PFA Dental World Newsletter — November/December • 2002

	Dental World^®		November/December • 2002
	PIERRE FAUCHARD ACADEMY


	Thoughts From the President
	This year has passed so quickly. It seems as though Dr. Campbell just put the President’s ribboned medal around my neck. And now it is time for me to put the President’s medal on Dr. Gary Lowder’s neck. We were privileged to travel to Costa Rica in March for the presentation of the Loader-Brenes Espinach Award. Drs. Saenz R. and Rodriquez C. were very gracious hosts and presented a great meeting. We attended the Elmer Best Award presentation in conjunction with the 100th Anniversary of the Canadian		Dental Association. Dr. Michael J. Cripton, past President of the PFA, was honored at their Awards Luncheon on May 27th. And 35 new Fellows were inducted into the Academy in a ceremony by Trustee Kevin Roach and Trustee delegate Barry Dolman and myself. It was a great honor to receive so many invitations worldwide. Thank you all so much for the honor of serving as President for a year. Thanks for all you do for the Pierre Fauchard Academy.
			Scott M. Welch, DDS President

Table of Contents- November/December 2002

Presidents Message
FDI Names New Executive Director

Web Site — A Window in 21st Century

Foundation News

2002 Calendar

Foundation News - United States

Dr. Steve Smith

Foundation News - Canada

Dr. Walter Bielli

Section News- International

Dr. Robert B. Shira – A Moral Hero
Section News- United States

Congressman Charlie Norwood…

Required Versus Desired Dentistry

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PFA Web Site — A Window Into the 21st Century

As many have discovered, establishing and maintaining a productive Web site can be costly. PFA went on line in August of 1996 and has expanded ever since to include much information (such as the membership directory) as well as material on the Academy and the Foundation. The cost of the Web site is more than offset by its efficiency in time to secure information, but we often fail to see the direct savings in money.

The Directory, when your Editor last had it printed and mailed under then-President Marty Naimark in 1993, cost us $10,000 in mailing and assembly costs, even though President Naimark had the printing of the copy donated. The time it took from submitting the membership information to get into the membership hands was several months and it was outdated by 18%, partly due to individual members failing to submit change of addresses to start with, and others retiring from their office address. The plans for publishing a Directory were for every three years. Now you can go to the Web site and get the most up-to-date membership information the Central Office has. Newly inducted members are added daily as they come in. Imagine the savings at today’s postage rates, the current printing costs, and the time it takes for the PFA staff on all levels to put it together.

Questions by members can be answered from the Web site information at all times of day and night. Response time is immediate, saving the office staff the time it would take to reply in writing (average business letter cost is about $5.50), postage, and time delays. Officers’ addresses, forms, and general information on the site all save time, money, and energy. Most dentists will agree, time is their most precious commodity. You will even be able to make direct on-line donations to the scholarship fund as soon as the Foundation Board accepts the proposal.

The newest feature “History of Dentistry” articles have generated more attention to our site, where the person browses around the rest of our information.

How many times have you talked to a colleague about joining, but have no pamphlet or information to give the prospective member? Just write down the Web site location—www.Fauchard.org— and everything is there. Think of the savings in time and money requesting a pamphlet be sent out, carrying them in your pocket to dental meetings, and having enough to distribute. A truly interested individual can go to the Web site at their leisure to get more information than can be contained in a pamphlet.

Postings of meeting dates, times, and places for PFA events is available right up to the day of the event, and not by hit or miss returned phone calls or mail. You can even purchase PFA merchandise and gifts at our sales location. Or register for a PFA charge card. You can even read this publication the minute the printer gets it to the presses long before it hits the mails. And there are links to other sites of dental interest.

To maintain the site costs us $200 per month to our Webmaster Mark Stanley’s company. Upgrades and added pages in expansion run per item. For example, putting Dental World on-line runs, on the average (depending on the number of pages), $3000 per year. This insures that members all over the world who do not get Dental Abstracts, or Life members who do not subscribe to Dental World can still read the organizational information on-line. I was in a jungle border town in Central America visiting a member’s office where they had their issue up on their computer screen! That would be weeks before they received their hard copy by mail.

Our Web site is arranged into 13 sections: Awards (10+ pages), Publications (6 pages), Dental World (22 issues), merchandise catalog (4 pages), Directory (200 pages), Affiliations (10 links), Museum (6 pages), Hall of Fame (19 pages), Musee d’Art Dentaire Pierre Fauchard (13 pages), Foundation (8 pages with two listing contributors), a calendar of events, mentorship (2 pages), and a place for inquiries—over 300 pages! A book, not a pamphlet.

In our first full year of the site (1997), we hosted 13,200 visitors. That doubled in the next two years and doubled again in 2000 and 2001. The visitors estimate for this year is 108,000. What publicity! Publications is the most visited site, followed by the Awards Section.

If you have not checked out our site for a while, do so in the near future to see what is happening. Sign up for credit card (PFA gets $ back when you do). Buy some PFA merchandise (PFA gets a commission when you do). And help us fund the operation along with a grant from the Foundation.

