Dentistry Uncensored with Howard Farran
Dentistry Uncensored with Howard Farran
How to perform dentistry faster, easier, higher in quality and lower in cost.
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1151 Pediatric Dentist Dr. Dave W. Epstein DDS, MSD, Founder of Wonderful Dental : Dentistry Uncensored with Howard Farran

1151 Pediatric Dentist Dr. Dave W. Epstein DDS, MSD, Founder of Wonderful Dental : Dentistry Uncensored with Howard Farran

3/6/2019 9:31:57 PM   |   Comments: 0   |   Views: 168

Dr. David W. Epstein is a retired Pediatric Dentist residing in Bloomfield, CT. He attended the University of Wisconsin on a scholarship in Metallurgical Engineering. He received a degree in Mathematics in 1964, followed by a Doctor of Dental Surgery degree in 1968 and a Master’s Degree in Pediatric Dentistry in 1970 all from Indiana University. 

VIDEO - DUwHF #1151 - Dave Epstein

AUDIO - DUwHF #1151 - Dave Epstein

In 1970, he joined the original Dental School Faculty at the University of Connecticut Health Center and taught until 1988. He began his private practice in 1972 in West Hartford, Connecticut and the practice has grown into a group practice consisting of five Pediatric Dentists and two Orthodontists. He is proud that his repacement upon his retirement was one of his former patients. For more than 45 years, the primary focus of his practice was preventive care with an emphasis on active child and parent participation. After listening to many negative comments about the taste of dental products being used, Dr. Epstein researched the idea of developing both a new prophy paste and fluoride varnish with delicious flavors and superior properties. His vision in creating Wonderful dental was to solve 2 major issues:

1) There was a need for better products to make the dental experience more 

pleasant for children 

2) Reduce the price by selling direct in order to save other pediatric dentists money on premium supplies. 

3) In His words, “This is my way of giving back to a wonderful profession that gave me so much. I loved treating patients and I love participating online giving advice and help where I feel competent.” 

Howard: It is just a huge honor for me today to be podcast interviewing Dr. David W Epstein DDS MSD he is a retired pediatric dentist residing in Bloomfield, Connecticut. He attended the University of Wisconsin on a scholarship and metallurgical engineering, he received a degree in mathematics in 1964 followed by a DDS degree in 68 and a master's degree in pediatric dentistry in 1970 all from Indiana University. In 1970 he joined the original dental school faculty at the University of Connecticut Health Center and taught until 1988. He began his private practice in 1972 and West Hartford Connecticut and the practice has grown into a group practice consisting of five pediatric dentists and two orthodontists. He is proud that his replacement upon his retirement was one of his former patients. For more than 45 years the primary focus of his practice was preventive care with an emphasis on active child and parent participation after listening to many negative comments about the taste of dental products being used Dr. Epstein researched the idea of developing both a new prophy paste and fluoride varnish with delicious flavors and superior properties. His vision and creating wonderful dental was to solve two major issues there was a need for better products to make the dental experience more pleasant for children, number two reduce the price by selling direct in order to save other pediatric dentists money on premium supplies. In his words this is his way of giving back to a wonderful profession that gave him so much love, he loves treating patients and he loved participating online giving advice and help where he feels confident and I just gotta say I've been a big fan of yours you were you were a member of dentaltown in 2003 and today it's 2019 that is unbelievable thanks for being a townie for a couple of decades.

Dave: It's my pleasure I will tell you I've learned a lot and your organization has been very helpful in a lot of ways in my practice and now even in my retirement so kudos to you.

Howard: Oh man thanks and you know what of the nine specialties recognized by the ADA I think the pediatric dentist specialty is the most active on dentaltown and they seem to be more active than any of them.

Dave: I have to tell you that since I've retired and I started this little company I've been in contact with pediatric dentists all over the country and as a group they are the kindest most interested gentlest and compassionate people I've ever encountered. I have had such a great experience and communicating with this group that it's really been fun and I can understand that they are the most active group because it is a group they really truly want to help each other and I think that's that is significant because they are so active on the dental boards.

Howard: and I have to ask you before we start are you related to the other David W Epstein DDS on dental town he's a dentist in Novato, California were you aware that there's two of you out there?

Dave: I am well aware you know like all of us we sometimes Google ourselves and when I grew up David W Epstein I found there was another David W Epstein DDS in California and I am not in contact with him but it would be an interesting meeting I think but I was aware that he is out there.

Howard: Well just for my own directory what does your W stand for maybe you guys have different middle names maybe that's how I can keep you apart what is your middle name?

Dave: I'm sure I I'm sure we have different middle names because my middle name was my mother's maiden name which was Weiss.

Howard: You know that's something we have in common when I had my four boys I thought it was totally sexist that their mother would give up their last name and take my last name so I so all four my boys their middle name is Wells which was her mother's maiden name and is out is that why you guys picked Weiss?

Dave: Yeah you know it is interesting why I always felt my mother was sort of I wouldn't call her a feminist but she definitely had strong ideas about passing on her family name and that became my middle name.

Howard: Well I now I want to do a podcast with the other David W Epstein and find out what his middle name is. So another thing about

 Dave: Absolutely

Howard: Another thing about all the professions is it seems like of all the professions the nine specialties recognized by the ADA this seems like pediatric dentistry changed in your career?

