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THE NEWSLETTER OF THE MONTEREY BAY DENTAL SOCIETY
SPRING 2015
The Referral
Important Considerations In The Referral Process
Referral Patients In Pediatric Dentistry
The Endodontic Referral
Dental Implant Referral
The Three C’s for Early
Orthodontic Intervention
Referral For
Homebound Patients
—Henry Ford
“
“
Coming together is a beginning; keeping together is progress; working together is success.
A Message From Your Incoming MBDS President
Greetings!
I hope this note finds you well, and you’ve
had a smooth start to 2015.
Firstly, I want to begin by saying what an
incredible honor it is to serve as your President
for this year. I have always been a proud
member of the Monterey Bay Dental Society,
and feel so grateful that I been entrusted with
this important responsibility.
Dentistry is a funny thing sometimes. Occasionally I feel
like I “fell” into the profession, with a random decision to
pursue healthcare in high school. For those of you who
attended our Installation of Officers dinner at Pasadera last
year, you may have had the opportunity to meet my parents,
Barbara and Chuck Sackett. Despite the endless support
they have given me, I’m sure they never envisioned their
son pursuing this particular career path either. After all,
my mother is an elementary school teacher (recently retired!),
and my father is a self-employed landscape contractor.
Still, they provided encouragement, and have now been
able to witness me become the President for my local
component. Thanks to all those who have helped this
journey come to fruition.
This has been an exciting year for the Monterey Bay Dental
Society. We have some new faces on the Board of Directors,
and their presence has helped the society to grow in ways
we couldn’t have predicted. In January, we gathered for yet
another annual Strategic Planning Meeting hosted by our
esteemed facilitator, Gail Grimm. Together, we were able
to come up with a vision for the society, and establish
some short and long-term goals.
Most notably, we are in the midst of expanding the roles of
our County Directors. These doctors will become liaisons
between our members and the Board of
Directors, and help to improve our ongoing
communication. Keep your eyes peeled for
some upcoming correspondence from your
particular County Director, depending on
your practice location. A special thank you
goes out to Drs. Jeanette Kern and Joseph
Robb, who took the lead in making these
changes happen.
Another new face on our Board of Directors is our head of
The Dental Health Committee, Dr. Jennifer Lo. Dr. Lo is a
pediatric dentist in Salinas, and took over the position from
Dr. Julius Kong. Even though she had some big shoes to fill,
she hit the ground running and has done a fantastic job already.
The purpose of this Committee is to coordinate all the Oral
Health Presentations for schools in the three counties that
we represent. Believe it or not, over 2000 children have now
been given oral hygiene and dental education due to the
efforts of Dr. Lo and her team. She is a modest and humble
doctor, but I’d like to take this opportunity to shine some
light upon Dr. Lo, and recognize her energy, efforts and time.
Once again, our Continuing Education program continues
to flourish, and is now being directed by Dr. Arianna
Ebrahimian. She has organized a wonderful lineup of speakers,
and the calendar is sure to include at least one or two
courses that spark your interest. Registration for classes is
easier than ever before, and can be completed on our updated
website. Thanks to Dr. Ebrahimian for keeping our members
engaged and maintaining the MBDS reputation as a
renowned CE venue.
The relationship between the MBDS and CDA remains
sound as well. In November of 2014, we were well attended
at the House of Delegates meeting in San Diego. We will
participate yet again in Sacramento this October, and in
September, we welcome CDA’s Executive Director, Peter
www.mbdsdentist.com I MONTEREY BAY SMILELINE – SPRING 2015
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A Message From Your Incoming MBDS President (Continued)
and help. If you have any suggestions as to
how we can better serve our members, please
feel free to contact either myself, or our
wonderful Executive Director, Debi Diaz.
Dr. Carl Sackett and Dr. Najia Gardezy with their daughter Lena.
DuBois to our Board of Directors meeting. We hope you
find tripartite membership valuable and we will continue
to ensure that MBDS has a strong presence within CDA.
Needless to say, we are practicing dentistry in a fast-paced
and ever-changing world. Dentists have to stay abreast of
the latest advancements in technology, and constantly
need to find ways to help them “stand out” amongst their
colleagues. The Board of Directors acknowledges this
challenge, and we hope the Monterey Bay Dental Society is
a trusted resource for our members to rely on for support
Thank you again for providing me the opportunity to
serve the Monterey Bay Dental Society in this capacity.
Being your President is something I could have never
imagined or foreseen, and you can rest assured I will do
all I can to make the Society even better.
Warm Regards,
Charles “Carl” Sackett, DDS
President, MBDS
The leaders who work most effectively, it seems to me, never say ‘I.’
And that’s not because they have trained themselves not to say ‘I.’ They don’t
think ‘I.’ They think ‘we’; they think ‘team.’ They understand their job to be
to make the team function. They accept responsibility and don’t sidestep it,
“
“
We are always looking for enthusiastic
individuals to help on our Board of Directors
too. I have enjoyed being in this leadership
role, and it has enriched my career in more
ways than one. By giving back to the
community in this manner, we can foster
goodwill amongst our peers and bring
personal fulfillment in our own lives.
Through my time on the Board, I have
truly found that it is in giving that we
receive. So, if you have any inkling to join
the Board of Directors, we would love to
speak with you further. In fact, your County Director
might be the perfect person to contact!
but ‘we’ gets the credit.... This is what creates trust, what enables you to get
the task done.
― Peter Drucker
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Table Of Contents
SmileLine
A Message From The
Incoming President........................................... 2
Table of Contents ....................................................... 4
New Members............................................................. 5
The Newsletter of The
Monterey Bay Dental Society
Published By
8 Harris Court, #A2, Monterey, CA 93940
(831) 658-0168
www.mbdsdentist.com
Editor
Lloyd Nattkemper, DDS
Advertising and
Continuing Education Content
Debi Diaz, Executive Director
Design and Production
Upcoming MBDS Calendar of Events for 2015........... 6
Editor’s Column .......................................................... 7
Outgoing and Incoming Board Members................... 9
CDA Leader Elected ADA President-Elect.................10
Be The Oxygen That Keeps CDA Fires Burning.........13
Important Considerations In The
Referral Process.............................................. 16
Referrals in Dentistry................................................ 18
You Can Help Cabrillo Hygiene Students—
And Your Patients At The Same Time! ........... 21
Heidi Heath Garwood
www.heathdesign.com
Referral patients In Pediatric Dentistry....................22
Cover photo
Guatemala Medical/Dental Mission Trip 2014 ........ 25
Parting Shot photo
The Endodontic Referral .......................................... 29
Dental Implant Referral ............................................30
Officer Installation Night, 2014................................. 35
Understanding Dental Fear In Children—
And When A Referral Is Appropriate.............. 37
©2015—This newsletter solicits and will publish,
space permitting, signed articles relating to
dentistry but willassume no responsibility for the
opinions or validity of the theories contained
therein. Subscription rate for non-MBDS
members is $15.00 per year. Acceptance of
advertisements in no way constitutes
professional endorsement by the MBDS.
This publication is printed by Sir Speedy,
Monterey, CA 93940.
The Three C’s for Early
Orthodontic Intervention ................................39
A Wonderful Referral For Homebound Patients....... 43
Classifieds................................................................. 47
Parting Shot............................................................... 50
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Welcome To Our New Members
APTOS
Jason Drew, DDS
783 Rio Del Mar Blvd
Aptos, CA 95003-4771
(831) 688-6060
MONTEREY
Wael Alfy, DDS
121 Fairground Rd.
Monterey, CA 93940
(831) 373-0681
James Barnes, DDS
831 Cass St.
Monterey, CA 93940
(831) 373-1279
Robert Chatterton, DDS
333 El Dorado St
Monterey, CA 93940
(831) 373-3068
PACIFIC GROVE
SOQUEL
Sarah Frahm, DDS
1121 Seaview Ave
Pacific Grove, CA 93950-5211
(785) 320-0282
SALINAS
Vasavi Chinnam, DDS
2840 Park Ave, Suite B
Soquel, CA 95073-2866
(831) 688-0555
WATSONVILLE
Irving Chao, DDS
1107 Los Palos Dr Ste 4
Salinas, CA 93901-3861
(831) 424-1535
Jason Cook, DDS
36 Aspen Way
Watsonville, CA 95076
(831) 729-2266
Aparnavalli Nayudu, DDS
1089 S Main St
(831) 757-7504
Huyen Nguyen, DDS
Salud Para La Gente
204 E Beach St
Watsonville, CA 95076
(831) 728-0222
Dhaval Patel, DDS
620 E Alvin Dr Ste F
(831) 449-2276
We encourage old members to reach out and welcome our new members if they have
not done so already. We are excited and happy to have them join us!
