Cliff's Notes

The Business of Dentistry

“Why Don’t Consultants Consult” & “Disinfecting a Dental Chair” & “A Product Review of Icon by DMG”

Cliff’s Notes for July 31, 2011

….. E-Blast…..


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


“Sometimes when people are under stress, they hate to think, and it’s the time when they most need to think.”

President Bill Clinton


In This Week’s Issue

  • Commentary – Why Don’t Consultants Consult?
  • Infection Control – What about the Chair?
  • Product Review – Icon by DMG, 3 Year Clinical Up-Date! (See Attachment)

Why Don’t Consultants Consult?………………………………………………………..

Throughout my 30+ career in the dental industry I have seen a lot of change and with each change there is an expert that “holds the magic wand” or at least they want you to believe they do.

As business gets tougher and more complicated we often look at the industry Gurus to tell us how to do things. The sad part is that most of them say the same thing and the person on stage is not the one that will be sitting next to you in your office. The basic principles of business and customer service do not change just because you have a degree in medicine.

Practice Management consultants usually focus on all the same things. They don’t consult, they teach and help systems become routine to increase production and generate additional revenues. You need to carefully assess the program and the people. Make sure that you, along with everyone involved, including your spouse, are on-board, understand, and are committed to the effort. Change is hard enough without internal dissension.

Most Practice consultants are pretty good at what they do. However, are they good at what you do? Or should I say what you want? I don’t know many that actually sat chair side and I don’t know too many that ask the simple question “what do you want to be and where do you want to go”? Not everyone wants a high volume practice and believe it or not, some docs even like doing hygiene.

My company, Henry Schein, calls me a Field Consultant. They spend a lot of money on continuing education and developing programs to help dental offices grow. The development of the DPAT was fueled by practice management principles. The information it provides is a starting point, it raise questions.

I consider my role, as a consultant, to be the person that tells you what you don’t want to here. By showing you the holes in the ship, you can make informed decisions as to how to fix them or should you just get another bilge pump. It’s all about what you want. You are the one that walks through the door every morning. You are the one that has to be able to sleep at night. It’s all about being happy and happiness takes a different form for everyone.

The very first thing a true consultant should ask is “What Do You Want to Be When You Grow Up”? The second is “What Do You Want as a Life after Dentistry”? Then they should be able to customize a plan to get you there. That plan requires the willing involvement of your staff, financial advisor, and your family. If they can’t “customize” than they don’t consult, they educate. It’s all about you and your family.

I have my preferences in true consultants and programs and would be happy to share some experiences at any time. Kerry Straine says it all in this video. Please pay attention to the very last statement, it kind of sums things up.

7:18Add to

video lang: en

5 Success Strategies for Dentists

Kerry Straine shares 5 strategies for success in your dental practice.

Infection Control – What About the Chair?…………………………………………

Since the mid 1980’s the dental industry has been very focused on infection control. The manufacturing sector has developed products and method to help control cross contamination and to better protect staff from bringing home some real nasty bugs. 

There was a time when disinfectants caused counter tops and other types of equipment to turn yellow and in some cases weaken the outer structure. For the most part, those issues have been solved, but what about your chair?

As we all know, dental chairs are very expensive. I would guess that you spent over $3k on your chair and never asked how to clean or disinfect it. Hey, when you bought your car did you ask how to clean it, I didn’t.

For years dental chair manufacturers have been searching for some type of salvation to accommodate infection control protocol and reduce or eliminate the damage to their equipment caused by industry accepted methods.

The problem with chairs, specifically, is the upholstery. The wipes and sprays that we use to kill bugs usually contain a certain levels of alcohol. The alkaline base is used more to help the material dry quickly through evaporation. However, the mix will also cause the upholstery to dry and crack reducing the life expectancy by half. Replacing the upholstery could run as high as $1200.00 for some brands.

So, what is recommended? Until just recently, the only recommendation that a manufacturer would publish was soap & warm water. This however is impractical due to the turnaround time that is necessary in dental production. The eventual upholstery replacement was a “cost of doing business”.

The good news is that just recently, 10 dental equipment manufacturers have endorsed, in writing, Optim 33TB by Sican. The 5-10 year studies are still out, but the written endorsement is more than we have ever had.

The part number for Optim 33TB wipes is 138-0096 and costs about the same as most other quality disinfection products, $13.79/canister (before any complimentary discounts) and should be considered by you and your staff to help extend the life of you dental operatory equipment, especially the chair.

5:04 Add to Added to queue OPTIM 33TB Surface Disinfectant Instructions

Product Review – Icon by DMG, 3 Year Clinical Review………………

It’s been well over a year since I took another look at Icon by DMG. I first learned about Icon about 4 months before its U.S. introduction and was impressed by the huge response at the International Dental Conference in Germany.

Over a year prior to that, a close friend of mine, Wayne Flavin, kept telling me that DMG was introducing a product that would revolutionize dentistry. Wayne is the director of Scientific Affairs for DMG America probably one of the most knowledgeable people I know when it comes to dental materials so when Wayne speaks, I listen.

July 27, 2011\

Hi Cliff,

   I wanted to let you see some newly published clinical information on Icon.  Icon, as you know stops the progression of proximal lesions. Evidence of this was just presented at the European Cariology Meeting (ORCA) and the IADR in San Diego. 

