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The voice of the Washington State Dental Association

GIVING BACK: WSDA Members from around the state share their GKAS event photos th e wsda ne w s · issue 4, march · 2013 · www.wsda.org · 1


PREMIER BUILDER OF DENTAL FACILITIES CONTACT US TODAY

GENERAL DENTISTRY PEDIATRIC ORTHODONITIC ENDODONTIC PERIODONTIC PROSTHODONTIC COSMETIC DENTISTRY ORAL SURGERY MAXILLOFACIAL SURGERY

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206.957.4400 | CONSTANTINEBUILDERS.COM

ENDORSED


Dr. Marissa Bender at 2013 Dental Action Day

WSDA news Cover story by Rob Bahnsen Dental Action Day photos by Anita Nowacka Cover photo courtesy of the Pierce County Dental Society

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editorial

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guest editorial

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cover story

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pndc news

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giving back: dr. mike buehler

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legislative news pictorial: dental action day

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issue 4 · march 2013

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the source: mercer advisors

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wohf news

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in memoriam

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nordic news

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giving back: walla walla clinic

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classifieds

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clinical corner

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parrish or perish

Like us on Facebook: www.facebook.com/WashingtonStateDentalAssociation WSDA News Editor Dr. Mar y Jennings Editorial Advisor y Board Dr. Victor Barry Dr. Richard Mielke Dr. Jeffrey Parrish Dr. Rhonda Savage Dr. Robert Shaw Dr. Mary Krempasky Smith Dr. Timothy Wandell Washington State Dental Association Dr. Danny G. Warner, President Dr. David M. Minahan, President-elect Dr. Gregory Y. Ogata, Vice President Dr. Bryan C. Edgar, Secretary-Treasurer Dr. Rodney B. Wentworth, Immediate Past President Board of Directors Dr. Theodore M. Baer Dr. Dennis L. Bradshaw Dr. D. Michael Buehler Dr. Ronald D. Dahl Dr. Christopher Delecki Dr. Christopher W. Herzog

Dr. Dr. Dr. Dr. Dr. Dr.

Gary E. Heyamoto Mary S. Jennings Bernard J. Larson Christopher Pickel Lorin D. Peterson Laura Williams

Director of Government Affairs Bracken Killpack

Association Of fice: (206) 448 -1914 Fax: (206) 443 -9266 Toll Free Number: (800) 448 - 3368 E- mail: info@ wsda.org/w w w.wsda.org

Art Director/Managing Editor Robert Bahnsen

In the event of a natural disaster that takes down the WSDA web site and email accounts, the WSDA has established a separate email address. Should an emergency occur, members can contact washstatedental@gmail.com.

WSDA Staff: Executive Director Stephen Hardymon

Manager of Continuing Education and Speaker Ser vices Craig Mathews

Assistant Executive Director Amanda Tran

Government Affairs Coordinator Michael Walsh

Director of Finance Peter Aaron

Membership Ser vices Coordinator Laura Rohlman

General Counsel Alan Wicks

Exhibits and Sponsorship Ser vices Coordinator Katie Olson

Director of Operations Brenda Berlin Director of Membership and Comunications Kainoa Trotter

Bookkeeper Joline Hartman Office Coordinator Leon Sandall

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The WSDA News is published 8 times yearly by the Washington State Dental Association. Copyright © 2012 by the Washington State Dental Association, all rights reserved. No part of this publication may be reproduced without permission of the editor. Statements of fact or opinion are the responsibilit y of the authors alone and do not express the opinions of the WSDA, unless the Association has adopted such statements or opinions. Subscription price is $65 plus sales tax per year for 8 issues of the News. Foreign rate is $97.92 per year. Advertising is published as a service to readers; the editor reserves the right to accept, reject, discontinue or edit any advertising offered for publication. Publication of advertising materials is not an endorsement, qualification, approval or guarantee of either the advertiser or product. Communications intended for publication, business matters and advertising should be sent to the WSDA Office, 126 NW Canal Street, Seattle, Wash. 98107. ISSN 1064-0835 Member Publication American Association of Dental Editors. Winner: 2012: Journalism Award, Best Newsletter, Division 1, 2012: Platinum Pencil Award Honorable Mention (2), 2008: Best Newsletter, Division 1, 2007 Platinum Pen Award, 2006 Honorable Mention, 2005 Platinum Pencil Award, 2005 Publication Award; International College of Dentists

table of contents issue 4, march 2013

a day in the life


editorial dr. mar y jennings

The deliciousness of giving

Last Monday, my nonprofit clinic caught on fire! I had to triage patients in the parking lot. As soon as I could, I ran over to a nearby clinic of ours where we were diverting patients. While restoring a tooth on a happy five-year-old patient, I caught my breath and thought, “Crisis managed…yea!” Then she threw up on me. As I drove home that night, still smelling of someone else’s mac and cheese, I thought about that child. Her father did not have any money for treatment and was clueless about how to help himself, much less her. My little patient was a sweet, tiny child with filthy, rough nails and worn clothes that had more than a just a few days worth of kid dirt. For many reasons, I wished her food had stayed inside her. I think every dentist worries about their patients and their lives. We have a unique vantage point to see poverty, neglect, the effects of depression and many other problems that I wish did not exist. I am lucky to share our nonprofit clinic with Dr. Sherwin Shinn. He is a warm cheerful man, and a great dentist. He finds humor in the smallest things and is an engaging conversationalist. He told me a secret a few weeks ago — he was selected as ADA Humanitarian of the Year. That achievement follows on the heels of being awarded the 2003 National Jefferson Award, and WSDA’s Citizen of the year. Dr Shinn has been volunteering, writing and lecturing about how to help underserved people all over the world for over 22 years. He is the founder of For World Wide Smiles and two other dental charities. I asked him why he gives. He said it was “delicious.” Helping others makes a warm feeling inside that is so indescribable and so wonderful that you just want to have that feeling again and again. It never gets old. Seeing Dr. Shinn’s sheer joy while explaining that brings tears to my eyes, and makes me want that experience too. I am also lucky to have watched the Spokane Dental Foundation partner with the Yakima Valley Farm Workers Clinic to create a non-profit clinic in Spokane. Area dentists volunteer while YVFW provides the space and the management systems. In this clinic setting everybody wins! Both general dentists and specialists get the opportunity to volunteer in a nice setting, with great stability and support. YVFW dental residents get to work right alongside dentists to learn and grow from the their association with them. The uninsured, working poor, and other vulnerable people are provided excellent care on a sliding fee scale. It is a perfect model for dental community giving. This month’s News is filled with pictures and stories of all your Give Kids a Smile events. We are celebrating you! Most of you do not limit yourselves to volunteering just one month a year. You help your patients and others every day. You volunteer for Rotary, your church and little leagues. You set a standard and serve as an example. That brings tears to my eyes, too. The best thing about dentists is that most of us really went into dental school to help people. We all joke that we had to say that during dental school interviews but most of us really meant it. I think giving shots and basically hurting people to help them all day long is a hard thing for any human to do to another human. On many levels, it’s just not right. To do something that difficult takes grit, tempered with kindness and empathy. Those professionally developed traits carry into everyday life. I think the experience fosters a humaneness that only those who have seen the elephant can really understand. These are tough times to be human. We have psychotic shooters on the loose, and the economy has many people just barely staying afloat. And yet we still work hard and give our talents to others. We remember to be human first. We learn, in spite of all the badness, the “delicious “joy of selfless giving. That is really what makes us special.

Dr. Mary Jennings Editor, WSDA News

“I think every dentist worries about their patients and their lives. We have a unique vantage point to see poverty, neglect, the effects of depression and many other problems that I wish did not exist.”

Dr. Mary Jennings, WSDA News editor, welcomes comments and letters from readers. Contact her at her email address:mjenningsdds@gmail.com.

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We have all been blessed by those deeply meaningful patient experiences, no matter how small or large: a grade school boy realizes that brushing and flossing could be his new “sport,” a young family proudly appears for their child’s first dental visit, an elderly patient’s gratitude for relief of pain, the early diagnosis for an oral cancer patient who now is completely cured. It is what we all live for as dentists, to give the gift of the opportunity for oral health. We best use our trained intellects when we also express our warm hearts. Together, we can achieve the same meaningful experiences as a collective group for oral health for Washington. The Washington Oral Health Foundation is our opportunity to share in giving the gift of oral health to the people of our state. We are fortunate to have a dental organization of progressive, active, and heartfelt dentists. Let us all come together to realize a future of oral health literacy, prevention of oral diseases, and opportunities for care. The need is greater than ever before, and even as we all face significant changes and struggles in our profession, we shall always stand as a profession that cares for the public’s health and well being. Let us take that stand together through the Washington Oral Health Foundation. If you are already involved with WOHF programs, we thank you, and ask for your continued support. If you are new to our work, please consider volunteering and joining many of your colleagues who have made a contribution to the Foundation. Here are our program opportunities and updates.

The Adopt-A-School program

The Adopt-A-School Program partners dentists with school nurses to provide free emergency care to children who are unable to function successfully in school due to oral disease. Certainly, we know that dental disease, pain, or infection can make it difficult for children to concentrate and learn in school, and this program provides care to the children that need it most. Through referrals from the school nurse, parents and guardians are given the opportunity to have an emergency appointment with a dentist and have their child treated, free of charge. This statewide program has grown tremendously, with 803 schools adopted, more than 1/3 of the public schools in the state. We salute all the Washington dentists who give their time and skills to these children.

School-based education programs

Our school-based education programs are partnerships of dentists and educators to reach thousands of children with comprehensive oral health education. Programs available through WOHF for dentists to share in their community’s schools include general dental education, disease prevention, anti-tobacco and anti-drug presentations. Dentists can truly inspire as well as educate children to make healthy, informed choices. WOHF updates these programs for flexibility and appropriate messages for varying ages of school children. If you have not yet presented this excellent information to a classroom in your community, consider doing it this year.

The WOHF Boys and Girls Club Initiatives

The WOHF Boys and Girls Club Initiatives serve children and families throughout our state in oral health education. Our volunteer dentists, along with WOHF staff, provide programs in prevention education, as well as support for families in seeking and receiving dental care. We realize that the knowledge of how to seek and receive care may not have been available to some people, and information about all aspects of receiving dental care can be taught in a supportive and empowering way. Emphasizing personal responsibilcontinued on page 27

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Dr. Sally Hewett Chair, WOHF Board

“The need is greater than ever before, and even as we all face significant changes and struggles in our profession, we shall always stand as a profession that cares for the public’s health and well being.”

guest editorial dr. sally hewett

The most important gifts we can give


member news give kids a smile events across the state

Dr. Lina Kim

Dr. Fred Dahm

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And while that culture continues through a dentist’s career and often into retirement, it’s largely done quietly, privately. Whether it’s continuing to deliver dental care to a patient of record who has fallen on hard times — something we’ve seen much of since the economic downturn — or working in the myriad free clinics and dental vans dotting the landscape since the loss of adult dental Medicaid, dental professionals continue to make time to give back. And, while children in this state utilize low cost care at a higher rate than many other states in the country (Insert info from Bracken here), there are still many kids who slip between the cracks of dental access. So each year in February, dentists around the state organize events designed to find children without a dental safety net and deliver the care they so desperately need – providing screenings, cleanings and restorative care in their offices, on dental vans — and even in museums, as they do at Snohomish County’s “Toothapalooza.” Here are pictures from just a few events from around the state.

Pierce County

Toothapalooza

More than 300 families turned out to participate in the 22nd annual Pierce County Dental Society Children’s Dental Health Day. Dental screenings, fluoride varnish applications, and dental treatments were given free of charge to participating children up to age 18. Eleven community agencies participated in the event, handing out free oral health education materials, mouthguards, and dental goodie bags. During the day there were a variety of children’s activities promoting oral health awareness and the importance of improved oral health. Twenty-one dentists from the Pierce County Dental Society planned and participated in the event. Other dental affiliates participating in the event included: Clover Park Technical College Dental Assistant program, Bates Technical College Dental Assistant program, and Pierce College Dental Hygiene program. Chompy the Carrot, the Super Tooth, and the Tooth Fairy made special guest appearances and had their pictures taken with children at the event. Chompy the Carrot gave live demonstrations to children and their families about the appropriate way to brush and floss their teeth. Our hats are off to all the Pierce County dentists who participated in this amazing event: Dr. Jordan Harris, Chair, Dr. Robert Chen, Committee Member, Dr. Sherwin Shinn, Committee Member, Dr. Lotus Su, Committee Member, Dr. Robert White, Committee Member, Dr. Jamie Brooks, Event Photographer, Dr. Steve Beck, Dr. Diantha Berg, Dr. Lisa Buttaro, Dr. Jordan Collins, Dr. Cheri Dunham, Dr. Minou Karbakhsch, Dr. Mostafa Norooz, Dr. Sammy Pak, Dr. Adam Poyfair, Dr. Jeff Reynolds, Dr. Kelcey Rhodes, Dr. Chuck Samuels, Dr. Mark Sundberg, Dr. Houng Tran and Dr. Kevin Xu!

