For Dr. Elaine deRoode, the concerns startedwith one unhappy patient. “The patient wascomplaining to my team about the dentalcare, and it was pretty clear that the realproblem was going on in their personal life.But the complaints meant that theirproblems had the potential to become myproblems.” Dr. deRoode, who seesorthodontic patients in her Miami practice,began collecting notes and records inanticipation that this case might go intopeer review.

The peer review system is a voluntaryprocess for resolving disputes between apatient and a dentist outside of a legal venueor the “court of public opinion.” The ADApromotes peer review as an option to the public atMouthHealthy.org, and dentists may encouragedissatisfied patients to consider initiating the process as away of settling a disagreement.

“It’s pretty much inevitable at some point in a dental careeryou are going to run into a dispute with a patient,” explainsMs. Grace DeShaw-Wilner, managing vice president ofprofessional affairs for the Michigan Dental Association.“Maybe it’s an unreasonablepatient, but at some point,that individual is going to gosomewhere with his or herdispute. Could be the BetterBusiness Bureau, it could bethe state dental board, itcould be an attorney’s office.But both the dentist and patient can benefit from utilizingthe peer review system.”

Peer review is a two-stage process. The first phase ismediation with volunteer dentists serving as mediators.“Both patients and dentists want to feel like they have hadtheir points of view heard, and they want the process to befree—peer review delivers in both respects,” notesDeShaw-Wilner. “The dentist and patient don’t have tonegotiate with each other, and that removes a great deal ofemotion from the situation.” In general, the process ofmediation is not about determining who is right or wrongbut rather to arrive at a solution that is mutually agreeableto both parties in an effort to resolve the dispute. In manycases, the parties come to an agreement throughmediation.

If mediation alone does not resolve the dispute, the processmoves to the second stage where a committee meets todiscuss the case. The peer review committee may examine

clinical records, talk to both the patient andthe dentist, and may arrange for a clinicalexamination of the patient by members ofthe committee.

If the peer review decision is in favor of thepatient, the dentist may be asked to refundor waive a fee. If the patient and dentisthave an otherwise positive relationship, the

remedy may have the dentist redo thedental work. The peer review committee’srecommendation may include asking thedentist to improve his or her knowledge andskills, perhaps by attending a continuingeducation course.

If the peer review committee decides infavor of the dentist, the patient may berequested to pay any outstanding fees.Sometimes patients have been asked toreturn a dental appliance or other device tothe dentist as part of the agreement.Regardless of whether the committee findsin favor of the patient or the dentist, moststate societies request the two parties toconsider the findings of the peer review

committee and the subsequent agreement to be final.

“Peer review creates the chance for a win-winopportunity,” explains Dr. Chris Salierno, chair of the ADANew Dentist Committee, and a general dentist in privatepractice on Long Island. “Patients win because they avoidthe hassle and expense of an attorney, and still tell theirside of the story with the opportunity for an expertevaluation of their situation. And dentists win because they

too can avoid the expense andcomplication of hiring anattorney, and the confidentialprocess means they canpreserve their reputation inthe community.

Because every state hasdifferent laws and guidelines

regulating dental practice, peer review is conducted at thestate or local level. The ADA establishes guidelines for bestpractices. However, each state dental society is the highestauthority for peer review cases in that state. Peer review isnot a court of law, and does not award damages or imposepunishments. A case in litigation generally won’t beaccepted by a peer review committee, although caseswhere there has been a consultation with an attorney or acase has been referred to a collection agency are usuallyeligible.

Many state societies offer peer review as a member-onlybenefit, or charge a fee to non-member dentists who wantto refer a patient to peer-review. “From a dollars and centsperspective, if you had even a single dispute to resolve, itwould be much less expensive be a member and utilize thepeer review process, than to try and resolve it outside ofADA membership,” explains Seattle general dentist Dr. KalKlass, who serves as chair of the peer review board for theSeattle-King County Dental Society.

