Episode 819: SDF in Dentistry: Why More Dentists Are Taking Notice

Now when I see those incipient lesions when the kids come back that I have are college age,
I get them in the chair. I get super floss. I run it to the foam part is right below the contact
area. I wet the foam with the liquid silver fluoride and then I floss it and scrub it up and down
on those incipient lesions and I arrest them on the spot.
Welcome to Austin, Texas, and welcome to the Dr. Phil Klein Dental Podcast. I'm sure you've heard of
that crazy medicament called SDF, silver diamond fluoride. You paint it on decay,
and like magic, it kills the bacteria and remineralizes the tooth, just like new.
You don't even need a filling. Well, not exactly. But in reality, SDF is a pretty remarkable
medicament that can do some extraordinary things to benefit our patients. In this episode,
we're going to look at the science behind SDF and how you can get the most out of this relatively
misunderstood and underutilized treatment. And to help us do that, we're talking with a general
dentist who is so excited about what SDF can do for patients that he's been lecturing about it for
more than seven years. Our guest is Dr. Timothy Bizga. a practicing dentist, educator,
and speaker from Cleveland, Ohio. He is a graduate and adjunct faculty member of the University of
Michigan School of Dentistry. Dr. Bizga combines decades of clinical experience with a passion for
leadership, education, and personal development. So let's find out what makes SDF so remarkable and
whether it deserves a bigger place in your clinical toolkit. Before we get started, I'd like to
thank all of you for tuning in. If you're enjoying the show, please follow us on Apple Podcasts and
Spotify, and even better, leave a review. By doing so, you're not only showing support for what we
do here, but your reviews are instrumental in getting more dental professionals to listen and
benefit from our content. We really do appreciate it. Dr. Bizga, welcome to the show. It's great
to be with you, Phil. Thanks for having me. Yeah, pleasure to have you on the show. Before I turn
the mic over to you with a bunch of questions, Dr. Bizga, I want to set the stage for this episode
by briefly addressing a few things. First, the history of SDF. And I also want to bring in some key
essentials related to dentin, dentinal caries, and what SDF is actually doing when it's clinically
used. So for some of us, SDF may seem like a relatively new material in dentistry,
but actually it's not. It's been around for more than 50 years. It was developed and introduced in
Japan in the 1960s, and it became an approved commercial product over there in 1970.
And it didn't arrive in the US until much later. It wasn't until 2014 when SDF was...
by the FDA as a desensitizing agent, and it became commercially available for dental use in the US
in 2015. So it's only been available here for about 11 years in the United States.
Now to fully grasp the benefits of STF, we have to understand the substrate it's working on,
and that's dentin. Dentin is about 70% mineral by weight, 20% organic material,
and 10% water. That's all by weight. That organic component is primarily type 1 collagen.
And that collagen is super important because it acts as a structural scaffold of the dentin.
When caries develops, we all know acid dissolves the mineral. So we're left with the collagen part
of the dentin. Unfortunately, in addition to that demineralization, our own host enzymes can
subsequently break down that exposed collagen, which is a bad thing because we're essentially
losing the scaffolding that we need for remineralization. So this is where SDF comes in.
It basically attacks this problem from several directions. From the silver side, silver has the
antimicrobial effects, helping to suppress the microbes that are producing the acid.
In addition, silver can inhibit our natural enzymes from degrading collagen.
Then we have the fluoride component of SDF, which promotes remineralization of the collagen matrix,
and that remineralization becomes highly resistant to acid attack. So as clinicians,
rather than simply removing all the carious tissue, SDF can help arrest the disease process,
suppress the bacteria, protect the collagen matrix, and promote remineralization of the...
affected dentin. And that's what makes FDF so intriguing. It's not just about killing bacteria,
it's helping to stabilize the entire carious lesion and remineralize the tooth. So with that brief
history and overview, let me turn it over to you, Dr. Bizga, and ask you this. Silver Diamond in
Florida has been called one of the most important advances in minimally invasive dentistry. What
ultimately convinced you to make SDF part of your clinical toolkit? It was because a good friend
and colleague told me I needed to try it. That's exactly why I got involved with it.
