Special Section: Minding the Money

Journal IDA The JOURNAL of the INDIANA DENTAL ASSOCIATION WINTER 2015 VOLUME 94, ISSUE 1 INDENTAL.ORG Minding the Money
Journal IDA The JOURNAL of the INDIANA DENTAL ASSOCIATION  WINTER 2015 VOLUME 94, ISSUE 1 INDENTAL.ORG  Minding the Money ...
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 2015, 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. Ted Brauer Dr. Eric S. Browning Dr. Lorraine J. Celis Dr. Jack Drone Dr. Dawn R. Durbin Dr. P. Bruce Easter Dr. Chad R. Leighty Dr. Thomas M. Murray Dr. David P. Pflum Officers of the Indiana Dental Association Dr. Steven J. Holm, President Dr. Chad Leighty, President-Elect Dr. Jay Asdell, Vice President Dr. Daniel W. Fridh, Treasurer Dr. Jack Drone, Editor Dr. Jeffrey A. Platt, Speaker, House of Delegates Dr. Jill M. Burns, Vice Speaker, House of Delegates Dr. Desiree Dimond, 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...
2015 WINTER CONTENTS 5 EDITOR’S MESSAGE Dr. Jack Drone 6 PRESIDENT’S MESSAGE Dr. Steven J. Holm 8 EXECUTIVE DIRECTOR’S MESSAGE Mr. Doug Bush 10 MEMBER ZONE Member Zone 10 COMPONENT 140 12 PARTICIPATION Dr. Bill Risk 14 GUEST EDITORIAL Dr. Jay Asdell SPECIAL SECTION 16 DENTAL ACCOUNTING Mr. Brogan Baxter 20 LIFE INSURANCE Ms Shareese Anderson 26 10 TIPS TO A SUCCESSFUL PRACTICE START UP 16 30 CHOOSING THE RIGHT BANK FOR YOUR DENTAL Minding the Money PRACTICE Ms Karen Scharf CASE REPORT 36 ENDODONTIC MANAGEMENT OF AN INFECTED IMMATURE TOOTH WITH SPONTANEOUS ROOT CLOSURE AND TYPE II DENS INVAGINATUS Ryan W. Baker, DDS, MSD Kenneth J. Spolnik, DDS, MSD 36 Case Report Ahmed Ghoneima BDS, MSc, PhD Ygal Ehrlich, DMD 42 CLASSIFIEDS 44 MEMBER INFORMATION 46 SMILE Dr. Tom Gilbert 47 LAST WORD Dr. Michael Rader 42 Classifieds
2015 WINTER  CONTENTS  5  EDITOR   S MESSAGE Dr. Jack Drone 6  PRESIDENT   S MESSAGE Dr. Steven J. Holm 8  EXECUTIVE DIREC...
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Editor’s Message Journal IDA Wishing You 10,000 Hours Dr. Jack Drone I was completing a hygiene examination in early December, when I asked the patient how her family was. She told me that her son had fallen on hard times in his early twenties. Things had not been going well for him lately and she felt like luck was not on his side or on her side. She then said she had seen a couple of articles in the local paper about my sons. She said that I seemed to have good luck and that my boys were lucky too…..Journal Editorial!! Her comments got me thinking. I do not write this article in a boastful way. I merely write about my side of her commentary. There is no doubt that things happen in life that can seem insurmountable, but I am only speaking of the surmountable. The two questions I thought of immediately were these. Why was success attributed to luck? And why was the perceived “lack of luck” so much more discussed than the perceived “presence of luck” and success. The first question coincided with a book that I was reading at the time, Outliers, by Malcolm Gladwell. The ultimate analytic in all of our souls craves to know why things happen. Gladwell’s book attempts to explain why people have success. To break his findings down, simply, he mentions that things must be repeated certain number of times, 10,000 for example, before there is some level of increased competency. He sites many examples, Roseto, Italy, the National Canadian Junior Hockey League, Bill Gates, and seamstresses in New York City. I would assume that if each of us travels back in time, we will find that dentistry became “easier” around our 10,000 hour or procedure. Fascinating! Where is the luck? Things can possibly be explained. psyche called “pervasive awfulism”, termed by Terry L. Paulson PhD. This one is really interesting. Turn on the evening news and then count the number of stories that are bad or awful. Then count the number of stories that are good. It will be about nine bad stories to one good story. Why? Paulson claims that horrific sells. My point is that to the patient in the chair that morning, my son’s good fortune in the Geography Bee was explained away by luck. In reality, he had spent over 100 hours studying countless books and software supplements, let alone help from teachers and parents. The other reference was also explained away by luck, as well. Another son had won a Junior Basketball Championship. 300 shots and 500 dribbles four times a week was our training slogan for the season. The result was winning. Coincidence or hard work? I have my opinion. The same inference has been made about our profession. The reality is that all of us have spent a lifetime cultivating our craft so that a buccal composite on tooth #29 seems outrageously expensive. The truth is that there are tens of thousands of hours behind that restoration that made it seem easy. A junior in dental school would have great anxiety over the same procedure. So as we begin another year in support of our profession, I wish you “good luck”! Or is what I should say “Continued excellence based on the thousands of hours of repetition and practice”! The second question of “lack of luck” being discussed more than successes stems from something in the human Winter 2015 · Volume 94 · Issue 1 | Journal of the Indiana Dental Association 5
Editor   s Message  Journal IDA  Wishing You 10,000 Hours Dr. Jack Drone  I was completing a hygiene examination in early ...
Journal IDA President’s Message The Changing Face of Dentistry Dr. Steven J. Holm When I was young I would drive with my father to a service station to fill the car with gas. You would stop at the pump and an attendant would come out to fill the tank for you. He would also check the oil, check the water in the radiator, check the air in the tires, and clean your windshield. After paying him you were sometimes rewarded with stamps which you could accumulate and later use to purchase merchandise. In today’s market, we pump our own gas, wash our own windshield, check our own air in the tires, and pay at the pump with a credit card. Gasoline has become a commodity and not a service. We base our buying needs on price and not on the service we receive. Dentistry is rapidly changing as well. The majority of patients base their dental decisions on price. If your dental insurance says you have to see ‘Dentist A’, you will probably go there, no matter how much you like ‘Dentist B’. It has become all about the money. Has anyone shopped at a grocery store that is more expensive, based on the fact you like the checkout clerk there better? This brings us to the model of “large group practices.” The stereotypical dental office is a 1-2 dentist practice that is not part of managed care insurance plans, but will take your insurance or cash. For many years this is what we all strived to become. If you practiced in any other setting, the attitude was that you were somehow less. There is a bias among some toward those that work in large group practices, that this business concept is less than ideal. My photo this issue is a shout out to the “Domers.” That is me and Joe Montana. 6 We all know the argument. Large group practices say dentistry is a commodity. They are a national brand rather than a person. Their bottom line is price and not quality. They over diagnose to meet production goals. They only care about making money. So where is the truth? I really don’t know. Somewhere in the middle I suppose. But if the ADA and the IDA want to increase their membership, their attitudes need to change. We need to recognize what we have in common, and quit obsessing on how we are different. The challenge for young dentists is staggering. They enter the market sometimes $250,000 or more in debt. They are then asked to purchase a practice which can cost $750,000. They have not seen patient one and they are one million dollars in debt. Large group practices offer solutions to this. They start the young dentist out on a competitive salary. They supply the marketing and the practice management needed to run a practice. How many dentists over forty can honestly say dental school prepared them for the business side of the profession? They have access to new equipment, they are provided C.E., and they work in an environment that allows them to be a dentist. When Inc. Magazine named businesses that created jobs, large group dental practices were two of the top ten! Now before anyone takes out the torches to burn me at the stake for becoming a “shill” for large group practices, be assured this is not my intent. We do need to get our heads out of the sand before it is too late. With government oversight increasing, the cost of dentistry continually rising and insurance companies putting on more and more pressure, it is important we come together. Solo practitioners are going to have trouble dealing with these issues. This is why physicians banded together. I Journal of the Indiana Dental Association | Winter 2015 · Volume 94 · Issue 1
Journal IDA  President   s Message  The Changing Face of Dentistry Dr. Steven J. Holm When I was young I would drive with ...
Journal IDA know…we are not physicians. If you look at history, however, dentistry always follows medicine – always. Bottom line is we need to talk. This spring the IDA’s Council on Dental Education and Practice is attempting to put together a Large Group Practice summit. Our goal is simple… to communicate. As a profession we need to build bridges. We cannot become that country club that is only for the privileged few. What do we hope to find out? I don’t know. And that is the point…we don’t know. Hopefully we can make some friends and allies. IDA Annual Session IUSD Alumni Dental Conference Dr. Gordon Christensen JUNE 10-13, 2015 I am not opposed to large group practices. I think like solo practitioners they provide needed dentistry. Do I see the dental landscape becoming Sears or K-Mart? Nope! I think there will be a place for both solo practices and large group practices to succeed side by side. First however, we must tear down the fences. French Lick Resort French Lick, IN indental.org/register Dr. Stanley Malamed Dr. Steve Ratcliff The Right MOVES For Every Stage of Your Career EARLY CAREER • Associate Placement and Recruitment • Practice Purchase MID CAREER MATURE CAREER • Profitability Improvement • Practice Sales • Practice Valuation • Emergency Exit Strategies • Continuing Education • Transition and Retirement Planning • Long-Term Transition Planning • Mergers and Partnerships n 1.800.988.5674 www.henryscheinppt.com BROKERAGE SERVICES VALUATIONS n PARTNERSHIPS n MERGERS n ASSOCIATESHIPS n © 2015 Henry Schein, Inc. No copying without permission. Not responsible for typographical errors. 15PT9453 Winter 2015 · Volume 94 · Issue 1 | Journal of the Indiana Dental Association 7
Journal IDA  know   we are not physicians. If you look at history, however, dentistry always follows medicine     always. ...
Executive Director’s Message Life’s Instruction Book Mr. Douglas M. Bush I’m not a big fan of inspirational posters or self-help books. In fact, I confess I enjoy the biting wit of the folks at www.despair.com. They turned cynicism into a business enterprise with such deinspirational thoughts as, “The journey of a thousand miles sometimes ends very, very badly,” and “I believe that children are our future. And that terrifies me.” Still, I can’t help being impressed with the wisdom of H. Jackson Brown. He’s the bestselling author of “Life’s Little Instruction Book” which was originally written as a goingaway present for his son who was departing for college. Even Brown admits that there is nothing revolutionary about what he writes. He says, “Most of us know what we need to do to make our lives more fulfilled and useful, but sometimes we forget. My little books are gentle reminders of those simple things which, if done well and in a spirit of love, can significantly change our lives.” At home: “Take good care of those you love.” “Be forgiving of yourself and others.” “Understand that happiness is not based on possessions, power or prestige, but on relationships with people you love and respect.” “Never go to bed with dirty dishes in the sink.” A poster of Brown’s “21 Suggestions for Success” hangs in a room at my house. (Let’s just say it’s where I have opportunity to sit and contemplate it on a regular basis.) I must admit, he’s right. There’s no arguing that his suggestions are simple. And that if followed, my life, and the lives of folks around me, would be better. The hard part is the application - doing the small things we know to be right when we are distracted by all of the stuff that life throws at us every day. But the year is young and there is still opportunity for “resolutions.” With that in mind, I share with you some of Brown’s “gentle reminders.” Everywhere: “Have a grateful heart.” “Become the most positive and enthusiastic person you know.” “Never resist a generous impulse.” “Don’t do anything that wouldn’t make your Mom proud.” Best wishes for fulfilling, successful and prosperous 2015. In your dental practice: “Give people more than they expect and do it cheerfully.” “Treat everyone you meet like you want to be treated.” “Commit yourself to quality.” “Commit yourself to constant improvement.” 8 IDA Executive Director Doug Bush can be reached at Doug@ indental.org or 800-562-5646. Journal of the Indiana Dental Association | Winter 2015 · Volume 94 · Issue 1
Executive Director   s Message  Life   s Instruction Book Mr. Douglas M. Bush I   m not a big fan of inspirational posters...
Journal IDA The IDA Insurance Trust was established in 2014 as a fiscally stable and viable option for IDA member dentists to find reasonably priced health insurance for staff, family and themselves. P No need to wait for open enrollment P No need for a qualifying event P Call TODAY to request a quote Call the IDA Insurance staff to educate yourself on your policy and review your options. 800-417-6424 www.IDAinsurance.com The IDA Insurance Trust is a multiple employer welfare arrangement. The multiple employer welfare arrangement may not be subject to all of the insurance laws and regulations of Indiana. State insurance guaranty funds are not available for the IDA Insurance Trust. Winter 2015 · Volume 94 · Issue 1 | Journal of the Indiana Dental Association 9
Journal IDA  The IDA Insurance Trust was established in 2014 as a fiscally stable and viable option for IDA member dentist...
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. Indianapolis District Dental Society Dental Networking Seminar - The IDDS Dental Networking Seminar was held February 14 at the Indiana Convention Center. Dentists from across the State attended the seminar to network with potential full or part-time associates, partners, or buyers. Fourth year dental students looking to join or buy dental practices in Indiana were also invited to participate. Women Dentists Seminar - The IDDS Women Dentists Seminar, held February 19, centered around the topic of Medical Aesthetics. Drs. Denise Flanagan and Kathy Stuart were presented with the IDDS Leaders & Mentors Award. Membership Committee Co-Chairs, Drs. Gabrielle Caron and Megan Keck, had a full crowd at Meridian Hills. Members braved the frigid temperatures to learn more about the science behind wrinkle reduction, body sculpting, botox and more. Dr. Diane Buyer displayed the new App for Drinks Destroy Teeth. Dr. Sue Germain encouraged everyone to volunteer for the Indiana MOM project on April 24-25. And President Dr. Heather Maupin told the guests in attendance that they are the future of dentistry, and their involvement is crucial to having a practice that represents them. Upcoming Events March 11 Spring GMM Speaker: Matt Modleski “Life, Leadership & High Performing Teams.” Blue Heron Ballroom at The Garrison Center. Social Hour at 5:30, Dinner at 6:30. Contact IDDS to register by March 2 at info@indydentalsociety.org March 13 OSHA/CPR Please contact www.indental.org/oc to register yourself and your staff today!! Space is limited. Lunch will be provided to those staying for both OSHA and CPR. April 23-25 IDA Mission of Mercy Project at State Fairgrounds Please visit www.indianamom.org to volunteer!!! May 8 Ethics Seminar Contact IDDS at info@indydentalsociety.org to register. Effective for this licensing period ending March 1, 2016, dentists and dental hygienists must receive 2 ce credits. This will fulfill your licensure requirement. Remember that Ethics is required of every member before your license expires at the end of February 2016 Dentists and Hygienists welcome. Seminar is from 9-11a.m. 2 CE’s awarded. Cost is $10/person. Contact info@indydentalsociety.org to register or call IDDS at 317/443-7375. Registration deadline is May 1. Please call the IDDS office at 317/471-8131 or email info@indydentalsociety.org to let us know if there is anything we can do to provide you with a member benefit. Thank you. Carolyn Hansen Want to see your component represented in Component 140? Email your component president or executive staff and let them know you want to see what’s going on in your area! Visit www.INDental.org/Component to contact leaders in your component. 10 Journal of the Indiana Dental Association | Winter 2015 · Volume 94 · Issue 1
Journal IDA  Member Zone  Component 140 In Component 140, Indiana   s component dental societies have the chance to showca...
