and infection”. 9 However, paying careful attention to detailsabout emotional and socioeconomic barriers and <strong>the</strong>ir effectson <strong>the</strong> lives <strong>of</strong> children and caretakers need to be considered.Signs and Symptoms <strong>of</strong> Abuse 6,7,8,9Physical abuseProminent areas <strong>of</strong> s<strong>of</strong>t tissue:Cheeks <strong>of</strong> <strong>the</strong> headFaceNeckBilateral injuriesLacerationsBruising to scalpBite marksCigarette burnsLacerations and bruises <strong>of</strong>:CheeksNose lipsNecksEarsTorn labial frenumOral mucosal burns with sloughing<strong>of</strong> tissueOral – hard tissue prominenceFractures <strong>of</strong> maxilla and mandibleMissing teethSexual Abuse*Palatal petechiae for forced fellatioSexually transmitted infections*Definitive diagnosis <strong>of</strong> <strong>the</strong>se conditions requireappropriate laboratory tests for confirmationEmotional AbuseLags in physical developmentLags in development <strong>of</strong> speechRocking motionsFacial ticsOdd reactions to persons in authorityWhile physical abuse tends to beepisodic, neglect tends to be chronic.– LA Children’s Trust FundCall to ActionToday, four children will die as a result <strong>of</strong> child abusein <strong>the</strong> United States as reported by Safe Horizon, a nationalcoalition <strong>of</strong> child advocates. This organization urges everyoneto help protect children and save lives. 10Traditionally, dental health pr<strong>of</strong>essionals have shown a lowreporting rate <strong>of</strong> child abuse and neglect. It is imperative thatdentists become more aware <strong>of</strong> <strong>the</strong>ir moral, legal and ethicalresponsibilities in recognizing and reporting cases <strong>of</strong> childabuse and neglect. 11Several initiatives have helped dentistry deal with childabuse and neglect. The most notable is <strong>the</strong> Prevent Abuseand Neglect through <strong>Dental</strong> Awareness Coalition (PANDA).PANDA was established to assist dental pr<strong>of</strong>essionals withmaking critical judgment calls on abuse and neglect cases. Thiscoalition also makes an effort to ease <strong>the</strong> uncertainty <strong>of</strong> making<strong>the</strong>se judgment calls that appear so subjective and complicatedby <strong>the</strong> doctor- patient relationship and family dynamics. 12Along with using resources like PANDA, dentists canbest help protect children from maltreatment through anunderstanding <strong>of</strong> <strong>the</strong> child protective services process.Contact <strong>the</strong> Office <strong>of</strong> Community Services to determine yourarea-reporting site. Arrange continuing education courses inyour district to improve your knowledge and understanding<strong>of</strong> <strong>the</strong> reporting process. Specifically in <strong>Louisiana</strong>, PreventChild Abuse <strong>Louisiana</strong> (www.pcal.org) has been one <strong>of</strong> <strong>the</strong>leading advocacy groups that provides crisis intervention,parent training, community information and advocacy, aswell as training to mandated reporters. Identify <strong>the</strong> childadvocates in your community. It may also be helpful towork with <strong>the</strong> child’s pediatrician when cases are suspected.Be proactive in observing children in your practice and helping toreduce <strong>the</strong> incidence <strong>of</strong> child abuse and neglect in <strong>Louisiana</strong>.AcknowledgementSpecial thanks to Rishu Garg, MPH for data collection andresearch assistance.References1. <strong>Louisiana</strong> Court Appointed Special Advocates, www.louisianacasa.org2. Child Welfare Information Gateway. Fact Sheet: Child abuse and neglectfatalities: Statistics and Interventions. June 2006.3. Keeping Children and Families Safe Act <strong>of</strong> 2003 (P.L. 108-36)4. LA Children’s code,[Art. 603(13)].5. LA Children’s code, revised statutes 14: Title VI: 601-713.6. Brannon, RB, Stro<strong>the</strong>r, EA. Child Abuse and Neglect: The Responsibility <strong>of</strong><strong>the</strong> <strong>Dental</strong> Community. LDA <strong>Journal</strong> Fall 2005, 64: 6-15.7. Mouden, LD. The Hygienist’s Role in Recognizing and Reporting Child Abuseand Neglect. Practical Hygiene 1996;5(2):25-28.8. Kellog, N and Committee on Child Abuse and Neglect. The Evaluation <strong>of</strong>Sexual Abuse in Children. Pediatrics 2005;116: 506-512.9. Kellog, N and Committee on Child Abuse and Neglect. Oral and <strong>Dental</strong>Aspects <strong>of</strong> Child Abuse and Neglect. Pediatrics 2005; 116:1565-2315.10. Safe Horizon. www.safehorizon.org11. Mouden, LD, Bross, DC. Legal Issues Affecting Dentistry’s Role inPreventing Child Abuse and Neglect. J Am Dent Assoc 1995;126:173-179.12. Mouden LD. How Dentistry Succeeds in Preventing Family Violence.<strong>Journal</strong> <strong>of</strong> <strong>the</strong> Michigan <strong>Dental</strong> <strong>Association</strong> September 1996:44-48.32 LDA <strong>Journal</strong>
