Cliff's Notes

Disinfectants Effect on Dental Equipment

Cliff’s Notes For November 10, 2008 …..E-Blast…..
Cliff Marsh, Henry Schein ……
Cell: 201-321-7494……Fax: 201-262-2210…..
cliff.marsh@henryschein.com

Disinfectants & Cleaning Products The Effects on Dental Equipment and the Immediate Environment

Years ago Cidex 7 by Johnson & Johnson was the most widely used cold sterilization solution in the dental industry. Everyone complained about the smell and J&J’s standard response was “we make it to kill things, not smell good.” That statement is very true, glutaraledhydes are among the most dangerous chemical you could have in your office. They need to be handled very carefully and the sad part is that in today’s modern dental office environment, they are not necessary. About 15 years ago a dental assistant in the Bergen County area went to Hackensack Medical Center with symptoms of severe kidney disease. After a regiment of tests, her kidneys seemed to be healthy but were reacting to something. After investigating her personal & work habits it was discovered that she had “glutaraledyde poisoning” it was absorbed through her skin and the vapors were in the environment. After the glutes were removed, her symptoms cleared up. This case was instrumental in the decision that Hackensack Medical made to limit and if possible remove glutes from their environment. For proper sterilization and room preparation procedures, you need to understand the products you are using. The word “sterilize” means the destruction of all living organisms. Remember, people are living organisms. In the dental office, we can not sterilize the treatment room, we can only disinfect it. When disinfecting a room you should use nitrile gloves. Vinyl may have pin holes and latex may have enzymes that will adversely react with the disinfectant that you choose to use. All disinfectant brands will work as long as they are used according to the manufacturers direction. These products are governed by CDC regulation. Some of them may need to be discarded according to DEP regulation. Disinfectants will damage your dental equipment over time. Plastic items and chair upholstery will begin to yellow and eventually hairline cracks will appear. Using barrier products will help protect your cavitrons, curing lights, etc. As far as your chairs & stools, every manufacturer recommends just soap & warm water. However, there is a product made by Palmero Sales called Chair Guard. Palmero is one of those smaller companies that has some great products. Chair Guard is used once at the end of the day. It cleans the upholstery and leaves a protective film that will protect the chair from chemical effects. The product needs to be used every day because the disinfectants will break down the protection after 6-10 room preps. Chair Guard is available in a 14oz aerosol (part # 134-3649) or by the quart (part # 134-4747). Chair Guard has a smell that will dissipate quickly. It is best used at the end of the day. As always, I am available if you should have any questions or concerns (201-321-7494). Cliff’s Notes is a client exclusive service.

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October 16, 2009 Posted by Cliff's Notes Blog | 1 | Leave a comment

American Association of Women Dentists

Cliff’s Notes For November 2, 2008 …..E-Blast…..
Cliff Marsh, Henry Schein ……
Cell: 201-321-7494……Fax: 201-262-2210…..
cliff.marsh@henryschein.com

The Northern NJ Chapter of the American Association of Women Dentists….

This past Friday, Halloween, I had the pleasure of attending a session on facial cosmetics that was presented by the NJAAWD and funded by Henry Schein. I was so happy that they finally had a good turn out, but more on women dentists later. Towards the end of the morning session, I received a “text message” that my daughter was sick and she needed to come home from school. Well, Murphy’s law struck again. All of my resources were not available so after the session I rushed to school and picked her up. When I saw her, I figured I would take her directly to her medical doctor. Henry Schein gives us great medical insurance and it enabled me to change doctors 2 years ago. When the “woman” medical doctor came into the room, I remembered why we switched practices. She walked in with a laptop, diagnosed the problem, e-mailed the script directly to the pharmacy, answered all of my questions and we were on our way in 15 minutes. We then stopped by the pharmacy drive through and picked up the script that was ready and waiting. I think that in the real world, I am an everyday consumer. The doc had at her fingertips all of my daughters records and could link to any site in the world for diagnostic assistance right there from the exam room. The moral of this story, is that if you haven’t embraced technology, you better start. The information age and the paperless environment are here to stay and your patients are living it everywhere they go, every day. Now, back the AAWD. By the end of this decade (next year) 50% of the practicing dentists in the United States will be women. This is a 180 degree flip from just 20 years ago. Most large or older practices are owned by men due to the fact that they are well established. Those practices will be needing to transition and find associates. The chances are very good that the new young wiz kid dentist will be a woman. Professional male partners need to understand that the female work process will be different. Notice I said process not efficiency or profitability. Manufacturers are now addressing the “ergonomic” issues facing the increasing female dental population. For example, Pelton & Crane has redesigned their chairs to go lower and to have narrower backs. Miltex Corp. has designed “petite” aspirating syringes for easier injections because women tend to have smaller hands. Male dentists should keep these things in mind when re-equipping their offices. Bringing on an associate or selling your practice is probably the biggest investment you will ever make in your dental career. M/M professional partnerships are hard enough, but F/M require more understanding on both sides. However, when navigated carefully by an experienced consultant the M/F professional association can be very financially rewarding. As always, I am available if you should have any questions or concerns (201-321-7494). NOTE: DRC (Dental Resource Center) Monthly News Letter http://www.drcdental.com Cliff’s Notes is a client exclusive service. Please consider the environment before printing this email.