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MedPro is pleased to be the newly endorsed professional liability insurance provider of the IDA Member Zone  Journal IDA  ...
MEMBER ZONE Participation Dr. William B. Risk “Participation.” This is the one word answer Indiana State Senator Ron Alting gave when asked the question, “What would be a good topic for this column?” What the Senator meant was that in his experience, few dentists participate in the political process. They do not make much of an effort to engage him or educate him on issues that are important to them and dentistry in the state of Indiana. We need look no further than the Washington Post newspaper to have proof of this fact. The Post listed Indiana as one of five states with a voter turnout of less than thirty percent in the most recent election. No doubt there were many dentists in that apathetic seventy percent who were not participating in the political process at even its lowest level. Senator Alting went on to say that we, the Indiana Dental Association, had the responsibility of educating our members on the issues and how to communicate these concerns to our law makers. Yes, there is a dentist, Dr. Denny Zent, in the Indiana House of Representatives, but he only has one vote and one vote can hardly be called a groundswell. It needs to be perceived by the legislature that from all across the state not only is there some concern about dentistry’s issues, but some action also needs to be taken. What are these issues? Just ask Dr. Leila Alter from Bedford, Indiana. She is participating in the process! Dr. Alter has gone to many meetings concerning Medicaid dental benefits reform and funding, the proposed Healthy 12 Indiana Plan 2.0, and Children’s Health Insurance Plan (CHIP) funding and reform. Not only is she attending these meetings, she is contacting the responsible officials and expressing dentistry’s concerns. As a matter of fact, Dr. Alter has even spoken to the Governor about some of these matters. Access to care is another issue. There is a perceived lack of access to dental care in many parts of the country and the proposed solution is the creation of a new dental provider, the dental health aid therapist (DHAT). Some efforts are being made to have DHATs treating the dentally underserved populations nationwide. In the dental insurance arena, among other things, we still have the issue of noncovered benefits. As you will recall, this is the practice of insurance companies telling the participating dentists not only what their fees are for services covered under a particular policy, but also what their fees must be for services not covered under that policy. In other words there is some homework that needs to be Journal of the Indiana Dental Association | Winter 2015 · Volume 94 · Issue 1
MEMBER ZONE  Participation Dr. William B. Risk     Participation.    This is the one word answer Indiana State Senator Ron...
Charitable Care Journal IDA done in preparation for participation. The basketball player doesn’t play in the game without preparation. There are the practices, working on his shot, listening to the coach about strategy and then participation in the game. We can meet our local legislators and become acquainted with them. This process is a little like dating. We see someone we are attracted to and we make ourselves available. We make ourselves more attractive by being sure there is IDPAC help, and we can even help them ourselves. But more than that we can speak to them in more casual settings and get to know them. Talk about the weather, the kids, the holidays, et cetera. As we continue to court our legislators we can slip in a bit about the dental issues. This is participation. One person doesn’t have to do the whole job; each of us only has to do a little. The New Year is here and one of our resolutions should be, as Senator Alting has stated, to participate in the political process. At the lowest level at least we should vote but that is setting the bar at far too low a level. Do a little reading, talk to IDA Director of Governmental Affairs Ed Popcheff, court your lawmaker. This is participation. About Dr. Risk Dr. William B. Risk is a general dentist practicing in Lafayette, IN. He can be reached at wriskdds@gmail.com. Dr. Bill Risk and Senator Ron Alting (left) have a friendly chat about the issues facing dentistry.. Winter 2015 · Volume 94 · Issue 1 | Journal of the Indiana Dental Association 13
Charitable Care  Journal IDA  done in preparation for participation. The basketball player doesn   t play in the game with...
GUEST EDITORIAL Passion Dr. Jay Asdell Dr. Jay Asdell – Candidate for the Indiana University Board of Trustees On January 10, 2015, the IDA Board of Trustees unanimously voted to support Dr. Jay Asdell’s candidacy for a position on the IU Board of Trustees. Dr. Asdell is a leader in the dental profession and his local community. He also has a life-long passion for his alma mater and feels he could play an important role in charting the course for IU as it embarks on implementing its Bicentennial Strategic Plan. Watch for future updates on how you can support the candidacy of Dr. Jay Asdell. PASSION….Passion is defined as an “irresistible motive for a belief or action.” In our lives, we are passionate about many things. I have a passion and a pride for Indiana University. I believe that Indiana University is the “best dollar in higher education.” However, we all know that higher education is under attack. Young adults are finding alternatives to college under the perception that college costs are spiraling out of control. As the cost of higher education continues to rise, it is imperative that those in charge are informed, aggressive and proactive. college student. I would work hard as Trustee of Indiana University to ensure that IU continues to remain “the best bang” for your education dollar. I feel strongly that there also needs to be a desirable connection between the students and alumni of Indiana University and the Trustees. I will work to maintain and strengthen the level of communication between the students, the alumni and the Board. Social media has allowed the skill of communication to ascend to a level previously unknown to society. It is important that we all respond on the same level. I feel the next 10 years are critical for Indiana University as the model for higher education is evolving. Your trustee should be hard working and insightful with regard to the changing attitudes and perceptions of the 21st Century My IU lineage goes back a long way. My wife, Rulan, is a graduate of the IU School of Dental Hygiene and my son Patrick is an IU Bloomington grad (Biology- BA, 2012) and is currently enrolled in medical school. My daughter Elizabeth 14 Journal of the Indiana Dental Association | Winter 2015 · Volume 94 · Issue 1
GUEST EDITORIAL  Passion Dr. Jay Asdell  Dr. Jay Asdell     Candidate for the Indiana University Board of Trustees On Janu...
Charitable Care will start at IU in the fall of 2015 and will be a member of the IU volleyball team. My father, grandfather, uncle and cousin all graduated from the IU School of Dentistry. My mother was a graduate of the IU School of Education. My brother and sister are both graduates of the IU School of Medicine along with their spouses. I can’t wait for that day to see my daughter in an IU uniform. Gloriana frangipana… I attended Indiana University in the late 70s after graduating from Loogootee High School, in a small town in southern Indiana. I was fortunate enough to gain acceptance to the Indiana University School of Dentistry after 3 years of undergraduate study in Bloomington. After graduation from IUSD in 1983, I completed a residency in Oral and Maxillofacial Surgery at St. Luke’s-Roosevelt Hospital in New York City. In 1986, I moved to South Bend and have been in the full private practice of Oral and Maxillofacial Surgery ever since. I have been the sole owner of my practice since 2001, which has given me invaluable experience as a small business owner. I have extensive experience in leadership and governance. I am a member of the IU Varsity Club board and a past board member of the IUSD Alumni Association. I am an Eagle Scout and have been a member of the LaSalle Council Executive Board, Boy Scouts of America, for 15 years. I am currently the Chief of the Dental Department at Memorial Hospital in South Bend and also a member of the St. Journal IDA How to Vote for IU Trustee Any IU degree holder can vote in the Trustee Election. The election begins in June 2015. The first step is to update your email address with the IU Alumni Association by calling 800-824-3044 or sending an email to advdata@indiana.edu. There are two ways to vote: 1. Vote online. Beginning June 1, any elegible IU graduate can vote online at: https://alumni.indiana.edu/about/election/vote. shtml 2. Vote by paper. Mailed ballots will be sent on June 1 to graduates who have voted by paper ballot in any of the past three elections. Request a paper ballot by coontacting Amy Cope, alumni trustee election coordinator, at truselec@indiana.edu or 812-855-6610. Joseph Co. Airport Authority Board. I was a Little League coach for both baseball and softball for many years. My hobbies include flying (commercial pilot license), tennis, music, playing the drums, lake time and of course, watching all IU teams play. I feel strongly that active participation is the key to success with any organization. I have held many positions in the Indiana Dental Association (current vice president), the American Dental Association (delegate), the Indiana Society of Oral and Maxillofacial Surgeons (past president), the Great Lakes Society of Oral and Maxillofacial Surgeons (past president), the American Association of Oral and Maxillofacial Surgeons (delegate for over 20 years) and several local dental societies and civic organizations. I am currently the Oral Surgery lead for the Indiana Missions of Mercy project which will give much needed dentistry to over 2000 patients who are unable to afford regular dental care. Once again, I feel that my vast experience in governance will be an asset as a member of the IU --Board of Trustees. Dr. Asdell has served as personal pilot to Coach Tom Crean on several occassions.. I am humbled by the opportunity to be an Indiana University Trustee. It is with great pride that I look forward to serving Indiana’s finest institution of higher learning as a member of the Indiana University Board of Trustees. Please feel free to contact me with any questions at my email which is hoosieroms@gmail.com and I encourage you to go to my website asdellforiu.com and follow us on Twitter and Facebook. GO HOOSIERS! Winter 2015 · Volume 94 · Issue 1 | Journal of the Indiana Dental Association 15
Charitable Care  will start at IU in the fall of 2015 and will be a member of the IU volleyball team. My father, grandfath...
SPECIAL SECTION Dental Accounting: the way it should be Brogan Baxter The good news is that there is a better way to manage your tax liability and experience exceptional cash flow in your dental practice. The bad news is that you are probably missing it because you don’t have dental-specific accounting. But following these five key strategies will help make 2015 the smoothest tax year ever. What do you think of when I say the phrase: “tax surprise”? Does your skin crawl or blood pressure jump? Are there immediate memories evoked of the time you got “the big one”? Do you immediately panic before going to your personal happy place? Regardless of the response you have, the pain and frustration that comes along with a tax surprise (which we quantify as any refund or taxes owed over $10,000 in a given year), can be mitigated with appropriate dentalspecific accounting. The good news is that there is a better way to manage your tax liability and experience exceptional cash flow in your dental practice but the bad news is that you are probably missing it because you don’t have dentalspecific accounting. With taxes being on the forefront of everyone’s mind, let’s understand how your accountant misses the target with estimates. Most accountants utilize the widely accepted practice of basing your current estimated taxes from prior year profits. This works great for the first quarter payment, but most accountants almost always fail to evaluate the business profitability routinely throughout the year - you’re lucky if your books are properly evaluated quarterly. 16 Let’s look at an example to see how problems happen: let’s assume you owned a practice with $1,000,000 in collections and overhead of 65% in a given business year. The following year, collections increased a nice 7% and you managed to cut expenses by around 3%. In this situation, neither your collections nor expenses look dramatically different from the prior year, so there won’t be any major warning signs, just a nice solid year. The problem comes, however, when combining the decent growth with the minor drop in cost; your net profit is up around $100,000 and your accountant had not planned for it, which translates into an approximated $40,000 surprise and the dreaded call you hope to never experience. Most dentists are lucky to meet with their accountant one or two times per year, generally around tax time and again late in the year, but when they typically have the “taxplanning meeting” late in the year, much of the damage has already been done. This doesn’t get caught earlier because most dentists do not have their books reconciled by their accountant any more frequently than semiannually or quarterly. No updated numbers means things are not being monitored as frequently as they should, which means your accountant won’t catch the $100,000 in Journal of the Indiana Dental Association | Winter 2015 · Volume 94 · Issue 1
SPECIAL SECTION  Dental Accounting  the way it should be Brogan Baxter  The good news is that there is a better way to man...
Special Section profit until you have very little time to plan for it. Once you finally close your books, back up your file, and hand over the information to your accountant you wonder if you’ll get that dreaded call - another dental tax surprise. Sure enough, you get the call that you’ll need to cobble together an additional $40,000 that you didn’t plan on, but congratulations on a great year anyway. Sound familiar? Journal IDA As this snowball builds upon itself, you realize that on April 15th you will also have to pay the current year’s first quarter tax payment which is based on the increased profitability from the prior year. Let’s not forget that you still need to fund the prior year’s retirement plan prior to filing your tax return as well. At the end of the day, here is what your first quarter cash outflows could look like: 2014 Q4 Est Tax Due 1/15 2014 Tax Surprise Due 4/17 2015 Q1 Est Tax Due 4/15 2014 Total Retirement Plan Funding Total due over 3 months $26,250 $40,000 $40,000 $30,000 $136,250 Since this isn’t your first rodeo and you have grown accustomed to tax surprises, you’re likely hoarding cash in anticipation of this bad news. People hoarding cash are like squirrels stock-piling nuts for the long winter, thus never being able to enjoy the lifestyle they’ve worked so hard for throughout the year because they want to be prepared “just in case”. Perhaps you’re not a stockpiler or cash hoarder, instead you ride the waves with being fine one month and stretched the next, so having to come up with the dollar amounts above are very painful and likely results in missed payrolls for yourself, or opting not to fund the retirement plan. What if you’re the young dentist with a breakout year? In this scenario, you may be expecting a great year-end bonus to take home due to the elevated bank accounts without fully understanding the tax implications of a $100,000 increase in net income. Eventually, this cycle of bad tax planning begins to constrict the opportunity to build wealth long-term regardless of whether you expected it or not. The ultimate failure that results from bad tax planning is the inability to save enough for retirement consistently. From the example above, $136,250 puts a dent in the bank account and savings strategy. Sadly, your retirement fund is often an after-thought with this situation, like the last person in line at a company picnic taking what scraps remain and moving down the line unfulfilled. Fortunately, we have five key strategies that can help you avoid this situation and make 2015 the smoothest tax year ever: 1. Convert to an S-Corporation. This structure will allow for better cash flow and more predictability (no more bank account roller coaster games) when a compensation structure is properly planned. When you convert to an S-Corporation, you are allowed to be an employee of the business you own; consequently, you are on payroll like everyone else and taxes are being withheld from every paycheck instead of lump sum payments paid quarterly. As an example, instead of having to cut a $40,000 tax check every 3 months, if you pay a little with each paycheck you could cut your quarterly tax check The ultimate failure that results from bad tax planning is the inability to save enough for retirement consistently. Winter 2015 · Volume 94 · Issue 1 | Journal of the Indiana Dental Association 17
Special Section  profit until you have very little time to plan for it. Once you finally close your books, back up your fi...
