MDDS Connections for Metro Denver`s Dental Profession

Transcription

ARTICULATOR
FALL ISSUE
MDDS
Connections for Metro Denver’s Dental Profession
Fall 2014
Volume 19, Issue 1
A Farewell to Barbie Arms
6
Diagnosis Challenge: Verrucous
Carcinoma Case
10
Building a Great Practice
Means Building a Great Team
14
Cannabis: Legalized; Now What?
28
PRSRT STD
U.S. POSTAGE
PAID
DENVER, CO
PERMIT 2882
The Articulator is a recipient
of the 2012 International
College of Dentists Silver
Scroll Award
B
SUCCESS
STORIES
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the first seminar,
I changed the way
I looked at cases,
looked at patients,
& went about diagnosis.”
Join us to discover the untapped
potential in your practice, and
write your own success story.
Call 866.879.1238 or visit
TheDawsonAcademy.com/Success
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“All of a sudden, as a practitioner,
you begin to see reasons for the
maladies facing your patients,
whereas most of the time, it goes
undiagnosed, unnoticed. The level
of confidence and understanding
gained through completing the
core curriculum at The Dawson
Academy is immeasurable.”
KEVIN KROSS DDS
ALLENDALE, MI
FLORIDA VIRGINIA UNITED KINGDOM ILLINOIS CALIFORNIA JAPAN COLORADO
ARTICULATOR
MDDS
Connections for Metro Denver’s Dental Profession
Volume 19, Issue 1
MDDS Articulator
Creative Manager & Managing Editor
Chris Nelson
Director of Marketing and Communications
Jason Mauterer
Communications Committee
Brandon Hall, DDS, Chair
Maria Juliana DiPasquale, DMD
Karen Franz, DDS
Kelly Freeman, DDS
Anil Idiculla, DMD
Jeremy Kott, DDS
Maureen Roach, DMD
Jennifer Thompson, DDS
MDDS Executive Committee
President
Larry Weddle, DMD
President-Elect
Ian Paisley, DDS
Treasurer
Sheldon Newman, DDS
Secretary
Nicholas Chiovitti, DDS
Executive Director
Elizabeth Price, MBA, CDE, CAE
Printing
Dilley Printing
The Articulator is published bi-monthly by
the Metropolitan Denver Dental Society
and distributed to MDDS members as a direct
benefit of membership.
Editorial Policy
All statements of opinion and of supposed fact
are published under the authority of the authors,
including editorials, letters and book reviews.
They are not to be accepted as the views and/or
opinions of the MDDS.
The Articulator encourages letters to the editor,
but reserves the right to edit and publish under
the discretion of the editor.
Advertising Policy
MDDS reserves the right, in its sole discretion,
to accept or reject advertising in its publications
for any reasons including, but not limited
to, materials which are offensive, defamatory
or contrary to the best interests of MDDS.
Advertiser represents and warrants the advertising
is original; it does not infringe the copyright,
trademark, service mark or proprietary rights of
any other person; it does not invade the privacy
rights of any person; and it is free from any
libel, libelous or defamatory material. Advertiser
agrees to indemnify and hold MDDS harmless
from and against any breach of this warranty as
well as any damages, expenses or costs (including
attorney’s fees) arising from any claims of
third parties.
Inquiries may be addressed to:
Metropolitan Denver Dental Society
925 Lincoln Street, Unit B
Denver, CO 80203
Phone: (303) 488-9700
Fax: (303) 488-0177
mddsdentist.com
©2011 Metropolitan Denver Dental Society
mddsdentist.com
Fall 2014
Inside This Issue:
A Letter From Our President.............4
Salud Family Health Center - A Valuable
Resource for Underserved Patients.......... 20
Member Matters...............................5
MDDF’S Smile Again Program® Partners
A Farewell to Barbie Arms......................6
With Warren Village To Change Smiles
And Change Lives.................................. 21
Dig Deeper Into Your Disability Policy.....8
Silver Bullets: CU-SDM
Diagnosis Challenge: Verrucous
Commencement 2014.................... 22
Carcinoma Case........................................10
Event Calendar...............................24
TEDxMileHigh........................................11
Cannabis: Legalized; Now What?...28
The Dentist's Business Plan and Personal
Financial Plan Must Coincide...............13
Why is So Much Attention Given to
Rate of Return?.....................................31
Building a Great Practice Means Building
a Great Team...................................14
Classifieds.............................................35
Screw-Access Marking: A Technique to
Simplify Retrieval of Cement-Retained Implant
Prostheses.............................................. 16
Get To Know Your MDDS Staff
Marlene J. Pakish, MBA – Finance & Operations Manager
Marlene joined MDDS in May as the Finance & Operations Manager. She has called
Colorado home since 1990 after moving from upstate New York.
Marlene received her BS and MBA from Regis University, but not consecutively
– there were many years in between each degree. Marlene and her partner share a
home in Golden with a puppy and kitten and enjoy the lifestyle of living in a small
town. When not taking care of the house, they enjoy sea kayaking in combination
with back country camping. Their many adventures have taken them to Yellowstone
National Park (twice), Minnesota’s Voyageurs National Park and river trips in Colorado and Utah.
They recently returned from an ocean kayaking experience in Maine.
Marlene has worked in small businesses and non-profit organizations for 20+ years. Her position
with MDDS encompasses a range of duties from accounting, assisting with meeting room set-up
and acting as staff liaison for the Peer Review Committee.
You can reach Marlene Pakish at (303) 488.9700 ext. 3268 or [email protected].
A LETTER FROM
OUR PRESIDENT
Larry Weddle, DMD, MS
A
hhAhhhh fall… you
can smell it in the
Colorado air. The leaves
are changing, football
season is in full swing, and the
cool breeze in our mountains that
was tinged with the fragrance of
summer barbeques now smells
of chimneys burning firewood. I
have always enjoyed fall and the changes it brings.
Change is a welcome and imperative force that
relieves us of our old antiquated habits.
Change is an important part of our dental society
as well. The leadership of our tripartite is actively
discussing changes we need to make on the local,
state and national levels. Many of our discussions
involve the phrase "The Power of Three." Our
society has the unique advantage of membership on
all three levels. There are certain benefits that a local
society can bring that a national cannot (and vice
versa). The fact that we belong to a local, state and
national society that have the capability to work in
sync towards a common goal is such an advantage
to the field of dentistry.
"Our leaders are committed
to maximizing our members’
dollars and are tirelessly working
on improving our three level
dental society."
The Power of Three’s purpose is to focus on the
strengths that the local, state and national levels
can bring. Our leaders are working to eliminate
redundancies in the three levels. Eliminating
redundant benefits will be done by identifying the
Dental Construction Specialists
Ask us how we can save you
time and money on your
next office project.
level of the tripartite that naturally excels at offering
a particular member benefit. Successfully doing
this can lead to elimination of any membership
confusion, reducing needless competition between
the levels, and increases overall membership value.
For example, our national society excels at lobbying
efforts with our nation’s senators and congress
people. Our local society excels at networking
opportunities and in-person continuing education.
Our leaders are committed to maximizing our
members’ dollars and are tirelessly working on
improving our three-level dental society. I am
honored to lead MDDS during this time and am
excited about the new changes that we will be
making to further strengthen organized dentistry
through the Power of Three.
Sincerely
Larry Weddle, DMD
MDDS President
2014-15 MDDS Board of Directors
Induction (July 30, 2014)
Phone: (303)637-0981 Web: www.bvgci.com
(Top row; left to right) Drs. David Klekamp, Michael Scheidt, Kevin Patterson, Karen Franz,
Walt Vogl and Brian Gurinsky (Bottom row; left to right) Drs. Nicholas Chiovitti, Ian Paisley,
Larry Weddle and Sheldon Newman
MDDS New Member Welcome Event
(August 21, 2014)
A great turnout for this networking event at Forest Room 5.
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mddsdentist.com
Articulator
Fall 2014
MEMBER
MATTERS
Obituaries
President 2000-2001
Dr. Roberta Shaklee passed away on August 29, 2014 after
battling ovarian cancer for over two years. Dr. Shaklee was President of the
Metropolitan Denver Dental Society from 2000-2001 and was the first woman to hold
an executive office for MDDS. Dr. Roberta Shaklee's enthusiasm for life and energy were contagious.
She was truly an amazing lady and she will be missed by us and everyone who knew her.
Dr. Jean-François Bédard
passed away on September 8,
2014. He graduated from
dental school at the Universite
de Montreal in 1993 and
maintained a successful
prosthodontic practice in
Denver, CO from 2001 until
his death.
Dr. Sandra Bujanda-Wagner
suffered from
stomach cancer and passed
away peacefully
on August 12, 2014
at the young age of 46. Dr.
Bujanda-Wagner regularly
contributed to Kids in Need of
Dentistry, The Johnson Clinic
and Make-a-Wish Foundation.
New Members,
Welcome!
Dr. Kyle R. Griffeth
Dr. Amanda D. Hallinan
Dr. Scott A. Hamilton
Dr. Namrata G. Hardy
Dr. Ryan T. Haywood
Dr. Alberta M. Hernandez
Dr. Kevin C. Hoth
Dr. Jacqueline M. Kramer
Dr. Pearl Lai
Dr. Ihsan B. Larsen
Dr. Mark E. Leedy
Dr. Brett W. Lopez
Dr. Tran Marvinh
Dr. Shaheen M. Moezzi
Dr. Lananh T. Nguyen
A Boost for COMOM (July 27, 2014)
Dr. Angela T. Phan
Dr. Patrick J. Reilly
Dr. Grace E. Rudersdorf
Dr. Manpreet S. Sarao
Dr. Keith B. Shaw
Dr. Andrew R. Stubbs
Dr. Aram C. Sun
Dr. Aaron P. Van Wyk
Dr. Sara M. Weinstein
Dr. Douglas K. Whetten
Dr. Matthew Whiteley
Dr. Cory J. Williams
Dr. Benjamin P. Yucha
Platte Valley Hospital presenting Dr. Nicholas Chiovitti, 2014 COMOM Site Chair, a check for $15,000 to help with the upcoming COMOM.
Congratulations,
Dr. Tom Zyvoloski!
Dr. Zyvoloski has been a general, full-service,
and cosmetic dentist for over 20 years. He
graduated from the University of Minnesota
Dental School and recently moved from
Minnesota to Colorado for the outdoor
lifestyle. He has won multiple awards including
being voted as “Top Cosmetic Dentist” by
Minneapolis St. Paul Magazine. Recently, he
opened his 4,027 sq ft office, Studio Z Dental,
mddsdentist.com
ሺ͵Ͳ͵ሻ͸͵͹ǦͲͻͺͳ
̷Ǥ
in Louisville, CO. It features a waiting room,
reception, manager office, private waiting
area, two restrooms, adminstrative area,
doctor’s office, staff lounge, consult, imaging,
lab, four open bay hygiene chairs, four open
bay ops, sterilization, chart room, and space
for two additional private ops. The office was
built in 9 weeks. Dr. Zyvoloski offers cosmetic,
family, and holistic dental services at his office.
