Restorative Dentistry

Journal IDA The JOURNAL of the INDIANA DENTAL ASSOCIATION FALL 2016 VOLUME 95, NUMBER 4 INDENTAL.ORG , 2 000 200 67 Restorative Dentists Restorative Dentistry
Journal IDA The JOURNAL of the INDIANA DENTAL ASSOCIATION  FALL 2016 VOLUME 95, NUMBER 4 INDENTAL.ORG  , 2 000 200 67  Res...
Journal IDA PE RSONNE L The Journal is owned and published by the Indiana Dental Association, a constituent of the American Dental Association, 1319 East Stop 10 Road Indianapolis, IN 46227. The editor and publisher are not responsible for the views, opinions, theories, and criticisms expressed in these pages, except when otherwise decided by resolution of the Indiana Dental Association. The Journal is published four times a year and is mailed quarterly. Periodicals postage pending at Indianapolis, Indiana, and additional mailing offices. Manuscripts Scientific and research articles, editorials, communications, and news should be addressed to the Editor, 1319 East Stop 10 Road, Indianapolis, IN 46227 or sent via email to karen@indental.org. Advertising All business matters, including requests for rates and classifieds, should be addressed to Karen Scharf, 1319 East Stop 10 Road, Indianapolis, IN 46227. A media kit with all deadlines and ad specs is available at the IDA website at indental.org/Advertise. Copyright 2016, the Indiana Dental Association. All rights reserved. Editorial Board Dr. Jack Drone, Editor Dr. Steve P. Ellinwood, Assistant Editor Dr. William B. Risk, Peer Review Editor Dr. Rebecca De La Rosa, Associate Editor Ms. Karen Scharf, Managing Editor Ms. Kari Alting, Advertising Manager Council on Communications Dr. Thomas R. Blake, Chair Dr. Manoj Bahl Dr. Lorraine J. Celis Dr. Jack Drone Dr. Dawn R. Durbin Dr. Ajay Joshi Dr. Megan Keck Dr. Matthew Kolkman Dr. Amanda Miller Dr. Thomas M. Murray Officers of the Indiana Dental Association Dr. Jay Asdell, President Dr. Gregory Phillips, President-Elect Dr. Daniel W. Fridh, Vice President Dr. Thomas R. Blake, Treasurer Dr. Jack Drone, Editor Dr. Jill M. Burns, Speaker of the House Dr. Rebecca De La Rosa, Vice Speaker of the House Dr. Chad Leighty, Immediate Past President Mr. Douglas M. Bush, Executive Director, Secretary Submissions Review Board Dr. Jeffrey A. Dean, Indianapolis, Indiana Dr. Roger L. Isaacs, Indianapolis, Indiana Dr. Joseph H. Lovasko, Hammond, Indiana Dr. Jeffrey A. Platt, Indianapolis, Indiana Dr. Christopher R. Miller, Indianapolis, Indiana A publication of the Indiana Dental Association.
Journal IDA PE RSONNE L  The Journal is owned and published by the Indiana Dental Association, a constituent of the Americ...
CONTENTS www.idainsurance.com 1-800-417-6424
CONTENTS  www.idainsurance.com 1-800-417-6424
Journal IDA C oming Soon New IDA WEBSITE PE RSONNE L The Journal is owned and published by the Indiana Dental Association, a constituent of the American Dental Association, 1319 East Stop 10 Road Indianapolis, IN 46227. The editor and publisher are not responsible for the views, opinions, theories, and criticisms expressed in these pages, except when otherwise decided by resolution of the Indiana Dental Association. The Journal is published four times a year and is mailed quarterly. Periodicals postage pending at Indianapolis, Indiana, and additional mailing offices. Manuscripts Scientific and research articles, editorials, communications, and news should be addressed to the Editor, 1319 East Stop 10 Road, Indianapolis, IN 46227 or sent via email to karen@indental.org. Advertising All business matters, including requests for rates and classifieds, should be addressed to Karen Scharf, 1319 East Stop 10 Road, Indianapolis, IN 46227. A media kit with all deadlines and ad specs is available at the IDA website at indental.org/Advertise. Featuring: Copyright 2016, the Indiana Dental Association. • Enhanced Find-A-Dentist Feature All rights reserved. • On-Demand Online CE • Practice-Building Articles and Resources • Local Component News • Members-Only Content and Resources • Members-Only Forums and Online Communities • Direct Access to ADA Resources • And More Yet to Come! Editorial Board Dr. Jack Drone, Editor Dr. Steve P. Ellinwood, Assistant Editor Dr. William B. Risk, Peer Review Editor Dr. Rebecca De La Rosa, Associate Editor Ms. Karen Scharf, Managing Editor Ms. Kari Alting, Advertising Manager Council on Communications Dr. Thomas R. Blake, Chair Dr. Manoj Bahl Dr. Lorraine J. Celis Dr. Jack Drone Dr. Dawn R. Durbin Dr. Ajay Joshi Dr. Megan Keck Dr. Matthew Kolkman Dr. Amanda Miller Dr. Thomas M. Murray Officers of the Indiana Dental Association Dr. Jay Asdell, President Dr. Gregory Phillips, President-Elect Dr. Daniel W. Fridh, Vice President Dr. Thomas R. Blake, Treasurer Dr. Jack Drone, Editor Dr. Jill M. Burns, Speaker of the House Dr. Rebecca De La Rosa, Vice Speaker of the House Dr. Chad Leighty, Immediate Past President Mr. Douglas M. Bush, Executive Director, Secretary Get Involved: Submissions Review Board Dr. Jeffrey A. Dean, Indianapolis, Indiana Dr. Roger L. Isaacs, Indianapolis, Indiana Dr. Joseph H. Lovasko, Hammond, Indiana Dr. Jeffrey A. Platt, Indianapolis, Indiana Dr. Christopher R. Miller, Indianapolis, Indiana • Serve as a beta tester • Contribute oral health-related articles • Submit your component news and A publication of the Indiana Dental Association. events • Share your thoughts and ideas with IDA members Contact Karen Scharf, IDA Director of Communications, at 800-562-5646 or karen@indental.org
Journal IDA C oming Soon  New IDA WEBSITE PE RSONNE L  The Journal is owned and published by the Indiana Dental Associatio...
2016 FA L L CONTENTS 7 EDITOR’S MESSAGE Dr. Jack Drone 8 PRESIDENT’S MESSAGE Dr. Jay Asdell 9 EXECUTIVE DIRECTOR’S MESSAGE Mr. Doug Bush 11 MEMBERSHIP HAS ITS PRIVILEGES Ms Jody Cleary 12 Member Zone MEMBER ZONE 12 MEMBERSHIP Dr. Bill Risk 14 COMPONENT 140 16 MEET DR. REBECCA DE LA ROSA, SPECIAL SECTION: Restorative Dentistry 18 THE BENEFITS OF A COLLABORATIVE APPROACH TO 18 COMPLEX CASES Mr. Terry Fohey, Mr. Brantley Kitching Restorative Dentistry 24 STANDARDS OF CARE IN DENTISTRY Ms Karen Scharf 28 FROM DENTAL CHAIR TO ADDICTION Ms Karen Scharf 33 CONVERTING “ONE TIMERS” INTO REGULAR PATIENTS Mr. Jeremy Tuber 36 COREMMIS IMPLEMENTATION 39 MEDICARE ENROLLMENT DEADLINE 33 Convert Patients 40 CLASSIFIEDS 45 MEMBER INFORMATION 46 LAST WORD Dr. Michael Rader 47 MONTHLY DUES ENROLLMENT FORM 40 Classifieds
2016 FA L L  CONTENTS  7  EDITOR   S MESSAGE Dr. Jack Drone 8  PRESIDENT   S MESSAGE Dr. Jay Asdell 9  EXECUTIVE DIRECTOR ...
save the date Journal IDA FEBRUARY 23 – 25, 2017 MIDWINTER MEETING, CHICAGO 2017 Midwinter Meeting Online registratiOn Opens nOveMber 1. block o≠ your schedule today! Please join us in the world class city of Chicago FEBRUARY 23-25, 2017, for the 152nd CDS Midwinter Meeting. Learn from the leaders in dental education. Choose from more than 200 courses, including valuable hands-on learning activities, Live Patient Demonstrations, special all-day tracks and staff teambuilding exercises. Then be sure to visit our Exhibit Hall, where more than 700 exhibiting companies will be there to show off their latest products and services. We’ve made it easier to bring your whole office too, with our 3=1 Free and Member Bring a Non-Member incentives. Join as an Associate Member for only $125 and register for the 2017 Midwinter Meeting for FREE. LEARN MORE AT ON.CDS.ORG/INDY17. CHICAGO DENTAL SOCIETY THE RESPECTED LEADER IN SCIENTIFIC DENTAL MEETINGSSM 6 Journal of the Indiana Dental Association | Fall 2016 · Volume 95 · Issue 4
save the date  Journal IDA  FEBRUARY 23     25, 2017 MIDWINTER MEETING, CHICAGO  2017 Midwinter Meeting Online registratiO...
Editor’s Message Journal IDA It Happened to Me…. Dr. Jack Drone I have talked a lot about the pace of life with my sons as they mature. We live ten miles outside of Rensselaer on a gravel road where the pace can be extraordinarily slow. I have encouraged them to live life like a no huddle offense in football, always keeping their heads on a pivot. This summer our family’s pace of life was slowed dramatically. My mother, who is 69, had a knee replaced in January, and it did not heal. About one month ago it was replaced again. She stayed with us for a few weeks before and after the surgery, and life had to slow a little because she needed time to heal. This was certainly not easy for me to adjust to. In the days before her surgery, she was attempting to get her life and affairs in order. A good friend of our family had developed terminal leukemia, and Mom wanted to visit her for what would turn out to be the last time. This was difficult because Mom was essentially wheelchair bound. I took the day off of work to help her with this visit and a few other things. We went to the hospital to visit our friend and two other couples stopped in at the same time. As I surveyed the room, there were two bed-ridden people, one in a wheelchair, one using a walker with oxygen, one mobile and me. It happened to me! This is a sure sign of aging. For the first time, I fully acknowledged that my parents are growing older, and by default, I must be too. That day, it hurt just a little, and I am not a soft person at all. I had that little feeling in my stomach that I get after a Notre Dame loss. My parents and many of the formative figures from childhood are aging. Wow! That afternoon after the visit, I began to think of what other instances like this are coming. Beyond my parents aging, what other moments are headed my way? I have been Editor of the Journal for almost nine years. Is it time for that to come to an end? When will my dentistry demand that I put down the handpiece and Hanau torch? Who will be honest enough to assess these things and tell me such? I do not want to know until then. Until then, I am back to the no huddle offense approach. Pace, rhythm, urgency. Time does not really recognize these human notions. What we do every day in our operatory, our office, our home, and our communities is what truly matters. As the year draws to a close, I wish you a calm, steady urgency in life and dentistry. Journal Editor Dr. Jack Drone is a general dentist practicing in Rensselaer, IN. He can be reached at jack@hillcrestdental.net. Fall 2016 · Volume 95 · Issue 4 | Journal of the Indiana Dental Association 7
Editor   s Message  Journal IDA  It Happened to Me   . Dr. Jack Drone  I have talked a lot about the pace of life with my ...
Journal IDA President’s Message A Tale of Two Task Forces Dr. Jay Asdell As Charles Dickens stated to start his famous classic, “It was the best of times, it was the worst of times.” Much to the surprise and dismay of a few, and some wailing and gnashing of teeth, the 2016 Indiana Dental Association House of Delegates had the gumption and foresight to pass two very important resolutions, 16/101 and 16/102. These resolutions authorize the IDA President to create two task forces, one to assess the potential for component redistricting and the other to examine and evaluate the council and committee structure of the IDA. Several years ago, the IDA Board of Trustees was charged with reading and discussing a book entitled “Race for Relevance,” written by Harrison Coerver and Mary Byers. This particular book reviewed the potential problems with boards in general and laid out several ways to streamline an association. The time has now come to “go big or stay home.” The first task force concerns the evaluation of the components and the case for redistricting. This is the 159th year of the Indiana Dental Association and our current component structure was set up years ago, “in a land far, far away”. Membership, enthusiasm to join, available technology and the population density were quite different when the component boundaries were defined. In order for the IDA to be “lean and mean,” if you will, a transition has to occur. We all know that all transformation is not necessarily good. As Woody Hayes once stated about throwing the football, “Three things can happen and two of them are bad.” However, our goal is to make this remodeling of the IDA a good one. It is time to bring the IDA machine up to speed. There are many ways to change the current system, ranging from drawing all new areas to keeping the components the same and making new districts to support the governance of the IDA. The task force is beginning to discuss all options and will come forth with a series of resolutions to make this a viable and exciting difference. It will not be easy and some feelings may get hurt but we must put our “big girl pants on” and make decisions based on the overall “good of the order” which is the Indiana Dental Association. The morphology of the “average” dentist is evolving daily and the IDA needs to evolve accordingly. 8 The second task force concerns the council and committee structure of the IDA. It is a fact that it is more difficult to get younger members, let’s call them Millenials, to participate. The “I really want to be a part of organized dentistry because it’s cool” attitude from back in the day is not around anymore. Rightfully so, we need to be more efficient in how we present information and how we do our business. It’s very frustrating to travel a long distance to attend a meeting and find the local folks didn’t show and that there is not much on the agenda. Once again, technology has allowed for web conferencing which has revolutionized the anatomy of a meeting. This task force will work hard to bring our council and committee structure up to date. Pedal to the metal… I sincerely want to thank the members of the Redistricting Task Force who are Jason Flanagan, Chair, Dave Yates, Terry Schechner, Beth Carter and Jeff Bennett with Jay Dziwlik as the staff liaison; and the Council Task Force who are Lorraine Celis, Chair, Dawn Durbin, Natalie Wargo, Matt Kolkman and Chad Leighty with Doug Bush as the staff liaison. I appreciate their volunteer spirit and taking the time to make this organization better. I’m sure when all the dust has settled, we will have moved the Indiana Dental Association forward to a place where it has never been. And that, my friends, is a good thing. IDA President Dr. Jay Asdell is an oral surgeon practicing in South Bend, IN. He can be reached at hoosieroms@gmail.com. Journal of the Indiana Dental Association | Fall 2016 · Volume 95 · Issue 4
Journal IDA  President   s Message  A Tale of Two Task Forces Dr. Jay Asdell As Charles Dickens stated to start his famous...