Dr. Lina Kim

For the past two years, Dr. Lina Kim has held not one, but two, GKAS events. This year she closed her office for a day to provide more than $4,000 in uncompensated care to low income families and residents of a nearby homeless teen shelter. The following Monday, Kim and her staff gave an oral health presentation to first grade students at the John Hay Elementary School on Queen Anne, in Seattle. Besides Dr. Kim, participants included Dr. Jessica Emard, Camilla Mesa, Pam Wallin, Edward Wang, Tara Ducay and Krisha Bautista.

Clark County

Toothapalooza

WSDA Members from around the state share their GKAS event photos

In Clark County, dentists participating in the 7th Annual Children’s Dental Health Day saw 130 patients and performed restorative procedures, pulpotomies, extractions, x-rays, sealants, and fluoride treatments. Dr. Peter Lubisich, WSDA’s 2102 Citizen of the Year, and participant in the Clark County event, said this: “We ended up seeing 130 patients yesterday. While it was fewer than the past years, it still felt quite busy once we got going.” Dentists and staff volunteers at the event included Drs. Peter Lubisich, Pete Lubisich, Joe Lubisich, Eric Messinger, Joseph Sepe, Judith Ris, Conway Jensen, Frank Foreman, Robert Rose, Karl Rose, Kirk Shillinger, Dan warner, Mike Warner, Linh Vo-Cheng, David Rafael, Gene Sakai, Brian Shafer, Katy Wright, Tyler Pritchard, Rich Mielke, Munib Derhalli, Connie Brown, Kyle Ostenson, Lenna Gordon, Rick Grabowski, Richard Knight, Wanda Palena, 20 dental students from OHSU, 57 Hygiene Students from Clark College, 19 hygienists, and 36 assistants.

Dr. Fred Dahm

In Renton, Dr. Fred Dahm saw 13 kids and completed nearly $5,000 in uncompensated dental services. Dahm says, “Doing Give Kids a Smile events is always gratifying. It feels good. My team and I probably get more out of it than the kids as it is so fulfilling!”

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member news give kids a smile events across the state

In the dental community, the culture of giving is ingrained early on – most dentists begin their charitable care in dental school by reaching out in their communities, assisting seasoned dentists.


member news give kids a smile events across the state

Toothapalooza

Clark County

Clark County

Clark County

Dr. Lina Kim

Clark County

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5th Annual Toothapolooza!

This year Snohomish County dentists again teamed with the Imagine Children’s Museum to present the mother of all GKAS events — a month of various activities plus a popular evening at the museum. Throughout the month, more then 2,300 goodie bags were distributed, and more than 950 children were screened. The evening event is designed for kids ages 1 - 12 and their caregivers, with fun, educational dental-related activities and experiments throughout the museum including a demonstration of how food and drinks can stain teeth, the effects of sugar, and more. Kids were screened by local dentists, provided with information regarding follow up visits if necessary, and given goodie bags with toothbrush, toothpaste and floss. Throughout the event, the 2min2X PSAs were shown on a continuous loup. Thanks to all who helped make this event so successful, including Dr. Nadia Abouhosn, Dr. Olga Ortuzar, Chris Morren, and Dr. Roy Carlson, Dr. Cam-Tu Vo, and Toni Aldridge. And special thanks to all the generous sponsors and donors of this event — Snohomish County Dental Foundation, Snohomish County Dental Society, Washington Dental Service, Colgate, Burkhart Dental Supply, Patterson Dental Supply and Royal Dental Manufacturing Inc.

Share with us!

If you have pictures from a Give Kids a Smile event you held in February, it’s not too late to have them published. Send a few high-resolution images along with the details of your event (how many dentists/staff members participated, how many children were seen, and a rough dollar amount of the care received) to Rob Bahnsen at rob@wsda. org, and we’ll publish your story next issue.

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Toothapalooza

member news give kids a smile events across the state

Dr. Lina Kim


pndc preview what’s new at the 2013 pndc Location, Location, Location The Pacific Northwest Dental Conference’s new home is Bellevue, Wash-

ington. “We made the change for a number of reasons,” said Dr. Robin Henderson, Chair of the Committee on PNDC, “And it wasn’t something that we took lightly. It will allow us to choose the best possible dates for the conference for many years to come. Finding acceptable dates in Seattle was growing increasingly difficult, and we felt that our best bet was to move the conference across the lake.” The saga of finding preferred dates has been ongoing with Seattle’s Convention Bureau — Bellevue was chosen because of its state-of-the-art facilities, luxurious amenities, and ease of access to our members. “It really is a beautiful, little jewel box of a city, with much to offer the Conference and our members,” says Henderson.

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pndc preview what’s new at the 2013 pndc

FIRST LOOK:

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pndc preview new at the 2013 pndc cover stor y what’s building a grassroots network

The new PNDC Mobile App Quick! Download the new PNDC mobile app — it’s one of the most powerful tools we’ve ever offered Conference attendees (it’s free, of course), and you’re going to love it! Committee Chair Robin Henderson (shown here test-driving the 2013 app), raves about its functionality and says it’s better than apps at some of the biggest shows in the nation. The app gives you all the information about the conference in the palm of your hand — including speakers, sessions, locations, room maps, the exhibit hall map, exhibitor list — even the scavenger hunt. It’s all there! Plus, every time you open the app, updates and important announcements will be pushed to the main screen, allowing you to update your day as needed.

New this year

Scott Henderson and Dr. Robin Henderson

This year, with programming in two venues, we want to make sure you’re where you need to be, so the app will cover transportation between Meydenbauer Center and The Hyatt Regency Bellevue, as well as room maps for both locations. Additionally, you’ll be able to fill out your course evaluations on the app — and as an incentive, each time you do, you’ll be entered into a drawing for one of two $100 gift cards to Purple Café! Download the PNDC 2013 app from the app store or Google Play today!

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pndc preview what’s new at the 2013 pndc

BOTOX ® therapies Dr. Timothy Hess has been administering and teaching BOTOX® and dermal fillers since 2009, and now he’s bringing his expertise to the Pacific Northwest Dental Conference in both a workshop and lecture setting. “A dentist’s expert knowledge of the head and neck anatomy make them ideal providers of BOTOX® therapies,” says Hess, “This workshop will focus on aesthetic and therapeutic procedures that can be easily incorporated into any dental practice. Following completion of this workshop the dentist will have the skills and confidence to start administering BOTOX® in their practices immediately.”

BOTOX® Therapies for the Dentist Lecture

Thursday, June 13 from 8:00 a.m. - 11:00 a.m. CDE Credits: 3 Hours Room: H-Cedar

BOTOX® Therapies for the Dentist Workshop

Thursday, June 13 from 2:00 p.m. - 5:00 p.m. • Code 10 CDE Credits: 3 Hours Dentists Fee: $1,800 Staff Fee with Dentist: $300 • Code 36 Limit: 30 Room: M-406

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pndc preview what’s new at the 2013 pndc Odiatu image © 2013 Mark Turner

Keeping your edge Dr. Uche Odiatu is a lifelong athlete who knows that keeping your edge mentally goes hand-in-hand with being active and fit. “Halle Berry is 45, Paula Abdul is 51, Rod Stewart is 65 and Mick Jagger is 69,” says Odiatu, “Why not have their energy levels and vitality? Don’t you want to kick off the covers and spring out of bed with incredible energy and spirit? Do you want to be more energetic, ready for a busy clinic day, and confident that you’ve lots to offer?” After this session Odiatu will have you bouncing out the door ready to take on the world each morning. Join this popular, returning lecturer as he shows you four key strategies you need to master to turn back the clock, identifies age-defying foods, and helps you to understand how the human body ages and the ways to combat ageing using science!

Keep Your Edge at Any Age

Friday, June 14 from 1:00 p.m. - 4:00 p.m. CDE Credits: 3 Hours Room: M-Theater

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No resting on our laurels — we’ve added some very cool new things this year - here are five examples!

1. We’re having a party! Welcome Reception · Thursday, June 13 · 5:30 - 7 p.m.

Please join us for the Welcome Reception at Meydenbauer Center Exhibit Hall. Unwind after a long day of classes with drinks and tasty treats from around the globe as we celebrate our move to Bellevue. Enjoy an evening of fun, food and shopping while mingling with colleagues and visiting more than 170 exhibits. Make your shopping list and check it twice — the two biggest spenders at the exhibit hall will be awarded an iPad or iPad mini. Make sure to use your Buyer Incentive form to participate and shop away at the PNDC. Sponsored by D-MMEX.

2. We’re going to MOVE you Shuttle service between the Hyatt Regency Bellevue and the Meydenbauer Center

Although the two properties are just 3.5 blocks apart, we want to make sure that if you don’t want to walk, you don’t have to. Free continuous shuttle service is available between the Hyatt Regency Bellevue and Meydenbauer Center. Please refer to lobby signs to familiarize yourself with the shuttle bus schedule at both locations. Boarding locations: Hyatt Regency Bellevue Pickup and drop-off: NE 10th Street, which is on the same floor as the Evergreen ballroom and foyer. Meydenbauer Center Pick-up and drop-off: NE 6th Street on the south side of the building.

3. We’re taking back the night! Special evening sessions, Thursday, June 13, 6 - 8 p.m.

Now, dentists attending the Pacific Northwest Dental Conference can earn 2.5 additional CDE credits by attending one of two offerings on Thursday evening from 6 - 8:30 p.m. Dr. John West will be presenting a free lecture on endodontics entitled “21 Endodontic Practice Builders that Can Be Immediately Applied to Your Practice.” West, one of the world’s premier interdisciplinary endodontic clinicians, will present the components of building your practice through endodontic skills. Also that evening, Dr. Tobin Bellamy will be presenting a hands-on oral surgery workshop (Fee: $250) where both every-day scenarios and some, more complex situations including ridge preservation, sinus exposure and root fracture will be discussed and practiced.

4. We’re refreshing you! Clinical Pearls programming, Thursday, June 13, 8:30 a.m. - 5 p.m.

It’s always good to review the building blocks of your field — so this year, the Committee on PNDC was determined to offer a refresher series of four lectures covering fundamental subjects including cracked teeth, periodontics, endodontic diagnosis, and orthodontics. And while on the surface these topics may seem basic, they’re anything but. Top local specialists will offer new insights, cutting-edge science, and practical knowledge you’ll be able to use in your practice immediately.

