PAGD Keystone Explorer Winter 2021-22

explorer Keystone Winter 2021-22 The Official Publication of the Pennsylvania Academy of General Dentistry inside... Where Do You Stand with Your Dental Ergonomics? The Best Laid Plans Dr. Rick Knowlton Remembered at PAGD Golf Outing Facts a Dentist Needs to Know About Disability Insurance 4 7 14 10

ii President (2022) Raymond Johnson, DMD, MAGD Warren, PA President-Elect (2022) Katherine Dangler, DDS, MAGD Altoona, PA Vice President (2022) Carl Jenkins, DDS, MAGD Watsontown, PA Immediate Past President (2022) Leigh Jacopetti-Kondraski, DMD Yatesville, PA Secretary (2023) Ann Miller, DDS, MAGD Chambersburg, PA Treasurer (2022) Eric Shelly, DMD, MAGD West Chester, PA Region 3 Regional Director (2022) Kurt Laemmer, DMD, MAGD Bradford, PA Region 3 Trustee (2022) Michael Kaner, DMD, MAGD, JD Feasterville-Trevose, PA Editor (2024) Alex Frisbie, DMD Mechanicsburg, PA BOARD OF DIRECTORS Janine Burkhardt, DMD, MPH, FAGD (2022) Philadelphia, PA Joseph Chipriano, DMD, MAGD (2024) Pottsville, PA Kyle Dumpert, DMD, MAGD (2023) Bedford, PA Keith Hollander, DDS, MAGD (2022) King of Prussia, PA Kerry Johnson, DDS, FAGD (2023) Lancaster, PA Amanda Sonntag, DMD, FAGD (2023) Wyomissing, PA PEAK Track I Chair Brad Strober, DMD, MAGD Edison, NJ PEAK Track II Chairs John Gustafson, DMD, MAGD Hershey, PA Eric Shelly, DMD, MAGD West Chester, PA Editor Alex Frisbie, DMD Graphic Designer Spencer Seastrom Contributors Alex Frisbie, DMD Stacey Gividen, DDS William Hoch, DMD, MBA, MAGD, FICOI Raymond Johnson, DMD, MAGD Mike Murphy Steve Neidlinger, CAE Eric Shelly, DMD, MAGD Keystone Explorer is owned and published quarterly by the Pennsylvania Academy of General Dentistry. The purpose of the journal is to print timely and appropriate material to stimulate, educate, inform, and recognize the general dentists of Pennsylvania in their pursuit of professional excellence. Views expressed in this publication are those of the authors and do not necessarily reflect the opinion of the Academy. Deadlines for material to be printed are: March, June, September, and November. Keystone Explorer reserves the right to edit or reject any article submitted for publication. Subscription is included in the annual dues of PAGD members. Domestic subscriptions are available to non-members at $26 per year. Subscription queries go to the Executive Director, Steve Neidlinger, 4076Market St, Ste 209, Camp Hill, PA 17011. © 2022 PAGD. All rights reserved. Pennsylvania Academy of General Dentistry Board of Directors Keystone explorer The Official Publication of the Pennsylvania Academy of General Dentistry

KeystoneExplorer | Winter 2021-22 1 from the editor’s desk | I really don’t like the term self-care, mostly because I hear it all the time, and it sounds a little whiney. But all of us can admit that taking care of ourselves (literally self-care) will result in a happier life and a longer career. So call it what you will, but I’ve recently undertaken a few self-care initiatives that are working well for me. First, I bought new loupes with an increased working distance and a greater angle of declination. I actually bought the loupes because I was living in fear of my old pair breaking and being unable to treat a full schedule of patients. The ergonomic improvements were an afterthought, but I soon realized that I should have made the investment a long time ago. Most of us are wearing loupes these days. The magnification and illumination are game changers, but don’t forget to re-evaluate the ergonomics of your loupes. I still vividly remember the sales rep at the school loupe fair talking students out of a longer working distance because “in the real world, you’ll be bending and tilting to see all areas of the mouth.” Perfect ergonomics isn’t realistic one hundred percent of the time, and I’ll still do some acrobatics for the benefit of a geriatric patient in a wheelchair. But that rep led us astray; our equipment should promote ergonomics rather than limit us, and my new loupes encourage a more upright posture. I’ll even admit that applying to endo residencies has crossed my mind a time or two just to sit upright at a microscope! Secondly, I made a conscious effort to reduce portion size and improve eating habits. I don’t stress too much about what I’m eating, as long as most meals include fruits and vegetables and not too heavy on carbohydrates. I try to eat a smaller portion during meals. I probably got used to overeating when I was younger and more active and as my activity level slowed down I failed to adjust my diet. I’m eating closer to what is recommended for an average adult, but it feels like less to me. This “diet” is simple, forgiving, and doesn’t make me feel weighed down throughout my day. I actually notice more energy when I eat less. Lastly, and most importantly, I’ve developed a better night time routine. I’m not sure if I should classify this as sleep habit or exercise or both, but it by far has had the most noticeable impact on how I feel. In the past, I’ve struggled with healthy sleep, but I find a light physical activity that requires mental concentration simultaneously relaxes my body physically and helps my brain wind down. It started when I had a sore neck after a long day, so I lay on the floor and began to stretch. As I held the stretches, I noticed that my thoughts weren’t going a mile a minute and I was feeling overall much more relaxed. Now, I do a simple series of relaxing stretches that are probably a primitive form of yoga. It’s actually shocking how much deeper I sleep when I do this, and it never seems to fail no matter how stressed, worried, or busy I am. The key (and this takes practice) is to really mentally focus on each exercise. My mind has a hard time going from a hundred miles per hour during the day to zero during sleep, and this seems to really help with the transition. It doesn’t have to be a huge time commitment—it’s the very last thing I do before I crawl into bed and I’m usually getting noticeably sleepy in under four or five minutes. At the risk of sounding too much like a millennial, I encourage everyone to make one or two self-care changes to make your days easier and more enjoyable. An Ounce of Prevention Alex Frisbie, DMD “Perfect ergonomics isn’t realistic one hundred percent of the time, and I’ll still do some acrobatics for the benefit of a geriatric patient in a wheelchair. But ... our equipment should promote ergonomics rather than limit us...”

