Howard: It's just a huge honor for me today to be podcast interviewing Hal Stuart and Dr. Craig Herre of the Stewart Center for bio rejuvenation dental medicine which was established in 2014 co-founders Dr. Hal Stewart and Dr. Craig Herre saw both young and established dentists who were frustrated with the current state of their practices it was their desire to create a comprehensive course that would give doctors a logical step-by-step approach to rehabilitating even the most broken down dentition while staying free of the limitations put on them by insurance companies. Teaching minimally invasive techniques was also a priority the goal the Stewart Center is to provide an intimate learning center for dental professionals who want to profoundly impact their patient's health in significant ways the opportunity to practice and an insurance and third-party free environment to acquire the confidence and ability to diagnose treat restore failing dentitions in a systematic and predictable way to learn state-of-the-art minimally invasive techniques. Let me introduce each one individually because you're looking at a two men Dr. Craig W Herre DDS who is the second vice president of the American Dental Association. How cool is that he's the president of Dental Health by Herre, co founder and co-director of the Stewart Center for bio rejuvenation dental medicine. The journey that brought Dr. Herre a partner in the formation began over three decades ago in his Leawood, Kansas practice he had provided comprehensive care with a focus on life enhancing rejuvenation dentistry for over ten years. To accomplish this he completed hundreds of hours of continuing education at prestigious schools like the Pankey Institute the Schuster Center right here in Scottdale and Orognathic Bioesthetics International OBI. As an expert in the field Dr. Herre has served as president of the Kansas Dental Association, chairman of the peer review committee in the fifth District Dental society, fellow of the American College of Dentists and as a teacher at OBI, he is also a member of the ADA American Academy for Cosmetic Dentistry American Academy of oral Medicine Sports Dentistry and the Johnson County Dental Society. Dr. Hal Stewart DDS FAGD is a CEO is a biological and systems focused dentist and believes that the focus of treatment should be to achieve and maintain a healthy and functioning chewing system. He believes that a healthy dentition is only part of the healthy body and so he focuses on treating problems such as neck and shoulder pain headaches, clenching and grinding that are often caused by dental problems. He has completed the entire curriculum of the Orognathic Bioesthetics International OBI foundation at bioesthetics.com and has also served on the teaching facility at OBI, he has studied exclusively at the Pankey Institute for Advanced Dental Studies and completed the advance esthetic master esthetic course at the Las Vegas Institute for cosmetic dentistry. He lectures extensively teaching dentists across the country and even around the world about advanced restorative and cosmetic dentistry. He currently serves as a mentor at the Schuster Center for professional development in Scottsdale Arizona and is a past president and current board member of the Texas Academy of cosmetic dentistry and is a member of Orognathic Bioesthetics International American Academy cosmetic dentistry the ADA and the AGD. Gentleman thank you so much after a long hard day at the office and instead of going home to come talk to my homies for an hour thank you so much for joining the show.
Hal: It's a pleasure Howard.
Craig: Happy to be here Howard.
Howard: You know when you when you talk about insurance free I don't I want to start there because the bottom line is I'm the average American between the ages of 16 and 70 will buy thirteen new cars with the median average price of $33,000 and then when someone comes in and their whole mouth is shot almost all the dentists will just point to the most broken down tooth there is and say well that of all your crappy teeth that's the worst one so let's just fix this one because your insurance will only pay for a thousand and then you won't get another thousand until next year so we're just gonna fix the worst one could you imagine walking on a car lot and they say well you know buddy you should really just walk or take the boss let me give you let me give you a bus schedule so you can catch the bus at Phoenix there's no sense spending thirty three thousand dollars on a new car. So tell me why is it that five percent of the American dentists of the numbers I seen have done one or more full mouth rehabs at thirty three thousand dollars or more and 95 percent of dentists will never do it one time in their life, first of all do you agree with those numbers?
Hal: Yeah I agree with them. Craig?
Craig: Yeah, that depends on how you define full mouth.
Howard: Well what my definition of full mouth is that you know but then when you walk in there you just sit there and say here's everything the dentists and the hygiene discuss you got these gum issues and cleanings you need these fillings crowns root canals here's the whole case so I guess what I mean is the whole case dentistry as opposed to you know they start off doing one tooth dentistry insurance driven and then maybe they'll go up to like quadrant dentistry and then a few will say well if I'm gonna numb up the right side might as well do the whole right side and come back and do the left side, as opposed to the dentist who just doesn't think about the insurance then when he gets to the fee instead of saying you know it's 20 10,000 20,000 30,000 says by the way you have insurance that's great they'll pay a thousand and the rest of it you have great credit and just like when they sell cars and you know if you've been approved and for a hundred and eighty five dollars a month for 60 months we can do everything today that the doctor and the hygenist talked about. I mean that's what I mean by comprehensive dentistry as opposed to insurance driven one tooth dentistry on an American population who doesn't blink at spending a thousand dollars for an iPhone.
Hal: Yeah well Howard you know the last time that I thought about insurance?
Howard: When was that?
Hal: Last time I thought about insurance was in 1994 that's the day that I quit taking insurance and I think it's a mindset there are plenty of people out there that want to have the finest dentistry that's available on and they're searching for people for doctors that will provide that for them right there's the insurance companies have interjected so much fear and dependency on upon dentists that it's you know in the pendulum has swung to that side and it's you know I've I've relegated to the fact that right now that we're gonna you know just the dentist's that we train are the ones that want to get out of that trap of insurance. So what I tell them is that if the analogy I use this if you buy a new house and they that you've got a this you know huge backyard and it's overgrown with weeds and the trees are dying and you know some of them have branches that are breaking off and you know that you bring a landscaper in and he says you know I'm gonna plant the rosebush over in that corner and replace that dead rosebush over there you do it okay though that looks really nice and then another gardener comes up and you know says I'm gonna trim that tree over there, well two or three four years down the road it's not any better than it was before you gotta have somebody come in with a plan because it's a system. So what we what Craig and I both described too is what we do is treat a system that involves airway, nerves, muscles, teeth, the brain and you have to look at it that way and you have to be you you have to get insurance completely out of your mindset and I'm not saying that flippantly I realize that there's a lot of young dentists that get out of school and they've got a big debt and you know the thought of you know starting a practice and spending you know $800,000 to you know start a practice or 500 and they feel like they need to get on PPOs and HMOs and all that stuff to get patients in the door but then two years down the road they're prisoners to all that and it doesn't have to be that way. I think it's the insurance companies have got dentistry exactly where they want them if you ask me but it doesn't have to be that way for those that want to get out of it it really doesn't there's so many patients out there that want to do it the right way they want to buy the new car you know in for their mouth.