5. ¡Estamos enseñando español! An Introduction to Dental Spanish · Gene Flanery

(We’re teaching you Spanish)

If you find yourself wishing you could communicate better with your Spanish-speaking patients, you’re not alone! This workshop will teach you how to properly greet your Spanish-speaking patients, identify terms used to describe and locate pain, as well as teach you the correct Spanish terms for oral hygiene, fillings, and extractions. No Spanish skills are needed. Friday, June 14 from 8:30 a.m. - 11:30 a.m. • Code 13 Friday, June 14 from 1:00 p.m. to 4:00 p.m. (repeat) • Code 18 CDE Credits: 3 Hours · Fee: $95 Limit: 30 · Room: H-Balsam

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pndc preview what’s new at the 2013 pndc

GET EXCITED!


member news dr. mike buehler’s yakima clinic

GIVING BACK For years, Dr. Mike Buehler dreamed of establishing a dental clinic in Yakima — Now his dream is a reality It’s rare for a conversation about lowincome dental clinics to include specific language about a market niche, but for WSDA member Dr. Mike Buehler, it was central to his dialogue about opening just such a clinic at the Union Gospel Mission in Yakima, Wash. Spreadsheets, proformas, and business plans were an integral part of Buehler’s project from the beginning, which came to fruition just last month, after years of dreaming and planning. 1 6 · th e wsda ne w s · issue 4, march · 2013 · www.wsda.org


As anyone who’s ever tried to organize a far-reaching project knows, dreams aren’t enough to make them a reality. Fortunately, Buehler is well known in the community, where he has worked and volunteered for more than 40 years. During that time, he formed relationships that became the basis of his fundraising efforts, as he cashed in chits he’d amassed over the decades. He says, “When I retired, my goal was to raise enough money to get a dental clinic built. I first got $250,000 from the Washington Dental Service Foundation, plus an additional $100,000 loan. I’ve also received other grants from organizations like United Way and the Community Foundation — along with in-kind donations from ADEC, who gave me $50,000 worth of equipment. I was also able to convince Tri-ply construction to build at cost, and got the plumbing and roofing at cost.” Several labs, including Nakanishi Dental Lab, were willing to discount their bills and offer pro bono services. But Buehler wasn’t done saving money yet — The electrical work was done by a licensed electrician on staff at the Mission, he got his computer hardware equipment at cost, and his architect offered her services at cost. He explains, “After 40 years, it wasn’t hard to get to the key players in the various companies and organizations to ask their help. I got everything free or at a discount – I’m even able to

at 200 percent of poverty and below, and free of charge with a volunteer service requirement to those below the poverty line. Buehler explains, “Patients in this program must first perform volunteer work for a credit of $10 per hour — until they’ve amassed enough credit to cover the procedure.” Additionally, qualifying patients will be allowed to mix volunteer service with payment for procedures, if they wish. So far, four local charities are approved agencies in the program — Habitat for Humanity, Union Gospel Mission, Red Cross, and the Salvation Army. The clinic will perform all emergent work immediately, with no volunteer requirement. The only thing that all patients will have to pay for — regardless of income level — are the lab fees. “There’s simply no way around it,” Buehler explains, “I cannot do 100 percent charity work on major items like crown and bridge, prosthetics, or implants, nor can I do that as a trade for volunteer hours — the lab bills will kill me. We’ll work with them on cheaper options – a less expensive crown, or perhaps going with stainless steel. Individuals will have to make a decision about the quality they want to have, and what they’re willing to pay on lab work.” If the program sounds familiar, it’s been done elsewhere — former WSDA Citizen of the Year Tim Verharen started a similar program called Service with a Smile some years back. Buehler tweaked

Buehler’s model requires patients to track their own service, get approved signatures, and present their paperwork at their clinic appointment. “I didn’t want the agencies to have to keep logs and phone me each month. I wanted to help clinic patients develop pride and responsibility, because I believe that the more they are asked to be active participants, the better the program will work.” get my supplies for the institutional price.” Later, when it was clear that Buehler’s hard work had paid off and the clinic would become a reality, the assertive fundraiser reached out to colleagues and raised nearly $100,000 in additional funds on his own.

Keeping costs down

By employing a cadre of mostly volunteer dentists (he’ll have a resident and an assistant whose salaries are paid for through the Central Washington Family Residency program, and two paid staffers — an assistant and a front office person), Buehler plans to meet his costs on as little as $350-$400 of patient income a day. But he knew he could only count on the loyalty of volunteers if the work of the clinic didn’t compete with private practices or the local Community Health Clinics, so he had to define his niche. “We are looking at a target market of people who are at 200 percent of poverty or below who have no dental insurance.” He continues, “We won’t see patients with Medicare or Medicaid coupons, or children. We won’t file any paperwork with the state, or with insurance companies, and I won’t bill.” Eventually, Buehler hopes the clinic will see 1,500 — 2,000 patients a year, with many of those patients of record who consider the clinic their dental home — but he’s looking for a really specific type of patient — low income, and willing to participate in their care.

Volunteering in exchange for dentistry

The clinic will offer dental services on a sliding fee scale to those

the model a bit, requiring patients to track their own service, get approved signatures, and present their paperwork at their clinic appointment. “I didn’t want the agencies to have to keep logs and phone me each month. I wanted to help patients develop pride and responsibility, because I believe that the more they are asked to be active participants, the better the program will work. Already, we’ve found our no-show ratio is the same as it was in my private practice, even though we have a clientele that historically has missed more appointments.”

Opening day

What Buehler couldn’t have anticipated was the crush on the first day — no matter how well thought-out his business plan was. “People had been hearing about the clinic for weeks before it opened,” he says “I’ve had free PSAs running on radio, coverage on local television affiliates, and articles in newspapers. We were hoping to have a soft opening like a restaurant would, with just a few patients – especially the first day, with our new computer system.” That first day alone, they were slammed with 40 walk-ins. Clearly, there’s a need in the community for these services. WSDA is proud of the community service doctors like Mike Buehler perform every day — expanding access to care to underserved people across the state. If you would like to volunteer at the Yakima Union Gospel Dental Clinic, you can contact Mike at buehler0352@msn.com.

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member news dr. mike buehler’s yakima clinic

Cashing in on his good work


legislative news 2013 legislative session update

LEGISLATIVE SESSION UPDATE The Washington State Legislature is nearly two months into its 105-day session. This session has been a very active one for organized dentistry. WSDA has been tracking more than 30 bills related to dental workforce, loan repayment, dental access, dental insurance, licensure, and several other issues. The 2013 legislative session is scheduled to end in late April. On February 22, the session reached its first significant milestone: the policy cutoff date for all non-fiscal or transportation related bills. This means that all policy bills that were not voted out of their committee of origin are dead for the session. However, all legislation introduced during the 2013 legislative session is automatically reintroduced during the 2014 legislative session. Here is a breakdown of some of the bills and fiscal issues that WSDA has been involved in:

New Dental Workforce Legislation

All new dental practitioner bills died in their committees of origin. HB 1516 and SB 5433 were nearly identical to dental therapist legislation that was considered during the 2012 legislative session. Both bills were supported by the Children’s Alliance, the Washington State Dental Hygienists’ Association, and other members of the Washington Dental Access Campaign. WSDA opposed both bills as they would have created dental practitioners with the ability to diagnose and perform irreversible procedures without the supervision of a dentist. HB 1514, legislation patterned after WSDA’s HD-13-2012, was introduced in the House by Representative Eileen Cody (DSeattle). WSDA opposed HB 1514 as did the Children’s Alliance, the Washington State Dental Hygienists’ Association, and

other advocates for dental therapists. Prior to the 2013 legislative session, WSDA’s leadership decided to not support legislation based on HD-13-2012. This decision was based upon further review of existing dental therapist models, new research on the cost-effectiveness of dental midlevel providers, the increased viability of expanding dental residency positions across the state, and the rejection of the model by the Children’s Alliance and other advocacy organizations. The House Health Committee held a hearing on HB 1514 and HB 1516 in early February. At the hearing, over a dozen dentists, lobbyists, and citizen advocates spoke in support and against the dental therapist model. WSDA’s panel of dentists questioned the viability of creating a new workforce member and spoke in support of better alternatives including dental resi-

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Residency Expansion and Loan Repayment:

WSDA is working with the Yakima Valley Farmworkers Clinic and the Columbia Basin Health Association to expand Community Health Center (CHC)-based dental residency positions in Eastern Washington. WSDA and these partners are requesting capital matching funds to expand dental clinics in Toppenish, Othello, and Walla Walla. These expanded clinics will allow for up to six new dental residency positions in rural parts of Eastern Washington. CHC and hospital-based residency positions continue to expand in Washington state. There are currently 33 CHC/hospital based residency positions; nine additional positions will be added this July. SB 5615 is a bill sponsored by Senator David Frockt (D-Seattle) which aims to reinvigorate the health professional loan repayment program for primary care practitioners who work in rural and underserved areas. This legislation was voted out of the Senate Health and Senate Higher Education committees. SB 5615 would require the state program to solicit and seek grants and donations from public and private sources. WSDA testified in support of SB 5615 and will continue to work on improvements and enhancements to loan repayment programs for newly licensed dentists. According to the American Dental Education Association, the average student debt load for 2011 dental school graduates is $203,374.

Adult Dental Medicaid Funding

In 2011, dental coverage for most Medicaid-insured adults was eliminated. As a result, nearly 450,000 low-income adults, including many people with disabilities and 130,000 seniors, were left with only access to emergency dental care. The WSDA and the Coalition to Fund Dental Access are fighting to restore the dental safety net and ensure that the state’s most vulnerable have access to comprehensive dental care. WSDA and the coalition are asking that the legislature do the following: • Restore comprehensive dental coverage for Medicaid-eligible adults. Today, only 38,000 Medicaid-eligible adults have comprehensive coverage; leaving 450,000 adults without comprehensive dental care. Reinstating adult dental Medicaid coverage will cost the state $28.7 million for the biennium.

• Include dental coverage in Medicaid expansion benefits. The Affordable Care Act provides states with a 100% match to expand Medicaid coverage to all adults who live at or below 138% of the federal poverty level. Adding dental coverage for this vulnerable population will not impact the state’s operating fund in this biennium. The Washington State Dental Association is a founding member of the Coalition to Fund Dental Access, a coalition created in 2007. Other coalition members include: University of Washington School of Dentistry, Solid Ground, Washington Association of Community & Migrant Health Centers, Poverty Action Network, Washington Dental Service Foundation, Children’s Alliance, Washington State Dental Hygienists Association, and many other organizations.

WSDA/WSDHA Joint Legislation

WSDA and the Washington State Dental Hygienists’ Association jointly authored and support HB 1330. HB 1330 would allow dental hygienists to provide preventative services to homebound patients under general supervision. The legislation also fixes a DOH legal interpretation that has prohibited dental hygienists from placing topical anesthesia under general supervision and prohibited dental assistants and EFDAs from placing topical anesthesia altogether. HB 1330 was voted out of the House Health Committee.

Washington Physicians Health Program

HB 1534 would increase the dental license surcharge for the Washington Physicians Health Program (WPHP) from $25 to $50. WPHP helps dentists, physicians and other health care practitioners recover from impairing illnesses such as addiction or other physical and mental conditions. WPHP is a non-profit organization and is not affiliated with the Department of Health. The program is funded by practitioners enrolled in the program, donations and the license fee surcharges on health care practitioners. The surcharge on dental licenses has been $25 for over ten years while the surcharge for physicians and physician’s assistants has been $50 for the last four years. HB 1534 was voted out of the House Appropriations Subcommittee on Health and Human Services and is supported by WSDA.

Licensure Grace Period

WSDA has worked with Representative Mike Hope (R-Lake Stevens) on HB

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1603. HB 1603 would establish a 30-day grace period for expired dental licenses and require all health carriers to reimburse dentists with expired licenses for services performed within 30 days of their license expiration date. While the license would remain active for an additional 30 days under HB 1603, all applicable late fees would still be imposed. HB 1603 was not voted out of the House Health Committee in 2013. However, HB 1603 will automatically be reintroduced in the 2014 Legislative Session.

Denturists

HB 1270 would provide the Board of Denturists with the authority to handle denturists’ disciplinary cases. HB 1270 was voted out of the House Health Committee. HB 1271 is based on legislation that passed in Oregon a few years ago and would expand the scope of practice of denturists. In 2012, the Department of Health conducted a sunrise review on a denturist scope of practice expansion that would have permitted denturists to make and place all “nonorthodontic removable devices.” DOH and WSDA both agreed that there was substantial risk of patient harm if denturists were permitted to make and place “nonorthodontic removable devices.” WSDA testified against HB 1271 and the use of this vague definition. HB 1271 was amended to allow denturists to make and place sports mouth guards, bruxism devices, whitening trays, removable cosmetic appliances, and snoring devices after a physician has ruled out snoring associated with sleep breathing disorders. Substitute HB 1271 was voted out of the House Health Committee.

Health Care Reform Legislation HB 1846 is legislation supported by

Washington Dental Service and would require that stand alone pediatric dental plans be offered both inside and outside of the health benefit exchanges. The Affordable Care Act requires that pediatric dental coverage be included as an “essential health benefit” and is required to be included in all small group and individual health insurance starting in 2014. Currently, all pediatric dental plans offered inside of the exchange are required to be priced and offered separately. It is unclear if HB 1846 would prohibit medical insurance providers from embedding pediatric dental coverage into their medical insurance outside of the exchange. HB 1846 was voted out of the House Health Committee and WSDA is closely monitoring the legislation.

legislative news 2013 legislative session update

dency programs and reinstating adult dental Medicaid funding.


legislative news dental action day in photos

ACTION! Dentists converge on the Capitol to make their voices heard

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legislative news dental action day in photos

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legislative news dental action day in photos

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legislative news dental action day in photos

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SAVE THE DATE!

Alaska Dental Society

ANNUAL SESSION

May 16-18, 2013 • Sheraton Anchorage Hotel

SPEAKERS ROBERT CONVISSAR, DDS “Lasers in Periodontics and Restorative Dentistry” (5.5 hrs CE) Hands-On Program – (3 hrs CE)

Dental Software updates – Eagle Soft, XL Dent, and Dentrix. Meeting Chairman Dr. Dominic Wenzell has crafted a program the will be a positive learning experience for the entire office. Plus king salmon and halibut are running. Make plans NOW to attend.

