virginia dental journal

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

z o OFFICERS President: Wallace L. Huff, Blacksburg President Elect: Charles L. Cuttino III, Richmond

Immediate Past President: William H. Allison, Warrenton - Secretary-Treasurer: Thomas S. Cooke III, Sandston

Executive Director: William E. Zepp, CAE P.O. Box 6906, Richmond, 23230-0906~

EXECUTIVE COUNCIL COUNCILORS

o u-- Includes officers and councilors listed and: I Edward J. Weisberg, Norfolk David C. Anderson, Alexandria -Vice Chairman II Bruce R. DeGinder, Williamsburg

Gus C. Vlahos, Dublin III Harold J. Neal, Jr., Emporia Richard H. Wood, Richmond IV James R. Lance, Richmond Andrew J. Zimmer, Norfolk V Daniel E. Grabeel, Lynchburg-Chairman

VI Ronnie L. Brown, Abingdon ~

Ex Officio Members: VII William J. Viglione, Charlottesville f..,r} Parliamentarian: Emory R. Thomas, Richmond VIII Rodney J. Klima, Burke Editor: Leslie S. Webb, Jr., Richmond Speaker of the House: D. Christopher Hamlin, Norfolk

Dea~, School of Dentistry: Lindsay M. Hunt, Jr., Richmond

.....J

SOCIETY PRESIDENT SECRETARY PATIENT RELATIONS ~ Z Tidewater, I James W. Baker Ralph Howell, Jr. James H. Nottingham, Jr. LU

2995 Church land Blvd 102 Western Avenue 142 W. York St, Ste 705 Chesapeake, VA 23321 Suffolk, VA 23434-4434 Norfolk, VA 23510

o Peninsula, II Guy G. Levy Wayne E. "AJ" Booker Lawrence A. Warren 367 Denbigh Blvd 6632 Geo Wa Mem Hwy 106 Yorktown Road Newport News, VA 23608 Grafton, VA 23692 Tabb, VA 23693

Southside, III John M. Bass Scott E. Gerard John R. Ragsdale III -

212 N. Mecklenburg Ave 9401 Courthouse Road 9 Holy Hill Drive South Hill, VA 23970 Chesterfield, VA 23832 Petersburg, VA 23805

z Richmond, IV Gary R. Hartwell Charles E. Gaskins III William J. Redwine -

P.O. BoX 980566 703 N. Courthouse Rd, Ste 201 6808 Stoneman Road Richmond, VA 23298 Richmond, VA 23236 Richmond, VA 23228

lJ Piedmont, V Frank C. Crist, Jr. Gregory T Gendron Frank C. Crist, Jr. 8116 Timberlake Road 7 Cleveland Avenue 8116 Timberlake Road Lynchburg, VA 24502 Martinsville. VA 24112~ Lynchburg, VA 24502

Southwest. VI William B. Thompson Dana Chamberlain

> Paul T Umstott

- P.O. Box 318 645 Park Blvd. 300 W Valley Street Chilhowie, VA 24318 Manon, VA 24354 Abingdon VA 24210

Shenandoatl Valley, VII Gerald J. Brown J. Darwin King Alan Robbins 1871 Amherst Street 1220 North Augusta Street P.O. Box 602Winchester, VA 22601 Staunton. VA 24401 Timberville. VA 22853

Northern Virginia. VIII Kirk M. Norbo Neil J. Small Paul N. Zimmet 6200 Wilson Blvd, #114 9940 Main Street 5206 Dawes Avenue Falls Church. VA 22044 Fairfax. VA 22031 Alexandria, VA 22311

Williar:n E. Zepp. CAE, Business Manager Leslie S. Webb, Jr., Editor

ASSOCIATE EDITORS 4. Charles E. Gaskins III 7. Rebecca Scango Swett 1. Bernard I. Einhorn 5. Barry K. Cutright 8. Melanie R. Love 2. A. J. Booker 6. William B. Thompson School of Dentistry Thomas Burke 3. H. Reed Boyd III

March 1998 Number 1

TABLE OF CONTENTS 5 Editorial 6 Letters to the Editor 7 Message From the President 8 Answering Questions About Dental Radiation 10 Abstracts 15 VDA 1997 Leadership Conference

.. 17 From the Executive Director 18 Legislative Update 21 Delegable Functions in Virginia, July 1, 1996 22 Virginia Congressional Delegation Listing 24 ADA's 138th Annual Session 25 Virginia Dentist Installed as ADA President 26 Report on the 1997 ADA House of Delegates 28 Upcoming Continuing Education 30 Membership Benefit Highlights: Dental Plan Information 30 Publication of Candidate Information 32 Medical Savings Account 34 Viva La Difference 35 Executive Council Actions in Brief 37 Virginia Businesses Choose DR 37 VDA News 39 Volunteer Service in Foreign Countries 40 Alliance of the VDA 42 Component News & Specialty News 48 Classified Advertising

COVER: Capitol Hill Photo by Dr. Leslie S. Webb, Jr. PUBLICATION TEMPLATE C:\Change

THE VIRGINIA DENTAL JOURNAL (ISSN 0049 6472) is published quarterly (January-March April-June, July-September; October-December) by the Virginia Dental Association, 5006 Monumenl Avenue, PO Box 6906. Richmond. Virginia 23230-0906. Telepbone (804)358-4927 SUBSCRIPTION RATES: Annual: Members, $6.00. Others $12.00 in U.S, $24.00 Outside U.S. Single copy: $6:00)' Second class postage paid at Richmond, Virginia Copyright Virginia Dental Association 1996 '::I POSTMASTER: Send address changes to Virginia Dental Journal. PO Box 6906, Richmond, VA 23230-0906. ", MANUSCRIPT AND COMMUNICATION for publications: Editor, PO Box 6906, Richmond. VA 23230-0906. ..".:',:,/,; ADVERTISING COPY, insertion orders. contracts and related information: Business Manager. PO Box 6906. Rlchmcinp. VA 23230-0906

VIRGINIA VDA COMMITTEE CHAIRMEN JOURNAL

EDITORIAL BOARD

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

Annual Meeting Bruce R. Hutchison

Auxiliary Education & Relations T. Andrew Thompson

Budgetand Financial Investments Raymond L. Meade

Cancer and Hospital Dental Service James A. Pel!

Caring Dentists Harry D. Simpson, Jr.

Constitution and Bylaws/Nominating William H. Allison

Dental Benefits Programs Fred A. Coots, Jr.

Dental Delivery for the Special Needs Patient AI J. Stenger

Dental Health and Public Information AI J. Rizkalia

Dental Practice Regulation Albert L. Payne

Dental Trade and Laboratory Relations George L. Nance, Jr.

Direct Reimbursement Benita A. Miller

Environmental Health and Safet; Paul F. Supan

History and Necrology French H. Moore III

Institutional Affairs Elizabeth A. Bernhard

Journal Staff Leslie S. Webb, Jr.

Legislative T. Wayne Mostiler

Membership H. Reed Boyd III

New Dentist Carolyn C. Herring

Peer Review and Patient Relations Neil J. Small

Planning William H. Allison

Search Committee for VA Board William H. Allison

-"--,------- ~------

Education Foundation Relief Foundation Ralph L. Howell, Jr. Scott H. Francis

Virginia Dental Services Corporation Kenneth E. Copeland, Sr., President

1998 ADA DELEGATION Delegstes: 139th ADA Session, October 24 - 28, /998, San Francisco, CAWilliam H. Allison (1999) Wallace L. Huff ( 1998) Ronald L. Tankersley ( 1999)

Gary R. Arbuckle (1998) Emanuel W. Michaels (1999) Raleigh H. Watson, Jr. (1998)

M. Joan Gillespie (2000) Leslie S. Webb, Jr. (2000) Richard D. Wilson (1999)

Alternate Delegates: Anne C. Adams (1998) Charles L. Cuttino III (2000) Bruce R. Hutchison (1999)

David C. Anderson (1998) D. Christopher Hamlin (1998) Gus C. Vlahos (1998)

Thomas S. Cooke III (1999) Lindsay M. Hunt, )1'. (1999) Andrew J. Zimmer (1999)

4 Virginia Dental Journal

EDITORIAL

e ADA Awareness Program

he ADA meeting in San Francisco this fall, the House .of Delegat~s will be ng on funding a three-year Public Awareness Campaign for dentistry at a t of $30 million per year. This will increase your ADA dues by $300 per ar! In 1996, the ADA House asked the ADA to develop a plan to promote dentistry to the public. I 1997 House funded a one-year member outreach program to educate ADA members about..television and print media dental advertising proposal. Members will then be asked to give their ice to their ADA delegates who will vote on the three-year proposal in October.I. ~

"Ir'ginia was the first state to have the ADA program unveiled during our January committee meetings. There is a possibility that the presentation will be repeated in the fall. We recently learned that the ADA is hoping to have videotapes of the presentation available for use by components. It would be nice to have this second presentation at our state meeting so that Virginia ADA delegates could get feedback from more members. I also think this would be a great subject for the VDA House of

IS Delegates to debate.