Howard: Yeah you know my mom how far are you like how far away are you from Beeville, have you ever heard of Beeville?
Hal: Ya no, my cousin lives in Beeville I know where it is.
Howard: That's where 80% of my grandchildren live and in you're in Flower Mound, Texas which is basically you know I grew up in Wichita which if you just take 35 up to Oklahoma City and Wichita from there to there I mean that that's flyover state America. You're doing this not in Beverly Hills or Key Biscayne or our downtown Manhattan you're doing this all in a flyover State and I remember having lunch just up last time I was visiting my mom Wichita and I visit some dentist a small town he was telling me yeah there's no money out here and we were eating in a Mexican restaurant in town of about 5,000 and I looked out the window and I said look over there at that, what are they called they're not circle-k 7-elevens they're quick chops he's quick stop's is out there called?
Hal: Quick trips
Howard: Quick trip and here's this town didn't I said 5000 fighting you have 2,500 and I said how many how many trucks over there right now at that quick stop how many cars. Their were six trucks and they were all f150s I think one of them was at f-350 I said every truck at that quick strip is 35 $40,000 that I knew that f-350 was a hundred grand. I said you say there's no money but how do all these people out here have money for a $35,000 f-150 or in $98,000 f-350 and I say you're doing this in flower man Flower Mound Texas.
Hal: Yes hey Craig's doing it in Leawood, Kansas.
Craig: Leawood, Kansas.
Howard: Yeah but that's the richest city in the world isn't it Leawood, Kansas.
Craig: Howard you said something a minute ago very profound, comprehensive dentistry we first question you asked was full mouth what's a full mouth. I love your definition of any complete treatment plan that is a complete plan that you that you complete on somebody including scaling, root planing, perio, whatever it is. We have to keep in mind that the things we're trained for in dental school are exactly what insurance covers, operative dentistry crown and bridge, dentures, perio,all that kind of thing the what we teach are the the the niche that we have found when you talk about TMD occlusion airway and how all that marries together and holistic and health related dentistry. Guess what, that's not covered by insurance now that's unfortunate for patient in some ways but we're working in an arena that's outside the traditional dental model and if we can establish you know some credibility with the patients and help them in ways that nobody's ever been able to and look at their whole body and the whole system people are willing to pay for that because it is out-of-pocket and they always ask about how much my insurance is gonna cover then you say nothing maybe fifteen hundred maybe a thousand but it's an interesting concept.
Howard: So now just in case there's any guests confused you used to be called the Texas center for occlusal studies and now I'm you're the Stewart center for Bio Rejuvenation Dental Medicine why the change of names?
Hal: Well two things, Craig and I you know Craig has ever been as much a founder of this as I am and a dear friend, an unbelievable dentist and Craig's passion in dentistry besides this he loves teaching is being involved in the political part of dentistry and they ADA and I and I admire him so much for that so Craig you know after becoming the vice president of the senior vice president of the ADA he's really focusing on that and but still teaching and the teaching Center was here in Texas at my teaching Center next to my office and I started thinking who were the you know dentist what do they think of when they go for quality education Spear, pankey, Kois, Dawson. Dentists like to put a name together with a philosophy and in when we were going through OBI, Craig and I it was Dr. Bob Lee out of Loma Linda and so I with a lot of Prayer and a lot of discussions with my mentor Mike shuster Howard you know might very well.
Howard: Yeah he was on he was on show number 544
Hal: Yeah I remember that, well Mike told me that he said Hal he said you should could you know when you put your name on something you put it out there it's you can't hide behind II think it's you so I talked with Craig say Craig will you be okay with this name change of brand change Craig said Hal, you know whatever we need to do to facilitate this and so you know that whether there's a good idea a bad idea at the end of last year we decided it or the end of 2017 that fell into place and we changed the name so that we can so it's more personal you know I've got my name on it I'm responsible and we're gonna you know I'm always here for month for our doctors anybody that wants to talk and Craig is too so that's why that's the name change. The reason we went to dental medicine is because over the last five years we have really realized that occlusal issues and TMJ issues are so intimately related with airway which is also intimately related with the comorbidities that the obstructive sleep apnea snoring can produce that this is we are dental physicians and this is dental medicine. We're not tooth doctors when we want to get dust away from just looking at individual teeth and looking at a much bigger picture of how we can profoundly affect people's lives and we don't have to cut 28 teeth. A full mouth to rehab or dragging myself the majority of full mouth rehabs we do, might involve what Craig 1 or 2 crowns and each patient.
Hal: We're not doing any subtractive we're doing all additive with the wonderful magic of adhesive dentistry and composites. So it's very it's minimally invasive but we're addressing the entire system and we're looking at airway joints occlusion we're looking at everything and that's what we teach our residents which is going to be become dental physicians.
Howard: True or false it seems like when I talk to I mean it depends on what your talking about on the job and they walk right out of school I tell them look you know you're gonna watch the Super Bowl this weekend but you know you need to go out and just learn how to pass and catch and block and tackle. I mean you're not ready for the flea-flicker play in the Super Bowl and you know they just need dudes they just need to get their hands wet. I mean a lot of these kids graduate and they can do their entire dental school recommended requirements every month or two but as they as they start to get down you know giving an anesthesia and fillings and crowns and root canals. You know they tell me that the most confusing thing to them is not pediatric dentistry endodontics surgery it's a oclusion. Why is that so confusing and I'm gonna ask you if this is true or not if I went to lunch with five endodontists they wouldn't really argue about much if you were to lunch with a bunch of pediatric dentists they'll maybe they'll argue on whether or not they like Silver Diamine Fluoride but man you go to you go to lunch with five occlusion guys I mean it's like five world religions why do you agree with that assessment or not?
