EXHIBIT 4.2(b)


                FIRST AMENDMENT TO NOTE AGREEMENT

      This First  Amendment,  dated as of  September 1, 2001 (the
or this  "First  Amendment")  to the Note  Agreement  dated as of
March   1,   2001   described    below,   is   between   Dentsply
International Inc., a Delaware  corporation (the "Company"),  and
each of the Purchasers  party to the Note  Agreement  referred to
herein (collectively, the "Noteholders").

                            RECITALS:

A.    The Company  and each of the  Noteholders  have  heretofore
entered into a Note Purchase and Private Shelf  Agreement,  dated
as of March 1,  2001 (as in effect  from time to time,  the "Note
Agreement").  Pursuant  to the Note  Agreement,  the  Company has
heretofore  issued  (i)  its  Series  A  Notes  in the  aggregate
principal  amount of 82,450,000  Swiss Francs and (ii) its Series
B Notes in the aggregate  principal  amount of  84,400,000  Swiss
Francs,   maturing,   in  each  case,  on  March  1,  2007.   The
Noteholders   are  the   holders  of  100%  of  the   outstanding
principal amount of the Series A Notes and the Series B Notes.

B.    The  Company  and  the  Noteholders  now  desire  to  amend
certain  provisions  of the Note  Agreement as of the date hereof
in the  respects,  but  only  in the  respects,  hereinafter  set
forth.

C.    Capitalized  terms used  herein  shall have the  respective
meanings  ascribed  thereto in the Note  Agreement  unless herein
defined or the context shall otherwise require.

D.    All  requirements  of law have been fully complied with and
all  other  acts  and  things   necessary   to  make  this  First
Amendment a valid,  legal and  binding  instrument  according  to
its terms for the  purposes  herein  expressed  have been done or
performed.

      NOW,  THEREFORE,  in  consideration  of good  and  valuable
consideration  the  receipt  and  sufficiency  of which is hereby
acknowledged,  the Company and the  Noteholders  do hereby  agree
as follows:
SECTION 1. Amendments.

Paragraph  5H of the  Note  Agreement  shall  be  and  is  hereby
amended in its entirety to read as follows:

           "5H. Intercreditor  Agreement.  The Company  covenants
      that on or before  September 30, 2001,  the agent under (on
      its own behalf and as agent on behalf of each lender  party
      to)  both  of the  Bank  Agreements  shall  enter  into  an
      intercreditor  agreement with Prudential and each holder of
      Notes which shall be in form and  content  satisfactory  to
      Prudential;   provided  however  that,  in  the  event  the
      Company replaces,  refinances or extends the term of either
      or both Bank  Agreements with a facility or facilities that
      either  (a)  require  guaranties  by  Subsidiaries  of  the
      Company or (b)  provide  that  Subsidiaries  of the Company
      may be borrowers  thereunder,  the Company shall cause each
      lender party to any such facility to  simultaneously  enter
      into   a   replacement    intercreditor    agreement   (the
      "Intercreditor  Agreement") with Prudential and each holder
      of Notes which shall  include  terms no less  favorable  to
      each holder of Notes than those  referenced  on the summary
      of  intercreditor  terms attached  hereto as Exhibit E, and
      shall  in  any  event  be  in  form,   scope  and   content
      satisfactory to Prudential."



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Paragraph  6A(3) of the  Note  Agreement  shall be and is  hereby
amended in its entirety to read as follows:

           "6A(3)    Debt  and  Priority  Debt  Limitations.  (i)
      The ratio, expressed as a percentage,  of Consolidated Debt
      to  Consolidated  Capitalization  to exceed  (a) 55% at any
      time during the period  commencing  on the Series A Closing
      Day and  ending on  August  30,  2001,  (b) 65% at any time
      during the period  commencing on August 31, 2001 and ending
      on  December  31,  2002,  (c) 55% at any  time  during  the
      period   commencing  on  January  1,  2003  and  ending  on
      December 31,  2003,  or (d) 50% at any time  thereafter  or
      (ii) the  aggregate  amount of Priority Debt to at any time
      exceed 15% of Consolidated Net Worth."

