The Issue The ultimate issues to be decided in this proceeding are whether the Respondent has violated provisions of Florida Statutes pertaining to the practice of dentistry and, if so, whether his license should be revoked or suspended for a specified period, or whether other disciplinary action should be invoked. Petitioner contends that Respondent violated the provisions of Section 466.028(1)(y), Florida Statutes, in connection with his construction and adjustments of a set of upper and lower dentures for Sally Cohen, a former patient. Respondent disputes the allegation and contends that his diagnosis and treatment of Sally Cohen was proper.
Findings Of Fact Petitioner holds license No. 1808 issued by Petitioner and has been licensed to practice dentistry in the State of Florida since 1953. Prior to his being licensed in Florida, the Respondent practiced dentistry in other locations beginning in 1940. Since approximately 1963, the Respondent's practice has been solely in the area of fabricating, constructing, fitting, and adjusting complete and partial dentures. Sally Cohen was formerly a patient of the Respondent. The Respondent first saw her during October, 1978, with a broken lower denture. The Respondent repaired it and refit it in her mouth. The Respondent saw Ms. Cohen in October, 1980. She was complaining of her old dentures. The Respondent observed her dentures and noted that they were slipping. He recommended that she get new dentures, and he told her that he would be able to make the dentures for her. He saw her again in April, 1981, observed the same conditions, and made the same recommendations. Ms. Cohen requested that he fit her for a new set of dentures. The Respondent took impressions, developed models, and sent the models to his laboratory for processing into dentures. When the laboratory completed the manufacture of the new dentures, Ms. Cohen returned to the Respondent's office to have the dentures fitted. The Respondent placed the dentures in her mouth, checked for "occlusion," and observed the fit of the dentures. The term "occlusion" pertains to the manner in which the upper and lower dentures touch. With dentures, it is important that the occlusion is as uniform as possible so as to assure a proper fit and prevent slippage of the denture plates within a patient's mouth. The occlusion and fit of Ms. Cohen's dentures appeared appropriate. The Respondent explained to Ms. Cohen at the fitting that there would be an adjustment period, and he explained good oral hygiene procedures to her. Ms. Cohen's upper ridge was anatomically good, but her lower ridge was in poor shape; and it was difficult to accomplish a fit of the lower plate without "overextending" the denture borders so as to make the lower denture as stable as possible in the patient's mouth. The Respondent ordinarily likes to wait for approximately one week after dentures are fitted to make an adjustment. Ms. Cohen, however, returned to his office on the first day after the fitting, complaining of pain. It appears that Ms. Cohen has a low pain threshold. Respondent again explained proper oral treatment to her. He observed no sore spots of significance in her mouth. He again checked the occlusion and fit of the dentures and observed no problems. Several times thereafter, Ms. Cohen returned to the Respondent's office complaining of pain from the new dentures. Each time, the Respondent checked the occlusion and fit of the dentures. He made minor adjustments. He properly observed the occlusion and observed no problems. The Respondent last observed Ms. Cohen on June 12, 1981. He felt at that time that she was in good condition. The Respondent was going on vacation, and he informed Ms. Cohen that Michael Overleese, the dentist who shared office space with the Respondent, would be handling any adjustments while the Respondent was away. While the Respondent was on vacation from his