Newsletter Member - Lee County Dentalleecountydental.com/Newsletter/2017.pdf · a comprehensive assessment of the TMJ, cervical and thoracic spine and shoulder girdle. Limited mobility

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Participation is what makes us great.NewsletterMember

September 2017 www.leecountydental.com

Dr. Joseph Mitchell President

The only constant is change, and our profession is no different. We constantly hear from the organizations that protect us and our patients about the new challenges that our profession faces, and the numer-ous battles that must be fought on our be-half. I am truly grateful for these groups and the work that they complete on our behalf. However, it is easy to get bogged down in all of these challenges and to start to worry that the best years of dentistry are about to belong to the past. I would like to take this opportunity to say that I believe this to be simply untrue, and that we as a profession have a great deal to look forward to in the coming years.

One of the things that I find most heartening, in our group in particular, and in dentistry in general is the generosity of its members. Time and again monetary donations are freely given to support our communities. Even more importantly, time and skill are donated at places like Project Dentists Care to address the underserved

of our communities, that we, as professionals and care givers, have an obligation to serve. I am happy that we can do this with a minimum of outside intervention and oversight. It speaks of a high degree of trust that our profession has earned and an acknowledgement that our efforts have a tremendous impact for the better. I am grateful for all of those who volunteer their time and money on a routine basis. I would like to call upon everyone in our profession to thoughtfully consider giving back time to our community, both in Project Dentists Care and in the Florida Mission of Mercy event that will be held in 2018, in our own backyard.

The other thing I most admire about our profession is our ability to over-come our competitive natures and to band together instead to work towards common goals. Instead of embracing a short-sided goal of improving oneself at the expense of others, we consistently join together to im-prove the profession as a whole. Through

study clubs, CE events, and addressing our common concerns, we elevate each other as well as ourselves. In this way, again, it speaks toward the tremendous trust that our profession has earned.

I think it’s important to highlight the trust we have built over the years. It allows for,

not only better patient care, but also greater freedom in our practices. It is the most valuable asset we have earned and the biggest reason that I am optimistic for the future. Amidst all the changes, fear, and uncertainty we face, we hold true to maintaining and develop-ing that trust within our community. With that at

the center of our focus, I can confidently take a step back from all the details that we constantly deal with, and see that we stand at the top of a profession that will continue to be both rewarding and prosperous. This year, like many years before it, is an exciting time to practice dentistry.

Let’s get social!

Thursday, September 21 from 6:30 - 9:30 pm at the Marina at Edison Ford( Pinchers on the river )

2360 West First StreetFort Myers, FL 33901

I am grateful for all of those who volunteer their time and money on a

routine basis.

“

“

WWW.LEECOUNTYDENTAL.COMPlease check your listing under “Find a Dentist” to make sure your information is correct. Our goal is to become as paperless as possible by posting meeting notices, newsletters, etc., on the website.

Also, please take notice of our sponsors that are posted on the website. We appreciate their support!

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Marina at Edison Ford

Lee County Dental Society, Inc.

Cordially Invites you to our

annual Member / New Member social

9.21. 2017

join usWe look forward

to seeing everyone so please…

for our annual Membership Social on

LEE COUNTY DENTAL SOCIETY, INC.SCHEDULE OF EVENTS

September 2017 – May 2018

September 21, 2017 Membership Social Thursday 6:30 – 9:30PM at the Marina at Edison Ford (Pinchers on the River) *Members, Prospective Members & Guests only*

October 19, 2017 Gary Thacker, Legally Mine Thursday “Asset Protection and Tax Reduction” November 16, 2017 Dr. Hal Haering Thursday “Medical Errors: Update on Laws & Rules & Domestic Violence” December 7, 2017 Holiday Party at Gulf Harbour Country Club Thursday 6:30 – 9:30PM *Members & Guests Only*