The December 22, 1997, ADA Washington Report stated that, according to a Roper Public Opinion SUNey, the American public is increasingly relying on television as its primary source of health news. Many dentists feel dentistry should have a marketing campaign to educate the public about the importance of dentistry and get them into dental offices. Are members willing to pay $300 more in dues to do this? Concern has been expressed that this large dues increase will decrease membership, thus weakening the status and strength of the ADA. It is crucial for the ADA to maintain a high percentage of dentists as members to maintain its prestige and political clout. Supporters of the awareness plan state it is up to the ADA to promote dental awareness among the public and that it will lose members if the ADA doesn't act proactively on this and other issues.

I hope you were able to attend the Awareness Campaign presentation in January. If not, talk to your component members who did attend and read the ADA News to learn more about this campaign. Then, let your VDA delegates to the ADA know your opinion. They want to hear from you!

Dr. Leslie S. Webb, Jr. Editor

Virginia Dental Journal 5

,;~.. ;[IILETTERS TOTHE EDI~()RJ November 6, 1997

Dear Dr. Members

It is with qreat pride and elation that I am writing you this note. First let me thank all of the volunteers who helped make the 138th ADA Annual Session so successful. If not for all ot the hard work, sacrifice. and unselfish acts of the volunteers, chairmen, and vice

chairmen. the Annual Session would not be possible.

I can't tell you enough times what beautiful accolades have been bestowed on our volunteers.

You have made yourselves and myself shine to all of the out ot towners. Thank you for all of your help and for making this one of the smoothest run ADA Annual Sessions.

You've made us all proud'!'!

Sincerely, Alan H. Singer, D.D.S. General Chairman of Local Arrangements i 38th ADA Annual Session

TIll' lulluwing Virginia Denti,t, were illdueled into tile Il)"n FELLOWSI-fIr CLASS uf'the Amcric.m C"llege "I" Del1li.,t, "11 r)cl"hcl' 17, I','n ill Wa,ilinglon, D.C

FI(ll1l kl"lln ri~ht Dr. 1.:I\\rL'llCC I!. C~\",h. :'\o!"lulh: Dr .I~l1nl''''' L (j: L1ril.,.'/'1. Burkl': DI". Th(~Jlla..., s. C()()~(' Jil. S

r =MESSAGE FROM THE PRESIDENT II: A~ 1prepare to write for the next issue ofthe VDAjournaL we in BlaCKsburg are digging out of eleven inches of snow. I certainly hope everyone got to spend some time with their families and loved ones during the holiday season.

As always. the winter months ofthe VDA are a very busy time.

The recent Leadership Conference at the Boar's Head Inn in Charlottesville entitled "Growing the VDA: Strength for the future" featured speakers from the ADA. VDA. and other affiliate groups. with expertise in areas of ethics. membership. foundations, political action and public service (DDS). Everyone did a superb job. but 1 thought the members of the VDA and the VDA staff were outstanding and they are to be commended, along with our lobbyist Chuck Duvall.

This year's winter committee meetings were held at the Omni Hotel in Richmond. January 30-February 1.at which time there was a special presentation of the proposed ADA Public Awareness Campaign. If this proposed public awareness campaign is approved by next year's ADA House of Delegates. it will call for funding of approximately $30,000,000.00 per year for each of the three years. Therefore. VDA members need to be informed so that they might share their thoughts concerning the campaign with members of our ADA delegation.

As you know. one of my top priorities of the VDA this year was to make certain that the needy children of Virginia have access to quality dental care. The Williamson Institute at VCU conducted the study for the Department of Medical Assistance Service (DMAS). The study showed the following reasons for dentists not accepting new Medicaid pari en ts (non -partici pating/partici pati ng):

I. inadequate fees 52% ( 66% .., broken appointments 32% ( 42% 3. complex paperwork 32o/r ( 28c;t 4. limited services 29C;c (26?c 5. slow payment 18q (J9 c/c 6. patient behavior 14% ( 160/, 7. treatment review process 12'if ( ]6cYr

The study made the following recommendations: l , To achieve a break even point with the thirty most frequently filed procedures. would cost6.1 million: 2. To

adjust reimbursement to 957< ofthe UCR as recommended by the Department of Health would cost g.1 million; and 3. To make inflation adjustments annually of fee sc hcdu le. The study also concluded that the administrative difficulties in the Medicaid system must also be addressed. However, almost all dentists agreed that the fee schedule was the primary problem. The study concluded with a summary statement. "it is clearly evident that an increase in reimbursement is of paramount interest and importance to dental providers. An increase in fees will influence positively their level of participation their continued participation and their willingness to become participants."

With the above recommendations made by the study. the Department of Medical Assistance (DMAS) went on record of suggesting the 8. I million to the Department of Planning and Budget. But when the 1998-2000 state budget was revealed on December 19. 1997. the following proposed increases in Medicaid expenditures for dental services were:

General Fund Non-General Fund Total 1998-1999 $1.5 million $1.6 million $3.1 million 1999-2()()() $1.6 million $1.7 million $3.3 million

Although we are appreciativc of the increases recommended in Medicaid expenditures for dental services. these amounts do not even reflect what the Williamson Institute Study concluded was necessary to achieve a break even point of the 30 most frequently reported procedures. namely $6.6 million annually,

I want to thank all those members who have worked so hard in getting the word to their legislators. but we need to continue to make contact with the members of the Virginia Assembly and let them know how important it is to at least increase the expenditures for dental service by that amount recommended by the Williamson Institute Study. Until this is done. hundreds of Virginia's Medicaid eligible children will continue doing without dental care, and that includes important preventive care which we all know saves the taxpayer money in the long: run.

Wallace L. Huff


!INFORMATION TO ASSIST IN ANSWERING QUESTIONS ABOUT DENTAL RADIATION lJ i I ~

submitted by Dave Milam, Medical Instruments, Ltd.

Mass media seems to constantly distort the benefits of dental radiation. As a consequence, patients ask some rather informed questions. To assist in answering such questions, the following information has been prepared using data collected by this corporation from surveys of over 18,000 dental x-ray systems. Supplemental information is obtained from tech support specs, professional publications, and related physics articles.

Offices having further questions or situations in need of a solution, please forward such request to our office. Any comments about this material are also welcome and may be directed to the postal or E-mail address at the bottom of this page.

QUESTION(A): How does dental radiography compare with say, annual background radiation?

"Annual background" is that majority of whole body radiation we humans receive each year just living. Current estimates place background at 200 to 360mR/yr. Normally, natural radiation accounts for 71% of our total annual exposure, medical adds15%, and another 11 % comes from potassium within the human body. The remaining 3% is tsorn consumer products and life style.' For many individuals, consumer products and life style contribute greatly to their annual exposure totals. Few people are aware of this and most simply choose to ignore the information.

Comparing dental exposure to "days in the sun" is not correct. It is best to make the comparison to background radiation which is present 24hrs/day. Background radiation is variable and depends on geography, altitude, and in what structure one lives and works. Background radiation is significantly greater in Denver than Richmond. As for altitude, an airline stewardess will receive more mR/Day than a beach life guard. In some parts of the world the background exposure is five times the 250mR/yr I have used.

To answer the question, let's take an intraoral system rated at 80kV, 15mA, .5sec selected, standard 7.0cm diameter collimation, using paralleling ?jj1JJ1 technique. The bone marrow dose equivalent from this system for a 21 film FMX survey is similar to a whole body exposure of about 15mRem. 2 Use of Kodak's EktaspfJed Plus intraoral film would reduce exposure value by another 50% to about 7.5mR/FMX. While difficult to maintain alignment, rectangular collimation would reduce the 7.5R/FMX by another 58% to a value of 3.25mR/FMX Child and young adolescent exposure is even less."

So. if the annual background (often termed "environmentaf') radiation is 250mR/yr then a FMX with Kodak's Espeed Plus film would add 7.5mR (adult) to the 250mR/yr of background radiation in our geographic area.

From the above example we can see where two bitewings/year would only increase the annual whole body exposure by 1mR per year Not a significant addition ~itb respect to whole body annual background exposure of 250mR/year. Remember this as you read further about lifestyle! QUESTIONJID~ What are some other consumer products that

i~crease an individuals background, or environmental radiation?


There are many items. A few are air travel. tinted eyeglasses, bricks, television, and tobacco. Yes, tobacco! Let's look at this one consumer item of lifestyle that gives zero benefit ena.t 00% nc;~.

Smoking 1 pack of cigarettes/day for a year yields an annual dose equivalent of 16,000mR (radiation is from lead and polonium radionuc/ides deposited due to radon decay). Attempts to denve a suitable tissue weighting factor places the effective dose equivalent at 1,300mRem to the bronchial epithelium and pulmonary region" The publication, "In Health", July/August 1990. also places the annual dose equivalent at 16,000mRiyear.

For those patients that smoke, an FMX survey (21 films) has the same cancer risk as smoking an average of 42 to 121 cigarettes. A bitewing examination is the same risk as about 2-50 Cigarettes.'

This isn't recent information. Exposure data from cigarette smoking was available as early as 1977. I have yet to obtain data on what second hand smoke contributes to the annual exposure of non-smokers. One can only imagine.

