Pennsylvania Dental Journal Pennsylvania Dental Journal

Transcription

Pennsylvania
Dental Journal
Vol. 77, No. 5 • September/October 2010
19
Evaluating Children’s Access
to Dental Services
32
Building Alliances
for Better Oral Health
35
Harrisburg Smiles
T H A Y E R
D E N T A L
L A B O R A T O R Y ,
I N C .
Thayer’s discount policy
doesn’t rely on coupons
or gimmicks . . .
Thayer Dental Laboratory has offered
the same volume discount to its customers
for over 30 years. We don’t offer special
coupons to anyone - and we only have
one price list for all our customers. Our
discount policy treats everyone fairly.
Pay your statement balance by the 10th
of the month:
For balances of $5,000 or more take
10% off your statement balance if you
pay by check - or 8% by credit card.
For balances of $2,500 to $4,999 take
pay by check - or 3% by credit card.
... that’s a
smart move.
For balances of $250 to $2,499 take
pay by check.
It’s just that simple.
THAYER DENTAL LABORATORY, INC.
131 Old Schoolhouse Lane • P.O. Box 1204
Mechanicsburg, PA 17055
717-697-6324 • 800-382-1240 • fax: 717-697-1412
www.thayerdental.com
“ Yo u r
P a r t n e r
i n
M a s t e r i n g
N e w
Te c h n o l o g i e s ”
®
P e n n s y l v a n i a D e n t a l J o u r n a l • w w w. p a d e n t a l . o r g
Dr. Bruce R. Terry (Editor)
85 Old Eagle School Road, Wayne, 19087-2524
(610) 995-0109 • [email protected]
4th...Dr. Michael S. Shuman…2013 ●
1052 Park Road, Blandon, 19510-9563
Dr. Joseph J. Kohler III (Associate Editor)
219 W. 7th Street, Erie, 16501-1601
5th...Dr. David R. Larson…2013 ●
1305 Middletown Rd. Ste 2
Hummelstown, 17036-8825
Dr. Brian Mark Schwab (Associate Editor)
1021 Lily Lane, Reading, 19560-9535
Rob Pugliese (Director of Communications)
P.O. Box 3341, Harrisburg, 17105
(800) 223-0016 • FAX (717) 234-2186
[email protected]
Dr. Richard Galeone (Editor Emeritus)
3501 North Front Street, Harrisburg, 17110
(717) 234-5941 • FAX (717) 234-2186
[email protected]
Dr. Judith McFadden (Editor Emerita)
3386 Memphis Street, Philadelphia, 19134
(215) 739-3100
Officers
Dr. William T. Spruill (President) ✸
520 South Pitt Street, Carlisle, 17013-3820
Dr. Dennis J. Charlton (President-Elect) ✰✸
P.O. Box 487 • Sandy Lake, 16145-0487
Dr. Andrew J. Kwasny (Immediate Past President)
3219 Peach Street • Erie, 16508-2735
Dr. Gary S. Davis (Vice President) ✸
420 East Orange St. • Shippensburg, 17257-2140
7th...Dr. Wade I. Newman...2014
Bellefonte Family Dentistry
115 S. School St., Bellefonte, 16823-2322
8th...Dr. William J. Weaver...2011 ✰
Brookville Dental, 123 Main Street
Brookville, 15825-1212
9th...Dr. William G. Glecos...2012
3408 State Street, Erie, 16508-2832
(814) 459-1608
[email protected]
10th...Dr. Donald A. Stoner...2011 ✸●
Oakmont Dental Associates
154 Allegheny River Blvd., Oakmont, 15139-1801
ADA Third District Trustee
Dr. Charles R. Weber
606 East Marshall Street, Ste 103
West Chester, PA 19380-4485
PDA Committee Chairs
Dr. Peter P. Korch III (Speaker) ●●
4200 Crawford Ave., NorCam Bldg. 3
P.O. Box 1388, Northern Cambria, 15714-1388
Communications & Public Relations Committee
Dr. David A. Tecosky
Dr. Jeffrey B. Sameroff (Secretary) ●✸
800 Heritage Dr., Ste 811 • Pottstown, 19464-9220
Government Relations Committee
Dr. Herbert L. Ray, Jr.
Dr. R. Donald Hoffman (Treasurer) ✰✰✸
105 Penhurst Drive, Pittsburgh, 15235
Dental Benefits Committee
Dr. Tad S. Glossner
Membership Committee
Dr. Karin D. Brian
Access to Care Committee
Dr. Joseph R. Greenberg
Trustees By District
Annual Awards Committee
Dr. Craig Eisenhart
1st...Dr. Thomas P. Nordone…2013 ✰
207 N. Broad Street, Philadelphia, 19107-1500
Concerned Colleague Committee
Dr. Bartley J. Morrow
2nd...Dr. Bernard P. Dishler...2011 ✸
Yorktowne Dental Group Ltd.
8118 Old York Road Ste A, Elkins Park, 19027-1499
3rd...Dr. D. Scott Aldinger...2012 ✰✸
8555 Interchange Road, Lehighton, 18235-5611
2
6th...Dr. John P. Grove...2011
PO Box 508, Jersey Shore, 17740-0508
September/October 2010 • Pennsylvania Dental Journal
Environmental Issues Committee
Dr. Marian S. Wolford
Forensic Odontology Committee
Dr. Jeff D. Aronsohn
New Dentist Committee
Dr. Brian Mark Schwab
PDA Central Office
3501 North Front Street
P.O. Box 3341, Harrisburg, 17105
(800) 223-0016 • (717) 234-5941
FAX (717) 232-7169
Camille Kostelac-Cherry, Esq.
Chief Executive Officer
[email protected]
Pennsylvania
Dental Journal
Mary Donlin
Director of Membership
[email protected]
The Official Publication of the Pennsylvania Dental Association
September/October 2010 • Volume 77, Number 5
Marisa Swarney
Director of Government Relations
[email protected]
Features
Rob Pugliese
Director of Communications
[email protected]
Rebecca Von Nieda
Director of Meetings and Administration
[email protected]
Leo Walchak
Controller
[email protected]
19
Pennsylvania Medical Assistance:
Evaluation of Children’s Access to Dental Services
by Monica Costlow, JD and Dr. Judith Lave
26
A Survey of Senior Dental Students’ Experiences
with Young Dental Patients in Pennsylvania
by Rochelle G. Lindemeyer, DMD
32
Building Alliances for Better
Oral Health
by Paul R. Westerberg, DDS
35
Harrisburg Smiles
by Rob Pugliese, Director of Communications
Board Committees Legend
✸ Executive Committee
✸✸ Chairman
✰ Budget, Finance & Property ✰✰ Chairman
● Bylaws Committee
●● Chairman
Departments
EDITORIAL Board
Dr. Daniel Boston
Dr. Allen Fielding
Dr. Marjorie Jeffcoat
Dr. Kenneth G. Miller
Dr. Andres Pinto
Dr. Deborah Studen-Pavlovich
Dr. James A. Wallace
Dr. Charles R. Weber
Dr. Gerald S. Weintraub
5
7
9
13
17
41
45
47
49
51
55
Impressions
Letter to the Editor
Government Relations
Membership Matters
It’s Your Money
In Memoriam
Cyber Salon
Awards & Achievements
Insurance Connection
Continuing Education
Classified Advertisements
The mission of the Pennsylvania Dental Journal is to serve PDA members
by providing information about topics and issues that affect dentists practicing
in Pennsylvania. The Journal also will report membership-related activities of
the leadership of the association, proceedings of the House of Delegates at the
annual session and status of PDA programs.
PENNSYLVANIA DENTAL JOURNAL (ISSN 0031-4439), owned and published by the Pennsylvania Dental Association, 3501
North Front Street, Harrisburg, 17110, is published bi-monthly: Jan/Feb, Mar/Apr, May/June, July/Aug, Sept/Oct, Nov/Dec. Address
advertising and subscription queries to 3501 North Front Street, P.O. Box 3341, Harrisburg, 17105. Domestic subscriptions are
available to persons not eligible for membership at $36/year; International subscriptions available at $75/year. Single copies $10.
Periodical postage paid at Harrisburg, PA. “The Pennsylvania Dental Association, although formally accepting and publishing reports
of the various standing committees and essays read before the Association (and its components), holds itself not responsible for
opinions, theories, and criticisms therein contained, except when adopted or sanctioned by special resolutions.” The Association
assumes no responsibility for any program content of lectures in continuing education programs advertised in this magazine. The
Association reserves the right to refuse any advertisement for any reason. Copyright ©2010, Pennsylvania Dental Association.
POSTMASTER: Send address changes to Pennsylvania Dental Association, P.O. Box 3341, Harrisburg, PA 17105.
MEMBER: American Association of Dental Editors
3
4
Impressions
Are You My Dentist?
Jane Smith (name and details
modified to protect her identity) was
your average dental patient. She
needed a filling but didn’t have dental
insurance. She lived in northern New
Jersey and found every dentist to be
too expensive. She had a friend tell
her about Dr. Maria Mendel (her real
name). Her friend told her that
Dr. Mendel worked out of her apartment and was very cheap.
So, Jane made an appointment and
went to see Dr. Mendel. The office
didn’t look like any other office she
had been to before. It looked more
like someone’s living room. After an
oral exam, Jane was told that she
needed a few fillings. No radiographs
were taken and Dr. Mendel said that
no local anesthetic was needed since
the cavities were not very deep.
Dr. Mendel didn’t use a drill. She said
the cavity was soft and just need to
be scooped out with a dental instrument. The fillings were pretty easy to
do and Jane thought she had found
herself a new dentist.
A few weeks later one tooth began
to hurt. She went back to Dr. Mendel
and was told that everything was fine.
She went back a few more times and
felt that Dr. Mendel didn’t want to
see her any longer. Because her tooth
continued to hurt, she went to another
dentist who took a radiograph and
performed an examination. He thought
something looked strange and called
Dr. Mendel.
Bill Jones (name and details also
changed) had heard about a dentist
near his apartment in the Atlanta
suburb of Roswell, Ga., named
Dr. Ardilla-Ramirez (real name). Bill
also was looking for affordable dental
care. He had lost his job a year earlier
D r. B r u c e R . Te r r y
and had no money or benefits for
dental care. He had a badly decayed
tooth and wanted an extraction.
Dr. Ardilla-Ramirez seemed professional
with her lab coat on. Her office had a
TV style lounge chair rather than a
standard dental chair. Bill thought it
was odd, but it was really comfortable.
Dr. Ardilla-Ramirez didn’t accept
insurance or credit cards. She only
took cash. She had three others waiting on a sofa in the same room while
she extracted Bill’s tooth. A week
later, with an infection, Bill returned to
the dentist, but the dentist told him
everything was fine. Bill eventually
went to an oral surgeon who found
half of the roots remaining, and when
he asked who the dentist was that
did the extraction, the surgeon was
surprised that he had never heard of
Dr. Ardilla-Ramirez.
Dr. Tim Gurley (real name) practiced
with his father for nearly 10 years.
He helped his dad as he eased into
retirement mode. New patients and
some current patients of his father’s
became Tim’s patients. He performed
extractions, restored implants and
made dentures.
They were all living the American
dream. Hardworking, dedicated
practitioners, seeing patients every day.
They practiced general dentistry and
had many patients. Maria Mendel, 47,
from Bound Brook N.J., Martha Gabi
Ardilla-Ramirez, 49, of Roswell Ga.,
and Tim Gurley, 40, of Tampa, Fla.
Maria practiced out of her home in
northern New Jersey. Martha alsopracticed out of her home in the Atlanta
suburb of Roswell. Tim practiced
in the Tampa office of his father
Dr. Max Gurley.
While each practice was different,
they all shared one very important
attribute.
Maria and Martha had each practiced for less than one year while Tim
had practiced for nearly 10 years.
What was the one thing they all had
in common? They were all found to
be practicing dentistry without a
license! Their respective State Boards
caught each of them after numerous
complaints were filed. In each case,
patients went to a new dentist with
a common complaint of poor dental
work. When the new dentist
questioned the work of the previous
dentist, each found that the dentistry
was done by someone they didn’t
know.
Maria worked out of one room
with a mix of questionable equipment.
She was also in possession of narcotic
medication without a license to prescribe or dispense. Martha, originally
from Bogotá, Columbia, also practiced
out of a room with a lounge chair
rather than a standard dental chair
(continued on page 6)
5
Impressions
and used mostly hardware store style
tools and a Dremel like tool rather
than standard dental instruments.
Tim had been extracting teeth, among
other procedures. Although he was
only a dental assistant, he had been
practicing dentistry under the supervision of his father, Dr. Max Gurley.
None of these individuals went to
dental school abroad or in the United
States. Maria and Martha hardly had
a normal practice. Each worked in
her apartment or a rented room. Their
patients had to be aware that they
weren’t for real. Was it denial because
of the affordability? I seriously doubt
that these two women accepted dental
insurance, so it was a fee-for-service
business. All dentists dream of a feefor-service practice. These imposters
figured out how to get this coveted
patient population into their chairs,
DentalEz and Barcalounger alike.
One of the biggest medical problems
facing our society today is access to
dental care. The complexity of the
problem has all levels of organized
dentistry and government scrambling
for solutions. It also has dental patients
seeking care in unlikely places.
Dentists volunteering their time have
been one important solution. Each
year, hundreds of thousands of hours
are donated around the world to
provide needed dental care to those
less fortunate. From the far Asian
continent to our neighborhoods,
dentists, dental students and dental
hygienists proudly give their time and
materials to help others.
Medicaid is another component to
the problem. The government reimburses providers at levels so low that
it hardly pays to offer their services.
With delay of claims and the number
of no-show patients, the dental
Medicaid system is seriously flawed.
But, it continues to operate and
6
provide needed care to many patients.
The dentists who stay in this system
are the real heroes.
Local nonprofit dental clinics also
help fill the dental care gap. Dentists
either volunteer to work in a clinic or
agree to see patients in their own
offices at no cost. This is a very generous solution, but there are too many
patients and too few dentists. More
importantly, we are not going to solve
the access issue with charity alone.
Dental schools also help, but they
operate as a business and do not
generally offer free dental care. They
must make money to cover their costs.
In fact, most dental schools don’t
even break even with the fees charged
in the dental clinic.
It’s time to stop blaming the lack
of access to care on someone else and
time to start trying to help. Anyone
who is not for one solution or another
must come up with an alternative,
otherwise they are just part of the
problem. If we try something and it
doesn’t work, then we will have to try
something else. It’s too easy to just say,
“it’s complicated and can’t be solved.”
I don’t want to see us mandated to
do things. I would rather we continue
to solve and promote what we do so
well, help others in need. Just do a
daily search for the keyword “dental”
under Google News and you will see at
least three news items each day about
dentists helping in their community.
That is the message we need to continue to promote – dentists are part of
the solution, not part of the problem.
As far as unlicensed dentistry, it goes
to show you that we are envied by
others and trusted by many.
—BRT
Letters to the Editor
Dear Dr. Terry:
In reviewing the Insurance Connection
in the May/June 2010 issue of the
Pennsylvania Dental Journal, it appears
to me that the more things change,
the more they stay the same. It
absolutely blows my mind to think
that fellow practitioners will sign an
agreement which allows a third party
carrier to dictate the fees which they
can charge in their dental office for
non-covered services. But, that report
says 85 percent of the participants in
the UCCI plan signed that contract.
Are we really that ignorant, as lambs
being led to the slaughter?
For years, the PDA committee that
addresses dental insurance issues,
which has been known by numerous
committee titles, in addition to the
ADA Council on Dental Benefit
Programs, has struggled to protect
our inalienable right to charge fees
that we think are appropriate based
upon the technology, the time, the
materials and the difficulty of procedure. Each and every dental office
must decide for itself what fee is
appropriate for each service that is
provided and this is as it should be.
However, to acquiesce to the dental
insurance industry telling us what
fees we can charge is appropriate to
dental socialism. The various
committees have struggled with this
issue because many of our colleagues
will readily agree to have a third-party
carrier dictate the fees that they charge
for specific services. Unfortunately,
this puts those of us who refuse to
participate in these plans at a distinct
disadvantage, as patients will constantly hassle us to reduce our fees or
they will leave our practice and go to
that of a “participant.”
In Pennsylvania, we are attempting
to have legislation passed which will
prohibit insurance companies from
the practice of dictating fees for
services that they do not cover. In the
journal article it states that UCCI
does not have plans to change this
policy unless the Pennsylvania General
Assembly passes legislation prohibiting
this insurance practice. The bottom
line, my dear colleagues, is that we
must become proactive and contact
our legislators on this important issue.
Rest assured that the coffers of UCCI
and the other third parties are funding
our legislators’ PACs much more than
we as individuals can do. However, if
we continue to try and remain unified
and support this legislative activity,
just maybe, we may obtain success in
the passing of this important legislation.
But, on the other hand, apparently
85 percent of the participants could
care less whether or not the legislature
acts on this issue. We can only continue to hope.
Sincerely,
George A. Kirchner, DDS
Dear Editor:
I enjoyed reading Dr. Mark Funt’s
“It’s Your Money” piece on health care
reform (July/August), since it’s always
stimulating to read a strong opinion
even when you don’t agree with it.
I can appreciate Dr. Funt’s pro-free
market, anti-big government philosophy, although the idea that government is the problem rather than the
solution would seem to have been an
easier sell back in the 1980s than in
2010 (Halliburton? BP? Enron?
Blackwater? Bernie Madoff?). But I
was disappointed that Dr. Funt ended
his article by repeating a story that’s
been going around that Congressional
staffers, who helped write the Health
Care Reform legislation, put in a
loophole exempting themselves from
the new law. On the face of it, the
implication is that these liberal policy
wonks, who, despite having devoted
years writing and rewriting a national
health care bill, in their heart of hearts
know the bill isn't any good, and so
they surreptitiously hid a clause deep
in the bowels of the bill to exempt
themselves, and only themselves. Sort
of a DaVinci Code scenario. But alas,
as with so many sources of right-wing
outrage sailing through the Internet
and over the radio waves, there is
much less fire here than smoke. A
nonpartisan website, FactCheck.org,
explains that all members of Congress
and their staffs are covered by the
new health care bill. The exemption
issue came up because of some overly
specific wording in a Republican
amendment to the bill, regarding which
government employees would be
required to buy their insurance through
the new state exchanges. Both parties
realize the need to correct the wording.
There is no hidden agenda. Passing
on a half-truth like this is not harmless.
Our nation has been paralyzed by
distrust of government, and more and
more politicians are elected not to
improve government, but to dismantle
it. You may believe, as I do, that the
health care law is a brave, if
incomplete, attempt to right serious
injustices in our health care system,
or you may believe that the whole
thing is a huge boondoggle, but in
making our point, let’s not fan the
flames of anti-government paranoia.
Jay Cohen, DMD
7
Letters to the Editor
Editor’s Note: Following is
Dr. Funt’s response to some of
Dr. Cohen’s assertions.
Dear Jay:
I agree with your comments on the
Enrons of the world, and I addressed
that issue in my article. You will be
glad to know that I do not believe the
recently passed financial regulation
bill went far enough in solving such
problems, especially in regards to the
“too big to fail” concept. I visited the
FactCheck website, which is from the
Annenberg Public Policy Center out
of the University of Pennsylvania.
The most recent article on the reform
bill that I could find was “More
Malarkey About Health Care” dated
April 19, 2010. The article does
conclude “that some Capitol Hill staff
workers may still continue to get
coverage the same way they always
have,” meaning they will not be subject
to the new health care bill. I guess
the details still need to be worked
out. Finally, I am not anti-government
and we could debate what role
government should play in the private
sector, but the crux of the article was
my opinion on how I feel the new
health care law will continue to add
to our deficit and how that deficit will
affect the economy in general and
investors in particular. Only time will
tell which one of your two scenarios
will play out regarding the health care
bill.
I appreciate your comments. It is our
ability to disagree and discuss our
differences that makes America great.
Mark
8
Pennsylvania General Assembly
The Pennsylvania General Assembly
returned to Harrisburg in midSeptember as PDA geared up for
election season and the end of the
legislative session.
Many of our legislative initiatives
remained undone when the General
Assembly adjourned for the summer.
Our first priority is to pass SB 1222
before the session ends in November.
This bill would prohibit all insurance
companies from capping fees on
services they do not cover under their
plans. We know this is an issue that
resonates with many members who
participate with insurance plans.
PDA continues to monitor and respond
to a number of other legislative issues,
advocating for the profession and your
patients on issues such as assigning
benefits to non-participating providers,
limiting insurers’ ability to retroactively
deny claims, the use of dental
amalgam, health care practitioner loan