Hal: No I agree and I know Craig does to I heard a lecture at grid in New York two years ago and he told a story about Pete Dawson was lecturing somewhere Pete said in my younger days I would meet with and you know and he said we'd go into a room and when we leave they'd be blood on the walls.
Craig: Well yeah you know you brought up something just a little bit ago Howard about dental school training and by the way we're fellow UMKC people.
Craig: We had good training and you know in our in our dental school we actually got a lot of repetitions and I happen to have a son that's in practice with me and he's a UMKC grad also. However his rep see he got in school and you know with endo and crown bridge and all that was way way less I think there's less patients and dental schools it's just more difficult to get your requirements. So they do have to develop repetitions when you get into practice and you can't just jump right out and be an occlusion guru or something like that so I mean there's still a need to go out and be a general dentist and get your practice in and all that but what we're trained for in dental school is really very mechanical if we see a hole in the tooth we want to fix it if there is a missing tooth we want to replace it and that's just where we're trained and many many dentists stay in that forever and ever and ever. What we're trying to tell dentist is to put the handpiece down stop and think for a minute take a look at what you're doing here because you're dealing with a human being behind that set of teeth and believe it or not those teeth are connected to their entire body and whatever goes on with the teeth generally affects the rest of the system so we're trying to get people to slow down and study what's going on. Now occlusion is another interesting issue because we've got there might be five different occlusal teaching philosophies in the United States and around the world and all of them are relatively the same except for one and there's a lot of different ways that you can go about dealing with occlusion and many of them are successful for the most part but what we use is something that's very predictable and we can take the I think the mystery out of what centric relation is and the mystery out of occlusion because we take it and I don't know just boil it down and it's really not that difficult once you understand it.
Howard: and that's what you call the stable condylar position SCP or CR
Craig: That's correct
Howard: and you said their were five occlusal cams and four were similar and one was different be more specific what are what are those five and what is the one that's more different?
Craig: Well I mean I think we look at you know the the Pankey Institute and you can kind of put Dawson in that too because they are their pedigree is very similar to it I think Frank Spear and John Kois have you know a similar philosophy but maybe a little bit different. OBI is centered relation based occlusion and then you've got LVI that you know they work in a different condylar relationship as a general rule more of logical relationship. So you know that I think most of them are similar other than what LVI teaches and that's not necessarily right or wrong it's a...
Howard: So you'd say Spear, Paneky, Dawson, Kois, OBI, Nash, Schuster, Hornbrook, Strupp is probably all CR and then just Dickerson and LVI would be neuromuscular would that be a fair way?
Craig: Yes I think that's a fair way now we get CR differently and we call CR something differently but yeah I think so
Howard: Very interesting so a lot of the kids tell me oh so what's in what would you say that the kid comes out says I know I need to learn more occlusion would you recommend why I know you're gonna recommend the Stewart Center for Biological medicine you'd recommend Herre and Stewart of the Stewart Center for bio rejuvenation dental medicine but on the two camps you guys are CR so Spear, Paneky, Dawson, Kois, OBI, Nash, Schuster, Hornbrook, Strupp or would you recommend neuromuscular because I know you have experience at LVI. So how do you how what would you say to a young child who's 25 and should I learn CR or neuromuscular? I mean they can't afford all these camps their $400,000 in student loans they can't do everything so what would you recommend for the first step?
Hal: What I would recommend for the first step is to read everything you can read about biology and I will tell you I'll tell you my definition of centric relation my definition they're centric relation our definition that we here to at the Stewart Center is and it's very specific right and there's a reason for it, it's when all the teeth are in complete occlusion MPI the inferability of the lateral pterygoid muscle is passive when you can achieve that, then your in centric relation. It's not necessarily an exact position because people's condyles are different they're different levels of degeneration, centric relation fourth you know a 16 year old with condyles that are not presumed at all is it the positional the position of those condyles might be a little bit different than someone that's 50 that's got very flattened and eroded condyles but when we can stabilize the condyle so that when the teeth are together or when they come together on our orthotic very the medial pterygoid inferability I mean though in familiar at the lateral pterygoid is passive that's biologically the way that it should work and that's where we a group you know are in the same camp with Dawson and Pankey. If you read Dawson's book that's exactly what he subscribes to the inferability of the lateral pterygoid muscle is passive when all the teeth are together. So that's our goal with whatever patient what we subscribe to is we don't do anything until we know the condyles are stable until we know that we achieve that position with an orthotic then we make the final restorative diagnosis.
Howard: Now to get your diagnosis on there's a lot of occlusion camps to sell ten or fifteen thousand dollar machines some occlusal camps a standard of care is a CBCT, again she's $400,000 in debt she's starting up her own practice what type of heavy-duty equipment would she need to follow you.
Craig: Articulating paper
Howard: That's a total Kansas answer make it faster so make it faster easier simple higher quality for a lower price or don't do it, but you're just saying articulating paper.
Craig: No yeah what I you know Howard really the world's changing and fast and technology is really getting better and better. Certainly you know we're starting to use CBCT's for occlusion we've used it for airway and joints for a long time but you know we're gonna be mounting cases virtually at some point that's not quite there yet we're going to be waxing cases virtually in doing these cases virtually but in honestly now we're still articulator based we're still wax based and we still build things that way. So it's not if you know technology does not it's not expensive for what we're doing at this point in time and go back to what you do if you're this young person who's got 400 grand in debt by the way the indebtedness is 287,000 right.
Howard: Now when you say average, average means mean
Craig: The mean
Howard: The mean because it seems like you know like like let's just say my four boys don't have any student loan debt so you know some some people you know their dad paid for it on a credit card is that you use of the that you said the average was how much money 287?
Craig: 287 debt of a graduating dental school now that may be the mean but
Howard: Well if it's the mean then you're factoring in all the people who didn't have any debt because her father was a dentist and paid for it but of the people that do have debt it would be that what I'm curious about do you know which number that is?
Craig: You know what I can get it for you.
