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May/June 2006 Volume 86, Issue 3
Missouri Dental Association Official Publication 

                                             New charitable care form
                                             will help MDA track goodwill
                                                                                                                                                        Join us for the 13th Annual

                                                                                                                                                 day at the game
                                                                                                                                             Get your tickets before they’re gone

                                                                                                                                              In This Issue
                                                                                                                                                                See details page 3

                                                                                                                                                   From the Editor
                                                                                                                                             3     For Your Benefit
                                             by Sam Miller, DDS                              charitable care, for the uninsured and
                                             Trustee, Southwest Dental Society               underinsured. What no one knows,                4     Legislative Update
                                                                                             unfortunately, is how much donated care
                                                      ental offices throughout the state     we are delivering. Your help is needed to       6     Pearls of Wisdom
                                             D        of Missouri continually perform
                                                      charitable treatment daily for a
                                                                                             enable the MDA to develop a database for
                                                                                             how much donated care you are
                                                                                                                                                   Educating the complete
                                                                                                                                                   denture patient
Leadership                                   myriad of reasons. These kind acts go
                                             unpublished in the local newspaper, or
                                                                                                                                             7     Tricks of the Trade
                                                                                           LET US SHOW WE’RE A
changing at
                                             escape the bright lights and cameras of
                                                                                                                                                   The importance of a good
                                             our local television stations. These giving
                                             gestures go totally unnoticed, even though         health-serving,                                    first impression

Association                                  the dentist isn’t really looking for the
                                                                                           not self-serving profession                       10 Insurance Insider
                                               Missouri dentists participate in local          Dentists have a proud reputation as one             Are you covered?
Vicki Wilbers to become new MDA              charity clinics, Donated Dental Services,       of the most respected and ethical of all
 Executive Director in November                                                                                                              12 Tech Talk: Podcasts
                                             and Give Kids a Smile programs                  professions. However, health care

         t the April 2006 MDA Board of
                                             regularly. All these charitable programs        professionals are the subject of ever           14 To Catch a Thief

A        trustees meeting, it was decided
         that Vicki Wilbers, current
Assistant Executive Director, would
                                             extend oral health care to a some of our
                                             neediest citizens. However, nearly all
                                             dentists routinely deliver in-office
                                                                                             increasing scrutiny because of escalating
                                                                                             costs and rising out-of-pocket expenses
                                                                                             for the insured and       CONTINUED PAGE 5
                                                                                                                                                   Fraud in the dental practice

                                                                                                                                             16 Hygienists & Well Being
become MDA Executive Director at the                                                                                                         17 Bites & Briefs
conclusion of the House of Delegates
                                                                                                                                             18 The Marketplace

                                                         Pearls of Wisdom
November 4, 2006. Dr. Jake Lippert,
current Executive Director will serve as
“Executive Director Emeritus” through
December 2007.
   Dr. Lippert announced his intention
to retire at the expiration of his                                         P RO S T H O D O N T I C S
November 2007 contract. An “ED
Succession Committee,” consisting of
current and past board members (Bob          Treating aggressive caries
Fox, Guy Deyton, Kevin Wallace, Mark
Zust, Dan Haney, and Dave Johnson)           by Dean Elledge, DDS, MS & Lindsay English, BS       UMKC School of Dentistry
was appointed with the charge to “begin
the process of finding a successor” to               oday, more than ever, patients choose esthetically pleasing composite
Dr. Lippert, who has successfully led
the MDA for over nine years.
   “It has been a wonderful opportunity
                                             T       restorations over traditional amalgam restorations. With the increasing use of
                                                     esthetic fillings, dentists are faced with an increase in post-operative sensitivity,
                                             recurrent decay, and unexpected root canal treatments. According to Dr. Gordon
to work with so many dentists, allied        Christensen, the best way to decrease the problems associated with esthetic restorations
health members, legislators and state        is to avoid the use of total-etch primers1. In lieu of total-etch systems, Christensen
agencies to improve the quality of life      suggests the use of desensitizing liquids, resin-modified glass ionomer liners, and self-
for the citizens of Missouri. I am proud     etching primers. When using the three previous materials, post-operative sensitivity
of what we have accomplished                 decreases due to the physical seal created by the desensitizing liquids, the resin liner,
together,” said Dr. Lippert.                 and the primer. The problem is they lack sufficient germicidal activity to destroy the
   Vicki brings over 14 years of             biofilm that is associated with caries.
experience with the MDA, having                 The option for overcoming these problems is the use of a germicidal base, copper
served in various capacities and in her      zinc phosphate cement. Only copper zinc phosphate cement has the potency to destroy
current position for the past eight years.   the oral biofilm2.
Her knowledge of the MDA, its                   While other solutions exist, the use of copper zinc phosphate cement shows
members, the change in Governance            promising results. In a study performed by Dr. Terry Donovan, restorations cemented
structure, staff management and all the      using zinc phosphate cement showed a 95.4% survival rate, with 45% of the
other programs make her an excellent         restorations lasting up to 52 years3. An important factor in the success of zinc
candidate to lead the MDA into the           phosphate cement is its infinitesimal solubility of minerals.
future.                                         Copper-based cements are not a new concept. The use of copper cement dates back
   “I’m humbled and honored to               to the 1870s when Dr. John Henry Holliday (aka Doc Holliday) used red copper
continue to serve this Association in the    cement to place a gold swaged crown over the carious molar of a six-year old girl.
future as its             CONTINUED PAGE 3   Reportedly, this crown was still in place when the patient                 CONTINUED PAGE 7
                                                   It’s time to eliminate the clinical
      Focus                       mda
      May/June 2006 Volume 86, Issue 3
                                                   performance board exam
                                                                                                   and costs to an already over-indebted           without depending on uncalibrated dental
                                                                                                   young professional. Nearly 100% of these        examiners that have undetected agendas
                      Focus MDA                                                                    candidates get their license later, so what     and without making it so dependent on
        (USPS 284-840; ISSN 0887-4646)                                                             is the effect on protecting the public’s        factors not in control by the candidate?
    is published six times annually, every other                                                   safety?                                            It is time to discard the antiquated
     month, by the Missouri Dental Association.                                                       A 20-year employee of mine (and one          clinical performance exam that focuses on
                                                                                                   of the single best assistants with which I      a two-day slice of the candidate’s life. The
                    Postmaster                                                                     have had the pleasure to work) assisted a       two-days of dental terror should be
            Send address changes to:                                                               student recently in an out-state sight (not     replaced by presentation of a series of
            Missouri Dental Association                                                            UMKC). She talked about the true                patients representing the work of the
             3340 American Avenue
            Jefferson City MO 65109
                                                   From the                                        professionalism of the examiners—less           candidate that is certified by the dental
                                                   Editor                                          one. She witnessed a prima donna more           school to be the true work of the
            Editor Robert Brunker, DDS                                                             interested in showing his knowledge and         candidate. A panel of dental examiners
                                                   Robert Brunker, DDS
        Managing Editor Jake Lippert, DDS                                                          inflicting behavior consistent with a           can examine the patients and, with the
       Associate Editor/Advertising Manager                                                        Marine boot camp sergeant than a dental         certification of the school, determine if the
                 Melissa Albertson                         hink back to the days you took the

                                                                                                   examiner. His overtly, even calculated,         candidate is worthy of licensure. The State
        Technology Editor John Flucke, DDS                 clinical board exams for licensure.     condescending attitude sickened her. I          of Missouri can have reciprocal
         Photo Editor/Allied Health Editor                 How did you feel about the              wonder how he made the candidates feel.         agreements with other states and their
                 Ed Kendrick, DDS                  experience? Were you comfortable with           Oh, but it was just one, was it not? That       board of examiners. Candidates from
                                                   the thought that four years of college and      singular examiner could have a                  other dental colleges outside of our state
         Missouri Dental Association Staff         four years of dental school all boiled          devastating effect on multiple candidates.      and outside of our schools with reciprocal
                                                   down to two days of performance that was        Similar experiences were expressed by           contracted agreements can elect to take a
                 Executive Director
                Jake Lippert, DDS
                                                   dependent on the presence of patients and       students at the UMKC site.                      traditional clinical performance licensure
                        other factors not under your control?              We all have board exam stories to tell.      exam.
                                                      The class of 2006 at UMKC School of          Some of us have stories about our own              The Missouri Dental Board should
            Assistant Executive Director           Dentistry just completed their clinical         experience. Would you like to do it again?      consider the elimination of the antiquated
                   Vicki Wilbers                   board exams. In talking with some of the        I would rather take a beating.                  clinical performance licensure exam. If
                       class members, I was reminded of my                What other professions force their           they don’t, they should be forced to take
                                                   personal experience with the two days of        candidates through a clinical performance       the exam again. I bet our able hygienist on
          Membership & Meeting Director            terror. Take these as exaggerations or          licensure exam? Physicians do not.              the Board would not want to take her
                  Stacey Butler                    literal truths, but here are some of the        Optometrists do not. Pharmacists do not.        board exam again either! Hygienists out
                      stories told.                                   Veterinarians do not. Dentists do! (Even        there, are you with me? Yours should be
                                                      Blood sucking assistants are demanding       those special dentists, the “specialists,” do   eliminated, as well.
                  Finances Director
                     Lisa Patten
                                                   $500, plus, a day for assisting students.       not!)                                              New members, this should be a worthy
                        One student had a patient sitting in the           “By God, I had to do it, so should the       goal of the New Dentist group. This old
                                                   chair and just prior to injection demanded      new graduates!” Is that what keeps this         dentist would support your efforts. It is
             Communications Director               considerable payment to continue his            gut-wrenching experience going in our           time to consider a new paradigm in
               Melissa Albertson                   willingness to be a board patient. The          profession?                                     licensure examinations—eliminate the
                     student wrote out a check in fear of his           The purpose of the licensure exam is to      necessity of the attending patient for
                                                   patient leaving. I hope the check bounced.      protect the citizenry of the State of           clinical procedures.
          Administrative Services Director            Another board patient tiring of the time     Missouri from incompetent dental
                  Margie Kunze                     it was taking to wait for a dental examiner     practitioners. Does a two-day clinical          Your comments and letters are welcome. Send to
                      to check his final restoration, simply left     performance exam do that? With our     of fax to 816-364-1186.
                                                   the exam site never to return. Result:          modern knowledge about tests and
             Administrative Secretary
                 Mandy Stokes
                                                   failure of the candidate! If that dentist has   measurements can we not accomplish the
                       office space being prepared and loans           same purpose without depending on the
                                                   activated, this presents unnecessary delays     presence of unpredictable patients,
         Editorial and advertising offices:
            Missouri Dental Association
               3340 American Avenue
              Jefferson City MO 65109

             Phone (573) 634-3436
              Fax (573) 635-0764
           Web Site

         Subscription rates are: Members:
      $25 (dues allocation); Non-members:
      Individual (US) $100 (Foreign) $125;
        Institution: (US) $35 (Foreign) $60;
       Single Copy: (US) $5 (Foreign) $10

                Article Contributions
         For Focus MDA article submission
       guidelines contact Melissa Albertson.
      The editor, publisher and staff are not
      responsible for views expressed in the
       Focus MDA, and these views do not
         necessarily reflect MDA policies.

                    Focus MDA
         is a publication member of the
      American Association of Dental Editors.

2         Focus MDA   May/June 2006
                                                                                                                                                                  MDA LEADERSHIP CHANGE
                                                                       July                                          14-16: Greater St. Louis Dental              CONTINUED FROM COVER
                                                                                                                   Society Mid-Continent Dental Congress.
                                                                         3-4: MDA Office Closed for                Chase Park Plaza Hotel, St. Louis. 314-        Executive Director,” says Vicki. “I’ve
                                                                       Independence Day holiday.                   569-4444 or See more            been fortunate to work with a gracious,
                                                                                                                   information on the ad on page 9.               kind and inspirational person, Jake
                                                                        20-22: Missouri Dental Board                                                              Lippert. My leadership style can be
                                                                       Meeting. St. Louis.                           14: Southeast Dental Society                 summed up as a “servant leader” who
For Your Benefit                                                                                                   Installation meeting. Call Dr. Keith           will devote myself to meeting the needs
                                                                                                                                                                  of those whom I serve, both the
CE                         Meetings            Events                    28-29: MDA EFDA Fixed Prosthetics         Cooper, SEDS president, for information.
                                                                       (Cost $325). 8:30 a.m. to 5 p.m. each       573-547-6520.                                  association members and the MDA staff.”
                                                                       day, Office of Dr. Guy Deyton, Kansas                                                         Vicki believes that the MDA must
                                                                       City.                                         21-22: Northwest Dental Society CE           continue to bring all entities involved in
June                                                                                                               and Installation meeting. Call Dr.             the community of oral health together to
                                                                                                                   Patricia Boice, NWDS president, for            create a synergy where the Association
 9: Greater Kansas City Dental Society                                 August                                      information. 816-279-8300.                     can achieve great things for dentistry and
CE. OSHA Update, presented by Dr.                                                                                                                                 the public which it serves.
Dean Perkins. Arrowhead Club, Kansas                                     18: MDA Board of Trustees Meeting.        22-23: MDA Leadership Development                 Says Vicki, “From the words of Albert
City. 816-737-5353 or                                   Begins at 10 a.m. MDA Executive Office,     Continuum begins at MDA Executive              Pine, ‘What we do for ourselves dies with
                                                                       Jefferson City.                             Office.                                        us. What we do for others and the world
  13-16: MDA Office Closed for staff                                                                                                                              remains and is immortal.’”
retreat.                                                                                                             23-24: MDA Bass Tournament. Osage               Through the remainder of Dr. Lippert’s
                                                                       September                                   Bluff Marina at Truman Lake. Contact           term, Vicki will spend increased time
  16: UMKC School of Dentistry                                                                                     Margie Kunze at MDA for details.               learning about dealing with legislative
Scholarship Golf Tournament. Shoal                                       4: MDA Office Closed for Labor Day                                                       and regulatory issues and with the various
Creek Golf Course, Kansas City. CE at                                  holiday.                                     29-30: ADA Sixth District Caucus.             state agencies. As Executive Director
10:30 a.m., Registration at 11:30 a.m.,                                                                            Greenbrier Hotel, Charleston, West             Emeritus, Dr. Lippert will continue
Lunch at Noon, Shotgun at start 1 p.m.                                   8: Greater Kansas City Dental Society     Virginia.                                      working with legislative and regulatory
To register, call 816-235-2022.                                        CE. Esthetics/Crown & Bridge, presented                                                    issues and will focus on the organization
                                                                       by Dr. Jose-Luis Ruiz and Practice          Send updates to be in “For Your Benefit” to    and strengthening of local legislative and
  23-24: MDA EFDA Removable                                            Management, presented by Char      Registration forms       regulatory committees (LRCs) and PACs.
Prosthetics (Cost $325). 8:30 a.m. to 5                                Sweeney. Located at the Elms Resort,        for many of these events can be found on          Congratulations to Vicki and Dr.
p.m. each day, Office of Dr. Guy Deyton,                               Excelsior Springs. Call 816-737-5353 for under Calendar of Events.         Lippert, for their continued efforts on
Kansas City.                                                           information or visit         Green boxes denote MDA event.                  behalf of organized dentistry and the
                                                                                                                                                                  Missouri Dental Association.

