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No Employees, Life Is Good! with Dr. Gigi Huynh a.k.a. 'tinker-bell' : Howard Speaks Podcast #31

12/16/2014 12:14:00 AM | Comments: 2 | Views: 1298

When Dr. Huynh’s employees quit on her, she realized she didn’t need them. Listen as Dr. Howard Farran interviews one of Dentaltown’s favorite townies about practicing solo, the perfect alginate impression, and much more!

Listen to the Show on iTunes
Click here to listen on iTunes

Listen to the Audio Here:

Audio Howard Speaks Podcast #31 with Gigi Huynh

Watch the Video Podcast Here:

Video Howard Speaks Podcast 031 Gigi Huynh

Links and References from the Show:
Misch Textbook
Arun Garg

Dr. Gigi Huynh's Bio:
Gigi Huynh D.D.S, private practice, Concord, CA. Gigi can be reached at concordsmile.com.

Transcript

Howard Farran: Okay today we have a special treat. No bones about it that on Dentaltown you are known as "tinker-bell". I tell everybody you are my favorite dentist in the whole world. While all the other practice management people talk about getting bigger, bigger and bigger and the average overhead is 65% and labor is 20% in rural America it is up to 25, 20 in the urban America. You are the only person I know, Gigi that has no employees. And you are also the only person I know that does all their lab work. You are also the only person I know you post impressions on removable, partials and dentures that are just mind-blowing. I am really, really looking forward to this interview. You graduated in 2007 from UCSF. You are in the San Francisco Bay Are, correct?

Gigi Huynh: Yes.

Howard Farran: First, let’s talk about why are you the only person I know that has no employees? And I bet you probably have the lowest overhead in town too.

Gigi Huynh: I think I probably have the lowest overhead in the country.

Howard Farran: What is your overhead?

Gigi Huynh: In terms of percentage? Probably about 35.

Howard Farran: 35? That is amazing. So how did you come to the conclusion that you wanted to be a full-service, by our self, no employees I would almost call it a dental spa. You are the doctor and when they come in they are only going to see or deal with you.

Gigi Huynh: Well, it’s by default. So I had two employees and one day they decided not to show up. I realized hey, life is better without them. The first month it was great because I make so much money and I didn’t have to pay anyone’s salary. I said hey, let’s keep it that way. I work shorter times. I get to go home earlier. Spend more time with my kids. I don’t have to stress out trying to get who does what they should do and check them back and all that stuff. It is like hey, life is great. I make more money that year then next year I start doing the same. But ever since I haven’t had employees I make more money and my practice keeps on growing. None of my patients left, so I said hey. Let’s do it this way.

Howard Farran: I think a lot of dentists don’t realize that basically their main mission in life is to create jobs. I mean I see dentists just running from room to room all day long and basically what they are working for is this huge payroll and then whenever you talk about overhead the last thing they want to do is make their own temporary or learn how to do any dentistry. There is Gigi, you do all of your own lab work. You also, how did you get so interested in removable? And what percent of your practice is removable?

Gigi Huynh: 70% is removable.

Howard Farran: Are you talking about break that down into full dentures versus partials.

Gigi Huynh: Not a lot of partials, Howard. Maybe 10 partials a year. The rest is just full dentures or dentures with locators or bars. But I try to minimize the partials department because first of all people don’t’ wear their partials. Second, it takes a long time to make. I try to get them into doing implants. If they are missing two or three teeth try to talk them into doing implants.

Howard Farran: Are you placing your own implants?

Gigi Huynh: I place a lot of implants. I place implants for many general dentists. I restore my own implants. So all days that I place my own implants I have a really good assistant that comes and helps me.

Howard Farran: How does one go about – you’re a newbie. You’re a baby. You only got out of school in 2007. How did you in just seven years develop a practice that is 70% removable? Do you advertise just for full dentures? Is that a big part of your marketing campaign?

Gigi Huynh: In 2008 I opened my practice. In one year after I graduated from dental school I found this place and I did a start-up. I opened my practice. 2010 I started doing marketing with dentures. So I hired Jerry Johns to write me a piece of marketing on dentures, so he did. I had lots of denture patients come in 2010 and 2011 because I did a lot of marketing. After that I kind of toned it down a little bit. So now I spend about $5,000 a year doing that and I just do it on newspaper. I don’t do any other forms of marketing anymore.

Howard Farran: Only newspaper advertising.

Gigi Huynh: Yes.

Howard Farran: That is probably because senior citizens, is it fair to say that most people who need a denture are a senior citizen?

Gigi Huynh: Yea, mostly. Except those meth addicts and stuff like that. But we don’t have a lot of that in California. You probably have more of that in rural America than in California.

Howard Farran: Bakersfield is hit hard with meth. I got a couple of buddies in Bakersfield they said it is an explosion in Bakersfield.

Gigi Huynh: Bakersfield is like 300 miles from me.

Howard Farran: Yea. And Johnny Carson called Bakersfield the armpit of California.

Gigi Huynh: Oh yea. It’s really hot down there. Lots of oil booms. The biggest oil boom in California right now.

Howard Farran: Is that right? Is that fracking or just?

Gigi Huynh: I don’t think they are allowed to frack. They just do the pump jets.

Howard Farran: Okay, Gigi. Why I mean if come on, you know if I got 100 dentists in a room and said raise your hand if you love making dentures I don’t think anybody would raise their hand. How come you raised your hand? Is it just an amazing attitude or as a strategic business did you realize dentists don’t like dentures so you are going to step in for a niche marketplace or how did this come about that you got into removable?

