l - Academy of General Dentistry


l - Academy of General Dentistry



The Newsmagazine for the General Dentist

March 2011, Vol. 39, No. 3


Cancer Costs Rising


The Patient Whisperer

Infinite Games

The Scarlet Letter

Public Officials Reaffirm Fluoridation

DANB Introduces CPDA Program

Silent Auction Donations Needed

Advocacy State by State

888.AGD.DENT / www.agd.org




The AGD’s Self-Instruction

program is a convenient,

cost-effective way to

earn valuable continuing

education (CE) hours in the

office, at home, or even on

vacation! There is no easier

way to earn credits toward

relicensure, membership

maintenance, or the AGD’s

Fellowship Award.

Each issue of the AGD’s

award-winning, peerreviewed

clinical journal,

General Dentistry, contains

three Self-Instruction

articles. Simply read the

articles and take the “openbook”

exercise following

each one. Exercises are

developed by and for

general dentists, ensuring

that you’re getting CE

that will benefit you, your

patients, and your practice.

Submit your answers using

the form at the end of each

issue or via the AGD Web site

(www.agd.org); we’ll score

and grade your responses.

For every exercise you pass,

you’ll earn two CE hours—

it’s that easy! Credits

are automatically

posted to your AGD

transcript, so there

is no additional

paperwork to

submit. And, like

all AGD CE offerings,

Self-Instruction is


Approved PACE Program Provider


Approval does not imply acceptance by a state or

provincial board of dentistry or AGD endorsement

06/01/2010 to 05/31/2014

To enroll in Self-Instruction, contact the

AGD Communications Specialist via phone

at 888.AGD.DENT (888.243.3368), ext. 4353,

or via e-mail at self-instruction@agd.org. Or, you

can enroll online at www.agd.org/publications/gd/

selfinstruct and start submitting exercises today!

l Online Contents l

March 2011

Obstructive Sleep


There is a rumbling sound

getting louder throughout

the country. It emanates

from the bedrooms of

many Americans, causing

stress and discomfort,

not only for the source

producing the sound, but

for all those within earshot.

That sound is snoring.

For many snorers—more

than 18 million Americans—it can indicate the presence of a very common, but serious,

sleep disorder: obstructive sleep apnea (OSA). Dentists already know about OSA and its

relationship to patients’ mouths, but the way in which OSA is diagnosed and treated has

posed some challenges for dentists. Page 34.


41 AGD Foundation Silent Auction Fundraiser

The AGD Foundation is in need of donations for this year’s Silent

Auction Fundraiser!

Associate Editor



Editor Roger Winland, DDS,



Editorial Coordinator Elizabeth Newman





Associate Designer Jason Thomas

Publications Norman D. Magnuson, DDS,

Review FAGD, Chair

Council William E. Chesser, DMD,


Jon L. Hardinger, DDS, MAGD



Peter Sturm, DDS, MAGD


Cathy McNamara Fitzgerald

Salithia Graham

Timothy J. Henney

M.J. Mrvica Associates

2 West Taunton Ave.

Berlin, NJ 08009



Rhonda Brown

Foster Printing Company

866.879.9144, ext. 194

Fax: 219.561.2017


AGD 2011 San DieGO!

Annual Meeting & Exhibits

Register to GO

to San DieGO!

Discover the industry’s best opportunity for

learning—the AGD 2011 Annual Meeting

& Exhibits, July 28 to 31, in San Diego!

See the registration insert, pages 16–19 of

this issue, to register today!

Academy of General Dentistry Corporate Sponsors

6 AGD Impact Online edition www.agd.org March 2011

I Advocacy: The AGD Difference I

12 Patients Abandoned as Allcare

Dental & Dentures Offices Close


DANB Introduces CPDA Program

13 Advocacy State by State


I Voices I

8 Editorial


9 Guest Editorial

A Continuing Journey of Education and


10 Corner Office

Hometown Pride


14 Cancer Costs Rising

15 FYI Research

FYI Dental School News

FYI Numbers









I Columns I

20 Exceptional Care

Less Is More

21 One for the Team

The Patient Whisperer






2 1


5 17





Air Force

Public Health



Peace Corps

Civil Service


22 Realizing Your Practice Vision

Strategies to Retain Your Best Employees

25 Coaching Corner

Infinite Games

26 Motivating and Managing

Increasing Patient Referrals

28 House Call

Vision Wisdom

30 Benefits Spotlight

Behind the Scenes

31 Best of the Blogs

The Scarlet Letter

32 Testing the Tools

What’s Hot and What’s Getting Hotter

42 Fact Sheet

Gingivitis vs. Gum Disease

43 Classifieds/Advertisers Index

How to Reach Us




Academy of General Dentistry

211 E. Chicago Ave., Ste. 900

Chicago, IL 60611-1999




888.AGD.DENT (888.243.3368)

Member Services: Ext. 5300

AGD Impact:

News: Ext. 4311

Product information: Ext. 4311

Classifieds: Ext. 4353


Member Services: membership@agd.org

AGD Impact: impact@agd.org

Self-Instruction Program: self-instruction@agd.org

AGD in Action: action@agd.org

Disclaimer: The Academy of General Dentistry does not necessarily

endorse opinions or statements contained in essays or editorials

published in AGD Impact. The publication of advertisements in AGD

Impact does not indicate endorsement for products and services. AGD

approval for continuing education courses or course sponsors will be

clearly stated. AGD Impact (ISSN 0194-729X) is published monthly

by the Academy of General Dentistry, 211 E. Chicago Ave., Suite 900,

Chicago, IL 60611-1999.

This online edition contains hyperlinks or references to other sites on

the World Wide Web. These links are provided for your convenience only.

As soon as you use these links, you leave this publication. The linked

sites are not under the control of the Academy of General Dentistry

(AGD); therefore, the AGD is not responsible for the contents or for any

form of transmission received from any linked website or reference

linked to or from this publication. The AGD disclaims all warranties,

expressed or implied, and accepts no responsibility for the quality,

nature, accuracy, reliability, or validity of any content on any linked

website. Links from this publication to any other website do not mean

that the AGD approves, endorses, or recommends that website.

*AGD members receive AGD Impact as part of membership; annual

subscription rates for nonmembers are $50 to individuals/$65 to

institutions (orders to Canada, add $5; outside U.S. and Canada, add

$15). Single copy rates are $5 to individuals/$6.50 to institutions

(orders outside U.S., add $1). All orders must be prepaid in U.S. dollars.

No portion of AGD Impact may be reproduced in any form without

prior written permission from the AGD. The opinions expressed in AGD

Impact are not necessarily endorsed by the AGD. The publication of

an advertisement in AGD Impact does not indicate endorsement for

products and services. AGD approval for continuing education courses

or course sponsors will be clearly stated.

© Copyright 2011, Academy of General Dentistry, Chicago, IL.

March 2011 www.agd.org Online edition AGD Impact 7

I Voices Editorial I


“Addictions satisfy our need

for drama by keeping us on the

roller coaster between pleasure

and pain, with peaks of elation

followed by valleys of despair.”


Addictions essentially serve as a way to

escape, a salvation from life’s challenges

or the emptiness inside. Our patients have

a multitude of ways of becoming unconscious

to avoid their feelings. The use of

food, alcohol, drugs, relationships, sex,

work, shopping, smoking, and other fleeting,

euphoria-producing behaviors are paths

that millions of them—and us—mistakenly

choose when seeking to find happiness and

to alter our moods. Our addictions are methods

that we use to move toward pleasure

though some of us aren’t even attempting to

feel high. We just want to reduce the anxiety,

escape the pain, and feel normal.

The goals of the addicted personality are

achieving pleasure and relieving discomfort.

Thus, addictions, whether involving compulsive

behavior or the

use of chemicals, become

our mood adjustors. They

become obsessive-compulsive

behaviors that

distance us from feelings

we want to avoid; they

become our way to block

emotional pain. But the

solution soon becomes

part of the problem as

the obsessive-compulsive

behaviors only make matters

worse because of the shame and guilt

they generate. Our resistance to emotional

discomfort causes us to anesthetize ourselves

so we won’t have to feel.

In our hectic dental practices we must

guard from walking numb, unable to feel

any pain or experience the joys of life. To

complicate matters, our culture encourages

us to numb ourselves with activities,

consumption, and entertainment. It fosters

addictive thinking with its instant gratification

philosophy and technology, encouraging

the mind-numbing and isolating effects of

television and other electronic opiates.

As human beings, we keep looking

for pleasure in the wrong places, trying

desperately to grasp the love, satisfaction,

and pleasure we crave from the outside.

But looking for meaning and happiness

outside of ourselves only leaves us feeling

more insecure, unsettled, unfulfilled, and

anxious. Addictions satisfy our need for

drama by keeping us on the roller coaster

between pleasure and pain, with peaks of

elation followed by valleys of despair.

Changing ourselves requires an ongoing

commitment to making conscious choices

and staying keenly aware of the consequences

of our choices. As we become

increasingly aware, the less we live impulsively

and the less we retreat into escapism.

As we gradually recognize the power of

our own choices, our addictions will loosen

their power over us.

If we can force ourselves to calm down

enough to see the mechanics of addiction

and our opportunity for choice, addiction

loses its grip. We can learn to replace automatic,

programmed responses with aware,

healthy actions and find positive ways to

fulfill our needs. We can use the habit of

compulsive eating as an example. Rather

than grabbing food when the desire arises,

we can make a choice to sit, breathe, and

feel what is going on inside us. Perhaps we

feel anxious and scared. At this point, we

can decide either to act on our compulsion

to eat or find a healthier way of dealing

with our anxiety or fear.

We can put ourselves on the path to

recovery from our addictions. No matter

how strong they are, we will succeed. It

doesn’t matter how many times you have

failed to stop your addictive behavior,

refuse to give up. Center your attention

on what you want and know that you are

stronger than your addiction.

Roger D. Winland, DDS, MS, MAGD


The opinions expressed here are

those of the writer and do not

necessarily reflect the views of the

Academy of General Dentistry.

8 AGD Impact Online edition www.agd.org March 2011

I Voices Guest Editorial I

A Continuing Journey of

Education and Fulfillment

AGD President Fares M. Elias, DDS, JD, FAGD, received the following letter and wishes to

share it with AGD Impact readers.

The opinions expressed here are

those of the writer and do not

necessarily reflect the views of the

Academy of General Dentistry.

Dear President of the Academy of General


I am writing to tell you about our journey

to become Masters in the AGD. My wife,

Indu Anilesh, and I graduated from the

Government Dental College of Bangalore

University, India, in the 1970s. We were

married in late 1977. In 1978, we immigrated

to the United States of America with

a young child in

hand. As a new

“During the past several years we

often were asked, ‘Why do you

have to spend money and time only

to lose income at your office just

to get education’ This is an easy

question to ask, but only a dentist

will understand the subtle nature

of the answer.”


family, we began

our journey of

education, work,

and unknown


With close

friends as our mentors,

we completed

the necessary

requirements and

were permitted to

practice dentistry

in the state of

New York. As we

stepped toward

organized dentistry,

we became more

involved with continuing dental education,

which provided us with additional skills.

Procedures that we used to struggle with

became a breeze after taking various handson

training classes. The theories we learned

and our participation in these continuing

education classes manifested in better patient

care. Treatment plans and modalities became

increasingly rewarding as we became welltrained

in the dental specialties. The AGD

gave us this opportunity and we looked forward

to improving our dental skills in a very

structured manner.

We also thoroughly enjoyed attending the

AGD’s annual meetings in various cities. We

were thrilled by the experience of listening

to experts in the field, learning hands-on

skills from the inventors themselves, and

with observing the governing aspect of the

AGD. We believe inspiration comes from

within, and the AGD has given us the opportunity

to explore our hidden talents.

During the past several years we often

were asked, “Why do you have to spend

money and time only to lose income at

your office just to get education” This is

an easy question to ask, but only a dentist

will understand the subtle nature of the

answer. We believe that happiness and a

sense of fulfillment cannot be achieved with

money. Instead, we believe wisdom cannot

be sold in conventions and intellect cannot

be bought over “Wall Streets.” It can look

like a waste of money, time, and energy for

all others, but the value can be appreciated

only by one’s own intellect.

I often used to worry about our retirement:

How to retire When to retire Now,

after my immersion in the various disciplines

of dentistry, the questions I have

are: Why retire What is the meaning of

retirement To us, dentistry is most enjoyable,

as if we were sailing through a river

of knowledge.

Our lives have been blessed in many

ways. We have a daughter, Smitha

Bhandari, a son-in-law, Tanneal Bhandari,

and a son, Sanjit Anilesh. We also have

been blessed with a big extended family and

many friends.

Last, our most sincere thanks to the staff

of the AGD. They have perfected the way

in which to help members in a very professional

manner and their expert guidance is

deserving of mention.


Katte Anilesh, DDS

Yonkers, N.Y.

March 2011 www.agd.org Online edition AGD Impact 9

I Voices Corner Office I

“If you haven’t

done so already,

consider getting

involved with

your local AGD

constituent to

realize how much

value it offers.”


The opinions expressed here are

those of the writer and do not

necessarily reflect the views of the

Academy of General Dentistry.

Hometown Pride

People exhibit a certain amount of pride

when they’re asked, “Where are you from”

Whether it’s a big city, a small town, a

suburb, or a rural area, most people have a

lot of good things to say about their neighborhood,

and they will share those things

willingly when meeting someone new. Last

month, people here in the Chicago area (and

many of the surrounding states) endured a

record-setting winter blizzard that dumped

almost two feet of snow on the city within

24 hours. While the wintry conditions

made travel next to impossible, knocked

out power lines, and created an overall

interruption in our daily lives—frustrations

that very easily could have led to short

tempers—people in the city came together.

The sense of community was very evident

as people who might very well have never

spoken to one other embraced the situation,

smiled and waved, and struck up conversations

as they shoveled snow.

I share this story because it reminds

me very much of the way in which local

Academy of General Dentistry (AGD) constituents

work together and the sense of

community that AGD constituent members

have when they share common professional

goals and interests. That community provides

a place where our members—people

with a common interest, if not common

backgrounds—can feel at home. Included

in that valuable membership is access to

career-advancing continuing education (CE)

courses. Constituents frequently offer AGD

Program Approval for Continuing Education

(PACE)-approved courses—at locations that

are convenient to our members. Our constituents

make it easier and more convenient to

earn CE, the most valued and primary driver

of AGD membership.

Constituent involvement also provides

an opportunity to network with people who

know what’s going on in your area. These

are people who you can contact easily and

even meet with face-to-face if you’d like.

And with so many constituent events going

on throughout the year, getting to know the

other AGD members in your area is easy to

do, and getting involved in planning those

activities is a natural step for many constituent

members. The constituent level is a great

place to get your feet wet in leadership positions,

allowing you to hone those skills for

national leadership involvement.

Constituent leadership mirrors the

national leadership in many ways. It also

provides constituent members with the

opportunity to get involved in an aspect of

the organization that is a bit different from

what you do every day in your practices.

If you have had success in marketing your

practice, why not share your successes by

volunteering for your local constituent’s

marketing committee If you enjoy finding

new, cutting-edge CE courses, consider

joining a CE-planning committee. The AGD

Constituent Editors program lets the inner

writer/editor in you come out—consider contributing

to your local constituent newsletter

as a writer or an editor.

Many constituent events also offer a

chance for local members to give back to the

profession. While you may form friendships

and relationships with other constituent

members at these events, they’re also a great

way to expand your horizons and perhaps

help new graduates learn more about the

profession. The mentor/mentee relationship

is a reciprocal one: Younger members meet

new people, learn about the profession, and

ask questions, while mentors have the opportunity

to meet new members, share their

insights, and reenergize their careers and outlook

on the profession. Every member was

a new graduate once—serving as a mentor

allows you to help someone and relate to his

or her experiences as a young professional.

If you haven’t done so already, consider

getting involved with your local AGD constituent

to realize how much value it offers.

Each constituent has its own website, accessible

at www.agd.org/constituent. Find out

what’s happening in your region, and the

next time someone asks you at an AGD

meeting where you’re from, you might find

yourself answering not with your hometown,

but with your region number!