practice, Ms. Cohen made several appointments to see Dr. Overleese. She continued to complain that the dentures hurt her mouth. She complained of generalized discomfort, but was generally unable to pinpoint a specific area of pain. Dr. Overleese made four adjustments of the patient's dentures during June and July, 1981. He properly observed the occlusion and fit of the dentures. He observed no problems. He felt that Ms. Cohen was not keeping the dentures in her mouth long enough to adjust to them. He did not observe any ulceration or irritation in places where Ms. Cohen indicated she was experiencing pain. Dr. Overleese did grind some spots on the patient's dentures in order to improve occlusion, but this is not an unusual occurrence. Occlusion of dentures can typically always be improved at least slightly. Dr. Overleese was somewhat frustrated with the situation. On her last visit, Ms. Cohen felt that Dr. Overleese told her that she would not be able to return for further adjustments. Dr. Overleese did not give instructions of that sort, but was misunderstood by Ms. Cohen. After the last visit, Ms. Cohen visited a lawyer. The attorney assisted her in filing a complaint with the Petitioner. The Petitioner conducted an investigation and retained Richard A. Saal, D.D.S., to examine Ms. Cohen. Dr. Saal examined her in October, 1981, and observed that there was a premature occlusion. He observed that the first bicuspid on the upper and lower right dentures met prematurely. The premature occlusion was obvious to Dr. Saal. Such an occlusion would result in movement of the denture plates, resulting in pain. Dr. Saal concluded that the most logical explanation for the premature occlusion was improper manufacture and fitting of the dentures or an improper adjustment of the occlusion. While this may be the most common explanation, it is not the only one. Such a prematurity could result from structural problems in the patient's mouth and from changes in the structure. Tooth grinding on the part of the patient or any action that changes the contour of the lower ridge of a patient's mouth could result in such a prematurity. It is not uncommon for such prematurities to develop with dentures that displayed a proper occlusion and fit when first placed in the patient's mouth. Given the fact that the Respondent and Dr. Overleese properly observed the occlusion of Sally Cohen's dentures and observed no abnormalities of the sort observed by Dr. Saal, it is concluded that events which occurred after Ms. Cohen's last visit to Respondent's office resulted in the premature occlusion.
Recommendation Based upon the foregoing Findings of Fact and Conclusions of Law, it is, hereby, RECOMMENDED: That a final order be entered by the Department of Professional Regulation, Board of Dentistry, dismissing the Administrative Complaint that has been filed against the Respondent, Leonard Foley, D.D.S. RECOMMENDED this 1st day of November, 1982, in Tallahassee, Florida. G. STEVEN PFEIFFER Assistant Director Division of Administrative Hearings The Oakland Building 2009 Apalachee Parkway Tallahassee, Florida 32301 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 1st day of November, 1982. COPIES FURNISHED: Theodore R. Gay, Esquire Mr. Samuel R. Shorstein Department of Professional Secretary, Department of Regulation Professional Regulation 130 North Monroe Street 130 North Monroe Street Tallahassee, Florida 32301 Tallahassee, Florida 32301 Patrick L. Bailey, Esquire Mr. Fred Varn Sullivan, Ranaghan, Bailey Executive Director & Gleason, P.A. Board of Dentistry 2335 East Atlantic Boulevard Department of Professional Post Office Box 549 Regulation Pompano Beach, Florida 33061 130 North Monroe Street Tallahassee, Florida 32301
The Issue Whether Respondent's license to practice dentistry in the State of Florida should be revoked, suspended or otherwise disciplined under the facts and circumstances of this case.
