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      Boundary Waters
                    The Newsletter of the Minnesota Academy of General Dentistry




	 Published Twice Yearly	                                                                                                                Issue #1 - February 2007

President’s Message         The AGD’s Response to the   Courses                     Leadership Conference        Special Olympics            Member Profile:
The president of the        AAP’s Guidelines            Henry Gremillion            Drs. Malterud,Nelson,        Deg Fung writes about Brad Nelson, DDS MAGD
MN AGD with a               The American Academy of     TMD/Myofacial Pain          Zollinger, Fung &            the AGD’s involvement Page 5
message on the 2007         Periodontology recently     Friday Feb 9th              Meiser attended the          with     the     Special
Convocation         in      released guidelines for     3M, St. Paul, MN            AGD’s       Leadership       Olympics
SanDiego                    referral of patients to a   •                           Conference in Chicago        Page 3                   Call For Volunteers
Page 1                      Periodontal Specialist.     Russ Baer                   Page 3                                                Are willing to take the
                                                        Surgical       Implant                                   Sedation
                            Here is the AGD’s                                                                                             volunteer     challenge?
                            response                    Placement                                                Recent    changes     in
                                                                                                                                          Dr. Williams asks if
                                                        Friday & Saturday                                        sedation     legislation
                                                                                                                                          you’re ready to do your
                            Page 2                      March 2 & 3                                              could affect you and
                                                                                                                                          part to help make the
                                                        Stillwater, MN                                           your patients.       Dr.
                                                                                                                                          Minnesota AGD all it
                                                        Pages 5/6                                                Linde explains how.
                                                                                                                                          can be.
                                                                                                                 Page 3
                                                                                                                                          Page 4



                                                        applicants would have to have their applications


President’s                                             in for Fellowship and Mastership by the end of
                                                        December so the extension allows the deadline


Message
                                                        to be pushed out to the end of February.

                                                                     Fellow Candidates, if you would like to take part
2007 Convocation for Fellows and Masters                            in this phenomenal opportunity you should get
On the Deck of the Aircraft Carrier USS your application in and get to the testing center
Midway                                                              and take your Fellowship exam. The AGD has a
                                                                    study packet that will allow you to effectively
As a member of the Dental Education Council find out the areas that you may have deficiencies.
and as the President of the MNAGD, I am
                                                                    Master Candidates, there is still time to get your
proud to announce that the AGD has negotiated
                                                                    application in. If you need help with a course or
a contract to provide a venue that will make your have any questions, please feel free to contact
Fellowship or Mastership Convocation a me at 612 –747-4853 and I will do what I can to
memorable moment. Receive your award on help. The AGD wants this to be a great year for
board the USS Midway Aircraft Carrier Museum our members.
docked in the San Diego Harbor. What an                                                                                Mark Malterud, DDS, MAGD is a practicing general
experience this could be for our members and Mark I Malterud, DDS, MAGD                                                dentist in St. Paul, MN. He can be contacted at
t h e i r f a m i l i e s , f r i e n d s a n d s t a f f ! T h i s MNAGD President                                    Mark@drmalterud.com
opportunity came to us late this year and the
Dental Education Council has approved an
application deadline extension. Normally


Boundary Waters, February 2007
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                                              B    O    U   N    D    A    R    Y        W    A    T    E    R    S