Journal IDA Special Section by half or more (and not wreck your bank account in the process). You’ll find that with structure and predictability, distribution payments, taxes, and W-2 salary increases can all get along with each other peacefully. Although taxes still need to be managed in an S-Corp., this is a huge step toward reducing the dreary year-end tax surprises because more taxes are spread throughout the year with a consistent paycheck. 2. Hire a dental-specific accountant. This is not a CPA that has “some” dental clients; this is a CPA that has “exclusively” dental clients. By being a specialist, and knowing dental terminology, he can develop a dental-specific chart of accounts (i.e. list of expenses). This chart of accounts needs to be voluminous as well, 30 line items won’t cut it anymore, so don’t accept that. Also, twist his arm and make the CPA promise to provide you “clouded Quickbooks” allowing for monthly (not quarterly) reconciliations of your P&L and balance sheets. Anything less frequent than monthly reconciliations will only increase the chances of a tax surprise. The frequent, consistent numbers will allow your CPA to communicate great ideas and proactive advice. 3. Develop an appropriate safety net. Having the money to pay a tax surprise makes the sting of the surprise slightly less painful, but having structures in place to ensure this happens is harder than you think. You need to be disciplined and be a numbers hawk consistently. Figure out how much overhead is necessary to fund 45-60 days of payables in the practice. That range will vary for each practice based on the business model and certain practice-specific trends. Let’s say you determined that overhead for 45 days is approximately $65,000. Great, you just figured out how much cash you want in the practice at all times - your minimum practice cash reserve. This balance will float up and down against the ideal as overhead fluctuates, so pay attention to the monthly averages on your bank statement and how they relate to monthly overhead. Be sure to take your income in a predictable manner since it’s easier on the cashflow and bank balances and is more predictable to manage. 4. Devise a more cashflow-friendly income structure. Most tax advisors for dentists don’t truly understand the ebb & flow of a dental practice and how that impacts your personal cashflow situation. As a result, they might suggest you take home most of the cash reserve or stab in the dark at where income should be set. Another mistake we see all the time is advice based purely on tax savings. Though heavily weighted cash distributions can mitigate employment taxes, it’s often in lieu of a generous W-2 to benefit your practice retirement plan savings through additional match you’re foregoing. Another missed impact from structuring income this way is that it will result in huge quarterly tax payments or sporadic, lumpy distributions neither of which are friendly on your personal or business bank account. Accountants miss this impact all the time, and it is very important to your stress levels and sanity to smooth those cashflows. Predictable bank accounts might seem boring, but they definitely help you sleep better at night. Tax advice can’t be in a vacuum and must take all financial aspects of your life into consideration. 5. Reevaluate your retirement plan. Not all 401Ks are created equal and you should learn how to identify whether yours is outstanding or mediocre. Consider a fee-only investment environment, free of commissions that prevent active asset management. Retirement plan commissions and internal expenses can eat away at your money so you’ll want to look at this as well. Add a generous match and allow a profit share component and you’ll be shocked at how much retirement savings can accumulate without the complication and expense of other “sophisticated” retirement plans. Additionally, you’ll get the benefit of being able to shelter even more money from Uncle Sam with a great retirement plan structure. Most tax advisors for dentists don’t truly understand the ebb & flow of a dental practice and how that impacts your personal cashflow situation. 18 About Brogan Baxter Brogan Baxter is the Chief Operating Officer and senior analyst at Four Quadrants Advisory Companies, a national accounting, financial planning, and advisory firm with only dentists as clients. They are the only dental advisory firm in the nation with a money back guarantee on their services. To learn more or put your current CPA to the test, contact Brian Wilson at 877.720.6213 or bwilson@4quadrant.com. Journal of the Indiana Dental Association | Winter 2015 · Volume 94 · Issue 1
Journal IDA  Special Section  by half or more  and not wreck your bank account in the process . You   ll find that with st...
Special Section Journal IDA Healthy Habit. We know that lifetime habits are built by one-on-one interaction with your patients. We think great banking should be the same! The Private Banking group is ready for you on your schedule, just call us and we’ll come to you! We have the unique flexibility to tailor our products and services to guide our clients’ financial relationships and meet their evolving needs. With over 100 years of serving the dental community we are a full service bank providing EXCLUSIVE PRODUCTS FOR DENTAL PROFESSIONALS DENTAL BANKING ACCOUNT DENTAL EQUIPMENT LEASING ACQUISITION FINANCING DENTAL PRACTICE LOANS DENTAL PRACTICE REFINANCE REMOTE DEPOSIT ONLINE BANKING MERCHANT SERVICES our customers with a full suite of financial services including: DOWNTOWN: 136 East Market Street - (317) 824-6160 CARMEL: 11450 N. Meridian Street - (317) 238-2831 BINFORD: 6840 Lake Plaza Drive - (317) 238-2860 SYB - NMLS# 433971 Winter 2015 · Volume 94 · Issue 1 | Journal of the Indiana Dental Association 19
Special Section  Journal IDA  Healthy Habit. We know that lifetime habits are built by one-on-one interaction with your pa...
Life Insurance the most meaningful gift a dentist can give Shareese Anderson Most people associate life insurance with death and sorrow, but the fact is, life insurance is meant to protect the living from grief and hardship. Life insurance is the most meaningful gift you can buy for the most important people in your life. Life insurance provides a value to every dentist regardless of age, income level, or family structure. Life insurance can help pay final expenses, provide for your family, protect your home and even protect your dental practice. Unfortunately, many dentists do not realize the significance of life insurance, so they either go without it, or they settle for inadequate coverage. Life insurance can be vital to your financial planning by serving as a cost effective way to: 1. Replace your income. Adequate life insurance can provide for your loved ones after you are gone and they can no longer rely on your income. Life insurance can be used to finance future college expenses, pay off mortgages, and allow your family to maintain their current lifestyle. 2. Resolve your financial obligations. The proceeds from your life insurance can be used to cover outstanding debts, unpaid medical expenses, funeral costs, credit card bills and even business expenses. 3. Settle your estate. Your life insurance can be designated to satisfying your estate taxes, protecting your family from having to sell off property or assets to settle this obligation. 4. Contribute to charity. All or a portion of your life insurance can be allocated to your favorite charity or organization. Life insurance is meant to protect the living from grief and hardship. 20 Journal of the Indiana Dental Association | Winter 2015 · Volume 94 · Issue 1
Life Insurance the most meaningful gift a dentist can give Shareese Anderson  Most people associate life insurance with de...
Special Section Journal IDA Different Types of Life Insurance While the basic intent of all life insurance policies is to pay a benefit when someone dies, you might have additional goals which will dictate the type of policy you buy. There are two basic categories of life insurance policies: term and permanent, and the most conventional form of permanent life insurance is whole life. One analogy often used to explain the difference between term life insurance and whole life insurance is the illustration of renting versus buying a house. There are definite advantages to renting a house, such as lower payments and no maintenance responsibility. On the other hand, the biggest advantage of owning a house is the ability to build up equity. The disadvantage to renting a house is that your lease will eventually expire. The landlord may or may not extend your lease and he can raise your rent payments at his discretion. The disadvantage of owning a house is that the costs, including mortgage, taxes, insurance and maintenance, are higher and equity can fluctuate with the market. Term life insurance is akin to renting a house. Your initial payments are lower, and when the term ends, you may not qualify for renewed coverage. And if you do, renewed coverage is invariably more expensive than your initial premiums. Whole life insurance is analogous with buying a house. Any premiums you pay that exceed the actual cost of coverage will be invested in a tax deferred account, building up “equity” for you, the policy holder. And just like a home equity loan, you can borrow money against those funds or even take withdrawals. This overview is an extreme simplification to give you a basic understanding of the broad differences in the categories of life insurance. A full discussion of the types of life insurance would be much more complicated than this. For instance, within the realm of whole life insurance, there falls: • universal whole life insurance • variable whole life insurance • variable universal whole life insurance • non-participating whole life insurance • participating whole life insurance • level premium whole life insurance • limited payment whole life insurance • single premium whole life insurance • indeterminate premium whole life insurance The difference between term and whole life insurance is often compared to the difference between renting and buying a house. And term life insurance includes: • level term life insurance • decreasing term life insurance • annually renewable term • 5-year renewable term • 10-year term • 15-year term • 20-year term • 25-year term • 30-year term • specific-age term Choosing the proper type and coverage for your life insurance can be complex and is best done with the guidance of a professional. Determining Life Insurance Needs An often-cited rule of thumb is that families should carry eight to ten times their annual salary in life insurance. That rule is rather simplistic, however, especially when you take into account practice ownership, student loan debts, escalating housing prices, the skyrocketing college tuitions your children will encounter and the myriad of other “life expenses” that require a more in-depth view of your life insurance needs. If you’re recently out of dental school and single, your immediate reaction might be, “I don’t need life insurance.” But that might be a hasty decision. Obviously, if you’re a single parent, you’ll want to invest in life insurance. But that’s not the only situation in which a single young dentist should purchase a life insurance policy. Ask yourself, who would undergo a hardship if you were to die. Do you Winter 2015 · Volume 94 · Issue 1 | Journal of the Indiana Dental Association 21
Special Section  Journal IDA  Different Types of Life Insurance While the basic intent of all life insurance policies is t...
Journal IDA Special Section have a cosigner on your student loans? What about loans associated with starting your practice? Do you provide support to any family members now, or will they rely on your support in the future? And who will cover your final expenses and funeral costs? An inexpensive term life insurance policy could cover all of these situations. And if you do plan to get married or have children in the future, purchasing life insurance while you are young and healthy is the best way to secure the most affordable rates. Determining the amount of coverage you require is a little bit art, a little bit science, and a little bit crystal ball reading. There is no simple, one-size-fits-all formula that can be applied to ascertain life insurance needs. There are many things to take into account, but this four-step process is a good place to start. Step One – determine your immediate needs. What expenses will your family incur immediately after your death? One of the first needs will be your final expenses. According to LearningVest Planning Services, “the average funeral in the United States costs anywhere from $7,000 to $10,000.” Additional short term expenses can include unpaid medical bills, attorney’s and other fees to settle your estate, and estate taxes. Next, factor in your current short-term debt. Add up all your immediate debt, such as student loans, car loans, credit card balances, home equity loans and any other outstanding debts. Then, calculate three to six months of living expenses, including mortgage payments, food and groceries, utilities, child care, etc. Tally your final costs, your short-term debt and six months of living expenses to arrive at your immediate needs. Step two – determine your family’s long term needs. Your family’s long term needs are any expenses required to maintain their current standard of living as well as expenses they will incur in the future, such as your children’s education, your spouse’s retirement, care of elderly parents, etc. A good place to start is with your current ongoing expenses such as mortgage payments, utilities, child care, groceries, tuition, health insurance, regular medical expenses. Take these annual expenses and multiple by the number of years you will want to provide coverage. For instance, if your youngest child is four-years-old and you want to provide your family with coverage until he turns 25, multiple your ongoing annual expenses by 21. Don’t worry about the future value of money when determining long term needs. The idea is to leave your family enough resources that, when invested wisely, will cover expenses in the future. 22 In addition to the expenses needed to maintain your family’s lifestyle, you’ll also want to consider any future expenses such as your children’s college tuition. While you might not know where your children will end up going to college and how much money they will need, keep in mind that according to the National Center for Education Statistics, “for the 2011–12 academic year, annual current dollar prices for undergraduate tuition, room, and board were estimated to be $14,300 at public institutions, $37,800 at private nonprofit institutions, and $23,300 at private for-profit institutions.” Step three – assess your current available resources. The next thing to factor in are the assets you already have available to cover your immediate and future expenses. How much money do you currently have in savings? Do you have an emergency fund established? Have you already started saving for your children’s future tuition payments? Do you have annuities or retirement savings in place? Do you have any other life insurance policies? Will your surviving spouse or dependent children be eligible for social security? Step four – calculate your deficit. Add your short term needs from step one and your long term needs from step two. Then subtract your available resources from step three. The total provides a good estimate of your current life insurance needs. Life events such as getting married, buying a house, having a child, starting a new practice, increasing your income, getting divorced, retiring, selling a practice, becoming a caregiver, all impact the level of life insurance you need. It’ important to review your life insurance after any major life event to ensure you have adequate coverage. Life Insurance Riders & Exclusions A life insurance rider is an additional provision added to your policy at the time of purchase that creates a benefit for you, the policy holder. While a rider will increase your premiums, there is typically little or no additional underwriting involved. The most popular riders are: • Guaranteed insurability – with this rider, you will not need to undergo a physical exam when you renew your policy. Your renewal rates will be based on your age rather than your health. • Term conversion – this allows you to convert your term policy into a whole life policy without undergoing a physical exam. • Premium waiver – if you get sick or disabled and are unable to work for a certain amount of time, this rider allows you to stop paying your Journal of the Indiana Dental Association | Winter 2015 · Volume 94 · Issue 1
Journal IDA  Special Section  have a cosigner on your student loans  What about loans associated with starting your practi...
Is Your Practice Growing by at Least 7% each year? Special Section Journal IDA With Paragon’s 7% Solution our doctors are shown how to double their net income in three to five years and double their practice in six to ten years. Some have doubled their practice in as little as one year! Some who have been with us for over 15 years have doubled, doubled, and doubled again. The 7% Solution. It works. THE PARAGON PROGRAM TM GROWTH, PROFITABILITY and FINANCIAL INDEPENDENCE. “ IT’S WHAT WE DO. Paragon is a partner with me in my practice. They are invested in both my business and clinical success. DR. BILL STOFER WARSAW, INDIANA Client Since 2003 “ I started working with Paragon when I reached the point in my practice that I didn’t know where to go next. They have motivated me and my staff to rebuild my office and grow in directions that I would have never thought of. I need someone to push me along and motivate me to stay on track and Paragon has done that. DR. DREW SHULMAN PHILADELPHIA, PENNSYLVANIA Client Since 2002 SEE US AT THE CHICAGO MIDWINTER MEETING - FEBRUARY 26-28 - BOOTH # 4438 Paragon Management Associates, Inc. 120 Northwoods Boulevard | Columbus, OH 43235 CALL: 800-448-2523 EMAIL: office@theparagonprogram.com VISIT: theparagonprogram.com Since 1986 No Hype. No Tricks. No Gimmicks. Just 29 years of results. Winter 2015 · Volume 94 · Issue 1 | Journal of the Indiana Dental Association 23
Is Your Practice Growing by at Least 7  each year  Special Section  Journal IDA  With Paragon   s 7  Solution our doctors ...
