The Second District Dental Society of New York Serving the counties of Kings and Richmond since 1868 VOLUME 40 NUMBER 5 SEPTEMBER/OCTOBER 2023 WWW.SDDSNY.ORG SDDS BULLETIN Looking for an Associate? Seeking Employment? See the SDDS Job Board on Page 18. Courses and Events Registration for the GNYDM Now Open! 2023 Greater New York Dental Meeting: Friday, November 24–Wednesday, November 29 by Jayme Spicciatie, GNYDM Program Manager The bustling exhibit floor at the 2022 GNYDM Continued on Page 2 » The Greater New York Dental Meeting (GNDYM) will be hosting their 99th annual event for free at the Jacob K. Javits Convention Center from Friday, Nov. 24 through Wednesday, Nov. 29 with FREE pre-registration. Join your colleagues and friends on the expansive GNYDM exhibit floor featuring over 900 exhibit booths. Meet face-to-face with companies from around the world featuring the newest products and cutting-edge technological advances. Network with friends and find new future opportunities. There Is Never a Pre- Registration Fee! The GNYDM education includes 200+ seminars and handson workshops. The GNYDM continues to expand the specialty meetings, including the World Implant EXPO, Global Orthodontic Conference, Pediatric Dentistry Summit, Sleep Apnea Symposium, 3D Printing & Digital Dentistry Conference, Public Health Symposium, Oral Cancer Symposium, Special Care Dentistry Forum, Women Dentists Leadership Conference, and the GNYDM Lab Symposium. Don’t miss out on the FREE pre-registration or the CE Passport. The CE Passport allows Upcoming Events *Advance registration is required for all events. Visit sddsny.org to register. FRIDAY NOV 03 Dyker Beach Golf Course, Brooklyn, NY, 9 A.M.–12 P.M. Continuing Education Course #2023–22 “Skillfully Responding to Conflict in Work and in Life Through the Use of Basic Mediation Techniques” by Shahram (Sean) Shekib, D.D.S., J.D. and Martin Applebaum, M.A., J.D. THURSDAY NOV 09 Dyker Beach Golf Course, Brooklyn, NY, 6:30 P.M. SDDS General Membership Meeting: New Members, Senior Dentists and Past Presidents Night “Current Legal Issues: OPD, Audits and Medicaid” by Amy Kulb, B.A., J.D. FRIDAY NOV 10 Hilton Garden Inn, Staten Island, NY, 9 A.M.–4 P.M. Continuing Education Course #2023–23 “Common Oral Lesions: A Guide to Diagnosis and Management” by Scott M. Peters, D.D.S. TUESDAY NOV 14 Max’s Es-Ca Restaurant, Staten Island, NY, 7 P.M. Richmond County Dental Society Membership Meeting “Comprehensive Care of the Cleft Lip and Palate Patient” by Lydia J. Lam, D.D.S. MONDAY NOV 06 SDDS Headquarters, Brooklyn, NY, 7 P.M. SDDS Board of Trustees Meeting Jacob K. Javits Convention Center, New York, NY 99th Annual Greater New York Dental Meeting Visit gnydm.com for registration and meeting information. FRIDAY NOV 24 – WEDNESDAY NOV 29
The Bulletin is the official publication of the Second District Dental Society. It is published bimonthly, by the Journal of the Second District Dental Society, Inc. The opinions expressed are those of the writers and are not necessarily those of the Second District Dental Society. Subscription rates; members, $4.50 per year; others, $5.50 per year. Material for publication must be typewritten and double–spaced and must be received six weeks prior to the month of issue. Business communications and requests for advertising rates should be directed to the Second District Dental Society, 111 Fort Greene Place, Brooklyn, NY 11217 The Bulletin reserves the right to alter or reject any copy. ADVERTISING POLICY The SDDS Bulletin and website welcome advertising as an important means of keeping the dentist informed about new and better products and services for the practice of dentistry. Such advertising must be factual, dignified, tasteful, and intended to provide useful product and service information. The publication of an advertisement is not to be construed as an endorsement or approval by the SDDS Bulletin and website and/or its publisher, the Second District Dental Society, of the product or service being offered in the advertisement unless the advertisement specifically includes an authorized statement that such approval or endorsement has been granted. As a matter of policy, the SDDS Bulletin and website will sell advertising space when the inclusion of advertising material does not interfere with the purpose of their publication. The SDDS Bulletin and website reserve the right to accept or reject advertising, at its sole discretion, for any product or service submitted for publication. A Publication of the SECOND DISTRICT DENTAL SOCIETY 111 Fort Greene Place Brooklyn, New York 11217 Tel (718) 522–3939 Fax (718) 797–4335 STUART L. SEGELNICK, EDITOR Jeffrey M. Galler, Business Manager ASSOCIATE EDITORS Paul S. Albicocco Gabriel D. Ariola Babak Bina Alyson K. Buchalter Jacques Doueck Howard I.A. Lieb Lauro F. Medrano–Saldaña Deborah A. Pasquale Craig S. Ratner Reneida E. Reyes James J. Sconzo Paul W. Teplitsky OFFICERS President–Raymond A. Flagiello President–Elect– Tricia S. Quartey-Sagaille Vice President–Paul W. Teplitsky Secretary–Valerie Venterina Treasurer–Phyllis G. Merlino Librarian Curator–Position Vacant BOARD OF TRUSTEES Paul S. Albicocco William W. Bongiorno Alyson K. Buchalter Saad A. Butt Christen J. Carute Joann M. De Leonibus John P. Demas Michael J. Donato Cherry Libramonte Marc Meiselman Mitchell D. Mindlin Charles J. Mistretta Gisele F. Richard Sari R. Rosenwein Stephanie B. Sager Sandra S. Scibetta Stuart L. Segelnick Aia Shalan Ronald Turchak Kirstin A. Wolfe OFFICE STAFF Bernard Hackett, Executive Director Stephanie Carter Shayo Farinre Christine Terrio SDDS BULLETIN Continued from Page 1 » you to take multiple courses or bring your entire team for daily seminars or workshops at a set price. 2023 GNYDM Highlights: • International programs • The Annual Pediatric Dentistry Summit • World Implant EXPO • Global Orthodontic Conference • Standard Proficiency laser seminar and workshop • Sleep Apnea symposium • Dental laboratory education • Technology education • Pre-Dental conference • New Dentist program • Education for hygienists and dental assistants • Social Media Pavilion, Botox, Dysport and dermal filler seminars and demonstrations • Invisalign EXPO We invite Second District Dental Society members to participate and volunteer at the 2023 Meeting. Please visit www.gnydm.com/volunteer/ volunteer-sign-up/ to sign up to be a volunteer and see the infographic on page 3. Mark your calendar now with show dates and remember it’s the only meeting where registration is FREE! Visit the GNYDM website at gnydm.com or visit their social media sites for more information and updates on programs. Participants at a GNYDM workshop 2 SDDS BULLETIN SEPTEMBER/OCTOBER 2023 — VOLUME 40 ◊ NUMBER 5
