Cliff's Notes

The Business of Dentistry

The 80/20 Rule, Are You the 80 or the 20?


Did you ever wonder how you are classified by the dental industry? Being in this industry for a long time I can tell you that there is so much data available that just by the way you run your practice determines your “growth” classification. The top 5% are the innovators and bleeding edge participants. Then there is the 80/20 rule. 20% of the remaining dental practices jump on board within the next 5 years and embrace change leaving the 80% waiting for the new and improved. Question, are you the 80 or the 20?

It was over 20 years ago when Rich Yangst walked into our office with a lead lined wooden box. That was my exposure to the Trophy X-Ray System., the first dental digital radiography system in the U.S. market. In 1997 Gendex Corp. introduced the Denoptics Phosphorus Plates but it wasn’t until 2010 that dental digital radiography became main stream. Mostly because of industry and peer pressure. Think about all those years you waited to implement digital imaging and now you can’t live without it.

Some of you younger folks may not remember Jackie Gleason as Ralph Kramden in the Honeymooner’s so you may want to watch this short seen Think about everything Ralph missed because of his fear of change. Change is inevitable so we need to embrace it.

Radiographic imaging is continuing to change …. X-ray film was replaced with sensors. X-rays will become obsolete in in the future and replaced by ultrasound. Temporary acrylics will be replaced by 3D printers, and impression materials are being replaced by digital scanners that also do shade matching. For your practice to thrive through the years to come you will need to prepare for the changes in an organized fashion by examining the ROI of each. A great place to start is the CariVu System by Dexis.

Why the CariVu and What is it? …. The CariVu is dental trans-illumination on steroids. I saw the original system, Difoti about 15 years ago (it is still called Difoti in Europe) and since Dexis Corp. took it over the technology has advanced dramatically. The ROI with this product is unlimited as is it’s ability to dramatically raise your standard of care. You can see inside teeth and find fractures and lesions that traditional x-rays can’t pick-up. The patient’s reaction to “no radiation” is a definite practice builder, however, there is a small down side. If patients know you have this technology they may be more resistant to x-rays. That is when you will need to explain that the CariVu cannot see below the gum line to examine the rest of the tooth. The reason the CariVu is a great place to start is because it is very affordable and can pay for its self in full in 90-120 days.

The 80% …. Everyone in an advancing industry will fall in line and implement new technologies, it will be required to run your business. The question is when do you jump in. My suggestion is to look at your practice and evaluate what will give you the best ROI and invest a portion of the increased revenue to implement the next level.

Carivu2Carivu TipCarivu


February 26, 2017 Posted by | Uncategorized | Leave a comment

The Un-Seen Pain Maker – The Use Tax


Get ready because it is coming. In fact, it’s been around for a long time but never really enforced. As a private citizen the Use-Tax doesn’t have any impact on your life, you have a spending window of around $5k and most of us won’t need that. Those that do are in such small numbers that the State doesn’t care. However, a business registered with the State, in my case New Jersey, is responsible to report all tax liabilities on all goods and services pertaining to the business operation. Whether or not sales tax is collected the business, by law, must remit any shortfall directly to the State Treasury Department.

Who is Responsible for Collecting a State’s Sales Tax? …… If a company has physical presence in a state they are required to collect that states sales tax. Physical presence does not have to be brick & mortar, having employees on the ground and doing business qualifies. However, if contact is made through interstate commerce and goods are received through an ICC service (UPS, FedEx, etc.) the seller is not required to collect your state’s tax and the responsibility is yours.

What is the Use-Tax? …… The Use-Tax (in New Jersey) is the state sales tax. Nobody charges sale tax, including the dental office, you are just obligated to collect it and forward it to the state. If a NJ based business receives goods or services and NJ sales tax was not collected, the business is obligated to report that transaction to the State and pay the amount due. The law is very clear and if you have any questions, please consult your tax advisor.