Dave: Well I think that it's changed both philosophically and technically, I think the technical advances have been amazing. When I started the only restorative material we used was amalgam and with the evolution of the composites our practice and I certainly my way I practice we evolved in a much more aesthetic form of Dentistry and we still have stainless steel crowns are still around but I think pediatric dentistry like all dentistry has become much more aesthetic. Philosophically it's changed a lot because when I went to school the philosophy was that I am the dentist and you're the child and you're on my playground and so we're gonna play by my rules, well I think parenting and legally that's changed a lot and we are much more considered the child's role in the practice and the parents role in the practice and I think we've seen a major change in and how pediatric dentists deal with the patient and the parent. I'm not sure it's all been positive because we found that certainly in my last few years of practice I found that there were a new breed of parents what we called helicopter parents that were very intrusive parents and there were very demanding parents. I will tell you that I treated children for 50 years I saw a lot of changes and I decided 50 years of kids was really enough but I did see a major change in me and the way the children behaved to. I think gets reflected in what we see in the school systems and certainly in medical and dental offices. I think that the stature may be or the commanding presence of a health professional has come down a notch and children are not so intimidated by professionals anymore I think that parents have a different attitude about how professional is supposed to deal with their child. I can relay a quick story to you I had a little boy and this goes back about four or five years ago when I was in the office and the child was sitting in the chair and was trying to climb out that year and I had my arm across the chair so he couldn't climb out and I said to him you know in this office I want to be friends with you but you have to cooperate with me in this office and the mother tapped me on the shoulder she said you know what she says I don't speak to him in that tone of voice I'd appreciate it if he wouldn't and I said no problem I said if you can get him to sit in the chair I'd be happy to take a look at his teeth and of course I never saw his teeth and they left and they probably ended up somewhere where somebody said let's put this child in the hospital fix his teeth because he's not gonna cooperate and it wasn't an ideal solution in the problem. 50 years ago I would have said the child listen kid this is my ballpark and I make the rules and if you want your mom to stay here and hold your hand you got to cooperate with me doesn't cut it so much today I think there's a different philosophy with parents and with pediatric dentists I think its led for to major changes in how pediatric dentists are practicing. I tried my when I was in practice I really I had no nitrous oxide and I rarely used any pre medication I had a frightening experience one time in the hospital so I opted not to take kids to the hospital but I found that with most kids if I just spent the time and spoke to them we could we can accomplish the treatment we needed in the office without a lot of auxiliary aids but I think things have changed a lot and I have great deal of respect for the pediatric dentists coming out of school because their training now they have been educated in acid in facets of pediatric chemistry that I was not so well educated and using the hospital and using medications and in-office sedation and that kind of things and anyway it is a way of dealing with child's behavior in my own mind I am not sure that that's in the best interest of the child always but it's sort of what has evolved and I respect that.

Howard: Well you know Blumberg just had an article that came out last week and it was called the name of the article was doctors knockout sheep to discover anesthesia dark side and they're finding that everybody thinks being put to sleep is just fine but this scientists are finding that it impacts that anesthesia impacts the kidneys the mind the immunity and for the brain anesthesia is a very abnormal state not to mention the fact that for every 200 million people that are put to sleep 1 million don't wake up. So the 200 million 1 million died No 1 million die within 30 days. So that's a 1 in 200 chance that this anesthesia is not a good idea and the risk jumps to 1 in 24 patients 70 years and older. So I it seems like on social media every you know once or twice or three times a year some story goes viral of some kid going to a pediatric dentist they put them to sleep and it doesn't turn out pretty. So it'll be interesting to see if information about the risk of anesthesia starts making people want you to try harder with getting the kid to cooperate than just rushing into the or.

Dave: Listen I hear what you're saying I always had a I took three months of anesthesiology in my training and I had a great deal of respect for the anesthesiologist and I had a great deal of respect for general anesthesia in general and I felt like if I could avoid it I tried to but that being said you sort of have to say how am I going to deal with behavior the child and that sort of presents its own issue so oh I hope you can see that it is a delimited in the general office for there for the pediatric dentist because it's a tough choice sometimes in a tough call if you have a child who has serious dental problems then you have to make that call. I think that until parents realize that their that until they get back to where they have trusted the professionals they're dealing with there's going to be a period where we are not going to be able to go back to the old ways of treating kids but we will be able to deal with behavior in other ways without putting the child to sleep I think medications are getting better. 50 years of children's dentistry I have to tell you I think that it is more difficult today than when I started and I think that their are there more hazards but that being said also I think that the quality of general anesthesia and the quality of the anesthesiologist has probably improved and it probably is safer than it was 25 or 30 years ago.

Howard: You know when you travel around the world you notice that most country I mean many advanced countries do not allow the attending doctor to do the surgery and the anesthesia they separate that and in America if you go to any Hospital and anesthesiologist has to do the anesthesia and a surgeon does surgery, you couldn't go into a hospital and perform the bypass while you're also doing the anesthesia but the only the only loopholes we seem to see in that are in dentistry.You studied anesthesiology what are you what are your thoughts about a dentist putting the child to sleep IV sedation, anesthesiology and also doing the pediatric dentistry. Do you think that's a good idea?

Dave: I dont think its a question whether it's a good idea it's a question of is the person performing this well trained and capable of doing this kind of a procedure. I know that for many years I knew pediatric dentists who did general anesthesia in their office they monitored the kids with a stethoscope taped in their ears and if they were competent and careful they didn't have problems but like anything else there's always a hazard and it's one that I wasn't comfortable with but if in your training you felt like you were well trained to that in that aspect of way of doing dentistry then then you certainly had the right to do that.

Howard: and I want to ask you another question since you've congratulations on practicing for half a century that is just amazing 50 years that's amazing. The man who got me interested in dentistry Kenny Anderson who lived next door to me he just celebrated his 50th anniversary still practicing in Wichita, Kansas that's just amazing but you have a degree in metallurgical engineering and when I got out of school the the restoration of choice was an amalgam and it just seems like the amalgam was so much more resistant to bacterial invasion they just seemed to last so much longer. Do you think the switching from amalgam to inert plastic resin composites with not any anti back properties, do you think that was a intelligent wise aesthetic health compromise and if your own let's say you had a grandson let's move girls off the table just a boy if you had a grandson who's six and had an occlusal cavity if you put an amalgam in there you probably wouldn't even have to look at it again till the kid was 40 if you put an occlusal composite in there how long I mean what do you think of that decision on your own grandson an occlusal on a six year molar, what would you recommend having a degree in metallurgical engineering and a pediatric dentist?

Dave: I have absolutely no reservations about amalgam however that being said you know 15 years ago we got rid of the amalgamator of the mater and so we don't even we didn't even have amalgam in so today I would put in a composite just because that's a with his life standard it's what my standard of care when I was in practice and well I certainly had nothing I could never say anything negative about amalgams. I think they were great restorations and lasted a long time, were they better than the composites I don't know.

Howard: Really you don't know...