     Winter session                                                                                        January 19 & 20, 2007

                                                                                                                  Holiday Inn Select Columbia

               LOOK GOOD FEEL GOOD
                         Dr. Louis Costa presents “Cosmetic Surgery: Look Your Best,
                         Feel Your Best” & “Extreme Makeovers: The Imperative Role of Dentistry”
                         Dr. William “Bo” Bruce presents “Clinical and Financial Success in
                         the General/Esthetic Practice”
                         Dr. Robert Fazio presents “Antibiotics in Dentistry”
                         & “Medicine & Dentistry: The Diseases that Affect Dental Care”
                         Dr. Ed Kendrick presents “Effective Temporary Restorations Workshop”

               Download course information on & look for registration late summer

                                                                                                                                                                   MDA New Dentist Committee presents the 13th Annual

                          Dr. Charles McGinty
                                                        Immediate Past President
                                                        Dr. Robert Fox
                                                                                   Greater Springfield
                                                                                   Dr. Guy Bates
                                                                                                           Dr. Douglas Wyckoff
                                                                                                                                      New Dentist Committee
                                                                                                                                      Dr. Matt Niewald
                                                                                                                                                                  day at the game

                          (417) 624-1444

                          President Elect/Secretary
                                                        (573) 334-8431

                                                        Greater St. Louis
                                                                                   (417) 887-3860

                                                                                                           (816) 632-2822

                                                                                                                                      (816) 914-1189
                                                                                                                                                                           10 28 06
                                                                                                                                       ADDITIONAL CONTACTS
                          Dr. J.C. Standlee             Dr. Gerda Thalheimer       Dr. Bryan Foote         Dr. Shanon Kirchhoff                                      MIZZOU TIGERS VS
                          (573) 893-4402                (314) 843-4412             (573) 449-2311          (573) 651-4400              Missouri Dental
                                                                                                                                       Insurance Services
                                                                                                                                                                    OKLAHOMA SOONERS
                          Treasurer                     Greater Kansas City        Northeast               Southwest                   (800) 944-7550
                          Dr. David Neal                Dr. Kenneth Weinand        Dr. Thomas Lemons       Dr. Samuel Miller           (573) 636-8752                     Catered Tailgate Party
                          (660) 646-4352                (816) 478-4244             (573) 769-2262          (417) 781-3182                    includes beverages & meal
                                                                                                                                       Missouri Dental Board        ————————————————
                                                                                                                                       Sharlene Rimiller               Event does not include CE

                          Focus MDA Editor              Speaker of the House       Missouri Dental Board   Legislative & Regulatory    Executive Director           ————————————————
                          Dr. Robert L. Brunker         Dr. Mark Zust              Dr. Jay Sheets          Dr. Matt Niewald            (573) 751-0040
                                                                                                                                                 Tailgate & Ticket $50
                          (816) 364-1186                (636) 928-1100             (573) 335-7693          (816) 914-1189
                                                                                                                                                                              Ticket Only $35
                                                                                                                                       Well-Being Program
                                                                                                                                       Ira Davis, Administrator             Tailgate Only $15
                                                                                                                                       (866) 442-0300 or            ————————————————

                          Greater St. Louis             Greater Springfield        Northeast               Southeast
                                                                                                                                       (573) 424-8467                   Go online to
                          Ellen Kessler                 Dr. Kelly Barnett          Dr. Tisha Kice-Briggs   Dr. Keith Cooper
                          Executive Director            President                  President               President                                                    Under Calendar of Events
                          (314) 965-5960                (417) 882-4117             (660) 665-1901          (573) 547-6520              American Dental               to download registration form.
                          Greater Kansas City           Central                    Northwest               Southwest                   (800) 621-8099               ————————————————
                          Pamela Ratliff                Karen Raithel              Dr. Patricia Boice      Dr. Michael LaFerla         (312) 440-2500              You may call the MDA to register at
                          Executive Director            Executive Director         President               President                           573-634-3436 or 800-688-1907.
                          (816) 737-5353                (573) 694-9281             (816) 279-8300          (417) 206-7770

                                                                                                                                                                              Focus MDA     May/June 2006               3
Time runs out as legislative session closes
Dominance of few key issues control time and tone of session and create mixed results for MDA backed bills

by Jake Lippert, DDS    Executive Director     on the bill (SB756).
                                               You will be required
           issouri legislative sessions each   to keep patient records

M          have a personality of their own,
           but none are predictable. Every
year, time there are a few key issues that
                                               a minimum of seven
                                               years from the time of
                                               last treatment, except
dominate and control the tenor of the          for a minor, where
session. This year Eminent Domain, the         you must keep the
sale and use of Missouri Higher Education      records for a
Loan Authority (MOHELA) assets to fund         minimum of seven
capital improvements for higher education      years beyond the age
institutions, voter photo ID at polls, and     of majority (age 17);
Medicaid fraud by health care providers        therefore, you must
were the hot buttons that consumed hours       keep their records
of debate and eventually forced the            until they have           Thanks to all the members who turned out for the 2006 MDA Legislative Day, April 11 in Jefferson City. Above left: Greater St. Louis delegation
demise of many bills because they simply       reached the age of 25     visit with Representative Sam Page. From Left, Dr. Art Misischia, Dr. Chuck Poeschel, Dr. Mark Zust, Rep. Sam Page and Dr. Mike Hoffmann. Above
ran out of time before the 6 p.m. deadline     or seven years from       right: MDA Trustees Dr. Ken Weinand, left, Greater Kansas City and Dr. Sam Miller, Southwest, visit about the day’s messages to legislators.
on Friday, May 12. After all was said and      date of last treatment,
done, MOHELA and Medicaid fraud went           whichever is longer.                                 legislators, including all the legislative                   managed care. To enroll, go to the DMS
down in flames, while Eminent Domain                                                                leadership, that this would be a positive                    web site, and click left navigation menu
(HB1944) and voter ID (SB1014) bills           Dental Carve Out                                     direction to take. The argument that there                   link that says, “Provider Enrollment
were passed in the waning moments.               The bill that would have carved                    would not be enough enrolled providers to                    Application.”
MDA backed bills had mixed results.            Medicaid dental out of the state’s                   care for the MC+ recipients is too                           providers.htm.
                                               managed care program wasn’t even                     prevalent at this juncture. We need many
Patient Record Keeping                         brought to the floor for debate in either            more dentists to enroll as Medicaid                          Radiology, Medicaid Fraud & Malpractice
  The bill that now will require dentists to   chamber. The President pro-tem of the                providers along the I-70 corridor to make                    Insurance
keep all patient records, including lab        senate threatened to kill any bill that came         a convincing argument. We strongly                             The other issues we were watching that
orders, for seven years passed late on the     to that chamber containing the carve-out             encourage you to enroll as a Medicaid                        did not pass included the requirement that
last day. There had been no statute            language. That threat prevailed, and                 provider, even if you don’t intend to                        dental assistants had to be licensed by a
language that prescribed the amount of         should the MDA Board decide to continue              provide services until carve out becomes                     separate licensing board to expose
time a dentist had to keep patient records;    that effort, we will have to find another            law. It will allow us to go to the                           radiographs, and the bill that would have
now there will be effective, August 28,        avenue. A much stronger grassroots effort            leadership next session and show that                        paid employees a percentage of any
2006, pending the Governor’s signature         will have to be made to convince enough              dentists will see Medicaid but not under                     amount recovered        CONTINUED NEXT PAGE

     Site assessment
     CPR/AED training
     Online equipment tracking
     Periodic maintenance

    Call us now to implement a
    complete life saving AED program.


                                                                                                                                                                        Endorsed by the Missouri Dental Association

4      Focus MDA   May/June 2006
if they reported “Medicaid fraud” by a provider.      rates dentistry enjoys when compared to our
The fraud legislation was essentially a “whistle      medical colleagues. The suggested purpose of the        CHARITABLE CARE FORM
                                                                                                              CONTINUED FROM COVER
blower” bill with few protections for the             fund would be to have providers charged a “tax,”
provider. It was opposed by all the provider          similar to unemployment insurance tax, to help
groups and supported by trial attorneys and many      offset any large increases in malpractice               uninsured patients. We should continue to strive to be a caring and
consumer groups.                                      insurance premiums. We will be watching for the         giving oral heath care profession in the eyes of our patients and
   We were successful in stripping any reference      report and if legislation is presented next year.       legislators.
to dentistry from the radiation bill prior to the        Other passed legislation of general interest           Most patients and legislators believe we can “write off” our
time it was included in a House Committee             include a request for citizens to display the           charitable dental care. However, most would be surprised to learn that
Substitute Professional Registration omnibus bill     POW/MIA flag on Memorial Day, Fourth of                 we cannot write off the value of our service. This lack of understanding
(SB1124), which came to the house as a consent        July, Veterans Day and September 11; U.S. and           may have our charitable acts viewed in a self-serving light; that we are
bill. On the floor of the House, an additional 12     Missouri flags will be flown at half-staff on all       doing it for the tax deduction. We all know this is untrue. Dentistry, as
amendments were added. Because of the                 government buildings on September 11. School            an organization, must have the data to educate and inform both our
changes, the bill had to return to the senate for a   nurses will be able to keep on hand and                 patients and legislators that we are indeed doing our part in providing
vote or referral to a joint conference committee.     administer pre-filled syringes of epinephrine to        charitable dental care for those truly in need.
As time ran out, the bill never made it to the        any student who the nurse feels is having an              The Missouri Dental Association has developed a charitable
senate floor for discussion. We were hopeful the      anaphylactic reaction. Sixteen year olds can            contribution form for use by our members. This simple to use form will
amended version would have passed so the issue        donate blood with parental permission. HB1687           aid the MDA in tracking charitable care. Make copies, and educate
would’ve been put to rest once and for all; it’s      allows unused or unaccepted drugs donated to            yourself and your staff in its simple purpose and use. A minimal
been a perennial piece of legislation we’ve had       the Prescription Drug Repository to be                  amount of information is needed, and no personal information is
to contend with.                                      distributed to out-of-state charitable repositories     required identifying the patient.
   One bill that did pass, HB1837, makes some         and to a foreign medical aid mission group.               The main purpose of the form is to document all discounted or
adjustments to the malpractice insurance reform          On the lighter side, HB1380 allows you to            charitable treatment value due to hardships. The MDA hopes you begin
bill of the previous session; however, there is a     serve as a private partner to finance, develop          using this form immediately and that you mail or fax completed forms
section that establishes a Health Care                and/or operate a toll bridge between Illinois and       to the Association office throughout the year as you complete them, or
Stabilization Fund Feasibility Board within the       Missouri in St. Louis. HB1739 allows you to be          you can e-mail the information to It is the plan
Department of Insurance to analyze medical            eligible to receive certain agricultural loans to       that soon you will be able to enter this information online, through
malpractice data, to determine whether such a         raise earthworms. SB725 allows underage                 your web browser, with no papers to mail or fax.
fund should be established in Missouri. The           culinary students to taste, but not consume,              This valuable reporting tool will allow the Association and, more
board will determine whether a stabilization fund     certain alcoholic beverages as required by the          importantly, our legislators to realize the magnitude of the charitable
is feasible, within Missouri, or within specified     curriculum. SB747 requires used car dealers to          care we perform daily. When we speak with our legislators and other
geographic regions thereof, or for specific           complete CE seminars to get a license.                  policy makers publicly, we will be able to refer to specific numbers.
medical specialties. If they determine the fund is       The mood around the capitol is constantly              You are quite aware of what you and your colleagues do routinely to
feasible within Missouri, the report will also        changing as the session progresses; you have to         help the neediest in our communities; now we must make sure that the
make recommendations to the General Assembly          experience it to get the true ambience and the          public and legislators are aware. With your help this will be the case.
on its structure, design and funding. The idea        true flavor. Try it sometime—how about as a
was floated last summer, and the MDA filed a          dentist legislator?                                      SEE FORM IN THE CENTER OF THIS ISSUE OR DOWNLOAD ON
letter asking dentistry be omitted from any              For questions about legisaltive issues, e-mail Dr.    MODENTAL.ORG, MEMBERS ONLY, PRACTICE MANAGEMENT
stabilization structure because of the current low    Lippert at

                                                                                                                                                        Focus MDA   May/June 2006         5
Educating the complete denture patient
by Joseph F. Shea, DDS, MS                    previous dentist). It also can lead to          the average patient. Indeed, their
Greater St. Louis Dental Society              complaints to the MDA Peer Review or            level of function might be only
                                              the Missouri Dental Board. This article         5% to 10% of dentate patients.
       atients normally look forward to the   will address how to avoid many of those

