Dr. Robert Tripke’s educational programs have influenced thousands of general dental practices by enhancing the quality of care and dramatically altering the economic status of those practices.
VIDEO - DUwHF #1175 - Robert Tripke
AUDIO - DUwHF #1175 - Robert Tripke
Robert A. Tripke, DMD, author of Behind the Dental Chair, How Smart Dentists Crack the Code and Build a Dream Practice, implemented an organized approach to non-surgical periodontal therapy in his Chenoa, Illinois practice in 1987. Due to the marked elevation in standard of care for his patients as well as a huge positive financial impact on his practice, shortly thereafter he began educating general dentists in these methods and protocols. For nearly 30 years Dr. Tripke has provided structured periodontal therapy training with the newest, most effective techniques available. His program is recognized in the industry as the pinnacle of soft-tissue management.
A passionate, animated and empowering speaker, Dr. Tripke’s educational programs have influenced thousands of general dental practices by enhancing the quality of care and dramatically altering the economic status of those practices. In recognition of his successes, Dr. Tripke was featured in the Dentistry Today article: “My Unparalleled Success with Soft Tissue Management in a Small Mid-American Town”.
Howard: It's just a huge honor for me today to be podcast interviewing Dr. Robert a Tripke DMD. he's had educational programs have influenced thousands of general dental practices by enhancing the quality care and dramatically altering the economic status of those practices. Bob is the author of behind the dental chair how smart dentists cracked the code and build a dream practice implemented an organizational approach to non-surgical periodontal therapy in his Chenoa, Illinois practice which is what about an hour from Chicago?
Robert: About 90 minutes maybe
Howard: About an hour and a half okay and where he's practiced since 1987 which was the same year I graduated. Due to the mark elevation and standard to care for his patients as well as a huge positive financial impact on his practice shortly thereafter he began educating general dentists in these methods and protocols. For nearly 30 years Dr. Tripke has provided structured periodontal therapy training with the newest most effective techniques available his program is recognized in the industry as the pinnacle of soft tissue management a passionate animated and empowering speaker Dr. Tripke's educational programs have influenced thousands of general dental practices by enhancing the quality care and dramatically altering the economic status of those practices. You know I got to tell you there used to be nine specialties recommended by our approved by the ADA up there by you and Chicago they just introduced the 10th one dental anesthesiologists but I would say out of all the specialties pareo has changed the most I mean when we got out of school it was all surgical and then about 10 years out of school they said let's treat it all with extractions and titanium and now they're looking at all those implants and 20 to 40 percent of more ailing and failing with peri-implantitis. So now I'm seeing the pendulum swing back to old fashioned periodontal surgery. Where do you think we're at in perio thewaw days?
Robert: Well there are so many things that have changed in perio I agree with him by the way before I forget I appreciate you making me seven years younger than I am but I actually started in my practice in 1980.
Howard: Oh okay.
Robert: Yeah 87 is when I started the perio program.
Howard: Okay but you have more hair than me so you've got to be younger. So it's a young girl she graduated say let's say she graduated this year and she's looking at a molar with five or six millimeter pockets and the old guy up the street is telling her just treat it with titanium but then she's looking at all the implants all the perio to that that were treated with titanium and they got peri-implantitis. So it's kind of it's very confusing periodontally.
Robert: Yeah well what we've done for years in my practice is I mean a five six millimeter pocket to me is not an extraction you don't take teeth like that out I mean I'm not saying I never do but it's not as a general rule that's not what we do. We develop a structured periodontal program for the patient what customized for that patient and we have adjuncts to the program and we have a we have rinses we have the patient use at home that break down the biofilm which never anything has ever been able to do that. I mean I I was married to chlorhexidine for 25 years in my practice and the only thing that happened with chlorhexidine my hygienist got ticked off because of the stain and my patients got ticked off because of the stain but you could control the disease with it and you can't control the disease with antibiotics either for a lot of reasons. Biofilms are a refractory to antibiotics so that doesn't do anything either and plus the bacteria develop resistance to it so there's another issue but there's product we have a product in our practice now and I don't mean to go product on you here but pareo protect is a product that I use in my office for patient anybody in my office has had an implant placed has to have a pareo protect used at home and it's a product that you take a couple of accurate alginates couple of accurate pour ups and fill out a work order in the pocket depths to a lab and they customize and calibrate those pocket depths in the trays that are made there clear and they hold the oxygen at a level that you send into based on your pocket depth measurements and it holds the oxygen at that level for as long as you want it there. Now this is a 1.7 percent hydrogen peroxide gel and every time I talk about this at a presentation very few people have ever even heard of this and I mean I guess if you wanted to use this long term I guess you might see a little whitening of the teeth with it but it's not designed for that. That it will do is we're dealing with anaerobic bacteria here anaerobic bacteria don't like oxygen sike holding a cross up to Dracula and if it's the most common-sense approach I've ever seen in my life to treating perio because if you can know if you can expose these bacteria or the biofilm to oxygen for extended periods of time you can break it down and control it over a long periods of time and that's essentially what's happening the oxygen stimulates new cell development, additional vascular ization in the site of healing, the tensile strength of the collagen in the healing is much higher and it tears down and breaks down the biofilm which is what we're trying to do after all anyway. So it's an amazing product and we don't have to deal with antibiotics when you give somebody an antibiotic if it's systemic you're gonna flood the bloodstream with this thing and every piece of tissue and every organ in the body gets exposed to the antibiotic that's not a good thing. Well this product we can stay away from the antibiotics we're going to use something called oxygen now all I want him to do is put it in the tray and I want to put in it twice a day 15 minutes each for the first two weeks and then once a day for 15 minutes indefinitely and the results are phenomenal with this product they're absolutely amazing what it does for the condition of the tissue and maintaining the pocket depth and we're doing it like I mean look at it look at athletes Howard I mean what do they do when they got injuries they go in hyperbaric oxygen chambers and it promotes healing and that's what you want to look at it that way that's kind of what we're doing here.
Howard: Well when you say you don't want to go all product on me I have no fear products because note number one Pareo Protect isn't paying us money you're not paying me I'm not paying you know we're all just talking hard but right if you took away about fifty dental companies I would be sitting on a rug outside with stuff I bought from Home Depot. So when dentist always tell I have the throne dental town when people will report a post say well that guy works for a company and he makes profit I'm like well what are you a volunteer public health dentist. I mean how great how come you can make a profit off a root canal but somebody that works at Pareo Protect can't make a profit but you obviously are passionate about Pareo Protect.