Gigi Huynh: It’s a bit of both. It is a little bit of both. My area happens to have a lot of seniors living in there. So I walk around after I opened my practice. I didn’t even know what area I was doing. I didn’t even do a demographic search or anything. After I opened my practice a few months later I drove around my area and saw lots of senior citizens housing and stuff. I am like gee, I need to start making removable. So I learned, I took lessons, I took CE’s, I spend a lot of money on CE’s. I spent an incredible amount on CE’s. I took CE classes and all that stuff.

Howard Farran: If someone decided you were going to be their role model give them advice on what CE do you recommend to learn removable?

Gigi Huynh: Oh my god, most of the removable believe it or not the principal I read Misch text and I haven’t been to his CE class yet. So I don’t know how good that is or how much you can learn from that in terms of removable. But believe it or not I try on the very first day that I start doing removable I started doing my lab work because I realized that would be the only way and the fastest way to get my skus up to speed to the highest level. Otherwise I would never get it there.

Howard Farran: Another reason you are my idol. I too joined the Misch camp right out of school. Got my fellowship in Misch’s too. Carl says the reason he became basically the number one implantologist around the world is because he first was a prosthodontist and he just did removable. When he started looking at implants he kept seeing these implants snapping off at the gum line and dentists getting mad at the implant manufacturer. He was looking at how they were attaching the removable and said you don’t even understand forces, you don’t understand removable. You can’t have an ill fitting denture snap onto implants. It is just not going to work. That cross-training. I also think one of the craziest TMJ theory I have ever seen in a lecture you can just tell the person has never done a single orthodontic case in their life. If they just did one ortho case they would realize half of what they are saying is reality, because that is not what you see in orthodontics. I think dentistry is very, very powerful when you cross-train. Orthodontics helps you learn TMJ. Removable dentures helps you in implants. So where did you learn – of all the courses you took on making a denture, Carl Misch’s textbook was the best source of information?

Gigi Huynh: I think the most important information I got is from Carl Misch and I had Manders who is a prosthodontist in town. I came and learned from the guy. I also went to the lab. My office is very close to a lab to a dentures lab. I go down there and I look at everyone’s impressions, everyone’s casts and I realized what I should not do. You learn it from there. You learn it from looking at things, touching things. You don’t learn from CE’s. You go to CE’s listen to what they say in two days you go home maybe you remember five things maybe even not. You are better off doing it.

Howard Farran: Giving a take away – one of the things Arizona has is one of the largest removable partial dental laboratories in the world in Nogales, Arizona. Actually, they are all shipped into Nogales, United States and then they are driven across the border to Mexico. They have this massive framework laboratory that literally casts hundreds of partials per day. The thing that amazed me is I spent an entire day there form 8 to 5 and 95% of the partial impressions that came in on the lab scripts that dentists didn’t even cut a single rest seat. It just said lower partial and it was a lower. It is like really? You couldn’t even design a partial or cut a rest seat, what are you seeing when you go into the labs?

Gigi Huynh: I just want to throw up.

Howard Farran: Go into detail why. Because a lot of these people they come out of school. They go work for an older guy he says don’t worry about. Take an impression the lab will do it all from there. That is not necessarily true. A lot of dentists don’t know what they are doing because they don’t see what everyone else is doing. So why when you walk into a removable lab and it makes you want to throw up explain why.

Gigi Huynh: I have never seen good impressions from a GD. That makes me disgusted. That make me feel disgusted, okay? I’m sad because first of all you spend four years in dental school, you spend hundreds of thousands of dollars you cant even have a really decent halfway looking impressions to represent your name with the lab guy that’s wrong.

Howard Farran: You’re talking about alginate impressions or?

Gigi Huynh: I am talking about alginate impressions. Simple alginate impressions for a cast for the metal framework.

Howard Farran: Okay. Well, walk us through how you do your routine alginate impression for an upper and lower.

Gigi Huynh: You got to learn your materials. It doesn’t matter whether it is expensive materials or cheap materials. Whatever you do you got to know your materials, your speed, your working time, whatever, your temperatures. Let’s say you live in Texas and you live in Galveston, Texas. It’s going to take faster for you for your alginate to set in Galveston, Texas or Phoenix, Arizona versus San Francisco in the summer where it is always 55 degrees. So the first thing when you buy any products you look at the material you say where should it be stored and you store it exactly where the box says. You take the temperatures of the room whatever. Myself, I think I learned this from Misch. I tell patients don’t wear anything the night before let the gum relax. And the first thing they do when they get up in the morning is get to my office whatever that time is. I try to take alginate impressions between 7 to 10:00 am. I think alginate works best during that time where my office is located.

Howard Farran: And GiGi what type of Alginate are you using? What brand?

Gigi Huynh: I use the Accu-Dent 2 system the blue injections.

Howard Farran: For alginate?

Gigi Huynh: Yea.

Howard Farran: Was that somebody getting an impression?

Gigi Huynh: No.

Howard Farran: So you use Accu-Dent 2 alginate impression systems.

Gigi Huynh: Yea. Doesn’t matter whether it is a study model or whatever.

Howard Farran: And why did you choose Accu-Dent 2?

Gigi Huynh: Because I tried many different materials and that is the best one I can come up with.

