WSDA News Issue 7 JULY 2018

issu

WSDA 8 201 ly · · ju e7

The voice of the Washington State Dental Association

news

monopsony noun plural -nies

a situation in which the market demand for a product or service consists of a dominant buyer

Also in this issue: 2018 PNDC in pictures WSDA Foundation gift DQAC update th e wsda ne w s · issue 7, july · 2018 · www.wsda.org · 1

PREMIER BUILDERS DENTAL FACILITIES

Constantine Builders has built its business foundation on the ability to establish relationships based on trust, dependability, quality craftsmanship and integrity. We always put the client’s needs first with the firm belief that the best source for future business is satisfied clients.

C O N S TA N T I N E B U I L D E R S . C O M 2 · th e wsda ne w s · issue 7, july 2018 · www.wsda.org

A glimpse into the future? PNDC photos by Scott Eklund/Red Box Pictures

WSDA news

4 editorial

5

guest editorial

28-29

strategic plan update

cover story

30-31

wdia news

6-8

PNDC photos by Scott Eklund/Red Box Pictures

issue 7 · july 2018

10-11

president’s awards

33, 35

hpv and oral cancer

12-21

pndc coverage

37 - 45

clinical corner

40

in memoriam

23

dqac update

25

volunteer news

49-53 classifieds

27

wsda academy

40

clinical corner

46

first person: dr. joe vaughn

Like us on Facebook: www.facebook.com/WashingtonStateDentalAssociation WSDA News Editor Dr. Mar y Jennings

Dr. Ashley L. Ulmer Dr. Amy M. Winston

Continuing Education and Events Coordinator Rachel McFarlane

Editorial Advisor y Board Dr. Brittany Dean Dr. John Evans Dr. Julie Kellogg Dr. Stephen Lee Dr. Joseph Vaughn

WSDA Staff:

Membership Ser vices Coordinator Rachel Gunderson

Washington State Dental Association Dr. Cynthia R. Pauley, President Dr. Christopher Delecki, President-elect Dr. Nathan G. Russell, Secretary-Treasurer Dr. Bernard J. Larson, Immediate Past President Board of Directors Dr. Marissa N. Bender Dr. Dennis L. Bradshaw Dr. Chris Dorow Dr. Linda J. Edgar Dr. John Gibbons Dr. Todd R. Irwin Dr. Christine L. Kirchner Dr. Eric J. Kvinsland Dr. I. Blake McKinley Dr. Randall H. Ogata

Executive Director Bracken Killpack Assistant Executive Director Kainoa Trot ter Controller Peter Aaron

Membership and Communications Coordinator Emma Brown Bookkeeper Joline Hartman Association Of fice: (206) 448 -1914

Director of Government Affairs Mellani McAleenan

Fax: (206) 443 -9266

Director of Operations Brenda Berlin

E- mail/web: info@ wsda.org/wsda.org

Toll Free Number: (800) 448 - 3368

Ar t Director/Managing Editor Robert Bahnsen Director of Continuing Education and Events Emily Rademacher, CMP Government Affairs Associate Emily Lovell

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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.

The WSDA News is published eight times yearly by the Washington State Dental Association. Copyright © 2018 by the Washington State Dental Association, all rights reser ved. No part of this publication may be reproduced without permission of the editor. Statements of fact or opinion are the responsibility 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 eight 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: 2017: Journalism Award, Platinum Pencil, Leadership Article, Division 1, Honorable Mention; 2016: Platinum Pencil Award; 2015: Golden Pen Award Honorable Mention; 2014: ADA Golden Apple Award for Outstanding Achievement in the Promotion of Diversit y and Inclusion; 2013: Journalism Award, Platinum Pencil; 2012: Journalism Award, Best Newslet ter, Division 1, 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 7, july 2018

a day in the life

editorial dr. john gibbons

Now is the time to invest in dental Medicaid

Dr. John Gibbons WSDA Board of Directors

“Regardless of who administers the benefit and how much money they claim they can save the state, increased funding is still needed – and needed now – to meet the needs of low-income patients in our state.”

It is no secret that Washington state’s Medicaid reimbursement rates are abysmal.

According to a 2017 Health Policy Institute Report, Washington is one of three states with the lowest Medicaid reimbursement rates for both adult and child dental services among those that provide dental services to Medicaid-eligible patients via a fee-for-service model.

It should come as no surprise that Washington’s Medicaid reimbursement rates cover only a small fraction of the cost for child and adult dental services, at 32.5 and 25.8 percent, respectively – again among the lowest in the nation. When comparing Washington’s Medicaid reimbursement rates relative to private dental insurance reimbursement rates, our state is also found at the bottom of the list.

However, despite our solid place at the wrong end of Medicaid reimbursement rates, our state continues to be a leader for children’s oral health. The 2015-16 Smile Survey revealed that there have been substantial decreases in untreated decay among preschoolers and third-graders, as well as a decay decrease among second- and thirdgraders in every major racial/ethnic group since 2005. Even more significant, we have a 56.4 percent statewide utilization of dental services among Medicaid-eligible children.

That’s close to the utilization rate for private dental benefits in many states.

This apparent contradiction poses an important question: How are we achieving these results with such an underfunded dental Medicaid program? The answer is clear: Dentists across the state are committed to providing optimal oral health care to all Washingtonians. Through innovative programs, such as the ABCD program, and the individual contributions of countless dentists who are dedicated to the communities they serve, we are providing care to the kids who need it most, despite meager reimbursement rates.

While we have been successful in treating our state’s Medicaid-eligible children, that success has not yet been translated to adult patients. As many will remember, the state cut most adult dental benefits during

the depths of the recession in 2011 and did not restore those benefits until 2014, leaving our state’s dentists grappling to get a handle on the demand for dental care.

Simply knowing that the adult dental benefit is subject to the chopping block anytime there is a state budget crisis leaves dentists and patients feeling unsettled. This is not a sustainable model, and a quick look at the state’s spending over the past few years shows that they continue to pay for costly extractions and dentures, many of which could have been avoided with more regular preventative care. This situation negates the original intent to save public dollars. As an old car repair commercial said, you can pay now or pay more later.

Program instability and reimbursement rates that do not come close to covering costs aside, the administrative hoops dentists have to jump through and high noshow rates make treating this vulnerable population very challenging for many of us.

For years, the WSDA has been advocating in Olympia for more money to be allocated toward the dental Medicaid program.

In general, the response has been that the funding simply did not exist. However, today that clearly is not the case. With the McCleary education funding decision more or less behind us, a recent state GDP increase of 4.4 percent (the largest increase of any state), and significant increases in state revenues as a result of a burgeoning state economy ranked number one in the nation, it is time to have this conversation again. This time, under the premise that the funds do, in fact, exist.

With the upcoming transition to managed care, there are many unknowns about the future of our state’s dental Medicaid program. But one thing remains clear: Regardless of who administers the benefit and how much money they claim they can save the state, increased funding is still needed – and needed now – to meet the needs of low-income patients in our state.

It is time to start making real investments in healthcare that focus on the whole person, and that includes the mouth.

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

The views expressed in all WSDA publications are those of the individual authors and do not necessarily reflect the official positions or policies of the WSDA.

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Challenging uncompetitive practices key to dentistry’s future in Washington

I met with some University of Washington School of Dentistry students at last month’s PNDC. While we were supposed to exchange ideas on how WSDA could help them through the challenging times at the dental school, I soon found myself delivering a “Danger, Will Robinson!” message.

Each of them is investing up to $500,000 in themselves and expecting to receive a return on that investment when they enter the dental marketplace. But there are forces at work – and one very powerful force in particular – that has found a way to get at that investment.

That force, of course, is Delta Dental.

It’s hard to believe from today’s vantage point, but there was a time when it felt like practicing dentists had a real partnership with Delta. We maintained a professional, arm’s-length relationship and worked together as “strategic partners” in promoting better oral health for all Washingtonians.

We supported each other’s mutual success as a means of achieving that common goal.

This atmosphere of mutual support served Delta well. The company increased its market share significantly through the 1990s and 2000s. While I believe that Delta historically behaved in good faith, something changed significantly around 2007.

Maybe Delta was feeling the same recessionary pressures we all were. Or maybe they just saw an opportunity.

Either way, recognizing their effective control of the market for dental benefits in Washington, they began making slow, systematic changes in benefits, governance and corporate structure. Looking back, it reminds me of the fable of the boiling frog, with the water temperature rising so gradually that the frog doesn’t realize it until it’s too late.

By 2011 Delta had the water at full boil.

They reduced fee reimbursements 15 percent, and there was nothing any of us could do about it.

That’s when I decided to leave Delta. In one year I watched more than 1,000 patients leave my practice, and I had to lay off several employees despite knowing they had nowhere else to go. Delta contacted my patients, encouraging them to see another dentist to save money. They contacted employers to help redirect employees away from my practice. After a year I had to stop the bleeding.

In “The Godfather,” Michael Corleone famously describes his revenge plans as “not

personal…it’s strictly business.” I believe that Delta operates like Corleone’s quote but most of us dentists cannot treat our patients and our practices like that. For many of us, it is very personal. We’ve worked incredibly hard to build relationships with our patients and employees. It hurts to watch it undermined by Delta.

As time passes, it still feels personal.

More importantly, it just feels wrong.

Elsewhere in this magazine, you can read about WSDA’s request that the Attorney General investigate Delta’s monopsony power as the dominant buyer of dental services in Washington. Simply put, monopsony is the mirror image of monopoly, where instead of a dominant seller and many buyers you have a dominant buyer (Delta) and many sellers (dentists).

Monopsony is illegal if a dominant market position is maintained through predatory or anticompetitive behaviors.

If Delta is found guilty of engaging in uncompetitive behavior, it may be in violation of the same antitrust statutes that the company repeatedly cites as the reason why organized dentistry can’t be actively involved in working with them on various issues.

Why are dentists so vulnerable to monopsony? If you’re a carrot farmer facing a monopsonist, you have options. You can ship your product to another market or plant another crop. Dentistry is a very different animal. We’re “all in.” We invest hundreds of thousands of dollars on our education. Buildings and equipment can represent millions more. Our staff teams must be recruited and trained. We can’t ship dental services to another market.

Many dentists can’t continue to supply the same quality of dentistry they did before Delta’s changes to the fee structure.

They can’t afford to invest in the latest technologies and continuing education to bring the latest innovations to their patients. When they leave the market or retire earlier than planned, the potential for inferior substitutes grows wider.

Today, most new dentists entering the market believe that owning their own practice is no longer attainable. This opens the door for exploitation of young people who may be carrying large student debt burdens and introduces more interference into the doctor patient relationship.

Economic theory holds that monopsony results in an inefficient market. Eventually

Dr. Todd Irwin WSDA Board of Directors

“Many dentists can’t continue to supply the same quality of dentistry they did before Delta’s changes to the fee structure. They can’t afford to invest in the latest technologies and continuing education to bring the latest innovations to their patients.” an inferior product will enter the market as the supply of the original product dries up.

In dentistry, these inferior substitutes come in for the form of corporate dentistry and mid-level providers. Both are supported by Delta Dental and its captive Arcora Foundation.

What can we do about this? Most importantly, we can’t accept the status quo.

Complacency is how we end up the frog in the pot.

Maybe new leadership at Delta will help us return to a more collaborative, “strategic partnership.” I sincerely hope so. But I don’t really expect Delta to relinquish their gains easily. So additional meetings will need to be held and additional legal battles like the one WSDA has just begun will need to be fought. So, stay informed. And stay involved to whatever level you can.

Returning to my conversation with the dental students, I recall one young man’s reaction to my cautionary tale. “You don’t have to convince us you have our best interests in mind,” he said. “We just need to know: What do you need from us?”

If we all have that attitude, we’ll be OK. The views expressed in all WSDA publications are those of the individual authors and do not necessarily reflect the official positions or policies of the WSDA.

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guest editorial dr. todd ir win

Dentists must address Delta Dental

cover stor y monopsony

monopsony WSDA asks Attorney General to investigate potential Delta antiutrust practices

Washington State Dental Association leadership has requested the Antitrust Division of the Washington State Attorney General’s Office to investigate whether Washington Dental Service (Delta Dental of Washington) has engaged in illegal monopsonist practices in our state. The following is a summary of the complaint filed with the AG’s office last month.