He said, Tim, this is something that's relatively new. I think it's pretty exciting.
And, you know, he explained to me, it's not really a moneymaker, but it's a really great service
that you can add into your toolbox.
Checked it out. And as you beautifully laid out, Phil, I came to understand this wasn't something
that was new. It was actually had a long history. It was just new to the United States.
And as I understand it, it came into this country through the Oregon health system. And they sort
of brought it in and started using it. And it started spreading across the country because it has a
lot of utility. And so I began deploying it in many different scenarios throughout my practice
across different populations. There's a, I sort of think,
a misnomer within the dental community that this is reserved just for treatment of children or
incipient caries, but I have found that it's very useful in adult and geriatric populations.
And as a general practitioner, I treat from cradle to grave and I have,
you know, families that bring in their children when they pop their first teeth to, you know,
people that are coming here and walkers and canes, et cetera. So I, I treat across the board and,
you know, we have great products available to us in dentistry today, but sometimes they fall short
of. what you need them to do. And I found this to fill a great void within my toolbox.
And I have used it since I believe 2018 is when I think I started putting this into use.
So I have a pretty good history with it. Man, I've seen some really remarkable results.
Yeah. And I'm glad you mentioned that it's not just for incipient decay and it's not just for pedo
cases. The reality is you can use this in a deep cavity where you're getting really close to the
pulp. And when you're in that proximity, instead of exposing the pulp or leaving practically no
dent in it all as a barrier, you could use SDF to arrest the caries in its tracks and preclude the
need for endodontic therapy. In many cases, avoid the continued sensitivity that patient's having
as the... effect is taking place and the remineralization takes place, the patient's going to feel
more comfortable. And now you're left with a better barrier protecting the pulp. It's just a
phenomenal service to the patient. Now you mentioned that the colleague that told you about STF
mentioned to you that, you know, it's... do you feel that that might be a reason why it's not being
adopted at a greater level than it is uh across the profession no i i have found that when i'm out
and i'm teaching about this subject people get excited but i've just found you know they they get
energized they think oh this is pretty cool because i demonstrate a variety of cases in my lecture
series that you know, shows the utility of the product and how you can use it in a variety of
different instances that really are great, not only for the patient,
but they make you feel good because they are truly minimally invasive. And I'm going to back up a
little bit about what you said. So I heard a lecture years ago from Franklin Tay, who's an
endodontist, about how even if we clean, You can't see clean on an x-ray.
You can't really see clean with your visual eye. We do our best to train to remove caries,
you know, visually, tactilely. But there are bacteria that are still behind that we can leave in
there and they can cause problems, as you've alluded to. What's neat about this is... I think the
zone of penetration in the dentin is about three millimeters. So you can realistically,
this is going to penetrate fairly deep and it's going to decontaminate,
if you will. It's going to, the fluoride levels are so high, the bacteria. I describe it as like a
nuclear bomb goes off. They're just completely destroyed. And then you get this impregnation of
silver that goes down into the tubules and then it can remineralize.
And as you said, harden tissue that is at one time soft and leathery.
And you can save that tissue and you can then go and begin building a restorative treatment plan on
top of it, knowing that the bacteria is taken care of. the material itself that you've placed is
actually strengthened the tooth. And that's pretty cool. And the only thing I would say is in order
to achieve those kind of levels, it isn't one treatment. You do need to do multiple treatments on
an area to sort of know that you're going to get the maximum benefit for the long haul if that's
what you're going for. When you say multiple treatments, multiple treatments of SDF or letting SDF
do its thing and then bringing them back to restore? Correct. So I do multiple treatments.
