los angeles dental society’s mission is to serve the needs and … · 2019-02-12 · and...

Los Angeles Dental Society’s mission is to serve

the needs and interests of its members and lead in

promoting oral health in the community.

Winter 2018EXPLORER

FEATURE STORIES

How to Have BetterCollections in the DentalPractice Page 8

Changes in ProviderContracting 3

Minimizing CancelledAppointments Page 17

MOBILEDENTISTS,HYGIENISTSTRAVEL TOYOUR DOOR

Page 5

TEETH CARE ON THE GO:

Los Angeles Dental Society Explorer

Explorerpublished by

Los Angeles Dental Society

Editorial Staff

Sonia Molina, DMD, Editor

Teresa Chien, Executive Director

Officers

Fariba Kalantari, DDS - President

Sadegh Namazikhah, DMD - Treasurer

Pilseong Kim, DDS - President-Elect

Richard Hirschinger, DDS, MBA - Vice President

Adam Geach, DMD - Secretary

Michele Frawley, DDS - Immediate Past President

EXPLORER Winter 2018

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President’s MessageExecutive Order

Editor’s Corner

Teeth Care on the Go: MobileDentists, Hygienists Travel toYour Door

How to Handle EquipmentFailure

How to Have Better Collectionsin the Dental Practice

Are you Asking the RightQuestions to Grow Your DentalPractice?

Dental Problems Could Be aSign of an Eating Disorder

Viewing Images on NewDevices

Claims of Superiority

CDA Addresses QuestionsAbout Changes in ProviderContracting

Want to Marry a Doctor?

Labor Law Corner

Minimizing CanceledAppointments

How to Handle Assistive andService Animals in theWorkplace

Classifieds

Welcome New Members

Inside this issue:Calendar of Courses

MONTH DATE MEETING/EVENT

January 20 Radiation Safety

23 California Dental Practice Act / Infection Control

29 CPR

February 10 8-Hour Infection Control

13 LADS After Dark (BH)

27 Cal-OSHA / Dental Board Investigations

March 10 Coronal Polishing 1

17 Coronal Polishing 2

20 Work Smarter Not Harder: The Digital Waterfall For Our Clinical Theater

26 CPR

SERVICEDOG


By Fariba Kalantari, DDS

PRESIDENT’SMESSAGE

By Teresa Chien, Executive Director

The options forcontinuingeducation areinnumerous.There are so manytopics and formatsfrom which tochoose from that

offering more of the same didn’t seemto add value to what LADS wascurrently providing to you already.While LADS will still continue to offerconvenient, local CE for our regularlyattending members, the ProgramCommittee wanted to address a morepressing issue – the lack of clinicalexperience among new dentists.

Dental schools do a fine job ofintroducing students to direct patientcare. While the curriculums vary acrossschools, the general outline is a rotationthrough various clinics and hospitalsettings. This exposure to all kinds of

patients is a wonderful foundation forbuilding experience, but it is simply that– exposure, not experience. The yearsstudents spend in clinical study do notcompare to the years of experience ofthe steadily practicing doctor. It is,therefore, LADS objective to assist bothassociates and practice owners intraining new dentists to excel in theirpatient care.

This year, LADS is adding to its CEcurriculum a new format in the form ofsmall group, hands-on study, targetedtoward young dentists but open toanyone wanting to hone their clinical

techniques. Taught by our ownexperienced LADS members, eachgroup study will cover tips and tricks onhow to complete common proceduresmore effectively, quickly and safely.Depending on the procedure, modelsmay be available for practice as well.

In its initial year, LADS plans to hostfour group studies. However, if demandcalls for more, we will certainly attemptto add more topics and groups. So don’tbe shy! If there is something you wantto learn, let us know.

We all know the adage “practice makesperfect.” LADS wants to give itsmember every opportunity to be thebest dentist they want to be. If you thinkyour fillings, bridges, extractions, etc.could be better or faster, check out acouple of our group studies this year.One slight change in your wristpositioning could wholly change yourpatient care! �

I am absolutely humbled and honoredto be serving as your President. I will domy best to meet the challenge. Let metake this opportunity to congratulateDr. Michele Frawley for a verysuccessful year and also thank all thePast Presidents and leaders of ourdental society for their vision.

I am not a native Angeleno, but I havebeen privileged to live and work in somany different communities, and thecommon denominator is that regardless of where we live or work, it is ourresponsibility to take care of ourcommunity.

These are no ordinary times. The worldis much more intertwined today than itwas when I was graduating from highschool. We need to have a deepunderstanding of cultures around theworld. It’s time to appreciate andcelebrate not only our similarities, but our differences.

It is through this unique demonstrationof unity in diversity that we can stand asan organization.

While we have made a lot of progress,we’re going to push hard this year tobuild on the success of 2017. LADS will continue to be a channel forconnecting members with resources–a catalyst for our members growthwhich will benefit our organizationalgrowth well into the future. In additionto LADS’ usual menu of services, we areoffering a couple of new programs tomeet new dentists’ needs.

Our continuing education will include,small-sized group study for dentistsseeking tips and tricks on common andnot-so-common clinical techniques.We’re proud to say that our ownexperienced LADS’ dentists will beleading these group studies so you’ll belearning from some of the best in town!

We also found out last year that youenjoy short-form lectures. So we’re

going to include some of these kinds oflectures again, one of which will befocused on the business side of dentistry.In one evening, you’ll learn aboutupdates in labor law, things you shouldbe aware of as a tenant, paymentsmanagement and more.

Finally, I’m very excited to be includingmilestone recognition into ourmembership appreciation services! Asthose who attended my installation willknow by now, I celebrated a milestonemyself that evening with my 50thbirthday. These marks of achievementare signs of our progress and I lookforward to acknowledging and thankingyou for your years of service inorganized dentistry. Keep an eye out inyour mail for a little surprise this year!

Once again, it's a true privilege to beleading our Society through thestrength of unity in our diversity. I look forward to meeting you at ourupcoming events. �

Unity InDiversity

Before I begin, I want to thank Dr. NeilMcLeod for his insight as editor for the2017 publication cycle. I know I lovelearning from accomplished dentists toimprove my own practice. I lookforward to sharing my experiences inthe hopes that it will help you, too.

I was LADS president in 2009, amoment marked by the housing crisis.Thousands of families lost homes, andthe news kept calling the crisis the worsteconomic recession since the GreatDepression. At the time, I thought a lotabout how we, as dental professionals,were just as vulnerable to financialhardship as anyone else. How we, too,could lose our life’s work overnight.

Dentistry is entrepreneurial–anyonewho runs their own practice will tell youthat. We clean teeth, balance thebudget, and market our services withonly the help of our employees. Andthat doesn’t even include our family andcommunity commitments. Talk aboutkeeping busy! But what happens whenhardship strikes, and we are preventedfrom running our practices? What willhappen to our employees and patientsthat depend on us?

Californians endured some of thelargest and most frightening wildfires inDecember. To help our dentists whoselives have been affected by the fires, theCDA Foundation created the Disaster

services, how will our patients receivecare? Our patients will be forced to findnew dentists, even if they are in themiddle of treatment plans.

Now is the time to use the LADSnetwork to its full potential. I hateseeing brilliant practices fade awaybecause of the unexpected. We can callvolunteers among ourselves who wouldadopt shifts for one another when ahardship strikes. The shift can be asshort as a day--or even a half day--aweek, enough to keep a colleague’spractice afloat and her patients treated.

We need to care for our colleagues asmuch as we care for our patients. I lookforward to building a stronger networkwith you throughout 2018. As always,please reach out to LADS if you haveany questions or concerns related tobuilding a strong dental practice.¡Ánimo! �

EDITOR’S CORNERBy Sonia Molina, DDS


Relief Grant Program. The DisasterRelief Grant awards up to $2,500 inimmediate and emergency supplies todentists and dental assistants who havesuffered loss. If you have beenpersonally affected by these fires orknow a colleague who has, please visitor direct them to the California DentalAssociation website for detailedinformation about eligibilityrequirements. If you can, pleaseconsider donating money to theprogram. Every dollar helps ourcolleagues rebuild their lives.

However, there is no need to wait fornatural and manmade disasters to striketo help our colleagues. Hardships comeinto our lives uninvited, no matter whowe are and no matter how much (orlittle) we plan for them. Asentrepreneurs, debilitating hardshipscan jeopardize our practices. Ifhardships prevent us from providing


Prefer to see your dentist from thecomfort of your La-Z-Boy? It can bedone.

A growing number of dentalprofessionals will come to you if youcan’t make it to their offices. They showup for appointments at patients’ homesor residential care facilities, packinglightweight X-ray equipment, portabledrills and battery-powered examiningtools that let them gently handle on-the-go cleaning and treating of teeth.

