March 2011 Nugget

March 2011

The line beTween Medicine & denTisTry blursInside:New guidelines for total joint prophylaxisBlood pressure monitoring in a dental officePLUS: Are you utilizing social media to benefit your practice?

member forumMarch 18, 2011

member forumMarch 24, 2011

Build Your own EmploYEE HandBookPresented by: Mari Bradford (CEA)

Topics will includE:• Handbookbenefitsandrisks• PoliciesRequiredbyStateandFederalLaw

• RecommendedPolicies• WhatNOTtoputinaHandbook

8:30am–1:30pm • 4 ceu (20%)SDDS Office

THE numBErs of Your pracTicE: THE good, THE Bad, avoiding THE uglYPresented by: Chris Mann, CPA, CFP; John Urrutia, CPA; Neil Beeman, CPA(Mann, Urrutia, Nelson, CPAs)

Topics will includE:• Thebeststructureforyourbusiness• Redflagswhensomeoneelseis“handling”yournumbers

• Howyourpracticeandyourpersonallifeworktogether

• WhatyourCPAshouldbedoing• Therighttimeforinvesting:expanding,building,partnering

6:30pm–8:30pm • no cEuSacraMentO hiltOn — arDen WeSt

continuing educationMarch 4, 2011

rpds — sTill a good opTion in THE agE of implanTs

Presented by: Alan Carr, DMD, MS

coursE oBjEcTivEs:• UniquedifferencesbetweenRPDsandotherprostheticoptions

• WhyreportsofperiodontaldiseaseinRPDwearersexist,andwhetherthereisatruecausalnaturetotherelationship

• Keyclinical/patientfeaturesthatputpatientsatriskfordissatisfactionwhenprovidedwithRPDs

8:30am–1:30pm • 5 ceu (core)hyatt regency SacraMentO

don’t miss these upcoming events!

general meetingMarch 8, 2011

BEnign & malignanT Tumors of THE nEck & skinPresented by: Barbara Burrall, MD

coursE oBjEcTivEs:• Recognizenormalvariantcutaneousstructures,arangeofbenigncutaneoustumorsandarangeofcutaneousmalignanttumors,includingmelanomaandnon-melanomacancers

• Performageneralheadandneckskincancerscreening

6:00pm–9:00pm • 2 ceu, coreSacraMentO hiltOn — arDen WeSt

SpouSe NIght!

prIce INcludeS haNdbook oN cd!

5ce, core

4ce, 20%

November 2007 | 3www.sdds.org

THE NUGGETMarch 2011

VoluMe 57, NuMber 3

Table of conTenTs

March 2011 | 3

The NuggeT IS a four-tIme INterNatIoNal college of deNtIStS JourNalISm award wINNer:

GoldeN PeN (hoNorable MeNtioN, 2007)Article or series of articles of interest to the profession

outstaNdiNG coVer (2007)Remarkable cover

oVerall Newsletter (2007)Exceptional publication overall

PlatiNuM PeNcil (2010)Outstanding use of graphics

featureS7 Breaking Down the Barriers

Tim Mickiewicz, DDS

8–9 Antibiotic Prophylaxis For Patients with Joint Replacements Kevin Keating, DDS, MS

10–11 Guidelines for Monitoring Blood Pressure of Dental Patients Kevin Keating, DDS, MS

12 Guidelines for Obtaining Medical Consultation for Patients Receiving Dental Treatment Art Curley, JD

SpecIalS9 Letter to the Editor (re: February 2011 Nugget)

Kevin Keating, DDS, MS

regularS4 President’s Message5 From the Editor’s Desk6 Cathy’s Corner11 Link of the Month14 YOU: The Dentist… the Business Owner15 Foundation Update17–18 Being Social20 YOU: The Dentist… the Employer23 Committee Corner23 Committee Meeting Schedule24–25 Vendor Members25 Vendor Member Spotlights26 We’re Blowing Your Horn!28 Advertiser Index29 Membership Update30 Event Highlights31 Classified Ads32 SDDS Calendar of Events

* featured on cover

4 | The Nugget Sacramento District Dental Society

and swallowing. It would also help to prevent further tooth decay on those patients.

More and more dental offices are taking blood pressure on adult patients as a screening for hypertension. We have screened patients for oral cancer during our initial and recall examinations. Dentists, dental hygienists and team members have talked with patients on oral hygiene, smoking cessation, diet and body mass index. Early intervention is important. That is why we are doing screening and educating our patients. According to the Institute of Medicine, sleep disorders and sleep deprivation is an unmet public health problem. It is appropriate for us to screen for sleep disordered breathing. It may not be just snoring. Referring those patients who seem to have obstructive sleep apnea or sleep related breathing problems to their physician for sleep test; and then follow up with a phone call or fax to patient’s physician would ensure patients receive the proper care. Their health and their quality of life will improve with the proper diagnosis and treatment. This is team work.

Our medical colleagues consult with each other to provide the best treatment for their patients. They started doing that during their medical school training and residencies. Calling/consulting your colleagues is expected and is part of the process in affirming the diagnosis and best treatments. Just as we

As dentists, we are part of the healthcare team. We are experts of the oral maxillofacial area of the body. Just like our medical colleagues, who are experts and specialists in their respective specialties, we do not know nor do we claim to know everything about the rest of the body. But we work together to provide good health for our patients.

Unless you practice pediatric dentistry, our patient population is getting older. With advances in modern medicine, patients are living longer. Some patients might come in with complicated health histories and a long list of medications they are taking. For these patients, in addition to checking our PDR or Epocrates, we may have to consult with their pharmacists and physicians. We also have patients in various age groups who come to see us after they have recent surgeries. We may have to work with our medical colleagues to find out if antibiotic coverage is needed.

Patients who are diabetic and developing acute periodontal problems may have a change in their diabetic condition. Patients on certain medications may develop dry mouth and dental cervical decay. They may need to have their medication modified. By talking with or faxing the information to their pharmacists and physicians, we would be able to provide better patient comfort in speaking, eating

PresidenT’sMessage

gatekeeperSconsult with our dental colleagues on dental/oral issues, we should also consult with our

medical colleagues on medical issues. The communications reaffirm that dental care is part of total health care and that dentists are part of the healthcare team.

We are the gatekeepers of our patients’ oral health, but we see more than the mouth and the face. For the health of our patients, let us collaborate with our medical colleagues in identifying the medical problems, and arriving at the best mode of patient care.

by Wai M. Chan, DDS

We are the gatekeepers of our patients’ oral health, but we see more than the

mouth and the face.

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www.sdds.org March 2011 | 5

One of our members cried out to the Dental Society last year for help regarding the ever-changing prophylaxis guidelines for treating patients. His specific frustration was that, once again, the guidelines for prophylactic antibiotics had changed, this time for total joint replacement. As we “ol’ timers” know, whether the guidelines for prophylaxis are from the AHA, AMA, ADA or AAOS, there have been many changes to prophylaxis guidelines since their implementation 30 years ago. Many of us will recall the early days when Endocarditis Prophylaxis started two days prior to dental treatment and continued for the five days following treatment. That morphed to a loading dose on the day of treatment followed by two days of antibiotics. Based on further evidence on outcomes, the guidelines then became 3 gm pre-op, followed by 1.5 gms of Amoxicillin six hours later, and then moderated to the standard we have now been using for many years. The Total Joint Replacement Prophylaxis Guidelines for Dentistry for many years mirrored the Endocarditis Guidelines. That is now not the case. The Total Joint Replacement Prophylaxis Guidelines are different and now include different antibiotic recommendations than the Endocarditis Guidelines. Therein lies the core issue that frustrated him: the guidelines have once again changed and what are we going to do about it? That leads us to this issue of the Nugget, dedicated to the topic of prophylaxis for dental treatment. One thing remains true, and that is nothing stays the same.

I think it is important for you to know that the SDDS Board of Directors met and discussed how to address this member’s concerns. During the discussion it became painfully obvious to the Board that only one in roughly three or four of the Board members knew that the American Association of Orthopedic Surgeons (AAOS) had published their guidelines almost two years ago and that these guidelines contradict AMA guidelines by recommending lifetime prophylactic antibiotics for dental treatment of patients with total joint prosthesis. The AMA guidelines requiring antibiotics for only two

froM TheediTor’s desk

“The Times, They Be A-Changing”(agaIN… & agaIN… & agaIN…)

years following surgical total joint replacement are superseded by the AAOS guidelines, since the Orthopedists are the experts in this field of medicine. So if only a small percentage of very knowledgeable Board members were aware of this change to the Total Joint Replacement Guidelines, the Board had to assume that this was a reflection of a similar ratio in our members. This observation was certainly an unexpected but very valuable outcome of this member’s request for help. In all fairness to our members, these guidelines were not well publicized by AAOS nor ADA. The Board appointed a Prophylaxis Task Force to look into the guidelines for Prophylaxis and make recommendations to the Board for action. The Task Force was also charged to develop strategies for addressing the changes and the fact that the guidelines seem to be in conflict by being required, not required, altered, modified, etc. The member had also insisted out of frustration that our Society to take the lead in developing a position paper on prophylactic antibiotics for all dentists that helps clear up the confusion and ends the constant changes. This too became a charge for the Task Force to consider.

