DERS DENTAL IRATORY, INC. ) your professional practice s our professional credential

:ERTIFIED DENTAL LABORATORY

on, SAUNDERS DENTAL LABORATORY, INC" shows our concern rds of technical skill and education, effective infection control fessional working environment. No law demands we achieve atlon. We do it for our personnel, our dental clients and their itorv certified? Do they qualify for certification? If not, call us for

The One Hundred Twenty Seventh Annual Meeting of the Virginia Dental Association

will convene at the Colonial Williamsburg Lodge Convention Center

from September 18 through September 22, 1996.

An excellent scientific session has been scheduled, including presentations by Drs. Karl Leinfelder, Sam Low, Richard Roblee, Pat Allen, and John Svirsky. 1996 ADA President Dr. Bill TenPas and his wife Kathy will join us on their way to the ADA Annual Meeting in Orlando.

The meeting will mark the final campaign stop for the next ADA President Elect Dr. Dave Whiston and his wife Julie.

In addition to the outstanding clinical presentations, meeting goers will enjoy numerous recreational and social activities, including a golf clinic exhibition with Curtis Strange, a shotgun tournament at Williamsburg's Golden Horseshoe, Tavern Dinners, tours of Colonial Williamsburg and Carter's Grove, or a trip to nearby Busch Gardens.

Plan now to attend the 1996 VDA Annual Meeting in Williamsburg!

OFFICERS President: Ronald L. Tankersley, Newport News

President Elect: William H. Allison, Warrenton

Immediate Past President: Leslie S. Webb, [r., Richmond

Secretary-Treasurer: Charles L. Cuttino, III, Richmond

Executive Director: William E. Zepp, CAE PO Box 6906, Richmond 23230

COUNCILORS 1) Edward J. Weisberg, Norfolk 2) Richard D. Barnes, Hampton 3) Harold J. Neal, Jr., Emporia 4) James R. Lance, Richmond

EXECUTIVE COUNCIL 5) Daniel E. Grabeel, Lynchburg, Chairman Officers and Councilors listedand Councilors at Large: 6) Gus C. Vlahos, Dublin David C. Anderson, Alexandria (1997) Vice Chairman 7) William J. Viglione, Charlottesville Andrew]. Zimmer, Norfolk (1997) 8) Rodney]. Klima, Burke Wallace L. Huff, Blacksburg (1996) Thomas S. Cooke, II, Sandston (1996)

Ex Officio Members: Parliamentarian: Emory R. Thomas, Richmond Editor: Francis F. Carr, ]r. Richmond Sp;aker of the House: D. Christopher Hamlin, Norfolk Dean, MCV School ofDentistry: Lindsay M. Hunt, ]r., Richmond

COMPONENT SOCIETY CONTACTS

SOCIETY PRESIDENT SECRETARY PATIENT RELATIONS

Tidewater, I David P. Paul, III James E. Krochmal W. Walter Cox 4616 Thoroughgood Dr. 80 I W. Little Creek Rd. Ste 107 5717 Churchland Blvd. Virginia Beach, VA 23455 Norfolk, VA 23505 Portsmouth, VA 23703

Peninsula, II Gisela K. Fashing Corydon B. Butler, Jr. Lawrence A. Warren 150 Strawberry Plains Rd. 1319 Jamestown Rd. 106 Yorktown Rd. Williamsburg, VA 23188 Williamsburg, VA 23185 Tabb, VA 23602

Southside, III Michael R. Hanley John M. Bass John R. Ragsdale, III 2001 W. Broadway 212 N. Mecklenburg Ave. 9 Holly Hill Dr. Hopewell, VA 23860 South Hill, VA 23970 Petersburg, VA 23228

Richmond, IV Edmund E. Mullins, Jr. Gary R. Hartwell William James Redwine 6808 Stoneman Rd. 4107 W. Franklin St. 6808 Stoneman Rd. Richmond, VA 23228 Richmond, VA 23226 Richmond, VA 23228

Piedmont, V Richard D. Huffman, Jr. Gregory T. Gendron Edward M. O'Keefe 4346 Starkey Rd., Ste 3 7 Cleveland Ave. 4102 Electric Rd. Roanoke, VA 2401 4 Martinsville, VA 24112 Roanoke, VA 24014

Southwest, VI Gus C. Vlahos Dana Chamberlain Jack D. Cole PO Box J 379 645 Park Blvd. 303 Court St. Dublin, VA 24084 Marion, VA 24354 Abingdon, VA 24210

Shenandoah Valley, VII Edward L. Amos Gerald J. Brown William J. Viglione 1002 AmherstSt. 324 Boscawen St. 3025 Berkmar Dr. Winchester, VA 22601 Winchester, VA 22601 Charlottesville, VA 22901

Northern Virginia, VIII M. Alan Bagden JamesA. Pell Neil J. Small 6120 Brandon Ave.,. Ste 104 Seven Corners Professional Bldg. 9940 Main Street Springfield, VA 221 50 Filiis Church, VA 22044 Fairfax, VA 22031

2

MEMBER PUBLICATION, AMERICAN ASSOClATlON OF DENTAL EDITORS

Francis F. Carr, [r., Editor William E. Zepp, CAE, Business Manager

ASSOCIATE EDITORS 1.

'1

Bernard I. Einhorn 3. Jeffrey N. Kenney 4.

H. Reed Boyd, III Gary R. Hartwell

5. Edward P. Snyder 6. R. Graham Hoskins

7. William C. Bigelow 8. Bruce W. Jay

l"1CV Thomas Burke

5 Editorial 7 Message from the President 8 Problems with Implant Maintenance

by Dr. Michael L. Huband 12 ADA Parameters: Friend or Foe?

by Dr. Ronald L. Tankersley

14 Abstracts 17 News Briefs 22 Svirsky on Infection Control 25 Executive Council Actions 28 News Briefs 30 Legislative Update 33 VDA Speaker's Bureau Questionnaire 34 Board of Health Questionnaire 35 Component News 38 MCV News 40 State Board of Health News

COVER: Williamsburg in Springtime provided bythe Virginia Department of Tourism.

PUBLlCATJON TEMPLATE & TYPESETTING: C:\Change

THE VIRGINIA DENTAL JOURNAL (ISSN 0049 6472) is published quarterly (January-March, April-June, July-September, October-December) by the Virginia Dental Association, 5006 Monument Avenue, PO Box 6906, Richmond, Virginia 23230-0906, Telephone (804)358-4927 SUBSCRIPTION RATES: Annual: Members, $6.00. Others $12.00 in U.S., $24.00 Outside U.S. Single copy: $6.00. Second class postage paid at Richmond, Virginia. Copyright Virginia Dental Association 1996 POSTMASTER: Send address changes to: Virginia Dental Journal, PO Box 6906, Richmond, VA 23230-0906. MANUSCRIPT AND COMMUNICATION for publications: Editor, PO Box 6906, Richmond, VA 23230-0906. ADVERTISING COPY, insertion orders, contracts and related information: Business Manager, POBox 6906, Richmond, VA 23230-0906.

3

VDA COMMITTEE CHAIRMEN VIRGINIA JOURNAL 1996 Annual Meeting Executive

Andrew J. Zimmer Ronald L. TankersleyEDITORIAL BOARD Auxiliary Education & Relations History and Necrology

A. Carole Pratt Edmund E. Mullins, Jr.

Budget and Financial Investments Institutional AffairsLouis M. Abbey Jeffrey Levin Elizabeth Bernhard Ralph L. Anderson James R. Batten Cancer and Hospital Dental Service Insurance Cramer L. Boswell Robert L. O'Neill William H. Higinbotham, Jr. James H. Butler

Caring Dentists Journal Staff Gilbert L. Button Harry D. Simpson, Jr. Francis F. Carr, Jr. Frank H. Farrington

Barry I. Griffin Constitution and Bylaws LegislativeJeffrey L. Hudgins Leslie S. Webb, Jr. Harold J. Barrett, Jr. Wallace L. Huff Lindsay M. Hunt, Jr. Dental Care Programs Membership

Kirk M. Norbo Bruce R. DeGinderLisa Samaha Hunter Ford T. Johnson

Dental Delivery for the Special Needs Patient New DentistThomas E. Koertge Patrick J. Dolan Russell A. Mosher, Jr.

James R. Lance Daniel M. Laskin Dental Education & Continuing Education Nominating Travis T. Patterson, III James K. Johnson Leslie S. Webb, Jr W. Baxter Perkinson, Jr.

Dental Health and Public Information Peer Review and Patient RelationsDavid Sarrett Gisela K. Fashing Edward M. O'Keefe Harvey A. Schenkein

James R. Schroeder Dental Practice Regulation Planning Harlan A. Schufeldt Douglas C. Wendt Leslie S. Webb, Jr. Kenneth J. Stavisky

Dental Trade and Laboratory Relations ReliefJohn A. Svirsky George L. Nance, Jr. Scott H. FrancisRonald L. Tankersley

Douglas C. Wendt Environmental Health and Safety Search Committee for VA Board Roger E. Wood Dennis E. Cleckner Leslie S. Webb, Jr.

N •••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••

Virginia Dental Political Action John C. Doswell, II

1996 ADA DELEGATION:

David A. Whiston, 16th District Trustee Delegates: Gary R. Arbuckle (1998) M. Joan Gillespie( 1997) Stephen L. Bissell (1996) Wallace L. Huff (1998) Leslie S. Webb, Jr. (1997) Emanuel W. Michaels (1996) Raleigh H. Watson, Jr. (1998) William H. Allison (1996) Richard D. Wilson (1996) Alternate Delegates: Richard D. Barnes (1997) Ronald L. Tankersley (1997) D. Christopher Hamlin (1996) Charles L. Cuttino, III (1997) Andrew J. Zimmer (1997) David C. Anderson (1 996) Lindsay M. Hunt, Jr. (1997) Anne C. Adams (1996) Bruce R. Hutchinson (1996) 4

EDITORIAL

I I Election Reform I All Virginians have the civic duty of voting in statewide elections every year. Commonwealth and

federal offices alternate, this is a schedule of voter participation we share with only one other state. The example should be good for us as the VDA also elects its officers every year. Even with this constant cycle before us, there is a perception that the election process of the VDA is not what it should be.

The general election presently held at the Annual Membership Meeting each year has the appearance of uneven representation of the association's will. There is larger attendance in someI parts of the state than others; the often whispered geographic factor exists. To say larger attendancer

t, does not imply crowded rooms full of interested dentists. A quorum for the Annual Membership Meeting is fifty members; look around late on that Sunday morning and count your colleagues. Low and close may be good baseball, but low attendance and close to no quorum is not good democracy. Comments pried from the non-involved on the total election process range from a vision of pre-set component rotations in office to the chestnut of an "old-boy" network. The leadership has heard these things and many more like them and is responding.

An Ad Hoc Committee on Election Reform has been meeting since last year to discuss this aspect of our governance. Chairman Les Webb will be making recommendations to the Executive Council in June with action to follow in the House of Delegates in September in Williamsburg. Proposals under consideration cover many areas and should have your attention. The ideas include multiple candidates for every office from President-Elect through Executive Councilor-at-Large to Alternate Delegate. There are suggestions on methods of campaigning for office, and means for fully informing you of the qualifications of the candidates. The problem is not the mass meeting format itself, but that aspect of the process is explored and alternatives offered. This diligent and innovative committee is working for you and the future of our Association.

This is important.

Talk to your component representative on this committee, talk to your Executive Councilor, and let your VDA Delegate know your feelings. Right now, this is still a work in progress and the membership needs to speak its mind. Through your Delegates you can influence the outcome and change this from a perceived problem into a well discussed reasoned policy for our association.

.J'rancis J. Carr, Jr. Editor

5

LETTERS TO THE EDITOR 'ear Editor:

.s you consider items for the ext .p~b,Hcation, please let our lel111:l~r~';k:n8w\,\'hat was said bytei,i'y~t·~ ;"'. ';~~tal.·· Hygienists fl;;:"',;>'it,.,, .'~~eir;JobbYist

,}~~sj~i(of the, ;'at~s~mbIY. .Their

....·'ments during the '~";4tt:~~~d~m~;J\;pril, 1996 UThe

i"Curet" ." should wake l~ifs~~~iJp> and Jet' them know laf' they are facing and how ey . are being portrayed in chmond.

r over two years, at the request numerous hygienists (including ne VDHA members), I have rked for the elimination of the st course examination that is luired by the Code of Virginia hygienists to receive credit for ir continuing education uses, This has been a grass­Its effort that was successful in House of Delegates by a vote

79-21 this year, but action in Senate is pending.

~ VDHA leadership and their )yist, who is widely known at

General Assembly and :essful in his endeavors, fought in every subcommittee and irnlttee meeting. Some

themes that they kept repeating to legislators were:

1. That hygienists could not get continuIng education until the General Assembly mandated it,

2. They are representative of all of Virginia's hygienists, (but only 23% of the registered hygienists belong to VDHA),

3. That the quality of CE courses in Virginia is not the best,

4. That the post course examination is needed for their professionalism and to prove their competence,

5. That the hygienists are not adequately represented in Richmond, since they are under the Board of Dentistry,

6. That their post course examinations were legitimate (even though they had answers printed after the questions at their Roanoke meeting last spring),

7. Give the law more time, and 8. That the problem of the post

course examination would be solved if all the hygienists would take their courses through the VDHA.

