vda journal vol 90 number 2 april, may & june 2013

Virginia Dental JournalVolume 90, Number 2 • April, May & June 2013

www.vadental.org

34 War Zone Dentistry

15 Old Dominion Dental Society Celebrates 100 Years

Stay Connected

In This Issue:

47 Prosthetic Rehabilitation of Palatal Incompetence

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

Thomas A. Conner, D.D.S.

has acquired the practice of

James O. Glaser, D.D.S.

Chesterfield, Virginia

Glen R. Miller, D.D.S.


Thomas C. Roberts, Jr., D.M.D.

Alexandria, Virginia

Sok W. Han, D.M.D.


Mary Gharagozloo, D.D.S.

McLean, Virginia

AFTCO is pleased to have represented all parties in these transactions.

Call 1-800-232-3826 or visit us online at www.AFTCO.net for a Free Practice Appraisal,

a $2,500 value!

AFTCO is the only company that has sold dental practices with a cumulative value of over $1,500,000,000

Contents AprilMayJune2013

on the cover

HEADLINES & ARTICLESPage3 Message from the Editor By: Dr. Richard F. Roadcap

7 Message from the President By: Dr. Kirk Norbo

9 Trustee’s Corner By: Dr. Julian H. “Hal” Fair, III

11-13 Letters to the Editor By: Bluefield College, Dr. Henry Botuck & Dr. Marvin E. Pizer

15 Old Dominion Dental Society Celebrates 100 Years

17-18 Civil Rights Participants Remember Danville’s Night of Infamy By: Katherine Calos, Richmond Times-Dispatch

18 LargeOffice,SmallFootprint By: Dr. William Moore 19 Ethics-DoingWhat’sRight,WhileDoingGood By: John “Jay” Owen, IV

21 Advertising and Public Relations Campaign-Coming Soon By: Dr. Mike LInk

21 MassiveChangesPredictedforDentalBenefitsMarkets By: Dr. Mary T. Dooley

23 TheFourStepsFor“DoneRight”Accountability By: Dr. Rhonda Savage

24-25 ASolidFoundationofPreventionforImprovedOralHealthCare By: Michelle McGregor, RDH, BS, M.Ed.

26-27 NewOralMedicineandOro-FacialPainClinicatVCUSchool... By: Dr. Bhavik Desai, Dr. A. Omar Abubaker and Dr. John Svirsky

27 Student Debt as a Barrier to Care By: Jeremy Jordan

34-35 War Zone Dentistry By: Dr. Elizabeth Taylor Nance

36 Dental Care in Pregnancy By: Sarah Bedard Holland

37 SeventhFreeDentalDayHeldInChester By: Dr. Tony Agapis and Dr. John Agapis

39 VDAServicesVendorsareHeretoHelp By: Elise Rupinski

40 DentistWithGoodHandsHasSonWithGoodFeet By: Dr. Michael Hanley

41 OfficeCultureImpactstheBottomLine By: Dr. James Schroeder

45-46 Pathology Puzzler By: Dr. John Svirsky

47-48 Prosthetic Rehabilitation of Palatal Incompetence By: Dr. Lakshya Kumar, Dr. Kaushal Agrawal, Dr. Saumyendra Singh and Dr. Kamleshwar Singh

55-56 2013Day-On-The-HillSetsStageForGeneralAssembly.... By: Laura Givens

BackCover VDAMemberSpotlight:Dr.DavidBlack By: Dr. Gene Ayers

DEPARTMENTSPage

9 Awards & Recognition

24-27 UniversityConnections

28-33 VirginiaMeeting

36-38 Outreach

42-48 Scientific

49-52 Membership

55-56 Advocacy

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

Thomas A. Conner, D.D.S.


James O. Glaser, D.D.S.

Chesterfield, Virginia

Glen R. Miller, D.D.S.


Thomas C. Roberts, Jr., D.M.D.

Alexandria, Virginia

Sok W. Han, D.M.D.


Mary Gharagozloo, D.D.S.

McLean, Virginia

AFTCO is pleased to have represented all parties in these transactions.

Call 1-800-232-3826 or visit us online at www.AFTCO.net for a Free Practice Appraisal,

a $2,500 value!

AFTCO is the only company that has sold dental practices with a cumulative value of over $1,500,000,000 www.VADENTAL.org | Virginia Dental Journal | APRIL, MAY & JUNE 2013 1

Old Dominion Dental Society annual conference photo. May 1, 1961 Alexandria, VA. Photo courtesy of Dr. Lori Wilson.

2 APRIL, MAY & JUNE 2013 | Virginia Dental Journal | www.VADENTAL.org

REPRESENTING AND SERVING MEMBER DENTISTS BY FOSTERING QUALITY ORAL HEALTH CARE AND EDUCATION.

EDITOR-IN-CHIEFASSOCIATE EDITORS BUSINESS MANAGER

MANAGING EDITORGRAPHIC DESIGN

RichardFRoadcap,D.D.S.,C.D.E.KatieSouthwell,DDS,RebeccaAngus,DDSTerryD.Dickinson,D.D.S.Mrs.ShannonJacobsMrs.ShannonJacobs

EDITORIAL BOARD Drs.RalphL.Anderson,CarlM.Block,CramerL.Boswell,JamesH.Butler,GilbertL.Button,B.EllenByrne,CharlesL.CuttinoIII,CraigDietrich,Dr.WilliamVDougherty,III,FrankH.Farrington,BarryI.Griffin,JeffreyL.Hudgins,WallaceL.Huff,LindsayM.Hunt,Jr.,ThomasE.Koertge,JamesR.Lance,DanielM.Laskin,KarenS.McAndrew,TravisT.PattersonIII,W.BaxterPerkinson,Jr.,LisaSamaha,DavidSarrett,HarveyA.Schenkein,JamesR.Schroeder,HarlanA.Schufeldt,JamesL.Slagle,Jr.,NeilJ.Small,JohnA.Svirsky,RonaldL.Tankersley,RogerE.Wood

VDA COMPONENT ASSOCIATE EDITORS

Dr.RodM.Rogge,Dr.CatherineOdenFulton,Dr.MichaelHanley,Dr.GregoryCole,Dr.WillMoore,Dr.BrittneyC.Ellis,Dr.JaredC.Kleine,Dr.ChrisSpagna,JeremyJordan,VCUD-2015

Dr.KirkNorbo,PurcellvilleDr.J.TedSherwin,OrangeDr.RogerWood,MidlothianDr.StevenForte,RichmondDr.TerryDickinson,RichmondDr.DavidAnderson,AlexandriaDr.AnthonyPelusoDr.MichaelJ.LinkDr.SamuelW.GalstanDr.BenitaA.MillerDr.DavidE.BlackDr.GusVlahosDr.RichardTaliaferroDr.NeilJ.SmallDr.DavidSarrettDr.A.J.BookerDr.RichardF.RoadcapAlexandraBartonDr.RandyAdams

BOARD OF DIRECTORSPRESIDENT

PRESIDENT ELECTIMMEDIATE PAST PRESIDENT

SECRETARY-TREASUREREXECUTIVEDIRECTOR

SPEAKEROFTHEHOUSECOMPONENT 1COMPONENT 2COMPONENT 3COMPONENT 4COMPONENT 5COMPONENT 6COMPONENT 7COMPONENT 8

ADVISORYADVISORY

EDITORVCUD-2013

LIAISON - ODDS

Volume 90, Number 2 • April, May & June 2013

(PeriodicalPermit#660-300,ISSN00496472)ispublishedquarterly(January-March,April-June,July-September,October-December)bytheVirginiaDentalAssociation,3460MaylandCt,Unit110,Henrico,VA23233,Phone(804)288-5750.

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www.VADENTAL.org | Virginia Dental Journal | APRIL, MAY & JUNE 2013 3

MESSAGE FROM THE EDITORDr. Richard F. Roadcap

Themandarinsofpersonalfinancetellustherearetwokindsofborrowing:onebad,theothergood.Theformerincludesdebtassumedtopurchasegoodsandassetsofdecliningvalue,suchascarryingabalanceonplastic,oraloantobuyatwenty-threefootcenterconsoleGrady-White™.Gooddebtisusedtoacquireassetsthatappreciateinvalue,suchasasingle-familyhome,ortopayforeducationneededforaprofessionoracareer.Bothmethodsoffinancingmaybeunavoidable,tomeetthedemandsoflifeandcareer,butonebuildsnetworthandtheotherdestroysit.

Almost every discussion of dental education and career opportunities revolves aroundthesubjectofburgeoningdentalstudentindebtedness.Itcolorsalmosteverydecisiononpostgraduateeducation,practicesetting,andcareergoals.Therearetwofigurestokeepinmind:$200,000and$300,000.Thefirstistheaveragedebtofin-statestudentsatstate-supporteddentalschools.Thesecondisthedebtincurredbyout-of-statestudents.Asreportedinthispublicationbythen-VCUdentalstudentRichardCarlile1,asurveyofhisfellowstudentsin2010revealednumbersapproachingthese,evenifwedon’tadjustforinflation.Theproblemhasbeenwithusforawhile,andshowsnosignsofabating.(Pleasereadinthisissueastudent’sperspectivebyAssociateEditorJeremyJordan.)

It may be easy to rationalize these numbers by assuming these debts can be repaidbyalifetimeofearnings.Thesameexpertsmentionedabovewilladviseyoungadultstogetoutofdebtassoonaspossibleandstartbuildingsavings.Dr.StuartBrothofHermitageWealthManagementtellsmethe(nominal)interestrateonstudentloanstodayissevenandahalfpercent.Withrealinterestrates2 todayhoveringnearzero,andthereturnonmostinvestmentsbarelyabovethat,the difference will insure that borrowers will be many years reducing the principal belowsomepopularbenchmark,suchasthepriceofahome.

Consideralsoretiringdoctorshopingtoselltheirpractice.Arecentgradu-atewith$300,000indebtisnotlookingtotakeonadditionaldebttoacquireapractice.Iexpectbankerstocounterthattheyhavemoneytolend,andbrokerswillsaypracticesarebeingsoldeveryday.TotheseargumentsIwillreplythattheyarecorrect.Butthere’llbeashortageofqualifiedpurchasers,andpracticeswillremainforsaleamuchlongerperiod.Manytransitionspecialistsarenowadvising senior doctors hoping to retire to practice an additional one and a half totwoyears,andthenclosetheoffice,asawayofoffsettingthelackofqualifiedbuyers.3Shuttereddentalofficescreatetheirownaccesstocaredilemma.

And,whatbecomesoftoday’sgraduatingseniors?Mygenerationmoonlightedtopaythebills.Dentalstudentstodaydon’thavethatoption.They’llhavetoseekemploymentwithasalarythatwillsupportdebtrepayment.Startinganewpractice,or“building”apracticeacquiredfromaretiringdoctorisoutoftheques-tion.Theycan’tendureafewyearsofreducedincomebecauseofthedemandsofdebtrepayment.Inthepast,franchises,DMSOs,andothernon-traditionalformsofpracticeownershipmadefewinroadsintothebusinessofdentistry.The rise of corporate dentistry has been fueled in large measure by a growing laborpoolofdebt-encumberedgraduatesinneedofasalariedposition.

1 Carlile R. The Financial Truths of Dental School. Virginia Dent J 2010; 87(1): 17

2 http://www.investopedia.com/terms/r/realinterestrate.asp#axzz2NdUNl2ju

3 Giroux TG. Hire an associate? Long transition? Partnership? Retire? I’m

confused! Dent Econ 2013; 103(2)

Is there any remedy for a process that produces dental couples who graduate with$600,000indebt?It’sunlikelythatthecostofeducatingstudentswilldecline.Technologyandthedemandforbetter-trainedandmoreversatiledentistswillcontinuetoraisecosts.Alreadytherearefewerapplicantstodentalschoolsnationwide,andthecostofaneducationplaysaroleinthis.Perhapsorganizeddentistry,dentalschools,thebankingindustry,andgovernmentpolicymavenscouldconveneasummittoinvestigatethedebtcrisis.Thetestimonyofstudentsandrecentgraduatesneedsalsotobeheard.

Once a year I visit the local middle school to encourage seventh and eighth graderstoconsiderdentistryasacareer.I’vereportedpreviouslyonmyencounters.Mysalespitchisbolsteredbyanearly2000svideo4 of real-life den-tiststalkingabouttheircareers.Onethemeremainsconstantinthevideo:den-tistshavealotofoptionsintheirlife.Teaching,research,privatepractice,andpublicservicearejustsomeofthecareerpathsavailable.Meanwhile,they’reearningagoodincometosupportalifestyletheenvyofmost.I’mfrequentlyaskedbythestudents“Howmuchmoneydoyoumake?”Sofar,they’veneveraskedhowmuchmoneyadentalstudenthastoborrow.Ihopetheydon’t.

4 “Something to Smile About”, DVD. Chicago: American Dental Association.

2005. DVD

FORE! Is your practice up to PAR?Denise Hill, RDH, BS, NSAFriday, April 19, 2013

Virginia’s Prescription Monitoring Program: A Resource for Patient ManagementRalph OrrWednesday, May 15, 2013

Go to www.vadental.org/online_learningfor more information and to register.


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MESSAGE FROM THE PRESIDENTDr. Kirk Norbo

Branding the VDAAtarecentvisittotheGeneralAssemblyaspartoftheVDA“DayontheHill”group,Iwasremindedwhyourassociationfounditnecessarytoadoptapublicrelationscampaign.TheintentofthisprojectisnotonlytodirectthepublictoseekcarefromVDAdentists,butalsogivenamerecognitiontotheVirginiaDentalAssociationanditsmemberdentists.

Icheckedinwithalegislator’sreceptionistandletherknowthatIwasthererepresentingtheVDA.Shelookedatmeinpuzzlement,havingnoknowledgeofwhomIwasrepresenting.AfterIexplainedthatIwaswiththeVirginiaDentalAssociationsheasked“So,whatdoesyourorganizationdo?”Igaveherasmuch information as I felt would answer the question and waited for my appoint-mentalongwiththeVCUstudentswhowereaccompanyingme.ThelegislatorknewexactlywhywewerethereandknewallabouttheVDAreputation(theimportanceofVADPACandknowingyourlegislator).ThereasonImentionthis interaction is to reinforce the direction the leadership of the Association has chosentofollowregardingtheupcomingpublicrelationscampaign.Whilesomeknowwhoweare,therearestillmanywhoneedtoknow.

All of us are aware of how much time and effort has been put into the MOM projects,theDonatedDentalServicesProgramandGiveKidsaSmile®,yettheVDAstillhasmuchworktodotoachievethedesirednamerecognition.Thisstatement is not meant to be critical of our efforts to provide care for the under-served in our state but rather to encourage our efforts to earn more respect for theVDAanditsmembers.Someofyoumayask,“Whydoesitmatter?”

Apathyandmediocrityaretwomajorobstaclesthathinderourquestforexcel-lence.Wealldesiretobepartofanorganizationthatisnotonlyheldinhighesteembutalsohasnamerecognition.TheRubinCommunicationsGroupwillpainttheVDAasanextraordinarygroupofdentists.MyhopeisthatthepublicwillcometoexpectahighlevelofexpertisefromVDAmembers.Thisexpertiseshouldincludebothclinicalskillsandethicalbehavior.Toattaintheexpertisenecessaryforeachofustobelabeled“VDAMember”,theremustbeaconstantsearchtoimproveprofessionally.Wouldn’titbegreattobepartofagroupthathasareputationofbeingexceptional?Thiswouldn’tbeahardgoaltoachieveifweallhadthiscommonvision.Apathyoftenstandsinthewayofachievingthisgoal.Membersarecontinuallyaskingthequestion,“WhatistheVDAdoingforme?”whentherealquestionshouldbe,“WhatcanIdofortheVDAthatwillhelpmeandmyprofession?”Lookforthoseopportunitiestogetinvolved.Eachofyouhavetalentsandqualitiesthatcouldbenefitthegroupandraiseusalltothatexceptionallevel.

Eventhoughthetopicofethicsseemsboringandirrelevanttomanyofus,itisessentialtothecoreofourexistence.Coulditbetruethatthoseofuswithhighethicalstandardsarehappierandsleepwellatnight?IfDr.OzorDr.Philhadresearchthatsupportedthispremise,howmanyofuswouldchangeourlifestylestobemorecontent?WhilethisisonlyspeculationandmembershipintheVDAisentirelyvoluntary,howwouldourimagechangeifthepubliccouldbe assured that none of our members would be accused of Medicaid indiscre-tions,insurancefraud,overtreatmentormisleadingadvertising?OurjobasmemberswillbetomakegooddecisionsthatwillinturnmakeourPRcampaignsuccessful.Dr.LarryCook,adentalethicist,spoketoVCUfaculty,studentsandtheirfamiliesonFebruary22and23.ThedentalschoolhasincorporatedtheMirmelsteinlectureseries,focusedonethics,intotheeducationalexperience

ofitsstudents.Itisimperativethatwecontinuethisthroughoutourprofessionaljourneyifweintendtogaintherespectofourcommunities.

Weareatacrossroadsindentistry,wherethedecisionswemakenowmaydictatethefuturesuccessoftheVDAaswellasourprofession.Ourculturehasadoptedthe“what’sinitforme”mentality.Dentistrymustfocuson“what’sinitforusandourpatients”,ourdentalfamily,ifourchosenprofession is to continue to survive and flourish.PleasejoinmeinmakingtheVDAandourupcomingPRcampaignaresoundingsuc-cess.HelptheVDAandmaximizeyourprofessionalpotentialwhiledevelopingasuperiorbrandforourassociation.

®

MEMBER SAMPLE

VDAF Names Executive DirectorTheVirginiaDentalAssociationFounda-tion,afteranationwidesearch,ispleasedtoannouncethatBethVann-TurnbullhasbeenhiredasExecutiveDirector.ShebeganworkApril1,2013,andwilloverseetheFoundation’soutreachprojects,includ-ingtheMissionsofMercy,DonatedDental

Services,andGiveKidsASmile!®.Herresponsibilitiesincludefundrais-ing,personnelmanagement,grantproposals,andcoordinationwiththeVDAandothernonprofitorganizations.

Ms.Vann-Turnbullbringsaextensivebackgroundinnon-profitmanage-ment.MostrecentlysheservedasExecutiveDirectorofDecaturCoop-erativeMinistry,inDecatur,Georgia.ItsmissionistoalleviateandpreventhomelessnessinthecityofDecaturandDeKalbCounty,Georgia.She’sagraduateoftheUniversityofRichmond,andhasstudiedatHarvardBusi-nessSchoolandGeorgiaStateUniversity.

SheplanstoliveintheCharlottesvillearea.PleaseextendawarmVirginiawelcometoBethatyourfirstopportunity.


Which Brokerage Firm is Truly Looking Out for YOUR Interests When Selling Your Practice?

◆

◆

◆Is it the �rm that has successfully represented sellers for over a decade? YES! NATIONAL PRACTICE TRANSITIONS has represented hundreds of sellers over the past ten years in the sale of their dental practices. We work diligently for our clients to maximize practice value while structuring the sale to minimize tax liabilities, but at the same time creating a fair and equitable transition for the buyers. In fact, we have a 100% success rate post-closing; meaning that we have never had a buyer default or fail. We emphasize to buyers the importance of having separate representation and we work hand-in-hand with their advisors to successfully complete the transaction.

Is it your accounting �rm that also owns a practice brokerage company? NO. �is could be thebiggest con�ict of interest that exists. Sellers look to their accountants for advice asking, “Is the price or taxstructure acceptable?” Will the accountant advise their client against a “bad” deal if a large commission is on the line to their �rm, or to a brokerage company they are partners with or are pro�ting from?

Your Accounting Firm WhoO�ers Brokerage Services?

Is it the equipment/supply companies who are also brokering practices? NO. In most cases, the owner is selling and retiring. �e supply companies want to please the buyer in order to gain or retain their business post-closing. Whatever the terms, their priority is to get the deal done in order to pick up the buyer as a new client, at whatever cost to the seller.

Dental Supply CompaniesWho Also Act As Brokers?

Is it a dual-rep brokerage �rm? NO. You cannot serve two masters. Dual-rep �rms charge buyers he�y fees, and as a result, their strategies usually negatively a�ect the �nal selling price and/or terms the owners agree to when selling. In addition, if a buyer has to choose between two similar practices- where one requires a substantial fee to a dual-rep �rm, and the other does not- which practice and brokerage �rm will they choose?

Dual-RepresentationBrokerage Firms?

[email protected]

National PracticeTransitions sm Amanda Christy

Regional [email protected] x 230

◆We are NOT a dual-rep company.


Trustee’s CornerBy: Dr. Julian H. “Hal” Fair, III, Trustee, ADA 16th District

Otherthanthefinancialstabilityofanorganization,nothingismoreimportanttoitssustainabilitythanmembershipretentionandgrowth.FinancialstabilityandmembershipgrowthareinseparableandtheADAacknowledgesthatmembershipgrowthwillnotoccurwithoutgrowingmembershipvalue.YourBoardofTrusteesandExecutiveDirectorhavemadethissubjectoneofourtoppriorities.ThisissuehasalsobeenamajortopiconDr.CharlesNorman’sPresident-Elect’sConferenceAgenda.

Yearsago,whenDr.GregChadwickwasPresidentoftheADA,heseta75%membershipshareasagoalandtheHouseofDelegatesgaveitsapproval.Wemadesomeprogresstowardthatgoal,butneverquitereachedit.Unfortunately,overthelastsixyears,wehaveseenasteadydeclineinourmarketshare.In2008,ourmarketsharewas70%.Intheyearsthathavefollowed,wehaveseenapproximatelya1%declineeachyear,leavinguswitha66.2%marketshareattheendof2012.Obviously,theADA-theVoiceofDentistry - cannot sustain itself as a viable organization if we allow this trend to continue.

ReversingthistrendisamaindiscussiontopicfortheBOTand,hopefully,willbeamaintopicatalllevelsofthetripartite.Ourtripartitesystemmakesthistopica challenge because each component throughout the country faces different dynamics,problems,andchallengessuchthatthereisnotaone-size-fits-all solution.HowdowegetmembersmoreengagedandexcitedaboutmembershipintheADAsothattheyeagerlyrenewtheirmembershipandworktoattractnewmembers?Membershipvaluevariesamongmembersandbetweenregions.Somemembersvaluenetworkingandcamaraderiewhichcanleadtovolunteerism.Othersvaluecontinuingeducationandallthatgoesalongwithattendingthosefunctions,andothersvaluepublications,groupinsuranceorcreditcardbenefits.ManymemberswilltellyouthatbeingpartoftheADAisallabout advocacy and what the ADA can do to protect and maintain this profession asweknowit.Still,othersjoinoutofasenseofdutyandloyalty.Theproblemwithadvocacyasamembershipvalue,however,isthatwhilemanymembers

appreciatewhattheADAaccomplishesthroughitsprograms,therearemanynon-memberswhoareperfectlycontenttoridethebackoftheADAandenjoythebenefitswithouteverjoiningorsupportingthatwhichsupportsandprotectsanddefineswhotheyareasdentalprofessionals.

Understandingtherealitythatdentistschoosetojoinformanydifferentreasons necessitates our engagement with both current members who may be lukewarmandnon-memberscontenttoenjoytheirfreeride.Past-PresidentDr.RonTankersleyoncesaidwemusttellourstorybetterbecausewehaveanincrediblestorytotell.Inordertotellourstory,wemustengageinone-on-oneconversationsthroughoutourtripartite.

Dr.Norman’sstoryofhisfirstvisitasPresident-Electtoacomponentsocietycanhelpuswithfirststeps.Heaskedtheirleadershiptotakehimtoanofficeofanon-membersothathecouldhaveaone-on-oneconversation.Themeetingwasverycordial.Attheend,Dr.Normanaskedhimwhyhewasn’tamemberoftheADA.Theanswerwasasimpleone.Noonehadeveraskedhimtojoin. Takingthisstorytoheartiseasy,dealingwithever-changingrulesinourfast-pacedworldisnot.WeareincompetitionwithmanyorganizationsandassociationsthatoffervalueandsomeofthesamebenefitsastheADA.Thisisourchallenge:growingmembershipone-on-onethroughengagementbecauseofaconvictionofpurposeforourprofession.AtthePresident-ElectsConferenceinJanuary,Dr.Normansaid,“Theplatformwestandonallowsustonetworkwithothersandformcollaborationsthatmakeourvoicestrongerthanever.”Dr.O’Loughlintoldthegroup,“Now’sthetimeforactionformembershipgrowth….Wehavetomakejoiningeasyfordentists,andweneedtobegreatatinnovatingvaluetogetherascomponents,constituentsandADA.We’vegottobeinthesameboatandrowtogether.Byallofusaligningtoservememberneeds,wecanknockthisoutofthepark.”Let’snottakeanythingforgranted.Let’shelpgrowourassociationtoday.