P      day when they receive their new
       dentures. They are happy about the
prospect that former dental problems will
                                              grievances through improved patient
                                                The art and science of prosthetic
                                                                                              Residual Ridge Resorption
                                                                                                 It is vitally important that
                                                                                              patients be educated to the
soon be over. Then, the day arrives when      dentistry has advanced rapidly during           sequelae of residual ridge
the new dentures are inserted, and they are   recent years, and new techniques and            resorption before, during
frequently shocked that a new array of        materials have greatly improved our             and after it has occurred. Of
dental problems is just beginning. Many       ability to replace missing tissues with         utmost importance is to
misconceptions and erroneous ideas exist      functional, natural looking artificial          explain this concept to
concerning the use and care of complete       appliances or prostheses. However, it must      patients who present with
dentures. Often these assumptions are not     be remembered from the outset that no           dental problems that
expressed until after the dentures have       prosthesis or artificial substitute,            might require complete
been delivered and the problems have          regardless of how painstakingly                 dentures, but who may
started.                                      fabricated, will ever function as efficiently   still be able to save
   Both the dentist and the patient have an
important role in the outcome of the                                                                               some

                                              Pearls of Wisdom
complete denture service. Patients                                                                                 teeth and roots via
frequently present with complaints such                                                                            removable partial
as: “The denture doesn’t fit”, “I can’t                                                                            dentures or             Go to , Members Only, Practice
chew with these dentures”, or “I had all                                                                           overdentures.
my teeth out six months ago, the denture                                                                           Patients will usually    Management to download “Instructions for
                                                                  P RO S T H O D O N T I C S
worked for awhile, but now it is real                                                                              function better with      Complete Denture Patients,” an education
loose.” However, examination of the                                                                                a removable partial
denture often reveals technical adequacy      as the original living tissues. Research has denture supported by two or three teeth         handout Dr. Shea supplies to his patients. It’s
that cannot be significantly improved         shown that the average chewing efficiency than with a complete denture. I will                 worded toward patients getting their first
upon or significant biologic deficiencies     of experienced denture patients is, at best, frequently educate patients that even if a
without a simple remedy. If the dentist       less than 20% as efficient as the average    removable partial denture is made on teeth      denture, but works well for those considering
cannot satisfy the patient’s wishes to        chewing efficiency of patients with          that are subsequently lost in the future, the   dentures, and those who’ve had dentures for
improve the situation, this can lead to       natural teeth. If the residual ridge has     ravages of residual ridge resorption have
disharmony between the patient and the        significantly resorbed, then the patient     been delayed for that time. What this            some time who are now having problems.
dentist (or with the patient and the          cannot be expected to function as well as    means is that if, for example, 10 years of                                 CONTINUED PAGE 10

6      Focus MDA   May/June 2006
PEARLS OF WISDOM                                             cements offer another option for the                    be on solid root structure to form a ferrule            Clinical Faculty in the UMKC Department of Dental
CONTINUED FROM COVER                                         reduction of problems associated with                   (Figure 6). The final crown will have a                 Hygiene. They have three children; Lindsay, 18
                                                             esthetic fillings. Hopefully, this review               metal collar.                                           years old, Abby, 15 years old, and Samantha, 9
turned 102 in 19674. Unfortunately, at this                  will prompt dentists to reflect on the                                                                          years old. His current hobbies are supporting
                                                                                                                                                                             Chief’s football, when they are winning, and
time, dentists were using pure copper                        history of copper cements. Copper                       Patient 3
                                                                                                                                                                             restoring his 1970 vintage Opel car. For
cements (97% cupric oxide) that proved to                    cements have positive attributes not found                 This 94-year-old patient reports that this
                                                                                                                                                                             questions, contact him at
be toxic. Fortunately, research shows that                   in other restorative materials. The copper              full crown restoration was placed soon                     Lindsay English is a third year dental student
the 2% copper cements were as or more                        cements also have the best germicidal                   after she was married 62 years ago                      at UMKC School of Dentistry. Lindsay is from Fort
effective than 97% copper cements and                        activity and provide essential factors                  (Figure 7). There is currently new decay                Smith, Ark., and earned a Bachelor of Science at
2% copper cements were less toxic2. A                        needed for physiology.                                  and existing repairs to the dentinal core.              Baylor University.
lower concentration of copper is able to                                                                             Clinical exam shows no caries adjacent to
disrupt the oral biofilm.                                    Patient 1                                               the copper zinc phosphate cement placed                 * MATERIALS LIST
   The enamel rods and dentinal tubules                         This 66-year-old presents with new                   in the central occlusal pit (Figure 8).                 1. Cooley & Cooley Ltd., 8550 Westland West Blvd., Houston, TX
provide teeth with a natural porosity that                   caries adjacent to an existing crown. With              Aggressive caries was present in other                  77041, 281-897 0009
is ideal for the attachment of a biofilm.                    an aggressive caries rate due to a poor                 areas of the tooth.                                             Doc’s Best Red Copper Zinc Phosphate Cement – Base
Once attached this biofilm provides a safe                                                                                                                                           Copalite Resin Liner
                                                             diet, she is a poor candidate for a                        The caries was removed and a resin
                                                                                                                                                                             2. Fuji IX Glass Ionomer Capsules Self-cure, G.C.
harbor for bacteria. This protects the                       replacement crown. The patient selected                 liner* was placed. Copper zinc phosphate
                                                                                                                                                                             America, Alsip, IL 60803, 800-323-7063
bacteria from the antimicrobial activity of                  the option for a filling repair. First, the             powder was added to the liner to treat                  3. Integra Post- Premier Dental, 1710 Romano Drive, Plymouth
saliva. It is the host’s main defense against                removal caries adjacent to the full crown               microporosities. Then a copper zinc                     Meeting, PA 19462, 888-773-6872
invading pathogens through antibodies                        is performed (Figure 1). Following                      phosphate core build-up was placed prior                4. Core Paste, Den-Mat Corporation, 2850 Skyway Drive, North
and metabolites. For a germicidal base to                    removal of the decay a copper zinc                      to full crown restoration (Figure 9).                   Back Doors, Santa Maria, CA 93455, 800-445-0345
be effective, it must be able to penetrate                   phosphate cement base* is placed (Figure
the biofilm. Copper cements are able to                      2). The restoration is finished with a glass            Dr. Dean Elledge was selected by the nation’s           REFERENCES
break through the biofilm because they                       ionomer restorative material* (Figure 3).               largest clinical news magazine, Dentistry Today,        1. Christensen, Gordon J., DDS, MSD, PhD. How to Kill a Tooth.
contain galvanically activated copper.                                                                               as a top clinician in continuing education for          Journal of the American Dental Association. 2005
Through the repulsion of silver and iron                     Patient 2                                               2006. Dr. Elledge graduated in 1983 from the            Dec;136(12):1711-3.
ions in this galvanically activated system,                                                                          UMKC School of Dentistry. He received his               2. Fraser, Timothy W., DDS, MA. The Impossible Dream: A Sterile
                                                               This 55-year-old smoker has aggressive
                                                                                                                     Masters in Prosthodontics from the University of        Field Beneath Modern Day Restorations.
copper ions are able to bust through the                     caries on several teeth that required
                                                                                                                     Minnesota in 1985. He teaches in the Department         Fraser_Literature_Review.htm (February 28, 2006).
biofilm and remain active in the dentinal                    endodontic therapy (Figure 4). A post*                                                                          3. Donovan, Terry, DDS, Simonsen, R.J., DDS, MS, Guertin, G. DDS,
                                                                                                                     of Advanced Education in General Dentistry at
tubules destroying bacteria5. Copper and                     was cemented with copper zinc phosphate                 UMKC and practices in the Kansas City area. He          MSEd., Tucker, R.V., DDS. Retrospective Clinical Evaluation of
iron are essential nutrients needed for                      cement to recruit the root for core                     has lectured to dental societies throughout the         1,314 Cast Gold Restorations In Service From 1 to 52 Years.
normal physiology and healing.                               retention (Figure 5). A composite core                  U.S. and in 18 universities. He lectures on             Journal of Esthetic and Restorative Dentistry. Vol. 16, Issue 03,
In the search for new and improved                           paste* was placed into the retentive head               restorative dentistry for the difficult dentition. He   May, 2004, pages 194-204.
solutions for old problems, copper                           of the post. The new crown margins will                 is married to Sally Elledge, RDH, MS, who is            4. FAQ’s DOC’S BESTTM Red Copper Cement. March 7, 2005.
                                                                                                                                                                             Cooley & Cooley, Ltd.
                                                                                                                                                                             E.htm. (April 29, 2006).
                   7% Copper       Glass Ionomer
                  Zinc Phosphate       with
                                                   Glass Ionomer      Resin with     Resin without   Polycarbonate                                                           5. Roggenkamp, Clyde. Dentinal Fluid Transport. Loma Linda, CA.
                                                   without Fluoride    Fluoride        Fluoride         Cement                                                               Loma Linda University Press. 2004
                      Cement         Fluoride

  to Microbes
                        +               +                –                +               –               –

   to Biofilm
                        +               –                –                –               –               –
 Activation of          +               –                –                –               –               –
 Metallic Salts

 Solubility of          +               –                –                –               –               –
 Metallic Salts

   Activity of
                        +               –                –                –               –               –
    Qualities                                                                                                        Figure 4: Bacterial invasion has
                                                                                                                     overcome the host’s defense

Figure 1: Caries removal adjacent to existing                Figure 2: The copper zinc phosphate cement              Figure 3: The restoration is finalized with glass       Figure 5: A prefabricated post is cemented
full crown restoration.                                      base is placed.                                         ionomer restorative material.                           with copper zinc phosphate.

Figure 6: Composite core with crown margins                  Figure 7: Marginal decay in a 60-year-old               Figure 8: Decay is absent adjacent to a 60-             Figure 9: Lined dentin and core build-up will
on root.                                                     restoration.                                            year-old copper zinc phosphate base in the              facilitate a healing environment.
                                                                                                                     central pit.
                                                                                                                                                                                             Focus MDA        May/June 2006                 7
The importance of a good first impression
                                             The proof would be on the bottom line           prototyping technology to create a perfect      If not used correctly, they can be a costly
                                             because as we all know time equals              model and die with no impressions. In the       nightmare for you, your laboratory, and
                                             money and shortcuts can be appealing.           meantime, critical examination and              your patients.
                                                Then along came tray manufacturers           evaluation of impressions (especially              Dentists using passive fitting, rigid trays
                                             who promised accurate, speedy                   dual-arch) can save you time and money          with a stiff impression material can get
                                             impressions using less material with their      by decreasing the possibility of remaking       excellent results. There a numerous
                                             dual-arch impression trays. The idea of         a case.                                         techniques taught, such as Dr. G. A.
                                             inexpensive disposable trays, less chair           The most common error we see is tray         Shoenrock’s Laminar impression
                                             time needed and lower material cost with impingement on hard and soft tissue                    technique that works beautifully. There
                                             accurate impressions of prepared teeth and causing flexible trays to distort (Figure 1).        are also some techniques taught that do
Tricks of                                    both arches simultaneously sounds                  This is a guaranteed “no fit” case and       not consistently produce accurate
the Trade                                    promising. In following, let me be the first probably a remake. The next most                   impressions. If you are having poor crown
Perspectives from                            to agree that this system works well if         common problem is (Figure 2) in using a         fits with excessive adjustments, I
the Dental Lab                               used correctly and                                                       technique some         recommend you talk to your laboratory
                                             when indicated.                                                          material               about your impression technique, as they
                                                At a recent                                                           manufacturers          see hundreds of impressions and should
by Bob Edmonds, CDT                          lecture, Dr. Gordon
                                                                            What is the real cost of a poor           advocate in which      be able to make recommendations to
Edmonds Dental Prosthetics                   Christensen                     impression? How does a poor              an impression is       correct the problem.
                                             referenced a study
         re you one of those fortunate       that found 90% of
                                                                        impression affect your valuable chair taken, then a wash
                                                                                                                      of light body
                                                                                                                                                What is the real cost of a poor
                                                                                                                                             impression? How does a poor impression

A        clinicians who enjoy 5 to 10
         minute crown insertion
appointments? If so, you already
                                             dental impressions
                                             were inadequate. I
                                             can attest that 85%
                                                                         time when you have to call a patient material is applied
                                                                         back for a “new” impression?...More to the prep and the
                                                                                                                      original impression
                                                                                                                                             affect your valuable chair time when you
                                                                                                                                             have to call a patient back for a “new”
                                                                                                                                             impression? Are you spending time
understand what I am about to say. If you    of the remakes in            importantly, how do excessive chair         is reseated. This is   redoing cases that could be used for new
are not getting similar results, please      our laboratory’s
consider the following observations from     fixed department
                                                                        side adjustments, or maybe having to sometimes done to
                                                                                                                      fill in bubbles or
                                                                                                                                             patients? What affect do remakes have on
                                                                                                                                             your profit?            CONTINUED NEXT PAGE
a laboratory owner of more than 35 years.    come from faulty          start over, affect your patient and their voids in an
   Over the past three decades, much has     impressions.
changed with dental impression materials     Doctors using the
                                                                         confidence in you and your practice? impression, yet it
and techniques for fixed prosthetics. We     dual arch tray                                                           distortion. An
have come from the copper band and           technique                                                                impression may
compound, polysulfide rubber base,           experienced 45% more remakes from               look perfect, but when the first phase
reversible hydrocolloid era, through to      poorly fitting crowns compared to those         impression rebounds, the stone die will be
several generations of polyether and         doctors using other types of trays. These       smaller than the preparation. A crown
polyvinyl siloxine materials. All were       statistics come from careful evaluations of made on this die will fit like a hat that is
attempts designed to produce a more          thousands of impressions by doctors using too small, high and tight with major
accurate impression technique yielding a     every imaginable technique.                     adjustments required. The manufacturer
more accurate model and die in the least        Today’s clinicians can do very well          promoting this technique suggests you ask
amount of time. Some impression material     prepping teeth, managing soft tissues, and your laboratory to apply five to seven
manufacturers promoted unusual               controlling mouth fluids and bleeding.          coats of die spacer. Why? To compensate
impression modalities, such as: inject and   Any competent laboratory technician can         for the distorted impression!
blow, cover teeth with cellophane then       make crowns and bridges that fit precisely         Again, let me say that the use of rigid
follow with a wash, take a dual-arch         on the models and dies they are given.          plastic or metal passively fitting dual-arch
impression then inject a wash, and reseat    The challenge is to deliver an accurate         impression trays and a wise choice of
the impression in mouth. Were they only      recording of the beautifully prepared case      impression materials can result in superb
trying to be different so they would have    to your laboratory. Sometime in the near        fitting restorations. Triple tray impressions
something unique to sell or were they        future, it will be possible to transfer         often get a bad rap. The technique is not
really providing time saving procedures?     digital data to a laboratory that uses rapid    bad, if used correctly and where indicated.

