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Dentist License Requirements

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					            Welcome From Our President
            Nathan Hershkowitz, DDS, MPH, MAGD


Dear Students and Residents,
We are proud to continue our rich history of providing you with
a great tool as you continue your studies and move towards
entering private practice.
This year we have updated, digitized and added to our own
Transition Into Dental Practice… A Practical Guide for Students
& Residents. This document is full of extremely important
information as you make your way through the maze of
licensure, general requirements from New York State and very
important practice management information: from start-up to
insurance to marketing and much more.
As a guide for you, please click on the bookmark tab in the left
margin of this adobe document, so you will be able to easily see
the areas covered in your guide.

Remember, if you are a student, the NYSAGD will pay your
membership while you are in school. And if you are a resident,
you have substantially reduced rates for a 4 year period from
your program to full membership.

The last 2 pages of the guide will give you more information on
joining The AGD; the only organization that exclusively
represents the interests and serves the needs of the general
dentist. Let us help you get started toward a future of lifelong
learning and quality patient care with the valuable resources and
opportunities in this guide.
For the good of dentistry,
Sincerely,



ps: Check out the AGD on Facebook and our own site
www.nysagd.org as well as the Academy at www.agd.org
      New York State
Academy of General Dentistry



  Transition Into Dental Practice…
       A Practical Guide for
       Students & Residents




                               Revised November 11, 2008
                                                                                                         2
                                     Table of Contents
   I.     Licensing Information
          1. New York Dental License Requirements…………………………….Page 3
          2. Education Requirements……………………………………………...Pages 4-5
          3. Continuing Education Requirements…………………………………Pages 6-14
          4. Dental Licensing Statistics……………………………………………Page 15
          5. Prescribing Controlled Substances……………………………………Page 16
          6. Official New York State Prescription Pads…………………………...Page 16
          7. DEA Registration Information………………………………………..Page 17

   II.    Insurance Information
          1. Malpractice Insurance
                  a. Dental Malpractice – Don’t get stuck without a carrier…….Pages 18-20
                  b. Crises in the Malpractice Marketplace……………………...Pages 21-22
          2. Disability Insurance
                  a. Disability Insurance – Planning for the unthinkable………..Pages 23-25
                  b. Group or Personal Disability Plans?...................................... Page 25

   III.   Risk Management
          1. Risk Management Tips………………………………………………..Page 26
          2. Informed Consent
                   a. How Informed are you about Consents?.................................Pages 27-28
          3. Informed Consent Patient Forms………………………………………Pages 29-34
          4. Endocarditis Prophylaxis Information…………………………………Pages 35-37
          5. Antibiotic Prophylaxis Regimens……………………………………...Pages 38-39
          6. Infection Control Standards……………………………………………Pages 40-42

   IV.    Employment Options
          1. What to expect as an Associate………………………………………...Pages 43-45
                 a. Making the Move That’s Right for You…………………….. Page 46
                 b. NYSAGD Externship Program……………………………….Page 46

   V.     Practice Management
          1. Creating a Practice Vision………………………………………………Pages 47-49
          2. Key Management Ratios………………………………………………. Pages 50-51
          3. Marketing Savvy………………………………………………………...Pages 52-54
          4. Patient Financing……………………………………………………….. Page 55
          5. Additional Articles and Guides………………………………………….Page 56

   VI.    The Academy of General Dentistry
          1. Fellowship, FAGD……………………………………………………….Page 57
          2. Mastership, MAGD………………………………………………………Page 58
          3. For Residents Only and Membership Application……………………….Page 59
          4. For Students Only and Membership Application………………………...Page 60


Disclaimer: The information contained in the following pages are for general informational use
only and the NYSAGD does not necessarily endorse opinions or statements contained in this guide.
                                                                                                    3
New York State Dentist License Requirements
General Requirements

The practice of dentistry or use of the title "dentist" within New York State requires licensure.

To be licensed as a dentist in New York State initially or through endorsement you must:

   •   be of good moral character;
   •   be at least 21 years of age;
   •   meet education requirements;
   •   meet examination requirements;
   •   meet experience requirements;
   •   be a United States citizen or an alien lawfully admitted for permanent residence in the
       United States (Alien Registration Card/USCIS I-551 Status/"Green Card"); and
   •   complete coursework or training in the identification and reporting of child abuse offered
       by a New York State approved provider.

You must file an application for licensure and the other forms indicated, along with the appropriate
fee, to the Office of the Professions at the address specified on each form. It is your responsibility
to follow up with anyone you have asked to send you material.

The specific requirements for licensure are contained in Title 8, Article 133, Section 6604 of New
York State Education Law and Part 61 of the Commissioner's Regulations. Copies of the relevant
sections of NYS Education Law and the Commissioner's Regulations are available upon request by
e-mailing opforms@mail.nysed.gov or by calling 518-474-3817 ext. 320.

You should also read the general licensing information applicable for all professions.

Fees
The fee for licensure and first registration is $345.
The fee for a limited permit is $105.
Fees are subject to change. The fee due is the one in law when your application is received (unless
fees are increased retroactively). You will be billed for the difference if fees have been increased.
    • Do not send cash.
    • Make your personal check or money order payable to the New York State Education
        Department. Your cancelled check is your receipt.
    • Mail your application and fee to:
        NYS Education Department
        Office of the Professions
        PO Box 22063
        Albany, NY 12201

Please Note: Payment submitted from outside the United States should be made by check or draft
on a United States bank and in United States currency; payments submitted in any other form will
not be accepted and will be returned.
                                                                                                       4
Education Requirements

To meet the education requirements for licensure, you must present evidence of completion of:

   1. not less than 60 semester hours of pre-professional (undergraduate) education, including
      courses in general chemistry, organic chemistry, biology or zoology, and physics; and
   2. a program of professional dental education consisting of either:
          o at least four academic years, or the equivalent thereof, in an accredited dental
              program or at least four academic years of dental education satisfactory to the
              Department, culminating in a degree, diploma or certificate in dentistry recognized
              by the appropriate civil authorities of the country in which the school is located, as
              acceptable for entry into practice in the country in which the school is located (see
              below).

If you have questions about acceptable programs, contact the New York State Board for Dentistry,
phone: 518-474-3817 ext 550 or by fax: 518-473-6995 or http://www.op.nysed.gov/dent.htm

Child Abuse Identification Reporting:

Graduates of dentistry programs in New York State after September 1, 1990 are credited with
having completed this coursework as part of their program.

Infection Control and Barrier Precautions:
New York State has mandated that all licensed health care professionals must complete training in
infection control every four years. Graduates from New York State dentistry programs after
September 1, 1993 are credited with having completed this coursework in their dentistry program,
and are exempt from this requirement for the first four years after graduation.

Written Examinations

The Department must receive verification of passing scores on Parts I and II of the National Board
Dental Examination directly from that organization.

For an application to take the National Board Dental Examinations or for transmittal of scores to
the New York State Education Department, contact:

Joint Commission on National Dental Examinations
211 East Chicago Avenue
Chicago, IL 60611
Phone: 312-440-2678
Web: http://www.ada.org/prof/ed/testing/natboard/commission.asp
                                                                                                     5




Clinical (Practical) Examinations

Beginning January 1, 2007, all applicants for initial licensure in New York must complete an
approved clinically-based dental residency program of at least one year's duration. A clinical
(practical) examination such as NERB will not be accepted for initial licensure after December 31,
2006.

Note: Dentist Advantage, The Academy’s Professional Liability Company, will provide liability
insurance coverage for your clinical exam if in states other than NY. Go to www.dentists-
advantage.com for more information.

If you are licensed as a dentist in another jurisdiction and have not completed an approved
residency program, you must meet the endorsement requirements. (See Applicants Licensed in
Another Jurisdiction (Endorsement) section.)

Dental Residency Programs

The Department must receive, directly from the residency program director, verification of
completion of an approved residency program accredited for teaching purposes by an acceptable
national accrediting body. You should confirm with your residency program director that the
residency program is participating in this route to licensure.

If you participate in a residency program in New York State, you must obtain a limited permit to
practice within the residency program.

You may complete a residency program in either a clinical specialty or in general dentistry. The
dental residency program requirements are:

   •   Specialty Clinical Dental Residency Program

       The dental resident applicant must complete a clinical specialty residency program in one
       or more of the following specialty areas: endodontics, oral and maxillofacial pathology,
       oral and maxillofacial radiology, oral and maxillofacial surgery, orthodontics and
       dentofacial orthopedics, pediatric dentistry, periodontics or prosthodontics. If the specialty
       residency program is not in one of these specialty areas, 50% of the program completed by
       the resident must include clinical training in one or more of these specialty areas or general
       dentistry to meet New York State requirements.

   •   General Dentistry Residency Program

       The dental resident applicant must complete a general dentistry program. During the
       residency program, the dental resident applicant must complete 9 dental procedures - 2 full
       crowns, 2 endodontically treated teeth (root canals), 4 restorations (2 anterior, 2 posterior),
       and 1 periodontal case (Type 1) - independently and to generally accepted professional
       standards. See the Reference Guide included with Form 4B for further information.
                                                                                                      6



Continuing Education Requirements
General Information

The continuing education requirement for dentists changed on July 1, 2008. New York State
Education Law requires dentists to complete 60 contact hours of continuing education in each
three-year registration period. The law that applies to these requirements (Title VIII of Education
Law) is available on this site.

The New York State Board for Dentistry does not maintain or have access to the continuing
education records of any licensee.

Continuing Education: Who is Required to Take it and Why?

   1. Why is continuing education important?

       Answer: The healthcare professions are always changing. New medications and new
       procedures are always being developed. To give the best care to your patients and allow
       your practice to evolve with your profession, you will want to continue your education
       throughout your professional career.

   2. Who is required to take continuing education?

       Answer: Every dentist registered to practice with a New York State license must take
       continuing education to be eligible for registration renewal.

   3. How many hours must be completed? Have the requirements changed?

       Answer: Beginning July 1, 2008, New York State Education Law requires dentists to
       complete 60 contact hours of continuing education in each three-year registration period.
       Prior to that date, dentists are required to complete 45 contact hours of continuing
       education during each three-year registration period.

   4. I am a dentist and my registration period begins prior to July 1, 2008 and ends after that
      date, how many hours of continuing education am I required to complete?

       Answer: To determine how many hours of continuing education you must complete, count
       the number of months from the beginning of your registration period through June 30, 2008
       and multiply that number by 1.25. Then count the number of months from July 1, 2008
       through the end of your registration and multiply that number by 1.667. Add these two
       totals to find the total number of hours you are required to complete during this registration
       period. A calculator to assist during this transition is available on our Web site.

   5. I just graduated and received my license and am in my first registration period. Do I need
      to begin taking continuing education immediately?
                                                                                                  7
   Answer: No. Licensees are not required to complete continuing education during their
   initial three-year registration period.

6. I was practicing in another jurisdiction and just received my first New York State license
   and registration. Do I need to begin taking continuing education immediately?

   Answer: Yes. Although this is the first time you received a New York State license, it is not
   your first license. You must complete the required continuing education during this and all
   subsequent registration periods.

7. I just received my registration and it is less than three years in length. Am I still expected to
   complete the total number of continuing education hours required for my profession?

   Answer: No. Registration periods are adjusted so that renewals occur during the licensee's
   birth month. When this happens, you can calculate how many continuing education hours
   you are required to complete. If you are a dentist, follow the instructions in question 4.

8. I do not practice my profession, but I am registered. Do I need to take continuing
   education?

   Answer: Yes. Any individual who holds an active registration must take the required
   continuing education.

9. I am licensed in New York State but my registration is inactive because I am practicing my
   profession in another jurisdiction. Do I need to complete continuing education before I can
   reactivate my New York State registration?

   Answer: Yes. To reactivate your New York State registration you will need to complete the
   amount of continuing education required for a normal triennial registration period. Since
   you are actively practicing your profession, you will be able to count continuing education
   credits earned up to 36 months prior to the month in which you reactivate your registration.

10. I am licensed in New York State but my registration is inactive because I have not been
    practicing my profession. Do I need to complete continuing education before I can
    reactivate my registration?

   Answer: Yes. To reactivate your New York State registration you will need to complete the
   amount of continuing education required for a normal triennial registration period. Since
   you are not actively practicing your profession, you will only be able to count continuing
   education credits earned up to 12 months prior to the month in which you reactivate your
   registration.

11. What is an hour of continuing education?

   Answer: An hour of continuing education is one contact hour of at least 50 minutes in
   duration. Most continuing education providers give credit in hours; however, you may see
   credit given in continuing education units.
                                                                                                 8
     One continuing education unit (CEU) equals 10 contact hours. Therefore, .1 CEU equals
     one contact hour, .2 CEUs equals two contact hours, .3 CEUs equals three contact hours,
     and so on.

     Individuals completing college-level course work should note that one semester hour
     equals 15 contact hours.

  12. If I complete more hours than required during the registration period, can I use them
      toward the hours required in my next registration period?

     Answer: No. Continuing education hours can not be carried over from one registration
     period to the next. The hours must be completed between the effective date and expiration
     date of the registration period for which they will be applied.

  13. Am I required to complete a certain number of hours per year?

     Answer: No. You can complete the hours any time during the three-year registration period
     as long as you have completed the required hours prior to the expiration date of your
     registration. However, we recommend that you complete courses each year so you are sure
     to have them completed before it is time to reregister.

Continuing Education Courses and Acceptable Subject Areas

  14. Are there specific courses that I must take to be eligible to renew my registration?

     Answer: Yes. All dentists who have a continuing education requirement must take the
     following courses. (see section: Continuing Education: Who is Required to Take it and
     Why? to determine if you are required to complete continuing education)

         o During your first registration period after January 1, 2002, you must complete on a
           one-time basis, a two-hour course regarding the oral health effects of tobacco and
           tobacco products.
         o During your first registration period which begins on or after January 1, 2008, you
           are required to complete, on a one-time basis, a State approved course in dental
           jurisprudence and ethics.
         o Beginning January 1, 2009, all dentists must achieve certification in
           cardiopulmonary resuscitation (CPR) and from that point forward, continually
           maintain certification.

     Dentists and dental hygienists must also complete a State approved infection control course
     every 4 years. A list of approved providers can be found on the Office of the Professions'
     Web site. Note: The NYSAGD is an approved provider for this course.