Journal IDA Special Section premiums until you are able to return to work. • Disability income – this rider provides you with income during the time you are disabled and unable to work. • Accidental death or dismemberment – this rider gives you or your family an additional payout if you are killed, go blind or lose a limb in an accident. • Serious illness – should you be diagnosed with a critical illness, this rider will provide you with a lump sum to cover your medical treatment. Most life insurance policies also have exclusions that limit the instances in which the benefits will be awarded. The most typical exclusions include: • • Suicide exclusion – if the insured commits suicide within a certain amount of time of purchasing the policy (typically two years) death benefits will not be paid out. Many insurance companies will refund the paid premiums to the insured’s family. • Dangerous activity clause – the dangerous activity clause either requires the insured to pay higher premiums if he or she participates in extreme activities such as mountain climbing, hang gliding, car racing, or it stipulates that benefits will not be paid if the death was attributed to one of these activities. • Aviation provision – this clause specifies that death benefits will not be paid if the insured is killed in a private plane crash. Commercial plane crashes are exempt from this exclusion. • Illicit activities exclusion – if the insured is killed by a drug or alcohol overdose or in the process of committing an illegal activity, death benefits will not be paid. Accelerated death benefit – similar to a critical illness rider, accelerated death benefits allow you to collect a portion of your policy benefits when you are diagnosed with a terminal illness and given a short time to live. All riders have stipulations attached. For instance, term conversion riders generally have deadlines to take advantage of the conversion. Some disability income riders include illness and accident, while others will only cover illness. Many serious illness riders contain a list of covered illnesses. It’s important to review all of your options and discuss your individual needs with a professional. The terms and conditions of the individual policy will outline the specific details of each exclusion clause. Saving Money on Life Insurance According to a 2013 LIFE Foundation study, 86% of respondents say they had not purchased life insurance because it is too expensive, yet they overestimated its cost by more than double. While life insurance is probably more affordable than you think, there are a few ways you might be able to save money on your premiums. Improve your health. JOIN SDC’S NETWORK And Get Back to What Matters Most! Superior Dental Care (SDC) makes participation easy with more patients in your chairs, efficient claims processing, and quick payments. SDC is the largest network in the region, with over 9,500 participating locations throughout Indiana, Ohio and Kentucky. Joining SDC’s network saves you and your office time and effort, so you can get back to what matters most! Improving and maintaining your overall health and fitness level can have a measurable impact on your premiums. Something as minor as losing a few pounds can push you into a lower risk class. Even if you’ve received a high premium estimate, you can request a reevaluation after you’ve improved your health. Quit smoking. Premiums for smokers are much higher, sometimes twice as high as premiums for non-smokers. Most insurers will reduce your rates once you’ve been smoke-free for a specified amount of time. Contact SDC today to request your application packet! dentistservices@superiordental.com (800) 762-3159 | (937) 438-0283 www.superiordental.com | 24 Pay your premiums annually. Many newly insureds opt for the monthly premium payment option because it’s easier to fit into the Journal of the Indiana Dental Association | Winter 2015 · Volume 94 · Issue 1
Journal IDA  Special Section  premiums until you are able to return to work.       Disability income     this rider provid...
Special Section household budget. However, quarterly, semi-annual and annual payment plans are less expensive in the long run. In fact, paying your premium annually can often save up to eight percent over the life of your policy. Avoid guaranteed issue if you’re in good health. The benefit of a guaranteed issue policy is that you don’t need to undergo a physical exam. This is a great advantage if you’re in questionable health and are worried about passing the medical exam. But premiums are much higher with a guaranteed issue policy, so if you have no doubt about passing the physical, opt for a traditional issue policy. Review your coverage regularly. Major life events can affect your coverage needs. For instance, when your youngest child graduates college and becomes an independent adult, you might decide to reduce your benefits and save on your premiums. Look into available riders. If a major life event has increased your insurance needs, you might consider adding a rider to your current policy rather than purchasing an additional policy. Some policies will offer riders that allow you to widen your coverage. Have you thought about... Journal IDA Get coverage while you’re healthy. The best time to purchase life insurance coverage is when you’re young and healthy. That’s when you’ll qualify for the best rates. And, let’s face it, you’ll never be younger than you are right now. Contact the IDA Determining the type of policy and appropriate coverage for your specific needs can be complex and time consuming. For professional advice and service, contact the IDA Insurance Services department at 800-417-6424. Already have life insurance? Whatever the policy and whatever situation you are in, one thing is guaranteed: Your needs and the insurance marketplace are changing. Call IDA Insurance for your free insurance check up today. About Shareese Anderson Shareese Anderson is a Life, Disability & Health Insurance Specialist with IDA Insurance Services. Shareese can be reached at shareese@indental. org. Disclaimer This information is intended to deliver a general overview and is meant for illustration purposes only. This is not designed to be tax, legal or investment advice. It is important to consult with an insurance professional for specific advice on your personal situation. Are you planning retirement from your practice in the next five to ten years? Does your practice have room for two or more dentists? We are looking for a few fine quality larger practices ($1 Million and above), with room for growth…and we just may be looking for you. Find out if you’re eligible to: your ✔ Receive the proceeds now from the sale oflove itpractice and continue to do dentistry because you ✔ Keep working with us as long as you wish - we pay 40 % of collections RETIREMENT? ✔ Ensure a successful and very smooth transition for your patients We are not a corporation or a management company. We are practicing doctors just like you, and we know how you feel. Selling your practice is an emotional issue. Let us work with you to make the transition smooth and easy. ✔ Transfer your administrative headaches to us, including payroll and supplies ✔ Minimize your tax liability ✔ Turn an idea into the plan of your dreams Get the best of both worlds… get paid now and retire when you’re ready later on. Find out now if we’re looking for you. Winter 2015 · Volume 94 · Issue 1 | Journal of the Indiana Dental Association 25
Special Section  household budget. However, quarterly, semi-annual and annual payment plans are less expensive in the long...
Top 10 Tips To a Successful Practice Start Up contributed by Bank of America Practice Solutions, IDA Endorsed Provider You have selected an amazing line of work with proven high success rates. With every chapter, every experience, and every challenge you will encounter in your career, there is opportunity. Hopefully you will take from this article the opportunity to grow, the opportunity to learn, and the opportunity to avoid costly mistakes so frequently made by new practice owners. Here are ten tips for making your practice start-up experience a successful one: have already established), it is important that you position yourself with industry-specific advisors who will help you with many crucial decisions you will be making for your start-up project. In no particular order, several trusted advisors who are vital to your practice are: 1. Do a little homework and prepare yourself. Dental Specific Contractors: This is very important. Trying to save money by cutting corners with a general contractor who is not experienced in building out dental practices can lead to unnecessary overruns and possible frustration with your equipment specialist and architect. Dental specific contractors exist in every market in the U.S. and are easy to find. Your equipment specialist should know reputable contractors they have worked with in the past. Also, check with colleagues who have already opened their offices and may have valuable feedback about contractor performance. During the past recession and as the economy rebuilds, dental practices have resurfaced in good shape and overall failure rates for practices remain very low. However, practices occasionally do fail and when this occurs, it can be a life-defining disaster, both professionally and personally. There was a time not too long ago that you could build a practice from scratch and have the luxury of a consistently booked schedule before even opening your doors for business. This is rarely the case today. So, as soon as your mind is made up to become your own boss, start getting an idea of the unknowns that lie ahead. Speak with current practice owners to find out what particular challenges they faced, what they did to prevail, and what (if anything) they would do differently today. 2. Build a network of trusted advisors. From the day you decide to start your own practice, you will be meeting many people. As you filter through all the advice and various relationships you will be establishing (or 26 Dental Specific CPAs: As we know, a general dentist can do root canals, but an endodontist is highly recommended for more difficult procedures. As with general contractors, there are thousands of general CPAs who would like to earn your business. Though it’s not necessary to make a change from your current CPA, you might consider starting a conversation with a dental specific CPA who works with a minimum of 25 dental clients and can lend another perspective on the value of using specialized CPA services. Journal of the Indiana Dental Association | Winter 2015 · Volume 94 · Issue 1
Top 10 Tips To a Successful Practice Start Up contributed by  Bank of America Practice Solutions, IDA Endorsed Provider Yo...
UNCERTAINTY Special Section Dental Equipment Specialists: Quite often this group is looked upon as a source whose primary interest is selling you as much equipment as the lender will approve you for. In most cases, this is not true for the better equipment specialists. A good equipment specialist is truly looking out for your best interest and can be one of your most insightful advisors. Typically, equipment specialists are very tenured and plan on staying in the dental field for their entire careers. It is very important to these specialists that you are well-positioned to succeed, for they plan to provide you with updated equipment and the latest technology for many years to come. As with your CPA, it is not uncommon to see dentists maintain career-long relationships with a trusted equipment specialist. Dental Specific Lenders: Currently there is a large amount of interest in dental practice financing from a plethora of lenders. You will find some lenders are very experienced with financing dental practice start-ups and others are simply general small business lenders. General small business lenders are typically looking to lend against the collateral in the transaction and not really interested in the “soft cost” which includes your build out or tenant improvement and working capital. Dental specific lenders who provide start-up financing are very familiar with the cost of your new project which may run upwards of $450,000 ( and of which only a third is equipment costs). Working with a lender who understands the project breakdown is very important. Journal IDA Feel confident about how you will be treated. Every day you are in control—of pain, of options, of caring treatment. When it comes to your professional liability protection, get the fair treatment and control you deserve with DentistCareSM, including: • PracticeGuard® Disability Protection 3. Secure financing. Although over the past few years there has been a significant amount of press about how banks have pulled back with lending to small businesses, the fact is there is no shortage of banks wanting to lend to dentists. However, you may find that your local bank and others are unfamiliar with the cost and funding allocation requirements for a start-up practice. But don’t worry, there are many major lenders that are very familiar with your needs and are willing to provide you with the required funds. Make sure your loan decision isn’t based solely on interest rate. Although the rate is important in keeping your payments lower, it should only be one factor when deciding on a lender. Here are some other loan features to consider: Loan Term: Similar to your home mortgage, you should consider the longest term available i.e.; 10-15 years. This will provide you with lower payments as you begin to grow your revenue stream. If your practice does better than expected, you can always pay down your loan similar to your mortgage. Loans can typically be prepaid without a penalty if you elect to do so after 3-5 years. Prepayment: Loan prepayment options will vary from lender to lender. Prepaying your loan may become an option after your practice is no longer considered a start-up • Enhanced Coverage Choices • Risk Resource Helpline Find out how DentistCare can help you reduce risk, keep from getting pulled in the wrong direction, and maintain the control you want. Visit ProAssuranceDentistCare.com for more information. Professional Liability Insurance & Risk Resource Services ProAssurance Group is rated A+ (Superior) by A.M. Best. 800.625.7814 Winter 2015 · Volume 94 · Issue 1 | Journal of the Indiana Dental Association 27
UNCERTAINTY Special Section  Dental Equipment Specialists  Quite often this group is looked upon as a source whose primary...
Journal IDA Special Section and is looked upon by lenders as an established practice. This occurs when you have demonstrated proven practice collections, your business revenue less your business expenses and personal expenses provides adequate cash flow, and the new loan you are considering is in your best interest or more attractive than your existing loan. Loan Structure: The payment structure is crucial and having a loan with graduated payments in the first 2-4 years provides breathing room and flexibility as your practice grows. Graduated payments can range from interest only payments for 6-12 months to a tiered payment structure for up to three years. Interest Rate: Rates can be fixed for the term or adjusted with prime or other rate indexes. Although payments may be less with an adjustable rate, rates will eventually begin to rise, so locking in with a competitive fixed rate today for the next 7-15 years might be your best solution. Lender Service Levels: As a start-up, you will have immediate banking needs such as credit card processing, direct deposit accounts, business credit cards, etc. During construction of a new practice, better dental specific lenders have internal processes in place to pay the building contractor, equipment company, and other vendors who may require deposits and incremental payments. They will also make sure all disbursements are made as planned so you can stay on schedule. 4. Have a business plan. If you haven’t already, you will learn how to present a treatment plan to a new or existing patient. You’ll want to be very specific with a comprehensive exam, diagnosis, and a course of action involving quality care. Similarly, developing a plan on how you are going to run your business from A-Z is instrumental in the success of your practice. You can access business plan templates from the ADA resource center and dental specific lenders. 5. Develop your business acumen. Remember, you will be a business owner, and you will need to develop business skills and acumen. From the moment you graduate and become licensed, it is wise to make a personal commitment to allocate a certain amount of time to learning the business of dentistry. Ask your professors if they can recommend a mentor who is already running a successful practice. Begin to explore what type of business model and practice philosophy you would like to incorporate in your practice. You may be surprised how colleagues or school alums who once had the same anxiety you have about starting a practice are willing to lend a hand and share their successes. Attending the IDA Annual Session is another excellent way to learn from others and find guidance directly from your peers. 28 6. Maintain a high level of credit worthiness. This is not really a secret, and you should already know how important your credit score is for you, both personally and professionally. A negative or low credit score can have a significant impact on qualifying for a practice loan. The amount of money you qualify for and the interest rate you receive may all be tied into your credit score. If you are not sure what is currently reflected in your credit file and would like to obtain your credit score you can go to myfico.com or to obtain a free copy of your credit report you can go to www.annualcreditreport.com. To inquire about a reported creditor you can contact one of the major three reporting credit bureaus: Equifax, 800-685-1111; TransUnion, 800-8884213; or Experian, 888-397-3742. 7. Keep your debt load at a manageable level and don’t overextend yourself. Temptations exist around every corner. Visit the next dental trade show or speak with your colleagues and you will hear the current buzz about the amazing technology that exists today in the dental profession. Vendors will tell you all about the value the latest technology will have on generating revenue in your practice and why you can’t live without it. While this may be true, you need to be very careful that you do not acquire equipment before you can cost justify such an acquisition. New technology can be very expensive and can be a burden on your cashflow if you are not ready to optimize the use and see immediate revenue or expense savings. This is also true with equipping all your operatories right from the start. Typically a 1,500 square foot office has room for four operatories; many dentists choose to equip two operatories as a start-up. There will be always be time later to equip your third or fourth room when your practice is at a level to support it. 8. Stay on budget. It is possible for total new dental start-up costs to range from $250,000 to $500,000 with an average cost just under $400,000. The total amount includes your landlord allowance (some landlords provide an allowance towards the build out), your construction costs (for a leased space), your equipment needs (dental and office hardware /software), dental supplies, office supplies and working capital (typically $75,000 to support your expenses while you see new patients and see insurance reimbursements.) Once you are approved by a lender and your project begins, it is crucial that you and your team remain on track to finish your project within budget. It may be helpful to apply for a little larger loan amount than you may be forecasting to allow for any unforeseen overruns that may occur while your office is being built. Lenders may accept a slight overage than original plans but an overrun of 10% or higher of your original amount may create concern from the lender, so try and stay on track. Journal of the Indiana Dental Association | Winter 2015 · Volume 94 · Issue 1
Journal IDA  Special Section  and is looked upon by lenders as an established practice. This occurs when you have demonstr...
