Virginia Dental Journal

If) II I r t~- -1- J

HIGH

QUALITY

HEALTH BENEFITS

ARE HARD To FIND

UNLESS You FIND A COMBINATION SUCH

AS THE VDSC INSURANCE SERVICE CENTER

AND TRIGON BLUE CROSS BLUE SHIELD

The Virginia Dental Association (VDA) and the Virginia Dental Services Corporation (VDSC) are proud

to announce a new association sponsored healthcare program through Trigon Blue Cross Blue Shield This new program is available for all dentists interested in setting up a benefit program

for themselves or their practice

Call our toll-free number between 830 am VDAs HEALTH INSURANCE PROGRAM INCLUDES and 530 prn Monday through Friday bull Choice of Products - Indemnity PPO POS

Simply dial 1-800-832-7001 for quick HMO and MSAs

bull Trigons extensive networks of participating and efficient service Its that easy The hospitals and doctors

VDSC Insurance Service Center also has bull Special Trigon Value Added and IVIembership

a toll free fax line 1-800-886-4913 benefits available to you because of your association membership

CALL TODAY for information on the wide variety of exciting health products

our association is offering for the upcoming year Our service and marketing

departments will be delighted to answer your questions Call the VDSC

Insurance Service Center at 1-800-832-7001 to find out how our

association is working to assist members in this important area

Leslie S Webb Jr DDS Susan P Lionberger DDS Editor Publications

ASSOCIATE EDITORS 1 Barry I Einhorn 4 Harry A Jack Dunlevy 7 Victor G 2 Eric W Boxx 5 Barry K Cutright 8 Danine F 3 Michael R Hanley 6 Robert G Schuster School of Den

Volume 77 January-March 2000 Number 1

Thomas Burke

TABLE OF CONTENTS

4 Editorial 5 Message From the President 6 Letter To the Editor 6 Candidate Information 7 Lab Communications With Ceramic Veneers

11 Abstracts 17 Overview of Virginias Sales Tax For Dentists 18 Direct Reimbursement News 19 Report on the 1999 ADA House of Delegates 25 VDA 1999-2000 Committees 28 International College of Dentists 30 VDA News 32 Continuing Education amp Meetings 34 Trigon VDA Sponsored Health Insurance 34 Automated External Defibrillators 35 Virginia Dental Service Corporation 35 Legislative Update 38 Membership Benefit Highlight - Career Alternatives 40 Standard of Care 43 Component News amp Specialties News 48 Classified Advertising

COVER Reflecting Moment at the University of Richmond

2000[J Linda Gilliam Photographer All Rights Reserved

PUBLICATION TEMPLATE CChange

THE VIRGINIA DENTAL JOURNAL (ISSN 0049 6472) IS published quarterly (January-March April-June October-December) by the Virginia Dental Association 5006 Monument Avenue PO Box 6906 Richmond Virginia 23230-0906 (804 )358-4927 SUBSCRIPTION RATES Annual Members $600 Others $1200 in US $2400 Outside US Single copy 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 PO Box 6906 Richmond VA 23230-0906

VIRGINIA VDA COMMITTEE CHAIRMENJOURNAL

EDITORIAL BOARD

Ralph L Anderson James R Batten Cramer L Boswell James H Butler Gilbert L Button B Ellen Byrne Charles L Cuttino fII Frank H Farrington Barry I Griffin Jeffrey L Hudgins Wallace L Huff Lindsay M Hunt Jr Thomas E Koertge James R Lance Daniel M Laskin Travis T Patterson fII W Baxter Perkinson Jr Lisa Samaha David Sarrett Harvey A Schenkein James R Schroeder Harlan A Schufeldt John A Svirsky Ronald L Tankersley Douglas C Wendt Roger E Wood

Annual Meeting Carole A Pratt

Auxiliary Education amp Relations Alan W Mahanes

Budget amp Financial Investments James W Baker

Cancer amp Hospital Dental Service Michael E Miffer

Caring Dentists Harry D Simpson Jr

Communication amp Information Technology Dennis E Cleckner

Constitution amp Bylaws Charles L Cuttino III

Dental Benefits Programs Richard D Barnes

Dental Continuing Education B Ellen Bryne

Dental Delivery for the Special Needs Patient AI J Stenger

Dental Health amp Public Information Samuel W Galstan

Dental Practice Regulation N Ray Lee

Dental Trade amp Laboratory Relations Wiffiam M Midkiff

Direct Reimbursement David Swett

FOUNDATIONS

Relief Foundation Scott H Francis

1999 ADA DELEGATION

Delegates 14(Jh ADA Session October9-1~ 199~ Honouu HI DavidCAnderson (2001) Charles LCuttino flJ (2001) Wallace LHuff (2001) Bruce R Hutchison (2002) Leslie SWebb Jr (2000) Richard D Wilson (2002)

Alternate Delegates Anne CAdams (2000) Richard D Barnes (2000) Bruce R DeGinder(2000) Ronald J Hunt (2001) Kirk Norbo (2001) William J Viglione (2001)

Ethics amp Judicial Affairs Ronald L Tankersley

Fellows Selection Donald L Martin

History amp Necrology French H Moore III

Infection Control amp Environmental Safety Paul F Supan

Institutional Affairs Elizabeth A Bernhard

Journal Staff Leslie S Webb Jr

Legislative Roger E Wood

Membership Kimberly S Swanson

New Dentist Carolyn C Herring

Nominating Charles L Cuttino III

Peer Review amp Patient Relations Neil J Small

Planning Wallace L Huff

Search Committee for VA Board of Dentistry Charles L Cuttino III

VADPAC Rodney J Klima

VDA Foundation Wiffiam H Allison

M Joan Gillespie (2000) Ronald LTankersley (2002) Andrew J Zimmer (2002)

Thomas S Cooke 11 (2001) Rodney J Klima (2000) Edward KWeisberg (2000)

Representing and serving member dentists by fostering quality oral health care and education

OFFICERS COUNCILORS President Andrew J Zimmer Norfolk I Edward J Weisberg Norfolk President Elect David C Anderson Alexandria II Bruce R DeGinder Williamsburg Immediate Past President Charles L Cuttino III Richmond III H Reed Boyd III Petersburg Secretary-Treasurer Thomas S Cooke III Sandston IV Anne C Adams Richmond Executive Director Terry Dickinson DDS V Mark A Crabtree Martinsville

PO Box 6906 Richmond 23230-0906 VI Ronnie L Brown Abingdon VII James C Gordon Jr Winchester VIII M Joan Gillespie Alexandria

EXECUTIVE COUNCIL Includes officers and councilors listed and William J Viglione Charlottesville - Chairman Bruce R DeGinder Williamsburg - Vice Chairman VDA STAFF Richard H Wood Richmond Terry Dickinson DDS - Executive Director D Christopher Hamlin Norfolk Bonnie Anderson - Administrative Assistant Rodney J Klima Burke Ronya Edwards - Marketing and Programs Coordinator

Linda Gilliam - Director of Finance Ex Officio Members Julie Heuser - DDS Project Coordinator Parliamentarian Emory R Thomas Richmond Susan Lionberger - Events amp Publications Coordinator Editor Leslie S Webb Jr Richmond Barbara Rollins - Assistant DDS Project Coordinator Speaker of the House Bruce R Hutchison Centreville Dean School of Dentistry Ronald J Hunt Richmond

SOCIETY PRESIDENT SECRETARY PATIENT RELATIONS

Tidewater I James E Krochmal Harvey H Shiflet III W Walter Cox 801 W Little Creek Rd 107 3145 Virginia Beach Blvd 104 5717 Churchland Blvd Norfolk VA 23505 Virginia Beach VA 23452 Portsmouth VA 23703

Peninsula II Gary A Riggs Jr Eric W Boxx Kent Herring 1610 Aberdeen Rd Ste B 113 Hampton Highway 122700 McManus Blvd 102B Hampton VA 23666 Yorktown VA 23693 Newport News VA 23602

Southside III Scott E Gerard Ronald L Wray John R Ragsdale III 9401 Courthouse Rd 202 P O Box 150 9 Hollyhill Drive Chesterfield VA 23832 McKenney VA 23872 Petersburg VA 23805

Richmond IV Charles E Gaskins III HA Jack Dunlevy William J Redwine 703 N Courthouse Rd 201 11601 Robious Rd Ste 130 6808 Stoneman Road Richmond VA 23236 Midlothian VA 23113 Richmond VA 23236

Piedmont V William W Martin Gregory T Gendron Craig B Dietrich 4935 Boonsboro Road 7 Cleveland Avenue 604 E Church Street Lynchburg VA 24503 Martinsville VA 24112 Martinsville VA 24112

Southwest VI Frances Anne Johnston Susan F OConnor Paul T Umstott PO Box 2045 PO Box 1086 300 W Valley Street Abingdon VA 24212 Galax VA 24333 Abingdon VA 24210

Shenandoah Valley VII Carolyn C Herring Robert B Hall Jr Alan Robbins P O Box 2826 130 W Piccadilly Street PO Box 602 Staunton VA 24402 Winchester VA 22601 Timberville VA 22853

Northern Virginia VIII AI Rizkalla Melanie R Love Neil J Small 3100 S Manchester S1 T-4 6711 Whittier Avenue 9940 Main Street Falls Church VA 22044 McLean VA 22101 Fairfax VA 22031

~I EDITORIAL II]

A new millennium begins A new VDA executive director starts his first full year Staffing changes occur at the VDA New VDA officers and committees get their tenures rolling However the challenges facing dentistry just dont seem to change

Managed care medicaid OSHA EPA CDC legislative issues dental licensure continuing education continuing competency dental hygiene issues adequate dental auxiliary manpower pool patient freedom of choice access to care fluoridation evidenced based care quality of care dental education and our scientific knowledge base all remain on the dental agenda These issues affect all dentists whether young or old teachers administrators researches or practitioners This means they affect you

We must all become knowledgeable about these challenges and we must be willing to get involved in our communities the legislative proshycess dental education and in organized dentistry if we hope to posishytively impact the results Be involved Do your part The profession of dentistry will be stronger due to your efforts

Leslie S Webb DDS Editor

4 Virginia Dental Journal

[II MESSAGE FROM THE PRESIDENT I~

I hope that each of you has had a joyous holiday season and a cheershyful and safe New Year as we begin the new millennium

Last October the ADA House of Delegates passed several resolushytions which reinforce the Associations commitment to pashytients and dentists freedom of choice in the dental care delivery process

1 The Direct Reimbursement national marketing promotion has been extended for three more years Although it is unshylikely that DR would replace traditional dental insurance programs it continues to give dental insurance benefit purshychasers another choice while maintaining a low administrashytive cost and wider treatment choice standards

2 Resolution 83H considers any alteration of a dental treatment plan by a third party claims analysis to constitute diagnosis and thereby the practice of denshytistry which can only be pershyformed by a dentist licensed in the state where the treatshyment was rendered This

provision has been successshyfully incorporated into the dental practice act in several states to prevent interference from third parties in delivershying appropriate dental care

3 Resolution 111 H calls for the Association to seek or supshyport legislation opposing inapshypropriate third party overpayshyment recovery practices It further encourages state denshytal societies to seek or supshyport legislation preventing third party payers from withshyholding benefits due on subshysequent patients to recover previous overpayments This practice has frequently sugshygested errors or wrongdoing on the part of the dentist and tends to have a negative imshypact on the traditional dentistshypatient relationship

The American and Virginia Dental Associations are taking pro-active steps to maintain the freedom of choice for our patients so that our member dentists may continue to deliver necessary high quality denshytal care Member interest particishypation and support in these proshygrams and policies makes a differshyence

bull Show your interest by commushynicating with your component Councilors Officers and VDA Committee representatives Let them know how you feel about these programs and polishycies

bull Participate by writing a letter sending a fax or email or makshying a phone contact when the

Association needs to make a point with the legislature or other appropriate entity

bull Support the ongoing efforts to maintain freedom of choice for our patients and our practices by giving financial support to ADPAC and VADPAC

For a more in-depth report on the 1999 ADA House of Delegates please see the article by Dr Wallace L Huff on page 19

As the 2000 General Assembly Session continues we as an Asshysociation have already reinforced our respected position with the Legshyislature through VADPACs first Day on the Hill Members of the VDA Executive Council VDA Comshymittee Chairs Liaison dentists and interested members participated in numerous visitations with Legislashytors on January 14th

This innovashytive activity should be continued and enhanced in future years

As a reminder mark off April 6-8 2000 as the dates for the Leadershyship Conference to be held at the Omni Hotel in Charlottesville I am looking forward to seeing you there

Andrew J Bud Zimmer oo S VDA President

Virginia Dental Journal 5

LETTER TO THE EDITOR I] To the membership of the Virginia Dental Association

On behalf of everyone associated with Lindl Corporation I personally would like to thank you for bestowshying on me an honorary membership in the Virginia Dental Association

As I indicated during my comments at the annual meeting any recogshynition of our lobbying activities needs to go to those associated with Lindl Corporation to the staff of the VDA and most importantly to the VDA membership Without their locally elected legislators very

little would be accomplished in Richmond

I have always been told that you are judged by the company you keep An honorary membership in the VDA certainly puts me in exshycellent company

A sincere thank you

Sincerely Lindl Corporation By Charles R Duvall

Past VDA President Charlie Cuttino preshysents Chuck Duvall with an honorary VDA memshybership at the Annual Meeting in September 1999

PUBLICATION OF CANDIDATE INFORMATION IN THE VIRGINIA DENTAL JOURNAL

Nominations for the elective offices of the Virginia Dental Association may be made either by a Composhynent President on behalf of the Component heshe represents or by obtaining signatures from a minishymum of twenty-five members of the Association These nominations should be directed to Dr Thomas S Cooke III VDA Secretary-Treashysurer The following positions are up for election at the 2000 Annual Meeting in Williamsburg Presishydent-Elect two ADA Delegate poshysitions (3 year term) five ADA Alshyternate Delegate positions (2 year term) two executive council (atshylarge) positions (2 year term)

All candidates must have submitshyted their CVs picture (black amp white head shot preferred) and bioshygraphical information to the attenshytion of Dr Leslie S Webb Jr Edishytor at the VDA Central Office no


later than March 15 2000 for pubshylication in the April-May-June issue of the Virginia Dental Journal Forms of submission of Candidate Information have been mailed to all VDA Component Society Presishydents

Candidates for the office of Presishydent-Elect of the Association will be allowed a maximum of 500 words Candidates for all other offices will be allowed a maximum of 250 words Candidates are asked to limit their biographical information to major accomplishments but to include such pertinent data as edushycation memberships honors poshysition of leadership held in the ADA VDA and Component Society and community leadership activities Due to space limitations the VDA Journal Editor will reserve the right to condense biographical informashytion if necessary

Should you have any questions reshygarding the Virginia Dental Journal criteria please contact Dr Les Webb either by phone (804-282shy9781) or by fax (804-282-3647) If additional Journal submission forms are needed please contact Susan Lionberger at the VDA Censhytral Office either by phone (800shy552-3886) or by fax (804-353shy7342)

II LAB COMMUNICATION WITH CERAMIC VENEERS II

Numerous articles in the dental litshyerature have described the many advantages of the porcelain veneer resortation 1234 It is exciting to pracshytice in a time when we can offer our patients lifelike results combined with functional parameters that will serve them for many years As the architect of our patients treatment plan it is our job to communicate to the ceramist all the necessary inshyformation for construction

Provisionals are the key

Using provisional restorations to work out the esthetics and function is the standard for traditional crown and bridge procedures involving the maxillary anterior region 5 When doing any maxillary anterior indirect restoration there are four requireshyments that we must communicate to the lab

1 The centric stop on the lingual 2 The correct concave lingual

contour 3 The correct incisal edge posishy

tion 4 The correct two plane facial

contour

There are nine other factors to be considered when optimizing esthetshyics 6

1 The correct incisal edge posishytion - This determines how much tooth structure is disshyplayed in relationship to the patients face Ideally there should be 1 mm of maxillary incisors visible at rest and the incisal edges should follow the smile line

2 Symmetrical gingival tissues shyThe gingival tissues are the 2nd

John C Cranham DDS Christopher A Hooper DDS

determining factor of crown length after the incisal edge position The gingival tissues should be symmetrical and balshyanced as they provide the backshydrop for esthetic resorations

3 The correct width-to-Iength-rashytio - The width-to-Iength ratio of the incisors should be 70shy75 For example a 10mm long central incisor should be 7-75mm wide

4 The maxillary incisors are in golden proportion - The meshysial-distal relationship of the maxillary anterior teeth should be central incisor 16 lateral incisor 1 mesial third of the cuspid 06 In other words if the width of the lateral incisor is assigned a value of 1 the central incisor should be 16 times the width of the lateral The width of the mesial third of the cuspid should be 06 times the width of the lateral Hence the golden proportion is 16 to 1 to 06

5 Maxillary anterior teeth have a disto-axial inclination - Maxilshylary anterior teeth should have a slight disto-axial cant This should become more exaggershyated as the teeth move distally The teeth therefore have a trigonal shape with the height of contour of the gingiva slight offset distally from the center of the tooth

6 The central incisal edges are parallel to the floor and perpenshydicular to the center of the patients face - When looking at a smile from straight on the incisal edge of the central incishysors should be parallel to the floor and perpendicular to the long axis of the face It is critishy

cal that the embrasure space between the two central incishysors is parallel with the long axis of the face and perpendicular to the floor

7 Incisal embrasures move apically as they move distallyshyThe contact point between the central incisors has the most incisal position The contact point between the central and lateral is positioned more apically and the contact point between the lateral and cuspid has the most apical position of all This provides the anatomy that makes each tooth distinct rather than creating a chiclet appearance

8 Posterior teeth become shorter as they move distally - This along with a correctly oriented occlusal plane provides an esshythetic smile with significant functional ramifications

9 Posterior teeth fill the buccal corridor with a full smile - It is important to see the buccal surshyfaces of the posterior teeth as they move distally In large mouths it is often possible to see all the way back to the meshysial of the second molars

The technician can utilize a model of our properly contoured provisionals to fabricate custom matrices to be sure the restorations esthetically and functionally meet the expectations of the patient and the dentists The same guidelines also apply to porcelain veneer resshytorations Without the precise knowledge of the optimum placeshyment of the new and improved inshycisal edge position the laboratory technicians only option is to guess


Case Report

Figures 1 and 2 exhibit a healthy 23-year-old female desiring an esshythetic change Upon comprehenshysive examination we found her periodontally healthy with functionshyally stable temporomandibular joints and without any clinical or radiographic caries Occlusal analysis found a cuspid protected occlusion without interferences on her posterior teeth There was a discrepancy between centric relashytion and centric occlusion without any apparent sign of instability There were no signs of wear moshybility migration sore muscles or joint breakdown Because of the apparent occlusal stability the deshycision was made to restore the pashytient in centric occlusion 7

Figure 1

Figure 2

A Smile analysis was completed using Dickersons SMILES form 8

This is a very useful tool to evalushyate many of the nine factors of esshythetics previously outlined From a cosmetic standpoint the centrals could be lengthened 15-20mm The previous composite resin was wider on tooth 9 than it was on tooth 8 The work up included a diagnostic wax up that idealized the new length achieving the golden


proportion for 6-11 and an optimum width to length to ratio of 75 in the maxillary centrals These qualishyties became the objective of our patients treatment plan This would provide the patient a fuller more balanced smile

The teeth were prepared for 6 emshypress veneers (fig 3) following conshytemporary standards 9 While the interproximal contacts were not normally broken during veneer preparations when tooth width is to be changed it becomes necesshysary It is important to note that these preparations were carried to the linguoproximalline angles This provides the technician complete freedom to build the optimum intershyproximal contour and build the mesio-distal widths into golden proshyportion A full arch impregum final impression was made and a facebrow was taken to mount the master cast

Figure 3

The Technology Transfer

To communicate correctly with our laboratory provisional restorations were fabricated that fulfill the four requirements for functionally esshythetic restorations and the nine facshytors for optimum esthetics By spot etching the center of each prepashyration the provisionals were conshystructed using composite resin to the ideal goals described in our plan (Figures 4 amp 5) Note how each tooth is constructed to the ideal inshycisal edge position to the ideal width-to-Iength ratio and the ideal golden proportion The procedure

is done two teeth at a time beginshyning with the centrals and moving distally (Figure 6 amp 7) Following this sequence the cosmetic objecshytives are optimally visualized It also gave the clinician a chance to evaluate function phonetics and patient approval

Figure 4

Figure 5

Figure 6

Figure 7

Whether doing porcelain fused to metal crowns involving the 6 maxshyillary anterior teeth or porcelain veshyneers it is important to develop a system that will evaluate the above parameters Curtain tests that are

utilized to find the ideal incisal edge position in removable prosthodonshytics also work well in these applishycations Finding the ideal esthetic position first and then fine tuning with phonetics is an extremely efshyfective technique for finding the ideal incisal edge position

The test begins with the E posishytion described by Kois and Spear 10 The E position determines if lengthening the maxillary anterior teeth would cosmetically improve the case The rule states that if the patient says EEEEEE (Figure 8) an imaginary horizontal line is vishysualized on the upper border of the lower lip A second horizontal line is visualized on the lower border of the upper lip If the incisal edges of the central incisors are half way between these two lines this is the 50 position Maxillary incisors in an older person can be lengthened to 50 and a younger person slightly longer to 70 Figure 9 shows the patients E position at 70 with the resin in place This represents an acceptable cosmetic position for a 23-year-old person We next examine the smile line (Figure 10) in relation to the lip line Notice how the increased length

Figure 9

Figure 10

uniformly meets the lower lip The final test is the F and V sounds (Figshyure 11) It should be noted that these sounds only tell you if the resshytorations are too long not too short The dentist can use the E position to determine optimum cosmetic length and fine tune by shortening as the F and V sounds dictate This insures the best esthetics and phoshynetics Figure 12 represents the gross contouring of the provisional restorations in harmony with the patients esthetics phonetics and function

Figure 11

Figure 12

The lingual contour and the centric stop will not be changed in this case so there is no need for additional communication An alginate imshypression was made of the provisionals and then mounted inshyterchangeably with the die model The laboratory uses the mounted model of the provisionals to make

a putty index of the exact position (Figure 13) The technician then utilizes the matrix to visualize this exact position while he or she foshycuses on all the artistic nuances communicated in the laboratory prescription This eliminates any guesswork when it comes to facial contour or length of the final porceshylain veneer restorations (Figure 14)

Figure 13

Figure 14

At the delivery appointment the area is isolated with a split dam technique (Figure 15) and bonded to place using a total etch techshynique The importance of isolation when dentinal bonding is well docushymented 11 The veneers are bonded to place two at a time beginning at the midline with the central incisors and moving distally When proper time is taken in the planning and provisional stages this appointshyment is one of great joy and conshytains few unpleasant surprises (Fig-

Figure 15


ure 16 17) When state of the art adhesive technology is combined with the tried and true principles of restorative dentistry we can proshyvide our patients with restorations that are not only gorgeous but will serve them for many years

About the Authors Dr John C Cranham has an esthetic orishyented restorative practice in Chesapeake where he resides with his wife and three children He graduated from VCU School of Dentistry Cum Laude in 1988 and teaches a 12 day per week in the AEGD program He lectures extensively on Functional Esthetshyics Posterior Esthetics and Contemporary Occlusal Concepts Dr Cranham also teaches at the Esthetic Epitome with Dr Ross Nash in Charlotte NC He is a pubshylished author on the above subjects Dr Cranham can be reached at 757-465-8900

Dr Christopher A Hooper has an esthetic oriented restorative practice in Virginia Beach where he also resides with his wife and two children After graduating from VCU School of Dentistry Magna Cum Laude in 1990 he attended UMKC Advanced Edushycation in General Dentistry program He lecshytures extensively on Functional Esthetics