  15. What are the requirements for the tobacco coursework?

     Answer: Dentists must complete a two-hour course in the oral health effects of tobacco and
     tobacco products. This course must cover the chemical and related effects and usage of
     tobacco and tobacco products and the recognition, diagnosis, and treatment of the oral
     health effects of tobacco and tobacco products, including but not limited to cancers and
                                                                                                9
   other diseases and must be offered by an approved sponsor. Dentists who can document
   that they completed a two-hour continuing education course after February 27, 1997,
   which is consistent with Education Laws and Regulations pertaining to continuing
   education that covered the required topics will be considered to have met the requirement.
   This course must be completed during the first registration period for which the dentist has
   a mandatory continuing education requirement.

16. What are the requirements for the New York State dental jurisprudence and ethics
    coursework?

   Answer: Dentists must complete, during the first registration period which begins on or
   after January 1, 2008 in which they have a continuing education requirement, a three-hour
   course in dental jurisprudence and ethics. Because the course must include the laws, rules,
   regulations and ethical principles relating to the practice of dentistry in New York State, the
   course must be approved by the Department.

17. What courses may I use to meet the CPR requirement? Which providers are acceptable?
    May I take an online course?

   Answer: Dentists may complete courses sponsored by the American Red Cross, the
   American Heart Association, the American Safety and Health Institute or the National
   Safety Council. All courses must be live and in person.

   The course must include, but need not be limited to, content in the following:

       o   scene survey;
       o   patient assessment;
       o   one and two rescuer cardiopulmonary resuscitation;
       o   mouth-to-mouth resuscitation;
       o   mouth-to-mask resuscitation;
       o   conscious choking;
       o   unconscious choking;
       o   bag-valve-mask resuscitation;
       o   recovery position;
       o   automated external defibrillator use;
       o   infection control matters;
       o   recognizing a heart attack; and
       o   cardiopulmonary resuscitation and automated external defibrillator scenarios.



18. May I count CPR training toward my continuing education requirement? How many hours
    may I count?

   Answer: Yes. Dentists may count CPR training toward their continuing education
   requirement. During each triennial registration period, you may count up to a maximum of
   twelve hours of CPR coursework, including coursework in Advanced Cardiac Life Support
   (ACLS) and/or Pediatric Advanced Life Support (PALS).
                                                                                                10
       o You may count a CPR course for up to three hours. A copy of your CPR card is
         proof of completion.
       o You may count a CPR course which includes training in the Automated External
         Defibrillator (AED) for up to four and one-half hours. A copy of your CPR/AED or
         BLS card is proof of completion.

   You may count an initial ACLS or PALS course for up to twelve hours and an ACLS
   recertification course for up to six hours. A copy of your ACLS or PALS card is proof of
   completion.

19. I am physically incapable of performing CPR. Am I still required by law to maintain
    certification?

   Answer: No. You may be granted an exemption to the CPR requirement if you are
   physically incapable of complying with the requirement. Documentation of your incapacity
   shall include a written statement by a licensed physician describing how your physical
   incapacity affects performing CPR. You will also be required to submit an application for
   exception which verifies that another individual or individuals will maintain certification
   and be present in the dental office while you are treating patients.

20. What about the other courses I complete to meet the continuing education requirement?

   Answer: All courses taken to meet the continuing education requirement must be formal
   courses in appropriate subject areas offered by approved sponsors.

21. What are appropriate subject areas?

   Answer: Appropriate subject areas are those courses that contribute to professional practice
   in your profession.

   Appropriate subjects include, but are not limited to, the following areas:

       o   basic and clinical dental sciences;
       o   behavioral science;
       o   pharmacology of new and developing drugs;
       o   drug interactions;
       o   public health issues;
       o   child abuse reporting;
       o   infection control;
       o   sterile procedures;
       o   legal or regulatory issues;
       o   patient counseling;
       o   risk management;
       o   other topics that contribute to the practice of your profession; and
       o   other matters of health care, law, and ethics that contribute to the public's health and
           welfare.
                                                                                               11
   The key is the subject matter's relationship to professional practice as defined in
   section 6601 of Education Law. Therefore, courses that are not related, such as
   PRACTICE MANAGEMENT, accounting, finance, statistics, and how to use the
   Internet are NOT ACCEPTABLE.

   If you are unsure whether a course you would like to take will meet the continuing
   education requirement, feel free to contact the Dental Board by phone at 518-474-3817,
   ext. 550 or by e-mail at dentbd@mail.nysed.gov.

22. Am I required to physically attend courses to meet the continuing education requirement?

   Answer: Yes. Prior to July 1, 2008, dentists are required to complete at least two-thirds of
   their continuing education hours via live courses (30 of the 45 contact hours required for a
   three-year registration). Beginning on July 1, 2008, dentists are required to complete at
   least seven-tenths of their continuing education hours via live courses (42 of the 60 contact
   hours required for a three-year registration)and dental hygienists are required to complete
   at least seven-twelfths of their hours via live courses (14 of the 24 contact hours required
   for a three-year registration). The balance of the remaining hours may be completed
   through appropriate self-study courses.

23. What is a live course?

   Answer: Live courses are those in which you are able to interact with the instructor. For
   example: a live lecture; a telecourse or teleconference in which you and the instructor can
   speak directly with each other; a course in which you and other practitioners discuss a
   taped presentation with a facilitator's assistance; a computerized course in which you are
   able to interact directly with the instructor. On the other hand, a televised lecture with no
   means of direct interaction would not be acceptable as a live course even if it is a live
   telecast.

24. Are there any other ways to obtain continuing education hours?

   Answer: Yes. In addition to formal courses offered by approved sponsors in appropriate
   subject areas, the following courses are acceptable for continuing education.

       o Emergency Medical Technician (EMT) programs. You may count an initial EMT
         Basic course for up to ten hours and an EMT Basic recertification course for up to
         five hours. (Note: First-aid courses are not acceptable.)
       o Registered/Accredited residency programs.
       o Mandatory infection control offered by a New York State approved provider.
       o Mandatory training in the identification and reporting of child abuse and
         maltreatment offered by a New York State Education Department approved
         provider (two hours).

   In addition, you may count up to seven (7) hours per triennial registration period for
   teaching a continuing education course as long as the course is in an appropriate subject
   area and is offered by an approved sponsor.
                                                                                               12
     Credit will NOT be given for life/work experience; informal group "study clubs" of
     dentists and/or dental hygienists run by an unapproved sponsor; studying on your own; or
     conducting research, writing for journals, making videos and/or faculty teaching.



Continuing Education Sponsors

  25. How do I know if a sponsor is approved?

     The following entities are authorized to approve sponsors of continuing education for New
     York State dentists and dental hygienists:

         o   The American Dental Association's Continuing Education Recognition Program
             (ADA CERP)

             A list of sponsors approved by ADA CERP is available from the Continuing
             Education Recognition Program, American Dental Association, 211 East Chicago
             Avenue, Chicago, IL 60611-2678; telephone (312) 440-2869; web site
             http://www.ada.org/prof/ed/ce/cerp/index.asp .

         o   The Academy of General Dentistry's Program Approval for Continuing Education
             (AGD PACE)

             A list of sponsors approved by AGD PACE is available from the Academy of
             General Dentistry, 211 East Chicago Avenue, Chicago, IL 60611-2670; telephone
             (312) 440-4300; web site http://www.agd.org/education/pace/
             Note that AGD sponsors must have national approval to be acceptable.

         o   The New York State Dental Association (NYSDA)

             Information regarding sponsors approved by NYSDA is available from the New
             York State Dental Association, 121 State Street, 4th Floor, Albany, NY 12207;
             telephone (518) 465-0044; web site http://www.nysdental.org/education/index.cfm.

         o   The New York State Education Department (NYSED)
                1. For dentists and for dental hygienists

             For information regarding these sponsors contact the New York State Education
             Department, State Board for Dentistry, 89 Washington Avenue, Albany, New York
             12234-1000; telephone (518) 474-3817 ext. 550;
             fax (518) 473-6995.

         o   Although they are not authorized to approve sponsors, colleges, universities, and
             other degree-granting institutions offering degree (A.A.S., B.S., M.S., D.D.S.,
             Ph.D.) and certificate or diploma programs carrying degree credit that are registered
             by the State Education Department or that are accredited by an equivalent
             accrediting agency are approved as sponsors for courses in their registered or
             accredited programs.
                                                                                                   13
             A list of New York State degree-granting institutions is available from the New
             York State Education Department, Office of Higher Education, Office of College
             and University Evaluation, 5 N. Mezzanine, Albany, NY 12234; telephone (518)
             474-5851; Inventory of Registered Programs web site
             http://www.nysed.gov/heds/IRPSL1.html.

     If you are unsure whether a sponsor offering a continuing education program is approved,
     feel free to call the Dental Board at (518) 474-3817, ext. 550 or e-mail
     dentbd@mail.nysed.gov



Recordkeeping, Reporting and Audits

  26. What records will I have to keep for the continuing education courses I attend?

     You will need to keep the following five items of information for each course for six years
     from the date of completion: title of the course; number of hours completed; if they were
     live or self-study; the sponsor's name; verification by the sponsor of your attendance; and
     the date and location of the course. All five elements are likely to be provided on a
     certificate of completion from the sponsor. Dentists' records must include verification that
     the sponsor has at least one full-time employee for courses completed on and after January
     1, 2000.

  27. Do I have to send these continuing education records to the State Education Department's
      State Board for Dentistry when I reregister?

     No. You will be required to certify completion of the required hours on the form to renew
     your registration by answering the continuing education question and signing the form.
     However, you are required to make your continuing education records available for
     inspection by the Education Department upon request. Random audits are conducted each
     month to insure compliance with these important requirements.



  28. What if an audit reveals that I did not comply with the mandatory continuing education
      requirement?

     You will be subject to disciplinary proceedings for professional misconduct. According to
     Section 29.1 of the Rules of the Board of Regents, willfully making or filing a false report
     is unprofessional conduct. Penalties may include censure and reprimand, a fine and/or
     suspension or revocation of your license to practice in New York State.

  29. What if it is time for me to reregister or I want to reactivate my registration and I have not
      completed the required number of continuing education hours?

     You may request a one-year conditional registration. The Education Department may grant
     a conditional registration to a licensee who admits to noncompliance with the continuing
     education requirements.
                                                                                                 14
     To be granted a conditional registration, you would have to agree to:

         o complete the hours lacking from your previous registration period;
         o complete the regular continuing education requirement prorated for the one-year
           conditional registration (15 hours for dentists and 8 hours for dental hygienists);
         o pay the full triennial registration fee for the conditional registration; and
         o at the end of the conditional registration year, provide proof of compliance and pay
           the full triennial registration fee for the remaining two years of your registration.

     Conditional registrations are valid for no more than one year and are not renewable. This
     means you MUST meet the requirements by the end of the conditional period. You will
     not be issued a registration for the remaining two years until you meet the requirements.
     Remember - if you are not registered you may not practice your profession in New York
     State.

  30. What if I do not meet the continuing education requirement and do not renew my
      registration?

     If you are not going to practice your profession in New York State, this is fine. Your
     registration will remain inactive until you meet the continuing education requirement and
     submit a registration renewal application with the appropriate fee.

  31. What if, due to circumstances beyond my control, I am having difficulty meeting the
      continuing education requirement?

     The Department may grant an adjustment (not an exemption) to the requirement for: poor
     health certified by a physician; a specific physical or mental disability certified by an
     appropriate health care professional; extended active duty with the armed forces of the
     United States; or extreme hardship which, in the judgment of the Department, makes it
     impossible for the licensee to comply with the continuing education requirements in a
     timely manner. You must request an adjustment from the Office of the State Board for
     Dentistry and provide written documentation of the circumstances preventing you from
     complying with the requirements.

Contact for Further Information

  32. What if I have questions or need further information?

     Contact the State Board for Dentistry, New York State Education Department, Office of the
     Professions, 89 Washington Avenue, Albany, New York 12234-1000, telephone 518-474-
     3817, ext. 550, fax (518) 473-6995, e-mail dentbd@mail.nysed.
                                                                                                       15
Licenses Issued, Past 5 Calendar Years

                       Profession Title                2003     2004        2005     2006    2007
    Dentist                                             720       751        760      765      392
    Dentist, 3-year limited license                        8        17          17     19        15
    Dental Hygienist                                    363       343        387      364      411
    Dental Hygienist, 3-year limited license               1         1           2      3         1
    Certified Dental Assistant                           83         92          59     86      102


Geographic Distribution of Registered Licensees*

As of January 7, 2008

Dentist
              County       Number             County   Number              County           Number
    Albany                      242 Jefferson                 64 Saratoga                       156
    Allegany                     10 Kings                 1,325 Schenectady                     116
    Bronx                       379 Lewis                      5 Schoharie                       10
    Broome                      115 Livingston                26 Schuyler                         6
    Cattaraugus                  28 Madison                   31 Seneca                           9
    Cayuga                       35 Monroe                 560 Steuben                           38
    Chautauqua                   64 Montgomery                26 St. Lawrence                    35
    Chemung                      51 Nassau                2,005 Suffolk                        1,236
    Chenango                     15 New York              2,506 Sullivan                         31
    Clinton                      37 Niagara                   99 Tioga                           12
    Columbia                     26 Oneida                 140 Tompkins                          61
    Cortland                     17 Onondaga               338 Ulster                           100
    Delaware                     17 Ontario                   53 Warren                          47
    Dutchess                    219 Orange                 221 Washington                        14
    Erie                        752 Orleans                   12 Wayne                           35
    Essex                        16 Oswego                    35 Westchester                   1,165
    Franklin                     21 Otsego                    26 Wyoming                         12
    Fulton                       18 Putnam                    51 Yates                            5
    Genesee                      25 Queens                1,623 NYS TOTAL                     15,149
    Greene                       18 Rensselaer                76 OTHER US                      2,834
    Hamilton                      0 Richmond               373 NON-US                            40
    Herkimer                     19 Rockland               342 TOTAL                          18,023
                                                                                                  16



Prescribing controlled substances
       To prescribe controlled substances within the state of New York, it is required to first apply
       for and receive a federal DEA number. Information regarding this application is included
       below.

New York State Official Prescription Pads
Please note that as of April 2006 you MUST use official New York State Prescription Pads for
ALL prescriptions! This is true regardless of whether you are writing for a controlled substance or
not, and even if you don't have a DEA number.

 It will take a few steps to get your new scripts: The steps are outlined at the web site:
www.health.state.ny.us/professionals/narcotic/ordering.htm. This includes downloads of the
necessary forms. Please note this is a lengthy process. You will have to send forms by mail twice,
one of them notarized, and you will have to email and receive email more than once to complete
the process. The final ordering of the scripts can be done online once you are registered and you
have an HPN number.

