Increase Your Production by Using the Newest Technology!
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Increase Your Production by Using the Newest Technology! With special guest – Dr. Paul Feuerstein
UNEDITED TRANSCRIPT
Richard Madow: Hi, this is Dr. Richard Madow and our guest today is Paul Feuerstein. Paul is joining us from North Billerica, Massachusetts. How are doing today, Paul?
Paul Feuerstein: I’m doing pretty good in North Billerica, Massachusetts.
Richard Madow: And where is that? Is that north of South Billerica?
Paul Feuerstein: Just about. It’s actually next to the city of Lowell, which is fairly famous because the movie “The Fighter” was filmed there, and also, Jack Kerouac is from there, so people know Lowell, Mass. If they go to Massachusetts, Boston, Lowell, Worcester, and the thing I had to learn when I first moved here when I grew up in New York City was to drop all my R’s.
Richard Madow: Yeah, you have kinda like the combination New York and Boston accent which is...
Paul Feuerstein: Yeah, it depends on where I am and who I talked to the other day, so...
Richard Madow: It’s really working for you, but you’re in the Boston area, wouldn’t you say?
Paul Feuerstein: Yeah, yeah, I’ve been here for 40 years. I mean, I’m entrenched in the city. Richard Madow: Fantastic, well, I’m sure just about every listener to our audio series knows who you are. One of the reasons is you’ve been the technology editor of Dental Economics for 15 years, and of course you’ve lectured all over the country and beyond. I’ll just give you a little brief intro. You went to SUNY Stony Brook during the ’60s, the crazy ’60s. And when you were in college you had like a quadruple major, I think, you were studying chemistry, engineering, computer science, and of course, music, and I know that you played in some bands. Did you still make it to classes when you were playing in bands in college?
Paul Feuerstein: Surprisingly, yeah. I remember most of the things that I did in college, so I guess I wasn’t as active as my friends. Let’s leave it at that.
Richard Madow: Well, somehow you managed to get accepted to dental school. You went to, this is quite an acronym, UNJMD, University of New Jersey School of Medicine and Dentistry. Is that it?
Paul Feuerstein: Yeah, it was originally called New Jersey College of Dentistry when I got there, and then they changed the name. I actually have two diplomas, and they just got acquired by Rutgers, and Rutgers just said they’re gonna send us a third diploma, so I’ll have three dental school diplomas. I don’t know if that’s good or bad; kind of the patients will look up and go, what the heck happened to this guy?
Richard Madow: And look, if you got your license taken away twice, you can still practice. Now, you have been a tech guy for, since tech was born. You were known pretty much for having one of the first computers in your dental practice way back when in 1978, which, I was still in college in ’78.
Paul Feuerstein: That predates the PCs and Bill Gates and all that sort of thing.
Richard Madow: It really does, and maybe you can tell us a little bit about that; that’s interesting. Ever since then you got bit by the combination of dentistry and technology, and you’ve not only been practicing but teaching, consulting, again, you’ve published tons of articles; you’ve been in all the meetings, you’ve worked with CAD/CAM, so you helped develop actually the Lava C.O.S. intraoral impression system. One more accolade, which we’ll give you is, which is really cool, along with being an adjunct assistant professor at Tufts, which is, of course, one of the great dental schools of the country, you were named “Clinician of the Year” at the Yankee Dental Conference just a short time ago, so congratulations on that.
Paul Feuerstein: Yeah, it was nice to be recognized. You do all these things, you and I work a lot, and we do a lot of things, running around, and meetings, and doing things for the profession, and every once in a while someone says, hey, nice job, and it was great; it really was great.
Richard Madow: And Yankee Dental was such a great meeting, I’d say of the larger meetings, along with Chicago are probably my favorite. I love Yankee Dental; it’s got a great vibe. Dave and I spoke there many times and everybody is just so nice. It’s a great place. Hey, I’m gonna surprise you with one more thing about your private practice, I was just googling you before the interview and found this review on Dr. Oogle about you. It says, “Dr. Paul Feuerstein, five stars, a thoughtful dentist who listens to you, takes pride in each filling, which he sculpts to match the tooth, and is a master at anesthesia, he has a great sense of humor to boot, one dentist you’ll not be adverse to visiting, highly recommended.” That’s quite a review!
Paul Feuerstein: I’m red. I treat people as people and not a bunch of teeth that walked in the door. I don’t say, oh good, No. 13 MO is coming in today, you know, so I think that…The people, I know who they are, I spend a lot of time schmoozing with them, much to the detriment of the practice probably; they always say, give him another 15 minutes with that patient; he’s gonna be yakking with that patient. That’s what I enjoy.
Richard Madow: It’s pretty obvious that your patients love you and sounds like you return it in the atmosphere you provide and the quality dentistry, all that great stuff. I’m really excited to have you on the audio series today. Thanks for taking time out of your schedule to do this.
Paul Feuerstein: Well, I have something for you.
Richard Madow: Okay.
Paul Feuerstein: [plays a guitar]
Richard Madow: [Applauds] Wow, a beautiful finger-picked rendition of “Here Comes the Sun.” That’s was fantastic!
Paul Feuerstein: I’m back. I actually flubbed a few things so you know it was live.
Richard Madow: Exactly, that was absolutely beautiful. You know, it’s funny, you’re a musician, I’m a musician. I’m amazed how many dentists are musicians and how many of us actually still play in our bands. I still play in my band with two guys that I actually went to elementary school with, and you’re still playing, you’ve got a musical family, so something about the dentistry-music connection is very cool. Paul Feuerstein: There a dexterity issue there, I think, and when you set up a band, there is also where the technology comes into play; you have to stand up on stage and plug things all over the place and not get electrocuted. You start to learn electricity and electronics and, so as far as, we talked about my background a little bit, in learning about the computers in the ’60s and ’70s before what they are now, I get appreciation for the physics and the mathematics with how things work, and then, as dentistry progressed, these little things embedded themselves into our equipment. So all of a sudden you have a dental chair that is computer controlled, and it all made sense to me and allowed me to work with manufacturers over all this time to speak two languages. They’d call me up and say, Paul, we got this new thing that has an Intel blah-di-blah, and I go, oh yeah, I could make it work this way; so that’s what sort of fostered this whole situation that I got myself into, good, bad, or otherwise.