Howard: Okay okay to do it yeah that'd be great in fact you should come back on the show and tell me we should do another one you should come back on the show with the president of the ADA would you do that?
Craig: Yeah absolutely
Howard: Yeah because I'm a big fan of the ADA, I mean when people complain about the ADA I said look I can complain about my mom and dad all day long but they're the only parents I have and I've been a ADA member every year forever because when my mom cried at my graduation it's because the American Dental Association made it such a prestigious profession and if you take and the only thing that ADA does wrong is they don't market all their state-by-state fights and battles all day long to all their members which they don't understand how America works if you want a bill passed you better have some big bills to hand out and if you not fighting every little piece of legislation then you're not gonna save your profession do you agree with that or disagree?
Craig: I do and I gotta be honest with you our advocacy at the ADA is unbelievable, our presence in Washington DC we've got a house outside of the Senate office buildings that we're getting ready to build, we've got one on the house side and a big presence there in Washington DC so that's not...
Howard: Let's not go into politics now and why don't you come back with the president ADA and we'll talk all things ADA political and we'll stay on the the subject of occlusion because the reason I was so honored you guys accepted my invitation to come on the show is because again I have my pulse on these dentists and occlusion is the most confusing thing that they ever deal with. Do you when you call yourself the Stewart Center for bio rejuvenation dental medicine is that also kind of like saying oral systemic health connection?
Hal: Absolutely it all starts with the the airway if you can't breathe you can't live. So everything we do I guess you says airway centric
Howard: Okay airway centric
Hal: Yeah we're looking at the airway number one because the vast majority of occlusal TMJ issues those patients have airway issues as well would you not agree with that Craig?
Craig: I absolutely do
Hal: Maybe a hundred percent of them
Craig: I think TMJ TMD is really a subset of an airway problem yeah it's a symptom of an airway problem.
Hal: So we are always the airway is the hub of the wheel and everything else centers around that. You know let's just wait...
Howard: Well I graduate in 1987 and from UMKC which is I think everyone to agree on is the best dental school in the entire solar system and I don't think these said two things I don't think they said two words about airway and all this stuff it for an 87. When did this really when did this knowledge really break out?
Craig: You know Gerald Simmons down in Houston lectured recently down and in Texas for us and he talked about the first CPAP machine was 1991 one so that meant it's a primitive thing. So if you think about it I mean airway is brand new unless you're a dental student past the year 2000 you probably never heard it. So I we started paying attention to it probably eight to ten years ago at least it was on the radar.
Howard: So it's definitely a definitely a new thing.
Hal: Yeah Howard, so let me give you an example of a case that I did this case if the doctors want to refer to it was published in the October 2018 issue of Dentistry Today and a patient came to me and he had erosion and attrition, his erosion was from GERD that was from a secondary comorbidity of an airway issue. So we got him an airway study done we got him on a CPAP then we stabilized his condyles his teeth were extremely eroded loss of vertical dimension all the treatment plans that he had got were 28 crowns with you know several root canals also planned because of the fact that you know with all the crown preps the doctor you know some of the dentists that give them treatment plans and said you're probably going to need you know four or five six root canals. He'd also been diagnosed or treatment planned for extractions and implants and all on for dentures. Nobody had talked about his airway is GERD we got him on a CPAP got the GERD under control, stabilizes condyles with an orthotic, established a new vertical dimension with there's a process that we teach that we go through that and then I restored his entire mouth with 26 composite direct composite resins and two crowns and those were just replacing two old crows he had and again that case is most published in the October 2018 Dentistry Today you know Damon Adams publication and that is a typical way that we look at a case. We go we diagnose from the inside out, dentists want to start working on teeth immediately but when I looked at this guy's mouth I wish I could show you the case you know there was something more going on than just clenching and grinding and him wearing his teeth down. So we identified those issues of course the diagnosis was his sleep issue incurred were made by his physicians but we prompted that the the sleep study and he went in a sleep study at my doctor Simmons that Craig was referring to in Houston and I was diagnosed put on a CPAP we got that under control, now we can do the dentistry that we need to do and the guys two years out now with 26 composite full-mouth composite resins and two crowns and he's doing great. So that's kind of in a nutshell the way that we look at things that when we're talking about dental medicine we're not you know we're not treating airway we're not diagnosing all that but we have a team that we work with Craig's got a team of physicians he works with I have a team that I work with we work with physical therapists, neurologists, pulmonologists, but we're really doing what's best for the entire system in health of the patient.
Howard: and then you know it was really you know I'm down here in Scottsville where you taught at the Mike Schuster Center and it's interesting how Scottsdale also has a Mayo Clinic and so does Florida and it was the Mayo brothers who really first realized, you know most before the Mayo brothers came on the scene I mean we got old and sick people just thought later you're old and sick was the Mayo brothers it blew their mind that here was this eighty year old grandmother that it's been her whole life on this small grains farm and paid off all of her bills and the family was willing to sell the entire farm and give it to a hospital they could save grandma. I mean you know when I grew up in and Wichita, Kansas you know if you got too old they wouldn't take you to the doctor and you got sick they just take you to the vet and put you down and it was the Mayo brothers you're all I say people value health care how true wealth is just health and it was the Mayo brothers these people will sell the farm to save an 85 year old grandmother and so it really comes down to values. So it really comes down the new patient exam so mote so here's here's what you're dealing with everybody listen to you right now under 30 if they have their office or their associate somewhere someone calls up and says yeah I want to get my teeth cleaned and I want to do that with Dr. Herre and I just want to make an appointment to get my teeth clean and the receptionist says okay how about Thursday at 1:00 and she comes in a one o'clock they pop bitewings and try to do the cleaning and try to rush everything in one hour and then they run to get the doctor and say hurry up you know I'm down to five minutes and he goes in there looks at the bitewings no cavities or has one cavity and that's the exam. I have a feeling that's not how you do your new patient exam. So will you address this the nuts I'm gonna hold your feet of fire that customer is always right they say and they're calling your office Dr. Herre and Dr. Stewart and say I want to get my teeth cleaned what is the first appoint like, do you grant that wish or do you say no you have to have intent those are new patient cleanings...educate us.