Charles J. Macfarlane, FACHE, CAE

Executive Director

10 AGD Impact Online edition www.agd.org March 2011

l Advocacy

The AGD Difference



Patients Abandoned as

Allcare Dental & Dentures

Offices Close Suddenly


Allcare Dental & Dentures,

a national dental chain,

unexpectedly closed its

offices in early January

2011, leaving patients in the

dust in more than 12 states.

The company was forced to

reopen some of its offices a

week later when the New

Hampshire attorney general

contacted the company and

required it to open offices so

patients could retrieve their

records, a legal right that

patients have, according to

American Dental Association

consumer adviser Matthew

Messina, DDS. If patients

did not receive their records,

federal law, Dr. Messina

says, requires Allcare to forward those records to

the patients’ new dental care provider. In addition,

patients who received incomplete care still are

Allcare’s responsibility—the company must provide

treatment or see that another dentist does. “You

can’t abandon patients,” Dr. Messina told the Wall

Street Journal (Jan. 6, 2011). “You can’t close up the

doors and say to a patient, ‘You’re on your own,’

because that’s abandonment, and that’s illegal.”

Michigan Attorney General Bill Schuette helped

to create a multi-state task force to coordinate

mediation of consumer complaints against Allcare,

protect patient records, and review business

practices for possible illegalities. In addition,

the consumer protection agency in Wisconsin is

investigating Allcare Dental & Dentures after it

received numerous complaints about the company,

mostly from customers who paid for their dental

work prior to treatment but did not receive the

treatment due to the company’s sudden closing.

Patients in other states also complained about poor

service and treatment before the company closed.

Allcare had 52 locations and employed almost

800 people in 15 states in early 2010 but reduced

its workforce and closed several locations earlier

this year. Dental offices in those areas affected by

the sudden closing are taking Allcare patients, and

some are even providing free treatment to those

patients who pre-paid for their Allcare services

but were not treated before the offices closed.

Dr. Messina encouraged patients to contact their

state’s attorney general and their state dental

boards. States affected include Illinois, Iowa,

Massachusetts, Michigan, New Hampshire, New

York, North Dakota, Nebraska, Ohio, Pennsylvania,

Tennessee, West Virginia, and Wisconsin.

As of Jan. 14, 2011, the Allcare Dental &

Dentures website has posted several messages

about the status of its company and the future care

that affected patients can receive, including the

names, locations, and phone numbers of dental

offices in a handful of states that are treating

Allcare patients. Visit www.allcareinfo.com for the

most recent updates.

DANB Introduces CPDA Program

In December 2010, the Dental Assisting National Board, Inc. (DANB) introduced

its Certified Preventive Dental Assistant (CPDA) certification program. The CPDA

certification program aims to certify expanded function dental assistants. The

program includes examinations on coronal polish (CP), sealants (SE), topical

fluoride (TF), and topical anesthetic (TA). The Academy of General Dentistry (AGD)

supports the use of expanded function dental assistants within the dental practice

to increase capacity and enhance service.

According to DANB, the organization shares the goal of public protection

emphasized by state dental boards and believes that the CPDA program furthers

this goal. The CPDA certification program will be available to all qualified dental

assistants beginning April 2011. The certification program was previously tested

under the name Certified Oral Preventive Assistant (COPA).

12 AGD Impact Online edition www.agd.org March 2011

l Advocacy

State by State

The Academy of General Dentistry (AGD) makes sure that general dentists can speak up when it

matters the most. That means monitoring the issues and relaying the facts so our members can

unite their voices on legislative and regulatory activities that affect their practices. Read on to find

out what’s happening throughout the country.














2 1


5 17





Air Force

Public Health



Peace Corps

Civil Service



Two New Bills Proposed

New York legislators have filed a bill to establish

a senior dental services grant program. The bill

was pre-filed on Dec. 13, 2010, and will be heard

during the upcoming legislative session.

The New York legislature also filed Senate

Bill 118 and Assembly Bill 111. Senate Bill 118

requires cultural awareness and competence

training for all medical professionals as part of

their licensing requirements. Assembly Bill 111

creates collaborative practice dental hygiene and

authorizes dental hygienists to provide certain

services in collaboration with a licensed dentist.

REGION 5: MaRYland

Board Considering Fee Increases

The Maryland Board of Dental Examiners is

considering fee increases. Regulation changes

proposed on Dec. 17, 2010, increase certain

renewal, late fee, and reinstatement fees for

dentists, dental hygienists, and dental radiation

technologists to collect revenue to fund the

board’s direct and indirect operating expenses. If

the proposal is adopted, the fee for dental license

renewal will increase $145 (from $415 to $560)

and the reinstatement fee for a lapsed license will

nearly double from $450 to $860. Interested parties

were to submit comments by Jan. 18, 2011.

REGION 6: MissouRI

Volunteer Act Bill Pending

The Missouri House of Representatives has a

pending bill to establish the Volunteer Health

Services Act, which allows licensed health care

professionals to provide volunteer services for

a sponsoring organization. The bill has been

pre-filed and will be heard during the 2011

legislative session.

The Missouri Dental Board adopted new rules

to allow a dental licensee to receive continuing

education by attending open meetings of the

Advisory Commission for Dental Hygienists. The

new rule was adopted Dec. 15, 2010.


New Rules for Expanded Services

On Dec. 14, 2010, the Ohio Dental Board

adopted new rules for expanded function dental

auxiliaries, certified dental assistants, coronal

polishing, and sedation administration and

monitoring, including education and certification

requirements. The rules went into effect on

Dec. 24, 2010.


New Hygienist Bills Proposed

The Oregon House Health Care Committee is

proposing a bill to establish a Dental Hygiene

Committee within the Oregon Board of Dentistry.

The bill, which has been pre-filed for the 2011

legislative session, allows the committee to make

recommendations to the dental board regarding

the regulation of dental hygienists, and the bill

directs the board to carry out these recommendations

except in certain circumstances.

The Oregon Senate Committee on Health Care

also pre-filed bills dealing with dental hygienists.

The first Senate bill creates limited access permit

dental hygienists and would become effective

upon passage of the law. The second bill creates

dental therapists and directs the Oregon Board of

Dentistry to issue certificates to dental therapists

to perform certain dental services.

REGION 12: Louisiana

Rules Include New Procedures

The Louisiana Bureau of Health Services

Financing recently adopted rules to include

coverage of two additional dental procedures,

increase the reimbursement fees for designated

dental services, and discontinue the lifetime

service limits for certain endodontic procedures

to provide clarification regarding covered services.

The newly adopted rules became effective

Dec. 1, 2010.

REGION 14: New Mexico

Amalgam Removal Required

In New Mexico, legislators filed Senate Bill 12 on

Dec. 15, 2010, which deals with amalgam. The

bill, to be heard in the 2011 session, requires

dental offices to remove dental amalgam prior to

the discharge of wastewater.

REGION 18: Texas

Amendment Adds Council

The Texas State Board of Dental Examiners

adopted an amendment to Section 101.2 of the

dental code, relating to licensure by examination.

The amendment adds the Council of Interstate

Testing Agencies (CITA) as a designated regional

examining board. The new rule went into effect

on Dec. 22, 2010.


New CPR Rule Proposed

In North Carolina, the Board of Dental Examiners

is proposing new regulations to clarify that CPR

certification may be obtained only by completing

a course provided by an instructor who is physically

present with the students. The proposed

regulations also permit the Board to increase

the annual renewal fee charged to dentists from

$189 to $289.

Are you missing issues

of AGD Impact or

General Dentistry

Then you’re missing out on important news and

research. Be sure your contact information is

correct and up-to-date!

Questions Please contact the Coordinator,

Circulation, at 888.AGD.DENT (888.243.3368),

ext. 4097, or news@agd.org.

March 2011 www.agd.org Online edition AGD Impact 13

l FYI l


Cancer Costs Rising

In the past few years, media reports have focused on baby

boomers and how they are aging and what effect that will

have on the rest of the country, now and in the future. As this

population of Americans (who were

born after World War II) is now reaching

the age of eligibility for Medicare,

the costs associated with ensuring a

large number of people under that

plan have become the focus for many


Specifically, cancer, one of the most

deadly diseases affecting people in the

United States and around the world, is

receiving more attention. The National

Cancer Institute released a study on

Jan. 12, 2011,in the Journal of the

National Cancer Institute that predicts

how much Americans can expect to

spend on cancer care in 10 years. Due

to the fact that baby boomers make up

a large part of the aging population

(more than 70 million people), the cost

of cancer care will increase by about

27 percent between 2010 and 2020.

The increase goes from $125 billion

this year to $158 billion in 2020 (not

including inflation). This number does

not account for any increase in the cost of cancer treatment

or any increases in cancer rates among the population either.

When the authors of the Journal of the National Cancer

Institute included estimates of these variables, the dollar

amount projected increased even higher.

The authors intended to assist policymakers by conducting

the study. Lead author Angela Mariotto acknowledged the

rising costs as “a challenge for both government and private

sectors.” In order to determine their projected costs, Mariotto

and her fellow researchers used data from Medicare payments

and the Surveillance, Epidemiology and End Results Survey.

They also modeled different scenarios in order to estimate how

much future cancer care costs would be. Mariotto explained

that, if cancer costs rise by 2 percent every year in every type

of cancer, then the cost of care for all cancers would be $173

billion in 2020. That is almost a 40 percent increase from

the money spent in 2010. But that is for all cancer types; the

authors note that there are certain cancers that cost much

more and the increases in spending therefore would be higher.

The results of the study do not just predict how much

cancer treatment will cost in the future, it also points out areas

in which spending could be reduced. Ken Thorpe, professor

of health policy at Emory University in Atlanta, who spoke

about the study, said that reducing smoking rates and fighting

obesity could decrease cancer costs by offering early prevention

to those who may otherwise develop cancer. Thorpe said,

“Seventy-five percent of what we spend in health care is linked

to chronically ill patients; less than 3 percent in prevention. We

do a great job of taking care of people after they’re sick; we do

a mediocre job of preventing people from getting sick.”

End-of-life care also can affect costs. Elizabeth Ward, who is

the national vice president of intramural research at the American

Cancer Society, said that policymakers and hospital personnel

can cut costs by researching when hospice care should be

offered instead of end-of-life care. She points out that costs for

the last year of a person’s life often include multiple admissions

to the hospital. Ward says that there are ways in which to

improve patient care and reduce costs at the same time.

The study also raises some ethical questions for end-of-life

care and, essentially, who should get the money for treatment

when many cancers are not curable Oncologists face difficult

decisions when it comes to available treatment options that

have medical benefits but sometimes pose side effects and

higher costs. Determining a “fair” way to allocate costs is

not an easy thing to do. Ethicists point out that addressing

patient suffering can help physicians determine how to access

resources for their patients.

Public Officials Reaffirm Fluoridation

The American Association of Public Health

Dentistry released information on Jan. 14,

2011, indicating that public health officials

are reaffirming the safety and effectiveness of

community water fluoridation while updating

their recommendation on the optimal level for

preventing tooth decay based on recent data.

The Department of Health and Human Services

and the Environmental Protection Agency

acknowledged the trend of increasing fluorisis

among U.S. children. Their recommendation is

to set the optical level for fluoride in drinking

water at 0.7 parts per million (ppm). The previous

recommendation was similar: 0.7 ppm to 1.2

ppm. The previous recommendation was based on

water temperature ranges throughout the country;

that is no longer applicable because water

consumption no longer varies by temperature.

14 AGD Impact Online edition www.agd.org March 2011

l FYI Research l

Dental Devices and

Consumables Market Expands

The availability of more advanced technologies

in dentistry is helping the global dental equipment

market to expand. MarketsandMarkets, a research and

global consulting company, estimates in its Global Dental Devices and

Consumables Market (2010-2015) report that the size of global dental

devices and consumables market to be worth $27.6 billion by 2015,

growing at a compound annual growth rate (CAGR) of 7 percent. The

report says that the market is estimated to grow, thanks to the increasing

demand for dental biomaterial and dental implants, which is growing at an

overall CAGR of 6 to 10.5 percent, respectively, from 2010 to 2015.

The report analyzes key trends in the market, as well as divides the global

dental equipment and consumables market by components and into various

geographic regions. It also discusses key market drivers, restraints, and opportunities

of the global dental equipment and consumables market. The report

indicates that the growing market will help reduce “the overall turnaround

time for dental procedures while improving efficiency of dental practitioners,”

and the availability of more natural and longstanding dental solutions.

l FYI Dental School News l

Dental School a Possibility in Northeast Missouri

A.T. Still University (ATSU) of Health Sciences is conducting a feasibility study

for the possibility of opening a dental school in Kirksville, Mo. The feasibility

study will look at such issues as the need for the program, availability of

qualified students, opportunities for suitable clinical experiences for students,

cost to initiate and sustain the program, and overall support from local and

regional advocates. If the ATSU dental school in Kirksville becomes a reality,

the university plans to commence classes in fall 2013.

NYU Conducts First Oral Health Survey

in Grenada

Earlier this year, students of the New York University (NYU) College of

Dentistry Henry Schein Cares Global Student Outreach Program performed

the most comprehensive oral health assessment and treatment program

ever undertaken in the Caribbean, which was hosted by the governments of

Grenada, Carriacou, and Petit Martinique.

Overall childhood caries prevalence on the Caribbean islands was

approximately 83.4 percent. About 25 percent of children examined said

that they did not own a toothbrush, and an even greater number had never

visited a dentist. For example, on the island of Grenada, which has about

26,000 children, researchers found almost 10,000 cavities in 1,000 children.

The NYU team examined 1,090 children ages 6 to 8 and 14 to 15 at 22

schools in seven parishes. The team provided free general and emergency

dental care, including fluoride varnish, sealants, root canals, fillings, and

extractions. The survey is the first phase of a four-year mission to develop a

comprehensive oral health model for the tri-island nation.

American Association of Endodontists

Annual Session

The American Association of Endodontists will hold its Annual Session

from April 13 to 16, 2011, in San Antonio, Texas. For more information,

visit www.aae.org/annualsession.

l FYI Numbers l

51 million

School hours lost each year

due to




Number of babies born each year

with cleft lip and/or cleft palate.


Percentage of seniors who, by age

65, have at least one chronic disease

and see seven physicians.


Percentage of nursing

home residents with

heart disease.

Source: Centers for Disease Control and Prevention and the American

Medical Association

Used Wind and Brass Instruments Harbor

Harmful Bacteria

Research has shown that playing a musical instrument can help

nourish, cultivate, and increase intelligence in children, but playing

a used instrument can also pose a potentially dangerous health risk.

Used wind and brass instruments and their cases were found to

be heavily contaminated with a variety of bacteria and fungi, many

of which are associated with minor to serious infectious and allergic

diseases, according to a study published in the March/April 2011

issue of General Dentistry, the peer-reviewed clinical journal of the

Academy of General Dentistry.

“Many children participate in their

school’s band ensemble and often the

instruments they play are on loan,”

said R. Thomas Glass, DDS, PhD,

lead author of the study. “Most of

these instruments have been played

by other students, and without the

proper sanitation, bacteria and

fungi can thrive for weeks and

even months after the last use.”

Want to learn more

See the March/April 2011 issue

of General Dentistry!

March 2011 www.agd.org Online edition AGD Impact 15

San Diego is home to a world-famous zoo, a breathtaking harbor, and premier golf courses. And, in 2011,

San Diego will once again be home to world-renown speakers and cutting-edge hands-on courses at the

premier event for general dentists—the Academy of General Dentistry (AGD) Annual Meeting & Exhibits.

Take the AGD Annual Meeting

& Exhibits Home … with the

AGD E-Learning Center!

New this year to the AGD Annual Meeting

& Exhibits, dentist registrants will receive

recorded sessions FREE! Register for

the AGD Annual Meeting & Exhibits

and receive access to approximately

60 hours of audio that is synchronized

to PowerPoint presentations on the

new AGD E-Learning Center. Plus, earn

continuing education (CE) credits and

have the ability to download the MP3

files onto your smartphone for education


For more information, contact the

AGD Meetings Department at

1.888.AGD.DENT (888.243.3368).