Calendar 2002-2003

29 November-4 December

27 February-2 March

24-27 September

Greater New York Dental Meeting, New York City

138th MidWinter Meeting, Chicago

New Orleans Dental Conference, New Orleans

(Have your PFA Event date put here. E-mail Editor Brophy at PFADWJMB@aol.com)

President’s Awards Luncheon

Dr. E. Steven Smith Receives PFA Distinguished Dentist Award

Dr. E. Steven Smith has been involved with dental education for the past 32 years. He graduated from Northwestern University Dental School in 1970, where he taught in the Oral Diagnosis/Radiology Department and developed a faculty practice within the dental school. He maintained a faculty practice there for 27 years.

Dr. Smith taught both dental students and dental hygiene students. He was active on faculty committees and in student research projects. He was the school’s faculty representative to the Student Clinicians of the ADA for 26 years and received the 1984 Dentsply Faculty Advisor Award. He was active in the Organization of Teachers of Oral Diagnosis in which he served as President. He was also active in the Oral Medicine Section of the American Association of Dental Schools, as well as on the Examination Committee of the Northeast Regional Board of Dental Examiners (NERB) from 1984-1994. He was tenured as Professor in 1984 and became Professor-emeritus in 1998.

A British Vulcan Bomber crashed at the Glenview Naval Air Base in 1979. Dr. Smith organized a Section on Forensic Dentistry at Northwestern to educate students, dentists, and law enforcement personnel. He became a member of the American Academy of Forensic Sciences and is currently a Fellow in the Odontology Section. He also served as President of the American Society of Forensic Odontology in 1992.

Your Editor has attended many of Dr. Smith’s lectures, taking first place in body part identification in his Lake County Seminar. He is an excellent educator and speaker.

Dr. Steve Smith

In 1998, Dr. Smith was asked by Nevada State Senator Raymond Rawson to help in developing their new dental school. He was Associate Director of Dental Programs for the University and Community College System of Nevada. In 1999, he was named Dean at the UNLV School of Dentistry, which officially opened in September of 2002, and currently serves as Associate Dean. Again he initiated a UNLV faculty practice with three clinics, negotiated a capitated dental program for 70,000 Medicaid patients, and developed a statewide oral cancer-screening program for Nevada’s 84 high schools with two dental mobile units. He participated in the development of a Pediatric Dental residency program and consulted in the school’s site selection and architectural drawings for the clinics. He serves as consultant to the Clark County Coroner’s Office on forensic cases and is a member of the Domestic Violence Task Force and the Fatality Review Committee for Clark County.

Professor Dr. Walter Lieber Bielli Receives PFA Certificate of Merit

Dr. Walter Bielli

Dr. Walter Bielli of Montevideo, Uruguay, has served as our PFA Chairman there for some time. He has been Professor of the Clinics of Prosthodontics at the Uruguay School of Dentistry from 1955 until his retirement. In 1974, he was designated the Student dean and First Vice Dean of the dental school until 1982.

Dr. Bielli was President of the Education Commission and Comptroller of Professors from 1960 to 1963. In 1964, he served on the Scholarship Committee for the Academy of Cultural Exchange of the Federal republic of Germany. In 1965, he was designated by the University of Buenos Aires (Argentina) to be a member of their Tribunal of Concourse.
In 1980, Dr. Bielli became Honorary Director of the Professor Program of the dental school with the Ministry of Public Health and with the financial support of the Kellog Foundation until 1982.
He is the author and impeller of the creation of the Clinic of Prosthodontics D.M.F.

He has established lectures in Uruguay, Argentina, Chile, Peru, Brazil, Germany, and Italy. He is a member of the Uruguay Dental Association, having served on their Board of Directors twice; the Argentina Dental Association; the Dentistry Federation of LaPaz, Bolivia; President of the Uruguay ICD (1884); ADI Fellow; founder of their Uruguay Chapter (1988) and Regent (1994); founder of the PFA Uruguay Section (1988); and President of the ICD South American Section (1996-1997) and ICD Master (2001).

In 2000, Dr. Bielli became Dean of the Dentistry School of the Catholic University of Uruguay.

Dr. Robert B. Shira – A Moral Hero

Carl Lundgren, PFA Past President

During the Vietnamese conflict in 1972, a little seven-year-old Vietnamese girl had been struck by a motor scooter and suffered from extensive fractures of the mandible. She arrived at an Army one-chair field office staffed by a recent dental graduate who did not know how to treat the injury. Major General Robert Shira, who was then the Chief of the Army Dental Corps, was visiting this outpost in the Delta. Since Dr. Shira was the only one capable of treating the fracture, he canceled a scheduled lecture in Saigon and stayed to treat the child.

This experience meant more to Dr. Shira than his previous experience in 1958 when he removed a tooth from then President Dwight D. Eisenhower. This event occurred while Dr. Shira was Chief of Oral Surgery at Walter Reed General Hospital in Washington, DC. Time and Life magazines covered that event.

Dr. Shira was born in 1910, grew up in Oklahoma, and then practiced general dentistry in Dewey, Okla, during the Depression. He won a highly competitive examination for a commission in the Army Dental Corps before World War II. When the War broke out, he was stationed in the Panama Canal Zone and immediately became heavily involved in wartime oral surgery injury cases. After six years of this, he was assigned as the Chief of Oral Surgery at Letterman General Hospital in San Francisco.