QUESTION (el:. What is a the equivalent of a 21 film FMX survey to days of annual background radiation? What about a panograph exam and its equivalent to annual background radiation?

Days of environmental exposure (annual bone marrow dose is 87 mrem/YiJ compared to bone marrow dose from an average 6.5cm diameter collimated intraoral FMX survey with 0 speed film IS 65 days of background radiation (weighted to adult marrow).2 Using Kodak's Ektaspeed Plus film would reduce this exposure 50% further to an equivalent of 33 days 3 Rectangular collimation reduces the irradiated area by 58% thus the dose is then reduced to 13 days of background.

Depending greatly on make, model, filtration, geometry, film/speed combination, the panographic exposure is about 14 days background radiation whole body equivalent." A lateral cephalometric is about 8 days, or less, of background.

QUESTION (0): As an operator of x-ray systems, how many exposures per week could an operator make before getting close to the Maximum Permissible Dose (MPD) of 100mR/week? Does pregnancy affect the MPD?

Using a 70kVp@7mA system (Output"'[email protected]) one could do about 3,500 seconds of exposure/week at 6 feet, with no physical barrier. before exceeding 1OOmR week." That's about 10,500 exposures usrnq 0 speed at a setting of 20/60 second Using Kodak's Ektaspeed Plus. one would have to surpass 21,000 exposures per week 10/60 sec to reach 100mR/week.

If pregnant. the MPD is lowered to about 14mR/week, 56mR/ mouth. or 500m/9months - Using the above exposures per week example, the pregnant operator MPD IS greatly reduced to the taking of a maxlmu_rl'1 of 2.900 Ektaspeed Plus exposures/week. Thats 1.450 exposures/week With U speed film. Remember that this exposure example IS wit~oJd) a barrier wnich IS NOT the normal office layout ~

trive to minimize our .~. protective barners, example one can see uired, even withQ1J1.l! n a percentage of the

,i1" edTLDmonitorsis

ABSTRACTS

The fof/owing abstracts were provided by the Department of Endodontics at VCUlMCV School ofDentistry. Weappreciate the contribution that these individuals have made to the Journal.

Short JA, Morgan LA, Baumgartner JC: A Comparison of Canal Centering Ability of Four Instrumentation Techniques. Journal of Endodontics, 1997: 23:503-7

The goals of root canal preparation include thorough removal of pulp tissue, necrotic debris, bacteria and dentin filings. One means of achieving these goals is to prepare the canal sufficiently large to incorporate anatomical irregularities. This can create problems in root canal preparation as larger, less flexible files tend to straighten the canals and transport the canal space in the apical, middle, and coronal thirds. Nickel-titanium (NiTi) instruments have been reported to have a decreased tendency for canal transportation and therefore remain better centered. Recently, some engine driven rotary systems usrnq NiTi instruments of varying designs have been introduced to facilitate cleaning and shaping. The purpose of this study was to compare three NiTi rotary systems with step back hand filing using stainless steel K-type files for their ability to remain centered in the canal

Fifteen pairs of extracted human mandibular molars were used in this study. Each pair of teeth had one of four canals instrumented with the following techniques: (1) the step-back technique using stainless steel Flex-H hand files, (2) the McXIM Series of NiTi rotary files, (3) Lightspeed NiTi rotary instruments, and (4) the ProFile 0.04 Taper Series 29 NiTi rotary instruments. Sixty root canals were instrumented in the study for a total of 15 canals per technique.

The teeth were sectioned into mesial and distal halves and radiographed to view the anatomy and canal curvature. Instrumentation was performed in two phases by the four techniques as follows: 1) Step back with coronal flaring usmq a quarter turn,

pull motion. 2) McXIM Series at 340 RPM 3) Lightspeed at 2000 RPM 4) ProFile at 350 RPM No instruments separated in this study.

Following each instrumentation phase, the specimens were disassembled and sections were photographed and imaged digitally. The final images from each instrumentation phase were superimposed over the preoperative Images. The results from changes in canal area due to the instrumentation techniques are as follows: No significant differences were found for the preoperative canal area measurements between groups at any level. There were significant differences at each level of the canal when instrumented from the preoperative size to size #30. At the apical level. there was a significant difference between Maxim senes and stainless steel hand files with hand filing resulting In greater canal area. At the middle and coronal levels the ProFile system produced a significantly larger canal area in the coronal level than the McXIM To instrument from the preoperative to size #40. there were no significant differences between the rotary


NiTi Instrumentation systems at any level. However, there V\dS a significant difference between Flex-R stainless steel hand iiles and all the NiTi rotary systems at all levels. with NiTI sYS);lns remaining better centered at all canal levels.

The results of this investigation confirm other studies that fu,md rotary NiTI Instruments to stay better centered In tile canal :,nd reduce preparation time compared to hand instrumentation With stainless steel flies.

Dr. Chris Achleithner is a first-year postgraduate student in Endodontics. He received his D.M.D. from University of Oregon Health Sciences Center in 1986. Dr. Achleithner is a Major in the U.S. Army Dental Corps.

Yared G, Dagher F: Evaluation of Lidocaine in Human inferioi Alveolar Nerve Block, Journal Of Endodontics 97;Vol 23:Pg 57=,

Routine local anesthetic techniques such as the inferior alveolar nerve block often fail to provide complete anesthesia. Recently. Bou Dagher, et aI., measured the degree of anesthesia following the administration of 1.8 ml of different solutions of 2% lidocaine and found no difference among the three solutions. The purpose of this study was to measure the degree of anesthesia following the administration of 3.6 ml of 2% lidocaine solutions with either 1:50,000, 1:80,000, or 1:100,000 epinephrine for inferior alveolar nerve block and to compare the results with those obtained followinq the administration of 1.8 ml of the same solutions.

The 30 adult subjects, 22 men and 8 women, ranging in age from 22 to 50 yr. with an average of 32 yr. who had participated in a previous recent study, were included in this study. An equal number of mandibular right and left sides were tested with the first molar, first premolar. and lateral incisor chosen as the test teeth. The contralateral canine was used as the unanesthetized control to ensure that the pulp tester was operating properly and the subject would respond during the experiment. Clinical examinations indicated that all teeth were free of canes. large restorations, and periodontal disease and that none had a history of trauma or sensitivity. Using a repeated measures design, each subject randomly received each anesthetic solution on three successive appointments at least 1 week apart. The anesthetic solutions tested were: 3.6 ml of 2~o lidocaine With 1:50.000 epinephrine. 1:80,000 epinephrine. 1 100,000 epinephrine All the injections were given blindly by one operator. For each injection. a 5-ml syringe was used to administer 3.6 ml of each solution I.e the equivalent of two 18-ml cartridges of the anesthetic solution At 1 min postinjection. the first molar was pulp tested and alveolar mucosal sticks were performed. At 2 rrun, the first premolar and lateral Incisor were tested. At 3 min, the control canine WaS tested and the subject was asked if the lip and tongue were numb. This cycle of testing was repeated every 3 min. All testing was stopped at 50 min posunjection.

There were no significant differences among the solutions with ard to the number and percentages of subjects who experienced

reg sthetic success, anesthetic failure slow onset of anesthesia, an~continuous anesthesia, and anesthesia of short duration The ~o hest incidences of anesthesia for all three solutions were as f~~OWS: first molar, 87% to 93%; first premolar 93%; and lateral , cisor, 83% or 90%, There were no significant differences among ~~e solutions at any time interval. ,Comparing these results with the previous results of the study usinq 1,8 ml of the same solution showed that the incidence of anesthesia was greater when the solutions were doubled in volume, The present study demonstrated that epinephrine concentration in a 2% lidocaine hydrochloride did not influence the degree of anesthesia since the three solutions were comparable in inferior alveolar nerve blocks,

Dr. Justin Thornton is a second-year postgraduate student in Endodontics. He received his D.D.S. from VCU School of Dentistry in 1996.

Silvaggio J, Hicks ML: Effect of Heat Sterilization on the Torsional Properties of Rotary Nickel-Titanium Endodontic Files, Journal of Endodontics 1997;12:731-734,

Rotary nickel-titanium endodontic instruments represent one of the newest technologies available to the dental practitioner. Instrument separation is of great concern to dentists who use rotary NiTi files, Because these instruments are used in a rotating manner, instrument separation is more likely to occur during torsional stress. Questions have been raised whether sterilization procedures adversely effect the ability of rotary NiTi instruments to withstand the torsional stresses encountered during root canal preparation, The purpose of this study was to determine whether heat sterilization adversely effects the torsional strength and rotational Ilexibility of rotary NiTi files,

Nine hundred sizes 2 through 1001 NiTi .04 Profile Series 29 liles (Tulsa Dental Products, Tulsa, OK) were divided into groups 0110 files each and sterilized 0, 1,5, or 10 times in the steam autoclave, Statim autoclave, or dry heat sterilizer. They were then subjected to torsional testing in a Torquemeter Mernocouole. In this testing instrument device, the hub of the file is rotated at 1,6 rpm, whereas the apical 3-mm segment of the file is held stationary between two brass jaws, Complete data were collected for sized 2 through 7, but not for sizes 8 through 10 because their torque resistance exceeded the testing limits of the Torquemeter Mernocouple. A one-way analysis of variance was used to compare all experimental groups in sizes 2 through 7 with their unsterilized controls. 54 comparisons were made for torsional strength and 54 for rotational fleXibility.