                                                                                                                                             Figures 1.1 & 1.2: Impression Tray impingement.
                                                                                                                                             White areas in the impressions are where the tray is
                                                                                                                                             contacting hard and soft tissue, causing impression
                                                                                                       Establishe                            distortion. These crowns will not seat accurately.
                                                                                                                  d in 1997
                                                                                                    Located in
                                                                                                     Servicing            Mo.
                                                                                                               the medic
                                                                                                       photo & c          al,

          Reputable, efficient services customized to accommodate your material
          Returning as much as 10 times more dollars than door-to-door gold buyers & pawn brokers!
          Rated on Dunn & Brad Street, references available
          Unique refining program options available including:
             On-site pick-up, assessment, deposit or purchase, payment in gold coins
             Witness your material being processed at our facility
             Receive a core sample for your independent analysis

                                                                                                                                             Figure 2.1 & 2.2: Reseated impression with a wash of
                                                Contact us for a fee schedule & shipping kit                                                 light body material. Note the thickness of the wash.
                                       (800) 835-0478                                       This bridge will be high occlusially and the margins will
                                                                                                                                             appear to be short. A guaranteed remake.

8      Focus MDA   May/June 2006
Foundation hosts contests to promote oral health
       ebruary marked the annual                   certificate to Wal-Mart and a Cavity         bad tooth. The display

F      celebration of Children’s Dental
       Health Month and MDA contests to
promote oral health among elementary
                                                   Busters dental kit containing an
                                                   instructional video and book, and various
                                                   dental health care items. The MDA
                                                                                                was placed in the school
                                                                                                cafeteria. The students
                                                                                                created their display
students. This year’s activities, sponsored        awarded her teacher, Beth Meyers, a $50      during a health class with
through the Missouri Dental Foundation,            gift certificate to Wal-Mart to be used      Mrs. Patricia Haydon,
focused on second and fourth graders.              towards school supplies or a celebration     their health teacher.
  Second grade students across the state           party for the class. Meladie’s classmates      The winning class and
participated in the coloring contest. They         also received dental care kits.              their teacher received a                      2006 CDHM Contest
were to draw pictures depicting the theme            Fourth grade students were required to     Kodak Easy Share Digital Camera and           Winners. Top, fourth
“A Healthy Smile is Something to Cheer.”           create a bulletin board, wall or door        Printer Dock for use in their classroom, as   grade bulletin board
Pictures were judged on neatness,                  display with an oral health theme.           well as oral health kits for each student     winner from Taneyville
originality, creativity and ability to reflect       Mrs. Griffin’s fourth grade class at       and a $50 Wal-Mart gift card to purchase      R-2 School, Taneyville
                                                                                                                                              and right, second grade
the theme.                                         Taneyville R-2 School in Taneyville, Mo.     refreshments for a classroom celebration      coloring contest winner
  Meladie Cloud of Clinton won first               won first place. The Taneyville students     party. Second and third place winners also    Meladie Cloud, Clinton,
place in the second grade coloring contest.        created a bulletin board display depicting   received prizes.                              a student at Davis R-12
She is the daughter of Terry and Mary              a “good tooth” and a “bad tooth” with          For more information on CDHM or             Elementary.
Cloud and is a student at Davis R-12               healthy food labels around the good tooth,   other Foundation activities, contact
Elementary. Meladie received a $50 gift            and candy and soda wrappers around the       Margie Kunze at the MDA.


How do remakes affect your laboratory
and their profits? Most laboratories do
not charge for remakes. They will remake
a crown for free using time that they
could have used making a new crown,
which results in the loss of revenue of
two units.
  More importantly, how do excessive
chair side adjustments, or maybe having
to start over affect your patient and their
confidence in you and your practice? You
know you can do a textbook prep, and
your laboratory is capable of making a
beautiful, well fitting crown (or you
should look for a new lab). However, this
crown rocks, the occlusion is too high,
the contacts are too tight or the margins
are short, etc., but the crown fits the
model. I suggest you evaluate your
impression technique. Do not always rely
on what a supply company’s sales
representative may claim about products
deemed to be the fastest, easiest and
cheapest. It could be the most expensive
thing you buy.
  When our clients say, “Those crowns
went into place with no adjustment,” we
know they did a good preparation and
gave us an excellent impression, and our
skilled technicians did a great job. The
result is a happy, confident patient who
knows they chose the right dentist.
  Please refer to Figures 1 and 2. If any
of these anomalies are present in your
impression, why not take a new
impression at that time and avoid the
embarrassment of explaining to your
patient why the crown must be remade?
By being extra careful in evaluating your
impressions and using a good laboratory,
there is no reason why you too cannot
enjoy 5 to 10 minute crown deliveries and
increase your profitability and patient

Bob Edmonds, CDT, is president and CEO of
Edmonds Dental Prosthetics, Inc. in Springfield,
Mo., a full service laboratory with branch
laboratories in West Plains and Jefferson City.
Bob began his career in 1961 and founded his
company in 1969 with a partner. He then became
sole owner in 1982. Edmonds Dental Prosthetics
has over 100 employees and was recently named
Manufacturer of the Year by the Springfield Area
Chamber of Commerce.

                                                                                                                                                            Focus MDA   May/June 2006   9
PEARLS OF WISDOM                                concept that everyone knows: If you bite        to function better with a functional/          this person, or are you going to be the
COMPLETE DENTURES                               on something hard while chewing, you            rational mold selection than with steep        next complaint on their list?
CONTINUED FROM PAGE 6                           only bite on it once. Your teeth and the        cuspal patterns that can act as occlusal          After the patient has expressed their
                                                nerve fibers of the periodontal membrane        interferences. The dental literature has       history, a clinical examination is
ridge resorption can be put off via a           act in concert with the muscles of              shown that patient expect to, but will not,    conducted. Every attempt is made to
removable partial denture, the patient will     mastication via a sensory feedback loop to      chew with more force with new dentures.        correlate the patient’s complaints with
have more ridge in 20 years with a partial      guide mastication and protect the teeth         Dentures cannot remedy the natural             clinical observations. When complaints
denture now than with a complete denture        from harmful noxious stimuli. Patients          muscle atrophy that occurs after teeth are     are incoherent with clinical observations,
now. And, of course, they will function         usually understand that concept, but do         extracted.                                     the potential for problems exists. When
better during that time.                        not understand its importance.                                                                 complaints understate clinical problems,
   Patients need to be told three magical          We continue to draw on another concept       The Role of Implants                           these patients are usually much easier to
concepts about residual ridge resorption,       that patients usually understand from their       During this discussion with patients, the    treat.
concepts originally elucidated by Tallgren.     common experiences. We explain that             role of implants can be introduced.               The clinical examination form that I
   First, residual ridge resorption is          once a nervous feedback loop is lost, a         Implants can be utilized to stabilize the      have found to be best is from the
chronic, progressive and irreversible. We       muscle weakens. Ask a patient if they           denture base, provide some proprioceptive      American College of Prosthodontists. This
tell patients, it is going to shrink, it is     have ever had, or have ever seen,               nervous feedback to improve mastication,       form is best explained via a downloadable
going to continue to shrink no matter what      someone who had a cast on a leg or arm.         and preserve existing residual ridges.         PowerPoint presentation from their
you do, and, it won’t come back. Second,        When the cast is removed the                    Implants are not a solution; however, for      website: It
the mandible shrinks at a rate four times       immobilized appendage is usually much           inadequacies in denture esthetics,             categorizes denture and patient-related
faster than the maxilla.                        smaller. Why? Because the                       occlusion and phonetics, implants must be      diagnostic criteria according to four
   In lay terms to the patient, you will get    immobilization has shut down the nerve          properly introduced as a adjunct to            classes. This classification is invaluable in
better suction on the upper denture now         loop that is functional, while the muscle       support the denture and maintain the           several ways. First, it objectively analyzes
and the lower denture will only get worse       would normally move the broken bone.            residual ridge, and not as a removable         the patient’s condition. Second, it
with time. Finally, they need to be told        The result: No movement and the muscle          prosthodontic panacea. Patients with           considers non-dental factors such as
that with immediate dentures, the most          gets smaller. With the muscles of               overdentures on implants who have              medical conditions, the patient’s past
resorption occurs during the first year and     mastication, that feedback loop is lost         denture-related problems will continue to      history with dentures and their
then slows to a more moderate, steadier         when the teeth and their nerves in the          have problems even if the dentures do not      expectations. Third, it classifies the level
rate. For patients, this concept means that     periodontal ligament are extracted for          move during function.                          of difficulty associated with these factors.
after teeth are extracted for an immediate      dentures. The muscles will weaken slowly                                                       Complex or difficult factors make the
denture, they can expect it to get loose        and progressively. Patients will notice a       Clinical Observations                          patient a Class IV patient—the most
during the first year and require a reline,     loss of tonus of the cheeks, lack of               My whole staff functions to educate         difficult—even if some of the denture
then relines in the future but less             support for the lips, lack of ability to bite   patients at all times during their             factors are favorable.
frequently.                                     with force into objects—and they will           experiences with us. We take as much              The difficulty factors can then be
                                                expect new dentures to remedy those             information as possible during the initial     discussed with the patient. When the
Muscle Atrophy                                  situations.                                     phone appointment and try to correlate         patient examination is related to their past
   Additionally, for patients considering          The dentist must resist the temptation       patient verbal complaints with clinical        history and to issues discussed above
extraction of their remaining natural teeth,    that opening the vertical dimension on the      observations.                                  related to residual ridge resorption and
an additional concept needs to be               denture, plumping out the denture base,            The initial exam starts with the patient    muscle atrophy, now all parties have an
explained. Once the teeth are removed,          and using cusp teeth will improve upon          expressing their chief complaint in            accurate understanding of what can be
not only does their remaining denture base      the patient’s complaint. As I discussed in      whatever terms they wish to use and for        accomplished via denture treatment (or no
start to deteriorate, but their muscles will    the last Pearls of Wisdom I wrote, Tooth        whatever amount of time they need. This        treatment). A copy of the examination
weaken. One of the overriding factors           selection for removable prosthodontics:         affords the dentist to not only take a         form is given to the patient to document
why denture patients can chew only at           Rational for selection, use 2003, the           complete history, but observe the patient.     what issues were discussed and the
10% to 20% of the level of dentate              selection of posterior tooth form does not      Can they see well? Do they hear well?          complexity of conditions that persist.
patients is not the fit of the denture or the   affect levels of mastication. The reason        Are they arthritic? Are they demanding,           Similarly, this protocol can be used for
teeth, but because of weakened muscles.         isn’t related to tooth factors but to the       reasonable, compliant? Do they relate          experienced denture patient desiring new
Patients need to be educated that along         issues discussed previously: Lack of            their history factually or emotionally? Do     dentures, or for patients having problems
with the removal of the teeth, surrounding      muscle power and fine discrimination,           they blame the previous dentist(s) for their   with immediate dentures who were not
structures are removed, namely the              poor denture base for stabilization of the      problems, or maybe the lab, a chairside        adequately educated before the teeth were
periodontal ligament and its rich nerve         dentures, and poor nervous feedback             employee, or the surgeon who extracted         extracted. In both circumstances, extra
web. We educate patients about this             during mastication. As I also discussed in      the teeth? All these observations help you     time needs to be spent evaluating and
importance by explaining to them a              that writing, patients will usually perceive    start to answer the question: Can you help     educating the patient before a decision can
                                                                                                                                               be made to treat the patient. Remember
                                                                                                                                               the old adage, “To explain before is to
                                                                                                                                               educate, to explain afterwards is to
                                                                                                                                               excuse.” Better to not be put on the
                                                                                                                                               defensive excusing why the new dentures
                                                                                                                                               did not live up to the patient’s
                                                                                                                                               expectations by spending some time
                                                                                                                                               before treatment educating the patient as
                                                                                                                                               to the inherent problems with dentures.