Howard Farran: We also for the international dentists the Japanese use alginates for crown and bridge, but they use a much more refined alginate. Are they using the Accu-Dent also?

Gigi Huynh: I don’t know what they use. I don’t really know. That’s interesting.

Howard Farran: Yea, Japanese they – you’re right it’s not the material. Whether it is poly-ether, poly-vinyl it just doesn’t matter. If you know your material and you master it you can do exquisite dentistry. I have seen exquisite dentistry done with different materials done all around earth. It’s amazing. On your first impression are you using edentulous trays?

Gigi Huynh: I use edentulous trays. I bought edentulous tray when I was a 3rd year student. In dental school the dental school kits it is really funny didn’t have a edentulous trays. So I went online and bought it because I read in the book, I read in the Edentulous textbook it says you use Edentulous stock tray. I looked and I said we don’t have that tray. I went online and bought that tray when I was in dental school and I am still using them.

Howard Farran: How many different trays are there for an upper and lower on your tray system? What Edentulous tray system would you recommend?

Gigi Huynh: I don’t know. I forgot. I think it is the COE trays GC trays whatever I think I paid $299 for the whole system. It has like four uppers and four lower size. I think that is really good. After the alginate trays if I make the removable complete I make a custom tray.

Howard Farran: So what percent of the time after you take an Edentulous alginate impression of upper and lower are you just using that to make a custom tray and then take a –

Gigi Huynh: Yes.

Howard Farran: Okay. You will make your own custom tray?

Gigi Huynh: Yes.

Howard Farran: Is this the light activated material where you put the material in soft and then put it in the light.

Gigi Huynh: Yes.

Howard Farran: Will you go over that system and the name of that and the brand and all that? I like to try to do these so when somebody is listening they can just follow you exactly. Instead of having to stop 20 times and say I wonder what I should do next. What tray system are you using?

Gigi Huynh: The tray system? Okay the Sterntech.

Howard Farran: Sterntech?

Gigi Huynh: Yea, I think so. I can give you the information when I get to the office. I think it’s Sterntech or Stern Gold Materials does that sound right?

Howard Farran: Yea. Stern Gold. And then you put it into the thing for the light.

Gigi Huynh: The Triad light box.

Howard Farran: Just for my viewers out there when I was listening to podcasts what I didn’t like was having to stop and take notes. What we do Gigi is we do a transcript of our ordeal so if they are out there on their bicycle or at the gym or doing pilates they don’t have to stop. And then anything you want to email me of names all that. So then when you make the custom tray then you are taking a – are you using a poly-ether, a poly-vinyl? What are you doing for the second impression? Are you still going back to alginate with that?

Gigi Huynh: It depends. If you are doing a partial you go back to alginate.

Howard Farran: That’s only 10 for you a year.

Gigi Huynh: I try not to do too many partials.

Howard Farran: So for your implants what impression material are you using?

Gigi Huynh: Implant I try to do just the heavy body and the light body.

Howard Farran: Poly-ether or poly-vinyl?

Gigi Huynh: Poly-vinyl PVS.

Howard Farran: Okay. What brand are you using?

Gigi Huynh: I use the Aquasil.

Howard Farran: Aquasil?

Gigi Huynh: Yea.

Howard Farran: Is that calk?

Gigi Huynh: Yea.

Howard Farran: Okay. Then so let’s switch gears to I think you are covering that nicely. What are you looking for when you are taking an alginate? How many times do you take an alginate on your edentulous tray system? Do you look at that and have to retake it and take another one? What tips would you give them for the alginate and for the custom tray on taking a great impression?

Gigi Huynh: Well, you have got to have all your anatomy there. Everything has to be there. The tray has to be seated completely. You cannot be short. If you are short from the alginate then your tray is short and everything is messed up. You cannot have bubbles. You cannot have any defects. In fact, your alginate impression has to look really, really perfect. It has to look as the textbook pictures. So if that is screwed up then every subsequent steps will be screwed up.

Howard Farran: So that is the base of the pyramid that everything is built on is that alginate impression. So for the master like you do you usually get it first try or does a perfectionist like you usually have to take tow or three?

Gigi Huynh: No. Well, depends on the day. I try to take one, but occasionally sometimes you choose low in the alginate set and it doesn’t have good injections. The Aquident system is an injection system. So it doesn’t have a good flow then sorry. Have to take another one. But that’s rare. The first year I did I had to retake so many times. I tell you the first year it was awful. I started taking impressions at 2:00 when it was 100 degrees outside and it was too hot and we screw up.

Howard Farran: Now are you having them go through mouth functions when you are taking a lower alginate? Do you have them stick out the tongue?

Gigi Huynh: Yea, we do all of that.

Howard Farran: Can you go over that briefly?

Gigi Huynh: Have them like stick the tongue up and do the suctioning motions and all of that. Exactly what you did in dental school. Stick your tongue move it up and down say ah if you do the upper. And on the lower do a suction motion. Tell them hey pretending you are sucking on a lemon. They do it for you.

Howard Farran: Okay. So now let’s transfer over to implants. So when did you start getting interested in placing implants? Are you doing it with 2-dimensional X-rays or did you go to 3-dimensional CAT scan X-rays like the CBCT? Start walking us through the implant. And first of all, what percent of your full denture cases are you using implants on?

Gigi Huynh: I mostly do for lower dentures only. And they are not a lot because not everyone can afford it. I try to do probably will do a few cases a month. We try to get them to do it, but some people just can’t afford it. Some people are too old or not a candidate for surgery. Some people don’t have enough bone whatever.