Findings Of Fact Upon consideration of the oral and documentary evidence adduced at the hearing, the following relevant findings of fact are made. At all times material to this proceeding, the Respondent was a licensed dentist in the State of Florida, having been issued license number DN 0005429. The patient, R.M., first presented herself to the American Dental Center (Center), a dental business owned and operated by Respondent, around July 7, 1987, and was seen by a dentist, other than the Respondent, employed by the Center. This dentist examined R.M. and recommended a new upper denture and lower partial. R.M. was seen again on December 7, 1987, by a dentist, other than the Respondent, at the Center who repaired tooth number 7 on her upper denture. This dentist also advised R.M. that she needed a new upper denture and a lower partial. On June 13, 1989, R.M. was seen by the Respondent at the Center, and the Respondent refused to reline R.M.'s upper denture. Respondent advised R.M. that she needed a new upper denture and a lower partial. On July 12, 1989, R.M. saw another dentist, other than Respondent, at the Center who replaced tooth number 7 in her upper denture, and this dentist advised R.M. that she needed a new upper denture and a full lower denture. On September 8, 1989, R.M. visited the Center and was seen by the Respondent. R.M. agreed to Respondent's treatment proposal of June 13, 1989, for a new full upper denture and a new lower partial. During this visit, the Respondent drilled two holes in the back of two of the lower teeth, numbers 22 and 27, in preparation for a cingulum rest. This procedure was not discussed with R.M. at that time. R.M. did not complain to the Respondent that there was sensitivity as a result of these holes. Also, on this same visit, the Respondent made lower partial impressions and full upper denture impressions. The Respondent properly performed a periodontal probing which was properly recorded in the records, notwithstanding the conflict in the testimony regarding R.M.'s records as to which dentist performed the periodontal probing. Likewise, the Respondent properly performed a soft tissue examination which was properly recorded in the records. On September 25, 1989, the Respondent checked the vertical dimensions of occlusion (VDO) with the full upper dentures and lower partial in place, and found both the vertical dimensions and the occlusion (bite) to be within reasonable bounds. Dr. Marshall performed the vertical dimensions and found them to be outside reasonable bounds. However, when Dr. Marshall performed this test, R.M. did not have the lower partial in place because the holes in teeth numbers 22 and 27 had been bonded by Dr. Odegaard. Because the lower partial could not be in place, the occlusion could not be checked. Also, not having the lower partial in place could have accounted for the difference in the vertical dimensions observed by Dr. Marshall and the Respondent. R.M. was apparently satisfied at this time with Respondent's work since she voiced no complaint. Respondent also selected shade of teeth at this appointment. At R.M.'s next visit, sometime between September 25, 1989, and October 6, 1989 (possibly October 1, 1989), the Respondent made a full upper denture impression in rubber base. R.M. was allowed a look at the full upper denture and the lower partial in place. When in place, the upper denture and lower partial did not interfere with Respondent's enunciation of certain words or certain numbers which would indicate that the upper denture and lower partial fit properly. R.M. initialed her chart indicating that she approved