forgiveness and policymakers’ call to
assess the ability for the underserved
and special needs patients to access
dental care.
We cannot accomplish these
legislative goals without your help.
Please take a few minutes to respond
to the CapWiz action alerts PDA
sends periodically to those members
with email addresses, or sign up
today to serve as a grassroots contact
dentist for your representative and
senator. Stay tuned for information
about the 2011 Day on the Hill,
which is slated for June 14. You’ll
find a registration form in the
November/December issue of the
Journal. All members, spouses and
dental students are encouraged to
attend.
on convincing members of the
House Appropriations Committee to
consider the bill. HB 1049 has not
moved from this committee.
Below are insights on some of the
issues that PDA will address before the
end of the year. Legislation that does
not pass will need to be reintroduced
next year.
• SB 1222, prohibiting insurers from
capping non-covered services:
PDA is working hard to correct an
unfair insurance practice that allows
insurers to cap those services not
covered under their dental plans.
This policy will significantly impact
your business operation and patients.
SB 1222, introduced on PDA’s behalf
by Sen. Kim Ward (R-Westmoreland),
was a primary focus for attendees
during Day on the Hill on June 8.
Those who attended were instrumental in having SB 1222 pass out of
the Senate Banking and Insurance
Committee that same day. PDA is
working to educate all senators about
the need to pass this legislation.
Please refer to the August edition
of Transitions to find out how you
can help pass this bill.
• HB 1049, insurance coverage
for general anesthesia when needed
for dental treatment for children
seven years of age and younger and
special needs patients: HB 1049
would allow dentists to use their
clinical judgment whether certain
children under the age of seven
need general anesthesia so they can
provide quality dental care. The bill
also would extend coverage to any
special needs patient of any age.
While it is difficult to pass insurance mandates, we are encouraged
that this bill has the momentum to
pass the House of Representatives.
Having been approved by the House
Insurance Committee in October
2009, PDA began focusing its energy
• HB 2509, Assignment of Benefits:
This legislation would require
insurers to assign benefits to those
providers who are not participating
providers in their patients’ insurance
plans. Rep. Thomas Murt
(R-Montgomery) introduced HB
2509 on PDA’s behalf and it is now
before the House Insurance
Committee for consideration.
Though it is unlikely this legislation
will pass either chamber before the
end of session, PDA is now educating lawmakers about this issue,
with the intent of reintroducing the
bill next session.
State Board of Dentistry
The State Board of Dentistry (SBOD)
is working on a number of issues
impacting the profession, including
who has the ability to administer
Botox and teeth whitening material.
The SBOD is also finalizing its plans
for how to implement the new
legislation that passed expanding the
scope of practice for expanded function dental assistants (EFDAs).
Allowing EFDAs to perform expanded duties allowed under Act 19
At its July meeting, the SBOD passed
proposed rulemaking that would
require all grandfathered EFDAs to
complete three hours of continuing
education on those duties now
allowed by law, specifically coronal
polishing. The three-hour requirement
is part of the 10 hours currently
required. Those EFDAs who will be
9
certified for the 2011-12 biennial
period would also have to obtain three
hours of continuing education. All
EFDA programs will integrate training
for these expanded functions into
their existing curriculums. These regulations are not yet final, but should
be in 2011.
Regulating Teeth Whitening as the
Practice of Dentistry
Due to growing concerns about the
preponderance of non-dental
professionals offering teeth whitening
services to the public, the SBOD
drafted a policy statement that would
effectively regulate teeth whitening
services as the practice of dentistry, to
be administered by dental professionals only.
10
The SBOD’s draft policy statement
states that tooth whitening may be
performed by a licensed dentist, or
other qualified dental staff (under
dentists’ direct supervision). Tooth
whitening is defined as any means or
methods used to whiten or bleach
teeth, or the dispensing of a toothwhitening agent to another person.
There is an exemption for those
products that consumers can purchase
over-the-counter. This policy is still
in draft form and must be approved
by offices in the Governor’s
Administration before it becomes final.
However, due to a pending lawsuit
against the North Carolina Board of
Dentistry regarding its policy restricting
tooth whitening as the practice of
dentistry, the SBOD is postponing
implementation of its policy statement
until the lawsuit is settled.
Regulating the Administration of
Botox and Dermal Fillers
The SBOD drafted a policy statement
stating that it considers it the practice
of dentistry when Botox products
and dermal fillers are administered to
the structures associated with the
human teeth or jaws, or associated
structures. If passed, this policy
statement will provide more guidance
to licensees and the public about
what is acceptable in the dental office.
Dentists who choose to perform this
service must be properly trained and
obtain informed consent from patients.
Stay turned for more information
once this policy statement is approved
and enacted.
A Call To Action
As John Adams once said, “Always vote
for principle, though you may vote
alone, and you may cherish the sweetest
reflection that your vote is never lost.”
With the 2010 statewide elections
just around the corner, it is imperative
that grassroots lobbying and volunteer
efforts be kicked into full swing. PDA
challenges our members to live up to the
aforementioned quote of John Adams
and cherish the fact that your vote as a
dentist means something, even if others
may disagree. The time and effort you,
as members, put into November’s
election will produce a profound result
on future legislation. Whether it is
contributing money to PADPAC,
writing to your state elected officials
or congressmen, or putting a candidate’s sign in your front yard, many
legislators will feel your influence and
appreciate your involvement.
When deciding whether to participate,
remember the battles of those legislators
up for re-election and their push to
pass legislation for you. Remember in
particular Sen. Jane Orie and Rep. Eddie
Day Pashinski and their dedication
to the dental profession by sponsoring
and helping pass HB 602, the EFDA
scope of practice legislation, and those
legislators who proudly voted in favor
of its passage. Without the aspirations
and the drive of these individuals,
this bill would still be in limbo in the
General Assembly. PDA encourages you
to take the time to contact Sen. Orie
and Rep. Pashinski especially, and
Become a
Mentor
we face everyday, and like Washington,
we too can and will stick together
and stay the course to write our own
history. Invest in PDA, and we will
surely make it worth your while.
Together, we can accomplish anything.
thank them for their commitment to
the profession.
And think about your PADPAC’s
achievements and the daunting challenge of finding new ways to interact
and voice your concerns to legislators.
The importance of PADPAC should
not go unmentioned; by continuously
donating to PADPAC you are investing
in the future. You are investing in
those noble men and women who
serve our state proudly and who are
everyday fighting for the interests of
the dental profession. We want you to
recognize the advantages of this
investment, and challenge you to take
a leap of faith and show your support.
Legislators want to hear from you,
and the more you get out and speak
directly to them, the more likely legislators will hear your call.
As George Washington once said,
“Associate yourself with men of good
quality if you esteem your own
reputation; for ‘tis better to be alone
than in bad company. Speak no evil of
the absent, for it is unjust. Undertake
not what you cannot perform, but
be careful to keep your promise. There
is but one straight course, and that is
to seek truth, and pursue it steadily.
Nothing but harmony, honesty, industry and frugality are necessary to make
us a great and happy nation.”
George Washington recognized the
importance of banding together as an
infant nation struggled to persevere
through the almost impossible challenges. PDA recognizes the challenges
Remember, the more member dentists
speak up and contact legislators, the
more we are combating opposition
from insurance companies and other
lobbies who are working against us.
PDA and PADPAC are here to help you
in this time of need, and no matter
what the issue, we stand firmly behind
you. As a reminder, all House of
Representatives seats and one-third of
Senate seats are up for re-election on
November 2. Reach out to your
representatives and let them know
you care and want to be heard. To find
out who your representative is, please
visit http://www.legis.state.pa.us.
We remind you that we do not back
a specific party, but only candidates
who fight for your issues and your
profession. To further discuss ways to
become involved in the election
process, donate to PADPAC or find out
whom your representatives are, please
contact Don Smith, government relations coordinator, at [email protected]
or (800) 223-0016, ext. 108.
Don Smith is a new member of the
government relations team, and would
be happy to attend district or local
dental society meetings to discuss
PADPAC or legislative issues. PDA
encourages you to take advantage of
this opportunity.
PDA recognizes new dentists and dental students as the future
of dentistry in Pennsylvania and wants to foster and encourage
their participation in the organized dentistry community.
Please show your support for new dentists, dental students
and the future of organized dentistry by agreeing to be a mentor.
Visit www.padental.org/mentoring to register as a mentor.
11
Membership Matters
A Checklist for Moving Your Practice
By Tori Rineer, Membership Coordinator
Perhaps you’re looking to downsize, expand or relocate your practice to a new area. Let PDA assist with making your
move as smooth and successful as possible with the “Moving Your Practice” Checklist.
Checklist for Moving Your Practice
❑ Determine a budget for the move
❑ Select new office location
❑ Professional Notifications
❑ Landlord/Lease holder
❑ Accountant
❑ Financial Institution
❑ Patients
❑ Display flyers in the office, discuss during
check-in or treatment, have staff give a reminder
at check-out
❑ Have new appointment and business cards,
stationary, address stamps and return mailing
labels made with the new office address
❑ Send postcards announcing the move to all
patients
❑ Include a message about the relocation in your
“on-hold” messaging system or after-hours
answering machine
❑ Pennsylvania State Board of Dentistry (SBOD)
• You must notify the SBOD within 10 days of a
change of office address.
• Contact information
Phone:
(717) 783-7162
Fax:
(717) 787-7769
E-mail:
[email protected]
Web:
www.dos.state.pa.us/dent
❑ Drug Enforcement Administration (DEA) Office –
Registration Change
• Registration changes (change of address) should
not be submitted until an approved state license
for the new address is received. Changes will
become effective immediately upon DEA approval.
• Phone, DEA Call Center: (800) 882-9539
Local Divisions
Philadelphia:(215) 238-5160
Pittsburgh: (412) 777-1870
Scranton:
(570) 496-1020
E-mail:
[email protected]
Web:
www.deadiversion.usdoj.gov
United States Postal Service: www.usps.com
Insurance providers
Electronic claims clearing house
Credit card companies
Professional Associations
• Pennsylvania Dental Association (800) 223-0016
We will forward your change of address to ADA
and your district/local dental society.
❑ Practice support providers:
❑ Utility companies, municipal services
❑ Practice software company
❑ Website design company
❑ Product supply companies
❑ Answering service company
❑ Patient payment/financing company
❑ Prepare the office
❑ Inventory supplies
❑ Disinfect instruments, countertops
❑ Properly dispose of refuse, chemicals, sharps
❑ Network by attending local dental society meetings in
new location
❑
❑
❑
❑
❑
Additional items for consideration:
❑ Place an advertisement in local newspapers
❑ Send thoughtful expressions of appreciation (flowers,
thank you cards or other modest gifts) to businesses
or referrals that helped to support your former office
❑ Thank your patients for staying with you and for
coming to your new location
The following resources can be used to help determine a
new location for your practice:
• Consider Pennsylvania! - Lists statistics for the number
of privately practicing dentists, population, number
of patients per dentist, average age of practicing
dentists and median household income, all broken
down by county. Contact PDA’s Membership
Department at (800) 223-0016 to request a copy or
simply visit www.padental.org/am/pdf/considerpa.pdf.
13
Membership Matters
ADA Library Materials
• Dental Office Design: A Guide to Building, Remodeling
and Relocating (2002)
• ADA Demographic Reports (State and County) The reports are valuable for dentists who are
establishing their practices or for those planning to
move. These reports also contain dentist profile
including county-level estimates of the number of
dentists, breakdown by primary occupation,
specialty, age and sex, population profile of county
level and benchmark data, current population
estimates and five-year projections. Reports also
include suggestions for evaluating a new practice
area. As State and County Demographic Reports are
custom-produced, please state the name of the
desired county(s) and state when ordering. Please
note that these reports are produced on a per-county
basis; one report equals one county. ($75 per report)
• A Guide to Closing a Dental Practice (2008)
• Practice Management – Starting Your Dental
Practice (Revised 2007)
• The Ultimate Dental PR Kit for Dentists and the
Dental Practice (2002)
This guide will help dental professionals develop
promotional and public relations campaigns for their
practices and shape public opinion about the
profession of dentistry. It discusses planning a public
relations campaign and provides examples of press
releases, speeches, public service announcements
and other promotional materials.
Many of these materials and more are available through the
Members’ Lending Library. All items found in the catalog
are free to PDA members, who are charged only nominal
shipping and handling fees. Visit www.padental.org/library
to view the entire library catalog or to place an order.
Supplemental ADA Materials
• New Practice Checklist – provides a list of key
issues frequently confronted by dentists opening a
new practice.
Welcome New Members!
Following is a listing of members who have recently joined PDA, along with the dental schools from which they graduated
and their hometowns.
Dr. Smriti Bajaj
University of Pittsburgh
Pittsburgh
Dr. Amy L. Cabe
West Virginia University
Canonsburg
Dr. William M. Crim
University of Maryland
Mifflintown
Dr. Jeffrey M. Gelb
University of Pennsylvania
Bryn Mawr
Dr. Miriam Behpour
Pittsburgh
Dr. Elsie M. Casimir
Temple University
Lower Gwynnedd
Dr. Sonal J. Dave
Philadelphia
Dr. Katarzyna I. Glab
Pittsburgh
Dr. Brendan P. Bernard
Mars
Dr. Jeremy R. Catherman
Clearfield
Dr. Kevin F. Dyer
New York University
Mechanicsburg
Dr. Sai Guduru
Boston University
Harrisburg
Dr. Nandhini Bogavelli
Boston University
Harrisburg
Dr. Kavitha D. Chadhalavada Dr. Mohammad B. Elkhatib
New York University
Blue Bell
Cherry Hill, NJ
Dr. Holly J. Branin
Temple University
York
Dr. Hal L. Cohen
Temple University
Philadelphia
14
Dr. Vincent P. Floryshak
Temple University
Chester Springs
Dr. Kamal Haddad
Case Western Reserve Univ.
Bethlehem
Membership Matters
Dr. William S. Heddaeus
Case Western Reserve Univ.
Penn Hills
Dr. Karl D. Maloney
New York University
Basking Ridge, NJ
Dr. Abhishek Pandit
Lancaster
Dr. Jacquline Tome
Breinigsville
Dr. Pieter H. Heemstra
Jefferson Hills
Dr. Richard C. Mandel
Springfield
Dr. Raj P. Patel
Temple University
Langhorne
Dr. Joshua Tran
Temple University
Tower City
Dr. Jaime L. Horne
Three Springs
Dr. Adam L. Martik
Pittsburgh
Dr. Matthew C. Poore
University of Maryland
Binghamton
Dr. Chinchai Hsiao
Philadelphia
Dr. Brian S. Martin
Blawnox
Dr. Tarik W. Jbarah
Reading
Dr. Mary J. Massaro
Temple University
Media
Dr. Christina R. RabijSchmeler
SUNY Buffalo
Pittsburgh
Dr. Daniel S. Van
Volkenburgh
Northwestern College
of Dental Surgery
Califon
Dr. Aditi Jindal
Pittsburgh
Dr. John Paul Matta
Poland
Dr. Brandon Kang
New York University
Wilkes Barre
Dr. Jonise A. McDaniel
Howard University
Harrisburg
Dr. Venkateswar R. Kapa
Boston University
Harrisburg
Dr. Amadee B. Merbedone
Fairchance
Dr. Steven Jae Doo Kim
Philadelphia
Dr. Damian C. Milillo
Temple University
Clifton Heights
Dr. Joseph A. Kobeski
Temple University
Chadds Ford
Dr. Bryan D. Mohney
Clearfield
Dr. Karessa Kuntz
University of Michigan
Pittsburgh
Dr. Heidi L. Moos
Alexandria, VA
Dr. Harold Ross Lambert
Newtown Square
Dr. Long Fnu Mugianto
Temple University
Radnor
Dr. Michael E. Lisien
Coraopolis
Dr. Adam W. Mychak
Pittsburgh
Dr. Monali Ma
Boston University
Philadelphia
Dr. Stephen J. Ollock
Temple University
Mainesburg
Dr. Rick A. Reinecker
Temple University
Reinholds
Dr. Felipe Rola
Lansdale
Dr. William J. Vincent
Temple University
East Petersburg
Dr. Timothy A. Weibley
SUNY Buffalo
Lemoyne
Dr. Lawrence Wong
Temple University
Philadelphia
Dr. Morgan S. Rutledge
University of Louisville
Greensburg
Dr. Jie Yang
Maple Glen
Dr. Kristen V. Scholl
Ardmore
Dr. Qing Yang
Philadelphia
Dr. Eric C. Seidel
Temple University
Gettysburg
Dr. Thadeus G. Zawislak
Temple University
Oil City
Dr. Maria B. Steed
Temple University
Cheltenham
Dr. Parveen Sultana
Philadelphia
Dr. Alan J. Tengonciang
Temple University
Philadelphia
Dr. Krishna C. Thumati
Boston University
Harrisburg
Dr. Loris J. Tinianow
Bryn Mawr
15
It’s Your Money
Fixed Income Investing
(Part 1)
By Mark J. Funt DMD, MBA
So far in this series, I have generally
written about investing in equities
(stocks). In this piece, I am going to
begin the discussion on fixed income
investing. Fixed income runs the
gamut from risk free, very short-term
savings/money market accounts, to
very risky long-term bond investing
and everything in between.
The bond market, a very large part
of the fixed income market, is a market
no different than the stock market.
Prices on bonds, like stocks, fluctuate
on an intra and inter day basis. As a
matter of fact, some people buy bonds
like they do stocks, in hopes of
capturing capital appreciation as well
as a fixed rate of return. Bonds come
in all shapes and sizes. There are
ultra-short, short, intermediate and
long-term bonds. There are zero
coupon, savings and Build America
Bonds. There are low, medium and
high quality bonds, taxable and tax
free bonds, very safe and very risky
bonds as well as low and high yielding
bonds. Just like stocks, the bigger the
risk you take in bond investing, the
greater the potential return. The yield
on bonds is generally based on the
past and present interest rates, the
year of maturity as well as the credit
quality of the issuer of the bond. Bonds
can be bought at par, at a premium
or a discount, the details of which will
be explained in a future article.
In order to be a serious bond
investor, you need to have some
understanding of the economy and
how fiscal and monetary policy affects
the economy, as well as how the
economy affects interest rates. As
always, I will try to explain these factors
in an over-simplified manner. The
first thing you need to know is that
the economy goes through natural
cycles of booms and busts. There are
periods of economic growth and
economic slowdowns that can lead to
recessions and even depressions.
After 6-7 years of economic growth,
the economy slipped into a recession,
which is defined as two consecutive
quarters of negative GDP (Gross
Domestic Product). Due to a series of
several very unfortunate economic
mishaps, which I have written about
in previous articles, this recession is
much worse than previous ones. In
many cases, the strength of the economic expansions and severity of the
economic downturns has to do with
how well the economy is managed
by the federal government. The truth
of the matter is that the President
of the United States has very little
control over the success and failure
of the economy, although he will get
the blame when the economy is failing
and the credit when it is strong. The
president, with approval of Congress,
can only do two things in controlling
fiscal policy — increase or decrease
governmental spending and/or
increase or decrease taxes. The Bush
administration opted to lower taxes
whereas the Obama administration
opted to increase government spending.
Some would question whether
spending money the government does
not have is a good idea to try to get
us out of a recession, but time will tell
who is and isn’t correct. The much
more powerful branch of the government is the Federal Reserve Board, the
body that controls monetary policy.
Although the Federal Reserve Chairman
is appointed by the President and
approved by the Congress, at this point
the Federal Reserve is completely
independent and autonomous from
the executive and legislative branches
of the government. The Federal
Reserve has many tools at its disposal
on how to accomplish its goals of
keeping the economy growing at a