In 1954, he began a 10-year service as Chief of Oral Surgery at Walter Reed Hospital. In 1965, he became the President of the American Society of Oral Surgeons and in 1967 began a 26-year term as Editor-in-Chief of the monthly Journal of Oral Surgery, Oral Medicine, and Oral Pathology.

He rose in rank and by 1967 he was selected to be the Chief of the Army Dental Corps and Assistant Surgeon General of the Army with rank of Major General. During the Vietnamese conflict, he developed a “Combat Effectiveness Program” to reduce dental emergencies among the fighting troops. He developed the expansion of training in managing maxillofacial injuries.

Dr. Shira’s career has been one of moral leadership in that he has great faith in his fellow man and has a keen desire to motivate younger dentists to become good dentists.

After retirement from the Army in 1971, he immediately was selected to become Dean at Tufts University School of Dental Medicine in Boston. During his tenure there, they built a new dental school building and increased the enrollment from 90 to 150 in each class. In 1979, he was promoted to Senior Vice President and Provost of the University.

Concurrently, without ever having served as an ADA Trustee, he was elected as the ADA President-elect in 1975-1976, and he served as ADA President the following year. During that time, he stressed the importance of unity within the profession and speaking to the public with one voice.

Beginning in 1962, and for nine years, he served as the Chairman of the ADA Council on Dental therapeutics, and at various times, as a consultant to the Councils on Research, on Scientific Sessions, and on Education.

Dr. Shira has lectured for decades on oral and maxillofacial surgery throughout the United States and in many other countries. A high percentage of dentists have heard his excellent lectures. Of particular note is his friendly manner of presentation. Amazingly, he remembers myriads of people worldwide by their name. His lectures are inspiring in that he gives of himself to help the dentists/students to learn in an atmosphere of kindness, support, encouragement, and sensitivity to their self esteem. He is above all courteous, helpful, and ethical.

At Tufts, he served as Professor of Oral Surgery from 1972 to 1993. He served on the Advisory Committee of the American Dental Society of Anesthesiology, and as a member on the Advisory Panel for the Army Medical Research and Development Command. He was the President of the Pierre Fauchard Academy in 1984. He served as Trustee for the L. D. Pankey Institute for Advanced Dental Education and was a member of the Health Care Policy Advisory Committee in the Reagan Administration. He was Chairman of the Dental Products Advisory Panel for the Food and Drug Administration.

He is recipient of 18 major professional awards including a Doctor of Science (Honorary) from Georgetown University, not to mention the 1969 PFA Gold Medal or the PFA Hall of Fame Award to the only living recipient of this honor.

While serving in the Canal Zone, he became acquainted with a dentist, Dr. Fernando Brenes-Espinach. Dr. Brenes was so impressed with Dr. Shira and with Dr. Clifford Loader, that he willed $5 million to the Pierre Fauchard Academy Foundation, the very Foundation in which Dr. Robert Shira is currently President.

Dr. Shira has a lifetime of being a moral hero and continues to be one by helping to serve thousands of needy patients through the Foundation of PFA.

Web update: Dr. Robert BruceShira passed away on November 23rd, 2002. We will greatly miss him.

From the Desk of Congressman Charlie Norwood…

We are still working hard in Washington to improve the health care arena. I have co-sponsored the Children’s Dental Health Improvement Act of 2002 (H.R.3659). This bill makes grants to the States to improve the dental services for children in the Medicaid and SCHIP programs.

We are again trying to pass medical liability reform to put some reasonable limits on malpractice awards. As always, the trial lawyers want absolutely no caps. Everyone needs a good lawyer now and then, but the types who go out drumming up business without regard to the consequences for our economy and nation as a whole need to be reeled in.

So many of our needed legislation is tied up in the Senate. I fear that this is going to lead to a lame-duck session after the election, or a large omnibus bill in late October. It is during sessions like these when spending goes out of control and bad laws are passed.

I will be in New Orleans for the ADA Convention and hopefully will see many of you personally. Speaking as one voice is so important for our profession. I just must be there when my old friend Howard Jones is sworn in as our new ADA President.

The Georgia Primary is over, and thanks to you all, we won the GOP Primary with 81.5% of the vote. The bad news is that I am running against a trial lawyer in the General Election.

When you visit Washington, DC, give me a call at 202/225-4101 and drop by.

Sincerely,

Charlie Norwood
PFA Fellow

P.S. My good friend, Greg Ganske, M.D., of Iowa, thanks you all for sending him help in his race there. We need such allies in Congress.

Required Versus Desired Dentistry

A Perspective on Private Practice

Dr. Amarjit Gill is a United Kingdom Fellow who serves as Chairman of the British Dental Association’s Private Practice Committee. He is also Director on the BDA Executive Board. In a series of articles, he has raised some concerning questions about public health service and dental private practice in the United Kingdom. These opinions expressed are his own and do not necessarily represent PFA policy. But his thoughtful ideas are stimulating to our own situations in many countries. All such articles are welcome that we may better share the problems facing our profession globally.)