If you have problems, the Bureau of Narcotic Enforcement will be very helpful in getting you
through the process (866) 811-7957.
                                                                                                  17
                          DEA Registration Procedures


                                   GENERAL INFORMATION

Information concerning the Drug Enforcement Administration (DEA) registration process can be
obtained by contacting the Registration Call Center at 1-800-882-9539. Our Registration Call
Center is staffed from 8:30 a.m. to 6:00 p.m., Eastern Standard Time. During non-business hours,
information is available through our automated Call Center menus.

Further information is also available online at: www.usdoj.gov/dea/

NEW APPLICATIONS

If you are applying for a DEA registration, you will need to complete a new application form. The
application form required depends upon the type of activity you intend to conduct. Dental
Practitioners need to complete DEA form 224. Applications for registration may be obtained from
a field office or by telephoning the Registration Section in our Headquarters office at 1-800-882-
9539. The DEA Form-224 is currently available on-line (Recommended). If you complete a paper
DEA Form-224, please mail it to:

                                 Drug Enforcement Administration
                                     Post Office Box 530295
                                     Atlanta, GA 30348-0295



The fee for a 3 year registration is $390 (subject to change).

The average processing time for a new DEA registration is four to six weeks provided that the
application is complete. To avoid delay in the processing of your application, be sure to check the
following before submitting the application to DEA.

   1.   Complete the application in its entirety;
   2.   Sign and date the application;
   3.   Enclose the appropriate fee or enter the credit card area information;
   4.   Mail the application to the address printed on the form.
                                                                                                  18
Insurance Information
Dental malpractice
Don't get stuck without a carrier
As stories concerning skyrocketing malpractice claims permeate the media, the federal government
is considering legislation to enforce a cap on non-economic damages (which some states have
already done). For medicine alone, malpractice insurance rates have increased at least 10 percent
in recent years. While most think the legislation is a good thing, some argue that it could actually
raise premiums by forcing carriers out of the marketplace-a trend that is not new to dentistry.

The problem: Insurance companies are being hit hard with patient claims. This translates to
premiums that have tripled, specifically in medical specialties. These high costs have become
enough to push physicians out of the states in which they practice or-worse-out of the profession.

Obstetricians in Nevada are having an especially hard time and many are moving to states where
insurance rates are affordable. This leaves patients in a lurch to find quality care.

In recent years, plaintiffs in medical malpractice lawsuits have been getting larger awards from
juries. In 2000, health professionals faced a more than 60 percent chance of losing their cases,
according to a study of jury awards released last March by Jury Verdict Research. The study said
that the median jury awards in medical malpractice claims jumped 43 percent between 1999 and
2000, from $700,000 to $1 million. More than half of medical malpractice jury awards were for
$500,000 or more.

The malpractice issue has the attention of a number of states. Pennsylvania Gov. Mark Schweiker
signed legislation aimed at stabilizing the state's medical malpractice insurance market, which had
reached crisis proportions in Philadelphia. Mississippi Gov. Ronnie Musgrove announced
lawmakers would call a special legislative session to address the issues of cost and availability of
medical malpractice insurance.

Another song
Experts say malpractice for dentists is its own story and generally does not reflect what is going on
in the larger health care market, specifically the high settlement amounts. With increasing
insurance costs and a bad investment market, dentistry is an after thought. Most insurance
companies write policies for dentists only if they are writing for physicians. And, when the cost of
business gets to be too high, they pull completely out of the market with little warning.

This post-Sept.11 era has made the market much tighter due to rising costs of reinsurance. Many
malpractice insurance companies rely on the stock market to provide adequate funding for the
policies they write. But with the market's increasing instability, many don't have the investments to
support the claims.

For example, two of the large malpractice insurance companies St. Paul and Safeco have left both
the physician and dental markets saying the cost of doing business is too high. Other companies,
such as Princeton and Frontier, also have left the market.

Experts agree government regulations capping plaintiff awards would be a welcome suggestion to
the business of insuring dentists. This would help keep the rates down, said Mark Buczko, vice
                                                                                                    19
president of Dentist's Advantage a division of Affinity Insurance Services Inc. "This would
definitely be good for the long run."

Trends in dentistry
It is important for dentists to consider coverage and who is providing that coverage. Insurance
companies who supply malpractice to both physicians and dentists don't always know the exact
needs of the dentist.

The difference between medical and dental malpractice is that the claims are inherently smaller in
dentistry. "The average claim is between $12,000 and $15,000," according to Mr. Buczko.

"The frequency and severity of the claims have remained fairly steady over the last 10 years," he
said. Although the company's largest dental claim was $1.7 million.

General practitioners should understand when they perform procedures that also are performed by
specialists, they are held to that same level of expertise. So, liability can be higher if the dentist
doesn't refer the case early enough.

Premiums with some companies have remained steady while others have skyrocketed. More
companies are leaving the marketplace because it is very tight, and suits are brought because of
aggressive collections. Patients feel they are entitled to money.

How much is enough?
"You should sit down with a representative from the carrier each year to determine if your
coverage amounts are right for your practice," said Bill TemPas, DMD, vice president, Oregon
Dental Society (ODS) Health Plans. ODS Health Plans have provided dentists in the state with
malpractice insurance for 20 years. The company is now looking to provide coverage for dentists
in other states.

The typical policy is $1 million to $3 million, with $1 million per occurrence for a maximum of $3
million. The cost to increase to $2 million to $6 million policy is minimal.

"Unfortunately, awards are usually determined by how much coverage a dentist has," said Dr.
TemPas. Your coverage also depends on your practice and the types of services you perform. If
you perform more surgery or place implants, experts agree you might need more coverage.

According to malpractice insurance executives, prior to purchasing a policy, there are many
questions to ask a potential carrier:

   •   Find out the company philosophy.
   •   What is the company's AM Best rating? Don't go with a company with a rating less than a
       B+.
   •   Make sure the company is committed to the marketplace.
   •   Make sure that the company writes dental malpractice and how long they have written
       policies.
   •   Ask about the philosophy of handling claims. Who handles the claim? Will the settlement
       amount be higher than it could be?
   •   Is there consent to settlement clause? Can you be the one to give consent to settle the case?
       While some companies will agree to this, you could be held liable for anything over and
       above the clause. Will you be forced to stick with binding arbitration?
                                                                                                  20
   •   Does the company have reinsurance? Companies survive by buying reinsurance to help
       cover the value of the entire policy amount. So, for example, $500,000 could be covered by
       the company writing the policy and $500,000 could be covered by reinsurance.
   •   Can you reach customer service and receive help? Does the company provide risk
       management services and how extensive are they?
   •   How often have rates increased?
   •   Does the company have a history of paying policyholder dividends?

When should I call?
"You should call your carriers when you think there might be a problem. A carrier that provides
risk management services will typically assist you in resolving the matter before it reaches the
point of becoming a claim," said Robyn Crimmins, vice president, Risk Management and
Communications, The Dentists Insurance Company (TDIC), which is part of the California Dental
Association. The TDIC has provided malpractice insurance to dentists since 1980. They believe
their success is because the company is owned and operated by dentists and because of the
company's conservative operational philosophy.

A complaint or claim does not necessarily mean a lawsuit. "It can be as simple as patient saying 'I
want my money back,'" Mr. Buczko said. This may initiate an investigation and keep the carrier
informed of any actions. AGD

Reprinted from AGD Impact, February 2003, Vol. 31, No. 2
                                                                                                      21

                                                                                        Toll-Free 1-888-778-3981

Crisis In the Malpractice Marketplace
Over the past 24 months insurance companies like SAFECO Insurance Company, St. Paul
Insurance Company, Kemper Insurance Company, Gulf Insurance Company and Princeton
Insurance Company have, either partially or totally, withdrawn from the dental malpractice
marketplace. This has not only caused concern for dentists, but it has sent them on a quest to find
professional liability coverage.

What is causing this exodus from dental malpractice? There are three primary reasons for the
current state of the market in dental malpractice. But, in order to understand this marketplace a
little better, a brief visit to the physician marketplace would be in order.

The Market
Much has been published about the malpractice crises facing physicians in many parts of the
country. The majority of the companies listed above, until recently, were heavily involved in
insuring physicians, as well as dentists and other healthcare professionals. Over the past 10 years
these companies have experienced an influx of malpractice cases being brought against their
clients. In addition to the increase, the "loss costs" -- the cost of settling and defending one claim --
for physicians increased 264% between 1991 and 2001.1 Insurance rates throughout the decade of
the 90's had been fairly stable, but by 2001 insurers were beginning to feel the pressure to adjust
rates. The large number of competitors in the marketplace helped keep rates in check, however,
this steady increase in costs began to put more and more pressure on companies' bottom-lines.

Understanding the marketplace trend over the past decade is only part of understanding the affects
of today's malpractice status. We must also look at business practices of insurance companies.
Customarily, insurance companies generate a significant amount of their income from investing
the premiums they earn. Insurers collect premium and pay claims on a regular basis, but in the lag
time between the collection of premiums and the payment of claims, a company will invest this
cash for their own benefit. The income earned can be -- and has been -- significant for these
companies. In fact, throughout the decade of the 90's companies routinely provided insurance at an
operating loss, paying out as much as $1.10 or $1.15 for every dollar of premium collected, only to
make up this loss and more on their investments. However, these days the abundant returns
companies had come to rely on are no longer there.

Another contributing issue remains in the background for many companies. The costs of their own
insurance, called reinsurance, were rising for the first time. Many reinsurance companies suffered
large losses in 2001 due to the terrorist attacks. Since then, their rates have been steadily rising as
they too attempt to return to profitability.

Rising Premiums

Faced with escalating loss costs, a diminished investment return and a higher cost for reinsurance,
many companies were faced with serious decisions. And with these decisions came questions.

   •   Could insurance companies possibly increase rates enough to solve these problems?
   •   As rates increase, what is the possibility that a significant amount of business is lost?
   •   Of that impending lost business, what are the possibilities of losing the profitable business
       and keeping the unprofitable?
                                                                                                  22
   •   Can all lines of business continue to be supported or, is consolidation of the more profitable
       business the option?

Many companies decided that rate increases alone would not be enough to return them to
profitability. They were concerned that if they raised rates significantly they would lose the
customers that would find it easy to move; that is, the customers that have not had claims. Those
customers that have had claims would find it difficult to secure replacement coverage and so they
would stay. This is known as adverse selection. Because a company would not have a good mix of
customers both with and without claims, it would become increasingly difficult to return to
profitability. Therefore, some companies have decided to exit or restrict their exposure in their
coverage for dentists, just as they have done with physicians.

Although companies issuing dental malpractice policies are not experiencing the same increasing
loss costs as with physicians, there is still a trend that suggests that both the frequency and severity
of claims against dentists is on the rise, with claim severity rising a bit faster than frequency.

What does this mean to you?

   1. As the supply of dental malpractice providers diminishes and the demand for coverage
      remains stable or slightly increasing with new dentist graduates, the expectation is that
      prices will begin to edge upwards. This will affect premiums that dentists will pay for
      coverage.
   2. As companies pull back or exit the market dentists will need to seek coverage with other
      carriers. Companies continuing to provide dental malpractice insurance will want to be
      assured that they do not become subject to adverse selection, therefore, they will tighten-up
      the rules of acceptance for new business and look closely at their current business. This
      may make it difficult for some dentists to find coverage.
   3. As the evolution continues toward a "sellers market," some insurance companies may view
      dental malpractice as a potential arena in which to make a quick profit. Companies that
      jump into the marketplace offering low rates then exiting as the claims start to accumulate,
      can wreak havoc on its customers. Dentists will need to do their homework on a company,
      making sure they are in for the long-term.
   4. The insurance industry is cyclical. The higher rates paid today could be returned as credits
      in the future when companies begin to focus on increasing market share. As consumers,
      dentists need to be aware of the financial stability of their carrier and their appetite to stay
      in the business to endure these cycles.
                                                                                                      23
Disability insurance….Planning for the unthinkable
It's the kind of thing no dentist wants to think about-an injury or medical condition that puts you
out of commission indefinitely or even permanently.

But the reality is, accidents happen. According to the Bureau of Labor Statistics, more than 5
million workers were injured on the job in 2001. Among dental professionals, 1.5 of every 100
reported job-related injuries that year. That figure may sound low, but even an injury as seemingly
minor as a broken thumb can wreak havoc on a dentist's practice and income.

As Thomas A. Howley Jr., DDS, MAGD, discovered, dentists, especially younger practitioners,
are much more likely to need disability insurance than life insurance. The Perkiomenville, Penn.-
based G.P. was injured in a car accident that left him unable to practice.

"Life insurance is very inexpensive by comparison," Dr. Howley says, "and you need that should
anything happen to you, but odds are, especially through your 20s to your 40s, that's not going to
happen."

"Most dentists are aware of standard neck and back injuries that come with the profession," Dr.
Howley adds, "It's the ones you don't expect-the falls, the broken bones-you just never think that
those things are going to happen."

In short, dentists need to expect the unexpected. Accidents, falls and other injuries that seem
relatively insignificant could sideline a dentist permanently, and disability insurance can help keep
an injury from becoming a disaster.

"You need to insure against your inability to earn a living wage due to injury or illness," says
Richard M. Kanter, DMD, FAGD, chair of the Academy of General Dentistry's (AGD) Council on
Group Benefits Programs. If you're still undecided, just look at the statistics, Dr. Kanter says.
"[Workers] are almost two times more likely to be disabled than to die before they retire."

Today, a 20-year-old worker has a 17 percent change of dying before reaching retirement age, but
that same worker has a 30 percent chance of being disabled before he or she reaches retirement, he
says.

A vulnerable position

Dentists occupy a unique place in the health care field that comes with some unique
vulnerabilities, according to David Shantz, vice president of group special accounts for Great-West
Life & Annuity Insurance Co., the underwriter for the American Dental Association's (ADA)
group disability insurance policies.

"Dentists are one of the remaining cottage industries in the country," Mr. Shantz says. "They're
usually sole proprietors or work in small units or partnerships. Typically, they're not part of a
bigger entity, so their livelihood is dependent upon their ability to produce."

Similarly, dentists' dependence on their hands and eyes place them in danger of losing income,
should they injure or develop chronic problems with either of those.
                                                                                                     24
"Dentists rely so much on their eyesight and dexterity," Mr. Shantz says. "They also operate in a
position that can cause physical problems that are debilitating to them in ways that wouldn't be for
someone doing an office job. As soon as the dentist is in a position where he or she can't practice,
they can't generate income."