the shape, shade, color, size and arrangement of teeth. There is insufficient evidence to show that the patient knew what she was initialing, and at this point had no complaints, or if she had, she did not voice them. R.M.'s next visit was October 6, 1989, and at this visit the full upper denture and lower partial were delivered to her, placed in her mouth and she was allowed to look at them with a mirror. R.M. voiced no complaints, other than a minor sore spot which Respondent corrected, and she paid the balance of her bill and left. At this same visit, both Respondent and R.M. realized that after a period of time certain adjustment would be needed. On October 16, 1989, R.M. called Respondent's office complaining that her dentures and lower partial were hurting. R.M. was advised that her chart would be pulled for the Respondent to review and that the office would call back. Upon being called back, R.M. was advised by Respondent's staff that Respondent wanted her to come in to the office for adjustments. However, R.M. refused to come back in for any adjustments and advised Respondent's staff that she wanted her money back or she was going to the Better Business Bureau or get a lawyer. Around November 24, 1989, R.M. visited Dr. Odegaard's office complaining of sensitivity on lower teeth numbers 22 and 27. Upon examination, Dr. Odegaard determined that the hole drilled in those teeth by Respondent had gone through the enamel into the dentin which was the apparent cause of the sensitivity. Dr. Odegaard bonded the holes in teeth numbers 22 and 27 which relieved the sensitivity. At that visit, Dr. Odegaard was aware of Petitioner's involvement in this case. Based on the testimony of the experts, it is apparent that drilling through the enamel of a tooth into the dentin is not an uncommon occurrence, and that, in itself, would not necessarily be practice below the standard of care. Notwithstanding the testimony of Dr. Odegaard and Dr. Marshall, there is competent substantial evidence, including Dr. Reichgott's testimony, to establish facts to show that the placing of the lingual rest on teeth numbers 22 and 27 was a treatment of choice and not any riskier than other procedures performed by dentists. Notwithstanding the testimony of Dr. Odegaard and Dr. Marshall, there is competent substantial evidence, including the testimony of Dr. Reichgott, to establish facts to show that: (a) a soft tissue and periodontal examination was performed and recorded in the patient's records; (b) the preparation of the lower lingual surface of the lower canine for the lingual rests was not practice below the standard of care, or (c) the failure to record in the patient's chart the possible sequela of sensitivity from lingual rests and alternate methods of treatment was not practice below the standard of care. While the Respondent's plan of treatment was brief, it was not inadequate record keeping or practice below the standard of care. On each visit where R.M. saw the Respondent in a professional capacity, the Respondent made certain notations in the record concerning what he had accomplished during each visit, and while these notations are brief they do adequately describe what Respondent had accomplished. There is competent substantial evidence to establish facts to show that Respondent's dental records and medical history records justified the course of treatment for R.M. There is competent substantial evidence to establish facts to show that Respondent's treatment of R.M. met the minimum standards of performance in diagnosis and treatment when measured against the generally prevailing peer performance.