The United Kingdom has experimented with a National Health Service (NHS) since 1948. What seemed like a good idea at the time has become a restraint on the providers in this increasingly technologically driven time and rising costs. Many dentists in England are beginning to question the efficiency and effectiveness of NHS, which they feel is underfunded and micromanaged.

The public, with greater knowledge, is beginning to demand more of the health provider than what is “required” or necessary. So dentists are beginning to feel the squeeze between what the government will pay and what the public wants. Thus, dental practices are moving away from completely funded public health service into private practice. Leaders of this movement, like Dr. Amarjit, blame the government. Last century’s system is not working in this century. Europe’s largest employer, NHS, has a lack of national standards, rigid demarcations between staff, unnecessary service barriers, a complete absence of incentives for service improvement, is over centralized, fails to empower its patients, and has a record of underproviding and underperformance.

The House of Commons (April 2001) reported that “NHS Dentistry lacks the weight to alter fundamentally what is a deteriorating situation. Even registered patients are being denied access to some treatments on the NHS as dentists selectively decide to ration what they will provide within the service and what privately.”

NHS dentistry fails to deliver on its most basic requirement—universal access to care and free at the point of delivery. And only half the population seeks dental care now!

The public perceives these problems as the dentists leaving a “benevolent” employer for the riches of private practice. In reality, the private practice is providing the level of care dentists seek for their own family even at the same rate of earnings that they received under NHS. But as a monopoly, NHS keeps the cost of dental care at a low rate while the dentist must endure the rising costs of maintenance, continuing education, increased overhead, purchasing improved technology, and simply living. Those dentists who are unable to afford any of those necessities face staff shortages, deteriorating facilities, and outdated equipment, but are expected to perform their profession up to modern standards.

Dr. Amarjit notes that the dental profession needs to compete for personal disposal income in the free marketplace without the NHS restrictions. The increasing commercial nature of their activities will change the profession into one with a new style of service delivery. Professional commercial retail companies, like Boots, and other companies, encourage fresher attitudes toward practice finances. The role of investing in improved infrastructure and newer technological and scientific training will become a competitive priority for dentists to compete in the market place for the public’s disposable income.

Integrity of the profession is compromised. When dentists treat dentists, they get a higher level of treatment than is provided for the public. Why is this right—two levels of treatment—one for the professional and one for the NHS public?
Time is a commodity. The more NHS patients seen by a dentist, the more they are paid. Where does this leave room for patient education? Where is there room for a developed doctor-patient relationship? Where is the NHS mechanism for patient complaints? For what the public wants from dentistry? Where is the freedom of choice in their personal treatment?

This disempowers the consumer. When consumer influence is denied, producer interest will dominate. This is not the case, since the producer is controlled by NHS. Staff is not paid well, even to the squeezed dental labs. They must take on second jobs to survive, or seek paying employment elsewhere. Good staff is often lost. Retraining poor help is costly, and accepting poor staff riddles the office with clerical errors. The controlled dental trade industry has their backs to the financial wall as well. Over half of them are in danger of going out of business. Offices often purchase the cheaper product, rather than the better one, to keep costs down.

Based on US statistics, private practices can expect a growth from £2.5 billion currently spent to go to £30 billion. (The exchange rate to US dollars is about £1 = $1.46.) Last year’s summer edition of Financial Times reported that the United States spent 12 times more per person on dentistry than is spent in the United Kingdom. Even if these figures are exaggerated, two to four times that amount would be attractive to UK professionals. Private practice has experienced a growth of a third over the last decade, while NHS spending has declined. A quarter of all adult patients now pay private dentists typically 50% higher fees than NHS (1999 Lating & Buisson Report). The trend is obviously toward private practice where preventative treatment is more likely. Consumers have demonstrated that they will pay for better dentistry and faster access. They are making their own judgment on NHS provided services.

The dental practitioner is now judged by his professional service in a free market place. What are the implications of this trend? Larger multidentist practices providing a variety of services, longer office hours available, state-of-the-art equipment and technology, more competent staffing, limited nondental owned practices, and better materials. The bottom line is the public buying health as opposed to curing a disease. The professional shifts to a diagnostic approach to care and away from a treatment-only mode. Long-term health care becomes the norm over fixing what is wrong when it goes wrong.

NHS can quantify so many fillings statistically but cannot measure prevention, diagnostic exams, and oral hygiene instruction. NHS rewards service it can measure. The patients will reward service that prevents them from pain, time off from work, discomfort waiting for an appointment. To make a decent living, a dentist needs to see between 40 to 60 patients a day just to earn an income of £56,000 (about $82,000) a year. When does this leave time for continuing education? What is the incentive to learn more?

Half the dental workforce is under the age of 40. NHS dental service providers have dropped. The British Dental Association in their policy statement has suggested that NHS create Dental Access Centres” in areas deficient of dentists as an answer to accommodating the needy public. This puts the cost of office maintenance onto the shoulders of the government, including payment of salaried staff.

While this may appear on the surface to be a money issue, which in part it is, it really is the emergence of independent professional practitioners from a monopolized dental business structure that fails everyone involved. But each UK dentist will need to make his own free choice.