Paragraph  6B(8) of the  Note  Agreement  shall be and is  hereby
amended in its entirety to read as follows:

"6B(8)     Sale-and-Leasebacks.   Enter  into  any   transaction,
directly or  indirectly,  whereby it shall sell or  transfer  any
property,  if at  the  time  of  such  sale  or  disposition  the
Company or any Subsidiary  intends to lease or otherwise  acquire
the right to use or possess  (except by purchase)  such  property
or like  property for a  substantially  similar  purpose (a "Sale
and Leaseback Transaction") except:

                (i)  any  Sale  and  Leaseback   Transaction   in
           which  the  property  is  sold  by  the  Company  to a
           Subsidiary  or  by a  Subsidiary  to  the  Company  or
           another Subsidiary, or

                (ii) the  Company  or any  Subsidiary  may  enter
           into  any  Sale and  Leaseback  Transaction  if (a) at
           the time thereof and  immediately  after giving effect
           thereto no Default  or Event of  Default  shall  exist
           (including  any  Event  of  Default  under   paragraph
           6A(3)(ii))  and  the  proceeds  from  the  sale of the
           subject  property  shall be equal to not less than 80%
           of its fair  market  value (as  reasonably  determined
           by the Company's Board of Directors); or

                (iii)following   the   acquisition   of   DeGussa
           Dental  Group  by the  Company  or one or  more of its
           Subsidiaries,  any  one or  more  Sale  and  Leaseback
           Transactions,  in an aggregate  equivalent  amount not
           to  exceed   US$100,000,000,   with   respect  to  the
           precious  metals  owned by Degussa  Dental Group prior
           to such  acquisition;  provided that any such Sale and
           Leaseback   Transaction  shall  be  entered  into  and
           effective no later than June 30, 2002; or"

The  following  shall be added as a new  Paragraph 6C of the Note
Agreement:

                "6C. Subsidiary  Accounts/Cash  Management.   The
           Company  will not permit any  Subsidiary  party to the
           Subsidiary  Guaranty  to  establish  or  maintain  any
           deposit,  checking or other account with any financial
           institution  that is a party to  either or both of the
           Bank   Agreements;   provided   however,   that   such
           Subsidiaries   may   continue  to  maintain  any  such
           accounts  that  were  in  existence  on the  Series  A
           Closing  Day in  accordance  with the  Company's  cash
           management   practices  in  effect  on  the  Series  A
           Closing  Day;  provided  further,  however,  that  the
           aggregate daily positive balances  maintained  therein
           on any day shall not exceed US$1,000,000."



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The  definition of "Bank  Agreements"  set forth in Paragraph 10B
of the Note  Agreement  is  hereby  amended  in its  entirety  to
read as follows:

           "Bank  Agreements"  shall  mean  (i) the  $250,000,000
      Facility A 364-Day  Competitive  Advance,  Revolving Credit
      and Guaranty  Agreement dated as of May 25, 2001, among the
      Company and the other Persons named as parties thereto,  as
      amended or otherwise  modified from time to time,  (ii) the
      $250,000,000   Five-Year  Competitive  Advance,   Revolving
      Credit  and  Guaranty  Agreement  dated as of May 25,  2001
      among the  Company and the other  Persons  named as parties
      thereto,  as amended  or  otherwise  modified  from time to
      time  and  (iii)  the  Revolving   Credit  Agreement  dated
      September 9, 1994,  among the Company and the other Persons
      named as party thereto,  as amended otherwise modified from
      time to time.
SECTION 2. Supplemental interest payments.

(a)   In  consideration  of the agreement of the  Noteholders  to
consent to amend the Note  Agreement  in the  respects  set forth
in  Section 1  hereof,  the  Company  hereby  agrees  to pay,  in
addition  to the  interest  payable  in  respect  of the Series A
Notes and  Series B Notes  pursuant  to the  respective  terms of
such  Notes  and of the Note  Agreement  as in effect on the date
hereof,  supplemental interest  ("Supplemental  Interest") on the
respective  unpaid  principal  balances of the Series A Notes and
Series B Notes  from and after  the date  hereof,  in  accordance
with this Section 2.