Perhaps the biggest benefit of peer review is in the nameof the process. “If there is a complaint about standard ofcare, do you want an attorney or an investigator to beassessing your treatment?” asks DeShaw-Wilner of theMichigan Dental Association, “or wouldn’t you prefer tohave your peers examine the treatment and come to anindependent, fully-informed decision?”

Solving Disputes with Peer Review

Inside this Issue• Solving Disputes with Peer Review

• Drug Seeking Behavior—Know theSigns

• Professional Ethics—a Great StudyClub Topic

• Disability Insurance Protects yourInvestment in your Dental Career

• News & Notes

Save the Date!27th ADA NewDentist ConferenceJuly 18-20 in DenverMeet in the Mile High City for theADA 27th New Dentist Conference—Climbing to New Heights July 18-20,2013 at the Four Seasons Hotel.

The 2013 conference offers up to 15hours of continuing educationincluding an emerging speaker track,a full day of leadership development,all-inclusive lunches and a fantasticFriday night event at Coors Field withan incredible pre-game picnic and aticket to the Colorado Rockies vs. theChicago Cubs game. VisitADA.org/newdentistconf fordetails.

ADA New Dentist News is prepared by the ADA New Dentist Committee

December 2012, Volume XVI, Number IV

NewDentistADANews

See Your ADA News Inside

Dr. Chris Salierno

A M E R I C A N D E N TA L A S S O C I AT I O N W W W. A D A . O R G

“Peer review creates the chancefor a win-win opportunity,”

Many dental diseases and treatments are the unfortunatesource of significant discomfort. As a result, many dentalpatients experience pain at some time or another. A fewpeople, however, take advantage and abuse the drugsprescribed to alleviate these symptoms. Some will abuse fortheir own use, others will sell to third-party abusers.

According to the latest data from the National Institute onDrug Abuse, approximately seven million Americans usedpsychotherapeutic drugs non-medically in 2010. Of those,pain relievers were the most commonly abused, withapproximately 5.1 million patients abusing prescriptionanalgesics. While stereotypes from popular culture mightsuggest that a drug seeker would be easy to recognize, thetruth is that regardless of income, race, gender, oremployment status, a potential abuser or “doctor shopper”may be difficult to identify. As a dentist, a health careprovider, what is the best way to guard against thisbehavior?

“You should never prescribe medication for someone who isnot a patient-of-record in your practice,” says Dr. HaroldCrossley, DDS, PhD, who has been a consultant to the UnitedStates Drug Enforcement Administration (DEA) since 1974.“It’s better to refer that stranger to an emergency roomrather than risk the well-being of the patient and those withwhom they come into contact. This action also protects yourdental license and your staff. Prescribing controlledmedications to someone who is not a patient of recordopens up the possibility of abuse or re-sale of thosemedications.”

Of course, patients in your own practice may also abuse orre-sell prescription drugs. The following is a partial list of“red flag” behaviors that Dr. Crossley associates with drug-seeking behavior:

• The patient waits until late afternoon or early evening toseek relief for pain that has lasted all day, often on aFriday or before a holiday.

• The patient requests aspecific drug, rather thanrequesting relief fromsymptoms.

• The patient refuses to beevaluated.

• The patient categoricallyrefuses over-the-countermedications as beingineffective or causing anallergic reaction, insteadrequesting a controlledsubstance medication.

• The patient states that aprevious prescription was lost or stolen, and needs to bereplaced.

• The patient asserts that his or her insurance company willnot pay for a prescription smaller than 50 pills, or thatthey will not pay for a prescription that cannot berenewed.

• The patient becomes manipulative, attempting to useguilt or threats to receive a prescription.

“If you are suspicious that a patient of record is seekingdrugs, it is your responsibility to perform an exam that isappropriate for the symptoms the patient describes,” Dr.Crossley points out. “As with all patients, carefully documentthe exam results and the questions you asked. And mostimportantly, only prescribe medications according toestablished protocols.”

Dr. Harold Crossley will present the CE course Medical andDental Implications of the Most Prescribed Medications onSaturday, July 20 2013 at the 27th New Dentist Conferencein Denver, CO. Learn more at ADA.org/newdentistconf.

NewDentistADANewsSave the Date:

EBD ChampionsConference,April 25-27, 2013Registration for the 2013 EBDChampions Conference in Chicagowill be open in mid-January atADA.org/ebdconference. Thisconference, limited to 100applicants, will help you findevidence online and evaluate what isthe best evidence. We’re seekingforward-thinking dentists to learnbasic EBD principles and mentortheir colleagues. Registration costs$150 and includes the opportunityto earn up to 14 hours of CE.

Is your ADA®Find-a-Dentist™Profile Up-to-Date?Your ADA Find-a-Dentist profilepage on MouthHealthy.org featuresan enhanced view of your credentialsand contact information, includingsocial media. Update your profiletoday at ADA.org/memberprofile.

DisclaimerThis publication of the American DentalAssociation is offered as information onlyand does not constitute practice, financial,accounting, legal or other professionaladvice. Persons need to consult with theirown professional advisors for any suchadvice. Reference herein to any productsand/or services of non-ADA resources isnot to be construed as an endorsement orapproval by the American DentalAssociation or any of its subsidiaries,councils, commissions or bureaus, or ofany state or local New Dentist Committee,of that product or service. Non-ADAresource manufacturers and serviceproviders are solely responsible for theproducts and/or services they provide.ADA is not responsible in any way for anyrepresentation or warranty, guarantee orany claims which may arise from theproducts or services. The ADA specificallydisclaims any and all liability for damagesarising out of the use of the services orproducts, including special andconsequential damages, expenses, orother claims or costs.

NewDentistADANews

The new ADA Practical Guide to Patients with MedicalConditions provides new dentists an overview of specificmedical conditions and how they may affect a medicallycomplex patient’s treatment plan — all in one easy-to-use resource. Written by a team of over 25 of today’sleading dental professionals and clinicians, this valuableguide includes over 200 color images, more than 75tables, and countless quick reference points to assist inproviding the safest and most comprehensive dental carepossible.

From cardiovascular diseases to substance abusedisorders, each condition has been covered concisely,giving the most important information. Chapters containa description of the disease, pathogenesis, andcoordination of care between the dentist and patient. Asan additional resource, the accompanying companionwebsite offers downloadable images and case studies.

As a special offer save 15% on all ADA catalog productswith campaign code 12246 through 2/15/2013. Toview the complete table of contents or place an ordervisit adacatalog.org or call 800.947.4746.

**“In making these materials available, the ADA does not,nor does it intend to, provide either legal or professionaladvice. Nothing here represents ADA’s legal or professionaladvice as to any particular situation you may be facing. Toget appropriate legal or professional advice, you need to

consult directly with a properly qualified professional orwith an attorney admitted to practice in your jurisdiction.To the extent we have included links to any websites, weintend no endorsement of their content and imply noaffiliation with the organizations that provide theircontent. Nor do we make any representations orwarranties about the information provided on those sites,which we do not control in any way.”

Everything you need to know about patients with medicalconditions—at your fingertips.

Drug Seeking Behavior—Know the Signs

SponsorWells Fargo Practice Finance

is the exclusive corporate sponsor ofADA New Dentist News.

Wells Fargo Practice Finance2000 Powell Street

Emeryville, CA 94608

wellsfargo.com/dentist

© 2012 American Dental Association

Dr. Harold Crossley

2012-2013ADA New DentistCommitteeChairDistrict 2 � NYChristopher Salierno, D.D.S.631.923.0777

