Dentistry Uncensored with Howard Farran
Dentistry Uncensored with Howard Farran
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1133 Dr. Mark Malterud DDS, MAGD on Comprehensive Minimally Invasive Dentistry : Dentistry Uncensored with Howard Farran

1133 Dr. Mark Malterud DDS, MAGD on Comprehensive Minimally Invasive Dentistry : Dentistry Uncensored with Howard Farran

2/1/2019 10:49:49 AM   |   Comments: 0   |   Views: 256
Dr. Malterud is a solo clinician who has practiced in St. Paul Minnesota for over 36 years. He has always been passionate about Minimally Invasive dental procedures and this has allowed him to help his patients avoid crowns and root canals by treating early and definitively. His long term success with Resin bonded dentistry started over 34 years ago when he abandoned placing Amalgams and focused on direct and indirect resin bonded dentistry. 

VIDEO - DUwHF #1133 - Mark Malterud

AUDIO - DUwHF #1133 - Mark Malterud

As his practice evolved he became involved with organized Dentistry and spent some time on councils and committees of the AGD and served as Region 10 Trustee for 6 years. His time there helped him focus his energies on keeping dental practices independent and thriving as he saw the tide swelling towards corporate practices and his belief is in the personal relationships with patients and delivering comprehensive quality care. He currently is involved with Smile Source as an Advisor and Administrator and runs a local group of more than 25 exceptional Smile Source independent dentists in Minnesota. When he isn’t practicing wet fingered dentistry he eagerly seeks out education and also lectures around the country on Minimally Invasive Dentistry.

Howard: It's just a huge honor for me to be podcast interviewing one of my buddies and good friends for over 25 years Dr. Mark Malterud, who is a solo clinician whose practices in St. Paul Minnesota for over 36 years. He's always been passionate about minimally invasive dental procedures and this has allowed him to help his patients avoid crowns and root canals by treating early and definitively. His long-term success with resin bonded dentistry started over 34 years ago when he abandoned placing amalgams and focused on direct and indirect resin bonded dentistry as his practice evolved he became involved with organized dentistry and spent some time on councils and committees of AGD and served as regent trustee for six years, his time there helped him focus his energies on keeping dental practices independent and thriving as he saw the tight swelling toward corporate practices and his belief is in the personal relationship with patients and delivering comprehensive quality care. He currently is involved with Smile Source as an advisor and administrator and runs a local group of more than 25 exceptional Smile Source independent dentists in Minnesota. When he isn't practicing wet finger dentistry he eagerly seeks out education and also lectures around the country on minimally invasive dentistry and I'm not getting to let him get off the show today so he promises me he'll build an online CE course for Dentaltown on something like minimally invasive dentistry. Think you'll ever have time to do that?

Mark: It'd be fun to do you know it's just a matter of what you guys think would be the the best fodder to put there.

Howard: Well you would know it's good as well as anybody I mean we, you, me and Howard Goldstein, we've all been this show for three decades and it's interesting though our generation was so quick to fly across the country and go to LVI or the missions tune all these Millennials have so much debt I mean they got $400,000 in debt and they see an online CE course for 18 bucks, they're thinking that's not even the uber fee to the airport to go fly to see some of these people so I think expense is a huge factor and that accounts for why I think are online CE do so well. I want to start there just with when you and I met I think we both had hair and so these podcasters I mean really I always say shoot me an email tell me who you are, what your name is, how old you are, what country live in or leave a note in the YouTube comments. I read all those YouTube comments of the deal but basically they're all saying they're still in a quarter are still in dental school and all the rest are under 30 I only get like one guy a week you says dude I'm in my 40s or 50s or 60s or they're all kids and they're scared Mark. They're truly scared because they're coming out of school half a million dollars in debt when I get to Phoenix no dental schools, A.T. Still in Mesa Arizona $100,000 tuition, Midwestern and Glendale Arizona hundred thousand dollar year tuition. They're coming out half a million dollars in debt and they're scared so I want you to put on your dad hat and pretend your daughter just walked out of dental school, she's sporting four hundred and fifty thousand dollars in student loans and she's her first question dad is Mark did I make a bad a bad idea do you think it's still worthy to be a dentist in 2019 $400,000 in debt or was that just a really bad mistake what would you say to her?

Mark: You know that that's a great lead-in because my daughter is at A.T. Stills and she is gonna be graduating in 2020. So she's my 2020 vision to the future and she is coming out about four hundred and fifty thousand dollars in debt and I would tell her to her face he's made the best damn decision she possibly can and I will do everything I can to make her successful in the dentistry that she does here and and broaden the base of her knowledge so that she can go ahead and treat the patients that we have in this practice. I realize these students, money's relative okay when you and I came out of dental school I graduated in 83 and most of the dentists that we're coming out of dental school at that point in time were 35 to $50,000 in debt. Well the average dentist was making 30 to $35,000 a year okay and these students are coming out 300 is the latest number but when they're going to private schools they're doing 400, 450, 500 thousand dollars in debt but at 300 if they're making $150,000 Howard that's two years of their income okay when I was in when the kids were coming out of school alongside me they were basically two years worth of income and so like I said it's relative, it's and I'm not pooh-poohing the depth aspect of it you know the the ask could fall at any point in time and dentistry could be taken pennies on the dollar that we head into the medical model. Which I'm hoping that groups like my Smiles Source group will keep us from that but I would tell my daughter she's in the best damn business that is out there and to go enjoy it and have fun. I mean I have I've been at this 36 years and I don't regret a day of it. I have a blast day in and day out and part of that is you know the educational background I had foundation at the University of Minnesota but I have been a consummate student and that's what I would recommend for these kids that are coming out of school. To be a consummate student and learn their dentistry and offer their patients a wide enough platter that they can make ends meet.