The term “monopsony” may be unfamiliar to many readers. We are all familiar with the concept of a monopoly, perhaps because we have rolled the dice, put our hotels on Boardwalk, and passed Go to collect $200. But, in real life, monopoly power is no game.

As Delta’s position as the dominant purchaser of dental services in Washington state proves, the same can be said about a monopsony.

While a monopolist dominates a market by controlling the supply of a good or product, a monopsonist holds sway over the market through dominance of demand. Classic elements of monopsony power include a purchaser (a dental benefits provider) controlling a very large market share, a limited or inelastic supply of the good or service in question (dentists), and an inability or unwillingness for new purchasers (other dental benefit providers) to enter the market or expand their market share.

Monopsony market power, in and of itself, is not illegal. The US Postal Service is a virtual monopsony in demand for the squat, jeep-like vehicles driven by mail carriers. Monopsony power is also seen in a number of labor markets: loggers or miners in employer-run company towns are regularly cited as examples.

However, if the monopsonist maintains buy-side market power through anticompetitive or predatory conduct, the monopsonist

can be found just as guilty as a monopolist in violating antitrust statutes. Examples of predatory monopsonist behavior include insisting on payments that are less than the provider’s cost of doing business; unwillingness to deal; and refusal to purchase except at an unreasonable price.

“We believe Delta Dental’s position and practices in Washington inappropriately leverage monopsony power for its corporate benefit, to the detriment of both dental service providers and their patients,” said WSDA President Dr. Cynthia Pauley. “We are optimistic that a careful examination of the facts will lead the Attorney General’s Office to reach the same conclusion.”

Delta’s market position is indisputably dominant. The company contracts with approximately 90 percent of the state’s licensed, practicing dentists, and it enjoys an estimated 66 percent market share among children and working-age adult patients enrolled in private dental benefit plans in the state, based on a review of publicly available data.1 In some markets, those already high percentages are even larger.

Furthermore, we understand that Delta is looking to contract with the state’s Medicaid program to provide carved-out managed care dental services to Medicaid patients, which would further increase its market share.

Unfortunately, the impact of Delta’s market power is well-known to dentists and their patients. Given its predominant market share, the company wields substantial bargaining leverage when contracting with dentists. Delta effectively offers its contracts to dental providers on a “take it or leave it” basis, with no room for negotiation, and with complete control of rates and terms.

1. Publicly available data used to determine Delta market share: 2012 WDS Annual Report, 2016 WDS Annual Report, Health Care Authority Medicaid statistics, United States Census Bureau Washington Quick Facts, and Health Policy Institute Research Brief on Dental Benefits Coverage for Working-Age Adults in 2014.

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For example, in 2011, Delta unilaterally and dramatically reduced its reimbursement rates for network dentists by approximately 15 percent. These new rates failed to cover many dentists’ costs for the provision of some services.

In the first five years following that precipitous reduction, Delta increased its benefit plan enrollees by 27 percent, its premium revenue by 30 percent, and its premium revenue-per-patient by 2 percent.

During that same period, Delta’s Chief Executive Officer’s compensation increased by 127 percent and its Board Chairman’s compensation increased by 115 percent. Only 10 percent of Delta’s increased premium revenue-per-patient was directed towards patient care and the company’s cash and investments increased by 67 percent.

While the company dramatically reduced reimbursements to dentists, it appears Delta retained the bulk of its savings for its corporate benefit, rather than passing these savings along to the dental patients covered by its plans.

“There is concern that patients are losing access to care as a result of Delta’s reimbursement rates and what many perceive as predatory behavior,” says WSDA Executive Director Bracken Killpack, noting that, in addition to driving some dentists to leave the market, others have been forced to sell their practices and retire earlier than they otherwise would have.

Delta’s actions have had other negative consequences for patients as well, including reduced access to innovations in dental care. For example, patient radiation exposure from digital X-rays can be as little as 10 percent of the exposure from film-based ra-

diography. But reduced reimbursement means that many dentists can no longer afford these capital-intensive technological advances for their practices and their patients.

Similarly, the fee reduction has forced many dentists to eliminate or reduce the volume of Medicaid patients or uncompensated care they provide. Because Washington’s Medicaid reimbursement rates are already extremely low, serving these patients places a significant financial burden on dental practices. When Delta unilaterally reduced reimbursement rates for non-Medicaid patients, whose care would otherwise help a dental practice cover this burden, it made it unaffordable for many dentists to provide discounted or free care to meet the needs of this underserved population.

Other changes imposed by Delta aren’t driven by, or aligned with, improved patient care. The company requires preventive periodontal services or treatments to be made in multiple visits simply for administrative, not clinical reasons. It has changed benefit coverage of some diagnostic procedure codes, including eliminating coverage for bitewing films essential in detecting disease between teeth, increasing intervals between coverage for panoramic X-rays, and refusing coverage for certain standard periodic X-rays for children.

Over the years, patients have come to expect these and similar basic diagnostic services to be covered by their dental benefit plans.

When these necessary diagnostic tools aren’t covered, patients are surprised and often frustrated to learn that they now must bear the cost. Some who may be unable to afford the additional expense are forced to refuse important procedures, running the risk that they may require more complex and expensive future care.

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cover stor y monopsony

“We believe Delta Dental’s position and practices in Washington inappropriately leverage monopsony power for its corporate benefit, to the detriment of both dental service providers and their patients.”

— WSDA President Dr. Cynthia Pauley

cover stor y monopsony

“Delta’s actions suggest that it has prioritized profits over patient care, and we believe that a strong case can be made that Delta has engaged in unlawful monopsony conduct that is harming consumer welfare in Washington.”

— Dr. Nathan Russell, WSDA Secretary-Treasurer.

“Delta’s actions suggest that it has prioritized profits over patient care, and we believe that a strong case can be made that Delta has engaged in unlawful monopsony conduct that is harming consumer welfare in Washington,” argues Dr. Nathan Russell, WSDA Secretary-Treasurer.

According to legal experts, making that case will require a careful review of a variety of indicators to help distinguish between legitimate and coercive behavior. In the health care marketplace, indicators of coercive behavior could include: 1. a decline in market output; 2. a pattern of provider exit because of low rates; 3. a large share of total market-wide reimbursement from the alleged monopsonist; 4. single rates for specialties rather than contract negotiations; 5. low reimbursement levels to providers; 6. limited opportunities to treat noncommercial patients; 7. low incomes and/or profit margins for providers; 8. no systematic excess capacity by providers market-wide; 9. few rival health care insurers; 10. low rates paid by rival health care insurers; and 11. difficulty of entry into the health care insurance market.

Many feel these factors can be observed in the dental benefits market dominated by Delta.

Another key factor in determining whether a dental benefit provider has monopsony power is whether there are reasonable alternatives for providers to shift their sales in order to make a monopsonist’s reduced reimbursement unprofitable. If there are few benefit plan providers in the market, as evidenced by the monopsonist’s large market share, and entry by new benefit plan providers is difficult, there are likely no reasonable alternatives for the provider.

It’s also important to factor in the significant switching cost a health care provider would incur in replacing lost patients when terminating a contract with a monopsonist. It’s not like an industry making and selling widgets, where excess product can simply be stored for sale at a later time. Dentists cannot store their time.

If the dentist can’t replace the monopsonist’s lost patients sufficiently quickly with patients covered by a rival health insurer, the dentist will incur a significant and irrecoverable loss. The situation is made even more difficult because the monopsonist controls such a large share of the market that there aren’t enough patients covered by other insurers to make up the loss.

When this combination of factors exists, as it does here in Washington, the health insurer may be able to exercise monopsony power over providers.

According to WSDA President-elect Dr. Christopher Delecki, WSDA turned to the Attorney General’s Office because it is the Office’s responsibility to protect the public from anticompetitive behavior, and because the complexities of monopsonist behavior demand a thorough and factually-intense investigation.

“When you sit down and review all of the available data about Delta in the context of a monopsony, you begin to appreciate the impact it’s having not only on dental practices, but even more importantly on patient care in our state,” said Delecki The WSDA letter summarizes how we believe Delta’s lack of transparency has frustrated dentists’ efforts to get the information necessary for this analysis, including Delta’s representations to the Office of the Insurance Commissioner that its 2009 corporate reorganization would not reduce member dentists’ rights and was supported by the members; the elimination of dentist input via the Provider Compensation Committee and Member Advisory Committee; the Delta Board of Directors’ veto of bylaws amendments supported by an overwhelming percentage of members; and the cancellation of the required annual membership meeting in 2017.

We’ve worked for years trying to obtain information from Delta to address our mounting concerns regarding patients’ access to care,” said WSDA Immediate Past President Dr. Bernard Larson.

“Since the company continues to thwart our efforts to get this information, our hope is that the AG’s office will have more success.”

WSDA leaders are confident that, if the Attorney General’s office decides to move forward with a formal investigation into Delta’s practices, they will conclude that the company has engaged in abuse of its monopsony power in the marketplace.

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SIGNED, SEALED, DELIVERED WSDA Foundation biggest gift to date helps Providence St. Peter Clinic in Olympia move closer to completion The WSDA Foundation recently announced that it will donate $200,000 toward the completion of the Providence St. Peter Foundation’s dental clinic in Olympia. This is the largest gift made by the WSDAF in its history, following grants of more than $100,000 already made in support of expanding the residency program in the state. “We’re excited about the Foundation’s significant investment in the dental safety net in Washington,” said WSDA Executive Director Bracken Killpack. “This gift will be used to complete the construction of the Olympia clinic, which will provide much needed care in the area and serve as a home for residents, as well.”

The request for the grant came from WSDA Board member Dr. Amy Winston, who has worked closely with Providence to expand the residency program. Peter Brennan, Executive Director for the

Providence St. Peter Foundation, said, “The generous support of the dental community, especially WSDA and its foundation, has been key to the development of our hospital-based residency program in Olympia. These funds are critical for funding construction and equipment for the clinic, which remains on track for an opening in early 2019.”

The Olympia clinic is managed by Providence and Neighborcare Health, supporting three residents each year. Providers are paid for by the federal government, contributing to the program’s sustainability. Dr. Dexter Barnes, WSDA Foundation President, said, “This type of residency program has proven to be a huge benefit to help meet the need for access to care and the WSDA Foundation is pleased and proud to be a part of this project.”

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foundation news providence residency donation

Back row: WSDA Immediate Past President Dr. BJ Larson, WSDA Executive Director Mr. Bracken Killpack, WSDA President Dr. Cindy Pauley, WSDA President-elect Dr. Chris Delecki. Seated: Providence St. Peter Executive Director Mr. Peter Brennan, WSDA Foundation President Dr. Dexter Barnes. Photo: Scott Eklund/Red Box Pictures.

Left to right: Dr. Jennifer King, Mr. Brandon Walker, Dr. John Gibbons, Ms. Debra Lewandowski, Dr. Robert Chen, Dr. Cindy Pauley, Ms. Jennifer Freimund, Dr. Chris Pickel, Dr. Bill Hooe, and Dr. Kal Klass. Below: ADA President-elect Dr. Jeffrey Cole

2 018 P R E S I D E N T ’ S AWARDS Presented in recognition of outstanding accomplishments in representing organized dentistry, enhancing the dentistry profession, and furthering the cause of improved oral health in Washington State

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President’s awards This year, the President’s Reception at the PNDC was refocused on WSDA Members, honoring their outstanding accomplishments and efforts to enhance dentistry and improve oral health in the state by presenting them with a President’s Award.

WSDA President Dr. Cindy Pauley felt that the event would be better used to celebrate the efforts of members who work long hours, behind the scenes, and often with no recognition to improve dentistry for all.

This year six awards were presented, and the honorees included both individuals and groups.

Service to the dental community

Concerned Dentists of Washington received the award because of their effort to communicate the importance of the doctor/patient relationship in the delivery of quality dental care, and for promoting the highest standards of oral health for all citizens of the state by holding insurance companies accountable to support patient care.