The Prophylaxis Task Force met this past December to discuss options and strategies for dealing with this issue. The first issue addressed was: should SDDS take the lead in developing guidelines for total joint prophylaxis and other medical conditions requiring prophylaxis against transient bacteremias? The Task Force members recognize that bacteremias of oral origin do occur and some of those bacteremias occur directly as a result of dental treatment. Other oral sources of bacteremia can be home oral health care, lack of home oral health care and those bacteremias that occur during the act of eating. We also recognized that our Society has many members who may have the interest, but unfortunately lack the academic research credentials or do not have the medical specialty expertise to develop these guidelines. Those best suited for developing guidelines are those in a University setting who have the clinical, research and medical specialization

by Kevin Keating, DDS, MSGuest editor

background to justify the rational for those guidelines. As such, we cannot issue a guideline for a medical condition without risking a regulatory legal charge of practicing medicine without a license. The Task Force found out that the ADA and the American Association of Orthopedic Surgeons are now working together with a joint panel of experts to develop a consensus guideline to be published hopefully in 2012.

The next issue the Task Force discussed was making our members aware of these new guidelines. The recommendation to the Board of Directors was to use the Nugget and the SDDS Continuing Education Program to make our members aware of the changes. This Nugget issue is the first step in that process.

Recognizing that whether a practitioner decides whether or not to follow guidelines is not a problem, until it is a problem. When it does become a problem, it generally involves defending in court the decisions made during treatment. So we asked Art Curley to weigh in on this matter using his vast experience as a Malpractice Defense Attorney. Hopefully it is NOT when we have a legal problem that we become better educated about standard of care issues as they relate to prophylaxis.

Those of us on the Board of Directors and the Task Force wish to thank Dr. Tim Mickiewicz for his passionate cry of frustration which led to our collective efforts to make all our members aware of the current guidelines for Total Joint Replacement, and that in the near future there may come revisions when the joint ADA and AAOS guidelines are made public. I also want to personally thank Dr. Mickiewicz for his written contribution to this issue of the Nugget. As the Guest Editor, it is my hope that you find the articles both informative and stimulating. I firmly believe that the personal principles which guide me though a career where nothing stays the same, absolutely apply here. In closing, I would like to share them with you. The principles by which I live are firm and intractable. The first firm and intractable principal is: Be Flexible.


President — Wai Chan, DDSImmediate Past President — Terrence Jones, DDS

President Elect — Victor Hawkins, DDSTreasurer — Gary Ackerman, DDSSecretary — Kelly Giannetti, DDS

Editor — James Musser, DDSExecutive Director — Cathy Levering

Dan Haberman, DDS, MSCarl Hillendahl, DDS

Jennifer Goss, DDSKenneth Moore, DDS

Craig Johnson, DDSViren Patel, DDS

Wallace Bellamy, DMDBrian Royse, DDS

Kim Wallace, DDS

Kevin Keating, DDS, MSDonald Rollofson, DMD

CE: Jonathan Szymanowski, DMD, MMScCPR: Margaret Delmore, MD, DDS

Dental Health: Dean Ahmad, DDSEthics: Volki Felahy, DDS

Foundation: Robert Daby, DDSLeadership Development: Terrence Jones, DDS

Legislative: Mike Payne, DDS, MSD / Gabrielle Rasi, DDSMembership: Lisa Laptalo, DDS

Peer Review: Bryan Judd, DDS / Brett Peterson, DDS

Dental Careers Workgroup: Robin Berrin, DDS Beverly Kodama, DDS

Budget & Finance Advisory: Gary Ackerman, DDSBylaws Advisory: Adrian Carrington, DDS

Fluoridation Advisory: Kim Wallace, DDSForensics Advisory: George Gould, DDS / Mark Porco, DDS

Strategic Planning Advisory: Victor Hawkins, DDS/ Gary Ackerman, DDS

Golf Tournament: Damon Szymanowski, DMDSacPAC: Donald Rollofson, DMD

SDDF Gala Fundraiser: Wes Yee, DDSSmiles for Kids: Donald Rollofson, DMD

caThy’scornerThe Evolution of “a coNcerN”Several months ago a member called me (as many do!) with a concern. As always, I asked that he write it up in an email, send me some background material and I would present it to the Executive Committee, the Board and the appropriate committee for review and consideration.

LSS (“long story short”)… this “concern” is the topic of this issue of The Nugget.

Thank you, Dr. Tim Mickiewicz, for bringing it forth. Thanks to the Board of Directors for seeing the importance of this topic. And thanks to Dr. Kevin Keating for chairing the task force, the information gathering, presenting the information and recommendations and, finally, for writing most of the articles for this issue — a “guest editor” indeed!

Lest you think that your phone calls, your emails, your comments “from a messenger” go unheard, they don’t.

With an organization that is local and that has more than 1500 members, we hear from you often. I have been involved in the association business for 17 years and I can truly say that SDDS members are definitely vocal! We have eight phones lines and two fax lines that are always busy and a DSL and server that deliver nearly 700 emails each day — all for the benefit of members, their concerns and their questions regarding the running of their businesses and the concern for their patients as well as their colleagues.

A couple of weeks ago I a got a call from another “concerned” member. But this call was different. Very different. It seems that we have a member who has liver cancer and needs a donor — quickly. Donating a part of your liver, as I understand it, is not a difficult procedure — but an enormous gesture. Obviously, this will be a lifesaving donation, if you are a match.

If you are interested, please contact me (confidentially, of course) and I can give you the details on how to be tested if you could possibly be a match. You need to be O positive and under the age of 55 to begin the process.

Like I said, members contact me all the time about their concerns and their issues. But this issue really will save a colleague’s life. Are you interested?

SaCraMento DiStriCt Dental SoCietyAmador • El Dorado • Placer • Sacramento • Yolo

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of products or services advertised. SDDS reserves the right to reject any advertisement.

The Nugget is an opinion and discussion magazine for SDDS membership. Opinions expressed by authors are their own, and not necessarily those of SDDS or the Nugget Editorial Board. SDDS reserves the right to edit all contributions

for clarity and length, as well as reject any material submitted.

The Nugget is published monthly (except bimonthly in June/July and Aug/Sept) by the SDDS, 915 28th Street, Sacramento, CA 95816 (916) 446-1211. Subscriptions are free to SDDS members, $50 per year for CDA/ADA members and $125 per year for non-

members for postage and handling. Third class postage paid at Sacramento, CA.

Postmaster: Send address changes to SDDS, 915 28th Street, Sacramento, CA 95816.

EDITORS EMERITuS: William Parker, DMD, MS, PhD • Bevan Richardson, DDS

sdds sTaffCathy leveringExecutive Director

della yee Program Manager/ Executive Assistant

Melissa Orth Publications Coordinator

lisa Murphy Member Liaison/ Peer Review Coordinator

Erin CastleberryMember Liaison/ Smiles for Kids Coordinator

Nugget EdITOrIal BOardJames Musser, dds

Editor

Paul Binon, DDS, MSDDonna Galante, DMD

Alexander Malick, DMDJames McNerney, DMDChristy Rollofson, DDS

Oladimeji Sorunke, BDSAsh Vasanthan, DDS, MS

Sacramento District Dental Society

by Cathy B. leveringSDDS Executive Director

Saturday: OctOber 1, 20116:30pm•HyattRegencySacramento

AgalatobenefitSacramentoDistrictDentalFoundation

More info:(916) 446-1227

A Gala event to support the

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Table & Corporate


What is it going to take? For too long dentists have lived in a self-imposed exile as the poor stepchild of medicine. Being isolationist by nature, most general dentists don’t enjoy the collegiality of large multi-specialist groups or hospital based practices. This perceived imbalance is perpetuated by our reluctance to contact physicians because of the “real doctor / just a dentist” discomfort… because of some odd programming that we are not equals. It is time for you to toss that mentality out of the window. Now, more than ever, we need our medical colleagues to be true partners in health care. This Nugget issue is a testament that cooperation between us is not just a liability issue but a true example of the compassion, empathy and sincere care we provide. If you take off your loupes you will see the blurry line between medicine and dentistry. I enjoy a great relationship with the medical community. This did not happen overnight and a concentrated effort is made every day to raise my personal bar of understanding increasingly complex cases. The strategy employed is not a huge secret and I refuse to use the trite appeal for collaboration or thinking outside of the box. Just think.

In our quest to do what is best for our patients, it is critical that we start with the most fundamental tenet of medicine… a good history. I am often privy to a patient’s full medical history provided through their primary care physician or referring specialist. It is not uncommon to see 10-20 medications listed and a list of chief complaints that consume a full typewritten page. You look at the medical history and perhaps the patient puts down only a few of their medications. Older patients are usually good about providing a decent list but how often do you look all of them up? Do you know how many nocturnal bruxism cases are exacerbated by SSRI’s, common antidepressants that everyone seems to be taking? Are you aware that certain birth control medications destroy the joints of young females and that penicillin

Breaking Downthe barrIerS

interferes with the efficacy of the birth control medication? Have you ever seen an ACE inhibitor induced angioedema, which can mimic a severe abcess or cellulitis? And of course you know never to mix the Ace inhibitor with an NSAID. The list is endless. The point: read the history and be a bit of a snoop, discretely of course. If you have a question, call the physician and ask a few questions. The rules: do your homework first and don’t waste their time. Respect them to be abrupt (no insult; they are busy too).

Edward O. Wilson, humanist biologist of DNA fame wrote a fascinating tome in 1998 “Consilience: The Unity of Knowledge.” The basic premise is uniting science and the humanities to explain natural phenomenon - heady stuff and a sure cure for insomnia. After four reads, I started to identify common themes that seem to transcend all cultures and subcultures such as ours. The unification of all knowledge! You can’t possibly amass all of the information out there, so people universally have innate abilities to search for answers, consult with elders, learn from the mistakes of others and a commonality of ethics. It’s basically a math and physics problem. So how is consilience a strategy for improved communication? Think. Search for the why behind a patient’s problem. Then draw on your team to help you find appropriate answers. Check your ego and realize you need the physicians… and they

need us. Increasingly, the process is becoming obvious. But you need to step outside of your comfort zone of complacency and realize that marginal integrity and the coefficient of thermal expansion are equally important to stress induced bruxism and degenerative joint disease secondary to estrogen imbalance. Learn about an amazingly unrecognized acid reflux issue. Acid reflux may be why your crown failed and may continue to do so until you appreciate the treatment of patients, not just teeth.