The bottom lineseemed to be, let us keep the post course exam and

get more money by increasing our membership and through CE courses. Why? As they say in their April "Curet", uso we can pass in the legislature the issues that have been important to all of us for many years. /I

I do not know what VDHA's goals are, other than passing the local anesthesia legislation, but having heard their presentations in person for two years in Richmond, I am very concerned about their perception of things and how they would affect the delivery of dental care in Virginia. Since we as dentists all work together as a team in our offices, I feel that we should be willing to support an alternative professional dental hygienist organization that is committed to working with dentists, as a team, to provide the best possible dental care to Virginia's citizens. Plans for such an organization are now being developed and deserve our full attention and support.

Sincerely, Walter E. Saxon, Jr., DDS

-

(Message from the President.....)

:,

II

I

I

The VDA can be proud of its legislative accomplishments this year. After our Legislative Committee determined our goals, Chuck Duvall, our lobbyist, charted the course. Then Mr. Zepp, Lisa Finnerty and many of you helped Mr. Duvall with the "leg work."

Dentistry and the citizens of the Commonwealth were the winners! The Virginia legislature is creating a study committee to evaluate the shortage of dental hygienists. Third party payers will be required to publicly disclose many of their financially coercive methods of limiting care. It will be illegal for a provider contract to indemnify the carrier for the carrier's negligence. The Joint commission on Health Care and the Bureau of Insurance will study the feasibility of requiring the point-of-service option. Considerable progress was made towards eliminating the mandatory post-test for hygienist's continuing education. Dentistry was added to professions included in the Procurement Act. And, the Commissioner of Health was directed to study the availability of dental services being provided across the state and make recommendations for enhancing such services no later than the beginning of the 1997 General Assembly Session.

These goals would not have been reached without our capable lobbyist, the VDA staff, your efforts and political Action Committee moneys. Unfortunately, many of our members have a negative view of political activity and, especially, PAC's. This attitude reflects a lack of information on the part of dentists and weakens our legislative position. It is our responsibility to educate our colleagues.

Although PAC's are frequently maligned by some politicians and the media as a negative element in the campaign finance system, PAC's are actually the result of 1970's Congressional finance reform to insure documentation of financial contributions. While we may be concerned about the enormous contributions made to politicians by organized labor, trial lawyers and the insurance industry, without PAC's we would most likely be unable to even acquire that information! The law requires PAC's to report their contributions, candidates to report the contributions they receive, and that these reports be available to the public. Would we want to eliminate those requirements?

Actually PAC funds represent the aggregate contributions of individual citizens committed to a particular outcome in the political process. Contributions to VADPAC by dentists, spouses and their friends are used to get our views on the table during political debate. Without PAC funds, it is difficult to be heard. Legislators have very busy schedules and are more likely to make time for those that support them. Fortunately, PAC funds will not "buy" votes. If PAC funds did "buy" votes, we would not have had the success we did this year, because we were certainly outspent by our opponents on several of our issues.

Unfortunately, our PAC is entirely too small to insure continued success in the legislative arena. There is legitimate concern that we may cease to be a player in the legislative process if we fail to enhance the strength of our PAC. Dentistry can be proud of its legislative accomplishments and its commitment to support only legislation that is in the best interest of patients. If we "drop the ball," our patients may no longer be able to receive the best oral health care in the future.

It is imperative that we personally support VADPAC, educate our colleagues on the nature of PAC's, and stress the importance of contributions to VADPAC. In addition, we need to all help the VADPAC Committee to develop more productive fund raising activities. Without an increased interest by a broader group of our colleagues, dentistry as we know it may sincerely be in peril. PAC laws permit us to know the strength of our political adversaries. If we fail to respond with our time, commitment and contributions, we can only blame ourselves. Any of you who are interested in becoming more active with our PAC activities should contact VADPAC Chairman, John Doswell, Bill Zepp, or Lisa Finnerty.•

7

PROBLEMS ASSOCIATED WITH IMPLANT MAINTENANCE

INTRODUCTION Osseointegration has revolutionized the replacement of lost teeth and associated oral structures. Studies have confirmed the high success rate of dental implants reported by Branemark and his colleagues." Although success rates are in the 90th percentiles, problems may stilI be encountered during the long term follow-up of implant prostheses. For discussion purposes these challenges and methods of correction may be divided into mechanical, functional,' and tissue maintenance.

DISCUSSION

MECHANICAL mechanical difficulties include: mobile fixtures, fractured fixtures and components, and abutment tooth intrusion.4·14

Implant fixtures that exhibit mobility, regardless of degree, are considered failures to osseointegrate. Mobility results in a fibrous tissue formation surrounding the implant. As this tissue becomes thicker with time there will be an increase in fixture moblllty." Mobile fixtures should be extracted. The fixture is extracted using rotational forces. An abutment connected to the fixture may facilitate adaptation of the extraction

...

Michael L. Huband, DDS instrument. All nonmineralized tissue should be removed and the surgical site closed with a periosteal flap. Following extraction the clinician must alter the design of the prosthesis or place another implant into the original site after a healing period of one year."

Most implant components are susceptible to fracture. Fractures of components can be indicative of a number of problems including: manufacturing imperfections, a discrepancy between the restoration and abutment cylinder, inadequate framework design, voids in the casting, metal fatigue, inappropriate occlusal loads during function, occlusal prematurities, parafunction, and significant forces applied to malposed implants. 4,9,10

Fixture fractures are usually seen in association with rapid crestal bone loss. The usual causative factor is inappropriate occlusal stress.':" If the fracture has occurred coronally to the internal threads the apical fixture fragment can be used to provide support to the prosthesis. This is done by grinding the remaining portion of the fixture flat under profuse irrigation. Reflection of a full-thickness flap may 'be required for access. Then a

longer abutment is attached after its abutment screw has been shortened to fit the remaining internal threads. Acrylic resin is used to close the space between the abutment and prosthesis. Depending on the location and number of fixture fracture~,

fabrication of a new prosthesis should be considered.":"

Fixture fractures that are apical to the internal threads are usually treated by removal of the entire fixture and often requires the use of a trephine bur.5 A trephine bur is a hollow cylinder that resembles a key-hole saw. It cuts the surrounding bone for removal of an osseous core containing the fixture. If the site is not to be used for another fixture, the remaining portion of the fractured fixture can be left within the bone providing the site is free of pathology.' Fractured gold and abutment screws are often seen in conjunction with ill-fitting components or occlusal disharmony." If the fracture has occurred coronal to the fixture head, it can often be rotated out of the fixture by engaging the fragment with a scaler, explorer, or tongs." Some manufacturers market screw retrieval devises for their products. When the fracture has occurred at or apical to the fixture head, a channel is cut into the fragment using the

• 8

smallest possible bur. A screw driver of corresponding size is used to remove the fragment. An alternate method is to contact the fragment with a round bur in a slow-speed contra-angle rotating in reverse.v":" When using a rotary instrument care must be exercised to avoid damaging the fixture. If these methods of screw retrieval fail, the abutment can be removed and replaced with new interchangeable components." Seating of the new abutment should be verified radiographically, 16 All fractures and failures should prompt the clinician to carefuIly inspect the occlusion, fit of the prosthesis, and bone levels around the Implant.':" Intrusion or apical migration of natural tooth abutments in tooth-implant combination cases have been reported.11-14

Intrusion of natural teeth can occur in any area of the mouth and does not appear to be specifically related to retainer design." The causes of intrusion are probably and theories proposed to explain this phenomenon include: disuse atrophy, debris impaction, impaired rebound memory, mechanical binding, and harmonic resonance patterns. 11,12,14 Periodontal health and parafunctional habits may also contribute to intrusion problems but cannot be identified as the sole factors."

Disuse atrophy results from the shrinkage of the unstimulated

periodontal membrane. The rigidity of the implant framework may limit stimulation to the dentition. II Debris impaction or microjamming occurs when debris is forced into the space within the attachment. This separation of the attachment may cause tooth intrusion. Intrusion may continue as more debris is forced into the widened space." Impaired rebound memory occurs when the rigid implant framework impairs the ability of a tooth intruded by stress or heavy occlusal forces to rebound back to its original position after intrusion. Mechanical11

binding may occur with precision and semiprecision attachments in which the walls of the attachment mechanically inhibit rebound of the tooth after an intrusive force. This is more likely to happen when the path of insertion is different from the long axis of the tooth." Harmonic resonance patterns are thought to occur when the energy absorbed by the implant prosthesis is transmitted as vibratory energy. This energy is thought to be absorbed by the periodontal ligament and stimulates osteoclastic activity. An equilibrium between the vibratory energy and bone remodeling is established. Excessive stimulation may result in apical migration of the tooth until a new equilibrium is established." To prevent apical migration sufficient implants should be

placed to allow for free standing implant prosthesis. When this is not possible, the prosthesis should only be connected to natural teeth using mechanical attachments that allow for retrievability, energy absorption, and future modifications. 11,12 If apical migration is observed, it is usually seen during the first year after functional loading. 11

Although this is usually considered a nonreversible process some success in reversing this process has been reported with: cleaning of the attachments, disconnecting solder joints, occlusal adjustments and changing coping contours.":"

FUNCTIONAL Functional problems may involve mastication and speech. These problems may be intensified by excessive salivary flow after initial prosthesis placement. The patient should be assured that this is expected and normal flow will return in a few days.S

Patients generally adapt quickly to chewing with an osseolntegrated prosthesis but must be informed that a learning period is required.' Problems associated with speech are related to altered tongue position, excessive salivation, and changes in air­flow during speech. These difficulties are usually resolved within a few weeks to months due to the high adaptability of the tongue." This should be explained to the patient in conjunction with instructions

to practice reading aloud and repeating difficult words.' Protracted speech problems may be encountered especially with a maxillary hybrid prosthesis. In these cases a gingival veneer fabricated from silicone or acrylic resin may be used to obturate the space between the prosthesis and gingival tissues thus reducing air escape from under the prosthesis. Overdenture therapy may become necessary if the problem becomes intractable.v-":"

TISSUE MAINTENANCE During the first year following placement of an implant prosthesis the patient must be seen every 3-4 months. After a year the recall schedule is individualized with 6 months being the longest interval considered.' The recall appointment should include: assessment of oral hygiene, review of home care, examination of the oral tissues, evaluation of the prosthesis and occlusion, prophylaxis and scaling, and radiographic monitoring. Assessment of hygiene and reinforcement of home-care are essential to oral health and long term implant success.' The microtlora associated with failing dental implants are identical to those found in adult periodontitis. Plaque retention may lead to gingivitis which can develop into peri-implantitis with accompanying bone loss. 19-25

Modification of prophylaxis and scaling techniques are required around dental

implants. Conventional metal instruments and ultrasonic scalers scratch and/or loosen components. Plastic26

instruments specifically designed for cleaning around implants should be used. In situations in which the calculus cannot be removed with these instruments, the judicious use of an air abrasive system may be lndkated." Radiographs are required to monitor bone levels. Radiographs are suggested every 3 months for the first year following implant restoration and then annually. 6,16 During the first year marginal bone loss from 1 to 1.5mm may be noted. This loss is mainly in response to surgical trauma. Subsequent annual marginal bone loss is around 0.05 to 0.1 mm. I

No radiolucency should be evident around the implant and a normal trabecular bone pattern should be present." If excessive bone loss is evident radiographically and/or clinically and the implant is still integrated as verified by lack of mobility, detoxification and grafting procedures are indicated to decrease pocket depth. 19,20

SUMMARY Implants are highly successful alternatives to conventional prostheses when patients are properly selected and sound prosthodontic principles are followed. Yet problems may still be encountered during follow-up exams. The clinician must be educated as to possible problems and

adequately prepared to manage the situation.

REFERENCES 1. Adell A, Leckholm U, Branemark PI. A fifteen-year study of osseointegrated implants in the treatment of the edentulous jaw. International journalofOralSurgery. 1981;10 :387-416. 2. Zarb G, Syminton J, Osseointegrated dental implants: preliminary report of a replica study. The journalofProsthetic Dentistry. 1983;50:271-6. 3, Laney W, Tolman 0, Keller E, Desjardins R, Van Roekel N, Branemark PI. Mayo Clinic Proceedings. 1986;61 :91-7. 4. Sones A. Complications with osseointegrated implants. The journal ofProsthetic Dentistry. 1989;62:581-5. 5. Branemark PI, Zarb G. Alberktsson T. Tissue-Integrated Prosthesis. Quintessence Publishing Co., Inc. Chicago. 1985. 6. Worthington P, Lang B, LaVelle W. Osseointegration in Dentistry. Quintessence Publishing Co., Inc. Chicago. 1994. 7. Hobo S, Ichida E, Garcia. L. Osseointegration and Occlusal rehabilitation. Quintessence Publishing Co., Inc. Chicago. 1990. 8. SchroederA, Sutter F, Krekeler G. Orallmplantology. Thieme Medical Publishers, Inc. New York. 1991. 9. Morgan M, James 0, Pilliar R. Fractures of the Fixture Components of an Osseointegrated Implant. The International journalofOraland Maxillofaciallmplants. 1993;8:409­13. 10. Beumer J, Lewis S. The Branemark Inplant System: Clinical and Laboratory Procedures. Ishiyaku EuroAmerica, Inc. St. Louis. 1989. 11. Rieder C, Parel S. A Survey of Natural Tooth Abutment Intrusion With Implant-Connected Fixed Partial Dentures. The International journal ofPeriodontics s: Restorative Dentistry. 1993; 13:335-47. 12. Sheets C, Earthman]. Natural tooth intrusion and reversal in

10

implant-assisted prosthesis: Evidence of and a hypothesis for the occurrence. The journal ofProsthetic Dentistry. 1993;70:513-20. 13. Cho G, Chee W. Apparent intrusion of natural teeth under an implant-supported prosthesis: A clinical report. The journal of Prosthetic Dentistry. 1991 ;68:3-5. 14. English C. Root Intrusion In Tooth-Implant Combination Cases. Implant Dentistry. 1993;2: 79·85. 15. Billard H. Removing broken abutment screws from internally threaded implants. The journal of Prosthetic Dentistry. 1993;69:344. 16. Parel S. The Smiline System. Taylor Publishing Company. Dallas. 1991. 17. Parel S, Balshi T, Sullivan D, Cardenas E. Gingival augmentation for osseolntegrated implant prostheses. Thejournal ofProsthetic Dentistry. 1986;56:208-211. 18. Saunders T, Oliver N.•A Speech-aid Prosthesis for anterior implant-supported prostheses. The journalofProsthetic Dentistry.