As dentists, we have unique lifestyle and work conditions that make achieving overall wellness difficult. Wellness has been defined as both physical and mental outcomes created by our daily habits. We strive to create better habits, to improve our outcomes. We do this throughout our careers with continuing education, but most of us likely don’t take enough time to think about our personal improvements. Dr. Bill Hettler developed six dimensions of wellness: emotional, occupational, physical, social, spiritual, and intellectual. Focusing on a few of these can help improve our daily outcomes for better wellness. Most of us, almost unconsciously, participate in continuing education to improve our occupational and intellectual wellness. The Pennsylvania AGD helps to facilitate our development in these categories through the PEAK course tracks. Group and host home events help build our social and emotional wellness. We have even had lectures on physical wellness from Dr. Uche Odiatu and will have a future ergonomics lecture at upcoming PEAK events. Dr. Odiatu stressed the importance of physical fitness for our profession. As dentists we are constantly moving, bending, and straining our bodies to be able to provide our patients with care. Staying fit allows us to perform at our peak and without pain. With physical fitness comes improved energy and mood. Adding a fitness routine to your daily activities can help create the habits needed for improved overall wellness. He also stressed the importance of improving our nutrition. The effects of nutrition on our growth and immune system is well documented in the literature. We have unique opportunities in dentistry to create habits that touch nearly all of the six dimensions of wellness on a daily basis. Learning and improving is only part of the equation however. The most important step is to take this knowledge and commit to action—changing our habits so we all can live our best lives. Dental Wellness Ray Johnson, DMD, MAGD “Most of us, almost unconsciously, participate in continuing education to improve our occupational and intellectual wellness. The Pennsylvania AGD helps to facilitate our development in these categories through the PEAK course tracks.” 2 | president’s message