Recommendation Having considered the foregoing Findings Of Fact and Conclusions Of Law, it is, accordingly, Recommended that the Board enter a Final Order dismissing the Administrative Complaint filed in this case. DONE and ORDERED this 27th day of May, 1992, in Tallahassee, Florida. WILLIAM R. CAVE Hearing Officer Division of Administrative Hearings The Desoto Building 1230 Apalachee Parkway Tallahassee, FL 32399-1550 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 27th day of May, 1992. APPENDIX TO THE RECOMMENDED ORDER The following constitutes my specific rulings pursuant to Section 120.59(2), Florida Statutes, on the Proposed Findings Of Fact submitted by the Parties in this case. Specific Rulings On Proposed Findings Of Fact Submitted By The Petitioner 1. Adopted in Finding of Fact 1. 2-4. Adopted in Finding of Fact 2, except for the date June 7, 1987, which is rejected in that it was July 7, 1987. Adopted in Finding of Fact 4. Rejected as not being supported by competent substantial evidence in the record. 7(a)(b). Adopted in Finding of Fact 6. 7(c). Adopted in substance in Finding of Fact 13, as modified, except for being "performed in a non-traditional area" which is rejected as not being supported by competent substantial evidence in the record. 7(d). Other than being asked to sign chart signifying approval which is adopted in Finding of Fact 9, this proposed finding of fact is rejected as not being supported by competent substantial evidence in the record. 7(e). Adopted in Finding of Fact 10. 7(f)-(i). Rejected as not being supported by competent substantial evidence in the record. 7(j)-(k). Adopted in Finding of Fact 13. 7(l). Neither material or relevant to the conclusion reached in the Recommended Order. 8-9. Rejected as making a conclusion without making a finding of fact that there was in fact a failure on the part of the Respondent, but in any case these are not supported by competent substantial evidence in the record. 10-11. Rejected as not being supported by competent substantial evidence in the record. Specific Rulings On Proposed Findings Of Fact Submitted By The Respondent The Respondent's "Findings Of Fact" are in part argument and part restatement of testimony rather than proposed findings of fact. However, for those that are truly findings of fact, I have adopted in Findings Of Fact 1-19. Copies furnished to: Albert Peacock, Esquire Department of Professional Regulation 1940 N. Monroe Street Tallahassee, FL 32399-0792 Peter Kurachek, D.D.S. 395 Sugar Mill Drive Osprey, FL 34229 William Buckhalt Executive Director Department of Professional Regulation Northwood Centre 1940 North Monroe Street Suite 60 Tallahassee, FL 32399-0792 Jack McRay General Counsel Department of Professional Regulation Northwood Centre 1940 North Monroe Street Suite 60 Tallahassee, FL 32399-0792
Findings Of Fact The Respondent, Prince Edward Denton, D.D.S., is now, and has been at all times material to this proceeding, a licensed dentist in the State of Florida, having previously been issued license number DN 0006762. Carol Hepp has been a dental assistant for twenty-seven years. She received her initial training as a dental assistant after graduation from high school when she went to work for Dr. Seth Rhodes in North Miami Beach. Since that time she has attended many training courses in her career as a dental assistant, including expanded duties courses at Emory University and the University of Florida. Ms. Hepp was employed by the Respondent as a dental assistant for a total of approximately four and one-half years. Ms. Hepp was so employed on February 2, 1988. On February 2, 1988, patient C.H. went to the Respondent's office to obtain treatment for a cracked tooth. The cracked tooth was tooth number 18, which was the last tooth in the patient's left lower jaw. During that visit, the patient C.H. was examined by the Respondent and by his dental assistant, Carol Hepp. Ms. Hepp explained the tooth crowning procedure to the patient. Ms. Hepp took a preliminary impression of the lower jaw by placing a two-part putty-like substance called "citrocon" in a tray, placing a plastic sheet over the top, and placing the tray into the patient's mouth. She held the tray in place for approximately six minutes and then removed it. This procedure yielded an approximate image of the patient's lower teeth. The Respondent took the final impression by applying a viscous substance around tooth number 18, and then inserting the preliminary impression into the patient's mouth. The Respondent held the impression in place until it was set or non-moveable, at which time Ms. Hepp took over the task of holding the impression in place for the balance of the approximately four-minute period during which the final impression material completely set up. After the impression was finished, Ms. Hepp took it to the Respondent who examined it and approved the finished final impression. After the final impression had been taken, Ms. Hepp made a wax form for purposes of fabricating a temporary crown for C.H.`s tooth number 18. This was done prior to the "preparation" of the tooth. The "preparation" of a tooth for crowning is the actual grinding down of the tooth that is to be crowned. The Respondent, and not Ms. Hepp, ground down the patient C.H.`s tooth number 18 in preparation for crowning. Following the Respondent's "preparation" of the subject tooth, Ms. Hepp packed a cord around the tooth. 1/ The grinding down, or "preparation," of a tooth for crowning is an irremediable task, which under no circumstances should be delegated to a dental assistant. Following the Respondent's "preparation" of the tooth, Ms. Hepp then fabricated and installed a temporary crown on the patient's tooth number 18. This was done by utilizing the wax form she had previously made, filling the form with a self-curing jet material, adding tooth color, and then placing the temporary crown over the prepared tooth. At all times during the treatment of the patient C.H., the Respondent was aware of, and had authorized, each step performed by Ms. Hepp, and was available to assistt Ms. Hepp had she requested his assistance. Accordingly, Ms. Hepp was working under the direct supervision of the Respondent at all times material to this proceeding.
Recommendation For all of the foregoing reasons, it is recommended that a Final Order be issued in this case dismissing all charges in the Administrative Complaint. DONE AND ENTERED at Tallahassee, Leon County, Florida, this 31st day of July, 1991. MICHAEL M. PARRISH Hearing Officer Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-1550 904/488-9675 Filed with the Clerk of the Division of Administrative Hearings this 31st day of July, 1991.
