A plea to use DMG Icon infiltrant

Don’t you think that this is the WORST part of orthodontia? You take off the brackets and voila! Straight teeth… with fugly white squares where acid beat the $#!† out your patients’ anteriors. And NOW you have to go drill on their teeth, destroying what you so carefully tried to perfect.

Once you’re here there’s no use in blaming the patient; it’s not like they’re going to get the brackets put back on to cover the white spots and then get more decalcification there. Yes, you should help them with their lifestyle choices (less energy drinks and voluntary mouth breathing, please) but at this point you have to do something to make them look better.

As a hygienist I’ve been totally itching for about the last four years to get the go-ahead to use a relatively new product called an infiltrant. There’s only one, it’s made by DMG and it’s called Icon. This infiltrant is placed on the tooth where it seeps into smooth-surface lesions that haven’t fully cavitated (although if you ask me the ones in the “Before” picture above look way gnarled out) and pretty much does a little remineralization voodoo.

I’d hoped that it would be classified as a sealant because Yay! I can do sealants. There’s no drilling done, right? There’s nothing taken away, right? There is, however, some irreversible improvement made to the tooth though and that (plus a significant etch time) means that when the CDT recognized that an infiltrant needed a code, where did that boom fall? Smack dab into Composite Land as a D2990. I know. The wording says “placement of an infiltrating resin restoration for strengthening, stabilizing and/or limiting progression of the lesion” and that SCREAMS prevention. Alas there’s the other word. Restoration.


Another problem is that this stuff is very expensive. See what it costs here for the mini kit for a maximum of six lesions?

That’s at best, $27 per tooth just for the kit (not including your other overhead or minusing the limited-time Amex card!). The suggested cost to a patient should be somewhere between your one surface composite fee and a sealant fee, and conservatively it takes at least 20 minutes of intense doctor time to place an infiltrant on a single tooth. Composites don’t cost that much or take that long to place so you know what that means, right? THE FEASIBILITY OF ICON SUCKS.

I really hope I’m wrong, but to most doctors, what’s a few millimeters of drilled-away tooth structure? Minimally invasive dentistry is for anal retentive freak dentists anyway. And every hygienist who has ever had a passion for preserving tooth structure, including me.

So yeah, this is bad news for Icon and for DMG, really. Sure, they got a CDT code this year but it’s not like anyone is going to use it. There’s like one dentist in a 5o mile radius that’s even ordered it around here. I know this because you can look on the DMG patient portal here and find a dentist that offers Icon in your area.

I have a challenge then. Actually two challenges – one for dentists, and the other for those who want to see this service added to the hygienist’s scope of practice in every state.

•If you’re a dentist and you love saving teeth, JUST DO THIS. Charge what you must, you’re not going to get rich, but you will have the warm fuzzy feeling that you’re doing the right thing by preserving tooth structure. We all know composites and amalgams eventually fail around their margins. There are no margins with an infiltration, just a lovely, arrested half-moon where an incipient lesion never progressed if you follow up with radiographs two decades from now (I may be exaggerating, but maybe not!). Go here, learn more, buy some.

•Those of you who are frustrated with dental hygienists wanting to become these mid-level providers that are supposed to help in low-access areas but will probably just come take your job away from you (I keed! I keed!) please support the use of infiltrants by hygienists. You will still need to diagnose that the treatment is needed but the service should be able to be delegated because of the very nature of the care being provided and the labor intensity needed for this smaller ROI.

As a realist, I don’t see squat happening as a result of this challenge. What can one blogger do? I have these silly dream glasses, when I put them on and see the future, well, there are no more cavities, on anyone, except arrested ones, and all the dentists are happy because all they have to do is play on the computer and nod their head every so often while their hygienists prevent all dental infirmities for ever and ever. Then I take them off again, and I see white spot lesions on teeth.

And I say…..dangit.




Thanks to Dental Products Report and The Catapult Group for this review of ICON from DMG America: http://www.dentalproductsreport.com/dental/article/review-catapult-group-delves-details-icon-dmg-america


Creepy dental mannequin calendar

This holiday season, don’t you know someone who would appreciate the Photoshopped finesse that can only be found in a printed new year calendar? Especially if they are aficionados of the lip-less look of their favorite Dexter, typodont, or other practice mannequin.