healthy pace and keeping inflation
low, a daunting task to say the least.
The most powerful tool the Fed has
is to lower or raise interest rates. The
Fed tries to stay ahead of the curve
and be proactive with its monetary
policy. However, like the stock market,
the Fed often goes too far, too fast or
too slow in accomplishing its goals,
causing bubbles in the economy. As I
previously stated, besides promoting
economic growth, the Fed is very
concerned about controlling inflation.
Inflation is simply defined as too
many dollars chasing too few goods.
This is a simple supply and demand
equation. If lots of people have lots of
money to spend, businesses will
increase the price of their goods and
services.
A perfect example is the recent
housing bubble. As the Fed lowered
interest rates, more and more people
could get loans as money became
more available and the prices of homes
“literally” went through the roof.
Of course, one of the causes of our
present economic tsunami is that the
banks gave loans to people who
could never afford to pay them back.
Many people blame Alan Greenspan
(the former Fed chairman) for lowering rates too low too fast, creating the
housing bubble. However, as bad as
inflation is, the Fed is much more
concerned about deflation. Deflation
is defined as a decrease in prices.
Deflation is more destructive to the
economy then inflation. If businesses
have to lower prices, this will cut into
their profits and may mean layoffs
17
It’s Your Money
or even shutting their doors. It is
actually better for the economy when
a business has pricing power as
opposed to no pricing power. Again,
look at home prices. The deflation in
prices has caused a lot of people to
see the value of their homes decline
dramatically. In some cases, the prices
dropped so low, their mortgage was
worth more than their home and
they just walked away (foreclosed) on
their home. This negative wealth
effect not only makes people feel
poorer but also takes away the ability
for them to borrow from their home,
which many people did as a source
of funds for many of their larger
purchases, not to mention what it did
to the construction industry.
The Fed, like the stock market,
looks at a myriad of economic reports
to determine what decision it will
make regarding the lowering or raising
of interest rates in order to strike that
balance between fostering economic
growth and stable inflation. These
indicators include but are not limited
to GDP, housing starts, durable goods
orders, consumer and producer price
indices and the unemployment report.
All of these stats are readily available
to anyone who wants to ascertain them.
The Fed can only control very
short-term interest rates and the market and market forces will determine
long-term interest rates. In many
cases, the bond market will bid up
longer term interest rates in anticipation of the Fed increasing short-term
rates or lower rates if the market
feels the Fed will be cutting interest
rates. In some cases, if the bond market feels the Federal Reserve is ahead
of the curve when it increases shortterm interest rates, longer term bonds
interest rates will actually decrease.
Although this may seem contradictory
to what I have written, this phenomenon is referred to as a bear flattening;
because the market believes the tight-
18
ening of monetary policy will keep
inflation in check even if this means
a slowing of the economy, which will
eventually lead to a lowering of interest rates. I know it gets confusing.
Bond prices respond directly to these
interest rate changes. There is an
inverse relationship between interest
rates and the prices of bonds. As
interest rates increase, bond prices
decrease and as interest rates decrease,
bond prices will increase. Remember,
just like stocks, bond prices are
changing all the time. Of course, there
are other factors that can affect the
prices of bonds as well. However,
you cannot be a serious bond investor
without understanding interest rates
and having some idea as to which
direction interest rates are headed.
For example, if you think interest
rates are going up, you may want to
buy short-term bonds so you can
take advantage of buying longer term
bonds when interest rates increase.
On the other hand, if you think interest rates are going down, you may
want to not only lock in higher interest rates with longer term bonds, but
also take advantage of capital appreciation of your bond as rates decline.
You are probably wondering how
you know which way interest rates are
going. First of all, as I write this
article, interest rates are at a historical
low and can only go up because they
just cannot go any lower. Secondly,
as mentioned before, you must keep
abreast of economic indicators.
Finally, you must understand and
be able to interpret something known
as “the yield curve” which fortunately,
will be the next article in this series
on fixed income investing. Stay tuned!
Pennsylvania Medical Assistance:
Evaluation of Children’s
Access to Dental Services
By Monica Costlow, JD and Dr. Judith Lave
Introduction
Medicaid Importance
A recent report by the Pew Center on the States
estimates that 17 million low-income children in the
United States, about one in five of all those between the
ages of one and eighteen, go without dental care each
year.1 The same report assessed all 50 states and the
District of Columbia on ensuring dental health and
access to care for disadvantaged children. Pennsylvania,
along with eight other states, received a poor grade.
In this article, we examine dental care for disadvantaged children in Pennsylvania, specifically focusing on
the Medicaid program. Eligibility criteria, covered
dental services, expenditures, and access to and quality
of services are discussed. We describe initiatives
undertaken by the state and examine policy options for
further improvement. We find that the Medicaid
program in Pennsylvania plays a very important role in
the provision of dental services to low-income children.2
The Medicaid program, called Medical Assistance in
Pennsylvania, is the underpinning of the health care
safety net. Medicaid was created by Congress in 1965
under Title XIX of the Social Security Act. It pays for
medical and long-term care for eligible low-income
American citizens and certain legal immigrants. Financed
by the federal government and the state, Medical
Assistance provides health care coverage – the key to
accessing care – for the Commonwealth’s neediest, most
vulnerable residents, while paying providers such as
hospitals, dentists, doctors, and pharmacies for treatment
that would otherwise go largely uncompensated.
Children can qualify for Medical Assistance by either
meeting an income requirement or having a disability
determination. As shown in Table 1, income eligibility
is specified in terms of the federal poverty level (FPL)
and varies by age and family size. For example, children
19
Pennsylvania Medical Assistance: Evaluation of Children’s Access to Dental Services
ages 1-6 are eligible for Medical Assistance if their family
income is equal to or less than 133 percent of the FPL, which
is $33,728 for a family of 4.
Table 1: Medical Assistance Income Eligibility
Requirements for Children
Age
% of the FPL Income limit for a family of 4 (2010)*
0-1
185%
$46,916
1-6
133%
$33,728
6-19
100%
$25,360
*https://www.cms.gov/MedicaidEligibility/Downloads/POV10Combo.pdf
Children also qualify for Medical Assistance if they meet
the Social Security Administration (SSA) level of disability.
A child under age 18 is considered disabled if he or she has
a medically determinable physical or mental impairment
which results in marked and severe functional limitations
and (i) can be expected to result in death or (ii) has lasted
or can be expected to last for a continuous period of not
less than 12 months.3 In Pennsylvania, a child who meets
the disability standards is eligible for Medical Assistance
regardless of the family’s income and assets.4
In FY09, 35.5 percent of children in Pennsylvania,
or about one million children, were covered by Medical
Assistance.5 Across the counties, coverage ranged from
a high of 60 percent of children in Philadelphia County, to
a low of 14.6 percent in Chester County (Figure 1).6
Figure 1:
FY09 Percentage of
Children Covered
by Medical Assistance by
Pennsylvania County
Source: Pennsylvania Department
of Public Welfare Medical
Assistance Enrollment Data and
estimates from the US Census
Bureau
20
Dental Services
Delivery of Dental Services
Two delivery models are used to provide dental services in
Medical Assistance: managed care and fee-for-service (FFS).
About 73 percent of children enrolled in Medical Assistance
receive their dental services via managed care, while 27
percent access dental services via the FFS network.7
Covered Dental Services for Children
For Medicaid enrollees under the age of 21, federallymandated services and benefits are provided under the Early
and Periodic Screening, Diagnostic and Treatment (EPSDT)
program. EPSDT is intended to assure the availability
and accessibility of medically needed medical care and to
help children and families use them effectively.8 Dental
services are an EPSDT benefit. Pennsylvania Medical
Assistance covers all medically necessary dental services
for children, including9:
• Periodic oral exams
• Diagnostic dental services
• Preventative dental services, such as sealants and
topical fluoride treatment
• Emergency treatment for control of pain and infection
• Oral and maxillofacial surgery
• Fillings and tooth extractions
• Root canal treatments
• Prosthetic appliances, such as dentures and crowns
• Orthodontics for children who qualify
• Periodontal services for children who qualify
• Radiographs/diagnostic imaging
Dental Expenditures for Children
In 2008, Medical Assistance spent about $124.9 million
on dental services for children, or approximately $109 per
enrolled child.10 There was considerable variation in
expenditures across the counties in Pennsylvania. The
expenditures ranged from $72 per child in Tioga County
to $223 in Fayette County.11
These expenditures are low relative to the national average for all children, which we estimate was about $284 in
2008.12 Pennsylvania dental expenditures are relatively low
in part because Medical Assistance dental fees are low. The
Pew Center on the States reported that Pennsylvania’s
Medical Assistance reimbursement rates were 53.2 percent
of dentists’ median retail fees in 2008.13
Access to and Quality of Dental Care
for Children in Medical Assistance
DPW requires Medical Assistance managed care organizations (MCOs) to report on two performance measures
related to access to dental care: (1) the proportion of
children aged 3 to 20 who had an annual visit and (2) the
proportion of enrollees age 4 to 21 with developmental
disabilities who had an annual dentist visit.
Figure 2 shows the proportion of children ages 3 to 20
enrolled in a Medical Assistance MCO who had an annual
dental visit from 2005 through 2009.16 While in 2009, less
than half of the children enrolled in Medical Assistance
had an annual dental visit (42.8 percent), this proportion
has been increasing over time. There is considerable variation across the plans. In 2009, the proportion of children
who had an annual dentist visit ranged from 37.6 percent
at AmeriHealth to 45 percent at Health Partners.
Figure 2: Proportion of Medical Assistance Children
in Managed Care Age 4 to 21 with an Annual Dental
Visit from 2005 through 2009
Access to Care
The Pennsylvania Department of Public Welfare (DPW)
provided us with the most recent data on annual dental
visits for children who are enrolled in ACCESS Plus (FFS
Medical Assistance). Table 2 shows that among all children
and within each age group, the proportion of children
with an annual dental visit increased from 2006 through
2009.14 In 2006, only 38.72 percent of children had an
annual dental visit, while over 55 percent of children did
in 2009.15
Table 2: Proportion of Medical Assistance Children
in FFS Age 4 to 21 with an Annual Dental Visit from
2006 through 2009
2006
2007
2008
2009
2-3 years
13.39%
19.58%
22.25%
23.95%
4-6 years
44.51%
50.89%
58.68%
59.91%
7-10 years
47.95%
51.97%
59.56%
60.80%
11-14 years
44.22%
47.54%
53.11%
55.50%
15-18 years
40.32%
43.25%
48.01%
50.21%
19-21 years
27.45%
28.39%
35.21%
38.49%
Total
38.72%
42.68%
48.90%
50.59%
Source: Department of Public Welfare Data
Source: Office of Medical Assistance Programs, Division of Quality
Assessment. HealthChoices Performance Trending Reports for 2007 and
2009. http://www.dpw.state.pa.us/Resources/Documents/Pdf/
AnnualReports/2009HealthChoicesPerfTrendingReport.pdf and
http://www.dpw.state.pa.us/Resources/Documents/Pdf/AnnualReports/20
07HealthChoicesTrendRpt.pdf
Figure 3 shows the proportion of Medical Assistance
MCO enrollees with developmental disabilities who had an
annual dental visit from 2005 through 2009. Overall,
44 percent of these enrollees had an annual visit in 2009.
Between 2008 and 2009, there was a slight improvement in
performance of all plans with the exception of AmeriHealth.
Again, there is wide variation in each plan’s performance.
In 2009, the proportion of children with developmental
disabilities that had an annual dental visit ranged from 33.4
percent in AmeriHealth to 53 percent in Health Partners.
21
Figure 3: Proportion of Medical Assistance Children in
Managed Care Age 4 to 21 with Developmental Disabilities
Who had an Annual Dental Visit from 2005 through 2009
Dental Provider Participation in
Medical Assistance
In order for children covered by Medical Assistance to
receive dental services, their families must be able to find a
dentist who accepts Medical Assistance payment. Analysts
often use the dental participation rate or the proportion of
overall dentists who treat individuals covered by Medical
Assistance as an indicator of potential access.
Quality of Care
The proportion of Medical Assistance children who
receive dental sealants is one indicator of quality of care.
Figure 4 presents recent trends in the proportion of Medical
Assistance children enrolled in a MCO who turned 8 years
old and had a protective dental sealant applied to their
teeth during the three years prior to the eighth birthday.
Between 2005 and 2009, performance on this measure has
improved in five of the six plans for which we have data.17
In 2009, the proportion of children reaching the age of 8
who had dental sealants ranged from 27.6 percent at Unison
to 56 percent at AmeriHealth.
Figure 4: Dental Sealants for Medical Assistance
Children in Managed Care from 2005 through 2009
The Total Number of Pennsylvania Dentists
Every other year, the Pennsylvania Department of
Health (DOH) surveys all dentists licensed in Pennsylvania.
Based on the findings of its last survey in 2009, the DOH
estimates that there were 6,261 practicing dentists in
Pennsylvania in 2009.18 However, since the DOH estimates
do not include the 398 dentists19 who were licensed for the
first time in Pennsylvania that year, the total number of
practicing dentists should be increased to 6,659.
Pennsylvania Dentists Who Accept Medical Assistance
There are two sources of data on the number of dentists
who accept Medical Assistance in Pennsylvania: DOH and
DPW.
• Pennsylvania DOH asked dentists in the biennial
survey discussed above: “Do you accept any of the
following coverage plans: Medicaid, Medicare and
Private Insurance?” Using the data from the survey,
DOH estimates that 871 dentists in Pennsylvania
accepted Medical Assistance in 2009.20
• DPW maintains information on every dentist who is
enrolled in Medical Assistance. (A dentist must be
enrolled in Medical Assistance to be paid for providing
services for Medical Assistance recipients in either
the FFS program or managed care plans.21) DPW
prepares separate reports on the number of dentists
currently enrolled in Medical Assistance and the
number of dentists who received a payment in any
given year (active dentists). DPW indicates that
between May 2009 and April 2010, there were 1,723
active Medical Assistance dentists in Pennsylvania.22
22
We used the DPW data for the number of dentists
who accepted any Medical Assistance payment in 2009, as
our estimate of the number of dentists participating in
Medical Assistance. We did not use the DOH estimate
because it underestimates the number of dentists who
accept Medical Assistance, particularly in counties where
managed care is mandatory. For example, according to the
DOH data, 127 dentists accept Medical Assistance in
Allegheny County.23 However, directors of two large Medical
Assistance managed care plans in Allegheny County
indicated that their plans had contracts with 220 and 205
unique dentists, respectively.24
Using our estimates of the number of practicing dentists
(6,659) and DPW data on the number of dentists who
accepted Medical Assistance (1,723), we estimate that about
26 percent of the practicing dentists in Pennsylvania
accepted Medical Assistance in 2009.25 There are no recent
data on the proportion of dentists nationally who treat
Medicaid patients. In 1999, the United States General
Accounting Office surveyed state Medicaid programs.26
Of 39 states that provided information about dentists’
participation in Medicaid, 23 reported that fewer than half
of the states’ dentists saw at least one Medicaid patient
during 1999.27 These, and other findings, indicate that
dentist participation in Medicaid, across all states, is low.
Pennsylvania Dentists Accepting New Medical
Assistance Patients
There is considerable turnover (leaving the program and
then reenrolling) among the Medical Assistance population,
particularly children. Therefore, it is important to know
whether Pennsylvania dentists are accepting new Medical
Assistance patients. Using DOH data, we estimate that
approximately 94 percent of dentists who treated Medical
Assistance patients in 2009 are accepting new Medical
Assistance patients.28 This is a rough estimate given, that
the DOH data do not include all Pennsylvania dentists
who treat Medical Assistance patients.
Medical Assistance Program
Improvements
Between 2005 and 2010, Pennsylvania undertook a
number of initiatives to improve the dental portion of the
Medical Assistance program. Most of these changes were
directly applicable to Medical Assistance dentists who
worked in FFS, although some were targeted to Medical
Assistance MCOs.
• DPW required Medical Assistance managed care plans
to report on three dental variables.
• To reduce the administrative complexity of the
program, the number of procedures that required
prior approval by DPW was decreased. In addition,
DPW changed the coding system to create uniformity
in coding for both private insurance and Medical
Assistance patients. And, finally Medical Assistance
dentists are now able to file for payment electronically.
• DPW increased reimbursement levels for dental
services, as shown in Table 3. Between 2005 -2008,
fees were increased as much as 76 percent for certain
procedures.29
Table 3: Medical Assistance Dental Services With
Increased Fees
Year
Service
2005
Sedation/anesthesia
Behavior management services (these are services such
as that make it easier for dentists to manage complex
patients )
2006
Behavior management services; Orthodontic services
2007
Prophylaxis, fluoride treatments, endodontics, crowns
and extractions
2008
Fluoride varnish, endodontics, dentures, extractions
and orthodontics
Source: US Department of Health and Human Services: Centers for
Medicare & Medicaid Services, Region III (Pennsylvania EPSDT
Review Report- Dental Services. April 2008 Site visit) Final Report.
December 31, 2008.
• DPW expanded the Access transportation system
to help ensure that Medical Assistance children make
their dental appointments.30
• In 2008, an ACCESS Plus Dental Care/Disease
Management Program was implemented to encourage
greater access to care and to establish dental homes
for individuals less than 21 years of age.31
• DPW added language to the contract that contains
provisions for expanded activities related to the
management of dental services and provider network
development for ACCESS Plus.
23
• Pennsylvania increased the types of Medical Assistancecovered dental providers. In 2010, the Pennsylvania
General Assembly passed legislation to expand the duties
of expanded function dental assistants (EFDAs).32 The
expanded function dental assistants can now perform
coronal polishing, apply fluoride varnish, and take
impressions of teeth for athletic appliances. Currently,
Medical Assistance does not directly reimburse
expanded function dental assistants for services, but it
reimburses the supervising dentist for dental services
provided by expanded function dental assistants.
• On April 1, 2010, Medical Assistance began to
reimburse enrolled physicians and certified registered
nurse practitioners for the application of topical
fluoride varnish for eligible children.33 However,
although children of all ages can benefit from fluoride
varnish, Medical Assistance restricts the application
of fluoride varnish by physicians and certified
registered nurse practitioners to children from birth
through four years of age.
• In 2010, the state added a dental-related measure to
the pay-for-performance program.
We cannot assess the impact of these policies on Medical
Assistance children’s use of dental services, although we
suspect that the impact of these changes is positive. We
note that there was a significant increase in annual dental
visits among all children aged 4-21 covered by Medical
Assistance FFS and MCOs.
Options to Consider for Improving
Dental Care for Children Under Medical
Assistance
Pennsylvania has a shortage of Medical Assistance dentists, especially in rural areas. This deficit could be