                                                                                                                                               Tissue Conditioning Treatment &
                                                                                                                                               Opportunities for Education
                                                                                                                                                  The education and evaluation process
                                                                                                                                               can be incorporated into clinical practice
                                                                                                                                               to supplement the information gathered at
                                                                                                                                               the initial evaluation. Almost all complete
                                                                                                                                               denture and removable partial denture
                                                                                                                                               patients present at their initial evaluation
                                                                                                                                               with gingival tissues that are inflamed and
                                                                                                                                               distorted from their previous prosthesis.
                                                                                                                                               Proper prosthodontic protocol is to restore
                                                                                                                                               these tissues to health before impressions
                                                                                                                                               are fabricated. While complete removal of
                                                                                                                                               the prosthesis for 48 hours is the best
                                                                                                                                               remedy, most patients will not comply
                                                                                                                                               with that procedure. Therefore, tissue
                                                                                                                                               conditioning treatment is the best
                                                                                                                                               procedure to allow the gingival tissues to
                                                                                                                                               recover before impression fabrication.
                                                                                                                                                  This tissue conditioning can take
                                                                                                                                               several visits to complete. During those
                                                                                                                                               visits, you have an        CONTINUED PAGE 13

10      Focus MDA   May/June 2006
                                                are too lengthy to be listed here. In fact    available only to you because we have         what inflation will do to your kid’s
                                                there are so many, I am sure there are        negotiated these on your behalf. An           college cost in 15 years and the best way
                                                some some of which you are not taking         example would be enhanced benefits or         to accumulate that, call us. And, if you do
                                                full advantage. One very important benefit    extended coverage where there is              not know the answer to what would
                                                that is underutilized is the Missouri         normally a gap. These are usually not         happen to your family or practice if you
                                                Dental Insurance Services (MDIS). MDIS        available from other sources.                 became ill or were seriously injured, by
                                                was formed in 1991 as a wholly owned              We serve only dentists. Our attention     all means, call us. Don’t expose yourself.
                                                subsidiary of MDA. Its primary objective      and effort is focused entirely, 100% on       MDIS has got you covered.
                                                is to provide and service quality insurance   issues that affect you. Indeed, we are           As the new Executive Vice President of
                                                and financial programs for dentists, their    specialists since we are not servicing the    MDIS, I am extremely impressed with the
Insurance                                       families and staff.                           general public or pursuing the myriad of      organization and capabilities of MDA and
Insider                                            In the marketplace, there are similar      other potential business clients. We are      MDIS. The officers, Board of Directors
                                                insurance and financial products available,   constantly evaluating, testing and            and staff are very professional and
News from MDIS
                                                but certainly not with the same penchant      challenging ourselves and the products        dedicated to justifying the value of
                                                for a perfect fit for you, our member. We     and services we provide to ensure they        membership. I look forward to being a

Are you                                         strive to distinguish our products and
                                                services from others in several major
                                                                                              meet the conditions of suitability for our
                                                                                                                                            part of the team and working with you.
                                                                                                                                               If you have questions or would like to

                                                categories. They are:                            The next time you feel uneasy about a      find out more about MDIS as a
                                                     The products and services are            particular situation and feel you may be at   membership benefit, do not hesitate to call
                                                provided to our members at a significant      risk, call us. If you are wondering whether   Greg Russell, MDIS Executive Vice
by Greg Russell                                 discount, not available from other sources.   you have enough or the right type of life     President, at 800-944-7550 or e-mail at
MDIS Executive Vice President                        There are special programs or features   insurance, call us. If you want to know

        ike a zebra without his stripes,

L       today’s practicing dentist is out of
        place and vulnerable, if they are not
a member of the Missouri Dental
Association. Faced with a jungle of
government compliance issues, the
dangers of ever-changing legislation, and
the threats imposed by a litigious society,
your practice and livelihood can be placed
in jeopardy at anytime by one of these
   Thank goodness you’re a MDA
member! A quick inventory of benefits
allows you to recall that through your
association’s legislative advocacy,
involvement as a CE provider, and
networking of information, you are
protected from many of the traps and
pitfalls that are waiting for you.
   And, there is so much more. All of the
benefits afforded by membership in MDA

 MDIS hires new
 Executive VP
        issouri Dental
 M      Insurance
 Services recently
 welcomed Greg D.
 Russell, LUTCF, as
 the new executive
 vice president of the
 MDA subsidiary insurance company.
    Greg was formerly with Capital
 Reserve Life Insurance Company
 where he most recently worked as their
 director of training and marketing.
    His career has taken him throughout
 the state and most likely, has led him to
 work with other professionals in your
 dental community. He is licensed in the
 lines of health, life, accident, property
 and casualty, and series 6 securities. He
 has earned the LUTCF certification
 from the National Association of
 Insurance and Financial Advisors.
    “I am very excited to on be board
 with MDIS and affiliated with MDA,”
 says Greg. “My goal is to make certain
 that MDIS provides the means to a
 secure financial future with fewer
 complications in life for all MDA
 members. Because we are focused on
 issues that impact your livelihood, we
 will be a valued, specialized and
 professional resource.”
    Greg resides with his family near
 Jefferson City and serves on the Blair
 Oaks R-2 School Board.

                                                                                                                                                      Focus MDA   May/June 2006     11
                                                Podcasts offer countless ways
                                                to educate, entertain your brain
                                                requires an iPod or other portable player.     built into the iTunes software. When
                                                The name association came about simply         Apple first began selling the iPod and
                                                because Apple Computer’s iPod was the          allowing free downloads of the

Tech Talk
                                                most marketed and the best-selling             iTunes software, it also had set up the
                                                portable digital audio player when             iTunes music store. This online store,
John Flucke, DDS                                podcasting began, and was used by early        which is accessed through the iTunes
                                                practitioners.                                 software sells individual songs as
                                                   What’s made the iPod so popular is how      well as full CDs for download. Once
        his technology thing just keeps         easy it is to use. It comes with software      podcasting went mainstream,

T       rolling along. Whether you’re
        embracing it and having fun with it
or just trying to figure it out, there is no
                                                called iTunes which allows easy
                                                management of all the audio files on your
                                                computer. When you first install it, iTunes
                                                                                               podcasts became available through
                                                                                                  When you access the iTunes store,
doubt that the changes we have                  will search your entire hard drive for all     one of the choices you can click on is
experienced for the last few years are here     the music and audio files that you have.       “podcasts.” From there you can
to stay and that the only constant we’re        You can then play them all through the         search by subject. Simply typing in
going to see is more change.                    iTunes program.                                the subject of your choice will yield and       advantage of listening to podcasts on your
  Along the lines of change and how we             But just having a great player and          amazing number of results. While                computer. You can download the iTunes
deal with it, there is a term that has been     organizer software isn’t where the real        researching this article, I typed in “dental”   software for free and listen on your
appearing in the media for the last year or     advantage comes in. When you connect           and got 23 hits.                                computer; just visit
so and is starting to have implications in      your iPod, the software will automatically        The best part about subscribing to           Additional online resources include:
both our professional and personal lives.       realize it is connected and begin to           podcasts through iTunes is that any time  
The word you may have heard is                  transfer all of your music files over to the   you open the iTunes software and have an  
“podcast.”                                      device. Each time you connect it, any new      active Internet connection, the software  
  Podcasting is method of distributing          files are automatically added which keeps      will check to see if there are any updated
multimedia files, such as audio programs        the files on the iPod the same as the ones     podcasts in your subscriptions. If there
or music videos, over the Internet for          on the computer. If you’re like me, I love     are, the software will download them            Recent “dentalcast” topics:
playback on mobile devices (such as MP3         having any song I own with me wherever         automatically. The next time you connect            Benefits of a Treatment Coordinator
players) and personal computers.                I go.                                          your iPod, the podcast will be transferred      with Dr. Rick Coker
Podcasting’s essence is about creating             These features alone were great, but        to it. This is done seamlessly and makes            Protecting the Family Jewels…Data
content (audio or video) for an audience        then somebody had the great idea of            keeping up to date with your podcasts as        Preservation in the Digital Dental Office
that wants to listen or watch when they         “podcasting.” Podcasting is a free             simple as starting the software! And,           with Dr. Skip Silvers
want, where they want, and how they             recorded broadcast. It’s usually interviews    because it automatically updates any new            CEREC; CAD/CAM Technology for
want.                                           or commentary and it is recorded in the        podcasts, you can take them with you to         the Dental Office
  Unless you’ve been living in a vacuum,        same format as digital music, which is         listen wherever you go.                             Dental Insurance; A View from Both
you’ve surely noticed all of these people       MP3. Podcasting first hit the mainstream          My favorite dental podcast is dentalcast     Sides of the Claim Form with Dr. Fred
in airports and gyms (or most likely, your      about 18 months ago and it immediately         ( It is done by my          Quarnstrom
kids) with the white earbuds in their ears.     began to take off. It gave anyone with         good friend Dr. David Dodell and is the             Guidelines for Selecting, Evaluating
These earbuds are connected to iPods.           enough gumption a chance to be heard on        original dental podcast. It’s well done,        and Purchasing a Dental Practice with
Although there are other brands and types       any subject they wanted to talk about.         informative, and even offers CE credit.         Kathleen Johnson
in existence too numerous to mention, the       Although many of the early podcasts were       The CE requires payment of a nominal fee            Emergency Prevention & Preparation
iPod is the best selling, and I believe, best   poorly done ramblings by those with little     and taking a short online exam, but you         with Dr. David Roberts
designed, digital music player in the           or no broadcasting experience, it wasn’t       can listen at no charge. See samples                Hypnosis and Its Use in Dentistry
world. So, for the sake of this article, I      long before professionals began to see the     following of some of podcast titles since       with Dr. Ashley Goodman
will reference the idea of podcasts via an      advantage to this type of exposure.            its inception.                                      Choosing, Constructing, and
iPod. However, keep in mind that neither           In fact, podcasting has become so              If you don’t have any desire to own a        Communicating with your Dental Lab
podcasting nor listening to podcasts            popular that a podcasting feature is now       portable music player, you can still take       with John Gimpel, CDT, David Lesh,
                                                                                                                                               CDT, and Lewis Sharp, CDT
                                                                                                                                                   Digital Dental Diagnosis with Dr John
                                                                                                                                                   Reducing Cancelled and Failed
                                                                                                                                               Appointments with Diane Glasscoe
                                                                                                                                                   Advances in Periodontal Treatment
                                                                                                                                               with Dr. Steve Rappeport
                                                                                                                                                   Email Communications with your
                                                                                                                                               Patients with Dr. Dov Glazer & Ben

                                                                                                                                               Dr. Flucke is a UMKC School of Dentistry graduate
                                                                                                                                               and also serves as the Technology Editor for
                                                                                                                                               Dental Practice Report. Contact him at 816-525-
                                                                                                                                               7373 or

                                                                                                                                                 Visit for archives of
                                                                                                                                                  Tech Talk and Pearls of Wisdom
                                                                                                                                                   articles. It’s all available under
                                                                                                                                                 Members Only on
                                                                                                                                                   Remember, if you have a web
                                                                                                                                                 site for your practice - share with
                                                                                                                                                   with us. We can add it to your
                                                                                                                                                   information under the “Find a
                                                                                                                                                   Dentist” feature so they public
                                                                                                                                                    can click on the link to learn
                                                                                                                                                      more about your practice.

12      Focus MDA   May/June 2006
PEARLS OF WISDOM                                having an annual exam to check the fit
                                                and occlusion on the dentures, cleaning
                                                any calculus or stain that has built up on
                                                                                                                                                                        I truly feel this is a great program,
                                                                                                                                                                          and I feel very blessed to have gone
                                                                                                                                                                        through it. My team knows it has
                                                the dentures, and performing a soft tissue                                                                              made a difference, and they
ongoing opportunity to visit the patient’s      and oral cancer exam. Dentures need to be                                                                               appreciate it also. Leadership and
chief complaint and to educate the patient.     relined every 3 to 5 years and then remade                                                                              coaching are two big things needed in
                                                every 7 to 10 years.                                                                                                    every organization for proper function
Often concepts have to be explained                                                                                                                                     and direction.
several times before the patient                   When this is all considered, the                                                                                                             — Dr. Kirk Opdahl
understands them. We encourage patients         statement that new dentures will solve all
                                                a patient’s dental woes once and for all is
                                                                                                                          into leadership                                                      Independence, Mo.
to bring someone whose opinion is
significant to these and all visits. This       shown to be grossly uneducated.
includes the initial exam, the tissue                                                                       Missouri Dental Association
                                                Joseph F. Shea, DDS, MS is a 1982 graduate of
conditioning visits, denture fabrication
visits and especially, the wax try-in visit.    UMKC School of Dentistry. He obtained a Masters             Leadership                               To learn more about the program, download an application
                                                                                                                                                     and watch a new testimonial video, visit,
                                                of Science in 1989 from the University of                   Development Continuum                    For the Dentist, Leadership Development.
  Often males are nondiscriminatory
                                                Michigan in Prosthodontics and Restorative
about esthetics related to dentures and will
                                                Dentistry. He is a Diplomate of the American
readily accept a wax try-in. However,           Board of Prosthodontics, a Fellow in the American
there is often what we term, “the Wizard        College of Prosthodontists and a Fellow in the               The 2006/07 application deadline has
of Oz” at home. That is, someone hidden         American College of Dentists. Dr. Shea is a past             been extended. Contact Vicki Wilbers
in the background who has an opinion
about treatment and can cause extreme
                                                president of the Greater St. Louis Dental Society
                                                and has a fulltime referral-based practice in St.
                                                                                                             for details at or
                                                                                                             573-634-3436, 800-688-1907.            Transform. 1nspire. Lead
difficulties if not satisfied. It is best to    Louis limited to the specialty of prosthodontics.
meet this person during treatment and to
educate that person along with the patient.
Often you will find this person has
dentures and expects the patient to
function just as well. Or, this person has
higher esthetic ideals than the patient that
must be fulfilled. Another scenario is this
person is dentate and expects new
dentures to solve all the patient’s
problems. In each of those scenarios,
problems can be avoided by educating this
hidden critic before it is too late.

Mastication Issues
   Once the dentures are delivered, the
educational process does not end. Patients
need to be taught that in order to stabilize,
the denture mastication should occur on
the right and left posterior segments
simultaneously. If a patient chews on one
side the denture will tip. Similarly,
patients need to be taught that the front
teeth are for smiling and not biting; as
well, they need to be re-taught that food
should be cut up and not bitten off, and
that if any biting of food does take place,
it should be done in the canine regions.
   Patients with immediate dentures need
to be re-educated about the muscle
patterns discussed above. One of the most
difficult problems immediate denture
patients exhibit is the retained muscle
pattern of their dentate condition as they
chew with removable complete dentures.
They will want to unilaterally chew, chew
on the front teeth, and will retain
clenching and bruxing habits on the new
dentures. If this persists, problems with
lack of stability, sore spots and difficulty
in adapting to new dentures will develop.

Present and Future Care of Dentures
   Patients need to be educated to properly
care for their dentures. A period of rest
must be conducted daily; it doesn’t matter
if it is at night or during the day, but the
basal tissues need to be allowed to recover
from wearing the dentures for several
hours each day.
   Denture adhesives are acceptable.
Turbyfill states that once a patient uses
adhesives they are “addicted” to the
sensation of fit that the adhesive gives. If
a patient presents at their first visit
wearing adhesives and wishes to stop
wearing adhesives after new denture
fabrication, they should be told they will
probably continue to wear adhesives.
   The need for future dental care needs to
be emphasized. Often denture patients
have not had regular recalls. They need to
be educated about the importance of                Photo copyright St. Louis Convention & Visitors Bureau

                                                                                                                                                                    Focus MDA      May/June 2006                13
                                              by Tess Fyalka

                 to catch
                                                                           maintained the doctor’s cash value for his    successful oral surgery practice. He also
                                              Illinois Dental News         insurance retirement. Using a signature       lectures on the topic of white collar crime
                                                                           stamp, the office manager instructed the      and is the author of two books on fraud in

                   a thief
                                                       r. J.M. of          insurance company that due to the illness     the dental practice, Employment

                                   fraud in
                                              D        Phoenix,
                                                       Arizona had a
                                              wonderful practice and
                                                                           it was time to “cash in” on the policy. All
                                                                           forms were completed and again stamped
                                                                           with the signature stamp. By the time Dr.
                                                                                                                         Embezzlement and Fraud in the Dental
                                                                                                                         Office: Scams, Schemes, and Broken
                                                                                                                         Dreams (Lexi-Comp) and, his most recent
                                              marriage. He had been        J.M. returned, he had not only lost his       publication, both of which are available at
                                 the dental   in dentistry for almost
                                              50 years and married
                                                                           wife but also his life savings.     
                                                                                                                            Although Dr. Lewis is the only dentist
                                   practice   just as long. Life took a    This tragic, true story is one of numerous    to talk publicly about his personal
                                              turn when his wife           actual cases shared in Dr. Dr. Donald P.      experience as a victim of fraud and
                                              became gravely ill, and      Lewis’s new book Your Roadmap to              embezzlement, his situation is not
                                              Dr. J.M. had to take a       Financial Integrity in the Dental Practice    uncommon. Currently, one out of four
                                              leave from his practice      (Lexi-Comp). Dr. Lewis, an oral and           dentists, one out of two veterinarians, and
                                              to care for her. He left     maxillofacial surgeon in Cleveland, OH        one out of five physicians is, has been, or
                                              the office in the hands of   knows all too well what it’s like to have a   will be embezzled. On average, each will
                                              his trusted office           thief on staff. In 1993, he discovered one    lose some $120,000. The Association of
                                              manager. The office          of his most trusted employees had stolen      Certified Fraud Examiners (ACFE)
                                              manager proceeded to         tens of thousands of dollars from him.        estimated that in 2003 alone,
                                              write to the insurance         Today, Dr. Lewis is a Certified Fraud       embezzlement cost American businesses
                                              company that                 Examiner, in addition to running a            $660 billion, or 6 percent of total
                                                                                                                         revenues. Moreover, while big companies
                                                                                                                         get the big headlines it’s the small
                                                                                                                         businesses that take the big losses. The
                                                                                                                         ACFE noted that the smallest businesses,
                                                                                                                         those with 100 employees or fewer,
                                                                                                                         experience higher median losses than the
                                                                                                                         largest organizations.
                                                                                                                            While the numbers reported by the
                                                                                                                         ACFE are startling, the true cost of fraud
                                                                                                                         to businesses is difficult to estimate
                                                                                                                         because not all fraud and abuse is
                                                                                                                         discovered, not all uncovered fraud is
                                                                                                                         reported, and civil or criminal action is
                                                                                                                         not always pursued.
                                                                                                                            In the 12 years since being a victim of
                                                                                                                         fraud and embezzlement in his own
                                                                                                                         practice, Dr. Lewis has helped to uncover
                                                                                                                         more than 150 cases of fraud in dental
                                                                                                                         offices around the country. He’s found
                                                                                                                         that there are a multitude of different ways
                                                                                                                         in which fraud can occur including
                                                                                                                         computer fraud, payroll fraud, credit card
                                                                                                                         fraud, false billing, check fraud, insurance
                                                                                                                         fraud, electronic transfer of funds, and the
                                                                                                                         list goes on. Computer fraud and phony
                                                                                                                         billing tend to be the most common.
                                                                                                                            Employees that use the computer to
                                                                                                                         commit fraud typically have learned how
                                                                                                                         to manipulate the software to their
                                                                                                                         advantage. Often they will devise a
                                                                                                                         scheme to eliminate patient payments
                                                                                                                         from the records and keep the funds for
                                                                                                                         themselves or transfer the funds into their
                                                                                                                         personal accounts. What’s more, it’s not
                                                                                                                         just cash that employees are stealing. In
                                                                                                                         fact, Dr. Lewis notes that the belief that
                                                                                                                         employees only steal cash is one of the
                                                                                                                         great misconceptions about fraud. Fact is,
                                                                                                                         staff members who commit fraud in the
                                                                                                                         practice steal checks, credit cards, and,
                                                                                                                         yes, cash. “The other misconception is
                                                                                                                         that checks are sacred, and no one but you
                                                                                                                         can sign your checks. That’s not true. An
                                                                                                                         employee can order new checks. They can
                                                                                                                         sign your name on the checks and make it
                                                                                                                         payable to them. They can steal checks
                                                                                                                         from the insurance company. They can
                                                                                                                         signature stamp checks. Checks are a huge
                                                                                                                            Dr. Lewis emphasizes that people often
                                                                                                                         assume the bank, the insurance company,
                                                                                                                         or the patient will examine the check and
                                                                                                                         discover a fraudulent signature, but that
                                                                                                                         seldom occurs. “People don’t realize the
                                                                                                                         banks process more than 35,000 checks
                                                                                                                         per minute. They don’t have time to check
                                                                                                                         for one signature.” And many patients
                                                                                                                         don’t even receive let alone look at their
                                                                                                                         cancelled checks.

                                                                                                                                                CONTINUED NEXT PAGE

14   Focus MDA   May/June 2006
Profile of a pilferer                            rationalization that allows people to do                            same situation. She joined them as did                              steal from the practice to get back at the
   If one of your employees is an                something they would never do—steal.                                employees four and five. The doctor had                             doctor.
embezzler, Dr. Lewis says it’s likely the        Often employees actually repay these                                five employees stealing from him before                                Ultimately, fraud is uncovered, notes
one in whom you have the greatest                “loans” the first few times, before the                             they finally got caught.”                                           Dr. Lewis, but it can take a very long
confidence. “The embezzler is your best          amounts get out of control and/or they no                              A study conducted by the U.S.                                    time. “I’ve seen cases that have gone on
friend. They are believable. They are            longer need to rationalize their behavior.                          Department of Commerce found that                                   for 12 to 15 years. I’ve seen cases where
tireless workers. They don’t take vacation,                                                                          about one-third of all employees steal                              someone has worked for someone for 20
and often they don’t even take a lunch           Motivation, opportunity, rationalization                            from their employers. In security, the                              years. The doctor retires and so does the
hour. They have control of everything and           For fraud and embezzlement to occur in                           common guideline is that 40% of the                                 employee. They don’t want to stick
you trust them beyond any doubt.”                the dental practice, Dr. Lewis says that                            workforce is inherently honest, 30% are                             around.” In other cases, the doctor wants
Meanwhile that individual quietly believes       certain factors must be in place. First, the                        looking for the opportunity to steal, and                           to change the computer system and the
that they are as important or more               employee has to have the motivation to                              the other 30% will steal given the right                            employee resists because they’ve been
important to the practice than the doctor.       steal—a perceived need. “It could be a                              circumstances. While the new hire may be                            successfully manipulating the existing
They have a strong sense of entitlement          financial need. It could be that their                              the one watched more carefully initially, it                        system.
and think nothing of stealing everything         spouse is out of a job. Maybe they have                             is the long-term employees who defraud
from paperclips and ink pens to thousands        someone who is sick in the family, or it                            the practice. They know the practice’s                              Fraud protection is personal involvement
of dollars in revenues.                          could be an addiction such as drugs,                                systems and procedures. They are given                                 Dr. Lewis urges dentists to become
   The increasing prevalence of                  gambling, or alcohol.” They have the                                far more control than they should be                                involved in their practices. “They can’t
embezzlement, fraud, and “cooking the            opportunity to steal. Then they come up                             given, and they are able to devise the                              say, ‘I just want to do dentistry. I don’t
books” at every level from the major             with a plan. Once they have their plan in                           scheme to skim.                                                     care about the business.’ They have to
companies, such as Enron, to the small           place, they will try it. “Typically, they will                         What motivates an otherwise loyal                                spot check. They have to learn their
dental practice down the street reflects a       start by stealing a small amount or                                 employee to start stealing from the                                 computer and know the software and how
shift in societal attitudes. “In the 1960s, if   seemingly insignificant item. It could be                           practice is often the great unknown, but                            it can be manipulated. They have to look
someone were caught stealing, they would         cash or checks, or it could be magazine                             the practice environment plays a                                    at the reports and understand them. And,
say, ‘I’m really sorry, and I’ll do my best      subscriptions or toothbrushes. It could be                          significant role. If the doctor engages in                          most important, they have to separate the
not to do that again.’ In the 1980s, the         anything. They carry out their plan to see                          some type of unethical activity, it breeds                          duties, and treat the practice like the
attitude was, ‘You caught me, but I was          if they are detected. If they are not                               the attitude of “If he doesn’t care, why                            business it is.”
just testing the waters and you need to          detected then they become greedy.”                                  should we?” In other cases, the doctor                                 Since being a victim of fraud and
thank me.’ Today the attitude is, ‘So what.         Dr. Lewis has found situations in which                          may be very ethical but overly trustworthy                          embezzlement, Dr. Lewis has changed all
Everybody does it.’ The ethics are               employees were operating in collusion to                            and otherwise oblivious to what is                                  of the systems in his practice to ensure
completely gone,” notes Dr. Lewis.               defraud the practice. “We’ve had instances                          actually happening with key systems that                            that history doesn’t repeat itself. “I’ve
   According to the American Institute of        in which five employees were stealing                               directly affect practice finances. In still                         changed my whole way of doing business,
Certified Public Accountants, employees          money. The office manager, we’ll call him                           other situations, the person handling the                           from the computers, to the payroll, to
who handle large sums regularly often            employee number one, was caught by                                  accounting functions may be overbearing                             billing, to credit cards. I write all the
begin to feel as if it’s their money and that    employee number two. Employee number                                and capable of intimidating the doctor and                          checks. I do all my payables. I reconcile
the lifestyle that goes along with such          two had a choice to turn in the office                              others. Consequently, no one questions the                          the bank statements. I know where those
sums is theirs by right. Furthermore, the        manager or be cut into the deal. She chose                          employee. In other cases, the doctor may                            checks are going and when they’re
notion that she’ll just “take a loan” is         to take her cut. Employee number three                              be a micromanager and the employee may                              coming back. But, more importantly, I
more common than is imagined. This is a          comes along and catches them. It was the                            feel picked on and justifies a reason to                            changed me.              CONTINUED NEXT PAGE

          Because rules and regulations
           don’t always come with manuals...
                        (and let’s face it, you don’t have time to create one)
                                                         A Conscious Sedation Manual for Dentists
                                                         A Dentist’s Guide to Informed Consent
                                                         written by a practicing Missouri dentist for Missouri dental practices

                                                         A Conscious Sedation Manual for Dentists                                                   A Dentist’s Guide to Informed Consent
                                                         Satisfies New Missouri Rules Regulating Conscious Sedation Effective April 30, 2006.       Written by a former Dental Board Member based on review of more than 1000 cases.

                                                         Over 300 Pages Including Sections On                                                       Over 100 Pages Including Sections On
                                                             Preoperative Patient Evaluation and Selection                                              Informed Consent to Improve Relationships & Treatment Acceptance
                                                             Review of Patient Data Base, Patient Medical History & Medications                         5 Standards of Informed Consent
                                                             Physical Assessment and Core Physical Evaluation                                           Improving Documentation and Consultations with Digital Photography
                                                             ASA Classification System                                                                  Documenting Diagnoses: Putting it Together in a 2-Page Form
                                                             Medical Consultations                                                                      Implementing Informed Consent in Your Practice
                                                             Pre-Sedation/Anesthesia Assessment                                                           Oral Informed Consent Protocol
                                                             Informed Consent for Sedation                                                                Written Informed Consent: How, When, and Why
                                                             Maintaining Appropriate Records
                                                             Sedation Monitoring Procedures                                                         Over 20 Forms Including
                                                             Patient Discharge Assessment                                                               Written Diagnostic Summary        Bleaching
                                                             Responding to Medical Emergencies Incident to Sedation                                     Partial Denture (Consult/Try-in)  Complete Denture (Consult/Try-in)
                                                             Sedation Rules and Statutes                                                                Non-Surgical TMJ Therapy          Non-Surgical Periodontal Therapy
                                                             6 Sedation Form Templates                                                                  Oral Surgery                      Periodontal Surgery
                                                             Controlled Substance Classifications                                                       Urgent Stabilization Consent
                                                             FDA Pregnancy Classifications                                                                (Hopeless Teeth, Infections, Decay, Unstable Bite, TMD)
                                                                                                                                                        Consent for Restorative Care (Comprehensive Consult Stage)
                                                         Also includes 17 Self Tests to assess knowledge about safe sedation
                                                                                                                                                        Extractions Endodontic Therapy
                                                         practices and 10 Pre-formatted Staff Meeting agendas to elevate your team
                                                                                                                                                        Single Tooth Reinforcing Restorations Consent (Crowns, Onlays, Inlays)
                                                         to competency
                                                                                                                                                        Tooth Replacement Prostheses Consent
                                                                                                                                                          (Implant Supported Crowns, Bridges, Partial Dentures)

                                                                                                                                                       Manuals created by Guy S. Deyton, DDS
                                                                                                                                                For sample sections, information or orders contact Julie
                                                                                                                                                        816-587-6444 or

                                                                                                                                                                                                        Focus MDA       May/June 2006   15
FRAUD IN THE DENTAL                                Print and review an audit trail report      stamp.                                         Fraud and white collar crime have
PRACTICE CONTINUED FROM PAGE 15                daily. It reflects every transaction that has       Periodically check the account number   increased considerably over the several
                                               transpired in the office since the last         to ensure it is the practice account.       years, and it appears the trend will
Instead of being the one who runs out the      printed audit trail.                                Bank deposits should be made daily      continue. While it is impossible to
door at five o’clock, every night I stay and       A separate report listing all patients      and the responsibility should be rotated    implement systems and controls that will
look at the reports. Every day I look at       with changes made to their accounts             among employees.                            completely eliminate the threat of theft
what I am doing. I pay attention, which        should be generated monthly to correct a            The employee making the bank            and fraud, dentists can take numerous
was the biggest thing that I learned.”         recurring problem or detect a problem.          deposit should not be the same employee     steps to curtail the likelihood that they
   While many dentists fear that tighter           A “no bill” report should be reviewed       responsible for checking the deposit slip   will be victimized by an unethical
controls will offend employees and make        monthly. An employee other than the             that is returned from the bank.             employee.
them feel they are not trusted, Dr. Lewis      person responsible for billing and                  Monitor deposits for unexplained
says he’s found that good employees like       accounts should run the report.                 increases or decreases.                     Article reprinted with permission from the Illinois
good internal controls. Employees that are         Conduct random checks of different              Signature stamps should not be used.    State Dental Society, Illinois Dental News,
suspect don’t like the controls.               accounts.                                           Monthly credit card statements should   February 2006, Volume 75, Issue 2.
   In his latest book, Your Roadmap to             Separate billing, collections, and          be received unopened and compared with
Financial Integrity in the Dental Practice     delinquent account responsibilities.            original receipts of purchases.
A Teamwork Approach to Fraud                       In practices with small staffs, the             The doctor should reconcile the bank
Protection and Security (Lexi-Comp) Dr.
Lewis offers hundreds of
                                               doctor must take a much more active role
                                               in monitoring these different areas.
                                                                                               statement monthly and cancelled checks
                                                                                               should be sent along with the bank
                                                                                                                                            Support, recovery
recommendations on how to ensure solid             Checks received should be                   statement.                                   for impaired hygienists
financial controls within the practice,        immediately stamped on the back with the            Make sure all deposits and checks are    MDA Well Being program is not just for
including:                                     practice’s bank deposit endorsement             accounted for.                               dentists; helps hygienists facing issues
                                                                                                                                            other than chemical dependency

                                                                                                                                            by Sue Clifford, RDH, BGS
                                                                                                                                            MDA Well-Being Committee Member

                                                                                                                                                     ears ago when the first impaired

                                                                                                                                            Y        dentist programs were created,
                                                                                                                                                     the impaired dentist was a male
                                                                                                                                            with a chemical dependency on alcohol
                                                                                                                                            and/or prescription drugs. Today there
                                                                                                                                            are more female dentists and the
                                                                                                                                            majority of dental hygienists are
                                                                                                                                            women. Impaired women may not only
                                                                                                                                            have a chemical dependency but also
                                                                                                                                            issues of sexual or physical abuse, low
                                                                                                                                            self-esteem, and depression. Ask any
                                                                                                                                            dental hygienist who practices clinical
                                                                                                                                            hygiene part-time or full-time, she/he
                                                                                                                                            will tell you it is physically very
                                                                                                                                            demanding. Hygienists are known to
                                                                                                                                            have chronic neck, back, shoulder pain,
                                                                                                                                            and permanent nerve damage. Chronic
                                                                                                                                            pain can lead to alcohol, pain and
                                                                                                                                            muscle relaxant drug use to the point
                                                                                                                                            where chemical dependency occurs and
                                                                                                                                            the impaired hygienist’s health and
                                                                                                                                            career are in jeopardy.
                                                                                                                                                A dental hygienist is a terrible thing
                                                                                                                                            to waste. Hygienists need to help each
                                                                                                                                            other instead of ignoring the problem or
                                                                                                                                            enabling (protecting) the chemical
                                                                                                                                            dependent before the hygienist has
                                                                                                                                            her/his license revoked, harms
                                                                                                                                            someone, or dies. This is where the
                                                                                                                                            MDA Well-Being Program steps in to
                                                                                                                                            help the hygienist into recovery. The
                                                                                                                                            impaired dental hygienist may
                                                                                                                                            volunteer to come forward for treatment
                                                                                                                                            or the hygienist is referred to the Well-
                                                                                                                                            Being Program by office staff, friends,
                                                                                                                                            colleagues, loved ones, and/or the
                                                                                                                                            Missouri Dental Board. The program
                                                                                                                                            administrator provides resources and
                                                                                                                                            coordinates the care of the hygienist
                                                                                                                                            throughout the course of treatment.
                                                                                                                                                The Missouri Well-being Committee
                                                                                                                                            board of directors includes one member
                                                                                                                                            from the Missouri Dental Association,
                                                                                                                                            Dr. William Kane, one member from
                                                                                                                                            the Missouri Dental Board, Dr. Eric
                                                                                                                                            Aubert, one member from the Missouri
                                                                                                                                            Dental Hygienists’ Association, Sue
                                                                                                                                            Clifford, and the committee
                                                                                                                                            administrator, Ira Davis, LPC,
                                                                                                                                            NCADAC. This year the committee
                                                                                                                                            members attended the American Dental
                                                                                                                                            Association 11th National Institute on
                                                                                                                                            Dentist Well-Being in Chicago, Illinois.
                                                                                                                                            One of the main concerns discussed at
                                                                                                                                            the meeting was how to reach out to
                                                                                                                                            impaired dental        CONTINUED NEXT PAGE

16      Focus MDA   May/June 2006
                                                                                                                                                                   IMPAIRED HYGIENISTS
                                             Addressing snide comments, complaints
 Bites &Briefs                                           ave you ever found yourself hearing an off-   staff will ignore these comments or, worse, laugh them
                                                                                                                                                                   CONTINUED FROM PREVIOUS PAGE

  NEWS WORTH NOTING                          H           the-cuff comment from a patient, such as,
                                                         “Am I paying for the doctor’s new car?” and
                                             wondered how to address it?
                                                                                                       off. Roman says a quick response to these kinds of
                                                                                                       remarks can help negate their effects. Staff should
                                                                                                       answer a rude comment with, “If you have any
                                                                                                                                                                   hygienists. For all Missouri hygienists,
                                                                                                                                                                   treatment is available through the MDA
                                                                                                                                                                   Well-Being Program. An impaired dental
                                                                                                                                                                   hygienist may be aware of his or her
                                                Risk management expert Kathleen Roman believes         concerns or questions about the treatment plan, we          chemical dependency, but feels
                                             dentists should consider members of their staff as        need to make sure that you and doctor have a chance         embarrassed, isolated and doesn’t seek
                                             “front line risk managers” and instruct them to respond   to talk before your next appointment.” Or, concerning       help. Or the impaired hygienist may think
                                             immediately to worries or complaints from patients.       payment, “If you have a minute, I know that our office      he or she has the situation under control
                                                “Employees who know the warning signals can give       manager will want to go over any aspects of the             and is in denial that there is a real
                                             their doctors a ‘heads up’ when patients’ comments or     payment plan that are of concern to you.”                   problem with drugs and alcohol. Dental
                                             actions cross the boundaries of appropriate behavior,”        According to Roman, this proactive tactic has several   hygienists are caring and compassionate
                                             she writes in the November/December 2005 KDA              benefits. First, it nips the problem in the bud and         when treating their patients. Hopefully the
                                             Today, magazine of the Kentucky Dental Association.       makes it clear to other patients who may be listening       care and compassion will apply to an
                                                Roman advises that discussion and role-playing can     that any comments will be taken seriously. Second, it       impaired dental hygienist. Help, support,
                                             help staff learn how to deal with inappropriate           decreases the likelihood that other patients will hear      and recovery are available. Contact the
                                             behavior by patients. Snide comments in the waiting       the complaints and mimic the same behaviors. Finally,       Well Being program administrator, Ira
                                             room about a dentist’s competence or pricing can have     taking these kinds of remarks seriously will help the       Davis, confidentially, by calling 866-442-
                                             a damaging effect on the practice, particularly when      dentist and staff head off potential trouble, such as       0300. To learn more go to,
                                             made within the hearing of other patients. Too often,     missed appointments, stopped payments or lawsuits. or for a brochure, e-mail

MDA creates new booklet
detailing member benefits
and professional resources
    he MDA recently created a brochure
T   to serve as an overview of the many
benefits available to MDA members, as
well as outline the many professional
resources to help in your practice.
“Membership Matters: Guide to
Membership Benefits and Professional
Resources” contains sections on:
Contacting the MDA, Understanding
Tripartite Membership, State & Federal
Regulatory Agencies, Practice
Management, Continuing Education,
Endorsed Services, Legislative Activities,
Peer Review, Well Being, Information &
Programs for the Public, Commitment to
Dental Students, Opportunities to Serve,
and a Year at a Glance Calendar. The
booklet is free to members, just call to
request or e-mail,
or download it at, Members
Only, Practice Management.

EFDA program undergoing
review; your comments and
suggestions are welcome
      n EFDA Ad Hoc formed by the
A     MDA recently met to discuss current
pitfalls of the EFDA programs, determine
common ground for changes to the
program, and set an action plan for
moving forward. The ad hoc will also be
considering any recommendations to be
made to the MDA Board regarding the
expanded function rule. If you have any
comments about the program or would
like to offer any suggestion you’d like to
have considered, please e-mail these to

Thanks to UMKC “Food for
Thought” speakers
    he Committee on the New Dentist
T   would like to thank the following
Food For Thought speakers for the 2005-
2006 academic year: Dr. Guy Deyton,
Kansas City; Dr. Ed Kendrick, Kansas
City; Dr. Matt Gassen, Jefferson City; Dr.
Matt Niewald, Kansas City; Missouri
Dental Insurance Services; and, Greg
Pinkerton, MBNA Practice Solutions.

                                                                                                                                                                             Focus MDA   May/June 2006     17
                                                  lakes and rivers, low cost of living, and        ownership potential. Full time, No evenings     office available, well managed with
                                                  excellent school districts.                      or weekends. For information, call 636-         ownership potential. Send resume to Human
                                                                                                   928-4888, ask for Rhonda, or e-mail             Resources, 10128 Shapfield Lane, St. Louis
                                                  SEEKING ASSOCIATE DENTIST. Exceptional                               MO 63123.
                                                  opportunity for an associate dentist
                                                  interested in an eventual buy-in to a            ASSOCIATE/PARTNER WANTED IN NEOSHO.             DENTIST NEEDED FOR EXCITING NEW PRACTICE
                                                  practice in an environment that emphasizes       Well-established family practice in             IN COLUMBIA. Thriving mid-Missouri dental
                                                  excellence in delivering quality patient         excellent location. 3,800 sq ft, 7 ops,         corporation with 3 offices, 3 in-house labs
                                                  care. Our office is centrally located at the     CEREC 3D, KCP, Piezo scalers, Panellipse.       and a mobile dental service is looking for a
                                                  intersections of the two major interstate        Immediate workload for an associate plus        dynamic dentist or two to set up in our new
 The                                              highways in St. Louis County. We are a well      buy-in opportunity. Visit     Columbia office. It is 5400 sq. feet with 11
                                                  established, fee-for-service practice            or call Call Mercer’s Associate Placement       operatories, lab, Cerec crowns and
 Marketplace                                      providing all phases of general dentistry in     Service at 800-588-0098.                        administrative offices. The need for a
 Classified Listings                              an office that is state-of-the-art and totally                                                   dentist to work with Medicaid children is
                                                  computerized. We are looking for a               EXCELLENT OPPORTUNITY FOR GENERAL               immediate. Columbia, home of the MU
                                                  meticulous and ambitious dentist committed       DENTIST IN A MIDSIZE GROUP PRACTICE             Tigers, is a "smart, innovative, artsy, eclectic,
                                                                                                   located in Columbia, Mo. Practice
Dentist Opportunities                             to excellence in his/her work and one who                                                        clever, savvy, vibrant, too-dynamic-to-fit-
                                                  will work with our team to achieve our           concentrates on pediatric dentistry.            into-a-short-tagline city" (Columbia Hotel
                                                  mission of “comprehensive dentistry              Competent and friendly staff in a new,          Marketing Association) - great place to live
DENTISTS NEEDED. Emergency Dental Care            delivered in a caring manner.” If you are        modern facility. Full or part time position     and raise a family. Earn $100,000 to
office seeks competent dentists in the            excited about the possibility of growing         available. Excellent salary plus benefits       $200,000 plus depending on your
Kansas City, Mo. office. Must be proficient       your dental care skills with a highly            and incentives. Call 573-814-1694, ask for      production without all the headaches of
and comfortable with molar endo and               successful dental practice committed to          Kerri or Donna.                                 running your own practice. Let us do the
surgical extractions. Evenings and weekend        excellence and individualized patient care,                                                      hiring, training, and collecting, and you
                                                                                                   GREAT OPPORTUNITY FOR ASSOCIATESHIP
hours included. Very well compensated;            please fax your resume or CV to St. Louis                                                        concentrate on treating your patients. Fax
                                                                                                   LEADING TO PURCHASE OF PRACTICE. Come
ownership potential exists. Contact Dr. Mike      Smile Center at 314-298-9895 or e-mail to                                                        resume to 573-674-4384 or email
                                                                                                   see our practice and if it is right for you.
Obeng at 402-597-1186 and fax resume                                                                  
                                                                                                   Above average compensation in a new
to 402-332-4629.
                                                  KANSAS, TOPEKA. Established dentist seeks        dental office building. Present dentist wants   DENTISTS NEEDED. EXCELLENT OPPORTUNITY
THE CHILDREN’S SMILE CENTER, OZARK,               associate/partner to share practice equity       to slow down. Contact Dr. Gene or DeAnna        FOR HIGHLY MOTIVATED GENERAL
MISSOURI, IS SEEKING AND ACCEPTING                position! Great upscale location, excellent      Grover at 573-265-8402.                         PRACTITIONERS. Patients and a dedicated
APPLICATIONS FOR A FULL TIME DENTIST. The         growth history, unique educational                                                               well-trained team are waiting for you.
                                                                                                   AN ESTABLISHED BUSY DENTAL PRACTICE IN
position offers a competitive salary,             opportunities, caring motivated staff! Please                                                    Practice locations in the KC area and Mt.
                                                                                                   THE AREA OF FARMINGTON, MO is seeking a
benefits package, and includes a signing          contact Susan at 303-973-2147 or                                                                 Vernon, Missouri, and Wichita, Kansas. Base
                                                                                                   confident and caring dentist to join our
bonus. This non-profit Medicaid dental clinic                                                                        plus commission plus excellent benefits
                                                                                                   team three or four days per week. Fax
will be providing dental services and                                                                                                              package. Contact Jay Hildreth at 785-456-
                                                  ASSOCIATE NEEDED FOR GENERAL PRACTICE IN         resumes to 573-431-0576 or call 573-
education to children, ages 4-12 who live in                                                                                                       7083, fax 785-456-6520 or
                                                  THE LOWER RIO GRANDE VALLEY OF TEXAS.            431-5555.
Christian and Stone counties. These two                                                                                                            e-mail
counties have been identified as a Primary        Close to South Padre Island and Old
                                                                                                   EARN WHAT YOU DESERVE NOW. FULL-TIME
Care Health Professional Shortage Area.           Mexico, this area is a hunting, fishing, bird                                                    SMALL TOWN CHARM WITH BIG CITY
                                                                                                   ASSOCIATE OPPORTUNITIES EXIST IN
This position is eligible for state/federal       watching and nature paradise with a                                                              OPPORTUNITIES. Well established, fee-for-
                                                                                                   MISSOURI, ARKANSAS, OKLAHOMA & TEXAS.
loan repayment. Application for repayment         wonderful winter climate. This is an upscale,                                                    service practice located in Carthage, Mo. is
                                                                                                   Guaranteed starting salary of $100,000
would to be submitted to determine                totally fee-for-service practice. Practice                                                       seeking a full-time dentist. Digital
                                                                                                   per year plus production-based bonus.
eligibility. If you are interested in improving   general dentistry 2-3 days a week without                                                        radiography and computerized system in
                                                                                                   Benefits include 401(k), health, life, and
the dental health and education of future         management worries. Make a change and                                                            all ops. Four full-time hygienists.
                                                                                                   malpractice insurance, direct deposit, paid
generations and want to live and work in a        enjoy dentistry and a new lifestyle in the                                                       Partnership potential for the right
                                                                                                   vacations and holidays, all with no late
special area of Missouri, contact Joe             Magic Valley. Contact James Burkholder,                                                          individual. 4-day work week with excellent
                                                                                                   nights or weekends. Please contact Dr. Tom
Millsap at 417-582-5439 or 417-209-               DDS: 956-428-5566 or 956-428-1375.                                                               compensation and benefits. Place fax your
                                                                                                   Kennedy in confidence at 800-658-2177
4700. Ozark is located between the                                                                                                                 resume to 417-359-5002.
                                                  DENTIST NEEDED ST. CHARLES: ST. LOUIS            for details or fax CV to 800-393-5188.
Missouri cities of Springfield and Branson.
                                                  AREA. Fast-paced, progressive, modern
Springfield is the third largest city in                                                           GREAT OPPORTUNITY FOR PART OR FULL TIME
Missouri and Branson is known as the
                                                  facility. Full staff and business support.
                                                                                                   DENTISTS IN AND OUTSIDE THE ST. LOUIS
                                                                                                                                                   For Lease/Sale/Wanted
                                                  Salary, bonus, pension 401(k).                                                                   ———————————————–—
vacation capital of the Midwest. Southwest                                                         AREA. Avoid the headaches of corporate
                                                  Associateship, acquaintance period,
Missouri is also famous for its beautiful                                                          and capitation dentistry. Fee-for-service       TURN-KEY, STATE OF THE ART, ALL DIGITAL
                                                                                                                                                   OFFICE AVAILABLE IN CENTRAL MISSOURI.
                                                                                                                                                   Excellent opportunity for new or recent
                                                                                                                                                   graduates. Please contact
                                                                                                                                          for more

                                                                                                                                                   BUY-IN/BUYOUT. WONDERFUL OPPORTUNITY,
                                                                                                                                                   BEAUTIFUL OZARK MOUNTAIN AREA. Fee-for-
                                                                                                                                                   service. All phases of dentistry including
                                                                                                                                                   implant restoration. Compassionate, quality
                                                                                                                                                   care. Practice dentistry the way you want!
                                                                                                                                                   Leave message: 417-962-3559.

                                                                                                                                                   GENERAL PRACTICE FOR SALE: PITTSBURGH,
                                                                                                                                                   KANSAS (SOUTHEAST). Established 25 years.
                                                                                                                                                   RDH, 3-6 ops. 2300 sq ft building for sale
                                                                                                                                                   or lease. Call 620-231-1721 (day) or
                                                                                                                                                   620-231-0144 (evening).

                                                                                                                                                   ST. LOUIS AREA: FORMER DENTAL OFFICE FOR
                                                                                                                                                   LEASE. 1,400 sq. ft. available in Woodland
                                                                                                                                                   Plaza in Florissant, Mo. Call Karen Shaw at
                                                                                                                                                   the Sansone Group 314-727-6664.

                                                                                                                                                   DENTIST/SPECIALIST WANTED TO SUB-LEASE
                                                                                                                                                   4-year-old 5-operatory dental building on
                                                                                                                                                   Thursday, Friday and possibly Saturday.
                                                                                                                                                   Possible buy-in at later date. Contact Steve
                                                                                                                                                   at 816-347-9933 or cell 816-668-8769.

                                                                                                                                                   DENTAL SUPPLIES WANTED. New free clinic
                                                                                                                                                   established in Osage Beach looking for
                                                                                                                                                   dental supplies, hand instruments, surgical

18       Focus MDA   May/June 2006
instruments, compressor, automatic film           NEAR CAPE GIRARDEAU: PENDING.
processor, mobile handpiece carts (2),            Wonderful opportunity! Grossing
dental chairs (2), operator stools (2),           $442,000. Four operatories. Large patient
assistant stools (2). Clinic is 501(c)3 not for
profit, all gifts are tax deductible. Call
                                                  base, all fee-for-service. Real estate
                                                  available. #104 FAIRVIEW HEIGHTS/                 Donated                                           Are you participating?
Jake at MDA 800-688-1907, Ext. 107 or
                                                  SWANSEA: SOLD #102 BELLEVILLE: SOLD.
                                                  #200 PERIO – CENTRAL MISSOURI: All                Dental                                               Thanks to the many who are.
OPPORTUNITY! Earn $175K your first year
                                                  fee-for-service. Periodontist relocating.
                                                  Contact The Dental Marketplace now if you         Services                                               We hope you’ll join them.
                                                  are considering an appraisal, purchase, or
with guaranteed increases and full                sale of a practice in Missouri. Call Guy
ownership through sweat equity. Well-             Jaffe at 314-997-0535 or 800-221-6927
established general dentistry practice, 90+       or e-mail
                                                                                                  While we can’t GIVE everyone a new “Smile”                 our practice has donated time and
new patients/month! Beautifully appointed         The Dental Marketplace is a member of           services to patients for over 20 years. Donated Dental Services gives us an organization who
office, 7 operatories. Collections over           American Dental Sales (ADS).                    can help us screen patients in our area who are especially needy where orthodontic treatment may
$2,000,000 last 3 years! Buyer receives
majority of profit from any growth in the         PRACTICE FOR SALE: EVAN MYERS &
                                                                                                  just change their lives. I am happy to participate in the Donated Dental Services program.
practice. Includes practice management            ASSOCIATES. EAST KC METRO: Eight                                                                               – Mark L. Dake, DDS, MSD
(coaching) and tremendous Seller assistance       operatory general practice, high volume.
in the transition. Call today for more            Great location. Refer to code KC285             “Dr. (Mark) Dake is fantastic. He treated her like a princess. He even called from his home
information. Professional Practice Advisors,      (NEW). LAKE OF THE OZARKS: Very
Inc. 800-863-9373 or online at                    successful dentist seeks, associate, partner,
                                                                                                  number in the evening after she got her braces on to make sure she was feeling all right.”                         or independent contractor to keep up with                                                          – Mother of DDS patient in Mountain View
                                                  patient overload. Potential for buy in
PRACTICES FOR SALE OR ASSOCIATESHIPS:             available. Refer to MOA608. METRO KC            “I can’t stress enough the professionalism, the warmness and the kindness that I get from both
KANSAS LISTINGS: Northeast Kansas,                NORTH: Part time associate needed. Refer
Mound City, & Central Kansas. MISSOURI            to MOA626. METRO KC NORTH – Seven
                                                                                                  dentists–the one who took my teeth out (Dr. Michael Parsons) and the one who’s getting me my
LISTINGS: Jefferson City and Joplin Area.         operatory general practice. Refer to code       dentures (Dr. Thomas Bogusky). I thank God for them.” – DDS patient in St. Louis
Excellent opportunities. Well established,        KC281. KC METRO EAST: Five operatory
profitable practices. Immediate ownership.        general practice, high net. Great location.     “I’m so impressed with Dr.
Financing available. For more information         Refer to code KC282 SOLD. KANSAS CITY
contact Tom Smeed, Healthcare Practice                                                            (Nicholas) Marino and the
                                                  AREA: Prairie Village area three operatory
Management, at 913-642-1988 or e-mail             fee-for-service general practice. Modest        people in his office. They                         price. Refer to code KC277. KANSAS CITY         treated me like a friend of
                                                  AREA: Prairie Village area two operatory        the family.”
                                                  general practice. Modest price. Great for
PRACTICE. A great opportunity exists to
                                                  merger. Refer to code KC270. Raytown -
                                                                                                  – Hillsboro DDS patient
purchase a practice without incurring an
                                                  Small general practice to merge. Refer to
unmanageable debt load. Attractive net
                                                  code KC287 (NEW). CENTRAL MO/
with potential of greater productivity, due
                                                  SEDALIA AREA: Small specialty practice
to the fact much dentistry is referred out.
                                                  with large drawing area. Could be satellite
All private fee-for-service patients. Well
                                                  or general practice startup location. Refer
established practice of over 10 years, with
                                                  to code MO331. CENTRAL MO/SEDALIA
plenty of growth available. Stable staff
                                                  AREA: Four operatory general practice.
with full-time hygienist. Three operatories
                                                  Available immediately. Refer to code
with room for expansion. Real estate and
                                                  MO327. PENDING. We have buyers for
office available for purchase also. Seller
                                                  quality practices in good locations and we
would like quick sale and will assist with
                                                  need listings. Salaried associate positions
transition. Growing area with small town
                                                  and permanent and temporary dentist
values in the beautiful rolling hills of                                                          Call Teena to learn more or to
                                                  placement. Our fees are paid by sellers                                                                                                             Plains
Southeast Missouri Financing available from                                                       enroll as a participating dentist                                                           t, West
                                                  and employers. Contact Evan Myers and                                                                                                odontis nt, Destiny
                                                                                                    (866) 792-9988                                                         Dak e, Orth    S pati e
national dental lenders. For more                                                                                                                               Dr. Mark a current DD
                                                  Associates 816-358-6782 or 800-311-                Information available on                                        nt with
information, call Gary Clinton at PMA, 800-                                               the Dentist                           SParticipa
                                                  2039, or see or                                                                  DD
William Otten & Associates, Inc. O’FALLON,
IL. General dental practice grossing
$350,000+, 3 ops equipped, plumbed for
1 more, bargain price, beautiful office in
booming area. WESTPORT
dental practice grossing $700,000, 4 ops,
fee for service/PPO, trained staff, very
profitable practice. HAZELWOOD, MO.
General dental practice and building,
grossing $650,000 – SOLD, April 13.
ARNOLD, MO. General dental practice, 7
ops, grossing $750,000 – SOLD, April 28.
County dental practice full time while
dentist is on maternity leave. Possible long
term association/ ownership. Needed by
June 15. For more information, call Bill
Otten at 636-391-4844 or check our

MARKETPLACE Practices for Sale: The Dental
Marketplace #97 FLORISSANT: Grossing
$600,000, three operatories. Dentist
retiring. #95 JEFFERSON CITY: Grossing
$520,000, five operatories. #90
COLUMBIA: Grossing $700,000 plus.
Enormously profitable! Large modern office.
Real estate available. Dentist retiring. #85

                                                                                                                                                                 Focus MDA      May/June 2006                  19

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