Dr. Marcela Alvarez

September 2021 General Meeting

Speaker:  Marcela Alvarez DDS, MSD 

Date:  September 21, 2021    

Time:  FREE Happy Hour: 5:30pm – 6:30pm * Meeting starts at 6:30pm

Team Approach for a Beautiful Smile

Restoratively Guided Orthodontic Treatment: 

The Ortho-Restorative Interface

Location:  Austin Country Club – 4408 Long Champ Dr, Austin 78746

Lecture Course * 2 Hours CE Credit

Cost: $40 Member Dentist/$50 Members with late registration (if available)
$50 Guest of Member Dentist; $70 Nonmember Dentist * CASH BAR
RSVP: By 10:00 a.m. FRIDAY, the week leading up to the event.
Registration is open now through September 17th.
To RSVP, PAY ahead online using the link that fits your desired plate type and membership status. Payments will be online only.

You will receive a confirmation email from Stripe to confirm your payment is complete.

Payments & Registration will not be accepted at the door. Please email Nancy if you need a vegetarian, vegan or gluten free meal. Reservations not cancelled by 10:00am Friday, Sept 17 will be billed.

Course Objectives:  Upon completion of this lecture, attendees should be able:

  • To understand how the Restorative Dentist can effectively communicate with the Orthodontist to accomplish an optimum result for the orthodontic-restorative patient.
  • To be able to use the concept of Pre-Orthodontic Bonding.
  • To understand the treatment options for the replacement of the missing maxillary lateral incisor.

Marcela Alvarez DDS, MSD

After completing her dental education in Mexico in 2007, Dr. Marcela Alvarez pursued a 3-year Prosthodontic Specialty Residency at LSU Dental School where she was awarded a Master of Science degree in Dentistry in 2016.  During her residency, Dr. Alvarez was mentored by globally recognized dental educators, including Dr. Bill Robbins.  Dr. Alvarez published an article, “How to Bond Zirconia: The APC Concept”, while in her residency, concerning the most popular and esthetic materials in dentistry.

As a Prosthodontist, Dr. Alvarez specializes in creating beautiful smiles with the proper function.  Her areas of expertise are preventive dentistry and esthetic dentistry.  She currently maintains a private practice in San Antonio, Texas partnered with Dr. Brad Beckel and Dr. Bill Robbins.

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Study Club 2021-2022

SIGN UP NOW: Use the AGD Sign Up Link Here

CADS Study Club 2021-2022

CADS Study Club 2021-2022

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June 2021 General Meeting

Date: June 15, 2021
Time: Free Happy Hour: 5:30pm – 6:30pm * Meeting starts at 6:30pm
Speaker: Dr. Robert “Tito” Norris

New Horizons in Interdisciplinary Dentistry

Austin Country Club – 4408 Long Champ Dr, Austin 78746

Lecture Course * 2 Hours CE Credit
Cost: $40 Member Dentist/$50 Members with late registration (if available)
$50 Guest of Member Dentist; $70 Nonmember Dentist * CASH BAR
RSVP: By 10:00 a.m. FRIDAY, the week leading up to the event.
Registration is open now through June 11th.
To RSVP, PAY ahead online using the link that fits your desired plate type and membership status. Payments will be online only.

Course Description:

For years dentistry has been practiced in a multi-disciplinary approach, with numerous dental specialties contributing to a patient’s care without fully understanding the overall goal established by a comprehensive treatment plan and communicated among all disciplines of an interdisciplinary team before treatment begins.  This lecture will offer a system to integrate the Global Diagnosis process into a systematic, 3-dimensional approach for providing optimal communication among all specialties.  Leading-edge advances in orthodontic, orthopedic, periodontic and restorative processes will be presented.

Course Objectives:  Upon completion of this lecture, attendees should be able:

  • To understand the value and power of a comprehensive interdisciplinary treatment plan
  • To be familiar with HIPAA-compliant cloud based software to enhance interdisciplinary communication
  • To have a deeper understanding of new possibilities in orthodontic and restorative interdisciplinary treatment, such as MARPE, DOME, SFOT, Canine Substitution, Y-bar Anchorage, Airway-Friendly diagnoses and orthodontics, Premolar reclamation, and 3D pre-orthodontic bonding