These liabilities are all the more reason for dentists to carry comprehensive disability insurance
coverage, Mr. Shantz says.

A worthwhile investment
Disability insurance may dwarf life insurance in terms of cost, but it could be an even more
important investment. Dentists may be able to rely on savings or on the payout of existing
accounts, but it might not outlast their disability.

So how much disability insurance is enough? Under current tax laws, disability benefits are
nontaxable. Mr. Shantz suggests that dentists carry a policy equal to 60 percent of their pretax
income, minus overhead costs. This ensures that dentists won't see a significant drop in their net
income when they receive disability benefits.

Peter Sturm, DDS, MAGD, advises young dentists to buy disability insurance as soon as they can.
"It's hard when you're first starting out and have other expenses as well," he notes. "There are lots
of things we're not taught in school, and this is one of them." Dr. Sturm served for several years on
the AGD Council on Group Benefits and suggests that dentists, especially those just starting to
practice, purchase flexible plans they can add to over the years.

"It's a very important part of financial planning," Dr. Kanter says. "You need to make sure your
policy includes cost-of-living riders, that it comes from a reputable company that stands behind its
policies, and that the policy is not cancelable before age 65."

Dentists shouldn't stop at just making sure they personally are covered-their practices need policies
of their own. Temporary disabilities-those lasting from two to three months to one year-will also
require the dentist to have a Business Office Policy, which helps cover office overhead expenses
like staff wages, mortgage or rent payments, uniforms and supplies. Many policies also include the
cost of hiring a replacement dentist to fill in and keep the practice going.

Read the fine print
The very policies intended to protect you may be riddled with exceptions and conditions that can
keep you from getting the benefits you need. Just as you investigate dental products before
investing in them, so too should you pay close attention to the provisions of your disability
insurance.

"The wording of disability policies isn't as simple as life insurance policies," Dr. Sturm notes.
"You have to study the language and the fine print. If there's any room to question an injury, the
insurance companies will take advantage of that."

Mr. Shantz recommends that dentists look for policies that cover dentists on an "own occupation"
basis, meaning you'll receive disability benefits if you are unable to perform the substantial
material duties of your profession, regardless of whether you're a general dentist or a specialist.
Without an "own occupation" provision, a disabled dentist may not be able to collect on his policy,
if he could physically work in anther profession.
                                                                                                 25
Policies should also encourage dentists to return to work, but Mr. Shantz advises against choosing
a policy that halts benefits once the dentist resumes practicing, even part time. Similarly, he
recommends coverage that allows benefits for both partial and total disability. The Residual
Benefit option in the AGD plan can provide partial coverage if a dentist returns to work and
receives less that his or her pre-disability income.

There are several policies and options including riders available to dentists, in the event they are
injured or disabled, to continue to collect benefits if they return to their practice part time or leave
clinical dentistry completely in favor of a job where their injury won't affect them.

Another rider is the Cost of Living Adjustment, or COLA, rider, which takes cost-of-living
increases and inflation into account and adjusts the monthly benefits as needed.

Most importantly, dentists need to be proactive and make certain their policies are worded in a way
that ensures the kind of coverage they may need. "The underwriting for disability insurance
coverage is more exacting than for life insurance," Mr. Shantz says. "There are things like poor
eyesight or arthritis that are not life-threatening, but they're disabling, and they can end a career."


Policy tips go with a personal or group plan?
Should you
   • Keep your old policy: Don't replace your old plan-supplement it with options. plans, both of which
Most insurance companies offer either individual or group disability coverageOver time, insurance
       companies restrict their benefits, and older policies may have features and provisions unavailable
have various costs and benefits. Dentists can weigh the pros and cons of each and choose to
       today.
   • Overestimate: It's or one have too much coverage than
purchase personal plans better tosponsored by an association. not enough. Purchase a flexible plan that
        allows you to add coverage later.
    • Go early: Premiums increase as you get older, andcapitalize on lower costs whilewith level young.
Individual plans are sold by commissioned agents so are guaranteed renewable, you're still or
    • Update your policy: Anytime your income or This responsibility opportunity to cultivate a
fixed premiums throughout the coverage period.family gives you thechanges significantly, you should
        adjust your policy, adding or subtracting coverage you of needed changes to your plan over
relationship with an insurance agent who may apprise accordingly.
    • Seek advice: An accountant, lawyer or insurance agent you trust can help you interpret the
                        substantial portion of informed of changes that need plan is paid
time. Nevertheless, ayour policy and keep youthe premium on an individual to be made. to the
        stipulations of
individual agent as commission.

Group plans are sponsored by an association or group and do not feature fixed premiums. The cost
may be low when the dentist is young, but typically increases every five years. Often, association
plans do not pay high commissions to individual insurance agents, and this means that these plans
could be 20 percent to 30 percent less over a 20-year period than individual plans. Also, the
association acts as an advocate for its participating members and works with the carrier to obtain
the best terms for its program.

Further information can be obtained by calling EAI Administrators at 888-369-7243,
or emailing insurance@nysagd.org
AGD Impact, Dec 2003, Vol. 33, No. 9
                                                                                                                    26
RISK MANAGEMENT TIPS
THE FOLLOWING INFORMATION CONTAINS HINTS TO PREVENT MALPRACTICE CLAIMS
AGAINST A DENTIST
1. 95% of cases are settled out of court because of time and expense.
2. Book: Malpractice, What they Don’t Teach You in Dental School. By Jeffrey J. Tonner J.D. 1996
3. Dental Charting is the single most common cause of punitive damages in a dental malpractice case.

10 RULES FOR DENTAL CHARTING
- Never, ever, alter or change a chart.
- Chart patient compliments using quotation marks.
- Chart patient non compliance (esp. refusal to see a specialists)
- Chart any bad or unanticipated results
- Make chart entries consistent with the appointment book
- Use dental lab personnel for difficult crown and bridge
- Follow-up telephone calls for difficult and invasive procedures (document that they were made.)
- Chart that alternative/recommended treatments plans were offered
- Review charting from assistants and hygienists
- Update medical status for each visit.

DOCUMENT REFERRALS
Be sure to document referral to a specialist and appoint a follow-up to check up on situations and symptoms where the
diagnosis is unclear.

HOW TO HANDLE AN UPSET PATIENT:
- Redo the work for no charge
- Pay another dentist to redo the work
- Refund the money

SIGN A CONSENT FORM
Always, always have the patient sign a financial arrangements contract and a consent form for endo, oral surgery,
perio surgery, ortho and large restorative and denture cases and implant procedures. If it isn’t in writing—signed—by
the patient it is not collectable.

REPORT ANY LAWSUIT TO YOUR INSURANCE CARRIER IMMEDIATELY
The very same day to avoid default

NATIONAL PRACTITIONER DATA BANK
Congress created in 1992 as a confidential clearinghouse for negative information concerning health care practitioners.
If you settle a matter privately the NPDB is not involved.

RELEASING THE CHART
When a patient changes dentist and records are requested, insist on a written release and retain the originals.

PROFILE OF A TYPICAL PLAINTIFF
- 89% of plaintiffs are women. The average dental practice proportion is 60% female and 40% male.
- 91% are over 55 years old
- Often employed in health related fields
- Involves a spouse or a friend who usually bring them to their appointment.
If a person comes to you as a new patient and complains about their previous dentist or several
dentists or says they had a personality clash with their last dentist this may indicate that this patient
will be hard to please.
                                                                                                              27

                                                                                              Toll-Free 1-888-778-3981




How Informed Are You About Consents?

You've been there before. A patient needs a procedure done but doesn't want to know about "the gory
details." If you don't explain everything to him, you know the patient isn't informed about the procedure that
he's just verbally consented to. Do you allow him to simply sign the consent form without any further
attempts of explanation? Can you be held liable for this?

Simple Procedures

As a practical matter, you obtain a patient's informed consent for simple procedures when you explain the
procedure to him before you begin. The patient may then give you express consent or implied consent to
proceed. For example, let's say you're about to take an X-ray. You first explain what you're doing and ask if
he'll let you begin. If he says, "Sure," that's express consent. If he silently offers to go with you for the X-
ray, that's implied consent.

For routine procedures you can assume that the patient implies consent as long as they don't object. But to
be on the safe side, always document the fact that you explained the procedure and that the patient
consented to it-no matter how he gave the consent. Of course, a patient may refuse to submit to a procedure,
or withdraw consent after he's given it. Document his refusal right away.

What if the patient withdraws consent while you're in the middle of a procedure? That's a judgment call. As
a rule, you should stop immediately-unless doing so would jeopardize the patient's welfare.

Invasive or Risky Procedures

Every invasive or risky procedure requires express informed consent, which can come in the form of either
a written or an oral statement. A written statement isn't necessarily required by law (except in something
such as clinical research projects). But many healthcare providers insist on a written statement anyway
because it documents the patient's consent, especially for any invasive or risky procedures.

In most cases, you will inform the patient about procedures either through verbal or written information.
But, how much information should be provided? The law specifies only that you must disclose enough
information for the patient to make an informed choice. As a rule, then, you should explain the patient's
diagnosis, the name of the procedure or treatment, how it will benefit the patient, what risks it involves,
what alternatives exist and what the patient's prognosis will be if the procedure isn't done.

If a legal dispute arises later, the court can measure a dentist's disclosure against the reasonable standard of
care, which is based on what a reasonable dentist would tell a similar patient in a similar situation. As an
alternative, the court could apply the reasonable patient standard, which approaches the issue from a slightly
different perspective: What would a reasonable patient want to know before making a decision?

But what about the original question-are you liable if you accept the signature and perform the procedure
without really informing the patient? In this case, probably not. Any competent adult patient can waive his
right to be informed, and you must respect that decision. But you should tell the patient what risks and
alternatives exist and offer to discuss them if the patient changes his mind. And, of course, always
document the discussion and the waiver in the their file.
                                                                                                            28
Here's another important point: If the patient changes his mind and tells you he wants more information,
you should give it to him immediately. Document his request and talk to him again before performing the
procedure.

Your Responsibilities with Special Circumstances

Here are some special situations that may occur:

    •   Minors
        The parents or guardian must give consent before a minor is treated. If the parents are divorced,
        determine which parent has the right to consent to any treatment and document the facts.

    •   Guardianship
        If a court has formally declared a patient incompetent, a court-appointed guardian of the person has
        the power to make decisions for him. You may be expected to confirm that the guardian has the
        power to give consent for the patient's treatment. If possible, place a copy of the court order
        appointing the guardian in the patient's file and document the guardianship in your notes.

    •   Language Barrier
        The explanation and the consent form should be in the patient's language. Also, consider having a
        translator present during the consent process and document it. Document the translator's name and
        other information on the consent form and in your notes.

The consent process can prevent a lawsuit. But more importantly, it protects the patient's right to make a
knowledgeable choice about his own treatment. By participating in the consent process, you act as patient
advocate while simultaneously meeting your legal obligations. When you follow both the letter and the
spirit of the law, everyone comes out ahead.
                                                                                                             29
ENDODONTIC (ROOT CANAL) INFORMED CONSENT

ENDODONTIC (ROOT CANAL) TREATMENT
I have been made aware of my condition:
_________________________________________________________________________
requiring endodontic (root canal) treatment in the opinion of my dentist. I am aware that the practice of
dentistry is not an exact science, and no guarantees have been made to me concerning the results of the
procedure.
I understand that an alternative treatment might be (but is not limited to) extraction of the involved tooth or
teeth.
I understand that the consequences of doing nothing might be worsening of the condition, further infection,
cystic formation, swelling, pain, loss of tooth, and/or other systemic disease problems.

Some complications of root canal treatment may be, but are not limited to:
 - Failure of the procedure necessitating re-treatment, root surgery, or extraction.
 - Post-operative pain, swelling, bruising, and/or restricted jaw opening that may persist for several days or
longer.
 - Breakage of an instrument inside the canal during treatment, which may be left as is, or may require
surgery by a specialist for removal.
 - Perforation of the canal with instruments which may require additional surgical treatment by a specialist
or result in the loss of the tooth
 - Damage to sinuses or nerves resulting in temporary or possibly permanent numbness or tingling of lip,
chin, tongue, or other area.

Successful completion of the root canal procedure does not prevent future decay or fracture. An
endodontically treated tooth will become more brittle and may discolor. In most cases a full crown is
recommended after treatment to lessen the chances of fracture.

I understand the recommended treatment, the risks of such treatment, and alternatives and the risks of these
alternatives including the consequences of doing nothing. Fee(s) involved have also been explained to me,
and I have had a chance to have all of my questions answered.

Patient Signature _______________________________________________________________
Date _____________________________

Witness________________________________________________________________________
                                                                                                     30
REQUEST FOR REMOVAL OF AMALGAM INFORMED CONSENT

I have requested the removal of my amalgam (silver) fillings. I know that this treatment is completely
elective on my part. I understand that the removal of my amalgams could result in structural damage
to the teeth including, but not limited to:

- Nerve damage or inflammation, possibly requiring endodontic treatment (root canal therapy).
- Cracked cusps requiring full coverage crowns.
- Possible tooth loss.

I understand that alternative fillings to replace my amalgams may be more costly and even less durable.
I understand that any medical condition I have may not be improved or may not lessen as a result of
the removal of my amalgam fillings,
and have not been told by Dr. _____________ that any medical symptom I have will be improved or
lessened.
I understand that the replacement of dental amalgam in a non-allergic patient does not indicate that
Dr. _________________ is of the opinion that amalgam is a health hazard.

I have read and understand the above information concerning the replacement of amalgam fillings. I
have been informed of the treatment, any alternatives (including doing nothing), and the benefits,
fee(s), and risks involved.

Patient Signature __________________________________________________________ Date
_____________________________
Witness_________________________________________________________________
                                                                                                               31
PERIODONTAL TREATMENT INFORMED CONSENT
I authorize Dr. __________________________ and his or her associates, hygienists, employees, and agents to
perform periodontal treatment for me as recommended:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

After a thorough examination and diagnosis, I have been informed of the recommended treatment plan,
alternative treatment, and the benefits and risks involved. I have also been informed of the risks of inadequate
or non-treatment, and the fee(s).
All of my questions have been answered to my satisfaction.