LDAwealth managementChad Olivier, CFP ®Wealth Consultant/LPL Branch Manager, The Olivier Group, L.L.C.Where and when should you start your financialplanning efforts? At different stages <strong>of</strong> your life –planning is essential. Financially, your life can be brokendown into four basic stages: The Early Starter, The PrimeTimer, The Pre-retiree, and The Retiree. Let’s look at <strong>the</strong> firsttwo stages <strong>of</strong> your planning and in <strong>the</strong> next issue we willcover <strong>the</strong> last two stages.Stage 1: The Early StarterThe Early Starters have graduated from <strong>Dental</strong> Schooland <strong>the</strong>ir adult lives have truly begun. This is <strong>the</strong> stage forstarting: start a budget, start tackling debts, start saving, andstart a retirement plan. The first step for an Early Starterbegins with getting a handle on a budget. How much moneywill be coming in after taxes, and how much will be goingout with monthly expenses? Then tackle <strong>the</strong> issue <strong>of</strong> debt.The Early Starters need to ensure that <strong>the</strong>y are truly getting<strong>the</strong> lowest rate on any student loans, car loans, and possiblymortgages. If <strong>the</strong>y have any credit card debt – <strong>the</strong>y need toget <strong>the</strong> lowest possible rate and <strong>the</strong>n try to pay it <strong>of</strong>f. Thenext crucial step for <strong>the</strong> Early Starter is building a personalsavings plan, trying to put away in savings three months <strong>of</strong>expenses. Then begin a retirement savings plan – ei<strong>the</strong>r a401(k) plan or, if no plan is available, <strong>the</strong>n an IndividualRetirement Account. If <strong>the</strong> Early Starter is already marriedand plans to have kids, this would be <strong>the</strong> time to beginlooking at a 30 year fixed term life insurance policy.Stage 2: The Prime TimerAbout five years after dental school, <strong>the</strong> typical dentist isentering what I like to call <strong>the</strong>ir “prime time” financially. ThePrime Timer should have <strong>the</strong> three to six months <strong>of</strong> expensesin savings and be ready to build financial security and networth. During this stage is <strong>the</strong> prime time to look at four mainfinancial areas:Retirement: The dental practice should have a 401(k)/pr<strong>of</strong>it sharing plan that allows a salary deferral <strong>of</strong> up to$15,500 for 2008 and <strong>the</strong> employer to put up to ano<strong>the</strong>r$30,000 in <strong>the</strong> plan for <strong>the</strong> employer contribution and pr<strong>of</strong>itsharing side. If this plan is not available, it is time to find outwhy. Keep in mind that a $45,500 contribution per year at a7% return for 20 years yields $2,171,936.Insurance: It is a good idea to look into disabilityinsurance; <strong>the</strong> coverage should cover current monthly expensesThe Stages <strong>of</strong> Financial Planning: Part Oneand be titled as an own occupation policy. A Prime Timer’shealth insurance policy will probably have a high deductible,which will cut down monthly premiums and enable <strong>the</strong>m totake advantage <strong>of</strong> <strong>the</strong> Health Savings Account (HSA). The HSAshould be funded every year up to <strong>the</strong> deductible; <strong>the</strong> fundedamount can be deducted from gross income and <strong>the</strong> HSA couldbe used for medical expenses tax free. I also suggest havingan umbrella policy for at least $1 million and considering <strong>the</strong>addition <strong>of</strong> more life insurance to cover current family lifestyle,college expenses, and any future expenses.Educational Planning: Now is <strong>the</strong> time to establisha 529 plan for any kids’ college education expense. The529 plan allows you to stay in control <strong>of</strong> <strong>the</strong> assets, growstax deferred, and is taken out tax free if used for qualifiededucational expenses.Wills/Trusts: Having a will in place that puts your assetsin a trust for your kids, will ensure <strong>the</strong> security <strong>of</strong> your assetsin <strong>the</strong> event you and your spouse should die simultaneously.The will should specify who will become guardian <strong>of</strong> <strong>the</strong>kids and <strong>the</strong> trust assets. Please note that it is always bestto have some type <strong>of</strong> checks and balances in place with <strong>the</strong>trust assets. For example, if your sister is <strong>the</strong> guardian <strong>of</strong> <strong>the</strong>kids, state in <strong>the</strong> trust documents that <strong>the</strong> assets must havea CERTIFIED FINANCIAL PLANNER practitioner alongwith an investment policy statement to help invest <strong>the</strong> assets.Maybe even indicate in <strong>the</strong> trust documents that reasonableliving expenses and education expenses can come out <strong>of</strong> <strong>the</strong>trust, but anything above that needs to be approved by yourspouse’s trusted relative.After <strong>the</strong>se two stages, you will have built up savings,fully funded your retirement each year, and established yourinsurance safety nets, as well as laying <strong>the</strong> foundations foryour estate and future wishes. Now it’s time to enter <strong>the</strong> lasttwo stages.Chad Olivier is author <strong>of</strong> “What Medical School Did Not Teach You about Financial Planning”and owner <strong>of</strong> <strong>the</strong> firm The Olivier Group, LLC in Baton Rouge, La., which specializes in retirementplanning and wealth management for physicians, dentists and o<strong>the</strong>r affluent individuals andfamilies. If you have any questions about this article or future topic suggestions, please call (888)465-2112 or visit us on <strong>the</strong> web at www.oliviergroup.com. Securities and Financial Planning are<strong>of</strong>fered through LPL Financial Member FINRA/SIPC. Please note that <strong>the</strong> above article is forinformational purposes only, nor is The Olivier Group specifically endorsed by <strong>the</strong> LDA. Financialplanning requires detailed individualized analysis <strong>of</strong> each person’s specific situation.CFP®, Certified Financial Planner and are certification marks ownedby Certified Financial Planner Board <strong>of</strong> Standards Inc.Fall 2008 33