(Editor’s note: Illinois Public Aid, which started out reimbursing about 58% of usual and customary charges, has dropped their Public Aid reimbursement fees 13% over the last year to 1998 levels. Many private practitioners have reconsidered their participation in the program. Who suffers?)

Table of Contents- November/December 2002

Presidents Message
FDI Names New Executive Director

Web Site — A Window in 21st Century

Foundation News

2002 Calendar

Foundation News - United States

Dr. Steve Smith

Foundation News - Canada

Dr. Walter Bielli

Section News- International

Dr. Robert B. Shira – A Moral Hero
Section News- United States

Congressman Charlie Norwood…

Required Versus Desired Dentistry

go to Page-1 | Page-2

	Table of Contents- November/December 2002

	Presidents Message		FDI Names New Executive Director
	Web Site — A Window in 21st Century		Foundation News
	2002 Calendar		Foundation News - United States
	Dr. Steve Smith		Foundation News - Canada
	Dr. Walter Bielli		Section News- International
	Dr. Robert B. Shira – A Moral Hero		Section News- United States
	Congressman Charlie Norwood…
	Required Versus Desired Dentistry
			go to Page-1 \| Page-2


	PFA Web Site — A Window Into the 21st Century
	As many have discovered, establishing and maintaining a productive Web site can be costly. PFA went on line in August of 1996 and has expanded ever since to include much information (such as the membership directory) as well as material on the Academy and the Foundation. The cost of the Web site is more than offset by its efficiency in time to secure information, but we often fail to see the direct savings in money. The Directory, when your Editor last had it printed and mailed under then-President Marty Naimark in 1993, cost us $10,000 in mailing and assembly costs, even though President Naimark had the printing of the copy donated. The time it took from submitting the membership information to get into the membership hands was several months and it was outdated by 18%, partly due to individual members failing to submit change of addresses to start with, and others retiring from their office address. The plans for publishing a Directory were for every three years. Now you can go to the Web site and get the most up-to-date membership information the Central Office has. Newly inducted members are added daily as they come in. Imagine the savings at today’s postage rates, the current printing costs, and the time it takes for the PFA staff on all levels to put it together. Questions by members can be answered from the Web site information at all times of day and night. Response time is immediate, saving the office staff the time it would take to reply in writing (average business letter cost is about $5.50), postage, and time delays. Officers’ addresses, forms, and general information on the site all save time, money, and energy. Most dentists will agree, time is their most precious commodity. You will even be able to make direct on-line donations to the scholarship fund as soon as the Foundation Board accepts the proposal. The newest feature “History of Dentistry” articles have generated more attention to our site, where the person browses around the rest of our information. How many times have you talked to a colleague about joining, but have no pamphlet or information to give the prospective member? Just write down the Web site location—www.Fauchard.org— and everything is there. Think of the savings in time and money requesting a pamphlet be sent out, carrying them in your pocket to dental meetings, and having enough to distribute. A truly interested individual can go to the Web site at their leisure to get more information than can be contained in a pamphlet.		Postings of meeting dates, times, and places for PFA events is available right up to the day of the event, and not by hit or miss returned phone calls or mail. You can even purchase PFA merchandise and gifts at our sales location. Or register for a PFA charge card. You can even read this publication the minute the printer gets it to the presses long before it hits the mails. And there are links to other sites of dental interest. To maintain the site costs us $200 per month to our Webmaster Mark Stanley’s company. Upgrades and added pages in expansion run per item. For example, putting Dental World on-line runs, on the average (depending on the number of pages), $3000 per year. This insures that members all over the world who do not get Dental Abstracts, or Life members who do not subscribe to Dental World can still read the organizational information on-line. I was in a jungle border town in Central America visiting a member’s office where they had their issue up on their computer screen! That would be weeks before they received their hard copy by mail. Our Web site is arranged into 13 sections: Awards (10+ pages), Publications (6 pages), Dental World (22 issues), merchandise catalog (4 pages), Directory (200 pages), Affiliations (10 links), Museum (6 pages), Hall of Fame (19 pages), Musee d’Art Dentaire Pierre Fauchard (13 pages), Foundation (8 pages with two listing contributors), a calendar of events, mentorship (2 pages), and a place for inquiries—over 300 pages! A book, not a pamphlet. In our first full year of the site (1997), we hosted 13,200 visitors. That doubled in the next two years and doubled again in 2000 and 2001. The visitors estimate for this year is 108,000. What publicity! Publications is the most visited site, followed by the Awards Section. If you have not checked out our site for a while, do so in the near future to see what is happening. Sign up for credit card (PFA gets $ back when you do). Buy some PFA merchandise (PFA gets a commission when you do). And help us fund the operation along with a grant from the Foundation.