So, let’s GO!

Register before the end of March and I’ll also give you some family fun for FREE! As you pick up your registration

materials in San Diego, mention the code President’s Welcome to receive a FREE insulated beach

bag packed with fun for the whole family to enjoy!

The AGD is always your destination for top-notch continuing education. With first-rate speakers, extensive

lecture and participation courses, and quality exhibitors, this meeting will offer you the excellent education

and distinctive experiences you have come to expect from us.

Let’s GO to a place where clear skies, warm weather, and breathtaking sunsets will bring fresh energy to

your professional career.

I look forward to seeing you all there!

Fares M. Elias, DDS, JD, FAGD

AGD President, 2010-2011

Click here to register for the

AGD 2011 Annual Meeting &

Exhibits in San Diego, Calif.

Registration Form

AGD 2011 Annual Meeting & Exhibits July 28 to 31, 2011

2. Registration Categories & Fees

Registration code

Registration code


Enter the primary registrants contact in formation

AGD ID # c ccccc

Last name First name Nickname for badge {if desired}


DM Dentist Member* $380

DT Dental Team* $120

RT Retired* $205

PP Past President* FREE

FMA Fellow/Master Awardee* FREE

EM Emeritus* FREE

DEL Delegate* $305


ST Student* FREE

RG Recent Graduate* FREE

FME Fellow Examinee* $680

NM Non-Member Dentist* $695

EX Exhibit Hall Only FREE

GST Guest* $75

NDA Non-Dentist Attendee* $75

YTH Youth* $25

Address City State/province ZIP/postal code

Business phone Fax E-mail

3. Names 4. Registration 5. Education course fees/AGD Fellowship Exam 6. Events 7. Fee total

Select registration category and fee

for each person registering.


Select from section 2.

List the course code + fee for participation courses, special courses, and lectures

that each registrant would like to attend.

*Registration category includes one ticket to the Welcome Reception. Additional tickets must be purchased.

m Special Needs: If you have special needs due to a disability, please provide us with details here. We will make every effort

to accommodate your requests.

Enter event code

and fee.

Total fees for

sections 4, 5, and 6.

Primary Registrant Registration code/fee Code/fee Code/fee Code/fee Code/fee Code/fee Code/fee

/$ /$ /$ /$ /$ /$ /$ $

AGD ID # (If applicable) Code/Fee Code/Fee Code/Fee Code/fee Code/fee Code/fee

/$ /$ /$ /$ /$ /$ $

Additional Registrant Name Registration code/fee Code/Fee Code/Fee Code/Fee Code/fee Code/fee Code/fee

/$ /$ /$ /$ /$ /$ /$ $

AGD ID # (If applicable) E-mail Code/fee Code/fee Code/fee Code/fee Code/fee Code/fee

/$ /$ /$ /$ /$ /$ $

Name Registration code/fee Code/Fee Code/Fee Code/Fee Code/fee Code/fee Code/fee

/$ /$ /$ /$ /$ /$ /$ $

AGD ID # (If applicable) E-mail Code/fee Code/fee Code/fee Code/fee Code/fee Code/fee

/$ /$ /$ /$ /$ /$ $

Name Registration code/fee Code/fee Code/fee Code/fee Code/fee Code/fee Code/fee

/$ /$ /$ /$ /$ /$ /$ $

AGD ID # (If applicable) E-mail Code/fee Code/fee Code/fee Code/fee Code/fee Code/fee

/$ /$ /$ /$ /$ /$ $

Name Registration code/fee Code/fee Code/fee Code/fee Code/fee Code/fee Code/fee

/$ /$ /$ /$ /$ /$ /$ $

AGD ID # (If applicable) E-mail Code/fee Code/fee Code/fee Code/fee Code/fee Code/fee

/$ /$ /$ /$ /$ /$ $

Name Registration code/fee Code/fee Code/fee Code/fee Code/fee Code/fee Code/fee

/$ /$ /$ /$ /$ /$ /$ $

AGD ID # (If applicable) E-mail Code/fee Code/fee Code/fee Code/fee Code/fee Code/fee

/$ /$ /$ /$ /$ /$ $

Registration/course cancellation policy

Full refunds, less a $50 processing fee, will be granted if written requests are received by the AGD

on or before July 15, 2011 (5 p.m. CST). Please send your request to meetings@agd.org or fax to

312.440.0513. All cancellation requests will be processed within 60 days after the AGD 2011 Annual

Meeting & Exhibits. Type of payment (check or credit card) must accompany all registration forms

and be received by the AGD on or before May 10, 2011 (5 p.m. CST) in order to receive advance fees.

Persons not registered by May 10, 2011, will be charged post-registration fees. There will be a $25

processing fee for any returned checks.

9. Payment options

Total the fees for all registrants

8. Grand total $

Please select method of payment:

q Check enclosed (payable to Academy of General Dentistry) q Credit card (circle one) VISA MasterCard Discover American Express

Credit card number Expiration date Card holder’s signature Date

The AGD reserves the right to cancel a course if the minimum registration expectations are not met.

Registrants will be notified, and full refunds will be issued.

Print name as it appears on card Billing address City, State, ZIP

Registration instructions

1) Enter the primary registrant’s contact information.

2) Select registration category and fee for each person registering.

3) Print each registrant’s first and last name and enter the registrant’s

six-digit AGD member number (if applicable).

4) Enter the registration category and fee for each registrant that was

selected from section 2.

5) List the course code and fee for participation courses, special courses, and

lectures that each registrant would like to attend. A meeting badge is

required to attend all courses. Visit www.agd.org/sandiego for a full list

of course offerings and descriptions.

6) Enter the event code and fee for the special events you would like to

attend. Dentist, dental team, and guest registrations have a ticket to the

AGD Welcome Reception included.

7) Total the fees for section 4, section 5, and section 6 for each registrant.

8) Total the fees for all registrants.

9) Indicate the method of payment. Registrations will not be completed

without payment.

Registration/course cancellation policy

Full refunds, less a $50 processing fee, will be granted if written requests

are received by the AGD on or before July 15, 2011 (5 p.m. CST). Please

send your request to meetings@agd.org or fax to 312.440.0513. All cancellation

requests will be processed within 60 days after the AGD 2011 Annual

Meeting & Exhibits. Type of payment (check or credit card) must accompany

all registration forms and be received by the AGD on or before May 10,

2011 (5 p.m. CST) in order to receive advance fees. Persons not registered

by May 10, 2011, will be charged post-registration fees. There will be a $25

processing fee for any returned checks.

The AGD reserves the right to cancel a course if the minimum registration

expectations are not met. Registrants will be notified, and full refunds will

be issued.

AGD Education Sessions

Agenda and times are subject to change. Reference the website and on-site

program for final details. Full descriptions of all events and courses are

available at www.agd.org/sandiego.

Course Codes:

L – Lecture Course

P – Participation Course

S – Special Lecture with Additional Fee

Academy of General Dentistry is designated as an Approved PACE Program

Provider by the Academy of General Dentistry. The formal continuing education

programs of this program provider are accepted by AGD for Fellowship,

Mastership and membership maintenance credit. Approval does not imply

acceptance by a state or provincial board of dentistry or AGD endorsement.

The current term of approval extends from June 1, 2010 to May 31, 2014.

Provider ID# 216217

AGD 2011 Annual Meeting & Exhibits Course Listing

Code Title Time Fees

Member Non-


Wednesday, July 27 and Thursday, July 28, 2011

S01 Fellowship Review Course 7:30 a.m. to 5:30 p.m. $300

Friday, July 29, 2011

S02 Exam

Fellowship Examination Check-in: 7:30 a.m.;

Instructions: 8:30 a.m.;

Exam: 9 a.m. to 1 p.m. $450

Thursday, July 28, 2011

All-day courses

L01 Total Facial Esthetics for Every Dental Practice 8 a.m. to 4 p.m. Free Free

L02 2011 New Information & Clinical Tips on Dental

Caries, Restorative Materials and Infection Control 8 a.m. to 3 p.m. Free Free

L03 Stay Out of Jail: The Top Coding Errors 8 a.m. to 4 p.m. Free Free

P01 Predictably Successful Endodontics: How to Feel,

Fill & Thrill Accessory Canals 8 a.m. to 4 p.m. $475 $525

P02 Tissue Regeneration for the Dental Practitioner 8 a.m. to 4 p.m. $375 $425

P03 Dental Photography: Communication Quality

Photography for the Modern Practice 8 a.m. to 4 p.m. $300 $350

P04 The Missed Injections: A Hands-on Review of

Anatomy and New Injection Techniques 8 a.m. to 4 p.m. $500 $550

P05 Dentures and Implant Overdentures: How They Have

Improved the Quality of Life. 8 a.m. to 4 p.m. $400 $450

P06 Interceptive Orthodontics: The Key to a Lifetime of

Good Oral Health 8 a.m. to 4 p.m. $475 $525

P11 Esthetic and Adhesive Dentistry 8 a.m. to 4 p.m. $550 $600

S03 The Christensen “Bottom Line” —2011 8 a.m. to 3 p.m. $50 $50

Code Title Time Fees

Member Non-


Thursday, July 28, 2011, and Friday, July 29, 2011

Two-day courses

P12 Lasers in Dentistry: A Two-Day Standard

Proficiency Course Thurs.: 8 to 11 a.m.

and 1 to 4 p.m.;

Fri.: 9 a.m. to 12 p.m.

and 2 to 5 p.m. $800 $850

P13 Implant Mentor Two-Day Program Thurs.: 8 to 11 a.m.

and 1 to 4 p.m.;

Fri.: 9 a.m. to 12 p.m.

and 2 to 5 p.m. $600 $650

P14 Anxious and Special-Needs Patient Care: It Makes

Sense, as Well as Dollars Thurs.: 8 to 11 a.m.

and 1 to 4 p.m.;

Fri.: 9 a.m. to 12 p.m.

and 2 to 5 p.m. $700 $750

Thursday, July 28, 2011, Friday, July 29, 2011, and

Saturday, July 30, 2011

Three-day courses

P15 Adult Oral Sedation Thurs.: 8 a.m. to 12 p.m.

and 2 to 5 p.m.;

Fri.: 9 a.m. to 12 p.m.

and 2 to 6:30 p.m.;

Sat.: 8 a.m. to 12 p.m.

and 2 to 5 p.m. $1,975 $2,195

Dental Team: $738

Student: $1,195

Morning courses

L05 Yikes, I’ve Got a Preschooler in My Chair! 8 to 11 a.m. Free Free

L06 Implant Versus Root Canal Treatment:

Which One is Best 8 to 11 a.m. Free Free

L07 Smile Design Simplified Once and For All 8 to 11 a.m. Free Free

L08 Sports Dentistry, Trauma, Treatment and Prevention 8 to 11 a.m. Free Free

L39 Financial Management for Spouses and Teens 9:30 to 11:30 a.m. Free Free

Afternoon courses

L09 Bright Smiles 1 to 3 p.m. Free Free

P08 The Effective Development and Use of Digital and

3-D Education Resources in Dentistry: Benefits,

Formats, and Application 1 to 4 p.m. $950 $1,000

P09 “Addition by Subtraction”—Conservative Veneer

Preparation Workshop 1 to 4 p.m. $375 $425

P10 Hands-on Fabrication of Pressure Thermal

Formed Appliances 1 to 4 p.m. $350 $400

L41 New Wealth Creation Strategies: Investment

Strategies for Volatile Markets 1 to 4 p.m. Free Free

Friday, July 29, 2011

All-day courses

L12 Face Regeneration: Concept to Reality 9 a.m. to 5 p.m. Free Free

L13 What’s the Real Deal About Street and Prescription

Drug Abuse 9 a.m. to 5 p.m. Free Free

L14 Everyday Oral Surgery for the Dentist Working in the

Public Health, Veterans, Correctional and Military

Administration 9 a.m. to 5 p.m. Free Free

L35 Cosmetic Pearls for the General Practitioner 9 a.m. to 5 p.m. Free Free

P16 Essix Aligner Therapy 9 a.m. to 5 p.m. $500 $550

P17 Improving Esthetics While Preserving Tooth Structure

& Tooth-Strengthening Adhesive Dentistry 9 a.m. to 5 p.m. $300 $350

P18 Treating OSA, Snoring, and Craniofacial Pain 9 a.m. to 5 p.m. $400 $450

P19 Looking for Answers About TMJ and Face Pain

Join Us for a Dissection Course 9 a.m. to 5 p.m. $1,500 $1,550

S04 Hot Topics in Restorative and Esthetic Dentistry 9 a.m. to 5 p.m. $50 $50

AGD 2011 Annual Meeting & Exhibits Course Listing

Code Title Time Fees

Member Non-


Friday, July 29, 2011

Morning courses

L10 California Dental Practice Act 9 to 11 a.m. Free Free

L15 What’s Hot and What’s Getting Hotter 9 a.m. to 12 p.m. Free Free

L16 Learn to Lobby: Government Relations Skills for

General Practitioners 9 a.m. to 12 p.m. Free Free

L17 Oral Care and Office Visits for People with

Developmental Disabilities Can Be Practical 9 a.m. to 12 p.m. Free Free

L18 What Dental School Forgot to Teach You About

Money: Investing Successfully for a Comfortable

Retirement 9 a.m. to 12 p.m. Free Free

L21 Take This Stress and LOVE It! Create Balance in

Your Practice! 9 a.m. to 12 p.m. Free Free

L23 Communicate with Latino Patients: Dental Spanish and a Cultural Impact 9 a.m. to 12 p.m. Free Free

L24 Everything Is Marketing 9 a.m. to 12 p.m. Free Free

P20 Professional Speaking Lab 9 a.m. to 12 p.m. $25 $50

P21 Creating Solutions with Nano Hybrid Composite Crowns in Less Than an Hour 8 to 11 a.m. $300 $350

S05 Senioritis … It’s a Good Thing: A Course for Dental Students and New Dentists 9 a.m. to 12 p.m. $20 $20

L04 Miracles or Myths Evidence for New Adhesives, Resin Restoratives and

Curing Devices 8 to 11 a.m. Free Free

L42 Implantes Cortos y Restauraciones Estéticas 9 a.m. to 12 p.m. Free Free

L36 Panel Discussion on CAD/CAM 10:15 to 11:15 a.m. Free Free

L11 Infection Control “A Practical Approach” and OSHA Update 11 a.m. to 5 p.m. Free Free

Afternoon courses

P07 Maximizing Material Performance for Direct Composite Placement 2 to 5 p.m. $450 $500

L19 Yes Is the Answer —What Was the Question 2 to 5 p.m. Free Free

L20 What Dental School Forgot to Teach You About Money: Investing

Successfully for a Comfortable Retirement 2 to 5 p.m. Free Free

L22 Women, Weight, and Wellness: Keep Your Edge at Any Age 2 to 5 p.m. Free Free

P23 Comprehensive Treatment Planning: A Systematic Approach 2 to 5 p.m. $235 $285

P24 It’s Not Peer Pressure, It’s Just Your Turn 2 to 5 p.m. $300 $350

P25 Let’s Put the “Teeth” Back Into Medical and Dental Care to Improve the

Quality of Life for Our Patients with Special Needs 2 to 5 p.m. $300 $350

P26 Yoga for Stress Relief, Pain Management & Healthy Living 2 to 5 p.m. $60 $100

P27 Getting Started on Social Media 2 to 5 p.m. $325 $375

P43 Migraine and the Trigeminally Mediated Disorders 2 to 5 p.m. $300 $350

Friday, July 29, 2011, and Saturday, July 30, 2011

Two-day courses

P28 Integrating Dental Implants into Your Practice Fri.: 9 a.m. to 12 p.m.

and 2 to 5 p.m.;

Sat.: 8 to 11 a.m.

and 2 to 5 p.m. $500 $550

Code Title Time Fees

Member Non-


Saturday, July 30, 2011

All-day courses

P29 Root Coverage Grafting for Teeth and Implants Using AlloDerm® 8 a.m. to 5 p.m. $1,995 $2,045