Richard Madow: I’d say good. Hey, so, Paul, why don’t you, usually I do this part, but I think you’ll do it even better. Why don’t you tell people the concept or the theme of this interview and then we’ll get cooking into the really good stuff.
Paul Feuerstein: Well, most of us as dentists work every day and a lot of us get burned out very quickly, and so dentists have little side things; one of my side things is playing guitar. I was absent the week they taught golf in school so instead of doing golf, I go to dental meetings. I go to pretty much every single meeting anybody has ever heard of here and around the world, in Canada, in Germany. I walk up and down the aisles and I look at things, partly because of the writing and teaching, I try to find things no one has ever found before or no one ever heard of. So I can go to the 3M booth, I can go to the Sirona booth, which is humongous, but I’d rather go to some tiny little booth that’s 10x10 and some poor guy or gal is standing there holding something, praying someone’s going to talk to them, and I walk up and go, hey, what’s that thing? And they go, oh, really, oh wow, I can actually explain something to you? And these are the things I try to find, rather than sit here and talk to you, Rich, about the latest devices in CAD/CAM and digital impressions, which we can do some other time, I find a bunch of little odds and ends that are kind of cool. So I would like to, if you don’t mind, have you take a walk with me through a couple of dental meetings and I’ll just run through randomly different areas that I’ve looked at, things that I’ve seen, and, you know, just touch the basics on it, and I’ll give you a little insight into finding more information. I don’t want to go in great detail on each thing; I think that would be the way to go here.
Richard Madow: That sounds like a great way to go. It’s funny because we’ve both been around for a while, but it’s still fun to walk up and down the aisle at a dental meeting. And I agree with you that, of course, 3M and Sirona, they make fantastic products, but sometimes it’s much more interesting to go to the little person that’s maybe trying to import a product into the U.S. or you go to Cologne, Germany, where a lot of the products get launched, so just see what’s out there. Lots of fun.
Paul Feuerstein: The problem with Cologne, which is one of my favorite meetings, is that there is no FDA in South Africa, and Chile, and Brazil, so there are products that will never come to the U.S. Real quick story. I was looking at a laser from Italy, and typically a laser we use for soft tissue, it comes in wattages, without getting too technical, 2 watts is a pretty decent amount of wattage if you’re doing some troughing if you’re doing an impression. This guy has this laser sitting there and it’s 12 watts. I went, wow, is that thing dangerous? He goes, oh, it’s very dangerous! So that’s the kind of fun of the IDS meeting in Cologne; it comes up every two years in March, and if anybody listening is a techy and wants to take a vacation in Germany, March every other year on the odd years, 2013, 2015, 2017, unbelievable stuff. A typical meeting is a hundred and twenty thousand dentists plus who knows how many other people are involved; if you can imagine the Greater New York Meeting or the ADA Meeting in seven or eight buildings, it takes three days to walk through this thing; it’s just beyond ridiculous. I can go on and on about Cologne. I’ll hold those, I’ll hold my thoughts on those.
Richard Madow: That’s probably a good idea since your wife may be listening. Anyway, I think it’s a great concept. We’re gonna walk done the aisle. Let’s walk down the aisle from the aspect that, yeah, you’re a high-tech guy, but you also have a practice, a real practice where you treat real people. So why don’t we start walking down an aisle where they have some kind of practical clinical product we could actually use in our practice, not that we can gawk at or say that’s really cool, but stuff that’s really useful. How does that sound?
Paul Feuerstein: All right, let’s take something simple. Every dentist has to diagnose caries. So we use our eyes; we use explorers. You know, it’s kind of funny to me. Patients spend thousands of dollars, we’re using this little bent piece of wire. “You need some crowns here.” The biggest thing in dental school when I grew up in the area and when you grew up, we were taught amalgams, and if there’s a little tiny caries or catch and you say, let’s watch it. Why? Well, it was too small to fill. Let’s wait till it gets big enough to put a big amalgam in, and obviously, with the new materials we have and the new processes, that’s ridiculous. So we can now go into earlier interventions. So how do you know if you’re going around the mouth and the patient’s a 45-year-old patient and you find a stick on the Lower second molar, and you go, wow, and nothing’s really in the X-ray, so do you fill that thing, do you do like a preventive resin restoration, do you seal it, what do you do? You kind of guess. Well, with some new things that are out, you don’t have to. The first product that came out was called DIAGNOdent from KaVo, and it’s this little laser, like a little radar machine that goes into the tooth, it bounces the laser into the occlusal of the tooth, it bounces back, you get a digital reading anywhere from 0-100. Basically, the higher the number, the more likely there’s a cavity there. I mean, you can’t check your brain at the door; you still have to look at these things. Let’s say it reads 22, and everybody who uses DIAGNOdent says, well, 25, I’m gonna fill it, 30, I’m gonna fill it. But you can now watch that cavity at 22, and you say to the patient, let’s check it again in three months; we’ll use the same machine and see where it is. If it’s static at 22, you say it’s arrested decay or it’s nothing. If it goes to 30, 35, the patient knows, you know, hey, guess what, this thing is growing; let’s get in there, make a tiny little hole, use some material, whatever it is, and you’re good. So that opens doors, the DIAGNOdent opens doors. So let me ramble on here a little bit. There’s been a number of different products that have done caries detection from all over the world, and right now I’m just picking a couple just to go through. Air Techniques has this very cool, like, a fluorescent system. It looks like an intraoral camera; it makes a road map of the tooth and shows decalcified areas and caries and potential caries. And you’re looking on the computer screen and seeing all these different things with numbers and colors and you say, wow, that’s something. Again, you can watch it or make a decision to go in and do some sort of restoration. A similar product is from Acteon. They have two now, SoproLIFE and SoproCARE, sort of like a blue light, almost like a curing light, and the tooth lights up in oranges and different colors, and again, each of these things mean something. You can see caries, early caries, demineralization, and more important, remineralization. A lot of times we all have patients that come out of ortho, and they didn’t brush for the entire two years, and they have these white splotches all over their teeth, and you go, wow, it’s chalky, what do I do? Do I take it out, do I throw some fluoride in there? So these devices will actually let you see this stuff, get a sense of the depth, how much enamel has been destroyed or not destroyed, and then if you decide to go ahead and use some of the fluoride products, especially the new ones, you can actually monitor the remineralization. The big, funny term that’s come up in the last few years called CAMBRA, it’s one of these acronyms, Caries Assessment Based on Risk Assessment, something like that; I should really know what it means.
