March 2011

March 2011

TEXAS DENTALJournalJournalJournalTEXAS DENTALJournalTEXAS DENTALJournalTEXAS DENTALJournalTEXAS DENTALJournalJournalJournalJournalJournalJournalJournalJournalJournalJournalJournalJournal

Bond Strength Comparison

2010 American Heart Association Guidelines for Basic Life Support (CPR)

2010 TDA Financial Report and 2012 Proposed Budget

Visit tda.org/

tdapublications

for the electronic

Texas Dental Journal

746 Texas Dental Journal l www.tda.org l August 2010

Texas Dental Association 140th Annual Session2010 TEXAS Meeting Photo Contest Award: Best of ShowPhotographer: Dr. Roy TiemeyerTitle: “Skimmers”

For information on entering your photo in the 2011 TEXAS Meeting Photo Contest, please visit texasmeeting.com.

Texas Dental Journal l www.tda.org l March 2011 251

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546 Texas Dental Journal l www.tda.org l June 2010

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Taking New Steps

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252 Texas Dental Journal l www.tda.org l March 2011

ContentsTEXAS DENTAL JOURNAL n Established February 1883 n Vol. 128, Number 3, March 2011

TDA GOVERNANCE

260 Candidates Forum — TDA President-elect 2011-2012 Michael L. Stuart, D.D.S.

292 Texas Dental Association 2010 Financial Report, 2012 Proposed Budget, and 2012 Budget Explanation

ARTICLES

267 Bond Strength Comparison of Color Change Adhesives for Orthodontic Bonding

Michael W. Duers, D.M.D., M.S.; Jeryl D. English, D.D.S., M.S.; Joe C. Ontiveros, D.D.S., M.S.; John M. Powers, Ph.D.; Harry I. Bussa, D.D.S.; Gary N. Frey, D.D.S.; Ronald L. Gallerano, D.D.S., M.S.D.; Sebastian Z. Paige, D.D.S.

The authors compare shear bond strengths of three different color change light-cured orthodontic bonding adhesives to a conventional light-cured orthodontic bonding adhesive.

279 Summary of the New 2010 American Heart Association Guidelines for Basic Life Support (CPR)

Roger E. Alexander, D.D.S.

The article summarizes the American Heart Association’s 2010 changes to the guidelines for basic and advanced life support procedures and how they apply to dental health care providers.


MONTHLY FEATURES

256 President’s Message

257 OfficialCalltoDelegates

262 TDA 140th Annual Session 2010 TEXAS Meeting Photo Contest

264 The View From Austin

308 Oral and Maxillofacial Pathology Case of the Month

310 TEXAS Meeting Preview

314 Oral and Maxillofacial Pathology Case of the Month

Diagnosis and Management

317 In Memoriam / TDA Smiles Foundation Memorial and

Honorarium Donors

318 Value for Your Profession

322 Calendar of Events

324 Advertising Briefs

338 Index to Advertisers

Texas Dental Journal is a member of the American Association of Dental Editors.

BOARD OF DIRECTORSTEXAS DENTAL ASSOCIATION

PRESIDENTRonald L. Rhea, D.D.S.

(713) 467-3458, [email protected]

J. Preston Coleman, D.D.S.(210) 656-3301, [email protected]

IMMEDIATE PAST PRESIDENTMatthew B. Roberts, D.D.S.

(936) 544-3790, [email protected] PRESIDENT, SOUTHEAST

R. Lee Clitheroe, D.D.S.(281) 265-9393, [email protected]

VICE PRESIDENT, SOUTHWESTJohn W. Baucum III, D.D.S.

(361) 855-3900, [email protected] PRESIDENT, NORTHWEST

Kathleen M. Nichols, D.D.S.(806) 698-6684,

[email protected] PRESIDENT, NORTHEAST

Donna G. Miller, D.D.S.(254) 772-3632,

[email protected] DIRECTOR, SOUTHEAST

Karen E. Frazer, D.D.S.(512) 442-2295, [email protected] DIRECTOR, SOUTHWEST

Lisa B. Masters, D.D.S.(210) 349-4424, [email protected]

SENIOR DIRECTOR, NORTHWESTRobert E. Wiggins, D.D.S.

(325) 677-1041, [email protected] DIRECTOR, NORTHEAST

Larry D. Herwig, D.D.S.(214) 361-1845, [email protected]

DIRECTOR, SOUTHEASTRita M. Cammarata, D.D.S.

(713) 666-7884, [email protected], SOUTHWEST

T. Beth Vance, D.D.S.(956) 968-9762, [email protected]

DIRECTOR, NORTHWESTMichael J. Goulding, D.D.S.

(817) 737-3536, [email protected], NORTHEASTArthur C. Morchat, D.D.S.


Ron Collins, D.D.S.(281) 983-5677, [email protected]

SPEAKER OF THE HOUSEGlen D. Hall, D.D.S.


Michael L. Stuart, D.D.S.(972) 226-6655, [email protected]

EDITORStephen R. Matteson, D.D.S.

(210) 2 - 5 5, [email protected] DIRECTOR

Ms. Mary Kay Linn(512) 443-3675, [email protected]

LEGAL COUNSELMr. William H. Bingham


EDITORIAL STAFF

Stephen R. Matteson, D.D.S., EditorNicole Scott, Managing Editor

Barbara S. Donovan, Art DirectorPaul H. Schlesinger, Consultant

EDITORIAL ADVISORY BOARD

Ronald C. Auvenshine, D.D.S., Ph.D.Barry K. Bartee, D.D.S., M.D.

Patricia L. Blanton, D.D.S., Ph.D.William C. Bone, D.D.S.

Phillip M. Campbell, D.D.S., M.S.D.Tommy W. Gage, D.D.S., Ph.D.Arthur H. Jeske, D.M.D., Ph.D.

Larry D. Jones, D.D.S.Paul A. Kennedy, Jr., D.D.S., M.S.

Scott R. Makins, D.D.S.Robert V. Walker, D.D.S.

William F. Wathen, D.M.D.Robert C. White, D.D.S.Leighton A. Wier, D.D.S.

Douglas B. Willingham, D.D.S.

The Texas Dental Journal is a peer-reviewed publication.

Texas Dental Association1946 South IH-35, Suite 400

Austin, TX 78704-3698 Phone: (512) 443-3675

FAX: (512) 443-3031E-Mail: [email protected]

Website: www.tda.org

Texas Dental Journal (ISSN 0040-4284) is published monthly, one issue will be a directory issue, by the Texas Dental Association, 1946 S. IH-35, Austin, Texas, 78704-3698, (512) 443-3675. Periodicals Postage Paid at Austin, Texas and at additional mail-ing offices. POSTMASTER: Send address changes to TEXAS DENTAL JOURNAL, 1946 S. Interregional Highway, Austin, TX 78704.Annual subscriptions: Texas Dental Association members $17. In-state ADA Affiliated $49.50 + tax, Out-of-state ADA Affiliated $49.50. In-state Non-ADA Affiliated $82.50 + tax, Out-of-state Non-ADA Affiliated $82.50. Single issue price: $6 ADA Affili-ated, $17 Non-ADA Affiliated, September issue $17 ADA Affiliated, $65 Non-ADA Affiliated. For in-state orders, add 8.25% sales tax.Contributions: Manuscripts and news items of inter-est to the membership of the society are solicited. The Editor prefers electronic submissions although paper manuscripts are acceptable. Manuscripts should be typewritten, double spaced, and the original copy should be submitted. For more information, please refer to the Instructions for Contributors statement printed in the September Annual Membership Direc-tory or on the TDA website: www.tda.org. All state-ments of opinion and of supposed facts are published on authority of the writer under whose name they appear and are not to be regarded as the views of the Texas Dental Association, unless such statements have been adopted by the Association. Articles are accepted with the understanding that they have not been published previously. Authors must disclose any financial or other interests they may have in products or services described in their articles. Advertisements: Publication of advertisements in this journal does not constitute a guarantee or endorsement by the Association of the quality of value of such product or of the claims made of it by its manufacturer.

15 1 1

Member Publication


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TEXAS MEETING

141st ANNUAL SESSION OF THE TEXAS DENTAL ASSOCIATION

May 5-8, 2011 - San Antonio, Texas

www.texasmeeting.com

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Friday, May 6, 2011The TEXAS MeetingSan Antonio, Texas

Component Peer Review Committee

and Judicial Committee

2011 Training Dates

Please contact Cassidy Neal at

512-443-3675 ext. 152 for meeting

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and meeting rooms.


President’s MessageRonald L. Rhea, D.D.S., TDA President

In this issue you will see a presentation of the 2012 Budget of the Texas Dental Association. Theofficers,directors,andstaffoftheTDAtake the responsibility of using your money very seriously. The process for preparation of this budget is a long and arduous task. Initially, the TDA secretary-treasurer and staff prepare a preliminary budget to run the Association and its programs for the year. Estimates of the income are made. This income comes from your dues, profitfromtheTDA’sTEXASMeeting,ourfor-profitsubsidiary(TDAFinancialServices,Inc.,also known as TDA Perks), advertising in the TDA publications and website, and so on. Each department proposes its expenditures to carry out the programs assigned to it, which arise from the strategic plan.

This preliminary budget is then sent to the Bud-get Committee of the Board under guidance of TDA secretary-treasurer Dr. Ron Collins. Each line is reexamined for appropriateness and its variation from previous budgets and known changes that can be expected in 2012. A very small percentage is set aside in a “Contingency fund” for times when even the best estimates

prove to be inaccurate. For 2012, this is 0.5 percent.

Then the budget is examined at the February Board of Directors meeting. The Board is initially responsible for setting the policies of the Associa-tion and assuring that its activities are in line with the strategic plan. Alterations in the budget may be made in this process.

Finally the completed budget is sent to the House ofDelegatesinMayforfinalapprovalandmodifi-cation for resolutions that the House passes.

When we complete the lengthy detailed process, whatdowehave?Wehaveafinancialbattleplanfor a future year, the events of which we cannot totally predict. Like all battle plans, the budget is gooduntilthefirstshotisfired,orinthiscase,thefirstpennyisspent.Leadershipcontinuallyrefersto the budget, and at each Board of Directors meeting the actual expenditures and income are evaluated to note variations from the budgeted amounts. Tough policy decisions are often made with the question, “Where did we budget for this and can we afford it?”


Official Call to the 2011 Texas Dental Association House of DelegatesHOUSE OF DELEGATES:In accordance with Chapter IV, Section 70, paragraph A of the Texas Dental Association (TDA)Bylaws, this is the official call for the 141st meeting of the Texas Dental Association House of Delegates. The opening sessionof the House will convene at 8:00 a.m. on Thursday, May 5, 2011, in Ballroom B on the street level of the San Antonio Conven-tion Center in San Antonio, Texas. The second meeting of the House will be at 8:30 a.m. on Saturday, May 7, 2011, in Ballroom B. The Sunday, May 8, 2011, meeting will be in the Marriott Rivercenter Hotel, starting at 8:30 a.m.

REFERENCE COMMITTEE HEARINGS: Reference Committees will meet on Thursday, May 5, 2011, in the Convention Center (please see the on-site program for specific room assignments). Reference Committee A will start at 11:00 a.m. or 15minutes after the adjournment of the House of Delegates, whichever is later. Reference Committee E will start at 12:00 noon. Reference Committee B will start at 1:00 p.m. Reference Committee C will start at 1:30 p.m. Reference Committee D will start at 2:00 p.m. The agendas for these meetings will be sent to the Delegates and Alternate Delegates prior to the meetings.

REFERENCE COMMITTEE REPORTS: Reference Committee Reports will be e-mailed in PDF format to all participants and these reports may be downloaded from any location with Internet access. Printed reports will be available on Friday, May 6, 2011 at 9:00 a.m. outside Rooms 1066 and 1067, the TDA Convention Offices in Exhibit Hall C, and may be downloaded at thislocation.

CANDIDATES FORUM: As a reminder, the TDA / ADA Candidates Forum will be held on Friday, May 6, 2011, from 2:00 p.m. to 4:00 p.m. in the Convention Center (please see the on-site program for specific room assignment).

DIVISIONAL CAUCUSES: Divisional Caucuses (Northwest, Northeast, Southwest, Southeast) will be held at 5:15 p.m. onFriday, May 6, 2011 (please see the on-site program for specific room assignments).

DELEGATE BOOK: In accordance with TDA Bylaws, the Delegate Book will be sent 30 days prior to the Annual Session. The supplement to the Delegate Handbook, containing the agenda and subsequent reports, will be sent after the spring TDA Board of Directors meeting, April 1-2, 2011. Delegates and alternates will receive their House book in a searchable PDF format.


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I appreciate this opportunity to tell you a little about myself and also to let you know the reasons I am running for president-elect of the Texas Dental Association. Very soon after completing

my dental degree at Baylor College of Dentistry, I became involved in organized dentistry. Joining the American Dental Association (ADA), TDA, and Dallas County Dental Society was never a question for me — I thought you had to be a member to practice dentistry! It was a couple of years later that I found out membership was not mandatory, but, by then, I was hooked. I had the opportunity to see the value of organized dentistry early in my career and to foster friendships that I continue to enjoy today. As a general dentist, I recognized the need to continue to learn, so naturally I joined the Academy of General Dentistry (AGD).

Those early years in practice were critical in the formation of the values I still hold dear. I wanted to be the best dentist I could be and treat my patients as I would want to be treated. “Golden Rule” dentistry is a good philosophy for practitioners of any age, and I have been fortunate to have great mentors throughout the years to emulate. As I began to serve on the state level with the Texas AGD,

two Texas leaders had a profound impact on my leader-ship style. Drs. Sam Rogers and Rene Rosas exhibited leadership with humility, always doing what was best for the members of the organization. They had great talent but never had the attitude that it was all about them. I wanted to be like that and have attempted to lead with that servant-leadership style.

Serving as parliamentarian of the TDA for the past 7 years has given me the opportunity to assist seven TDA presi-dents. While their styles and personalities were all differ-ent, each person always strived to leave the TDA better at the end of their term than at the beginning. As president, that would be my goal. The TDA and our profession have faced challenges, but I believe the next few years will be our most critical. The current state budget crisis, the continuing faltering economy, and the recently passed healthcare overhaul are only a few of the “outside” fac-tors that will impact dentistry. The TDA must continue to position itself to be the chief influence in Texas when deci-sions are being made affecting dentists. We are “The Voice of Dentistry in Texas!” That is more than just a simple phrase. It describes the vision of who we are. It is vi-

tally important that we maintain and even expand our membership numbers in the future. It is only together that we have the strength and resources to adequately counter the forces intent on changing the best healthcare delivery system in existence.

I recently had the opportunity to sit at a table with a diverse group of dentists and TDA staff members discussing how the TDA could best present our great message to the public, non-member dentists, and TDA members. Following a full day of brainstorming, the result was that the TDA has something to offer everyone. The resources this Association possesses can assist dentists in every career stage with valuable tools to meet the challenges of dental practice. The value of being a TDA member should be apparent to every dentist in this state. We have a great message, and we will be telling it even louder in the future.


CandidatesForumTexas Dental AssociationPresident-elect,2011-2012

Michael L. Stuart, D.D.S.


Practice Information:Full-time solo private practitioner of dentistry since 1986Stone Canyon Dental, 192 S. Collins Rd., Ste. 100, Sunnyvale, TX 75182Office Phone: (972) 226-6655E-mail: [email protected]

Education:Dallas Baptist College, Bachelor of Science, 1974Southwestern Baptist Theological Seminary, Master of Church Music, 1978Baylor College of Dentistry, Doctor of Dental Surgery, 1986

Professional Memberships:Member of the American Dental Association, Texas Dental Association, and Dallas

County Dental Society since 1985Member of the Academy of General Dentistry since 1986Fellow, Academy of General Dentistry, 1997Fellow, American College of Dentists, 1999Fellow, International College of Dentists, 2002Fellow, Pierre Fauchard Academy, 2010

Service to DentistryPresident, Dallas County Dental Society, 2007-2008President, Dallas Academy of General Dentistry, 1991-1992President, Texas Academy of General Dentistry, 1997-1998Trustee from Texas to the Board of Trustees, Academy of General Dentistry, 1998-2004Member of the Council on Dental Practice of the American Dental Association, 2001-2005Chair, Council on Dental Practice, ADA, 2004-2005Editor, Texas Academy of General Dentistry GP, 1994-1996Editor, Dallas County Dental Society, 1999-2002Delegate, Academy of General Dentistry, 1993-2000Delegate, Texas Dental Association, 1996-2004Alternate Delegate to the American Dental Association, 1999-2002Delegate to the American Dental Association, 2004-2013 (Currently)Secretary-Treasurer, Dallas County Dental Society, 2004-2006Member of the Communications Committee, Texas Dental Association, 2003-2004, 2005-2006Parliamentarian, Texas Dental Association, 2004-Current Parliamentarian, Academy of General Dentistry House of Delegates, 2006-2008Secretary-Treasurer, Texas Section of the International College of Dentists, 2004-2011Chair, Academy of General Dentistry’s Council on Dental Care, 2005-2006Board of Directors, Southwestern Medical Foundation, 2007-2008Chairman, John Findley for ADA President-elect Campaign Committee, 2006-2008Member, Steering Committee for Pat Blanton’s candidacy for ADA Vice-President, 2010Mentor, Great Expectations Program for First Year Dental Students, Baylor College

of Dentistry, 2007-Current

Service to Community and ChurchMember, Board of Directors, Mesquite Independent School District Education Foundation, 2010Member, Deacon and Elder, Sunnyvale First Baptist ChurchChair, Deacon Fellowship, Sunnyvale First Baptist Church, 2010-CurrentMember of Golf and Grounds Committee, Dallas Athletic Club, 2009-2011

AwardsNominated for Texas Dentist of the Year, 2002Named Distinguished Alumnus of the Year, Dallas Baptist University, 2005

Personal InformationMarried 38 years to Kathy, a retired educator and principal, Mesquite ISDTwo daughters: Laura, a 1999 graduate of Texas A&M University; Maryanne, a 2001 gradu-ate of Baylor College of Nursing Five grandchildren: Grace Renee, age 8; Abigail Katherine, age 7; Anna Kaylynn, age 6; Wil-liam Aaron, age 3; Clayton Stuart, age 1Hobbies include golf, running, fishing, skiing, and church music.

A few years ago, I had the privilege to represent Texas as a member of the ADA Council on Dental Practice and serve as chair of the council my final year. Listening to fellow coun-cil members from all across this nation convinced me that we are blessed beyond mea-sure to be dentists in Texas. While we share common challenges with other states, the TDA has been incredibly successful protecting den-tistry from outside forces. As president, I would be serving during the legislative session in 2013. I pledge to you that I will do my utmost to continue that successful legacy. Our legislative council and lob-byists are second to none in effectiveness. That must and will continue. Dentists must continue to have the respon-sibility to provide quality care, and the dentist must be the only provider doing irreversible procedures. I believe that with all of my being.

If elected, my term will also see a change in the executive director for the TDA, due to the upcoming retirement of Ms. Mary Kay Linn. She has served this Association with incred-ible dedication and effective-ness, and the challenge will be to select a qualified person to replace her and have a smooth transition in 2012. I look for-ward to leading that process.

It is a privilege indeed to be a candidate for president-elect of the Texas Dental Association. I pledge to you my best effort and to listen to you more than talk to you. The strength of our Association is found in its members. While I do not have all of the answers, together we can find those answers and formulate the solutions to solve the challenges ahead. I look forward to serving with you.

Curriculum Vitae:Michael L. Stuart, D.D.S.


Texas Dental Association 140th Annual Session

2010 TEXAS Meeting Photo ContestCategory: Natural Wonders

Award: 1st PlacePhotographer: Ms. Tessa Kolodny, RDH, of Arlington, Texas

Title: “Feeling Blue”

For information on entering your photo in the 2011 TEXAS Meeting Photo Contest, please visit texasmeeting.com.

Texas Dental Journal l www.tda.org l August 747

Texas Dental Journal l www.tda.org l March 2011 263 Texas Dental Journal l www.tda.org l August 747


Stephen R. Matteson, D.D.S., FICD, Editor

The View From Austin

A dentist friend of mine told me about an “Oh my!” moment in his practice when he discovered that a clerical error in hisofficehadresultedintheextractionofthewrongtooth.He had intended to refer a patient to an oral surgeon for the extraction of tooth #19 but his referral letter errantly listed tooth #30 as the tooth to be removed. Tooth #19 was badly broken down but could have been used as a bridge abutment. The “Oh my!” moment occurred when the patient returned to begin restoration of tooth #19 and the error was seen. Breaking out in a sweat and with abdominal distress sinking in, he had to tell the patient of the problem, refer the patient back to the oral surgeon to remove unrestorable tooth #19; and that the original treatment plan had to be changed.

Being a forthright person, my friend informed the patient that he had insurance to cover errors like this one. The patient then replied, “No Doc, I do not want to sue you because if I did, you would not be my dentist anymore.” My friend reflectedonthiseventasanencouragingonefromtheviewpoint of his patient’s loyalty when the chips are down.

The literature on apologies for errors in medicine indicates that when medical errors occur, the attitude of the physi-cian has an impact on the behavior of patients and families. When a sincere apology is made, lawsuits may be avoided orjuriesmayfindforlessseverefinancialpenaltiesifcasescome to court. Hospitals have reported that losses to litiga-tion are reduced when physicians are trained to provide these apologies. The literature on this subject in dentistry is sparse but similar results from such behavior by dentists would seem to parallel that in medicine.

Apology law varies from state to state. Two types of laws have been enacted across the country pertaining to the admissibility of evidence in court, “full disclosure,” or “sympathy only” versions. Full disclosure laws are in place in eight states and protect physician admissions of fault and error, as well as expressions of sympathy, regret, and condolence. The sympathy only law, such as the one found in 28 states including Texas, protects physician expressions ofsympathy,regret,andcondolenceonly.Specifically,the State of Texas statute states that it does not protect “a statement … concerning negligence or culpable conduct.”

“I’m Sorry”The Texas Law provides that a communication which “ex-presses sympathy or a general sense of benevolence relat-ing to the pain, suffering or death of an individual involved inanaccident”isinadmissible(1).TheTexaslawhasanadditional limitation that prevents admissibility only of state-ments made to the patient or one related to the patient in theseconddegree(anyrelativewhoistwomeiosesawayfrom a particular individual in a pedigree; a relative with whomonequarterofanindividual’sgenesisshared(i.e.,grandparent, grandchild, uncle, aunt, nephew, niece, half sibling). Therefore, statements made to non-related parties orofficestaffarenotprotected.Thesestatutesillustratethecomplexity and different approaches to apology legislation that apply to accidental injuries.

Well, back to my friend. Just saying “I’m sorry” would not have been possible. When the patient chose to continue his treatmentinthatoffice,thedentisthadtorevealtheerror,refer the patient back to the oral surgeon to extract the cor-rect tooth, make it clear the oral surgeon was not respon-siblefortheerror,andconfirmthattheproblemwasduetoaclericalerrorinhisoffice.Fortunately,thispatientwasalong-term patient who wanted to continue receiving care by my friend. So, all ended well with the patient receiving an adjusted restorative plan.

With all of this in mind, Texas dentists are encouraged to confer with their legal counsel about how to comply with the Texas Apology Law.

Reference1. TEX. CIV. PRAC. & REM. CODE ANN., § 18.061 (2004&Supp.2005).

BibliographyMcDonnell, WM, Guenther E. Narrative review: Do state laws make it easier to say “I’m Sorry?” Ann Intern Med. 2008; 149:811-815.Lazare A. “Apology in Medical Practice: An Emerging Clinical Skill,” Journal of the American Medical Association (Sept.20,2006),Vol.296,No.11,pp.1401–04.Leape LL. “Full Disclosure and Apology: An Idea Whose TimeHasCome,”PhysicianExecutive(March–April2006),Vol.32,No.2,pp.16–18.



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Bond Strength Comparison of Color Change Adhesives for Orthodontic BondingMichael W. Duers, D.M.D., M.S.Jeryl D. English, D.D.S., M.S.Joe C. Ontiveros, D.D.S., M.S.John M. Powers, Ph.D.Harry I. Bussa, D.D.S.Gary N. Frey, D.D.S.Ronald L. Gallerano, D.D.S., M.S.D.Sebastian Z. Paige, D.D.S.

AbstractThis study investigated whether three different color change light-cured orthodontic bonding adhesives have comparable shear bond strengths to a conventional light-cured orthodontic bonding adhesive. The sample of 240 bovine incisors was divided into four groups of 60 each. Each group tested one of four orthodontic bonding ad-hesives: 3M Unitek Transbond PLUS,Ormco Gréngloo, Ormco Blúgloo, and 3M Unitek Transbond XT (control). Thefour groups were further divided into two subgroups of 30 with shear bond strength tested at two different times (15 minutes and 24 hours) post-bond.The shear bond strength was mea-sured on a universal testing machine. The data were analyzed by two-way analysis of variance and post-hoc comparisons (Fisher’s PLSD) at the0.05 level of significance. The aver-age shear bond strength was greater at 24 hours than at 15 minutes for Transbond PLUS, Blúgloo, and Trans-bond XT. For Gréngloo, the average shear bond strength was greater at 15 minutes than at 24 hours. Gréngloo tested at 15 minutes had the highest average shear bond strength. Gréng-loo tested at 24 hours had the lowest average shear bond strength. All four orthodontic bonding adhesives demon-strated bond strengths considered to be clinically acceptable for orthodontic purposes.

KEy WORDS: shear, bond, transbond, gréngloo, blúgloo

Tex Dent J 2011;128(3):267-275.