January 18, 2018 Dr. Piero Palacios Thursday “Contemporary Orthodontics and Orthognathic Surgery” February 15, 2018 Dr. Pat RicaldeThursday “Obstructive Sleep Apnea and Dentofacial Deformities” March 15, 2018 Dr. Anthony Anfuso, 21st Century OncologyThursday “Head and Neck Cancer / Pathology” April 19, 2018 Dr. Richard A. Rasmussen, Jr. Thursday “Soft Tissue Considerations and Management” May 4, 2018 Dr. Rick Ferguson –“Bone Graft and Socket Grafting”Friday Dr. Arthur Acker – “Packer Technique; Sinus Bump” Location TBA

Meeting times: 5:30 - 6:30 Happy Hour • 6:30 - 7:00 Dinner • 7:00 - 7:15 LCDS Business • 7:15 - 8:15 Speaker. General membership dinner meetings will be held at The Landings-Helm Club 4420 Flagship Drive, Ft. Myers 33919, unless otherwise stated.

No Show Policy: We will continue the policy of billing for “no shows” at the membership dinner meetings. If you RSVP’d that you would attend, but discover you cannot, please let me know. Cancellations are appreciated!

If you have any questions, please contact Cinda Collmer, Executive Director, at 239-936-9240 or [email protected].

ADA Annual Session | October 20-24, 2017 | Atlanta, GAWCDDA Annual Meeting | February 2, 2018 | Tampa, FLFDA’s Dentists’ Day on the Hill | February 5-6, 2018 | Tallahassee, FLFLA-MOM | March 9-10, 2018 | Fort Myers, FLFlorida Dental Convention | June 21-23, 2018 | Orlando, FL WCDDA Summer Meeting | August 3-5, 2018 | Naples, FL

Upcoming Dates

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Volunteers needed — Call Rebeca 561-1949www.projectdentistscare.org

Clinic hours - Wed. night, Fri. and Sat. morningsTo date we have seen 900 patients / 45 volunteer dentists

Thank you for your wonderful support!Project Dentists Care • 2051 McGregor Blvd. • Fort Myers, FL 33901

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Temporomandibular pain and dysfunction are common complaints, effecting 25% of the population at some point in their lives. Temporomandibular disorder (TMD) is a collective term used to describe this multifaceted problem. The 3 most common causes of pain are (1) myofascial restrictions and muscle tension often due to psychological stress, (2) internal de-rangement due to the position of the articulating disc, or (3) degenerative joint disease. These dis-orders are commonly associated with headache, ear-related symptoms, cervical spine dysfunction and poor posture.

Characteristic findings on physical examination may include: • Limited jaw opening (normal range is 40-50 mm measured from biting surfaces of the upper and lower front teeth) • Changes in occlusion • Palpable spasm of the masseter and ptery goid muscles • Edema • Clicking, popping or locking of the TMJ • Tenderness to palpation of the TMJ externally via the external auditory meatus

• Lateral deviation of the mandible during motion

Conservative management, including physical therapy, orthotics, behavior modification, and medications, are effective for the vast majority of patients. Because the pain and symptoms of TMD are often self-limiting, aggressive and non-reversible treatments such as surgery, exten-sive dental treatment or orthodontic treatment should be avoided.

Patients should receive instruction on jaw rest and posture, including: • Avoid heavy chewing (e.g. gum, tough meat, bagels, granola bars) • Limit jaw opening (e.g. place the tip of the tongue on the roof of the mouth when yawning, cut food into small bites) • Avoid grinding and clenching (e.g. maintain teeth slightly apart with tip of tongue gently resting on roof of mouth, use progressive relaxation techniques, self-monitor every few minutes) • Avoid forward head posture • Avoid leaning or sleeping on jaw

Patients may use ice, heat, and over-the-counter medications to manage pain and inflammation.Physical therapy (PT) performed by a licensed

physical therapist with specialized training in TMD is an effective method to decrease pain, decrease muscle hyperactivity, and re-establish joint mobil-ity and function. PT examination should include a comprehensive assessment of the TMJ, cervical and thoracic spine and shoulder girdle. Limited mobility in the upper cervical spine, forward head posture and TMD are strongly correlated. Manual therapy techniques, including myofascial release, upper cervical joint manipulation and intra-oral TMJ manipulation, have been demonstrated to improve mouth opening and motor control.