Member Awards & Recognition

Send your “Awards & Recognition” submissions for publication in the Virginia Dental Journal to Shannon Jacobs, VDA Director of Communications Email: [email protected]

Dr. Terry DickinsonHumanitarian Award

Acedemy of General Dentistry

Dr. Leroy Howell2013 First Citizen

Suffolk/North Suffolk Rotary Clubs

Member Value, Engagement, and Purpose


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LETTERS TO THE EDITOR

Bluefield College Dental School

February 18, 2013

LettertotheEditor:

Dr.KirkNorbo,aNorthernVirginiadentistandpresidentoftheVirginiaDentalAssociation,expressedhisconcernsinanopenlettertothepublicabouthisreservationsregardingthedentalschoolprojectbeingdevelopedbyTazewellCountyandBluefieldCollege.WeregretDr.NorbowasunabletoattendourinformationmeetingheldattheCollegeonJanuary28becausehadhedonesohewouldhaveheardmanyofhisquestionsanswered.Notwithstanding,weap-preciateDr.Norbo’sinterestinthisprojectandwishtorespondtohiscommentsandconcernsinthisforum,theonethathechose.

Dr.Norbostated,“IhaveapersonalexperiencethatmakesmeeitherqualifiedorbiasedinevaluatingtheTazewellprojectasIwasastudentatOralRobertsUniversitySchoolofDentistryfrom1979-1983.”Theschoolopenedin1978andclosedaftereightyearsofoperation.Dr.Norboisconcernedthattheproposednewdentalschoolwillhaveasimilardemise.

WhetherDr.Norboisawareornot,manyissuescontributedtotheclosingofOralRobertsSchoolofDentistry.Thatdentalschoolsignificantlymisseditsen-rollmenttargets.Theschool’senrollmenttargetwas50studentsineachclass,butthefirstclassheldonly25students.Thesubsequentyearsapparentlywerenotbetter,astheschoolhadjustgraduatedapproximately100studentsbeforeitclosed.Additionally,OralRobertsUniversitywasstaggeringundertremendousdebt.Alongwiththedentalschool,theUniversityhadopenedalawschoolandamedicalschool,havingconstructedanewhospital.TheUniversityclosedthemedicalschoolandhospitalaspartofaplantoeliminatea$25milliondebt.NotonlydidOralRobertsclosethemedicalschool,theUniversitycloseditslawschoolanddentalschool,too.TheBluefieldCollegeSchoolofDentalMedicinewillnotbeencumberedwithdebtaswastheOralRobertsschool.Also,basedonthenationaldentalschoolapplicant-per-enrolleeratioof2.8to1.0(asof2010-11,reportedbytheADEA),BluefieldCollege’sdiligenceinrecruitingshouldbesuccessfultoachieveapositivelaunchofourdentalschool.

ThefirstquestionposedbyDr.Norbowaswhetheradentalschoolshouldbeadriverforeconomicdevelopment.Hecontends,“[W]henthefocusofanydentalschoolrevolvesaroundincomeproduction,theprofessionandultimatelypatientcareisinbigtrouble.”Astheplannersofthisnewdentalschoolhavesaidfromthebeginning,thisproject–firstandforemost–willenhancetheoralhealthofchildrenandfamilies,addressingalongstandingprobleminourruralcommunities.Inaddition,weacknowledgethatthisschool,likemanyhighereducationinstitutions,willbeaneconomicdriverincreatingnew,high-payingjobs,stimulatingnewandexistingbusinesses,andservingasacatalystasthefirstentitytoopeninthenewBluestoneBusiness&TechnologyCenter.Finally,thedentalschoolwillprovidegreateraccesstodentaleducation,especiallyforthose throughout Central Appalachia who even now must leave home to acquire thiseducationand,forvariousreasons,oftendonotreturn.And,perhapsyoungpeople in our area who would have never thought about the dental profession willgivetheprofessionconsideration.

Thenextquestionposedwaswhetherstudentindebtednessarisingfrombor-rowingtoattendourdentalschoolwoulddrivegraduatestosuburbanareas.Certainly,adentaldegreeisoneofthemostexpensivegraduatedegreesastu-dentmaychoosetopursue,anddentalstudentshistoricallyhavegraduatedwithconsiderabledebt.The2010surveybytheAmericanDentalEducationAssocia-tion indicated the average amount of outstanding educational loans reported by graduatingdentalstudentsfortheirdentaleducationwas$200,111.Theaver-agedebtupongraduationwasloweratpublicdentalschools($177,040)thanatprivatedentalschools($236,224),mainlybecauseofthetremendousfinancialstatesubsidiesreceivedbypublicschools.

The School of Dental Medicine plans to prepare dentists for a primary care dental practice in rural or otherwise underserved communities and will not have a focus on graduating dentists to enter careers in bench research or dental subspecialties.WhileweexpectsomegraduateswillstayandserveinourruralareasscatteredthroughoutSouthsideandSouthwestVirginia,certainlynotallgraduateswill.GraduateswhohaveaheartforthepeopleinourpartofAppala-chiawilleitherpurchaseexistingpracticesfromretiringdentists,seekemploy-ment in any one of several community health centers that have been unsuccess-fulinrecruitingdentists,oropennewpracticesinareasunderserved.

Withoutquestion,atremendousneedexists.ThevastmajorityoftheCom-monwealthhas65licenseddentistsper100,000residents,butinSouthwestVirginiathatratioisonly33dentistsper100,000–one-halfthestatewidenorm.Inadditiontoattractingstudentswhohaveaheartforservice,wewillbeseekingpartnerstoofferscholarshipsorloanforgiveness,suchasTazewellCounty’sscholarshipcommitmenttograduateswhochoosetoserveinruralcommunities.Otherscholarshipprogramsexisttohelpdentalstudents,includingtheNationalHealthServiceCorpsScholarshipprogram,aprogramthatpaystuition,fees,othereducationcosts,andalivingstipend,inexchangeforatleasttwoyearsofserviceatanapprovedfacilityinahigh-needHealthProfessionalShortageArea.

Soeventhoughthedebtissignificant,andwhiletheschooliscommittedtoseekingopportunitiestoassiststudentsinminimizingdebt,theaverageannualsalaryofdentistsintheU.S.exceedsthatofU.S.pediatricians,familypractitio-nersandgeneralinternists.Werecognize,however,thatadentalpracticeinruralSouthsideorSouthwestVirginiawillnotplaceadentistintheupperearningbrackets.Butjustashundredsofotherhealthprofessionalswhoworkintheseruralareasrepaytheireducationloans,webelievethatthedentalstudentsinsuccessfulpracticeswillfindthatthecareerandprofessionareworththeinvest-ment.

Equallyasimportant,ifnotmoreso,willbethedentalschool’sthird-andfourth-yearstudents,whowillworkwithdentalfacultytorenderoralcareinunderservedareasandtothosewhoareonMedicaid.Ourdentalschool’sclini-calexperiencesthatareapartofalldentalstudents’educationwillnotbeinacentralizedlocation,asisthecaseinmostdentaleducationalprograms.Rather,theywillbelocatedinseveral“builtout”clinicslocatedinruralandunderservedregionsinSouthsideandSouthwestVirginia,andperhapsextendingintoneighboringAppalachianstatesandcommunities.Ourdentalschoolisdesignedtohaveapublichealthresearchfocusandrelyonadispersedclinicalexperi-encethatbenefitsresidentsinruralcommunities,notjustonceayearbutonanongoingbasis.

AnotherquestionraisedbyDr.Norbowas,“Willabrandnewschoolinabeautiful,butruralarea,beabletocompeteascompetitionisfierceandgettingfiercer?”While,anecdotallyspeaking,thiscompetitionmaybetheimpression,

12 JANUARY, FEBRUARY & MARCH 2013 | Virginia Dental Journal | www.VADENTAL.org

thedataspeaksotherwise.TheAmericanDentalEducationAssociationnotesthat,whilenationaldentalschoolenrollmenthasincreasedoverthepast10-yearperiod2001-02to2010-11,thenumberofapplicantshasincreasedevenmore.Enrollmentatdentalschoolshasrisenfrom4,407to5,170(a17percentincrease),butthenumberofapplicantshasrisen,aswell,from7,412to12,001(a62percentincrease).BasedonDATscoresandGPA,theapplicantsappeartobequalifiedandhavethecredentialstobesuccessful.Thus,thesupplyanddemand is quite evident and demonstrates room for a new dental program such astheonebeingdeveloped.Withmoredentistsprojectedtoretireandleavetheprofessionthanthoseenteringitinthenext10years(ADEA),ourdentalschoolwillbemeetingagreatnationalneedinpreparingthenextgenerationofdentalprofessionals.Andfurther,morepeopledesiretopreservetheirdentition,findingextractionsanddenturesalessappealingoptionthaninthepast.Therefore,thedemandforroutinedentalservicesisanticipatedtogrow.

Dr.Norbofurtherasked,“Howfinanciallysustainableisthemodeloverthemid-longterm?”Hebaseshisskepticismaboutthefinancialplanofthenewdentalschool(onewhichhehasnotyetseen)onastudyhereferstoastheUVA-Wisestudy.Infact,therearetwostudiesthathavebeenconductedinrecentyears.OnestudywasbyUVA-Wisetoinvestigatedevelopingadentalschool,andtheotherwasastudybyVCUinvestigatingthecreationofadentalclinicinWiseCounty.Dr.Norboreferstotheclinicandaskswhyitwasn’tdevelopedwhenoffered“freemoney”bytheCommonwealth.TheVCUstudyprojectedstart-upcostsof$2,643,400,whichincludedconstructionofthefacilitiesandtheinstallationofdentalequipmentandofficefurniture.Thestudyfurtherprojectedongoingannualoperationalcostsof$1,041,650,butdeemedtheclinicwouldgeneraterevenueofonlyapproximately$150,000peryear.Thus,thestudyprojectedthat,inordertobreakeven,theclinicwouldrequireaminimalsubsidyfromthestateorprivatefundingof$900,000annually.

ThemodelproposedintheUVA-Wisestudyisnotourmodel.TheCountyisnotbuildingatraditionaldentalschoolsimilartoVCU,astheUVA-Wisestudyproposedandalmosteveryexistingdentalschoolacrossthecountryprovides.Unlikethosemodels,ourplancallsfortheuseofexistingdentalresourcesintheregionsservedinsteadoftryingtoreplicateresourcesthatalreadyexist.OurfinancialmodelissustainableandonethathasbeenemployedbyatleasttwoothersuccessfuldentalschoolsintheU.S.,aswellashavingbeenreviewedbydentalexperts,includingtheCollege’sconsultant,Dr.KarenP.West,deanoftheUNLVSchoolofDentalMedicine.

Whiletouchingsomewhatonpreviousquestions,Dr.Norbo’sfinalquestionwas,“WhatintheUniversityofVirginiastudyshouldbeconsidered?”HethenenumeratedaspectsofconcernraisedintheUVA-Wisestudy,specifically:

1.“Demandfordentalservicesislowduetolackoffundstopayprovid-ers.”WeagreewithDr.Norbo,andweinvitehimandmembersoftheVirginiaDentalAssociationtoadvocatealongwithusonthispublichealthissue.Virginia’sinvestmentindentalservicesforthoseoflowereco-nomicmeansisoneofthelowestinthecountry.That’swhythirdgradersinSouthwestVirginiaare107percentmorelikelytohaveuntreatedcavi-tiesthanistypicalforthirdgradersatthestatewidelevel.Let’sworktochange policies so that we can improve access to dental care for young andvulnerableotherpopulations.

2.“Therecentlyimplementeddentalhygieneprotocolisworkingwell.”WhilethatdentalhygieneprotocolisworkingwelltotheextentthathygieneserviceshavebeenexpandedinSouthwestVirginia,thedatadetailsthatasignificantnumberofchildreninourregionstilllackaccesstodentistsandprofessionalpreventiveandtreatmentcare.

3.“Graduatessettledownwheretheycanmakealiving.”Again,wedon’tdisagree.But,doeseveryoneinSouthwestVirginianeedtomovetoNorthernVirginiaorotherareaswhereonecan“makealiving?”Dr.Norbo now actually is suggesting why a dental school is needed here fromaneconomicdevelopmentperspective.Secondly,prospectivedental students who are solely focused on how much money they will

makeneednotapplyatournewdentalschool.Weseekstudentswhoseebeyondthemselvestoaworldwhichneedstheirservice.

4.“Recruitmentoffacultywouldbeamajorchallenge.”Yes,andthatiswhywewillpaycompetitivesalaries.Thissameargumentwasmadeasthe Appalachian School of Law and Appalachian College of Pharmacy werebeingenvisioned.Facultywhodesiretoliveinlargeareaswithlowcrime,greatoutdooractivityoptionsandlowcostoflivinghavebeensuc-cessfully recruited and retained by both of these successful institutions of highereducation.Secondly,similartothepreviousstatement,prospec-tivefacultywhoaresolelyfocusedonthemoneyneednotapply.Facultywhodocometeachatthisschoolwillfeel,inpart,calledtoserveandliveoutthemissionoftheschool.5.“Southwest,VAisanattractiveplaceforallkindsofbusinessesbutisadentalschoolonofthose?”Yes.WeinviteDr.Norbotocomevisitandseewhy.Infact,aletterwassentlastweektoDr.Norboinvitinghimtovisitthesiteofourfuturefacilityandreviewourplan.

WeareexcitedthatourdentalschoolwilladdressasignificantneednotonlyinSouthwestandSouthsideVirginia,butinothersimilarlysituatedunderservedcommunities.Weareconfidentthatthebusinessplanissoundforthemodeldeveloped.And,wearecommittedtoseeingthisnewschoolbecomeareal-ity.WearedeeplyappreciativeofDr.Norbo’sclosingstatement–“IknowtheVirginiaDentalAssociationandthededicated,loyaldentalpractitionersstandreadytohelpandprovideanyhelpnecessarytomakethebestdecisionpos-sible”–andwelookforwardtopartneringwithhimandmembersoftheVDAinlaunchingthisnewdentalschool.

Sincerely

JamesH.Spencer,III DavidW.OliveCounty Administrator PresidentTazewellCounty,VABluefieldCollege276-988-1202 [email protected] [email protected]

Whatintheworldisthematterwithsomeparents?Whatintheworldisthematterwithsomephysiciansanddentists?Thereisavaccineoutthere(Gardasil)thatwillprevent70%oftheoropharyngeal,anal,penile,andcervicalcancersstemmingfromtheHumanPapillomaVirus,(plusitpreventsgenitalwarts).But,only23%ofgirlsinthiscountry,ages11to17,havebeengiventhevaccine.InAustraliathevaccinationrateforgirlsis70%.

Andwhataboutboys?About8000boysandmendevelopcancerscausedbyHPVeachyear,and6000ofthemareoropharyngealcancers.Andyet,only1%ofboyshavereceivedvaccinations.

Thereisaterribledisconnecthere.AreAustralianparentssmarterthanthoseintheUSA?AreAustralianphysiciansanddentistsmoreconcernedabouttheirpatientsthantheircounterpartshere?AreAmericandoctorsafraidtosaytheword“sex”?HavesomeignorantAmericanpoliticianssoscaredthepopulationthat thousands of people will be getting cancer that could have been saved from thisdreadeddisease?WhathaveYOUdonetocounterthisignorance?Yes,DOCTOR,oralcancerisinyourdomain.

Doinganoralcancerscreeningisanimportantservice,butanevengreaterservice is telling parents how to prevent those cancers from occurring in their childreninthefirstplace.

HenryBotuck,[email protected]

Passing Up the Chance to Prevent Oral Cancer

mailto:[email protected]


LETTERS TO THE EDITOR

Ifyouhavejustcompletedformaltraininginadentalspecialtyandhavedecidedonthecommunityyouwishtoliveandpracticein,thereareapproachesthatleadtoasuccessfulpractice.

• The location:findanofficethatisconvenientforgeneraldentistsaswellasdentalspecialiststoreferpatientstoyou.(Ifpossible,betheonlydentalspecialistinyourspecialty.)Theofficeshouldbeeasilyaccessibletothecommunitybycarorcivictransporation.

• Announcements: thesesshouldclearlystateyourspecialty,phonenumber,addressandespeciallyfreeandavailablespaceforcarparking.Ifanarticleinthelocalnewspapercanbeaccomplished,designateyoureducationandexactlythenatureofyourprofessionalservices.

• Visits: visit as many general dentists as possible and invite them tolunch.Iwouldalsovisitwiththeotherdentalspecialistsandinvitethemaswelltolunchwithyou.

• Professional Society: become an active member of the local dental societyaswellasthestatedentalassociation.Ifthelocaldentalsocietypublishesanewsletter,askifyournameanddentalspecialtymightbeinit.Onceamember,attendasmanydentalprogramsthatareavailable.Ifthereisaguestspeaker,donothesitatetoaskanyquestionsandgentlymakeashortcommenthowthesubjectrelatestoyourspecialty.Thanktheguestspeakerforhisorhercontributionstodentistry.Asyoubecomeactiveyoumaybeaskedtobecomeanofficerinthedentalsocietyorevengiveasmalllectureonyourspecialty.Thisisgoodexposure!

• New patients: when you have a new patient referred by another dentist,callhisofficeandthankhimforthereferralandexplainwhatyoufeelisthecorrectdiagnosisandyourproposedtreatment.Afterthepatienthasobtainedtheresultsyoudesire,Iwouldsuggestthiskindoflettertothereferringdentist:“Yourpatient,Mr./Ms.---hasbeentreatedsuccessfullyandIamreferringyourpatientbacktoyourofficeforyourcontinuedexcellentcare.”Iwouldusethesameapproachwhenthereisaphysicianreferral.

• Other affiliations: it is nice to become a member with your family ofareligious(church,temple,mosque)organization.Thisgivesyouevenadditionalexposuretofellowcongregants.Affiliatingwithacivic organization that engages in charitable deeds also has many advantages.Themembersoftheseorganizationswillquestionwhatkindofdoctorareyou.Thismeansmoreexposuretothecommunity.Asawarning,beawareofanyorganizationthatdiscriminatesagainstotherreligions,races,gender,ornationalorigin.Stayfaraway!!

• Other professional personnel:ifpossiblejointhelocalmedicalsociety.Ifacceptedasanassociatemember,that’sfine.Gotothemedicalsocietymeetingsasoftenaspossible.Familyphysiciansareagoodsourceofreferraliftheyunderstandyourspecialty.Almostallhospitalswillacceptdentiststotheirstaff.GotothemeetingoftheMedicalDepartment(nottheSurgicalDepartment)andyouwillbesurprisedhowmanyphysicianswillreferpatientstoyouroffice.Mostimportant,manyofthephysicianshavetheirlunchinthehospital

Starting and Building a Dental Specialty Practicediningroom.Sitwiththemafterintroducingyourselfandiftheop-portunityarisesexplainyourtrainingandspecialtyandhowitrelatestothegeneralhealthofthepatient.Donotgetinvolvedwhentheyengageinmedicaldebatesormedicalissues.

• Family participation:ifyourspousecarestobesocial,thiscanbeadefiniteadvantagetoyou.Heorshecanjoineitheradental(orevenmedical)auxiliaryandbeasubtleadvocateforyou.

• Your discovery:ifyoushouldfindadifferenttechniqueora“shortcut”fordentistry,publishitinalocalnewsletterorstatedentaljournal.Makereprintsandsendthemtoyourreferringdoctors.

• Office staff:thisisvital.Theindividualwhoanswersthephonecanmakeorbreakapractice.Thispersonmusthaveapleasantvoice,he or she must be intelligent and understand what encompasses your practice.Sheorhemustrevealconcernforthepatient’sanxietyandprofessionalneeds,andmaketheappointmentthatcompatibleforyouandthepatient.Everyoneonyourstaffshouldtreatpatientswithintelligence,kindnessandcompassion.

Icouldgoonbutnowyouhaveanoverwhelmingpracticeandareseekinganassociate!!Goodluck!

MarvinE.Pizer,MA,MS,DDS,FACOMS(hon.)

Formerly:ClinicalProfessorofOralandMaxillofacialSurgery,VCUSchoolofDentistry:AdjunctProfessorofMedicalPhysiology,TheAmericanUniversity,Washington,DC

Virginia Dental JournalVolume 90, Number 1 • January, February & March 2013

www.vadental.org

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39

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Leadership, Policy & Change: How Can They Help Me?

In This Issue:

13 “Cuddles” Dolls Bring Joy to Wise, VA

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& Cover

Correction:Virginia Dental JournalVolume 90 Number 1January-March 2013

Page: 9

Title: An Unusual Com-plication From Oral Surgery...

By: Marvin E Pizer, DDS, MS, MA (Ed.)

Paragraph two should read as follows: He was chairman of Oral Surgery at Howard Harvard Dental School;...


Dr.RandyAdams,alocalPediatricDentistinRichmond,assumed the role as President of the Old Dominion DentalSociety(ODDS)inDecember2012.ThepastPresidentisDr.JimWatkinsofHampton.Dr.Adams

begins his presidency as the ODDS is preparing to celebrate its 100-year anniversary.PlansaretohonortheearlyODDSpioneersbyfocusingonacontinuousmodeltoraisethequalityofthedentalprofession.Dr.Adamsstatesthatoneofhisgoalsaspresidentistoworkwithdentalorganizations,especiallytheNationalDentalAssociation(NDA)andtheVirginiaDentalAssociation(VDA)throughthesecurrentandchallengingeconomictimes.AnotheroneofhisgoalsistoincreasetheODDSmembershipandtomakemembershipmorerelevanttoyoungmembers.

Dr.Adamsalsosupportsmentoringtoothersandinspiringasenseofservicetopullinterestedpeopleintothisgreatprofessionofdentistry.

The Centennial Celebration of The Old Dominion Dental Society was held in NewportNews,Virginia,April13th – 14th,2013.Thismeetingcelebrateda

Old Dominion Dental Society Celebrates 100 Yearscenturyofrichhistory,continuedlearningandfellowship.TheconferencemetattheNewportNewsMarriottatCityCenter,740TownCenterDrive,inNewportNews.

Anall-dayseminaronestheticrestorationswastaughtbyDr.RonJacksonofJacksonProfessionalServices,Ltd.HeistheDirectoroftheAdvancedAdhesiveAestheticDentistryandCompositeArtistryProgramsattheLasVegasInstituteforAdvancedDentalStudies.Thisisarecognizedpost-graduatelearningcenter,wherethelatesttechniquesindentalscienceandtechnologyaretaught.

Intheevening,aformalbanquetcelebratedthe100-yearmilestone.AlsorecognizedwerememberswhohavemadesignificantcontributionstoTheOldDominionDentalSocietyandtothedentalprofession.ThespecialguestbanquetspeakerwasDr.RaymondGist,thefirstAfrican-AmericanpresidentoftheAmericanDentalAssociation.

Please logon to www.OldDominionDentalSociety.orgformoreinformation.

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RandyAdamsrememberstheDanvillejailasmetalandconcrete,nothingassoftasamattressinthesummerthatturnedthetideoncivilrights50yearsago.

Asa17-year-old,hewasamonganestimated600peoplechargedwith1,200offensesduringtheDanvilleMovement,theonlytimethatnationalattentionfoundVirginiaauthoritiesusingthebrutaltacticsoftheDeepSouth.

OnthenightofJune10,1963,Danvillepolicecorralled50demonstratorsinablindalleybesideCityHallandattackedwithnightsticksandfirehoses.Forty-sevenpeoplewenttothehospitalfortreatment. Thatwastheyearthat:

• authoritiesinBirmingham,Ala.,usedpolicedogsandfirehosesagainstnonviolentblackprotestersinMay;

• civilrightsactivistMedgarEverswaskilledinMississippiinJune;

• theRev.MartinLutherKingJr.gavehis“IHaveaDream”speechattheMarchonWashingtoninAugust,withsupportfromhundredsfromRichmondandevenDanville;

• fourblackgirlswerekilledinaSundaymorningchurchbombinginBirminghaminSeptember;and

• PresidentJohnF.Kennedy’sproposedcivilrightslegislationwasstrengthened in response to the summer’s violence and reported outofcommitteetwodaysbeforehisassassinationinNovember.ItbecametheCivilRightsActof1964.