Figure 16

Implants and Practice Management Dr Hooper can be reached at 757-496-7300

References 1 Christensen GJ Christensen RP Clinical obshyservations of porcelain veneers A three year report J Esthet Dent 1991 3 174-179 2 Tourati B Miari B Light transmission in bonded ceramic restoration J Esther Dent 1993 5 (1) 11-16 3 Sheets CG Taniguaehi TAdvantages and limishytations in the use of porcelain veneer restorashytions J Prosthet Dent 199064406 4 Stassler HE Nathanson D Clinical evaluation of etched porcelain veneers over a period of 18shy42 months J Esthet Dent 1989 121-28 5 Dawson PE Evaluation diagnosis and treatshyment of occlusal problems Sl Louis MO CV Mosby Co 1989 321-352 6 Cranham JC Nash RW The Functional Esshythetic Interface Compendium June 1999 vol 20 no 6 584-595

Figure 17

7 Cranham JC Hooper CA Contemporary esshythetic restorative dentistry Lecture VCU School of Dentistry October 234 1998 B Dickerson WG Cooperative treatment planshyning in creating Empress SMILES Signature 1996 Summer2-8 9 Garber D Porcelain Laminate Veneers Ten years later part I Tooth Preparation J Esthet Dent 1993 5(a) 57-62 10 Spears F Photography as a laboratory comshymunication tool Dent Economics May 1998 vol 84 no 5 90-91 11 Hormati A Fuller JL and Denchy GE (1980) Effects on contamination and mechanical disshyturbance on the quality of acid etched enamel J Am Den Assoc 10024

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ABSTRACTS

The following abstracts were provided by the Department of Endondontics at VCUMCV School of Dentistry We appreshyciate the contribution that these individuals have made to the Virginia Dental Journal

Hebling J Giro EMA de Souza Costa CA Biocompatibility of an Adhesive System Applied to Exposed Human Dental Pulp Journal of Endodonshytics 1999 25676-682

Acidic conditioners and adhesive resin application to the pulp tissue have been suggested as an effecshytive and innocuous pulp therapy However it has been reported that the components of adhesive sysshytems and composite resins have definite cytotoxicity when in direct contact with fibroblasts Few studshyies using human teeth have been performed to indicate whether or not dental materials can be used for pulp capping of dental cavities with or without pulp exposure The objective of this study was to reshyport the histological features of the pulpodentin complex of human teeth after direct pulp capping with the All Bond 2 adhesive system Histological observations were compared with the pulp response promoted by calcium hydroxide

Thirty-two sound human premolar teeth scheduled to be extracted for orthodontic purposes were divided into three groups A Band C In group A dentin and pulp tissue were directly etched for 15 seconds with 10 phosphoric acid followed by application of primer and adheshysive of the All Bond 2 adhesive sysshytem In group B the axial wall and the pulp tissue were protected with a calcium hydroxide-saline paste

On day 7 group A was associated with abscess formation underlying the adhesive material These teeth also demonstrated large areas of neutrophilic infiltrate and the death of adjacent odontoblasts During the 30 and 60 day periods neutroshyphilic accumulation was replaced by a fibroblastic response Moreshyover resin fragments dispersed in the pulp tissue were found within the plasma membrane of macrophshyages or giant cells A lack of denshytin bridge formation could be shown in all samples in group A In conshytrast group B demonstrated odonshytoblast-like cells underlying coagushylation necrosis caused by the calshycium hyd roxide These teeth showed only small infiltrates of inshyflammatory cells Pulp repair with dentin bridge formation could be seen starting in 30 days and it was apparently complete at 60 days The remaining pulp tissue showed normal histological characteristics In group C the pulp tissue exhibshyited the normal morphology

Studies using human teeth includshying this study have indicated that patients submitted to direct pulp capping with dentin adhesives reshymain asymptomatic for the time periods tested This clinical findshying confirms the lack of a relationshyship between clinical symptoms and histological characteristics of pulp tissue In addition this study showed that there was no radioshygraphic evidence of periapical alshy

terations Consequently the clinishycal radiographic evaluation of teeth submitted to a variable range of pulp treatment can neither predict the biocompatibility of a dental mashyterial nor can it indicate the safety of new pulp therapy Further histoshylogic studies of pulpal response to new techniques and materials are required to determine biocompatility and pulpal response

Dr Linda W Baughan is a second year post graduate student in endodontics at VCUlMCV School of Dentistry She received her DDS from VCUlMCV in 1983 She is presently tenured faculty in the Department of Endodonshytics Virginia Commonwealth University

_----~

Swift Edward J and Trope Martin Treatment Options for the Exposed Vital Pulp Practical Periodontics and Aesshythetic Dentistry 1999 11 (6)735shy739

The exposure of dental pulp genshyerally occurs by accidental trauma or preparation techniques by the clinician While frank carious exshyposures are optimally treated with pulpectomy and root canal therapy the proper treatment for mechanishycally exposed pulps has been conshytroversial The purpose of this arshyticle is to describe the indications techniques and prognosis for two types of vital pulp therapy direct pulp capping and partial pulpotomy

Vital pulp therapy has a high rate of success if the pulp is not inshyflamed the coronal restoration seals out bacteria and a nontoxic pulp dressing is used While the capping of an inflamed pulp can be successful the use of a partial


pulpotomy technique should be considered instead It is essential that bacteria be eliminated during the healing phase or failure is likely to occur Calcium hydroxide is the most common pulp dressing used today Its high pH is antibacterial and causes liquefaction necrosis of exposed pulp which will in turn stimulate secondary dentin formashytion Calcium hydroxide powder and paste preparations such as Dycal and Lifereg are all acceptable as pulp capping agents but require a proper coronal restoration to preshyvent microleakage

DIRECT PULP CAPPING Indicashytions recent laquo24 h) or mechanical exposures on immature teeth or teeth with simple restorative needs Technique Anesthetize rubber dam disinfect tooth with chlorhexidine gently rinse pulp with sterile saline or anesthetic Blot gently with sterile cotton pellet if hemorrhage occurs Place calcium hydroxide then a resin-modified glass ionomer baseliner (eg Vitrebond) Finally place a denshytinenamel bonding system to seal the cavity and then restore with an appropriate restoration Recall at 1 3 6 and 12 months then yearly and use electrical pulp testing thershymal testing palpation and percusshysion to evaluate pulpal health with periodic radiographs to detect the development of any apical patholshyogy Prognosis 80 successful when performed under ideal conshyditions

PARTIAL PULPOTOMY Indicashytions also called Cvek pulpotomy recent (but gt24 h) or mechanical exposures on immature teeth or teeth with simple restorative needs where more extensive pulpal inshyflammation is expected than with a direct pulp cap Technique Anesshythesia isolation and disinfection as described above At the exposure site 1 to 2 mm of the superficial


pulp tissue should be removed with a high-speed diamond bur under copious water irrigation Extend preparation apically if excessive bleeding continues Rinse with sterile saline or anesthetic Dry with sterile cotton pellet Place a calshycium hydroxide paste Place liner bonding system and restoration as described above Recall as above Prognosis 95 for traumatized teeth where pulpal inflammation is limited predictable The success rate for carious exposures is under investigation

Dr Nicole M Yingling is a first year postgraduate student in enshydodontics at VCU School of Denshytistry She received her DMD from the University of Connectishycut School of Dental Medicine in 1992 She is currently on active duty with the United States Air Force ~ ----------

Doroschak AM Bowles WR Hargreaves KM Evaluation of the Combination of Flurbiprofen and Tramadol for Management of Enshydodontic Pain J Endodon 1999 25660-3

Odontalgia has been reported as the most common type of orofacial pain The hyperalgesia associated with odontalgia may be difficult to manage and can present a chalshylenge for the practitioner

This study evaluated the hypothshyesis that a combination of an NSAID (flurbiprofen) and an opioid (tramadol) provide greater pain reshylief than either drug alone Flurbiprofen was selected because it is a potent anti-inflammatory anshyalgesic effective for endodontic pain and tramadol was selected beshycause it is a centrally acting analshygesic

Forty-nine patients reporting sponshytaneous pain originating from a vishytalnonvital tooth underwent pulpecshytomy under local anesthesia The patients were then administered on a double-blind basis either (I) plashycebo (one capsule to start and then every six hours) (II) flurbiprofen (100mg loading dose and then 50mg every six hours) (III) tramadol (1 OOmg loading dose and then 1OOmg every six hours) or (IV) a combination of flurbiprofen and tramadol (II amp III) A pain evaluashytion form was then filled out by the patient six hours after treatment and then for the two days following treatment twice in the AM and twice in the PM Results from the present study demonstrated that definitive dental treatment comshybined with placebo medication reshyduced pain by gt50 by the first day after the emergency appointment and 90 by the second day The combination of the two drugs proshyvided significantly better analgesia in the first 24 hours than that proshyduced by either drug alone After the first 24 hours their effectiveshyness was equivalent to that seen in the placebo group

Since NSAIDS have a ceiling in their analgesic dose-response curve certain patients may require additional pain management therapy with an opioid analgesic and together with endodontic therapy can provide significant short-term (24-hour) pain relief

Dr Harold J Martinez is a secshyond year postgraduate resident in Endodontics at the VCU School of Dentistry He received his DDS degree from the Baltishymore College of Dental SurgeryshyUniversity of Maryland in 1995 Dr Martinez completed a oneshyyear AEGD while on active duty with the US Air Force from 1995 to 1998 ~ - shy

Jones DM Effect of the Type of Carrier Used on the Results of Dichlorodifluoromethane Applicashytion to Teeth Journal of Endodonshytics 1999 10692-694

A valid diagnosis is fundamental in providing proper dental treatment The diagnosis of pulpal disease is most often based on the correlashytion of clinical symptoms and the results of diagnostic tests such as the electric pulp test cold test and heat test Thermal tests have been proven to be one of the most preshydictable tests in endodontics and the cold test has perhaps been the most widely used in pulpal diagnoshysis Agents such as ethyl chloride ice CO

2 snow (dry ice) and dichloshy

rodifluoromethane (DDM) have been reported for use as a source for cold DDM is sold commercially as Endo Ice This study detershymined the temperature changes produced within the pulp chamber after applying DDM in a spray or liquid form to the surface of a tooth using four different applicators

The apical 20 to 30 mm of an exshytracted mandibular incisor was secshytioned and a thermocouple wire placed into the apical foramen unshytil the tip of the wire reached the pulp chamber A radiograph was exposed to ensure proper placeshyment of the wire The root of the tooth was securely held in position by a wooden pin positioned on a table Four different applicators were used to test temperature changes (i) 2 cotton pellets (large) (ii) 4 cotton pellets (small) (iii) wood handle cotton-tip applicashytors and (iv) cotton rolls Each of the applicators was tested 10 times The DDM was sprayed dishyrectly onto the cotton pellets from a distance of 50 mm for 3 seconds This allowed the applicator to beshycome saturated to the point of havshying DDM dripping from the applishycator The intrapulpal temperature

was recorded prior to placement of the dripping applicator onto the midfacial surface of the crown for 10 seconds A second temperature was recorded after placement of the applicator and the difference beshytween the two readings was calcushylated to determine the change in pulp chamber temperature

The 10 cotton-tip applicators and cotton rolls were tested in the same manner as the cotton pellets except that they were held directly on the tooth instead of with cotton pliers The entire procedure was then reshypeated except the four applicators were saturated with DDM in the folshylowing manner DDM was sprayed into a paper cup until a liquid had formed in the bottom of the conshytainer Each applicator was then dipped into the liquid until satushyrated The applicators were applied to the teeth as stated above and temperatures were recorded

The mean temperature change in degC after direct spray ranged from 5 degC with the cotton tip applicator to 471 degC with the large cotton pelshylet The small cotton pellet and the cotton roll changes were 28 degC and 58 degC respectively The results after submergence in DDM were similar with the mean change of the large cotton pellet being 391 deg and the cotton-tip applicator being 9 degC The large cotton pellet when sprayed or dipped was found to be significantly different from all other groups All other groups were not significantly different from each other The larger cotton pellet (2) held by stainless steel forceps was found to be significantly better than the other carriers in obtaining and holding reduced temperatures

The volume of DDM each applicashytor could hold seemed to be the determining factor in mean temshyperature change The small cotton pellet did not offer enough material

to hold sufficient amounts of DDM to significantly reduce the temperashyture The cotton-tip applicator also held less volume of DDM and the tightly wound cotton fibers may not have allowed complete penetration of the DDM Additionally the wooden stick may have acted as an insulator The cotton roll allowed for more volume of DDM but could have allowed wicking of the DDM into the unsprayed end thereby reshyducing its effect

In conclusion a sprayed large cotshyton pellet produced the coldest temshyperatures within the pulp chamber when compared with the other apshyplicators The mean temperature change of 35degC to 45 degC as seen with the large cotton pellet should allow for truly diagnostic pulp tests

Dr David B Ferguson is a firstshyyear postgraduate student in enshydodontics at MCVNCU School of Dentistry He is a graduate of Kansas State University and reshyceived his DDS degree from the University of Missouri-Kansas City School of Dentisty 1990 Dr Ferguson completed an AEGD with the US Army Dental Corps in 1991 He is currently a Major and will return to active duty afshyter completion of the endodonshytic residency

Tamse A Fuss Z Lustig J Kaplavi J An Evaluation of Endodontically Treated Vertically Fractured Teeth Journal of Endodontics 1999 July 506-508

A vertical root fracture (VRF) in an endodontically treated tooth is a postendodontic treatment complishycation that leads to extraction of either tooth or root The VRF may be a longitudinally or diagonally orishyented root fracture either originatshying in the crown or limited to the root


only The signs symptoms and radiographic features may imitate periodontal disease or root canal treatment failure thus making dishyagnosis difficult

The purpose of this survey was to evaluate the clinical manifestations and radiographic features of 92 endodontically treated teeth reshyferred for extraction after a clinical diagnosis of VRF or endodontic failshyures and that proved to indeed have a VRF following the extraction

Patients from five public clinics were referred from July 1995 to January 1997 to one oral surgeon for extraction accompanied with the initial diagnosis of VRF or enshydodontic failure and a recent radioshygraph Patients were examined by the oral surgeon for chief comshyplaints and for sig ns and sympshytoms (a) sensitivity to palpation and percussion (b) presence and locashytion of a fistula (c) presence locashytion and depth of a periodontal pocket and (d) swelling The dishyagnostic periapical radiographs and clinical findings were later evalushyated by the authors

The results revealed that premolars were the predominant group to have VRFs (52) Of that the maxillary second premolars acshycounted for 272 of the fractures In the mandible the fracture was found in the mesial root of molars 24 of the time Pain (51) or abcess (31) was the major comshyplaint The most predominant clinishycal sign was deep pockets in 62 cases (67) Usually these pockshyets were located on the buccal Other signs and symptoms were sensitivity to percussion mobility and a fistula The most significant finding was that a combination of periapical and lateral radiolucency (often described as halo or Jshyshape) was present in 58 cases (63)


Diagnosis of VRF in an endodontishycally treated tooth is a complicated problem for the clinician This is evident from this study in which the diagnosis of root canal failure by the referring dentist was made in 53 of the cases In only 33 of the cases was the correct diagnoshysis of VRF made This study identishyfied some of the prominent clinical findings and radiographic features for VRFs in endodontically treated teeth that can help the practitioner make a correct diagnosis of VRF

Dr Mark A Kerr is a first-year postgraduate student in Endoshydontics at the VCU School of Dentistry He received his DDS from VCU School of Dentistry in 1996 After graduation Dr Kerr completed an AEGD program at VCU and then practiced general dentistry in the Richmond area

Nielson CJ Periapical Repair after Conservashytive Treatment of a Cariously Inshyvolved First Molar Journal of Endodontics 1999 Jan60-62

The purpose of the article was to present a case report wherein exshyisting pathology including both bone and root resorption was sucshycessfully treated and pulp vitality maintained by restoration of a deep carious lesion in a mandibular first molar

Moore in 1967 was the first to reshyport successful restitution of perishyapical health by the use of both inshydirect and direct pulp-capping proshycedures His protocol included treating deep caries with calcium hydroxide then at a subsequent apshypointment removing all the remainshying carious dentin and restoring Sapone in 1976 reported two cases of cariously involved teeth with peshy

riapical lesions that were successshyfully treated with direct pulp capshyping Jordan et al in 1976 used a protocol in which subsequent reshymoval of the remaining caries was not done after initial indirect pulp capping and was able to show resoshylution of periapical pathosis with preservation of pulp vitality in 11 cases

The author presented a case involvshying a 23 year old male with a deep carious lesion in the mandibular right first molar The patient was asymptomatic and was currently demonstrating normal responses to thermal and electric vitality testing and percussion Distinct apical rashydiolucencies were noted on the blunted distal and mesial roots along with condensing osteitis With the absence of clinical symptoms the decision was made to temposhyrarily restore the tooth then evalushyate and permanently restore at a future date if symptoms did not arise Complete caries removal without a carious or mechanical exposure and placement of an IRM restoration was indicated at this time 7 weeks later the IRM was left in the deepest portion of the preparation and an amalgam resshytoration was placed over the IRM base The patient was reevaluated at 8 weeks post-amalgam placeshyment 8 months and 11 months with updated radiographs At all time intervals the bone revealed osshyseous healing with diminishing osshyteitis The tooth remained asympshytomatic throughout the reevaluation period and tested normal to percusshysion thermal test and the EPT at the final appointment

Bottom Line No report has ever shown success in patients over the age of 24 years old The author suggested that patients under the age of 24 years old would have younger pulps which could withshystand the onslaught of carious inshy

suits due to the richer blood supply and natural defenses Case selecshytion and diagnosis are considered critical to the success of these cases Clinical success depends on a tooth demonstrating vitality to thermal and electrical stimulation an absence of spontaneous pain and an absence of rarefactions on the radiographs

Dr John T Marley is a second year-postgraduate student in enshydodontics at MCVNCU School of Dentistry He received his DDS degree from the State University of New York at Buffalo School of Dental Medicine in 1994 He is presently on active duty with the US Army and will continue to serve on active duty upon completion of the program

---~----

Fan S Wu M-K Wesselink PR Coronal leakage along apical root fillings after immediate and delayed post space preparation Endodontics amp Dental Traumatolshyogy 1999 15124-126

In some cases an endodontically treated tooth whose treatment afshyter an evaluation period is clinically and radiographically successful needs to be restored with a post and core and artificial crown In this case delayed post space preparashytion is required This preparation procedure may damage the sealer which has set in the apical root cashynal thus compromising the apical seal Performing post space prepashyration immediately after root canal obturation but before the sealer cement sets may however mean that the apical seal remains intact

The purpose of this study was to measure microleakage along the apical root fillings in a crown-apex direction after immediate and deshylayed post space preparation using

The difference in leakage between the fillings using different sealers was not sigshynificant and the data of using different sealers were pooled to form two groups each of 40 teeth imshymediate and delayed post space preparashytion The apical root fillings after delayed post space preparashytion leaked signifi shycantly more than those after immedishyate post space preparation

In this study delayed post space preparashytion resulted in more leakage than immeshydiate preparation which was in agreeshyment with the results in previous studies

the modified fluid transport device An aseptic technique should be Eighty human mandibular maintained especially during deshypremolars each with a single canal layed post space preparation and were obturated with laterally conshy subsequent post cementation The densed gutta-percha cones and a post space should be well irrigated sealer Immediate post space before cementation and the post preparation was carried out on half should preferably be cemented with the number of teeth and delayed the tooth under rubber dam If an post space preparation performed aseptic technique is not used conshy1 week after canal filling on the reshy tamination during these procedures maining 40 teeth Leakage along may jeopardize apical healing the apical root fillings was detershymined using a fluid transport device Dr Peter Mayer is a second year under a head space pressure of 30 postgraduate student in EndoshykPa (03 atm) dontics at the VCU School of

Dentistry He received his DDS The results revealed that after imshy degree from Case Western Reshymediate post space preparation no serve University School of Denshyfilled root showed leakage regardshy tistry in 1988 Upon graduation less of the type of sealer used he completed a GPR at When delayed post space prepashy Southside Hospital in Youngshyration was performed five apical stown Ohio Dr Mayer served root fillings using AH26 and two apishy in the US Navy Dental Corps cal root fillings using Pulp Canal from 1989 to 1998 Sealer showed leakage of less than or equal to 20 microliters per day

1999 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 requlations

Nora M French DMD Monroe E Harris Jr DDS Michael J Link DDS French H Moore Jr DDS Gopal S Pal DDS Gary Taylor DDS Richard D Wilson DDS Carolyn B Hawkins RDH Stephanie P Olenic RDH Susan A Underwood Citizen Member

STAFF Marcia J Miller Executive Director Pam Horner Administrative Assistant Kathy Lackey Administrative Assistant Ida Hill Office Services Specialist 6606 W Broad Street 401 Richmond VA 23230-1717 (804 )662-9906 FAX(804 )662-9943


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OVERVIEW OF VIRGINIAS SALES TAX FOR DENTISTS II II David S Lionberger Esquire - Christian amp Barton LLP

Virginia imposes a sales tax upon purchases of tangible items (other than real property) in Virshyginia A complementary tax the use tax is imposed upon tangible items which are acquired outside of Virginia (ie not subject to Virshyginia sales tax) but are used in Virginia Localities also impose sales and use taxes and the combined state and local sales tax rate and use tax rate is 45 of the sale or cost price of an item Code of Virginia sectsect 581-603 to 581-605

Medicines and drugs dispensed by or sold on prescriptions or work orders of licensed dentists are related to the provision of proshyfessional medical services and may be sold to patients free from the state and local sales and use tax Code of Virginia sect 581shy6097 23 Va Admin Code 10shy210-940 However except for controlled drugs purchased by lishycensed physicians dentists are generally deemed to be the conshysumers of all tangible items purshychased for use in their practice Therefore dentists pay the sales tax on any purchases of supplies used in providing dental or orthshyodontic services (including bulk orders) (eg administrative supshyplies medical supplies and misshycellaneous items used in pracshytice) 23 Va Admin Code 10shy210-2060 Ruling of Commisshysioner PO 98-103 May 26 1998 Ruling of Commissioner May 30 1984 If the supplier falls to collect the sales tax at the time of purchase the dentist should report the tax by filing a consumer use tax return Form ST-7

Pursuant to an exception effecshytive in 1998 non-prescription drugs and proprietary medicines acquired for the cure treatment or prevention of disease are free from sales tax regardless of the status of the purchaser Thus dentists may acquire these items for use in their practice free from sales tax and may sell these items to patients free from sales tax The Department of Taxation has issued some guidance on this test for instance ruling that toothshypaste and cod liver oil do not qualify for the exemption since they are not primarily medicines Ruling of Commissioner PO 99shy32 Mar 18 1999 Essentially the Department considers three factors to determine whether a particular item constitutes a nonshyprescription drug andlor proprishyetary medicine

1) Is the item a non-prescripshytion drug (ie a substance or mixture of substances containing medicines or drugs for which no prescripshytion is required)

2) Is the product for topical or internal use and

3) Is the product for the cure mitigation treatment or preshyvention of a disease in hushyman beings

The Department consults the Federal Food and Drug Administrations guidelines in the classification of products for purshyposes of the non-prescription drugs and proprietary medicines exemption

Further the sales tax does not apshyply to durable medical equipment

purchased by or on behalf of an individual patient Durable medishycal equipment is that which (1) can withstand repeated use (2) is primarily and customarily used to serve a medical purpose (3) generally is not useful to a pershyson in the absence of illness or injury and (4) is appropriate for use in the home 23 Va Admin Code 10-210-940 The fact that an item is purchased from a medishycal equipment supplier is not disshypositive of its exempt status In order for an item to be exempt from the tax it must meet all of the above criteria