Orthotic (occlusal splints, night guards or bruxism appliances) are routinely used to manage TMD. It is important to check the fit of the appliance pe-riodically as the orthotic may require adjustments as cervical and TMJ alignment improves. Occlu-sion and orthotic fit may change rapidly while the patient undergoes manipulative physical therapy.

Occlusal therapy, including extensive occlusal adjustment, orthodontic treatment, restorative dentistry (crowns, bridges) and orthognathic surgery, create permanent changes are rarely necessary and should be considered a last resort according to several recent publications. Once conservative treatments have stabilized symptoms and improved cervical and TMJ alignment, limited occlusive adjustment may be indicated.

mary’s flowerMary Devlin | 239.292.6648

By AppointmentNaples | Bonita Springs | Fort Myers

[email protected]

Brianne Carter, PT, DPT Gulf Coast Medical Center / Outpatient Rehabilitation239-343-1645 • [email protected]

Temporomandibular DisorderTMD

d DESIGND E S I G N → I N

SP

IRA

TION → PUB

LIC

AT

ION

→

Brenda Diamond-Schlicht

Email →[email protected]

Cell →239.265.6049

CALL ME I CAN HELP YOU STAND OUT FROM THE CROWD!

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LEE COUNTY DENTAL SOCIETYEXECUTIVE COUNCIL MEMBERS

July 1, 2017 – June 30, 2018

OFFICERSPresident: Dr. Joseph Mitchell 239-939-5556Immed. Past President: Dr. Heather Adu-Sarkodie 239-728-3636 V. Pres. & Program Chair: Dr. Yolanda Kieser 239-936-2175Secretary/Treasurer: Dr. Andrea Mier Parsons 239-549-7771

BOARD MEMBERSDr. Heather Adu-Sarkodie 239-728-3636Dr. Diana Barajas 239-948-5900Dr. Peter Gostout 239-945-3818Dr. Michele Laboda 239-561-2258Dr. Andrea Mier Parsons 239-549-7771 Dr. Joseph Mitchell 239-939-5556Dr. Jennifer Taschner 239-936-0635

DELEGATES TO F.D.A.Dr. Sudhanshu Desai 239-542-5676Dr. Ken Jandik 239-275-7907Dr. William (Billy) Truax, III 239-334-6136Dr. Peter Gostout – alternate 239-945-3818 Dr. Michele Laboda – alternate 239-561-2258 Dr. Jennifer Taschner – alternate 239-936-0635

Membership & Retention Chair: Dr. Jennifer Taschner 239-936-0635 Professional Relations Chair (Peer Review): Dr. Deirdre Catlin 239-936-7400 Ethics Chair: Dr. Deirdre Catlin 239-936-7400 Children’s Dental Health Co-Chairmen: Dr. John Richards 239-936-1808 Dr. Oliver Favalli 239-418-1444 Dental Hygiene & Assisting Advisory Board: Dr. Deirdre Catlin 239-936-7400 PROJECT DENTIST’S CARE OF S.W. FL., INC. President: Dr. William Truax, II 239-561-1949 Vice President: Dr. Nicholas Dundee 239-574-5555 Secretary/Treasurer: Dr. Ken Jandik 239-275-7907 Board Members: Dr. Maria Diaz, Phil Gaylor, Richard Hall, Leah Kirby, Barney Pultz, Michael Rich, Dr. Billy Truax III, Pastor Jon Zehnder Executive Director for LCDS & PDC: Cinda Collmer 239-936-9240 Email – [email protected]

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mailto:[email protected]

Florida SouthWestern State College (FSW) Dental Hygiene Program reconnected with over 80 alumni and faculty members on August 28, 2016. The reunion was hosted by the FSW Alumni Network. The event welcomed students from the graduating classes of 1995-2016. “It was wonderful to see so many familiar faces and get an opportunity to hear how well everyone is enjoying their careers as dental hygienists,” said FSW Program Director, Karen Molumby. “I’m looking forward to our next reunion in 2020 which will mark the program’s 25th anniversary of graduating excellent dental hygienists.”