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October 16, 2009 Posted by Cliff's Notes Blog | 1 | Leave a comment

Dental Sterilizers

Cliff’s Notes For October 27, 2008 …..E-Blast…..
Cliff Marsh, Henry Schein ……
Cell: 201-321-7494……Fax: 201-262-2210…..
cliff.marsh@henryschein.com

Sterilizers……Never A Concern Until They Fail…………………………

Over the last several weeks, I have been experiencing an unusual amount of sterilizer failures. When a sterilizer goes down, most offices begin to panic, so let’s look at some problems and solutions. The most common problem is water or steam leaking from the door. This is usually nothing more than a defective door gasket. In some cases, as a temporary solution, you can try reversing the gasket. This may give you a day or 2 of breathing room so you can order and install a new one. You do not need a service technician to do this. If the unit is not leaking but turns on and can’t reach temperature or pressure, then a service technician is required, but we will get into repairs later. Sterilizers use distilled water (NOT SPRING WATER). Distilled water will not leave any sentiment build-up inside the unit and will be kinder to your instruments. Remember, distilled water is for autoclaves and ultrasonic cleaners only, not clean water systems on delivery units. Although you are working with distilled water it does not mean that the entire system does not need cleaning and maintenance. Use the cleaner recommended by the OEM (original equipment manufacturer). Most full size sterilizers recycle their water. After the pressure and steam are vented the remaining moisture condensates at the bottom of the chamber. The water is then sucked back into the water reservoir. The returning water, although sterile, carries dirt particles back into the system. That is why they need cleaning. Lower quality autoclave pouches will leave traces of ink particles due to the low quality ink that is used in their printing. I can’t tell you how many units I have seen with “blue sludge” in the reservoir & chamber. Saving pennies on a sterilization pouch may end up costing you big $$ on repairs and down time. Sterilizer repairs can be very expensive. If the unit needs to be taken out of the office, expect an ISO 9000 repair estimate of over $1,000.00. An ISO 9000 Certified Repair Facility will guaranty that when the unit is returned it will meet all original manufacturer specifications. A non certified facility will only repair the parts that are not working and only guaranty the work they did. If something else go wrong with the unit, there would be another charge. An ISO 9000 Certified repair would guaranty the entire machine regardless of what malfunctions during the warranty period. As for the difference between Automatic & Manual Systems, that’s another discussion. Please have a safe and wonderful day. As always, I am available if you should have any questions or concerns (201-321-7494). Cliff’s Notes is a client exclusive service. If you do not wish to receive these e-mails please reply to cliff.marsh@henryschein.com ” Please consider the environment before printing this email.

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October 16, 2009 Posted by Cliff's Notes Blog | 1 | Leave a comment

Dental Clinical Liabilities

Cliff’s Notes For September 22, 2008 …..E-Blast…..
Cliff Marsh, Henry Schein ……
Cell: 201-321-7494……Fax: 201-262-2210…..
cliff.marsh@henryschein.com

“Defense Wins Games & Offence Sells Tickets” “Defense Wins Games” is a well known phrase in competitive sports and it hold true for most situations that I have been involved with over the years. Let’s talk about some of the defensive points in a dental practice. To start, we need to examine your clinical liabilities.