“Therewassomuchviolence,andsomuchoftheviolencewasdirectedagainstyoungchildren,”saidLauranettLee,curatorofAfrican-AmericanhistoryattheVirginiaHistoricalSociety.“Andsomuchwasseenontelevision.ItwokeAmericauptowhatwashappening.

“MuchlikeourrecentNewtownexperience,whenchildrenareinvolveditreallybringsthingshome,”shesaid,referringtotherecentschoolmassacreinConnecticut.“Itreallymakesyoustopandthink,‘Whatarewedoing?’”

RaymondHylton,ahistoryprofessoratVirginiaUnionUniversity,saidthebrutalityandsenselessnessofevents“maywellhaveturnedKennedyfrombeingonthesidelinesandnotwantingtotakehugestepstoavoidoffendingSouthernDemocratstosubmittingthecivilrightsbill.”InDanvillethatsummer,Adams--nowapediatricdentistinRichmond--joinedafamilyeffort.Hisuncle,JuliusAdams,helpedcreatetheDanvilleunitoftheSouthernChristianLeadershipConferencetotakeamoreactiveapproachtodesegregation.

“Ijustrememberwalkingdownthestreet,”Adamssaid.“Wesatdowninagroup.Theycalledthepolicecarsortrucksandputusinandtookustojail.Ialsorememberitwasnonviolent.Ourprincipleatthetimewaswewerenottorespondbacktoanythinganybodydidtous.Iftheyhityouordidanythingelse,youweresupposedtoturntheothercheek.Ittookalotofwillpowerandself-control.”

Adamswasn’ttherethedaythatmarcherswerebeatenwithnightsticksandblastedwithfirehoses,butheheardaboutit.

RuthHarveyCharity,aDanvillelawyer,recalledwhathappenedina1982interview for Southern Exposuremagazine,inwhichsheestimatedthat600peoplewerechargedwithoffensesoverthecourseoftheprotest.TheLibraryofVirginiahascasefilesofmorethan250peopleinitsDanvillecivilrightscollection.Nationallyknownlawyers--includingArthurKinoy,WilliamKunstlerandLenHolt--joinedthelocalgrouptopushforfederalcourtrulingsonconstitutionalrights.

OnJune10,followinguponaMay31march,astudentgroupwenttoCityHall.Leaderswerearrestedandpoliceturnedfirehosesonmembersofthegroup,whoranfranticallyforprotection,Kinoysaidinthearticle.

Thatnight,Charitysaid,“Reverend(H.G.)McGheeledagroupdowntothejail‘toprayforourbrothersandsisters.’Ashestoodup,theorderwasgivento‘letthemhaveit.’Andthe‘NightofInfamy’happened.

“Yousee,therewasanalleybetweenthejailandtheMunicipalBuilding....Thestatetroopershadbeencalledin,andtheylineduptoblockthealleysotherewasnoexit.Thefiretrucksandhoseswerepulleduptotheentrance,thustrappingthepersonswhoweretherefortheprayerservice.

“Whentheorderwasgiven,citypolice,(including)deputizedgarbagecollectors...movedinagainstthedemonstrators,beatingthemandturningonthehoses,washingthepeopledownthestreet,likesomuchtrash.GloriaCampbell(wifeoftheinfluentialRev.LawrenceG.Campbell)receivedsuchahigh-intensitystreamofwater,ittoreherdressoff,andI’msureshestillsuffersfromtheinjuriessustainedthatnight.”

Adams said he couldn’t understand why the group had been treated in such a violentfashionwhenthedemandsweresimplejustice--desegregationofpublicfacilities,equaljobopportunities,andappointmentofblackrepresentativestocityboardsandcommissions.

“AtfirstIfeltverybadbecauseIdidnotunderstandwhyweasagroup(were)treatedthatway,”hesaid.“Itdidn’tseemtomethatitwasasbigadealastheyweremakingaboutthethingswewanted.Itseemedtomeitshouldhavebeensomethingeverybodycouldhaveagreedon.”

Injail,thedemonstratorssangfreedomsongsandprayedwiththeblack

Civil rights participants remember Danville’s Night of InfamyBy: Katherine Calos, Richmond Times-DispatchReprinted with permission from the Richmond Times-Dispatch

Dr. Randy Adams


ministerswhowereamongtheleaders,hesaid.“Irememberussingingandhearingotherpeoplesingingaswell.Ithinkitwasjustthepointofusbeingtogetheranddoingsomethingtopassthetimeand,especiallytheyoungerpeople,tomakethemfeelcomfortableandtoknowtheywerenotalone.”

Hyltonsaid15studentsfromVirginiaUnionwenttoDanvilleonJuly28,continuing a civil rights activism that in Richmond had been successful and peaceful.Holtwroteinhis1965bookabouttheDanvilleMovement,“AnActofConscience,”thatVUUprofessorBen-ZionWardybroughtalongdrug-lacedhamburgerasaweaponagainstpolicedogs.

King,presidentoftheSouthernChristianLeadershipConference,cametoDanvilleonJuly11toshowhissupport.

“IhaveseensomebrutalthingsonthepartofpolicemenallacrosstheSouthinourstruggle,butveryseldom,ifever,haveIheardofapoliceforcebeingasbrutalandviciousasthepoliceforcehereinDanville,”KingsaidinaportionofthespeechrecordedbyaRoanoketelevisionstationandarchivedattheUniversityofVirginia.

“I’msurewewillallagreethatwestandtodayonthethresholdofamostsignificantbreakthroughincivilrights....Youhaveinspiredallofusthroughyourcourageousefforts,yourwillingnesstosuffer,andyourwillingnesstostandupforacausewhichyouknow,andwhichweallknow,isarighteouscause,andonethatwillultimatelytriumph.”

InjusticeinDanville,hesaid,“isathreattojusticeeverywhere.Andaslongasthiscommunityhasproblems,aslongastheNegroisnotfreeinDanville,Virginia,theNegroisnotfreeanywhereintheUnitedStatesofAmerica.”

Lookingatprogressinthe50yearssincethatsummer,Hyltonusedtheanalogyofa100-milejourney.“We’vegottenalittlebeyondthe50-milepoint,butwehaveawaystogo,”hesaid.“There’stremendousimprovement,butwecan’tbecomplacent.Thereisstillmuchtobedone.”

[email protected](804)649-6433

RoanokedentistsDrs.RandyDickey,JohnSingleton,andSeanLynchhaverecentlyopenedanewdentalpractice,whichmayjustbethegreenestinthevalley.ThenewfacilitywasdesignedandbuiltwiththePassivhausdesignstan-dardsforenergyefficiency.ItistheonlydentalpracticeintheworldtomeetthestringentstandardandoneofonlyahandfulofbuildingsinVirginiatoattainthecertification.Thenew5,500squarefootbuildingtookthreeyearstocomplete.Itboasts14operatories,27parkingspaces,sterilizationfacilities,alab,andofficesforeachofthedoctors.

“WeopenedinJanuary,”saidDrDickey.“Ithasbeenalotoffuntofinallybeinournewbuilding.We’reallreallyexcited.”

ThePassivhaus(or“passivehouse”)conceptoriginatedinGermanyinthelate1980s.Theconceptisaseriesofguidingprinciplesandstandardsthatleada

Large Office, Small FootprintRoanoke practice is one-of-a-kind in US, worldBy: Dr. William Moore, Associate Editor, Component 5

buildingtobeultra-efficient.Conceptssuchas“superinsulation”leadthebuildingtobeverythermallyefficientandthusrequireminimalheatingandcoolingascomparedwithaconventionalbuilding.Thebuildingsaredesignedandlandscapedtomaximizeheatgaininthewinteranddeflectheatinthesummer.Thisisdonebycarefullypo-sitioningwindowstomaximizeafternoonsunexposure;thewindowsareconstructedinawayastopromotenetheatgain,eveninthewintermonths.Landscapingisalsousedtodampentheamountofsunreachingthebuildinginthewinter.Thereisafocusonmakingthestructureasair-tightaspossible,asthisleadstolessdemandforheatingandcooling.

“Whentheybuiltthebuilding,theytapedtheframefromtheinsideandoutside,”notedDr.Dickey.“Theythenusedvacuumpressuretocheckthateverythingwassealed.”

Thedentistspurchasedapropertydownthestreetfromtheirexist-ingpracticeandbuiltthenewbuildingfromthegroundup.AdamCohenwithStructuresDesign/Build,aRoanoke-basedarchitectureandconstructionfirm,oversawtheproject.Mr.Cohenhasa25-yearGreenBuildinghistoryandboastsGreenBuilderandLeadershipinEnergyandEnvironmentalDesign(LEED)certifications.BycompletingthePassiveHouseInstituteUStraining,Mr.Cohenbecameoneoflessthan100UnitedStatesdesignerstomeetthecertification.

Whilethepracticeisupandrunningatfullspeed,thereisstillalotofunpackingtobedoneandtheofficeisstillsparselydecorated.Dr.Singletonisplanningonusinghisloveofphotographytofurnishtheofficewithsomeofhisbestpieces.TheenergysavingsfromthePassivhausdesignareexpectedtopayforthem-selveswithintenyearsduetoreducedenergycosts.

Continued from page 17

Tooth#30(MO)hasbeenpreppedtoreceiveacompositerestoration,checkedoffanddeemedrestorable.Compositeislayeredintothemesialboxattheperfect angle and cured to allow optimal integration between the tooth and the bondingagent,aswellastoensureperfectdepthofcureandminimizeleakageassociatedwiththerestoration.Thepulpalfloorontheocclusalaspectisfilled,themarginalridgegivenidealanatomy,andcareistakentoplaceadistinctcentralgrooveandaccessoryanatomyallowingperfectfooddeflectionduringmastication.Aftercuring,therestorationispolishedandsentforgrading.

Nextonthelist-#10ML.Anidealpreparationwascompletedwithretentivefeaturesandanestheticbevelplacedsothecompositewillblendrightin.Myloupeswereremovedtorestmyeyesandadmiremywork,onlyinsteadofrelief,panicsetin.Sitting,lookingmedeadintheeyes,wasatesttooth–Ihadcompletedmyworkonmypersonaldentoformtoothandnottherequiredandspeciallymarkedtesttooth.Myimmediatethoughtwas,“…thisisridiculous…,”then,accompaniedbytachycardia,cametherushofself-preservationthoughts:“Icanjustre-prepthetesttoothandnoonewillknow.”Instead,Idecidedtoconfronttheprofessor,admitmymistake,andtakethefailinggradeonmymockboards.Failingwasnotonlygoingtomeanlossofapassinggrade,butalsoseveralclinicsessionstomakeupthefailedwork.Intheend,Imadethecorrectdecision:Iwasabletoacceptmymistake,freemymindofburden,andIevenlearnedsomethingduringtheprocess.

Whatwouldyoudointhiscase?Haveyoueverpreppedorextractedthewrongtooth?Damagedanadjacenttooth?Seatedacrownwithoutoptimalmarginsbecausethecementwill“closethespace”?Startedatreatmentwithoutaproperorcompletediagnosis?Whentheseethicalsituationsarise,itishardtomakethecorrectdecisionandtellthepatientwhatwehavedonebecause,“…theywillneverreallyknow.”Asdentists,orinmycase,dentalstudent,weworkinaprofessionthathasbeenestablishedbasedontrust.Patientsdonotunderstand

Ethics: Doing What’s Right, While Doing GoodBy: John “Jay” Owen, IV, VCU School of Dentistry, Class of 2014

John “Jay” Owen, IV is in the class of 2014 at the VCU School of Dentistry and is a member of the VDA Ethics Committee.

thecomplexityofthedentalproceduresandcannotseetheresults,butrelyonusto do the correct thing – both ethically and professionally.Itisimportantthatwe,asaprofession,continuetooperateinanethicalfashionandbuildtherelationshipoftrustwithlongtimeandnewpatients.Weneedtorememberthatrapportbasedintrustwillbefarmorebeneficialthannotredoingarestorationorprovidingafreefixforthedamagedadjacenttooth,eveninthoseproceduresthatrunoverintolunchoradatewiththewife.

Inthecurrentstateofaffairsandchangesinsocietynorms,ethicshastakenonanewconnotationandisnotbasedoncommonbelief,butratherbasedonsituationalcircumstances.Itisourjobtomaintainunityinthoughtandpracticeaboutwhatisprofessionallyethicalsofuturedentists,likemyclassmatesandme,canenjoytheworldofdentistryasthosewhocamebeforeus.Eveniftheproperandethicaldecisioncomeswithalosstoourfinancialbottomline,ourpersonalcofferswillbefilled.Thisyearisagreattimetocleanourslatesandworkasafamilytobettertheprofessionweallpledgedtoprotect.

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DENTAL PRACTICE TRANSITIONS

Approved PACE Program ProviderFAGD/MAGD CreditApproval does not imply acceptance by a state or provincial board of dentistry or AGD endorsement4/1/2012 to 3/31/2016Provider ID# 302387

Your local PARAGON practice transition consultants are Kim Anderson, D.D.S. and Paul Martin.Contact them at 866.898.1867 or [email protected].

THE PARAGON DIFFERENCE

After handling thousands of transactions over the past two decades, PARAGON consultants know that no two clients and no two transactions are the same.

A practice transition is a very personal event that requires very special attention. Nothing is taken for granted. We customize every single transaction to satisfy the needs and goals of our clients. We handle each transaction as if we are the client. This is just one of the many reasons why PARAGON is so unique.

Judge for yourself! Call us for a complimentary consultation. No obligation…just a very worthwhile education!

C

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CM

MY

CY

CMY

K

VA-MAR-2013.pdf 1 3/3/13 8:31 PM


In-Office Anesthesia is Ideal for: • DentalPhobicPatients(Fearful)• PatientswithSpecialNeeds• UncooperativePediatricPatients• MedicallyCompromisedPatients• PatientswithExtensiveDentalTreatments• PatientswithGagReflex

NOVA Dental Anesthesia provides In-Office Sedation/General Anesthesia for Pediatrics and Adults by our Hospital-Trained Dentist Anesthesiologist. We want to make your patient’s experience as safe and pleasant as possible. The level of sedation may be customized to the needs of the dentist and the desires of each patient within the familiar surroundings of your office. IV Sedation/General Anesthesia allows the dentist to devote complete attention to the dental procedure and to be able to schedule other appointments after completion of anesthesia facilitated procedures.

Wissam F. Ali DMD (703) 672-6919 Dentist Anesthesiologist [email protected]

ENROLL YOUR PRACTICEIN SPRING TRAINING

Proud to be working with

An Company

800.210.0355demandforce.com/vda

Join the winning team: ensure your

practice is a part of the Demandforce Network

Learn how Demandforce can:

Swing your online reputation in the

right direction to attract new patients

Up your batting average: reach your

patients more effectively through email

and text

Keep your bases loaded: reduce your

no show rate

Demandforce


Want a healthy body?

Start with a healthy mouth.

Every member of your

household should visit a VDA

dentist every six months.

®

The rule of thumb, see your dentist every six months,

has not changed. During the visit, your dentist or

dental hygienist will check for tooth decay, evaluate

the health of your gums, and examine your mouth for

any signs of conditions such as oral cancer, vitamin

deficiency and diabetes. They may also study your bite

and movements of your lower jaw joints and perform a

head and neck examination for any abnormalities.

Plaque and tartar buildup, which happen between

visits, are always on your dentist’s radar screen. If not

removed, they can harden on the teeth and irritate the

gum tissue, which can lead to gum disease.

Your dental professionals

can be valued members

of your family’s total

healthcare team. Their

training and attention to

signs of trouble can help

identify or even prevent

potential medical

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3460 Maylan

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VADental.org

MAKE THE APPOINTMENT.

AND KEEP IT.

®

12447.1 VDA Brochure for PrintREV.3-6.indd 1

3/6/13 9:47 AM

ThePRTaskForceiscontinuingtoworkdiligentlyonthe2013advertisingandPRcampaign.Thecommercials will begin to air in the second quarter of2013andthewheelsarealreadyinmotion.TheHealthyBody,HealthyMouthcampaignwillincor-poratetelevisionadvertisements,publicrelationsefforts,awebpresence,printedcollateralpiecesandsearchenginemarketing.Thecampaignwillbedirectedatconsumerstoletthemknowthata healthy mouth is an integral part of a healthy body.Consumerswillbedirectedtovadental.orgtofindaVDAMemberdentisttoprovidetheirdentalcare.TheVDAwebsiteiscurrentlyberedesignedforthiscampaign.

Priortotheadsairingontelevision,allpractic-ingVDAmemberswillreceivealargesupplyofbrochures.Thesepieceswillbereflectiveofthe advertising campaign and will be a great way to continue the conversation with your patients and your community about the new campaign.PleasebeonthelookoutthisspringforapackagefromtheVDAwithyourbrochures.

Asthefinalpreparationsforthecampaignarecompleted,nowisanexcellenttimetobesurethatyour

practice website is up to date and ready for potential new patients who will be lookingyouuponline.Itisalsoagreattimetocheckoutyouroverallonlinepresence.VDAServiceshastwoendorsedvendorsthatareheretohelp!

Advertising and Public Relations Campaign -- Coming Soon!By: Dr. Mike Link, Chair, PR Task Force

Dr. Michael Link, a general den-tist practicing in Newport News has served on the VDA Board of Directors for the last four years. He is the chair of the PR Task Force. Dr. Link can be reached at [email protected]

Also,don’tforgetthatasmembersyoucandownloadthenew‘VDAMember’logofromvadental.org/logo to use on your website andtoletpatientsknowthatyouareaVDAmember.

ThisisaveryexcitingtimefortheVDAas we reach out to the public about the importanceofmaintainingtheiroralhealth.Thankyoutoallmembersforyoursupportofthiscampaign!

ProSites (prosites.com/vda)offersVDAmembersa25%discountonwebsitedesignservices.

Demandforce (demand-force.com/vda)isofferingto waive their set-up fee for allVDAmemberdentists.

Demandforcecanhelpyourpracticewithmarketingandcommunicationswithyourcurrentpatients,gatheringonlinesurveysandenhancingyouronlinepres-ence.

®

MEMBER

SAMPLE

ENROLL YOUR PRACTICEIN SPRING TRAINING

Proud to be working with

An Company

800.210.0355demandforce.com/vda

Join the winning team: ensure your

practice is a part of the Demandforce Network

Learn how Demandforce can:

Swing your online reputation in the

right direction to attract new patients

Up your batting average: reach your

patients more effectively through email

and text

Keep your bases loaded: reduce your

no show rate

Demandforce

The National Association of Dental Plans is preparing for dental marketstoshiftdramaticallyfroman employer-based to a direct-to-consumermodel.Aseminarpresented last November by

Careington Dental Solutions discussed many trends which are driving this change.Duetohealthcarereform,largecompaniesaremovingemployeestoprivateexchanges.Employersareincreasinglyofferingonlyvoluntarydentalbenefitswhichmanywillnotpurchase,whileotheremployersaredecreasingtheircontributionstoemployer/sharedfundedplans.Theystated that dental insurance premiums are increasing faster than medical premiums,andthatthenumberofDPPOsisincreasingasdentalindemnitydecreases.Retiringbaby-boomers,estimatedat44million,willlosetheiremployer-fundeddentalbenefits.Increasingawarenessoftheneedfordentalhealthisexpectedtoleadtoademandforaffordableplans.

ThenumberofAmericanswithoutdentalinsuranceisprojectedtogofrom133millionto221million.This seminar presented their best products for this direct-to-consumer market,andhowtopromoteit.Theyofferedthefollowingsolutions:Dis-countplans,Hybridplans,Affordableindividualproducts,FlexibleSavings

Massive Changes Predicted for Dental Benefits MarketsBy: Mary T. Dooley, DDS, Chairman, VDA Dental Benefits Committee

Accounts,Pre-paiddebitcards,PlansforretireesandthoseonMedicare,PediatricwithDiscountAdultplan,andBundlingDentalwithotherhealth-relatedproductsandtravelandleisure/financialservices.

Anexamplemodelforavoluntaryemployerwithminimum20%enrollment,combinessomeinsuredbenefitswithdiscounts on non-covered services.AnAffordableIndividualproductexamplewouldre-price a porcelain crown to$660dentistfee,insurancewillpay$450andout-of-pocketwillbe$210.AHybridplanwouldreducebenefittoonly$100andincreasepatientoutofpocketto$560.Hybrid example #2 would re-price the dentist fee of $240 for an exam, 4BWX and prophy to $120, with a plan benefit of $100 and patient cost of $20.

Toseekandcreatepositivepressisthenumberonestepinthepromotionplan.PositivepressisbeingcreatedonlinewhereBrighter.com compares “dentistfees”andreputationswithaccesstodiscountnetworks.Dental-Plans.comandiDental.comalsooffermanydifferentplanssaidtobespecifictoyourzipcode.Ifyouhavenotheardoftheseplansorsites,ordon’tknowmuchofwhattheypropose,please take a couple of minutes to review online what they have in store for your zip code. I believe it is important toknowthedetailsofwhatothersareplanningforus.


800-300-3046 x4519 (new enrollment) 800-859-9975 (already enrolled)

carecredit.com/dental

Mention: VDA

And that’s what they’ve been telling us, for 25 years.

The idea’s a simple one: Let’s make it easier for families to get the care they want.

Let’s make it easier for them to get it now – without delaying.

And let’s give them options on how to pay for it.

Let’s keep making care possible … today.

If you’ve got a good idea, people will tell you.

Good Idea_VDA_031913.indd 1 3/19/13 12:16 PM


Articles of Interest

Everyjobinthedentalpracticeisimportant.Thedentalteamfeelsempow-eredandencouragedwhentheyaregivenresponsibility.Andwithresponsi-bilitycomesaccountabilitytotheteam,thedoctor,thepractice,andpatients.Accountabilityisoftenviewednegatively,asifit’sjustawaytopointafingeratsomeonetoblameorhighlightfailure.Butaccountabilitydonerightisexactlytheopposite.Itisasystemwithinthepracticethatgivestheteammembersthetime,tools,andtrainingtheyneedtosucceed.Therearefourkeystepstoaccountabilitydoneright:

Step #1: Sole Responsibility. Foreachspecificjob–recare/recall,scheduling,orderingsupplies,etc.–onepersonisputinchargeandisclearontheex-pectationsandthetrainingneededtoaccomplishthetask.It’sagoodideatoputexpectationsinwritingsotherearenomiscom-munications,andexpectationsshouldincludebothmeasureablegoals(suchaspastdueaccountbalances)anddesiredbehavior.Forexample,yourgoalcouldbetoreduceA/Rtolessthan5%ofproduction,withthebehaviortomakeuseofapatientfinancingcompanylikeCareCredit.

Step #2: Time. Clearlydefinedtimeisscheduledfortheteammembertoworkonthejob.Ifnot,it’salmostguaranteedthejobwillnotgetdone.Thismeansthatif,forexample,wewantthepersoninchargeofrecallandreactivationtomakecallsTuesday,Wednesday,andThursdayfromtwotothreeintheafternoon,thenthatpersonisnotalsotryingtojuggleansweringin-boundphonecallsorpatientcare.

Step #3: Due Date. Eachjobshouldhaveanon-negotiablecompletiondate.Thedatecouldbemonthsaway,laterthatdayoranongoingeventscheduledonthecalendar.Forexample,recareandreactivationreportsonthedoctor’sdeskthefirstworkingdayofeachmonth.

The Four Steps For “Done Right” AccountabilityBy Dr. Rhonda Savage

Step #4: Follow Up. Whenyoufollowup,thedoctorhastheopportunitytopraiseandappreciatewhattheteammemberdid.Dailycoachingisabigpartoffollow-up.Creatingacultureofcoachingisoneofthewaysyoucanmakechangestickanditcanbedoneinmanydifferentways.Indailycoachingitisabouthelpingtheteamalongthepathofsuccess.Ifsomethinggoeswrong,takeadeepbreathandchoosethebesttime to discuss the situation with the team member in a way that is productive.

Onegreattechniquethatcanmakedailycoachingeasieristhe“feel,felt,found”techniquethatclearlystatesintention.Thisishowitworks.Let’ssayyouhavetwoteammemberswhoseemtobicker,eveninfrontofpatients.Thecoachingmightgosomethinglikethis:

AliceandLinda,Ifeelwehaveacommunicationchallengeandit’saffectingthesuperiorlevelofpatientcareweasateamarecommittedtoproviding.Whenyouwereinconflictinfrontofourpatienttoday,Icouldtelltheyfeltuncomfort-able,andIdid,too.Ihavefoundthatthebestwaytokeepourpracticeandteamhealthyistodiscussanyissuesbetweenteammembersprivately.Itismyintentiontoalwaysprovideourpatientswithacomfortable,welcomingandwarmenvironment,andbothofyouareanimportantpartofthat.Sointhefuture,pleasedonotargueinfrontofpatientsagain.