P30 Think Like a Laser Dentist—The Biological Rationale for Laser Use in Dentistry 8 a.m. to 5 p.m. $475 $525

P31 Surgical Extractions Using New High-tech Devices 8 a.m. to 5 p.m. $525 $575

P32 Esthetics and Edges—Anterior Restorations and Occlusion 8 a.m. to 5 p.m. $475 $525

P33 A Hands-on Approach to Diagnosis and Treatment Planning of the

Geriatric or Special Needs Patient 8 a.m. to 5 p.m. $425 $475

P34 Cancers of the Oral Cavity and Beyond 8 a.m. to 5 p.m. $475 $525

S06 Treatment Planning Guidelines for Fixed and Removable Prosthodontics 8 a.m. to 5 p.m. $50 $50

Morning courses

L43 Current Trends in Controlled Substance Abuse 8 to 10 a.m. Free Free

L25 Accelerate Your Practice 8 to 11 a.m. Free Free

L26 Supra-gingival Dentistry: Excellence with Metal-free Posterior Indirect Onlays,

Full Crowns and Fixed Prosthesis (in Spanish) 8 to 11 a.m. Free Free

L28 Clues to Your Patient’s Health: The 30 Most Physician-Prescribed Medications 8 to 11 a.m. Free Free

L29 Biomimetic Restorative Dentistry 8 to 11 a.m. Free Free

L30 Short Implants and Aesthetic Restorations: Maximize Implant Placements

and Minimize Bone Grafting, Sinus Lifts and Prosthetic Procedures 8 to 11 a.m. Free Free

L31 How Forensic Dentistry Identifies Unknown Individuals 8 to 11 a.m. Free Free

L32 Take Charge of Your Choices and Lead an Abundant Life 8 to 11 a.m. Free Free

L33 Risk Prevention and Management 8 to 11 a.m. Free Free

P36 Dental Hypnosis: It’s Not Like Pulling Teeth 8 to 11 a.m. $235 $285

P37 Caries Management: Theories, Procedures and Reality 8 to 11 a.m. $300 $350

P41 Esthetic Dentistry For Tots and Teens 8 to 11 a.m. $400 $450

L37 Successful Investing —How to Make Money in Uncertain Times

(Introductory Course) 8 to 11 a.m. Free Free

L54 Periodontal Inflammation and the Risk for Cardiovascular Disease 10 to 11:30 a.m. Free Free

Afternoon courses

L40 Practice Management Panel 11:15 a.m. to 12:15 p.m. Free Free

P35 The Role of Forensic Dentistry in the Identification of Individuals 2 to 5 p.m. $350 $400

L27 Supra-gingival Dentistry: Excellence with Metal-free Posterior Indirect Onlays,

Full Crowns and Fixed Prosthesis 2 to 5 p.m. Free Free

P38 Hands-on Practical Course on Short Implants 2 to 5 p.m. $250 $300

L34 My Aching Back 2 to 5 p.m. Free Free

P39 Anterior Mock-Up and Veneer Preparations 2 to 5 p.m. $375 $425

P40 CPR Training 2 to 5 p.m. $70 $70

P42 The Erbium Laser: The “Star Wars” of Dentistry 2 to 5 p.m. $400 $450

L38 Take Your Investing to the Next Level (Advanced Course) 2 to 5 p.m. Free Free

Event Tickets

Code Title Time Fees

Thursday, July 28, 2011

E01 Welcome Reception —Adult 5 to 7 p.m. $50

E01A Welcome Reception—Youth 5 to 7 p.m. $25

Saturday, July 30, 2011

E02 AGD Foundation Fun Run/Walk Individual: $35

Team: $250

E03 Saturday Night Celebration—Adult 8 to 11 p.m. $95

E03A Saturday Night Celebration—Youth 8 to 11 p.m. $50

E03B Saturday Night Celebration—Awardee’s First Guest 8 to 11 p.m. $57

I Exceptional Care I

Less Is More

Learning to Listen to Your Patients

“Our desire to

educate and help

others sometimes

can be a barrier

in our ability to

be patient, to

listen well, and

to thoughtfully

consider the

concerns of those

who we serve.”



was recently in a discussion with George Vaill,

a dental lease negotiator, when he said, “In the

absence of detail, we are just negotiating against

ourselves.” While our discussion was in regard

to a lease, it occurred to me that his statement

was as relevant in lease negotiations as it was in

treatment discussions with patients. His statement

brought to mind the countless treatment presentations

that I have observed over the years during

which a patient expressed concerns regarding fees,

time, or discomfort, and a dentist or team member

proceeded to give a long dissertation in

response without an appropriate understanding

of the patient’s true concerns.

It’s not always pleasant to consider

that we may be overeducating our

patients in an attempt to guide them to

accept our treatment plans. Sometimes,

when a patient is not enthusiastically

participating in the discussion, we may

continue to share information to the

point that his or her eyes glaze over. It’s

true: Most of us are uncomfortable with

silence as a reaction, especially when

we’re the vendor presenting the product,

so it’s easier to just keep talking.

If you are lucky enough to have

a patient who is willing to share his

or her concerns, you should take the

opportunity to really listen before

responding. For example, if the patient

seems stressed by the amount of time

required for an implant process, ask if

he or she is concerned about the number

of visits, the timing of the visits, or if the

procedures will interfere with an upcoming

event. You could say, “Your concerns with this

procedure seem related to time. Is this because

of your work schedule or because you are afraid

that the appointments will interfere with another

aspect of your life” Or, you might say: “Is there a

specific aspect of the time frame of this procedure

that concerns you” Or, you could be even more

specific: “Are you concerned about how long the

procedures will take while you are in the office or

the length of time that you will be inconvenienced

by the temporary”

You may see that treatment acceptance improves

significantly when you take the time to really delve

into your patient’s concerns. Here’s a tip: Get into

the habit of asking at least one clarifying question

before you respond to a patient’s question. There

are three benefits of this approach:

Your patient will see that you are interested in

1 listening to his or her concerns and that you’re

not just trying to talk him or her into treatment.

This will give you a big plus in the trust and value

part of the patient’s decision.

You will find that you are able to answer your

2 patient’s concerns more quickly and more

accurately. The ability to help your patients make

good decisions more quickly during an actionpacked

day is a win-win for everyone.

You make it easier for the patient. Too much

3 information can be very confusing for the

patient. In fact, any time that you go beyond two

or three sentences without allowing your patient

to respond will likely increase your risk for the

“nod syndrome.” Many married couples know this

syndrome—and that nodding doesn’t truly indicate

agreement or even that the other party is listening!

Sometimes the “nodder” is simply politely ignoring

your information. (By the way, you will find there

is a direct correlation between patients who nod

politely with little engagement in the discussion

and cancellations in your appointment schedule.)

Our desire to educate and help others sometimes

can be a barrier in our ability to be patient, to

listen well, and to thoughtfully consider the

concerns of those who we serve. We are by nature

first “tellers” and second “listeners.” Thoughtful

listening requires us to be selfless rather than selfish.

It requires us to discipline our thoughts and

find a way to give our patients the message they

need in a way that they can hear it, and then give

them the space and time to respond accordingly.

In the absence of detail, we are only negotiating

against ourselves. u

Lorraine Guth is a professional speaker and

consultant, as well as president of Motivations

by Mouth. She conducts management

consultations for dentists in both the United

States and Canada to improve communication

with patients and team members and

to improve treatment compliance. She

can be reached at 636.257.2066 or at


20 AGD Impact Online edition www.agd.org March 2011

I One for the Team I

“Patients take

their emotional

cues from the

dental team. If I’m

defensive with a

patient, the patient

will become

defensive, too.”

The Patient Whisperer

Strategies for Defusing Difficult Situations


started my dental career in a highly organized

office. Our patients rarely waited for an

appointment, our fees were low, the facility was

beautiful, and the team was highly competent.

Despite being nearly perfect, we still had disgruntled

patients from time to time. Now that I’m

the office manager of a practice that’s transitioning

to new management after being purchased, it’s

my job to find solutions for angry patients. The

following are key strategies to minimizing tempers

without feeling the strain.

Strategy 1: Understand patient psychology.

Going to the dentist is upsetting for some people.

They have to make arrangements with their

employer or maybe get a babysitter in order to

come to their appointment. Having their space

invaded by the clinical team may be uncomfortable

for them. They fear lectures

because they may be embarrassed about

their home care. Tempers often flair

regarding financial matters because

dental plans vary so much, and people

have trouble understanding their benefits.

Understanding these patient issues

and accepting the fact that I will need

to assist them through their ups and

downs helps me handle the situations

with grace when they do arise.

Strategy 2: Listen and sympathize.

When patients are having issues, using

your listening skills becomes very

important. Whenever a patient is yelling

in my office, I ask to speak to him or her

alone in our consult room. I bring a pen and pad of

paper and take notes while the patient fully explains

what’s going on. When the patient is done talking, I

repeat his or her side of the story in my own words.

Regardless of the situation, the patient is always less

angry after someone listens to his or her concerns.

Strategy 3: Be honest, but be yourself.

Patients take their emotional cues from the dental

team. If I’m defensive with a patient, the patient

will become defensive, too. If I lie to a patient, he or

she doesn’t trust me anymore. My approach is to be

consistent with how I speak to patients throughout

the entire situation. I keep my tone conversational,

provide honest information, and hold my ground.

Once the patient realizes that he or she can’t poke

holes in my story because I’m telling the truth, and

he or she sees that no one else in the room is yelling,

the patient becomes more accepting of the situation.

Strategy 4: Present a solution.

If I hone in on a solution as quickly as possible, it

cuts down on the amount of time that I must spend

with an angry patient. If I have done a good job

listening to the patient, then finding a solution is

much easier. I try to be creative and helpful. If the

office has made a mistake, I correct it, and I thank

the patient for his or her understanding. I hold

my ground when it comes to financial disputes.

Solutions that involve giving away free services are

not fair to the office, so I avoid them, especially

when the account has been correctly managed.

Strategy 5: Learn from the problem.

Dentistry is a complicated industry and it requires

constant training and updating to stay competitive.

After a problem has been addressed, take the time

to figure out what went wrong and fix it for next

time. Rather than addressing mistakes individually,

discuss what happened in a team meeting so that

everyone can learn and nobody feels singled out.

Learning from past mistakes will help the team

improve its customer service skills and all of the

patients will benefit. u

J. Kate Wilcox has been a front desk team

member since 2008. Currently she is an office

manager of a multispeciality

dental practice in


downtown Chicago.

March 2011 www.agd.org Online edition AGD Impact 21

I Realizing Your Practice Vision I

Strategies to Retain

Your Best Employees

Enhancing the Stability of Your Practice

Retaining good employees is crucial to both

short-term productivity and long-term

sustainability of practice performance.

When a key employee leaves, the practice

and the doctor immediately experience stress.

Significant time is wasted on recruiting and

training a replacement. In addition, temporary

workers may need to be hired as the practice

scrambles to minimize impact on patients and

its own bottom line. Practice performance inevitably

declines and several months may elapse

before the practice is restored to its previous

level of patient care, customer service, production,

and collections.

Turnover also has an adverse impact on

remaining employees, who must shoulder the

increased workload and must pacify dissatisfied

patients who are quick to spot inferior service,

errors in billing, and other quality lapses. The

loss of one employee often triggers the departure

of one or two others as well, which plunges the

practice into “crisis” mode instantly.

Annual revenue at a dental practice can drop

anywhere from 3 to 10 percent due to the loss

of a single good employee. Because the cost of

turnover is not listed on the year-end financial

balance sheet, this cost is widely underestimated

and often goes unnoticed.

Retention: The stealth asset

The flip side of this is that retaining key

employees will provide your practice with a

huge competitive advantage. If your competitors

have unstable work forces, they are forced to

invest tens of thousands of dollars in recruiting,

training, and increased supervision. They are

constantly dealing with conflict, inefficiency,

and mistakes within their practice. And, without

staff continuity, they will have a hard

time establishing good relationships

with their patients. Patient loyalty is

fragile today and patients are more

likely to leave such a practice. All of

these challenges will make it far more

difficult for such practices to compete

with you.

Practices with a stable workforce are

able to build and maintain close relationships

with patients. They usually

have greater expertise and capacity,

as well as consistency and quality in

the delivery of service, because they

have more employees who know what

they are doing. Staff members who are

part of stable organizations usually are

able to work more cohesively as they

understand each other well and will

have been cross-trained to fill in for

absent team members.

Staff continuity is the stealth asset

that enables practices to perform

well year after year. So, how do you

improve the odds of keeping your

best people And why do they leave

The key to retention is to understand

what good employees want today. My

conversations with dental employees

22 AGD Impact Online edition www.agd.org March 2011

have generated the following list of what people want.

This was not a scientific survey, but it provides anecdotal

evidence of what employees are looking for in their place of


The issue of salary and benefits was intentionally left

out, as it only muddles the interpretation of such surveys

and discussions. Everyone expects to be paid a competitive

salary. With the exception that most single employees

wanted health insurance, nothing

new was gleaned from a discussion of


What good employees want

Based on my conversations, employees

want the following, starting with the

most important:

1. Be treated with respect, consideration,

and fairness by their


2. Good co-workers

3. Opportunity to learn and grow

4. Contribution and input valued and appreciated

5. Sympathy toward personal problems

6. Reasonable work hours

Compare this list with what your practice offers and see

how well these expectations and desires are met. This list

also may reinforce and confirm your thinking and give you

the confidence to invest more in certain areas.

Item No. 6 reflects a desire for work-life balance. Late

hours are undesirable for employees who have children.

There is a tension between what patients want and what

employees want. Patients want the convenience of early

morning, after-work, or Saturday appointments, but these

are the very hours that employees dislike. Make a decision

regarding your office hours after careful consideration of all

of the issues and then stick with it.

Retention strategies

Here are six areas that you need to consider carefully in

order to improve retention of good people at your office:

No. 1: Quality of supervision

Most employees don’t leave jobs or companies. They leave

bosses. Here are some things you can do to make sure poor

supervision doesn’t cost you good employees.

Treat employees with respect. Each individual has unique

talents, capabilities, and behaviors. Look to capitalize on

an employee’s strengths. Give that employee some independence

and flexibility, based on his or her capability. Treat all

employees as professionals and talk to them with respect.

If they are not worthy of your respect, you probably should

have never hired them.

Clarify expectations. Give clear, unambiguous direction.

Explain the reasons for your thinking. Have a written set of

job expectations and the results expected from them.

“Annual revenue at a

dental practice can drop

anywhere from 3 to 10

percent due to the loss of

a single good employee.”

Provide timely feedback. Poor communication is one of

the major reasons for good employees departing. Provide

prompt, specific feedback, which will help employees take

corrective action before things boil over.

Show patience. When mistakes are made, be slow to

anger. Employees appreciate mature leaders who exercise

self-control and avoid flying off the handle. Give your

employees some room for failure

and keep things in perspective. Take

every mistake as an improvement

opportunity. Remember: It could be a

deficiency in your systems or training

program, rather than negligence on the

part of the employee.

Carefully consider your

supervisors. One area that needs

particular attention is the selection

and training of any staff member who

might be managing other people. Many

practices drop the ball in this area. They often choose an

unsuitable person for the position of office manager, which

results in disgruntled employees and increased turnover.

The office manager must have experience in this position

and demonstrated proficiency. Ideally, potential candidates

for office manager should attend at least a few good

leadership courses before they receive management responsibility.

Without this experience and training, subordinate

employees are not likely to respect the office manager and

the relationship is inherently doomed to fail from the outset.

It is better not to have an office manager at all than to have

someone who is unqualified. Your practice and your people

are too important to be left in the hands of a novice.

No. 2: Relationships with your employees

An employee’s association with a practice is an emotional

relationship, not one based on logic or rationale. If an

employee has strong emotional bonds with co-workers and

supervisors, that employee is more likely to remain with the

practice. The following are simple ways to build relationships

with your employees:

Care about people as individuals. Get to know your

employees so you can relate to them on a personal level.