Dr. Duers, currently a Major, US Air Force; previously a resident, Department of Orthodontics, the University of Texas Dental Branch at Houston; [email protected]. English, chair and program director, Department of Orthodontics, the University of Texas Dental Branch at Houston; [email protected]. Ontiveros, associate professor of restorative dentistry and biomaterials, Department of Ortho-dontics, the University of Texas Dental Branch at Houston; [email protected]. Powers, professor of restorative dentistry and biomaterials, Department of Orthodontics, the University of Texas Dental Branch at Houston; [email protected]. Bussa, associate professor of orthodontics, Department of Orthodontics, the University of Texas Dental Branch at Houston; [email protected]. Frey, associate professor of restorative dentistry and biomaterials, Department of Orthodon-tics, the University of Texas Dental Branch at Houston; [email protected]. Gallerano, associate professor of orthodontics, Department of Orthodontics, the University of Texas Dental Branch at Houston; [email protected]. Paige, 2nd year orthodontic resident, Department of Orthodontics, the University of Texas Dental Branch at Houston; [email protected].

Corresponding Author: Dr. Jeryl D. English, D.D.S., M.S. 6516 M.D. Anderson Blvd., Ste. 473, Houston, TX 77030-3402. Phone: (713) 500-4470; FAX: (713) 500-4372. E-mail:[email protected].

Reprints will not be available.

The authors have declared no potential conflict of financial interest, relationship and/or affiliationsrelevant to the subject matter or materials discussed in the manuscript. This article has been peer reviewed.

Introduction

The introduction of the acid-etch bonding tech-

nique by Buonocore in 1955 has led to dramatic

changes in the practice of orthodontics (1-3). By

the late 1970’s, the bonding of orthodontic brack-

ets became an accepted clinical technique (4-6).

English Bussa Gallerano PaigeEnglish Bussa Gallerano PaigeEnglish Bussa Gallerano PaigeEnglish Bussa Gallerano Paige

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The ability to bond orth-

odontic brackets to enamel

can dramatically reduce

clinical chair time, elimi-

nate band space and its

subsequent closure, and

circumvent the poor esthet-

ics, difficult hygiene and

gingival irritation resulting

from orthodontic bands (7).

Two concerns that come

with the bonding of orth-

odontic brackets are the

remnants of excess orth-

odontic bonding adhesive,

or flash, and its potential

effect on the health of the

enamel surface throughout

treatment; and the return

to a sound, unblemished

enamel surface after the

removal of the orthodontic

brackets.


Despite the advances in dental care and the reduced prevalence of dental caries in children, the formation of white spot lesions is not uncommon around orth-odontic brackets (8). Gorelick et al. found that half of the patients treated with fixed appliances had at least one white spot lesion af-ter treatment, and there were no differences in incidence between banding and bonding (9). It has been noted that the develop-ment of white spot lesions can occur as quickly as 1 month into treatment, and even though they may regress, they still may pres-ent an esthetic problem 5 years after removal of the appliances (10-13). Poor brushing, sugary liquids, and acidic liquids also play a role. During the bonding procedure it is not uncommon to leave excess bonding adhesive around the margin of the brack-et. The attribution of this excess bonding adhesive to the forma-tion of white spot lesions has been investigated. It is thought that if the excess adhesive is not removed, it can act as a me-chanical irritant to the gingiva and as a site for bacterial colo-nization, which can potentially increase the incidence of white spot lesions (14-16). It has also been recognized that if the excess bonding adhesive is not removed, it can increase the amount of plaque and, therefore, potentially increase the occurrence of white spot lesions during orthodontic treatment (17-20).

After the completion of orth-odontic treatment, the objec-tive of debonding is to restore

the enamel surface as closely as possible to its pretreatment condition by removing the at-tachment and all the adhesive resin from the tooth. The sites of potential failure within the bracket-adhesive-enamel com-plex during debonding are within the bracket, between the bracket and the adhesive, within the adhesive, and between the tooth surface and the adhesive. Vari-ous debonding techniques have been suggested with failure usu-ally occurring within the adhe-sive, leaving behind adhesive resin on the tooth surface that must be removed. This is pref-erable to a situation where the enamel becomes the weakest link and fractures during debonding (21). Due to most adhesives hav-ing a strong color resemblance to the teeth, removing the residual bonding material can be a diffi-cult task and adhesive remnants may easily remain undetected (22,23). It has been reported in the literature that the removal of the remaining adhesive follow-ing debonding may also remove up to 150 μm of surface enamel (23-26).

Recently, orthodontic bond-ing adhesives with color change capability have been developed to help locate excess adhesive during bracket placement and detect any remaining adhesive after bracket removal. Trans-bond PLUS is a color change orthodontic bonding adhesive manufactured by 3M Unitek. It incorporates a pink dye that becomes photobleached when it is exposed to light, both ambi-


ent and curing. The bleaching of the dye is not an indication of polymerization, it just renders suitable esthetics throughout treatment. The intended ben-efit of the dye is to facilitate the removal of excess adhesive during bracket placement that will potentially cause the build-up of plaque (16). Blúgloo is a two-way color change adhesive developed by Ormco Corpora-tion. It possesses the property of color change with tempera-ture; at cooler temperatures the adhesive possesses a blue color, which changes to a translu-cent color when the adhesive increases to body temperature. This allows for removal of ex-cess adhesive during bracket placement and identifiable cleanup of the remaining adhe-sive after debonding when the adhesive is cooled with air or water. The company claims that Blúgloo has 150 percent greater bond strength when used with their own esthetic bracket (27). A similar two-way color change adhesive manufactured by Ormco Corporation is Gréngloo. According to the manufacturer’s website, Gréngloo polymerizes faster than other light-cured orthodontic bonding adhesives providing a higher percent of total bond strength at initial force loading (28). It is also designed with a patented ingre-dient which increases impact resistance by 118 percent and has a chemical affinity for metal brackets which can ensure reli-able bond strength. The green color contrast at lower tempera-tures during bonding facilitates accurate bracket placement and makes it easy to remove ex-cess adhesive. As the adhesive warms to body temperature, the color disappears, remaining

clear throughout treatment. After debonding, simply introduce a short blast of cool air or water to lower the surface temperature, and the adhesive turns green again for easy and thorough cleanup.

The purpose of this study was to compare the shear bond strengths attained when us-ing these three color change light-cured orthodontic bonding adhesives and a conventional light-cured orthodontic bonding adhesive. These conditions were studied at two different debond times: 15 minutes and 24 hours.

Materials and MethodsOn the basis of previous studies indicating that bovine enamel and human enamel were simi-lar in their physical properties, composition, and bond strength, it was decided to use bovine teeth for this investigation (29-32). These teeth have been used in various studies for compari-son of bonding characteristics and bond strengths (33-39). Two hundred and forty extracted bo-vine incisors (Animal Technolo-gies, Inc., Tyler, TX, USA) were collected and stored in a disin-fecting solution of 0.25 percent sodium azide solution in saline for no more than 2 months. The roots of the incisors were shortened with a diamond disk to allow for mounting in acrylic resin cylinders (SAMPL-KWICK® fast cure acrylic resin, Buehler Ltd., Lake Bluff, IL, USA). The facial surfaces of the incisors were left exposed to be used as the bonding surfaces. The enamel surface was ground

(Ecomet 6® variable speed grinder-polisher, Buehler Ltd., Lake Bluff, IL, USA) to obtain a suitable surface area for the bonding of orthodontic brackets. The specimens were randomly divided into four groups of 60 specimens each.

Each of the four groups was to represent one of four light-cured orthodontic bonding adhesives [(Transbond PLUS, 3M Unitek, Monrova, CA, USA), (Gréngloo, Ormco Corporation, Glendora, CA, USA), (Blúgloo, Ormco Cor-poration, Glendora, CA, USA), (Transbond XT, 3M Unitek, Mon-rova, CA, USA)]. Each of the four orthodontic bonding adhesive groups was further divided into two subgroups to be debonded at two different time periods (15 minutes and 24 hours), giv-ing a total of eight groups of 30 specimens each. Transbond PLUS, Gréngloo, and Blúgloo are color change light-cured orth-odontic bonding adhesives, and Transbond XT is a conventional light-cured orthodontic bonding adhesive used as the control.

Before bonding, each specimen was rinsed and then thoroughly air dried. The enamel surface was etched for 15 seconds with 35 percent phosphoric acid (Transbond etching gel, 3M Unitek, Monrova, CA, USA), rinsed, and thoroughly air dried. A thin coat of primer (Transbond primer, 3M Unitek, Monrova, CA, USA) was applied to the enamel. The orthodontic adhesive was placed on the base of the orth-odontic bracket (LP Twin Mini Master Series 0.022 mandibu-lar incisor brackets, American Orthodontics, Sheboygan, WI, USA). The bracket was seated and positioned on the specimen,


and the excess orthodontic adhesive was removed (Il-lustration 1). The orthodontic adhesive was light cured for 20 seconds (5 seconds on each of the four sides) with a curing light (Ortholux LED curing light, 3M Unitek, Monrova, CA, USA). The curing light was tested on a photometer and demonstrated the proper inten-sity and wavelength of light. All of the specimens were bonded by the same operator.

The specimens in the group to be debonded at 24 hours were placed in distilled water in an incubator at 37° Celsius to simulate the oral environment prior to testing. The 15-minute specimens and the 24-hour specimens were then tested under shear load utilizing a universal testing machine (Model 4465, Instron Cor-poration, Canton, MA, USA) at a crosshead rate of 1.0 mm/minute (Illustration 2a and 2b).

Mean values and standard deviations of bond strengths were calculated. The data were analyzed by two-way analysis of variance and post-hoc comparisons (Fisher’s PLSD) at the 0.05 level of significance. Fisher’s PLSD intervals for comparisons of means between two times and within four orthodontic bonding adhesives were 0.8 and 1.2 MPa, respectively.

The debonding characteristics for each specimen were determined with the Adhesive Remnant Index (ARI) developed by Artun and Bergland in 198440. This is a four-point scale used to assess the amount of orthodontic bonding adhesive remaining on the tooth surface after debonding. ARI 0 signifies 0 percent of the adhesive remaining on the tooth, ARI 1 signifies less than or equal to 50 percent of the adhesive remaining on the tooth, ARI 2 signifies greater than 50 percent of the adhesive remaining on the tooth, and ARI 3 signi-fies 100 percent of the adhesive remaining on the tooth with a distinct impression of the bracket mesh. Each specimen was examined by one operator under 3.5x magnification.

ResultsSixty teeth were bonded using each orthodontic bond-ing adhesive for a total sample size of 240. Each orth-odontic bonding adhesive group was divided into two

Illustration 1. Bracket placed on tooth.

Illustration 2a. Instron set up before exerting force.


Illustration 2b. Instron set up while exerting force.


subgroups to test the two debond times (15 minutes and 24 hours). Gréngloo tested at 15 minutes had the highest average shear bond strength at 9.91 MPa (Figure 1 and 2). Gréngloo tested at 24 hours had the lowest average shear bond strength at 6.44 MPa (Figure 3). The average shear bond strengths for the remaining six groups had a range of 6.59 MPa to 8.18 MPa. The average shear bond strength for all groups was 7.69 MPa.

Transbond PLUS, Blúgloo, and Transbond XT (con-trol) showed no significant difference in average shear

Figure 1.BondStrength(MPa)ofFourAdhesivesatTwoTimes.

Figure 2. Bond Strength Comparisons at 15 Minutes.


bond strengths when com-pared at 15 minutes and at 24 hours (Table 1). Gréngloo demonstrated average shear bond strengths that were significantly higher than those of the control group at 15 minutes and significantly lower than those of the control group at 24 hours. When comparing the aver-age shear bond strengths of each orthodontic adhesive across the two different time points (15 minutes and 24 hours), only Transbond XT showed no significant difference.

Testing Time

15 Minutes 24 Hours

Mean Std. Dev. Mean Std. Dev.

6.59b 3.05 7.69c 3.71

9.91 4.69 6.44 3.04

7.31b 2.71 8.18c 1.82

7.56ab 2.88 7.82ac 3.97


Figure 3. Bond Strength Comparisons at 24 Hours.

Table 1. Means Table for Bond Strength, MPa.

*Meanswiththesamesuperscriptedlettersarenotdifferentstatistically(P>0.05).

Orthodontic Bonding Adhesive

TransbondPLUS(Plus)

Gréngloo(GG)

Blégloo(BG)

TransbondXT(XT)


Figure 4. Adhesive Remnant Index

When examining the amount of orthodontic bonding adhesive re-maining on the specimens follow-ing debonding, Gréngloo tested at 15 minutes and at 24 hours had the lowest average ARI score at 0.97 (Figure 4). Transbond PLUS tested at 24 hours had the highest average ARI score at 2.23. The average ARI score for all groups was 1.57.

DiscussionEver since Buonocore revolu-tionized clinical orthodontics in 1955 by introducing the acid-etch technique, there have been numerous attempts to further

improve the protocol. Products have been marketed to improve bond strength, reduce bonding steps, decrease chair time, and reduce unwanted effects to the enamel surface. Orthodontic bonding adhesives with color change capability have been developed to facilitate the re-moval of excess adhesive during bracket placement and identify remaining adhesive after bracket removal. This targets two con-cerns that come with the bond-ing of orthodontic brackets — enamel decalcification, or white spot lesions, and unnecessary removal of enamel surface during debonding.

This study compared shear bond strengths using a conventional light-cured orthodontic bonding adhesive (Transbond XT) and three color change light-cured orthodontic bonding adhesives (Transbond PLUS, Gréngloo, and Blúgloo). The shear bond strengths were measured at 15 minutes and 24 hours after bonding. For Transbond PLUS, Blúgloo, and Transbond XT (control), the average shear bond strengths measured at 24 hours were greater than those mea-sured at 15 minutes (Figure 1). For Gréngloo the average shear bond strength measured at 15 minutes was greater than that measured at 24 hours. The high-


est average shear bond strength was Gréngloo at initial testing, which is in agreement with the manufacturer’s claim that Grén-gloo provides a higher percent of total bond strength at initial force loading.

The amount of orthodontic bond-ing adhesive remaining on the specimen after debonding was greater at 24 hours than at 15 minutes for Transbond PLUS and Blúgloo (Figure 4). Gréngloo demonstrated the same aver-age ARI score at 15 minutes and 24 hours, which was also the lowest average ARI score. This finding is in agreement with the manufacturer’s claim that Grén-gloo has a chemical affinity for metal orthodontic brackets. Only Transbond XT had a higher aver-age ARI score at 15 minutes than at 24 hours. Of particular note was Transbond PLUS resulting in a higher average ARI score at 15 minutes and at 24 hours when compared with the results of Transbond XT, which conflicts with the findings from the stud-ies of Vicente and Bravo in 2006 and 2007 (41,42).

Transbond PLUS, Gréngloo, and Blúgloo demonstrated adequate bond strengths for use in clinical orthodontics. The major dif-ference in the three products is the conditions under which the color change takes place. Transbond PLUS changes from a pink tint to translucent after exposure to light. Gréngloo and Blúgloo change from a green tint and blue tint, respectively, to translucent after an increase in

temperature; and their respective color tints return with a decrease in temperature. Each can be advantageous for various rea-sons depending on the clinician’s preference.

The combinations of orthodontic bonding adhesives and tech-niques used in this study have not been tested in this manner under the same testing condi-tions. Bond strengths are tech-nique sensitive, and the same orthodontic bonding adhesives can yield different results in varying experimental condi-tions. Furthermore, remnants of adhesive remaining on the tooth surface after laboratory shear testing may be different than those after clinical debonding. This study has clinical interest because it evaluated the shear bond strengths of four com-mercially available orthodontic bonding adhesives and assessed the amount of residual adhesive remaining on the tooth surface after debonding. However, labo-ratory results cannot be extrapo-lated to the clinical environment, hence, clinical studies need to be performed to yield clinically meaningful results (43). It may also be of interest to repeat this study using longer time periods to evaluate the trends of the shear bond strengths and ad-hesive remnants after 24 hours, with particular interest in the shear bond strength trend of Gréngloo.

ConclusionsBoth Transbond PLUS and Blúg-loo produced average shear bond strengths similar to those of the control group (Transbond XT) when compared at 15 minutes and 24 hours. Gréngloo dem-onstrated average shear bond strengths that were significantly higher than those of the control group at 15 minutes and signifi-cantly lower than those of the control group at 24 hours. It is not clear why the three products demonstrated different bond strengths, but it may be due to differences in their chemical make up. Although the aver-age shear bond strengths varied among the different orthodontic adhesives at two different time points, the measurements were still within the recommended bond strength range for orth-odontic bonding. Therefore, Transbond PLUS, Blúgloo, and Gréngloo are practical options for orthodontic bonding.

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19. Alexander SA, Ripa LW. Effects of self applied topical fluoride prepa-rations in orthodontic patients. Angle Orthod 2000;70:424-430.

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Peer Review: Process Snapshot

For more information about peer review please contact the Council on

Peer Review via Cassidy Neal at 512-443-3675 ext. 152.

Peer review is organized dentistry’s dispute resolution process that gener-ally handles complaints from patients against dentists regarding the quality or appropriateness of clinical dental treatment received.

Need a peer review sign for your office?

You may print a copy of the peer review sign from the Resources section of the members homepage on the TDA Website (tda.org).


Summary of the New 2010

American Heart Association

Guidelines for Basic Life

Support (CPR)

AbstractApproximately every 5 years, American Heart Association (AHA) experts review emergingscientific evidence and recentclinical experiences and update the AHA guidelines for basic and advanced life support procedures for in-hospital and out-of-hospital victims of life-threatening cardiac events. This article summarizes many of the 2010 changes in those guidelines as they apply to dental healthcare providers (HCP).More detailed informa-tion will be available in the near future as these guidelines are fully implemented and instruc-tional materials are released by the AHA. Until they are trained in future AHA or American Red Cross (ARC) basic or advancedcardiac life support (BLS, ACLS)courses in 2011, dentists, dental assistants, dental hygienists, and office staff should continue to relyon the training and information they received in their most recent basic (and/or advanced cardiac)life support training course.

KEy WORDS: Basic Life Sup-port (BLS), 2010 American HeartAssociation Guidelines, Cardio-pulmonary Resuscitation (CPR),2010 CPR Guidelines, 2010 BLS Guidelines, medical emergency management, dental officeemergencies

Tex Dent J 2011; 128(3):279-288.

IntroductionEach year an estimated 350,000 people suffer a cardiac arrest in the United States and Canada and receive an attempted resuscitation (1). This number does not include victims who suffer an out-of-hospi-tal cardiac arrest where resuscitation is not attempt-ed. The concept of chest compressions and rescue breathing to save victims of cardiac arrest was first introduced to doctors at a meeting of the Maryland Medical Society 50 years ago (2). The first guidelines were issued by the American Heart Association (AHA) in 1966. Since that epic moment, Basic Life Sup-port (BLS) and Advanced Cardiac Life Support (ACLS) have become the centerpieces for emergency respons-es to life-threatening cardiopulmonary emergencies in medical and dental offices, and in everyday life.

Roger E. Alexander, D.D.S.

Dr. Alexander is professor emeritus, Department of Oral and Maxillofacial Surgery, Baylor College of Dentistry — Texas A&M Health Science Center, Dallas.

Contact Information: Department of Oral & Maxillofacial Surgery, Baylor College of Dentistry – TAMHSC, 3302 Gaston Ave.,Ave.,A Dallas, TX 75246. Telephone:Telephone:T (972) 240-7718, Fax: (214) 828-8382.E-mail: [email protected], Alternate E-mail: [email protected].

Reprints of this article will not be available.

The author has no declared financial interests in any product mentioned in this article.

This article has been peer reviewed.

Alexander


On November 2, 2010, the AHA marked that 50-year milestone by publishing the newest (2010) guidelines for cardiopulmonary resuscita-tion (CPR) and emergency cardiac care in Circulation.(3) The guidelines were last revised in 2005 and were summarized in a previous article in this journal (4).

Publication of new BLS guide-lines (which include recom-mended CPR protocols) are often received with concern by healthcare providers (HCPs), not only because they often intro-duce changes to long-held dogma and learned skills, but also because of the perception that the skills learned in the most recent recertification classes may now be obsolete. This should not be a concern, however. The AHA emphasizes that the 2005 guidelines are still considered safe and effective, and that there is no problem with rescuers continuing to follow them until such time as they have been up-dated with the newer guidelines. The 2010 guidelines are simply the latest refinements of previ-ous knowledge and techniques, based on published evidence and experience since the 2005 guidelines were published. They represent the collective opinions of 356 resuscitation experts from 29 countries who have analyzed current data over the past 3 years and believe the new modi-

fications of skills and knowledge will result in better compliance and improved outcomes when resuscitations are performed by both lay and professional rescu-ers. Dental HCPs will be taught these new concepts in future AHA and American Red Cross (ARC) training courses.

The new guidelines will be incor-porated into AHA and ARC train-ing classes as new instructional materials are released by the AHA over the next few months and new textbooks and training aids are developed. The “2010 Handbook of Emergency Car-diovascular Care for Healthcare Providers” is scheduled to be-come one of the first new training books to be released, and will be available by the time this article is published. The cost will be $25. As training materials are released, future ACLS courses will introduce the changes in the new ACLS guidelines.

This article will only preview the new BLS guidelines. Interested readers who wish more informa-tion can obtain a complete set of the 2010 guidelines from any of the American Heart Associa-tion’s publication sources for $20. The sources can be found on the AHA website (www.heart.org/HEARTORG/CPRAndECC/CPR_UCM_001118_SubHomeP-age.jsp). Based on past trends, it is anticipated that the Journal of the American Dental Associa-tion will publish a more compre-tion will publish a more compre-tionhensive summary of the changes sometime in early or mid-2011.

What’s New or Changed in the 2010 Guidelines? This article will summarize only the most significant changes to guidelines that relate to health-care providers. Some of the more significant changes for lay bystanders will also be briefly discussed, because healthcare providers may become involved in rescues away from the office, where a professional team ap-proach is not applicable.

Lay rescuers and HCPs will continue to be taught two sub-stantially different BLS protocols. This approach was begun several years ago, and an even wider de-parture from HCP guidelines was implemented with the introduc-tion of “hands-only (compression-only)” CPR in 2008 (5). Anecdot-ally, the author has heard that this change has caused confusion in some dental offices, who are under the impression that the lay guidelines now also apply to HCPs, but the HCP guidelines have not substantially changed, when applied in a professional environment. Dental HCPs need to be aware of the scope of lay providers’ training, however, be-cause they may become involved in out-of-office rescue situations, involving lay persons rather than trained HCPs. In those situa-tions HCPs may need to follow lay protocols rather than those usedwhen they are functioning with a trained office team.



Emphasis on Compressions, Compression-only CPR, and “C-A-B”. The most dramatic recent changes in CPR for lay rescuers has been the intro-duction of “compressions-only” (“hands only”) CPR, and the other signifi-cant change occurred in the adult and pediatric CPR algorithms changing the sequence from “A-B-C” to “C-A-B”. Lay rescuers are taught to assume cardiac arrest if an adult suddenly collapses, does not respond to verbal stimulation, and is not breathing (or is breathing abnormally). They are also taught to avoid opening the airway, listening for breathing, or search-ing for a pulse. The long pauses that have been caused by lay rescuers awkwardly trying to open the airway, deliver two adequate ventilations, and find a pulse during the performance of CPR are thus avoided. The experts believe there will be enough residual oxygen in the victim’s blood stream and lungs to briefly sustain life during the performance of CPR. Lay rescu-ers are instructed to initiate chest compressions immediately, to compress the chest continuously (at a rate of at least 100 per minute), and to mini-mize any interruptions of chest compressions until advance emergency care (EMS) and/or an automatic external defibrillator (AED) arrives at the scene. To highlight the need for adequate chest compressions, the empha-sis is on “push hard, and push fast.”

Limiting Pulse Checks to 10 Seconds (HCP). Both lay rescuers and HCPs have demonstrated difficulty in detecting the presence or absence of a pulse, especially in victims who are hypotensive or have bradycardia. The 2010 guidelines stipulate that professional rescuers should not check any longer than 10 seconds for a pulse, and if a definitive pulse is not felt within that time period, cardiac arrest should be assumed and chest com-pressions should be immediately started. This includes minimizing inter-ruptions of chest compressions to perform periodic pulse checks during CPR. The emphasis should be on performing continuous chest compres-sions, with a minimal number of brief pulse checks.

Lay rescuers are instructed to initiate chest compressions immediately, to compress the chest continuously (at a rate of at least 100 per minute), and to minimize any interruptions of chest compressions until advance emergency care (EMS) and/or an automatic external defibrillator (AED) arrives at the scene.

Eliminating Delays and Interruptions. Since the introduction of the 2005 guidelines, the AHA has made a concerted effort to reduce wasted time during the performance of CPR, and to reduce the number of in-stances where bystanders are reluctant to perform CPR, or are unable to perform CPR correctly. Studies show that less than 50 percent of adult cardiac arrest victims receive bystander CPR. One of the impediments has been the difficulty in teaching how to open an airway, diagnose the lack of pulse, and deliver adequate rescue breaths using a mask or other barrier device (2). Even HCPs occasionally demonstrated difficulties accomplish-ing those skill-related tasks. This translated to delays in beginning chest compressions which, in turn, resulted in a low percentage of successful outcomes to CPR (averaging a mere 6 percent worldwide). When victims are shocked with an automatic external defibrillator (AED), shortening the intervals between the cardiac event, initiating CPR, and delivering the first shock substantially improves the victim’s chance for survival and recov-



ery (2). Ironically, surveys have failed to validate the belief that rescuers do not get involved in CPR because of a reluctance to perform mouth-to-mouth ventila-tion, as widely stated in the me-dia. They cite fear, uncertainty, or panic as the primary causes for delay or non-involvement (6). Studies show that delays in initiating CPR are most often due to confusion, uncertainty and/or panic, and it is hoped that by simplifying the procedures, and removing those elements that most lay rescuers found difficult or confusing to perform will in-crease lay bystander willingness to become involved and yield improved outcomes.