Special Section 9. Establish professional and practice goals. It is crucial to establish goals which can be short, moderate or long term in nature. A goal is nothing more than a target that needs to be believable, achievable and measurable. Once a goal is established, the measurable component will help you stay focused and will force you to adjust and reinvent ways to achieve your goal along the way. Professional goals can include the number of new patients per week or month, number of hygiene appointments, amount of monthly production, collections, etc. Try to be disciplined, as only you are responsible for the overall performance of your practice. A simple tool of having specific goals for you and your team may make the difference of success or challenges. 10. Maintain your associate position as you are growing your business. No one on earth is more familiar with your debt load than you are as you begin your pursuit of practice ownership. Between your student loan debt, your car loan, your mortgage payment if you purchased a home, (if not, rent can be as much as a mortgage) and now your practice debt, the Journal IDA numbers will seem enormous. It will be very important to maintain guaranteed (predictable) income after you open your practice and while you are building your practice revenue. Once your practice is built and opened for business, maintaining an outside associate position for 2-3 days per week may help you better predict cashflow and pay your bills while you are adding patients to your new practice. You may consider associating for up to three days per week and reduce your associating days as you add days to your own practice. This associate position will typically be in another town or city as to demonstrate a non threatening or no risk of taking patients position for the dentist you currently working for. About Bank of America Practice Solutions Bank of America Practice Solutions offers a full range of dental practice financing options. To discuss any financing solutions that you are seeking in order to achieve your goals, contact them at 800.692.0790. Disclaimer This information is intended to deliver a general overview and is meant for illustration purposes only. This is not designed to be tax, legal or investment advice. It is important to consult with a banking professional for specific advice on your personal situation. • Inexpensive • Disposable The Original E-VAC Tip • Non-Toxic PROTECT YOUR PATIENT FROM PAINFUL TISSUE PLUGS PROTECT YOUR EQUIPMENT FROM COSTLY REPAIRS CONTACT YOUR LOCAL DENTAL SUPPLY FOR THE E-VAC TIP PACKAGED 100/ZIPLOCK BAG E-VAC INC.© CALL/FAX: (509) 448-2602 • EMAIL: kenevac@hotmail.com PURCHASED BY: General Practitioners • Pediatric Dentists • Periodontists • Prosthodontists • Dental Assistants • Hygienists • Hospitals • Universities Made in USA • FDA Registered Winter 2015 · Volume 94 · Issue 1 | Journal of the Indiana Dental Association 29
Special Section  9. Establish professional and practice goals. It is crucial to establish goals which can be short, modera...
Choosing the Right Bank for Your Dental Practice Karen Scharf Choosing the right bank for your dental practice shouldn’t be taken lightly. It’s an important decision and you should take some time to weigh the options. It’s not as simple as walking into your personal bank and opening up a new checking account. On the other hand, choosing a business bank doesn’t have to be an overwhelming decision. The process can be relatively straight forward; it’s simply a matter of knowing what your practice needs and what each bank has to offer. Personal versus Business Banking Just as the needs of your practice are different from your personal needs, the features of a business banking account are different from a personal account. Business accounts allow for merchant services (the ability to accept credit cards from your patients), corporate credit cards (the ability to give your staff a credit card charged to the practice), ACH payments and collections, night drops, foreign exchange accounts (useful if you purchase equipment or supplies from Canada, Mexico, or any other foreign country) amongst other features. Loan terms are typically different with business banking and usually include the option to secure funds to purchase or lease equipment. Cash management services and lines of credit may be offered to help you manage your working capital; portfolio evaluation, asset analysis and debt and equity structuring can help the bank’s business customers remain whole. Many business bank accounts also offer 30 employer services such as payroll processing or group retirement accounts. Unlike personal accounts, there may be transaction caps associated with business banking which place limits on the number and total dollar value of monthly transactions. With a transaction cap, if your practice makes too many deposits or withdrawals, or deposits or withdraws too much money, you will incur a fee. While your need for some of the features of a business bank account might not be immediate, it is nonetheless imperative that your dental practice have its own business account, distinct and separate from your personal account. Mixing your practice finances and personal finances, even only temporarily, is considered commingling funds, and is a very risky action. Commingling occurs anytime you: • use your personal bank account for business needs or your practice bank account for personal needs; • transfer money between your personal and practice bank accounts without proper structure and documentation; • deposit checks made payable to your practice into Journal of the Indiana Dental Association | Winter 2015 · Volume 94 · Issue 1
Choosing the Right Bank for Your Dental Practice Karen Scharf  Choosing the right bank for your dental practice shouldn   ...
Special Section your personal bank account; • • business savings account write checks or make withdrawals from your practice account to pay personal expenses. • business credit card • merchant services • Journal IDA automatic bill payments The danger in commingling is that you risk losing your personal liability protection, referred to as “piercing the corporate veil.” If the courts determine that you’ve treated the practice’s money as your own, they may hold you personally responsible for the practice’s debts and lawsuits. With business banking, there are additional available features that you might not have considered: • lines of credit • equipment leasing • wholesale lockboxes • signature authority on checking accounts • deposit-only cards • discounted employee checking accounts Knowing Your Requirements • sweep accounts Before evaluating and choosing a bank, it is necessary to know what you’re looking for. It’s important to develop a well defined list of explicit requirements as well as an understanding of how those requirements will impact your dental practice. Common features that are most likely high on the priority list for your practice are: • payroll services • retirement accounts In addition to putting your personal assets at risk, commingling funds makes tax time a nightmare. Commingling also leads to shoddy record keeping, which makes it difficult to measure your practice’s profitability and make improvements where necessary. • business checking account It’s important to be familiar with the banking features your practice needs not only now, but several years down the road. And, because features are often bundled in business banking, it’s equally important to know what features you Call 1-800-232-3826 for a free practice appraisal, a $5,000 value! AFTCO is the oldest and largest dental practice transition consulting firm in the United States. AFTCO assists dentists with associateships, purchasing and selling of practices, and retirement plans. We are there to serve you through all stages of your career. Stephen A. Trager, D.D.S. has acquired the practice of Wade E. Carnes, D.D.S. Indianapolis, Indiana AFTCO is pleased to have represented both parties in this transition. Helping dentists buy & sell practices for over 40 years. WWW.AFTCO.NET Winter 2015 · Volume 94 · Issue 1 | Journal of the Indiana Dental Association 31
Special Section  your personal bank account              business savings account  write checks or make withdrawals from y...
Journal IDA Special Section don’t need to avoid paying fees for services that you will never use. If your practice is new and you’re not familiar with all the nuances of business banking, you’ll want to make sure the bank offers a knowledgeable, business-banking-specific customer service representative who is readily available. Put the bank through a test – call the business banking customer service line and see how long it takes to get through, how long you’re left on hold, and how long it takes to get your question answered. Send an email and see how long it takes to get a response. Along the line of customer service, how important is the “personal touch” to you? Do you prefer high touch or high tech? Think about how and when you like to bank. Do you want to do your banking online? Through a mobile device? ATM? Do you want to do your banking face-to-face, in person at your local branch? Will you need after hours access to make deposits or withdrawals or to speak to a bank representative? How will these needs change in the future? It’s important to know these criteria ahead of time because not all banks offer the same automated banking features to their business accounts as they do for their personal accounts. Some banks may not have a business banker available at small, local branches. On the other 11:35 AMsome may have hand, IN-FEB-2014.pdf 1 2/18/14 extended corporate hours on certain days of the week. Next, consider your cash flow needs. How much flexibility will you need with cash flow management? Do you anticipate cash flow being steady throughout the months? Or do you expect fluctuations, such as when patients are trying to use up flexible spending accounts in November and December? Will you be penalized for going over transaction limits? Will cash flow be weak at the beginning of the year, when insurance companies are slow to pay their claims? Also enquire about the bank’s average processing time to determine when your deposited funds will be available. The Expedited Funds Availability Act, also known as Regulation CC or Reg CC, outlines a timetable that banks must follow when processing funds, but even within the schedule banks can hold your money for up to nine days. And there are separate guidelines set forth specifically for insurance checks. If your practice is new, or you’re unsure about cash flow, you’ll want to make sure your funds are available with the shortest delay possible. Another way to improve cash flow is by utilizing a bank that offers wholesale lockboxes. With a wholesale lockbox, payments, which are sent directly to a specific Post Office box, are collected and deposited by the bank. Because they’re processed immediately, the money reaches your bank account much quicker than if you handled the transaction on your own. Do you want investment advice or a sweep account? With a sweep account, you combine your standard business checking account with an investment account that is easily liquidated, such as a CD or money market. You set a minimum and maximum balance that you want to keep in your checking account. Each night, funds over the maximum balance are automatically “swept” into your investment account where they accrue a higher interest rate. If your checking account balance should fall below your designated minimum, the bank will liquidate the necessary investments and deposit the funds into your checking account. C M Be sure to ask about other services that the bank might offer. Are you interested in payroll processing? If you already have a payroll processor, will your current system integrate seamlessly with the new bank account? What about other employee benefits services? Tax preparation? Accounting services? Do you need a bank that is compatible with your dental office or billing software? Y CM MY CY CMY K And finally, if you’ll need a loan, it’s important to take into account your borrowing needs. Will You Need a Loan? If your practice is new, if you’re buying out a partner, or if you’re buying into an existing practice, you may need a loan to get things off the ground. Look into the types of small business loans that each bank offers and the lending criteria that they have outlined. 32 Journal of the Indiana Dental Association | Winter 2015 · Volume 94 · Issue 1
Journal IDA  Special Section  don   t need to avoid paying fees for services that you will never use. If your practice is ...
Special Section Ask if the bank is a member of the Small Business Administration’s (SBA) Preferred Lender Program. The SBA provides a guarantee to the bank, similar to a co-signer on a student loan or other personal loan. With this guarantee, banks are more willing to lend money to new or small businesses. If your practice is new or does not yet have a proven track record, it may be easier for you to qualify for an SBA loan over a traditional business loan. SBA Preferred Lenders have been approved for streamlined loan processing because they have effectively administered a high volume of successful SBA loans. This means you will get your approval quicker. However, it’s not necessary for a bank to be part of the Preferred Lender program in order to process SBA loans. It’s a good idea to find a bank that is at least familiar and comfortable with dealing with SBA loans, even if you are not in immediate need of a loan. Having an established relationship with an SBA lender can prove very helpful to dental practices which often have inconsistent cash flows and lack of adequate collateral for obtaining traditional bank loans. The SBA typically offers flexible repayment terms and has several programs that might come in handy in the future, such as the Microloan Program. Journal IDA to decide between a large national bank and a small community bank. Each offers its own pros and cons. Many of the advantages of a large national bank may seem obvious. For starters, large banks have a large menu of services. If you’re looking for a place to consolidate all of your personal and business financial needs, a large bank might be the place to look. Large national banks often offer their own brokerage and investor services, brokers to buy and sell stocks and bonds, estate planners, private bankers and business consultants. Big banks also have a funding advantage; because they’re able to borrow money at a lower rate they can take bigger investment risks than smaller banks. This may equate to your ability to get approved for a loan that you might not otherwise qualify for at a smaller bank. Local Bank versus National Bank Large banks are on the cutting edge of technology and typically offer more high tech tools than small banks. If you’re interested in depositing your checks through a mobile device, utilizing online banking, accessing enhanced feature ATMs, taking advantage of peer-to-peer banking and benefitting from additional high tech services, you’ll probably want to consider a large bank. When choosing a bank for your dental practice you’ll need The biggest advantage of a large bank is accessibility. For immediate help, call 866.921.5306 or ViSit DENTALCAREALLIANCE.COM PROTECT YOUR VISION 1 2 3 RELIEVE HEADACHES Better balance between work and life 1 Use DCA’s support to achieve your professional, personal and financial goals 2 DCA offers flexible options to help you realize your equity while protecting your patients and staff DCA 37116 INDent Journal_ First Aid.indd 1 3 DON’T CHOkE UNDER PRESSURE Practice the scope of dentistry you want to practice 1 2 3 Maximize your earning potential by focusing on patients, not paperwork 4 Enjoy autonomy and maintain control over your clinical decisions Human resources, payroll & benefits Marketing and accounting Insurance management and negotiations Facility management, staff training, C.E. courses and OSHA complaince 2/17/14 2:20 PM Winter 2015 · Volume 94 · Issue 1 | Journal of the Indiana Dental Association 33
Special Section  Ask if the bank is a member of the Small Business Administration   s  SBA  Preferred Lender Program. The ...
Journal IDA Special Section Big banks have hundreds, maybe thousands, of branches across the country and even across the globe and ATMs on almost every corner. If accessibility and convenience is high on your priority list, chalk one up for big banks. On the other hand, large banks are notorious for charging large fees. Chase’s business checking accounts, for instance, have monthly service fees as high as $95 depending on the type of account. And because national banks have a more hierarchical structure, your local branch doesn’t always have the authority to waive service fees or negotiate better loan rates. If you’re not concerned about having a lot of high tech bells and whistles, you might consider a small, local bank. While many small banks do not have the financial and technical resources to offer the latest innovative tools, others have made enormous strides in the high tech department, with services that rival the big banks. One of the biggest advantages of small banks is that they are, well, small. Because they don’t have multiple layers of bureaucracy they can often make decisions much faster than large banks. They also have a greater interest in supporting and growing the local community. Both of these factors may work in your favor if you’re applying for a loan. Atis investments ad slick_Layout 1 6/30/14 3:44 PM Page 1 You Have Plenty of Things to Worry About [Your Retirement Plan Doesn’t Have To Be One of Them] Small banks are also better known for their superior customer service and personal attention. It’s not uncommon for small bank customers to have direct access to the bank Vice President or to the executive who actually makes the loan decision. When you walk into a small bank, you’re often greeted by name, and because there are fewer branches and staff transfers, you are likely to see the same banker every time you visit your branch. On the other hand, community banks do not have the coverage of large national banks. Their branches and ATMs are usually limited to a small radius, which can lead to high access fees if you need to use an ATM outside of your network. And if you decide to move your practice or open a second practice in another community, you might not have access to the same local bank. Small banks also tend to stick with they do best – banking. They may not offer the extended services of a large bank, such as tax preparation and investment advice. When evaluating a small bank, keep in mind its lending authority. What is the largest size loan they can authorize? How close to that limit are your borrowing needs? Will you outgrow the bank’s capabilities as your business matures? And there is always the argument that small banks are riskier than large banks since they don’t fall under the “too big to fail” umbrella which might qualify them for government bail outs. The Dodd Frank financial reform regulations have put even more strain on community banks. However, as long as the bank is FDIC insured and you do not exceed the $250,000 limit on the totality of your accounts, you should consider the community bank relatively safe. (Keep in mind that investment accounts, such as mutual funds, stocks and bonds, annuities, etc., are not FDIC insured by any bank.) Fees to Consider At Atis Investments, we know that you have enough on your plate. That’s why we focus on the details, carefully matching you with a retirement plan that will fit the unique needs of both your company and its employees. Let us worry about your company’s retirement plan — you can worry about everything else. Give us a call today. Atis Investments John J. Evanich Kurt F. Schultz 9717 Prairie Avenue • Highland, IN  46322 219-836-2102 • Invest@AtisWealth.com Once you have your banking requirements outlined, you’ll want to consider what all of these requirements are going to cost. The fact is, many banks will offer a suite of services that is very similar to their competitors. In some cases, the only way to distinguish them will be the fees. When evaluating a bank, outline a typical scenario for your dental practice and ask the bank representative what your monthly fees will be. What’s your average daily balance? How many checks do you usually write each month? How often do you make deposits and what is the average amount? Will you be using automatic bill payment services? Payroll services? Merchant account? Don’t forget about the little fees. Over time, they can really add up. Ask about minimum balances and how fees are assessed if you go below the minimum. Is it a once a month fee? An every occurrence fee? Is there a cap on the fees? Think about the future of your practice. How will these 34 Journal of the Indiana Dental Association | Winter 2015 · Volume 94 · Issue 1
Journal IDA  Special Section  Big banks have hundreds, maybe thousands, of branches across the country and even across the...