Dr. Robert “Tito” Norris

Dr. Norris is a 1992 graduate of the University of Texas Health Science Center at San Antonio Dental School.  He then moved to Washington, D.C. where he completed a General Practice Residency at the V.A. Hospital followed by orthodontic specialty training at Howard University, graduating as valedictorian with the highest GPA in the program’s 25-year history.  After serving as an Air Force orthodontist in Misawa, Japan, Dr. Norris returned to San Antonio, TX in 1998 and opened a thriving private orthodontic practice.  He holds several patents and trademarks, and is the inventor of the Norris 20/26 Passive Self-Ligating Bracket System.  He is Board Certified by the American Board of Orthodontics, and is a member of numerous dental organizations and study clubs.  He lectures nationally and internationally on topics including esthetics, efficiency, sustainability, customer service, accelerated treatment, substitutions and autotransplantations and aligner treatment.  He has created and manages several other companies pertaining to real estate investments, marketing, retail sales, and a non-profit providing complimentary orthodontic care to children in need.

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Thomas Bramwell

Thomas Bramwell Welch

Thomas Bramwell Welch (December 31, 1825 – December 29, 1903) was a British–American Methodist minister and dentist. He pioneered the use of pasteurization as a means of preventing the fermentation of grape juice. He persuaded local churches to adopt this non-alcoholic wine substitute for use in Holy Communion, calling it “Dr. Welch’s Unfermented Wine.”

Welch was born in Glastonbury, England on December 31, 1825. He moved to the United States when his father emigrated in 1834. He attended public schools in Watertown, New York.

At age 17, Thomas Welch joined the Wesleyan Methodist Connexion, founded the same year (1843). From its beginning, the Wesleyan Methodist Connexion strongly opposed (1) the “manufacturing, buying, selling, or using intoxicating liquors”, and (2) “slaveholding, buying, or selling” of slaves.[3]

With the first edition of their Discipline, the Wesleyan Methodists expressly required for the Lord’s Supper (Communion) that “unfermented wine only should be used at the sacrament. This requirement was about 25 years before Welch used pasteurization. So it is clearly evident that pasteurization was not the only method used to prepare it unfermented. There were traditional methods to prepare unfermented wine (juice) for use at any time during the year, e.g., to reconstitute concentrated grape juice, or to boil raisins, or to add preservatives that prevent juice from fermenting and souring.

Throughout his late teens, Welch was active in the Underground Railroad that transported escaped slaves from the south into Canada. He was one of many Wesleyan Methodists connected to the “Underground Railroad.”

By age 19, he graduated from Gouverneur Wesleyan Seminary and became an ordained Wesleyan Methodist minister. He ministered first in Poundridge, in Westchester County, New York, then in Herkimer County, New York.

While in Herkimer County, he married Miss Lucy Hult. They would have seven children. The children included: Charles E. Welch, who became a dentist, and Emma C. Welch Slade (1854-1928) who also became a dentist.

He continued in the work of ministry until his voice failed him, and he was obliged to direct his attention to other pursuits. He then attended New York Central Medical College (Syracuse campus), becoming a physician in Penn Yan, New York. Welch then relocated to Winona, Minnesota in 1856. He changed his profession to dentistry.

He continued to practice dentistry in Vineland until 1880 and “enjoyed a very successful and lucrative practice through the entire time.” Thomas Welch was a Methodist and staunch Prohibitionist, who actively worked to reduce or end the sale of alcoholic beverages in New Jersey and adjacent regions. Currently, Welch’s Grape Juice is sold in grocery stores.

Dental Board Adopts Pandemic Emergency Rule Amendment

By Jeanine Lehman, Attorney at Law

The Texas State Board of Dental Examiners held an emergency board meeting on the evening of August 24, 2020 to discuss and take action on an amendment to emergency board rule 108.7(16) concerning the standards for safe practice during the COVID-19 disaster.  In response to Texas Governor Abbott’s Executive Order GA 19, that rule was adopted earlier in the pandemic to allow dental practices to re-open.  The board meeting was held via Zoom, broadcast on a YouTube channel – demonstrating the hard work and resiliency of the dental board and dental community during this pandemic.

The dental board unanimously adopted three changes to the emergency board rule.

  • Dental Health Care Personnel (DHCP) may resume the use of ultrasonic devices for hygiene services. The language in the rule requiring DHCP to use only hand instruments and low speed polishing tools for hygiene services was deleted.
  • DHCP are no longer required to complete the full treatment of one patient before leaving the treatment area and going on to another patient.
  • DHCP are required to remove PPE before returning home, but are no longer required to change from scrubs to personal clothing.