Pediatric Differences. Only 5-15 percent of pediatric (child/infant) cardiac arrests are true cardiac arrests due to ventricular fibrillation or other arrhythmias (2). Many pediatric cardiac ar-rest cases are due to trauma or are secondary, due to breathing failure (termed “asphyxial”). The AHA continues to recommend a combination of ventilations and chest compressions for most child and infant scenarios, ex-cept for certain situations, such as a collapse during an athletic event that may call for CPR and defibrillation. Ventilations are recommended because studies have shown that children who received compressions-only CPR for management of non-cardiac (asphyxial) arrests (e.g. SIDS, disease, drowning) had poor results, comparable to those children who received no CPR at all (2). It is unknown whether

administering compressions prior to ventilations (“C-A-B” instead of “A-B-C”) in infants and chil-dren has any significant positive or negative effect, but initiating compressions first only delays the administration of ventila-tions for about 18 seconds (7). For that reason, the guidelines recommend CPR with ventila-tions (using the “C-A-B” algo-rithm) for infants and children in order to standardize training and the telephone guidance given by emergency dispatchers. The rec-ommendation for the depths of compressions has been increased and it is now recommended that the depths should be approxi-mately 1/3rd of the anterior-pos-terior dimension of most child-rens’ chests (2). This corresponds to approximately 1 1/2 inches in infants and 2 inches for most children. The pulse assess-ment has been deemphasized in children as it has been in adults, due to the difficulty in reliably and consistently detecting the pulse. Lay rescuers are taught to not assess the presence or absence of a pediatric pulse, and HCPs should not spend more than 10 seconds attempting to palpate a Brachial pulse.

No “Look, Listen, Feel.” Stud-ies have suggested that the previ-ous “look, listen, feel” protocol significantly delayed the start of chest compressions, so it has been deleted from the guidelines. Immediate recognition of sudden cardiac arrest is based on noting unresponsiveness (previously “shake and shout;” now, “tap on the shoulder and shout”) and

the absence of normal breathing (i.e. the victim is not breathing, or is showing periodic gasping breaths). If no signs of respon-siveness and normal breathing are noted, CPR should be imme-diately started.

Emphasis on Deeper, Full-Re-laxation Chest Compressions. The quality of chest compres-sions is emphasized, and the new mantra is “Push Hard, and Push Fast.” Rescuers are advised to compress the chest of an adult victim at a rate of at least 100 compressions per minute, and push the chest deeper than pre-viously recommended. The 2010 guidelines recommend compress-ing the chest of an adult victim at least 2 inches (not 1 1/2-2” as previously taught), and allowing the chest to fully recoil (expand) after each compression to al-low the heart to refill completely before the next compression. The compressions: ventilations ratio for HCP rescuers remains 30 compressions: two ventilations for adult victims that have not been intubated or had some other advanced airway device imple-mented. This c:v ratio is arbitrary and based on expert consensus and limited evidence. Additional data are needed in the future to confirm whether this is the most ideal combination of compres-sions and ventilations (6).

More Frequent Compressing Rescuer Changes (Rescuer Fa-tigue). Numerous studies show that rescuer fatigue significantly compromises CPR outcomes, even when rescuers do not per-


ceive they are fatigued. Even after performing CPR for more than 5 minutes, some rescu-ers claim not to be fatigued but studies show that fatigue begins to adversely affect chest com-pressions after as little as 1 min-ute of CPR, resulting in shallower and less effective chest compres-sions (6). The 2010 guidelines recommend that whenever there are a sufficient number of res-cuers, those performing chest compressions should switch approximately every 2 minutes, interrupting compressions for less than 5 seconds during the changes. For two rescuers this can be best accomplished by positioning one rescuer on each side of the victim’s chest, so they can quickly switch roles.

Continued Emphasis on Defi-brillation. Several studies have documented that survival rates from cardiac arrest decrease 7 – 10 percent for every minute that passes from the time of arrest to the administration of the first defibrillating shock, if no CPR is provided (8). When bystander CPR is provided the reduction in survival is only decreased 3 – 4 percent per minute. Prompt by-stander CPR coupled with early use of an AED (<10 minutes) can significantly increase survival rates and improve neurologic outcomes. Survival rates of up to 74 percent have been docu-mented in out-of-hospital arrests when CPR and defibrillation oc-curred in less than 3-5 minutes (7). CPR alone, however, general-ly does not terminate ventricular arrhythmias nor restore a per-fusing rhythm. The 2010 guide-lines state: “To give the victim the best chance of survival, three actions must occur within the first moments of a cardiac arrest: activation of the … EMS system,

provision of CPR and operation of an AED” (7). It is noted that there continues to be ongoing discussion on two AED issues: 1) whether providing CPR before shocking the patient should be routinely recommended (versus administering a shock imme-diately), and 2) the ideal num-ber of shocks to be delivered in sequence before CPR is resumed. The AHA expresses concern that the currently marketed AED units cause delays of up to 37 seconds between shock delivery and CPR compressions, and they urge manufacturers to seek new methods to decrease the amount of time chest compressions are interrupted for AED rhythm analysis.

New Link Added to the AHA “Chain of Survival.” The 2010 guidelines have an increased emphasis on the post-resuscita-tion period, which has resulted in the addition of a new link in the AHA’s previously-four links “Chain of Survival” for optimum success in the management of cardiac emergencies. In addition to the previous four links (Early recognition and activation of the EMS system, early bystander CPR, rapid use of an AED if in-dicated, and arrival of advanced medical care) a new link of “Inte-grated post-cardiac arrest care” has been added.

Elimination of Cricoid Pres-sure Technique. Randomized studies show that the technique recommended for HCP rescuers over the years, to apply two-finger pressure over the cricoid cartilage (to allegedly reduce the risk for aspiration and gastric inflation), really does not work reliably. The procedure was difficult for rescuers to perform properly and generally not help-

ful, so routine use in adult CPR is no longer recommended (2).

Aspirin Concerns. One inter-esting section of the new guide-lines, actually found in the First Aid section, brings up the ques-tion of whether first responders should administer aspirin to victims experiencing chest pain? Although the literature is clear that there is an ultimate benefit for patients experiencing a heart attack, concern is noted regard-ing whether on-scene rescuers can properly diagnose an acute coronary event and recognize contraindications to aspirin administration, such as aspirin allergy, bleeding disorders, and potential medication interactions (6). There is limited discussion about whether delaying aspirin administration until the victim arrives at an advanced medical facility would compromise the effect, but no definitive recom-mendation is made one way or another. This appears to leave this important issue for future guidelines to clarify.

CPR Devices. There is an entire section that reviews the evidence regarding the use of various devices to assist rescuers in pro-viding compressions and ventila-tions. The majority of these de-vices are not of interest to dental HCPs, and overall the majority of the devices appear to poten-tially delay chest compressions and/or AED shocks, and there-fore are not recommended. The 2010 guidelines summarize this by stating: “To date, no adjunct has consistently been shown to be superior to …conventional (manual) CPR for out-of-hospital basic life support …”(9)


Summary of Healthcare Provider ActionsAll CPR Cards Are Not Equal. As noted previously, the new 2010 guidelines present only minor refinements to the HCP actions for managing adult and pediatric cardiopulmonary ar-rest. Because of the dramatic differences between HCP and lay rescuer protocols, many den-tal emergency response experts believe, as the author does, that it is extremely important that all dental office personnel be trained in healthcare provider-level classes (called “Professional Rescuer” in the ARC system) (10). Lay-oriented CPR classes are cheaper and shorter in dura-tion, but offer minimal skills and knowledge training. If dental auxiliaries are allowed to attend lay CPR training classes, they may be able to attest that they have a “valid CPR card,” which meets the most-minimal state standards, but they will not be equipped with the knowledge and skills required of a health-care team member working on a dental office rescue team. When someone is having an emergency in the dental office is not the time to find that your auxilia-ries only know how to perform “hands-only” chest compressions as a single rescuer, and have had no introduction to the AED.

Train Your Team. Dental offices should respond to a life-threat-


ening emergency by working as a team, whose available members can perform any of several ac-tions, and multiple actions can be carried out simultaneously by the team members (e.g. one rescuer activates the emergency response system and retrieves the AED or emergency oxygen, while another begins chest com-pressions and a third provides ventilations) (6,10). In the au-thor’s opinion, mock emergency drills should ideally be practiced by the office team monthly, or at least every 6 months, at mini-mum. These need not be disrup-tive and generally take less than 15-20 minutes. These recom-mendations are consistent with other published recommenda-tions for dental offices (11).

HCP Algorithm for Adult Vic-tims. In the following summary, the person having the emergency has been intentionally identified as the “victim” rather than the “patient,” because dental office emergencies don’t always involve patients under treatment. They can involve visitors who have accompanied a patient to the office, passers-by in an adjacent hallway or parking lot, or may in-volve one of the dentists or staff members in the office. The most obvious change in the sequence is that chest compressions are begun before ventilations are administered.

• The doctor (or first respond-er) in the room should check for responsiveness by grasp-ing or tapping the victim’s shoulder and loudly asking

“Are You OK?” (or a similar phrase). Simultaneously the rescuer should assure the victim’s airway is open (head tilt, chin lift or other appro-priate technique) and look for signs of breathing — e.g. rise and fall of the chest, or exhalation noise. (Some arrest victims may have oc-casional gasping during the initial moments of the arrest, but this is not considered adequate breathing.)

• If the victim is unresponsive and not breathing normally, an emergency should be called out. The EMS system (9-1-1) should be activated immediately and office emer-gency equipment brought to the scene.

• The doctor/first responder should check for a Carotid pulse, taking no more than 10 seconds. If a definitive pulse is detected, but the victim is not breathing, then rescue breathing should be administered (one breath every 5 seconds) via mouth-to-mouth breathing, or us-ing a barrier, pocket mask, or bag-valve-mask device. Oxygen can be added, if indicated, upon equipment arrival. Assessment for some other cause of the breathing loss should begin (e.g. airway obstruction), and appropriate treatment initiated.

• Compressions. If no pulse is detected within 10 sec-onds, or there is uncertainty regarding the presence or absence of a pulse, then car-diac arrest is presumed and


chest compressions started immediately. No initial ven-tilations are administered be-fore compressions begin (6). (Compressions are more ad-equate when performed on a firm surface, so I recommend that several team members work together to quickly and carefully remove the victim from the soft upholstered dental chair onto the floor. This also generally provides better access to the victim’s side during CPR, as well as improved compression qual-ity.) Compressions are per-formed at a rate of at least 100 per minute; interrup-tions should be minimized. If possible, two HCPs should perform chest compres-sions, positioned on opposite sides of the chest and ideally change roles approximately every 2 minutes (five cycles), to prevent rescuer fatigue and resulting shallower com-pressions (6). Chest com-pressor changes should not take longer than 5 seconds. Each compression should be at least 2 inches deep and the chest must be allowed to completely relax after each compression, to allow the heart to refill with blood be-fore the next compression.

• Ventilations. After 30 com-pressions have been admin-istered, the airway should be opened and two rescue breaths should be admin-istered by mouth-to-mouth (with barrier), mask, or bag-valve-mask. Each breath should be delivered over 1 second time and produce vis-ible chest rise. The rescuer should take a regular breath rather than a deep breath before delivering each rescue breath, which prevents over-

inflation of the victim’s lungs and prevents the rescuer from getting lightheaded (6). Oxy-gen can be added upon equip-ment arrival at the scene.

• AED. As soon as the AED arrives on scene, one res-cuer should apply the pads to the victim’s exposed, bare chest, and the AED should be turned on. Compressions are stopped and the AED verbal prompts are followed. If a shock is delivered but an acceptable rhythm is not detected, rescuers will be prompted to resume CPR

compressions and ventila-tions until the AED prompts them to stop for the next rhythm analysis (and addi-tional shocks if indicated).

• Upon arrival of the EMS responders, the rescue scene is turned over to the arriving paramedics for continuation of the rescue and transporta-tion to a hospital.

Figure 1 attempts to create a simplified algorithm for HCPs (adult victim) in a dental office situation, based on the 2010 AHA guidelines.

Figure 1: 2010 Algorithm for Dental Healthcare Providers; Adult Victim*

Unresponsive Patient with

No Breathing or Periodic (“Gasping”) Breathing

Activate EMS (9-1-1)

Bring AED to Scene (Send other personnel, if available)

Check Pulse (<10 Seconds)

No Pulse Detected

Begin CPR (30c:2v)

(Start Compressions First)

AED Arrives; Apply Pads

To Patientʼs Bare Chest

Follow AED Verbal Prompts;

Clear and Shock as Prompted (If ythm is not shockable, continue CPR)rh

EMS Arrives & Takes Over

*Based on concepts presented in Figure 2, Reference 6

Give 1 breath

every 5-6 seconds;

every 2 minutes;

ssess ause

Pulse Detected

recheck pulse

a c

Figure 1. 2010 Algorithm for Dental Healthcare Providers; Adult Victim*

* Based on concepts presented in Figure 2, Reference 6.


Pediatric variations in HCP Resuscitations. The 2010 guidelines have not changed dramatically for children (and infants), but some minor refine-ments have been introduced for HCPs. CPR should be performed if a child’s pulse is less than 60/minute, and rescuers are re-minded not to spend more than 10 seconds attempting to locate a pulse. Single rescuers who perform chest compressions on infants should use the two-finger technique; In two-rescuer infant CPR, the compressor uses two

Figure 2. Dental students at Baylor College of Dentistry also learn how to hold mock emergency drills in their future offices as they practice medical emergency management in classes.


thumbs on the lower third of the sternum, with both hands encircling the infant’s chest, squeezing the infant’s thorax simultaneously with chest com-pressions (termed “circumferen-tial squeeze”) (7). Some evidence suggests this variation provides higher coronary artery perfusion pressures. Like the 2005 recom-mendations, the compressions: ventilations ratio in infants is 30:2 for single rescuers and 15:2 for two-person rescues. There should be minimal interruptions of compressions for delivery of

the ventilations (7). Studies show that HCPs often deliver excessive ventilations during CPR, which can be harmful. Each breath should be given slowly, over 1 second in time, while watching for chest rise. Once chest rise is noted, the lungs are full. For-eign Body Airway Obstruction protocols are largely unchanged, except that the “C-A-B” protocols apply for unresponsive vic-tims, rather than the previously recommended “A-B-C” protocol (compressions before ventila-tions). The Foreign Body Airway


Obstruction guidelines remain largely unchanged from the 2005 guidelines.

Pediatric hyperoxemia con-cerns. The guidelines note that there is some evidence in animal studies that high oxygen expo-sure may be harmful in children once spontaneous circulation is restored following cardiac arrest (2). It is recommended that 100 percent oxygen be used during resuscitation, but once circula-tion is restored, if appropriate equipment is available the in-spired oxygen should be titrated to maintain oxyhemoglobin satu-ration >94 percent, pending ar-rival of EMS personnel, to reduce the risk of hyperoxemia (7).

DiscussionThis article alerts dentists to the upcoming changes because it is important that all dental health-care providers are aware of the changes. The changes forwarded in the 2010 AHA guidelines are not as extensive as they were in the 2005 guidelines, and mostly represent refinements of the techniques and knowledge we have already learned, based on new evidence that has been published since 2005. The great-est change is the new emphasis on high-quality chest compres-sions, with minimal interrup-tions, delivered in a new “C-A-B” algorithm (compressions before ventilations). Additional informa-tion will be provided in upcoming AHA or ARC training classes and office teams will be able to get hands-on practice, incorporating these changes.

Publication of the 2010 AHA guidelines for CPR and emer-gency cardiac care do not render

the 2005 guidelines obsolete. The knowledge and skills learned by HCPs in their last AHA or ARC class remain safe and ef-fective, but the AHA resuscita-tion experts feel the refinements will further enhance the older skills, result in greater bystander involvement, and result in more successful outcomes. These new aspects will be incorporated in future AHA and ARC CPR classes as soon as training materials can be developed and instructors can be updated.

As noted above, most dental emergency response experts recommend that all dental HCPs (dentists, assistants, hygien-ists, office staff) renew their CPR cards annually, even if they are provided with a 2-year expiration date by the issuing organization. Studies have shown that reaction times, and the quality of resusci-tation skills erode quickly when not used. After 6 –12 months the typical dental rescuer may not be able to react and perform to the highest level if called upon to do so during an actual emergency. By renewing their skills each year, and regularly participating in mock emergency drills with the office team, dental offices will ensure the highest probability that any patient who experiences an unexpected life-threatening emergency problem will have a successful outcome. It is also beneficial if the entire office staff undergoes CPR renewal as a group, rather than each taking an individual class. Many AHA and ARC CPR instructors are willing to come into a dental office and hold a HCP class for the entire staff on site, and some will even incorporate mock patient emer-gency drills as part of the session, using the office’s own emergency equipment for familiarity.

BLS guidelines for HCPs now includes defibrillation efforts, by definition (12). It is highly rec-ommended that each dental of-fice purchase a good quality AED (Automated External cardiac De-fibrillator) and arrange for the of-fice staff to participate in an ini-tial AED provider course to learn how to incorporate this impor-tant piece of equipment into the office’s emergency plan (10-14). Once trained, in future renewal courses dentists and their staffs can be updated in one integrated session of a combined CPR and AED course. Further informa-tion on AED purchasing can be found in the literature (10).

References1. Travers AH, Rea TD, Bobrow

BJ et al. Part 4: CPR over-view: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscita-tion and Emergency Cardio-vascular Care. Circulation 2010; 122 (Suppl3):S676-84.

2. Field JM, Hazinski MF, Sayre MR et al. Part I: Executive summary: 2010 American Heart Association Guidelines for Cardiopulmonary Resus-citation and Emergency Car-diovascular Care. Circulation 2010; 122 (Suppl3):S640-56.

3. Field JM, Hazinski MF, Sayre MR et al. 2010 American Heart Association Guide-lines for Cardiopulmonary Resuscitation and Emer-gency Cardiovascular Care. Circulation 2010; 122 (Suppl3):S639-933.

4. Alexander RE. The new 2005 American Heart Associa-tion Guidelines for Basic Life Support: A Preview. Texas Dent J 2006; 123:200-9.

5. Sayre MR, Berg RA, Cave DM et al. Hands-only (compres-sion-only) cardiopulmonary


resuscitation: a call to action for bystander response to adults who experience out-of-hospital sudden cardiac arrest. Circulation 2008; 117:2161-67.

6. Berg RA, Hemphill R, Abel-la BS et al. Part 5: Adult basic life support: 2010 American Heart Association Guidelines for Cardiopul-monary Resuscitation and Emergency Cardiovascular Care. Circulation 2010; 122 (Suppl3):S685-705.

7. Berg MD, Schexnayder SM, Chameides L et al. Part 13: Pediatric Basic Life Support: 2010 American Heart Asso-ciation Guidelines for Cardio-pulmonary Resuscitation and

Emergency Cardiovascular Care. Circulation 2010; 122 (Suppl3):S862-75.

8. Link MS, Atkins DL, Pass-man RS et al. Part 6: Electri-cal therapies: 2010 American Heart Association Guidelines for Cardiopulmonary Resus-citation and Emergency Car-diovascular Care. Circulation 2010; 122 (Suppl3):S706-19.

9. Cave DM, Gasmuri RJ, Otto CW et al. Part 7: CPR tech-niques and devices: 2010 American Heart Association Guidelines for Cardiopul-monary Resuscitation and Emergency Cardiovascular Care. Circulation 2010; 122 (Suppl3):S720-28.

10. Alexander RE. Selecting an


automated external defibril-lator (AED) for the dental of-fice: Which is “best?”. Texas Dent J 2004; 121:1168-79.

11. Malamed SF. Medical emer-gencies in the dental office, 6th Ed. St. Louis; Mosby-Elsevier, 2007: 500.

12. Malamed SF. Automated external defibrillators, Part 2. Dentistry Today 2003; 22:109-14.

13. Lazar RA. AEDs in dental offices. Dental Econ 2007; 97:116-21.

14. Kandray DP, Pieren JA, Ben-ner RW. Attitudes of Ohio dentists and dental hygien-ists on the use of automated external defibrillators. J Dent Educ 2007; 71:480-6.

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I feel optimistic that 2010 was the turning point in the

economic downturn and Texas will be a leader in the

national recovery. Although unemployment remains

relatively high by past standards, most indicators sug-

gest that we have reached a bottom and are now headed

in a positive direction. Our membership numbers have

had a slight increase and these factors bode well for

TDA’s financial future.

The year 2010 showed a modest recovery in our invest-

ments in the Reserve Division of our General Fund. The

year showed a gain of $129,250 (6.61 percent). How-

ever, the interest made in other accounts in the Oper-

ating Division suffered significantly in that rates have

remained historically low, barely above any inflation we

may have had in costs of goods and services we pur-

chase to run the business of the TDA. The Relief Fund,

our philanthropic trust, showed a gain of $16,241 (2.98

percent). A total distribution of $12,951 was made

among five different charitable organizations in 2010.

As your new secretary-treasurer, I have set a number

of objectives that I feel will strengthen the Association.

My overall financial vision for the TDA is to work toward

implementing changes that will institute and maintain

audit recommendations, consolidate accounts, review

insurance risks and any gaps to determine the neces-

sary monies to have for any unintended “rainy day”

contingencies, and to maximize a return on our assets

with an acceptable level of risk.

The 2010 unaudited year-end analysis showed we had

income of $6,246,692 at 4.5 percent below budget and

expenses of $5,607,360 at 16.6 percent below budget.

This realized surplus of $639,332 has been placed into

a TDA savings account for use in future years.

Similar surpluses from the early 2000’s had been

placed into an interest bearing account labeled “Op-

erating Reserve Account,” ostensibly to be used for

cash demands presented during future years opera-

tions. This account grew to more than $950,000 by

2010; however, no demands were made upon it. The

TDA Board of Directors decided that funds from this

account would be used to pay the $900,000 National

Labor Relations Board (NLRB) settlement costs we in-

curred in 2010. The remainder has been consolidated

with other TDA savings accounts for clarity and to

maximize potential return on investment.

The annual TEXAS Meeting, our publications/web-

site, and TDA Financial Services, Inc. (TDA Perks) and

MBL Partnership (our “for-profit” affiliates) continue to

provide significant income streams for the Association

that help maintain dues levels at a minimum. Based

on our best projections of income and expenses for

the fiscal year 2012, there appears to be no need for

a dues increase. Of course if the House of Delegates

(HOD) passes significant projects, a decision will have

to be made on either a dues increase or to take addi-

tional monies from savings.

The Board has approved a consolidation of Opera-

tion’s bank accounts. We have eliminated several

bank accounts leaving only those mandated by HOD

resolutions or those that must remain segregated by

regulatory agencies or generally accepted accounting

principals. A monthly cash flow analysis for 2010 was

completed. From that we were able to see the seasonal

fluctuations in our Operation’s Division accounts. It is

my intention to maintain funds for day-to-day opera-

tions at an adequate minimum, moving un-needed

funds into a higher interest bearing saving’s account;

or from that account, back into checking if cash flow is

needed for seasonal adjustments.

2010 Financial ReportTexas Dental Association

Prepared by Ron Collins, D.D.S., TDA Secretary-Treasurer

,


As the budget is a priority item, it is presented early

in the HOD. At the end of the session, any additional

added projects or programs with a financial implica-

tion would raise the estimated expenses to pay for

them. The HOD will then be empowered to decide if

additional monies should be taken from the savings

account or by a dues increase which would be one of

the last items of business.

The building extension adjacent to the TDA main

building will be paid for by 2012 and the assessment

for it will cease after the 2012 dues year. The new

facility will house the Board of Directors meetings

as well as some for-rental offices. In addition it has

been designed to accommodate 100-120 people to be

used by outside organizations as a conference center

for additional rental, thus producing a new source of

revenue.

Two of the more challenging areas in estimating in-

come and expenses 18 months in advance were travel

and a search for a new executive director. Travel as-

sociated with Board, councils, committees, the ADA

delegation, and staff is always difficult to predict for a

number of reasons. The different cities involved where

members reside changes every year due to elections

and presidential appointments and the costs of hotel

space can change dramatically in 18 months from city

to city. The expenses for 2012 will include a search

committee and an outside vendor to consult with the

search committee.

The vendor’s expertise will be used in narrowing the

field for a suitable list of candidates for the search

committee to interview for finalists. The Board will

make its final decision from those finalists. The 2012

budget includes an estimate of 1 month’s overlap sal-

ary for transition from our present executive director

to the new executive director at the end of 2012 and

all associated costs for this search are included in a

separate line item of $100,000.

With the help of a special Financial Task Force, an

analysis of possible risks to the association was made

in concert with an outside insurance broker. As a

result of this analysis, newly recommended coverages

for exposures were proposed and are included in this

budget. One particular benefit to the membership at

the local level is that TDA will pay the premiums of all

components for their Directors and Officers liability

insurance.

This budget continues to support the TDA Smiles

Foundation, the Association’s philanthropic founda-

tion, at a level of $100,000. There are philosophical

opinions as to the amount that the TDA membership

should support our foundation. However, this is the

greatest area that can positively affect the public im-

age of the TDA — a concern that consistently rates as

the number one priority in past surveys. The founda-

tion, along with our legislative activity, are two of the

best weapons in our battle in the Texas Legislature to

preserve the dental profession as we practice it today.

This also helps fulfill the financial goal of the TDA

strategic plan on public image.

As your secretary-treasurer, I will continue to pursue

my objectives to strengthen the financial position of

the TDA, to make the reporting as clearly understand-

able and accurate as possible, and to remain watchful

so that systems and procedures are carefully followed.

I remain optimistic about the financial outlook of the

TDA in the next 2 years.