Craig: Well yeah if you look at that in the true sense of the word cleaning is a diagnosed procedure you can't just assume somebody needs their teeth cleaned some of the state dental boards actually won't even allow that to happen unless it's been diagnosed and recommended by the doctor however and I know Hal and I different just a little bit in how the patient enters the practice but both of us do consultations first we'll do a persona non-grata pro bono evaluation just for 30 minutes or we'll bring the patient in and do a comprehensive oral evaluation first before we do anything before we touch the patient. We don't generally include hygiene on the first visit unless it's after we've done the comprehensive evaluation. What's amazing is I had a dentist in that taught at UMKC a couple of days ago and you know he's in his 70s now he just came in to he said his oral appliance broke and he needed the new one I don't those but he also was one of his teeth cleaned and I started probing around in there because I do the probing on the initial new patient and everybody does it differently that's how I do it and you know there were some six and seven millimeter pockets and there was some bleeding and he had no idea never even seen that before. So if you bring this guy in for a pro fee what happens I'll just send your hygienist panics starts probing it's bleeding all over comes in and says what should I do she needs more than that his teeth cleaned. So I mean just say it make the analogy of going into a physician for the first time and you know you get to see the doctor for five minutes at the very end they take a look at everything and say well your blood pressure's a little high but we'll probably okay now let's just watch that. It's the same thing I mean it is amazing what you can uncover out of eight twenty one-year-old who's healthy seemingly and you start looking around and you find out that they've actually started to wear their teeth down they've got upper airway resistance syndrome they've got erosion going on all these different things could be happening and you totally miss that which doesn't do any good for your practice but it also doesn't do any good for the patient. You know we think the oral systemic problem everybody thinks that's a periodontal issue and it is you know the you know coronary artery disease and periodontal disease and all that but it goes way way way beyond that we have the ability to impact so many things for people it's just unbelievable.
Hal: Well and also Howard it's not something today you know and this is specifically towards that not even the young dentists but you know the dentists they've been out there for you know two three years five years ten years. What you have to do is create a mindset to practice. Craig and I mean one I I can't remember the last time Mary Ann, my office manager came back and he said we have you basically call that one to get their teeth cleaned. Well if you on my office we don't they never asked that anymore so there's there's about a you know two to three or four maybe even five year period that if a doctor wants to take his or her practice from an insurance-based commodity-based tooth based dental practice to one that's general medicine their's a growing period in there and you've got to have the tools to deal with those patients that do call for a cleaning because I did it. I mean luckily I did it 25 years ago when I was only out of dental school for two or three years and their's a two or three year period where you struggle and you know you stick to your convictions though and you're passionate about what you want to do. I can't Craig when was the last time you had a patient call your office and say I hear y'all are really good I want a cleaning. I mean that never happens in my practice anymore. There's a guy here in Dallas called Sewell Cadillacs and bate made our reputation if you probably have heard the name Howard. People they go to Sewell Cadillacs for a reason because they want what they're selling so you've got to bet that's where you go with with this.
Howard: Now what was his name selling the Cadillacs?
Howard: Sewell, what was his first name do you remember his first name?
Hal: No I can't remember
Howard: What I loved about him which was so genius is I read his autobiography 20 years ago when someone would take their car this little trick was so amazing when people would take in their Cadillac to get fixed all the other Cadillac dealerships have put him in some cheap rental car he say what are you doing I'm gonna put in the brand-new Cadillac and then then at the end of the day I'm gonna say do you want to come in and pick up your old Cadillac or do you want me to drive over to your house and pick up a check for 25 grand we'll keep your old Cadillac or trade-in and for 25 grand you can upgrade to your new one and then the other thing that was so neat about him is he actually went to 100 customers that had bought a Cadillac from him and looked at their bathroom because he said a Cadillac person doesn't want to come in and use the bathroom at Walmart or the IHOP and he made his bathrooms look like his customers. I mean he is he was just an amazing man but he sold more Cadillacs and anybody in the United States and he was in Dallas Texas
Hal: Yeah, what I tell young dentists I have a lot of young dentists and they shadow me I say find every dentist that you know search around that doesn't take insurance that has the kind of practice that I have you're here for a reason and go spend time with them. Look at what they're doing look at what they're saying look at what they're how they talk to their patients all the doctors that I know that do what Craig and I do or maybe they have a little bit different philosophy but their insurance independent don't depend on insurance and they have these incredible practices they all have three things, passionate, believe in what they do and they're excellent communicators and that I would tell a dentist if you want to be successful whatever kind of dentistry you do, learn how to communicate and learn how to communicate with patients and give them what they're looking for. They're not looking for dentistry patients want to have Mike Shuster always says patients wasn't as little dentistry as possible that's what they really want. They want to feel good they want to be they want they don't want to hurt they don't have pain anymore they want to be they want to feel attractive we can do that for them they might want to just be able to have a good night's sleep, we can help them with that so.
Howard: When you say your airway Center you know I'm you know a lot of people put tmd occlusions sleep apnea snoring and appliance therapy in one category would you say it's airway centric sleep apnea snoring then tmd occlusion I mean is there any, you know so if your airway centric would sleep apnea and snoring and appliance therapy come before tmd and occlusion or how how would you put that in order?
Craig: Howard that is such a great question and you do see sort of the TMJ gurus in major cities are also you know trained in sleep dentistry and the way we deal with that is and how alluded to this earlier is we diagnose from the inside out and we and we diagnose the fact that there is an airway problem and before we start putting them in a down forward appliance or something to treat them we get more information and try to find out everything that's going on because what I said earlier is TMD really in most cases unless they've had an injury or something as a symptom of a improper airway and that's maybe developed from even their infancy inability to nurse you know large tonsils and adenoids as a child their maxilla didn't grow there's all these different kind of things that can happen and so really TMD is not necessarily standalone is really our current thinking and that airway is the biggest problem. Now we deal with that differently when you talk about appliance therapy the mid say probably ninety five ninety eight percent of people that treat airway as a dentist make some sort of a mandibular anterior repositioning and appliance and you know we know how to make those we generally don't we deal with TMD more from a cure standpoint where we want to you know get them to the orthodontist and expand the arches or we get them to an oral surgeon and an orthodontist and do an MMA or some sort of surgery where we can give the tongue more room because essentially you just don't have a big enough tongue box for your tongue.