For example the sales tax applies to sales to a dentist by a dental laboratory or supplier of dentures plates braces and similar prosshythetic devices or the component parts thereof unless such denshytures braces etc are purchased on behalf of a specific patient If such items are purchased in bulk by a dentist and then dispensed to a particular patient the origishynal purchase by the dentist will be subject to the tax even if the items withdrawn from the bulk inventory are modified for a specific patient However the tax does not apply to charges by the dentist to the patient for such dentures plates braces etc 23 Va Admin Code 10-210-500

Sales tax applies to purchases by a dentist of furnishings equipshyment tools and all other dental supplies of any type

By contrast the sale of a service other than services to fabricate an item for a customer or services which are provided in connection


with or as part of the sale of tanshygible items is not subject to sales tax or use tax Dentists are deemed to be providing professhysional services thus the sale of such services to a patient is not subject to sales tax The charge for any dental services provided should be clearly separated from any charge for tangible items proshyvided to a patient Code of Virshyginia sect 581-6095(1) 23 Va Admin Code 10-210-2060

Dental laboratories engaged in

the production of dentures and prosthetic items are generally deemed to be industrial manufacshyturers who can qualify to buy mashyterials used directly in manufacshyturing such items exempt from sales tax When dental laboratoshyries make sales of such items to dentists they must collect and pay the tax on all charges for such property including any charges for labor or other expenses since the labor is considered to be proshyvided in connection with the sale of the tangible item

David S Lionberger is an associate with the Richmond Virginia law firm of Christian amp Barton LLP He practices in the tax corporate and busishyness law departments

~I DIRECT REIMBURSEMENT NEWS

Ronya Edwards Marketing and Programs Coordinator

A Look Back at 1999

1999 was a good year Benefits Administration Inc (BAI) signed on 11 new firms in 1999 As of December 31 1999 BAI adminshyisters DR plans for a total of 32 companies in Virginia bringing the total number of lives covered under a DR plan to approximately 5300 Two new firms are schedshyuled to sign on to a DR plan on January 1 2000-Chesapeake Hardware Products Inc in Newshyport News and NCS Technoloshygies Inc in Sterling

As of December 1 1999 the ADA has reported 312 DR implemenshytations have taken place nationshyally as reported by those states participating in the DR campaign Also there have been 3587 inshyquiries and requests for more inshyformation on DR received by the ADA The word is spreading and more and more CEOs CFOs HR Managers and brokers are beshycoming more aware of Direct Reshyimbursement


A Look Into 2000

The ADA House of Delegates voted to continue the DR marketshying campaign for another three years So now the ADA is planshyning to modify their marketing strategy to include two new print advertisements with more conshycise messages and strong calls to action and an expansion of the target audience to include comshypanies of between 25 and 2999 employees

The VDA will continue to support the ADAs campaign with our own marketing efforts on the state level The VDA promotes DR through trade shows magazine advertisements targeted mailings to CEOs CFOs and HR managshyers of Virginia businesses DR information packets for employshyers broker training and through the VDA web site The VDA not only tries to educate employers about DR but also VDA member dentists and dental office staff through DR dental information

packets mailings free brochures and educational materials for dental professionals and patients and speaking about DR at comshyponent and study club meetings

The VDA Direct Reimbursement Committee with the help of Jon Swan and Cork Coyner of Benshyefits Administration Inc is hard at work trying to promote DR throughout Virginia and to come up with innovative and effective ways of educating more people about DR If you have any feedshyback or would like to learn more about Direct Reimbursement or maybe even have a possible DR lead please contact Ronya Edwards at the VDA office

REPORT ON THE 1999 ADA HOUSE OF DELEGATES

Wallace L Huff DDS Chairman VA Delegation

Approximately 32000 attendees consisting of dentists team memshybers exhibitors and guests were present at the 140th annual session of the American Dental Association held in Honolulu Hawaii October 9-131999

This was the first time that the ADA annual session had been held at the Ilew Hawaii convention center and was also the largest but as Dr Kathryn Kell chair on ADA Sesshysions and International Programs stated The people of Hawaii and the convention center representashytives went all out to accommodate each attendee Everyone really had the Aloha Spirit Everyone seemed excited to be there and were having a great time

Dr Richard F Mascola a Prosthshyodontist from Jericho NY was inshystalled and the 136th President of the association Dr Robert M Anderton a general dentist and lawyer from Argyle Texas who served as 15th district trustee on the ADA board of trustees was elected by the house as President-Elect of the ADA in a two way race

Candidates for the offices of the First Vice President Second ViceshyPresident and speaker of the house of delegates ran uncontested as did trustee candidates for four districts Elected unanimously were Dr J Kendall Dilletray Wichita Kansas as first Vice President and Dr Ronald B Gross Dottstown PA as Second Vice-President Both Dr Dillehay and Dr Grose are orthshyodontists Dr James T Fanno (also an orthodontist) from Canton Ohio was elected for a fifth term as speaker of the house

The four new trustees are Dr Edwins S Mehlman an endodonshytist from Providence RI 1st district Dr Richard Haught a general denshytist from Tulsa OK 12th district Dr Edward Leone Jr a general denshytist in Denver CO 14th district and Dr Frank K Eggleston a general dentist in Houston TX 15th district

Dr Rene M Rosas is beginning his fourth year as treasurer and Dr John S Zapp continues to serve as the ADA Executive Director

Congressman Charlie Norwood (RshyGA and a dentist) made an unexshypected visit to the first meeting of the HOD on October 9 and was greeted by an standing ovation The applause was for the work Congressman Norwood had done in getting the US House of Repshyresentatives to pass the ADA supshyported patients bill of rights 275-151 on October 7 Congressmen Norwood and John Dingell (D-NY) cosponsored this patient protection legislation Rep Norwood gave much of the credit for this legislashytive victory to the delegates the asshysociations non-stop lobbying for efshyfective patient rights legislation and to the ADA grassroots action teams

The ADA has already achieved nushymerous legislative victories through the grassroots efforts but to ensure that our profession is not only beshying protected from issues that afshyfect our profession now we must continuously prepare for issues in the future With these thoughts in mind the HOD ratified the recomshymendation from ADPAC and the council on government affairs that the association develop a new spring conference in Washington

that would combine grassroots training and in depth education on issues of importance to dentistry The House further voted to ensure that all action team leaders be given the opportunity to attend this conshyference As in the past the ADA will pay airfare for action team leadshyers or their designated alternate

The American Dental Political Acshytion Committee (ADPAC) received $75325 in capital club contributions at the national meeting in Honolulu A one year membership in the capishytal club requires a minimum $100 contribution and is separate from the contributors state dental PAC contributions ADPAC provides poshylitical education and contributes to selected candidates for congresshysional office and supports the asshysociation network of grassroots dentists who work with members of congress to advance the professhysions legislative agenda I would like to inform the dentists of VA that all delegations of the 16th district (VA SC and NC) had 100 parshyticipation in this endeavor and that also included the executive direcshytors I want to personally thank the Virginia delegation for demonstratshying their leadership and commitshyment to our profession by particishypating in ADPACs major donor program to ensure that dentistry has a role in electing the people who will write the laws that affect the delivery of dental care

The house considered more than 133 resolutions and as anticipated the resolutions dealing with new specialties in the dental profession received the most activity The three (3) applicants seeking speshycialty status in this years house were oral and maxillofacial radiol-


ogy dental anesthesiology and oral medicine Of the three only oral and maxillofacial radiology received the HODs approval on all six of the requirements for specialty recognishytion and become the first new speshycialty in dentistry in the last 36 years Endodontics was the last specialty before this Dental anesshythesiology and oral medicine failed to get the needed votes on all the requirements set by the national certifying boards for dental specialshyists The majority of testimony for both of these specialities focused on compliance with requirement 4 which stated that in order to be recshyognized as a specialty substantial public need and demand for sershyvices which are not adequately met by general practitioners or dental specialists must be documented Both of these applicants failed to meet that requirement Dr Mascola the ADAs new president complemented the house vote on OMR by stating that the advancing new technology and complex oral health procedures in our profession indicated the need for a new specishyality Rest assured you will be hearing more from the other speshycialty applicants at future HODs meetings

As always the 2000 budqet was a featured agenda of the 1999 House (Resolution 38) As you may reshycall the 1998 HOD directed that $343 ($382 less $25 for DR (directshyRebursement)and $14 for one-time programs be used as the baseline membership dues figure for the 2000 budget Keeping this fact in mind the full dues payment for ADA members will be $395 for the year 2000 The increase is $52 against the base figure but only $13 more than full dues paying members paid last year The increase in dues will help cover a $64 million deficit in next years $70718490 budget The task of deciding which proshygrams are essential and which


ones can be eliminated based on revenue seems to get more difficult each year

One of the resolutions adopted by the HOD with a high budgetary imshypact was Res35 - Direct Reimshybursement This resolution directs the ADA to conduct a second three year national marketing campaign to promote DR for another three years The resolution also calls for the ADA to provide support for conshystituent dental societies that are inshyterested in doing their own promoshytional campaigns - and that progress reports on the campaign be presented to the House each year The $25 million funding is subject to yearly approval by the HOD The DR Campaign now inshyvolves 42 Constituent dental socishyeties Overall awareness of DR has gone from 0 in 1996 to 80 today

The resolution dealing with dental indicators received almost as much activity as the specialities The committee report that came from a 1996 House resolution defined denshytal indicators as assessment inshystruments The Reference Comshymittee heard many speakers voice concerns that the indicators could be used against dentists in their dealings with third parties or in lawshysuits The Board of Trustees supshyported Res 87 from the 5th District which called for the Dental Indicashytors Committee and program to be disbanded Res 87 was adopted by the House and all the resolutions that were related to dental indicashytors (13 resolutions) were declared moot Chuck Norman (NC) Chairshyman of the Council on Dental Pracshytice is to be commended on the hard work he and his committee put forth on this issue

Resolution 114 approves up to $400000 be appropriated from the ADA Capital Improvement Program account to prepare appropriate arshy

chitectural interior design plans and to solicit bids for the completion of the renovation of the Chicago Headquarters Building The Board of Trustees are to report the proshyjected costs and proposed funding to the 2000 HOD

Other significant resolutions that were passed by the House

Res 112H - Urges that the ADA Board of Trustees investigate and report by next April the financial poshylitical and administrative conseshyquences of HR 1304 and similar legislation to the Association its constituents and components HR 1304 would allow physicians denshytists and other health professional to negotiate contracts collectively with Health Plans and the House is asking the Board to look careshyfully at the ramifications of such legshyislation at the local state and nashytional levels

Res 50H - Encourages dental schools and ADA component and constituent societies to enhance communication and work together to address issues of mutual imporshytance including access to care and development of satellite dental clinshyics

Res 68H - Calls for ongoing supshyport to implement and maintain an ADA allied dental personnel recruitshyment and retention program to be funded in 2000 for $72150 Apshypropriate ADA agencies will estabshylish an oversight recruitment and reshytention committee for immediate implementation of proposed proshygrams

Res 71H - Directs the ADA to supshyport lifelong continuing education of its members and encourages varishyous methods of demonstrating conshytinued competency through overshysight of practitioners by state

boards of dentistry and peer review The ADA discourages mandated periodic in-office audits or compreshyhensive written examinations to asshysess continued competency or as a requirement of license renewal The ADA encourages new methods of supporting continuing compeshytency and will promote this policy in all discussion of competency isshysues

Res 78H - Calls for a recruitment campaign to attract qualified stushydents including qualified underrepresented minorities - into dentistry The proposed program and its finances should be submitshyted to the 2000 House of Delegates for consideration

Res 89 - Calls for the ADA to closely monitor all activities in the area of continuing competency The resolution was referred to a Board-appointed task force which has been charged with developing Dentistry-The Model Profession a position paper on issues of regushylatory boards government strucshyture profession authority and conshytinuing competency The paper will be presented to the Board of Trustshyees at its April 2000 meeting

The 1999 House of Delegates adoption of Res 11 H amends the Associations Guidelines of licenshysure policy as it relates to licensure by credentials

Res 3H - Directs the Association to encourage state dental societies to educate professionals and conshysumers about fluoride to urge state and local dental public health and drinking water authorities to idenshytify the states groundwater sectors with natural fluoride levels above 20 parts per million and to comshymunicate with local health and drinking water authorities about standards for fluoride levels Dishyrects the Association to urge denshy

tists to become familiar with fluoshyride concentrations that exceed 20 parts per million in their local water supplies and to provide approprishyate counseling to patients in an efshyfort to reduce the risk of dental fluoshyrosis in permanent teeth

Res 4H - Accepts provisional or inshyterim restorations and prostheses as valid treatment modalities that should be reimbursed Directs Asshysociation to urge third-party payers to accept this policy

Res 24H - Urges that state tobacco settlement funds be targeted toshyward improving health and reducshying the morbidity and mortality of tobacco-related diseases Further urges that state tobacco settlement funds be used to increase funding to dental programs in order to imshyprove access to care for underserved populations Also urges that a portion of state tobacco settlement funds be targeted toshyward tobacco control programs Urges the Association to continue to assist constituent dental societshyies in forming strategies that proshymote the use of state tobacco settlement funds accordant with Association policy

Res 83H - Declares that a thirdshyparty challenge of a dental treatshyment plan be considered diagnoshysis and thereby constitutes the practice of dentistry which can only be performed by a dentist licensed in the state where the treatment was rendered Encourages the American Association of Dental examiners state dental associashytions and states board of dentistry to adopt this position and pursue legislation andor regulations to meet this end

Res 111 H - Calls for the Associashytion to seek or support legislation opposing inappropriate third-party payer overpayment recovery pracshy

tices Encourages state dental soshycieties to seek or support legislashytion to prevent third-party payers from withholding fully assigned benefits to a dentist when an incorshyrect payment has been made to the dentist on behalf of a previous pashytient with the same third-party payer

Res 15H - Adopts new policy on health information confidentiality and privacy that

bull supports legislation to protect patient health information

bull limits third-party use of patientshyidentifiable information to that necessary for proper patient care except for specified reshysearch purposes

bull establishes patient protections and rights with regard to pershysonally identifiable health inforshymation and how that informashytion is used

bull declares immunity from liability for health care providers who unintentionally release confishydential information or who propshyerly disclose information subseshyquently disclosed or misused by a third party and

bull requires that law enforcement officials obtain proper authorishyzation to examine patient records

Res 47H - Amends the ADA Prinshyciples of Ethics and Code of Proshyfessional Conduct by adding a new POSTEXPOSUREBLOODBORNE PATHOGENS section

All dentists regardless of their blood borne pathogen status have an ethical obligation to immediately inform any patient who may have been exposed to blood or other po-


tentially infectious material in the dental office of the need for postexposure evaluation and folshylow-up and to immediately refer the patient to a qualified health care practitioner who can provide postexposure services The dentists ethical obligation in the event of an exposure incident exshytends to providing information conshycerning the dentists own bloodborne pathogen status to the evaluating health care practitioner if the dentist is the source individual and to submitting to testing that will assist in the evaluation of the pashytient If a staff member or other third person is the source individual the dentist should encourage that pershyson to cooperate as needed for the patients evaluation Also directs the Council on Scientific Affairs to develop and publish a report on postexposure protocols and reshysources for further information

Res 74H - Urges constituents soshycieties to support enactment of legshyislation giving each Board of Denshytal Examiners the means to stop unshylicensed dental or dental hygiene practice

Res 92H - Directs the Association to support and encourage states to adopt adequately funded fee-forshyservice models for Medicaid proshygrams to increase dentist participashytion and increase access to care for Medicaid participants

Res 21H - Changes the office of ADA treasurer to make it an elecshytive one establishes rules for the election of treasurer and specifies that the treasurer may serve a maximum of two consecutive threeshyyear terms of office The resolushytion also urges the Board to amend its rules to designate the treasurer as chairman of the Administrative Review Committee and to amend its rules to correspond with the amendments to the Constitution


and Bylaws made in this resolution Res 29H - Directs the ADA presishydent to appoint a task force to study the allocation of delegates and the composition of the ADA House of Delegates The task force shall consist of one member from each of the 16 trustee districts and findshyings and recommendations are to be reported to the 2000 House of Delegates

Res 46H - Authorizes the Future of Dentistry Project directing that a report be made to the 2000 House of Delegates

Res 1H - Amends the ADA Bylaws Chapter XVII Finances by the adshydition of new Section 50 Special Assessments to allow the House of Delegates the option of approving special assessments to fund speshycific projects that are of limited dushyration

Res 85H - Calls for a study of the Active Life member category to consider an allowable income level or hours worked that would permit Active Life members to pay no dues and maintain membership for report to the 2000 House of Delegates

A special thank you goes to

Ron Tankersley who served as chairman of the 16th District Caushycus and did an outstanding job

Will Allison who served as parliashymentarian for the 16th District Caushycus

Dr Terry Dickinson our new VDA Executive Director and Staff (espeshycially Bonnie Anderson) for the arshyrangements in Charlottesville VA Everyone was most appreciative of the effort put forth to ensure that the 16th District had an enjoyable meetshying in a great location in preparashytion for the 1999 ADA HOD Thanks also for the support

throughout the annual session in Honolulu Hawaii And last but not least - for his selection of attire that made the Va Delegation the brightshyest and sharpest looking group there Well - at least we were able to find a fellow delegate without much effort

The members of the VA Delegation - Drs Weisberg Deginder Klima Cooke Barnes and Cuttino who were the reporting caucus chairpershysons of the Reference Committee that they served on Thanks for a job well done

Rod Klima (Chairman of VADPAC and the 16th District representative to ADPAC 2000) for his efforts in helping the 16th District achieve 100 participation in ADPACs capital club Thank you Rod and congratulations on your appointshyment to ADPAC 2000

The outgoing VDA delegation members Will Allison and Manny Michaels Both Will and Manny have played key roles in the sucshycess of the VDA Delegation Both have been an asset to our professhysion the VDA and the ADA Both of them will be sorely missed not only by the members of the VA delshyegation but by all who have been fortunate enough to have served with them Thanks for your tireless efforts and ajob well done I would also like to recognize Ken Morgan (NC) who is also retiring as a delshyegate Thank you Ken for the many contributions you have made to our profession

I want to thank all the members of the Virginia Delegation for their conshyscientious and tireless efforts put forth from the pre-convention caushycus at the Boars Head Inn Charlottesville VA to the Convenshytion Caucus Reference Committee hearings and House of Delegate Sessions in Honolulu Hawaii Evshy

eryone did a superb job and they are to be commended for their great effort

Bettie McKaig (NC) who served as 1st VP of the ADA this past year Thanks Bettie for a job well done

Congratulations to Charlie Cuttino who was elected Secretary-Treasurer of the 16 th

Trustee District (Year 2000)

Dave Anderson who served as 16th

District Teller to the HOD in Honoshylulu

Mannie Michaels (one of my menshytors) who was installed as Presishydent of the International College of Dentists in Honolulu (US Section)

Hang M Dang a dental student from Virginia Commonwealth Unishyversity who was a winner of the 1999 ADADentsply Student Clinishy

cian Competition You make all of us in the dental profession proud Thank you

Our Trustee Dr Greg Chadwick who has announced his candidacy for President of the ADA Greg has been an involved and effective leader as the 16th District Trustee and has represented us with disshytinction at the ADA in Chicago He is committed to our profession and has the knowledge and the experishyence to lead the American Dental Association It would be an honor for the 16th district to have this leadshyership bestowed upon another one of our own (Dr Jim Gaines (SC) and our own favorite son Dave Whiston have both served as President of the ADA) The camshypaign has started and more inforshymation will follow

Dr Carroll Player (SC) who was elected to replace Dr Chadwick as

our trustee when he finishes his term in 2000 I feel confident that we will receive the same high calishyber of leadership from Dr Player that we have come to expect from our past trustee Dr Chadwick

Members of the VA delegation who serve on ADA Councils and Comshymittees are

Charlie Cuttino - Council on Dental Benefits Proshygrams

Rod Klima - ADPAC (2000) Chris Hamlin - Council on Ethics

By-laws and Jushydicial Affairs

The 2000 16th District Caucus will be September 22-24 at the Emshybassy Suite Greensboro South Carolina Hal Zorn the Executive Director of SCDA will be in charge of the arrangements

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VDA 1999-2000 COMMITTEES [II II The 2000-2001 VDA Membership Directory amp Resourse Guide has not been produced yet Below is an updated list of the VDA 1999-2000 Committees for your convenience

ANNUAL MEETING Dr A Carole Pratt Chairman Dr Ralph L Howell Jr Dr Corydon B Butler Jr Dr John M Bass Dr Frank D Straus Dr Edward M OKeere Dr Patrick J Woznak Dr Kirk Norbo Ex Officio Dr Andrew J Zimmer President Dr David C Anderson President-Elect Dr Thomas S Cooke III SecretaryshyTreasurer Dr Michael E Miller VSOMS

AUXILIARY EDUCATION amp RELAshyTIONS COMMITTEE Dr Alan W Mahanes Chairman Dr Theodore A Blaney Dr Michael R Hanley Dr Elizabeth C Reynolds Dr Jeffrey A Clifton Dr Dana H Chamberlain Dr John E Boyles Dr Sudha P Patil At-Large Dr Ronald G Downey Dr Charles R French II Dr Patrick D King Dr Albert L Payne Dr J Roger Kiser Sr(VDAA Liaison)

BUDGET amp FINANCIAL INVESTshyMENTs COMMITTEE Dr James W Baker Chairman Dr Wayne E (AJ) Dr David R Ferry Dr Charles E Gaskins III Dr William W Martin Dr David L Stepp Dr Gerald J Brown Dr Charles R French II Ex Officio Dr Thomas S Cooke III SecretaryshyTreasurer

CANCER AND HOSPITAL DENTAL SERVICE COMMITTEE Dr Michael E Miller Chairman Dr James E Krochmal Dr L Warren West Dr Jonathan E Carlton Dr James P Julian Dr Michael A Abbott Dr R Jonas Collins Dr Patrick J Dolan At-Large Dr Karen C Day Div Dental Health State Health Dpt Dr William S Deeley Va Society of Pediatric Dentistry Dr Jeffrey 11 Kenney VSOMS

COMMITTEE ON THE NEW DENTIST Dr Carolyn C Herring Chairman Dr Todd Bivins Dr Matthew D Dollar Dr Dr Marc A Beltrami Dr Karen McAndrew Dr Garland G Gentry Dr Timothy E Collins Dr Peter K Cocolis Jr EX-OFFICIO Dr Russell N Mosher MCV Student Liaison Darcy Amacher

CARING DENTISTS COMMITTEE Dr Harry D Simpson Jr Chairman Dr Allen S Zeno Dr Carl D Hellberg Dr Gordon Prior Dr Victor S Skaff Jr Dr George D Gilliam Dr Thomas M Starkey Dr Michael S McCann At-Large Dr Walter H Dickey Virginia Board of Dentistry Liaison Repshyresentative

COMMITTEE FOR DIRECT REIMshyBURSEMENT Dr David Swett Chairman Dr C Mac Mahanes Dr Mitchell A Avent Dr C Sharone Ward Dr Marcel G Lambrechts Jr Dr James K Muehleck Dr Susan F OConnor

Dr Theodore P Corcoran At-Large Dr Steven J Barbieri (Endodontics) Dr John A Svirsky (Oral Pathology) Dr Ronald L Tankersley (Oral Surshygery) Dr Robert A Miller (Orthodontics) Dr Kathryn A Cook (Pediatrics) Dr Benita A Miller (Periodontics) Dr Douglas D Wendt (Prosthodontics) Ex Officio Dr Leslie S Webb Jr