It's never for me a one-time placement. And then now if it's like they come in and I'm going to do
an immediate restorative to fill a large hole just to like seal it up as an interim or a sedative
fill, I'll place SDF. I'll leave it on for several minutes to make sure I get a good penetrance and
good soak, if you will. I'll air dry it. There's no rinsing of the product. And then I'll place a
type two auto cure type glass ionomer restorative. You don't want to use any light cure materials
when you do this protocol because the heat from an LED curing light can prematurely set the silver
and it'll precipitate. at the surface instead of penetrating deeper into the tooth tissue,
which is where you want it. So you want to go with auto setting materials like IRM or Tempit,
which is a really great solution that's in a compule or glass ionomer cement.
If the tooth is open and let's say there's multiple lesions and this is like a case where it's
almost like the decay, there's so much of it, it's hard for you to get ahead of it. What I like to
do is I'll bring them in for multiple treatments and that way I can treat multiple sites. They're
about a week apart, ideally. That way it has its chance to do its thing. And then we can do some
minimal caries removal if we want to make it more cosmetic. And then we can begin covering.
Or in the deeper areas, I'll just leave it as is. And I know that not only is the bacteria
arrested, but we also have this impregnation of silver. But that takes a good couple of coats,
if you will. One pass at it isn't really going to give you that long-term effect that you're going
for if you're going for a resting. of the decay. So when I talk to different dentists about their
methodology in terms of removing the decay, I get different responses.
Some dentists still want to go down to squeaky clean dent and then they use the SDF. Others say,
absolutely not. Do not remove all the decay. Leave the leathery dent because that's the part that
can be remineralized. And then you have this extra protection and you avoid the exposure.
And again, it depends on how big the cavity is, how much decay there is, where it is,
the age of the patient. What do you typically do clinically when it comes to removing the decay in
preparation for SDF? Well, for me, I try to get as much as I can.
All right. So I try because anything that you're leaving within without being too,
you know, so the way I describe it is if you ever cleaned a toilet bowl.
And I hope many of you have had a chance who are listening to at least once in your life clean a
toilet bowl. And I tell everybody, clean the rim underneath the bowl,
clean the sides of the bowl, leave the deepest portion of it. That's the part I won't touch.
The very, very deepest part. If I'm worried it's going to unhorn, uncap a pulp horn,
or we're going to be getting, depends on the age of the patient too. If they're 65 and above.
they're probably not going to have a chance of an exposure. If they're 19 years old,
I'm probably going to leave a little bit, arrest the decay, and then we can move on and do
restorative treatment, you know, over the top of it. And there's a whole, you know, bunch of
materials that you can go with after that.
That's sort of if that gives you a visual picture or the listeners a visual picture, it's like
cleaning a toilet bowl. Yeah, that is a very visual picture, not one I've ever heard before,
but very visual picture. Do you show that in your lectures that I do that analogy with photos?
I do. I do. You must get quite a response. Well, people get excited because dentists are looking
for opportunity. We are weird people. We are very weird people. They like to add tools in the
toolbox, Phil. And when they see it demonstrated and see what you can do and what's possible, there
are people that this fits very nicely into treatment protocols that you can provide.
Right. But as far as patient education, you leave those visuals out. Oh, yeah. I mean,
they don't need to understand how to fly the plane. They just care if you take off and land safely.
Right. You know, I'm not up in the cockpit doing the 32 or 54 point check that he is,
but I trust that he knows what he's doing. Yeah. Yeah. I was talking about the toilet bowl analogy,
but that would be not part of patient education. Right. Right. So let me let me ask you this.
When we were in dental school or when I was, I'm older than you are. When I was in dental school,
we were taught to remove all the leathery dentin, take it all. But now that we understand how STF
works and what it needs to work with, should we change our game plan as far as the removal of decay
and be exceptionally sensitive to the leathery decay or the affected dentin,
which we talked about already, why that's important, and make sure we don't remove all of that when
we're excavating in preparation for STF? interesting thing, at least my approach to it,
Phil, is it's not a one size fits all. There are scenarios like in my head,
what you were describing, where I would say, let's say I have a 14 year old who tooth number 19,
their six year molar that's only been in their mouth, you know, less than a decade.