Vice-ChairDistrict 3 � PABrian Schwab, D.M.D.610.944.9293

Committee MembersDistrict 1 �

CT, ME, MA, NH, RI, VTTimothy Oh, D.M.D.207.667.6789

District 4 �

DE, DC, FDS, MD, NJ, PR, VIEdgar Radjabli, D.D.S.410.736.1054

District 5 � AL, GA, MSChris Hasty, D.D.S.229.382.8711

District 6 � KY, MO, TN, WVRachel Dasher, D.M.D.423.727.6319

District 7 � IN, OHHeather Maupin, D.D.S.317.838.7100

District 8 � ILMadalyn Davidson, D.M.D.217.253.5216

District 9 � MI, WIEric Childs, D.D.S.517.278.3000

District 10 � IA, MN, NE, ND, SDRyan Ritchie, D.D.S.320.587.3993

District 11 � AK, ID, MT, OR, WADan Bruce, D.D.S.208.376.2920

District 12 � AR, KS, LA, OKMichael LeBlanc, D.D.S.913.745.2500

District 13 � CARex Yanase, D.D.S.310.378.4244

District 14 �

AZ, CO, HI, NV, NM, UT, WYJennifer Enos, D.D.S.480.225.1363

District 15 � TXAndrea Janik, D.D.S.817.428.8700

District 16 � NC, SC, VAShamik Vakil, D.D.S.919.357.2288

District 17 � FLIrene Marron-Tarrazzi, D.M.D.305.646.1524

NewDentistADANews

How long could you survive financially if you got sick orinjured and couldn’t practice dentistry, even temporarily?Without adequate disability insurance, the financialconsequence could be considerable. That’s why the ADAsponsors a high quality, low-cost disability insurance plan(the ADA-sponsored Income Protection Plan) availableexclusively to ADA members. In addition, this members-only plan contains features that are customized to meetthe needs of ADA practicing dentists and the coverage maybe assigned for collateral purposes to finance a practiceloan.

Protect your income and yourdental practiceDr. Janine Randazzo in Midlothian, Virginia, never expectedto become disabled, but knew the importance of disabilityincome protection. Dr. Randazzo obtained the ADA-sponsored Income Protection Plan insurance at the outsetof her career, increased the monthly benefit when shebought her practice, and added ADA-sponsored OfficeOverhead Expense Plan to help pay her dental practicecosts if she became disabled.

As it turns out, Dr. Randazzo, experienced periods oftemporary disability when her two children were born; bothtimes she collected several weeks of disability benefitsfrom her ADA-sponsored plans (after satisfying a 30-daywaiting period) until she could return to the practice ofdentistry.

“The Office Overhead Expense Plan helped pay my staffand rent, and the Income Protection insurance replaced aportion of my lost earnings so I didn’t have to wipe out oursavings,” Dr. Randazzo said.

Dr. Randazzo also tookadvantage of the ability tocustomize her coverage bypurchasing optional planfeatures that further enhancecoverage. Under the ADA-sponsored Income ProtectionPlan, for example, she elected to purchase the FutureIncrease Option so later on she can increase her monthlybenefit amount without a medical exam. She alsopurchased both the Cost of Living Adjustment toautomatically increase her benefits (if disabled) to helpguard against inflation, and the Residual Plus option thatprovides coverage for a partial or progressive disabilityeven if it is not totally disabling.

“All dentists should have disability insurance becauseanyone can get injured or sick,” Dr. Randazzo states.

“Insurance is peace of mind. You hope you never need it,but if you do, you’re glad you have it.”

Financial safety netDr. R. Joseph Bolchoz, Jr., in Mt. Pleasant, South Carolina,couldn’t agree more. He had to stop practicing permanentlyin his 40s because of a rare, progressive eye disorder. Withhis clinical career cut short, Dr. Bolchoz’s ADA-sponsoredIncome Protection Plan became his financial safety net. Hisadvice: “Have disability insurance in place from the first dayyou start practicing. Then, once a year, take a look at yourincome and increase your coverage as much as you can.”

Graham Greenland is still in dental school, but a recentmedical scare convinced him of the need for disabilityinsurance. Now in his second year at Detroit Mercy,

Greenland signed up forADA-sponsored studentdisability insurance and plansto keep his coverage aftergraduation. “I’ll alwaysmaintain my ADAmembership so I can stay intheir sponsored insuranceprograms,” he says. “It’s in

my pocket in case I need something to fall back on.”