COMMUNICATION amp INFORMATION TECHNOLOGY COMMITTEE Dr Dennis E Cleckner Chairman Dr Corydon B Butler Jr Dr Brian Dixon Dr CarlO Atkins Jr Dr James W Shearer Dr Claude V Camden Jr Dr Robert B Hall Jr Dr Joseph Cusumano

CONSTITUTION amp BYLAWS COMmiddot MITTEE Dr Charles L Cuttino III (Immediate Past President) Chairman Dr Bruce R Hutchison Speaker of the House Dr Emory R Thomas Parliamentarshyian Dr Gary R Arbuckle Past Parliamenshytarian At-Large Dr Emanuel W Michaels Dr Guy G Levy Ex Officio Dr M Joan Gillespie

DENTAL BENEFITS PROGRAMS COMMITTEE Dr Richard D Barnes Chairman Dr Dennis E Cleckner Dr Richard W Bates Dr Benita A Miller Dr B Scott Ward Dr Susan F OConnor Dr Robert E Grover Dr Kirk M Norbo At-Large Dr John R Ragsdale III (Periodontist) Dr Cramer L Bosewell (Orthodontist) Dr 1 Wayne Mostiler (Oral Surgeon)


Dr Mitchell A Avent (Pedodontist) Ex Officio

Dr Leslie S Webb Jr (ADA Council) Dr John W Willhide (ADRP) MCV Student Liaison Guy Hughes

DENTAL CONTINUING EDUCATION COMMITTEE Dr B Ellen Byrne Chairman Dr Ralph L Howell Jr Dr Robert W George Dr James L Slaqle Jr Dr James R Evans Dr French H Moore III Dr Rebecca S Swett Dr AI Rizkalla Dr Gilbert L Button (MCV) Dr Gary R Hartwell (MCV) Ex Officio Tom Burke MCV CE

DENTAL DELIVERY FOR THE SPEshyCIAL NEEDS PATIENT COMMITTEE

Dr AI J Stenger Chairman Dr Stanley P Tompkins Dr James D Watkins Dr Kevin S Swenson Dr John M Fedison Dr Glenn A Young Dr David Swett Dr Patrick J Dolan Dr Richard D Barnes Dental Benshyefits Programs Chairman Dr William M Midkiff Dental Trade amp Lab Relations Chm Dr Samuel W Galstan Dental Health amp Public Information Chm Dr Karen C Day Div Dental Health State Health Opt Dr James H Revere Jr MCV School of Dentistry

DENTAL HEALTH AND PUBLIC INshyFORMATION COMMITTEE Dr Samuel W Galstan Chairman Dr Pamela Ann Morgan Dr Sharon C Covaney Dr Shari L Ball Dr Robert Carl ish Dr Thomas W Littrell Dr Ellen R Kelly Dr Brenda J Young At-Large Dr Gisela K Fashing Dr Roger H Flagg Dr Dan Kelly Ex Officio Dr Karen C Day Div Dental Health 26 Virginia Dental Journal

State Health Opt Dr Leslie S Webb Jr Journal Editor

DENTAL PRACTICE REGULATIONS COMMITTEE Dr N Ray Lee (Oral Surgery)Chairman Dr Sanford L Lefcoe Jr Dr James D Watkins Dr Earl L Shufford Dr Norman J Marks Dr Albert L Payne Dr Frances Anne Johnston Dr Robert B Hall Jr Dr James L Gyuricza Dr William E Bernier (Endodontics) Dr Dennis G Page (Oral Pathology) Dr John F Monacell (Orthodontics) Dr Roger E Wood (Pedodontics) Dr Steven L Saunders (Periodontics) Dr Dewey H Bell Jr (Prosthodontics) Dr Joseph M Doherty (Public Health)

DENTAL TRADE AND LABORAshyTORY RELATIONS COMMITTEE DrWilliam M Midkiff (At-Large) Chairshyman Dr John C Cranham Dr George L Nance Jr Dr Howard Baranker Dr Daniel F Savage III Dr David L Stepp Dr Harry M Sartelle III Dr Joseph Cusumano At-Large Dr Karen McAndrew Dr Raymond L Meade

ETHICS AND JUDICIAL AFFAIRS COMMITTEE Dr Ronald L Tankersley Chairman Dr Emanuel W Michaels Dr Daniel E Grabeel Dr Lawrence J Kyle Dr Raleigh H Watson Jr Dr Harold J Barrett Jr Ex Officio Dr Andrew J Zimmer VDA President MCV Student Liaison Todd Pillion

INFECTION CONTROL AND ENVIshyRONMENTAL SAFETY COMMITTEE Dr Paul F Supan Chairman Dr Roger H Flagg Dr Michael E Sagman Dr Richard F Roadcap Dr William D Covington Dr Charles E Harris Dr Andrew B Martof

At-Large Dr Julie G Sharp Dr Robert M Block

INSTITUTIONAL AFFAIRS COMMITshyTEE Dr Elizabeth A Bernhard Chairman Isle of Wight Health Dept) Dr Charles Wesley Dr Frank B Sherman Dr Frank H Farrington Dr C James Harland Jr Dr Karen Day Dr W R Armentrout At-Large Dr Francis F Carr Jr Dr James I Bernhardt Ex Officio Dr Raymond Smith Dr W C Fleenor Dr E L Overman

JOURNAL STAFF COMMITTEE Dr Leslie S Webb Jr Editor amp Chairshyman Dr Bernard I Einhorn Dr Eric W Boxx Dr Michel R Hanley Dr HA Jack Dunlevy Dr Barry K Cutright DrRobert G Schuster Dr Victor G Saunders Dr Danine Fresch Thomas C Burke MCV School of Denshytistry Dr Karen C Day Div Dental Health State Health Dpt( Dr Terry D Dickinson Business Manshyager

LEGISLATIVE COMMITTEE Dr Roger E Wood Chairman Dr William H Higinbotham Jr Dr Jeffrey N Kenney Dr Bonnie Pearson Dr Dana H Chamberlain Dr J Ted Sherwin Dr William H Allison At-Large Dr Francis F Carr Jr Dr Wallace L Huff Dr Melanie R Love Dr Michael S Morgan Ex Officio Dr Ronald J Hunt Dean MCV School of Dentistry Jocelyn Lance Alliance Representashytive MCV Student Liaison Madeline Hahn

MEMBERSHIP COMMITTEE Dr Kimberly S Swanson Chairman Dr Richard K Quigg Dr Jon E Piche Dr Kevin Swenson Dr James W Shearer Dr Timothy E Collins Dr Rebecca S Swett Dr Gary J Johnson Ex Officio Dr Anne C Adams MCV Student Liaison Ashley C Epperly

PEER REVIEW AND PATIENT RELAshyTIONS COMMITTEE Dr Neil J Small Chairman Dr W Walter Cox Dr Kent Herring Dr John R Ragsdale III Dr William J Redwine Dr Craig B Dietrich Dr Paul 1 Umstott Dr Alan Robbins

PLANNING COMMITTEE Dr David Anderson President-Elect Dr Charles Cuttino Immediate Past President Dr Wallace Huff Past President Dr A Carole Pratt Chairman Annual Meeting Committee Dr Alan W Mahanes Chairman Auxshyiliary Ed amp Relations Committee Dr James W Baker Chairman Budshyget amp Financial Affairs Committee Dr David Swett Chairman Commitshytee For Direct Reimbiursement Dr Carolyn C Herring Chairman Committee On The New Dentist Dr Richard D Barnes Chairman Dental Benefits Programs Committee Dr AI J Stenger Chairman Dental DelSpecial Needs Patient Comm Dr N Ray Lee Chairman Dental Practiace Regulations Committee Dr Ronald L TankersleyChairman Ethics amp Judicial Affairs Committee Dr Roger E Wood Chairman Legisshylative Committee Dr Kimberly S Swanson Chairman Membership Committee

SEARCH COMMITTEE FOR VIRshyGINIA BOARD OF DENTISTRY CANshyDIDATES DrCharles L Cuttino III (Immediate Past President) Chairman

Dr Stanley P Tompkins Dr Corydon B Butler Jr Dr Richard F Roadcap Dr John S Kittrell Dr Mark A Crabtree Dr Robert G Schuster Dr Robert B Hall Jr Dr James L Gyuricza

AD HOC COMMITTEES 1999middot2000

AD HOC SUBCOMMITTEE ON MIshyNORITYDIVERSITY MEMBERSHIP RECRUITMENT

A MINORITYDIVERSITY MEMBERshySHIP RECRUITMENT

Dr James D Watkins Dr Carole A Pratt Dr Barry I Griffin Dr Sudah P Patil

B LIFE AND RETIRED MEMBERshySHIP RETENTION

Dr Emanuel W Michaels Dr Charles F Fletcher Dr Leslie S Webb Jr

AD HOC COMMITTEE ON RECOGshyNITION AWARDS FOR VDA MEMshyBERS Dr Charles L Cuttino III (4) Chairman Dr Emanuel W Michaels Dr Anne C Adams Dr Russell N Mosher

SALESUSE TAX STRIKE FORCE (Seeking clarification of the taxable stashytus of dental materials and supplies used in Virginia)

Dr James W Baker Dr Robert A Levine Chuck Duvall (Lobbyist)

EXECUTIVE COMMITTEE Dr Andrew J Zimmer President Dr David C Anderson President Elect Dr Thomas S Cooke III SecretaryshyTreasurer DrCharles L Cuttino III Immediate Past President Dr William J Viglione Council Chairshyman Dr Bruce R DeGinder Council Vice Chairman

EXECUTIVE COUNCIL DrWiliiam J Viglione (At-Large) Chairshyman Dr Andrew J Zimmer President Dr David C Anderson President Elect Dr Thomas S Cooke III SecretaryshyTreasurer Dr Charles L Cuttino III Immediate Past President Dr Rodney J Klima (At-Large) Dr D Christopher Hamlin (At-Large) Dr Richard H Wood (At-Large) Dr Edward J Weisberg (1) Dr Bruce R DeGinder Vice Chairman Dr H Reed Boyd III Dr Anne C Adams Dr Mark A Crabtree Dr Ronnie L Brown Dr J Darwin King Sr Dr M Joan Gillespie Ex Officio Dr Bruce R Hutchison Speaker of the House Dr Ronald J Hunt Dean MCV School of Dentistry Dr Emory R Thomas Parliamentarshyian Dr Leslie S Webb Jr Journal Editor

OTHER COMMITTEES 1999-2000

FELLOWS SELECTION COMMITshyTEE Dr Donald L Martin Chairman DrHarry E Ramsey Jr Dr Richard D Barnes Dr James K Johnson Dr Donald G Levitin Dr Frank C Crist Jr Dr William J Viglione Dr Henry M Botuck

NOMINATING COMMITTEE Dr Charles L Cuttino III (Immediate Past President) Chairman Dr 1 Wayne Mostiler Dr Thomas J Morris DrRichard F Roadcap Dr Gary R Hartwell Dr Gregory 1 Gendron DrFrances Anne Johnston Dr Robert G Hall Dr Kirk Norbo

VIRGINIA DENTAL POLITICAL ACshyTION COMMITTEE Dr Rodney J Klima Chairman Dr Tracy S Oliver


Dr David P Mueller Dr William R Parks Dr Bruce R DeGinder Dr Ronald L Wray Dr Scott E Gerard Dr Edward F Ross Jr Dr Roger E Wood Dr Frank C Crist Jr Dr Edward P Snyder Dr Gus C Vlahos Dr Ronald D Jessup Dr Victor G Saunders Dr Gerald J Brown Dr Bruce R Hutchison

FOUNDATIONS AND SERVICE CORPORATION - 1999-2000

VIRGINIA DENTAL ASSOCIATION FOUNDATION Dr William H Allison President Dr Ralph L Howell Jr Dr James K Johnson Dr Anne C Adams Dr Daniel E Grabeel Dr Peter J McDonald Dr C Mac Garrison III Dr Charles French II Dr Andrew J Zimmer VDA President Dr David C Anderson VDA President Elect Dr Thomas S Cooke III VDA SecreshytaryTreasurer

VIRGINIA DENTAL ASSOCIATION RELIEF FUND FOUNDATION Dr Scott H Francis President Dr Harold P Hearner Jr Dr Scott E Gerard Dr Edward F Ross Jr Dr Gregory T Gendron Dr Cramer L Boswell Dr William A Grupp II Dr Susan W Connolly Dr Andrew J Zimmer VDA President Dr David C Anderson VDA President Elect Dr Thomas S Cooke III VDA SecreshytarylTreasurer

VIRGINIA DENTAL SERVICES CORmiddot PORATION Dr Jeffrey Levin President Dr Frank C Crist Jr Dr Fred A Coots Jr Dr James E Hardigan Dr Robert A Levine Dr Harvey H Shiflet III Beach Dr Thomas S Cooke III - Ex Officio

INTERNATIONAL COLLEGE OF DENTISTS II II

New Fellows from the Virginia Class of 1999 of the International College of Dentists inducted into the college at the annual conshyvocation ceremony on October 8 1999 in Hawaii Front Row (Left to Right) Dr Thomas W Littrell (Galax) Dr Wallace L Huff( Blacksburg) Dr Daura Christopher Hamlin (Norshyfolk) Dr James W Baker (Chesapeake) and Dr Emanuel W Michaels (President of the USA section of the ICD) Back Row (Left to Right) Dr Albert L Payne (Danville) Dr Peter J McDonald (Christiansburg) Dr Richard D Huffman Jr (Roanoke) Dr C Daniel Dent (Richmond) and Dr Richard OK Wilson (Richmond)

New Fellows from the Virginia Class of 1999 inducted into the American College of Dentists on October 8 1999 at the annual convocation ceremony Left to Right Dr Ronald J Hunt (Richshymond) Dr Herbert Reed Boyd III (Petersburg) Dr Edward J Weisberg (Norfolk) Dr Jay S Lipman (Hampton) and Dr Kevin M Laing (Van Wert Ohio)

Dr Emanuel W Michaels President USA Section of the International College of Dentists


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VDA NEWS [I I~ In recent months there has been quite a change in the staff at the VDA As we said good-bye and good luck to Mr Bill Zepp Connie Jungmann Tanya Moore Lisa Finnerty and Liz Keith we also said hello and welcome aboard to Dr Terry Dickinson Julie Heuser and Susan Lionberger Under the dishyrection of Dr Terry Dickinson (VDA Executive Director) these are the faces of the staff of the VDA

Bonita L (Bonnie) Anderson Administrative Assistant

Bonnie was born and raised in Minneshysota where she attended Bethel Colshylege in S1 Paul Before moving to Virshyginia in 1982 she lived in Lincoln Neshybraska for 15 years Bonnie joined the VDA staff in January 1996 leaving her position with a law firm in Chesterfield County where she had worked as ofshyfice manager and paralegal for 11 years Bonnie and her husband Doug live in Midlothian and have two adult children and five grandchildren

As Administrative Assistant Bonnie works with the Executive Director has internal oversight responsibility for all VDA committees and committee meetshyings has direct responsibility for cershytain specific committees as well as the Executive Council the House of Delshyegates and the VDA Fellows In addishytion to her other duties she greets VDA visitors and directs incoming calls to the appropriate staff member


Ronya Edwards Marketing amp Programs

Coordinator

Ronya is the Marketing amp Programs Coordinator for the VDA and the Dishyrector of Operations for the Virginia Dental Services Corp (VDSC) She works closely with the VDSC the VDA Foundation the Relief Fund and Dishyrect Reimbursement She also mainshytains the VDA website (wwwvadentalorg)

Ronya graduated from the University of Richmond in December 1997 with a BS in Business Administration with concentrations in Marketing and Ecoshynomics She began working at the VDA in January 1998

Ronya believes that she has gained valuable experience while working at the VDA and has met and had a chance to work with a lot of nice people She is thankful for such a wonshyderful opportunity

Linda Gilliam Director of Finance

Linda has been with the VDA for 9 years this March Her background is

in accounting and real estate sales and management Her hobbies include gardening and photography Three of her photographs were used for Virginia Dental Journal covers in 1999 Her work is also displayed on this issues cover She also has some photoshygraphs exhibited in a local art gallery

Julie Heuser Donated Dental Services

Project Coordinator

Julie has served as the Donated Denshytal Services Project Coordinator since July of 1999 Her responsibilities inshyclude the case management of DDS patients and mangement of volunteer dentists and labs as well as fundraising public relations and volunshyteer recruitment associated with the Project

Julie is a May 1999 graduate of the University of Virginia and is glad to be back home in Richmond

Susan P Lionberger Events amp Publications

Coordinator

Susans responsibilities include planshyning the VDA Annual Meeting the

January amp June Committee Meetings and the April Leadership Meeting She also is responsible for all printed mashyterials pertaining to the meetings as well as laying out the Virginia Dental Journal She recently started working on the events and publications needs for the VSOMS and VAO

Susan is a 1992 graduate of the Unishyversity of Tennessee in Knoxville and a 1993 graduate of the Southeastern Paralegal Institute in Atlanta Before joining the VDA in August 1999 Sushysan was the events planner for the law firm of McGuire Woods Battle amp Boothe LLP in their Richmond office

Susan enjoys traveling cross stitch and University of Tennessee football She and her husband of 9 months live in Richmond with their cat Ziggy

Barbara Rollins Assistant DDS Project

Coordinator

Barbara Rollins came to the VDA as Assistant Donated Dental Services Project Coordinator in October 1998 Her primary responsibility is to assist in coordinating DDS which involves screening and matching qualified apshyplicants needing dental services with volunteer dentists in the program She enjoys being part of this valuable project Barbara received a Bachelor of Science degree in Medical Technolshy

ogy from Mary Washington College and Medical Technology Certification from the University of Virginia Barshybara lives in Chester with her husband two terrific children and three cats

r-----------The Virginia Dental Associations attorney Mark Rubin has completed a written review of the Trigon contract analysis that the American Denshytal Association recently provided to the association Because of the number of issues addressed and the length of the analysis it was felt that further clarification of the most important points should be addressed by our atshytorney This analysis is currently available at the Associations ofshyfice If a member would like a copy please call (804) 358-4927 or fax your request to (804) 353shy

L 7342

Hello Im a 77 year-old widow I live off $500 every month My teeth are rotting out of my mouth

Please help me I have nowhere else to turn

Hear the cry for help There are elderly disabled and chronically ill people in your community who need dental care and cannot afford it These people have comprehensive dental needs and they have nowhere else to turn You can make a difference in these peoples lives Help give someone a reason to smile

Donated Dental Services provides free comprehensive dental care to elderly disabled and chronically ill individuals through a network of caring volunteer dentists specialists and laboratories People like you Join the DDS volunteer team and give a DDS patient a reason to smile-s-straight from your heart right in your own office

Donated Dental Services The inherent dignity of every individual is reflected through a healthy smile

Call (804) 257-98]0 for information on how you can volunteer


I

UPCOMING CONTINUING EDUCATION ~I I

Feb 23 2000

Feb 23 2000

March 6-10 2000

March 102000

March 172000

March 24 2000

April 14 2000

April 26 2000

May 19 2000

May 19 2000

May 19-21 2000

June 22-25 2000

Aug 11 2000

Sept 1-2 2000

Sept 15 2000

Sept 15 2000

Sept 16 2000

Sept 162000

Oct 29 2000

Nov 4-5 2000

Nov 17 2000

Component

NVDS (8)

VAGD

MCV-Anatomy

Peninsula (2)

Southwest (6)

NVDS (8) VDA co-sponsored

Tidewater (1)

NVDS (8)

Shenandoah (7)

VAGD

Southwest (6)

VSOMS

Southwest (6) VDA co-sponsored

VAGD

VDA Annual Meeting

VDA Annual Meeting

VDA Annual Meeting

VDA Annual Meeting

Tidewater (1)

VAG 0

Southwest (6)

Location

Fairview Marriott

Charlottesville

MCV

Newport News Omni

Van Dyke Center Emory

Fairview Marriott

Holiday Inn Chesapeake

Fairview Marriott

Sheraton - Harrisonburg

Richmond

Pipestem WV State Park

Sheraton - VA Beach

Higher Educational Center -- Abingdon

Virginia Beach

Williamsburg Lodge

Williamsburg Lodge

Williamsburg Lodge

Williamsburg Lodge

TBA

Richmond

Donaldson Brown Conference Center Blacksburg

SpeakerTopic

Dr Harold Slavkin Research Update

Dr Glenn Menzie Precision Attachments

Dr Hugo Seibel amp Dr Milton Sholley Head and Neck Anatomy

Dr Robert Strauss Medical Emergencies in the Dental Office

Dr Adam Kegey Dental Forensics and Frieda Pickett RDH Drugs amp Herbal Supplements of the Milenium

Dr Jeff Morely Practical Cosmetic Dentistry

Dr Tom Orent 1000 Gems

Dr Hugh Doherty What They Didnt Teach You About Business in Dental School

Steve M Seltzer MBA 101 Technology Pearls for Dentistry

Dr Dan Becker Pain amp Anxiety Control Medical Urgencies amp Emergencies in Dental Practice

TBA

Dr Peter Waite Snoring and Sleep Apnea

Dr Franklin Weine Avoiding Problems in Clinical Endodontics

Dr Henry Gremillion Facial Plans

Dr Gerard J Chiche Recipe for Successful Anterior Esthetics

Dr John A Svirsky AIDSOSHAInfection Control for the 21st Century

Dr John A Svirsky Name That Disease and Other Oral Pathology Party Games

Dr Roger L Kiesling Clinical Decisions in Practice Survival

Dr Fred Bell Implants

Dr Ed McGlumply amp Dr Larry Peterson Implant Dentistry Dr John Kois Periodontics amp Restorative Dentistry

Dr Marvin Ladov Oral Surgery Impactions Extractions Corrective Actions


Component CE Programs --For registration information please contact the appropriate person below ($40 - Members of VDA amp Auxiliaries --$75 - Persons other than VDA members Fee includes lunch and coffee break)

Component I (Tidewater) Virginia Donne (Executive Secretary) (757) 491-4626 Component II (Peninsula) Kathy Harris (Executive Secretary) (757) 565-6564 Component III (Southside) Dr James L Slagle (CE Coordinator) (804) 733-9490 Component IV (Richmond) Linda Simon (Executive Secretary) (804) 379-2534 Component V (Piedmont) Dr William W Martin (CE Coordinator) (540) 344-4112 Component VI (Southwest) Dr Francis Anne Johnston (CE Coordinator) (540) 628-9507 Component VII (Shenandoah) Patricia Fuller (Executive Secretary) (804) 985-1939 Component VIII (Northern VA) Susann W Hamilton (Executive Director) (703) 642-5297

MCV Program - For registration information for the Alton D Brasher Postgraduate Course in Head amp Neck Anatomy please call Dr Hugo Seibel at 804-828-9623 VAGD Programs - For registration information please call the VAGD Office at 804-320-8803 VDA Programs - Registration information will be mailed in JuneJuly for the 2000 Annual Meeting in Williamsburg

AIDA CmiddotERP CONTINUING EDUCATION RECOGNITION PROGRAM

The VDA is recognized as a certified sponsor of continuing dental edushycation by both the ADA CERP and the Academy of General Dentistry

[I MEETINGS II] Month Organization Meeting Location

April 5-9 2000 VDA Leadership Meeting Omni Hotel - Charlottesville VA

June 8-11 2000 VDA Committee Meeting Sheraton Oceanfront Hotel - Virginia Beach VA

June 22-25 2000 VSOMS Annual Meeting Sheraton Oceanfront Hotel - Virginia Beach VA