Dr. John Gibbons was the driving force behind legislation in 2018 that extended eligibility for patients with developmental disabilities to receive services under the state’s Access to Baby and Child Dentistry (ABCD) program. Gibbons worked closely with Senator Rolfes and other lawmakers to enact the legislation, and to promote special training for serving these patients.

Dr. Jennifer King was a leader in WSDA efforts to enact legislation that established important new safety protections for patients of Dental Service Organizations (DSO) and instituted clear prohibitions on non-dentist employees interjecting themselves into the doctor-patient relationship.

The Pierce County Dental Foundation demonstrated what can be accomplished when dentists work together to promote better oral health for their community.

They disburse an average of $30,000 a year in community grants and scholarships in Pierce County, and recently launched a drive to raise a $1 million endowment to further these contributions.

As Executive Director of the SeattleKing County Dental Society for the past 12 years, Ms. Jennifer Freimund was a leader in driving community-based oral health programs, including the establishment of the Swedish Community Specialty Clinic to provide dental services to low-income patients at Seattle’s Swedish Medical Center.

Mr. Brandon Walker has shown tremendous leadership during a period of instability at the University of Washington School of Dentistry, serving as a vocal proponent of organized dentistry having a strong voice in plotting a course for the future of the school.

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pndc news 2018 pndc in pictures Photos by Scott Eklund/Red Box Pictures 1 2 · th e wsda ne w s · issue 7, july 2018 · www.wsda.org

pndc news 2018 pndc in pictures

PNDC 2018 IN PICTURES With a program filled with sessions for every team member, the PNDC was a world-class success! th e wsda ne w s 路 issue 7, july 路 2018 路 www.wsda.org 路 13

pndc news 2018 pndc in pictures

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Photos by Scott Eklund/Red Box Pictures

pndc news 2018 pndc in pictures

It’s fair to say that PNDC 2018 was an unqualified success. With scads of continuing education offerings for every member of the dental team, and fun social events, the PNDC delivered on its promise.

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pndc news 2018 pndc in pictures

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Photos by Scott Eklund/Red Box Pictures

pndc news 2018 pndc in pictures

The Exhibit Hall was hoppin’! With amazing exhibitors, giveaways and drawings, a fabulous happy hour with small bites and a signature cocktail, the Exhibit Hall was the place to meet and congregate. There was even a fresh Austin Powers look-alike in the house!

pndc news 2018 pndc in pictures

At the selfie stations, team members had a blast creating their own visual momento of the conference. Massage chairs offered a welcome respite from the hustle of the day. Workshops continue to be popular among attendees, with a variety of sessions covering exodontia and more!

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Photos by Scott Eklund/Red Box Pictures

pndc news 2018 pndc in pictures

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pndc news 2018 pndc in pictures See you next year!

The Committee on PNDC is already planning next year’s conference in Bellevue, June 20-22, 2019. Mark your calendars for another fantastic event!

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pndc news sponsor thanks

THANK YOU TO OUR PNDC SPONSORS

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Proposed Opioid Prescribing Rules

In an effort to combat the opioid crisis that has been plaguing our state, the Legislature passed ESHB 1427 during the 2017 legislative session, which requires the Medical Quality Assurance Commission, Board of Osteopathic Medicine and Surgery, Nursing Care Quality Assurance Commission, Dental Quality Assurance Commission, and the Podiatric Medical Board to adopt rules establishing requirements for prescribing opioid drugs by January 1, 2019.

In developing the rules, the disciplining authorities considered the Agency Medical Directors’ Group and Centers for Disease Control guidelines and consulted with the Department of Health (DOH), the University of Washington, and professional associations.

The end goal was for all the boards and commission to adopt the same set of rules. In an effort to promote coordinated and consistent rules across the professions, each board and commission identified in the bill sent representatives to form the Opioid Prescribing Task Force. The Task Force held seven stakeholder meetings across the state, taking testimony from providers, technical experts, and stakeholders, including chronic pain patients.

At their last meeting on March 14, the Task Force developed the final 1427 Conceptual Rules draft (version 7.1). The draft was then disseminated to the different commissions and boards to undergo their individual rule-making processes.

The Dental Quality Assurance Commission’s (DQAC) proposed version of opioid prescribing rules is now available for stakeholder comment. You can view the entire rule draft at https://content. govdelivery.com/attachments/WADOH/2018/06/11/file_attachments/1022083/OTS-9642.2.pdf.

length and can count toward CE requirements for license renewal.

Diagnosis Identified on Prescriptions (WAC 246-817-911): Prescribers will be required to include the diagnosis, indication for use, or the ICD code on all opioid prescriptions.

Some of the highlights of the proposed rule include:

Send your Comments to DQAC

Patient Notification, Secure Storage and Disposal (WAC 246-817-907) Dentists will be required to provide information to patients educating them on the risks associated with the use of opioids and document such notification in the patient record. Upon the first issuance of an opioid prescription as well as the transition from acute nonoperative pain or acute perioperative pain to subacute pain, dentists will also be required to notify patients about the safe and secure storage of opioid prescriptions and the proper disposal of unused opioid medication, including the availability of recognized drug take-back programs. This requirement can be satisfied with a document provided by the Department of Health.

Continuing Education Requirements (WAC 246-817-909) In order to prescribe an opioid in Washington state, a dentist must complete a one-time continuing education (CE) requirement regarding best practices in the prescribing of opioids and DQAC’s opioid prescribing rules. The CE must be at least three hours in

Prescribing Limits: Acute Nonoperative Pain & Acute Perioperative Pain (WAC 246-817-913) Dentists will be limited to writing a seven-day supply, unless there is clinical documentation in the patient record to justify the need for a higher quantity.

Subacute Pain (WAC 246-817-916) Dentists will be limited to writing a fourteen-day supply, unless there is clinical documentation in the patient record to justify the need for a higher quantity.

Prescription Monitoring Program (PMP) Requirements (WAC 246-817-980) Under the proposed rule, dentists who prescribe opioids would be required to register to access the PMP and would be required to query the PMP prior to every prescription of an opioid. However, the PMP query requirement will not apply in situations when the PMP or the EMR cannot be accessed due to a technological or electrical failure. Dentists will be able to delegate PMP queries to an authorized designee.

WSDA fully understands the impact this rule can have on your practice and how you care for your patients. That is why we have advocated and continue to advocate for the adoption of sensible and pragmatic rules, and will continue to push back on onerous requirements.

Please consider submitting any comments, concerns, or suggested changes regarding these proposed rule changes to DQAC by emailing DQAC’s Program Manager at jennifer.santiago@doh. wa.gov.

Your feedback is important · Join the email list

Stay informed about the rules and regulations affecting your profession, sign up for the interested parties email list today! Visit https://public.govdelivery.com/accounts/WADOH/subscriber/new

Questions?

Please contact Director of Government Affairs Mellani McAleenan at mellani@wsda.org or Government Affairs Associate Emily Lovell at emily@wsda.org with any questions or concerns regarding these proposed rules.

th e wsda ne w s · issue 7, july · 2018 · www.wsda.org · 23

regulator y news dqac update

DQAC UPDATE

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WSDA members pitch in to make a difference

WSDA President-elect Dr. Chris Delecki and MTI Van Manager Ellen Broyles attend to the needs of a patient

Pierce County gives back

On March 9, in a collaborative event between the Bates Dental Assisting Program, Pierce College Dental Hygiene Program and The Nativity House in Tacoma, Pierce County Dental Society volunteers provided $52,200 in uncompensated care including free dental screenings, dental cleanings, restorative work and emergent dental care to seniors, veterans and families in need who lacked the resources to pay.

Delecki provides free care

Dr. Robert Chen, PCDS President, Mary Galagan, Professor at Pierce College Dental Hygiene Program, and Pierce College Dental Hygiene students came to help those in need

th e wsda ne w s · issue 7, july · 2018 · www.wsda.org · 25

WSDA President-elect Dr. Chris Delecki recently held a free dental day even aboard one the MTI dental vans in Bellevue. Delecki saw six patients during the day, performing full-mouth cleanings, restorations and extractions for the men living in the Winter Shelter for the organization Congregations for the Homeless. Delecki hopes to get the word out about all volunteer work done by WSDA members in the state, saying, “Please contact Rob at the WSDA News with information about your volunteer efforts at rob@wsda.org!”

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An enduring benefit of membership

In 2014, the WSDA Task Force on Membership recommended establishing a program of free education for WSDA members, specifically, members up to 10 years out of dental school. Called the WSDA Academy, its mission was to develop scholars and create a community of young dentists committed to the Academy’s tenet, “aliqua, virtus, amicitia” (education, excellence, friendship).

Topics and speakers for the Academy are recommended by the New Dentist Think Tank, and held mostly at the WSDA office or in larger facilities in King County. In the four years since its inception, the Academy has continued to grow session sizes, from 23 attendees in the beginning to 33 currently, with occasional 50-attendee sessions. Typically, sessions are three hours in length and held in the evening to accommodate work schedules. Dinner is provided at no cost.

Dr. Luke Daining, a frequent attendee of Academy offerings, says, “The sessions are always excellent. You can tell that the WSDA will only book speakers with valuable information to share, and they always ask for feedback in order to improve future courses. Another intrinsic value of the courses is definitely the social component. I generally see a handful of familiar faces and many new faces at the courses. The WSDA does a good job of integrating the social and educational portions of the courses. I also really appreciate the meals that are served at the courses, as I am typically coming straight from work.”

As you might expect, sessions fill up quickly, most within 24 hours. “Our most successful courses have been our clinical offerings,” says Kainoa Trotter, Assistant Executive Director of the WSDA, “but majority of the sessions have sold out. Most of the speakers are WSDA members, which serves as an opportunity to scout upcoming speakers for PNDC. Most of the attendees are graduates from other schools besides UW, so it’s a great introduction to the WSDA

for young dentists new to Washington, and allows them to begin to build their professional network in the state.”

Trotter says that repeat attendees renew their membership in the WSDA at significantly higher rates than those who have attended just one session or none at all, and the number of repeat academy attendees has grown each year. Dr. NamThien Vu told us, “I’ve been to about nine to 12 Academy courses in the last three years. What I like about the Academy courses is that they are affordable CE, and the speakers are well-respected clinicians around the area who are knowledgeable in research and clinical dentistry.”

Vu gives the Academy sessions high scores and says he plans to attend them for as long as he is qualified.

Daining agrees, saying, “I definitely plan on attending more sessions in the future. I would, and do, tell colleagues that the WSDA Academy courses are evidence that the WSDA cares about all of their members, especially their newer members. The courses allow me to learn more about the WSDA, and learn more about all that they do for their member dentists. The relationships formed during these courses are invaluable in making me feel connected to the WSDA, as well as the local dental community.”

Session information is distributed via email to qualified attendees. Upcoming offerings include volunteerism, prosthodontics, and oral surgery. For more information and to determine if you qualify to attend Academy sessions, visit wsda.org/academy.

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member news wsda academy

WSDA ACADEMY

wsda news strategic plan update

STRATEGIC PLAN UPDATE WASHINGTON STATE DENTAL ASSOCIATION BOARD OF DIRECTORS

Last year, WSDA finalized its 2017-2020 strategic plan. We promised members we’d check in from time to time to gauge what has been completed, and talk about new objectives as the are determined.

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What follows is a listing of strategic goals (SG) outlined in the strategic plan by Board Work Group assigned to the goal.

Advocacy & External Communication

3. Established a Board of Directors Code of Conduct and revised the list of director expectations; refined the new director orientation and mentorship process.

4. Leadership & Governance Board Committee reviewed current board self-evaluation tool.

1. Launched the Washington Dental Service (Delta) initiative that aims to more closely align Delta with the patients it exists to serve and ensure those most knowledgeable about oral health and patient care have a voice when it comes to the best interests of patients.

Relationships

2. Held meetings with appropriate Department of Health staff related to enforcement of practice ownership laws.

2. Developed and implemented recommendations for WSDA website content to be blocked to non-members.

3. Determined the Association’s position on third-party administration of dental Medicaid. Budget proviso requires the benefit be contracted out to a managed care organization.