1993;70:546-7. 19. Misch C. Contemporary Implant Dentistry. C V Mosby St.Louis. 1993. 20. Meffert R. Treatment of the Ailing, Failing Implant. CDA journal. 1992;6:42-45. 21. Alcofordo G, Feik D, et al. Microbiology of failing osseointegrated dentalimplants. Abstract: ASM Annual Meeting; New Orteens, 1989. 22. Becker W, Becker B, et al. Clinical and microbiologic findings that may contribute to dental failure. International journal ofOraland Maxillofacial Implants. 1990;5:31­38.

23. Fleming T, et al. Microbiota associated with peri-implant health and disease. Academy of Osseotntegrstion Annual Meeting. 1989. 24. Mombelli A, Van Oosten M, et al, The Microbiota associated with successful or failing osseolntegrated titanium implants. OralMicrobiology and Immunology. 1987;2: 145.

25. Rams T, Link C. Microbiology of failing dental implants in humans: Elecron microscope observations. journal ofOrallmplantology. 1983; 11-93-1 00. 26. Thomas-Neal D, Evans G, Meffert R, Davenport W. An SEM evaluation of various prophylactic modalities on different implants. International journal ofPeriodontal and Restorative Dentistry. 1989:9:301-11."

Michael L. Huband, DDS, is a graduate of the Medical College of Virginia School of Dentistry and is a second year resident in Fixed Prosthodontics at the Louisiana State University School of Dentistry.....

NOTE THESE DATES: VDA Leadership Conference (Mark your calendar now for these future meetings.) November 1 - 3, 1996

Boar's Head Inn, Charlottesville

VDA Committee Meetings ADA 137th Annual Meeting June 14-16, 1996 September 28-0ct. 2, 1996Sheraton Oceanfront, Virginia Beach Omni Rosen Hotel, Orlando, FL

16th Trustee District Caucus VSOMS Annual Meeting September 6-8, 1996

Asheville, NC July 4 - 6, 1996 Boar's Head Inn, Charlottesville

VDA 127th Annual Meeting September 18-22, 1996 V AO Annual Meeting Colonial Williamsburg Lodge June 28-July 2, 1996

Cavalier, Virginia Beach

11

D A For years, others have been imposing to develop its criteria based on the

A "standards" on the dental profession. consensus of practicing dentists after the Attorneys try to establish the "standard consideration of available scientific of care" in professional liability literature. The result is the American litigation. Government regulators Dental Association's Dental Practice determine the minimum "standard of Parameters. In the absence of care" for health care facilities and appropriate outcomes data, professional benefit plans. Now, third party payers consensus provides the best guidance make treatment decisions based on available for dentists and their patients.

P A R A IV1 E

their internal "guldellnes" and IIstandards of care". Indeed, they claim that closed panels are necessary to maintain "quality control".

Because of these activities, the ADA Council on Dental Benefit Programs realtzed that it was imperative that the American Dental Association be proactive in the "quallty control" arena of practice. The ADA House of Delegates agreed, and funded the Dental Practice Parameters project.

By definition, IIstandards" and "guidelines" are based on scientific outcomes data, and if followed, will result in predictable results. Unfortunately, there is little statistically significant outcomes data for dental

Unlike "standards" and "guldellnes," which must be strictly followed, II parameters" are a range of acceptable treatment. The ADA's Parameters describe the range of acceptable treatments for a given condition. They mandate that the key element in making actual treatment decisions be the "professlonal judgment of the dentist and the needs of that specific patient at a specific time".

The ADA Parameters permit a broad range of treatments for given conditions. Those of us that are actually involved in patient care recognize that quality patient care necessitates a high degree of discretion in treatment planning. The "one-slze-flts-ali" model is inappropriate in clinical practice. We

TER

procedures currently available. Without such outcomes data, it is inappropriate to construct "standards" or IIguidelines". Any organization that attempts to do so, is basing their criteria on opinion or consensus, not science. The ADA elected

must recognize, however, that the range of treatment will become more restricted as outcomes data does become available. Regardless of the "feetlngs" of individual dentists, government agencies or third party payers, a profession based in science can not ignore statistically significant data.

S 12

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rr

,, f

Although broad in scope, the The ADA's early experience with the F Parameters are also very specific in Parameters has been very favorable. I ~ describing considerations that should be made and procedures that should be performed on patients with certain conditions. The dentists that deviate from these Parameters should do so only under unique circumstances and with thorough documentation.

Although the Parameters are notintended to serve as legal documents, they do represent the consensus of over 140,000 practicing dentists.Indeed, they are the profession's statement on the "scope of clinical oral health care". This gives them more credibility than the opinions of I

_

II

Both the permissiveness and the restrictive nature of the Parameters bother some dentists. Some are concerned that the Parameters are too broad, others consider them too specific. With these anxieties being expressed, it is reasonable to ask, "Are the ADA Parameters friend or foe?"Both the American Medical Association and the American Association of Oral and Maxillofacial Surgeons developed parameters before the ADA. In both cases the parameters have proven very helpful with third party payers, regulators and in professional liability issues. In fact, there is convincing evidence that there has been an increase in the quality of care in many areas as a result of the parameters. Generally, only doctors markedly deviating from accepted practices have found the parameters to be detrimental. It is unlikely that the absence of parameters would have resulted in a more favorable outcome for these individuals.

individuals, bureaucrats or third party payers.

Many disputes with third party payers and "patients-turned-plaintiffs" involve the type, not the quality, of treatment provided. In these cases, it is unusual for a reasonable practitioner not to be aided by the ADA Parameters. They have already been used many times for the benefit of both dentists and their patients. It is anticipated that their usefulness will increase as our members and the outside communities of interest become more familiar with them.

Are the ADA Parameters friend or foe? If properly used and maintained, they are the friend of both dentists and patients. They are just another example of the ADA's member dentists working together for the enhancement of dental health.

Dr. Ron Tankersley VDA President Member, ADA Parameters Committee Past-Chairman, ADA Council on Dental Care Programs A

, ..

I :» t :»

F t :»

I ftffI

13

I

ABSTRACTS

In this issue are four articles abstracted from the current literature by the post-doctoral residents in pedodontics. The Virginia DentiJl Joumal is grateful to the Medical College of Virginia School of Dentistry, to the graduate students, to Dr. Frank Farrington, Oisirmsn, and to Dr. Arthur Mourino, Director of the Graduate Program, Department ofPedodontics.

Sports Dentistry by D. Kumamoto Compendium 1993; 14: 492-502

The fabrication and use of mouthpieces for athletes is a major concern for sports dentistry. The ADA and The Academy of Sports Dentistry has attempted to make mouthguards a requirement for many sports, however athletic organizations have resisted their recommendations.

Mouthguard Protection According to Andreasen 30% of

school-age children will experience some form of trauma to their teeth. Kracht and Kaleta compared the cost of replacing or repairing a tooth to the price of a mouthguard. Their result revealed that the cost of a mouthguard ranges from $2 to $50, the fee for treating a damaged or lost tooth ranges from $50 to $1300. A study by Hickely et al studied the effect of concussions on human cadavers. They concluded that a mouthguard significantly reduced the amount of intracranial pressure and bone deformation of the skull when a blow was given to the inferior border of the mandible. The NCAA injury surveillance system reports that concussion is the most prevalent head injury to football players.

Preseason Examinations The ADA recommends that sport

teams have a dentist give preseason examinations to all team members and the dentist be available for emergencies.

Types ofMouthguards The three major categories of

mouthguards are: 1) "stock" or "one-size-fits-all":

This is a non-adjustable mouthpiece, and for that reason it may be bulky, loose, and cause difficulty in breathing and speaking.

2) Mouthformed: This mouthpiece is shell-lined or thermoplastic mold type. It is the Boil and Bite type. This mouthpiece may be bulky and uncomfortable.

3)Custom type: This mouthpiece is fabricated by a dentist. The mouthpiece is usually made from a maxillary impression. The close adaptation of the mouthguard to the teeth makes for a tighter and more comfortable fit. The disadvantage with this mouthpiece is cost, and a two appointments procedure.

Characteristics of a Good Mouthguard Material

1. Material must be flexible 2. Material must be resilient so it

does not tear easily 3. Non-toxic 4. Lack of odor or taste 5. Cost 6. Stability of shape when being

stored

With the use of mouthguards, traumatic injuries to the teeth and soft tissue and soft tissue can almost be eliminated in most contact sports for both men and women. By cushioning the blow an athlete receives during injury, the mouthpiece may prevent concussions and mandibular fractures, as well as teeth avulsions

and luxations. The team dentist is a vital player in reducing and preventing oral injuries. The sports dentist can enhance his image in the community , build his practice, be part of a team, provide a public service, and have fun, all at the same time.

Nadia Diab, DMD

Dr. Nadia Dlsb is a second year advanced education student in pediatric dentistry. She esmed a degree in Biology from Northesstem University in /990, and received her DMD from Tufts University in /994....

Premature loss of the maxillary primary incisors: Effect on speech production by T.O. Gable, AW. Kummer, L. Lee, N.A. Creaghead, and ).F. Moore. [oums! of Dentistry for Children 1995; 62: 173-79.

Predicting pulpectomy success and its relationship to exfoliation and succedaneous dentition by). Coli and R. Sadrian. Pediatric Dentistry1996; 18: 57-63.

The treatment of primary maxillary incisors in "baby bottle decay" has been a concern to dentists because of possible adverse effects to a child's speech from extraction or hypoplasia of the permanent successor from pulpectomy treatment. If the primary incisors of a two year old child are severely decayed and the teeth are extracted, will these cause a future speech impediment? If pulpectomies are performed on the primary incisors, will toxic dental root canal materials cause the formation of decalcified spots on

• 14

. e facial of the permanent incisors?

The effect of missing maxillary ncisors on speech production has 'een studied by several authors. how studied the effect of articulation '(.the sounds, "f, v, 0, s, z" of hUdren with missing maxillary Hmary central incisors in comparison

.children with normal maxillary 'iral incisors. The results of her "estigation revealed that 75% of iJdren with missing incisors

duced misarticulations. In a 1rol study, 82% of children 'out missing teeth produced 1fticulations. The overall

'fenCe was not found to be , f'

cant.

.kson and Byrne suggested that nterior open space created by :issing teeth may cause changes ~!ci~coustic characteristics of sound 'llftion and that developing and -:I~hing sounds may be affected. <tested children prior to their . 'on of primary incisors, using [sounds"s, z, f," then retested lldren following exfoliation and

eruption of the permanent They concluded that there

.9;significant differences for the 'dions of sounds from "~~re loss of the primary ,ary incisors. 5i}

,

Succedaneous enamel defects seems to be the result of the infection existing prior to the pulpectomy procedure and not the pulpectomy procedure itself. There was a direct correlation between enamel defect and the amount of root resorption. The study indicates that a pre-existing infection would not likely be resolved by a pulpectomy in a case of excessive root resorption. The authors suggest extraction as the treatment of choice for these teeth.

Pulpectomy success The success of the pulpectomy

was significantly related to the amount of preoperative root resorption. Minimal or no preoperative root resorption has a significant higher pulpectomy success rate. Zinc Oxide Eugenol (ZOE) pulpectomies filled to the apex or 1 mm short showed higher success rates than overfills.

Pulpectomy tooth loss There was a 20% incidence of

anterior cross-bites or palatal eruption of the succedaneous permanent incisor. In the molar region there as a 21 .6% or ectopic eruption of the premolar or difficulty in natural exfoliation of the pulpectomized molars. Teeth with pulpectomies were usually lost at the right time of exfoliation and were not related to the amount of ZOE fill. However 36% of the pulpectomies required tooth extraction due to infection.

A summary of the two articles suggest that a clinician should not be overly concerned with deciding to extract primary teeth for speech consideration or performing pulpectomies for fear of iatrogenically causing defects to the permanent dentition. In cases of

severe decay, extraction may well be the best treatment of choice. If esthetics is a concern, banding the maxillary primary second molars and fabricating a lingual arch with attached anterior prosthetic teeth(Kiddy partial) can be performed. In cases of moderate decay with imminent pulpal exposure, pulpectomies may be the treatment of choice.

Christopher Maestrello, DDS Nadia Diab, DMD

Dr. Christopher Maestrello is a first year advancededucationstudent in pediatric dentistry. He is a graduate of the University of Richmond and received his DDS degree from MCV in 1988. He practicedgeneraldentistry in Virginia Beach from 1988 to 1995....