The amendment to emergency board rule 108.7(16) became effective on August 25, 2020 after being reviewed by the Texas Governor’s office.  The rule is available on the dental board’s website at tsbde.texas.gov/78i8ljhbj/Emergency-Rule-108.7-Updated-1.pdf and in the September 4, 2020 issue of the Texas Register.  The rule will be in effect for 120 days unless changed by the dental board or unless the COVID-19 emergency disaster declaration of Governor Abbott is terminated.

During the meeting, board members made several observations including that the dental profession is doing a good job, that there have been no dental cluster outbreaks of COVID-19, that dentists must be mindful of what infection control is in place for practices, and that dentists need to look at board rules and set standards for every office.

In addition to the specific dental board guidelines for safe practice during the COVID-19 disaster in the emergency rule, the emergency rule incorporates by reference the Centers for Disease Control (CDC) Guidelines.  This is a changing area, so dentists will want to review the emergency rule as amended and the CDC guidelines and to look frequently for new developments in board rules and CDC guidelines.

During the August 24, 2020 meeting, the board also unanimously approved the appointment of attorney Casey Nichols as the new dental board Executive Director effective September 1, 2020.  Ms. Nichols was formerly the General Counsel of the dental board.

Jeanine Lehman is an Austin, Texas dental, health and business law attorney with a statewide practice – www.jeanine.com. She can be reached at (512) 918-3435 or Jeanine@Jeanine.com. © Jeanine Lehman 2020. This article is not legal advice.

Advocacy: An Essential Member Benefit

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Advocacy: An Essential Member Benefit

As a valued member of the Capital Area Dental Society, what would you consider to be a member benefit? We all have varying perspectives on how we feel that member benefits should and could help us as dentists. Our tripartite membership in the ADA, TDA and CADS provides countless benefits to support us as members by providing access to savings, services and resources for our business and life and to support driving our career forward.

There is one benefit that I did not mention that in my mind is the most essential benefit for all members and our profession and that is …. ADVOCACY!

We can all attest to the fact that organized dentistry has been an amazing advocate for dentists and the profession of dentistry during these unprecedented times. Membership is essential for strong advocacy whether it is at the local, state, or national level.

At the national level, the ADA lobbies Congress, and the Administration to fight for issues that matter to dentists and patients. The ADA also provides technical support to help state dental societies advance their respective policy agendas. One of the success stories of the ADA’s advocacy efforts was when the Action for Dental Health Act was signed into law in 2018. The Action for Dental Health Act will allow organizations to qualify for oral health grants to support activities that improve oral health education, improve dental disease prevention, and expand outreach programs.

Another huge accomplishment in the advocacy arena for organized dentistry is the ADA calling on Congress to apply federal antitrust laws to the business of insurance by repealing parts of the McCarran-Ferguson Act of 1945. Currently, federal law does not prohibit state-regulated health insurers from engaging in collusive practices, such as price fixing, bid rigging and market allocation schemes. This anti-competitive behavior hurts consumers by making health insurance less affordable. The ADA has been advocating for the repeal of the 1945 McCarran-Ferguson Act antitrust exemption for the health insurance industry for more than 20 years! There are over 90 bills related to third party payor issues in legislatures nationwide.

Most recently, the ADA has fought effectively to get HHS to extend the deadline for all dentists to apply for funding through the Enhanced Provider Relief Fund Payment Portal. The portal allows dental providers to apply for payments made for health care-related expenses or lost revenue attributable to the pandemic.

At the state level, The Texas Dental Association is our advocate for all legislative and regulatory arenas on behalf of the public and profession of dentistry. We have a stellar group of dentists in Texas that serve on the Council on Legislative and Regulatory Affairs (CLARA). They work to implement the TDA’s legislative agenda and to maintain positive working relationships with legislators, state officials, and allied professional groups. CLARA also informs members about governmental actions, mobilizes the TDA’s grassroots organization, and works with regulatory agencies to help ensure a competitive marketplace for dentists and quality dental care for all Texans.

The TDA also has an online publication, The Root, which houses current happenings at the state capitol, timely legislative updates, dental board news, regulatory reminders, and other important legislative information. When the Texas Legislature convenes in Austin for a regular session every 2 years, TDA hosts Legislative Day. Dentists from across Texas are invited to come together at the State Capitol to attend appointments scheduled with Congress and House representatives from their districts and speak about issues important to dentistry.