And since they gave me this forum to be a bit preachy… whatever happened to the old school professional courtesy? Be nice to those nurses and medical assistants, they are the gate keepers to the physician and will open the door to having someone to bounce questions off of. Give them a break on the fees, they deserve it. I have physicians shadow me for their sleep medicine rotations. They are amazed at how seamless our practice is when we juggle multiple chairs with staffs that seem to read our mind. They are sometimes a bit jealous of our independence from the Medicare debacle, our patients who accept a wellness preventive oriented practice… as a group we even earn more than the average primary care doc. We are equals and compatriots in the battle to do what is best for that person in front of us. I don’t have all of the answers and have been humbled many times. But I’m not afraid to ask that stupid question.

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Registration Check-in 8 to 9:30 a.m.

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Targeting SmilesSporting Clays Tournament. Saturday, May 22, 2010Birds Landing Hunting Preserve & Sporting Clays. Rio Vista, CA

For Information

Birds Landing Hunting Preseve & Sporting Clays 2099 Collinsville Road

Registration Check-in 8 to 9:30 a.m.

$95 Donation Per Shooter Includes:

$45 Donation Per Non-Shooter Includes:

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2nd annual targeting SmilesSporting clays tournament. Saturday, May 21, 2011BirdsLandingHunting&SportingClays(nearRioVista,CA)

$120/individualshooter•$50/non-shooter(lunchonly)Event information: (510) 604-3323 • [email protected]

by tim Mickiewicz, DDSsdds Member


following placement of the prosthetic joint, the current AAOS recommendation again recommends the need for preoperative antibiotic prophylaxis for the lifetime of the patient. As we know, the AMA guideline recommends prophylaxis for two years, but those most closely associated with joint failure the orthopedic surgeons, have published their recommendations which will supersede those of the AMA.

In light of the American Heart Association’s reasoning behind modification of their recommendations for prophylactic antibiotics for those at risk for bacterial endocarditis, there appears to be controversy about the relative risks associated with dental treatment versus other sources of oral cavity induced bacteremias. Since there is controversy over the perceived and real risks of bacteremias originating in oral cavity, the ADA and the AAOS have appointed a joint task force of experts to develop an evidence-based position paper on antibiotic prophylaxis recommendations for dental treatment for those patients with total joint replacement. It is my understanding this joint position paper is anticipated to be completed in 2012. Until this joint position paper is developed and disseminated, it is strongly recommended that the premedication protocols of the American Academy of Orthopaedic Surgeons should be used for managing patients with total joint replacement.

The AAOS position paper also states that the health care professional who is planning

Yes, the protocol has changed again.

There are more than 1,000,000 total joint replacement surgeries performed annually in the United States, of which approximately seven percent are to replace failing prosthetic joints.1 Infections of total joint replacements usually result in failure and lead to the replacement of the prosthesis. Recognizing the

risks to prosthetic joints associated with blood born bacteremias, the American Association of Orthopaedic Surgeons (AAOS) and American Academy of Orthopaedic Surgeons have modified their recommendations for preoperative prophylactic antibiotics for medical and dental procedures.

In February of 2009, the American Association of Orthopaedic Surgeons (AAOS) presented their most current recommendations for antibiotic prophylaxis in patients with total joint replacements. The revised guidelines recommend that patients with total joint replacements should receive prophylactic antibiotics appropriate for the type of medical or dental procedure that is anticipated. The prophylactic antibiotics are given to minimize the hematogenous spread of bacteria to the prosthesis. The antibiotic recommended in these newer guidelines is specific for the common bacteria associated with the medical or dental procedure. Dermatologic procedures would focus on staphylococci and oral procedures would require antibiotics more appropriate for streptococci. Unlike the prior guidelines, wherein prophylaxis was recommended only for the two years

Antibiotic Prophylaxisfor patIeNtS wIth JoINt replacemeNtS

treatment should do so in consultation with the patient’s surgeon on the need for prophylactic antibiotics and confirm if that surgeon has specific recommendations that are different than those of the guidelines. This is also the recommendation of TDIC. It is TDIC’s recommendation to obtain written confirmation of the surgeon’s recommendations for prophylaxis. They suggest utilizing a faxable Medical Consultation form that can be returned to your office from the surgeon’s office confirming both the need for prophylaxis and the preferred prophylactic antibiotic regimen for that patient. Using a faxable Medical Consultation form to obtain a medical recommendation to utilize or not utilize prophylactic antibiotics is necessary for legal reasons. Art Curley, a prominent Malpractice Defense attorney and consultant for TDIC, states that not to do so would be ill advised, especially in the event an untoward outcome occurs3.

The following should be pointed out so that there is no confusion: The AAOS guideline states that patients with pins, plates and screws, or other orthopedic hardware that is not within a synovial joint are not at increased risk for hematogenous seeding by microorganisms.

At right is the table from the AAOS guidelines, listing those for whom they recommend prophylactic antibiotics. I also have reproduced their antibiotic regimen which is not the same as other prophylactic antibiotic regimens.

referenCeS:1. Number of Patients, Number of Procedures, Average Patient Age, Average Length of Stay —

National Hospital Discharge Survey 1998-2005. Data obtained from: U.S. Department of Health and Human Services; Centers for Disease Control and Prevention; National Center for Health Statistics.

2. Information Statement: Antibiotic Prophylaxis for Bacteremia in Patients with Joint Replacements, American Academy of Orthopaedic Surgeons: February 2009, Revised June 2010

3. Art Curley, Esq., The Dentists Insurance Company malpractice attorney consultant, Personal Communication. January 2011.

by Kevin Keating, DDS, MSsdds Member

The health care professional who is planning treatment

should do so in consultation with the patient’s

surgeon on the need for prophylactic antibiotics.


• All patients with prosthetic joint replacement

• Immunocompromised/immunosuppressed patients

• Inflammatory arthropathies (e.g.: rheumatoid arthritis, systemic lupus erythematosus)

• Drug-induced immunosuppression

• Radiation-induced immunosuppression

• Patients with co-morbidities (e.g.: diabetes, obesity, HIV, smoking)

• Previous prosthetic joint infections

• Malnourishment

• Hemophilia

• HIV infection

• Insulin-dependent (Type 1) diabetes

• Malignancy

• Megaprostheses

Cephalexin, Cephradine, Amoxicillin2 grams PO1 hour prior to treatment

taBle 1: Patients at Potential increased risk of Hematogenous total Joint infection2

aaoS recommended Protocol for Dental Procedures likely to cause Bacteremias2

Note: There is no alternative antibiotic suggested for those patients who are allergic to penicillin and cephalosporin antibiotics. Consequently, one must consult with the patient’s surgeon and obtain written confirmation as to what alternative antibiotic therapy should be utilized.

The faxable Medical Consultation form suggested by TDIC is a valuable tool for facilitating this consultation. The benefit of the fax form is it allows for direct communication in a timely fashion and does not require pulling the physician or you away from patient care. For those insured by TDIC, one can obtain this form on line at http://www.thedentists.com/risk_management/recordkeeping/forms or by calling the TDIC advice line at 800.733.0634.

letter to the edItorRe: February 2011 Nugget — “Is This Dentist Real?”

Dear Dr. Acheson,

I write for several reasons. First I wish to thank you and congratulate you for your well thought out Nugget issue on the access to care and the potential for change to come to the dental work force model. I absolutely agree with you that the current model for oral health care delivery is not broken. I am glad that you correctly pointed out that two well organized and financed Foundations have been the force behind the actions that have institued Dental Health Care Therapists in Alaska. They were also the motivating force behind workforce changes in other states as well. There are up to 20 states wherein work force models are being championed by outside forces for changing how dental care is delivered. With roughly 10,000,000 individuals in California who reportedly have barriers to dental care, we need to be ever vigilant. Forces outside organized dentistry will move to provide solutions for those ten million Californians who have the potential to change the work force model we currently enjoy.

I will use your discussion regarding AB2637 as a point to illustrate how others who have a vested interest in oral health care can effectively change our model without our participation in the actions by the legislature — specifically, the endodontic component of the RDAEF duties established by AB2637. The duty allowing a RDA with EF training to “fill’ canals was put into the legislation by an interested stakeholder group after the dentists essentially signed off on the intended legislation. Those few dentists involved in the legislation’s development, who noticed the change in the endodontic duty, assumed it something the endodontic community wanted. Only after the passage of the legislation did it become evident to the endodontic community and the broader dentist community that this had been “slipped” into the legislation. One motivation for making this a duty was the hope it would help with a barrier to care by allowing more endodontics to be done for those in need.

Fortunately, because of the risks associated with disesthesia, paresthesia and overextension into the sinuses, this duty has been changed in the regulations from filling root canals, to fitting gutta percha in preparation for condensation by the dentist. I know because I represented both the American Association of Endodontists and the California Association of Endodontists and worked with the Dental Board of California to change this duty.

We in the dental community need to be vigilant and we also have to be knowledgeable about the various potential models that may be proposed to change how dental care is delivered. We need to be knowledgeable because on the surface, a proposed solution for reducing barriers to care may look appealing to the legislature. Due to the demographics of ten million underserved Californians, we may or may not be able to dissuade the legislature from acting. And if change does come, we need be able to ensure that the dentist stays at the head of that model so the model change will have the potential to be effective.

