THE NAME OF THE OFFENDING DENTIST HAD TO BE REDACTED FOR LEGAL REASONS.

BEFORE THE GEORGIA BOARD OF DENTISTRY
                STATE OF GEORGIA

IN THE MATTER OF:                                         )
)
Dr. C, D.M.D.                                        )                                
                                                                                 )                         DOCKET NO:  [2008-0365]
Georgia License # XXXXXX                              )
                                                                                 )
        Applicant.                                                       )

PUBLIC CONSENT AGREEMENT FOR RENEWAL

Pursuant to O.C.G.A  43-1-1-19(g), 43-11-46(b), and 43-11-47(g), the Georgia

Board of Dentistry ("Board"), in its discretion, has considered the application for renewal

of the license of Dr. C, D.M.D. ("Applicant") to practice dentistry in

the State of Georgia.  By agreement of the Board and Applicant, the following disposition

of this matter is entered pursuant to the provisions of the Georgia Administrative

Procedure Act, O.C.G.A. 50-13-13(a)(4).  In conjunction therewith, the Board hereby

enters its Findings of Fact and Conclusions of Law as follows:

FINDINGS OF FACT

1.

Applicant was issued a license to practice dentistry in the State of Georgia on or

about May 16, 2006.

2.

On or about December 5, 2007, Applicant applied for her renewal of her license to

practice dentistry in the State of Georgia.  On her renewal application, Applicant

indicated that disciplinary action had been taken against her by a state or regulatory board

since the date of her last renewal.

3.

On December 22, 2006, Applicant entered a Consent Order with the Board of

Dental Examiners of Alabama for using Sargenti material or paste containing

paraformaldehyde in the performance of a root canal on tooth #18, failing to provide a

pretreatment x-ray of tooth #18 upon the request of patient, and informing the patient that

the cause of her pain and numbness following root canal on tooth #18 was an injection

rather than from the overfill of the canal(s), as a result of the manner in which the root

canal procedure was performed and/or use of Sargenti material or paste containing

parformaldehyde.  The Board of Dental Examiners of Alabama placed Applicant on

probation for one (1) year, and ordered her to complete sixteen (16) hours of approved

continuing education related to endodontic treatment utilizing the gutta percha

technique, and pay an administrative fine total five thousand five dollars ($5,500.00).

4.

O.C.G.A. 43-11-47(a) states:

The board shall have the authority to ...discipline a dentist licensed under
this chapter or any antecedent law upon a finding by a majority of the
entire board that the licensee or applicant has: (5) ...had other disciplinary
action taken against him or her by any lawful licensing dental authority
other than the board....

5.

Applicant admits to the above-styled Findings of Fact and waives any further

finding of fact not already contained in this Agreement.

CONCLUSIONS OF LAW

Applicant's conduct constitutes sufficient grounds for the imposition of

conditions upon Applicant's license to practice dentistry in the State of Georgia

under O.C.G.A. Title 43, Chapter 11 and 43-1-19.

ORDER

The Board, having considered all of the facts and circumstances surrounding this

case hereby orders, and Applicant hereby agrees, that this matter shall be disposed of as

follows:

1.

Upon docketing of this Consent Agreement, Applicants license to practice

dentistry in the State of Georgia shall be renewed, subject to the following terms and

conditions:

(a)      Applicant shall pay a find of five hundred dollars ($500.00) payable by

certified check or money order to the Board within ninety (90) days of

the effective date of this Agreement.  Such fine shall be sent to the

Georgia Board of Dentistry, 237 Coliseum Drive, Macon, Georgia 31217-

3835.  Failure to pay said fine pursuant to the terms of this paragraph shall

be deemed a violation of this Agreement and may subject Applicant's

license to further discipline.

(b)       Applicant shall provide the Bo ad with documentation of completion of

the conditions imposed in her Consent Order from the Board of Dental

Examiners of Alabama.

(c)       If Applicant shall fail to abide by all State and Federal laws relating to

drugs and regulating the practice of dentistry, the Rules and Regulations of

the Georgia Board Dentistry, or the terms of this Consent Agreement,

Applicant's license shall be subject to revocation, upon substantiation

thereof, and shall not be subject to restoration.  Summary suspension of

Applicant's license, pending any such proceeding may be ordered

pursuant to the provisions of the Georgia Administrative Procedure Act,

O.C.G.A. 50-13-18(c)(1), or any other statute authorizing such

emergency action.

3.

In addition to and in conjunction with any other provision contained herein, this

Consent Agreement and the dissemination thereof shall serve as a public board order.

4.

Approval of this Consent Agreement by the Board shall in no way be construed as

condoning Applicant's conduct, and shall not be construed as a waiver of any of the

lawful rights possessed by the Board.

5.

Applicant has read this Consent Agreement and understands its contents.

Applicant understands that she has a right to a hearing in this matter and freely,

knowingly and voluntarily waives that right by signing this Consent Agreement.

Applicant understands that this Consent Agreement will not become effective until

approved by the Board and docketed by the Division Director.  Applicant further

understands and agrees that a representative of the Legal Services Section of the

Professional Licensing Boards Division may be present during the presentation of the

Consent Agreement and that the Board shall have the authority to review the

investigative file and all relevant evidence in considering this Consent Agreement.

Applicant understands that this Consent Agreement, once approved and docketed, shall

constitute a public record, which may be disseminated as a disciplinary action by the

Board.  If this Consent Agreement is not approved, it shall not constitute an admission

against interest in the proceeding, or prejudice the right of the Board to adjudicate this

matter.  Applicant hereby consents to the terms and sanctions contained herein.

Approved by the Board this [18th] day of [January], 2008.

GEORGIA BOARD OF DENTISTRY

BY:    ___________/s/_____________
CLYDE H. HANDRES, D.M.D
          Board President

Board Seal:

ATTEST:   __________/s/___________
                 RANDALL D. VAUGHN
                 Division Director
                 Professional Licensing Boards Division

CONSENTED TO:  ___________/s/_______________
Dr. C, D.M.D
                                Applicant

As to Dr. C, D.M.D:

Sworn to and subscribed before me
this [18th] day of [Feb], 2008

___________/s/____________
NOTARY PUBLIC

My commission expires:   [10/4/2010]