MBDS Board Room available
Members can now utilize the board room at the dental society for a small fee to host study groups,
meetings or staff events. For more information, contact the Dental Society at 831-658-0168
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Upcoming MBDS Calendar of Events for 2015
Continuing Education 2014
Friday, June 5th, 2015
John West, DDS, MS
Building Your Practice through Endodontics:
“The Secrets of Predictability, Safety and Efficiency”
Embassy Suites, Seaside, CA 93955
9 AM – 5 PM
7 CE Units (Core-80%)
Member Dentists $280
Non-CDA members $380
Auxiliary $130
Friday, September 18, 2015
Doug Young, DDS
“Minimally Invasive Dentistry”
Embassy Suites, Seaside, CA 93955
9 AM – 5 PM
7 CE Units (Core-80%)
Auxiliary $130
Friday, November 13, 2015
Paul Homoly, DDS
“Case Acceptance for Everyday Dentistry – a non-sales
approach to a healthier practice”
Hyatt Regency Monterey
9 AM – 3 PM
5 CE Units (Non-Core-20%)
Auxiliary $130
REGISTRATION FEES —Fees include lunch
Thursday, July 16th, 2015
Speaker TBA
“Emergency Preparedness”
6:00 PM • Seacliff Inn – Seacliff Room, Aptos, CA
Thursday, October 8th, 2015
Michael Perry, DDS
“Models of Dental Practice” (2 CE units – 20%)
6:00 PM • TBA
Friday, November 20th, 2015
Installation of Officers
7:00 PM • Chaminade Resort & Spa
Santa Cruz, CA. 95065
MBDS Board Of Director’s Meetings
6:00 PM
Dental Society Office,
8 Harris Ct, A2, Monterey
Tuesday, January 13, 2015
Tuesday, March 10, 2015
Tuesday, May 12, 2015
Tuesday, July 14, 2015
Tuesday, September 8, 2015
Tuesday, November 10, 2015
2015 CDA House of Delegates –
Sacramento, CA
June 19, 2015 — Special HOD
General Membership Dinner Meetings
Hyatt Regency, Sacramento
Thursday, May 14th, 2015
Leslie Canham
“HIPAA” (2 CE units – Core)
6:00 PM • Bayonet Blackhorse, Monterey, CA
Friday, October 16th - Sunday, October 18th, 2015 –
Hyatt Regency, Sacramento
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Editor’s Column
Lloyd Nattkemper, DDS,
Editor
The Referral
My Uncle John and his brother—my dad—grew up in Vallejo
during the late 1920’s and the Great Depression. Vallejo, and
the neighborhood where they lived, wasn’t a nice place to
grow up. Times were tough, even for two boys who were
equally tough and hard working. In spite of various boxing
matches and impromptu fistfights, Dad was apparently immune to dental problems (to my horror, I learned later on he
never flossed and consistently used “extra firm” toothbrushes
he replaced once every year or two!) Uncle John always
seemed to have tooth issues though, from when he was a kid
on through old age. When I took BART over to Walnut
Creek during dental school for weekend visits–John had settled there as a school teacher in the ‘60s–he and I would go on
walks and he would tell me stories. A lot of them were about
experiences he had at the dentist. Some were good to hear—
how his dentist after the War had made a beautiful bridge—
take a look, here, lower right—back in 1948 and it was still
there, all gold—he was proud of it. Some stories weren’t so
great. How he went two weeks in severe pain in high school
after his dentist broke a tooth off trying to get it out and John
ended up in an emergency room with so much swelling he
couldn’t open his mouth. Or at the beginning of World
Dental office circa 1948.
War II, having twelve fillings done in just over an hour by a
youngster he was positive wasn’t a real
dentist—and who wasn’t much good at anesthesia. One of the
root canals his dentist did—the one who had done the nice
bridge—never simmered down. His dentist swore everything
looked just fine and suggested John had some sort of
psychological problem—gave him some Valium to take
when it bothered him. There was the time his precious
daughter had a wisdom tooth abscess. John’s dentist (this
was a different one, years later) took it out ok, and Andree
healed. But the experience was so frightening to her and so
painful—he never really got her numb—that she refused to
go to a dentist until I was in dental school and she was
suffering from giant cell “pregnancy” granulomas in her
mouth (she saw me as a third year dental student). John
asked me a number of times over the years for reassurance—
that I wouldn’t be like some of those dentists. That I wouldn’t
do stuff to my patients if I didn’t really know what I was
doing. That I would listen to them if they said there was
something wrong.
Yet anyone who does dentistry, who understands the breadth
and depth of this profession, respects and appreciates the true
general dentist. Someone who can handle anything, who is
there for their patients 24/7 and can just as deftly perform a
molar RCT as fabricate a complex implant-retained hybrid
RPD. Or place the implants in the first place—in spite of sinus
proximity or a history of chronic periodontitis. In the past
several years there have been distinct, relatively sweeping
changes in dentistry. Literally hundreds, perhaps thousands
of courses all over the world are now offered for any dentist—
general practitioner or specialist—in almost any aspect of
surgical, rehabilitative, restorative and prosthetic care. And it is
more than clear that economic shifts (as well as information
on the Internet) have brought changes in when patients seek
care, what they are seeking, and who they seek care with.
All of this has meant shifts in the scope of what many general
dentists are doing in their practices, in the relationships among
general dentists and specialists, and in the scope of what
specialists are doing in their practices as well.
With all of this in mind, patients continue to depend upon
us—treating dentists and specialists—to provide what is in
their best interest. Exactly what is “in their best interest”
is about as subjective a concept as you might ever try to
fathom—we have to consider affordability of treatment
options, patient compliance and tolerance of treatment, the
patient’s “dental I.Q.”, their age and dental history, their life
expectancy, even their oral hygiene When we graduated from
dental school, every one of us—and our colleagues graduating
from medical school—took the Hippocratic Oath. Its core
principle—First Do No Harm—cannot be misconstrued.
It was with Hippocrates’ principle and Uncle John’s request in
mind that this edition of the MBDS SmileLine was conceived.
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Editor’s Column (Continued)
What follows in the next few pages
should offer some valuable insights
in helping determine whether you’re
capable, desirous, and fully suited to
treat a patient who presents with a
problem you don’t routinely manage.
Such as; a 5-year-old, uncooperative and
acting out because their brother told
them the dentist is scary, a 42-year-old
physician suffering from a “hot tooth”
that happens to be a maxillary first molar
with sharply curved roots, a cowboy who
hasn’t seen a dentist in 10 years and has
Joe Grenn, DMD and I at his favorite restaurant in Marin County. Joe is an endodontist, educator, athlete and
artist – and a friend and mentor to me for 30 years.
so much calculus, actively bleeding
gingiva and debris you can’t really see his
to provide recommendations based on their own experience,
teeth, or a recently retired schoolteacher with a tooth that
in regard to a specific aspect of the referral process. You will
looks normal clinically and radiographically, tests vital, isn’t
read a periodontist’s guide to making a great implant referral.
cracked, but is keeping her up at night and is too tender to
An RDHAP’s description of what she does, why she does it
chew with. And you might learn a few “pearls” – what
and the specific niche she and her colleagues in our community
patterns of eruption to look for as kids grow up that could
fill: I guarantee you will be impressed. And, you’ll read a
lead to orthodontic problems, what sorts of questions to ask
young general dentist’s insightful guide in selecting who the
that 5-year-old’s folks to help figure out if it’s worth a try on
best specialist is for each individual patient. I have done my
your own, who you could suggest for helping continue mainbest to keep everything you will read “neutral” to avoid
tenance care for the 89-year-old NPS professor who can no
spotlighting any individual practice and instead have
longer come into your office. The level of trust and liking
encouraged the authors to focus on, you guessed it, what
colleagues have for one another can ease decisions and help
is “in the patient’s best interest.” Unfortunately, not all
make everyone’s (I’m talking about you and your staff’s, as
specialties are represented. People are busy, and in spite of
well as your patients’) lives better. Trust—developed through
gentle requests and reminders some colleagues just couldn’t
experience—patients who have been thoughtfully and
get to it. But I hope this SmileLine edition will serve as a
professionally cared for and who “report back” positively
conversation point, and that through those conversations,
on their referral. Liking—nurtured through consistent, timely,
our patients–your patients–will receive the best care possible.
concise but thorough communication, and a coordination of
philosophies and treatment plans.
Don’t miss reading the fine articles by Geri Menold, who will
be stepping down from her tenure as State Trustee this year,
Each author in this edition is one of your professional
and David Stein, recently retired and who long served on the
colleagues, right here in our dental component. I asked each
MBDS Board, most recently
on Peer Review. These two
people are still very involved in
service—to you, to patients,
to others.
Pretty inspiring.
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Monterey Bay Dental Society Board of Directors
Thanks to our Outgoing Board of Directors — Nov 2013 - Nov 2014
President
President-Elect
Vice President
Secretary/Treasurer
State Trustee
Immediate Past President
County Directors
Publications
Legislative and Cal D Pac
Dental Health Committee
Ethics Committee
Peer Review Committee
New Dentist Committee
Membership Committee
Continuing Education Committee
Tim Griffin, DDS
Carl Sackett, DDS
Ariana Ebrahimian, DDS
Mona Goel, DDS
Geralyn Menold, DDS
Daniel Pierre, DDS
Drs. Eric Brown, John Chan, Julius Kong,
Adriana Lalinde, John Stevens
Nannette Benedict, DDS
Julius Kong, DDS
David Shin, DDS
Richard Kent, DDS and James Leamey
Garrett Criswell, DDS
Carl Sackett, DDS
And Welcome to Our Incoming Board of Directors — 2015
President
President-Elect
Vice President
Secretary/Treasurer
State Trustee
Immediate Past President
County Directors
Publications
Legislative and Cal D Pac
Dental Health Committee
Community & Public Relations
Ethics Committee
Peer Review Committee
New Dentist Committee
Membership Committee
Continuing Education Committee
Carl Sackett, DDS
Richard Kent, DDS
Eric Brown, DDS
Geralyn Menold, DDS
Tim Griffin, DDS
Drs. John Chan, Ryan Payne, Jeanette Kern,
Rajneesh Dail, Adriana Lalinde, Joseph Robb,
Mark Ebrahimian & Noreen Yoshida
Nannette Benedict, DDS
Jennifer Lo, DDS
Drs. Lindley Zerbe & Eric Brown
David Shin, DDS
James Leamey, DDS
Garrett Criswell, DDS
Richard Kent, DDS
Arianna Ebrahimian DDS
9
CDA Leader Elected ADA President-Elect
Carol Summerhays, DDS, a general dentist
who practices in San Diego, has been elected
president-elect of the ADA.
Summerhays has held numerous ADA
leadership positions and has served on various
committees, including strategic planning,
compensation, governance, government affairs
and new dentist. She also served as CDA
president in 2009 and held many positions on
CDA committees and councils, including the
CDA Presents Board of Managers, and was
chair of the CDA Foundation Board of Advisors
and its initial comprehensive campaign that raised $24
million in contributions and commitments.
“I am honored to have been elected as ADA president-elect,’
said Summerhays, who has also served as the ADA Thirteenth
District trustee. “There are many challenges facing our
profession today. This opportunity that my colleagues in
California and across the nation have given me will allow
me to advocate for dentistry and the patients we serve.”