You can do this by meeting one-on-one with each of your

staff members in an informal way on a regular basis. Talk

to them about their successes, as well as any difficulties or

frustrations that they may be experiencing. These may be

work-related issues or personal issues.

Address work-related issues by removing obstacles and

providing the necessary resources and support. Early

intervention is preferred, as problems are often more easily

solved when they are small. These individual meetings

also are your opportunity to express sincere appreciation

for your employees’ contributions. In many cases, your

best employees may have gone beyond the call of duty to

March 2011 www.agd.org Online edition AGD Impact 23

“When mistakes are made, be slow to

anger. Employees appreciate mature

leaders who exercise self-control and

avoid flying off the handle.”

accomplish something important but are hesitant to brag

about it. It is up to you to acknowledge it and thank them

for it.

When it comes to personal issues, sympathize with

your employees and offer simple solutions if appropriate.

Employees are not necessarily looking for you to intrude into

their personal lives and solve all of their problems; they just

want some consideration. By listening to them and showing

genuine concern, you are showing that you care about them

as individuals. Have an open-door policy and make yourself

available anytime they need help.

Stand by your people. Conflict and disagreement are part

of work. During the course of their work, your employees

will run into difficulties with patients at some point. When

these situations arise, defend the employee if he or she has

done the right thing for your practice.

If the employee’s approach was not the best solution,

handle the situation in a diplomatic manner. Make it clear

that you still support the employee personally, but not

the manner with which he or she handled the specific

situation. Help the employee understand what went wrong

and propose a better solution. Stick up for your employees

whenever possible.

No. 3: Training and learning opportunities

High achievers are hungry for personal and professional

development. They want opportunities to learn and grow.

They want to expand their skills and take on more challenges.

When was the last time you took your staff offsite to

a course or workshop How about having an expert present

a seminar at your office Equip your staff with better tools,

methods, and strategies so they can enhance their own

performance as well as practice performance.

No. 4: Employee involvement and engagement

Top performers want to be involved in the growth of your

practice. They want to contribute. Solicit your staff for ideas.

Hold a monthly staff meeting and seek staff members’ input

on how to improve issues within your practice and then act

on good ideas.

No. 5: Rewards for longevity

Reward employees who have a long length of service at your

practice. By doing so, you are sending a message to other

employees that loyalty is something you value. Structure

your benefits and compensation so that benefits increase

significantly with tenure. Vacation time should increase

with tenure, for example. In addition, you could consider

increasing other benefits (increasing continuing education

reimbursements, increased practice contribution, etc.) at the

two-year, five-year, and 10-year marks. Clearly describe the

increase in benefits in your human resources manual and be

sure to review it with all employees periodically. You also

may consider giving a special one-time bonus for employees

who have been with your practice for five or 10 years.

No. 6: Onboarding process for new employees

“Onboarding” is the process by which a new employee is

integrated into the practice, but onboarding is as much

about retaining talent as it is about getting people settled in

their new job.

A systematic onboarding process will help the employee

develop a sense of belonging, promote behaviors aligned with

practice goals and values, demonstrate your commitment

toward them, and expedite the process for them to become

productive. It is the first step toward long-term retention of

any new employee.

The first 90 days will set the tone for the employee’s

long-term employment. Assuming you’ve recruited the

right person, the level of effort that the employer puts forth

during this initial period will determine the length of his

or her stay, as well as how quickly he or she achieves optimum

productivity. Your onboarding process should include

the following:

• On the first day, discuss and deliver written job descriptions,

job expectations, and key results that are to be

achieved on the job. Also, provide the employee a list

of training objectives that must be completed in 30 or

60 days.

• A rigorous training program which addresses items on

the list, one at a time.

• A formal weekly meeting to compare progress with job


• A formal performance review at the 90-day point.

Your onboarding process should do everything possible to

increase the odds of the new employee succeeding in your


Your future

To retain good people, compensate and treat them fairly,

build a relationship with them, invest in their development,

and engage their hearts and minds. Implement a systematic

onboarding process to get any new employees started off on

the right foot. Dentists who put these principles into action

will have a dependable talent pool for future growth and a

stable, low-maintenance practice with happy employees and

satisfied patients.

Peter Gopal, PhD, is president of Visionary Management,

a dental practice management consulting firm based

in Pennsylvania. He is a graduate of


the Wharton Management Program.

Contact him by phone at 215.295.6975,

or visit www.visionary-management.com.

24 AGD Impact Online edition www.agd.org March 2011

I Coaching Corner I

Infinite Games

Learning to Let Go

“It is wise to keep in mind that neither success nor failure is ever final.” —Roger Babson

“We have been

seduced into

believing that our

lives and practices

are games that

have to be won—

or we’re losers.”

What is success to you What’s failure

How are you feeling about your

practice What are you feeling like

right now What about yesterday, or the

day before Chances are the answer is not always

the same.

As we say in the South, “Some days you’re

the bug, some days you’re the windshield.” Or,

as friends who live on the coast say, “Some days

you’re the bait, some days you’re the fish.”

In the book, Finite and Infinite Games by James

P. Carse, finite games are defined as the contests

of everyday life—the games we play with winners

and losers, games that have a beginning and an

end. Infinite games are more mysterious and ultimately

more rewarding. They are unscripted and

unpredictable; they are the source of true freedom.

Is your practice a finite or an infinite game

What about your life What about your career

How do you know That may be troubling

to answer because any process can

be characterized in “finite” or “infinite”

terms. What’s more important is how

we characterize these processes. In

reality, characterization is almost always

a matter of choice, and by choosing to

characterize something as “infinite,”

you can redefine it in a meaningful and

healthy way. By doing so, we allow

ourselves mistakes, experimentation,

joy, peace, and a whole lot more—both

positive and negative.

Unfortunately, most of what we experience

in our lives and professions is

finality, and this burdens us with tremendous anxiety

and stress. We have been seduced into believing

that our lives and practices are games that have to

be won—or we’re losers. The stress and anxiety is

quite similar to that of a competitive sports game,

where there is a time limit and a winner and a

loser. The anxiety of wondering who will win is

the thrill. Is that the kind of thrill you want in your

practice and your life Instead, I’ll ask you to take a

different look at your life and practice.

What are the sources of your stress and anxiety

Are they items that you could actually do something

about, or have you given in to believing what you’ve

read, heard, or were told These are the scripts you

believe, which take the enjoyment, satisfaction, and

fulfillment out of your life and practice.

What do you think would happen if you took

a less-scripted approach to your practice and to

your life Would you feel more anxiety or less

Assuming you’re honest, you’d probably feel more

anxiety—at least at first.

But, as you become more comfortable with

allowing things in your life and in your practice to

flow easily and being less controlling, you’ll start

noticing changes. Some changes will be subtle,

others huge. You’ll start not worrying as much.

You’ll learn that your life and your practice will

not end tomorrow if something doesn’t get done

today or Mr. Jones postpones his dental care. Your

team and your patients will find you to be more

pleasant and approachable.

Most importantly, you’ll truly learn that your

practice and your life are indeed very long games

that give you all sorts of opportunity for connection,

fulfillment, service, and peace. u

Don Deems, DDS, FAGD, known as The

Dentist’s Coach ® , is a trained professional

personal and business coach and a practicing

dentist. He is co-founder of the Dental Coaches

Association and a Top Leader in Continuing

Education for the past six years. He also is

co-author of the book Roadmaps to Success:

America’s Top Intellectual Minds Map Out Successful Business

Strategies, along with Ken Blanchard and Stephen Covey. His

newest book, The Dentist’s Coach: Your Practical


Guide to Building a Vibrant Practice and the Life

You Want, is scheduled to be available this spring.

To learn more, visit www.drdondeems.com.

March 2011 www.agd.org Online edition AGD Impact 25

I Motivating and Managing I

Increasing Patient Referrals

Why Internal Marketing Is Key

Why do patients refer or not refer other

patients Knowing the answer can mean

the difference between just getting by

this year or your growing production

significantly. To achieve a highly productive 2011,

a series of steps must be taken to increase patient

referrals, regardless of insurance participation,

location, or other factors affecting your practice.

Understanding internal marketing

One of the keys to growth this year (or indeed any

year) is internal marketing. To be effective and

create the desired result, internal marketing must:

• Support various marketing strategies in a stepby-step


• Be continually evaluated over time to review

effectiveness and to identify potential areas of

refinement and improvement.

• Have a variety of key scripts that allow the

team to train and perform at the highest level of


• Be implemented and followed consistently by

dentists and teams who have been properly

trained to perform their tasks.

Internal marketing must be properly carried out

on a daily basis. When this behavior occurs daily,

it will almost certainly increase patient referrals.

The main challenge is that most practices have

highly inconsistent internal marketing.

An effective patient referral program depends

on three things: superior customer service, availability

of patient financing, and effective education

and outreach.

Superior customer service

Superior customer service is defined as a customer

experience so positive that the customer

develops intense loyalty and loves to refer.

Dentists often feel that if the staff simply would

be a little nicer to the patients, this would result

in referrals and case acceptance. Unfortunately,

today’s consumers are far too busy and sophisticated

to base their decisions solely on nice

team members.

Being nice is not enough to create a loyal

patient base. In hundreds of phone calls to dental

practices, Levin Group has noted that the phone

is typically answered in a very pleasant manner

and that the front desk person will ask for all of

the proper information if the call is about a new

patient appointment. The language is typically

very functional and the main goal is to get the

patient’s appointment scheduled.

Contrast that with scripting, such as, “Mrs.

Jones, I am delighted that you called. We love

meeting new patients. Whom may we thank for

referring you Oh, Bob Smith. He is one of our

favorite patients and we enjoy having him in the

practice. I am so pleased that he referred you to

our office. … Let me take a moment to tell you a

little bit about our practice. …”

This is just one example. With powerful scripting,

practices can transform functional customer

service into an experience that is welcoming,

positive, and highly effective.

Availability of patient financing

Patient financing is only one step of an internal

marketing program, but it’s an important one.

Unfortunately, many practices utilize patient

financing from outside companies but do not use it

properly. Highly successful practices make certain

that every patient receives complete information

about all of the financial options regardless of

how long they have been in the practice or how

26 AGD Impact Online edition www.agd.org March 2011

“Highly successful practices make

certain that every patient receives

complete information about all of the

financial options regardless of how long

they have been in the practice or how

prosperous they may appear to be.”

prosperous they may appear to be. Patients who are grateful

for having flexible financial options tend to convey that

information to friends and family.

Outside patient financing companies often have materials

that can be used to communicate information about the

financing program, which makes the discussion easier for the

practice. Keep in mind that the majority of patients will be

approved for patient financing.

Effective education and outreach

Ongoing communication, education, and outreach to

patients makes a difference. Dental practices often are

“one-way streets.” Patients come in, get treatment, and leave.

Afterward, they typically do not hear anything from the

practice until the next time they are due to come in. With

e-mail, text messaging, social media, regular mail, and other

opportunities, it is easier to communicate with patients than

ever before.

The more frequently you communicate with your

patients in an educational manner, the more likely it is

that patients will convey what they have learned to others.

Levin Group recommends that you set up an annual

communications plan with your patients to educate and

motivate them to take advantage of specific treatment and

to refer others. An e-mail about implants to a 45-year-old

patient may spark a conversation with his or her parent

who may be missing teeth.

Supporting continued growth

Patient referrals are crucial for dentists wishing to grow

their practices in 2011 and beyond. The right strategies

will make growth possible. Frankly, this is a tricky time for

dentists. As we saw recently in the down economy, many

practices dropped by 10 percent or more. This led to a flurry

of patients who were more interested in going to practices

based on fee levels than the customer service they may have

experienced in their original practice.

Over time, Levin Group predicts that more patients will

begin to seek out lower cost offices. They may feel that the

present practice does not achieve a level of customer service

and marketing that creates a desire to stay. You can avoid this

fee trap simply by putting in place a strong internal marketing

program that will both impress your current patients and

increase referrals.

Levin Group’s online Resource Center, www.levingroup.com,

provides a comprehensive range of educational materials on

internal marketing, as well as a variety of topics critical to a

practice’s success, including management, financial planning,

and transitions. In addition, you can sign up to receive Levin

Group’s new publication, Dental Business Review, which

features practical information to improve your practice. You

also can connect with Levin Group on Facebook and Twitter

(@Levin_Group) for tips, news, and sharing ideas. u

Roger P. Levin, DDS, is chairman and CEO of Levin

Group, Inc., a leading dental practice management

consulting firm. He can be contacted


at customerservice@levingroup.com

or www.levingroup.com.

Read AGD Impact

and General Dentistry

on the Web!

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March 2011 www.agd.org Online edition AGD Impact 27

I House Call I

Vision Wisdom

How to Protect Your Eyesight

Many people take their vision for granted.

They never think about what might

happen if one day they suddenly could

no longer see as well as they used to. But

weakening vision is something that affects many

people, even before “old age” sets in. It’s important

to think about the ways in which you may overuse

your eyes throughout the day and understand the

risks associated with those activities.

Common culprits

There are a few things that most people do every

day that can cause severe vision damage without

even realizing it. Staring at a computer all day, not

wearing sunglasses, poor diet, and not getting your

eyes checked on a regular basis can contribute to

decreased visual capabilities.

Computer vision syndrome

The number of people who use computers daily

for a long period of time is increasing. As a

result, their eyesight is suffering. The American

Optometric Association defines computer vision

syndrome (CVS) as “a group of eye and visionrelated

problems that result from prolonged

computer use.” The symptoms of CVS include:

• eyestrain

• headaches

• blurred vision

• dry eyes

• neck and shoulder pain

The American Optometric Association says

that these symptoms can be caused by poor

lighting, a glare on the computer screen, improper

viewing distances, poor posture while sitting,

vision problems that have not been corrected, or a

combination of all of these factors.

Sometimes working at a computer for an

extended period of time is unavoidable. Try these

tips if you spend a lot of time in front of a computer.

Get a comprehensive eye exam. According

1 to the National Institute of Occupational

Safety and Health (NIOSH), people who work at

computers often should have an eye exam before

they start working on a computer and once a year

thereafter. During the exam, be sure to tell your

eye doctor how often you use a computer at work

and at home.

Use proper lighting. Eyestrain often is caused

2 by excessively bright light either from outdoor

sunlight coming in through a window or from harsh

interior lighting. When you use a computer, the

brightness of the lighting should be about half that

found in most offices. Eliminate exterior light by

closing drapes, shades, or blinds. Reduce interior

lighting by using fewer light bulbs or fluorescent

tubes, or use lower intensity bulbs and tubes. If

possible, position your monitor so that windows are

to the side of it, instead of in front or behind it.

Many computer users find their eyes feel better

if they avoid working under overhead fluorescent

lights. If possible, turn off the overhead fluorescent

lights in your office and use floor lamps that provide

indirect incandescent or halogen lighting instead.

Minimize glare. Glare on walls and finished

3 surfaces, as well as reflections on your computer

screen, also can cause computer eyestrain.

Consider installing an anti-glare screen on your

monitor and, if possible, paint bright white walls a

darker color with a matte finish.

Adjust the brightness and contrast of your

4 computer screen. Adjust the display settings

on your computer so the brightness of the screen is

about the same as your work environment.

Blink more often. Blinking is very important

5 when working at a computer because it wets

your eyes to prevent dryness and irritation. When

28 AGD Impact Online edition www.agd.org March 2011

working at a computer, people blink less frequently—about

five times less than normal, according to studies. Tears

coating the eye evaporate more rapidly during long nonblinking

phases and this can cause dry eyes. Also, the air in

many office environments is dry, which can increase how

quickly your tears evaporate, placing you at greater risk for

dry eye problems.

Take frequent breaks. To reduce your risk for computer

6 vision syndrome and neck, back, and shoulder pain, take

frequent breaks during your computer work day. According

to a study, pain and eye strain were reduced when computer

workers took “mini-breaks” throughout their work day.