And it has a bombed out occlusal. It is vital. And my thought process is I want to avoid or kick
the can of endodontic therapy as far down the road as possible. Well,
in that case, I'm going to begin by SDF treating. not, I'm going to penetrate,
especially if there's some of that enamel's gone and I can really see that soft and leathery lesion
kind of poking its head. I'm going to let it absorb. I'm going to treat it a couple of times and
then I'm going to go in and I'm going to begin, you know, restorative treatment and hopefully. with
enough penetrance, I'm going to be able to be more conservative in how much tooth structure needs
to be removed before placing a more definitive restorative. And I know then the bacteria is
arrested and I've stabilized as much of that broken down tooth structure to keep that pulp tissue
alive. and kick that can down the road. That scenario might be different,
though. I'm using this more as I'm putting out wildfires of caries that's going on.
Initially, I may paint and spread this material around to all the lesions to begin arresting it,
regardless of caries removal. But in my thinking, The best thing to do in the long run is to do
normal restorative treatment that we're taught, which is numb the patient, drill,
get access, clean DEJ, get as much of the material out. So I don't want this to sort of feel like
we're disregarding for normal restorative therapy that we're taught, which is sound and has years
of research. This is for those scenarios where maybe moving to that step initially might put it
more at risk for endodontics. Right. And I want to pump the brakes and use this as a let's try to
stabilize, get the bacteria levels down and be a little smarter about our approach.
Right. Does that make sense? Yeah, that makes total sense. And I think I alluded to that a little
bit in what I said earlier, and I agree 100%, especially as being an endodontist for my career.
So one of the things dentists seem to think is that STF is for pedo patients,
strictly pedo patients, usually the patients that are very high risk, those patients that aren't
particularly cooperative. So to do a procedure and get the patient numb and...
to restore a primary tooth, even with a stainless steel crown, would be quite challenging. What's
your response to the dentist that says, yeah, I have it for pedo cases, but I'm not going to use it
on the typical adult patient because I practice traditional dentistry? So I'm never trying to,
I guess, convince my colleagues that maybe the way you're doing that is incorrect.
I shy away from trying to do that. My suggestion is more towards enlightenment,
and I describe the scenarios like root caries on geriatric patients who,
as we know, the amount of medications that our elderly patients are on is just...
rising. There's a lot more combination therapy and they all have xerostomia as a side effect.
And as soon as we get those changes in our soft tissues and it happens to everybody,
you're going to have root exposures from orthodontic therapy, toothbrush abrasion,
or just hormone changes as we age, the normative stuff that we all experience.
As the mouth changes, the person's biology, saliva flow,
the critical pH of cementum is 5.5 and it breaks down really quick.
And the options for traditional restorative on root isn't very good because the bond strengths are
just miserable. And so when you have an otherwise great tooth,
but they've got beginnings of root decay that you're seeing because, you know, they have some
exposure and some lateral plaque traps. What are you going to do? You know, there's traditional
restorative. I've done those. You end up creating more damage to the toot to get access to that
lesion than maybe is worth it. And the way I describe it is maybe the juice isn't worth the
squeeze. Yeah. No, no. Totally makes sense. And would you use a fluoride varnish once that SDF?
treatment is completed on the root surface? Yes. That's how you lock it in. Yeah.