GPR Program Spotlight: NYPBMH General Practice Residency Program by Gisele F. Richard, D.D.S., James J. Sconzo, D.M.D. and Aaron Brandwein, D.D.S. New York-Presbyterian Brooklyn Methodist Hospital, Division of Dental Medicine (NYPBMH Dental Medicine) is located at 506 6th Street in the Park Slope neighborhood of Brooklyn. Our program was launched under the direction of Second District Dental Society (SDDS) Past President Dr. Robert Seminara, who instilled the need for quality patient care, which continues to this day. Amazing things have been happening here at NYPBMH Dental Medicine for the past 24 years. NYPBMH Dental Medicine’s attending staff has been homegrown “Brooklyn Family Style,” thanks to Dr. Seminara. This attending tradition continues as many of our newer attendings, both general dentists and specialists, are graduates of our program. The program is a one-year general practice residency with an option for a second year. Presently, we have 13 PGY-1s and 4 PGY-2s. There are no post-graduate specialty programs at the hospital. The program is structured in a block schedule format to include general restorative care, prosthodontics, oral surgery, periodontics, endodontics, orthodontics, and pediatrics. Each block schedule has at least one general dentist and one to two specialists overseeing patient care. Patients are treated Monday through Saturday. Residents see patients three days a week, with office hours Monday, Tuesday, and Thursday from 8:30 a.m. to 8:30 p.m. and Wednesday, Friday, and Saturday from 8:30 a.m. to 4 p.m. Each room is staffed with a dental assistant. Our didactic sessions are Wednesday evenings. This is in addition to our daily treatment and case planning discussions. All residents receive access to Spear Education and are required to complete specific units each week. In addition to the CODAmandated rotations, our program offers a rotation in radiation oncology and private practice. The hospital has a level two trauma designation and our residents have the opportunity to treat maxillary and mandibular fractures, in addition to routine dental abscesses and tooth avulGraduation day for residents of the NYPBMH Dental Medicine GPR program sions. Residents are on call an average of two to three times per month. The value of community service has always been at the forefront of our mission statement. We work hand in hand with our hospital outreach liaison and SDDS to help meet the needs of our Brooklyn neighbors. At community fairs and neighborhood schools, our residents and attendings screen and educate attendees on oral hygiene, smoking cessation and oral cancer awareness. In addition, we often help staff the Colgate van and participate in the Give Kids a Smile and Salute Veterans with a Smile programs. We are always in the market for new specialists (especially oral surgeons and periodontists) that share our desire to mentor our residents and help care for our patients in need. 4 SDDS BULLETIN SEPTEMBER/OCTOBER 2023 — VOLUME 40 ◊ NUMBER 5
NYPBMH Dental Medicine residents during Hospital Residents Night at the SDDS General Membership Meeting Attendings from NYPBMH Dental Medicine at an attending awards ceremony Residents listen to a lecture during grand rounds WELCOME TO OUR NEW MEMBERS! REINSTATEMENTS DR. RUBEN CUETO (General Practice; New York University, 1996) 278 Wilson Ave, Brooklyn, NY, 11237 DR. CHRISTOPHER O’NEAL (General Practice; Howard University, 2011) 4607 5th Ave, Brooklyn, NY, 11220 DR. GREGORY BALAES (General Practice; The State University of NJ Rutgers, 2017) 215 Flatbush Ave, Brooklyn, NY, 11217 932 Woodrow Rd, Staten Island, NY, 10312 TRANSFERS DR. FALLON CUNNINGHAM (General Practice; Howard University, 2017) Transferred from Queens County Dental Society DR. SAMUEL KANG (General Practice; University of Pennsylvania, 2019) 5119 5th Ave, Brooklyn, NY, 11220 Transferred from Nassau County Dental Society DR. YOUNGJAE SUNG (Orthodontics and Dentofacial Orthopedics; University of California- Los Angeles, 2020) 22 Graham Ave, Brooklyn, NY, 11206 Transferred from Western Los Angeles Dental Society DR. NATALIE HIRAYAMA (General Practice; University of British Columbia, 2018) Transferred from New York County Dental Society DR. SARA HASHIMI (General Practice; State University of New York, Buffalo, 2018) Transferred from Suffolk County Dental Society WWW.SDDSNY.ORG 5
S D D S 2024 Second diStrict dental Society cordially inviteS all memberS to join uS for our annual inStallation of officerS and awardS luncheon Sunday, january 7, 2024 reception 12 p.m. luncheon 1 p.m. to 4 p.m. the liberty warehouSe 260 conover Street, brooKlyn, ny 11231 celebrating the inStallation of incoming preSident dr. tricia Quartey-Sagaille and the 2024 SddS officerS $75 per perSon | buSineSS attire formal invitation to follow rSvp online by friday, december 15th for more information: (718)522-3939 info@SddSny.org
OCR AND ONC RELEASE UPDATED VERSION OF THE SECURITY RISK ASSESSMENT TOOL The Office of Civil Rights (OCR) and the Office of the National Coordinator for Health Information Technology (ONC) at the U.S. Department of Health and Human Services (HHS) recently announced the release of version 3.4 of the Security Risk Assessment (SRA) Tool. The SRA Tool is a desktop application that assists health practitioners comply with the HIPAA Security Rule, which requires health practitioners to meet HHS-established standards to ensure the protection of patient electronic health information. With the SRA Tool, practitioners can identify and evaluate their cybersecurity systems for potential vulnerabilities that may leave them open to hacking and ransomware attacks. The updated version of the SRA Tool includes new features, as well as bug fixes and stability enhancements. Visit https://www.healthit.gov/topic/privacy-security-and-hipaa/security-risk-assessment-tool to download version 3.4 of the SRA Tool. Recordings of ONC-led training webinars and accompanying slides may also be accessed at this link. Readers may also wish to consider signing up for regulatory courses (e.g., HIPAA, OSHA, sexual harassment) at the upcoming Greater New York Dental Meeting (GNYDM) to ensure they are up to date on all state and/or federal requirements for healthcare providers. Visit gnydm.com to pre-register for the Meeting and to view a course catalogue. CALLING ALL RESIDENTS: SUBMIT AN ARTICLE FOR THE SDDS BEST CASE OF THE MONTH FOR YOUR CHANCE TO WIN! by Stuart L. Segelnick, D.D.S., M.S., SDDS Bulletin Editor Treating patients is not always easy, and we often find ourselves diagnosing and treating someone in a unique way. Or we sometimes come across a patient with a rare disorder and must research its impact on our treatment plan. The SDDS Bulletin would like to invite all our hospital resident members to submit a case report of under 1,000 words, with two to four photos, illustrating thought-provoking cases. Examples of submissions might be: • Utilizing a unique technique for treating a clinical presentation • Exploring the diagnosis of a rare situation and its impact on treatment • Featuring a case report that demonstrates exceptional clinical expertise • Reporting on a new product, instrument, or material that might enhance treatment outcomes (Use of lasers, CBCT scanners, intraoral