2012 Proposed BudgetTexas Dental Association

Revenues

ANNUAL SESSION

PUBLICATIONS/WEBSITE

BUILDING

OPERATIONS

ExpensesANNUAL SESSION

PUBLICATIONS/WEBSITE

BUILDING

CAPITAL IMPROVEMENTS

CONTINGENCY

CENTRAL OFFICE

BOARD OF DIRECTORS

COMMITTEES

COUNCILS

ADA/NATIONAL ORGANIZATIONS

HOUSE OF DELEGATES

FEDERAL INCOME TAX

2010 2010 2011 2012 Actual Budget Budget Proposed

1. Annual Session 1,805,872 1,869,850 1,908,650 1,908,700 2. Journal 414,180 457,301 475,527 442,646 3. TDA Today 39,455 39,265 39,655 39,690 4. TDA Website 21,140 24,950 20,400 18,990 Total Publications/Website 474,774 521,516 535,582 501,326 5. Building a. Building Leases 165,327 219,873 186,327 191,917 b. Building Extension Leases 2,802 23,352 4,500 11,000 Total Buildings 168,129 243,225 190,827 202,917 6. Operating a. Dues 2,707,766 2,651,113 2,626,912 2,660,078 b. Interest & Dividends 492 132,500 12,000 30,000 c. Miscellaneous 3,421 7,500 7,500 5,000 d. Contributions — Grants — AAPD 6,600 0 0 0 e. Dental Assistant Training 43,156 8,000 47,042 36,580 f. Seminars 0 0 0 0 g. Affiliates Administration 90,588 86,502 96,534 92,690 h. MBL Partnership 340,449 415,000 415,000 340,449 i. Cash Carry Over 605,445 605,445 469,008 577,774 Total Operating 3,797,917 3,906,060 3,673,996 3,742,571 TOTAL REVENUES 6,246,692 6,540,651 6,309,055 6,355,514 7. Annual Session 1,327,971 1,374,700 1,376,796 1,388,455 8. Journal 302,848 331,500 347,845 327,100 9. TDA Today 45,189 60,100 61,100 49,100 10. TDA Website 18,347 20,685 20,510 18,870 Total Publications/Website 366,384 412,285 429,455 395,070 11a. Building Leases 224,055 252,122 241,560 233,800 11b. Building Extension Leases 70,879 84,700 57,425 63,435 Total Buildings 294,934 336,822 298,985 297,235 12. Capital Improvements 30,166 35,000 35,000 30,000 13. Non Budgeted Contingency 5,948 40,000 40,000 30,000 14. Central Office Departments 2,792,179 3,233,209 3,155,213 3,237,053 15. Board of Directors 207,175 254,195 250,220 219,595 16. Committees 67,048 93,600 71,231 81,585 17. Councils 273,542 330,610 356,475 318,465 18. ADA/National Organizations 193,358 279,640 190,990 259,545 19. House of Delegates 48,655 65,590 54,690 48,510 20. Federal Income Tax 0 85,000 50,000 50,000 TOTAL EXPENSES 5,607,360 6,540,651 6,309,055 6,355,514 REVENUE OVER EXPENSE BEFORE OTHER EXPENSE 639,332 0 0 0 21. NLRB SETTLEMENT (from Operating Reserve account) 900,000 0 0 0 REVENUE OVER EXPENSE (260,668) 0 0 0


Central Office

DepartmentsPERSONNEL

EXECUTIVEDIRECTOR

OFFICE OPERATIONS

SERVICES

OTHER EXPENSES



14. Central Office Departments Personnel a. Regular Salaries 1,295,578 1,622,583 1,556,409 1,600,000 b. Salaries — Temporary 25,060 1,000 1,000 1,000 c. Payroll Taxes 117,723 145,974 140,879 140,460 d. Dental Reimbursement — Employee 11,290 13,639 16,537 13,869 e. Health Insurance 133,951 187,890 204,803 162,981 f. Retirement 134,595 168,825 162,981 155,031 Total Personnel 1,718,196 2,139,911 2,082,609 2,073,341 Executive Director: g. Salary 145,401 146,799 151,217 155,754 h. Auto Allowance 7,200 7,200 7,200 7,200 i. Health Insurance 7,366 8,169 8,687 8,878 Total Executive Director 159,967 162,168 167,104 171,832 Office Operations: j. Insurance — Directors/Officers 35,202 35,226 50,000 55,800 k. Maintenance 30,481 42,330 36,328 34,000 l. Postage & Couriers 29,630 34,384 35,804 31,700 m. Printing 12,377 11,200 12,100 12,100 n. Supplies — Office 18,581 22,475 16,700 18,400 o. Taxes — State & Local 2,754 2,432 2,675 3,288 p. Telephone 29,072 32,200 32,225 30,100 Total Office Operations 158,097 180,247 185,833 185,388 Services: q. Accounting Services — Payroll 3,941 3,951 4,346 4,200 r. Accounting & Auditing Services 32,131 32,985 34,634 35,000 s. Bank Charges 15,825 11,618 15,104 15,000 t. Consultants 0 0 0 0 u. ED Search Expenses 0 0 0 100,000 v. Human Resources 84,445 40,000 0 0 w. Legal Services 123,357 123,000 123,000 135,000 x. Lobbying 268,500 275,100 297,600 269,500 y. Gifts and Memorials 2,808 2,200 2,200 2,000 Total Services 531,007 488,853 476,883 560,700 Other Expenses: z. Contributions 100,000 100,000 100,000 100,000 aa. Dues Processing 68,827 70,255 65,000 70,000 bb. Education & Organizational Development 5,721 16,750 16,000 13,300 cc. Meetings 10,516 11,528 12,651 10,100 dd. Professional Dues & Memberships 3,384 5,660 4,160 5,050 ee. Subscriptions-Publications 4,221 3,155 3,473 3,707 f f. Recruiting 458 1,500 1,500 500 gg. Travel 31,785 53,182 40,000 43,135 Total Other Expenses 224,912 262,030 242,784 245,792 Total Central Office 2,792,179 3,233,209 3,155,213 3,237,053


Board of Directors, Councils,

Committees, ADA, HOD

BOARD OF DIRECTORS

COMMITTEES

COUNCILS

ADA/NATIONALORGANIZATIONS

HOUSE OF DELEGATES

FEDERAL INCOME TAX



15. Board of Directors: a. President 28,410 33,230 33,230 29,000 b. President — Stipend 30,000 30,000 30,000 30,000 c. President Elect 10,644 11,915 13,915 13,320 d. President Elect — Stipend 8,400 8,400 8,400 8,400 e. Past President 9,152 8,450 10,200 7,990 f. Secretary Treasurer 6,612 7,185 7,185 7,225 g. Secretary Treasurer — Stipend 8,400 8,400 8,400 8,400 h. Editor 5,612 11,950 13,225 11,830 i. Editor-Stipend 8,400 8,400 8,400 8,400 j. Vice Presidents 20,816 29,660 29,660 24,760 k. Senior Directors 17,770 25,700 25,700 18,800 l. Directors 17,313 24,700 25,200 18,800 m. Other Officers 14,404 12,250 12,250 12,075 n. Board Meetings 21,241 23,955 24,455 20,595 o. Board Docs 0 10,000 0 0 Total Board of Directors 207,175 254,195 250,220 219,595

16. Committees: a. Access to Care 8,496 8,640 8,640 17,100 b. Assets Management 39 2,410 1,410 200 c. Awards 24,529 26,450 20,500 19,000 d. Budget 5,805 5,526 5,026 5,360 e. Building 173 524 425 650 f. Communications 2,761 8,185 2,000 4,000 g. Finance and Audit 2,397 2,100 3,830 3,310 h. New Dentist 8,351 15,420 13,915 18,120 i. Personnel 72 200 200 200 j. Future Focus Committee 14,425 24,145 15,285 13,645 Total Committees 67,048 93,600 71,231 81,585 17. Councils: a. Annual Session Council 18,136 23,725 27,425 24,530 b. Legislative and Regulatory Affairs 119,122 124,276 166,311 116,171 c. Constitution and By — Laws Council 6,915 4,311 4,311 6,330 d. DENPAC 52,630 65,000 50,000 50,000 e. Dental Economics Council 5,077 13,350 10,350 10,000 f. Dental Education, Trade and Ancillaries Council 39,663 26,515 44,690 48,424 g. Ethics and Judicial Affairs Council 7,866 11,590 8,590 13,255 h. Membership Council 11,805 45,503 28,458 33,415 i. Peer Review Council 12,327 16,340 16,340 16,340 Total Councils 273,542 330,610 356,475 318,465 18. ADA /National Organizations: a. ADA Delegates 151,819 225,390 134,740 213,345 b. ADA 15th Trustee Headquarters 10,071 17,600 17,600 14,350 c. ADA Texas Reception 31,469 36,650 38,650 31,850 d. National Museum of Dentistry 0 0 0 0 Total ADA /National 193,358 279,640 190,990 259,545 19. House of Delegates: a. HOD 50 Year and Life Luncheon 3,900 4,000 4,100 4,000 b. HOD Headquarters 42,686 59,390 48,390 42,310 c. HOD Past President’s Breakfast 2,069 2,200 2,200 2,200 Total House of Delegates 48,655 65,590 54,690 48,510 20. Federal Income Tax 0 85,000 50,000 50,000 Total Miscellaneous 0 85,000 50,000 50,000


Annual Session

ANNUAL SESSIONREVENUE

ANNUAL SESSIONEXPENSE



1. Annual Session Revenue a. Advertising 7,700 9,500 6,500 9,000 b. Clinics for Continuing Education 943,856 900,000 941,000 961,000 c. Classes 3,165 4,500 4,500 2,500 d. Contests — Photo 222 350 350 200 e. Exhibits 627,913 700,000 700,000 690,000 f. Merchandise Sales — Logo Shop 1,731 6,000 3,000 0 g. Miscellaneous 0 1,500 300 0 h. Other Groups 85,273 100,000 100,000 100,000 i. Registration 56,678 60,000 65,000 61,000 j. Sponsorships 79,334 88,000 88,000 85,000 Total Annual Session Revenue 1,805,872 1,869,850 1,908,650 1,908,700

7. Annual Session Expense a. Audio-Visual 189,006 148,000 155,000 160,000 b. Bank Charges 41,917 40,000 40,000 40,000 c. Classes 4,195 4,500 4,500 2,500 d. Clinician Handouts 196 15,000 10,000 200 e. Clinician Honorariums 262,200 300,000 300,000 300,000 f. Clinician Support 173,815 175,000 175,000 175,000 g. Clinics — Other 0 0 500 500 h. Council/Board Dinner 3,334 4,500 4,500 4,500 i. Education 0 0 0 0 j. Exhibits 184,185 160,000 160,000 170,000 k. Hospitality Suite 34,051 40,000 40,000 40,000 l. Insurance 0 0 0 5,000 m. Logo Shop 2,488 6,000 1,500 0 n. Meetings 0 0 0 0 o. Miscellaneous 9,201 4,000 4,000 4,500 p. Onsite Program 29,967 35,000 35,000 35,000 q. Other Groups 48,466 70,000 70,000 70,000 r. Photo Contest 3,667 4,000 4,000 4,000 s. Postage 13,633 15,000 18,000 17,000 t. President’s Reception 1,335 2,000 2,000 2,000 u. Printing 0 0 0 0 v. Promotion 49,292 50,000 50,000 48,000 w. Red Coats’ Breakfast 431 450 450 450 x. Registration 119,363 135,000 135,000 128,000 y. Shuttle Services 6,741 8,500 8,500 11,000 z. Stipends 19,250 19,250 19,750 22,750 aa. Supplies — Office 2,984 5,000 3,000 4,000 bb. Temporary Salaries 0 500 500 0 cc. Texas Party 50,609 45,000 45,000 45,000 dd. Tours 0 0 0 0 ee. Travel 45,584 60,000 60,596 69,055 f f. VIP Reception 32,063 28,000 30,000 30,000 Total Annual Session Expense 1,327,971 1,374,700 1,376,796 1,388,455 Annual Session Net Revenue 477,900 495,150 531,854 520,245


Publications/WebsiteJOURNAL REVENUE

JOURNAL EXPENSE

TDA TODAY REVENUE

TDA TODAY EXPENSE

WEBSITE REVENUE

WEBSITE EXPENSE



2. TDA Journal Revenue a. Advertising 291,150 336,000 354,400 319,000 b. Single Issue Purchases 54 500 500 200 c. Subscriptions — Membership Dues 122,976 120,801 120,627 123,446 d. Miscellaneous 0 0 0 0 Total TDA Journal Revenue 414,180 457,301 475,527 442,646 8. TDA Journal Expense a. Meetings 90 100 100 100 b. Postage & Couriers 44,734 50,000 57,000 50,000 c. Printing & Production 257,902 280,800 290,345 276,600 d. Supplies — Office 25 500 300 200 e. Travel 97 100 100 200 Total TDA Journal Expense 302,848 331,500 347,845 327,100 3. TDA Today Revenue a. Advertising 4,675 5,000 5,500 5,000 b. Subscriptions — Membership Dues 34,780 34,265 34,155 34,690 Total TDA Today Revenue 39,455 39,265 39,655 39,690 9. TDA Today Expense a. Postage 20,138 24,000 24,500 22,000 b. Printing & Production 25,051 36,000 36,500 27,000 c. Supplies — Office 0 100 100 100 Total TDA Today Expense 45,189 60,100 61,100 49,100 4. TDA Website Revenue a. Advertising and Merchandise Sales 19,640 16,950 17,400 15,990 b. Sponsorships 0 5,000 0 0 c. TDA Affiliates Support 1,500 3,000 3,000 3,000 Total TDA Website Revenue 21,140 24,950 20,400 18,990 10. TDA Website Expense a. Education & Organization Development 175 600 600 600 b. Postage 0 25 25 25 c. Promotion 779 1,000 1,000 500 d. Repairs and Maintenance 0 0 0 0 e. Software and Software Support 6 350 200 500 f. Subscriptions — Publications 0 50 25 25 g. Supplies — Office 116 150 150 150 h. Travel 897 1,510 1,510 970 i. Website Engineering 0 1,000 1,000 100 j. Website Hosting 5,574 5,000 5,000 5,000 k. Website Services — TDA Express 10,800 11,000 11,000 11,000 Total TDA Website Expense 18,347 20,685 20,510 18,870 2-4 Total Public/Web Revenues 474,774 521,516 535,582 501,326 8-10 Total Public/Web Expense 366,384 412,285 429,455 395,070 Communications Net Revenue 108,391 109,231 106,127 106,256


Buildings

BUILDING REVENUE

BUILDING EXPENSE

EXTENSION REVENUE

EXTENSION EXPENSE

BUILDING MAINTENANCE FUND



5. TDA Building Revenue a. Lease Income 165,327 219,873 186,327 191,917 Total TDA Building Revenue 165,327 219,873 186,327 191,917 11. TDA Building Expense a. Building Tenants 1,733 1,400 1,400 1,300 b. Gifts & Memorials 60 500 500 300 c. Insurance — Operating 17,413 24,000 22,000 20,000 d. Meetings 0 0 0 0 e. Postage 23 0 0 0 f. Repairs & Maintenance — Equipment 12,211 2,000 3,500 3,000 g. Service Contracts 79,434 88,000 89,760 88,000 h. Supplies — Office 3,260 9,000 5,000 5,000 i. Taxes — State & Local 53,277 57,200 59,000 53,000 j. Telephone 0 750 400 200 k. Utilities 56,645 69,272 60,000 63,000 Total TDA Building Expense 224,055 252,122 241,560 233,800 5. TDA Extension Revenue b. Lease Income 2,802 23,352 4,500 11,000 Total TDA Extension Income 2,802 23,352 4,500 11,000 11. TDA Extension Expense l. Capital Expenditures 0 0 0 0 m. Insurance — Operating 0 2,500 2,500 2,500 n. Interest Expense 25,689 29,500 11,525 4,500 o. Legal Fees 0 0 0 0 p. Repairs & Maintenance — Equipment 0 8,500 4,000 3,000 q. Service Contracts 9,722 7,800 5,000 8,800 r. Taxes — State & Local 16,390 19,000 21,000 24,835 s. Telephone 7,718 4,400 5,000 7,800 t. Utilities 11,360 13,000 8,400 12,000 Total TDA Extension Expense 70,879 84,700 57,425 63,435 TDA Building Maintenance Fund Building Maintenance & Repair 10,313 17,473 2,493 59 (1) By House Resolution 132-1997-H, building repairs are funded from the interest generated from the Building Maintenance Fund from 2 years previous to the current year. The 2012 budgeted amount for these lines is the interest earned in the year 2010 by the Building Maintenance Fund


Texas Dental Association 2012 Budget Explanation1a. Income from vendor advertising

in the Annual Session program brochures.

1b. Income from ticketed clinician classes and events.

1c. Income from classes such as cooking and painting.

1d. Fees from Photo Contest.1e. Income from exhibit booth

spaces.1f. Income from sale of TDA logo

items.1g. Other income associated with

the TDA Annual Session.1h. Fees from alumni lunches

and other professional groups’ events.

1i. Pre-registration and on-site registration fees.

1j. Income from corporate sponsorships.2a. Income from sale of classi-

fied and display advertising in Texas Dental Journal.

2b. Sale of single issues.2c. Income from sale of Journal

subscriptions, including allocations of dues of $17 per

dues-paying member.2d. Fees from continuing education offering.3a. Income from advertising in TDA

Today. 3b. Member subscriptions allocated from dues at $5 per

dues-paying member.4a. Income from advertising on the

TDA Website.4b. Vendor support for web related

promotion.4c. Payment from affiliates for

portion of website development and maintenance costs.

5a. Income from leased space in the TDA building.

5b. Income from leased space in the TDA building extension.

6a. Dues income available for operations after allocation of

$22 per member for Texas Den-tal Journal and TDA

Today.6b. Money earned from various

short-term investments of dues collected and any interest income from current revenue.

6c. Legislative Day and other income associated with the operating fund.

6d. American Academy of Pediatric Dentistry DHI Grant.6e. Income from dental assistant

training program.6f. Income from sponsored seminars.6g. Payment from the for-profit

affiliate, FSI, for administrative support of staff and equipment provided by the TDA.

6h. Distribution of 90 percent of the partnership income from TDA Member Benefits, Ltd, in which TDA is the limited

partner.6i. Surplus carried over from 2009.7a. Audio-visual for clinicians.7b. Charges in connection with the

Annual Session bank accounts and credit card charges.

7c. Costs of classes, such as cooking and painting.7d. Printing of clinicians’ handouts.7e. Cost of honoraria, hotel, and

travel.7f. Course supplies, electrical, and

gifts for clinicians; convention center meeting rooms; and signs.

7g. Other costs associated with clinics.

7h. Costs of Council/Board Dinner.7i. Costs associated with education.7j. Exhibit hall costs, printing of

exhibitors’ prospectus, refreshments, electric/ decorating for exhibitors and

security.7k. Cost of catering for speakers,

staff and A/S Council during Annual Session.

7l. Insurance premiums paid to cover meeting cancellation.

7m. Cost of merchandise sold at the Annual Session.

7n. Staff meetings associated with Annual Session7o. Charges for other costs associated with the Annual

Session.

7p. Cost of printing on-site program.7q. Alumni luncheons and CPR

classes.7r. Costs associated with the

Photo Contest.7s. Postage used for Annual Session.7t. Costs associated with the

President’s Reception. 7u. Costs associated with printing

materials.7v. Mass mailings, promotional

items, and advertising.7w. Cost of A/S Council and A/S

staff breakfast during meeting. 7x. Cost for registration firm for

the Annual Session, as well as on-site setup cost, electrical, and staffing.

7y. Cost of shuttle transportation around downtown for

attendees.7z. Stipends paid to the San

Antonio Dental Society, TDA Alliance, and the Dental

Assistants Association.7aa. Supplies purchased for use at

the Annual Session.7bb. Temporary help hired specifically for the Annual Session.7cc. Catering, music and space

rental for The Texas Party.7dd. Tours.7ee. Annual Session staff travel and

Annual Session Council travel to scout other dental meetings.

7ff. Catering, music and space rental for the VIP Reception.

8a. Cost of meetings held in connection with Journal business.8b. Cost of mailing the Texas Dental Journal to all members.8c. Cost of printing, typesetting

and artwork for the Texas Dental Journal.8d. Supplies used for the Texas

Dental Journal. 8e. Staff travel in connection with

Journal business.9a. Cost of mailing newsletter, TDA

Today.9b. Cost of printing newsletter,

TDA Today.


9c. Supply costs associated with TDA Today.

10a. Educational programs for website staff.10b. Cost of postage for mailing to

potential website advertisers.10c. Costs on site at the Annual

Session to promote the website.10d. Maintenance costs for website

specific software.10e. Costs associated with software and support for the

website.10f. Professional publications related to the website.10g. Supply costs for the website.10h. Travel costs for staff to promote the website to the

membership at the Annual Session.

10i. Costs for maintaining updates and enhancements to the

website.10j. Costs to design, implement and

host website.10k. Software service costs to maintain TDA Express.11a. Expenses allotted to maintain

the tenant relations.11b. Gifts of appreciation for service

vendors and memorials for building display.

11c. Premiums paid for insurance associated with the TDA

Building.11d. Staff meetings associated with

the building.11e. Postage used for mailing building information.11f. Cost of equipment maintenance

for the building.11g. Service contracts associated

with building such as the el-evator service, security, HVAC, landscaping, etc.

11h. Supplies used to maintain the building.

11i. Property taxes paid on building.11j. Telephone expense allocated to

the building.11k. Gas, water and electricity ex-

penses.11l. Capital Improvement needs are reviewed and prioritized,

and estimated costs are projected.

11m. Premiums paid for insurance associated with the TDA

Extension.11n. Interest paid for building extension term note.11o. Legal Fees associated with the

building extension.11p. Repairs and maintenance

required above and beyond the service contracts.

11q. Service contracts associated with building such as the

janitorial service, security, HVAC, landscaping, etc.

11r. Property taxes paid on the TDA Extension.

11s. Telephone expense allocation to the TDA extension.

11t. Gas, water and electricity ex-penses.

Building Maintenance Fund uses interest earnings for remodeling and major repair costs. The budgeted expense amount is based on the

interest earnings for the year ended 2 years prior to the

budget year.12. Capital improvement needs are

reviewed and prioritized, and estimated costs are projected.

13. Contingency for approved expenditures by the Board of Directors.

14a. Full- and part-time salaries and year-end bonus (one week’s salary). The amount for 2012 reflects maintaining

current staffing levels with annual salary adjustments. 14b. Temporary help for the TDA

Central Office.14c. Employer’s portion of FICA

and Medicare based on 7.65 percent plus state and federal unemployment tax.

14d. Direct Reimbursement Dental Plan for employees.

14e. Medical insurance for employees.14f. Payments to retirement plan

for all eligible employees.14g. Salary for the Executive Director.14h. Car allowance for the Executive

Director.14i. Health insurance for the Executive Director.

14j. Liability coverage for TDA Officers and Component Society Officers, personal property coverage and workers’ compensation insurance.14k. Maintenance contracts for of-

fice and computer equipment and general office operations.

14l. Postage, metering equipment and maintenance, and UPS and Federal Express charges.

14m. All printing jobs done outside office such as stationery,

business forms, office forms, and dues statements.

14n. General office, printing and copy machine supplies.

14o. Personal property taxes of the Central Office furniture and equipment.

14p. Eight incoming WATS and busi-ness lines for Central Office using XO Communications, facsimile charges, and cellular phones.

14q. Cost of payroll service used by TDA.

14r. Accountant fees for annual audit, consulting services, and tax return preparation.

14s. Charges for transaction fees and returned checks.

14t. Expenses associated with outside consulting firms.14u. Expenses related to search for

new Executive Director.14v. Cost of out-sourced human

resource service.14w. Retainer for legal counsel and

related legal expenses.14x. Expenses associated with

consulting firms engaged for legislative lobbying services.

14y. Flowers for funerals, special gifts to VIP’s, members, and their families.

14z. Funding for the operating costs of the Texas Dental Association Smiles Foundation.

14aa. Credit card processing fees and other bank charges for

processing dues payments.14bb. Continuing education and organizational development

costs for TDA staff members.14cc. Meals and supplies not directly

related to a specific council, committee, or board meeting


that occurs at the TDA Central Office.

14dd. Memberships to the Austin Club, TSAE, ASAE and other licensing requirements for TDA staff.

14ee. Press clippings and other subscriptions used in the Central Office.14ff. Advertising cost for open staff

positions.14gg. Travel expenses for Executive

Director and TDA staff not related to a council or committee.15a. Travel reimbursement for the

President while on TDA business.15b. Stipend paid to the President.15c. Travel and per diem reimbursement for the President-Elect while on TDA

business.15d. Stipend paid to the President-

Elect.15e. Travel and per diem reimbursement for the Past

President, previously included in the Other Officers line.

15f. Travel and per diem reimbursement for the Secretary-Treasurer while on

TDA business.15g. Stipend paid to the Secretary-

Treasurer.15h. Travel expenses for the Editor.15i. Stipend paid to the Editor.15j. Travel and per diem reimbursement for the four

Vice Presidents while on TDA business.

15k. Travel and per diem reimbursement for the four

Senior Directors while on TDA business.

15l. Travel and per diem reimbursement for the four Directors while on TDA business.15m. Travel and per diem reimbursement for the Speaker

of the House and Parliamentarian while on TDA business.

15n. Costs associated with conducting Board meetings such as coffee, soft drinks, lunches, Board dinners (the cost of the Board lunch and dinner is deducted from BOD per diem), mailing and printing of Board-approved communications and

conference calls.

15o. Costs for board.docs, an electronic governance software.16a. Meeting and travel costs for

the Committee on Access to Care Medicaid and CHIP which monitors access to care and state funding issues.

16b. Meeting costs and travel reimbursement for committee

that oversees the investments of the Reserve Fund and the TDA Relief Fund.