Richard Madow: I think you’re close enough.
Paul Feuerstein: But the idea is, when you see something that is potentially a cavity or caries, stop and think before you pick up that handpiece, and look at the whole patient. Are they drinking Mountain Dew every single day? Are they meticulous in home care? Do they have zillions of restorations or very few? You have to assess the whole situation before diving in, no matter what these machines said; machines are just a guide. That’s what you have to do there. Also, there’s an intraoral camera from Carestream that also has one of those little lights that shows things like that; there’s a bunch of new things. There’s a new product from DEXIS called CariVu, which actually uses a bright light that shines through the tooth, so transillumination, which we’ve used for years to reveal the cracks and fractures, and there’s a camera on it so you can actually look through the tooth with high, high intensity light, and it almost looks like an X-ray; it’s a brand new product just launched this year. It’s interesting stuff. So anyway, if you’re sitting there and you say, do I just sit there and watch it, do I think about it? Well, a lot of products have come out in biochemistry and you’ll see ads on TV right now for Sensodyne that says something about “It’ll rebuild your enamel.” Well, it will, because they found that there are certain products that have calcium, and if you can reseed the calcium back into the enamel, you can actually rebuild hydroxyapatite. And so companies like 3M, GC, and VOCO have come out with products that contain things like tricalcium phosphate, many people have seen something called GC’s MI Paste Plus. VOCO has something called Remin Pro. These are products that have not only fluoride but there’s calcium ion that recrystallizes the tooth. And again, using the machines, you can say, wow, I’m actually rebuilding this person’s enamel, and I haven’t touched a handpiece; I haven’t done anything.
Richard Madow: So are these products like a glorified prophy? How do you use these products?
Paul Feuerstein: Some of them are in prophy paste, some of them are in sealants, some are in the fluoride varnishes, some of them are in toothpastes. They’re coming out as we speak. When you open up the magazines, whether it’s Dental Economics, Dentistry Today, Inside Dentistry, Dental Practice, or what, you see these big ads; take a look at them. This is interesting new stuff, a bunch of new stuff is happening. A lot of them are focusing right now on the fluoride varnishes, as we say in Massachusetts, vahn-ishes, and go on from there. That’s been pretty amazing.
Richard Madow: It is amazing. Let me ask you to just back up a second because DIAGNOdent is pretty cool; it was really revolutionary when it came out, especially because, as you said, we’re using this thing that our patients have called “the hook” for 50 years, like the cavemen dentists used that. Now all of a sudden there is something they can make a few beeps and give a number, but is the DIAGNOdent on the way to being outdated because of these other units are so much more sophisticated in the whole spectrum of diagnosis they give you?
Paul Feuerstein: Well, I personally would say no; it does what it does, it’s simple, it’s portable, it’s little, it’s not expensive, so I think there is still a place for it. To me, it’s my digital explorer for lack of a better word. It gives a little bit of information, that when you have these other things, they can actually take a photo of the tooth. The granddaddy of them all came out about two years ago from Canada called the Canary System. It’s an unbelievable system with a camera and you can look at the tooth in all different directions, all dimensions, and it maps the tooth in nine different spots, and shows calcification, decalcification, caries. You can actually look around amalgams and restorations to see if there’s preliminary caries going on in there. The Canary System is a little bit big, a physically bigger unit, so that’s the extreme other end of the DIAGNOdent on one end and this Canary System on the other end. It’s almost to the point, what we call TMI, way more information than anybody wants to know, but it’s all there.
Richard Madow: I agree. You get to the point of, how much am I going to spend to find an area of decalcification that may not even need treatment?
Paul Feuerstein: That’s the hard question. Everybody has to find their comfort level and look at the different systems, and that’s why you have the trade shows. That’s why you have reps from the various companies coming to your office saying, hey, you want to try this thing out? And they’re expensive; some of these things are $5,000-$6,000. This one is about $15,000. Try before you buy. I wouldn’t by a car without trying it, going for a test drive, so they’ll let you do it, but if they don’t, say goodbye.
Richard Madow: You know, it’s interesting, and before we move to our next topic, I’ll maybe do like a general kind of philosophical question for you. I’m gonna make an assumption here; you tell me if I’m right. You talked about Canary, the Spectra by Air Technique, SoproLIFE, SoproCARE, Carestream’s camera, CAMBRA, the new DEXIS one, the old DIAGNOdent. Which one do you recommend? Which one’s best? I have a feeling you’re gonna say, go to a show, put them all in your hands, look how much they cost, and pick the one that’s best for you. Is that how you assess things?
Paul Feuerstein: I take it a step further. The cost is a factor but not THE factor because you have to see if it’s gonna fit into your style of practice, and some of it’s glitzy stuff too for your patients, I mean, the patients see these gigantic teeth on the screen. When intraoral cameras first came out, you’d say, this is a fracture, and they’d go, whoa, what do I do now? This becomes another thing that the patients can see and codiagnose with you so, if any of you are old enough, I don’t know if you remember this even, Rich, is Bob Barkley. Does that ring a bell to you?
Richard Madow: Sure, Bob Barkley, is he like the father of preventive dentistry or something along those lines? Paul Feuerstein: Yep, he was basically the first practice management guru in the world. He died early on, but he said, his philosophy was: Don’t do a treatment plan without having the patient see what you are doing. Show the patient all the stuff, show them photos of the teeth, show them all the stuff in the mirror, and they will help you diagnose what they think is wrong. There’s nothing better for me than using one of these detection systems, something obvious, we know what it is, we take a picture, put it up on the screen, the patient’s sitting there, and then walk out of the room. And they stare and you make sure they stare at it, it’s creepy looking; and you come back and they go, “What’s that orange thing over there? Is that my tooth? Is that a crack in my tooth?” So I think it’s a philosophical thing, and how much time you want to spend with that or just say boom, you got a cavity; let’s fix the thing and come back next Thursday. So, and to say which one is the best, each one of them has some little buttons in different places. Some of them have software that works in different ways, so you’re right. I’m not gonna give you a straight answer. They’re all very good, so that’s a tough call to pick the best one. And I’m asked that all the time, which is the best. There is no such thing unless in the Hammacher Schlemmer catalogue they have something called “The Best.”
Richard Madow: But it’s always something you don’t need.
Paul Feuerstein: Right.
Richard Madow; The best foot arch tickler. I don’t need that.
