Spring 2018

4 New Mexico Dental Journal, Spring 2018 LEADERSHIP President’s Message Three Thoughts on the Evolution of one NMDA Officer 1. It seems like a lifetime ago; and yet other times it seems like just yesterday. Imagine, you're 32 years old, just graduating from the USC Dental School in 1980. You've had associate offers by professors. You take and pass the California Board; but you really want to come home to New Mexico. And so you pack all your meager belongings into a U-Haul and drive home to prepare for and pass the NM Board Exams. Now what? You know you can do the dentistry taught to you. But you also know there's much more to learn and be responsible for. Geared to succeed through university studies and dental school, but ill- prepared for the business side—that was me. I suppose there were young dentists without a fear in the world; but I was not one of them. Then, after knocking on practice doors, comes that intermediary associate job opportunity. Your 'foot is in the door' to practice dentistry. A year later, having been turned down by ABQ banks, you arrange a high interest loan with a local dental supply company and start your very own prac- tice. The slight dread greatly outweighed by the intense pride of driving up to your own practice—a doctor. 2. Much of my early prescription protocol rolled over from dental school. We were cautioned about the long-term health effects of acetaminophen and ibuprofen. And we knew about oxycodone and its synergistic effects with over-the- counter medications mentioned above. But our go-to opiate prescription for strong pain was acetominophen #3 (or #4) with codeine. Oxycodone was a last resort. We didn't—or at least I didn't—know much about hydrocodone. In fact, I recall pharmaceutical salespersons dropping by the practice and leaving quantities of hydrocodone samples that pretty much remained in a drawer for years. It was a different time without significant concerns about opiates. Mindful of the current alarm with opiate abuse, I'm not aware of dentists in significant numbers that are major contribu- tors to the epidemic. Although "The Journal of the American Dental Association estimates dentists are responsible for 12% of fast-acting opiate pain relievers, " and dentists categorized as "frequent prescribers," the more concerning aspect to this are the huge dosages often prescribed by ER doctors. Throughout the country, many in our profession are now reassessing their prescribing habits because dental boards are mandating guide- lines and others; because they feel a responsibility. Some may be fortunate enough to never have experienced excruciating pain. As one who has, acetaminophen and ibuprofen sometimes just don't cut it ! I've called the Board of Pharmacy and phar- macies I'm acquainted with to alert them of my opiate protocol. Should I clinically determine a patient is suffering this kind of distress or; if a loyal patient I trust informs me of such, I typically prescribe 8-10 tablets along with a NSAID. If facing a prolonged holiday weekend the maximum is 12—all without refill approvals. Anyone presenting a prescription fromme for more than 12, I've demanded to be contacted immediately. It's my common sense approach to doing my part against the opiate crisis. 3. I've often said that this noble profession is in good hands into the future. There's a burst of energy and commitment on the part of our young dentists. This was made evident at both of our last local and national HODs conventions. The world around us is rapidly changing, and we can choose to resist it and just keep keeping on —making small measured changes we feel better about. Or we can actually effect change. In a recent visit to the NMDA offices, I found the conference room full of young dentists conducting a study club. They get it! They eagerly practice the vision set out by ADA President Crowley, "A learned, evidence-based, ethical, compassionate, highly respected dental professional committed to equitably promoting, protecting and restoring oral and general health for our patients and our communities—no matter what." It’s essential that we interact with our peer organizations (Tripar- tite) and find ways to represent the profession in meaningful and consequential ways. We've gained ground in convincing the public that total body health is inextricably related to dental health. Imagine if we could engage the entire health care system where physicians, dentists, nurse practitioners, and CDHCs work together to improve health and lives ? There's so much more we can do. Respectfully, Joe L. Valles, DDS NMDA President 2017–2018 joevalles@aol.com  • 505-243-3535 Joe L. Valles, DDS