BRETT UEECK, DMD, MD, FACS – “Optimizing Anterior Esthetics w/ Immediate Implant Placement” (3 hrs CE)

JUDY KAY MAUSOLF – “Communications Solutions” “People Will Forget Everything EXCEPT How You Made Them Feel” ALEX FLEURY, DDS, M.S. – “New Dimensions in Endodontics” (5.5 hrs CE)

“Medical Emergencies 2013 Update” (3 hrs CE)

CALL US AT (907) 563-3003 • VISIT akdental.org FOR MORE INFORMATION

Yo u ’ r e t h e r e f o r y o u r p a t i e n t s . We ’ r e h e r e f o r y o u .

CALL US

800-448-3368 FA C E B O O K U S www.facebook.com/WashingtonStateDentalAssociation 2 4 · th e wsda ne w s · issue 4, march · 2013 · www.wsda.org


Looking for an Associate or Someone to Buy Your Practice?

The WSDA is trying to gauge whether a “job fair” of prospective buyers and Associates would be helpful to dentists interested in adding an associate or selling their practice. If so, the Association would organize the event, recruit members interested in buying or becoming associates, and host the event at the Fremont office in the Spring. If you’re seeking an associate or planning to sell your practice, and are interested in attending, please email Kainoa Trotter, Director of Membership and Communications at Kainoa@wsda.org.

Alliance of the WSDA at Dental Action Day

With just a skeleton crew available for this year’s Dental Action Day in January, the WSDA Alliance still managed to hand out 350 goodie bags to legislators and their staff — impressive stuff, that. The DAD effort, a cherished tradition eagerly anticipated by staffers, is led by Alliance chair Lois Clark. This year, Alliance stalwarts Mary Ann Psaltis and Sue Minahan carried out the group’s mission. Minahan (the wife of WSDA President-elect Dr. David Minahan) is excited for the coming year, noting that the group will be reorganizing in the near future. Details will be finalized at the 2013 Pacific Northwest Dental Conference. Stay tuned!

Christiansen appointed to interim DECOD post

The Department of Oral Medicine recently announced that Dr. Rolf Christensen was appointed Interim Director of the Dental Education in Care of Persons with Disabilities (DECOD) Program. Dr. Christensen brings an innovative perspective rich with organizational and administrative experience to the DECOD program. He received a DDS from the UW School of Dentistry in 1980, and a Master in Health Administration from the UW School of Public Health in 2001. He has practiced dentistry for years and has been an affiliate faculty member for 14 years in the Department of Oral Medicine, teaching in the Dental Urgent Care Clinic. Kimberly Hanson Huggins, who holds faculty appointments in the Departments of Oral Medicine and Oral Health Sciences, will serve as Director of Special Patient Care Outreach for the School of Dentistry in addition to her other responsibilities. Ms. Huggins received Dental Hygiene and B.S. degrees from Loyola University, Chicago. Ms. Huggins managed a dental disease prevention program for the Department of Public Health Seattle and King

County and served as a Region X Dental Consultant to Head Start before joining the School of Dentistry in 1985. Ms. Huggins has managed a wide range of funded research studies in the Department of Oral Medicine and conducts outreach and health promotion activities for the Department of Pediatric Dentistry. She has been nationally recognized for her work developing fact sheets about patients with special needs for health care professionals and caregivers. The new leadership team will work with the current DECOD faculty including Drs. Glenn Govin, Ara Greer, Kenyu Takamoto and Lisa Stampalia; Dr. Nicole Murray; and a team of dedicated dental hygienists and clinical staff to enhance all aspects of the nationally renowned DECOD program.

Enroll now in the National Dental Practice-Based Research Network

The nation’s network conducts research in working dental offices, with real-life patients, on topics relevant to daily clinical practice. Dentists and hygienists partner with Network researchers to evaluate existing and novel strategies for improving patients’ oral health. This partnership helps minimize the impact of network studies on clinic operations and patient flow. There are many ways to participate in the network, and practitioners choose their level of engagement. Dentists and hygienists can take part in formulating research questions, contributing to protocol development, and disseminating research results. Dentists and hygienists providing general and specialty care are invited to join the National Dental PBRN by visiting their website at www.nationaldentalpbrn.org/ index.php and clicking “Enroll Now.” After completing the enrollment questionnaire, you will be contacted by staff from the Western Region of the Network. Additional information about the network and enrollment is available at the website, or contact Jeri Starrett, RDH at jeri.l.starrett@ kpchr.org or call (503) 894-3004.

ADA Offers $100 For Every New Non-Member You Recruit

As an active member, you know firsthand that membership in the WSDA can help you achieve career success and strengthens the dental profession. The ADA Member-Get-A-Member Campaign provides the ideal opportunity to share this success, by encouraging your nonmember colleagues to join. You will be rewarded with a $100 American Express gift card for each new, active member you recruit (up to five members or $500 in American Ex-

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press gift cards)! Or you may decline the incentive and ADA will contribute $100 to the ADA Foundation. Some restrictions do apply. Also, don’t forget, the WSDA will provide you and the recruited dentist with a complimentary Full Conference badge to the Pacific Northwest Dental Conference (value $200). Learn more by visiting http:// www.ada.org/8185.aspx or contact Laura Rohlman, Membership Services Coordinator, at 800.448.3368 or laura@wsda.org.

DQAC Is Looking For New Commissioners

The Dental Quality Assurance Commission is looking to fill several positions with actively-practicing dentists. At the end of June, three of the 12 dentists on the Commission will be completing their terms, though one is eligible for reappointment. Commission members are appointed by the Governor to a four-year term and may serve no more than two consecutive terms. DQAC meets about every eight weeks at the Department of Health in Tumwater, Wash., unless otherwise specified. Business meetings are usually scheduled on a Friday morning, and are followed by disciplinary panels on Friday afternoon. All applicants must be citizens of the United States, Washington residents, and have been practicing dentistry for no less than five years before appointment. If you are intersted in applying, please contact WSDA Director of Government Affairs, Bracken Killpack, at 800-448-3368 for additional information. If you would like to apply for one of the available Commission positions you can access an application at the Governor’s website, http://www.governor.wa.gov/ boards/application/application.asp. Applications must be submitted no later than March 31, 2013. Contact DQAC Program Manager, Jennifer Santiago, at jennifer.santiago@doh. wa.gov or 360-236-4893 if you have any questions.

WSDA seeks nominations for Speaker of the House

The WSDA is currently accepting nominations for the Speaker of the House at the 2012 WSDA House of Delegates. To apply for the position, please submit a letter of interest and your CV to Brenda Berlin at brenda@wsda.org. Deadline for submissions is April 19, 2013. Selection of Speaker of the House: 1. The Speaker shall be an Active, Life or continued on page 27

newsflash issue 4, march 2013

newsflash


PROFESSIONAL RACTICE P SPECIALISTS,

INC.

1-800-645-7590

Aaron Pershall - Randy Harrison

NEW! REDMOND, WA – Established G/P collecting $570K in 2012. Very strong hygiene program! 4 ops and laser. Lots of potential!

CENTRAL, ID – Excellent satellite opportunity! Highly Profitable G/P on just 2 days/week. Incredible lease! Associate position available!

NEW! WEST SEATTLE – Great merger opportunity! G/P collecting $200K in 2012 out of 2 operatories. Bring your marketing plan. Flexible lease. Lots of potential!

IDAHO PARTNERSHIP – Group practice seeking partner. Multiple rural locations available! Numerous transition/ownership options.

CHEHALIS, WA – Great merger or start up alternative! G/P collected $200K in 2011. Flexible lease! WESTERN OREGON OMS – Excellent, high profit practice with tremendous growth potential. Great location close to a major hospital.

NEW PERIO!

SW

WASHINGTON

NEW - OREGON ENDODONTIC! RURAL ALASKA – High profit practice collected $375K in 2011 working only 10 weeks per year! Office includes small apartment and SUV. Perfect satellite practice!

www.PracticeSales.com

FAIRBANKS, AK – Exceptional G/P collecting $1.8M+. Excellent cash flow! 100% fee for service and great cash flow! Newer facilities, CT scanner, Cerec, and more! Flexible transition options. SW ALASKA – Looking for adventure? Great G/P situated in a sportsman’s paradise! Collections of $700K+ working only 37 weeks per year! Associateship also available! KENAI PENINSULA, AK – Rural G/P collecting $1.3 Million in 2011. Amazingly profitable! Great staff, laser, digital x-rays, pano and newer equipment. Exceptional opportunity for the experienced doctor!

Aaron@PracticeSales.com RandyH@PracticeSales.com

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guest editorial, continued from page 5

a. Voting delegate of the WSDA House of Delegates

for lower grades will be more focused on encouragement for the future. New judges will be paired with more experienced judges, which will make things easier and more enjoyable for first-timers. Volunteer judges are expected to evaluate projects in an impartial manner while applying the judging guidelines and provide positive feedback to the student. It’s a fun and interesting way to give back to the state, so come and help out. To sign up to be a judge, go here: https://www.wssef.org/reg/judge.php. For a brochure with additional information, go here http://www.wssef.org/WSSEF%202012%20 Judges%20Brochure.pdf.

b. Member of WSDA Board of Directors

Practice-Based Research Workshop

Retired member in good standing. 2. The Speaker will be selected by the Board of Directors annually at least one hundred twenty (120) days prior to the beginning of the House of Delegates. 3. The Speaker shall not serve more than three (3) consecutive years. 4. The following individuals will not be eligible to serve as Speaker of the House:

c. Any member running for an officer’s position or a position on the Board of Directors of WSDA 5. In case the Speaker is unable to fulfill the duties, the Board of Directors shall appoint a replacement Speaker of the House. Duties of Speaker of the House: 1. To conduct the second business session of the House of Delegates. The WSDA president shall preside over the first business session. 2. The Speaker of the House shall be a member of the Reference Committee on Rules and Order. 3. To perform such other duties as custom and parliamentary procedure require or as prescribed by the House of Delegates from time to time.

Call WDIA for a Free Insurance Review

Washington Dentists’ Insurance Agency recommends that all dentists review their insurance coverage at least once each year to determine if what they currently have meets their present and future needs. WDIA is happy to meet with you to review your insurance coverages. Please contact WDIA at (206) 441-6824 or 800-282-9342 to schedule an insurance review.

WSSEF needs judges

Golden Apple-winner Dr. Mike Huey is looking for judges — lots of them. “We need about 200 judges for the Washington State Science and Engineering Fair (https://www. wssef.org/),” Huey said recently, “It’s a lot of fun, but we have thousands of entries!” Anyone who has a desire to promote the advancement of the sciences and science education can participate as a judge at the event. Those judging the high school division will require more specialized knowledge in a particular field, while judges

Are you interested in learning about practice-based research? If so, we invite you to participate in the “Saturday Workshop on Practice-Based Research in the National Dental PBRN: Connecting Clinical Researchers with Full-Time Practitioners for the Benefit of Both” at the IADR/AADR Annual Conference in Seattle, Wash. The workshop is scheduled for 1:00-3:30PM, Saturday, March 23, 2013. The National Dental PBRN, “the nation’s network,” will host a no-cost workshop for clinical researchers, dental practitioners, and others interested in conducting studies within the network (nationaldentalpbrn.org). The workshop will bring together dental practitioners currently involved or interested in joining the nation’s network and clinical researchers developing or interested in designing a network study. The structured workshop will enable researchers and dental practitioners to discuss the strengths and limitations of practice-based research, examine potential research ideas, and work through the clinical implementation of a proposed study within network clinics. The workshop will provide dental practitioners with hands-on experience working with dental researchers to design clinical research studies. By discussing research topics that are important to them with researchers and other clinicians, dental practitioners will be able to influence the design, and if interested, participate in the development of clinical studies. Practitioners will enhance their understanding of clinical research methods, earn Continuing Education credit, and network with current and new National Dental PBRN participants. Registration is free, but required. To find out more and to register for the National Dental PBRN workshop, contact Lisa Waiwaiole by email at lisa.ann.waiwaiole@ kpchr.org or call (503) 335-2454. Space is limited.

th e wsda ne w s · issue 4, march · 2013 · www.wsda.org · 27

sibility and health literacy, our education programs reach out to the entire families. With the partnership of the Boys and Girls Clubs, we can help to foster healthy lifestyles for lifelong health. This month, WOHF staff and volunteers have partnered with the Boys and Girls Clubs of the Olympic Peninsula to host an Oral Health “Smile Night” for members and their families.