Special Section fees change as your practice grows? If you’re utilizing payroll services, are you charged on a per employee basis? How many employees do you see yourself having in five or ten years? What percentage rate does the merchant account charge? One or two percentage points can make a difference, especially as your practice grows and more patients are using their credit cards. Does the merchant account charge per credit card batch? As your practice grows, will you need to batch more often? Remember, fees for business banking are not the same as fees for personal banking. It’s not enough to grab a bank’s brochure or look at their website for their list of service fees. Because business accounts are highly customized, most fees are not widely publicized. Your best option is to make an appointment with the business banker and discuss your own personal needs. Establishing an Ongoing Relationship In the end, it all comes down to relationships. Having a good working relationship with your bank is critical. Make sure you feel comfortable with your banker and the other banking staff. Find a banker who understands the dental industry and the idiosyncrasies of owning a dental practice, or at least is interested in learning about it. Journal IDA Make the effort to establish and grow the relationship. Visit your banker once or twice each year to discuss your financials and future plans. Your banker can be a great resource of ideas for supporting and growing your practice. Developing this relationship will help your banker see your practice for its potential rather than just its bottom line. This can be very helpful when it’s time to secure a loan or line of credit. Banking, even business banking, is nothing more than people working with people. So, when choosing a bank for your dental practice, make sure you find people you will enjoy working with and who are willing and able to work with you. About Karen Scharf Karen Scharf is the Indiana Dental Association Director of Communications. Karen can be reached at karen@indental.org. Disclaimer This information is intended to deliver a general overview and is meant for illustration purposes only. This is not designed to be tax, legal or investment advice. It is important to consult with a banking professional for specific advice on your personal situation. Practice Sales ◆ Practice Appraisals Transition Consultation Trust your dental practice with a brokerage firm that has... ◆ Successfully transitioned hundreds of dental practices over the past decade. We customize a plan FOR YOU to maximize patient and staff retention, minimize your tax liability, and ensure a smooth and successful transition. Call us today for a free initial consultation! ◆ An impeccable reputation for experience, service & results. ◆ Achieved its success with unparalleled service & a face-to-face approach. ◆ A 100% success rate post-closing; we’ve never had a buyer fail or default. Jason Gamble, MBA Regional Representative j.gamble@NPTdental.com 877.365.6786 x229 F: 877.641.0808 INFO@NPTdental.com www.NPTdental.com Trust our Experience, Rely on our Expertise. Winter 2015 · Volume 94 · Issue 1 | Journal of the Indiana Dental Association 35
Special Section  fees change as your practice grows  If you   re utilizing payroll services, are you charged on a per empl...
SCIENTIFIC ARTICLE Endodontic Management of an Infected Immature Tooth with Spontaneous Root Closure and Type II Dens Invaginatus A Case Report Ryan W. Baker, DDS, MSD • Kenneth J. Spolnik, DDS, MSD Ahmed Ghoneima BDS, MSc, PhD • Ygal Ehrlich, DMD Clinicians frequently encounter the sequlae of trauma, but are rarely present when the trauma actually occurs. It is important to be aware of possible healing responses after dental trauma has occurred. Spontaneous natural closure of an open apex in an immature tooth with a hard tissue barrier (HTB) is rare. To our knowledge, this is the first time 3D images of such a tooth are reported. 3D images were also done on the follow-up visit (30 month) to confirm healing. Treatment was successfully done according to the principles of regenerative endodontics. This demonstrates the relevance of this treatment in immature teeth with arrested root development in the adult patient. This work was done by a resident in Endodontics at Indiana University School of Dentistry (IUSD). The 3D imaging was done in collaboration with the Department of Orthodontics & Oral Facial Genetics at IUSD. Each author has contributed to this work. 36 Journal of the Indiana Dental Association | Winter 2015 · Volume 94 · Issue 1
SCIENTIFIC ARTICLE  Endodontic Management of an Infected Immature Tooth with Spontaneous Root Closure and Type II Dens Inv...
Scientific Article Journal IDA Abstract Apical periodontitis in an immature maxillary lateral incisor (#10) with arrested root development and a natural closure of the open apex in 22-year-old male was endodontically treated in a manner that conserved the existing hard tissue barrier (HTB). A dens invaginatus Oehlers II was also present. The patient reported no symptoms, but did recall an incident of dental trauma as a child. A 3D image showed the nature of the HTB closing the open foramen as well as the anatomy of the immature root with the dens invaginatus. Porosities were seen in the HTB and that is consistent with the histological “Swiss Cheese” appearance known to occur in apexification. Endodontic treatment was performed in a single-visit. Access to the root canal system (RCS) included penetration through the dens invaginatus. The canal was not mechanically cleaned, but only irrigated with sodium hypochlorite, ethylenediaminetetra-acetic acid (EDTA), chlorhexidine using the EndoVac® system. The barrier was maintained and covered with a 5mm layer of mineral trioxide aggregate (MTA). A sterile damp sponge was placed on the MTA. On the following visit the MTA had set, and an EndoSequence fiber post was placed in the canal and EndoSequence dualcure core build-up material was used to close the access and restore the tooth. A clinical and radiographic follow-up, 30 months after the initial treatment revealed resolution of the radiolucency and apical trabecular bone deposition and the patient was asymptomatic. Introduction Closure of the open apex in an infected immature tooth is usually achieved after disinfection of the root canal and dressing it with calcium hydroxide or other materials. Spontaneous natural closure of an open apex in an immature tooth with a hard tissue barrier (HTB) has been observed following luxation injuries, but it is not commonly seen.1, 2 A single-visit endodontic treatment was performed in a 22-year-old man who presented with asymptomatic apical periodontitis (AP) in an immature maxillary lateral incisor Figure 1 - Clinical view taken at initial visit (#10) with spontaneous root closure and a dens invaginatus Oehlers II. The research done on apexification and in regenerative endodontics provided the background for the treatment provided. The nature of the unusual anatomy of this tooth was assessed using Cone Beam Computed Tomography (CBCT) imaging. The treatment aims were to address the AP by disinfecting the RCS and yet not harm the HTB created or the cells responsible for its creation and maintenance. Disinfection of the canal was to be done solely by copious irrigation with sodium hypochlorite, ethylenediaminetetraacetic acid (EDTA) and chlorhexidine (CHX), and mineral trioxide aggregate (MTA) was to be placed over the HTB. After the MTA had set, the tooth was to be restored with resin restoration and a fiber post. Case Report A 22-year-old male presented to the Graduate Endodontic Clinic at Indiana University School of Dentistry (IUSD) for evaluation of tooth #10. A periapical radiolucency (PARL) was detected on tooth #10 in radiographs taken as part of a hygiene recall exam. The patient presented with no symptoms. The tooth exhibited a lingual pit invagination (Figure 1) suggestive of a dens invaginatus. His medical history was unremarkable. The periapical radiographs and the CBCT scans (Figures 2 and 3) revealed: 1. A dens invaginatus, Oehlers Type II in which the dens ends below the proximal CEJ (Fig. 3); Figure 2a - PA radiograph of maxillary lateral incisor #10 region at initial visit. Immature root with arrested root and spontaneous closue of the open apex is seen. A dens invaginatus type II is also noted. Figure 2b. A dens invaginatus type II was also seen on contralateral # 7, but root formation in # 7 was complete. Winter 2015 · Volume 94 · Issue 1 | Journal of the Indiana Dental Association 37
Scientific Article  Journal IDA  Abstract Apical periodontitis in an immature maxillary lateral incisor   10  with arreste...
Journal IDA Scientific Article 2. An immature root with a wide canal and arrested root development; 3. Natural closure of the open apex with a HTB containing a number of porosities; 4. A large PARL with extensive bone loss. The clinical examination did not elicit a vital pulpal response and the tooth was not sensitive to percussion or palpation. The clinical diagnosis was pulp necrosis with asymptomatic apical periodontitis in an immature tooth with arrested root development and a dens invaginatus (Type II). After anesthesia and rubber dam isolation, access to the canal was achieved. The dens was included in the access. The HTB was probed with a hand file and found to be complete, and the foramen was not patent. Figure 3a - A CBCT image showing the immature root and the voids in the HTB Disinfection was done with copious irrigation (15 ml) with NaOCl 6%, using a conventional syringe and the EndoVac system (SybronEndo, Glendora, CA). It was then followed by irrigation with 6ml’s each of EDTA (Henry Schein, Melville, NY), 70% isopropyl alcohol(Dux Dental, Oxnard CA) and CHX 2% (CHX-Plus, Vista, Racine, WI) in that order using the EndoVac system (SybronEndo, Glendora, CA). Following disinfection, a layer of grey MTA, (MTA, Dentsply Tulsa Dental Specialties, Tulsa, OK) 5mm in depth was manually placed, followed by a sterile sponge moistened with sterile H2O. An interim restoration of grey Cavit (3M ESPE, St. Paul, MN) was placed over the sponge. A layer of IRM (Dentsply Caulk, Milford, DE) was placed over the grey Cavit to improve the seal (Figure 4). On the following appointment (1 week later), the interim restoration was removed, and the MTA layer of had fully hardened. A final irrigation was performed with 5ml NaOCl 6%. The canal was dried and acid etched with phosphoric acid (35%) (UltraDent, South Jordan, UT) for 20 seconds, followed by a thin layer of bonding agent (OptiBond, Kerr, Orange, CA) which was then light cured. The canal was then back filled with EndoSequence (Brasseler, Savannah, GA) shade A2 dual-cure core build-up and a size large 0.06 EndoSequence fiber post was placed to length. The core material was light cured for 40 seconds and allowed to self-cure for 4 additional minutes. The post and core material were then trimmed flush with the cavo-surface margin. The occlusion was checked with articulating paper and adjusted so that there was minimal occlusal contact (Figure 4). Clinical and radiographic follow-up, 30 months after the initial treatment revealed resolution of the radiolucency (Figure 5) and apical trabecular bone deposition and the patient was asymptomatic. Figure 3b - A 3D image of # 10, the void in the HTB is seen as well as the extension of the invaginatus into the tooth A CBCT scan was taken using (Kodak 9000 Extraoral Imaging System, Carestream Health Inc. Rochester Figure 4 - Stages in the Treatment. 4a 5mm MTA was placed over the HTB and MTA was covered with a moist sponge and sealed with IRM 4b Post and core restoration with EndoSequence post and EndoSequence core material 4c #10: 30 month follow-up Figure 5 - Post Op CBCT. Evidence of bone healing is seen in the apical area of #10. MTA layer appears relatively homogenous, but voids are seen in the composite resin restorations A video of the 3D image of #10 can be viewed at http://indental.org/case-video. 38 Journal of the Indiana Dental Association | Winter 2015 · Volume 94 · Issue 1
Journal IDA  Scientific Article  2.  An immature root with a wide canal and arrested root development  3.  Natural closure...
Scientific Article Journal IDA NY) according to the following protocol (Kv 85, MA 10 Voxel 76, scan time 45 seconds). The scanning data was assessed and the 3D images of the tooth and the HTB were reconstructed using InVivoDental Imaging software program (Anatomage Incorporated, San Jose, CA). The porosities seen in the HTB were consistent with the histological “Swiss Cheese appearance” of the HTB previously reported and which referred to soft tissue inclusions within the HTB.3 On the following visit after the MTA had set, the tooth was restored with a fiber post and a resin core restoration. The patient was observed for up to 30 months. Clinical and radiographic evidence of healing was seen and confirmed with a follow-up CBCT scan. Discussion Clinicians frequently encounter the sequlae of trauma and are rarely present when the trauma actually occurs. It is important to be aware of possible healing responses. In this case we report the spontaneous closure of an open apex in an infected immature tooth with arrested root development. AP was controlled solely by irrigation and without instrumentation of the canal. The HTB was maintained and incorporated in the root canal filling. Root development of the treated tooth was arrested when ¾ of the root was formed and the foramen is fully open. It can be estimated4 that the offending event occurred between the ages 8-11. This coincides with the patient’s vague recollection of a dental trauma when he was very young. Apical periodontitis eventually developed after bacteria gained access to the root canal system (RCS) possibly through the lingual invagination. It could also be that infection at that age was the initiating event that interrupted root formation and not the early facial trauma. Hard tissue deposition can occur in the presence of infection5-7 and a HTB can be formed even before the AP has been resolved.8, 9 Interestingly, the tooth had been asymptomatic for years and AP was only noticed on a routine oral hygiene exam. Disinfection of the RCS in the immature tooth is challenging. Copious irrigation with minimal instrumentation is now INCREASE PATIENT ACCEPTANCE of COMPLEX TREATMENT PLANS Especially when the costs of care come out of their own pockets, patients ask, “WHAT CAN YOU DO FOR ME?” Do your current support materials answer the question? Do they demonstrate your talents and the outcomes you’ve achieved? At Dental Presentations, we’ve spent more than 16 years writing, designing, and producing support materials for dental practices, organizations, and institutions. Our patient profiles tell the compelling stories of transformative dental experiences in layperson-friendly language. PUT OUR EXPERIENCE TO WORK FOR YOU! a division of B Plus C Communications [317] 257-1186 www.DentalPresentations.com Winter 2015 · Volume 94 · Issue 1 | Journal of the Indiana Dental Association 39
Scientific Article  Journal IDA  NY  according to the following protocol  Kv 85, MA 10 Voxel 76, scan time 45 seconds . Th...
