Listen on iTunes
Stream Audio here:
Watch Video here:
Angie Stone explains why nursing homes are almost always ill-equipped when it comes to oral hygiene, and how to help the patients there keep their teeth!
|
VIDEO - Angie Stone - HSP #99
|
|
AUDIO - Angie Stone - HSP #99
|
Angie Stone, RDH, BS began her career in the Navy as a dental assistant. After completing her enlistment, she continued to assist while obtaining her hygiene degree. As Angie practiced hygiene she completed her bachelors in psychology. She has taught in dental assisting and dental hygiene programs. She has also provided onsite education to dental professionals in 40 states and 5 countries and territories. In addition to numerous published articles, her original research regarding xylitol and elders was published in a peer reviewed medical journal in November of 2013. Angie’s book, Dying from Dirty Teeth, was launched in March of 2015. Her company, HyLife, LLC, brings oral care services to dependent elders because they shouldn’t “die from dirty teeth”. Angie is a six time attendee of CareerFusion and was awarded the Sunstar Award of Distinction in 2012 for her work with xylitol and the geriatric population.
Angie Stone
HyLife, LLC
www.hylifellc.com
Office: 608.884.0038
email:
astone@hylifellc.com
Howard Farran: It is a huge honor today to be interviewing Angie Stone on a topic that really strikes dear to me. Angie I just want to start with why you interest me so much. I live in Ahwatukee, which is actually the city inside the city limits of Phoenix, but it's a little area, about 80,000 people. Everybody calls it Ahwatukee. It used to be a separate city, then it got annexed by Phoenix. There's a half dozen nursing homes.
I've been practicing 28 years. Whenever my patients of record for the last however many years, they call up and say can you go in and see so and so. I always want to go in there. I'm just blown away by the oral condition of these nursing homes. Everything we did for their whole lifetime just disappears in probably 18 months from root surface decay. It's really got me rethinking everything I've ever thought.
I have to look at myself. When a 65 year old lady comes in and her molar is broken down and needs a root canal, build-up, and crown and the root canal's a grand and the crown's a grand and the whole things probably going to be $2500. I'm sitting here having flashbacks that as soon as she's in the nursing home, that's a wooden barn that's just going to be eaten by bugs and termites and it'll all be destroyed. Yet if I pulled that tooth and placed a titanium implant and a crown-
When I go into those nursing homes, I have a half dozen patients that I can see their face right now where all the root canals, fillings, and crowns I did, they're all just mush and then those shiny titanium implants- who would've guessed the lucky ones would've been the people that pulled all their teeth and placed four implants and a Hader Bar and a snap on denture. They're the only ones at the cafeteria eating.
I've said enough. You know what I'm thinking. You're coming out with a book next month, Dying From Dirty Teeth and the Oral Care of Dependent Elders. Take it away Angie.
Angie Stone: Yeah. Actually the book launched at the end of March. The book is already available. We're pretty excited about that.
Howard Farran: Did you post this on Dentaltown?
Angie Stone: I did not post it on Dentaltown.
Howard Farran: You should start a thread. First of all there's 198,000 registered dentists and hygienists around the world and there's 53 columns. I'm trying to think, that should just go under hygiene.
Angie Stone: You think so?
Howard Farran: Discussions of hygiene. You should just post that and say, hey I'm Angie Stone. I was named after a stone model from Crown and Bridge and tell them. Do you agree or disagree that what's going on in nursing homes is not on television with oral health and that the dental community doesn't really grasp quite what's going on in America's nursing homes?
Angie Stone: Yeah. They don't. We have to remember that five percent of our population will live at some point in a nursing facility. Five percent doesn't seem like very much, but when you- in the book I outline how the population is aging and what that's going to look like in around the year 2030. How many people were going to be in nursing homes.
As the dental community, I think what happens is, and we've all felt this. It's like all of a sudden we're going through charts one day and we're like oh whatever happened to him, oh whatever happened to her? We may have spent 30 years, or 28 like yourself, taking care of these people and then all of a sudden they can't come in to see us anymore. They disappear from our patient base.
As clinicians we're not really in tune to where these people end up and what happens to them and what happens to their oral health until, and this is what happened to me, you have a personal experience with loved ones in a facility. Then it comes rushing to you and you think, oh my gosh I never knew what's going on.
My grandmother lost 60 percent of her teeth in a nursing home in two years. She was 90 when she went in, she had almost a full complement of teeth, but in two short years, under the care of the care team and the dentist that was coming in to do exams, she lost 60 percent of her teeth. I'd been working in this area for awhile, but when I saw that happen, I was like you've got to be kidding me. At 92 we're dealing with this? There's got to be a better way. That's basically what my book talks about is what's happening, why it's happening, and then my personal solution that I've created to help.
Howard Farran: I can't wait to hear about it. I personally out of morbid curiosity went and stayed in a nursing home and befriended the staff and just tried to understand what's going on. What I'm seeing in Arizona, I don't want to name names of nursing homes, but I've been in a dozen, is it's ran by CDAs and they'll put 20 to 28 people on a wing. This poor little girl who's usually like 5'2" and 140 pounds has to get them bathed, showered, to the cafeteria, brush, floss. If I just told a hygienist like yourself, you have to clean all these people's teeth just one time a day, I don't think you could do it like you do a cleaning. I don't think you could do it in a day. She's got to bathe them and clothe them and get them to the nursing home.
Can a CDA really brush and floss grandma's teeth in the nursing home every morning and every night?
Angie Stone: No sir.
Howard Farran: Absolutely not.
Angie Stone: As dental professionals-
Howard Farran: I have to tell you one other insight on the nursing home. I'm not worried about it because when you go to a nursing home, there's no men in the nursing home. There's like 100 women and one man named Lucky. Men are lucky, we die- we're dead by 74 on average, women live to be 79. The last five years you're talking about, is it mostly women?
Angie Stone: It is mostly women in my experience. However I have taken care of several- in fact the patients, the residents that I have now are mostly men, actually.
Howard Farran: Really?
Angie Stone: Yeah. Yeah. I think it just depends. I think statistically you're right, it's usually females that are there. The one thing that really kind of irks me is that as hygienists in particular, if we see a resident from the nursing home in our office, we get all kinds of bent out of shape that the oral care is poor and that nobody is brushing and flossing these teeth of these residents. Then we tend to write back nasty notes to your certified nursing assistants. It's not their fault.
Do you know how much education they have for brushing and flossing teeth? Do you know how much if they go to a formal-
Howard Farran: The same amount we had in dental school on nutrition?