Robert: I'm very passionate about as a most common sense approach to Perry Oh I've ever seen and I never I've never enjoyed putting people on antibiotics so this replaces all that.
Howard: They're out of st. Louis, who's the owner of Pareo Protect?
Robert: Oh Lord
Howard: It's the Lord no I was not expecting that .
Robert: Either way it works.
Howard: I said who's the owner a parent protect me I said the Lord.
Robert: I believe his name is Keller
Howard: You believe his name's Keller out of St. Louis. So you are saying that due to the biofilm antibiotics aren't gonna get in there you don't like chlorhexidine because the staining but you like this Pareo Protect this making trays. You know we have 400 courses on dental town and they've been viewed almost a million times you should make an hour online CE Course of what you're actually doing so they can see it but visually visually talk about it so when someone has perio do you take alginate impressions, do you scan it, how do you make the trays, do they make the trays?
Robert: Well first thing we're gonna do is go through the diagnosis and treatment planning then we're going to go through the scaling and root planing procedures that we go through, you know irrigation scaling root planing I might want to use a little laser treatment that that depends with patient to patient but when we get to the point of maintenance with this patient I've got to have a way that I can give them something to take home and use that is not something that's going to cause any problems with the rest of their body and then same is gonna be extremely effective with this disease and again I just to me if you're dealing with a bacteria that doesn't like oxygen they make it look at oxygen and you know what's going to happen to it and that's all we're doing here it's the 1.7 percent hydrogen peroxide gel just the vehicle that's all it is but yeah then we take it once we're through with the scaling and root planing and we decide I want them on maintenance with this will take a couple of accurate alginates make a couple of accurate pour ups and then you know you got a little work order you fill out and send in the pocket depth measurements to the lab and there's five I think there's five labs six labs that do that make these trays now and they will custom make the trays and calibrate them based on your pocket depth measurements they'll hold the gel.
Howard: and what lab is making your trays?
Robert: The one that I use is one in St. Louis.
Howard: So you actually use Pareo Protect, you actually as a company to make the trays?
Robert: Well they have a lab and St. Louis yes.
Howard: and the owner of that is Duane C Keller DMD yep Pareo Protect in St. Louis, Missouri that is so how long have you been used in Pareo Protect?
Robert: Oh I don't know probably a year and a half two years now.
Howard: and what are your thoughts?
Robert: An unbelievable product, I've never seen not only the results but the sustainable results that I've gotten with this and I'll tell you what it really makes it work patients don't like to be put on antibiotics a lot of them won't even go fill a script you may tell you they filled it but they didn't and with this product I don't have to talk about antibiotics and when I tell them that they act relieved that we're not gonna make them take an antibiotic because they know let's some people get sick with the antibiotic you know they get reactions to it this type of thing. There's nothing with this it, it's as enert of a product you're ever going to find so the patients are very receptive to it.
Howard: I had a full head of hair in a six-pack I took one prescription of antibiotics and look at me now it almost killed me but you know when I was in school I was formally taught at the University of Missouri Kansas City that you know gum disease all related to teeth because if you extract all their teeth the gums heal up perfectly and they're all fine. Okay well when you extract those teeth and put implants in yeah you know you're still looking at peri-implantitis. So what is your view on that periodontal around teeth versus implants?
Robert: Well I mean I'd always prefer to save the patient's tooth if it's something can be done I mean I'm not gonna play a hero with some of these teeth I mean you got 8 9 10 12 millimeter pockets we're not going I'm not going there but you know five six millimeter pockets no I mean that's that's not even an issue to you know get it under control through the standardized traditional scaling and root planing procedures but then we have a way to maintain it out of the office and this is the vehicle to do it.
Howard: So do you think these kids are coming out of school they're young they're twenty five podcast listeners are very young talk to them about periodontal therapy. I mean do you think their periodontal training is adequate what would what do you think they should be doing to develop their knowledge and huge specialty of periodontist.
Robert: Well the first thing it's got to start with is something that I wasn't educated on as much as I wished I'd been and that is how important it is to probe these patients and we probe him in our dental office we probably every patient have since 1987 six points per tooth every hygiene visit unless it's a therapy appointment we're probing these patients so and you have to stay on top of it that way but once you probe them I mean we're talking about standardized traditional skills non-surgical scaling and root planing procedures but there's so much technology out there today for you know magnetostrictive and piezo technologies out there today for hygienists to treat this disease that they can almost get away almost exclusively from hand instrumentation because there's a lot of problems with that too. I mean we get carpal tunnel issues with hygienists all the time with hand instrumentation you do that enough over a number of years you're gonna have some probably have some form of issues with it may not need surgery but you're probably going to tell people you have symptoms so you can get away from a lot of that with just the technology alone but yeah. I mean I don't think you need I didn't have a great background in perio when I started doing this in my office but I got introduced to this by a company back in 1987 and I know you know the company his name it was Prodenttech the professional dental technologies they no longer exist in that form any longer but that's how I got introduced to this and when I actually got a flyer in the mail from these people in my office and I read the flyer and I was looking out the window of my private office and as I looked out the window the following words came out of my mouth I said where in the hell has this been all my life because I said this is my answer to everything it solves every problem to me in a dental practice. It solves the busy-ness problem it solves the quality of care problem it solves the financial problems it solves the morale problems because everybody in that office is involved in the system when it's in place from the front desk all the way to even the dental assistants are involved in this so it's everybody the morale just goes through the ceiling and everybody benefits from it too financially.
Howard: and how do they how do they benefit financially?
Robert: Well for I'll give you an example my hygienists when I started this in 1987 she was fresh out of hygiene school and I know when I say these numbers people on the other end of this conversation are gonna eyebrows is gonna go up in the air and I'm gonna say that's not possible but in 1987 fresh out of hygiene school she was making eight dollars and fifty cents an hour okay now in all things are relative to I mean when you look at where we are today I mean what's the cost of gallon of milk compared to what it was then a buck and a quarter and now it's 550 or seven bucks depending on what kind you buy but it's all relative that way but 850 an hour Howard now did I put the perio program in place I said run it I've got I want you to run this system for three months because I got to see what we're doing with it versus what we were doing without it and then we're gonna sit down and I'm gonna after work when I did this with all the employees not just the hygienist and I said we'll sit down and I'll figure out what's fair in terms of compensation this this hygienist did such a fantastic job with this system and at prac is that three months later I sat her down when I'd have to work I gave her again $8.50 an hour I gave her a five dollar an hour raise. Now I'm here to tell you there aren't many people in dentistry getting 50 more than 50 percent in an hour raised in terms of dollars it isn't happening nobody gets that kind of a raise but she deserved it I mean within two weeks she had a new car and within two months she had a new apartment I mean it changed that changed her life and she deserved it.