Howard: You know I mean yeah one of the things a lot of people including myself we're having a hard time wrapping their mind around is a super dentist concept. I mean it's so it takes so much knowledge to just be on top of endo or pediatric dentistry or ortho, a little own place implants or restore implants or placing implants and sinus lifts and bone grafts. I mean yeah seems like a lot of people are touting about you know some super dentist but it seems like I mean we're not going back to 1900 where there's no specialties and one doctor does everything. What would you what skill set would you push her towards I mean would you want her to be a super dentist or would you want her to focus on some narrow more narrow curriculum?

Mark: Well the stuff that I don't do as much of the ortho, TMJ type stuff, sleep, I've gotten to a point in my career and and this the the younger listeners have to hear this there are a lot of guys like me that it's kind you start looking at the end of your spectrum of work and I'm closer to the end than I am to the beginning and to go out and really become proficient at some of these new areas like sleep dentistry and some of the information is coming about about TMJ and TMD and myofascial pain. It takes a bunch to be able to learn that stuff so I'm going to hopefully have Rachel go in and become you know get proficient in those areas they're kind of filled in for our practice and then we will transition. I can teach her the other stuff it's the stuff that I that I don't have proficiency at that. I want her to learn those aspects of it she has more desire to go along those lines too because she can do more managing and she'll graduate with an MPH along with her DMD degree out of A.T. Stills and so she's gonna have some managing back on, and you also have to realize Howard that not that my daughter you know if she listen to this thing she'd probably chew me out she's an older student. She worked in my office for six years after getting a degree in marketing in psychology and finally you know and she said her entire life I will never do dentistry dad that's your gig and all of a sudden she decided that dentistry was going to be a good thing for her and it just fit her personality and she got to see exactly what I get day in and day out in the office and one day she said I'm gonna go take my core sciences and I'm gonna go to dental school and she's done it, so she'll graduate when she's 35 years old so she doesn't have this;

Howard: Is she married with children?

Mark: Nope

Howard: Single?

Mark: Well she's got a good boyfriend at this point in time.

Howard: So is this 35 make her the oldest person in the class or is that common at A.T. Still

 Mark: I believe there's one or two that are older than her but she was you know she ends up being one of the older people in her dental school class.

Howard: We had a guy like that when I was when I got accepted to dental school my gosh the first week I was still 20 and they kept having all the entrance meetings at these bars and I'll never forget standing out at Red Birds Red Birds bar across from University of missouri-kansas state dental school and this teacher asked me what are you doing out here I said well they won't let me in and I said I'm only 20 and the guy said you're not old enough to buy a drink and you're in dental school but we had a guy in her class who was like Rachel's age and his name is Joe Disano and he worked in an Italian restaurant his whole life and his dream was to be a dentist and I just thought that was so cool and then there was the oldest ones in the class were pharmacists believe it or not they were pharmacists they all had one thing in common. They became a pharmacist they did it ten years after the second or third time someone stuck a gun to their head stealing opioids. One was from New Mexico one was a Kurt than Ben Glennon out of Hays Kansas and they were tired of being robbed. He said man I didn't go to pharmacy school to die and so they wanted to go into dental. They were always telling her classes before anybody knew of opioids I mean nobody in dental school ever told me that was an abused drug and it was a problem all that but man Kurt Glendenning was telling the whole class he goes do not ever have this stuff in your dental office, you have this stuff in your dental office you're gonna let me looking at a gun someday and but anyways so that's so cool that Rachel's  following her dad. So she's gonna do the stuff you don't do which is ortho, TMJ and sleep.

Mark: Yeah

Howard: and then what are you mainly doing what do what are you gonna be teaching her what's your bread and butter?

Mark: I do implants they you know restorative dentistry to the nth degree you know building full mouth reconstruction if I get the cases coming in we don't market heavily towards it but my real forte in this office what is really you know driven the dial is I have a significant number of patients that seek us out because of the minimal invasive aspect of our practice and it has become a strong driver of new patient flow and it's almost organic you know and these groups get together and they talk and they pass the word on that they are happy with what they're seeing and doing and they having done at the at the office. So we get a lot of people come in that way and you know frankly you know a lot of these people are seeking dentists that have a less crown happy type of a philosophy and I'll use that term because when you when you start grinding the tooth down for the crown it's easy dentistry for you and I, I mean it's the simplest dentistry that we can possibly do okay but it's also quite abusive to the tooth and consequently anytime you're removing extra tooth structure to make it so that a crown will be able to fit on that too I think the to structure belongs to the patient we should leave as much of it as possible and ultimately down the road we are going to have better materials better techniques better equipment to be able to restore that tooth then I'll have much more to work with or Rachel will or whoever follows down the road will have more to work with so that they can restore those teeth then keep them vital for a longer period of time. Well I by practicing this way and I literally abandoned amalgams back that was 35 years ago I'm at 36 that was just a second year of practice I said that's it I'm done doing amalgams. I'd met Paul Belvedere you recognize that name and Paul lives in the Minneapolis St. Paul area where I'm at and he taught me how to bond teeth appropriately and I've been doing it that way for years and years and years and I'm seeing you know 30 plus year old restorations with crappy materials still working pretty well into people's mouths and now the better materials and the better equipment and I'm expecting my restorations to last 25, 30, 35, 40 years down the road and I fully expect one to do that um and as yeah pretty bizarre routine at five point seven is the national average when they do meta-analysis of how long restorations last.

Howard: Paul Belvedere passed away at age 87 of Edina, passed away with his family. That guy was just a legend, you miss Paul?