Articulator
Fall 2014
5
REFLECTIONS
A FAREWELL TO BARBIE ARMS
By Jason Mauterer, CDE
R
aise your arm if
you’ve been on the
edge of your seat
waiting for the next
Reflections
letter
from Dr. Carrie Seabury.
Me too! Unfortunately, I
drew the proverbial short
straw. It is my solemn duty to notify you
that Dr. Seabury is no longer with us…as
the Editor of the Articulator. Instead she
is focusing her “spare” time representing
all dentists as an alternate delegate to
the ADA (AKA Wonder Woman). She’s
actually not totally gone, as she’s still
kicking it with the Communications &
PR Committee and ready to help train
the next one of YOU ready to embark on
a journey to the glamorous and rewarding
world of dental editing (wink wink nudge
nudge). Whew…I’m glad that part’s over
with.
With that sad news out of the way, let’s
move on to what’s likely going to amount
to a clip show of the last few years of
our talented and entertaining (possibly
circuitous at times) MDDS Editor. When
I came to MDDS late in 2010, there had
been a fairly major change in staff and that
turbulent year yielded only three of the
usual five Articulator issues. Dr. Seabury’s
second issue went to press that same
week, and just as old Murphy warned us,
something went wrong. Her cover article
on mid-level providers that was printed
was not the final version. Ugh! So then she
had to grovel for your forgiveness in her
third issue. Rough start for the only female
editor MDDS has ever had. But then came
the Disneyesque magic that we all fell for –
the reason our arms are still in the air. Let’s
avoid a cramp and find some good arm
place-holders, maybe some Barbies would
like to reach for the heavens in support of
Dr. Seabury, while we reminisce about the
Amelia Earhart of MDDS dental editors.
I think it’s fair to say that she had a way
with colorful metaphors. It might also
be fair to say that each issue under her
contained a lesson in 80’s and 90’s pop
culture that could not only connect your
ears with a grin, but somehow made her
point perfectly clear. The last so-called fair
claim I’m going to make is that she gave us
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PDF of all her letters. And of course there’s
a reference table. You’re welcome, again.
(Queue the Dr. Carrie Seabury clip show…
and William Shatner’s version of Rocket
Man.)
“Change is universal (except in Ozzy
Osbourne’s case – that dude hasn’t changed
in 30 years).”1
“Truth be told, and I know this comes as a
shock, Will Smith is hilarious and Carlton
Bank’s dances are truly inspirational, but
it hasn’t really helped me stay fresh in my
practice.”2
"Dr. Seabury
truly captured our
imaginations with her
writing while being a
champion for MDDS.
She will be missed."
~Dr. Larry Weddle
a candid insight into her life. We’ve gotten
to know Dr. Seabury quite personally over
the last four years; she’s shared everything
from her new-baby-sleep-deprivation
(that was her first Reflections, btw) to her
kids’ Jamba Juice “vomitorium” aboard
Flight 342. The insight into her home and
practice were offered from more than just
an editor, but a friend (albeit a quirky
friend who apparently watched a LOT of
TV back in the day).
Instead of just making references to all
the hilarious, yet deep and thoughtful,
fodder she provided us over the years,
I’ll just get to the heart of it. Following
are ten of my favorite quotes from the Dr.
Carrie Seabury Articulator Reflections
letters collection. It wasn’t easy limiting
myself…you’re welcome. Your homework
is to go reread the articles and figure out
what deep message lies within each quote,
but I’ll make that easy on you – check the
MDDS Facebook page for a consolidated
“My more experienced colleagues need to
grow a meticulously coiffed white beard
and find a young warrior to teach the skill
set needed to catch a fly with a pair of
chopsticks.”3
“They couldn’t dance, they couldn’t rap,
and to be brutally honest, their Shufflin’
skillz would make LMFAO throw up in
their mouths a little.”4
“Captain Kirk taught us the true meaning
of bravery, audacity, tenacity, and…
smarmy.”5
“Hey Jay-Z - Can I get a woop woop for
docs who see Medicaid patients?”6
“Bacon works hard for me and most
importantly, bacon promises to save me
should there ever be a zombie apocalypse.
I speak the truth. This is my serious face.
My game-on face. My Crispy Bacon face.”7
“You and I both are acutely aware of Daisy
Duke’s incredible talent of assembling a
carburetor in the dark.”7
“We have all heard him crooning about
‘When a Man Loves a Woman’ but why
has he never given thought to ‘When
a Woman Loves a Man’s Longer Than
Shoulder Length Permed Bleach Blonde
Hair?’”8
“As my shock turned into apologies to our
surrounding passengers, and my efforts to
contain the vomitorium of row 36 proved
ineffective, I was reduced to a few rounds
of hysterical snort giggle type laughter.”9
Articulator
Fall 2014
Wipe those tears (of laughter, of course) away and let’s finish this 21 Barbie
arm salute to the greatest female editor MDDS has ever known! After four
years and 19 issues of the Articulator, Dr. Seabury’s legacy is laser-etched
into the annals of our history and has certainly raised the bar of our
beloved journal. MDDS would like to thank and salute you, Dr. Seabury
– may your invisible jet continue to soar high, Dr. Wonder Woman.
3. Seabury, Carrie, DDS (2012, RMDC). Wax-On, Wax-Off. Articulator, 16(2), 6-7
References
7. Seabury, Carrie, DDS (2013, RMDC). Crispy Bacon. Articulator, 17(3), 6-7.
1. Seabury, Carrie, DDS (2011, March/April). Can You Spare Some Change? Articulator, 15(3), 6-7.
2. Seabury, Carrie, DDS (2011, June). New - It’s Like a Mogwai turned Gremlin. Articulator,
15(4), 6-7.
4. Seabury, Carrie, DDS (2012, Summer). Access to Care Shuffle. Articulator, 16(5), 6-7.
5. Seabury, Carrie, DDS (2012, Fall). Foundation of Giving Back. Articulator, 17(1), 6-7.
6. Seabury, Carrie, DDS (2012, Winter). Fat Squirrels and Hibernating Bears - Winter is Coming.
Articulator, 17(2), 4-5.
8. Seabury, Carrie, DDS (2013, Fall). The Hair That Should’ve Stayed. Articulator, 18(1), 6.
9. Seabury, Carrie, DDS (2014, RMDC). Mayday Mayday Mayday...Flight 342 Just Got Jamba’d.
Articulator, 18(3), 6.
UNLEASH YOUR INNER AUTHOR!
MDDS is seeking an editor for the award-winning Articulator! This volunteer position is open to
MDDS members and is an integral part of MDDS communications as well as the Board of Directors.
Please contact Jason Mauterer, MDDS Director of Marketing & Communication, at (303) 957-3270
or [email protected] for more information about the position.
mddsdentist.com
Articulator
Fall 2014
7
PRACTICE
MANAGEMENT
DIG DEEPER INTO
YOUR DISABILITY
POLICY
By David M. Richards
S
tatistics show that most dentists and dental
specialists in the US (approximately 75%*)
carry an individual disability insurance (IDI)
policy to protect their incomes from a disabling
injury or illness. Such a high participation rate suggests
they realize the importance of the coverage because
of the physical nature of the occupation and the fine
motor skills required to practice. Many of today’s
younger dentists and specialists learned about these policies as they
were leaving school and were approached by an agent giving a seminar.
IDI policies are issued by a handful of companies and they all appear
similar on the surface. If you dig deeper into the contracts, however,
you will discover there are major differences in contract language from
policy to policy that could mean millions of dollars to the insured in
a real-life claim. When comparing today’s policies, go beyond the
familiar discussion of the “own occupation” language in the contract
as most major carriers are offering “true own occupation” plans today.
Look instead at the following riders or options to make sure you have
adequate protection: ***
1) Student Loan Protection: Today’s average general dentist leaving
school has a student loan debt burden of $241,097.** This is a major
concern for long-term financial planning as such debts are not
forgiven for most disability claims. Make sure your IDI policy pays
an additional tax-free benefit to cover these monthly payments. This
benefit rider provides coverage for a period of 10 or 15 years from
the policy date. When a qualifying total disability occurs, benefits are
payable during the remaining portion of the 10 or 15-year term that
has not elapsed when the disability begins.
2) Catastrophic Disability Coverage: This optional policy feature pays
additional tax-fee benefits in the event of a severe injury or illness
requiring assistance with two out of six named “activities of daily
living.” Combined with the base monthly indemnity the policy can
replace up to 100% of pre-disability income if it includes this feature.
3) Retirement Plan Contribution Protection: Did you know that if you
become totally disabled you can no longer contribute to your qualified
retirement plan? This optional feature pays an additional monthly
8
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benefit to a trust account in your name to replace the qualified plan
contributions. The proceeds can be invested in various mutual funds
for potential growth and are then distributed in a lump sum at age 65.
4) Residual or “Partial” Disability Protection with “Recovery” Benefits:
If you suffer a “Partial” disability, you could still be practicing, but
suffering a big earnings loss. Make sure your policy has a low earnings
loss threshold (15% is the best available) and pays a dollar for dollar
benefit based on the earnings loss up to the total disability monthly
benefit during the first 12 months of a partial claim. Do also carefully
study the “recovery” provision to make sure benefits continue with a
minimum 15% earnings loss upon full recovery and your full-time
return to work – all the way to age 65 if the loss continues. Many
policies severely limit recovery benefits.
5) “Mental/Nervous Disorder” Benefit Limitations: Avoid policies with
strict limitations on payment of claims for such disorders (24-month
aggregate benefit limits are common today). Look for coverage that
treats such disorders as any other illness.
A properly structured IDI policy is considered by many Financial
Advisors to be the cornerstone of your financial plan because it
protects your most valuable asset – your ability to practice Dentistry
or your specialty. Dig deeper into your policy to make sure all you’ve
worked so hard for is properly protected.
David Richards is a Financial Advisor and Disability Income Specialist
for Wealth Strategies Group, LLC in Denver, CO. He has 21 years of
experience working with Dental professionals. He can be reached for
comment or more information at (303) 714-5875, via email at david.
[email protected] and on the web at www.ddsdi.com Registered
Representative and Financial Advisor of Park Avenue Securities LLC
(PAS). Securities & Services and Advisory Services offered through PAS,
member FINRA, SIPC. Wealth Strategies Group is not an affiliate or
subsidiary of PAS. GEAR #2013-9993 (exp. 07/16).
* Source: 2009 State of the Individual Disability Income Industry – Fall 2009 – Disability Management Services.