Journal IDA Executive Director’s Message As ObamaCare Exchanges Struggle, IDA Insurance Trust Stands Strong Mr. Douglas M. Bush ObamaCare is back in the news, and the news isn’t good. Earlier this year UnitedHealthcare, the country’s biggest health insurance carrier, announced that it was withdrawing from most Affordable Care Act (ACA) state exchanges. In August, Aetna followed suit claiming sick patients were driving up costs. They are not alone. According to the Wall Street Journal, all five of the nation’s largest insurance companies say they are losing money on their ACA policies. 1 Experts point to two fundamental problems. First, not enough people are enrolling in the exchanges. Even using both a carrot (subsidies and tax credits), and a hammer (fines if you don’t buy insurance) enrollment in state and federal exchanges is still falling far short of expectations. Second, those who are enrolling are sicker than expected. Insurance companies have historically relied on underwriters and actuaries to gauge risk and price their plans accordingly. But ObamaCare changed the game. Exchange plans are not allowed to consider a prospective policyholder’s health history when they quote a premium. They literally don’t know the health status of the patients for whom they are committing to pay claims. Without predictability, pricing is a roll of the dice. Insurance companies that guess wrong are forced to leave the market, or steeply increase premiums at renewal to more closely align income with claims experience. The IDA Insurance Committee saw this coming. (See “Health Care Reform: Preparing for the Coming Train Wreck,” IDA Journal, Summer 2013). For years, they had considered self insurance as an option for making health coverage more affordable for IDA members. When the Affordable Care Act passed in 2010, they knew the time was right. A number of insurance executives and consultants were recommending self insurance as a way of avoiding the increased regulation and associated costs of the new health care law. But self insurance is usually a strategy exclusive to large employers – hardly an option for the average small dental office. But there was another alternative. Small employers could come together, pool their numbers, and collectively form a large group capable of self insuring. With the help of attorney Jim Hamilton, a partner with Bose McKinney & Evans, LLP, and Kristi Hassinger, an employee benefits consultant with Hays Companies, the IDA developed what is known as a multiple employer welfare arrangement (MEWA). As its name implies, a MEWA allows “multiple employers” (in our case, dental offices) to band together as a single large risk pool. This allows small dental offices access to the same benefits of self insurance that large employers enjoy. We knew we had the numbers. Over 1,300 IDA dentists and members of their office staff participated in the IDA’s fully IDA Insurance Trust Board Jim Lipton, DDS, President, Highland Brain Henry, DDS, Treasurer, Lafayette Mara Catey-Williams, DDS, Gas City Steve Ellinwood, DDS, Fort Wayne David Holwager, DDS, Cambridge City Paul Kolman, DDS, Indianapolis Gregory Phillips, DDS, Columbus Pat Tromley, DDS, Evansville Fall 2016 · Volume 95 · Issue 4 | Journal of the Indiana Dental Association 9
Journal IDA  Executive Director   s Message  As ObamaCare Exchanges Struggle, IDA Insurance Trust Stands Strong Mr. Dougla...
Journal IDA insured large group plan, but to establish a self insured program, these dental offices had to commit to come together as a single trust. We traveled the state, explained the concept, and one office at a time the dentist employers agreed to join forces. participation agreement with the Trust and agree to abide by membership terms. And unlike the ObamaCare state and federal exchanges, the Trust is medically underwritten, meaning premiums will vary based on the claims experience of each individual dental office. When we demonstrated that our participation was assured and our financial plan was strong, the Indiana Department of Insurance granted us permission to launch the IDA Insurance Trust on January 1, 2014. While the IDA Insurance Trust may not be the best option for every member, it is an option that every member should explore. The plan is administered by IDA Insurance Services. Ashley Hudgins, Wanda Barger or Marilyn Sergi can answer your questions, prepare a quote, or help you explore other health insurance options if the Trust is not right for you. For more information, contact them at (800) 4717-6424 or Wanda@indental.org. The Trust is governed by a volunteer board of eight trustees, all of whom participate in the program. From the Trust’s inception, the Board has acted conservatively, pricing the program to assure adequate funding even if faced with a worst case scenario. For instance, it is structured so that no matter the size or volume of claims, funds are available to pay claims, or stop loss insurance is in place to pay claims for the Trust. Based on this prudent approach the Trust has built a solid reserve of $6.7 million. These funds are held in trust and may be used to pay future claims, stabilize premiums or increase future benefits. The IDA Insurance Trust is an exciting member benefit, but it is not for everyone. To protect the financial stability of the Trust, dentist employers must enter into a 10 Mr. Doug Bush is serving his 20th year as IDA Executive Director. He can be reached at doug@indental.org. 1. “Obama Health Law’s Instability Is Intrinsic,” The Wall Street Journal, August 18, 2016, Pg A2. Journal of the Indiana Dental Association | Fall 2016 · Volume 95 · Issue 4
Journal IDA  insured large group plan, but to establish a self insured program, these dental offices had to commit to come...
Journal IDA Membership Has Its Privileges “I love being part of a professional organization and having opportunities to network with other dentists.” Jody Cleary It’s Time To Renew Your American Dental Association/Indiana Dental Association/ Local Dental Society Membership IDA members will be receiving email reminders regarding the 2017 membership renewal beginning November 1, 2016. Please verify that IDA has your correct email address by visiting indental.org/directory and clicking the link to update your profile. (Please note, you will need to login with your IDA number and password to access the member directory.) To avoid any lapse in member benefits, membership must be renewed by December 31, 2016. You have two options to pay your membership dues: 1. Pay in full with a check or credit card (VISA, MasterCard or American Express) 2. Pay in 12 monthly installments, January to December 2017. In order to activate monthly installments, you must enroll in the program no later than December 15, 2016. The first installment will be deducted from your checking account in January. The enrollment form is available at the back of this issue or at indental.org. Your tripartite membership provides you powerful tools and partners in practice through the resources of the ADA, the IDA and your local dental society. Dr. David Wolf, Indianapolis One of your greatest member benefits is Advocacy. IDA and ADA work on behalf of all members to help enact key legislation that affects the practice of dentistry. Advocacy through the IDA allows you to express your “voice” in government regulation, work to advance the dental profession, push to enhance access and quality dental care for patients, and to fight unwarranted regulations of the dental profession. Additional member benefits include license renewal reminder calls; reducing your cost of doing business by reducing legal fees through the IDA peer review program; saving time researching products and services such as credit card processing, gloves and dental supplies, office supplies and insurance; encouraging “mutual aid agreements” between dentists; personalized well-being counseling as needed; answering your dental questions; monitoring legislative, regulatory, economic and social trends to keep you informed and to protect the interests of dentists and patients; and more. Your membership also offers several opportunities for high quality, cost effective continuing education, including the IDA Annual Session, OSHA compliance and basic life support courses, ethics live programs and self-study Journal, radiology self-study program, HIPAA compliance presentations, component programs and more. Have questions about your membership? Call the IDA Central Office at 800-562-5646 and you will receive a friendly voice from our IDA Staff. We are here for you. About the Author Ms Jody Cleary is the IDA Director of Membership & Financial Services. She can be reached at jody@indental.org.. Fall 2016 · Volume 95 · Issue 4 | Journal of the Indiana Dental Association 11
Journal IDA  Membership Has Its Privileges    I love being part of a professional organization and having opportunities to...
MEMBER ZONE Membership Dr. William B. Risk The practice of dentistry was very different in 1920. Antibiotics weren’t available and infected teeth were extracted to keep dental patients alive. Dentists stood at the chair all day with their belt driven handpieces and besides removing teeth they placed amalgams about as fast as they could because dental caries was so prevalent. This was a time before fluoride was used to prevent dental disease. It was generally accepted that about half of all dental patients were edentulous by the time they were forty. Technology happened. The air driven handpiece arrived on the scene and the delivery of dental care became much more efficient. Better and more esthetic dental materials were developed. With the advent of antibiotics and fluoride supplements, teeth were being saved instead of removed and thus there were more teeth to treat. Dental assistants were utilized to a much greater extent and dentistry started changing. But there was a catch, as with all professions. In 1879, the practice of dentistry became regulated by the government with the passage of the first Indiana dental practice act. The act was amended frequently in the first few decades as public demand for dental treatment grew. Fortunately, there was the Indiana Dental Association. Because the great majority of dentists in Indiana have always been members of the IDA, the Association was able to represent the dental profession and gave dentists a unified voice throughout this evolution. “New issues and changes are inevitable and membership in the IDA gives you a voice in the debate at both the local level and the state level.” 12 As it became apparent dentists needed to delegate certain duties to their assistants in order to manage increased workloads, the IDA analyzed the situation. Over a period of two or three years, members of the Association debated various aspects of which jobs and responsibilities to delegate, the toughest debate being the placement of restorative materials in prepared teeth. Finally, a consensus was reached and the IDA approached the State Legislature with dentistry’s suggestions. The Dental Practice Act was modified and we have expanded dental assistants today. The same process was followed by the IDA concerning continuing education for relicensure. The IDA was able to get x-ray certification regulations modified to the extent that dentists were able to qualify their assistants with on job training. And then, technology happened. Today we have dental implants, esthetic ceramic, and zirconium restorative materials. There are all of the CAD/CAM techniques which produce crowns while you wait. There are the continually improving digital imaging procedures which include the ability to scan and design restorations on the computer and send to labs electronically. Digital radiographic techniques which permit the precise placement of dental implants are now utilized. Another innovation which is now entering the dental arena is 3D printing. Dentures are going to Journal of the Indiana Dental Association | Fall 2016 · Volume 95 · Issue 4
MEMBER ZONE  Membership Dr. William B. Risk  The practice of dentistry was very different in 1920. Antibiotics weren   t a...
Member Zone be processed in a new way in the future. Will scanning eliminate the need to take an impression? And, by the way, what has happened to the gold foil restoration? What hasn’t changed is the need for dentistry to speak with a single voice. Today over 80% of Indiana dentists belong to the IDA. What this means is that when our lobbyist Ed Popcheff speaks to a legislator at the State House, he is really speaking for dentistry. Membership in the IDA gives Ed credibility. New regulations will be coming up and the IDA will be an important entity in arriving at appropriate resolution of these issues. Will there be changes to HIPAA? Will there be some regulation of the insurance industry? What is to be done with the matter of the dental therapist? Will there be new guidelines for sterilization and disposal of contaminated waste? What are we to do? In the actual practice of dentistry, will some of our standard practices need to be redefined in terms of our ongoing Journal IDA technological advances. Who can scan? Will patients be able to go to the beauty salon to get their teeth whitened and scanned and have their hair stylist place their newly milled veneers? Just as in the past, change is why the IDA is so important today and why it is important to be a member. New issues and changes are inevitable and membership in the IDA gives you a voice in the debate at the local, state and national levels. Facebook, Tumblr, Pinterest, and all of the other ways we communicate today only assist in the debate and help in coming to a conclusion. After resolution is achieved our lobbyist can approach the legislature with dentistry’s voice and the Indiana Dental Association can continue the process of morphing the dental profession to meet the future. Be an IDA member. About Dr. Risk Dr. William B. Risk is a general dentist practicing in Lafayette, IN. He can be reached at wriskdds@gmail.com. Fall 2016 · Volume 95 · Issue 4 | Journal of the Indiana Dental Association 13
Member Zone  be processed in a new way in the future. Will scanning eliminate the need to take an impression  And, by the ...
Journal IDA Member Zone Component 140 In Component 140, Indiana’s component dental societies have the chance to showcase their members’ achievements, reflect on past events, or provide information about upcoming opportunities for members. West Central Dental Society by Kristin H. York DDS, WCDS Secretary/Treasurer The West Central Dental Society (WCDS) sponsored their annual Chic-Nic golf fundraiser on June 16, 2016 at Coyote Crossing Golf Course in West Lafayette, Indiana. The ChicNic event has been occurring since 1911. This year the event was wonderfully organized by the past WCDS Vice President, Joel Dragoo. Joel was able to obtain 17 sponsors this year, a tremendous amount of sponsors for our small dental society component. Biohorizons was this year’s, “Title Sponsor” and Strategic Financial Group, LLC was this year’s, “Event Sponsor.” Seventy-six dentists from the Greater Lafayette area along with key sponsors participated in this year’s fundraiser. The day consisted of brunch, dinner (served every year with chicken and picnic menu items and is where “Chic” for chicken and “Nic” for picnic is derived) , 18 holes of golf scramble, contests, gifts, and prizes. This event holds a special place near and dear to a lot of hearts here at the WCDS, as it supports two special entities. The Judy Buckles Scholarship, an annually awarded to dental assisting students, and to the fully functioning live patient Dental Assisting Clinic. This Dental Assisting Clinic, which is lead by Dr. Bill Risk, is unique as it’s one of the few clinics where students can get live patient experience BEFORE their externship. These are available through the Ivy Tech Community College – Lafayette and all proceeds made at the event are donated to these entities. nurse, 1959, a certified dental assistant, an Associate of Applied Science, 1986, and a Bachelor of Science, 1991. Judy Buckles was truly loved and admired by her students and staff. Unfortunately, Judy lost her fight with cancer in 2006. She will always be greatly missed by everyone, but her legacy and goal to give to the Greater Lafayette and dental communities lives on. Several dental assisting students who obtain their degree at the clinic she created and ran, can earn a scholarship that bears her name. The WCDS will donate $4,500 this year to these two special entities. This was made possible through the Chic-Nic fundraiser, allowing Judy’s legacy and support to be carried forward. A wonderful tribute to what this dental pioneer and community leader has begun and the money donated will continue to pave the way for a unique dental education for future dental assisting students. Any donations to the Judy Buckles Scholarship or the Ivy Tech Community College – Lafayette, Dental Assisting Clinic can be sent to: Ivy Tech Community College – Lafayette, 3101 S. Creasy Lane, Lafayette, IN 47905. Attention: Rhonda Overman, Director of Development. Judy Buckles, along with collaboration from Bill Risk, was the founder and program administrator of the Ivy Tech Community College – Lafayette Dental Assisting Clinic, started in 1973. She believed in higher education, as her list of training consisted of the following: a certified dental From left to right: Marc Ditto, current WCDS Past President, Joel Dragoo, current WCDS President Elect, Ryan Helms, current WCDS President, and Erik Challgren, WCDS Board member 14 Journal of the Indiana Dental Association | Fall 2016 · Volume 95 · Issue 4
Journal IDA  Member Zone  Component 140 In Component 140, Indiana   s component dental societies have the chance to showca...
Member Zone Journal IDA South Central Dental Society On August 6, 2016, South Central Dental Society hosted their annual social event at Huber’s Orchard and Winery. The Vine to Wine Tour included a private trip out to the beautiful vineyards with owner Mr. Ted Huber as their personal guide. This amazing tour included in-depth information about wine making and comprehensive tastings of wine and spirits throughout the tour. The tour also included a private tour of Huber’s cellar and distillery. Afterwards, attendees enjoyed a private catered lunch at the winery. Attendees left to right: Dr. David Howell, Ms. Cathy Howell, Dr. Mark Thomas, Ms. Karen Thomas, Ms. Barbara Newton, Dr. Richard Newton, Dr. Beth Carter, Dr. Dawn Durbin, Mr. Brion Carter, Ms. Carol Sutherland Indianapolis District Dental Society January 20, 2017 OSHA/BLS at Hillcrest Country Club, 6098 Fall Creek Road. Please register yourself and your staff at www.indental.org/oc or contact Heather Parton at IDA (317) 634-2610. Lunch will be served to those attending both OSHA and BLS. OSHA is from 9-11 a.m. Note: BLS is now extended an additional hour due to American Red Cross requirements, so it will be from 11:30-3:30. Register Today--Space is limited. January 25, 2017 Dental Day at the Capitol. Contact the IDA at (317) 634-2610 or go to their website to register. This is an important event that allows you personal time with your legislators. Lobbyists are always there pushing their dental agendas to legislators, so this is a chance for you to have open discussion of your opinions regarding dentistry’s future. February 3, 2017 IDDS Ethics Seminar at Hillcrest Country Club, 6098 Fall Creek Road. Remember that 2 CEs in Ethics and Jurisprudence is required of every dentist and hygienist before the licensure period expires at the end of February, 2018 This seminar will fulfill your licensure requirement. Dentists and Hygienists welcome. Seminar is from 9-11 a.m, $10/person. 2 CE’s awarded. Contact IDDS at (317) 471-8131 or info@indydentalsociety.org to register. Registration deadline is January 26, 2017. February 4, 2017 Dental Networking Seminar. Indianapolis Convention Center. 10a.m.-1p.m. Come and network with your peers. If you have a practice to sell, need an associate, or just want to visit and socialize with your colleagues, please join us. Must be registered to attend—cannot just show up that day without registering ahead of time. Good food, wonderful door prizes! Win a new iPad2. Statewide members in active practice only (no retirees or nonmembers). Contact IDDS to register now at info@ indydentalsociety.org or call us at (317) 471-8131. Registration deadline is January 26, 2017. Fall 2016 · Volume 95 · Issue 4 | Journal of the Indiana Dental Association 15
Member Zone  Journal IDA  South Central Dental Society On August 6, 2016, South Central Dental Society hosted their annual...