scanners, or 3D printers are examples of acceptable topics) Second District Dental Society (SDDS) has no limitation on the type of report you can submit; however, the judges will give greater weight to the above examples. Please make sure you have a signed photo release allowing use of your patients’ photos for publication. Photos must have a resolution of 300 ppi or greater. Every month, the SDDS publication team will choose a winning submission. This worthwhile endeavor began with a suggestion from Dr. Babak Bina and input from SDDS Publication Committee members: Drs. Paul Albiccoco, Alyson Buchalter, Jeffrey Galler, Howard Lieb and Sumaya Ibraheem. These members will also comprise our judging panel. The winning article will be published in the SDDS Bulletin along with the author’s photo and bio. The author will receive a $100 Award for SDDS Best Case of the Month. There will only be one award given per case, even if there are multiple co-authors. Please send your submission to editor@sddsny.org. Your article can not only help other SDDS members learn from your experience, but also favorably represent your hospital residency program. Feel free to contact us at Second District at (718) 522-3939 or info@sddsny.org should you have any questions. WWW.SDDSNY.ORG 7
The Wrinkles that Botox Causes for Dentists by Kristen Guarente and Al Anthony Mercado, Esq. In the ever-increasingly competitive profession of dentistry, dentists search for the competitive edge. In some practices, this competitive edge is spelled B-O-TO-X. Botox is marketed as a way to increase patient traffic to the dental office by providing them with additional aesthetic and therapeutic treatment options. However, the use of Botox in dentistry carries additional unique risks that are unknown to many dentists. This article will discuss the use of Botox in dentistry, identify risks in its use and provide guidance for minimizing those risks. A History of Botox The Food and Drug Administration (FDA) first approved Botox in 1989 and, since its initial approval, its uses have expanded to encompass various medical conditions. The FDA-approved uses of Botox include treating:1 • The appearance of glabellar lines (wrinkles) • Overactive bladder • Urinary incontinence associated with a neurological condition • Chronic migraine in adult patients • Upper limb spasticity in adult patients • Cervical dystonia in adult patients (severe neck muscle spasm) • Severe axillary hyperhidrosis (excessive underarm sweating) • Blepharospasm (spasm of the eyelids) • Strabismus (squint) In 2013, Botox was approved for temporary improvement of “crow’s feet” in adults and has since been proven to be an effective, nonsurgical tool in cosmetic treatment. Since the effects of Botox last only four to six months, it can generate increased patient traffic to a medical or dental office. Contrary to popular belief, the FDA has not approved Botox for a specific use in dentistry. In dental treatment, its use is technically “off label.” Some of the accepted uses of Botox as part of a therapeutic and/or cosmetic dental treatment plan are for addressing:2,3 • Bruxism • Temporomandibular joint disorders • Orofacial myofunctional disorders • Sialorrhea (excessive salivation/ drooling) • Facial pain and trigeminal neuralgia • Oral and maxillofacial trauma • Denture wearers struggling with getting used to a new set of dentures due to irregular and uncoordinated muscle activity • Dentofacial aesthetics and gummy smile • Drooping of corners of mouth • Perioral lines, or wrinkles around the lips, commonly called the “smokers wrinkles” Dermal fillers can also be used to treat • High lip line cases as an alternative to gingivectomy, crown lengthening and veneers • Angular cheilitis •“Clack triangles” between teeth after periodontal and implant treatment that did not preserve the papilla • Lip volume for proper phonetics (in addition to or in place of teeth lengthening with fixed or removable prosthodontics) • Lip and perioral volume aro- und the mouth for retention of removable prosthodontics There is no exclusive list of accepted therapeutic or cosmetic uses for Botox in dentistry. This, combined with the lack of FDA approval specifically for dental applications, makes its use subject to regulatory compliance issues as well as the increased risk of professional misconduct charges and malpractice allegations. Case Study: Dazed & Confused A 52-year-old female plaintiff with a history of bruxism underwent placement of a fiveunit bridge in the upper-right portion of her mouth, as well as the placement of two upper anterior implants, six lower anterior veneers, and crownwork. The plaintiff, who was an admitted Botox user, received Botox injections to her jaw muscles and around her eyes during her dental work. The plaintiff alleged that the dental work was negligently performed and she needed to have all the restorations removed, root 8 SDDS BULLETIN SEPTEMBER/OCTOBER 2023 — VOLUME 40 ◊ NUMBER 5
canals performed, new implants placed and a replacement bridge made by a subsequent treating dentist. With regard to Botox, the plaintiff alleged that she was “heavily drugged” for the dental procedures when the defendant dentist discussed using Botox around her eyes and therefore she did not, and could not, consent to its use. The plaintiff woke up to realize that Botox had been injected between her eyebrows without her consent. She further testified that months later, the dentist told her that “he would like to administer Botox injections while she was in a groggy state.” Although it was clearly self-serving testimony, the dentist’s documentation regarding the dental indications for the use of Botox and consent discussion was poor. Importantly, the plaintiff also alleged that the use of Botox around her eyes was outside the scope of dentistry. An expert review was critical of the treatment, including that there was no appropriate documentation of the plaintiff’s periodontal condition and care, and there were no notations within the chart advising the plaintiff that much of the treatment was not ideal and that she was proceeding at her own risk. The expert also commented unfavorably on the lack of documentation regarding the dental indications for the use of Botox and the related consent issue. Similarly, imaging studies and documentation by the plaintiff’s subsequent treating dentist showed unacceptable margins around most teeth and improper crown lengths. Additionally, the lack of a bite guard had resulted in dislodged veneers. These objective findings were unfavorable to the defendant dentist and, ultimately, the lawsuit was resolved in favor of the plaintiff. This case study highlights several Botox-related risk factors for dentists, including informed consent and whether its use is within the scope of dentistry. The specific lesson here is that there can be no informed consent discussion when a patient is “dazed and confused.” The Unique Risks Associated with the Use of Botox in Dentistry The