It’s bad enough that we all had to hover over these our first semester of dental school. Now they’ll be entering your dreams in an Inception-like takeover of your subconscious fears. NO! YOU NEVER GRADUATED AND YOU MUST SAY THANK YOU FOR THE UGLY WALLET FROM THE FAKE EVIL WOMAN YOU MARRIED!

Please tell me that you don’t really want one of these calendars. If you insist, it is available at this link here at Practicon, for pretty cheap, for a gag, for someone you pretend to like but just want to oog out really really bad.

Or you can just browse the rest of the calendar here. Do it quickly. Don’t linger. Because the longer you look, the more you’ll begin to question reality.

And if the nightmare above actually does describe your current marital situation, sorry, wasn’t trying to dis on your spouse. But you may want to consider this a wake-up call.


Postcard from a square operatory

Originally published in the May 2012 British print magazine Dental Hygiene and Therapy, this article was written as a snapshot of life as a hygienist in these United States, delivered as a postcard to the UK, and corrected to their spelling preferences. So if your spell-check throws up all over this piece, just remember, the intended audience is civilised hygienists and dental therapists.


by Trish Walraven

I live in Texas, and work in a box.

Well, not really. But at the same time, really! This box, like most boxes, has four walls. There’s a ceiling and a floor, too, but those aren’t what drive this story. It’s all about the walls. When I look at the walls, instead of trying to climb one (or get driven up one!) my inner designer starts its analysis. What decorations help to make this box more enjoyable?

Most importantly, there’s a patient in the centre of my box.

So there’s a sky blue wall behind me as I’m facing the patient. This is the dental hygienist scope of practice in the state of Texas. You’ll notice the sleek steel shelf hung firmly on that wall that lets me provide all hygiene services – even when the doctor is away. On that shelf are my preventive allowances: pit and fissure sealants, fluoride treatments, periodontal therapy, temporary fillings, restoration polishing, and even a flashing snowglobe of laser-assisted bacterial decontamination. This wall is also marked by an ugly patched-up area. If you pulled off the patch, you’d find a pretty big hole, left by a restriction that the Texas laws place on the administration of local anaesthesia by hygienists. Texas is in that 10% of the US where a handful of Board dentists hold the rest of their profession hostage with this issue. It seems to deflect attention from those other efforts that will give hygienists better governance over their work lives but, for now, it is difficult to get the laws changed in favour of hygienists. The patch is cool, though. It’s made up of an intense pharmacy-compounded topical gel that I use on my patient when she needs scaling and root planing. It’s not perfect, but it does keep the dentist from having to stop what he’s doing to anaesthetise her, and she loves that there is no post-injection pain and lingering numbness afterwards.

Which brings me to the second wall: a green-means-go fluorescent mural featuring a hot pink clock. It flashes the amount of time I have with my patient: 30 minutes! And that’s if she’s on periodontal maintenance or has staining. If she’s healthy or a child the clock starts ticking at 20. Everything mounted to this wall is geared towards squeezing the most out of every moment. Ultrasonic tips? The thinnest, curviest ones available, and enjoyed even by my youngest patient because they knock off every bit of calculus and plaque at a range of comfortable settings. Baking soda jet polisher? Much faster than the rotary polishing cup and paste. Oral hygiene advice? Suggested as I’m performing the initial examination and demonstrated later with a hand-held mirror and floss. Assistants instantly appear to chart and record probing depths with the click of a mouse, loupes and a headlamp keep me from having to reach up and change the overhead light position. I am a master of efficiency.

The third wall is a more subtle shade of green. It’s the one with all the niches and windows, with family photos and favourite mementos left by patients. I love this wall the most because it lets me see the world outside. One of the windows faces the reception room. The room is empty – not because we don’t have patients, but because none of my patients ever have to wait there, thanks to a well-coordinated  team using custom-designed communication with audible BlueNotes that chime as soon as a treatment room is open, or when a patient arrives, or when the dentist needs supplies because of an unanticipated event. This kind of empty reception room can be found in all corners of the world. Many practices are now implementing this idea – a spark that came out of my brain and then became a computer programme. I am proud of helping to shape the world outside my box.

