We are off and running with a great start to the year! Thank you to everyone who attended our first hybrid meeting. It was so nice to see all of your faces. For those that joined virtually, we hope you had a great experience. The Virtual Collaborative Series is already a big success! We have made 6.5hr of CE available and had 288 virtual attendees, and it's only the first month. We are working very hard to bring you the best experience we can in these trying times. 

Please remember the need for volunteers is higher than ever. Our community members need our help. While there are many avenues to volunteer, please consider volunteering at the brand new St. Pete Free Clinic. It's an amazing experience, and your efforts are most appreciated. We are going to set some volunteer goals for our society, so keep track of your hours! More on this initiative to come soon. 

The ADA meeting is happening in Orlando this week. It's all virtual, so there is still time to register and find interesting courses. It's a very exciting time for Florida. Our district, District 17, is running a candidate for ADA President-Elect. We have an incredible candidate Dr. Cesar Sabates out of Miami. We are very hopeful that Dr. Sabates has what it takes to be Florida's very first ADA President. 

Looking forward to seeing you all at our joint meeting with UPCDA on November 11th. We will be announcing our new slate of board members. As always, please reach out to me if I can be of any assistance.

Be well and stay safe.

PCDA President    

The Pinellas, Upper Pinellas and Hillsborough County Dental Associations teamed up to provide additional added value and benefit to your membership! This year, due to ever-changing circumstances, each one of our affiliates will live-stream their lectures in addition to the regularly scheduled in-person general membership meeting. Members in all three affiliates will have access to 15 virtual CE webinars! Pre-registration is required prior to each virtual meeting.

Post webinar, a CEU Certificate will be emailed to you by your affiliate and the WCDDA will upload the course attendance into CE Broker for you.

Topic & Speaker: Simplifying Complex Cosmetic and Restorative Dentistry, William C. Strupp, Jr. DDS & Michael W. Brumm, DMD

Program Description: Protocols for treatment planning, preparing, and delivering a full mouth restorative case will be covered. 

When: Wednesday, November 11, 6:00pm Social – 7:00pm Business & Lecture

Where: Hilton St. Petersburg Carillon Park, Lake Carillon Drive, St. Petersburg, FL

Final RSVP needs to be received by November 6, 2020.

RSVP your dinner selection Chicken or Veggie and any dietary restrictions you may have to smilepinellas@gmail.com.

In patients requiring dentoalveolar surgery, few present a higher risk of acute complications than the anti-coagulated patient. Failure to form a stabilized fibrin clot can lead to sometimes severe levels of blood loss and disruption of the critical first step in the healing process. Patients may be on oral anticoagulants for a variety of medical conditions, and it is also important to understand their indications for anticoagulation and the stability of their primary disease.  

Anticoagulants can target platelets, solitary or multiple coagulation factors, or enhance natural anticoagulation pathways. In general, the literature does not support discontinuation of anticoagulants for dentoalveolar surgery. Almost all publications however, have only analyzed dental extractions, and fail to comment on more complex dentoalveolar surgery. While postoperative bleeding after extraction is easy to access and control, a floor of mouth hematoma or uncontrolled bleed in the maxillary sinus is not a simple fix. Consultation with the physician prescribing the anticoagulant must be specific in outlining these risks if we feel a patient should be taken off their medication prior to surgery.  

While papers on continuing anticoagulants for simple dental surgeries have increasingly appeared in the medical literature, some physicians will still sign off on their patients request to discontinue their medication prior to a dental appointment because “that’s what we did last time”. This scenario can create confusion for the patient when trying to educate them on the current evidence and also cultivate distrust between the patient and their physician. Proceeding with the procedure is generally reasonable given their underlying medical condition is stable. A gentle reminder that future simple dental surgeries should not require discontinuation of anticoagulation therapy is usually effective.  