KeystoneExplorer | Winter 2021-22 3 executive director’s message | Get Those Letters! Steve Neidlinger, CAE With the holiday season past us, it’s time for everyone’s favorite eminently futile tradition: The New Year’s Resolution. Whether it be healthier eating, saving money, or finally learning the piano, we start each year with the lofty ideals that leave us with nowhere to park at the gym and the poor cashier at Starbucks with a single tear on their cheek. At least until January 15, when the siren call of the Mint Cherry Mocha Hot Cocoa drags you back onto its rocky caffeinated shores. Is this the year that your career gets the January jonesing? According to, career was the least popular category for New Year’s Resolutions in the US in 2021, after health, self-improvement, money, family, love, and my personal favorite from slackers and realists, don’t have one. I submit that 2022 should be the year that you get after your Fellowship or Mastership in AGD. Here’s why: 1. Get Paid While there’s no hard evidence regarding it, Spock-like logic should lead us to believe that achieving Fellowship and Mastership would lead to more productivity for you and your practice. Learning beyond dental school begets greater confidence in your skills. Greater confidence in your skills begets less referrals to specialists and colleagues. Less referrals to specialists and colleagues begets more income staying in your practice. Want hard evidence? Check back with PAGD in mid-2022—one of our resolutions will be putting this hypothesis to the test. 2. The All-Enveloping Void of Obsolescence During dentistry’s darkest times in 2020 when non-essential procedures were nixed, the most heartbreaking calls I would take were from dentists who relied almost completely on hygiene checks to keep the doors open and the lights on. PAGD godfather Dr. Rick Knowlton used to say that continual development is what allows GPs to stay competitive. For a period of time, it was what allowed GPs to stay employed. You will need to go well beyond the educational bare minimum required by the State of Pennsylvania to continue to do what you have been trained to do. 3. Like What You Do, Do What You Like As Sisyphus would attest, nobody wants to do the same thing every day. I’m told that’s one of the advantages of general practitionership. Variety truly is the spice of life that gives it all its flavor, and adding to your armory of skills puts a little more saffron in your allegorical paella. So why would you limit yourself to the same focus every day? Wouldn’t it be much more enriching to throw in the occasional ortho case? Or implant? Or endo? Ok, maybe not endo… 4. The People You Serve Disintermediation. It’s a concept that economists use to explain why the consumer should be as close to the producer in the exchange of goods and services as possible. It’s why Uber and Lyft are beating up taxi services, and why Netflix isn’t mailing you hard copy DVDs of Dexter anymore. And it’s the reason that you want to do as much as you can in your own office. Giving a patient a diagnosis and a referral for what could be a short and simple fix increases the likelihood that they won’t get it done. But by allowing them to schedule their follow-up at the front desk on their way out increases their likelihood of resolving their problems in your capable hands, and saves them time and extra effort. For those that haven’t already, I encourage you to make 2022 the year you get your Fellowship or Mastership in the AGD. Map out a plan to get in your study hours, whether through PAGD or another PACE credit-offering organization. You don’t have a job: you have a profession. And by dedicating your time and energy to developing yourself as a professional, you benefit both yourself and those you serve. And unlike burpees, this is one resolution you won’t regret in the morning. “For those that haven’t already, I encourage you to make 2022 the year you get your Fellowship or Mastership in the AGD. Map out a plan to get in your study hours, whether through PAGD or another PACE credit- offering organization.”

Q dentistry issues Where Do You Stand with Your Dental Ergonomics? Recently, I just purchased new loupes. I had been using my old ones for twelve years (including dental school) and have known that for some time I would need to make the investment to get new ones. I got sized for the new pair and didn’t think twice about using them. After three days of use, I felt like I had aged 20 years. My neck was sore, and my upper back and shoulders were fatigued in a way that they have never been. Three days! This was an eye-opening experience for me on how proper form can have a severe impact on physical well-being, both long and short term. 4

KeystoneExplorer | Winter 2021-22 5 health + wellnessB By Dr. Stacey Gividen The definition of good/proper posture is when the head is centered over the shoulders and spine and the cervical curve maintains ideal positioning. By that definition, as dentists, we deviate from that model every day we see patients. With poor ergonomics, we may not notice it on a day-to-day basis, but long term, the progression of musculoskeletal disease (MSD) is slow, yet inevitable. MSD is when improper, repetitive motion causes minor physical disabilities that create pain and discomfort in day-today activities. It is extremely common and increases with age. Early diagnosis, treatment, and change in habits are all components to being able to lead a pain-free and active lifestyle. Dentists are especially vulnerable to MSDs. An average of two out of three dental professionals experience occupational pain1 and, as such, MSD forces early retirement for nearly one-third of dentists.2 The economic impact cannot be ignored. In 2004, approximately $131 million in lost income in the dental profession was attributed to MSD.3 These numbers are staggering! What exactly happens when we try to bend like a pretzel to do that DO resin on tooth No. 14 (or any filling for that matter)? Picture this: a rod (the neck) holding a bowling ball (our head) straight up. The weight is centered over the rod and, therefore, the position is easily maintained. Now, angle that rod and bowling ball 10% to 15% one way. What happens? The weight and effort of holding that ball up increase exponentially. Increase that angle even more (as you do when doing that filling, crown, or extraction) and the weight is even more. On average, the weight of a human head is eight to 12 pounds. When we lean forward, our muscles in the neck and mid-back (occipital, trapezius, and rhomboid muscles) must contract to maintain the static position and weight of our head when we work. Over time, this causes fatigue and furthermore creates a muscle memory that will be reverted back to when you bend over again. Essentially, we are training our muscles improperly!4 Arthritis, joint degeneration, headaches, neck/back pain, and numbness with tingling are all complications of poor ergonomics. If you are one who suffers from chronic neck and back pain, then seek the services of a physical therapist. Physical therapists can come to the office to do an ergonomic assessment and then create a specific recovery program to help decrease inflammation, reset and retrain your muscles, help put motion back into your joints, and re-stimulate nerve communication. If needed, a referral can be given to a chiropractor and a massage therapist. Your dental equipment—chairs, loupes, handpiece delivery system, etc.—can play a big role in ergonomics. Orascoptic manufactures a “saddle chair” that helps maintain ideal posture, which in turn, allows for proper provider/patient positioning. An ergonomic how-to guide is also beneficial to reference when working on the maxillary vs. mandibular arches.5 “With poor ergonomics, we may not notice it on a day-to-day basis, but long term, the progression of musculoskeletal disease (MSD) is slow, yet inevitable. An average of two out of three dental professionals experience occupational pain and, as such, MSD forces early retirement for nearly one-third of dentists.”

