Cliff's Notes

The Business of Dentistry

“Do Sterililizers Work?” – “Dental Staff, Heaven or Hell” – “Product Review – OraVerse”

Cliff’s Notes for July 10, 2011

….. E-Blast…..


Cliff Marsh, Henry Schein ……Cell: 201-321-7494……Fax: 201-262-2210…..E-mail:


“All mankind is divided into three classes: those that are immovable, those that are movable, and those that move.”

Benjamin Franklin


In This Week’s Issue

  • Infection Control – Sterilizers, Is it Really Sterile?
  • The Dental Staff & Team Harmony; It Can be Heaven or It Can be Hell?
  • Product Review – OraVrese by Septodont!


Sterilizers, Is it Really Sterile?………………………………………………………….

Many factors can cause sterilization to fail-from procedural errors that are easily remedied, like overloading, to mechanical problems that can take your sterilizer out of service until repairs can be made. Since this variety of factors can influence successful sterilization, the ADA and CDC encourage dentists to regularly assess the efficiency of their in-office sterilizers. In addition, state or local regulations may exist. Click here regarding state dental board or log onto for regulatory information.

So, how do we monitor the sterilization process and why is it a “top line” priority? Well, I guess part of my job is to tell you the things you don’t want to hear. In the first segment of this infection control series I stated that 15% of your clinical expenses involved infection control. That covers the following:

  1. Disinfectant wipes & solutions.
  2. Face Masks, Gowns, Eye Wear, Gloves & Barriers.
  3. Instrument management and maintenance.
  4. Documentation & management of hazard & infectious waste.
  5. O.S.H.A. (Employee management).
  6. Protection of your patients, friends & family

There are several different ways to confirm sterilization. The best overall method is to use a combination of mechanical, chemical, and biological indicators.

Mechanical Monitoring:

When using a manual sterilizer, record cycle time, temperature, and pressure as displayed on the sterilizer gauges for each instrument load. This is a very cumbersome process and in a normal dental office environment it is almost impossible. Also, manually kept, in-office records will usually fall short in a court of law should you be involved with litigation on a cross contamination issue (defensive business strategy). For more information on employee protection and safety, you can log onto www.employeerelationssolutions or

When using an automatic sterilizer like a Midmark or Statim will simplify monitoring. These units will fail and shut down if the time, temperature and pressure cannot be achieved. However, this alone will not keep you out of court or assure you that you’re not bringing bugs home.

Chemical Indicators:

Use chemical indicators, such as indicator tapes, with each instrument load. These indicators are supposed to change color after exposure to the proper sterilization environment. Failure of the indicator to change color indicates that it was not exposed to the proper sterilization environment (e.g., proper pressure or temperature). In such cases, the instrument load should be re-sterilized.

Indicator tapes are sterilizer-specific (i.e., tapes for steam sterilizers cannot be used to test chemical vapor sterilizers). However, don’t trust them to assure you that sterilization has occurred. The ink used to create the “color change strip” varies in quality and will only indicate that the item has been exposed to heat. Crosstex & Henry Schein have recently introduced new “ink technology” that requires heat, pressure and time before changing color, but unfortunately, it is still to defendable in a court of law. For more information on this technology log onto:

Chemical indicators should not replace biological indicators, as only a biological indicator consisting of bacterial endospores can measure the microbial killing power of the sterilization process.

Biological Indicators:

The CDC recommends that you monitor sterilizers at least weekly with biological indicators.1 Check to see whether your state dental board has different requirements.

Biological monitoring can be done in two ways:

In-office incubator and spore monitoring strips (contact Cliff for a list of products). This method usually gives results in 24-48 hours. Once again, when relying on this protocol you may be exposing yourself to legal challenges and the staff time increases your overhead costs. A Maxitest System (#120-6076) costs about $290.00 and refill indicators (#102-5804) cost about $110.00 for a box of 25 indicators.

Spore Monitoring Programs:

This process usually takes a week. Although it takes longer to get results using a service, third-party monitoring programs may offer more credibility than in-house monitoring.  A positive spore test result indicates that sterilization failed. This is the method of choice for dental offices. The third party documentation will cost no clinical time and can be a “golden ticket” to avoid litigation. The Maxitest 12-pack mail-in monitoring strips (#101-5830) will cost you less than $7.00 per test. A bulk package of 48 for testing weekly (#101-1253) will reduce the expense to about $6.00.

It is important to maintain a log of spore test results. Check with your state dental board or your legal advisor to determine how long you need to keep spore testing records.