Effect of 1- and 4- minute treatments of topical fluorides on a composite resin by K. Kula, T., Kula, and E.L Webb:. Journal of Pediatric Dentistry 1996; 18, 24-28

There has been concern of the effects of topical fluoride treatments on dental materials such as porcelain, composite resins, sealants, and glass ionomer materials. The glass-like substances which are present in these materials react to the acidic pH levels of the acidulated phosphate fluoride (APF), which may cause weight loss and surface changes of these materials. These effects are influenced by the length of time these materials are exposed to the APF agent. This article studies the comparison of surface topography and weight changes on a composite resin following a l-mlnute immersion and a 4-minute immersion using

15

- -

ABSTRACTS, cont. 1.23% APF gel, a 2.0% sodium fluoride gel, and water.

Forty composite resin specimens containing barium boroaluminosilicate glass and silica tiller particles (Prisma APH, Caulk Co., Milford, OE) were used in this study. The specimens were condensed into stainless steel dies(0.7 in. X 0.1 in.) And were placed on glass slabs. Each specimen was cured with an incandescent llzht source (Elipar, ESPE, West Ger for 80 seconds. The specimen then polished with 6' sandpaper and alumina polish; stored in distilled water. TI composite resin specimens wer

composite resins with regards to the length of application. This study points out the fact that caution should be taken when using a 4­minute APF gel or foam on patients with composite resin restorations.

Scot K. Watase, OMO

Dr. Scot K. Watase is a first year advanced education student in pediatric dentistry. He attended Wprtmnnt rnl!pfTp in S:mt:l R:lrh:lr:l_

Currently, the best storage medium for avulsed teeth is Hank's balanced salt solution or similar types of pH-balanced cell preserving solutions. Studies have shown that water and saliva actually damage POL cells. Milk is a compatible storage medium provided it is cold and fresh.

Cells stored in milk were less able to differentiated than those

STATEWIDE CONTINUING EDUCATION REGISTRATION FORM

Mail to: Virginia Dental Association Component #divided into eight groups, wil P.O. Box 6906 Make separate che-c'k­pay-a'bTle-to-:specimens in each group. Each: Richmond, VA 23230-0906 Virginia Dental Association

Program Name: .Date, _was allocated to either the APF the APF gel, the NaF gel, or wa Name: l-minute immersion or the' 4-i Please use full name

StreetAddress: ~_immersion. Each specirnet City,State, Zip: ~ ~ _weighed twice before and twlc

each immersion. After treatme Office telephone number: _~ _ completed, the specimens: Otherpersonnel attending: _

(Please use full names) examined under the el microscope and scored for voh Fee(s) enclosed: $~ _ $20-Members ofVDA & auxiliaries: $75-Persons other than VDA particle loss by two investigator!

This study resulted in no sigr difference in either the mean; scores or the weight changes. the l-mlnute immersion spec Yet, the 4-minute imn specimens resulted in slgnlftcanuy higher mean visual scores as well as significant weight loss occurring in these specimens. Among the 4­minute immersion specimens, the 1.23% APF gel and foam had higher mean visual scores of voids and particle loss as well as more weight loss when compared to the 2.0% NaF gel or water.

Although composite resins differ in strength and use, this study showed the effects different fluorides have on

members. Fee includes lunch and coffee break. For additional information, call VDA aI1l800/552-3886.

Please copy form if you are registering for more than one Component Meeting.

See page 39 ofthis Journal/or listing ofContinuing Education programs.

extraoral time. This article reviews the pertinent research on avulsed teeth and recommends a new philosophy based on the length of extraoral time, the stage of development of the root apex, and the type of storage media use. The reader is referred to the article for suggestions of management based on the length of extraoral time and state of development of the root apex. This summary will focus on the storage media used

Hank's solution and other pH­balanced cell preserving solutions are available commercially. Though somewhat expensive they can be purchased in small containers for single tooth storage (ex. Save-A-Tooth, 3M Company). If would be ideal if all schools and day care centers etc. could have this solution on hand in case of an avulsion. Also

6

all dental offices that treat dental trauma should have this solution in the office. There is a 3 year shelf life of the product.

Timothy E. Collins, DDS

Dr. Timothy E. Collins is a second year advanced education student in pediatric dentistry. He attended Radford University and received his DDS degree from MCV in 1994. ,..

ADA FIELD SERVICE COMING TO VIRGINIA

The Virginia Dental Association has been selected to participate in the 1996-1997 ADA Field Service Program. Twelve constituent and component societies will be included in the program. In addition to Virginia, state dental associations in Indiana, Kentucky, Tennessee, and Wisconsin were selected.

The ADA Field Service Program is an intensive eighteen month "hands on" program designed to help dental societies enhance their membership efforts. Since 1991 the program has worked successfully with 56 dental societies. The program has demonstrated success in increasing dues revenue and new members while decreasing the number of non­renewals.

The VDA will receive on-site customized membership marketing services and organizational support from ADA Field Representatives for one year, beginning in the summer of 1996. Following the initial twelve month campaign, the Field Representatives will provide six months of informal follow-up activities. The majority of the funding for the program is provided by the American Dental Association.

The ADA Field Representatives will work with both the VDA and the Component Societies to provide customized membership recruitment and retention services. Some of the specific services offered are: • Record cleaning and development of

prospect lists; • Organizational analysis; • Development of a written plan of action

with goals, objectives, strategies and tactics; • Benefits Communication Workshop for

leadership and committee volunteers; • Assistance with direct mail campaigns,

phone-a-thens and other "hands-on" support;

• Assistance with customized packets, brochures and letters for target groups;

• Presentations at dental society meetings; and • Participation in membership orientations

and special events.

The ADA Field Service Program worked with the Richmond Dental Society during 1995. Individual Component Societies will be receiving additional information later this year. ~

AMERICAN COLLEGE OF DENTISTS HOLDS 75TH

ANNUAL MEETING, DR. MALBON HONORED

The American College of Dentists held its 75th Annual Meeting in Las Vegas in conjunction with the 1995 ADA Session. The theme for the meeting was "A Distinguished Past, A Dynamic Future".

The convocation speaker, Dr. John DiBiaggio, President of Tufts University and a former Dean of the MCV School of Dentistry, dedicated his address to the memory of the late Dr. Bennett Malbon. He gave a warm and thoughtful reminiscence of their long friendship and of Dr. Malbon's devotion to the profession and the ideals of the American College. At the time of his death, Dr. Malbon was Regent of Regency III of the College and Past Chairman of the Virginia Section.

17

VIRGINIA BOARD OF DENTISTRY The Virginia Board of Dentistry is appointed by the Governor and is

composed of seven dentists, two hygienists and one citizen representative. Contact

the Board office or a member of the Board on questions on rules and regulations.

President Patricia Lee Speer, DDS First term ends 6/30/96 6606 W. Broad Street Richmond, VA 22314 (804)662-9906 FAX (804)399-6429

Vice President Robert J. Isaacson, DDS, MS, PhD First term ends 6130/97 MCV School of Dentistry Department of Orthodontics

, Richmond, VA 23298-0566 (804)828-9326 FAX (804)828-5789

Secretary-Treasurer French H. Moore, [r., DDS First term ends 6130/96 303 Court Street Abingdon, VA 24210 (540)628-7862 FAX(540)676-5537

Alonzo M. Bell, DDS First term ends 6/30/96 1755-B Duke Street Alexandria, VA 22314 (703)836-3384 FAX(703)836-8132 .

Monroe E. Harris, Jr., DDS First term ends 6130/97 110 N. Second Street Richmond, VA 23219 (804) 783-2800 FAX(804)379-2859

Mark A. Crabtree, DDS First term ends 6/30/98 407 Starling Avenue Martinsville, VA 24112 (540)632-7392 FAX(540)632-2341

John S. Lyon, DDS First term ends 6/30/99 2774 Hydraulic Rd. Ste #201 Charlottesville, VA 22901 (804)973-2968 FAX(804)973-0257

Catherine R. Cotter, CDA, RDH, MEd First term ends 6/30/96 Spotsylvania Vocational Center 6703 Smith Station Road Spotsylvania, VA 22553 (540)898-2655 FAX(540)891-1784 (540)891-0675 (Direct)

Saundra D. Nelson, RDH, MS First term ends 6/30/96 2000 Twenty seventh Street Newport News, VA 23607 (804)244-1010 FAX(804)928-0589 (804) 838-5999(Mon's & Wed's)

Pat K. Watkins First term ends 6130/99 6606 W. Broad Street, Fourth Floor Richmond, VA 23230-1717 (804) 662-9906

STAFF

Marcia J. Miller, Executive Director

Pam Horner, Administrative Assistant

Kathy Lackey, Administrative Assistant

Lychia Morris, Office Services Specialist

6606 W. Broad Street, #401 Richmond, VA 23230-1717 (804)662-9906 FAX(804)662-9943

Howard M. Casway, Esquire Office of the Attorney General Assistant Attorney General 900 E. Main Street, Fourth Floor Richmond, VA 23219 (804)786-1023 FAX(804)371-8718

TENTH NATIONAL CONFERENCE ON THE

YOUNG DENTIST

J~'ADA Committee on the New Dentist has nbunced the program for the Tenth National 'nference on the Young Dentist, which will be held W'2S-27, 1996, at the Stouffer Renaissance Hotel in 'veland, OH. The theme for the Conference is "A

de of Excellence." The Conference is partially edbya grant from Chesebrough-Pond's USA Co., rs of Mentadent toothpaste. , Conference program includes outstanding

;iIing education opportunities directed towards the 'ung practitioner. Conference workshop topics

practice management and clinical, leadership and ional issues. Scheduled speakers include Mr.

Lombardi, Jr.; Dr. Suzanne Boswell; Dr. line Dzierzak; Dr. Marvin Ladov; and Mr. and ames Rhode. A special managed care seminar will

'be offered, "The Changing Face of the '(place: Is Managed Care Right For You?" In '''ii,. the Conference also offers an idea exchange en forum where New/Young Dentist Committee .can share ideas and concerns with their peers, iedal programming where these individuals can :e their leadership skills. '!/i:"-'~·

,.registration fees have been established for ADA t~ and additional discounts apply for early ~()n. For more information on this outstanding rship benefit, contact the ADA's Committee on "tDentist extension 2779.

Tenth National Conference on the Young Dentist

July 25 - 27, 1996

RESULTS OF NATIONAL ORAL HEALTH SURVEY

RELEASED

Results from the first phase of a nationwide survey of oral health in children and adults were released recently by the National Institute of Dental Research (NIDR), providing a snapshot of the nation's dental health status. The survey provides the most reliable estimates yet of dental disease in several population subgroups, including children under age 5, older adults (age sixty and over), and black Americans and Mexican Americans--the two largest minority groups in the U.S.

What emerges from the first three years, or Phase I, of the 1988-94 National Health and Nutrition Examination Survey--called NHAN ES 1I1--is a more complete picture of the dental treatment needs of children and adults from Mexican American, non­Hispanic black, and non-Hispanic white backgrounds. The NIDR, which is one of the Federal government's National Institutes of Health, sponsored the oral health component of NHANES III in collaboration with the National Center for Health Statistics.

"While there has been remarkable improvement in the nation's dental health over the past couple of decades, the survey findings point to many challenges for the American public and the dental community," said NIDR Director Harold Slavkin, DDS. "For example, it appears that caries in permanent teeth continues to decline among school-aged children, and that's good news, but the other side of the coin is that 45 percent of children and adolescents still suffer from this preventable infectious disease: there is our shared challenge."

Tooth Decay in Children and Adolescents NHANES III dental examiners found no caries, or

tooth decay, in the permanent teeth of 55 percent of children and adolescents aged 5 to 17. Only a couple years earlier, a 1986-87 survey had found that 50 percent of 5-1 7 year-olds were caries-free in their permanent teeth. The NHANES III survey showed that black children enjoyed the highest caries­free rate in permanent teeth--61 percent, followed by white children at 55 percent and Mexican American children at 51 percent. (Throughout this paper, white ·and black refer to people of non-Hispanic white and black backgrounds.)

. •_·»·_,···~'l!";,"'~"l'miIIt_M

19

( SU RVEY, cont. ) Unfortunately, tooth decay continues to affect millions

of U.S. children and adolescent, with the majority experiencing caries by their late teens. Only 33 present of 12-17 year-olds were caries-free in their permanent teeth. Caries in the permanent teeth was not distributed evenly among children and adolescents, the survey showed. Most of the caries -80 percent-- was found in a quarter of the 5-1 7-year-olds.

The survey showed that most of the caries (80 percent) in the permanent teeth of children and adolescents had been treated, or filled. Although black and white youngsters had about the same amount of caries in their permanent teeth, black children had more than twice as much untreated decay as did white children.

Sixty-two percent of children aged 2-9 had no caries in their primary (baby) teeth, the survey found. While caries rates in primary teeth were similar for girls and boys, they increased. with age and differed among race­ethnicity groups.

Among 2-4 year-olds, more white children were caries­free in their primary teeth (87 percent) than either black or Mexican American youngsters (78 percent and 68 percent, respectively). Among 5-9 year-olds, about half of white and black children had no caries in their primary teeth, while only about a third of Mexican American children were caries-free.

Untreated decay in primary teeth was a major problem uncovered by the survey. Nearly half (47 percent) of the caries in the primary teeth of 2-9-year-olds had not been treated. Mexican American children had the highest percentage of untreated decay--62 percent, followed by 59 percent for black children and 41 percent for white children.

NHANES III revealed that use of dental sealants more than doubled since 1986-87, but still remained low. Sealants are plastic films painted onto the chewing surfaces of teeth to protect them from decay. The survey found sealants on the primary teeth of less than 2 percent of children, and the permanent teeth was three times as common in white children (22 percent had sealants) as in black children (8 percent) or Mexican American youngsters (7 percent).