16c. Cost of awards presented by the TDA, including meeting and travel reimbursement costs for committee.

16d. Meeting costs and travel reimbursement for committee

that formulates initial budget recommendations for

the Board of Directors.16e. Meeting costs and travel reimbursement for committee

that administers Building Fund and is responsible for oversight of the building.

16f. Meeting costs, travel reimbursement, and projects of

the Communications Committee.16g. Meeting costs and travel reimbursement for committee

that monitors the TDA financial functions.16h. Meeting costs, travel reimbursement, G.O.L.D. Reception, and projects of the

New Dentist Committee.16i. Meeting costs to discuss personnel issues. Minimal

costs are budgeted as this com-mittee meets in conjunction with Board Meetings or by telephone conference.

16j. Oversight of the strategic plan is accomplished through the Future Focus Committee.

17a. Reimbursement for travel, meeting costs, and council projects for the Council on

Annual Session.17b. Reimbursement for travel,

meeting costs, and council projects for the Council on

Legislative and Regulatory Affairs.17c. Reimbursement for travel,

meeting costs, and council projects for the Council on Constitution and Bylaws.

17d. Administrative support for DENPAC.

17e. Reimbursement for travel, meeting costs, and council projects for the Council on Dental Economics.

17f. Reimbursement for travel, meeting costs, and council projects for the Council on Dental Education, Trade, and Ancillaries.

17g. Reimbursement for travel, meeting costs, and council projects for the Council on Ethics and Judicial Affairs.

17h. Reimbursement for travel, meeting costs, and council projects for the Council on Member Services.

17i. Reimbursement for travel, meeting costs, and council projects for the Council on Peer Review plus training sessions for component officers.

18a. Reimbursement for travel and hotel for 44 Delegates and

Alternates to attend the ADA Annual Session and Pre-Caucus, and meeting costs of printing, postage and supplies.

18b. Printing, supplies, meeting rooms and general expenses associated with the 15th Trustee District Headquarters at the ADA Annual Session.

18c. Reception given by the TDA at the ADA Annual Session.

19a. Costs of luncheon for 50 Year and Life Members at the TDA Annual Session.

19b. Costs associated with meetings of the TDA House of Delegates, including reference

committees. 19c. Costs for breakfast for Past

Presidents and Past Vice Presidents at Annual Session.20. Estimated costs for federal

income taxes for non-related business income.

21. Settlement paid for the National Labor Relations Board claim.


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. Review TDA References

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Case History

A 14-year-old female was referred by her gen-eral dentist to the oral surgeon for evaluation and management of a large expansile lesion associated with the left buccal cortex of the mandible. The area demonstrated recent growth by report. The patient’s medical history was non-contributory. Clini-cally, t th #21 was missing and t th #20 and #22 were converging onto each other. Firm, mild expan-sion of the mandibular buccal cortex in the area of #21 was appreciated. Intermittent neurosensory changes were reported but not reproducible. No lymphadenopothay or overlying mucosal changes were appreciated. Teeth #20 and #22 responded normally to electric pulp testing (E.P.T.) and cold testing. Radiographically, there was a large, well circumscribed, unilocular radiolucency associated with unerupted tooth #21, and it appeared as if the lesion extended almost to the apex of the tooth (Figures 1a and 1b). Significant displacement of the roots of teeth #20 and #22 were observed. The CT scan showed that the inferior alveolar canal had been displaced as well. It also revealed a thinning of the inferior border of the mandible and all cortices were intact. Aspiration of the lesion revealed sero-sanguinous fluid.

The tooth and associated cystic lesion was removed by the oral surgeon and submitted for histologic examination.

Histologic sections showed a well defined tumor surrounded by a thick fibrous capsule (Figure 2). The tumor was arising from a thin epithelial lining and it consisted of a proliferation of polyhedral to spindle cells organized in sheets and lobules (Fig-ure 3). Within this cellular proliferation there were rosettes and duct-like structures composed of co-lumnar epithelial cells (Figure 4). Some foci of pink, somewhat calcified material was present associated with the tumor cells.

What is your differential diagnosis? See page 314 for the diagnosis.

Oral and Maxillofacial Pathology

Case of the Month

Juliana Robledo, D.D.S., South Texas Oral Pathol-ogy, San Antonio, Texas; andJames B. Mazock, D.D.S., private practice of oral and maxillofacial surgery, San Antonio, Texas

Mazock

Figure 1a. Panoramic radiograph showing a large radiolucent lesion associated with unerupted tooth #21

Figure 1b. Reformatted three dimensional image from cone-beam.

Robledooo ee


Figure 2.Thickfibrouscapsulesurroundingthetumor(2.5xmagnification).

Figure 3a. Tumor consists of sheets and lobules composed of polyhedraltospindlecells(4xmagnification).

Figure 3b. Small pseudoducts and pink calcifying material seen withinthetumor(20xmagnification).

Figure 4a.Duct-likestructureinthetumor(40xmagnification).

Figure 4b.Rosetteinthetumor(40xmagnification).


Preview

Improved Temporization with Modern Materials

KleiveKleive

Mark Kleive, D.D.S.

The placement of temporary restorations is common in all dental prac-tices because it allows patients to use their teeth during the manufac-turing phase of their restorative treatment. While the dental profession has not placed much emphasis on the importance of well-fabricated temporaries because their service is usually short in duration, the op-portunity to improve patient comfort, practice efficiency and communi-cation with the laboratory technician exists if we utilize modern materi-als and techniques.

Temporary MaterialsFor many years, polymethyl methacrylate (PMMA), polyethyl methacrylate (PEMA),and various types of preformed crowns were the industry standard materials for temporary restorations. While many of their properties were acceptable for use by the patient and in communication with the dental technician, these products were not as efficient or effective to use (in the hands of the average dental team member,including the dentist) as modern materials. In particular, the modern, widely-usedchemical cured composite resins (bis-acrylates) facilitate fabrication more efficientlyand in ways that enhance the many functions of temporaries.

The most popular temporary materials on the market today are the chemical curecomposite resins, which include products such as ProTemp™ (3M ESPE US),Luxatemp® (DMG America), and Integrity (DENTSPLY International).

The Advantages of Bis-acrylate Materials:They are widely available in many shades. They dispense easily. Minimum heat is required for setting. There is very little shrinkage. They have excellent biocompatibil-

Mark Kleive, D.D.S., and Richard Hunt, III, D.D.S.

“Yes Marge, These Are Just the Temporaries!”: A Hands-on WorkshopThursday, May 5, 2011 8:00 AM – 4:00 PM

Mark Kleive, D.D.S., and Sheri Kay, R.D.H., M.S.

You’re Hired! And We’d Like the Rest of You to StayFriday, May 6, 2011 8:30 AM – 11:30 AM1:30 PM – 4:30 PM (repeat)


ity. They can be polished with existing armamentarium. They lack objec-tionable smell or taste. They can be repaired easily. Their color is stable. They resist wear.

Functions of Temporaries

A well-fabricated temporary provides theopportunitytoinfluencethefinalrestorative outcome by demonstrat-ing appropriate tooth form, establish-ing a consistent color, supporting gingival health, providing occlusal support, maintaining arch space, and improving communication among the dentist, patient, and dental techni-cian. Communicating Tooth Form: The temporaries offer an important guideforfabricationofthedefinitiverestoration.Themostefficientwaytocommunicatethedesiredfinaltooth form to the dental technician is to provide a sample of this form by including a model of the temporary inthearch(1).Whilethelabora-tory technician’s ability to accurately “copy” the exact contours of a tem-porary restoration may be limited, the goal is to closely follow the accepted contours to maintain the length, form, tooth position, and phonetics for the patient. The goal is to leave as little to interpretation as possible. An accu-rate guide with temporaries will allow the dental technician to use his or her artistry within the parameters of what the patient has already experienced asacceptable(2).Awrittendescrip-tion of the desired changes wanted, even an average likeness of the de-sired outcome such as a photograph and/or an impression of the tem-porary, will do more to improve the communication process between the dentist and dental technician. Com-municating Tooth Color: Most tempo-rary materials have industry-standard toothshades(A1,A2,B1,andsoon)that can be used to communicate the desired color outcome to both the patient and the dental technician. The additional translucency and charac-

terization of porcelain will add further aesthetic value for the patient. Supporting Gingival Health: Well-fabricated temporaries help support gingival health for the finalrestoration.Thepatientcanbrushandflossnormallyandkeepthetissuesinexcellenthealth.Thereissignificantgratificationforthedentistandbenefitforthe patient when, after removing a temporary restoration, the gingival is healthy and ready to support an optimal cementation or bonding environment. Temporar-iesalsohavetheadditionalbenefitofsculptingthesofttissuecontoursadjacenttonaturalteeth,implantsandponticsites(3).ProvidingOcclusalSupportandMaintaining Arch Space: It is widely known that teeth can move or shift without appropriate support from the adjacent and opposing teeth. The goal for the den-talteamistominimizethisriskasmuchaspossibleasitmayhaveasignificanteffectontheefficiencyofseatingthefinalrestoration.TrialPhaseCommunica-tion: While the dentist and patient can compare study models or wax-ups of the intendeddefinitivetreatment,nothingwillprovideasmuchinformationtobothparties as well-fabricated temporaries that have been tried in the mouth during a trial phase. Most importantly, this trial phase allows the patient to experience changesincontour,texture,bite,andcolorandoffervaluablefeedback(4).This builds additional trust and rapport between the patient and dentist. With thisinformation,thedentist,patient,anddentaltechniciancanmoveconfidentlyforward with the permanent treatment phase and expect excellent results.

Using Chemical Cure Composite Resins (Bis-Acrylates)While bis-acrylates are the most widely used temporary materials in dentistry and their handling characteristics are well known, many dentists are inexperi-enced when it comes to proper technique from dispensing to insertion. Below is asimple,yetefficientoutlineforfabricationthatyieldssuperiorresults:Fabri-cate matrix of intended tooth form using either a clear acrylic sheet or silicone laboratory putty. Fill matrix with bis-acrylate material. Place matrix over pre-pared teeth based upon the manufacturer’s recommendations and then remove. Evaluatetemporaryforvoidsandaddflowablecompositeifnecessary.Place

Figure 1. The patient wants to improve his smile with restorations on the maxillary incisors.


temporary in heat environment — under curing light or in hot water, to increase the density of the bis-acrylate. Place temporary in rubbing alcohol solution for 30 seconds to dissolve air-inhibited layer. Trim any gross excess with acrylic bur. Polish in successive stages with silicone point, bristle brush, and ragwheels.Evaluateforfitintra-orallyand adjust as necessary. Cement in place with appropriate temporary mate-rial.Theindividualclinicalsituation(forexample, a single crown, multiple an-terior crowns, or veneers) may require additional steps, such as placement of characterizing tints or stains. The goal is to achieve temporaries that most closelymatchthedesiredfinalrestora-tions.Mostcliniciansfinditeasiertopractice the outlined fabrication on pos-terior temporaries and later move with confidencetoanteriortemporaries.

Improved Efficiency and ResultsFrank Spear writes that three things facilitate the fabrication of excellent temporaries: time, proper materials, and propertechnique(5).Experiencehasdemonstrated that when proper materi-als are used with proper techniques, the results are improved, and although it takes a bit more time to fabricate thetemporaries,theefficiencygainedin communication and delivery of the finalrestorationssavesmoretimeandincreasesprofitability.Thepatient’sexperience is more satisfactory, sup-porting happy relations, doctor-patient trust, and referrals. The dentist and lab technician experience improved rela-tions and satisfaction with their part-nered results.

Improved Temporization

Figure 3. A silicone matrix is fabricated from a wax-up of the desired final contours.

Figure 2. Close-up image demonstrates the existence of two PFM crowns and rotated lateral incisors.


Figure 4. The tooth preparations are completed and an impression is made.

Figure 5. The bis-acrylate material is placed into the matrix, ap-plied to the teeth, and then removed.

Figure 6. A simple armamentarium is used to trim the temporaries.

Figure 7. The temporaries demonstrate a preview of the final restorations for the patient, dentist, and technician.

Figure 8. The final restorations follow the design of the temporar-ies and provide a pleasing aesthetic result.

References 1. Fondriest JF. Using provisionals to

improve results in complex esthetic restorative cases. Pract Proced Aes-thetDent2006;18(4):217-224.

2. Magne M, Magne P, Cascione D, Munck I. Optimized laboratory-fabri-cated provisionals. Dental Dialogue 2006; April.

3. Magne P, Magne M, Belser U. The diagnostic template: a key element to the comprehensive esthetic treatment concept. Int J Periodontics Restor-ativeDent1996;16(6):560-9.

4. Donovan TE, Cho GC. Diagnostic provisional restorations in restorative dentistry: the blueprint for success. J CanDentAssoc1999;65(5):260-2.

5. Spear FM. The art of temporization. SpearPerspective;1(1).GreatLakesOrthodontics, Ltd.


Adenomatoid Odontogenic TumorOral and Maxillofacial Pathology Case of the Month (from page 308)

Oral and Maxillofacial Pathology

Diagnosis and Management

Discussion

Adenomatoid odontogenic tumor (AOT)isclassifiedasabenignodontogenic tumor. The tumor cells are derived from enamel organ epithelium and it is characterized by the presence of unusual duct-like or gland-like structures. AOT is a relatively uncommon neoplasm, representing 2 percent to 7 percent ofallodontogenictumors(1-3).Thistumor is seen more often in young patients between the ages of 10 to 19 and females are affected more than males. The anterior portion of the jaws are affected more fre-quently than the posterior regions and the maxilla is involved twice as often as the mandible. The most common clinical presentation of AOT is in association with an unerupted maxillary canine, presenting as a slow-growing, symptom free lesion which is frequently discovered dur-ing a routine radiographic examina-tion. Larger lesions may cause some bonyexpansion(1-4).

There are various types of ad-enomatoid odontogenic tumors. They can occur intraosseously and extraosseously. The intraosseous

AOT may be radiographically divided into two types: follicular or dentig-erous type and extracoronal type. The follicular or dentigerous type is associated with the crown of an unerupted tooth. The extrafollicular, or extracoronal type, is not associ-ated with an impacted tooth but may occur in the interradicular areas of erupted teeth. The follicular type appears as a unilocular radiolucency involving the crown of an unerupted tooth and sometimes extends api-cally along the root, past the cemen-toenamel junction. The extracoronal typeisalsoawelldefinedunilocularradiolucency located between or superimposed upon the root of an erupted tooth, likely a result of trapped enamel epithelium during development. The extraosseous or peripheral type of AOT occurs on the gingival tissues; it is rarely detected radiographically but may develop slight erosion of the underlying al-veolar bony cortex. This type is often clinically diagnosed as a gingival fibroma.Adenomatoidodontogenictumors may appear completely ra-diolucent, however in some cases; smallfinecalcificationsarepresentand may be helpful in differentiating themfromadentigerouscyst(3-6).

Histologically, the AOT is a well definedlesion,whichisusuallysur-roundedbyathickfibrouscapsule.The lesion itself has very distinctive features; however it may demon-strate proliferation into the lumen mimicking a solid tumor or show varying degrees of cystic change (1-3).Thetumorconsistsofsheets,strands, or whorled masses of spin-dle-shapedcellsinascantfibrousstroma(1-3).Thesecellsarepositiveforcytokeratyns(7).Thecellsmayform rosette-like structures about a central space which may or may not contain an eosinophilic material. This material stains positive for amyloid. The characteristic duct-like struc-tures in the AOT may be prominent, scant or even absent. These struc-tures consist of a central “lumen” surrounded by a layer of columnar or cuboidal epithelial cells. The nuclei of these cells are polarized away from the center. These structures are not true ductal elements. Small calcifiedfocicanbeseenthrough-out the tumor and it is believed to represent abortive enamel formation. Large areas of a pink matrix material has also been reported to occur in AOT and may represent dentinoid or cementum. The number, size, and


degreeofcalcificationsinthistumordetermines how the lesion presents radiographically(1-7).

Awelldefinedradiolucentlesionsur-rounding an impacted tooth is highly suggestive of an odontogenic cyst or neoplasm. The clinical and radio-graphic presentation of this patient favored various developmental and neoplasticconditionsoversomekindofinflammatoryprocess(2,3,6).Thefirstconsiderationwasadentigerouscyst, it is the most common develop-mental odontogenic cyst and it arises in association with an impacted tooth. The dentigerous cyst is usually detected on a routine radiographic examination and presents as a well definedunilocularradiolucency.Anodontogenickeratocyst(OKC)canbe radiographically identical to a dentigerous cyst. Aspiration of an OKCmaybecreamy,thick,orkera-tinatious, however in this case there was serosanguinous, straw-colored fluiduponaspiration(3).

Another consideration was unicystic ameloblastoma. The radiographic features, age of the patient and site of the lesion were supportive of this diagnosis.Ameloblasticfibroma,abenign odontogenic tumor which occurs mostly in the posterior mandible of young patients as a unilocular radiolucency associated with an impacted tooth, also had to be considered. Finally, the adeno-matoid odontogenic tumor typically affects teenagers, presents as an asymptomaticwelldefinedunilocularradiolucency involving the crown of an unerupted tooth, and sometimes extends apically along the root, past

the cementoenamel junction. This characteristic may help differentiate this lesion from a dentigerous cyst. TheAOTismorelikelytooccurinthe anterior maxilla, different from this case which is located in the posteriormandible(2,3).

The treatment of choice is conserva-tivesurgicalenucleation.Thethickcapsule usually surrounding this tumormakesenucleationfavorableto remove the lesion in its entirety. Aggressive behavior has not been reported, however large tumors have had more aggressive approaches to treatment such as large resections with iliac bone grafts. No recurrenc-es of AOT have been reported and therefore the prognosis is excellent. In our case the inferior border was intact but compromised and ad-ditional support was achieved via a lingual splint wired to the mandibular dentition. The patient is an other-wisehealthyteenagerandwilllikelyhave spontaneous bone growth in the defect, therefore grafting proce-dures were deferred. The patient is healing without incident for a follow-upperiodof6months(1-3,6).

References

1. ORAL PATHOLOGY: Clinical Pathologic Correlations. Regezi JA, Sciubba JJ, Jordan RC. 4th Edition. Saunders 2003.

2. Oral and Maxillofacial PATHOL-OGY. Neville BW, Damm DD, Allen CM, Bouquot JE. Third Edition. Saunders Elsevier 2009.

3. Litonjua LA, Aguirre A, Estrada MC. Radiolucency in the man-dible. Oral Surg Oral Med Oral

Pathol Oral Radiol Endod 2004; 98: 511-515.

4. Philipsen HP, Reichart PA, ZhangKH,NikaiH,YuQX.Ad-enomatoid odontogenic tumor: biologicprofilebasedon499cases. J Oral Pathol Med 1991; 20: 149-58

5. Swasdison S, Dhanuthai K, JainkittivongA,PhilipsenHPAd-enomatoid odontogenic tumors: an analysis of 67 cases in a Thai population. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008; 105: 210-215.

6. Philipsen HP, Reichart PA, Ad-enomatoid odontogenic tumor: factsandfigures.OralOncol1999; 35: 125-31

7. Martinez A, Mosqueda-Taylor A, Marchesani F, Brethauer U, Spencer ML Adenomatoid odon-togenic tumor concomitant with cystic complex odontoma: Case report. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009; 108: e25-e29.


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L. Norton Hindley III, A.S.A.L. Norton Hindley III, A.S.A.

Creating “treatment plans” for practice transitions treatment plans” for practice transitions for more than 23 years…for more than 23 years…

SPDDSSPDDSSPDDSSPDDSSPDDSSPDDSSPDDSSPDDSSPDDSSPDDSSPDDSSPDDSSPDDSSPDDSSPDDSSPDDSSPDDSSPDDSSPDDSSPDDSSPDDSSPDDSSPDDSSPDDSSPDDSSPDDSSPDDSSPDDSSPDDSEmployees Bene�t TrustEmployees Bene�t TrustEmployees Bene�t TrustEmployees Bene�t TrustEmployees Bene�t TrustEmployees Bene�t TrustEmployees Bene�t TrustEmployees Bene�t TrustEmployees Bene�t TrustEmployees Bene�t TrustEmployees Bene�t TrustEmployees Bene�t TrustEmployees Bene�t TrustEmployees Bene�t TrustEmployees Bene�t TrustEmployees Bene�t TrustEmployees Bene�t TrustEmployees Bene�t TrustEmployees Bene�t TrustEmployees Bene�t TrustEmployees Bene�t TrustEmployees Bene�t TrustEmployees Bene�t TrustEmployees Bene�t TrustEmployees Bene�t TrustEmployees Bene�t Trust

Group Health Care PlansDesigned for Dental Offices

Health Care Coverage is our business ... we’ve been Health Care Coverage is our business ... we’ve been Health Care Coverage is our business ... we’ve been Health Care Coverage is our business ... we’ve been Health Care Coverage is our business ... we’ve been Health Care Coverage is our business ... we’ve been Health Care Coverage is our business ... we’ve been Health Care Coverage is our business ... we’ve been Health Care Coverage is our business ... we’ve been Health Care Coverage is our business ... we’ve been Health Care Coverage is our business ... we’ve been Health Care Coverage is our business ... we’ve been Health Care Coverage is our business ... we’ve been Health Care Coverage is our business ... we’ve been Health Care Coverage is our business ... we’ve been Health Care Coverage is our business ... we’ve been Health Care Coverage is our business ... we’ve been Health Care Coverage is our business ... we’ve been Health Care Coverage is our business ... we’ve been Health Care Coverage is our business ... we’ve been Health Care Coverage is our business ... we’ve been Health Care Coverage is our business ... we’ve been Health Care Coverage is our business ... we’ve been Health Care Coverage is our business ... we’ve been Health Care Coverage is our business ... we’ve been Health Care Coverage is our business ... we’ve been Health Care Coverage is our business ... we’ve been Health Care Coverage is our business ... we’ve been Health Care Coverage is our business ... we’ve been Health Care Coverage is our business ... we’ve been Health Care Coverage is our business ... we’ve been Health Care Coverage is our business ... we’ve been Health Care Coverage is our business ... we’ve been Health Care Coverage is our business ... we’ve been Health Care Coverage is our business ... we’ve been Health Care Coverage is our business ... we’ve been Health Care Coverage is our business ... we’ve been Health Care Coverage is our business ... we’ve been Health Care Coverage is our business ... we’ve been Health Care Coverage is our business ... we’ve been Health Care Coverage is our business ... we’ve been Health Care Coverage is our business ... we’ve been Health Care Coverage is our business ... we’ve been Health Care Coverage is our business ... we’ve been Health Care Coverage is our business ... we’ve been Health Care Coverage is our business ... we’ve been Health Care Coverage is our business ... we’ve been Health Care Coverage is our business ... we’ve been Health Care Coverage is our business ... we’ve been Health Care Coverage is our business ... we’ve been Health Care Coverage is our business ... we’ve been Health Care Coverage is our business ... we’ve been Health Care Coverage is our business ... we’ve been Health Care Coverage is our business ... we’ve been Health Care Coverage is our business ... we’ve been Health Care Coverage is our business ... we’ve been Health Care Coverage is our business ... we’ve been Health Care Coverage is our business ... we’ve been Health Care Coverage is our business ... we’ve been Health Care Coverage is our business ... we’ve been Health Care Coverage is our business ... we’ve been Health Care Coverage is our business ... we’ve been Health Care Coverage is our business ... we’ve been Health Care Coverage is our business ... we’ve been Health Care Coverage is our business ... we’ve been Health Care Coverage is our business ... we’ve been Health Care Coverage is our business ... we’ve been Health Care Coverage is our business ... we’ve been Health Care Coverage is our business ... we’ve been Health Care Coverage is our business ... we’ve been Health Care Coverage is our business ... we’ve been Health Care Coverage is our business ... we’ve been Health Care Coverage is our business ... we’ve been Health Care Coverage is our business ... we’ve been Health Care Coverage is our business ... we’ve been providing it exclusively to the dental industry since 1996!providing it exclusively to the dental industry since 1996!providing it exclusively to the dental industry since 1996!providing it exclusively to the dental industry since 1996!providing it exclusively to the dental industry since 1996!providing it exclusively to the dental industry since 1996!providing it exclusively to the dental industry since 1996!providing it exclusively to the dental industry since 1996!providing it exclusively to the dental industry since 1996!providing it exclusively to the dental industry since 1996!providing it exclusively to the dental industry since 1996!providing it exclusively to the dental industry since 1996!providing it exclusively to the dental industry since 1996!providing it exclusively to the dental industry since 1996!providing it exclusively to the dental industry since 1996!providing it exclusively to the dental industry since 1996!providing it exclusively to the dental industry since 1996!providing it exclusively to the dental industry since 1996!providing it exclusively to the dental industry since 1996!providing it exclusively to the dental industry since 1996!providing it exclusively to the dental industry since 1996!providing it exclusively to the dental industry since 1996!providing it exclusively to the dental industry since 1996!providing it exclusively to the dental industry since 1996!providing it exclusively to the dental industry since 1996!providing it exclusively to the dental industry since 1996!providing it exclusively to the dental industry since 1996!providing it exclusively to the dental industry since 1996!providing it exclusively to the dental industry since 1996!providing it exclusively to the dental industry since 1996!providing it exclusively to the dental industry since 1996!providing it exclusively to the dental industry since 1996!providing it exclusively to the dental industry since 1996!providing it exclusively to the dental industry since 1996!providing it exclusively to the dental industry since 1996!providing it exclusively to the dental industry since 1996!providing it exclusively to the dental industry since 1996!providing it exclusively to the dental industry since 1996!providing it exclusively to the dental industry since 1996!providing it exclusively to the dental industry since 1996!providing it exclusively to the dental industry since 1996!providing it exclusively to the dental industry since 1996!providing it exclusively to the dental industry since 1996!providing it exclusively to the dental industry since 1996!providing it exclusively to the dental industry since 1996!providing it exclusively to the dental industry since 1996!providing it exclusively to the dental industry since 1996!providing it exclusively to the dental industry since 1996!providing it exclusively to the dental industry since 1996!providing it exclusively to the dental industry since 1996!providing it exclusively to the dental industry since 1996!providing it exclusively to the dental industry since 1996!providing it exclusively to the dental industry since 1996!providing it exclusively to the dental industry since 1996!providing it exclusively to the dental industry since 1996!providing it exclusively to the dental industry since 1996!providing it exclusively to the dental industry since 1996!providing it exclusively to the dental industry since 1996!