Mark: I miss him a lot I the a little bit of an inside story there, I was at the American Society for dental esthetics meeting it was his 87th birthday that day and he we all wished him happy birthday saying happy birthday too and he hopped on an airplane went home that night he fell and hit his head, had a deep bleed and he really never woke up from there but he had received a high honor at that thing and it was just kind of a Paul Belvedere meeting. So he went out on an extremely high high time and his health was going downhill rather rapidly. So as it was almost you can't say a blessing but it was one of those things that if you're going to go out I sure as hell want to go out the way he went you know, they have that the last day of your life basically be completely in your honor.

Howard: Well 87 that's a damn good life but back to you're minimally invasive dentistry every time I ever met a ninety to a hundred year old dentist and the first one I met that was like 92 and so practicing was George Rui of St. Paul, Missouri and I they also the same thing I when I'd ask him which lasts longer like a silver filling or a gold inlay or onlay and they'd always lean over and they'd say the tooth that lasts the longest is the one nobody ever touched when you drill on a tooth and do a filling it's gonna come back to bite you and need a crown and then you do a crown that it's gonna come back need a root canal in the crown you know root go down the crown it's gonna end up getting extracted then you're gonna do a bridge then you're extract every. So when you follow that patient 10, 20, 30, 40 I used to cringe at the cosmetic revolution when it came out because you and I were at the forefront of that a cosmetic revolution it was led by Ivaclaire, Vivadent, LVI, all these people like that and they were getting all these hot little you know young 25 year old women who wanted movie star teeth and do them veneers and I you saying oh my god that girl's 25 what's that gonna look like when she's 35 or 45 or 55 or 65 or 75 or to live as old as Paul Bo. So I want you to tell these young ones you've never seen their dentistry 10 years later what happens to the upper 10 teeth when you peel off all the enamel and do 10 upper veneers to make her look Instagram hot what does that look like 10 20 30 years later?

Mark: You know what most the time you're seeing some stains around the edges if they're if they're bonded well they'll do you'll do fine I actually did six veneers on my daughter because she had some heavy heavy wear, they look really good at this point in time and we're I guess we're about 12 to 13 years down the line but that's not the that's not the norm it really is not the norm and what ends up happening is 10 to 15 years down the line they start getting stains around the edges the smile doesn't look good anymore and you start talking about replacing them. So if they're 20 years old they're replaced at 35 they're replaced again at 50 they're replaced the again at 65 and I mean think of the investment that these people have started to go down that path to have their teeth whittle down and put veneers or crowns on them and it's it's really quite sad and so you can save them a lot of heartache by doing some minimal invasive things. I mean I have one patient that came to me because she wanted me to do six veneers on her front teeth we ended up doing basically bonding on one tooth and whiten her teeth because they were modeled in color and we got him to match up really nice and Invisalign and for about half the price of what she would have paid for the other work that we were going to do she has a smile that will pretty much last her a lifetime and it's her natural smile and the nerves inside the teeth aren't aren't being you know traumatized multiple multiple times down the line.

Howard: So you're placing your own implants and restoring them?

Mark: I've been placing implants since 1985

Howard: So basically what would you tell young kids are coming out of these schools like your daughter Rachel's she's gonna come out of that A.T. Stills, she's never will have placed a single implant so their question to you is how do I learn how to place implants? Do I pick a system first, a teacher, a mentor. Walk them up that stairway, how they can go from graduating?

Mark: You know what I would do first of all getting out of dental school and I did not do this and that's why I'm telling these students that find some mentors not just one find some various mentors that you can spend some time with. I gladly I'm right close to the University of Minnesota and I have University of Minnesota students come over and look over the shoulder and you know spend some time in the office to try to get an idea of if this is some type of a you know practice that they'd like to be involved with or you know down the road if that's the type of practice they like to do. I get the opportunity to lecture over there for the AGD and so the students get to see some of the wacko things that I do and consequently it trying to peek some of their interest so they show up at my office to take a look at what the heck malt root is doing and it's fun to see those young minds and I'll tell you they're good young minds out there and it's fun talking with them and you know they're learning different than you and I did I mean like you said we in fact you and I were at Panky together you probably don't even remember that.

Howard: Of course I do

Mark: The Farran report back then you're you get your stuff done and then you're going doing the Farran report. So didn't get to spend as much time down there with this I thought that we would have the opportunity too.

Howard: What was that hotel across the street that resort that was right on the ocean

Mark: The Sonesta

Howard: The what? The Sonesta, so I lived in that place for six weeks that was so fun I took my ex and four baby boys and they'd play on that beach all day eaten cheeseburgers in the sand and now that was good times.

Mark: Yes it was but you know I back to the students and stuff, I really I think one of the biggest problems we have with the dental schools right now is they are so in bed with corporate and the corporates are constantly coming in and working you know the students to get them tell them things are dire you will not survive on your own, you can't have your own practice you need to come in and work in the corporate world and you know I don't believe that one iota I firmly believe that the the students that want to practice independently they can still and when I say independent I don't mean that they're practicing solo, you know I in this day and age I think a small independent group practice is probably the best way to go. So ultimately I see Rachel coming into my practice we bring in another associate or two that can have an opportunity to buy in and then I transition out and then the three of them or whatever it ends up two, three of them run a practice that they just have a blast at. You know that they can cover between the three of them making cover all aspects of Dentistry and their patients, my patients appreciate being able to have one person that can do most of their dentistry. I parcel out tough root canals, I parcel out pida patients, you know that are pain in the ass patients. So I parcel out the pida patients the oral surgeons and you know the specialists that if i don't want to spend the time you know gi lining or pucker power to be able to deal with certain patients I'll refer them out but those that I enjoy and I know that I can do good quality dentistry on I'll keep them in office and I enjoy that aspect of it. So you know I but you got to realize I'm working with I've got you know multiple lasers in the office I have cone beam, CT. I'm a CE junkie and I love all kinds of technologies and I'll probably never be a rich dentist but I'll be it I'll have a hell of a lot of fun doing exactly what I want to do and make sure that the work that I do for my patients is really you know I try it to be second to none.