Tooth Decay and Tooth Loss in Adults Tooth decay is nearly universal among American

adults. The survey found that 94 percent of people age 18 and older had either untreated decay or fillings in the crowns of their teeth. On average, American adults had 22 decayed, missing, or filled coronal surfaces (out of 128 possible surfaces).

Women had more caries than men (24 decayed, missing, or filled surfaces, versus 21 in men), but they also had slightly less untreated decay. Whites had approximately twice as much coronal caries (24 surfaces) as did blacks (12 surfaces) and Mexican American (14 surfaces); however, blacks and Mexican Americans had more tooth surfaces in need of treatment than did whites. Blacks had an average of 3.4 untreated surfaces, Mexican Americans had 2.8, and whites had 1.5.

When gums recede, tooth roots become exposed and subject to decay. The survey found root caries in 23 percent of adults. On average, adults had only one decayed or filled root surface. Decay of tooth roots was more prevalent in black and Mexican American adults than in whites. Half the root caries found in white adults had been treated, but most of the root caries in black and Mexican American adults was untreated.

The survey also showed that 10 percent of adults are missing all their teeth. The remaining 90 percent have, on average, 23.5 teeth. Almost a third of adults have all 28 teeth. Gender did not playa role in tooth loss, the survey found, but age and race­ethnicity did. Virtually none of the adults aged 18 to 24 were toothless, but 44 percent of those age 75 and older were missing all their teeth. Mexican American adults had an average of four more teeth than did black or white adults.

Removable complete or partial dentures are a fact of life for millions of Americans, the survey showed. About 20 percent of adults aged 18 to 74 wore some type of removable denture, with use more common in women than men and more common in white adults (22 percent) and black adults (21 percent) than in Mexican American adults (9 percent). As expected, denture use increased with age; half of Americans age 55 and older wore a partial or complete denture.

20

percentage of denture wearer--60 percent-­~,problems with their appliances.

d caries is one indicator of dental treatment tit doesn't tell the whole story. The survey

f>a number of dental conditions that might 'om treatment, including defective fillings,

d bridges; loss of healthy tooth structure as a estorations or trauma; recurrent caries (decay . ps around a tooth restoration); and damage

.. or soft tissue at the center of the tooth. u,

that more than 40 percent of adults who r almost 62 million Americans-- had a least "r tooth' space that might benefit from 'No differences were found by gender or blems did increase with age.

m) problems continue to plague millions NHANES III looked at such key

'eriodontal disease as attachment loss-or 'pport for the teeth--and bleeding gums, ;'lnflammation. Overall, women had 1:31 health than did men, and whites had ,.. '] problems than did blacks or Mexican

~ that the prevalence and extent of hment loss increased with age. ent loss of 3-4 mm was found in 30 4-year-olds, 63 percent of 45-54­percent of people over 65. More ,estruction--attachment loss of 5 mm ~ in 15 percent of those surveyed. ~",most prevalent among adolescents; :17-year-olds had gums that bled on

~' first national survey to look at the auma in children and adults. The ,percent of Americans aged 6 to

sort of injury to the lnclsors-the . e most common injury was a uma was more common in males

The survey was the first national survey in 25 years to examine problems with occlusion, or positioning and alignment of the teeth. The results show that one-fourth of children and adults aged 8 to 50 had perfect alignment of the front teeth. A comparison of the survey findings to those of a survey conducted in 1966·70 showed a 20 percent increase in adolescents with a normal overbite.

The survey also revealed that 18 percent of children and adolescents and 20 percent of adults had undergone orthodontic treatment. Both malocclusion and orthodontic treatment were more common in whites than in blacks or Mexican Americans.

*******

Note: Oral health results from Phase I of NHANES III, which was conducted from 1988 to 1991, are reported in the February 1996 Special Issue of the Journal of Dental Research. An article on dental caries and sealant use in children based on the NHANES data appears in the March 1996 issue of the Journal of the American Dental Association. Data from the second phase of NHANES III, conducted from 1991 to 1994, are not yet available. NHANES III was designed to collect nationally representative data on many aspects of health and nutrition, including oral health.

Abstracts for the papers in the February 1996 Special Issue of the Journal of Dental Research can be found on the Internet under the home page for the International Association for Dental Research (http://medhlp.netusa.net/iadr/iadr.htm ).

From the home page, select "Publications Information," then "Journal of Dental Research." Click on "Special Issue (NHANES)" to get a list of the 10 abstracts, then click on the abstract you wish to view....

21

·:·~r':>~~OIOgy dealing with ,'~;/design and operation of

''P~ysical environment. In the future • rY'to'institute ergonomics standards. If

~r~ developed they will be designed to assist ~~;s in identifying jobs which may lead to

~b.ilbskeletal disorders. This might mandate that ,"'employers evaluate their facilities and jobs to

;; :"':"determine whether ergonomic hazards are present.

Areas of concern in dentistry are carpal tunnel syndrome and back problems associated with working posture. It is difficult to rule out non-work related activities such as sports (tennis or cycling, for example) and computer usage as causative or additive factors relative to repetitive dental procedures.

The studies cited by OSHA on causal association contain significant methodologic deficiencies. No one can predict when OSHA will publish proposed new rules concerning ergonomics, for OSHA does not need congressional approval to proceed. The only good news is that OSHA, due to budget cutbacks will . ' be operating at reduced speed.

Dry Heat Ovens The Food and Drug Administration (FDA) has classified sterilizes as Class II medical devices under their control. Manufacturers of such devices must follow FDA regulations in order to produce their product. Some of the regulations to which manufacturers are subjected are:

1. Adulterated or misbranded devices are prohibited.

2. Domestic device manufacturers and initial distributors must register their establishments and list their devices.

3. The FDA has the authority to ban certain devices and restrict the sale and distribution of others.

4. Manufacturers must provide for notification of risks and of repair, replacement or referral information.

5. "Good Manufacturing Practices," records, reports, inspections and compliance with certain performance standards are required.

There is equipment that may be able to achieve sterilization by cannot yet be called sterilizes because they have not been reviewed by the FDA to assure regulatory safety and effectiveness as sterilizers. A number of health professionals are using devices that are not approved by the FDA to sterilize their instruments.

I feel that if your office is in the market to buy a heat sterilizer that you purchase one that is approved for that purpose. It is no longer acceptable for offices to purchase "kitchen appI·lances" such as convection ovens, toaster ovens, or microwaves to sterilized dental instruments. The only justification for using non-approved sterilizes is the lower cost. Controlling cost is definitely an important consideration, but the health of patients is our most important concern. It seems an unacceptable compromise in providing patient care when small heat sterilizers currently range in price from about $300 to $600.

Fire Safety Policy Offices with 11 or more employees are required to have a written emergency action plan. It must be on file in the dental office and made available to employees. A written plan is not required for offices of fewer than 11 employees, but is recommended.

22

rhust be a fire evacuation plan with a drawing •. fflce and the evacuation routes. Doors eproperly labeled as exit to prevent walking '10set during the emergency. Other Ilt consideration include: hich employee calls the fire department lly 911 }?--Normally the employee "stthe phone will call. .ho evacuates patients? 110 removes the appointment book and ully the Exposure Control Plan and

S'(do you really want to do these again}? in any switches be safely turned off? Do "end time doing this. %ve an office fire drill at least once a year. nere are the smoke detectors in the ':~nd who is responsible for their '\nance and battery changing?

Fire extinguishers must be maintained and periodically checked (This involves a visual inspection once a month and signing the tag attached for documentation). In the event of a sudden fire employees should evacuate and not stop to use the extinguisher. At the completion of an evacuation there should be a head count to ensure all personnel and patients are out of the building.

In a number of localities the fire department will evaluate dental facilities and make recommendations, including employee training and inspection of fire extinguishers. ...

Dr.Ty Ivey of the Georgia Dental Association (I) and Republican Congressman Dr. Charlie Norwood of Georgia (r) explain Washington politics to ADA President Dr. Bill TenPas during the Public Affairs Conference.

SET YOUR siGIiTS ON

SEATTLE Join us SUMMER ;96 JuLy 10, 11 & 12 for the • Expanded Exhibit Hall Hours

• Sensational Speaker LineupPAciFic NORTliwEST • 3S0+ Commercial Booths

• More Hands-on WorkshopsDENTAL CON FERENCE • Spectacular Special Events

For a complimentary Preview Program call (206) 448-1914 or f:.x: (206) 728-4470

23

Upcoming Continuing Education 1996

Component 1 Friday, October 18, 1996 Dr. John A. Svirsky "AIDS/OSHA Update"

Sheraton Oceanfront Hotel, Virginia Beach Send registration to the Tidewater Dental Association.

Component 3 Friday, September 6, 1996 Dr. Michael Glick Country Club of Petersburg. Send registration to the Virginia Dental Association.

Component 4 Friday, October 4, 1996 - Dr. W. Baxter Perkinson, Jr. "Implant Restoration & Porcelain Restorations" Holiday Inn, 164/West Broad. Send registration to the Richmond Dental Society.

Component 5 Friday, May 31, 1996 - Drs. Gary Maynard and Richard Wilson "Practice Building With Quality Periodontics and Restorative Dentistry" * Note: $20 fee forJunch

Roanoke Airport Marriott. Send registration to the Virginia Dental Association.

Component 6 Friday, August 16, 1996 Drs. John Kenney & Lynn Mouden "Dentistry's Role in Preventing Child Abuse and Neglect." Martha Washington Inn, Abingdon. Send registration to the Virginia Dental Association.

Use "Statewide Continuing Education Registration Form" card in this issue to register. ( )

AIDA c·~·~·~ CONTINUING EDUCATION RECOGNITION PROGRAM

=

24

VDA Executive Counci~1=--A-=--c--,--ti~o~n~s~ _ The Executive Council of the Virginia Dental Association met on January 28, 1996, and took the following actions:

APproved a recommendation that the VDA submit the following names to the Governor for consideration for appointment to the - Board of Dentistry to fill the unexpired term of Dr. Erma Freeman:

a) Dr. Michael J. Link b) Dr. Edmund E. Mullins, jr. c) Dr. Francis F. Carr, Jr., and/or d) Dr. J. Darrell Rice

Received as information only a recommendation that the Legislative Committee evaluate whether the VDA should sponsor the Legislative Luncheon in the same year as the Public Affairs Conference or the Grassroots Conference.

Approved a recommendation that the current ADA rules regarding the Relief Fund Indenture of Trust be adopted by the VDA and that VDA legal counsel examine the current Indenture of Trust Rules relative to Virginia law.

Approved a recommendation that the official delegation to the ADA Public Affairs Conference in Washington, DC will be as follows: a) The Chairman or a designated member of the Legislative Committee; b) The Executive Committee; and c) Selected VDA Staff

Approved a recommendation that travel expenses incurred by representatives of the VDA in an official capacity, as established by the Executive Committee, be reimbursed for travel, lodging, and the ADA-established per diem. All travel expenses will be submitted to the VDA in travel voucher form.

Received as information only a recommendation that the Ad Hoc Committee on the For Profit Subsidiary be dissolved.

Approved a recommendation that the Bylaws of the Virginia Services Corporation be amended to allow for a Board of Directors consisting of five (5) Directors to include Doctors Jeffrey Levin and Bruce K. Barr.

Received as information only a recommendation that a "Mark Your Calendar" announcement for the VDA Annual Meeting be mailed to the membership in early May of each year, followed by the registration packet on or about July 1 of each year.

Received as information only a recommendation that the Annual Meeting Committee will proceed with plans to incorporate Health Screening in the Annual Meeting program and include a release form, cost, and questionnaire.

Approved a recommendation that on-site registration fee will increase by $50 over the preregistration fee for all dentists and by $10 for all auxiliaries for 1996 only.

Deferred to the June 1996 Budget and Financial Investments Committee Meeting, a recommendation that Luncheons for Freshman, Sophomore, Junior and/or Senior Dental Students be funded by the Student Loan Fund if the current income permits.

Received as information only a recommendation that a budgetary category be established for expenses incurred by officers and/or Executive Director for social functions and entertainment of dignitaries or special guests in an official capacity.

Received as information only a recommendation that an additional budgetary line item for conference call expenses will be implemented.

Approved a recommendation that all standing committees who are requesting funds from the VDA submit their budgets or financial requests to the Budget and Financial Affairs Committee in writing at least 60 days prior to the June Committee meeting and defend those requests at the June meeting at the request of the Budget and Financial Affairs Committee.

Approved a recommendation that the Executive Committee approve expenditures exceeding budgeted amounts of the VDA's annual budget during the interim period between passage of the annual bUdget by the House of Delegates as a matter of checks and balances.

25

'to include 'ibeVOA office

'ent'and/or

ID eceiv~d': form. ,.con:lI'T1 datiCinthatthe\/'DA explore the possi~i1ity of extendtns VDA membership to ASDA

',ru3mbers'aftheNCUlMCYScl1001 ofOentistry, to stimulate early membership and maintain a roster of future members. The ./'.<~assachusetts Dental Society program should be used as a model.

THEREFORE. BE IT RESOLVEDth~(~ Dental Hygienists (HB12BO). '.

~ ~ ,..

}i"opposed to the administration of local anesthesia by

26

Approved a recommendation that the present funding of $2,500 for the VDA-MCV Freshman Dental Class Luncheon be continued as a line item of the VDA Scholarship-Loan Fund Account

Referred to the Budget and Fiscal Affairs Committee a recommendation that.funding ~e p.rovided for an annual fun~tion for each of the Sophomore and Junior classes in the form of a lecture and reception as a line Item m the VDA BUdget with an estimated additional cost of $750 for each function.