Kevin Keating, DDS, MSsdds Member

SDDS Membership Committee presents the2011 NEW MEMBER DINNER • April 6, 2011

6pm • Old Spaghetti Factory • Contact SDDS for more info (916.446.1227)


140/90. It is reported that 30% of patients with hypertension are unaware of their disease and consequently untreated; and up to 60% of hypertensive patients who are taking medication have blood pressure that is not adequately controlled.2 Consequently, making blood pressure monitoring a routine for any dental procedure is a great benefit to your patients by ensuring they are well informed and by minimizing the risks associated with treating those patients who are unaware of the severity of their hypertension.

So what are the guidelines to be used for determining if treatment should be delayed? In the textbook, Dental Management of the Medically Compromised Patient, the authors have provided a table which clearly delineates the guidelines for managing patients based on their blood pressure taken on the day of treatment. Since the majority of minor surgical and nonsurgical dental procedures done using local anesthetic are considered low risk, treatment can generally be provided with elevated blood pressure reading below 180/110.2 It is recommended that those patients with hypertensive readings greater than 160/100 should be evaluated by their physician within a month. For patients with readings greater than 180/110, they should be evaluated and treated immediately within the week. The guideline is very clear for those patients whose systolic blood pressure is

Individuals with diagnosed or undiagnosed hypertension enter our dental offices daily as our patients. As a general rule, the patients we see with hypertension are well managed because they have previously been diagnosed and treated by their physicians. Unfortunately, many individuals we see as patients have either not been diagnosed and treated as hypertensive or have experienced physiological changes wherein their current mediations are no longer managing their blood pressure adequately. Consequently, it is a great benefit for the patient and the dentist to routinely monitor blood pressure as part of a routine dental examination and treatment. It is beneficial for the patient who has undiagnosed or poorly managed hypertension to be made aware of their condition so that they can seek appropriate medical consultation and treatment. This practice can also be extremely beneficial for both the patient and the treating dentist for those patients whose blood pressure is so high that it would be imprudent to proceed with elective dental treatment until the blood pressure has been evaluated and managed by their physician.

In 2003, the current classification of blood pressure in adults was established and the recommendations for follow-up care were established.1 Hypertension was defined in that report as blood pressure in excess of

Guidelines for Monitoringblood preSSure of deNtal patIeNtS

in excess of 180 or the diastolic pressure is in excess of 110, and that is to postpone elective dental treatment and refer the patient to a physician. Those who, in addition to the severely elevated pressure, are also experiencing symptoms such as headache, shortness of breath, chest pain, nosebleeds, or severe anxiety, may require urgent medical attention2. The guidelines below summarize the recommendations for treatment and referral to their physician based on blood pressure readings.

For those patients whose blood pressure warrants postponing elective dental treatment and referral to their physician, it is important to also obtain a written medical release. A medical release can be sent with the patient stating the blood pressure reading along with a request for the physician to report on their recommendations for that patient’s care. TDIC suggests a faxable Medical Release form that can easily be returned from the physician’s office with their recommendations for the patient’s care.

From practical experience, when a patient is rescheduled and sent to their physician with a release, they are instructed that their physician must fax back the form prior to being rescheduled for care. I have observed as a general rule that it will be a few weeks before the physician will release that patient for dental care, depending on how

by Kevin Keating, DDS, MSsdds Member

guIdelINeS: from the textbook, Dental Management of the Medically Compromised Patient

blood Pressure deNtal treatMeNt Medical coNsultatioN< 120/80 Any treatment required None required

> 120/80 but < 140/90 Any treatment required Recommend patient see a physician

> 140/90 but < 160/100 Any treatment required Recommend patient see a physician

> 160/100 but <180/110 Any treatment required monitor blood pressure during treatment

Refer patient for medical consultation

> 180/110 Defer elective treatment Refer patient for medical consultation.If symptomatic, refer immediately.


challenging it was to effectively bring down that individuals blood pressure. On occasion, the physician will only suggest an anxiolytic to assist in lowering blood pressure on the day of treatment. In these situations where there has been medical clearance for treatment using oral sedation, medications such as Valium, Ambien, or Halcion can be utilized with the medical recommendation confirming that such a strategy would be beneficial.

Twenty five years ago, I admit it was a bit of a challenge getting staff accustomed to taking the pulse and blood pressure readings prior to my entering the operatory. During this transition period of making it a routine of taking blood pressure at every patient visit, I had the experience of having a patient with a blood pressure of 230/120. I called his physician, who wanted that patient forego dental treatment and be seen by a physician immediately. That evening this patient had a severe stroke leaving him severely disabled. Had I treated him, it would have been “caused by my dental procedure” and I would have likely been in court. Several months later, when this individual was brought in by his son for care, his family was very appreciative of all that we had done in trying to take care of their father and that we had taken the time to get him ensure he was seen by a physician. This one instance overcame any resistance by staff to monitoring blood pressure as a matter of routine.

How does one fit taking blood pressure into a busy dental practice? The easiest and least disruptive is to your schedule is to make it the chair side assistant’s duty to take both blood pressure and pulse readings after seating the patient in the operatory. The assistant asks how the patient is doing, catches up on the typical small talk, puts on the bib, answers questions, and takes a preoperative blood pressure.

I have two recommendations for implementing monitoring blood pressure. The first is that taking the blood pressure not be the first item done after seating the patient. It will take a few minutes for the blood pressure to stabilize after walking from the waiting room to sitting down in the operatory. If the initial pressure seems high, waiting a few more minutes to let the patient calm, a second blood pressure reading can then be taken to assess the patient’s ability to proceed with treatment that day based on the guidelines for hypertension. If we get multiple readings above the threshold, we then cancel treatment and send the patient home with our faxable Medical Consultation form explaining our concerns. A sample statement on the fax might be: “Today the

blood pressure readings were 179/115 and 185/110. Dental treatment using local anesthetic is needed. Please evaluate and let me know your recommendations for treatment”. Obviously if the patient happens to be symptomatic, 911 should be called.

The second recommendation I have is to chart that blood pressure reading. Looking back over multiple visits it is possible to track changes in blood pressure. Specific to this recommendation, I will share one other anecdotal report of a patient experience that makes this worthwhile. A patient who was having complex dental work involving multiple endodontic procedures, periodontal surgery and full mouth reconstructive procedures was referred to our office with a complaint of a dull ache in the lower jaw for several weeks. We were unable to locate a dental cause for his pain at that time. We did notice that he had a significant increase in his blood pressure compared to readings from other visits for treatment over the prior several months. The blood pressure was not over the guidelines, but because of the change we recommended he see his physician for evaluation and rescheduled to see if his lower jaw pain became more specific with time. The following week he missed his appointment. We called to find out he went in to see his physician who took an EKG and immediately

sent him to the hospital where he had bypass surgery. We saw him later to reevaluate for the toothache he had been complaining of. The toothache went away immediately following the bypass and was determined to be cardiac angina pain referring to the mandible. So, having the blood pressure recorded over many visits serendipitously pushed this one patient off to see his physician where testing found led to cardiac surgery.

After the initial transition of implementing blood pressure monitoring into ones practice, taking blood pressure becomes part of the routine and staff then gets at ease with taking these vital statistics. In fact, the staffs gains an understanding of high blood pressure readings and point it out to you when a patient has higher than expected readings. Having a staff that is familiar and comfortable taking a blood pressure has a huge benefit if ever you should have a medical emergency that requires you to decide whether or not to call 911. Having the initial preoperative baseline blood pressure to compare the current blood pressure reading to gives you more information with which to make a decision to call for the paramedics. Since instituting routine blood pressure monitoring, we have more than once been thanked by patients who feel that we have “saved their lives” by making them aware of their hypertensive health problem.

referenCeS:1. Chobanian AV, Bakris GL, Black HR, et al. Seventh Report of the Joint National Committee

on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension 2003;42:1206-1252

2. Little J, Falace D, Miller C, Rhodus N Dental Management of the Medically Compromised Patient, Seventh Edition, 35-49, St. Louis, Elsevier Mosby 2008

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dental treatment, should consider obtaining medical clearance before proceeding with such treatment. Relying solely on a guideline to make a decision as to collateral or incidental treatment, such as antibiotics, steroids or drug holidays, places the dentist at risk should a complication occur. The dentist could be at risk because it may be the opinion of the patient’s physician that treatment was contraindicated under the circumstances presented or that the collateral treatment or incidental treatment (such as antibiotics) was inappropriate.

Two years ago there was a case in New Jersey in which an oral surgeon provided IV sedation to a patient with a medical condition that could affect the airway during anesthesia. The surgeon relied on general surgical principles and guidelines. There was an anesthetic complication and the patient died. The patient’s physician, at the malpractice trial, testified that had clearance been requested he would have either ordered that the patient be treated in the hospital or the surgery not be performed with sedation. The jury agreed with the physician and awarded $11 million to the surviving family. Had the surgeon obtained and documented medical clearance and then performed the surgery, there would not have been a claim against the dentist. Therefore in cases where patients may be considered medically at risk, as stated in guidelines or consensus statement, the treating dentist or surgeon is advised to consider obtaining and documenting medical clearance for dental treatment.

Published guidelines for dental treatment, such as those by the American Heart Association and American Association of Orthopedic Surgeons are consensus recommendations for their specific area of concern. They cannot and do not stand alone as evidence of the standard of care. Indeed, evidence in any legal setting starts with either the spoken word or a written declaration under oath. For a guideline to come into evidence, an expert must testify that it represents the standard of care, unless it is given “judicial notice.”