addressed in part by making greater use of other medical
providers. Children in Pennsylvania see primary medical
care providers such as pediatricians, physicians, nurse
practitioners, physician assistants, and nurses for checkups and evaluations for school. It is generally understood
that the primary care setting may be an ideal place to
deliver preventive dental services, such as an oral health
assessment, fluoride varnish and parental education, for
children enrolled in Pennsylvania Medical Assistance.
As a result, many state Medicaid programs are reimbursing
physicians, certified registered nurse practitioners or
physician assistants for dental services. North Carolina’s
Into the Mouth of Babes, a preventive dentistry program
24
that targets children from birth to three years of age,34
utilizes pediatricians, family physicians, nurse practitioners,
nurses, physician assistants and other public health
workers in community health clinics to provide dental
services to Medicaid children. After successfully completing
a training period, providers are eligible to bill Medicaid
up to six visits for oral care provided during the first three
years of a child’s life.35 The covered dental services include:
risk assessment, oral screening, prevention services such as
fluoride application and education for parents and children.36
Pennsylvania has taken a step in this direction with its
current policy to reimburse enrolled physicians and
certified registered nurse practitioners for the application
of fluoride varnish to children aged zero through four.
Pennsylvania could go even further by directly reimbursing
other medical providers to expand the availability of
dental care for Medical Assistance children, similar to the
North Carolina medical model.
Another approach is the state of Washington’s Access
to Baby and Child Dentistry (ABCD) program. ABCD works
to: enroll Medicaid-eligible children by age one; educate
families about dental hygiene and eating habits; provide
outreach and case management; train dentists in best care
practices for young children; and create referral networks of
pediatric dentists for children with more difficult treatment
needs.37 From 1997 to 2008, the number of Medicaid
children under age six who received annual dental care
more than doubled because of ABCD.38 Pennsylvania could
consider a pilot program similar to ABCD to improve children’s dental health.
We acknowledge a final option is to continue increasing
dental fees to reach the national Medicaid average of 60.5
percent of retail fees.39 However, budget constraints may
cause this to be impossible in the current fiscal and political
climate.
Conclusion
About one-third of the children in the Commonwealth
receive dental care services through the Medical Assistance
program. Although the proportion of Medical Assistance
children that had an annual dentist visit has increased
markedly overtime, but is still low by national standards.
According to the Kaiser Family Foundation, about 60
percent of children covered by public insurance had an
annual dental visit.40 An important factor influencing
access to care is dental provider participation in Medical
Assistance. We estimated that only 26 percent of
Pennsylvania’s practicing dentists treated and billed for at
least one Medical Assistance patient in 2009. That proportion is low. This is concerning because 55 Pennsylvania
areas are experiencing a shortage of dental professionals
and the number of licensed dentists has decreased.41
Pennsylvania has also undertaken a number of important
initiatives to streamline and improve the Medical Assistance
program. We believe that these changes should have a
positive effect on children’s dental health, but future data
and formal evaluations of the initiatives will reflect
Pennsylvania’s grade. It will probably be difficult to increase
the proportion of Pennsylvania dentists without a major
increase in fees, which is currently unlikely. In the meantime, Pennsylvania may be able to increase children’s access
to dental services by considering policies to improve the
delivery of dental services in the Medical Assistance program,
similar to the North Carolina and Washington models.
Monica Costlow, JD is a Senior Policy Analyst with the
Pennsylvania Medicaid Policy Center at the University of
Pittsburgh. Ms. Costlow earned her JD from the University
of Pittsburgh School of Law, in addition to an Advanced
Certificate in Health Law. She previously worked as a compliance consultant for a multi-specialty physician practice.
Dr. Judith Lave is a Professor of Health Economics,
Director of the Health Administration Program, Director
of the Pennsylvania Medicaid Policy Center and co-director
of the Center for Research on Health Care at the University
of Pittsburgh. Prior to coming to the University of
Pittsburgh, she was the Director of the Office of Research
at the Health Care Financing Administration, now CMS. She
received her PhD in economics from Harvard University.
She is the author of more than 140 scientific publications.
FOOTNOTES
1 The Pew Center on the States, The Cost of Delay: State Dental Policies Fail
One in Five Children, February 2010.
2 The focus of the article is on children’s dental services, but we would like to
acknowledge that Pennsylvania Medical Assistance covers a
comprehensive dental package for most enrolled adults and limited
emergency dental services.
3 Disability Evaluation Under Social Security, September 2008.
http://www.ssa.gov/disability/professionals/bluebook/general-info.htm
4 If a disabled child is in a family that has a private insurance policy, than the
private health insurance policy is the primary payer. Medical Assistance covers those services that are not covered by the private health insurance policy.
5 Pennsylvania Department of Public Welfare Medical Assistance Enrollment
Data, Author calculation
6 Id.
7 US Department of Health and Human Services: Centers for Medicare &
Medicaid Services, Region III (Pennsylvania EPSDT Review Report- Dental
Services. April 2008 Site visit) Final Report. December 31, 2008.
8 Id.
9 Medical Assistance Handbook, http://www.dpw.state.pa.us/oimpolicymanuals/manuals/bop/ma/Table%20of%20Contents.htm
10 Department of Public Welfare Data, Author calculations
11 Id.
12 Hiroko et al estimated that in 2005 average dental expenditures per child
were $252, which is about $284 in current dollars. (Hiroko I. et al. “Dental
care needs, use and expenditures among U.S. children with and without special health care needs.” J Am Dent Assoc 2010; 141; 79-88.) More current
data on expenditures per child are not available.
One in Five Children, February 2010. This is the FFS Medical Assistance
reimbursement rate. Managed care payment rates are proprietary.
14 Department of Public Welfare Data. These data relate to children who are
continuously enrolled (i.e. they may have no more than one enrollment
gap of 45 days) over the measurement year, which goes from January 1 to
December 31.
15 Id.
16 The dates in the graphs are for the reporting year and actually refer to use
in the prior year. In addition, Medical Assistance MCOs determine utilization
rates using either 10 or 12 month continuous enrollees. CMS uses the total
number of children enrolled in Medical Assistance, which they determined
to be 27 percent in their 2006 report.
17 Note that data for Gateway for 2008 and 2009 are not available because of
administrative errors by a dental contractor. Information provided to authors
by Gateway Health Plan.
18 Pennsylvania Department of Health, “2009 Pulse of Pennsylvania’s Dentist
and Dental Hygienist Workforce.” Volume 4, October 2009.
19 Pennsylvania Department of State Data
21 Medical Assistance MCOs are able to negotiate fees and reimburse Medical
Assistance non-participating dentists for services rendered on an out-of-network basis.
22 Department of Public Welfare Data
23 Id.
24 Information provided to authors. These dentists may identify the Medical
Assistance managed care plans as being private insurance.
26 United States General Accounting Office, “Oral Health: Factors
Contributing to Low Use of Dental Services by Low-Income Populations,”
GAO/HEHS-00-149, September 2000.
27 Id.
29 US Department of Health and Human Services: Centers for Medicare &
Medicaid Services, Region III (Pennsylvania EPSDT Review Report- Dental
Services. April 2008 Site visit) Final Report. December 31, 2008.
30 Id.
31 Id.
32 Previously HB602, now Act 19
33 Pennsylvania Department of Public Welfare, Medical Assistance Bulletin
http://www.dpw.state.pa.us/PubsFormsReports/NewslettersBulletins/0036731
69.aspx?BulletinId=4526
34 R. Gary Rozier, et al. Prevention of Early Childhood Caries in North Carolina
Medical Practices: Implications for Research and Practice. Journal of Dental
Education, Volume 67, Number 8.
35 Shelly Gehshan and M. Wyatt, “Improving Oral Health Care for Young
Children.” National Academy for State Health Policy, April 2007.
36 Id.
37 The Pew Center on the States, “Washington’s ABCD Program: Improving
Dental Care for Medicaid-Insured Children” June 2010.
38 Washington Dental Service Foundation, “Access to Baby and Child Dentistry
Program,” http://www.deltadentalwa.com/Guest/Public/AboutUs/
WDS%20Foundation/Strategic%20Focus%20and%20Programs/Access%20to
%20Baby%20and%20Child%20Dentisty.aspx
One in Five Children, February 2010.
40 The Kaiser Commission on Medicaid and the Uninsured, “Dental Coverage
and Care for Low-Income Children: the role of Medicaid and SCHIP.”
January, 2008.
41 Pennsylvania Department of Public Welfare, Dental Information for
Stakeholders and Advocates, http://www.dpw.state.pa.us
25
Kristopher Bennion, DMD1, Andres Pinto, DMD, MPH2,
Jena Roath3, and Rochelle G. Lindemeyer, DMD4
Private Practice New Braunfels, Texas1, University of
Pennsylvania School of Dental Medicine, Department of
Oral Medicine2 , Dental Student, University of
Pennsylvania School of Dental Medicine3, and University
of Pennsylvania School of Dental Medicine, Division
of Pediatric Dentistry4
A Survey of Senior
Dental Students’
Experiences with
Young Dental Patients
in Pennsylvania
*Corresponding author:
Rochelle G. Lindemeyer, D.M.D
Department of Pediatric Dentistry
University of Pennsylvania School of Dental Medicine
240 S. 40th Street
Philadelphia, PA 19104
[email protected]
Telephone: 215-776-6671
FAX 215-590-5990
ABSTRACT
The purpose of this study was to determine graduating dental students’ perceptions about their training and
experience in examination and treatment of infants and their plans to examine infants upon graduation. A survey
was distributed to dental students graduating from Pennsylvania dental schools in 2007 and 2008. Of the
returned surveys, 47.9 percent correctly identified 12 months as the recommended age for the first dental exam.
Sixty-five percent of responders felt they would be comfortable performing exams on young children. This
study’s primary objective was to test the association between performance of a clinical exam in a young child,
enjoyment of clinical and didactic pediatric dental experience, plans for additional training in pediatric dentistry
and willingness to see children younger than two years old in practice. Performing a clinical exam on a young
child was associated to willingness to see children younger than two years of age in practice. Early exposure
(lecture or clinical) to young pediatric patients while in dental school was significantly associated to perceived
comfort with oral exam of young patients but not to reported willingness to see them in practice.
Key words: pediatric dentistry, dental education, infant dental care
26
A Survey of Senior Dental Students’ Experiences with Young Dental Patients in Pennsylvania
INTRODUCTION
According to the Third National Health and Nutrition
Examination Survey (NHANES III), although the incidence
of dental caries is concentrated among 20-25 percent of
children, dental caries remains one of the more prevalent
childhood diseases. For most Americans, oral health status
has improved during the period of 1988-1994 and
1999-2004. However, for youths 2-5 years of age, dental
caries in primary teeth has increased.1 A study in 2002
concluded that a substantial number of children in this
country do not receive professionally recommended
preventive care, particularly dental care.2 In response to
pediatric dentistry’s move away from a surgical model of
treatment and toward a model concentrated on preventive
medicine, the American Academy of Pediatric Dentistry
recommended in 1985 that the first visit for every child
occur no later than 12 months of age.
The goals of this first visit are to assess the risk for dental
disease, initiate a preventive program, provide anticipatory
guidance and decide on the periodicity of subsequent
visits.3 In spite of these recommendations, several studies
have indicated that there is a misunderstanding or disagreement among general practitioners about these guidelines.4-8 In a 2001 random survey of general practitioners
representative of the 9 regions of the U.S., only slightly
more than half (53 percent) of the respondents were aware
of the ADA and AAPD recommendation that a child’s first
dental visit should be no later than 12 months.5 General
dentists will often be asked to see children for their initial
dental visits, as the current shortage of pediatric dentists
makes it impossible for all age one dental visits to be
performed by pediatric dentists. Although general dentists
may be available in areas of shortage of pediatric dentists,
studies have shown a general lack of willingness of general
dentists to treat young pediatric patients under the age of
two years.6, 9, 10 Several studies have explored possible
reasons for this, including lack of training or exposure to
young pediatric dentistry patients while in dental school.11, 12
There is a strong association between a dentist’s willingness
to perform certain dental procedures and their dental
school training.13, 14 Studies have shown that when dental
students were provided with a program directed toward
more exposure to young pediatric patients, they were more
prepared to provide care to these patients after graduation.4, 14-17 A survey sent to 3,559 randomly selected general
dentists in Texas found that the level of dental school
training was significantly associated with the dentists’
attitudes toward providing dental care to Medicaid-enrolled
preschool-aged children.4 Pre-doctoral clinical infant oral
health programs were established at the University of
Michigan School of Dentistry15 and the University of North
Carolina at Chapel Hill.16 Surveys were distributed and
respondents who had attended these programs felt better
prepared to conduct oral examinations in children aged
0 to 36 months than those who had not participated in the
programs. Similarly, dental students who rotated through
a public health based “Infant Oral Health Program” in
Iowa were reported being more willing to see very young
children when compared to dentists who did not rotate
through such a program.14
Academic and clinical training in pediatric dentistry pose
a similar challenge. Faculty shortages nationwide have
impacted the pediatric dental workforce. As discussed by
Seale and Casamassimo,11 the educational system has a
shortage of faculty trained in the care of children and
increasingly relies on general dentists to teach pediatric
dentistry. As a result, the teaching pool becomes limited to
manageable children with a low level of disease. They
further suggested that a relative lack of hands on experience
treating young children in predoctoral pediatric dentistry
programs might negatively affect access to care in the U.S.
Most schools are teaching the first dental visit at 12 months
or younger, but only half provide actual experiences with
infants.18
The purpose of this study is to survey graduating dental
students from the three dental schools in Pennsylvania
on their perceptions on training in infant oral health (IOH),
examining young pediatric patients and their perceived
willingness to do so upon graduation in their own practices.
The primary hypothesis tested is that there is an association
between performance of a clinical exam on a young child,
desire for additional training in pediatric dentistry, enjoyment of clinical and didactic training in pediatric dentistry
and willingness to see children younger than 2 years of
age in practice.
The second hypothesis that will be tested is that there is a
difference between exposure to the clinical exam of a young
child in a lecture setting versus a clinical setting and
subject’s perceived comfort to do an exam in a young child.
The third hypothesis to be tested is that there is a difference between observing an operative procedure on a child
younger than 5 years of age versus performing the procedure, and subject’s perceived comfort with an oral exam in
a young child. The purpose of the analysis is to observe if
the “intensity” of exposure has any influence on the subSeptember/October 2010 • Pennsylvania Dental Journal
27
ject’s comfort level with clinical examination of young
children and perceived willingness to provide care to
young children in practice.
Fig 1. Graduating dental students’ exposure to infant oral
examination on patients younger than 2 years of age.
YES
M AT E R I A L S A N D M E T H O D S
Subsequent to Institutional Review Board approval,
anonymous paper surveys were distributed by mail to
graduating dental students from the three Pennsylvania
dental schools: University of Pennsylvania School of
Dental Medicine, Kornberg School of Dentistry Temple
University and University of Pittsburgh School of
Dental Medicine. The survey consisted of 15 questions
divided into 3 main categories and based on the
guidelines for infant oral health from the American
Academy of Pediatric Dentistry. Five questions related
to student’s pediatric dental didactic education with
respect to infant oral health. Six questions related to
student’s experiences in examining pediatric patients
younger than two years of age, and four questions
related to student’s intentions to examine pediatric
patients in their practices upon graduation.
Statistical Analysis
No formal sample size calculation was performed as the
intent was to capture the universe of graduating senior
dental students in Pennsylvania. Chi-Square analysis
was used to determine if a statistically significant association existed between variables of interest. A double
tailed analysis was set up with a significance level of
p<.05 (Stata v.10.1 Statacorp, College Station, Texas).
NO
90.0%
80.0%
70.0%
60.0%
50.0%
40.0%
30.0%
20.0%
10.0%
0.0%
Taught how
to perform exam
in lecture
Observed exam
performed in
the classroom
Observed exam
performed in
a clinical setting
Performed
exam themselves
Fig 2. Patient age groups that graduating dental students would
be willing to see in their own offices upon graduation.
35.0%
30.0%
25.0%
20.0%
15.0%
10.0%
5.0%
0.0%
R E S U LT S
A total of 400 surveys were distributed. There was a
response rate of approximately 42 percent with 167
returned surveys. Eighty (47.9 percent) of the surveys
correctly identified 12 months as the recommended age
for the first dental exam. Of the returned surveys,
73 (44 percent) reported they had been taught how to
perform an infant oral exam in lecture while 41 (24.6
percent) stated that they had seen an exam performed
in a classroom setting, with another 45 (26.7 percent)
having seen an exam performed in a clinical setting
(Fig. 1). Only 28 (16.9 percent) stated that they
themselves had performed an examination on a patient
younger than 2 years of age. (Fig. 2). Only 18 percent
of participants stated they planned to see patients
younger than 2 years of age upon graduation. As patient
age increased, student willingness to provide dental
care to children increased as well, with 22.6 percent
willing to see 3-6 year olds, 29.3 percent willing to treat
28
0-2 years of age
3-6 years of age
7-11 years of age
12+ years of age
Fig 3. Percentages of dental students who are willing
to see children younger than 2 years of age in their own
offices based on their experiences in dental school.
YES
NO
80.0%
75.0%
70.0%
65.0%
60.0%
55.0%
50.0%
45.0%
40.0%
35.0%
30.0%
25.0%
20.0%
15.0%
10.0%
5.0%
0.0%
Performed infant
exams in
Dental School
Plans on taking
classes in
Pediatric Dentistry
post graduation
Enjoyed their
didatic training
Enjoyed their
clinical training
Table 1. Analysis of variables that may affect dental students’ willingness to treat pediatric patients younger than
2 years of age upon graduation (NS=not significant). Percentages have been rounded.
Performed an Infant exam
while in dental school
Yes: n=28 (17 % of total)
Willing to see
children < 2 years of age
upon graduation
Yes: n=13 (46%)
No: n=15 (54%)
Yes: n=21 (25%)
No: n=62 (74%)
Yes: n=24 (23%)
No: n=82 (77%)
Yes: n=25 (20%)
No: n=99 (80%)
(p=0.024)
Plans on taking classes in pediatric
dentistry after graduation
Yes: n=83 (50% of total)
(NS)
Enjoyed didactic training
in pediatric dentistry
(NS)
Enjoyed clinical training in
Pediatric dentistry
(p=0.03)
7-11 year olds and 30.5 percent stating they would only
see children over the age of 12 years. Twenty five percent
of responders stated that they planned to take continuing
education dealing with pediatric dentistry upon graduation. Twenty percent of students enjoyed their time in the
pediatric clinic and 22.5 percent stated that they enjoyed
their didactic training in pediatric dentistry (Fig.3).
Performing an infant dental exam while in school and
perceived enjoyment of clinical pediatric dental training
were significantly associated to willingness to see infants
below 2 years of age. (Table 1). Perceived satisfaction with
didactic pediatric training was not associated to willingness