Summerhays acknowledges that the profession
is in an era of rapid and significant change with
record-high dental student debt, the impact
of the Affordable Care Act, various new
workforce models and more.
“This is a time for action and positive results,”
Summerhays said. “Unity and resolve throughout the Tripartite will move us forward to
meet all challenges, strengthen the profession
and support member hopes and dreams.”
Summerhays is a graduate of the USC
Ostrow School of Dentistry and is a member of the
American College of Dentists, Academy of General
Dentistry, American Association of Women Dentists,
Hispanic Dental Association and the Pankey Institute.
She and her husband, Soames, live in San Diego and
have two sons, Giles and Bryce.
Summerhays succeeds Maxine Feinberg, DDS, as ADA
president and will be installed at the ADA House next fall.
10
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Please Help Our Dental Community And These Students With
An Opportunity That Could Change Their Lives!
The MPC Dental Assisting Program is looking for great dental offices to send students
to for the last leg of the program. We are looking for offices willing to train and
mentor these highly trained and motivated students who will be graduating on
Thursday, May 28. Without externship experience these students will not be able
to graduate, this is a much needed and integral part of their training.
The criteria is as follows; it must be a general practice, no specialties, there must
be at least one RDA working to help mentor the student and the office has to be
willing to allow the student to get hands-on experience with all aspects of the
dental practice, including front office, chairside assisting, sterilization and any other
aspect your office has to offer. These students, because they are going through an
RDA approved program can do all Dental Board of California RDA approved functions.
Externship dates:
Monday, April 6 – Thursday,
May 28, 2015, Monday – Thursday,
(whatever hours your office is open)
If your office would like to help our students please contact:
Karoline Grasmuck, RDA, CDA, CPFDA (831) 646-4137 • [email protected]
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Be The Oxygen That Keeps CDA Fires Burning
Dr. Geralyn Menold, DDS
MBDS Trustee
“For the gem of any idea to spark and then ignite, it takes
a lot of oxygen to make it burn. In CDA, only membership
can provide that oxygen. There is no limit to what this
association can do. That oxygen will always be there.”
(Curley, Douglas. Telling It Like Gaynor Sees It. CDA
Journal, July 1977, Vol. 25, No. 6.)
It is with immense gratitude and sadness that I begin my
final year as your trustee. My journey as a member of the
Monterey Bay Dental Society began in 1986 as the only
female dental specialist in the tri-county area. I was informed
of this fact by Carole Hart, who welcomed me into the
society and became a good friend and mentor. I had the
good fortune to continue on to be the first woman president
of the MBDS, as well as the first woman trustee from this
component (both positions also as the first member dentist
practicing in San Benito County).
As a specialist, I have had the opportunity to meet with
many of our members in all three counties of the Monterey
Bay Dental Society. I have also had the pleasure of meeting
many of your patients who you have loaned to me through
referrals for orthodontic treatment. This is a unique opportunity for me to see many young people grow and mature.
I see them years later in unexpected places as they pursue
jobs and careers in the surrounding communities. I am
proud to have been an important influence in their lives
and in the growth of their self-esteem through the selfconfidence that having a beautiful smile can bring.
This past year, I had the rare privilege of working with the
13th District delegation at the ADA House of Delegates in
San Antonio to ensure the election of the incredible Carol
Gomez Summerhays as President-elect of the ADA, the
first woman dentist from California to be elected to that
position. Anyone who knows Carol knows that she is an
inspirational leader and remarkable human being. I can’t
think of anyone more conscientious to lead the profession!
The ADA House of Delegates was followed by the CDA
House of Delegates where another major event occurred.
A landmark decision was made to move forward with
the business plan for a Management Services Organization
or MSO, The Dentists Service Company (TDSC). If and
Three First Ladies: (LEFT) Geralyn Menold, DDS—First Female MBDS President, First Female MBDS Dental Specialist, First Female San Benito County
Dentist, First Female MBDS Trustee. (MIDDLE) Carol Summerhays, DDS—First (future) Female ADA President from California. (RIGHT) Debra Finney, DDS
First Female CDA President
13
(Continued)
when this new subsidiary is created, it will provide specific
services directly to CDA members at a savings. This has the
potential to rival the success and advantage for membership
that TDIC has provided since its creation in 1980. I was in
my postdoctoral orthodontic program when my classmates,
along with other California dentists, found themselves in
the midst of an overwhelming rise in professional liability
insurance rates. CDA members who chose to participate
advanced money to form TDIC and the rest is history.
This money was returned to the contributing members
and dividends are paid to policyholders on an annual basis.
I had the honor of working with Dr. J. David Gaynor, the
proud owner of TDIC policy #1, on the TDCIS board
(now TDIC Insurance Solutions) following my year as president of the MBDS (1994-95).
I have had and continue to have some amazing experiences
both here in the local component and at CDA on the
state level. One exceptional opportunity that all members
should experience is CDA Cares. This event—there have
now been six of them— is largely responsible for the
reinstatement of some adult Denti-Cal benefits. If you
haven’t participated yet in one of these events—or if you
have—I strongly encourage you to sign up and be part of
this fantastic experience. You won’t regret it!
I encourage all of you as fellow members of the Monterey
Bay Dental Society to consider getting involved as a
volunteer leader either with the local MBDS Component
as a board or committee member, or at the CDA level in
John and I were Olympic torchbearers in 2002
14
(Continued)
Sacramento. You can call Debi at the office in Monterey
or speak with a board member if you have an interest in
joining a committee or representing your local area.
Leadership applications for CDA positions are available
online and the due date for the 2016-2017 year is
May 31st. You can contact me if you need guidance
about the application process or the positions available.
There are also ADA positions which can be applied for,
usually by about the end of February.
You are the oxygen that keeps the association going!
Geralyn Menold, DDS
Dr. Menold attended the UCLA School of Dentistry
and completed her orthodontic residency at the
University of Connecticut School of Dental Medicine.
She is married (John) with 3 adult children. John
and Dr. Menold were olympic torchbearers in 2002.
15
In Ecuador on an IHE trip, 2014
Jeffrey Ryan Lehr, DDS
It seems quite simple. When a patient is in need of a procedure that requires the expertise of a specialist, shouldn’t
the general dentist just refer to the best specialist in town?
However, as a general dentist who wants the best treatment
and results for the patient, the answer isn’t always so simple.
When referring a patient to a specialist, the general dentist is forced to answer the question: Who is the best? Is
it the specialist who is best procedurally? Is it the specialist who is best at communicating with patients? Or is it
the one who is best at communicating with the general
dentist? There are no clear-cut answers, and rarely will
any specialist encompass all of these characteristics. So,
how does the general dentist, who has been trusted by
the patient as the advisor, decide where the patient
should seek treatment?
Once general dentists establish a trusted community of
colleagues to which they feel comfortable referring, there
are several important factors that must be taken into
account when determining which specialist will be the
best fit for each specific patient. One important factor
to consider is the patient’s understanding for the referral.
If the patient has a good understanding of the procedure
or procedures involved, and feels comfortable with the
process, the availability and experience of the specialist
become deciding factors. However, if the patient is apt
to need careful explanation and education about the
procedure or course of therapy, the general dentist
will need to consider referring to a specialist with a
compassionate nature and willingness to spend time
educating the patient.
The specialist’s ability to communicate effectively with
both the patient and the general dentist must also be
considered. Some patient referrals will require constant
communication between offices, such as periodontal or
multi-disciplinary cosmetic procedures. In these cases, it
is important that the specialist’s office be able to
reliably communicate the patient’s progress with the
general dentist.
In addition, the emotional needs of the patient must also
be considered. One very obvious consideration is the
patient’s ability—and their willingness—to invest time
and money in their oral health. The general dentist must
ensure that the patient’s overall expectations for service
will be met, including the caliber of the specialist’s staff,
office environment, and customer service. Finally, the
general dentist should also make an effort to match
16
(Continued)
the personality of the specialist and patient. While this
consideration may seem trivial, patients are most likely
to comply with recommended treatments if their emotional
needs are met by the specialist they are referred to.
General dentists tailor each treatment plan to the needs
and desires of the patient, much the same way as they
choose a specialist that is the best fit for the procedure.
As a dentist in a community with many talented and
trusted colleagues, I am grateful to have the luxury of
considering all of these factors and being able to ensure my
patients receive the most comprehensive care available.
Ryan Lehr, DDS
Ryan Lehr, D.D.S., received his degree from
Creighton University School of Dentistry. He has
been in private practice for 3 years and has joined a
group of dentists at the Monterey Peninsula Dental
Group who have served as great mentors for him.
A Monterey native, Dr. Lehr completed B.S. in Finance
at Santa Clara University before heading to work on
the trading floors in New York City and in private
banking in San Francisco. Dr. Lehr then decided to
pursue his lifelong dream of becoming a dentist.
Dr. Lehr is an avid golfer, tennis player, skier and
runner. For Dr. Lehr, being able to form lasting
relationships with patients and follow in his father’s
footsteps of serving the Monterey Peninsula is a
dream come true.
17
Referrals in Dentistry
Karl Brose, DDS
We all have our zones of treatment
comfort. Step out of these zones
and it is in the best interest of
patient care to refer to someone
who treats that area as a specialty,
or has taken the time to become
educated to a greater degree.
For example, would you do the
dentistry in question on your wife?
Or would you be more comfortable
referring to a specialist?
These comfort zones could be as
simple as avoiding an extraction or
as complex as bone grafting, but
one of the most demanding for me
has been the perio referral. Here, I’m assuming we are
not talking about the straight forward referrals such as
the new patient with rows of 6mm+ pockets, or lack of
gingival attachment, or a case of gummy smile etc, etc.
But rather one of the many patients on whom we have
attempted to treat their perio concerns; people we have a
vested interest in becoming healthy, but instead are still
unhealthy with unreachable pockets and/or poor
hygiene. We must now ask the specialist for help.
The specialist referral now takes on a list of questions.