Because each patient is different, guidelines cannot cover all situations at all times. Whether or not a patient needs premedication is ultimately within the purview of the physician familiar with their medical condition. What we are talking about is systemic non-dental conditions out of the maxillofacial area, such as the heart, prosthetic heart valves, prosthetic joints, systemic illnesses (HIV, hepatitis C, immunocompromised, diabetes, splenectomy) and pharmacological treatments such as blood thinners, steroids, bisphosphonates and immune suppressants. These conditions all reference medical conditions that are outside of the scope of licensure of a dentist. However dental treatment can impact other areas of the body and cause or aggravate illness, the treatment of which is within the scope of licensure for physicians, and not dentists. Therefore a dentist, having been apprised of a medical condition that might be impacted by proposed

Guidelines for ObtainingmedIcal coNSultatIoN for patIeNtS receIvINg deNtal treatmeNt

The medical clearance should confirm that following the guidelines is recommended or, if not recommended, what are the physician’s specific recommendations for the care of that patient? The medical clearance advice from the physician can on occasion present a situation where there is a conflict between the advice and the dentist’s knowledge of applicable guidelines. When the physician’s advice is contrary to well-established guidelines or policies in consensus statements, a dentist cannot unilaterally override that advice based merely on their interpretation of the guidelines or policies. It is been the experience of the author that merely arguing the guidelines with the consulting physician will not bring about any change in the medical advice or order. Rather the dentist has two choices. The first is that the dentist can inform the patient that there is a conflict between the advice of the physician and established guidelines or policies and require the patient get a second opinion before performing treatment. If the second opinion concurs with the guidelines, that opinion should be documented by the dentist prior to proceeding with treatment. Another option is to decline treatment based on the conflict, such as when the patient refuses to seek a second opinion, and inform the patient they will have to seek care elsewhere for the particular condition for which treatment was recommended.

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yOU arE a dEnTIsT. You’ve been to school, taken your Boards and settled into practice. End of story?

Not quite. Are you up to speed on tax laws, potential deductions and other important business issues?

In this monthly column, we will offer information pertinent to you, the dentist as the business owner.

fitness by increasing the respiratory response, as well as lowers blood pressure and heart rate. It also reduces pain perception, stimulates circulation and increases oxygen tension. The net effect is that you feel better.

In the November 1995 issue of Pain, Drs. Weisenberg, Tepper and Schwarzwald, after testing 80 subjects, reported that pain perception was lessened when watching a humorous film in comparison to watching a neutral film or no film at all. Interestingly, watching a repulsive film showed the greatest decrease in pain perception.

The Journal of the American Medical Association published “The relationship with malpractice claims among primary care physicians and surgeons,” in its Nov. 19, 1997, issue. 124 doctors were videotaped during 10 consecutive office visits. The researchers found that the primary care physicians who have never been sued spent more time with their patients, used humor and encouraged patients to talk. No such differences were found among the surgeons.

Ben and Jerry’s Homemade, Inc. has their “Joy Gang.” Joy grants are awarded for creative ways to bring happiness to the workplace. The grants have varied from hiring a masseuse to providing a hot chocolate machine.

Humor experts exist and are frequently used by Fortune 500 companies. I had the pleasure of recently speaking with Dr. Steve Allen Jr., retired family practitioner, son of the famous comedian and humor expert. I asked Dr. Allen how he would sum up laughter in the workplace. He said, “Humor and lightheartedness let you take a look at difficult situations from a different point of view.” He added that one needs to be very careful and must look at the “pluses and minuses” of the intended humor; you do not

Happiness and humor in the office enhance employee and employer satisfaction, increase profit, heighten creativity and result in exceptional patient care. You do not have to transform your practice into a comedy club, but recognize that the little things in human relations reap huge rewards. Small changes in attitude, cooperation and respect can create major changes in your practice.

Dr. Paddi Lund, a general dentist in Australia, has authored Building the Happiness-Centered Business, published by Solutions Press of Australia. In his discourse, Dr. Lund illustrates how a happy staff is one of the most powerful business tools available to the dentist, or any businessperson. Our practice has incorporated many of his ideas. As a result, we interact much more positively with each other as well as with our patients.

We handle problems differently. We address negative behavior and energy quickly. We take responsibility for our actions and interactions. If something goes wrong, we look at the system first to see what needs changing. Patients are referred to and communicated with by their names, not by their procedure or symptom.

Content, happy staff members are much more likely to offer creative suggestions and ideas. An empowered staff is a more productive staff. Personally, I am more apt to buy something from a happy, warm and kind establishment, instead of a disinterested, unhappy and threatening one.

There is significant data to support the benefits of humor. Dr. William Fry, psychiatrist, humor researcher and former man of the year for the Association for Applied Therapeutic Humor, reports in the medical magazine Hippocrates the many physical benefits of laughter. He claims that laughter boosts cardiovascular

Happiness & Humor in the Officegood buSINeSS & good for youby Marvin Greene, DDSChicago Dental Society (Reprinted with permission)

youThe DenTisT, The Business Owner

want to tease people and be discriminatory. Dr. Allen said it is essential to be able to laugh at yourself.

Humor must be used with no sarcasm and extreme sensitivity. A doctor needs to be

sincere, clear and non-offensive at all times. Being lighthearted and friendly could be a valuable tool. As caregivers, each of us needs to strike a balance between professionalism and being a human being.

In my opinion, happiness and humor go hand in hand to create awesome patient care. They enable individuals to feel better about themselves, which translates into so many positives for everyone involved. Therefore, remember to lighten up around your staff and patients to create rewards for all.

Dr. Greene is a board-certified oral and maxillofacial surgeon. He may be reached at (773)327-2400 and www.oralandcosmeticsurgery.com.

This article reprinted from the July/August 2006 CDS Review with permission from the Chicago Dental Society

Approach each situation on a case-by-case basis.

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continued on next page

Social media, it’s sweeping the nation, and it’s everywhere you turn. The growth of Facebook is staggering, with 100 million users added to it in less than nine months; it took television 13 years just to reach 50 million users, according to data from the United Nations Cyberschoolbus website.

It’s no wonder it seems almost impossible to keep up with it all. But learning about social media and how to apply it to your practice could be worthwhile. It can help grow your practice and improve communication with your patients.

Eric Rieger, President and Founder of WEBIT Services (a computer tech company in Illinois), says, “They [dental practices] know they need to be out there, but they don’t know why or what or how to go about it and what the different options are available with Facebook.”

With so many options available to your practice to access the social media world, how do you make your office social media compliant?

Tracy Zander, marketing coordinator for West End Dental, said start with a plan. Ms. Zander said a dental practice must have a social media plan with goals for what you and your staff want to accomplish with it if you want to succeed. And, she added, you need guidelines for the use of social media with specific parameters, like making sure that someone is in charge of “what you’re doing out there.”

“There must be someone active with it on a routine basis because if you’re not active on it, then it’s doing nothing for you,” said Ms. Zander, who checks the West End Dental Facebook page at least four times a day.

Ms. Zander noted that West End incorporated social media into its marketing program because direct mail wasn’t doing enough to grow the practice.

“Facebook is a more sophisticated word of mouth,” said Ms. Zander.

But now “word of mouth” has gone digital. Even though users do not personally know anything about the posters of reviews on sites like yelp.com and Angie’s List, they listen to their advice.

According to Ms. Zander, dentists want more patients like the ones coming in the door now. But, she said, direct mail pieces and a listing in the telephone book alone won’t guarantee you will get the same type of patients you have now.

Ms. Zander pointed out that Facebook offers a means to reach potential patients through this electronic word of mouth. Facebook offers the option of placing paid advertising, which she sees as a valuable marketing tool. According to Ms. Zander, you can target your ads to the friends of your “fans’” (now designated by Facebook as people who “like” your page). By doing this, you could obtain new patients without asking your current patients to refer their friends. According to Facebook’s advertising web page (www.facebook.com/advertising), you can target ads by location, sex, age, keywords, relationship status, job title, workplace or college.

In addition to its use in marketing, Facebook offers the dental practice the means to communicate with patients regularly.

By keeping your page current, a must in the world of social media, you can continue your patients’ oral health education outside of the office by posting useful tips on maintaining oral health at home. And anytime you have a special promotion on products or services, you should use social media as a way to inform your patients of the specials. Both Ms. Zander and Mr. Rieger agree that your Facebook page should be updated by posting one or two times a week.

“It’s a way to keep West End Dental at the forefront of their minds and to think that ‘my dentist goes the extra mile.’ Patients are then more apt to send their friends our way,” said Ms. Zander.

Facebook isn’t the only social media available to oral health professionals.

According to a 2007 national study by the market research firm Grunwald Associates, 96 percent of Generation Y has joined some form of social network.

YouTube is another social media venue, and it can be used with your Facebook page by linking to videos, Mr. Rieger said.

BeiNgsocial

neW feature!engagesocialmediamarketingtoestablishbranding,buildyourpracticeandprotectyourreputation

SocialMedia&Dentistry:can the new ‘word of mouth’ helpyourpracticegrow?

By Rachel Azark

Reprinted with permission from Chicago Dental Society

AreyoureadytoputyourdentalpracticeonFacebook?Hereareafewtipstogetyoustartedoncreatingyourveryownpage.

1.Visitwww.facebook.com/pages/create.php

2.ChooselocalbusinessunderCreateaPage

3.Pickyourpagename.Usethenameofyourpractice

4.Fillinbasicinformationlikelocation,businesshoursandcontactinformation

5.Start telling your patients to“like” your page (formerlyknown as becoming a fan)via word of mouth, e-mailstothemoronpaperworktheymightreceiveinyouroffice

hOW tO create yOur faceBOOk page


testimony…continued from previous page

Paul D. Raskin, D.D.S.2344 Butano Dr., Ste. C2Sacramento, CA 95825(916) 971-6700

Our 30th year of practice limited to removable prosthetics, with fixed dentures now on our list of services.