Some see patients with physical ormental disabilities, includingagoraphobia and autism. But theyprimarily treat independent seniorsliving in residential care facilities whojust find it easier to have their dentalcare delivered to their door.

On a recent morning at Mistywood, asenior living complex in Roseville, Dr.Dave Kanas was seeing his first patientof the day, a man who’d been botheredby a loose tooth and a partial denturethat needed adjusting. Kanas and hispatient, Harry “Buzz” Harrison, jokedand bantered like old friends.

Kanas, who retired from regulardentistry seven years ago, snapped onblue dental gloves and a mask, openedhis portable dental kit – improvisedfrom a fishing tackle box – and got towork. He did a thorough exam ofHarrison’s mouth, using a fiber-opticlight with a disposable mirror. Pickingup a portable X-ray machine, he shotand developed a black-and-white imageof Buzz’s loose tooth – in 50 seconds.Finally, he adjusted Harrison’s partialdenture, made of a new flexible plastic,to make it more comfortable.

Harrison, wearing blue jeans and a

California football jersey, never had toleave his green recliner.

“I’d be lost without him,” said Harrison,a lively octogenarian who’s lived fouryears in his studio apartment. Without amobile dentist, “I’d have to drive to anappointment, and you don’t want medriving,” chuckled the 81-year-oldretired high school teacher.

“If (patients) can go to their dentists, Iencourage that,” said Kanas, an Auburnresident who bought a Prius last yearbecause he averages 400 miles a weekdriving to see patients from Sacramento

TEETH CARE ON THE GO: MOBILE DENTISTS,HYGIENISTS TRAVEL TO YOUR DOORBy Claudia Buch, Sacramento Bee

to Grass Valley. “Mobile dentistry takesover when they can’t go anymore,”primarily for medical or age-relatedreasons.

Like replacing a missing tooth, mobiledentistry fills a niche.

“Research shows about 30 percent ofthe population experiences barriers to(dental) care, which include

transportation, geography, education,language and economics,” said AliciaMalaby, spokeswoman for theSacramento-based California DentalAssociation, in an email. “Mobile dentalvisits eliminate a barrier, allowingpatients to obtain care and helping themmaintain good oral health.”

The CDA doesn’t track how many of itslicensed dentists are mobilepractitioners. But the California DentalHygienists’ Association oversees alicensed class of hygienists who areallowed to work independently ofdentists and do mobile teeth cleaning.That category of hygienists has nearlyquintupled in the last decade, from 112licenses in 2005 to 540 this year.

Especially for older patients, there’s areal need to bring dentistry to theirbedside. “In some cases, we are the onlydental entity patients see,” said CDHApast president Karine Strickland, whohas a mobile hygienist practice based inSanta Cruz.

One of California’s pioneers for mobilehygienists is Sacramentan Judy Boothby,who was instrumental in getting statelegislation passed in 1998, creating anew license for a Registered DentalHygienist in Alternative Practice,known as RDHAPs. She holds thestate’s license No. 1.

“The worst thing tosee is an elderly

person with $5,000worth of crowns and

bridges, but theirgums are bleedingand infected. Theyend up losing allthat expensivedental work

because nobody isbrushing or flossing

their teeth,”


Boothby, who visits 50 to 70 patients aweek from Yuba City to Jackson, sees anendless variety of cases. She’s treatedpatients in their 20s with multiplesclerosis and young children withautism. She’s had patients withdementia, Alzheimer’s and Lou Gehrig’sdisease. She’s had women in their 80swho want their teeth whitened for agrandchild’s wedding. And in three casesthis year, Boothby said, she foundevidence of oral cancers, which werereferred to a dentist for treatment.

“The worst thing to see is an elderlyperson with $5,000 worth of crowns andbridges, but their gums are bleeding andinfected. They end up losing all thatexpensive dental work because nobodyis brushing or flossing their teeth,” saidBoothby.

Recently, an assisted living facility calledabout a new resident who wasn’t eating,she said. An exam revealed part of hisdenture had broken off and wasimbedded in the roof of his mouth. Insuch cases, where care goes beyondroutine oral hygeine, RDHAPs likeBoothby refer to traveling dentists likeKanas for further treatment.

Kanas, now semi-retired and withoutthe overhead and staffing of aconventional office, said he enjoys hismobile practice, Mobile 1 Dental,primarily because of the patientcamaraderie and flexible scheduling.

“I don’t make as much as I did, but thehappiness factor is what I’m interestedin. I’m much more relaxed than I waswith a full practice and the pressure oftrying to keep up the patient volume,”he said.

Technology has made mobile equipmentlighter and quieter, helping theprofession’s growth and acceptance.

“It’s definitely enabled by technology.Mobile dentistry just wouldn’t bepossible without the technology we havetoday,” said Dr. Masood Cajee, owner ofSmilesAhead Dental Care, based inManteca. “We can take X-rays with a

handheld X-ray gun that didn’t exist 20years ago.”

Cajee, whose mobile visits representabout 5 to 10 percent of his overallpractice, said, “It takes dentistry beyondthe four walls of the practice and servespopulations that were really difficult toserve before.”

Boothby keeps a rolling cart filled withsterilized packets, ultrasonic cleaner anda suction vacuum for cleanings. Kanasfound his 15-pound X-ray machine inWashington state, part of surplusmilitary equipment used by dentists whoparachuted into remote areas to treatsoldiers. His equipment is battery-powered, so he’s never hunting for cordsor plugs.

Despite technical improvements, mobiledentistry clearly isn’t for everyone.

“In a nursing home environment, it’svery difficult. You don’t know if they’reavailable or agreeable to be seen becausetheir day-to-day health or mental statusmay change daily,” said Cajee, whoworked several years for a dentalpractice that provided care toSacramento skilled nursing facilities.

Other issues are the ergonomics ofleaning over bedridden patients andthose in wheelchairs. Incontinence,aggressive Alzheimer’s patients andother issues that residents struggle withon a daily basis also can be off-putting.

In some cases, after an initial visit toassess a patient’s needs and mental state,Kanas will prescribe a Valium to relax apatient before an upcoming visit.

Despite these challenges, Kanas said heoften walks out from appointments“with a smile on my face,” buoyed bythe personalities and stories from hisclients. Boothby recalls a husband whohired her for several years to regularlyclean the teeth of his invalid,homebound wife. In thanking Boothby,she said he told her: “I always knowwhen you’ve been there. She always hasher lipstick on, her breath smells better... and I can kiss her.”

It’s a bit of giving back. “We’ve all hadparents, grandparents or even youngpeople who are unable to helpthemselves,” said Cajee. “Sometimes it’sthe small things you’re doing that canprovide some comfort. It fulfills the bestof this calling we call dentistry.”

MOBILE DENTISTRY: AT A GLANCE

What it is: House calls made by dentistsand dental hygienists, who travel to apatient’s home, a skilled nursing facilityor residential care home. Carrying theirown portable equipment, they doroutine cleanings, X-rays, extractions,fillings and denture fittings.

What they charge: Varies by individualpractitioner, but fees are typicallycomparable to conventional officecharges. Mobile hygienists generallycharge $135 to $200 for a deepcleaning. Mobile dentists may charge$90 to $150 for an initial consultation,then $80 to $175 for a regular exam,$25 to $29 for single X-rays or $1,400for a single, custom-fitted denture. Fora mobile dentist’s exam, X-rays andcleaning in a private home, it’s about$300; slightly less in a residential carefacility. Fees include cost of travel.

How it’s paid: Some patients paydirectly; others have mobilepractitioners bill their insurance orDenti-Cal.

Who uses it: Generally elderly patientswho can’t, or prefer not to, travel, oryounger patients with physical ormental disabilities that prevent themfrom easily going to a dentist’s office.Mobile dentists and hygienists treatthose in hospice care, as well as patientswith agoraphobia, autism, Alzheimer’s,dementia and physical disabilities.

How to find it: For mobile hygienists,search for a Registered DentalHygienist in Alternative Practice(RDHAP), listed by name andgeographic region at the CaliforniaDental Hygienists’ Association website,cdha.org �

TEETH CARE ON THE GO: MOBILE DENTISTS, HYGIENISTS TRAVEL TO YOUR DOOR (CONT.)


When faced with equipment failure,practice owners must be prudent withtheir actions should they seek to file aclaim with their insurance carrier. Atbest, failure to preserve property canresult in a delay in payment; at worst, itcan result in the loss not being coveredat all.

Some practice owners are unaware thatmany insurance companies, includingThe Dentists Insurance Company, havethe right to inspect malfunctioningequipment in order to determine thecause of failure. Under most policies,some causes are covered, while some arenot. The burden of proof to establishthat the cause of the loss is covered restswith the insured.