Paul Feuerstein: You got it. I once looked at that and they actually have a little section of their website of how they pick “the best,” it’s actually kind of interesting.
Richard Madow: I’m definitely gonna check this out.
Paul Feuerstein: Take a look, yeah.
Richard Madow: Interesting company, for sure. So now we talked about tiny areas of decay that may or may not even be there, we’re gonna detect them, treat them early, maybe remineralize them. Really cool stuff. How about the opposite situation? Maybe there’s a ton of caries or a humungous cavity in there, you think maybe even looking at a pulp exposure; anything new in that arena?
Paul Feuerstein: Obviously you don’t need a fancy machine for that; you have to use your own vision, your own brain. X-ray is obviously important there to see the depth of this brown thing on the patient’s tooth, and symptoms are gonna dictate it. The interesting thing that’s come through, again through biochemistry, is that there are some new products that have replaced our good friend, Dycal. When we were in school, if you were close to an exposure or have an exposure, put this Dycal on it. It did something, I mean, there was something to it, but overall, it really was an overall failure. So some companies have come up and taken the concept of that, of this pulp cap building new dentinal bridges, and they are now available to us to use as bases. If you use glass ionomer, glass ionomer has had a very good run, but a step further are a bunch of products, got calcium, again, using this recalcification. So an early one is the MTA paste that a lot of the endodontists have been using. Septodont came out with something called Biodentine, which you have a little capsule, you mix it up, squirt it into the tooth, takes a little while to set, and makes this extraordinarily hard material. You can put it directly on an exposure. And the brand new product that I came across, and it may not be the only one, one from Bisco called TheraCal LC, LC meaning light cure, is like a little syringe. You have it close to the exposure, squirt the stuff at the bottom of your prep, light cure it, and go on from there. You can etch it, bond to it, whatever. And VOCO Corporation, very nice company, I like VOCO too, has something called Calcimol LC, also light cure, again, a little syringe you squirt at the bottom of the prep and build on that. That’s been pretty neat. But a new thing that’s been coming up in this year is something called bioactive restorative materials. I really can’t tell you I’m an expert on this yet, but Pulpdent, for example, has some new restorative bases and materials that also have the calcium stuff, tricalcium phosphate, who knows what, and not only will this material bond to the dentin or the enamel; it actually forms enamel at the enamel junction, and it’s kind of hard to explain, but you just have to go to the Pulpdent website to see what’s going on from there. And a tiny company out of nowhere called Doxa came out with a new cement, a crown and bridge cement, that has that same bioactive material in it. And what they are saying, and again, I read the clinicals, I can’t give you twenty-year studies, is you cement your crowns with this Ceramir cement, not only will it bond to the tooth and bond to the dentin, it also forms an enamel crystal at the margin. So who knows where we’re going with this stuff, this is just getting to be… My main degree is actually biochemical engineering and biochemistry, so to me, that is all fascinating. That was everybody’s most hated course in dental school and high school, but it comes back to haunt you now, that they’re showing you these slides and pictures of molecules and scanning electron microscopes, and it’s pretty cool stuff.
Richard Madow: It’s amazing compared to Dycal, which, you place it and you pray that something good happens.
Paul Feuerstein: That’s the chemistry side of the high-tech world. I will say one other thing, there was an article that came out early this year from the British Dental Society or the Royal College of Britain or something, where they’re using some sort of electronic impulses on teeth; they can stimulate new hydroxyapatite growth, and the headlines were like, “Dentists don’t need to drill teeth anymore” and all this kind of Enquirer type stuff. So the problem for us as dentists is that patients might see this stuff in magazines or on the TV and they go, “Hey, Doc, you don’t need to do a filling; you can just use that new thing from Britain,” which is probably ten years away.
Richard Madow: And still won’t replace... it’s funny cause I saw that thing on the internet, like a pop-up on the side, little ad thing, I saw that last week. I thought, oh, this is not good for us.
Paul Feuerstein: Mixed blessings, mixed blessings.
Richard Madow: Hey, quick tangent, what’s your feeling, or is there any difference between, cause you mentioned you liked this small company called Doxa, which I’ve never heard of, of course. Do you feel better going to get a product developed by 3M or DENTSPLY, you know, companies like those, instead of going to these companies that come out of nowhere, maybe mixing stuff up in someone’s bathtub? Does it matter to you?
Paul Feuerstein: It does, and this particular company, I just picked them at random here, but I couldn’t even tell you where they come from. Again, they present you with clinical studies and they’ve gone to dental schools and gotten grants to prove their products. But one of the things about 3M, I spent some time at the 3M technology center; it’s wild, the room looks like King Arthur’s round table, and once every six weeks or so, every division sits around and talks to each other. So you have the guys that make pavement for the driveways and paint, Scotch Tape, Post-it Notes, the dental and medical, and they all sit around and they’ll talk to each other about their latest product and how they make these. And the R&D that they have, the testing that they go through, is torturous, so, yeah, I’m not glorifying 3M, although they are wonderful, but if 3M comes out with a product, you know that it does what it’s supposed to do exactly the way that they say it does. Take this Doxa, not to put them down, but I’m basing my information on the information that I intelligently read, and reading the studies, but that’s kind of an interesting question, and that goes to the entire industry because there are so many restorative materials, and there’s still market leaders in each region, whether it’s filling materials or cement or sealants, each one has their own little niche. But I do get a little nervous wondering if some of the reason they have giant market share is because they’re giant companies and take out big ads and have big booths and things like that. I mean, they can stand behind these things, but does that mean that the little tiny company is less efficient or less worthy? So, I don’t know; that’s a tough question. I think, again, if you want to be on the cutting edge, you take some chances. Of course, you’re working with your patients, but if there’s approval, they have to go through approvals, FDA this, and all sorts of things called 510(k)s, lots of things like that, so I’m not adverse to looking at a tiny company.
Richard Madow: Cool, interesting concept. I’m glad we brought it up.
Paul Feuerstein: You’re making me think.
Richard Madow: That’s horrible. I never said this was gonna be easy, you know. Like when you write an article and you get the proof, and back and forth; this is live. Ok, so let’s say we’re still at this neat dental convention somewhere and you’re walking up and down the aisle. What are some things that are catching your eye?