Accountability done right is:

• Puttingonepersoninchargeofatask• Givingthetimeandtrainingtosucceedbyaspecificduedate• Givingappropriateandencouragingcoaching

Thiswillensureapositiveimpactontheteam’smorale,patientcareandthepractice’shealth.

Dr. Savage started her career in dentistry in 1976 as a dental assistant. After graduating Cum Laude from Seattle University and then with honors from the University of Washington School of Dentistry, Dr. Savage spent almost two decades in private practice and also as an active duty dental officer in the U.S. Navy during Desert Shield/Desert Storm. Today, Dr. Savage is CEO for Miles Global, an internationally known and well-respected practice management and consulting firm exclusively serv-ing dentists. Dr. Savage can be reached at [email protected]


University Connections

Dentalhygieneisoneofthefewhealthcareprofessionsbasedexclusivelyonpreventivecare.Theprofessionwascultivatedintheearly1900sbyavisionarydentist,Dr.AlfredC.Fones,whograspedthesignificanceofpreventiontoavertordecreasetheseverityofdentaldisease.Atatimewhenextractingteethwasthecommonpracticeofdentistry,Dr.Foneshypothesizedthatremovingthe“stickyfilmandbacteria”fromtheoralcavitywouldreducedentaldisease.Hewentagainstthegrainandin1906trainedhisassistant,IreneNewman,asthefirstauxiliarytoscaleandpolishteethandcoinedtheterm“dentalhygienist.”1 The scope of dental hygiene care and delivery of preventive oral health care servicescontinuestoevolve.SinceDr.Fones’stime,agreaterunderstandingofthe cause and effect of oral bacteria in relation to oral and systemic health has beenrealized,resultinginimprovementsinpreventionmethods.Oralhealthislinkedtocardiovasculardisease,prematurebirth,poorbirthoutcomesanddia-betes.Additionally,thereisanincreasedriskfordevelopinggingivitisandperi-odontaldiseaseamongolderadultswhomaybediabeticand/ortakingcertainanti-hypertensiondrugs.2 Periodontaldiseasecanleadtoosteoporosis,renaldysfunction,immunodeficiencydiseases,environmentalimmunosuppressionanddiabetes.3 Improved oral health through prevention methods can reduce disease and lessen the economic burden of treatment by providing essential dentalcarewiththepotentialofdecreasingotherhealthrisksorsystemiccondi-tions.Asthecountryfaceshealthcarereformsanddisparitiesinaccesstooralhealthcarecontinuetorise,thedeliveryoforalhealthcaremustevolvetomeettheneedsofthepublic. “2001OralHealthinAmerica:AReportoftheSurgeonGeneral”outlineschal-lenges to improving oral health and recommends a focus on prevention and producinghealthratherthanrestoringhealth.Itfoundthatthecurrentworkforceisnotmeetingtheneedsofallpopulations.Tenyearslater,“2011OralHealthinAmerica:AReportoftheSurgeonGeneral”continuestoemphasizeprevention,improvementofpublicknowledgeandbehaviorsandpolicytoimproveoralhealthoutcomes.4

A Solid Foundation of Prevention for Improved Oral Health CareBy: Michelle McGregor, R.D.H., B.S., M.Ed., Assistant Professor and Director of Dental Hygiene Program, VCUSchoolofDentistry

Rootedinpreventionandeducationofpatients,dentalhygienistsarepoisedto be on the front lines serving the oral health needs of our communities in responsetotheSurgeonGeneral’sreport.Tomeettheseneeds,modelsoforalhealthcaredeliverymustevolve.Theemergingtrendindentalhygienecareisdirect access to the patient resulting in the hygienist providing preventive ser-vicesdirectlyforpatientswithoutseeingthedentistfirst.Directaccesstodentalhygieneservicescanbeaccomplishedthroughexpandedlevelsofsupervisionoremergingworkforcemodelswithinaspecificscopeofpractice.Currently,35stateshavelegislativepoliciesthatallowdirectaccessservicesbydentalhygienists.5 The direct access model allows patients to access services provided by dental hygienists without a prior visit to or authorization from a dentist.Theframeworkforthesenewmodelsofsupervisionexpandingpermis-sibleoralhygieneservicesisindividualtoeachstate.InVirginia,apilotprogrambeganin2009toaddressoralhealthcareinunderservedareas.TheGeneralAssembly passed legislation for the pilot program that allowed dental hygien-



istsemployedbytheVirginiaDepartmentofHealth(VDH)toprovidepreventivecareinspecifieddentallyunderservedareasinSouthwestVirginia.Thepilothashad impact and demonstrates improvement in oral health care services across theCommonwealth. In2012,“remotesupervision”wasadoptedbytheGeneralAssemblyasthestandardofcareandextendedtotheentireCommonwealthofVirginia.Asmanyas20states,excludingVirginia,maybeconsideringoralreadyhaveimplementedorpilotedneworalhealthworkforcemodels.TheAmericanDentalHygienists’Association(ADHA),theAmericanDentalAssociation(ADA)andthefederalgovernment(e.g.IndianHealthService)allhavesupportednewformsoforalhealthprofessionalworkforcemodels.Suchmodelsincludetheadvanceddentalhygienepractitioner(ADHP),thecommunitydentalhealthcoordinator(CDHC),dentalhealthaidetherapistsandarangeofdentaltherapistmodelssimilartothoseinNewZealand,Canada,GreatBritainand,mostrecently,Minnesota.

Currently,thereisnoprotocolformid-levelprovidersinVirginia.Asthistrendcontinuesandoralhealthcaredeliverytransforms,educationalinstitutionswillneedtopreparefuturepractitionerswiththeappropriateknowledge,skillsandattitudesforsafeandsuccessfulpatientoutcomes.Theeducationalqualitymustalignwiththescopeofpreventiveservicesrequiredforthesenewroles.

TheDentalHygieneProgramatVirginiaCommonwealthUniversity(VCU)wasinitiatedin1969asanintegralcomponentoftheVCUSchoolofDentistry.Today,dentalanddentalhygieneprogramsworkcollaborativelytomeetthedevelopingneedsoforalhealthcaredeliveryandpatients.TheDentalHygieneProgramatVCUresidesintheDepartmentofOralHealthPromotionandCommunityOut-reach.Thisdepartmentisresponsibleforthecoordinationofpreventionactivitiesandservicesforthepublic.AstheonlydentalhygieneeducationprogramintheCommonwealthofVirginialocatedwithinadentalschool,VCU’sprogramoffersstudentsastate-of-the-artlearningfacilityandexposuretoinnovativefacultyandcutting-edgetechnologyinaprofessionalnetworkingenvironment.TheDentalHygieneProgramandDentalProgramatVCUprovideaUniversity-designatedservice-learningcoursetostudents.Service-learningasacoursecombinesclassroominstruction,reflectionandcommunityservice,promotingcivicrespon-siblyandcommitment.Studentsexperiencetheimportanceofcollaborationwithotherhealthcareprofessionalsandparticipateininterdisciplinarycare.Theseex-periences prepare dental hygiene students to collaborate with other oral health careprovidersandaugmentrelationshipswithotherhealthcaremembers.

ThisyeartheAmericanDentalHygienistsAssociation(ADHA)celebratesits100thanniversaryasaprofessionalorganization.Dentalhygienistsservemanyrolesincludingadvocate,educator,researcherandclinician,butthefocussince the early 1900s has remained on promotion of good oralhealththroughprevention.

1. Milling,LaurieA.RDH,BS.A Grand History. RDHMagazine.Retrieved2-6-2013at:http://www.rdhmag.com/articles/print/volume-30/issue-7/features/a-grand-history.html2. ShibukawaY,FujinamiK,YamashitaS.Clinicalcase report of long-term follow-up in type-2 diabetes patient with severe chronic periodontitis and nifedipine-induced gingivalovergrowth.BullTokyoDentColl.2012;53(2):91-93. Garcia,R.I.,Henshaw,M.M.andKrall,E.A.(2001),Relationshipbetweenperiodontaldiseaseandsystemichealth.Periodontology2000,25:21–36.doi:10.1034/j.1600-0757.2001.22250103.x4. U.S.DepartmentofHealthandHumanServices.OralHealthinAmerica:AReportoftheSurgeon-General,Rockville,MD:U.S.DHHS,NationalInstituteofDentalandCraniofacialResearch,NationalInstitutesof

Health,2011.AccessedJanuary25,2013at:http://silk.nih.gov/public/[email protected]

5. AmericanDentalHygieneAssociation.Advocacy,DirectAccess2013.AccessedFebruary20,2013at:http://www.adha.org/resources-docs/7524_Direct_Access_Map.pdf

Michelle McGregor, RDH is an Assistant Professor and Director of the Dental Hygiene Program at the VCU School of Dentistry. For more informa-tion on the Dental Hygiene Program at VCU, please contact Michelle McGregor at [email protected]

http://www.rdhmag.com/articles/print/volume-30/issue-7/features/a-grand-history.html



http://www.adha.org/resources-docs/7524_Direct_Access_Map.pdf

http://www.adha.org/resources-docs/7524_Direct_Access_Map.pdf



The incidence of oral mucosal lesions in the general population ranges between 12%and85%acrossdifferentpartsoftheworld(1-3).Earlydetectionoforalmucosaldiseasesisassociatedwithincreasedpatientcomfortand,insomeinstancessuchasheadandneckcancers,earlydetectioncanresultindecreasedmorbidityandmortality(4).Patientknowledgeaboutoralcancerhasbeenfoundtobelacking,buttheyhavebeenfoundtobereceptivetotheideaofperiodicoralcancerscreeningasapreventivemeasure(5).Similarly,chronicoro-facialpainisassociatedwithsignificantcompromisesinthequalityoflifeaswellaswithpsychologicalco-morbidities(6).Thereisasignificantpopulationofpatients locally and in the Commonwealth who suffer from various types of oro-facialpain,TMDsymptoms,andoralmucosalandmucocutaneouslesions,aswellasexhibitoralmanifestationsofsystemicdiseases.

TheDepartmentofOralandMaxillofacialSurgeryatVirginiaCommonwealthUniversity(VCU)SchoolofDentistry,incollaborationwiththeDepartmentofOralPathology,hasrecentlyestablishedanOralMedicineClinicwithintheDentalFacultyPrivatePracticeattheVCUSchoolofDentistry(Dentistry@VCU).Facultyfrombothdepartmentswillserveasattendingpractitionersforthisclinic.The Oral Medicine Clinic was established after identifying unmet oral health needsinthegreaterRichmondareaandacrosstheCommonwealthofVirginiaandtoestablishtheVirginiaCommonwealthUniversitySchoolofDentistryasavenueforprovisionofcomprehensivedentalandoralhealthcare.

TheAmericanAssociationofOralMedicinedefinesOralMedicineas“thediscipline of dentistry concerned with the oral health care of medically compromised patients and with the diagnosis and non-surgical management ofmedically-relateddisordersorconditionsaffectingtheoralandmaxillofacialregion.”OralmedicineexistsasadistinctdisciplineinseveraldentalschoolsacrosstheUSAandinternationally,offeringbothpatientcareandeducationaltraininginthisdiscipline.OralMedicineisalsoofferedasaCODA-certifiedresidencytrainingprogramineightuniversitiesandhospitalsintheUnitedStates.

Withinthescopeofanoralmedicinepractice,patientswithoralmucosaland mucocutaneous diseases and oral manifestations of systemic disease areevaluatedandmanaged.Someofthecommonconditionstreatedbyan

New Oral Medicine and Oro-Facial Pain Clinic at VCU School of DentistryBy: Bhavik Desai, DMD, PhD; A. Omar Abubaker DMD, PhD; and John A Svirsky, DDS, MEd

oralmedicineproviderinclude,butarenotlimitedto,orallichenplanus,oralcandidiasis,leukoplakia,melanoticandpigmentedorallesions,andburningmouthsyndrome.Patientssufferingfromchronicoro-facialpainconditionssuchastemporomandibularjointdisorders,discderangementsandmyofascialpain,as well as neuropathic pain disorders including trigeminal neuropathies and atypicalfacialpainarealsomanagedinoralmedicine.

Patients with any of the above conditions will be seen in the newly established VCUOralMedicineClinic.Patientswhomayneedabiopsyoftheirorallesionsafter a tentative diagnosis has been made can be promptly referred to their outsideoralsurgeonsortotheOralandMaxillofacialSurgeryPracticeattheVCUSchoolofDentistryforsuchabiopsy.Patientswhohavehadpriorbiopsiesand need re-evaluation and follow-up care or periodic assessment of their condition(precancerousandnon-precancerousconditions)canalsobeseenattheoralmedicinepractice,aswellaspatientswithproblemsrelatedtoradiationtherapyandchemotherapy..Detailedevaluationandnon-surgicalmanagementoftemporomandibularjointdisordersarealsoperformedinthisclinic.Patientswho do not respond to conservative therapy can be referred for surgical intervention,ifdeemednecessary.

InadditiontoprovidingpatientcareintheOralMedicineClinic,thefacultyalsocontributes towards an important educational component of healthcare needs thatisnototherwiseidentifiedinthedentalcurriculum.Dentalstudentsandpost-doctorateresidentsattheVCUSchoolofDentistrywillrotatethroughtheclinicforexposuretopatientswithoralmedicineproblemsandorofacialpain.Theintegration of dentistry and medicine within the scope of oral medicine equips graduatingdentalstudentswiththeknowledgetofacediagnosticchallengesinanageingandincreasinglymedicallycomplexpatientpool.Itinvolvesrecognition,diagnosisandmanagementoforalmucosaldisease,oro-facialpainanddentalmanagementofmedicallycomplexpatients.Oralmedicinetrainingofgraduating dentists can help the graduates learn how to manage at least some ofthosepatientswithchronicoro-facialpain,includingtemporomandibularjointdisorders,andidentifythosepatientsinneedofreferral,whennecessary.Futureplanstoenhancetheeducationalpotentialofthecliniccompriseintramuralandextramuraleducationactivitiestoboostertheknowledgeofcliniciansfromvariousspecialtiesinoralmedicine.Theclinicisproposedto

Continued on page 27

Dr. Desai (L) and Dr. Abubaker consult with patient in Oral Medicine clinic.



Jeremy Jordan is in the Class of 2015 at the VCU School of Dentistry. He is also the editor of the American Student Dental Association (ASDA) District 4 newsletter.

It’s no secret that the cost of a dental education is on the rise; however, theramificationsofthissteeppricearecurrentlyunknown.AccordingtotheAmericanDentalEducationAssociation,thecostofattendingdentalschoolhasnearlytripledover the past twenty years and most current dental students will begin their career with almost a quarter of amillion dollars in debt.Although some studentswillpursueprogramsthatofferloanrepaymentoptions,othersseetheaccumulatingdebtandinterestasadistantburdentobedealtwithupongraduation.Ineitherinstance,studentdebtisundoubtedlyaffectinganumberofdecisionsaboutwhen,where,andhowthesestudentswillpracticedentistry.

Inthecurrenteconomicclimate,theissueofstudentdebtisanobvioustopicofdiscussion,needofreform,andadvocacy.Allthesame,itisimportantthatstudentsanddentists,alike,recognizethataccesstodentalcareisaneverpressingissue.Several years ago, theAmericanStudentDentalAssociation (ASDA) resolvedto utilize the phrase ‘barriers to care’ rather than ‘access to care.’ The use of‘barrierstocare’allowstherecognitionofanumberorpotentialbarriers,includingthose geographic, financial, personal, and those involving government policy.Although advocates and politicians continue to search for solutions to each of thesebarriers,itisnecessarytoconsiderthepotentialeffectofthestudentdebtloadondentalcare.

Dentalstudentsdon’thavetheanswerseither–studentsarejustasconcernedwithhowtheirdebtwillaffecttheirpractice,withthethreatofcompetingwithmid-levelproviders,andwiththeaccesstocareissue.Asanorganization,ASDAisopposedtodentaltherapistsandmid-levelprovidersofanykind.Studentsareconcernedthattheseprogramswillcreateconfusionamongpatients,anddiminishthequalityoforalhealthcareprovided.Studentsfeelthatnopatient,regardlessofbarrierstocare,deservestoreceivesecond-ratedentistry.Furthermore,becauseofthedebtassociatedwithadentaleducation,educatingmoredentists,orcreatingmid-levelproviderprograms,isunlikelytoimproveaccesstocare.

Asmoredebtisamassed,studentsaredeliberatingmoreoptionsforrepayment.Formanystudents,theguaranteedsalariesofcorporatedentistryseemtobethemostsuitablesolution.Insomecases,itdoesn’ttakelongforstudentstoregretthatdecision,asthey’reforcedtocompromisetheirethicalintegritytomeetstrictquotasandproductionrequirements.Forothers,practicinginanunderservedareaisaspeculativerisk,andtheyworrythatsmallpatientpoolsandotherfactorsmaycontribute to loandefault.Becauseof concernwith decreasing reimbursementrates,studentdebthasthepotentialtoimpactwhichinsuranceandgovernmenthealthcareplansgraduateswillaccept.Althoughitmightseemthatbymakingthesedecisionsstudentsareabsentintheirroleofimprovingaccesstocare,thechoices being made have as much to do with necessity to meet loan payments as theydothestudents’preferences.

Weighing each factor proves that the best areas for improvement are in patient education,improvinghealthprograms,andprovidingincentivesforgraduatestopracticeinunderservedareas.Inmanyinstances,patientsavoidseeingdentistsunlesstheyareinpain.Emphasisontheimportanceoforalhealth,andits linkto systemic health, will help patients, and others, to make dentistry a priorityandallowdentists to stressprevention.Througheducation, improvements canbemade tohealthprogramssodentistsare likely toparticipate,affordability isincreasedforpatients,andpatientsareencouragedtoseetheirdentist.Focusingon education and improvements to health care programs are idealized solutions toaddressaccess to care;however, ifmorepatientsaremotivated to see thedentist,eitherbypriorityorbyincreasedaffordability,asignificantimpactcouldbemadeoncurrentoralhealthdisparities.Atthesametime,incentives,suchasloanrepayment programs, for graduates to practice in underservedareas,will helpmeetthepotentialneedformorepractitioners.

Accesstocareisamultifactorialissue.Eachbarriertocare,includinggeographic,financial,personal,andgovernmentpolicyfactors,mustbeconsideredinfindinganappropriatesolution.Whiletheissueofstudentdebtwon’tdisappearovernight,acknowledging its impact as a barrier to care aides in determining a solution.

Student Debt as a Barrier to Care By: Jeremy Jordan, Class of 2015, VCU School of Dentistry

Fortunately,theleadersoforganizeddentistryarehardatworkinsolvingaccesstocare,advocatingforstudents,andinprotectingtheprofession.It’sbecauseoftheseleadersthatthestrengthofdentistryasaprofessionissowellrecognized.Earlierthisyear,US Newsreporteddentistryasthenation’sbestcareer.Despitewhatseemstobeanuncertainfuture,theexampleofdentistsprovidesstudentswithcontinuedinspirationandsupportsourenthusiasmtojointheprofession.

serve as a site of educational training in oral medicine for dental and medical providerswhoarekeentogainexpertiseinthediagnosisandmanagementoforalmucosalconditionsandoro-facialpain.Thisgoalwillbeimplementedbymeansofhands-oncontinuingeducationcoursesorcertificateprograms.Theoralmedicineclinic will also be used as a resource for community service and outreach activities suchasannualoralcancerscreenings.

TheClinicislocatedinroom101oftheLyonsbuildingoftheVCUSchoolofDentistry.Theprovidersintheclinicparticipatewithmostmedicalanddentalinsuranceproviders.Ifthereareanypatientswhomaybenefitfromtheclinicservices,theschedulingstaffcanbereachedat(804)628-0310.

REFERENCES1)PrevalenceanddistributionoforalmucosallesionsinanadultTurkishpopulation.CebeciA,GulsahiA,KamburogluK,

OrhanB,OztasB.MedOralPatolOralCirBucal.2009;14(6):E272-7

2)PrevalenceoforallesionsamongSaudidentalpatients.Al-MobeeriekA,AlDosariA.AnnSaudiMed.2009;29(5):365-

368

3)Oralmucosaalterationsinasocioeconomicallydeprivedregion:prevalenceandassociatedfactors.Vieira-Andrade

RG,ZuquimGuimarãesFdeF,VieiraCdaS,FreireST,Ramos-JorgeML,FernandesAM.BrazOralRes.201;25(5):393-

400.

4)Advanceddiagnosticaidsinoralcancer.MasthanKM,,BabuNA,DashKC,ElumalaiM.AsianPacJCancerPrev.

2012;13(8):3673-6

5)Patients’perceptionsoforalcancerscreeningindentalpractice:across-sectionalstudy.AwojobiO,ScottSE,NewtonT.

BMCOralHealth.2012;12:55

6)Orofacialpainandtemporomandibulardisorders:theimpactonoralhealthandqualityoflife.ContiPC,Pinto-Fiamenqui

LM,CunhaCO,ContiAC.BrazOralRes.2012;26Suppl1:120-3

Oral Medicine, Continued from page 26

http://www.ncbi.nlm.nih.gov/pubmed?term=Vieira-Andrade RG%5BAuthor%5D&cauthor=true&cauthor_uid=22031051

http://www.ncbi.nlm.nih.gov/pubmed?term=Vieira-Andrade RG%5BAuthor%5D&cauthor=true&cauthor_uid=22031051

http://www.ncbi.nlm.nih.gov/pubmed?term=Zuquim Guimar%C3%A3es Fde F%5BAuthor%5D&cauthor=true&cauthor_uid=22031051

http://www.ncbi.nlm.nih.gov/pubmed?term=Vieira Cda S%5BAuthor%5D&cauthor=true&cauthor_uid=22031051

http://www.ncbi.nlm.nih.gov/pubmed?term=Freire ST%5BAuthor%5D&cauthor=true&cauthor_uid=22031051

http://www.ncbi.nlm.nih.gov/pubmed?term=Ramos-Jorge ML%5BAuthor%5D&cauthor=true&cauthor_uid=22031051

http://www.ncbi.nlm.nih.gov/pubmed?term=Fernandes AM%5BAuthor%5D&cauthor=true&cauthor_uid=22031051


A program of the Virginia Dental Association

September 18-22, 2013

The Homestead Resort

Hot Springs, Virginia

Pre-Registration: June 10—August 30 Register by June 30 and receive early-bird discounts!

Registration materials will be mailed in early June.

Additional Virginia Meeting information on the following pages.

Photo courtesy of The Homestead Resort, Hot Springs, VA


Learn From the Best! The Virginia Dental Association is proud to host some of today’s top dental professionals and course instructors! We hope that you and your staff will take full advantage of the wide variety of continuing

education opportunities available in September!

Dr. Mark Hyman

A 360 Slam Dunk Guide for Successful Teams –Complex Treatment Planning “Change is inevitable – growth is optional.” In this fast-paced, ever-changing world, dental teams must commit to taking a serious look at every aspect of the practice. Enjoy this fast paced, fun filled, dynamic seminar that will super-charge your practice today!

Ms. Laney Kay Blood, Spit, and Fears: A Painless OSHA Update Let’s face it: most OSHA training courses are anything but fun. Join us for a class that will change your mind forever. It’s fast, informative, fun, and it satisfies your annual OSHA requirements. Dr. Gary Radz Clinical Application of Composite Resins –Learning Predictability & Efficiency The implementation of composites into today’s practice requires that the clinician can place these restorations efficiently with an excellent esthetic result. This hands-on course is designed to demonstrate the application of composite resins, both anterior and posterior, using the most current materials and techniques to help the clinician improve the level of their final restorations. Mr. Bruce Christopher Bambi vs. Godzilla Difficult people are everywhere! They can be patients, staff, doctors, almost anyone. This program humorously reveals the six basic difficult personality styles that are out to drain you and your practice of vital energy. You will learn what they do, why they do it, and what you can do about it!