INVITING YOUR CONSIDERATION WHEN YOU WISH TO REFER PATIENTS FOR:

• Complete dentures, remote or immediate

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Four types of videos could be presented:

• Patientinterviewsortestimonials

• Twoorthree-minutevideoson a particular procedure

• Newsedationtechniques

• Theuseofbrandnewequipment in the office

“To see or hear or listen to a doctor can be very reassuring before you actually go in for a consultation especially for potential patients,” said Mr. Rieger.

Christina Gualandi, office manager of Starved Rock Dental Spa, noted one YouTube posting

where a dentist from Texas describes the Cerec technology in his office and shows the viewer the kid-friendly environment of the office.

Taking photos and videos of just what the office looks like can also be comforting to a potential, new client, he added.

You don’t need sophisticated equipment to do a YouTube video. A video camera like a Flip

video recorder will do the job of producing videos in which you describe a procedure or give a tour of your office and upload it right on to YouTube.

In the world of social media, blogs have been around for a while.

A blog is another area where you can write about your own views on dentistry or your particular area of expertise. It is a way to provide detailed entries, which can’t be done on Facebook and Twitter.

“You wouldn’t want to post more than one or two times a week for fear of crossing the fine line of useful information and information overload, said Mr. Rieger. “You want to make it so it’s active, but you don’t want to have overload.”

A blog is just another useful tool to give a potential patient more information about the practice when they’re looking for a particular doctor.

Twitter could be called the “new kid on the block,” but there are mixed views regarding the phenomenon of Twitter.

Ms. Gualandi says Twitter has helped her network with other businesses; she sees it as being more useful in the business side of the practice as opposed to serving the patients.

“Twitter is a little bit harder to use and understand (than other social media),” said Ms. Gualandi.

BenefitS Of SOcial MeDia

• Patientscanstaycurrentwiththelatestservicestheirdentistsprovide

• Dentistscanshowpatientswhatcontinuingeducationcoursestheyhaveattended

• Theofficecanintroducenewproductsorspecialoffers

• Socialmediaoffersdentistsanonintrusivewaytomaintainconstantcommunicationwithpatientsthathavesignedupto“like”theirFacebookpages

• it’sagreatwaytogogreenintheofficeanduselessdirectmail

“(Social media) is really so exciting! It is a learning process. The more time you spend with it, the better you’ll be with it,” said Ms. Gualandi.

Ms. Azark is the editorial assistant for the CDS Review (Chicago Dental Society).

You don’t need sophisticated equipment to do a YouTube video.

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Ameriprise Financial cannot guarantee future financial results. Consult your attorney or tax advisor regarding specific tax issues. Financial planning services and investments available through Ameriprise Financial Services, Inc., Member FINRA and SIPC. © 2009 Ameriprise Financial, Inc. All rights reserved.

yOU arE a dEnTIsT. You’ve been to school, taken your Boards and settled into practice. End of story?

Not quite. Employee evaluations, hiring and firing, labor laws and personnel files are an important part of being an employer. Are you up on the changes that happen nearly EVERY January 1st?

In this monthly column, we will offer information pertinent to you, the dentist as the employer.

you


Dealing withemploymeNt ISSueSFrom risk Management Staff (tdIc)

The DenTisT, The emplOyer

allegations of wrongful termination or discrimination, establish guidelines for disciplinary actions and terminations, and include them in your employee manual. Additionally, every office should have a written policy prohibiting on-the-job harassment, including sexual harassment, with an internal complaint procedure that an employee can use to file a confidential complaint. This policy should be included in your manual as well.

Once you begin using an employee manual, adhere to it strictly. Disseminate the employee manual to all employees, and obtain a signed acknowledgment that each employee received and read it. Keep the signed acknowledgement in their personnel file. A copy of the manual should always be accessible for employee access and review. To gauge how closely you are following the guidelines outlined in your employee manual, conduct a periodic audit of your day-to-day operations. Regularly review and update your manual to accommodate new laws and changes in your office. When you make changes to the manual, distribute those changes to all employees and obtain a signed acknowledgment that they received the changes.

It is also important to clearly designate whether your employees are at-will or for cause. With at-will employment, either the employer or the employee may lawfully terminate the employment relationship at any time as long as the termination does not

Harmony among the office staff, common goals, established rules and good communication are essential to a smoothly functioning dental office. Without these, an office can be an uncomfortable place to work, as well as a breeding ground for liability.

Every dental office has its own culture, conditions of employment and benefits. Clearly communicated workplace standards

prevent surprises and false expectations among management and employees. Established office guidelines protect you from potential employment practices liability claims and foster a more productive and creative team. When employees know what to expect and what is expected of them, you will have fewer complaints and less absenteeism and turnover. Having a written employee manual is the starting point to implementing effective employment practices.

Your employee manual should reflect your employment practices. It is important for your manual to address office policies, procedures and protocols, including the administration of benefits and pregnancy leave. To prevent

When employees know what to expect and what is expected of them, you will

have fewer complaints.

violate a specific law or is not discriminatory. However, if the employment relationship is for cause then the specific terms of that agreement control the situations in which the termination is lawful. That is, employment can be expected to continue unless there is “cause” to terminate it. Cause can include inadequate or substandard work performance and inability to do the job, as well as gross misconduct, embezzlement, violation of a stated office procedure, or reduction in work force.

Further, employers may not base employment decisions on an individual’s age, race, sex, national origin, religious beliefs, color or ancestry, physical or mental disability, medical condition, marital status, sexual orientation, political beliefs, or any other basis protected by federal, state or local law, ordinance, or regulation. Basing employment decisions on the above factors would expose employers to liability for wrongful termination.

The growth of federal and state legislation dealing with employee discrimination and sexual harassment, the changing legal views on wrongful termination, and the increasing tendency of disgruntled employees to turn to the courts for retribution, have created a need for employment practices liability (EPL) insurance. Your professional liability carrier may offer EPL coverage. TDIC offers such coverage as an additional endorsement. As long as you have employees, you risk facing allegations of wrongful employment practices.

HAVeyOUCHeCKeDTHeWeB?TheSDDSwebsiteisyoursourceforCe,events,importantannouncementsandmore!Checkitoutatwww.sdds.org


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Spotlightor1sttooth

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© 2010 Sacramento District Dental Society

Dr. timothy Durkin•Pinegrove,CA

“We held a dental office field trip on January 24th for kids ages 1 to 2 ½. It was the first visit for all except my granddaughter. Everyone received a goodie bag with the ‘1st Tooth or 1st Birthday’ materials we bought from SDDS. They were a big hit!”

Starter pack:100SmilingKidsBrochures(english)

50SmilingKidsBrochures(Spanish)

10ToddlerToothbrushes(assortedcolors)

503.25”Magnets(shownabove)

10infantgumMassagers(assortedcolors)(items above are also available individually)

www.sdds.org/1sttooth.htm

SMART PARENTS

SMIL ING KIDS


The Do’s and Don’tsof infant dental care

Do’s1. Do visit your dentist.

2. Do take prenatal vitamins.

3. Do clean baby’s mouth after feeding or bottle.

4. Do ask doctor about fluoride supplements

for your baby.

5. Do start brushing right away.

6. Do bring baby to a dentist as soon as first tooth erupts.

7. Do help brush and floss your child’s teeth

until age nine.

8. Do take responsibility for your child’s healthy

eating habits.

9. Do soothe baby with songs, books, toys and love.

Don’ts1. Don’t smoke, drink or do drugs while pregnant or

before pregnancy.

2. Don’t postpone dental treatment for yourself.

3. Don’t let your baby fall asleep while breast

or bottle-feeding.

4. Don’t let your child snack frequently.

5. Don’t let your child suffer from dental pain (toothaches).

6. Don’t soothe baby with a bottle of sugar–containing

drinks and juices.

7. Don’t pass cavity causing germs to your baby.

A g u i d e t o d e v e l o p i n g

h e a l t h i e r b a b y t e e t h

If you need a dentist referral, please call

the Sacramento District Dental Society

915 28th Street

Sacramento, CA 95816

916/446.1211


www.sdds.org

www.sdds.org

www.first5sacdental.org

PADRES INTEL IGENTESHIJOS SONRIENTES


Qué hacer y qué no hacer respecto a la atención dental del bebé

Qué hacer1. Visite a su dentista.2. Tome vitaminas prenatales.3. Límpiele la boca al bebé después de alimentarlo o de

darle el biberón.4. Pregúntele a su médico sobre los suplementos de

fluoruro para su bebé.5. Comience el cepillado inmediato.6. Lleve al bebé al dentista tan pronto como le salga el

primer diente.7. Ayude al niño a cepillarse los dientes e a usar el hilo

dental hasta que cumpla nueve años.8. Asuma la responsabilidad de inculcarle hábitos alimen-

ticios saludables a su hijo.9. Tranquilice al bebé con canciones, libros, juguetes y amor.

Qué no hacer1. No fume, beba ni consuma drogas al estar embaraza-

da o antes del embarazo.2. No posponga su propio tratamiento dental.3. No deje que el bebé se quede dormido mientras esté

amamantando o tomando el biberón.4. No deje que el niño coma bocadillos con mucha

frecuencia.5. Si el niño tiene dolores en los dientes, llévelo al dentista.6. No tranquilice al bebé con biberones de bebidas y

jugos azucarados.7. No le pase a su bebé los microbios que causan las caries.