Journal IDA Member Zone Meet IDA’s New Vice Speaker of the House: Dr. Rebecca De La Rosa Karen Scharf Empathy. That was the impression I was left with when I interviewed Dr. Rebecca De La Rosa for her IDA Board Member profile. Dr. De La Rosa was elected as the Vice Speaker of the House of the Indiana Dental Association during the May 2016 House of Delegates meeting. During the course of our conversation, Dr. De La Rosa talked about respecting individuals, engaging every person she meets, seeing the beauty in everyone. Empathy. But I’m getting ahead of myself. Let’s go back to the beginning. Dentistry is actually a second career for Dr. D. At one time, she was a research chemist for a steel mill, and she was on the fast track. She had been promoted seven times in three years. But she had always had a passion for the sciences, and she couldn’t help but think there was something Dr Rebecca De La Rosa, DDS, PC Position: Vice Speaker of the House Practice Area: General Practice Component: Indianapolis District Dental Society Contact Info: Avon Family Dentistry 7318 E US Highway 36 Ste 100 Avon , IN 46123-6882 Phone (317) 272-7715 16 beyond research chemistry. In addition to exploring several other opportunities, including an MBA program, optometric school, medical school, Dr. De La Rosa spent some time observing two dentists, Dr. Mark Kendra and Dr. Cynthia Molenda. Observing these dentists at work left her impressed with how dentistry merged the art and science of medicine. Interestingly, Dr. D had been a dental phobe. During her senior year of undergrad at Marian University, she started experiencing some tooth pain. She hadn’t been to the dentist in over seven years, she wasn’t sure where to turn, but she knew it was time to address her oral health issues. And that’s how she became acquainted with Dr. Molenda. Her dental experience with Dr. Molenda was amazing, and it was one of the things that steered her to, finally, choosing to go to dental school. If you ask Dr. De La Rosa about the people who have inspired her, Dr. Molenda tops the list of her professional inspirations. Dr. John Schymik, former IDA Speaker of the House, encouraged Dr. D to pursue the Board position many years ago, and Dr. Charles Steffel has been mentoring her all along the way. As far as personal inspiration, Dr. De La Rosa mentions Sr. Mary Rose Stockton, chemistry professor, and Sr. Gloria Gallagher, music professor, both of Marian University. And of course, her parents. When Dr. De La Rosa built her new dental office, she dedicated a cornerstone to her parents, Delfina and Journal of the Indiana Dental Association | Fall 2016 · Volume 95 · Issue 4
Journal IDA  Member Zone  Meet IDA   s New Vice Speaker of the House  Dr. Rebecca De La Rosa Karen Scharf Empathy. That wa...
Member Zone Reynaldo. Her parents taught her that it is in giving that you truly receive, as well as the value of integrity, honesty and generosity. Dr. De La Rosa chokes up as she recounts what an amazing couple her parents were. Being from Northwest Indiana, they enjoyed spending time in Chicago, going ballroom dancing and taking in the performing arts. When her mother was diagnosed with Alzheimer’s, Dr. D witnessed her father becoming an amazing caretaker, helping her mother maintain her dignity, while he also maintained his position as a role model and parent. During all stages of Alzheimer’s, Delfina always found a way to communicate with her husband and three children, even if it was just through the sparkle in her eye. She wasn’t able to speak, but she was still able to engage. It was the experience of living through her mother’s 12-year battle that helped shape Dr. De La Rosa’s philosophy of accepting what life brings, weeding out what is important and what isn’t, and celebrating each day. It was also this experience that reinforced the importance of engagement. Dr. D embraces the idea of engaging every person she meets, getting to the substance of things, and seeing the beauty in everyone. “Once we truly engage an individual,” Dr. De La Rosa says, “things fall into place, and we’re able to find their holiness.” Dr. D extends this philosophy to her dental practice. She opened her practice is Avon, IN, in 1990, just three months Journal IDA after graduating dental school. From the beginning, she and her staff have engaged with each and every patient and treated them like the unique individuals that they are. “Our goal,” Dr. D explains, “is to make every patient feel as if they are the only patient in the building every time.” There are private rooms for every patient, and every team member goes out of her way to communicate and educate each patient on a one-to-one basis. As a recovering dental phobe, Dr. D understands that an informed patient is a less apprehensive patient, so her staff has full liberty to determine how much time is needed with each patient. And that’s part of the reason her staff enjoy working for her. The other part is that she regularly reminds them that they are the most important asset in the practice. She encourages them to be free thinkers and openly share their ideas. “I hired each staff member for her amazing talent, and I don’t want to stifle that,” Dr. D says. Her staff respect her, and she respects them. In fact, each staff member has her own desk area, a space of her own, where she’s encouraged to enjoy some down time and let the creative juices flow. When asked about the Indiana Dental Association, Dr. De La Rosa actually beams. “I LOVE organized dentistry!” she exclaims. “There is something powerful about colleagues with similar interests and concerns working together to move the profession forward. When individuals put their best foot forward to move a common goal forward, something magical happens.” Why does Dr. De La Rosa think she’s a perfect fit for the IDA Vice Speaker of the House position? She’s been attending the House of Delegates meetings since she graduated dental school. She is always amazed at how, at the beginning of the meetings, there is polarization, but in the end, slowly but surely, it turns into remarkable, positive resolve to move the profession forward. According to Dr. De La Rosa, every member of the House of Delegates has the same core values, and when they are allowed to express their opinions, they can easily find commonness in what others are sharing. Dr. D says since she is a good listener who is a creative and objective thinker, she will be good at facilitating this resolve. “Everything is a compromise,” she says, “and compromise always leads to good productive results!” About the Author Ms Karen Scharf is the Indiana Dental Association Director of Communications. She can be reached at karen@indental.org.. Dr. Rebecca De La Rosa, Indianapolis District Dental Society, was elected Indiana Dental Association Vice Speaker of the House at the IDA Annual Session on May 21, 2016. Fall 2016 · Volume 95 · Issue 4 | Journal of the Indiana Dental Association 17
Member Zone  Reynaldo. Her parents taught her that it is in giving that you truly receive, as well as the value of integri...
Journal IDA Special Section - Restorative Dentistry Special Section: RESTORATIVE DENTISTRY The Benefits of a Collaborative Approach to Complex Cases Terry Fohey, CDT Brantley Kitching, CDT Laboratory communication seems to be one of those buzz phrases that I am hearing over and over lately. Such was the case during the final session of a recent lecture about restoring complex cases. Wonderful, I thought. I look forward to hearing the most effective way to transfer all of this great information from the dental office to the laboratory. This will make it possible for even the most complex cases to be completed in as few appointments as possible. The requisite armamentarium is extensive. It includes an impression of the preparations, an opposing cast, a cast of the provisional restorations, a facebow, a bite registration to articulate the prep cast, a bite registration to articulate the provisional cast, photos, shade information, and a properly filled-out prescription. (Illustration 1) This seems straightforward enough, provided the information is verifiable once it is on the articulator at the laboratory and will provide predictable results. (Illustration 2) As we all know, what is shipped in the box is only part of the equation. Just as important to the end result is the extent of communication with and involvement of the dental laboratory. The level of laboratory interaction changes with the expectations of every case. There are several levels of cases that we restore on a daily basis – single molar porcelain to metal restorations, large restorative cases, and interdisciplinary restorative cases. Illustration 1 18 Journal of the Indiana Dental Association | Fall 2016 · Volume 95 · Issue 4
Journal IDA  Special Section - Restorative Dentistry  Special Section  RESTORATIVE DENTISTRY  The Benefits of a Collaborat...
Special Section - Restorative Dentistry Cast with anterior provisionals in place and posterior preparations, articulated with bite registration. Journal IDA Silicone matrix of provisionals The matrix fabricated on the provisional verifying the articulation of the working cast and providing the guide to fabrication of final restorations. This is verification making this situation predictable. Cast preparations articulated with the same bite as above. Above right and left: Illustration 2 The single-molar porcelain-fused-to-metal (PFM) requires a minimal amount of information-- casts, impression of preparations, shade, material, and instructions. Frequently, the casts can be hand articulated without a bite registration. The importance of shade information and quality of photography increases as the location of the teeth moves closer to the front of the mouth. On the single unit central, arguably the most difficult esthetic event in dentistry, the quality of the photography is as important as the quality of the preparation and impression. The patient communication is also important so that everyone understands that the shade match can, and often does, take several attempts and appointments with photos before the case is accepted. Large restorative cases require more laboratory involvement. It may be beneficial for large restorative cases to be referred to the laboratory for a diagnostic wax up. The wax up will give the laboratory the opportunity to make the case in wax to demonstrate the tooth position, contour, and arrangements that are possible, based on the existing tooth position. (Illustration 3, next page) Involving the laboratory early in the process has great value because any findings can be previewed and approved by the dentist and patient in wax, or even plastic, by prescribing the fabrication of a provisional. Fall 2016 · Volume 95 · Issue 4 | Journal of the Indiana Dental Association 19
Special Section - Restorative Dentistry  Cast with anterior provisionals in place and posterior preparations, articulated ...
Journal IDA Special Section - Restorative Dentistry Provisional restorations can be easily changed, compared to changing ceramic, making this a more cost effective approach to testing the patient expectations. Interdisciplinary cases require the most extensive laboratory communication. For a diagnostic wax up of cases that have no incisors, how do we know the tooth position? Following the surrounding dentition is a good guide, however, how can we be more accurate? Anatomic averages, as taught by Dr Jack Turbyfill as the 10/20 rule, apply. This wax up uses 20mm from the depth of the vestibule for the length and position of the incisal edge of the central incisors. The total length of the centrals is 10.5mm and controlled by red wax. Interdisciplinary restorative cases that start at the general dentist’s office are very common. Complex cases that involve removing teeth, repositioning teeth, repositioning tissue, implant placement, and restorations involve a number of specialists and consultations to arrive at a treatment plan. As the treatment plan is executed, the situation requires the restoring dentist to make the final call of completed treatment, such as when the orthodontic treatment is complete, and when and where the implants should be placed. Any shortcomings or compromises in treatment can Illustration 4 create challenges In this example of a single unit implant, the for the restoring patient would have benefited from a collaborative dentist and labora- approach between the oral surgeon and the dentist tory, as they are to prevent placement that compromised long term success the ones responsible for making everything look and function properly. (Illustration 4) A collaborative approach to these interdisciplinary restorative cases, in which all the dental specialists approach the case as a team, from the very beginning, seems to create the most success. The labial position of the centrals is 10mm from the incisive papilla. Utilizing this approach, the patient has the opportunity to meet with the entire team of professionals that will create the restorations and smile before treatment begins. Following all patient consultations, the team discusses the findings. A treatment plan is not presented to the patient until all of the dental specialists have voiced their opinion. Support for the lip is provided by the red wax. The largest benefit of this approach is that none of the restorative team is surprised during treatment. A case that involves orthodontics would need to be evaluated to be sure that the teeth are in the correct restorative position before the brackets are removed. For the cases involving implants, the space would need to be evaluated and planned for proper placement. Additionally, this allows the laboratory to play an integral role in the process. Above photos: Illustration 2 Having the patient consult with the laboratory may be a new idea for some; however, it is the norm in practices involved 20 Journal of the Indiana Dental Association | Fall 2016 · Volume 95 · Issue 4
Journal IDA  Special Section - Restorative Dentistry  Provisional restorations can be easily changed, compared to changing...
IS YOUR PRACTICE GROWING Special Section - Restorative Dentistry Journal IDA by AT LEAST 7% Each Year, Every Year? We have OVER 30 YEARS of growing dental practices. GET YOUR FREE CD! Call today or visit: TheParagonProgram.com/CD DR. MICHAEL AGNINI DR. MATTHEW FRAIZ Client Since 2005 Client Since 2011 LAKELAND, FL INDIANAPOLIS, IN In our first year with Paragon does a great job Paragon, production of recalibrating the doctor increased by 81%. Over the next and the entire staff back to the six years we grew 193%. In practice’s original vision and goals. today’s competitive market, it is I’m leaps and bounds ahead of imperative that you have a highly- where I’d be without them.” skilled business advisor.” the ParaGon ProGram TM DE NTA L PR A CTI CE M ANAG EM ENT SINCE 1986 Growth, Profitability and financial indePendence. IT’S WHAT Fall 2016 · WE VolumeDO. 95 · Issue 4 120 Northwoods Boulevard Columbus, OH 43235 CALL: 800-448-2523 EMAIL: office@theparagonprogram.com VISIT: theparagonprogram.com | Journal of the Indiana Dental Association 21
IS YOUR PRACTICE GROWING Special Section - Restorative Dentistry  Journal IDA  by AT LEAST 7  Each Year, Every Year  We ha...
Journal IDA Special Section - Restorative Dentistry with high-profile patients. In practices that have laboratories in the office, the benefit of a relationship between the patient and the technician creating the smile has been long known. In Europe, it is very common for the patient and dental technician to interact many times throughout the process of creating a new smile. This allows the laboratory to develop a rapport to understand exactly the patient’s expectations. ous budgets. For example, one particular patient needed to restore her entire mouth to get the esthetic and functional results that she desired. She was not financially able to afford the entire treatment plan at once. But, the patient did not want to compromise the long-term result. Therefore, we were able to develop a transitional approach that fit her budget and would eventually give her the results she desired. The laboratory and the entire dental team have much to gain through, and based on, these direct patient interactions. Patient Interaction with the Dental Technician The experiences that we have had at the laboratory have been very enlightening. For example, if a patient’s expectations are extremely high, we may recommend multiple provisional restorations to determine the patient’s acceptable end result. This approach allows more accuracy in establishing the fee that will work for everyone to be satisfied with his or her efforts. Surprisingly, we have discovered that, patients will often disclose relevant health issues with the laboratory they may have been hesitant to share with their dentist. Such issues include alcohol addiction and bulimia. This information can be very beneficial in determining the appropriate treatment and material choice for the patient. We have also had the opportunity to encourage patients to include additional (posterior) teeth in their treatment plan to achieve an ideal smile. We have also been instrumental in helping patients realize their dream smiles within vari- A face-to-face meeting is always the ideal interaction with a patient. Many patients have driven from surrounding towns – and several patients have even flown in from out of state with the restoring dentist for a meeting. When that is not feasible, utilizing digital technology via photography, web Dental Office Space Available at Glendale Town Center NOW G! IN LEAS 2500-5000 Square Feet Available! Great visibility off of 62nd Street. 6101 N. Keystone Avenue Indianapolis, IN 46220 http://kiterealty.com/properties/glendale-town-center 22 Contact Andrew for more information: ahasbrook@kiterealty.com 317-713-5663 office or 317-714-3158 cell Journal of the Indiana Dental Association | Fall 2016 · Volume 95 · Issue 4
Journal IDA  Special Section - Restorative Dentistry  with high-profile patients. In practices that have laboratories in t...