The WSDA Outreach Program

The WSDA Outreach Program is another opportunity for Washington dentists to serve the elderly and disabled population. Patients are referred from specific agencies, qualified for the program, and then can receive care that is discounted by 25 percent from participating dentists. Our state now has more than 400 dentists who participate, and we invite you to become one of these dentists. You can select the number of patients you are willing and able to treat. These patients have shared deep gratitude and appreciation for these programs. WOHF staff and their dedicated office volunteers and interns are happy to help support your efforts to give back in your community. If you would like to give us feedback on a program, or talk about other needs in your area that WOHF could help with, please call 206-448-1914. For more details on all our programs, please visit our website at www.wohf.org. The Washington Oral Health Foundation Phone-a-Thon is coming up this March, and we will be giving you a call to ask for your involvement and support for our education programs, oral care initiatives and outreach to those in the greatest need. Together, we can achieve significant progress for oral health education and prevention of disease. You will be happy to know that our programs are statewide, and there are possibilities in your area of the state for your support. Our statewide programs are also generously supported by the following Partners in Prevention: America West Bank, AmericanWest Bank, Oregon Dental Society, NORDIC, Constantine Builders, and Stuart Silk Architects. We heartily thank them for their commitment. Please expect our call to answer your questions and please consider a significant donation to WOHF. It is our collective gift, one that we can all receive that wonderful feeling and pride in making a difference for lifelong oral health for our state.

guest editorial continued

newsflash, continued from page 25


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Nakanishi Dental Laboratory has achieved DAMAS accreditation, a level of certified quality only 1% of laboratories in the world have reached. Quality certifications, such as DAMAS and CDL, are just another way for us to provide our clients with peace-of-mind that the restorations they receive from us not only look and fit great, but are made using the highest quality materials and production processes. • We have a system for tracking and controlling the manufacturer’s lot number for all the materials used in every patient’s restoration. • All the materials used in our products have been verified as FDA registered. • Our laboratory equipment has been maintained and inspected above and beyond industry standards, and used strictly within the manufacturer’s guidelines.

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Kitsap County

Snohomish County

Tuesday, April 9 Speaker: Patterson Dental Topic Hygiene or Galileo Location: Kitsap Golf & Country Club,

Wednesday, March 20 SCDS General Meeting Speaker: Dolphine Oda, DDS Topic Oral Pathology Location: Mill Creek Country Club

Bremerton

Time: 6:30 – 8:00pm

CDE Credits: 1.5 To register, contact KCDS at kitsapcds@hotmail.com or call 360-697-5422.

Botox® & Dermal Filler Training Upcoming coUrse Dates Apr 5-6 ....... Seattle (Level I,II) Apr 19-20 ..... Denver (MDDS) Apr 26-27 ...............San Diego May 3-4 ............ Salt Lake City

FrontlineTMJ & Facial Pain Therapy for Every Dental Practice

Friday, April 19

All Day Clinic Speaker: Dr. Rhonda Savage, CEO of Miles Global Topic Communication is Everything Location: Kitsap Golf & Country Club, Bremerton Time: 8:30am – 4:30pm CDE Credits: 7 To register, contact KCDS at kitsapcds@hotmail.com or call 360-697-5422.

Tuesday, May 14 Speaker: Drs. Troy Okunami

Upcoming coUrse Dates Apr 4-5 ......................... Seattle Apr 18-19 ..... Denver (MDDS) Apr 25-26 ...............San Diego

Special Savings!

and Elizabeth Sheldon

Topic Invisalign: What’s new and Does it Work?

Location: Kitsap Golf & Country Club, Bremerton

Time: 6:30 – 8:00pm

CDE Credits: 1.5 To register, contact KCDS at kitsapcds@hotmail.com or call 360-697-5422.

sign Up by april 1ST & save Up to $700

King County

earn Up to 16 ce participation Hours

Tuesday, April 30 Speaker: Dr. Grant Chyz Topic: Fundamental Techniques

[SCAn For DETAILS]

for Success with Posterior Composites Location: Salty’s on Alki, Seattle Time: 6-9 p.m. (CDE Credits: 2) For registration contact SKCDS at 206448-6620 or skcds@skcds.com

Friday, May 3 Speaker: Dr. Tim Hess Topic: Review of Facial Aesthetics: Clinical

Applications of Botox and Dermal Fillers in the Dental Practice with Live Demonstration Location: Airport Marriott Hotel, SeaTac Time: 8 – 4 p.m. (CDE Credits: 7 ) Co-sponsored with Washington AGD. For registration contact SKCDS at (206) 4486620 or skcds@skcds.com.

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AAFE-Ad-Seattle-2.25x9.75-Mar.indd 1

2/8/13 11:42 AM

(CDE Credits: 1)

Wednesday, April 17 SCDS General Meeting Joint meeting with Snohomish Co. Dental Hygiene Society Speaker: Kimberly Hanson Huggins, RDH Topic:TMJ disorders Location: Mill Creek Country Club (CDE Credits: 1)

Friday, April 26 BLS for Healthcare Providers & First Aid Courses

BLS is 8:30AM - 11:30AM First Aid is Noon - 3:00PM Speaker: I Know CPR in Everett. Contact the SCDS office to register.

Wednesday, May 15th General Meeting Speaker: Dr. David Minahan, President-

elect, Washington State Dental Association

Topic: WSDA Update & Current Issues Location: Mill Creek Country Club (CDE Credits: 1)

Pierce County March 19, 2013 Speaker: Dr. Arash Niazi Topic: Vital Pulp Therapy and Regenerative Endodontics

Location: Fircrest Golf Club Time: 5:30 pm to 8:30 pm

(CDE Credits: 1) Register online here: http://piercecountydentists.org/index.php/events/

April 19, 2013 Speaker: Dr. Tieroana Low Dog Topic: TBA Location: McGavick Conference Center,

Clover Park Technical College, 4500 Steilacoom Blvd SW, Lakewood, WA 98499 Time: TBA (CDE Credits: 6) Register online here: http://piercecountydentists.org/index.php/events/

Want your meetings included here?

Contact Rob Bahnsen at rob@wsda.org or call 800-448-3368.

membership news cde around the state

CDE around the state


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I Investment Management I Financial Planning I Retirement Plan Services

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Mercer Global Advisors Inc. is registered with the Securities and Exchange Commission and delivers all investment-related services. Mercer Advisors Inc. is the parent company of Mercer Global Advisors Inc. and is not involved with investment services.


The Reality

During the 20-year period between 1992 and 2011, the S&P 500 Index delivered an annualized 7.8 percent investment return. This annualized return was realized despite market upsets including the dot-com bubble demise in 2000-2001, the financial crisis of 2008 and its volatile aftermath. In stark contrast, over the same 20-year period, the individual investor produced a mere 2.1 percent annualized investment return, underperforming even inflation. What causes such disparity in performance results? The answer lies within the typical challenges faced by the individual investor – personal behavioral biases fueled, often unnecessarily, by media hype and noise.

The Cause – Behavioral Bias

Research indicates most individuals are not predisposed to prudent long-term investing habits due to a variety of behavioral biases. These biases can include reactive emotional responses to outside influence, loss aversion that favors action or inaction when doing the exact opposite would be more beneficial, even behaviors precipitated by one’s personal money history can precipitate unconscious bias. Such biases are largely to blame for the average investor’s inability to outperform even inflation during the most recent 20year return period. By reacting impulsively or unadvisedly to short-term events and exiting the market in part or altogether, the average investor consistently misses out on myriad opportunities to take part in financial market upswings the world over. Other common behaviors also impact the performance success of the individual investor. A tendency to stock pick often results in a portfolio lacking in true diversification, which increases exposure to concentrated risk and asset class overlap. Furthermore, decades of academic research have yet to identify any conclusive evidence that market timing works with any level of consistency.

The Good News

It is possible to overcome these behavioral barriers and to realize better investment returns. Thorough planning, a disciplined approach, and access to objective expertise and advice all help the individual investor to control instincts for a better long-term investment outcome.

A Comprehensive Financial Plan

It is crucial to create a written financial plan – one that clearly outlines your personal investment philosophy. Committing the plan to paper guarantees accountability for all involved parties; it can also provide context, clarity and long-term vision dur-

ing times of market uncertainty when your investment discipline can be tested. Revisiting the written plan regularly ensures that it maintains alignment with any lifestyle, time horizon, risk profile or circumstance change you encounter as you move through the different phases of your life. Without a structured plan that defines your investment and financial objectives, it is easy to become distracted by short-term market volatility and the corresponding noise generated by the financial press. All news can feel related to the market, whether global, political or economic in nature. It is important to understand and accept that markets can and do reflect reactions to short-term forces; any manner of stock market participation will expose investments to occasional short-term dips. Having a disciplined and comprehensive investment approach helps the individual investor maintain a purposeful long-term perspective during periods of volatility or uncertainty.

Sophisticated Portfolio Design

A methodical, academically-validated and scientific approach to portfolio design and asset allocation can enhance an individual investor’s long-term investment outcome. Portfolio design and the appropriate objective-driven strategy are implemented using broadly diversified asset classes, extensive global market representation and appropriate alternative investment allocations. Weighting each holding in a manner that aligns with the investor’s unique risk profile helps to eliminate company-, country- and industry-specific risks, leaving the portfolio to produce and excel at its intended objective. The most common investment objectives include: maximized risk-adjusted return, limited tax exposure, protection against downside market risk, income generation, preservation of capital and/or maximized portfolio longevity.

Institutional Caliber of Investment Management

Effective portfolio management requires comprehensive financial planning acumen and wealth management expertise within

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varying market, taxation and time horizon environments. It also requires a solid understanding of the operational efficiencies and dependencies intrinsic to optimal long-term portfolio success. Objective advice from a knowledgeable expert, coupled with fee-only investment management both before and during life’s evolving phases can be invaluable to the individual investor.

The Bottom Line

Creating a long-term investment strategy that is right for you and your financial objectives involves careful planning, lifelong introspection and discipline. Implementing the strategy requires a comprehensive understanding of the market and your own behavioral tendencies toward it. Finally, maintaining it requires a strategic and proactive approach to accumulating, managing and distributing wealth over the span of your lifetime. Mercer Advisors specializes in providing clients with clarity, insight and partnership. We develop and utilize the best financial planning, investment and tax strategies to build, enhance and protect your long-term investments. Based on decades of academic research, our planning and investment approaches are both disciplined and structured. Most importantly, as you encounter evolving life events over time, your Mercer Advisors wealth management team is there as your trusted partner to help ensure you are always prepared. If you are interested in learning more about how Mercer Advisors can assist you in creating, maintaining and achieving a successful long-term investment strategy, please contact Yolanda Carbajal, CFP® in our Bellevue branch location at 888.642.4636 or at yolanda.carbajal@merceradvisors.com. Indexes include: REITS: NAREIT Equity REIT Index; EAFE: MSCI EAFE; Oil: WTI Index; Bonds: Barclays Capital U.S. Aggregate Index; Homes: median sale price of existing single-family homes; Gold: USD/troy oz.; Inflation: CPI. Average investor return is based on a Dalbar Inc. analysis, which utilizes the net of aggregate of monthly mutual fund sales, redemptions and exchanges as a measure of investor behavior. Returns are annualized (as well as total return, where applicable) and represent the 20-year period ending 12/31/11 to match Dalbar Inc’s most recent analysis. Mercer Global Advisors Inc. is registered with the Securities and Exchange Commission and delivers all investment-related services. Mercer Advisors Inc. is the parent company of Mercer Global Advisors Inc. and is not involved with investment services.

the source mercer advisors

The challenges faced by the individual investor


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WOHF continues its long standing legacy of face-toface visits with kids in every corner of the state

Recent WOHF Presentations: January 8

47 children Lil’ People’s World Preschool, Seattle

January 18

25 children Kitsap Juvenile Detention Center

January 24

70 children West Auburn High School, Auburn

January 24

200+ children and families Hamilton International Middle School, Seattle

February 12

200+ children and families Echo Lake Elementary, Shoreline

February 13

40 families Federal Way Boys & Girls Club

February 20

25 students La Petite Preschool in Kent

For more than a decade, the Washington Oral Health Foundation has taken its show on the road, performing school presentations across the state, delivering education about oral health, prevention, and the dangers of meth and tobacco to children of all ages. Whenever possible, the Foundation has sought to include parents in evening events, designed to further ingrain oral health messaging with families. WOHF Directors Tom Tidyman and Ruth Abate have recently amped up the program, teaming with dentists in local communities, pre-dental and dental students from the University of Washington, and local nurses, hygienists and assistants to further the scope of this dynamic program, with tremendous results. Since the start of the year presentations have been made in 13 schools, Boys & Girls Clubs, and one juvenile detention facility in the state. Tidyman estimates that nearly 1,500 children were in attendance at presentations, with hundreds more in attendance at local Family Science nights. At press time, WOHF staff were just returning from a blitz of the Sequim School District and the Boys & Girls Club, where more than 800 students were seen in presentations at every school in the district. February 20