Howard: I don't want to get too sidetracked off this but the one thing that I keep reading over and over and over is it's not even coming from dentistry it's the anthropologist who keep finding you know thirty thousand year old and neanderthal and denisovans, the 23 me doing the DNA tree and so many of these anthropologists saying you know humans are Homo sapiens are two million years old and it looks like all these malocclusions just recently popped up over the last couple hundred years. I mean you don't know if you don't find these mouth noises and they and a lot of them are saying they think it's because babies used to nurse for four or five years and now when a baby has any difficulty nursing they switch to a big bottle we're just going in or a sippy cup the food is all pureed in a little jar gerbers, they're not chewing and so they're not getting any forces on their maxilla they're not and so then these kids I mean we have the United States has ten thousand eight hundred full-time orthodontists putting everybody through this machine because they didn't get any forces on their face the kid never picked up a bone and had to chew on it for nutrition trying to get some meat off or roots or berries. Do you think that the we seein allergies to we're in the 1 billion of Earthlings that live in the richest some communities have all these allergies were the other six billion kids that are growing up crawling around in the dirt and getting exposed to all this antigens that they have better immune systems do you do you think our diet either using a bottle a sippy cup and eating Gerber's baby food is a large reason all these musculoskeletal TMD problems sleep apnea flopping up?
Hal: I do I mean I have no no doubt in my mind that that's the case if you look if you go back in history and you look at the when their in the Industrial Revolution from that point forward and you look at from a dental standpoint what started happening that's you can pinpoint it back to that Weston Price you know you I'm sure you're familiar with Weston Price you've ever read his book. I firmly believe genetically we have all the right genes to seem to produce what we need to produce but the epigenetics is exact there's an environmental factors nursing I think is huge you got so many babies now that they nurse for a while then they start bottle feeding and that's that's huge. Diet I think diet is probably as big a factor if not bigger than then the the nursing part they're both huge. If you if someone said you had to pick two things those are the two that I would pick.
Howard: It's really worried if I was an orthodontist I'd be our pediatric dentist I be having webinars in my village about come in now when you're pregnant and learned how to maybe have a more of a different diet lifestyle where your kid won't have to go through the orthodontic factoring by the way orthodontics that's another thing that confuses a lot of these kids because these kids say well you know you go to the orthodontist and about 25 percent of time they pull the fourth for first bicuspids which is a lot better than 30 years ago is about 75% of time and now it's about 25 % they blow out the curve is fee the curve Wilson and when the kids are done orthodontic lee most of them come back in they get out that articulating paper and they go these teeth aren't even in correct conclusion what what letter grade would you give the 10,800 orthodontist on how the occlusion is when they're all done?
Hal: oh I'm gonna okay I'm I'm just gonna go out there and this is not anything personal against any orthodontist this is what they're taught the letter grade that I would give is an F. Not all of them...
Howard: Well just several hundred orthodontists from Orthotown just end the podcast, no I'm just kidding but a lot of them agree. Why do you give that letter grade because so many people agree with you?
Craig: I think they're stuck in a model that is a production based they advertise and market smiles and straightening teeth rather than building healthy occlusions and enhancing the airway and expanding. I'll tell you going back I think the pediatric dentists are the ones that have the biggest potential to make a difference in kids lives because just what you said they can market to moms before the babies are born but they can take care of these very young children.
Hal: Howard I don't see children haven't seen them for 25 years this later on this year probably will happen this year bringing in a bringing in a partner into my practice that specifically identifies those issues and children and we're gonna start not doing pediatric dentistry we're gonna start bringing children in and start exploring their jaws when they're when they're young so they don't have to put up with all these issues.
Howard: Well your in Texas I got four I got four of my five grandchildren Beeville so what I do is I used to go to Beeville shoot a deer and throw it at the back door and take away all their baby food and just say go out there and chew on that deer for a week spread those spread those jaws and maxilla and start building up those muscles but it is amazing and I was at a house a weekend and there was a seven-year-old little boy and he was taking a nap on the couch and I mean it sounded like boulders grinding clear across the room and it didn't even dawn on anybody that there was a problem and I'm like dude do you hear him when he sleeps and they're just like what oh he always that's what I said oh he always does that I like oh my gosh.
Hal: I had a physician and his wife in because she did come to me for the consultation and we went on with the comprehensive exam with the CBCT, access the airway, home sleep study. She's having like 35, 40 APNIC events a night and we're in the consultation room in the physician wonderful people but the physician was talking about her snoring and they were laughing about it and you know he was like I've got to go and I finally after about 35 40 minutes of that I finally said okay I said let's get serious I said if we were talking about your wife has a terminal cancer would you be laughing right now. I said this is a serious issue you know and it they changed the tone of the entire consultation by immediately because my dad died of Parkinson's at 85 years old he was the healthiest Parkinson patient his positioned had never seen the guy was a picture of health but he did all of Parkinson's. My dad has a severe obstructive sleep apnea and I have no doubt in my mind that played a huge part in his and his Parkinson's and from when I finally started researching this and learning more about it I became passionate about it because it at home it hit me in the heart and the the man that was the most important person in my life succumb to you know I mean we all got to go sometime but he didn't have to go like that. That's not a that's not a very dignified way to go with Parkinson's and he didn't have to do that.
Howard: I'm gonna throw something at you that I hear on the street all the time for 30 years oh I'm not gonna learn all this they're gonna want me to on every new patient mount up study models on an articulator I'm not interested in that so my question is what percent of your new patients do you do study models and mount them on a semi adjustable articulator?
Howard: and what percent of and what percent of the there are two hundred eleven thousand Americans who have an active license to practice dentistry today what percent of them did not mount up a single new patient models on an articulator for all of 2018 the whole year?
Craig: That's what I was going to say, 98
Howard: 98% okay so if 98 percent do not do this one time and all of last year so in 2019 talk to my homies why should they take full-mouth study models and mount them up on an articulator?