Angie Stone: Less than that.
Howard Farran: One hour.
Angie Stone: Yeah. Yeah. It's about one hour. That's hands on and lecture. As you mention, it's nothing to have 12 to 15 residents per shift. They have to, as you mention, bathe them, dress them, feed them, give them their medicines, give them their physical therapy. It's insane for the dental community to just think that those folks are going to be able to take care of the oral health. The residents need a higher level of oral health care than the normal person.
Howard Farran: It's not going to be done by brushing and flossing. It's not going to be done by mechanical plaque removal of brushing and flossing every morning and night, is it?
Angie Stone: It's not.
Howard Farran: Plus you haven't also addressed, I'd be curious what percent of the five percent of the Americans [inaudible 00:08:06] nursing home are women versus men. I'd also be curious to know, that five percent, what percent have diseases that allow them they couldn't brush their teeth, whether it be intense rheumatoid arthritis, or dementia or Alzheimer's. They're in there for a reason and a lot of those reasons would mean that you couldn't even brush and floss your teeth.
Angie Stone: That's right. The thing is is that we've got to control the biofilm and the bacteria in the mouth. You and I are really pretty good at that with mechanical disruption of those things as we know. As we age, and no different than little kids, they're not, older people are traditionally not good at that. As you mentioned, they may have arthritis, they have Alzheimer's, they have dementia, how do we expect that they can take care of their own teeth? They just can't.
I just saw another case last week, I was called by a daughter of a nursing home resident and said that her mom isn't eating. She keeps telling them that her mouth hurts. I went in and looked and I was lucky enough to have had X-rays from about 16 months ago. She's lost 65 percent of her teeth in 16 months. They're all, as you said Doctor Farran, just off at the gum line. She's got all these root tips. 65 percent of her teeth in 16 months.
We've got to do better. All of this disease in the mouth lends itself to other diseases, mostly aspiration pneumonia. It's like people like, oh well pneumonia is an old person's friend. That's great, but do we really want to die from dirty teeth? That just seems ridiculous to me in the year 2015 that people are dying from dirty teeth.
Howard Farran: Another interesting thing is, obviously when you go back and look at what we knew 100 years ago, it looks like 100 years ago they didn't even have the germ theory. You go back 500 years and a thousand years. Obviously there's a lot of research saying that when you talk about streptococcus mutans causing decay or [inaudible 00:10:12], that just massively overly simplistic.
The San Diego Zoo has about 4500 species and they think there's 12,000 species of bacteria, fungi, and viruses living from our mouth to the back door. In that 30 feet of track is probably three pounds of gut microbiome with 12,000 different species numbering at like 10 trillion cells. Who knows what's in their mouth? Who knows what diseases this could be linked to?
Angie Stone: Yeah.
Howard Farran: Thus the title of your book, Dying From Dirty Teeth. It'll probably take five- it may be 100 to 500 years before they know how 12,000 species all interact with each other and all the diseases they cause and don't cause. We are going to have to make decisions based on limited knowledge of what species of bacteria we're talking about.
Angie Stone: Correct. Correct. I just think that we've got to do better. We at least have to keep the pH up, do something to help. It might not, as you say, it might not be down the road really what is the absolute best thing possible, but we've got to start doing something better. I really think that just getting in there, being present, from a dental side, with the residents is going to help a lot instead of just letting them age without any kind of dental professional onsite.
Howard Farran: What can we do today? What will your book recommend that we can do today?
Angie Stone: I've done some research with this population and xylitol. That was published in a peer reviewed medical journal in October of 2013 where we simply went into the nursing homes and we talked to the nursing assistants. I did not teach them about brushing and flossing because I know that that's not going to happen. Research has been done that if you teach these nursing assistants to do better with oral care, even though they know, that does not translate into an improved oral health situation of the residents.
I went in instead with a different idea. I taught them to give these residents xylitol several times a day. What we did is we tracked the biofilm on the teeth with pictures. Again, this is just a brain child of mine. I'm not technically a researcher, I don't have access to a university. We just did what we could.
The reduction in the plaque on the teeth in over a 12 week period was absolutely phenomenal just by having the aides give the residents gum or mints. That's one piece of it.
Howard Farran: Can I stop you right there for more details?
Angie Stone: Yeah. Yeah.
Howard Farran: We hear that with xylitol not all brands are created equal. Some people say that there has to be a certain amount of xylitol. Do you buy in that certain brands are better, that there's certain amount of xylitol? Some people say that some gums say they add xylitol for marketing purposes but they don't have a therapeutic dose. Can you cover the specifics on the xylitol, the gums, the drops, the names?
Angie Stone: Absolutely. What we know is that we get the best dental benefit when we have a product that's 100 percent xylitol sweetened. It's really easy to determine what products are going to give us a dental benefit. We simply look at the ingredient list. In the best case scenario for dental health, the xylitol is in the first spot on the ingredient list and there's no other sweeteners listed. The reason for that is-
Howard Farran: What would other sweeteners be listed? What would they be called?
Angie Stone: Sorbitol, maltitol, mannitol, aspartame. Any of the-
Howard Farran: Say that again one more time.
Angie Stone: Sorbitol, maltitol, mannitol, aspartame. Any of the other sweeteners. We're already exposed to those other sweeteners a lot in our diet. The bacteria's consuming those sweeteners throughout the day. That's okay, but we've got, as you mentioned, we've got to have a certain amount of xylitol in a product. We want to hit that bacteria about five times a day with a 100 percent xylitol sweetened product. Whatever company you like that's doing that, whatever products you like best, that's fine.
Howard Farran: Can you name some brands just in case somebody doesn't even know any?
Angie Stone: I can. I can. Spry, the company Xlear is the leading manufacturer of 100 percent xylitol sweetened products in the country and that's the Spry, S-P-R-Y, dental defense system. They also have the biggest variety of products. We know a lot of our patients can't chew gum five times a day, particularly when we're talking about elders.
The Spry line has toothpaste, mouthwash, gum, candies, mints. They've got sprinkling xylitol that can be put in water for a good therapeutic dose. They also have dry mouth sprays, dry mouth gels. They've got the most breadth of products.
Howard Farran: I wonder where that name Spry comes from.
Angie Stone: I'm not exactly sure why they've decided that.
Howard Farran: I wonder if that's a family name. Just for the people, how does xylitol disrupt plaque?