How good at communication are the specialist and
his/her team? How will they approach our mutual
patient? Does our office use the same precise phrases or
words so that the patient knows what to expect of their
visit? Without this similarity, the patient may feel
insecure or even threatened. Are we on the same page
as the specialist?
This implies that our office knows how the specialist’s
office runs, and vice versa. If not, then the final result
will not look good in the public eye.
Our office staff’s comfort level making this referral
is also a concern. Nothing speaks more highly of a
successful referral than having our entire staff completely
behind the exchange of patient care. And nothing will
kill a referral quicker than staff
member’s comments that don’t
back the doctor’s referral.
When positive, these comments
called ‘co-flows’ (from David
Smith’s consultation), come from
the two doctors sharing their
mutual respect with their staff
members. If both office teams
know each other well, then the
correct, positive comments come
out unforced and natural; an
occurrence that is immediately
picked up by the patient.
This type of co-flow should
happen often. Take for example
an endo referral that may not be
successful due to hyper-calcified canals. If the referring
doctor does not warn the patient ahead of time, then the
specialist may look like the bad guy when an extraction
is necessary. Or at the very least the referring doctor
looks a little sketchy not being aware of this limitation
to endodontic therapy.
It becomes a matter of both offices having high quality
communications and alert, constant focus on how the
‘play’ of a solid referral works. This makes each party
mutually responsible for a good outcome.
During my 42 years, referring to specialists has been
predicated on a shared knowledge of the ‘gold nuggets’
we each have garnered through those years of experience.
These ‘nuggets’ are what I share with my referrals. These
specialists have been my go to ‘Gordon Christensen’s of
nuggets’; teaching me how to use referrals correctly and
making our mutual treatments smooth and successful.
The dentists on the next page are a short list of the
many people who gave me support and the experienced
‘know-how’ to deal with the subtle quirks of referring.
Without them it would have been more mystery than
science, more struggle than pleasure, and a lot more dull.
These professionals are the color in my professional life.
18
Referrals in Dentistry
(Continued)
My local (and cherished) periodontal, endodontic, orthodontic and oral surgical colleagues—
your ongoing support, guidance and the
outstanding care you provide for patients
I refer is exceptional and deeply appreciated!
I will always be indebted to the guidance and
superb examples provided by:
• Bob Christoffersen and the rest of the Arthur Dugoni
U.O.P. Dental School colleagues: the basics of
clinical excellence.
• USAF: 2 years- patients without the overhead hassle,
speed, smoothness, order, lots of TDY courses.
• Dr. Bob Millslagle (Retired general dentist): 20 years
of a close working relationship, very professional with
his referrals- finally my edges are getting smoother,
thank you Bob.
• Dr. Bob Minor (Retired endodontist): Gave it his all,
great philosophy- we made an uber team and have a
super friendship.
• Dr. Ben Benson (Retired general dentist): The original
character, sense of life’s fun, great leader (study clubs
etc.), good common sense, kept our feet on the ground.
• Dr. Carl Misch: Best of the best implant teachers,
wrote the book; he gave me basics for implant
care and referrals.
In conclusion, the more you know about your referral
offices and the overall dental picture, the more successful
you will be. Patients will return with positive tales and
stories of their treatment. You will gain more new
patients, sleep easier and may even find these referral
specialists at the top of your list of friends.
• Dr. Joe Bigas (Retired endodontist): The big picture,
how root canal systems react to dental procedures;
a great friend.
19
20
You Can Help Cabrillo Hygiene Students—And Your Patients At The Same Time!
The Cabrillo College Dental Hygiene Class of 2015
will be taking their boards in June. Some students already have patients lined up. Most of them don’t.
They are working hard to find qualifying patients and
have reached out to the MBDS membership for help.
If you think you may have patients in your practice
who might qualify–especially patients who have
financial limitations–pass this information on!
Here are the requirements:
While not prohibited, CRDTS strongly discourages the
submission of TEETH in the Treatment Selection which
include any of the following:
Teeth
Minimum of 6 teeth to a maximum of 10 teeth with no
more than 3 being anterior teeth (anterior teeth = canines
and/or incisors)
Qualifying Calculus
A qualifying deposit of calculus is defined as explorer detectable subgingival calculus which is DISTINCT, OBVIOUS and can be EASILY detected with a #11/12
explorer as it passes over the calculus.
-Qualifying deposits of calculus must be apical to the
gingival margin (subgingival) and may occur with or
without associated supragingival deposits.
For purposes of anesthesia it is recommended that the
teeth selected be as contiguous as possible
Qualifying Calculus
At least 1 surface of qualifying subgingival calculus on a
minimum of 6 teeth At least 12 surfaces of qualifying
subgingival calculus
At least 8 of the 12qualifying surfaces must be on posterior teeth (posterior teeth = molars and/or premolars)
At least 3 of the 8 posterior qualifying surfaces must be
on molar(s)
There is no requirement for any of the 12 surfaces to be
on anterior teeth but if chosen, no more than 4 of the 12
surfaces can be on anterior teeth
-Gross caries
-Faulty restorations
-Extensive full or partial veneer crowns -Multiple
probing depths in excess of 6 mm
The exam will be held June.5-7. If the patient qualifies
we will pay them $250 dollars for each quad that is
used over that weekend. According to Heidi Iniguez,
the Cabrillo DH Senior who is coordinating patient
screenings, “the sooner we can identify the patients,
the better.”
Triage for board pts is held Tuesday and Saturday
from 1-3:45. Heidi encourages anyone that can’t
make those hours to call regardless to see if there is
a way to fit them in.
The Cabrillo College Dental Hygiene Clinic can be
reached at (831) 479-6431.
Treatment Selection Prohibitions
CRDTS prohibits the submission of TEETH in the
Treatment Selection which include any of the following:
Grade III mobility
Grade III or IV furcations
Orthodontic and/or Invisalign brackets, buttons and/or
bonded retainer Implants Partially erupted teeth Retained deciduous teeth
One additional way you can help Cabrillo students
and needy patients: if you have pediatric patients in
need of care—exams, hygiene instruction, x-rays
and cleanings—Cabrillo is looking for patients!
They have Pedo clinics every Saturday from 8 to 12.
$10 for exam, $40 cleaning and $20 BWX.
What a bargain!
21
Referral Patients In Pediatric Dentistry
Kenji Saisho MD DDS
Central Coast Pediatric Dental Group
In the world of pediatric dentistry, referral patients often
can be categorized in three or four sections: complicated
patients, complicated parents, large treatment plans.
They almost always are referred for sedation dentistry
for the aforementioned reasons.
This evolved into a series of seminars; those interviews,
along with her previous research, led to her book. Her
work revolutionized how the medical field took care of
the terminally ill. Her five stages of grief have now become widely accepted
Within these three categories lie a wide range of
clinical experiences, from very young patients who
are precooperative, to teenagers who are just not
cooperative, to special needs patients who don’t
know what it means to be cooperative. Obesity, asthma,
ADHD, autism, and diabetes further complicate the
clinical picture in patients requiring sedation dentistry.
Complicated parents, that just about says it all. They are
present in everyone’s dental practice, it just feels like they
are more concentrated in a pediatric dental practice.
Large treatment plans or plans including treatment
which is not in the daily armamentarium of general
dentists may include pulpotomies, stainless steel
crowns on primary or permanent teeth, the ever so
undesirable anterior stainless steel crowns, or the
newer zirconia crowns.
They come in with parents, grandparents, foster parents,
and with friends of parents. Patients come in with social
workers, therapists, and truant officers.
Parents come in with widely (and oftentimes wildly)
different beliefs about dental care. They can be
categorized by all of the different stages of the
Kübler-Ross model of grief.
The Kübler-Ross model, commonly known as The Five
Stages of Grief, is an hypothesis first introduced by
Elisabeth Kübler-Ross in her book On Death and Dying,
which was inspired by her work with terminally ill
patients. Kubler-Ross was inspired by the lack of
curriculum in medical schools that addressed death
and dying, so she started a project about death when
she became an instructor at the University of Chicago
Medical School.
Kenji Saisho, MD DDS
Kenji Saisho is a partner at Central Coast
Pediatric Dental Group. He attended medical
school at the Chicago Medical School in North
Chicago, IL and is board certified in family
medicine. After ten years of clinical (medical)
practice in Salinas, he attended UOP Dental
School, graduating in 2003,and has been working
at CCPDG since that time. He has four dogs, and
also has interests in golf, cars, and cooking.
22
Referral patients In Pediatric Dentistry
(Continued)
The five stages of grief can also parallel other social
situations of loss. Wikipedia cites grieving in divorce,
substance abuse, and lost relationships as examples.
Dealing with dental caries is similar in many respects
DENIAL:”But (s)he isn’t having any pain.” “(S)he
can’t have cavities on all of those teeth!”
The third stage involves a hope that the dentistry can be
avoided through bargaining.
During this time patients/parents will try to bargain
with doctors. Composites instead of amalgams,fillings
instead of crowns, treatment instead of extraction, four
visits instead of sedation dentistry,
DEPRESSION:”What’s the point of fixing these teeth?”
One of the first reactions seen with a diagnosis of
dental caries or other dental disorders is denial, in
which the patient or parent imagines what is referred
to as a false, preferable reality. No cavities, no need to
brush or floss, no need to stay away from candies or
soda, no problem, right?
ANGER: “This can’t be true!” “How did this happen?”
“Who is to blame?”
After denial comes anger. Especially in today’s society,
people feel a need to blame someone else for their
predicament. Other family members, ex-spouses, and
the dentist make good scapegoats.
BARGAINING: “Aren’t they just baby teeth?”
“Can’t we let them just fall out?” “Can’t we just do
fillings instead of crowns?”
ACCEPTANCE: “Okay, how do we fix this?”
In this last stage, patients and parents move past
the other stages and accept the diagnosis/condition.
Unfortunately, at times admitting the existence of
the problem does not mean the same as accepting
and resolving the problem.