800+ children Sequim Oral Health Day · Greywolf Elementary, Helen Haller Elementary, Sequim Middle School, Sequim High School, Sequim Boys & Girls Club

February 21

106 children Meeker Elementary School, Puyallup

February 25

391 children Asotin Elementary School, Clarkston

February 26

107 students First Lutheran of Richmond Beach Preschool and Kindergarten, Edmonds

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70 students Lake Forest Park Elementary, Lake Forest Park

wohf news school presentations

BACK TO SCHOOLS:


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       

 

   

 

  







     



     



 

    



       

        

                

 



   



  

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• Pairing dentists with local school nurses through Adopt A School • Educating kids about oral health • Facilitating access and preven- tion for Boys & Girls Club members • Help the elderly and disabled through WSDA Outreach – Call 211 for info

What we need : • Donations to support the good work WOHF does across the state • Feedback about programming and needs in your area - what works, what doesn’t • Ideas about how we can better serve your component, city, or town • Volunteers willing to present to local schools, Boys & Girls Clubs

From a supporter: The Washington Oral Health Foundation reflects and extends the concern for patients by every member of WSDA. It is the well organized part of the private sector safety net that has existed for years in this state and is part of the ethical fabric of the member dentists of organized dentistry. Dentists have a big collective heart that cares for individual patients, the community at large, the environment, and the constant improvement of quality of care that can be provided. Dentists are thus motivated to give away toothbrushes to the homeless, do a free filling for a patient down on their luck, get a stranger out of pain, volunteer for an overseas mission, and support the Foundation of their Washington State Dental Association. It’s what defines them as a Professional. — Dr. Vic Barry, 2013

FOR WHOM THE BELL TOLLS… Every year, the Washington Oral Health Foundation has called supporters across the state. This year, they’re shaking things up a bit and asking for more than just your generosity.

Every year at this time, the Washington Oral Health Foundation reaches out across the state during its biggest fundraiser: the Phone-A-Thon. In the past, WOHF board members would gather for a day at the WSDA office and call like mad, asking colleagues and friends to help out a good cause. They were tireless in their efforts, to be sure, but they also knew that their pitch needed some retuning. “First of all,” says Dr. Sally Hewett, President of the WOHF Board, “We weren’t reaching some of our supporters across the state, but just as important, we weren’t focused on asking for feedback — this year, we are.” In addition to creating a cohort of callers all across the state, the organization will devote time during each appeal to ask questions about local programming needs, and how the Foundation can address them. Keenly assessing of all programs the Foundation is involved in, WOHF Director Tom Tidyman and the Board will see which are working, which could use a tweak, and see if shifting focus is called for. The goal: to

th e wsda ne w s · issue 4, march · 2013 · www.wsda.org · 35

allow the foundation to reach more Washingtonians in a meaningful way, and better tailor all of their programming in the future. While nothing is sacrosanct, Tidyman and the Board know that educational programming is desperately needed in schools, Boys and Girls Clubs, and churches across Washington, and they’re committed to offering some type of prevention, oral health care, and drug and tobacco messaging to children. But even with your generosity, the Foundation’s resources are limited, and it’s good business to critique and assess their programming to zero in on the need across the state. “Some of the money we raise will be used to collect data on all of our programs,” says Hewett, “So that we’ll have sound, qualitative information to base future programming decisions on. Plus, we’ll be able to use that data to report to members, give to legislators, and use in grant requests with organizations looking to fund educational efforts.”

wohf news phone-a-thon

The work of the Foundation includes:


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3 6 · th e wsda ne w s · issue 4, march · 2013 · www.wsda.org


This work is licensed under a Creative Commons Attribution-ShareAlike 3.0 Unported License.

RECRUIT TO WIN!

WSDA 12th MAN CHALLENGE www.wsda.org/12thman

letter to the editor lynn stedman

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Facial pain not responding to traditional treatment? Trigeminal Neuralgia (TN) is a neurological disorder affecting the trigeminal nerve that, in its early phases, may mimic a dental abscess or TMJ/TMD. The rarity of this disorder and the variability of symptoms mean that some patients are initially treated for dental or sinus issues before a neurological disorder is recognized.

If you suspect that one of your patients may have TN or would like to rule out that possibility, we can help. • South Sound Gamma Knife at St. Joseph can provide referrals to local neurologists experienced in the treatment of TN. • If conservative treatment fails, Gamma Knife provides a highly effective, non-invasive, outpatient treatment. In a single session, Gamma Knife delivers a precise dose of radiation, targeting the trigeminal nerve where it exits the brain while leaving surrounding tissue unharmed. • Gamma Knife treatment is Medicare-approved and safe for patients who are not good surgical candidates because of age or other medical conditions.

We value the relationships we have with the dental community and promise to work closely with you as you guide your patients through therapeutic decisions. For more information or referrals, please call us at 253-284-2438 or 1-866-254-3353.

1802 S. Yakima, Suite 103 Tacoma, WA 98405 Phone: 253-284-2438 or toll-free at 866-254-3353 Fax: 253-272-7054

www.SouthSoundGammaKnife.com

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You know that sinking feeling you get when you realize you were supposed to do something and you missed it? Like: Today it’s my spouse’s turn to pick up the kids. Uh… nope, it was yours. So, who does have the kids? Or remembering — just as you’re walking in the door — that it’s your sweetheart’s birthday, and you’ve forgotten to get her anything. Oops. Sometimes we make assumptions that can turn around and bite us! And making assumptions about your dental malpractice policy is another area you can’t afford to be wrong about. Let me give you a few common examples of when your malpractice policy probably isn’t going to provide you with coverage:

• You work for a governmental entity

It isn’t uncommon for a dentist to do some part-time work outside of their regular practice and occasionally it’ll be for a governmental entity, like a correctional facility for example. This exposure is specifically excluded in our policy and is usually excluded by other carriers as well. Most insurance carriers will not be interested in setting themselves up as a potential deep pocket for a governmental agency, should a claim or suit arise. If you provide services for a health department, county or state hospital, correctional facility or any other government agency, you need to make certain that your malpractice carrier does provide coverage. If they don’t, you should require that you’re provided sufficient coverage through that governmental entity, and make sure you have written confirmation, annually. Your contract should, among other things, be specific about the limits of coverage provided; the period of time covered; and should also specify the coverage provided if a claim or suit arises after your contract has ended with that agency, for patient care that was rendered during your contract term.

• You design, manufacture or sell products under your name

Your malpractice policy is not designed to provide coverage if you or someone else is designing, developing, manufacturing, selling or distributing products under your name. You need a Products Liability Policy for this type of exposure. This would not apply for common dental appliances made for specific patients in your practice.

• You are a member, partner, director or shareholder of any partnership, association or corporation

There can be two different scenarios for this example and both of them require different approaches. The first scenario is one we addressed in a previous article (see WSDA News, Issue 8, August 2012) and that is simply if your practice is incorporated, or if you are perceived to be or are practicing as a group with other dentists, you need a Corporate/Partnership Professional Liability Policy. If you have a solo practice but operate under a different name, e.g. “1234 Dental”, add that name to your individual professional liability policy. The second scenario is if you serve on a Board, whether you volunteer or whether you are compensated for your services, that Board should carry a Directors and Officers Policy. In the event you are sued for decisions that are made as a function of this responsibility, the D & O policy provides coverage. These are just three examples of exposures that are not typically covered under a dental malpractice policy. Identifying the risk and then properly insuring it under the correct policy is something you can do through a conversation with your carrier. But this also begs the question, when was the last time you read your malpractice policy? You should be familiar with the exclusions in your policy, and if there’s language you’re not familiar with or don’t understand, discuss it with your company’s representative. Don’t wait until you need the coverage to discover you don’t have the correct policy for the exposures you have. You can avoid that sinking feeling by asking the right questions now.

th e wsda ne w s · issue 4, march · 2013 · www.wsda.org · 39

Melissa Sanchez Manager, NORDIC Sales and Marketing

“When was the last time you read your malpractice policy? You should be familiar with the exclusions in your policy, and if there’s language you’re not familiar with or don’t understand, discuss it with your company’s representative.”

nordic news what do you mean I’m not covered?

What do you mean I’m not covered?


Paul C. Fawson, III, D.D.S. has acquired the practice of Kelly R. Clarke, D.D.S. - Spokane, Washington

Ronald C. Heilman, D.D.S. & Fred R. Dahm, D.D.S.

Call 1-800-232-3826 or visit us online at www.aftco.net for a free practice appraisal, a $2,500 value!

have merged their practices - Bellevue, Washington AFTCO is pleased to have represented all parties in these transactions.

AFTCO is the oldest and largest dental practice transition consulting firm in the United States. AFTCO assists dentists with associateships, purchasing and selling of practices, and retirement plans. We are there to serve you through all stages of your career.

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$PAC-078_DENTAL_WA-StateDentalAssoc_BW_7.25x4.75_Jan2013.indd 1

1/11/13 2:34 PM

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Eight years ago, Walla Walla dentist Dr. Ron Will heard about a plan to open a free dental clinic in the area. He’d just moved into a new facility and had a raft of dental equipment he was willing to donate — he just needed to find a place to use it. Dental vans in the area were addressing some of the access issues, but couldn’t keep up with the demand — especially once adult dental Medicaid funding dried up. The Board of the Sonbridge Community Center — a facility affiliated with the Seventh Day Adventist Church, but serving the entire community — approached Will with the idea of establishing a dental clinic on their property in College Place. Centrally-located and easily reached by their target audience, the community center seemed the ideal place to set up shop.

Getting started

Beset by a number of roadblocks along the way, Will recounted that the interest in building the clinic never waned, saying, “The Sonbridge Clinic people had to get their infrastructure in place before we could move forward. A dental clinic isn’t like a medical clinic — they can just open up a room and start seeing people. We had to really put a lot of effort into it. For the first six years, we drew up various plans, but it wasn’t until we partnered with the Sonbridge Medical Clinic to share a waiting room that things really began to gel. Finally, two years ago when the main part of the building started getting framed in, we knew we were going somewhere.” At that time they formed a committee including Will, Paul Rasmussen (head of entire community center project), Keith Canwell (director of NW Medical Teams dental van in the valley), Dr. Julie Kellogg, Dr. Don Kellogg, Dr. Cameron Stewart, Dr. Eric Gustavsen, Dr. David Hernandez, and Dr. Todd Schroeder — and be-

gan having monthly meetings to plan the clinic. Then four months ago they convinced recently-retired Walla Walla University professor Mel Lang to be the Director of the dental clinic. Lang explains, “I really wasn’t looking, but it seemed to be a good fit and a good cause, and I was compelled to help out.”

Details, details

Details still need to be ironed out — the group still needs some equipment, including a Scan X, a phone system, a lab lathe, and basic supplies totaling about $50,000. The clinic will coordinate with the local MTI vans and take referrals from area dentists. Screening will be handled by Help Line, starting with the patients most in need, and gradually expanding services outward. Still, the committee is not entirely sure what the capacity of the clinic will be. Lang plans a soft opening in March, saying, “We hope to open a couple of nights a week, for 2-3 hours a night. I have hired a volunteer who was a dental assistant, and she is going to run the office and make the appointments. I have already been in touch with a number of other dentists in the community who are willing to help.” With around eight dentists committed to volunteer at the facility, Lang is estimating they’ll be able to see 12-15 patients a week to start — for a total of about 600 patient visits a year — but all involved are hopeful that they’ll grow the number of volunteers and be able to expand the patient load considerably. Still, every bit of dental care delivered to the underserved helps.

Interested in helping out?

If you live in the area and are willing to donate time and expertise to the clinic, or if you’d be interested in making a donation of cash or materials, please contact Mel Lang at mel.lang@wallawalla.edu

th e wsda ne w s · issue 4, march · 2013 · www.wsda.org · 41

member news giving back in walla walla

EXPANDING ACCESS Free clinic in Walla Walla nears completion


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4 2 · th e wsda ne w s · issue 4, march · 2013 · www.wsda.org


Call for nomination recommendations for elective offices of the WSDA Dr. Rod Wentworth, Immediate Past President of the WSDA and Chair, Task Force on Nominations, has put out a call for recommendations for elected positions within the Association. Submission deadline is June 27, 2013. The House of Delegates of the Washington State Dental Association is scheduled September 19-21, 2013, in Chelan. Elective position descriptions are available upon request. During the meeting, the House will fill the following elective offices (terms are for one year unless otherwise specified). · President-elect: One year and three-year term as ADA Delegate · Vice President: One year as an ADA Delegate · Secretary-Treasurer: Three-year term and three-year term as ADA Delegate · Board of Directors: Four positions, three-year terms · Committee on Budget and Finance: One position, four-year term · Committee on Government Affairs: One position, three-year term · Delegates to the ADA House: Two positions, three-year terms beginning January 2014

Timelines

In accordance with a resolution passed by the 1994 House of Delegates, nominations for these vacancies must be submitted to the Association Office no later than 12 weeks before the first day of the House of Delegates, June 27, 2013. The Task Force on Nominations will meet soon to formulate recommendations for elective offices, so it is imperative that nominations be submitted in a timely fashion.