Craig: Well I mean I don't think that, that's not even a question that to me that is like a cat scan it's like taking bitewings and a full mouth series. It's data that we're collecting on the patient so that we can do part of our comprehensive evaluation and then develop a systemic treatment plan. If you don't have that you have no idea how the mouth even works, photography's the same way you've got to have a complete set of photography that I mean photographs are more important than radiographed sometimes, theirs some things photographer even miss.
Howard: Well anybody who says the CBCT is better than a pano I have to argue with them because man when you show a pano to a patient the first thing they do is they point to that are and say is that my right side I mean whoever discovered putting an R on the right side and L on the left that was the smartest guy in all of dental radiology because you show them a CBCT it's like looking at the Hubble space craft.
Hal: Was that Larry or curly that decided you are on the right side?
Howard: It's great you show them a pano and they get it they just instantly get it you show them study models and they're very intrigued because the radiograph is of themselves they see all their teeth in one picture of the R and the L and then the study models but what articulator do you guys use the same articulator
Hal: Yeah AD2 from American Dental technologies
Craig: AD2 American Dental technologies
Howard: American Dental Technologies and how many of those you guys have?
Hal: I have 14 articulators
Craig: (Inaudible 55:06) with other company
Hal: They're all in use at the same time.
Howard: So that's their articulator you recommend is the American dental technology is articulator
Hal: Absolutely it's a...
Craig: Howard here's a tip for you who somebody you should have owned is Dave Williams who owns AD2 he's brilliant.
Howard: Who owns AD2?
Craig: Yeah he owns the company Roth William the orthodontic that was his dad
Hal: Roth Orthodontics
Howard: Yeah Roth orthodontics
Craig: Roth William yeah
Hal: It was originally Roth Williams and then Bob Williams is Dave's dad. Bob was probably 85 88 now and he still lectures in China he's amazing but yeah Dave Williams with AD2. He's a great guy, makes a incredible product and they're extremely reasonably priced.
Craig: Absolutely and he is...
Hal: and earlier Howard in the broadcast about the instrumentation we use we use a condylar centering orthotic that we built for our patients some maxillary orthotic, it's permissive it's not that its passive it's not it doesn't force the mandible anywhere we use an instrument called the MCD measures condylar displacement that's the instrument that we use from 2 that that shows the displacement of the joint and it also gives us the exact measurement of when the joint is stable and not moving anymore and we use an AD2 articulator that's our instrumentation.
Howard: Now you're calling it an 82 art an 82 articulator at American Dental technologies?
Hal: A capital A capital D the number 2 and the company is American Dental technologies right Craig?
Howard: and is it fully adjustable or a semi adjustable articulator?
Howard: and so on you so when they take your course you recommend that they come with an AD2 semi articulator from American Dental technologies?
Hal: Better than that when they register for our course it includes an AD2 articulator they get one as part of their tuition and then Dave and then Dave Williams gives them a really nice deal and a package deal if they want to if they want to buy more and they always do because once they start doing this they and this is what separates us, our doctors are required to complete two cases when they go through our program. They have to complete it they up they don't learn it and give work lip service to us they actually have to do it. That was very important to both Craig and myself that we were going to teach it that they have to do it they have to do it show it to us presented to us and once they do that they get two cases under their belt in the year with us then we set them free and they're rocking and rolling.
Howard: Many of the dentist so I talked to you about this in particular they just say I just hate sales I'm not good in sales and I would rather just do a PPO practice where they point to a tooth and I just fixed that too because you know dentistry medicine in law or natural selection to people who live in libraries who get A's in calculus in physics and geometry and they're more they're far more likely to be introvert and then they come out of school and you just said something very profound you said that successful dentists are passionate, believe in what they do and are excellent communicators. Well I mean if you I have flown on a gazillion miles an airplane and when I sit next so when I say hey describe to me I'm a dentist. No one ever said excellent communicator outgoing charismatic. I mean they're they're shy introvert scientists they're more like an engineer and a physicist they're not into a sale. So how what would you say to that person listening is saying I just can't see myself selling a big case
Hal: and I would say and you don't have too. Craig and I...
Craig: The case sells itself.
Hal: Craig and I are both blessed that where we are wonderful excellent communicators, you get somebody that can do it for you. Mike Schuster has always said that if you can't do it you do the dentistry get someone to do it for you but selling is you're selling selling is identifying the listen to the patient what is your pain what it what pains you why are you here what what are you currently doing about it why is it not working. Obviously what you're doing about it's not working that's why you're here then you introduce yourself as the expert, you know I say well I'm currently writing a book on this exact subject because I am or I've you know one of the articles I had published reminds me of your case I don't have to say you know I'm an expert you say things like that but you know to be honest you need to be you need to have the qualifications. Once you identify yourself as the expert you tell your story, I'll tell the story about my own mouth about getting restored I'll tell the story about my dad dying of Parkinson's because of sleep apnea then you tell them about the features and the benefits of your treatment you don't have to go into detail patients don't want to hear detail but you tell them about how do you do what you do in a nutshell how they're gonna benefit from it and then the benefits from the benefit and what I mean by that is you're gonna have a beautiful stable occlusion or bite it's gonna be it's gonna it's gonna feel great you're gonna be able to chew whatever you want that's a benefit but the benefit of the benefit is you're gonna be healthier you're gonna have it you're gonna feel better about yourself this team that you get with a beautiful smile it functions better but it looks beautiful as well and then you ask them so would you like to what one do you want to do about it and then you shut the hell up and quit talking and let the patient talk and so that's the point of if you're not if you can't do that find somebody that can do that for you and then you do the dentistry because not everybody is a great communicator I mean you know that's we all have our strengths and weaknesses.
Howard: and do you do any marketing or advertising or is it all word-of-mouth referral?
Hal: All word of mouth
Craig: I'm 100% word-of-mouth but you got to go out and create that word-of-mouth Howard you got to go out and meet the community and I'm talking about the medical dental chiropractic physical therapy the people who are gonna be seeing these people also and you could also general dentists, go educate general dentists your colleagues.