Howard: I'm gonna pin you down on a few specifics because they want specifics, you know there's you go the IDF meeting is coming the IDS meeting is coming up and Cologne is it IDF or IDS?

Mark: IDS.

Howard: IDS and it's my favorite meeting it's in Cologne and it's every other year you know United States is fragmented at fifty states they all have a meeting with Chicago and Henman and Yankee you know that but the Europeans they pretty much do one meeting every other year and it's just a mind-blowing meeting in Cologne,Germany. Hundred thousand dentists will attend but gosh when your daughter goes there there's literally I mean literally several hundred dental implant companies. So I'm gonna pin you down the ground, she's saying I don't want to go study 200 systems. What system do you use and why and what would be a good system for her to get into?

Mark: You know what I would infadically move her towards Megagen, which is what I'm using. I've been using Megagen for well let's just say I had a real early Megagen implant that I was put in that kind of predated some of the FDA, so it happened to be on a friend and a for a friend type thing but I put it in there and I was looking for something that had a Morris taper, keyed Morris taper and that I could platform switch because I was using Astra for years an Astra great implant. I mean I loved that implant the problem is the cost for parts and pieces was starting to drive it up so much that I couldn't keep my prices down for my patients and consequently an old dental or implant supplier who was a friend of mine too but he had gone to Megagen and he came back said Mark you got to take a look at this. So I looked at it and I tell you it is a great system you don't have to buy the whole broad spectrum of implants they have there's really kind of a narrow range of implants that you end up using you know four and four and a half millimeter implants anywheres from 8 to 13 millimeters long and that takes care of a significant amount of the dentistry that you do and it keeps you in a safe zone but well they have implants up to 8 millimeters wide so you can put them right into freshly extracted molar sites and you know I'm not prone to doing that type of Dentistry I kind of like to develop the site and put an implant in to good fresh bone but you know other people like doing it that way I mean they've had good success getting good extra you know fixation of the implant into a molar site. So yeah I would wholeheartedly encourage people to use that Megagen system.

Howard: Yeah I'm a big fan of Megagen, I think I know what the secret is to is that that guy that started that had a hundred dentist DSO first. So what he got it in the implant business he could go from an idea to have it milled out you know in a hundred milled out in a week in the basement and then have all his doctors have them placed in another week. So his product cycle I think the European product cycle was we're gonna ask a bunch of dental school teachers to study this, they're gonna get back a year or two later then we're gonna talk and talk and I think they took the product cycle from five years to about you know a year and that's also why the Cologne meeting is every other year to give time for all the dental manufacturers to come back with their new product line. So most of your dental R&D is timed to be released at the IDS meeting in Cologne, Germany. So right now you talk to any R&D; department they're just putting the finishing touches on their big old presentation product rollout in march. I want to pin you down on implants, is CBCT the standard to care if she wants to get in implants but you're also recommended in her investing in a CBCT if yes which one did you buy and why?

Mark: I firmly believe that CBCT has become the standard of care it's pretty tough i don't know how defensible you would be if you're placing implants and utilizing something other you know utilizing a panoramic x-ray and going in and not realizing there was an undercut in a place and all of a sudden you hit the you know one of the lingual arteries or something that come through the lingual plate of bone and and have a problem you'd be virtually in this defensiveable from  that perspective because they ask you you know, did you have as cone beam CT to see that anatomic structure, no but I bone sounded while they didn't bone sound clear down to the you know where the undercut was.

Howard: Do you remember back in the 80s and we'd have a pan-o and we get all excited because there'd be some grandma was like an inch of mandible and you're like oh this is perfect and then by time we got in there to surgery and flapped it all back it was like a piece of paper and before you larroed it down before you could have five six millimeters of width, you're about into the inferior alveolar canal. I mean and what's funny is all the legendary implant gurus they all place twenty thirty, thousand implants without a CBCT they were all on panos. So which CBCT did you get and what did that set you back?

Mark: I bought a Planmeca

Howard: Planmeca, same here

Mark: Yeah I had a planmeca basically because I knew the technology that they had was something that they kept the same platform and you could switch out tube heads and do things so it was very upgradable whereas if you were utilizing any of the other manufacturers they were coming out with new models and you basically if you wanted to get a wider field of view or you wanted to change things out you just had to sell your your machine at a huge loss and then order up something else and so you know I've done a couple of upgrades on my comb beam CT and and it's just a matter of you know changing out some minor stuff.

Howard: Okay is that the true story because I I heard another rumor why you bought that one? Because you're okay because you're Mark Malterud a Viking and you bought Planmeca cause it's from Helsinki, Finland is it this like isn't this the old Viking network the good-old-boy Viking network Club.

Mark: Its northern European influence but you know it's the word the epic of the people up there

Howard: Yeah exactly

Mark: Yeah they build unbelievable equipment.

Howard: My theory is this on them, I I've been to Planmeca in Helsinki, Finland I've been to three shape and in Copenhagen, Denmark and those guys those dentists there they point-blank told me they go dude in the winter it's so cold for so long there's only two strategies either work hard ten hours a day six days a week all through the winter or you become an alcoholic and there's you can't go outside when it's 20 below zero and there's only four hours of sunlight. So man during the winter nobody works harder than Scandinavians and then in the summer that's when they tear it up cut loose go to the French Riviera the Mediterranean whatever but man they just put their nose of the grindstone at fall and they don't come up for air until summer and that I think that's one of the huge secrets or success. So you bought the Planmeca sodi laser, why did you buy a laser?

Mark: You know I I started out years ago with the air abrasion okay and I was sold to me back years years and years ago that the air abrasion was gonna phase out which it hasn't I still use it every day for my bonding.