to provide care to children younger than 2 years of age.
Didactic and clinical exposure to exam of a young child
was statistically associated to subject’s perceived comfort
level with this exam. (Table 2) Similarly, both observation
and performance of an operative procedure on a child
younger than 5 years of age were associated with subject’s
perceived comfort with the clinical exam of a young child.
(Table 3)
DISCUSSION
Our findings support the concept that there is a link
between a dentist’s willingness to perform procedures and
their dental school training. The main finding of our
survey was that if a student performed an examination on
a child younger than 2 years of age while in dental school,
they were more willing to do so upon graduation. In spite
of the guidelines established by the AAPD, a majority
of graduating dental students in Pennsylvania do not feel
prepared to follow these recommendations. Furthermore,
less than half of the dental students could identify 12
months as the recommended age for the first dental exam.
When considered as a single group, students who enjoyed
clinical and didactic pediatric instruction tended to have
performed an infant clinical examination while in dental
school. However, this association did not yield significant
results when separately evaluating the effect of didactic
and clinical training on willingness to see infants younger
than 2 years of age. However, any level of exposure to
infant exam (didactic or clinical) was associated to senior
29
dental students’ comfort with performing on oral exam in
young individuals. The rationale for this finding may lie in
the structure of the question in the survey that addressed
students’ comfort level with clinical exam of young children, without mentioning age, versus the specific question
regarding willingness to see children younger than 2 years
old. Responders may have been comfortable with the exam
but not interested in performing continuing care to very
young patients. Interestingly, willingness to take continuing
education in pediatric dentistry did not affect the desire to
see children younger than 2 years of age after graduation.
Our findings are consistent with those of other
authors13,14, 15, 17, 18 who reported significant associations
between attitudes and hands-on educational experiences
with very young children. With the shortage of pediatric
faculty and subsequent decreases in faculty-student ratios,
patients demonstrating behavior management challenges
or complex restorative care requiring close faculty
supervision will probably not be accepted in pre-doctoral
clinics.11 Pediatric dental clinics increasingly rely on
general dentists to teach pediatric dentistry, who may
themselves feel less competent in dealing with the very
young child. Young children are therefore often sent
immediately to the graduate clinics for examination and
treatment regardless of their dental needs. Pre-doctoral
pediatric dentistry programs teach students to treat
children four years of age and older, who are generally
well-behaved.11
This study was limited by the response rate as there is
potential bias in that those students responding were those
who enjoyed pediatric dentistry. In addition, this study did
not attempt to distinguish those who were planning to
enter an advanced program in pediatric dentistry. Students
who did not enjoy pediatric didactic or clinical experience
in dental school may have been oriented towards other
specialties, introducing sampling bias.
The majority of graduating dental students from Pennsylvania
dental schools have not performed or seen an infant exam
performed while in dental school, and they do not plan to
see children younger than two years of age in their own
offices upon graduation. This continues to create a barrier
to access to care for young children in the state. With
general dentists staffing most of the federally qualified health
centers in the state of Pennsylvania, it is critical to expose
pre-doctoral dental students to clinical contact with very
young patients. If general dentists provided screenings and
anticipatory guidance for young healthy children, while
referring children with more extensive needs to pediatric
dentists, it is possible that more parents would access
dental care for children at an earlier age. Given the survey
design, it was not possible to separate responders by
academic institution or geographic area, which could affect
the generalizability of our findings. The results reported in
this study must be interpreted with caution. This study
was not designed with a priori sample size calculation, and
several groups of responders had lower number of responses
per cell, which could have influenced the statistical analysis.
Table 2. Comparison between classroom instruction, clinical observation of a clinical exam of a child younger
than 2 years old, and subject’s perceived comfort to do an exam on a young child.
Taught to do an oral exam in
children <2 yrs old
in the classroom p=0.002
Subject’s perceived comfort to do
an exam on a young child
Total
Yes
No
YES
n=53
n=10
63
NO
n=57
n=37
94
YES
n=34
n=6
40
NO
n=75
n=41
116
Observed an oral exam on a child
<2 yrs old (clinical setting) p=0.01
30
Table 3. Comparison between performing an operative procedure on a child younger than 5 years old, observing a
clinical procedure on a child younger than 5 years old, and subject’s perceived comfort to do an exam on a young child.
Performed operative procedures
in children <5 yrs old p=0.004
Subject’s perceived comfort to do
an exam on a young child
Total
Yes
No
YES
n=64
n=16
80
NO
n=44
n=31
76
YES
n=92
n=28
120
NO
n=17
n=19
36
Observed operative procedures
in children <5 yrs old p=0.001
CONCLUSIONS
Eighty two percent of graduating dental students from
Pennsylvania dental schools do not plan to see children
younger than two years of age in their own offices
upon graduation. Students who have performed infant
exams while in dental school are more likely to be willing
to see patients younger than 2 years of age in their own
offices upon graduation from dental school. Any level
of exposure to pediatric dentistry (lecture or clinical) was
associated with self-perceived comfort with oral exam
of young children, but not with willingness to see
patients younger than 2 years of age in practice. Barriers to
access to care for children in Pennsylvania may be related
in part to the lack of clinical exposure to infant exams in
pre-doctoral dental education in pediatric dentistry.
(6)
REFERENCES
(14)
(1)
(2)
(3)
(4)
(5)
Dye BA, Tan S, Smith V, Lewis BG, Barker LK, Thornton-Evans G, et al.
Trends in oral health status: United States, 1988-1994 and 1999-2004.
Vital Health Stat 2007; (248):1-92.
Yu SM, Bellamy HA, Kogan MD, Dunbar JL, Schwalberg RH, Schuster MA.
Factors That Influence Receipt of Recommended Preventive Pediatric
Health and Dental Care. Pediatrics 2002; 110(6):e73.
Nowak AJ. Rationale for the timing of the first oral evaluation. Pediatr Dent
1997; 19(1):8-11.
Cotton KT, Seale NS, Kanellis MJ, Damiano PC, Bidaut-Russell M,
McWhorter AG. Are general dentists’ practice patterns and attitudes about
treating Medicaid-enrolled preschool age children related to dental school
training? Pediatr Dent 2001; 23(1):51-5.
Seale NS, Casamassimo PS. Access to dental care for children in the United
States: A survey of general practitioners. J Am Dent. Assoc 2003;
134(12):1630-40.
(7)
(8)
(9)
(10)
(11)
(12)
(13)
(15)
(16)
(17)
(18)
Santos CL, Douglass JM. Practices and opinions of pediatric and general
dentists in Connecticut regarding the age 1 dental visit and dental care for
children younger than 3 years old. Pediatr Dent 2008; 30(4):348-51.
Brickhouse TH, Unkel JH, Kancitis I, Best AM, Davis RD. Infant oral health
care: A survey of general dentists, pediatric dentists, and pediatricians in
Virginia. Pediatr Dent 2008; 30(2):147-153.
Salama F, Kebriaei. Oral care for infants: A survey of Nebraska general dentists. Gen Dent 2010; 58(3):182-7.
Shulman ER, Ngan P, Wearden S. Survey of treatment provided for young
children by West Virginia general dentists. Pediatr Dent 2008; 30(4):352-7.
Siegal MD, Marx ML. Ohio dental care providers’ treatment of young children, 2002. J Am Dent Assoc. 2005; 136(11):1583-91.
Seale NS, Casamassimo PS. U.S. predoctoral education in pediatric dentistry: its impact on access to dental care. J Dent Educ 2003; 67(1):23-30.
Rich JP, III, Straffon L, Inglehart MR. General Dentists and Pediatric Dental
Patients: The Role of Dental Education. J Dent Educ 2006; 70(12):1308-15.
Smith CS, Ester TV, Inglehart MR. Dental Education and Care for
Underserved Patients: An Analysis of Students’ Intentions and Alumni
Behavior. J Dent Educ 2006; 70(4):398-408.
Weber-Gasparoni K, Kanellis MJ, Qian F. Iowa’s public health-based infant
oral health program: A decade of experience. J Dent Educ 2010;
74(4):3633-71.
Wandera A, Feigal RJ, Green T. Preparation and beliefs of graduates of a
predoctoral infant oral health clinical program. Pediatr Dent 1998;
20(5):331-5.
Lekic PC, Sanche N, Odlum O, deVries J, Wiltshire WA. Increasing general
dentists’ provision of care to child patients through changes in the undergraduate pediatric dentistry program. J Dent Educ 2005; 69(3):371-7.
Fein JE, Quinonez RB, Phillips. Introducing infant oral health into dental
curricula: A clinical intervention. J Dent Educ 2009; 73(10):1171-7.
McWhorter AG, Seale NS, King SA. Infant oral health education in U.S.
dental school curricula. Pediatr Dent 2001; 23(5):407-9
31
Building Alliances
for Better Oral Health
MA Reimbursement for
Topical Fluoride Varnish by
Primary Care Practitioners
By Paul R. Westerberg, DDS
Chief Dental Officer, Department of Public Welfare
As of April 1, 2010, Pennsylvania joined the vast
majority of states whose Medicaid programs offer reimbursement to primary care physicians and other licensed
medical professionals for the appropriate application of
topical fluoride varnish to the teeth of young children.
This achievement represents a significant milestone in a
process that has taken years of collaborative effort involving individuals from a variety of concerned organizations
that included the Pennsylvania Dental Association (PDA),
Pennsylvania Department of Public Welfare’s Office of
Medical Assistance Programs (OMAP), the Pennsylvania
Chapter of the American Academy of Pediatrics (PAAAP)
and the Pennsylvania Academy of Family Physicians
(PAFP). Cooperative input from all parties involved has led
to the availability of an effective tool for the prevention
of dental caries for strategically-placed health professionals.
It has also created potential for a new environment of
interdisciplinary collaboration leading to overall health
improvement for Pennsylvanians.
Why is this type of program necessary?
The etiology of dental caries is that of an infectious disease; inoculation with pathogenic bacterial flora generally
occurring during infancy from contact with caregivers.
The most recent NHANES data available pegs the caries
rate for children ages 2-5 at 28 percent, with nearly three
quarters of those children having untreated decay.1
Children whose socio-economic status is below the federal
poverty level as a group have a significantly higher dental
caries rate than children in more affluent circumstances.2
Unfortunately, because there are multiple factors
negatively influencing access to care for this population
segment, many young children who are at significant risk
for dental caries are not getting the age appropriate
32
preventive care that they need. Population estimates for
Pennsylvania based on age indicate that there are approximately 750,000 children under 5 years of age in the state.3
More than 245,000 of those children (33 percent, approximately 1 in 3) are between the ages of 1 and 5, should
have experienced eruption of primary teeth and are eligible for MA dental benefits.4 Children eligible for MA are
eligible to receive necessary dental services from birth
until their 21st birthday. However, this cohort of younger
children has historically demonstrated a disproportionately low rate of utilization of dental services, including preventive services. Faced with this same dilemma in their
populations, many states have sought innovative methods
to get needed preventive services to these young children.
Use of medical professionals who are already involved
with this population has been
identified as one option. Available national survey data
has indicated that only 1.5 percent of infants and 1-yearolds had a dental visit annually, while 89 percent of the
same group had an office-based physician visit.5 Given
this level of contact, the involvement of the primary care
practitioner and staff as allies in the battle of caries
detection and preventive intervention appears to be
advantageous if there are no legal preclusions. Investigation
as to compliance with Pennsylvania statute indicated
that topical application of fluoride varnish by a physician,
certified registered nurse practitioner (CRNP), or registered
nurse under direction of a physician is within the
respective scope of practice for each professional group.
OMAP recognizes oral health care for children and
adults as a priority, and in addition to the fluoride varnish
initiative, has implemented other programmatic changes
in recent years aimed at improving access to care, especially for children. In September 2008, OMAP issued a
Medical Assistance (MA) Bulletin announcing updates to
the Early and Periodic Screening, Diagnosis and Treatment
(EPSDT) Program Periodicity Schedule. Included among
the various updates were two dental-related changes.
The first added dental risk assessments and referral to a
dental home as a required component of the periodic
screens occurring at 12 months, 18 months, 24 months
and 30 months of age. This move marked a change
in the timing of the first dental screen required, moving it
two years earlier on the schedule and aligning the
requirement with AAP, ADA and AAPD guidelines. The
second change added referral to a dental home as a
required component of every periodic screen, beginning
at three years of age – again highlighting to physicians
the importance of oral healthcare throughout childhood.
The bulletin also outlined the specific parameters of what
actions constitute a meaningful referral to a dental home.
OMAP issued another MA Bulletin in April 2009 that
announced the implementation of the Pediatric Dental
Periodicity Schedule outlining recommendations to
MA-participating dentists based on American Academy of
Pediatric Dentistry guidelines for timely delivery of
preventive services for children. Of particular note was
reinforcement to the dental community of the recommendation that the dental home be established no later than
12 months of age.
Through this multi-pronged approach, OMAP is
attempting to create an environment of increased awareness
of the issues and collaborative effort between health
professionals in both the medical and dental communities
across the State to more effectively address and prevent
early childhood caries.
What are the program details?
In order for an MA-participating physician or certified
registered nurse practitioner (CRNP) to become eligible
for reimbursement for the topical application of fluoride
varnish through the Pennsylvania Medical Assistance
Program (MA), they must demonstrate completion of an
appropriate training curriculum in oral evaluation
technique (including the detection of dental caries) and
the topical application of fluoride varnish. To simplify and
standardize this process, with the assistance of the PDA
in review of the curriculum, OMAP identified a one-hour
CME credit course available on the AAP website as the
preferred means for practitioners to acquire reportable
documentation of having met the training requirement.
The course is available at no charge to the individual
practitioner and provides an official certificate of
completion upon passing a post-test for the course.
Upon receipt of the CME certificate, the practitioner
submits a copy of the certificate to OMAP via the Division
of Enrollment in the Bureau of Fee for Service Programs.
The practitioner is then eligible to bill OMAP for topical
fluoride varnish application for their patients who are
eligible MA consumers under five years of age.
As referenced earlier, these children are seen more
frequently by primary care practitioners during their first
years of life under the EPSDT program. Once a
practitioner identifies a child with erupted teeth and no
history of a recent visit to a dental home, it is expected
under EPSDT that a meaningful referral to a dental home
is attempted by the practitioner in addition to the topical
application of fluoride varnish. If the child returns to
the physician’s office for the next EPSDT screen visit
without having experienced a dental visit in the interim,
33
the practitioner is again responsible to make a renewed
referral attempt to a dentist and should again apply topical
fluoride varnish. Ideally, once a dental home is established
for the child, the dental staff should assume responsibility
for preventive oral health services including fluoride
treatments. The physician should continue to perform an
oral assessment and reinforce the importance of regular
visits to the dental home, but should defer application of
topical fluoride in favor of the dental home going forward.
Where do we go from here?
In order for the program to be successful there must be
better communication and understanding on the part of
all stakeholders involved. Parents/caregivers must be better
educated as to the importance of maintaining oral health
of the primary dentition, need for early evaluation,
preventive interventions, and appropriate treatment when
needed. As noted previously, primary care physicians and
CRNPs can and should play an expanded role in this
education process and facilitate the establishment of a
dental home for young patients in their care by developing
meaningful communication with dental professional
colleagues in their communities. The American Academy
of Pediatrics has established its own Oral Health Initiative
and offers a wealth of information to physicians and
other medical professionals through its association website
and sponsored events (http://www.aap.org/ORALHEALTH).
Pedodontists and general practice dentists who are already
comfortable treating young children could outreach to
their community primary care medical colleagues to assist
in development of referral networks. The PDA participated
in the development of OMAP’s fluoride varnish program
and has repeatedly stated its support for the program in
its recent publications. Enthusiastic support at the district
and local society levels will factor heavily in the success
of the program by maintaining and hopefully expanding
the referral base for dental homes capable and committed
to preventing what is still the most common chronic
disease among children. OMAP remains focused on oral
health as part of overall physical health and will continue
to partner with our MCOs in HealthChoices and case
management vendor in ACCESS Plus to improve our programs targeting oral health issues. We face complex issues
in our search for solutions. Combined and collaborative
efforts offer our best chance for success.
To review or download any of the MA Bulletins
referenced in this article, use the following web link and
type the appropriate number listed below in the box for
Bulletin Number under Search Option A:
http://www.dpw.state.pa.us/PubsFormsReports/Newsletter
sBulletins/003673169.aspx
Enter 99-08-13 for the Bulletin issued in September 2008
on Updates to the Early and Periodic Screening, Diagnosis
and Treatment (EPSDT) Program Periodicity Schedule
Enter 27-09-02 for the Bulletin issued in April 2009 on
Implementation of the Pediatric Dental Periodicity Schedule
Enter 09-10-08 for the Bulletin issued in March 2010 on
application of Topical Fluoride Varnish by Physicians and
CRNPs
1 Dye, B.A., Tan, S., et al. “Trends in oral health status: United States, 1988-1994
and 1999-2004.” National Center for Health Statistics. Vital Health Stat 11, 2007.
2 U.S. Department of Health and Human Services. Oral Health in America:
A report of the Surgeon General. Rockville, MD: U.S. Department of Health and
Human Services, National Institute of Dental and Craniofacial Research,
National Institutes of Health, 2000.
3 US Census Bureau Data, Annual Estimates of the Resident Population by
Sex and Age for States and for Puerto Rico: April 1, 2000 to July 1, 2009.
Available at: http://www.census.gov/popest/states/asrh/SC-EST2009-02.html,
Accessed July 29, 2010.
4 Internal Data, Pennsylvania Department of Public Welfare, Office of Medical
Assistance Programs, June 2010.
5 American Academy of Pediatrics, Policy Statement: Preventive Oral Health
Intervention for Pediatricians, Pediatrics 2008 Dec:122(6).
Paul R. Westerberg, DDS, MBA
Dr. Westerberg is a graduate of Temple University School of Dentistry and began his professional career in
private practice in the Philadelphia area, serving patient populations in both inner city and suburban locations.
After earning an MBA from the University of Delaware, he transitioned to the corporate environment as
a program dental consultant and then as Dental Director administering managed care Medicaid, Medicare,
and CHIP healthcare services in southeastern Pennsylvania. Moving to public service in state government,
Dr. Westerberg originally joined the Office of the Medical Director in the Office of Medical Assistance Programs
of the Pennsylvania Department of Public Welfare as the Executive Dental Consultant. He has served as the
Chief Dental Officer for the Department since 2002.
34
HARRISBURG