I understand that the practice of dentistry is not an exact science, and I acknowledge that no guarantees have
been made to me concerning the results of my periodontal treatment. A risk of failure, relapse, or worsening of
my periodontal condition may result regardless of
the efforts made during treatment . Additional or re-treatment is always a possibility.
I recognize that long term success depends upon my cooperation and routine maintenance as well.
I specifically authorize my dentist to select alternative methods of treatment based on my condition as disclosed
during the procedures authorized by my execution of this form, including conditions which were unknown at
the time this periodontal treatment began.
I understand that there are substantial risks and consequences that may be associated with any surgical, dental,
diagnostic, or anesthetic procedure.
I understand that not every conceivable hazard can be listed, but that the following possibilities exist, however
infrequent or rare:
· Excessive bleeding ·Pain · Temporary or permanent numbness of the lip, tongue, or other facial area · Jaw
fracture · Swelling · Infection ·Allergic reactions to medications, anesthesia, etc… · Bruising · Gum recession
with “longer” appearing teeth · Exposure of crown margins
· Sensitivity · Food impaction areas · Speech changes

Knowing these risks I consent to treatment:
Patient Signature ___________________________________________________________
Date _____________________________
Witness________________________________________________________________________
                                                                                                                   32
HOME BLEACHING INFORMED CONSENT
Home bleach ingredients are carbamide peroxide, hydrogen peroxide and glycerin. These solutions have been in
use in dentistry for many years, however, they have only recently been used for bleaching. The FDA has
approved the use of peroxide solutions for oral antiseptics, but not as bleaching materials. Some risks involved
with treatment include, but are not limited to:
- hot and cold sensitivity
- a burning sensation in the tissues soft tissue ulcers
- nausea
- jaw joint disorders from the appliance
- sore throat from swallowing solution

Contraindications: Patients with root sensitivity may find the problem aggravated. Persons with allergies to
carbamide peroxide, hydrogen peroxide, and glycerin should not undergo treatment. Pregnant women should
not undergo treatment.

EXPECTED RESULTS
 - As tooth lightening is unpredictable, no guarantee of whitening is made. Most patients find that their teeth
will lighten 1-2 shade on a dentist’s shade guide.
 - Treatment time can vary-although most people see some results in about 5 days.
 - Treatment time is usually 2-6 weeks.
 - Yellow and brown stains usually lighten better than gray or blue stains. Some patient ’s stains relapse after
treatment is discontinued . Tooth whitening effects may last indefinitely or some darkness may reappear.
Periodic re-treatment is generally indicated.

Instructions
- After thoroughly cleaning the teeth, place bleaching solution into the appliance as directed.
- Place the filled appliance in the mouth. Do not swallow excess bleach.
- Wear the appliance________ hours a day. Follow the directions given to you as to the maximum and
minimum amount to time the appliance may be worn.
- Replenish solution every _______ hours.
- Be sure to clean the appliance thoroughly at least once a day.
- Do not wear you appliance while eating.
- If gums or teeth become uncomfortable, discontinue treatment and contact this office.

I have read and understand the above information concerning home bleaching. I have been informed of the
treatment, the fee(s), any alternatives, and the benefits and risks involved. All of my questions have been
answered to my satisfaction.

Patient Signature ________________________________________________________________
Date _____________________________
Witness________________________________________________________________________
                                                                                                       33
ORAL SURGERY INFORMATION AND CONSENT
Prior to your appointment to have your teeth removed you should have a good meal with protein
and vitamin C. Be sure to take the premedication as instructed to help with swelling. Pick up your
pain medication prior to your appointment and bring it with you the day you have surgery.

It is helpful to have someone available to take you home after the appointment and to be on hand
to help you . You will need to lie down and rest the remainder of the day and will be tired for 2 to
3 days up to a week depending on the difficulty of the surgery.

You need to be informed that when third molars are removed there is a slight chance that the nerve
in your jaw can be damaged and you may have temporary or permanent numbness in your lower
jaw or lip after surgery. When upper third molars are removed there is a slight chance that the
sinus may be affected. We will need to see you to remove sutures and observe healing after
surgery.

It is important to refrain from smoking for 24 hours following surgery to help prevent the clot from
dislodging. You will need to eat soft foods for about one week. Refrain from spitting or using a
straw for 2 days following surgery.

You may have some swollen after difficult surgeries. Using an ice pack or frozen vegetables
against the area that is swollen or sore for periods of 20 minutes may help relieve any discomfort.
Use your pain medication as instructed. You should not drive if you are taking narcotic pain
medications.

If taking the pain medication every 3 to 4 hours isn’t enough you may alternate with ibuprofen
(600 mg) 1 to 2 hours after you have taken your pain medication.

I have read and understand the above information. I have been informed of the treatment, any
alternatives (including doing nothing), and the benefits, fee(s), and risks involved. I have had all of my
questions answered.


SIGNED ____________________________________________________________
DATE _________________________________
                                                                                                           34
HOME CARE FOLLOWING SURGICAL PROCEDURES
1. RINSING - Do not rinse or spit for 24 hours; then use warm salt water rinses every 3 hours for the next 7
days (MIX: ___ tsp salt to 1 glass warm water). Begin using hydrogen peroxide (1part) diluted with water
(4 parts) on the third day by holding over surgery site for 1 minute. Do this twice per day.

2. WOUND CARE - Do not place tongue on wound or sutures; avoid smoking or drinking alcoholic
beverages for at least 48 hours.

3. DIET
Eat well - Eat high protein/high calorie soft or liquid foods, avoid small hard foods.
Suggestions:
eggs
cottage cheese
yogurt
warm soups (blend if needed)
applesauce and other fruits
milk and milk drinks
vegetables and other foods as preferred

4. REST - Get plenty of rest – 8 to 10 hours a night and avoid any strenuous exercise for 2 days.

5. SWELLING - Ice pack to face (if flap operation) with pressure; 10 minutes on/5 minutes off, for as long
as 6 hours or remainder of day.

6. PAIN - Take pain medication as directed. If you have been prescribed a pain medication that contains
codeine or a similar narcotic, avoid driving or operating machinery.

7. HEAT: - Use no heat on face.

8. PACK - Hold gauze pressure pack over wound for at least 2 hour(s) after surgery to stop bleeding. If
oozing continues, carefully replace gauze packs
every 2 hours until it stops. It is normal to have some oozing during the first 24 hours after surgery.

9. COMPLICATIONS
There may be some swelling for up to 5 days if a flap was used; this is normal. The following may be
regarded as complications and you should contact us as soon as possible if you have uncontrollable pain,
severe bleeding, marked temperature rise, inability to open mouth,
or excessive hot swelling occurring a few days after the operation.
                                                                                                              35
Endocarditis Prophylaxis Information
If you have congenital heart disease, print out this information and give it to your physician. You can also
download a PDF version of the wallet card. Healthcare professionals: please see below for reference to the
complete statement.

                          PREVENTION OF BACTERIAL ENDOCARDITIS

                                                Wallet Card

 This wallet card is to be given to patients (or parents) by their physician. Healthcare professionals:
                   Please see back of card for reference to the complete statement.

Name:__________________________________________________________________________

     Needs protection from BACTERIAL ENDOCARDITIS because of an existing heart condition.

Diagnosis:_______________________________________________________________________

Prescribed by:____________________________________________________________________

Date:___________________________________________________________________________




You received this wallet card because you are at increased risk for developing adverse outcomes from
infective endocarditis, also known as bacterial endocarditis (BE). The guidelines for prevention of BE
shown in this card are substantially different from previously published guidelines. This card replaces the
previous card that was based on guidelines published in 1997.

The American Heart Association’s Endocarditis Committee, together with national and international experts
on BE, extensively reviewed published studies to determine whether dental, gastrointestinal (GI) or
genitourinary (GU) tract procedures are possible causes of BE. These experts determined that no conclusive
evidence links dental, GI or GU tract procedures with the development of BE.

The current practice of giving patients antibiotics prior to a dental procedure is no longer recommended
EXCEPT for patients with the highest risk of adverse outcomes resulting from BE (see below on this card).
The committee cannot exclude the possibility that an exceedingly small number of cases, if any, of BE may
be prevented by antibiotic prophylaxis prior to a dental procedure. If such benefit from prophylaxis exists, it
should be reserved ONLY for those patients listed below. The Committee recognizes the importance of
good oral and dental health and regular visits to the dentist for patients at risk of BE.

The committee no longer recommends administering antibiotics solely to prevent BE in patients who
undergo a GI or GU tract procedure.

Changes in these guidelines do not change the fact that your cardiac condition puts you at increased risk for
developing endocarditis. If you develop signs or symptoms of endocarditis – such as unexplained fever –
see your doctor right away. If blood cultures are necessary (to determine if endocarditis is present), it is
important for your doctor to obtain these cultures and other relevant tests BEFORE antibiotics are started.
                                                                                                             36
Antibiotic prophylaxis with dental procedures is recommended only for patients with cardiac
conditions associated with the highest risk of adverse outcomes from endocarditis, including:

    •    Prosthetic cardiac valve
    •    Previous endocarditis
    •    Congenital heart disease only in the following categories:

          –Unrepaired cyanotic congenital heart disease, including those with palliative shunts and conduits

        –Completely repaired congenital heart disease with prosthetic material or device, whether placed by
surgery or catheter intervention, during the first six months after the procedure*

         –Repaired congenital heart disease with residual defects at the site or adjacent to the site of a
prosthetic patch or prosthetic device (which inhibit endothelialization)

    •    Cardiac transplantation recipients with cardiac valvular disease

 *Prophylaxis is recommended because endothelialization of prosthetic material occurs within six months
                                        after the procedure.



Dental procedures for which prophylaxis is recommended in patients with cardiac conditions listed
above:
All dental procedures that involve manipulation of gingival tissue or the periapical region of teeth, or
perforation of the oral mucosa*

*Antibiotic prophylaxis is NOT recommended for the following dental procedures or events: routine
anesthetic injections through noninfected tissue; taking dental radiographs; placement of removable
prosthodontic or orthodontic appliances; adjustment of orthodontic appliances; placement of orthodontic
brackets; and shedding of deciduous teeth and bleeding from trauma to the lips or oral mucosa.

Antibiotic Prophylactic Regimens Recommended for Dental Procedures

                                           Regimen – Single dose
                                           30–60 minutes before
   Situation              Agent                 procedure
                                            Adults        Children
        Oral           Amoxicillin            2 gm        50 mg/kg
                        Ampicillin         2 g IM or      50 mg/kg
                                              IV*         IM or IV
Unable to take
                           OR
oral medication
                       Cefazolin or      1 g IM or IV     50 mg/kg
                       ceftriaxone                        IM or IV
  Allergic to         Cephalexin**†            2g         50 mg/kg
 penicillins or
                           OR
 ampicillin –
                       Clindamycin          600 mg        20 mg/kg
                           OR
                                                                                                          37
    Oral regimen   Azithromycin or         500 mg       15 mg/kg
                   clarithromycin

Allergic to           Cefazolin or      1 g IM or IV    50 mg/kg
penicillins or        ceftriaxone†                      IM or IV
ampicillin and
unable to take            OR
oral medication
                      Clindamycin        600 mg IM      20 mg/kg
                                           or IV        IM or IV



*IM – intramuscular; IV – intravenous

**Or other first or second generation oral cephalosporin in equivalent adult or pediatric dosage.
†
 Cephalosporins should not be used in an individual with a history of anaphylaxis, angioedema or urticaria
with penicillins or ampicillin.

Gastrointestinal/Genitourinary Procedures: Antibiotic prophylaxis solely to prevent BE is no longer
recommended for patients who undergo a GI or GU tract procedure, including patients with the highest risk
of adverse outcomes due to BE.

Other Procedures: BE prophylaxis for procedures of the respiratory tract or infected skin, tissues just
under the skin, or musculoskeletal tissue is recommended ONLY for patients with the underlying cardiac
conditions shown above.

Adapted from Prevention of Infective Endocarditis: Guidelines From the American Heart Association, by
the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease. Circulation, e-published April
19, 2007. Accessible at www.americanheart.org/presenter.jhtml?identifier=3004539.

Healthcare Professionals – Please refer to these recommendations for more complete information as to
which patients and which procedures need prophylaxis.

                     The Council on Scientific Affairs of the American Dental Association has
                     approved this statement as it applies to dentistry.
                                                                                                       38
Antibiotic Prophylaxis in Dentistry
Risk Stratification for Infective Endocarditis

High Risk Category - Prophylaxis Recommended
Prosthetic cardiac valves, including bioprosthetic and homograft valves
Previous bacterial endocarditis
Complex cyanotic congenital heart disease (e.g., single ventricle states, transposition of the great
arteries, tetralogy of Fallot)
Surgically constructed systemic pulmonary shunts or conduits

Moderate Risk Category – Prophylaxis Recommended
Most other congenital cardiac malformations (other than above or below)
Acquired valvular dysfunction (e.g., rheumatic heart disease)
Hypertrophic cardiomyopathy
Mitral valve prolapse with valvular regurgitation and/or thickened leaflets

Endocarditis - Prophylaxis Not Recommended
Negligible-risk category (no greater risk than the general population)
Isolated secundum atrial septal defect
Surgical repair of the atrial septal defect, ventricular septal defect, or patent ductus
   arteriosus (without residua beyond 6 months)
Previous coronary artery bypass graft surgery
Mitral valve prolapse without valvular regurgitation
Physiologic, functional, or innocent heart murmurs
Previous Kawasaki disease without valvular dysfunction
Previous rheumatic fever without valvular dysfunction
Cardiac pacemakers (intravascular and epicardial) and implanted defibrillators




Dental Procedure and Endocarditis Prophylaxis
Endocarditis Prophylaxis Recommended*
Dental extractions
Periodontal procedure including surgery, scaling and root
planing, probing, and recall maintenance
Dental implant placement
Endodontic (root canal) instrumentation or surgery only beyond the apex
Subgingival placement of antibiotic fibers or strips
Initial placement of orthodontic bands but not brackets
Intraligamentary local anesthetic injections
Prophylactic cleaning of teeth or implants where bleeding is anticipated
                                                                                                         39
Endocarditis Prophylaxis Not Recommended
Restorative dentistry** (operative and prosthodontic) with or without retraction cord***
Local anesthetic injections (non-intraligamentary)
Intracanal endodontic treatment; post placement and buildup, placement of rubber dams
Postoperative suture removal
Placement of removable prosthodontic or orthodontic appliances
Taking of oral impressions
Fluoride treatments
Taking of oral radiographs
Orthodontic appliance adjustment
Shedding of primary teeth

*Prophylaxis is recommended for patients with high- and moderate-risk cardiac conditions
**This includes restoration of decayed teeth (filling cavities) and replacement of missing teeth.
***Clinical judgment may indicate antibiotic use in selected circumstances that may create
significant bleeding.