Forms and Photos Get forms here: http://tinyurl.com/2013NomPack Members interested in running for elective offices should complete and return the enclosed Biographical Questionnaire, Conflict of Interest Statement and Disclosure of Dental Affiliations Form to the Association Office. Feel free to make copies of the materials as needed.

The following forms must be submitted and emailed to brenda@wsda.org — get forms here: http://tinyurl. com/2013NomPack • Completed biographical questionnaire for each prospective candidate. • A statement from the candidate of 250 words or less on his or her reasons for running for office, sent by email. This will be used in the WSDA News and with materials distributed to delegates. Please note, submissions longer than 250 may be edited at our discretion.

• A color, high resolution (300 dpi or greater) head-and-shoulders photograph of each candidate, suitable for publication in the WSDA News. • A conflict of interest statement signed by the candidate. • A disclosure of dental affiliations form. To be considered, each submission must contain all of these elements.

Background Information

Bylaws provisions for the available positions are enclosed in the nomination packet, available here: http://tinyurl. com/2013NomPack. The WSDA bylaws provide that “no person shall be elected to the office of President-elect, Vice President, or Secretary-Treasurer who has not been a member for the preceding five consecutive years.” The Task Force on Nominations cannot list any member for office unless the member has signified willingness to serve. Recommendations from component societies are of great assistance to the Task Force on Nominations in its deliberations and are greatly appreciated.

Terms of Office

All terms begin when the WSDA House adjourns on September 21, 2013, with the exception of the ADA Delegates whose terms begin on January 1, 2014.

Questions?

For additional information, please contact Amanda Tran at (800) 448-3368 or e-mail amanda@wsda.org.

th e wsda ne w s · issue 4, march · 2013 · www.wsda.org · 43

membership news call for nominations

CALL FOR NOMINATIONS Participate in organized dentistry


Sam Martin, MBA, CFP®, CPA and Margaret M. Boyle, CPA, CVA

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4 4 · th e wsda ne w s · issue 4, march · 2013 · www.wsda.org

sam@cpa4dds.com | nate@wealth4dds.com | mmb@cpa4dds.com


OPPORTUNITIES AVAILABLE

OPPORTUNITIES WANTED

GREAT DENTIST NEEDED — $1,000 Finder’s Fee. Richland, Wash. We need a great general dentist to join our practice. We have a thriving practice and we need help. Great opportunity for someone who wants to treat people with the best that modern dentistry has to offer. Ortho, implants, perio, endo, pedo, sleep, cosmetic, or just great restorative and hygiene, we provide all aspects of general dentistry to our patients. Spacious, modern office with digital x-rays, electric handpieces, digital charts, digital IO cameras, and more. Oneof-a-kind patient experience with soaring windows, indoor live palm trees, and a 20-foot water feature – a truly gorgeous place to work. We handle the marketing, new patient generating and management hassle. Great income potential and great working conditions. We have it all! Hurry! First responders to refer someone we hire will receive a $1,000 finders fee. Send your name, your email, prospective doctor name and phone number to careers@ cadwelldental.com or fax (509) 627-6720

ASSOCIATE WANTED — Seeking full and part-time experienced general dentist to join established family and cosmetic dental practice in Bonney Lake. Dentist must be skilled and personable and will be provided a great opportunity with high pay potential at our state of the art facility. Please fax resume to: (253) 891-1442 or email to: docvan99@aol.com.

LONGVIEW, WASH. — We have a great opportunity in a thriving state of the art pediatric dental practice for an energetic, caring pediatric dentist. Our practice is modern, large, and paperless, with wonderful dedicated team members that are easy to work with, and we have our own surgical center. Joining doctor will be highly compensated, with flexible scheduling. Please contact me at (360) 636-1900 or at dr.eid@ happykidsdentistry.com, and make sure to check our website.

DENTISTS NEEDED — Interested in relocating to where opportunities are? We have multiple general dentist opportunities available in and around the Portland / Vancouver area!

Sign on bonus and relocation assistance offered for multiple locations in and around the Portland, Oregon metro region

At Gentle Dental, we aim to provide our network of doctors and staff with a competitive compensation package. Our benefits include: Enhanced professional training, opportunity to excel and advance in your dental career, Gentle Dental University, tuition reimbursement, life insurance, financial reward, malpractice insurance paid, and 401 K Plan. 
For more information contact:
Ron Brush
Manager of Doctor Recruitment, Direct: 800-8369945
Cell: (971) 295-9914
eFax: 877-2333542
Email: brushr@interdent.com. SOUTH SEATTLE — Seeking qualified pedo, ortho and general dentists. Fully digital office with experienced expanded team. Attractive stress free environment Competitive reimbursement. Full and part time. Opportunities for ownership in a growing company. Do not miss your chance. Contact Jacob at (206) 349-2967 or by email at info@fortdental.net. PUYALLUP — Dentist opportunity in Puyallup. We are looking for an associate dentist to blend into our established, wellrespected general practice serving patients of all ages. We have a state of the art office, a long-term team, and are fully digital including Cerec. Please email resume to Drurback@puyallupvalleydental.com.

PEDIATRIC OPPORTUNITY AVAILABLE — Pediatric dentist opportunity. South King County, multiple office sites. Solid seven figure practice. Existing patient base. Part time but will eventually lead to full time. Potential to buy in. Email CV to skcpedodds@gmail.com. OPPORTUNITY AVAILABLE — Opportunity for dentist interested in TMD/facial pain practice. Poulsbo Wa. Call (360) 9818796, tmdclinic@aol.com. VANCOUVER, WASH. — Gentle Dental offers exciting opportunities for general dentists and specialists throughout the Pacific Northwest. We are seeking committed professionals for our existing and our brand new state-of-the-art facilities. If you’re interested in joining a progressive group practice and are dedicated to providing quality care, please contact Ron Brush by phone at: (971) 295-9914 or by e-mail brushr@interdent.com. ENDODONTIST — Gentle Dental is looking for an endodontist in South Seattle. This is an excellent opportunity to work for a caring and professional group practice setting. Fun and friendly dental staff along with great patients who you will enjoy taking care of. Contact: Ron Brush, Direct: 800-836-9945, cell: (971) 295-9914 and email brushr@interdent.com. ASSOCIATE DENTIST — We are looking for a passionate doctor with exceptional interpersonal skills and a desire to deliver five-star customer service to join our team. The position requires 1-2 years of experience. Applicant must have a current license in Washington. If you’d like to learn more about our opportunity, send a cover letter and resume to submitdentistresume@ gmail.com. GENERAL DENTIST NEEDED — Apple Valley Dental & Braces is seeking a General Dentist for our growing group practice in Eastern Washington. We offer a great salary and great benefits. We are looking for someone who is confident, energetic and a people person! Earnings are production based and we are busy! Please contact Jolene Babka, Corporate Manager, at (509) 823-4484 for further information.

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DENTIST OPPORTUNITY IN PORTLAND, ORE — Do the clinical dentistry you want to do. We offer paths in which you can manage or open your own practice with profit sharing. Pdxdentist@yahoo. com. ASSOCIATE DENTIST POSITION — Lynnwood. Candidates should have experience with all facets of general dentistry with emphasis on oral surgery and implant placement. Our office has been established in the area for ten+ years with a stable client base and with proficient staff. We offer a competitive compensation package, Email your CV to motzko4807@gmail. com. PART-TIME GP IN BELLEVUE — We are looking for an associate in Bellevue to work 2.5 days Wed-Fri. More days possible. We are a top office in our area. Beautiful modern office with state of the art technology. Fantastic patients and team. Fully digital. Must be highly skilled and experienced. Please email resume to bellevuedentists@ gmail.com. OPPORTUNITY WANTED — General Dentist looking for an office in need of a dentist on Fridays and Saturdays in Western Wash. I have 19 years of private practice experience in all aspects of dentistry. Prefer endo and surgery. Call (360) 4029370 or email scubatooth@msn.com. DENTIST OPPORTUNITY IN GRAHAM, WASH. — Seeking experienced dentist for busy, well established, successful, fee for service, group dental practice. Full-time position available. Excellent immediate income opportunity ($180,000 to $375,000 + per year) depending on productive ability and hours worked. Secure, long-term position. You can concentrate on optimum patient treatment without practice management duties. Modern well-equipped office with excellent staff, and lab services provided. If you are bright, energetic with a desire to be productive, very personable, and people oriented, and have great general and specialty clinical skills, Fax resume to Dr. Hanssen at (425) 484-2110.

classifieds issue 4, march 2013

OPPORTUNITIES AVAILABLE


Member Company: American Dental Sales Practice Valuation Study Group Institute of Business Appraisers

www.mydentalbroker.com

Call Toll Free Phone (866) 348-3800 Fax (866) 348-3809

info@mydentalbroker.com 16300 Christensen Rd. Suite 213 Seattle, WA 98188 4 6 路 th e wsda ne w s 路 issue 4, march 路 2013 路 www.wsda.org


OFFICES FOR SALE OR LEASE

OFFICES FOR SALE OR LEASE

GIG HARBOR — Opportunity in the beautiful Pacific Northwest. Associate needed for busy Gig Harbor office. Great staff, set your own hours. Also, other specialists needed. Call Carol at (360) 779-7219.

OFFICE SPACE TO SHARE — Excellent opportunity for specialist who wants to work one or two days a week or a start-up practice for any practitioner. Front office support. Contact Melissa at (425) 481-1038 or email office@gentletouchdental.com.

FOR LEASE, BURIEN, WASH — Brand new, 2,700 foot, six op dental office with pano room, lab, break room, two restrooms and private offices. Completely wired and plumbed for state of the art digital dental office. $10/ft, NNN or $2,200/mo. Must see to believe and appreciate. Great opportunity for start up or relocation. Contact (206) 909-3863.

OFFICES FOR SALE OR LEASE LYNNWOOD, NORTH SEATTLE — Dental office condo for sale or rent. Owner financing or four months free rent. 1,300 square feet. Three ops. Dr. Hertl (206) 3007060. Email skihertl@gmail.com.

FOR SALE — Well established dental office in South Tacoma, four ops, paperless and all digital. Average three years collection around $900K. Please direct question and send your resume via thinguy@gmail. com.

EVERETT GP FOR SALE — Busy general practice located on main Everett thoroughfare. Over 25 years of goodwill and a solid patient base. The seller is retiring. Practice Transition Partners, 888-789-1085, contact@practicetransitions.com.

MUST SEE — Under fair market price. Professional brick building for medical/ dental office. Located in downtown Auburn, across from Auburn Regional Hospital. 4,992 sq. ft. Contact HDN at (206) 304-0317.

FOR SALE — Beautiful stand alone redecorated 2,000 sq. ft., open concept bldg with five ops and plumbed with N2O. This practice is nestled in the foothills of Mt. Rainier, just a 50-minute drive from Seattle. The area offers a recreational paradise, with skiing just 40 minutes away and great schools. 0ngoing practice for over 25 years with loyal patients and a experienced staff. For more details call (253) 797-1353.

NEXT/ANNIE MILLER & ASSOCIATES — New dental practice listings and sites for sale in Bellevue, Kirkland, Federal Way, Renton and Tukwila. Call today for tours and info. Annie Miller, Re Max Eastside Broker’s Inc. (206) 715-1444 or email at annie@nextnw.com.

DENTAL OFFICE SPACE AVAILABLE NOW — Recently remodeled dental office in the Southcenter area, 1,350 Square Feet. Oxygen, nitrous, water, air already plumbed in so it’s ready for you to start practicing! Some dental equipment is available. Growth area, large traffic. Call Medical Centers Management (253) 508-1293. FOR SALE — Renton and downtown Seattle (satellite). General dentistry, great locations,practice collecting $650,000. Room to grow. Call for details. (206) 4207063. MILL CREEK — Beautiful, modern dental office space available for lease to a specialist. Convenient location in close proximity to several general dentists. Tenant improvements tastefully completed. Serious inquiries only. If interested, please contact millcreekofficespace@gmail.com. SPACE SHARING OPPORTUNITY — Presently working three days/ week and have ample room to share space in our five chair downtown Seattle general practice office with in-house lab and technician. Bring your patients and staff and share the rent, utilities and supplies. Contact Rick Nicolini, DDS at (206) 310-5709 or drnicolini@hotmail.com.

