Virginia Dental Journal

bull bull

Dental journal VOLUME 72 bull NUMBER 1 bull APRILJUNE 1995

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Phone 703-345-7319 800-476-7319

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ACCIDENTAL DEATH AND DISMEMBERMENT - Up to $300000 24-hour accident insurance available to member and family

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VIRGINIA DENTAL ASSOCIATION OFFICERS Councilors

President Leslie S Webb Jr 1) Edward J Weisberg Norfolk 6800 Patterson Ave Richmond VA 23226 2) Richard D Barnes Hampton

President Elect Ronald L Tankersley 3) Harold J Neal Jr Emporia 716 Denbigh Ave Suite C-l Newport News 236024) James R Lance Richmond

Immediate Past President Raleigh H Watson Jr 5) Daniel E Grabeel Lynchburg Chairman PO Box 191 Berryville VA 22611 6) Gus C Vlahos Dublin

Secretary-Treasurer Charles L Cuttino III 7) William J Viglione Charlottesville 3217 Grove Avenue Richmond VA 23221 8) David C Anderson Alexandria Vice Chairman

Executive Director Mr William E Zepp CAE Ex Officio Members PO Box 6906 Richmond VA 23230

Parliamentarian Emory R Thomas Richmond EXECUTIVE COUNCIL Editor Francis F Carr Jr Richmond

Officers Listed Above and Councilors Speaker of the House Bernard I Einhorn Norfolk Councilors at Large Dean MCV School ofDentistry Lindsay M Hunt Jr Thomas S Cooke II Sandston (1996) Richmond Wallace L Huff Blacksburg (1996) Stanley M Stoller Springfield (1995) Andrew J Zimmer Norfolk (1995)

ADA DELEGATION David A Whiston Trustee to the 136th Annual ADA Session Oct 7-11 1995 Las Vegas 16th District Delegates

William H Allison (1996) Daniel E Grabeel (1995) Emanuel W Michaels (1996) Stephen L Bissell (1996) Wallace L Huff (1995) Ronald L Tankersley (1995) M Joan Gillespie (1997)

bull Richard D Wilson (1996)

Alternate Delegates Gary R Arbuckle (1996) Bruce R DeGinder (1995) Dr Lindsay M Hunt Jr (1995) Richard D Barnes (1995) Bernard I Einhorn (1995) Raleigh H Watson Jr (1995) Charles L Cuttino III (1995) Andrew J Zimmer (1995) Leslie S Webb Jr (1996)

COMPONENT SOCIETY DIRECTORY SOCIETY PRESIDENT SECRETARY -lREASURER PATIENt RELAnONS

OR SECRETARY COMMITTEE Tidewater C Marshall Mahanes David P Paul ill W Walter Cox

7913 Azalea Garden Road 4616 Thoroughgood Drive 5717 Churchland Blvd Norfolk VA 23518 Virginia Beach VA 23455 Portsmouth VA 23703

Peninsula Bruce R DeGinder Jeffrey N Kenney Lawrence A Warren 240 McLaws Circle SU 153 12420 Warwiclc Blvd 106 Yorktown Road Williamsburg VA 23185 Newport News VA 23606 Tabb VA 23602

Southside H Reed Boyd ill Roger A Palmer John R Ragsdale ill PO Box 1369 307 Dogwood Lane 9 Holly Hill Drive Petersburg VA 23805 Emporia VA 23860 Petersburg VA 238847

Richmond Jeffrey Levin Benita A Miller Thomas S Cooke ill 501 Libbie Avenue 5700 Old Richmond Ave SU C-14 39 West Williamsburg Road Richmond VA 23226 Richmond VA 23226 Sandston VA 23150

Piedmont James W Shearer Gregory T Gendron Edward M OKeefe 25 Cleveland Avenue SU 8 7 Cleveland Avenue 4102 Electric Road Martrinsville VA 24112 Maninsville VA 24112 Roanoke VA 24014

Soumwest Paul T Umstott Dana Chamberlain Jack D Cole 300 West Valley Street 645 Pane Blvd SU 225 303 Coun Street Abingdon VA 24210 Abingdon VA 24354 Abingdon VA 24210

Shenandoah Valley Wayne D Remington Alan J White William J Viglione PO Box 145 40 Lambert Street SU 221 3025 Berkmar Drive Earlysville VA 22936 Staunton VA 24401 Charlottesville VA 22901

Northern Virginia Rodney J Klima James A Pell Neil J SmaIl Burke Professional Center 7 Comers Prof Bldg 9940 Main Street 4205-B Lyngate Court 6319 Castle Place SU I-E Fairfax VA 22031 Burke VA 22015 Falls Church VA 22044

MEMBER PUBLICATION AMERICAN ASSOCIATION OF DENTAL EDITORS

Francis F Carr Jr Editor Mr William E Zepp CAE Business Manager

ASSOCIATE EDITORS 1) Bernard I Einhorn 5) Edward P Snyder 2) Jeffrey N Kenney 6) R Graham Hoskins 3) H Reed Boyd III 7) William C Bigelow 4) Benita A Miller 8) Bruce W Jay

MCV - Michael V Dishman

Volume 72 April-June 1995 Number 2

TABLE OF CONTENTS

5 Editorial Letter to the Editor

6 Guest Editorial

8 Presidents Message

10 VDA Welcomes New Executive Director An Alternative Approach to the Treatment of Oral Leukoplakia

12 Class II Posterior Composites--Ways to Reduce Bond Stress and Microleakage by Using Low Modulus Materials

15 Northern Virginia Sponsors the Future

16 Legislative Update

17 VADPAC

19 Component News

COVER View at Montpelier Orange County home ofJames Madison fourth president of the United States Photographed by Dr Ted W Sherwin Orange

TIIE VIRGINIA DENTAL JOURNAL (lSSN 0049 6472) is published quancr1y (Jan-March April-June July-Sept Oct-Dec) by the Virginia Dental Association at the Corporate Centre 5006 Monument Avenue PO Box 6906 Richmmd Virginia 2323(0906 Telephone 804358-4927 SUBSCRIPTION RATES Annusl Members $600 OthC115 $1200 in US $2400 in other countries Single copy $600 Second cia postage paid at Richmond Virginia Copyright Virginia Dental Associatim 1995 POSTMASTER Send address changes to Virginia Dental Joumsl PO Box 6906 Richmond VA 23230-0906 MANUSCRIPT AND COMMUNICATION for publicatims should be addressed to the Editor Francia F Carr Jr PO Box 6906 Richmond Virginia 23230 ADVERTISING COPY insertim orders contracts and requests for infonnation relating to advertising should be addressed to the Business Manager Mr William E Zepp CAE PO Box 6906 Richmond Virginia 2323(0906

VIRGINIA DENTAL JOURNAL EDITORIAL BOARD

Dr Louis M Abbey Dr Ralph L Anderson Dr James R Batten Dr Cramer L Boswell Dr James H Butler Dr Gilbert L Button Dr Frank H Farrington Dr Barry 1 Griffin Dr Jeffrey L Hudgins Dr Wallace L Huff Dr Lindsay M Hunt Jr Dr Lisa Samaha Hunter Dr Ford T Johnson Dr Thomas E Koertge Dr James R Lance Dr Daniel M Laskin Dr Travis T Patterson III Dr W Baxter Perkinson Jr Dr David Sarrett Dr Harvey A Schenkein Dr James R Schroeder Dr Harlan A Schufeldt Dr Kenneth J Stavisky Dr John A Svirsky Dr Ronald L Tankersley Dr Douglas C Wendt Dr RogerE Wood

COMMITTEES

1995 Annual Meeting Dr Bruce R Hutchison Chairman

Budget and Financial Investments Dr Jeffrey Levin Chairman

Cancer and Hospital Dental Service Dr Robert L ONeill Chairman

Caring Dentists Dr Harry D Simpson Jr Chairman

Constitution and Bylaws Dr Raleigh H Watson Jr Chairman

Dental Care Programs Dr Kirk M Norbo Chairman

Dental Delivery for the Special Needs Patient Dr Gregory T Gendron Chairman

Dental Education and Continuing Education Dr James K Johnson Chairman

Dental Health and Public Information Dr Gisela K Fashing Chairman

Dental Practice Regulations Dr Douglas C Wendt Chairman

Dental Trade and Laboratory Relations Dr Harlan A Schufeldt Chairman

Environmental Health and Safety Dr Dennis E Cleckner Chairman

Executive Dr Leslie S Webb Jr Chairman

Financial Aid and Auxiliary Educashytion Dr Anthony W Savage Chairman

History and Necrology Dr Edmund E Mullins Jr Chairman

Institutional Affairs Dr C James Harland Jr Chairman

Insurance Dr J Darrell Rice Chairman

Journal Staff Dr Francis F Carr Jr Chairman

Legislative Dr Harold J Barrett Jr Chairman

New Dentist Dr Benita A Miller Chairman

Nominating Dr Raleigh H Watson Jr Chairman

Peer Review and Patient Relations Dr Edward M OKeefe Chairman

Planning Dr Raleigh H Watson Jr Chairman

Relief Dr EY Lovelace Jr Chairman

Search Committee for VA Board of Dentistry Candidates Dr Raleigh H Watson Jr Chairman

Virginia Dental Political Action Dr John C Doswell II Chairman

NOTE THESE DATES (Markyour calendarnowfor these future meetings)

VDA Committee Meetings June 9-111995 Cavalier Hotel Virginia Beach

VSOMS Annual Meeting June 29-July 2 1995 Kingsmill Resort Williamsburg

VAO Annual Meeting June 23-27 1995 Kiawah Island South Carolina

VDA 126th Annual Meeting September 13-17 1995 Hyatt Regency Reston

16th Trustee District Caucus September 22-24 1995 Charleston SC

ADA 136th Annual Meeting October 7-11 1995 Las Vegas

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Editorial

~) Le VDA Annual Meeting is just around the comer Reston and the washi~kon the

membership to a fine session scientific educational and social

We must remember how important the House of Delegates is to our Annual Meeting As the supreme authoritative body of the Association each of its sessions are conducted crisply and authoritatively by the Speaker In its actions the House can set policies and can approve the budget These powerful duties require responsible actions Too often there are extremely short House sessions with little debate of the serious issues involved The House has the power to debate and decide policy for the Associashytion it should do more of it Remember

bull The longer health care stays under the present intense public scrutiny the more planning and action are necessary from the House

bull The more the Delegates take part in the VDA process the broader the base of the Association response and the greater its credibility

This is our twenty-fourth House of Delegates session it needs to be our best Do your part

Frands F CaTT Jr Eaitor

Letter to the Editor

Dear Dr Carr

Thank you for permitting me to use the Journal to convey my appreciation to all members of the Virginia Dental Association for the privilege and pleasure of serving as your executive director from May 1 1970 until January 1 1995

As I became a part of your profession I realized that dentistry in Virginia is highly respected because of dedicated practitioners When I became involved with changes in the education and regulation of health professions I was so proud that Virginia dentists always considered the welfare of their patients as a requisite for change To Dr Raleigh Watson and all of you who shared in the Presidential Banquet in Williamsburg your tributes and gifts will be a constant reminder of how fortunate I am to have been a part of your caring Association

To Dr Fred Carr and all who contributed letters and articles in the Virginia Dental Journal you have my humble and everlasting appreciation To all of the people I worked for and with--dentists your families your staffs and many others from related organizations especially our MCV School of Denshytistry you enriched an important part of my life My love and friendship will be with you always

Mrs Pat K Watkins

5

Guest Editorial Recently I reread an essay that Dr Harry Lyons wrote in 1962 in which he described the implicit

contract that exists between the dental profession and the public Dr Lyons wrote The professional person is educated beyond the general level of his community and has special knowlshyedge and skills He professes his dedication to the publics welfare over his own He professes that he gives more than he receives willingly and by design He professes his indebtedness to his predecessors from whom he inherited the knowledge the skills and the tradition of his profession He professes that he in turn will enrich and further endow the profession in which he enjoys membership

No one has privileges greater than members of the health service professions-privileges granted by society both by custom and by legislative enactment The healing arts professions early in our countrys history were given privileges that may be described as monopolistic in that no one but a physician may practice medicine only a dentist may practice dentistry

It is axiomatic that for every privilege granted by society it exacts a concurrent responsibility This is the privilege-responsibility complex of a profession

Dentistrys monopolistic privileges carry the implied obligation of providing dental health care ultishymately for the entirepopulation of our country rich and poor alike This is a responsibility that the profession may ignore only at the peril of losing its privileges and its status In the past this responsibilshyity has not always been met fully As a consequence the profession has suffered modifications in some state laws governing the practice of dentistry

Essentially our agreement is that as professionals we are granted a monopoly in providing dental care autonomy in regulating our practitioners and are relatively free from excessive governmental regulashytion In exchange we agree to fulfill the dental health needs of the public including those with limited ability to pay our fees Certainly our autonomy has been abridged somewhat by the FTC OSHA Medicaid and third party agencies Nevertheless we still retain a remarkable amount of independence Only we can perform dentistry limiting our competition We set our own fee schedule and decide where and how we practice Few fields are as autonomous as ours

Recently a letter in a local newspaper described the difficulty in identifying dentists who accept Medicaid patients The letter raises the question whether we are keeping our pan of the contract The dentists responding to the complaint pointed out that Medicaid payments have been frozen for ten years and are woefully inadequate But if we view dentistry as a vital health service as I am certain we do refusing to see at least some Medicaid patients may be indefensible If a dentist refuses to treat indigent patients he or she must ask What will be the outcome if every dentists response is the same as mine We will have abrogated our contract and will deserve to come under more governmental conshytrol

The best remedy is for all offices to agree to accept some Medicaid patients In that way no single office will be unduly burdened and more importantly we would be fulfilling our responsibility to the public

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I believe there was a time when the dental profession would have accepted this responsibility Someshyone would have called a special meeting everyone would have shown up and after an animated discusshysion there would be an agreement that would involve everyones participating in the solution

Not now Today we have consultants who recommend niche marketing (Ive never heard of one recommending targeting poor people) Convert MOD amalgams to full crowns Market dentistry as a purely cosmetic service Set your fees higher than your colleagues to establish your superiority

Have we gone too far down the road away from the implicit contract we had with the public Has governmental intervention altered the relationship irreversibly Perhaps the pressures on both parties in these complex times have led to the abrogation of the tacit agreement that once existed

Mavbe so But there is still a need for the professional person to empathize with those unable to

ur services We cannot go who like Dr Harry Lyons STATEWIDE CONTINUING EDUCATION REGISTRATION FORM

Mail to Virginia Dental Association PO Box 6906 Richmond VA 23230-0906

Program Name -=-shy

Component -------_~~-Make separate check payable to

Virginia Dental Association Date _

ecognize that what society

Name _ Please use full name

Street Address _ ontributor to the Journal ~ ity State Zip _

Office telephone number _ Other personnel attending _

(Please use full names)

$20-Members ofVDA amp auxiliaries $75-Persons other than VDA members Fee includes lunch and coffee break rgoing a complete transforshy

For additional information call VDA at 11800552-3886 alue to the membership the Please copy form if you are registering for more than one Component Meeting rmation and materials In

See page 9 of this Journalfor listing of Continuing Education programs ished on an annual basis

and activities of the Assoshy)ctober following the VDA

Annual Meeting

As we work on this project over the next few months we would be more than happy to consider materials for inclusion or make corrections from the previous edition If you have any contributions for the Directory please contact Lisa Finnerty at the VDA central office at 1800552-3886 or FAX the material to 1804353-7342