Howard: but they say there's two hundred thousand Americans who have an act in licensed practice dentistry probably 150,000 general dentists at 32 hours a week or more 30,000 or specialists 32 hours a week or more of those hundred and 50,000 general dentists and the United States right now how many of them do you think have a pareo program?
Robert: Do you want my honest answer?
Howard: I do
Howard: This is Dentistry Uncensored.
Robert: I will tell you it's less than 10%
Howard: Oh absolutely, absolutely.
Robert: Way less than 10%, you know what Howard when I started speaking on this topic in 1988 it was a fall of 88 I started speaking I honest to god thought that I would talk about this after I started going out and talking to people on about this I thought I was gonna do this for about oh I don't know maybe year and a half maybe two years maybe three on the outside and I said to myself by then everybody's gonna have figured this out I mean this is a no-brainer. I mean it doesn't increase your workload it reduces it it allows the hygienist to have all the time they need to treat every patient they're not restricted in times in fact my office they set the on their own time what do you need to treat this case you tell me you get it I don't care what it is and the fees gonna be based on how long you have to what it takes to treat the patient anyway. So yeah I mean it's I ran the system with her and I mean that pay raised to me I never thought my lifetime I never give anybody a $5 an hour raise I don't care what they were making I mean that that to me was astronomical but there aren't a lot of dental offices doing this today and I still even when I speak today I used to speak I mean I would one 25 years stretch I was given 40 seminars a year for 25 straight years and that's a lot and I you can't keep talking to people about this about anything for that long a period of time number one if you don't believe in it number two if you're not passionate about it, there's no way to talk about it you can't keep doing it and it shows but anybody who sees me speak knows how crazy I am about this system in a dental practice. I spoke to I spoke to a group of dental students senior dental students last November at a dental school not at the school it was off-site I bought him all the beer they could drink and all the pizza they could eat one night and put him in a room and I had other ulterior motives to talk to him but the one thing I wanted to do is speak to them about this system and after the presentation was over I'm there were there had to be I don't know they weren't all there and I didn't get the whole class but I probably got 25 of them there and of that 25 of them at least 15 or 20 of them walked up to me and said nobody's ever told us about this nobody's ever told us that if we put a patient in a hygiene chair and we do what you just told us that we need to do that we could make these kind of changes in their mouth and we can make this kind of money doing it and I said I know they didn't teach me either. I had one of my colleagues a kid I went to the kid he's going up now he's my age but he he went to dental school with me and he read the book the book I wrote and he told me he said listen Bob he said this book should be in the hands of every senior second semester dental student in the United States he said they all should be reading this book and I said tell me about it if I'd have known this seven years earlier I'd have been out of dentistry seven years earlier I'd have been retired laying on a beach somewhere.
Howard: I posted a book on dentaltown all my social media.
Robert: I know, I appreciate it.
Howard: It's behind the dental chair, how smart dentists cracked the code and build a dream practice there are two key, it's on Amazon. There are two keys to unlock a dream practice for both dentists and their teams the first key is to remove yourself as some participating members and those dental insurance plans you dislike the most, do this slowly over an extended period of time. Explain to your patients that as participating members in their new in their dental plan you're a handcuffed regarding the procedures you can offer them. The second key is to implement a structured periodontal therapy program and generate 300 to 400 thousand dollars per hygienists per year in the dental practice. Allow patients to make educated decisions about their care. Dr. Robert Tripke has been successfully doing it since 1987 and this book will help you crack the code too. What I don't understand is we live in the richest country in the world and by age 65 10% have zero teeth times two missing half and then by seventy four 20% missing all 30 times to missing half and these dentists think that I mean women have nightmares of losing all their teeth. Why do they find it acceptable for 20% of Americans to lose all their teeth and another 20% to lose more than half in the richest country in the world?
Robert: Well I think what you're asking me is why don't dentists to tell patients about this and teach them this so they will treat it I mean that's essentially what you're asking me and the answer to that question is twofold number one they have a fear of rejection to all dentists do because you've got so much rejection in dental school you don't want any more of it. So you're afraid to say anything to anybody no seriously I mean you don't you want to you don't nobody watching more rejection they want everybody to like them and they're going to be their best friend well number one that's never gonna happen anyway. I don't care what you tell them but the point is is that they're afraid to tell Mr. Smith who's been in the practice for five years 10 years 25 years they're afraid to tell him something that they haven't told him before and certainly not in the way they're about to tell him and they're so afraid of it they're afraid he's gonna have some questions like well why don't you tell me this before and that makes someone will literally swallow their tongue to think about having to answer it and to me I don't care what anybody asks me if it's gonna add three to four hundred thousand dollars a year per hygienists above and beyond when I make it now and hygiene I'll figure out a way to answer any question that's how I feel about it and that's what I did but for some reason they had that fear they also I personally don't think that they really understand the actual financial benefit of something like this to a practice. In 1987 I was five hundred and fifty thousand dollars in debt and in today's dollars that's 1.6 million dollars in debt and I know you know this Howard because you came into dentistry a little after I did but it was still hanging around prime interest rate 1980 21% prime interest rate today 5% maybe a little lower okay. Unemployment in 1980 was 11% mortgage rates were almost 14%. Now none of these kids getting out of dental school today have anything like that to contend with in terms of economic conditions, those conditions were driving people away from my dental practice. They're not gonna take off work to come and see me they're afraid you're gonna lose their job they can't afford to give up the money whatever whatever so they're not gonna do it and I have mean it was tough to get people to come into the office let alone generate sizeable amounts of income but I retired one point six million dollars in debt in two years in today's dollars in two years with that system in that office in a town of eighteen hundred and fifty people. Now when people tell me that they get out of dental school today and they got three to four hundred thousand dollars in debt and they have no choice but to go corporate I got a lot of problems with that not because I got any big well I may have but that's another story neither they have any major problems with corporate but I got huge problems with people feeling obligated to go into it I mean if somebody can walk up to you and say you walk into the front door of this dental office right here and I'm gonna guarantee you three to four hundred grand a year every year you're in there above and beyond what they're making now and hygiene with this system in place. I know that $300,000 that means nothing to me anymore that's not even a deterrent for anything that's the ticket out of this that's the ticket to let them choose anything they want in dentistry is running a program like this.
Howard: So if someone's listening to you right now and they want to implement a program like this walk them through how would they go from hearing you right now to implementing a program?
Robert: Call me
Howard: Call you and what number?
Robert: 309-838-8518 they can call me anytime.
Howard: If they call you at 309-838-8518 What do you get, what are you gonna do what are you gonna tell them?
Robert: First thing I'm gonna do is that find out what they're doing I mean are they still dental school are they out are they in private practice well how many hygienists have they got what kind of a pareo program do you got. I mean here's one thing they can I can find out in a matter of seconds on a phone I'll have them take and print with their software a series of these codes I want all the 4341 all of 4342 all of 4910s and all the ProFee codes.
Howard: Okay repeat all that.
Robert: All the 4341's.
Howard: Which is what the code for what?
Robert: That's the scaling for case type twos and three patients all of 4342s and that's scaly and root planing with limited numbers of teeth usually one two three teeth in areas of the mouth and all the 4910s which is a pareo maintenance code and all the ProFee codes. Now they're gonna when you print all those you're gonna take you're gonna sit there and add them all up and find out how many total of those codes you have you're gonna have a number there let's call that A now have your software do it do it again print the 4341s print the 4342 s and print the 4910s that's it call that B hold them up you get a number now take B and divided by a you're gonna get your pareil percentage that percentage should be 60% or above and no well over 90% of the dental practices in this country it's way below 40%.
Howard: So you're saying 60% should be currently being treated for some form of perio?
Robert: Yeah I think it's you that's on the low end Howard. I mean seventy five to ninety percent of them have the disease what are we talking about here. Here's the number for you that will blow you away seventy five to ninety percent of them have the disease and less than 1% of the hygiene services are towards treating perio less than 1% ProFee's outnumber pareil therapy by 20 to 1 so we've got 80% at least of the patients adults having a disease - by 20 to 1 we're not treating it. They did a study and they found that from 2004 to 2010 in that 6 year period the incidence of periodontal disease in this country increased 5 fold and how that's I mean that tells me nobody's doing it.
Howard: So why do you think parieo would increase between 2004 and 2010?
Robert: I don't know why that 6-year period white showed me that type of increase I don't know I what I don't understand is why it's increasing at all in any timeframe I mean why in the world dentists are not treating this in dump right and by the way this is really gonna throw some gasoline on the fire here but I've been saying for years speaking that I think it's only a matter of time before insurance companies the government Medicare Medicaid I don't care they're all gonna get in on this because of the effects and the lengths of pareo and to heart disease stroke diabetes premature births respiratory ailments Alzheimer's arthritis cancer they've linked it to every damn one of them and here's the thing, they're losing so much money because dentists are not addressing the disease it's a lot more money cost more to treat any of those systemic disorders than it does a treat perio. So there's at some point because they have seen this and they're seen that people with chronic diseases in this country are not getting better and yet if we did and they've done studies to show that if you treat the perio some of these people are showing amazing turnarounds in their health, rheumatoid arthritis symptoms are showing to be reduced by strict by patients after they've had periodontal therapy. So they're gonna get they're gonna get their hands in this Howard at some point and I said it years ago I've been saying this for 25 years at some point if dentists don't this they're going to turn it over to the physical to the physicians and they're going to tell them hey dentists don't want to treat the disease you guys treat it and they'll go hire the hygienist and bring them in their office and they'll start treating it. I mean now the dentist will start screaming way it's an oral disease it belongs to us it doesn't belong to you if you're not going to treat it.
Howard: Well I remember who was the old ADA president our ADA executive director I think it's like Richard Brenner or something and he do you remember him and he went to a dental company I think it was united concordia or Aetna or one of the majors do you remember him? He was like...
Robert: Vaguely I do.
Howard: Yeah he was the executive director of the American Dental so it's like a decade then he went on to dental insurance and he was showing me data that was just I mean the premature baby is a million dollars and one of the fastest things are linking it to is the mother having gingivitis and perio. If we could have got her a cleaning and got that something in the something when the body's seen all that infection in the mouth and the body might think you know this is not a good time to drop a frog and you know kick that baby out and then there they're looking at a 1 million dollar bill and so he was saying that what he was seeing is that premature babies will drive it the fastest. I mean they they that looks like the lowest hanging fruit do you agree with that?
Robert: Absolutely absolutely anybody looks at an infant that's going and I have a daughter that was a preemie okay she was we had her on a heart monitor for almost seven months after she was born and so in this case I'll have to assume it had nothing to do with pareo since my wife is a hygienist but that's another story.
Howard: Tiffany's a hygienist?
Robert: Yes yeah she speaks with me yeah she's got a workshop in the afternoon she does.
Howard: Have you guys all thought about doing the online seahorse it'd be massive marketing for your program?
Robert: I got four videos out there and I'm already was already working with your other Howard on putting them on your site.
Howard: Well you know it to me I don't get about pareo is that about women I mean one of the you go to any woman and say how much money would I have to give you to pull your front tooth and you could never replace it she won't take a million dollars.
Howard: and then you say well what if you woke up and you lost all your teeth like 10% do by 64 and 20% do by sunny four and she says it would be the most god-awful nightmare and then when I say what if you woke up and your teeth were gone and you were bald like me at that point they're looking at suicide they go I would absolutely kill myself if I had no teeth in your hair so and then that same America between the ages of 16 and 74 buys 13 new cars with a median average price of thirty three thousand five hundred dollars so why can't this dentist sell a prevention to losing all your tea to a woman who wouldn't give you her teeth for a million dollars.
Robert: Well because again they're afraid of talking about something they haven't talked about before now if it's a new patient there shouldn't be any issues with that because they don't have anything to compare it to but if it's the existing patient they're afraid to bring to even broach the topic because they're gonna ask me questions and I don't know how I'll answer those questions and I don't want to be put in that box and be uncomfortable and rather than that I'll turn my head away from three to four hundred thousand dollars a year. Now again I'm gonna tell you Howard you you couldn't ask me a question that I wouldn't figure out a way to answer for three to four hundred thousand dollars a year there's no way, dentists are like that I don't know what it is but they have a lot of fear that way.
Howard: Yeah I remember people and people are always saying you know well if your kid was until what would you do if your kid came home from school and said this I'm like well maybe you should just have a conversation with your kid you know instead of trying to pass some law to make make it go away why don't you just have a conversation yeah. You know it's a thing you set you say that because there's three publicly traded dental offices that are publicly traded there's none in America there's none over here but there's two in Australia and one in Singapore and one of the reasons one of the reasons they said when they're looking at the American model they say how come with the new patient exam the doctor spends 10 or 15 minutes and you get all this treatment but on a recall exam they spend no time and nothing there's no diagnosing and treatment planning and they can show you a model and it's just like what a doctor goes into a new patient why do they spend so much more time and can tell you so much more of the obvious but then when he gets kicked to recall you know they're just getting that so something's up what do they call recall most benign maintenance or what do they call it?