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           (b)  The  Supplemental  Interest payable on the Series
A Notes  and  Series B Notes  for any day from and after the date
hereof  shall be and mean  interest  (computed  on the basis of a
360-day  year   consisting  of  twelve  30  day  months)  on  the
respective  US  Dollar  Equivalent  (as  defined  below)  of such
unpaid  principal  balances at the  corresponding  rate per annum
set forth in the table  below,  determined  by  reference  to the
respective  ratings from time to time  assigned to the  Company's
long-term,  senior,  unsecured  debt (which is not  guarantied or
subject  to any other  form of credit  enhancement)  by  Standard
and Poor's  Ratings  Group and Moody's  Investor  Service,  Inc.,
and published by the applicable rating agency:


           -------------------------------------------------

           Applicable Debt Ratings  Supplemental Interest
           -------------------------------------------------
           -------------------------------------------------

              BBB+ or Baa1 (or              0.40%
                  higher)1
           -------------------------------------------------
           -------------------------------------------------

                BBB or Baa21                0.60%
           -------------------------------------------------
           -------------------------------------------------

              BBB- or Baa3 (or              1.00%
                  lower) 1
           -------------------------------------------------


           1    In the  event of a split  rating,  the  higher of
                the two ratings  will  determine  the  applicable
                Supplemental Interest.

           (c)  Supplemental   Interest   shall  be   payable  in
arrears  on each  March 1, June 1,  September  1 and  December  1
subsequent  to the  date  hereof  in US  Dollars  in  immediately
available funds by wire transfer for credit to:

                Prudential      Managed
                Account
                Account             No.
                890-0304-391
                The Bank of New York
                New York, New York
                (ABA No.:  021-000-018)


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Each such wire  transfer  shall also  reference  the name of the
Company,  and the following  information for the applicable Note
to which  such  payment  applies  " _____%  Series  __ Notes due
____________,  Security No. !INV ____!, PPN _____",  and the due
date and  application  (Supplemental  Interest)  of the  payment
being made.

           (d)  For   purposes   hereof,   the  term  "US  Dollar
Equivalent"  shall mean the amount  determined by converting  the
aggregate  outstanding  Swiss  Franc  balances  of the  Series  A
Notes  or  the  Series  B  Notes,  as the  case  may  be,  to the
equivalent  in US Dollars  using a rate of exchange of (a) in the
case of the Series A Notes,  1.649 Swiss  Francs/1.000 US Dollars
and  (b)  in  the  case  of  the  Series  B  Notes,  1.688  Swiss
Francs/1.000 US Dollars.

           (e)   Changes in the applicable  Supplemental Interest
rate shall become  effective on the fifth  Business Day following
the  date  Standard  and  Poor's  Ratings  Group  and/or  Moody's
Investor  Service,  Inc.,  as the  case  may  be,  publishes  the
relevant change in its applicable rating.
SECTION 3. REPRESENTATIONS AND WARRANTIES.

      3.1  As of the date this First Amendment  becomes effective
pursuant to the  provisions  of Section  4.1 hereof,  each of the
Company and each  Subsidiary  party to the  Subsidiary  Guaranty,
jointly and severally,  represent and warrant to the  Noteholders
as follows:

           (a)  There   are  no   set-offs,   claims,   defenses,
      counterclaims,  causes  of  action,  or  deductions  of any
      nature  against  any  of the  obligations  under  the  Note
      Agreement  or the  Subsidiary  Guaranty or evidenced by the
      Notes.

           (b)  After  giving  effect  to  the  amendments   made
      herein:  (i) no Event of Default  and, to the  knowledge of
      the Company and the  Subsidiaries  party to the  Subsidiary
      Guaranty,  no Default, has occurred and is continuing,  and
      (ii)  the  representations  and  warranties  set  forth  in
      Paragraph 8 of the Note  Agreement  and  Paragraph 5 of the
      Subsidiary  Guaranty  are true and correct on and as of the
      date this First Amendment  becomes  effective with the same
      force and  effect as though  made on such  date,  except to
      the  extent  that  any  such   representation  or  warranty
      expressly relates solely to a previous date.
SECTION 4. Miscellaneous.