** Source: Source: 2013 ADEA Dean’s briefing book
*** Optional riders are available for an additional premium. A person’s eligibility for benefits is determined on a case
by case basis taking into consideration the factual circumstances presented as well as the terms and conditions of his/
her policy(s).
Articulator
Fall 2014
WE NEED YOUR
SUPPORT
THANKS TO OUR
MWDI SPONSORS!
Go to mwdi.org
to donate
Includes cash donations and
sponsorships; this does not include
donated service and equipment.
Mile High Founding Members
(Contributions of $5,280+)
JARCHITECT
OE
1st Impressions Orthodontics
Dr. Terry L. Brewick - Governor's Park Dental Group
Brighton Smiles - Dr. Jaci Spencer
Burnham Oral Surgery - Dr. Michael Burnham
Dr. David E. Chavez
Denver Metro OMS
The Doctors at Mountain Range Dentistry, Dr. Nicholas Chiovitti
& Dr. Paul K. Mizoue
Dr. Mark S. Ehrhardt
Dr. Louisa I. Gallegos
Larry Gayeski, CPA
Dr. Alan Gurman
Dr. Roger D. Nishimura
Ohmart Orthodontics
Dr. Ian Paisley
Dr. Shon Peterson
Rocky Mtn. Dental Partners - Aspen/Aurora/Cherry Creek
Dr. Robert T. Rudman
Dr. Michael Scheidt & Kathryn Scheidt, MSN
Sedona Periodontics - Dr. Chris Sakkaris
Stamm Dental, Drs. Heather Stamm & Kai Kawasugi
Tennyson Pediatric Dentistry
Dr. Larry T. Weddle, Jr.
Dr. Cassady B. Wiggins
Young Dentistry for Children
Benefactors (Contributions of $2,000+)
2013 MDDS Delegates to the CDA
Dr. Kimberly Danzer
The Dental Center
Dr. Mitchell Friedman,
Dr. Anil Idiculla
Dr. Sheldon Newman & Linda Newman
Dr. Sean W. Shaw, Periodontics Dental Implants
Dr. Joseph K. Will
Patrons (Contributions of $500+)
Alpha Omega Dental Fraternity
Bank of America
Dr. Jack W. Choi
Colorado Society of Oral & Maxillofacial Surgeons, Inc.
Dr. Charles S. Danna
Dr. Karen D. Foster
Dr. George G. Gatseos
GHP Investment Advisors
Dr. Paul L. Glick
HJ Bosworth Company
Dr. Michael B. McKee
Dr. James C. Nock
Dr. Alexander H. Park
Ridgeview Pediatric Dentistry
Dr. Michael N. Poulos
Dr. Edward F. Rosenfield
Dr. Christopher J. Sakkaris
Dr. Eric W. VanZytveld
Dr. Gregg Lewis Jacob Williams
Dr. Herbert T. & Lenore Williams
Young Dentistry for Children
DENTAL INSTRUMENTATION
Board Room Founders
(Contributions of $3,000 each)
Dr. Michael A. Burnham
Dr. Nicholas Chiovitti
Dr. Charles S Danna
Dr. Mitchell Friedman
Dr. Troy A. Fox
Dr. Sheldon Newman
Dr. Ian Paisley
Dr. Michael J. Scheidt
Dr. Larry T. Weddle Jr
The MWDI is owned and operated
by the Metro Denver Dental Society
9
CLINICAL
DIAGNOISIS CHALLENGE:
VERRUCOUS CARCINOMA CASE
By John McDowell, DDS
A
64-year-old man presents for evaluation
of his chief complaint, “I have this bump growing
on the outside of my
lower gums. It has
been growing slowly over the
last few weeks. Even though it
doesn’t hurt, I am concerned
that it might be cancer.” His
medical history is positive for hypertension
(Lisinopril 40 mg/day; Coreg 6.25 mg b.i.d.) and
Type 2 diabetes (Glyburide 2.5 mg/day). He has
had periodic dental treatment with his most recent
dental prophylaxis occurring four months prior to
the present visit. He quit smoking 24 years ago but
smoked approximately one pack of cigarettes per
day for approximately 20 years (he states he began
smoking in college). He states he consumes about
one or two glasses of wine per week. His family
history is non-contributory. He denies a history
of any lung, liver or kidney disease. He denies a
history of hepatitis, neurologic disease/condition,
immune compromise/suppression, autoimmune
disease or drug allergies.
the exception of bilateral detectable lymph nodes in the submandibular and
submental chains. All detectable nodes are freely-movable, firm (but not
bony hard) and not tender to palpation. No
other lymph node chains or groups demonstrate
any lymphadenopathy. His intraoral exam
demonstrates generalized gingival inflammation
with scant amounts of plaque found on all dental
surfaces. No mandibular right probing depths
exceed 4 mm. The gingival tissues around the
lesion bleed slightly upon probing. There is no
significant mobility noted on any of the teeth on
the mandibular right.
The lesion shown (and related to his chief
complaint) is a single ovoid nodule located on
the facial surface of the attached mandibular
right gingiva. The nodule is very firm but not
bony hard. The nodule appears to have a broad
base. From the clinical examination, the depth of
the lesion cannot be determined definitively but
the lesion does not appear to invade the deeper
structures or the lingual gingival tissues.
What is your differential diagnosis, your working
diagnosis and your plan for this patient? Answers on pg. 29
His vital signs are all within normal limits. His
extraoral examination is non-contributory with
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AS SEEN ON:
10
TEDxMileHigh
DENVER
SPOTLIGHT
By Brandon Hall, DDS
A
re you looking for some inspiration?
Do you like getting together with fellow
talented Coloradoans? How about
pushing the boundaries of the status quo?
All of this came together at the TEDxMileHigh
event on June 14th here in Denver. It was held
at the Ellie Caulkins Opera House, which
served as the perfect venue for this special day. I attended this
year as well as two years ago. As a business owner and someone
who strives to be philanthropic, it’s the perfect opportunity to
immerse myself among colleagues and learn about the people
pushing the norm in the fields of healthcare, business, art and
entrepreneurship. It’s truly an inspirational day.
TED began in 1984 “as a conference where Technology,
Entertainment and Design converged, and today covers almost
all topics — from science to business to global issues — in more
than 100 languages. Meanwhile, independently run TEDx
events help share ideas in communities around the world.” I
think most of us are familiar with “TED Talks.” In fact, you can
cruise over to the website (www.ted.com) and watch a plethora
of videos on a variety of topics, among them social media,
human sexuality and entrepreneurship. Since TED’s inception,
the popularity of it has soared and with the advent of streaming
video content on the internet and Youtube, many of their “talks”
have become viral. They even have weekly hour long podcasts.
As far as the TEDx event here, the speaker portion was held from
1:00pm to 5:00pm with exhibits before and after. In between
sessions people had the ability to connect and share ideas. The
roster of speakers was quite diverse but awe-inspiring. Among
them were three high school prodigies talking about their
research in the field of science and medicine, a master penman
and a business coach. You discover that people have a multitude
of talents and those talents span all horizons. But what emanates
throughout each person’s story is the passion they hold for what
they do. I believe that is important to us as dentists. It’s crucial
to keep the passion for the dental treatment we provide. If you
have lost that passion or struggle to find it, an event like this has
the ability for you to reinvigorate yourself.
Like the speakers and attendees at the TEDxMileHigh event,
we all have a gift. That gift is the ability to provide dental care
to people from all walks of life. Everyone chooses what type of
practice they want to have. It’s important that we work hard
with insurance companies, the government, the public and,
most importantly, ourselves to protect our livelihoods and
professions. Let’s not let outside influences dictate how we
practice. That way, like each speaker at the TED, we have an
inspiring story to tell, no matter how big or how small.
11
Take a
Closer
Look
All malpractice
policies are not
created the same
There are a lot of differences between being a Member of the Trust and just another policy
number at a large, commercial carrier. Both give you a policy the Practice Law requires, but
that’s where the similarity ends. Consider…
Who do I talk to when I have a patient
event, claim or question?
The Trust: Local dentists who
understand your practice, your
business and your needs.
Them: Claims call center (likely in
another state).
Do I have personal input and access
to the company?
The Trust: Yes. You are represented by
your CDA Component Society giving
you direct, personal access to the
Board of Directors.
Them: No.
How much surplus has been returned
to dentists in Colorado?
The Trust: Over $1.2M has been
distributed back to Colorado dentists
as a “return of surplus” (after all, it’s
your Trust, your money).
Them: $0
Besides a policy, what do I get when I
buy coverage?
The Trust: Risk mitigation training,
educational programs and an on-call
team that “speak dentist.”
Them: That’s it; just a policy.
Do I have to give my “Consent to
Settle” a case?
The Trust: All settlements are based
on the best interests of the dentist,
patient and Trust Members.
Them: Read the fine print; ask about
their “Hammer Clause.”
How many years has the company
been serving Colorado dentists?
The Trust: 27 years. Established by
dentists in 1987.
Them: It’s hard to say... they tend to
come and go.
Protect your practice. Call the Trust today.
Dr. Nathan Reynolds
Dr. Randy Kluender
303-357-2604
303-357-2602
www.tdplt.com
???
FINANCIAL
THE DENTIST’S BUSINESS PLAN AND PERSONAL
FINANCIAL PLAN MUST COINCIDE
By Edward Leone Jr., CFP, RFC, DMD, MBA
D
r. Jones has just purchased Dr. Smith’s dental practice.
This practice has operated for 35 years and met all of
the criteria which Dr. Jones and his advisors desired.
Financing through a local bank was accomplished
and after a short period of introduction and familiarity with
the staff and patient population, Dr. Jones was in charge of
his new dental practice. Along with this very important
acquisition comes tremendous responsibility.
In order to manage this practice efficiently and to impose his personal desires
and direction for the practice, Dr. Jones needs to develop a business plan. This
business plan must include the following:
1. A statement of practice philosophy
2. Establishment of ownership form (Sole Proprietor, C Corporation, S
Corporation, LLC) which lends the best benefit to the doctor regarding tax issues,
fringe benefits, staff and employee status, retirement savings strategies along with
other business issues
3. Set performance standards which can be communicated to staff, quantified and
monitored with periodic adjustment for improvement (examples—technology
needs, compliance standards, continuing education, administrative efficiency,
scheduling, collections, billing practices, insurance protocols, receivables,
overhead control, patient relations)
4. Establish effective benchmarks and examine return on investment before
engaging a product or service
5. Establish understandable staff policies (office manual, performance evaluation
system, fringe benefit policy, bonus incentive system)
6. Develop internal and external marketing strategies
7. Establish a succession plan
The business plan requires much dedicated thought and execution, but must be
engaged in order for the dentist to have a successful and implementable personal
financial plan. Most dental practices employ the expert help of a certified
public accountant and an attorney. Expanding the team of advisors to include
the spouse, a certified financial planner and one or more experts on a variety of
insurance needs is essential to making the business plan workable and coincident
with a personal financial plan. This collection of advisors will help the dentist
avoid being influenced by human characteristics which we all possess (emotion,
fear and group think) which can divert or alter what can be a successful plan.