3. Assessed and modified newly licensed dentist recruitment process based on Relationships Board Committee feedback.

4. Developed a list of a minimum of 10 organizations and associations, along with contact information, who could become allies in access to care issues.

5. Advocacy & External Communication Board Committee, staff, and public affairs consultants had an in-person discussion regarding the scope of the communications and media plan including how the plan with incorporate the “Washington Dentists Care” campaign.

6. Advocacy & External Communication Board Committee, staff, and public affairs consultants held an in-person discussion regarding “top crises” that require a plan.

7. Encouraged DentPAC Board of Directors and fundraising consultant to finalize “donor contribution tiers” for DentPAC. 8. Supported fundraising consultant in developing 2018 election cycle fundraising plan.

9. Finalized and implemented the reconfigured Committee on Regulatory Affairs, legislative decision making process for the Board, and “Elite Advocates” (combination of DAD group leaders, DentPAC liaisons, and grassroots advocacy leaders).

10. Evaluated recent changes to Dental Action Day and proposed further actions to increase effectiveness and attendee satisfaction.

Leadership & Governance 1. Evaluated recent changes to the House of Delegates and proposed further actions to increase effectiveness and attendee satisfaction.

1. Designed and implemented a metric that tracks the open rate and click through rate of 12 monthly membership emails.

4. Brought WSDA Board delegation to Seattle-King County Dental Society Board and obtained buy-in to increase membership market share of King County dentists ages 35-44 to 52 percent.

5. Defined the scope and definition of the SKCDS “micro event” concept for the 2017-18 fiscal year. Obtained buy-in from SKCDS leadership for the plan.

Education & Financial Stability 1. Determined the location of and finalized the contract for the PNDC 2020.

2. Overhauled the PNDC sponsorship program, changed PNDC lecture formats, and expanded one WSDA Academy event to include targeted, nonmember recruitment to achieve the 20 percent innovation requirement for 2017-2018.

3. Designed and executed the revised PNDC annual survey. Set an overall satisfaction benchmark for future meetings.

4. Discussed sponsorship and potential for an exhibitor presence at 2018 House of Delegates.

5. Reviewed current dividends from WDIA and Canal Centre to determine if levels are appropriate.

6. Activated the remaining proceeds of the NORDIC sale consistent with the Investment Policy Statement adopted by the Board of Directors.

7. Reviewed non-dues revenue projections and discussed course correction options as necessary.

8. Adopted a revised Investment Policy Statement.

2. Reviewed the selection and recruitment process for the Leadership Institute, made recommendations for future recruitment. Also reviewed the selection and recruitment process of the Task force on Nominations, made recommendations and presented them to the Board.

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wsda news strategic plan update

COMPLETED STRATEGIC GOALS

wdia news loan insurance

PURCHASING OR REFINANCING A PRACTICE? Make Sure You Have Insurance For Your Loan

Summer is a busy time. Many dental practices are being purchased, startup practices are opening, and many offices are remodeling or refinancing their business loans. Whether you’re obtaining a loan to purchase a practice or refinancing an existing loan, your lender will require insurance for collateralization. Most lending institutions require several types of insurance coverage to be in place to protect their interest, should you become disabled, die, or experience physical damage to your office. The best (and least expensive) way to satisfy the bank is by purchasing Business Loan Protection, Term Life Insurance and a Business Owners Policy.

WDIA highly recommends that you begin the insurance application process prior to or when you begin procuring your loan.

The underwriting for these policies takes time, and you want the policies approved before your loan is finalized.

Business Loan Protection Insurance

Many banks require you to collateralize disability insurance for your loan, but WDIA believes that your personal disability insurance should not be used as a collateral assignment. A less- expensive Business Loan Protection (also called Business Reducing Term) policy should be used instead. Business Loan Protection is a disability policy that specifically makes your monthly loan payments should you become disabled. Even if your bank does not require disability insurance, WDIA believes having the coverage is worth it for your peace of mind.

Term Life Insurance

Term Life Insurance has no cash value, so it is very inexpensive. Simply put, if you should die, your beneficiary receives the set benefit amount. Your family should be the beneficiary of your life insurance policy, never the bank. When you collaterally assign the bank to your policy, it will be paid only the amount remaining on your loan. The rest will go to your family.

Business Owners Policy

Purchasing a Business Owners Policy is also a must for protecting you in case of damage to your property due to fire, water damage, etc. This policy also covers you for general liability and provides loss of income protection if you are unable to practice while damage to your office is being repaired. The bank will require that you name it as an additional insured on your policy until you have paid off your loan. If you are doing tenant improvements to your office space, you may need Builders Risk insurance, which covers property and materials onsite during the build-out.

Because WDIA works only with dentists, we are very familiar with the loan process and can help ease some of the stress that can accompany obtaining a loan. WDIA already has working relationships with the banks and lenders that most dentists are using, as well as the practice transition teams they are utilizing.

For quotes or more information on coverage for your practice loan, contact WDIA at 1-800-282-9342 or info@wdiains.com.

YOUR WDIA TEAM: Matt French (pictured) · Kerri Seims 206.441.6824 · 800.282.9342 www.wdiains.com A WSDA Company 3 0 · th e wsda ne w s · issue 7, july 2018 · www.wsda.org

wdia news loan insurance

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A GUIDE FOR THE DENTAL TEAM

Human Papilloma Virus (HPV) and Oropharyngeal squamous cell carcinoma (OPC)

Human papilloma viruses (HPV) are a group of small species-specific, doublestranded DNA viruses that specifically infect epithelial cells of the skin and mucosa, including the oral mucosa (1-7). Over 200 types of HPV are described (2), and are divided into low- and high-risk categories. Low-risk types of HPV (e.g., 6/11, 2/4, 13/32) are associated with venereal and common warts and focal epithelial hyperplasia. High-risk types (e.g., 16, 18, 31, 35, 45), also known as carcinogenic (oncogenic) HPVs, are associated with cervical, oral and oropharyngeal, anal, vaginal, vulva,r and penile squamous cell carcinomas (SCC) (1-6).

Prevalence:

In 2009, a cross-sectional study of the prevalence of oral HPV infection demonstrated that 6.9% of the U.S. population between the ages of 14-69 has HPV in their mouth, and that 1% has the carcinogenic HPV type 16 (6). This study showed that HPV infection is three times more common in males as in females, which corresponds to the clinical incidence of Oropharyngeal squamous cell carcinoma (OPC) being significantly more common in males (1-2, 6).

In the last 15 years or so, the incidence of HPV-associated OPC (referred to in this article as HPV+ OPC) has steadily increased, almost doubling from 40% in the year 2000 to 70% in 2009 (7-8). This near doubling is attributed to the increasing incidence of infection with carcinogenic HPV. It is important to note that HPV infection is transient, and that the immune system

References 1. Vokes EE, Agrawal N, Seiwert TY. HPV-Associated Head and Neck Cancer. J Natl Cancer Inst 2015 ; 107:djv344.

2.Polesky JM and Hirsch MS. Human papilloma virus infections: epidemiology and disease association. Uptodate.com online publication. Dec 2017, edited again May 2018.

3. Haddad RI, Brockstein BE, Brizel DM.et al. Uptodate.com online publication. June 2017, edited again May 2018.

4. David J. Adelstein and Cristina P. Rodriguez. Human Papillomavirus: Changing Paradigms in Oropharyngeal Cancer 2010: Curr Oncol Rep 12:115–120.

5. Blitzer GC, Smith MA, Harris SL, Kimple RJ (2014). Review of the

clears the virus on average within one year (2). For a variety of reasons, this virus may persist in a small number of patients (16). Patients with persistent carcinogenic HPV lesions are more likely to progress to epithelial dysplasia and SCC, though this does not always occur. It is also important to note that exposure to carcinogenic HPV does not mean that the exposed person will necessarily develop oral or oropharyngeal SCC. In the U.S., the CDC reports close to 6 million new cases of all types of HPV infection annually (2); of those, only 12,000 develop OPC, and 21,000 develop cervical and other genital cancers, so the overall risk of developing OPC from HPV infection is very small—about two cancer cases per 1,000 infected patients.

Clinical presentation:

The clinical presentation, patient profile, and prognosis of HPV+ OPC are different from that of tobacco-associated oral cavity SCC (referred to in this article as tobacco+OC). HPV+ OPC is believed to be a sexually transmitted disease caused by the same HPV types that cause cervical cancer, especially types 16 and, to a somewhat lesser extent, 18 (1-3). The main modes of transmission are oral-genital sex and, to a lesser extent, deep kissing (1-3). HPV+ OPC patients tend to be young adults, especially young white males (1-6), though the number of young females diagnosed with this condition is also on the rise (7). These patients tend not to smoke or drink (or do so only lightly), and tend to be within the age range of 30-60 or occasionally older (1-3). The posterior mouth, including the continued on page 35 clinical and biologic aspects of human papillomavirus-positive squamous cell carcinomas of the head and neck. It J Radiat Oncol Biol Phys.

2014: Mar 15;88(4):761-70.

6. Poling JS, Ma X J, Bui S et al. Human papillomavirus (HPV) status of non-tobacco related squamous cell carcinomas of the lateral tongue.

Oral Oncology 2014 50:306-10.

7. Gillison ML, Broutian T, Pickard RK, Tong ZY, Xiao W, Kahle L, Graubard BI, Chaturvedi AK (2009-2010). Prevalence of oral HPV infection in the United States. JAMA. 2012 Feb 15;307(7):693-703.

8. Gillison, M. L. (2007). Current topics in the epidemiology of oral cavity and oropharyngeal cancers. Head & neck, 29(8), 779-792.

9. Wesley R. McIlwain, BS; Amit J. Sood, BA; Shaun A. Nguyen, MD, MA; Terry A. Day, MD. Initial Symptoms in Patients With HPV-

th e wsda ne w s · issue 7, july · 2018 · www.wsda.org · 33

Dolphine Oda, BDS, MSc Professor & Director Oral Pathology Biopsy Service, UW-SoD

“The necessity and efficacy of booster doses is not yet adequately studied, and the uptake of HPV vaccines worldwide remains low. While Gardasil 9 is active against seven oncogenic HPV types, immunogenicity and length of protection may be inadequate.”

clinical news hpv and oral cancer: a guide for the dental team

HPV AND ORAL CANCER

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tion and cannot transmit disease (12-15). The first is the bivalent vaccine (Cervarix) against HPV types 16 and 18. The second vaccine (Gardasil) is quadrivalent against HPV types 6/11 (low risk), as well as 16 and 18. The third vaccine (Gardasil 9), used most commonly, is multivalent against nine types of HPV: two are the low-risk types 6/11; and the other seven are oncogenic HPV types 16, 18, 31, 33, 45, 52, and 58. Immunization is recommended for males and females before the age of “risk for exposure,” which is ideally between 11 and 12 years of age, with a range of 9-26 for both males and females (12-15).

The vaccines have historically been administered in three doses 0-6 months apart, which is still recommended (12-15). Although some immunity is achieved after a single injection, two or three doses are recommended depending upon age. Cervarix is more immunogenic following a single dose, and the immune response is longer lasting. On the other hand, three doses are more effective in achieving prolonged immunogenicity. For example, a 2017 Scandinavian study including 9,437 patients with 12 years of followup reported that the quadrivalent HPV vaccine (administered in three doses) “shows continued protection in women for at least 10 years, with a trend for continued protection through 12 years of follow-up” (15). The necessity and efficacy of booster doses is not yet adequately studied, and the uptake of HPV vaccines worldwide remains low. While Gardasil 9 is active against seven oncogenic HPV types, immunogenicity and length of protection may be inadequate. Thus, clinical surveillance for genital and oral cancers remains very important to achieve early diagnosis and treatment.

HPV+ OPC survival rate:

The literature consistently demonstrates that patients with HPV+ OPC have a significantly better survival rate than patients with other types of OPC. HPV+ OPC patients usually first present at TNM stages 3 and 4, but despite the more advanced stage of the disease, the prognosis is significantly better than that of patients with HPV negative OPC (three-year survival rates of 74% and 43%, respectively) (6).