Robert: Yeah recare yeah well you know Howard here's the problem with that situation when people if people keep coming in for a recurve visit and every time they come in the message is Jim you're a great you're doing a great job you have no cavities see in six months Jim you're doing a great job no cavity see in six months they hear it every time you come in you could put it on an endless loop out at the front desk and just let let the damn thing play and nobody has to even know keep the names out of it to protect the innocent but bottom line is this is what happens. So they don't put the patient puts no value on this visit because they already know what you're gonna say before they ever even get in the room okay. So if they got something better to do that day I'm gonna go do it I mean I already know what you're gonna tell me so what I got to come in there for other than the fact because you tell me I need to and they think they're going to come out with whiter teeth cleaner or whiter your teeth but nobody talks about a disease process that is shortening these people's life expectancies nobody even says even broaches the topic and they don't understand.
Howard: You and I have lived through for economic contractions 80 87 March of 2000 and then layman's brother but this is the first time I've lived through a contracting life expectancy. I mean I always thought every year or two the average American would live several months longer and now it's been going down three years in a row I mean I was I didn't even see that coming I mean that pendulum came back yeah it is amazing. A lot of people who listen to podcasts are younger than us, a lot of them are saying I you know the average dental student comes out of school two hundred eighty three thousand dollars in student loans and she's seeing these LANAP lasers for you know they're like a hundred and forty thousand and so it's a big purchase for her. Would you recommend that she buys a hundred and forty thousand dollar laser to tree pareo?
Robert: Out of dental school no absolutely not that's something to do down the road and you'll be able to afford it down the road if that's what you want to do but I never the only time I ever buy anything in my dental practice it has to ask to satisfy three criteria it's got to make my job easier it's got to make the patient's experience better and I got to make money off of it. If it doesn't do all three of those I'm not buying it but when you're fresh out of dental school you got other things that are more important than that you can treat these people scaling and root planing irrigation you can do the perio protect system to maintain them after you get them to that point you don't have to invest that type of money right away, now down the road yeah I don't have a problem with that but getting out of dental school investing that stuff no absolutely not, I don't think so.
Howard: Yeah the easiest dollar earned is a dollar an expense saved so if you can do it faster easier higher quality lower cost you really got to think about that. You also are you talking about pareo protect but you're also talking about Oracare.
Robert: Yeah Oracare is a rinse it's an activated chlorine dioxide and xylitol and first of all I will tell you it's antibacterial but that at that point we're even with chlorhexidine. Now from this point on we're going to separate Oracare from chlorhexidine and that is it's also anti viral I've got an I've got a lady my office she's in her early 40s since she was five years old she's had an epidemic of cold sores. There isn't hardly two or three months go by in her life since she was five but she doesn't fight cold sores they put her on all types of medications over-the-counter prescription the latest was a thousand milligrams of valtrex twice a day and the valtrex was killing her pocketbook it was also very negative effects on her liver and it wasn't doing a whole hell of a lot to do anything with the cold sores. So she comes into my office each diagnosis a case type to perio patient so I went ahead and treatment plan her for that and treatment plan her for perio protect trays when we're done this type of thing but I told her I said here's one thing we got to do you've got issues with the cold sores I've got something that's antiviral let's give it a whirl because I'm gonna have you out of any way for the perio condition you had. So I put her on the rinse she's now a year and a half removed rinsing with that product and has never in a year-and-a-half had a recurrence with a cold sore. So it's antiviral antibacterial it's antifungal meaning denture patients with ill-fitting dentures you see them come in they rinse with this stuff for five days and the fungus is gone. It neutralizes volatile sulfuric compounds that cause bad breath and most importantly it breaks down the biofilm which is what perio protect does too.
Howard: So what so what if she said what's the difference in Oracare and Perio Protect?
Robert: Well Perio Protect for me is going to be used and for those patients in a little more advanced situation. I mean you know you're you're more advanced case type twos and your case type threes are automatic, implant patients every one of them gets pareo protect to protect those implants. Oracare is a standard rinse for any patient even in my case even if they don't have periodontal disease you know it's still an indicated use bad-breath, antiviral, you know antifungal all types of things so it's an amazing product it really is.
Howard: and where's Oracare out of?
Robert: Oh lord
Howard: Back to the Lord.
Robert: Where is it yeah to the Lord again.
Howard: Well here's to confusing to me about Oracare a lot of...
Robert: Dr. Richard Downs is the inventor the CEO the inventor of Oracare but and I know him personally I've met him and he spoke at my presentation before.
Howard: I notice older dogs like me a lot of people call Oracare dentists select.
Robert: Oh really?
Robert: I've never heard but
Howard: Yeah a lot of them just are explaining the Oracare and they'll say oh you mean dentist select.
Robert: Well I'll see I don't I don't really know that much about dentists select in terms of its components and everything and what it does so I don't I really shouldn't comment but I do know everything I've talked to you about with or care it is what I said it is and it is an amazing product because it does so many things for so many people.
Howard: This is dentistry uncensored so I don't like to talk about anything anybody agrees on I like to talk about you know where they disagree and they there's a big disagreement of whether this is a communicable disease. I mean I go into dental offices and they've seen grandma every three months for 10 years with pareo and they've never seen grandpa, now what does that was the other end of her body what if you saw her every three months for chlamydia at some point when you say we need to see grandpa. I mean so the question and then and then I it seemed to me I believe it's communicable because when you see these newspaper cases where a kid had to go to the OR and be put to sleep because he had he needed eight pulpotomy chrome steel crowns well I don't have to see anybody in the family I know that didn't come from nowhere that means mom and dad have blown out Carius grandmas the babysitter and she's wearing an upper flipper and a lower partial and hasn't seen a dentist and you can't have a two-year-old with that much infection unless it's living in a herd in a barn with a bunch of people teeming with streptococcus mutans in the saliva and they're all kissing the baby and sharing. So my question to you is you think grandma and grandpa can switch back perio do you do you think it's a contagious disease?
Robert: I absolutely do there's not a whole lot of doubt in my mind that it is. I mean you can't kiss somebody without that bacteria hold unquote being transmitted from one mouth to the next mouth it's just it's impossible.
Howard: Their saying 30 million bacteria and Mike organisms and a regular kiss and a hundred and forty million on a deep kiss and so I mean it's like when I see a woman with a baby bump I tell her look you know if you walked out in the backyard and saw a giraffe that I mean it came from somewhere you just you know you just can't have a giraffe up here and that baby when it's born it's not gonna have any of these diseases and then it's and then and in fact here's some research it's way too much information when they go into a household your microbial flora of your stool is similar to the other people living in this herd. I mean so you're you're living in a herd and a barn and I tell her I said everybody that's gonna touch this baby kiss this baby share utensils I need to treat the whole herd and it seems like they totally get that in Germany and Liechtenstein and Austria but Americans are man they just routinely will see somebody every three months for five years that have never seen another person living in this house. What do you think of that?
Robert: Well know I've discussed that with my patients before I've discussed the fact that if you've got it you better get your husband in here let me look at your husband too there's a pretty good chance something's going on there and I actually would be surprised if there isn't. So you know but now getting them to send John into the office is the other problem here but if you but if you can explain to them the what's... What I found it so valuable with all this is the links the links with all these systemic disorders people relate to that stuff. You know they relate to the fact that heart disease stroke diabetes nobody wants to be involved in anything do you want to own any of these things.
Howard: I'll give you two more examples of things I've seen regularly for 31 years in Phoenix Arizona this little girl's been coming to my practice every six months and she was 2 years old she's never had a cavity she's never had gingivitis then she goes to ASU and she comes back and she's got three cavities and gingivitis. I say Megan the only thing that explains us is your swapping spit with somebody that's got cavities or gingivitis, I mean you never had this for 18 years and their eyes get really big and she says I do have a boyfriend I said well I think he should come in and get his cavities fixed. Same thing with the divorce still you know she was fine forever she got divorced she went back out on the market she's got a new lover and boom out of nowhere her disease missing filled teeth gingivitis perio status it all changed because she's trying spit with someone else.
Robert: Yeah yeah I don't I don't have any doubt I don't know how well you could prove that today but the anecdotal evidence is so obvious just as you're explaining it. I mean it's it's everywhere and I might the way I look at this as I say let's just pretend that we can't prove it it's rather obvious isn't it when every time you bring someone in your office and they have this disease and you bring Joe the husband in and Joe looks like a mirror image of that patient why do we have to have a study to prove anything I mean we shouldn't even need a study guide so I should be automatic.
Howard: do you think you and I are gonna see a return of periodontal surgery more like it was in the 80s I mean now that you're doing this pareo protect and you're doing all this do you think quadrant gum surgeries or cut are more likely to come back or stay away?
Robert: I hope stay away I could never I mean that's it that's a last resort for my patients and it is a resort. I mean sometimes you do have to do that there's no well there's no alternative and we talked about it earlier we talked about how deep the pockets are I mean you can only do so much with non-surgical approach but at the same time I don't like to go the surgical route with anything if I don't have to I'm that's just how I am I try to be as conservative as I can but I want but it's got to fix the problem with what I'm doing isn't fixing the problem then we gotta go the other route.
Howard: Well my belief is that I am I'm really preventive on one rooted teeth but you got to pay attention to two but I'm the most three root of teeth obviously scare me the more I mean a maxillary molar scares me more than a you know incisors and canines. How do you how do you look at three rooted teeth differently than two rooted teeth?
Robert: Well there you've got all types of situations I mean you've got furcation involvement I mean you don't have furcation involvement with single rooted teeth and four patient's is when you start getting bone loss in that area it just fester's it becomes a very chronic problem and ultimately if you get a through-and-through furcation there's not a whole lot you're gonna do to restore that tooth.
Howard: So this is dentistry uncensored I'm gonna try to get you in trouble as best I can. Arestin, good or bad yeah I mean do you like it or not like it is there a place for it or really not really?
Robert: I used Arestin for many many years I did I'm gonna be very honest about it I had very very mixed results with it. I'm not saying it didn't do any good for my patients sometimes it did but again what I didn't find with Arestin what I didn't know then that I know now is that this biofilm that we're talking about with pareo is not something that you can just knock out with that type of a of a product. I mean it's got to be something that is specific for the biofilm and certain things that will destroy the biofilm and certain things don't and I look back on and now I kind of feel that maybe the reason why I wasn't getting the long-term results so yeah I did use it absolutely I did I think probably everybody did it was doing any type of perio.
Howard: but you're not a big fan of it now?
Robert: No no.
Howard: You've also I've been a big fan of yours for a long time you've also talked about Revenue Well. What's your thoughts on Revenue first of all what is it and why do you talk about it?
Robert: Well Revenue Well is a company that is tied into dental practices intimately in terms of social media they do so many things if I I'd take it I could probably spend an hour talking about all the social media related things they do but I'll give you a couple, one of them is immediate treatment plan follow-up a patient comes in the office they get diagnosis and treatment plan Revenue Well before they even hit the front door of your office to leave can either text or email that patient and they can show them the treatment plan itself the insurance coverage the out-of-pocket and down below there is a little green square a rectangle and said it says Care Credit on it and all you got to do is tap that button and you'll find out if you've been approved through Care Credit to go ahead and do your treatments. Some people don't want to sit around in a dental office with other people there and discuss these things they want to be more private about it on their own time you want to go home and talk about it with their husband or a significant other and so they go home and they do that and they can do it with Revenue Well because they can send it right there as fast as a click of a button with a text or an email and another thing they do is if this thing that cancelled you got a crown scheduled for 3 o'clock in the afternoon and it that procedure cancels at 8 o'clock in the morning they're there technology integrates with your software and allows you to bring up every patient in that office that has been treatment plan for a crown and has not completed the procedure and allows you to immediately text or email those patients about a vacant slot in your schedule 3 or 4 o'clock in the afternoon for a crown and if you'd like to come in and get it done today we can accommodate you. So that you know how much time people spend going through people's charge to going through computer listings and trying to find everybody's information they can do it with almost a click with this technology and there's no contract which I love about Care Credit they even have some promos I've seen them before I don't know if it's a promo today or not but they will allow you to put their technology into your office and run it for 30 days and if you like it stay with them if you don't get rid of it.
Howard: Are you talking about Revenue Well or care credit?
Robert: Revenue Well
Howard: Ok yeah just said Care Credit.
Robert: Well I said Care Credit because they kind of work synergistically because Care Credit puts their button on Revenue Wells information on the text of the treatment plan so the patient had just click it and know if they've been approved or not. By the way, yes I do we have Care Credit in my office that was a perfect storm too because when I started perio therapy in the and in 87 late 87 I introduced at the same time Care Credit which made the treatment affordable for the patients and treatable by me because I was now going to get paid for it. So it was a it was a tremendous adjunct to my practice and I can't imagine running a dental practice without Care Credit.
Howard: and what's amazing is i when you look at the Care Credit what I love the most about Care Credit I don't hear most people talking about that is you know the dentist always thinks that he has all these problems because there's nothing to him and it's the country the governor the mayor the economy whatever and then Care Credit can come in and say here's what all the providers how much they're financing in your zip code your county your city whatever and then it's like okay doctor so it's all it's all someone else's fault but you're in a building with eight dentist and you bill out the you finance the least of this care credit. I mean and go back to that car the average new car in America is thirty-three thousand five hundred and five percent of the dentists will do a case like about that size every Friday for their whole career and then 95% of the dentists will never do it one time and what's really embarrassing here's what's really embarrassing, when you meet a dentist and the veterinarian across the street is doing more care credit on dentistry for dogs and cats then you are for humans.
Howard: It's like dude that dog is a dinner in some countries and they're spending more money on that dog across the street for dental then you are for dental on homosapiens.
Robert: Well listen Howard I used to have to tell patients why are you taking your dog across the cross the highway from where I practice is a veterinary clinic I said yeah you go in there for your dog you have the dog's teeth cleaned I said you don't even have your own teeth cleaned what what were we talking about here.
Howard: Yeah and by the way me and Bob are aren't these aren't commercials we're not getting paid care credits not gonna send us a case of beer for saying this but you need to get care credit to come by your office just to show you what everybody in your town is doing because I know dentist... I remember one time in school one time I got sick because I did this on chemistry exam at Creighton and I missed like six and I was like six out of 40 I mean I was ready to throw up and then I realized that like but then you find out in the curve that that was an A. I mean you're thinking how could 34 out of 40 be a it's all the curve dentist like that herd mentality they like to know what everyone else is doing and when they find out on a report that every dentist and that is billing is financing more financed for cases then they start realizing that maybe it's not the Congress the governor the trade deficit you know they always tell you well we're 21 trillion dollars in debt well what does that have to do with your last patient with gum disease.
Robert: Exactly and bottom line is there's nothing you can do about all those conditions with the government anyway you got to get up every morning go to work and make that thing work in the office and Care Credit is such a fantastic adjunct to success financially in dentistry I think.
Howard: and the smartest thing they did is they got away from GE before that thing collapsed. I mean he was I mean when I was in an MBA school Jack Welsh was like he walked on water I mean he was like the greatest business guru of the time and did you ever think you'd see GE fall from grace like that?
Robert: No no way
Howard: I mean it was incredible but boy they're they're so excited to be free from that lot Ness monster dragged around their throat. So I'm gonna you put your dad hat on you know again that you're this audience is skewed to the very young a quarter of the people listen shows and by the way send me an email Howard@dentaltown.com tell me who you are what country you live in how old you are a quarter and we're still in school and their remaining three quarters they're all Millennials so they're coming out there they're listening to you right now. It was so fun at townie meeting listen to how people listen to the podcast I've learned that a lot of them the Millennials all listen to it at one point five they said you're too old and you talk too slow so you're our show only takes a 40 minutes if I listen to 1.5 or whatever but the other thing it was very interesting they how many I'm listening to it in pairs or groups where two or three people will meet and they'll listen to a podcast and they really do love it because I mean how often are you or me gonna go lecture in their small town and here we are I coming in right on their phone but they're young and they're scared because they're in debt said put your dad hat on what if that little girl was your daughter walking had a dental school 25 years old with 283 thousand dollars of student loans what would you tell her?
Robert: Well you've already told what I'd tell them first of all don't get involved in these insurance plans that are gonna you're gonna make a nickel on a dollar to be involved in. I mean you've got to see I mean that's if you're running a volume dental practice and you want to run you want to practice like that then that's your thing go ahead and do it but I don't I don't like hurting people in and out of my door all day long and trying to shove four more down the throat of my hygienist all day. I want to slow it down I want to raise the standard of care and I want to I want to make I want to make appreciably more money. So what I would tell somebody coming out of dental school with that debt is if number one stay away from those plans because you don't need them to be successful there's a market for there's always a market even a small town that I practiced in for all those years eighteen hundred fifty people there are people a good percentage of them that want quality care and there's always going to be people who want quality care so offer it and number two and get paid for it which you're not going to do if you're a participating member and a lot of those plans and the second thing is make sure you got a structured perio program in that office because look you and I you're I don't know how old you are now but...
Robert: Okay yeah I'm 64 so I'm what I'm going to tell you right now is there's there comes a time in every dentist life and I don't care who you are male female I couldn't care less at some point every one of their lives and when you're in your 20s and 30s you think you're invincible.Well it doesn't stay that at some point the back starts to go the hips start to go the knees start to go I've had four major surgeries in the last four years I've had one hip replaced about eight weeks ago I got another one it's gonna be replaced this year I've had double back surgery I've got two eight-inch rods ten two inch screws and a cage in my back and I had developed post surgical neuropathy so I have a neurostimulator in my back so and this is a partly was dentistry and partly was travelling around the company like an idiot for that many years as many as I was doing I mean I was beat my body up pretty bad doing it. Plus I've worked three-and-a-half days in the office and then traveled to California come back overnight I was insane but anyway nobody's body's gonna hold up forever and for some of these people it's gonna happen near 40 somebody's coming in early 50 some in their mid-50s but here's the thing if you're not if you don't have something in that office that can allow you to generate money when you're no longer capable or even willing to pay the price physically to make the kind of money you used to make then you're in trouble and these this is what perio therapy does it positions the dentist and the dental practice that you can continue to make excellent income in a dental practice every day whether the doctor sees a patient or not in terms of restorative and I'm not knocking restorative don't get me wrong but listen to this 1971. In 1971 the number of decayed missing or filled permanent teeth in children ages 5 to 17 was 7.1.
Howard: It was 7.1?
Howard: In 1971?
Robert: Yes easy to remember.
Robert: In 2004, that number had dropped a 2.1 so we got it in that time frame we had almost a 70% drop in restorative needs.
Howard: It dropped from 7.1 to what?
Howard: 2.1 okay.
Robert: Yeah now so the restorative dropped off the tabletop almost 70% and those kids are no longer kids by 2004 there are 38 to 50 years of age and they're not coming into a dental office needing restorative they're coming into a dental office swamped in perio disease and nobody talks about it and the dentist's that's says Jesus no restorative with these people how am I gonna make a living because you look the other way and you didn't even see the perio that's the problem and it's it is the answer I'll take it to my grave it's the answer to all problems in my opinion in that dental practice I don't care what the problem is you got part of that practice you're not liking put a pareo program in there and watch it change everything changes.
Howard: Well I can't believe we went over an hour but I can't let you go with one more question you got it you got address peri-implantitis because that these that there a lot of the talking on dentaltown is very stressful it's mostly like can you imagine if you're that little girl you graduated from dental kindergarten and you go into practice with your mom and your mom's got her diplomat the International Congress of oral implantology and she thinks she's an implant Queen and you're her daughter and 20 to 40% of these implants that are five to nine years old I got they go peri-implantitis all the way around them and she's just looking at this like what is going on. So what is your thoughts on peri-implantitis which seems to be one of the fastest growing problems in all of perio?
Robert: I still I don't have a sample size for ten years if that's what you're looking for but I will tell you this if I think it's a maintenance issue and I truly believe that I told my patients for years you can't get a cavity with the implant but you can lose it due to bone loss and gum disease so I think it's a maintenance issue a lot of them don't maintain their normal maintenance schedules for pareo which should be every 90 days it's not every six months or a year that's one problem and then there's nothing to sustain that practice or that patient outside of the office in terms of those implants and that's where in my office Oracare comes in and that's where perio protect comes in and I can honestly tell you my the implants that I've used these products with for these patients I haven't seen a problem these implants not one not with anybody. Now if they're not using it that's another issue if they're not showing up for visits when their suppose to see the hygienist it's another issue but if they're doing those things I don't see the issue so I firmly believe it's a maintenance issue.
Howard: and here's some very controversial one one of my idols of all time is Rella Christensen and she's I an RDH with a PhD in microbiology her husband Gordon Christiensen a prosthodontist with a PhD but Rella says that when she's looking at DMFT in pari oh that's a six month treatment plan she almost sees no correlation was it altering lowering DMFT in perio but at three months it's significant. So the fact that all these insurance plans will pay for a six month when there's really not much epidemiological evidence to support that but at three months it's a game changer.
Robert: Yeah absolutely and that's why I tell all the doctors that I talked to I say this is an issue of education and you're the one that's got to educate the patient or the patient you've got to educate the patient that of the relevance of these 90 day visits because what happens here is this disease recycles itself every 90 days in everybody's mouth and that means the bacteria they miss on a daily basis takes 90 days to go far enough under the gum line and we all miss something, go far enough under the gum line to reach the tissue attachment perforate it and begin to destroy the bone so the whole thing I tell them is nothing more than a race a race about who's gonna get their first US or the plaque if the plaque gets here before we get there they're gonna lose bone if we get there before the plaque gets there they don't lose bone and the key to that is 90 days but if you get in that and see inside that window and you're golden as far as maintenance is concerned.
Howard: You know I love the sound of the 90 day visit so much better than three-month recall.
Howard: I mean that does and I'll tell you what women have nightmares of losing their teeth in fact I saw one study that said something like almost by age 40 almost 90% of all women report having one nightmare losing their teeth and men you know and there's good studies now linking perio to erectile disfunction and when they say well how does that happen I say well how could you not understand erectile dysfunction I mean it's not that hard so. I mean so to me I mean and then the other thing is I want to tell the young people when they're when they're looking at all this where they want to you know clean air and clean water and save the whales and all this kind of stuff what they don't realize is that that's a rich man's dilemma you know you go back 75 years ago to or two they were only trying to win a war they didn't care about dumping something that they were you know these plants. In fact when general ledger got sued for dumping all that stuff in there in the river up northeast that they showed him documentation they asked the Pentagon where do we pour this stuff and they said port in the damn River. I mean nobody cared when you were being bombed at Pearl Harbor you have the Nazis but when you get really rich well what's the use or you when you when you start getting rich you bid up the prices of luxuries and the ultimate luxury is to live one more day. So when you you know we just had the Guinness Book of World Record just certified the oldest person on earth it was a woman and I divided it I times at times how many hours she led I figured out and she lit she's lived a million hours and when you start living a million hours and you start getting rich they don't want to lose their teeth. They don't they don't want to lose their health I mean the ultimate health is just your health there's no one who has wealth that wouldn't trade it all for their health and so I really appreciate what you've been to be yourself up traveling for years you know you remind me of the robert barkley 2.0 you remember Robert Barclay ?
Robert: I sure do
Howard: and he was and he was traveling around the country trying to set up these perio programs and you know what the dentists actually told him I am booked a month in advance doing immediate dentures I don't have time for this garbage and Bob Barclay had to they explain to them like do you want your daughter to end up with an immediate denture is that is this your vision for your grandchildren.
Robert: Yeah well and the other thing is Howard when I talked about this earlier and I said I don't think dentist perceived the financial impact or value of this system in a practice they say well I want to do a crown well do they know what they don't realize is a perio program generates more income for them than the crown does and they don't have a lab bill and if they got a I don't care if they got a CEREC or not they're still paying more money to do it then they are gonna you know be able to generate from the restorative standpoint versus that with a perio. Perio generates so and they don't have to do the work to generate the pareil that's the other key.
Howard: Well you just you just said a CEREC so you gotta answer is that that's another thing she when she's come out of school she's like I'm 283 thousand dollars in debt I'm you know that those lana pleasers are 140 those those Sarah machines are 140 what would you tell her about buying a CEREC?
Robert: It's a luxury not a necessity, not when your starting out.
Howard: Well speaking of luxury not a necessity I'm worried that your wife's name is Tiffany does that mean she's always going to Tiffany's and buying diamonds and jewelry?
Robert: Yeah too much.
Howard: Is that why they named her Tiffany they knew that she her mom liked jewelry?
Robert: No that I don't know I actually don't know the reason he named her Tiffany.
Howard: but I'm at but seriously man thanks for traveling all over the country for all those years I thanks for working with Howard Goldstein on online CE. I'm telling you the fastest way to reach the Millennials is put it on the iPhone or the iPad and and they'll sit there and they'll watch it and everybody needs a perio program and if someone's listening to you say she's listening and she wants you to set up a perio program for her mom's office how do you how do you do that?
Robert: Well they can either call me or they can email me you know you know the number 309- 838-8518 and the email is email@example.com.
Howard: and just go to Amazon and type in you can just type in if you just go to Amazon click books and put Tripke he's a trip take a trip ke trip ke but if you go to Amazon type books and just put in a Robert trip key behind the dental chair how smart dentist cracked the code and build a dream practice. Bob thank you so much for giving me an hour of your life and coming on the show today and talking to my homies it was an honor to podcast you.
Robert: Well this was my pleasure much more believe me and I appreciate the opportunity thank you so much.
Howard: Alright buddy have a rockin hot evening.