Dentists need to address the following in the conduct of business and personal
wealth planning:
C. Income requirements
D. Risk factors
E. Time horizons
F. Special needs
G. An inflation factor along with expected rate of return on investments.
As you should realize, these are very essential but complex issues which the
dentist cannot dedicate adequate time to address and monitor with his or her
limited skill sets in many of these areas. It is also important to review all of these
business and personal plan elements periodically to consider adjustment and
improvement. We urge our patients to do a dental checkup. I urge you to do a
wealth checkup with the purpose of dedicated detail to each issue listed above
and the focus on savings, debt, taxes, lifestyle costs and major capital investments.
Timing, dedication and discipline are essential to business and personal success.
Dr. Jones should not be an exception to the rule, but rather, a part of the successful
membership of our great profession.
Dr. Leone is a past President of MDDS and CDA. Along with service as an ADA
Trustee, he has also held the office of Treasurer of the American Dental Association.
Dr. Leone continues to practice clinical dentistry and is also an Associate at GHP
Investment Advisors Inc. in Denver.
Walt’s
Fine Upholstery
Specializing in Medical and
Dental Furnishings
303-467-9291
We are experienced and dedicated professionals who:
• Service the Front Range with 38 years of experience
• Know your equipment’s upholstery needs
• Give guaranteed quality results
1. A personal financial analysis
• Feature materials especially for medical applications
2. Risk management regarding casualty exposure, liabilities including malpractice
and life termination issues
• Minimize operatory down-time
3. Tax planning
4. Investment planning for business and personal wealth building
5. Education planning
6. Estate Planning
7. Retirement Planning which takes into consideration:
A. Projected age at retirement
B. Life expectancy
mddsdentist.com
Same Quality Service • New Address
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Walt’s Fine Upholstery on Facebook
5985 Lamar St. Suite D • Arvada, Colorado 80003
Articulator
Fall 2014
13
PRACTICE
MANAGEMENT
BUILDING A GREAT PRACTICE MEANS
BUILDING A GREAT TEAM
By Derek Rawnsley and Scott Beard
O
ne of the key characteristics
of a good dentist is fierce
independence – having a solid
sense of how you are going to
practice your craft, your way.
Derek Rawnsley
Scott Beard
And while such a trait is key to becoming a
successful practitioner, understanding the critical benefit of teamwork is just
as important. After all, running a successful practice is a lot like running a
successful sports franchise - you have to assemble the right team.
For a dentist to be successful, one must quickly understand that no one
can do it alone, and a key part of the profession is to develop partnerships
with the right teammates. Just as a quarterback concentrates on his skill
set (running an offense and
passing) he needs the blocking
and running and receiving of
quality teammates.
For many new dentists
however, the thought of
building a solid team might
take a backseat to getting the
practice up and running and
building a patient base.
But try to imagine if a
quarterback
took
the
field without competent
teammates. He could call the
ideal play against the defense,
line up the players in the
correct position, take the snap
and throw a beautiful spiral
downfield…and get sacked if
his line doesn’t block, or have his pass intercepted because a receiver ran the
wrong route.
What follows is a list of teammates a dentist might consider when assembling
their winning team:
• Teammate - Certified Public Accountant: CPAs can assist with a lot more
than tax preparation. A CPA who is proficient in working with dental
clients can help with expense efficiencies and identify areas in which you
can improve cash flow. They have access to dental financial statistics that
allow you compare your practice with its peers. A well-skilled dental CPA
understands the nuances of the various specialties, whether you are a general
dentist or an endondontist.
• Teammate - Attorney: Using an attorney is wise for matters such as lease
negotiations, employment contracts and buy/sell agreements. Finding an
attorney who works with dentists can speed up the process and also identify
14
mddsdentist.com
potential problems or concerns that are specific to the industry. It can also
make a practice purchase or sale run more smoothly as these attorneys know
the specific issues to address. Attorneys can help with HR compliance and
guidelines in order to avoid issues in these areas.
• Teammate – Insurance Agent: An insurance agent can help identify and
offer suggestions that best fit the needs of a dentist both personally and for
their practice(s). Insurance needs can be complex and finding an agent who
can provide insight in all areas is beneficial.
• Teammate – Banker: A good banker can offer financing solutions to
buy or expand a practice. In addition, they may have programs to assist
with purchasing the real estate that houses your business. Additionally, a
banker with key understanding of the dental industry should offer insight
on how financial decisions you
make today will impact your
practice in the future.
What is key in developing
any relationship with these
teammates is a very simple
test dentists should apply to
every member of the team: Is
this business relationship an
investment or just an expense?
In other words, do you have a
consultative relationship with
the members of your outside
team? Are they providing
you sound advice and ways
to improve your practice and
maximize revenue?
A quality teammate is an
investment. If it is an expense,
you should strongly consider making a change.
The good news is that more often than not, a relationship with one core
teammate can lead to others. If you already have a good CPA, ask them
about attorneys, insurance agents and bankers they might recommend.
Have a good attorney? Ask about insurance agents. Also, take advantage of
referrals and networking opportunities from dental trade associations and
professional groups.
The key is to realize that no matter how large or small your practice is, there
is always a need for quality teammates to help propel you toward your goals.
Derek Rawnsley is Vice president and Business Development Officer for Pacific
Continental Bank, based in Denver. Scott Beard is Executive Vice President and
Director for Healthcare Lending for Pacific Continental Bank. They can be reached
at [email protected] and [email protected]
Articulator
Fall 2014
Hire a broker
you can trust!
Selling or Buying a Dental Practice?
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• 140-seat Auditorium (can be divided in 2)
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Articulator
Fall 2014
15
CLINICAL
SCREW-ACCESS MARKING:
A TECHNIQUE TO SIMPLIFY
RETRIEVAL OF CEMENTRETAINED IMPLANT
PROSTHESES
Todd R. Schoenbaum, DDS; Yi-Yuan Chang, BS, MDC; and Perry R. Klokkevold, DDS, MS
Abstract: One of the commonly cited disadvantages of cement-retained implant prostheses is their inability to be retrieved. The screw-access marking
technique discussed in this article allows for any clinician, at any time, to simply and predictably retrieve the cemented implant prosthesis. By applying
a discrete, but easily recognizable, marking on the occlusal surface of the restoration, the entry point into the screw-access chamber can be precisely and
safely created. The screw-access marking technique is efficient, effective and widely applicable.
There has been much debate about screw-retained versus cement-retained
implant prostheses with regards to longevity, ease of use, costs, complexity
and esthetics. 1-5 The primary advantages commonly cited in favor of screwretained prostheses are that they are easier to retrieve and do not carry the risk
of retaining cement subgingivally. 6 In spite of this, cement-retained prostheses
continue to be a popular choice for implant restorations due to their ability to
compensate for some implant angulation issues, relative ease of fabrication,
predictable costs—which are generally
unaffected by fluctuations in the costs
of alloys—occlusal esthetics,7 decreased
bacterial leakage,8 increased mean
porcelain fracture loads,9 and familiar
restorative cementation protocols.
Current Removal Methods
The existing technique for the removal of cement implant restorations is to
measure the distance between landmarks and the screw-access chambers based
on periapical radiographs and to make rough estimates of the screw access line of
draw on the occlusal/palatal surface of the restoration.15 If available, photographs
from, or immediately after, the surgical phase can be valuable in determining the
access as well. Although this is a viable technique, it can be difficult to perform
accurately and does not account for buccal-lingual
angulation of the implant. Cone beam computed
tomography (CBCT) scans may help to resolve
this issue, but are generally avoided due to
increased costs and radiation exposure compared
to periapical radiographs. When single-unit
prostheses (and larger fixed partial dentures) are
removed this way, it often results in destruction
of the existing restoration. The resulting access
opening is often too large or irregular to allow
the restoration to be used again if desired.16 The
inaccuracy of this method can lead to significant
damage to the abutment as well, compromising
Figure 1
its ability to be reused if desired (Figure 1).
Although it is often the only choice for removal,
Fig 1. The removal of cement-retained implant restorations can be difficult
this “measure and estimate” technique is stressful
and unpredictable, often requiring the destruction of the crown and/or
and time-consuming for the clinician.
Inevitably, some cemented implant
restorations will need to be removed
at a future date. Common prosthetic
reasons for removal include: fractured
porcelain; fractured or loose abutment
screws;
hypoocclusion;
open
interproximal
contacts;
excessive
contours; retained cement leading
to peri-implantitis; failed esthetics;
and unacceptable recession of the periimplant gingiva.4,10-14 In the authors’ the abutment.
experience, the removal of a cemented
implant prosthesis is often performed by a clinician who was not part of the
original treatment team and is, therefore, unaware of the precise location
of the screw access. As such, removing the cemented implant prosthesis is
highly unpredictable due to the lack of standardization of techniques and
materials used in implant prosthetics and the inability to identify the materials
used radiographically. This ultimately leads to difficulty and unpredictability
in removal, increased treatment time, and added costs for the patient.
16
mddsdentist.com
An alternative technique using a silicone occlusal
index was developed in 2007 to mark screw-access holes on cemented implant
prostheses.17 In this technique, the estimated location of the screw-access holes
on the occlusal surface is marked with wax, and a silicone putty matrix is formed
over the top. The limitations of this technique are that the screw-access hole
indication is only an estimation based on gold calipers, and that the clinician
performing the removal must be in possession of the matrix.
Articulator
Fall 2014
Figure 3
Figure 2
Fig 2. The cast with the definitive implant abutment is mounted on thesurveyor to accurately record the path of the screw-access chamber. Fig 3. Surveyor pin
Figure
2 the screw-access chamber on the cast.
aligned
with
Figure 1 b
Figure 4
Figure 4
Figure 5
Figure 9
Figure 6
Figure 7
Figure 8
Fig 4. Once aligned, the surveyor pin is raised without changing the position of the cast. Fig 5. A fine-point
sable brush is fitted to the surveyor in place of the pin. Fig 6. The prosthesis is placed on the abutment, then
the brush is loaded with an opaque brown or white stain and lowered to the crown. Note the small concavity
created on the occlusal surface to receive the stain; this ensures that the screw-access marking will not wear
away under load. Fig 7. In situations where a more discrete marking is desired, a white opaque stain is used.
Fig 8. The screw-access marking clearly indicates the precise location of the screw access through the occlusal
surface of the restoration. If the prosthesis needs to be removed at any future date, the screw can be easily
and predictably accessed by creating a hole at that location. Fig 9. The white-colored screw-access marking is
subtler, but it is equally effective at indicating the location of the screw-access chamber.