Angie Stone: Xylitol is different from our other sweeteners in that xylitol is a five carbon structure. Our simple carbohydrates are six carbon chains. The bacteria in the mouth, couple that you mentioned, mainly the streptococcus mutan, consumes that simple carb, the six carbon chains. We know they can use the simple carbs as a food source. They digest those carbs and then they have secretions. We know the secretions are the acid, the stickiness, and the building blocks for the plaque.
When we put xylitol into the mouth, xylitol only has a five carbon structure and that switches up that whole chain of events. Now we've got the bacteria consuming the xylitol and they can't digest it. It's just that simple. Without digestion, there's no secretions, without secretions, there's no acid, there's no stickiness, there's no building blocks for the plaque. It just slips off the teeth, it's not able to stick.
Howard Farran: Angie, I'm always trying to estimate what all these- we just passed 100,000 downloads after just 75 podcasts. I just try to estimate what all these people are thinking. Someone's driving to work thinking, I heard all that artificial sweetener was carcinogenic, I heard when I was a kid that causes cancer. What would you say to that hygienist or dentist or dental assistant listening to that, thinking that right now.
Angie Stone: That's a great question. Xylitol is a natural occurring sugar, it's not artificial. There's nobody sitting in a lab creating xylitol. Xylitol is found in our plants, fruits, and vegetables. We eat it every day whether we know it or not, and the xylitol is created every day in our bodies in the liver. It turns out we need it for our metabolization. Xylitol is completely safe. Again, nobody is creating xylitol.
Howard Farran: Right on. You said Spry is the leading manufacturer of xylitol in the United States. What type of product? You said they had gums, they had drops, candies. What all did you say they have?
Angie Stone: There's toothpaste, mouthwash, gum, mints, candies, dry mouth sprays- xylitol's amazing for the dry mouth population- and dry mouth gel.
Howard Farran: In your experience, these senior citizens, what do they seem to like the most? I would think seniors would like sucking on candies.
Angie Stone: Yeah. They like the candies and the mints. For people that still have their faculties about them, the mints is most likely their product of choice. As they decline though and if they can't suck on the mints because they're an aspiration risk, we can put the xylitol into their water that they drink or we can put it into a gel, in a tooth gel, and then they just put a little bit of the gel on a finger, either the aide's finger or the resident's finger, and just simply smoosh it right on the front teeth. They don't even have to get it any place in particular. They just need to get it into the mouth so we can feed those bacteria. It's really very easy.
Howard Farran: Fantastic. Xylitol would be your first defense in these nursing homes.
Angie Stone: Yes sir. Yes.
Howard Farran: Is their toothpaste, is that a fluoridated toothpaste? Is that an all around good toothpaste?
Angie Stone: Yes. Xylitol is definitely a health food type product if you will. It's housed in health food stores mostly at this time. We know traditionally health food stores don't like fluoride. There is a non fluoridated Spry toothpaste and there's also a fluoridated Spry toothpaste because the dental community typically likes fluoride. There's two different groups that are absolutely being marketed to so there's each, fluoridated or non fluoridated.
Howard Farran: You're from Wisconsin, right?
Angie Stone: I am.
Howard Farran: Was that where Senator McCarthy was from?
Angie Stone: I don't-
Howard Farran: Senator Joseph McCarthy?
Angie Stone: I didn't brush up on that.
Howard Farran: For you younger kids who aren't 52, that was basically the reason fluoride is so bad. It got branded because Moscow fluoridated their water and we had a senator called Joseph McCarthy that thought Joseph Stalin couldn't do anything for good. He was just completely evil so the only reason this was done, because it made them more susceptible to Communist thinking. He went on the US Senate floor with a diagram of the brain with a red spot in the middle of the brain showing that's the area where the fluoridated water affects the brain and makes you susceptible to Communist ideology. About half the country believed it.
Here we are in 2015 and the Berlin Wall came down and we still have 25 percent of American cities not fluoridated, which is just bizarre to me because fluoride was made in supernovas, just like you were saying xylitol is made in fruits and vegetables and we eat it all day whether or not. Fluoride was made in supernovas, it's the 13th most common- it wasn't made by a manufacturer or fertilizer industry. It's the 13th most common element in the earth. It shows up in the ocean at 1.4 part per million, we only put it in the water at half that amount, that's naturally occurring in the ocean which covers 71 percent of earth. People just think it's unnatural.
Anyway. Enough of that. Enough of that rant. I don't know why they don't make it just a federal law that says all community water is fluoridated and then if you don't like it, you can buy bottled water. It's the poor people drinking out of the hose.
Angie Stone: Right.
Howard Farran: When I grew up with five sisters, we were so damn poor we didn't even know we were poor. I thought everyone drank out of the garden hose when they came from school.
Angie Stone: [crosstalk 00:21:22]
Howard Farran: The bottom line is the poor people drink the city water and it's just the top ten public health measures we've ever done. We wouldn't put up to an election whether or not we should keep iodizing salt and have goiter pop up in 24 percent of the town. We wouldn't sit there and put it up for a vote whether we should put vitamin D in milk so we could have rickets coming back in 25 percent of the towns.
All the things that we've done for public health is not up for election for goiter, beriberi, rickets and all the other disease we prevented with nutrition. This is really what you're saying. This is kind of a nutritional way.
The first medication ever invented was limes for ... They still call the British Navy Limeys for scurvy. The first cure mankind had was a doctor in England figured out that if you ate a lime, you'd have vitamin C and that would prevent scurvy. Here you're saying that xylitol is found naturally in plants and vegetables and this is going to disrupt plaque.
Continue, I'm sorry to keep interrupting you.
Angie Stone: No. This is all good. This is great stuff. I would absolutely put xylitol into use with this population. Another reason is that it's over the counter, it's easy to get, don't need a prescription for it. A lot of things go into what you can use with this population. It has to taste good, has to be easy to get, it can't be super expensive. The thing that I found is that xylitol is absolutely fantastic at helping to control the bacteria.
The second part of what my book talks about is actually having then a dental hygienist who is an oral care specialist, so also a certified care giver, but only focusing on oral care, going into these facilities and brushing and cleaning between the teeth once a week. There's research to show that if we do that, then we can reduce the risk of aspiration pneumonia and we can reduce the risk of heart attack, stroke because we're keeping the oral cavity clean. We're controlling the bacteria with the xylitol and then we're getting in there once a week to be sure that everything that has been sitting on the teeth, if there's anything, there's usually not a whole bunch, but we're getting it off.
We're in there once a week also. If somebody breaks a tooth or if something is going on, I can alert somebody within seven days. I know for us that seems like a long time, but honest to goodness, my grandmother went goodness knows how long without anybody realizing that she had so many broken teeth.