Howard Farran: So you probably almost never do it on the upper denture is that what you are saying?

Gigi Huynh: Almost never.

Howard Farran: And the lower like what percentage of the lower dentures would you say you are doing lower dentures with? Is it like 10%?

Gigi Huynh: Maybe 25.

Howard Farran: That’s a lot. One in four. And are you talking about two implants with a ball and snap on or are you talking about four implants with a hangar bar what are you talking?

Gigi Huynh: Locators most of the time.

Howard Farran: Two implants.

Gigi Huynh: Yea, two implants. Locators most of the time.

Howard Farran: And what implant system did you go with and why?

Gigi Huynh: I use Legacy 3 because they have so many brass components and it is really easy to restore them. They have a lot of choices. They have the excellent GBS system that they do for the upper ___ I really like it.

Howard Farran: So you are going Implants Direct which is in California. Honestly, did you just use that because they are in California?

Gigi Huynh: No. Actually the manufacturers is in Las Vegas. So they ship it from Vegas.

Howard Farran: They ship it from Vegas? Did you ever meet the oral surgeon who founded that company Jerry Misnick?

Gigi Huynh: I don’t think so. I never met him. I think he is something else, but he’s brilliant.

Howard Farran: He is brilliant and genius and something else. So you are using Jerry Misnick’s Implant Direct. The Legacy 3 system.

Gigi Huynh: Yes.

Howard Farran: And you also said the GBS system.

Gigi Huynh: Yes, the abutment.

Howard Farran: The GBS abutment. The Legacy 3 system. Okay. And how did Gigi go about learning to place her first implant? Did you also just read Carl Misch’s book?

Gigi Huynh: Well I read Carl Misch my fourth year in dental school. I think I bought that book the implant surgeries book. So I bought that book when I was in fourth year. I really like it so 2007 when I first started working I went to take classes with implants seminars in LA.

Howard Farran: Was that through implants direct? I know they put –

Gigi Huynh: No implant seminars with Arun.

Howard Farran: Oh. Arun Garg.

Gigi Huynh: Yea. So I did that. And then I did the master series and then I went to Dominican Republic and learned how to place the on live person. It was very nice when I got there I learned with really good oral surgeons.

Howard Farran: How many days were you in the Dominican Republic?

Gigi Huynh: Three days I think.

Howard Farran: And how many implants and patients did you get to do in three days?

Gigi Huynh: I think we got 20 implants each. And used them all up. I think they got me two or three more we did them all. We did a lot of sinus lifts. It was crazy.

Howard Farran: And were you drinking tropical drinks on the beach while you were placing these?

Gigi Huynh: No. I didn’t even go anywhere near the beach. I didn’t even see the beach. It was so bad on the beach. We went until like 10:00 every night.

Howard Farran: That’s good. You got your money’s worth.

Gigi Huynh: It’s really worth it. Had a lot of fun and came back and started placing implants. The first two years after that I was really skeptical and I did every single case I have tried the digital stent that make everything. Then like you said the cross-training with the removables make me really good with the angulation. I realized that any one that I have not get them and I look at them now and I can really feel the bounce with my hands I can just lay it flat and place an implant and anyone can restore it.

Howard Farran: Go back through the 3D. When you first started you used a lot of 3D, but did you buy a 3D machine?

Gigi Huynh: No. I send patients to go get a 3D. I didn’t buy a 3D. I would love to, but I don’t have any rooms in my office anymore to put a 3D.

Howard Farran: How big is your office being the only person in there?

Gigi Huynh: 900 square feet.

Howard Farran: And how many operatories?

Gigi Huynh: I have three ops and I tore out the biggest top to do my lab. So now I have two ops. But doing removable I don’t need a lot of rooms.

Howard Farran: You send out for your 3Ds for your implant cases?

Gigi Huynh: Yes.

Howard Farran: And what percent of your implant cases do you send out for a 3D now?

Gigi Huynh: None.

Howard Farran: None so you just did for the first couple of years?

Gigi Huynh: Yea. The first two years I did and I haven’t seen anything … I haven’t send any patients to get CBCT. 14 so far and I place a lot of implants every month.

Howard Farran: But you are mostly placing implants anterior on the mandible in front of the metal framing, correct?

Gigi Huynh: Yes. I also place implants for other GPs so those are single crowns. I place a lot of them and they really love it. They say they can just put the abutment on and restore it.

Howard Farran: Gigi what is your fail safe way to make sure you are not hitting the metal frame or the anterior loop and not getting any paresthesia in the lower lip when you are placing anterior implants in the mandible for a snap on lower denture?

Gigi Huynh: Okay so go back to your anatomy class in the first quarter of dental school – the only way you are sure is you can put your hands there and feel the mental foramen stay away from it.

Howard Farran: You feel that with your gloves on inside the mouth you can feel the mental foramen

Gigi Huynh: Yea. I can put my fingers in my mouth and feel it. We all learned that in dental school.

Howard Farran: I wouldn’t say we all did that.

Gigi Huynh: They made us do that.

Howard Farran: So do you put the patient at 12:00 reach right down in there and feel the mental foramen and then are you laying a full flap or are you doing a tissue punch through the mandible?

Gigi Huynh: I slap every single case I place I very rarely, very, very rarely I do a tissue punch.

Howard Farran: Okay and are you dissecting out the mental foramen on both sides just so you can see and visualize where that is at?