6 Bhealth + wellness Aside from proper positioning, there are things that can be done outside the office to ensure health and longevity for your dental career. Engage in exercise, both muscle and cardiovascular. Muscle toning and strengthening of the head/ neck and back muscles are especially beneficial—i.e., lap pulls, rows, and swimming. Running and walking are easy, well-rounded forms of exercise. Despite busy schedules, being creative and incorporating these types of exercises into a routine can be done! Proper diet and nutrition will also help facilitate ligament and bone care—i.e., calcium, Vitamin C and D, magnesium, and manganese.6 Even after having my loupes adjusted, it took almost two weeks to feel normal again. Old habits are hard to break, so if you are feeling a little tight and sore in your head, neck, and shoulder areas, then make a change! With proper ergonomics, you will have the ability to practice in a more efficient, healthy, and long-term manner. Dr. Stacey Gividen grew up in Hamilton, MT. She did part of her undergraduate work at Purdue University and then received her bachelor’s degree in exercise physiology from the University of Utah. She received her DDS degree from Marquette University School of Dentistry in Milwaukee, WI., in 2004. She is a guest lecturer in the Anatomy and Physiology Department at the University of Montana. She will present Dental Ergonomic Knowledge That Will Move You for the 2021 PEAK Track II Spring Meeting, April 28–May 1 in Bedford, PA. This article first appeared in DentistryIQ, and has been reprinted with permission. References 1 Rucker, et al., Ergonomic risk factors associated with clinical dentistry. Journal of the California Dental Association, Feb. 2002;30(2):139-148. 2 Burke FJ, Main JR, Freeman R. The practice of dentistry: an assessment of reasons for premature retirement. Br Dent J. 1997;182:250-254. 3 Valachi B. Practice Dentistry Pain-Free: Evidence-Based Strategies to Prevent Pain and Extend Your Career. Portland, Ore: Posturedontics Press; 2008. 4 Marston J. D.C. 5537 Old Highway 93, Ste. A. Florence MT 59833. 5 years-to-your-career. 6 Humphrey J. DPT, MTC, CFS. 1016 Brooks Avenue Corvallis MT 59828. “Running and walking are easy, well-rounded forms of exercise. Despite busy schedules, being creative and incorporating these types of exercises into a routine can be done!”

KeystoneExplorer | Winter 2021-22 7 health + wellnessB 7 The Best Laid Plans By William L. Hoch, DMD, MBA, MAGD, FICOI Throughout the course of life my physical and mental well-being were left for granted and seemed to be better than most. Graduation with honors from high school, college, and professional school. Served with distinction in the military including the Middle East. Many personal and professional adventures seemed to follow me, and life was very fulfilling and seemed to be enriched in this manner. I could achieve what I wanted both physically and emotionally and the family and professional circumstances of my life both worked and was what most would say was well above the norm. Then one day I met challenges which I was not prepared to handle. I believed I could handle anything thrown at me by life, disease, finance, and business because frankly I had proven that to be the case. Performing in my roles as husband, doctor, helper, son, father was second nature to me. I had invested in me. I trained to do and understand all of these roles and had the assurance and insurance that problems which afflicted people would not cause me or my universe problems. Then over a three-week span, I saw three people near and dear to me be overwhelmed by illness, disease, and behavioral issues which shook the rock-solid view of my life. Each were involved and invaded by mental and physical problems which most would call unbelievable if confronted alone. But I had three at once. Together. No problem, Doc. Write up a plan of care and follow it. Learned that in school. Went to graduate business school to see what and how businesspeople handled situations like this. I have four university degrees, four professional certifications. These will allow me to fix this. Nope. One of those three died in a heroic attempt to prolong their life. Then the second ended their life. The third is still with me and that story goes on and makes me smile. I thought I was going to be OK. I really did. Then, in a gym, during the time of their and my trials and the horrors of illness, dementia, and addiction, I injured my shoulder. And my right hand began to shake. And would not stop shaking.