We sincerely hope that this departure from the usual release date will not inconvenience you in any way We can assure you that the finished product will be well worth the wait 1

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Maybe so But there is still a need for the professional person to empathize with those unable to provide for dental care for their families

Each one of us can do more than we do to help those who are in need of our services We cannot go back to a simpler time but we can return to the virtues of our predecessors who like Dr Harry Lyons exuded professionalism integrity and compassion

If not Dr Lyons observation will surely come true it is important to recognize that what society gives it may also-take away

Robert M Rubin DMD Dr Rubin is an orthodontist in Norfolk and a long-time contributor to the Journal t

Membership Directory Receives Facelift The Virginia Dental Association Membership Directory is currently undergoing a complete transforshy

mation In an effort to increase utilization of the Directory and increase its value to the membership the Directory will be greatly expanded and will feature extensive resource information and materials In addition the VDA Membership Directory and Resource Guide will be published on an annual basis

In order to provide the most current information regarding the leadership and activities of the Assoshyciation the publication date for the Directory is being scheduled for early October following the VDA Annual Meeting


We sincerely hope that this departure from the usual release date will not inconvenience you in any way We can assure you that the finished product will be well worth the wait t

7

Presidents Message

Much activity has occurred in the Virginia Dental Association since my last report Chuck Duvall our lobbyist has done a great job in guiding our legislashytive package through the Genshyeral Assembly We achieved all of our legislative goals for this session A listing of our legislashytive achievements is found elsewhere in this issue of the Journal

In my visits to the General Assembly I found strong support for dentistry among our legislators I attribute this to a strong liaison system and the efforts of our members who serve as liaisons If you are not currently serving as a liaison to your legislator and would like to become involved let your component president or the VDAknow

I would like to thank Drs Rod Klima David Anderson Tom Cooke Ron Tankersley Phil Peters and Charlie Cuttino for taking time to speak to our legislative issues at the General Assembly Personal involveshyment of members at committee hearings is a must for success A special thank you also goes to the Legislative Committee and Dr HJ Barrett Jr its chairman

This is an election year in Virginia Get involved with the candidates in your district

Work in the campaign throw a party for a candidate and contribute to their campaign Make them aware of dentistry Join VADPAC and ADPAC so that dentistrys message is heard in the Virginia legislature and in Congress

I would like to recognize those VDA members serving on ADA councils and commitshytees

Dr Richard Wilson Chairman Council on Dental Education

Dr James D Watkins Council on Dental Education

Dr Ellen Byrne Council on Scientific Affairs

Dr M Joan Gillespie Council on Ethics Bylaws and Judicial Affairs

Dr Leslie S Webb Jr Council on Dental Benefit Programs

Dr Anne C Adams ADA Committee on the Future of Auxiliaries

Dr Ronald L Tankersley Parameters Committee

Dr David A Whiston ADA Trustee

These VDA dentists devote significant time to their duties and should be applauded for their service They are a valushyable resource for our Associashytion Dr Bennett A Malbon served as vice chairman of the Council of Governmental Affairs and Federal Dental Service His recent death has saddened us all His contribushytions to this Council the VDA

and dentistry will be missed Our sympathies and support go to his family

At our central office the phone system has been upshygraded and activity is in full swing for upcoming meetings The VDA committee meetings will be held June 9-11 at the Cavalier Oceanfront Hotel in Virginia Beach Our annual meeting at the Hyatt Regency Hotel in Reston on September 13-17 will feature two full days of continuing education Dr Gerald Chiche Dr Howard Skurow and Mr Don Martin are our speakers I look forward to seeing you at these events

Dr Leslie S Webb Jr VDA President

Bennett A Malbon DDs

Bennett Malbon oral surshygeon leader in organized dentistry education and philanshythropy died on Sunday April 23 1995 Our profession mourns the loss of this dedishycated positive and talented dentist Dr Malbon was in Washington DC attending a meeting of the Regents of the American College of Dentists at the time of his death

Born in Currituck County NC October 271931 Dr Malbon graduated from Randolph-Macon College in 1954 and the Medical College

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8

of Virginia in 1958 He comshypleted the Oral Surgery resishydency at MCV in 1961 and he began practice in Richmond

with Dr Philip Peters in 1961 a relationship that lasted for 34 middotyears He became Board certishy3fied in 1963

In dentistry his prominent ervice included terms as

president of the Virginia Dental Association the Virginia Society of Oral and Maxi11ofashyial Surgeons the Richmond ental Society and the Richshyond Dental Study Club He ad been an ADA delegate

ce 1980 chairman of the A 16th District Caucus and

as currently chairman of the frginia Delegation He was a

mber of the ADA Council overnmental Affairs and a

stee of the American Dental sociation Political Action

ittee He was Regent of ency 3 of the American lege of Dentists and had ved as president of the

lnia Section of the Amerishyollege He was active at

vels of his Oral and Maxilshyial Surgery organizations elude service on the Proshy

ional Conduct Commission e American Association of and Maxillofacial Surgery adbeen a consultant to the uireVA Hospital and had Chief of Dental Services th Chippenham and Richshy

d Memorial Hospitals Dr ns confident presence in

-u dentistry and his counsel will be missed

Dr Malbon was a lifelong supporter of higher education He served on the Board of Trustees of Randolph-Macon College and the MCV-VCU Alumni Association Board He participated in search commitshytees for the current president of Randolph-Macon College and for two deans of the School of Dentistry at MCV His persisshytence and vision while VDA president led to the Endowment Fund for the School of Denshytistry

Dr Malbon believed that our lives are made better by sharing with others In long service as a trustee of the MCV Foundation he constantly impressed the need for giving to advance the educational goals of the professhysion He was on the Board of the Maymont Foundation working to improve that Richshymond institution and to conshytinue his love of gardening His patients and his fellow practishytioners in their lives are richer for his presence

He was a member of Omicron Kappa Upsilon and Delta Sigma Delta a fellow of the Virginia Dental Association the American College of Denshytists and the recipient of the Harry Lyons Award from the Richmond Dental Society

Dr Malbon is survived by his wife Susan Gladding Malbon one daughter Jane Bell Dunlap a son Bennett A Malbon Jr a

grandson Ryan Dunlap and a brother Alton Malbon of Wake Forest NC Services were held at Grace and Holy Trinity Episcopal Church on Thursday April 27 with burial in Hollyshywood Cemetery 1

Bennett A Malbon 1931-1995

Bennett Malbon was an indishyvidual with many talents A compassionate oral surgeon he was eulogized in a Richmond newspaper which said Pulling teeth does not usually engender great affection but the news of Dr Malbons passing brings sadness to many not only his family and close friends A talent which brought him great pleasure was his lovely backshyyard garden which he created

To honor him his friends and family would like to transform an area outside the student dining room between two buildings at the MCV School of Dentistry into the Bennett A Malbon Memorial Garden

You may send contributions to the Deans Office MCV School of Dentistry PO Box 980566 Richmond VA 23298-0566 1

9

Welcome to the New Executive Director

William E Zepp The Virginia Dental Associashy

tion extends a warm welcome to Mr William E Zepp CAE who became the new executive director of the VDA on January 1 1995 Bill Zepp joins us after a successful eight-year term as executive director of the Monshytana Dental Association

He is a Montana native and holds a BA from the Univershysity of Portland (Oregon) and an MA from the University of Hawaii He has taught in both high school and college and served as an elementary and secondary school principal in Montana and Washington Bill and his wife Patricia have two children Amy Zepp Still and Jon Zepp

Bill was the first full-time executive director of the Monshytana Dental Association He set up their office organized meetings programs and proceshydures and worked with the 11th ADA Trustee District Montana law allows for denshyturists and for general supervishysion of hygienists so he knows how to work in difficult legislashy

tive circumstances While in Montana Bill became a Certishyfied Association Executive and is active in their Association

Since his arrival he has been busy organizing the office hiring and training new staff manning our meetings and working through his first General Assembly session with our new lobbyist He has become involved in 16th ADA District activities and has already visited several composhynents We are glad to have him in our Association and look forward to a long and pleasant relationship ~

An Alternative Approach to the Treatment of Oral Leukoplakia

by Dennis G Page DDS MS Associate Professor Department ofOral Pathology Medical College ofVirginia School of Dentistry and Thomas M Grisius BS and Marianna Clougherty BS dental students MCV School ofDentistry Corresponding author Dr Dennis Page Departshyment of Oral Pathology MCV

Oral leukoplakia is a white lesion of the oral cavity that is defined by two clinical characshyteristics It cannot be rubbed off and a definitive diagnosis cannot be rendered solely from its clinical appearance Leukoplakia can be caused by numerous factors including but not limited to chronic irritation tobacco and alcohol use vishyruses and neoplasia Large

studies have revealed that approximately 20 of all leukoplakias are either epitheshylial dysplasia or squamous cell carcinoma at the time of initial recognition However the percentage of premalignant or malignant lesions is as high as 45 in high-risk sites such as the floor or mouth or ventral surface of the tongue One study showed that 175 of leukoplakias evolved into squamous cell carcinoma over a mean follow-up time of eight years Leukoplakias have a surprisingly high recurrence rate of 344 even after comshyplete excisionI It is obvious that leukoplakic lesions espeshycially in high-risk sites need to be excised but is also apparent that surgery may be somewhat limited in its ability to successshy

fully eradicate the problem These findings have led to an intense search for alternative approaches in treating leukoplakia One of the most promising agents for treating leukoplakia is 13-cis-retinoic acid (Accutanereg) which is a retinoid

RETINOL AND RETINOIDS

Vitamin A (retinol) is found in dairy products eggs and meatI Hypervitaminosis A can occur because the percentage of retinol absorption remains constant even as the intake increases The excess retinol is stored in the liver and abnormal liver function tests have been reported in patients who conshysume as little as 50000 illday but liver damage can occur at

10

lower doses if the patient drinks alcohol5

Retinoids are compounds that are either natural or synthetic analogues of vitamin A Of the more than 1500 synthetic analogues 13-cis-retinoic acid (13-cRA) has generated the most clinical interest Unfortushynately side effects such as cheilitis dry skin hypertrishyglyceridemia xerostomia and teratogenic effects have been reportedgt These side effects are dose-dependent with the incidence and severity being high at the 2 rugkgday level However the side effects diminish considerably at the 05-10 mgkgday level which appears to be tolerable for most patients

RELATIONSHIP TO CANCER ~

The first study that showed an association between vitamin A deficiency and cancer appeared in 19415 Subsequently a low intake of vitamin A has been linked with an increased risk for cancer of the lung colon breast pharynx larynx esophashygus and bladder

THERAPEUTIC USE IN ORAL LEUKOPLAKIA

The use of vitamin A suppleshyments in the treatment of leukoplakia began in the early 1960s but was not widely accepted because of the side effects Silverman and his colleagues7 showed clinical success in 7 of 16 patients (438) with the administration of 300000 to 900000 illday delivered as troches However three of the four patients with complete resolution had recurshyrences within two weeks of discontinuing the vitamin A troches In addition half of the patients in the study developed noticeable side effects

The development of 13-cRA in the 1970s made possible the systemic administration of retinol for therapeutic purposes A group from MD Anderson Cancer Center found a greater than 50 reduction in lesion size in 27 of 44 (67) oral leukoplakias treated with 12 mgkgday 13-cRA8 However 79 of the patients developed side effects Hays and his colleagues used 15 mgkgday of 13-cRA for three months to obtain clinical improvement in 62 of their patients with oral leukoplakia By continuing the responding patients on a mainshytenance dose of 05 rugkgday they achieved a relapse rate of only 10 Lippman and his coshyworkers treated patients with a three month induction of 13shycRA at 15 rugkgday which was then reduced to a mainteshynance dose of 05 rugkgday for nine months Of the patients who completed the mainteshynance phase there were no relapses This study demonshystrated the value of using a higher initial dose but then reducing to a lower dose to maintain a disease-free status

Based upon these studies it appears that 13-cRA can reshyverse abnormal epithelial proliferation within the oral cavity Although there has been considerable speculation the specific biochemical mechashynism for this action is unshyknown One popular theory is that 13-cRA suppresses epidershymal growth factor and in that fashion alters epithelial prolifshyeration

RESEARCH AT THE MEDIshyCAL COLLEGE OF VIRGINIA

After obtaining permission from the Committee for the Conduct of Human Research we received funding from

Roche Inc to begin a clinical trial in the use of 13-cRA for the treatment of oral leukoplakia In order to be eligible for the study the leukoplakia must be at least two centimeters in diameter and have been present for at least one year Females who are capable of having children and patients with active liver disshyease are excluded form particishypation Each eligible patient is given 50 mg of 13-cRA per day but not to exceed 1 mgkg of body weight Given an average body weight of 150 pounds most patients will be slightly under the 1 mgkg limit As a comparison 13-cRA (Accutane) is prescribed at levels of 05-20 mgkgday for adolescents with severe acne Patients will be clinically examined biopsied if necesshysary and serum profiles obshytained prior to taking the medication Thereafter they will be seen at monthly intershyvals and the dosage adjusted as appropriate based upon side effects and lesion improvement There is no cost to the patient for his or her participation in the study For further informashytion contact Dr George Kaugars at 800677-7841

REFERENCES

1 Waldron CA Shafer WG Leukoplakia revisited A clinicopathologic study of 3256 oral leukoplaIdas Cancer 1975 361386shy1392

2 Silverman S Jr Gorsky M Lozada F Oral leukoplakia and malignant transformation a follow-up study of 257 patietss Cancer 1984 53563shy568

3 Willis ED Biochemical Basis of Medicine Bristol England John Wright amp Sons Limited 1985159shy165

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4 Havel RJ Calloway DH Gussow JD Mertz W Nesheim MC Fatshysoluble vitamins in recommended dietary allowances 10th ed Washingshyton DC National Academy Press 198978-93

5 Lippman SM Kessler JF Meyskens FL Retinoids as preventive and therapeutic anticancer agents (Part II) Cancer Treat Rep 1987 71493-515

6 DeVita VT Jr Hallman S Rosenberg SA Cancer Principles and Practice of Oncology 3rd ed Philashydelphia JB Lippincott Company 1989167-180

7 Silverman S Jr Renstrup G Pindborg H Studies in oral leukoplakias ill Effects of vitamin A comparing clinical histopathologic cytologic and hematologic responses Acta Odont Scand 1963 41271-292

8 Hong WK Endicott J Itri LM 13shycis-retinoic acid in the treatment of oral leukoplakia New Engl J Med 1986 3151501-1505

9 Hays G Lippman S Weber R Batsakis J Wargovich M Hong W Evaluation of a synthetic analog of vitamin A and beta carotene on the clinical and histologic appearance and biologic markers in human premalignant oral lesions Oral Surg Oral Med Oral Pathol 1991 72311 (abstract)

10 Lippman SM Toth BB Batsakis JG et al Low-dose 13-cis-retinoic acid (13cRA) maintains remission in oral premalignancy more effective than beta-carotene in randomized trial Proc Am Soc Din OncoI1990 959 (abstract)

11 Lippman SM Garewal HS Meyskens FL Retinoids as potential chemopreventive agents in squamous cell carcinoma of the head and neck Prev Med 1989 18740-748 ~