  Three year clinical results from ORCA show that Icon treatment of these lesions resulted in only 5% progression rate while the control group (Watch and See group) had a 46% progression rate. At the IADR Meeting similar results were demonstrated where three groups were tested; Icon treatment, sealing lesions with a bonding agent, and the control (Watch and See). The results showed that while the Watch and See group suffered with 64% of their lesions progressing, the Icon group had 16%.  This patients were children in Bogota, Columbia and were ranked by ICDAS scores as being “very high risk” patients so the scores are indicative of what can be expected in high risk groups.

   I think that your accounts would benefit from this information.  We’ve got 16 in vivo trials ongoing and 22 in vitro studies either completed or continuing.  The wealth of science is building that resin infiltration is the treatment of the future where only a fraction of the caries lesions we see will progress to restoration in the future.  Watching a lesion grow deeper and bigger until it can be restored isn’t the only option a dentist has today.

Hope to talk to you soon,


Wayne J. Flavin

Director of Scientific Affairs

DMG America

242 South Dean Street

Englewood, NJ 07631

Tel 201.894.5505

Fax 201.894.5273

4:11 Add to Added to queue

video lang: en

Icon® treatment video vestibular

Icon®, the worlds first caries infiltration product from DMG allows the early treatment of caries – without drilling!

When I reviewed the technique video, I immediately fell in love with this product and what it could do. However, it was considered a cot a cosmetic procedure and not covered by insurance. Most of my clients are like me, I don’t use first of the assembly line so I held back on recommending it until I got a “chair side” consensus. Well, after understanding the technique everyone told me it worked. But, what would the long term results be?

Last week, I got the chance to see 3 years of clinical results that confirmed the previous 4 years of clinical research. Below you will find a summary of the results.

Please see the attachment for more detailed information and think about “post ortho”.

Placebo-Controlled Randomized Clinical Trial on Proximal Caries Infiltration:

3-Year Follow-Up:

H. Meyer-Lueckel¹, K. Bitter², S. Paris¹ ¹Clinic for Operative Dentistry and Periodontology, University School of Dental Medicine, University of Kiel, Germany ²Department of Operative Dentistry and Periodontology, Charité – University of Berlin, Germany.

RESULTS: The consensus results revealed progression of 1/24 (5%) and 11/24 (46%) lesions in the test and in the control group, respectively.

CONCLUSION: For interproximal caries lesions extending radiographically around the enamel-dentin junction (E2, D1), resin infiltration in combination with self-applied non-invasive measures is more efficacious in reducing lesion progression compared with self-applied non-invasive measures alone.

Radiographic Comparison of Lesion Progression After Infiltration, Sealing and Floss Instructions in a High Caries Risk Population – 24 Months Follow Up:

Caries Research Unit UNICA, University of Bogotá, Colombia and Department of Cariology University, Copenhagen, Denmark.

CONCLUSION: The infiltration of proximal caries is an efficacious method to reduce lesion progression in-vivo.

Effect of Caries Infiltration (Icon) Technique and Fluoride Therapy on the Color Masking of White Spot Lesions: Journal of Dentistry- 2011 March.

CONCLUSION: Resin infiltration was proven to be an effective treatment for masking white spot lesions. Also, after a new acid challenge, the group infiltrated with low viscosity resin (Icon) presented the lowest mean color change. The color changed significantly less than when fluoride was applied to the teeth. This difference was evident even after a new exposure to the acid.

Application Time on Penetration of an Infiltrant (Icon) Into Natural Enamel Caries:

Journal of Dentistry- 2011 Jul; 39 (7):465-9.

RESULTS: After 30 seconds resin penetration averaged 134μm and 1 minute 375μm. These were significantly lower compared to those after 3minutes 518μm and 5 minutes 616μm.

CONCLUSION: 3 minute application of an infiltrant seems to be sufficient to achieve an almost complete penetration of enamel caries.

Wear and Morphology of Infiltrated White Spot Lesions:  Journal of Dentistry- 2011 May; 39(5):376-85.

CONCLUSION: Infiltration strategies had equivalent wear resistance to toothbrush abrasion, surface and morphological aspects pointed to improved surface stability and infiltration quality for the infiltrant material.

Review of the Effects of Infiltrants and Sealers on Non-Cavitated Enamel Lesions:

Oral Health and Preventive Dentistry- 2010; 8 (3):295-305.

CONCLUSION: It can be concluded that while fissure sealing acts as a diffusion barrier on the top of the lesion surface, the infiltration technique (Icon) creates a barrier inside the lesion by replacing the mineral lost with a low-viscosity light-curing resin.

Icon Caries Infiltrant for the Treatment of White Spot Lesions:

Bergdoll, P. Beck, D. Cakir, and J. Burgess, University of Alabama at Birmingham, Birmingham, AL.

CONCLUSION: The Icon infiltrating resin seals WSL but one coat allows penetration. Two coats (applications) prevent further demineralization. (The second infiltration step is necessary.)

Caries Infiltration with Resins: A Novel Treatment Option for Interproximal Caries

Compendium of Continuing Education in Dentistry- 2009 Oct; 30 3:13-7. Case Western Reserve University.

CONCLUSION: Clinical data show this new technique complements existing treatment options for interproximal caries by delaying the time point for a restoration and consequently closing the gap between noninvasive and invasive treatment options.

For reference only. Not to be reproduced without permission.  For more information, contact Wayne Flavin: (800) 662-6383 x142

Sunday, July 31, 2011……………………………………………………..

Did you take any time off yet? Don’t miss the summer. I will not be available from August 12th until the 19th. I will have access to e-mail but please forgive me if it takes a little longer than usual to get back to you, I’ll be fishing!

Enjoy the day…….

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 31, 2011 - Posted by | Uncategorized

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