Before graduating, in 1996, from Southern Illinois School of Dental Medicine, Rich Bailey had already become an entrepreneur selling his wildly successful Billy-Bob Teeth, which he invented while sitting in denture class. These novelty chompers brought laughter to millions and spawned a new global market.
VIDEO - DUwHF #1162 - Dr. Rich Bailey, DMD
AUDIO - DUwHF #1162 - Dr. Rich Bailey, DMD
Rich has also enjoyed serving as a small town dentist in North Idaho. It was during this time that he recognized the incredible and largely unmet dental needs of senior citizens in long-term care facilities.
He developed a unique approach to meeting the needs of this community and Onsite Dental Services was born. Their mission: “Enhancing Quality of Life by Improving Oral Health.”
Howard: It is just a huge honor for me today to be podcast interviewing Dr. Rich Bailey DMD. He's a director of on-site dental services but you probably know him from back in the day, he was the founder of Billy-Bob Teeth that is just amazing. He has an article this month in Dentaltown magazine mobile treatment of geriatric patients. Before graduating from Southern Illinois School of Dental Medicine Dr. Rich Bailey had already become an entrepreneur selling Billy-Bob Teeth which he invented while sitting in denture class. The novelty chompers brought laughter to millions and spawned a new global market while serving as a dentist in a small North Idaho town. Bailey first recognized the incredible and largely unmet dental needs of senior citizens in long-term care facilities. He developed a unique approach to meeting the needs of this community and Onsite Dental Services was born, its mission enhancing quality of life by improving oral health. Onsite Dental Services is a mobile dental practice bringing a full line of dental services to his patients residing in long-term facilities the needs of those in skilled nursing or long-term facilities are unique with a gentle touch and a primary focus on prevention. He seeks innovations to meet each patient's individual needs. Hey it's just a huge honor to have you on this show by the way I was a big customer a billy-bob dental teeth I mean they were what year did that come out?
Rich: Oh I think the first set of dental set of teeth probably were invented in 94 so I was still in school at the time and you know we were slowly turning it into a business a buddy in Iowa was it still at school.
Howard: and when I was in before that was the year Amazon went live so we're using it the internet?
Rich: They've made a little more money than my partner and I have but we've still been able to make the trailer payments.
Howard: but you were but you were selling them online in 94?
Rich: No I don't think we started that till probably 96 97 somewhere in there you know in the beginning it was literally like you know gun shows kargh shows county fairs Coon dog conventions just weird stuff state fairs and then we slowly moved our way up to you know Sturgis in the Superbowl and you know you name it NASCAR if there was a lot of people there we seemed to you know we just basically if you could make people laugh they'd buy they buy teeth it wasn't tough once we figured it out.
Howard: Oh it was it was genius I bought several pairs I think every dental speaker in America walked out and started his lecture with billy-bob teeth and at one time as a joke and then on Halloween and my four boys loved them I mean that was...
Howard: That was just amazing and what a type dentaltown this is a day after st. Patrick's Day and dental town started 20 years ago in 99 and that's about when you were selling them online right?
Rich: Yeah you guys have done well Howard.
Howard: Well thanks man it well it's that we're just riding the wave of the Internet wave I mean I I saw that way break out about 94 about when Amazon went public I think Google went public in 98 and I just I mean I never forgot is the first time I got online it was yahoogroups no it was CompuServe and if you went to dentist at CompuServe you're in this email chain where I met Mike Bar and it was just so damn cool to be talking to a dentist in Florida when you were in Phoenix and I was just instant crack cocaine addiction for me I just said this is hot but nobody really saw the vision I mean when I when I launched downtown at 99 my dad and my sister my ex but the entire day crying in my kitchen telling me I'm wasting all the family money and this is no because it was AOL dial-up and but I'll never forget what Jeff Bezos said they asked him it was 94 I knew I knew it was gonna work and he said um why are why are you selling books and if you're selling books why aren't you books.com why are you Amazon he says well the problem is the pipes and right now the pipe is so small the only thing you can sell is something that doesn't require a picture or a video so it just taxed or some books but as the pipes get bigger we'll be able to download photos and then we'll go in and dismember all the Direct Mail businesses whether you know whatever their melon your catalogs for your own mailbox and then he said someday it'll get so big that it'll be movies and video so it's just a matter of the pipes. So we jumped on sir yeah so what do you think the next the next thing I mean we live through that that right I've been surfing that internet ride for twenty years what do you think the next big thing is you're an entrepreneur you're a hell of an entrepreneur?
Rich: Well one thing that I see every day is what they call the silver tsunami you know there's so many senior citizens the baby boomers coming into this age group right now that there's there's just incredible you know need to serve those people not enough to do it so anybody that's in the that's in the senior citizen business is going to do just fine.
Howard: Yeah and you know um by the way though all the people who bought Billy-Bob Teeth will spill silver tsunami as those fell tsunami with an S but the T aside there's a T Billy Bob in that a tsunami but you know it's it's when you look at the demographics what's the fastest growing demographics on women over a hundred what's the second woman over ninety what's the third women over eighty I mean you I think you have a woman now in Japan who just got certified by the Guinness Book of World Record as the oldest person alive I think she's a hundred and fourteen which 114 is 1 million hours.
Rich: That's incredible.
Howard: So now we have humans living a million hours I mean who would have thought that but yeah the so let's talk about that so the ADA recognizes nine specialties one of them's pediatric dentistry and they probably should be looking at geriatric dentistry because one of those things that's so embarrassing being American is that four-and-a-half percent of Americans and we'll finish out their life in a nursing home and the average person and a nursing home is getting one root surface cavity a month. So as soon as grandmas but in there a year she's got twelve root surface cavities you concur with that or not really?
RIch: Oh yeah there's route carries everywhere you look in this and in our neck of the woods yeah there's huge need.
Howard: So you said silver tsunami will that also be silver diamine fluoride?
Rich: Yeah that's one of the products I was just using that this morning actually on a patient you know we can't put every fire out but if we can slow the fires down you know I always try to pretend that that's my grandma on the chair what would I want done and you know the seniors can't handle major dentistry a lot of a lot of them so you have to do this most conservative simple thing possible to do it's in their best interest I believe so that's a great product to accomplish that.
Howard: Well why is it so that that's really the controversy of it I mean I think the pediatric of all the specialties the pediatric dentists are probably the most vocal on dentaltown and we just had I mean literally we have a thousand pediatric dentists that participate on dentaltown and how I see that debate is that you know if you need a pulpotomy chrome steel crown I will just absolutely do it the flip side of that is there's younger pediatric I call them next generation pediatric dentists that don't want to be dragging a two-year-old kid to an OR because whenever you put a child to sleep it's high-risk dangerous and so they like to paint silver diamond for it on there but then a lot of the older dentists are saying you know. So can you address that controversy why does it seem like all the pediatric dentists my age the majority of them want to do it the way they've done it their whole life and the younger pediatric dentist under 30 like on Jeanette McLain here right here in Arizona she likes the stuff why does she like it and people older than her dad would not like it?
Rich: I don't think it's any more complicated than that saying it's hard to teach old dogs new tricks. You know we all we all get in a routine habit you know you know we have techniques that work well in our hands and there's nothing wrong with either approach it's just difference in philosophy but with seniors you know they can't handle a lot so it's a very gentle way to you know slow things down we're not we're not look we're not trying to do you know full mouth restoration we're just kicking the can down the road. So that's one of the tools at our disposal I'm hoping that our little chat today will inspire some young dentists to consider this as an option because it's I feel like it's the best I mean I just love what I do and I can't you know that wasn't always how I felt about dentistry that you know different stages of my career so I finally found the shoe that fit and I hope some other dentist will you know be inspired to you know think about this as an option.
Howard: Well you know the key to I mean business in three words is supply and demand and when and demographics matter and you're supposed to go over they ain't and there isn't anyone hardly anyone doing mobile dentistry let alone in nursing homes would you agree with that?
Rich: Yeah there's very few and there's there's a reason for that Howard, before I got into this I took quite a bit of continuing ed and I wanted to see you know how other dentists were doing it and what I found is that everybody understands that there's a problem everybody can see the prevention is a problem everybody can see that there's not enough dentist caring you know for seniors but what didn't seem to be out there was a simple way to earn a living you know the dental schools and management companies trained us to run on the treadmill and a brick and mortar practice that's just what they do in and you know it's a totally different animals serving this group of people so I could see immediately that there's going to be you know a need for a different different kind of equipment and also different workflow in order to make it profitable because if you can't make it profitable you're not going to motivate many dentists to do what we do so I had to simplify and cut the fat off it you know just figure out what I need and what I didn't need. So if you want I could show you the equipment today you know kind of how it's set up.
Howard: Yes please it's on iTunes you know we always pride ourselves in a good sound file but you know we put this on YouTube because YouTube and Google are the two largest search engines in the world we have over 10,000 subscribers on our YouTube channel thanks for subscribing youtube.com/dentaltownmagazine so if you're listening to itunes switch over to youtube now you can see some video. So show us where are you out right now are you in your mobile?
Rich: I'm in the 6th floor of an assisted living facility here in here in the state of New York and they give us you know depending upon which facility we're talking about we borrow different rooms so this time we happen to be borrowing the library which works just fine. You can see that chair right there this chair is an electric wheelchair I'm gonna I'm gonna turn it on and it it's not only the dental chair it's also the taxi service so this chair elevates up I'm lifting it up right now and seniors don't do real well when you tip them to back too far back in a chair so we do stand-up dentistry we raise them up to a comfortable height for us and then I tip them back to where you know we can get in there and that way they're not you know struggling with saliva but you can see how high this chair is now comparison to me and also the chair you know a lot of seniors have trouble getting around so I literally Drive the chair down the road I got a little joystick right here and I can drive this thing wherever I want it to go I go down the hall pick up a senior citizen you know bring him back we've got a couple pillows that make that make it more comfortable so that's part of what helps another thing that helps...
Howard: I need to stop you right there now this medical electric chair this dental electric wheelchair is that did you buy that from John McPeake president ASI medical?
Rich: No no I bought I bought this on I'm actually a dealer for this particular brand of chair and so you know buy used chairs and you know they're pretty expensive you buy them new but there's a you know big market for the use them so buy a good used want to make sure if I when my technicians checks it out. So the chairs you know about five thousand dollars but what it does everything and it will tip...
Howard: Well how do my homie buy one of these chairs what's the name of it?
Rich: This ticular brand is called Permobil.
Rich: Ya and I would recommend any of your listeners that want to check into this call me because it's easy to buy a pile of junk it's also easy to buy a chair that doesn't have all the features that you need you know the chair has to have elevate, tilt it has to have the legs have to be able to move you know a lot of these chairs don't have all these power functions so you got to have all the right bells and whistles on these chairs to make sure that's actually going to serve your purpose. So but and I've trained a couple dentists
Howard: So you want him to call you, what number do you want them to call you at?
Rich: Call me on my cell phone 509-330-3232
Howard: So how crazy are you going out your cell phone number on dentistry uncensored? That was your worst idea of the day how are you gonna how are you, how are you gonna ruin that idea. You don't want them to go to Permobil that the website that makes it Jarrett's permobil.com you don't want him to go to there and buy it because you said it'll be too expensive and what?
Rich: Oh these chairs brand new about 25 thousand dollars but you can pick them up
Howard: Are you serious?
Rich: Yeah if you know if you know what you're looking for you can pick one up for you know four or five thousand dollars but you got you got to make sure they have all the right bells and whistles but you can't just have the chair because you got to have good lighting so I'm going to show you this light stand right here this light stand is one of my inventions I've got a patent on this thing but this light stand just holds a standard conventional dental light at the right height because as I said we're doing stand-up dentistry. So we have to have good lighting at the right height so this these two pieces of equipment work perfectly together the the chair puts enough weight on the pedestal so that the light stand is totally stable you know that the chair weighs 250 pounds and the you know the patient weighs 100 and whatever so there's you know over 400 pounds typically on this chair which is resting on the pedestals of the light stand which stabilizes the light otherwise light wouldn't be as stable as we'd want it to be you you can wrench all over this light and it doesn't you know it's not going anywhere so conventional dental light mounted on this post you move it just like a volleyball when you call a volleyball net stand you know how they put wheels on them to move they'll move the post it's the same concept.
Rich: Then another PC unit another piece of equipment that I use is this this delivery unit by ASI thing is it's a beast it's it's had it for years and just totally pleased with that so that's another piece of equipment you know I also bring a big big cabinet like that store all the equipment in it's got lockable doors you know so nobody gets in there at night keep all the Sharps and you know chemicals and whatnot locked up so that's some of the equipment that I use you know but there's a lot more to thin just the equipment you got a as I mentioned I've trained a couple dentist out in Idaho to do what I do and a big part of it is you know approaching the administrators the right way approaching the patients the right way approaching the family members the right way it's not rocket science once once you understand it but it's a little different animal than conventional dentistry. So you really have to do you know it's like anything once you see it a few times you get it but what I do is not taught in dental schools I can tell you that.
Howard: Okay so what are you doing then? Well first of all I want to stop you I Phoenix Arizona is a big retirement for Canadians west of the Mississippi if they're east of us if they go to Florida but I don't know if any of these young kids listening have ever really been in a nursing home so what is the clientele like in a nursing home is it I assume it's ninety percent women?
Rich: No it's it's a mixed I mean there probably are more women than men but there's there's a mix and also nursing home is for people that need a higher level of care what I'm in right now for example is an assisted living facility so these are these are seniors that still have you know a lot of independence but they you know they need some help some of them. So basically people that can walk or an assisted living facility people that are struggling to walk are in a nursing home that that's an oversimplified way of explaining it but you know we need dentist at both kinds of both types of facilities and you know so and something else to think about too you know I didn't understand when I was in dental school you know a brick and mortar practice in a sense to me as a treadmill there's always somebody pushing the faster button there's the staff which you got to keep happy which to me was sometimes a miserable endeavor and overheads a you know a monster sometimes. So there's a lot of pressure on dentists who's you know and and you live in the moment of you know the or they call it units ten minutes you know management companies talk about ten minutes that's a unit and so every part of your day is scheduled out and some people love that but to me that kind of felt like a prison after awhile, so I this this is the part of the reason why I love this so much is I get to be me and I'm not on a treadmill I still make earn a great living but I'm I I'm not on a treadmill anymore and I'll tell you give you an example of that is I don't have a schedule I know that sounds crazy but seniors are kind of quirky and it might find it might take a guy ten minutes to find his pants or whatever so you know to have a schedule that's based around that and you never know how long it's going to take you to do something I found it just didn't work well. So I have a list of people that need and want to be seen and I just go down the hall and see whose awakes who's not playing bingo see who's in a good mood and that's who we get in the chair and so you know I can be spontaneous I can keep someone in the chair for as long as it takes or if it's a short visit then we set them free and go get somebody else. So every day I don't know what stress has disappeared not to mention the fact that overhead is like for a business like this is about 15% which sounds ridiculously low for the dental industry but think about it there's no building to maintain there's no parking lot to maintain there's no land lines there's no property taxes I have one part-time employee well one and a half you know depending on which day the week it is I don't have a hygienist I got rid of that a while back that didn't seem to work fit well for this. So you know it's bare bones overhead so which which means that you you don't have to work like your one-legged man at a butt-kickin party you can you can relax and it's over heads not gonna eat you alive and you get to have fun with patients you know seniors our kicks so I enjoy the heck out of you know the interaction part of it so.
Howard: Overhead is amazing so let's take four dentists to take home $25,000 a month at 50% overhead which was the average overhead when I got out of school three decades ago you'd only have to do 50,000 and at 25,000 today over average overhead is 65 percent according to a DA which means the net twenty-five thousand you got to do seventy one thousand five hundred and twenty percent of dental practices have overhead over 80 percent so they have to do a hundred and twenty-five thousand dollars on that 25. So when you look at that you just said you have fifteen percent overhead I mean that is just amazing. So is it insurance Medicaid Medicare cash only how does that work?
Rich: It's a mix of Medicaid and private pay so like the facility that I'm at right now it's probably 95 percent Medicaid but I've been at facilities where there's 0% Medicaid but it almost doesn't make a difference because I'm gonna remember that there's no a lot of vitality left on seniors teeth and and mostly what I'm doing is class five fillings and so you can excavate a lot of caries in a short period of time if you've got good techiche and you don't have to anesthetize so you know if that's that's part of the secret to how you earn a good living at this is there's you know time is money and we don't have to hassle with the drama of anesthetic then you can do quite a bit of dentistry in a short period of time and even the people that are private pay you know they I think once I get a chance to explain the service to the families they realize that I'm not a scam artist I'm just a guy trying to help seniors if they want it and we're just not look we're not looking to do major dentistry we're simply looking to find simple conservative ways to help them keep what they currently have.
Howard: So you're mostly doing restorative dentistry yep you're mostly doing some class five fillings?
Rich: Mostly doing fillings and realigning dentures you know seniors don't adapt well to change and you if you make an 85 year old a brand-new set of dentures even if they look great and fit well they're probably not gonna wear them you know change is so hard they they like their favorite old denture just like they like their favorite old shoe. So I always try to remember we're in the business of making people happy so they end up usually under being a lot happier with if we can simply improve their favourite old denture either you know adjust the sore spots or tighten it up with a realign or you know fix the broken tooth whatever but that usually ends up making them happier than getting a new denture. Most of them can't tolerate conventional crown bridge at the stage that's kind of hard on them so we're smoothing off rough edges we're packing in fillings you know glass ionomer whatever you want to use and there's really very little drama when you remove the anesthetic and it's you know it's very profitable when you don't have to you know tinker with it so it's it's pretty efficient.
Howard: Yeah you know what everybody always talks about you know when you talk about politics always talking about life liberty the Second Amendment the right to bear arms but you know it's life liberty and the pursuit of happiness and I I just a pursuit of happiness is one of the things that solves so many political debates of it they're always talking about amendments or laws or this but you said it well grandma wants her old dentures she wants to be happy she doesn't want to break in a new denture. So I'm gonna put you down on these fillings oh so if you're doing mostly restorative is that mostly root surface decay or is it recurrent decay under class twos?
Rich: There's some of both but but I would say the majority of it is new recurrent our new caries in nooks and crannies some of its interproximal but you know so like for example people with dementia I figured out this routine of app when I get done with the Profi and you know they get used to the vibration of the Profi cup and I'm you know I'm also distracting them with Lawrence Welk or Glenn Miller or whatever their favorite music is so we're rocking those are you correct used to the vibration of that polishing cup and then then I start sneaking in there with a little like number two round bur on the slow speed which has a similar vibration if you take it easy and then you bump it up to a four or a six round you know just just keep excavating caries and if you have to take it up to an eight and you know some sometimes people who have Alzheimer's or dementia ask what are you doing in there and I'll say well you know your daughter Debbie wanted to make sure we got your teeth cleaned real well and I saw this one tooth and need a little extra attention so we're getting that cleaned out for you we're gonna be done here in just a minute but just keep listening to Lawrence here and and we'll be done here in just a minute. So they I've done a dozen cavities on seniors and quite often they don't even know that they had any restorative work done you know we drilled filled and billed they didn't even know it. So it's a that's a real innocent so as you can see it's not sexy high-end dentistry you know we're hardly ever place an implant we're hardly ever doing root canals, my criteria for taking out a tooth this is just a personal thing is if if it's if there's pain swelling or they want it out I'll take it out but if I took out every tooth that's non restorable is broken down I'd be putting a lot of seniors through a lot of a lot of invasive and as you know it's hard on seniors even if the tooth slides out nice and easy they sometimes look like they're in a bar fight the next day so you know I will take it out into one of those three conditions but if it's not one of those three I'm not going to try to talk them into it because that's a it's a pretty fast way to make an enemy and you know nursing homes are like little towns everybody talks so if you if somebody's sore the bruise that that spreads real quickly so we're trying to be simple and a non invasive so yeah.
Howard: This is Dentistry Uncensored and I want you to I want you to really um address something you see seems like thirty years ago when I got out of school all the fillings were silver fillings and every ingredient was silver filling is antibacterial mercury silver zinc tin copper. Then we had this aesthetic revolution where we were taking out all these fillings and replace them with inert plastic I mean when you're you're seeing the end of this on that this life cycle where someone's approached their 1 million hours on the surface of Earth do you think the idea to stop using silver fillings and replace them with inert plastic do you see this as a good idea when you're nursing homes and there are you using composites are you going back to amalgam? I've seen research that says when you do a root surface cavity with an amalgam it'll last four to six times longer than if you did it with an inert plastic composite, then some people are trying to say well then maybe we should use you know glass ionomer so talk about the antibacterial effects why do we use rant on that what are your thoughts on that?
Rich: Well yeah I'll tell you from my own set of experiences I know that that you can find research on both sides of that argument and I have no dog in that fight because the reason I don't argue with people much about it is because when I started off in private practice you know 20 some years ago I was in a blue-collar town and you know 90% of my patients had had a mouth full of these amalgam fillings and you know most of these people lived it to be in their 80s and 90s and were relative healthy so I really had a hard time justifying talking people into taking them out to replace them. Now that being said I'm not God I don't know everything could they cause a health risk I don't know I don't know but I because of what I saw I had a hard time talking people into what I did was I just said hey it's your mouth it's your decision you've read something that makes you feel strongly it doesn't violate my conscience to do it but also on the other hand I have a hard time gonna I'm not going to try to talk you into it so it from and nobody can argue with the restorative value that the material brings they they're pretty tough and they last decades so that's that's a pretty good track record.
Howard: I think the evidence is overwhelming that they last twice as long as posterior composite I mean I mean when you know when you tell a dentist that posterior to service mo decompose the last six and a half years you know they're always gonna say well not in my hands yeah I can't I couldn't take swimming lessons when I was a kid because I kept walking on the water I couldn't get underneath the water you know they just think they're so gifted but you know when the military says their silver fillings last 38 years and you can find studies but anyway but back to grandma... so what do you do you got grandpa he has dementia has Alzheimer's he doesn't recognize his own child there, are you placing amalgam, glass ionomer or composite?
Rich: I'm using a composite that releases fluoride so one of my favorite materials is Activa it's a self curing material that they have out now that is considered bioactive so there's an interchange of ions with that in the two structures so that's a material that I use a lot in and part of the reason why I like that material two reasons one is I've been doing it long enough that I've been able to see my work you know survive through the years now and it's doing great you know so I've seen my own I guess in a sense been able to you know see my own work over the course of time so that's part of the reason. The other reason why I tend to use that one the most is because the tip is tiny and when you're trying to you know tease you know a restorative material into a new connect cranny and you can sneak it around and Bend that tip and get into some of these interproximal areas without you know upsetting the patient without pushing on tissue that little tiny tip is pretty handy you know we're trying to be like dental ninjas in there so that little tiny tip makes a difference. Now that being said I still use amalgam once in a while I don't use it a lot but I use it under the circumstances where it's sub gingival and I can't seem to get the tissue out of the way and you know potential bleeding you know we can't isolate it well so I still use alloy but only under those circumstances it doesn't violate my conscience to do it and really all dentistry when you think about it is you know everything that we do is really fall short of God's handiwork you know when you see a tooth that's never been touched by a dental tool that's way better than anything that we can provide them so you know everything is a compromise I don't care in my opinion everything that we do is not as good as the original equipment so basically to my mind all restorative materials including implants and root canals it were all just limping people down to the final stage of life.
Howard: There one night you're just trying to get them to their 1 million hours of life.
Rich: I'm just kicking the can down the road hoping the good teeth outlive them not the other way around.
Howard: but I just want to be clear because I know I know we live in a society now where you know one of whether it comes to vaccinations or water fluoridation or amalgam that so you know it's this new deal where people just decide well I know I don't want to believe that it's like well you know you know space and time existed 14 billion years before you and space and time doesn't really care if you agree with them or not but it is the aesthetic health compromised when we stopped using gold and silver gold filling I have seven restoration my mouth. So yeah absolutely anesthetic all compromised and we just saw that with a movie on Netflix where the root cause were dentists just want to believe they just want to no longer believe in the focal theory of infection I mean they did they just want to believe something and the outrage was so outlandish that Netflix took the movie down. So I think there's snowflake error where we're not gonna say something to offend you I mean that's why I call this podcast dentistry uncensored because I don't care if I offend you're not I'm trying to help you and and if you don't agree with me I mean sure you can shoot the messenger or you can just sit there and say does Howie have a point is there a point and the point is silver fillings last twice as long and and I see we're both fans of pulp dent Larry Clark was on this show episode 417 he's the dental products of materials with a pulp dent corporation and that that's their whole gig of saying man the next generation of fillings obviously the market wants some white but obviously everybody in biology or carey ology wants them to be antibacterial so you went with pulp dent. So if you did so if you saw a hundred cavities how many of them would get a restoration versus how many I'm gonna get silver diamond fluoride?
Rich: If I can restate I would say probably probably 80% of the teeth maybe 90% of teeth that I crossed paths with I can at least get the carry stopped with my restorative material for the ones that are too far gone I basically excavate some caries to get down to as deep as I can reasonably and then I paint it in you know and then sometimes I'll even cover it up with some composite after that you know it's not perfect dentistry but as I said we're at the stage of life where it's ninth-inning you know bases loaded two on two out so it doesn't I think it's a good option that's what I do if it was my mom my grandma.
Howard: I also want to point out was something that are always talking about their fee because that's the way insurance bills but when I look at your overhead it's time I mean you know an hour you know you pay your rent on a monthly time you pay you pay all your bills monthly but your income receives and these fee deals. So it's not the Medicaid fee I mean who cares that the Medicaid fee is $100 or $200 what matters is how much are you billing per hour a lot of my dentist friends say they can't believe that so-and-so across the street takes Medicaid but that guy when you come in and you have seven cavities he'll just sit down and do all seven fillings in one hour and if Medicaid only pays on our bucks we just made 700 bucks an hour and as our maintenance.
Rich: Ends are meeting
Howard: Yes ends our meeting exactly. So you're a big provider of Medicaid it sounds like you take Medicaid on these people?
Rich: Yeah yeah it's pretty easy to you know even if they're paying me a low fee I'm fast and I don't have to get them numb and there's no drama and I can do a lot of you know the most inefficient part of this business is moving the stuff so that's why it's important to make sure that you know you see as many people in the building as you can that you don't move the equipment more than you have to as long you know these people aren't going anywhere in general so as long as they I can get to them then I'll line them up and you know knock them down it's not it's not rocket science.
Howard: So you said twice you're going to get a numb there might be some kid listening in dental school saying what do you mean you don't get them numb?
Rish: Well occasionally you do like we had a patient this morning who is you know closer to my age and you know we can't we can't go and make you know big restorative work on someone middle aged but someone who's in their 80s or 90s rarely for restorative work do I have to get him numb I mean occasionally but that...
Howard: When they're there anybody's in 90s a lot of times when I take bitewings their nerve their pulp chamber is at the bone level I mean you can see that whole clinical crown doesn't even have a pulp changer Mark's been laying down secondarily dentin for eight or nine decades so that's the point you're making?
Rich: Yep exactly so you can sneak in there and you know I've never enjoyed the invasive part of dentistry so the fact that I don't do as much as I used to I enjoy that part of it.
Howard: and what are you are you don't have a dental assistant this is a one-man show?
Rich: I have one dental assistant and and you know they helped me do everything that I do here they clean things up they tear things down they're usually running the saliva ejector while I'm running a Cavett Ron in there you know pop and tartar off you know they hand me whatever I need but yeah I hygienist I tried it for a while it just didn't work real well you know you're paying a gas 40 bucks an hour and as I said it sometimes it takes a little while to track folks down in a nursing home so it just didn't make sense plus you know once I have them in the chair as soon as I'm done cleaning things as well as they can tolerate it that's the best time to just start excavating carries you know minimize wasted movement so.
Howard: It's another thing no one wants to talk about but of the only three publicly traded dental offices that are publicly traded two are in Australia and one is in Singapore None of them right none of them have hygienists for exact same reason they say I can't pay a hygienist $40 an hour to a 55 dollar cleaning and so when you look at people who are stewards of capital who have been able to access public capital which is one three hundred smiles pacific smiles group Q&M in singapore and i believe my dentist which now has 800 dental offices United Kingdom nobody publicly-traded can make the hygiene system work and then it can't work because if insurance will give you $800 for a root canal but only give you $50 who are cleaning well you know when you hug me six to eight hundred dollars for a root canal or crown you can you can hire a doctor but when you give me $50 for a cleaning I can't even hire a $40 an hour hygienists and that's what you're saying too.
Rich: Yeah it just it just didn't make sense.
Howard: and what doesn't make sense is every time I'd go into a dental office in Phoenix Arizona to see one of my friends when you walk in the back door unlock 90% of the time the docs just sitting there and he's got one or two hygienist cleaning teeth and he's got some assistant making a temporary crown and it's like dude you could be doing cleanings all day long and they just tell you I don't want him to I'm too I'm too lazy but they know it's high overhead.
Rich: Yeah it this is practice kind of practice isn't for everybody you know you kind of have to be self-motivated and you got to have the desire to do it you got to love seniors but if if someone you know enjoys the idea of working with seniors and wants to have little to no stress this is the this is the ultimate job and one of the things about this job Howard that seniors kind of forget I exist five minutes after I leave which is a blessing because if you want to have some freedom my son and I have taken road trips that took us weeks I was gone for weeks I think it was you know eight nine thousand miles I put on the car and I don't think anybody noticed I was missing and I can't tell you how much I love that when you have a regular private practice and you have a big you know you know a group of people that you employ there's gonna be a handful of people that are mad at you if you disappeared for six weeks oh that that's the other killer thing about this is kind of this lifestyle.
Howard: So know when you're billing so would so when you're doing your practice management what software are you on that you're billing Medicaid and Medicare or Medicaid?
Rich: We use one called curve which is cloud-based you know my wife my wife likes it so that's why we picked it but yeah I we've got that down to a science. Really if someone wants to do what I'm doing you got to have them call me because they need to see it themselves you know we can chat about it on a podcast and we can you know I can describe it in more detail if you want but for them to know whether the shoe fits they got they got to come hang out with me for an afternoon and see what I do and see we all of that...
Howard: I wish you would post it after your on dentaltown he got a lot of traction your treatment your this month mobile treatment of geriatric patients dental town magazine March 2019 I don't have the guts to post on there he just told me to call him and give out your cell phone number only you can do that but let's go back to Curve Dental out of Utah right it's hard to say Curve Dental without saying cloud base I mean it was out was that the number one reason you went with curved at all because cloud bases so explain your decision on that.
Rich: As I said I'm not looking at the computer screen I don't do any I don't do any charting here other than paper so I basically I do paper charting here put it in a three-ring binder it's all in alphabetical order when I'm done with this facility I hand that over to my office manager she cranks on that for a day and she's got all the billing done and she enters everything into our computer. So that's how we do it I just didn't want to spend any extra time charting here as far as why we bought it we bought it because my wife seemed to like it for some reason so we'd have to ask her.
Howard: For me for the logistics you'd be thinking that you know you want to carry around a laptop a server be installing all kinds of software or I mean that you just I mean it's like your smartphone you well you don't have Google on your smartphone when you search Google you're just going to a cloud-based software saying with all your social media sites whether it be Facebook or Twitter or LinkedIn so your wife it's probably the cloud-based function but that's working well for you Curve?
Rich: She seems to like it and I really have nothing to do with this so happy wife happy life you know how that goes.
Howard: So I'm so talk about your article in dental town what made you write the article on downtown thank you for that but what was your journey in doing that?
Rich: You know I was actually pretty happy all by myself in the mountains of Idaho just doing my thing and I had a dental colleague in southern Idaho who wanted to do what I do and she you know came up for a trip and she kept nudging me that she you know she wanted to be trained and you know I'm not I wasn't against it but you know it sounds like a bunch of work to me that and and I didn't want to babysit anybody and I didn't want to I didn't want to be I just told her my biggest goals I don't want anybody or anything to make me miserable because I'm pretty happy the way things are but she is doing well and it actually was fun to train someone. So I just decided that and plus the other thing is I have a real simple system that anybody could do if they want to do it and there's a huge need and as part of me started thinking it may be it's kind of selfish of me not to share the knowledge that I have acquired you know however you know I just have everything dialed in and I think anybody could do what I do if they they saw it if I trained them. So anyhow she she has nudged me to be a little more open with with you know this knowledge that I have acquired so anyhow I just thought I'm gonna do make one effort at I'm gonna write an article and then I'm going to teach a class I'm teaching a class down in Atlanta at the special care dental association dentistry Association next month it's called mobile dentistry made easy. So I'm going to teach one class...
Howard: That's your presentation?
Howard: Oh tape it, film it and then you can make it an online dental course.
Rich: I should shouldn't I.
Howard: Yeah film that because these yuppies I'm these Millennials they love to watch it on their iPad or their iPhone kind of drive into a bricks-and-mortar convention I mean it's just so what's the name of that Society it's called the special care what?
Rich: Special Care Dentistry Association, so you know it kind of covers geriatric dentistry but also people that have special needs. So the class is called mobile dentistry made easy and I think I'm teaching it on April the 12th or 13th it's done on Saturday whatever that is next month so yeah we'll just see what happens I will tape thanks for the suggestion and if there's interest, then I'll teach some other dentists to do what I do and if there's not then I'll go back to just doing it myself and being happy.
Howard: So the special care Dental Association the 31st annual meeting April 12th to the 14th in Atlanta Georgia the website is SCdaonline. So how long you been a member of that group?
Rich: I've been there a couple years a few years they're a good group as I said I'm an entrepreneur I can't stop my brain from you know running and so the way I do it the way I practice dentistry with this equipment the way I approach seniors is different than anybody any training that I've ever received there so you know I have picked up some things at that I'm not gonna say there is a value there but I'm hoping that I can bring some value because you know we just need more dentists to do this you know there's so many so many seniors that are in need and not getting it and part of what I'm going to teach in that course to talks about the prevention side of it because that's one of the big challenges I talked about that in the article a little bit that you know seniors it's kind of a perfect storm for tooth decay they're losing their hand dexterity there they're you know losing some of their mental abilities they've had bone loss so there's all these nooks and crannies where food gets caught you know they're on these high sugar diets a lot of them so you know all those things combined means four ton of class five caries and without daily prevention you know they they can destroy their teeth faster than I can fix them sometimes so that's a big part of what we're gonna talk about down there as well.
Howard: So the president is Sam Zechman do you know Sam from the Rhode Island Department of Health?
Rich: I met him yep.
Howard: and David Miller so it's it's really interesting because these boys and girls are all pretty much from the especially no one talks about which is you everybody talks about oral surgeons and endodontist and periodontist but they don't talk about public health dentistry which is one of the nine specialties and they just added the especially of dental anesthesiology and what you guys are related about is the public health and geriatric. Would you say geriatric dentistry should be its own specialty or is geriatric dentistry really just a part of pediatric of Public Health dentistry where do you see geriatric dentistry?
Rich: Oh , I do think it should be a specialty by itself because you know just like with piedo the dentistry itself is not tough but you have to be able to approach the patients the right way you know if they're not approached the right way and the treatment isn't handled the right way then you know you're not gonna have happy customers you know you're not gonna be really helping them. So yeah it's not rocket science but training needs to happen in order people for people to you know serve the people serve the seniors.
Howard: What do you think I'm I wasn't smart enough to ask what do you think these dentists you need to be thinking about?
Rich: I hope that anybody who listened today will just you know read your read the article and if they're interested come down you know come down to that dental conference and be part of the discussion and you know give me a call if they have questions I you know I'm I've talked to a couple people that have read the article already that wanted more you know wanted more information you know you can't pack all the details in an article and you can't see it all online you got to witness it so tell them to reach out to me their shoot me it shoot me an email or you know give me a call and I'll be happy to help people.
Howard: What email do you want to give them?
Rich: My email is firstname.lastname@example.org and onsite is O N S I T E so email@example.com so they can shoot me an email call me text me whatever.
Howard: So I'm going to switch subjects how did you move from the most beautiful state in the world which is Idaho and all the way out to New York City that's the other side of the country would yeah I know you didn't move there for the potatoes you left the potato heaven what would was what was going on in your life where you decide to go from Idaho to New York?
Rich: Well oh boy you don't have enough time to hear the whole story but I'll give you this real shortened version of it I basically grew up in a faith group and I'm not going to name the one that I just didn't feel like I was taught truth and had some doubts about whether you know I had great parents love my folks but I'm not sure they did their homework on who you know when they taught me about who God is so I took the time to read the Bible a few times myself after reading it I you know I couldn't deny that was God's Word and you know I had little kids at the time and I you know kids can smell hypocrisy if you're not if you're saying in one thing and doing another that they can sniff that out so you know just try to start living my faith. I'm one of Jehovah's Witnesses you know I have to believe that God is guiding this organization you know I can't tell you to not enough time to tell you the whole story but basically their headquarters is back here in New York so I'm volunteering a couple days a week at one of their their centers here and provide care for the people that share the good news.
Howard: So you're I'm sorry you're at you're working with or for a faith-based organization right now?
Rich: I'm working for them I'm volunteering my time so we provide dental care for the folks if you know anything about Jehovah's Witnesses they you know they knock on people's doors and they try to teach people what the Bible says.
Howard: Is that what you are then a Jehovah's Witness then?
Rich: I am yeah we don't we don't get involved in politics we don't you know we stay neutral with all that stuff you know Jesus didn't get involved in politics so we feel like that's the example to follow so and we try to teach people who God is and what he has planned for the earth so you know I've got a couple years left with my kids and I just wanted to you know see a little bit more of the world too you know when you grow up in one town your whole life and that's all you know then you know you kind of get that only that version of life experience so I just wanted them to see things outside of their own comfort zone.
Howard: I want to read you a post someone posts on dentaltown last night and my response and tell me if you saw this similarly. Someone someone went on dental town under under dental town message board under laser is religion and the spiritual side dentistry and she says we ever one of her loved teachers at our son's school was in a head-on clays on Friday and just about died he's an induced coma goes on and on on but then she says um she says it's not a perfect world but with a perfect God as creator why not are we being published what purpose is this supposed to serve but you know anyway you can see this person is struggling and my so I just sent you the text on it because that's above my pay grade when people are questioning God but my but anyway I say I thought it would be really really romantic if you would reply because basically what she says she's suffering from depression because she can't understand why you see so many horrible things going on in the world and so why doesn't God allow such horrible things to go in the world like the New Zealand massacre to the Holocaust to slavery to.
Howard: So she's struggling with that so I emailed you the link to that thread by the way I have four boys and their nanny from birth on was a Jehovah's Witness and sweetest lady in the world the boys I I think the boys half the time will call our mom she's just on just an adorable woman but I think you're an adorable man I really think I mean you you really are I mean that makes a bit and that Big Bob Billy Boy teeth I mean that was genius to do in dental school to sit there and have overhead of 15 percent while feeling very purpose-driven because you're going where they ain't and and these kids my final question is this I see you know 30 years ago maybe you came out with $80,000 a total debt now these kids are borrowing 80 to $100,000 per year right here in Arizona to private dental schools charging 100 grand a year they come out $400,000 in debt if they decide they want to go on and be as specials like an orthodontist they might go three more years and now come out six hundred thousand in debt or 750 and then if they marry the girl sitting next to them in class now they get married and now there are one and a half million dollars in that and whenever you marry another dentist them one when when they start making babies one of them usually quits working for a decade so now you got a million and a half dollars debt you got it you got your paying student loans on a doctor who's home raising three or four kids my question to you is if you came out four hundred thousand dollars in student loans do you think your business model of what you're doing could work and pay the bills?
Rich: I do I net somewhere between fifteen hundred and two grand a day it's not incredible money but...
Howard: It is incredible what are you talking about fifteen hundred dollars a day.
Rich: Oh yeah or two grand yeah so ends our meeting I could complain but no one would listen.
Howard: You know the only time I make fifteen hundred dollars net a day and I'm out stealing cars on the weekend and you know I'm only a hundred mile I'm only five miles from Apache Junction I'm pretty sure that's where all the stolen cars go on their way.
Rich: Oh Howard one other selling point to this kind of practice low startup overhead you know to start from scratch if you had nothing and you needed everything would cost about 60 grand for a lot of dentists they already have some of the stuff you know they've already got handpieces and sterilizer and that constant so might be as low as 30 grand but it's compared to a conventional brick-and-mortar practice it's inexpensive to start this kind of practice, you've got to know which stuff to get you got it you got to get the right stuff not the wrong stuff you got to know how to use it get in how to approach the you know the administrators and the people but it's not rocket science once you got it you got it.
Howard: Are you connecting with Howard Goldstien the guy in charge of the dentaltown online CE?
Rich: I'm not, I probably should be.
Howard: Yeah so let's film that because I feel I feel bad when I'm in Phoenix Arizona and there's a dentist on every corner but I've spent a lot of time in nursing homes and nursing homes are it's like a time machine I mean you have these little bitty nurses and they're not registered nurses they're not even LPNs and usually they're certified nurse assistants and this little girl is usually and I say a little girl because that's not racist or sexist that's just what I see with my own eyes you're going to nursing home what percent of the employees in the nursing homes are women?
Rich: Oh 80, 90.
Howard: and they you know so when big old fat grandpa falls down they can't even get him back to the chair let alone if he's in a shower or wet in Slippery these girls said tell me they're calling the fire department two to three times a week because it takes five big firemen to go pick up this really 250 pounds six foot six grandpa and so when you follow them around and you look they gotta feed them they gotta bathe them they gotta do their medical they gotta do everything you know what oral homecare comes down to a Dixie cup a toothbrush a beat a toothpaste a back-and-forth twice on the front's of the incisor spit in a cup and it's done I mean there's no home care in a nursing home do you agree with that?
Rich: Yeah very little you know I it's probably more than you want to get into but I have obsessed about that issue because it's a complex problem. So you know we've I've been able to solve it in some of my facilities it takes time though it's a paradigm shift for a lot of people that are here you got us you got to show them photos you got to get families involved you got to show them the laws you know you know once they're on board with you know with the solution you gotta train the right people you got to give them the right stuff you gotta also hold them accountable daily. So it's not it's also not rocket science but it but it is doable oh and also I charge you know once I get a facility set up with a prevention program I charge 500 bucks a month I don't do it for free you know people don't value what they don't pay for so you know there's there's residual income off these facilities to maintain these prevention programs because honestly of all the things I can do to help these seniors that prevention program is more important than what I do in the restorative side.
Howard: and what tools I mean some of your patients have dementia some have full-blown Alzheimer's some have rheumatoid arthritis they don't have hand dexterity are you doing this mostly with the mouthwash or?
Rich: We use we use chlorhexidine if you've done any research on pneumonia the bacteria that kill people via pneumonia started in the mouth and so all the research points to chlorhexidine. You know chlorhexidine of course is liquid and a lot of seniors would aspirate that so what we do is we take a little five ounce cup and we have the assistant dip the bristles of the toothbrush in the cup get them damp and they brush the teeth with dampened bristles there's also toothbrushes that are designed to go over the top of a toothbrush they get the lingual and the buccal at the same time call us curve is the name of that so the right equipment the right stuff it's you know it makes a huge difference you know seniors when you also when you're using chlorhexidine every day you reduce inflammation you know cuts down on all kinds of cardiovascular problems when you reduce inflammation in the mouth so that's one of the things for prevention.
Howard: and where are you getting your chlorhexidine gluconate?
Rich: I think I just order from i give them the option if they want me to get it I use Pearson dental if they get it on themselves you know they've got their own pharmacies that they're all tied into I don't care where they get it and we don't use a lot of it but we do use it so.
Howard: Does New York have they ever grown one good Idaho Potato?
Rich: I have no idea, next time we chat Howard I'll have the answer to that question.
Howard: You know I grew up my dad had nine Sonic drive-ins and of course the kingpin was on McDonald's and Ray Kroc and he was the guy who discovered Idaho put him on a map remember jr. Simplot and
Rich: Oh yeah
Howard: So I got to tell you my quick story so jr. Simplot was growing these Idaho potatoes and in California where the first nine McDonald's open the french fries were just unbelievable so then here comes Ray Kroc and he goes and buys out McDonald's brothers and starts expanding this and when he starts expanding it those french fries don't taste like they did in the plain illinois like they did in southern california and he first thought you know there was they weren't giving him the recipe or something and nobody could figure it out and finally it was Jr. Simplot that figured out look man when you take these Idaho potatoes and you put them in a dry desert Southern California that tastes totally different after it's cooked then when you take it and send it to a hundred percent humidity Midwest Illinois, so now you got these these soggy moisture potatoes and you have these wimpy welty french fries and a Ray Crock almost blew a gasket and the guy who solved the problem became a billionaire what he figured out was here's what we're gonna do we're gonna take that Idaho Potato and we're gonna skin it and cut it and we're gonna just deep-fry it for the first like ten seconds we're just gonna blanch it and that oil is gonna lock all that humidity end and then we're gonna sell we're gonna transport frozen pre blanched potatoes and then with those start showing up all over Illinois it tasted just like the ones that word that had some curing time in the dry desert of Los Angeles.
Rich: Think that was in the movie the founder well it wasn't that?
Howard: I don't know it wasn't that look I love that movie that was what was his name Keaton...
Rich: Michael Keaton
Howard: God that was the great me I actually got to see Ray Kroc speak I was ten years old which talking you know you're you're going to this dental convention the special needs special care dentistry convention well my dad went to the restaurant convention so we got in this Lincoln Town Car and Wichita drove down Interstate 35 6 hours to Dallas got to sit in the front row I was only ten I'll remember like just that you know just bits and pieces of it but I'm yeah that was wild times they had just rolled out the interstate so it's the first time the whole United States was going a hundred miles away from home before that every old folk you met in Parsons Kansas had never even been to Nevada Missouri but after Eisenhower rolled out that interstate people just was a psychological snap where people in Kansas said well how let's just drive all the way to the ocean and we'll see Disneyland and swim in the ocean and now all these people have no idea how that I Isen hours interstate infrastructure change the world probably as big as later on the internet coming along I mean I don't know I don't know what was bigger the interstate or the internet but they were both huge. Hey I love you to death love you're purpose driven love your mission driven I really...
Rich: Hey you guys do too Howard yeah you guys are good folk I appreciate what you guys do with your magazine.
Howard: Well thank you and thanks for writing an article in it and I hope you connect up with Howard Goldstein and tape that conference because this is something where the young the next generation of kids need to go service the four-and-a-half percent of Americans that are in a nursing home.
Rich: Okay Howard goldstein that's the guy I need to reach out too, can you email?
Howard: Right now
Rich: Okay alright sounds good.
Howard: Thank you so much for coming on the show.