SMILES
RESHAPING ACCESS TO CARE
IN CAPITAL REGION
By Rob Pugliese, Director of Communications
Sometimes, the most satisfying
results are those achieved from overcoming significant challenges.
In the continuing efforts to find new
opportunities to treat those indigent
patients who lack insurance or who
may not be eligible for reduced-cost
programs, PDA member dentists are
always searching for new ways to
improve access to care. We all realize
that Pennsylvania has been one of the
most difficult state environments to
enact improvements to the system,
with low reimbursement levels and a
cumbersome structure.
Then there are the patients with
emergencies who often have no place
to go and dentists who have no place
to send them. Purely volunteer efforts
are often difficult to maintain. As a
result, working toward an access to
care plan that will have more long-term
sustainability may necessitate starting
small and working up to something
larger.
What began as just one more promising idea in a local dental society’s
continuing efforts to improve access
to care has now blossomed into a
much broader success story that could
have long-lasting impact for the
underserved population of south central Pennsylvania.
Considering the group of dedicated
individuals involved, their persistence
and success shouldn’t really be a
surprise.
The Harrisburg Area Dental Society
(HADS) has a reputation for being
one of the more active societies in our
state. Its members have achieved
tremendous results in numerous
initiatives the last several years,
including two public relations efforts
in 2009 – a 30-minute television
program broadcast on ABC27 here in
Harrisburg, largely due to the hard
work of HADS vice president Dr.
Marianna Clougherty, that included a
phone bank for patients; and a special
interactive dental exhibit from the
National Museum of Dentistry that
HADS brought to the Whitaker Science
Center in downtown Harrisburg,
with then HADS secretary Dr. Ashleigh
Lancaster-Fishel coordinating this
educational event.
In their latest foray, HADS members
have been working for the last two
years toward their goal of a comprehensive program to provide better
care for the neediest patients in their
communities. Developing this access
model, and working through all of the
kinks, has been anything but easy.
“We didn’t want to do something
that was only going to be good for a
year,” said Dr. Andrew Gould, one of
the HADS members who spearheaded
this process. “We talked about keeping
it functional, long term.”
The seeds were planted in 2008
with the creation of HADS’ Task Force
on Access to Care.
Dr. Gould, who was HADS president
at the time, said the idea came about,
in part, from a desire to change public
perception about the good work dentists do in their communities.
“We were in a HADS meeting and a
touchy subject had come up. It had to
do with our governor,” Dr. Gould
said. “He had made a statement in the
news about ‘our health care professionals not giving back to the community.’ We quickly realized that our
access to care problems were not only
due to the obvious reasons – apathy,
lack of funds, initiatives – but also the
public’s perception of what we as
health care providers actually give to
the community.”
Dr. Gould and his colleagues decided to launch the HADS Task Force
on Access to Care, which has evolved
into an official standing committee
within the HADS Executive Committee
branch (Committee on Access to Care
and Outreach).
The group’s mission statement is,
“To act as a conduit of emergency
dental care for the underserved dental
populations and help match those
dental needs with the available
resources in our dental community.”
35
HARRISBURG SMILES
Dr. Gould further expanded on this
mission.
“The purpose of this committee
was to provide the public with raw
numbers of what we, as dentists, give
back to the community in initiatives
that are already present and working,
come up with sheer numbers to
provide the public – and governor –
of what the results are of what dentists
are already doing, make the public
more aware of Access to Care and
what they can do to help, and even
where they can go to receive dental
care, and finally, the purpose of the
Task Force was to create a program to
provide dental care to the underserved in our area,” he said.
The first part of the committee’s
purpose came rather easily. The Fifth
District Dental Society Executive
Committee, under the direction of
then Fifth District president Dr. Jim
Boyle, created a survey to ask area
dentists what they were doing for
Access to Care without receiving any
compensation. This included all of the
hours that dentists donate to the
underserved at their own practices
and offices without billing or collecting
any payment. Gould explained that
the total hours of pro bono work from
HADS members is higher than what
most people would imagine, and that
it is very difficult to place a dollar
figure on the dental care donated to
the underserved in the Harrisburg area
and throughout the Fifth District.
“Like many of my colleagues,
volunteering within the community is
a big part of [our] joy in doing
dentistry everyday. I do a lot of work
for the West Shore School District
and have a relationship with them
where they will call me and I will see
their kids for no fee,” Dr. Gould said.
“I also volunteer my time with HADS
when we do clinics and public
appearances, and finally, I have donated
my time at the Mission of Mercy –
a church organization in downtown
Harrisburg run within the Christ
Lutheran church, which HADS past
president John Kiessling has been in
charge of for more than five years.”
The next phase of the task force’s
goals, and a monumental one — to
create a comprehensive program to
care for the underserved — has taken
two years to implement due to its
complexity, clearing all of the significant logistical hurdles as the initial
idea has grown exponentially.
The HADS Task Force members
originally thought that they would
create a network that would link all
The group’s mission statement is,
“To act as a conduit of emergency
dental care for the underserved dental
populations and help match
those dental needs with the available
resources in our dental community.”
36
of the underserved population, both
adults and children, to a phone number or a central station where they
would receive a dental screening.
The task force considered Harrisburg
Area Community College (HACC) as
a possible central station for this
effort before realizing that there were
several issues that would have to be
resolved, including funding.
“We all had ideas and thoughts, but
had trouble getting the plan in place.
We were running into logistics problems and how to put it all together –
especially something as monumental
as a central station and a published
phone number,” Dr. Gould said.
At that point, Highmark Blue
Shield contacted Dr. Gould to set up
a meeting to discuss HADS efforts.
Eventually, Dr. Gould and Dr. Harry
Meyers, who chairs the HADS
Committee on Access to Care and
Outreach, took part in a roundtable
discussion at Highmark’s headquarters
that greatly enhanced the proposed
efforts. Drs. Gould and Meyers
learned that Highmark had money
available for access to care initiatives
and would be accepting proposals for
grants. This was a valuable resource
previously unknown to HADS.
All of this contributed to the construction of an umbrella organization
called Harrisburg SMILES, where
several partners have been able to
coordinate efforts. A coalition was
born, and HADS began fine-tuning a
model with two central screening or
contact areas serving Harrisburg-area
both the East and West Shores of the
Susquehanna River, with a network
that would help those two entities
handle the treatment of needy patients
and refer them to get the proper treatment they need.
“We found out that Hamilton Health
Center in Harrisburg, Christ Lutheran
Church, and Good Hope Ministry
through Holy Spirit’s Health Share
program are willing and able to help
HARRISBURG SMILES
us in our initiative,” Dr. Gould said.
“All we need now are the HADS volunteers to pull our network together.”
Members of this new coalition –
HADS, HACC, Hamilton Health
Center, Christ Lutheran Church, and
Holy Spirit’s Health Share – gathered
for monthly, sometimes weekly,
meetings for the past two years,
exchanging their ideas in an effort to
make all the logistics work.
Hamilton Health Center has been
an effective partner for HADS in this
effort because of its modern facility,
full-time staff, and availability of after
hours care and transportation for
patients, and finally, much of the work
done there is without any cost to the
patient.
“The coalition also met with social
service organizations in a town hall
meeting format and sought their input,”
Dr. Gould said. “You can not imagine
how many calls we, as a dental society,
get in reference to social service organizations’ clients needing dental care —
usually emergency care, which is what
this initiative is primarily focused on.
We want to include all the social
service organizations in the future so
their needs are also met.”
Pastor Jody Silliker of Christ
Lutheran Church in Harrisburg is the
Intake Coordinator for the East Shore
patients in Dauphin County. Christ
Lutheran Church already houses
several community and health-related
ministries, including a dental clinic
run by Mission of Mercy two days
each month. Through donations from
area businesses and HADS dentists,
Christ Lutheran now houses two
fully-equipped operatories capable of
doing all facets of dentistry in their
church.
“The plan is, now that the dental
clinic is established, Christ Lutheran
will provide this ministry two
additional days a month, using HADS
volunteer dentists who will go there,”
Dr. Meyers said. “Jody will refer
patients to other partners when her
church or Mission of Mercy cannot
meet that need.”
In addition, The Health Share
Program of Holy Spirit Hospital, will
be working with many patients in
communities in Cumberland County
and Perry County on the West Shore
of the Susquehanna River. Susan
Williams is the west shore coordinator
for Harrisburg Smiles, and refers to
dentists in their offices on the west
shore.
“Prior to working on this project, the
Health Share Community Partnership
had already recruited several dentists
and an oral surgeon to provide dental
care to individuals who were in need
of immediate care. After meeting with
those affiliated with Harrisburg Smiles,
I learned that there were even more
dentists who were willing to work for
the greater good,” Williams said.
Williams had previous experience
working with Dr. Meyers, through his
affiliation with Health Share of Holy
Spirit.
“When working with him and
speaking with him, it is obvious that
he is a caring individual who only
wants to see the best care given to all
patients,” Williams said. “After
beginning work with the Harrisburg
Smiles Project and making referrals to
Dr. Andrew Gould, the same
exuberance portrayed when working
with Dr. Meyers also comes through
in Dr. Gould’s work. Both of these
individuals show a tremendous compassion for those in need.”
HACC’s dental hygiene and
Expanded Function Dental Assistant
(EFDA) programs are providing
radiographs, clinical exams and dental
prophylaxis to needy patients as well;
and, if there are restorative needs,
patients may be sent to the EFDA
clinic or Hamilton Health Center to
have basic restorations placed.
HADS member dentists will be
volunteering to see patients in their
own offices gratis or may go to these
other sites to treat patients. Some have
taken part in past by volunteering at
HACC or Hamilton Health when there
have been programs for the underserved sponsored by United Concordia
and the Highmark Foundation.
Harrisburg SMILES is up and running, and will be fine-tuning the
process in months ahead. Getting all
HADS member dentists to volunteer
and assist in this initiative has
quickly become a primary goal of the
coalition.
“Without volunteers, the patients
referred through our screening partners
will never get seen in a timely
manner. HADS can’t continue to rely
on the same individuals donating
their time,” Dr. Gould said. “It has to
be a group-wide effort.”
Dr. Gould added that further
evaluating how Harrisburg SMILES
can possibly tap into Highmark grant
funds that can be used to help aide
the needy Harrisburg-area patients
more effectively is another obstacle
this group of volunteers will consider
in the very near future.
“As we continue to evolve, we will
try to adapt and meet the community’s
needs as best as possible,” Dr. Meyers
said.
“I’m really, really excited about this
and I’m really proud of the work we’ve
done,” Dr. Gould added.
Harrisburg SMILES already has more than 40 PDA members who have volunteered in this effort. To become a part of this
and volunteer with Harrisburg SMILES, contact Dr. Harry Meyers at (717) 697-7000, Dr. Andrew Gould at (717) 774-7700
or Dr. John Kiessling at (717) 657-3290.
37
DAY
HILL
June 8,2010
ON THE
“Besides just learning how things are done in Harrisburg, I actually felt as if we
made a difference. Both the officials and the aides took the time to listen and ask
pertinent questions. It is truly a good experience. Only after you have done it do
you feel like you have made a difference.”
— Dr. Thomas Nordone, First District Trustee, first time attendee
“I truly had a great time and experience with my friend and colleague Dr. Mike
Christiansen. It was also rewarding to be teamed with two dental students, one
from Pitt and one from Temple. They were not afraid to share their thoughts
and their candor was very refreshing. It was awesome that they took their time as
well to attend. PDA did a fantastic job with the organization of the whole day.”
— Dr. John Pagliei, Second District, second time attendee
38
“
Dr. George Bullock shares information
with Dr. Amanda Horn and Dr. Priya Thomas.
“
Day on the Hill is the single most
important day on the PDA calendar. Our
entire year should revolve around this day.
We, as a profession, need to be proactive
in dealing with our legislators so that we
have a strong voice in the policy-making
processes that directly affect us. Face-time
with our own personal lawmakers is the
key to having a successful Day on the Hill.
Day on the Hill will protect the profession
as it currently stands and will hopefully
safeguard it perpetually. I encourage everyone who has a vested interest in dentistry
to participate in Day on the Hill! Imagine
the message we could send to Harrisburg
if several hundred or even a thousand
dentists, dental students and members
of the Alliance flock our Capitol instead of
the one hundred or so we have recently
had attend.
I have been participating in PDA’s
Day on the Hill for about 10 years. From
my very first experience, I have felt that
this time is well spent! The legislators really
listen and try to understand the issues we
bring before them. Senator Robbins, my
state senator, said that they (the legislators)
couldn’t be experts on everything so they
need to reach out to their constituents to
get information and a better understanding
of the how any bill being considered is
going to affect those involved.”
“Every dentist should find the time to
come to the Capitol and lobby for realistic
and fair laws that will guide our profession.
The legislators will be passing new
legislation and it will affect the way we can
and do our work. If we don't speak out
and be heard on the issues, then we have
no room to later complain about the laws
that govern this profession.
”
— Dr. Dennis Charlton
President-elect, 9th District
DAY
HILL
ON THE
”
— Dr. Brian Mark Schwab
Fourth District and Associate
Editor, third time attendee
CEO Camille Kostelac-Cherry
briefs dental students prior to
Senate hearing.
Dr. Pete Carroll heads
to the Capitol.
Dr. Richard Clark with state Senator,
Sen. Ted Erickson.
39
Dental Student Testimonials
“
This was my first time attending
PDA’s Day on the Hill. I was motivated to
attend because of the numerous issues
currently pressing the dental profession.
Dentistry is my career, so I want to protect
it from the vulturous insurance companies
that destroyed the medical profession.
It is important to participate in Day
on the Hill to protect your patients, your
profession and yourself by being actively
involved in legislative efforts. Apathy now
leads to deterioration later.
DAY
HILL
ON THE
I was able to sit in on the Senate Insurance
Committee meeting to see the passing of the
non-covered services bill. It was incredible
to see a bill that directly affects my profession
being passed by my elected officials.
Dr. Richard Clark (right) talks policy
with Sen. Ted Erickson.
PDA organized this event very effectively
and it went off without a hitch. I look
forward to attending next year!
— Christopher Adams
Temple University
”
“
This was the first year I participated in
PDA’s Day on the Hill. I wanted to become
proactive about Pennsylvania dental
legislation as this has a direct impact on our
future careers. Also, this was a great
opportunity to get involved with PDA.
This is an important event because our
voices are heard and actually listened to.
We have a say in legislation, we just need
to be proactive.
Sen. Kim Ward with dental students
Ben Drane and Nicole DeShon.
From my perspective, the top three reasons
someone should attend a future Day on the
Hill are to:
• Meet PDA and see how the organization
is working for us.
• Meet and network with local dentists.
• Become educated about the overall lawmaking and lobbying process.
Thank you to PDA for organizing a very
smooth day.
Dr. Karin Brian delivers PDA
materials to a legislative office.
40
”
— Jordan Bower
Temple University
In Memoriam
Dr. John W. Staubach
By James M. Boyle, III, DDS, MS
In July, both the Baseball
Hall of Fame and Football Hall
of Fame honored their giants
of the game, both past and
present. Induction ceremonies
were held respectively in
Cooperstown, New York and
Canton, Ohio. In York,
Pennsylvania on July 22, the
Pennsylvania Dental
Association lost Dr John W. Staubach, a true hall of famer
and giant of organized dentistry.
John was born in Basel, Switzerland, on June 25, 1933.
He graduated from Sparks High School of Sparks, Maryland
and, following service to his country in the United States
Army during the Korean War, graduated in 1959 from
Franklin and Marshall College in Lancaster. Dr. Staubach
earned his dental degree from the University of Maryland
in 1963.
Dr. Staubach represents everything positive and
professional in organized dentistry. His exemplary leadership
and work ethic in the York County Dental Society led to
his service as president of the Fifth District Dental Society
in 1984. John continued his tireless work at the state level
in various committees and in 1994-1995 he led PDA as
president. Following his term as president, Dr. Staubach
contributed at the national level where he served four years
as Pennsylvania’s trustee to the American Dental Association.
Dr. Staubach was a member of the Academy of
General Dentistry and a Fellow of the International College
of Dentists, as well as the Pierre Fauchard Academy.
“John was a giant in our profession and in his community,
as you can see from his extensive resume. All who knew
him, knew him to be a mentor and a role model,” said PDA
president Dr. William T. Spruill. “There are many in
current leadership who owe huge thanks to John for being
the catalyst for our involvement by his personal example
and guiding light.”
The success of organized dentistry is dependent on a
grassroots methodology. As Babe Ruth was to home runs,
John Staubach was to the grassroots work of organized
dentistry.
Regardless of level of office he served, many member
dentists of York County can recall a phone call or visit from
John Staubach to discuss pending legislation, a political
candidate running for office or to seek an opinion of issues
affecting their practice. John was a mainstay at all meetings
and was uncanny at mobilizing ideas and frustrations of
membership into solutions and actions. Dr. Staubach was
approachable, he listened, and was easy to find because
anyone involved with the PDA or ADA knew his lovely wife
of 54 years, Lois, was by his side. It was not just John but
both he and Lois who reached out to new dentists and their
families to welcome them to York County or state meetings
and receptions.
“His gentle and elegant wife, Lois, was ever at his side;
a testimony to their love for each other and their commitment to all things worthy of endeavor,” Dr. Spruill said.
John and Lois raised two beautiful daughters, Melodie
and Heather, and was father-in-law to two gentlemen. John
enjoyed everything life had to offer including a good joke,
which he loved to share. Ask any of his five grandchildren
about their grandfather’s favorite joke and a warm, loving
smile appears.
“I am thankful for the gift of Dr. John Staubach and for
his contributions to so many aspects of all of our lives,”
Dr. Spruill said. “His presence, his guidance and his wisdom
will be missed.”
We in organized dentistry lost a hall of famer, yet his
legacy remains as an example to us all. Rest in peace, John,
and thank you for all you have done.
PDA received the following letter from Monica Robinson,
Dr. Staubach’s granddaughter. He wrote the letter to her
on April 19, 2003.
Dear Monica,
Today you asked that I write a letter to you about the
future. You know, the future is not limited to the unforeseeable years ahead. Whether they be 5, 10 or 15 matters
little because you see I consider tomorrow the future. And
because of that, as the stairs seem to become steeper and
distances seem greater than in years past and everyone
seems to be in a greater hurry than I. I am reading more
and writing less. I cherish sitting in the yard or porch with