8 Bhealth + wellness I went to several doctors, attempting to find an answer. I eventually ended up in Cleveland, near where my father was an oral surgery resident in the early 1950’s. I was told about my condition, what could be done, and the risks involved in the fixing of it at a place called the Cleveland Clinic. Many trips, scans, visits, appointments, and lots of people to meet. And yet, I was ready to act from the first visit as Parkinson’s Disease is a progressive degenerative disease. And I was in the same current of life as millions of others who are so afflicted. Using a cranial incision shorter than I use to take out twelve teeth, the team at Cleveland Clinic inserted an electrode into my brain and a battery under my left clavicle. And one day it was all connected, and as it was turned on, I felt my center of my body move back to where it should be. And the shaking stopped. A famous person said once that what does not destroy us makes us stronger. I work now, manage people’s health problems, insert implants, and restore teeth as before. I am not what I was when I was 42, yet I know the truth, the value, and the meaning of friendships like never before. The photo of me in bed with my family was taken by someone I hold very dear, she was responsible for me getting to Cleveland. To have my kids there meant more than I can tell you all. This summer my son and I got to go to Yellowstone National Park and bike, hike, and kayak as we did before in Glacier National Park and Yosemite. Thanks to Sandy, David, Lucie, Tammy, Laura, and Matt for being there. Learning how important each of them is in my life is my next lesson and the fuel for the next adventure. We can overcome the obstacles life throws at us. It can be difficult and require change and work in directions none of us thought we would ever have to confront. I always said that I would start to expire once I stopped learning. I hope my story helps all who read it and gives them strength and the ability to move on. “A famous person said once that what does not destroy us makes us stronger. I work now, manage people’s health problems, insert implants, and restore teeth as before. I am not what I was when I was 42, yet I know the truth, the value, and the meaning of friendships like never before.”

KeystoneExplorer | Winter 2021-22 9 dentistry issues Q Our Services Practice Sales and Mergers Transition Planning and Design Associate Search and Placement Partnership Agreements Practice transitions are not linear, and the steps of the process are not always predictable. At DDSmatch, we have a proven process that consistently helps our clients plan and execute a successful practice transition that meets their individual goals, captures the practice’s value, and preserves its legacy. Professional Guidance Throughout the Entire Transition Process 855.546.0044 | It's never too early to start planning. Call today to schedule time for a complimentary consultation! Transition on Your Own Terms with DDSmatch

10  pagd news Dr. Rick Knowlton Remembered at PAGD Golf Outing On September 17, 36 golfers gathered at Four Seasons Golf Club in Landisville to enjoy each other’s company and pay tribute to Dr. Rick Knowlton, longtime AGD and PAGD leader and friend to dentistry. The smiles and laughs outshone the shanks and duffs, and great times were had by all. And $6,048.91 was raised for Temple Dental’s Dean’s Scholarship Fund in the name of Dr. Rick Knowlton. Special thanks are due to the event sponsors: Dr. Fred Lally, Endless Smiles Dental Group Dr. Laurie Stanell, Buckingham Dentistry Eastern Mobile Wash, Elizabethtown Patterson Dental Pennsylvania Dental Assistants Association White Family Dental, Elizabethtown Dr. Bob Fredrickson with the money putt Dr. John Gustafson, showing off the strong form Dr. Ed Enriquez collapsed to the pressure of teeing off while getting his picture taken Dr. Janine Burkhardt claims the ladies longest drive

KeystoneExplorer | Winter 2021-22 11 pagd news  Team Knowlton Jr. may not have won the tournament, but they won our hearts Team Floryshak-Cook-Secret-Enriquez Team Curran-Dively-Lowery-Nolan lines up a birdie The success of this outing is solely due to Sue Knowlton, seen here with her team and the birdiemaker Dr. Ray and Craig Johnson, flanked by Pat Ward and Dr. Kyle Dumpert

12  pagd news In September/October, PEAK Track II held their hopefully- returning-to-regular Fall Meeting at the Radisson Lackawanna Station in downtown Scranton. Thursday featured excellent member presentations on endo and materials. Dr. Hal Crossley brought to bear over 50 years of dental pharmacology experience on Friday. On Saturday, Dr. Jonathan Spenn gave tips and tricks on exodontia, live with a pig jaw, hands-on. On Sunday, Dr. George Schmidt helped with implant case selection and where they can go wrong. On the social end, attendees enjoyed the dining scene at POSH and a tour and tasting at Susquehanna Brewing Company. Great times and great dentistry! PEAK Lights Up the Electric City Your cornhole champions, Drs. Cuong Tran and Steven Dotter Dr. Dejan Golalic, one of PEAK’s best reviewed The team at Hamilton Dental, Drs. Leigh Jacopetti and Joel Hamilton Dr. Eric Shelly nabs a full piggy incisor Birthday boys, Drs. Levi Evalt and Jim Basara

