by Amy Rosinsky, DDS

My passion has always been public health, even prior to applying to dental school. After graduation, private practice and another county based oral health center were just not the right fit. In 2017, I finally found my passion, working with and advocating for individuals living with HIV/AIDS. If you are thinking to yourself that you have not had a patient living with HIV, I can almost guarantee you that you have. They may not be comfortable disclosing their status due to experiences of stigma.

My goal in practice, after providing the best possible care, is to show compassion for people who may have been abandoned by their family and friends, or treated differently because of their status. I’ll never forget a time when a patient was nearly in tears because I shook his hand at the conclusion of his new patient visit. A previous health care provider had not wanted to touch his bare skin. Though that event occurred in the early 90’s when less was known about how HIV was transmitted, it stuck with him as a traumatic event by which all future providers would be judged. This was his sign that he would be safe and treated with respect in our clinic, far more than any words could have.

Saturday August 27th was the 35th annual Festival for Life, Colorado AIDS Walk at Cheeseman Park. After the event was held virtually for the last two years, it was great to see 50 participants in the competitive run category and 178 walkers! Over $45,000 dollars were raised; most of which through small $10 to $25 donations. While all of this community engagement is wonderful, the most powerful portion of the Festival for Life for me is the National AIDS Quilt Memorial, lovingly made by friends and family of those who have lost their fight with HIV/AIDS. The quilts have a way of speaking to the heart of the person lost and often hold significant pieces of memorabilia. If you have never attended such an event, I highly encourage it.

Now more than ever before, people are living longer, growing old, and living well with HIV.  In fact, September 18th is HIV and Aging Awareness day. Long-term survivors often face similar health challenges of their peers. Extreme dry mouth due to polypharmacy is the number one issue in a dental office. Appropriate salivary function is essential to a healthy mouth and affects everything from caries risk and taste to calculus formation and denture retention. There are many products that can help your patients combat the effects of dry mouth, and often a more frequent recare interval is needed.

So how do you treat a patient living with HIV/AIDS? Since we all follow Standard Precautions, the most important part of the answer to that question is with compassion, from a trauma-informed care lens, as you would treat any other patient in your office.

In the movie Cast Away, Tom Hanks’ character performs an extraction with a rock, salt water, and an ice skate. I always cringe at that part and wonder how much was left behind.

Solo practice dentistry often feels like Cast Away, alone and on an island. I know firsthand. I purchased my practice in rural Colorado less than a year out of training. Our local dental society is located in a city an hour away. Occasionally, I can get together with others, but it’s pretty rare. I made friends with many of the local dentists and occasionally have the opportunity to “talk shop” with my local colleagues. Running a small business (the practice),  family, and social responsibilities leaves little time to meet.

So, I generally practice alone. I make a concerted effort to stay current on continuing education and learn and grow from my experiences practicing.

All that said, I often feel alone on that island and that sometimes leads to my feelings of reexamination. I wonder if I’m using “a rock, salt water, and an ice skate.” I constantly strive to insure I am practicing at the standard of care. Am I the only dentist in Colorado who feels this way?

Fortunately, I have discovered a friend and a confidant in the Trust. I have discovered, as many of you have, that because the Trust is run by dentists, each of us has someone who has been there and can provide better help than a large insurance carrier would.

I have now served on the Board of the Trust for a year and a half. I am so thankful for the opportunity to serve with these wonderful people. They work very hard for the Trust and its members.

Dr. DeLapp is a true ally in our practices. I no longer feel alone in practice in the same way I did before getting to know Dr DeLapp. So, remember you aren’t alone on an island! You have a team of dentists supporting you. From us at the Trust, it’s personal.

Howard Pack, DDS

People often ask me how I can tolerate working and owning a business with my husband.  I honestly don’t know how anyone could work with a business partner that is anyone other than their spouse!

I met my husband, Kevin, when I was a first-year dental student and he was in his third year. We became friends and started dating my second year.  We learned right away that we both had different strengths when it came to dentistry.  He would casually stick around the lab when I was struggling with waxing up a denture, and swoop in and save the day and show me his skills?.  After many hours in the lab together, we bonded over dental cases, while jamming to Dido, Chris Isaak, Van Morrison, or Steely Dan.  As we helped each other study for Pathology, Advanced Operative Dentistry, or Dental Materials, or whatever the weekly project or fire was that needed to be put out, we became very good friends. Over time, we found our love for each other, and for dentistry, was mutual. 

After getting married and working separate residences and jobs, we both decided to move back to my home town and take over a private dental practice together. In the beginning, there were some challenges because we were balancing a new baby and office.  As our kids have grown older, we have cherished both the ability to keep our work a part of the family and the flexibility that allows us to keep our family as our first priority.  There are seldom times when we need to give each other space.  We both have found our groove with our personal strengths clinically and business-wise.  We are usually both so busy doing our own thing at work, that we sometimes come home and still have to ask, “How was your day?”

Kevin and I have found a way to separate work and home as much as we can.  We try to only let it overlap if it’s beneficial, even though there are many times when that is impossible.  It’s a family run shop, so we try to remain colleagues at work and mom and dad at home.  There have been times when we have to discuss something going on from work at home and the kids will beg us to not talk about it in front of them.  I think it stresses them out some times.  There are times at work when I have to ask my husband to pick up the kids from school and get them to hockey practice because my endo is taking longer than I expected.  