The Authors’ Technique
The purpose of the technique detailed in this article—a modification of a
technique first described by Schwedhelm in 200618—is to resolve one of the
major concerns and make the retrieval of cemented implant restorations
easier and more predictable. With this minor modification, the retrieval
of the cement-retained implant prostheses is no more difficult than that of
screw-retained units, even when the clinician creating the access was not
involved in the initial treatment.
During the fabrication of the restoration, the laboratory can perform a
simple modification to the prosthesis to ensure that, if needed, the future
retrieval will be nearly as simple as removing a screw-retained prosthesis. By
making a small indentation on the occlusal surface of a cemented restoration
and clearly marking it with an opaque white (or brown) tint, the access
point into the screw chamber can be easily identified. The great advantage
of this technique is that the screw-access marking is easily identified by any
astute clinician at a future date, even one with no involvement with the initial
treatment, ensuring simplified access and removal.
Screw-Access Marking Technique Step-By-Step
The technique is carried out as follows:
1. Place the definitive abutment on the implant analog on the laboratory cast.
2. Mount the cast in a surveyor (Figure 2). This is done to accurately record
the path of the screw-access chamber and will allow the occlusal surface
to be precisely marked, indicating the location for the screw access. The
surveyor pin (Figure 3) is aligned with the screw-access chamber on the
cast, ensuring that it is correctly aligned in both mesial-distal and buccal(continued on .page 18)
mddsdentist.com
Articulator
Fall 2014
17
CLINICAL
(cont. from pg. 17)
Figure 10
Figure 11
Figure 9
Figure 12
marking technique is best indicated for cemented
posterior implant restorations, particularly when
implant angulation is outside of the expected range.
The screw-access marking method will also work
on anterior units, as long as the angulation places
the screw access palatal to the incisal edge. Due to
esthetic concerns, this technique is not indicated
for anterior cemented restorations with a line of
draw that would result in the indicator marking
being placed on the facial surfaces. Removal of
cemented implant restorations—with or without
the screw-access marking—does still have a risk for
porcelain fracture during the creation of the access.
The risk of porcelain fracture can be minimized by
using appropriate burs for the material being cut
(ie, fine grit diamond burs), with light intermittent
pressure and water coolant. When appropriate,
the prosthesis–abutment complex can be reused
and the access closed as would be done for any
other screw-retained restoration. This technique is
not applicable for solid abutments or “one-piece”
implant designs.
Summary
Fig 10. The definitive prosthesis and abutment ready for delivery. Fig 11. The definitive abutment is delivered
and torqued to the specified level. Fig 12. The definitive restoration is cemented with a resin-modified glassionomer cement. This cement provides good retention but remains slightly soluble should any cement be
retained subgingivally. Postoperative evaluation reveals healthy peri-implant gingiva. Fig 13. Should the
prosthesis need to be retrieved at a future date, the white-colored screw-access marking clearly indicates where
to create the hole.
lingual angulation.
3. Align the cast so that the surveyor pin passes
directly down the screw access of the abutment
(Figure 4).
4. Replace the surveyor pin with a fine-tip sable
brush (Figure 5).
5. Place the definitive restoration on the abutment.
Create a small concavity with a fine diamond bur at
the point of contact to ensure that the opaque stain
does not wear away under function (Figure 6).
6. Lower the brush (pre-loaded with the opaquing
porcelain) onto the surface of the restoration
(Figure 7), allowing the opaque stain (white
or brown) to flow into the concavity created
by the bur. The brown stain (Figure 8) is more
obvious than the white stain (Figure 9), although
it may be esthetically objectionable under some
circumstances.
7. Fire the restoration according to the
manufacturer’s instructions.
8. Deliver the definitive abutment, and torque
to manufacturer specifications (Figure 10 and
Figure 11). Note in Figure 10 that the subgingival
18
mddsdentist.com
emergence of the abutment has been stained to
better match the gingival shade of the restoration,
thus guarding against esthetic complications
secondary to future changes in the gingiva. In
Figure 11, the screw-access chamber is cleaned
with 2% chlorhexidine solution, dried and
obturated with polyvinyl siloxane (PVS). Note
that the custom abutment in Figure 11 has been
designed with the margins at approximately 0.5
mm subgingivally to ensure that removal of the
excess cement is easily performed with minimal
chance of retaining cement subgingivally.
Discussion: Technique Advantages and
Applications
This technique is a simple and convenient way to
increase the ease with which cemented implant
restorations can be removed if needed. The
screw-access marking is subtle enough to be
esthetically and functionally unobtrusive (Figure
12 and Figure 13). The additional time required
to perform the technique is minimal and requires
no special training for the ceramist. If widely
implemented, this technique will remove one
of the major difficulties with cementretained
restorations by making their retrieval significantly
more predictable and efficient. The screw-access
By creating and staining a small marking on
the occlusal surface of cement-retained implant
restorations, the access point to the abutment screw
can be clearly identified, ensuring that any future
retrieval of the prosthesis is simple and predictable,
thus resolving one of the primary difficulties with
cement-retained implant restorations.
REFERENCES
1. Misch CE. Screw-retained versus cement-retained implant-supported prostheses. Pract
Periodontics Aesthet Dent. 1995;7(9):15-18.
2. Hebel KS, Gajjar RC. Cement-retained versus screw-retained implant restorations: achieving
optimal occlusion and esthetics in implant dentistry. J Prosthet Dent. 1997;77(1):28-35.
3. Chee W, Felton DA , Johnson PF, Sullivan DY. Cemented vs. screwretained
implant prostheses: which is better? Int J Oral Maxillofac Implants. 1999;14(1):137-141.
4. Berglundh T, Persson L, Klinge B. A systematic review of the incidence of biological and
technical complications in implant dentistry reported in prospective longitudinal studies of at
least 5 years. J Clin
Periodontol. 2002;29 suppl 3:197-212; discussion 232-233.
5. Drago C, Lazzara RJ. Guidelines for implant abutment selection for partially edentulous
patients. Compend Contin Educ Dent. 2010;31(1):14-28.
6. Sadan A, Blatz MB, Bellerino M, Block M. Prosthetic design considerations for anterior singleimplant restorations. J Esthet Restor Dent. 2004;16(3):165-175.
7. Weininger B, McGlumphy E, Beck M. Esthetic evaluation of materials used to fill access holes
of screw-retained implant crowns. J Oral Implantol. 2008;34(3):145-149.
8. Piattelli A, Scarano A, Paolantonio M, et al. Fluids and microbial penetration in the internal
part of cement-retained versus screw-retained implant-abutment connections. J Periodontol.
2001;72(9):1146-1150.
9. Al-Omari WM, Shadid R, Abu-Naba’a L, El Masoud B. Porcelain fracture resistance of
screw-retained, cement-retained, and screwcement- retained implant-supported metal ceramic
posterior crowns. J
Prosthodont. 2010;19(4):263-273.
10. Schwarz MS. Mechanical complications of dental implants. Clin Oral Implant Res. 2000;11
suppl 1:156-158.
11. Jemt T, Lekholm U, Gröndahl K. 3-year followup study of early single implant restorations ad
modum Brånemark. Int J Periodontics Restorative Dent. 1990;10(5):340-349.
12. Jemt T. Failures and complications in 391 consecutively inserted fixed prostheses supported
by Brånemark implants in edentulous jaws: a study of treatment from the time of prosthesis
placement to the first annual checkup. Int J Oral Maxillofac Implants. 1991;6(3):270-276.
13. Jemt T, Lindén B, Lekholm U. Failures and complications in 127 consecutively placed fixed
partial prostheses supported by Brånemark implants: from prosthetic treatment to first annual
checkup. Int J Oral Maxillofac Implants. 1992;7(1):40-44.
14. Becker W, Becker BE. Replacement of maxillary and mandibular molars with single
endosseous implant restorations: a retrospective study. J Prosthet Dent. 1995;74(1):51-55.
15. Patil PG. A technique for repairing a loosening abutment screw for a cement-retained
implant prosthesis. J Prosthodont. 2011;20(8):652-655.
16. Chee W, Jivraj S. Screw versus cemented implant supported restorations. Br Dent J.
2006;201(8):501-507.
17. Hill EE. A simple, permanent index for abutment screw access for cemented implantsupported crowns. J Prosthet Dent. 2007;97(5):313-314.
18. Schwedhelm ER, Raigrodski AJ. A technique for locating implant abutment screws of
posterior cement-retained metal-ceramic restorations with ceramic occlusal surfaces. J Prosthet
Dent. 2006;95(2):165-167.
Articulator
Fall 2014
DISC_MDDS_artad_Summer2014v3.qxp_Layout 1 9/2/14 1:11 PM Page 1
Stability
· Strength ·
Service
2014
SCHEDULE - LAST TWO EVENTS
October 9, 2014
Implant Direct
Overdentures: A New Look on
Classic Prosthodontics
Dr. Xavier Saab, Prosthodontist
Houston, Texas
November 20, 2014 Diagnosing and Managing Patients to
Avoid Complications
Straumann
Dr. Dean Morton, Prosthodontist, Professor and
Chairman of the Department of Oral Health and
Rehabilitation at the University of Louisville School
of Dentistry. Director of the Advanced Education
Program in Prosthodontics.
Louisville, Kentucky
SCAN THIS CODE FOR THE
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Location: Mountain West Dental Institute
Beauvallon Building: 925 Lincoln Street,
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Time: 5:30 PM to 8:30 PM
Complimentary light dinner at 5:30 PM.
Lecture begins promptly at 6:00 PM.
CE credits are available. Fees for 2014
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Please Note: Capacity is limited. If
interested in attending, please R.S.V.P. to
reserve your place (see below).
BEFORE
AFTER
Images courtesy of Dr. Aldo Leopardi (Implants in sites 7 and 9, Four-unit FPD)
R.S.V.P. to http://discevents.eventbrite.com
2000 S Colorado Blvd, Annex
Building, Suite 410
Denver, CO 80222
www.dentalliability.com
mddsdentist.com
Phone:
(303) 357-2600
Fax:
(866) 699-1559
Toll Free: (877) 502-0100
Aldo Leopardi, BDS, DDS, MS
Prosthodontist /// P. 720.488.7677 /// F. 720.488.7717
Or visit www.knowledgefactoryco.com
Articulator
Fall 2014
19
NON PROFIT
NEWS
SALUD FAMILY
HEALTH CENTER A VALUABLE
RESOURCE FOR
UNDERSERVED
PATIENTS
By Lisa Bennett, DDS
W
hen I tell people I work in a public health
clinic I am often asked one of the following
questions: Are you employed by the
government? Do you get loan repayment?