Class II Posterior Composites-Ways to Reduce Bond Stress and Microleakage by Using Low Modulus Materials

by Peter C Moon PhD Associate Professor Department ofRestorative Dentistry MeV School ofDentistry

With the increased patient interest in alternatives to amalgam restorations there have been several reviews of clinical problems of posterior composftest-s- The reviews emphasize how the problems can be minimized The probshylems are related either to wear or microleakage Recent clinishycal research reports suggest that wear can be greatly reduced by proper selection of materials and avoidance of extremely large restorations and careful evaluation of bruxing pashytients 45 Microleakage the topic of this paper is a source of stained margins pulpal sensshyitivity and secondary decay These clinical problems are most evident on dentin margins where the bond is not as strong as it is to enamel These dentin margins occur in deep proximal Class II restorations and root caries The ways to reduce microleakage described in the reviews will be summarized Next a new way to reduce bond stress and failure which causes microleakage will be introduced that depends on using low elastic modulus materials

Microleakage is the result of polymerization shrinkage as the composite cures Marginal gaps are formed as the shrinkage stress developed during curing exceeds the bond strength To insure the dentin bond provided by a dentin bonding agent is fully developed before the composite resin starts to shrink the dentin bonding adhesive should be precured before the

composite resin is light cured The reviews pomt out several ways to r~uce the shrinkag~ stress acting on t~e bond soIt IS not over stressed into breaking and gap formation The first procedure controls the direction of the shrinkage to reduce stress Shrinkage is greater toward the light for light cured composites by a factor or twoshyas measured by strain gauges used in the MCV dental materishyals laboratory This shrinkage has been observed in our laboratory as a concave depresshysion formed on the bottom of an open-ended cylinder filled with composite when cured from the top down Thus curing from the occlusal causes the composite to pull away from the gingival margin and form a gap at the dentin margin in deep class two restorations (ie where the stress is the highest and the bond is the weakest due to distance from the light source) Horizontal incremental layering and curing has not been shown to reduce the shrinkage gaps or bond stresses significantly when curing from the occlusal surshyface only It does produce a more complete cure for the bottom layers than bulk curshying 8 However curing vertical increments through the buccal and lingual tooth surface using a clear matrix and wedges is more effective because the shrinkage is toward the cervical floor and proximal walls67 The final increments should be cured again occlusally after finishing for a final cure of 60 seconds to reduce wear Also to seal occlusal gaps heal finishing cracks or voids a low viscosity resin like Fortify (Bisco Dental Co) may be used during the final curing step after finishingl

-

12

Another method of reducing shrinkage that has been sugshygested is to reduce the volume of composite polymerizing This can be accomplished by inserting a precured composite ball into the interproximal area of restoration after it is filled with compositel The excess composite that is pushed out is removed and the restoration cured from buccal lingual and finally from the occlusal as previously described Also a study showed that curing a composite resin veneer that covers cervical dentin has a much lower leakage if cured from the lingual through the tooth initially than if cured only from the facial 11 Sized stanshydard preformed silanated porcelain proximal inserts are commercially available to replace the precured composite ball fabricated bythe dentist

There is a third way to reduce polymerization bond stress that was not included in the reshyviews This new way we have developed at MCV is to use low elastic modulus materials in the interproximal area and dentin interface that can stretch to allow stress relaxation 12 There are three materials that can be used to accomplish this objective The first is the low modulus light cured glass ionomer liner Vitrabond (3M CO)14 The self-curing glass ionomers like Ketac- Bond (Espe Co) have a much higher modulus and are not as effecshytive Vitrabond has an elastic modulus that is only about oneshyfifth of Ketac-bond and 150th of a highly filled composite like P-50 (3M Co)1416 The Vitrabond can stretch 50 times farther to relax the stress A cured Vitrabond liner of several hundred microns (3mm) should coat the pulp wall and preparation floor but not

extend out on gingival floor as it can dissolve out if extended to the margins 1

To further reduce the stress a thicker low modulus dentin bonding agent layer should coat the preparation walls2324 Two coats of Scotchbond Multipurshypose or Prime and Bond are about 26 microns which would reduce the bond stress The coats need to be cured sepashyrately The low modulus of unfilled dentin bonding agents are usually less than Vitrabond Air thinning should not be used as a thicker layer of this low modulus resin enhances stress relaxation at the dentin intershyface Also air thinning inhibits curing and may weaken the bond~9

The last lower modulus material to use is a microfilled resin like Silux or Silar for the interproximal portion of the Class II in increments up to the height of contact and on the prep floor The modulus of these microfills is less than half that of P-50 and can stretch twice as much as P-50 to relax the shrinkage stressl The self-cure Silar has an advantage in lowering the stress because it cures more slowly It can creep as it cures to reduce the effecshytive shrinkageP Also it does not required the clear matrix band and wedges to allow buccal and lingual light curing Clinical studies have shown that interproximal wear is not higher for microfillsU Howshyever the final occlusal increshyment placed should be a wearshyresistant hybrid composite likeTPHl

It is recommended that some combination of these stress reducing procedures be used for large deep Class II restoration to mininuze microleakage

These methods benefitdeep Class I restorations also The use of one procedure alone may not prevent microleakage 1322

Posterior proximal composites should not be placed especially on dentin unless precautions to limit interproximal gap formashytion from developing are followed

REFERENCES

1 Leinfelder KF UsingComposite Resin as a PosteriorRestorative material JADA V122pp6S-70 (April 1991)

2 Cheung GSPReducing Marginal Leakage of PosteriorComposite ResinRestorations A review of clinical techniques J Prosthet Dent V63 pp286-288 (March 1990)

3 BowenRL EichmillerFC MarjenhoffWA Glass-Ceramic Inserts Anticipated for Megaftlled CompositeRestorations JADA V122pp71-75 (March 1991)

4 Wilson EG Mandradjieff M BrindockT Controversies in Posteshyrior CompositeResin Restorations Dent Clin Non Am V34 (1)pp27shy44 (Jan 1990)

5 Mazer RB LeinfelderKF MicrofillPosterior Composite Resin JADA V123pp33-38 (April 1992)

6 Lutz F Krejei I LuescherB Oldenburg TR ImprovedProximal Margins Adaptationof ClassII Composite Resin Restorations by Use of Light-ReflectingWedges Quintesshysence Int V17 pp659-664 (1986)

7 Lembrechts p Braem M Vanherle G Evaluation of Clinicalperformance for Posterior CompositeResinsand Dentine AdhesivesOpec DentV12 pp53-78 (1987)

(Continued on next page)

13

8 Moon PC Covey DA Mechanical Properties of Microfill and Hybrid Composite Resin Restorative Materishyals J Dent Res AADR Abstract 1284 V68 p341 (1989)

9 Glasspoole EA Erickson RL Effect of Finishing and Degree of Cure on Composite Wear J Dent Res Abstract 145 V68 p127 (1990)

10 Bowen RL direct communicashytion

11 Segura KJ Donly KJ Croll T The Effect of Polymerization Shrinkshyage During Veneer Placement J Dent Res lADR abstract 240 V70 p295 (April 1991)

12 Davidson cL Kemp-Scholte CM Complete Marginal Sealing by Improved Strain Capacity J Dent Res IADR Abstract 736 V68 p959 (1989)

13 Kamp-Scholte CM Davidson CL Marginal Integrity Related to Bond Strength and Strain Capacity of Composite Resin Restoration Sysshytems J Prosth Dent V64 pp658shy664 (1990)

14 Lewis BA Burgess JD Gray SE Mechanical Properties of Five Dental Base Materials J Dent Res IADR Abstract 2408 V70 p567 (1991)

15 Barkmeier WW Huang CT Bond Strength and Microleakage of a New Dentin Adhesive System J Dent Res IADR Abstract 159 V69 pl28 (Mar 1990)

16 Jones CW Hall GC Johnson C Rizkalla AS Suton EJ Mechanical Properties of Three Commercial Composites J Dent Res IADR Abstract 1720 V70 p481 (1991)

17 McCaghren RA RetiefDH Sussell CM Microleakage Evaluation

of VitrabondP-50 Class II Restorashytions J Dent Res IADR Abstract 2393 V70 p565 (April 1991)

18 Moon PC Moxley JE Haas TW Measurement of the Mechanical Properties of Dentin Bonding Adheshysives J Dent Res IADR Abstract 1020 V70 p393 (April 1991)

19 Rueggeberg FA Margeson DH The Effect of Oxygen Inhibition on an UnflliedFilled Composite System J Dent Res V69 pp1652-1658 (1990)

20 Feilzer AJ De Gee AJ Davidson CL Different Setting Stresses in Composites for the Two Curing Modes J Dent Res IADR Abstract 2084 V70 p527 (1991)

21 Ziemieki TL Wendt JR Leinfelder KF Wear of Composite Resin in Proximal Contact J Dent Res IADR Abstract 260 V70 p298 (April 1991)

22 Poschke A Bergmann P Woack MJ Roulet JF Margin Quality of Posterior Hybrid Composite Restorashytions in Vitro J Dent Res IADR Abstract 1014 V70p392 (April 1991)

23 Moon PC Moxley JE Haas TW Mechanical Properties of PolymershyFilled Dentin Bonding Adhesives J Dent Res AADR Abstract 1368 V71 p 277 (March 1992)

24 Moon PC Chang YH Effect of Dentin Bonding Adhesive Layer Thickness on Composite Resin Shrinkage Stress J Dent Res AADR Abstract 1351 V71 p275 (March 1992) ~

Pearlofthe Month by Francis J Filipowicz DDS MS

~

Hot Compress

A hot moist compress is one of the most effective ways to soothe muscle spasms or focalize an area of infection Patient compliance is not always great since the proceshydure is inconvenient and a bit messy

Placing a wet towel or wash cloth in the microwave for a minute more or less will make the procedure much more effective and convenient Since the center of the towel will be hotter it will maintain the heat for a much longer period One could do the same thing with a small moist poultice held over a periodontal abcess

Some of the principles for cold and hot compresses

1) Cold will minimize circushylation reduce swelling and works best with trauma

2) Heat will increase circulashytion repair and draw or focalize an area of infection ~

DENTISTRY HEALTH CARE THAT WORKS

14

Northern Virginia Sponsors the Future

by Timothy E Russell DDS

The Northern Virginia Dental Society launched its Science Talent Awards Program in March This is its initial effort to recognize the research accomplishments of area high school students

parents counselors and teachshyers of talented science students (3) promote dentistry to the viewing public at local and regional levels (4) gain valushyable media exposure and (5) provide another way for denshytists to contribute to their community Costs are minimal and the benefits are substantial

If you would like information about the Component VIn Awards Program please call Dr Tim Russell at 703360shy1776 1

Dr Russell is a 1964 graduate ofMCV and practices in Alexanshydria He has served as student mentor Scientific Review Commitshytee member and as judge and chairman ofcategory judges at local and regional levels ofother science fair competitions

Competitions were held at five regional science and engineering fairs involving seven county public high school systems NVDS judges evaluated 1395 projects each project had won at the students respective high school Winners at the regional level were chosen for their exceptional science talent as evidenced by their project presentations and interviews Fifty-eight awards were presented to the winners Awards consisted of certifishycates ADA Select literature and the National Institute for Dental Researchs Broadening the Scope a Long Range Research Planfor the Nineties

Participation in regional science and engineering fairs provides our profession with a fresh and exciting means to compete for highly qualified students on a level playing field Components are able to (1) promote dentistry within the scientific community (2) proshymote dentistry as a career to

Dr Shalba Ranjbar (r) interviews one ofNVDS s 58 award winners

NVDS joined more than 70 scientific and engineering organizations

in judging projects at the Fairfax competition

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Legislative

UPDATE

The following is a review of legislation of interest to the Virginia Dental Association and the status of those issues upon adjournment of the General Assembly

Licensure by Endorsement Senate Bill 767 patroned by

Senator Jane Woods and House Bill 2002 patroned by Delegate Dave Brickley were introduced at the request of the Virginia Dental Association These bills prohibit licensure by endorsement and retain the current requirement of testing for all dentists seeking a license to practice in the Commonshywealth of Virginia

Governor Allen signed the licensure by endorsement legislation which will become law effective July 1 1995

Confidentiality of Records This measure parallels existshy

ing sect 541-2910 dealing with confidentiality of investigative information for those individushyals licensed by the Board of Medicine

The Virginia Dental Associashytion called for the introduction of this measure because it believed that the confidentiality of all investigative materials unresolved complaints and unsubstantiated complaints should be maintained by the Board of Dentistry At the present time the Board may disclose any and all material maintained on individual dental practitioners to any requesting individual or organization under the Freedom of Infonnashytion act This provides an intrusion into the privacy of the dentist and may lead to the dissemination of unfounded facts to the general public

HB 1913 maintains the confidentiality of these files and thus precludes the kind of actions described above This bill has been signed by Govershynor Allen

Pans Le~islation

SB 553 requires insurers health service plans and health maintenance organizations to provided coverage for diagnosshytic and surgical procedures involving any bone or joint of the skeletal structure including any bone or joint of the head and neck face or jaw Lanshyguage in SB 553 was the product of compromise beshytween the insurance industry and the Virginia Dental Assoshyciation during deliberations before the Special Advisory Commission on Mandated Health Insurance Benefits

The measure which becomes law on July 1 is needed beshycause some insurers exclude coverage for the treatment of diseases of the facial bones and

(L to r) Gov Mills E Godwin Jr and VDA President Elect and Mrs Ron Tankersley discuss Virginia issues at the VADPAC dinner

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joints while providing coverage for identical or similar treatshyment of those diseases affecting bones and joints elsewhere in the body

Any Willin ~ Provider Delegate Jay DeBoer (Demoshy

crat Petersburg) patroned House Bill 1869 which was initially designed to clarify Virginias Any Willing Proshyvider Statute

During the course of considshyeration of this measure in the Health Welfare and Education Committee of the House of Delegates an amendment was added which would basically have stripped outthe existing Any Willing Provider language

VDA was part of a group of health care providers that spoke adamantly in opposition to the amendment This amendment was subsequently defeated in the committee and Virginias Any Willing Provider Statute remains intact

The Virginia Chamber of Commerce listed the repeal of the Any Willing Provider Statute as one of its major initiatives for the 1995 session of the General Assembly The Chamber joining forces with the insurance industry and other business entities will undoubtshyedly try a repeal of this statute in future General Assembly sessions

Utilization Review The Virginia Dental Associashy

tion joined with numerous health care providers in advoshycating the introduction of HB 1973 This measure patroned by Delegate John Watkins (Republican Chesterfield County) puts into place an effective utilization review criteria for the patients and health care providers of the Commonwealth The VDA feels that the measure is balshyanced in terms of trying to consider the requirement of insurers HMOs health care providers and patients

As passed the measure accomplishes the following

bull Places requirements on insurers HMOs and others that perform utilization review to determine if treatment or testing is medically necessary

bull Includes an involved set of internal appeals and reviews

bull Puts into law the standards generally set out by the Utilizashytion Review and Accreditation Committee ( a national group of insurers HMOs and others that perform utilization review)

bull Requires an independent final appeal that is to be conducted by a peer of the treating health care provider licensed in Virshyginia or another state with comparable licensing laws

bull Prohibits the utilization review agent from retaliating against a provider for advocatshying the needs of hisher patient

Assiampnment of tax credits Senate Bill 1106 allows

clinics that provide health care services without charge to assign a portion of their tax credits to physicians and denshytills who provide health care services again without charge at the clinic