The cool thing about that is that I can then notify somebody whether it's the family, whether it's the care team at the facility. If that patient or that resident does have a dentist, I can alert the dentist. Hey, Doctor Farran, something's going on with William. I can snap a picture of it, I can send you the picture, and you can tell me hey Ang, you know what I don't know if we can do anything with that, we're just going to watch it. Is William able to come in and I can assess that situation? Can he come in? Can you help with transportation? There is such a cool link that we don't have to lose these patients and they can be dentally healthy until the day they leave this world. That's my soap box.
Howard Farran: That's a great soap box. I find it interesting, Colorado was the only state that passed hygienist to independent practice and all the dentists, literally, they almost went completely insane. They literally went crazy. Only six hygienists did it. They were all in small towns of about a thousand that had no dental office. I have met the dentist up the street from them in the big town up the street and they love it.
She's down there cleaning teeth and- you can't afford, with the price of a cleaning, to build an office and market and website, so they all put a dental chair in one of the rooms of their house. They're all doing this in their house. A couple times a day, they're sending a referral to a dentist saying I think number 19's broken and needs a crown or this or that. The dentists up the street just love it.
Angie Stone: Of course.
Howard Farran: What I'm thinking is what are the possible [inaudible 00:25:50]? What if you're an older dentist and you only work three days a week and your hygienist wants to work four or five or what if you work four days a week? I immediately start thinking, what about having your hygienist start going into nursing homes and paying her to clean teeth and then she would be finding or he would be finding problems.
I want you to talk about it because you do have the business model. You have the Hylife, which is H-Y-L-I-F-E LLC, which brings oral services to dependent elderlies. Talk about that, that business model. How have you been able to make a business model out of this?
Angie Stone: It's brand new Doctor Farran. We launched last year under one roof. We have all the infrastructure of the business going. Basically what it is is I have contractors who are hygienists, also certified care givers, and we put them into the nursing homes and they go and they brush the teeth once a week, clean between the teeth and also bring the resident the xylitol products.
All of the oral care products are included in what the resident pays. Right now it's all self pay. It's interesting because once the family members- what we're learning is the family members are really the people that are going to drive this. Once they know that this isn't really being taken care of- it's nobody's fault, but there is a way to have their loved one taken care of so they don't die from dirty teeth, they're like oh my gosh, we never knew. Let's get some services going here.
Again, we go in and we brush and we clean between the teeth once a week. We offer xylitol, the care team gives the xylitol after each meal and we're keeping them healthy. If something happens, we alert somebody.
I have Hylife, is the company, and then I have hygienists that are working as contractors as oral care specialists.
Howard Farran: I think Hylife will go over well in Colorado since they just legalized marijuana. They were the first to legalize marijuana and independent hygiene. I would just say Hylife in Colorado and that website should get a million hits.
Are you just doing this in Wisconsin or have you done this in other states?
Angie Stone: I have. I have ten oral care specialists right now in five states.
Howard Farran: Fantastic. How's it going?
Angie Stone: We're trying to find a direct line to the clients. That seems to be our last big challenge is how to get the information to the loved ones. I thought in the beginning, silly me, that I'd just be able to go to the nursing homes and say oh my gosh there's this issue, you all know you have the issue, I have a solution, but they're not that open. That surprises me in a way, but I think what they're feeling is that they may be found out that they're not really doing everything they should be doing.
Again, that's not my platform at all. It's like I don't care if someone thinks they should be doing it or not. The bottom line is I can help so that it's getting done and we can help each other, camaraderie with the care team and the families. We're there once a week. The clients that I've been seeing, I can't tell you the relationship that we've developed with these clients and their family members.
It's an absolutely fantastic, a fantastic model. Again, we've got to be able to get to the client. I'm thinking that the dental offices can absolutely help. As a hygienist, I see people that could use help with their oral care and I oftentimes know their families. As a hygienist and/or a dentist, to me it seems like wouldn't it be great if a dental office saw somebody and they're like oh my gosh, you know what? I'd really like you to be healthier when I see you the next time. Maybe you could have Hylife services come in. When we see you the next time in the dental office you're going to be healthier and there's going to be less trauma for the dental office to have to deal with.
Howard Farran: My advice for that is, number one, I think if you got ten people doing this in five states you said, I think you should start a thread on Dentaltown to start getting those ten people to start posting what they're doing as a case study and how they're going so you'll be talking in front of a choir of 200,000 dental professionals around the world so everybody can see this and brainstorm and read your book and all that.
One of the best business tricks I ever started- I've had to deal with literally 500 different dental companies on one matter or another and one of the best lessons I ever learned was from Armand Hammer. United States from coast to coast is only four time zones, Russia's 12 time zones. When the sun's coming up in Moscow it's going down over the Bering Strait. That thing wraps around half the planet. It's a huge country. It had all this natural resources and nobody could ever get business done with them.
There's a man in New York named Armand Hammer who's a pharmacist. He charted a jet. He went to Berlin, chartered a jet and said fly me to Moscow. They go, you can't do that. He go, what are they going to do, shoot me down? Just charter the damn jet. He did his homework on Stalin and he knew that from America he liked Hershey's bars and Marlboro Red cigarettes.
He got this huge chest that was half chocolate bars and half Marlboro Red cigarettes and he chartered this jet. He started flying into Moscow and two Soviet MiGs jumped up on his tail and they go what are you doing? They go I have an appointment with Joseph Stalin. Now the fighter pilots are like, I'm not going to shoot down a guy that has a meeting with Joseph Stalin.
They let him land, the military showed up. He just kept saying I brought this gift for Joseph Stalin. Finally they bring him to Stalin. He opens up this chest of chocolate bars and cigarettes and Stalin's all happy and everything. He says, what are you doing? He goes, I can't do business with your Ministry of the Interior. I'm trying to get oil out of your ground, blah blah. Stalin pulled out a piece of paper and said, if you say no to this man, I will kill you. That's how Occidental Petroleum just got on fire and that's how Armand Hammer became a billionaire and all that stuff.
I would go in those nursing homes and I would find the Joseph Stalin, the top dog. Obviously they're scared. All social animals don't like transparency because we have a complicated social structure. Everyone likes to be in the closet about everything. Every time I see a story on nursing home, it's they're getting abused or they got bed sores. The last thing you probably want is a hygienist trained in healthcare to spot this one's got bed sores, did someone slap this lady. They probably don't like that.