1.Quality and broken appliance issues are rather easy to deal with, we have all been there. As long the patients chart is clear, up to date and all treatment plans have been signed off on and approved the resolutions to these situations are usually not too painful.

2. Oral Cancer. It takes about four years for an oral cancer to become invasive. The ADA guide lines only require visual screening. New technologies can now detect abnormal tissue before it becomes cancerous. If you do incorporate this new technology , the patient must sign a waver should they not want the procedure. This is regardless of whether or not the service is free or at a specified cost. If a long time patient develops oral cancer while under your care, you will have to legally defend yourself. The better records you have (defense) the less it will cost and the faster the case will be over. It may sound cold, but the court is not interested in how much you “care”.

3. The ADA has stated that periodontal disease affects over 80% of the adult population in the United States. Over 35% are at an advanced stage that require “soft tissue management”. I know that all you hear lately is “soft tissue, big $$” but in the real world the dollar is the offense. The defense is your early diagnosis and treatment. If a patient has been coming to your office for several years and develops a periodontal condition, it had better be noted in their chart of the previous concerns and conversations you have had with them with regard to “gum disease. Make sure they signed the chart. Now let’s look at the #1 non-clinical issue……..Employment law. Yes there is such a thing and it is designed to protect your employees from you and you from your employees. You need to have an employee file for everyone that works for you. From the first application they fill out (and they all need to fill out employment applications) to the day they leave. Everything regarding their tenure must be documented and signed by all parties. You need to have an employee handbook that clearly states office policy. You can not terminate an employee without due cause and such cause must be documented and signed or witnessed Consult your legal advisors for more details. I can’t tell you the amount of exposure you will have if you don’t do this right. It is time consuming, but it is part of running a business. As always, I am available if you should have any questions or concerns (201-321-7494) or you can contact our compliance specialists (Health Compliance Team)) directly at 1-800-724-1263. Cliff’s Notes is a client exclusive service.
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The information in this email is confidential and may be legally privileged. It is intended solely for the addressee(s). Access to this e-mail by anyone else is unauthorized.

October 16, 2009 Posted by Cliff's Notes Blog | 1 | Leave a comment

The Other Side of Dental Practice Management

Cliff’s Notes For September 15, 2008 …..E-Blast…..
Cliff Marsh, Henry Schein ……
Cell: 201-321-7494……Fax: 201-262-2210…..
cliff.marsh@henryschein.com

The Other Side Of Practice Management………….

We need to stop looking at a dental practice as being two dimensional and start seeing it as a multi-dimensional object, it has many sides. Have you ever tried to count the number of practice management groups that are telling you how they could re-engineer your practice? Well, most of them see it as two dimensional. They address patient management and staff interaction/productivity. However, who helps you with correcting work flow, employees, advertising, marketing, accounting, etc? A dental practice is a very unique business. Many things need to be customized and cookie cutter solutions do not always work. I have walked into so many offices that the staff is running over each other going in and out of sterilization areas with processed pouches out on the counter. By reorganizing or changing your sterilization center, you could seat at least one additional patient per work day. If you work four days per week and your chair time is $350.00/hour, well, do the math. I said it in last weeks e-blast, ROI (Return On Investment). Bookkeeping is probably one of the most over looked sides. Most dental offices do not follow good business standards. We all keep good records and provide the proper information to our tax advisers, but how many of us have had our accountants come into the office and review our bookkeeping policies and procedures. You are not a general consumer, you are a business that buys and sells goods and services. Your “cash management” is just as important as patient management. Once again, use professionals. You are a doctor and the chances are you did not study finance or accounting. Embezzlement is a nasty word, but it is the real world. 20% of the dental office in the United States have reported it. As of the other 80%, maybe they didn’t have a problem or maybe they weren’t looking. Checks & balances are good things. Ask a professional and if you do not know one, get a recommendation. As always, I am always available if you should have any questions or concerns. Cliff’s Notes is a client exclusive service. If you do not wish to receive these e-mails please reply to cliff.marsh@henryschein.com ” hspace=”0″ align=”left” />

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The information in this email is confidential and may be legally privileged. It is intended solely for the addressee(s). Access to this e-mail by anyone else is unauthorized.

