August 2019 Severe Dental Virtual Reality Therapy Pediatric Anxiety and Behavior Problems JournaCALIFORNIA DENTAL ASSOCIATION

A Persistent Problem in Dental Practice Peter Milgrom, DDS Connect with us | @tdsc_dentists

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1 Savings compared to the manufacturer’s list price. Actual savings on tdsc.com may vary. 2 THIS PROMOTION IS FOR THE PURPOSE OF SOLICITING SALES OF DENTAL SUPPLIES. NO PURCHASE NECESSARY. Void where prohibited and outside 50 US and DC. Begins 9 a.m. PST on 9/5/19; ends 4 p.m. PST on 9/7/19, with prize drawings daily. ARV of all prizes: $1,500. Odds of winning depend on number of entries received. Visit tdsc.com/giveaway for complete Official Rules. Sponsor: The Dentists Supply Company (TDSC), 1201 K St, Sacramento, CA. TDSC operates an online marketplace for dentists, offering dental supplies from major manufacturers and distributors. Aug. 2019 CDA JOURNAL, VOL 47, Nº8

departments

481 The Associate Editor/Take a Single Step

485 Impressions

533 RM Matters/To Treat or Not To Treat? Unvaccinated Patients Create Ethical Dilemmas

537 Regulatory Compliance/Required Courses and Continuing Education

542 Tech Trends 485

f e at u r e s 491 Dental Anxiety: A Persistent Problem in An introduction to the issue. Peter Milgrom, DDS

495 Dental Anxiety, Communication and the Dental Team: Responses to Fearful Patients This paper draws attention to evidence-based research that studied dental health professionals’ (DHPs) responses to patients’ concerns and demonstrates that DHPs should assist dentally anxious patients by encouraging them to express their fears early on. Ruth Freeman, PhD, and Gerry Humphris, PhD, MClinPsychol CPsychol

503 Individuals With Severe Dental Anxiety — Classification, Diagnosis and Psychological Treatment This paper presents different ways to assess and diagnose dental anxiety and the evidence base of treatment for dental anxiety. Magnus Hakeberg, DDS, PhD, and Ulla Wide, PhD

513 Is Virtual Reality Exposure Therapy the Future Treatment for Anxious Dental Patients? The aim of this paper is to acquaint the reader with the application of virtual reality exposure therapy (VRET) within the general dental practice. Kumar Raghav Gujjar, BDS, MDS, and Ad de Jongh, PhD

523 Dental Anxiety and Behavior Problems in Children Attending for Dental Treatment This article outlines various approaches to assessing and managing dental phobia in children and young people based on four key areas. Tim Newton, PhD; Jennifer Hare, BSc, MSc D, Health Psy CPsychol; and Geanina Bruj Milasan, BSc

AUGUST 2 0 1 9 479 CDA JOURNAL, VOL 47, Nº8

Volume 47, Number 8 JournaCALIFORNIA DENTAL ASSOCIATION August 2019 CDA Classifieds.

Free postings. published by the Editorial Production Manuscript California Kerry K. Carney, DDS, CDE Randi Taylor Submissions Priceless results. Dental Association editor-in-chief senior graphic designer www.editorialmanager. 1201 K St., 14th Floor [email protected] com/jcaldentassoc Sacramento, CA 95814 Upcoming Topics Ruchi K. Sahota, DDS, CDE 800.232.7645 September/Safety/Risk associate editor Letters to the Editor cda.org Management II

October/3D Printing www.editorialmanager. Brian K. Shue, DDS, CDE November/Aesthetics com/jcaldentassoc CDA Officers associate editor R. Del Brunner, DDS Subscriptions Gayle Mathe, RDH Advertising president Annual subscriptions are [email protected] senior editor Sue Gardner advertising sales available to association members at a rate of $36. Richard J. Nagy, DDS Peter Milgrom, DDS [email protected] To manage your printed guest editor 916.554.4952 president-elect Journal subscription online, [email protected] Andrea LaMattina, CDE log in to your cda.org Permission and account or email Judee Tippett-Whyte, DDS publications manager Reprints [email protected] for vice president Andrea LaMattina, CDE assistance. View the [email protected] Kristi Parker Johnson publications manager publication online at editorial and [email protected] cda.org/journal. communications specialist Ariane R. Terlet, DDS 916.554.5950 secretary [email protected] Joie R. Harrison communications and Steven J. Kend, DDS media relations specialist treasurer [email protected] Blake Ellington CDA classifieds work harder to tech trends editor bring you results. Selling a practice Debra S. Finney, MS, DDS, speaker of the house Jack F. Conley, DDS or a piece of equipment? Now you [email protected] editor emeritus