Dr. Barry Musikant Common Sense Endodontics: Where Sophistication and Simplicity Meet In this course, Dr. Musikant will detail the different systems that are available to dentists today and help you understand why engine-driven reciprocation results in clinical excellence. You will take away common-sense, money-saving solutions to endodontics that are easy to incorporate into your practice. Ms. Susan Richardson Let’s Do It! Search Engine Optimization, Social Media, and Online Marketing U.S. consumers spend 7.5 hours+ per month on Facebook. Social networking is an essential way for current and prospective patients to connect with your practice. They are already using social networks. NOW is the time for you to engage with your patients…online. Ms. Rebecca Wilder Systemic Disease and Oral Health: News You Can Put Into Practice Dental hygienists need to stay current with information that is vital to a patient’s health and be proactive in their approach to treatment! This course reviews current evidence on oral systemic connections discusses treatment strategies to incorporate into everyday practice, as well as providing information for best treatment strategies for patients at risk for disease and product recommendations for periodontal patients. Dr. Lawrence Wallace WOW! Complete Dentures in an Hour! With new materials and innovative, easy-to-learn techniques, you can fabricate complete dentures in one visit in about an hour, all without a lab. Used for complete dentures, immediate dentures, and temporary implant overdentures, these techniques will help you attract new patients, expand your practice, and increase your income.

Dr. Ben Miraglia Invisalign Clear Essentials I This one-day, case-based training provides participants with the clinical and operational confidence to successfully treat a range of highly predictable cases. Your team will learn a full range of support resources designed to meet the needs of non-orthodontic practice, as well as clinical, operational, and marketing skills. Tuition for this course covers the doctor and up to 8 team members.

These are just a few of the speakers and courses we are offering! Please visit our website for more information. www.vadental.org/events/vam/ce


Indulge in Luxury

If you haven’t reserved one or more of these marvelous rooms, you’ll want to do it soon! Guarantee that you and your staff will be able to enjoy the meeting to the fullest extent by booking your rooms now!

Bring Your Staff And Pay Less With Multi-Room Discounts!

First additional room—$150 per room, per night Second additional rooms—$125 per room, per night

Third or more additional rooms—$100 per room, per night

*To make a reservation, upgrade your room or book multiple rooms, fax the form on the following page to The Homestead Resort.*

$190.00 per room, per night **This base fee excludes the 15% per room, per night resort fee, as well as state and local taxes.**

Guest Room Guest Suite

The Great Hall Dining Room Sam Snead’s Tavern

Photos courtesy of The Homestead Resort, Hot Springs, VA


Ultimate Enjoyment The Homestead Resort offers endless options to you and your family!

For a full list, please visit www.thehomestead.com/activities. Make your activity reservations early as slots fill quickly!

1-800-838-1766, option # 4

Canyon Ranch Spa Club—new in 2013!

When it comes to the spa world, nothing says luxury, innovation and healing transformation better than Canyon Ranch. Canyon Ranch SpaClub ® at The Homestead will be unveiled in

Spring of 2013, elevating the spa experience at the historic resort. This exciting union marries the warmth of The Homestead’s Southern hospitality and its natural springs with this spa

pioneer in wellness and healthy lifestyles.

Carriage Tours NEW Outdoor Water Park

Gorge Tour

Segway Tours

Photos courtesy of The Homestead Resort, Hot Springs, VA


KAFislocatednearKandaharCity,aciviliantown.Thebaseisano-salutezoneduetosecurityconsiderations.

MytourincludedboththeFourthofJulyandRamadanduringthetroopdraw-down,withtheUSactivemilitaryexitingby2014.WorkingduringRamadanoftenrequiredcoveringmyarmsduringclinicandcoveringmylegsandarmswalkingtothegym.Indigenousnativepatientsinthehospitalandworkersonthemilitarybasecouldtakeoffenseatbyexposureofuncoveredfemalearmsandlegs. KandaharAirFieldiswidelyknownfornoise,uniqueshopping,blimps,andfoulsmells.Pairsofroaringjets,frequenthelicopters,transportairplanes,buzzingdrones plus armored transport and personnel vehicles made sleeping a chal-lenge.Continuousgas-poweredgeneratorswerehummingeverywhereonKAF.Staccatooutgoingartilleryoftenpunctuatedthenight.Themostjarringnoisewastherocketattackalert.Oneday,wehadsevenalerts.SometimesthealertswereaccompaniedbyaKAFwidepoweroutage.

TheBoardwalkandinside-the-wireBazaarofferedpricehagglingopportunitieswiththelocalbusinessmen.

The elegant blimps hovering over a nearby mountain were a reminder of wartime useoftechnology.Theywereinclearviewunlesstheoccasionalsandandduststormshidthem.Fornasalstimulation,Ihadthecontinuousstaleodorofburn-ingtrashinconjunctionwiththeeverpresentoffensivePoohPond. ThepublichealthenvironmentwasvastlydifferentfromtheUS.ActivecasesofpolioandmalariaexistinAfghanistan.Thelifeexpectancyforbothsexesisaround44years.Mypre-deploymentactivitiesincludedfirearmscertification,multiplemilitaryandculturalcompetencycoursesplusAfghanistan-specificvac-cinationsincludingAnthraxandsmallpox.Takinganti-malariamedicationwasafactofdailylife. Ourwatersupplywastreatedwithnumerousconcentratedchemicals.Thus,bottledwaterwassuppliedfreeeverywhere,toeveryoneonKAF.Stayinghydratedinthedesertclimatewasadailychallenge.ThecustomarybreezesatKAFhelpedmitigatethetriple-digitsummertimetemperaturesandthemanyduststormsofsouthernAfghanistan.Thedustpenetratedeverything,eventhenoseandears.

I had the distinct honor of recent deployment to KandaharAirField(KAF),Afghanistan.Lastsummer,IservedasaVirginiaNationalGuarddentalofficerassigned to the NATO ISAF(InternationalSecurity Assistance Force)Role3MMU(Multinational Medi-calUnit)hospitalinKandaharAirField,Af-ghanistan.IsupportedOperation Enduring FreedomintheKAFCombat or Trauma Hospital.

WAR ZONE DENTISTRYBy: Elizabeth Taylor Nance, DDS, MSHA

AlthoughKAFRole3MMUwasaNATOhospital,theUSNavyoperatedthefacility.MostoftheUSdoctorsandmedicalstaffwereNavy,withtheUSArmystaffingthedentalclinic.TheNATORole3hospitalwasatallfortifiedbuilding.JustlikeallbuildingsonKAF,thebuildinghadgeneratorsenablingservicesevenduringpoweroutages.

ThemilitaryhospitalinKAFsentstafftotheKandaharCitycivilianhospitalforsupport.Asyouhaveread,manyoftheUSmilitaryresponsibilitiesarebeingtransferredtoAfghancontrol.TheRole3NATOhospitaldutiesmightremainwiththeUS.

AsaNATORole3hospital,inadditiontoUSmilitary,theproviders and staff included Australians,British,andBelgians.Thehospitalsignincluded the Red Cross and the Red Crescent since we workedintheIslamicRepublicofAfghanistan.

The Role 3 hospital was a fortified,bunkerstructuremadetowithstandrocketattacksandotherexplosions.Sincethehospitalwasadjacenttotheairfield,patientsweretransportedfromthefieldtoKAFviagroundorairtransport.Hospitalstaffwaspagedwhen litter transportation was required to carry the patients to the hospital emergency or operatingroom.My military mission was to delivery emergency dental care to American and NATO coalitionforces,selectcontrac-tors and nationals in the war zone.Sincemilitarydogsplayed an integral role with the USforces,theirdentalneedswere also met in the dental clinic:endodontictreatment,extractionsandtreatmentofinfections.Thedentalexcur-sions to nearby Afghanistan villages had ceased before my deployment.

The Role 3 dental clinic had four teams of dentists and assistants,rotatingthroughthreeoperatories.Weworked8:00-6:00,sevendaysaweek.WhentheBritishteamwaspresent,thethreeArmyteamsworkeddiffer-entrotations.Onedentalteamwasalwaysoncalltoevaluateandtreatdentalemergencies.

ANavyOMFSwasassignedtotheoperatingroomfortraumaticsurgicalcases.TheRole3dentalclinicconsistedofthreegeneraldentistsandoneendodontist.

Dr. Nance with military dogs

Military dog receiving treatment

Outside of workplace


Thehospitaldentaldepartmentlookedsimilartomanydentaloffices.Wehadareceptiondesk,astafflounge,aPanorex®room,asterilizationroomandastorageroom.Awidehallwithahighnarrowwindow(forsecurity)randownthecenterofthesuite.

Eachoperatorywasequippedwithhandpieces,suction,andaporcelainspit-toon.Weuseddigitalrecordsandphotography.Afterenteringpatientrecordsandnotesdigitally,thepaperrecordsfromthepatient’ssign-inwereburned. ObtainingsuppliesandequipmentwasachallengeattimesduetothePakistantransportationembargo.Butroutineandemergencysuppliesarrivedviaalterna-tiveroutes. Isawmanyinterestingemergencycases.Alldentalcaseswereevaluatedthentreatedafterconsideringthepatient’smission,militaryprioritiesandotherfactorssuch as the patient’s R&R plans and their date for redeployment (returning state-side).Dependingonthepatientneeds,mostcaseswerecompletedthatdaysoservicememberscouldreturntodutyimmediately.DentaltreatmentbeyondthescopeofourclinicinAfghanistanwasprovidedinGermany.

Many times salvageable teeth were treated surgically or with antibiotics so to en-ableendodontictreatment.Inadditiontoextractingmanyinfectedthirdmolars,IperformedmultipleI&Ds,extractedfailedimplantsplusnon-restorablefracturedteethandhopelessperiodontallyinvolvedteeth.

Ofspecialinterestwasthetreatmentofadehydratedsoldier’sparotiditis.HewasplacedonclindamycinandlemondropsthenconfinedtoquartersonKAFfortwodays.Afterre-evaluation,hewasreturnedtofulldutywithinstructionstostayhydrated. Intheater,TMJandtraumaticissueswereprevalent.Atoothfracturedandbeyondendodontictherapyorrestorability,wasextracted.Replacementofex-tracted teeth was a challenge since dental laboratories were not readily available inAfghanistan. Most American military members’ dentistry was provided stateside before de-ployment.Theforeignmilitarymembers’dentistryoftenhadnotbeenaddressedbeforetheywere“intheater”.

Eachday,IwalkedtothehospitalfrommymodularhousingoverpavedandunpavedroadsinfullUSArmydesertcamouflagedcombatuniformwithmyM9sidearm.Atwork,Ichangedtoamilitaryscrubforpatientcareandplacedmysidearminanearbylockedcabinet.

Evenduringwartime,Icouldn’tresistgoing through my 1600+ digital photos andpresentingaCEtomyunit:“InTheaterDentistry”. Day to day differences between workinginawarzoneandworkingstatesideincluded:

• Dressing in full military uniform with boots and M9 side arm and magazine.

• Takinganti-malarialprescriptionmedicine

• Maintaining constant awareness about life threatening factors suchassuicidebombers,rocketattacksanddisease

• Locatingbunkerswhichcouldprovidesafetyduringarocketattack

• Knowing that both the internet and cell phones were owned and monitored by non-friendly countries

• Maintaining hydration levels• Actively protecting critical military

and personnel information

A war zone is stressful but since basicneedslikewater,food,shelter,electricity and running toilets were provided,Iwasabletofocusonmymission.

Dr. Nance serves in the Virginia (Army) National Guard and is Dental Director for the Virginia Department of Health, Peninsula Health District, in Newport News. She was deployed to Afghanistan in 2012. Previously she was in private practice and on the faculty of the VCU School of Dentistry. She can be reached at [email protected]

Aspecialadventurewasdonatingplatelets.Donationrequiredprescreeningandtestingofmybloodbyastatesidelab,thenreceiptofclearanceweekslater.Thedonationtookaboutthreehours.DuringmasscasualtiesservicedbytheKAFhospital,callswentouttothestafffordonationsofblood.

Anotheradventurewasseeingmyoldestson,aMarineintelligenceofficer,atKAF.WewereinterviewedfortheArmedForcesNetworkandforaRichmondTimes-Dispatcharticle.

Servingmycountryonthisdeploymentwasahighlightofmylife.IhaveanewappreciationoftheopportunitiesandfreedomsthatweoftentakeforgrantedinAmerica.

MAJ Elizabeth Nance (VA Army Na-tional Guard) and CAPT Wilsom Nance (US Marine Corps)

Presenting CE “In Theater Dentistry” at KAF

Treating patients in Role 3 Dental Clinic

The investment you have made in your dental practice is an important part

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in practice transitions of all kinds, providing advice and options that work

to ensure that you get optimal results to support your professional goals.

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12PT6814_PPT_8.5x5.5bw:Layout 1 12/12/12 4:44 PM Page 4

Outreach


Virginia’sdentalcommunityisdoingamazing things to increase access to oral health services throughout the Commonwealth.Dentalprofessionalsacross the state are teaching fellow providers and patients about the importance of optimal oral health care ateveryageandphaseoflife,includingstressing the importance of oral health careduringpregnancy.Becausedentaldiseaseinpregnantwomenislinkedwithpre-termbirth,treatmentandeducation during pregnancy can lower

apatient’sriskforprematurebirthandhelptolayafoundationforalifetimeofgoodoralhealthforthepatientandherchild.

Asyouknow,preventive,diagnosticandrestorativetreatmentsaresafeandeffectivethroughoutpregnancytoimproveandmaintainoralhealth.TheVirginiaOralHealthCoalitionhasbeenworkingwithareaobstetriciansaspartofitsmedical and dental collaboration initiative to educate them about the safety of oral health care during pregnancy and encourage them to refer their patients

Dental Care in PregnancyOral Health Coalition educates physicians, other providersBy: Sarah Bedard Holland, Executive Director, Virginia Oral Health Coalition

toadentist,iftheydonothaveone.ReferralsfromOB-GYNproviderscanhelp grow a dental practice and establish ongoing relationships with physician practicesandnewparents.

Onthenationalscale,theNationalMaternalandChildOralHealthResourceCenter(OHRC)recentlyreleasedaconsensusstatementintendedtoimprovetheoverallstandardoforalhealthcareforpregnantwomen.“OralHealthCareDuringPregnancy:ANationalConsensusStatement” was developed with inputfromorganizationsliketheADA,ADHA,AAPD,AssociationofStateandTerritorialDentalDirectorsandotherstoserveasaguidelineforstakeholderswho wish to improve the provision of oral health care and services during pregnancy.

Toviewmoreoralhealthresourcesforproviders,pregnantwomenandcaregivers,visittheOHRCwebsite.TolearnmoreabouttheCoalition’smedicalanddentalcollaborationinitiative,pleasecontactKatherineLibby,programmanager,[email protected], or visit the Coalition’s website at www.vaoralhealth.org.

http://www.mchoralhealth.org/PDFs/OralHealthPregnancyConsensus.pdf

http://www.mchoralhealth.org/PDFs/OralHealthPregnancyConsensus.pdf

http://www.mchoralhealth.org/Topics/pregnancy.html


http://www.vaoralhealth.org

Outreach


FreeDentalDaywasahugesuccess!Thiswasourseventhannualeventwhich helps the underserved in our community with basic dental services forfree.ItwasheldinourdentalofficeinChesteronFebruary22.Therewasnoscreeningprocessandeachwastreatedonafirstcome,firstservedbasis.Patientsbeganformingalineat10:00p.m.thenightbefore.Shelterswereprovidedbyvolunteerstohelpprotectpatientsfromthecold.Twelve

Seventh Free Dental Day held in ChesterBy Dr. Tony Agapis and Dr. John Agapis

dentists,fourhygienists,andthirtyassistantswereabletotreat178peoplewithextractions,prophys,andfillings.Iamalwaysamazedbythegenerosityandhardworkofallthosethathelpdeliverthecaretothesegoodpeople.Ifanyonewouldliketovolunteerfornextyear’sevent,pleasecontactusat:[email protected].

SteveSheltonisaveteranwhohadhisteethextractedthroughthe2012RoanokeMissionsofMercy.HewasthenreferredtotheDDSprogramwhereDr.StephenAloufpro-videdhimwithfullupperandlowerdentures.Thedentureswere donated by Lewis Bowles with Service Dental Lab in Lynchburg.

ThankyouDr.AloufandLewisBowles!!

A TEAM Effort

Before

After


Outreach


Dentistry and oral health care play a critical role in the diagnosisandtreatmentofpatientswithcleftlipand/orpal-ate,craniofacialsyndromesandanomalies,andcongenitalandacquireddefectsoftheheadandneck.Inanefforttoprovideunifiedcareforthesepatientsandtheirfamilies,theCleftandCraniofacialTeamatSt.Mary’sHospitalwasrecentlyformedinRichmond,Virginia.ServinggreaterRichmond,theStateofVirginiaandtheEasternUnitedStates,ourteamutilizesthemostcomprehensiveandcurrenttechnologiescoupledwithunequaledcare,compas-sionandskill.Thisuniqueprivatepracticeteamcombinesthetalentsofplasticsurgery,ENT,neurosurgery,dentistry,

oralsurgery,orthodontics,speechpathologyandsocialworktoprovidecomprehensivetreatmentunparalleledinthecommunity.Thisselectgroupservesasamodelforotherteamsthroughoutthecountry.

NationallyrecognizedbytheAmericanCleftPalate-CraniofacialAssociation,theteamrepresentsaninnovativeapproachtothetraditionalhospital-basedservicesofthepast.Each member of the team has access to information gathered by other team members viaaunifiedchartingsystemspecificallydesignedforthepurposeofmanagingpatientswithcraniofacialanomalies.Patientsareseenbymembersoftheteamindividually,onlywhennecessary,andtreatmentplansarediscussedandformulatedwhentheteammeetsonamonthlybasis.

The team provides an approach to patient care that streamlines the multidisciplinary needsofthemostcomplexpatientswhileunderstandingthechallengesapatientandtheirfamilymayhavewithaprenataldiagnosisofcleftlipand/orpalate,craniofacialsyndromesoranomalies.Theteamispresenteverystepoftheway.LindaShait,BSN,RNtheteam’spatientcarecoordina-tor,helpsidentifypatientneeds,providesaccesstocareandnavigatesthemultidisciplinetherapies.

Helpyourpatientsintheircarefromprenataldiagnosistoadulthood and optimize their quality of life through referral and treatment.Dentistryplaysavitalroleinthemanagementofthesepatients,optimizingfunctionandesthetics,whilepairingwithothertreatmentmodalitiesofhearing,vision,speech,socialwork,geneticcounselingandsurgicalintervention.It’snever too early or too late to refer these patients to the Cleft andCraniofacialTeamatSt.Mary’sHospitalforanevaluationthat elevates quality of life and highlights the individual needs of everypatient.

Formoreinformationpleasecontact:LindaShait,BSN,RNPediatric Specialty Care CoordinatorTelephone:804287-7396Fax:[email protected]://www.bonsecours.com/our-services-childrens-services.html

The Cleft and Craniofacial Team at St. Mary’s Hospital

Sharline Z. Aboutanos, MDPlastic & Reconstructive Surgery

Alan J. Burke, MDOtolaryngology,PlasticandFacialSurgery

Natario L. Couser, MDOpthalmology

Jennifer B. Humberson, MDGenetics

Frank P. Iuorno, Jr DDS,MSOrthodontics

Wendi L. Lopez PSY D, HSPPClinical Psychology

Christopher L. Maestrello, DDSPediatric Dentistry

Karen S. McAndrew, DMD, MSProsthodontics

Michael E. Miller, DDSOralandMaxillofacialSurgery

Melissa Redfearn, MS, CCC-SLPSpeech Language Pathology

Ann M. Ritter, MDPediatric Neurosurgery

Linda Shait, RN, BSNTeam Coordinator

Isaac L. Wornom, III, MDPlastic & Reconstructive Surgery

Edwin V. Wortham, MDOpthalmology


Articles of Interest

DidyouknowthattheVDAServicesendorsedvendorsarepeer-reviewedandrecommendedbythememberdentistsontheVDSCBoardofDirec-tors?AllvendorshavebeenthoroughlyvettedbytheBoardandtheyarerecommendedforusebyVDAMembersbecauseoftheirstrongproductandserviceofferings.Inaddition,manyoftheendorsedvendorsofferbenefitsandpricingthatareexclusivetoVDAMembers–bringingaddedvaluetoyourmembership!

TheVDSCwasstartedin1995asasubsidiaryoftheVDA.ThepurposewastofindandrecommendproductsandservicestoVDAmembersandalsotocreateanewsourceofnon-duesrevenue,thusenhancingmembervaluewhiledecreasingthecostofmembership.Manyoftheendorsedvendorsprovideasourceofrevenue,atnoextracosttoyou,whichhelpstosupportyourassociationanditsprograms.Thisrevenueisusedtokeepduesaslowaspossibleandin2012alone,theduessavingswasover$80permember!Overthepast18years,theVDSChasprovidedover$2.5millioninsupportformanyprogramsincluding:theVirginiaMeeting,CEcoursesateachcomponent,MOMProjects,theVDAwebsiteandtheVCUSchoolofDentistry.

BelowpleasefindanintroductiontotheVDAServicesendorsedvendors.Complete information about these programs can be found online at vaden-tal.org/vdas.

Insurance Whetheryouarejuststartingoutinpractice,youarewellestablishedoryouareretiredfromdentistry,theVDAServicesvendorsareheretohelp.B&B Insurance Associates, Inc.(877-832-9113;bb-insurance.com)canprovide you with comprehensive insurance coverage at all stages of your career.B&BInsuranceisafamily-ownedagencythathasbeenworkingwithVDAMembersforover12years.Withexpertiseintheinsuranceneedsofdentalprofessionals,thelicensedagentsatB&Bareaone-stopshopforallofyourinsuranceneeds.WhetheryouarelookingforanendorsedMedi-cal Protective (medpro.com)professionalliabilitypolicyoracomprehen-sivereviewofyourentireinsuranceportfolio,B&BInsuranceishereforyou.

Financial ServicesBank of America Practice Solutions (bankofamerica.com./small_busi-ness/practicesolutions)iscommittedtoworkingwithdentiststoprovideacomprehensivepracticeandequipmentfinancingsolution.Whetheryouarebuyingapracticeforthefirsttime,purchasingequipment,expandingyourpracticeorconsideringacommercialrealestatepurchase,BankofAmericaPracticeSolutionshasavarietyofproductstofityourneeds.VDAMembers are also invited to apply for both personal and business credit cards through Bank of America (bankofamerica.com).

Products and Services for the Dental OfficeFromwebsitedesign,togloves,toelectronicclaimsandmarketingand

VDA Services Vendors are Here to HelpElise Rupinski, VDA Director of Marketing and Programs

communicationsforyouroffice,theVDAServicesvendorsoverawidevarietyofproductsandserviceswithspecialbenefitsexclusivelyformembers.ProSites (prosites.com/vda)offerswebsitedesignservicesandaplatformthatallowsyourofficetoeasilyedit,updateandchangeyourpracticewebsite.Havingaprofessionalpresenceonthewebisparamountwithtoday’stechno-logicallysavvypatientsandProSitesisofferingVDAmembersa25%discounttheirset-upfeetohelpyouimproveyouronlinepresence.Tocomplementyournewpracticewebsite,youcouldalsoconsiderthemarketingandcom-munications tools available through Demandforce (dental.demandforce.com).Patientcommunications,surveys,appointmentreminders,socialmedia optimization and email campaigns can all be managed using Demand-force’sinnovativetechnology.VDAMemberswillhavetheirset-upfeewithDemandforce waived and the company guarantees a three-to-one return on yourinvestmentwiththem–awin-winforyouandyourpatients!

Youcanalsoenhanceyourpatient’sexperienceanddecreaseyouraccountsreceivablebytryingouttheelectronicclaims,real-timeclaimadjudicationandeligibilitychecksthroughMDE (whymde.com).Asaninnovatorinthefield,MDEisworkingtorevolutionizeyourfront-officeefficiencyandimproveyouraccountsreceivable.WithMDE,youcanletpatientsknowwhattheywilloweyourofficeforservicesonthesamedayastheirappointment.Youcanmaketheir payment process easier by offering options for payment including Care-Credit (carecredit.com/dental)patientpaymentplansandacceptingcreditcards through endorsed processor Worldpay (worldpay.us).CareCreditoffersVDAmembersasavingsof$170offoftheenrollmentfeeandWorldpaycanprovideyourofficewithafree,noobligationstatementreviewtoseehowmuchyourofficecansavebyswitchingprocessors.Forthoseaccountsthatdoendupdelinquent,VDAServicesrecommendsthecollectionsservicesof Transworld Systems (transworldsystems.com/gkurtz).Theprofes-sionals at Transworld can offer your practice a number of solutions for aging receivables that can maintain your relationship with your patient and improve yourpractice’sbalancesheet.