Referral patients present to our office for their first visit
in all of these stages of grief. Often still in denial there
is a problem, the presence of visible decay and pain may
not be evident. Recognizing the stages of grief and
loss/emotions is helpful in addressing the needs of the
referral patient and their family.
“
Adults are just outdated children.
― Dr. Seuss
“
“
“
During the fourth stage, the parent or patient (with
older patients) becomes saddened by the thought of
their dental situation. Unlike the initial application of
the Kübler-Ross model of grieving with death and dying,
depression in the dental model of the Kubler-Ross model
is not nearly so grim.
The more that you read, the more things you will know.
The more things you learn, the more places you’lll go.
― Dr. Seuss
23
24
Guatemala Medical/Dental Mission Trip 2014
Dave Stein, DDS
I have always wanted to go on a medical/dental mission
trip but because of having a solo private practice with
staff that need to work and earn a living I just couldn’t
make that work. I sold my practice January 1, 2014 and
free from the rigors of private practice I was able to go
on what I hope will be my first of many mission trips.
teams, 2 dentists , as well as support staff for all areas
and a kitchen team to insure the quality of the food we
ate, which was superb. There were a total of 84 on the
team from the U.S. not including the individuals based in
Guatemala with Helps International. Helps provided
translators most of whom were local high school students
from a private school as well as some other local adults
who spoke a different language altogether called Quiche.
I got connected with this group through my daughter
who was a surgical intensive nurse in San Diego.
The local organization there, Iaomai, teams with a
larger organization known as Helps
International who is based in
Guatemala. Iaomai, from San Diego,
has sent teams at least once a year
since 2009 to Guatemala to do
medical work including surgeries,
medical clinics, dental clinic as well
as a stove team to install stoves in
the homes (huts) of the local people.
The team this year consisted of 5
surgeons,24 nurses , 2 pharmacists,
4 anesthesiologists , 5 medical clinic
Our work site was 85 miles north of Guatemala City
which took a 2 1/2 hour bus ride on a well paved but
winding road to a very nice compound used as a local
meeting site. Once we arrived on
site the team got busy that Sunday
transforming the buildings and rooms
into an amazing hospital, medical
clinic, and dental clinic complete with
portable dental units that allowed us
to provide restorative care for the
local people as well as extractions.
I was looking for just such a group to
go with that had established sites,
provided the equipment and supplies
so I could go and focus on providing
25
care rather than being
concerned with the logistics.
Because of their experience
with travel, customs, immigration and transportation
were all taken care of for us
and was flawless.
There were 5 operating
rooms where surgeries
from cleft palate/lip repair,
hysterectomies, hernia
repair, and such were
provided at no cost to the
local people. Some travelled as far as a 7 hour walk to
seek care. When we arrived, the team was greeted by
hundreds of individuals some of who had been standing
in line for days camped out at night waiting for the
chance to be seen by the American team of doctors.
Once off the bus I turned to my left and was greeted by
the throng of Guatemalans who began to applaud for us.
We hadn’t done anything for them yet but still they were
so grateful we had given our time and talent to come
help them. I still get goose bumps remembering that
reception and the smiles on their faces. Worth every
sacrifice to get there!
Since there were only two dentists on the team, Chris
Henninger DMD, from San Diego, and I took different
rooms and Chris did extractions the first two days and I
did restorative—then we switched for the next two days.
The dental units that were provided had maybe been
used maybe once and were in excellent condition as well
as the handpieces and curing lights.
I was impressed with the quality of the
equipment and instruments we had
which allowed us to provide quality
care to the Guatemalan people. Their
mind set is very different there than
here in the United States. They don’t
value teeth nearly like we do and if they
feel pain, for any reason, they want the
tooth removed. It was a challenge daily
to convince some of them that all they
needed was a simple filling in a tooth
rather than to have the tooth removed
(Continued)
and I had to change my
mind set to fit their thinking
and their culture rather
than mine. Over the
period of four and a half
days we removed around
330 teeth between the two
of us, did 89 fillings and
48 cleanings.
We worked with an RN
who had been a hygienist
who did cleanings with a
cavitron as well. She was
from Texas and a real sweetheart with that Texas twang.
She told me at the end of the week, “If calculus were
concrete I could have built me a house!.” Funny lady and
just a joy to work with. She worked harder than anyone
on the dental team as rarely did we find a patient who
had ever had their teeth cleaned. Calculus came off in
sheets and loads of periodontal problems!
One of my early restorative patients was a 42 year old
female who presented with caries on the mesial surfaces
of #8 and #9 (a very common problem we saw). I have
no doubt she expected to have these teeth removed and
she would end up looking like so many of her peers
with missing upper anterior teeth. After telling her we
could fix these teeth the decay was removed and after
about an hour the teeth were restored with composite.
The two helpers I worked with were so impressed at the
result they took the patient into the bathroom so she
could see her smile in the mirror. After wards the ladies
relayed to me the patient stood and
looked in the mirror for a minute and
then the tears started streaming down
her cheeks. She turned to them and
hugged them both and kept saying
“gracias, muchas gracias.” That’s why
we all went on this trip. The patients
were so grateful for the care we
provided for them and I finished
each day dog-tired but filled with joy
at what we were able to do for these
wonderful people.
26
There were many abscessed teeth we removed and
drained. Tons of decay due to lack of understanding of
what causes decay, lack of home care or even a tooth
brush for that matter, and poor diet with tons of candy
and soda. We could have stayed busy for months at just
this one site. Since lack of potable water can make even the
local people sick they have to buy their liquids and soda
often costs the same or less than water and tastes better.
So you can imagine what the teeth of the young children
looked like after consuming soda and candy all day long.
Travelling through cities I saw mothers with a straw in a
bottle of soda feeding their young
child. Not a good picture or situation.
The surgeons slow down and do only
minor procedures on Friday so the
operating rooms were open for the
dental team to use for very young
children and/or children with multiple
extractions. Chris saw 5 children in
the OR and my last case was an 8 year
old on whom 14 primary teeth were
removed. She was already on the OR table and still awake
when I can into the room with 5 of us with masks, head
covers and headlamps on. She had to have been terrified
to be in this situation but was so brave and appeared calm.
The parents of these children, as I came to understand,
prepare their children to recognize what a privilege it is to
receive this kind of care and the children seem to understand
so were very stoic and well behaved. I only had one child
all week that was a bit of a management problem but
otherwise all the other kids were a joy to treat.
Once this child was asleep the teeth were removed and
she was packed with gauze Chris picked her up off the
(Continued)
operating room table and carried her from the OR in his
arms to recovery and she looked so content. The mother
was brought in and once she was comfortable her daughter
was OK looked at the two of us folding her hands together
and said “gracias, gracias.” What a great feeling to know
we took care of these abscessed, decayed rotting teeth for
this little girl and relieved not only her current pain and
problems but some future issues as well. I could not have
finished the week with a more gratifying patient.
Due to the travel, sleeping arrangements (6 to a room in
bunk beds), strange place and lack
of quality sleep I don’t believe I have
worked this hard, been that tired but
been that excited in my entire career
in dentistry. I have always wanted
to go on some mission trips and
provide dental care to others but
until my retirement I was just not
able to make it happen. Chris, the
other dentist, has a different work
environment than I did and even at
the young age of 38 with two young children ages 2 and
4 goes on at least one and often two trips a year. I want
to encourage all of you to consider doing some mission
work whether here in your local community, in the state
of California or out of the country. I received much
more from this trip than I gave to these wonderful
people and I’m certain you would find that as well.
As is the standard for this trip we left the site on Saturday,
one week from the time we arrived, and went to Antigua.
We stayed in a wonderful hotel for some much needed R
and R, toured the city, and just enjoyed the country and
each other for the next three days. The cost of the trip
27
(Continued)
included the stay and gave all of us a chance to “get back
to normal” before the flight home.
I have never worked with so many people on a team that
were so caring, giving and willing to do whatever needed to
be done whenever it needed to happen. We had two RN’s
from the post-op night shift come down to the dental clinic
on their off time and process extraction instruments for us.
As you know once anesthetic is in effect extractions can be
very fast and our slow gear in the machine for extractions
was instrument processing. I was so impressed that these
nurses would come and clean and process instruments for
the dental team. Just goes to show the level of dedication
and caring among everyone involved.
If you have any questions or would like information
on how to get involved with this team please contact
me at [email protected] or for specific
information and to apply visit the Iaomai web site at
http://helpsinternational.com/. I can envision a team
next year with 4 to 5 dentists, 2 to 3 hygienists and 3 to
4 assistants and we could really make an impact on the
dental needs for the people of Guatemala. To see a video
of the trip visit vimeo.com/108252726 and notice the
smiles not only on the faces of the people we served but
also on the faces of the volunteers. Photos can also be
viewed at:
http://www.photosbyjrun.com/guate2014/index.html
David Stein, DDS
Dr. Stein practiced family and restorative
dentistry in Salinas from 1982 until 2014.
He was actively involved in organized dentistry
from early in his career. Some of Dr. Stein’s
activities with the Monterey Bay Dental Society
included chairing the Committee on Community
Affairs, Committee on Direct Reimbursement,
Committee on Continuing Education, and the
Committee on Peer Review (member for 6 years,
chair for 2 years). Dr. Stein served as President
of the MBDS in 1999-2000. In addition, Dr. Stein
served on the CDA Council on Peer Review from
2008 until November 2014. He was the recipient
of the MBDS Outstanding Dentist of the Year
Award in 1993. It is your editor’s hope that
Dr. Stein will find things to do other than
dentistry (although clearly he loves dentistry!)
in the years ahead that he can enjoy as much.
28
The Endodontic Referral
William Kuhn, DDS
Having a specialist (endodontist) write about referrals
might appear to be self-serving rather than educational
but many of us have acquired skills that can benefit both
the patient and the general pracitioner or non-endodontic
specialist. These skills are beneficial both diagnostically
and therapeutically.