Paul Feuerstein: One of the things, and you must find this in your lectures and seminars, is hygienists have a couple of nightmarish things that they have to go through, and one of them is perio charting. In my office, they look at the schedule in the day and there’s three patients set up in the hygiene schedule and it says, “perio chart,” “full perio chart,” and they stand in the middle of the hall and yell, “Who is around at 2:00 to help me chart? I don’t care if it’s the UPS guy. I need somebody in that room to help me perio chart!” It’s a big pain in the neck. So in that little niche thing, a couple of companies have come up with perio charting systems which allow you to do it yourself. First of all, something that has been around for a long time, called a Florida Probe. People either love it or hate it. I like the product myself, and there’s this electronic perio probe, and you go around from the sulcus and it talks to you. It’s like a little probe on a spring. It goes 2, 3, 4, 3, 3 and gives this fabulous chart. And the nice thing about the Florida Probe is each time you probe the sulcus, it’s exactly the same pressure, so it’s reproducible. So if three people did a probing with the Florida Probe, they are gonna get almost exactly the same readings; whereas with a standard probe, if that patient winces, you might not get that 7; you might get a 5 or something like that. So it’s a very nice product, a little challenging to use for a lot of people, it’s not inexpensive but it’s not expensive, and there is a lot of hardware involved. But the company realized that they wanted to do something different, and they looked at things like Dragon NaturallySpeaking and said, why can’t we do a perio charting? Well, if you have Dragon NaturallySpeaking, use that as an example, that’s like 300,000 words, and if you say, “suppuration” or “furcation,” Lord knows what’s gonna show up on the screen. So what they did is they took the entire vocabulary and narrowed it down to a few hundred words, so when you’re using their new product, I think it’s called Florida Probe VoiceWorks, you can sit there (if you go on their website there is a nice demo), and you just go 3 2 3 4 4 2 3, whatever it is, furcation, mobility, blah, blah, blah, and it just charts the thing right across, and it really, you wear a little headset like the kids wear during gaming, you steal one from your kid and bring it to the office. Very nice product. Very little training, and there is not a lot of superfluous information. Very, very good product, and they’ve been showing it around at a lot of dental meetings. But I have a little passion here. There is an odd product called the Dental R.A.T. The R.A.T. means it’s bigger than a mouse, basically it’s a foot controlled mouse; it’s probably twice the size of a foot, and there are little controls that you move around with the ball of your foot, and that’s the mouse itself. There is a little button you can hit with the heel of your foot; that’s the clicker, and there are buttons labelled 1 2 3 4 5 6 7 8, and you can just tap it, you do a little tap dance as you’re going around. It’s a wireless thing. Tap your feet around and you get the same thing 3 2 2 3 3 3 3, and it does a beautiful little chart, and it’s a really neat product. It’s something that’s hard to explain over the phone, so if you just went to, I think it’s dentalrat.com would be the website, I’m pretty sure. But here’s the cool story. The owner of the company, dental hygienist from Idaho, and her name is Becky Logue, and she is at every single dental meeting, and she is just so passionate about this thing and how it works, and she’s done very nicely with this whole product. In a lot of the meetings, dentists would come up and say, Becky, that’s cool, but I’m a dentist and I don’t want a perio chart but can you make me like a foot mouse, just a little foot mouse? I don’t need to do all those extra stuff. I can sit there and I’m working with the patients and my hands are covered with whatever, but I can use a foot mouse. And she said, a foot mouse, yeah, I can do that, and she has all the patents on these things. So she just designed something called Boomer the foot mouse. It looks like a boomerang; that’s why it’s called Boomer. So visualize a boomerang with a couple of big buttons; it’s probably about 12 inches, maybe 15 inches from edge to edge, and you tap around, and there’s a mouse you can use with the seat. And she’s at some dental show and people started coming up to her saying, “Hey, Becky, I have a kid, my kid has CP and really has limited use of his hands. Can they use this thing?” And she’s like, whoa, this isn’t just a dental product; this is like for anybody with a handicap, anybody who can’t use their hands, is unable to or doesn’t want to, and there’s a big marketplace sitting out there. So, she’s opening up this secondary company, part of Dental R.A.T. called Boomer. Here’s the situation. You have a new product. You want to launch it to the world. How do we do that? One of the things, I don’t know if this is going to happen, one of the places she’s approached is the Shark Tank, so...
Richard Madow: That’s a great product for Shark Tank. The whole story is just fantastic.
Paul Feuerstein: Yeah, so I don’t when or how or if it’s gonna happen, but she’s talked to me about it and says, I’m gonna bring Boomer to the Shark Tank, so who knows. So people around the world will learn about periodontal disease.
Richard Madow: That’s very cool. Well, Dental R.A.T.’s a great product. They exhibit at TBSE, or they have, and it’s really cool. They always have a nice little crowd around their booth, and they’ve done really well, and I know people are really happy with the product. And it’s funny cause TBSE, it’s obviously not like the Chicago Midwinter, it’s kind of a smaller hall, and if people don’t like a booth, we really hear about it, so we’ve heard only good things about Dental R.A.T., so...
Paul Feuerstein: And TBSE is an intimate show, and I think that the exhibit is like that you have a targeted audience, these dentists and dental assistants and dental hygienists and dental office personnel coming in and they want to be there; they weren’t forced to go there, and certainly have some fun. It’s always a great learning experience, and it’s only the best of things I could say about what you guys do.
Richard Madow: Oh, well, thanks. Well, definitely cool stuff. I mean, I’m gonna highly recommend anybody listening to the show. It’s funny, I had my dental cleaning this morning, and I go to a fantastic dental practice, and they send out like one of those [makes sound] signals throughout the office and it means “Can somebody come in here and help me chart?” Fortunately they’ve got a robust staff and they are not understaffed, and somebody always cruises in and helps, but I know in many practices it’s not quite that simple.
Paul Feuerstein: Yeah, so, I don’t want to run out of time. There’s another really cool thing I came across...
Richard Madow: Please.