In all cases, the dental provider must be prepared to use local measures in controlling bleeding during and after surgery. During surgery direct pressure using gauze, blunt instruments, and bone wax can be used to control a vigorous bleeder. Normal bleeding time ranges 9-15 minutes so a minimum 10-15 minute waiting period may be warranted before checking for stable hemostasis. Direct pressure will not be effective if a large enough vessel has been disrupted, in which case ligation with silk suture or hemostatic clips is required. In preparation for normal postoperative bleeding, gelatin scaffolds infused with topical thrombin are an excellent adjunct. The gelatin sponge is placed into the socket and sutures are placed to retain the material followed by application of pressure with a firm gauze packing. Educating the patient with a hand mirror on what normal bleeding looks like and how to replace their dressing can spare us from the anxiety provoking phone call after discharge. All patients should be informed on other measures such as head elevation, pain control, and the use of moist tea bags to help maintain hemostasis as an outpatient.  

Even a simple extraction and the use of adequate local measures can fail in the anti-coagulated patient. It is essential to be available for follow up as uncontrolled rebleeding may occur hours or even days after the procedure was completed. Applying pressure and repeating local measures will usually regain hemostasis. Contact information for the physician should be obtained prior to surgery in the event that bleeding is persistent after repeat attempts at local control. In this scenario, consultation may be required to stop the offending medication or reverse it in more severe cases. Postoperative patients presenting with signs of hypovolemic shock (anxiety, pallor, hypotension, tachycardia and tachypnea) should be emergently directed or transported to the emergency department.

  

Christopher P. Maly, DDS

PCDA Member

If you are interested in presenting or speaking to provide CE to your PCDA colleagues at future meetings - please let us know! Submit your resume or speaking portfolio to smilepinellas@gmail.com by April 30th of each year.

The PCDA would like to welcome new members, Dr. Christopher Maly and Dr. Jason Ehrenman to the association - Welcome!

Registration for the 2021 Dentists' Day on the Hill (DDOH) is now open! DDOH will take place on Tuesday, March 16 with a legislative briefing on Monday, March 15 at 6:00 p.m. at the Hotel Duval.

Legislative Briefing - NEW LOCATION and DINNER!

The legislative briefing will begin at 6:00 p.m. with dinner and entertainment to immediately follow at Hotel Duval. Please be sure to RSVP to both if you plan on attending the briefing ​AND the dinner.

A room block has been reserved at the Hotel Duval. To book your room, please call 850.224.6000 and mention ​the "Florida Dentists' Day on the Hill," or click here and select March 15-16 as the dates of your stay. Rooms are $219 a night and are limited - reserve yours today!

Questions? Contact Alexandra Abboud at aabboud@floridadental.org or call the Governmental Affairs Office at 850.224.1089

Dear Colleagues:

I hope you and your families are well and resuming your practices given the “new normal” as we recover from the COVID-19 slow down. The last several months have certainly been somewhat stressful and somewhat restful as we have endured significant financial concerns, practice limitations, and variations in protocols for infection control and patient management. I am confident that the future will allow us to better care for our patients and safeguard our staff members even though we would have appreciated a bit less abruptness. 

The St. Pete Free Clinic has resumed its patient treatment, and many of these patients have been unable to obtain care for oral infections and pain relief. There is an urgent need for our dental association to step up. Our commitment to our community will hopefully be shared and displayed by ALL of us. I would like to request that upon receiving this letter, that you give Claudia Rosas a call at the Free Clinic in order to offer help with treating patients. Attached is a link to the google sheet where you can sign up to volunteer. Please follow the instructions that will be on the google sheet. The brand new clinic facility has begun its operation, and I have already had the opportunity to be there and begin the post COVID – 19 functions. They have made important changes in protocols to become compliant with the CDC/OSHA/ADA guidelines. I would welcome a call should you have any questions regarding PPE supplies and patient care. Claudia can be reached at the following number 727-485-8795 ext. 328 or you may e-mail her at claudia.rosas@stpetersburgfreeclinic.org

I want to thank each of you for being willing to participate in sharing in the care of our St. Petersburg community that cannot afford dental treatment. As our emergency room physicians have borne the brunt of the pandemic, our opportunity to provide help to patients with dental emergencies is here, and our involvement will allow a reduction in emergency room visits due to dental concerns. Please ask your office coordinator to call Claudia upon receiving this letter to confirm a date to help. If we all participate and commit one day volunteering at the clinic, our work will be light and the community will be served well. Thanks in advance for being part of this great effort. 

Sincerely,

John H. Thee, DMD

727-347-3777