I would start with the top dog, whoever that person is, build their trust. Let them know this isn't about- you're not with CNN or FOX News. You're not a journalist, you're just trying to help.
Angie Stone: Right.
Howard Farran: You're saying the monetary system, this isn't going to be paid for by Medicaid or Medicare or insurance, it's going to be a cash deal. If someone's listening to this and their grandma's in a nursing and they wanted you to do this for their grandma, how much a month do you think this is going to cost?
Angie Stone: 100 bucks.
Howard Farran: 100 bucks a month.
Angie Stone: Right.
Howard Farran: That seems so reasonable.
Angie Stone: I know. They're seen four times. My team is there four times. It is reasonable. Plus they get all their xylitol and they get all of their toothbrushes and their toothpaste. It's a no brainer.
Howard Farran: They get attention. You know what my mom used to do? My mom was the strictest Catholic woman you'd ever find in your life. We had to go to Mass every single day. You know what she counted as a Mass substitute? It was the eight Beatitudes. I think it was in Matthew. Visit the sick, the dying, the elderly, the [inaudible 00:33:33].
She considered skipping Mass and going to the nursing home and dragging in me and my five sisters and making the rounds because it made them so happy. My [comptroller 00:33:43] is the sweetest lady in the world, Stacie, and she has two dogs. One night a week she takes her two doggies to a nursing home because everybody just loves those doggies.
They probably just love the attention. It's one reason some people have to get out of dentures. If you make a denture on a 75, 80 year old lonely woman, she's going to hallucinate a sore spot every week just to come in and see the handsome charming dentist and get talked to and touched and adjusted. It's her big social event. That's the only reason she got up and took a shower this morning is because she's going to go on her little social visit to the dentist. I only have about 50 of those people that have been coming to me. They seem to never die. They're always out and about and having fun.
I have one, a grandpa, he's actually, Gonzales, he's probably an 85 year old man and he walks a mile and a half to my office every time. He just wants me to check. I go in there and I check and there's never anything wrong. Then he flirts with my assistant Jan for at least 20 minutes.
Tell us more of that program. If a hygienist or a dentist is listening to this right now, what would be the first step? Would you first see if you have a hygienist who's got a day a week extra to do, would you first see if there's a nursing home? I would imagine every dentist has all the nursing home CEOs in their- the CEOs I'm sure they all go to the dentist. Somebody's treating every single nursing home CEO in America. What would be the first steps on this?
Angie Stone: I think that you're right on there Doctor Farran. My model is I never envisioned this to be a full time gig for anybody. My Hylife was built upon four pillars. The first pillar is, first and foremost, is serving the elder community and keeping them dentally healthy. That is the number one focus. The number two focus would be to create some extra income for the oral care specialist. I'm not talking big dollars here. I'm talking maybe enough- maybe if somebody had 10 clients a month, they would get $500 for the month. Maybe a student loan payment, maybe for their kid's college fund, maybe for a car payment. Something like that. One day a week-
Howard Farran: And you get out of going to Mass. That's always a-
Angie Stone: That's right.
Howard Farran: That's a big benefit.
Angie Stone: Then also to have the hygienist be in charge of something that they can do on their own, that they're in charge of when they go to the nursing home, they're in charge of when they see their clients, things like that. The fourth pillar is absolutely camaraderie of the oral care specialist. We've got monthly calls that we do and support of like minded people.
If there's a hygienist that's listening that would like that, they can always check out our website at hylifellc.com. If there's dentists that are listening and if they think oh my gosh my hygienist would be great at this, we have clients that they could see, the dentist could also visit hylifellc.com.
It's magical. I think where the magic is going to happen is when we can have an oral care specialist taking care of the oral care needs and we're combined with a dental office that can actually clean the teeth, or the hygienist has the permission of the dentist to go into the nursing home and clean the teeth. We've got a dentist that we can confer with if, like you said, number 19's busted, what should we do.
If we could have both of those aspects met, that's where the rubber's going to hit the road. You know what Howard? As you mentioned, in most of the states, we can't just go clean the teeth by ourselves. All of the laws have got to change. I might be dead by the time that happens. I was like I've got to do something now that I can absolutely do to make a difference.
I can't wait for all this fighting to get over. I want to make a difference now. The oral care piece is how I think that I can help.
Howard Farran: By the way, when she's saying hylife.com, she's spelling it H-Y-L-I-F-E. The hy I take it's for hygienist?
Angie Stone: Yes. It's a combination of hygiene and life and how hygiene-
Howard Farran: Then LLC is the corporation. I'll give you an example of why I would not fear a hygienist going in their independent practitioner. We just had a local deal with our board. If you're going to teach a hands on course, the dentist from the other 49 states isn't licensed in Arizona. You can't have a dentist come in and do a hands on course because they don't have a license.
I called the homeless shelter for the vets and I told the guy, I said, we could do this in your place because they would have a license. Call the state board and ask the Arizona State Board of Oral Examiners if it is okay if licensed dentists in good standing come to the homeless shelter for the American Vets and do volunteer free dentistry on the vets while with instructors from the Universities to learn how to do better, faster, easier, higher quality dentistry. Who could say no to that?
She just said- that's what she said. Who could say no to that? Could you imagine trying to explain to your local newspaper or television station why the hygienist was not allowed to go into the nursing home and clean teeth on people who lose 65 percent of their teeth in 16 months? In fact, I wish every hygienist would start doing this and then start tipping off the newspaper stations. Hey my name is Shirley and I'm breaking the law. Come cover this story. It would be-
That's what the Supreme Court [inaudible 00:39:37]. They cherry pick cases that are just so ridiculously black and white. There might be a million cases on a certain subject and they just look for the one that's like, okay, come on. Look at this case, look at these exact details. How could we not see the reality here? I wish they would do that with medical marijuana. Just absolutely [fries 00:39:59] me that the state's got money- America's got five percent of the world's population and 25 percent of their prisoners and they got two million people in jail and a million of them are in there for what both our last two presidents have done while they were in college.
If they were all [pardoned 00:40:16], think of the money they're spending at $35,000 a year keeping these guys locked up for drugs when I'm pretty sure the last few presidents have done them. That money could be channeled to cleaning teeth of the elderly or education or health care. It's just so sad that we don't blink at putting $35,000 into keeping some guy in a cage, but then when somebody wants a $5,000 student loan to go to hygiene school, we don't have the money for that.
Angie Stone: Right.
Howard Farran: Or to give the elderly a cleaning. I wish that would change big time.