All of the items listed above with the exception of the Any Willing Provider bill (HB 1869) have been signed by the Governor and will become law on July 1 1995

The VDA was also involved in measures which provide for immunity from civil liability for acts or omissions committed by dentists while providing their services without charge at a free clinic in the absence of gross negligence or willful misconduct Jim Scott (Demoshycrat Fairfax County) was the patron of this bill )


17

Virginia Dental Political Action Committee

VADPAC sponsored two programs in connection with the VDA Winter Committee meetings On Friday January 27 Dr Charles Blair of BlairshyMcGill Associates of Charlotte spoke on Overhead Control That Makes Cents to 78 Virshyginia dentists spouses and staff Dr Blair graciously donated his services to ADPAC and VADPAC for this seminar to assist dentistrys legislative efforts

Friday evening Governor Mills E Godwin Jr addressed an enthusiastic group of Virshyginia dentists and guests at the VADPAC annual dinner Twice governor of the Commonshywealth Mr Godwin offered thoughtful advice and warm encouragement to us from his years of public service

Dr John C Doswell u VADPAC chairman urges all Virginia dentists to join VADPAC in order to get out the message that Dentistry is Health Care That Works li

A Gracious Thank You

Dr John C Doswell n Richmond Virginia

Dear John

Thank you so much for your nice note to Katherine and me expressing your appreciation

for our visit to the Dental Association meeting in Richshymond recently It was a most interesting evening and I was pleased to have a chance to meet a number of the dentists who were attending There was a good spirit prevailing and it was a wonderful evening for us to be with such a fine group of Virginians

Over the years we have been to many meetings of various kinds but there was a special warm feeling with your group

With all good wishes and appreciation I am

Most sincerely

Mills E Godwin Jr

Dr Charles Blair (c) answers questions during a break at his VADPAC seminar Overhead Control That Makes Cents

Dr John C Doswell II (1) presents Governor Godwin with a framed print of tlu State Capitol in appreciation for his address at the VADPAC dinner

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meeting hosted by our composhyComponent News nent with DR expert Roger

COMPONENT I Tidewater Dental Association

Barry Einhorn Associate Editor

A number of our members have retired in recent months We wish them luck in their new lives and hope that they will enjoy long life and good health The lucky guys are Roger Visser Barry Einhorn Irwin Hurwitz and Brodie Williams Jr Dr Williams practiced dentistry for 52 years 47 of those years as an active and contributing member of our component

We are proud of Dr Jack Cherin who was appointed chairman of the Ethics Comshymittee of the American Acadshyemy of Head and Neck Pain and TMJ Orthopedics by its board of directors Jack was also elected associate editor of the Journal of the American Academy ofHead and Neck Pain

We are also proud of Dr Ed Weisberg who was elected president of the Optimist Club of Wards Comer Norfolk Ed has a distinguished career of working with youth in our community which is the primary focus of Optimists

COMPONENT 1 Peninsula Dental Society

Dr Jeffrey N Kenney Associate Editor

As summer approaches the Peninsula Dental Society continues to be busy At our March membership meeting officers elected for 1995-96 were as follow PresidentshyGisela Fashing President ElectshyJeffrey Kenney Secretary-Cory Butler Treasurer-Guy Levy Councilor-Richard Barnes

Direct reimbursement (DR) has become a major goal for our component Ron Tankersshyley gave an informative overshyview at our March membership meeting An effort was made to organize our membership to recruit potential companies via personal contacts with CEOs and other important company employees Our DR Committee met several times including March 27 to discuss strategies for contacting businesses (especially those with over 100 employees) Basically the dentist is not trying to sell the concept rather to make the initial contact and to get the company interested in a moneyshysaving win-win situation The CEO or company representative was encouraged to attend a

Schultz presenting the pertinent important information and data regarding DR programs This meeting was held on May 23 since this was after Journal deadline details will appear in upcoming Component News

Our joint CE meeting with the Tidewater Dental Associashytion was held April 28 and 29 We look forward to more joint CE courses in the future Important upcoming VDA dates include the June 9-11 VDA committee meetings in Williamsburg and the VDA Annual Meeting in Reston September 13-18

From the General Assembly the existing any willing proshyvider legislation was preserved in spite of efforts by multiple opposing groups In theory this prevents closed-panel insurance plans This does however fall short of the VDA goal to prohibit economic discriminashytion against non-participants of an insurance plan Also a bill passed which provides recourse for practitioners who feel patients have been unfairly treated by insurance utilization review procedures In addition the VDA s legislative initiative against licensure by endorseshyment passed


19

COMPONENT III Southside Dental Society

Dr H Reed Boyd III Associate Editor

Much has been going on in our Component here in Southshyside Virginia On April 1 a Health Fair was held in South Hill a small community at the junction of 1-85 and US 58 about 80 miles south of Richshymond Dr John Bass and his wife Faye were instrumental in organizing the fair getting the Southside Dental Society and the MCV School of Dentisrry together to provide more than 300 oral health and cancer screenings in the new Mobile Dental Van I had seen the van in photos and had even seen its exterior Now that I have been inside and actually been a part of its mission let me tell you what an impressive facility this van is It is a fully self-conshytained dental office any of us would be proud to work in Keith Williams its custodian is very capable and knowledgeshyable in its workings Gone are the days of straight-back chairs flashlights and tongue depresshysors for examination With the van which is attractive both inside and out we can now serve the public in a professhysional and comfortable setting for both patient and dentist without sacrificing the quality of the service we provide I

20

would encourage each composhynent to get in touch with Dr Frank Farrington Chairman of Pediatric Dentistry at MCV and schedule a van visit in your component

The January 9 1995 issue of ADA News reported that Mary Logan Director of the Division of Legal Affairs of the ADA was leaving In the My View column she wrote If I were a dentist In this article she mentioned many of the benefits of membership in organized dentistry She closed her article with this statement Im not a dentist Im just a lawyer But Im still proud This is a terrific organization and thats the real scoop That to me is high praise coming from anyone I would encourage each of you to go back and read this article It will make you proud and very glad you are a part of organized dentistry especially if the dues seem high

I was in St Petersburg Florida for a course (all of which I would highly recomshymend) with Dr Pete Dawson Reading USA Today I ran across an article about a former major league baseball player and chewing tobacco Bill Tuttle played center field for several major league teams from 1952-63 Today he is dying from oral cancer which doctors relate directly to his chewing tobacco The Amerishycan Fund for Dental Health has

recruited Joe Garagiola to be national spokesperson for its National Spit Tobacco Educashytion program Gloria Tuttle Bills wife wrote a very touchshying letter outlining the ordeal she and her husband are now going through due to chewing tobacco In the letter she details how Bill Ieamed everything from the other big leaguers about the game including how to chew tobacco Now she says he cant even open a bottle of ketchup due to the ravages of the cancer She opened her letter I am watchshying the man I love die It is the most difficult thing I have ever had to do in my entire life This is an important message that needs to be brought in to our high schools and colleges in an effort to prevent more cases such as Bills I have copies available of the article and letter if anyone would care for them

Our component notes with sadness the passing of Dr Joseph H Turner on April 17 1995 He had been practicing dentistry for 63 years Dr Turner attended VPI in 1927-28 and graduated from MCVs School of Dentistry in 1932 Back then the dental program was only five years long one year of undergraduate college and four years in dental school He began practicing in Front Royal in 1932 and moved to Fayetteville NC in 1934 where he practiced for one

year He returned to South Hill in 1935 and practiced there permanently Dr Larry Hensshyley a dentist married his daughter and practiced with Dr Turner for two years In 1972 Dr Turner planned to retire and built a retirement home in Palmer Springs on Kerr Lake However he quickly found out that he missed dentistry and added a two-chair office onto his new retirement home and continued to practice dentistry until he formally retired again in early 199563 years after beginning his first practice and just before his untimely death

Dr Turner had iJ long and great career in dentistry He was a past president of the Southside Dental Society and was active outside of dentistry When he returned to South Hill in 1935 he organized the Union Gospel Chapel Dr Turner would have been 88 in July of this year We gratefully rememshyber his long and successful career Component III and the VDA extend our sympathy to his family

I would encourage each of you to keep abreast of the VDA and ADA calendars of events and make plans to attend those meetings as well as those of your own component Hope to see you at the VDA Annual meeting in Reston September 13-18 Mark your calendar now

Dr Benita A Miller Associate Editor

Our members have been busy this winter and spring In February Dr Willie Crockett was presented with our Societys highest honor the Harry Lyons Award for outshystanding leadership scholarship and service to the dental professhysion A long-time professor at MCV Dr Crockett has reshyceived many other honors including Fellow of the VDA Fellow of the American Colshylege of Dentists president of OKU and the OW Clough Teaching Award for his dedicashytion to teaching and to denshytistry Always active in his community Dr Crockett also established a dental clinic for the Crump Nursing Home in Henrico County He has always had our highest respect as the utmost professional and gentleshyman and his open mind and forward thinking made him a consummate teacher He is greatly admired by all and brings distinction to the Harry Lyons Award

Another newsworthy memshyber Dr Bob Eshelman reshyceived attention from the Richmond Times Dispatch for his non-dental pursuits An amateur radio operator since

age 14 Dr Eshelman recently was named Worlds Greatest DXer by QST Magazine a leading amateur radio magazine published by the American Radio Relay League The title refers to his ability to establish long distance or DX contacts in other countries and Dr Eshelman has made these contacts with amateur radio operators in all of the 326 countries where it is possible to do so

Through its president Mrs Jennifer Hudgins the members of the Alliance to the RDS have ccordinated a number of activishyties to benefit dentistry and the publics awareness of oral health Gift bags and baskets of apples were presented to all state legislators during National Dental Health Month For its major philanthropic project for March the Alliance sponsored a Table Topper party and brunch at the home of Mrs Caroline Sweeney A great success this festive event raised funds for the MCV Mobile Oral Health Clinic a staffed and equipped dental vehicle providing primary oral health care and education to rural and urban underserved communities throughout the state MCV provides faculty staff and students to deliver care but other costs such as dental supplies maintenance and travel expenses come from a variety of sources If you


21

would like to make a taxshydeductible contribution to the MCV Mobile Oral Health Clinic please contact Mrs Pat Hunt at 804323-1686

We have a hiatus from conshytinuing education through the summer until September 19 when we will sponsor our VDA statewide program Dr Leonard Horowitz on Dentistry in the Age ofAIDS He is the author of Deadly Innocence the controversial accounting of the events surrounding the deaths of Dr David Acer and Kimshyberly Bergalis More details in this summers Journal

Weare saddened by the loss of five of our members Drs Bennett Malbon Ralph Hodges C Rodes Boyd William Overcash Jr and Aubrey Harlow

On a happier note we welshycome our newest arrivals Bayley Locker Wood born to Letty and Richard Wood Anne Temple Londrey born to Susan and Jeff Londrey Kathryn Margaret Finley-Parker born to Kitt and Tom Finley-Parker and Jacob Scott Gore born to Michelle and Scott Gore

COMPONENT vu Shenandoah Valley Dental Society

William C Bigelow Associate Editor

As spring begins in this area we enjoy the gorgeous trees and flowers that decorate our beaushytiful part of the State As the second quarter begins we look forward to interesting and enlightening continuing educashytion courses The spring meetshying of Component VII was held on May 19 1995 at the Omni Hotel Charlottesville Drs J Gary Maynard Jr and Richard D Wilson presented a program on Practice Building with Periodontics and Restorative Dentistry

Plans are being made for the fall meeting in October 1995 at the Wintergreen resort A program on Porcelain Veneers and Aesthetic Dentistry will be presented by Dr Cherlyn Steets from Newport Beach Califorshynia As information on that meeting is formalized registrashytion forms will be sent to the members Any member of the VDA outside the Component interested in attending this meeting should contact the Component President Dr Wayne Remington at 804973shy7744 The Component would also like to take this opportushynity to welcome new members into the Component Dr AnnashyMaria Boggs is practicing pedshyodontics in Harrisonburg Dr John Boyles has joined the practice of Dr Bob Markley in Staunton Dr Jack T Kayton III has joined the practice of Dr Wayne Remington in Charlotshy

tesville We welcome all of these new dentists to the area and are excited about their membership in the Component

We are looking forward to an exciting year and invite any of the other components to our area to visit

COMPONENT VIII Northern Virginia Dental Society

Dr Bruce W Jay Associate Editor

Greetings from Northern Virginia host of the 1995 Virginia Dental Association meeting in September 13-17 1995 at the Hyatt Regency Reston If you havent marked your calendar do so now as this meeting promises to be one of the most exciting yet

The Nonhern Virginia Dental Clinic (Component VIIIs volunteer clinic for the indishygent) recently received a grant in the amount of $20000 from the Eugene and Agnes Meyer Foundation Our clinic is being overwhelmed by the number of needy patients and any help that you may be able to give would be cheerfully accepted Please call 703820-7170 to offer any donations or support

Our component mourns the passing of Dr Joe W Guest on March 9 1995 A graduate of

22

the University of Tennessee he received his dental degree from the University of Kentucky He served in the Navy Dental Corps before settling in Arlingshyton in 1982 Joe was a fellow of the Academy of General Denshytistry and active in Rainbow Christian Services and the Kiwanis Club of Arlington

The Northern Virginia Dental Society welcomes its newest member Dr Ea-Lim Bophary

MCVNews by Michael Dishman MeV Editor

The School of Dentistry is happy to announce that the renovation of the Dental Hyshygiene Clinic is finished The completion of this state-of-theshyart facility along with the new Graduate Prosthodontic Clinic and the renovated Wood Clinic mark the culmination of this clinic renovation at the School of Dentistry

In this issue we feature the Department of Oral and Maxilshylofacial Surgery Dr Dan Laskin serves as chairman of a this active department Presshyently there are over 25 research projects underway Members of the department have published 11 articles 11 abstracts 8 book chapters and 3 books and presented 38 lectures at various professional meetings and courses during the last year

alone Two dental students and one resident participated with members of the faculty who coshyauthored five presentations at the recent meeting of the Amershyican Association of Dental Research in San Antonio Also the department recently reshyceived $12500 from the American Association of Oral and Maxillofacial Surgeons for a research training grant for dental students interested in oral and maxillofacial surgery

Several of the articles chapshyters and books mentioned above are noteworthy The book chapter and articles are

bull Abubaker AD Differential diagnosis of arthritis of the temporomandibular joint Oral and Maxillofacial Clinics of North America 1995

bull Campbell RL Monitoring during outpatient general anesthesia What should be done and need not be done Chapter in Controversies in Oral and Maxillofacial Surshygery P Worthington and WD Evans (eds) WB Saunders 1994

bull Worley CM Strauss RA Augmentation of the anterior temporalis fossa after temporal is muscle transfer Oral Surg Oral Med Oral Path 78146-150 1994

bull Giglio JA Gunsolley JC Laskin DM Short K Effect of removing third molars on plaque and gingival indices J Oral Maxillofac Surg 52584shy587 1994

bull Bluhm AE Laskin DM The effCct of polyetra-fluorethylene cyhnders on osteogenesis in rat fibrelar defects J Oral Maxillofac Surg 53163-1661995

The books are bull Medical Management of Temporomandibular Disorshyders Laskin CM (ed) Oral and Maxillofacial Clinics of North America WB Saunders 1995

bull Progress Notes The Changing Face of Oral and Maxillofacial Surgery Laskin DM WB Sanders 1995 The last work represents 20 years of editorials written by Dr Laskin as editorshyin-chief of the Journal ofOral and Maxillofacial Surgery