use of Botox in dentistry is subject to compliance with the definition of dentistry found in §6601 of the New York State Education Law, which defines the practice of dentistry as diagnosing, treating, operating, or prescribing for any disease, pain, injury, deformity, or physical condition of the oral and maxillofacial area related to restoring and maintaining dental health. The practice of dentistry includes the prescribing and fabricating of dental prostheses and appliances and may include performing physical evaluations in conjunction with the provision of dental treatment. In a written opinion, the New York State Board for Dentistry explained the potential use of Botox and collagen in the practice of dentistry and compliance with §6601. That opinion states, This section does not specify modalities of practice and does not limit the practice of dentistry to any specific methods of treatment. As a result, Education Law does not prohibit a New York State licensed dentist from using botulinum toxin type A and collagen in the oral and maxillofacial area, consistent with Section 6601, as long as it is related to restoring and maintaining dental health. When providing such services, the dentist must also be competent to provide such services. Rules of the Board of Regents Section 29/1(b)(9) defines unprofessional conduct as: “practicing or offering to practice beyond the scope permitted by law, or accepting and performing professional responsibilities which the licensee knows or has reason to know that he or she is not competent to perform, or performing without adequate supervision professional services which the licensee is authorized to perform only under the supervision of a licensed professional, except in an emergency situation where a person’s life or health is in danger.” Therefore, it is incumbent upon a dentist to provide all services within the defined scope and competently. Whether a specific use of these modalities is lawful would depend upon the circumstances presented. This opinion from the New York State Board for Dentistry provides three basic pieces of guidance on the use of Botox in dentistry: 1. The Education Law does not prohibit a New York State licensed dentist from using Botox and collagen in the oral and maxillofacial area, consistent with §6601, as long as it is related to restoring and maintaining dental health. 2. The dentist must be competent to provide such services. 3. A dentist’s use of Botox solely for cosmetic purposes or beyond the scope of competence can constitute professional misconduct and subject the dentist to licensure proceedings as well as the imposition of fines. Accordingly, as a matter of caution, dentists using Botox as part of their treatment plan should ensure that it is related to the restoration and/or maintenance of dental health and document such in the dental record.4 Similarly, dentists should ensure that they, or the dental provider using it in their office, have the requisite training to use Botox in patient care. The need for requisite training highlights another risk of using Botox in the dental office: dental malpractice. There are several areas of increased risk related Continued on Page 10 » There is no exclusive list of accepted therapeutic or cosmetic uses for Botox in dentistry. This, combined with the lack of FDA approval specifically for dental applications, makes its use subject to regulatory compliance issues as well as the increased risk of professional misconduct charges and malpractice allegations. WWW.SDDSNY.ORG 9
to malpractice for dentists who use Botox that include competence, supervision, and informed consent. Competence The dentist, or person under their supervision, should be trained in the storage, preparation, dosage, and use of Botox through an accredited course. For example, the user should be aware of the lethal, maximum recommended, and proper therapeutic dosages for patients. The user should also be aware of the side effects and contraindications of Botox. Supervision/Vicarious Liability New York State law permits “licensed medical professionals” such as RNs and LPNs to inject Botox under the supervision of a physician or dentist. Nonlicensed individuals may not inject Botox, even with supervision. A dentist can face malpractice liability based upon an allegation of failing to adequately supervise or permitting an unlicensed individual to perform a Botox injection. In addition, under the doctrine of “vicarious liability,” one person may be held liable for the acts of another person. Therefore, in the dental setting, a dentist may be vicariously liable for anyone permitted to perform Botox injections in their office, and this type of liability may not be covered by your malpractice policy. Informed Consent The use of Botox in the restoration or maintenance of dental treatment requires a detailed informed consent discussion about the material risks, benefits, and alternatives, including not using it as part of the treatment plan. In addition, the dentist should inform the patient that Botox is not FDA approved for specific uses in dentistry and explain its “accepted” uses in dentistry. It is important to discuss and emphasize that there are no guarantees related to the use of Botox, especially for aesthetic results. The dentist should be familiar with the information on the package insert including, but not limited to, storage, dosage, use, contraindications, warnings, side effects, and adverse reactions. Possible side effects when used in conjunction with antibiotics are commonly overlooked as part of the informed consent discussion. Some antibiotics, including gentamycin, amikacin, tobramycin, and neomycin, may exaggerate the effects of Botox.5 Fortunately, adverse reactions to Botox are localized and uncommon. Side effects may include a temporary change in facial expression, allergic reactions, rash, itching, headache, neck or back pain, muscle stiffness, difficulty swallowing, or shortness of breath. However, when a facial injury related to the use of Botox is permanent, it can result in a significant liability award. As noted below, if the use of Botox is outside the definition of dentistry, there is an additional risk that it will fall outside of professional liability coverage. Finally, the dentist should use their best professional judgment in deciding what is part of the informed consent discussion, and it is vital to document the discussion in the dental record. It is recommended that a separate note be made independent of any pre-made electronic or paper consent form. Lesser-Known Additional Risks to Consider When Using Botox Breach of Contract and Advertising Liability In addition to malpractice and professional misconduct allegations, dentists may also face breach of contract allegations. More specifically, a patient may be dissatisfied that they did not obtain relief from TMJ pain, still have a gummy smile, or wrinkles around the mouth are still visible. As part of the treatment plan and informed consent discussion, the dentist should manage expectations regarding the results of the Botox treatment and ensure that the patient understands that there are no guarantees to achieve a specific result. Similarly, dentists who advertise Botox treatment as part of their practice (or as available in their office by another vendor) using websites, advertisements, and/or social media must comply with New York State truth-inadvertising laws.6 Professional Liability Insurance Coverage Issues Related to Botox Use Allegations related to the use of Botox may fall outside the scope of professional liability insurance coverage. Some of these types of allegations include using Botox outside the definition of dentistry and inappropriate guarantees made to patients. When there are Botox allegations that fall outside the scope of professional liability coverage, a dentist’s personal assets could be exposed, and they could be responsible for a monetary payment related to those allegations. For these reasons, dentists should be certain that their use of Botox is within the definition of dentistry and that no guarantees are made regarding the outcome from its use. In addition, dentists should review their professional liability insurance policy to determine whether their current use of Botox falls outside of the policy’s coverage. Botox: The Verdict for Dentists The use of Botox in dentistry provides the benefits of increased treatment modalities for patients and the possibility of a competitive edge. While attractive, these potential benefits should be viewed in the context of the additional unique risks dentists face when using Botox. Caution must be taken to ensure that the use of Botox is within the definition of dentistry. Similarly, dentists must ensure that they, or the licensed professional performing the injections, have the competence and experience to perform the treatment. Additional attention should be given to ensure that an appropriate informed consent discussion takes place before treatment and that it is documented in the dental record. Patient expectations as to the results of Botox treatment need to be managed with an emphasis on dispelling any notion that there are guaranteed results. Finally, dentists should be aware that certain uses of Botox that do not fall within the definition of the practice of dentistry may fall outside of professional liability insurance coverage. Kristen Guarente is a claims specialist with MLMIC Insurance Company. Al Anthony Mercado is the managing attorney for Mercado May-Skinner NY and an employee of MLMIC Insurance Company. This article originally appeared in MLMIC’s The Scope Dental Edition, Issue 12, Second Quarter 2023 and has been reprinted here with permission. Copyright MLMIC Insurance Company, 2023, All Rights Reserved. REFERENCES/FOOTNOTES: 1. accessdata.fda.gov/drugsatfda_docs/ label/2011/103000s5236lbl.pdf. 2. Applications of botulinum toxin in dentistry: A comprehensive review: Natl J Maxillofac Surg. 2015 Jul-Dec; 6(2): 152–159. ncbi.nlm.nih.gov/pmc/ articles/PMC4922224/. 3. Botox Therapy in Dentistry: A Review. J Int Oral Health. 2015; 7(Suppl 2): 103–105. ncbi.nlm.nih. gov/pmc/articles/PMC4672850/. 4. Dentists can contact The New York State Board for Dentistry at dentbd@nysed.gov, Telephone: (518) 474-3817, ext. 550 with questions of whether a particular use of Botox falls within the definition of the practice of dentistry. 5. Althawadi, N., Ujam, A. & Visavadia, B. Botox hidden dangers. Br Dent J 232, 192–193 (2022). doi.org/10.1038/s41415-022-4006-3. 6. NYS General Business Law §349 & §350. Continued from Page 9 » 10 SDDS BULLETIN SEPTEMBER/OCTOBER 2023 — VOLUME 40 ◊ NUMBER 5
2024 SDDS DENTAL STUDENT LOAN FORGIVENESS PROGRAM Apply by March 31 and you could be one of several new dentists selected to receive an award up to $10,000 to help decrease your student loan debt. View eligibility requirements to see if you qualify. Don’t miss out on this opportunity! Are you: • A newly licensed dentist who has had your license for five years or less and has completed your residency program or specialty training program? • Licensed in New York and in second year of postgraduate training (if you have converted to full Active membership)? • An Active tripartite member of Second District Dental Society? • Burdened with over $50,000 in verified dental school loan debt? • Practicing the majority of the time in Brooklyn and/or Staten Island? If so, now is your opportunity to apply for the SDDS Dental School Loan Forgiveness Program. You could be one of several new dentists selected to receive an award of up to $10,000 to decrease your dental student loan debt. Visit www.sddsny.org for complete program eligibility details. Program opens on January 1, 2024 Application deadline is March 31, 2024 New ADA-Endorsed Clinical Practice Guideline for Dental Pain Management in Pediatric Patients The American Dental Association (ADA) has recently endorsed a new clinical practice guideline developed by the American Dental Association Science and Research Institute, the University of Pittsburgh School of Dental Medicine and the Center for Integrative Global Oral Health at the University of Pennsylvania School of Dental Medicine. According to the guideline, acetaminophen or non-steroidal anti-inflammatory drugs (NSDAIDs) such as ibuprofen are recommended as the first treatment option for short-term dental pain management in children under the age of 12. The panel which developed the guideline determined that in the absence of immediate dental care, acetaminophen, NSAIDs, or both used simultaneously, can effectively address post- extraction and/or toothache pain when used as directed. While the dosing guidelines evaluated by the panel may differ from the dosing guidelines recommended by the medication manufacturers, dentists are advised that the risk of harm to pediatric patients from use of either medication is low if patients adhere to prescriber directions. To view the new pain management guideline, visit ada.org/ painmanagement. Guidelines for dental pain management in adolescents and adults are currently in development. WWW.SDDSNY.ORG 11
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Therefore, you should not rely on the information provided herein as a policy interpretation or as legal advice on any subject matter for any purpose and should always seek the legal advice of competent counsel in your jurisdiction. All policy provisions discussed in this brochure are subject to underwriting approval. Information in this document should not be construed as a The only dentist professional liability insurance carrier endorsed by NYSDA. See how much you can save. Visit MLMIC.com/NY or call (888) 392-0638 today. MLMIC features some of the most competitive dental premiums in the state. Comprehensive coverage options. Concierge-level service. Exclusive New York-focused extras. For dental professional liability insurance in New York, there’s simply no better choice than MLMIC. See how much you can save. Visit MLMIC.com/NY or call (888) 392-0638 today. Coverage You Can The only dental professional liability carrier endorsed by NYSDA. The material provided in this document is for general informational purposes only. Nothing contained in this document is intended to constitute, and should not be construed as, a solicitation of insurance in any state in which MLMIC is not licensed, an interpretation of any insurance provision or policy nor as legal advice on any subject matter. Therefore, you should not rely on the information provided herein as a policy interpretation or as legal advice on any subject matter for any purpose and should always seek the legal advice of competent counsel in your jurisdiction. All policy provisions discussed in this brochure are subject to underwriting approval. Information in this document should not be construed as a coverage interpretation of the policy in whole or in part. Actual coverage determinations are subject to all of the terms and conditions of the actual policy, endorsements, application, and any actual claims. Nothing contained in this document shall serve to amend, alter, or modify the terms, conditions or exclusions of each individual insurance policy. All references to MLMIC refer to MLMIC Insurance Company, Two Park Avenue, New York, NY 10016. Coverage You Can Trust. The only dentist professional liability insurance carrier endorsed by NYSDA. See how much you can save. Visit MLMIC.com/NY or call (800) 416-1241 today. MLMIC features some of the most competitive dental premiums in the state. Comprehensive coverage options. Concierge-level service. Exclusive New York-focused extras. For dental professional liability insurance in New York, there’s simply no better choice than MLMIC. See how much you can save. Visit MLMIC.com/NY or call (888) 392-0638 today. Coverage You Can Trust. The only dental professional liability carrier endorsed by NYSDA. The material provided in this document is for general informational purposes only. Nothing contained in this document is intended to constitute, and should not be construed as, a solicitation of insurance in any state in which MLMIC is not licensed, an interpretation of any insurance provision or policy nor as legal advice on any subject matter. Therefore, you should not rely on the information provided herein as a policy interpretation or as legal advice on any subject matter for any purpose and should always seek the legal advice of competent counsel in your jurisdiction. All policy provisions discussed in this brochure are subject to underwriting approval. Information in this document should not be construed as a Coverage You Can Trust. The only dentist professional liability insurance carrier endorsed by NYSDA. See how much you can save. Visit MLMIC.com/NY or call (888) 392-0638 today. MLMIC features some of the most competitive dental premiums in the state. Comprehensive coverage options. Concierge-level service. Exclusive New York-focused extras. For dental professional liability insurance in New York, there’s simply no better choice than MLMIC. See how much you can save. Visit MLMIC.com/NY or call (888) 392-0638 today. Coverage You Can The only dental professional liability carrier endorsed by NYSDA. The material provided in this document is for general informational purposes only. Nothing contained in this document is intended to constitute, and should not be construed as, a solicitation of insurance in any state in which MLMIC is not licensed, an interpretation of any insurance provision or policy nor as legal advice on any subject matter. Therefore, you should not rely on the information provided herein as a policy interpretation or as legal advice on any subject matter for any purpose and should always seek the legal advice of competent counsel in your jurisdiction. All policy provisions discussed in this brochure are subject to underwriting approval. Information in this document should not be construed as a coverage interpretation of the policy in whole or in part. Actual coverage determinations are subject to all of the terms and conditions of the actual policy, endorsements, application, and any actual claims. Nothing contained in this document shall serve to amend, alter, or modify the terms, conditions or exclusions of each individual insurance policy. All references to MLMIC refer to MLMIC Insurance Company, Two Park Avenue, New York, NY 10016. Coverage You Can Trust. The only dentist professional liability insurance carrier endorsed by NYSDA. See how much you can save. Visit MLMIC.com/NY or call (800) 416-1241 today. Coverage You Can Trust. The only dentist professional liability insurance carrier endorsed by NYSDA. MLMIC features some of the most competitive dental premiums in the state. Comprehensive coverage options. Concierge-level service. Exclusive New York-focused extras. For dental professional liability insurance in New York, there’s simply no better choice than MLMIC. See how much you can save. Visit MLMIC.com/NY or call (888) 392-0638 today. The only dental professional liability carrier endorsed by NYSDA. The material provided in this document is for general informational purposes only. Nothing contained in this document is intended to constitute, and should not be construed as, a solicitation of insurance in any state in which MLMIC is not licensed, an interpretation of any insurance provision or policy nor as legal advice on any subject matter. Therefore, you should not rely on the information provided herein as a policy interpretation or as legal advice on any subject matter for any purpose and should always seek the legal advice of competent counsel in your jurisdiction. All policy provisions discussed in this brochure are subject to underwriting approval. Information in this document should not be construed as a The only dentist professional liability insurance carrier endorsed by NYSDA. See how much you can save. Visit MLMIC.com/NY or call (888) 392-0638 today. MLMIC features some of the most competitive dental premiums in the state. Comprehensive coverage options. Concierge-level service. Exclusive New York-focused extras. For dental professional liability insurance in New York, there’s simply no better choice than MLMIC. See how much you can save. Visit MLMIC.com/NY or call (888) 392-0638 today. The only dental professional liability carrier endorsed by NYSDA. The material provided in this document is for general informational purposes only. Nothing contained in this document is intended to constitute, and should not be construed as, a solicitation of insurance in any state in which MLMIC is not licensed, an interpretation of any insurance provision or policy nor as legal advice on any subject matter. Therefore, you should not rely on the information provided herein as a policy interpretation or as legal advice on any subject matter for any purpose and should always seek the legal advice of competent counsel in your jurisdiction. All policy provisions discussed in this brochure are subject to underwriting approval. Information in this document should not be construed as a coverage interpretation of the policy in whole or in part. Actual coverage determinations are subject to all of the terms and conditions of the actual policy, endorsements, application, and any actual claims. Nothing contained in this document shall serve to amend, alter, or modify the terms, conditions or exclusions of each individual insurance policy. All references to MLMIC refer to MLMIC Insurance Company, Two Park Avenue, New York, NY 10016. The only dentist professional liability insurance carrier endorsed by NYSDA. See how much you can save. Visit MLMIC.com/NY or call (800) 416-1241 today. MLMIC features some of the most competitive dental premiums in the state. omprehensive coverage options. Concierge-level service. Exclusive New York-focused xtras. For dental professional liability insurance in New York, there’s simply no better hoice than MLMIC. See how much you can save. isit MLMIC.com/NY or call (888) 392-0638 today. Coverage You Can Trust. The only dental professional liability carrier endorsed by NYSDA. ial provided in this document is for general informational purposes only. Nothing contained in this document is intended to constitute, and should not be construed as, a n of insurance in any state in which MLMIC is not licensed, an interpretation of any insurance provision or policy nor as legal advice on any subject matter. Therefore, you t rely on the information provided herein as a policy interpretation or as legal advice on any subject matter for any purpose and should always seek the legal advice of Coverage You Can Trust. The only dentist professional liability insurance carrier endorsed by NYSDA. See how much you can save. Visit MLMIC.com/NY or call 888) 392-0638 today. MLMIC features some of the most competitive dental premiums in the state. Comprehensive coverage options. Concierge-level service. Exclusive New York-focused extras. For dental professional liability insurance in New York, there’s simply no better choice than MLMIC. See how much you can save. Visit MLMIC.com/NY or call (888) 392-0638 today. Coverage You Can The only dental professional liability carrier endorsed by NYSDA. erial provided in this document is for general informational purposes only. Nothing contained in this document is intended to constitute, and should not be construed as, a on of insurance in any state in which MLMIC is not licensed, an interpretation of any insurance provision or policy nor as legal advice on any subject matter. Therefore, you ot rely on the information provided herein as a policy interpretation or as legal advice on any subject matter for any purpose and should always seek the legal advice of ent counsel in your jurisdiction. All policy provisions discussed in this brochure are subject to underwriting approval. Information in this document should not be construed as a e interpretation of the policy in whole or in part. Actual coverage determinations are subject to all of the terms and conditions of the actual policy, endorsements, application, actual claims. Nothing contained in this document shall serve to amend, alter, or modify the terms, conditions or exclusions of each individual insurance policy. Coverage You Can Trust. The only dentist professional liability insurance carrier endorsed by NYSDA. See how much you can save. Visit MLMIC.com/NY or call (800) 416-1241 today.
SDDS President Dr. Raymond Flagiello (back row, far right) with the 2023 SDDS Loan Forgiveness Program award recipients at the September 2023 SDDS board meeting. Back row, from left to right: Drs. Mariam Vonderheide, Thema Hepburn, Emma Guzman, Jonathan Shorter, Alan Meskin, Chloe Andrews, Aia Shalan and Anastasiya Guzchenko. Front row, from left to right: Drs. Vahid Saeidi, Kasey Muchnicki, Tamar Brown, Maxine Navi and Stephanie Sager Meet the 2023 SDDS Loan Forgiveness Program Award Recipients! Second District Dental Society (SDDS) has assisted its newly-licensed members with their dental school loan debt through its Loan Forgiveness Program, which awards grants of up to $10,000 to selected qualified applicants. Since its inception in 2016, the Program has awarded grants totaling almost $1.1 million. This year, 20 SDDS members were selected as the recipients of grants totaling $200,000. The awardees are Drs. Chloe Andrews, Tamar Brown, Michael Erdos, Anastasiya Guzchenko, Emma Guzman, Margo Harary, Thema Hepburn, Christina Kim, Youn Ju Lee, Alan Meskin, Kasey Muchnicki, Mozna Mussa, Maxine Navi, Vahid Saeidi, Stephanie Sager, Aia Shalan, Johnathan Shorter, Brian Sirotnikov, Mariam Vonderheide and Pranali Vyas. All grants are paid directly to the loan provider on each awardee’s behalf. As in previous years, this year’s award cycle was open to newlylicensed SDDS members who had been licensed for five years or less, were working in Brooklyn and/or Staten Island, were fully active members of SDDS and had over $50,000 in documented dental school loan debt. Applicants were also required to submit dental school transcripts, complete three essays distinguishing themselves to the SDDS Loan Forgiveness Program Committee and have their employers complete a directed recommendation form illustrating their character and leadership skills. To keep the selection process free from bias, all applications were reviewed by the SDDS Loan Forgiveness Program Committee through its program consultants, International Scholarship, and Tuition Services. Wednesday, December 6, 7-11 P.M. The Inn at New Hyde Park 214 Jericho Tpk., New Hyde Park, NY WWW.SDDSNY.ORG 13
Skillfully Responding to Conflict in Work and in Life Through the Use of Basic Mediation Techniques Featured Speaker (Top): Shahram (Sean) Shekib, D.D.S., J.D. Co-Founder, Attune Mediation; Clinical Assistant Professor, Columbia University College of Dental Medicine; Certified Mediator Featured Speaker (Bottom): Martin Applebaum, M.A., J.D. Co-Founder, Attune Mediation; Member, Mediation Panel of the New York City Family Courts Conflict is a fundamental aspect of life. We can choose to deepen conflict by hardening into it, or we may see conflict as an opportunity to creatively work through often difficult disputes to reach workable solutions and even find mutual understanding. This seminar will introduce practical mediation techniques that may be used to defuse emotional reactivity and closed-mindedness and to create a space for dialogue and resolution. Participants will not only receive valuable conceptual tools but will, through hands-on exercises, have an opportunity to put theory into practice. More specifically, this course will provide participants with a handson opportunity to learn how to directly foster a space for dialogue and resolution by: • Empowering people to directly resolve problems • Defusing anger and defensiveness • Bringing to awareness unconscious assumptions and bias • Going beneath the surface of positional arguments • Validating the values each