your grandmother while watching the brilliant sunsets,
which promise a new tomorrow. I relish the sight of the
wild ducks and Canada geese gracefully gliding, on silent
wings, out of the early morning mist with their plaintive
cries and gracefully landing on the pond as they too greet
41
In Memoriam
the new day. Who cannot help but enjoy the sight of deer
cautiously slipping from the woods in order to browse in
the fields at evening time.
I don’t fuss as much about the weeds in the garden or
the peeling paint on the barn. I spend more time with
family and friends. I have come to realize that life should
be a pattern of experiences to savor and hold dear in our
memories, not one to endure.
With the passing of time it becomes less important to
save anything but rather more important to share with
family and friends.
I don’t dress up as much as I used to except perhaps
for church. But I try to always wear a smile — even for the
clerks at the grocery store.
Continued learning is not an option to set aside. I try to
expand my vocabulary. I want to see, hear and do different
things now before tomorrow comes.
I’m not certain what others would have done had they
known they would not be here for tomorrow that we all
seem to take for granted.
I think I would have communicated more with family
members and a few good friends. And I might have been a
better person had I called those with whom I had squabbles
and apologized.
It’s these little things (perhaps not so little after all when
I think about it) left undone that would make me angry if
Dr. Charles M. Ludwig
Dr. Charles M. Ludwig, a
former PDA president and state
public health dentist, died on
July 23 in Lititz. He was 81.
He was born on April 12,
1929 in Jersey City, N.J., the
son of German immigrants. He
earned his BS from St. Peter’s
College in 1950 and his DDS
from Temple University School
of Dentistry in 1954.
Charlie served as a Lieutenant
in the United States Navy Dental Corps from 1954-1956.
He opened his first practice in Ringwood, N.J. in 1956. He
married Betty Olene Gourley on August 31, 1957 in
Mount Lebanon, Pa. In September 1960, the family moved
to Harrisburg and soon after he became involved with
organized dentistry in 1963.
He served as president of the Harrisburg Area Dental
42
I knew my remaining hours were limited. I’d be angry
because I had not written certain letters or notes that I
intended to write one of these days but had not set aside
because I was “too busy.”
I, at times, am sorry that I didn’t tell my family, my
mother and father-in-law and yes even my own parents
just how much they meant to me.
I’m trying very hard not to put off, hold back or save
anything that would bring more laughter and luster to grow
grandma’s and my lives. And each morning, as days pass
all too quickly, I open my eyes and tell myself this is a
special day and how lucky I am to be married to grandma.
You see Monica, each day, each minute, each breath we
take truly is a gift from God.
Monica, live your life to the fullest, never stop learning
and look to tomorrow — the future.
Remember, life may not be the party we hoped for, but
while we are here we might as well dance.
Love,
Grandpa
Perhaps someday Monica, when you’ve grown older and
the ink has long since faded on this paper – you too will
understand what I have been trying to tell you.
Society in 1973-1974 and then made a great impact as
president of PDA in 1986-1987.
“Charlie was the best friend to the Pennsylvania dentists.
He stood on principle,” said Dr. Harry Meyers. “And his
principles primarily were two things – One, the integrity
of the dental profession, that it not be dictated to by third
parties, and two, the patients. He was the first public health
dentist in the Commonwealth of Pennsylvania.”
“He sacrificed so much for the ability of Pennsylvania
dentists to practice without undue interference from third
parties,” Dr. Meyers added.
Dr. Meyers recalled times when Dr. Ludwig rallied support for causes important to dentistry and how Dr. Ludwig’s
close friendship with the late state Sen. John Shumaker
was so valuable for PDA and the profession of dentistry.
In 1993, Dr. Ludwig received the Distinguished Service
Award from the Pennsylvania Society of Orthodontists, the
first general dentist to receive this award. After retiring
from private practice in 1994, he worked for the Pennsylvania
Department of Health from 1994-1999. In 1999, he was
appointed to the Northeast Regional Board of Dental
In Memoriam
Examiners, for whom he administered exams until the
spring of 2010. Charlie also worked from 2003 to 2006
doing contract work at Hamilton Health Center in Harrisburg.
“Charlie was a man who would passionately throw
himself into whatever he was involved in,” said Dr. Samuel
Selcher. “As PDA president, he spent countless hours
walking the Capitol halls on behalf of dentistry. As Public
Health Dentist, he did all he could with limited resources
to improve the dental health of Pennsylvania.”
Charlie was also very active in community service work
and he served two years as an Elder at Paxton Presbyterian
Church.
He will be remembered for his dedication to his profession,
his willingness to help others and his great sense of humor.
“His legacy is that he fought to maintain our integrity as
a profession, free of external interferences, yet he very much
cared that the patients would receive appropriate dental
care,” Dr. Meyers said.
Charlie was predeceased by his parents and a brother,
Howard, in 1970. He is survived by his current and ex-wives,
his two children, Donald Ludwig (of Langen, Germany)
and Carol E. Bell (of Harrisburg), two step-children, Diane
Davenport (of Baltimore, Md.) and Doug Steinhauer (of
Lancaster). He is also survived by his grandchildren, Erich
and Sarah Bell, his step-grand-daughters, Ellexia, Vallerie
and Abigail Davenport, a brother, retired Colonel Wesley A.
Ludwig (of Leavenworth, Kan.) and a sister-in-law, Dorothy
Trehou Ludwig (of Highland Lakes, N.J.).
Dr. Morris Malmaud
Boca Raton, Fla.
Temple University (1942)
Born: 3/28/18
Died: 8/3/02
Dr. Isadore B. Mandel
Delray Beach, Fla.
University of Pittsburgh (1945)
Born: 12/14/21
Died: 2/11/05
Dr. Dominick J. Maldonato
Scranton
Born: 12/28/08
Died: 12/16/09
Dr. Lewis N. Bernstein
Boynton Beach, Fla.
Born: 11/02/12
Died: 12/1/03
Dr. Roy A. Smith
Burbank, Calif.
Born: 6/11/06
Died: 2/16/05
Dr. Daniel G. Genthner
Bethlehem
University of Pennsylvania (1955)
Born: 5/28/30
Died: 5/21/10
Dr. Roger M. Owens
Ocala, Fla.
Born: 12/5/16
Died: 12/18/03
Dr. Jacob D. Promish
Philadelphia
Born: 2/11/09
Died: 9/9/05
Dr. Richard A. Smith
Fort Myers, Fla.
Washington University (St. Louis)
Born: 4/25/27
Died: 6/24/10
Dr. Martin W. Pollock
New York, NY
University of Pennsylvania (1943)
Born: 5/7/21
Died: 2/29/04
Dr. Clifford C. Pierson
Portland, Ore.
Born: 11/24/10
Died: 10/25/06
Dr. I. Irwin Fisher
Boca Raton, Fla.
Born: 3/7/16
Died: 8/19/04
Dr. Benjamin L. Mandel
Glenside
Born: 6/26/14
Died: 12/27/06
Dr. Floyd E. Baker
Philadelphia
Meharry Medical College of Dentistry
(1946)
Born: 3/28/19
Died: 7/5/10
Dr. Don C. Donaldson
New Kensington
Born: 10/29/22
Died: 8/23/04
Dr. Irving Abrams
Philadelphia
Born: 8/6/20
Died: 5/1/2007
Dr. Ralph L. Cohen
Sewickley
Born: 2/13/23
Died: 8/11/10
Dr. Jeffrey E. Kanner
Yardley
Born: 10/19/45
Died: 8/18/10
43
Cyber Salon
What’s Your Status?
By Dr. Brian Mark Schwab, Associate
Editor
In the online social networking
era, things just happen differently than
they would have prior to the myriad
of technological advances and access
that have shaped the first decade of the
21st Century.
In previous columns, we have
focused on the various social networking sites Facebook, MySpace, LinkedIn
and Twitter. We have also focused
on PDA’s new Social Networking site,
which is up and running and ready
for business. In addition to promoting
our new site, we have also provided
articles about how easy social networking is. A 5 year old can do it and so
can a 105 year old. Now we are going
to focus on some of the minor aspects
of social networking that can help
make your experiences just a little
more exciting and enjoyable.
I am certain that some of you are
totally new to social networking. You
have figured out how to search for
someone, you probably have uploaded
a picture and you probably have
emailed or posted a message for
someone you know. Now it is time to
explore the many additional features
that are available to you.
On Facebook, one of the options
you have on your profile page is to
enter “What’s on your mind?” You type
something in the box and hit “Share”
and it will appear on your friends’
page the next time they log into their
account. You could post something
minor like, “When is this heat going
to break?” or something exciting such
as, “I just had my first hole-in-one!”
or something else of significance or
insignificance to you. This is your
way on Facebook of communicating
to your pals without having to email,
text message or telephone them to tell
them what is going on.
On Twitter, you actually do the
same thing but it is known as a “Tweet.”
On the PDA’s social networking site,
you are prompted to enter “What’s on
your mind? Question for other
Members?” This is where you can post
good news, bad news, inquiries about
dental products, materials, legislation
or virtually anything you’d like. It is
a forum that is available only to PDA
members who have registered to use
the site. It is the hope of the PDA
Board of Trustees and staff members
that members will utilize this excellent
forum to openly discuss and debate
questions and topics introduced.
There is a forum for general dentists,
specialists, public health and volunteering, new dentists and others.
Literally, there is a forum for everyone
and if you have an idea for a new
forum, please contact Jessica Forte and
[email protected].
Social media can be used as a tool
to reach out to people whom you
would otherwise not have direct access
to. Imagine the capability of being
able to connect a dentist in Philadelphia
with a dentist in Erie. Suppose the
Philadelphia dentist posted that she is
planning to purchase a Panorex
machine and she wanted feedback on
two different brand names. The dentist
in Erie just purchased one and really
liked the customer service and special
financing he received from company
A versus company B. In literally 10
seconds, he could share this excellent,
firsthand information with a colleague.
No long distance phone calls, no
lengthy emails, none of that. These
two dentists may never have even “met
one another” had it not been for the
PDA’s social networking site. This
example represents the type of activity
that we would like to see.
Our site is a dynamic fusion of
vision and mission; to connect members together for the common benefit
and to offer member value through
PDA membership. Imagine how this
site can be used to quickly distribute
information on legislation. I hope
you currently receive CapWiz alerts.
Unfortunately, there is no method to
discuss the CapWiz alerts with your
colleagues or leaders. Those days are
over now, as we have an excellent
way to discuss activities in Washington
and Harrisburg and all around the
state right at our fingertips. Our
impact will be greater if we can educate
each other and promote legislation
that will have a positive impact on
our profession.
If you have not yet taken the time to
log into www.community.padental.org
please take 10 minutes and explore
the site. In addition to using it as a
direct connection to PDA, you will find
it easy and fun to use. Hope you have
a great time social networking!
45
Awards & Achievements
Your Representation on the National Level
PDA would like to recognize and thank all of our volunteers who have given their time serving on ADA councils and committees during 2009-2010. Following is a list of PDA members and the ADA group that they served on during the past year:
Dr. Gary S. Davis
Council on Access, Prevention and Interprofessional
Relations, Vice Chair
Dr. Ronald K. Heier
Council on ADA Sessions
Dr. John B. Nase
Council on Communications
Dr. Lauri A. Passeri
Council on Dental Benefit Programs
Dr. Jon J. Johnston
Council on Dental Practice
Dr. Thomas W. Gamba
Council on Ethics, Bylaws and Judicial Affairs
Dr. Herbert L. Ray Jr.
Council on Government Affairs
Dr. Nancy R. Rosenthal
Council on Membership
Dr. Craig A. Eisenhart
Council on Members Insurance and Retirement Programs
Dr. Stephen T. Radack III
Joint Commission on National Dental Examinations
Dr. Jennifer Davis
Committee on the New Dentist
Dr. Jay R. Wells, III
American Dental Political Action Committee
47
Insurance Connection
Third-Party Complaints
Experiencing problems with thirdparty insurance? Let PDA know with
this easy to use Third-Party Complaint
form. This form gives dentist and
dental staff the opportunity to provide
PDA and ADA with basic information
regarding payer concerns. The
information received will be used to
keep a close watch on carrier trends
and problems.
PDA’s Dental Benefits Committee
(DBC) meets regularly with third-party
insurance representatives to discuss
issues raised by members. This ongoing dialogue has resulted in greater
cooperation in billing procedures,
faster reimbursement timelines and
network referrals. Dentists throughout
Pennsylvania need to report the
problems they are having with thirdparty payers so PDA may advocate
effectively during these meetings.
PDA is a dedicated advocate for the
dental profession regarding insurance
issues. Members can assist PDA in
this effort by keeping DBC informed
of the insurance problems encountered in daily interactions. Questions
may be addressed to our new government relations coordinator Ivan
Orlovic, at [email protected] or by
phone at (800) 223-0016, ext. 105.
Ivan comes to us from Delta Dental
of Pennsylvania, where he has worked
in several insurance-related departments over the span of five years.
His knowledge of the dental industry
will help serve members with insurance-related problems. Please contact
him for his assistance in handling any
issue you may have with an insurance
company. Ivan is also available to
attend district and local dental society
meetings to hear from you firsthand
and to inform you about PDA’s initiatives to improve insurance practices
in Pennsylvania.
THIRD-PARTY COMPLAINT FORM
1. Date:
2. Dentist Name:
3. County:
4. Third-Party Name:
5. Dentist contracted with plan
6. How was the claim filed, paper or electronic:
7. What type of complaint or problem applies to you?
❑ Coordination of benefits
❑ EOB language
❑ Downcoding (changed code to a less complex or lower
cost procedure)
❑ Bundling (combining procedures that results in a
reduced benefit)
❑ Review by a non-dentist
8. Utilization review (a system to evaluate procedure utilization
frequency/plan abuse)
❑ Delayed payment
❑ Denial of claim or pre-authorization
❑ No direct pay to non-participating provider
❑ Denial of payment after pre-authorization
❑ Lost claims, x-rays or other documentation by carrier
❑ Extensive or additional documentation requested
❑ Interference with the doctor-patient relationship
❑ Other
Please give a brief description of the problem and the actual or
proposed solution:
49
Contact: Lori Burkette
Administrative Secretary
(412) 648-8370
On-Campus Programs
November 13
Tylenol and Liver Disease
Dr. James Guggenheimer
November 20
Evidence-Based Dentistry
Dr. Robert Weyant
October 15
OSHA Bloodborne Pathogen Update
Dr. W. H. Milligan
December 3
From the Heart
Dr. James Lichon
October 16
Why Should You be Using an
Articulator in Your Practice?
Dr. David Donatelli
Dr. John Ference
December 4
Surgical Crown Elongation
Dr. Pouran Famili
Dr. Ali Seyedain
October 29
The Role of Nutrition in Longevity
and the Prevention of Diseases
Dr. Nasir Bashirelahi
December 10
Oral Health Promotion for At-Risk
Populations
Dr. Dennis Ranalli
Dr. Deborah Studen-Pavlovich
Dr. Adriana Modesto Vieira
November 5
Potpourri – Topics Include:
Immediate Implant Placement in
Extraction Sockets
Dr. Andrew Baumhammers
December 11
An Update on Local Anesthesia
Therapeutics and Complications
Dr. Paul Moore
Cone Beam Computed Tomography
and Its Applications in
Dentomaxillolfacial Imaging
Dr. Anitha Potluri
December 11
CPR
John Brewer, NREMT-P
Attachments
Dr. David Donatelli
January 15, 2011
Public Health Challenges for the
Delivery of Dental Care
Dr. Robert Weyant
Oral Ulcerative Diseases
Dr. Joanne Prasad
November 6-7
Local Anesthetics for the Dental
Hygienist
Dr. Paul Moore
November 12
Endodontics Series #1
Speaker to be determined
January 22, 2011
Anesthesia Review
Dr. Paul Moore
Dr. Joseph Giovannitti
Dr. Michael Cuddy
February 4, 2011
Effective Communication for Dental
Hygienists
Ellen Cohn, PhD, CCC-SLP
Joanne M. Nicoll, PhD, RDH
February 5, 2011
Conscious Sedation/Med Emergencies
Dr. Paul Moore
Dr. Michael Cuddy
February 19, 2011
Advanced Anesthesia
Dr. Paul Moore
Dr. Michael Cuddy
March 5, 2011
CPR
John Brewer
March 5, 2011
An Update on Local Anesthesia
Therapeutics and Complications
Paul A. Moore, DMD, PhD, MPH
March 19, 2011
A Review of Radiologic Procedures
for the Dental Professional:
DEP Requirements
Judith E. Gallagher, RDH, MED
Marie D. George, RDH, MS
May 13, 2011
Endodontic Continuum:
Building Upon Success
Stephen P. Niemczyk, DMD
Off-Campus Programs
Bradford
October 14
Pediatric Dentistry Made Easy for the
General Practitioner
Dr. R. Glenn Rosivack
Johnstown
October 13
Updates in Pediatric Dentistry:
Treating Tiny Tots to Teens
Dr. Lance Kisby
51
November 18
The Restorative Edge
Dr. James Braun
Reading
October 15
Miracles and Myths of Direct
Composite Restorations
Dr. Mark Latta
Temple University
Contact: Dr. Ronald D. Bushick
or Nicole Carreno
(215) 707-7541/7006
(215) 707-7107 (Fax)
Register at
www.temple.edu/dentistry/conted.htm
November 5
Exquisite Complete and Implant
Retained Over-Dentures Calibrated
for the General Practitioner
Joseph Massad, DDS
November 19
Empowering the Dental Team to
Deliver “Quality” Periodontal Care in
Restorative Practice
Samuel B. Low, DDS, MS, Med
December 3
The Art and Science of CAMBRA:
A team approach using chemical
treatments and minimally invasive
dentistry
Douglas Young, DDS, MS, MBA
October 22
Update in Restorative Dentistry
Lou Graham, DDS
52
Wellsboro
Pennsylvania College of Technology
Contact: Rebecca Von Nieda, PDA
(800) 223-0016, ext. 117
October 29
It’s About Time!...Early Oral Cancer
Detection
Jonathan Bregman, DDS
Danville
Geisinger Medical Center
(800) 223-0016, ext. 117
October 27
An Overview of Oral Pathology
Bobby M. Collins II, DDS, MS
November 17
Evidence-Based Dentistry (EBD)
in a Clinical Context
Richard Niederman, DMD
December 15
Hormones, Heart, Health and
Hygiene: Exploring How Oral Health
Affects Women’s Systemic Well-Being
Betsy Reynolds, MS, RDH
Chambersburg
The Orchards Restaurant
(800) 223-0016, ext. 117
October 22
Rational and Stress-Free Endodontics
Barry Lee Musikant, DMD
November 19
Loading of Implants with the Teeth
in a Day® and Computerized Guided
Teeth in an Hour™ Protocols
Glenn J. Wolfinger, DMD, FACP
PDA and PDAIS
Stroudsburg
Stroudsmoor Country Inn
(800) 223-0016, ext. 117
October 28
It’s About Time!...Early Oral Cancer
DetectionTM
Jonathan A. Bregman, DDS
Monroeville
Doubletree Hotel
Pittsburgh/Monroeville
Convention Center
(800) 223-0016, ext. 117
November 19
Esthetics & Implants—
Controversies & Innovations
Dennis P. Tarnow, DDS
Dental Society of Chester
County and Delaware County
DKU Continuing Dental Education
Springfield Country Club
Delaware County
Contact: Dr. Barry Cohen
(610) 449-7002
[email protected]
November 11
Functional Occlusion in the Daily
Practice of Dentistry
DeWitt C. Wilkerson, DMD
December 10
Secrets to Success of High Strength
Ceramics in Dentistry
Christian F.J. Stappert, DDS, PhD
February 2, 2011
Christensen’s Bottom Line 2011
Gordon Christensen, DDS
April 15, 2011
Innovations in Implant Dentistry
Dennis Tarnow, DDS
May 12, 2011
Growth and Planning Strategies to
Improve Your Practice
Mark Murphy, DDS
Schuylkill County Dental
Society
Fountain Springs Country Inn
(formerly Fountain Springs
Country Club)
Contact: Dr. David Paul
(570) 874-1954
Beaver Valley Dental Society
Contact: Dr. David Spokane
(724) 846-9666
December 9
Updates on In-Office Anesthesia for
the General Dentist
Dr. Wayne Roccia
January 20, 2011
Sedation in the Dental Office
Dr. Walter Laverick
February 17, 2011
3D Cone Beam Imaging for the
Dental Practice
Dr. Farrel Gerber
March 4, 2011
CPR Training
Vangard Medical
Florida Health Seminar
December 20, 2010 – January 2, 2011
Boca Raton, Florida
• Pain Management/Dental Anesthesia
Risk Management
• Endodontics
• Implant Dentistry
• Pediatric Dentistry
AGD, ADA-CERP CE credits. Special
hotel/car rental rates.
Contact Linda Golnick, coordinator,
at (248) 388-1959, (248) 681-0315
(FAX) or [email protected].
October 14
Implants for the General
Practitioner/Dental Trauma Avulsion
Dr. Paul Mancia
November 11
Orthodontic Update
Dr. John Sadowski
53
Medical Assistance is optional. Want
to know more? Call (570) 742-9607,
e-mail [email protected], or fax your
resume to (570) 742-9638.
Rates: $45 for 45 words or less, $1 for each additional word. $1 for each word set in boldface
(other than first four words). $10 to box an ad. $5 for PDA Box number reply. One free ad to
deceased member’s spouse.
Website: All Journal classified ads will be posted on the public section of the PDA website, unless
otherwise requested. Ads will be posted within 48 hours of receipt, but no earlier than one
month prior to the date of the Journal issue. Ads will be removed at the end of the two months
of the Journal issue.
Deadlines: Jan/Feb Issue — Deadline: Nov 1 • Mar/Apr Issue — Deadline: Jan 1 • May/Jun Issue
— Deadline: Mar 1 • Jul/Aug Issue — Deadline: May 1 • Sept/Oct Issue — Deadline: Jul 1 •