FSW’s Dental Hygiene students were very busy during the 2016-2017 academic year, focusing on the dental educational needs of a variety of communities throughout southwest Florida. The collaborative efforts between the FSW Dental Hygiene Program and our community outreach partnerships enabled our students to provide educational oral

healthcare presentations to the Voluntary Pre-kindergarten Education Program (VPK), Florida Department of Health in Lee County WIC Program, and Buckingham Exceptional Student Center, as well as elementary school visits for Dental and Dental Hygiene Health months, Give-Kids-A-Smile Day, and assisted living/nursing homes. These presentations touched the lives of our members from the youngest to the oldest on how to improve their oral health.

Serving the community is a very important component of the college experience. It sets a path for a lifetime of connecting with others to solve problems and improve lives. It also helps

develop important social skills that can be used for future endeavors. Through

these volunteer programs, FSW Dental Hygiene students gained

a sense of pride, satisfaction and accomplishment,” added Carol Chapman,

Clinical Coordinator, FSW Dental Hygiene

program.The FSW Dental Hygiene Program will pilot

a new bachelor’s degree completion program associate to bachelor’s degree bridge opportu-nity with St. Petersburg College. This program with St. Petersburg College will permit our FSW students, in their final year of the program, to begin in their online Bachelors of Applied Science in Dental Hygiene (BASDH) degree program in Fall of 2017. “Our students will graduate in May of 2018 with their AS degree and can earn their BASDH degree by May of 2019. The Dental Hygiene Faculty are very excited for our students as they embark on an excellent opportunity to advance their dental hygiene education.”

The FSW Dental Hygiene Program is fully accredited by the Commission on Dental Accreditation. For 22 consecutive years, graduates have earned a 100 percent pass rate on the National Board Dental Hygiene Examination (NBDHE). The program boasts a 92 percent completion rate among students accepted into the program, with 333 graduates since 1995. Each class is diverse with students of

various ages and ethnic backgrounds. The program diversity enhances our ability to reach many populations in our community.

The FSW Dental Hygiene Program faculty, staff, students and alumni would like to congratulate Dr. Richard Olitsky, Dental Clinic Supervisor, on his retirement June 13, 2017, after 16 years with FSW’s Dental Hygiene Program. Dr. Olitsky was instrumental in the development and progression of the Dental Hygiene Program. His expertise as a periodontist in the clinical and classroom settings was a significant benefit to our students. “He will be dearly missed,” said FSW Program Director, Karen Molumby.

FSW Dental Hygiene Program Reconnects with Alumni

New Members

Saturday, February 10,

2018.

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Scott Baur, DMD – Bonita SpringsKanwal Chawla, DDS – Fort MyersNathan Dewsnup, DMD – Bonita SpringsMaria Diaz, DMD – Fort MyersElena Gaar, DMD – Bonita SpringsBayonne Joseph, DDS – Fort MyersAngela Litvak, DMD - NaplesJose Morales, DMD – Fort MyersLauren Widmer, DDS – Cape CoralKaren Wilkinson, DMD – Fort Myers

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Antibiotic Prophylaxis in Dentistry

Infection and pain, two inflammatory conditions that occur in association or separately, often require dental care. Their treatment employ therapeutic agents along with the various dental procedures that may be prescribed. The focus of this paper is Standards of Practice of dis-pensing the two major classes of drugs involved: antibiotics and narcotic analgesics.

The propensity of bacteremia following invasive surgical procedures is of major concern to practitioners. Prophylactic antibiotics are em-pirically employed to offset serious subsequent infections. Besides routine infection control measures taken in operating rooms, antibiotics in specific doses are administered to patients preoperatively. For example, intravenous antibi-otic boluses are administered with other agents prior to cardiac, neurosurgical, orthopedic and many other procedures. By the same token certain invasive dental procedures are required to institute prophylactic antibiotics. Daily brushing and flossing can upset oral natural flora causing bacteremia and subsequent endo-carditis. The guideline, however, recommends prophylactic antibiotics in only certain patient populations deemed at high risk of infection with the endorsement of the American Dental Association (ADA), the American Academy of Orthopedic Surgeons (AAOS) and the American Heart Association (AHA).