Findings Of Fact During the summer of 1982, Petitioner, Habib H. Ghahremannezhad, of Thibodaux, Louisiana, sent a letter to the Respondent requesting information on the requirements to take the Florida dental examination. He had been advised by a representative of the American Dental Association that foreign dentists could take the examination. 1/ In response to his letter, the Respondent sent him the required application forms, which had a submission deadline in late September, 1982. Petitioner submitted them on time as required; and just a few weeks before the examination, in November, 1982, he received further instructions from Respondent which included the requirement that he, the candidate, bring with him to the examination a stipulated number of real human teeth in what could be described as perfect shape. Teeth of this nature are difficult to get; and though Petitioner called many practicing dentists in the area where he lived and also contacted the local dental school, he was unable to procure the appropriately preserved teeth within the short period of time between his receipt of notification of the requirement and the test. As a result, he was required to purchase a human skull from a medical supply house, from which he extracted the required teeth. These skulls are prepared for use by medical students and are dried out. The teeth in them, therefore, are brittle and fragile. Though he stored them in a glycerine/water solution up to the examination, this could not and did not restore already dehydrated, dead, brittle teeth to their former condition. The appropriate teeth would have been freshly extracted and thereafter stored in a mixture of glycerine and water which would have preserved their resiliency and rendered them not brittle and subject to easy breakage. There was no evidence presented, however, to show that Petitioner received his instructions any later than other candidates who suffered under the same handicaps as he in procuring appropriate teeth. In fact, he admits he was not singled out for late instructions, and the other candidates had the same problems. The mannequin examination consisted of at least nine different procedures. Each procedure was performed by the candidate with a monitor in the area. When the procedures were completed, they were thereafter graded anonymously (each procedure model was marked only with the candidate's examination number, not the name) by three separate examiners who independently, out of the presence of each other (and who were also identified only by a number), assigned a numerical grade to each procedure based on criteria set out on a prepared grading sheet. Under the rules for this examination, a grade of 3.0 out of a range from 0 to 5 is required to achieve a passing score. Respondent achieved a grade of 2.71, which was a failing grade and which was arrived at by averaging the three grades for each procedure, adding these nine averages and dividing by nine. Petitioner scored, as follows: (a) Procedure 01 Examiner 003 - 2 Examiner 071 - 3 average 2.67 Examiner 072 - 3 (b) Procedure 02 Examiner 072 - 3 Examiner 071 - 3 average 3.0 Examiner 008 - 3 (c) Procedure 03 Examiner 072 - 1 Examiner 071 - 1 average 0.67 Examiner 008 - 0 (d) Procedure 04 Examiner 008 - 2 Examiner 071 - 1 average 2.0 Examiner 072 - 3 (e) Procedure 05 Examiner 072 - 4 Examiner ,071 - 4 average 4.0 Examiner 008 - 4 (f) Procedure 06 Examiner 059 - 5 Examiner 066 - 3 average 4.33 Examiner 037 - 5 (g) Procedure 07 Examiner 059 - 3 Examiner 066 - 3 average 3.67 Examiner 037 - 5 (h) Procedure 08 Examiner 059 - 3 Examiner 066 - 4 average 4.0 Examiner 037 - 5 (i) Procedure 09 Examiner 059 - 0 Examiner 066 - 0 average 0.33 Examiner 037 - 1 Petitioner makes numerous allegations regarding the fairness of the examination and what he considers to be discrimination against foreign dental students. He produced, however, no evidence save his own opinion to support these claims except in the case of the instructions (Petitioner's Exhibit 1), which, on Page 3 at Paragraph 7, state that a candidate who fails this examination two times will not be eligible to take the remaining examinations for licensure "except for a candidate who graduated from the University of Havana prior to 1962, who may take [this] examination an unlimited number of times." Petitioner claims this provision discriminates against foreign dentists. If any discrimination is shown, it is clearly reverse discrimination in favor of older Cuban dentists, a decision which is an approved policy of the Respondent. Consequently, there is no showing whatever that Petitioner was in any way discriminated against. Petitioner also contests, however, the grades given him on Procedures 3 and 9. Procedure 3 was a "Dental Class III preparation for a composite restoration on a maxillary central incisor." Here, the tooth Petitioner had for preparation was one of those fragile teeth which had dried out and was brittle. As a result, the tooth broke as he was working on it. At this point, he showed his problem to the monitor, who advised him to include that area in the preparation. He did that, as instructed, and received a low grade on his procedure, which he contends was the fault of the instructions given him by the examiner. Procedure 3 was designed to test the candidate's ability to demonstrate an acceptable preparation to Respondent's standards. This preparation would be a minimal preparation which would be for a very small cavity. Petitioner was graded low on this procedure by all