Referred to the Budget and Fiscal Affairs Committee a recommendation that adjunctive funding be provided for an annual function for the Senior Class in the form of a picnic/golf event, presently sponsored by the Richmond Dental Society.

Defeated a recommendation that the tuition fee for the VDA-sponsored CE programs be increased to $40 per person.

Defeated a recommendation that the CE budget be increased by $12,000 to establish a pilot regional quality continuing education course.

Approved a recommendation that the VDA not support the ASOA request for funding of $500. The VDA will provide a direct grant of $500 to the MCV ASDA for attendance at the ASDA Regional Meeting.

Received as information only a recommendation that the VDA support the use of mouth guards to prevent sports related injuries.

Received as information only a recommendation that the VDA support the use of preventive measures for the prevention of dental decay, including the proper use of topical and systemic fluoride supplements, community water fluoridation, and dental sealants.

Received as information only a recommendation that the VDA acknowledge and support the Division of Dental Health in the celebration of the 75th Anniversary of Public Health Dental Programs in Virginia since 1921.

Approved a recommendation that the contract of the insurance consultant, Sam Rosenthal, be renewed.

Approved a recommendation that a letter be sent to Insurance Commissioner Foster on or about the first of April regarding the actions of the Acordia Company and Mary Bowman Telfer.

Approved a recommendation that the VDA appropriate $500 to support activities associated with the recognition of 75 years of Public Health Dentistry in Virginia.

Defeated a recommendation that the VDA survey the membership regarding the availability of dental hygienists in each dentist's area.

Approved the following Policy Statement: WHEREAS, it is prohibitive from an educational standpoint for hygienists to adhere to the ADA educational requirements for administration of local anesthesia which would include instruction in Biochemistry, Anatomy and Physiology, Pharmacology, and clinical practical training; and,

WHEREAS, this bill will not enhance the quality of health care delivery in the Commonwealth; and,

WHEREAS, this does not address a current health care need in the Commonwealth; and,

W HEREAS there are significant potential~i<J\tBs.CuI8r,cerebraland p ..u...1.·.monary sequela associated with the admini t t· , .. ." .-- 1---d '. . IS ra Ion of local anesthesia especially those ~~g;~7!~~'"c ~~~~~gs. . .

8.QProved a recommendation that Article I. Membership. Section 1. Subsection D. shall read:

Life members shall be those who have been active members in good standing of a constituent society of the American Dental Association for 30 consecutive years, or a total of 40 years, (membership in the National Dental Association prior to 1975 accepted) or a member having attained Life Membership in the American Dental Association, and having attained the age of sixty-five (65) years.

Approved a recommendation that Article I. Membership. Section 1. Subsection C. shall read:

Honorary Members shall be those practitioners of dentistry or medicine and others who have made valuable contributions to the science of dentistry, or those whom this Association deems to honor. The surviving spouse of a member dentist may be included in this category.

Referred back to the Institutional Affairs Committee for further clarification, the recommendation that Article VIII. Section 2, B. Specialized Standing Committees; 4. Institutional Affairs Committee a. Membership: shall read:

The Committee shall consist of one representative of each State institution including each mental health hospital, the Dental Division of the State Department of Health, the State Department of Corrections, the Department of Youth and Family Services, VCU/MCV School of Dentistry, UVA, and four members-at-Iarge appointed to serve four (4) year terms on a rotational basis. All representatives shall be approved by the President of the Association.

b. Duties: shall read:

The duties of this Committee shall discuss issues of quality care and make recommendations concerning dental care for all State funded institutional persons and previously institutionalized mental health, mental retardation and substance abuse services patients including those persons eligible for public access dentistry.

• roved a policy statement that the VDA Peer Review and Patient Relations Committee will work to adopt the ADA Peer Review Manual but the Committee feels that definite amendments will have to be made.

efeated a policy statement that mandatory cooperation with the Peer Review System should be a prerequisite for membership in the Virginia Dental Association.

roved a policy statement that confidentiality of Peer Review records is best maintained at the Component level. Data on cases shall be reported on a biennial basis.

efeated a policy statement that referring to Page 7, of the ADA Peer Review Manual, the Committee will review cases involving fee disputes.

roved a policy statement that in regard to non-VDA members, the Committee feels that it is appropriate to mediate for members only. Non-members will be informed of complaints received and they will be informed that VDA membership is open to them.

roved a policy statement that voluntary cooperation with the Peer Review System should be encouraged.

efeated a recommendation that a survey be developed to be distributed to the membership regarding the method of voting for elective positions at the VDA level.

roved a recommendation that the VDA endorse Benefits Administration, Inc. for the administration and promotion of Direct Reimbursement subject to: a) A favorable review of their financial profile; b) Discontinuing other DMO plans; and c) Ownership of data by the VDA.

roved a recommendation that the VDA release the $10,000 for one year unconditional membership in the ADRP as soon as possible....

27

Gladys and Ron Tankersley, Pat and Bill Zepp and Dan Grabeel visit the Capitol. (photo by Jocelyn Lance) prepare to

1".. ,I

~1'H~fi~E!SJJ,eaker Newt Gingrich speaks to the Public '~~tfa!rs Conference. (photo by Jocelyn Lance)

ong~~ss. Despite oprnrons expressed by Speaker Gingrich and others that HR 2400 would not pass this year, the Tuesday visitations resulted in seven new cosponsors for the bill, including Rep. Tom Davis (R-VA).

If you are interested in receiving information regarding future sessions of the Public Affairs Conference, or would like information regarding the newly revitalized Grassroots Program in Virginia, please contact VDA Public Affairs Coordinator Lisa Finnerty....

VDAGoesto ~ 'a ltol .Hlll

,,"' , ',',", '"" , and .. """,,' ,sodetystaff members from

l'r6ughout the United States attended this year's session at the Capital Hilton. The Virginia contingent included the entire Executive Committee, the Chairman of the" Legislative Committee, selected VDA staff members, as well as several individual members. AADA Legislative Director and member of the ADA Council on Governmental Affairs, Jocelyn Lance, and Dr. Dave Whiston, ADA Sixteenth District Trustee, were also in attendance. During the January

Norwood (R-Georgia) is one of three dentists serving in the 104th

28

Committee Meetings, the VDA Executive Council determined that the Association should have official representation at the ADA Public Affairs Conference.

On Tuesday, March 19, the VDA delegation visited each Virginia Member of Congress in their Capitol Hill offices. Discussions focused on the OSHA reform bills introduced in last year's session, military dentistry, antitrust relief, malpractice reform, and Rep. Charlie Norwood's Family Health Care Fairness Act, HR 2400. Dr.

prll thirteenth over 200 "scientists from across ia represented their '.' nities at the Eleventh ttl Virginia State Science & :ering Fair held in 'on. VDA participated in nand awards presentations

of the newly formed Science Talent Awards , (VSTAP).

purpose of VDA's ent and representation te Fair is to promote an

'among Vlrglnla's youth try and dental research s: Recognition of these norrvated students by

dentistry comes at a 'h they are exploring ions.

re drawn from MCV's f Dentistry and VDA lp, Their task was to winners from thirteen

categories based on cellence as evidenced search, presentations

stlve interviews. After ""five hours of judging 5TAP winners were

~nson, VDA President­, nted the Association's (Iring an impressive , Many of the VSTAP

t on to win first place Fair's categories and ,aureen Drohan of gfield High School r's Grand Prize.

Ms. Drohan's project was titled "The Long Term Delivery of Antibiotics to Disease and Infection".

Treat Chronic

Menier's Bone

She employed fibrin as a sustained release vehicle to deliver tetracycline and gentarnydn to sites of intraosseous infection. This VSTAP winner will represent Virginia at the International Science & Engineering Fair to be held this May in Tuscan, Arizona.

The Virginia Dental Association is privileged to have participated in the Virginia State Science & Engineering Fair and extends its best wishes for success to each and every one of these remarkable young scientists.

Tim Russell, DDS

Dr. Omar Abubaker of Mev's School of Dentistry interviews young scientists competing for VDA's Science Talent Award at the Fair.

29

I -------- ---------,

1996 Legislative Update j.~-----~--

The 1996 Virginia General Assembly Session was the longest on record. The ordinary sixty day session was extended to sixty-two days through powersharing in the Senate and extensive budget deliberations. VDA Lobbyist Chuck Duvall and Public Affairs Coordinator Lisa Finnerty lobbied and monitored numerous bills of interest to dentistry during the course of the session.

House Bill 1280, introduced at the request of the Virginia Dental Hygienists Association by Delegate Dick Fisher (R-Vienna), would allow dental hygienists to administer local anesthesia under the direction of a licensed dentist. This administration could take place after the hygienist had completed a training program prescribed by the Board of Dentistry that included instruction in the administration of local anesthesia.

VDA actively opposed this measure, which was carried over in the Health, Welfare and Institutions Committee in the House of Delegates until the 1997 Session of the Virginia General Assembly. All members of the HWI Committee were contacted by a dentist either in Richmond or in their local districts; and the vast majority of the legislators shared the concerns of the VDA regarding the implementation of such legislation.

VDA opposition to this measure was based upon the following facts: -The administration of local anesthesia is an invasive, nonreversible procedure. -Dental hygienist preparatory education and clinical training have not adequately trained them to administer local anesthesia.

-Contlnued medical assessment during the administration of local anesthesia is necessary to recognize and treat local and emergency situations.

Since the measure has been carried over to the 1997 Session, it is vital that the VDA representatives meet with members of the HWI Committee During the intervening months and discuss with them our concerns with regard to HB 1280.

HB 1393, patroned by Delegate Ken Plum (D-Reston) was introduced at the request of Virginians for Patient Choice, the coalition for patient choice. This coalition, in which VDA actively participated, consisted of a variety of provider groups united to provide effective and enforceable protection for consumers in the Any Willing Provider Statute.

Important provisions within HB 1393 include: -HMO's or insurers creating a network must notify the Department of Health Professions that a

network is being formed. Providers will have access to this information and have a chance to apply for participation in the network.

-HMO's or insurers are required to provide an application for participation to any provider requesting it.

-HMO's or insurers may not deny participation to provider based on gender, race, age, religion or national origin.

-HMO's or insurers must notify patient when his or her primary care provider is terminated from the network. The patient may continue to receive service from that primary care provider for a period of 60 days unless the provider is terminated for cause.

-Provlders must notify their patients when they voluntarily terminate their contract. -HMO's or insurers must notify provider 60 days in advance of any termination unless the

termination is for cause. -HMO's or insurer must disclose to purchaser any financial arrangement that affect the amount or

quality of health care service that can be provided. -HMO's or insurers may not require provider to waive legal redress against them. Though this measure has been passed by both Houses of the Legislature, it is imperative that the

Governors office hear from members ofthe VDA advocating his signature.

30

At the request of the Virginia Dental Association, Delegate Butch Davies (D-Culpeper) introduced House Joint Resolution 8/. This resolution, which has been approved by both Houses of the Legislature nd does not need the Governor's signature to be implemented, will establish a joint legislative study (study

aonsisting of legislators from both the House and Senate as well as private citizens) to review the availability of dental hygienists across the Commonwealth. Areas to be considered in this study include:

1. Determine the availability of dental hygienists throughout Virginia. 2. Review the Commission on Dental Accreditation Standards applicable to alternative accredited

educational programs in dental hygiene which parallel existing programs. 3. Determine the possibility of existing funding and approved programs to make available additional

educational opportunities to those that desire to become dental hygienists. 4. Consider ways, initiatives and programs which will encourage and make available additional

hygienists in rural and underserved areas. Composition of the study will include 4 members of the House of Delegates, 3 members of the

enate, a representative from VDHA, a representative of the VDA, a citizen at large, a dental hygiene ducator, and a member of the Board of Dentistry. . It is vital that VDA participate actively in this legislative study and provide all pertinent information

make certain that the study produces positive results.

At the request of the VDA, language was inserted in the biennial Budget requesting that the ommissioner of Health study the availability of current dental health services being provided and make ommendations for enhancing these services by working with representatives of the VDA and other

:(fessionalgroups practicing dentistry. ff The Commissioner is to report his findings and recommendations "the Governor and Chairmen of the House Appropriations and Senate Finance Committees by the

mencement of the .1 997 General Assembly Session. This language amendment to the Budget was introduced in order to review the current dental

.ices being provided under the Department of Health and to see if options are available to get an even er "bang for the buck" by working actively with VDA components, professional groups and practicing tlsts all across the Commonwealth. These Budget amendments were introduced by the respective irs of the Health and Human Resources subcommittees in the Senate and House - Frank Hall (D­,mond) on the House side, and Senator Joe Gartlan (D-Fairfax) on the Senate side.

House Bill /482 was introduced at the request of the VDA by Delegate Vince Behm (D-Hampton). measure adds dentistry to the Virginia Procurement Act under the definition of Professional Services.

Though dentistry had been included under Medical Services, this will make it clear that, as with cine, dentistry is also to be listed as a professional service. . Delegate Frank Ruff (R-C1arksville) introduced HB 826, which would delete the current requirement

post-course examination be given as evidence of satisfactory completion of an approved continuing tion course. This measure was carried over in the Senate Education and Health Committee until the Session of the General Assembly.

\ All measures, with the exception of resolutions, which have been approved by both Houses of the lature must be signed by the Governor before they take effect. The Governor has until April 8,

.6, to sign these measure. If any of them are amended or vetoed, they will be reviewed by the General mbly when it reconvenes in Richmond on April 17, 1996, for their Veto Session.