October 16, 2009 Posted by Cliff's Notes Blog | 1 | 1 Comment

Dental Managagement & Communication Disney Style

Cliff’s Notes For September 1,2008 …..E-Blast …..
Cliff Marsh, Henry Schein Dental……
Cell: 201-321-7494……e-mail:cliff.marsh@henryschein.com

“ A Smart Man Speaks and a Wise Man Listens” Jimi Hendrix “Jimi Hendrix, go figure. It proves that genius comes in many different forms. Although the statement is not politically correct, it is true. We learn a lot when we listen. Several years ago I attended a 2 day session sponsored by the NJ State Chamber of Commerce. They were presenting a “people management” concept developed by the Disney College. Yes, there is such a place and it is in Orlando. The college offers 1st class, 2 week business management classes for executives. They keyed on a phrase that was coined by IBM, it was “Management By Walking Around.” MBWA told managers that by getting up from your desk and walking around, you get a better feeling of what your group is thinking and doing. Disney changed it. MBWA became “Management By Wandering Around.” The thought is that if you “wander” your hands are in your pockets and you become very approachable. When you can be approached with ideas by the people that you supervise, you are now managing a team and not a group. At the time, I had my own company and employed a number of people, so the first day back, I tried it. It was amazing and I became a believer. As I wandered (10-15 min.) 3 people came up to me with ideas on how to make their job easier. Not all the ideas were good, but everyone felt that they were part of the process and their vote counted. It became routine for me. I recently did a “team discovery” session for a large office having organizational problems. After listening to the 2 docs and 8 staff members complain, it was apparent that they were all saying the same thing but in different ways. As we addressed the communication problem, other issues seemed to start going away. These types of sessions help increase office productivity. Team focus and harmony are the most important assets your organization can have. Morning huddles (every day) are needed to review the day and pre-view tomorrow. Have regular staff meetings 1 or 2 times a month. Schedule lunch & learn sessions to help train your staff on procedures and strategies that relate to the office’s productivity and an advanced standard of care. As always, I am available at any time if you should have any questions or concerns.

Cliff’s Notes by Fax…Industry News..Local Seminars…Exclusive Promotional Offers…Dental Industry Business & Stocks. If you are not currently receiving Cliff’s Notes by Fax, simply fax your office name and fax number to 201-262-2488…or e-mail cliff.marsh@henryschein.com. This is a client exclusive service. If you do not wish to receive these e-mail’s, please reply to cliff.marsh@henryschein.com ” hspace=”0″ align=”left” />

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October 16, 2009 Posted by Cliff's Notes Blog | 1 | Leave a comment

State Sales Tax & Use Tax

Cliff’s Notes For August 25,2008 E-NEWS LETTER & REPORT
Cliff Marsh, Henry Schein Dental……..
Cell: 201-321-7494……..e-mail:cliff.marsh@henryschein.com
Attention, Out of State & Online Shoppers: Taxes Are Coming………………

New York has e-commerce retailers like Amazon collecting state sales tax. You need to remember, Amazon does not charge tax, they collect it and forward it to the state. The rest of the country will follow shortly. Let us try to clarify the state tax laws of New York and New Jersey. If you do business in the states of New York or New Jersey, you are obligated by state law to pay sales tax on any taxable goods you purchase. If the seller does not collect the appropriate sales tax at the time of sale, you are obligated to file a USE TAX form and forward the tax amount to the state. This law, it is cemented into stone, ask your tax advisor. Also, New Jersey & New York have enacted and enforced a “Reciprocal Tax Agreement” that obligates each state to attempt to collect tax for the other. This program has been in effect for over 10 years. It is on a voluntary basis for all sellers, however, state law authorizes tax audits by either state across state boundaries. What this means is that if you are in New Jersey and purchase something from a company in New York, New Jersey has the right to audit the New York companies sales records and charge you for the tax, interest and penalties. Please do not fall for the sales pitch “we don’t charge tax” because no one does, we collect it. Those sellers are not are putting the full sales tax liability on you. New York and New Jersey also look at taxable and non-taxable items differently. In New Jersey, anything that you purchase that stays in the mouth (becomes property of the patient) is non-taxable. For example, non-taxable items would include cements, composites, anesthetic, prophy pastes, etc. Gloves, masks and gowns are also non-taxable because they are classified as wearing apparel and in NJ, the category is tax free. New York is quiet different. In NY, everything is taxable except needles and anesthetics. Now, who’s tax do you pay if you buy from out of state? The law is very clear, it is the sales tax laws that govern the state you are in when you physically take possession of the product. Another important note, if the company you buy from has any type of physical presence in your state (including installers or service techs) they are obligated by law to collect the appropriate sales tax. The only time a seller can avoid having to collect sales tax for a state, is if their entire organization only deals with their customers through an ICC licensed interstate carrier such as United Parcel or Federal Express. For more information on state sales tax liability, I suggest you consult your personal tax advisor.