Special Section - Restorative Dentistry chats, and video is an extremely helpful option as well. Admittedly, there are many levels of restorative cases. Regardless of the degree of difficulty a particular case may carry, the relationship the dentist has with the laboratory will have as direct of an effect on the final result as providing the proper case armamentarium. Working together to meet a patient’s expectations is the goal of each case. Every restoration is customized and should be treated individually. Every dental practice also has its own requirements, or niche, to fill. Laboratories have specific requirements to provide the most favorable results. Journal IDA About the Authors Terry Fohey’s career has spanned nearly four decades. He is a past president of the Georgia Dental Lab Association, former board member of the Southeastern Conference of Dental Laboratories and the founder of NuCraft Dental Arts and The Dental A.R.T.S. Center. He has been involved in dental education, written for various dental publications, and most importantly has created a thriving dental business. Brantley Kitching graduated from The University of Texas Health Science Center in San Antonio in 1982. He is certified in crowns and bridges as well as ceramics. After working as an in-house technician in two dental offices, he owned his own laboratory in Hobbs, New Mexico, specializing in Crown and Bridge and Dentures. Consider the most desirable outcome a battle. The patient, dentist, specialist and laboratory should be in the same foxhole, fighting together to achieve victory. Would you like to earn CE credit for the preceding article? This article originally appeared in IDA’s Foundations in Dentistry Volume I book which allows dentists and hygienists to earn CE credit quickly and easily by reading articles and taking CE quiz(zes). A limited supply of Foundations Volume I is still available. The all inclusive pricing covers the physical book and all continuing education certificates - up to 10 hours. For more informaiton, or to order Foundations in Dentistry Volume I contact Karen Scharf at karen@indental.org or 800-562-5646. Foundations in Dentistry Volume II is available for order online at indental.org/FoundationsCE. Fall 2016 · Volume 95 · Issue 4 | Journal of the Indiana Dental Association 23
Special Section - Restorative Dentistry  chats, and video is an extremely helpful option as well. Admittedly, there are ma...
Journal IDA Special Section - Restorative Dentistry SPECIAL SECTION Standards of Care in Dentistry are they enough? Dr. Jack Drone Standard of care… It’s one of those nebulous terms that most healthcare professionals think they understand, but when asked to explain it, they’re often at a loss for words. Many dentists aren’t exactly sure how the standard of care is defined and who is responsible for setting that definition. Standards of care are determined by each state’s dental act and precedent law. Standard of care is not using your best judgment, or doing what you learned in dental school. According to Douglas Terry, DDS, international lecturer and author of the textbook Natural Aesthetics with Composite Resin (Montage Media), standard of care “is what a reasonable, prudent dentist should be doing under the same or similar circumstances while applying scientific, evidencebased concepts.” Since new scientific, evidence-based concepts are constantly being developed, can we conclude that the standard of care is in a constant state of flux? According to the Indiana State Board of Dentistry, “standard of care is a dynamic process impacted upon by technological advances and information gained by clinical and basic research.” Joseph P. Graskemper, D.D.S., J.D. summed it up nicely when he wrote, “The standard of care continually evolves with the advent of new materials, new procedures and new court rulings.” 24 In order to keep up with the standard of care, dentists must be well read and actively participate in high quality continuing education. It’s an ethical issue as well as a legal issue. In fact, the historical 1898 case of Pike v. Honsinger, which attempted to legally define standard of care, specifically states that the healthcare professional “is bound to keep abreast of the times, and a departure from approved methods in general use, if it injures the patient, will render him liable.” Today, standard of care has evolved beyond “approved methods in general use.” In the case of Helling v. Carey, two ophthalmologists were found negligent for not performing glaucoma tests on a young woman, even though “it was universal practice of ophthalmologists not to administer glaucoma tests to patients under age 40.” The court concluded that the doctors were negligent because they failed to administer a test that was simple, quick and inexpensive. “Where its presence can be detected by a simple, well-known harmless test, where the results of the test are definitive, where Journal of the Indiana Dental Association | Fall 2016 · Volume 95 · Issue 4
Journal IDA  Special Section - Restorative Dentistry  SPECIAL SECTION  Standards of Care in Dentistry are they enough  Dr....
Special Section - Restorative Dentistry the disease can be successfully arrested by early detection and where its effects are irreversible if undetected over a substantial period of time, liability should be imposed upon defendants even though they did not violate the standard existing within the profession of ophthalmology.” How does this view of standard of care apply to your own use of routine cancer screenings? What about standards for specialties? First, it’s important to note that there are not two sets of standards depending on who is performing the procedure. If a general dentist performs a specialty treatment, he or she will be held to the same standard of care as a specialist performing that treatment. When it comes to non-recognized specialties, cosmetic dentistry or implant dentistry for instance, Frank Recker, DDS, JD, explains that the general Journal IDA dentist “would be held to the standard of care expected of the dental profession in general (competent), not a specialty standard. On the other hand, when you perform endodontic therapy, for example, you are held to the standard of the endodontist, i.e., the specialty standard.” Is standard of care enough? According to Ali Allen Nasseh, DDS, MMSc, international lecturer and postdoctoral professor at Harvard School of Dental Medicine, “The standard simply reflects that which is minimally required, meaning that anything less would be considered negligent. This is why astute clinicians don’t aspire to the standard of care, but rather to excellence in care.” This doesn’t necessarily mean that not following the standard of care equates malpractice. There is a difference between poor dentistry and malpractice. In order to con- There are 10 “standards of care” that encompass the practice of dentistry: 1. Failure to diagnose in a timely manner any oral condition or disease that requires treatment or observation. Failure to inform a patient of any diagnosed oral condition or disease as well as appropriate treatment recommendations. 2. Failure to refer a patient for appropriate treatment or observation when their needs exceed your ability to provide that professional care. 3. Failure to provide after hours care or emergency care, or make arrangements for after hours care for all patients of record. 4. Failure to provide appropriate post-operative care, both routine as well as unexpected. 5. Failure to provide informed consent, relevant information concerning risks and benefits of recommended treatment, relevant information concerning possible alternative treatment(s) and relevant information concerning prognosis without recommended treatment. 6. Failure to advise a patient of less than desirable treatment outcomes. Failure to advise a patient of relevant treatment recommendations concerning undesirable treatment outcomes. 7. Failure to take necessary precautions to prevent aspiration or swallowing of objects used or placed in the mouth. 8. Failure to properly document and maintain the integrity of patient records. 9. Failure to provide in office or after hours care for a patient of record without proper dismissal of the patient from your care. 10. Failure to perform surgical or other dental procedures properly. Failure to take appropriate surgical precautions when performing surgery or other dental procedure. Many dentists believe that their legal liability is related to how well they perform their dental procedures. However, it is important to note that 9 of the 10 standards of care are errors of omission rather than commission. In other words, legal liability is much more related to what you don’t do instead of what you do.7 Thomas J. David, DDS Fall 2016 · Volume 95 · Issue 4 | Journal of the Indiana Dental Association 25
Special Section - Restorative Dentistry  the disease can be successfully arrested by early detection and where its effects...
Journal IDA Special Section - Restorative Dentistry stitute malpractice, the patient must have been harmed. Oftentimes, not following the standard of care leads to bad dentistry, but not necessarily a ruling of malpractice. “Treat patients the way you would want to be treated if your roles were reversed,” says Dr. Thomas J. David a general dentist who has been involved in civil litigation issues for more than 30 years and has testified for plaintiff and defense in standard of care and personal injury cases. “Foster a relationship of trust with your patients. If your patients trust you, they will be understanding if things don’t turn out the way you expected. “When deciding what type of treatment to recommend for a patient, ask yourself if your recommendation Dr. Thomas J. David would be the same if this was a member of your family,” suggests Dr. David. “If you can answer yes, you should feel comfortable with your treatment advice to your patient.”7 “Thorough documentation of records is essential to avoiding or successfully defending a lawsuit.” Remember, you are responsbile for your hygients following proper standards of care. Standards of care for Clinical Dental Hygiene Practice for 2016 are available at https://www.adha.org/ resources-docs/2016Revised-Standardsfor-Clinical-DentalHygiene-Practice.pdf Treating patients well and feeling comfortable with treatment advice doesn’t, however, prevent a patient from alleging malpractice. Dr. Nasseh suggests most malpractice lawsuits can be avoided by “managing conflicts internally by direct communication and responsible action against specific charges made by a patient.” He goes on to say, “Most legal grievances result from miscommunications or Let’s grow! Immediate career opportunities and flexible practice transition options available. 25+ years experience. There’s strength in our numbers. 855.979.3524 26 DentalCareAlliance.com Journal of the Indiana Dental Association | Fall 2016 · Volume 95 · Issue 4
Journal IDA  Special Section - Restorative Dentistry  stitute malpractice, the patient must have been harmed. Oftentimes, ...
Special Section - Restorative Dentistry inadequate empathy for the patient. Clear, concise communication can help ward off any misunderstandings down the line.” Avoid Malpractice through IDA Peer Review Another way to avoid malpractice is by taking advantage of the Indiana Dental Association’s Peer Review program. The IDA peer review program is intended to resolve standard of care issues between the dentist and patient fairly and confidentially. The peer review process has two phases. In the first phase, a mediation-trained dentist will contact the involved parties and make every attempt to help the patient and dentist reach a mutually satisfactory resolution. If mediation is not successful, the case proceeds to the second phase: review by committee. During this second phase, a panel of dentists will review findings and recommendations for a resolution. This process is non-binding and voluntary and is allowed by Indiana state law. Journal IDA References 1. Graskemper JP. The standard of care in dentistry. J Am Dent Assoc. 2004;135(10): 1449-1455. 2. Neuman, Lisa. (2008). Standard of Care in Dentistry. Inside Dentistry, Volume 4, (Issue 9). 3. PIKE V. HONSINGER. 155 N.Y. 201 (N.Y. 1898) Retrieved from casetext.com/case/pike-v-honsinger 4. Bal, Sonny B., MD, JD, MDA & Brenner, Lawrence H, JD. (2015). “Pike v Honsinger was attempt to apply legal definitions to standard of care.” Orthopedics Today, (December 2015). 5. Recker, Frank, DDS, JD. “Leeway in standard of care?” BusinessBite Practice Management Information for Implant Dentists. American Academy of Implant Dentistry. aaid.com/ uploads/cms/documents/practice_management_legal_leeway_ in_standard_of_care.pdf 6. “How the Dental Peer Review System Works and What You Expect from It.” American Dental Association. ada.org/~/media/ ADA/Member%20Center/FIles/peer_review_overview.ashx 7. David, Thomas J., DDS. “Does Your Practice Measure Up?” Inscriptions. July/August 2015. 15. While you as the dentist cannot initiate the peer review process, in instances where you are unable to resolve complaints, or suspect the complaint may escalate into a lawsuit, you can encourage your patient to open a peer review case with IDA. Additional information on IDA Peer Review is available at indental.org/Complaint or by contacting Ed Rosenbaum, IDA Director of Professional Services, at edr@indental.org or 800-562-5646. About the Author Dr. Jack Drone is Editor of the Journal and a general dentist practicing in Rensellaer, IN. He can be reached at jack@hillcrestdental.net. Builders of medical & dental offices throughout Indiana Allen Galloway Phone: 317 269 0543 Fax: 317 269 0544 Email: allen@bcmionline.com www.bcmionline.com Fall 2016 · Volume 95 · Issue 4 | Journal of the Indiana Dental Association 27
Special Section - Restorative Dentistry  inadequate empathy for the patient. Clear, concise communication can help ward of...
Journal IDA Special Section - Restorative Dentistry From Dental Chair to Addiction Dentistry’s role in curbing the opioid crisis in Indiana Karen Scharf The news has been inundated recently with stories about the opioid crisis in America. And the coverage is now starting to focus on the crisis’s link to dentistry. In June 2016, NBC Nightly News aired a segment entitled “Hooked: How Opioid Abuse Starts at the Dentist for Many Americans” which discussed how opioid addiction can begin with a dental procedure, specifically, teenagers being prescribed pain killers after having their wisdom teeth removed. Of the 2.5 million emergency department visits per year in the U.S. related to drug overdoses, 1.4 million are caused by prescription drugs. In 2013 alone, 71.3% of prescription drug overdoses were from opioids.1 The most frequently abused opioids are immediate-release (IR) opioids, and according to Food and Drug Administration statistics, dentists prescribe 12 percent of IR opioids in the United States.2 How do patients get from the dental chair to drug addiction? First, there seems to be a widespread problem with overprescribing amongst all healthcare professionals. Despite the fact that the overall amount of pain reported in America has not changed,3,4 the number of prescription opioids sold has increased by almost 400%.5 And in Indiana, the numbers are striking, with 109.1 painkiller prescriptions being written for every 100 residents.6 But it’s not always that linear of a transition. A recent study by the University of Pennsylvania Perelman School of Medicine and School of Dental Medicine found that over 50% 28 of the opioids prescribed after wisdom tooth removal were not used by the patient. “When translated to the broad U.S. population,” said lead study author Brandon C. Maughan, MD, MHS, MSHP, “our findings suggest that more than 100 million opioid pills prescribed to patients following surgical removal of impacted wisdom teeth are not used, leaving the door open for possible abuse or misuse by patients, or their friends or family.”7 That assessment is supported by a separate survey commissioned by the Hazelden Betty Ford Institute which found that 74% of those with excess pills reported keeping them.8 This is particularly troubling since, according to the CDC, most people who abuse prescription opioids get them for free from a friend or relative.9 What Can Dentists Do? Write fewer scripts How can dentists help curtail the opioid crisis that is plaguing the state of Indiana? The first step is obvious: write fewer opioid prescriptions. Journal of the Indiana Dental Association | Fall 2016 · Volume 95 · Issue 4 21
Journal IDA  Special Section - Restorative Dentistry  From Dental Chair to Addiction Dentistry   s role in curbing the opi...
Special Section - Restorative Dentistry “Research shows that prescription-strength NSAIDs, like ibuprofen, combined with acetaminophen, can offer more effective pain relief and fewer adverse effects than opioidcontaining medications,” says Dr. Maughan. “While opioids can play a role in acute pain management after surgery, they should only be added in limited quantities for more severe pain.”7 Journal IDA Keeping the game fair... Write smaller scripts When an opioid is necessary, dentists should consider writing shorter prescriptions. In NBC Nightly News’ Hooked, the audience was introduced to Brittany Ringersen who was prescribed a 30-day supply of opioids after having her wisdom teeth removed. With such a large number of pills, Brittany was able to continue taking the opioids long after the pain subsided, and within a very short amount of time, she became an addict.10 “We see it across medical and dental practices that physicians and dentist are giving patients extra medication just in case to avoid to seeing the patient again or writing for refills,” says Dr. Brian 21 Bateman with the Division of Pharmacoepidemiology and Pharmacoenocomics at Brigham and Young Women’s Hospital. “This is an obvious problem that leaves a lot of left over medication and patients hold on to it.”11 ...so you’re not fair game. Perform Risk Assessments The fast-changing practice of dentistry According to Dr. Paul Moore, professor of pharmacology and anesthesiology at the University of Pittsburgh School of Dental Medicine, as few as 50% of patients will actually need a prescription. The dilemma is not knowing which patients need a script, and which might be at risk of misusing or abusing the drugs.11 The Department of Health and Human Services recommends dentists complete a full evaluation and assessment to verify the need for pain medication as well as perform an opioid risk assessment prior to treating each patient.12 Many dentists are hesitant to have this risk conversation with their patients. In fact, two-thirds of dentists surveyed do not agree that such screening is compatible with their professional role. Ronald J. Kulich, Ph.D., Professor at Tufts University School of Dental Medicine, says dentists should realize that everyone is uncomfortable with the discussion, however data shows that patients appreciate it rather than feel insulted by it.13 is getting hit from all angles. Choose a specialized protection plan designed to help you cover your unique Indiana risks. You get game-changing coverage made easy. Professional Liability Insurance & Risk Resource Services Take Advantage of ADA Resources ProAssurance Group is rated A+ (Superior) by A.M. Best. In its letter expressing support for the Surgeon General’s Turn the Tide campaign to end opioid abuse, ADA states, “As prescribers of opioid pain medications, dentists have a role to play in keeping these drugs from becoming a source 800.625.7814 • ProAssuranceDentistCare.com Fall 2016 · Volume 95 · Issue 4 | Journal of the Indiana Dental Association 29
Special Section - Restorative Dentistry     Research shows that prescription-strength NSAIDs, like ibuprofen, combined wit...