Dave: I think listen I've seen composite so I placed 15 years ago that looked absolutely fantastic. I've seen amalgams that were placed two years ago they looked terrible but the material itself I think how it's handled in and the competency and the skills of the operator certainly are big influence on how long restorations are going to last and I don't think I don't think I have a expertise and the ability to say yes amalgam was better our composites are better. I used both, I was comfortable with both but I you know I think that kind of composites are used pretty much universally now just more for more reason that more than anything for the aesthetics.

Howard: Well all say on that is that if you have a high volume low fee practice and you're not using intense isolation rubber dam with a full time assistant high-speed suction you need to really do amalgam, composite when people tell me they think they're composites lasts as long as amalgam they're always using a rubber dam they always have a high speed suction and you forget there's two million dentists on earth and 1 million of them don't do not get to practice with high speed suction a dental assistant and if the isolation is even remotely an issue I wish you would switch back but you said something in your intro that I've noticed the biggest change in dentistry in my 31 years and that is 31 years ago people you would tell someone what they need and they'd say well you're the doctor and it seems like now that Google's come out that the social media and the internet that trust I've seen trusts going down trust in institutions like dentistry like the Centers for Disease Control. I remember you know 30 years ago when you would say the Centers for Disease Control recommends water fluoridation people say oh that's interesting and you give them a handout and they would be Pro water fluoridation in 1989. Now you hand someone a recommendation from the CDC and they yeah they're just a shell organization for big pharma and and it's just big money. So trust has I've noticed trust in pretty much everything has been going down and in the last 30 years and do you think it's different it's harder to get a parent to trust you as a pediatric dentist today than it was when you started half a century ago?

Dave: I think the attitude the parent certainly has changed and in general the public is feels more had more like they have the right to question anything and I probably I think that has happened in you know in medicine and in dentistry. I think that I was very fortunate I practiced pediatric dentistry in a modern middle-class community and we tried to I think that the attitude that I had in the practice was that you know I'm here to give your child the best service that I can and I think that I think that it's the relationship between a dentist and his patients that really makes establishes whether the parents going to trust the dentist or not. I always felt like people brought children to my office because they wanted their child they have a good experience and they wanted me to give them good care and I always tried to use the best materials that I could and I tried to provide care of the child in the most loving manner that I could and in 50 years of practice I think the trust that was bestowed upon me by the parents in our community it was you know I felt very comfortable and I felt very good that I was a trusted member of the community. There's a lot of publicity that's around about untrustworthy professionals whether they be lawyers or dentists or physicians and I and I think that certainly the public has become more aware and feels freedom to question things better today but no I you know what I in general I think that to make a statement that people don't trust as much as they used to I think that's maybe a generalization that doesn't really come down to a person-to-person relationship.

Howard: Right that is a problem with statistics because it just describes the whole population but it doesn't describe the individual I've always have people of an issue realizing that. So I want to talk about I'm being an entrepreneur industry because not only did you start your own practice but you even started a The Wonderful Dental Company and today kids are listening to you podcasters are young I have to admit I don't think there's anyone listening to us today that are our ages they're all under 30 that anybody in fact leave a comment and if you're watching this on YouTube leave a comment I how old you are where you're what country you're from or send me an email but a lot of them are in dental school and they're wondering you know they need to be an entrepreneur to go start their own dental office as opposed to getting a job as an employee at a DSO and you've been an entrepreneur twice you've started your own practice and you started your own dental manufacturing company The Wonderful Dental Company what are your thoughts on being an entrepreneur in dentistry?

Dave: Being an entrepreneur means that you identify a need and you started business to fill that need and you take the risks that are associated with doing that business and when I started in practice I looked at communities that needed a children's dentist and I took the risk to open an office I was a maverick even in 1972 when I opened my office. My first office design was done by a designer in New York who charged me a fortune for designing the office but I was so confident that that I knew what I wanted to do and I knew what I wanted my practice to be that it was worth the money to have this designer, design an office for me and it worked out great as far as going into another kind of a business you know it was partly because I knew retirement was coming up and I was looking for something but I really did not like a lot of the products that I used and I saw that there was a way to change it and make a business out of it I think that early on in my career I will tell you this sort of thing happened and evolved because I got hooked on tapes. I got hooked on motivational tapes and as I listened to those tapes they told me a lot of things one of the things they he was is that no matter what you do and no matter what piece of equipment or material used there would be a better material there would be a better way of doing things and after they somebody found a better way of doing it there would be a better way after that and so when I was in my office and looked at what I was doing you know I tried to sort of look at how I was doing things and was there a better way to do it. Not always a faster way or but was there a better way of doing things and things changed in my office because I always felt like I needed to seek out better solutions. I think that one of the things I learned in engineering was that engineering is a science of solving problems and what I found fascinating about dentistry and about being in practice in dentistry was every day was a different problem, every child was a different challenge. It was interesting that that I could always look at the day and say then there's something interesting going to happen today and I think for young people in going into practice if they take the attitude that I've learned how to do dentistry but in my practice I would like to make things better as I go along I'd like to improve the way I do things improve materials. I've told all the people in my practice be aware of what using if you can think of a better way of doing something make a change and I think that's really the basis of being an entrepreneur is recognizing that their's a need for something and changing it. I think dentists in general are really good entrepreneurs because they put their neck on the line and they start a practice with the hope of being successful and it's a lot of work.

Howard: You said that so well and I also think it's interesting that you you know you find the demand and then you create a supply so the question is demographics you know when you're setting up your own office do you say demographics matter? I mean could any pediatric dentist go anywhere in America and do fine or would there be far greater places to become a pediatric dentist than other places?

Dave: Like anything else a little bit of research the more you know the more you understand the better choices you make so are there better places of course, it doesn't mean that you can't you know listen if you look at how big Mcdonald's and Wendy's do business they open across the street from each other. So obviously they look at the demographics again they say hey you know what this is what this community wants and we're gonna supply that need.