Journal IDA Scientific Article recommended for disinfection of the infected immature tooth in regenerative procedures,10 and was the treatment of choice for this case. An alcohol rinse was done before the irrigation with CHX to prevent interaction with sodium hypochlorite and potential discoloration.11 EndoVac was included in our irrigation protocol as it was shown to be able to produce a sterile environment in vivo.12, 13 The HTB was complete. The foramen was not patent nor was patency forcibly attempted. The goal was to reduce the microbial insult causing the AP and maintain the HTB and use it as a barrier for containing the disinfectants and obturating material within the canal space. Furthermore, the naturally formed barrier has the potential to maintain itself as a protective barrier against the ingress of irritants. The CBCT and the 3D imaging showed that the HTB contained porosities which were not seen in the periapical radiograph (Fig 2, 3). A 5mm layer of MTA was used placed on the HTB to seal the porosities and to augment the existing barrier.14, 15 MTA has also been successfully used in one visit apexification treatments MTA has mild antibacterial properties, is biocompatible with the apical tissue.16 Intracanal MTA causes an increase in pH across dentin and has potential antiresorptive properties.17 Exposure of dentin to MTA can also bring about the release of fossilized bioactive molecules such as TGF β1.18 These could activate dental cells to form mineralized tissue which could contribute to the maintenance of the HTB. The nature of the HTB formed in apexification has been investigated and the calcified tissue has been found to contain a mixture of cementum, bone, and dentin with inclusions of soft connective tissue islands giving the barrier a “Swiss Cheese” histological appearance.3 These inclusions could be the voids seen in the CBCT image. Hard tissue, cementum, dentin and bone can be formed in the presence of infection5-7 and a HTB can be formed before the inflammation has been resolved.8, 9 The wide diameter of the open apex and possible remnants of dental pulp cells could have also contributed to the hard tissue deposition.19, 20 Restoration of the tooth was done with a fiber post and resin material which can bond to dentin and make the tooth less susceptible to tooth fracture as has been suggested.16, 21, 22 The naturally occurring HTB demonstrates the regenerative potential of the apical area. In the future, regenerative treatment of immature tooth may enable hard tissue to be formed all along the canal walls including the cervical area which would make these immature teeth less susceptible to root fracture. References 1. Cvek M. Endodontic Management and the Use of Calcium Hydroxide in Traumatized Permanent Teeth. In: Andreasen JO, Andreasen FM, Andersson L, editors. Traumatic Injuries to the teeth. 4th ed. Oxford, UK: Blackwell Munksgaard; 2007. p. 598-657. 2. Barker BC, Mayne JR. Some unusual cases of apexification subsequent to trauma. Oral Surg Oral Med Oral Pathol 1975;39(1):144-150. 3. Trope M. Endodontic Considerations in Dental Trauma. In: Ingle JI, Bakland BL, Baumgartner CJ, editors. Ingle’s Endodontics. India: BC Decker Inc; 2008. 4. Moorrees CF, Fanning EA, Hunt EE, Jr. Age Variation of Formation Stages for Ten Permanent Teeth. J Dent Res 1963;42:1490-1502. 5. Wang X, Thibodeau B, Trope M, Lin LM, Huang GT. Histologic characterization of regenerated tissues in canal space after the revitalization/revascularization procedure of immature dog teeth with apical periodontitis. J Endod 2010;36(1):56-63. 6. Torneck CD, Smith JS, Grindall P. Biologic effects of endodontic procedures on developing incisor teeth. II. Effect of pulp injury and oral contamination. Oral Surg Oral Med Oral Pathol 1973;35(3):378-388. 7. Torneck CD. Effects and clinical significance of trauma to the developing permanent dentition. Dent Clin North Am 1982;26(3):481-504. 8. Chosack A, Sela J, Cleaton-Jones P. A histological and quantitative histomorphometric study of apexification of nonvital permanent incisors of vervet monkeys after repeated root filling with a calcium hydroxide paste. Endod Dent Traumatol 1997;13(5):211-217. 40 Journal of the Indiana Dental Association | Winter 2015 · Volume 94 · Issue 1
Journal IDA  Scientific Article  recommended for disinfection of the infected immature tooth in regenerative procedures,10...
Scientific Article Journal IDA 9. Felippe WT, Felippe MC, Rocha MJ. The effect of mineral trioxide aggregate on the apexification and periapical healing of teeth with incomplete root formation. Int Endod J 2006;39(1):2-9. 10. Endodontists AAo. Considerations for Regenerative Procedures. 2013 [cited 2013 February 4, 2013]; Available from: 11. Basrani BR, Manek S, Sodhi RN, Fillery E, Manzur A. Interaction between sodium hypochlorite and chlorhexidine gluconate. J Endod 2007;33(8):966-969. 12. Cohenca N, Heilborn C, Johnson JD, Flores DS, Ito IY, da Silva LA. Apical negative pressure irrigation versus conventional irrigation plus triantibiotic intracanal dressing on root canal disinfection in dog teeth. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;109(1):e42-46. 13. da Silva LA, Nelson-Filho P, da Silva RA, Flores DS, Heilborn C, Johnson JD, et al. Revascularization and periapical repair after endodontic treatment using apical negative pressure irrigation versus conventional irrigation plus triantibiotic intracanal dressing in dogs’ teeth with apical periodontitis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;109(5):779-787. 14. Steinig TH, Regan JD, Gutmann JL. The use and predictable placement of Mineral Trioxide Aggregate in one-visit apexification cases. Aust Endod J 2003;29(1):34-42. 15. Simon S, Rilliard F, Berdal A, Machtou P. The use of mineral trioxide aggregate in one-visit apexification treatment: a prospective study. International Endodontic Journal 2007;40(3):186-197. 16. Bogen G, Kuttler S. Mineral trioxide aggregate obturation: a review and case series. J Endod 2009;35(6):777-790. 17. Heward S, Sedgley CM. Effects of intracanal mineral trioxide aggregate and calcium hydroxide during four weeks on pH changes in simulated root surface resorption defects: an in vitro study using matched pairs of human teeth. J Endod 2011;37(1):40-44. 18. Tomson PL, Grover LM, Lumley PJ, Sloan AJ, Smith AJ, Cooper PR. Dissolution of bio-active dentine matrix components by mineral trioxide aggregate. J Dent 2007;35(8):636-642. 19. Laureys WG, Cuvelier CA, Dermaut LR, De Pauw GA. The critical apical diameter to obtain regeneration of the pulp tissue after tooth transplantation, replantation, or regenerative endodontic treatment. J Endod 2013;39(6):759-763. 20. Andreasen JO, Paulsen HU, Yu Z, Bayer T. A long-term study of 370 autotransplanted premolars. Part IV. Root development subsequent to transplantation. Eur. J. Orthod. 1990;12(1):38-50. 21. Hemalatha H, Sandeep M, Kulkarni S, Yakub SS. Evaluation of fracture resistance in simulated immature teeth using Resilon and Ribbond as root reinforcements--an in vitro study. Dent Traumatol 2009;25(4):433-438. 22. Desai S, Chandler N. The restoration of permanent immature anterior teeth, root filled using MTA: a review. J Dent 2009;37(9):652-657. Acknowledgements The authors are grateful to D. Heid for her administrative support and editing of the manuscript and to N. Alderson from Illustrations IUSD for graphic editing. About the Authors Ryan W. Baker, DDS, MSD is an Endodontist in private practice in Avondale, Arizona. Kenneth J. Spolnik, DDS, MSD Diplomate of ABE, Chair and Program Director, Endodontics, IUSD. Ahmed Ghoneima BDS, MSc, PhD, Orthodontics & Oral Facial Genetics, IUSD. Corresponding Author: Ygal Ehrlich, DMD Research Director Endodontics, Assistant Clinical Professor of Endodontics, IUSD. Dr. Ehrlich can be reached at yehrlich@iu.edu. Winter 2015 · Volume 94 · Issue 1 | Journal of the Indiana Dental Association 41
Scientific Article  Journal IDA  9.  Felippe WT, Felippe MC, Rocha MJ. The effect of mineral trioxide aggregate on the ape...
Journal IDA Winter 2015 Classifieds Positions Available We are a well-established general dentistry family practice located in Indianapolis seeking a full time & experienced associate dentist 3-5 days per week. South Chicago Heights and Calumet City: We are in search of Dentists to join our fast growing corporation! Base pay for the first 3 months guaranteed and we sponsor the H1-B Visa. For further consideration please submit resume to icyangdds@yahoo.com. You can learn about our practice here: www.avalondds.com. Please send resume & inquiries to avalondds@gmail.com. General Dentist: Large Dental Group seeking General Dentist to for their Phoenix AZ practice. For more information or to apply online: http://gentledental.catsone.com/ careers/ Associate Dentist Needed Village Dental at Saxony is a general dentistry practice focused on delivering comprehensive family care. We treat our patients in an amenity-rich, high tech, patient friendly atmosphere. We are looking for an associate to continue our philosophy of care for our growing patient base. classifieds Please email CV to dbender12@gmail.com. 42 Michigan Community Dental Clinics, Inc. is seeking dentists to join our elite group of dental practitioners who are creating a culture of quality improvement in a patient centered dental practice. We currently have opportunities available at our Hillsdale, St. Johns, Three Rivers, and Ypsilanti clinic locations. We offer compensation on par or above ADA average, and incentive pay based on production. Generous benefits for full-time dentists, $20,000 sign-on bonus for FT, and $4,000 for PT available for select location, sponsorship for state and federal loan repayment. (EOE) Please contact Kathleen Borgeson at 231-437-4760 or visit www.midental.org Private practice dating back over 30 years is looking for an associate dentist. Group practice setting with all digital charting and xray. Applicants should possess a minimum of 1 year clinical experience and enjoy endo and oral surgery. Future buy-in potential. Email CV to indydentalteam@gmail.com. NW Indiana-In immediate need of a highly motivated and detail oriented General Practitioner for a full and parttime associate for a very busy and well established practice in Schererville, Indiana. Modern digitally equipped office with 5/6 operatories. Please send resume by E-mail ASAP to barzucc@gmail.com or Fax to (219)865-4097 General Dentists needed to work in our busy Indianapolis and Northwest IN practices. You will 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, and CE reimbursement; visa sponsorship with covered legal fees; signing bonus/ relocation assistance. New dentists encouraged to apply. Send resume to jobsfordentalprofessionals@gmail.com, or call 773-456-7071. Journal of the Indiana Dental Association | Winter 2015 · Volume 94 · Issue 1 Large Dental Group seeks both part and full time dentists (general and specialized) throughout Washington, Oregon, California, Hawaii, Arizona, Nevada and Oklahoma. We are currently filling positions in Portland and Phoenix. For more information or to apply, please call Ron Brush at 971-295-9914 or email BrushR@InterDent.com. Long established General Dentistry Practice in Indianapolis seeking experienced associate. Implant and surgical experience a plus. Full and/or part time with immediate high income earnings potential. Send CV to ryan.elrod@amdentinc.com Established Shelbyville, IN practice seeking highly motivated General Dentist for a position 2-3 days per week. Great patient base. Surgical experience a plus. Send resumes to amdentalhr@gmail.com. Help enhance the quality of life for children by providing a positive dental experience right in the school setting. Excellent compensation. Monday - Friday. No evenings. For more information or to apply www. smileprograms.com. Seeking Dentist for our busy westside dental office. Dentist earning potential up to $200,000. Immediate opening available. One year experience preferred. Contact lkm1229@hotmail.com. A bustling general practice in Indianapolis has lots of patients with periodontal needs. We are looking for a part time periodontist to join this wonderful team. Please email your CV to stjpark99@gmail.com or call (757) 318-1776. Our growing Dental Group is looking for a General Dentist to join our offices located in South Chicago Heights and Calumet City. We sponsor H1B Visa. Please send resume to icyangdds@gmail.com.
Journal IDA  Winter 2015  Classifieds  Positions Available  We are a well-established general dentistry family practice lo...
Classifieds Positions Available | Practices Available Associates needed to join our fastgrowing group of practices. With offices currently in Indianapolis and South Bend, we are looking to expand and need highly skilled providers. Are you a general dentist who wants to treat patients without the hassle of practice management? This is the opportunity for you! We offer competitive salary, bonus opportunity, and mentorship. Send inquiries to: dentoffice2015@sbcglobal.net Winter 2015 PRACTICES AVAILABLE Want to know more? Contact Dr. William Myers at drwilliammyers@me.com or at (574)549-7232. We look forward to growing with you! Journal IDA General practice in Northwest Indiana available Summer 2015. Dentist retiring after 38 years in practice. Great opportunity for recent graduate to own a practice and immediately begin treating patients with minimal financial investment. Potential for significant practice growth. The Navy is currently seeking Dentists around Indiana to care for Indy’s Reserve Sailors and Marines. This is not your typical dental office or waiting room. Navy Dentistry: ­Where procedures performed can be more impactful than you ever imagined. Commitment: One weekend/month locally and two weeks/ year providing dental care at our Navy and Marine boot camps. Dentists won’t deploy unless they volunteer. Contact jobs_michigan@navy.mil Modern building with 4 ops and space for 2-4 more available. New computers in all areas , equipment app and building app available as well as practice app. Gross varies from $425,000-485,000 over last 3 years, but only $35,000 write-offs each year. Molar endo, ortho and some surgery sent out. 27 hour week with 30-35 hours of hyg per week. Dr wishes to retire but accommodate the transition. Please phone or text 317-691-5572. Looking for an Orthodontist to help in creating an Ortho practice within a general setting. Please call 248-425-8444 for details. Ask for Abe. Seeking an alternative to dead-end associateships? Located just a short drive from greater Indianapolis, this opportunity offers an immediate pathway to practice co-ownership and equity in a thriving and growing practice. Your earnings rate will far exceed an associate position. For more information contact Chip Eggers, DDS at (616) 460-6860 or chip@paragon.us.com. Meridian Dental Center is seeking an associate dentist. Multi-doctor private practice with robust patient base dates back over 35 years. Convenient commute to all surrounding Indianapolis suburbs. Fully digital office with highly trained, professional staff. Future buy-in potential. Email CV to info@meridiandentistry.com or fax to 317-926-6022. New graduates gain experience working under the guidance of experienced Doctors. Our facility is equipped with the latest in technology including a CT-3D, cone-beam system. We offer competitive salaries not tied to production and some of the best benefits in the industry, including malpractice, CE and professional dues allowance, Student Loan Payoff, and free family Medical/Dental insurance. Contact wpecina@afdent.com 574-277-2220. www.afdent.com/mishawaka Main treating dentist needed for a fully digital, modern office. Good patient flow in a growing area. Office is fully staffed with two experienced hygienists, expandedfunctions assistants, receptionist, and office manager. Four treatment rooms with space for more. Hours 8-5, Monday through Thursday. No on-call hours. Send CV to acct@NewParisDentistry.com Questions? Call Laura at (574)536-6299. classifieds Modern, Fast-growing, High Tech Dental Practice on North Side Indianapolis-Carmel area seeking Highly skilled, Ethical Dentist with great communications skills for an Associate Position ( FT/PT). Compensation: base+ % commission. Please Email CV at jdentist@gmail.com. Hancock County Practice for Sale: Great location!! Greenfield 3/4 operatory dental practice. Growing and profitable, (average yearly collections last 4 yrs. $498,000.00). Established patients and all equipment stays, excellent opportunity for new graduates. Dentist retiring after 22yrs at this practice. Contact 317-462-1252 or robertgottschalk77@yahoo.com Afdent, located in Mishawaka, IN has an immediate need for Dentists. If you are a new graduate or experienced doctor looking for an opportunity or are tired of the corporate dental world and worrying about patient volume, consider Afdent. Winter 2015 · Volume 94 · Issue 1 | Journal of the Indiana Dental Association 43
Classifieds  Positions Available   Practices Available Associates needed to join our fastgrowing group of practices. With ...