TheVDAServicesvendorscanalsohelpyousavemoneyatyourpractice–morevalueforyourmembershipintheVDA.Checkouttheexclusivemember pricing for a full suite of gloves form seven manufacturers through the VDA Services Glove Program (vdaservicesgloves.com).Yourofficecanalsosave15%offofyourpayrollprocessingservicesthroughPaychex (paychex.com),aleaderinthepayrollservicesindustry.ThroughSolmeteX (solmetex.com),VDAmembersareabletoreceiveafreecontainer($179value)anda$30rebatewhenyoupurchaseaSolmeteXamalgamseparatorfromyourdentaldealer.

TheVDAServicesvendorsareheretohelpyou.Pleasevisitvadental.org/vdastolearnaboutalloftheendorsedvendorsandtheexclusivebenefitstheyprovidetoVDAMembers.

VDSC Board of Directors Dr. Lanny Levenson, President Dr. Bruce Hutchison Dr. Steven Forte, liaison Dr. Les Webb, Vice President Dr. Jeffrey Levin Dr. Kirk Norbo, liaison Dr. Rod Klima, Treasurer Dr. Robert Levine Dr. Roger Wood, liaison Dr. Alonzo Bell Dr. Stephen Radcliffe Dr. J. Ted Sherwin, advisory Dr. Fred Coots, Jr. Dr. Edward Weisberg Dr. Harvey Shiflet, III, advisory Dr. Frank Crist, Jr. Dr. Andrew Zimmer Dr. Gus Vlahos, advisory Dr. Wallace Huff Peer Reviewed • Members-Only Benefits • Supporting the VDA


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Wehaveaprofessionalathleteinourmidst.No,I’mnotontheProfessionalBowlingTour.WillBates,thesonofourveryownDr.RichBates,wasrecentlydraftedbytheSeattleSoundersofMajorLeagueSoccer.Hewasonback-to-backStateChampionshipteamsinChesteratThomasDaleHighSchoolandthenwasNCAAFreshmanoftheyearastheUniversityofVirginiawontheNCAAtitle.Hissenioryear,hecamebackfromACLsurgerytobethesecondleadingscorerintheAtlanticCoastConference.

Willgraduatedinthreeandahalfyears(Hearthat,kids!)andhasjustmovedtoSeattle.Hehopestobeinthestartinglineupbeforelong.

Fromwheredidthisgeneticallysuperiorlineagederive?HaveyoumetRich’swife,Sue,astaryogaandPilatesstudent?Richwas(oris)agoodathletehimselfhavingplayedlinebackeratVirginiaMilitaryInstitute.HeisamemberofFatBoys,amen’sindoorsoccerleaguewheresprintingisfrownedupon.Hepossessesamodestskillsetingolf.Hisdrivesgoalongway,althoughmostlyinwaywarddirections.

RichandSuearelookingforwardtoseeingWillplaythissummerinthestateofWashington.TheyhopethereareplentyofGrandCherokees®torent,foritwouldbeashametogoJeeplessinSeattle.

Dentist with Good Hands has Son with Good FeetBy: Dr. Michael Hanley, Associate Editor, Component 3

L-R: Mrs. Sue Bates, Will Bates, Dr. Richard Bates


Dr. James Schroeder practiced in Richmond. Please email him your experiences and questions to be addressed in future columns. [email protected] may be contacted at (804) 307-5108.

Oneofthemostunderdevelopedareasofanybusinessisofficeculture.Forthepurposeofthisarticle“culture” isdefinedasthebehaviors,attitudesandvaluesreflectedinanorganization.

Acrossthestate,dentalofficeshavebeenimpactedbytheeconomy.AsIengagedifferentofficesIhavediscoveredawidevarietyofresponsestotheexternalforceidentifiedasthedownturnoftheeconomy.Ihavealsoseencreativeandinnovativeresponsesthathaveresultedinasignificantgrowthinofficeproductionaswellasseveredeclineswhichresultedinthereductionofstaffand/orpoorofficeproductivity.Asdentistsourcreativefocusisoftenintheclinicalareaofpatientcare.Ourresponsetotheeverchangingexternalforcessuchasinsurancecarriersortheeconomyisoftenpassiveorevenexhibitsavictimmentality.Intoday’severchangingenvironmentwecannotaffordtheeitherchoice,particularlythelatterone.

Althoughtherearemanywaystorampupyourofficeproductivityfactor,todayI will discuss your leadership role in the intentional development of a thriving officeculture.Oftenwedonothavetheeyestoseewhatislimitingourpracticegrowthbecauseitseemstotallyunrelatedtoourdentalexpertise.Whenwehirean individual for a clinical position we are very fastidious about proper training inprocedures,sterilizationandequipmentutilization.Administrativepositionsreceivetraininginthedifferentsystemssuchasinsurance,calendar/appoint-mentbookcontrolandtherecallsystem.

Unfortunately,weoftenoverlookthedevelopmentofthehighbehavioralandattitudestandardswhichshouldbeexpectedinallpatientandco-workerrela-tionships.Weallowthenewemployeetobringtheirbehaviorandattitudefromhome,offthestreetorfrompreviousplacesofwork.ThisislikeplayingRussianroulette.Youmaybefortunateorskilledinselectingtherightindividualforthepositionbutgreatculturesarenotdevelopedbyaccidentjustasbeautifulsmilesarenotcreatedbychance.Alltheexternalmarketingcanbeshortcircuitedunlesswehaveanexceptionalinternalculturereceivingnewpatients.Forexample,themannerinwhichthephoneisansweredisanimportantbyproductofanofficecultureandrequiresintensescriptedtraining.

Behaviorsandattitudesaredevelopedoutsidetheofficeoftenarenotaccept-ableinacultureofservicetoeachotherandtothepatient.And,thereisoftenacertainarroganceexhibitedbyprofessionalsthatimplies,“Idon’thaveaprobleminthisarea,”ortheydownloadittoanofficemanagerprovidinglittleleadershiporexpectations.Moreoftenthannottheofficemanageriswellintentioned,butill-equippedtocarryoutthecriticalresponsibilitythatwillultimatelybeamajorfactorinthegrowthoftheprofessionalpractice.

Whenprovidinganintroductiontoanewemployee,Iwasexplainingthatourculturewasbuiltonservingbotheachotherandourpatients.Laterthatdayanolderemployeecametomeandsharedthatthenewcomerhadsaid,“What’sDr.Schroedertalkingabout,thisservingeachotherstuff?Ineverservedanybody.”Fortunately,shewasteachable,andwehelpedherdevelopintoagreatstaffmember.Thisdidnothappenwithoutteaching,trainingandmodelingoverape-riodoftimealongwithafewdifficultconversationswhichheldheraccountable.InmedicalanddentalofficesthatIworkwithasaconsultant,Ioftenfindthedoc-tor ignores unacceptable behaviors and attitudes and thus allowing the lowest denominatortosettheofficeculturalstandard.Thispatternfuelspoorbehaviorfromallstaffmembers.Withthatcycleofbehavior,patientsexperiencepoorserviceandleavethepractice,ortheydonotraveaboutyouinthecommunity.Andthisisanimportantwayinwhichofficecultureimpactsthebottomline.Insurveyingpatients,thenumberonereasontheytellotherpeopleinthecom-munityaboutyourofficeis,“Iexperiencedgreatandgraciousservicethroughouttheoffice!”Iamnotdiscountingtheimportanceofexcellentdentistry,butveryfewpeoplereferfriendsbasedsolelyontheexcellenttechnicalservicewhichtheyreceived.

Office Culture Impacts the Bottom LineBy: Dr. James Schroeder

Greatofficeculturesattractgreatemployees!Whenwetaketimetoclearlyidentifyappropriateattitudesandstandardsofbehavior,andweholdemployeesaccountable,greatthingshappen.Clarityofexpectations,alignmentandequip-pingourpeopletomeetourexpectations,followedbyexecutionandaccount-abilityyieldamazingresults.

InallthedifferentbusinessesIconsultwith,Ialwaysinterviewtheemployees.Thetopemployeesoftenexpressthedesiretome,“Pleasehelphim/herbealeader and addressthedifficult/lowperformingpeoplethatarepreventingthebusinessfromreachingitsfullpotential.”OftenthepeopleIworkwithhavemanyyears of education and letters after their name but they have never acquired the skillsandconfidencetoexecutethispartoftheirbusiness.

Another area of culture development which is often not addressed is the differ-encesencounteredbetweengenerationalgaps.Upbringing,workethic,values,communicationstylesallimpactteamwork.Co-workerswilleitherclashortheywillbecomeawell-oiledmachine(withrespectfortheirdifferences)largelydependingonthestrengthoftheinvestmentinteamworkandinthemodelingthatyouprovide.

Behaviors and attitudes play an important part in the growth of your practice and consequentlyinyourbottomline.Thecultureofyourofficealsoplaysacriticalroleintheenjoymentofyourday.Itcannotbemeasuredonaspreadsheet,butitiswoventhroughouttheareasofproductivity,newpatientsandprofitability.Thereisnotmuchyoucandoaboutchangesoftheeconomy,butthereisatremendousamountyoucandointhedevelopmentofyourofficeculture.Itistheplatformuponwhicheverythingisdelivered.Whetheryourofficeisthrivingorstrugglinginthisareacangreatlyaffectthereturnonyourinvestment.

Whenwasthelasttimeyoumadeaninvestmentoftime,freshenergyorhadaconversationongrowthanddevelopmentofyourofficeculture?Isthetimenow?


Scientific

Casamassimo PS, Thikkurissy S, Edelstein BL, Maiorini E.Beyond the dmft: The human and economic cost of early childhood caries. JADA 2009; 140(6): 650-657Background:Earlychildhoodcaries(ECC)isthemostcommonchronicdiseaseofallchildhoodillnesses.ECCcancausesuffering,pain,diminishedquantityoflife,andevendeath.Mostoftenthoseeducated,insured,andemployedarenotawareoftheconsequencesofuntreatedECCthatareexperiencedbyamajorityofthe4.5millionchildrenwhodeveloptheconditioneachyear.Deathandseri-ousmorbidityasaresultofECCisnotanewphenomenon;however,therecentdeath of a 12 year-old boy in 2007 from untreated dental caries gave new light totheproblemswithaccesstodentalcare.Extremeeventssuchasthesearehighlypublicizedinthenews;however,effectsofECConfamilies,community,andsocietyareoftenunnoticed.Moreover,traditionalsurveillancemeasureshave not portrayed the full range of ECC’s impact on affected children and their families.

Purpose: The purpose of this report was to review evidence from a variety of perspectives to argue that the consequences of symptomatic ECC are multiple andsignificantandthatbroadersurveillanceofthedisease’simpactisneces-sary.

Methods: A traditional method to describe a disease impact is the morbidity and mortality(M&M)pyramid,avisualmodelwhereincreasinglysevereconse-quencesarelayeredontoponeanother.TheauthorsreviewedtheliteraturefordescriptionsandquantificationofmorbidityassociatedwithECCandorganizedthestudiesintothemorbidityandmortalitypyramidinanattempttoexplainthedepthofECC’spenetration.TheECCM&Mpyramidisattachedbelow.

Results: ECC has a low rate of associated fatality and a high rate of dysfunc-

tionandsotakesontheclassicalpyramidshape.AnM&Mpyramidprovidesobservation of both the measure of consequence and the ability to relate that to otherconsequences.Forinstance,foreachdeathfromECCortreatment,therewillbecertainnumberofhospitaladmissions,missedschooldays,orepisodeofpain-induceddifficultyineatingorsleeping.ThestudyofM&Mcanhighlightthemagnitudeofadisease’seffectsonsociety.Throughthisanalysis,healthcareprofessionals can better direct resource allocation and utilization of services to maximizepreventionandtreatment.AnM&Manalysiswillrepresentdimen-sionsofadiseaseinarangeofpatients,fromlowrisktohighrisk,andthuswillprovideinsightintoassociatedexpendituresandlossofhumancapital.

Hospitalcostsareplacedtowardsthetopofthepyramid.Inmanyhospitals’emergencydepartments(ED),dentalpainisamaincauseofpediatricadmis-sion.FamiliesseekEDdentalcareformanyreasonssuchaslackofaprimarydentist,inabilitytopayadentist,theperceptionthattheirchildisinseriousdangerorpain,ortheconvenienceoftheED.OftentheEDdentalinterventionislimitedtomanagementofpainandinfection,andnotaddressingthesourceofinfection.Asaresult,thatleavessignificantcosttothepatient,thehospital,andsociety.NumerousEDadmissionsbecomeprolongedhospitalizationsforman-agementoffacialcellulitis.TreatmentundergeneralanesthesiaforextensivedentalrepairisanothercostlyandriskyconsequenceofECC.ItisestimatedthattensofthousandsofyoungchildrenintheUnitedStatesundergodentalrehabili-tationundergeneralanesthesia.Thecostsoftheseservicestofamiliesandthepublicareextensive,especiallywhenconsideringthatdentalcariesislargelyapreventabledisease.Adverseeventsinsedationandgeneralanesthesiaplacepediatricpatientsatthehighestrisk.

ECCisalsorelatedtochildren’sabilitytoplay,toattendschool,eat,andsleepandhasbeenshowntohavenegativeeffectsonachild’sgrowth.ECCalsocanaffectatthelevelofthefamily.Onestudyconcludedthatadysfunctionalfamily

canleadtoarecurrenceofECC.Unfortunately,theimpactofECConcommunitiesisjustbeginningtoberealized.RecentlyadoptedpoliciesconcerningECCwillallowchildrentocomeintodentalofficesfarearlierinordertopreventdentalcaries.Theseearly interventions have been shown to be cost effective and cost saving but will require an increase inworkforceandhealthcosts.

Conclusions:ECChasalarge,sometimesnotapparent impact on society and the health care system.Thisrecognitionwillreinforceoralhealthplanninginthefuture.ECCisstronglylinkedwithvulnerablesubpopulations,childrenofimpov-erished,minorities,orimmigrants.Insummary,“MeaningfulassessmentsoftheeffectofECConchilddevelopment,learning,andfamilyfunctionandtheeconomicburdensitplacesonfamilies,com-munities,andthehealthcaresystemareneededtodescribe the importance of this preventable disease adequately”.TheepidemicofECCwillcontinuetoputthehealthandlivesofchildrenatriskuntilacomprehensiveassessmentisdeveloped.

Dr. Jo K. Cronly is a resident in pediat-ric dentistry at Virginia Commonwealth University.

AbstrActs


Scientific

Sankenshwari RM, Ankola AV, Tangade PS, Hebbal MI. Feeding Habits and Oral Hygiene Practices as Determinants of Early Childhood Caries in 3 to 5 year-old Children in Bel-gaum City, India. Oral Health Prev Dent 2012; 10(3): 283-290

Background:EarlyChildhoodCaries(ECC)isaseriouspublicconcern,especiallyamongfinanciallydisadvantagedsocialgroupsinbothdevelopedanddevelopingcountries.EarlyChildhoodCarieshasbeendefinedinthisstudyas“decayed,missingorfilledtoothinprimarydentitionunder71monthsofage”andSevereEarlyChildhoodCaries(SECC)as“anysmoothsurfacecariesinlessthanthreeyearsofage”.

IthasbeenobservedthatchildrenwithSECCsufferfromsignificantlylowerheightandweightwhencomparedtochildrenwithoutECC.ECCisapotentialriskmarkerforanemiainchildrenwithirondeficiency.PediatricdentistsshouldrecommendregularevaluationofironlevelsinpatientswithSECC,regardlessoftheirgrowthrecord.

Purpose:Investigatetheexistenceofanyrelationbetweenfeedinghabitsandoral hygiene practices and the prevalence of ECC among preschool children in BelgaumCity,India.

Methods:Thisisacross-sectionaldescriptivestudy.Thepilotwasconductedintwostages.InthefirststageaquestionnairewaspreparedinEnglishandtrans-latedtoMarathiandKannadalanguages.Twentyclose-endedquestionswereaskedpertainingtosociodemographicparameters,feedinghabits,dietandoralhygienepractices.Inthesecondstage,afinalquestionnairewith50questionswasgiventothemotherandtheirchildrenwereexaminedforECC.Subjectswereobtainedfrom12pre-schoolsand8Anganwadis(Hindifor“courtyardshel-ter”–state-runfacilitiestohelpcombatchildhoodhunger).Thesamplesizewasestimatedtobe1,250.Childrenaged3to5yearswhoseparentshadconsentedtobepartofthestudy.Thisstudywascompletedinthreemonths.Dentalexami-nations were carried out in the schools under natural light using mouth mirrors andcommunityperiodontalindex(CPI)probes.DentalcarieswasassessedusingtheWHOdentitionstatusanddmftwascalculatedbasedonthesame.

Results:Of1,250subjects,approximately1,086werebreastfed.InregardstothedurationofbreastfeedingandECCprevalence:(0-3months)52.7%present-edECC,(4-6months)74.07%,(7-12months)62.34%,(13-24months)58.04%,(25-36months)75%.TheprevalenceofECCwasalsohigherinchildrenwhowerefedatnight(eitherbreastfedorbottlefed),butnostatisticalassociationbetweenthetwowasfound.

Conclusion:ChildrenwhoarebreastfedareatasignificantlylowerriskofbeingaffectedbyECCthanchildrenwhoarenotbreastfed.Breastfeedingforlessthan6 months and more than 24 months was found to be statistically associated with theprevalenceofECC.Theageatwhichoralhygienepracticesforchildrenarestarted and parental assistance with oral hygiene practices were all found to be protectivefactorsagainsttheriskofECC.

Dr. Marcela Mujica is a resident in pediatric dentistry at Vir-ginia Commonwealth University.

Niji R, et. al. Maternal Age at Birth and Other Risk Factors in Early Childhood Caries. Pediatr Dent 2010; 32(7): 493-8

Background: The classical understanding of dental caries has been described asdietarycarbohydratemodifiedbacterialinfectiousdiseasewiththefocusonmicro-organisms,sugarconsumptionandoralhygienehabits.Contemporaryemphasishasbeenonearlychildhoodcaries(ECC)anditsglobalimpactinspecifichigh-riskgroups.Anewmovementwithinpediatricdentistrybelievethatdentalcariesshouldbetreatednotsimplyasainfectiousdisease,butasasocialandbehavioralcondition.Tothepoint,childrenwhosemothershavelesseducationandlowerincome,andthosewhoweredeeplyreligiouswerefoundtohavehigherrisksforECC.

Purpose: The goal of this study is to identify the impact of the mother’s age and otherchildcarepracticesonchildren’shealth.

Methods: There were 646 mother-child pairs who participated in the commu-nityoralhealthprogramatages1.5–3yearsofageinTokushimaPrefecture,Japan.Examinationsofchildrenwereconductedfrom1992–2005.Question-naireswerecompletedbytheaccompanyingmotherswithanswersverifiedbyexaminingdentistduringaninterview.

Clinicalexaminationswereperformedbythreecalibratedpediatricdentists(Kappascoresmean=0.95)CariesscoringwasbasedonWorldHealthOrgani-zation(WHO)methodology.Cariesactivitytest(CAT)

Results: Therewere646mother-and-firstchildpairsandthemothers’agesatbirthrangedfrom17-47yearsold.Twelvepercentofmotherswere27yearsold,13%werebetween17-22yearsold,82%werebetween23–34yearsold,and5%werebetween35-47yearsold.

Themeancariesprevalenceamong3year-oldswas41%.Thecariespreva-lencewashigher(63%)inchildrenbornfrom17-22year-oldmothersvs.themean,andcomparativelylower(38%,34%)inchildrenof23-34year-old,and35andoldermothers.

Cariesactivitytestsvaluesofchildren1.5yearsofagewerenotsignificantlydifferentcomparedtootherages(P<.001).

Conclusion: Thereisastrongcorrelationbetweenyoungmaternalage,specifi-cally22yearsoldandyounger,andECC.Latechildbearingageswerenotanimportantfactorforcaries.Oralhealthprogramsthatfocusonyoungandnewlyexpectantmothersandhigh-riskchildrenarecriticalfactorstoimprovechildren’soralhealth.

Dr. Brian Burke is a resident in pediatric dentistry at Virginia Commonwealth University.

AbstrActs


Scientific

Martins-Junior PA, Oliveira M, Marques LS, Ramos-Jorge ML. Untreated Dental Caries: Impact on Quality of Life of Children of Low Socioeconomic Status. Pediatr Dent 2012; 34(3): 49-52.

Background: Whiletheprevalenceoftoothdecayhasdecreased,thedistributionofthediseaseremainsuneven,mostlyaffectingindividualsfrompoorerregions.Fewstudieshaveevaluatedtheoralhealth-relatedqualityoflife(OHRQoL)asitrelatestotoothdecayinchildrenandadolescents.Childrensufferingfromtoothdecayexperiencepain,problemswitheating,chewing,smiling,selfesteem,andcommunication.Alsoimpactedarethegeneralhealth,dailyactivities,schoolattendance,scholasticachievementandsubsequentlysocialrelationshipsofthesechildren.Knowinghowtoothdecayaffectsthequalityoflifeofchildrencanhelpdentistsinmakingclinicaldecisionsandencouragethesedentiststosupportoralhealthpublicpolicies.However,littleisknownabouthowtoothdecayaffectsthesocial interactions and psychological well-being of children who do not have ac-cesstodentaltreatment,orhowthesechildrenandfamiliesperceivetheirqualityoflifeisaffectedbythetoothdecay.Purpose: This study’s purpose was to evaluate the impact of untreated tooth decayontheoralhealth-relatedqualityoflife(OHRQoL)ofchildrenfromfamiliesoflowsocioeconomicstatus.

Methods: This was a cross-sectional study involving randomly selected children ageseighttotenyearsoldfrompublicschoolsinshantytownsinDiamantina,MinasGerais,Brazil.Theparticipantswerefromfamiliesoflowsocioeconomicstatus.Theparticipantsweredividedintotwogroups,thosewithouttoothdecayandthosewithuntreatedtoothdecay.Datawascollectedthroughinterviewswiththechildrenandaclinicalexamination.TheChildPerceptionQuestionnaire(CPQ)wasusedtodeterminetheimpactoftoothdecayonthechildren’sdailylives.Thisquestionnaireaddressed25itemsincludingoralsymptoms,functionallimitations,emotionalwellbeing,andsocialwellbeing.TheclinicalexaminationwascompletedattheschoolandwasbasedonthecriteriaoftheWorldHealthOrganization.Theexamwasperformedby2traineddentistsand1trainedassistant.Descrip-tiveanalysis,Mann-Whitney,chi-squaretest,andhierarchicallyadjustedPoissonregressionmodelswereused.

Results: The study recruited 112eighttotenyearolds.Therewasa100%responserate.Responsesshowedthosewithuntreatedtoothdecayhadaworseperceptionoftheiroralhealth.Thestudyrevealsthenegativeimpactofuntreatedtoothdecay,regardlessofgender,age,ormalocclusion.Discussion: This study shows how children from families of low socioeconomic status with untreated tooth decay have a negative perception as it pertains to their oralhealthstatus.Theyperceivetheiroralhealthstatustobefairorpoor.Theenvironmentinwhichthesechildrenareraisedalsoinfluencestheirhealthbehav-iorandunderstandingoforalhealth.TheoralsymptomssubscalesoftheCPQachievedhighermeanvaluesthantheemotional,socialwell-being,andfunctionallimitationssubscales.Theresultsalsoshowthatwhilethechildrenareconcernedwiththeappearanceoftheirteeth,theydonotattempttohidetheirsmile.Thefindingsalsosupportpreviousliteraturethatshowseighttotenyear-oldsarebeginningtodevelopglobaljudgmentsregardingself-perceptionandself-esteem.

Conclusions: Twoconclusionscanbemadefromtheresultsofthisstudy:1. Tooth decay has a great impact on the functional and biopsychosocial

aspectsofthedailylivesof8-10yearolds.2. Childrensufferingfromtoothdecayareatagreaterriskofadecreased

qualityoflife,regardlessofage,gender,ormalocclusion.

Dr. Erika Lentini is a resident in pediatric dentistry at Virginia Commonwealth University.