“It is a policy requirement that we areprovided an opportunity to inspect thebroken equipment, and along with thisrequirement is the policyholder’sresponsibility to preserve the propertyin question,” said Sheila Davis, assistantvice president, Claims and RiskManagement Claims, TDIC. “This isessential so that we can determinewhether the loss is covered. Disposal ofproperty without our go-ahead couldaffect your claim.”

In 2015, TDIC had a total of 446property claims with an average value of$30,000-$50,000, not including loss ofincome. Most claims were due to waterdamage, typically resulting from thefailure of a water supply line to dentalequipment.

A common scenario is this:Unbeknownst to the practice owner,there is a point of weakness in the watersystem. Perhaps there is a loosecompression fitting, a worn valve or atiny hole in a piece of flexible tubing. Atnight, or over a weekend, when thewater is not being used, the water

pressure builds and the dam bursts,flooding the office.

When faced with a situation like this,practice owners need to follow certainprotocols. Because of the complexnature of dental equipment, they shouldpreserve not only the entire mechanism,but the failed parts as well.

“Each of these can usually be examinedto determine why the failure occurredand which part failed,” Davis said. “Butif the equipment is disposed of, then theopportunity to determine how and whythe failure occurred is lost.”

Some practice owners erroneouslyassume the repair technician’s reportcan be used to obtain this information.But the reality is, most of these“reports” are just invoices; they oftenlack the details needed to make adetermination of cause.

“We need to know exactly how theequipment malfunctioned and why itfailed. Tech reports don’t generallydisclose this,” Davis said.

In addition, the opportunity to recoverthe amounts paid in the claim from theresponsible party may be lost if the causeof the damage is disposed of. Forexample, should an insurance carrierdetermine the loss was caused by amanufacturer’s defect, the manufacturerwould have a right to inspect the

equipment independently. If there is noequipment to inspect, it is difficult, if notimpossible, to hold the at-fault partyaccountable.

In some cases, practice owners don’twant the equipment taking up preciousoffice space, nor do they know what todo with the broken equipment once aclaim is in process. But more often thannot, technicians will be happy to returnfor the equipment in a few days, after theinsurance representative has had a look.

“For any type of equipment breakdown,it’s better to err on the side of cautionand keep the equipment. In most cases,we can send out someone to inspect theequipment or failed component the sameday or the following day,” Davis said.

In one recent case, a dentist experiencedthe failure of her vacuum. Knowing shecouldn’t afford to close her practiceduring the claims process, she replacedit, storing the broken one on site. TDICwas able to get an inspector out to herpractice right away, and she was able tocontinue seeing patients while her claimwas being processed.

“We understand that you can’t afford tohave downtime,” Davis said. “But bycalling us in tandem with calling atechnician, and by preserving your oldequipment, you can ensure your claimwill be processed smoothly.”

Experiencing an equipment breakdownis an unfortunate reality of the dentalprofession. As a practice owner, thesteps taken during this time can meanthe difference between a smoothrecovery or a complicated one. Byfollowing a few simple protocols,dentists can get back to business quicklyand painlessly. �

HOW TO HANDLE EQUIPMENTFAILUREBy: TDIC Risk Management


The goal for most practice owners is tosend out as few billing statements aspossible. This goal correlates withsetting strong payment policies andadhering to those rules. However, whena patient is unable to pay at the time ofservice, despite the practice's efforts tocommunicate the payment policies, thepractice should be prepared with analternative method.

But before it gets to this point, there aresteps dental practices can take toimprove their collections process. Hereare five tips for better collections.

1. NO SURPRISES.

Patients should be informed and have aclear understanding of the practice'sfinancial policies from the beginning ofthe relationship with the office. At theonset of treatment, the practice shouldobtain a signed financial agreement (inaddition to a signed informed consentform) that states what the patient'sresponsibilities are and when payment isexpected. The practice should makesure to follow through as well.

2. UTILIZE A TEAM APPROACH.

Co-payments should be confirmedwhen appointment confirmation callsare made. The morning huddle should

include any important financial updatesfor patients scheduled that day.

3. SEND STATEMENTSCONSISTENTLY.

When the practice has extended creditand patients carry a balance, statementsshould be sent consistently in order tomaintain financial arrangements andregular payments. Keep balances top ofmind. It's very easy for patients to"forget." Stay on top of balances andmake regular follow-up calls for thosebalances that begin to lag.

4. KNOW THE NUMBERS.

Run reportsregularly and checkfor billing and claimserrors. If the staffdoes not know thecapacity of thepractice's softwaresystem, trainingshould be set up.

5. REVIEW.

Practice financialprotocols should bereviewed annually.Dentists shouldconsider schedulingan annual staffmeeting to reviewthe practice owner'sexpectations andsystems and identifybad habits. Retrainand role play ifnecessary to improvecommunication andconfidence whendiscussing financeswith patients.

CDA recommends that dentists conductresearch and understand the followinglaws pertaining to dentists who engagein debt collection activities on their ownbehalf:

• Federal Fair Debt CollectionPractices Act

• California Robbins-Rosenthal FairDebt Collection Practices Act

• Civil Code Section 1788-1788.3

• Civil Code Section 1788.10-1788.18

• Civil Code Section 1788.20-1788.22

• Civil Code Section 1788.30-1788.33 �

HOW TO HAVE BETTERCOLLECTIONS IN THE DENTALPRACTICEBy CDA Practice Support Reprinted with permission from California Dental Association

®

Dentists often believe they need morepatients, so they ask how to get them.But the more appropriate questionsshould be about how to get the patientsthey already have to accept treatment.

WE HAVE AN ISSUE IN OURPROFESSION that is seldomdiscussed—we’re not asking the rightquestions. There are a lot of things thatwe do well in dentistry—we’re caring,compassionate, and dedicated. However,sometimes we’re not able to thinkoutside the box.

Dentists want to know, “How can I getmore new patients?” I want to know,“Why do you want more new patients,and what is happening with the patientsyou do have?

The real question dentists should beasking is, “What can I do with myexisting patients to increase myproductivity and meet the goals I’ve setwith my team?”

There’s a good chance that you have allof the opportunities you need right inyour own practice. I’d like to help youidentify your opportunities today andshare three questions you can use inyour practice to help you meet yourneeds with your existing patients.

1. ARE YOU SURE THAT THE BACKDOOR IS CLOSED?

If you have an abundance of patients inthe office, you may not notice that it’swide open!

• Do you monitor your active patientcount monthly?

• Do you monitor your hygieneretention monthly?

• Do you know how many patients aredue this month but are not beingseen?

If you’re not monitoring these keyperformance indicators, you may notrealize how many patients are coming toyour office once and then not returning.

2. WHAT ARE YOU DOING TO KEEPTHE PATIENTS YOU CURRENTLYHAVE HAPPY IN THE PRACTICE?

Patients expect more with every visit.

• Are you keeping up with technologyand techniques?

• Do you have affordable financingoptions or an in-office membershipplan to help your patients say yes totreatment?

• Are you engaging your patients ontheir own terms with your socialmedia presence?

Look around your practice. Can you domore to keep your patients happy?

3. WHAT ARE YOU AND YOUR TEAMDOING TO GET THE DENTISTRY OUTOF THE CHARTS AND INTO THEMOUTHS OF YOUR PATIENTS?

You already have an advantage with yourexisting patients. You have established thefirst of six steps in case acceptance—youhave built the relationship. Patients aremore likely to follow through with yourrecommended treatment if they trust you.Many times, the failure comes from notcreating the urgency or providing therisks and benefits of treatment in a way inwhich patients can relate.

A couple of weeks ago, I asked anarborist to come to my house and trimthe limb of my neighbor’s sweetgum treebecause it was hanging over my fence

ARE YOU ASKING THE RIGHTQUESTIONS TO GROW YOURDENTAL PRACTICE?By Danya Montoya Reprinted with permission from DentistryIQ.


and dropping sweetgums balls in myyard. It’s on a hill and my storage shed isat the bottom of the hill, so I was alwaysafraid someone would “Charlie Brown”it down that hill on a sweetgum ball. Iwas told it would cost $200 to trim thelimb. When the arborist evaluated thetree in person, he realized that the treewas on a hill, and that the root systemwas close to our pool plumbing andsprinkler system. Because of these risks,he changed his recommendation fromtrimming the limb to removing the tree.Now the cost was $1,800, but the way hepresented the risks and benefits made itdifficult for me to say no. It was good forhim and good for me.