The faculty of the department maintain busy didactic and clinical teaching schedules in addition to their considerable scholarly contributions The department has expanded the training of residents in oral implantology especially in the management of patients with complex problems requiring sinus lifts bone grafts and nerve transposition

The department is actively pursuing contributions for the S Elmer Bear Professorship Fund This named professorshyship will honor the past chairshyman of the department Contrishybutions are welcome

Under the direction of Dr Dan Laskin the Department of Oral and Maxillofacial Surgery


23

is prominent at the local regional and national levels The faculty of the department maintain a high level of teachshying service and scholarly activities L

News from the Division of DentalHealth

The Dental Disease Prevenshytion Grant which is part of the Preventive Health and Health Services Block Grant has been available to the Division of Dental Health since 1981 This funding which comes to the state from the federal governshyment has been used for prevenshytion activities such as commushynity water fluoridation schoolshybased fluoride mouthrinse programs care programs in areas where no dental public health program existed and for the education of Virginias youth regarding the hazards associated with tobacco prodshyucts

Some of the successes of this program are having 90 of the population on public water supplies feasible to fluoridate consuming optimally fluorishydated water caries prevention programs in three dental shortshyage areas in the state 31000 children not on fluoridated water supplies participating in a school based fluoride mouthrinse program and placing 55000 dental sealants in dental public health proshygrams in 1994

Despite the activities and allocations of this grant (about $200000 per year) there are still areas in the Commonshywealth where populations are underserved For example no community water fluoridation no school based prevention projects regarding the benefits of regular dental care no access to routine dental care for dental specialists When asked why this situation exists decision makers have stated that there is no demand

In an effort to alleviate this problem part of the Dental Disease Prevention funding this year supported a dental educashytion project in the counties south of Richmond to promote oral health A dental hygienist was hired to plan and impleshyment this project She came to the Division of Dental Health with a wealth of experience from the North Carolina Public Health Program and the Unishyversity of Virginia Hospital dental program Ms JoAnn Wells RDH travels daily to Halifax Mecklenburg and Dinwiddie Counties to provide education to school children regarding proper prevention techniques nutrition and the benefits of regular dental care Her educational information extends to teachers and school administration also

She is responsible for creating an interest in having the water fluoridated in Halifax County

introducing school based fluoride mouthrinse there reviving the mouthrinse proshygram in Brunswick County and developing an interest in all three counties for a dental prevention project With the cooperation of the Halifax School District an oral health survey is planned for May in Halifax County

Although a cursory survey of the childrens oral health reveals a high caries rate according to Ms Wells people accept this as the norm No public health dental programs exist in these areas to treat the indigent and because of the small number of practitioners in the area few are available for referrals of this magnitude Ms Wells has done an outstanding job of creating the awareness of the need for dental care

Next year preventive grant money will again support this project and plans are to begin projects such as this in Apposhymattox Campbell and Bedford Counties in the Southside and King and Queen King William and other counties of the Middle Peninsula

The need for dental care is there Through good dental education programs we can create the awareness in the public that the need exists and we hope this awareness will lead to a demand for optimal oral health Public health

24

working cooperatively with the private practice of dentistry is a great partnership in fulfilling the demand for optimal oral health for all Virginians

Virginia Board of Dentistry

The Virginia Board of Denshytistry is appointed by the governor and is composed of

Erma Freeman DDS 1st term ends 63097 21207 Chesterfield Ave Ettrick VA 23803 804526-2424 FAX 526-4660

seven dentists two hygienists For further information about

this preventive program or dental public health programs

and one citizen representative Contact the Board office or a member of the Board on ques-

John L Harris III MS DDS 1st term ends 63095 1930 Braebum Drive

please call Dr Elizabeth tions on rules and regulations Salem VA 24153 Bernhard at 804n86-3556 703989-5098

President VDA Counsel Honored Patricia Lee Speer DDS Robert 1 Isaacson DDS MS

1st term ends 63096 PhD John P Ackerly III VDA 6606 W Broad St 1st term ends 63097

counsel since 1968 was named Richmond VA 22314 MCV School of Dentistry to the Board of Visitors of the 804662-9906 DepanttnentofChthodontics University of Virginia on Richmond VA 23298-0566 March 1 1995 by Governor Vice President 804828-9326 FAX 828-5789 George Allen A graduate of Alonzo M Bell DDS

the University and its law 1st term ends 63096 French H Moore Jr DDS school and a partner in Mays amp 1755-B Duke Street 1st term ends 63096 Valentine in Richmond Mr Alexandria VA 303 Court Street Ackerly will serve for a fourshy 703836-3384 Abingdon VA 24210 year term He is widely known 703628-7862 FAX 676-5537 in dentistry for his extensive Secretary-Treasurer knowledge of issues in our Catherine Cotter Haywood Saundra D Nelson RDH MS profession The VDA congratu- RDHMEd 1st term ends 63096 lates our able attorney on his 1st term ends 63096 2000 27th Street appointment and wish him well Spotsylvania Voc Ctr Newport News VA 23607 as he serves his alma mater 1 6703 Smith Station Road 804244-1010 FAX 929-0589

Spotsylvania VA 22553 703898-2655 FAX 891-1784 Marcia J Miller Executive

Director Mark A Crabtree DDS 6606 W Broad Street 401 1st term ends 63098 Richmond VA 23230-1717 407 Starling Avenue 804662-9906 FAX 662-9943

Contract Analysis is Martinsville VA 24112 1

available through the 703632-7392 FAX 632-2341

VDA Central Office Paul F Ferguson Esq

1800552-3886 or 1st term ends 63097 804358-4927 2030 Clarendon Blvd 300

Arlington VA 22201 703527-0764

25

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Mrs Jocelyn Lance ofRichmond addressed the ADA Grassroots Confershyence in Washington DC in March She is National Legislative Chairman ofthe Alliance to the American Dental Association

The Alliance to the Virginia Dental Association visited the Virginia General Assembly on February 141995 Bearers of the Valentines Day gifts were (1 to r) Mesdames Brenda Gordon Allene Rice and Melanie Kerneklian

26

1995 VDASTATEWIPE CONTINUINGEPUCATION pROGRAM

Component 2 Kim Blore

October 27 Newport News Dr Harold Crossley A Reviewof Drugs of Abuse and Their Impact on Dental Practice

Component 3 October 20 Country Club Drs John Moriarty amp David Simpson Periodontics Current Therapy for the General Practitioner

bull Component 4 Linda Simon

September 29 Richmond Dr Leonard Horowitz AIDS-Politics policies amp DentalPractice Management

Component 6 August 11 Abingdon Dr Jerry Bouquot Pathology

To register for this course contact the Richmond DentalSociety CalMrs Linda Simon executive secretary at 804379-2534 or write to

Richmond Dental Society PO Box 13066 Richmond VA 23225

Additional Component Continuing Education Friday November 3 1995 830 am-430 pm Component 5 will host a seminar on Problem Solvingin Prosthodontics Speaker Dr James P Coffey Dept of Prosthodontics VCUMCV School of Dentistry Location Roanoke Airport Marriott

2801 Hershberger Road Roanoke VA 24017 Contact Dr Richard Huffman 703989-3321

4 DELTA DENTALreg Americas First Leading and Largest

Delta Dental Plan of Virginia

Corporate Headquarters Marketing Office 3807 Brandon Ave SW 360 PO Box 2759

Roanoke VA 24018 Glen Allen VA 23058-2759 1-800-572-3044 1-800-533-4137

New Benefit Program from the Virginia Dental Association

YRT PIAN FOR YOUR EMPLOYEES OFFERS ECONOMICAL

lllGH-QUAIIfY COVERAGE

YRT life insurance underwritten by Northwestern National Life Insurance ~arly Renewable Company has Term (YR1) life insurance been the choice the choice of the Virginia for professionals Dental Association like you for morefor their own personal than 30 years protection is now available Since it was firstfor their employees introduced in 1957 the YRT During the Virginia Dental

program has grown to insure thousandsAssociation active enrollment campaign of lawyers physicians accountants you can offer this new YRT product with dentists and other professionals across its economical high-quality protection to the country your employees

YRT is a quality benefit you can offer to Outstanding features include your employees with minimal effort onmiddot Flexible coverage up to $300000 your part For further information onmiddot Individual portable policy YRT for your employees or information middot Disability waiver of premium on YRT and 100 PLUS for association middot Guaranteed coverage to age 70 members contact(and over for qualified insureds)

Suter Haycraft amp Simmons 113Park Avenue Falls Church Virginia 22046 703241-0011 Fax 703538-1571

Underwritten by

m NWNLGROUP A division of Northwestern National LIfe Insurance Company

Home Office Minneapolis Mr--

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VernonH Shafer Sr eDT

Consultant

Vernon H Shafer Ir fDT

Richard M Shafer CDT

Dennis PClaypool III AnT-COT

Lynn M Jtnnlngs eDT

Ollielt Manager

George K Smith CDl

Michael Senn eDT

Albert A ODailey CDT

Andreas Brinkord ZT

RickWinegardner eDT

Rachell V Hooper SecretaryBookkeeper

Serving the Dental Profeeeion since 1942

Certified Dental Lahomtnry

Member National Association ofDenW

Laboratories

Member Virginia State Dental Laboratories Aaampamplalion

DenerCertined Laboratory

Clinical Retarlth and Associaws

Evaluator Laboratory

AT LAST the ultimate Esthetic Restoration from a small commercial laboratory that understands Anatomic and Functional Harmony the PankeyDawson way The restorative system is IPS EMPRESS the result of years of intense research and development by IvoclartWilliams Since its introduction both dentists and technicians alike have been virtually unanimous in their acclaim of EMPRESS for breathtaking esthetics and consistent precise fit

EMPRESS is a whole new generation of glass ceramic leuciteshyreinforced for strength Using the lost wax technique pre-shaded ceramic ingots are vacuum pressedfor consistent precise fits of 15-25 cu

Clinically for crowns veneers and onlays tooth preparation and bonding are the same as with previous all ceramic restorations only the results are different

And why Bay View Dental Lab Because no other lab in the state has made more of a commitment to proving that consistent high quality work can come from a commercial dental lab Our staff of board certified technicians combine for almost 200 years and over 250000 units of experience All work from die trim to final glaze and hand polish is done under 7-10X magnification For a laboratory that knows understands and will deliver the Anatomic and Functional Harmony your restorations need choose Bay View Dental Lab And for the ultimate in esthetics your patients want we choose IPSEMPRESS

We guarantee youll be IMPRESSED with EMPRESS

For addit Bay Vie 10nai inform 7829 Ca~b~~ntal Labo~~~on COntact NOrfOlk v Avenue ry Inc Tel lrgmia 23

ephone (804) 518-4001 583-1787

_~-----ZgtPROFESSIONAL MARKETING AND APPRAISAL (703) 934-6131

FULL SERVICE PRACTICE BROKERAGE

PRACTICE SALES amp PURCHASES

PRACTICE APPRAISALS

NATIONAL SALES NETWORK

FINANCING ARRANGED

MARKETING CONSULTING

MANAGEMENT CONSULTING

ASSOCIATE EVALUATION

BUYER CONSULTING amp REPRESENTATION

CONTRACTILEASE NEGOTIATION

COMMERCIAL REAL ESTATE SERVICES

PROVIDING OUTSTANDING SERVICE amp SATISFACTION

STANLEY S ZELMAN DDS AGENTCONSULTANT

reg ASSOCIATED WITH WEICHERT REALTORS

OFFICES IN BETHESDA amp WASillNGTON DC

11350 RANDOM HllLS ROAD SUITE 800 FAIRFAX VA 22030 bull (703) 934-6131 FAX (703) 591-3049

FOREST IRONS amp ASSOCIATES INC Temporary professional coverage for dental practices

800-433-2603

r 1

Solar Orthodontic Laboratory

Serving the needs of Virginia Dentists since 1976

introduces

A patented elastomeric acrylic for comfortable accurate adjustment-free retention ofconventional interocclusal appliances

bull Adjustment free fit ~1(800) 291-8804 Call Jack Wedding CDT to receive informationbull Little if any occlusal adjustment about the Talons Introductory Offer

bull The ultimate in comfort patient compliance

bull Clasping and periodontal contact eliminated bull No plasticizing chemicals

Talon isa registered trademark of comfort Acrylics Inc

Solar-Ortho Lab bull 413Industryllive bull Hampton Virginia 23661 bull 804838-8804

Starting Expanding Acquiring a Practice

Over 55000 Dentists Financed Since 1975 Whatever your needs you may qualify with HPSC for credit to finance new practice equipment leasehold improvements working capital merchandise contracts shyplus computers and other office equipment And if youre looking to acquire a practice we may fund up to 100 of the purchase price at competitive fixed interest rates (no points variables or hidden fees)

Our equipment lease is openshyended add as your practice grows We offer many innovative custom plans all geared to cash flow with tax benefits You may lease or loan from 6 to 72 months

To stay close to our customers we fund and service all of our accounts in-house Call us Weve financed over 55000 dentists Wed love to do your office

InnovativebullFinancing for H ealthcare Professionals

60 State Street Boston MA 02109-1803

1-800-225-2488 Fax 1-800-526-0259

A Happier Future

It could be 1 Every Lab One Crown is internally stained created with multi-colored

opaques and custom shaded to the patient in-lab if you wish 2 Our master ceramists schooled in the Dawson Technique craft only eight

units a day to assure you the individual excellence you deserve Compare that to 15 units at most other labsi

S

U 3 Our fully coordinated team features the highest caliber waxers and i

finishers to support our unparalleled standards 4 We offer the revolutionary Empress All-Ceramic Restorative System for

marginal integrity and unsurpassed esthetics 5 Our well respected heritage in cast frames and precision attachments adds

to our fixed expertise to produce what many dentists call the best combination work in the business

So for a happy 1994 and a brighter future for you and your practice call the one lab you must have on your side

(804) 455-8686 1003 Norfolk Square bull Suite Six Norfolk Virginia 23502~3234

Coming February 3 and 4 1995Hear the incomparable Dr Frank Spear on Creating Restorative Excellence A Complete Approch right here at Lab One 16 Credit Hours Small intimate class with limited seating available so you must register now Call for details

THE LONGER

YOU WAIT

THE MORE

YOU LOSE

Youve worked too hard to let your practice ~aste away as you approach retirement

AFTCOs Pre-Sale Program enables you to practice less maintain your income protect the value of your practice and can considerably improve your Quality of Life

If you are considering retirement within the next ten years the time to act is NOW

For information call AFTCO today

EQUITABLE TRANSACTIONS THROUGH DUAL REPRESENTATION

RGIS LABORATORY

Send Us Your Impressions

Sturgis has survived and mastered technique and material changes since 1928 we are not the new kid on the block Over 60 years in tfie business has established our reputation for fine craftsshymanship We utilize state-of-the-art equipment and skills Anyone Sturgis technician has over 300 years experience at his disposal meaning we can offer you older type restorations such as Porcelain Jacket Crowns or the very latest in the Dicor Crown Our personalshyized approach guarantees you a finer quality restoration by a skilled technician who takes pride in his work

Our fee schedule has no surprises with a policy of no remake or reshade charges and we pay the postage both ways on your shipment For your added convenience we have a toll free number as communication is our key to the future