June 23-27 2000 VAO Annual Meeting Cavalier Hotel - Virginia Beach

Sept 13-17 2000 VDA Annual Meeting Williamsburg Lodge - Williamsburg VA

Sept 22-24 2000 16th District 16th District Caucus Embassy Suite - Greensboro SC

Oct 28-Nov 1 2000 ADA Annual Session Chicago Illinois

Jan 2001 (dates TBA) VDA Committee Meeting TBA

April 2001 (dates TBA) VDA Leadership Meeting TBA


June 23-28 2001 VAOIVSOMS Annual Meeting Frenchmans Reef Marriott - St Thomas VI

Sept 12-16 2001 VDA Annual Meeting Hyatt Hotel - Crystal City VA

Sept 18-22 2002 VDA Annual Meeting Waterside Marriott -- Norfolk VA

Sept 10-14 2003 VDA Annual Meeting Marriott -shy Richmond VA

Sept 8-122004 VDA Annual Meeting Waterside Marriott - Norfolk VA

Sept 14-182005 VDA Annual Meeting Marriott - Richmond VA


TRIGON VDA SPONSORED HEALTH INSURANCE II II VDSC Insurance Service Center

In the results of a physician surshyvey released last fall Trigon Blue Cross Blue Shield and its affilishyated HMO HealthKeepers Inc emerged as front-runners among eight other managed care orgashynizations The survey was conshyducted by Virginias largest local medical organization the Richshymond Academy of Medicine The survey collected opinions about managed care organizations from 465 physicians and office managshyers In total scoring of their reshysponses Trigon tied in the numshyber-one spot

Physicians gave Trigon the top better than average rating in

several areas including Conducts easy and appropriate special referrals Has precertificationreferral proshycess that is reasonable to folshylow Helps patients understand precertificationreferral process Has reasonable fee-for-service payments

In a category to rate overall pershyformance physicians were asked if they would recommend a speshycific insurance plan to a family member or friend The surveys summary of the answers speaks for itself The responses were wide ranging with Trigons HMO

and non-HMO product as the most favored Trigon Blue Cross Blue Shield has the largest PPO network in Virginia with more than 14000 participating physicians and hosshypitals The Virginia Dental Sershyvices Corporation and the Virginia Dental Association is proud to sponsor the Trigon health insurshyance plans For information on starting a plan for yourself or your practice contact the VDSC Insurshyance Service Center at (800) 832shy7001 Monday through Friday from 830 am to 530 pm Our expeshyrienced staff will assist you with all your health insurance needs

AUTOMATED EXTERNAL DEFIBRILLATORS II II Jeffrey Levin DDS VDSC President

The Automated External Defibrilshylator (AED) Protocol Committee an ad hoc committee of the Virshyginia Dental Services Corporashytion met on November 30 1999 to establish guidelines and make a recommendation to dentists concerning the use of the AED during emergency situations arisshying in the dental office and elseshywhere for the purpose of saving lives The Protocol Committee consists of the following Drs Jeffrey Levin Richard Wilson Charles Cuttino Michael Miller Ronald Tankersley and Robert Strauss The committee is staffed by Ronya Edwards of the VDA

The AED Protocol Committee recshyommended to the Executive Council of the VDA to strongly enshy


courage members of the dental profession to become certified in CPR as well as trained in the proper use of AED equipment when available

The American Red Cross as well as the American Heart Associashytion are now training people in the use of the AED during CPR courses

The Virginia General Assembly passed an Amended Good Sashymaritan Law in April 1999 protectshying health care professionals in the use of AEDs for the purpose of saving lives during an emershygency situation

Courses are being given throughshyout the year at the MCVVCU

School of Dentistry the American Heart Association and the Amerishycan Red Cross

The VDSC plans to introduce an AED purchasing and training proshygram to the VDA membership in the near future As a VDA memshybership benefit members will reshyceive a rebate with the purchase of an AED unit as well as a cershytificate for free training through either the American Red Cross or the American Heart Association More information on this benefishycial program is forthcoming

II IL VIRGINIA DENTAL SERVICES CORPORATION

Dr Thomas Cooke III VDA Secretary-Treasurer

Over the past year the VDSC has grown in both services offered to our members and non-dues revshyenue to the VDA This year that contribution amounts to about $2500 per dues paying member Over the past three years that amount approaches $4000 As the VDSC continues to grow and exshypand its programs and as more VDA members utilize these sershyvices and participate in the VDSC endorsed programs the more money that can be given back to the VDA to help support and fund VDA functions and to help maintain dues levels

The VDSC has added numerous VDA member programs since its incorporation in 1995 that can enshyhance your practice and maybe even save you a couple of dollars in the process The following are just to mention a few

For electronic claims processing call ENVOY at 888-545-6127

For payroll services call PAYCHEX at 800-729-2439

For office supplies call Association Members Only at 800-420-6421

For dental supplies and equipment call Profit Finder at 800-443-5095

For financial services call Mercer Global Advisors at 800-462-1580

For more information on all of the VDSC and VDA endorsed proshygrams please call Ronya Edwards at the VDA office at 800-552-3886 and ask for a brochure You can also visit the VDA web site at wwwvadentalorg and check out the Endorsed Programs web page

Help support your association-we all benefit

VDA LEGISLATIVE UPDATE II]

It is difficult to try to look into the crystal ball in late December and give you news that will be current when you receive this in February With that as a caveat we will atshytempt to try to highlight briefly some of the legislative matters we have touched upon previously and othshyers that have arisen since you reshyceived your last publication of the Virginia Dental Journal

Special Needs Dental Care

As we previously reported the Mandates Commission of the Bushyreau of Insurance has reviewed this legislation which mandates general anesthesia for special needs denshytal care The Mandates Commisshysion unanimously reported that the legislation should be considered fashyvorably by the General Assembly

Chuck Duvall VDA Lobbyist

The bill has been introduced by Delegate Jim Shuler (DshyBlacksburg) who introduced it preshyviously

Medicaid Dental Service Reimshybursement Rates

As we last reported the ongoing saga of Medicaid dental service reshyimbursement rates continues

Governor Gilmore when he reshyleased his 2000-2002 biennial budshyget on December 17 1999 incorshyporated no new funds to increase the Medicaid dental service reimshybursement rates

A report prepared as a result of budget language VDA secured in the 1999 Session indicated that an additional $10 million would be needed to bring the dental reimshy

bursement rates up to the 85th pershycentile

VDA has requested additional fundshying through a budget amendment Many of you by the time you read this report will have been contacted and asked to advise your legislator(s) to assist in trying to secure additional Medicaid dental service reimbursements

Licensure of Health Care Facilities

Legislation is being reviewed by the General Assembly that would reshyquire the licensing of health care provider offices Obviously this inshycludes dental offices One of the criteria for licensure being disshycussed is the use of anesthesia

Dr Ron Tankersley and Dr Roger Wood representing VDA made


excellent presentations before a legislative subcommittee looking at this issue They noted that at present the Board of Dentistry reshyquires a dentist licensed in the Commonwealth to demonstrate competency in the administration of various levels of anesthesia before they are allowed to administer anshyesthesia

In fact the dental model described to the Legislature by Doctors Tankersley and Wood was held out as a model that other health care providers should emulate

With all of that said however there is still legislation being reviewed that may require the licensure of dental offices VDA is in opposishytion to such legislation since all practitioners are licensed and varishyous state and federal entities have regulatory authority over dental ofshyfices

Dental Study

The Joint Health Care Commission completed a very extensive review of dental services in underserved areas during 1999

As a result of that study various pieces of legislation have been inshytroduced including

A bill to create a dentists loan bull repayment program

A resolution to examine the feashybull sibility of establishing a public dental health program in those communities which do not have access to public dental health services

bull A request that the VCUMCV School of Dentistry develop a plan for establishing a precepshytor externship program for denshytal students

The Joint Commission has also inshytroduced a resolution to continue their study for another year As part of the continuation of the study they plan to review

bull Various ways to increase the number of persons with dental insurance

Review methods to increasebull the number of dentists particishypating in the Medicaid program

Potential safety concerns reshybull garding the use of dental amalshygam

We indicated at the outset that it is difficult in December to crystal ball all of the various issues that will be introduced in the 2000 Session of the Virginia General Assembly Obviously we have touched upon only a few By the time you receive this hopefully you will receive adshyditional information from VDA that outlines the full complement of legshyislation

VADPAC Participation is Essential

Most of you have paid your VDA dues and hopefully have particishypated in VADPAC for this year If you have not done so we encourshyage you to become a part of VADPAC It is vital that VDA play an active role in campaigns across Virginia

Just to give you some indication of what is spent in campaigns I thought we might share with you information presented by the Virshyginia Public Access Project (VPAP) which is a non-partisan group that collects information regarding camshypaign financing

According to the VPAP the top fifshyteen donors by occupation are as follows

1 $2417498 -- Attorneys Law Firms

2 $1223921 -- Real Estate Developers

3 $ 850161 -- Electric Utilities

4 $ 746357 -- Tobacco

5 $ 729770 -- Auto Dealers

6 $ 711453 -- Physicians 7 $ 680946 -- General

Contractors 8 $ 638796 -- Realtors 9 $ 601728 -- Technology

Firms 10 $ 597276

Coal MiningProcessing 11 $533161

Beer amp Wine Distributors 12 $ 527156 -- Banks 13 $ 503284 -- Telecom shy

Long Distance 14 $ 489034 Insurance

Companies 15 $ 457468 -- Trial Lawyers

(Totals include donations to Senate candidates between 1196 and 11 2599 and to House of Delegate candidates and partyleadership committees between 1198 and 11 2599)

The General Assembly Session is scheduled to adjourn on March 11 2000 with the Veto Session schedshyuled for April 19 2000

If you have any questions at all durshying the session please feel free to contact the VDA directly or call my office at 804644-7884 or bye-mail at Lindlcoroaolcom As always thank you for your assistance in helping us advocate for your pashytients


MERCY MEDICAL CENTER DIVISION OF DENTISTRY

AND THE MARYLAND ACADEMY OF GENERAL DENTISTRY

CONTINUING EDUCATION PROGRAM PRESENT

DRUGS IN DENTISTRy-UPDATE 2000middotmiddot FRIDAY FEBRUARY II 2000 - 8AM-1230PM Richard f1jnn PhD

Dr Wynn is professor and Director of Pharmacology University of Maryland Dental School He has extensive experience in research teaching and pharmacologic considerations in the practice of dentistry

The all new nuts and bolts course will bring you up to date with newly approved drugs and considerations for the compromised dental patient This information will change the way you practice dentistry

MEDICAL EMERGENCIES IN THE DENTAL OFFICE - AN OvERVIEW FRIDAY MARCH 3 2000 - 8AM-1230PM Mark Eisen DDS MS

Dr Eisen is a former Assistant Professor of Oral and Maxillofacial Surgery at the University of Maryland Dental School He is currently in an Oral and Maxillofacial Surgery group practice in the Baltimore area

The course will review office preparation prevention and recognition of medical emergencies The discussion will include the basics of the emergency medication box and the treatment of the most common emergencies

CONSERVATIVE ANTERIOR ESTHETIC RESTORATIVE DENTISTRY THE ART OF MAKING SMILES SATURDAY MARCH 25 2000 - 8AM-1230PM Howard Strasslet DMD FADM

Dr Strassler is a professor and Director of Operative Dentistry at the University of Maryland Dental School He is a consultant for numerous dental manufacturers ad journals as well as having published over 350 papers

Selection of the proper dental material from the plethora of choices is critical for patient health and satisfaction Maintaining color stability of natural teeth and restorations is also important This course is an in-depth study of these primary restorative problems

ANTI-INFECTIVE PERIODONTAL THERAPY SATURDAY MAy 13 2000 - 9AM - 1230PM Thomas Rams DMD MSD and Lawrence Page DDS PhD

Dr Rams is Professor and Chairman Department of Periodontology Temple University School of Dentistry and Director of Oral Microbiology Testing Service

Dr Page is a full-time periodontist in Ellicott City Maryland and a Clinical Professor of Periodontology at Temple University Dental School He has numerous publications and practices anti-infective therapy

Effective methods for the diagnosis and control of subgingival infections and resulting periodontal diseases will be presented Both patient subgingival control training and routine office subgingival control techniques are able to control periodontitis Data showing long-term control of periodontitis with pockets initially as deep as 8-12 mm will be presented

REGISTRATION

Name (s) _

Address _

Phone and Fax _

Pay $85 registration per course by check VISA MASTERCARD D1SCoER Card ______ Exp Date_

Register by phone 410-332-9262 or by Fax 410-545-4253

Note Courses will be hosted by Mercy Medical Center 301 St Paul Place BaltiInore MD 21202

Continental Breakfast and cornpliInentary parking are included in registration fee

These courses each qualify forfow (4) hours of CDE credit toward the Academy of General Dentistry Fellowship amp Membership vlorviandAcademv q C7enem Denlit) 11 an A(ad(7J~) oj Genera DenlHl~l aptJTOced vationolSponsor for F-IC71JLtGD credn 12189-12 1 198

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II MEMBERSHIP BENEFIT HIGHLIGHT- CAREER ALTERNATIVES

Kimberly S Swanson DDS VDA Membership Task Force

Each year the American Dental Association Council on Access Prevention and Interprofessional Relations receives over 500 reshyquests for information on alternashytive dental careers from members considering leaving traditional practice Non-clinical career altershynatives include academia public health the dental product indusshytry the insurance industry and inshystitutional accreditation services

In 1995 the Council developed an Alternative Dental Careers Packet in response to members needs This packet discusses isshysues and factors that dentists need to take into consideration when thinking about career altershynatives The material included is purposefully general in order to address a wide range of situashytions and needs It will serve as a starting point for dentists to exshyplore options and allow them to pursue further focused research on the alternative career of their choice The packet underwent a complete revision in 1998 and now includes information on apshyplicable web sites The packet is available to members only through the ADA Manager of Interprofessional Relations at exshytension 2861

The ADA also addresses nontrashyditional practice settings Develshyoping New Ways to Practice Denshytistry is a new publication availshyable through the ADA Catalog Inshyformation on options such as porshytable dentistry on-site dental clinshyics and dentistry in private homes are available Also availshyable is Providing Dental Care in Long-Term Care Facilities A Reshy


source Manual Call the ADA Catalog at 1-800-947-4746 for additional information

Approximately 2750 dentists serve in the Armed Forces and United States Public Health Sershyvice In 1997 the Department of Defense Authorization Bill gave dentists more incentive to enlist by providing an automatic $30000 signing bonus Attractive loan repayment programs are also available Participating denshytists are eligible for ADA tripartite membership or direct membershyship in the ADA Direct membershyship means that the dentist is an ADA member but not a member of the state or local society This would be appropriate for dentists who have frequent geographical transfers For information call ADA extension 2607 or e-mail the ADA at membership adaorg For information on the US Pubshylic Health Service call the Pubshylic Health Dental Staffing Officer at 1-800-279-1605

Dentists and Dental Students interested in careers in dental reshysearch should contact the NashytionaI Institute of Dental Research at wwwnidrnihgovThis web site lists employment training and career development opportunishyties Students may also make inishytial inquiries with the Associate Dean For Dental Research at their school Also the University of North Carolina-Chapel Hill has a web site Careers in Dentistry that highlights the many different careers that dentistry offers Conshytact the ADA Office of Student Affairs at extension 2386 for more information

For dentists in traditional and nonshytraditional careers who want to add something to their personal and professional life there is alshyways the option to spend time doing volunteer work overseas Interested member dentists may request a free copy of Internashytional Dental Volunteer Organishyzations A Guide to Services and Directory of Programs Call the ADA Department of International Dental Health at extension 2726 There is also information on the ADA web site wwwadaorg under the Dental Practice section

For more information on the many benefits of membershlp in orgashynized dentistry call the ADA at (312) 440-2500 or use the memshybers-only 800 number listed on the back of your membership card You may also call the Virshyginia Dental Association at (804) 354-4927 or 1-800-552-3886 Membership matters

Looking for info on upcoming CE courses

Whats happening at the VDA

Want to learn more about Direct Reimbursement

Visit the VDAs website for answers to these

questions and much more

wwwvadentalorg

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Adv 440-A (9198) Virginia Dental Journal 39

STANDARD OF CARE ~I I~ Thomas P Cox ARM General Agent The Medical Protective Company

The following is offered from a risk management perspective and not as legal advice The term stanshydard of care has clinical and legal implications

The standard of care (standard) is often an issue in medical malshypractice cases The plaintiff will atshytempt to prove that the care proshyvided by a doctor was below the acshycepted standard the defense will attempt to prove that the doctor met the standard But what is a stanshydard of care How is it detershymined Is it an absolute standard What factors may determine the standard in a given situation These are some of the questions this article will attempt to answer by reviewing the facts of a dental malshypractice case

The patient was a 53 year-old feshymale who presented on an emershygency basis complaining of intracshytable pain in 19 Her past medishycal history was significant for deshypression hypertension diverticulishytis and hypercholesterolemia As the doctor a general dentist in prishyvate practice attempted local anshyesthesia in preparation for a root canal the hypodermic needle broke at the hub and became lodged in the patients jaw The procedure was immediately discontinued the patient was referred to a surgeon and the needle was removed the next day without complication

Postoperatively the patient claimed to have developed TMJ dysfuncshytion as well as trigeminal neuralshygia related to extensive scar tissue in the area of the incision She also claimed intractable facial pain which forced her to quit employshy


ment and take disability retirement as well as forcing her to limit her daily activities When the patient filed a proper and legal claim for damages she became a plaintiff and the doctor became a defenshydant

The plaintiff alleged that the stanshydard was breached because a 30shyguage short needle was used in the administration of the anesthetic it was argued that a 27-guage long needle should have been used The plaintiff identified dentists in general practice willing to testify based on information in dental jourshynals and textbooks that the needle broke upon contacting bone beshycause it was the wrong needle Note that the plaintiffs experts were from a different part of the state than the defendant dentist The defense identified as experts denshytists from the defendants geoshygraphic area willing to testify that using a 30-guage short needle was appropriate in this case and is in fact the standard in the geographic area in which the defendant pracshytices Questions concerning the defendants clinical competence were not raised

Further complicating this case was the issue of whether it was a medishycal malpractice case or a product liability case The plaintiff retained an expert with a PhD in electrical engineering willing to testify that the needle was structurally sound breaking upon contact with bone only because it was the inapproprishyate needle The defense countered with a PhD in mechanical engishyneering willing to testify that the needle failed because of a strucshytural weakness

Another peripheral risk manageshyment item that must be mentioned is informed consent Proper inshyformed consent is more accurately described as informed decisionshymaking the dentist assists the pashytient in making an informed decishysion about what treatment option to pursue Is so doing the dentist also gets the patients expectations in line as well as ensuring that the patient understands the risks then allows the patient to make the deshycision on how to proceed

The standard of care is often deshytermined by a reactive rather than proactive analysis

In a perfect world the standard of care would be determined by a group of dentists in practices simishylar to the defendants practice who would argue in a very scientific and factual way which needle should have been used in this specific case This group would rely on the facts of the case current literature research expert evidence and pershysonal experience The goal would be consensus

But a malpractice case is not a scishyentific inquiry The only consensus that matters is whether a jury beshylieves based on a preponderance of the evidence that a dentist made a mistake that a reasonable and prudent dentist would not make and that the error harmed the pashytient

Perhaps this sounds more like a professional difference of opinion It may well be and a professional difference of opinion alone does not mean that one position is correct and the other is incorrect However

when a claim of malpractice is alshyleged in Virginia the plaintiff must have an expert willing to assert that the standard of care was breached when this happens professional differences become opposing exshypert arguments in an attempt to convince a jury that one side or the other is wrong During the discovshyery period after a suit has been filed depositions of the experts will occur Each attorney will attempt to isolate strengths and weakshynesses in the position of the exshyperts with an eye on discrediting the oppositions experts in front of the jury Prior to trial the plaintiffs attorney will attempt to convince the defense that it should settle the defense attorney will attempt to convince the plaintiff that there is no case and going forward will be futile At trial each side will attempt to present its experts in a manner that does the best job of educating the jury The doctor will attempt to explain how he or she tried to do the best job possible the plaintiff will talk about how much he or she has been harmed This is quite reshymoved from a scientific inquiry Many doctors compare it more to theater often a theater of the abshysurd

So what is the standard of care

Blacks law dictionary says that the standard of care is that degree of care which a reasonably prudent person should exercise in same or similar circumstances The flexshyibility built into this definition frees dentists from the responsibility to be perfect in practicing their professhysion Rather than being perfect or heroic they must simply be reasonshyable and prudent Be cautioned however that general dentists proshyviding care that might arguably fall within the purview of specialists could be held to the standard of the special ist

Since it is not carved in stone the current standard will be influenced by multiple factors 1) currently acshycepted methods of performing a specific procedure 2) the location and services generally provided by the practice 3) the state of current research and technology related to the procedure These factors are combined with the doctors assessshyment of the patient including the patients condition and history leadshying to a clinical decision as to what the best treatment should be The patient should then be given the recommended treatment plan along with other viable options and the patient then makes the decision as to what will be done

This is personalized care that inshycreases the probability that the pashytient will receive quality care When this approach is taken and well documented a vigorous defense can be mounted against any alleshygation of malpractice Why Beshycause it can be demonstrated that the dentist genuinely tried to do what was in the best interest of the patient

How is a standard of care detershymined

As you can see the answer deshypends on whether the question is being asked about a specific proshycedure in your office or in a court of law In your practice the standard of care is determined by you It should be based on the usual risk management recommendations stay current with your continuing education attend meetings of and contribute to your specialty society and study club and keep up with journals specific to your practice These activities are obvious comshyponents of excellence in practice they also speak volumes on behalf of any doctor forced to defend alleshygations of malpractice They in turn

influence members of a jury beshycause this is the kind of commitshyment that each jury member exshypects from hisher own doctor

Is the standard of care an absoshylute standard

Any standard must be based on a uniform foundation However the treatment should not be assembly line care but instead personalized for each patient By staying curshyrent in your field trying to do what is best for the patient working to develop positive communication with patients and staff and by docushymenting your care and your patient advocacy you will increase the probability of quality patient care and patient satisfaction This in turn will decrease the risk of litigashytion


This Is No Time To Haggle With Your Insurance Companv

The Professional Protector Planreg for Dentists valued daily limit is the PPPs enhanced Business Interrupshytion coverage that is a no-hassle approach to restoring your dental practice

Most other companies pay you only the actual loss you have sustained from a business interruption The PPP makes the claims process faster and easier

With the PPP you select adaily limit and the number of days the coverage applies At the time of a covered loss you will be paid this amount At this stressful time you receive your money quicker with less paperwork and without financial documentation

For more information on the Professional Protector Plan for Dentists please contact the agent listed below orcall 1-800-922-5694_a_L_a

Professional Protector Plan

for Dentists

Professional Services Plan (PSP) A division of Brown amp Brown Inc

401 E Jackson Street Tampa FL 33601-1258

TOLL FREE 800-467-8734 FAX 813-222-4288

Serving dentists insurance needs for over 30 years httpsrwwwprotectorplancom

The Professional Protector Plan is a registered trademark ofPoe amp Brown Inc Tampa FL Coverage is underwritten by Continental Casualty Company National Fire Insurance Company ofHartford CNA LoydsofTexas and American Casualty Company ofReading PAfour ofthe CNA companiesCNA Plaza Chicago IL 60685 CNA is a registered service mark and trade name ofCNA Financial Corporation

A thought for the new millennium Will I treated a Donated Dental Services pashy

~I COMPONENT NEWS dental decay be around for the next hunshy tient this week He was a mildly retarded dred years I think not But there will man who didnt really appreciate what always need for dentists so dont look was happening But his elderly aunt who