Howard: Yeah you know they called that indestination, when you open up a hamburger place now in the middle of nowhere people have to think of you and drive out there but if you got the the big guy on the corner McDonald's you think oh I'm hungry I want a hamburger I'm going to McDonald's but then when you get to that destination you need now see it's an indestination and across the street is Burger King and Wendy's and in-and-out burger and all these other places and it's the last second you decide you know what I don't want another Big Mac I'm gonna go try a Wendy's burger because they use square patties because they don't cut any corners my dad taught me that when I was 10 years old and they were doing demographics and for Sonic everybody was saying oh don't put one over there there's a McDonald's over there and my dad put up nine Sonic drive-ins he said my god I would have be in the parking lot of McDonald's I was on their drive through there was a little alley off to the side. So when it comes to demographics and and demand and you create a supply what were you seeing in your practice of pediatric dentistry that made you want to start the wonderful dental company and start making your own varnish and micro brushes prophy paste what would it by the way this is not a commercial for wonderful dental he did not pay to come on the show I had to beg him to come on this show and but what were you seeing with regular market fulfillment of these products that made you want to start your own product your own company?

Dave: Yeah what I saw was that like so many dental materials they're developed in a laboratory by chemists or engineers, it really I saw a need for products that were developed in a pediatric dental office that would satisfy the patient. You know when varnish when we first switched to varnish we switch from fluoride trays and gels and foams to the varnish because for a couple of reasons one it was easier to apply it was equally as effective it was less costly and but that when we started the fluoride varnishes didn't taste as good as the gels in the foams and I saw a need to change it because I saw so many kids leave the office or push back on having a fluoride varnish treatment or standing at the sink trying to scrape it off their teeth or spitting it out and I knew it didn't taste good I tasted it myself I tried all the products we used and I knew the varnish didn't taste good but it was I thought it was in the best interest of the practice and finally I reached a point where I said you know it doesn't have to be this way there can be better product their could be better tasting varnish, their can be better tasting prophy paste and so I went to the chemists and I said you know here's a list of a hundred different flavoring companies let's try some flavors and see if we can't get something that's a little more compatible with varnish or with prophy paste and make this a little more pleasant for the kids and I will tell you that I feel really good about if anybody goes on to our Wonderful Dental website and looks at some of the we have hundreds of comments from children's dentists all over the country that they're not getting pushed back from the kids anymore that they like the flavors that they walk out with us while on their face and really that was really an important aspect because I saw looked at my practices basically like you said at the beginning my goal was to have a preventive practice where we treated kids of parents that helped to educate them on the importance of dental care and how to prevent dental decay. So yeah their was a need for betel better products and it just took a little bit of pursuit and a little bit of time to find those products and develop them.

Howard: Well just for the kids that are in dental school are still what I call dental kindergarten let's back up a little bit what's the difference well when you talk about a fluoride treatment in dental office what is the difference in a fluoride varnish versus a fluoride gel or foam or well would you explain the different types of fluoride treatments and when treating children?

Dave: When the research first came out on fluoride one of the things that was measured was the uptake of fluoride into the enamel and Dr. Norm Tinanoff at the University of Maryland taught with me at UConn and he and I became good friends and he is really a guru on fluoride and we've discussed different modalities of applying fluoride and the way the fluoride works this is over a long period of time over a six-month period of time fluoride that is there has been absorbed and into the enamel of a tooth slowly releases and it affects not only the ability of the bacteria to metabolize sugars the fluoride release helps to counteract the destruction of acids that are produced in the mouth. So the idea was how do you get the fluoride to be taken up by the enamel and when we started we use fluoride I remember when we first started I was at Indiana and Joe Muhler who developed Stannous Fluoride which the in the clinics was called pickle juice, which was horrible tasting but we painted it on the teeth and it had to stay on for four minutes it was like unbearable for the child. When I got into practice that changed and we had fluoride gels and we have fluoride foams that were put into a little styrofoam trays that we put on the teeth they were supposed to stay on for two minutes then they eventually got down to one minute but even those were an encumbrance on the child and keeping that fluoride tray on the three-year-olds mouth for a minute sometimes turned out to be a very difficult procedure. Fluoride varnish which was really developed in the scandinavian countries came out and it and the idea was is that a varnish is based in a sticky base when you paint it on the teeth it forms a film on the enamel and the fluoride that's incorporated the end of the varnish literally is some contact with the enamel for long periods of times up to six hours and therefore there's a much greater uptake over that long period of time of fluoride into the enamel and that's why the fluoride varnish has proved to be equally effective with any of the fluoride gels or foams but certainly took less time to put it on and got comparable results. Not to say that the gels and the foams were not equally as effective as the varnish it's just the varnish turns out to be easier.

Howard: and so is the what is the market share now of fluoride gel or foam versus varnish on do you know how that breaks down?

Dave: I really don't honestly I would think that more and more children's dentists are starting to move to varnish because it's an easier procedure and it and truthfully it's it's less expensive to the dental office the tray the styrofoam tray and the foams cost more and it was they were messier the child had to put the trays his mouth and stand the sink or they had to use of suction fluoride varnish takes a few seconds to paint on simple instructions are given to the parent you know don't eat anything very crunchy or hard for a couple hours there's a warning on there not drink anything too hot but my experience told me that children never drink anything hot enough to dissolve the varnish off the teeth so there really wasn't in the consideration but the main thing was don't brush for four to six hours that provided them at the best update from the varnish.

Howard: and so flouride treatments in the dental offices in the dental office are recommended by the ADA for poor oral hygiene, active caries, eating disorders, drug or alcohol abuse, lack of regular professional dental care, active orthodontic treatment combined with oral hygiene, high levels of caries causing bacteria in the mouth, exposed root sources of teeth, decreased salivary flow resulting in dry mouth, poor diet existing restorations tooth enamel defects or undergoing head neck radiation and I'll never forget my buddy Rella Christian who has a PhD in oral microbiology she was so blunt with the research in the literature and like she used to tell me that she can't even find any evidence of six-month cleanings reducing DMFT but at three-month cleanings she sees significant and a lot of times he's dentist they might only see the hygienist every six months but they're coming back to the dentist for fillings or this or that and I think general dentist seeing restorative patients should be using a lot more varnish fluoride, varnish if especially for patients have any of those conditions. Do you agree or disagree?