Ten significant changes occurred lor torsional strength and 10 for rotational flexibility, Eight of 10 changes in torsional strength were Increases. 52 of 54 comparisons for torsional strength and 47 of 54 for rotational Ilexibility showed a significant increase or no change. These results clearly demonstrate that heat sterilization 01 rotary nickel-titanium files up to 10 times does not increase the likelihood of instrument fracture,

Dr. Katherine R. Garrett is a second-year postgraduate student in Endodontics. She received her D.D.S. degree from Indiana University School of Dentistry in 1989. Dr. Garrett served in the U.S. Navy Dental Corps from 1989 to 1996.

Dean JW, Lenox RA, Lucas FI, Culley WL, and Himel VT: Evaluation of Combined Surgical Repair and Guided Tissue Regeneration Technique to Treat Recent Root Canal Perforations, Journal of Endodontics 1997;23:525-532,

The treatment of mechanical root canal or furcation perforations depends on recognition of the condition, operator training and experience, and the location of the perforation, Presently, an Ideal means of repairing these root defects does not exist. The prognosis of all root perforations depends on the time between perforation and closure, the location of the perforation on the root surface or pulp chamber floor, and the relative size of the perforation. The shorter the time lapse, the smaller the Size, and the more apical the perforation, the greater the chance for success. A new technique developed from the University of Tennessee College of Dentistry, holds promise for successful repair of root perforations that occur during endodontic or prosthetic post preparation therapy, The technique includes both endodontic retrofill and the perforation site with a reinforced zinc oxide and eugenol and periodontal guided tissue regeneration. The purpose of this study was to determine clinically, radiographically, and histologically, in a dog model, the nature and extent of the healing that takes place in repaired endodontic retrofill and guided tissue regeneration technique,

Six dogs had root canal therapy on the mandibular fourth premolars and first molars. The clinicians perforated the distal root of each tooth on the furcation aspect halfway between the furcation and the apex. A surgical procedure was performed to gain access to the root apices, The perforation sites were filled with IRM, A xenograft of freeze-dried demineralized bone (human) was placed in the access ostectomy site and covered with Gore-Tex Augmentation Material (GTAM). Controls included unfilled perforations and not using bone grafts and/or GTAM. Dogs were killed at 6, 12, and 24 wk post surgery.

The results 01 this study show that if root canal perforation sites are exposed and treated that it is necessary to till the perforation adequately; il not, significant inflammation and poor healing generally result. When the root perforation sites are prepared and filled with IRM, greater amounts of bone fill were found more often in surgical access defects when GTAM was used to cover the opening. The inclusion of FDDB in the treated sites had no effect on the healing observed, The radiographic healing observed in teeth with filled perloration sites, expressed as reduction in the defect radiolucency was found to be quite extensive.

In conclusion, the results of the present study indicate that regenerative membranes enhance bony closure of surgical access openings after root canal perforations have been filled, The addition of a bone xenograft does not seem to enhance the healing,

Dr. Ellen Ramos Kelly is a first year postgraduate student in Endodontics at VCU School of Dentistry. She received her D.M.D. degree from the University of Pennsylvania School of Dental Medicine in 1994. After graduation she completed residency in Periodontics and received her certificate in June of 1997.


ABSTRACTS, cont. [~ Thomas Mayer & Peter Eickholz: Microleakage of Temporary Restorations after Therrnocyclinq and Mechanical Loading, Journal of Endodontics 1997;23:320-322.

The marginal seal of four temporary filling materials in endodontic access cavities was examined in vitro after thermocycling and mechanical loading using dye penetration tests and a quantitative marginal analysis of replicas in the SEM. Class I cavities were prepared in 44 extracted human molars and filled with a minimum of 3.5 mm of either Cavit, Kalsogen, IRM, or TERM. After setting and the thermocycling procedure, Cavit showed less microleakage in the dye penetration test and fewer marginal crevices in the quantitative marginal analysis.

After loading, two Cavit fillings collapsed into the endodontic cavity. The marginal conditions of Term were comparable to Cavit after thermocycling and mechanical loading. Kalsogen and IRM restorations demonstrated significantly increased microleakage and a higher percentage of marginal crevices after thermocycling and loading.

Results of this study seem to indicate that temporary restoration with Cavit of endodontically treated teeth which are not under heavy occlusal forces provides a superior seal. If, however, the restoration will be under significant occlusal forces, then a reinforced restoration such as TERM provides a better seal.

Dr. Sean M. O'Sullivan is a first-year postgraduate student in Endodontics at VCU School of Dentistry. He received his D.D.S. degree from the University of Maryland Dental School in 1991. After graduation he joined the U.S. Army and completed an AEGD1 year program at Fort Carson, CO, and continues to serve on active duty.

Wilcox LR, Roskelley C, Sutton T: The Relationship of Root Canal Enlargement to Finger-Spreader Induced Vertical Root Fracture, Journal of Endodontics 1997; 23:533-4.

Vertical root fracture has been the cause for failure of many endodontically treated teeth. Common reasons for vertical root fracture include, the force of condensation, spreader design, root size and post placement. The purpose of this study was to determine if there is a relationship between percentage of root canal enlargement (dentin removal) and vertical root fracture.

Thirty-four extracted maxillary anterior teeth free of curvature, apical resorption, caries to the CEJ and previous root canal treatment were used. Teeth with fractures and craze lines were eliminated The roots were embedded in acrylic with a small amount of impression material to act as the periodontal ligament, and radiographed from the facial and proximat surfaces. Each canal was prepared to 20% of the total Width of the tooth and obturated with gutta percha by lateral condensation using a fine finger spreader. A constant condensation force was ensured by usmq a iig set at 3.3kg.


Each tooth was then removed from the acrylic and examinee for fractures and craze lines. If no fracture was pre~ent, the gutta percha was removed, canals reinstrumented to 30 /0 of root Width, obturated and evaluated as before. Teeth that did not fracture continued to be tested at 40% and 50% of root Width. O:lly complete fractures eliminated a tooth at anyone stage of canal enlargement.

Results showed that twelve of thirty-four teeth developed vertical root fracture - 5 teeth at 40% and 7 at 50% root width. 1he remaining 19 teeth all developed craze lines by the end of tne experiment. The results show that although all teeth developed craze lines, the more tooth structure that was removed, the mora likely a root is to fracture.

While it is not common practice to remove gutta percha 3 and 4 times in a single tooth, the study IS useful to note for retreatment procedures. The repeated stressing of the tooth may also accelerate the effects of smaller, long-term stresses from poorly designed restorations.

Dr. Helen Sempira is a first-year postgraduate student in Endodontics at VCU School of Dentistry. She received her D.D.S. degree from Indiana University School of Dentistry in 1992. Dr. Sempira served in the U.S. Navy Dental Corps from 1992 to 1997.

VIRGINIA BOARD OF DENTISTRY

July 1. 1997 - June 30, 1998

The Virginia Board of Dentistry is appointed by the Governor and is composed of seven dentists. two hygienists and one citizen representative. Contact the Board office or a member of the Board on questions on rules and regulations.

Mark A. Crabtree, DDS--President French H. Moore. Jr.. DDS--Vlce-Presldent Nora M. French. DMD Monroe E. Harris, Jr., DDS Michae J Link. DDS Edmund E Mullins. DDS Gary Taylor, DDS Carolyn B. Hawkins, RDH Stephanie P Olenlc, RDH Pat K. Watkins

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VIRGINIA DENTAL ASSOCIATION 1997 LEADERSHIP CONFERENCEJ

Dr. Thomas S. Cooke III, VDA Secretary/Treasurer

The Virginia Dental Association Leadership Conference was held in Charlottesville on November

Dr. Huff introduces the Ethics Panel comprised of Dr. Charlie French, Dr. Ron Tankersly, Kathleen Todd, Dr. Joan Gillespie, Dr. Richard Wilson, and Dr Bruce Deginder.

cc m E14-16 at the Boars Head Inn. It began on Friday with c

~a Goals Review Team Workshop, reviewing the goals '" oo

established in 1995, defining areas where they had been met and identifying areas that needed improvement. The Foundation had a workshop on Fridayafternoon. The speaker was Robert McDonald from The Florida Dental Association Foundation. He had several good suggestions that will help in the implementation of the VDA Foundation's mission.

The program on Saturday was entitled "Growing the VDA: Strength for the Future." After opening remarks by VDA President Dr. Wally Huff, Dr. Bruce DeGinder

Elizabeth Keith (VDA Membership Coordinator) gave a Field Service Program wrap-up. Kathleen Todd, Esq., ADA Associate General Council, spoke about the ADA Code of Conduct and Ethics, and there was a lively discussion concerning advertising and the ADA response to the FTC. The ADA is presently

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. . common practice to make. changes at the beginning of ~ new year. The VDA staff is It . to be no exception to this rule, With several shifts In assignment and responsibility, as

. prO~lngney into 1998. The faces will certainly remain the same, but members will be contacting . weJour

.... staff in new roles.