Nov/Dec Issue — Deadline: Sept 1
Payment: Upon submitting ad.
Mailing Address: Send ad copy and box responses to:
PDA Dental Journal • PO Box 3341 • Harrisburg, PA 17105
Classified Advertising Policy: The Pennsylvania Dental Association is unable to investigate the
offers made in Classifieds and, therefore, does not assume any responsibility concerning them. The
Association reserves the right to decline to accept or withdraw advertisements in the Classifieds.
The Journal reserves the right to edit classified ad copy.
How to reply to a PDA Box Number:
Your Name
& Address Here
Pennsylvania Dental Journal
PO Box 3341
Harrisburg, PA 17105
Attn: Box S/O____
OPPORTUNITIES AVAILABLE
Dentist
Consulting firm seeking Practice
Transition Consultant. Full training
and support. Unlimited earning
potential. [email protected]
or (866) 898-1867.
Outstanding Career Opportunities
In Pennsylvania, providing ongoing
professional development, financial
advancement and more. Positions also
available in FL, GA, IN, MI, VA and
MD. For more information contact
Jeff Dreels at (941) 955-3150, fax CV
to (941) 330-1731 or e-mail [email protected]. Visit our
website: www.Dentalcarealliance.com.
Lancaster Group Practice
Associateship or Associate to
Partnership in Lancaster. Large group
dental practice. Income potential of
$100,000 to $200,000 plus. Must be
a multi-skilled, excellent dentist. This
may be one of the best dental practices in the state! Call (717) 394-9231
or e-mail [email protected].
POSITION AVAILABLE
Harrisburg applicant must be proficient
in all chairside phases of fabricating
dentures. This position is ideal for
a retired dentist wishing to work part
time. Salary negotiable. Respond to
PDA Box S/O 1.
Associate Needed
Do you aspire to be a partner in a
growing group practice? Do you have
management abilities? Then you may
be the kind of associate we are seeking.
Our group is located in the Central
Susquehanna Valley near Bucknell
and Susquehanna Universities. We are
seeking a general dentist capable of
a wide range of procedures. No HMO’s
Associate Dentist
Dental Dreams desires a motivated,
quality oriented Associate Dentist for
its offices in Pennsylvania (Reading,
Harrisburg, York, Allentown and
Philadelphia), Connecticut,
Massachusetts, Illinois and Texas. At
Dental Dreams, we focus on providing
the entire family superior quality
general dentistry, in a modern
technologically advanced setting with
experienced support staff. Because
we understand the tremendous value
of our Associate Dentists, we make
sure that their compensation package
ranks among the best in the industry.
Our average colleague Dentist earns
$240,000 per annum, and is supported
with health insurance, 3 weeks
vacation and malpractice insurance.
Visa sponsorship assistance is available.
For more information, please call
Chyrisse Patterson at (312) 274-0308,
extension 320 or e-mail your CV to
[email protected].
LONG-TERM CAREER
OPPORTUNITY
Thriving 5-doctor group practice in
Chambersburg seeks to add an outstanding associate dentist to our group.
Beautiful new office facility and
wonderful staff. Excellent compensation and benefits. Fee-for-service
practice, no HMOs. See our website
at www.chambersburgdentistry.com.
Contact Dr. Pastor at [email protected] or (717) 264-2011.
55
General Dentist Wanted
HealthDrive is seeking a caring General
Dentist to join our group practice.
We currently have a PT (2 days)
opportunity available in the
Scranton/Wilkes-Barre area. We offer
a competitive salary, paid malpractice
insurance, flexible schedule (no
weekends), established patient base,
equipment, supplies and complete
office support. If interested in this
opportunity, please call MARIA
(toll free) at (877) 724-4410 or e-mail
[email protected].
Dentist Wanted
Part time. What unique skills can you
bring to our practice? Fax resume to
(215) 396-9517 or e-mail resume to
[email protected].
Allentown/Lehigh Valley Area
GENERAL DENTIST needed. Group
practice is seeking a general dentist
for full-time or part-time employment.
Salary commensurate with experience.
Associate position available with partnership potential. Beautiful Allentown
area location with general dentists
and specialists under one roof.
Fax resume and cover letter to (610)
820-9922 or call (610) 820-9900.
General dentist is needed for busy NE
Philadelphia dental office. F/T P/T.
Great reimbursement for the right
person. Call (215) 331-7585 or fax
resume (215) 331-7589.
Dentist Wanted
Pediatric dentist, orthodontist is
needed for NE Philadelphia dental
office. P/T. Call (215) 331-7585 or fax
resume (215) 331-7589.
Dentists Wanted
Growing practices located in Newark,
Delaware seeking full- and part-time
associate dentists. Excellent earning
potential in state of the art practices.
Fax resume to (302) 369-9777 or
56
e-mail [email protected].
Delaware Board Certified preferred but
will consider all applicants. For more
information, please visit our website at
www.christianadentalspa.com.
dental practitioner and utilize their
technical skills and professional
judgment to provide a full range of
dental services to an underserved
population.
Dentist Jobs
Aspen Dental offers tremendous
earning potential and a practice
support model that empowers you to
achieve your goals. We eliminate
obstacles for dentists to own their
own practice. To learn more and apply,
contact: Seth Cowen, (866) 451-8817,
or www.aspendentaljobs.com.
Many will be eligible for a comprehensive benefits package including:
• Competitive Pay.
• Student Loan Repayment Program,
PA State and/or National Health
Recruitment Program Cumulative.
• Annual leave and sick leave.
• Retirement benefits, health benefits.
• Full- or part-time hours available
Monday through Friday.
SEEKING GENERAL
DENTIST/SOUTH CENTRAL
PENNSYLVANIA
Exceptional opportunity to own a
thriving and highly regarded general
practice. Associateship leading to
full ownership or outright purchase
with option to retain present owner
or not. Full FFS with no HMO or
PPO. Grossing approximately
1.6M with high net. Strong emphasis
on implant restorations. First class,
eight operatory facility. www.chambersburgdentalarts.com or contact
Dr. Jeff Landon (717) 267-0800.
Successful general dental practice in
the Lancaster area, seeking a full- or
part-time associate for our expanding
practice. Modern working
environment, excellent location and
outstanding staff. Interested applicants
mail resume to 22 Millersville Road,
Lancaster, PA 17603 or fax to
(717) 394-3157.
Dentist Wanted
Dentist wanted at Bradford County
Dental Health Services in Towanda.
Towanda is nestled in scenic northeastern PA, approximately 40 minutes
south of Elmira, NY and 1 hour north
of Williamsport, home of the Little
League Baseball World Series. The
incumbent shall serve as a general
We are an Equal Employment
Opportunity Employer. Contact Robin
by e-mail at [email protected].
FOR RENT
Dental Office for Rent
Five operatories, supply room, handicap bathroom, reception area, waiting
room, ramp into the office, 13 parking spaces. One block from Rt. 206 in
Village of Lawrenceville, NJ. Please
call (609) 896-0224 if interested.
AVAILABLE
Dental Office Space Available
Located at 500 W. Township Line
Road, Havertown, PA.
• Available Mondays, Tuesday
afternoons, Thursday and Friday.
• Newly renovated in 2006.
• 3 operatories with PCs, Monitors
and Digital X-ray.
• 1 Laboratory.
• Business area.
• Reception area.
• Drs. private office.
Busy corner property at Township
Line Road and Greenview Lane.
Please contact Thomas Chermol Jr.,
DDS at (610) 283-3903 or e-mail
[email protected].
EQUIPMENT FOR SALE
ITEMS FOR SALE
Two items for sale: 1) “Ritter “J” chair,
delivery unit, light and two stools –
in very good condition. 2) Antique
mahogany dental cabinet, multi-drawer,
milk glass top, marble base. If interested, please contact (610) 459-3519.
FOR SALE
FOR SALE
Small town dental practice and real
estate in Lancaster County. First floor
with three operatories. Employee
parking in rear. Second floor private
one bedroom apartment. Average
collections over $265,000 on two
day/week. Priced to sell. Call (717)
665-1587 or [email protected].
Northeast Pennsylvania
Well-established general practice for
sale in Wayne County/Pocono
Mountain area. Owner looking to
retire. Completely renovated 1,300 sq.
ft. modern office with room for
expansion. Real estate also available.
Please contact [email protected] or
(570) 862-4921.
Lancaster County
Established family practice for sale in
Lancaster County. Dentist willing to
transition with buy-out. Spacious
office with seven ops. and high tech
equipment. Pleasant suburban
setting. $800,000 gross/yr. Please call
(717) 725-0032.
Practice for Sale – Chester County
Exceptional solo general practice.
Well-established in growing area. 5
ops + 1 plumbed, 2,750 s/f and 2,320
active patients. Rev. 700K on 32 hr/wk.
Schick digital Panorex, intra-oral
cameras, award winning Downingtown
schools. (R/E also available) Call (610)
North of Pittsburgh
IMMEDIATE SALE: Active general
practice a few miles north of
Pittsburgh. Well established, busy,
EXCELLENT staff, facility, patient
base, equipment, OPPORTUNITY.
Contact [email protected].
Wilkes-Barre/Hazelton Area
IMMEDIATE SALE: Active general
practice in the Wilkes-Barre/Hazelton
area. Well established, busy, two-office
practice. EXCELLENT gross and net
revenues. OUTSTANDING OPPORTUNITY. Contact [email protected].
Practice Sales
Please call Nancy Schoyer at
(888) 237-4237 or e-mail to
[email protected] and ask about
our 19 listings in PA. We have
practices for sale near Harrisburg,
four in York County, the Pittsburgh
and Philadelphia areas, Linesville,
Williamsport, Berks County and
Hanover. Call The MCNOR GROUP
AT (888) 273-1014, ext. 103 or
NEW PRACTICES FOR SALE
We have six excellent new listings!
Central – Grosses $400K.
Great location. 6 ops. FFS.
Near Pittsburgh – Practice and
building for less than $295K.
Motivated seller.
Scranton – Practice and building
available. This practice grosses $600K.
Berks County – Great place to
raise a family. This practice collects
over $900K.
Near Chambersburg and Bedford –
Practice and building for sale.
Great practice.
Near Philly – Seeking an associate
to buy-in and buy-out. $1.4 million
in revenue in this modern highly
profitable practice just 30 minutes
from Philadelphia.
Please see John McDonnell’s article in
the November 2009 issue of the Dental
Economics magazine, page 94 titled
“Why Not Sell Now?” Contact THE
MCNOR GROUP AT (888) 273-1014
ex. 103 or [email protected]
for more information on these and
other opportunities in the area.
www.mcnorgroup.com.
PRACTICE BUYERS WANTED
For great practices in the Pennsylvania
area. We have many practices available for sale. Are you tired of being an
employee in a dead end job? Call us
for a FREE CONSULTATION to find
out about these opportunities. THE
MCNOR GROUP, (888) 273-1014,
ext. 103 or [email protected].
www.mcnorgroup.com.
PRACTICE FOR SALE NEAR
PITTSBURGH
This is a great opportunity. This practice is located in 1,400+ square feet
and has four fully equipped treatment
rooms, and is collecting over $990K
with high earnings. The real estate is
also available for purchase. This is a
great practice for someone that has a
dead end job and wants to control
their destiny. We have 100 percent
bank financing available at reasonable
rates and terms. THE MCNOR
GROUP, (888) 273-1014, ext. 103 or
[email protected].
www.mcnorgroup.com.
ERIE
Established general practice. Sold as
practice only enhancing your practice
and profit margin OR as a turnkey
operation, including equipment and
real estate. Respond to PDA Box S/O 2.
57
ORAL SURGERY —
PRACTICE FOR SALE
West Virginia, near major university.
Great place to live. College sports,
educational and cultural activities.
Stable economy, growing population.
Annual collections $558,000 on
reduced schedule. Contact
George D. Stollings and Associates,
Inc. at (304) 486-5714 or
[email protected].
Lancaster County
Very established practice for sale.
Newly redecorated, equipment is
approximately 3+ years old. Dentrix
software - limited insurances. Contact
Sharon Mascetti at Henry Schein
Professional Practice Transitions at
(484) 788-4071 or (800) 730-8883.
PRACTICE OPPORTUNITY —
NEAR ERIE
General Dentistry. Owner seeks
associate that would then purchase the
practice within 2 to 3 years.
No Medicaid. No PPOs. Laser,
digital X-ray, computer charting,
intraoral, camera and more. Contact
George D, Stollings and Associates,
Inc. at (304) 486-5714 or
[email protected].
Western Pennsylvania / Greater
Pittsburgh Area / Eastern PA
Several practices available with
collections ranging from $200,000
to $ 1,000,000.
PA (#’s are collections)
Shadyside
$700,000
North Huntingdon
$500,000
Allison Park
$350,000
Mercer County
$660,000
Clearfield County
$1,000,000
North Huntingdon
$550,000
Clearfield County
$500,000
South Westmoreland
County/Greensburg area $210,000
58
South Hills Pediatric
Practice
$500,000
Mid Mon Valley
$250,000
Canonsburg
$385,000
Tri-State Periodontist
$750,000
Mid Mon Valley
$350,000
Latrobe
$400,000
Forest Hills
$320,000
Venango County
$360,000
Delaware County
$260,000
Altoona
$280,000
OH – Numerous.
We also have several other dental
practices and dental labs available in
Michigan, Massachusetts and
Southern California.
Please contact Bob Septak at
(724) 869-0533, ext. 102 or e-mail
[email protected] or WWW.UDBA.BIZ.
Practice w/ Real Estate for Sale!
South Central PA. General - family,
4 ops, freestanding building.
Rev $650K. 2,000 active pts. Contact
Donna at (800) 988-5674.
www.snydergroup.net.
York
Busy dental practice in York for
immediate sale. Owner semi-retiring
and relocating. Will stay on
20 hours max a week to assimilate
new owner. Five operatories with
three hygienists. Please respond to
[email protected].
Practice for Sale – Delaware County
Perfect Area! 2,700 s/f general
practice. 7 ops, building for sale also.
Panorex, Imaging system. Rev. $964K.
Contact Donna at (800) 988-5674.
Practice for Sale – Pennsauken, NJ
General dental practice and building
for sale, accumulate EQUITY, while
you work, not rent receipts,
Pennsauken, N. J., 7 minutes from
PHILADELPHIA, well known
location, 4+ ops, equipment good,
1,000+ sq. ft., tax saving investment.
Call (856) 665-6404.
Practice for Sale – Burlington
County, NJ
General/family 4 + 1 ops, 2,000
active pts, 1,900 s/f partnership,
leased space. Rev. $800K. Call Donna
at (800) 988-5464.
Practice for Sale – Salem County, NJ.
W/E, general with 3 ops, free standing
bldg., newly renovated, great net! Rev.
$600K. Call Donna at (800) 988-5674.
Dental Practice for Sale –
Northwest PA
General practice, wonderful community
5 ops w/room for expansion. Rev.
$541K. Call Donna at (800) 988-5674.
Dental Practice Sale – Adams County
6 ops in 2,900 s/f stand alone bldg.
R/E for sale, 2,200 active pts. Strong
Hyg., Digital, Cerec, Intra-Oral
Cameras and Panorex. Rev. $620K.
Dental Practice Sale – Cumberland
County
4 ops in 2,200 S/F (r/e also available)
free standing building. Over 3,000
active pts. 4 days/wk. Strong hyg.
Rev. $527K 6 yr. young practice.
Camden County, NJ – Home Office
for Sale
Beautiful corner property, office –
1,300 s/f. home – 2,400 s/f, 4 large ops.
– 2,000 active pts. All endo referred.
Rev. $324K. Contact Donna at
(800) 988-5674. www.snydergroup.net.
PRACTICE FOR SALE
DUTCHESS County, NY. Wonderful,
4 ops, digital, general practice with
2,000 active patients. Rev $825K.
Dental Practice Sale – Northampton
County
General, freestanding building
w/1,600 s/f, 4 new Adec ops + add’l
ops., 2,000 active pts. Rev. $1.2M.
North Central Pennsylvania
2,100 active patients, 6 fully
equipped treatment rooms, collections
of $400,000. Two busy full-time
hygienists. Excellent growth potential
and tremendous value. College town.
Wayne County
General practice with great reputation.
Consistently collects over $800,000
per year on 4 days per week. 1,500
active patients, 5 treatment suites (3
equipped, 2 plumbed, ready for equipment). Very warm, comfortable facility.
High profit margin with purchaser
income of $315,000 after debt service.
Delaware County
Great Opportunity! ACB of 600
patients collecting 180,000 a month,
3 plumbed ops with 2 equipped with
impressive new equipment and
custom cabinets. Growing practice is
computerized and digital. Great
merger or start up practice. Contact
[email protected].
Berks/Schuylkill County Area
More than 2,000 active patients, 40
new patients per month and growing.
Five treatment rooms and very modern
and bright office. Collections in excess
of $900,000 with excellent cashflow.
Harrisburg
Busy, long standing city practice with
high traffic location and visibility.
2,800 active patients and tremendous
potential to boost revenues. Excellent
cash flow and return on investment.
Real estate also available. Contact
[email protected].
Chester County
Group practice opportunity. Excellent
community reputation. Group has
more than 9,000 active patients and
provides mix of general dentistry. Very
attractive cashflow and compensation
rate. Contact [email protected].
Central Dauphin County
Hershey area (15 minute drive),
great location, all phases of dentistry.
1,200 active patients, mostly FFS.
Great pre-tax cash flow and tax
benefits. Real estate available. Contact
[email protected].
Harrisburg West Shore
A tremendous opportunity to purchase
a small practice with 1,250 active
patients and turn it into a very high
producing practice. Great cash flow,
tax benefits and return on investment.
Excellent facility and equipment.
All the right ingredients for success.
Real estate available also. Contact
[email protected].
Halifax
$500,000 part-time. 1, 600 s/f, 4 ops
(2 dentists, 2 hygienists). Growth
potential, low overhead. Staff stays.
Area underserved. 25 miles north
of Harrisburg; great for outdoorsman.
Office tour: Dolphin-dps.com.
(512) 864-1628.
North Central Pennsylvania
Dental practice and office building
for sale in scenic North Central
Pennsylvania. Owner looking to
retire. Please respond to PDA Box
S/O 3.
Practice and Office Building for Sale
For sale in Western Pennsylvania, a
dental practice and income producing
office building, which includes four
operatories. The practice/office building is located in a beautiful college
community. 100% financing available.
Call (724) 458-7620.
PROFESSIONAL SERVICES
Practice Transitions
Selling – buying – merging –
establishing associateships.
CERTIFIED VALUATIONS FOR ALL
PURPOSES by Master Certified
Business Appraiser. Professional
Practice Planners, 332 Fifth Avenue,
McKeesport, PA 15132.
(412) 673-3144 or (412) 621-2882
(after hours.)
Consulting Services
CPA having 23+ years’ experience
(including with AFTCO Associates)
offers independent dental advisory
services involving Buying, Selling,
Mediation, Valuation, Expert Witness
or Tax Planning. Joseph C. Bowers,
MBA, CPA/PFS, (610) 544-4100 or
PARTNERSHIPS OR DELAYED
SALES
We have many satisfied clients with
associates in your area that we have
helped to either buy-in, buy-out
or a delayed sale with the current
associate. Without a quality valuation
and plan up-front, these transactions
normally fail. Call or e-mail us to
arrange a FREE CONSULTATION to
find out if you are a candidate for
this service. The result is higher
income and a higher practice value
for the seller and a clear financially
positive path for the associate. THE
MCNOR GROUP, (888) 273-1014,
ext. 103 or [email protected].
www.mcnorgroup.com.
59
NEW OWNER REPRESENTATION
Our family and organization has
represented over 1,000 new owners
over the last 65 years in the
Mid-Atlantic area that have purchased,
started or became partners in a dental
practice. Ownership is a decision
that is too important to make without
a qualified facilitator. We can get the
new owner 100 percent financing
plus working capital. Call us for a
FREE CONSULTATION and allow us
to send you a list of our references.
THE MCNOR GROUP, (888) 273-1014,
ext. 103, or [email protected].
www.mcnorgroup.com.
PRACTICE VALUATION
APPRAISAL
We are the only transition consulting
company in the area that has a
Certified Valuation Analyst (CVA) as a
principal that focuses exclusively on
60
the transition of DENTAL PRACTICES.
Please see the article by CVA Karen
Norris on page 82 of the April ‘07
issue of Dental Economics on this
subject or call or email us for a FREE
CONSULTATION and a copy of the
article. If you are selling, buying,
creating a partnership or just want to
find out the current value of your
practice contact THE MCNOR
GROUP, (888) 273-1014, ext. 103,
or [email protected].
www.mcnorgroup.com.
Practice Transitions
We specialize in Practice Sales,
Appraisals and Partnership
Arrangements in Eastern Pennsylvania.
Free Seller and Buyer Guides available. For more details on our services,
contact Philip Cooper, DMD, MBA
America Practice Consultants, (800)
Professional Temporary Coverage
Professional temporary coverage
of your dental practice (locum
tenens) during maternity, disability
and personal leaves. Free, no
obligation quotes. Absolute confidentiality. Trusted integrity, since
1996. Nation’s most distinguished
team. Always seeking new dentists
to join the team. No cost, strings
or obligation - ever! Work only
when you wish (800) 600-0963.
www.doctorsperdiem.com. E-mail:
[email protected].

Pennsylvania Dental Journal Pennsylvania Dental Journal

Transcription

Similar documents

www.odscompanies.com/members

www.odscompanies.com/members

Koyfman Dental - DL Harkins Construction in Orlando, FL

Managed Care of North America, Inc. (MCNA Dental Plans) offers a

View or print our GKAS flyer - College of Dentistry

Children in Need of Dental Treatment Program

HELP DENTAID TO END ORAL PAIN

Dental Careers Exploration Camp

CSOP Bldg1 Suite 107 broch - 1123

to open them in a new window for printing.