Paul Feuerstein: ...at least a year ago. People have come to me and I may be jumping the gun here, but like, “Paul, what’s the coolest thing you’ve seen, hands down?” and I’ve seen a lot of stuff, and strangely enough, it’s a sterilizer. A company, SciCan, has something called, has a StatIM sterilizer, a little tiny sterilizer. They have different models, and if most offices have this thing, it’s a little drawer you put your instruments in there; it turns them over in under ten minutes, uses high pressure, and it’s a cool little thing, and you can run handpieces through there like in between patients. One of the problems with the StatIM, not per se, any sterilizer, is every once in a while, it doesn’t work; you got a fault, a little thing pops up on the screen, error 33, or, you know, something’s wrong, or you see stuff that if you have the little spore tester things or the little indicators, something went wrong. But sometimes these things happen and you’re not really aware of it, so you may run your sterilizer through a cycle and you put your stuff back on the shelf, and how do you know for sure without monitoring this thing every single cycle if you’re up to speed? And then, your worst nightmare is sometimes the sterilizer goes down, so what do you do? You call the local company. They come in, some rep comes and says, you know what, I just did a diagnostic on the thing and it needs new little board, so we’ll send out to San Francisco, you’ll have it in two days, and then I’ll go down and get you a loaner and get you this and get you that, then they come back, install it and charge you for a second visit. SciCan took the ball on this and put a whole computer inside the StatIM G4, and in the back of the StatIM is a network cable that’s plugged into your internet network and is in constant contact and is constantly sending signals back and forth. And if there is a fault with one of your cycles, you can get a text message, an email, an automated phone call, “Hi, check your sterilizer; something’s wrong,” and then it starts running diagnostics over the internet, and by the time you even know something’s wrong, there’s a repair guy on his way to your office with the part that you need to have the thing fixed. This is to me so unbelievable.
Richard Madow: That is like futuristic.
Paul Feuerstein: It’s Big Brother. It’s the whole thing, and more and more companies are starting to look at that model and put it in dental chair, your x-ray machine, put it in this, put it in that, and there’s also appliances and refrigerators that do this now, and washing machines. But this to me was phenomenal, and then they went beyond that. In Massachusetts, we have to keep a log of every cycle and send to the state and do all this sort of thing. This machine keeps the log in the computer. There’s a little USB port in the front; you want a copy of it? You plug a USB stick in there, boom, you have the whole report for every single cycle the thing has ever done.
Richard Madow: That’s the only way to go. Who can keep that stuff manually? Forget it.
Paul Feuerstein: So that’s my all-time favorite thing.
Richard Madow: Do you see that as kind of being the future where things in our dental practice will be communicating via the internet with the outside world just automatically?
Paul Feuerstein: Absolutely, absolutely. And you know, there’s a limit to the size and the type of equipment. It’s not gonna be every little thing, but your larger pieces of equipment, and like I say, I’m looking to see this with the X-ray machine. You get this also if you’re in the digital impression world, but it’s a little more obvious. It’s a computer running this system; if something goes down, if you’re using the CEREC, the E4D, or iTero, or Trios, or whatever you’re using, there are also diagnostics there. They are not directly connected but there will be a little thing that pops up on the screen, says contact service, service calls in, they remote into your computer and tell you what’s going on. I think it’s called something like internet enabled or internet diagnostics or something like that, but that for me was, that’s like the geekiest thing I could possibly think of. Richard Madow: And for you, that’s quite a statement.
Paul Feuerstein: So there was one of the things I say that’s the best.
Richard Madow: That is really cool. Keep going. What are some other cool products that you see in the aisle?
Paul Feuerstein: Oh, you know, there’s an influx, and I don’t know if it’s good or bad, I’m not sure on that yet, with iPads and iPods and things like that, that are being added to certain pieces of equipment and using them as controllers. There’s a laser I saw in one of the meetings had a little iPod on, and they have a little screen, and if you want to remember how to remove a fibroma, you push a little button on the iPod, and a little video comes up that says, set the thing at 3, and here’s a little video of how it works, and if you want the iPod to do it, push here, and it will set your thing to 3, so stuff like that. Bien-Air has been up front. They make the electric handpieces and some other things and they have incorporated the iPad and the iPod into their electric handpieces now, and if anybody does automated endo, you can sit there and you have like ten different companies’ worth of different files, and what’s the speed of this one, what’s the speed of that one, and how do you use it? It’s all built into the software in the iPod or iPad connected to the Bien-Air handpiece. So you just punch in I’m using the Kerr or whatever brand it is, and it comes up on the screen. Preset the machine to the right torque and the right spinning, the right rotation, and stuff like that. I’m seeing a lot of this like that using iPads. I’m nervous about one little thing, that Apple did not design these things for a dental operatory environment to be cleaned, cleanable, disinfectable, durable; things gets bounced around and splashed with water. So one of the companies, Crosstex, the guys that make bibs and all sorts of disposals, they’ve come up with an iPad cover, I think it’s called iCover or something like that. I that’s pretty cool too. But that’s some of the things I’ve been seeing around there. Um…
Richard Madow: Yeah, keep going. This is fun, just naming these random products. Anything else?
Paul Feuerstein: Yeah, actually, again, I’m standing in a tiny booth and I see this woman, looks like she has a hearing aid in, but I knew it was a demo, and I go, what do you got there? And she goes, well, she starts explaining to me that we as dentists are sitting here and using high-speed handpiece at whatever the frequency is, and over the time of your practice, there’s hearing loss. I said, I don’t have to worry about that. I played in rock bands, so I’m gone anyway.
Richard Madow: I was just thinking the same thing. Paul Feuerstein: I had amplifiers behind my head all this time. There’s this company called DentalEar, and that’s the name of the company on the website, dentalear.com, and they make a little tiny sort of hearing aid thing you put in your ears, and it’s not like noise cancelling headphones, it’s just a noise reduction to the drill noise, and it’s tuned into it and it cuts the noise down by something like 60 or 70%. So again, I’m walking down the aisle and this guy just jumps out in front of me, he didn’t know who I was, he shows me his iPhone, and I say, that’s nice, and he goes, this is my business card. It’s a business card on the face of the iPhone and you can hand it off to other people. Push a button, hand it out to patients, hand it out to customers, hand it out to whoever you want, and it’s all embedded with things about your practice. Press here for directions, press here for this. It’s like on the iPhone screen, it’s like a virtual office business card. So you know, kind of a neat little thing.
Richard Madow: And what’s the name of that company?
Paul Feuerstein: It’s called Dentalfone.
Richard Madow: I have an iPhone, but how do you hand that off? I mean, you can’t like tap iPhones, I don’t think.
Paul Feuerstein: Apparently you can send... I don’t know.
Richard Madow: I know you can air drop. I think you can air drop things.
Paul Feuerstein: You know, I just saw…
Richard Madow: Well, if you’re interested, it’ll probably be on their website, right?
Paul Feuerstein: Yeah, yeah, yeah, so they’ll go, whoa, you should tell them a little bit more about it, I don’t have an iPhone; I’m a Samsung guy, so... You think about this for a second, a company called MouthWatch, and what they were selling was an intraoral camera that you give to your patients, and a HIPAA compliant interface, so a patient can take pictures of their teeth and send them to you. What they really want this for is if you’ve done some surgery and the patient doesn’t feel like coming in for a postop, they can take a picture of their mouth and send it to you with their little home intraoral camera. So it’s called MouthWatch. I’m making fun of it; it’s actually a very cool product but kinda makes me laugh every once in a while, thinking that’s a little different.
Richard Madow: I feel like I’m ready to hit the gong on that one, I don’t know. Paul Feuerstein: I don’t know, I don’t know. There was also a product that’s called the Button. I remember as a kid I had something like the Button. You give this to the patient and when you’re working on the patient, if they push the Button, the handpiece stops. I said, really? I’m sorry. Even though I’m gonna be quoted, in my personal opinion, I don’t like that product. How’s that? Am I allowed to say something like that?
Richard Madow: Of course. I tell you something though, have you ever had an MRI? They’re horrible, right?
Paul Feuerstein: They give you the Button.
Richard Madow: They give you the Button, and MRIs are horrible for some people; some people don’t seem to mind them. But I had an MRI recently. I didn’t have to press the Button, but I loved having it in my hand.
Paul Feuerstein: I guess, all right, I’ll buy that.
Richard Madow: But yeah, I think it would be kind of weird if like every ten seconds your handpiece stops. We’re taking the Button away, dude.
Paul Feuerstein: Growing up, the dentist gave you this little air thing that ran the old drills and you had the same idea. I think you had to squeeze it, I think squeeze it to shut off or if you let go it shut off, something like that. So I don’t know. It’s personal opinion. Something I came across, a very interesting product, is one of the things we hate doing when we do crown and bridge, traditional crown and bridge, not talking about the digital, is retraction. You have to sit there for twenty minutes and pack this little piece of string around; it keeps popping out, you know. Why can’t they do something else? So there are some products out there, there are some gels and there’s some putties that squirt around, and DENTSPLY got this clever idea. They have an impression material called Aquasil, and they’ve been promoting something called Aquasil Cordless, and I said, what is this? They said you can use this impression material and you don’t need any cord, and what they do is they give you these little cartridges that attaches to a, looks like a handpiece, it’s part of the product, with a tiny, tiny tip, and you attach it to your foot pedal and with very, very high pressure it squirts the material into sulcus and actually pushes the material away, and you can get some decent impressions with this thing. I found it to be good, I’m not going to give it a “very good,” but a “good,” pretty close. You can see the margins. Neat product. It’s called Aquasil Cordless.
Richard Madow: And does that have a hemostatic product in there to get rid of the blood?
Paul Feuerstein: You sort of put a solution on it first, but it’s under the pressure, it’s one of these things with the hydrophilic, you know, that sort of thing, where it doesn’t really matter. So clever product. I think it has a nice use, and they have a couple of tweaks they might want to do on this thing, but kinda liked it. It’s nice to take one impression and not have worry about it. Something else I see walking up and down the aisles, boy, I don’t know. I could go on for hours.
Richard Madow: I was gonna say, it’s a lot of stuff. I think we can maybe squeeze something else in, in a minute or two if you have some time. Anything you want to talk about. The sky is the limit.
Paul Feuerstein: I think the biggest hot button, and I’ll give this a tiny, tiny, a short thing; it takes three hours to talk about is this whole world of digital impressions right now. CEREC is about to announce its thirtieth anniversary; it’s been here thirty years, and it’s been doing very, very well, and they’re constantly improving, improving, improving, and the good news for everybody, except for Sirona, is there’s competition now. They’ve validated that you can take a digital impression, you can do restorations in your own office, and it works. So there’s a number of competitors, and I’ll call them competitors. E4D came out next, iTero came out right after that, 3M came out with the Lava C.O.S. Then a company called 3Shape came out with something called Trios. Boy, I could get in trouble for this. Carestream has one called the 3500. The number of new intraoral cameras that are 3D and take digital impressions, and some of the early ones only took the digital impressions. As a dentist, my first thought, not as a tech guy but as a dentist, is if I could take a digital impression and send it to my lab, I’d be happy. Because if the impression is absolutely accurate, the lab gets this thing, they have the file, the can do all the CAD/CAM at the lab. I don’t want to sit down, design a restoration, get a milling chamber, and do all those other things. The iTero originally came out, all you did was take the digital impressions, send to the lab, and then some of the users got frustrated and said, geez, why can’t we do crowns with this thing? It wasn’t designed for that. A whole secondary industry is coming up now, and it’s going to revolutionize this whole system of milling units, software. Jim Glidewell has his own milling unit now that works with almost every single system on the marketplace. You could have the iTero, for example, or the Trios 3Shape, and just literally plug in Jim Glidewell’s mill, and that’s one of several. There’s one from Roland; actually, did you know that Roland, the guys that make keyboards, that make dental mills?
Richard Madow: I had no idea.
Paul Feuerstein: Same company. And the interesting thing, one of the Roland mills, it’s a limited use, it’s a limited product, something like $16,000, and the new 3M True Definition scanner is $12,000.
Richard Madow: Wow, is Sirona running scared a little bit? I mean they are a humongously successful company.
Paul Feuerstein: Yes and no. They’re not running scared because they watch everybody else, and they constantly move up the next level, so they’re still the mark. So Sirona comes up with something else, somebody else comes up with something. If you go to the booth, you’ll see the Sirona guys are at the E4D booth, the E4D guys are at the 3Shape booth; everybody is watching each other. The winners are us as the dentists. So Sirona came out, as most people know, with the Omnicam. Unbelievable, full color, real fast, real simple scan. So Trios, the 3Shape Corporation Trios, said, we can do color, so they come out with color. So Sirona says, we’ll do color in HD, so they came out with color in HD. 3Shape goes, we’ll put color in HD and we’ll do the color matching; we’ll take a shade for you. With all these things that are happening, I think that’s gonna be very interesting to see this whole thing unfold. The bottom line, I have to be honest with you, every single system works, so there’s another one, which one is the best? It depends on which day you ask me, but they all work, and I think it’s important for everybody to take a hard look at digital impressions, and you may not have to invest that hundred and some odd thousand dollars to get into the system. Ultimately you might, but just to get started, it’s a low level entry way to do this now. And it’s almost like shopping for a stereo. You might be able to buy an intraoral scanner from one company, the mill from another company, the software from another company. The challenge, the thing that Sirona has, it’s one-stop shopping; they only have to cover one company. They have it coming down, of course Sirona also has 3D digital X-rays, ___ X-rays. Their biggest competitor right now is gonna be Planmeca, because earlier in 2014, actually the end of 2013, Planmeca essentially bought E4D, so now the E4D is called Planmeca scan or PlanScan; it’s a parallel integration; it’s a very parallel system to Sirona. The challenge though is Sirona’s got so many years on Planmeca, they got to do a lot of fast dancing, but they’re gonna get there, they’re gonna get there.