Preventive measures are strongly recommend-ed via accessibility of care and keen professional assessment or verification of risk. Patients need to be educated to observe good oral hygiene in daily brushing and flossing.

The recommendation is that patients with preexisting cardiac disorders namely those with prosthetic heart valves, prosthetic material used in repair, previous infective endocarditis (IE), congenital heart disease (CHD), et cetera undergoing ALL dental procedures involving manipulation of gum tissue such as deep clean-ing and/ or surgeries in the periapical region be placed on antibiotic prophylaxis.

The recommended regimens are carefully chosen based on proven efficacy against the predominantly implicated microbial species in bacteremia resulting in infective endocarditis (IE) – Viridans group streptococci, Staphylococ-cus aureus, enterococcus, pseudomonas, and serratia. In the course of processing a prescription and dispensing a drug, the pharmacist may call the prescriber for further clarification during DUR (drug utilization review – both prospective and

retrospective). Issues regarding the choice of drug agent, dosage, schedule, route, quantity or duration; patient’s age, allergy profile, drug intolerance, co-morbidities, drug-drug or drug-food interactions will prompt such a call. In In accordance with antibiotic stewardship judicious use of antibiotics is an important effort to reduce drug resistance, multi-drug resistant or-ganisms MDROs and to avoid ADRs particularly anaphylactic reactions.

Narcotic Analgesics in DentistryDentists perform various surgical procedures including tooth extraction and root canal

therapy to alleviate oral pain. Such pain arises from infection, trauma or procedures them-selves (post-surgical pain). Narcotic analgesic agents are often prescribed for post-surgical pain on an acute basis. The fixed-dose combina-tions are most common among the choices:Tylenol No.3 ® – acetaminophen 325mg with codeine 30mg Vicodin®, Lortab® or Norco® - hydrocodone 5mg, 7.5mg or 10 mg with acetaminophen 300 – 325 mgVicoprofen® - hydrocodone 7.5 mg with ibuprofen 200 mg

Continued on next page

8

Infection and Pain: Drug Treatment Updates

By Dr. Yaw Adu-Sarkodie, RPh., PharmD., CPh.

Tables from Circulation, 2007; 116:1736-1754.

99

Percocet® - oxycodone 5 mg with acetaminophen 325mg*Ultracet® – tramadol 37.5 mg with acetaminophen 325 mg* Tramadol is controlled but it is not a narcotic.

Unlike the case with antibiotics, there is no set guideline for a narcotic regimen to use pre- or post-op. Prescribers use their own professional discretion or practice experience, with or without input from a pharmacist. Notably absent from the short list above are M S Contin®, Morphine Sulfate IR Oxycontin®, Oxycodone IR, Dilaudid®, Nucynta®, oxymor-phone, methadone, fentanyl, etc. These formulations of morphine and oxycodone as well as the other agents are conventionally reserved for pain management of chronic, terminal illness or treatment of non-dental pain. This is an important observation because a prescription purported to be from a dentist for such drugs would raise the red flag! Anxiolytics, commonly, Valium® (diazepam), Ativan® (lorazepam) and Xanax® (alprazolam) are also used in dentistry discretely such as a maximum of 2 doses preoperatively. Similarly, any pre-scriptions calling for other agents in that class at different dosing schedules or quantities would call for more scrutiny.

All of these agents are controlled because of their addiction and abuse potential. Recent epidem-ics of abuse, diversion, overdoses and fatalities prompted the DEA to reschedule all HCPs (hydroco-done combination products) to schedule 2 (CII) – final rule 8/22/14, effective 10/6/14. Trama-dol became a controlled sub-stance schedule 4 (Civ) 8/18/15. The current opioid overdose epidemic has caused many states including Florida to take extra measures to curb the problem. (Some 4000 deaths from opioid overdose episodes in Florida last year alone - NPR report 7/14/17)The Florida Board of Pharmacy passed a new law on 12/24/15, Validation of Prescriptions for Controlled Substances - Florida Statute 64B16-27.831, effec-tive 11/22/16. Pharmacists are required to take a 2- hour CE credit course as of 9/30/17 renewal deadline and biennially

thereafter. Essentially pharma-cists have a new set of tools via PDMPs (PRESCRIPTION DRUG MONITORING PROGRAMS) to aid in performing DUR regarding controlled substance dispensing. The Florida version is called e-FORSCE (electronic Florida Online Reporting of Controlled Substances Evaluation). It func-tions as a databank that provides some information and clues about patient care, patient behav-ior regarding drug abuse, diver-sion and prescription insurance fraud; it protects patient privacy as well.