Component I for a new profession any time soon cares for him and his Alzheimer afflicted Tidewater

mother was so thrilled that I am still feelshy

f bull

Dr Barry Einhorn Editor

By the time this column is read Y2K will have come and gone and the billions of dollars spent to avoid problems all but forgotten I find it interesting that big busishyness had no qualms in spending enorshymous sums of money on a suspicion of trouble and when it comes to providing health care and dental care for our citishyzens there is a reluctance to spend the dollars

Speaking of providing dental care for indigents we are proud to be partners with the American Red Cross in the esshytablishment of a Dental Clinic at the Park Place Multi-Service Center in downtown Norfolk This clinic is a first nationally for the Red Cross and hopefully will serve as a model for similar clinics throughout the country The clinic will provide emershygency care as well as preventative sershyvices The clinic will be manned by volshyunteers from Component 1 and stushydents from the School of Dental Hygiene of Old Dominion University Special recshyognition was given to the efforts of Drs Ed Weisberg Ed OKeefe Jamie Krochmal Charles Wesley and Robert Howell in the establishment of the clinic On Friday April 14 we will hold a conshytinuing ed course featuring Dr Tom Orent It is entitled the 1000 Gems Semishynar The program will be held at the Holishyday Inn Chesapeake Please call Ginnie Donne at 757-491-4626 for information

We are gearing up for National Childrens Dental Health Month Dr Anthony Peluso is serving as chairman and is coshyordinating with DrAlex Kordis of the US Navy The Navy has been a willing and effective partner for years in our camshypaign to bring the message of prevenshytion to the school children of Tidewater We all mourn the loss of our friend and colleague Dr Herbert Bonnie Herb was one of the giants of organized Dentistry in our state and remained actively inshyvolved in our profession until his death We will miss his sage advice and keen sense of fairness

Component II Peninsula

Dr Eric Boxx Editor

No news to report

Component III Southside

Dr Mike Hanley Editor

WOW This column actually made it to print Not that I was really worried about Y2K I was pretty sure that when I woke up on January 15t there would be a messhysage about teeth on the recorder and a lab bill in the mailbox I am however running a special on IRM Carbocaine 3 and Bumble Bee tuna (in water)

The Southside is planning a number of events in 2000 Weve already had a very interesting presentation from Dr Paul Ferrara the director of Virginias Forenshysic Science Department Tell you what at your next crime scene dont leave any DNA they will find you It was our annual Spouses Night Some wives were overheard to say even in winter all they talk about is golf

If you or your staff need an OSHA amp Oral Pathology update please join us on Febshyruary 25 with the nonpareil Dr John Svirsky presiding

Following that will be a CPR recertificashytion course with Vivian Biggers RN Over the holidays no fewer than four friends and acquaintances had heart or choking problems Two of them died My wife will be joining me in the class Bring your spouse you may need their help sometime

ing good about it three days later Call Julie Heuser at DDS (804) 257-9810 and sign up to help someone in your area

If you are in Southpark Mall on Saturday February 26th dont be alarmed to see a large number of dentists present Its our annual Dental Health Fair headed up by Dr Sam Galston

That is all the news from the Southside Talk to you in May

Component IV Richmond

Dr Jack Dunlevy Editor

New Years greeting from your colshyleagues in Central Virginia Component IV has begun the New Year with a full slate of activities

Our January monthly membership meetshying featured AWiliiam Feria MD speaking on Sedation of Patients in the Dental Office Our February monthly meeting featured Joseph Callahan 10 who discussed Medical Dental Ethics as it applies to Medical Malpractice Comshyponent IV also sponsored an all day proshygram on February 11 William C Strupp Jr DDS gave a Crown and Bridge Update

February is Childrens Dental Health Month and the Dental Alliance of the RDS is again assisting the Dental Health Pubshylic Information and Community Involveshyment Committee in several programs The Committee sponsored a Poster Conshytest for fifth graders at the Richmond Public Schools with winners selected at the Dental Health Fair The Fair takes place at the Science Museum on Februshyary 19 Special thanks to the RDS Allishyance for their work with the puppet show MCV dental students again lend a hand at this annual event

The March monthly meeting will feature four periodontists from our component Dr Charles E Gaskins III Component


IV President will moderate a panel disshycussion Panelists will include Dr John C Doswell II Dr Barry I Griffin and Dr Chris R Richardson The topic will be Adjunctive Periodontal Pocket Manageshyment Strategies

We also anticipate another all day course On March 24 Dr Gordon Christensen speaks on Whats New Whats Hot Whats Not

Our April monthly meeting will feature Dr Anchew Martof He is set to discuss Dental Management of the Head and Neck Cancer Patient

The Component expresses appreciation to the Alliance of the RDS as well as to Dr and Mrs John Kittrell The Alliance sponsored a dessert for Senator John Watkins at Kathy and John Kittrells home Senator Watkins was re-elected this year and his jurisdiction includes parts of Component IV

Also Dr Charlie Clough has retired from his oral surgical practice after many years of service in Richmond Enjoy your reshytirement Charlie Were sure youll stay busy

Component V Piedmont

bullbullbullbullbullbullbullbull -r bullbullbullbullbull

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Dr Barry Cutright Editor

The Piedmont Component met in Roanoke in October Dr Steven Seltzer presented the lecture entitled 101 Techshynology Pearls for Dentistry It was simishylar to watching market wrap up after a heavy day of trading Dr Seltzer left no stone unturned Summarizing whats up whats down and whats history Fortushynately for those of us who tend to be atshytention deficit he also left a great handshyout which included special requirements tips and where to buy If you are anticishypating changes in your game plan you should make a point to tap into his plethora of research

Back to the future A note about our spring meeting Dr Hugh Doherty DDS and CFP will present two half-day proshygrams

Day One -- How to Play the Great Game of Business and Win 44 Virginia Dental Journal

Day Two - Its Your Money - Use It or Lose It

Dr Doherty has authored over 200 manushyscripts on management and finance and currently is author of a monthly column Money Smart for the dental publication Dental Economics This meeting is scheduled for Friday and Saturday April 28 and 29 2000 at the Homestead The Homestead meeting was over booked last year so I would encourage you to plan now to spend and attend this meetshying Dont worry youll make it back with one good idea In fact you may make such a good decision that you dont care what the ADA or VDA dues are imagshyine that

Component VI Southwest

Dr Robert G Schuster Editor

The word sweet often causes one to ponder desserts chocolates or other caries contributing agents But in Southshywest Virginia sweet translates to the Sugar bowl bound VATech Hokies Yes on January 4 2000 the Hokies will play the Florida State Seminoles for the colshylege football national championship Many of our component members are Hokie fans and congratulations are in order

The approaching New Year causes us to reflect on history but also stimulates thoughts of future plans and goals Our component is currently preparing for the winter committee meetings in Richmond VA on January 14-16 2000

The first component meeting of 2000 will be held at the Van Dyke Center in Emory VA on March 17 Dr Adam Kegey will begin the day with a presentation on Foshyrensics and Ms Frieda Pickett RDH will follow with a presentation entitled Drugs amp Herbal Supplements of the Millenshynium

Our Spring meeting will be held at Pipestem State Park and Resort in West Virginia on May 19-21 2000 This is a family weekend event which features a golftournament old-fashioned barbecue and the many amenities offered by Pipestem Resort State Park

A component meeting is also scheduled for Augustmiddot 11 2000 at the Higher Edushycation Center in Abingdon VA Dr Franklin Weine will present Avoiding Problems in Clinical Endodontics The Virginia Highlands Festival in Abingdon is also scheduled at this time The festishyval features arts crafts antiques and entertainment

Best wishes to all for a Happy New Year that will hopefully bring new challenges and aspirations

Component VII

Shenandoah Valley 4 Dr Victor G Saunders Editor

Happy New Yearand welcome to the new millennium from Component 7 We hope everyone had a happy and healthy holishyday season

The Shenandoah Valley Dental Associashytion Officers fro the year 2000 are Dr Carolyn Herring President Dr Vic Saunders President-Elect Dr Robert Hall Secretary-Treasurer Dr Darwin King amp Dr Bill Viglione Executive Counshycil

We would like to welcome the following new members into Component 7 Pracshyticing in Charlottesville -- Dr Ed Akeel Dr George Choby Dr Suzanne Dennis and Dr Paul Byers transferring from Camp Lejeune NC

The Component is eagerly preparing for the Spring Meeting to be held March 17 2000 in Charlottesville at the Omni Hoshytel The speakers will be Dr Asgeir Sigurdsson Dr William Vann Jr and Dr Martin Trope all of whom are from the University of North Carolina School of Dentistry The topic will be Primary and Permanent Tooth Trauma Current Therapies and Future Directions Dr Sigurdsson is the graduate program dishyrector in endodontics Dr Trope is the chairman of the endodontic department and Dr Vann is the chairman of the pedishyatric dentistry department

The SVDA Summer Meeting will be held May 192000 in Harrisonburg at the Four Points Sheraton The title of the CE proshy

gram will be 101 Technology Pearls for Dentistry by ADA Speaker Steve M Seltzer MBA

Best Wishes for a successful and prosshyperous Y2K

Component VIII Northern Virginia

Dr Danine Fresch Editor

No news to report

VAE NOTES [II II] Dr Steven Barbieri President

Since you are reading this I assume we all survived Y2K and are now looking forward to the new millennium Before discussing the future however a brief look back is in order The last Virginia Academy of Endodontists meeting of the 20th century was exciting and informative Dr Ellen Byrne presented a wonderful discussion on antibiotic usage and the problems associshyated with the development of resistant bacshyterial organisms

Congratulations to two of our members Dr Bruce Overton and Dr David Wozniak upon achieving Diplomate of the Board status in 1999 Dr James Lance one of the founders of the VAE retired after 27 years in private practice We wish him well

As for the future the first year of the 215t

century should prove to be eventful Plans for a spring meeting to be held in conjuncshytion with MCV are under way In addition our annual meeting will be held in conjuncshytion with the VDA annual meeting in the fall Details will be forthcoming in future issues of the Virginia Dental Journal We welcome all members to participate in these programs

VAO NOTES I~ Dr M Alan Bagden Immediate Past President

As winter continues its more than approshypriate to ponder warm summer breezes and THE BEACH Virginia Beach that is This years annual meeting will be hosted by President Rod Klima at the old favorite Virginia Beach This years

meeting will be held at the Cavalier Conshyference Center on the beach during the end of June The exact dates are June 24-27 2000 The featured speaker will be Dr Slick VanArsdale who will certainly present a world class perio-ortho lecture for all in attendance To make this meeting even greater we will be fortunate to have the all-time favorite beach band BILL DEAL performing for the annual beach party If you have never seen them or have seen them countless times youre sure to remember this as the ultimate in sand-in-your-toes rock and roll Mark it now on your calender and plan on attending

Also worth noting is the formation of the College of Diplomates of the American Board of Orthodontics Foundation (CDABOF) This very worthwhile endeavor will serve to support the ideals of the CDABO while at the same time supporting the advancement of superior research and continuing education as well as providing financial support to residents and recent graduates to assist them in attaining their board certification Contributions can be sent to Dr Alan Bagden to support this group Make any donations payable to the CDABOF A cumulative list of contributors will be maintained in the VAO newsletter Additional mailings and pledge information will be forthcoming as the year progresses

Enjoy the rest of the winter Plan on atshytending the AAO and VAO meetings Theyre both great opportunities to get toshygether with peers and learn whats new in our wonderful profession

~L VSOMS NOTES II] Dr Paul K Hartmann President

The Virginia Society of Oral and Maxillofashycial Surgeons is busy preparing for our Febshyruary ACLS Recertification Course at St Marys Hospital in Richmond This will be offered on Saturday February 19th followed by a Risk Management Course on Sunday February zo- The Risk Management Course will have a class for staff as well as a class for VSOMS members and nonmemshyber OMSs

We are all sorry about the departure of Lisa Finnerty at the VDA Central Office Lisa has been so supportive and helpful to all the OMSs across the Commonwealth over the last few years in both legislative and administrative affairs She has moved to Roanoke to start a new career in the pharshymaceutical industry and we wish her the best of luck

A reminder to set aside the time for Dr Peter Waite at our 2000 Annual Meeting in Virginia Beach June 22-25 Dr Waite is the Chairman the Department of Oral and Maxillofacial Surgery at the University of Alabama and will lecture on Snoring and Sleep Apnea This is one you shouldnt miss

ALLIANCE NEWS ~I II] Carol Rasmussen President

The Alliance once again joined the Virginia Dental Association at the Omni Hotel in Richmond on January 14 and 15 2000 for our Winter Board of Directors Meeting and Luncheon and at the state capital in Richshymond for Legislative Day

The Board discussed where the Virginia Alliance has been and where the members see us going New topics of focus for Denshytal Health Education were entertained and we renewed our commitment to our legisshylative grass roots efforts

Information and invitations went out to all members to attend Leadership Conference which will be held in Indianapolis in April 2000 Through a special funding grant from the American Dental Association several scholarships will be awarded to those memshybers wishing to help with expenses Applishycations are available through Board Memshybers and Component Presidents Every Conference has been a fun and rewarding learning experience and this year Indy is revving their engines and tweaking their performance for a memorable time Please get your applications in early and be an inshytegral part of our pit crew

Williamsburg in September is not really that far away Plan now to attend The dates are September 14-162000 Co-Chairs for this event are still needed If you or someshyone you know can help us strut our stuff please speak with your Component Presishydent or any Board Member

Chicago in October follows the above date quickly and the Windy City is promising the time of your life with priceless sensory experiences Sounds good to me Dare to be there

Say What Say what if there were an organization comprised exclusively of spouses of denshytists What if these spouses provided sershyvices and dental health education to their local and state communities What if memshybers involvement provided an outlet for creativity personal growth improved self-


esteem and social enrichment What if it didnt take a lot of time or money but any and all efforts were welcomed and appreshyciated

Say what if YOU were a member of such an exciting organization You could expeshyrience warm camaraderie and lasting friendships with wonderful and caring people who understand and support the dental profession and the dental family The profession you dental spouse chose to pledge allegiance to and to which we all embrace

You could share your thoughts and talents and choose to make a difference We need you Dont say What Say Yes

Send your name spouses name and VDA number home address and telephone number to Ms Barbara Yandle Membershyship Chair 5900 Turkey Oak Road Richshymond Virginia 23237 Include a check in the amount of $35 (State and National Dues for 1 year)

[II PUBLIC HEALTH NOTES ~ Dr Karen C Day Director Division of Dental Health

The Division of Dental Health was recently awarded $107147 for two categorical fluoshyridation grants from the Centers for Disease Control and Prevention (CDC) The grants were written in cooperation with the Office of Water Programs in the Virginia Departshyment of Health These grants will fund imshyprovements in monitoring and reporting water system compliance to CDC initiatshying and upgrading fluoridation of several water systems and establishing a fluoride training center for engineers and watershyworks operators Fluoridation of public washyter systems began in Virginia in the Town of Fries in 1952 Today 162 water systems provide optimally fluoridated water to Virginias citizens Out of 59 million Virginshyians who are served by community water systems approximately 48 million people receive fluoridated water With 81 of comshymunity water system customers drinking fluoridated water Virginia has met the Healthy People Year 2000 Objective CDC also recently cited fluoridation as one ofthe top ten public health measures of the twenshytieth century Extensive research has shown repeatedly that fluoridation of pubshylic water supplies is a safe and effective way to reduce tooth decay However in spite of all the improvements in oral health many due to fluorides tooth decay is still a serious problem affecting an average of 45 percent of children in Virginia


~I SCHOOL OF DENTlSlRY

Tom Burke Assistant Dean

Oral Pathology - com or bust

Weve all have heard and read that the Internet (the Web) is where it is happenin these days and for the Department of Oral and Maxillofacial Pathology this is also the case We have been on the web for a couple of years at wwwvcuedudentistrv opath The purpose of our web site is to serve you As of this moment there are a number of things you can do with our web site

1 Order biopsy kits and cytology kits - A biopsy kit includes a plastic bottle filled with 10 formalin a Tissue Exshyamination Request Form and a postshyage-paid mailer These have unlimshyited shelf-life so it is best to have them on hand prior to actually needing them When the time arrives simply biopsy the patient drop the specimen in the bottle then into the mailer and then into the mailbox Well send you a dishyagnosis (fax and mail) and replaceshyment kits Cytology kits work much the same way The service is billed to the patients medical insurance not to your office This year weve diagnosed about 7300 cases and its growing

2 Refresh or expand your knowledge base - you can take a Continuing Edushycation course on Oral Cytology and actually receive CE credit from the VCU School of Dentistry Maybe youd like to take a stroll down memory lane and peer in on our Sophomore Dental Oral Pathology Course For the futurshyists there is a web-based case simushylation software called IMPACT (Intershyactive Multimedia Patient Case Tutor) which will give you the chance to play doctor with an interesting case

3 Check out some really cool hyperlinks to other Oral Pathology Sites on the Internet - Via our web site you can access a lot of knowledge stored at other schools and agencies

4 E-mail us your clinical or radiographic consults E-mail them to us using jpg files You can then call us with your questions or concerns

5 Read past issues of our department newsletter We normally mail out

newsletters to our tissue contributors on a periodic basis Now you can go back and refer to those previous isshysues

6 You can e-mail us with any ideas How we can better serve you and your ofshyfice We already provide an autoclave spore testing service that many pracshytitioners use but you may have other ideas Were thinking about a case of the month and expanding our CE offerings on the site If you have any suggestions just send us an e-mail or call us at 1-800-677-7841

As the future unfolds the Department of Oral Pathology will be utilizing the web even more for undergraduate and postgraduate dental education within the School of Denshytistry and through distance learning outside of the School of Dentistry As an example with Dr Lou Abbeys leadership we have submitted a grant to do distance education in General amp Oral Pathology for a number of outlining Dental Hygiene programs Who knows down the road we may be doing real time intraoral consults of you and your patients in your office from our offices in Richmond Teleradiology and telehistology are also on the horizon So stay tuned for future improvements and as always send us your ideas or come by and visit when you are in Richmond

Remember- our web site is wwwvcuedu dentistrvopath

Dr Lou Abbey and Dr John Svirsky conshysult on one of the 7300 biopsies reviewed in 1999

VCU School of Dentistry Student Wins

Fifty-three students from dental schools throughout the United States and Puerto Rico participated in the 1999 ADA DENTSPLY Student Clinician Program held in conjunction with the 140th Annual Session of the ADA in Honolulu Hawaii in October 1999 Only six students were seshylected as winners Ms Cindy Dang Medishycal College of Virginia won second place in the Clinical Application and Techniques Category Her winning clinic title was Wear behavior of flowable and condensable comshyposite resins

VCU School of Dentistry Hosts 1999 Anshynual Meeting for Prosthodontics

VCU School of Dentistrys Department of Prosthodontics planned and implemented a regional workshop attended by one-third of the nations dental schools The meetshying was held in conjunction with the Amerishycan Association of Dental Schools and foshycused on the important issues facing prosthodontic education Thirty-five faculty members representing fifteen dental schools from the southeast and mid-atlantic states traveled to Richmond to discuss isshysues of competency and evaluation the

scope of pre-doctoral education and the incorporation of new prosthodontic materishyals into the curriculum

Dr Donald Crabtree Assistant Professor of Prosthodontics organized and planned the meeting This was the largest group ever to attend the annual meeting The exceptional attendance enhanced discusshysion and provided attendees with the opshyportunity to share educational concerns concluded Dr Crabtree

Prosthodontic educators pose during a break in the meeting activities

Ms Hang Cindy Dang of the Medical College of Virginia was awarded second place at the 1999 ADAfDENTSPLY Student Clinician Proshygram

INTRODUCING DENTAL DUES GOLDOPTIONSM FINANCING IT JUST GOT EASIER

Need to Pay your Dental Dues Need New Office Equipment Need to Consolidate Your Bills

The Virginia Dental Association is pleased to present the Virginia Dental Association GoldOption SM Loan with no annual fee no prepayment penalty and no collateral In as little as 15 minutes you can have up to $50000 at your disposal to use for virtually any purpose you can imagine - even paying your dental dues

The Virginia Dental Association GoldOption Loan offers you the cash you want at the rate you deserve Your preferred status makes you eligible for this fixed-payment loan at the low variable rate of Prime+2 You select your payment amount based on your term and the amount you borrow GoldOption allows you to request additional funds to use over and over again

Access your funds by direct deposit into your personal checking account direct payment to creditors or by check

Apply by phone and receive a decision in as little as 15 minutes

Call toll free 1-800-527-3621 When calling please mention Priority Code JPX9-DZ-873-WN

bull Receipt of maximum credit line is subject to income and creditworthiness standards The Annual Percentage Rate(APR) is a variable APR of prime plus 2 currently 105 There is a check transaction fee equal to 2 of the

US Dollar amount of each check you use to obtain an advance (fee minimum $2 maximum $15) To avoid check transaction fees have your

funds deposited directly into your checking account or sent directly to your creditors

lJUpon approval MBNA will send funds as requested The total amount requested cannot exceed your credit line If it does and MBNA cannot contact you all approved amounts may be sent to you in check form for your endorsement Allow two weeks processing time from account opening Please continue to make payments to your creditors until you receive MBNA payment confirmation from those creditors GoldOption MBNA MBNA America MBNA Consumer Finance are service marks of MBNA America Bank NA (0 1998 MBNA America Bank NA


classified ads

Classified advertising rates are $30 for up to 30 words Adshyditional words 25 each All advertisements must be preshypaid and cannot be accepted by phone or fax Checks should be payable to the Virginia Dental Association The closing dates for all copy will be the 1st of January April July October Example April 1 at 5pm is the closing date for the April-May-June Journal issue After the deadline closes the Journal can accept no ads nor can it alter or cancel previously ordered ads This deadline is firm

As a membership service ads are restricted to VDA and ADA members unless employment or continuing educashytion related Advertising copy must be typewritten and sent to Journal Classified Department Virginia Dental Association PO Box 6906 Richmond VA 23230-0906

The Virginia Dental Association reserves the right to edit copy or reject any ad

and does not assume liability for the contents of classified advertising

Opportunity Wanted - Central Virginia - Personable and moshytivated young orthodontist with professional experience seekshying full-time or part-time associateship in an orthodontic multishyspeciality general or pediatric dentistry practice Flexible with respect to work schedule and contract arrangements Send confidential replies to Dr MAP 9425 Charter Creek Drive Apt 2-E Ashland Virginia 23005

Ergonomic Equipment For Sale Eliminate aching backs wrists and necks Patented technology to help your practice in comfort and prevent job related staff and hygienist ailments Call Dr Joe Chicurel (540) 943-5389

CONTINUING EDUCATION 16 CREDITS$10000 (8 CEUS $50) FOR STATE LICENSURE OTC and Rx Oral Medicine Self-Study Exams Send $100 to American Academy of Oral Pharmacology 860 E Broad St ATTN Dental CE Dept Elyria OH 44035 (877) 877-SMILE (7645)

Dentist Career Associateship Opportunities available in high-end successful fee-for-service driven practices potenshytially leading to partnershipownership positions These prishyvately owned and operated practices are looking for ambitious hard-working licensed general and speciality dentists To learn about the tremendous opportunities available in MD and VA contact Jeff Nulf at 1-800-889-2893 and visit our website at wwwdentalrecruitingcom

OPPORTUNITY FOR GENERAL DENTISTS Nations largshyest most experienced Interim Professional Service (Locum Tenens) for dentists Competitive pay travel opportunities and flexible schedules Forest Irons amp Associates Inc 888-433-2603