KeystoneExplorer | Winter 2021-22 13 pagd news  Newlywed Drs. Tony Matteoti and Stephanie Wong present their first PEAK Drs. David Pyle and Janine Burkhardt survey the wares at SBC Dr. Hal Crossley urges attendees to use their head when prescribing Norm Tabas, Scott Hudimac, and Todd King get the behind the scenes tour of SBC Dr. Jonathan Spenn going through his exodontia armamentarium Dr. Kyle Dumpert shows off the cornhole form Drs. Sue Rotzal, Matt Freedman, Andrew Stewart, Dan Martel, and Carl Jenkins at POSH Scranton

14 Q dentistry issues FACTS A DENTIST NEEDS TO KNOW ABOUT DISABILITY INSURANCE By Mike Murphy, Hagen Insurance Group For most dentists, the idea that one could become disabled due to an illness or injury seems pretty remote. You work in an office setting and aren’t exposed to many elements of nature. No matter how many times one may say, “It will never happen to me,” there’s no getting around the fact that it does happen— everyday—to people just like you.

KeystoneExplorer | Winter 2021-22 15 dentistry issues Q While Social Security may seem like the obvious solution, benefits are limited to long-term disabilities and hard to procure—with a six-month waiting period before payments begin. Even then, the income you receive may not be enough to cover your mortgage, medical bills, or any other day-to-day needs. It certainly won’t cover the expenses to keep your practice open and ready to handle patients when you return to work. If this statistic seems high, it’s important to keep in mind that 90% of all disability claims are the result of common illnesses such as stroke or cancer, not random accidents. That’s why it makes so much sense to protect yourself—and your loved ones—from the financial impact a disability could have during your working years. After all, how long would you be able to make ends meet if you were out of work for a month, a year, or possibly even longer? How much time and money did you invest in yourself to become a dentist? FACT The likelihood of a 20-year-old worker being disabled before they retire is more than one in 4.1. Workers’ Compensation is another program that provides disability benefits; however, not all employers are required to participate in it. What’s more, you will only qualify for benefits if injured on the job or become seriously ill due to a work-related activity. Injuries or illnesses that take place in the home are not covered under this program. Most dentists are not covered by Workers’ Compensation unless they are in a multi-partner practice. FACT In 2016, the average monthly benefit paid by Social Security Disability Insurance (SSDI) was $1,171 a month. FACT The average disability claim lasts almost three years. Yet, according to an industry survey, half of all working Americans couldn’t go one month without a paycheck before financial difficulties begin.

16 While a disability can cause financial hardship at any age, it can be particularly troublesome for working-age families. After weighing all the facts, it’s easy to see why dentists need—and deserve—a quality, economical source of disability protection. The Academy of General Dentistry developed a Group Disability Insurance Plan with Met Life Insurance Company substantial enough to stand on its own and flexible enough to be an extra safeguard for those members who want more financial security. There is, of course, one more potential source of disability benefits. While some may have access to disability coverage at work, these plans are often generic in nature and may not have all the features and benefits needed and don’t contain the terms and coverage a dentist needs covered. And, because these plans accept a wide range of applicants, they often charge high premiums to the firm to help offset the risk. Plus, most workplace plans are not portable so one cannot take this coverage when changing jobs. And since many dentists are self-employed, you need disability coverage to ensure you can continue your firm, even if an illness suspends your work for a period of time. For more information U.S. Social Security Administration, “Fact Sheet,” June 2016 @ The Council for Disability Awareness, “Disability Statistics,” @ U.S. Social Security Administration, “Fact Sheet,” June 2016 @ To find out about the member-exclusive AGD Group Disability Insurance Plan, please visit the website to review what is available for AGD members. All the information you need about the program, including its features, costs, eligibility, renewability, limitations, exclusions, and more are provided along with application forms. You can obtain a coverage overview and apply right online, if you prefer to speak with a representative, call directly to (877) 280-6487. Four Key Factors for a Dentist to Consider When Obtaining Long Term Disability Insurance: 1. The benefit period: How long will benefits continue? a. 5 years b. 10 years c. To age 65 or 70 2. Waiting period once disabled: 60-90-180 days 3. Monthly benefit amount: a. 60% of annual earnings b. 70% of annual earnings 4. Definition of disability: Your “own occupation” as a dentist versus any occupation you may be trained for by education or experience. Q dentistry issues FACT Less than 5% of disabling accidents and illnesses are work-related. Therefore, 95% of all disability claims are not covered by Workers’ Compensation.