First, let me share a few thoughts about the more boring,
but perhaps most important, diagnostic aspect of endodontics. There are times that a patient will come in to your
office in pain. It may seem to be an endodontic problem
(a root canal will solve the problem.) This may or may not
be the case. A large majority of these cases are slam dunks
diagnostically. However, there are times when the diagnosis
is tough to figure out. The cause may be myofascial, neuropathic, sinus related, or tmd. These patients can benefit
from a referral to an endodontist. Why so? Endodontists
are trained in diagnosing facial pain. We may or may not
be able to always definitively diagnose but we can refer to
the proper specialist or clinic. Sometimes there are multifactorial causes. An example would be an irreversible
pulpitis which causes the myofascial pain.
An aspect of the referral that may not be appreciated is an
evaluation of the prognosis. A generic example might be
retreatment. All things being equal, the prognosis is
reduced as compared to a non-treated tooth. In many
cases reduction in prognosis is due to overly large root
preps or overly large access. The reduction in pericervical
dentin increases the liklihood of a fracture or “strip perf.”
Also underappreciated is the size of the apical lesion.
Presence of a large lesion will also deleteriously affect the
prognosis. These subtleties can be communicated to the
patient so he/she can make an informed decision.
cannot see in a full skull shot. We can effectively come
up with a three-dimensional rendering of the area under
consideration and look at the area from any angle. So
what, you say? We can see things, such as resorption and
the extent of the resorption, that we couldn’t see before:
another way to come up with a more accurate prognosis.
A common misconception about CBCT is the ability to
detect fracture(s). The resolution is relatively poor. The
slice thickness, regardless of the brand, at this point in
the CBCT evolution, is too thick to elucidate most
fractures. If it is able to be detected with the CBCT
then it can probably be detected clinically rendering
the CBCT useless for that task.
I chose to touch on a few areas that, perhaps, some of
you didn’t consider before. I encourage you to utilize
your specialist colleagues especially when uncertain
about diagnosis or prognosis—chances are your patients
will benefit and appreciate your decision.
Mount Whitney, 2012
Will Kuhn, DDS
Many endodontists now utilize a couple of technological
advantages that can help us with both diagnosis and
treatment. The dental operating microscope can help us
discover fractures and when discovered we can determine,
better than without a microsope, the depth of the fracture.
There are many other uses for the microscope but it is beyond
the scope of this article. There is another technological advantage and that is Cone Beam Computed Tomography
(CBCT). If we use the type called focused-field CBCT it
can be a tremendous advantage; seeing detail that we
Dr. Kuhn has practiced endodontics in Santa Cruz for
16 years. He earned a BA in psychology at UCLA in
1986 and subsequently a BS and DDS in dentistry at
UCSF in 1991. He completed his endodontic training
at the University of Texas Health Science Center in
San Antonio in 1996. In his spare time, Dr. Kuhn competes in ballroom dancing, plays the piano and guitar,
and enjoys hiking.
29
John Avera, DDS
Dental implants are one of the most
amazing dental innovations of the 20th
and 21st centuries. Because of the pioneering work of Per-Ingvar Branemark,
Tomas Albrekson and a host of others,
we can provide root form implants to
support restorations that replace natural
teeth lost or missing from congenital
defects, injury or disease. They are
now considered the standard of care in
many situations. Their success rate is
very high but they can and do fail.
Their failure can be catastrophic as
their placement is an invasive surgical
procedure and costly to the patient. We, therefore must
do everything we can to insure success.
The placement of dental implants should be restoratively
or prosthodontically driven. By this I mean from the
top down. The medical history and parafunctional
habits are extremely significant for the success of implant
and restoration. We must consider oral hygiene, caries
and the presence of uncontrolled periodontal disease.
The mucogingival complex must be evaluated in detail
as this will be the framework for the esthetic component
of the restoration as well as being necessary for the
long-term success and stability of the fixture. If we do
not have an adequate zone of healthy, keratinized
attached gingiva around our implants then the chance
of failure is greatly increased. Currently research has
shown us that the incidence of peri-implant mucositis
around implants is much higher than once thought and
this can lead to irreversible peri-implantitis. Keratinized
attached gingival creates a tight seal around our implants
and this can help with implant maintenance and help
prevent the formation of peri-implant mucositis. It is
important to remember, a natural tooth has the benefit
of a periodontal ligament and connective tissue attachment
but implants do not have the benefit of this connective
tissue seal and are ankylosed to the bone. Peri-implant
disease is present in two forms, per-implant mucositis
and peri-implantitis. Risk factors for peri-implant disease
are as follows: previous periodontal disease, poor
plaque control, residual cement, occlusal overload,
smoking, open contacts, genetic factors, diabetes and po-
tential emerging risk factors. The occlusion is
not only critical when we seat the restoration
but also must be checked at each examination
as occlusal patterns can change over time;
especially when opposing restorations are
placed, this can certainly change the occlusal
pattern. Interproximal contacts are just as
important. As with natural teeth open
contacts can lead to severe bone loss from
food impaction but with implants this can
occur more rapidly and aggressively than
around natural teeth. It is reported that
peri-mucositis is present in 48% of implants
followed for 9 – 14 years. Peri-mucositis is
often reversible; however, peri-implantitis
is extremely difficult to control.
When a patient is referred for possible implant placement,
the implant procedure in general should have been
explained to the patient. If the ridge has collapsed
vertically or horizontally or if the sinuses are low or have
pneumatised then a bone graft or sinus augmentation is
most often necessary; as such, the patient will need to
be advised of details involving these procedures, time
frames involved in healing, and of course, approximate
costs. If the patient is told only that they need an implant
at the restorative dentist’s office, and during their
consultation at the surgeon’s office they are told they
will need a ridge augmentation or sinus augmentation
as well, this can potentially become confusing and
irritating to the patient. Also the time needed for healing
and osseointegration should be explained to the patient
at the restorative office. Every surgeon has his own time
line and only a few offices can successfully provide
“teeth in an hour.” So the patient should be prepared
in most cases for a healing period of 3 – 4 months at
least before restorative procedures can begin.
Often a patient is referred for “immediate placement.”
However, once the clinical and radiographic evaluation
are completed issues such as the lack of buccal or palatal
cortical plate, root proximity, unhealed endodontic
infection or abscess formation may dictate that an
extraction and socket preservation procedure are
needed first, followed 3 – 6 months later with
implant placement.
30
(Continued)
Often a patient is referred for an implant consultation
and the restorative dentist is not sure whether an implant
can be placed or even whether the patient is willing to
go through the procedures necessary and expense at all.
This is when encrypted emails or telephone conversations
are very useful so that everyone is on the same page. If
the site has been previously grafted I personally want to
know what grafting material was used. Certain grafting
products are better than others for stimulating quality
bone formation. Cone Beam Computed Tomography or
CBCT is an extremely useful tool in determining bone
volume, quality and anatomical structures to be avoided.
Most surgeons prefer to take their own CBCT as their
software is set up for this. If the referring dentist has
taken their own CBCT it is important to make sure the
scan has the necessary information needed and that a
“Viewer” is included on the disk. In most cases the
implant procedure is completed by a team composed of
the following; the patient, the restorative dentist, the lab
and the surgeon. A surgical guide is required for most
cases to obtain optimum results and should be provided
by the restorative dentist, ideally working with a lab
that fabricates it and which will also fabricate the
restorative work. By this, I mean that the crown and
bridge lab should fabricate the guide for a screw retained
or cemented restoration and a removable lab should
fabricate the guide for an implant-retained overdenture.
The removable lab should not provide the guide for the
crown and bridge restoration and vice a versa. Computer
designed guides are also excellent as long as the corresponding labs are involved from the beginning. Remember, to
insure the esthetics of an anterior restoration placed on
an implant, a surgical guide is critical. If a guide is not
used the ultimate results will be a crap shoot. The guide
should be more than just a bleach tray or “suck down.”
The surgeon needs to know where the lab technician and
restorative dentist wants the line of draw. This requires
a hole or slot in the guide for drill guidance. This helps
position the fixture in the proper buccal-lingual and
mesial-distal position so that the restoration is functionally and esthetically successful.
A milled or computer generated abutment is always
superior to a standard abutment as we have more control
over the emergence profile with the milled abutment.
This is important for esthetic issues in the anterior as
31
(Continued)
well as insuring that the interproximal contours in the posterior are tight
enough to prevent food impaction.
The milled or computer generated
abutment is also
superior to the custom cast abutment
because the
surfaces are significantly more accurate and fit more
intimately with a milled interface versus a cast interface.
After the implant has been placed and
restored I like to see the patient back
to make sure everything went well for
them. I check the occlusion and interproximal
contacts. I like to check the comfort,
functions,
esthetics and ease of maintenance.
I think anyone dealing with dental implants should read
the CDA Journal, December 2014. This is an excellent
issue on dental implants.
“
“
Correspondence for the referral
should be made by the referring dentist and then the results of the consultation should be sent back to the
referring dentist. If the patient decides
to accept therapy, then a guide and if
necessary
a temporary (flipper or Essix) should
be fabricated and then the patient
scheduled for surgery. Once healing
has been completed, second stage surgery (uncovering), is scheduled. Following a successful uncovering or second stage
procedure and placement of a healing abutment,
the patient is referred back to the restoring dentist and
correspondence should be sent describing the procedure,
implant type, implant size and any recommendations.
If placement was flapless then the healing abutment is
already in place but the patient should still be seen for
radiographic verification of integration before being sent
back to the restoring dentist with the same information.
Service to others is the rent you pay
for your room here on earth.
― Muhammad Ali
32
unhappily. ‘It all depends on what you want,’ put in Merry. ‘You can trust us to
stick with you through thick and thin – to the bitter end. And you can trust us
to keep any secret of yours – closer than you keep it yourself. But you cannot
“
“
‘But it does not seem that I can trust anyone,’ said Frodo. Sam looked at him
trust us to let you face trouble alone, and go off without a word. We are
your friends, Frodo.