Three distinct plans now available:Three distinct plans now available:Three distinct plans now available:Three distinct plans now available:Three distinct plans now available:Three distinct plans now available:Three distinct plans now available:Three distinct plans now available:Three distinct plans now available:Three distinct plans now available:Three distinct plans now available:Three distinct plans now available:Three distinct plans now available:Three distinct plans now available:Three distinct plans now available:Three distinct plans now available:Three distinct plans now available:Three distinct plans now available:Three distinct plans now available:Three distinct plans now available:Three distinct plans now available:Three distinct plans now available:Three distinct plans now available:Three distinct plans now available:Three distinct plans now available:Three distinct plans now available:Three distinct plans now available:Three distinct plans now available:Three distinct plans now available:Three distinct plans now available:Three distinct plans now available:Three distinct plans now available:Three distinct plans now available:Three distinct plans now available:Three distinct plans now available:Three distinct plans now available:Three distinct plans now available:Three distinct plans now available:Three distinct plans now available:Three distinct plans now available:Three distinct plans now available:Three distinct plans now available:Three distinct plans now available:Three distinct plans now available:Three distinct plans now available:Three distinct plans now available:Three distinct plans now available:Three distinct plans now available:Three distinct plans now available:Three distinct plans now available:Three distinct plans now available:Three distinct plans now available:Three distinct plans now available:Three distinct plans now available:

HSA High DeductibleHealth Plan

PPO PlanFreedom Plan

• Multiple deductibles available for all plans• Multiple deductibles available for all plans• Multiple deductibles available for all plans• Multiple deductibles available for all plans• Multiple deductibles available for all plans• Multiple deductibles available for all plans• Multiple deductibles available for all plans• Multiple deductibles available for all plans• Multiple deductibles available for all plans• Multiple deductibles available for all plans• Multiple deductibles available for all plans• Multiple deductibles available for all plans• Multiple deductibles available for all plans• Multiple deductibles available for all plans• Multiple deductibles available for all plans• Multiple deductibles available for all plans• Multiple deductibles available for all plans• Multiple deductibles available for all plans• Multiple deductibles available for all plans• Multiple deductibles available for all plans• Multiple deductibles available for all plans• Multiple deductibles available for all plans• Multiple deductibles available for all plans• Multiple deductibles available for all plans• Multiple deductibles available for all plans• Multiple deductibles available for all plans• Multiple deductibles available for all plans• Multiple deductibles available for all plans• Multiple deductibles available for all plans• Multiple deductibles available for all plans• Multiple deductibles available for all plans• Multiple deductibles available for all plans• Multiple deductibles available for all plans• Multiple deductibles available for all plans• Multiple deductibles available for all plans• Multiple deductibles available for all plans• Multiple deductibles available for all plans• Multiple deductibles available for all plans• Multiple deductibles available for all plans• Multiple deductibles available for all plans• May choose different plans and deductibles within the dental office• May choose different plans and deductibles within the dental office• May choose different plans and deductibles within the dental office• May choose different plans and deductibles within the dental office• May choose different plans and deductibles within the dental office• May choose different plans and deductibles within the dental office• May choose different plans and deductibles within the dental office• May choose different plans and deductibles within the dental office• May choose different plans and deductibles within the dental office• May choose different plans and deductibles within the dental office• May choose different plans and deductibles within the dental office• May choose different plans and deductibles within the dental office• May choose different plans and deductibles within the dental office• May choose different plans and deductibles within the dental office• May choose different plans and deductibles within the dental office• May choose different plans and deductibles within the dental office• May choose different plans and deductibles within the dental office• May choose different plans and deductibles within the dental office• May choose different plans and deductibles within the dental office• May choose different plans and deductibles within the dental office• May choose different plans and deductibles within the dental office• May choose different plans and deductibles within the dental office• May choose different plans and deductibles within the dental office• May choose different plans and deductibles within the dental office• May choose different plans and deductibles within the dental office• May choose different plans and deductibles within the dental office• May choose different plans and deductibles within the dental office• May choose different plans and deductibles within the dental office• May choose different plans and deductibles within the dental office• May choose different plans and deductibles within the dental office• May choose different plans and deductibles within the dental office• May choose different plans and deductibles within the dental office• May choose different plans and deductibles within the dental office• May choose different plans and deductibles within the dental office• May choose different plans and deductibles within the dental office• May choose different plans and deductibles within the dental office• May choose different plans and deductibles within the dental office• May choose different plans and deductibles within the dental office• May choose different plans and deductibles within the dental office• May choose different plans and deductibles within the dental office• May choose different plans and deductibles within the dental office• May choose different plans and deductibles within the dental office• May choose different plans and deductibles within the dental office• May choose different plans and deductibles within the dental office• May choose different plans and deductibles within the dental office• May choose different plans and deductibles within the dental office• May choose different plans and deductibles within the dental office• May choose different plans and deductibles within the dental office• May choose different plans and deductibles within the dental office• May choose different plans and deductibles within the dental office• May choose different plans and deductibles within the dental office• May choose different plans and deductibles within the dental office• May choose different plans and deductibles within the dental office• May choose different plans and deductibles within the dental office• May choose different plans and deductibles within the dental office• May choose different plans and deductibles within the dental office• May choose different plans and deductibles within the dental office• May choose different plans and deductibles within the dental office• May choose different plans and deductibles within the dental office• May choose different plans and deductibles within the dental office• May choose different plans and deductibles within the dental office• May choose different plans and deductibles within the dental office• May choose different plans and deductibles within the dental office• May choose different plans and deductibles within the dental office

• Employer determines the amount of employee contribution and w• Employer determines the amount of employee contribution and w• Employer determines the amount of employee contribution and w• Employer determines the amount of employee contribution and w• Employer determines the amount of employee contribution and w• Employer determines the amount of employee contribution and w• Employer determines the amount of employee contribution and w• Employer determines the amount of employee contribution and w• Employer determines the amount of employee contribution and w• Employer determines the amount of employee contribution and w• Employer determines the amount of employee contribution and w• Employer determines the amount of employee contribution and w• Employer determines the amount of employee contribution and w• Employer determines the amount of employee contribution and w• Employer determines the amount of employee contribution and w• Employer determines the amount of employee contribution and w• Employer determines the amount of employee contribution and w• Employer determines the amount of employee contribution and w• Employer determines the amount of employee contribution and w• Employer determines the amount of employee contribution and w• Employer determines the amount of employee contribution and w• Employer determines the amount of employee contribution and w• Employer determines the amount of employee contribution and w• Employer determines the amount of employee contribution and w• Employer determines the amount of employee contribution and w• Employer determines the amount of employee contribution and w• Employer determines the amount of employee contribution and w• Employer determines the amount of employee contribution and w• Employer determines the amount of employee contribution and w• Employer determines the amount of employee contribution and w• Employer determines the amount of employee contribution and w• Employer determines the amount of employee contribution and w• Employer determines the amount of employee contribution and w• Employer determines the amount of employee contribution and w• Employer determines the amount of employee contribution and w• Employer determines the amount of employee contribution and w• Employer determines the amount of employee contribution and w• Employer determines the amount of employee contribution and w• Employer determines the amount of employee contribution and w• Employer determines the amount of employee contribution and w• Employer determines the amount of employee contribution and w• Employer determines the amount of employee contribution and w• Employer determines the amount of employee contribution and w• Employer determines the amount of employee contribution and w• Employer determines the amount of employee contribution and w• Employer determines the amount of employee contribution and w• Employer determines the amount of employee contribution and w• Employer determines the amount of employee contribution and w• Employer determines the amount of employee contribution and w• Employer determines the amount of employee contribution and w• Employer determines the amount of employee contribution and w• Employer determines the amount of employee contribution and w• Employer determines the amount of employee contribution and w• Employer determines the amount of employee contribution and w• Employer determines the amount of employee contribution and w• Employer determines the amount of employee contribution and w• Employer determines the amount of employee contribution and w• Employer determines the amount of employee contribution and w• Employer determines the amount of employee contribution and w• Employer determines the amount of employee contribution and w• Employer determines the amount of employee contribution and w• Employer determines the amount of employee contribution and waiting periodsaiting periodsaiting periodsaiting periodsaiting periodsaiting periodsaiting periodsaiting periodsaiting periodsaiting periodsaiting periodsaiting periodsaiting periodsaiting periods

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SPPDS Employee Benefit Trust is a Texas licensed, multiple employer welfare arrangement, governed by ERISA,providing self-funded health coverage for dentists, their employees, and dependents. AD-9


Alexander, Kenneth VaughnVidor, Texas

August 27, 1939 – December 23, 2010Good Fellow, 1991 • Life, 2004 Crabtree, Leonard Eugene

Houston, TexasMarch 16, 1934 – January 4, 2011

Good Fellow, 1989 • Life, 2000 Inman, Thomas Carroll

Houston, TexasOctober 31, 1931 – December 25, 2010

Good Fellow, 1985 • Life, 1997 • Fifty Year, 2010 Richardson, James Matthew

Hallsville, TexasJune 6, 1945 – January 2, 2011

Good Fellow, 1998 • Life, 2010

In MemoriamThose in the dental community who

have recently passed

In Memory of:

Memorial andHonorarium Donors

to the Texas Dental Association Smiles Foundation

Your memorial contribution supports:• educating the public and profession about oral health; and• improving access to dental care for the people of Texas.

Please make your check payable to:

TDA Smiles Foundation, 1946 S IH 35, Austin, TX 78704

Margie SpringfieldBy Dr. & Mrs. Russell &

Paula Owens

Kenneth Naylor, Sr.By Dr. Charles Robertson

Shigemi Glenn SenoBy Charles Robertson

Eleanor BlaschkeBy Beverly Zinser

Sylvia LankfordBy Beverly Zinser

Dr. Lewis GilcreaseBy Dr. Robert Tocker

Robert HuelskampBy Beverly Zinser

James HymanBy Beverly Zinser

Marie KingDrs. Jamie and Jennifer Bone

Mr. & Mrs. Noel BryantDrs. Jamie and Jennifer Bone

In Honor of:Dr. Dan MacauleyBy Bobby M. Boaz

Dr. & Mrs. Thomas RandersBy Dr. Barry Currey


value for your profession

Provided by TDA Perks Program

Critical Terms to Negotiate When Leasing Office Space

Evan Reynolds, The Reynolds Company

As a dental professional, you’ll probably lease office space atleast once during your career. The process can be daunting, as you’re introduced to a number of new con-cepts and terms. Obviously, there are legal and real estate experts that can assist you in the process however it’s extremely beneficialif you also possess some basic knowledge. The following is a brief overview of the critical items that should be addressed in the leasing process.

It’s important to first establish how muchsquare footage you’ll be leasing, and exactly how it will be calculated. There’s a standard methodology for measuring space, and you’ll want to make sure that both parties are on the same page. You may also want to have a mechanism in the lease that allows for a re-measurement


once you occupy the space, to be certain you have an accurate number.

Assuming your lease space will require the construction of interior improvements, you’ll need to negotiate a period of time to complete these improvements without incurring rental cost. I recommend you get at least 120 days for interior construction before any rental payments are due. It will likely take you 75 to 100 days to complete construction.

The key related economic items to be negotiated include: the lease term, rental rate, and tenant-improvement allowance. The tenant-improve-ment allowance is the amount of money the landlord gives you to help construct your interior improvements. Each of these items affects the others in most negotiations. For example, the longer the lease term, the higher the tenant improvement allowance you can get. The longer the lease term, the lower the rental rent will be in most cases. The vast majority of dental leases are at least 7 years in length; most being 10 years.Leasingadentalofficeisanexpensive,long-term commitment and the terms negotiated need to be consistent with that fact, i.e. a longer lease term will provide more allowance money and greater cost certainty for a longer period. The obvious primary objective is to negotiate for the lowest rental rate and highest tenant improvement allowance. The overall economics of the transaction can also be enhanced by negotiating for free rent to start the lease term.

Anotherkeyeconomiciteminanofficeleaseisestab-lishing how the landlord will charge you for the cost of operating the building. You will pay your proportion-ate share of these costs in a building where there are multiple tenants. You will pay all of these costs in a building where you are the only tenant. There are somestandarddefinitionsforestablishinglegitimateoperating expenses that can be charged to a tenant. You will need to make sure that these items are well defined,aswellastheprocessforannualoperating-expense reconciliation.

Negotiating for renewal options beyond the original term is very important for a dental tenant because of the disruptions and expenses related to moving. You want make sure you have the option to stay for an extended period if you choose. It’s typical to negotiate the right to extend your lease for two or three 5-year periods after the initial term expires. I prefer that the

rent during these renewal terms be at market rates. Some would argue that it is better to pre-negotiate these rates far in advance to ensure there won’t be a significantincreaseatthetimeofrenewal.Inmyopin-ion, the market rate at the time of renewal is almost always lower than a rate that is pre-negotiated for far into the future. You will have to negotiate the market terms each time you renew the lease, but I believe that the savings will be well worth it.

You must also understand the existing condition of the space, including all mechanical, electrical, and plumbing systems.Adentalofficerequiresabove-standardelec-tricity and extensive plumbing. The landlord will often have little knowledge of these systems, so it’s important to have an experienced dental contractor tour the space to make sure there are no problems. Not having enough powerorplumbingcapacitycanbedisastrousifyoufindout after you have already signed your lease.

It is critical to negotiate for the right to assign or sub-lease your space, particularly in a situation where you sell your practice. It’s standard in most leases to allow you to sublease or assign the lease, but it also typical-ly mandates that you remain a guarantor on the lease if you sell your practice. You’ll want to make sure you’ll be relieved of the entire lease obligation once you sell your practice to another dentist.


Another critical item to negotiate is the right to be the exclusive provider of dental services in the real estate project. This is typically more important if you are in a retail project; not as much if you are in a multi-tenant officebuildingorprofessionalofficepark.Usually,you’ll want this exclusive to be as broad as possible, to eliminate the possibility of competitors leasing space in the same project. You’ll also want to make sure you understand any exclusives that may already be in place. For example, there may be an ortho-dontist in a project that has an exclusive to provide orthodontic services. This would obviously prevent a general dentist from doing the same if he or she were to lease space in the same project.

In almost all cases, the landlord will want you to personally guarantee the lease for the entire lease term. You want to try to limit the guarantee to only a few years, or possibly limit the guarantee to only the amount paid by the landlord for the tenant improve-ment allowance and leasing commissions.

Other items that need to be addressed include: park-ing, signage, and the non-disturbance agreement. You may want to negotiate for reserved parking in some cases, particularly in a busy retail project. It is important to get as much signage as you can get. This may include building, pylon, monument, and suite signage. You’ll want to try to get the landlord to agree to provide a non-disturbance agreement, which will ensure that your lease will not be affected, should the landlord default on its loan and the project enters foreclosure. Most landlords don’t want to provide this document for smaller tenants but it’s important to se-cure if you can, particularly given the number of fore-closures that occur in the current economic climate. Negotiatingadentalofficeleasecanbeanintimidat-ing process; however, with the help of experienced professionals and a basic understanding of the key lease concepts, you can secure a quality lease that will protect your interests for many years to come.

The author, Evan Reynolds, is president of TDA Perks Partner The Reynolds Company, a healthcare real estate services firm that specializes in helping Texas dental professionals with their office space needs. The company is headquartered in Dallas, and has offices in Austin and Houston. For more information regarding The Reynolds Company, visit thereynoldscompany.com, or call (972) 231-8900. For information regarding other TDA Perks Programs, visit tdaperks.com, or call (512) 443-3675.

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Sign up for our newsletter or ask for more information.

Catharine Quartapella Goodson DDS. UT Houston 1985General Dentist providing In-office Dental I.V. Moderate

Sedation Services for your patient.

In-office DentalI.V. Sedation Services for

your patient.Sedation customized to

your patientspsychological &

physical requirements

Travel to your practice alongwith all necessary

equipment and supplies.

(office) 281.332.6964(cell) 713.417.9924

Website:www.portableiv.com

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tsApril 201111 – 13The American Association of Public Health Dentistry will hold its National Oral Health Conference at the Hilton Pittsburgh in Pittsburgh, PA. For more information, please contact Ms. Pamela J. Tolson, CAE, 3085 Steven-sonDr.,Springfield,IL62703.Phone:(217)529-6941;FAX:(217)529-9120;E-mail:[email protected];Web: aaphd.org.

13 – 16The American Association of Endodontists will hold its annual session at the San Antonio Convention Center in San Antonio, TX. For more information, please contact Mr. James M. Drinan, AAE, 211 E. Chicago Ave., Ste. 1100,Chicago,IL60611-2616.Phone:(312)266-7255;FAX:(312)266-9867;E-mail:[email protected];Web: aae.org.

15 & 16TheTDASmilesFoundation(TDASF)willholdaTexasMissionofMercyeventinDallas,TX.Formoreinformation,pleasecontactTDASF,1946S.IH35,Ste.300,Austin,TX78704;Phone:(512)448-2441;Web: tdasf.org.

28 – 30The American Dental Society of Anesthesiology will hold its annual meeting at the Westin Keirland Resort & Spa in Scottsdale, AZ. For more information, please contact Ms. Barbra Josephson, ADSA, 211 E. Chicago Ave.,Ste.780,Chicago,IL60611.Phone:(312)664-8270;FAX:(312)642-9713;E-mail:[email protected]; Web: adsahome.org.

May 20115 – 8The Texas Dental Association will hold its 141st annual session, The TEXAS Meeting, at the Henry B. Gonza-lez Convention Center in San Antonio, TX. For more information, please contact TDA, 1946 S. IH 35, Ste.400,Austin,TX78704.Phone:(512)443-3675;FAX:(512)443-3031;Web:texasmeeting.com.

6TheTDASmilesFoundation(TDASF)willholditsHealthySmilesGolfClassicinSanAntonio,TX.Formoreinformation,pleasecontactTDASF,1946S.IH35,Ste.300,Austin,TX78704;Phone:(512)448-2441;Web: tdasf.org.

9 – 11The ADA will hold its Washington Leadership Conference in Washington, D.C. For more information, please contactMr.BrianSodergren,ADA,111114thSt.,NW,Ste.1100,Washington,DC20005.Phone:(202)789-5168;FAX:(202)789-2258;E-mail:[email protected];Web:ada.org.

17 – 21TheAmericanAcademyofCosmeticDentistrywillholditsannualscientificsessionattheHynesConventionCenter in Boston, MA. For more information, please contact Ms. Kelly Radcliff, AACD, 5401 World Dairy Dr., Madison,WI53718.Phone:(800)543-9220;FAX:(608)222-9540;E-mail:[email protected];Web: aacd.com.

26 – 29The American Academy of Pediatric Dentistry will hold its 64th annual session at the Marriott Marquis NewYorkinNewYork,NY.Formoreinformation,pleasecontactDr.JohnS.Rutkauskas,CAE,AAPD,211E.ChicagoAve.,Ste.1700,Chicago,IL60611-2663.Phone:(312)337-2169;FAX:(312)337-6329;E-mail:[email protected];Web:aapd.org.

June 201111TheTDASmilesFoundation(TDASF)willholdaSmilesonWheelsmissioninMineralWells,TX.Formoreinformation,pleasecontactTDASF,1946S.IH35,Ste.300,Austin,TX78704;Phone:(512)448-2441;Web: tdasf.org.

15 – 18The ADA will hold its 25th New Dentist Conference in Chicago, IL. For more information, please contact Mr. RonPolaniecki,ADA,211E.ChicagoAve.,Chicago,IL60611.Phone:(312)440-2599;FAX:(312)440-2883;E-mail:[email protected];Web:ada.org.


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tsThe Texas Dental Journal’s Calendar will include only meetings, symposia, etc., of statewide, national, and international interest to Texas dentists. Because of space limitations, individual

continuing education courses will not be listed. Readers are directed to the monthly advertisements of courses that appear elsewhere in the Journal.

17 – 18TheSouthwesternSocietyofOralMedicinewillholdits62ndannualmeeting,“Diabetes,InflammatoryPeri-odontal Disease and the Relationship to Systemic Health,” at the Marriott Plaza San Antonio Hotel in San Anto-nio, TX. For more information, please contact Dr. Ron Trowbridge, 2943 Thousand Oaks, Ste. 4, San Antonio, TX78247.Phone(210)653-7174;FAX(210)653-8204.

23 – 25TheADACouncilonAccess,PreventionandInterprofessionalRelations(CAPIR)willmeetinChicago,IL.Formore information, please contact Ms. Carrie Campbell, ADA, 211 E. Chicago Ave., Chicago, IL 60611. Phone: (312)440-2500;FAX:(312)440-7494;E-mail:[email protected];Web:ada.org.

July 201115-17ADPAC, the American Dental Political Action Committee, will meet. For more information, please contact Ms. CynthiaTaylor,ADA,111114thSt.,N.W.,Ste.1200,Washington,D.C.Phone:(202)789-5172;FAX:(202)898-2437; E-mail: [email protected].

28 – 31The Academy of General Dentistry will have its annual meeting and exhibition at the Ernest Morial Convention Center in New Orleans, LA. For more information, please contact Ms. Rebecca Murray, AGD, 211 E. Chicago Ave.,Ste.900,Chicago,IL60611.Phone:(312)440-3368;FAX:(312)440-0559;E-mail:[email protected];Web: agd.org.

28 – 30The International Association of Comprehensive Aesthetics will meet at the Manchester Grand Hyatt in San Diego, CA. For more information, please contact Ms. Mary Williams, IACA, 1401 Hillshire Dr., Ste. 200, LasVegas,NV89134.Phone:(888)NOW-IACA;FAX:(702)341-8510;E-mail:[email protected];Web: theiaca.com.

August 20115 & 6TheTDASmilesFoundation(TDASF)willholdaTexasMissionofMercyeventinTexarkana,TX.Formoreinformation,pleasecontactTDASF,1946S.IH35,Ste.300,Austin,TX78704;Phone:(512)448-2441;Web: tdasf.org.

18 & 19National Conference on Dentist Health and Wellness will be in Chicago, IL. For more information, please con-tactMs.MaryGilliam,ADA,211E.ChicagoAve.,Chicago,IL60611-2678.Phone:(312)440-2500.FAX:(312)440-7494; E-mail: [email protected]; Web: ada.org.

September 201112 – 17The American Association of Oral and Maxillofacial Surgeons will meet at the Pennsylvania Convention Center in Philadelphia, PA. For more information, please contact Dr. Robert C. Rinaldi, AAOMS, 9700 W. Bryn Mawr, Rosemont,IL60018.Phone:(847)678-6200;FAX:(847)678-6286;Web:aaoms.org.

14 – 17The FDI Annual World Dental Congress will meet at the Banamex Convention & Exhibition Centre in Mexico City, Mexico. For more information, please contact Mr. John Hern, FDI/USA Section, ADA, 211 E. Chicago Ave.,Chicago,IL60611;Phone:(800)621-8099ext.2727;FAX:(312)440-2707;E-mail:[email protected].

22 – 27The ADA Kellogg Executive Management Program will be in Chicago, IL. For more information, please contact Mr.RonPolaniecki,ADA,211E.ChicagoAve.,Chicago,IL60611;Phone:(312)440-2599;FAX:(312)440-2883; E-mail: [email protected]; Web: ada.org.


B r i e f s

IMPORTANT: Ad briefs must be in the TDA of-fice by the 20th of two months prior to the issue for processing. For example, for an ad brief to be included in the January issue, it must be received no later than November 20th. Remittance must accompany classified ads. Ads cannot be accepted by phone or fax. *

Advertising brief rates are as follows: 30 words or less — per insertion…$40. Addi-tional words 10¢ each.

The JOURNAL reserves the right to edit copy of classified advertise-ments.

Any dentist advertis-ing in the Texas Dental Journal must be a member of the American Dental Association.

All checks submitted by non-ADA members will be returned less a $20 handling fee.

* Advertisements must not quote revenues, gross or net incomes. Only generic language referencing income will be accepted. Ads must be typed.

Advertising

PRACTICE OPPORTUNITIES

MCLERRAN AND ASSOCIATES:

AUSTIN: Associate to purchase. High gross-ing, family practice located in retail center with seven operatories was recently re-modeled. Near major freeway. High growth area. Practice boasts solid, well-established patient base. ID #108.

AUSTIN: North, high grossing, five operato-ry practice in free-standing building. Plenty of room to expand. Fee-for-service patient base, good equipment. Owner wishes to sell and continue part-time as an associate. ID #115.

NEW! AUSTIN: Unique, quality fee-for-ser-vice practice in five operatory free-standing building. Grossed near seven figures, boasts quality staff and well-established patient base. ID #123.

NEW! AUSTIN: Newly built out, seven operatory (four equipped) practice in high growth, affluent area in northwest. Practice grossed mid-six figures on limited sched-ule in second year, is equipped and priced like a startup. Excellent opportunity with tremendous upside. ID #124.

NEW! AUSTIN: Two operatory practice in free-standing building grossing low six fig-ures on a part-time schedule. Practice and real estate available in transition. ID #125.

CORPUS CHRISTI: Doctor retiring, six op office with excellent visibility and access. Good numbers, excellent patient base, good upside potential. Excellent practice for starting doctor. Priced to sell. ID #023.