AGD2022 Registration Opens January 25, 2022 Expand your knowledge and grow professionally with AGD2022’s numerous education offerings: Richard Baxter, DMD, MS Oral Medicine, Oral Diagnosis, Oral Pathology John C. Comisi, DDS, MAGD Oral Medicine, Oral Diagnosis, Oral Pathology Harvey Levy, DMD, MAGD, FACD, FICD Special Patient Care Susan Muller, DMD, MS Oral Cancer Education Dania Tamimi, DDS, DMSc Oral and Maxillofacial Surgery Art Wiederman, CPA Practice Management While at the Rosen Shingle Creek resort in Orlando, Florida, you can enjoy: • Recently renovated and stylish lodgings. • 15 restaurants and lounges serving all culinary tastes. • 18-hole championship golf course redesigned by Arnold Palmer Design Company. • 13,000-square-foot full-service day spa and elite salon. • Four seasonally heated swimming pools. • 255 acres of lush landscaping that includes a nature trail and outdoor sports courts. AGD2022 THE PREMIER MEETING FOR GENERAL DENTISTRY ORLANDO, FL JULY 27 - 30 AGD2022.ORG Academy of General Dentistry Nationally Approved PACE Program Provider for FAGD/MAGD credit. Approval does not imply acceptance by any regulatory authority or AGD endorsement. 6/1/2018 to 5/31/2024 Provider ID# 216217 LEARN MORE

Mark Weglos, DMD, FAGD of Dresher, PA passed away suddenly in October 2021. Dr. Weglos was an active participant in PAGD and particularly in the PEAK Track I Mastertrack. He was 57 years old. Mark was a Temple Dental Graduate and completed his post-graduate residency at Einstein in Philadelphia. He achieved his Fellowship in the AGD in 2009. In addition to his skills in dentistry, he graduated valedictorian from the Culinary Institute of America and displayed his talents as a chef for his PEAK colleagues at the 2021 Spring PEAK Track I meeting in Plymouth Meeting. PAGD leadership offers its many condolences to Cathy, the Weglos family, and the many people who were fortunate enough to call Mark a friend. Remembering DR. MARK WEGLOS

KeystoneExplorer | Winter 2021-22 19 advocacy\ Chairperson Dr. Lugo welcomed attendees. Special welcome was made for Mr. Wyant, the new designee from the Pennsylvania Department of Health. Mr. Wyant is the public health program director for DOH. The minutes were approved with minor amendments to correct misspellings. Prosecutorial Report The board waived the prosecutorial report. One case was openly discussed involving a dentist found guilty of Medicaid fraud in Ohio that had allowed his Pennsylvania license to lapse before reactivating it in 2019. He has a long history of Medicaid fraud in other states, and his license is already under suspension as a result. Financial Report Michelle Witmer from the Bureau of Finance and Operations presented the board’s financial position. Ninety-eight percent of the board’s operating income is derived from renewal and application fees. With the proposed increase in fees upcoming, Ms. Witmer projects that the SBOD should be operating with a net profit again in the 2024–25 biennial budget. Hygienist Use of Lasers Dr. Keith Brewster, who is a Fellow in the Academy of Laser Dentistry, presented on the subject of lasers use for hygienists. The presenter reiterated that use of lasers does not expand the scope of hygienist practice, but instead allows for already existing hygiene care using lasers under dentist supervision. The presenter recommended any regulations or policy statements to reference American National Standards Institute (ANSI) standards for laser use in a dental office, as the standards can easily be changed as technology changes without requiring regulatory change. Depending on the wavelength used and based on careful case selection, the presenter characterized laser use as mostly noninvasive. The presenter recommended the following potential steps for laser hygiene treatment: 1. Preoperative photobiomodulation (PBM) therapy 2. Anesthesia as needed 3. Probe to reconfirm pocket depth and architecture 4. Ultrasonic scaling with antimicrobial agent 5. Light hand instrumentation as needed 6. Irrigation and flushing of periodontal pocket with ultrasonic and water 7. Periodontal pocket decontamination laser therapy 8. Placing debrided and treated tissue in close proximity to the root structures 9. Post-op instructions and documentation 10. Post-operative PBM therapy In addition, the presenter recommended PBM for helping the healing process via antimicrobial therapy. Dr. Matta recommended that the Scope of Practice Committee review and recommend a response to this presentation. Status of Regulations The approved licensing fee increases are set for final publication in the Pennsylvania Bulletin in March 2022. They are not slated to take effect until 2023. Elections With the expiration of Dr. Lugo’s term as Chair and Ms. Hart-Hughes term as Secretary, the board conducted elections. Dr. Casey was nominated for Chair by Dr. Matta, and Dr. Unis-Sullivan was nominated for Chair by Dr. Mountain. Dr. Casey received the most votes for Chair. Dr. Unis Sullivan was subsequently approved as Secretary. State Board of Dentistry Report Meeting Summary November 20, 2021