can include photos to help buyers Natasha A. Lee, DDS Robert E. Horseman, DDS immediate past president humorist emeritus see the potential. [email protected] Connect to the CDA community by And if you’re hiring, candidates Management following and sharing on social channels anywhere can apply right from Peter A. DuBois executive director the site. Looking for a job? You can post that, too. And the best part— Carrie E. Gordon @cdadentists chief strategy officer it’s free to all CDA members. Kristine Allington Journal of the California Dental Association (issn 1043–2256) is published monthly by the chief marketing officer California Dental Association, 1201 K St., 14th Floor, Sacramento, CA 95814, 916.554.5950. All of these features are designed to Periodicals postage paid at Sacramento, Calif. Postmaster: Send address changes to Journal of the California Dental Association, 1201 K St., 14th Floor, Sacramento, CA 95814. help you get the results you need, Alicia Malaby communications The California Dental Association holds the copyright for all articles and artwork published faster than ever. Check it out for director herein. The Journal of the California Dental Association is published under the supervision of CDA’s editorial staff. Neither the editorial staff, the editor, nor the association are responsible for yourself at cda.org/classifieds. Cris Weber any expression of opinion or statement of fact, all of which are published solely on the authority creative and ux director of the author whose name is indicated. The association reserves the right to illustrate, reduce, revise or reject any manuscript submitted. Articles are considered for publication on condition that they are contributed solely to the Journal. Copyright 2019 by the California Dental Association. All rights reserved.

480 AUGUST 2 01 9 Assoc. Editor CDA JOURNAL, VOL 47, Nº8

Take a Single Step Ruchi K. Sahota, DDS, CDE

ecently, my life was dedicated to a challenging project. I promised The preparation, the process, the experience. It is myself that if I lived to talk about it, I would be sure to share my story familiar, is it not? Transitioning through our life’s with all of you. Before undertaking phases is similar. Moving through dental practice Rthis endeavor, we assessed. We questioned transitions is very similar too. if we were ready. Many collaborators were consulted. A team was formed. Books were borrowed from the library. Online research commenced. Facebook of the various generations of dentists Members of the California Dental groups, Pinterest and scores of blogs were are also very difficult to predict. Will a Association have even more resources at scrutinized. Armamentarium was collected practice purchase go through without their fingertips. We can call 1-800-CDA- well before the start date. We pondered. any hitches? How will a millennial new SMILE and speak with experts about What was the correct timing? The start graduate change over to an office setting regulatory changes our practices encounter. date was determined a year in advance. with baby boomers and Generation Xers? We can visit our website, cda.org, which But were we prepared? A great change was When is the right time for a dentist to retire provides hundreds of articles and checklists around the corner. Were we geared up? and where does she go once she retires? that steer members in the right direction. Potty training was rough. But the As I scrolled through the stories CDA aims to provide its members with principles were simple: 1. Initiate the on a popular potty-training Facebook practical and beneficial benefits and support. process slowly and track key factors so group page, I realized that even the It strives to help members sustain and that we begin the process at the right deviation of durations of transitions was develop the quantity and quality of patients time. 2. Ensure a sense of participation, similar. Some children took a few days we have. Programs are developed to help us control and independence throughout to potty train and some took months. be better dentists and help our offices thrive. the process. 3. Be straightforward, direct Some dental practice sales are seamless Though we know that the majority of dental and as transparent as possible about and some are painstakingly dragged graduates intend to enter an associateship intentions and expectations. 4. Stay alert out over many months or years. in an existing private practice with a solo for obstacles and understand that there may Who prepares dentists to move through dentist, we see CDA embracing graduates be challenges, but stay positive and move the cycles of practice and professional who chose any modality of practice — be it forward in a positive direction. 5. When changes? Who decodes the secrets to buying ownership, partnership, corporate dentistry, instant success is not attained, stay patient. a practice? Dental schools try to prepare academics or the federal services. Embracing The preparation, the process, the their graduates. Thousands of continuing them means helping dentists thrive in experience. It is familiar, is it not? education gurus advertise easy and simple whatever transition they encounter Transitioning through our life’s phases courses of action to help dentists through themselves in. The mission of our California is similar. Moving through dental their transitions. Facebook groups provide Dental Association states that it is practice transitions is very similar too. threads and threads of dialogue from others committed to the success of our members in What is the most exigent variable in who have gone through similar transitions. service to their patients and the public. The potty training? The toddler’s personality. It is nice to hear those stories. It is nice association describes itself as a “community Likewise, we dentists all have varying to know others are encountering similar of dentists committed to enhancing the personalities, issues and backgrounds that challenges. It is nice to be able to bounce professional lives of our members.” affect our ability to transition through thoughts off of each other. However, are the Many years ago, this meant supporting residency, to associateship, to practice principles detailed on these Facebook posts only owner dentists. But now as only ownership, to partnership and/or maybe objective? Are they accurate? Have the legal 77.5% of dentists are practice owners to building multiple locations. Just as matters been vetted? Have the loopholes as compared to the 84% in 2005,1 the potty training can be contingent on the been scrutinized? A