or aggressively they should invest.

• Over half wondered if they should be seeking out better financial advice.

• 51 percent will decide whether to purchase products that generate retirement income during this timeframe.

What You Can Do to Prepare Seek advice. Whether you are just starting out in the work force or halfway to retirement, the most productive thing you

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can do is seek professional advice. Meet with a financial professional to analyze your current investment strategies and to become educated on products and services, which can offer you long-term retirement security.

Consider long-term care needs. Inevitably, many of us will need some type of long-term health care as we approach our retirement years. The right long-term care insurance plan can help you protect your retirement funds and give you the flexibility to be involved in decisions about your future care. The cost of long-term care insurance depends on your age, the benefits you choose, the length of coverage and other factors.

Consider life insurance. Take stock of everything you do for your family so you can understand the value of what you provide in addition to your income. You work hard to help your family have a comfortable life. Life insurance can help ensure your family will be taken care of and continue to let you be part of their future if you were no longer around.

Create a cash reserve. Cash reserves are sometimes an overlooked component in the retirement plan. It’s a good idea to set aside cash that can carry you for several years, while investing the remainder in your growth portfolio. Review your accounts every six to 12 months to maintain a healthy balance between investments and cash reserves.

Investigate Annuities. An annuity with a guaranteed lifetime annual payout can help insure you against poor returns on other investments, and help protect you against the risk of outliving your assets. As with every other potential scenario, there are many personal variables, but in general, the combination of delaying Social Security and purchasing an annuity can be a powerful planning solution to manage longevity and investment return risks.

Consider a Reverse Mortgage. If your home is paid for when you retire, and you choose to stay in it, you may consider a reverse mortgage. Reverse mortgages pay you a monthly income out of your equity and the money does not have to be repaid as long as you are living in the home. Upon your death, the loan would be paid out of the proceeds from the sale of your home. Meeting with a financial advisor can help you determine if this is a viable option for you.

Unfortunately, there is no one-size-fits-all solution for retirement planning. Most of us will need professional supWEST MICHIGAN DISTRICT DENTAL SOCIETY | MAY/JUNE 2007

FINANCIAL NEWS

port to determine a plan that will maximize and protect our retirement assets. Meeting with a qualified financial professional now can help you map out your intentions and safely navigate the “Retirement Red Zone” when the times come. For more information, visit www.prudential.com.

Douglas A. Kliewer is a Financial Planner, with the Prudential Financial Planning Services, a division of Pruco Securities Corporation, a Prudential Financial Company. His office is located at 502 Northland Dr., Rockford, MI 49341.

IFS-A126420, Ed 11/2006

WEST MICHIGAN DISTRICT DENTAL SOCIETY | MAY/JUNE 2007

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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.

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.

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.

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.

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.

Thinking about Buying or Making a Practice Change? Talk to us in Confidence – 100% financing for buying or selling a practice. We sell more professional practices than anyone.

Getting the right people together for over thirty-five years. Qualified as an expert in valuations by Michigan courts. Licensed broker. Registered member of National Association of Real Estate Appraisers. Call Paul or Brian Goldman at The Goldman Group, 800.834.1993.

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.

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.

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Busy Dental Practice for Sale – NW lower Michigan, beautiful and growing community, good school system, yearround recreation. Transition and terms negotiable. Contact Elaine Fleming at 616.234.5605 for information.

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.

Associate Dentist Wanted – Full-time for a group practice. Minimum two years of experience preferred. Busy, productive practice with opportunity to perform all aspects of general and cosmetic dentistry. For more information, contact Janie at 616.942.3343.

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.

General Practice Opportunities in Michigan (FT or PT) – Current openings in state correctional facilities in Muskegon and elsewhere. Avoid business stresses of private practice. Call Ken, Richard, or Ed for details at 800.600.9313.

WEST MICHIGAN DISTRICT DENTAL SOCIETY | M AY/JUNE 2007

CLASSIFIED ADS

ADVERTISER INDEX

The Bulletin wishes to thank our valued advertisers who support organized dentistry by helping to defray the cost of printing and mailing.

Looking for an Associate or Buyer for Your Practice? For over fifteen years, Peak Performers has assisted hundreds of practices in finding the right candidates. The NEW Peak Associate Placement and Transition Programs allow you to customize the services you need for your search.

You select the options that fit your individual needs and your budget.

These options range from doing it yourself, to our renowned full service support. Utilize as little or as much of our resources and experience as you need. See additional information at www.peakdental.com or call 888.477.7325.

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.

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.

Holland – Associate needed for productive, growing, fee-for-service, general practice. Part-time could grow into full-time in approximately a year.

New, spacious office building. Great staff, friendly atmosphere. Holland was voted one of the top five communities in the country to retire. Call Kate at 616.399.4490.

For Sale – 1998 Gendex GX-Pan, $4500. Also available: 1970 Moss Lateral Ceph. Make offer. Call 538.5920 Mon.–Thurs.

Dental Office for Lease – Sparta, MI. Classy, finely-appointed 2000 sq. ft. suite, Sparta Ave. and M-37, roadside signage, recent $75,000 renovation, $12 sq. ft., plus utilities. 616.874.4192.

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!

Bank of Holland................................17

Centric Laboratories............outside back cover

CPR for Healthcare Providers ..........23

Davis Dental Laboratory................inside front cover

Founders Bank & Trust.......................8

MDA IFG...........................................24

ProNational...............inside back cover

Prudential Financial..........................21

Sullivan-Schein .................................13

WEST MICHIGAN DISTRICT DENTAL SOCIETY | M AY/JUNE 2007

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WEST MICHIGAN DISTRICT DENTAL SOCIETY | M AY/JUNE 2007

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

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