Tell us about that. Cause that's really important that locking in effect. Yeah. How do you, I love
that. How do you lock it in? Yeah. So I use, you know, a fluoride varnish like fluoridose and I,
I choose a flavor. any flavor the patient you know we usually give them choice they have about you
know seven different flavors and which is great because giving choice gives patients a little bit
of control the reason is is silver fluoride tastes very metallic and so as soon as the saliva mixes
with it they go yeah and they taste it but i like it not only to flavor mask because you choose a
nice mint flavor cherry or whatever you got melon or going on It also,
the wax rosin, it locks in and it lets that SDF just sit in there and really dwell on that lesion
so you can get that max penetration. And so I love it for those things. And that's usually where
people go, wow, I didn't think about it. That's a great, I have tons of those cases and I really
don't love the options I have for treating them, you know, other than give them some Prevenant 5000
or some sort of fluoride toothpaste and hope that it doesn't advance. Right.
So it's not a great strategy. Right. No, this is a very clever strategy, very conservative.
And I totally agree. It's like heroics to go in there and try to restore this decayed root on an
elderly patient where the dentin is almost impossible to bond to. Tell us about how you apply the
silver diamine fluoride to the root surface. Like, how do you apply it for how long and so forth?
Okay, so the SDF liquid, once it's painted on, I try to leave that and agitate it,
move it around, scrub it within, you know, the... of where I'm trying to deliver the material with
some form of a micro brush. And they come in all shapes and sizes. So you really can't complain
that you can't get access because some of the micro brushes are so small, you can slip them right
underneath the gum tissue where a lot of these lesions live. And then the idea is to You're going
to think I was a plumber in another life. Here comes another analogy. Yeah, you plunge it,
just like plunging a toilet. And you plunge it up and down, and you can feel you're getting the
liquid in the microbrush into the lesion. A lot of these live subgingivally.
And that's where the analogy of like plunging a toilet comes in. You're getting it in there. You're
trying to move it around. And I try to let it dwell in there for at least two minutes.
So I usually go with cotton roll isolation. is four handed dentistry. You can do this on little
kids. They'll sit still for a minute or two. You're just telling them I'm painting medicine and
they sit still. Adults, I do the same thing. You know, you just explain I'm painting medicine and
we need to keep it dry and they're usually really good about it. And then after I let it. air dry a
little, and then I'll go ahead with my air water and I'll just make sure that there's no liquid
that's blowing around, let it dried off pretty good. And then I'll seal it with the fluoride
varnish. I dismiss them. That's it. And I, and if I'm doing a multiple treatments, like I said,
if it's root carries, I tell the three treatments, I want to have this three shots at this one week
apart. It can be two weeks if you got a vacation or work or something, but. I think it's best to do
multiple treatments to really get that impregnation of the silver where you know it's arrested and
you got a long-term success. So when they come back for that second treatment, does the fluoride
varnish that you originally placed over the STF the first time interfere with the second
application or is that gone already? They dissolve after they've eaten and chewed and brushed their
teeth. So when they come back, there's no varnish present. There's just the silver and the
fluoride. from your treatment and the lesion will then turn black. And the way I describe it,
even though this isn't the real process, it's like it's cauterized. All right. It's a liquid
cautery. You're painting this on the lesion will turn black when the magic has happened.
That's how we know that it's done its job. And so you may see the shadow of where you've treated,
especially if it's sub G, if it's above, you know, and it's on the clinical crown, you'll see it
turns black. And I've learned that if immediately upon application it turns black,
that's a highly metabolically active lesion that you're dealing with. If you apply it on and you
don't see it turn color before your eyes, it's not broken. That means it's less metabolically
active, so it's not uptaking as quick. But trust me, in a week when they come back, it'll be dark.
Right. And then what do you do then for the darkness? Nothing. You can leave the dark. You don't
have to remove it. That is your silver and your fluoride on the surface, your impregnation.
If this is a root caries situation where, you know, tough access,
I'm not going to be able to get a restorative material. I'll have them back. I'll reapply the SDF,
let it sit and dwell on that lesion as long as needed, one to two minutes dried,
and then I'll apply the... fluoride varnish again, dismiss them. And again,
it's for flavoring as well as to lock it in until they go home. And then the varnish will dissipate
over the next 24 hours. And by the time they come back in a week, if they're getting a third
treatment, it'll be ready for the last treatment. Now on the patient that has gingival recession
with an exposed root, that becomes an aesthetic issue, especially on the lower anteriors.