Dental Prophylaxis Antibiotic Regimen
(NO FOLLOW-UP DOSE RECOMMENDED)
Standard general prophylaxis:
Amoxicillin
Adults: 2.0 g; Children: 50 mg/kg PO l hour before procedure

Unable to take medications:
Ampicillin
Adults: 2.0 g IM or IV; Children: 50 mg/kg IM or IV within 30 minutes before procedure

Penicillin-allergic:
Clindamycin
Adults: 600 mg; Children: 20 mg/kg PO 1 hour before procedure
OR
Cephalexin* or Cefadroxil*
Adults: 2.0 g; Children: 50 mg/kg PO 1 hour before procedure
OR
Azithromycin or Clarithromycin
Adults: 500 ma; Children: 15 mg/kg PO 1 hour before procedure

Penicillin-allergic and unable to take medications:
Clindamycin
Adults: 600 ma; Children: 20 mg/kg IV within 30 minutes oral before procedure
OR
Cefazolin*
Adults: 1.0 g; Children: 25 mg/kg IM or IV within 30 minutes before procedure
# Total children's dose should not exceed adult dose.
* Cephalosporins should not be used in individuals with immediate type hypersensitivity reaction (urticaria,
angioedema, or anaphylaxis) to penicillins.
                                                                                                    40



Inside the Infection Control Guidelines
Note: The NYSAGD is an approved Infection Control Provider in New York State. Our provider
is Olivia Wann, RDH, BS with Modern Practice Solutions, http://www.modernpracticesol.com/ .
You may find more information on past infection control lectures at www.nysagd.org and go to
http://nysagd.org/view_doc_by_id.php?edit=1&inpage=true&id=187



The Centers for Disease Control and Prevention's (CDC) update of infection-control guidelines for
the dental profession is finally here—and it's big. Everything about it is big. More than 200,000
copies were mailed to dental professionals, dental education programs, state dental boards and
dental laboratories across the country. Linda S. Orgain, MPH, health communications specialist,
says the CDC's Division of Oral Health has been inundated with phone calls requesting additional
information and resources. Even the report itself is super-sized, dwarfing its 1993 predecessor by
more than 75 pages.

Not to worry. Less than a quarter of those pages are actually dedicated to infection-control
recommendations. What makes the 2003 guidelines so much meatier from its previous editions is
the inclusion of nearly 100 pages of research, background material and supporting supplements
from more than 450 articles.

Size isn't the only difference between the revisions. Guidelines for Infection Control in Dental
Health Care Settings—2003 is the latest word in infection control in the dental office.

It features contributions from hundreds of experts from dozens of health-care fields to provide
evidence-based recommendations for everything from staff education and management to the
efficacy of alcohol-based hand rubs.

“These recommendations represent a consensus of experts in infection control regarding strategies
for the prevention of disease transmission in dental health care settings,” the CDC stated. “Because
transmission of infectious agents should be similar in dental and medical settings, pertinent
sections of infection-control recommendations from other CDC guidelines have been included
where applicable. There also is a new section on research considerations.”

It's hoped that the overhauled guidelines will provide dentists a clearer understanding of why
certain recommendations were made. “Proper infection-control procedures can prevent
transmission of diseases to patients and dental health care personnel,” said William G. Kohn, DDS,
associate director for science in the CDC's Division of Oral Health. “This new document provides
the latest information to assist the dental profession in maintaining its already strong record of safe
dental care.”

Admittedly, it's a huge amount of information—remember, 100 pages—for a busy GP to sift
through, much less implement. AGD Impact is providing the low-down on the guidelines and
highlighting the organizations offering resources and navigation to ensure your office isn't left
behind.
                                                                                                      41

Inside the guidelines
Broadly, the guidelines are divided into two parts. The first (and longest) half is dedicated to the
evidence—the clinical studies, background information, and evidence-based rationales behind the
recommendations. The CDC included this information because of demand in the dental profession.

“A lot of people within the profession were asking for more information on why we were
recommending certain things [in the guidelines],” says Jennifer L. Cleveland, DDS, MPH, a dental
officer and epidemiologist at the CDC's Division of Oral Health. “I think that with the rationale
included in the guidelines it becomes more acceptable to the dental community and it enhances
their understanding of the guidelines.

“One of the things these guidelines did, was to make it science- and evidence-based. What this
does, it allows people to look at the why; not just the what,” says John Molinari, Ph.D., chair, of
Department of Biomedical Sciences, University of Detroit Mercy School of Dentistry.

The second half of the report comprises the actual guidelines. According to the CDC, much of
what is recommended is already familiar to dentists. “Dentists are already familiar with and
routinely use most of the recommendations such as barrier techniques to protect against blood
borne disease transmission,” says Daniel M. Meyer, DDS, associate executive director, American
Dental Association (ADA) Division of Science.

Some recommendations are new, but most carry over from 1993, and others were integrated from
other infection-control reports, such as the CDC's hand hygiene and needle-stick guidelines and the
Occupational Safety & Health Administration's 1991 blood-borne pathogen standard.

Some of the new recommendations include:
• Using standard precautions rather than universal precautions.
• Work restrictions for health-care personnel occupationally exposed to or infected with infectious
  diseases.
• Management of occupational exposures to blood borne pathogens, including postexposure
  prophylaxis.
• Latex hypersensitivity.
• Dental water quality.

Notable about the 2003 guidelines is the participation of experts in other health care fields. “The
1993 guidelines were written by CDC staff. We wanted to include more outside experts in the field
and other agencies that could participate in the writing and compilation of the background
material,” Dr. Cleveland says.

Each recommendation is supported by evidence, then ranked according to the level of evidence.

From an infection-control consultant's perspective, the guidelines should make it easier for dentists
to discover what's needed to achieve good infection control, using specific policies and procedures,
and backing it up with research and cited studies.

“It's a very comprehensive document. The 1993 guidelines didn't have that and I think it left a lot
of people with questions on how to implement these recommendations,” says Mary Govoni, RDH,
an infection-control educator for more than 11 years, based in Okemos, Mich. “The groups that
I've spoken to are excited to know that everything is in one comprehensive document.”
                                                                                                 42


Navigating the guidelines
The CDC Web site offers dentists several resources to help navigate the guidelines, including
frequently asked questions, fact sheets, and links to related infection-control articles and
guidelines.

To further assist dentists, the CDC joined in a cooperative agreement with the Organization for
Safety & Asepsis Procedures (OSAP) to develop a comprehensive workbook that offers a specific
interpretation of the guidelines for the dental team. According to OSAP Executive Director
Therese Long, “We think it's going to be a tremendous aid to clinicians in understanding the
guidelines.” (For information on how to obtain the 2003 guidelines and the OSAP workbook, see
sidebar on page 15.)

The ADA is offering its members a “roadmap” to the guidelines through its Web site, and a
continuing education course.

Still, the document does run more than 100 pages, which is a lot of information for a busy
practitioner to get through. Services are available to help dentists understand and implement the
guidelines in the dental office. “Get somebody to help you. Hire a consulting service. I think a lot
of dentists see the guidelines as so comprehensive they don't know where to begin,” says infection-
control consultant and lecturer Harold Edelman, DDS.

Implications
Though the CDC lacks regulatory and enforcement powers, the guidelines are de facto regulations;
they are the template from which most states legislators and local dental boards draw their various
laws and rules.

Thanks to advances in technology and better infection-control practices, infection control has come
far in dentistry. Infection-control experts say most practitioners are eager to comply with new
polices and regulations, but too many general dentists do not understand that infection control is
not static; it needs to be regularly updated.

Dental professionals have an outstanding record in infection control, Dr. Cleveland says.

Unlike group settings, such as hospitals, where infection-control updates and training are closely
monitored and enforced, most GPs own and operate their own practices and hire and maintain their
own staff. In a solo practice, it is easy to lose track of threads of new information from entities,
like OSHA and the CDC.

“The CDC believes that dental offices that follow these new recommendations will strengthen an
already admirable record of safe dental practice,” Dr. Kohn says. “Patients and providers alike can
be assured that oral health care can be delivered and received in a safe manner.”
                                                                                                   43

Employment Options: What to expect as an associate -
For many new dentists associateship is first step toward ownership
Long hours. New surroundings. Staggering debt.

Nearly 4,000 students will graduate from dental schools this year, and according to a 2002 survey
by the American Dental Association (ADA), more than 74 percent of those new dentists will begin
their careers as associates. The reasons for this are twofold: opening up a solo practice is expensive
and by working as an associate, young dentists are able to gain valuable experience and save
money at the same time.

The transition from the comfortable cocoon of the classroom into private practice can be nerve-
wracking for a new graduate. One young dentist interviewed joked that it’s like “being thrown to
the dogs.” Although students spend the latter part of their schooling working on patients in clinical
settings, nothing can quite prepare you for when you’re on your own for the first time.

“I can still remember my first patient, my very first day,” said Jason Hartman, DDS, a 2000
graduate from the University of Michigan School of Dentistry. “I was by myself because [the
owner] was on vacation and I was sweating bullets. You learn quick.”

Dr. Hartman, who now practices in Bay City, Mich., knew early on he would work as an associate
after graduation.

“I didn’t feel like I was ready to get up and buy a practice or open one on my own,” he said. “I
wanted someone to show me the ropes, not only in dentistry, but on the business side as well.”

Dr. Hartman’s reasoning is common. Many dental students rely on student loans to put them
through four years of schooling. According to an ADA survey the average debt in 1998 was
$84,000, not including undergraduate loans. The thought of accruing more debt is daunting.

“To start a practice just out of school was too scary,” agreed Eric Bloom, DDS.

Although Dr. Bloom recently opened his own practice in Illinois, he continues to work part time as
an associate. Since graduating from the University of Iowa College of Dentistry in 1997, he has
worked nonstop for several practices, including a stint at a managed-care company. In all, he
works six days a week between the two practices, usually 10 or more hours a day. While he’s
ecstatic about his own practice, Dr. Bloom said he recognizes the positives of working for an
established business.

“There’s security there,” he said. “The practice I’m working in [part time] is very busy so I always
know my schedule is going to be full. We have three hygienists and you stay busy. You know
you’re going to get paid and I’m getting paid on production, so you like to be busy.”

Dr. Bloom has also had the benefit of working for a dentist that helped him get started.

“He’s a great guy and you could always ask him questions and he’d give you the answer,” he said.
“I’m lucky to have somebody who’s been through it before and who helps me avoid some pitfalls.”
                                                                                                      44


On the downside, associates sometimes find themselves conforming to their owner’s ways before
developing a technique of their own.

“You have to use the materials and supplies that that dentist uses,” Dr. Bloom said. “You have to
do the procedures they do.”

It takes time
John Gammichia, DMD, is a recent owner. He became partners with his father about four months
ago. Dr. Gammichia toiled as an associate for eight years before becoming an owner. In the
beginning, he remembers feeling discouraged when he would talk to an old classmate or read
something in a publication where new graduates we’re talking about how great everything was.
Meanwhile, he was thinking to himself, “this is not as easy as I imagined.”

Those experiences prompted him to begin lecturing on the subject.

“People are going to dental school and they have no idea what it’s all about,” he said. “I had just
survived my fifth year of practice and remember sitting back in the office and thinking about what
a huge, roller coaster ride I had been on. One of the reasons I was lecturing was to let young
dentists know that the light at the end of the tunnel was indeed a train coming at them.”

Dr. Gammichia now travels about 15 times a year to speak to dental students and young dentists
about what to expect during the first five years out of school. He said he knew “maybe one person”
who scored a home run with their first associateship.

“I’m out eight years and I’m still struggling. I heard someone say that they put 26 units in and it
was a piece of cake. For me, that’s like 60 appointments. Now, when I hear someone say that, I
know there is a possibility they could be stretching the truth.”

Dr. Gammichia suggests keeping in touch with classmates or joining dental study clubs as ways of
coping with the transition.

“The hard part is balance because now I have a family,” said Dr. Gammichia, who is married with
three children.

Plan ahead
Chris Chung is a third-year student at the University of California School of Dentistry-San
Francisco. Despite being more than a year away from graduation, he already knows he will enter
the workforce as an associate in 2005.

“I’ve weighed the options and starting my own practice is just not financially feasible,” he said. “I
want to build up my speed. The time we get in school isn’t enough for you to be confident to do all
the various kinds of procedures that a general dentist needs to be able to do.

Mr. Chung expects the grunt work to continue as an associate and said he is willing to “work his
way up” in a practice. He hopes to earn a salary based on production, rather than a flat fee, so that
he will be motivated to perform.
                                                                                                   45


“Ideally it would be great to get an associateship where I can build a practice within a practice,” he
said.

Of course, not everyone becomes an associate after graduation. Kim Rauk, DDS, completed her
degree in 2003 at the University of Minnesota. Although she considered working as an associate,
more and more she found herself leaning toward opening a solo practice.

Dr. Rauk, who is from a small Minnesota town, knew she wanted to practice dentistry in a country
setting. But when she started inquiring at various dental practices in rural areas, she found no one
interested in taking on a partner or selling their practices.

So in January she opened her own practice.

“A lot of my classmates are asking me, ‘how did you start?”

“I always knew I was going to leave the metro area,” she said. “My husband and I are both from
smaller communities and we knew we eventually wanted to live in the country. We thought we’d
have to stay in the city to make some money the first year…but this has worked out.”

Dr. Hartman plans eventually to own his own practice, but is in no hurry to do so now.

“I enjoy working as an associate,” he said. “There are some days when I wish I had my own
practice, but I can go home and not worry about paying the bills.”

He especially enjoys having another dentist there if the patient requires a second opinion.

“We have an interesting relationship. Even though there is an age difference (Hartman’s boss is
56) we share the same practice philosophy,” he said. “We do some things differently, but he does it
his way and I do it mine. We rarely disagree.

Dr. Gammichia stresses to young dentists to take pride in their work as they slowly build a
reputation.

“You don’t have much except your signature,” he said. “I don’t care how young you are, you’re
building a reputation. The smallest thing you do, take pride in it because there’s a lot of people you
don’t know that will see your work. I felt really honored when my lab technician referred his wife
to my office. All because I spend that extra couple of seconds making the prep and impression
right on.”
                                                                                                 46


• Making the Move That's Right for You
The ABC's of getting started in practice and the key considerations involved in purchasing the
practice that's best for you.