The right quality the right service the right price Our goal is your success in pleasing your patients Acquaint yourself with Sturgis by giving us your impressions today

J MINOR STURGIS PORCELAIN LABORATORY The state-of-the-art dental laboratory

PO Box 1404 Atlanta GA 30301

For more information call 1-800-241-5533

TheNEW and IMPROVED PROFESSIONAL PRO~fR

- - -

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The eO~~~~~td ~~[~~~lJ~middotiK~LoCUlIt~~~~y~~ coveragfp~of$~E~Ofessip~yen~t~0J bullbullbull Limited90~b-a~~iability torPlanIxu1k~it~ore~onve~eJl~)utLmiddot middotmiddotarymiddot a tic~ns ure DefenseDiscip~ nd bullthatsno~tllemiddotoriiyj-cent~s(m it h~~~9mcentjt 1- L middotCoverage monratftcictlVetct6Ui-moreijian$6obQS insured dentists andan ever grgwhtg ~FirstAidC9J~~~e(~~isin addition to

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~~~~~1~e~~~~)middot~~cal~7~~~b~ the Professi~~rroe~orPlari~~bullbull lttgtmiddot bull bull b1creasedbullbull Ne~T)~nJstdisCouhts

Herea~ j~t~fefofthe new ~~iJI-) Increased Leave-of~Absencediscounts Irovelticoverages ~lici4~~ountsY91iget N~~ DentalAItestl~siolo~tCtasses with the ProfeSsional Protector PhiIL gt If your dentallragiceinsurance Iro~cuhisntproviding this level of iimovation and changetomeet then~lisOfyour Iroes~ion maybeitstime YOUon

JltJIN rnEpROFE~~IONA~PROTEcrOR PLAN middotmiddot~ND

ENJOy TIfEDIFFERENCE

Call today for deiil~iiii bullbullbullbull~ bullbullbull StlT8i1HAYCRAFTampSIMMONS

jIf$UmiddotlillcNC E F 0 fl (HE PR OF -E ss ION A L

CNA TheProfessionDl ProtedorP1atl isQ~tdid~ofPoe 6 BroumInl tmd isunderwritten byContinental Casualty Company and

Ntilional Fire Insurance Company of Hmtford two of the CNAInsllrance Companies

Virginia State DentalLaboratoriesAssociation Office 1009 Borden Road gt Richmond Virginia 23229

804282-7334

Please support our member labs

CENTRAL ViRGINIA

Capitol-Great Impressions 2103 Lake Ave Richmond VA 23230 804282-6200

Goodwin Dental Lab 2110 Maywill St Richmond VA 23230 804358-2113

TIDEWATER ViRGINIA

Bay View Dental Lab Inc 7829 Caribou Ave Norfolk VA 23518 804588-5544

Churchland CR amp BR Lab 3802 Poplar Hill Rd F Chesapeake VA 23321 804484-4106

Crown amp Bridge Lab Inc 7511 Avenue J Norfolk VA 23513 804588-1591

Ernst Dental Lab 454-0 Wythe Creek Rd Poquoson VA 23662 804868-8978

Ferguson CR amp BR Dental Lab 102 American Legion Rd Chesapeake VA 23321 804483-0100

James River Dental Lab 95 29th Street Newport News VA 23607 804244-7198

Lab One 1003 Norfolk Square Norfolk VA 23502 804455-8686

Old Dominion Orthodontic 500 Rodman Ave 3 Portsmouth VA 23707 804399-1229

Pontiques Ltd 401 Oyster Point Rd 6 Newport News VA 23602 804882-8730

Poplar Hill Ortho Lab 4012 Raintree Rd 120B Chesapeake VA 23321 804484-1919

Professional Dental Lab Inc 603 J Clyde Morris Blvd 7 Newport News VA 23601 804599-6705

Quality Dental Lab Inc 5265 Challendon Dr Virginia Beach VA 32462 804497-8211

Virginia Dental Labs Inc 130 W York St PO Box 807 Norfolk VA 23510 804622-4614

SOUTHWEST ViRGINIA

Dental Prosthetics Inc 1736 Memorial Ave SW Roanoke VA 24015 703345-5388

First Impressions Dental Lab 221-A Pollard St Vinton VA 24179 703345-5388

Haislip Dental Lab Drawer 427 South Boston VA 24592 804575-7947

JampM Crown amp Bridge Lab 4326 Brambleton Ave SW Roanoke VA 24018 7031989-3277

Pennington Crown amp Bridge Lab 128 N Pollard St Vinton VA 24179 703343-0434

Saunders Dental Lab Inc PO Box 13866 Roanoke VA 24034 703345-7319

Top Shelf Dental Ceramics Inc 403 Boulevard Salem VA 24153 703389-9006

Zuber Dental Arts Lee-Hi Shopping Center Salem VA 24153 703m2-0548

NORTHERN ViRGINIA

Aloha Dental Studio 7200 R Telegraph Square Dr Lorton VA 22079 703339- 7754

Johnson-Miller Dental Lab 915 N Stafford Street (1st Fir) Arlington VA 22203 703525-3771

Northern Virginia Dental Lab Inc 4126 Village Ct Annandale VA 22003 703941-2214

Pedemonte Dental Ceramics Inc 5101 Backlick Rd A Annandale VA 22003 703354-6220

Saylors Dental Lab Inc 8669 Phoenix Drive Manassas VA 22110 703361-4176

Triangle Dental Lab PO Box 145 Triangle VA 22172 703221-1555

Make a risk-free tax_deductible investmentof$60 and realistically saveseveral hundred dollarson dental supplies Guaranteed Ordera DentaCheque couponbookand evaluate the 103offers from 57 companies If youcant benefit return the bookfor a fun refund

Offers indude 5 invoice discountshonored by17 dental supplycompanies freeprodUCts and rebateson popularanesthetics needles diamonds restorativeand impressionmaterials infection control and cotton productsprophyand endosupplies and more Coupons are

validthroughout 95 There isan important humanitarian reason toorder a book and evaluate how muchyou can save TheNationalFoundationof Dentistryfor the Handicapped a charitableaffiliate of the ADA uses revenuefrom DentaCheque salesto expandits programs Thisyear the projectswill provide more than $32 millionin dental services for 35000 mentally physically and medically disabled individuals

Many verydeserving andvulnerablepeople needhelp I urge yOU to placean order bycallingthe Foundation at 1_800-366-3331

Thanksverymuch

~~ Cordon l ChristensenDDS MSD PhD Member BoardofDirectorsNational Foundation of Dentistry for the Handicapped

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Medical Protective Policyowners NEVER get letters like this

Any allegation of malpractice against a doctor is serious business If you are insured by The Medical Protective Company be confident that in any malpractice claim you are an active partner in analyzing and preparing your case We seek your advice and counsel in the beginning in the middle and at the end of your case In fact unless restricted by state law every individual Medical Protective professional liability policy guarantees the doctors right to consent to any settlement-shyno strings attached In an era of frivolous suits changing government attitudes about the confidentiality of the National Practitioners Data Bank and increased scrutiny by credentialing committees shouldnt you have The Medical Protective Company as your professional liability insurer Call your local General Agent for more information about how you can have more control in defense of your professional reputation

A+ (Superior) A M Best AA (Excellent) Standard amp poors800344-1899middot

Whats So Special About Partials From Virginia Dental Laboratories

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

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

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

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

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

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

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

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

5 Commitment Virginia Dental Laboratories is bull dedicated to providing you and your patients

with the highest quality partial dentures available We believe that the combination of our quality raw mateshyrials such as Vitallium Alloy our skilled technicians our unequaled experience and our steadfast dedication specially qualify us to satisfy the needs of you and your patients

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

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

Since 1932

irginia Dental Laboratories Inc 130 W York Street Norfolk Virginia 23510 (804) 622-4614

]l)Y Austcnal Inc All Rights Reserved Vitallium trademark licenser [0 AustenaJ Inc hy Pnzer Inc

SAUNDERS DENTAL LABORATORV INC

Believes your professional practice deserves our professional credential

CERTIFIED DENTAL LABORATORY

Through certification SAUNDERS DENTAL LABORATORY INC shows our concern for responsible standards of technical skill and education effective infection control techniques and a professional working environment No law demands we achieve and maintain certification We do it for our personnel our dental clients and their patients Isyour laboratory certified Do they qualify for certification If not call us for a complete get-acquainted-kit

SAUNDERS DENTAL LABORATORY INC 502 McDowell Avenue NE PO Box 13866 Roanoke Virginia 24037

Phone 703-345-7319 800-476-7319











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TABLE OF CONTENTS


6 Guest Editorial






17 VADPAC

19 Component News





COMMITTEES


































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Editorial









Dear Dr Carr




Mrs Pat K Watkins

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Program Name -=-shy












Annual Meeting



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~

Hot Compress







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Legislative

UPDATE









Pans Le~islation




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Dear John





Most sincerely

Mills E Godwin Jr



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Arlington VA 22201 703527-0764

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Underwritten by



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Consultant




Lynn M Jtnnlngs eDT

Ollielt Manager

George K Smith CDl

Michael Senn eDT


Andreas Brinkord ZT

RickWinegardner eDT





Laboratories











ephone (804) 518-4001 583-1787




PRACTICE APPRAISALS


FINANCING ARRANGED













800-433-2603

r 1



introduces













1-800-225-2488 Fax 1-800-526-0259

A Happier Future




S








THE LONGER

YOU WAIT

THE MORE

YOU LOSE






RGIS LABORATORY









- - -


~(~ihi bull - shy












804282-7334


CENTRAL ViRGINIA



TIDEWATER ViRGINIA














SOUTHWEST ViRGINIA









NORTHERN ViRGINIA











Thanksverymuch


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Since 1932













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TABLE OF CONTENTS


6 Guest Editorial






17 VADPAC

19 Component News





COMMITTEES


































4

Editorial









Dear Dr Carr




Mrs Pat K Watkins

5









6







Program Name -=-shy












Annual Meeting



7













7

Presidents Message






















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8
























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10












REFERENCES




11














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12









REFERENCES









13




















~

Hot Compress







14












15

Legislative

UPDATE









Pans Le~islation




16




















17







Dear John





Most sincerely

Mills E Godwin Jr



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Arlington VA 22201 703527-0764

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Underwritten by



L- ~~ -------- shy

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Consultant




Lynn M Jtnnlngs eDT

Ollielt Manager

George K Smith CDl

Michael Senn eDT


Andreas Brinkord ZT

RickWinegardner eDT





Laboratories











ephone (804) 518-4001 583-1787




PRACTICE APPRAISALS


FINANCING ARRANGED













800-433-2603

r 1



introduces













1-800-225-2488 Fax 1-800-526-0259

A Happier Future




S








THE LONGER

YOU WAIT

THE MORE

YOU LOSE






RGIS LABORATORY









- - -


~(~ihi bull - shy












804282-7334


CENTRAL ViRGINIA



TIDEWATER ViRGINIA














SOUTHWEST ViRGINIA









NORTHERN ViRGINIA











Thanksverymuch


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Since 1932






























TABLE OF CONTENTS


6 Guest Editorial






17 VADPAC

19 Component News





COMMITTEES


































4

Editorial









Dear Dr Carr




Mrs Pat K Watkins

5









6







Program Name -=-shy












Annual Meeting



7













7

Presidents Message






















-

8
























9















10












REFERENCES




11














-

12









REFERENCES









13




















~

Hot Compress







14












15

Legislative

UPDATE









Pans Le~islation




16




















17







Dear John





Most sincerely

Mills E Godwin Jr



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Arlington VA 22201 703527-0764