NOTICE: Amalgam Separators Are Required to be Installed By 10/1/09……. Call Today for a free on-sight inspection 201-321-7494 Cliff’s Notes by Fax…Industry News..Local Seminars…Exclusive Promotional Offers…Dental Industry Business & Stocks. If you are not currently receiving Cliff’s Notes by Fax, simply fax your office name and fax number to 201-262-2488…or e-mail cliff.marsh@henryschein.com.

October 16, 2009 Posted by Cliff's Notes Blog | 1 | Leave a comment

Profit from Dental Technology

Cliff’s Notes For August 11,2008 E-NEWS LETTER & REPORT
Cliff Marsh, Henry Schein Dental……..201-321-7494 ………cliff.marsh@henryschein.com

How to profit from technology………
It has been almost 20 years since Harvard professor Michael Porter wrote, “Firms will not ultimately succeed unless they base their strategies in improvements and innovation, a willingness to compete and a realistic understanding of their national environment and how to improve it.” Some of us may not appreciate Wall Marts policies, but they have become a money machine and technology got them there. In the late 1980’s, Wall Mart recognized the need for predictable merchandise flow. Wall Mart partnered with it’s major suppliers and utilized technologies to reduce expenses and enhance services. One example is the inventory control coordination with Johnson & Johnson. Wall Mart created a format that every time a J&J product was purchased at one of their stores, the product scanner at the check-out counter reported to J&J that the reporting Wall Mart location needed to be re-supplied. The investment made in technology allowed Wall Mart to increase their number of inventory turns and greatly increase cash flow. By being more profitable on J&J products, they now had the desire and ability to promote the Johnson & Johnson brand at their stores. This was a win-win for both companies and provided Wall Mart’s customers with an opportunity to buy quality name brand products at lower prices. This concept holds true for any business including dental practices. Technology is here and it is only moving faster. If you want to grow and compete, you need to embrace the changing industry and demographics. Let’s start with computers and software. If you are partially or fully computerized you need to upgrade your hardware every 5 years. You need to upgrade your software annually. Do not spend a lot of money on any type of new technology until you have an evaluation of your hardware and determine what type of strain the new technology will put on your system. Your IT system is the heart of your business. When used correctly, it will reduce expenses in many areas, organize tasks and generate revenue by focusing on opportunities. Where do you start? Well, I would start by understanding that I do not know enough about any of this to attempt to do it myself. Ask experts that work with dental office (specific) networks and software. You are very good at what you do because you do it every day. You need to relay your wants and needs to the experts and allow them to return to you options and solutions. At that point, you will be able to make an informed decision with regard to the ROI (return on investment) for your business. Most practice evaluations are free. For more information, call Cliff @ 201-321-7494 or e-mail cliff.marsh@henryschein.com. Don’t walk over dollars to pick up dimes. Too many of us would spend $30k or more on a new car, but are afraid of investigating the ROI of technology for the most important asset we have, our business & our livelihood.

Cliff’s Notes by Fax…Industry News…Local Seminars…Exclusive Promotional Offers…Dental Industry Business & Stocks. If you are not currently receiving Cliff’s Notes by Fax, simply fax your office name and fax number to 201-262-2488…or e-mail cliff.marsh@henryschein.com. This is a client exclusive service. If you do not wish to receive these e-mail’s, please reply to cliff.marsh@henryschein.com ” hspace=”0″ align=”left” />

Please consider the environment before printing this email.

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The information in this email is confidential and may be legally privileged. It is intended solely for the addressee(s). Access to this e-mail by anyone else is unauthorized.

October 16, 2009 Posted by Cliff's Notes Blog | 1 | Leave a comment