I love working with my husband.  He is my partner, my mentor and my best friend.  I trust and know we will work together to do what’s best for not only our office, but for our family.   And I’m still happy to let him help me with my lab work and show me he’s still got the skills that impressed me over twenty years ago.

Kami L. Marr D.D.S.
Marr Family Dentistry, P.C.
Greeley, Colorado
www.marrfamilydentistry.com

by Kimberly Suter, DDS

My childhood home had a crab apple tree in the backyard.  My brother and I hated that tree. I picked up more crab apples out of the lawn than I can count. As an adult, however, that smell brings back good memories- we fought, we laughed and we did some ornery stuff with those smashed apples.  It’s funny how something that I hated so long ago can make me smile today.

Our roots are who we are; never forget where you came from.  No matter how successful, how important, or how impressive you have become, stay humble and remember the little steps in life and the people that surrounded you that have made you who you are today.  I am a firm believer that every single person that has crossed my path has made me into the person I have become.  From babysitters, grade school classmates and Jr. High teachers to college friends, dental school professors and colleagues, please remember, they are who made you.  Always remember where you came from.

Dismissing a patient is sometimes the best option for the practitioner and the patient. However, it can be uncomfortable and challenging. Knowing when and how to correctly terminate the relationship is critical to avoid an issue such as abandonment.

Formal, written notice should be mailed to the patient (no email or text!). Under Colorado law, certain provisions must be met when dismissing the patient such as reason(s) for dismissal, advising patient of conditions requiring further treatment or evaluation, 30 days of dental emergency availability, as well as other requirements.  Each dismissal case is different and the letter should, therefore, be individualized.

Ultimately, the decision to dismiss a patient is the practitioner’s. For a more thorough discussion of Dismissing a Patient as well as guidelines visit the Resource Library for the full article, Dismissing a Patient (Breaking Up is Hard to Do…or is it?)

If you are not a member of the Trust and would like to be contacted about becoming a member please go to Contact Us on the Home Page banner or feel free to reach out to Dr. Candace DeLapp [email protected]

As dentists we understand the pro and cons of dental treatments, but rarely do our patients. Obtaining informed consent is the process of giving a patient enough information to make an informed decision and is the basis for all of our recommended treatment. Do all procedures require informed consent? Probably not all, i.e., oral exam. However, informed consent is considered standard of care and is strongly recommended for most procedures:  oral surgery, endodontic, prosthodontics, and Invisalign, etc. Our Colorado dental malpractice carrier (www.tdplt.com) the Dentists Professional Liability Trust, fields calls on a daily basis on the most effective way to present and maintain consent for the benefit of both the dentist and the patient.

Informed consent is “not” just a paper to sign. Sometimes the message is misconstrued that informed consent is just a sheet of paper to be signed quickly. This could not be further from the truth.  Informed consent provides a cognitive checklist of areas to review with patients prior to performing a procedure. Ultimately, the goal is to provide significant information about the procedure, allowing time for feedback (reflection), and clarification so a patient’s expectations can be managed. Providing time for the patient to make an informed decision increases patient autonomy and can help reduce the malpractice gap. Obviously, with certain procedures time is of the essence while not with others.  Deciding on having a root canal is much more time sensitive than deciding to do Invisalign or dental veneers.

For more information on the Informed Consent process learn more in the Resource Library.

If you are not a member of the Trust and would like to be contacted about becoming a member please Contact Us or reach out to Dr. Candace DeLapp at [email protected].

The Dentists Professional Liability Trust of Colorado is a dental malpractice carrier and works in partnership with the Colorado Dental Association and seeks to provide our dental community with resources to help Colorado dentists and their patients by providing tools and information to improve the understanding of dental procedures.

Cosmetic medicine is not an exact science, and patients occasionally have less than perfect outcomes with dermal fillers. Less experienced providers are more likely to make mistakes such as overfilling and asymmetry. Other side effects such as infection and allergic reactions can occur. Hyaluronic acid fillers such as Juvederm and Restylane products can be partially or completely removed with an enzyme called hyaluronidase. When injected into the affected areas, hyaluronidase dissolves the hyaluronic acid particles and may help in the event of vascular compromise, lumpy or irregular texture, infection in the treatment area, overfilling and dissatisfying results. Hyaluronidase isn’t perfect, and since products tend to be made from animal derivatives, certain patients may be at higher risk for allergic reaction and therefore not good candidates for the treatment. Make sure your patients know to call you immediately if they are experiencing pain, or unusual swelling, or the area feels warm to the touch. These are signs of infection that need to be addressed swiftly. Calcium based fillers can NOT be reversed with hyaluronidase. Each dermal filler product is unique and a wide variety of products are available. If this is a procedure you rarely provide, you might want to consider whether the possible complications are worth it. -Berkley Risk Complications with Dermal Filler Procedures. Is it worth it?

No Child under the age of 12 should snore. If they do, they me be suffering from obstructive sleep apnea. Children can be misdiagnosed with ADHD when in fact they have OSA. Common symptoms of OSA in children are: Sleep in abnormal positions, snore loudly and often, stop breathing, sweat during sleep, behavioral problems. Restless sleep. Headaches in the am and bed wetting. As a dentist some of the oral signs you may notice are: mouth breathing, chapped lips, exaggerated gag reflex and dark circles around their eyes. We as dentists, see our patients more frequently than MD’s do so we can screen and refer to sleep specialists. We can CURE KIDS with OSA with early treatment (tonsillectomy and max expansion with forward maxillary growth) but adults we can only treat. So, Keep your eyes open!!!