NYSAGD’s Externship Program
Join an AGD member in his or her office, clinic or hospital for a week in the summer. Learn first
hand of the life of a dentist in their practice. Also, learn about the importance of the AGD and
how you may reach your goals.

All you need to do is fill out the application and email or fax to our office.
                                                                                                     47
Practice Management, Creating a Practice Vision
The 'vision' thing
Success depends on knowing who you are
You've graduated school and are excited about practicing dentistry.
Now what? Do you:
Open your own practice?
Work as an associate?
Enter public health or academia?

Most importantly: why?

Even if you have been in practice for a while, considering the type of dentistry you want to
perform-and why-will help you focus your practice, meet the needs of your patients and ensure
success on your terms.

"The first thing we teach in coaching any kind of practice is to redefine the vision and mission,"
said Dru Halverson, a practice management consultant for Jameson Management in Davis, Okla.
"Every goal they set from that point on needs to reflect the vision they have. If not, that project is
for naught."

Vision is a foundation for constructing your career, not just five or 10 years out, but as long as
you remain a dental professional, says Ms. Halverson. In case you need reminding, it tells you
who you are and what you are about.

"Once [new dentists] get out of school, they tend to relax and think "I don't ever have to study
again," Ms. Halverson said. "But what they need is to shift from clinical skills to management
skills. They need to eat up every book, every tape, every course they can go to and learn about the
business of dentistry."
John Gammichia, DMD, has been in practice for seven years. Fresh out of school he joined his
father's practice two days a week. To fill the remaining three workdays, he needed to find an
associateship. He joined a practice, but did not research its background. It turned out that the
practice had only the bottom line in mind and no philosophy of treatment. It was a good lesson
learned.
Next, he worked for an established dentist who wanted to open a satellite office. Dr. Gammichia
soon realized that meant essentially starting up his own practice because he had to recruit the
patients for the new office on his own, another good learning experience. The third associateship
was in a capitation-fee based practice. While it helped him build up procedural speed, he soon
became disgruntled with "doing a filling every 10 minutes."
Now in full-time partnership with his father, Dr. Gammichia said during each associateship he
learned just what kind of dentist he wanted to be. Sharing the same philosophy of practice with his
father, he can accomplish their mutual goal of "treating people right" while doing the best
dentistry.
                                                                                                     48


As a graduate of the Pankey Institute, he realized balance, specifically Pankey's "cross of life,"
which illustrates the importance of balancing work, worship, play and love to achieve what is in
the middle-joy.

Nathan Redmond, DMD, a member of the Academy of General Dentistry (AGD) Council on
Dental Education, said he willingly lived in his parents' basement during dental school in
Alabama, his home state, entered a general practice residency after graduating last June and now
is in the midst of planning a startup.

His vision all along, he says, was to practice without "anybody else's fingerprints on it." He
believed that buying into an existing practice would force him to adopt a practice philosophy that
he might not share. "This is allowing me to practice my own style that fits with my vision," he
said.

Dr. Redmond, who plans to practice in the next town over from where he grew up, believes that
through thoughtful planning, potential problems can be averted. "I talked to a lot of dentists, both
younger and older, to look at their struggles and learn from their mistakes," he said. That has
helped him to better understand the process involved in obtaining the knowledge and skills
necessary to carry out his vision.

More knowledge needed

As Ms. Halverson puts it: "Many people know the information, but don't know how to implement
it into their practice. There are always things that can get in the way of great dentistry, but if you
have great vision and great skills it will all come together. You have to work at that always-you
have to be a lifetime learner. You can never think you've arrived and don't have to work at it
anymore."

Dr. Gammichia thinks continuing education from graduation on is essential in shaping a practice
vision. Many students he has encountered really don't know what kind of dentist they want to be
or what kind of practice environment would fit with who they are. Some don't even know who
they are, which can translate to a lack of confidence out in the real world.

"I was as green as they come," he says now. "I had been to one dental office before I decided to be
a dentist and that was my father's. Probably most dental students are familiar with one or two
practices and don't even know the types of dentistry that are out there." It's a far more complex
practice environment than it was when America was still awash in caries. Hanging your own
shingle was a fait accompli once you graduated and new technology still meant high-speed,
turbine-driven hand-pieces.

"A dentist's success," Ms. Halverson said, "used to be very narrowly defined. It was about the
amount of money, the number of patients and the number of gadgets. I don't know a lot of dentists
who are wealthy and they probably never will be. It's somewhat of a struggle for them throughout
their careers, so they need a sense of pride.
                                                                                                     49
Finding reality

A third new dentist, David Caggiano, DMD, a member of the AGD Council on Membership,
exhibits the candor and introspection that also seems to permeate the philosophies of Drs.
Gammichia and Redmond. Willing to take a hard look at himself, he readily admits that he would
have been better off working out an 18-month associateship with a practice that featured "high-
end cosmetics and full mouth reconstruction." But he says he became frustrated with the drawn
out negotiations through a dual representation broker and gave up.

"Looking back, I should have worked it out, stayed there for a year-and-a-half and then I could
have broken free," he said. It was a bad business decision because the practice profile would have
afforded some valuable experience. He is looking again. While he received a "great financial
deal" with his current position, "it's not worth it. Money's great but you have to weigh so many
other things when working with someone else," he said.

"It takes a lot of time to look for a position in dentistry and you have to be careful with what you
are looking for," he said. "You want to find a job with someone who is willing to take you under
their wing-and those are hard to find."

"I see many new dentists going into practice and leasing the Mercedes they always wanted. They
think they should reward themselves, but trying to go right from school into private practice
without getting additional training is tough." He adds that practice isolation, inadvertent or not,
can be deadly and lead to quick burnout.

Real education

"Something I hear all the time and it's very pertinent, is that I'm older for a new dentist. I
graduated at 29 and most of my classmates were 24. When you're younger, you probably don't
anticipate when treating patients that a complete stranger might look at you as a kid and is going
to question everything you do. You really need the skills and the experience to be confident, and
being confident is important. Let's face it, you're a salesman too," Dr. Caggiano said.

Dr. Gammachia has learned the hard way that practicing with confidence is key. He means true
confidence, not bravado. "If you don't have it, you can get chewed up and spit out," he says.

Dr. Redmond said despite the high debt with which many graduates are saddled, it may be a big
mistake to take a relatively high paying job out of school because you believe it's payback time. In
fact, he says, a solid vision for the way you want to practice could well involve going into further
debt because the "number one thing you have to have on hand is working capital for a business
plan and other needs. If you don't have the money to pay bills while you're waiting on payments
from insurance companies, you could come up short very quickly and the creditors start calling."

Ms. Halverson notes that many lenders will gladly build in the cost of a practice management
consultant because it "makes more sense to the bank" and so, is a risk the lender is more willing to
take.

"Happiness is going to come from how you treat people. You don't need to weigh yourself against
the dentist across town making twice the amount. You can end up doing dentistry you're not proud
of and doing it on people who more or less trust you blindly,"
                                                                                                             50



Key Management Ratios to Gauge Your Practice's Health
Dr. Blair’s nationally-acclaimed Profits Plus program computes over 100 different statistics for each
participating doctor’s dental practice and provides industry benchmarks for comparison purposes. Having
reviewed over 200 practices to date, he lists the following benchmark ratios as those that provide the
greatest keys to improving profitability in most practices.

   1. Fee Profile – Most doctors have no idea where their fee schedule stands in relation to other dentists
      in their local area, says Blair. His experience shows that most dentists operate with a schizophrenic
      fee schedule, with some fees below the 50th percentile (managed care), some fees above the 95th
      percentile, and the remaining fees all across the board. Using zip code specific fee data for each
      participating practice, Dr. Blair provides an analysis setting forth the fees for each ADA code at the
      50th, 75th, 85th, 90th, and 95th percentiles for that doctor’s zip code.

       The first step doctors should take in order to improve their profitability is to simply set their fees in
       a rational manner, says Blair. He recommends that doctors select a fee percentile appropriate to
       their practice and the quality of care they are providing; once selected, all fees below that percentile
       should be moved immediately to that specific percentile. Any fees that are already above the
       selected fee percentile would remain at their current level. This results in a fee schedule that is
       fairer to the doctor, patient, and insurance company alike, says Blair. This fee analysis, and related
       procedure mix consulting, has produced dramatic results for his Revenue Enhancement Program
       participants, with an average increase in practice profitability of over $66,000 annually.

   2. Collection Rate – This practice ratio is simply the percentage of collectible production actually
      collected by the practice. Most practices report a collection rate of 96-98%, with 97% being the
      most common percentage. Practices with a below-average collection rate should examine their
      over-the-counter (at time service is rendered) collection rate, increase use of credit cards and third
      party payment options, and review and enforce their collection policies, says Blair.
   3. Conversion Rate – This ratio measures the doctor’s ability to persuade patients to accept treatment
      where treatment is recommended. This is simply the actual production divided by the total
      production recommended. In general dentistry, pedodontics, and endodontics, the conversion rate
      averages over 90%, says Blair. In other specialties such as periodontics, oral surgery, and
      orthodontics, the average conversion rate is lower, with orthodontics being the lowest, around 70%.
      Doctors should track not only their performance against the industry benchmark, but also their
      practice’s progress over time to see if they are improving. Adequate training for the doctor and staff
      in case presentation, and providing flexible patient financing are the keys to improving a below-
      average conversion rate, says Blair.
   4. Revenue Per Full-Time Employee – This benchmark measures the practice’s labor efficiency. It is
      determined by dividing the annual practice collections by the number of full-time staff, excluding
      lab employees and doctors. Blair says that most practices’ annual revenue per full-time employee
      falls in the $90,000-$130,000 range, with $110,000 being the average. Doctors below the industry
      benchmark may be suffering from overstaffing, an under-producing staff and/or doctor, and/or a
      low fee schedule.
   5. Revenue Per Full-Time Business Employee – If the prior benchmark indicates a labor problem,
      it’s important to look closer into each of the three component areas (clerical, chairside, and
      hygiene). This ratio is determined by dividing the average monthly revenues for the past twelve
      months be the number of full-time employees in the clerical (front desk) area. Blair says that most
      practices are in the range of $25,000-$35,000 of revenue per month per full-time clerical employee,
      with an average of $30,000. Practices below the industry benchmark may be overstaffed in the
      business area, have underproductive employees, or inadequate revenues due to low fees or
      production, says Blair.
                                                                                                           51
    6. Monthly Revenues Per Chairside Employee – This benchmark determines the labor efficiency of
       chairside employees and is calculated by dividing the monthly practice revenues by the number of
       full-time chairside employees. The average revenues per full-time chairside fall in the range of
       $15,000-$20,000 for most practices, with an average around $17,500. Below-average practices may
       have overstaffing, low fees, poor production mix, and/or inadequate doctor clinical speed.

        Blair says that most practices with labor problems can trace them to the hygiene department.
        Accordingly, he places greatest emphasis on statistical measurements of labor efficiency in this area
        of practice, using the following three benchmarks:

    7. Annual Revenues Per Full-Time Hygienist – This ratio determines the overall productivity of the
       hygiene department and is calculated by dividing the annual hygiene revenues by the total number
       of full-time hygienists. Most practices fall within the range of $90,000 - $110,000 of revenue per
       full-time hygienist, with the average being $100,000. Below-average production can result from
       poor scheduling, inadequate procedure mix, excessive broken appointments, or slow clinical speed.
    8. Adult Propy to Perio Procedure Mix – This statistic measures the percentage of total hygiene
       department production from adult prophys and perio related procedures. Most general practices are
       reporting a mix of 75% adult prophy revenue and 25% perio procedures from their hygiene
       department. A lower percentage of perio procedures usually indicates insufficient soft tissue
       management production due to lack of training, proper scheduling, coding errors, or inadequate
       diagnostic abilities.
    9. Ratio of Hygiene Production to Total Compensation – This is the most accurate measure of the
       hygienist’s worth to the practice, and is calculated by dividing the total production of each hygienist
       (excluding doctor exam fees) by that hygienist’s total compensation (includes salary, bonuses,
       payroll taxes, and fringe benefits). Blair says that while most practices desire a 3:1 ratio here, the
       average ratio is around 2.5:1. The problem here can be either underproduction or
       overcompensation. This can be attacked on either front by revising the compensation formula to a
       percentage of total production, or increasing production through better scheduling, expanded hours,
       or increasing the mix of soft tissue management procedures.

        Using over 100 statistical parameters to analyze each doctor’s practice, Dr. Blair has determined
        that the average practice is losing over $100,000 in profitability annually to management errors that
        are fairly easy to correct. So take time to analyze your practice – it will be one of the best
        investments that you ever make!

Reprinted with permission from the Blair McGill Advisory. The Blair McGill & Hill Group, LLC specializes
in financial consulting for the dental profession. For information on subscriptions or consulting, call (704)
424-9780.
                                                                                                               52



Marketing savvy
The best laid plans can build your patient base
Word-of-mouth may be the most effective and least expensive way to find new patients, but it's not the only
tool at your disposal. Many inexpensive strategies exist for you to put in place, and will leave a good
impression on your patients. The important thing to remember is to be proactive about marketing your
practice. Take the time to learn what your patients want and develop a strategy to meet those needs. While
some ideas are listed below, be creative and have fun doing it.

Make a plan

You wouldn't start work on a patient without mapping out a course for treatment, so don't just try out new
strategies as you think of them—devise your marketing plan beforehand.

Before you start an external marketing campaign or spend money on advertisements, start with your internal
marketing strategies, says Stephen J. Persichetti, DDS, FAGD, Portland, Ore. These include answering
telephones politely, being punctual for your patients, providing easy-to-read bills and statements, and
providing proper follow-up care. “If you make your patients happy, they will talk about you to their
friends,” Dr. Persichetti says.

Staff chemistry can make or break you. If the staff works together well and enjoys each other's company,
patients will be put at ease. Patients can sense when there is unrest in the office, and they won't want to
return to a hostile environment.

If a patient is happy with the service he or she has received and says so, ask them to refer new patients to
your practice. “If you like having a certain patient in your practice, tell them, and ask if they have any
friends they might like to refer,” Dr. Persichetti says.

When implementing marketing strategies, it is important to evaluate whether they are successful. One way
to do this is investing in practice-management software. Melvin Pierson, DDS, opened his Sicklerville, N.J.,
practice in the fall of 1999, with no patients; he now has more than 5,000. He says dental software allows
him to track how patients find his office (word-of-mouth, a telephone directory, print advertisements, etc.)