When are you planning to move to private
practice? Do you see a lot of meth mouth? I end up
responding in my educator tone of voice that I adopt
when teaching dental students: No, I am not employed by
the government; I am eligible for loan repayment; I am not planning to move
to private practice; No, I don’t see a lot of “meth mouth,” but I do occasionally
see “Mountain Dew mouth.”
I have been working at the Salud Family Health Center in Brighton for six years.
Salud is a non-profit Federally Qualified Health Center (FQHC) meaning it
is eligible for federal funding as well as reimbursement for Medicaid. Dentists
working for FQHC’s may apply for loan repayment. The most common
programs are the National Health Service Corps (NHSC.hrsa.gov) and the
Colorado Health Service Corps (coloradohealthservicecorps.org). Much like
private practice, Salud dental clinics provide a wide range of dental services
with the option to refer to cooperating specialists when necessary. Salud
differs from private practice in its mission to increase access and offer medical,
dental and behavioral health care at each site. Salud dentists are employees so
we benefit from paid vacation time and holidays; IRA contributions; health,
disability, life, and malpractice insurance; reimbursement for continuing
education and organized dentistry memberships; and payment of dental and
DEA license renewal. We have autonomy in patient treatment and enjoy the
ability to work in collaboration with a large group of dentists. We also serve
as preceptors for fourth-year dental students. They gain an appreciation for
public health dentistry and some, like me, go on to pursue a career in this
field.
I chose a career in public health dentistry because I enjoyed my experience as
a dental student rotating through community health centers, and I found a
way to apply my college major of Spanish. I am grateful for the opportunity to
provide high quality oral health care to a population with limited resources. I
plan to continue working for Salud because I am passionate about my role as
a community leader, educator and public health dentist.
20
mddsdentist.com
Salud patients consist of the members of the communities in which
Salud clinics are located. Patients that receive high priority are medically
underserved, low income or are migrant and seasonal farmworkers. Salud
accepts insurance, Medicaid or uses a sliding fee scale based on income. The
population we see is at higher risk for dental disease. As a reflection of today’s
culture, “Mountain Dew mouth” is prevalent as well as “baby bottle tooth
decay,” and we focus heavily on education and prevention. We see everyone
from infants with neonatal teeth to patients over 100 years old. All members
of a family come to see us and most patients view Salud as their lifelong dental
and medical home.
Public health clinics, like Salud, are valuable resources for underserved
patients. They also provide an exciting and challenging environment in which
to practice dentistry. It is rewarding to serve the mission of Salud, “to improve
access and reduce barriers to care including: ability to pay, transportation,and
language… without regard to age, sex or disease process.” A prospective
patient may call our Contact Center at (303) 655-4955. For more information,
visit our website at www.saludclinic.org. To advocate for Salud Family Health
Centers and to ensure we continue to provide access to our patients and
communities, please consider joining our National Advocacy Network at
www.saveourchcs.org.
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Articulator
Fall 2014
MDDF’S SMILE AGAIN PROGRAM® PARTNERS
WITH WARREN VILLAGE TO CHANGE SMILES
AND CHANGE LIVES
By Elyse Montgomery, Director of Family Services, Warren Village
D
id you know that families with children are
the fastest growing segment of the homeless
population? Celebrating 40 years of serving
the Denver community, Warren Village is
committed to helping move families from
poverty and homelessness to stability and prosperity. We
recognize that a holistic approach to help clients address
their economic, physical, psychological and social wellbeing is essential to help families thrive, experience success in the workforce
and reduce dependence on public assistance. Located in the Capitol Hill
neighborhood, Warren Village is a two-year transformational program,
nationally recognized for its programs to help motivated low-income, single
parent families move from public assistance to self-sufficiency. Combining
subsidized housing, on site nationally accredited child care, intensive
case management and career development, residents begin the process of
rebuilding their lives and achieving their dreams.
Warren Village has had the privilege of partnering with the Smile Again
Program since 2002. The Smile Again Program helps connect survivors of
domestic abuse with dental care professionals who provide cost-free dental
care. Our experience with the Smile Again Program has been overwhelmingly
positive and life-changing for our clients.
Many of the families at Warren Village have been previously homeless.
The relationship between homelessness and domestic violence is extremely
strong; the majority of our families have experienced domestic violence.
When people think of domestic abuse, often certain images come to mind
– usually of a battered or bruised woman. What people may not realize is
that domestic abuse may also include isolation from family and friends and
a partner controlling many aspects of an individual’s life, including financial
control. Many of our clients come to us with huge unmet or emergency dental
needs. We find that our clients have neglected their teeth and their dental
health due to high cost of care, poverty, lack of insurance or refusal from
partners to allow medical services.
Over the years we have referred many clients to the Smile Again Program. One
success story is that of a young woman named Barbara. Raised primarily by
her grandmother and an extended network of relatives, Barbara and her high
school sweetheart became young parents at age 17. They tried to live together
as a couple while moving from place to place and staying with relatives who
would take them in. Sadly, the nature of their relationship changed once their
son was born. The verbal abuse escalated to physical abuse. Her boyfriend
spent more and more time running with the wrong crowd, leaving her with
all of the financial and parenting responsibilities. Barbara dropped out of high
school in her senior year and worked at a fast food restaurant to support the
family and eventually went to a shelter to escape the abuse.
Once moving to Warren Village and establishing her own home for the first
time, Barbara had a hard time finding work. In conversation with staff we
learned that she was very self-conscious of her teeth and smile and suffered
from chronic pain due to dental decay and gum disease. She had not seen a
dentist in over five years. We referred Barbara to Smile Again and the results
were amazing! Not only did her volunteer dentist help her with all of her
dental issues, the entire office staff made her feel welcomed, appreciated and
important. After some time focusing on her health, Barbara’s life improved.
She was able to get a job working full-time as a customer service representative
at a call center and now has plans to attend college.
CAN YOUR
DENTAL TEAM
HELP DEFEND YOU
IN A MALPRACTICE
LAWSUIT?
Friday, Oct. 31st, 2014
Presented by Dr. Mitchell Gardiner
The MWDI is owned and operated
by the Metro Denver Dental Society
Register Online Today mddsdentist.com
21
EDUCATION
SILVER BULLETS: CU-SDM
COMMENCEMENT 2014
By Rick Collette, First Year Dental Student
W
ill you carry on?
Or be carried
away?” asked Dr.
Robert Greer, who
gave the 2014 commencement
address at the University of
Colorado School of Dental
Medicine. The true measure of a person, he
said, is not their successes, but how they handle
their failures. The Class of 2014 has many
challenges yet before them, and there are no
magic solutions—or silver bullets, according to
Dr. Greer.
He spoke to the major points in dentistry from
doing no harm to providing compassionate
care. “Believe in something” and “pursue your
passions” are certainly good advice. But it was
his poignant story of his own meteoric rise
followed by the sudden death of his beloved
wife that struck home. Calling up Napoleon
Bonaparte, Dr. Greer insisted that the measure
of a person is how they handle their “personal
Waterloo.” Though he gave no easy answers,
the questions themselves spoke volumes.
For the CU School of Dental Medicine class
of 2014, their challenges will come in a variety
of settings. Fourty percent of the graduates are
entering general practice, with a further thirty
percent doing an AEGD or GPR program.
Four are attending specialty programs, two in
periodontics, one in pedodontics, and one in
prosthodontics. Interestingly, only 11 of the
graduates plan to stay in the greater Denver area.
The rest are scattering throughout the country
as far east as Washington, DC and as far west as
Hilo, HI. No matter where they end up, we who
remain at the CU School of Dental Medicine
wish them luck in their upcoming adventures.
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a law office for dental and medical business needs .
Office Leases
Practice Transitions
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Emphasis is placed on understanding client needs and using technology, resources, and relationships with your
brokers, consultants, bankers and CPAs to meet those needs in an efficient, effective and professional manner.
Law Office of Kimberley G. Taylor, LLC | www.lawofficekgt.com | 303-526-8456 or 970-926-6389 | [email protected]
EVENT CALENDAR
OCTOBER 2014
October 3-4
Colorado Mission of Mercy –CMOM
Prairie View High School
12909 East 120th Avenue
Henderson, CO 80640
All Day
(303) 710-6548
October 9-14
ADA Annual Session
San Antonio, TX
Henry B. Gonzalez Convention Center
October 14
CPR & AED Training
Mountain West Dental Institute
Denver, CO 80203
6:00pm - 9:00pm
(303) 488-9700
October 16
How to Build
Your Dream Practice!
Denver, CO 80203
6:00pm - 9:00pm
(303) 488-9700
October 23
MDDS New Member Welcome Event
Three Dogs Tavern
3390 W. 32nd Avenue,
Denver, CO 80211
6:00pm - 8:00pm
24
October 24-25
Botulinum Toxin & Dermal Fillers
& Frontline TMJ & Orofacial Pain
Denver, CO 80203
Oct. 24 8:00am - 5:00pm
Oct. 25 8:00am - 1:00pm
(303) 488-9700
November 13-15
Oral Surgery for the General Dentist
A Practical Approach 3 Day Hands On Seminar
Denver, CO 80203
8:30am - 4:00pm (all three days)
(303) 488-9700
October 31
Can Your Dental Team Defend
You in a Malpractice Lawsuit?
Denver, CO 80203
8:30am - 3:30pm
(303) 488-9700
November 21
All on Four: Live Implant Surgery
and Immediate Provisionalization
Denver, CO 80203
8:00am - 4:00pm
(303) 488-9700
NOVEMBER 2014
DECEMBER 2014
November 1
MDDS Event Behavior Management Strategies
in Pediatric Dentistry with Special Consideration
of Medical Immobilization
Denver, CO 80203
8:00am - 3:30pm
(303) 488-9700
December 5-6
Nitrous Oxide/Oxygen
Adminstration Training
Denver, CO 80203
Dec. 5 8:30am - 5:00pm
Dec. 6 8:00am - 12:00pm
(303) 488-9700
November 6
MWDI Donor Appreciation Event
Denver, CO 80203
6:30am - 9:00pm
(303) 488-9700
JANUARY 2015
You can find more details on all of these events at
mddsdentist.com
January 22-24
2015 Rocky Mountain Dental Convention
Colorado Convention Center, 700 14th St,
Denver, CO 80202
& The Mountain West Dental Institute,
925 Lincoln St. Unit B
Denver, CO 80203
All Day
(303) 488-9700
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25
Take 5 and
Make Colorado
Healthier!
It’s our profession’s time to shine! Enroll as
a Medicaid provider and Take 5 new
patients or families today.
For the first time, adults are now covered by
Medicaid in Colorado. This means that an
estimated 300,000 Colorado adults will be
seeking dental treatment. They need you
– and in fact their well being depends
on it.