The proposed dentistry you have in yourcharts is the same thing. It’s there! Howare you explaining the risks and benefitsof the treatment and creating urgency tohave it completed? I would encourageyou to talk at your morning huddleabout what is already diagnosed. Whatcan you do or say differently toencourage your patients to moveforward with treatment? That will makeit good for you and good for them.

The bottom line is this: we need toknow what questions to ask.

• Is the back door open?

• What are you doing to keep yourpatients happy?

• What are you doing to get thedentistry out of the charts and intothe mouths of the patients whoalready trust you?

If you need help with answers, you mightwant to turn to outside resources thatcan help you get where you want to go. �


CAN A DENTIST DETECT AN EATINGDISORDER?

People with eating disorders often masktheir disease, making it hard for aprimary physician to detect. But thedentist can see telltale signs, such asredness and ulcers, that patients can'thide. Dr. Gigi Meinecke, a practicingdentist and president of the MarylandAcademy of General Dentistry,discusses how dentists can help treatpeople with eating disorders.

WHY ARE DENTISTS ABLE TODETECT EATING DISORDERS?

It might surprise some people that a largenumber of diseases and conditions of thebody have symptoms that can appear inthe mouth. Some of these manifestationsare disease-specific and help to raise adegree of suspicion in the alertpractitioner. Eating disorders are amongthose conditions which present with veryclassic appearances on the teeth as well asthe soft tissues inside the mouth.

Patients suffering from these disordersoften attempt to keep their food-relatedproblems a secret and will avoid theirmedical practitioner. It's not uncommonfor the dentist to be the firstpractitioner to diagnose these disorders.According to the National Institute ofDental and Craniofacial Research, 28percent of patients with bulimia are firstdiagnosed during a dental exam.

What are some of the oral healthsymptoms for someone who might havean eating disorder?

The dentist will often identify one ormore of the following in patients witheating disorders: specific wear-patternson the teeth in characteristic locations,redness and/or ulcerations in themouth, lesions on the soft palate,irritations in the corners of the mouth,decreased saliva production andenlarged parotid glands, the large

DENTAL PROBLEMS COULD BE ASIGN OF AN EATING DISORDER

salivary glands located between the earand jaw. Additionally, the patient maypresent or complain about dry mouth,burning tongue and sensitive teeth, orthey may notice that their teeth appearshorter.

WHICH EATING DISORDERS CAUSETHESE PROBLEMS?

Eating disorders are commonlyclassified in two groups: anorexianervosa and bulimia nervosa. Both havesubtypes, and many patients oftenpresent with a combination ofsymptoms which may blur thedistinction between anorexia or bulimia.Generally speaking, these disorders mayinvolve the following: severe calorierestriction, binge eating, purging andself-induced vomiting. Each of thesebehaviors will produce harmful ordestructive effects in the mouth whichbecome detectable to the dentist.

HOW CAN MALNOURISHMENTCAUSED BY EATING DISORDERSCONTRIBUTE TO DENTALPROBLEMS?

Nutritional deficiencies will typicallymanifest themselves first as the softtissue complications that I've described.Here are a few that come to mind:chronic ulcerations in the corners of themouth (angular cheilitis), painfulinflammation of the tongue (glossitis),fungal infections of the mouth(candidiasis), burning sensation in themouth or tongue (glossodynia), poor

healing of oral injuries, loss ordistortion of taste and predisposition togum disease. Nutritional deficienciesmay also contribute to dry mouth(xerostomia). Unfortunately, mostpeople are not aware that persistent drymouth encourages tooth decay.

HOW ARE DENTAL PROBLEMSCAUSED BY EATING DISORDERSTREATED?

Identification of the problem with aproper medical referral is a dentist's firstpriority. Then, patient educationregarding the oral effects of theirdisorder with a compassionate,nonjudgmental approach is often key toenlisting the patient as a partner in theirtreatment. I've personally watchedpatients become highly motivated inpreventing further damage to their teethonce they understand the link betweentheir eating disorder and their dentalproblems. Sadly, many of the effects onteeth may require placement of caps(crowns) or other filling materials, withsome advanced cases needing rootcanals or even removal of the tooth.

IS THERE A WAY TO PREVENT THESEDENTAL PROBLEMS WHILETREATING THE EATING DISORDER?

Simple strategies, such as rinsing withplain water and not brushing your teethfor an hour after vomiting — whichcontradicts what most people areinclined to do — will decrease thedamage caused by stomach acids.Additionally, using a fluoride containingtoothpaste and home fluoridetreatments prescribed by the dentist candecrease decay as well as decrease toothsensitivity. Regular dental visits to checkfor problems before they become largeand expensive is also somethingeveryone should do. �

By Andrea K. McDaniels, The Baltimore Sun

Are consumer, tablet and 6MP displaysequally useful for detecting anatomicaland pathological structures?

It depends on who is interpreting theimages, research published in the July2014 issue of Oral Surgery, OralMedicine, Oral Pathology and OralRadiology says.

With new technologies come potentiallyuseful mobile devices and radiologyapplications. However, scientists inFinland could find only one studyevaluating the effect of liquid-crystaldisplays on diagnostic performance ofpanoramic radiographs and none ontablet use.

Their aim, therefore, was to compareobserver performance in detecting bothanatomical and pathological structures inpanoramic radiographs using consumergrade and tablet displays undersuboptimal conditions as compared tothe 6MP (megapixels) display calibratedwith Gray Scale Standard DisplayFunction under low ambient lightconditions. Their research hypothesiswas that medical display in low ambientlight conditions is better than consumergrade display or tablet under highambient light.

To investigate, the researchers selected30 panoramic radiographs showingclearly visible structures. After an hour oftraining on how to use viewingprograms, two observers with differentlevels of interpreting experienceevaluated all images on each of the threedisplay types.

Observer 1 was an oral and maxillofacialradiologist with eight years ofexperience. Observer 2 was a resident inoral and maxillofacial radiology with twoyears of interpreting experience. Theyevaluated images on the consumer gradedisplay and the tablet during the firstsession and on the 6MP display threeweeks later. They were each allowed oneminute per image to evaluate sevendifferent anatomical structures andpathological lesions from the left side ofthe jaw.

The observers used a five-point scalingsystem:

1. definitely not a finding;

2. probably not a finding;

3. unable to evaluate;

4. probably a finding;

5. definitely a finding.

When successful ratings were tallied,researchers found that the lessexperienced observer performedsignificantly worse on a 30.4 inch tabletas compared to a 30.4 inch 6MP displayin identifying dentinal caries in the lowermolar and periapical lesions in the uppermolar in panoramic radiographs under

bright-light conditions. The moreexperienced observer performedsimilarly on the tablet and 6MP display.

In discussion, the researchers noted thatother studies evaluating the accuracy ofradiographic methods have shownsignificant differences in diagnosticperformance between individualobservers and have attributed this todifferences in experience, training orvisual perception.

“With regards to visual perception, inlow lighting conditions the rods in theeye are activated and small differences ingray scale between pixels on the monitorcan be seen. Conversely, at brightlighting levels, the rods are less activeand small contrast differences are moredifficult to observe,” the authorsexplained in discussion.

They cited previous supporting research.“To associate with differences inexperience, training or visual perception,it seems that a more experiencedradiologists sees more shades of gray.”

They concluded that a dentist in the early phases of training ininterpreting panoramic images may be more dependent on a high-qualitymedical display used under optimalviewing conditions, while anexperienced dentist can achieve highdiagnostic standards using suboptimaldiagnostic technology. �

Posted online August 15, 2014 at http://www.ada.org/epubs/highroad/jadaRadiology/081314.html#oneCopyright © 2014 American Dental Association. All rights reserved. Reprinted with permission.



The public has never been betterinformed about health care options;however, they lack the specializedknowledge and experience that dentistspossess. This can sometimes lead toconfusion over a dentist’s qualificationsand expertise.

Advertising is a common point ofconfusion. Marketing is vital to thecontinued growth of a practice, butmany promotional statements may bemisunderstood by the potential patient.

It is not uncommon to see statements inadvertising such as “Voted Best Dentistin Alpine County.” In this instance, theadvertisement may be in violation ofSection 651(b)(8) of the CaliforniaBusiness & Professions Code, whichstipulates that a statement, endorsementor testimonial is likely to mislead if itfails to disclose materials facts.

Therefore, if adentist advertisesthat they were“voted best dentist”,they must cite thesource of the claimin theiradvertisement. Forexample, astatement such as“Voted 2016 BestDentist by XYZNewspaper” wouldbe acceptable.

Another commonissue in advertising is claims ofsuperiority. Statements such as “Moststate-of-the-art dental office” or“Superior training and expertise” maybe in violation of the CaliforniaBusiness and Professions Code Section1680i, which prohibits the advertising ofeither professional superiority or theadvertising of performance ofprofessional services in a superiormanner.