			Calendar 2002-2003
	29 November-4 December 27 February-2 March 24-27 September		Greater New York Dental Meeting, New York City 138th MidWinter Meeting, Chicago New Orleans Dental Conference, New Orleans (Have your PFA Event date put here. E-mail Editor Brophy at PFADWJMB@aol.com)

	President’s Awards Luncheon
	Dr. E. Steven Smith Receives PFA Distinguished Dentist Award
	Dr. E. Steven Smith has been involved with dental education for the past 32 years. He graduated from Northwestern University Dental School in 1970, where he taught in the Oral Diagnosis/Radiology Department and developed a faculty practice within the dental school. He maintained a faculty practice there for 27 years. Dr. Smith taught both dental students and dental hygiene students. He was active on faculty committees and in student research projects. He was the school’s faculty representative to the Student Clinicians of the ADA for 26 years and received the 1984 Dentsply Faculty Advisor Award. He was active in the Organization of Teachers of Oral Diagnosis in which he served as President. He was also active in the Oral Medicine Section of the American Association of Dental Schools, as well as on the Examination Committee of the Northeast Regional Board of Dental Examiners (NERB) from 1984-1994. He was tenured as Professor in 1984 and became Professor-emeritus in 1998. A British Vulcan Bomber crashed at the Glenview Naval Air Base in 1979. Dr. Smith organized a Section on Forensic Dentistry at Northwestern to educate students, dentists, and law enforcement personnel. He became a member of the American Academy of Forensic Sciences and is currently a Fellow in the Odontology Section. He also served as President of the American Society of Forensic Odontology in 1992. Your Editor has attended many of Dr. Smith’s lectures, taking first place in body part identification in his Lake County Seminar. He is an excellent educator and speaker.		Dr. Steve Smith In 1998, Dr. Smith was asked by Nevada State Senator Raymond Rawson to help in developing their new dental school. He was Associate Director of Dental Programs for the University and Community College System of Nevada. In 1999, he was named Dean at the UNLV School of Dentistry, which officially opened in September of 2002, and currently serves as Associate Dean. Again he initiated a UNLV faculty practice with three clinics, negotiated a capitated dental program for 70,000 Medicaid patients, and developed a statewide oral cancer-screening program for Nevada’s 84 high schools with two dental mobile units. He participated in the development of a Pediatric Dental residency program and consulted in the school’s site selection and architectural drawings for the clinics. He serves as consultant to the Clark County Coroner’s Office on forensic cases and is a member of the Domestic Violence Task Force and the Fatality Review Committee for Clark County.

	Professor Dr. Walter Lieber Bielli Receives PFA Certificate of Merit
	Dr. Walter Bielli Dr. Walter Bielli of Montevideo, Uruguay, has served as our PFA Chairman there for some time. He has been Professor of the Clinics of Prosthodontics at the Uruguay School of Dentistry from 1955 until his retirement. In 1974, he was designated the Student dean and First Vice Dean of the dental school until 1982. Dr. Bielli was President of the Education Commission and Comptroller of Professors from 1960 to 1963. In 1964, he served on the Scholarship Committee for the Academy of Cultural Exchange of the Federal republic of Germany. In 1965, he was designated by the University of Buenos Aires (Argentina) to be a member of their Tribunal of Concourse.		In 1980, Dr. Bielli became Honorary Director of the Professor Program of the dental school with the Ministry of Public Health and with the financial support of the Kellog Foundation until 1982. He is the author and impeller of the creation of the Clinic of Prosthodontics D.M.F. He has established lectures in Uruguay, Argentina, Chile, Peru, Brazil, Germany, and Italy. He is a member of the Uruguay Dental Association, having served on their Board of Directors twice; the Argentina Dental Association; the Dentistry Federation of LaPaz, Bolivia; President of the Uruguay ICD (1884); ADI Fellow; founder of their Uruguay Chapter (1988) and Regent (1994); founder of the PFA Uruguay Section (1988); and President of the ICD South American Section (1996-1997) and ICD Master (2001). In 2000, Dr. Bielli became Dean of the Dentistry School of the Catholic University of Uruguay.