Journal IDA Special Section - Restorative Dentistry of harm.”14 To aid its members in fulfilling this role, ADA has created many resources, including practice tools and free continuing education, which are available from the ADA member center at ADA.org/opioids. Utilize INSPECT Prescription Drug Monitoring Programs (PDMPs) are staterun electronic databases used to track the prescribing and dispensing of controlled prescription drugs to patients. PDMPs continue to be among the most promising state-level interventions to improve opioid prescribing, inform clinical practice, and protect patients at risk.15 PDMPs are proving successful across the country. For instance, Florida established their PDMP in 2010, and in 2012 saw more than 50% decrease in oxycodone overdose deaths.16 New York began requiring prescribers to check the state’s PDMP prior to prescribing opioids and in 2013 saw a 75% decrease in patients seeing multiple prescribers for the same drugs.17 Indiana’s PDMP, the Indiana Scheduled Prescription Electronic Collection and Tracking Program (INSPECT) is administered by the Indiana Board of Pharmacy. An INSPECT report summarizes the controlled substances a patient has been prescribed, the practitioner who prescribed them 30 and the dispensing pharmacy where the patient obtained them. As of January 1, 2016, the program moved to 24hour reporting, providing nearly real-time data.18 The information is shared with at least 20 states. 21 Any practitioner licensed to prescribe or dispense controlled substances may establish an INSPECT account and request a patient prescription history. Practitioners may only request reports on patients for whom they are providing treatment or evaluating the need for treatment, including patients who have made initial appointments, and the patient history report must be used only for the purpose of making treatment decisions. Practitioners may not request a report on staff members, prospective employees, or anyone else for whom there is no chart or patient record available. In a survey of Indiana’s qualified prescribers, 71% reported using INSPECT, and over 50% of users reported resulting changes in their prescribing practices.19 INSPECT has been proving successful in curbing the opioid crisis in Indiana, and the State continues to enhance the program. In September, at the direction of Governor Pence, a pilot program was Journal of the Indiana Dental Association | Fall 2016 · Volume 95 · Issue 4
Journal IDA  Special Section - Restorative Dentistry  of harm.   14 To aid its members in fulfilling this role, ADA has cr...
Special Section - Restorative Dentistry initiated to allow for the integration of INSPECT data with hospital patient records.20 To register for an INSPECT account visit https://extranet.pla. in.gov/pmpwebcenter/NewRegistration.aspx. For additional information, visit http://www.in.gov/pla/inspect/. About the Author Ms Karen Scharf is the Indiana Dental Association Director of Communications. She can be reached at karen@indental.org References 1. “Opioid Abuse in the U.S. and Its Impact on Dental Education”, American Dental Education Association. Webinar: May 25, 2016. 2. Denisco, Richard C., MD, MPH, Kenna, George A., PhD, RPh, et al. Prevention of prescription opioid abuse. Journal of the American Dental Association, Volume 142 (Issue 7): 800–810. 3. Chang H, Daubresse M, Kruszewski S, et al. Prevalence and treatment of pain in emergency departments in the United States, 2000 – 2010. Amer J of Emergency Med 2014; 32(5): 421-31. 4. Daubresse M, Chang H, Yu Y, Viswanathan S, et al. Ambulatory diagnosis and treatment of nonmalignant pain in the United States, 2000 – 2010. Medical Care 2013; 51(10): 870-878. 5. CDC. Wide-ranging online data for epidemiologic research (WONDER). Atlanta, GA: CDC, National Center for Health Statistics; 2016. Available at http://wonder.cdc.gov. 6. “Inside the Orance Bottle”. Recovery Brands. Available at: http://recoverybrands.com/inside-the-orange-bottle/ 7. “100 Million Prescription Opioids Go Unused Each Year Following Wisdom Teeth Removal” News Release: Penn Medicine. September 22, 2016. 8. “Confronting the Opioid Crisis”, Hazelden Betty Ford Institue for Recovery Advocacy. 9. “Prescribing Data”. Centers for Disease Control and Prevention. Last updated March 16, 2016. Retrieved from: http://www.cdc.gov/drugoverdose/data/prescribing.html 10. “Hooked: How Opioid Abuse Starts at the Dentist for Many Americans”. NBC Nightly News. Aired: Jun 21 2016, 7:16 pm ET. 11. Snow, Kate, Deo, Parminder. “The Deadly Triangle: Dentists, Drugs and Dependence”. June 21, 2016. Retrieved from: http://www.nbcnews.com/health/health-news/deadly-triangledentists-drugs-dependence-n596601 12. “Program Integrity: Drug Diversion Toolkit” Centers for Medicare & Medicaid Services. Page last Modified: 03/03/2016 8:39 AM. Retrieved from: https://www.cms. gov/Medicare-Medicaid-Coordination/Fraud-Prevention/ Medicaid-Integrity-Education/Provider-Education-Toolkits/ drug-diversion-toolkit.html 13. “Opioid Abuse in the U.S. and Its Impact on Dental Education”, American Dental Education Association. Webinar: May 25, 2016. 14. August 25, 2016 ADA letter expressing support for the Surgeon General’s Turn the Tide campaign to end opioid abuse. Available at: http://www.ada.org/~/media/ADA/ Journal IDA Advocacy/Files/160825_surgeongeneral_turnthetide_nosig. pdf?la=en 15. “Prescription Drug Monitoring Programs (PDMPs)” Center for Disease Control and Prevention. Page last updated: March 23, 2016. Available at: https://www.cdc.gov/drugoverdose/pdmp/ index.html 16. Centers for Disease Control and Prevention. Decline in Drug Overdose Deaths After State Policy Changes — Florida, 2010–2012. MMWR 2014; 63(26);569-574. 17. PDMP Center of Excellence at Brandeis University. Mandating PDMP participation by medical providers: current status and experience in selected states [PDF File], 2014. Available from: http://www.pdmpexcellence.org/sites/all/pdfs/COE%20 briefing%20on%20mandates%20revised_a.pdf 18. http://www.in.gov/pla/inspect/2338.htm 19. http://www.addiction-intervention.com/addiction/ prescriptiondrugabuse/indianas-drug-monitoring-programresults-in-fewer-prescriptions-for-scheduled-meds/ 20. http://www.wbiw.com/state/archive/2016/09/governor-pencedirects-state-agencies-to-act-on-recommendations-frommeeting-of-governors-task-force.php 21. “HHS Research on Pain Treatment and Opioid Misuse and Overdoes - Translating Service into Action”. US Department of Health and Human Services. July, 2016. Since 1968 We are pleased to announce... Esam Jumani, D.D.S. & Gloria I. Figuera Inaga, D.D.S. have acquired the practice of Kenneth B. Rundle, D.D.S. Highland, Indiana WE ARE PLEASED TO HAVE REPRESENTED ALL PARTIES IN THIS TRANSITION. Call today for a FREE PRACTICE APPRAISAL ($5,000 value) 1-800-232-3826 www.AFTCO.net Practice Sales & Purchases Over $3.2 Billion Fall 2016 · Volume 95 · Issue 4 | Journal of the Indiana Dental Association 31
Special Section - Restorative Dentistry  initiated to allow for the integration of INSPECT data with hospital patient reco...
Converting “One Timers” into Regular Patients without feeling like a used car salesman Jeremy Tuber Within a few weeks of relocating to a new city, I jumped on the teeth-whitening band wagon and visited a dental office in the vicinity of my new home. After fifteen minutes of paperwork and an hour in the operatory, I headed home with a brighter, whiter smile. Despite having a mouth full of sensitive teeth, I was delighted with the procedure, as well as the dentist’s gentle demeanor. However, I never went back. Think about that for a moment. I had no dental home; I was new in town; I had a great experience; I even liked the dentist, and yet, I never went back. Why? I was never asked. I didn’t go into this dentist’s office thinking, “If I like the doctor and the team, this could be my new dental home.” I was there to get my teeth whitened—nothing else. Like many other one-time patients (including emergency patients), my focus was on an immediate need, but that doesn’t mean that I would have been opposed to becoming a regular patient. The truth is, you can convert one-time patients into regular patients if you follow a system (provided below)— if you address the patient’s immediate need, and then you tactfully ask the patient at the appropriate time. To be fair, maybe the practice wasn’t looking for new patients when I came in, or maybe I wasn’t a fit for their patient base. However, I do know that patients, like money, don’t grow on trees. With that in mind, we’ll look at an approach you can take to convert one-and-done people into patients who are happy to return for regular checkups and treatment. Keep in mind that this is just one approach. If the approach below doesn’t feel right to you, feel free to 32 modify it so it suits your personality. Get ‘em while you got ‘em approach to retaining patients Whether you’re talking with someone associated with sales at a fitness club, chiropractor’s office, or marketing firm, she’ll tell you that if the consumer walks out of your office without an agreement to return, the likelihood the consumer comes back plummets. Admittedly, sales and dentistry are like mixing oil and water, but if building your patient base is a priority—you’ll need to embrace sales. You’ll want to make it a priority to ask the one-timer/first-timer if he might be open to becoming a regular patient before he’s left the office. Dentists wince at the idea of incorporating any sales into their practice—many are probably wincing after reading this paragraph. However, if a dentist really believed she could improve the oral and systemic health of the people who come into her office, why would she be opposed to asking a person if coming back in for treatment would be desirable? No matter what your profession, if you truly believe in the value of service you provide, why should you avoid asking patients/ Journal of the Indiana Dental Association | Fall 2016 · Volume 95 · Issue 4
Converting    One Timers    into Regular Patients  without feeling like a used car salesman Jeremy Tuber  Within a few wee...
Special Section - Restorative Dentistry customers/consumers if they want it? Contrary to popular belief in the healthcare profession, “sales” does not have to be a dirty word, and sales can be done with honesty, tact, and professionalism. Build your patient base without feeling like a used car salesperson 1. Note the appointment times of first-time patients before the day begins. 2. Make certain your dental team takes extra time and care in dealing with these people. It’s important these patients feel at home from the moment they walk in the door. 3. Each member of the dental team who interacts with the patient should reassure the patient that the team and the doctor are focused on attending to their immediate need. 4. While the patient’s oral health might need attention, attend to or treat the immediate need/want first. If you shift the focus of the appointment before you address the immediate need/want, your patient may feel you don’t listen or that you’re just out for more money. For example, “I know you came in today to have your teeth whitened, however, we’ll need to talk about a couple of problems I can see between your central and lateral incisors.” We both recognize that you’re looking after the patient by caring for the overall oral health, but your patient’s perception might be that you’re looking to just make more money rather than attending to the immediate need/want.1 5. After the procedure or treatment, let the patient know you attended to her need and that she’s in better shape than when she came in. For example, “Okay, Joan, we’ve gone ahead and extracted that third molar that was giving you so much trouble. You may feel a little discomfort that will subside after a couple of days, but the grinding sensation you were having—well, we’ve taken care of it, so you should be in great shape.” 6. Verify the patient is pleased and/or that she’s had a good experience. While it might be tempting, do not skip this step. If the person isn’t pleased or hasn’t had a good experience, she will not entertain the idea of becoming a regular patient of yours. After the treatment, ask the patient how she’s feeling. If she is in pain, focus on asking how she’ll feel about having her need addressed. For example, “I know that tooth is going to be sensitive for a few hours. How Journal IDA 30 Celebrating 30 Years 1986 2016 of Superior Service LEADING THE WAY Superior Dental Care (SDC) has led the way in dental benefits for 30 years. As a dentist owned and directed dental carrier, SDC is proud to support the IDA in the work they do to advance dentistry throughout Indiana. Industry leaders supporting industry leaders ...now that’s something to smile about! dentistservices@superiordental.com (800) 762-3159 www.superiordental.com LEADING THE WAY IN DENTAL BENEFITS SINCE 1986 does it feel? I remember it was causing you so much pain when you came in, but you’ll be as good as new tomorrow—how does that sound?” If the patient is in pain, skip step 7. 7. Ask the patient if there’s anything else that might be causing her trouble, or perhaps something she was thinking she’d like to have done. For example, “I am glad we were able to treat that cavity before it really started to bother you—it was great to meet you. [PAUSE] It’s up to you, but if I am able to get a look at your teeth a couple of times during the year, we’ll be able to spot any troubles quickly so they don’t turn into bigger problems. Is that something you’d like to do?”* 8. Ask permission to follow up, which gives you another opportunity to connect with the person (possibly getting her to see the value of being a patient). After the patient responds to the question in step 7, ask if she would be open to you checking up on her within the next 24 hours to make sure she’s doing okay. For example, “It looks like you’re going to be in good shape, but I just want to follow up with you and make sure you’re doing great and that you don’t have any questions. Would that be okay?”* Fall 2016 · Volume 95 · Issue 4 | Journal of the Indiana Dental Association 33
Special Section - Restorative Dentistry  customers consumers if they want it  Contrary to popular belief in the healthcare...