three examiners, who each made additional handwritten comments on the form. All comments related to excessive depth of the preparation, which is not related to the width and size of the preparation. These latter conditions could, indeed, be related to the instructions of the monitor and, if they were the only comments, might justify adjustment. However, Petitioner made his preparation too deep, in fact exposing the pulp (nerve) of the tooth. This defect is not related to the size of the preparation as increased by the instructions of the monitor to include the area in the preparation. By itself, pulpal exposure is sufficient to cause a grade of 0 for this procedure. Here, the groove was so deep and so grossly oversized it went beyond any tolerance which might be given for a situation where, like here, the examinee has no idea, because of the dead tooth and no X rays, how close to the surface the pulp is. Further, two of the three grade sheets bear the notation "SMN," which means "saw monitor's notes." This indicates that before awarding a grade, these two examiners were aware of the problem that Petitioner had and that the monitor had advised him to include the break area in the procedure. Even after making allowances for that, two of the examiners graded Petitioner's work as "1," and the other gave him "0." These grades are consistent and within normal deviation, and all are failing grades. In light of this, one cannot conclude the rating for this procedure was improper so as to merit upward adjustment. As to Procedure 9, this was to prepare a "wax-up for a cast-gold bridge on the above [formerly] prepared teeth. . ." Petitioner contends he did as directed, completed the procedure, and turned it in. In an actual clinical situation, this work would not be done in the mouth of the patient, but for examination purposes, the candidates were directed to make the wax pattern directly in the model-- a far more difficult and rarely done procedure. However, the grading criteria take into consideration the conditions under which the examinee has to work in determining a pass or fail grade. This procedure has been changed with the 1983 examination. Candidates will no longer be required to work under this previous, more difficult method. After Petitioner completed the procedure, he turned it in and left. When the first examiner looked at the device prepared by Petitioner and attempted to take it apart, he broke it. Petitioner was awarded a grade of 0 by two examiners and a "1" by the third. He contends that since his wax model was broken by the first examiner, this was not his fault, and he should not have been given failing grades. He states that when he handed the pattern in, it was intact and, contra to claims of the examiner, he does not believe the pattern broke as a result of the area of cohesion being too small, as this item was graded as passing in the prior procedure. In addition, Petitioner contends that even if the wax cohesion was insufficient, this still does not justify a "0," since there were at least three other major areas which should be considered. However, review of the grading sheets, at least for Examiners 059 and 037, shows that numerous other deficiencies were found in Petitioner's procedure here, aliunde the wax cohesion and breakage, and these other deficiencies would justify a failing grade--even a "0." In the area of the broken wax pattern, however, examiners are indoctrinated as to all procedures to be tested the day before the examination and go over them thoroughly in advance. As to wax patterns, they are told at this time that the pattern may be removed, but only using "utmost care." Here, the candidate is asked to make a wax pattern for a 3/4 crown for one tooth, the back attachment to be waxed to a full crown. The stability of the pattern to withstand withdrawal is related to how well the procedure is waxed. In the opinion of Dr. Agnini, the Respondent's expert, sufficient wax could have been inserted to strengthen the wax pattern as it was being built under exam conditions. The examiner's (059) comments were that he broke the pattern and that the attachment was poor. It was the poor attachment that caused the device to break. Review showed that it was insufficiently waxed (See sheet for 059, Comment 5d.), and this did not meet the criteria. Respondent's witness concedes the possibility that the wax pattern breaking influenced in a negative fashion the judgment of the graders. However, as previously found, there were several other identified deficiencies on this procedure, and the low grades awarded rate to the procedure in its entirety--not solely to the fracture. There is no showing this procedure was unfairly or improperly graded. Although the examiners are not told how to withdraw the pattern during the standardization briefing other than to do it carefully, all examiners are licensed dentists and should know how to remove a wax pattern.
Recommendation Based on the foregoing, it is, therefore, RECOMMENDED: That a final order be entered by the Board of Dentistry finding that Petitioner has failed to achieve a passing score on the December, 1982, Dental Mannequin Examination and upholding the grade awarded to him on that examination. RECOMMENDED this 8th day of November, 1983, in Tallahassee, Florida. ARNOLD H. POLLOCK, Hearing Officer Division of Administrative Hearings The Oakland Building 2009 Apalachee Parkway Tallahassee, Florida 32301 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 8th day of November, 1983.