Measures without emergency clauses signed by the Governor take effect on July 1, 1996.

POOR RESPONSE ON HB 1393 JAny Willing Provider petitions and Intent To Participate forms were sent to the entire VDA onses were received from only 105 doctors. Dentistry does owe a sincere thankyou to these 105

",,s!~specially to VDA lobbyist Chuck Duvall. However, a 4 % response rate does not indicate legislative ~Jn any way guarantee legislative success.

31

WHY A DIRECT REIMBURSEMENT PLAN?([ JJ Direct Reimbursement is a simple, Cost-effective method for employers to provide dental health care benefits to their employees. Whether the company is large or small, these self-funded dental benefit plans can be designed to employer's specifications. DR plans have been proven to save employers money when compared with traditional dental insurance plans.

What Are The Advantages Of A DR Plan?

Freedom of Choice: In a Direct Reimbursement plan, employees are free to choose their dentist without being forced to choose from those on a provider list.

The dentist and the patient determine the treatment plan without limitations imposed by insurance companies.

Flexibility: Flexibility of plan design allows the employer to control the level of benefits in the plan. An employer may choose to include deductibles and/or an annual maximum benefit.

Costs: Plan cost is based on actual dental expense incurred, not on premium payments made, regardless of usage.

Administration: An employer can choose to have a third party administrator (TPA) administer the plan, or elect to self-administer the DR plan. Either way, administrative costs are far less than with a traditional dental insurance plan.

...................................................................................................................................

Benefits Administration/ Inc. (OAf) administers Direct Reimbursement Dental Plansand

Section 125 Cafeteria Plansin four states and the District ofColumbia.

BAI has received [he endorsement of the American Association ofOrthodontists to market

and administer their Concept DR dental reimbursement plan.

e Virginia Dental Association endorses BAI as the sole administrator to market DR plans in Virginia.

How Can You Participate In Promoting DR?

First, educate yourself about the advantages of Direct Reimbursement. Secondly, talk with your patients about their dental benefits plan. Each day you are in contact with patients, business organizations, and neighbors; among this group of people you probably know at least one business owner or human resource manager for a business. These are the individuals who are making the insurance purchasing decisions for their business or company. Your role is to help us to identify those decision makers whom you feel will be open to discussing the benefits of DR.

If you are able to provide a referral or have a contact who would like more information about Direct Reimbursement, please contact anyone of the individuals listed below:

Connie L. [ungrnann Assistant Executive Director Virginia Dental Association

804-358-4927 800-552-3886 (toll free in-state)

804-353-7342 FAX

CP. Coyner, Benefits Consultant Benefits Administration, Inc.

804-320-4500 804-379-3509 FAX

Jon L.W. Swan, Benefits Consultant Benefits Administration, Inc.

804-378-6206 804-379-3509 FAX

------------------------

.. ViI"g!niC3._~enta!Association Speaker's Bureau With your assistance, the Dental Health and Public Information Committee of the Virginia Dental Association is developing a list of those member interested in participating in a Speaker's Bureau.

Please take a moment to fill out this questionnaire.

Name: Address: __ Your VDA Component: ­Office Pllc:>I1:e:(J }:fc:>:rtl.~ :F>1:l()11.~_:(.) e-mail : X¥:< J

List presentations for 1996-1997: Topics:

A. Presentation to: Pre-schools: Primary schools; -'­Secondary schools: -..-- .. ­Colleges: ..

B. Continuing education seminars given to: Dentists: Dental Assistants: Dental Hygienists:.-.. . Physicians: Nurses: EMT's:

c. Community Dental Health Seminars: Lamaze Classes:---------- -----.--- ... -­Parent Workshops:- .. ---­PTA's: ......- .-.-. Geriatric Groups:. . Other, please specify:

D. Any other topics or groups not mentioned:

Please photocopy and return your cornpteted questionnaire to the VDA Office, PO Box 6906, Richmond, VA 23230.-0906

33

Pilot Survey of Dentists from the Division of Dental Health/ Elizabeth Bernhard, DMD, Director

1996 marks the 75th Anniversary of Public Health Dentistry in Virginia. The continued success of our Dental Clinic Programs in seventy-nine Local Health Departments can be attributed in part to the support of private practice dentists.

We are developing a display which we will circulate throughout the Commonwealth from July 1996 through July 1997 to recognize the accomplishments of Public Health Dentistry. As part of the display we would like to include a list of dentists who have worked in Health Department dental programs in the past. Please take a few moments to complete the survey below so that you may be included in the recognition of the partnership between the private practice of dentistry and dental public health. (Even if you have not participated in public health programs we would appreciate your returning this survey.)

The questions below the dotted line will serve to provide important information regarding the delivery of preventive services in Virginia and will not be associated with your name for any reason. Thank you for your assistance.

Have you worked in a Health Department Dental Program in VA? Yes No

Ifyes, which Health Department and what year? _

Please briefly describe your experience with the health department.

Ifyou worked in a health department, may we include your name in the display? Yes No Name (as you would like it to appear in the display)

Year of Graduation and Place of Graduation from Dental School

Date of Birth VDA Component --- - --------- Specialty Were you a rural dental scholarship recipient? Yes No Is your current practice location rural? Suburban? _ Did you participate in a Dental Public Health Extramural Rotation? Yes No If yes, which Health Department did you work with and do you remember the superVising dentist? Health Department------------ - - -Supervising DentisL_________ _ Year-----­Please briefly describe your experience.

Do you know the Public Health Dentist in your county? Yes No Do you refer patients to the Health Department for care? Yes No ~,CARf_(:

'O ()~Have you participated in a fluoridation hearing? Yes No ~ ('\

Do you prescribe fluoride supplements? Yes No ~ '7.I.IJ :: 0::: ~ 0Does your practice recommend sealants? Yes No Q, 1921-1996 ~

DENTAL PUBLIC HEALTHDo you participate as a Medicaid Provider? Yes No Other Comments:

Please photocopy and return your completed questionnaire to the Division of Dental Health, PO Box 2448, Richmond, VA 23219

• 34

A\D)A. @) _ World Dental Congress

September 2S-october 1. 1996

Orlando 9fl

Dr. Douglas C. Wendt, Springfield, Virginia, was named President-Elect of the American Prosthodontic society at its recent 68th Annual Scientific meeting in Chicago.

Dr. Wendt, whose current practice is limited to prosthodontics, served in the U.S. Army, 1942-1945 and was a Major, U.S. Air Force Dental Corps, 1946­1954, Command Dental Surgeon, Military Air Transport Service.

His teaching service includes Professor, Military Science, University of Oregon; Professor, Prosthodontia, University of Oregon; Senior Consultant and Lecturer, U.S. Naval Dental School, Bethesda, Maryland, a position he currently holds, and Professorial Lecturer, Georgetown University, Washington, DC.

Dr. Wendt is a member of many professional organizations and is a Diplomate of the American Board of Prosthodontics and a Fellow of five other groups. He is Past President of the Northern Virginia Dental Society, Southeastern Academy of Prosthodontics, Virginia Dental Association, Federation of Prosthodontic Organizations, American Board of Prosthodontics, Academy of Denture Prosthetics. In addition, he has held committee and program chairmanships in scores of other groups. He has been active in post graduate course presentations, research, lectures and clinics, many of his articles have appeared in professional publications.

Dr. Wendt resides with his wife, Josephine Bullis Wendt, in Springfield, Virginia, and will be installed as president of APS at its 69 th Annual Scientific Meeting in the Hyatt Regency, Chicago, February 20-22, 1997.

35

Component News "J"'------------

Dr. Barry Einhorn Tidewster. I

All of us in Tidewater are anxiously awaiting the disappearance of the snow and the return of spring. As a harbinger of the new season we will be holding our joint spring meeting with the Peninsula Dental Society of April 11 and 12 at the Holiday Inn, Chesapeake. On April 11 Dr. Daniel M. Laskin will present "Newer Concepts in the Management of Temporomandibular Disorder." On April 12 Dr. Kenneth Shay will discuss "Older Patients: Clinical Challenges and Practical Approaches." Call Ginnie Donne for information at 491-4626.

In a recent edition of the Eastern Virginia Medical School newspaper, Dr. Bruce Barr was cited for pioneering a program of training first year medical students in the diagnosis of dental disorders. It is surprising to learn that this program is unusual among the nation's medical schools. Component I is proud of its members who recently and in the near future will be volunteering their services in overseas dental clinics. Calvin Belkov, Eugene Kanter, Sonny Lefcoe and Barry Einhorn either have, or will be working in a clinic in Pardes Katz, Israel. Marshall Brownstein of Component IV will also serve the clinic. The champion of all overseas volunteers is Jack Atkins, who for years has been quietly traveling to third world countries to treat indigent patients.

We mourn the loss of two colleagues: Samuel Buxton and Ernest L. Bayton, Jr..A.

Dr. Cory Butler Peninsula, II

As Spring turns into Summer we draw closer to the VDA Annual meeting which will be held at the Williamsburg Lodge and Convention Center in Williamsburg from September 18 ­22. A wonderful meeting is in store for the entire family; remember there are mandatory continuing education requirements (15 hours per year) and a majority of these hours can be acquired at this meeting. Speaking of meetings, a thank you to all who attended the joint CE program with Tidewater on April 11 and 12; both Dr. Laskin and Dr. Shay gave interesting talks; prior to this program our component had a presentation and open panel discussion on "Endodontics" by Drs. Ken Mello, Bill Trimmer and Fairfield Ward. Our January 8 meeting was canceled due to weather and has been rescheduled for April 22 at the Onmi Hotel, Newport News; Dr. David Sarrett from MCV will speak on "CAD-CAM Restorative Dentistry". Special thanks go out to Dr. Fabienne Morgan, our CE Chairman, for a job well done. Our component has been busy this past Spring continuing to work on Direct Reimbursement by identifying more business contacts that may be interested in this fantastic benefit package. On the local level, Dr. Jeff Kenney continues to develop a "Grass Roots" campaign by making our local dentists more aware of the issues

currently being considered by the VA General Assembly and Congress and identifying legislative contacts in our geographic area. It is important to become involved; together we can make a difference. On the state level Mr. Bill Zepp continues to make improvements that are certainly evident, especially in the legislative area. Congratulations should go out to him and his staff for all their efforts in the 1996 VA General Assembly, specifically in reference to the "Any. Willing Provider" issue. If you have any questions regarding what the VDA is doing for you, please do not hesitate to call the VDA office at (804)358­4927.

Mr. Zepp, we look forward to working with you in the years ahead.

Don't forget the VDA Committee Meetings in Virginia Beach on June 13-16.

As many of you know, the VDA endorses Dr. David A. Whiston for ADA president-elect in 1996. Dr. Carr writes, "he is the one candidate who brings the commitment to responsible leadership that both the profession and the position demand." I encourage your support of Dr. Whiston in his endeavor, whether that is monetarily or otherwise; contact Mr. Zepp for more information on how you may help. Finally, we would like to welcome the newest member of our component, Dr. Curtis Henley, Jr. who practices in Grafton. .A.

36

r. ReedBoyd. III outhside Dental Society, III

ow, have we had a winter! The hole state has been snowed under nd down here in Southside Virginia e have been plastered. We have

eceived about 30 inches of snow and ther areas of the state had a lot ore, but our area doesn't deal with.

'now well at all. We usually get It and 'eep it for only a few hours and then Verything returns to normal. If it .... ys longer, we do not have the 'uipment to move it or extensive pplies of chemicals to melt it. Since e do not normally get much snow e do not allot substantial budgetary sources to snow removal. For

xample, the snow storm back in anuary closed most school systems or TWO weeks. Dentists report issing an entire week in the office, me a little longer. The second snow arm was almost as bad. Most chool systems have missed anywhere r 14-16 days of school and are now ~estling with options to make up ose missed days. My wife, a school acher, and our children went to hool on a SATURDAY! Other turday make-up days are scheduled om now through April.

hrough it all, dentistry has still been oing on in this area. During ebruary, the Southside Dental ociety dusted off the tried and true 'health fair at the mall" idea. On ebruary 24 we held the "Dental xtravaganza" at Southpark Mall in olonial Heights. MCV brought the ental Van loaded with students to

help do oral health and cancer screens, as well as, pass out information to interested people, people that might make dental PATIENTS! Thanks to Dr. Frank Farrington and the students at the MCV Dental School for their efforts and help!

The Alliance to the Southside Dental Society had a display on the effects of smokeless tobacco on the oral structures. It was amazing to listen to the "oohs" and It ahs" of the people once they saw the effects that tobacco can have on one's mouth. Of course, there were the non-believers and those who make their living with tobacco. This part of the state produces a lot of tobacco on large farms and, of course, Philip Morris is a large employer in this area, so this is a two-edged sword. Dentists here have to educate patients on the hazards of tobacco use. Thanks to Barbara Yandle for her efforts in coordinating the Alliance!

The Dental Division of the State Health Department was represented at the Mall. They are celebrating their 75th

anniversary of service in Virginia. They had several displays to educate the public both about the Public Health Department and dental health in general. Joanne Wells, R.D.H. was the contact person and very helpful in putting together the Health Department's exhibit. We are investigating a public school dental health program which would involve the schools, the Southside Dental Society, the Public Health Department and the MCV Dental Van. This program has proven very successful in Dinwiddie County and we are looking to expand into the City of Petersburg and other areas. Many thanks, Joanne! Of course, there were members of the Southside Dental Society present to answer questions and offer support. We had child identification kits complete with pictures and a

toothbrush swap. This event provided exposure to the public of many aspects of dental health that were new to them. It also provided us a chance to introduce ourselves, COLLECTIVELY, to the public in a non-threatening and safe environment. If you have a "busyness" problem, this is a good project to get involved with. Sam Galstan and Mike Hanley were the leaders of the dentists' efforts. Thanks Sam and Mike!