Simultaneously, our Membership Coordinator, Liz Keith, indicated her interest in working with the DDS Program. Liz and Tanyashare office space at the VDA and are acquainted with each other's duties and responsibilities. Liz is well informed regardingDDS activities and is attracted by the strong relationships formed with both patient/clients and volunteer dentists, as well as the satisfaction of helping individuals improve their lives by receiving needed dental care. Liz will serve as the DDSProgram Coordinator, beginning in late January; she brings a knowledge of the VDA membership, a strong awareness of the DDS operation, and a desire to serve both members of the dental community and members of the public to make the DDS Program a continued success.

If you're keeping track in your scorecard, you realize that we are now in need of a Membership Coordinator. Not to fear: Assistant Executive Director Connie Jungmann will include membership duties as a primary responsibility in 1998. Connie has worked closely with membership matters throughout her entire career with dental associations and has been an advisor to the development of the new ADA Tripartite Association lVIanagement System (TAMS), set to unveil in 1998. Connie's work with various publications, including the Virginia Dental Journal, will transfer to Tanya Moore, and her responsibilities with many dental benefits programs, including the internal aspects of Direct Reimbursement, will be included in our new staff position. Oh yes, the new staff position ...

What began as a Publications position has evolved to the role of Marketing and Programs Coordinator, with responsibilities to the Virginia Dental Services Corporation, the VDA foundations, internal aspects of DR, Dental Benefits Programs, and electronic billing, as well as assisting Connie with our computer operations, both internally and externally. VDA has entered an era requiring increased attention to marketing and development, whether the topic is membership services, for-profit subsidiary products, or foundation development. We are currently interviewing for this position and will undoubtedly be introducing a new staff member to the VDA leadership and members during the January Committee Meetings.

Once these individuals have completed the necessary transitions and the new staff member is in place, we know that we will be able to continue the improved level of service to the VDA membership and devote necessary time and attention to newly emerging programs. We are also fortunate to have many very qualified and capable staff members at VDA, with the experience, background, and desire to insure the success of our ever-expanding endeavors.

If the changes are confusing to you, please remember that you can still contact Linda Gilliam for financial matters, Lisa Finnerty for legislative and public affairs, and Bonnie Anderson will cheerfully answer your questions or direct you to the staff member with the latest information. We are all here to serve you.

William E. Zepp, CAE Executive Director


LEGISLATIVE UPDATE Chuck Duvall, Jr., VDA Lobbyist and Lisa M. Finnerty, VDA Public Affairs Coordinator

An issue of major concern at the 1997 VDA Annual Meeting was Virginia's current Medicaid system. The Virginia Dental Association had already been working with several groups on the Medicaid issue. At the present time, there is an inadequate number of dental providers statewide accepting Medicaid patients. Only approximately 19.7% of those children eligible to receive Early and Periodic Screening Diagnostic Treatment (EPSDT) dental services in the Commonwealth of Virginia are receiving such preventive services. The 1997 Virginia General Assembly Appropriations Act required the Department of Medical Assistance Services (DMAS) to study the availability of dentists accepting Medicaid payments. The study was to identify the geographic areas of the state with the greatest shortages and recommendations for improving access to dental care for Medicaid recipients. This study was conducted by the Williamson Institute for Health Studies at Virginia Commonwealth University.

After holding focus groups across the Commonwealth and receiving responses from almost 1700 dentists, the Institute determined that there were several primary reasons for dentists not accepting new Medicaid patients. Included in these reasons were: inadequate fee schedule; broken appointments; complex and excessive paperwork; limitations on covered services; and slow payments.

The study recommends that DMAS establish a Dental Health Coalition designed to expand availability and delivery to Medicaid children. They further suggested that DMAS dental providers need to be given additional financial incentives in order to accept DMAS pediatric beneficiaries. DMAS went on record as recommending $8.1 million dollar increase in the 1998/2000 state budget to the Department of Planning and Budget.

The proposed budget was presented on December 19,1997 by Governor Allen. The budget contained a $3.1 million dollar dental Medicaid increase for 1998/99 and a $3.1 million dollar dental Medicaid increase for 1999/2000. In light of the many budgetary demands that the Governor and his staff faced. we are certainly indebted for the recommended increase in Medicaid expenditures for dental services. However, the sums do not reflect what the Williamson Institute study concluded was necessary to achieve a break-even point with the thirty most frequently reported procedures. That figure was $6.6 million per year. Furthermore, the Williamson Institute indicated that to adjust reimbursement to 95% of the UCR as recommended by the Department of Health would cost $8.1 million per year. Obviously. other budgetary pressures necessitated that the number be reduced.


We must move forward and continue to make positive contacts with members of the Virginia General Assembly to underscore the importance of (1) maintaining the amount suggested by the Governor and (2) also increasing the amount to try to secure, at a very minimum, a break-even point with regard to DMAS dental services. To achieve the breakeven amount, we need an additional $3.5 million in 1998/1999 and an additional $3.3 million in 1999/2000. Half of the funds are general fund monies with the other half coming from federal matching funds.

It is imperative that VDA members who have not made contact with their legislators do so ASAP. You can contact your legislator through the General Assembly switchboard by calling (800)889-0229. If you are a Richmond resident you may call 698-1990.

POINT-OF-SERVICE Charles R. Duvall. Jr., VDA Lobbyist and Lisa M. Finnerty, VDA Public Affairs Coordinator

. m used to refer to allowing patients to choose their provider at the point at which the service is delivered. In .'s a terould be able to go out of network if they desired to see a provider that did not participate with their particular ents ~y This rs an option which most HMO's and managed care programs do not allow. The VDA worked with co~PtChoice (VPC), a patient-provider coalition, to make certain that a point-of-service option for managed care

~~Ie; by the Joint Commission on Health Care (JCHC) during 1997. Dr. Leslie S. Webb, Jr., a past president of VDA, u I~he POS task force which was assigned to study the issue. The task force met four times during the summer and

t~ various information and actuarial analyses regarding the pas issue. At the final task force meeting on November task force voted 7-5 to recommend that the Joint Commission introducelegislation to requireall HMOs to include a

\. "(POS) option as a benefit component In all HMO products. The legislation would result In a POS option being 'alf:mployees through prior enrollment in either the HMO or pas product. Employees choosing the POS option would 't1aifional costs associated with pas benefits. othePOS analysis and Task Force deliberations was presented at the December 16,1997, full JCHC meeting. Opponents 'entsprovided testimony to the JCHC. On Tuesday, January 6,1998, the POS recommendation was once again presented CHC. The full committee voted 7-6 to introduce the pas legislation.

usly a controversial issue and legislators need to hear from VDA members in support of the legislation. Proponents " employees should have the ability to enroll in a plan that provides a greater choice of providers than a traditional closed and that POS enrollees should pay an additional cost associated with that option. Opponents cite concern over the

.'such a mandate will have on overall health care costs, the current availability of pas plans on the market, and the e burden on employers.

like additional information please feel free to contact Lisa Finnerty at the VDA Central Office at 800/552-3886.

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L~ DELEGABLE FUNCTIONS IN VIRGINIA, JULY 1, 1996 . J~ Below is a list of dental functions which clearly deliniates which dental personnel can perform each in the dental office.

fUNCTION DO~ Final diagnosis Intraoral adjustments to removable or fixed appliances Write prescriptions X1 X1 Sign prescriptions Write laboratory work orders X1 X1

XXXXX

Sign laboratory work orders X Cement permanent or temporary restorations X Pulp capping X Place amalgam with carrier X Condense and carve amalgam Place and contour composite Place and fit archwire

X X XXX

Place and remove retraction cord X XImpressions for working models

XXX

X X X

Prophylaxis' Coronal polish X Use of prophy jet

XXX

Impressions for mouth quajds or custom fluoride trays X Original clinical exam X Preliminary dental screening X X Subgingival irrigation or application of Acticite X X Apply Sealants Hold impression after placed by dentist

XX

X X X X

Impression for study model X Place orthodontic separators X Check for loose bands and brackets X

XXX

X X X XRemove arch wires X X

Select and prefit bands and brackets Cement/bond bands and brackets

XX X X

Administer and adjust nitrous X Monitor nitrous X XX Place topical anesthetic X X X Administer fluoride X X X Application of desensitizing agents X XX Expose radiographs XX2 X Remove socket dressing X X X Remove sutures XX X Remove supragingival cement X X X Place and remove periodontal dressing X X X Instruct patient in placement & removal of appliances X

AFTER adjusted and fitted by DDS XX

Obtain BP, pulse, temperature X X X Record medical history X X

X X

Place and remove matrix X Place and remove rubber dam X

X X X

Cement temporary or permanent crowns and bridges Use of TENS unit

X X

Place temporary fillings X

Xl - Exact wording dictated by dentist ~2 - Display certificate in plain view of public. Refer to Board of Dentistry Regulation 4.5.A.ll for educational requirements.