Journal IDA classifieds Winter 2015 Classifieds Practices Available | Real Estate | Space Available PRACTICES AVAILABLE Great opportunity for experienced dentist or new graduate. Buy-in buy-out. Owner will stay to introduce. Fast growing North side location with good visibility. Established family business, quality dental services for over 60 years. Please contact rrlr74@gmail.com or 260-637-1527. Lebanon: New startup in a highly visible location. Two operatories, Available immediately. Would make a great satellite location, inexpensive “hobby” or startup practice for a minimal investment. Asking $40,000 OBO, very motivated to sell. (317)408-8130. East side Indy 5 fully equipped operatory dental practice for sale (room to expand 2 more ops) . Modern, chartless, digital. This practice collected over $925,000 for 2013. An excellent growth opportunity as this practice is only open 3-4 days per week 5 weeks vacation. This practice can easily grow to $1.25 million per year. Dentist willing to stay on after sale if needed. Contact Buyindypractice@yahoo.com. Great location!! Busy Muncie Dental practice for sale. Dentrix/Dexis all digital, modern, paperless. Collections for 2013 were $430,000 on only 2-3 days per week with 9 weeks vacation!! This practice has great growth potential to grow to $850,000 per year. Contact munciepracticeforsale@yahoo.com REAL ESTATE Free standing building with three exam rooms and parking available for lease on near south side of downtown Indy. Contact Tom Hovanec (317) 490-3344. SPACE AVAILABLE 3250 Square feet of available office space located on the south side of Indianapolis at County Line and Emerson Parkway. Building ownership is also available with rented space. Please contact Dr. Michelle Ebeyer with questions or inquiries at 317-883-3368. New Members Dr. Bridget Merritt-Brooks (Meharry Medical ‘94) INDIANAPOLIS DISTRICT DENTAL SOCIETY 44 NORTH CENTRAL DENTAL SOCIETY Dr. Dana J. Morris (Univ of Louisville 2006) members FIRST DISTRICT DENTAL SOCIETY NORTHWEST INDIANA DENTAL SOCIETY Dr. Steven Blanchard (Univ of MI ‘80) Dr. Josef S. Bringas (Univ of Detroit 2005) Dr. Anne V. Gormley (OSU 2007) Dr. Ashwani K. Sharma (UTHSC 2011) Dr. Nicole L. Sweet (IU 2008) Dr. Olubunmi Adekugbe (Univ of PA 2012) Dr. Claudette Munyabera (Meharry Medical 2008) SOUTH CENTRAL DENTAL SOCIETY Dr. Nickolaus Weiss (Marquette Univ 2008) In Memoriam Dr. Thomas H. Beavers of Indianapolis and member of the Indianapolis District Dental Society passed away on January 11, 2015. Dr. Beavers graduated from the Indiana University, School of Dentistry in 1944. Dr. James R. Platt of Fort Wayne, IDA Past President and member of the Isaac Knapp District Dental Society, passed away on January 10, 2015. Dr. Platt graduated from the Indiana University, School of Dentistry in 1961. Dr. Edwin C. Errington member of the Isaac Knapp District Dental Society, passed away September 27, 2014. Dr. Errington graduated from Northwestern University in 1951. Dr. Robert C. Ryan of Muncie and member of the East Central Dental Society passed away March 12, 2014. Dr. Ryan graduated from Indiana University, School of Dentistry in 1944. Dr. Edward E. Packard of South Bend and member of the North Central Dental Society passed away in January 2015. Dr. Packard graduated from the University of Nebraska Medical Center in 1948. Dr. Charles D. Smith member of the West Central Dental Society passed away June 2014. Dr. Smith graduated from Indiana University, School of Dentistry in 1944. Journal of the Indiana Dental Association | Winter 2015 · Volume 94 · Issue 1
Journal IDA  classifieds  Winter 2015  Classifieds  Practices Available   Real Estate   Space Available  PRACTICES AVAILAB...
Member Info Journal IDA Winter 2015 ENDORSED SERVICE PROVIDER Get the kind of financing you need. Practice Solutions Meet the challenges of managing and growing your practice or clinic with help from the industry-leading Bank of America Practice Solutions. You’ll get a financial solution customized to your individual needs, personalized service and expert guidance every step of the way. Our specialists can help you with these financing options: • New office start-ups — Up to 100% project financing,* including design, construction, equipment and�working capital. • Practice sales and purchases — Take advantage of our experts’ buying and selling experience and�industry�knowledge. • Business debt consolidation** — Improve your cash flow. • Office improvement and expansion — Remodel, refurbish, or expand. • Commercial real estate — Comprehensive real estate loan options to buy, refinance,* or relocate (terms�up�to 25 years). • Equipment financing* — A variety of options and flexible terms. Want to know more? Call our Practice Specialists at 1.800.360.0669 or visit us online at bankofamerica.com/practicesolutions. Priority Code: ADD0313C * All programs are subject to credit approval and loan amounts are subject to creditworthiness. Some restrictions may apply. Loans greater than $250,000 may be eligible for a 20-year term. ** Bank of America Practice Solutions may prohibit use of an account to pay off or pay down another Bank of America account. Bank of America is a trademark of Bank of America Corporation. Bank of America Practice Solutions is a division of Bank of America, N.A. ©2014 Bank of America Corporation. AR2B8FDF-01032013 Winter 2015 · Volume 94 · Issue 1 | Journal of the Indiana Dental Association AD-11-12-0264.A 45
Member Info  Journal IDA  Winter 2015  ENDORSED SERVICE PROVIDER  Get the kind of financing you need.  Practice Solutions ...
Journal IDA Smile Imagine Dr. T Gilbert om I woke up with my deadline for my IDA Journal article upon me and I was perplexed on what to write about. I got dressed and headed to the YMCA for my morning run. When I run by myself I usually wear headphones and listen to podcasts, music or the morning radio news. I like to listen to National Public Radio to get my update on the latest happenings. The early show is called Morning Edition and it tells the current happenings in the world including interesting stories. This particular morning, I was listening to NPR when they announced it was the 34th anniversary of John Lennon’s tragic death. I am 46 years old and I do remember the day, and the overwhelming feeling of shock that one of the most influential people in the world was gone. John Winston Lennon was born in 1940 in Liverpool, England. He died December 8, 1980 in New York, New York. He left his wife, Yoko Ono and two sons, Julian and Sean. He was the founder, songwriter and singer of the world famous band The Beatles. He partnered with another man of immense musical talent named Paul McCartney. The Beatles hit the top of the music charts with many songs and albums. The band had been dissolved at the time of John Lennon’s death and the band members were all working on solo projects. John had a successful solo career with many hits, but maybe the most memorable one to me is, “Imagine.” John Lennon and Yoko Ono were living in an apartment in Manhattan in 1980. When John would exit or enter the building there were usually fans waiting for him to get his autograph or just to get close to him. John could have had his driver pull into a secure courtyard of the building, but he usually liked to be dropped off in front so he could be with his fans. On December 8th one of his fans, Mark David Chapman, was waiting for him. Mark walked up to John and shot him several times in the back and surrendered himself peacefully to the police. No one really knows why he shot John Lennon. He has since been quoted saying, “I am sorry for causing this pain. I am sorry for being such an idiot and choosing the wrong way for glory.” In an interview recently with Paul McCartney he said about Mark, “He is a jerk of all jerks, there was no reason to do what he did.” I guess he just did it for glory; to be noticed by the media and the world. What a shame that he caused this much pain to so many people for this pathetic reason. 46 Why was John Lennon so important, and why was it so tragic when he was gunned down 34 years ago? I think it is because music is so important and John was all about the music. Music allows us to escape into our artistic brain. It allows us to relax and enjoy and let down our defenses. I love music and I may not be the best singer but I love karaoke. For our office Christmas party, I had our office team and spouses over to my house for food, drink, conversation, and karaoke. I hired a good friend who is a karaoke DJ and our team rocked out my house and had a great time. Music allowed us to take away the serious nature of dentistry and enjoy each others’ company. I really like to karaoke, so I know that I will sing and sometimes I am nervous that others will not join in, but once the music takes hold then everyone jumps right in. Try some karaoke with your team in the future and have a lot of fun. John Lennon left us back in 1980, which is so tragic, but he left behind so much more than he could ever provide in person. He left behind a legacy of music and peace. Think about the famous line from his solo hit, Imagine, “You may say I’m a dreamer, but I’m not the only one. I hope some day you will join us and the world will be as one.” Remember John Lennon and his message of music and peace in 2015. One quick joke to end on: What does the best dentist of the year get? A little plaque. Ha-ha. Treat your patients well and talk to you soon, Tom About Dr. Gilbert Dr. Thomas M. Gilbert is a general dentist practicing in Fort Wayne, IN. He can be reached at tomgilbertdds@comcast.net. Journal of the Indiana Dental Association | Winter 2015 · Volume 94 · Issue 1
Journal IDA  Smile  Imagine Dr. T Gilbert om I woke up with my deadline for my IDA Journal article upon me and I was perpl...
Last Word Florence’s Stone Journal IDA Dr. Michael D. Rader The massive slab of marble lay undisturbed in the yard of the cathedral workshop for decades. Purchased and transported at great expense from the distant quarries of Carrara, a sculpture was to be created from the five meter tall pure white marble block. Called “The Giant,” the marble carried the hopes of Florence’s City Fathers to restore the glory of Florence as an important artistic center and independent city-state free from the domination of the Medici family. The statue was begun in 1463 by Agostino di Duccio working under the direction of the famed sculptor Donatello. Di Duccio abandoned the project in 1466 upon the death of Donatello. Ten years passed until Antonio Rossellino was commissioned to resume the work. Rossellino’s contract was mysteriously terminated shortly thereafter and the block was neglected until 1501 when the Overseers of the Florence Cathedral again called for artists’ submissions. Many, including the renowned Leonardo da Vinci, passed on the opportunity to vie for the commission. Some were discouraged by the awkwardly proportioned, partially hewed slab. Others were wary of the stone’s faults that many thought made it impossible to carve without breaking. The great da Vinci simply rejected the project because he felt that sculpture was an inferior art form. One proposal, submitted by a relatively unknown 26 year old Florentine, promised a bold vision worthy of the city. Michelangelo Buonarroti spent three years painstakingly chiseling out his masterpiece from the abandoned block of marble. He created the statue of David, recognized throughout the world as the epitome of the High Renaissance and a universal symbol of the highest form of art and human expression. At this point in the narrative a patient reader might reasonably ask, “While this story is mildly interesting, how is it relevant to dentistry and more importantly to my practice? I’ll concede that while we might occasionally refer to our profession as the “art and science” of dentistry thus being tangentially connected, very few dentists sculpt anything other than restorations and none approach the talent and artistry of Michelangelo. Yet there is much to learn in the process of Michelangelo’s creation of David. That lesson was taught to me recently by my patient Joanne. In a previous column (and the Pursuit of Happiness) I described Joanne as the one patient in my practice everyone in the office dreaded seeing. Every visit brought a familiar litany of complaints; that is until Joanne’s recent visit. At her last recent recall appointment as was her custom Joanne found something to complain about. First she said, “The lights are too bright.” Later, “The water is too cold, then too warm”, and, finally, “Flossing is too painful:” Again, typical Joanne. After her exam as I rose and turned to leave the hygiene room Joanne, in almost a whisper said, “Mother died last month.” I was surprised by both the gentleness in her voice and the fact that Joanne, a woman in her 70s could have a mother still alive. Joanne continued, “When Mother was 88 and could no longer stay in her own home and needed care I moved into her house to take care of her. I’ve lived with Mother for the last five years. I’m so grateful that I was able to care for her. She was such a good mother to me and I wanted to be as good to her.” I was stunned. I was seeing a side of Joanne I never suspected existed. Joanne was a warm, caring daughter who had dedicated five years to the loving, compassionate care of her elderly mother. In the 35 years I had known Joanne I insisted on seeing only the flaws that were superficial and most obvious. I hadn’t cared to look any deeper choosing to label Joanne as only a chronic complainer. My failure to see the genuine Joanne has been my loss. Michelangelo’s genius lay in envisioning the final work already existing within the marble and needing only to be ‘set free’. Where other less talented sculptors saw a misshapen, defective piece of marble, Michelangelo saw the inner beauty. The masterpiece always existed within the marble. Our challenge is to find the inner beauty in all our patients. Being able to envision and find that beauty is where true genius resides. About Dr. Rader Dr. Michael D. Rader is a general dentist practicing in South Bend, IN. He can be reached at drrader@sbcglobal.net. Winter 2015 · Volume 94 · Issue 1 | Journal of the Indiana Dental Association 47
Last Word  Florence   s Stone  Journal IDA  Dr. Michael D. Rader The massive slab of marble lay undisturbed in the yard of...
Journal IDA 48 Last Word Journal of the Indiana Dental Association | Winter 2015 · Volume 94 · Issue 1
Journal IDA  48  Last Word  Journal of the Indiana Dental Association   Winter 2015    Volume 94    Issue 1