Howard: Which one did you buy the creative or did you just go with the...

Mark: I bought the creative.

Howard: Okay you and I both bought it from Kim Kooch was lecturing on that back in the day

Mark: and Bill Brown

Howard: and Bill Brown

Mark: Okay

Howard: Yeah did we both buy them the same guy Kim Kooch and Bill Brown

Mark: Yeah and then once the lasers came out I thought you know what so I bought the one of the original Biolase and it wouldn't cut worth crap yeah I mean it was terrible for cutting teeth I cut soft tissue I can do all kinds of things with it but I eventually settled into the Fotona laser and I'll tell you there is nothing when you take a look at lasers at this point in time having that dual wavelength with nd-yag and erbium YAG I can cut like a maniac with that. You know if I want to cut hard tissue if I want to cut bone or tooth then and yet I can tone it down so that I can do pips or sweeps type techniques for do an endo. So we're really using sub ablative energy to clean out the insides of teeth and then pareo procedures and then cosmetic type things utilizing the nd YAG to be able to actually get rid of wrinkles even though I haven't used it on myself but that has it's the same thing laser that they're using in cosmetic, in the cosmetic industry is just different different hand pieces. So that's something else Rachel's going to get into is going more to the aesthetic side of you know facial aesthetics because I have no wishes to go down that route even though I did buy some handpieces and stuff to be able to help with snoring and sleep but...

Howard: So you bought the Fotona laser

Mark: Fotona

Howard: and the CEO like that is a Keith Bateman right

Mark: Keith is vice-presidents yeah he's one of the main guys for it.

Howard: I always remember his name because on his nicknames KGB it's Keith G Bateman and everybody called him the kid the laser KGB but so are you using that Fotona more for hard tissue or soft tissue or both?

Mark: Combination, you know I'll tell you I have somebody with a hot joint you know the TM joint if I just take extra orally with the ND-YAG and literally lays the tissue for a minute you can pretty much reduce down the inflammation the area rapidly utilizing you know the bio stimulation or low-level laser stimulation. So I mean it works out great for healing for you know cutting tissues for I don't use it as much for cutting preparations as I do for bone and you know basically implant uncovery. I haven't had to yet utilize it for salvaging implants but the ND-YAG you know or the erbium YAG utilizing it in that area for pareil around a failing or an ailing implant works out beautifully utilizing some of their tapered tips so you can get in there and clean out the threads and stuff of an implant and get rid of granulation tissue and the degranulate the area and then ultimately I'm using it there's another avenue of dentistry that I've been doing of late and that's utilizing ozone in my practice. So I'm using it for inflammatory processes and cutting down infections I've been using it for ten years now and I couldn't even tell you the last time I had a localized osteitis from an extraction and I do some pretty tough extractions and consequently we just don't have any types of infections coming on afterwards when we're rinsing with ozonated water and you know sometimes bubbling ozone gas into the area he's always on an oxygen create a very very strong antimicrobial.,

Howard: So why is ozone always been more popular in Australia, New Zealand, South Africa why do you think it hasn't taken off in the United States to the level it's taken off those three just like when I read publicly traded stocks that are in the dental implant business they always point to imagine what their us cells would be if the dentist placed the same number of implants for ten thousand people as they did in Germany in Korea. I mean the upside on dental implants in America I mean it's gonna be an easy double and then double again. I mean in Germany and South Korea the average general dentist places one every week I mean we're nowhere close to that in the United States. So again why do you think the Germans and the Koreans the general dentists all place implants and the Americans hardly do and why is ozone more popular in South Africa, Australia, New Zealand than the US?

Mark: You know I think it's because of our FDA they scared the crap out of the US doctors. We can utilize ozone at will in our practices you don't want to hurt anybody with it it's almost impossible actually to hurt anybody with ozone. It's extremely safe that's extremely efficacious you know they're very few and that that might be an area you know come to think of it along minimally invasive lines. That might be an area that we do a some type of a continuing education in the realms of ozone. I don't know if you've had anybody do that yet?

Howard: No

Mark: It'd be interesting to see if it if it might fly but I'm telling you if you get the information out there and educate the masses about the safety of it and how applicatious it is. You know I'm an extremely strong believer in that I show a case when I'm lecturing of a guy that I literally was putting in implants and I had a snap-on smile to gain his vertical so it gave us a spot to start from with his reconstruction and in the interim we're gonna put in some implants well he ended up just basically trashing his mouth in a period of less than two weeks and it took less than and I mean literally the graph that I had put in and the membrane were completely exposed and I mean completely exposed and all I did was rinsed it with ozonated water ran ozone gas over the area and then had him used some ozonated oil and I have the documentation of the following weeks of healing and it was unbelievable how it within a week there was one little spot that wasn't healed over. So a crip tissue back up over the membrane and I mean it was astounding what it was able to do in that short period of time and you know just I'm off on a tangent with you because I don't think you even knew that I was doing ozone I didn't put that down in my bio but it's it seems to be a bigger and bigger part of my practice day in and day out and that's people are starting to seek us out for what we do with with the ozone too.

Howard: and who are you buying now that's ohthree and TheraCal?

Mark: Well that's what I'm using for my root canal or to avoid root canals one of the things one of the things that I am doing is that when we get a pulp exposure and even a carious exposure, I had one this morning wasn't expecting it at all the carry is wrapped around to the lingual of the you know a really really strong lingual cusps but it that the decay wrapped in there and I'm scooping out decay next thing I know I popped into the where the nerve was and I'm like oh man, didn't really bleed to any extent cleaned up the area hit it with ozonated water, I hit it with ozone gas and laid TheraCal on it and once the TheraCal was then we went into air abraded finished the preparation up and bonded it and I am now about probably about 220 teeth over the last six years since I started using TheraCal and ozone and I've lost ten nerves in that time and if you saw the size of some of the exposures that I've had most doctors would say are you crazy trying to even possibly do a pulp cap on something like that and these patients many of them they come in and they don't it's either they're gonna have their tooth extracted they don't want root canals and I can't convince them that the technology has changed on root canals that we can do things better and we can clean the canals out better than what was done years ago with root canals but they're adamant that if you don't do something to save the nerve inside the tooth they just want it cold. So I have a good number of people that allow me to push the boundaries of utilizing ozone and TheraCal on these teeth but to that point when you have 220 and you had 10 go south on you, that's not too bad. That's a high you know.