Journal IDA Special Section - Restorative Dentistry 9. During the follow up call (whoever makes it), ask the patient how she is doing and if she has any questions or concerns. If she has agreed to come back in, indicate that you see on the schedule she’ll be coming back in on DATE and TIME. Tell her, “That’s great. We’ll look forward to seeing you again.” If the person is not feeling fine, attend to that need immediately. If the person is feeling fine but she didn’t agree to come back in for treatment, ask, “I am so glad you’re feeling better—we enjoyed having you visit! So we make sure we’re on top of things well before they cause you any discomfort, would you be open to coming back in and seeing us in SPECIFIC MONTH?” 10. If the patient has indicated she had a relatively good experience in your office but still hasn’t agreed to come in for treatment after asking her twice, make sure you periodically send her a marketing/promotional postcard or follow up email every couple of months. Keep this practice up for a year or until she’s scheduled an appointment. If after a year the person has not scheduled an appointment, send her a letter indicating that you’d still love to see her and that it’s not too late. Let her know you wish her the best and that you genuinely hope she establishes a dental home. situation. • The doctor or dental team members are too aggressive or overzealous. Conversely, some doctors and teams lack the self-assuredness to confidently ask “one-timers” if they would consider coming in for regular treatment. The key to increasing your odds for success is finding a balance. • The approach is used at an inappropriate time, such as when the patient is in notable pain, is in a bad mood, is overly rushed or distracted or the patient appears not to be satisfied. About the Author Jeremy Tuber is the Manager of Communications for the Arizona Dental Association. This article orignially appeared in the June 2015 issue of AzDA’s Inscriptions and was reprinted with permission. 1 Of course there are instances when attending to your patient’s perceived need is not as important as another oral health issue you’ve diagnosed. In these cases, you’ll need to gently inform the patient what you’ve discovered, as well as help her understand that having the issue you found treated will benefit her. * Some dental offices are set up to have the hygienist, dental assistant, or even the front office person ask or engage the patient in this area. From a logistical standpoint, this might be ideal. However, from a sales or effectiveness standpoint, it would be best if the doctor asked the patient these questions. Yes, dentists are terribly busy, but five extra minutes might be the difference between a new patient and a person you’ll never see again. You make the call if it’s worth it. Common mistakes doctors make using this sales approach • Doctors and/or their team ask people to become patients before they’ve attended to the immediate need, or before they’ve verified the patient has had a pleasant experience. • The doctor or a dental team member awkwardly blurts out, “Hey, maybe you could consider being one of our patients,” which puts the people in an uncomfortable 34 At Blue & Co., LLC, we’re focused on the needs of dentists. Our insightful, dental industry-tailored, proactive solutions include: • Payroll & Accounting • Accounting & Assurance • Tax Preparation & Consulting • Business Valuation • Retirement Plan Services • Practice Management Services & Solutions • Practice Formation & Transitions Kam McQuay, CPA p/f: 317.713.7933 / kmcquay@blueandco.com Angie Zirkelbach, CPA p/f: 317.713.7961 / azirkelbach@blueandco.com 500 N. Meridian St., Suite 200, Indianapolis, IN 46204 Journal of the Indiana Dental Association | Fall 2016 · Volume 95 · Issue 4 blueandco.com
Journal IDA  Special Section - Restorative Dentistry  9.  During the follow up call  whoever makes it , ask the patient ho...
Special Section - Restorative Dentistry Journal IDA Fall 2016 · Volume 95 · Issue 4 | Journal of the Indiana Dental Association 35
Special Section - Restorative Dentistry  Journal IDA  Fall 2016    Volume 95    Issue 4   Journal of the Indiana Dental As...
Journal IDA CoreMMIS Implementation UPDATE Indiana Health Coverage Programs IHCP Will Implement CoreMMIS on December 5, 2016 The Indiana Health Coverage Programs (IHCP) will replace its current information system, IndianaAIM, with the new CoreMMIS, which stands for Core Medicaid Management Information System, on December 5, 2016. Along with CoreMMIS, a new provider interface called the Provider Healthcare Portal (Portal) will replace Web interChange. These new tools offer enhanced features that will make working with IHCP easier and more efficient. You have goals. PARAGON can help you reach them. Are you thinking of buying a dental practice, merging, or selling your practice? The future you want is closer than you think. Our guidance makes all the difference. Take your next step with confidence. Call PARAGON today. Your local PARAGON dental transition consultant Chad Bruner 866.898.1867 info@paragon.us.com paragon.us.com 36 Approved PACE Program Provider FAGD/MAGD Credit Approval does not imply acceptance by a state or provincial board of dentistry or AGD endorsement 4/1/2016 to 3/31/2020 Provider ID# 302387. The transition to CoreMMIS and the Portal will require providers to make some preparations in advance of the December 5 implementation date. Register on the Provider Healthcare Portal • Providers will need to create a provider account on the new portal for every service location. A provider representative should be identified to establish the provider account and to manage the users, or delegates, who will have access to the provider account. The provider representative will authorize delegate users who must then create delegate accounts on the Portal in order to do work on the provider’s behalf. Current users of Web interChange will likely be the users identified as delegates for the portal. • Providers will access the portal through indianamedicaid.com. Access will be provided in advance of the implementation date to allow time for providers and delegates to register their Portal accounts. Web-based training on the registration process will also be made available at indianamedicaid. com at that time. Portal and training availability will be announced via a CoreMMIS bulletin. Learn about the Portal and CoreMMIS Previously published CoreMMIS bulletins BT2016011 and BT2016502 offer a general introduction to the features of the new Portal. A more thorough introduction will be available in sessions offered at the 2016 IHCP Annual Provider Seminar on October 18-20, 2016, in Indianapolis. Portal sessions will cover claim submission, member management and eligibility, prior authorization and care management, and provider enrollment and profile maintenance. To learn more about the seminar or to register3, visit the 2016 IHCP Annual Provider Seminar and Workshop Registration pages at indianamedicaid.com. INDIANA – SEPTEMBER 2016 – 1/4 Page 4/C – 3.75”(W) x 5”(H) Journal of the Indiana Dental Association | Fall 2016 · Volume 95 · Issue 4
Journal IDA  CoreMMIS Implementation  UPDATE  Indiana Health Coverage Programs IHCP Will Implement CoreMMIS on December 5,...
CoreMMIS Implementation Detailed web-based training on all Portal functions will be posted to indianamedicaid.com before the Portal’s implementation. This will allow Portal users to view the training at their convenience and to revisit training documents as often as necessary. Notice of training availability will be announced via a CoreMMIS bulletin. Providers will see some differences in the way the new CoreMMIS processes and communicates information. This will require some changes in the way providers interface with the system, including changes in the way providers submit claims and other information to the IHCP. These differences will be communicated to providers before implementation through a series of CoreMMIS bulletins. Anticipate suspension of business transactions To ensure a successful transition to CoreMMIS, the IHCP will temporarily suspend certain business transactions in the days and hours before implementation. This step is necessary so that processing in the current system can be finalized and information can be converted to the new system. Every effort will be made to keep disruption of normal business activities to a minimum. Business transactions that will be affected include: • Provider enrollments and profile updates • Fee-for-service claims and adjustments (paper and electronic) • Written correspondence WEB LINKS 1. Bulletin BT201601 is available online at: http://provider.indianamedicaid.com/ihcp/Bulletins/ BT201601.pdf 2. Bulletin BT201650 is available online at: http://provider.indianamedicaid.com/ihcp/Bulletins/ BT201650.pdf Journal IDA Notice and guidance related to these and other necessary transition time frames will be announced via a CoreMMIS bulletin. Stay informed The IHCP appreciates the quality services providers offer our members and is committed to working closely with the provider community during this transition. It is critical that providers stay informed as implementation approaches. Watch for future publications and sign up for the IHCP email notification4 alerts at indianamedicaid.com. Direct questions to your IHCP Provider Relations field consultant5 or email incoremmis2015im@hpe.com. Reprinted from Indiana Health Coverage Programs CoreMMIS bulletin BT201658, September 29, 2016 Editor’s Note: Registration for the new portal begins October 11, 2016. Information is available at http://provider. indianamedicaid.com/ihcp/Bulletins/BT201661.pdf Imagine being embarrassed to smile It’s a fact: thousands of children and adults don’t have dental insurance or access to adequate oral health care. My Community Dental Centers (formerly Michigan Community Dental Clinics) was formed to change that, to make a difference by providing exceptional dental care to all, even those who can’t afford it. We’re looking for dedicated professionals who want to make a difference in one of our 27 modern, state-of-the-art facilities across the state. In return, you’ll receive benefits that include compensation comparable to the ADA average; signing bonuses at select locations; health, vision and dental insurance; life insurance; short- and long-term disability; ADA/MDA dues contribution; retirement plans, malpractice coverage and more. But your greatest benefit? Knowing you’re helping improve lives one smile at a time. Join us. Call 231.437.4830 or email TSR@mydental.org www.mydental.org 3. Provider Seminar information is available online at: http://provider.indianamedicaid.com/general-providerservices/provider-education/2016-ihcp-annualprovider-seminar.aspx 4. Subscribe to the IHCP email notifications at: http://provider.indianamedicaid.com/ihcp/mailing_list/ default.asp EOE 5. Find contact information for field consultants at: http://provider.indianamedicaid.com/about-indianamedicaid/contact-us/provider-relations-fieldconsultants.aspx Fall 2016 · Volume 95 · Issue 4 | Journal of the Indiana Dental Association 37
CoreMMIS Implementation  Detailed web-based training on all Portal functions will be posted to indianamedicaid.com before ...
Journal IDA Medicare Enrollment Deadline Medicare Enrollment Deadline Extended to February 1, 2017 Karen Scharf After several delays and extensions, the Centers for Medicare and Medicaid (CMS) have announced the final deadline for Part D provider enrollment is February 1, 2017. Beginning February 1, CMS will require dentists who write prescriptions for Part D drugs to be enrolled in an approved status or validly opted out with Medicare, in order for their patients’ prescriptions to be covered under Medicare Part D. Why should a dentist enroll in Medicare to prescribe Part D drugs? • Approximately 100,000 dentists currently write prescriptions for Medicare Part D beneficiaries. (Your patients might be using Part D benefits without your knowledge.) • It prevents patients’ prescription drug claims from being denied by their Part D plans and at the point of sale, beginning February 1, 2017. • It will prevent numerous inquiries from patients that will receive a written notification if their prescriber isn’t enrolled. • By enrolling in Medicare, a dentist assists the federal government in fighting fraud in the Medicare Part D program. • Fighting fraud in the Medicare Part D program is a high bipartisan priority of Congress. • Dentists can also assist the federal government in fighting fraud in the Medicare Part D program by making sure that the taxonomy associated with their NPIs reflect that they are a dentist (and not a dental assistant, resident, or hygienist, for example). • Unenrolled dentists’ Medicare patients may choose to find a dentist who is enrolled in Medicare so that their prescriptions are clearly coverable by the Part D program. • Enrolling is easy, free of charge, and can be done online in about 20 minutes If you choose not to enroll or opt out of Medicare, please be aware: • Unenrolled dentists’ Medicare patients will receive written notifications in the mail that their dentist is not qualified to write Part D prescriptions when the patients fill a prescription (which will only be covered on a provisional basis). • After a provisional supply of a drug has been covered, a Part D drug benefit plan will no longer cover a 38 • prescription written by an unenrolled dentist. Unenrolled dentists who contract with managed care plans to provide dental services to Medicare beneficiaries cannot opt-out. There are several ways for a dentist to enroll in Medicare. Enroll Online • • Dentists can enroll in Medicare online by using PECOS at go.cms.gov/pecos. By using internet-based PECOS to submit your enrollment application, you can easily enroll in Medicare without paying expensive consulting firms. Please visit the dentist-specific tutorial video on how to use internet-based PECOS at: Go.cms.gov/ PECOSVideo. Enroll With Paper Application Form 855i Enroll using CMS form 855i if: • You currently, or plan to, provide services covered by traditional Medicare fee-for-service (Part B) • You are currently, or plan to be, a Medicare Advantage (Part C) provider • You currently (or plan to) prescribe Part D drugs Enrolling with form 855i allows you to prescribe Part D drugs; order and certify certain items or services; contract with Medicare Advantage (Part C) plans; and be reimbursed for the covered services furnished to Medicare beneficiaries. Please note: When using CMS 855i, select from either the Maxillofacial Surgery, Oral Surgery (dentist only), if applicable, or select Undefined Physician type and write in ‘General Dentist.’ Form 855o Enroll using CMS form 855o if: • You do NOT, and do not plan to, provide services that are covered by traditional Medicare fee-for-service (Part B) • You are NOT, and do not plan to be, a Medicare Advantage (Part C) provider. • You DO, or plan to, prescribe Part D drugs. Journal of the Indiana Dental Association | Fall 2016 · Volume 95 · Issue 4
Journal IDA  Medicare Enrollment Deadline  Medicare Enrollment Deadline Extended to February 1, 2017 Karen Scharf After se...
Medicare Enrollment Deadline Enrolling with form 855o allows you to prescribe Part D drugs and order and certify certain items or services. While the CMS-855o form states it is for practitioners who want to order and refer, it is appropriate for use by prescribers who also want to enroll to prescribe Part D drugs. Please note: CMS is updating the CMS-855o to include the General Dentist option. Until that form is updated, dentists should select from either the Maxillofacial Surgery, Oral Surgery (dentist only), if applicable, or select Undefined Physician type and write in ‘General Dentist’. • • • Journal IDA opt-out period. You should verify that you are not indirectly contracted with a Medicare Advantage (Part C) plan, for example, as some dentists are. If you are a Delta Dental provider, you must enroll using either 855i or 855o in order for prescriptions to be covered under Medicare Part D. CMS does not have a standard opt out affidavit form. Additional opt out information is available online at go.cms.gov/optoutinfo. Sources: Opting Out of Medicare 1. Taking NO action is NOT the same as Opting Out. In order to Opt Out of Medicare, you must file a written affidavit with CMS. You may opt out and still prescribe Part D drugs; however, before opting out you should consider the following: • You must have a valid opt-out affidavit on file with Medicare in order for prescriptions to be covered under Medicare Part D. • Opt out periods last for two years and automatically renew unless you cancel your opt-out in writing no later than 30 days before the end of the current 2-year 2. 3. 4. 5. 6. https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/ MedicareProviderSupEnroll/Downloads/CMS-4159_FAQs.pdf https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/ MedicareProviderSupEnroll/Part-D-Prescriber-Enrollment-Dentists. html https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/ MedicareProviderSupEnroll/Downloads/opt-out-decision-matrix[October-2015].pdf https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/ MedicareProviderSupEnroll/Part-D-Prescriber-Enrollment-Opt-Out. html https://www.cms.gov/Outreach-and-Education/Medicare-LearningNetwork-MLN/MLNMattersArticles/Downloads/SE1311.pdf https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/ MedicareProviderSupEnroll/Part-D-Prescriber-Enrollment-MAC-List. html THERE ARE MANY REASONS TO GET A PRACTICE VALUATION... PROTECTING YOUR FAMILY MAY BE THE BEST. Your practice is likely your biggest asset. You should know what it is worth. Use Henry Schein Professional Practice Transitions for your practice valuation. Because how it’s done—matters. 1-800-988-5674 www.henryscheinppt.com © 2015 Henry Schein, Inc. No copying without permission. Not responsible for typographical errors. 15PT3335 15PT3335-Family_7.5x 5.indd 1 8/31/15 12:30 PM Fall 2016 · Volume 95 · Issue 4 | Journal of the Indiana Dental Association 39
Medicare Enrollment Deadline  Enrolling with form 855o allows you to prescribe Part D drugs and order and certify certain ...