In December 2017, the American Joint Committee on Cancer reported that stage 3 HPV+ OPC has a better prognosis than stage 1 tobacco+ OC. This observation led to clinical trials investigating “deintensification” of treatment strategies to reduce treatment-associated morbidity induced by multimodal treatment including surgery, radiation, and chemotherapy (11).

Patients with HPV+ OPC have less potential for a second primary SCC and a 60-80% reduction in mortality compared to patients with HPV negative OPC (6). In addition, patients with HPV+ OPC respond better to treatment and have a better prognosis and survival rate than tobacco+ OC (1-8).

Immunization for HPV infection:

Three types of vaccines are available; all are of synthetic deriva-

Positive and HPV-Negative Oropharyngeal Cancer onlinefirst. JAMA Otolaryngol Head Neck Surg. Published online March 20, 2014.

10. Michaud, D. S., Langevin, S. M., Eliot, M., Nelson, H. H., Pawlita, M., McClean, M. D., & Kelsey, K. T. (2014). High‐risk HPV types and head and neck cancer. International Journal of Cancer.

11. Worden FP, Bradford CR and Eisbruch A. Treatment of locoregionally advanced (stage III and IV) head and neck cancer: the oropharynx. Uptodate.com online publication. September 2017.

12. Lauri E. Markowitz, Eileen F. Dunne, Mona Saraiya, Harrell W. Chesson, C. Robinette Curtis, Julianne Gee, Joseph A. Bocchini, Jr, Elizabeth R. Unger.. Human Papillomavirus Vaccination: Recommendations of the Advisory Committee on Immunization Practices (ACIP).CDC: August 29, 2014 / 63(RR05); 1-30.

https://doi.org/10.1002/cam4.1155 14. Luciano Mariani and Aldo Venuti. HPV vaccine: an overview of immune response, clinical protection, and new approaches for the future. J Transl Med. 2010; 8:105. Published online.

15. Kjaer SK, Nygård M, Dillner J et al. A 12-Year Follow-up on the Long-Term Effectiveness of the Quadrivalent Human Papillomavirus Vaccine in 4 Nordic Countries. Clin Infect Dis. 2018 Jan 18;66(3):339-345.

16. Herrero R, Quint W, Hildesheim A, et al. Reduced prevalence of oral human papillomavirus (HPV) 4 years after bivalent HPV vaccination in a randomized clinical trial in Costa Rica. PLoS One. 2013 Jul 17;8(7):e68329.

13. Tino F. Schwarz, Andrzej Galaj, et al. Ten‐year immune persistence and safety of the HPV‐16/18 AS04‐ adjuvanted vaccine in females vaccinated at 15–55 years of age. Cancer Medicine: Open access October 2017.

th e wsda ne w s · issue 7, july · 2018 · www.wsda.org · 35

clinical news hpv and oral cancer: a guide for the dental team

oropharynx, tonsillar area, and tongue base, is the most common site of occurrence (7-10). The clinical presentation is also different from tobacco+OC. HPV+ OPC lesions are usually small in size, and often present at more advanced stages of the disease (TNM stages 3 and 4) with unexplained cervical lymphadenopathy (neck mass) (1-3). The lymph nodes are usually large and cystic. Less frequently, patients present with dysphagia, odynophagia, weight loss, otalgia, tonsillar mass, and sore throat (13). Otalgia is probably one of the earliest subtle symptoms that are often ignored by both the patient and the provider.

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ROD JOHNSTON, MBA, CMA

BUCK REASOR, DMD

To celebrate our merger, we’re offering a FREE Valuation. expires 12/31/18 Get started today! 877-866-6053 or info@omni-pg.com Practice listings: omni-pg.com Real estate listings: omni-hcre.com

3 6 · th e wsda ne w s · issue 7, july 2018 · www.wsda.org

OPPORTUNITIES AVAILABLE

OPPORTUNITIES AVAILABLE

GENERAL DENTIST WANTED – North Spokane. Private practice. Well-established general dental practice with single owner seeking associate general dentist. We have a state of the art, 10 op facility with Cone Beam CT, digital X-rays and pan, implants, IV sedation and Cerec. The staff is well trained and competent, but also kind and excellent to work with. PT/ FT. Flexible arrangements. We would love to hear from you to discuss this opportunity further. Call 509-251-0226 or con-tact info@ drmillerdentistry.com for more details.

DENTAL ASSOCIATE, REDMOND WA — Privately owned Redmond practice seeking Dental Associate with minimum 1 year working experience. This is a unique opportunity to work with the best team. You will produce!

You will have a full schedule! and You you will have patients the day you start! Modern, paperless, all digital office, Performing General and advanced dentistry. Efficiently run office with great systems in place and an awesome team. You will have fun and be busy. This is a full-time (3-4 days a week). If you are interested in this position, please forward your confidential resume with a cover letter about yourself and days you are available. Thank you and we look forward to hearing from you.

Email: r_becky.ferrell@yahoo.com.

DENTIST — Pedodontist, FT Associate, Eagle River, Alaska. Permanent position, 4-5 day work week, immediately available for an Alaska Licensed pediatric dentist. Discovery Dental Kids is looking for a compassionate, pediatric dentist who will deliver excellent care to children of all ages from infants to teens. We provide a range of preventive and restorative services, oral sedation and GA with an onsite anesthesiologist. All in a beautifully custom designed practice located 15 miles from Anchorage and surrounded by mountain views and Eagle River. Competitive compensation. Contact Leanne 907-3513459 for more details.

REDMOND GENERAL DENTAL PRACTICE — Looking for 2 days a week, friendly, gentle professional dentist to joined our awesome hard-working team!. Please submit your resume and cover letter to the dentalofficeresume@gmail.com, We look forward to hearing from you!

HYGIENIST NEEDED, PUYALLUP — Fulltime dental hygienist position, open immediately in general practice in Puyallup, WA. Wed-Friday. Please fax resume to 253-7999060, or call Gretchen or Rachel at 253-8640555 with any questions.

PART TIME GP ASSOCIATE IN ELLENSBURG — We are looking for a long-term associate in Ellensburg, WA to work 2.5 days WedFri. We are an easy-going office where you will be allowed to treat as you see fit. Please email resume to uwdentaldoc@hotmail.com.

DENTISTS NEEDED — Jefferson Healthcare is opening the state’s first Dental RHC! We are seeking general dentistry dentists to head up this new clinic. Competitive salary, incredible benefits, and the opportunity to be a part of an amazing organization! Apply now on our Careers website at jeffersonhealthcare.org!

SEEKING A DENTIST — For a general family and patient oriented practice. The office is well established and located in Whatcom county, north of Bellingham. Looking to fill a part-time position or an associate interested in purchase.

Please email to dx123@comcast.net for details.

DENTISTS NEEDED — Lake Washington Institute of Technology dental clinic is seeking dentists. We have part-time positions for M/T/Th. • http://www.lwtech.edu/about/ human-resources/jobs/apply/ search for dentist • Contact: Carrie.Sasynuik@lwtech.edu phone: 425-739-8157

DENTISTS NEEDED, STATEWIDE — We have wonderful practices throughout Washington and we are interested in bringing new doctors into the Smiles Family! Our practices are set in beautiful communities and have super fun and upbeat staff. If you are interested in joining a great team with tons of earning potential, send me, Jodie Barker, your resume via email at jbarker@smiles-services.com.

We will call all qualified candidates. Just a reminder: we are an equal opportunity employer! Thank you for your interest! We look forward to speaking with you.

DENTIST OPPORTUNITY, CENTRAL WASHINGTON — Seeking experienced dentist for a busy, well established, successful, multi-specialty group, fee for service dental practice to work full time with part time options. Come join our professional, modern office and become a part of our wonderful team. Please send resume and direct any inquiries to felixzario509@yahoo.com.

DENTIST NEEDED — Family Health Center, Longview WA is looking for a DDS or DMD with at least 1 yr experience. NonProfit Community Health Center. WA State DEA license. Apply to jobs@cfamhc.org.

ASSOCIATE DENTIST - (Mill Creek/Snohomish/Everett) Seeking a dentist to join our great team. One day/week, possibly leading to more days in the future. Contact: jacob. foster@gmail.com.

PEDIATRIC DENTIST ASSOCIATE POSITIONS — North of Seattle. Part time, competitive pay, or part time to grow into full time opportunity. Modern clinic with conservative philosophy. Email NorthSeattleDentist@gmail.com.

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LOCUM TENENS — 1985 UW graduate, Washington license, 32 years GP experience.

Cerec user, extensive surgical/grafting experience in addition to typical restorative skills.

Located on the Olympic Peninsula, but have a small plane so I’m close enough to anything this side of the Cascades. Contact cell/text (360) 531-1762, or chuljian1863@gmail.com.

DENTISTS NEEDED — Dental Professionals is recruiting dentists for temporary and permanent positions throughout western Washington – Vancouver to Bellingham and the Olympic Peninsula. No fee to you and you pick the days and geographic locations that you are available to work. This is a great opportunity to earn supplemental income or find a permanent position. If interested please call Bob at (206) 767-4851.

ASSOCIATE, EASTERN WA — We have a great associate opportunity for a dentist looking to be compensated well with less of the headaches and stress. Group practice composed of general dentists, orthodontists, and oral surgeons. For new grads it’s the perfect opportunity to learn your craft by working side by side with generalists and specialists while being paid very well. Base salary starting at $200,000 (for experienced dentists) plus bonuses, but opportunity to earn much, much more. New grad salary starting at $175,000, plus bonuses. Full benefits package and moving allowance. We are offering a signing bonus, moving allowance, paid time off, license reimbursement, and a continuing education stipend. State of the art clinics and equipment. Mix of children and adult dentistry.

Mix of State and private insurance. Come try out Eastern Washington, where there’s 300+ days of sunshine, beautiful landscaping, the gorgeous Columbia River and family friendly communities and low cost living! We have openings in Spokane, Yakima and Tri-Cities!

Please send inquiries to jbabka@applesmiles. com.

classifieds issue 7, july, 2018

OPPORTUNITIES AVAILABLE

LOCAL DENTAL COMPU TER I.T. SUPPOR T, SINCE 2001

What makes us different?

We answer our phones!

Many of our clients call us in the 2-minute gaps between patients. Leaving a voicemail and waiting for a callback is not an option here! We do not use call centers or 3rd party answering services. When you call our number, one of our Seattle-based office techs will be answering the phone.

We staff our office.

The technician that answers your call is not going to be driving or working at someone else’s office.

We offer same-day onsite appointments.

We know the effect that a downed server, a malfunctioning operatory PC, or a broken x-ray scanner has on your practice.

We do not use contracted technicians.

All of our people are employed, trained, and vested in our company and our clients.

We have vast experience in dental industry.

We work with every single practice management, imaging and hardware vendors.

Our techs are familiar with the particular needs, schedules, timelines, and necessities of a dental office.

Learn how we can help, contact me today

Tyson Varosyan

CEO ·&www.wsda.org Director of Technology 3 8 · th e wsda ne w s · issue 7,Founder, july 2018 206-715-TECH (8324) www.utspro.com

OPPORTUNITIES AVAILABLE

OPPORTUNITIES WANTED

ASSOCIATE DENTIST, BREMERTON-KITSAP COUNTY — Established practice in Bremerton. Kitsap Co is the best place to live outside the I-5 corridor. Come live in the best place to raise a family and work in a thriving dental practice. Permanent position available, 4-5 day work week. Experience and residency preferred. We provide full range of preventive and restorative services (implants, IV sedation, oral surgery, orthodontics, etc).

Experienced providers can easily produce/ earn $200K+/year. Potential for ownership/ partnership for the right person. Contact bremertondental@gmail.com.

MULTI-SPECIALTY GROUP PRACTICE OPPORTUNITIES — With more than 400,000 patients throughout our 50+ practice locations in Oregon, Washington, and Idaho, and a built-in specialty referral network to more than 30 specialists, Willamette Dental Group has been a leader in preventive and proactive dental care since 1970. What makes this multi-specialty group practice unique, and better, is a commitment to proactively facilitating the best possible health outcomes.