Gigi Huynh: Yea. I do. I would dissect if I am that far. But usually I never go that far like way out there opt the mental foramen to say hey I’m near it. I am near the danger zone where I am going to have to dissect. If I am in the danger zone I would.

Howard Farran: Are you usually placing two implants or four or three? What is your standard protocol?

Gigi Huynh: I don’t have a set – it is based on the patient’s anatomy.

Howard Farran: Okay. Tell us what you are looking for and what changes your diagnosis and treatment plan on number of treatments.

Gigi Huynh: Okay. The first thing I do is if they say they want to get an implant I will take an ___ cast and look at the cast. And I see if the dentures if two is good enough then I will do two. If they have a u shape and it is a really big arch I will say go with three at the minimum or four if they can afford it. If it is a small arch I would say just do two.

Howard Farran: Okay. Do you have any personal contraindications like if they reach a certain age or if they are diabetic or if they are smokers or has that not been a factor with your implant success?

Gigi Huynh: I try not to touch a smoker. But if they sign consent forms and they say it depends on how much they smoke. If they smoke two or three cigarettes a day it wouldn’t be a big issue. I put them on Chantix I try to convince them to take Chantix at least a few months before we do it so they kind of ween off stay away from smoking a little bit so it will be successful until the implant is good like three months after. Go ahead and smoke it wouldn’t be bad anymore. It is not as risky anymore.

Howard Farran: I would think that people who wear dentures have a higher rate of smoking or past history of smoking than people who have all of their teeth since smoking is related to tooth loss.

Gigi Huynh: Yes. Absolutely.

Howard Farran: What percentage of your dental patients would you say have a history of smoking?

Gigi Huynh: Oh, probably 90% of them.

Howard Farran: And what percent of them are still smoking at the time they need the denture?

Gigi Huynh: Most people like none now. None.

Howard Farran: So the cultural change in America say in World War II half the adults smoked now they are saying it is a quarter. So you are saying that what you are seeing in the San Francisco Bay Area is that they probably had a smoking contributed to losing their teeth in the past, but when they show up to you it is not an immediate denture it is replace an existing denture and they no longer smoke?

Gigi Huynh: Yes. It is very rare to find an active smoker. I probably have two or three patients whoa re active smokers in my practice.

Howard Farran: And what percent of your dentures are new immediate dentures versus replacing an old existing denture?

Gigi Huynh: I don’t do a lot of immediate dentures. It is very rare. Very, very rare.

Howard Farran: It is basically replacing …

Gigi Huynh: Replacing existing dentures. Yea. Most of the time.

Howard Farran: What would you say the average age of the patient in your office is replacing an existing denture?

Gigi Huynh: I don’t know. They range anywhere from 50 to 106.

Howard Farran: You have a 106 year old?

Gigi Huynh: Yes.

Howard Farran: Oh my god you should have posted that on Facebook.

Gigi Huynh: She is really, really healthy. She doesn’t take any medications and she can still drive.

Howard Farran: That is probably why she is 106 because she doesn’t take any medications.

Gigi Huynh: Yes. Absolutely.

Howard Farran: I noticed Ivoclar a few years ago came out with a new higher indenture tooth. Let’s talk about denture teeth and cosmetics. Do you remember the – what was the Ivoclar was it the blue tooth?

Gigi Huynh: I don’t know. I never use Ivoclar teeth.

Howard Farran: What teeth are you using and what about cosmetics? I mean what percent of these dentures are women versus men?

Gigi Huynh: Oh my god, I think I see more women than men. Probably 60 or 65% of my patients are women.

Howard Farran: I assume women want high cosmetic dentures. Are you making them to where any dentist sitting across a table would know that is a denture or do you try to make them look more natural or cosmetic or? Talk about what your artistically, cosmetically what you are trying to –

Gigi Huynh: Vita, Vita has really nice teeth. I really like Vita teeth. If they want that kind of teeth. I have samples I just show them. If not I just use the regular Dentsupply teeth the IPM teeth.

Howard Farran: If they don’t mention cosmetic you use Dentsupply IPM teeth. And if it is a high cosmetic case you are using Veta teeth?

Gigi Huynh: Yea. I show them. I have samples of dentures set in both teeth. I just show them and this is this and this is that. The costs are not too much of a difference. Choose whatever you want to choose.

Howard Farran: And then do you line them up straight as if they just walked out of braces and bleaching like a Hollywood smile? Do you try to add some imperfections so it looks natural or what are your thoughts there?

Gigi Huynh: I try imperfections. I don’t want to be a dictator and I don’t want to say hey, this is my style. I tell them okay I can tilt them a little bit. We do two times trying anterior trying and posterior trying so I can tilt the teeth a little bit. I can line them up perfectly the textbook look or whatever. They have input or they bring in pictures of them when they were young and they show me I want my teeth to look like this. We try to comply to patients.

Howard Farran: You are saying if I took a picture of myself in high school to my barber he could cut my hair like it was when I was in high school?

Gigi Huynh: Try not to.

Howard Farran: So what percent would you say in California as a man who grew up in Kansas for 25 years and lived in Arizona for 28 years you always think Californians have the highest cosmetic desires and wants and needs – what percent of your 50 to 75 year old ladies want just as white as they can be, as straight as they can be just look like they just had veneers done?

Gigi Huynh: I tell you I never had anyone go for A2 teeth. Probably 98% of the teeth that I ordered are A1 shade.