Howard: What other health care like like I'll be honest I'm here in Phoenix Arizona in I'd say the last year Ahwatukee, I live in Phoenix but everybody here calls it Ahwatukee just is what it is in fact if you say to someone on my area do you live in Phoenix I say no I live in Ahwatukee but Ahwatukee is Phoenix Arizona so the but anyway I'm long story short I'd say in the last year I've had dinner every chiropractor has come over to my house or got a dinner a hundred is ill all the natural paths naturopaths chiropractors pharmacists but physicians they're there I mean most of the physicians in where I live in Ahwatukee, they don't even have an email or any social media on their website there they're kind of talking about in the mill. I mean they're just they don't want new patients once they sign up for Medicare or Medicaid they're so busy they're just trying to get through the day they don't want to they don't want to listen to anybody who wants to tell you to you know so so do you did you have most luck with chiropractors, naturopaths, podiatrists, pharmacist, or did you have a lot of luck with physicians in your area?
Craig: Hal I don't know if you are the same as me I gotta be honest with you general dentists probably my biggest refer general dentists.
Hal: Met too and Dios, osteopath
Howard: General dentists an osteopath is your biggest.
Hal: I get most referrals from osteopaths yeah.
Craig: You know who doesn't know anything about TMJ but they see it every single day in their practice our ENT's.
Craig: If somebody goes in with ear pain or an ear problem and they look in the air and it's not red they are pretty much saying go see your dentist you got TMJ but instead of doing that they're wise enough most of them especially if you're going to talk to them that they won't send her to their regular dentist because they understand that most dentists don't even know what the TMJ is and they'll send them to you as their preferred referral.
Howard: Interesting I can't, go ahead
Hal: Every new patient that I see we do a complete comprehensive exam I write it for complete review of findings for that patient give it them but I also send it to every one of their medical providers. So their general to their you know their general practitioner their any specialist I send that to every single one of them and so how many dead how many physicians get a complete review of findings from a dentist about a patient. I mean that never happens.
Hal: That's all yeah you start doing that in six months you can have so many patients referred you by physicians you're not gonna know what to do with them
Howard: Well gentlemen I can't believe our shows an hour and we went well over an hour you guys have been so generous with your time is there any question that I should have asked it wasn't smart enough to ask or anything you want to talk about that I didn't bring up?
Hal: All I'd like to say is that I've always admired you Howard from the from afar and I want to commend you for what you do for dentistry thank you
Howard: Thank you I am proud of Dentaltown turns 20 years old on this coming st. Patrick's Day and I beat Facebook by four years.
Craig: That's pretty good
Craig: You are social media for dentists you are it.
Howard: Yeah it's the social media has been a very fun just and I like this I mean gosh I was when I was 50 years old I didn't you know what a podcast is here I'm 56 and having a podcast of dentistry. I've always been a big fan of any technology that helps share information so dentists can go faster easier higher quality lower cost more miniature just more you know you know I'm a big believer in capitalism and free enterprise and I believe that I never set out to set up a chain of dentist because I thought finding the location and a group deal on supplies and equipment and composite that that's not what dentistry is about dentistry is about getting a highly educated doctor who can communicate a very trustworthy doctor-patient relationship and I don't see any skills of economy in that. I mean I can see skills of economy of stamping out a Model T Ford but I don't see any skills of the economy of lining up a thousand dentist in a row you know what I mean. I think it comes down I'm call me old-fashioned I think dentistry comes down to we sell the invisible. I know when I bought a Starbucks coffee or I know when I bought an iPhone or a Dell computer I know what those are but when I go to my doctor and he says you have this disease I mean how do you how do you I mean you have to trust the person and it's all about the the doctor-patient relationship it's all invisible it's all on trust it's all on referral. Look at advertising I mean there's solid evidence that says if someone comes into word-of-mouth referral they'll buy $3 and they come in off advertising they'll buy $1 because you know they they come in there and they don't know you from Adam and you say I have four cavities they're like I don't know if I believe you. It's kinda like when my engine light comes on it's so tempting to take it to all these other places but I always take it to the dealer of the man I bought it from who I've known for 20 years simply because if he tells me I need a new transmission I believe it but if I went to some change shop in Phoenix Arizona I think this guy is a commission-based salesman.
Hal: I did same thing how that's amazing this morning I engine light came on I've got a garage right across the street or in down two blocks from my office so convenient I don't take you there I take it to the dealer that I bought now six seven cars from my trust them it's 20 miles away that's what I'm gonna do. Inaudible 1:09:03)
Howard: I blame this all on my five sisters because I played Barbie dolls till I was 12 we didn't pull any engines or rehab a car and when the guy starts talking to me and you know he starts telling me what's wrong oh I can't I think it's hilarious when he asked me if I want to see the old part it's like I wouldn't even know what the part is this is all a trusting relationship. Gentlemen...
Hal: You have five sisters?
Howard: Five, to two older sisters three younger sisters
Hal: I have five sisters myself
Howard: Well there's a special place in heaven for both of us we might be sharing a room.
Hal: Mine are all quite a bit older, I'm the youngest.
Howard: I'll tell you what, I never changed a spark plug but I know how to dress a Barbie doll twenty different ways so I give em credit and cooking and baking oh my gosh in fact is so embarrassing I'll never forget some dentists at my house man this big frame this this big I'm in need of embroidery and he said Oh what is that it was it was a tree 11 everything yes huh that's interesting yeah I know like I said yeah I I did that when I was like nine and the guy go you were in bordering. You know not people don't embroidery or crochet when they have five brothers but hey gentlemen seriously thank you for all that you do. Dr. Herre I'd love it if you came back on the show with the president ADA and talked to all things politics and even though they say you never supposed to talk about religion sex politics or violence we should have the president ADA on and you're the second vice president and talk about that because the one thing I want you to come back and talk about a lot of these kids they tell me they go well dude I got four hundred thousand dollars in students loans, I can't afford to join the ADA.
Craig: A subject I would absolutely love the opportunity. I'll bring Jeff with me.
Howard: Okay let's do it again thank you so much for coming on the show today and talking to my homies I really it was an honor to podcast both of you.
Craig: Hey Howard it was a ball thank you.