The software evaluates which marketing tools (direct mailers, newspaper ads, etc.) yield the greatest
returns, helping you determine your best marketing source. Less expensive programs, like Microsoft Office,
which includes Excel, will allow you to create spreadsheets that track referrals and marketing plans.

Be creative

Your marketing strategy can be as unique as your office—don't be afraid to try something a little different.
One effective marketing tool Dr. Pierson uses is something he calls PiersonBucks, generic-looking signed
checks worth $50. This can be used toward paying off a bill or receiving a free whitening. If one of Dr.
Pierson's patients refers a new patient who makes an appointment, the referring patient receives a
PiersonBuck. “It's very effective and easy to explain,” Dr. Pierson says. PiersonBucks even have several
spin-offs, including gift certificates to local restaurants or movie passes. “We tell them, refer six patients
and get a free whitening treatment.” With so many elective and cosmetic procedures not covered by
insurance, Dr. Pierson says the PiersonBucks have been very successful in bringing—and keeping—new
patients into the office.
                                                                                                              53


Know your community

Be aware of your patients' general income level and demographics and tailor your marketing plan to fit their
needs. If you practice in a working-class community, your patients may be less interested in cosmetic
dentistry and full-mouth reconstruction than in a more affluent neighborhood.

If you have a large non-English-speaking patient base, you may want to hire multi-lingual staff members.
Patients will feel more comfortable talking about dental and health issues in their native language,
according to Neil J. Gajjar, DDS, who practices in Mississauga, Ont., Canada. Dr. Gajjar's staff speaks five
different languages. “Speaking the same language as the patient automatically makes them feel more at
home,” Dr. Gajjar says. “We notice that patients book appointments when that particular staff member is
working.”

If you have a large number of patients of a certain religion or ethnic group, you might wish to tailor your
office design to those principles, such as Feng Shui or Vastu Shastra, to make those individuals feel more
comfortable in your office.

Getting involved in your community is another way to spread your name around. Sponsor local youth sports
teams, perform community service, or offer free screenings for local charity groups. “People like to see
their dentist at functions and events,” Dr. Gajjar says. “Plus, it will remind them that they need to visit you.”
Offer your time and service at school health fairs or sports screenings, and turn kids into mini-marketers by
sending them home with magnets, toothbrushes or business cards. Dr. Pierson says, “It's more worthwhile
to give up an hour of your time doing that than to run an ad that costs two or three times [your hourly
earnings] and might not get you any patients.”

Get personal

Make your patients feel that you care about them personally. They will remember acts of kindness before
all the freebies. Sending birthday cards and remembering important events will make patients feel that
you're individually invested in them. “Patients will remember that personal touch,” Dr. Pierson says.

And while you keep tabs on your patients, you should keep them up to date about you and your practice.
Through a newsletter, tell patients about new skills or new technology or employees you hire—anything
about the practice.

Offer conveniences

Your patients are busy, just like you, and they may not come back if you waste their time. But patients will
remember when you made their lives easier. In addition to installing radios or televisions in each operatory,
consider adding wireless Internet access in the waiting room and operatories, allowing patients to surf the
internet. Remind your patients about their appointments through e-mail, so they can easily enter those dates
into a personal data assistant (Palm Pilot).

Allow your patients and potential patients to find more about you by creating a Web site. Potential patients
who are looking for a dentist will find you through search engines, says Dr. Gajjar. If you create a Web site,
make sure it has an easy address to remember (like www.drjones.com) and that it will be picked up by
major search engines like Google and Yahoo. And if you don't feel comfortable designing a Web site
yourself, contact a local Web developer. The AGD has developed “Member Web pages” which allows you
to create one page of information about you and your practice. It can be customized and then set up to link
to your site. Go to http://www.agd.org/members_only/login/ (members only).
                                                                                                          54
Beyond the Yellow Pages

A large ad in the Yellow Pages is an expensive route to take and typically doesn't yield as much of a return
as other forms of advertising. If you must, Dr. Persichetti suggests making the ad no larger than a business
card.

Other print ads may be even more effective. A recurring ad in the local newspaper keeps your name at
potential patients' fingertips every time they read the news. They may forget radio or TV ads, but they will
look through a newspaper or magazine when searching for a dentist. Dr. Pierson writes informative articles
about periodontal disease and other dental problems in the local newspaper. Dr. Gajjar has been successful
in advertising in bridal magazines. “So many men and women have come to us for whitening prior to their
wedding,” he says.

No matter how you choose to market your practice, be sure to create a plan that suits your own personality
and attitude. Set yourself apart from the rest of crowd, but don't compromise care, integrity or your
practice's identity.




Put your plan in place
Marketing dos and don'ts for your office

    •   Keep it simple. If you can't explain your referral program in a few sentences, then it's too
        confusing for patients to remember.
    •   Beware bargain hunters. Complimentary cleanings or whitening treatments may get
        patients in the door, but many will just be looking for the best deal or to spread their dental
        bill around several offices. They won't be the long-term patients you want to attract.
    •   Don't promise more than you can deliver. Patients may come to expect free gifts all the
        time if you shower them with specials and freebies. It's the service and care you give that
        should keep them in your practice.
    •   Ask for help if you need it. If you don't feel comfortable coming up with a marketing plan on
        your own, enlist the help of a marketing or practice management consultant to generate
        ideas and action. But be careful to make sure that the plans they devise fit your needs and
        goals for your practice.
                                                                                                            55
Patient Financing - Getting to 'yes' with CareCredit
Your constituent members didn't become dentists because they love dealing with finances. But dentistry
may feel like a career in banking when it comes to billing and collecting payment from patients.

To help remove that stress and increase patient acceptance, the Academy offers its members patient
financing through CareCredit. By handling credit and payment issues, CareCredit allows you and your
patients to focus on treatment, removing potential stressors from the doctor-patient relationship by ensuring
affordability for the patient and up-front payment for you. And for constituent officers, the program can be
a great recruitment tool.

Dental practices that offer practice-financed time payments to patients could be draining hard-earned
profitability. Nonpayment is always a possibility. And then there are the cost and hassle involved in
collections, and the likelihood that patients won't return once they owe money to a practice.

Offering patients a financial solution can help increase production by as much as 48 percent, especially for
treatment plans with a significant out-of-pocket expense. Studies show the average person only has $300
available credit on his or her consumer credit cards and can't write a check for more than $500 out of
monthly cash flow.

"A primary reason people either don't come to the dentist or don't say "yes" to treatment is cost. They're not
saying, 'I don't want the dentistry.' They're just saying, 'I need a way to pay for it'," says Cathy Jameson,
president of Jameson Management Inc., an International Dental Lecture and Consulting Firm.

CareCredit offers Academy members interest free payment plans for three, six or 12 months, low minimum
payments and revolving lines of credit for additional treatment or add-on charges, without the need to re-
apply. CareCredit also offers an extended payment plan for higher-level treatment fees from $1,500 to more
than $25,000. The extended payment plan has low interest rates, and terms can be extended. It is one of the
lowest monthly payments available.

"I believe that CareCredit is largely responsible for increasing patient acceptance of needed treatments that
have been delayed or not done at all," says Ian E. Shuman, DDS, FAGD. "It has also helped eliminate
billing from the practice, allowing me to care for people and practice dentistry, not banking."

CareCredit will supply your practice with high-quality promotional materials designed to increase treatment
acceptance and to effectively present the financing program.

CareCredit has assured Academy members an easy process. Your patients will fill out a short credit
application via automated phone system, fax or online, and they will receive a quick credit decision. Online
applicants receive a response within minutes. Patients will receive a convenient, monthly payment for
comprehensive treatments or procedures. To enroll in CareCredit's patient financing program or to get more
information, go to http://www.carecredit.com/jumppage/agd/ or call 800.300.3046, ext. 4519 (new
enrollment) or 800.859.9975 (already enrolled).
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Additional Articles are available as follows:


• Getting Off to the Right Start in Your New Practice
Anticipating and responding effectively to day-to-day situations can help you get off to the right
start in building the kind of practice you've always wanted.

• Retaining Patients: Ten Tips for Success
Ten tips for assuring a smooth transition of the seller's patients to you, the owner of the new
practice.

Reprinted by permission of Countrywide Practice Brokerage Inc. Martin and Risë Mattler are
principals of Countrywide Practice Brokerage Inc., a Manhattan-based firm specializing in the
appraisal and sale of dental practices. For further information about getting started in practice, contact
them at ctrywide@optonline.net or call 800-222-7848.




Another guide if you want!
AGD Student and Recent Graduate Transitional Manual
Transitioning into your dental career isn’t always easy. That’s why the AGD partnered with
Dentist’s Advantage to give you the student manual You’ve Graduated, Now What? This manual
provides you with instant access to all of the practice management tips that you may not have
learned in dental school, such as goal setting, financial planning, and marketing, along with
printable worksheets to keep you on track! This invaluable resource is now available for
download*.

* Save this file to your desktop, and then extract all files to view the manual.
* Adobe Reader 7.0 or higher is required to view this manual.
                                                                                                    57
Distinguish Yourself in Dentistry!

Become an Academy of General Dentistry (AGD) Fellow

If you're seeking the best opportunity to distinguish yourself professionally through quality
continuing education, consider Fellowship in the AGD. Attaining Fellowship is a rigorous process
that requires three years of membership in the AGD, passing an exam, and culminates with receipt
of an award at the convocation ceremony held each year at the AGD annual meeting.

Membership
To be eligible for Fellowship, you are required to maintain three years of continuous membership
within the AGD. Your eligibility extends to September 30 of the year of the convocation for which
you apply. To join the AGD, fill out an application, e-mail membership@agd.org, or call
888.243.3368, ext. 5300.

Fellowship Exam
Taking the comprehensive, 400-question exam is one step toward achieving Fellowship. It can be
taken as early as your first year of active membership. Click here for more information about the
AGD Fellowship Examination.

CE Credit
Completion of 500 hours of approved continuing education credit is required, with at least 350
hours earned in course attendance. Credit may be earned through post-graduate education, self-
instruction programs, teaching, and authorship of a published scientific article. Download the
specific Fellowship Award Guidelines . A maximum of 150 credit hours can be earned in each
of the 16 dental subjects.

Approved program providers include those accepted by AGD Program Approval for Continuing
Education (PACE) or American Dental Association Continuing Education Recognition Program
(CERP). These programs can be local or national. We encourage you to contact all AGD
constituents, dental schools, local study clubs, and other approved providers to find out what
courses are available.

The AGD offers a variety of continuing education opportunities to help aid you in fulfilling your
continuing education credit.
                                                                                                        58
After Fellowship Achieve the Highest Academy of General
Dentistry (AGD) Honor—Become a Master!
Achieving Mastership is a professional designation within the AGD beyond Fellowship, and
reflects a general dentist's ongoing commitment to provide quality care through continuing
education. There are four distinct steps that need to be accomplished in order to earn the
Mastership Award.

Attaining Fellowship
The AGD Fellowship Award can be obtained by maintaining three years of continuous
membership in the AGD, passing the Fellowship Exam, completing 500 hours of continuing
education, submitting an award application, and finally, receipt of the award at the convocation
ceremony held at the AGD annual meeting.

CE Credit
To achieve Mastership, the individual must complete a minimum of 1,100 hours in approved
continuing dental education. Download the specific Mastership Award Guidelines .

At least 400 hours must be accrued in participation courses, those that involve actual application of
a technique or skill under close supervision by highly qualified experts. Masters have been trained
by the best to be the best.

In addition, to qualify for Mastership, individuals must meet the requirements of a rigorous
didactic formula that insures they are exposed to current scientific and clinical approaches in all
disciplines of dentistry.

Approved program providers include those accepted by AGD Program Approval for Continuing Education
(PACE) or American Dental Association Continuing Education Recognition Program (CERP). These
programs can be local or national. We encourage you to contact all AGD constituents, dental schools, local
study clubs, and other approved providers to find out what courses are available.
                                                                                                    59
For Residents Only
The AGD is the only organization that exclusively represents the interests and serves the needs of
the general dentist. Let us help you get started toward a future of lifelong learning and quality
patient care with the valuable resources and opportunities listed below.

Apply Residency Credits to Fellowship Awards
Acquire up to 250 hours of continuing education (CE) credit towards the Fellowship Award
upon completion of an AEGD or GPR program. That’s half the total required hours!

Free Annual Meeting & Exhibits Registration
AGD resident members receive free registration to the Annual Meeting & Exhibits. Residents are
invited to attend lectures and capsule clinics and browse the exhibit hall.

AGD Career Center
Simplify your search! As your residency draws to a close, start your job search here and post your
résumé or Curriculum Vitae online for employers who are seeking general dentists just like you!

Podcasts, Case Studies, and Blogs
The AGD offers information in the way you like to receive it! The AGD podcasts offer interviews
and industry news each month. GD: General Discussion offers online case studies for review bi-
monthly. Dr. John Gammachia shares The Daily Grind of running a general dental practice in the
AGD blog.

Free Insurance Contract Analysis
When you venture into your own practice after residency, one of the tools you’ll need is insurance
contract analysis. As an AGD member, you’ll receive a free service that helps you assess the terms
and ramifications of insurance contracts.

Award-Winning Publications
Subscriptions to the AGD’s publications General Dentistry and AGD Impact are included in your
membership fee. AGD Impact will keep you current on general dentistry news, and our award-
winning scientific journal, General Dentistry, will inform you of all of the latest advancements in
your field. Articles are also available online now!

Member Discounts
Save money on both professional and personal products and services through the AGD Benefits
Plus program.

Reduced Membership Rates
Academy of General Dentistry (AGD) members participating in an accredited advanced education
in general dentistry (AEGD) or general practice residency (GPR)* in the U.S. or Canada Residents
can enjoy all of the benefits of AGD membership for only $67 per year*! In addition, AGD offers
discounted membership dues for recent graduates up to four years following graduation from
dental school. See our membership application to find your membership rate.

*Other types of residencies (i.e., post-doctorate, masters) do not qualify for the residency discount.
                                                                                            60




For Dental Students Only
The Academy of General Dentistry (AGD) has information and resources specific to the needs of
dental students. From advice to discounts, the AGD can help you through dental school and
beyond!

Survey: » Dental Student Need

Just go here for all information: http://www.agd.org/membership/DentalStudents/

For Full-Time Dental Students in New York State, membership in the
AGD is paid for by the NYSAGD. Just fill out the application and it
will be billed to the NY Constituent.

For AGD Student Application Go To
Student Membership Application

				
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