Dave: I will tell you in addition to all the important things that you just mentioned the important thing to me was don't let the child ever get a cavity. We started putting fluoride varnish on kids literally and when they started getting teeth and infant child care has been has been proven to be very effective. I don't have a I really didn't do a study in my office but when we started putting fluoride varnish on the kids and this goes back probably eight or ten years ago I will tell you that in the ten years that we started infant child care the kids that came in every six month that had fluoride varnish put on their teeth at six years of age I would guess that well ninety percent of more carries free. I just think it was a very effective way of preventing this disease. When I tell you that my kids and my grandkids literally and they get their share of junk not by the use of fluoride varnishes they've managed to stay decay free and I think that a pediatric dentist and I even and I even would encourage the general dentist get young children into your practice and put the varnish on. I think just as important was treating the conditions that you mentioned more importantly than just let's prevent this disease from happening with kids and I think the varnish is a very effective way of doing that. As far as frequency goes kids with poor hygiene we absolutely saw that more than twice a year and we put the varnish on more than twice a year I've encouraged in the orthodontist in our group, every time a child comes in for an adjustment on his braces if his hygiene is poor take 20 seconds and paints and varnish on you'll eliminate the white spots around the brackets when the brackets come off, it is a very effective preventive measure.

Howard: You're a very wise man, I mean the only secret to lower prices is lower cost I mean if United start matching Southwest Airlines prices they would absolutely go out of business because the only reason the Southwest Airlines could lower their prices is because they lowered the cost instead of flying hub-and-spoke they flew direct. So you know they would look at a route like Phoenix LA they say we're gonna buy 150 million dollar 737 and we're gonna fly back and forth just back and forth from Phoenix LA and they keep their planes in the sky 12 hours a day whereas everyone else keeps at 8 hours a day and it's a big when dentists by the way a lot of young kids on will email me asking me to join a multi-level marketing thing and let me just tell you multi-level marketing doesn't work because structurally you build in six different middlemen from the manufacturer the customer. So the only way you would lower the cost is to disintermediate the middleman. Why do you think so many dentists still buy their supplies to a middleman who if you buy a share of their publicly traded stock whether it be Henry Schein or Paterson you can see how much the markup is. Why do you think when it's entrepreneur like you disintermediates the middleman and sells direct do you feel that you are selling it at a lower price instead of going through a middleman and having a shiner Patterson distribute your products that wonderful dental?

Dave: l you know it was interesting in if I go back 20 years when I first started being an entrepreneur I actually developed a prophy paste that was called glitz and I gave to the supply houses and it was not competitive and the reason it wasn't competitive was because I didn't have the funds to do the advertising that 3m and DENTSPLY did and so this sort of fell by the wayside and I started wonderful I said you know what I don't need I don't need to spend the money on marketing that that these companies do I think by lowering my costs and doing things online and trying to communicate on person I started this business by calling some of my friends and I said I have a better product I want you to try it and tell me what you think and it literally became a grassroots business that started spreading by word of mouth and that's how the business developed though we do a lot of emailing and I talked and I'm on the phone all day long talking to offices about the products and how we control our costs. I am convinced that I don't need to mark this product up 120 percent to stay in business. I need a much smaller margin to stay in business and I want to pass those savings along to the offices I think their's going to be a trend in the future that you're gonna see more and more direct sales companies. I think what happened with Patterson and Schein just recently they just settled a huge lawsuit because they were found guilty of collusion and price-fixing and they paid a huge fine for that. Listen there's going to be a place for them they certainly provide a good service they have a dental representative that walks into your office makes it very easy to order and you know they are very good about if you don't like something about taking it back, as we are I give everybody a hundred-percent guarantee on our products but it's really convenient when a guy walks in says hey we tried this didn't like it take it back exchange it. So I think it's the ease of doing business than the dental offices that is keeping the dental supply houses in business and I'm sure they'll continue to prosper and make a lot of money. I think dentists are you know they don't they're not one of the things I tell everybody came in my office the most important thing in my office is time I would say to a new employee what do we sell in this office and they would say you know toothbrushes or dental care but the real answer was we sold time and that's a non recapturedable commodity and so the dentist office who says you know I don't have the time to go online that start worrying my supplies from individual private suppliers but you know what that the savings is significant they'll find the time.

Howard: That lawsuit was huge and it was significant and when you look at the largest dental insurance company in the United States it's actually Delta Dental of California which controls Delta and I believe 19 states and it's in just Delta of California is larger than MetLife, Aetna, United Healthcare all that I mean they control dentistry Delta Dental in California, Texas, New York, Maryland, Washington DC, Delaware, Louisiana, Mississippi, Montana, Pennsylvania, Florida, George. They're not giving price increases yet every time the earth goes around the Sun inflation is driving up our cost so if if you're getting paid the same amount for cleaning as you were ten years ago you have to put on your thinking cap and start driving down your costs you got to go faster easier higher quality lower cost. So driving down costs I would think would be huge and when you look at dsos where they're basically paying hygienists 8% of collections assistance 6% front desk 6% their dentists 25% of collected revenue and they're paying 5% for lab and 4% for supplies. I go into dental offices that haven't got a raise from the dental insurance company in a decade and I see there sundry supply drifting up 6, 7 percent so if your supplies were a 6% and I'm telling you that the DSOs are at 4, what's 2% of what you collected last year. I mean the average general dentists I believe last year did what was it seven I think in the last number seven seventy eight so times 0.02 yeah you're you're leaving $15,000 a year on the table just by having a higher supply. So you have to realize that that nice person that comes into your office once a week and takes all your supply orders is that little weekly monthly visit worth 15 grand a year or do you want to sell direct?

Dave: Well I think that you come down to the basic issue and that is how valuable is the time and there's no question that if you have you know if the guy comes in and you've got a you know whatever system they use he walks and he looks at your supply shelf and he replenishes anything that needs to be replenished and it takes nobody's time to do that that's a valuable commodity, time. If you think if you want to say any more if you want to monetize the supplies and say yes I can save. Hey listen I being very honest I have officers now they're saving 15, 20 thousand dollars a year just on varnish and you know prophy paste that you know we have I think we have a very premium prophy paste and as compared to the other premium prophy paste there are 60 or 70 dollars for 200 we're a $30 whether we did that because we sell direct and but that takes an effort somebody has to consciously say hey I'm gonna go look up the website for wonderful dental and I'm gonna put in the order and I'm gonna pay for that order and instead of just getting a bill once a month from the dental supply house you know it means putting in an order every time. So there's some offices saying yes my time is more valuable I don't need to deal directly I'll take the fifteen thousand dollar hit and be happy with all the service so I'm getting it's a personal decision.