Plonka KA, et. al. A Randomized Controlled Clinical Trial Comparing A Remineralizing Paste with an Antibacterial Gel to Prevent Early Childhood Caries. Pediatr Dent 2013; 35(1): 8E-12E(5)

Background:ManyfactorscontributetoEarlyChildhoodCaries(ECC),includ-ing early colonization of mutansstreptococci(MS),lackofgoodoralhygieneandfrequentconsumptionofsugars.TherearemanyagentsthathavebeenproventoreducetheMScount.Previousstudieshavefoundthatusingalowfluoridechildren’stoothpasteresultsinMSremoval,andthereislessECCinchildrenwhobrushregularlyversusthosewhodonot.Althoughtherearemanydenti-fricesavailablewithbactericidalactivityandremineralizingability,littleisknownorhasbeenstudiedabouttheireffectivenessinpreventingECC.Purpose: The purpose of this study was to compare casein phospopeptide-amorphouscalciumphosphate(CPP-ACP),chlorhexidinegel(CHX)and0.304percentfluoridetoothpasteforreducingmutans streptococci colonization and preventingearlychildhoodcariesinalowsocioeconomiccommunity.

Methods: Mothers of healthy children who were seen at community health facilitiesinalowsocioeconomicstatusdistrictofQueenslandwereapproachedforthestudy,44daysafterbirth.Thestudyaimedfor600participants(200pergroup).Childrenwereexaminedattheirhomesat6,12and18monthsofageandatthecommunitydentalclinicat24monthsofage.Ateveryvisit,calibratedexaminersevaluatedthechildrenforcavitationsandwhitespotlesionsandtooksamples from the children’s tooth surfaces and spread them on agar strips con-tainingMSandlactobacilliselectivemedia.Participantswererandomizedtouseeither10%CPP-ACPtopicalcream,0.12%CHXgelornoproductaftereveningtoothbrushing.Oralhealtheducationwasgivenbeforethevisitwasoveraswell as a questionnaire to assess compliance and the child’s feeding and oral hygienehabits.Thedatawasanalyzedtodeterminetheeffectofthepreventiveagentsoncariesratesat12,18and24months.

Results:Atotalof542patientswereseenaftera24-monthperiod.Thecariesincidencewas1%intheCPP-ACPgroup,2%intheCHXgroupand2%inthestandardcontrolgroup.AmongthoseoriginallycolonizedwithMSat12monthsofage,nochildrenintheCPP-ACPgroup,22%ofchildrenintheCHXgroupand16%ofchildreninthestudycontrolgroupcontinuedtoharborMSafter24months.AmongthoseoriginallycolonizedwithMSat18monthsofage,5%ofchildrenintheCPP-ACPgroup,72%intheCHXgroupand50%inthestudycontrolgroupremainedpositiveforMSafter24months.

Conclusions: ChildreninthegeneralcommunityarelikelytobenefitfromusingCPP-ACP,whichwillboostthepreventiveeffectsoftoothbrushingduetoitsremineralizingandantibacterialactivities.SinceCPP-ACPandCHXworkviadifferentmechanismsofaction,acombinationofthetwoproductsislikelytoproduceadditivebeneficialeffectsforpreventingECC.Theseagentsarenotareplacementfordailytoothbrushingwithfluoridetoothpaste,butareadjunctiveintreatment.

Althoughpresentdatashowsthat,whenapplieddailyfromthetimeoftootheruptionto24monthsofage,CPP-ACPhasthegreaterabilitycomparedtoCHXtoreduceMSlevels,thereisinsufficientevidencetojustifydailyuseofCPP-ACPorCHXgeltocontrolearlychildhoodcaries.

Dr. Tiffany Williams is a resident in pediatric dentistry at Virginia Commonwealth University.

AbstrActs

45

ScientificPathologyPuzzlerwith Dr. John Svirsky

Afifty-nineyearoldwhitefemalewasseeninitiallybyalocaldentistinMarch2012withanuneventfuloralexamination.Herpastmedical history was reviewed and included medical management ofchronicfatigue,fibromyalgia,hormonereplacementtherapyandaherniateddisk.HermedicationsincludeVicodin®,Flexeril®,estradiol,probiotics,Fiberpsyll®,Savella®,Zomig®,Amerge®,VitaminD,Calcium,Dehydroepiandrosterone,Magnesiumcitrateandfishoil.

OnOctober6,2012,athernextappointmentthepatientpresentedwitharaisedlesionoftheleftcheekoffourweeksduration,sec-ondarytoacheekbite(accordingtothepatient).(Figure1)Priorto this appointment the patient saw a physician who recommended thatadentistevaluate.Thedentistatthisappointmentdidanincisionalbiopsy.

Whichofthefollowingshouldbeincludedinadifferentialdiagnosis?

1. Fibroma2. Lipoma3. Papilloma 4. Peripheral giant cell granuloma5. Pyogenic granuloma6. Salivary gland tumor7. Traumatic ulceration8. Verrucouscarcinoma

AVelscope®photograph(Figure2)isattachedshowingthelackoffluorescence.Doesthischangeyouropinionorhelpdiagnosethelesion?Theansweris,No!

Figure 1 Figure 2

Continued on page 46

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Scientific

PathologyPuzzlerwith Dr. John SvirskyLookingattheclinicalphotograph,Ifeltthatitwasa1.0cmby0.8cmlesionwithaverrucous/papillaryappearance.Basedontheclinicalpicture,Ithoughtallbutthepapillomaandtheverrucouscarcinomacouldbeexcluded.

Afibromawouldhaveasmoothsurfacetextureandbeofnormalmucosalcolorunlessbeingchewed(thenthesurfaceofthefibromamayhavewhiteareas).Fibromasarenormallyhyperplasiasecondarytotraumaratherthanatruetumor.

Alipoma,likethefibroma,wouldhaveasmoothsurfacetextureandbenormalmucosacolorifdeeperandayellowishcolorationifsuperficial.Theyarefarlesscommonorallythanfibromas.

Apapillomawouldhavethissurfacetexturebutnormallydonotreachthissize.Nowwiththeassociationoforalcancerandhumanpapillomavirus,the“fearindex“ofaclinicaldiagnosisofpapillomahasgoneup.HoweveronepapillomadoesnotHPVmake.AnumberofpatientsareundergoingHPVsalivatest-ing,butIamnotinfavorofthis.ThepercentageofthepopulationthatisHPVpositiveishighcomparedtothesmallnumberofpeoplewithHPVrelatedoralcancers.Salivatestsgivepatientsareasontoworryaboutanoutcomethatisimpossibletopredict.Ifeelthesamewayaboutwholebodyscanstofindoccultlesions.Moreunnecessarysurgerywillbedonetofindthingsthatwillneverbeaproblem.

Aperipheralgiantcellgranuloma(PGCG)wouldnotbeconsideredsincethislesiononlyoccursontissuethatisonornearthegingiva.AlsothesurfaceofaPGCGcouldbeulceratedbutnotpapillary.

ApyogenicgranulomahasthesameclinicalappearanceasaPGCGbutcanoccuranywhere.Newlesionsarevascular(granulationtissue)withsurfaceulceration and as they mature they become the color of normal mucosa (more fibrous).Theyactuallybecomeafibromawhenfibrosed.

Atraumaticulcerationisusuallyflatandattimeshasahyperkeratotic“collar”.Theywouldnothaveapapillarysurfacetexture.Theulcerationtypicallyhasabrown,necroticappearance.

Thelesionturnedouttobeaverrucouscarcinoma(VC)(Figures3&4)whichinrealityisanexophyticsquamouscellcarcinoma.ThislesionappearstobeanearlyVCsinceitissmall,wellcircumscribedandhasaverrucous/pebblysurfaceappearance.Verrucouscarcinomasarethelesionsmostcloselyassociatedwithhumanpapillomavirustype16.Thislesionistypicallyfoundinmenwithanaver-ageageof65-70.Alesionofthissizeshouldhaveanexcellentprognosissinceitwasdiagnosedearlyandwasonlyacentimeterinitsgreatestdimension.

ThiscasewassubmittedbyDr.StanleyKayes,ageneraldentistinprivatepracticeinHaymarket,Virginia.

Figure1:A1cmby.8cmelevatedlesionwithapapillaryappearanceoftheleftbuccalmucosa.

Figure2:AVelscopepictureshowinglackoffluorescenceinandaroundthelesion.

Figure3:Histologicpictureshowingparakeratinclefting

Figure4:Histologicpictureshowingabroadreteridgewithdysplasticchanges

Figure 3

Figure 4

Contined from page 45


Scientific

ABSTRACTPalatopharyngealinsufficiencyisaconditionthatresultsfromthecleftofthepalatalregion.Itinducesnasalregurgitationofliquids,hypernasalspeech,nasalescape,disarticulationsandimpairedspeechintelligibility.Rehabilitationofpalatopharyngealinsufficiencyrequiresaninderdisciplinaryapproach.Asaresult,thepatientcanbesociallyandphysicallyrehabilitatedwiththeimprovedfunction.Thisarticledescribesaclinicalcaseseriesofararecongenitaldisorder,oralsubmucouscleft,andsoftpalatecleft.Asystematicdiagnosisandtreatment plan has been described which involves mainly a prosthodontist and aspeechtherapist.Thepatients’phoneticswereconsiderablyimprovedafterwearingtheprostheses.

INTRODUCTION Cleftsofthepalatemaybecongenitaloracquired.Partialorcompletelossofthesoftpalateresultsininsufficientstructureoralteredfunctionoftheremainingstructuretoprovideclosurewiththepharynx.Theprostheticrehabilitationofthesedefectspresentsachallengetoclinician.Insuchasituation,anobturatorprosthesis is designed to close the opening between the residual hard palate and/orsoftpalateandthepharynx.Thesubmucosalcleftisaconditionwhichischaracterizedbyseparationofmusclesinthesoftpalate,andbythebluishhueinposteriorsoftpalate,displacedmusculature,attenuatedrapheand/orbifurcationofuvula.1

Thespeechdisorderinsuchcasestakestheformofdysarthria2 which manifest moreinresonancethanarticulationdisturbance.

The production of speech sounds is a phenomenon of several highly integrated factorswhichKantnerandWestdividedinto:(1)respiration,(2)phonation,(3)resonation,(4)articulation,and(5)neurologicintegration. 3

Prostheticrehabilitationofthemaxillofacialregionhasplayedanimportantroleinimprovingthequalityoflifeofpatientswithcongenitalmaxillarydefects.4 CLINICAL REPORT Case 1A 26 year-old female patient reported to the clinic with the chief complaint ofaspeechdefect.Thepatient’smedicalhistorywasunremarkable.Patientspeechexaminationrevealedimpreciseconsonantproduction,distortedvowels,hypernasality,harshvoicequalityandslowspeakingrate.AV-shapedgroovewasobservedintheposteriormedianpalatalregionwhilepronouncing‘AH’.(Fig1a) Case 2A 19-year-old male patient was referred to The Department of Prosthodontics fromTheDepartmentofPlasticSurgery.Thepatienthadnasalregurgitationofliquids(sometimesfood)andhypernasality.Examinationofthenasalresonance

Prosthetic Rehabilitation of Palatal Incompetence A Clinical Case SeriesBy: Dr. Lakshya Kumar MDS1,Dr. Kaushal K. Agrawal MDS1,Dr Saumyendra V. Singh MDS1,and Dr. Kamleshwar Singh MDS1

wasdonebyalternatingclosureofthenoseduringrepeatedpronunciationof/i-a/and/u-i/duringconnectedspeech,andbothmarkedhypernasalityandnasalescapewereobserved.1(Fig1b)Oralendoscopicexaminationshowedthesizeandshapeofadefectpresentonposteriorpartofthepalate.(Fig5a&5b) CLINICALPROCEDUREPrimaryalginateimpressions(Zelgan;DentsplyIndiaPvt.Ltd.,Gurgaon,India)weremadeforboth.(Fig.2)Theimpressionswerepouredwithdentalstoneandadiagnosticcastwasprepared.Onthediagnosticcast,aspecialtrayof

self-cure acrylic was fabricated(Pyrax;PyraxPolymer,Roorkee,India).

Case 1 A special tray was made of self cure acrylic with a wrought wire loop incorporated,verticallydirected in the pharyngeal portionoftray.Softenedhigh-fusing modeling compound(Pinnacle;DPI,Mumbai,India)wasplaced on the vertical extension,shaped,andflamedtocreateasmoothsurface.Afterplacing

the hardened compound in the oral cavity the patient was allowed to wear the palatalliftforseveralminutestobecomefamiliarwiththesensationofthelift.Small additions were made to the compound posteriorly until the soft palate was broughtintolightcontactwiththeposteriorpharyngealwall.Thehigh-fusingmodelingcompoundwasthenaddedlaterally.Followingeachaddition,thepatientwasaskedtobreathethroughthenoseandattemptspeech.Thepatientatthisstagewasaskedtospeak‘b’and‘p’.

Oncetheresultsweresatisfactorythecompoundwasreducedby1-2mm.Onthis,zincoxideeugenolimpressionmaterialwasadded(ideallymouthtemperaturewax)andthenreinsertedinthepatient’smouth.Thepatientwasaskedtospeak,swallowwater,andmovetheheadinalldirections.(Fig.3a)

Case 2 Aretentivewroughtwireloopof6mmdiameterwasextendedposteriorlyfrompalatalportionofmaxillaryrecordbasetofacilitateplacementandretentionofimpressionmaterialintopharynx.High-fusingmodelingcompoundwasaddedinto the defect area to the retentive loop posteriorly in order to serve as the tray forsubsequentadditionsoflow-fusingcompound(Greenstick;DPI,Mumbai,

India). Duringmoldingofwarmedlow-fusingcompoundonretentiveloop,thetraywasinsertedinthepatient’smouth.Thepatientwasaskedtoflextheneckfully,andtorotateleftandright.Whenbordermoldingwascompletedaroundtheentireperiphery,therewasnoescapeofliquid from the oral to nasal cavities and the articulation of plosive soundssuchas“b”and“p”andnasalconsonants“m”,“n”,and“ng”wasimproved.5


Low-fusingcompoundwasreducedevenly(1-1.5mm)onallperipheralsurfacesoftheobturator.Acoatingoftissueconditioner(Visco-gel;Dentsply,DeTreyGmbH,Germany)wasusedtotakefinalimpressionofobturatedportionoftheprosthesis.(Fig.3b) Afterfinishingandpolishing,thefinalpositionandcontourofobturatorwasdeterminedwithprosthesispositionedintothemouth.(Fig.4a&4b)

Pressureindicatingpastewasusedtoevaluateexcessivepressureareasandthoseareaswerethenrelieved.Thepatientwasinstructedtoweartheprosthesiscontinuouslyaslongassheiscomfortable.The patient was also instructed to determine the value of wearing the prosthesisduringeating.Thepatientwasinstructednottoweartheliftprosthesisduringnightasitwasnotrequiredandmoreover,thiswillallowthemucosaofthepalatetorecover.

DISCUSSIONA palatal lift functions best when there is residual function of the superior constrictor muscles and is especially effective if the levator muscles still havesomeabilitytocontract.Apalatalliftshouldnotcompletelyoccludethe nasopharyngeal port for hypernasality to be eliminated as this will in turn,causeinabilitytobreathethroughthenoseandhyponasalspeech.Wearing a palatal lift prosthesis that completely eliminates nasal breathingmayalsoreducethepatient’swillingnesstowearthedevice.In1967,Langrecommendedtheuseofapalatalliftprosthesisfortheneurologicallycompromisedpatient,providedconcomitantspeechtherapywasoffered.6

Nasal endoscopy is the method of choice to evaluate the effect of the palatallifttherapy.Reductionofhypernasalityisnotlikelytooccuruntilthelateralextentoftheliftisincreasedsufficientlytoreducethesizeofthelateralports.

Soundslike‘b’and‘p’areplosivesoundswhichrequirehighintraoralpressure.Thepalatopharyngealvalvingmechanismregulatesresonationandspeechutteranceandpartakesinnon-speechoralactivitiessuchasswallowing,blowing,sucking,andwhistling.7,8Palatopharyngealinsufficiencyimpliesthepresenceofhypernasality,inappropriate nasal escape and decreased air pressure during the productionoforalspeechsounds.

Follow-upandspeechtherapy:-thepatientswererecalledaftertwodaysandoneweek.Duringthefollow-upappointments,themucosaoverthepalatewascloselyobserved.Thepatientswereabletoweartheprosthesiscontinuouslyoveraperiodofoneweek.ThepatientswerethenreferredtoaDepartmentofENTforspeechtherapy.

SUMMARY AND CONCLUSIONThe purpose of this case series is to present a clinical condition which requires amultidisciplinaryapproachforproperrehabilitation.Remarkablechangeswerenotedinhypernasality,nasalregurgitationoffoodandliquidimmediatelyafterinsertionoftheprosthesis.

1 Department of Prosthodontics, Faculty of Dental Sciences C.S.M. Medical University (Upgraded KGMC), Lucknow (Uttar Pradesh)

CORRESPONDANCE:DrLakshyaLumarFlat-205,NewTeacher’sApartment,TGCampus,KhadraLucknow.(UttarPradesh)INDIAMobile – 09412119778E mail address – [email protected]

REFERENCES

1. Glossaryofprosthodonticterms.JProsthDent1999;81:88-89.2. DarleyFL,AronsonAE,BrownJR.Differentialdiagnosticpatternsof

dysarthria.JSpeechHearRes1969;12:246-693. KantnerCE,WestR.Phonetics.NewYork:HarperandBrothers;

1941.4. BeumerJ,CurtisTA,MarunickMT.MaxillofacialRehabilitation.St.

Louis,IshiyakuEuroAmerica,Inc;1996:225–284.5. EckertSE,DesjardinsRP,TaylorTD.Clinicalmanagementofthesoft

palatedefect.ClinicalMaxillofacialProsthetics.HanoverPark,Illinois:QuintessencePublishingCo,Inc.2000.p.121-31.

6. LangBR.Modificationofthepalatalliftspeechaid.JProsthDent1967;17:620-6

7. BeumerJ,CurtisTA,MarunickMT.Maxillofacialrehabilitation:Prosthodontic andsurgicalconsiderations.StLouis:IshiyakuEuro-America;1996.p.285-329.

8. SprintzenRJ,BardachJ.Cleftpalatespeechmanagement.StLouis:CVMosby;1995.p.263-8

LEGENDSFig1a&1b-ThedefectFig2-Primaryimpressionofdefect.Fig3a&3b-ImpressionofthedefectFig4a&4b-FinalprosthesisinsertedFig5a&5b-Closureofdefectpreandpostprosthesisfabrication



RepresentingVirginia’sdentistsattheADAHousehasbeenanhonor,privilegeandforme,anecessity.Ilovemyprofessionand have an aversion to all those whoknowlittleornothingofourgrandlife’sworkandtellushowourprofessionshouldberun.Ifwedonotstandtogetherandvigilant,awellmeaninggovernmentandprofitmotive driven insurers will drive the professionIlove.Ihaveenjoyedmy stay but this will be my last elec-tion.Youngercolleaguesmuststepupandkeepourprofessionviableandforthebenefitofourpatients.

Dr. David Anderson

Candidate for the office of:

ADA Delegate

TheVirginiaDentalAssociationisuniquely positioned to represent the interests of thousands of dentists throughoutourstate.Theirconcernsregardingkeyissuessuchas:accesstodentalcare,dentaleducation,thedentalworkforce,studentconcerns,andmembershipmustbeaddressed.Leadership through cooperation and aclearvisionoftheVDA’sfutureareessential to our continued growth and prosperity.Ihavebeenprivilegedtoserve as an Alternate Delegate for the pastsix-years.IfelectedtoserveasaDelegatetotheADAHouse,Iwilldedicate my years of proven leadership inthemilitary,academics,administrationand community service to advance the goalsoftheVDAandourprofession.

Dr. Fred CertosimoCandidate for the office of:

ADA Delegate

2013 VDA Elected Leadership Candidates

Dr. Steven ForteCandidate for the office of:Secretary/Treasurer

It has been an honor and a pleasure toservetheVDAasyourcurrentSec-retary/Treasurer. Over the past 18months I have learned a lot about the activities of our organization and the wonderful people who give much of their time and abilities to see that we maintainaviableorganization.Over-all,wehaveastrong,financiallystableassociation,butmanychallengesareahead of us to assure that we sustain our status as a leader amongst other dentalassociations.IamproudtobeanactivememberoftheVirginiaDen-talAssociationandIaskforyourvoteforasecondtermasyourSecretary/Treasurer. I will continue towork tothe best of my ability, to serve ourmembership and the Board of Direc-tors. Thank you very much for yourconsideration.

Dr. Michael Link


President Elect

ForthepastfouryearsithasbeenmyhonortoserveontheVDABoard of Directors representing Componenttwo.IalsoserveasanADAAlternateDelegate,andhave held this position for the past sevenyears.Previously,Iservedour profession in other leadership positions,includingPresidentoftheVirginiaBoardofDentistry,chairmanoftheVirginiaChaptersofthePierreFauchardAcad-emy and International College of Dentistry.

Currently,IamtheChairmanoftheVDAPublicRelationsTaskForce.TheTaskForcewascharged with devising a unique plan to bring more members into

theVDA.OurMembersneedtofeelthattheirVDAisrespondingtotheirneedsandispertinentintheirdentalpractices.TheVDAneedsto be more responsive and relevant to our members in order to bring themvalueinbeingamemberinourassociation.Formanyyears,we,Dentists have not effectively communicated our achievements to the public.HowcanthepublicandotherDentistsperceiveouraccomplish-ments and achievements if we do not broadcast our distinguishing goals?Movingforward,theVDAneedstobringabettermessagetoourmembersandtothepublic.

Iamcommittedtoworkingtosolvethemanyproblemsfacingdentistrytoday.Someofourdemandingissuesare:thereductionofmember-shipintheVDA,howDentistrywillbeaffectedbytheAffordableCareAct,theexpansionofanewdentalschoolinthesouthwesternpartofthestate,theinfluenceofthirdpartypayers,thegrowingnumberof large group practice models and reduced access to care for the underprivileged,andthelistcontinuestogroweachyear.OurnewlyelectedADAPresident-ElectDr.ChuckNormanstatedsoeloquentlyinhisaddressattheADAannualmeetingthat,“Wemustadapttochang-ingrealitiesorfacetheprospectofbecominglessrelevant.”AdaptingtorealitiesiswhattheVDAneedstodotostayrelevanttothepublic,legislatorsandtoourmembers.

TheVirginiaDentalAssociationhasbeenblessedwithoutstandingleadership that has positioned us to be the leading authority in Oral HealthcareforVirginia.Indeed,ourleadershiphaslongbeentheenvyamongotherstates.However,wecannotsitbackandrestonourpastsuccess;wemustbereadytoadapttoanever-changingenvironment.Asleaders,weneedtoensurethatwearemakingadifferenceinserv-ingthedentalneedsofthelessfortunate,whilemeetingourmember’sneeds.

Whenitcomestoresolvingissues,Iworkhardtobuildconsensuswhilebeingcommittedtonevercompromisingourcorevalues.What-evertheproblemsare,wecansolvethembyworkingtogether.AsyourPresident,IwilldevotemytimeandresourcestocontinuingthefineworkofthisAssociationwhilemovingusforwardinkeepingtheAs-sociationstrongandrelevant.Iamuniquelyqualifiedtorepresentyou,theDentistsofVirginia,andIrespectfullyaskforyourvote.


Dr. Ralph HowellCandidate for the office of:ADA Delegate

Ourprofessioniscurrentlyexpe-riencing numerous challenges and stressesfrommanyexternalsourcessuchasregulatoryagencies,thirdpartypayers,andpolicymakersthathavenofirst-handknowledgeofthepracticeofdentistry.Whencombin-ing these stresses with the additional problemsofanextendedrecessionandthemanyunknownsoftheAffordableHealthcareAct;itiseasytoconcludethat our Profession and our Associa-tion must adapt and position ourselves ifwearetosurviveinthefuture.Inorder to combat these issues we need to maintain a strong association and to regainourmarketshareofmember-ship.HavingservedtheAssociationin various leadership positions in the past,andcurrentlyservingontheADACouncilonCommunications,IfeelthatI can effectively continue to represent theVDAasaDelegatetotheADA.IhumblyaskforyoursupportfortheofficeofADADelegate.

Dr. Ted SherwinCandidate for the office of:ADA Delegate

Thisissuchanexcitingtimetobeservinginorganizeddentistry.Whetherit is at the state or national level there seems to be great effort to meet the current and future needs of our profession.Iwouldliketocontinuetobe part of the process at the national levelasaDelegatefortheVDA.