The final wall is painted metallic gold, with the words ‘Preferred Provider’ stencilled in black all along the baseboards. From this wall emerges a door into a second operatory where a dedicated hygiene assistant is waiting with my next patient. I’ll see him and then move back in here once my services are complete. I’ll also use my diagnostic skills to let the patient know the doctor will be recommending a crown on one tooth, a bridge in the opposite quadrant. Focusing on treatment plan acceptance and dollars on the doctor’s bottom line is how I make up for the 30% or more discount patients receive in this middle tier of managed care here in the US. And it’s how I earn all those glittery stars on the wall: my home, a car, vacation time, designer handbags.

I like my box just fine. But if I had my own way, the walls would be different. Maybe they would all be windows.



You can also view this article in its original PDF from the paper magazine.  Also, many, many thanks to Eva Watson and DH&T’s editor Julie Bissett for the opportunity and for getting this published!

1939 – The year of the glowing wand

Welcome to the latest edition of Timewarp Tuesdays, where you are NOT asked to click your heels three times, or threatened to have houses dropped on your relatives, or coerced to chant “there’s no place like home” because there was much more to 1939 than overbudget Hollywood films.

Like Tube Lights! There were tube lights, the precursors to fiber optics, in ginormous scale. Wands! To deliver light to the unlit crevices of orificies from Omaha to Oregon to Oz.

Click on the photo below to see this excerpt from the March 1939 issue of Popular Science in its full-size:


 This looks pretty amazing for the time, actually. And it makes me wonder if our isolites, our fiber-optic handpieces, our loupe-mounted headlights, and other super-LED tech will seem quaint in another 70 years. And if so, what will replace them? Teeth lit from the inside? A glowing pink ball that drops from the ceiling and slowly expands to fully illuminate the oral cavity?

In the end it’s about the power of the light, something that is essential for our practice. Maybe Glenda said it best back in 1939:

“You’ve always had the power, my dear. You’ve had it all along.”



ADA Session No-Nos

For the most part, the American Dental Association meeting in Las Vegas this past week was a dignified, educational, and exciting exhibition. On the other hand, this article is dedicated to some of the stuff that didn’t go over so well.

Exhibit No. 1: Booth Babes

Really? If this is what it takes to sell your dental products, you probably need better products. Hot girls are nice and all, but you seem to have forgotten that half of dentists these days are women themselves.


Exhibit No. 2: Excessive use of color

I get it already. But yellow is the least of the problems here.

Exhibit No. 3: Roll it, don’t fold it

When you only have one thing hanging up at your booth, you really should make sure that thing isn’t creased and messy-looking.


Exhibit No. 4: Voyeurism

An interproximally wedged bit of corned beef begged me to visit the Sonicare AirFloss demo after lunch, and of course I’d been wanting to try it out ever since its preview here at DentalBuzz. What I didn’t realize was that a bunch of people would be peeking their heads around the corner from the sinks while I shot microbursts between my teeth.


Exhibit No. 5: You look stupid

There’s two ways to get into this group. If you’re getting paid to look like a fool, hey, in this economy, at least you have a job!  And then there’s the second way, which proves that paper crowns should only be passed out to small children at Burger King.


Exhibit No. 6: Pretentious company names

But the URL was available!!!! Even the kids wearing the orange shirts look skeptical.


Exhibit No. 7: Unpretentious company names

And sometimes you should try harder to come up with a name for your business.


Exhibit No. 8: Pawn Stars

Editing is a reality TV show’s best friend, as evidenced by the Pawn Stars Roadshow held at the ADA meeting.There were the obligatory purchases of dental gold (3.5 ounces for $2,000, on one sale) but for the most part the items that were brought on the stage for appraisal were met with yawns, disinterest, and concerns about authenticity.

One thing’s true though: the reality show’s stars are the real deal. What you see on the History Channel’s number one show is what you get. Not only did pawn shop owner Rick Harrison share his story about how he became the “media whore” that he is today (his words, not mine) and his experiences in the dental chair, we got a glimpse of the real Chumlee Russell when he accidentally fell off the back of the stage. Now I know why there are “I Heart Chumlee” shirts for sale all over Vegas.


Exhibit No. 9: Bad planning

So, you create a display area for a show that’s esthetically pleasing and then JACK IT UP with loud hand-scribbled posters. Either they forgot to offer a show deal or it’s genius marketing to make it look like they’re going out of business and have the BEST SHOW SPECIAL EVER! And what’s with the unapproachable chick stance? Wow, tough sell.


Exhibit No. 10

There’s no exhibit number ten. I just wanted to make fun of this guy again: