In my opinion a product can only be judged by the service and aftersales support you receive once you have the equipment. If you buy a BMW and receive bad service you will feel that you have made a bad judgement in it,s purchase, but the fact is a BMW is a great car. The same applies to purchasing high tech dental equipment. Peace of mind in service and support is invaluable and priceless. However the best way to consider this investment is ROI, the initial price is irrelevant when you consider the financial returns. If something cost you a 100,000 pounds but returned you 200,000 pounds that would be considered a good investment. 3 questions need answering when investing in high tech dental equipment, does it have a benefit to the patients, does it have a benefit to the doctor and does it give a good return on investment. With the Biolase dental Laser all 3 are a great big YES. so i would say go ahead invest in a new Waterlase, this technology is still fairly new in the UK so you have a tremendous chance to make a real point of difference. You have already made the first investment in the Mark colonna seminar, may i highly recommend a couple more the marketing books by Dr Rod Kurthy and the clinical DVD by Dr James Jesse.  
Best Wishes
Mark Babb
Dental Medical Technologies
New Zealand  

Hi Glenn,

Here’s some stuff I was able to dig up.  You were dead-on right about being cautious with the Flagyl on the liver and for patients on Coumadin.

1.  Rocephin (Ceftriaxone sodium)  is a sterile, semisynthetic, broad-spectrum cephalosporin antibiotic for intravenous or intramuscular administration.

Microbiology: The bactericidal activity of ceftriaxone results from inhibition of cell wall synthesis. Ceftriaxone has a high degree of stability in the presence of beta-lactamases, both penicillinases and cephalosporinases, of gram-negative and gram-positive bacteria.

2.  Augmentin® (Amoxicillin and Clavulanic Acid) is a brand name for the drug amoxicillin/clavulanate potassium.

Augmentin is used in the treatment of lower respiratory, middle ear, sinus, skin, and urinary tract infections that are caused by certain specific bacteria. These bacteria produce a chemical enzyme called beta lactamase that makes some infections particularly difficult to treat. It’s also used for other infections as long as the bacteria turns out to be susceptible to Amoxicillin.

Amoxicillin is a semisynthetic antibiotic with a broad spectrum of bactericidal activity against many gram-positive and gram-negative microorganisms. Amoxicillin is, however, susceptible to degradation by b-lactamases and, therefore, the spectrum of activity does not include organisms which produce these enzymes. Clavulanic acid is a b-lactam, structurally related to the penicillins, which possesses the ability to inactivate a wide range of b-lactamase enzymes commonly found in microorganisms resistant to penicillins and cephalosporins. In particular, it has good activity against the clinically important plasmid mediated b-lactamases frequently responsible for transferred drug resistance.

3.  Flagyl is Metronidazole (MET).  It is an antiprotozoal.  It is also used to treat anaerobic infections.  It is a Narcan or Antibuse analog so it will make the patient sick with ethyl alcohol.

Metronidazole is the drug of choice for subgingival plaque consisting primarily of anaerobic Gram-negative rods and spirochetes. It is bactericidal rather than bacteriostatic, which allows it to function effectively independent of the host defense system.

The hydroxymetabolite of metronidazole (produced in the human liver) is even more active against A. actinomycetemcomitans in vitro, and has been shown to act synergistically against A. actinomycetemcomitans. In addition, both metronidazole and its hydroxymetabolite act synergistically with amoxicillin. Metronidazole covers most anaerobes, and amoxicillin most facultative and aerobic bacteria, making this combination useful for many mixed periodontal infections. Recommended doses of metronidazole are 250 to 500 mg TID for 7 to 10 days.304

Contraindications. Some objections to use of metronidazole are gastric discomfort, severe diarrhea, and bitter taste. A significant GI reaction may occur if metronidazole is taken in conjunction with alcohol, since MET has an antabuse effect.  Flagyl should be used with caution in patients with liver disease.

Source: Journal of Periodontology, Annals Vol. 1  (491 – 566): Section 5B: Non-Surgical Pocket Therapy: Pharmacotherapeutics  Connie Hastings Drisko

Do not drink alcohol while taking Flagyl and for at least 72 hours after last dose.

If Flagyl is taken with certain other drugs, the effects of either could be increased, decreased, or altered. It is especially important to check with a physician before combining Flagyl with any of the following:

Blood thinners such as Coumadin
Cholestyramine (Questran)
Cimetidine (Tagamet)
Disulfiram (Antabuse)
Lithium (Eskalith)
Phenobarbital
Phenytoin (Dilantin)

Bob

Glenn,

I think what I like best about this case is the great “micro-dentistry” diagnosis. With the scope you are able to diagnosis and perform the dentistry on a much smaller scale.

I would like to share a tid-bit I learned from an “old timer” (even older than me) about why we place a “watch” on that decay. It shows how change comes hard and with some difficulty. Years ago – before carbide burrs and highspeed handpieces – the only burrs were steal and the handpieces were belt driven. You may have seen some of these in the museum. The surface of the healthy enamel was very difficult to penetrate with a steal burr but if you would wait until the decay was big enough so that the steal burr could get into it then you could undermine the enamel and it was easier to break away the healthy part and you could get a decent prep – even extension for prevention with this method. Times have changed and we need to stop “holding our horses” for our howitzers now.

Thanks again Glenn for practicing outside of the box and for sharing with us.

Haven’t heard of anything like that, Keep us updated.

I wonder if a new batch of “bad” tips are on the market. I know that has happened before. I really try to fire the laser out of the patients mouth prior to starting any procedure, and look for the everfrearful white spark. Sometimes the tips blow from the inside out, if you are just near an metallic surface, i.e. crown/amalgam. I had that happen yesterday, and sure enough, bad tip, replaced and kept on working. Kept me from blowing fiber/handpiece. Seriously though, I wonder what’s happening to you guys, full moon in that part of the country? Hope you are both back lasering soon.
Mark