Make a pledge to Take 5. Join your
colleagues and make a commitment
to address the needs of those served
by Medicaid. On July 1, the full
benefit for the Colorado Medicaid
Dental Program will be available to
patients and includes a $1,000 annual
benefit, in addition to a full denture
benefit.
DentaQuest will administer the Colorado
Medicaid Dental Program, and will provide
regional field representatives to personally
assist dentists, help with Medicaid
enrollment, and educate your staff on best
practices for efficient billing and patient
management. DentaQuest administers
dental benefits in 28 states.
Visit cdaonline.org/Take5 and join the
list of CDA members committed to
caring for the new population of
patients in Colorado. Questions? Call
the CDA at 303-740-6900 or
800-343-3010.
26
mddsdentist.com
Articulator
Fall 2014
PROFESSIONAL MARKETING AND APPRAISAL
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Help Serve Colorado’s Underserved
You can help serve our underserved population by
signing up for the new Colorado Medical Dental
Program for Medicaid members, administered by
DentaQuest, the nation’s most experienced dental
benefits manager. Our mission is to improve the oral
health of all.
With DentaQuest, you’ll experience:
• Online EOBs
• Easy claims filing
• Online eligibility
• Timely payment
• Online utilization
management
And you’ll be helping our residents who are most in
need.
Sign up today! Just call Provider Support at 855-225-1731
or visit www.DentaQuest.com.
Buying or Selling a Dental Practice
25 Years Colorado Dental Transition Experience
The demand for successful dental practices is at an all
time high, and We at PROFESSIONAL MARKETING &
APPRAISAL are working daily with qualified buyers!
If you are thinking of retiring, moving, or a career change
we will counsel you as to the fair market value of your
practice at NO COST TO YOU. We will discuss our
TIME TESTED strategies for a seamless transition. We
will explore your options and take into consideration your
personal and professional needs in a private and
confidential manner.
Jerry Weston, MBA
Tyler Weston, Broker
(303) 526-0448
dentaltrans.com
[email protected]
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6 N Tejon, Suite 501
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[email protected]
719-445-5044
720-319-9419
www.hcmws.com
Articulator
Fall 2014
27
MWDI
SPEAKER
CANNIBIS: LEGALIZED, NOW WHAT?
By Bart Johnson, DDS, MS
N
ow that recreational use of marijuana has been
legalized in Colorado and Washington, there
is even more reason for the dental team to
know about the drug, its effects and how best
to counsel patients who use it for either medicinal or
recreational uses.
Historically, the oldest known written record of cannibis
use was from the Chinese Emperor Shen Nung in 2727 BC. Greeks
and Romans knew of it, and it spread throughout the Middle East in
the Islamic empire to North Africa. There is debate if it was a principle
ingredient of the holy anointing oils using “Kaneh-Bosm,” which some
historical botanists identify as cannabis, but whom also recognize three
or four other plants that may have been the actual constituent. It was
brought to South America (Chile) in 1545 and was a plantation product
for the production of hemp for clothing, paper and
rope (the stalk of the plant is very fibrous and woody;
it is where the raw hemp material is derived). In
North America during the colonial times, it was one
of several plantation products; again more for the
hemp than for the psychoactive drug.
rolled cigarettes (joints) provide the oils across the capillary network of
our very large lung field for a quick and effective rise in blood levels.
Ingestion of the leaves in food forms (classically brownies or cookies)
results in a slower but still effective uptake of the drug. Smoking
marijuana has a much higher combustion temperature compared to
tobacco, and because the goal is to hold it in the lungs as long as possible,
it is capable of inflicting much more heat damage to the oral and fine
pulmonary alveolar tissues. Some of this effect can be reduced by using
a bong or hookah; pulling the lipid-soluble –9THC through the water
not only cools it, but filters out the water-soluble impurities for a better
high. Recently, vaporizers have entered the market that also provide the
drug in a vapor form that can be inhaled across the pulmonary mucosa.
There is a pharmaceutical version of –9THC called dronabinol (brand
name Marinol) that is available in 2.5, 5 and 10 mg tablets. While
effective, most users find the natural leaves to be
more enjoyable. It may be because of the minor
psychoactive substances found in the leaf, or
the subtle tastes and smells that various strains
provide.
As dentists, we have a
responsibility to educate
our patients. We can
inform them about the
oral effects of the hightemperature combustion
and encourage them to
limit their exposure or
at least mitigate it with
water pipes.
The main psychoactive drug in marijuana is delta-9
tetrahydrocannibinol, or –9THC. However,
research into the composition of the smoke has
found over 400 different chemicals, 23 of which have
been identified as having some psychoactive effect.
It should be noted that marijuana also has unusually
high levels of benzo(a)pyrene, the most wellresearched carcinogen found in tobacco smoke. The
plant has two main species, Cannibis sativa, which
has no –9THC, and Cannibis indica, which has
the psychoactive –9THC. As with many farmed
products, there are different strains which experts can point to subtle
differences in taste, smoothness, activity and appeal.
28
What do we know about –9THC? It mimics
a class of endogenous neurochemicals known
as the endocannabinoids. Research has yet to
definitively identify the roles of these chemicals
in our brain biochemistry, but they appear to be
involved in brain neuromodulation by blunting
the release of neurotransmitters. Just like we need
to control our brains by activating certain portions
when the time is right, we also need to shut down
competing or unnecessary portions at other times.
These chemicals appear to function globally in our
“shutting down” process.
How the plant is grown and processed will yield various products. Only
the female plants have the –9THC, and so the males are eliminated
from the production strains. The females that have not yet been fertilized
and gone to seed (Sensimilla or “without seeds”) are better for drug
levels in the leaves; once a plant has gone to seed, the seeds reduce the
concentration of psychoactive substances elsewhere in the plant. Note
that marijuana seeds are technically not illegal to possess as they have
no –9THC.
The most concentrated version of –9THC is in hashish. The tops of the
plants are cultivated and the sap that flows out is 3x more concentrated
with –9THC. It is milked, dried and concentrated into slabs where it
can be ingested via eating, smoking or made into a tea.
With that concept in mind, the actions of marijuana make sense: we see
the patient get “stoned” where their learning, movement, memory and
other cognitive functions become impaired. They become apathetic and
unmotivated, which for some (particularly adolescents) is a desired goal,
and often interpreted as a sense of peacefulness and dreamy relaxation.
They experience distortion of time and space, emotional disinhibition,
and motor impairment. In the medical applications of the drugs, many
patients find pain pathways are blunted and marijuana can function well
to help reduce chronic pain syndromes. In the chronic user, unfortunately
these “shutting down” processes can go on to lead to permanent memory
loss and irrevocable diminution of cognitive ability. In the short-term
users who stop using the drug, many often remark how they have “come
out of the fog” and their thinking is much clearer once use ceases. All
of these effects are magnified in the adolescent brain because it is still
developing.
The most common way marijuana is ingested is via smoking. Hand-
The drug has many side effects. Perhaps the most beneficial in the
mddsdentist.com
Articulator
Fall 2014
medical setting is hypothalamic stimulation of appetite, which is helpful for
emaciated cancer and HIV+ patients. In the recreational user, this is simply
known as the “munchies” where they want to eat a lot. Other side effects
include red eyes, sometimes very dilated pupils and disoriented behavior/
paranoia. Some people get suppression of the immune system and the heat
damage to the pulmonary tissues.
The most dangerous threat of marijuana to society is the impaired driver.
Because of distortion of time and space (objects appear farther away than
they really are), motor impairment and diminution of reaction time, drivers
using this drug become very dangerous to others, including themselves.
Traffic accidents, many fatal, have occurred by driving under the influence
of marijuana.
Many states have passed medical marijuana laws that allow a physician to
prescribe regulated amounts of the drug for their patients who will gain
benefit. Two states, Colorado and Washington, passed laws that now allow
for recreational use of the drug under very regulated conditions. Both states
only allow this use in adults over the age of 21, and in private areas only.
DUI laws are strict in both states. In Colorado, people can grow up to six
plants for personal use only and possess 1 oz of the drug while driving; In
Washington, they also can possess 1 oz but cannot grow their own (i.e.,
must buy it from licensed establishments) unless authorized for medicinal
purposes. In Colorado, tourists can use it while in-state, but cannot transport
it across state lines. Both states sell the drug via dispensaries which cannot
be pharmacies since pharmacies are federally controlled.
The fiscal numbers are impressive: Colorado started six months earlier than
Washington and has already tallied $115 million in revenue and $20 million
in taxes; Washington just started in July 2014 but has already generated $3.8
million in revenue. It remains to be seen if these new laws will have overall
positive fiscal effects (increased revenue, no significant uptick in accidents
and medical problems) or if they will end up costing each state a lot of
money in unforeseen ways.
As dentists, we have a responsibility to educate our patients. We can
inform them about the oral effects of the high-temperature combustion
and encourage them to limit their exposure or at least mitigate it with
water pipes. We can teach them about responsible use of the drug just
like we would do with alcohol. We can encourage our children not to use
this drug because it is well-known as a gateway drug for other substance
abuses, as well as the known damaging effects on the adolescent brain. We
can be compassionate for our medical users as this drug may be one of a
few that can restore a form of quality of life, even if it means they function
in a chronic foggy state. Oral hygiene for people in this situation may be
challenging, and we have to do our best to find ways to be sure it happens,
even if that means recruiting family members to help. If our patients or
colleagues get to dangerous places with their use of the drug, we can refer
them to rehabilitation centers for help. In the end, I am personally against
the use of any chemical that interferes with the natural exquisiteness of
our brain biochemistry, but recognize that certain limited situations may
warrant exceptions.
mddsdentist.com
DIAGNOISIS CHALLENGE:
VERRUCOUS CARCINOMA
CASE - ANSWERS (from pg. 10)
Suggested answers: The differential diagnosis is 1. Squamous
cell carcinoma; 2. Verrucous carcinoma; 3. Squamous
papilloma; 4. Verruca vulgaris. The diagnostic imperative
(the disease or condition that must be ruled out) is exophytic
squamous cell carcinoma. The plan with the highest utility is
to perform (or refer for the surgical procedure) an excisional
biopsy. An excisional biopsy was performed excising tissue
from the distal of the mandibular first molar to the pre distal
of the mandibular first molar also taking the associated dental
papillae and periosteum. In this case, the biopsy diagnosis
was verrucous carcinoma with evidence of mild dysplasia
extending to the margins of the submitted tissue. A second
surgical procedure with wider excision revealed clear margins.
Verrucous carcinoma (VC) of gingival tissues is uncommon
but not rare. VC most often is diagnosed in older men.
Although it is well known that there is no safe form of tobacco,
most chronic users of smokeless tobacco do not develop oral
malignancies. In fact, many well-designed studies have shown
no strong correlation between smokeless tobacco use and oral
malignancies.