Howard Farran: A1 I would have guessed in California it was all B1.

Gigi Huynh: No. It’s A1. B1 is too – but A1 my lab tech he kind of make fun of me. He said A1 is the official shade of your office.

Howard Farran: And it is the official steak sauce in my house. By the way you post some amazing you are a phenomenal cook aren’t you?

Gigi Huynh: I am not really phenomenal. I like to cook, but nothing really special.

Howard Farran: The pictures you post of the dishes are to die for. In fact, I am going to talk about that a little bit. I don’t want to draw attention to the fact you are a woman, but you are. And when I was in dental school the senior class only had one. The person I interviewed before you Barry he had no women in his dental school, Barry Glassman. Now dental schools are 45% of the graduates of women. You said at the onset that you have a husband and you said kids. You didn’t say how many. Do you have one or two?

Gigi Huynh: I have one.

Howard Farran: I thought you said kids plural, which kind of surprised me. I was like I have only seen pictures of one. Is it different do you think for the average female American dentist having to play mom and play dentist and you were saying earlier that not having staff you had less overhead you could go home early, spend more time with your children. Talk about you are obviously a role model in so many different ways. Talk about issues of being a woman dentist who has children and a husband and how you balance being a super mom with a super dentist.

Gigi Huynh: I am not sure if I ever put it in that way. I don’t know. I try to go home early to spend time with my kids you know in the afternoon. I think it is important to spend time with him after he gets off of school.

Howard Farran: What time does he get out of school and how old is he?

Gigi Huynh: Back then he got out of school at 3:30. He is 20 now, so he is in college. But back then he finished at 3:30 and I try to go home at least at the latest 5:00 so I can see what he is up to and make sure he is doing what he is supposed to. So now I don’t really have to worry about him that much. The great things about it is about me I think my situation is different is that I went to school, I started dental school when my kid was already nine years old. I did not really have to struggle between an office and a young child. It is really, really a grateful thing. Because otherwise it would be very, very difficult to spend so much time to go away and take CEs and try to improve your hand skill doing whatever I need to do and having to worry about a little kid. It is not going to happen. I think if any female dentist who is in their 20s trying to do what I’m doing is going to be very extremely difficult. Unless they don’t have kids.

Howard Farran: So you recommend not having children in dental school.

Gigi Huynh: I don’t even think having children when you first start out and you are trying to get your skill up to speed at least in the first five years of practicing dentistry is very wise because you take at least five years to master some kind of skill. And if you don’t devote the time it is not going to happen. You are just going to get by. Skill just doesn’t come overnight. I think. So you are going to have to devote some time to whatever that is.

Howard Farran: Absolutely. And being good at what you are doing is a big component of happiness. It is hard to be happy when you go to work every day and you are lousy at your job. Imagine a football player that every time they played in a game they never caught the ball. Actually, they would probably play for the 49ers.

Gigi Huynh: No they probably play for the California Golden Bears.

Howard Farran: What is your team? The Golden Bears?

Gigi Huynh: Yes. California Golden Bears.

Howard Farran: What sport is that?

Gigi Huynh: UC Berkeley Golden Bears.

Howard Farran: Oh college football. So you like college football better than the 49ers?

Gigi Huynh: Oh yea.

Howard Farran: You just like more of the high scoring game where people are playing for free as opposed to professionals?

Gigi Huynh: Yea. The tickets are cheaper.

Howard Farran: And the tickets are cheaper. You always have an eye on cost. That is what I love about you. Now, Gigi you have talked openly in the past you have also now that your child has gone to college now you see the whole world as a canvas and the United States. You have even though about may relocating your office. Are you still thinking those thoughts or walk through the thinking process of now that your child is in college that you could go anywhere.

Gigi Huynh: Well, I would love to live somewhere where there is no tax.

Howard Farran: You are always cutting overhead. You have no staff. You watch college ball instead of the 49ers for lower priced tickets and now you are looking at a state with no income tax. So what states are we talking about? Texas, Nevada, what states have no income tax that got your attention?

Gigi Huynh: There are seven of them.

Howard Farran: Do you know all seven?

Gigi Huynh: I don’t know. I don’t remember them all off the top of my head, but who likes to pay tax? Do you know any person that likes to pay tax?

Howard Farran: No. Absolutely not.

Gigi Huynh: So I don’t like paying tax.

Howard Farran: You are in California. That is a high tax state. What is your state income tax out there?

Gigi Huynh: Like 10%.

Howard Farran: 10%?

Gigi Huynh: Yea. And our sales tax is close to 10% too, 9.75 I think.

Howard Farran: When you buy something it is almost 10%.

Gigi Huynh: When we buy something it is almost 10% more.

Howard Farran: So if you buy something it is 10% tax and then your state income tax is 10% you are looking at states that don’t have a sales tax or a state income tax.

Gigi Huynh: Yea. It would save you a lot of working years.

Howard Farran: Well, I am out here in Phoenix, Gigi and almost every new patient family that I got I mean, at least 10% of all of Arizona moved in from California. The number one reason they moved in from California is to escape taxes and regulation. They just said it is not a pro business environment and they just moved their company out here.

Gigi Huynh: I am not alone.

Howard Farran: So have you ever thought about coming to Phoenix?

Gigi Huynh: Well, I’m not sure. I don’t have an Arizona license. I have a California license, I have Texas license, I have Georgia license. I don’t have an active Arizona license, so.