We currently have openings in Oregon and Washington for general dentists, endodontists, oral surgeons, pediatric dentists, and locum tenens dentists. As a member of the Willamette Dental Group team, we offer a competitive salary commensurate with experience. We are a performance based culture and offer a generous and comprehensive benefit package. Among the many amenities we offer are competitive guaranteed compensation, benefits, paid vacation, malpractice insurance, in-house CEs, and an in-house loan forgiveness program. Please contact Courtney Olson at colson@willamettedental.com and visit www.willamettedental.com/careers to learn more!

LOCUM TENENS — 1980 graduate of University of Washington. Experienced in all aspects of general dentistry including Cerec. Available for limited days this summer and most days starting in September.

Please email brucej@brucejohnson.com.

DENTIST OPPORTUNITY IN WESTERN 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.

OPPORTUNITY WANTED, GREATER SEATTLE AREA — 2018 University of Illinois at Chicago grad seeks a general dentistry position in the greater Seattle area. View my CV here: https://sites.google.com/view/risharesume/home.

TACOMA TURNKEY DENTAL OFFICE — Close to downtown Tacoma and retail shopping areas. Easy access with plenty of parking space. 2,800 sq. ft fully equipped dental office ready to operate with 5 treatment rooms, 6th plumbed, cozy reception, 2 Doctor rooms, Lab, staff lounge, 2 rest rooms, storage room, laundry room. file cabinet. A digital Panoramic and 3 digital intraoral xray systems are also available for sale if interested. Great opportunity for Specialists and General Dentists. Please call for an inquiry.

Call 253-230-8325 for details. Thanks.

SNOHOMISH PERIO ASSOCIATE — Do you possess outstanding clinical skills and the desire to provide uncompromising patient care?

Our highly successful Snohomish County practice near The Boeing Company is seeking an associate periodontist for our office. Applicants must have great people skills and always put the needs and desires of the patient first.

We provide an extremely high standard of care and offer a wide array of dental services.

Our support team is dedicated to providing thoughtful care in a warm and friendly environment. The growth of our friendly, state-ofthe-art, private practice has created an excellent career opportunity for a highly skilled periodontist with good communication skills to join our caring and professional team.

Those in search of a long-term career opportunity with unlimited professional growth potential are encouraged to submit a resume at contacttamilee@gmail.com.

SPOKANE — Seeking full-time general dentist, able to work a varied shift schedule including weekends; must be able to do all aspects of general dentistry including molar endodontics and 3rd molar/surgical extractions; able to adapt to new systems and paradigms; great opportunity to grow and learn; 1-5 years experience preferable. Unlimited income potential! Send resume to Dr. Bradley J. Harken; bradharken@hotmail.com.

PROSTHODONTIST NEEDED — Hughes Dental Group (Everett, WA) is adding Prosthodontist (buy-in) to expand our One-Stop-Shop for patients. Experienced in AO4, overdentures, F/, RPD, and dental implant placement and related surgeries.

Large patient base from which to diagnose and present ideal treatment. Digital radiography, CBCT. Waiting for your input to add scanner and 3D printer. Office has professional street presence, outstanding visi-bility, and high traffic count. Silverlake area of Everett. Check out website, FB presence, and then con-tact DrBob@ HughesDentalGroup.com.

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OPPORTUNIT Y WANTED, 2018 UNLV School of Dental Medicine seeks a general dentistry position in the Seattle area. View my C V here: https: //doc s.google.com / document /d /13Tn-Aorg5_ AWjwYtae5xsCwgSekUgITLkksIJDa69Q/edit?usp=sharing.

OPPORTUNIT Y WANTED — 2018 NY UAEGD (Tacoma-Community Health Care) GR AD — Seeks a general dentistry position within 30 miles of Seattle. View my C V here: https://dr ive.google.com / open?id=1Bpe4lkcU W5ci D9P x f- 8K RYCa0IlvOa15.

OPPORTUNITY WANTED, WESTERN WA — 2018 UWSoD graduate seeks a general dentistry position in Western Washington.

View my CV here: www.linkedin.com/in/ sampada-deshpande-2692a592.

OPPORTUNITY WANTED, WESTERN WA — 2017 University of Washington, NYU Medicine AEGD (expected completion July 2018) graduate seeks a general dentistry position in the greater Seattle area. View my CV here: https://drive.google.com/file/d/1NjBevZkfVR7 DXM3hxoUfsSPt47UfzKuC/view?usp=sharing.

OPPORTUNITY WANTED — 2018 UMNSoD graduate seeks a general dentistry position in Bellevue, Sammamish or Redmond.

View my CV here: https://www.visualcv.com/ prgnya-sheelam.

OPPORTUNITY WANTED, 2018 UW GRAD — 2018 Graduate of UWSoD seeks a general dentistry position in the King, Snohomish, or Pierce County areas. View my CV here: https://drive.google.com/ file/d/198GrZzIuVv6DQU6ttw6EDdZSoo_ oFH7t/view?usp=sharing.

OPPORTUNITY WANTED — 2017 UWSoD graduate seeks a general dentistry position in Washington. View my CV here: https://drive. google.com/open?id=1ilkwp4P4pc91JX6OU 5u_0lX7SEYqG2bQ.

classifieds issue 7, july, 2018

OPPORTUNITIES AVAILABLE

clinical corner issue 7, july, 2018

CLINICAL CORNER

Bilateral unilocular radiolucency associated with partially erupted teeth #s 18 & 31

Figure 1

Contributed by:

Dr. Calley Christie Woodinville Oral & Maxillofacial Surgery, Woodinville, WA

History of present illness

This is a 13-year-old white male who presented with a complaint of mild swelling and tenderness in the left posterior mandible. The

right posterior mandible was asymptomatic where no pain was reported or swelling noted. However, a panoramic radiograph (Figure 1) revealed bilateral corticated unilocular radiolucencies associated with partially erupted teeth #s 18 and 31. Both teeth are reported to be vital. The patient’s past medical history is negative for any systemic

illness or surgery. The patient was placed on amoxicillin by the general dentist.

Test your knowledge!

Visit https://dental.washington.edu/ oral-pathology/case-of-the-month/ and see if your assessment of the case is correct.

4 0 · th e wsda ne w s · issue 7, july 2018 · www.wsda.org

OFFICES FOR SALE OR LEASE

OFFICES FOR SALE OR LEASE

OPPORTUNITY WANTED — 2018 USC Pediatric Dentistry graduate seeks a pediatric dentistry position in the greater Seattle or Tacoma area. View my CV here: https://drive. google.com/file/d/1ZRCM40Znk96q7DlkOV 0HgICt3mgzEeV5/view?usp=sharing.

GENERAL PRACTICE FOR MERGER, Seattle — Strong merger opportunity centrally located in the core of downtown Seattle w/ an experienced dentist willing to work-back part-time/pre-retirement! Collecting $1M+.

Provides perio cleanings; cosmetic; whitening; TMJ treatment; sports guards; crown/ bridge/dentures/partials. Referring out: endo; oral surgery; pano; ortho & perio surgery.

Current non-renewable lease is expiring.

Equipment in good condition & available (if needed): five fully-equipped, computerized operatories, cavitrons, lab & autoclaves w/ cassettes. Digital intra-oral camera. Nitrous.

Assorted surgical endo, hygiene & operative instruments. For more information contact: Jennifer Cosgrove at (425) 216-1612 or Jennifer@cpa4dds.com.

PERIODONTIC PRACTICE FOR SALE, Eastern Washington — State of the art, family friendly periodontic practice in Eastern Washington. Five fully-equipped operatories. High collections; low overhead. Approx. 1,700 sq/ft + common area. Sterilization room & private office. 3-D Cone Beam. For more information contact: Jennifer Cosgrove at (425) 216-1612 or email Jennifer@cpa4dds.com.

OPPORTUNITY WANTED — 2018 NYUAEGD, ICHS Bellevue graduate seeks a general dentistry position in Seattle or Eastside.

View my CV here: https://sites.google.com/ site/alexanderhodge/resume.

OPPORTUNITY WANTED — 2018 Case Western School of Dental Medicine graduate seeks an associate position in the Bellevue/ Greater Seattle Area. View my CV here: https:// drive.google.com/file/d/1vmWnpHw89nS_ pYX8ft6i2nAGsSZbJlDu/view?usp=sharing.

OFFICES FOR SALE OR LEASE FOR SALE, BOUTIQUE ISSAQUAH DENTAL OFFICE — 1,800 sq. ft. Four operatories brand new as of five years ago. One private surgical operatory brand new as of two years ago Consult room Office overlooks beautiful, serene greenbelt Located three blocks off I-90, two blocks from the Issaquah Costco/Corporate Costco, this boutique dental office is positioned to provide convenient hassle-free service to three fast growing areas—Issaquah, Sammamish and the Issaquah Highlands. Also, easily attracts patients from Renton, Mercer Island, and Bellevue. For more information, please contact Dr. Ron Sherman 425.922.6700 or drron@ drronsherman.com Please see our ad on page 38 for more details: https://issuu.com/wsda/ docs/wsda_news_issue_6_may_2018.

FOR LEASE, KENT — Great location, four ops, 1250sq/ft, gorgeous view, plenty of parking, close to everything. Endo, ortho and two GP’s with separate offices currently in building. Perfect for perio, OS or another GP. TI’s included. Contact Dr. Ryan McNamara 206-799-6168 PEDIATRIC w/ORTHO PRACTICE FOR SALE — Greater Seattle Area/SE Lake Washington. Pediatric w/Orthodontic specialization (Associate). Large modern facility collecting $1.9M+ w/ latest computerization, ortho imaging Pan/Ceph & software. Longterm lease available. Staff trained expanded duties, modern premedication techniques & general anesthesia. Eight chairs fullyplumbed for all utilities/N2O. Excellent location. Owner willing to work-back. For more information contact: Jennifer Cosgrove at (425) 216-1612 or Jennifer@cpa4dds.com.

ORTHODONTIC PRACTICE FOR SALE, Snohomish County — Tremendous opportunity in the heart of Snohomish County collecting $629K. 2,145 sq/ft approx. Five fully-equipped chairs + private exam/consult room. X-ray. Pan/ Ceph. Ortho2 software w/digital charting. For more information contact: Jennifer Cosgrove at (425) 216-1612 or Jennifer@cpa4dds.com.

GENERAL PRACTICE FOR SALE, Rural Snohomish County — Outstanding family practice with great cashflow in picturesque country setting. Ideal for doctor and family seeking quality of life away from city traffic. Four fully-equipped operatories w/5th possible. Approx 1,450 sq/ft. Low overhead.

Collecting $588K+ on a 3-day workweek.

Opportunity to grow! For more details contact: Jennifer Cosgrove at (425) 216-1612 or Jennifer@cpa4dds.com.

GENERAL PRACTICE FOR SALE, Snohomish County — Price reduced to sell! Charming, Snohomish County practice in a thriving, family-based community! Collecting $583K. Excellent cash-flow. 1,500 sq/ft-approx. Three fullyequipped operatories. TMJ Therapy. Refers out implants, perio & ortho. Easy freeway access/ close to major hospital network. For more information contact: Jennifer Cosgrove at (425) 216-1612 or emailJennifer@cpa4dds.com GENERAL/COSMETIC PRACTICE FOR SALE, Olympia — Beautiful, state-of-theart practice in the heart of the State’s capital!

Buy-in/out option available. Eight fully-computerized operatories w/Adec chairs. Digital radiography & pano. Lasers. Nitrous. Rotary endo /elements obturation. Dexis CariVu. Intra-oral cameras. iTero. Dentrix/Dexis. 3,900 sq/ft approx. For more information contact: Jennifer Cosgrove at (425) 216-1612 or Jennifer@cpa4dds.com.

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FOR SALE OR LEASE, BONNEY LAKE — 16,104 SF Bonney Lake building available at $3,200,000. Perfect for owner occupant with a fully equipped oral surgery suite available along with a dental suite encompassing the first floor. 2nd and 3rd floors fully leased.