- See Board of Dentistry Regulations for definition

Reproduced from the Board of Dentistry's Bulletin 1996 Fall/Winter Issue. If you have any questions, call the Board Office at (804)662-9906.


JOHN W. WARNER (R) 225 Russell Senate Office Bulding Washington, DC 20510 Phone: (202) 224-2023 Fax: (202) 224-6295 E-mail: [email protected]

CHARLES ROBB (R) 145 Russell Senate Office Bulding Washington, DC 20510 Phone: (202) 224-4024 Fax: (202) 224-8689 E-mail: [email protected]

HOUSE OF REPRESENTATIVES

1. HERBERT H. BATEMAN (R) 2350 Rayburn House Office Building Washington, DC 205'10 Phone: (202) 225-4261 Fax: (202) 225-4382

2. OWEN B. PICKETT(D) 2430 Rayburn House Office BUilding Washington, DC 20510 Phone: (202) 225-4215 Fax: (202) 225-4218 E-mail: [email protected]

3. ROBERT C. SCOTT (D) 2464 Rayburn House Office Building Washington. DC 20510 Phone: (202) 225-8351 Fax: (202) 225-8354

4. NORMAN SISISKY (D) 2371 Rayburn House Office Building Washington, DC 20510 Phone: (202) 225-6365 Fax: (202) 225-1170

5. VIRGIL H. GOODE (D) 1520 Longworth House Office Building Washington, DC 20510 Phone: (202) 225-4711 Fax: (202) 225-5681

6. ROBERT W. GOODLATTE (R) 123 Cannon House Office Building Washington, DC 20510 Phone: (202) 225-5431 Fax: (202) 225-9681 E-mail: [email protected],GOV

7. THOMAS J. BLILEY JR. (R) 2409 Rayburn House Office Building Washington, DC 20510 Phone: (202) 225-2815 Fax: (202) 225-0011

8. JAMES P. MORAN (D) 1214 Longworth House Office Building Washington, DC 20510 Phone: (202) 225-4376 Fax: (202) 225-0017 E-mail: [email protected]

9. RICK BOUCHER (D) 2329 Rayburn House Office BUilding Washington. DC 20510 Phone: (202) 225-3861 Fax: (202) 225-0442 E-mail: [email protected]

10. FRANK R. WOLF (R) 241 Cannon House Office Building Washington, DC 20510 Phone: (202) 225-5136 Fax: (202) 225-0437

11. THOMAS M. DAVIS III (R) 224 Cannon House Office Building Washington, DC 20510 Phone: (202) 225-1492 Fax: (202) 225-3071 E-mail: [email protected]

CONTACTING YOUR LEGISLATOR 11] The most successful legislative program is a partnership between the VDA lobbying efforts and the work and dedication of the scores of dentists who volunteer their time to let legislators know dentistry's position on the issues. These efforts can be as simple as making a phone call or writing a letter. These contacts will have an even greater impact if a personal relationship exists between you and your lawmaker.

You should always feel comfortable contacting your legislator. Most elected lawmakers and their staff want to know as many of their constitunts as possible. Members' opinions are a vital element of the VDA legislative program. Following are some effective ways to structure your letter to a legislator.

* Keep your letters short. Address only one issue in a letter. Identify a bill number if possible. * Do not send form letters or carbon copies. Use your own words and stationery. * Speak to issues of public policy and publlc benefit. * Speak to economic considerations - - - especially yours. * Highlight quality of care issues and impact on patients. * Write when your legislator does something you approve of; this will help your legislator remember you the next time.

Take the opportunity to maintain your involvement in the legislative process beyond the ballot box. Actively participate in fund raising, letter writing, and personal contact with and for the candidates.


Dr. Raymond L. Bertolotti AdhesionDentistry Dr. Gordon J. Christensen DentalMalerials Dr. Rella P. Christensen tn(ection Control Dr. Bernard B. Fink Practice Transitions Dr. David A. Garber Periodontics-Esthetics Dr. Henry A. Gremillion TMD Dr. Harald O. Heymann Reslora tive

Dr. Lee Lipsenthal Nutrition-Medical Care Dr. Joseph J. Massad Removable Prosthetics Dr. Michael J. McDevitt Periodontics Dr. Carl E. Mi

ADA'S 138TH ANNUAL SESSION

Dr. Wally Huff prepares to address the masses at A Dayan the Hill.

A Dayan the Hill brought dentists from accross the country together as a unified voice.

These troops rally with the other hundreds of dentists present on Capitol Hill.

President Whiston addresses the vaned issues dentistry IS currently facing

Dr. Dave Whiston doesn't waste time getting down to business in his new role as President


VIRGINIA DENTIST INSTALLED AS ADA PRESIDENT

David A. Whiston, D.D.S., who practices oral and maxillofacial surgery in Falls Church, Virginia and is past chief of Dentistry, Oral and Maxillofacial Surgery at Northern Virginia Doctors and Fairfax Hospitals, was installed October 22, 1997, as President of the American Dental Association. Dr. Whiston's installation took place in Washington, D.C., at the ADA's 138th Annual Session.

As president, he will lead the more than 140, ODD-member organization's efforts to protect and improve the public's oral health and promote advances in dentistry.

Dr. Whiston graduated with honors from the West Virginia University of Dentistry and completed graduate studies at the University of Texas and the University of Pennsylvania.

His previous responsibilities with the ADA include serving four years as Trustee from the Sixteenth District, which includes North Carolina, South Carolina, and Virginia. He has worked on numerous ADA councils as Board liaison or chairman, served as the Association's spokesperson on regulatory issues, and has been involved with the ADA's strategic planning process since its inception.

Dr. Whiston is a member of the board of the National Foundation of Dentistry for the Handicapped and is a past president of the Northern Virginia Dental Society; the Virginia Dental Association; and the Virginia, Greater Washington and Middle Atlantic Societies of Oral and Maxillofacial Surgeons.

Dr. Whiston and his wife, Julie, live in Arlington, Virginia.

Virginia's own Dave & Julie Whiston receive a standing ovation from the 1998 ADA House of Delegates.

Dr. Dave Whiston enjoys his first boxed lunch as President of the ADA.


REPORT ON THE 1997 ADA HOUSE OF DELEGATES

Dr. Wallace Huff, President

More than 29,000 dentists, dental team members and guests came to Washington, DC, for the 138th Annual Session of the American Dental Association, and by all accounts those who attended had a beneficial and enjoyable time at the meeting.

The highlight of the 138th Annual Session was the installation of our own Dave Whiston as ADA President. Dave had just completed his one-year term as President Elect of the ADA and was installed as the 134th President of the Association. Dave assured the House of Delegates that they could expect a maximum effort from him and the other officers. We in Virginia and the 16th District, as well as the other Districts, are aware of Dave's strong leadership. knowledge of the issues and tough decision making that he has exemplified in the past while serving on the ADA Board of Trustees and as PresidentElect. There is no doubt that he will exhibit the same strong leadership in the position of President of the ADA.

Dr. Timothy Rose, a Periodontist from Appleton, Wisconsin, and currently serving as President of the American Academy of Periodontology, was voted by the House as President Elect of the ADA in a three way race.

Candidates for the offices of First Vice President, Second Vice President and Speaker of the House of Delegates ran uncontested, as did trustee candidates for four districts. Elected unanimously were Dr. Chauncy Cross of Springfield, Illinois as First Vice President and Dr. Joseph R. Kenneally of Biddeford, Main as Second Vice President. Dr. James 1. Fanno from Canton, Ohio was reelected unanimously to a third term as Speaker of the House of Delegates. The four new Trustees are: Dr. John W Staubach. 3rd District: Dr. Henry Finger. 4th District: Dr. 1. Howard Jones. 4th District; and Dr. George L. Bletsas. 9th District. Dr. Rene M. Rosas is beginning


his second year as Treasurer of the ADA.

Another highlight of this session was the Capitol Hill Rally by the ADA House of Delegates and other dentists in support of the Patient Access to Responsible Care Act (PARCA) legislation. More than a thousand people participated in the rally which was organized by the ADA and supported by the American Dental Political Action Committee.

Dentist/Rep. Charlie Norwood from Georgia, spoke urging dentists to continue signing up PARCA sponsors. He reminded everyone that "no never means no in this town" be firm, but don't be pushy he advised. As buses loaded to return Delegates to the business of the ADA House, other dentists headed across capitol grounds to talk to their congressman or senator about becoming a cosponsor of PARCA.

PARCA would provide basic guidelines to protect patients in self-insured and other health plans. The house bill had 90 Republicans, 120 Democrats and 1 Independent as cosponsors as of December 31, 1997.

Two of the resolutions brought before the House that showed the greatest amount of activity were the resolutions calling for the recognition of two new dental specialities and both were narrowly defeated. Res. 19-1996 which called for the recognition of Oral and Maxillofacial Radiology as a dental speciality was defeated after failing to achieve a majority vote in the House. The House adopted a motion to reconsider, but defeated the resolution in a second vote. Res. 14 which would have recognized Dental Anesthesiology as a dental speciality was also defeated.

Listed below are some of the key resolutions which were passed by the House.