Richard Madow: Ok, I’ll end it with the impossible question because, first of all, I love you talking about like buying a new stereo because what was more fun in the ’70s than buying a stereo? It was the greatest. But it seems like, with everything else, with TVs, with computers, with cars even, things keep getting better and they keep getting cheaper, and you think if I just wait, it’s gonna be better and cheaper. Oh no, but I’m not ready yet; if I just wait, it’ll be even better and even cheaper. How do you know what to do?
Paul Feuerstein: There’s two answers. Better yes, cheaper no. Dentistry, we’re in a sad little marketplace; it’s called the small vertical market, and what happens is, when a consumer company comes out there, Apple comes out, they can sell like millions and millions of these products. In dentistry, they are lucky if they sell twenty. So a cone beam, they are not gonna sell a thousand a week; they are gonna sell two a week, three a week if they’re lucky, and so it’s a limited production item. They are not able to buy the parts of the item in gigantic quantities; they handle each one. Also, the company itself has to stay in business, so you really think an intraoral sensor cost $10,000? They probably cost 12ȼ, but in order to have that toll-free number and people behind them, the company stand behind it, the R&D, the developers, and everyone else behind it, we’re screwed as the dental profession because we’re so small. There’s a company, Olympus Corporation, came in at one point with a new digital camera for dentistry. They said this isn’t enough sales; they just stopped the whole product because the marketplace is so tiny. So better yes, cheaper, probably not, within reason, unless the underlying technology becomes cheaper, the sensors inside these machines becomes cheaper, yeah, they come down from a hundred and thirty to seventy-five thousand; that’s certainly cheaper. It’s not gonna be 3,000 bucks for a cone beam anytime soon.
Richard Madow: For sure.
Paul Feuerstein: So I think that that’s the thing about dentistry itself is that we’re in a very small marketplace, and again, how many companies are making cone beams? So if every single dentist bought a cone beam and there were twelve companies out there, it’s still diluting the system. They are not going to sell hundreds and hundreds of these things, as much as they’d love to.
Richard Madow: Right. And every dentist certainly is not buying a cone beam.
Paul Feuerstein: Soon they will. That’s another story.
Richard Madow: Ok, we’ll get to that next time. Hey, I just want to bring up all the products that you’re mentioning. They come from the traditional distributer dental companies, not the small mom-and-pop companies, but you know, the larger companies we’re heard of. If you want to buy them and get the best deal, save the most money, and experience the greatest customer service, definitely give our friends at Darby a call. Darby Dental is the company that we love to recommend; we’ve been dealing with them for many years because we know they have the absolute best prices, best customer service; they’re not going to have some sales rep come and bring a bunch of stale donuts and bagels to your office and then mark your prices up. That’s just not the way they operate, so give them a call, Darby Dental, 855-879-1136. It’s actually a special hotline we set up for you at Darby Dental, it’s 855-879-1136. You’ll definitely get the best pricing, fast shipping, incredible customer service, and it’s always great to save money, even when you’re buying the most cutting-edge dental products; so give the folks at Darby Dental a call. Well, hey, Paul, this has been a lot of fun. I hope you had some fun doing this as well.
Paul Feuerstein: You’re great, Rich. You make it easy.
Richard Madow: Thanks. I don’t even know, cause I read your articles all the time, but I don’t know if you have a blog or some electronic media that people can follow. Do you have anything like that?
Paul Feuerstein: The best thing you can do is look for me on Facebook. That’s the easiest one I work with. It’s my name, Paul Feuerstein, DMD, Dental Technology. There is also me, Paul Feuerstein, on my regular Facebook page. That’s if you want to see my kids and grandkids, go there, but this, I specifically have this, so when I get press releases from companies and dental shows. In fact, I take photos walking up and down the aisles, posting live from the floor on the Facebook site. So Paul Feuerstein, DMD, Dental Technology, and then there’s spin off from there too. I have a blog. I don’t keep it up as well as I should. It’s very easy if you have a phone with a camera. Oh, here’s a cool thing, push a button, boom, upload it to Facebook. Gets there very, very quick. There is a parallel Twitter feed, the Twitter feed comes off of the Facebook page.
Richard Madow: So, hey, everybody, definitely check out Paul’s Facebook page. Follow him, friend him, you can even see that he is the one lecturing dentist who has shaggier hair than I do, if you check him out on Facebook.
Paul Feuerstein: Only because I can.
Richard Madow: And how about if somebody wants to drop you an email with a question or comment?
Paul Feuerstein: Very simple. My email address, again, I was in the internet real early, so I have a great address so, [email protected], and I answer emails at all sorts of time at day or night, no matter what time zone you’re in.
Richard Madow: So turn off your thing that dings when an email comes in. Well, hey, Paul, it’s been a fantastic hour plus. I know we’ve known each other for quite some time. You’re one of my favorite guys to run into in a meeting because we of course talk dentistry and music and all kinds of other cool stuff. If you see Paul at your local or international meeting, don’t be shy. You’re a super friendly guy, you love to chat with everyone, so pull him over, say hello. I’m so glad we finally could nail down a time for the audio interview, and I have a feeling we’ll have you here again one day. Paul Feuerstein: That would be great, Rich, and just keep up what you’re doing cause it helps me in my practice, to be honest with you. You’re one of the people I look forward to seeing through reading your information. I get your daily email blast. It’s great for me too as a practicing dentist, so thanks so much for what you guys do.
Richard Madow: You got it. Talk to you soon.
Paul Feuerstein: All right, Rich.
Richard Madow: Bye.