Note: For more information about ADA-sponsoredinsurance costs, coverage, limitations, and terms forkeeping coverage in force, call 888.463.4545, e-mailada@greatwest.com, or visit insurance.ADA.org.

The testimonials reproduced in this article were obtained inresponse to questions posed by Great-West. The articledoes not constitute tax, legal, or financial advice. Pleaseseek professional input as appropriate to your situation.

Disability Insurance Protects yourInvestment in your Dental Career

Mr. Graham GreenlandDr. Janine Randazzo

“Insurance is peace of mind. Youhope you never need it, but if

you do, you’re glad you have it.”

Renew your ADA Membershipfor 2013With more than 157,000 dentist members, you’re part of adynamic community and your membership is what enables theADA to deliver the high-qualityresources and services you value.Maintain your ADA membership in2013—with uninterrupted accessto the many professional andpractice resources from the ADA,and your state and local dentalsocieties. Watch your mail forrenewal information.

ADA® is a registered trademark of the American Dental Association. ADA Business ResourcesSM is aservice mark of the American Dental Association. ADA Business Resources is a program brought to you by ADA Business Enterprises, Inc., a wholly owned subsidiary of the American Dental Association.All practice financing is subject to credit approval.© 2012 Wells Fargo Bank, N.A. All rights reserved. Wells Fargo Practice Finance is a division of Wells Fargo Bank, N.A.

We’re here to help you plan your future

Wells Fargo Practice Finance

1668-0912-ADA-NDN-Dec

Whether you’re preparing for ownership or planning for growth, working with experienced professionals who understand the dental business can help you navigate your future success with confidence.

To get started, visit wellsfargo.com/dentistnews, or call 1-888-937-2321. Make sure to request your free issue of Strategies for Success: The Future of Dentistry.

e he’rWWe’ruoan ypl

actice Fo Prgarells FFarWWells F

’thWh

elo he terheur futur

inanceF

lhifi

uop yl

thfiaepe pru roer yethWhxperieng with eorkinw

uop yelan hess cusinb

tisiv,detratstegoT w1232-739-888-1 kaM.

sseccuSroffoseigetartS

anp or plhierswnor og farino unhs wlaessionofed prcn

uce surur futoe ytavigau n

entsitned//dmoc.ografsllewerfruoytseuqeroterusek

:s yrtsitneDfoerutuFehT

wth,oor grg fnninlae dentd thanderstn.econfideness with ccc

swe llacro,foeussiee

.

icamerk of the Aademared trergk f

ADA® is a rtiociassotal Aenican Dmerk of the A

egiste marvicser

a wholly.,Inc,,isesprerty ADA Business Enou byvoedit appro crt tecnancing is subje fiticacll prAeveserts righll rA.A.Nank,

Aarells FW210© 2

.A.gNNgo B

ank,,go Barells FWecD-DNNADA--2190-8661

escesourADA Business Rtion.ciassotal Aenn D SM is aot t

Aam br

DocesourADA Business Rn.

tion.ciassotal Aough

enican Dgr

Amery of the Aes is a pr

wned subsidiaroal.v

e is a division of inance Fticacrgo Parells FW.ed

News & Notes

Important Reminders about yourADA-sponsored Member-OnlyInsuranceAttention 2012 grads: Followinggraduation, your ADA-sponsoredcomplimentary student life and/ordisability insurance will convert tothe practicing dentist programwhere premium payment is requiredto continue coverage. Your firstbilling notice will arrive in earlyDecember and payment is dueJanuary 1, 2013 in order for yourcoverage to continue.

Attention new dentists: 2011grads and prior: Take advantage ofmembers-only low premiums andget extra value from your ADAmembership by considering anincrease to your current coverage ornew coverage under the ADA-sponsored Member Insurance Plans.Visit insurance.ADA.org, call888.463.4545, or emailada@greatwest.com.