	Dr. Robert B. Shira – A Moral Hero Carl Lundgren, PFA Past President
	During the Vietnamese conflict in 1972, a little seven-year-old Vietnamese girl had been struck by a motor scooter and suffered from extensive fractures of the mandible. She arrived at an Army one-chair field office staffed by a recent dental graduate who did not know how to treat the injury. Major General Robert Shira, who was then the Chief of the Army Dental Corps, was visiting this outpost in the Delta. Since Dr. Shira was the only one capable of treating the fracture, he canceled a scheduled lecture in Saigon and stayed to treat the child. This experience meant more to Dr. Shira than his previous experience in 1958 when he removed a tooth from then President Dwight D. Eisenhower. This event occurred while Dr. Shira was Chief of Oral Surgery at Walter Reed General Hospital in Washington, DC. Time and Life magazines covered that event. Dr. Shira was born in 1910, grew up in Oklahoma, and then practiced general dentistry in Dewey, Okla, during the Depression. He won a highly competitive examination for a commission in the Army Dental Corps before World War II. When the War broke out, he was stationed in the Panama Canal Zone and immediately became heavily involved in wartime oral surgery injury cases. After six years of this, he was assigned as the Chief of Oral Surgery at Letterman General Hospital in San Francisco. In 1954, he began a 10-year service as Chief of Oral Surgery at Walter Reed Hospital. In 1965, he became the President of the American Society of Oral Surgeons and in 1967 began a 26-year term as Editor-in-Chief of the monthly Journal of Oral Surgery, Oral Medicine, and Oral Pathology. He rose in rank and by 1967 he was selected to be the Chief of the Army Dental Corps and Assistant Surgeon General of the Army with rank of Major General. During the Vietnamese conflict, he developed a “Combat Effectiveness Program” to reduce dental emergencies among the fighting troops. He developed the expansion of training in managing maxillofacial injuries. Dr. Shira’s career has been one of moral leadership in that he has great faith in his fellow man and has a keen desire to motivate younger dentists to become good dentists. After retirement from the Army in 1971, he immediately was selected to become Dean at Tufts University School of Dental Medicine in Boston. During his tenure there, they built a new dental school building and increased the enrollment from 90 to 150 in each class. In 1979, he was promoted to Senior Vice President and Provost of the University.		Concurrently, without ever having served as an ADA Trustee, he was elected as the ADA President-elect in 1975-1976, and he served as ADA President the following year. During that time, he stressed the importance of unity within the profession and speaking to the public with one voice. Beginning in 1962, and for nine years, he served as the Chairman of the ADA Council on Dental therapeutics, and at various times, as a consultant to the Councils on Research, on Scientific Sessions, and on Education. Dr. Shira has lectured for decades on oral and maxillofacial surgery throughout the United States and in many other countries. A high percentage of dentists have heard his excellent lectures. Of particular note is his friendly manner of presentation. Amazingly, he remembers myriads of people worldwide by their name. His lectures are inspiring in that he gives of himself to help the dentists/students to learn in an atmosphere of kindness, support, encouragement, and sensitivity to their self esteem. He is above all courteous, helpful, and ethical. At Tufts, he served as Professor of Oral Surgery from 1972 to 1993. He served on the Advisory Committee of the American Dental Society of Anesthesiology, and as a member on the Advisory Panel for the Army Medical Research and Development Command. He was the President of the Pierre Fauchard Academy in 1984. He served as Trustee for the L. D. Pankey Institute for Advanced Dental Education and was a member of the Health Care Policy Advisory Committee in the Reagan Administration. He was Chairman of the Dental Products Advisory Panel for the Food and Drug Administration. He is recipient of 18 major professional awards including a Doctor of Science (Honorary) from Georgetown University, not to mention the 1969 PFA Gold Medal or the PFA Hall of Fame Award to the only living recipient of this honor. While serving in the Canal Zone, he became acquainted with a dentist, Dr. Fernando Brenes-Espinach. Dr. Brenes was so impressed with Dr. Shira and with Dr. Clifford Loader, that he willed $5 million to the Pierre Fauchard Academy Foundation, the very Foundation in which Dr. Robert Shira is currently President. Dr. Shira has a lifetime of being a moral hero and continues to be one by helping to serve thousands of needy patients through the Foundation of PFA. Web update: Dr. Robert BruceShira passed away on November 23rd, 2002. We will greatly miss him.


	From the Desk of Congressman Charlie Norwood…
	We are still working hard in Washington to improve the health care arena. I have co-sponsored the Children’s Dental Health Improvement Act of 2002 (H.R.3659). This bill makes grants to the States to improve the dental services for children in the Medicaid and SCHIP programs. We are again trying to pass medical liability reform to put some reasonable limits on malpractice awards. As always, the trial lawyers want absolutely no caps. Everyone needs a good lawyer now and then, but the types who go out drumming up business without regard to the consequences for our economy and nation as a whole need to be reeled in. So many of our needed legislation is tied up in the Senate. I fear that this is going to lead to a lame-duck session after the election, or a large omnibus bill in late October. It is during sessions like these when spending goes out of control and bad laws are passed.		I will be in New Orleans for the ADA Convention and hopefully will see many of you personally. Speaking as one voice is so important for our profession. I just must be there when my old friend Howard Jones is sworn in as our new ADA President. The Georgia Primary is over, and thanks to you all, we won the GOP Primary with 81.5% of the vote. The bad news is that I am running against a trial lawyer in the General Election. When you visit Washington, DC, give me a call at 202/225-4101 and drop by. Sincerely, Charlie Norwood PFA Fellow P.S. My good friend, Greg Ganske, M.D., of Iowa, thanks you all for sending him help in his race there. We need such allies in Congress.