Howard: Now that TheraCal that's Bisco and they won the townie Choice Award for that I I've always loved the town of Choice Award because every year we have several thousand dentists vote on what their favorite products and services are and I mean when everybody's voting that has eight to ten years of college, it's I mean I remember the first two or three years I came out Gordon I'd always sit down and say man it's amazing what a big sea of doctors of dental surgery how they can get right you know just by but my because a lot of people said well that's just market share everybody's just gonna vote for what they thought what they use how was I gonna tell you if it's the best well when everybody voting is a Doctor of Dental Surgery it really means something. By the way Byoung Suh is amazing man he was podcast number 727 the Bisco story with Dr. Byoung Suh BSCH MCH PhD founder of Bisco, he is an amazing man. So do you use any other Bisco products or is that pretty much the only one that use?

Mark: TheraCal, i'm using their Theracem now because the TheraCal was working so well i use the Theracem. I'm also utilizing their zirconium primer and I they if I was using if something other than what I've been using for the last 22 years for bonding I would probably go to Bisco's bond, they're all bond but I have been using something from altered and called pq1 for literally I had one of the first packages that Neal sent me out of the R&D; department one day when I was in there doing some bond studies with them and he sent me out some q1 and I still use PQ one and I am telling You no bond degradation, no you know brown lines around the peripheries it's I don't even know if you can find it on Ultradent's website anymore they still make it because I can still buy it and you know it's. So when I go on lecture I don't lecture on bonding because I'm an old stick-in-the-mud and I've got something that works for me and I'm not messing with it might not.

Howard: What was his what was his anti bleeding agent the hemostat...

Mark: (inaudible 44:11)or viscostat

Howard: Yeah I mean I will never forget it was in 1987 Dan Fisher was lecturing and he'd come out with this on anti bleeding Viscostat and he would cut himself on the arm and it start bleeding and then he would coagulate it with this stuff and his arm was the demo and it looked like a pin cushion and when I first saw that I mean I didn't it was just amazing how passionate he was because he didn't even feel the blood he just like started cutting himself they start bleeding and that did you ever see him do that?

Mark: I never saw him do it I heard stories about it but I've known Dan for a lot of years and I can believe it himself to show people how fast it would coagulate but I never heard about him cutting himself.

Howard: Oh yeah it was fair astringent is 15.5% ferric sulfate and Viscostat is 20% ferric sulfate and my god that guy and then when some of the early vaccines remember those guys used to test them on themselves and their grad students they come out of the vaccine the government's like no way you're gonna do this and they're like who have you tested on they're like I test on myself and all my grad students did it too amazing. I want to get back just something you started earlier I'm you and I are so damn old that we saw the first round of DSOs like orthodontic centers of America go public on the New York Stock Exchange when you and I got out of school there were a dozen on NASDAQ they all imploded and then they went away and now they're back and it's true they are in dental schools they always thinking. You can get any dental student to show up if you offer free pizza that's what I learned when you go to lecture at a dental school  you're like okay all I gotta do is buy 10.

Mark: (Inaudible 45:58)

Howard: What's that?

Mark: I said it's easier if you offer beer too.

Howard: Yeah and you get to be so that all the DSOs go in there and they say hey you know when when Mark and Howard graduated all the pharmacists live by themselves and now they all work for CVS and Walgreens and that's the way it's going but I you see zero evidence of that's where it's all going because number one none of them can do an IPO you don't see any of them publicly traded in the United States, not a single one but you mentioned at the very beginning that you were also working with Smile Source and that you're a big believer in a non DSO private practice what is smile source and why are you involved with that? That's Trevor Mar.

Mark: Yeah Trevor's the CEO for the company and what it is it's a group of now about six hundred and twenty dentists or dental offices around the country and closer to a thousand dentists that are involved with it and they're all passionate about remaining independent and what we found is that you can not play in the same sandbox with the big boys unless you can buy things at the rates if they're buying keep your rates and economies there and so it started out as kind of a buying group consider it from that perspective but it morphed into we have things that we do these peer mastermind things. So we have meetings each of our groups has local meetings, so I'm an administrator for 25 offices here in the Twin Cities and we have a meeting five times a year you know meetings five times a year yeah things called a peer mastermind okay and what it amounts to is we we discuss issues that are happening at that time it's a problem in somebody's office and we shoot it around the room and people get to comment ask questions about how it's you know why are they at that point how did this happen how did that happen and then we each give our opinion about where we go with it. So the person that's there is getting all these years of experience to be able to help them with decisions and we had you know we had one young lady that came in and she had to have a heart-to-heart with one of her employees and she was literally losing sleep over it and there are enough of us there that have enough confrontational tolerance that it's like no you just sit down and talk to her tell her what your expectations are and you go forward from there you know if she doesn't feel like she's gonna be there then she'll self-select herself you know out of the practice and so the next morning she went in had the meeting and sure enough the employee which she wanted her gone anyways she self-selected out of the office just with the conversation that you know she was talking about what it was going to take to help her makes you know be successful in the office and the girl goes I'm not putting that type of energy into it and she was gone. So but by bouncing that off from her colleagues she was able to feel confident enough to go back to her office and deal with the issue and we see that weekend or you know meeting in meeting out that there's always something good that comes out of it. You know decisions to sell one of a practice that maybe isn't performing as well as the doctor wants it to and one of our other members bought the practice from another member. So because she had she needed to expand because she had an associate that needed more time. So it morphed into much more than just the buying group and that's what I enjoy about it and it's kind of like you've got a good group of doctors that support each other and will help each other become you know maintain their success and as a group we're out performing the ADA numbers. When they start talking about dentistry has been kind of flapped over the last year's the you know Smile Sources five percent gains plus you know with each of their practices and the average practice is probably about you know 1.1 million dollars which doesn't sound like much to you but most of them are solo practices and you know guys like me that you know I always see in patients three days a week but we're producing a lot of dentistry in a short period of time and so it can be...