Howard Farran: A lot of dentists in Arizona don’t even have a license.

Gigi Huynh: What are you talking about? That is not even something …

Howard Farran: That is true. Immigrants. There are a lot of dental offices in Phoenix, Arizona in apartment complexes and trailer homes where they just moved up from Central and South America and they work on people who immigrated here. I see dentistry all the time and I will say where does this dentist practice? They go oh he is in such and such apartment complex on the third floor. He just has one chair in his room. And Europe has another problem. After the Bosnia Croatian war a lot of people felt sorry for the refugees and said we will honor your license. So a lot of people just went and manufactured a dental license. It is amazing how many dentists all throughout Europe who said they went to dental school in Bosnia or ___ Croatia whatever literally bought a diploma on Ebay or just on the internet and are practicing dentistry and never went to one day of school.

Gigi Huynh: How do they know what they are doing? For me I spent a lot of money on CEs after dental school.

Howard Farran: Did you put yourself through dental school or were you lucky enough to have parents that paid the way?

Gigi Huynh: I paid everything for all of my education from undergrad to dental school.

Howard Farran: You weren’t a spoiled little princess where daddy paid for everything?

Gigi Huynh: No. I wish. I wish I had a rich daddy. No, I don’t.

Howard Farran: So are you paying for your son’s college or do you make him learn the tough lesson himself? Even though you could help him.

Gigi Huynh: I have been paying everything. I pay for private school from kindergarten all the way up. I pay for Stanford three years of Stanford and four years of ___ right now.

Howard Farran: Wow that is a – yea, I had to put myself through 100%. I didn’t get one dime’s help from my parents. And then I – it was very troubling because I had four boys and I thought well maybe that is a big part of my success. Maybe I should make them crawl through dirt and eat government cheese. It was a hard time putting yourself through dental school. Did you have trouble making that decision with your child? I mean did you think maybe it should be tough love and make him just crawl through the gutter like we did or do you think both of us pay our kids to college and that is okay?

Gigi Huynh: You know, I am a softy and my husband is a softy we are both softy when it comes to the kid. So we just pay.

Howard Farran: Yea.

Gigi Huynh: We have no choice. Plus my son was very young when he started off to college so we had to pay for it. He is too young I don’t think he would qualify for a loan or anything like that. So we just pay.

Howard Farran: Gigi are there anymore questions I am not smart enough to be asking about your practice with no employees, your practice focuses on removable, placing your own implants, mixing super mom with super dentist – because I have only got you for 10 more minutes. Are there any great ideas that I missed?

Gigi Huynh: I don’t know. What is – are your interests? I don’t know if anybody who listens to this podcast I don’t know what they really want to learn from me. I mean there are not that many of us who want to do removables.

Howard Farran: I mean supply and demand. If everybody sells a red widget and there is a market for blue it might be smart to do blue. The fastest growing segment of the American population is women over 100. Second is women 90 to 100. Third is women 80 to 90. I mean those upper age groups of females is the fastest growing segment of any demographics you look at. And overhead just keeps inching higher and higher and higher and a lot of that is tied to labor. You have given them a lot of device to think about. By the way are you participating in any insurance plans?

Gigi Huynh: No.

Howard Farran: No insurance? Just cash only?

Gigi Huynh: Yes. Most of the time.

Howard Farran: And do you report any of it to the IRS?

Gigi Huynh: I do.

Howard Farran: Or do you just have a big box of cash out in the back office?

Gigi Huynh: We do. You know, usually I just bury my cash in a coffee can. Yea, we do. We have to because of giving the patient a receipt. Troubles they come back up. Back to what you were saying and I think this is very important. Doesn’t matter where you practice in America this is the way the population goes. So even if you say you don’t want to have anything to do with alginate in your practice you don’t want to have to have plaster in your practice you will have to. The best thing to do is to take an alginate impression a really good alginate impression and pull it right away. The minute that impression is taken you spray it and disinfect it you have to pull it with a vacuum mixer. So you got to do it because there is no way you are not going to do … you got to learn this skill and you got to perfect it. There is no way you avoid doing it unless you practice next to a prosthodontist.

Howard Farran: Gigi, you said 70% of your practice is removable. What is the other 30%? What else is on your menu?

Gigi Huynh: Crown, bridge, implants, you know, a lot. I have about 10 little kids. They are really cute. I love seeing them.

Howard Farran: Do you place amalgams or only composites or?

Gigi Huynh: Well, it depends. If it is a huge and deep MOD people can’t afford a crown, I would do an amalgam versus composite because I can do that better than composite, but –

Howard Farran: It’s also critical thinking. I think when a doctor says I treat a population of 1,000 people and I don’t have certain modalities like an amalgam it just makes me think well you’re not even a critical thinker. Are you trying to tell me there are zero indications where an amalgam would not be better than an inert plastic composite? It’s a man, maybe they got root surface decay. It just blows my mind how people are doctors and they are supposed to be intelligent, critical thinkers and they are just missing complete categories of treatment.

Gigi Huynh: I love amalgam. It would be very hard for me to get rid of it. My patients by the time they get to me they have their cavities I don’t know 15, 20s now they are in their 70s and 80s the decays are big. You have to use amalgam unless they can afford a crown. Some people don’t want a crown or can’t afford it for whatever reason.