Howard: So if you go to there is a little button there you can click get a free sample and the sample is for a wonderful prophy paste free or a wonderful varnish free and if you take their survey they'll even pay for shipping if you don't take the survey you're gonna pay a dollar ninety-nine for shipping and your price and your flavors on varnish or bubblegum, chocolate, mint, strawberry and for your prophy paste it's a bubblegum, chocolate, marshmallow and then mint so the question is why do you not have a marshmallow varnish you're confusing my walnut brain.

Dave: Well I will tell you that you know I have been doing this for a while and we've been working on this for a while and we are trying to improve there is something inherently in a marshmallow or vanilla flavoring that discolors the varnish and turns it dark yellow and until we solve that problem.

Howard: That is hilarious.

Dave: Yeah when I first started using varnish it was came in a tube and it was almost brown yellow we painted on the kids teeth and the mother would look at the kid when he walked out and say I probably guessed he played like a horrible is teeth look and that was an issue so one of the things that we saw was that we are varnishes either clear we have our chocolate is white because again the chocolate flavor does not adapt to a clear varnish. We've been working on a marshmallow garnish now for over a year and I have not found a flavoring that doesn't discolor the varnish itself so why why the marsh you know one of these days we just came out with a bubble gum trophy paste then I am like any I tested it on my grandson's and I almost couldn't get him to spit it out it's that good I have a pediatric dentist in California called me and said listen I gotta tell you I was I was doing a cleaning on this child we were using the marshmallow prophy paste and I turned around to write a note and I turned back around the kid was eating it out of the cup there is a way to make a better tasting product but were trying to improve.

Howard: Do you know why I asked you to come on the show deal any idea?

Dave: I got an email from one from a guy one of my customers one of the offices that use us and said would you be willing to go meet Howard Farran and I said you know sure why not I was I have to tell you I was I was a little bit nervous about coming on and talking to you on you know on a podcast but the more I thought about it the more I thought you know what I have something good to offer people and I really in my heart want to save everybody some money and I really think I can make a better product for dentists and I can help dentists and you know I'm not an altruistic person totally I'm doing this because I started a little business it keeps me very busy in retirement I'm 77 years old and I've been to an awful lot recently including a 14-hour surgery a couple of years ago but the bottom line is is that I love doing this I loved dentistry, I loved Pediatrics, I enjoy kids. I really enjoy communicating with my peers and pediatric all over the country this has been a joy and a blessing for me to have this business. So when you ask me you know how did I get on here I'm not really sure how you got to me but I suspect somebody contacted you.

Howard: No it was it was actually on the pediatric dentistry Board somebody named deciduous duelist posted a Wonderful varnish review and he says "switched over to Wonderful varnish year ago this has been by far our most accepted fluoride varnish I have liked this product the most and have had the least negative responses I have spent the last five years more or less hating fluoride varnish and tried all different types and techniques and can't get the majority of kids to be happy about it. It always feels like a blemish or on a perfect visit I even have to talk myself out of not applying the appropriate amount I thought about switching to brushed on foam but everything I read states varnish is superior, so we stick with it." and then all these pediatric dentists are board-certified pediatric dentists start piling on gone fishin says "I am equally impressed by this product" I mean it just goes on and on I mean it's almost like I mean I'm like BAM now I want it now I want to get the fluoride bars I went to free sample I went to put it on my own teeth but almost every almost everybody piling on is not a general dentist they're not even pediatric dentist their board-certified pediatric dentist and another guy says "my last product I was he figured it was 60 cents per application and with you he thinks it's 30 cents per application" So I thought my gosh I want to get a pediatric dose I'm gonna get the founder of this company come on and by the way it's not a fear of public speaking a lot of people you know a lot of times I ask people to come on the show or lecture or at a study club or come lecture Townie Meeting I'll go my god you'd be the best speaker come lecture at Townie meeting and they're just they always say oh it's it I'm so afraid I mean fear of public speaking is considered by many to be the greatest but you know I was having dinner Friday night and with the dentist and he says you know it's not fear of public speaking it's fear of not being liked and I thought that was very profound and what I have to say to that is theirs seven and a half billion people on earth 99.9% of all the humans on earth don't even know you exist so why would you be afraid of public speaking or not being light but so kudos to you for having the guts to come on but have you read that thread on dentaltown called Wonderful Fluoride review?

Dave: I try and keep up with  everything that's being said Howard, and you know what I can't even thank you enough for the warm things you've just said and passing that on but you know what as far as putting myself out in front of the public I think that's easy I and for me I always felt like if I got up in front of a group and I was sincere and acted in a kind manner that there was nothing to be afraid of.

Howard: Yeah and I was never afraid of public speaking and I think it's more to do with a character defect that I truly don't care  if I really believe inside I won't tell you well if you don't agree or you think it's the dumbest thing you ever heard that doesn't bother me I mean I've heard lots of people say things that I don't agree with or but I I'm just sharing the love and I think people are glad you came on and talked about this. You also on your post on dentaltown going all the way back to 2003 you always talked about an entrepreneurial dentist should have a great recall system what are your thoughts on the recall system?