The law reinforces the Con-trolled Substances Act of 1970: a valid prescription for a controlled substance must be issued for a legitimate medical purpose by a practitioner acting in the usual course of sound professional practice. The prescriber is re-sponsible for proper prescribing. The pharmacist has a corre-sponding responsibility to ensure dispensing such a prescription is for a legitimate medical purpose.

One diversion technique drug seekers use is that they visit DENTISTS and emergency rooms to” fill gaps “ created by overuse by obtaining controlled substance prescriptions from dentists and ER doctors. As practitioners, dentists have access to e-FORSCE to make clinical decisions about their patients or clients of whom each should be treated on an individual basis.

Any call from a pharmacist regarding a prescription for any drug including antibiotics and controlled substances may be for clarification or VALIDATION based on patient data, prescriber information as well all the clinical issues regarding the drug agents themselves.

The ultimate goal, through such communication, is to follow prop-er Standards of Practice and to ensure patient welfare and safety.

References:Excerpts from ASCP Regional Meeting, St. Petersburg, Florida, June 23-25, 2017

Tools for Validating Prescriptions for Controlled Substances – Donald Sullivan, RPh, PhD

Clinical Practice Guidelines Reference Manual, 2014; 37 (6): 15-16

From previous page

PUTTING YOUR FUTURE FIRST

and your kids’ and their kids’...

At Meridian Financial Group, we pride ourselves on building lifelong relationships and serving as a comprehensive resource for our clients’ financial needs.

With a specialty working with physicians and dentists throughout Florida, I continue to help my clients with asset protection, wealth accumulation, and preferred compensation.

As a Member Firm of M Financial Group, an elite consortium of independent insurance, investment, and executive benefits firms, our clients benefit from a balance of independence and M Financial’s significant presence in the marketplace. The collective volume and experience of M Member Firms results in a powerful combination of exclusive products, priced with our superior experience, and ongoing client service and advocacy.

MERIDIAN Financial Group

13710 Ben C Pratt/Six Mile Cypress Pkwy., Ste. 3, Fort Myers, FL 33912

f 239.690.9821 ● www.mfgflorida.com

Securities offered through M Holdings Securities, Inc., A Registered Broker/Dealer, Member FINRA/SIPC. Meridian Financial Group is independently owned and operated. ####-2017

Justin J. Smith Financial Advisor

p 239.690.9820 [email protected]

PUTTING YOUR FUTURE FIRST

and your kids’ and their kids’...

At Meridian Financial Group, we pride ourselves on building lifelong relationships and serving as a comprehensive resource for our clients’ financial needs.

With a specialty working with physicians and dentists throughout Florida, I continue to help my clients with asset protection, wealth accumulation, and preferred compensation.

As a Member Firm of M Financial Group, an elite consortium of independent insurance, investment, and executive benefits firms, our clients benefit from a balance of independence and M Financial’s significant presence in the marketplace. The collective volume and experience of M Member Firms results in a powerful combination of exclusive products, priced with our superior experience, and ongoing client service and advocacy.

MERIDIAN Financial Group

13710 Ben C Pratt/Six Mile Cypress Pkwy., Ste. 3, Fort Myers, FL 33912

f 239.690.9821 ● www.mfgflorida.com

Securities offered through M Holdings Securities, Inc., A Registered Broker/Dealer, Member FINRA/SIPC. Meridian Financial Group is independently owned and operated. ####-2017

Justin J. Smith Financial Advisor

p 239.690.9820 [email protected]

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