Modify your work area. If you need to look back and

7 forth between a printed page and your computer screen,

this can cause eye strain. Place written pages on a stand

next to the monitor. Bad posture during computer work also

contributes to computer vision syndrome. Adjust your chair

to the correct height.

Benefits of sunglasses

Just as you wear a seat belt to protect yourself when you’re

in a car, it’s wise to protect your eyes before something

happens to them. Wearing sunglasses is one of the best

ways in which you can care for your vision. Sunglasses with

ultraviolet (UV) protection are the best to wear when you’re

in the sun. UV light causes long-term damage to the inner

structures of the eye, but wearing sunglasses can help prevent

conditions such as cataracts and macular degeneration.

A cataract is an eye condition in which the lens of the eye

becomes clouded, impairing vision. Macular degeneration is

an eye disease in which the macula, a structure within the

eye that allows you to see, gradually deteriorates, leading to

decreased vision or blindness.

Diet and nutrition

What you eat is an extremely important part of the daily

lifestyle choices you make. Foods you eat and the dietary

supplements you take affect your overall health as well

as the health of your eyes. Eat lots of colorful fruits and

vegetables for optimum eye health. A diet high in saturated

fat and sugar may increase your risk of eye disease. On

the other hand, healthy foods, such as greens and fruits,

may help prevent certain eye diseases and other health


Want More

For more information about eye health and vision,

check out these websites.

• All About Vision ® (consumer guide to vision awareness)—


• American Optometric Association—www.aoa.org

• American Academy of Ophthalmology—www.aao.org

• American Academy of Optometry—www.aaopt.org

Regular exams

Routine eye exams are important, regardless of your age or

your physical health. Eye exams are an important part of

health maintenance for everyone. Adults should have their

eyes tested to keep their prescriptions current and to check

for early signs of disease. Eye exams for children play an

important role in ensuring normal vision development and

academic achievement.

It’s important to have a regular eye exam, not just a vision

screening. Vision screenings are limited eye tests that help

identify people who are at risk for vision problems. These

are the brief vision tests performed by the school nurse, a

pediatrician, other health care providers, volunteers, or administered

at a driver’s license facility. Tests done by licensed

ophthalmologists or optometrists are the best for providing a

comprehensive picture of your overall eye health. u

If you have questions about your vision health, talk to your



CE Credits

CE Credit for

Peer-Reviewers Is

Now Available!

Peer-reviewers for the Academy of General

Dentistry’s (AGD) scientific journal, General

Dentistry, can now earn continuing education

(CE) credits for their reviews! Each review

that a peer-reviewer completes will be

approved for 3 CE credits, with a limit of

9 CE credits earned per year.

General dentist and specialist peerreviewers

are crucial in guaranteeing that

the journal continues to publish the finest

in practical, clinical dentistry.

If you are interested in reviewing

for General Dentistry,

please send an e-mail to


Please provide any areas

of specialty that you are

interested in reviewing.

March 2011 www.agd.org Online edition AGD Impact 29

I Benefits Spotlight I

Behind the Scenes

AGD Councils and Committees—Always at Work

AGD Council and Committee members are appointed by the president-elect with the approval of the

Board of Trustees (Board) in accordance with Chapter IX, Section 2.A.4. of the AGD Bylaws. Each council

and committee has a designated charge that aligns with the current organizational strategic plan.

The Governance section of the AGD website is dedicated to offering AGD members and current

council and committee members information about councils’ duties, contact information, and

meeting materials.

There are a vast number of councils that address the many areas of the AGD. They are listed here

along with an overview of their responsibilities.

Visit the Governance

section of the AGD

website for more

information about all

of the AGD councils.

Access helpful

links and contact

information there, too.

Annual Meetings Council

Plans all programs and events for the AGD annual

meetings, including all scientific sessions.

Constitution, Bylaws and Judicial Affairs Council

Studies and makes recommendations to both the

Board and the House of Delegates (HOD) on any

proposed change in the Constitution and Bylaws.

Dental Education Council

Guides, approves, initiates, researches, and

develops programs of continuing education in

accordance with policies established by the HOD.

Dental Practice Council

Advocates for the general dentist, as well as the

public, on all factors that affect the practice of

general dentistry.

Examinations Council

Responsible for construction, administration, scoring,

and security of the Fellowship examination.

Governance/Credentials and Elections Council

Responsible for collecting and recording admission

tickets for each House of Delegates (HOD)


Group Benefits Council

Identifies, evaluates, and recommends group

benefit programs to the Board that will provide

added value to AGD membership.

Legislative and Governmental Affairs Council

Studies legislation that affects the dental profession

and the public that it serves.

Marketing Council

Increases awareness of the AGD brand to dentists

(members, nonmembers) and general public

through any and all available marketing avenues.

Membership Council

Provides guidelines for accepting and retaining

members in the AGD and assists the various

constituent and component AGDs in implementing

these guidelines as necessary.

Program Approval for Continuing Education (PACE)


Administers the Program Approval for Continuing

Education, evaluating all applications for program

provider approval, and granting or denying

approval for each.

Public Relations Council

Initiates, reviews, and recommends programs and

policies that serve to raise public awareness of

dental services, proper dental health behavior, and

the general dentist as an integral member of the

healthcare team.

Publications Review Council

Assists in the management of the AGD’s printed

and electronic media, both to the profession and to

the public, and provides feedback on article topics

and editorial lineups.

Technology and Web Use Council

Addresses and oversees the presentation of items,

including the AGD website.

If any of these councils and what they do pique your interest, volunteer to get involved and help

continue the success of the AGD behind the scenes! Visit the Volunteer for Leadership section of the

AGD website to learn how you can get involved today.

30 AGD Impact Online edition www.agd.org March 2011

l Best of the Blogs l

A Peek into the Personal and Professional Lives of General Dentists





(Click for e-mail request.

Press “Send” to subscribe.)

The Scarlet Letter

By John Gammichia, DMD, FAGD

Hey all,

I want to thank you all for commenting on

Friday’s blog. I truly appreciate your support

and your translucency. I know I have said this

a billion times, but I write to make you all feel

less alone. This time, you all made me feel less


I am still not over everything that is going on

in my life so, let’s talk about this a minute.

I have been a dentist for 15-and-a-half years.

I have been paying for insurance for the entire

time. Now I am talking about malpractice

insurance and general insurance. If someone

slips on a wet spot on your floors and gets hurt,

your general office insurance will take care of

it. So why do I get all bent out of shape when

someone brings a complaint to me

Most of your comments were, “You are a

good guy, don’t worry about this a bit.” I wish it

were that easy. I know I should just say to them,

“Talk to my people.”

And I would if it weren’t for that one question

“Have you ever had a claim against you”

It is everywhere. Every time you fill out any

sort of dental application, any insurance form.

I liken it to being arrested. Let’s say you get

arrested, and then forever you have to answer

the question, “Have you ever been arrested”

Or, God forbid, you’ve been convicted of a

felony. (I haven’t, but I’ve sure done enough

stuff to know that I’ve been damn lucky.)

That stuff never leaves you. They don’t ask if

you were acquitted. They don’t want to know

anything about it. They Read just the want rest to put you in

this one “arrested” box. of the Blog

So, we are back to the question above. They

don’t ask you if the person that put a claim

Have Your


AGD Impact

wants to hear

from you!

The AGD would like

to hear what you have

to say about your

experiences with


Please send your

responses, your

name and degree,

and your city/state to


John Gammichia, DMD, FAGD, is the author of The Daily Grind and a general dentist member of the Academy

of General Dentistry (AGD). Dr. Gammichia graduated from the University of Florida College of Dentistry in

1995 and currently shares a practice with his father in Apopka, Fla., a suburb of Orlando. He received his

Fellowship in the AGD (FAGD) at the 2008 Annual Meeting & Exhibits.

March 2011 www.agd.org Online edition AGD Impact 31

I Testing the Tools I

What’s Hot and What’s Getting Hotter

By Howard S. Glazer, DDS, FAGD


Luxatemp Ultra

DMG America

242 South Dean Street

Englewood, NJ 07631



There is little doubt that bis-acryl materials

dominate the market for making provisionals. For

many years, Luxatemp has led the way in that field

as a standard to which all others were compared.

Luxatemp Ultra has just created a new benchmark.

This new bis-acryl incorporates all of the benefits

of the original Luxatemp and Luxatemp Fluorescence

by using nanotechnology to produce a very strong and

durable provisional material. With greater flexural

strength than other leading provisionals, Luxatemp Ultra

is available in six shades (A1, A2, A3, A3.5, B1, and BL) in

the usual 76 g automix cartridge, or three shades (A2, B1

and BL) in the 15 g Smartmix syringes.

Luxatemp Ultra has the same outstanding esthetics

and fluorescence as Luxatemp Fluorescence, but it

offers a harder and more durable material that handles

easier, cures faster, and provides for long-term durability.

Undoubtedly, Luxatemp Ultra will enable you to

make both long- and short-term provisionals faster and

easier than what you have been using to date. And,

with Luxatemp Ultra, you have the reliability of a

material that is stronger and longer lasting than before.

So, whether for a single unit, simple three- to four-unit

bridge, or full-mouth rehabilitation, Luxatemp Ultra will

allow you to make a provisional restoration with the best

esthetics and confidence.


Wondergloss Model Shine

Dental Creations, Ltd.

P.O. Box 21325

Waco, TX 76702



Everyone likes something shiny: a

new penny, a new car, a new smile!

Now you can make those study

models you use for case presentation

look even more presentable with

Wondergloss Model Shine. This is

an easily applied liquid—not a dip

or soap—to give a professional shine

to your models, whether plaster or

stone. Wondergloss actually forms

a less than (1) micron of thickness

(so it will not alter the accuracy of

articulated models) on the model

surface and resists chipping and

staining. This also is valuable when

using an articulator, transporting the

models, and/or in constant handling

of the models.

Available in a 32-oz. bottle, it

dries very fast and is relatively

inexpensive. Combine this with

the company’s two great products

Wonderfill and Wonderadmix and

you’ll have great models to show

your patients. An educated patient is

a better patient and a good presentation

means good demonstrations.

A shiny model can make a good

impression great!

32 AGD Impact Online edition www.agd.org March 2011



Septodont, Inc.

205 Granite Run Drive

Suite 150

Lancaster, PA 17601



Anyone who has ever practiced

dentistry has experienced that

moment when a patient’s decay was

so advanced that the dentine was

severely damaged and you were

precariously close to the pulp. At

that point it would have been great

to have a product that would allow

you to both repair the damaged

dentine and prompt a re-growth of

dentine to protect and maintain the

vitality of the pulp. Biodentine is not

another glass ionomer material.

Biodentine is a mineral

material based on a tricalcium

silicate core that requires no

dentine surface conditioning or

adhesive resin bonding.

Research shows that it

creates an excellent seal that

reduces the risk of bacterial

intervention and sensitivity.

Biodentine can be used as a bulk core

material or pulp-capping (both direct

and indirect) material, and it is safe

for pulpotomies. It can be built up

to replace enamel but should be left

in place no longer than six months.

At that time, you can reduce it to the

level of a base and place any composite

material over it in conjunction

with normal adhesive resin protocols.

This material is also indicated

for similar instances during which

you might have used MTA cement,

including root repair primary

to perforations; apexification;

internal/external resorption; and for

retrograde filling in an apicoectomy

procedure. Biodentine is radioopaque,

pre-dosed in capsules,

and triturated in any amalgator for

about 30 seconds. This innovative

and unique material takes dentine

repair to a whole new level of



G-ænial Bond

G-ænial Universal Flo

GC America, Inc.

3737 West 127th Street

Alsip, IL 60803



Golly “G,” they’ve done it again!

GC America has created two

new products to answer the

demands of today’s esthetic dentistry

needs. G-ænial Bond is an enhancement

of the company’s already

successful G-Bond. The primary difference

is that it now incorporates the

advantages of both the self-etch (SE)

and etch-and-rinse (ER) systems into

one significant product. Traditional SE

materials have a lower bond strength

on enamel and the ER systems will

often increase the risk of post-op

sensitivity. Now there is a system

that eliminates these potential disadvantages.

The 5-mL bottle provides

a material that has a 30-second total

application time, is Hema-free, and

requires no refrigeration.

G-ænial Universal Flo enters

the ever-growing marketplace for

low or “no” flow flowable resins. As

a bis-GMA-free material, G-ænial

Universal Flo has all of the benefits of

a good composite in an easy handling

flowable that stays where you place

it. Available in 15 shades, this terrific

new material is indicated for all cavity

classifications I-V, has great flexural

strength, and increased wear-resistance

due to the smallest nano-hybrid

particles in the marketplace for a

flowable. G-ænial polishes to a high

gloss and will maintain its glossy

appearance for a significant period of

time. These products are worth trying

and you will be glad you did.

Howard S. Glazer, DDS, FAGD, practices in New Jersey. For the past 20 years, he has lectured and published articles on cosmetic

dentistry, forensic dentistry, and patient management. He can be reached at impact@agd.org. Dr. Glazer has not received any

remuneration for the products mentioned. He has received products from these and other companies for evaluation purposes.

Dr. Glazer evaluates the latest in dental materials, equipment, and technology. All reviews are the opinions of the author, a practicing

general dentist, and are not shared or endorsed by AGD Impact or the Academy of General Dentistry.

March 2011 www.agd.org Online edition AGD Impact 33

The Dentist’s Role in Diagnosis and Treatment

By Elizabeth Newman

34 AGD Impact | Online www.agd.org edition | March www.agd.org 2011 March 2011

There is a rumbling sound getting louder

throughout the country. It emanates from

the bedrooms of many Americans, causing

stress and discomfort, not only for the source

producing the sound, but for all those within

earshot. That sound is snoring. At first, it may appear

to be simply an annoying habit that a lot of people

have. And, in some cases, it could be merely an annoyance.

But for many snorers—more than 18 million

Americans, according to the American Academy of

Dental Sleep Medicine (AADSM)—it can indicate the

presence of a very common, but serious, sleep disorder:

obstructive sleep apnea (OSA). Dentists already know

about OSA and its relationship to patients’ mouths, but

the way in which OSA is diagnosed and treated has

posed some challenges for dentists: The most obvious

of these is that physicians typically diagnose sleep disorders

and dentists then help to treat them. But dentists

need to understand their role in both diagnosis and

treatment of sleep disorders and how to overcome the

challenges involved, not only for their sake, but for the

health and well-being of their patients.

Identifying OSA

Who is clinically at risk for OSA According to the

AADSM website (www.aadsm.org), patients with sleep

disorders often are “obese, middle-aged men. OSA risk

increases with weight gain because excess fat in the

back of the throat can narrow the airway. Women and

men with OSA often have neck sizes of more than 16

or 17 inches, respectively.” But anyone can suffer from

OSA—even athletes and children.

The AADSM website defines OSA as “a sleep-related

breathing disorder that prevents airflow during sleep.

OSA occurs when the tissue in the back of the throat

collapses and blocks the airway. This keeps air from getting

into the lungs.” The AADSM explains that, when

there is not enough air in the lungs, the body responds

by waking up, sometimes hundreds of times per night.

Signs of OSA include loud snoring, choking or gasping

during sleep, and long pauses in breathing while sleeping.

A person with the disorder may get up frequently in

the night, sometimes due to restlessness and insomnia.

Not all OSA sufferers snore, and not all snorers have

OSA. A May 2009 article in Australian Family Physician

says, “It is estimated that more than 60% of adults occasionally

snore and more than 30% regularly snore, and

that obstructive sleep apnea occurs in approximately

10% of females and 25% of males, of whom 2 and 4%

respectively have OSA with sleepiness.”

Most times, people who have OSA aren’t aware of

these symptoms because, well, they are asleep! But

even if they aren’t aware of the symptoms, the physical

effects are certainly palpable. Watching for the

symptoms—or having their bed partner watch for

symptoms—will help people to know if they might

have OSA and need to talk to their dentist or physician

about the next steps for diagnosis.