Dave: Well I will tell you that I you know I'd let me relate a story to you sort of put some light on things. When I first started in practice I opened in my office and when the first person one of the first people that came to see me well as a friend of mine who was an insurance salesman he drove up in his Mercedes and I you know I talked to him and I ended up buying some insurance from him. I thought to myself amazing it guys my age he's very successful already how did that happen and as I looked at it the principal I'm on the insurance salesman was is that his first year he went out he sold ten policies and he got a commission from the ten policies and the next year he went out and he sold 20 policies but in fact what happened was the first guys that he sold the first ten policies he sold we're still paying a premium so in the second year he had 30 premiums coming in and I thought AHA that's the secret a secret is to have that insurance policy renewing and I thought in my practice how does this apply to dentistry if I could build my practice and everybody who came through my doors kept coming back eventually I would have a system that would be like that insurance salesman system I would have that guaranteed income. The other thing I realized early on was is that I only have two hands I have so many hours in the day I can do so much with those two hands and that was a limited amount how could I end up being successful in dentistry and being a cut above the average and it occurred to me that the only way you can really make more as if you have other profit centers within your practice. The profit center being has somebody else producing money for you, there's no question about that a good recall system you have hygienist who does procedures you do an exam and by the way I examined every child in every recalled it was the policy of my office that I saw every parent at every visit and I saw every child that ever visit nobody came to my office without me doing the exam on or talking to the parent but what happened was is that I you know I looked at there at the recall visit my it was X number of dollars and this all I only made five dollars on the recall system on that on that visit but that was five dollars I couldn't produce with my own hands and I saw that the most important thing in my office was to build that recall system and everything in that office was geared towards building that recall system. We had you know today there's so many programs that are available for helping you with the recall system and texting and phone calls and messaging and way beyond me and we didn't have it fifty years ago and I don't have that technology but it's there and one of the things that we ended up doing was we had we made sure that when everybody left that they had our phone number in their phone and why do we do that, well because today everybody gets so many extraneous phone calls that they just click off if they don't recognize the number but if it comes up you know Dr. Epstein's calling then they pick up the phone and so when we confirmed appointments and they on the phone somebody recognized our phone number but there are lots of things that you can do to improve a recall system. We had our best speaking voice on that phone full time person dealing with our recall system, we tried to not we tried to make sure that everybody that left the office had their next visit scheduled people say well I don't have my schedule book with me I really don't know what's gonna be in six months and our answer was listen book your appointment now you will get the time that you want to come in that's most convenient to you if you booked it now you can always change it if there's an inconvenience but they walked out of that office with an appointment and yeah we had to make a few changes but 90% of the people who made that appointment kept that appointment and our recall system grew to the point where I actually I stopped doing restorative work in the afternoon I only did restorative work in the morning because that was most comfortable for me. I enjoyed my day more it made my life easier one of the things that I saw when I looked at the pediatricians I have a lot of good friends very close friends for pediatricians by the way for a pediatric dentist there's no better source of referral than a pediatrician. I treated every pediatricians kids for nothing and I made sure that I created the best relationships I could with them but I looked the pediatric practices and what I saw was there were very successful people the more successful they got the harder they worked and it just was backwards. Their was a great line that I can tell you a quick story I don't know whether you've ever heard remembered Dr. Ted Levitus he was a really a pillar and pediatric dentist very early on and I was talking with Ted and he tells the story that he shared a building with a pediatrician and one Monday morning the pediatrician came in his office and was hopping man and he said you know what's wrong he said he says you're not gonna believe this he says the kid fell and banged his tooth yesterday morning at seven o'clock and they called me and Ted says that's crazy they're my patients is why didn't they call me he says you know what I said that to the mother why didn't you call Dr. Levitus he's your pediatric dentist my mother says oh I would never bother doctor Levitus Sunday morning at 7 o'clock it was like you know the parents owned the pediatrician but the bottom line is that as you go into your practice look for ways to make your job easier not harder try and reach a goal where your success leads to less stress rather than more stress. I see guys now we're on production then they they get in at 7:00 in the morning they work to seven a night and they're producing as much as they can and it's very stressful and it leads to problems at leads to mistakes it leads to quality work at least unhappy patients. I would encourage young guys today do your thing enjoy your work try and build a successful practice, you don't have to kill yourself you don't you know. It's one of my concerns about the conglomeration of the conglomerates that are forming in dentistry because so many of them are all on production and that's a tough way to live.

Howard: Right you talked about on pillars in dentistry if someone asks you who's the father of pediatric dentistry who would you say would you say Robert Bunin 1702 to 1748, some people call him the father of oral hygiene others call him the father of pediatric dentistry who would you call the father of pediatric dentistry from a historical perspective?

Dave: You know I never really thought about that, I had such wonderful training I trained at Indiana University the two people there or three people I trained under there were pillars of pediatric dentistry, well Ralph MacDonald who went on he wrote the textbook on pediatric dentistry and went on to become the Dean of the school and Paul Starkey who was president the American Society of dentistry for children and Jim Roche who was for thirty years was the secretary of the American Board of pediatric dentists and they were the greatest influences on me as far as pit in the history of pediatric dentistry it goes this there were I really can't identify anyone that I know historically but those were people that I really learned from.

Howard: and then one last question some of the older people call pediatric dentists piedadontist and some of the younger piedadontist say they actually really don't like that, I mean if you look at a chart and the lady's name says Judith and she says please call me Judy one time she's upset if you call her Judith instead of Judy. Why why did it change from piedadontist to pediatric dentistry and why is that kind of a sensitive name to some of the younger pediatric dentist? I mean they will absolutely correct you on the spot.

Dave: It's really funny that you say that because well I was a piedadontist when I started I became a pediatric dentist but I think what happened was is that I don't know where's the pediatric dentist did it but it was associated people started confusing it with podiatry

Howard: Podiatry you think that was it?

Dave: I think that's part of it I you know I never had an objection to piedadontist but pediatric dentist became certainly more understandable more it just piedadontist was sort of a esoteric name, of course if you say to an orthodontist you know you really shouldn't call yourself ortho you should call yourself the tooth straightener, which is what it means he would probably take objection. So I think you know I think there was just some confusion with podiatry but that's that.

Howard: Yeah so you young piedadontist young pediatric dentist yet to realize that when we were little kids their was no such thing as pediatric dentist when Dave and I were young there were just piedadontist so we I always have to change out my mind. My final question

Dave: Sure

Howard: When you look at the history of retail, retails really only had one business strategy for the last three centuries and that is 300 years ago if your shop was a hundred square foot the next generation would build a 200 square foot and I would put you out of business and then the next generation go 400 square and the next 800 and they seemed to have maxed out at 250,000 square feet. The one-stop shopping convenience was a successful strategy for three centuries now I'm seeing the standalone pediatric dentist model contracting being replaced by combining pediatric dentistry with an orthodontist. I know having four kids that have now made me five grandkids I don't I would prefer one stop shop where a pediatric dentist and say you know what I'm gonna let the orthodontist come over here and talk to you. Do you think that's the new strategy?