      Academy of General Dentistry                  The guidelines define that it is the role of the        Why did the AGD choose to respond to the AAP
                                                    general dentist to manage the overall dental health     guidelines?
           (AGD) Response to                        care of the patient. When appropriate, any care         The AGD’s Board of Trustees (BOT) wanted to
          American Academy of                       rendered by a specialist should be coordinated with     take a firm position and set the record straight.
                                                    that of a general dentist, with a clear understanding   They found the AAP guidelines to be extremely
     Periodontology (AAP) Guidelines                of the role of each in providing care to the patient.   offensive to general dentists, especially the well-
                                                    The AGD encourages you to share this message            qualified AGD member who is not only skilled in
Talking Points for AGD Members to Use with with your colleagues. We hope that these AGD                     periodontal treatment, but who frequently
Periodontists and Other Dentists                    guidelines will help you enhance the relationship       accomplishes periodontal procedures. An even
                                                    and increase the dialogue you have with your            greater transgression is the AAP’s implication that
Do the AAP guidelines apply to general specialists.                                                         the AGD endorsed such an erroneous document.
practitioners (GPs)?                                                                                        Also, the AGD wants the dental community to
No. Please explain to the specialists you work with                                                         know that it is being vigilant and standing up for
that the AAP guidelines do not apply to GPs. Why? What is the latest update on the AAP’s response           the rights of the general dentist.
First, the guidelines specifically state that the to the AGD’s request to remove the AGD’s name
guidelines are not a medicolegal standard, and the from the AAP guidelines?
AGD categorically rejects any future inference or On October 12, 2006, the AAP replied to the AGD.          What is the history behind the AAP guidelines?
claim that they are a medicolegal standard. The AAP stated that the AAP stands by its                       In June 2005, the AGD was invited by the AAP to
Second, the AAP guidelines did not take into guidelines and is prepared to defend its guidelines.           provide comments on their draft document,
account the fact that there are many well-qualified The AGD remains steadfast and continues to              “Referral Guidelines for the Co-Management of
AGD members who are not only skilled in support the fact that the tone and implication of the               Patients with Periodontal Diseases.” In July 2005,
periodontal treatment but who also frequently AAP’s guidelines are a detriment to the general               the AGD submitted a thorough review and
accomplish periodontal treatments. Also, you dentist.                                                       expressed substantial concerns to AAP leadership
should note in your conversation with your                                                                  about many of the draft items.
colleagues that the AAP guidelines imply that the
AGD endorsed the document. The AGD Why doesn’t the AGD agree with the AAP                                   When the AAP released its final guidelines in
categorically does not endorse it and the AGD guidelines?                                                   August of this year, the majority of AGD’s input
finds offensive the implication that it did.        The AGD has four objections to the AAP                  was apparently disregarded. When the AGD
                                                    guidelines. First, the AAP ignored much of AGD’s        received the AAP letter and guidelines this August,
                                                    feedback on the original AAP draft guidelines, the      the AGD Executive Committee raised the alarm,
Does the AGD have its own set of referral AAP did not incorporate the AGD’s feedback, and                   and then the AAP letter was shared with the AGD’s
guidelines GPs can use?                             the AAP did not send the final draft of the             Board of Trustees (BOT). The BOT directed legal
Yes. The AGD has its “General Guidelines for guidelines to the AGD for review prior to their                counsel to respond immediately to the AAP, after
Referring Dental Patients to Specialists and Other adoption and publication. Second, the AAP                receiving additional input from the AGD’s Council
Settings for Care.” You are encouraged to misused the AGD tradename and trademark in a                      on Dental Care. The AGD does not endorse this
download or print this document and share a copy manner that implies that the AGD did in fact               document and the AGD’s BOT communicated
with the specialists who you work with in your endorse the final AAP guidelines. Third, the AAP             through legal counsel to AAP about its concerns.
community.                                          guidelines ignore the fact that general dentists
                                                    should treat periodontal disease to the level that he   The AGD’s goal is to continue to set the record
                                                    or she has attained appropriate continuing              straight within the dental profession and to educate
What supporting material was used to develop education. Finally, the original draft document                the public about the fact that many general dentists
the AGD guidelines?                                 presented to the AGD by the AAP was two pages.          can and do treat periodontal disease.
The AGD guidelines were developed by the AGD’s The final guidelines were five pages, and the
Council on Dental Care and they were approved by increased in size was not attributable to AGD              Can I get a copy of the letter the AGD sent to
the AGD’s House of Delegates (HOD). The comments.                                                           legal counsel, the AAP guidelines, and the ADA
guidelines are based on the American Dental                                                                 guidelines?
Association’s (ADA) code of ethics, a code that the                                                         Yes, this information, along with other resources
AGD (and presumably, the AAP) supports. The Why does the AGD find that the AAP guidelines                   on this topic, is available on our Web site at
AGD guidelines were developed to address the are unacceptable to general dentists?                          www.agd.org.
mechanics of dental referrals. The guidelines First, there are inaccuracies in the AAP guidelines
assume that all dentists who use the guidelines that require the general dentist to abstain from            Is there anything I can do to voice my support
have the requisite skill and knowledge in diagnosis procedures that many of our members are qualified       for the AGD?
and treatment planning to determine when a to administer. General dentists do receive                       Yes, we would encourage you to use these talking
referral is needed.                                 education and training in periodontal therapy while     points and the AGD guidelines to take an active
                                                    in dental school and many received advanced             role in increasing communications with your local
Did the AGD always have its own set of referral training in periodontal treatment modalities                specialists about the AGD guidelines and how the
guidelines, or were the AGD guidelines following dental school. The AAP guidelines do                       AGD disagrees with the current AAP guidelines.
developed in response to the AAP guidelines?        not address the general dentist who is confident in     You also have the option of submitting a pre-
The AGD developed its own guidelines in 1990 his or her knowledge and ability to treat                      written letter that you can personalize and send to
and these AGD guidelines are reviewed on a periodontal disease.                                             the AAP president, Dr. Preston Miller, via our
regular basis. They were not developed as a                                                                 AGD Web site.
response to the AAP guidelines. The AGD Second, the AAP’s guidelines overlook the fact that
encourages you to explain to your colleagues that some general dentists elect to perform periodontal
the AGD has its own referral guidelines, and the procedures on patients who need treatment. A more
AGD encourages you, as well as other members of accurate statement would have read “referral to a
the dental community, to read and reference these periodontist should be discussed and offered to the
guidelines. These guidelines place a special patient” if the general dentist does not provide
emphasis on communications, as well as corrective dental services for periodontal
facilitating and improving the referral process.    procedures.