Upon the date  that the  Noteholders  shall  have  received  from
each  of  the   Company  and  the   Subsidiaries   party  to  the
Subsidiary  Guaranty a  counterpart  hereof  signed by such party
or   facsimile   or   other   written   confirmation   (in   form
satisfactory  to the  Noteholders)  that such  party has signed a
counterpart  hereof,  this First Amendment shall become effective
as of the date hereof.

This First  Amendment  shall be construed in connection  with and
as part  of the  Note  Agreement,  and  except  as  modified  and
expressly   amended   by  this   First   Amendment,   all  terms,
conditions  and  covenants  contained in the Note  Agreement  and
the Notes are  hereby  ratified  and shall be and  remain in full
force and effect.

Any  and  all   notices,   requests,   certificates   and   other
instruments  executed  and  delivered  after  the  execution  and
delivery  of  this  First   Amendment   may  refer  to  the  Note
Agreement  without  making  specific   reference  to  this  First
Amendment  but  nevertheless  all such  references  shall include
this First Amendment unless the context otherwise requires.



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The  descriptive  headings  of the  various  Sections or parts of
this  First  Amendment  are for  convenience  only and  shall not
affect  the  meaning  or  construction  of any of the  provisions
hereof.

This  First  Amendment  shall be  governed  by and  construed  in
accordance with New York law.

The execution  hereof by you shall  constitute a contract between
us for the uses and  purposes  hereinabove  set  forth,  and this
First  Amendment  may be executed in any number of  counterparts,
each  executed  counterpart  constituting  an  original,  but all
together only one agreement.

Each of the  Subsidiaries  of the Company party to the Subsidiary
Guaranty  hereby  joins in this First  Amendment  to evidence its
consent  hereto,  and each such  Subsidiary of the Company hereby
reaffirms its  obligations  set forth in the Subsidiary  Guaranty
and in each other  document  given by it in  connection  with the
Note Agreement and the Notes.

This  First  Amendment  shall be  governed  by and  construed  in
accordance with New York law.

                               [BORROWER:]

                               DENTSPLY INTERNATIONAL INC., a
                               Delaware corporation


                               By:
                               Name: William R. Jellison
                               Title: Sr. VP and Chief
                               Financial Officer


                               By:
                               Name: William E. Reardon
                               Title: Treasurer


                                [GUARANTORS:]

                               CERAMCO INC., a Delaware
                               corporation


                               By:
                               Name: William E. Reardon
                               Title: Treasurer


                               CERAMCO MANUFACTURING CO., a
                               Delaware corporation


                               By:
                               Name: William E. Reardon
                               Title: Treasurer




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                               DENTSPLY INTERNATIONAL
                               PREVENTIVE CARE DIVISION L.P., a
                               Pennsylvania limited partnership


                               By:
                                   Dentsply International Inc.,
                                   a Delaware corporation, its
                                   general partner


                                   By:
                               Name: William E. Reardon
                               Title: Treasurer


                               G.A.C. INTERNATIONAL, INC., a
                               New York corporation


                               By:
                               Name: William E. Reardon
                               Title: Treasurer


                               MIDWEST DENTAL PRODUCTS CORP., a
                               Delaware corporation


                               By:
                               Name: William E. Reardon
                               Title: Treasurer


                               RANSOM & RANDOLPH COMPANY, a
                               Delaware corporation


                               By:
                               Name: William E. Reardon
                               Title: Treasurer


                               TULSA DENTAL PRODUCTS INC., a
                               Delaware corporation


                               By:
                               Name: William E. Reardon
                               Title: Treasurer




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                               DENTSPLY FINANCE CO., a Delaware
                               corporation


                               By:
                               Name:
                               Title:


                               DENTSPLY RESEARCH & DEVELOPMENT
                               CORP., a Delaware corporation


                               By:
                               Name:
                               Title:


ACCEPTED AND AGREED TO:

THE PRUDENTIAL INSURANCE
COMPANY OF AMERICA


By:______________________________
     Title:

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