Dave: I don't think it's new I started doing that and they in the 1970s in fact when I opened my practice I opened the office and I shared the space with the orthodontist and they did it for a couple of reasons. One is I had just finished taking a course on orthodontics for the pediatric dentist and I took this course and I had it was interesting I learned a lot about orthodontics but when I came back the bottom line was am I gonna do orthodontics on my kids and my grandkids the answer was no. I want a orthodontist I want somebody who's had two years of orthodontics three years of training in orthodontics who was a professional at what he does to do the orthodontics. That being said I also saw that even by the by the third or fourth year in practice I was referring literally hundreds of thousands of dollars worth orthodontic care to the orthodontist and it was shortly after within two years of starting my practice that we formed a corporation of which the orthodontist and the piedadontist were both equal partners. They ever had a mutual benefit to it and it certainly it got around the issue in those days of fee splitting and all that because it was none of that we were a corporation we worked for the corporation we had a salary and we shared the expenses and it was mutually beneficial and I think that from a standpoint of the benefits of the patient it was wonderful to be able to say you know what I'm gonna ask dr. so-and-so to come over and take a look because I see down the road he's gonna need some braces and I would like him just to see take a look and tell me if there's something that we should be addressing early on that might help things later on. I think that that is a very symbiotic relationship between a pediatric dentist and an orthodontist, its advantageous to the orthodontist the pediatric dentist the parent and the patient so I think it I think going forward you'll see more and more of it. I think that the I think that the profession has taken almost 50 years to catch up with what I saw in the 70s and I by the way I will tell you I've had a wonderful relationship with the Orthodontist in our group, they are the among my closest friends we work well together we have a great deal mutual respect. There was a time when orthodontics was sort of the snobbery specialty in dentistry you know the Orthodontist was the snob of Dentistry and he didn't to give any injections and it was you know it was it was just it was all aesthetics etc. What happened over the years was working side by side with the orthodontist I saw that the pediatric dentists really really put in the sweat to bring about a patient who was a good patient who went to the orthodontist because the parents trusted the pediatric dentist and the patient was a good patient and there became a wonderful mutual professional respect for the two specialties. I think that was something that was very important and of course I didn't want a lot of friends with the orthodontist in the community because they saw I thought I was stepping on their toes but you know what my primary goal was to take care of my patients and give them the best care and I thought having an orthodontist in the office was one way of helping to provide that good care.

Howard: and one last final comment we have so much in common and that is you provided the pediatricians children dentistry free of care right?

Dave: Absolutely

Howard: and when I got here my two older sisters are Catholic nuns so my first instinct was to go to the 18 different churches in Ahwatukee and provide and tell the pastors priests rabbis whatever they were that I would do them for free and that was my biggest source of referral and when I started doing veneers and when I learned how to do cosmetic veneers my first three cases were free on pastors because that I told him I said you're standing in front of several hundred people would you like to do this and three they said yes and then I went to hair salons and and did the the woman doing the boutique and I would I would say I'll do your bleaching bonding veneers take out all your old fillings if you will put the before and after picture on your deal and you just got to get out there and run for mayor. I've had every single chiropractor in my home in the last year pressing the flesh I always invite pharmacists for their I mean if I'm gonna go out dinner on Friday night why do you want to sit there no eat with the same family always you know why I wanted you I I'll be taking a couple of my kids you know moldable people but all still shoot out a request to maybe the pharmacist at Walgreens you know a minister or a clergy, physician. So I love the way that you just your instincts were just to get out and press the flesh and I would rather have a pediatrician referring me a child who hasn't had any bad experience to a pediatric dentist then waiting until that kid is 6 or 7 and has a really bad experience to where a general dentist can't work on him, so then he writes a referral slip and says this kid like I can't handle this kid now I'm gonna send him to you my god wouldn't you rather had that child at 2 from a pediatrician that at six from a general dentist?

Howard: Yeah you know what you touched on two very good points first of all like you there were lots of people in this community whose kids I treated for free because they went on the principle first you give and then you get and that absolutely is true today as is as true today as it was in 1970. The other thing is is that going out to dinner with the people that you know and love is wonderful but you know what going out and meeting people is it's really fun, it's interesting and I encourage you know the when the young guys came into my practice I said I am NOT gonna give you a practice you must go out and build your own practice and this is how I built my practice and this is how I would advise you to go about doing it and I think that's I think that's great advice you know what putting something out there helping people and providing good care for the people that that you depend on I think that's very important I think it's a great point and you and I are a lot alike we don't have a lot of hair but we is inside underneath the lack of hair is some brain matter that's thinking and I think that's what that I would tell young people today, use your brain.

Howard: and I gotta tell you the importance that is, my kids you know when I would invite these older people to dinner and we go out to dinner and they come to the house and bbq my kids I think it was so stimulating in their brain like for instance a big shout out to my second son Gregory Welles friend whose birthday is today one time when I was going to dinner it was with Tim Rainey a dentist in refugio, most people think well I'm going to dinner with Tim Rainey I'm certainly gonna get a babysitter for the kids and I was my first instinct with my god tim is so smart I want my four little boys to see that and guess what Tim gave great for his birthday present, to go hunting on his farm out there in refugio, Texas and Sunday Greg and Tim were calling me and he just had so much fun but he actually got to go hog hunting with Tim Rainey all because when I had dinner with Tim Rainey I brought my little munchkins with me and I think it was stimulating for the children and it's just so get out there and press the flesh and act like you're running for mayor and Dr. David W Epstein thank you so much for coming on the show today I want everybody to go to and request your free samples and again doc thank you so much for coming on the show today.

Dave: It's absolutely been an honor and a pleasure and it's so nice to meet you even if it's only on a podcast I look forward to meeting you in person one of these days real soon. 

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