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                                                                                                                               Boundary Waters, February 2007
                                                 B    O   U    N      D   A   R    Y        W    A    T      E   R     S

                                                          come when we no longer practice. What will                 and maintain current ACLS certification as
2006 Leadership                                           be our legacy? Just great restorations in the              well as complete a course of education that
                                                          mouths of those we have treated or a vibrant,              includes a minimum of 60 hours of didactic
Conference                                                profitable practice environment for our younger             education “in both enteral and parenteral
                                                          colleagues and an increasing excellence in the             administration” that involves “personally
My fellow Generalists:                                    care their patients receive.                               administering and managing at least ten
                                                          Come join us in the MN AGD. You will be                    individual supervised cases of parenteral
The Academy of General Dentistry Leadership               surprised how personally rewarding taking a                conscious sedation.”
Conference was recently held in Chicago. It               bigger role in our proud profession can be. It
                                                          may be just the kind of kick your life needs.              Practice Requirements- An individual qualified
helped us “wet fingered” dentists improve our
                                                                                                                     to administer general anesthesia or conscious
skills in areas that will allow us to build an
                                                          Paul K. Zollinger, DDS                                     sedation, who is in charge of the administration
interested and committed group of dentists
                                                          Vadnais Heights, MN                                        of the anesthesia or sedation, must remain in
here in Minnesota. We learned to advance the
                                                                                                                     the operatory room to continuously monitor the
non-clinical skills of the general practitioner and
                                                                                                                     patient once general anesthesia or conscious
protect our right to practice in the wide field of
dentistry. As specialty organizations try to              Special Olympics                                           sedation is achieved and until all dental services
                                                                                                                     are completed on the patient. Thereafter, an
restrict the kinds of procedures general dentists         By Deb Fung, DDS Roseville, MN                             individual qualified to administer anesthesia or
can legally do, the AGD in Minnesota is
                                                                                                                     sedation must ensure that the patient is
working . The American Association of                     Recently at the Academy of General Dentistry               appropriately monitored and discharged.
Periodontists (AAP) have sent out                         (AGD) Leadership Conference in Chicago,
recommendations that suggest a dramatically               there was a lot of emotion in the room as we               On Site Inspections- Dentists must have an on-
reduced role in periodontal health by the                 listened to an athlete share her story with us.            site inspection conducted at one primary office
general dentist and the oral surgery profession           She spoke about how much meaning to her life,              facility within 12 months following receipt of the
enacting rules critically restricting sedation            training and competing in the Special Olympics             certificate. Dentists who hold existing
even by well trained general dentists.                    gave to her. Now 25 years old and a triple gold            certificates must have an on-site inspection
                                                          medalist in figure skating, she had participated            conducted with two years of the effective date
I came back with a greater conviction that there          as an athlete with the event since she was 12              of the rules. In both instances, on-site
is no other organization that can look out for            years old.                                                 inspections must thereafter be conducted at
our interests other than the AGD. The ADA                                                                            least once every five years.
has been the voice of dentistry for years yet             The AGD Foundation announced on
because of the need to represent all of the                                                                          Comments- The requirement that the dentist
                                                          November 20, 2006 that it was partnering with
dental profession as a whole, it cannot really                                                                       stay in the operatory during adult oral (enteral)
                                                          the Special Olympics to help identify providers
fully address the generalist’s needs.                                                                                sedation will take this treatment option away
                                                          for primary dental care for these athletes.
                                                                                                                     for most patients. Short appointments of 1 or 2
                                                          Seeing this young woman’s confidence and
                                                                                                                     hours could still be done, but if the patient or
                                                           smile lighting up the audience demonstrated
                                                                                                                     doctor would need to use the restroom, the
                                                           first hand how exciting it is that the AGD is
                                                                                                                     appointment would be done. Also, this would
                                                           going to have a role to play with the Special
                                                                                                                     prevent checking hygiene patients, going to the
                                                           Olympics.
                                                                                                                     lab to polish something, talking to the driver or
                                                                                                                     friend about changes in treatment, and staying
                                                           General dentists interested in providing
                                                                                                                     in the operatory while the hygienist does
                                                           health care services for persons with
                                                                                                                     periodontal treatments or cleanings.
                                                           intellectual disabilities will have the
                                                                                                                     Unfortunately, the Board decided to not allow
                                                           opportunity to identify themselves through the
                                                                                                                     a well trained staff person to monitor the oral
                                                           provider directory available at
                                                                                                                     sedation adult. The alternative is to use another
                                                           www.specialolympics.org. Also remember
                                                                                                                     person to administer the sedation such as
                                                           that while you may not currently have a special
                                                                                                                     another dentist or a CRNA Certified
                                                           Olympian in your practice, you may already
                                                                                                                     Registered Nurse Anesthetist for moderate or
                                                           know someone with intellectual disabilities
                                                                                                                     long appointments. Of course this significantly
                                                           that you might support in becoming involved
                                                                                                                     increases the costs to the patient for treatment.
                                                           in Special Olympics.
                                                                                                                     ADA Guidelines Proposals- These are very
                                                                                                                     similar to the current and proposed Minnesota
                                                          Supporting these inspirational athletes,                   regulations. They will be voted on at the ADA
Specialists have chosen to be leaders in our              through this partnership, is an excellent                  House of Delegates this fall. Your delegates
field by virtue of their extra education and as            opportunity to give back to the community and              would probably appreciate your input to them
such have been represented in the ADA                     to the dental profession.                                  on this matter.
leadership and the State Board of Dentistry to
a much greater extent than their proportion in                                                                       Legislative Issues: So far only talk. But, the
the profession.        Each specialty has its             Sedation Article                                           feeling on the street is that there will be a major
organization. The general dentist, too, must              By Dave Linde,                                             push to institute Universal Health Care in
have its voice. We need to elevate our practice           Minnesota Legislative Report                               Minnesota. Governor Pawlenty’s national
to the same level of credibility as the specialist.                                                                  aspirations may give added impetus to this. We
                                                          There are several legislative and Board of                 were able to prevent this from happening in the
General dentists will benefit greatly by stepping          Dentistry items that will affect medicine and               early 90’s. This time it probably will be even
up their leadership contribution to the                   dentistry this year.                                       more difficult. You may want to get on the e-
profession, especially those of us who have been                                                                     mail list for Citizen’s Council for Health Care
                                                          Board of Dentistry Proposed Regulations:                   at www.CCHConline.org . The director
practicing over 20 years. It is our time to give
back to the profession, keep it healthy for the           Sedation:                                                  Twila Brase has been a tireless advocate for
sake of those who follow us, as well as the                                                                          patients and practioners since the early 90’s.
                                                          Education Requirements- Dentists who                       Your support of CCHC should be considered.
patients who we see every day. A time will
                                                          administer conscious sedation must complete


Boundary Waters, February 2007
                                                                                                                                       3
                                            B    O   U    N   D    A    R    Y       W    A    T      E   R     S

                                                     • possible speaking opportunities.                        • Annual Meetings - Planning or scouting
                                                     • innovative ideas to use in your practice.                       for one or more of our exceptional
                                                     • leadership development training.                                local annual meetings or, for the
                                                      • experience in leadership for future roles                      AGD Annual Meeting.
                                                              in the association.                               • Dental Education, Dental Article
                                                     The profession receives:                                          R e v i e w Te s t i n g ( D A R T ) ,
Call For Volunteers                                                                                                    Examinations, Program
                                                       • enhanced public awareness about                               Approval,           Continuing
Each year, the local and national
                                                               dentistry.                                              Education             ( PA C E )    -
leadership in the US and Canada strive to
                                                      • guided development of valuable products                        Opportunities to serve in the
recruit future leaders for the AGD. This
                                                               and services for members.                               preparation, evaluation and
has proven very successful in that we have
                                                      • determined rules, regulations, and laws                        testing of the outstanding
been blessed with dedicated, quality
                                                               that govern the profession.                             continuing education which is our
people who are eager to serve at all levels.
                                                      • unity within organized dentistry.                              hallmark as the Academy of
These individuals serve the AGD by
                                                     Types of Volunteer Positions                                      General Dentistry.
becoming involved in planning and
                                                     The AGD's volunteer opportunities                         • Dental Care Issues - Participating in
conducting local continuing education
                                                     include:                                                          how dentistry is delivered to the
courses, participating as members of
                                                      • Council/Committee Assignment: These                            public. Involvement in third party
constituent and regional board of directors,
                                                               groups are appointed to work in                         issues.
and serving on a national level in the
                                                               support of the goals and                        • Legislative & Government Affairs -
council and committee structure.
                                                               objectives of the AGD’s newly                           Educating our elected and
Leadership appointments usually occur at
                                                               adopted strategic plan, “AGD                            appointed officials in state,
different times during the year depending
                                                               2010."                                                  provincial, and national
on the location and circumstance of need.
                                                      • Task Force Assignment: These groups                            government. Taking dentistry's
For example, it is not unusual for a task
                                                               are appointed to address a                              message to our legislators.
force to be assembled to address a
                                                               specific issue for a specified                   • Membership & Group Benefits
particular issue that may develop during
                                                               period of time.                                         Programs - Recruitment of new
the year.
                                                      • Author: You will write articles for the AGD                    AGD members who share the
                                                               constituent publications.                               common principle of lifelong
In an effort to involve more members and                                                                               learning through continuing
                                                      • Reviewer: You will review articles for the
identify potential volunteers at all levels of                                                                         education.       And, providing
                                                               AGD publications.
the organization, we are initiating a new                                                                              excellent benefits to those
                                                        • Constituent Speaker/Spokesperson
once again conducting the annual process                                                                               existing members.
                                                               Bureau: You will represent the
of recruiting future leaders for the AGD.                                                                       • SmileLine and SmileLine Online
                                                               AGD at various presentations
The Call for Volunteer Leaders will give all                                                                           Volunteer
                                                               (schools, health fairs, etc.) or in
AGD members the opportunity to complete                                                                       • Scientific Review Panel Member
                                                               media interviews as an expert on
a Call for Volunteer Leaders form indicating                                                                  • Constituent Speaker/Spokesperson
                                                               a variety of oral health topics.
their areas of interest in serving the AGD.                                                                   • Strategic Planning
                                                      • Constituent Volunteer: You will serve as
                                                               an AGD constituent by giving time              Volunteer Expectations
Members who complete the Call for                              in an area of interest or for a                As an AGD volunteer, you should:
Volunteer Leaders form will be entered into                    specific project.                              • be an AGD member in good standing.
a database. As the national and local                 • Public Liaison: You will interact with the              • attend and fully participate in all
leadership prepares to make                                    general public to increase dental                       scheduled volunteer meetings
appointments, we will review all the                           awareness.                                              and/or events.
respondents who indicated interest in the             • Liaison to Other Dental Organizations:                 • be able to provide the requisite skills
areas where volunteer leaders are needed.                      You will represent the AGD at                           required by the position.
While in some cases there will be more                         meetings of other dental                        • be open and willing to learn from your
interested volunteers than available                           organizations and offer                                 fellow volunteers.
positions, every effort will be made to                        suggestions for collaboration.                 An effective AGD volunteer is:
engage those members interested in                   Volunteer Opportunities
getting involved. Each year members will             The following are volunteer opportunities                • knowledgeable in the area for which he/
have the opportunity to renew their interest         that currently exist in various areas of                          she is volunteering. (You don't
to serve as a volunteer.                             leadership on both local and national                             need to be an expert, but an
                                                     levels. Members with related areas of                             understanding of the topic is very
Why Volunteer?                                       interest or expertise will be contacted.                          helpful.)
                                                      • Budget & Finance - Preparation of and                 • familiar with the AGD's core purpose and
                                                               involvement in the budgetary                            strategic goals.
Getting involved in the AGD provides
                                                               process for the AGD in pursuit of              • open to new ideas and ready to share
benefits to you and your profession.
                                                               our activities in serving general                       experiences.
                                                               dentistry.                                     • highly energetic and committed to the
You'll receive:                                       • Communications & Public Information                            volunteer experience.
                                                               – Getting the word out about what
• recognition as a leader who has a                            the general dentist, as the primary
        commitment to the profession.                          care provider of dental services,
• opportunity to network with peers in the                     does for the public. And, what the
        profession.                                            AGD dentists do for organized
                                                               dentistry.




4
                                                                                                                             Boundary Waters, February 2007
                                         B   O   U    N   D   A       R   Y        W    A   T   E   R    S




                                                                              That meeting also marked Brad’s first AGD National Meeting as a
Member Profile                                                                 Delegate for our Minnesota chapter!

Member: Brad Nelson, DDS,                                                      Brad has also been a member of the ADA and MDA since 1984,
MAGD                                                                          and a member of the St Paul District Dental Society since 1994.
                                                                               Brad likes general dentistry because of variety of procedures and
 Brad is a 1984 graduate of the                                               long term patient relations.
University of Minnesota School
of Dentistry. He completed a                                                  In regard to working toward his Mastership award, Brad had these
General Practice Residency in                                                 comments:
the US Air Force 1985.
                                                                                  “The Mastership is much more practical than getting an award
Today, he is a general dentist                                                for continuing education. It is a way of organizing and disciplining
practicing in Bayport,                                                        professional development through continuing education. This
Minnesota. He lives in Afton,                                                 education has made general dentistry more fulfilling because I can
Minnesota with his wife and 4                                                 do more procedures with confidence. Also since I am a solo
children.                                                                     practitioner, it has allowed me to see and discuss how things are
                                                                              done by a group of other dentists on an ongoing basis.”
 Outside of dentistry, his interests are outdoor activities such as
fishing, camping,biking, hiking, and cross country skiing.                     Brad currently sits on the Board of Directors in the Minnesota
                                                                              Academy of General Dentistry and hopes to start a Master Track
 Brad has been a proud member of the AGD since 1984 and                       Program for those hoping to get their MAGD.
received his fellowship award in 1998. And just this past summer in
Denver he received his Master award. A member achieving this                   He can be contacted at his office at 651.439.4115 or at
distinction has completed a challenging course of hands-on study in           bradleynels@aol.com
16 dental disciplines, totaling 600 hours of continuing education.



Boundary Waters, February 2007
                                                                                                                  5
                            B   O   U   N   D   A   R   Y   W   A   T   E   R   S




.



     To register for this or other courses sponsored by the
     Minnesota AGD, please go to www.mnagd.org or call
                    Colleen @ 651-428-8799

                      This newsletter was complied by Jay Williams, DDS
       If you have any questions or comments, please contact me at: jay@millicitydental.com




6
                                                                                  Boundary Waters, February 2007

				
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