What is a Taxable & Non-Taxable Liability? …… This is a very difficult question because every state has different rules. Tax is due in the state where you take possession. For example, if you live in NJ and go to New York to buy something you would pay a New York sales tax. New Jersey accepts that, but if you go to PA to buy something and the tax rate is lower, NJ will want you to report and remit the difference. Another issue that complicates the equation is that different states classify taxable items differently. In NJ, 40% of the clinical supplies used are non-taxable when in other states such as NY, 98% are considered taxable.

How will Non-Compliance Hurt? …… As technology advances, more business tax audits will be conducted. I went through one and it is not fun. The state was in the building for 4 days. The company was clean and we always played by the rules. But a $250.00 purchase of copy paper from an out of state stationary supply slipped through the cracks. We were able to negotiate a settlement. A $17.00 tax liability cost us $2500.00 in penalties and interest on top of 4 days of accounting fees. The State of NJ has no published list of non-taxable items, only a general rule and if you choose wrong, you pay. During our audit we spent over an hour arguing about retraction cord, is it taxable or not? We won that one, it was the auditor’s judgment. That would have cost $15k. Ask your tax advisor for more information, laws change…….

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February 20, 2017 Posted by | Uncategorized | Leave a comment

Dental LED Curing Lights – What Who Don’t Know!

t2ec16hhjgmffobufofbbrklvzl9w60_35  LED Curing Lights were introduced to the dental industry a number of years ago. Their clinical effectiveness and success has been proven in thousands of studies and cannot be disputed. However, as George Harrison once wrote “all things must pass”… Nothing lasts forever.

It is true that LED “bulbs” last 10 times longer than traditional bulbs and burn much cooler, but unlike their counterparts they don’t just blow out. The deterioration of LED bulbs is a slow process and may be accelerated by multiple factors within a dental clinical environment. The lights effectiveness will diminish over time and will not give any warning until revealed by clinical failures.

Let’s start with the LED Crystal …The main cause of deterioration lies in the enlargement of defects in the LED crystal, which supply on thermal influence, as to high temperature. These defects do not participate any more in the light generation and the LED lose luminous flux, thus it’s brightness. This is where the old saying “you get what you pay for” comes in. When two competing products are so different in price, there is usually a reason and the reason is the quality of components such as the crystals.

The Crystal Housing & Lens … Quality crystals in a quality housing with a quality lens is essential for quality performance. Many housings and lenses are made of plastic or a low quality metal and that will accelerate deterioration of crystal defects due to temperature fluctuation. Debris build-up on the light exit points will create an excessive heat build-up and add to the strain on the crystals. At this point the light will not preform properly.

LED vs Restorative Material … This is a question that I have been asked my entire career and I was here when Dentsply first introduced the NuvaLight (ultra-violet) and the magic of light cure composites began. Whenever someone told me about a curing light that is so powerful it would cure in 5 seconds I would ask how long the material manufacturer recommended? The answer was usually 20 seconds. If the material manufacturer recommends 20 seconds, then you cure for 20 seconds because that is how long it takes for the chemical reaction to take place. With the emergence of LED lights nothing has changed, until today.

The New Game Changer … Technology is a wonderful thing, it actually fuels its-self. In dentistry we tend to think of technology as software and scanners but the technology used to create perfect clinical materials is now finding faults in trusted restorative techniques. A newly developed computer analysis is now available to measure the compatibility of an LED Light output to the material it is being used to cure. When a manufacturer (i.e. 3M ESPE, Ivolclar Vivadet) develops a light cure material, they “tune it” to their LED Light. Another manufacturer’s light may require a different curing time to avoid an incomplete cure or a burn (over-cure). New technology has revealed the possibility of over-cure as a for cause restorative failure. This becomes extremely critical when considering bulk fill composites.

The Answer … For years I thought it was all about the materials but now I believe it is all about a married system. A computer analysis of the LED Lights in your office and how their output relates to the materials you use takes about 1 hour and can be provided free of charge and I do suggest it. Please feel free to contact me at any time with any questions or concerns.

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February 5, 2017 Posted by | Uncategorized | Leave a comment