Suites available for lease also. Excellent location with 50,000 CPD. Contact Sam Suznevich at KWC Offenbecher. 253-569-2493 suznevich@kw.com.

EDMONDS TWO OPERATORY DENTAL PRACTICE — Potential for three ops. Former denture clinic (with full lab) turned into a general office. Potential for growth in the area. Great starter practice or satellite office.

Motivated seller. Email skanzaki@aol.com for information.

RESTORATIVE, IMPLANT, PERIODONTAL PRACTICE priced for IMMEDIATE SALE­— Great Value at $299K. Poulsbo, WA. $600K Collections. Full Schedule of Treatment Planned Patients. (4) Ops. Digital & Nitrous Oxide. Equipped for Restorative, Implant Placement & Restoration, Periodontal Treatment. Contact: Jeff Huey at Jeffrey.c.Huey@ gmail.com or Text (206) 227-2919.

SUBLEASE IN ISSAQUAH — Dental office space is available for sublease in Downtown Issaquah. It is great option for specialities.

Office is modern, and located in high traffic area. Email eundds@msn.com.

SILVERDALE GENERAL DENTISTRY — Collects 730,000 per year. 6 year old practice. nice view of Silverdale bay and Mt. Rainier. contact dental8@outlook.com.

NEW! PUYALLUP — Dental practice for sale.

Annual collections of $400,000 on 3 days per week. Four operatories. Contact Frank - frank@ omni-pg.com; 877-866-6053 ext 4. (WD223) NEW NE PORTLAND — Free standing building with parking and dental practice for sale.

Three ops, room for more. Established dental practice for over 54 years. Email megan@omni-pg.com or call (877)866-6053. (OD113)

classifieds issue 7, july, 2018

OPPORTUNITIES WANTED

Delivering Solutions For Your Long-Term Financial Success By acting as your Chief Financial Officer for your practice and as a Personal Wealth Manager for your family.

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The Dental Group

Comprehensive | Professional | Tax Efficient LLC A DENTAL GROUP COMPANY

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For dentists and specialists who believe that planning, implementation and monitoring are crucial to long-term financial success and quality of life.

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Comprehensive Financial Planning* Wealth Management Investment Management Retirement Plan—CFO Services

Call 425-216-1612 today to see how we can help you!

Now Hiring General Dentists

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Oral Surgeon

Salem & Portland, Oregon

Endodontist

Salem & Eugene, Oregon

Pediatric Dentist

Salem & Eugene, Oregon

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View all practice opportunities at willamettedental.com/careers

Visit Our Booth At Upcoming Conferences CDA

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Oct 18 – 20

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Courtney Olson, Regional Recruiter colson@willamettedental.com Tel: 503.952.2539 Mark Van Dusen, DMD, Orthodontist

4 2 · th e wsda ne w s · issue 7, july 2018 · www.wsda.org

OFFICES FOR SALE OR LEASE

OFFICES FOR SALE OR LEASE

NEW LYNNWOOD — Dental practice for sale.

Annual collections of approximately $400,000 with no marketing. Five ops, convienient location, lots of parking. Contact Frank 877-8666053 ext 4, frank@omni-pg.com. (WD224)

FIRST HILL SEATTLE — Well established fee for service practice for sale. 2016 collections of $1,350,000. Four ops, digital x-rays. Email rod@omni-pg.com. (WD191)

DOWNTOWN BELLEVUE — General dental practice for sale. Annual collections over $550,000. 15 new patients/month with no marketing. A lot of work being referred out.

Contact Frank - 877-866-6053; frank@omnipg.com. (WD212)

NEW SEATTLE — Established general dental practice for over 50 years in desirable, high income household neighborhood. Three operatories. Annual collections over $500,000.

Room to grow. Contact Frank 877-866-6053; frank@omni-pg.com. (WD225) MUKILTEO — Practice with amazing view of the sound. Watch the ferries coming and going from this four operatory practice. Amazing visibility and free marketing from the main street that goes to the ferry terminal. Lots of treatment diagnosed, waiting for you to come and get it done. Contact rod@omni-pg.com. (WD201) DOWNTOWN — General Dental Practice located near the water. Four operatories. Annual collections approximately $400,000/year. Call Frank - 877-866-6053. (WD173) LAKE CHELAN — General Dental Practice for sale. Annual collections $600,000+. Good patient base, room to grow. 4 operatories in newer, beautiful building which is also for sale. Contact rod@omni-pg.com. (WD184) SKAGIT COUNTY — General Dental Practice for Sale. Annual Collections over $250,000.

Four operatories. Be the only dentist in town.

Email frank@omni-pg.com. (WD172) EASTSIDE — Great location just off I-90. Annual collections over $400,000. Two ops, possible room to grow. Call Frank 877-866-6053.

(WD180) LINCOLN COUNTY — Owner is selling two separate general dental practices both within 35 miles of Spokane. Excellent cash flow for a practice of this size. Contact rod@omni-pg. com. (WD189) SW SNOHO COUNTY — General dental practice for sale. Annual collections of $300K. Four operatories. Call Frank 877-866-6053. (WD209) NORTH KING COUNTY — Annual collections almost $900,000. 5 operatories, Prime location. Low overhead, hi net practice with great cash flow. Email rod@omni-pg.com. (WD190) MADISON PARK — General Dental Practice for sale. Desirable neighborhood, highly visibility. Annual collections of $1.5 million.

Contact rod@omni-pg.com. (WD208)

SOUTH OF SEATTLE — Practice for sale. Annual collections over $700K. 4 chairs. Numerous referral sources. Call Frank 877-866-6053 (WD206) ISLAND PRACTICE FOR SALE — Annual collections over $300,000. Newer buildout.

Great location, tons of room for growth. Contact rod@omni-pg.com. (WD182) SW KING COUNTY — Ortho practice for sale. Annual collections $980,000. Large space with room to grow. Six chairs. Large waiting room. Call Frank 877-866-6053. (WD207) SOUTH SOUND — General dental practice for sale, $300,000 collections, four ops. Priced for fast sale! Email rod@omni-pg.com. (WD199) SOUTH SNOHOMISH COUNTY — General dental practice for sale grossing over $500,000 on three days per week. Three operatories, plenty of parking. Contact Frank 877-8666053 ext 4; frank@omni-pg.com. (WD161) SOUTH SOUND ORAL SURGERY PRACTICE — Only oral surgeon in town! Great potential.

Confidential sale. Email rod@omni-pg.com.

(WD200) SOUTH SOUND— Two practices for sale.

Combined revenues of $950K. Must be sold together. Contact rod@omni-pg.com. (WD202) WHATCOM COUNTY — GD practice for sale.

Annual collections approximately $250,000.

View of Mt. Baker, busy street. Building also for sale with another space for rental income.

Email rod@omni-pg.com (WD177) NORTH SNOHOMISH COUNTY — Practice for sale. Annual collections over $650,000.

Great visibility with awesome signage. Call Frank - 877-866-6053. (WD179) OLYMPIA — GD practice, building also for sale. Annual collections over $1.1 million with good cash flow to doctor. Contact rod@omnipg.com (WD176).

NORTH SPOKANE — Fast growing area practice for sale. Located on a busy intersection.

Incredible room for growth. Contact frank@ omni-pg.com; 877-866-6053. (WD210) NORTH PIERCE COUNTY — Dental practice for sale. Four ops located in Medical/Dental building. Annual collections of $400,000.

Contact Frank at 877-866-6053. (WD218)

th e wsda ne w s · issue 7, july · 2018 · www.wsda.org · 43

PIERCE COUNTY — Dental practice for sale.

Annual collections of $400,000, 3 ops. Great location - potential to grow! Priced for quick sale. Call Frank at 877-866-6053. (WD219) OREGON DENTAL PRACTICES FOR SALE — Portland, Southern Oregon Endo, Albany building, Central Oregon and Southern Oregon GP and building for sale. Contact megan@omni-pg.com for info.

BOTHELL PREMIER RETAIL SPACE AVAILABLE — 2,000 SF at North Creek Plaza. Near UW Bothell, Cascade Community College, and the Bothell Technology Corridor. Contact steve@omni-pg.com.

KENT — Woodmont Place Shopping Center High Visibility space available. Signage along Pacific Highway. 1,300 sq. ft. Three exam rooms, x-ray room, darkroom, lab area, executive office, kitchenette, great signage, plenty of parking. Asking $2,275.00/month - modified gross. Contact steve@omni-pg.com.

LYNNWOOD PLUMBED DENTAL OFFICE — Roughly 2,000 sq. ft., 5 ops including Nitrous and O2, plenty of parking, visibility from 196th. Contact steve@omni-pg.com.

MARYSVILLE DENTAL BUILDING — Two additional tax lots for sale. Well-kept 6,600+ medical building with three dental tenants in place.

One smaller unit is not rented. Residential home included. Contact steve@omni-pg.com.

BELLEVUE MEDICAL CORRIDOR — Highland Professional Building built in 2016. Entire 2nd floor available for lease - approx. 3840 sq. ft. Plumbed for 7+ operatories or medical rooms. Plenty of parking. Rent $30.00 + $6.00 NNN per sq. ft. Email steve@omni-pg.com.

DENTAL OFFICE IN LYNNWOOD — Roughly 1,400 sq. ft. Plumbed for four ops including Nitrous and O2. Visibility from 44th Ave W. $24.00 per sq. ft. + $3.62nnn. Email steve@omni-pg.com.

GRANDRIDGE DENTAL/MEDICAL OFFICE FOR LEASE — Opportunity for a start-up or move your existing practice. Fully built out, 4 equipped operatories, reception, waiting area, lab, sterile, office, staff lounge. Contact steve@ omni-pg.com.

classifieds issue 7, july, 2018

OFFICES FOR SALE OR LEASE

classifieds issue 7, july, 2018

OFFICES FOR SALE OR LEASE

OFFICES FOR SALE OR LEASE

OFFICES FOR SALE OR LEASE

MEDICAL DENTAL BUILDING FOR SALE IN NORTH SEATTLE — Currently built out as an orthodontic office. Twelve parking stalls for the sole use of property. Contact steve@ omni-pg.com.

FOR LEASE — High exposure commercial spaces in Sequim Professional medical/dental office spaces within 5th Avenue Medical Specialists complex. Excellent front plaza corner lot exposure in busy area of medical and dental offices in Sequim. Bring your business ideas to this great location. Water, sewer, garbage & grounds maintenance included. Tenant pays all other utilities.1229 SF @ $1600 per month-gross lease. Contact: Dollie Sparks.

(360)582-7361 cell. (360)683-6880 office dolliesparks@gmail.com.

SPACE FOR LEASE, WENATCHEE — Dentist moving to new location. 3,504 sq.ft + 300 sf basement. Presently 10 ops can be split-up call 509-421-4914 or email drharveyopenwide@gmail.com.

NORTHGATE — Turn key dental office for sale/space for lease. Very nice, fully built dental office with up to six operatories. Second floor of a quality professional/medical office building. Excellent opportunity for a start-up or move your existing practice. No patients, assets only. Asking price $50,000.00. Contact Steve Kikikis at steve@omni-pg.com.

PRACTICES FOR SALE COMING SOON — Snohomish County, Skagit County Perio, Grays Harbor County, Spokane, Downtown Seattle. Contact Rod to be notified when available – rod@omni-pg.com.

SHARED SPACE — Looking for someone who wants to cut their existing overhead by sharing my existing office space. I have a new modern office that is not being fully utilized. Ideal for startup, specialist or smaller existing practice.

I have done this in the past and it has worked wonderful. Call Dr. Frank at 425 985-8390 GP PRACTICE MILL CREEK — Priced to sell four chairs, busy shopping center, 400k ‘15, 700k ‘16, lots of room to grow, Open Dental, low overhead, strong referral, motivated seller, email FVqualitydentalcare@gmail.com PRACTICE FOR SALE, AUBURN — Existing DDS is ready to retire! Four ops, Selling the book of business, solid patient base. Great staff would like to stay. Collections average $700K$900K at 3.5 days/week. Contact ted12@msn. com or lori.leonarddds@outlook.com.