The House of Delegates approved a 549.00 dues increase. As of January 1. 1998. the ADA's membership dues

fee went from $316.00 to $365.00. This was the first dues increase that is to be used for general operating expenses of the Association since 1989. The expenses of the Association have been increasing steadily since that time, and the House of Delegates saw fit to make this adjustment in dues for operation expenses. This $49.00 dues increase is projected to boost the 1998 revenues to $64,550.050 with budgeted expenses of $65,512,300, which will leave a projected net surplus of $37,750.00.

Res. 32-H. Plans for the ADA's PubliC Awareness Campaign continued when the House of Delegates approved Resolution 32-H. This is a one year outreach program which has been designed to educate members on the details of the Public Awareness Campaign. This Resolution has a budget of $797,800 which will allow Jordan Associated (of Oklahoma) to produce broadcast equality versions of TV advertisements and a video outlining the campaign, as well as fund the necessary travel by Jordan staff to present the Campaign to dental constituents nationwide.

The Resolution also approves funds for a membership survey which will be designed to learn how member dentists feel about the Campaign, and the results are to be compiled in time to be acted upon by the 1998 House of Delegates in San Francisco. If passed. the proposed three-year campaign would cost approximately $30 million a year. The goals of this campaign would be to increase consumer demand for dental services and to enhance the image of the profession.

Other key resolutions under Communication and Membership Services.

Res. 105 H directs the Association to reflect the diversity of its members in its governing documents and to review and recommend changes to the ADA Bylaws, Organizations and Rules of the Board of Trustees. Standing Rules for

'ncils and Commissions and Manual 'he House of Delegates to reflect fsity, including gender neutrality,

34-H urges all constituent and 'ponent so~ieties to comply with licable civil rights laws In their [iibership practice,

$/28-H calls for the ADA to stigate options allowing foreign ned dentists to alter their ibership numbers from 143 and to Id any numbering system in the re that could discriminate against

P1' 44-H calls for a study to obtain data

;bd outthe most convenient and cost ient system that allows members .ay theirdues each month and report 'e 1998House of Delegates,

!.52-H calls for a six-step approach elping to ease the financial burden ~ew dentists.

;36-H updates the policy statement ]des, HIV infection and the practice Bentistry to conform to the .ganized code.

'. 65-Hcalls on the ADA to support ,jslation or regulations that ensure a Jists freedom to exercise their ')cal judgement without undue

~ence from any third-party entity. It ~encourages constituent societies upport similar policy.

.74-H In 1998 the ADA Public ~irs Conference will be replaced by " nnual Grassroots Conference. The ,unCi I on Federal and State ernment Affairs and Federal Dental '. ices and ADPAC will investigate the ,tandthe value of having an Annual ',ssroots Conference and report this . ktothe 1999 House.

,s. 81-H calls for a task force "mediately) to ensure that dentistry a part in the implementation of title

'I ofthe Social Security Act (kid care). ,6 task force will report back to the 8 House.

82-H calls for the ADA to seek Sures (legislative or administrative)

that would require third-party payers to allow patients to authorize payments directly to their dentist, without changing and without regard to the practitioners practice status.

Res. 96-H calls for a special task force to study the implications of adopting a new advisory opinion to the ADA Principles of Ethics and Code of Professional Conduct dealing with the announcement of credentials by general dentists and report back to the 1998 House.

Res. 45-H urges the Board of Trustees to continue scheduling the House of Delegates and scientific session of the ADA to meet concurrently.

Res. 85-H calls for the ADA to advise constituent and component societies and public health agencies about the morbidity of intra and perioral piercings. As scientific information becomes available, the Council on Scientific Affairs will develop a policy statement on intra and perioral piercings.

Res. 95-H calls for the ADA Council on Scientific Affairs to review the literature and develop a research plan on appropriate and attainable levels of nitrous oxide in the dental office. This is to be a priority topic of the Association's research agenda and the Council is to submit a report to the 1998 House of Delegates.

Res. 24-H calls for the ADA's program to promote Direct Reimbursement to target those businesses which market supplies and services specifically to dentists and their practices.

Res. 42-H amends the comprehensive policy statement on Dental Auxiliary Personnel, Dental Auxiliary Education Section, third paragraph to read "Dental hygiene education programs are designed to prepare a dental hygienist to provide preventive dental services under the direction and supervision of a dentist. Two academic years of study or its equivalent in an education program accredited by the Commission on Dental Accreditation typically prepares the dental hygienists to perform clinical dental hygiene servlces.

However, other programs, accredited or otherwise, which utilize such methods as institutionally-based didactic course work, in office clinical training or electronic distance education can be an acceptable means to train dental hygienists. Boards of Dentistry are urged to review such innovative programs for acceptance."

I would like to thank all the members of the Virginia Delegation for their preparation for the pre-convention caucus in Williamsburg, VA. I would especially like to recognize our Executive Director, Bill Zepp, and our VDA staff for the arrangements in Williamsburg. Mr. Zepp and staff thought of every detail to ensure that the 16th District (Virginia, South Carolina, North Carolina) had an enjoyable meeting in a great location in preparation for the 1997 ADA House. Thanks also for the support throughout the annual session in Washington, DC. I think the preparation and tireless effort of our Delegation was obvious at the Convention Caucus, the Reference Committee Hearings and the House of Delegate Sessions in Washington, DC.

My thanks to Lynn Campbell (SC) for his leadership as the 16th District Caucus Chairman and to our Trustee, Greg Chadwick (NC), for representing us with distinction at the ADA in Chicago.

A special thanks to the outgoing South Carolina Delegation Chair, Carl Wessinger, for his leadership and service. He will be missed not only by the SC Delegation, but by the entire 16th District.

I would like to recognize members of the Virginia Delegation who serve on ADA councils and committees. They are: Les Webb, Chairman, Council on Dental Benefits Programs; Joan Gillespie, Council on Ethics, Bylaws and Judicial Affairs; and Anne Adams, Chairperson, Council on Membership.

I would like to thank the Virginia Delegation for giving me the opportunity to serve as chairman.


UPCOMING CONTINUING EDUCATION 1998 Please note: This is the correct CE schedule for 1998. The CE schedule printed in the Octoher-Decemher issue of till' Virginia Dental Journal was in error, \Ve apologize for any inconvenience this ilia)' have caused.

!\Ltrch C)_I::', 1'i9S

Murch 1.1. !ll()X

March ::'O,llJ'iX

March 27, IlJl)!:\

April S, 1'i9!:\

April 16, 19'i1'S

April 2-l. jllC)k

\-lay 7, !l)l)S

~'olllpom'nt

Ricluuoud: -l)

TJd~waler ( I)

MCV Scllllol ol Dcnrixuy

Ri~hmond (-l)

Richmond (4)

NVDS (8)

Southwest (6)

~VDS

Richrnond (4)

Tidewater ( I )1 Peninsula (::')

NVDS

South,,,,,t 161

Embass\ Suit~, Hutel

Holiday Inn Greenbrier. Chcxupc.rke. VA

Richmond, VA

Emoa,sy SlIit~s Hotel

Fairview Marriott

Marion, IIcnlock Haven Conference Center

Crystal City Marriott Forum

Embassy Suites Hotel

Chesapc'"kc COnfcl'CI1Ce Center Cnesapeak,'. VA

Fairvic Marriou

Pilx'stcl1l St;llc Park, Pipe-tern. WV

Hi~hcr hlllc',III(lll,t1 ('c'lller. .\hin",doll

I )''ila!,hlln Hrll\\ II CllnkrLllLl' CL'l1h: r . HLlcL -, hurg

h;lI1k .I De~aCl,lni, .II .. Allomey "Colkctilll1.S: How To & Hll\\ NOI To"

DI. lv1ichacl Vcnot "Re,dly PI'actic;ll DCllli'llf'

"The Alton D, Brashear School o! Medicine 1'(1,I~r"dualL' Course In Head & Neck Anatomy"

Dr. Howard Farrar: "I'\linlcss Success in '98: The Busine-,s or Dcnli.,lry Seminar"

Dr. Linda Bauglun "Salivary Dysfunction in the Older Adult Patient"

Drs, Harald Heymann, Charles Wakefield, & Karl Leinfelder: Symposium on Adhesive Dentisrry and Cements: a panel of 3M, Caulk, & Kerr speakers to present and defend the clinical and technical aspects and application of their product.

Sally l\1cKenzie,CMC---"Diagnosing and Correctinj; Malfunctioning Management Systems"

Dr. Samuel Low: ---Successful Management of the Periodontal Patient

Dr. B, Ellen Byrne, "Local Anesthetics"

Dr. Hl1W,lrd Farran Hampton Road-, Dental Sympoxiurn

Dr. Duuic l Cirec'llstcin: "TIlL' Dr. Dan Show"

Bill 11;1) nc,,"!Jc\cloplng Pdllelll RC'!;lliull,llips"

!'raLI;ulIj Dcmul. "Sl'LTCh 10 \1;1n~I!!ill!! the .\cLl,lcralcd Dcnr.rl P"dCUCC"

cor~TINUING EDUCATION RECOGr\ITION OJROGRAM The Virginia Dento; Association IS recognized as a certified sponsor of conrmumq dGniol education by both the ADA CERP and the Acadr-my of General Dentistry.