Una guía para desarrollar dientes del bebé más sanos

Si necesita que le recomienden un dentista, llame a Sacramento District Dental Society

915 28th StreetSacramento, CA 95816

916/446.1211


www.sdds.org www.sdds.org

www.first5sacdental.org

or1sttooth

1stbirthday

916.446.1211 • saCraMEnTO dIsTrICT dEnTal sOCIETy • www.sdds.org/1stT

ooth

.htm

Every child should visit the dentist by…


or1sttooth

1stbirthday


ooth

.htm



lInk TO yOUr praCTICE WEBsITE On WWW.sdds.Org!

$300 for one year (renew for $100/year)

SDDS members only, please.

Visit www.sdds.org/MembersOnline.htm for more info.


YOu ASKED FOR THIS!

Nugget Survey 2009

Twenty-five years ago, the American Academy of Pediatric Dentistry established its recommendation that children be seen within six months of their first tooth appearing or by age one, whichever occurs first. Yet, today, the typical response from my dental colleagues, pediatricians and other physicians when asked by a parent is to “see the dentist at age three” or even age five. My own informal survey in 2009 of offices accepting Denti-Cal patients in Sacramento County indicated they had no protocol for and did not want to see a patient under age five.

The CDC, in its 10-year update on the state of Oral Health in the U.S., indicated the only area of dental health that had worsened from 1994 to 2004 was cavities in children aged two to five years old. The problem worsened by 30%!

My colleagues and I in practices limited to children routinely treat cavities in children ages two to five. I treat eight children monthly, average age three, whose cavities are

coMMiTTee cornerDental Health Committee:the well baby tooth check

so extensive they require general anesthetic to accomplish the treatment. I can list about 20 colleagues in the Sacramento area alone who do the same. Age three or five is too late.

Two is too late!

And yet... Babies don’t come with cavities. The six-month-old and the 12-month-old in the mobile car seat in your hygiene room (with mom) do not have cavities. Are you and your staff prepared to counsel these new parents to insure those new teeth grow into healthy cavity resistant mouths? Can you identify the low risk infants and toddlers who you want to keep as the nucleus of a cavity free young population in your growing hygiene department? Can you identify the high risk patients who you would rather refer to a pediatric colleague? Can you identify incipient problems in these very young children and refer to a pediatric colleague for management before they are a major treatment challenge? The pediatricians have been learning and training to counsel parents on oral health

by H. Scott thompson, DDS SDDS Dental Health Committee

at age four months and refer to a dental home when the first tooth appears. Do you have a well-thought and planned response for the new parents in your practice?

Your preferred pediatric colleague would likely provide you with all the information, resources and training you want. Your SDDS

Dental Health Committee also has and is developing more resources for you.

We all know that all the restorative and surgical intervention we do for our patients does absolutely nothing to improve the state of oral diseases in our patients. If we want to truly impact the cavities and periodontal disease of our young patients, we need to start before the disease starts. The first tooth deserves a dental home.

Board of DirectorsSDDS • 6:00pmMar 1 • May 3 • Sept 6 • Nov 1

Ce CommitteeSDDS • 6:00pmMar 22 • May 7 • Sept 20 • Nov 29

CPr CommitteeSDDS • 6:30pmFuture meetings TBA

Dental Health CommitteeSDDS • 6:30pmMar 21 • May 16 • Sept 12 • Nov 14

ethics CommitteeSDDS • 6:30pmApr 27 • Sept 28 • Nov 16

2011 SDDS CoMMittee MeetinGS:

Committee meetings, CE courses and more available 24/7 on the SDDS website.

Visit www.sdds.org and click the “Calendar” button.

foundation (SDDf)SDDS • 6:00pmApr 5 • Sept 12 • Nov 17

Golf CommitteeSDDS • 6:00pmMar 15

leadership Dev. CommitteeSDDS • 6:00pmMar 7 • Mar 29

Mass Disaster / forensics CommitteeLocation TBA • 6:30pm2011 Meetings TBA

Membership CommitteeSDDS • 6:00pmMar 15 • May 17 • Sept 21 • Nov 15

nugget editorial CommitteeSDDS • 6:15pmMay 17 • Sept 27

SacPaC CommitteeSDDS • 6:00pm2011 meetings TBA

Babies don’t come with cavities!

or1sttooth

1stbirthday


ooth

.htm




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we’re blowing your horn!

coNgratulatIoNS to...Have some news you’d like to share with the Society? Please send your information (via email, fax or mail) to SDDS for publication in the Nugget!


Dr. Ashkan Alizadeh, for joining fellow SDDS member Dr. Brian Steele’s practice in Placerville.

Dr. Joan Burgren, for her son Robert’s acceptance in a summer investment banking analyst internship position with Deutsche Bank, headquartered in Frankfurt, Germany!

Dr. Timothy Durkin for hosting a dental office field trip on January 24th, in support of the “1st Tooth or 1st Birthday” campaign. (more info on page 22)

Dr. Maryam Hoang and her husband, for their first baby on the way — due July 2011.

Dr. Lisa Laptalo and her husband Luko, for their baby on the way — due August 2011.

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new MeMberswelcometo SddS’s new members, transfers and applicants.

CLIP OUT this handy NEW MEMBER UPDATE and insert it into your DIRECTORY under the “NEW MEMBERS” tab.

March 2011

iMPortaNt NumberS:

SDDS (doctor’s line) . . . . . . . (916) 446-1227

ADA . . . . . . . . . . . . . . . . . . (800) 621-8099

CDA . . . . . . . . . . . . . . . . . . (800) 736-8702

CDA Contact Center . . (866) CDA-MEMBER (866-232-6362)

CDA Practice Resource Ctr . . cdacompass.com

TDIC Insurance Solutions . . (800) 733-0633

Denti-Cal Referral . . . . . . . . (800) 322-6384

Central Valley Well Being Committee . . . . . (559) 359-5631

total actiVe memberS: 1,318total retired memberS: 199total dual memberS: 2total AFFILIATE memberS: 12

total STUDENT/ ProVisioNal memberS: 3

total curreNt applIcaNtS: 3total dhP memberS: 35

total New memberS FOR 2011: 10

total MEMBERSHIP (AS OF 2/11/11): 1,572

keep usupdated!Moving? Opening another office?Offering new services?Share your information with the Society!

We can only refer you if we know where you are; and we rely on having your current information on file to keep you informed of valuable member events! Give us a call at (916) 446-1227.

The more accurate information we have, the better we can serve you!

Annie Barnes, DDSGeneral Practitioner1741 Professional DrSacramento, CA 95825(916) 485-5539Dr. Annie Barnes graduated from Loma Linda University in 2001 with her DDS. Her general practice is located Sacramento where she practices with her husband and fellow SDDS new member, Dr. Stephen Barnes. Drs. Barnes live in Carmichael.

Stephen Barnes, DDSGeneral Practitioner1741 Professional DrSacramento, CA 95825(916) 485-5539Dr. Stephen Barnes graduated from Loma Linda University in 2004 with his DDS. His general practice is located Sacramento where he practices with his wife and fellow SDDS new member, Dr. Annie Barnes. Drs. Barnes live in Carmichael.

Grant Irwin, DDSGeneral Practitioner2335 American River Dr, Ste 307Sacramento, CA 95825(916) 929-0331Dr. Grant Irwin graduated from Loma Linda University in 1984 with his DDS. His general practice is located in Sacramento and he lives in Folsom with his wife, Debbie.

William Koett, Jr., DDSGeneral Practitioner1820 Professional Dr, Ste 7Sacramento, CA 95825(916) 972-9279Dr. William Koett, Jr. graduated from the UOP Arthur A. Dugoni School of Dentistry in 2001 with his DDS. His general practice is located in Sacramento and he lives in Folsom with his wife, Alice.

Feroz Nawabi, DDSGeneral Practitioner1035 Suncast Ln, Ste 110El Dorado Hills, CA 95762(916) 941-0323Dr. Feroz Nawabi graduated from the Herman Ostrow School of Dentistry of USC in 2004 with his DDS. He is currently practicing in El Dorado Hills and lives in Rocklin with his wife, Joan Haley.

Kenneth Silva, DDSGeneral Practitioner16985 Placer Hills Rd, Ste DMeadow Vista, CA 95722(530) 878-0704Dr. Kenneth Silva graduated from Indiana University in 1985 with his DDS. His general practice is located in Meadow Vista and he lives in Applegate with his wife, Tamara.

Kirk Youngman, DMDGeneral Practitioner8908 Madison AveFair Oaks, CA 95628(916) 536-5151Dr. Kirk Youngman graduated from Washington University in 1983 with his DMD. He is currently practicing in Fair Oaks and lives in Folsom with his wife, Karilyn.

New TRANSFER memberS:Nima Aflatooni, DDSTransferred from San Francisco Dental SocietyGeneral Practitioner9381 E Stockton Blvd, Ste 219Elk Grove, CA 95624(916) 670-1886Dr. Nima Aflatooni graduated from the UOP Arthur A. Dugoni School of Dentistry with his DDS. He is currently practicing with his father in Elk Grove.

An Le, DMDTransferred from Santa Clara County Dental SocietyGeneral Practitioner9184 E Stockton BlvdElk Grove, CA 95624Dr. An Le graduated from the University of Connecticut in 2009 with her DMD and later completed a residency at the University of Texas - San Antonio in 2010. She is currently practicing in Elk Grove.