Another thing I'm worried about is if these people are going to Hylifellc.com, they're all speaking to the choir where if you guys- Dentaltown has, you can set up your own private message group. You could also start a thread. If you guys were having a conversation in the middle of an auditorium of 200,000 people, that'd be phenomenal marketing where if you're having a conversation in a private room- if you've only got 10 people, you should have 10,000 hygienist doing this.
Angie Stone: Yeah. I guess I get a little squirmish because a lot of the boards and things that are online, if you're talking about something and it appears that you're promoting your own thing, they frown on that. I'm always a little cautious because I don't know if someone's going to say you can't promote that here. I don't [crosstalk 00:41:43]
Howard Farran: What we do on Dentaltown is ... When I started Dentaltown- remember Orthotown is still, I'm not an orthodontist, but they've decided you have to be a licensed orthodontist specialist to be a member. They won't let anybody- I can't go on there and I own the site.
Now Dentaltown, what we did is that if you're sharing information and knowledge, that's good. If you're just promoting, if you're spam then we delete it. What we do is we give everybody- everybody has a signature. In your signature you can say your name, your book, your website, whatever. As long as above that line, the post is sharing information, and all of our moderators are volunteers so no one's doing it with an axe to grind. As long as they feel that you're sharing from the heart- it's actually really good marketing because when people start building a relationship with you and trusting you and liking what they're reading, then they see below the line, here's a website, here's your new book, here's the deal.
It is a- anyway, when I started, the dentist got mad because people were signing up from [inaudible 00:42:48] and 3M and Ultradent, all these manufacturers.
Angie Stone: Sure. Yeah.
Howard Farran: I just told him no I'm standing my ground. If you took away 500 dental companies, I'm sitting on a rug with some pliers from Home Depot. I'm not a good dentist. I need my 300 rpm [inaudible 00:43:02], I need my 3D X-rays, I need my Root ZX. I need so many toys.
If my 3.8 powered loupes fog, I walk out of the [inaudible 00:43:15]. I wouldn't even- I think dentists are these little fancy artists in a studio and they're painting and sculpting and you take away their oils and put in water colors, they lose it. They're very brand loyal, they like all their toys. Those manufacturers have to be seeing the discussions. If all the hygienists were saying you're making everything blue and we want it red, your team mates- that's why I called it Dentaltown.
The manufacturers are not even five percent, I think they're like three percent of- it's mostly all dentists and hygienists. Yeah. I wish you would talk about that. I just think it's a horrible crisis that nobody talks about.
If we were really talking about it, the even bigger discussion is should we draw the line at dumping $2500 into a tooth on a 65 year old? What would you say if a 65 year old lady say, there's a swarm of termites coming about 10 years down the hill. They're in Oklahoma now and we're in Kansas. I'm going to build this barn out of wood. You know everybody knows in 10 years the termites's going to come up and eat the whole barn. You sit there and think if we built this barn out of aluminum, then the termites are dead on arrival.
That's a huge discussion. Again, I don't think it's a discussion for men. Tell you the truth Angie, when I go to those nursing homes, you can go in entire wings without seeing one man. Like I say, I don't have data, I should look for that data. I'm starting to think- what I'm starting to do is ask women when they're 65 and they need a root canal, build-up, and crown, I start saying, how old was your mother when she died? If they say she's still alive I'm like wow. Wow. Wow.
My follow up question is did your mother, did she get Alzheimer's or dementia? If she says yeah she's got full blown Alzheimer's, I'm thinking okay this person won't even know the name of her doctor let alone brush and floss her teeth.
Angie Stone: Right.
Howard Farran: Where's the discussion of all the endodontists and all the geriatric dentist teaching in our fine dental schools, where's the parameters of when we draw the line and say you're a woman, your mom's still alive at 85 with full blown dementia, Alzheimer's, rheumatism. Maybe we should start thinking titanium instead of root canals, crowns, bridges, fillings, inlay, just basically wooden stuff that termites eat.
You're pioneering a new discussion. You know what I mean?
Angie Stone: That is so interesting, what you just said to me, that I had never even thought about it that way. Yeah. You just taught me something very profound. I appreciate that.
Howard Farran: Yeah. You know what? What I think'd also be good for you, and I'll try to help find one, but as far as these dental schools, there's a lot of really interesting people specializing- it's not a specialty yet- but geriatric dentistry. There's people that this is their whole focus of dentistry. That would be fun to get them to join your conversation.
Tell me, I got you for ... It's 46 minutes, I got you for 14 minutes and I'm not going to let you go. Tell me, the one thing I have to ask is you're a hygienist and you started your career in the Navy as a dental assistant.
Angie Stone: I did.
Howard Farran: I don't know why, this is a bias, but I think of Navy I think of an aircraft carrier with 5,000 boys. How did a little girl dental assistant- did you actually go on a boat? Were you the only girl on the boat? What was that experience like?
Angie Stone: That's great. I never stepped foot on a ship.
Howard Farran: You were in the Navy and never saw a boat.
Angie Stone: Isn't that crazy?
Howard Farran: You were a dental assistant in the Navy.
Angie Stone: I was.
Howard Farran: In Wisconsin?
Angie Stone: No. I was stationed in Patuxent River Maryland and then in Great Lakes Illinois. My whole mission was dental readiness. If our sailors were not dental ready, they couldn't be placed on a ship. Our whole mission was on shore duty to have them dentally ready so they could be deployed.
Howard Farran: That's kind of funny because now you're at the retirement end and you started out with basically probably the number one issue for those boys was cavities and wisdom teeth.
Angie Stone: That's right. That's right. Absolutely.
Howard Farran: That's probably what you're doing. Do the thirds need to come out and get these cavities fixed before they make it into the nerve.
Angie Stone: That's right.
Howard Farran: Here you are at the other end of your career. Do you see any of those Navy boys that you saw in the beginning? Are any of them now in the nursing home?
Angie Stone: No not yet. I haven't come across any.
Howard Farran: Tell me, you were a dental assistant and then how long did you do that? What made you go to hygiene school?
Angie Stone: Out of high school I knew that I felt that I wanted to become a hygienist and I wanted to teach dental hygiene, that was my goal. I did a semester at college at Marquette in Milwaukee. Always had this thing in the back of my mind that I wanted to be in the military. At that point, in the early eighties, the military is no place for a girl. Don't go to the military, you're too smart, yada, yada.
I didn't like being at college at that point. I left and joined the Navy and dental assisted for five years in the Navy. Then got out and dental assisted for another eight years and thought that hygiene degree was never finished. I went back to hygiene school with a five year old and a six month old and a husband driving semi to keep me in school.