HOward: Let me go back, didn't Smile Source didn't they get their cut their teeth on ophthalmologists or opticians.

Mark: Yeah so what happened was (inaudible 50:53)

Howard: Yeah what blew my mind on that story is didn't they get like something like two-thirds of all the opticians or something like that, talk about their optician roots first.

Mark: Well they are vision which is what Smile Source came out of there was some Dr. Glenn Ellisor was the guy in a some friends of his down in Houston they found that they could buy a bigger ad if they put their names together this is back in the yellow pages times and so because they were going up against the pearls and you know all the different corporates that were out there that had the front full-page ads in the Yellow Pages and so they decided they were gonna get a group together and they would get Yellow Pages ads and they'd rotate through where the calls were come from and so they worked that aspect of it and then ultimately they found out that if they bought larger volumes of things that they were getting economies and so they kept getting guys wanting to join in and join in in the Houston area and pretty soon people from out state wanted to and so they set up a franchise model and ultimately you end up owning you know they for legal purposes it's called a franchise even though you are completely independent you buy your own products your whatever your own formulary is you can buy. It's just that by being a large group you have the buying power so they did that with vision and then there was a cocktail party, well probably about seven years ago where or eight years ago where some dentists were talking some ophthalmologist or optometrist and tell them about the corporates coming in and they told the whole story and then it just kind of spun off Smile Source from there because if we were do the exact same thing that they were going through 25 years ago and so it's been a good story and it's been good I'm coming up on you know I'm into my getting done with my fourth year it started my fifth with Smile Source and...

Howard: So it started his vision source and you know a market share they got of the option of the opticians?

Mark: That I don't know (Inaudible 53:14)

Howard: It was high I mean okay Vision Source is a family of over 3,300 locally owned optometry practices collaborating to provide quality professional. So they got 3300 and I think there's only 5000 in the United States I mean they basically got 60% and that's what blew my mind the first time I heard those guys lecture was when they came to Phoenix I went and checked them out and I was blown away it's like these guys got 30 years experience getting two-thirds of a market and then they set their eyes on dentistry and how and now you're saying they're up to six hundred offices with a thousand dentists and six hundred offices. So what does that cost you a month to join and are you a happy customer, would you recommend other people join Smile Source to maintain independence?

Mark: Absolutely you know and it's the amount that's something that is part of a franchise fee I have to zip the I cannot tell you the exact amount because that's something that...

Howard: because you wouldn't get it right, I bet if you asked every single dentist on Smile Source how much it costs a month I bet every one I'm gonna give it him a different answer they just don't like their accounting.

Mark: Well what's up happening is that you know let's just put it this way the amount that you pay for Smile Source comes back to you threefold with the savings that you get and you know there are a bunch of our members that bought comb beam CTS at an unbelievable price and then many of them just bought scanners at an unbelievable price because the big boys deal with us in literally you know we're we're some of the big vendors out there were some of their largest accounts and what they love is that they've got you know very forward-thinking dentists that are passionate about dentistry and that's they're also passionate about education. So it's a good thing and I would sign up for it in a heartbeat you know even being an administrator

Howard: You've got to get Trevor Maurer he's the president CEO down there and on Kingwood, Texas got to have him come on the show and tell everybody all about it.

Mark: Hasn't Trevor been on with you before look that one up I'm not sure but I thought I know he was on some podcast but I thought he was on yours at one point.

Howard: I don't know I lost my internet connection do you give Internet?

Mark: Yeah but if I touch my keyboard I'm afraid that I'm going to screw something up here so that then I'm not gonna know this this Skype thing is the students that are out there the young doctors they're probably laughing their asses off at me right now but it's kind of like I've never done.

Howard: Let me tell you these young kids about Microsoft, you know Microsoft bought Skype and they bought LinkedIn and so when you and I the first big bull market I ever witness was a 94 to 2000 that six year upswing I call it the y2k everybody goes to the internet market I call it the y2k market because everybody was trying to get all their hardware and software replaced because y2k which means they only had enough memory, memory was short so they just did two digits for the year nineteen whatever and at zero zero the computers at all think here in 1900. So everybody was buying computers software hardware hand over fist and then it just stopped right at after New Year's Day 2000 and by March, it took till March for all the Wall Street to figure out no one was selling anymore and then the whole internet bubble collapse but in that big right up their were four big companies and it was Microsoft and Intel they called that Wintel and then there was a Dell computers whose dad was an orthodontist I met and then the Cisco and now that all went away then now we're back to the other bubble that just started popping two or three months ago and letting out steam and they called it the faanm, Facebook, Apple, Amazon, Netflix, Microsoft, Microsoft's in there again and they have seven revenue. I mean they were the only company that was in both at the top of both bubbles I mean Microsoft is it a Bill Gates is probably I mean how could he be underrated he's one of the top richest guys in the world him and Jeff Bezos and Warren Buffett but it's an incredible company but no Trevor Maurer I never had him on the show did I, I don't see him on the show. Did you see him on the show?