So when they come back and it's dark, That means it's working. And medically,
it's great. I mean, that's what you're looking for. What happens when the patient says, this looks
terrible? All my lower teeth show when I talk. Now, of course, it didn't look great before because
they still had root exposure. Now it's dark or black. What do you do then? Okay,
I'll give you a story. Treating a four-year-old boy. And his mom and I have known each other for
years, since high school. And he had... his baby teeth,
he had some lesions that we treated, and he had them everywhere. And I told her after we had done
multiple treatments, we can leave the dark. We don't have to do anything. They're arrested. They're
baby teeth. They're going to shed in a couple years. The caries is taken care of. And the little
boy, he said to me, I want white. And so what did we do? He wanted white. He didn't want the dark
because he was aware at four years old, he didn't like the dark. So all I did is take a round burr
and I scooped the black part away. cleaned it out. And what's amazing is I did this without
anesthetic. Why? Because silver diamine fluoride is also a wonderful treatment for hypersensitive
dentin. Yeah. That's what FDA, that's, that's what it's approved for by the FDA desensitization.
Yeah. So you, you, you've got this wonderful effect. So we could scoop all that stuff out and then
we put some glass ionomer tooth colored restorations in because of the caries risk.
good material choice to get some extra fluoride release in those. And he did quite well until those
two shed. Now he's a teenager and it's great. They're space holders for the adult teeth.
And we didn't lose any of that leeway space. And it made a huge savings for the mother
orthodontically. Now, what do you say to dentists who say, you mentioned it earlier in this podcast
episode, there's no money in it. It's not profitable, but I don't. see it as being not profitable.
I think it's a great practice builder. And I think that patients appreciate the conservative nature
of your approach. What are these dentists thinking that they are missing out on going straight to
restorative work? Again, when I have found, and I have done lectures on this now,
I have a history of seven years of talking about this. And what I found is most people just weren't
aware of what the protocols are. Like, well, tell me what are the steps that I need to do?
How do I go about handling this? And that once they're shown,
the adoption goes up and people are now what I'm excited about is I am an adjunct professor at
University of Michigan where I attended dental school. They teach this in the school and the
students are doing this. There's now an awareness level coming in from the students that are new
graduates. And I feel like you're going to see this begin to catch wind over the next several years
where people, it's going to be more commonplace. It's going to be right in there. People are going
to be doing this with regularity. As I mentioned, it's only here 11 years. Do you think we're doing
okay as a profession, given that this, what I call medicine, I don't look at it as a dental
material. This is a medicine. It's antimicrobial. Would you say that we're doing fairly well in
adopting the use of SDF clinically based on the fact that it's been here 11 years,
or do you think it's been a slow slog to get here? I would say that I'm still surprised when I
raise my EICO how many people are deploying it. It's usually, I'd say, 40% of the room.
So I think we have room to grow still. You know, I'd still say we're in the adoption phase.
You know, we have people that, you know, I'd say when it first started, there wasn't enough of
well, what is this and what do we have here and how do you use it? And now people have been
deploying that and you've got people like myself who tell the great success stories of people
you've been able to help, cases that were otherwise unmanageable that now you were able to treat in
a very predictable way. That's easy to do. It's easy to do. That's what I love about it.
It's very easy to do. I tell people it is not a moneymaker because You know,
this isn't something that you're charging hundreds for. We're talking application is five cents an
application. OK, it's not costing us a ton. So you can't really bomb and gouge people for it.
And yet it is so satisfying with what you can do in terms of results and applications.
My favorite treatment, just to throw out. there because it happened to me. I was a college kid when
soon as I left mom and dad's care, I stopped doing what I normally was reminded every night before
bed, which is brush and floss. And because of that. All of my caries class two developed.