Partnership available with a large well-established 20-year practice on the HamptonNewport News peninsula This pracshytice enjoys many new fee-for-service patients monthly This is an opportunity for a general dentist who is interested in pracshyticing comprehensive dentistry while learning the business skills of managing a practice In addition techniques on how to earn millions and invest these assets will be shared if the partshynership is consummated Experience preferred but will conshysider efficient talented dentist who practices all phases of genshyeral practice and can communicate well with patients Fax resume to 757-827-7772

Dentist Coordinator Position Available -- provide 20 hours per week of dental care to homeless patients and supervise dental students Days are negotiable but prefer Monday Wednesday and Friday $35 per hour Newly renovated facilshyity and all new state-of-the-art equipment Send resumes to J Price 517 West Grace Street Richmond VA 23220

Dental Practice For Sale By Owner Well-established Genshyeral Dental Practice and attractive office for sale in Smithfield Virginia Three operatories furnished with three-year-old equipshyment All operatories business office and laboratory computshyerized and networked with digital x-ray intraoral cameras (3) and Florida Probe Call (757) 357-4121 for more information andor viewing appointment

ANew Narne ANew VDA Annual Meeting

QirHEi~ia MEETING

September 13-17 2000 Williamsburg Lodge - Williamsburg VA


Whats So Special About Partials FroDl Virginia Dental Laboratories

1 Integrity Virginia Dental Laboratory uses bull Vitalliumreg Alloy-the only partial denture

alloy that is processed under the same quality control conditions as orthopedic implant alloy-with over 50 years of patient success

2 Accuracy Our entire procedure for constructshybull ing Vitallium Partial Dentures is quality-conshy

trolled to achieve the utmost accuracy This accuracy means faster delivery of the restoration reduced chairtime and greater patient satisfaction

3 Quality Our partial denture restorations begin bull with quality raw materials such as Vitalliumreg

Alloy Vitallium Alloyreg is totally biocompatible It is nickel- and beryllium-free Its surface wont tarnish dull or corrode in the oral cavity or in the body

4 Experience The exceptional skills quality bull craftsmanship and proven techniques of

Virginia Dental Laboratories come only as the result of years of experience painstaking effort and a deep commitment to integrity

Commitment Virginia Dental Laboratories is 5bull dedicated to providing you and your patients with the highest quality partial dentures available We believe that the combination of our quality raw mateshyrials such as Vitallium Alloy our skilled technicians our unequaled experience and our steadfast dedication specially qualify us to satisfy the needs of you and your patients

For special treatment on your next partial denture case please contact Virginia Dental Laboratories

We are happy to survey design and estimate from your diagnostic casts at no obligation to you Contact us today

Since 1932

irginia Dental Laboratories Inc

130 W York Street Norfolk Virginia 23510 (757) 622-4614 (800) 870-46 14

copy 1992 Austenal Inc All Rights Reserved Vitallium trademark licensed to Austenal Inc by Pfizer Inc

Vol 77 Numb 1 Jan_March 2000


HIGH

QUALITY

HEALTH BENEFITS

ARE HARD To FIND

UNLESS You FIND A COMBINATION SUCH

AS THE VDSC INSURANCE SERVICE CENTER

AND TRIGON BLUE CROSS BLUE SHIELD

The Virginia Dental Association (VDA) and the Virginia Dental Services Corporation (VDSC) are proud

to announce a new association sponsored healthcare program through Trigon Blue Cross Blue Shield This new program is available for all dentists interested in setting up a benefit program

for themselves or their practice

Call our toll-free number between 830 am VDAs HEALTH INSURANCE PROGRAM INCLUDES and 530 prn Monday through Friday bull Choice of Products - Indemnity PPO POS

Simply dial 1-800-832-7001 for quick HMO and MSAs

bull Trigons extensive networks of participating and efficient service Its that easy The hospitals and doctors

VDSC Insurance Service Center also has bull Special Trigon Value Added and IVIembership

a toll free fax line 1-800-886-4913 benefits available to you because of your association membership

CALL TODAY for information on the wide variety of exciting health products

our association is offering for the upcoming year Our service and marketing

departments will be delighted to answer your questions Call the VDSC

Insurance Service Center at 1-800-832-7001 to find out how our

association is working to assist members in this important area




Thomas Burke

TABLE OF CONTENTS








EDITORIAL BOARD
















FOUNDATIONS


1999 ADA DELEGATION


































~I EDITORIAL II]





























A sincere thank you

















contour
















Case Report


Figure 1

Figure 2






Figure 3




Figure 4

Figure 5

Figure 6

Figure 7




Figure 9

Figure 10


Figure 11

Figure 12



Figure 13

Figure 14


Figure 15





Figure 16



Figure 17








ABSTRACTS









_----~















































---~----














SUCCESS f)bull

We could give you I



























A Look Back at 1999




A Look Into 2000























































































Youre The Captain

~~ItSwYQllImmShip






(703) 449 1500



(

I

I

copy 1999 HPSC Inc






























































Alloys


Attachments


Restorative Systems




Lisa McLaughlin


800 243-9942 x 293

SternVantagetrade


wwwsterngoldcom

A Cookson C Company








Coordinator








Project Coordinator




Coordinator






Coordinator




L 7342








I


Feb 23 2000

Feb 23 2000

March 6-10 2000

March 102000

March 172000

March 24 2000

April 14 2000

April 26 2000

May 19 2000

May 19 2000

May 19-21 2000

June 22-25 2000

Aug 11 2000

Sept 1-2 2000

Sept 15 2000

Sept 15 2000

Sept 16 2000

Sept 162000

Oct 29 2000

Nov 4-5 2000

Nov 17 2000

Component

NVDS (8)

VAGD

MCV-Anatomy

Peninsula (2)

Southwest (6)


Tidewater (1)

NVDS (8)

Shenandoah (7)

VAGD

Southwest (6)

VSOMS


VAGD

VDA Annual Meeting

VDA Annual Meeting

VDA Annual Meeting

VDA Annual Meeting

Tidewater (1)

VAG 0

Southwest (6)

Location

Fairview Marriott

Charlottesville

MCV

Newport News Omni


Fairview Marriott


Fairview Marriott


Richmond


Sheraton - VA Beach


Virginia Beach

Williamsburg Lodge

Williamsburg Lodge

Williamsburg Lodge

Williamsburg Lodge

TBA

Richmond


SpeakerTopic











TBA

















































































Dental Study


















4 $ 746357 -- Tobacco




Firms 10 $ 597276

























REGISTRATION

Name (s) _

Address _

Phone and Fax _






Merer



















wwwvadentalorg

TJi~~4cent J


Jishyl






THE



































for Dentists



TOLL FREE 800-467-8734 FAX 813-222-4288







f bull






Dr Eric Boxx Editor

No news to report

























- -
















Component VII











No news to report
































































classified ads














QirHEi~ia MEETING















Since 1932









Thomas Burke

TABLE OF CONTENTS








EDITORIAL BOARD
















FOUNDATIONS


1999 ADA DELEGATION


































~I EDITORIAL II]





























A sincere thank you

















contour
















Case Report


Figure 1

Figure 2






Figure 3




Figure 4

Figure 5

Figure 6

Figure 7




Figure 9

Figure 10


Figure 11

Figure 12



Figure 13

Figure 14


Figure 15





Figure 16



Figure 17








ABSTRACTS









_----~















































---~----














SUCCESS f)bull

We could give you I



























A Look Back at 1999




A Look Into 2000























































































Youre The Captain

~~ItSwYQllImmShip






(703) 449 1500



(

I

I

copy 1999 HPSC Inc






























































Alloys


Attachments


Restorative Systems




Lisa McLaughlin


800 243-9942 x 293

SternVantagetrade


wwwsterngoldcom

A Cookson C Company








Coordinator








Project Coordinator




Coordinator






Coordinator




L 7342








I


Feb 23 2000

Feb 23 2000

March 6-10 2000

March 102000

March 172000

March 24 2000

April 14 2000

April 26 2000

May 19 2000

May 19 2000

May 19-21 2000

June 22-25 2000

Aug 11 2000

Sept 1-2 2000

Sept 15 2000

Sept 15 2000

Sept 16 2000

Sept 162000

Oct 29 2000

Nov 4-5 2000

Nov 17 2000

Component

NVDS (8)

VAGD

MCV-Anatomy

Peninsula (2)

Southwest (6)


Tidewater (1)

NVDS (8)

Shenandoah (7)

VAGD

Southwest (6)

VSOMS


VAGD

VDA Annual Meeting

VDA Annual Meeting

VDA Annual Meeting

VDA Annual Meeting

Tidewater (1)

VAG 0

Southwest (6)

Location

Fairview Marriott

Charlottesville

MCV

Newport News Omni


Fairview Marriott


Fairview Marriott


Richmond


Sheraton - VA Beach


Virginia Beach

Williamsburg Lodge

Williamsburg Lodge

Williamsburg Lodge

Williamsburg Lodge

TBA

Richmond


SpeakerTopic











TBA

















































































Dental Study


















4 $ 746357 -- Tobacco




Firms 10 $ 597276

























REGISTRATION

Name (s) _

Address _

Phone and Fax _






Merer



















wwwvadentalorg

TJi~~4cent J


Jishyl






THE



































for Dentists



TOLL FREE 800-467-8734 FAX 813-222-4288







f bull






Dr Eric Boxx Editor

No news to report

























- -
















Component VII











No news to report
































































classified ads














QirHEi~ia MEETING















Since 1932







EDITORIAL BOARD
















FOUNDATIONS


1999 ADA DELEGATION


































~I EDITORIAL II]





























A sincere thank you

















contour
















Case Report


Figure 1

Figure 2






Figure 3




Figure 4

Figure 5

Figure 6

Figure 7




Figure 9

Figure 10


Figure 11

Figure 12



Figure 13

Figure 14


Figure 15





Figure 16



Figure 17








ABSTRACTS









_----~















































---~----














SUCCESS f)bull

We could give you I



























A Look Back at 1999




A Look Into 2000























































































Youre The Captain

~~ItSwYQllImmShip






(703) 449 1500



(

I

I

copy 1999 HPSC Inc






























































Alloys


Attachments


Restorative Systems




Lisa McLaughlin


800 243-9942 x 293

SternVantagetrade


wwwsterngoldcom

A Cookson C Company








Coordinator








Project Coordinator




Coordinator






Coordinator




L 7342








I


Feb 23 2000

Feb 23 2000

March 6-10 2000

March 102000

March 172000

March 24 2000

April 14 2000

April 26 2000

May 19 2000

May 19 2000

May 19-21 2000

June 22-25 2000

Aug 11 2000

Sept 1-2 2000

Sept 15 2000

Sept 15 2000

Sept 16 2000

Sept 162000

Oct 29 2000

Nov 4-5 2000

Nov 17 2000

Component

NVDS (8)

VAGD

MCV-Anatomy

Peninsula (2)

Southwest (6)


Tidewater (1)

NVDS (8)

Shenandoah (7)

VAGD

Southwest (6)

VSOMS


VAGD

VDA Annual Meeting

VDA Annual Meeting

VDA Annual Meeting

VDA Annual Meeting

Tidewater (1)

VAG 0

Southwest (6)

Location

Fairview Marriott

Charlottesville

MCV

Newport News Omni


Fairview Marriott


Fairview Marriott


Richmond


Sheraton - VA Beach


Virginia Beach

Williamsburg Lodge

Williamsburg Lodge

Williamsburg Lodge

Williamsburg Lodge

TBA

Richmond


SpeakerTopic











TBA

















































































Dental Study


















4 $ 746357 -- Tobacco




Firms 10 $ 597276

























REGISTRATION

Name (s) _

Address _

Phone and Fax _






Merer



















wwwvadentalorg

TJi~~4cent J


Jishyl






THE



































for Dentists



TOLL FREE 800-467-8734 FAX 813-222-4288







f bull






Dr Eric Boxx Editor

No news to report

























- -
















Component VII











No news to report
































































classified ads














QirHEi~ia MEETING















Since 1932




















~I EDITORIAL II]





























A sincere thank you

















contour
















Case Report


Figure 1

Figure 2






Figure 3




Figure 4

Figure 5

Figure 6

Figure 7




Figure 9

Figure 10


Figure 11

Figure 12



Figure 13

Figure 14


Figure 15





Figure 16



Figure 17








ABSTRACTS









_----~















































---~----














SUCCESS f)bull

We could give you I



























A Look Back at 1999




A Look Into 2000























































































Youre The Captain

~~ItSwYQllImmShip






(703) 449 1500



(

I

I

copy 1999 HPSC Inc






























































Alloys


Attachments


Restorative Systems




Lisa McLaughlin


800 243-9942 x 293

SternVantagetrade


wwwsterngoldcom

A Cookson C Company








Coordinator








Project Coordinator




Coordinator






Coordinator




L 7342








I


Feb 23 2000

Feb 23 2000

March 6-10 2000

March 102000

March 172000

March 24 2000

April 14 2000

April 26 2000

May 19 2000

May 19 2000

May 19-21 2000

June 22-25 2000

Aug 11 2000

Sept 1-2 2000

Sept 15 2000

Sept 15 2000

Sept 16 2000

Sept 162000

Oct 29 2000

Nov 4-5 2000

Nov 17 2000

Component

NVDS (8)

VAGD

MCV-Anatomy

Peninsula (2)

Southwest (6)


Tidewater (1)

NVDS (8)

Shenandoah (7)

VAGD

Southwest (6)

VSOMS


VAGD

VDA Annual Meeting

VDA Annual Meeting

VDA Annual Meeting

VDA Annual Meeting

Tidewater (1)

VAG 0

Southwest (6)

Location

Fairview Marriott

Charlottesville

MCV

Newport News Omni


Fairview Marriott


Fairview Marriott


Richmond


Sheraton - VA Beach


Virginia Beach

Williamsburg Lodge

Williamsburg Lodge

Williamsburg Lodge

Williamsburg Lodge

TBA

Richmond


SpeakerTopic











TBA

















































































Dental Study


















4 $ 746357 -- Tobacco




Firms 10 $ 597276

























REGISTRATION

Name (s) _

Address _

Phone and Fax _






Merer



















wwwvadentalorg

TJi~~4cent J


Jishyl






THE



































for Dentists



TOLL FREE 800-467-8734 FAX 813-222-4288







f bull






Dr Eric Boxx Editor

No news to report

























- -
















Component VII











No news to report
































































classified ads














QirHEi~ia MEETING















Since 1932





























A sincere thank you

















contour
















Case Report


Figure 1

Figure 2






Figure 3




Figure 4

Figure 5

Figure 6

Figure 7




Figure 9

Figure 10


Figure 11

Figure 12



Figure 13

Figure 14


Figure 15





Figure 16



Figure 17








ABSTRACTS









_----~















































---~----














SUCCESS f)bull

We could give you I



























A Look Back at 1999




A Look Into 2000























































































Youre The Captain

~~ItSwYQllImmShip






(703) 449 1500



(

I

I

copy 1999 HPSC Inc






























































Alloys


Attachments


Restorative Systems




Lisa McLaughlin


800 243-9942 x 293

SternVantagetrade


wwwsterngoldcom

A Cookson C Company








Coordinator








Project Coordinator




Coordinator






Coordinator




L 7342








I


Feb 23 2000

Feb 23 2000

March 6-10 2000

March 102000

March 172000

March 24 2000

April 14 2000

April 26 2000

May 19 2000

May 19 2000

May 19-21 2000

June 22-25 2000

Aug 11 2000

Sept 1-2 2000

Sept 15 2000

Sept 15 2000

Sept 16 2000

Sept 162000

Oct 29 2000

Nov 4-5 2000

Nov 17 2000

Component

NVDS (8)

VAGD

MCV-Anatomy

Peninsula (2)

Southwest (6)


Tidewater (1)

NVDS (8)

Shenandoah (7)

VAGD

Southwest (6)

VSOMS


VAGD

VDA Annual Meeting

VDA Annual Meeting

VDA Annual Meeting

VDA Annual Meeting

Tidewater (1)

VAG 0

Southwest (6)

Location

Fairview Marriott

Charlottesville

MCV

Newport News Omni


Fairview Marriott


Fairview Marriott


Richmond


Sheraton - VA Beach


Virginia Beach

Williamsburg Lodge

Williamsburg Lodge

Williamsburg Lodge

Williamsburg Lodge

TBA

Richmond


SpeakerTopic











TBA

















































































Dental Study


















4 $ 746357 -- Tobacco




Firms 10 $ 597276

























REGISTRATION

Name (s) _

Address _

Phone and Fax _






Merer



















wwwvadentalorg

TJi~~4cent J


Jishyl






THE



































for Dentists



TOLL FREE 800-467-8734 FAX 813-222-4288







f bull






Dr Eric Boxx Editor

No news to report

























- -
















Component VII











No news to report
































































classified ads














QirHEi~ia MEETING















Since 1932













contour
















Case Report


Figure 1

Figure 2






Figure 3




Figure 4

Figure 5

Figure 6

Figure 7




Figure 9

Figure 10


Figure 11

Figure 12



Figure 13

Figure 14


Figure 15





Figure 16



Figure 17








ABSTRACTS









_----~















































---~----














SUCCESS f)bull

We could give you I



























A Look Back at 1999




A Look Into 2000























































































Youre The Captain

~~ItSwYQllImmShip






(703) 449 1500



(

I

I

copy 1999 HPSC Inc






























































Alloys


Attachments


Restorative Systems




Lisa McLaughlin


800 243-9942 x 293

SternVantagetrade


wwwsterngoldcom

A Cookson C Company








Coordinator








Project Coordinator




Coordinator






Coordinator




L 7342








I


Feb 23 2000

Feb 23 2000

March 6-10 2000

March 102000

March 172000

March 24 2000

April 14 2000

April 26 2000

May 19 2000

May 19 2000

May 19-21 2000

June 22-25 2000

Aug 11 2000

Sept 1-2 2000

Sept 15 2000

Sept 15 2000

Sept 16 2000

Sept 162000

Oct 29 2000

Nov 4-5 2000

Nov 17 2000

Component

NVDS (8)

VAGD

MCV-Anatomy

Peninsula (2)

Southwest (6)


Tidewater (1)

NVDS (8)

Shenandoah (7)

VAGD

Southwest (6)

VSOMS


VAGD

VDA Annual Meeting

VDA Annual Meeting

VDA Annual Meeting

VDA Annual Meeting

Tidewater (1)

VAG 0

Southwest (6)

Location

Fairview Marriott

Charlottesville

MCV

Newport News Omni


Fairview Marriott


Fairview Marriott


Richmond


Sheraton - VA Beach


Virginia Beach

Williamsburg Lodge

Williamsburg Lodge

Williamsburg Lodge

Williamsburg Lodge

TBA

Richmond


SpeakerTopic











TBA

















































































Dental Study


















4 $ 746357 -- Tobacco




Firms 10 $ 597276

























REGISTRATION

Name (s) _

Address _

Phone and Fax _






Merer



















wwwvadentalorg

TJi~~4cent J


Jishyl






THE



































for Dentists



TOLL FREE 800-467-8734 FAX 813-222-4288







f bull






Dr Eric Boxx Editor

No news to report

























- -
















Component VII











No news to report
































































classified ads














QirHEi~ia MEETING















Since 1932






Case Report


Figure 1

Figure 2






Figure 3




Figure 4

Figure 5

Figure 6

Figure 7




Figure 9

Figure 10


Figure 11

Figure 12



Figure 13

Figure 14


Figure 15





Figure 16



Figure 17








ABSTRACTS









_----~















































---~----














SUCCESS f)bull

We could give you I



























A Look Back at 1999




A Look Into 2000























































































Youre The Captain

~~ItSwYQllImmShip






(703) 449 1500



(

I

I

copy 1999 HPSC Inc






























































Alloys


Attachments


Restorative Systems




Lisa McLaughlin


800 243-9942 x 293

SternVantagetrade


wwwsterngoldcom

A Cookson C Company








Coordinator








Project Coordinator




Coordinator






Coordinator




L 7342








I


Feb 23 2000

Feb 23 2000

March 6-10 2000

March 102000

March 172000

March 24 2000

April 14 2000

April 26 2000

May 19 2000

May 19 2000

May 19-21 2000

June 22-25 2000

Aug 11 2000

Sept 1-2 2000

Sept 15 2000

Sept 15 2000

Sept 16 2000

Sept 162000

Oct 29 2000

Nov 4-5 2000

Nov 17 2000

Component

NVDS (8)

VAGD

MCV-Anatomy

Peninsula (2)

Southwest (6)


Tidewater (1)

NVDS (8)

Shenandoah (7)

VAGD

Southwest (6)

VSOMS


VAGD

VDA Annual Meeting

VDA Annual Meeting

VDA Annual Meeting

VDA Annual Meeting

Tidewater (1)

VAG 0

Southwest (6)

Location

Fairview Marriott

Charlottesville

MCV

Newport News Omni


Fairview Marriott


Fairview Marriott


Richmond


Sheraton - VA Beach


Virginia Beach

Williamsburg Lodge

Williamsburg Lodge

Williamsburg Lodge

Williamsburg Lodge

TBA

Richmond


SpeakerTopic











TBA

















































































Dental Study


















4 $ 746357 -- Tobacco




Firms 10 $ 597276

























REGISTRATION

Name (s) _

Address _

Phone and Fax _






Merer



















wwwvadentalorg

TJi~~4cent J


Jishyl






THE



































for Dentists



TOLL FREE 800-467-8734 FAX 813-222-4288







f bull






Dr Eric Boxx Editor

No news to report

























- -
















Component VII











No news to report
































































classified ads














QirHEi~ia MEETING















Since 1932








Figure 9

Figure 10


Figure 11

Figure 12



Figure 13

Figure 14


Figure 15





Figure 16



Figure 17








ABSTRACTS









_----~















































---~----














SUCCESS f)bull

We could give you I



























A Look Back at 1999




A Look Into 2000























































































Youre The Captain

~~ItSwYQllImmShip






(703) 449 1500



(

I

I

copy 1999 HPSC Inc






























































Alloys


Attachments


Restorative Systems




Lisa McLaughlin


800 243-9942 x 293

SternVantagetrade


wwwsterngoldcom

A Cookson C Company








Coordinator








Project Coordinator




Coordinator






Coordinator




L 7342








I


Feb 23 2000

Feb 23 2000

March 6-10 2000

March 102000

March 172000

March 24 2000

April 14 2000

April 26 2000

May 19 2000

May 19 2000

May 19-21 2000

June 22-25 2000

Aug 11 2000

Sept 1-2 2000

Sept 15 2000

Sept 15 2000

Sept 16 2000

Sept 162000

Oct 29 2000

Nov 4-5 2000

Nov 17 2000

Component

NVDS (8)

VAGD

MCV-Anatomy

Peninsula (2)

Southwest (6)


Tidewater (1)

NVDS (8)

Shenandoah (7)

VAGD

Southwest (6)

VSOMS


VAGD

VDA Annual Meeting

VDA Annual Meeting

VDA Annual Meeting

VDA Annual Meeting

Tidewater (1)

VAG 0

Southwest (6)

Location

Fairview Marriott

Charlottesville

MCV

Newport News Omni


Fairview Marriott


Fairview Marriott


Richmond


Sheraton - VA Beach


Virginia Beach

Williamsburg Lodge

Williamsburg Lodge

Williamsburg Lodge

Williamsburg Lodge

TBA

Richmond


SpeakerTopic











TBA

















































































Dental Study


















4 $ 746357 -- Tobacco




Firms 10 $ 597276

























REGISTRATION

Name (s) _

Address _

Phone and Fax _






Merer



















wwwvadentalorg

TJi~~4cent J


Jishyl






THE



































for Dentists



TOLL FREE 800-467-8734 FAX 813-222-4288







f bull






Dr Eric Boxx Editor

No news to report

























- -
















Component VII











No news to report
































































classified ads














QirHEi~ia MEETING















Since 1932









Figure 16



Figure 17








ABSTRACTS









_----~















































---~----














SUCCESS f)bull

We could give you I



























A Look Back at 1999




A Look Into 2000























































































Youre The Captain

~~ItSwYQllImmShip






(703) 449 1500



(

I

I

copy 1999 HPSC Inc






























































Alloys


Attachments


Restorative Systems




Lisa McLaughlin


800 243-9942 x 293

SternVantagetrade


wwwsterngoldcom

A Cookson C Company








Coordinator








Project Coordinator




Coordinator






Coordinator




L 7342








I


Feb 23 2000

Feb 23 2000

March 6-10 2000

March 102000

March 172000

March 24 2000

April 14 2000

April 26 2000

May 19 2000

May 19 2000

May 19-21 2000

June 22-25 2000

Aug 11 2000

Sept 1-2 2000

Sept 15 2000

Sept 15 2000

Sept 16 2000

Sept 162000

Oct 29 2000

Nov 4-5 2000

Nov 17 2000

Component

NVDS (8)

VAGD

MCV-Anatomy

Peninsula (2)

Southwest (6)


Tidewater (1)

NVDS (8)

Shenandoah (7)

VAGD

Southwest (6)

VSOMS


VAGD

VDA Annual Meeting

VDA Annual Meeting

VDA Annual Meeting

VDA Annual Meeting

Tidewater (1)

VAG 0

Southwest (6)

Location

Fairview Marriott

Charlottesville

MCV

Newport News Omni


Fairview Marriott


Fairview Marriott


Richmond


Sheraton - VA Beach


Virginia Beach

Williamsburg Lodge

Williamsburg Lodge

Williamsburg Lodge

Williamsburg Lodge

TBA

Richmond


SpeakerTopic











TBA

















































































Dental Study


















4 $ 746357 -- Tobacco




Firms 10 $ 597276

























REGISTRATION

Name (s) _

Address _

Phone and Fax _






Merer



















wwwvadentalorg

TJi~~4cent J


Jishyl






THE



































for Dentists



TOLL FREE 800-467-8734 FAX 813-222-4288







f bull






Dr Eric Boxx Editor

No news to report

























- -
















Component VII











No news to report
































































classified ads














QirHEi~ia MEETING















Since 1932






ABSTRACTS









_----~















































---~----














SUCCESS f)bull

We could give you I



























A Look Back at 1999




A Look Into 2000























































































Youre The Captain

~~ItSwYQllImmShip






(703) 449 1500



(

I

I

copy 1999 HPSC Inc






























































Alloys


Attachments


Restorative Systems




Lisa McLaughlin


800 243-9942 x 293

SternVantagetrade


wwwsterngoldcom

A Cookson C Company








Coordinator








Project Coordinator




Coordinator






Coordinator




L 7342








I


Feb 23 2000

Feb 23 2000

March 6-10 2000

March 102000

March 172000

March 24 2000

April 14 2000

April 26 2000

May 19 2000

May 19 2000

May 19-21 2000

June 22-25 2000

Aug 11 2000

Sept 1-2 2000

Sept 15 2000

Sept 15 2000

Sept 16 2000

Sept 162000

Oct 29 2000

Nov 4-5 2000

Nov 17 2000

Component

NVDS (8)

VAGD

MCV-Anatomy

Peninsula (2)

Southwest (6)


Tidewater (1)

NVDS (8)

Shenandoah (7)

VAGD

Southwest (6)

VSOMS


VAGD

VDA Annual Meeting

VDA Annual Meeting

VDA Annual Meeting

VDA Annual Meeting

Tidewater (1)

VAG 0

Southwest (6)

Location

Fairview Marriott

Charlottesville

MCV

Newport News Omni


Fairview Marriott


Fairview Marriott


Richmond


Sheraton - VA Beach


Virginia Beach

Williamsburg Lodge

Williamsburg Lodge

Williamsburg Lodge

Williamsburg Lodge

TBA

Richmond


SpeakerTopic











TBA

















































































Dental Study


















4 $ 746357 -- Tobacco




Firms 10 $ 597276

























REGISTRATION

Name (s) _

Address _

Phone and Fax _






Merer



















wwwvadentalorg

TJi~~4cent J


Jishyl






THE



































for Dentists



TOLL FREE 800-467-8734 FAX 813-222-4288







f bull






Dr Eric Boxx Editor

No news to report

























- -
















Component VII











No news to report
































































classified ads














QirHEi~ia MEETING















Since 1932
















































---~----














SUCCESS f)bull

We could give you I



























A Look Back at 1999




A Look Into 2000























































































Youre The Captain

~~ItSwYQllImmShip






(703) 449 1500



(

I

I

copy 1999 HPSC Inc






























































Alloys


Attachments


Restorative Systems




Lisa McLaughlin


800 243-9942 x 293

SternVantagetrade


wwwsterngoldcom

A Cookson C Company








Coordinator








Project Coordinator




Coordinator






Coordinator




L 7342








I


Feb 23 2000

Feb 23 2000

March 6-10 2000

March 102000

March 172000

March 24 2000

April 14 2000

April 26 2000

May 19 2000

May 19 2000

May 19-21 2000

June 22-25 2000

Aug 11 2000

Sept 1-2 2000

Sept 15 2000

Sept 15 2000

Sept 16 2000

Sept 162000

Oct 29 2000

Nov 4-5 2000

Nov 17 2000

Component

NVDS (8)

VAGD

MCV-Anatomy

Peninsula (2)

Southwest (6)


Tidewater (1)

NVDS (8)

Shenandoah (7)

VAGD

Southwest (6)

VSOMS


VAGD

VDA Annual Meeting

VDA Annual Meeting

VDA Annual Meeting

VDA Annual Meeting

Tidewater (1)

VAG 0

Southwest (6)

Location

Fairview Marriott

Charlottesville

MCV

Newport News Omni


Fairview Marriott


Fairview Marriott


Richmond


Sheraton - VA Beach


Virginia Beach

Williamsburg Lodge

Williamsburg Lodge

Williamsburg Lodge

Williamsburg Lodge

TBA

Richmond


SpeakerTopic











TBA

















































































Dental Study


















4 $ 746357 -- Tobacco




Firms 10 $ 597276

























REGISTRATION

Name (s) _

Address _

Phone and Fax _






Merer



















wwwvadentalorg

TJi~~4cent J


Jishyl






THE



































for Dentists



TOLL FREE 800-467-8734 FAX 813-222-4288







f bull






Dr Eric Boxx Editor

No news to report

























- -
















Component VII











No news to report
































































classified ads














QirHEi~ia MEETING















Since 1932







SUCCESS f)bull

We could give you I



























A Look Back at 1999




A Look Into 2000























































































Youre The Captain

~~ItSwYQllImmShip






(703) 449 1500



(

I

I

copy 1999 HPSC Inc






























































Alloys


Attachments


Restorative Systems




Lisa McLaughlin


800 243-9942 x 293

SternVantagetrade


wwwsterngoldcom

A Cookson C Company








Coordinator








Project Coordinator




Coordinator






Coordinator




L 7342








I


Feb 23 2000

Feb 23 2000

March 6-10 2000

March 102000

March 172000

March 24 2000

April 14 2000

April 26 2000

May 19 2000

May 19 2000

May 19-21 2000

June 22-25 2000

Aug 11 2000

Sept 1-2 2000

Sept 15 2000

Sept 15 2000

Sept 16 2000

Sept 162000

Oct 29 2000

Nov 4-5 2000

Nov 17 2000

Component

NVDS (8)

VAGD

MCV-Anatomy

Peninsula (2)

Southwest (6)


Tidewater (1)

NVDS (8)

Shenandoah (7)

VAGD

Southwest (6)

VSOMS


VAGD

VDA Annual Meeting

VDA Annual Meeting

VDA Annual Meeting

VDA Annual Meeting

Tidewater (1)

VAG 0

Southwest (6)

Location

Fairview Marriott

Charlottesville

MCV

Newport News Omni


Fairview Marriott


Fairview Marriott


Richmond


Sheraton - VA Beach


Virginia Beach

Williamsburg Lodge

Williamsburg Lodge

Williamsburg Lodge

Williamsburg Lodge

TBA

Richmond


SpeakerTopic











TBA

















































































Dental Study


















4 $ 746357 -- Tobacco




Firms 10 $ 597276

























REGISTRATION

Name (s) _

Address _

Phone and Fax _






Merer



















wwwvadentalorg

TJi~~4cent J


Jishyl






THE



































for Dentists



TOLL FREE 800-467-8734 FAX 813-222-4288







f bull






Dr Eric Boxx Editor

No news to report

























- -
















Component VII











No news to report
































































classified ads














QirHEi~ia MEETING















Since 1932


























A Look Back at 1999




A Look Into 2000























































































Youre The Captain

~~ItSwYQllImmShip






(703) 449 1500



(

I

I

copy 1999 HPSC Inc






























































Alloys


Attachments


Restorative Systems




Lisa McLaughlin


800 243-9942 x 293

SternVantagetrade


wwwsterngoldcom

A Cookson C Company








Coordinator








Project Coordinator




Coordinator






Coordinator




L 7342








I


Feb 23 2000

Feb 23 2000

March 6-10 2000

March 102000

March 172000

March 24 2000

April 14 2000

April 26 2000

May 19 2000

May 19 2000

May 19-21 2000

June 22-25 2000

Aug 11 2000

Sept 1-2 2000

Sept 15 2000

Sept 15 2000

Sept 16 2000

Sept 162000

Oct 29 2000

Nov 4-5 2000

Nov 17 2000

Component

NVDS (8)

VAGD

MCV-Anatomy

Peninsula (2)

Southwest (6)


Tidewater (1)

NVDS (8)

Shenandoah (7)

VAGD

Southwest (6)

VSOMS


VAGD

VDA Annual Meeting

VDA Annual Meeting

VDA Annual Meeting

VDA Annual Meeting

Tidewater (1)

VAG 0

Southwest (6)

Location

Fairview Marriott

Charlottesville

MCV

Newport News Omni


Fairview Marriott


Fairview Marriott


Richmond


Sheraton - VA Beach


Virginia Beach

Williamsburg Lodge

Williamsburg Lodge

Williamsburg Lodge

Williamsburg Lodge

TBA

Richmond


SpeakerTopic











TBA

















































































Dental Study


















4 $ 746357 -- Tobacco




Firms 10 $ 597276

























REGISTRATION

Name (s) _

Address _

Phone and Fax _






Merer



















wwwvadentalorg

TJi~~4cent J


Jishyl






THE



































for Dentists



TOLL FREE 800-467-8734 FAX 813-222-4288







f bull






Dr Eric Boxx Editor

No news to report

























- -
















Component VII











No news to report
































































classified ads














QirHEi~ia MEETING















Since 1932
























































































Youre The Captain

~~ItSwYQllImmShip






(703) 449 1500



(

I

I

copy 1999 HPSC Inc






























































Alloys


Attachments


Restorative Systems




Lisa McLaughlin


800 243-9942 x 293

SternVantagetrade


wwwsterngoldcom

A Cookson C Company








Coordinator








Project Coordinator




Coordinator






Coordinator




L 7342








I


Feb 23 2000

Feb 23 2000

March 6-10 2000

March 102000

March 172000

March 24 2000

April 14 2000

April 26 2000

May 19 2000

May 19 2000

May 19-21 2000

June 22-25 2000

Aug 11 2000

Sept 1-2 2000

Sept 15 2000

Sept 15 2000

Sept 16 2000

Sept 162000

Oct 29 2000

Nov 4-5 2000

Nov 17 2000

Component

NVDS (8)

VAGD

MCV-Anatomy

Peninsula (2)

Southwest (6)


Tidewater (1)

NVDS (8)

Shenandoah (7)

VAGD

Southwest (6)

VSOMS


VAGD

VDA Annual Meeting

VDA Annual Meeting

VDA Annual Meeting

VDA Annual Meeting

Tidewater (1)

VAG 0

Southwest (6)

Location

Fairview Marriott

Charlottesville

MCV

Newport News Omni


Fairview Marriott


Fairview Marriott


Richmond


Sheraton - VA Beach


Virginia Beach

Williamsburg Lodge

Williamsburg Lodge

Williamsburg Lodge

Williamsburg Lodge

TBA

Richmond


SpeakerTopic











TBA

















































































Dental Study


















4 $ 746357 -- Tobacco




Firms 10 $ 597276

























REGISTRATION

Name (s) _

Address _

Phone and Fax _






Merer



















wwwvadentalorg

TJi~~4cent J


Jishyl






THE



































for Dentists



TOLL FREE 800-467-8734 FAX 813-222-4288







f bull






Dr Eric Boxx Editor

No news to report

























- -
















Component VII











No news to report
































































classified ads














QirHEi~ia MEETING















Since 1932







(

I

I

copy 1999 HPSC Inc






























































Alloys


Attachments


Restorative Systems




Lisa McLaughlin


800 243-9942 x 293

SternVantagetrade


wwwsterngoldcom

A Cookson C Company








Coordinator








Project Coordinator




Coordinator






Coordinator




L 7342








I


Feb 23 2000

Feb 23 2000

March 6-10 2000

March 102000

March 172000

March 24 2000

April 14 2000

April 26 2000

May 19 2000

May 19 2000

May 19-21 2000

June 22-25 2000

Aug 11 2000

Sept 1-2 2000

Sept 15 2000

Sept 15 2000

Sept 16 2000

Sept 162000

Oct 29 2000

Nov 4-5 2000

Nov 17 2000

Component

NVDS (8)

VAGD

MCV-Anatomy

Peninsula (2)

Southwest (6)


Tidewater (1)

NVDS (8)

Shenandoah (7)

VAGD

Southwest (6)

VSOMS


VAGD

VDA Annual Meeting

VDA Annual Meeting

VDA Annual Meeting

VDA Annual Meeting

Tidewater (1)

VAG 0

Southwest (6)

Location

Fairview Marriott

Charlottesville

MCV

Newport News Omni


Fairview Marriott


Fairview Marriott


Richmond


Sheraton - VA Beach


Virginia Beach

Williamsburg Lodge

Williamsburg Lodge

Williamsburg Lodge

Williamsburg Lodge

TBA

Richmond


SpeakerTopic











TBA

















































































Dental Study


















4 $ 746357 -- Tobacco




Firms 10 $ 597276

























REGISTRATION

Name (s) _

Address _

Phone and Fax _






Merer



















wwwvadentalorg

TJi~~4cent J


Jishyl






THE



































for Dentists



TOLL FREE 800-467-8734 FAX 813-222-4288







f bull






Dr Eric Boxx Editor

No news to report

























- -
















Component VII











No news to report
































































classified ads














QirHEi~ia MEETING















Since 1932


































































Alloys


Attachments


Restorative Systems




Lisa McLaughlin


800 243-9942 x 293

SternVantagetrade


wwwsterngoldcom

A Cookson C Company








Coordinator








Project Coordinator




Coordinator






Coordinator




L 7342








I


Feb 23 2000

Feb 23 2000

March 6-10 2000

March 102000

March 172000

March 24 2000

April 14 2000

April 26 2000

May 19 2000

May 19 2000

May 19-21 2000

June 22-25 2000

Aug 11 2000

Sept 1-2 2000

Sept 15 2000

Sept 15 2000

Sept 16 2000

Sept 162000

Oct 29 2000

Nov 4-5 2000

Nov 17 2000

Component

NVDS (8)

VAGD

MCV-Anatomy

Peninsula (2)

Southwest (6)


Tidewater (1)

NVDS (8)

Shenandoah (7)

VAGD

Southwest (6)

VSOMS


VAGD

VDA Annual Meeting

VDA Annual Meeting

VDA Annual Meeting

VDA Annual Meeting

Tidewater (1)

VAG 0

Southwest (6)

Location

Fairview Marriott

Charlottesville

MCV

Newport News Omni


Fairview Marriott


Fairview Marriott


Richmond


Sheraton - VA Beach


Virginia Beach

Williamsburg Lodge

Williamsburg Lodge

Williamsburg Lodge

Williamsburg Lodge

TBA

Richmond


SpeakerTopic











TBA

















































































Dental Study


















4 $ 746357 -- Tobacco




Firms 10 $ 597276

























REGISTRATION

Name (s) _

Address _

Phone and Fax _






Merer



















wwwvadentalorg

TJi~~4cent J


Jishyl






THE



































for Dentists



TOLL FREE 800-467-8734 FAX 813-222-4288







f bull






Dr Eric Boxx Editor

No news to report

























- -
















Component VII











No news to report
































































classified ads














QirHEi~ia MEETING















Since 1932












Coordinator








Project Coordinator




Coordinator






Coordinator




L 7342








I


Feb 23 2000

Feb 23 2000

March 6-10 2000

March 102000

March 172000

March 24 2000

April 14 2000

April 26 2000

May 19 2000

May 19 2000

May 19-21 2000

June 22-25 2000

Aug 11 2000

Sept 1-2 2000

Sept 15 2000

Sept 15 2000

Sept 16 2000

Sept 162000

Oct 29 2000

Nov 4-5 2000

Nov 17 2000

Component

NVDS (8)

VAGD

MCV-Anatomy

Peninsula (2)

Southwest (6)


Tidewater (1)

NVDS (8)

Shenandoah (7)

VAGD

Southwest (6)

VSOMS


VAGD

VDA Annual Meeting

VDA Annual Meeting

VDA Annual Meeting

VDA Annual Meeting

Tidewater (1)

VAG 0

Southwest (6)

Location

Fairview Marriott

Charlottesville

MCV

Newport News Omni


Fairview Marriott


Fairview Marriott


Richmond


Sheraton - VA Beach


Virginia Beach

Williamsburg Lodge

Williamsburg Lodge

Williamsburg Lodge

Williamsburg Lodge

TBA

Richmond


SpeakerTopic











TBA

















































































Dental Study


















4 $ 746357 -- Tobacco




Firms 10 $ 597276

























REGISTRATION

Name (s) _

Address _

Phone and Fax _






Merer



















wwwvadentalorg

TJi~~4cent J


Jishyl






THE



































for Dentists



TOLL FREE 800-467-8734 FAX 813-222-4288







f bull






Dr Eric Boxx Editor

No news to report

























- -
















Component VII











No news to report
































































classified ads














QirHEi~ia MEETING















Since 1932










Coordinator




L 7342








I


Feb 23 2000

Feb 23 2000

March 6-10 2000

March 102000

March 172000

March 24 2000

April 14 2000

April 26 2000

May 19 2000

May 19 2000

May 19-21 2000

June 22-25 2000

Aug 11 2000

Sept 1-2 2000

Sept 15 2000

Sept 15 2000

Sept 16 2000

Sept 162000

Oct 29 2000

Nov 4-5 2000

Nov 17 2000

Component

NVDS (8)

VAGD

MCV-Anatomy

Peninsula (2)

Southwest (6)


Tidewater (1)

NVDS (8)

Shenandoah (7)

VAGD

Southwest (6)

VSOMS


VAGD

VDA Annual Meeting

VDA Annual Meeting

VDA Annual Meeting

VDA Annual Meeting

Tidewater (1)

VAG 0

Southwest (6)

Location

Fairview Marriott

Charlottesville

MCV

Newport News Omni


Fairview Marriott


Fairview Marriott


Richmond


Sheraton - VA Beach


Virginia Beach

Williamsburg Lodge

Williamsburg Lodge

Williamsburg Lodge

Williamsburg Lodge

TBA

Richmond


SpeakerTopic











TBA

















































































Dental Study


















4 $ 746357 -- Tobacco




Firms 10 $ 597276

























REGISTRATION

Name (s) _

Address _

Phone and Fax _






Merer



















wwwvadentalorg

TJi~~4cent J


Jishyl






THE



































for Dentists



TOLL FREE 800-467-8734 FAX 813-222-4288







f bull






Dr Eric Boxx Editor

No news to report

























- -
















Component VII











No news to report
































































classified ads














QirHEi~ia MEETING















Since 1932







Feb 23 2000

Feb 23 2000

March 6-10 2000

March 102000

March 172000

March 24 2000

April 14 2000

April 26 2000

May 19 2000

May 19 2000

May 19-21 2000

June 22-25 2000

Aug 11 2000

Sept 1-2 2000

Sept 15 2000

Sept 15 2000

Sept 16 2000

Sept 162000

Oct 29 2000

Nov 4-5 2000

Nov 17 2000

Component

NVDS (8)

VAGD

MCV-Anatomy

Peninsula (2)

Southwest (6)


Tidewater (1)

NVDS (8)

Shenandoah (7)

VAGD

Southwest (6)

VSOMS


VAGD

VDA Annual Meeting

VDA Annual Meeting

VDA Annual Meeting

VDA Annual Meeting

Tidewater (1)

VAG 0

Southwest (6)

Location

Fairview Marriott

Charlottesville

MCV

Newport News Omni


Fairview Marriott


Fairview Marriott


Richmond


Sheraton - VA Beach


Virginia Beach

Williamsburg Lodge

Williamsburg Lodge

Williamsburg Lodge

Williamsburg Lodge

TBA

Richmond


SpeakerTopic











TBA

















































































Dental Study


















4 $ 746357 -- Tobacco




Firms 10 $ 597276

























REGISTRATION

Name (s) _

Address _

Phone and Fax _






Merer



















wwwvadentalorg

TJi~~4cent J


Jishyl






THE



































for Dentists



TOLL FREE 800-467-8734 FAX 813-222-4288







f bull






Dr Eric Boxx Editor

No news to report

























- -
















Component VII











No news to report
































































classified ads














QirHEi~ia MEETING















Since 1932











































































Dental Study


















4 $ 746357 -- Tobacco




Firms 10 $ 597276

























REGISTRATION

Name (s) _

Address _

Phone and Fax _






Merer



















wwwvadentalorg

TJi~~4cent J


Jishyl






THE



































for Dentists



TOLL FREE 800-467-8734 FAX 813-222-4288







f bull






Dr Eric Boxx Editor

No news to report

























- -
















Component VII











No news to report
































































classified ads














QirHEi~ia MEETING















Since 1932






















REGISTRATION

Name (s) _

Address _

Phone and Fax _






Merer



















wwwvadentalorg

TJi~~4cent J


Jishyl






THE



































for Dentists



TOLL FREE 800-467-8734 FAX 813-222-4288







f bull






Dr Eric Boxx Editor

No news to report

























- -
















Component VII











No news to report
































































classified ads














QirHEi~ia MEETING















Since 1932






















wwwvadentalorg

TJi~~4cent J


Jishyl






THE



































for Dentists



TOLL FREE 800-467-8734 FAX 813-222-4288







f bull






Dr Eric Boxx Editor

No news to report

























- -
















Component VII











No news to report
































































classified ads














QirHEi~ia MEETING















Since 1932






TJi~~4cent J


Jishyl






THE



































for Dentists



TOLL FREE 800-467-8734 FAX 813-222-4288







f bull






Dr Eric Boxx Editor

No news to report

























- -
















Component VII











No news to report
































































classified ads














QirHEi~ia MEETING















Since 1932





































for Dentists



TOLL FREE 800-467-8734 FAX 813-222-4288







f bull






Dr Eric Boxx Editor

No news to report

























- -
















Component VII











No news to report
































































classified ads














QirHEi~ia MEETING















Since 1932










f bull






Dr Eric Boxx Editor

No news to report

























- -
















Component VII











No news to report
































































classified ads














QirHEi~ia MEETING















Since 1932














- -
















Component VII











No news to report
































































classified ads














QirHEi~ia MEETING















Since 1932










No news to report
































































classified ads














QirHEi~ia MEETING















Since 1932















































classified ads














QirHEi~ia MEETING















Since 1932


















Since 1932






Virginia Dental Journal

Documents

Transcript of Virginia Dental Journal