The TDA worked around the clock for its members during the pandemic closely collaborating with Governor Abbott’s office and his Strike Force to help get dentists and patients back into the dental office. They provided timely updates to members via email and social media and secured 300,000 N95 respirators for Texas dentists! Most recently, TDA successfully advocated to favorably amend the TSBDE COVID-19 Emergency Rule. It helped ensure that dentists can continue effectively treating patients during the pandemic.

Now more than ever it is important to contribute to DENPAC and ADPAC. DENPAC is the political action committee of the TDA and ADPAC is the political action committee of the ADA. Both give dentists a voice in the public policy arena on behalf of our practices, patients, and profession, and is our most powerful resource to make a difference!

Shailee J. Gupta, DDS, MPH

CADS President 2020-2021



Rehiring Your Employees During the Pandemic

Rehiring Your Employees During the Pandemic

By Jeanine Lehman, Attorney at Law

During the pandemic, dentists face daunting tasks for reopening their practices and continuing operations, including obtaining adequate personal protective equipment, putting safety protocols in place, addressing COVID-19 in the workplace, and navigating the ins and outs of financial options, including the Paycheck Protection Program. One of the most difficult tasks for some practices is rehiring employees, who may receive more money on unemployment than for working.

CARES Act Federal Payment. Under the CARES Act, for pandemic unemployment, the federal government provides an extra $600 of weekly benefits. This is in addition to State of Texas unemployment benefits. This extra amount is last payable the week of July 25, 2020, unless extended. With the extra $600, many unemployed individuals receive more on unemployment than working. For example, a person, who had been working 40 hours a week at $16/hour, receives $933/week on unemployment vs. $640/week from working. 

Rehire Offer. The offer to rehire an employee should be in at least two written formats. For example, by letter, email, and text, as well in person or by phone. The offer should include all the terms, including rate of pay, location, job duties, and schedule. A written notice of how the practice is providing a safe working environment should also be provided. Records should be kept of the two written forms of the offer and the safe working environment notice.

Voluntary Incentives. A dental practice may voluntarily offer incentives to encourage employees to come back to work – for example, raises, re-employment bonuses, training, scheduling changes, or other benefits.

Refusal of Rehire. The Texas Workforce Commission (TWC) on its website states that “If you offered any of your employees a chance to return to work and they refused, TWC needs to know. Please report each individual who refused to return to work on our online Employee Work Refusal documentation.” Here is the link: https://apps.twc.state.tx.us/EBS_REF/ewrd/employeeWorkRefusalDoc  A copy of the completed online Employee Work Refusal form should be saved via printing or screenshot. If a rehire offer for a suitable position is refused and there is not an exception to rehire, the employee will most probably become ineligible for unemployment benefits. 

Exceptions to Rehiring. On June 16, 2020, the TWC provided guidance to unemployment claimants concerning continued eligibility for unemployment benefits if they refuse rehire. While each case is evaluated by the TWC on an individual basis, because of the COVID-19 emergency, the following are reasons benefits would be granted if the individual refused suitable work:

  • People 65 years or older, and/or people with medical issues, like heart disease, diabetes, cancer, or a weakened immune system, or who are at a higher risk for getting very sick from COVID-19. (Source: DSHS website)
  • Household member at high risk – People 65 years or older or who are at a higher risk of getting very sick from COVID-19 (source DSHS website).
  • Diagnosed with COVID – the individual has tested positive for COVID-19 by a source authorized by the State of Texas and is not recovered.
  • Family member with COVID – anybody in the household has tested positive for COVID-19 by a source authorized by the State of Texas and has not recovered, and 14 days have not yet passed.
  • Quarantined – individual is currently in 14-day quarantine due to close contact exposure to COVID-19.
  • Child care – Child’s school or daycare is closed, and no reasonable alternatives are available.

Work Search Requirement Reinstatement. Early in the pandemic, the TWC waived the work search requirement for unemployment benefits. On June 16, 2020, the TWC announced that starting July 6, 2020, the work search requirement will be reinstated. This means that unemployment claimants will need to engage in specified amounts of work searches and document the same. The goal is to find suitable employment and to return to work. With late June’s surge in COVID-19 cases and hospitalizations, the reinstatement of the work search requirement may be reconsidered by the TWC.

Changing Requirements. During the pandemic and its aftermath, considerations for employment and operating a dental practice will be subject to changing laws, orders, rules, and opinions. Therefore, ongoing vigilance and consultation with a knowledgeable attorney concerning changes will be critical.