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Underwritten by



L- ~~ -------- shy

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Consultant




Lynn M Jtnnlngs eDT

Ollielt Manager

George K Smith CDl

Michael Senn eDT


Andreas Brinkord ZT

RickWinegardner eDT





Laboratories











ephone (804) 518-4001 583-1787




PRACTICE APPRAISALS


FINANCING ARRANGED













800-433-2603

r 1



introduces













1-800-225-2488 Fax 1-800-526-0259

A Happier Future




S








THE LONGER

YOU WAIT

THE MORE

YOU LOSE






RGIS LABORATORY









- - -


~(~ihi bull - shy












804282-7334


CENTRAL ViRGINIA



TIDEWATER ViRGINIA














SOUTHWEST ViRGINIA









NORTHERN ViRGINIA











Thanksverymuch


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Since 1932








TABLE OF CONTENTS


6 Guest Editorial






17 VADPAC

19 Component News





COMMITTEES


































4

Editorial









Dear Dr Carr




Mrs Pat K Watkins

5









6







Program Name -=-shy












Annual Meeting



7













7

Presidents Message






















-

8
























9















10












REFERENCES




11














-

12









REFERENCES









13




















~

Hot Compress







14












15

Legislative

UPDATE









Pans Le~islation




16




















17







Dear John





Most sincerely

Mills E Godwin Jr



18















19




20















21
















22



















23












24




















Arlington VA 22201 703527-0764

25

r



26























Underwritten by



L- ~~ -------- shy

--


Consultant




Lynn M Jtnnlngs eDT

Ollielt Manager

George K Smith CDl

Michael Senn eDT


Andreas Brinkord ZT

RickWinegardner eDT





Laboratories











ephone (804) 518-4001 583-1787




PRACTICE APPRAISALS


FINANCING ARRANGED













800-433-2603

r 1



introduces













1-800-225-2488 Fax 1-800-526-0259

A Happier Future




S








THE LONGER

YOU WAIT

THE MORE

YOU LOSE






RGIS LABORATORY









- - -


~(~ihi bull - shy












804282-7334


CENTRAL ViRGINIA



TIDEWATER ViRGINIA














SOUTHWEST ViRGINIA









NORTHERN ViRGINIA











Thanksverymuch


I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

















Since 1932





COMMITTEES


































4

Editorial









Dear Dr Carr




Mrs Pat K Watkins

5









6







Program Name -=-shy












Annual Meeting



7













7

Presidents Message






















-

8
























9















10












REFERENCES




11














-

12









REFERENCES









13




















~

Hot Compress







14












15

Legislative

UPDATE









Pans Le~islation




16




















17







Dear John





Most sincerely

Mills E Godwin Jr



18















19




20















21
















22



















23












24




















Arlington VA 22201 703527-0764

25

r



26























Underwritten by



L- ~~ -------- shy

--


Consultant




Lynn M Jtnnlngs eDT

Ollielt Manager

George K Smith CDl

Michael Senn eDT


Andreas Brinkord ZT

RickWinegardner eDT





Laboratories











ephone (804) 518-4001 583-1787




PRACTICE APPRAISALS


FINANCING ARRANGED













800-433-2603

r 1



introduces













1-800-225-2488 Fax 1-800-526-0259

A Happier Future




S








THE LONGER

YOU WAIT

THE MORE

YOU LOSE






RGIS LABORATORY









- - -


~(~ihi bull - shy












804282-7334


CENTRAL ViRGINIA



TIDEWATER ViRGINIA














SOUTHWEST ViRGINIA









NORTHERN ViRGINIA











Thanksverymuch


I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

















Since 1932



Editorial









Dear Dr Carr




Mrs Pat K Watkins

5









6







Program Name -=-shy












Annual Meeting



7













7

Presidents Message






















-

8
























9















10












REFERENCES




11














-

12









REFERENCES









13




















~

Hot Compress







14












15

Legislative

UPDATE









Pans Le~islation




16




















17







Dear John





Most sincerely

Mills E Godwin Jr



18















19




20















21
















22



















23












24




















Arlington VA 22201 703527-0764

25

r



26























Underwritten by



L- ~~ -------- shy

--


Consultant




Lynn M Jtnnlngs eDT

Ollielt Manager

George K Smith CDl

Michael Senn eDT


Andreas Brinkord ZT

RickWinegardner eDT





Laboratories











ephone (804) 518-4001 583-1787




PRACTICE APPRAISALS


FINANCING ARRANGED













800-433-2603

r 1



introduces













1-800-225-2488 Fax 1-800-526-0259

A Happier Future




S








THE LONGER

YOU WAIT

THE MORE

YOU LOSE






RGIS LABORATORY









- - -


~(~ihi bull - shy












804282-7334


CENTRAL ViRGINIA



TIDEWATER ViRGINIA














SOUTHWEST ViRGINIA









NORTHERN ViRGINIA











Thanksverymuch


I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

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I

I

I

I

I

I

















Since 1932











6







Program Name -=-shy












Annual Meeting



7













7

Presidents Message






















-

8
























9















10












REFERENCES




11














-

12









REFERENCES









13




















~

Hot Compress







14












15

Legislative

UPDATE









Pans Le~islation




16




















17







Dear John





Most sincerely

Mills E Godwin Jr



18















19




20















21
















22



















23












24




















Arlington VA 22201 703527-0764

25

r



26























Underwritten by



L- ~~ -------- shy

--


Consultant




Lynn M Jtnnlngs eDT

Ollielt Manager

George K Smith CDl

Michael Senn eDT


Andreas Brinkord ZT

RickWinegardner eDT





Laboratories











ephone (804) 518-4001 583-1787




PRACTICE APPRAISALS


FINANCING ARRANGED













800-433-2603

r 1



introduces













1-800-225-2488 Fax 1-800-526-0259

A Happier Future




S








THE LONGER

YOU WAIT

THE MORE

YOU LOSE






RGIS LABORATORY









- - -


~(~ihi bull - shy












804282-7334


CENTRAL ViRGINIA



TIDEWATER ViRGINIA














SOUTHWEST ViRGINIA









NORTHERN ViRGINIA











Thanksverymuch


I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

















Since 1932









Program Name -=-shy












Annual Meeting



7













7

Presidents Message






















-

8
























9















10












REFERENCES




11














-

12









REFERENCES









13




















~

Hot Compress







14












15

Legislative

UPDATE









Pans Le~islation




16




















17







Dear John





Most sincerely

Mills E Godwin Jr



18















19




20















21
















22



















23












24




















Arlington VA 22201 703527-0764

25

r



26























Underwritten by



L- ~~ -------- shy

--


Consultant




Lynn M Jtnnlngs eDT

Ollielt Manager

George K Smith CDl

Michael Senn eDT


Andreas Brinkord ZT

RickWinegardner eDT





Laboratories











ephone (804) 518-4001 583-1787




PRACTICE APPRAISALS


FINANCING ARRANGED













800-433-2603

r 1



introduces













1-800-225-2488 Fax 1-800-526-0259

A Happier Future




S








THE LONGER

YOU WAIT

THE MORE

YOU LOSE






RGIS LABORATORY









- - -


~(~ihi bull - shy












804282-7334


CENTRAL ViRGINIA



TIDEWATER ViRGINIA














SOUTHWEST ViRGINIA









NORTHERN ViRGINIA











Thanksverymuch


I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

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I

I

I

I

I

I

I

















Since 1932















7

Presidents Message






















-

8
























9















10












REFERENCES




11














-

12









REFERENCES









13




















~

Hot Compress







14












15

Legislative

UPDATE









Pans Le~islation




16




















17







Dear John





Most sincerely

Mills E Godwin Jr



18















19




20















21
















22



















23












24




















Arlington VA 22201 703527-0764

25

r



26























Underwritten by



L- ~~ -------- shy

--


Consultant




Lynn M Jtnnlngs eDT

Ollielt Manager

George K Smith CDl

Michael Senn eDT


Andreas Brinkord ZT

RickWinegardner eDT





Laboratories











ephone (804) 518-4001 583-1787




PRACTICE APPRAISALS


FINANCING ARRANGED













800-433-2603

r 1



introduces













1-800-225-2488 Fax 1-800-526-0259

A Happier Future




S








THE LONGER

YOU WAIT

THE MORE

YOU LOSE






RGIS LABORATORY









- - -


~(~ihi bull - shy












804282-7334


CENTRAL ViRGINIA



TIDEWATER ViRGINIA














SOUTHWEST ViRGINIA









NORTHERN ViRGINIA











Thanksverymuch


I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

















Since 1932



Presidents Message






















-

8
























9















10












REFERENCES




11














-

12









REFERENCES









13




















~

Hot Compress







14












15

Legislative

UPDATE









Pans Le~islation




16




















17







Dear John





Most sincerely

Mills E Godwin Jr



18















19




20















21
















22



















23












24




















Arlington VA 22201 703527-0764

25

r



26























Underwritten by



L- ~~ -------- shy

--


Consultant




Lynn M Jtnnlngs eDT

Ollielt Manager

George K Smith CDl

Michael Senn eDT


Andreas Brinkord ZT

RickWinegardner eDT





Laboratories











ephone (804) 518-4001 583-1787




PRACTICE APPRAISALS


FINANCING ARRANGED













800-433-2603

r 1



introduces













1-800-225-2488 Fax 1-800-526-0259

A Happier Future




S








THE LONGER

YOU WAIT

THE MORE

YOU LOSE






RGIS LABORATORY









- - -


~(~ihi bull - shy












804282-7334


CENTRAL ViRGINIA



TIDEWATER ViRGINIA














SOUTHWEST ViRGINIA









NORTHERN ViRGINIA











Thanksverymuch


I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

















Since 1932


























9















10












REFERENCES




11














-

12









REFERENCES









13




















~

Hot Compress







14












15

Legislative

UPDATE









Pans Le~islation




16




















17







Dear John





Most sincerely

Mills E Godwin Jr



18















19




20















21
















22



















23












24




















Arlington VA 22201 703527-0764

25

r



26























Underwritten by



L- ~~ -------- shy

--


Consultant




Lynn M Jtnnlngs eDT

Ollielt Manager

George K Smith CDl

Michael Senn eDT


Andreas Brinkord ZT

RickWinegardner eDT





Laboratories











ephone (804) 518-4001 583-1787




PRACTICE APPRAISALS


FINANCING ARRANGED













800-433-2603

r 1



introduces













1-800-225-2488 Fax 1-800-526-0259

A Happier Future




S








THE LONGER

YOU WAIT

THE MORE

YOU LOSE






RGIS LABORATORY









- - -


~(~ihi bull - shy












804282-7334


CENTRAL ViRGINIA



TIDEWATER ViRGINIA














SOUTHWEST ViRGINIA









NORTHERN ViRGINIA











Thanksverymuch


I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

















Since 1932

















10












REFERENCES




11














-

12









REFERENCES









13




















~

Hot Compress







14












15

Legislative

UPDATE









Pans Le~islation




16




















17







Dear John





Most sincerely

Mills E Godwin Jr



18















19




20















21
















22



















23












24




















Arlington VA 22201 703527-0764

25

r



26























Underwritten by



L- ~~ -------- shy

--


Consultant




Lynn M Jtnnlngs eDT

Ollielt Manager

George K Smith CDl

Michael Senn eDT


Andreas Brinkord ZT

RickWinegardner eDT





Laboratories











ephone (804) 518-4001 583-1787




PRACTICE APPRAISALS


FINANCING ARRANGED













800-433-2603

r 1



introduces













1-800-225-2488 Fax 1-800-526-0259

A Happier Future




S








THE LONGER

YOU WAIT

THE MORE

YOU LOSE






RGIS LABORATORY









- - -


~(~ihi bull - shy












804282-7334


CENTRAL ViRGINIA



TIDEWATER ViRGINIA














SOUTHWEST ViRGINIA









NORTHERN ViRGINIA











Thanksverymuch


I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

















Since 1932














REFERENCES




11














-

12









REFERENCES









13




















~

Hot Compress







14












15

Legislative

UPDATE









Pans Le~islation




16




















17







Dear John





Most sincerely

Mills E Godwin Jr



18















19




20















21
















22



















23












24




















Arlington VA 22201 703527-0764

25

r



26























Underwritten by



L- ~~ -------- shy

--


Consultant




Lynn M Jtnnlngs eDT

Ollielt Manager

George K Smith CDl

Michael Senn eDT


Andreas Brinkord ZT

RickWinegardner eDT





Laboratories











ephone (804) 518-4001 583-1787




PRACTICE APPRAISALS


FINANCING ARRANGED













800-433-2603

r 1



introduces













1-800-225-2488 Fax 1-800-526-0259

A Happier Future




S








THE LONGER

YOU WAIT

THE MORE

YOU LOSE






RGIS LABORATORY









- - -


~(~ihi bull - shy












804282-7334


CENTRAL ViRGINIA



TIDEWATER ViRGINIA














SOUTHWEST ViRGINIA









NORTHERN ViRGINIA











Thanksverymuch


I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

















Since 1932
















-

12









REFERENCES









13




















~

Hot Compress







14












15

Legislative

UPDATE









Pans Le~islation




16




















17







Dear John





Most sincerely

Mills E Godwin Jr



18















19




20















21
















22



















23












24




















Arlington VA 22201 703527-0764

25

r



26























Underwritten by



L- ~~ -------- shy

--


Consultant




Lynn M Jtnnlngs eDT

Ollielt Manager

George K Smith CDl

Michael Senn eDT


Andreas Brinkord ZT

RickWinegardner eDT





Laboratories











ephone (804) 518-4001 583-1787




PRACTICE APPRAISALS


FINANCING ARRANGED













800-433-2603

r 1



introduces













1-800-225-2488 Fax 1-800-526-0259

A Happier Future




S








THE LONGER

YOU WAIT

THE MORE

YOU LOSE






RGIS LABORATORY









- - -


~(~ihi bull - shy












804282-7334


CENTRAL ViRGINIA



TIDEWATER ViRGINIA














SOUTHWEST ViRGINIA









NORTHERN ViRGINIA











Thanksverymuch


I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

















Since 1932











REFERENCES









13




















~

Hot Compress







14












15

Legislative

UPDATE









Pans Le~islation




16




















17







Dear John





Most sincerely

Mills E Godwin Jr



18















19




20















21
















22



















23












24




















Arlington VA 22201 703527-0764

25

r



26























Underwritten by



L- ~~ -------- shy

--


Consultant




Lynn M Jtnnlngs eDT

Ollielt Manager

George K Smith CDl

Michael Senn eDT


Andreas Brinkord ZT

RickWinegardner eDT





Laboratories











ephone (804) 518-4001 583-1787




PRACTICE APPRAISALS


FINANCING ARRANGED













800-433-2603

r 1



introduces













1-800-225-2488 Fax 1-800-526-0259

A Happier Future




S








THE LONGER

YOU WAIT

THE MORE

YOU LOSE






RGIS LABORATORY









- - -


~(~ihi bull - shy












804282-7334


CENTRAL ViRGINIA



TIDEWATER ViRGINIA














SOUTHWEST ViRGINIA









NORTHERN ViRGINIA











Thanksverymuch


I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

















Since 1932






















~

Hot Compress







14












15

Legislative

UPDATE









Pans Le~islation




16




















17







Dear John





Most sincerely

Mills E Godwin Jr



18















19




20















21
















22



















23












24




















Arlington VA 22201 703527-0764

25

r



26























Underwritten by



L- ~~ -------- shy

--


Consultant




Lynn M Jtnnlngs eDT

Ollielt Manager

George K Smith CDl

Michael Senn eDT


Andreas Brinkord ZT

RickWinegardner eDT





Laboratories











ephone (804) 518-4001 583-1787




PRACTICE APPRAISALS


FINANCING ARRANGED













800-433-2603

r 1



introduces













1-800-225-2488 Fax 1-800-526-0259

A Happier Future




S








THE LONGER

YOU WAIT

THE MORE

YOU LOSE






RGIS LABORATORY









- - -


~(~ihi bull - shy












804282-7334


CENTRAL ViRGINIA



TIDEWATER ViRGINIA














SOUTHWEST ViRGINIA









NORTHERN ViRGINIA











Thanksverymuch


I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

















Since 1932














15

Legislative

UPDATE









Pans Le~islation




16




















17







Dear John





Most sincerely

Mills E Godwin Jr



18















19




20















21
















22



















23












24




















Arlington VA 22201 703527-0764

25

r



26























Underwritten by



L- ~~ -------- shy

--


Consultant




Lynn M Jtnnlngs eDT

Ollielt Manager

George K Smith CDl

Michael Senn eDT


Andreas Brinkord ZT

RickWinegardner eDT





Laboratories











ephone (804) 518-4001 583-1787




PRACTICE APPRAISALS


FINANCING ARRANGED













800-433-2603

r 1



introduces













1-800-225-2488 Fax 1-800-526-0259

A Happier Future




S








THE LONGER

YOU WAIT

THE MORE

YOU LOSE






RGIS LABORATORY









- - -


~(~ihi bull - shy












804282-7334


CENTRAL ViRGINIA



TIDEWATER ViRGINIA














SOUTHWEST ViRGINIA









NORTHERN ViRGINIA











Thanksverymuch


I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

















Since 1932



Legislative

UPDATE









Pans Le~islation




16




















17







Dear John





Most sincerely

Mills E Godwin Jr



18















19




20















21
















22



















23












24




















Arlington VA 22201 703527-0764

25

r



26























Underwritten by



L- ~~ -------- shy

--


Consultant




Lynn M Jtnnlngs eDT

Ollielt Manager

George K Smith CDl

Michael Senn eDT


Andreas Brinkord ZT

RickWinegardner eDT





Laboratories











ephone (804) 518-4001 583-1787




PRACTICE APPRAISALS


FINANCING ARRANGED













800-433-2603

r 1



introduces













1-800-225-2488 Fax 1-800-526-0259

A Happier Future




S








THE LONGER

YOU WAIT

THE MORE

YOU LOSE






RGIS LABORATORY









- - -


~(~ihi bull - shy












804282-7334


CENTRAL ViRGINIA



TIDEWATER ViRGINIA














SOUTHWEST ViRGINIA









NORTHERN ViRGINIA











Thanksverymuch


I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

















Since 1932






















17







Dear John





Most sincerely

Mills E Godwin Jr



18















19




20















21
















22



















23












24




















Arlington VA 22201 703527-0764

25

r



26























Underwritten by



L- ~~ -------- shy

--


Consultant




Lynn M Jtnnlngs eDT

Ollielt Manager

George K Smith CDl

Michael Senn eDT


Andreas Brinkord ZT

RickWinegardner eDT





Laboratories











ephone (804) 518-4001 583-1787




PRACTICE APPRAISALS


FINANCING ARRANGED













800-433-2603

r 1



introduces













1-800-225-2488 Fax 1-800-526-0259

A Happier Future




S








THE LONGER

YOU WAIT

THE MORE

YOU LOSE






RGIS LABORATORY









- - -


~(~ihi bull - shy












804282-7334


CENTRAL ViRGINIA



TIDEWATER ViRGINIA














SOUTHWEST ViRGINIA









NORTHERN ViRGINIA











Thanksverymuch


I

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I

I

I

I

I

I

















Since 1932









Dear John





Most sincerely

Mills E Godwin Jr



18















19




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Arlington VA 22201 703527-0764