Howard Farran: And the antibacterial properties of the tin ion in the amalgam it is half mercury the other half is silvers and copper tin just like the high dentists use stanisflouride[ph] which has tin ions it is the tin ions flying out of the amalgam that retard the biological infection of streptococcus mutans you know, root surface decay. Just drives me crazy when I see some lady wheeled in from a wheelchair home and she had ten root surface cavity placed a year ago all inert plastic composite. They didn’t use glass ionomer, they could have used amalgam and nothing lasted a year with root surface decay and the person who did it was a cosmetic dentist. It is like really a cosmetic dentist on a lady with Alzheimer’s and dementia and rheumatism who doesn’t even know her daughter’s name. Really doctor?

Gigi Huynh: Yea. I think they are – yea, that is really sad some people just like black label amalgam and get rid of it.

Howard Farran: It shows that you are not a critical thinker.

Gigi Huynh: Yea. and cambra.

Howard Farran: Review cambra real quick – cambra? Caries…

Gigi Huynh: Risk assessment by management yea that is probably one of the most critical things to all the success in my practice in terms of crown and bridge.

Howard Farran: Well, I only got you for five more minutes, spend the last five minutes if it is that important to you reviewing cambra and tell them why that’s important for you. Because I bet 9 out of 10 dentists don’t think about cambra. Why is it so important to you?

Gigi Huynh: Cambra is so important. You have to put people on cambra if they have cavities. If their gums are not in good shape you clean their teeth, tell them to go home and use that chlorahexadine for two weeks. Come back you will see how amazing the gum is. Most of the time and most people will think I like but I would say 98% of the time when I cut the crowns and I check impressions I don’t have any blood in it. It is really amazing.

Howard Farran: And that is from putting them on chlorahexadine gluconate or peridex for two weeks.

Gigi Huynh: Yea. Two weeks I put all my patients who have teeth on cambra.

Howard Farran: Do you write them a prescription for that or do you sell it to them out of your office?

Gigi Huynh: I don’t sell it. I write a prescription they can get it at Costco, at Sam’s wherever.

Howard Farran: Do you have to have a prescription for it in California?

Gigi Huynh: Yes. I purposely am not selling it because people think oh she is making money that is why she is selling me this stuff. If I tell them this stuff is good for you you will see the difference when you use it your gum will stop bleeding. These toothpastes are really, really great if you use them you won’t have cavities and will reduce cavity chances and stuff like that if you brush and floss. So cambra is a big success. It is all my success with cambra I have very, very low failure rates in crown and bridge in all my patients.

Howard Farran: I just realized we are at the end. I should have worn my hat that you made me. You are the only person on earth who – did you crochet that or knitted that?

Gigi Huynh: I knitted that.

Howard Farran: That was the sweetest thing in the world. I could not believe when I got a package from you and I had my own personal Gigi knitted hat. What made you do that?

Gigi Huynh: Well, you asked for it.

Howard Farran: I was teasing you because you were showing other things that you’ve knitted, right? I was teasing you saying well, where is my knitted hat and you actually did it.

Gigi Huynh: Yea, I knit hats for lots of people. I love wearing hats.

Howard Farran: Yea?

Gigi Huynh: How cold is it in Phoenix is it cold enough to wear a hat?

Howard Farran: Actually, the last two days – I always bike, swim and run at 5:00 every morning and the last two days I walked outside it is 70 degrees I turned around and ran back in and got a jacket. When you are used to 110 for six months when it drops 40 degrees to 70 it is freezing out here.

Gigi Huynh: Yea, that’s tough.

Howard Farran: And you always know who the Canadians because they are running around half naked when it is 60 degrees they are in shorts. They are used to frozen tundra and all of the Phoenix people are looking like who is that crazy person jogging down the street half naked. You know it is a Canadian tourist it would never be a local. Gigi, seriously you are my favorite townie. I tell everybody my favorite dentist is you. You just you think outside the box. Your work ethic is amazing. I have been a huge fan of your posts on Dentaltown for years. You are just number one in my books in so many ways. You think outside the box. You are only true to yourself. You put quality first. I mean, I don’t know anybody with zero employees. You place your own implants. To think you have done all of this and you only graduated in 2007 I mean you have only been out of school seven years. I have been out 28 years. I mean you are an amazing person and it was a huge honor that you would spend an hour with me today on my podcast and I want to thank you for all that you do for your patients, your family, for dentistry and for Dentaltown.

Gigi Huynh: Oh my pleasure. Thank you so much. I am not even like a superstar dentist or anything you just make it sound really, really wonderful.

Howard Farran: No, Gigi the impressions you post the work you do and to know that most dentists can’t get that kind of work if they send it to the most expensive lab in the United States. You post pictures from your impression, your models, your cases. I mean every single thing that you post I just look at that and think damn. I mean you are – maybe you only know yourself but I know a ton of dentists and you are an amazing dentist.

Gigi Huynh: Trust me, Howard, if I can find an assistant who I can delegate to and do the exact quality of impressions I would.

Howard Farran: Well I tell you what I am 52 when I need my first denture I am going to you.

Gigi Huynh: Perfect. That’s a deal. It’s going to be free.

Howard Farran: I already got a free hat so you can match my hat with my free denture.

Gigi Huynh: Okay, perfect. Thank you.

Howard Farran: Thank you once again, Gigi. I hope you have a great day. Can’t wait to see you again.

Gigi Huynh: Alright. Thank you. Bye.

Category: Implant Dentistry, Prosthodontics, Restorative Dentistry

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