Jeanine Lehman is an Austin, Texas dental, health and business law attorney with a statewide practice – www.jeanine.com. She can be reached at (512) 918-3435 or Jeanine@Jeanine.com. © Jeanine Lehman 2020. This article is not legal advice.

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Editor’s Corner August 2020

Organized Dentistry, What Have You Done For Me Lately?

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Reopening Your Dental Office During the Pandemic

By Jeanine Lehman, Attorney at Law

An eternity seems to have passed since the City of Austin cancelled the SXSW festival due to COVID-19 in early March. Austin was spared the influx of over 400,000 visitors from around the world and a possible fate akin to New Orleans. That said, dental practices have suffered greatly due to their closure pursuant to the Governor’s Executive Orders GA-09 and GA-15, which limited health care providers to certain emergency services – to preserve personal protective equipment (PPE) for frontline healthcare workers fighting COVID-19. 

Reopening. On April 27, 2020, Governor Abbott announced that effective May 1, 2020, dentists may reopen their practices per Executive Order GA-19, which allows dentists to no longer be limited to emergency services. Dentists must comply with Texas State Board of Dental Examiners (TSBDE) emergency rule 108.7(16) which requires compliance with the rule’s and CDC guidelines. These include having COVID-19 procedures, screening of dental health care personnel (DHCP), as well as patient pre-appointment screening, in-office screening, and post appointment instruction, use of standard precautions, transmission-based precautions (including N-95 respirator masks, KN-95 masks, or their substantial equivalent for procedures likely to involve aerosols), and emphasis on proper use of personal protective equipment and reduction of aerosol production. An example is that for hygiene services, only hand instruments and low-speed polishing tools may be used. The guidelines also have office considerations and many more requirements. The rule is available on the TSBDE website. The Governor also provided a manual with minimum health protocol checklists for employers, businesses and individuals, which should be used, at: gov.texas.gov/opentexas   Patients and others should be directed to wear face coverings while not in the dental chair. Dental practices should follow applicable guidelines, including TSBDE, CDC, OSHA, public health authorities, and other governmental entities, and make reference to ADA and TDA resources. The Texas Dental Association’s “Guidelines for Reopening Dental Offices Safely During the COVID-19 Pandemic” is helpful and includes resource references. 

Employees. When Order GA-09 was issued in March, many practices fired or furloughed some or all of their employees, who then filed for unemployment. To bring back fired employees, they  need to be rehired and customary new hire paperwork is required. Hopefully, fired and furloughed employees will want to come back to work and realize there is a limit to unemployment benefits. That said, many employees will receive more money from unemployment benefits than from working at their past wage levels, due to added pandemic federal unemployment benefits of $600/week. To estimate an employee’s unemployment benefits, $600/week is added to the results from the Texas Workforce Commission’s benefits calculator: https://apps.twc.state.tx.us/UBS/benefitsEstimator.do 

COVID-19 in the Office. A COVID-19 positive patient, visitor, or team member may be present in the dental office. Such person may be asymptomatic but spreading the virus. Therefore, the practice needs to have a plan in place for what to do if notified by a patient, team member or visitor of COVID-19 infection, including compliance with the requirements of State and local public health authorities. For eligible employees, the practice also needs to comply with the Families First Coronavirus Response Act administered by the U.S. Department of Labor, including for paid sick leave and enhanced family medical leave requirements. A poster concerning employee rights is required.

PPP Loans. Practices receiving Paycheck Protection Program loans should carefully track and document allowable expenses that apply to loan forgiveness. To avoid or limit the reduction in loan forgiveness, they need to be aware of and minimize the reduction in the number of full time equivalent employees and employee compensation.

Costs & Adjustments. Dental practices will incur significant costs, including for enhanced PPE, office improvements, and probable reduction in patient capacity. For example, a hygienist doing hand scaling will see fewer patients in a day. The American Dental Association has issued a statement on third party payer reimbursement for costs for increased standards for PPE. Dentists should also carefully track and document their loss of revenue and increased expenses caused by the pandemic. Those data will be helpful if they choose to sell their practices.

Changing Requirements. The reopening of dental practices will be subject to changing orders, rules, laws, and opinions. Therefore, ongoing vigilance and consultation with a knowledgeable attorney concerning changes will be critical.

Jeanine Lehman is an Austin, Texas dental, health and business law attorney with a statewide practice – www.jeanine.com. She can be reached at (512) 918-3435 or Jeanine@Jeanine.com. © Jeanine Lehman 2020. This article is not legal advice.