person in conflict holds • Bringing these values into dialogue • Finding common ground through creative problem solving Participants will learn proven mediation techniques that support these objectives, applying the science on emotional reactivity through the following skills: • Active listening • Restating what the speaker has expressed • Reframing what is being expressed by the speaker in terms of underlying needs/values/goals • Open and directed questioning • Summarizing • Nonviolent communication • Creative problem solving Participants will have the opportunity to explore the above through guided role play exercises. Upon successful completion of this course, attendees will learn and practice mediation skills that: 1. Empower people to resolve their own problems 2. Defuse anger and defensiveness 3. Bring to awareness unconscious assumptions and bias 4. Go beneath the surface of positional arguments to validate the values each person in conflict holds 5. Bring these values into dialogue, fostering deeper, open communication 6. Dramatically increase the probability of finding common ground through value-based creative problem solving CONTINUING EDUCATION COURSE #2023–22 *Advance Registration Required — Register online at sddsny.org* Friday, November 3, 2023 ◆ Dyker Beach Golf Course, Brooklyn, NY ◆ 9 A.M.–12 P.M. ◆ MCEU–3 HOURS Current Legal Issues: OPD, Audits and Medicaid Featured Speaker: AMY KULB, B.A., J.D. Attorney, Jacobson, Goldberg and Kulb, LLP Office of Professional Discipline (OPD) and Medicaid initiate cases based upon complaints by patients, mostly alleging dissatisfaction with dental work. Other issues include alleged billing fraud and complaints alleging unsanitary or substandard facilities. Both agencies also initiate cases based upon reported events, such as a criminal conviction or termination for cause of other professional privileges. Billing patterns and credentialing issues can trigger audits by Medicaid, managed care entities and insurance network plans. This lecture will identify these issues and present preventative strategies, as well as strategies on how to manage and defend these proceedings. Upon successful completion of this lecture, attendees will learn about current issues in dental investigations and proceedings by OPD, Medicaid, and audits, as well as preventative and defense strategies. SDDS NOVEMBER GENERAL MEMBERSHIP MEETING: New Members, Senior Dentists and Past Presidents Night *Advance Registration Required — Register online at sddsny.org* Thursday, November 9, 2023 ◆ Dyker Beach Golf Course, Brooklyn, NY ◆ 6:30 P.M. ◆ MCEU–1 HOUR Second District Dental Society is an ADA CERP Recognized Provider. ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry. Second District Dental Society designates each activity in this brochure for the stated number of continuing education credits. Second District Dental Society is a recognized sponsor by the N.Y.S. Education Department, ADA CERP and the AGD. Unless otherwise stated, all featured speakers have disclosed that they do not have any relevant financial arrangements or affiliations with any corporate organizations that would constitute a conflict of interest concerning the continuing education activities stated herein. Comprehensive Care of the Cleft Lip and Palate Patient Essayist: EMAD ABDOU, D.D.S. Member, American Association of Oral and Maxillofacial Surgeons; Member, International Association of Oral and Maxillofacial Surgeons This lecture will discuss the treatment and care of babies born with a cleft lip and palate through primary surgery to young adulthood. Treating such patients involves treatment by a multidisciplinary team consisting of oral and maxillofacial surgeons, pediatric dentists and orthodontists. This presentation will focus on the timeline of different procedures including primary surgical lip and palate repair, orthodontic management, bone grafting and orthognathic and cosmetic surgery. Cleft lip and palate are two of the common birth defects in which dentists play a major role in treatment. Upon successful completion of this lecture, attendees will learn the role of different dental specialties in the care of the cleft lip and palate patient, as well as the timeline of treatment from infancy to adulthood. RICHMOND COUNTY DENTAL SOCIETY MEMBERSHIP MEETING *Advance Registration Required — Register online at sddsny.org* Tuesday, November 14, 2023 ◆ Max’s Es-Ca Restaurant, Staten Island, NY ◆ 7 P.M. ◆ MCEU–1 HOUR Common Oral Lesions: A Guide to Diagnosis and Management Feature Clinician: SCOTT M. PETERS, D.D.S. Assistant Professor of Dental Medicine, Columbia University Medical Center This six-hour course will focus on the diagnosis and management of some of the more frequently encountered oral mucosal and radiographic pathologies. The topics covered will be divided into the following categories: • Variations of normal anatomy: Fordyce granules, linea alba, leukoedema, tori/exostoces, varices, Stafne bone defect, idiopathic osteosclerosis, antral pseudocyst fissured tongue, geographic tongue, coated/hairy tongue • Oral manifestations of autoimmune and dermatologic diseases: Aphthous ulcerations, erythema multiforme, plasma cell gingivitis, lichen planus, mucosal pemphigoid, pemphigus vulgaris, oral manifestations of Crohn’s disease • Infectious pathologies: Candidiasis; impetigo; HSV; EBV; VZV; hand, foot and mouth disease; herpangina • Premalignant lesions and SCC: Leukoplakia, erythroplakia, erythroleukoplakia, actinic cheilitis, proliferative verrucous leukoplakia, oral submucous fibrosis, SCC (various forms) • Pigmented lesions: Melanotic macules, amalgam tattoo, melanoma, drug-induced pigmentations, cultural tattooing, post-inflammatory hypermelanosis • Common reactive lesions and benign neoplasms: Fibroma, papilloma, mucocele, “3Ps,” xanthoma, lipoma, granular cell tumor • Odontogenic cysts and tumors: Dentigerous cyst, odontogenic keratocyst, lateral periodontal cyst, glandular odontogenic cyst, ameloblastoma, adenomatoid odontogenic tumor, odontoma, odontogenic myxoma, cementoblastoma • Non-odontogenic radiographic lesions: Traumatic bone cyst, cemento-osseous dysplasia, central giant cell granuloma, condensing osteitis Upon successful completion of this course, attendees will: • Non-odontogenic radiographic lesions: Traumatic bone cyst, cemento-osseous dysplasia, central giant cell granuloma, condensing osteitis • Learn how to recognize oral mucosal and radiographic pathologies • Develop differential diagnoses for these entities • Understand the role of tissue biopsy and other ancillary tests in establishing a definitive diagnosis • Become familiar with how these conditions are treated CONTINUING EDUCATION COURSE #2023–23 *Advance Registration Required — Register online at sddsny.org* Friday, November 10, 2023 ◆ Hilton Garden Inn, Staten Island ◆ 9 A.M.–4 P.M. ◆ MCEU–6 HOURS 14 SDDS BULLETIN SEPTEMBER/OCTOBER 2023 — VOLUME 40 ◊ NUMBER 5
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