DENTAL OFFICE TO SHARE — Three to four days a week in Federal Way. Good location - on a busy street, close to a shopping center, and freeways. Three operatories. Bring your own staff or we can share some of ours. Good for a startup practice or a specialist. Please email at seattlesmiles@gmail.com. FOR SALE BELLEVUE — Beautiful Bellevue dental practice near Crossroads Mall. Open and spacious with three existing operative rooms, and room to expand. Pano and Ceph machine in office. Digital x-ray system in place. Convenient location on a main street near Microsoft. For more information, please call (425) 213-6606. FOR LEASE — 300 Pelly Ave N. Dental suite available in Renton, walking distance to the prestigious Landing, as well as Boeing. 1,361 sq. ft. on 2nd floor, with only two other dentists in building. Three operatories, open configuration, plumbed with electrical, air, vacuum, and plumbing. Corner lot with heavy traffic flow. Rate is $23.26/SF/Y NNN, Triple Net is $5.60 (incl utilities). Contact Dennis Schmuland (425) 417-1206. NEXT/ANNIE MILLER & ASSOCIATES — Providing consulting services to the dental community for the past 35 years. New practice start-ups, practice transitions, sales and valuations. Dental space planning and architecture; real estate leasing and acquisitions, employment benefits; staffing resources and training; financing. Call today for your free consultation…we can’t mint money for you, but we can sure save what you have now! Annie Miller (206) 7151444. Email: annie@nextnw.com.

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EQUIPMENT FOR SALE USED/REFURBISHED EQUIPMENT — adec, Gendex, Pelton Crane, Dentalez, Porter, Air Tech, Midwest, Midmark and etc. Lab equipment. Parts are also available for almost all equipment. Call Dental Warehouse at 800-488-2446 or http://cascadedental.net. MOBILE DENTAL SYSTEMS — Mobile dental operatory suitable for a variety of locations ie..assisted living, missionaries. Excellent condition stackable containers. approximately 45 lbs Contact (360) 981-8796. PRICED TO SELL — DentalEZ compressor, replaced regulator, $99. Please call Dr. Zakaria (206) 364-7680.

EQUIPMENT WANTED EQUIPMENT WANTED — Looking for wide range of used equipment. Adec, Kavo, Midmark, Pelton Crane, Midwest, Gendex, Air Techniques, Apollo, Porter, Cerec, Sirona. If you want to sell equipment, call (206) 260-3563.

SERVICES LOCUM TENENS — ­ Guest dentist. Need some time away? Vacation, maternity, etc. I can be there. Over 25 years of personable, patient oriented general practice experience. Doug Seymour, DDS (425) 488-2508. PROT ECT YOU R ONLINE R EPUTATION — Studies show potential patients (even referrals) will Google you before they schedule. One negative review costs an average of 30 new patients. New eBook shows how to protect your hard earned reputation and brand. Free at DDSReputationDefender.com. LOCUM TENENS DENTIST — Want to take a vacation? Need a knowledgeable, reliable ad personable dentist to help with your practice while you’re away? Experienced locum tenens dentist will provide exceptional care to your patients. Over 25 years of private practice general dentistry. Serving all of Washington and Oregon. References available upon request. Contact Bob Houtz, DDS at (360) 457-9568.

classifieds issue 4, march 2013

OFFICES FOR SALE OR LEASE


parrish or perish continued

parrish, continued from page 46

percent; 2010, 24 percent. We all heard the “conventional wisdom” that women would practice less therefore would be “taking up a seat” some male should have who would practice more. While the statement is legally and morally irrelevant, is there any evidence supporting the thought? A 2000 British survey showed more women than male dentists were working part-time, more likely to work in the Community Dental Service and took longer breaks which were closely associated with childrearing. The American Journal of Orthodontics in a 2005 survey found similar patterns: days worked per week and lengths of leaves were tied to number of children. Women were less likely to own an ortho practice, and those who did employed fewer staff. The Journal of Canadian Dentistry Association in 2012 reported fewer women were likely to own a practice, worked 4-6 fewer hours per week and saw fewer patients; as expected, they had lower salaries. They were also more likely to work in urban settings. And finally, JADA in 2005 reported on 2001 WDS data that showed “the mean and median numbers of days worked were about 10 percent lower for female dentists…, (they) treated 10 percent fewer patients, performed 10 percent fewer procedures and had a combined income of about 10 percent less than that of male dentists.” While we need to allow more time for this first significant cohort of female dentists to work through a lifetime of service to evaluate their true overall impact, short term evidence suggests women are, in fact, working less than their male counterparts. Nevertheless it is clear that women are making a major impact on the profession by their sheer numbers. But should the tendencies thus far shown by women dentists (working less, urban preference, non-ownership) give us pause in considering our overall delivery system as they approach half of the workforce? Are we going to need 10 percent more dentists to provide the same amount of care? How can we attract dentists, male or female, into rural areas? What impact, good and bad, will fewer dentists in private practice have on the system? But, even more importantly, what are the social impacts of the apparent “end of men”? While it is unlikely that I will live to see the complete demise of men practicing dentistry, are there societal changes Rosen reports invading the lives of our female colleagues. If they are casting men aside as irrelevant, a burden and ineffectual partners and revert to a matriarchal society, that’s probably more crucial to all of us than any impact on dentistry—a challenge for all, especially those parents of boys.

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SERVICES

OFFICE CONSTRUCTION

GUEST DENTIST — Time off, vacation, maternity leave? Temporary placement for day, week, or longer. Experienced, team and patient-oriented GP. Joe Schneider, DDS, FAGD. (206) 878-1237.

TRAVELING ENDODONTIST— Looking for general practice offices that would like their endodontic patients treated in-house. My two dental assistants and all high tech equipment ready to travel to your office one to two days/month. Efficient and productive office systems in place. High production income split without having to refer. Patients simply love this service. References available. Please call (360) 303-2421.

CONSTANTINE BUILDERS INC. (CBI)WSDA endorses CBI as their preferred builder of Dental facilities with over 25 years of experience from ground up buildings, renovations, remodels, and interior tenant improvement projects. All projects are completed on time and within budget. CBI provides the highest level of quality service with integrity that exceeds our client’s expectation. Please see our display ad on page two and website at www.constantinebuilders.com for additional information and how you can become another satisfied client. Telephone (206) 957-4400, O. George Constantine.

HAVE SEDATION, WILL TRAVEL — Make fearful patients comfortable with IV Conscious Sedation. I am set up to come to your office and sedate your patients so that you can perform needed treatments the patients avoid due to fear. I have 16 years experience providing safe IV Conscious Sedation. Serving Washington & Oregon. Richard Garay, DDS. (360) 281-0204, garaydds@gmail.com. MOBILE I.V. SEDATION — Have your patients treated in your office with safe and proven techniques. Set your practice apart from others. Attract new patients. Increase quality referrals. Neil E. Bergstrom, DDS (360) 825-6596. IN-HOUSE PERIO — Board certified Periodontist looking for GP offices that would like their periodontic /implant patients treated in-house. References available. Please call (201) 780-9156.

THINKING OF SELLING YOUR PR ACTICE? — And need a broker? Before you pick up the phone, there’s someone you should call first. Norm Culver, DDS has been seminaring and consulting with dentists on practice transitions for years. With this expertise, he knows how to help you find the best broker for the sale of your particular practice. Dr. Culver is an independent consultant and not a broker — so there is no cost to you. (206) 784-6941 or email normculver@ aol.com. GUEST DENTIST — Will fill in at your practice for maternity leave, injury, illness, family emergency, etc. 35 years of general dental practice experience. Personable and patient oriented. Dr. Ed Kardong (206) 842-6300.

CONTINUING EDUCATION MODERATE SEDATION COURSE — Instructor: Steven Ganzberg, D.M.D., M.S. Dates: April 19-21 at UCLA and May 15-19 at Wendel Family Dental Centre (Vancouver, WA), 2013. Cost: $11,995. A deposit of $5,000 due by February 1, 2013. Course is 80+ hours with 20 patient cases. Contact: Lori, 360-944-3813 or loris@wendeldental.com. Space is limited. AGD #218643.

History of present illness:

This is a 51-year-old male who presented with a smooth-surfaced, focally ulcerated, grey-blue, firm nodule on the hard palate (Figure 1). It is described as slow growing. It is around two cm in diameter at its greatest dimension. The swelling is ulcerated but otherwise not painful. This “Clinical Corner” case was contributed by Dr. Serv Wahan of Oral and Maxillofacial Surgery, Arlington, Wash.

Test your knowledge!

An answer to this case study can be found on the University of Washington’s Web site at http://www.dental.washington. edu/departments/oral-surgery/case-of-themonth.html. Click on “Case of the Month” and look for the March 2013 entry.

Figure 1

th e wsda ne w s · issue 4, march · 2013 · www.wsda.org · 49

clinical corner issue 4, march 2013

Single dome-shaped swelling on the hard palate

classifieds issue 4, march 2013

SERVICES


parrish or perish

The end of men…dentists?

Let’s get the cold facts out first. 1. I’m 66 so I am very familiar with Leave it to Beaver, and I have lived through the feminist revolution…and the wussification of the American male. 2. I went to an all-male college. 3. I’m the father of two talented adult daughters. 4. I’ve been married for 45 years to my wife who provided the family income for six years of pre-dent and dental school, plus she was the major family financial contributor until I was actually making serious money in practice. 5. My UW dental school class was among the first to have a significant percentage of women. 6. I was complimented, years after graduation, by a female classmate who said she felt, “I was never one of the guys who had a problem with women in dental school.” I like to think that was true then and today. 7. I believe there are significant differences between males and females, but there are very few things women cannot do except father a child, and I’m willing to debate women in combat, Mr. Panetta. Dr. Jeffrey Parrish

8. I am not a complete Neanderthal.

“If everyone is thinking alike, then somebody isn’t thinking.” — George Patton

I recently found an Atlantic magazine article entitled, “The End of Men” by Hanna Rosin. Ms. Rosin raises some interesting points which probably have some bearing on our profession that we all should consider, and I see examples of her thesis expressed in our younger generation of dentists. As a male, I was intrigued by the title and have become increasingly worried there may be some truth expressed therein. And as a geezer, I really don’t think it is the best for society in general long term. Ms. Rosen’s premise is that women are taking over most of employment (and ultimately society) because they are more suited to this post-recession age. They are acquiring 60 percent of the bachelors and masters degrees (which are necessary for entrance into many jobs), and the “modern, post-industrial economy is simply more congenial to women than to men.” Men were three-quarters of the recession era job losses, and the industries that men have dominated are simply not coming back: construction, manufacturing, and other blue collar jobs. Women have demonstrated they are the “best educated, most conscientious, most stable workers”, so they are hired. Studies have shown that the most successful firms are those who promote women. Men are simply failing to adapt. And men who are failing to adapt to the changing employment environment in the blue collar world are increasingly unemployable, poor marriage material and ultimately irrelevant to women and their children. Look at what is happening in the lower classes, especially in the African American lower classes: men are not present. It has become almost totally matriarchal with women in control of all decisions; men have been cast aside. But Rosen asserts the same thing is beginning to happen in the upper classes as well. Immature, impulsive men cannot manage to get into college, complete school and ultimately get a job. Middle and upper middle class women recognize this and, more and more, view a husband as a millstone not an asset. Women are also receiving 50 percent of professional degrees. Clearly the ratio of women in our profession has changed dramatically over the last several decades: 1984 women entering dental school, 24 percent; 2009, 45 percent. Active licenses: 1999, 15

The views expressed are those of the writer and do not necessarily reflect the opinion or official policy of the WSDA.

continued on page 44

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“On a positive note, the video of the incident has gone on to become an internet sensation”

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th e wsda ne w s · issue 4, march · 2013 · www.wsda.org · 51

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You may never really know how good your insurance company is until a claim is filed against you. At NORDIC, we’re invested in you and the business of insuring you and your practice. When you call with a question, you’ll speak directly with the person handling that aspect of your policy, not a random operator. In fact, you’ll always speak with a live person unless you call after hours. We think that’s important. Those big companies? Not so much. NORDIC prides itself in excellent customer service before, during, and after a claim is filed against our customers.

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5 2 · th e wsda ne w s · issue 4, march · 2013 · www.wsda.org

WSDA News · Issue 4 · March 2013  

The official publication of the Washington State Dental Association

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