CORPUS CHRISTI: Three operatory, fee-for-service/crown and bridge oriented family practice in great location. High grossing practice on 3-day week! Doctor ready to retire. Make an offer. ID #098.

RIO GRANDE VALLEY: Excellent four opera-tory, 20-year-old general practice. Modern, new finish out in retail location with digital

radiography. Fee-for-service patient base and very good new patient count. Great numbers. Super upside potential. ID #093.

SAN ANTONIO: Prosthodontic practice with almost new equipment and build out. Doc-tor wants to sell and continue to work as associate. Beautiful office! Perfect for stand alone or satellite office. ID #060.

SAN ANTONIO, NORTH CENTRAL: Two-op practice just off major freeway; perfect starter office. Terrific pricing. ID #009.

SAN ANTONIO: Four operatory general family practice located in professional office building off of busy thoroughfare in affluent north central side of town. Very nice equip-ment and decor. Excellent opportunity. ID #003.

SAN ANTONIO: Well-established, endodon-tic specialty practice with solid referral base. Located in growing, upper middle income area. Contact for more information. ID #074.

SAN ANTONIO: Oral surgery specialty practice. Very good referral base. Almost new build out, great location, and excellent equipment. Good gross and net. Transition available. ID #113.

SAN ANTONIO, NORTH CENTRAL: Six operatory general practice located in high growth area- All operatories have large win-dows with great views. Very nice equipment, solid patient base, great hygiene program. Priced to sell. ID #112.

SAN ANTONIO, NORTH CENTRAL:Three operatory office in retail/office center with great visibility and access. New equip-ment and nice build out. Good solid num-bers, very low overhead. ID #111.

SAN ANTONIO: Six operatory practice with three chair ortho bay located in 3,400 sq. ft. building. Modern office with newer equipment. Free-standing building on busy thoroughfare. Practice has grossed in seven figures for last 3 years. Great location with super upside potential. ID #055.


SAN ANTONIO, NORTH CENTRAL: Five operatory, state-of-the-art facility with new equipment. Located in a medical professional building in high growth, affluent area. Gross-ing seven figures with high net income. ID #106.

SAN ANTONIO NORTH WEST: Excellent, four-chair general family practice in high traffic retail center across from busy mall location. Solid gross income on 30 hours/week. Ideal opportunity for doctor wanting a quick start in low overhead operation. ID #086.

SAN ANTONIO, SOUTHEAST: Three opera-tory, 30-year-old practice in high traffic retail center, good equipment, solid patient base, low overhead. Perfect location for a satellite office or high gross Medicaid office. ID #121.

NEW! SAN ANTONIO, SOUTHEAST: Three operatory satellite office located in highly vis-ible retail center. Excellent location. Practice has tremendous upside potential. ID #121.

NEW! WEST OF SAN ANTONIO: Doctor retir-ing. Four operatories in modern, open, free-standing building. Excellent fee-for-service patient base. Newer equipment. Very nice decor. Very nice numbers with low overhead. Low competition in mid-sized city. ID #122.

SEGUIN: Three operatory, 30+-year-old prac-tice with condo is priced very aggressively as doctor must sell. Call now to learn more about this great deal. ID #118.

SOUTH TEXAS BORDER: General practitio-ner with 100 percent ortho practice. Very high numbers, incredible net. ID #021.

WACO AREA: Modern and high-tech, three op general family practice grossing in mid-six figures with high net income. Large, loyal pa-tient base. Office is well equipped for doctor seeking a modern office. ID #107.

Contact McLerran Practice Transitions, Inc.: statewide, Paul McLerran, DDS, (210) 737-0100 or (888) 656-0290; in Austin, David McLerran, (512) 750-6778; in Houston, Tom

Guglielmo and Patrick Johnston, (281) 362-1707. Practice sales, appraisals, buy-er representation, and lease negotiations. See www.dental-sales.com for pictures and more complete information.

GARY CLINTON / PMA WEST OF FORT WORTH PRACTICE FOR SALE: A little more than an hour west of Fort Worth, this is an excellent high six-figure gross-ing practice with high operating profits. Excellent recall; six operatories;fee-for-service; no DMO or low fee PPO. We have the best source for 100 percent buyer funding. Gary Clinton is a senior member of the Institute of Business Ap-praisers, Inc. “For over 37 years, you’ve seen the name ... a name you can trust.” I personally handle every appraisal/tran-sition/sale. No real estate commission. Every call is very confidential. General and specialty practice certified apprais-als. DFW: (214) 503-9696; WATS: (800) 583-7765.

GARY CLINTON / PMA NORTHWEST OF DALLAS CARROLLTON AREA PRAC-TICE FOR SALE: Well-established prac-tice; exceptional recall; full general service practice with lots of crown and bridge. Retiring dentist. Will continue to work as needed 1 day per week. We have the best source for 100 percent buyer funding. Gary Clinton is a senior member of the Institute of Business Appraisers, Inc. “For over 37 years, you’ve seen the name ... a name you can trust.” I personally handle every appraisal/transition/sale. No real estate commission. Every call is very con-fidential. General and specialty practice certified appraisals. DFW: (214) 503-9696; WATS: (800) 583-7765.

WE NEED SELLERS! Some areas reduced fees. No real estate commission. Gary Clinton / PMA. Serving the dental profes-sion since 1973: I have buyers! Sell your practice and travel while you have your health. In many cases, you can stay on to work 1-2 days per week if you wish. I need practices to sell/transition as follows: any practice in or near Austin, San Antonio,


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DFW and Houston areas, and other Texas locations. We have buyers for orthodon-tic, oral surgery, periodontic, pedodontic, and general dentistry practices. Values for practices have never been higher. Tax ad-vantages high for present time. One hun-dred percent funding available, even those valued at more than seven figures. Call me confidentially with any questions. We have the best source for 100 percent buyer funding. Gary Clinton is a senior member of the Institute of Business Appraisers, Inc. “For over 37 years, you’ve seen the name ... a name you can trust.” I personally handle every appraisal/transition/sale. No real estate commission. Every call is very confidential. General and specialty practice certified appraisals. DFW: (214) 503-9696; WATS: (800) 583-7765.

ORTHODONTIC PRACTICES FOR SALE / TRANSITION — GARY CLINTON / PMA TEXAS: O-1 West Central Texas mid-sized to larger community — Ideal transition;professional referral based; traditional fee-for-service, referral, highly productive. Gorgeous building with room for two in this planned 50/50 partnership; within 5 years complete buy-out with owner working 1-2 days as needed. O-2 South Texas — Retir-ing orthodontist. Initial associateship with high salary, transitional sale, or immediate buy-out; seller will stay 1-2 days per week as needed. Seven figure practice collections; 60 percent profits; lovely building. He is ready to spend time with his grandchildren. Easy drive to San Antonio. We have the best source for 100 percent buyer funding. Gary Clinton is a senior member of the Institute of Business Appraisers, Inc. “For over 37 years, you’ve seen the name ... a name you can trust.” I personally handle every appraisal/transition/sale. No real estate commission. Every call is very confidential. General and specialty practice certified appraisals. DFW: (214) 503-9696; WATS: (800) 583-7765.

GARY CLINTON / PMA ARLINGTON PRACTICE FOR SALE: The place to be for young families. Texas Rangers base-ball. Cowboys football, and Six Flags for entertainment. Well-established practice. Excellent recare program. Near seven figure gross, over 50 percent net. Garden style offices and operatories. We have the best source for 100 percent buyer funding. Gary Clinton is a senior member of the Institute

of Business Appraisers, Inc. “For over 37 years, you’ve seen the name ... a name you can trust.” I personally handle every appraisal/transition/sale. No real estate commission. Every call is very confidential. General and specialty practice certified ap-praisals. DFW: (214) 503-9696; WATS: (800) 583-7765.

GARY CLINTON / PMA FORT WORTH AREA GENERAL PRACTICES FOR SALE: Fl — Excellent patient base; well-estab-lished recall. Bread and butter practice. Very fast growing area near Texas Motor Speedway. Average gross with excellent net. F-2 — Primarily fee-for-service 30+-year-old practice in southwest Fort Worth/White Settlement/Lake Worth area. Asso-ciate buy-out or outright sale. Solid recall program. Above average gross. F-3 — Near Burleson. Excellent practice for sale We have the best source for 100 percent buyer funding. Gary Clinton is a senior member of the Institute of Business Appraisers, Inc. “For over 37 years, you’ve seen the name ... a name you can trust.” I personally handle every appraisal/transition/sale. No real estate commission. Every call is very confidential. General and specialty practice certified appraisals. DFW: (214) 503-9696; WATS: (800) 583-7765.

ORAL SURGERY PRACTICES FOR SALE. GARY CLINTON / PMA: OS-1 West Hous-ton / Sugar Land area — High growth area. State-of-the-art practice. Many referring doctors for cosmetic and implant, and re-constructive surgery. Outright sale. Seven-figure gross. Seller and family are relocat-ing out of state; will transition on a limited basis. OS-2 Southwest Houston — Retiring surgeon. Bread and butter practice. Seven-figure gross on 4 days; will transition. We have the best source for 100 percent buyer funding. Gary Clinton is a senior member of the Institute of Business Appraisers, Inc. “For over 37 years, you’ve seen the name ... a name you can trust.” I personally handle every appraisal/transition/sale. No real estate commission. Every call is very confidential. General and specialty practice certified appraisals. DFW: (214) 503-9696; WATS: (800) 583-7765.

GARY CLINTON / PMA PLANO / FRISCO AREA: Future rapid growth area where people will want to live. Practice in the


middle of the high growth area. Projected seven-figure gross. Newly equipped, gor-geous office. We have the best source for 100 percent buyer funding. Gary Clinton is a senior member of the Institute of Busi-ness Appraisers, Inc. “For over 37 years, you’ve seen the name ... a name you can trust.” I personally handle every appraisal/transition/sale. No real estate commission. Every call is very confidential. General and specialty practice certified appraisals. DFW: (214) 503-9696; WATS: (800) 583-7765.

GARY CLINTON / PMA HOUSTON PRAC-TICES FOR SALE: H-l North Houston. Fast growing, most requested area; seven-figure gross, high net. Nine operatories, full recall. Very attractive large building. H-2 Well-es-tablished practice, retiring dentist. Excel-lent recall in southwest Houston area. H-3 Clear Lake area practice. Well-established. Average gross. We have the best source for 100 percent buyer funding. Gary Clinton is a senior member of the Institute of Busi-ness Appraisers, Inc. “For over 37 years, you’ve seen the name ... a name you can trust.” I personally handle every appraisal/transition/sale. No real estate commission. Every call is very confidential. General and specialty practice certified appraisals. DFW: (214) 503-9696; WATS: (800) 583-7765.

GARY CLINTON / PMA BRYAN / COL-LEGE STATION PRACTICE FOR SALE: Retiring dentist; excellent visible location ready to hand over the ball to a young motivated dentist. Will transition PRN. We have the best source for 100 percent buyer funding. Gary Clinton is a senior member of the Institute of Business Appraisers, Inc. “For over 37 years, you’ve seen the name ... a name you can trust.” I personally handle every appraisal/transition/sale. No real estate commission. Every call is very confidential. General and specialty practice certified appraisals. DFW: (214) 503-9696; WATS: (800) 583-7765.

GARY CLINTON / PMA WEST TEXAS AREA WELL-ESTABLISHED PRACTICES FOR SALE: W-1 North of Lubbock — Highly productive practice; large growing patient base. Doctor will work for purchaser as needed. Purchase building outright or lease/purchase. W-2 Abilene — Retiring dentist outright sale/PRN transition; great location south side of Abilene. W-3 San An-

gelo — Excellent well-established restorative practice. Very nice newer equipment. Den-tist relocation. Purchase building or lease/purchase. Transitional or outright sale. We have the best source for 100 percent buyer funding. Gary Clinton is a senior member of the Institute of Business Appraisers, Inc. “For over 37 years, you’ve seen the name ... a name you can trust.” I personally handle every appraisal/transition/sale. No real estate commission. Every call is very confidential. General and specialty practice certified appraisals. DFW: (214) 503-9696; WATS: (800) 583-7765.

GARY CLINTON / PMA AUSTIN PRAC-TICE FOR SALE: Excellent practice with gross over high six figures. Building may be purchased with practice or leased with later purchase options. We have the best source for 100 percent buyer funding. Gary Clinton is a senior member of the Institute of Busi-ness Appraisers, Inc. “For over 37 years, you’ve seen the name ... a name you can trust.” I personally handle every appraisal/transition/sale. No real estate commission. Every call is very confidential. General and specialty practice certified appraisals. DFW: (214) 503-9696; WATS: (800) 583-7765.

GARY CLINTON / PMA GARLAND PRAC-TICE FOR SALE: North Garland area. Doctor retiring for health reasons; 20+ year practice. Average gross. We have the best source for 100 percent buyer funding. Gary Clinton is a senior member of the Institute of Business Appraisers, Inc. “For over 37 years, you’ve seen the name ... a name you can trust.” I personally handle every appraisal/transition/sale. No real estate commission. Every call is very confidential. General and specialty practice certified ap-praisals. DFW: (214) 503-9696; WATS: (800) 583-7765.

DDR PRACTICE SALES — DUNN/ISEN-HART: SERVING TEXAS DENTISTS FOR OVER 40 YEARS. National direct (and fax): (800) 930-8017.

CORPUS CHRISTI: Laid back lifestyle with the benefits of the Gulf Coast. Lucrative revenues on 4 days per week. Denture focus could be expanded to a broader scope of restorative general treatment. In-house lab with experienced technician. Great location, great staff, and a great lifestyle. Motivated


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seller. High six-figure gross provides owner six-figure income. Dentists will work as as-sociate if desired. Call DDR Practice Sales at (800) 930-8017.

BRYAN/COLLEGE STATION AREA: Well-established practice serving rural commu-nity of 5,000 just 20 minutes from Col-lege Station. Providing seven-figure gross collections with substantial 40 percent net. High quality implant practice. Four fully equipped operatories, private office, two full-time hygienists and a great staff. Own-ership of free-standing 1,900 sq. ft. building is optional. Over 4,000 patient base with average age of 45. Call DDR Practice Sales at (800) 930-8017.

GALVESTON: Must sell for relocation. Thriving practice in Galveston providing the best of both worlds ... the great outdoors and a laid back lifestyle, yet quick access to metropolitan Houston. This 15-year practice has three fully equipped operato-ries, private office, full-time hygienist, and a great staff. Half interest in free-standing building included in price. Generating mid six-figure gross collections on only 3 days per week. Owner currently splits time with out-of-town practice. Call DDR. Practice Sales at (800) 930-8017.

AUSTIN: Five operatory, two hygienists, one associate dentist, gross of seven figures in 2010. Mature practice; doctor wants to sell practice but is also willing to work contact for buying dentist; great location in beauti-ful Austin. Practice in the heart of most de-sired city in Texas. Substantial net income with four fully equipped operatories and two full-time hygienists. Current associate will remain at buyer’s discretion. Call DDR Practice Sales at (800) 930-8017.

DALLAS: Practice in high-traffic profes-sional building, run very lean. Mid six-fig-ure net. Need to add patient charts to your practice? Call DDR Practice Sales at (800) 930-8017.

CORPUS CHRISTI: General dentistry prac-tice — location, location,, location; 25-year-old practice grossed more than seven fig-ures last year with a single dentist and one hygienist. Updated office, very profitable practice, excellent staff. Call DDR Practice Sales at (800) 930-8017.

HOUSTON: Motivated buyer seeking Gal-leria area practice. Willing to acquire office, staff, or charts only. Looking to expand his practice. Call DDR Practice Sales at (800) 930-8017.

SAN ANTONIO: Beautiful fast-growing area, exceptional practice with five operatories. Ten-year-old practice, doctor motivated to sell. Earns a seven-figure gross on 4-day week. Excellent opportunity for younger dentist to make his or her mark. Call DDR Practice Sales at (800) 930-8017.

GOLDEN TRIANGLE GENERAL DENTAL PRACTICE — SALE: Outstanding practice for sale developed by published mentor. Supported by outstanding staff and latest in dental equipment. Strong revenues and profit margin. Excellent new patient flow. Given high level of FFS revenues, doctor to transition to comfort level of purchaser. Come build your retirement in low com-petition community. Contact The Hindley Group at (800) 856-1955. Visit us at www.thehindleygroup.com.

SOUTH HOUSTON GENERAL DENTAL PRACTICE — SALE: Most attractive office located on busy thoroughfare in rapidly growing south Houston suburb. Six treat-ment rooms, five fully equipped. Two addi-tional plumbed operatories such that prac-tice has capacity to grow well in excess of seven figures. Contact The Hindley Group, LLC, at (800) 856-1955. Visit us at www.thehindleygroup.com.

NORTH TEXAS GENERAL DENTAL PRAC-TICE — SALE: Small, well-established practice in mid-sized community in north Texas. Three fully-equipped operatories. Experienced staff with excellent skills. Doc-tor will assist with transition. Contact The Hindley Group, LLC, at (800) 856-1955. Visit us at www.thehindleygroup.com.

CORPUS CHRISTI GENERAL DENTAL — SALE: Moderate revenues with a very healthy profit margin. Experienced and loyal staff. Totally digital and highly effi-cient facility layout. If you need to practice to refund your retirement, but don’t want to fight the competitiveness of the city, come see this practice. Contact The Hindley Group at (800) 856-1955. Visit us at www.thehindleygroup.com.


DFW METROPLEX ORAL SURGERY PRACTICE — SALE: Well-established practice enjoying 2009 revenues exceeding seven figures from two locations. Extensive referral base, experienced staff, and highly qualified mentor to assist in transition. Don’t miss this opportunity. Contact The Hindley Group at (800) 856-1955. Visit us at www.thehindleygroup.com.

NORTHWEST HOUSTON GENERAL DEN-TAL PRACTICE — SALE: New practice in growing area located near well-traveled Highway 290 and Jones Road. Two fully equipped treatment rooms with three oth-ers plumbed for expansion. Digital X-rays. Moderate revenues on 3.5 days per week. If you want to be in the rapidly growing NW quadrant, this practice is for you. Contact The Hindley Group at (800) 856-1955. Visit us at www.thehindleygroup.com.

SOUTH OF HOUSTON GENERAL DENTAL PRACTICE — SALE: Established practice in mid-size town generating revenues ap-proaching seven figures the last 3 years. Associate in place providing orthodontic treatment. Building is also for sale. Contact The Hindley Group at (800) 856-1955. Visit us at www.thehindleygroup.com.

WEST HOUSTON GENERAL DENTAL PRACTICE — SALE: Wonderful opportunity in rapidly growing community west of Hous-ton. Excellent revenues, steady new patient flow. Four operatories. Capable staff. Con-tact The Hindley Group at (800) 856-1955. Visit us at www.thehindleygroup.com.

LAS VEGAS ORAL SURGERY PRACTICE — SALE: Excellent practice with revenues of seven figures with net profit margin over 48 percent. Strong professional referral base and new patient flow. Latest in 3D digital projection including CT scanner. Highly skilled, experienced staff. Doctor will assist in transition. Contact The Hindley Group at (800) 856-1955. Visit us at www.thehindleygroup.com.

DALLAS / FORT WORTH: Area clinics seeking associates. Earn significantly above industry average income with paid health and malpractice insurance while working in a great environment. Fax (312) 944-9499 or e-mail [email protected].

WACO PEDIATRIC DENTAL PRACTICE — SALE: Well-established practice with moderate revenues and high profit margin on 4 days per week. Limited competition and a large facility. Ample room to grow in this community that is home to Baylor Uni-versity. This is a wonderful central Texas community in which to raise your family. All ortho cases are being completed, unless purchaser would like to expand new cases. No Medicaid being seen, but good opportu-nity with facility capacity. Experienced staff and steady new patient flow. Wonderful mentor. Building also available. Contact The Hindley Group at (800) 856-1955. Visit us at www.thehindleygroup.com.

BRYAN/COLLEGE STATION GENERAL DENTAL PRACTICE — SALE: Well-estab-lished practice in mid-size town. Four op-eratories. Healthy revenues, excellent profit margin, and strong new patient flow. Doctor must transition due to health reasons. Building also for sale. Contact The Hindley Group, LLC, at (800) 856-1955. Visit us at www.thehindleygroup.com.

EAST TEXAS GENERAL DENTAL PRAC-TICE — SALE: Well-established practice in small town in hills in East Texas. Moderate revenues on 4 days per week; three opera-tories; excellent staff. Room to expand in adjacent space. Contact The Hindley Group, LLC, at (800) 856-1955. Visit us at www.thehindleygroup.com.

FORT WORTH ORTHODONTIC PRACTICE — SALE: Excellent opportunity for satellite office; general dentist wanting to add ortho-dontics to services offered; female dentist desiring part-time position while children in school; or older dentist wanting to utilize orthodontics as less physically taxing exit strategy. Doctor will mentor or assist with transition. Contact The Hindley Group, LLC, at (800) 856-1955. Visit us at www.thehindleygroup.com.

WEST TEXAS GENERAL DENTAL PRAC-TICE — SALE: Spacious office with five fully-equipped operatories; two additional spaces plumbed for future use. Strong revenues and profit margin. Excellent new patient flow. Eight hygiene days per week. Contact The Hindley Group. LLC, at (800) 856-1955. Visit us at www.thehindleygroup.com.


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ARLINGTON ORAL SURGERY PRACTICE — SALE: Highly successful practice with strong revenue history of more than seven figures. Selling doctor cut production in half due to back injury but will assist purchaser in rebuilding practice. Extensive referral pattern. Building also for sale. Contact The Hindley Group, LLC, at (800) 856-1955. Visit us at www.thehindleygroup.com.

SOUTHEAST OF HOUSTON GENERAL DENTAL PRACTICE — SALE: Wonderful location on well-traveled street. Excellent revenues and profit margin. Four fully-equipped operatories. Contact The Hindley Group at (800) 856-1955. Visit us at www.thehindleygroup.com.

NORTH CENTRAL TEXAS GENERAL DEN-TAL PRACTICE — SALE: Wonderful op-portunity in small town that is 1 hour north of DFW Metroplex. Four operatories. Good new patient flow. Excellent staff. Building also for sale. The Hindley Group, LLC, (800) 856-1955. Visit us at www.thehindleygroup.com.

ASSOCIATESHIPS: EAST TEXAS GENER-AL DENTAL PRACTICE — Small but busy practice generating mid-range revenues on 4 days per week. Located in quaint small town with excellent access to forests and lakes for hunting, fishing, and boating. Excellent opportunity for dentists look-ing ahead to separation from the military. Pre-determined buy-in terms. SOUTH CENTRAL TEXAS PERIODONTAL —Won-derful practice completing periodontal treatment seeks long-term associate who desires to be a partner within 1-2 years. Great location with strong new patient flow. Pre-determined purchase and partnership terms. Wonderful mentor looking for an “equally-yoked” individual. Excellent staff. SAN ANTONIO PERIODONTIST AND ENDO-DONTIST ASSOCIATESHIPS — Periodontist associateship with pre-determined buy-in for very active, multi-office periodontal practice. Endodontist associate also needed in this practice. Outstanding mentor and cohesive staff. If you are “equally yoked” and the right person, this is an outstand-ing opportunity. WEST TEXAS GENERAL DENTAL PRACTICE — Associateship with pre-determined buy-in and partnership terms. Nine operatories. Strong mentor and experienced staff. Excellent revenues and

profit margin. Large Medicaid component. EAST TEXAS GENERAL DENTAL PRACTICE —Associateship for busy practice in large facility. Strong mentor. Excellent revenues and profit margin. Predetermined buy-in and partnership terms. EAST OF HOUS-TON GENERAL DENTAL PRACTICE Well-established practice in small town seeks associate desiring practice buy-in with pre-determined terms. Steady new patient flow a] strong revenues. Contact The Hindley Group, LLC at (800) 856-1955. Visit us at www.thehindleygroup.com.

HOUSTON AREA PRACTICE FOR SALE: Profitable practice for sale. Well-established. Call Jim Robertson at (713) 688-1749.

ADS WATSON, BROWN & ASSOCIATES: Excellent practice acquisition and merger opportunities available. DALLAS AREA — Six general dentistry practices available (Dallas, North Dallas, Highland Park, and Plano); five specialty practices available (two ortho, one perio, two pedo). FORT WORTH AREA — Two general dentistry practices (north Fort Worth and west of Fort Worth). CORPUS CHRISTI AREA — One general dentistry practice. CENTRAL TEXAS — Two general dentistry practices (north of Austin and Bryan/College Station). NORTH TEXAS —One orthodontic practice. HOUSTON AREA — Three general dentistry practices. EAST TEXAS AREA —Two general dentistry practices and one pedo practice. WEST TEXAS — Three general dentistry practices (El Paso and West Texas). NEW MEXICO —Two general dentistry practices (Sante Fe, Albuquerque). For more information and current listings, please visit our website at www.adstexas.com or call ADS Watson, Brown & Associates at (469) 222-3200.

FULLY EQUIPPED MODERN DENTAL OFFICE SPACE AVAILABLE FOR LEASE. Have four ops. Current doctor is only using 2 days a week. Great opportunity to start up new practice (i.e., endo, perio, oral sur-gery). Available days are Monday, Tuesday, Thursday per week. If you are wanting an associate, please inquire. Call (214) 315-4584 or e-mail [email protected].

TEXAS PANHANDLE: Well-established 100 percent fee-for-service dental practice for immediate transition or complete sale at below market price by retiring dentist.


Relaxed work schedule with community centrally located within 1 hour of three ma-jor cities. The office building can be leased or purchased separately and is spaciously designed with four operatories, doctors’ pri-vate office and separate office rental space. This is an excellent and profitable opportu-nity for a new dentist, a dentist desiring to own a practice, or a satellite practice expan-sion. Contact C. Vandiver at (713) 205-2005 or [email protected].