The typical appearance of VC is a well-demarcated exophytic
nodule with a verruciform or papillary surface. Slow, painless
growth is a common patient history given. VC is considered
by many authors to be a low-grade variant of squamous
cell carcinoma. Metastasis of VC is rare with lymph node
involvement being so uncommon that radical neck dissection
is not indicated in most cases. Although VC does not typically
demonstrate the course of oral squamous cell carcinoma.
Following receipt of the pathologist’s report indicating a
diagnosis of VC, close follow-up is indicated. Potential
recurrence must be discussed with the patient. Discontinuance
of risky behaviors (including the use of tobacco products
and alcohol consumption) must also be discussed with the
patient.
Articulator
Fall 2014
29
ROCKY MOUNTAIN
DENTAL CONVENTION
IN BEAUTIFUL DENVER, CO
JAN
22
23
24
Hosted by
Rocky Mountain Dental Convention
20 CONNECT
15 RMDC ▶ DENVER,CO
The Colorado Convention Center
Photo
by: Scott Dressler-Martin and VISIT DENVER
Photo by: Scott Dressler-Martin and VISIT
DENVER
Learn more at
RMDCONLINE.COM
DON’T MISS OUR EXCITING LINE-UP!
Dr. Steven Buchanan
Ms. Teresa Duncan
Dr. Mic Falkel
Dr. Greg Gillespie
Dr. Sam Low
Dr. Henry Salama
Dr. Maurice Salama
Dr. John Svirsky
Ms. Rebecca Wilder
...and many more!
CONNECT
RMDCFRIDAY NIGHTPARTY
(across from the Convention Center)
Friday, January 23 - 5:30pm-8:30pm
Featuring DJ Bedz, official DJ
for the Denver Broncos & Nuggets!
SPONSORS:
Capitol Ballroom at the Hyatt Regency
Rocky Mountain Dental Convention
20 CONNECT
15 RMDC ▶ DENVER,CO
HOSTED BY
BENEFITING
FRIDAY NIGHT AFTER-PARTY at Chlóe
1445 Market Street
30
9pm-2am
RMDCONLINE.COM
“WHY IS SO MUCH ATTENTION
GIVEN TO RATE OF RETURN?”
FINANCIAL
By Daniel Flanscha, CFP®, CLU, ChFC
I
am always amazed, how much emphasis is placed on
investment Rate of Return in America. In this article,
we are going to explore the difference between Average
Rate of Return(s) (ROR) and Actual ROR and discuss
how any financial plan based on ROR assumptions can
lead to a false sense of security and potentially to financial
disappointment and insecurity.
We begin with a simple example and
grossly exaggerated ROR to make a
point. For this example, assume you
invested $100,000 and the first year you
doubled your money (+100% ROR).
At the end of the first year you had
$200,000 in your account. The second
year you lost 50% (‐50%) so you ended
up with $100,000. The third year you
doubled your money again (+100%
ROR) and end the year with $200,000.
The fourth year you again lose 50%
(‐50%) finishing the year back with an
account valued at $100,000. What was
your actual rate of return? It is easy to
see that it is zero. Now let us look what
your average ROR was:
100 + 100 [two positive years] – 50 – 50 [two negative years] = 100 / 4 years
= 25% Average ROR.
One is prompted to ask: "Why are financial institutions allowed to market on
the basis of average ROR?"
Are you upset yet?
Let’s take a look at a real time period and compare “average” versus “actual”
ROR. If you had invested a consistent amount of money at the beginning
of each year for 10 years starting in 1995 in large company stocks (based on
the S&P 500), at the end of the ninth year your average ROR would have
been 14.00%, but your actual ROR would have only been 7.52%. To be
fair, the actual ROR is not always lower than the average ROR. To further
demonstrate, I will share with you another example. If you had made the
same investments in the previous example but started in the year 2000, by
the end of the ninth year (end of 2009) your average ROR would have been
1.21% and your actual ROR would have been 1.33%. Obviously, the actual
ROR can turn out to be higher than the average.
What happens when you apply this in a method that traditional financial
planning uses – linear math? Suppose you visit with a financial planner/
banker/investment sales person and they tell you: if you invest $10,000 per
mddsdentist.com
year and receive an average of 14.00% at the end of 20 years you would have
$910,000. You may feel satisfied, secure and at peace knowing you will have
close to a million dollars in net worth. But what if in reality you only receive
an actual ROR of 7.52%? If this were so, the reality is your account would
be worth just under $467,000. There is a BIG difference between $910k and
$467k! So what are you basing your financial decisions on? In the second
example, if your actual ROR had been 1.33% your account would have been
worth $227,000. So I repeat – Why are we paying so much attention to ROR
and why are we basing retirement aspirations and
serious financial decisions on them?
I believe there are several reasons. First it is easy
to apply mathematical assumptions to money to
arrive at conclusions. Secondly, I believe deep
down human nature tends to be a little greedy.
We often think we will be the one who actually
earns the 14% ROR It is no wonder so many are
disappointed and become disenchanted with
what they have been doing financially over the
past couple of decades.
So what is the solution? First I believe it is
important to use ROR assumptions, in our
planning, that are more realistic. Secondly, I
believe the past decade has taught us that saving
may be as important as investing. This is a truth
that was known in the past but often ignored, when we thought the stock
market would promise us double digit ROR Unfortunately, as a general rule,
I don’t think we understand anymore the difference between saving and
investing. Many people think they are saving when the reality is they are
investing and there is BIG difference between these too. Finally, I believe it is
important for each of us to spend more time and energy studying planning
options. From a macro economic perspective other issues such as: lost
opportunity costs, the velocity of money, long term tax efficiencies and the
coordination and integration of financial moves must be considered. Those
things go beyond the scope of this article but it is through the consideration
of these things that we can begin to potentially achieve better results with
even less risk than we would if we were depending on ROR.
The next time you hear someone begin to share with you an example
regarding money using some sort of ROR assumption, you will at least
be able to take note and begin to evaluate the scenario from a different
perspective. Based on personal experience it will not take long for you to
observe a situation in which ROR is utilized to justify some future number.
Just turn on the television or radio or pick up some sort of publication.
My guess is you won’t make it through the day without seeing or hearing
something.
Articulator
Fall 2014
31
Metro Denver Dental Society’s
Awards Gala and President’s Dinner
Ellie Caulkins Opera House Lobby
Thursday, January 22, 2015 (Night of the RMDC)
6:30pm – 10:00pm
J
oin MDDS President, Dr. Larry Weddle, at this premier RMDC
social event. Attendees will be dressed to impress for live music,
reception, dinner and society awards ceremony.
Enjoy this unique and fun event for only $72/pp.
You are invited to the~
Thursday. November 6th, 2014
6:30pm - 9:00pm
Donor
AppreciationEvent
Members and Vendors are invited to an evening of food and drinks at the
Mountain West Dental Institute in honor of all our supporters, without
whom the MWDI would not exist. Look for the invitation in the mail.
Denver, CO 80203
Please reply by Monday, November 3, 2014.
mddsdentist.com (303) 488 – 9700
Casino Night
Casino Night
Friday, March 20th, 2015
@
Benefiting the Metro Denver
Dental Foundation
Register Online at MDDSDENTIST.COM
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Real Estate
Dental Space for lease near Southglenn Mall Dental office space
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Dental Office Space Highlands Ranch/Littleton Share space with
specialty practice in high profile dental/medical building 2 days
a week. Highlands Ranch/ Littleton. Reply to danceattack73@
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General Practices for Sale with CTC Associates: Practice listings
along the Front Range in Denver, Arvada, Lakewood, Littleton,
Castle Rock, Colorado Springs, and Fort Collins. Additional
opportunities available in Montrose and throughout the eastern
mountains. We also have opportunities in New Mexico, Utah,
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practice opportunity, go to www.ctc-associates.com or call Larry
Chatterley and Susannah Hazelrigg at (303)795-8800.
Ortho Practice for Sale with CTC Associates: New, beautiful, high
tech, spacious Orthodontic practice for sale in Colorado Springs.
This practice offers private consultation room, large imaging
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Practices for Sale: Listings in Colorado: Denver, Centennial,
Boulder, Arvada, Parker, Colorado Springs, South I-25 corridor,
Central & Western Colorado, Grand Junction and WY & KS.
For more information and listing description(s), please visit our
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Peter Mirabito, D.D.S., Jed Esposito, M.B.A., ADS Precise
Consultants 855-461-0101. Practice Sales, Practice Appraisals,
Partnerships & Buy-In’s.
Announcements & Services
Transition Services with CTC Associates: For more information
on how to sell your practice or bring in an associate, or for
information on buying a practice or associating before a buyin or buy-out please contact Larry Chatterley and Susannah
Hazelrigg at (303)795-8800 or visit our website for practice
transition information and current practice opportunities www.
ctc-associates.com.
Visit mddsdentist.com/classifieds
to place an ad.
We believe Dental Practice Transitions are more than TRANSACTIONAL, they are
TRANSFORMATIONAL
Appraisals
Practice Sales
Buy-Ins or Buy-Outs
Buyer Representation
Post-Transition Coaching
Start-Up Coaching
Associateships
Candidate Matching
Negotiations/Mediation
Practice Management
“
The practice brokerage business is essentially transactional. Our company’s mission is to go further, to be TRANSFORMATIONAL
for our clients and in the industry. Beyond adding value to our services, we understand that success isn’t just about what you
accomplish in your life, it’s about what you inspire others to do with their lives.
Larry Chatterley (Founding Broker)
CTC Associates
Practice Transition Specialists
[email protected]
303-795-8800
”
www.ctc-associates.com
35
At Carr Healthcare Realty…
We provide experienced representation and skilled
negotiating for dentists’ office space needs.
Colin Carr
President
Denver Metro
Whether you are purchasing, relocating, opening a new
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receive some of the most favorable terms and concessions
available.
Every lease or purchase is unique and provides substantial
opportunities on which to capitalize. The slightest
difference in the terms negotiated can impact your practice
by hundreds of thousands of dollars. With this much at
stake, expert representation and skilled negotiating are
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303.817.6654
[email protected]
Roger Hernandez
Colorado Springs
Southern Colorado
If your lease is expiring in the next 12 – 18 months, allow
us to show you how we can help you capitalize on your
next lease or purchase.
Our Services
• Identification and evaluation of desirable properties
• Negotiation of lease rate or purchase price
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• Demographic information
• Assistance with the organization of ground-up
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719.339.9007
[email protected]
ContactPhotos.indd 4
12/12/13 4:56:31 PM
Kevin Schutz
Boulder
Northern Colorado
970.690.5869
[email protected]
ContactPhotos.indd 5
12/12/13 4:56:31 PM
Lease Negotiations • Office Relocations • Lease Renewals • Purchases

MDDS Connections for Metro Denver`s Dental Profession

Transcription

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