Team Harmony, It Can be Heaven or It Can be Hell!…………………

If there’s one constant frustration most dentists suffer with, it’s problems within the team.
Let’s talk about a friend of mine, Dr. Bill. He actually got to the point he hated his team! He was so fed up with everything they did that he was almost in that weird place of being giddy and hopeless. He had given up hope altogether and was just trying to piece a day together, one at a time. He prayed that his team wouldn’t at least break something or throw something away; believe it or not, they had actually thrown away good pieces of equipment!

Your practice is likely nothing close to his, although I’m sure you have your frustrations and concerns. I would ask you to make a list right now, but that would probably irritate and distract you. Instead, I want to teach some leadership and management skills you can put to use right away — as in today!

Team members start working in your practice with the best of intentions. They want to do a good job. They’re excited about the possibilities, and they hope they’ve found the perfect place they’ll be able to work a long time. No one likes to have to look for a new job and everything that goes with it. So the honeymoon starts — and, at some time in the near future, ends. That’s when the trouble starts. How can you keep the relationship good, focused, productive, and professional?

We begin with a “staff discovery meeting” that the doc does not attend. Staff looks for a neutral party to vent frustrations and validate their concerns. I have done many of these and the information gathered always leads to resolutions and solutions. Please feel free to contact me to discuss individual issues. Discovery session are free of charge and take about 1 hour depending on staff size.

Maybe starting with organized morning huddles should be considered. For more information, log onto:

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Henry Schein We Do That – Team Harmony

Product Review – OraVerse by Septodont!……………………………………..

It’s a whole new direction in distinguishing your practice. And doctors all over the U.S. are introducing their patients to the reality of accelerating the reversal of lingering numbness with OraVerse. 

OraVerse (#228-2078) is the first and only local anesthesia reversal agent that allows you to bring patients back to normal sensation twice as fast. In clinical trials, the median time to recovery of normal sensation in the upper lip was 50 minutes for OraVerse patients vs. 133 minutes for the control group, and in the lower lip was 70 minutes for OraVerse patients vs. 155 minutes for the control.

In fact, in clinical trials, OraVerse patients were also more quickly able to:



Drink normally

Minimize drooling

In the trials, the median time to observed recovery of normal function was 60 minutes for patients receiving OraVerse compared to 120 minutes in the mandible and 105 minutes in the maxilla for the control group.

“I don’t just get numb, I stay numb for hours. That means half the day is gone before I can feel my lips and tongue again.”
Connie L., dental patient, Chicago, Illinois

Market research shows 88% of patients may be interested in receiving a product like OraVerse1. Respondents were aware that a second injection was required and that there may be an extra charge.

OraVerse is indicated for reversal of soft-tissue anesthesia, i.e., anesthesia of the lip and tongue, and the associated functional deficits resulting from an intraoral submucosal injection of a local anesthetic containing a vasoconstrictor. OraVerse is not recommended for use in children less than 6 years of age or weighing less than 15 kg (33 lbs).

Important Safety Information:

In clinical trials, the most common adverse events with OraVerse (phentolamine mesylate) vs. control were post procedural pain (6% vs. 6%), injection site pain (5% vs. 4%), tachycardia (5% vs. 6%), bradycardia (2% vs. 0.3%) and headache (3% vs. 4%). Following parenteral use of phentolamine in non-dental indications, myocardial infarction and cerebrovascular spasm and occlusion have been reported, usually in association with marked hypotensive episodes producing shock-like states. Although such effects are uncommon with OraVerse, clinicians should be alert to the signs and symptoms of tachycardia and cardiac arrhythmias, particularly in patients with a history of cardiovascular disease, as these symptoms may occur with the use of phentolamine or other alpha-adrenergic blocking agents. See full prescribing information for details. You can also contact the Health Compliance Team @

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Oraverse Lake Forest, IL Reverse the Numbing from Dental Anesthesia Quickly

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Say No to Numb

Enjoy this video dentist dental numb OraVerse!


Sunday, July 10, 2011……………………………………………………..

Well, the summer is in full swing. Did you plan your marketing approach for the fall? You can start with a “back to school” special and sports mouth guard protection. The Brain Pad is something worth looking into. For more information please feel free to contact me at any time. 

Cliff Marsh

Henry Schein Dental

P.O. Box 663 / 45 Rt. 46 East, Suite 605

Pine Brook, NJ 07058

Cell: 201-321-7494

Fax: 201-262-2210




July 10, 2011 - Posted by | Uncategorized

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