The Virginia Dental Association has appointed an Ad Hoc Committee to study Election Reform. Les Webb, of Richmond, is the chairman. The committee is looking at all aspects of the election process within the VDA. If you have any comments, please contact your component's representative on that committee, Les or me.

Dr. John Bass of South Hill has gained an outstanding honor. John, an avid runner and bike rider, has participated in several marathons and competed in several long distance cycle races across several western states. These competitions involve riding several hundred miles through all types of weather and conditions. Recently, John had an accident and suffered a wrist injury, requiring surgery and extensive rehabilitation and reducing his time in the office. John has been active in the civic affairs of South Hill. For years, he has been involved with the Chamber of Commerce. He and his wife were instrumental in putting together an oral cancer screening there last year. For all his efforts and dedication, John was recently chosen to carry the OLYMPIC TORCH on its journey through Virginia on its way to

37

( Component News, cont.) Atlanta. Congratulations, John, what a tremendous and exciting honor! I am really looking forward to seeing the Torch and especially seeing John carry it. If you know John, you know that this is an honor he richly deserves. Another good example of a dentist, dedicated not only to his profession but also to the community he serves.

Our Continuing Education course is scheduled for June in Emporia at the same time as the Pork Festival. The VDA Committee Meeting are schedule in Virginia Beach that same month and, of course, the Annual Meeting of the VDA is set for Williamsburg, September 18-22. Please come, you will enjoy the fellowship, the learning> and the happenings of the VDA. Hope to see you there! ..

Dr. Cary R. Hartwell Richmond Dental Society. IV

As Spring draws to an end there are many worthwhile committee activities to report. The Dental Health, Public Information and Community Involvement Committee under the very capable leadership of Dr. Shari Ball has sponsored dental health fairs at both the Science Museum and Children's Museum in Richmond. This committee obtained a signed proclamation from both Governor Allen and Richmond Mayor Young

announcing National Children's Dental Health Month. There were also projects to update the dental health video library and to provide dental educational material to ten area elementary schools determined to have the greatest needs for this type of information. In conjunction with the Richmond Dental Society Alliance, a wonderful new production of the Children's Puppet Show has been presented at numerous schools and dental health fairs.

The Committee on the New Dentist chaired by Dr. Russ Mosher, Jr. has also been most active. The "Real World Tour" of local dental offices by senior dental students was a huge success and plans are to expand the program next year. On March 28 Dr. Mosher and VDA Executive Director Bill Zepp presented the ADA Transition Training Seminar at the Dental School. The VDA New Dentist Committee and the ADA Staff will alternate years on presenting this important new ADA program. This committee was again responsible for an outstanding afternoon of Golf and Tennis followed by an evening cookout on May 17 to honor MCV's graduating senior dental students and their families.

Recommendations from the Long Range Planning Committee (Dr. Anne Adams, Chair) will provide the guidance needed by the Society to move forward into the 21 st century. The success of our participation in the ADA Field Service Program demonstrates the ability of our organization to recruit outstanding dentists who will be capable of providing leadership in the future. All goals with regard to recruitment, decreasing nonrenewal rates and increasing market share were exceeded in this program.

Have a great summer! May you return in the fall with renewed vitality and dedication to the dental profession.....

Dr. Edward P. Snyder Piedmont Dental Society, V

As this issue of the Virginia Dental Journal is published we, in The Piedmont Dental Society, will either soon be attending or just experienced what I expect to be/was an excellent continuing education program on "Practice Building with Quality Periodontics and Restorative Dentistry" given by Drs. Maynard and Wilson. The program was scheduled for Friday May 31, at the Roanoke Marriott.

If you noticed in the previous edition of The Virginia Dental Journal, one of our own, Dr. Jesse Wall, had a case report published concerning the "Treatment of a Habitual Smoker Using Nicotine Gum: A Case Report". Please review this excellent case report, and if anyone in our component has something that they would like to publish, please contact me at the address below. I hope everyone has a safe and fun summer. Ed "Chopper" Snyder 15 Cleveland A ve"/ Ste. #6/ Martinsville/ VA 24112 ...

38

Graham Hoskins 'lIthwest Dental Society, VI

gust 16 will be the date of the nual Abingdon meeting at the rtha Washington Inn. The akers will be Dr. John P. Kennedy

"d Dr. Lynn D. Mouden on entistry's Role in Preventing Child 'use and Neglect." This meeting is ed to coincide with the local

ghland Crafts Festival which offers usual shopping and browsing portunities. The Barter Theatre is t across the street •from the rtha Washington Inn and makes for enjoyable stay.

',j

e Fall meeting will be Nov. 15 at .... Donaldson Brown Center at Va 'eh in Blacksburg and the speaker Ii be Dr. Valerie Beecham and the ic will be Pharmacology.

,e component welcomes Dr. William ~nley of Lebanon into Retired Life embership and welcomes the Ilowing members into Life embershlp: John Kelley of Bristol, ne Rorrer of Abingdon, and lIiam Stanton of North Tazewell.

e Southwest Component also notes th sadness the death of Dr. Walter

,ierce of Bluefield.

omponent member Wally Huff eeds our help in running for resident-elect of the VDA. The ection will take place at the state nvention in September in iIliamsburg. The Southwest omponent will sponsor a hospitality om at the Williamsburg meeting and eryone is welcome! ....

Dr. William C Bigelow Shenandoah Valley Dental Society; VII

Having survived the "Blizzard of '96" and in many areas broken records for total snowfall, Component VII is ready for a beautiful spring.

Raleigh Watson, past President, Bill Vigilone, Counselor, and officers Ed Amons, Ted Sherwin, and Jerry Brown, have kept busy with several meetings, and many FAX and phone calls. The purpose of these meetings was to plan for some great CE , increase membership and retention, and to increase our component's contributions to ADPAC and the Commonwealth Club. Also discussed was the need for a part-time Executive Secretary for our component, and a leadership conference.

Component VII is honored to announce Linda Miles on September 13, at the Sheraton Inn in Charlottesville. Mrs. Miles will speak on "The Art of Selling Dentistry". Additional information may be received by calling Jerry Brown at (540)667-8165. Component VII was very proud to have Parker Mahan, DDS, PhD, as our featured speaker on April 26 at the Sheraton Inn, Harrisonburg.

Component VII members, please don't forget how important your continued support of ADPAC/VADPAC and the Commonwealth Club is to the future success of our dental profession. Call

Jerry if you're unsure of your current contributions.

Shenandoah Valley Dental Society would like to welcome new members: Ann Marie Pawl, Mark Friedlander, and Vincent Albert. ....

Dr. Bruce ~ jay Northern VA DentalSociety. VIII

Having endured one of the most difficult winters in many, many years we are very pleased to be welcoming spring back to our area. Please mark your calendars to join us for an evening CE presentation on Wednesday, May 15 at 6 p.m. entitled: "Plastic Surgery and Dental Cosmetics" presented by Dr. Derrick Antell. The program includes dinner and will take place at the Fairview Marriott in Falls Church. The Northern Virginia Dental Society mourns the passing of Dr. Raymond G. McGehee on March 10, 1996. Born in Clifton Forge, Dr. McGehee attended VMI and received his dental degree from MCV in 1948, graduating first in his class. In 1953, after three years of Army service, he established his practice in Arlington. An avid artist and photographer, Dr. McGehee was a co-founder and director of Art Recollection, Inc. He is survived by his wife of 48 years, Gay Ellett

39

McGehee of Arlington, six children md seven grandchildren. ::::omponent VIII warmly welcomes :he following new members: Drs. '1arjun Ayati, Joseph J. Buchino, Jma M. Chaudhari, Jeffrey S. Clark, >aul P. Couture, Allen S. Garai, -Ierschel L. Jones, Townes Lea, III, '1aggie Lee, C1ementina Perez-West, ;herry Sayadian, Michael S. Song, .ana Soules, Eddie R. Stallings, Linh r. Tran, Kenneth VanStalen, and effrey D. Wagman. ...

Mev Notes

Assistant Dean for Continuing Education

ADA Accreditation Team Reviews

In March, the School of Dentistry underwent a review of its educational programs and administrative processes by the American Dental Assoclation's Commission on Dental A..ccreditation. The site team was :omposed of fifteen members who "eviewed the DDS and advanced irograms with the exception of oral ;urgery and AEGD which have .eparate accreditation schedules. I\.lthough the official report from the tte team will not be received until I\.ugust, the draft report indicates 'ery few recommendations for mprovement. The report also :ommends the School for mprovements implemented since the ast site visit in 1988. n important aspect of the :creditation process is a self-study mducted by the faculty which

highlights both strengths and weaknesses of the dental school. MCV/VCU was the first dental school to submit the narrative of this report on computer disk. This report, which usually requires volumes of paper, was reduced to a computer disk and one paper document of appendices. This unique method of submission earned the School one of its commendations. By providing the report on disk, the site visitor could quickly access information while meeting with faculty. It also provided them instant access to background data to assist them in writing their individual reports.

Saravia-Kendall Jamaica Project Marks 10th Anniversary

This month marks the tenth anniversary of the Medical College of Virginia's participation in the Joint Dental Schools' Jamaica Project. In April of 1986, the late Dr. Mario Saravia took a group of six junior dental students, two oral surgeons, two general dentists, a pedodontic resident, a dental hygienist, and his wife, Eileen, to rural Jamaica to work in various location. They provided care to many children and adults in the central highlands known as Christiana utilizing clinics, schools, and churches. The conditions were extremely primitive and the resources scarce, allowing only extractions to be done. Mario and Eileen spent most of the time attempting to coordinate limited personnel and insufficient supplies with an overwhelming need at five remote treatment sites. Thanks to the sponsorship and support of Mr. Leonard Kirby, a Jamaican Minister of Parliament, that first trip succeeded against tremendous odds.

Since 1986 more than 250 dental students, faculty and auxiliaries have treated over 8,600 patients through

the Jamaica Project. Each year 10-12 dental students pay the costs of their own airfare and meals to participate in this once­in-a-Iifetime experience. These students also participate in fund raising activities throughout the year to pay for needed equipment and supplies to maintain the project. Due to the students' devotion and the generosity of patrons and faculty support, the vision of Mario Saravia and Mercedes Kendall has survived curriculum changes, budget cuts, hurricanes and even the untimely death of both of these visionaries. The project was recently renamed the Saravia-Kendall Project to honor their memories.

During the past ten years, the project has made many gains. In 1987, Mrs. Mercedes Kendall became the chief Jamaican sponsor of the project. She provided food, lodging, transportation and a home base for the project in Duncans, Trelawney. Also in 1987 the University of Minnesota and Louisiana State University joined the project, allowing for more continuity of treatment. Equipment from the old Wood Clinic and Lyons Clinic were refurbished and installed in the Long Pond Health Center to provide preventive and restorative dentistry along with emergency care. The MCV/VCU faculty became, and continues to be, veteran participants and consistent supporters of the project. Full-time faculty members who have provided their time and talent to the project include: Dr. Robert Barnes, Dr. Michael Dishman, Dr. William Brokaw, Dr. Gilbert Button, and Dr. Carol Brooks (from the

40

Department of General Practice.) Dr. Omar Abubaker, Dr. Robert Campbell, and Dr. Louis Mercuri, (from the Department of Oral

.. Surgery) and Dr. Ron Guttu (now teaching at University of Washington School of Dentistry) have participated in the project. In addition, Dr. Donald Crabtree from the Department of Prosthodontics has also contributed to the success of the project. Adjunct faculty who have participated and even led project teams over the past ten years include: Dr. Noel Root, Dr. Mick Pope, Dr. Bruce DeGinder, Dr. John Robinson, Dr. Greg Zoghby, and Dr. Donald RelJins.

opefully the next ten years will rovide not only a continuation but ierhaps an expansion of the Saravia­endall Jamaica Project. ..

• Elizabeth Bernhard

996 marks the 75th Anniversary of ·blic Health Dentistry in Virginia. It appropriate that the Virginia Dental sedation join in the celebration ce a dental survey requested by the A in 1920 lead to the formation the Bureau of Mouth Hygiene and

ental Care in 1921. The continued >,pport of dentists in private practice as contributed to the success of the 9 local health department dental inks in providing preventive and storative dental services to the andally disadvantaged for the past

~. years. Members of the local ·rnal components have been · mental in assuring community bUe health measures such as ;mmunity water fluoridation, school

based fluoride mouth rinse programs and oral cancer screens. Their participation in public hearings, PTA meetings and community organizations is invaluable.

As part of the year long celebration of Public Health Dentistry in Virginia begun at the annual Dental Public Health Continuing Education meeting in July, the Director of Dental Health will be developing a display that will be used at local, state and national dental meetings and health fairs. To recognize those who have assisted the Virginia Department of Health in its efforts to assure optimal oral health for all Virginians a list of the names of those participating in any public health activity will be displayed. In order to identify those of you who have been involved in Dental Public Health, past and present, a survey is included in this issue (page 34) for you to photocopy and return to the Virginia Department of Health, Dental Health Division.

Please take a few moments to complete the survey form so that you may be included in the recognition of the partnership between the private practice of dentistry and dental public health...

A'Q}A. @D World Denial Congress

September 28-0c:lober 1. 1996

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