Journal IDA Classifieds Positions Available POSITIONS AVAILABLE General Dentist - Crown Point, IN PT Dentist - Crown Point, IN Private practice actively searching for a Part-Time Associate Dentist in an extraordinary patient/team environment. We focus on warm, caring and expert communication while providing quality, comprehensive dental care. Qualified Requirements: Doctorate of Dental Surgery (DDS) Current & Valid State of Indiana Dental License; Additional certifications/permits/ licenses as required by state and federal; e.g. CPR, Federal DEA License or Permit, current, valid and in good standing. Are you looking for the opportunity to work in a beautiful facility equipped with current technology and an established practice with a professional team? classifieds Submit your CV or your Resume to: danielle@awdds.com 40 General Dentist - South Bend IN Full-Time Associate Opportunity for a General Dentist to join one of our highly successful affiliated practices in South Bend, IN. State of the art practice facilities. Strong commitment to long-term dental care for the whole family. Experienced practitioners or Recent Grads welcome! Email Resume bames@dentalcarealliance.com www.dentalcarealliance.com Wisconsin Opportunities General Dentists and Specialists - Dental Associates is opening new locations in Wisconsin. Consider joining this dentist owned, family practice that fosters a culture which invites our patients into our “dental home” and provides them with a caring and empathetic approach to dentistry. You will not only experience the support and stability of working within a group, but also the flexibility of managing your own practice. We will ensure you have everything you need to be the best. It’s a win-win for all involved. Signing bonus and relocation allowance available. Call or email Susan today at (800)315-7007 sbullen@dentalassociates.com Associate Dentist Wanted - Warsaw I am looking for an ambitious General Dentist who wants to develop a long term career in a highly successful practice. A new graduate or experienced is great. Three full time hygienists, nine operatories, fully digital. I am located in Warsaw, Indiana with great outdoor recreation. Check out our website at lakesidefamilydentistryllc.com and email me at drmike2000@hotmail.com Associate Dentist - Indianapolis Full Time Associate Dentist in Indianapolis, IN. Competitive pay, full benefits, malpractice coverage, and paid time off. If you love working with children, Kool Smiles is the place for you. Please contact almarshall@benevis.com General / Pediatric Dentist FQHC practice in Indianapolis area is seeking a full time general or pediatric dentist. We offer competitive pay, great benefits package, CE allowance and eligibility for student loan repayment. GPR or experience preferred. Please send CV to rgandolph@iuhealth.org Journal of the Indiana Dental Association | Fall 2016 · Volume 95 · Issue 4 Full-Time Associate opportunity in Crown Point. Well-established, state of the art facility. Excellent earnings and great benefits! Experienced Practitioners or Recent Grads welcome! Email resume bames@ dentalcarealliance.com Learn more @ www. dentalcarealliance.net Associate North Central Indiana Ready for a Change? Fantastic Opportunity in North Central Indiana. Owner/Dentist looking for competent, patient-oriented associate to join modern, fast-paced practice. Huge growth potential in small town, lake area while big-city amenities are easily accessible. Offices equipped with paperless charts. digital radiography and capable EFDAs. Partnership or buyout considered for the right candidate. Patient care is our #1 priority. If this appeals to you, please respond via email with resume and cover letter. NCINDDS@gmail.com Dentist/Associate Desired An exciting opportunity for an associate to work for a privately owned multilocation dentist. We are looking for a long term relationship. Future Buy-in/ new practice purchase opportunities will be available. We prefer experienced dentists. You will be working primarily on your own. Must be very good at extractions, and treatment planning and willing to turn around same day work. Digital, and chartless. Southside Indy, Eastside Indy, and Anderson offices. 4-5 days a week No weekends/ No evenings. This is the position that does not come along everyday. We will be very selective. Send resume all4youdentalcare@yahoo.com
Journal IDA  Classifieds  Positions Available POSITIONS AVAILABLE General Dentist - Crown Point, IN  PT Dentist - Crown Po...
Classifieds Journal IDA Positions Available Dentist Needed in Goshen, IN Well established dental practice needs energetic, experienced and motivated Full-time associate. Must be an excellent diagnostician and highly skilled in all aspects of restorative work. Surgical extractions a big plus! Requires gentle touch, outgoing personality and superb chair-side manners. Would also be interested in new graduates. We offer great patients and an experienced, energetic staff. Salary and benefits are determined with knowledge and experience. Contact us at 574/229-8180 or lgood@abgdental.net. Associate Dentist - Fishers, IN Associate Dentist wanted for our successful general dentistry practice in fast-growing Fishers, IN. This is a great opportunity for the right person with possibility for future buy-in/ buy-out. We have an experienced dentist and staff in place, with a good patient base and an amazing location, where we provide a wide range of treatment. We are chartless, with digital x-rays. We’re looking for a team player with an upbeat personality and a required minimum of 3 years of post graduate experience. Please send resume to Complete Dental Care of Fishers, 11479 Lantern Rd, Fishers, IN 46038 or email at cpsdds73@gmail.com. PT Oral Surgeon/Dentist Our Office is looking for a PT Oral Surgeon/Dentist to add to our team of Excellent Dental Professionals. We are high-tech, modern and fast pace Dental Group employing people with excellent clinical and personal skills. OS need to Dental Assistant - Full Time We are looking for a full time Dental Assistant. Hours are Monday- 9-8, Tuesday-9-5, Wednesday- 9-8 and Thursday-9-5. Please call 260-486-2339 and ask for Office Manager Vickey. Associate Dentist Needed Immediately Private practice in Indy seeks motivated dentist to work 1 - 5 days a week. (MonFri) Hours are 8-5 no weekends no evenings. Fully digital modern office with great staff. Pay is based on experience and will be a percentage of production. Extractions, C & B, Dentures, RCT’s, Fills. No hygiene! Total autonomy and freedom to treatment plan on your own. Single owner dentist with 22 years of experience. Great opportunity for the right person. Send resume info@tenthstdentalcare.com General Dentist - Elkhart, IN Heartland Dental supported offices are looking for outgoing and positive Dentists that are seeking career satisfaction and continuing education opportunities. There are 100 reasons to join Heartland Dental, discover yours! For more information, contact kayers@hearland.com or apply today at heartland.com. Dentist Needed for Maternity Leave Looking for a caring Dentist to cover 3 months of maternity leave from November 14, 2016-Feburary 23, 2017 for private practice on east side of Indy. Office is open Monday, 7-5, Tuesday 7-6, and Thursday 7-6. Please email linadds1@gmail.com or call 920-791-7272. Private Office Seeks Dentist Associate East side Indy practice seeks motivated Dentist to work 4 days per week. No weekends No evenings. Percentage of Production Salary. Not Based On Collections! Chartless, fully digital, modern office with expanded duty assistants. Full autonomy to practice in your comfort level the way you want to practice. This is a rare opportunity to work for a single owner private practice. Personality must be upbeat, positive, and motivated to produce quality dentistry. www.tenthstdentalcare.com Part-Time General Dentist (and practice for sale) Work at your own pace/ set your own schedule/ no expected production goals. Honest and caring environment. Practice is also for sale (I’m flexible) 8151 E. 21 St. Indianapolis. dentists@caringdentists.org Dr. Reyes 317/246-9859 Part Time Dentist - Fishers, IN Mid America Health is currently seeking a Part Time Dentist to join our growing team! This position is 2 days per week (Mondays and Thursdays) based out of the Fishers area and is a rewarding opportunity providing portable dental services to children at local schools. All supplies, equipment and support staff are provided. Join our team today at www.mahweb.com! classifieds General Dentist - South Bend, IN Area Heartland Dental supported offices are looking for outgoing and positive Dentists that are seeking career satisfaction and continuing education opportunities. There are 100 reasons to join Heartland Dental, discover yours! For more information, contact kayers@hearland.com or apply today at heartland.com. be proficient in 3rd molar extraction, sedation and implant placement. Please email jdentist@gmail.com for any questions. Fall 2016 · Volume 95 · Issue 4 | Journal of the Indiana Dental Association 41
Classifieds  Journal IDA  Positions Available Dentist Needed in Goshen, IN Well established dental practice needs energeti...
Journal IDA Classifieds Positions Available Administrative/ Clinic Assistant Established Brownsburg, Indiana Dental practice hiring team member. Computer and communication skills critical. Team mentality important. Send resume to 4474 Pinewood, Brownsburg, IN, 46112. Contact info@smilesbytodd.com Kool Smiles - Dental Specialists Needed in Indiana Kool Smiles has Oral Surgeon, Pedodontist, Orthodontist, Endodontist, and Dental Anesthesiologist Full Time and Part Time opportunities available throughout Indiana! We offer generous compensation and outstanding benefits including: 401k, PTO, malpractice, health, & life insurance, CE, licensing reimbursements, and Visa/permanent residency sponsorship. For more information contact Emily Platto today at eplatto@benevis.com! classifieds Full time associate Associate needed for practice south of Fort Wayne. Ownership possibilities included. Practice is 100% fee for service. Great starting salary plus benefits and buy in opportunity. Great work environment and staff. Email resumes to: drevanseck@gmail.com 42 Kool Smiles - Dental Specialists Needed Nationwide! Kool Smiles has Oral Surgeon, Pedodontist, Endodontist, Orthodontist, and Dental/Medical Anesthesiologist Full-Time and Part-Time opportunities available nationwide! Kool Smiles offers generous compensation and outstanding benefits including: 401k, PTO, malpractice, health, & life insurance, continuing education, licensing reimbursements, and Visa/ permanent residency sponsorship. For more information contact Emily Platto at eplatto@benevis.com! Kool Smiles - Associate Dentist Opportunities in Louisiana Kool Smiles Associate Dentist - FT/PT/ Multi-Site opportunities in Louisiana!! Earn up to $650 Daily Guarantee or % of Collections!! Up to $20,000 Sign-On Bonus + Relocation. We offer outstanding benefits including: 401k/PTO, malpractice, health, and life insurance, CE, licensing reimbursements, and Visa/ Permanent Residency sponsorship. Contact a recruiter today at jobs@koolsmilespc.com! Great Dentists Wanted - Hiring Bonus Lagrange & Albany IN Midwest Dental supports great local dentists. Our culture of joy sets us apart from other dental organizations. Joy leads to better care, better ideas, better outcomes, and rewarding careers. Whether you are fresh out of school, a seasoned veteran or anywhere inbetween, we match you with practice opportunities that meet your long-term goals while supporting you along the way. Great Benefits • Signing Bonus • Guaranteed Salary • Partnerships • Profit Sharing • Work/Life Balance • Practice Leadership • Enhanced Learning • Administrative Support Education Requirements Doctorate of Dental Surgery (DDS) or Doctorate of Dental Medicine (DMD) required please contact cbixler@midewest-dental.com Kool Smiles - Associate Dentist Opportunities Nationwide Kool Smiles Associate Dentist - FT/PT/ Multi-Site opportunities in 16 States!! Earn up to $650 Daily Guarantee or % of Collections! Up to $20,000 SignOn Bonus + Relocation. We also offer outstanding benefits including: 401k/ PTO, malpractice, health, and life insurance, CE, licensing reimbursements, and Visa/Permanent Residency sponsorship. Contact us at http://www.koolsmilesjobs.com/connect! Journal of the Indiana Dental Association | Fall 2016 · Volume 95 · Issue 4 Hygienist - Lebanon, Indiana Looking for a smiling, friendly hygienist with an “I can help” attitude. Must have one year experience, be ready to work hard and make a difference in our small town practice close to Indy. Send resume and salary history to info@toshdentalgroup.com. Full/Part Time Dentist - NW Ohio High production dental practice in Northwest Ohio seeking full &/or parttime general dentists and part-time oral surgeon. Paperless system and digital x-ray. Great opportunity for recent grads to hone skills & speed, or experienced dentists to practice dentistry without the hassles of running a practice. Base salary commensurate with experience plus quarterly bonus available. Benefits include health insurance, retirement plan, flexible hours and days, professional liability insurance and some continuing education. Loan repayment site for eligible dentists. Please send CV to hrdepartment@dentalcenternwo.org. EOE. Associate Position Robust private practice, located in Indianapolis, is looking for an associate dentist. Fully digital office with highly trained staff. Excellent compensation and CE opportunities. Email resume to Indydentalteam@gmail.com. General Dentist-Multi-location Northern Indiana dental practice looking for an Associate Dentist with opportunities in both Plymouth and Bourbon offices. Modern offices, including Digital X-ray equipment, Intra-oral Cameras and XLDent practice management software. We are a nonPPO, non Medicaid, family owned and operated practice. We are looking for a commissioned-based associate with the opportunity to transition into a partnership or buy-out. Please send resume to: kclauss@bourbonfamilydentistry.com
Journal IDA  Classifieds  Positions Available Administrative  Clinic Assistant Established Brownsburg, Indiana Dental prac...
Classifieds Journal IDA Positions Available General Dentist/Pediatric - Part Time Are you a general dentist who like to treat children? We are looking for a part-time dentist in Richmond, IN for our dentist-owned group practice. Please send CV’s to dentaljobsindiana@gmail.com General Dentist - Kokomo Sign On Bonus Available. Heartland Dental supported offices are looking for outgoing and positive Dentists that are seeking career satisfaction and continuing education opportunities. There are 100 reasons to join Heartland Dental, Discover Yours! Contact kayers@ heartland.com Associate opening- Large Private Practice Hadley Family Dentistry has the rare opening for an associate dentist for our south Indy location Mondays and Tuesdays. We do have some flexibility with which days of the week they are. We are looking for an energetic, caring doctor willing to work with all ages of patients to help with our growing patient base. We are a large private practice with two locations. We prefer post grad field experience but would consider other applicants. You would be working primarily independently. Digital, and chartless office. Please send resume to nicole@drhadleydental.com. Full Time Expanded Duties Dental Assistant We are looking for a smiling, friendly person to join our busy, patient-centered practice in Huntingburg, IN. Must be a self starter and multi-tasker with a passion for quality dentistry and a desire to broaden your knowledge in the dentistry field. Offers full time if you have a great personality and exceptional work ethic. Please send resume to SMichaelSandy86@aol.com. Contracted Pediatric Dentist The Robbins Dental Clinic at Healthy Beginnings, a division of the Elkhart County Health Department, is looking for a dentist who is interested in working with our pediatric patients on Monday’s from 10:00 am to 6:00 pm. Initial duties would include dental exams, diagnoses, and the possibility of becoming a full time position in the future, which would include restorative procedures. We have a wonderful staff that can guide you into loving pediatric work. You may e-mail your resume to: msizemore@ elkhartcounty.com. Also, visit us at www. elkhartcounty.com for more information about our program and services. General Dentist - Hammond, IN General Dentists needed to work in our busy Indianapolis and Hammond, IN practices. Have clinical freedom and autonomy like in traditional private practice without the burdens of practice management, and no production quotas. Our offices are state-of the-art with great support staff. Production based compensation (est. $175k+) with minimum guarantee, paid malpractice, health, disability insurance, 401K, and CE reimbursement; visa sponsorship. Call 773-456-7071 or send resume to ABolivar@destinydentalcare.com. PT Oral Surgeon / Endodontist Northwest, IN Large, established family practice located in Northwest Indiana is looking to grow into a multi-specialty office. We are one of the highest rated offices in the area with a first class staff and facility. We would like a talented specialist to join our team on a part time basis. This is a great opportunity for a specialist to establish themselves in the northwest Indiana area. We have the ability to market and grow with the right candidate Please email C.V. to nwindianadds@ gmail.com. Associate Dentist Kool Smiles is hiring full time dentist positions available in multiple locations in Indiana. Dentists will work 4-5 days per week and we are offering $20,000 sign on bonus’s and full relocation. Very competitive daily guarantee, and great benefits. Please contact Alyssa Marshall at almarshall@benevis.com for more information. classifieds Merrillville - Hygienist and EFDA NWI practice seeks to add an EFDA and hygienist to our growing dental family. Looking for an “I can help” attitude and someone who is reliable and selfmotivated. Office is located in Merrillville, IN, just off I-65 and US-30. Compensation will be in line with experience and skills. If you are interested in joining our team, email your resume to merrillvilledentalcenter@gmail.com General Dentist Full Time - Chicago Exciting Opportunity! Growing Chicago based PPO/fee-for-service dental group seeking a general dentist with 2+ years experience to join us on a full-time basis. Offices located in south, southwest and west suburbs. Expecting growth to northwest and north suburbs of Chicago soon. In-house dental specialists, administrative and clinical support, and modern, digital offices. Competitive compensation and comprehensive benefits package (health care insurance and 401(k)) as well CE opportunities. H-1 Visa sponsorship available. Relocation allowance available. IL license required. Please email your cover letter and CV to dentists@csgsmiles.com. Fall 2016 · Volume 95 · Issue 4 | Journal of the Indiana Dental Association 43
Classifieds  Journal IDA  Positions Available  General Dentist Pediatric - Part Time Are you a general dentist who like to...