SUGAR CREEK / SUGAR LAND: General dentist looking for periodontist, endo, ortho specialist to lease or sell. Suite is 1,500 sq. ft. with four fully-equipped treatment rooms, lab, business office, telephone sys-tem, computers, reception and playroom; 5 days per week. If seriously interested, please call (281) 342-6565.

AUSTIN: Unique opportunity. Associateship and front-office position available for hus-band/wife team. Southwest Austin, Mon-day through Thursday. Option to purchase practice in the future. Send resume and questions to [email protected].

GALVESTON ISLAND: Unique opportunity to live and practice on the Texas Gulf coast. Well-established fee-for-service, 100 percent quality-oriented practice looking for a quali-ty oriented associate. Ideal for a new gradu-ate or for an experienced dentist wanting to relocate and become part of an established practice with a reputation for providing comprehensive, quality dental care with a personable approach. Practice references available from local specialists. Contact Dr. Richard Krumholz, (409) 762-4522.

ROUND ROCK GENERAL PRACTICE FOR SALE. High visibility location. I want to move to my satellite office full-time. Only one PPO (Delta). E-mail inquiries [email protected] or call (512) 965-6725.

HOUSTON: General dentist with pediatric experience needed. Full-time position avail-able. Excellent compensation. Please send CV to [email protected].

ASSOCIATE FOR TYLER GENERAL DEN-TISTRY PRACTICE: Well-established gen-eral dentist in Tyler with 30+ years experi-ence seeks a caring and motivated associate

for his busy practice. This practice provides exceptional dental care for the entire fam-ily. The professional staff allows a doctor to focus on the needs of their patients. Our office is located in beautiful East Texas and provides all phases of quality dentistry in a friendly and compassionate atmosphere. The practice offers a tremendous opportuni-ty to grow a solid foundation with-the doc-tor. The practice offers excellent production and earning potential with a possible future equity position available. Our knowledge-able staff will support and enhance your growth and earning potential while helping create a smooth transition. Interested can-didates should call (903) 509-0505 and/or send an e-mail to [email protected].

ASSOCIATE NEEDED FOR NURSING HOME DENTAL PRACTICE. This is a non-traditional practice dedicated to delivering care onsite to residents of long term care facilities. This practice is centered in Austin but visits homes in the central Texas area. Portable and mobile equipment and facilities are used, as well as some fixed office visits. Patient population presents unique techni-cal, medical, and behavioral challenges, seasoned dentist preferred. Buy-in potential high for the right individual. Please toward CV to e-mail: [email protected]; FAX (512) 238-9250; or call (512) 238-9250 for additional information.

PEDIATRIC DENTIST: Pediatric Dental Wellness is growing and needs a dynamic dentist to work full time in our pediatric practice. The perfect complement to our dedicated staff would be someone who is compassionate, goal oriented, and has a genuine love for working with children. If you are a motivated self-starter that is willing to give us a long-term commitment, please apply. Salary plus benefits. Looking to fill position immediately. Send resumes and cover letters to [email protected].

GREAT OPPORTUNITY FOR A PEDIAT-RIC DENTIST OR GP to join our expanding practice. We are opening a new practice in the country (Paris, Texas), just 1 hour past the Dallas suburbs and our original loca-tion. The need for a pediatric dentist out there is tremendous, and we are the only pediatric office for 70 miles in any direc-


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tion. We are looking for someone that is personable, caring, energetic, and loves a fast-paced working environment in a busy pediatric practice. We are willing to train the right individual if working with children is your ambition. This position is part-time initially, and after a short training period will lead to full-time. If you join our team, you will be mentored by a Board certified pediatric dentist and will develop experience in all facets of pediatric dentistry including behavior management using oral conscious sedation as well as IV sedation. For more information, please visit our websites at www.wyliechildrensdentistry.com and www.parischildrensdentistry.com. Please e-mail CV to [email protected].

ASSOCIATE SUGAR LAND AND CYPRESS: Large well-established practice with very strong revenues is seeking an associate. Must have at least 2 years experience and be motivated to learn and succeed. FFS and PPO practice that ranks as one of the top practices in the nation. Great mentor-ing opportunity. Possible equity position in the future. Base salary guarantee with high income potential. Two days initially going to 4 days in the near future. E-mail CV to Dr. Mike Kesner, [email protected].

SEEKING ASSOCIATE DENTISTS. Den-tal Republic is a well-established general dental practice with various successful locations throughout the Dallas Metroplex. A brand new state-of-the-art facility in a bustling location will be opening soon. Join our outstanding and professional team in creating beautiful healthy smiles for all. Let us give you the opportunity to enhance your professional career with excellent hours, competitive salary/benefits, and by forming long-lasting friendships with our patients and staff members. Please contact Phong at (214) 960-3535 or e-mail CV to [email protected].

CARE FOR KIDS, A PEDIATRIC FOCUSED PRACTICE, is opening new practices in the San Antonio and Houston area. We are look-ing for energetic full-time general dentists and pediatric dentists to join our team. We offer a comprehensive compensation and benefits package including medical, life, long- and short-term disability insurance, flexible spending, and 401(K) with employer contribution. New graduates and dentists

with experience are welcome. Be a part of our outstanding team, providing care for Texas’ kids. Please contact Anna Robinson at (913) 322-1447; e-mail: [email protected]; FAX: (913) 322-1459.

SAN ANGELO, ABILENE: Associates — outstanding earnings. Historically proven at over twice the national average for general dentists; future potential even greater. Thriv-ing, established practice in great location. Bright and spacious facility. Experienced, efficient, loyal staff. Best of all worlds; big city, earnings, small-town easy lifestyle, outstanding outdoor recreation. Contact Dr. John Goodman at [email protected] or (325) 277-7774.

ASSOCIATE DENTIST NEEDED IN EU-LESS: Well-established general practice seeking full-time associate/future partner. Cosmetic and full family practice. Please send resume to [email protected].

ESTABLISHED, SUCCESSFUL GENERAL PRACTICE AVAILABLE FOR OWNERSHIP with no personal financial investment. Niche market limited to removable prosthetics and related services. Guaranteed minimum sal-ary plus unlimited potential from net profits. Full benefits package. Onsite lab. Monday through Friday, 8 a.m. to 5 p.m. Profession-al gratification, personal rewards. E-mail [email protected].

GREAT OPPORTUNITY FOR ORTHODON-TISTS AND GENERAL DENTISTS to join our busy practices providing orthodontic care in the Rio Grande Valley area. We are looking for orthodontists to oversee all aspects of patient care and general dentists to work in coordination with our ortho-dontists to be able to provide the highest quality care for our patients. Be a part of our exceptional team helping the children of Texas get great smiles. Please contact Dr. Hal D. Lerman at (214) 789-4601 or e-mail to [email protected].

KATY: Dr. Bui X. Dinh, D.D.S., M.S. is looking for a dentist right now with mini-mum 2 years experience. Please contact office manager Michelle, (832) 620-6982 or fax resume to (281) 579-6045.


FOR SALE — GREAT 41-YEAR SUC-CESSFUL PRACTICE IN SOUTH CEN-TRAL TEXAS. Owner retiring but will stay through transition period. Five operatories in beautiful building, Pan-0, digital X-ray. Experienced long-term dependable staff. Room for multiple dentists. Please mail let-ter of interest to Box 1, TDA, 1946 S. IH 35, Ste. 400, Austin, TX 78704.

SEEKING ASSOCIATE: Established general dental office in Brownsville (30 minutes away from South Padre Island) is seeking a caring, energetic associate. We are a busy office providing dental care for mostly chil-dren. Our knowledgeable staff will support and enhance growth and earning potential allowing the associate to focus on patient dental care. Interested candidates should call (956) 546-8397.

NEW, TYLER: Excellent opportunity, loca-tion, and lifestyle. Join an established doc-tor and share a 2-year-old, free-standing, award-winning building on busy south Tyler Street. Five of 10 ops and private office available. Share reception, lab, and steriliza-tion. Equity position in property available or lease. E-mail [email protected].

TEMPLE DENTAL CENTER IN TEMPLE, TEXAS, IS FOR SALE: Doctor changing professions. Firesale! Four operatories, tons of equipment and instruments, three wall X-rays (film just needs sensors to convert), Panorex (also easily converted) Velopex pro-cessor. Call (254) 791-0977 and leave mes-sage. E-mail [email protected].

GREAT PRACTICE IN BEAUTIFUL EAST TEXAS. This fee-for-service practice was established by a prominent community-in-volved dentist with an excellent reputation for quality care. The office has 1,300 sq. ft. with four available treatment rooms and a large private office. Don’t miss the opportu-nity to become part of this stable economic town with an experienced staff and a grow-ing patient base. Interested? Call (972) 562-1072 or e-mail [email protected].

EXPERIENCED DENTISTS ARE NEEDED FOR TWO PRIVATE GROUP PRACTICES LOCATED IN KATY AND SPRING. General dentistry practice with a comfortable and friendly atmosphere without administrative responsibilities. Full- or part-time position

with competitive compensation, benefits, and flexible schedule. Great opportunity for a quality oriented person. Please call Dr. Akerman at (832) 934-2044 or e-mail [email protected].

TEXAS — PEDIATRIC DENTAL ASSO-CIATE NEEDED. Fast-growing pediatric dental practice is looking for a pediatric dentist to join our team. We are located north of San Antonio just 10 minutes from New Braunfels and 45 minutes from Austin. We offer a generous compensation pack-age including paid time off and holidays. Experience is a plus, but new graduates are welcome. Please respond via e-mail to Sherri at [email protected] or by fax (210) 659-9436.

ENDODONTIST NEEDED TO JOIN WITH HOUSTON PERIODONTIST. Full- or part-time. Brand new state-of-the-art office. As-sociateship with possible partnership. Ideal for primary or second office. Please initiate contact by fax to (713) 795-5514.

AMARILLO: SEEKING FULL-TIME DEN-TIST TO WORK IN STATE CORREC-TIONAL SETTING. We offer a flexible work schedule, excellent state benefits, retirement, and a very competitive salary without the financial challenges faced in private practice. Contact the dental director at (806) 381-7080 x 8301, e-mail at [email protected], or visit the job site at http://jobs.texastech.edu.

TEXAS — HOUSTON: A well-established pediatric dental practice is seeking a full-time pediatric dentist to join our dental staff. Centrally located near the Texas Medical Center, West University Place, Rice University, and The Galleria, the office is easily accessible off the Southwest Freeway. Our office’s neighbor is one of Texas Chil-dren’s Hospital’s largest outpatient medical groups with 12 pediatricians. Please send all inquiries either by fax (713) 522-1537 or e-mail [email protected].

MATURE GULF COAST PRACTICE. Still growing, upscale retirement community. Great visibility in retail strip center, great anchors. Three operatories, hygiene 3 days per week. Great numbers, small investment. Call for appointment, (361) 205-4582.


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EAST TEXAS GENERAL PRACTICE NEEDS ASSOCIATE TO TRANSITION TO OWNER/PARTNER, buyout to fit situation. Thirty-five-year-old practice in dynamic northeast Texas hub city, centrally located and easily accessible Dallas, Shreveport, and Arkansas. Great for fishing, hunting, and all outdoor activities. Practice is in a 2,300 sq. ft. office (owned) in a professional building across from the regional hospital. Four ops, two hygienists provide 6 hygiene days/week. Softdent and Kodak digital X-rays including Pano. Good patient base and excellent staff to stay. Doctor moving closer to grandkids. Call (903) 572-4141.

LONESTAR ON-SITE CARE is seeking a caring dentist to join our group practice. We currently have a PT (2-3 days) opportunity available in the Houston, Texas, area. We offer a competitive salary. Paid malpractice insurance, a flexible schedule (no week-ends), established patient base, equip-ment, supplies, and complete office support provided. If interested in this opportunity, please call Maria toll free at (877) 724-4410 or e-mail [email protected].

EXCITING OPPORTUNITY FOR TEXAS DENTISTS. We are seeking general den-tists for our future locations in Lubbock, Abilene, Midland, and Odessa. Full- or part-time available. Exceptional salary plus bonus. Health insurance available. This is an immediate opportunity to perform qual-ity dentistry with a helpful and energetic staff. Please e-mail your CV resume to [email protected] and join our team today.

NEW MEXICO MOUNTAIN RESORT OP-PORTUNITY. Tired of the fast pace? Join me and work 2-3 days/week. Great patient base with good attitudes because they love living in this beautiful place. Modern equipment/digital X-ray and Pano. Cool summers, mild winters, six golf courses, hunting, hiking, skiing, horse racing, arts, and culture theater. General or specialist. Must be dedicated to good patient care and have outgoing personality. Send resume to Dr. John Bennett at 200 Sudderth Dr. #C, Ruidoso, NM 88345; FAX: (575) 257-5170; or e-mail: [email protected].

OFFICE SPACE

SPACE AVAILABLE FOR SPECIALIST. New professional building located south-west of Fort Worth in Granbury between elementary and junior high schools off of a state highway with high visibility and traf-fic. Call (817) 326-4098.

ORTHODONTIST NEEDED NEXT TO DEN-TIST IN HIGH GROWTH, HIGH TRAFFIC AREA IN ROUND ROCK, north of Austin in one of the fastest-growing counties. Avail-able at $155/sq. ft. For more information, e-mail [email protected] or call (512) 457-8206.

SHERMAN — 1,750 SQ. FT. DENTAL OFFICE. Building has established general dentist and perio/implant dentist. Plumbed and ready to go. High traffic and visibility with lots of parking. Sherman is beautiful and growing town 50 miles north of Dallas and near Lake Texoma, the second largest lake in Texas. It has great schools, a vibrant arts community, and is home to many, many Fortune 500 companies such as Texas Instruments and Tyson Foods. Call (760) 436-0446.

ALLEN: Prior dental, high end practice that relocated. Five plumbed and ready ops, reception, office, conference, two bath, some built-in cabinets, no equipment. High traffic visibility with lots of parking. Affluent resi-dential, across the street from large grocer. Offering 5-7 years lease plus extensions. Levin Realty, (323) 954-1934, [email protected].

ROUND ROCK — DENTAL SPACE AVAIL-ABLE FOR LEASE: 323 Lake Creek, 2,032 sq. ft. Lease rate is $18 PSF + $6.50. PSF NNN. Existing air lines and plumbing. Call Darren Quick, (512) 255-3000.

ROUND ROCK — ORTHODONTIST SPACE FOR LEASE: On IH-35, between FM 620 and Hwy. 79. Call Darren Quick, (512) 255-3000.

INGLESIDE DENTAL BUILDING FOR SALE! 1,700 sq. ft., two chairs plumbed. Rental side, near Corpus Christi!. Busy main street location. Vacant, no equipment. Landscap-ing, parking, owner/dentist, $115,900. Great


opportunity! Photographs available. E-mail [email protected] or call (702) 480-2236.

ARLINGTON DENTAL OFFICE FOR LEASE: Current doctor is only using 1 day a week. Has four up-to-date operatories with HD TVs in each op, assistant com-puter, doctor computer, Casey educational system, digital X-rays, digital panoramic machine, electric handpiece, sterilization room, laboratory, and Cerec CAD/CAM technology. Perfect for new practice start up. Visit our website to view our office. Contact (817) 274-8667, [email protected], www.docdds.com.

THE BEST FACILITY IN TOWN CAN BE YOURS. We build free-standing dental of-fices throughout the state of Texas. One-hundred percent financing is available. Each facility is custom designed to your specifications by nationally acclaimed Fazio Architects.

THROUGHOUT TEXAS: Why lease when owning a building provides so many incred-ible advantages? Past clients tell us building a custom facility for their practice was easily the best decision of their career. I’d be hap-py to put you in touch with them to hear of their experiences directly. We’ve helped more than 800 of your fellow dentists achieve their dream during the past 20 years... And look forward to using that experience to assist you. Check us out at fazioarchitects.com. Then, give me a call at (512) 494-0643. Or e-mail [email protected].

ROUND ROCK: Property site available for dental/medical facility on Gattis School Road near the area’s new high school. Ex-cellent frontage with more than 25,000 cars passing by daily. Demographics for this area are through the roof. Call Jim at (512) 494-0643 or e-mail [email protected].

ROUND ROCK — OLD SETTLERS DEN-TAL PARK: Three pad sites available. Thriving two-doctor general practice already onsite. Good frontage and traffic on four-lane road. High growth area has shortage of specialty dentists. Call Jim at (512) 494-0643 or e-mail [email protected].

AUSTIN — MCNEIL DRIVE DENTAL PARK: Successful general dentist with established

practice has two pad sites available. Beauti-ful wooded area with great traffic volumes. Once you tour this office, you will want to build next door. Call Jim at (512) 494-0643 or e-mail [email protected].

WHITNEY: Free-standing vacant building for sale. Perfect location, 6 miles from the lake for any specialty start-up. Location near hospital complex, 2,600 sq. ft., no equipment, four bathrooms, private office, built 1978. Pictures are available. For more information call (972) 562-1072 or e-mail [email protected]

PLAINVIEW, TEXAS, COULD USE TWO NEW DENTISTS. For sale — fully equipped free-standing, high visibility dental office. Ex-cellent opportunity for right person. Contact Dr. J. Irvin Gaynor, [email protected] or (806) 292-3156.

ORTHODONTIST / ORAL SURGERY OP-PORTUNITY AVAILABLE. Northwest Hous-ton, 7700 Highway 6N, 77095, Copperfield; 2,039 sq. ft. space available for specialty practice. General build-out allowance, high income demographics, high traffic count. Next to Straw Smiles, high volume family practice. Call John Torry, (713) 824-9608.

HIT THE GROUND RUNNING IN THRIV-ING CITY OF FLOWER MOUND. Beauti-ful adorned dental office, five operatories. Plumbed chairs, state-of-the-art equipment. Rent below market. A really great opportu-nity for a beginner or a seasoned practitio-ner. Landlord supported and onsite. This is a once-in-a-lifetime opportunity where you can move in immediately in a beautiful and well-appointed office sitting on the creek with windows abundance. Please contact Nick at (972) 899-9992 or (972) 899-6412.

FOR SALE

LARGE INVENTORY OF QUALITY RE-FURBISHED AIR DRIVEN DENTAL HANDPIECES. All have been repaired and tested by a qualified technician. All have new ceramic bearing turbines and all are fiberoptic. For sale — Star 430 SWL, $269; Kavo 640B, $279; Kavo 642B, $299; Kavo 647B, $299; Midwest Tradition push button or lever, $239; new Kavo multi-flex coupler five-hole, $249; new Kavo coupler six-hole,


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$149; new Star coupler five-hole, $145. Slow speed and implant handpieces avail-able, too. Quality discounts are possible. I have been a TDA member for 25 years. If what you are looking for is not on this list, we stock a wide variety at wonderful prices, just inquire. Call (877) 863-4848 or visit our website, www.truespindental.com.

FOUR COMPLETE OPERATORIES IN-CLUDING cabinets, Pelton Crane chairs (recently re-upholstered), and chair mount-ed lights. Midwest fiber optics, two X-ray units, two Einstein inter-oral wireless cameras, and more. Call (512) 280-5114 or [email protected].

INTERIM SERVICES

TEMPORARY PROFESSIONAL COVER-AGE (Locum Tenens): Let one of our distinguished docs keep your overhead covered, your revenue-flow open wide,

your staff busy, your patients treated and booked for recall, all for a flat daily rate not a percent of production. Nation’s larg-est, most distinguished team. Short-notice coverage, personal, maternity, and disabil-ity leaves our specialty. Free, no obligation quotes. Absolute confidentiality. Trusted integrity since 1996. Some of our team seek regular part-time, permanent, or buy-in op-portunities. Always seeking new dentists to join the team. Bread and butter procedures. No cost, strings, or obligations —ever! Work only when you wish. Name your fee. Join online at www.doctorsperdiem.com. Phone:(800) 600-0963; e-mail: [email protected].

OFFICE COVERAGE for vacations, mater-nity leave, illness. Protect your practice and income. Forest Irons and Associates, (800) 433-2603 (EST). Web: www.forestirons.com. “Dentists Helping Dentists Since 1983.”

TEMPORARY

PER DIEM INC


MISCELLANEOUS

LOOKING TO HIRE A TRAINED DENTAL ASSISTANT? We have dental assistants graduating every 3 months in Dallas and Houston. To hire or to host a 32-hour ex-ternship, please call the National School of Dental Assisting at (800) 383-3408; Web:www.schoolofdentalassisting-northdallas.com.

DENTAL OFFICE needed to lease 12 hours per week for Dental Assisting School. Class hours are during office downtime one weekend day and one weekday evening. Lease payment to office is $500 to $1,500 per month, depending on enrollment. Seek-ing locations in Dallas, San Antonio, and Houston. Please call the National School of Dental Assisting at (800) 509-2864.

THE NATIONAL SCHOOL OF DENTAL ASSISTING — NORTH DALLAS offers the Texas RDA course and exam. Call (800) 383-3408 for available dates.

DOCTORSCHOICEGOLDEXCHANGE.COM: Try our high prices for dental scrap. Check sent 24 hours after you approve our quote. See why we have so many repeat custom-ers. Visit www.DoctorsChoiceGoldExchange.com.


ADS Watson, Brown & Accociates ......................276AFTCO ....................................................................304A.J. Riggins Co......................................................337Anesthesia Education and Safety Foundation..........................................................278Bright Now Dental .................................................254Crown Dental Studio .............................................258DDR Dental Trust ...................................................307Dental Systems......................................................306Doctors Per Diem ..................................................336Fortress Insurance ................................................258Gary Clinton, PMA.................................................303Hanna, Mark — Attn. at Law .................................306Henderson, Sherri L. & Associates......................265Hindley Group........................................................316JKJ Pathology........................................................290JLT Energy Consultants .......................................266Kennedy, Thomas John, D.D.S., P.L.L.C..............337Knight Dental Group .............................................259LVI Global/Dr. Reece..............................................305Medical Protective.................................................289Ocean Dental..........................................................277OSHA Review............................... Inside Back CoverParagon, Inc. ..........................................................321Patterson Dental ..........................Inside Front CoverPortable Anesthesia Services ..............................321Professional Recovery Network...........................338Robertson, James M .............................................290Sharp & Cobos.......................................................304Sharps ....................................................................307Southern Dental Associates.................................263SPDDS ....................................................................316TDA Express ..........................................................320TDA Financial Services Insurance Program..........................................288/Back CoverTDA Perks Program...............................................251Texas Health Steps................................................255Texas Medical Insurance Company.....................291TEXAS Meeting — Reminder Dates.....................254TEXAS Meeting — Speakers ................................276USA Civilian Dental Corps....................................257UTHSCSA Oral & Maxillofacial Lab......................290Waller, Joe..............................................................317

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The Professional Recovery Network (PRN) The Professional Recovery Network (PRN) addresses personal needs involving counseling addresses personal needs involving counseling services for dentists, hygienists, dental students services for dentists, hygienists, dental students and hygiene students with alcohol or chemical and hygiene students with alcohol or chemical dependency, or any other mental or emotional dependency, or any other mental or emotional dependency, or any other mental or emotional difficulties. We provide impaired dental profesdifficulties. We provide impaired dental profesdifficulties. We provide impaired dental profes-sionals with the support and means to confidensionals with the support and means to confidensionals with the support and means to confiden-tial recovery.tial recovery.tial recovery.

If you or another dental professional are conIf you or another dental professional are conIf you or another dental professional are con-cerned about a possible impairment, call the cerned about a possible impairment, call the cerned about a possible impairment, call the Professional Recovery NetworkProfessional Recovery NetworkProfessional Recovery Network and start the and start the Professional Recovery Network and start the Professional Recovery Networkrecovery process today. If you call to get help recovery process today. If you call to get help recovery process today. If you call to get help for someone in need, your name and location for someone in need, your name and location for someone in need, your name and location will not be divulged. The Professional Recovery will not be divulged. The Professional Recovery will not be divulged. The Professional Recovery Network staff will ask for your name and phone Network staff will ask for your name and phone Network staff will ask for your name and phone numbers so we may obtain more information numbers so we may obtain more information numbers so we may obtain more information and let you know that something is being done. and let you know that something is being done. and let you know that something is being done.

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Join us on facebook.com/texasdental or groups.to/texasdentalFollow us on twitter.com/theTDAGet LinkedIN at linkedin.com, search “Texas Dental Association”

Join us on Facebook, Twitter and LinkedIn!

The Texas Dental Association has created groups on Facebook, Twitter and LinkedIn. The goal of these groups is to provide updates on events and current issues.

If you do not have a Facebook or LinkedIn account, you can set one up in minutes!

Questions? Contact Stefanie Clegg, TDA web & new media manager at (512) 443-3675 or [email protected]


You may already know that you can enjoycompetitive auto insurance rates and specialmoney-saving discounts through the LibertyMutual Advantage® program.* But did youknow that Liberty Mutual offers many otherdiscounts on both auto and home insurance?*In fact, you could save hundreds of dollars ayear on auto insurance alone. And you couldsave even more by insuring your home, aswell.

Contact us for your FREE no-obligation quote: • Call 1-800-524-9400 and mention client #110024

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*Discounts and savings are available where state laws and regulations allow, and may vary by state. Certain discounts apply to specific coverages only. **Figure based on a February 2008 sample of autopolicyholder savings when comparing their former premium with those of the Liberty Mutual Advantage program. Individual premiums and savings will vary. Coverage provided and underwritten by LibertyCounty Mutual Insurance Company and its affiliates, 2100 Walnut Hill Lane, Irving, TX. A consumer report from a consumer reporting agency and/or a motor vehicle report, on all drivers listed on your policy,may be obtained where state laws and regulations allow.© 2009 Liberty Mutual Insurance Company. All Rights Reserved.

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Did you know that TDA members could save up to $327.96 or more a year on auto insurance?