― J.R.R. Tolkien,
The Fellowship of the Ring
33
34
Officer Installation Night, 2014
October 24th,2014 - Pasadera Country Club:
The Monterey Bay Dental Society’s Annual Officer
Installation / Awards Dinner this past October was
truly a special event. While our society has had some
“lean years” owing to the recent recession, challenges
with corporate dentistry, many members retiring,
younger dentists in the area unable to afford membership
in the tripartite (ADA, CDA, MBDS), things are turning
around. And the caliber, and number, of fine practitioners
serving on your board is outstanding—with a wide variety
of experience, age, specialty and background. The
evening included some delightful social time, where
several new members of our society met and mingled
with board members and their spouses.
Mona Goel, DDS received an appreciation award for her
tenure as MBDS Secretary / Treasurer—Mona served in
this position from 2008 through 2014. Awesome, Mona!
Among the highlights of the evening:
Tim Griffin, DDS was presented a gavel and plaque in
appreciation for his fine work as MBDS President
(2013-2014), in addition to having served on the board
since 2006 as County Director, Vice President and
President Elect. Serving with Tim has been--is--always
a pleasure. This man truly loves dentistry and taking an
active role in serving his community.
Julius Kong, DDS received a plaque and appreciation
as MBDS Outstanding Dentist of the Year—particularly
in recognition of his outstanding efforts as Chairman of
the Dental Health Committee (Julius has served from
2011 to 2014 as County Director and Dental Health
Committee Chair). Well done Julius!
Appreciation Award for Outgoing Secretary/Treasurer: Mona Goel, DDS (2008-2014)
Yours truly Lloyd Nattkemper, DDS—received
on behalf of the Monterey Bay Dental Society—The ADA’s “Golden
Apple Award”—(thanks
to Daniel Pierre, DDS
thoughtfully submitting a
previous issue of the
SmileLine to the ADA for
review and consideration). The ADA Award
was presented ...” In
recognition of Excellence
Golden Apple Award—for all MBDS
in Member-Related Serv- ADA
Members to be proud of!
ices/Benefits for a dental
society with total membership fewer than 1,000 dentists.” As I shared that evening, the SmileLine issue for
which we received the award—and all those we have
published in the past few years, including this one—are
written by, for and about us—member dentists. We all
deserve to be proud of this!
Plaque & Continuous plaque plate for Outstanding Dentists of the Year: Julius Kong,
DDS (2011-2014- County Director and Dental Health Committee Chairman)
35
Officer Installation Night, 2014
(Continued)
Dr. Carl Sackett with his parents, Chuck and Barbara Sackett.
all happen—and does so every day for us, even weekends,
trust me, also received sincere appreciation from all
those in attendance. We are in good hands.
Respectfully submitted
MBDS Editor
“
Anything that’s human is mentionable,
and anything that is mentionable can
be more manageable. When we talk
about our feelings, they become less
overwhelming, less upsetting, and less
scary. The people we trust with that
“
Carl Sackett, DDS, our incoming President, gratefully
acknowledged and thanked his parents, both of whom
were in attendance, along with his lovely wife, for their
support and encouragement. Carl gave a great presentation
including vignettes and vintage photos of our board
members, and inspiring words about the year to come.
Debi Diaz, our beloved Executive Director, who made it
important talk can help us know that
we are not alone.
― Fred Rogers
36
Understanding Dental Fear In Children—And When A Referral Is Appropriate
Children with negative behaviors during dental treatment
are most likely experiencing dental fear. The best way to
help families and children to have positive, comfortable
dental visits is to provide information to parents in
advance—to advise them what to expect during their
child’s first dental visit. Ways to aid in that are to have
questions on the health history form that address the
child’s temperament, history of previous negative
medical or dental experiences and a question about
their expectations for the child’s behavior at the dental
visit. It is important to assure parents that certain
behaviors are age-appropriate and are not necessarily
related to dental fears. Things going on in the mouth
can provoke fear in young children. Other things that
may provoke fear are new experiences, sounds, sensory
stimulations, etc.
Based upon how parents respond to the questions on
the health history, that can help guide you (along with
a verbal interview with the parent or parents) in
determining if you feel the patient can be comfortably
and appropriately managed in your own office or if a
referral to a pediatric dentist is wisest. Things to look
out for are if the child’s interaction with their parents is
age appropriate in the office. Possible negative child
behaviors to look out for are if the child seems fearful,
anxious, inhibited, withdrawn, uncontrolled or “acting
out” towards others. Examples of uncooperative
children can present as defiant, attention-seeking, angry,
poor self-controlled or poor relationships.
Another thing to consider is the parental perception
of the child. Parents do not always have objective
perceptions of their child’s behavior. It is good to also
talk to parents about their expectations. Parents tend to
have different comfort levels and expectations as to how
they would like their child treated. Some parents would
rather help stabilize a child even if their child is very
vocal and mobile. Some parents would prefer to not
have their child experience anything negative and
would rather have their child put to sleep for any
treatment that is to be done.
The most important thing is to develop trust, communication and respect for both the child and the parents.
If a child has difficulty tolerating radiographs or a
prophy, and you anticipate that a lot of treatment may
need to be done, a referral to a pediatric dentist may
be a good idea. When children do well with a first visit,
as children have sequential visits, they will either get
accustomed to treatment (the ideal scenario) or have
increasing difficulty tolerating dental visits, due to
familiarization with the process of having treatment
performed. Children can remember the sensation
of anesthesia or the feel of hand pieces on their teeth
and may decide they their didn’t like it or don’t want
to experience it again.
Factors in behavior management decisions are risk
versus benefits, the urgency of treatment, consequences
of deferred treatment and interactions between dentist,
parent, or possibly child. Risks to consider are possibly
causing harm to the patient (or to your staff or yourself
by a child who is acting out) and possibly traumatizing
the patient for future treatment. The goal should
always be about establishing a dental home—a place
and environment where the child feels safe and where
experiences are consistent and positive. This takes place
through establishing communication, alleviating fear,
building trust and promoting a positive attitude toward
dental care. At any time, if it is difficult to determine
the way that necessary treatment may be done, referral
to a pediatric dentist should be considered.
“
When the trust account is high,
“
Jennifer Lo, DDS
Dr. Lo is a pediatric dentist practicing in Salinas.
She is also serving as Chairperson of the
MBDS Dental Health Committee
communication is easy, instant,
and effective.
― Stephen R. Covey
37
Healthcare Professional Network Alliance
Putting Health back into Health Care
Carol Johnson — 831-245-9733
Wellness Program Development
[email protected]
www.HCPNAlliance.com
(passcode available upon request)
38
The Three C’s for Early Orthodontic Intervention
Dr. Joe Mitchell, DDS
Over the years I have had calls from colleagues in all
areas of dentistry and at all stages of their practice
lifetime asking whether a young patient they just saw
should be referred for an orthodontic evaluation.
Because they were concerned enough to ask, the answer
was invariably, yes. These conversations were great
learning opportunities for my colleagues and for me –
and our patients were always the beneficiaries.
Although there are no real hard and fast rules as to when
to refer a child for treatment, The American Association
of Orthodontists recommends an orthodontic evaluation
at age seven. At this time the incisors and the first permanent
molars should be erupted or erupting and we can check
for important landmarks of dental and facial development.
It is a great idea to make a quick orthodontic check a
part of the regular exam and prophy appointment at age
seven. If a panoramic radiograph is available it is also an
excellent time to check on the formation of the teeth.
At this age all of the adult teeth except third molars
should have some crown formation so congenitally
missing teeth can be identified. In some cases this would
be the time to consider putting the wheels in motion to
close the spaces caused by the missing teeth. A good
example would be a case where all second premolars are
missing and we would like the first molars to move
mesially to close the spaces. A panoramic film can also
help to identify ectopically erupting teeth as well as
supernumerary teeth. Many of these can benefit
from early intervention
I have found that most patients who need early help fall
into one of three categories. I call them the “Three C’s”
for early intervention. Crowding, Cross-bites and
Crummy bites. Of course you could have an entire
alphabet of reasons to refer but these usually cover
most of them.
Crowding: A small amount of crowding in the incisors
(3-4 mm) can be corrected at any age so early treatment
may not be necessary. Significant crowding—6 mm or
more-- can benefit from early help and severe crowding
of 10 mm or more should be treated.
Methods of treatment can vary. A simple Lower Lingual
Arch can be used to gain a few millimeters of arch length,
or easily and effectively maintain the approximately 4
mm of Leeway space available when the lower primary
Joe Mitchell’s original staff members from 1987. He likes to think of them as "the Original Fab Four" of orthodontics in Monterey County
39
The Three C’s for Early Orthodontic Intervention (Continued)
second molars are exchanged for the second premolars.
In cases where the incisors are forced to erupt lingually,
early treatment with braces or a lingual arch may be
indicated. This loss of correct position in the arch is
often followed by lingual collapse of the arch form and
more crowding. In the 7 and 8 year old patient this loss
of space can most likely be re-gained. If left un-treated,
management becomes more difficult and can sometimes
lead to tough choices—such as whether extractions may
be required. In severely crowded cases, a referral is very
important. Not only does it give the patient more options
for treatment but it can make a big difference in the
health of the teeth and bone. Teeth pushed into unhealthy
positions in the arch are also difficult to clean. In some
cases a Serial Extraction approach with eventual removal
of adult pre-molars can be used effectively while waiting
for full eruption of teeth. When evaluating crowding it
is important to consider not only the teeth you can see
clinically at age seven but also the ones you can’t see.
Again a panoramic X-ray can help to identify developing
arch length shortages.
small upper jaw and widening provides the added benefit
of increased arch length.
Buccal cross-bites (where the lower teeth are completely
lingual to the upper posterior teeth) can be especially
hard to treat. These do better when treatment is
initiated early.
Single tooth anterior cross-bites can be very destructive
to the tooth, bone and gingival tissue as the affected
teeth are pushed out of their normal position in the
bone. Correction with a removable appliance can be
fairly simple and quick and can provide important
benefits to the patient.