Did hygiene for awhile and went back for my bachelor's degree so I could teach dental hygiene. Did that for a bit and it didn't take me very long to figure out that that's not where I wanted to be.
Howard Farran: Why is that? It seems like most people that don't like teaching said they love the teaching, they didn't like the politics of the school.
Angie Stone: Yeah. Yeah. The politics is ... You're very forthcoming and thinking of all the new things that you can do and grasping that new stuff. It seemed to me like I couldn't do that in the hygiene schools because we had to teach to the boards, which I get. You couldn't really- it was so stifling at the time. I was just like, you know what this is not what I'm supposed to be doing.
I'm educating. I've spoke now in 40 states and five countries. I'm a speaker. I'm teaching, I just am not teaching in the traditional sense.
Howard Farran: Do you want to speak more?
Angie Stone: Of course.
Howard Farran: Do you know what the biggest secret is on speaking gigs?
Angie Stone: What's that?
Howard Farran: There's about 250 dental societies, there's 50 states and about 250, 260 dental societies. It's all volunteers and you're in a committee. They say okay we need three people to be in charge of the speakers at next year's meeting. Three people raise their hand and they say okay don't get the speakers we had last year and we want someone on hygiene, someone on root canals, and someone on practice management.
These three guys go home or women go home and they have no idea. Dentaltown put up 307 one hour courses, they're all ADA approved AGD approved. They've been viewed over half a million times.
Angie Stone: Unreal.
Howard Farran: I'm in charge of getting a speaker in Endo so they just go to Endo and there's like eight guys that all do an hour each. It's like their demo. There was one guy who put up a one hour course on Endo and got booked 76 study clubs after releasing it.
Angie Stone: What?
Howard Farran: What it is it's a demo.
Angie Stone: Sure.
Howard Farran: If they want you in as a speaker, so you go create a online hour, we get it ADA approved. Our business model is we'll do- I got 50 employees I got to feed, but our business model is if you put it up for free, we'll do it for you, but if you charge a dollar, we split it with you 50/50.
If you want the most views, put it up for free.
Angie Stone: Sure.
Howard Farran: If that's how you make your living and feed your family, then charge a fee, but any fee is an economic barrier to entry so that will decrease your views. If you give a one hour rock star performance, you're basically getting demo'd for all around. That's why I've lectured in 50 countries is just from the online courses on Dentaltown. They'll pick you up in countries you couldn't find on a map. Give us a summary.
There's a hygienist driving to work right now and she's in charge of the speakers for next year's meeting. There's a dentist driving to work right now, they're listening to you. Probably 85 percent of our podcasts are just listened to and not seen on video.
This person's driving to work, you got eight more minutes. Tell me if I had you come in and speak to my dental society, is this a one hour program, a half day, an all day, what is your ... How do you like to do that? What do you like to speak on and at what length?
Angie Stone: My signature course is oral care for dependent elders dying from dirty teeth. That's my signature course. That's a three hour course, so that's a half day. I do have another course called my favorite things, dental hygiene style, which is wildly popular with the hygienists. Again as you mentioned earlier, we need products. We are nothing if we just have ourselves and a patient. It can get really confusing as to what products work well. I talk about all of the things that have changed my life as a clinical dental hygienist and how I don't want to practice without these things, my favorite things. The companies give samples and things like that. It's a fun course. That's my other course that I do a lot. That's three hours as well so I can fill a whole day.
Howard Farran: You got seven more minutes. Give us some low hanging- give us some things that you can't practice without.
Angie Stone: Oh my gosh. First of all, loupes and lights.
Howard Farran: Oh yeah.
Angie Stone: No way.
Howard Farran: Oh yeah.
Angie Stone: No way. I will not. If they took my loupes away, I might be okay. If they took my light away, I would not want to practice. I hear dental professionals all the time say oh my gosh, those things if I wear loupes they're going to ruin my vision, I'm going to be dependent on them all the time, you've got to be kidding me right? There's no science to support that.
Then when they say they're wearing loupes, like are you wearing a light? Not a lot of people are wearing lights yet on the hygiene side. Once you put that light on your head, you are like Superwoman or Superman. You've never seen the distal of number two like you do until you put a headlight on your head. That's one thing.
Ergonomic chairs. I have to take care of myself right? Nobody is really looking out for me, I'm supposed to look out for myself so ergonomic chairs. XP Technology from American Eagle Instruments. I don't sharpen my instruments. I don't want any other instrument in my hand.
Howard Farran: Wait, wait, wait. Stop there. Two things. XP Technology, Eagle what?
Angie Stone: Okay. It's XP Technology.
Howard Farran: What does the XP stand for?
Angie Stone: Extreme Performance.
Howard Farran: Okay. Is that what-
Angie Stone: It's from American Eagle instruments. They are non sharpening instruments.
Howard Farran: Is that when they take the metal and put it in liquid nitrogen and bring it to- is it a cold freezer? How does this technology work?
Angie Stone: No. This is ... I haven't talked about the specifics of the XP Technology in the manufacturing process. Give me just a sec. I can't come up with the name that's infused into the stainless steel. The Rockwell hardness of the instrument goes up intensely. They can make that instrument thinner right out of the package because they don't have to accommodate for us sharpening it. I use my XP instruments for about a year without sharpening. Then I turn them in and I get new ones.
Howard Farran: You turn them back in to American Eagle?
Angie Stone: Yes.
Howard Farran: What's the price on that? Obviously they just cant give you free instruments for the rest of your life. What is the exchange policy?
Angie Stone: No. You get like, if you turn in 12, you get one free or something like that.
Howard Farran: Okay.
Angie Stone: You can turn in any instrument for your 12 to get one free if you're a part of the rewards program. The technology is absolutely amazing. I'm not-
Howard Farran: You said loupes and light, but you didn't say what brand you like. Do you know what brand?
Angie Stone: I'm an Orascoptic girl.
Howard Farran: Orascoptic girl. That light's on your forehead?
Angie Stone: On my glasses.
Howard Farran: Okay. It clips onto your glasses and the light source in your pocket.
Angie Stone: Yes. Yes.
Howard Farran: The only problem I have with that, it seems like when I put it in my- you know how you put a cell phone in your pocket and you butt dial people?
Angie Stone: Yeah.
Howard Farran: I'm always butt dialing people with my iPhone 6. It seems like that's the only thing that I'm still having to work out is ... seems like sometimes I'll move my legs or hit the rheostat and I'm adjusting my light. That's still a- I put it in my pocket. I don't know if I should be clipping it on a belt. You don't have that problem?