20 \advocacy Considerations for Trying Times These are financially challenging times for sure. Whether or not you and your practice have been challenged by COVID or is thriving with a large demand, you face financial issues either way. One of the big financial concerns of the time is inflation. For months, the Fed was claiming that inflation is transitory but they are now backtracking on that. The Consumer Price Index is hovering around 6% but we know that it is calculated without the inclusion of gas and other significant items we all use. I suspect with meat prices increasing by 30% and many other things rising in cost, the real effective inflation rate is well above 10%. If you want to confirm this claim, check out for a more realistic calculation of inflation. It has been a long time since dentists have had to function with high inflation. This article will hopefully give you several strategies to deal with inflation and make good financial decisions. Financial Freedom and Net Worth A worthy financial goal for practicing dentists is financial freedom. I would define financial freedom as the point where the monthly passive income is equal to the monthly budget. You define your budget. Many people create budgets that include the normal items such as mortgage, utilities, groceries, school, insurance, and taxes. Many will budget for vacations and leisure but often don’t factor in unexpected repairs and medical expenses which are notorious for blowing up a budget. Now with inflation creeping in you will need to consider whether your practice income is keeping up with inflation and adjust your budget if it is not. If your budget costs increased by over 10% but you only raised your fees 5%, you will need to increase your production to make up the deficit or you will need a larger fee increase. This insidious thief we call inflation will sneak up and steal the money you were using to create your financial freedom. Financial Strategies for Inflation Eric N. Shelly DMD, MAGD

KeystoneExplorer | Winter 2021-22 21 finances While it is a great accomplishment to achieve financial freedom, it does not make you wealthy. It just means that you have enough to cover your expenses without working. With inflation, financial freedom won’t last very long unless you build up your net worth and create the buffer you need to live without financial worries. The beauty of financial freedom is that your money works for you instead of you working for money. As my friend and mentor, Robert Helms says, “It’s like your dollars go to work for you and come home with friends.” The strategy that is commonly used by retirement planners is to have you invest in stocks, bonds, and mutual funds, to accumulate enough to withdraw about 4% per year, and hope it doesn’t run out. Cashflow vs Networth Investing The traditional method requires a large amount to accumulate compared to a cash flow model of investing. The idea is to find investments with cashflow until the stream of cash covers all your living expense and then continue until you have a buffer of cash flow that will support your retirement lifestyle. Many advisors suggest that your budget or expenses will drop when you retire, but I would disagree. Once free from working, you will have the opportunity to travel and participate in leisure activities. You will likely develop some new hobbies and have some related additional expenses. It usually requires significantly less net worth using the cashflow model. Also, if some of the cashflow investment are real estate or other real assets there will be appreciation and equity building up as well. The real estate acts as a hedge against inflation while the stock bonds and funds do not. Leverage to Build Net Worth Because of inflation, it is challenging to grow your net worth using strictly investments like CDs and other interest earning investments. If you find a CD that pays 4% but the real interest rate is at 10%, you are losing spending power. You would need 10% just to break even. How can we get around this? The answer is leverage or debt. For example, you could buy one house for $100,000 cash and it might cash flow $200 per month. But using debt we can put down 25% on four $100,000 houses and borrow 75% giving you a cash flow of $800 per month. If the houses double in value to $200,000 over ten years we still only pay back $75,000 per house. We add the appreciation to our net worth. It is possible to do the same thing without the hassle of owning houses, but that is for another day. During times of high inflation you will pay back your loan in devalued future dollars but the asset will retain its intrinsic value. It will be worth more of those deflated dollars. Using debt is the best way of overcoming the effect of inflation Reduce Taxes Another way to beat inflation is to reduce taxes. The number one largest expense for everyone is taxes. Your total tax rate can be over 50%. Believe it or not, the IRS tax code has a very small section on how to calculate the taxes you owe but the rest of the tax code is filled with ways of reducing your taxes. The government uses the tax code to create the behavior they desire. For example, the government doesn’t want to be in the housing business or the oil exploration business. There is a tax incentive for investors to encourage them to do both of these things. If these tax deductions drive oil exploration and rehabbing houses in rundown communities then government does not have to spend any money doing this. The private sector does it more efficiently. It is important to understand what tax savings are created by certain investments. There are investments that allow you to deduct 2–5 times the amount you invest. So it is important to spend some time learning how to invest using these deductions. Hedge Against Inflation And finally, I present a defensive strategy. Consider buying 5–10% of your portfolio in precious metals as a store of value. Understand the dollar is a fiat currency and not really money. Gold and silver serve as the best example of money. Gold has held its value in purchasing power well over time. In Roman times you could by a formal toga and good sandals for an ounce of gold worth $1,800 today. For a similar amount of money, you could by a nice suit and a pair of good shoes. Should the dollar collapse, an ounce of gold will still have the it original purchasing power. I hope you now have some ideas to mute the effects of inflation. I have introduced the strategies of cash flow vs. net worth, leverage, tax mitigation, and investing in precious metals as a hedge. It is up to you to learn how these strategies can be used to defeat the inflation thief. Eric N. Shelly DMD, MAGD PAGD Treasurer CEO Freedom Impact Consulting LLC

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