PAID ADVERTISEMENT f-----------------,

Virginia School ofDental Assisting

..Educating Virginia's Finest Dental Assistants"

~

Central Virginia Campus Western Virginia Campus 1905 Huguenot Rd, #200 Roanoke, Virginia Richmond, Virginia 23235 Northern Virginia Campus Local Phone 804-7941754 Fairfax, Virginia

Toll Free in VA 1-888-99-DENTAL State Wide Fax 1-804-794-7974

X-ray Certification and Other Courses for Dental Assistants Several times per semester, VSDA offers "Dental Radiation Safety: as an individual course. Upon successful completion of this 8-hour course, a participant is certified to expose and develop radiographs in the State of Virginia. Our course offers training in technique as well as radiation safety and includes:

All Aspects of Radiation Safety Other VSDA courses include: Endo Films & Quick Developing FMX Placement and Film Mounting

Adult & Infant CPR Use of RINN XCP Holders Osha & Infection Control Panoramic & Cephalometric Technique Comprehensive Dental Assisting Developing & Fixing and Processor Maintenance 12 wk course (Sat. only) Qualiry'Conrrol Measures and Troubleshooting See dates below. And Much More!

The Fee For the Course is $99.00 & includes hand-outs and supplies. Those students enrolled in our 12 week Dental Assisting Course need not register for this course, as it is included. Space is Limited, so call today to reserve a seat for your assistant. Or you may complete the registration sheet below and mail or FAX it to VSDA at 804-794-7974.

VSDA Registration Form Spring 1998

Name SS# _ Print or Type Name as it should appear on you Certificate

Home Phone Work Phone _

Address City ST _ Zip _

Dental Practice Name _

Complete Practice Address _r"

Birth Date County or City of Residence _

Visa or MC # Expires _

Print Name of Card Holder Signature _

Please enroll me in Ihe course listed below: Check one please. This form may be duplicated for other assistants or students. Reg.. tration is accepted until class begins provided that a class is not full VSDA may cancel any class wlo notice if enrollment is low

Check Here Course # Section # Date Time Cost 100 001 Jan 3-Mar 22 (Richmond) 12 Weeks $1,595.00 101 001 Feb 2B (Richmond)

Mar 14 (Fairfax) Apr 4Jun 20 (Roanoke)

Bam - 5pm $99.00 101 002 Bam - 5pm $99.00 100 002 12 Weeks $1,595.00 101 003 April 26 (Richmond)

May 23 (Roanoke) June 27 (Fairfax)

Bam Spmv $99.00 101 004 Bam - 5pm $99.00 101 005 Barn v Spm $99.00

Mal! this regisrrauon form and credit card information or check (payable 10 VSDA) to: Virginia School of Dental Assisting, 1905 Huguenot Road, Suite 200, Richmond, Va 23235. Or Fax it (credit card only) to 804-794-7974.


MEMBERSHIP BENEFIT HIGHLIGHT: DENTAL PLAN INFORMATION by Kimberly S. Swanson, D.D.S., VDA Membership Task Force

Dental Benefit Information: The staff at the ADA is available to answer questions about the design and administrative features of various dental benefit plans, including managed care plans, Direct Reimbursement, and fee-for-service plans. Information on dental plan statistics is also available. In addition, both the ADA and the VDA have staff available to contact employers in your area to offer them information on dental plan design and coverage. For information or assistance, call the ADA Council on Dental Benefit Plans at extension 2746 or the VDA Central Office.

Marketplace Issues: Dentists and patients must consider many options and issues regarding the dental marketplace and managed care. To educate the public in this area, the ADA Catalog contains literature on patient considerations in selecting a dental plan and on issues for employers in designing and offering a dental plan. Resources for dentists include a booklet on alternative dental benefits models design and their respective impact on a dental practice, available through the Council on Dental Benefits Programs, extension 2746. "A Dentist's Guide to Managed Care Marketplace Information" and "A Financial Impact Analysis of Plan Contracts," a computer spreadsheet program developed by the Council on Dental Practice, are available through the ADA Catalog. Additional resources on these and other related marketplace issues are also available through the ADA Catalog. Call 1-800-947-4746 to place catalog orders.

Quality of Care: The ADA initiated the development of Dental Practice Parameters, which place the dentist's professional judgment as the primary factor in determining the appropriateness of care. For information on Dental Practice Parameters, as well

as up-to-date information on policy and methods on quality improvement and assessment, call the ADA Office on Quality Assessment, extension 2772.

Claims Filing and Dental Procedure Codes: The ADA's Current Dental Terminology (CDT-2) lists every dental procedure code with detailed descriptions to assist in filing accurate dental claims. CDT-2 is now also available on computer disk. To order the CDT2 using a credit card, call the ADA Catalog customer service staff at 1-800-947-4746. If you have specific questions regarding procedure codes that are not answered in CDT-2 call the ADA Council on Dental Benefit Programs, extension 2753.

Electronic Claims Submission: "A Dentist's Guide to Electronic Claims Processing" explains electronic claims process and the paper-less submission of claims using computer-to-computer transmission of data. This publication is free to members. To request a copy, call the ADA Council on Dental Practice, extension 2895.

Enjoy the full value of the powerful partnership that is organized dentistry! For more information on the many benefits of tripartite membership: contact the ADA at 312-440-2500 (or use the members-only toll-free number listed on the back of your membership card), the VDA at 800-552-3886, or contact your local dental society. Information may also be obtained online through the ADA (www.ada.org) and the VDA (www.vadental.org) websites.

PUBLICATION OF CANDIDATE INFORMATION IN THE VDA JOURNAL

Nominations for the elective offices of the Virginia Dental Association may be made either by a Component President on behalf of the Component he/she represents, or by obtaining signatures from a minimum of twenty-five members of the Association. These nominations should be directed to Dr. Thomas S. Cooke III, VDA Secretary-Treasurer.

All candidates must have submitted their CV's, pictures (black & white head-shots preferred), and biographical information to the attention of Dr. Leslie S Webb, Jr., Editor at the VDA Central Office no later than March 1, 1998, for publication in the AprilMay-June issue of the Virginia Dental Journal. Forms for submission of Candidate Information have been mailed to all VDA Component Society Presidents.

500 words. Candidates for all other offices will be allowed a maximum of 250 words. Candidates are asked to limit their biographical information to major accomplishments, but to include such pertinent data as education, memberships, honors, positions of leadership held in the ADA, VDA and Component Society, and community leadership activities.

Due to space limitations, the VDA Journal Editor will reserve the right to condense biographical information, as necessary

Should you have any questions regarding the Journal criteria, please contact Dr. Les Webb either by phone 804-282-9781 or by fax 804-282-3647. If additional Journal submission forms are needed, please contact Tanya Moore at the VDA Central Office either by phone 800-552-3886 or by fax 804-353-7342.

Candidates for the offices of President-Elect and SecretaryTreasurer of the Association will be allowed a maximum of


Special Winter Lease Rates for VDA Members

Honda Accord LX Dodge Grand Caravan SE

Ford Expedition XLT Dodge Durango SLT

Jeep Grand Cherokee Laredo Lexus ES 300

Chevrolet Corvette

$ 265 $ 375 $ 389 $ 409 $ 435 $ 485 $ 629

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(804) 358-8319 Monthly payments quoted. 38 month, closed end leases, 15,000 miles/year.

Fit'st payment, security deposit, taxes, tag fees and $1500 down payment due at delivery. Dependent upon availabilty, prices subject to change Other terms and mileages available.

All makes and models available, at similar savings.

SEVEN NEW PRODUCTS ADDED TO MBNA FINANCIAL SERVICES MEMBERSHIP BENEFITS PACKAGE

The Virginia Dental Association and MBNA America Bank have added seven new products to the VDNMBNA endorsed financial services program offered exclusively to VDA members. The seven new products are in addition to the MBNA Gold and MBNA Platinum MasterCard programs already offered. The new VDNMBNA endorsed programs include:

Gold Saver money market accounts, offering superior market rates and liquidity of funds. Call MBNA at (800) 345-0397 for more information or to open an account. Gold Certificate certificate of deposit accounts, which offer flexible terms and some of the most competitive rates in the industry. To obtain current rate information or to open an account, call MBNA at (800) 345-0397. Gold Option revolving loan accounts that combine the best features of a flexible line of credit and the predictability of a fixed

payment loan. There is no annual fee, and you can select the loan term and payment schedule. For information, call (800) 626-2760. Gold Reserve, a line of credit that gives you the financial flexibility of immediate access to a significant cash reserve. Members will be issued a book of GoldReserve checks that may be used any time or anywhere checks are accepted. No interest charges are incurred until there is a balance on the account. For more information or to apply for an account, call MBNA at (800) 626-2760

Other new VDA-endorsed MBNA financial products Include MBNA home equity loans and home equity lines of credit A home equity loan IS an installment loan secured by your home, which offers fixed monthly payments and the added advantage of taxdeductible interest. A home equity line of credit offers a credit line secured by your home, plus loans up to 100 percent of the value of your home. For m

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