Complete anterior cross-bites or under-bites are probably
the most important of all cross-bites to refer for early
treatment. We would like to see these patients once
the central incisors and the permanent first molars have
erupted. An anterior cross-bite can force the patient
to posture the lower jaw forward to avoid traumatic
incisor contact. Long term, we believe this can cause
Cross-bites: This is an area where referral for treatment
is almost always indicated. Whether posterior, anterior,
buccal or lingual, cross-bites in a 7 and 8 year old can be
a problem.
Posterior cross-bites are usually associated with a narrow
upper arch relative to a normal lower arch. This causes
the upper teeth to fit lingual to their normal position
with the lower teeth. The narrowing of the upper jaw
can be a result of prolonged thumb or finger sucking
habits or even from mouth breathing. In mouth breathing
patients the tongue is held low in the mouth to allow
the air to pass through the mouth rather than the nose.
Lack of support of the tongue against the palate can
cause the palate to narrow, creating a cross-bite and an
uncomfortable fit of the posterior teeth. The patient will
usually shift the lower jaw to one side or the other to get
a more comfortable bite. It is this jaw shift that is the
larger problem. If left un-treated it can lead to asymmetrical mandibular growth, which is far more difficult to
correct. A simple Quad Helix expander can correct the
cross-bite in a few months and prevent future problems.
Many times there is also crowding associated with the
40
The Three C’s for Early Orthodontic Intervention (Continued)
an imbalance in the growth of the upper and lower jaws,
leading to a more serious skeletal problem of the jaws.
Left untreated some of these cases will require orthognathic surgery to adequately correct the problem. I have
had very good success in these cases by using a reverse
headgear, sometimes in combination with palatal
expansion, to advance the maxilla and correct the
under-bite. It is important to get the incisors into a
positive overjet relationship and preferably with
significant overbite to provide a coupling of the anterior
teeth. Unfortunately we have very little control over
lower jaw growth. If we can get the incisors properly
related early we can “drag” the upper jaw along with
the lower jaw as it grows. Almost all of these cases will
need full treatment as late teens to definitively correct
and stabilize the occlusion.
Crummy Bites: This category would include anterior
open bites of 3mm or more, deep bites where the lower
incisors are impinging on the palate, and a significant
overjet of 6 mm or more causing the lower lip to be
trapped behind the upper incisors. A severe overjet
presents a potentially hazardous situation if the incisors
are sticking out into the “Danger Zone.” Open bites
can also affect speech patterns which may be difficult
to correct later on.
And in this category I would also include just plain old
crooked teeth, especially where the young patient’s self
esteem is being negatively affected. The research is clear
that a healthy and attractive smile increases self-esteem
at any age.
Although not every seven year old is a candidate for
treatment, my experience shows that early intervention
has an important place in orthodontics and can positively
affect the overall quality of results when used appropriately.
If you are not sure if your patient will benefit from early
treatment, refer them to your favorite orthodontist for
an evaluation. This simple step will give the parents
peace of mind knowing that their child is on track for
a healthy and attractive smile.
Joe Mitchell, DDS
Dr. Joe Mitchell grew up in Ohio and earned both
his DDS and MS in Orthodontics from Ohio State
University. Understandably he is a big
college football fan. He is a Diplomate of the
American Board of Orthodontics and a Fellow
of the American College of Dentists. He has been
practicing orthodontics in Salinas since 1987, is
a Past President of the Monterey Bay Dental
Society and MBDS Trustee to the California
Dental Association.
His love for music, guitars and The Beatles is
evident in his office where music is a central
theme and the juke box plays every day. If he
had hobbies he is pretty sure they would be
incredibly exciting and dangerous like – Yacht
Racing, Helicopter Flying, Mountain Climbing
and maybe Stamp Collecting.
41
Long-time MBDS member and well-loved member of
his community (Bill practiced for nearly 50 years in
Pacific Grove) turned 90 on March 4th of this year.
He is still going strong. His hygienist and friend of
many years, Billie, asked that those who remember
Bill send belated birthday greetings. You can do this
through Billie’s email address:
[email protected]
Happy Birthday Bill!!
“
My advice to other disabled people
would be, concentrate on things your
disability doesn’t prevent you doing
well, and don’t regret the things
“
William “Bill” “Ziggy” Ziegenbein, DDS
it interferes with. Don’t be disabled
in spirit as well as physically.
― Stephen Hawking
42
A Wonderful Referral For Homebound Patients
Karine Strickland
Registered Dental Hygienist in Alternative Practice
The licensure of the Registered Dental Hygienist in
Alternative Practice allows the hygienist to serve patients in the following settings: Residences of the homebound~ Skilled nursing facilities~ Residential care
homes ~ Independent Senior communities~ Public Schools
Mobile RDHAP’s practice providing access to preventive
oral hygiene services for those in our community that
are unable to obtain dental care in the traditional dental
office setting. Patients of record are typically children
of low income families, elderly or developmentally
disabled individuals with transportation, mobility,
cognitive and/or behavioral issues.
Often because of the aforementioned limitations, the
RDHAP is the only dental professional available to
evaluate the patient in many years. RDHAP’s are often
times considered the “first responders” of oral health
for homebound individuals. Lost fillings, fractures,
fistulas, chronic inflammation are realities that often
go unnoticed when cognition is diminished or minimally
present. Daily and effective oral home care is one of the
first areas of self-care that looses priority in daily living
activities. Careproviders/family members do not have
the expertise, in most cases, to recognize many of these
oral health concerns and are very often more concerned
with priority health conditions that are time consuming
and potentially life threatening.
Diana Carr, RDHAP
Tulsi Patel, RDHAP
RDHAP’s enjoy their patients. Many patients are
non-verbal, however, their shining eyes, blown kisses
and smiles, post procedurally, convey their thanks
and appreciation for the care that is provided.
Many deserving patients support the success of an
RDHAP practice, however, those dentists that are and
have been supportive of the collaborative dental care
that an RDHAP can provide, are very much appreciated
and have also contributed with their time and concern.
We often work together creatively to assist patients in
dental pain. Dentists are needed to provide care in
Andrew Fan, RDHAP
43
A Wonderful Referral For Homebound Patients (Continued)
nursing homes, in residential care facilities, in schools
and in their patient’s homes, to meet the oral health
needs of our community. We have many dentists looking
at retirement in the next few years, who are encouraged
to consider working in collaboration with an RDHAP.
We can be amazing team! We can make a difference in
our community!
Dental offices throughout Monterey Bay have elderly
patients that may have difficulty getting to the dental
office routinely, as they did at one time. These patients
may still be living at home, may no longer drive, and
would be appreciative of in-home services. Consider
referral to an RDHAP, who can be your eyes and ears,
in the patient’s home, an extension of you, in a collaborative outreach. Technology allows us to provide intra-oral
photos, and with legislation recently signed by our
governor, an RDHAP will soon be able to provide
xrays for patients, which can then be forwarded to you,
for your diagnosis. Technology easily allows for fast
delivery of documentation and ease of virtual
treatment planning.
There are currently six RDHAP’s licensed and residing
within Monterey County. It is uncertain as to whether
they are all actively practicing and providing in-home
services. Information can be obtained by contacting
[email protected]
When the trust level gets high enough,
people transcend current limits,
discovering new and awesome abilities
“
“
Trust each other again and again.
of which they were previously unaware.
― David Armistead
Karine Strickland, RDHAP
Karine Strickland graduated in 1979 with an AS degree
in Dental Hygiene from Cabrillo College. Karine has
provided professional oral hygiene services within
private practice settings in Santa Cruz and Santa Clara
Counties for 34 years. She continued her education
earning her BS degree in Health Arts in 1999.
Additionally, she attended the University of the Pacific
Arthur A. Dugoni School of Dentistry’s Registered
Dental Hygienist in Alternative Practice (RDHAP)
program and resultant CA licensure in 2005. Karine is
now practicing full time providing dental hygiene care
for the residents of skilled nursing facilities, and e
lderly and developmentally disabled homebound
individuals. Karine participated in the Virtual Dental
Home Teledentistry HMPP. As of March 16, 2015,
Karine is one of 10 CA RDHAP’s additionally licensed
to take xrays and, in collaboration with the dentist of
record, provide temporary fillings in the field. This has
been a year of professional leadership as California
Dental Hygienists’ Association President. Karine
enjoys travel, exercise, home improvement projects,
friends and family celebrations. Karine is extremely
proud of her two adult children, a son living in Florida
and a son residing in Santa Cruz. The family is
looking forward with anticipation to the addition of a
“daughter” via her son’s wedding plans this summer.
44
45
46
Classifieds
Dental office for rent.
1100 sq. ft. with 3 operatories.
3235 El Dorado Street, Monterey, Ca.
For more information, call 831-372-2882
Curing Light: $90
Please call 831 595-6632 for more information
ASSOCIATE OPPORTUNITY!
I am looking for a Doctor to come and treat patients. We have a
thriving practice in Santa Cruz and we need help.
Please call 831-316-1591 to hear a
message with more details about the
position and instructions on
how to apply.
Dental office for lease available on Romie Lane. Prime location.
2,555 square feet. 6-7 operatories. Up to 2 dentists.
Rent negotiable. Please call Pam Jones (831) 594-1357
DENTAL OFFICE FOR LEASE OR SALE
Five operatories with equipment, laboratory and sterilization areas.
Located at 121 Fairgrounds Rd., Monterey, CA.
For more information contact 831-601-8879
Dental Space, 4 Opr Rooms, Ideal location, Fully equipped,
READY FOR OCCUPANCY.
Call 831-206-5667
Salinas Office Space Available –
Medical/Dental/Professional/General Office
224-4 San Jose St., across the street from Salinas Valley Memorial
Hospital. 1235 sq. ft. at $1,190 monthly
rent. Newly decorated, carpeted, and
painted. Open-beam ceiling, balcony,
and large parking lot.
For information please call
Owner Steven Gordon
at 831-757-5246.
47
48
49
Parting Shot
“
“
Every successful individual knows that his or her achievement
depends on a community of persons working together.
—Paul Ryan, U.S. Representative from Wisconsin
and Chair of the House Budget Committee
50

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