GIG HARBOR — Established practice is collecting $730,000 per year. Experienced staff, great location, 5-6 ops, break room, lab, consult room, sky lights, many windows with trees to view. Fully computerized, digital x-ray and digital pan. Reply to dental8@outlook.com.

FOR SALE, SOUTH LAKE UNION — Established office 1.5 million collections. Near Space Needle, middle of Amazon. 60 new patients a month, no advertising being done.

Good lease. If you’re interested email back to dentalofficeforsaleseattle@gmail.com.

CLE ELUM — Well established, general practice for sale, located in a fast growing area. 4 complete operatories, 1850 square feet. Option to lease or purchase building. Located 1.5 hours east of Seattle, 10 minutes from Suncadia. Contact Dr. Lorin Peterson at klcehome@ msn.com or 509-674-1389.

FOR LEASE — A dental office is available (12/1/2017) for lease. Currently, it is a dental office with three chairs set up. Total square feet is 1100 square feet. Total rent is $3300.

Flexible term. Possible signage along busy 148th Avenue in Bellevue. Call (206) 4983668 for showing.

DENTAL PRACTICE FOR SALE, NORTHGATE — Well established fee for service dental practice for sale. Distress Sale $395k. $60k a month. Many services currently being referred out such as ortho, implants, wisdom teeth, molar endo and perio. 5 fully equipped operatories, lab, break room, washer and dryer and 2 private offices. Fully digital. Great staff. Possibility of office property for sale as well. Please call (206) 909-3863.

BELLINGHAM — Lease turnkey dental suite.

Formerly successful pediatric and orthodontic Class-A office space. Save $200,000+ construction costs. Ample parking. Interstate-5 access. High-traffic/visibility location. Customization available. Lincoln Professional Center: 360-739-1421 adengst@gmail.com.

FOR SALE — New practices for sale, located in Bellevue, Burien, Tukwila, Olympia, Tacoma. Also numerous pre-existing dental spaces for lease. Call today. New office development consultants for over 35 years. Annie Miller at REMAX (206) 715-1444.

G/P PRACTICE FOR SALE IN NORTH KING COUNTY — Annual collections almost $900,000. Five operatories, Dexis Digital X-rays w/ two sensors. Office located in the prime location in town. Practice has been in same location since 1975. Well trained and tenured staff will assist with the transition and stay on with the practice. Seller is a Delta Premier Provider. Seller does no endo, oral surgery, or pedo. Low overhead and hi net practice with great cash flow. Contact: Buck Reasor, DMD, Reasor Professional Dental Services, info@reasorprofessionaldental. com, (503) 680-4366.

G/P PRACTICE FOR SALE IN GRAYS HARBOR COUNTY — Doctor has two practices that are 30 miles apart. One practice is the only dental office for 30 miles. Annual collections of $580,000. If you are seeking a small community to raise your family and become an active member in the community then this is a great opportunity. The main office has four fully equipped operatories. Well trained and experienced staff will assist and continue in the transition. Well-established practice that has been in the same location for 25 years. Outstanding and productive hygiene program in place. Excellent collection policy. Contact: Buck Reasor, DMD-Practice Transition Broker, Reasor Professional Dental Services. info@reasorprofessionaldental. com, 503-680-4366.

FEE FOR SERVICE PRACTICE FOR SALE IN SEATTLE — 2016 collections of $1,350,000.

Cosmetic/reconstructive in the Kois philosophy. Fee for service practice Great cash flow.

Four fully equipped operatories, digital XRays, refers out endo and oral surgery. Well trained and experienced staff will continue and assist with the practice transition. Well established practice that has been in the same location for over 20 years. Selling Dr. will mentor purchasing Dr. for a limited time.

Buck Reasor, DMD, Reasor Professional Dental Services, info@reasorprofessionaldental. com, (503) 680-4366.

DENTAL PRACTICE FOR SALE — Great location in Lynnwood. Three operatories, fully equipped, dental office. Dentist is retiring.

Contact Dirk at dirk1@msn.com for details.

FOR LEASE — Downtown Redmond medical/dental office space for lease. Up to 2,800 sq ft. of space on the second floor, floor to ceiling windows on all sides. Prime location in City Center Building across the street from City Hall, Library, School, and Bus Stop.

Perfect for high visibility. Building currently occupied by two GPs, an endodontist, chiropractor, and physical therapy clinic. Please email redmonddds@gmail.com.

4 4 · th e wsda ne w s · issue 7, july 2018 · www.wsda.org

SERVICES

BELLEVUE/FACTORIA — Newly renovated (incl hardwood floor & granite reception countertop, etc.) dental off for lease. 1,200 sq. ft. 3-ops (4th op can be added) in a stylish off bldg. slmliu at comcast dot net. Easy I-90/I-405 frwy access. Across street from Factoria Mall. 15’ pole sign by Factoria Blvd.

INTRAORAL X-RAY SENSOR REPAIR/ SALES — Repairs with rapid turnaround.

Save thousands over replacement costs. We specialize in Kodak/Carestream, Dexis Platinum, and Gendex sensors. We also buy/sell dental sensors. Call us 919-229-0483 www. repairsensor.com.

AVAILABLE, SOUTHCENTER — Just available. 1200 square foot fully equipped four operatory dental space. Cerec , Panoral, four chairs, lights, nitrous, air and vacuum all available and in place. Please call Dr. Jerome Baruffi at Medical Centers Management (206) 575-1551.

DAVID K DESIGNS — Affordable dental space planning and design services. Permit and construction plans provided in auto cad format. We guarantee and secure your building permit for construction. Construction costs in the NW have skyrocketed the past few years, We provide designs that meet your budget requirements. Website: www.davidmedicaldesign.com Contact Kelly to schedule a free consultation: (206) 999-3457

SPECIALTY DENTAL BUILDING — Available for lease or sale in the Spokane Valley.

6000+ sq. feet. Full conference room and administrative space. 4 operatories and an ASC suite. Equipment and furniture negotiable.

Please contact renee@spkoms.com.

FOR IMMEDIATE OCCUPANCY — A fully plumbed dental office. 1,350 sq ft , three operatories, air, water, vacuum, nitrous oxide and oxygen, private office, lab, staff lounge, separate staff entrance. This office has exceptional exposure to the Southcenter Mall traffic. Please call Dr. Jerome Baruffi at Medical Centers Management (206) 575-1551.

FOR SALE — General practice in Battle Ground, WA. Three fully equipped operatories, busy main street location. Contact Vicki at (360) 521-8057 or lyledkelstrom@gmail.com.

FOR SALE — General practice in beautiful Central Washington, same owner since 1979, consistent annual collections: $700,000, 60 percent OH, largely FFS, digital technology, 3,400 sq. ft., five ops, asking $425,000.

Email: FredH@arizonaTransitions.com.

TURN KEY FACILITY — Available in Covington for start up practice. This nearly new facility is all built out and equipped with two dental operatories with room for expansion to four ops. The chairs, cabinets, lights, N20, etc are all nearly new and in place for a dentist to get started. It is located in one of the busiest commercial areas in our state in Covington WA, in a shopping center with a Starbucks, Mattress Firm, Panda, The Rock and more. It is a modern looking facility, all complete and perfect for a new practice start up. You can start your own practice without having to go to the bank for a loan. If interested in seeing call Al at (425) 455-4480 or (206) 391-9009.

SPECIAL INTEREST FOR SALE — “Unhappy Patients: A Look At Dental Patient’s Complaints About Their Dental Care”. Curtis F. Smith, DDS Based on the author’s years dealing with patient complaints for an insurance company. Available from Amazon $9.95 DENTAL 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://cascade-dental.net.

OFFICE CONSTRUCTION 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.

th e wsda ne w s · issue 7, july · 2018 · www.wsda.org · 45

classifieds issue 7, july, 2018

OFFICES FOR SALE OR LEASE

first person dr. joe vaughn

Dentistry is like Taylor Swift concert…sort of

Dr. Joe Vaughn Editorial Advisory Board

“Did you know that there’s somewhere around 196,000 practicing dentists in the United States right now? That’s a lot of licenses, a lot of practice philosophies, a lot of diversity.”

On a random Tuesday night this past May, I found myself sitting with 56,000 other people in Seattle’s CenturyLink Field. This time, it wasn’t the 12th Man I was sitting with, it was 56,000 “Swifties” at the Taylor Swift concert.

Surprisingly, it was one of the most unique experiences I’ve ever had. Thousands of people there to hear and see one thing. People were dancing and singing, introducing themselves to the fans around them, connecting on a level that was more in sync than what I had ever experienced at a Seahawks game. For just this one night, their differences didn’t matter.

What separated them was no more. For one night, we were all on the same team.

I tend to see dentistry in the everyday, and without a doubt I saw dentistry that night as I looked around the stadium at thousands of tiny lights swaying back and forth in perfect harmony. I couldn’t help but think, “This is what our profession looks like.”

Did you know that there’s somewhere around 196,000 practicing dentists in the United States right now? That’s a lot of licenses, a lot of practice philosophies, a lot of diversity.

We were trained differently. We learn differently. Our states differ on what’s required to even become a dentist.

But despite all of that diversity and all of those things that make us different, there’s no doubt that we all share a central bond. Maybe it’s the rigorous training we all went through. Maybe we connect on the tribulations of starting a practice or dealing with difficult staff interactions. Maybe it’s the joy of successfully treating a complicated case and being able to share that with our peers.

Whatever that something is, it doesn’t ever seem to go away. Put me in a room with 1,000 people of all different professions, and I will naturally gravitate toward the 10 dentists in the room, and we’ll probably talk all night. Dentistry is a part of who we are, and it only makes sense to connect with those who have also committed their lives to its practice.

When I stood in that stadium, surrounded by people I might not have had much in common with, I felt a connection to them. We were different, but we were there for one reason. And what brought us together was the love for live music.

It’s the same in dentistry, but instead of music bringing us together, it’s organized dentistry. Whether it be the WSDA or the ADA or any other local component in between, we are connected by a common purpose.

I feel empowered when I see the WSDA tackling the opioid crisis. I feel empowered when I see them making great efforts to fight the inconsistencies of powerful insurance companies. I don’t feel so alone anymore about my enormous student debt when I see the ADA reveal stats that the average dental student debt right now in America is above $250,000. I feel reassured when a more experienced dentist reaches out to lend support, guidance, and mentorship.

Organized dentistry has always been important, but I think it’s important now more than ever. It gives us that voice in the political arena. It gives us all a support system, one that today’s new dentists especially need. And it also gives us a platform from which to network and learn and do big things for our patients and for the world. It is the glue that holds us together.

Without it, we’re just a bunch of lonely, isolated lights glowing in the wind, with no synchronicity or the slightest chance of ever working together to realize a bigger purpose.

But when we decided to become a part of organized dentistry and actually participate, we became part of the same team. We stepped into the same stadium for the same reason, swaying back and forth in full sync. And we began to take those necessary steps to make the biggest impact possible, not only for our patients, but for our entire profession.

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

4 6 · th e wsda ne w s · issue 7, july 2018 · www.wsda.org

The Obvious Choice for Washington Dentists

YOUR WDIA TEAM: Matt French · Kerri Seims 206.441.6824 · 800.282.9342 www.wdiains.com A WSDA Company th e wsda ne w s · issue 7, july · 2018 · www.wsda.org · 47

Washington State Dental Association 126 NW Canal Street Seattle, WA 98107

PRESORTED STANDARD U.S. POSTAGE PA ID SEATTLE, WA PERMIT NO. 8115

CHANGE SERVICE REQUESTED

Shared strength.

Northwest Dentists Insurance Company is now part of The Dentists Insurance Company family.

Both organizations share a proud heritage of protecting dentists and a commitment to pursue this singular focus.

NORDIC policyholders will continue to benefit from quality coverage and exceptional service — all led by the same Pacific Northwest based management and staff. With director boards of dentists and public members with remarkable industry expertise and business acumen, you can be sure we have our policyholders’ interests at heart.

800.282.9342 | nordicins.com

Endorsed by

4 8 · th e wsda ne w s · issue 7, july 2018 · www.wsda.org