If a patient is unaware of his or her OSA, his or

her dentist may be able to identify particular physical

symptoms. In the AGD Impact article “Breathing

Easier” (March 2009), Dennis Bailey, DDS, FAGD,

says that physical signs of OSA include bloodshot eyes,

black circles around the eyes, and puffy eyes. Dentists

also might encounter a coating on the tongue, which

can be a result of mouth breathing. “‘Redness of the

soft palate or an enlarged uvula or tongue also can be

signs of OSA,’” adds Dr. Bailey.

People with OSA often wake up with a dry mouth

or a sore throat (due to the mouth being open during

sleep). They also might feel sleepy throughout the day,

even if they “sleep” for a seemingly long period of time.

They may have tired-looking eyes as a result of the

condition. All of these are physical symptoms that dentists

may notice during a routine exam or cleaning.

The overall health effects of OSA can be quite

severe. According to the AASDM, “OSA patients are

much more likely to suffer from strokes and heart

March 2011 www.agd.org Online edition AGD Impact 35

problems, such as heart attack, congestive

heart failure, and hypertension.

They also have a higher incidence of

work- and driving-related accidents.”

In addition, the American Academy of

Sleep Medicine (AASM) cites fluctuating

oxygen levels; impaired glucose

tolerance and insulin resistance;

impaired concentration; and mood

changes as additional health problems

that result from undiagnosed and

untreated OSA (“Obstructive Sleep

Apnea,” AASM fact sheet).

The authors of the Australian

Family Physician article mention

other health effects caused

by OSA. “Increasing evidence

suggests that untreated OSA

is associated with greater cardiovascular

disease (CVD),

similar in proportion to that

seen with cigarette smoking.

Untreated OSA is associated

with a 2–4-fold increased

chance of cardiovascular

events in the community, and

clinic populations. Despite this

strong association between

OSA and CVD, the effective

size of OSA treatment on

subsequent development of

CVD is unknown.”

OSA can affect other areas of a

person’s life as well. The Australian

Family Physician article mentions the

disorder’s effects on family, noting

that “snoring is associated with greater

divorce rates.” According to the article,

patients with any of the following

snoring habits should be referred for

assessment by a sleep physician: “sufficient

to disturb partner more than

three nights per week; audible in

other rooms; occurs despite alcohol

abstinence; occurs in lateral sleep

position; or occurs greater than 10%

of the night.”

The American Sleep Apnea

Association suggests asking several

questions that might help people to

determine whether they have OSA:

• Are you a loud and/or regular snorer

• Have you ever been observed to gasp

or stop breathing during sleep

• Do you feel tired or groggy when

you wake up, or do you often have a

headache as soon as you wake up

36 AGD Impact Online edition www.agd.org March 2011

• Do you feel tired or worn out during

the day

• Do you fall asleep while sitting, reading,

watching TV, or driving

• Do you often have problems with

memory or concentration

John Bixby, DMD, FAGD, the dental

director at ComfortSleep, Center

for Diagnosis of Sleep Disorders, in

Neptune City, N.J., recommends giving

these types of questionnaires to both

patients and their bed partners, since

those people have firsthand experience

and can observe the patient while he or

she is sleeping.

Understanding OSA and helping

patients who have it could put dental

and medical professionals in a position

to save many people’s lives—not only

those who suffer from the disorder,

but those who may be on the road, in

flight, or working with them.

Other sleep questionnaires include

the Berlin Sleep Evaluation and the

Epworth Sleepiness Scale. Dr. Bailey

says that the Epworth scale “draws

an empirical correlation between the

information collected on the questionnaire

and other predictors, like the

Mallampati Score, with the potential

for detecting patients who could be

at risk for OSA’” (“Breathing Easier,”

March 2009).

There also are different levels of OSA:

mild, moderate, and severe. The AASM

indicates that those with mild OSA have

five or fewer episodes of apnea (stops in

breathing while sleeping)—or an apneahypoapnea

index (AHI) of 5; patients

with moderate OSA have an AHI index

of 15–30; and patients with severe OSA

have an AHI of greater than 30. People

who have moderate OSA, the AASM

says, experience “involuntary sleepiness

during activities that require little attention,

such as watching TV or reading”

(“Obstructive Sleep Apnea,” AASM fact

sheet). The AASM fact sheet explains

that severe OSA can affect people

when they are engaged in activities that

require a lot of attention, including talking

or driving.

The authors of the Australian Family

Physician article explain: “By definition,

excessive daytime sleepiness due

to OSA should be considered when it

occurs despite adequate sleep volume

and following exclusion of other

common causes of sleepiness such as

depression, anemia, medication side

effects, or electrolyte disturbance.

Sleepiness can be a subtle symptom

and use of the Epworth

Sleepiness Scale is a

good guide.”

Undiagnosed OSA not

only produces different

health conditions, it can

seriously affect the judgment

of people who have

it, especially when they

are driving or required

to perform tasks that

require focus and concentration.

The authors

warn that undiagnosed

OSA can result in very

dangerous, even fatal circumstances:


OSA is associated with motor vehicle

collisions, often confounded by

chronic sleep deprivation and circadian

factors. Judgment, speed and

accuracy, personality change, memory

loss, and scholastic performance also

can be affected.”

Concern about the impact of sleep

disorders has resulted in the development

and proposal of new screening

guidelines. According to a February

2010 Wall Street Journal, “Last fall, the

National Transportation Safety Board

recommended that drivers and pilots

of commercial buses, trucks, airplanes,

and ships be screened for [OSA], citing

several accidents in which undiagnosed

sleep apnea was thought to play a

role.” Understanding OSA and helping

patients who have it could put dental

and medical professionals in a position

to save many people’s lives—not only

those who suffer from the disorder,

but those who may be on the road, in

flight, or working with them.

Brock Rondeau, DDS, IBO, DABPC, a

general dentist and experienced lecturer

from London, Ontario, Canada, whose

practice is limited to the treatment of

patients with orthodontic, orthopedic,

TMJ, and snoring and OSA problems,

recently educated those in the trucking

business about OSA. “The Canadian

Trucking Alliance hired me to talk to

the truckers here in Canada,” he says.

“A lot of people are falling asleep at the

wheel and no one is checking them!

Pilots are tested, but no one is testing

the truckers. Mandatory testing is

coming, and when it arrives, we won’t

have enough dentists to treat them.”

Diagnosis diligence

According to the AASM’s “Clinical

Guideline for the Evaluation,

Management and Long-term Care

of Obstructive Sleep Apnea in

Adults” (Journal of Clinical Sleep

Medicine, March 2009), “OSA should

be approached as a chronic disease

requiring long-term, multidisciplinary

management. There are medical,

behavioral, and surgical options for

the treatment of OSA.” It is very

important, however, for dentists to

understand that they cannot legally

diagnose a patient with a sleep disorder—even

if they are very certain that

the patient has OSA. According to Dr.

Bixby, “OSA can be diagnosed only by

a physician. However, we as dentists

must be screening our patients for it.”

He stresses the importance of dentists

assessing a patient’s airway and looking

for signs of OSA. “There are about

35,000 cases of oral cancer found by

dentists each year,” he says. “Compare

this to the fact that there are about

20 million undiagnosed patients with

OSA. Who better is there to help them

than their dentists who see them—and

their airways—so often” Dentists play

an integral role in the initial identification

and the continued treatment of

OSA, and therefore must work closely

with the patient’s physician to ensure

that the patient is receiving treatment.

So what should dentists do if they

suspect that a patient has OSA Dr.

Bixby says, “It’s very simple: Just look

for symptoms during the oral exam,

ask the right questions, and then, if

you suspect that the patient has OSA,

refer him or her to a physician for a

sleep study.”

Sleep studies at a sleep center

In order for patients to receive a

proper diagnosis, they must undergo

a sleep study. “For patients who are

suspected of having a sleep disorder,

it is recommended that they have a

complete overnight sleep test to get a

baseline,” says Dr. Bixby. “This is the

best way to diagnose OSA. You should

never attempt to treat a patient—even

for snoring—without a sleep test.”

Dr. Rondeau echoes that advice.

“The only way to tell for sure is with

a sleep study,” he says. “You cannot

confirm OSA any other way—you have

to have the sleep study.”

Home-monitored sleep studies

Home-monitored sleep studies are

another option, but Dr. Bixby points out

that home sleep studies don’t always

give the most comprehensive results.

March 2011 www.agd.org Online edition AGD Impact 37

“You get so much more data with an

in-lab test,” he says. “Some health care

professionals push the home monitors,

but those devices monitor only four or

five things going on in the body, while

the sleep-center study monitors about

eighteen! Also, with an in-lab test,

there’s always someone monitoring

what’s going on who can stop the test

to make adjustments if needed.”

Another problem with home monitors

is that sometimes patients aren’t

sure how to use them, which could

result in incorrect or misleading results.

The authors of the Australian Family

Physician article found that unattended,

in-home polysomnography tests require

“the patient setting themselves up with

the aid of detailed instructions … Test

failure rates are modestly high, thus

requiring repeat testing.”

There is a wide variety of home

sleep monitors for dentists and patients

to try, but again, these devices might

not produce the same accuracy as the

results from a technician-monitored

study at a sleep center, says Dr. Bixby.

He adds, “I’ve seen some dentists take

the results of a home study, send it offsite

to a sleep physician who looks at

the data and says, ‘Yes, this person has

OSA,’ use that as a diagnosis, and then

give the patient treatment. They are

trying to get around having the patient

go in for a sleep study. A sleep study is

just better medicine.”

Establishing a relationship

The most important part of the diagnosis

is getting accurate results so that the

physician and the dentist can determine

the best treatment plan for the patient.

Because dentists can refer a patient to

a sleep physician for a sleep study and

diagnosis, they must understand the

importance of forming a relationship

with a sleep center. “It is extremely

important that the dentist become

very comfortable communicating with

the sleep center during this period of

diagnosis and treatment, especially

if the dentist is performing the oral

appliance therapy,” advises Dr. Bixby.

“Communication is key.”

Jonathan Fashbaugh, president of

Concerto Internet Marketing LLC, a

Colorado-based Internet marketing

firm that helps dentists advertise their

OSA services accurately and efficiently

online, agrees. “Talking to my clients,

I would say that establishing a good

referral relationship with a sleep physician

and/or sleep center is critical,” he

says. “It’s also the most challenging

part of building a practice in which

OSA is a focus.”

Dr. Rondeau advises general dentists

and their team members to develop a

very strong relationship with a sleep

center. “Dentists must establish a relationship

with the sleep physician, too.

That’s key—you have to do that.”

While some dentists may be new to

the sleep medicine world, Dr. Rondeau

acknowledges that it takes time to

truly bond with a sleep physician. “It

does take a while to form that relationship,

but once you have it, it’s very

helpful. I’ve been doing this for a long

time and I have a great relationship

with my sleep physician. We help each

other: I refer patients to him and he

refers patients to me.”

The multidisciplinary, tag-team

approach to OSA can be fun, too, says

Dr. Rondeau. “Physicians have the

advantage of working with other physicians

all of the time, whether it’s in

hospitals or other places. On the other

hand, dentists often work alone in an

office by themselves. Maybe they’re

in group practice, maybe not, but they

don’t really converse with a lot of

physicians. Treating OSA gives them

the opportunity to get into the medical

world and actually talk to medical

professionals, which is kind of a neat

thing to do.”

Treatment preferences

Once the dentist and physician have

established that a patient does, in fact,

have OSA, there are three treatment

38 AGD Impact Online edition www.agd.org March 2011

options: an oral appliance, a continuous

positive airway pressure (CPAP)

machine, or surgery. The authors of

the AASM guideline explain that surgery

was the original treatment for

OSA when it was first diagnosed years

ago. The surgery “includes a variety

of upper airway reconstructive or

bypass procedures.”

However, most patients today do not

undergo surgery for OSA.

The February 2010 Wall

Street Journal article found

that “Today, 60% to 70%

of patients are treated with

CPAP, in which the breathing

mask, connected by

tube to an air pump, sends

pressurized air through the

patient’s nose. The air flow

keeps the upper airway and

prevents apneas.” The AASDM adds,

“CPAP uses pressurized air generated

from a bedside machine. The air

moves through a tube, connected to

a mask that covers your nose, mouth,

or nose and mouth. The force of the

pressurized air keeps the airway open.

CPAP opens the airway like air into

a balloon; when air is blown into the

balloon, it expands.”

The AASM guideline explains that

“positive airway pressure (PAP) is the

treatment of choice for mild, moderate,

and severe OSA and should be offered

as an option to all patients. Alternative

therapies may be offered depending

on the severity of the OSA, and the

patient’s anatomy, risk factors, and preferences

should be discussed in detail.”

The Wall Street Journal article notes

that comfort and appearance may cause

some patients to react adversely to the

CPAP. “Many patients complain that the

CPAP mask and the air pressure make

them feel claustrophobic. Others balk at

sleeping with a mask and tubes on.”

One of the alternatives to CPAP is

an oral appliance. An article in the

February 2006 issue of Sleep says,

“Oral appliances (OA) are indicated for

use in patients with mild to moderate

OSA who prefer them to continuous

positive airway pressure (CPAP) therapy,

or who do not respond to, are not

appropriate candidates for, or who fail

treatment attempts with CPAP.”

Additional studies support the efficacy

of oral appliances. The August

2007 issue of Chest notes, “Oral appliances

are often considered by patients

to be a more acceptable treatment

modality compared to CPAP, as they are

quiet, portable, and do not require a

power source. There is now an increasing

evidence base to support the use of

oral appliances in clinical practice.”

Not only are dentists who treat OSA

patients helping the patient, they are

changing their lives—and their family

members’ lives.

When it comes to oral appliances,

the possibilities are endless. According

to Dr. Bixby, mandibular advancement,

or moving the jaw forward, is the basis

of all oral appliance therapy. “As you

bring the lower jaw forward and hold

it there through the night, you decrease

the severity of OSA,” he explains.

“There are plenty of appliances out

there—more than there are letters in

the alphabet!” says Dr. Bixby. “You just

need to find one that you like working

with—they all work on the basic

principle of mandibular advancement,

with some offering add-ons.”

Dr. Rondeau says that patients

often don’t know they have options.

“Sometimes the sleep clinic will give

the patient a CPAP machine no matter

what. There are alternatives like oral

appliances, but a lot of times patients

don’t even know about them.”

Oral appliance challenges

If oral appliance therapy is recommended,

dentists need to know what to

do. Patients should undergo a thorough

dental examination to assess their candidacy

for an OA. In addition, because

the appliance adheres to the teeth, the

AASM guideline recommends that

“candidates for a [mandibular repositioning

appliance (MRA)] require

adequate healthy teeth upon which to

seat the oral appliance, no important

TMJ disorder, adequate jaw range of

motion, and adequate manual dexterity

and motivation to insert and remove

the OA, as determined by a qualified

dental professional.”

There are drawbacks to the use of

oral appliances, though. A literature

review published in the February 2009

issue of Sleep explains that oral appliances

can cause certain symptoms for

patients, including “long-term dental

and skeletal changes.” The

authors also say that some

oral appliances extend

beyond the dental arches,

which applies pressure to the

gums and the oral mucosa.

In addition, the authors

found that some immediate

minor side effects do occur.

“Commonly reported minor

and temporary side effects

included TMJ pain, myofascial pain,

tooth pain, salivation, TM joint sounds,

dry mouth, gum irritation, and morning-after

occlusal changes.” While some

consider these to be minor side effects,

patients may not tolerate them well.

The Snoring and Sleep Apnea Dental

Treatment Center reports on its website

that “jaw muscle and joint pain occur

in approximately 10% of the patients.

The pain will disappear when the

patient discontinues use of the appliance.

However, the pain can recur for

these patients when they start wearing

the appliance again.”

In addition, oral appliances can

change a person’s bite, which may

be uncomfortable and result in difficulty

chewing. “Changes in the bite

can occur for about 30 to 40% of the

patients. Although the changes may

be slight, it may still be difficult for

the patient to close their back teeth

together, which may have an effect

on their ability to chew effectively,”

according to the Snoring and Sleep

Apnea Dental Treatment Center. The

CPAP is another option for those

patients whose experiences with oral

appliances are not positive.