Mark: No 

Howard: Were you drinking Viking beer and and hallucinating that Trevor was on the show?

Mark: Maybe some aquavit.

Howard: Okay so what am i, I can't believe ma'am we already we already went over now I can't believe we already went over an hour. I want to go back to one thing on your root canal. To me it really scares me when I see some twenty five-year-old dental student walkout of dental school half a million dollars in debt and she tells me she looks me in the eyes and says man I hate endo, I hate it endo, I don't want to do it. I want to get into the soft and pretty stuff, I want to get into bleaching, bonding, veneers, Invisalign. You know I want to do pretty stuff I don't like blood guts and I don't like molar endo then I'm sitting over here thinking my god you do and the most amazing cleaning on someone what a service they come in they got gingivitis gum disease you spend an hour doing a cleaning and you're only gonna get 60 bucks for that but you do a molar root canal you're gonna get $1,000 an insurance will pick up 80% of it and when you're $400,000 in debt you know I really as your advisor I don't really give a crap if you like it or not. What would you say to some kid who who's already decided at 25 he hates molar endo, how do you get him to erase that horribly expensive thought out of his head?

Mark: You know maybe maybe having him seek out a mentor like what I was saying earlier and watch what they're doing with endo and realize that it's not that tough anymore you know the rotary endo that we have or reciprocating endo and Apex locators are pretty damn accurate so you're going into it with a different perspective and it's actually quite easy to do molar endo in it now for me I take it one step farther utilizing sweeps or back when we had pips to go in and use that sub ablative energy to clean out the canals I am you know. I know that I'm getting that thing cleaned out to a point that we're gonna have good success down the road now that means you're investing in a you know a sixty five seventy thousand dollar laser that's going to do more than endo, much more than endo.

Howard: Where are you buying your ozone? What would type of ozone equipment, who's manufacturing it?

Mark: You just manufactured on your own, I mean you've got the ozone generator and it's a medical grade ozone generator.

Howard: Where do you get the ozone generator?

Mark: I bought my not at Longevity in Canada, the Longevity up in Canada and they've got a

Howard: The company is called Longevity?

Mark: Yep

Howard: Now are you gonna do a course on... you should do a course on your three things that are you talking about CBCT; I wouldn't want to practice without CBCT, lasers no zones that'd be a great course or an article.

Mark: Well one of the things that you don't know is that I also write an article for the AGD about two to three times a year on minimal invasive dentistry I don't think I put that in there but so I've got probably the last six years I've been putting out articles for the the AGD in their general dentistry magazine and it's kind of fun but you know after a period of time you start losing some of the can't recycle cases but you got to tell a different story. So well then next what I'm gonna do it behind implants.

Howard: It's gonna be on implants your next articles on implants?

Mark: I think minimal invasive dentistry follows that line, I don't like cutting down adjacent teeth.

Howard: Right

Mark: You know and I'd rather utilize the available bone and create a tooth that is all by itself.

Howard: Right

Mark: Clean appropriately

Howard: wWll is there anything you know I can't believe we already did went over an hour is there anything else that we should have talked about that we didn't talk about or is there anything you thought I was gonna ask you that I didn't

Mark: No, I'm surprised that it went as fast as it did, you know having a conversation with someone that you know it makes it a lot easier.

Howard: Now is it gonna be hard to get your I'm trying to what is the temperature today in Minneapolis St. Paul where you're at?

Mark: I think it got up to a high of 9

Howard: Yeah and it's a it was cold here today it was 67 are you afraid that your daughter's you're not gonna say sorry I'm staying here in the desert and have no desire to go back to Minneapolis st. Paul

Mark: Their's a Rr. wonderful down there we got to worry about so we'll see how that happens.

Howard: Oh you mean she got a boyfriend down here...

Mark: Yeah she lives yeah she's in the Scottsdale area she's close to where you're at, in fact it's gonna make it very easy for me to come down to the townie meeting because you're literally two miles from where she lives.

Howard: Oh nice I can't wait to I can't wait to meet her with you that's just gonna be awesome but seriously you've been a big friend and role model of mine. I have seen you at these courses for years I mean we've been buying a lot of these same technology, same courses and what I love about you is you're doing it you're crushing it in real world fly over America you know St. Paul, Minnesota where as so many people think that you're only gonna be successful in Scottsdale or Beverly or Key Biscayne or downtown Manhattan and they don't realize that the majority of the market is that big ol Midwest at flyover State you know half of America lives in 147 metros the other half lives in 19,000 towns and I just love talking to real world gurus like you who are crushing it in real world America.

Mark: Well thank you very much Howard and I've followed your career for a lot of years and it's it's been fun from you can even walk it watching you walk in front of the ADA crowd at the off-site location that they put you at the ADA meeting about 20 years ago that you said you never speak there again and I've seen you there since so you must have mended your ways but;

Howard: Well it's so funny because when I was young and filled with piss and vinegar and pissing everyone off the old guard they tried to shut me down but now all my buddies now my buddies are the old guard so though most of the people in key positions are the ones like you laughing 30 years ago now they're all a bunch old guys but I'm continually reminded of all my immature crazy stuff I did oh my gosh oh yeah yeah I remember the first time I spoke in the ADA my whole lecture is the four things I hated about them the most. That's just not something it's not something I learned at the Dale Carnegie Institute on how to win friends and influence people but my gosh. So now when my four boys are being crazy I just think yeah I remember crazy that was me but man again thanks for all that you do thanks for coming on the show and sharing all your knowledge and I cannot wait to see at the Townie Meeting.

Mark: What's the dates on that?

Howard: It's March March 22,23rd scottsdale-arizona spring baseball training, it's a great time to come down here and I will see you at Townie Meeting.

Mark: Right next to TopGolf down there too so makes it fun!

Howard: All right I'll see you there. 


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