American Student DentalAssociation (ASDA) LaunchesDonor ProgramWant to give back to the nextgeneration of dentists? ASDA hascreated a program where colleagueswithin organized dentistry cancontribute to the association.Donations will be put towardsoperational costs and educationalprograms for ASDA’s 19,000members, who are also ADA studentmembers. Each contributor willreceive an ASDA lapel pin as well asrecognition on the website and inASDA News. For additionalinformation or to donate, go toASDAnet.org/donate.

Helping Nursing Home ResidentsPay for Dental Care — FreeWebinarIncurred Medical Expense (IME)billing is routinely used to pay foreyeglasses and hearing aids forMedicaid recipients living in long-term care facilities. But manydentists are not aware that it is alsoavailable for dental treatment. TheADA’s National Elder Care AdvisoryCommittee has posted a free, 60-minute webinar at ADA.org/IME todiscuss challenges in treating longterm care residents, and help thesepatients get the dental treatmentthey need.

NewDentistADANews

Every day, dentists face questions that may not have asimple solution. There’s one aspect of decision-making thatshould be kept in mind while making a decision: professionalethics. Addressing thorny issues in an ethical way can beeasier when you share and learn from others.

“It’s important to keep ethics as an active conversation,”explains Dr. Dan Hammer, a staff dentist currently servingwith the Second Dental Battalion at Marine Corps BaseCamp Lejeune in North Carolina. “If you take a proactiveapproach, such as discussing ethics in a study club format,dentists become more familiar with the options available tohelp them navigate a tough decision. This familiarity makes iteasier to make the right choice under pressure because youhave practiced being in this situation before by discussing itamong colleagues in a study club setting.”

A study club can be an idealsetting to discussprofessional ethics in afriendly environment withpeers who may be facingsimilar challenges. Mr. JayDziwlik, assistant executivedirector of the IndianaDental Association, makesabout 35 ethicspresentations each year tostudy clubs in his state. “It’seasier for all of us to be ourbest when we spend timesystematically thinkingabout what it means to

make the best choice, especially when the best choice isn’tnecessarily the easiest choice. These study clubs aren’tbringing ethics to dentistry, dentistry is already ethical. Butthey can serve as a course-correction.”

An ethics study club can tackle any number of topics, such asadvertising the dental practice, reporting suspectedsubstance abuse, and balancing patient autonomy withdiagnosis and treatment planning. Mr. Dziwlik suggests askingother dentists and dental team members for their pressing

concerns, or asking the state board of dentistry what topicshave been generating large numbers of complaints.

The ADA Council on Ethics, Bylaws and Judicial Affairs hasdeveloped materials intended to help dentists with ethicaldecision-making. One of the resources is a rubric that canassist dentists with navigating an ethical dilemma. Your studyclub can approach the dilemma with these six steps:

E valuate the facts

T hink about the conflict presented

H ow many principles apply?

I dentify applicable codes and code sections

C ompare different options

S elect the best options under the circumstances

If you’d like to explore ethics with your study club, here aresome suggestions for making the event a success:

• Ask your state or local dental society for a speakerrecommendation. If the society has an ethics council orcommittee, that is a good place to start.

• Do a search at ADA.org for ADA Ethics Resources. You’llfind a number of materials, including a PDF of the Codeand links to ethical scenarios that can serve asspringboards to discussion.

• Consider using note cards for questions as a way forparticipants to raise questions discretely and anonymously

“It’s important for new dentists to serve as a resource foreach other and for current students,” notes Dr. Hammer,who speaks to dental student audiences on ethics topics.“We had dentists who were two to four years out of schoolcome and talk to us at University of the Pacific, and it was areal eye-opener. It was the discussions we had followingthese presentations that made individuals realize they werenot alone, and gave us practice navigating the dilemmas in asafe environment. And practice in discussing these topicswith our colleagues makes us better clinicians, bettercolleagues, and better at serving patients.”

Professional Ethics—aGreat StudyClub Topic

Dr. Dan Hammer