Chalise Morgan, DDSTransferred from Orange County Dental SocietyGeneral Practitioner4140 Mother Lode Dr, Ste 112Shingle Springs, CA 95682(530) 672-8059Dr. Chalise Morgan graduated from the UCLA School of Dentistry in 2007 with her DDS and later completed a residency at the Lutheran Medical Center in 2008. She is currently practicing in Shingle Springs and lives in El Dorado Hills.

New studeNt member:Zachery CastiglioneUCSF School of Dentistry, 2011

New aPPlicaNts:Israel Armijo, DMDJose Terraza, DDSRobert Wright, DDS, MS

welcoMe back!

welcoMe back!

welcoMe back!

frOM the 2011 midwinTEr survEY


saCraMEnTO dIsTrICT dEnTal sOCIETy prEsEnTs ThE 31sT annUal MiDWinTEr COnvEnTiOn & ExpO

FEBruAry 3 & 4, 2011at the Sacramento Convention Center

Under the

oardwalUnder the

… down by the C-e (e-e-e) …

(L to R): CE Committee members Dr. Michael Forde and Dr. Jonathan Szymanowski (Chair) welcome attendees to the beach! • Registration is underway as doctors and staff check in for two days of fun in the sun. • Courses this year covered everything from practice management software and customer service to financial tips and licensure renewal requirements. • The 31st Annual MidWinter Convention provided plenty of time to socialize between classes, as we returned to the very convenient one-floor layout!

(L to R): The Expo Hall was completely SOLD OUT this year, with over 60 vendors to visit! • Lunch selections reflected the boardwalk theme, featuring subs, corn dogs and nachos, and were included in registration price! What a bargain! • The lunch break was a time to check in with colleagues and gear up for the next round of classes. • Dr. Dennis Peterson soaks up some rays before heading out to his next class.

(L to R): Scott German (Fechter & Co, SDDS Vendor Member) presents Dr. Edi Guidi with the iPad he won in the Expo Hall! • FREE massages provided by Anthem College — what a treat! • See you next year! (February 9 & 10, 2012)

560attendees

25speakers

36classes

14CeUnitsavailablein2days!

Expo sold ouT with60vendors(152reps)!

Plus… Boardwalk food, corn dogs, nachos, beer, roller coasters and all …”Under the Boardwalk… Down by the CE (E-E-E)”

Thanks to all who attended to make this year the best in years!

Stay tuned for the Mardi Gras — February 9 & 10, 2012!

Midwinter 2011A Great Success!

UNDER THE BOARDWALKE E

SDDS PRESENTS THE 31ST ANNUAL MIDWINTER CONVENTION & EXPO

“LOVED, LOVED, LOVED having the massage

therapists available to rub my aching back!!! They

definitely need to come back next year!!”

“Everything went very smoothly and the exhibits

were great. My staff thought it was wonderful (won some prizes). Excellent organization. Looking forward to next year!!”

“The committee and all of SDDS continue to make MidWinter a great benefit! I managed to get 12 units

in two days for a very reasonable price. You have

great energy and, for a small show, you do big things!!”

Selling your practice? Need an associate? Have office space to lease? Place a classified ad in the Nugget and see the results! SDDS member dentists get one complimentary, professionally related classified ad per year (30 word maximum; additional words are billed at $.50 per word). Rates for non-members are $45 for the first 30 words and $.60 per word after that. Add color to your ad for just $10! For more information on placing a classified ad, please call the SDDS office (916) 446-1227. Deadlines are the first of the month before the issue in which you’d like to run.

SddS member deNtIStS caN place claSSIfIed

adS for free!


dentists serving dentists — Western Practice sales invites you to visit our website, westernpracticesales.com to view all of our practices for sale and to see why we are the broker of choice throughout northern California. (800) 641-4179. 03-09

great loCation on madison ave in CarmiChael — 40 years established. no mediCal, no capitation. dr. retiring. great, loyal patients and staff — will stay. (916) 966-8567 [email protected]. 12-10

Stop the Screaming! in-office sedation services by MD anesthesiologist • Pedo/Adults • Medi-Cal Provider • 20 years experience • Call (800) 853-4819 or [email protected]. 05-07

loCum tenens — I am an experienced dentist, UOP graduate and i will temporarily maintain and grow your practice if you are ill / maternity leave or on extended vacation. (530) 644-3438. 04-10

loCum tenens — loma linda grad, 1980. temporary dentist for emergencies, vacations and maternity leaves. (530) 823-0502. 02-11

New claSSIfIed SectIoNS!Vacation homes • Misc items for sale • Home rentals / sales • Tickets

Contact SDDS at (916) 446-1227 for more information.

3‘-8”

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5‘-4”

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Vacation Trade

3‘-8”

S.V.

6“

2‘-6“

2O -6O

2O -6O

3O -5O

4O -6

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2‘-6“

lite

S.V.

knee

space

carpet

carpet

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2‘-8”

2‘-2”

8‘-10”

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Sporting Event Trade

YOu ASKED FOR THIS!

Nugget Survey 2009

greater saCramento area multi-sPeCialty offiCe looking for an associate pediatric dentist and orthodontist 2–4 days/week. Ideal candidate is a skilled team player looking for long-term commitment. Fax resume to (916) 817-4376. 11-10

Have an UPCoMinG PreSentation?

The SDDS LCD projector is available for rent!three days — $100Members only please

call SddS at (916) 446-1227 for more information or to place a reservation.

design your oWn dental suite offering generous tenant improvements for this 800 sq ft office space. rent negotiation is available. the suite is in a three story mid-town dental complex. (916) 448-5702. 11-10

DreAM OFFICe shell — nICest / newest In saCramento! Build / design 2,000 sf to suit. near watt / el Camino, close to shopping. Great for new / existing practice, general / specialty. Call Dr. Favero (916) 487-9100. 03-C1

free rent — Fully equipped, 4 ops, Dentrix software, Arden area, great for starting new practice. Former location of 35 year practice. Contact douglas yee (916) 801-1707. 11-10

oPeratory sPaCe to share with orthodontist or endodontist in general dental office on J street and 51st street. Contact Dr. steven Brazis at (916) 731-5151 to discuss details if interested. 02-11

suite for lease — in Midtown sacramento at 30th & P. ideal for perio, endo or oral surgery. improvements + allowance for modification. signage, high visibility, on-site parking and freeway access. in the midst of sutter’s medical campus expansion. (916) 473-8810. lic. 01227233. 02-11

oPeratory sPaCe to share in roseville. Contact dr. alan Pan at (916) 781-6688 to discuss details if interested. 03-C1

CALL THE sdds hr hOTlInE WITH ALL YOuR BuRNING quESTIONS — 1-800-399-5331

saCraMEnTO dIsTrICT dEnTal sOCIETy prEsEnTs ThE 31sT annUal MiDWinTEr COnvEnTiOn & ExpO

FEBruAry 3 & 4, 2011at the Sacramento Convention Center

Under the

oardwalUnder the

… down by the C-e (e-e-e) …

sdds calendar of evenTs18 Member Forum Build Your Own Employee Handbook Mari Bradford (CEA) SDDS Office 915 28th Street, Sacramento 8:30am–12:30pm

21 Dental Health Committee 6:30pm / SDDS Office

24 Member Forum The Numbers of Your Practice:

The Good, the Bad, Avoiding the Ugly John Urrutia, CPA

(Mann, Urrutia, Nelson, CPAs) Sacramento Hilton — Arden West 2200 Harvard Street, Sacramento 6:30pm–8:30pm

29 Leadership Development Committee 6:00pm / SDDS Office

April 12, 2011:Turn it On & Off:

What’s New in Local Anesthesia

Earn

2CE UnITs!

APRIL GENERAL MEMBERSHIP MEETING: rECrUITMEnT nIghT

6pm: Social & Table Clinics7pm: Dinner & Program

Sacramento Hilton, Arden West (2200 Harvard Street, Sac)

Presented by:alan Budenz, Ms, dds, MBa

COuRSE OBJECTIVES:• Understand causes of local anesthesia failures; have better knowledge to overcome these failures• Provide more effective anesthesia for any dental treatment procedure• Discuss sciences behind new anesthetic buffering and reversal agents being introduced to dental practitioners.• Apply the latest anesthetic agent technology to their daily practice, and describe new trends in achieving profound

patient comfort.

YOu ASKED FOR THIS!Nugget Survey 2009

PRSRT STD

US POSTAGE

PAID

PERMIT NO. 557

SACRAMENTO, CA

915 28th StreetSacramento, CA 95816916.446.1211www.sdds.org

ADDRESS SERVICE REqUESTED

For more calendar info, visitwww.sdds.org

SAVE THE DATE FOR THE 32nd annUal MIdWInTEr COnVEnTIOnTONS OF CE & A GREAT TIME! YOu WON’T WANT TO MISS IT! FEBruAry 9–10, 2012

8 General Membership Meeting Benign & Malignant Tumors

of the Neck & Skin Barbara Burrall, MD Spouse Night Sacramento Hilton — Arden West 2200 Harvard Street, Sacramento 6:00pm Social 7:00pm Dinner & Program

10 Dental Health Sub-Committee 6:30pm / SDDS Office

15 Golf Committee 6:00pm / SDDS Office

Membership Committee 6:00pm / SDDS Office

16 SDDF Broadway Series 9–5 8:00pm / Sac Community Center

marcH1 Board of Directors Meeting 6:00pm / SDDS Office

4 Continuing Education Removable Partial Dentures:

Clinical Considerations Alan Carr, DMD, MS Hyatt Regency Sacramento 1209 L Street, Sacramento 6:30pm–8:30pm

7 Leadership Development Committee 6:00pm / SDDS Office

CE Committee 6:00pm / SDDS Office

Documents

March 2011 Nugget