25

r



26























Underwritten by



L- ~~ -------- shy

--


Consultant




Lynn M Jtnnlngs eDT

Ollielt Manager

George K Smith CDl

Michael Senn eDT


Andreas Brinkord ZT

RickWinegardner eDT





Laboratories











ephone (804) 518-4001 583-1787




PRACTICE APPRAISALS


FINANCING ARRANGED













800-433-2603

r 1



introduces













1-800-225-2488 Fax 1-800-526-0259

A Happier Future




S








THE LONGER

YOU WAIT

THE MORE

YOU LOSE






RGIS LABORATORY









- - -


~(~ihi bull - shy












804282-7334


CENTRAL ViRGINIA



TIDEWATER ViRGINIA














SOUTHWEST ViRGINIA









NORTHERN ViRGINIA











Thanksverymuch


I

I

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I

I

I

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I

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I

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I

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I

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Since 1932

















19




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24




















Arlington VA 22201 703527-0764

25

r



26























Underwritten by



L- ~~ -------- shy

--


Consultant




Lynn M Jtnnlngs eDT

Ollielt Manager

George K Smith CDl

Michael Senn eDT


Andreas Brinkord ZT

RickWinegardner eDT





Laboratories











ephone (804) 518-4001 583-1787




PRACTICE APPRAISALS


FINANCING ARRANGED













800-433-2603

r 1



introduces













1-800-225-2488 Fax 1-800-526-0259

A Happier Future




S








THE LONGER

YOU WAIT

THE MORE

YOU LOSE






RGIS LABORATORY









- - -


~(~ihi bull - shy












804282-7334


CENTRAL ViRGINIA



TIDEWATER ViRGINIA














SOUTHWEST ViRGINIA









NORTHERN ViRGINIA











Thanksverymuch


I

I

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I

I

I

I

I

I

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I

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I

I

I

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I

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Since 1932






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24




















Arlington VA 22201 703527-0764

25

r



26























Underwritten by



L- ~~ -------- shy

--


Consultant




Lynn M Jtnnlngs eDT

Ollielt Manager

George K Smith CDl

Michael Senn eDT


Andreas Brinkord ZT

RickWinegardner eDT





Laboratories











ephone (804) 518-4001 583-1787




PRACTICE APPRAISALS


FINANCING ARRANGED













800-433-2603

r 1



introduces













1-800-225-2488 Fax 1-800-526-0259

A Happier Future




S








THE LONGER

YOU WAIT

THE MORE

YOU LOSE






RGIS LABORATORY









- - -


~(~ihi bull - shy












804282-7334


CENTRAL ViRGINIA



TIDEWATER ViRGINIA














SOUTHWEST ViRGINIA









NORTHERN ViRGINIA











Thanksverymuch


I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

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I

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Since 1932












21
















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24




















Arlington VA 22201 703527-0764

25

r



26























Underwritten by



L- ~~ -------- shy

--


Consultant




Lynn M Jtnnlngs eDT

Ollielt Manager

George K Smith CDl

Michael Senn eDT


Andreas Brinkord ZT

RickWinegardner eDT





Laboratories











ephone (804) 518-4001 583-1787




PRACTICE APPRAISALS


FINANCING ARRANGED













800-433-2603

r 1



introduces













1-800-225-2488 Fax 1-800-526-0259

A Happier Future




S








THE LONGER

YOU WAIT

THE MORE

YOU LOSE






RGIS LABORATORY









- - -


~(~ihi bull - shy












804282-7334


CENTRAL ViRGINIA



TIDEWATER ViRGINIA














SOUTHWEST ViRGINIA









NORTHERN ViRGINIA











Thanksverymuch


I

I

I

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I

I

I

I

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I

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Since 1932


















22



















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24




















Arlington VA 22201 703527-0764

25

r



26























Underwritten by



L- ~~ -------- shy

--


Consultant




Lynn M Jtnnlngs eDT

Ollielt Manager

George K Smith CDl

Michael Senn eDT


Andreas Brinkord ZT

RickWinegardner eDT





Laboratories











ephone (804) 518-4001 583-1787




PRACTICE APPRAISALS


FINANCING ARRANGED













800-433-2603

r 1



introduces













1-800-225-2488 Fax 1-800-526-0259

A Happier Future




S








THE LONGER

YOU WAIT

THE MORE

YOU LOSE






RGIS LABORATORY









- - -


~(~ihi bull - shy












804282-7334


CENTRAL ViRGINIA



TIDEWATER ViRGINIA














SOUTHWEST ViRGINIA









NORTHERN ViRGINIA











Thanksverymuch


I

I

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I

I

I

I

I

I

I

I

I

I

I

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Since 1932





















23












24




















Arlington VA 22201 703527-0764

25

r



26























Underwritten by



L- ~~ -------- shy

--


Consultant




Lynn M Jtnnlngs eDT

Ollielt Manager

George K Smith CDl

Michael Senn eDT


Andreas Brinkord ZT

RickWinegardner eDT





Laboratories











ephone (804) 518-4001 583-1787




PRACTICE APPRAISALS


FINANCING ARRANGED













800-433-2603

r 1



introduces













1-800-225-2488 Fax 1-800-526-0259

A Happier Future




S








THE LONGER

YOU WAIT

THE MORE

YOU LOSE






RGIS LABORATORY









- - -


~(~ihi bull - shy












804282-7334


CENTRAL ViRGINIA



TIDEWATER ViRGINIA














SOUTHWEST ViRGINIA









NORTHERN ViRGINIA











Thanksverymuch


I

I

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I

I

I

I

I

I

I

I

I

I

I

I

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Since 1932














24




















Arlington VA 22201 703527-0764

25

r



26























Underwritten by



L- ~~ -------- shy

--


Consultant




Lynn M Jtnnlngs eDT

Ollielt Manager

George K Smith CDl

Michael Senn eDT


Andreas Brinkord ZT

RickWinegardner eDT





Laboratories











ephone (804) 518-4001 583-1787




PRACTICE APPRAISALS


FINANCING ARRANGED













800-433-2603

r 1



introduces













1-800-225-2488 Fax 1-800-526-0259

A Happier Future




S








THE LONGER

YOU WAIT

THE MORE

YOU LOSE






RGIS LABORATORY









- - -


~(~ihi bull - shy












804282-7334


CENTRAL ViRGINIA



TIDEWATER ViRGINIA














SOUTHWEST ViRGINIA









NORTHERN ViRGINIA











Thanksverymuch


I

I

I

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I

I

I

I

I

I

I

I

I

I

I

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Since 1932






















Arlington VA 22201 703527-0764

25

r



26























Underwritten by



L- ~~ -------- shy

--


Consultant




Lynn M Jtnnlngs eDT

Ollielt Manager

George K Smith CDl

Michael Senn eDT


Andreas Brinkord ZT

RickWinegardner eDT





Laboratories











ephone (804) 518-4001 583-1787




PRACTICE APPRAISALS


FINANCING ARRANGED













800-433-2603

r 1



introduces













1-800-225-2488 Fax 1-800-526-0259

A Happier Future




S








THE LONGER

YOU WAIT

THE MORE

YOU LOSE






RGIS LABORATORY









- - -


~(~ihi bull - shy












804282-7334


CENTRAL ViRGINIA



TIDEWATER ViRGINIA














SOUTHWEST ViRGINIA









NORTHERN ViRGINIA











Thanksverymuch


I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

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I

















Since 1932



r



26























Underwritten by



L- ~~ -------- shy

--


Consultant




Lynn M Jtnnlngs eDT

Ollielt Manager

George K Smith CDl

Michael Senn eDT


Andreas Brinkord ZT

RickWinegardner eDT





Laboratories











ephone (804) 518-4001 583-1787




PRACTICE APPRAISALS


FINANCING ARRANGED













800-433-2603

r 1



introduces













1-800-225-2488 Fax 1-800-526-0259

A Happier Future




S








THE LONGER

YOU WAIT

THE MORE

YOU LOSE






RGIS LABORATORY









- - -


~(~ihi bull - shy












804282-7334


CENTRAL ViRGINIA



TIDEWATER ViRGINIA














SOUTHWEST ViRGINIA









NORTHERN ViRGINIA











Thanksverymuch


I

I

I

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I

I

I

I

I

I

I

I

I

I

I

I

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I

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I

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I

I

















Since 1932

























Underwritten by



L- ~~ -------- shy

--


Consultant




Lynn M Jtnnlngs eDT

Ollielt Manager

George K Smith CDl

Michael Senn eDT


Andreas Brinkord ZT

RickWinegardner eDT





Laboratories











ephone (804) 518-4001 583-1787




PRACTICE APPRAISALS


FINANCING ARRANGED













800-433-2603

r 1



introduces













1-800-225-2488 Fax 1-800-526-0259

A Happier Future




S








THE LONGER

YOU WAIT

THE MORE

YOU LOSE






RGIS LABORATORY









- - -


~(~ihi bull - shy












804282-7334


CENTRAL ViRGINIA



TIDEWATER ViRGINIA














SOUTHWEST ViRGINIA









NORTHERN ViRGINIA











Thanksverymuch


I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

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I

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I

I

I

I

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I

I

I

















Since 1932














Underwritten by



L- ~~ -------- shy

--


Consultant




Lynn M Jtnnlngs eDT

Ollielt Manager

George K Smith CDl

Michael Senn eDT


Andreas Brinkord ZT

RickWinegardner eDT





Laboratories











ephone (804) 518-4001 583-1787




PRACTICE APPRAISALS


FINANCING ARRANGED













800-433-2603

r 1



introduces













1-800-225-2488 Fax 1-800-526-0259

A Happier Future




S








THE LONGER

YOU WAIT

THE MORE

YOU LOSE






RGIS LABORATORY









- - -


~(~ihi bull - shy












804282-7334


CENTRAL ViRGINIA



TIDEWATER ViRGINIA














SOUTHWEST ViRGINIA









NORTHERN ViRGINIA











Thanksverymuch


I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

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I

I

I

















Since 1932










Underwritten by



L- ~~ -------- shy

--


Consultant




Lynn M Jtnnlngs eDT

Ollielt Manager

George K Smith CDl

Michael Senn eDT


Andreas Brinkord ZT

RickWinegardner eDT





Laboratories











ephone (804) 518-4001 583-1787




PRACTICE APPRAISALS


FINANCING ARRANGED













800-433-2603

r 1



introduces













1-800-225-2488 Fax 1-800-526-0259

A Happier Future




S








THE LONGER

YOU WAIT

THE MORE

YOU LOSE






RGIS LABORATORY









- - -


~(~ihi bull - shy












804282-7334


CENTRAL ViRGINIA



TIDEWATER ViRGINIA














SOUTHWEST ViRGINIA









NORTHERN ViRGINIA











Thanksverymuch


I

I

I

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I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

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I

I

I

















Since 1932



--


Consultant




Lynn M Jtnnlngs eDT

Ollielt Manager

George K Smith CDl

Michael Senn eDT


Andreas Brinkord ZT

RickWinegardner eDT





Laboratories











ephone (804) 518-4001 583-1787




PRACTICE APPRAISALS


FINANCING ARRANGED













800-433-2603

r 1



introduces













1-800-225-2488 Fax 1-800-526-0259

A Happier Future




S








THE LONGER

YOU WAIT

THE MORE

YOU LOSE






RGIS LABORATORY









- - -


~(~ihi bull - shy












804282-7334


CENTRAL ViRGINIA



TIDEWATER ViRGINIA














SOUTHWEST ViRGINIA









NORTHERN ViRGINIA











Thanksverymuch


I

I

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I

I

I

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I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

















Since 1932






PRACTICE APPRAISALS


FINANCING ARRANGED













800-433-2603

r 1



introduces













1-800-225-2488 Fax 1-800-526-0259

A Happier Future




S








THE LONGER

YOU WAIT

THE MORE

YOU LOSE






RGIS LABORATORY









- - -


~(~ihi bull - shy












804282-7334


CENTRAL ViRGINIA



TIDEWATER ViRGINIA














SOUTHWEST ViRGINIA









NORTHERN ViRGINIA











Thanksverymuch


I

I

I

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I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

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I

I

I

















Since 1932




800-433-2603

r 1



introduces













1-800-225-2488 Fax 1-800-526-0259

A Happier Future




S








THE LONGER

YOU WAIT

THE MORE

YOU LOSE






RGIS LABORATORY









- - -


~(~ihi bull - shy












804282-7334


CENTRAL ViRGINIA



TIDEWATER ViRGINIA














SOUTHWEST ViRGINIA









NORTHERN ViRGINIA











Thanksverymuch


I

I

I

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I

I

I

I

I

I

I

I

I

I

I

I

I

I

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I

















Since 1932



r 1



introduces













1-800-225-2488 Fax 1-800-526-0259

A Happier Future




S








THE LONGER

YOU WAIT

THE MORE

YOU LOSE






RGIS LABORATORY









- - -


~(~ihi bull - shy












804282-7334


CENTRAL ViRGINIA



TIDEWATER ViRGINIA














SOUTHWEST ViRGINIA









NORTHERN ViRGINIA











Thanksverymuch


I

I

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I

I

I

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I

I

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I

I

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I

















Since 1932









1-800-225-2488 Fax 1-800-526-0259

A Happier Future




S








THE LONGER

YOU WAIT

THE MORE

YOU LOSE






RGIS LABORATORY









- - -


~(~ihi bull - shy












804282-7334


CENTRAL ViRGINIA



TIDEWATER ViRGINIA














SOUTHWEST ViRGINIA









NORTHERN ViRGINIA











Thanksverymuch


I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

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I

I

I

I

I

I

I

I

I

I

















Since 1932



A Happier Future




S








THE LONGER

YOU WAIT

THE MORE

YOU LOSE






RGIS LABORATORY









- - -


~(~ihi bull - shy












804282-7334


CENTRAL ViRGINIA



TIDEWATER ViRGINIA














SOUTHWEST ViRGINIA









NORTHERN ViRGINIA











Thanksverymuch


I

I

I

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I

I

I

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I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

















Since 1932



THE LONGER

YOU WAIT

THE MORE

YOU LOSE






RGIS LABORATORY









- - -


~(~ihi bull - shy












804282-7334


CENTRAL ViRGINIA



TIDEWATER ViRGINIA














SOUTHWEST ViRGINIA









NORTHERN ViRGINIA











Thanksverymuch


I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

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I

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I

I

I

I

















Since 1932



RGIS LABORATORY









- - -


~(~ihi bull - shy












804282-7334


CENTRAL ViRGINIA



TIDEWATER ViRGINIA














SOUTHWEST ViRGINIA









NORTHERN ViRGINIA











Thanksverymuch


I

I

I

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I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

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I

I

I

I

I

I

















Since 1932




- - -


~(~ihi bull - shy












804282-7334


CENTRAL ViRGINIA



TIDEWATER ViRGINIA














SOUTHWEST ViRGINIA









NORTHERN ViRGINIA











Thanksverymuch


I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

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I

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I

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I

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I

I

I

I

















Since 1932




804282-7334


CENTRAL ViRGINIA



TIDEWATER ViRGINIA














SOUTHWEST ViRGINIA









NORTHERN ViRGINIA











Thanksverymuch


I

I

I

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I

I

I

I

I

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I

I

I

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I

















Since 1932







Thanksverymuch


I

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Since 1932



















Since 1932
















Since 1932



Documents

Virginia Dental Journal