I got proximal decay. And what did my dad do? He just drilled and filled. And man, it could have
been a lot different. Now, when I see those incipient lesions, when the kids come back that I have
our college age, I get them in the chair. I get super floss. I run it to the foam part is right
below the contact area. I wet the foam with the liquid silver fluoride,
and then I floss it and scrub it up and down on those incipient. and I arrest them on the spot.
I prevent them from having issues when they go back to school and I remind them that they should
floss and at least once a week and I tell them there's two things you should do at least once a
week when you're at school. Floss your teeth and wash your sheets. I think that's a really good
thing to remind every college kid. That is good college advice. When you treat those incipient
lesions into proximally with silver diamine fluoride, they will remineralize to the point where you
don't have to do anything else as long as they continue to keep it clean. Is that correct? That's
right. No drilling. And they really don't get blackened because these are usually very,
very... pinpoint little notches you begin to see at the enamel encroaching near the DEJ where you
know breakdown's beginning to happen faster than remineralization. And it's just a matter of time
before they're going to end up and you're going to need to go in there and drill. And so I
remineralize and then hopefully we prevent because as soon as you lose marginal ridges,
that's when teeth begin to break down. And then we've got to call you, Phil, for the endo. Yeah, I
know. That's right. So I'm hoping, Dr. Bizga, that after this podcast, any of our skeptical
listeners may be more open-minded to using this medicine on their patients because it does offer,
as you've explained very well, tremendous advantages. And as far as your favorite, is SilverSense
still the one you use in your office? I do. That's what I use in my practice. And is that for the
flavor? Because they're all 38% silver diamond florida. No, no. SilverSense.
Any of the silver fluorides that you buy, they taste metallic and awful if you were to sample.
Okay, so there's no flavor in there. No, no. It has a slight bluish tint to it so you can see the
liquid and where you're applying it, and that's very helpful. And then what I do for the flavoring,
because it is nasty tasting for the patients. Right, the fluoride varnish. The fluoride varnish, I
use fluoridose. It comes in a multitude of flavors. We let the patient pick and we apply that after
it's dried. that leaves them with that fresh feeling.
And usually mint is the one most people go with, I find. And I do want to say, Dr. Bizga, before we
wrap it up, that it's great that you're going around lecturing for years on silver diamond
fluoride. I think it's a medicine that every single dentist should take seriously. A lot of KOLs
talk about a lot of great things. They talk about digital workflow and CBCT and chairside milling
and everything else. But this simple... procedure can be so impactful on the path a patient takes
in terms of their dental care. Because if incipient lesions especially can remineralize and you
never have to go further than that, I mean, that's a great thing. That really is a great benefit to
the patient. Any closing thoughts before we wrap it up? Give it a try.
If you haven't deployed it, I know that on, on YouTube, there's some great videos for application,
you know, protocols that, um, I've seen over time or ask a colleague or email Phil or myself,
you know, always were willing to share good news is shareable. That's why we talk about it because
it's, this is a, a something good for both your practice and your patients.
And, you know, I think it's worth a look. Anybody who's on the fence about it,
give it a shot. I think you'll be surprised at the utility. Yeah. You still friends with your
colleague who recommended to you way back? Yes, of course. Good, good. Of course. Thank him for me.
You probably know who he is. It's Dr. Lou Graham. Oh, yeah. I know him well.
Lou Graham. I know him well. Lou Graham is the man. He has been a great mentor to me and to many.
He's also a great speaker. And he was the one who turned me on to it before anybody was talking
about it. He likes to put his arm around me because you really need to get this in your practice. He
goes, you really need to take a look. This is something that is very useful and take a look.
And that's all he really said. And when Lou said something like that, I knew to take it serious.
And I thank him for it. All right, another episode down. And thank you all for listening out there.
Dr. Bizga, great conversation. Really enjoyed it. Hope to have you on the show again soon. I
appreciate you, Phil. Thank you.