It is helpful to turn to the CDA Code ofEthics (the code) for direction. Section6A of the code gives the followingguidelines for advertising: “It isunethical for a dentist to mislead apatient or misrepresent in any materialrespect either directly or indirectly thedentist’s identity, training, competence,services, or fees. Likewise, it is unethicalfor a dentist to advertise or solicit

patients in any form of communicationin a manner that is false or misleading inany material respect.”

This emphasizes the importance ofveracity, the ethical principle of beinghonest. It may also be unwise to createunrealistic expectations throughadvertising.

Advisory Opinion 6.A.1.c clarifies that“A statement or claim is false ormisleading when it … is intended or islikely to create false or unjustifiedexpectations of favorable results.”

Thus, even with the best intentions,advertising may be unethical if it is likelyto create unjustified expectations.

The dentist who desires to practiceethically should proceed with cautionwhen marketing himself or herself.Highlighting what makes your practicea great choice among many options iscritical in a competitive marketplace,and can be tricky. The ethical principlesof veracity (honesty), integrity and non-maleficence (do no harm) provideexcellent guidance in marketing andsustaining a successful practice.

When in doubt, contact yourcomponent ethics committee before yousign off on that new ad.

For further guidance, contact BritneyRyan, CDA judicial council manager, at800.232.7645. �

CLAIMS OF SUPERIORITYBy Robert D. Stevenson, DDSMember, CDA Judicial Council

®


have associate dentists treating patientsbut the plans would pay based on thecontract with the practice owner. Nomore. Now the standard ADA claimform has places for the billing provider(the owner, in whose name areimbursement check for the claim willbe paid) and for the renderer or treatingprovider. Plans have moved towardpayment based on who rendered careand what that associate’s contract statusis with the plan.

For most plans, this makes little to nodifference in how claims are paid. Butwhen there is a difference in how theowner of a practice is contracted andhow the associates are contracted withthe same plan, it does make adifference.

Differences in contract status betweenthe owner and the associate are themain reason payments are increasinglybeing made based on who renderedcare. We first started seeing this changesome five years ago, but some dentaloffices still call to ask how plans pay vis-à-vis the contract status of the associate.Some offices say they prepare claims inthe name of the owner as they’ve donefor a very long time. They do this out ofhabit (because “that’s the way it’s alwaysbeen done”) and because they don’t

know any better. Some offices haveresponded that perhaps they shouldcontinue to bill associates’ care underthe single name of the owner.

If there’s a difference in how the owneris paid versus how an associate is paid,the desire to bill under the owner isunderstandable. But CDA’s response isas follows:

1. Now that they know this animproper way to bill for most plans,they have an obligation to do it thecorrect way.

2. If an office continues to file claims inthe name of the owner for thepurpose of avoiding a different feeschedule assigned to the associate, anoffice will get away with that untilthey are audited by the plan, andplans have become more aggressivein auditing the dentists they’recontracted with.

CONTRACTING ASSOCIATES

Increasingly, plans want all dentistsassociated (and this is key – dentistswho are associates of the practice areemployed by the practice) to beseparately contracted with their plans.As discussed above, some plans havedifferent fee schedules for treatmentbased on when or how recently a dentistcontracted with the plan. For thisreason alone, plans want each dentistassociated with a practice to have theirown contracts with the plan.

Aside from a possible differentiation offees, plans also look to credentialcontracted providers to assure they areup to date on their licensingrequirements (e.g., have requiredcontinuing education credits), have

Have you ever had one of thosemoments when you received a decisionfrom a dental benefit plan and thought,“There ought to be a law?” Well, thereisn’t a law, in many cases.

All health plans must meetrequirements as determined by the stateagencies that regulate, license andcertify them. However, the issues thatmatter most to providers as well aspatients — what is included in the plan’sscope of benefits, what limitations andexclusions apply to coverage, how muchplans pay for treatment and how oftenthey adjust their fees, for example — arenot governed by state laws orregulations. They are the responsibilityof the plans. Patients and providersmust be diligent about knowing andworking with these policies and makingappeals based on the policies, ascontracts between dentists and plansgovern most of the issues dentists willexperience.

CDA continues to receive questionsfrom members about recent changes inhow plans contract with dentists. Thesechanges affect how plans pay and howpractice associates are included in plannetworks. To address these questions,here is an overview of the significantchanges seen in provider-plancontracting over the past few years.

PAYMENT

Dental plans have increasingly movedtoward payment of claims based on whorendered care. It wasn’t that long agothat dental plans almost universally paidclaims based on the contract status ofthe practice owner. The practice could

CDA ADDRESSES QUESTIONSABOUT CHANGES IN PROVIDERCONTRACTINGReprinted with permission from California Dental Association

®


liability insurance coverage, aren’tpracticing under a suspended licenseand are not on probation. And associatecontracting assures the plan’s ability toaudit treatment and billing done for theassociate.

Because of these requirements tocontract with practice associates, somepractice owners have consideredbringing independent-contractordentists into the practice. These aredentists who bring their own practicesunder the roof of the dental practice.They bring their own plan contracts,they tend to be specialists who bringtheir specialty expertise into generaldental practices, and they submit theirown claims.

CONTRACTING NEW PRACTICEOWNERS

It is a myth that when a dentistpurchases a practice from anotherdentist, the new owner to some extentinherits the contract status of theprevious owner. This is not the casewith any plan in California. Apreviously noncontracted provider whopurchases a practice — and this couldbe a dentist moving into the area andpurchasing an existing practice or anassociate with a practice who steps up tobuy the practice of a retiring dentist —will need to establish their own contractwith whatever plans they desire to dobusiness with.

However, this isn’t the case with everydental plan. Some dental plans allow for“portability” of a dentist’s existingcontract. If a dentist has beencontracted with some plans, either as an

associate in the practice they are buyingor contracted in another location inCalifornia, that contract status willfollow the dentist to their new locationand be applied in the new ownershipstatus. Of course, any plan would needto know about a change in status or ofaddress in regard to practice ownership.But, again, not every plan allows thisportability. Be aware that a dentistpurchasing a dental practice may haveto recontract when becoming the newowner of a practice, and this couldmean a change in how the dentist, asthe new owner, is paid by the plan.

Similarly, if a dentist has been the soleproprietor of a practice and decides toincorporate or bring a partner into thepractice, this change in ownershipstructure may result in having torecontract with some plans.

CONTRACTING AT A NEW LOCATION

As mentioned above, taking over apractice as a new owner may likelyrequire recontracting with one or moredental plans. But with some plans,provider contracts are portable,meaning a dentist may take theircontract wherever they practice inCalifornia, either as an associate or asthe owner of a new practice.

Changing practice locations doesn’tprecipitate a new contract with plans.That would constitute a simple changeof address. But there may be arequirement to establish a new contractif a practice opens a second location.The existing contract a dentist has withplans will apply at the original location,but a new contract may be required at anew second location. Again, most planswon’t require a new contract for thislocation.

In summary, the need to adjust tomarketplace realities has promptedsome dental plans to change the waythey contract with dentists. The keytakeaways: 1) Hiring associates requiresestablishing plan contracts for thoseassociates; 2) Payment of claims ismainly based on who rendered the carebeing claimed; 3) Purchasing a practicemay result in recontracting with plans.A dentist who already has a plancontract may be able to bring theirexisting contract status into that newlypurchased practice, but the contractstatus of the former owner can’t betransferred to the new owner. Andwhile a change in location usuallydoesn’t require the dentist to recontractwith plans, opening a second office may.

In any of these situations — hiring of anassociate, changing locations orpurchasing a practice — it would bebest to contact CDA Practice Supportto discuss the usual contractingrequirements.

To discuss contracting requirements,contact CDA Practice Support at800.232.7645. �

CDA ADDRESSES QUESTIONS ABOUT CHANGES IN PROVIDER CONTRACTING (CONT.)


Bloomberg Businessweek has a funbreakdown of which occupations havehad the highest shares of people whoare married from 1950 to 2010, basedon data from the Census Bureau.

While engineers, mathematicians andscientists today are (unfairly)stereotyped as awkward nerds who don’tknow how to interact with the oppositesex, in 1950 they were among theoccupations most likely to be married.Today, the most commonly conjugatedoccupations are instead more oftenmedical professionals with doctorates,starting with dentists (81 percent ofwhom are hitched):

OCCUPATIONS IN WHICHPEOPLE ARE MOST LIKELY TOBE MARRIED

1) DENTIST

2) CHIEF EXECUTIVE

3) SALES ENGINEER

4) PHYSICIAN

5) PODIATRIST

6) OPTOMETRIST

7) FARM PRODUCT BUYER

8) PRECISION GRINDER

9) RELIGIOUS WORKER

10) TOOL AND DIE MAKER

There are a few likely explanations forwhy people who take the title “Dr.”occupy so many of the top slots, besidesthe fact that every Jewish motherconsiders them highly marriageable.

One is that marriage rates are stronglycorrelated with income, and docs tendto have both high income and stableearnings. One analysis, for example,found that nationwide, doctors are morelikely than any other profession to be inthe top 1 percent of earners; about onein five doctors lands there. Anothermight reflect the age composition ofthese workers compared with others:People are getting married later in lifenow, and by the time you get toofficially call yourself “Dr.” you’re likely

to be older because you’ve been intraining for so long. That seemsunlikely to be the whole story, though. I also wonder whether there’s somethingabout the personalities or culturalbackgrounds of people most likely tobecome doctors that also orients themtoward settling down. Given how earlyin life would-be doctors have to startpreparing for their future careers,perhaps they are more milestone-focused more generally.

BloombergBusinessweek also crunchedthe numbers for divorcées. Turns outthat in 1950, many of the occupationswhose members were most likely to endup divorced were creative or artisticones (artist, writer/director, dancer,designer, writer), which perhaps reflectsthe communities that were mostaccepting of divorce at the time. In2010, the occupations with the highestdivorce rates were predominantly inmanufacturing or other areas that havebeen subject to downsizing (drillingmachine operator, knitter textileoperative, force operator, windingmachine operative, postal clerk). This seems to support the idea thateconomic stability is a good predictor of marital status. (Marital stability andfamily structure, in turn, are alsobelieved to reinforce economic stability and success.) �

WANT TO MARRYA DOCTOR?By Catherine Rampell, The Washington Post


Reprinted with permission from CalChamber

My employee gave two weeks’ notice that she isquitting, but I want to end her employment today.Will that turn her quit into a termination? And ifso, will it mean she can collect unemploymentinsurance even though she quit? And do I have topay her out for the two weeks?

If an employee gives two weeks’ notice that she is quitting andinstead you end her employment earlier than notice period, youhave turned a voluntary quit into a termination. Let’s look athow that will affect her unemployment insurance (UI)eligibility, and whether you must pay her out for the noticeperiod she gave.

UI ELIGIBILITY

An employee who is terminated for “misconduct” is disqualifiedfrom receiving UI benefits. If you terminate an employee as aresult of her having given notice to quit, she will not have beenterminated by you for misconduct and thus would not bedisqualified. In this situation, she will likely be eligible to collectbenefits, which could in turn have a negative effect on your UIreserve account and cause your UI rates to go up.

If, however, you pay the employee for the full period of notice,then the Employment Development Department (EDD) stillwill consider the separation to be a voluntary quit for UIpurposes. This is because by being paid out for the noticeperiod, the employee has not suffered any loss of wages.According to EDD, for UI purposes, a voluntary quit becomesa termination only if the employee suffered a wage loss. (Notethat this discussion pertains only to UI eligibility, not whetherthe separation was a quit or a termination for other legalpurposes, such as a wrongful termination lawsuit.)

In deciding whether to pay out the notice period even thoughyou are terminating the employee, it is critical to firstdetermine whether she would be eligible for UI even if EDDstill considers it a voluntary quit. Remember that an employeewho quits with good cause (such as to relocate with his/herfamily to another state, or to take a substantially better job)might be eligible to collect UI anyway. If that is the case, yourturning the quit into a termination will make no difference inwhether she will collect UI.

PAYING FOR NOTICE PERIOD

If you are an at-will employer and don’t require employees togive advance notice of quitting, then there is no legal obligationto pay out a notice period if you terminate the employee early.Note that the lack of a legal obligation to pay those wages doesnot change the UI eligibility discussed above.

However, it’s important to check your employee handbook orother company documents that might create a requirement foremployees to give notice. It’s not unusual to find an employeehandbook that states that employment is at will, meaning eitherparty can end the relationship without notice, but then to find apolicy in the same handbook asking that employees give twoweeks notice if they are planning to quit. By requiring notice,you may be creating an obligation to allow the employee towork the two weeks or to be paid out for it. �

LABOR LAW


If you’ve noticed an increase in canceledappointments at your practice, it may bedue to the overall increase in themnationwide during these difficulteconomic times. Even in a boomingeconomy, canceled appointments arepart of operating a dental practice, butthey can be managed to minimize theireffect on your bottom line.

One way to reduce your cancellations isto confirm and reschedule appointmentsin the same manner every time. Thiscreates a pattern your patients get usedto, which may make them less likely tocancel. Below are a series of talkingpoints created by the ADA that you cantry with your patients. Read them aswritten, or modify them to fit yourneeds. The important part is to usethem consistently.

If you receive the patient’s answeringmachine:

“Hello, this is [Name] from [ABCDental] calling for [Patient Name]. Ourphone number is XXX-XXX-XXXX.This is a reminder that your dentalappointment is scheduled for [Date] at[Time]. Oral health is an important partof overall health. Regular checkups areimportant. See you on [Date] at[Time].” In order to respect HIPAAregulations, it is best to limit yourmessage to appointment time and date.Do not discuss treatment in a messageyou are leaving.

If a patient calls back to indicate heor she is unable to keep the dentalappointment:

“I’m sorry to hear you can’t make yourappointment. Regular checkups areimportant to keep an eye on your oralhealth and to take care of any problemas early as possible. Left unchecked,conditions can worsen over time. Wecan reschedule your appointment for[suggest different date/time].”

If a patient says he or she can’t affordthe appointment or lost dentalbenefits, etc.:

I’m sorry to hear that, and I canunderstand that now might not be agood time for you. It’s important to seethe doctor regularly. Tooth decay, gumdisease and other conditions can worsenover time and that means treatment canbe more complicated and costly.Regular checkups mean the doctor candiagnose conditions early on whentreatment is simpler and moreaffordable. We could reschedule yourappointment for [suggest differentdate/time].”

If patient will not reschedule theappointment:

“Give our office a call when you’re ableto see the doctor again so we cancontinue to care for your dental health.In the meantime, we encourage you tobrush twice a day with fluoridetoothpaste, floss once a day and eat abalanced diet. These things will help,but aren't a substitute for professionaldental care. Take care, and we lookforward to hearing from you soon.”

3 tips to help prevent cancellations:

1. Write your home phone number onthe appointment card. Thispersonalizes the dentist/patientrelationship, making brokenappointments less likely.

2. Call your patients at home, or ontheir cell phones, to confirm theirupcoming appointments.

3. Make sure your staff membersremind patients to notify the office ifthey can’t make an appointment. �

Copyright © 2018 American Dental Association. All rights reserved.


It is becoming more and more commonto see animals accompany their ownersinto stores and workplaces to assist asservice or assistive animals — butwhether someone has a legal right to doso depends on the circumstances.

There are two situations where you mayhave to allow animals in the workplace:

• To provide an accommodation for anapplicant or employee with adisability; and

• To allow a disabled customer orpatron to bring a service animal intoyour place of business.

Different rules apply to each situation, soit is important to look at them separately.

ANIMALS ON THE JOB: ASSISTIVEVS. SERVICE ANIMALS

Let’s start by detailing the differencesbetween the types of animals allowed inworkplaces and places of business.

First, “assistive animals” generally help aperson with a disability to performhis/her job. Under the California FairEmployment and Housing Act (FEHA),an assistive animal is an “animal that isnecessary as a reasonableaccommodation for a person with a

disability.” Examples of assistive animalsinclude:

• Guide dogs trained for the blind orvisually impaired;

• Signal dogs or other animals trainedfor the deaf or hearing impaired;

• Service dogs or other animalsindividually trained to therequirements of a person with adisability; and

• Support animals.

The last type of assistive animal — the“support animal” — is very broadlydefined. A “support animal” is a dog “orother animal that provides emotional,cognitive, or other similar support to aperson with a disability, including, butnot limited to, traumatic brain injuries ormental disabilities, such as majordepression” (2 CCR 11065(a)).

There is no training requirement forsupport animals; the sole requirement isthat the animal provides support to theemployee. Between the broad legaldefinition and the lack of requiredtraining, virtually any animal couldqualify as a support animal under the law.

Second, “service animals” may come intoyour business to assist a customer with adisability. While the scope of animalsthat may qualify as an assistive animal foremployees under the FEHA is quitebroad, the definition of service animalunder the Americans with DisabilitiesAct (ADA) for purposes of access topublic accommodations is muchnarrower. (California’s Unruh Act doesnot define service animals but adopts theADA definition.)

Under the ADA, service animals must be“individually trained to do work orperform tasks for the benefit of anindividual with a disability, including aphysical, sensory, psychiatric, intellectual,or other mental disability” (28 CFR36.104). Animals that provide “emotionalsupport, well-being, comfort, orcompanionship” will not qualify asservice animals.

Service animals are limited to dogs and,under certain circumstances, miniaturehorses. No other animals can qualify asservice animals under the ADA.

WHEN IS AN ASSISTIVE ANIMAL AREASONABLE ACCOMMODATION?

Both the federal ADA and California’sFEHA prohibit employers fromdiscriminating against applicants andemployees because of a mental orphysical disability. Those laws alsorequire that employers reasonablyaccommodate an individual’s disability,unless the employer can show that theaccommodation would impose an unduehardship.

A “reasonable accommodation” is anymodification or adjustment to a job,employment practice or workenvironment that allows an individualwith a disability to enjoy an equalemployment opportunity. A reasonableaccommodation can include amodification or adjustment that enablesan employee to perform essential jobfunctions or enjoy equivalent benefitsand privileges of employment thatsimilarly situated employees withoutdisabilities enjoy.

SERVICEDOG

HOW TO HANDLE ASSISSTIVEAND SERVICE ANIMALS INTHE WORKPLACE

Reprinted with permission from CalChamber


Reasonable accommodations can takemany forms, including use of assistiveanimals in the workplace.

As with any request for accommodation,the answer to whether an employer mustallow an assistive animal is, “it depends.”Each request for accommodation isunique. You should always conduct anindividualized assessment to determinewhether the requested accommodationwould be reasonable under thecircumstances.

If an employee asks to bring an assistiveanimal into the workplace, you shouldengage in a timely, good-faith interactiveprocess with the employee.

As part of this process, you can requirethat the employee provide medicalcertification from a health care providerconfirming that he/she has a disabilityand explaining why the employeerequires the assistive animal in theworkplace (e.g., why the animal is anecessary accommodation to allow theemployee to perform the essentialfunctions of the job).

Assuming that the employee has adisability and the use of an assistiveanimal is a reasonable accommodation,you must allow the employee to bringthe animal to work unless doing so wouldimpose an undue hardship.

As a condition of allowing an employeeto bring an assistive animal to work, youcan ask the employee to confirm that theanimal will behave appropriately in theworkplace and meet minimum standards,such as being free from offensive odors,being housebroken, and not endangeringthe health or safety of anyone in theworkplace. If the animal doesn’t behaveappropriately, you can challenge whetherthe animal meets the minimum standardsfor being in the workplace. However,you can only do so during the animal’sfirst two weeks in the workplace, so pay

close attention and promptly address anyissues that arise.

Requests for assistive animals in theworkplace can also give rise to a varietyof other issues, including complaintsfrom other employees about the animalsor conflicts with other laws that maypreclude an animal from being present incertain workplaces. If an employee claimsto be allergic to another employee’sassistive animal, you may have twoemployees to accommodate — theemployee requiring the assistive animaland the employee with the allergy. Youcan work with both employees to figureout how to best accommodate everyoneinvolved, such as providing theemployees with fans or air filters. Ifallowing an animal to be present at workmay violate other laws, such as healthand safety requirements, you can takethat into account when determiningwhether the requested accommodation isreasonable or whether it would imposean undue hardship.

When in doubt, always consult legalcounsel.

HOW SHOULD A BUSINESS HANDLEA CUSTOMER WITH A SERVICEANIMAL?

In addition to any worker's right to anassistive animal, businesses that are opento the public must allow individuals withdisabilities to bring a service animal withthem into the establishment. Theserequirements can be found in the federalADA, California’s Unruh Civil RightsAct and the state’s Disabled Persons Act.

You cannot refuse to provide service oraccess to a disabled customer because ofa service animal’s presence. If youprohibit animals in your business, youmust make an exception for serviceanimals. Certain individuals who aretraining service animals must also beallowed to bring those animals in.

Should a customer with a service animalenter your business and the need for theanimal is not obvious, you are limited toasking the customer the following twoquestions to confirm that the animalqualifies as a service animal:

• Is the animal required because of adisability?

• What work or task has the animalbeen trained to perform?

If the need for the service animal isobvious, such as a guide dog leading ablind person, then you should not askeither of these questions.

You cannot ask the customer about thenature of his/her disability, or requireany documentation, such as proof thatthe animal is trained. Do not ask thecustomer to have the animal demonstratethe task it is trained to perform.

In a recent California Court of Appealcase, a business was sued after a customerclaimed he was denied access to thecompany’s business because of his serviceanimal’s presence (Miller v. FortuneCommercial Corporation, 15Cal.App.5th 214 (2017)). The companyfiled a motion asking the court to dismissthe case before trial on the grounds thatthe customer’s dog was not a trainedservice animal, the dog was not broughtinto the stores for the purpose of beingtrained, and even if it had been, thepeople handling the dog were notqualified to train the dog.

The court agreed and dismissed the case.The customer appealed, and the decisionwas affirmed. As discussed above, theADA requires that service animals betrained. The court found that while thedog had received some generalobedience training, it was not trained as aservice animal. Since the dog was nottrained as a service animal, the customerhad no right to bring the dog into thebusinesses.

(CONT.)


BEST PRACTICES

• A request from an employee to bringan assistive animal into the workplaceshould be treated just like any otherrequest for accommodation: Once theemployee requests an accommodationor you receive notice that anemployee has a disability that mayneed an accommodation, engage in atimely, good-faith interactiveprocesswith the employee todetermine if use of the animal wouldbe a reasonable accommodation.

• You cannot bar customers fromentering your business if they have aservice animal. Any signs that state“no animals” should indicate thatservice animals are allowed.

• Assistive and service animals are notpets. They are working animals; theirjob is to assist their owners.Employees should not pet or engagewith an assistive or service animalwithout first asking permission of theanimal’s owner.

• There are organizations that will, for afee, allow individuals to certify orregister an animal as a service orassistive animal. Some even sell vests,tags or other items for the animal towear. Such a certification or tag alone,however, does not give an employeeor customer the right to have theanimal with them in your workplaceor business.

o In the case of an employee, theanimal must meet the definitionof an assistive animal and benecessary as a reasonableaccommodation for theemployee’s disability.

o In the case of a customer, only aservice animal must be allowed inyour business. If the need for theanimal is not obvious, you can askthe two questions identified aboveto confirm whether the animalqualifies as a service animal. �

(CONT.)

LADS Continuing Education Course March 20, 2018 | Maggiano’s 6 - 9pmWork Smarter Not Harder: The Digital Waterfall For Our Clinical Theatre

Greg Campbell, D.D.S. is recognized nationally and internationally as an expert on integrating CAD/CAM dentistry into offices and is frequently sought out by industry leaders to lecture about Digital Dentistry. Dr. Campbell is highly entertaining and has a great understanding of CAD/CAM technology. He trains other dentists how to use this technology and is a certified advanced and basic CEREC trainer. Dr. Campbell is also an industry leader in Computer Guided Implant Surgery. Dr. Campbell is a beta tester for Ivoclar Vivadent, Sirona Dental, Vita and Meisinger and Sweden & Martina, and has authored two books on CAD/CAM dentistry.

Dr. Campbell is also a key opinion leader for Kuraray America. Dr. Campbell graduated from the University of Southern California School of Dentistry in Los Angeles, California and completed advanced training in Cosmetic Dentistry at UCLA. In addition to speaking and teaching about this great technology, Dr. Campbell maintains a private practice in Long Beach, California.

Course description: This presentation will give an overview of several digital products including chairside scan-ners, digital shade guides, and patient communication programs. What is working and how will this benefit the dental practice and clinician. Dr. Campbell will show you how to integrate this technology and steps for success for your practice.

To register or obtain more information about any course, please call the LADS office or visit the LADS website.


EMPLOYMENTDentist

7/21/2017 Dental Practice Seeking an Experienced Associate! Full time andpart-time positions are available and will negotiate pay upon your experience.Prefer bilingual in English and Korean. Email [email protected] or call to setup an interview at 213-385-2875

6/1/2017 Excellent opportunity for General Dentist! Jefferson Dental Clinics isseeking a Dental Associate (General Dentist) to join our team with locations inDallas and Houston Texas. Dental Associates are the mentors of the dentalpractice and take ownership of the patient’s well-being through moral businesspractices and high-quality patient care. Email inquiries to: [email protected].

5/17/2017 Periodontist Opportunities Private general dental office in thefinancial district of Downtown, Los Angeles is seeking Periodontist Specialist for1-2 days per month. We are looking for someone to provide a high level ofservice, quality, patient comfort, and communication. Please email your resumeto [email protected].

4/19/2017- GP Opportunities Interested General Dentists please contactLakewood Dental Center. 310.283.3345

4/19/2017- 3-4 days a week associate position We are looking for a LicensedDentist to add to our awesome Downtown Dental Team. Duties include but notlimited to Fillings, Crowns, Oral Surgery, Deep Cleanings and Prophylaxis. We area growing private dental office and looking for an outgoing, great personally andcheerful dentist. Downtown Dental, 255 S. Grand Ave #204, Los Angeles, CA90012. www.downtowndentalla.com 213.620.5777

Available Dental Staff Opportunities

8/11/2017 Immediate Opening For Experienced Office AdministratorImmediate opening for dental office administrator with experience as officemanager. Los Angeles office with both general and specialty care. Must befluent in Spanish and have knowledge of insurance billing, treatment planning,dental marketing and H.R. Minimum 5 years experience as an officeadministrator / manager. Compensation based on experience. Bonus andbenefits including generous health insurance, 401K profit sharing and otherbenefits. Please send resume to [email protected]

3/28/2017 Bilingual (Spanish) DA wanted We are looking for a dental assistantwho is bilingual (Spanish speaker). Has to have a reliable mode oftransportation and be punctual (on time). Front office experience is a plus. The office is located in Van Nuys. Please email your resumes [email protected]

3/21/2017 Established GP practice looking for a RDH Established GeneralDental practice (located near USC) with in-house Oral Surgery and Orthodonticsis looking for a Registered Dental Hygienist to work 3 + days/week. Applicantmust be motivated, professional and a team player. Bilingual Spanish preferred.Please email resumes to [email protected].

3/6/2017 Fast-paced, 3 Dr. practice in Beverly Hills seeking highly skilled dentalassistant Looking for candidate well versed in CEREC, Invisalign, implants, anddigital dentistry. Should be friendly, excited to learn, have good grammar and typingskills, and a team player. International dentist preferred. Please email cover letterand resume to [email protected]

AVAILABLE PRACTICES

8/16/2017 SHARE A DENTALOFFICE Looking for another generaldentist to space share. 2operatories available for rent 2days a week (Fridays andSaturdays) in prime medical/dentaloffice building on Sunset Blvd inBeverly Hills/West Hollywood.Contact Dr. Tiffany Dushane. Email:[email protected] or Phone:323-533-4528.

5/25/2017 DENTAL SUITE FOR LEASE Private general dental office in thefinancial district of Downtown, Los Angeles is seeking Periodontist Specialist for1-2 days per month. We are looking for someone to provide a high level ofservice, quality, patient comfort, and communication. For inquiries please replyto [email protected] or 310-280-8942.

5/17/2017 SHARE AN OFFICEOffice space available in primemedical building adjacent to theCedars Sinai Medical Center. 1-2operatories are available for aGeneral Dentist or Specialist. Newly redecorated, Modern, high-tech, 5 operatory facility.Call: Ruth 310-652-0450

Fax resume: 310-652-0458 or email: [email protected]

C L A S S I F I E D S


LADS Continuing Education Course February 27, 2018 | Maggiano’s 6 - 9pm

Cal/OSHA & Ethics in Practice (Free Consultation)Maintaining a safe and healthy workplace isn’t just a good idea – it’s the law. And now, you can hear about it directly from the horse’s mouth. Dan Leiner, Area Manager of Los Angeles County’s Cal/OSHA, will speak about what triggers an enforcement inspection, types of citations and penalties, implementation of an effective Injury and Illness Prevention Program (IIPP), and regulations specific to dental facilities, including:

• Bloodborne pathogens • Hazard communication• Aerosol transmissible diseases • Personal protective equipment

Dan will also present Cal/OSHA’s free *consultation service offered to dentists individually to learn about specific potential hazards in their practice, improve programs that are already in place, and even qualify for a one-year exemption from routine OSHA inspections. No other OSHA course can offer this service!*The consultation is confidential and will not be reported to the OSHA inspection staff.

Dan Leiner is currently the Area Manager of the San Fernando Valley Cal/OSHA Consultation Service office in Van Nuys. He was an industrial hygiene consultant for six years with Cal/OSHA Consultation’s Santa Fe Springs office and has been an Area Manager since 2000. Dan is an instructor with the University of California, San Diego’s OSHA Training Institute Education Center.Dan has over 25 years of experience in the health and safety field as an industrial hygienist working in the aerospace industry, in a Los Angeles County lead-using industry outreach project, and with Cal/OSHA Consultation. Dan holds Bachelors and Master of Science degrees in Environmental and Occupational Health from California State University, Northridge.

Carlos Alvarez is currently the Chief of Enforcement for the Dental Board of California (DBC). With 22 years of law enforcement experience with several police departments in LA County, Carlos expanded his career to become an Investigator for the DBC in 2012. From then on he was promoted to a Supervising Investigator in 2014 and then in 2017 to Chief of Enforcement. As the Chief, he directs day to day operations and activities to the Complaint and Compliance Unit, Investigative Analysis Unit, Discipline Coordination Unit and Enforcement Unit. He ensures that the goals, objectives, and mission of the Dental Board are being upheld to protect the consumers of California.


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S Teresita Castillo, DDSGeneral PracticeOffice Address Pending

Cameron Freelove, DDSOrthodonticsOffice Address Pending

David Ganji, DDSGeneral Practice14650 Aviation Blvd Ste 220Hawthorne, CA 90250

Jenny Garcia, DDSPediatricsOffice Address Pending

Lucy Hallajian, DDSPediatricsOffice Address Pending

Yoon-Young Heo, DDSPediatricsOffice Address Pending

Nancy Ho, DDSGeneral Practice14311 Ramona BlvdBaldwin Park, CA 91706

Joo Hyung Kim, DDSGeneral PracticeOffice Address Pending

Jung Yeol Lee, DDSGeneral Practice4428 Slauson AveMaywood, CA 90270

Reginald Moore, DDSGeneral Practice10300 Compton BlvdLos Angeles, CA 90002

Andrew Nickel, DDSPediatricOffice Address Pending

Davina Patel, DDSGeneral PracticeOffice Address Pending

Barbara Perlitch, DDSGeneral PracticeOffice Address Pending

Lisa Pham, DDSGeneral PracticeOffice Address Pending

Sahar Rodfar, DDSGeneral PracticeOffice Address Pending

Benjamin Sapir, DDSGeneral PracticeOffice Address Pending

Dien Sun, DDSPediatric Office Address Pending


925 N. La Brea Avenue, 4th FloorLos Angeles, CA 90038

CHANGE SERVICE REQUESTED


LADS Continuing Education Course Jan 23, 2018 | Maggiano’s 4:30 - 9pm

California Dental Practice Act and Infection Control

Lygia Jolley, RDH, BA has been licensed as a practicing Registered Dental Hygienist since 1986, and for the past 15 years as a full-time educator for San Joaquin Valley College Dental Hygiene Program in Visalia, California. She instructs the following courses: Radiology, Law and Ethics, Local Anesthesia, Dental Materials and assists in teaching Pre-clinic Lab, and Clinic. She is a Past President of California Dental Hygienists’ Association. She has served as CDHA Immediate Past President, President, President Elect, CDHA Secretary/Treasurer, ADHA delegate, VP of Administration and Public Relations, CDHA Trustee and component president. She taught part-time at Fresno City College as a radiology lab and clinical instructor for 6 years, and practiced dental hygiene in the San Fernando Valley and the Central Valley areas for 17 years. She graduated from the Dental Hygiene program of Fresno City College in 1986, and is a 2004 graduate of Fresno Pacific University where she earned a Bachelor’s Degree in Management and Organizational Development. She has been married for 25 years, and is a Mother of 2 sons and a daughter. In her little bits of spare time she focuses on her family, playing piano and organ, doing church activities, and reading fun books that have nothing to do with dental hygiene, and watching or going to football, baseball or basketball games.

To familiarize attendees with the dental hygiene practice act and regulations which govern the practice of dentistry. This course will review dental practice act of dentists, dental assistants, and specialty categories, registered dental assistant, registered dental assistant with expanded functions, registered dental hygienist, and registered dental hygienist in alternative practice. Attendees will receive the knowledge to help them make correct legal and ethical decisions to solve problems that may arise while practicing dentistry.

The participant will be able to complete the course with a clear knowledge of the regulatory requirements for minimum standards in Infection Control as required by regulation. The participant, upon completion of the course, will possess a clear understanding of the regulations, processes, and procedures necessary to comply with the regulations and will be able to assess their level of learning and mastery of the course content through workplace application.

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