Angie Stone: No not so much. I clip it on the inside of my pocket so it just stays in one spot on my pocket. I think Orascoptic does have something now that has the light right on the bows of the glasses.
Howard Farran: The other problem I'm having with my light and glasses is that when I take them off and I hang it up, you got to hang it up just perfectly. It's hard to hang up because if you bump the light then when you put them back on again, you're adjust the light, you're adjusting everything. I wish someone would share their tips of how do you hang up your light? You got a battery pack, you got the cord around the deal, you got the light. If you don't hang it up in between patients just right, then when you put it back on your head you're adjusting it again.
One time I got frustrated and I said, you know what I'm always adjusting the light when I put them back on, I'm always butt dialing the light. I finally just said I'm going back to the overhead light. You can't. You can't do it. Once you've had all that light and all that you can't do it.
It's a one way street. It's like the Hotel California. Once you check in you can't ever leave. You're right. Once you- as a dentist, I pay for that for all my clinical staff, assistants and hygienists. At first some said they didn't want it. I said look, this isn't the house of Stevie Wonder. You're going to see with magnification and light. It took some of them were kicking and screaming and crying, but they all now say thanks coach for making me do that because now I'm a better dental assistant, my temporaries are better. Everything's better when they can see.
You said American Eagle XP Technology? You only got a minute and a half left so give us some other products that you can't practice without.
Angie Stone: Okay. Xylitol. All of my patients are on board with xylitol. I don't want to practice without that knowledge and those products.
Howard Farran: They can buy those products from you at Hylife.com?
Angie Stone: No. That would be from Xlear. Dental professionals always get wholesale pricing so they can go directly to Xlear, it's X-L-E-A-R.com
Howard Farran: X-L-E-A-R.COM.
Angie Stone: Correct.
Howard Farran: Can they get the Spry brand there?
Angie Stone: Yes. Yes. Xlear is the manufacturer of Spry.
Howard Farran: Okay. It's clear with an X.
Angie Stone: Yes.
Howard Farran: X-L-E-A-R is the manufacturer of Spry. Man they're just into funky names aren't they?
Angie Stone: I know. I know. They are.
Howard Farran: Okay. Xylitol. You still got 57 seconds. Name some more products you can't live without.
Angie Stone: Okay. SE Cushions by Zirc.
Howard Farran: SE Cushions.
Angie Stone: Uh huh. I put those on the end of my saliva ejector so I don't give my patients hickies when I put the saliva ejector in their mouth. Zirc Mirrors. Oh my gosh. The Zirc Mirrors are fantastic.
Howard Farran: Z-I-R-K?
Angie Stone: Z-I-R-C.
Howard Farran: Zirc Mirrors. What's unique about a Zirc Mirror?
Angie Stone: It has different layers of anti-reflectiveness. They are so much brighter than your standard rhodium mirrors.
Howard Farran: Really?
Angie Stone: Oh my gosh Doctor Farran they are fantastic.
Howard Farran: I have never heard of that. I am going to absolutely- you can see significantly, it reflects significantly more light?
Angie Stone: Yes.
Howard Farran: Huh. Zirc, so they got a zirconium element in the ...?
Angie Stone: I believe so yes.
Howard Farran: I assume it's zirconium. Huh. Interesting. That element reflects more light. What else?
Angie Stone: The Vera Angles from Young Dental. Vera Prophy Angles. They're smaller they're bent different so we can see better and of course Florida Probes VoiceWorks system for periodontal charting. Voice activated charting.
Howard Farran: Young Dental, that's in Missouri isn't it?
Angie Stone: Yes.
Howard Farran: I went to dental school in Missouri. That's a good company in Missouri.
Angie Stone: Excellent company. Excellent company.
Howard Farran: What's unique about their Vera Prophy Angle?
Angie Stone: They're smaller and they're angled different so that we can see the tooth better when we're polishing. They have external ribbing on the prophy cups so we can use those better and approximately to remove stain.
Howard Farran: What was the last thing you were saying when I interrupted you about Young?
Angie Stone: VoiceWorks. VoiceWorks.
Howard Farran: Oh okay. Florida Probe.
Angie Stone: From Florida Probe.
Howard Farran: That is you don't have to call a dental assistant or the dentist to come in and chart for you. It's voice activated.
Angie Stone: It is. These guys have got it down. Traditionally there's been some issues with voice activated charting. Not with this thing. They were charting on the Chicago Midwinter Show floor.
Howard Farran: Why would you need voice activated when you're just making up all the numbers anyway? Don't you just measure three measurements and then just start making stuff up? I'm kidding. I'm kidding. That was a joke. That was a joke meaning we are out of time.
Angie, I wish you'd make a CE course on both. I wish you'd do a CE course about dying from dirty teeth. You got 10 people, I bet that course could take it to a thousand. Then I wish you'd do another course on products you can't live without.
Hey, I really respect your passion, your mission, your education, your knowledge. You educated me. I don't know a tenth of what you know on all this stuff. Thank you for giving me an hour of your time and your life. Thank you for all you do for dentistry.
Angie Stone: Doctor Farran thank you for giving me this opportunity to chat with you. You have taught me a bunch today too. I think we're a great pair.
Howard Farran: All right. You're from Wisconsin, right?
Angie Stone: Yes sir.
Howard Farran: What's your favorite cheese?
Angie Stone: Just the regular old mild cheddar.
Howard Farran: Mild cheddar.
Angie Stone: I'm pretty boring.
Howard Farran: You don't like the sharp cheddar, huh?
Angie Stone: No. Not so much.
Howard Farran: Huh. Okay. That seems to be our only difference. On that note I got to go. Thank you so much for time.
Angie Stone: Thank you Howard.
Howard Farran: If you need a speaker at your next meeting, you got to bring Angie Stone in there. The reason, I'll tell you why you got to bring her in here is not only this is the most important subject, but when you read reviews of conferences that the ADA receives for 20 years, the number one complaint with all dental conventions is there wasn't anything for my staff. It's too much clinical, root canals, fillings, crowns. Here's this one dentist and she's got two assistants and a hygienist and two receptionists. You look at the line up of speakers it's all how to do an [apicoectomy 01:03:15] and bone graft around an implant. You look like you would have a rocking hot bring down the house Elvis day for the entire dental office team. That's why I would bring Angie Stone in.
Okay Angie, have a great day.
Angie Stone: Thank you.
Howard Farran: Bye bye.
Angie Stone: Bye bye.