Future advancements

As mentioned earlier, there are a great

number of oral appliance options on

the market these days, and Dr. Bixby

says that dentists will have even more

March 2011 www.agd.org Online edition AGD Impact 39

options in the future. He says that

one device currently going through

FDA approval is an oral appliance

which includes a computer chip that

measures temperature when the

patient is wearing the device. These

temperature readings are recorded

and sent to a database to show how

compliant patients are in using the oral

appliance. This may be very helpful

for employers, especially those who

are in high-risk professions, such as

trucking or aviation. If an employer

is concerned about an employee who

has OSA operating a vehicle or heavy

machinery, the employer can monitor

how often the employee is using

the oral appliance. This is a major

breakthrough, Dr. Bixby says, because

“insurance companies and employers

don’t want the risk of accidents.”

Coding challenges

While the future of OSA treatment is

exciting, dentists still find some challenges

in coding and billing insurance

companies. Rose Nierman, owner of

Nierman Practice Management in

Tequesta, Fla., has developed a way

to make things easier. “I was a dental

hygienist in a very busy TMD practice

in the early 1980s, and we had to figure

out how to bill in order for medical

insurance to cover TMJ treatment. The

next evolution was the OSA program,

because that gets billed to medical,

too. About 10 years ago, we came

out with the Dental Sleep Medicine

DentalWriter software.”

The software is designed to make

things easier for dental practices that

specialize in treating OSA. “The software

actually prepares the practice to

treat OSA,” she says. “A general practice

isn’t used to all of the documents—the

reports to send to other doctors and

the sleep labs, and the medical billing.”

The software synchronizes with the

patient’s history and the results of the

sleep study. “By entering the findings,

either online or in the software, SOAP

[subjective, objective, assessment, and

plan] reports are generated that allow

dentists to work directly with physicians,”

Nierman says.

Although Medicaid does not cover

OSA treatments, it does cover CPAP

machines, and oral appliances were

added in November 2010 to the list

of equipment that, effective January

2011, Medicare will cover. “We’re

helping doctors get set up to bill for

oral appliances,” says Nierman. “They

need to submit a special application—it

isn’t Medicare Part B; they’re actually

offering the service as a durable medical

equipment supplier.”

Nierman believes that the 2010 decision

that established only one code for

all oral appliances makes it much easier

for dentists to bill Medicare for OSA

treatment. Dentists must be sure that

they are using an FDA-approved appliance,

but that is the only significant

restriction. Medicare also requires 90

days of follow-up care before dentists

can submit another code, Nierman says.

“Private care usually uses the same type

of guidelines, and they pay a little more.

There are follow-up care codes, too.”

Nierman advises dentists to document

everything. “You want to be

sure that you’re using the right code,

that you’re billing exactly how you’re

supposed to, and that you have the documentation

in place to show what you

did and why it’s a medical necessity

instead of a dental condition,” she says.

According to Nierman, as more

people are diagnosed with OSA, the

public is becoming more aware of

the condition—and insurance companies

are noticing, too. “I would say

that insurance companies have really

stepped up to the plate in the last

six to 12 months,” she says. “And the

Medicare decision added legitimacy

to OSA treatment—it’s become a little

more mainstream now.”

Transforming lives

The best way to find that information

is to learn—a lot. “Dental professionals

must educate themselves and then educate

their patients,” says Dr. Rondeau.

“I recommend that dentists take a

course and involve staff members.”

That way, he says, everyone on the

team knows exactly what to tell

patients when they have questions.

Once dentists have the education and

are confident in their abilities, sleep

centers will respond and want to work

with the dentist.

Not only are dentists who treat

OSA patients helping the patient, they

are changing their lives—and their

family members’ lives. “I have people

thanking me, hugging me for saving

their marriage, for increasing their husband’s

energy level,” says Dr. Rondeau.

“It affects everything. Patients have

memory loss, they become depressed—

all kinds of things happen when people

are so tired.”

Many dentists who see the rewards

of treating patients with OSA shift their

practices to focus on it. “The dentists

with whom I work enjoy doing OSA

treatment because it’s easy, it has a

high rate of return, and best of all, it’s

rewarding,” says Fashbaugh. “Similar

to TMJ treatment, they are transforming

lives. OSA patients who are finally

getting truly restful sleep can’t believe

the change in the way they feel, and

the reality is that they are living longer

because of their dentist.”

Dr. Rondeau likes the challenge

of working with OSA patients. He

explains, “It’s fun. Now I have to think.

I have to figure out where the obstruction

is, if there is an obstruction, how

do I motivate this patient, how do I talk

him or her into a sleep study, how do I

convince him or her to go It’s a mental

challenge. But I feel a lot more satisfaction

because I’m helping patients.”

Treating patients for OSA improves

their overall health, says Dr. Rondeau.

“I really feel like we’re helping people

now. I think the future of dentistry is

as a health-centered practice. You fix a

patient’s teeth, you fix their gums—that’s

great. But what about their entire body

Successfully diagnosing and treating

OSA reduces high blood pressure, diabetes,

heart attack, acid reflux—and more.”

If the mouth really does act as the

window to the rest of the body, then

Dr. Rondeau and others who treat

OSA feel that they are changing lives.

“The bottom line is that you want to

feel good about your job,” says Dr.

Rondeau. “You can do this by helping

your patients feel better.” u

Elizabeth Newman is a Chicagobased

freelance health care and

trade association writer and editor.


40 AGD Impact Online edition www.agd.org March 2011

AGD 2011 San DieGO!

Annual Meeting & Exhibits

Silent Auction Donations

Needed for 2011!

The AGD Foundation is in need

of donations for this year’s

Silent Auction Fundraiser,

which will be held in San

Diego, Calif., during the AGD’s

59th Annual Meeting &

Exhibits, July 28 to 31, 2011.

AGD Annual Meeting & Exhibits

AGD Foundation Silent Auction

Fundraiser Donations Form

San Diego, July 28 to 31, 2011

Individual/AGD constituent/company name

Contact name

Street address


ZIP code

Phone Fax E-mail


Silent Auction Donations

Needed for 2011!

The Academy of General Dentistry (AGD) Foundation

is in need of donations for this year’s Silent

Auction Fundraiser, which will be held in San

Diego, Calif., during the AGD Annual Meeting &

Exhibits, July 28 to 31, 2011.

Proceeds from the auction will fund AGD

Foundation programs that make dental care

available to underserved populations, children,

the elderly, and those with physical and

intellectual disabilities. The AGD Foundation

needs continuing education courses, new dental

equipment and instruments, passes to behindthe-scenes

tours, vacation getaway packages,

sports souvenirs, autographed memorabilia,

event tickets, cash, and more! Donations are

needed by May 1, 2011.

For more information about donating to the

AGD Foundation Silent Auction Fundraiser, please

contact Marilyn Mays, manager, AGD Foundation,

at 888.AGD.DENT (888.243.3368), ext. 4329, or


Donations will be acknowledged on the

AGD Foundation Web page, at the AGD Annual

Meeting & Exhibits on-site auction, and in postmeeting


Website address, if applicable (Website address will be included with your item description.)

Dollar value of item(s):

Description of item(s) (Please be as detailed as possible and

include applicable expiration dates or restrictions.):

1. $___________________ __________________________________________________


2. $___________________ __________________________________________________


3. $___________________ __________________________________________________


4. $___________________ __________________________________________________


For best exposure and to raise as much money as possible, please include a product brochure or more information

when available. While all contributions are appreciated, items that are easily shipped will bring more return for

your donation.

Thank you.

To make a donation, complete this form and mail or fax it to:

Marilyn Mays

Manager, AGD Foundation

211 E. Chicago Ave., Ste. 900

Chicago, IL 60611

Fax: 312.335.3426

The AGD Foundation is a 501(c)(3) charity; gifts to the AGD Foundation are fully deductible for United States

federal income tax purposes, subject to the limitations placed on charitable gifts by the Internal Revenue Service.

Be sure to check with your tax professional or attorney for specific, allowable deductions in your state.

March 2011 www.agd.org Online edition AGD Impact 41

I Fact Sheet Gingivitis vs. Gum Disease I

Stop It Before It Starts

Many people have some form of gum

disease, but they don’t realize it because

the symptoms usually are painless at first.

Gingivitis and gum disease are two terms

that patients need to know, including their

symptoms, how they affect oral health,

and ways in which to prevent them.

What is gingivitis

Gingivitis is inflammation of the gums.

When your gums are healthy, they appear

pink and firm, and they form a sharp point

where they meet the tooth. The bacteria

that cause cavities and gum disease are

always present in the mouth. When too

much food and bacteria build up in the

spaces between the teeth and the gums,

plaque forms. Over time, the plaque can

harden into tartar and irritate the gums.

Toxins in plaque may cause the gums to

become infected, red (instead of a healthy

pink color), to bleed easily, and to be occasionally

tender. Gingivitis is a mild form of

gum disease and is reversible with proper

home care and professional dental care.

What is gum disease

When gingivitis is not treated with brushing,

flossing, and regular dental cleanings,

it can evolve into a condition called

periodontitis. If you have periodontitis,

your gums pull away from your teeth and

form pockets that are infected with a

variety of different bacteria. Your immune

system tries hard to fight the bacteria as

the plaque spreads and grows below the

gum line, but this is not always a good

thing. Bacterial toxins and your body’s

natural response to fight the infection

start to break down the bone and connective

tissue that hold teeth in place.

If left untreated, the bones, gums, and

fibers that support the teeth can be

destroyed. Your teeth will eventually become

loose and may need to be removed.

How does gum disease develop

There are many risk factors associated

with gum disease. They include:

• Smoking, one of the most significant

risk factors associated with gum disease.

• Hormonal changes in girls/women,

which can make gums more sensitive

and make it easier for gingivitis to


• Diabetes, which puts people at a

higher risk for developing infections,

including gum disease.

• Prescription and over-the-counter

medications, which sometimes can

reduce the flow of saliva, which has a

protective effect on the mouth.

• Diseases, such as cancer or AIDS, and

their treatments can sometimes have

negative effects on the health of a

person’s gums.

• Genetics, which can cause some

people to be more prone to severe gum

disease than others.

What can I do to prevent

gum disease

There are several things you can do to

prevent both gingivitis and gum disease:

• Brush your teeth twice a day (with

fluoride toothpaste).

• Floss your teeth every day.

• Visit the dentist routinely for a

check-up and professional cleaning.

• Don’t smoke—and if you do smoke,


• Make sure your diabetes is wellcontrolled.

• Know the side effects of the

medications you are taking.

What are the symptoms of

gum disease

Symptoms include bad breath that won’t

go away even after chewing gum or eating

mints; red or swollen gums; tender

or bleeding gums; painful chewing; loose

teeth; sensitive teeth; or receding gums

or teeth that appear longer than others.

What is the treatment for

gingivitis and gum disease

Dentists treat gingivitis by cleaning

teeth to remove plaque and tartar.

Scaling (cleaning) of the tooth and

root surface may be necessary. Your

dentist also may prescribe special

mouthwashes or medicines. For gum

disease, dentists usually have to use

treatments like antibiotics, antimicrobials,

deep scaling and root planing (cleaning

and smoothing) of the root surface,

or removing the infected gum tissue

or teeth. Your dentist will talk to you

about all of the treatment options

available if you have gingivitis or gum

disease. Your dentist also may refer

you to a gum specialist (periodontist) if

necessary. Always ask questions if you

are concerned about your oral health.


Brought to you by the AGD, this website answers important dental health questions,

offers the latest information on current treatments, provides tips for first-rate oral

hygiene, and can help visitors find highly qualified general dentists near where they live.

Access More

Fact Sheets

Published with permission by the Academy of General Dentistry.

© Copyright 2010 by the Academy of General Dentistry. All rights reserved.

I Classifieds I

Position Available

Florida, Ocala—Associate dentist wanted for Ocala,

Fla. FFS, doctor-owned, established practice. F/T with

benefits; in-house lab. Call Natalie at 352.873.2000.

Indiana, northeast—Associate dentist wanted for

newly opened general practice in northeast Indiana,

equipped with the latest technology. Associate will

provide support for two offices, with opportunity

for ownership. Staff is experienced, professional,

and motivated. Opportunity may be part-time

or possible full-time. Please call 260.434.1133

for more information.

Missouri, Moberly—Associateship/Partnership

opportunity for skilled dentist. Fully digital, paperless

office in medium-sized Midwest community, seeking

general dentist for associate with transition to partner.

Contact office at our SmileDental.us website.

New Hampshire, Concord—Large, busy general/

pediatric dental practice seeks a motivated professional

for a full-time associate to replace retiring

dentist, leading to possible buy-in. Team active with

Christian medical/dental short-term missions. Contact


New Hampshire, Hanover—Partnership opportunity

available in beautiful Hanover, N.H. Senior partner

of a two-dentist practice is looking to transition out.

The practice is a low-volume, fee-for-service practice

that does not participate in any managed care plans.

Hanover is an idyllic New England college town

located on the New Hampshire-Vermont border.

Home to Dartmouth College and the Dartmouth

Hitchcock Medical Center. Hanover is a wonderful

environment in which to live, raise a family, and care

for patients who value health and appreciate quality

dental services. Experience preferred. For further

information, please contact us at 888.888.6506 or


Wisconsin, eastern Wisconsin—Being a dentist

just got better … two new locations coming Spring

2011! Dental Associates of Wisconsin is a progressive

growing practice, serving the dental needs of

eastern Wisconsin for more than 30 years. Our

multi-specialty dental centers provide complete

family dentistry, serving all specialty areas. Freedom

from administrative hassles … you’ll enjoy providing

dentistry in the latest, state-of-the-art environment.

Opportunity, lifestyle, and quality dental care all come

together at Dental Associates. You will find the ideal

friendly practice environment to enrich your career

and provide you with quality of life. It is a place to

grow, and a place to stay! Competitive compensation,

excellent benefits package, and no personal financial

investment make this opportunity a MUST-SEE!

Come grow with us—become part of this

family and join the other dentists practicing with

us today. Simply call, click, or send your résumé

CV in confidence to: Dental Associates, Ltd., Attn:

Susan Bullen, 11711 W. Burleigh St., Wauwatosa,

WI 53222; 800.315.7007 or 414.778.5205; e-mail:

sbullen@dentalassociates.com; or fax to


Practice for Sale

Arkansas, Fort Smith—Dental office space available

for lease with option to buy. 1,850-sq.-ft. with up

to six operatories. For details, call 479.452.4393 or

e-mail jerrycclemons@cox.net.

California, San Francisco Bay Area (East Bay)—

General practice for sale near Berkeley, Calif. Twentyyear-old

practice with average gross of $300,000.

Three operatories; plumbed for four. Growth potential.

Currently a 32-hour work week. Asking $190,000. Call


North Carolina, Pinehurst—General dental practice

for sale. Appraised for $293,000. Brokers welcome

for nonexclusive listing. Will consider some owner

financing. Will work during transition or walk away.

Call 910.295.0772.

(In previous issues of AGD Impact, this practice was

incorrectly listed as appraised for $239,000. AGD

Impact regrets this error.)

Advertisers Index

If you would like more information about

the companies that advertised in this issue

of AGD Impact, please contact:


Academy for Academic Leadership



Dental Savings Club



GC America



Oral Cancer Foundation






Policies: Classified ads in AGD Impact are confined to practice sales, practice opportunities for dentists and auxiliaries, and the personal sale

of used equipment and other dental products. All ads must be submitted typewritten by fax or e-mail; it is recommended that you notify us in

advance of your classified submission. AGD Impact reserves the right to decline, withdraw, or edit ads at its discretion.

Rates and Payment Information: Classified advertising rates are $60 minimum for up to 30 words and $2 for each additional

word. We accept checks and credit cards for payment. Please contact us to arrange payment. Contact: Cassandra Bannon,

phone: 888.AGD.DENT (888.243.3368), ext. 4353; fax: 312.335.3427; e-mail: impact@agd.org.

March 2011 www.agd.org Online edition AGD Impact 43

44 AGD Impact Online edition www.agd.org March 2011

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