Journal IDA Classifieds classifieds Positions Available | Practices Available | Equipment | Job Seekers 44 POSITIONS AVAILABLE PRACTICES AVAILABLE Dental Assistant Seeking a motivated and experienced CDA for a quality, well-established, fee-for-service practice. Team members enjoy a Mon-Thur schedule and opportunities to expand their professional knowledge through ongoing CE, working with CEREC and leading industry professionals. The successful candidate either possesses or demonstrates the aptitude to acquire the knowledge, skills, and abilities to successfully serve patients as the right hand of the doctor. - Full-time in Lafayette - High School Degree or equivalent - Radiology and DANB certified. If you meet these attributes, we would be excited to meet you and further discuss a future! Submit resume to jobs@ellsworthdaydds.com So. IN Family Dentistry practice for sale Efficient. 27 year established practice. Located in very high traffic area; highly visible. Great schools. $450,000+ per 3 day week. Active patient count 1125. 15 minutes from downtown Louisville, KY. Perfect for new graduate or satellite office. Why take on excessive debt? Low asking price. Contact: soinpracticeforsale@gmail.com. General Dentist We are seeking a full-time experienced general dentist for our Wisconsin Office. Practice in a beautifully remodeled space in a great location, near Janesville/ Madison. We are searching for a candidate who will be involved in the community in order to build long term relationships with our loyal patient base. Comprehensive benefit package offered, with Income Guarantee. $5,000 Signing Bonus and Relocation fees available! This position has future partnership potential. Email resume to dental2848@gmail.com Are You Exceptional? Our well established, fee for service dental practice in Chicago South Suburbs is growing again! We are looking for outstanding General Dentists, Orthodontists and Pediatric Dentists interested in joining our team of exceptional Dental Professionals. Our facility is state of the art and our support teams are fully trained…the only thing missing is you! Send your resume to ddsjob456@gmail.com Dental Office for Sale - Northwest IN Free standing 4000 sqft fully equipped dental office building for sale. Located in Northwest IN on a very busy intersection across from Jewel, major retailers and banks. Office is fully furnished with state of the art equipment, Adec dental chairs and cabinets, 3D i-Cat scan, Waterlase laser, fully digital, 8 tx rooms and plumbed for 12.For sale at $749,000 only, valued at over 1.4 Million. Once in a lifetime opportunity. Sale of patient base is negotiable. If you are Qualified and Pre-Approved, please send your inquiry to drdds2016@gmail.com Dental Practice in Southwest Indiana Well established practice with 4 operatories and serving 1,942 active patients. After all expenses are paid, the first year annual cash-flow is estimated to be 230k on a 4 day work week. For a full detailed report, contact Chad Bruner: cbruner@paragon.us.com, 614-588-3518. www.paragon.us.com EQUIPMENT Intraoral X-Ray Sensor Repair We specialize in repairing Kodak/ Carestream, Dexis, Gendex & Schick CDr. sensors. Repair & save thousands over replacement cost. We purchase old/ broken sensors. www.RepairSensor.com / 919-924-8559 JOB SEEKERS General Practice For Sale Long established FFS practice for sale in Northern Indiana. Confidentially listed, spacious, standalone 6 operatory building with 2015 revenue of 785K. Practice offers good profitability with a 4 day work week. Real estate offered for sale or lease. Flexible, Pankey trained Practitioner willing to stay on to transition patients to a new owner. Practice proforma with after tax cash flow analysis available. Contact; northindianadentist@gmail.com. General Practice #IN-1276 Wabash County. 5 Operatories. Average collections $397,387 (net $170,434). Nice location; large modern office. Longevity/ solid patient-base. Room for growth. Contact Jason Gamble, MBA, NPT. 877365-6786 x229, j.gamble@NPTdental. com, www.NPTdental.com. Journal of the Indiana Dental Association | Fall 2016 · Volume 95 · Issue 4 General Dentist - Griffith, IN Heartland Dental supported offices are looking for outgoing and positive Dentists that are seeking career satisfaction and continuing education opportunities. There are 100 reasons to join Heartland Dental, discover yours! For more information, contact kayers@hearland.com or apply today at heartland.com. Temporary Dentist Dentist available in Indianapolis and surrounding areas to cover maternity, medical, or personal leaves. I am very personable with a calm and friendly demeanor. You can rest assured knowing I will provide quality care to your patients and keep your office running smoothly in your absence. TempDentistIndy@gmail.com
Journal IDA  Classifieds  classifieds  Positions Available   Practices Available   Equipment   Job Seekers  44  POSITIONS ...
Member Info Journal IDA New Members Dr Paul Botsford (Roseman Univ 2016) FIRST DISTRICT DENTAL SOCIETY Dr Paul Effinger (Midwestern Univ 2016) GREENE DISTRICT DENTAL SOCIETY Dr Megan R Booe (IU 2016) INDIANAPOLIS DISTRICT DENTAL SOCIETY Dr Jabrea Lynne Bennett (IU 2012) Dr Vidya R Bettagere (IU 2016) Dr Samantha Blaha (Univ of Nebraska 2016) Dr Katherine L Boehm (IU 2016) Dr Kylie Bontrager (IU 2016) Dr Shira Ruggs Dancy (IU 2016) Dr Jenna M Davies (IU 2012) Dr Brandt Finney (IU 2016) Dr Quantez T Freeman (IU 2015) Dr Wendy J Garvin (IU 1997) Dr Jeffrey Golder (IU 1988) Dr Angela L Greenaway (IU 1999) Dr Cheryl R Hartman (IU 2007) Dr Donald R Helfert (IU 2010) Dr Jenonghwa Hong (IU 2016) Dr Emily Jane Horcha ( Univ of KY 2012) Dr Daniel B Jenks (IU 2016) Dr Armaun Karimzadeh (IU 2015) Dr Patrick S Kelly (IU 2016) Dr Chanh M Le (Univ of Detroit 2015) Dr Corey D Martinez (IU 2015) Dr Dean Morton (Univ of Iowa 1995) Dr Dean H Oller (IU 1991) Dr Carol Patel (Univ of Louisville 2013) Dr Dalibor Plecas (IU 2016) Dr Erin Rake (IU 2010) Dr Tanet A Sinchai (IU 2008) Dr Amul H Singh (SUNY at Buffalo 2001) Dr Aaron R Springhetti (Univ of Louisville 2013) Dr Helena M Swank (IU 2009)) Dr Timothy J Treat (IU 2016) Dr Jack G Windsor (IU 2016) Dr Stephanie A Wright (IU 1999) Dr Virginia Young (Univ of FL 2016)) ISAAC KNAPP DISTRICT DENTAL SOCIETY NORTH CENTRAL DENTAL SOCIETY Dr Tamara Gierke Button (IU 2007) Dr Daniel P Joldersma (Univ of Detroit 2016) NORTHWEST INDIANA DENTAL SOCIETY Dr Kara E Clark (IU 2012 & Pittsburgh 2016) Dr Shaun Freeman (IU 2016) Dr Timothy J Kamp (Midwestern Univ 2016) Dr Faye M Kostidis (IU 2004) Dr Omosede Osagiede (Boston Univ 2015) Dr Anthony M Pulver (Midwestern Univ IL 2015) Dr. Katherine M Zuccarelli (Loyola Univ 1991) members EAST CENTRAL DENTAL SOCIETY SOUTHEASTERN INDIANA DENTAL SOCIETY Dr Travis Gross (IU 2005) Dr Franklin Awah (Univ of AL 2016) Dr Abigail J Colclasure (Univ of Louisville 2016) Dr Zachary S Colclasure (Univ of Louisville 2016) Dr Brittney D Levsey (Univ of Louisville 2004) Dr Noopur D Patel (IU 2016) Dr Nicholas Rorick (IU 2011) WESTERN INDIANA DENTAL SOCIETY Dr Nichole Barnett (IU 2016) Dr Theodore Kula III (IU 2016) In Memoriam Dr. James W. Bayley of Lafayette and member of the West Central Dental Society, passed away October 4, 2016. Dr. Bayley graduated from Indiana University, School of Dentistry in 1964. Dr. James E. Dumas of Fort Wayne and member of the Isaac Knapp District Dental Society, passed away September 22, 2016. Dr. Dumas graduated from Indiana University, School of Dentistry in 1964. Dr. Jonathan L. Gray of Indianapolis and member of the Indianapolis District Dental Society, passed away December 2015. Dr. Gray graduated from University of Illinois, School of Dentistry in 1972 Dr. Ralph “Dan” Rohn formerly of Alexandria and member of the East Central Dental Society, passed away July 29, 2016. Dr. Rohn was an IDA Past President. He graduated from Indiana University, School of Dentistry in 1953. Dr. C. Neal Heape of Sullivan and former member of the Western Indiana Dental Society, passed away August 2016. Dr. Heape graduated from Indiana University, School of Dentistry in 1977. Dr. Jeffrey L. Winn of New Whiteland and member of the Indianapolis District Dental Society, passed away October 4, 2016. Dr. Winn graduated from Indiana University, School of Dentistry in 1987. Fall 2016 · Volume 95 · Issue 4 | Journal of the Indiana Dental Association 45
Member Info  Journal IDA  New Members  Dr Paul Botsford  Roseman Univ 2016   FIRST DISTRICT DENTAL SOCIETY Dr Paul Effinge...
Journal IDA Last Word The Servant as Leader Dr. Michael D. Rader The Roman Empire was in dire straits. The barbarians were at the gates. The Roman senate in an act of desperation sent a delegation to visit the modest farm of disgraced former senator Lucius Quinctius Cincinnatus where he was found plowing his field. They offered Cincinnatus total dictatorial power with the title of Magister Populi (Master of the People) if he would raise an army and save the Republic. Cincinnatus led the army and in the decisive “Battle of Mons Algidus” routed Rome’s enemies. With victory firmly established Cincinnatus abruptly resigned his dictatorship and returned home to resume his life as a farmer. This entire episode played out in sixteen days. His actions have been cited as an example of outstanding leadership, civic virtue, and sacrificing personal ambition to the common wealth. Centuries later, on a far away American continent another man displayed equal personal restraint of ambition. George Washington led the revolutionary army to victory against the British Empire, the world’s greatest army and at the height of his popularity and power voluntarily left to return to Mount Vernon and private life. King George, III asked American portrait painter Benjamin West what Washington would do after winning independence. West replied, “They say he will return to his farm.” “If he does”, the King replied, “He will be the greatest man in the world.” Such a sacrificial act was unknown and incomprehensible in Europe where monarchs ruled with tyranny and fought for unabashed power. And to Washington’s contemporaries he was the greatest man. “Franklin was wiser than Washington, Hamilton was more brilliant, Jefferson was more intellectually sophisticated, Adams was more engaging, and Madison was more politically astute, but Washington was still the greatest. And they would all agree to that.” Founding BrothersEllis. Today as our nation contemplates who it will elect as its next president it might be useful to consider what yardstick we as voters use to measure our leaders. Are we looking for a leader who will build a wall or someone committed to opening more doors? Do we want a leader who promises free college tuition or a leader who holds a more strict interpretation of the Constitution? Perhaps rather than choose a leader based upon on specific policies or positions that are subject to change as circumstances and unanticipated complications arise, we might examine a characterdriven or character based leadership style. The type of leadership practiced by Cincinnatus and Washington is frequently referred to as servant leadership. A servant leader places duty, honor and service before any self consideration. 46 A servant leader is moral; not only in his or her personal and professional life but in encouraging moral behavior among followers. The servant leader’s focus is to serve the organization’s members nurturing their growth as well as building a similar culture in the organization. The servant leader’s primary concern is the success of all stakeholders which could include employees, customers, colleagues, partners, community and ultimately all of society. And most importantly, the servant leader continually looks inward, always reflecting upon his or her motivations as a counterweight to the ever present human temptation of hubris. This last characteristic seems almost completely lacking in most of our career politicians. But these words are not about our national, state or local elections and leaders. What motivates each of us? Why do we accept the mantle of leadership for the myriad of opportunities that exist for each of us? Is our motivation as unalloyed as we would like to believe or are we blind to our own personal ambition and selfaggrandizement? Is an impressive curriculum vita our goal and impetus for action? We live in a culture increasing dominated by Facebook, incessant tweets and 24 hour instant communication. Personal happiness and success is often defined as not being frustrated in the realization of our wants. It seems easy to confuse one’s personal desires as synonymous with the common good. Any person who views life through the lens of an iPhone at the end of a “selfie stick” is likely to be lacking in perspective and empathy. Is the selfless leadership practiced by Cincinnatus and Washington aberrant flukes in history or examples we should embrace as our goal? Or have we descended into a dark age of diminished expectations where the best we might hope for was suggested by the cynic who said, “If you’re looking for a leader, first find someone who is intelligent, energetic and has integrity. If he doesn’t have the last, pray that he lacks the first two as well.” I hope not. About Dr. Rader Dr. Michael D. Rader is a general dentist practicing in South Bend, IN. He can be reached at drrader@sbcglobal.net. Journal of the Indiana Dental Association | Fall 2016 · Volume 95 · Issue 4
Journal IDA  Last Word  The Servant as Leader Dr. Michael D. Rader The Roman Empire was in dire straits. The barbarians we...
Last Word Journal IDA 2017  IDA  Monthly  Dues  Program       Pay  your  2017  ADA,  IDA  and  local  dental  society  membership  dues  through  our  Monthly  Dues  Program   that  allows  you  the  convenience  of  paying  in  monthly  installments.  Should  you  enroll  in  this  optional   program,  the  IDA  will  deduct  dues  payments  from  your  bank  account  each  month.  There  is  no  fee  for  this   program  for  2017.     To  enroll  in  the  Monthly  Dues  Program,  complete  this  form  and  return  to  IDA  by  December  15,  2016.     Authorization  Agreement  for  Preauthorized  Bank  Payments     Dentist  Name:  ______________________________________________________________     ADA  #  _________________________________     I  hereby  authorize  Indiana  Dental  Association  to  initiate  debit  entries  to  my  bank  account  indicated  below  and  the   bank   named  below  to  debit  the  same  to  such  account.     Bank  Name:  ____________________________________________________________________________________________________________       Bank  City:   __________________________________________________________________     State  ___________     Zip  __________________           Routing  No:  ____________________________________________________      Account  No:  _________________________________________     Notice:  This  authority  is  to  remain  in  full  force  and  until  the  Bank  has  received  written  notification  from  me  or  its  termination  in  such   time  and  in  such  manner  as  to  afford  the  Bank  a  reasonable  opportunity  to  act  on  it.       Name:  ___________________________________________________________________________________________________________________       Address:  ________________________________________________________________________________________________________________       City:  _________________________________________________________________________     State  ___________     Zip  __________________       Phone:  _________________________________________________________     Component:  _________________________________________       Signature:   _____________________________________________________     Date:  _________________________________________________         Please  fax  this  completed  form  to  317-­‐634-­‐2612,  email  (jody@indental.org)  or  mail  to:   IDA,    Attn:  Jody  Cleary,    1319  E  Stop  10  Road,    Indianapolis,  IN  46227     OR,  go  online  at  INDental.org  and  sign  up!   # Refund  Policy:    At  IDA’s  discretion,  participants  may  request  a  refund  until  April  1,  2017.  After  this,  no  refunds  will  be  given.   Fall 2016 · Volume 95 · Issue 4 | Journal of the Indiana Dental Association 47
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