	Required Versus Desired Dentistry A Perspective on Private Practice
	Dr. Amarjit Gill is a United Kingdom Fellow who serves as Chairman of the British Dental Association’s Private Practice Committee. He is also Director on the BDA Executive Board. In a series of articles, he has raised some concerning questions about public health service and dental private practice in the United Kingdom. These opinions expressed are his own and do not necessarily represent PFA policy. But his thoughtful ideas are stimulating to our own situations in many countries. All such articles are welcome that we may better share the problems facing our profession globally.) The United Kingdom has experimented with a National Health Service (NHS) since 1948. What seemed like a good idea at the time has become a restraint on the providers in this increasingly technologically driven time and rising costs. Many dentists in England are beginning to question the efficiency and effectiveness of NHS, which they feel is underfunded and micromanaged. The public, with greater knowledge, is beginning to demand more of the health provider than what is “required” or necessary. So dentists are beginning to feel the squeeze between what the government will pay and what the public wants. Thus, dental practices are moving away from completely funded public health service into private practice. Leaders of this movement, like Dr. Amarjit, blame the government. Last century’s system is not working in this century. Europe’s largest employer, NHS, has a lack of national standards, rigid demarcations between staff, unnecessary service barriers, a complete absence of incentives for service improvement, is over centralized, fails to empower its patients, and has a record of underproviding and underperformance. The House of Commons (April 2001) reported that “NHS Dentistry lacks the weight to alter fundamentally what is a deteriorating situation. Even registered patients are being denied access to some treatments on the NHS as dentists selectively decide to ration what they will provide within the service and what privately.” NHS dentistry fails to deliver on its most basic requirement—universal access to care and free at the point of delivery. And only half the population seeks dental care now! The public perceives these problems as the dentists leaving a “benevolent” employer for the riches of private practice. In reality, the private practice is providing the level of care dentists seek for their own family even at the same rate of earnings that they received under NHS. But as a monopoly, NHS keeps the cost of dental care at a low rate while the dentist must endure the rising costs of maintenance, continuing education, increased overhead, purchasing improved technology, and simply living. Those dentists who are unable to afford any of those necessities face staff shortages, deteriorating facilities, and outdated equipment, but are expected to perform their profession up to modern standards. Dr. Amarjit notes that the dental profession needs to compete for personal disposal income in the free marketplace without the NHS restrictions. The increasing commercial nature of their activities will change the profession into one with a new style of service delivery. Professional commercial retail companies, like Boots, and other companies, encourage fresher attitudes toward practice finances. The role of investing in improved infrastructure and newer technological and scientific training will become a competitive priority for dentists to compete in the market place for the public’s disposable income. Integrity of the profession is compromised. When dentists treat dentists, they get a higher level of treatment than is provided for the public. Why is this right—two levels of treatment—one for the professional and one for the NHS public?		Time is a commodity. The more NHS patients seen by a dentist, the more they are paid. Where does this leave room for patient education? Where is there room for a developed doctor-patient relationship? Where is the NHS mechanism for patient complaints? For what the public wants from dentistry? Where is the freedom of choice in their personal treatment? This disempowers the consumer. When consumer influence is denied, producer interest will dominate. This is not the case, since the producer is controlled by NHS. Staff is not paid well, even to the squeezed dental labs. They must take on second jobs to survive, or seek paying employment elsewhere. Good staff is often lost. Retraining poor help is costly, and accepting poor staff riddles the office with clerical errors. The controlled dental trade industry has their backs to the financial wall as well. Over half of them are in danger of going out of business. Offices often purchase the cheaper product, rather than the better one, to keep costs down. Based on US statistics, private practices can expect a growth from £2.5 billion currently spent to go to £30 billion. (The exchange rate to US dollars is about £1 = $1.46.) Last year’s summer edition of Financial Times reported that the United States spent 12 times more per person on dentistry than is spent in the United Kingdom. Even if these figures are exaggerated, two to four times that amount would be attractive to UK professionals. Private practice has experienced a growth of a third over the last decade, while NHS spending has declined. A quarter of all adult patients now pay private dentists typically 50% higher fees than NHS (1999 Lating & Buisson Report). The trend is obviously toward private practice where preventative treatment is more likely. Consumers have demonstrated that they will pay for better dentistry and faster access. They are making their own judgment on NHS provided services. The dental practitioner is now judged by his professional service in a free market place. What are the implications of this trend? Larger multidentist practices providing a variety of services, longer office hours available, state-of-the-art equipment and technology, more competent staffing, limited nondental owned practices, and better materials. The bottom line is the public buying health as opposed to curing a disease. The professional shifts to a diagnostic approach to care and away from a treatment-only mode. Long-term health care becomes the norm over fixing what is wrong when it goes wrong. NHS can quantify so many fillings statistically but cannot measure prevention, diagnostic exams, and oral hygiene instruction. NHS rewards service it can measure. The patients will reward service that prevents them from pain, time off from work, discomfort waiting for an appointment. To make a decent living, a dentist needs to see between 40 to 60 patients a day just to earn an income of £56,000 (about $82,000) a year. When does this leave time for continuing education? What is the incentive to learn more? Half the dental workforce is under the age of 40. NHS dental service providers have dropped. The British Dental Association in their policy statement has suggested that NHS create Dental Access Centres” in areas deficient of dentists as an answer to accommodating the needy public. This puts the cost of office maintenance onto the shoulders of the government, including payment of salaried staff. While this may appear on the surface to be a money issue, which in part it is, it really is the emergence of independent professional practitioners from a monopolized dental business structure that fails everyone involved. But each UK dentist will need to make his own free choice. (Editor’s note: Illinois Public Aid, which started out reimbursing about 58% of usual and customary charges, has dropped their Public Aid reimbursement fees 13% over the last year to 1998 levels. Many private practitioners have reconsidered their participation in the program. Who suffers?)