During the past eight years of service asanAlternatedelegate,Ihavehadthe privilege to serve four times as District Chair of our Observation Team onBudgetandFinance.Inaddition,IhavehadthehonortoservetheHouseon ADA Board of Trustee Committees for Strategic Planning and Budget andFinance.Thesehavebeenterrificopportunitiestoworkwithothermembers of our District Delegation as well as other delegations to build consensusonkeyissuesfacingourprofession.IaskforyousupportforafirsttermasDelegateinordertobuildonthisexperience.

Dr. Michael Abbott


ADA

Alternate Delegate

It has been my honor over the last several years to serve the VirginiaDentalAssociationinnumerous leadership positions and I previously served my component on the Board of Directors and asyourPresident.Iwouldnowliketofurthermyservicetothe association by respectfully requesting your vote for ADA alternatedelegate.Mycombinationofleadershipexperienceandmanagementtrainingwellqualifiesme to effectively confront the manyexternalforceswhichourprofessioncontinuestoencounter.I pledge to do my best to serve you and represent all members of our associationontheADAdelegation.Thankyouinadvanceforyourconsiderationandsupport.

Dr Vince DoughertyCandidate for the office of:

ADAAlternate Delegate


Dentistry has always been a part of my life.Iwatchedmyfatherpracticewithoutalloftoday’stechnologicaladvances.Somuch change has occurred over the last fortyplusyears.Iwanttocontinuehelpingdirectthechangeinawaythatbenefitsthepracticeofdentistryandourpatients.

Ihavethewill,theconfidence,andthepassionfortheposition.Ipromisetorepresentyouinthebestwaypossible.Serving as ADA Alternate Delegate and aspastPresidentofNorthernVirginiaDentalSociety,Ihaveacquiredleadershipanddecisionmakingskillstoactonyourbehalf.Oneoftoday’scriticallyimportantissuesisaccesstocare.AspastchairoftheVDAtaskforceonaccesstocareandworkforceissues,IfeelIhavetheknowledgetomakeinformeddecisions.Any vote that I cast will be based on the followingquestion,“Doesthisstrengthenthedoctor/patientrelationship?”

Irespectfullyaskforyourvote.Iunderstandthatinfulfillingtheposition,it will be an ongoing responsibility to our profession.Ihopetocontinuetoserveyouinthiscapacityandlookforwardtorepresenting our great state on a national level.


Dr. Paul OlenynCandidate for the office of:ADA Alternate Delegate

Dr Edward WeisbergCandidate for the office of:

ADAAlternate Delegate

As a member of the Delegation to the ADA I have usedmybudgetaryexperiencetohelp scrutinize the ADA Budget Proposals and ensure that our dues dollars are spent in the best possible manner and that any dues increasesarejustified.Ihaveanunderstanding of how the ADA Houseworkstovoicethedesiresofthemembership.Ihavebeenactivein my support of Organized Dentistry andaskforyoursupporttoelectmeasanAlternateDelegate.

TheHouseofDelegatesof The American Dental Association adopts the budget and develops

HavingservedtheVirginiaDentalAssociation as an alternate delegate to theAmericanDentalAssociation,Ifeela great sense of accomplishment and pride.Thehonorofhavingrepresentedthis association at a national level is somethingIwouldliketocontinuewithinthefuture.Inthepast,IhavebeenanactivememberoftheVirginiaDentalAssociation,includingholdingthetitleofPresidentoftheNorthernVirginiaDentalSociety,ChairmanofthePatientRelationsCommittee,andDelegatetotheVirginiaDentalAssociation.Ihave been honored to have had a chance to serve our community in these positions and have felt a great sense of responsibility while serving in these offices.

Ilookaroundandseeafastchangingworld.TheAmericanDentalAssociationneeds to be able to interact with the government at both the state and federal leveltoquicklyandaccuratelyassesshowtheeverchanginghealthcaresystemwillaffectourpatients,ourpracticesandourselves.Iamaskingforyourhelptocontinuetofightagainstcorporateinterventionandgovernmentregulation.Yourvotewillhelpmetofightforthepracticesthatwehaveworkedsohardtobuild,sothattheymaycontinuetothrive.

thepoliciesandprogramsofourAssociation.AsamemberoftheVDAandthe16thdistrictdelegations,IhavebeenactiveinthedelegationandIamseekingtocontinuethisasanAlternateDelegatetotheADA.IamcommittedtoabroaderinvolvementbasewhichwillenhancemycommitmenttotheVDAandservingmycolleagues,itsmembers.IwillbeopenmindedandlistentoanymemberwhohasanopinionandwillformulateapositionwhichwillbestbenefitourVirginiamembersnotjusttheneedsofonlyafew.


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DCA 33539 vda_magazine_ad_MECH.indd 1 3/1/12 6:40 PM


MembershipTidewater Dental AssociationDr.AmenAlemayehu–VirginiaBeach–VirginiaCommonwealthUniversity– 2011

Dr.ArnoldJ.Berger–VirginiaBeach–UniversityofKentuckyCollegeofDentistry – 2010

Dr.LouisC.Berger–VirginiaBeach–UniversityofKentuckyCollegeofDentistry – 2009

Dr.MichaelFolck,II–VirginiaBeach–UniversityofNorthCarolina–2000

Dr.IramaL.Forbes–Norfolk–Uni-versity of Puerto Rico – 2008

Dr.MichaelD.Gigliotti–VirginiaBeach–VirginiaCommonwealthUniversity–2012

Dr.MarkA.LaRusso–VirginiaBeach–UniversityofIllinois,Chicago–1994

Dr.JuliaC.Latham–VirginiaBeach–UniversityofMichigan–2011

Peninsula Dental AssociationDr.MichaelL.Hutchings–Yorktown–UniversityofCalifornia,SanFrancisco– 1980

Richmond Dental SocietyDr.YuriyAbramov–Richmond–StateUniversityofNewYorkatStonyBrook– 2012

Dr.LeslieJ.Fina–Reedville–NewYorkUniversity–2008

Dr.GaryR.Hartwell–Richmond–WestVirginiaUniversity–1966

Dr.JohnM.Peroutka–Richmond–VirginiaCommonwealthUniversity– 2003

Dr.ErikaA.Sachno–Richmond–VirginiaCommonwealthUniversity– 2002

Dr.BhavikSaileshDesai–Richmond–UniversityofPennsylvania–2010Piedmont Dental SocietyDr.MonicaJethwani–Roanoke–UniversityofColorado–2011

Dr.JaveriaMirza–Summerfield,NC–UniversityofMedicineandDentistryofNewJersey–2009

Dr.PeggyLovecchio–Salem–Me-harry Medical College – 2007

Southwest Virginia Dental SocietyDr.SherrySloneBaker–Clintwood–UniversityofLouisville–1996

Dr.ChristopherW.Thurston–Abingdon–VirginiaCommonwealthUniversity–2012

Shenandoah Valley Dental AssociationDr.NoemiCruz-Orcutt–Charlottes-ville–UniversityofIowa–2011

Welcome New MembersDr.JeffDickson–Winchester–Uni-versity of Louisville – 2007

Dr.NicholasA.Minutella–Charlottes-ville–UniversityofMaryland–2011

Northern Virginia Dental SocietyDr.SheilaAgullana–Woodbridge–UniversityofColorado–2011

Dr.RachelA.Agunga–Alexandria–OhioStateUniversity–2011

Dr.MohammadS.Aman–Leesburg–BostonUniversity–2009

Dr.JenniferC.Bobbio–Ashburn–VirginiaCommonwealthUniversity– 2010

Dr.NancySu-FangChang–Arlington–UniversityofPennsylvania–2009

Dr.NeelamJhararDube–Reston–NewYorkUniversity–2011

Dr.RichardB.Grundy–Centreville–VirginiaCommonwealthUniversity– 1995

Dr.JustinM.Hardison–Manassas–UniversityofConnecticut–2009

Dr.MichaelH.Kim–Leesburg-UniversityofMichigan–2003

Dr.SuhadKim–Leesburg–Univer-sity of Detroit Mercy – 2003

Dr.SushantMahajan–Gainesville–UniversityofPennsylvania–2010Dr.MonicaNeshat–GreatFalls–VirginiaCommonwealthUniversity– 2003

Dr.ChuongC.Phan–Leesburg–HowardUniversity–2001

Dr.LarryG.Reyes–Arlington–Uni-versityofMaryland,Baltimore–2011

Dr.KellyD.Richardson–Fairfax–VirginiaCommonwealthUniversity– 2008

Dr.AfreenS.Sayeed–Fairfax–UniversityofTexasHealthScienceCenteratHouston–2010

Dr.ShimaShadman–Vienna–VirginiaCommonwealthUniversity– 2012

Dr.DavidM.Treff–Alexandria–NewYorkUniversityCollegeofDentistry– 2008

Dr.ClaudiaC.Villarroel-Soto–FallsChurch–UniversidaddelValle,Bolivia–1995;Howard–2007

Dr.AnasZainulAbedeen–Freder-icksburg–UniversityofBaghdad– 2003

In Memory Of:

Dr. Dennis ClecknerVirginiaBeachTidewater Dental AssociationMarch1,2013

1. ThefollowingitemswasconsideredandthenotedactiontakenbytheBoardofDirectorsduringmeet-ingsheldinJanuaryandFebruary2013:

A. Approved-Background:TheVDAexecutivedirectornolongerservesastheexecutivedirectoroftheVirginiaDentalAssociationFoundationandtheVDAReliefFund.Therefore,thefollowingBylawchangeisrecommended:

Resolution:InArticleIV,Section4–strikethefollowing: G.g ServeastheExecutiveDirectoroftheVirginiaDentalHealthFoundationandtheVirginiaDentalAssociationReliefFund.

B.Background:Qualitydentalprogramsarevitalforourcitizens’healthandthereputationforthatqualityandrigoroftentakesdecadestobuildwhilerequiringanextraordinaryfinancialcommitmenttosuccessfullyoperate,therefore,beit

Resolution:TheVirginiaDentalAssociation’smembershipisnotinfavorofestablishinganewdentalschoolatBluefieldCollegeinTazewellandplanstotakeanactiveroleineducatingallstakeholdersonthesignificantfinancialrisksofandflawedrationalefortheproposedproject.

VDA Board of Directors Actions in Brief


Advocacy

ThankyouverymuchtosomanyofyouforyourpastsupportoftheVirginiaDentalPoliticalActionCommittee (VADPAC). Yoursupport,alongwithnearly1,500 of your colleagues from across the Commonwealth, has helped to shape our positive and for-ward-lookinglegislativeandregulatorypolicies.Asnotedinthearticlewhichbeginsonpage55,theVDAhadaverysuccessful2013GeneralAssemblyandourmembershipisoftenheldupasamodelforlegislativetriumphandvictory–weneedtokeepitthatway!All100seatsintheHouseDelegatesareupforgrabsinNovemberwhichmakesourparticipationintheformofpeopleandmoney critical in 2013 and beyond. Your participationwillensure we sustain the very positive reputation our members have in the halls of the Capitol and protect the profession for future generations.

Your generosity has played a large part in protecting the dental profession and our patients. Our profession continues to facedown,amongotherthings,anextendedeconomicdownturnandthe threats from and burdensome red-tape of insurance compa-nies,bothofwhichimpactourabilitytoservethemostvulnerablepatients.And, it is for that reason that we must remain more vigilant than ever in protecting patients and our profession. We need your generous support today! If you have not already contributedtoVADPACor,ifyouwouldliketoincreaseyourcon-tribution,[email protected] or 804-523-2185.

VADPAC -- When We Give Together, We Have a Stronger Voice!

Peer Reviewed ٠ Members-Only Benefits ٠ Supporting the VDA

VDA Services is a service mark of the Virginia Dental Association. VDA Services is a pro-gram brought to you by the Virginia Dental Services Corporation, a for-profit subsidiary of the Virginia Dental Association.

FINANCIAL SERVICES For you and your dental office

Credit Cards and CDs 866-438-6262 Bank of America

Practice Financing 800-497-6076 Bank of America Practice Solutions

Patient Financing 800-300-3046 CareCredit Ext. 4519

Collections 804-282-9007 Transworld Systems/Green Flag

PRODUCTS & SERVICES For your dental office

Amalgam Separators 800-216-5505 SolmeteX

Electronic Claims & Merchant ServicesMDE — 866-633-1090 WorldPay — 866-495-6547 Stand-alone credit card transactions or fully integrated credit card and real-time electronic claim transactions through MDE,Worldpay and your practice management software.

Gloves 877-484-6149 VDA Services Gloves

Marketing & Communications 800-210-0355Demandforce

Payroll Services 800-729-2439

Paychex

Website Design 888-466-7975 ProSites

INSURANCE For you, your family and your dental office

B&B Insurance Agency 877-832-9113Full service agency for health (including endorsed Anthem), life, malpractice (including endorsed Medical Protective) home, disability, workers comp., long-term care and much more.



VDA Members are invited to contact B&B Insurance for all of your business and personal insurance needs. In 2000, B&B was recommended by the Virginia Dental Services Corporation and since then we have been working with hundreds of VDA Members to provide comprehensive insurance services. B&B is ready to work with you to evaluate your insurance needs and to provide you with high-quality customer service and an expertise in the insurance needs of the dental community.

Please call 877-832-9113 or visit www.bb-insurance.com to find out more about the VDA Services Insurance Program with B&B Insurance. The licensed agents at B&B are ready to assist you with all of your insurance

needs.

Recommended by:


Advocacy

OneneverknowswhatJanuary’sweatherwillbringtoRichmond.WithsnowfallingthedayandnightpriortothehighlyanticipatedJanuary18event,therewasabitofapprehensioninthecapitalcityandsurroundingareas.

Afewinchesofsnow,however,couldnotstoptheVDAfromcompletingitsmissionontheHill.Theweathermayhaveinhibitedsomefromattending,butitcouldn’tkeepourgroupfromoneofthemostimportantmorningsoftheyearfortheprofessionofdentistryanditspatients.Nearly100dentistsanddentalstudentsarrivedreadyandabletodelivertheVDA’smessagetoGeneralAs-semblymembers.

Day-On-The-HillparticipantswerefamiliarwiththeVDA’sprincipalconcernasthe2013sessionbegan:preservingtheoralhealthcaresafetynetrunprimarilybytheVirginiaDepartmentofHealth.Lastyear,budgetreductionsproposedbytheGovernorposedseriousthreatstooralhealthcareaccessforthousandsofdisadvantagedVirginians.

Youmayrecallthat,in2012,theVDAanditsmemberslobbiedtohavefundingrestoredforlocaldentalclinicsmanagedbytheVirginiaDepartmentofHealth.ThankstothehardworkoftheVDAanditsmembers,weweresuccessful.Budgetmoneywasrestoredfortheseprograms,andtheGeneralAssemblydirectedtheVDHandlocalclinicstakeholderstostudythisprogram.Thatstudywasconductedlastyear.

Unfortunately,thestudydidlittletoassuagetheVDA’sconcernsabouttheprogram.Atthesametime,itwasapparentthatadditionalGeneralAssemblyfunding would be necessary to transition the program to a preventive care model.Inbrief,thismeantthattheVDA’scommitmenttopreservingaccesstooralhealthcarewouldbetestedagain,thistimebythe2013legislativesessionwheretheVDAwouldproposeadditionalmoneyforthetransitionandcontinuetoadvocateformorecosteffectivemeanstomeettheseneeds.

DentistsandVCUdentalstudentsgatheredforbreakfastthatcoldJanuary18morningandreceivedtheremarksofDelegate M. Kirkland Cox before departingfortheHill.DelegateCox,theHouseMajorityLeader,addressedtheimportanceofgrassrootspoliticalactioninachievingbenefitsfortheprofes-sion’spatientsanddiscussedmanyofthekeyissuesthelegislaturewouldbelookingtotackle.

DelegateCox,atirelessandcommittedlegislator,wasintroducedtoDay-On-The-HillattendeesbyhisfriendandVDABoardofDirectors’member,Dr. Sam Galstan.DelegateCox,asDr.Galstanobserved,hasanacuteunderstandingofhowlegislationandthestatebudgetimpactdentistry.Dr.GalstanalsonotedthatCoxhasprovidedaconsistentlyhighlevelofleadershipacrossthehealth-

2013 DAY-ON-THE-HILL SETS STAGE FOR GENERAL ASSEMBLY DELIBERATIONSEnd-of-Session Review Underscores Success of January 18 EventBy: Laura Givens, VDA Director of Legislative & Public Policy

carefieldduringhislegislativecareer.

Day-On-The-HillparticipantsalsoreceivedabriefingfromVDAlobbyistsChuck Duvall,Denny Gallagher and Tripp Perrin. The issues covered in their presentationandtheresultsofVDAlobbyingonthesetopicsduringthesessionareasfollows:

Preserving the Oral Healthcare Safety Net While Local VDH Dental Clinics Transition to Preventive Care:

Asnotedabove,theVDAanditsmembersarecommittedtopreservingaccesstooralhealthservicesforVirginiansinneed.Tothisend,theVDAaskedforapprovalofbudgetlanguageanda$967,944GeneralFundappropriationtocontinuefundingthroughthefiscalyearbeginninginJulyforclinicsmanagedbytheVirginiaDepartmentofHealth.Day-on-the-HillparticipantstoldlegislatorsthattheVDA’sbudgetlanguageconstitutesa“roadmap”forasuccessfultransi-tion to preventive care while the appropriation means that dental services would continueforthousandsofVirginians.

Final Legislative Action:TheGeneralAssemblyapprovedboththeVDA’s“roadmap”budgetlanguageandtheappropriationof$967,944inGeneralFundmoneytocontinueoperationoflocalVDHclinicsinthefiscalyearbeginningJuly1,2014.Thelegislaturealsoappropriated$696,362innon-GeneralFunddollarsfortheseprogramsforthesameperiod.

Medicaid Expansion:Day-On-The-Hillattendeesaskedlegislatorsthatif Medicaidistobeexpanded,thesamepartnersresponsibleforVirginia’ssuc-cessful Smiles for Childrenshouldbeinvolved:DMASanditsDentalAdvisoryCommitteeandtheVDA.

Final Legislative Action:TheGeneralAssemblyestablishedaMedicaidInnova-tion and Reform Commission to oversee the development and implementation of Medicaid reforms beforeVirginiaexpandsthisprogram.RichmondDelegate John O’Bannon,aphysicianandCommissionmember,said,“Medicaid is the fastest growing item in the state budget, and Medicaid expansion without significant reforms could wreck Virginia’s finances. We need to make sure that patient-centered cost saving reforms are fully implemented before we think about moving forward.”TheGeneralAssembly’sapproachtoMedicaidexpansioniscurrentlybeingreviewedbytheGovernor.

Definition of Dental Hygiene:TheVDAsupportedlegislationintroducedbyDelegate Dickie Bell(R-Staunton)tomodernizethedefinitionofdentalhygiene.LegislatorswereinformedduringDay-On-The-HillmeetingsthatDelegateBell’sbill does not change any of the current education and training requirements


fordentalhygienistsnordoesthebillchangeadentalhygienist’s“scopeofpractice”.DelegateBellintroducedthemeasureattherequestoftheVirginiaDentalHygienistsAssociation.Bothassociationsworkedtogethertomakethebillacceptabletodentalhygienistsanddentists.

Final Legislative Action:TheGeneralAssemblyapprovedDelegateBell’sbill(HB1349)onaseriesofunanimousvotesinboththeHouseandSenate.ThelegislationisnowpendingbeforeGovernorMcDonnell.

Affordable Care Act: BeforetheJanuary18DayontheHill,GovernorMcDon-nellannouncedthatVirginiawouldnotestablishitsownhealthcareexchange,deferringinsteadtothefederalgovernment.Nonetheless,itwaspossibleastheGeneralAssemblybeganitsworkthatlegislationwouldbeintroducedtoestab-lishastate-basedexchangeforuseatalatertime.Inthisevent,theVDAaskedthat legislators include a stand-alone dental plan toinsurecompetitivemarketsthatwouldproducemoreconsumerchoiceandbetterpatientbenefits.

Final Legislative Action: TheGeneralAssemblypassedlegislationauthorizingthe State Corporation Commission’s Bureau of Insurance to license and regulate insurers who want to offer policies under the federal program ultimately agreed uponbyVirginiaandfederalauthorities.ThislegislationiscurrentlybeingreviewedbytheGovernorandallsubsequentdevelopmentsinthisregardwillbecloselymonitoredbytheVDA.

New Dental School Proposed:Neartheendofthisyear’sGeneralAssembly

session,theVDABoardofDirectorsaskedthatanumberofamendmentsbeaddedtolegislationdesignedtohelpfundadentalschoolinTazewellCounty.Thisproject,ajointventureofBluefieldCollegeandTazewellCounty,wasthebasis for legislation patroned by Senator Phillip Puckett.IntheVDABoard’seyes,theassociation’samendmentswerenecessarytoensure–at the outset ofthisproject–thatfinancingwouldbeauthorizedonlyiftheSouthwestVirginiaHealthAuthorityreceives“…a prospectus, operational budget, and five-year business plan … together with identification of all revenue and funding resources required to fully meet the five-year operational budget.” WithSenatorPuckett’sgraciousacceptance,theVDA’samendmentswereadoptedbyboththeSenateandHouse.SenatorPuckett’slegislation,Senate Bill 1347,isnowpendingbeforeGovernorMcDonnell.

TheVDAthanksallmemberdentists,VCUdentalstudentsandothermembersofthedentalcommunitywhoparticipatedatthisyear’sDay-On-The-Hill.Wehopethatthiseventwillcontinuetogrowintheyearstocome;areviewofthepastseveralGeneralAssemblysessionscertainlygivesprooftothesuccessandimportancetotheDay-On-The-Hillactivities.

Please mark your calendars to attend the 2014 Day-On-The-Hill: January 17, 2014.

Should you have any questions regarding legislative affairs that have an impact onyourpatientsandyourprofession,[email protected].



Virginia Dental Association3460 Mayland Ct, Unit 110

Henrico, VA 23233

VISIT US ONLINE AT www.VADENTAL.org

Dr.DavidBlackcurrentlyservesontheVDABoardofDirectors as the Component Fiverepresentative.Begin-ningthatjourney,Dr.Black,with diploma in hand from WestVirginiaUniversitySchoolofDentistry,settledinVintonwithwifeBarbara,and opened a solo dental practicein1971.Theusualhardworkofbuildingapracticeensued,butnotwithout thought of giving to hiscommunity. David was instrumental in establishing the BradfordFreeClinicinRoanokeand,asavolunteer,helpeditgrow.Heenjoyed

VDA Member Spotlight: Dr. David BlackBy: Dr. Gene Ayers, Associate Editor, Component 5

teaching radiology for dental assistants at the local community college aswellasservingonnumerouslocalvolunteerboards.Amongthese,continuous service on his church vestry board led him to become involvedindentalmissionarytrips,includingtimespentinBolivia,Haiti,andJamaica.WhenthetimecamehewasanaturalfittoserveaslocalchairmanfortheM.O.M.projectsinRoanoke,Virginia. Dr.BlackhasservedhisdentalcommunityasRoanokeDentalSocietyTreasurer,PresidentofFifthComponent(Piedmont)DentalSociety,VDAHouseofDelegatesmember,ComponentrepresentativeforVADPAC,localarrangementschairmanfortheVDARoanokestate

Dr. Black

meetingandasamemberoftheCouncilonSessions.HisparticipationhasledtorecognitionasaFellowoftheVDAandtheInternationalCollegeofDentists. ContinuingeducationhasbeenDr.Black’spassion.Hehascompletedcontin-uumcourseswiththePankeyInstitute,DawsonAcademyandNash-RosenthalCosmeticDentistryandnumerousindividualcourses.HehasbeenactiveintheAcademyofCosmeticDentistryandtheAcademyofGeneralDentistry.Recent-lyDavidmergedhissolopracticewiththeHarveyDentalGroupforanewdirec-tionforfull-timepracticeemphasizingrestorativeandcosmeticdentistry. Thoughhehasthrivedondentalactivityofallsorts,thereallifefocusforDavidhasbeenhiswife,twodaughtersandsevengrandchildren,thelattermovinghimmoreenergeticallythanever.Likesomanyotherslikehimindentistry,Dr.Blacklooksbackonhiscareer, grateful for the satisfaction and opportunity to serve that dentistry provides.

Dr. and Mrs. Black, grandchildren

vda journal vol 90 number 2 april, may & june 2013

Documents

dental practices

practice ofjames

practice ofthomas

virginia dental journalvolume

practice ofmary gharagozloo

free practice appraisal

john svirsky47

aftco assists dentists