Dentistry Uncensored with Howard Farran
Dentistry Uncensored with Howard Farran
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1177 Dr. Todd Bovenizer DDS, MS, Board Certified Orthodontist at Bovenizer and Baker Orthodontics : Dentistry Uncensored with Howard Farran

1177 Dr. Todd Bovenizer DDS, MS, Board Certified Orthodontist at Bovenizer and Baker Orthodontics : Dentistry Uncensored with Howard Farran

4/21/2019 11:17:30 AM   |   Comments: 0   |   Views: 134

Dr. Todd Bovenizer is a board-certified orthodontist and the founder of Bovenizer & Baker Orthodontics. He graduated from Virginia Tech with his Bachelor’s in Biology and from West Virginia with his Master’s in Orthodontics and Doctor of Dental Surgery. 

VIDEO - DUwHF #1177 - Todd Bovenizer

AUDIO - DUwHF #1177 - Todd Bovenizer

Dr. Bo is Past President of the North Carolina Association of Orthodontists and Member of the American Association of Orthodontists and the Southern Association of Orthodontists. He is part of Damon’s Mentor Program. This allows orthodontists from the Southeast to visit the office and shadow Dr. Bo to learn about state-of-the-art technology and techniques regarding the Damon system. He speaks nationally for Ormco. Dr. Bo lives in Cary, NC with his wife, Megan and their three wonderful girls. Dr. Bo can be found cheering on his kids at the soccer field. He is also heavily involved in their school, Cary Christian where he serves as President on their board, and his church, Colonial Baptist.

Howard: It's just a huge honor for me today to be podcast interviewing Dr. Todd Bovenizer, he's a board-certified orthodontist and the founder of Bovenizer and Baker orthodontics. He graduated for Virginia Tech with his bachelor's in biology from West Virginia and his master's in orthodontics and Dr. dental surgery. Dr. Bo is past president of the North Carolina Association of orthodontists and member of the American Association of orthodontists and Southern Association orthodontist. He is part of Damon's Mentor Program this allows orthodontists from the southeast to visit the office and shattered Dr. Bo to learn about state-of-the-art technology and techniques regarding the Dayman system he speaks nationally forum Co. Dr. Bowe lives in Cary North Carolina with his wife Megan and there are three wonderful girls. Dr. Bo can be found cheering on his kids at the soccer field, he's also heavily involved in their school Cary Christian where he serves as president on their board and his church colonial Baptist. He could be found running his kids around playing tennis and traveling to the coast. Dr. Bo also loves bitmojis, the Carolina Hurricanes hockey team, dave matthews is big ring a charcoal grill and Chipoltle. Now how could it worth it on his support hockey that seems like a moral conflict.

Todd: Well we're completely ban wagoner's my three daughters have taken a liking to it this year and it's been kind of funny Howard, you know every week there's a couple games here in town and they're begging me all the time what a soccer family and two of them play field hockey so I don't know if it's just taking the ice to the field but it's a wonderful family thing for us all five of us go and we really just enjoy it we get in the car our phones are not with us we've got one purpose to get to the game we sit together we eat popcorn and it's like my wife and I said we had no idea that this was gonna take off but it's kind of like a family thing we do so it's been it's been relatively new and we're kind of writing the the Canes success this year. We haven't been two playoff contenders since you know 06 07 we won the cup of no six I was you know at the games then and then it kind of just died off here in North Carolina as far as you know the playoffs but now we were contenders to make the playoffs this year so we're excited about it.

Howard: Wow that is odd that is so cool. You know I was thinking on having you on the show today that you know they the ADA just started their 10th profession with anesthesiology when you and I got our school is only nine and orthodontics is it seemed to be steady Eddie all when I graduated all throughout the 80s and the 90s and the 2000's are changing fast in the ortho space. What do you think of all the changes going on, I mean Smiles Direct Club's gonna do an IPO, Invisalign what do you think about all these changes? It's got to be making an orthodontists have a more competitive market with more challenges and how is this affecting you and what are your macroeconomic thoughts from 30,000 feet?

Todd: I couldn't agree with you more changing rapidly you know I've been in private practice for 13 years so I set up my office when I was a resident of West Virginia. So I graduated in April and I started building the practice that I'm in in December of 2005 so I was actually doing construction while I was a resident I was coming down I moved my wife to Cary and because my family was here and I was coming down meeting with the contract was meeting with the architects and opened up a 06 and none of this stuff was around. I mean a busy line was was around obviously but they were still making many changes to that there was so many changes to to Invisalign it still wasn't where it is today. I mean they put so much R&D; into that and it's like I told my partner you know I've only been doing it for 13 years and he's been with me for four and the profession has changed so much in the 13 years it's like I tell him it's hard to imagine we're gonna be in ten years from now like he's seeing it because he's only been in it for four years so he's seeing everything around I'm like listen man you know 13 years ago we didn't have any of this stuff. You know the iPhone had just come out I phoned gen1 you know we had just started texting when I was you know in my first year of private practice it was still phone calls you know texting didn't even exist and look we all were texting. You know most people don't even take voicemails anymore they say hey if you need to get me leave me a text you know people just don't want to be on a phone and orthodontics is just wow it's it is changing so rapidly I can't even get my I can't even get my head around it. You know Howard not only smarter that club Invisalign all these direct consumers big look what we're doing online I mean look what you and I are doing right now. I mean the consumer has so much at their fingertips and the orthodontist and that the dental profession has so much their fingertips every day with podcasts and Facebook groups and close Facebook groups. I mean it's almost like you can you can learn so much information as an orthodontist or dentist or an endodontist just from being online with these different groups. It's exciting but you know I tell people you better embrace the change and if you're not if you're not looking at it to you you know you the front of your windshield you know you need to be you need to be looking at it in the rearview mirror you need to be ahead of it okay so if you're trying to chase this stuff it's gonna lead people to harm.

Howard: So what do you think of what do you think of this direct-to-consumer ortho movement what are your thoughts on smiles direct club and are you gonna participate in their IPO?

Todd: I don't think so I do the passive investing you know I'm a ban garter so you know IPOs and all that I read the paper and lift you know lift just had their IPO and it's getting a lot of story but you know what I would say about the director to consumer whether it be smiles direct club you know you've got all these other companies one coast coming up for spark you know 3M has their own a liner what they're doing is the strategy is to go broad you know in my opinion so there's going really broad with this and they're trying to gather up as many people as they can from from a horizontal standpoint and they just want to reach as many people as they can then once they do that they were then go vertically. So I think what we're seeing now is just the beginning phases of it and what it's doing for people like me is it's getting more people aware of orthodontics and I like that so people are aware of orthodontics and they come in my office and they've heard of smiles direct club they've heard of six month smiles. I mean six month smiles have been going on for I don't know seven or eight years and that's been in our area I mean obviously our area's right next to Research Triangle Park and you know people are a little bit more ahead of the technology curve. So six month smiles I mean we've dealt with that wave it seems like you know years ago and now we're dealing with the smiles direct club wave and you know the Invisalign wave but it is getting people more in tune to orthodontics and orthodontists and just treatment treatment options and you know I like when people come in educated and I like to educate them further on you know what can I do what can you expect from treatment in our office versus treatment on your own.

Howard: So when so it looks like a lot of these patents have come off on the clear aligners and now you start and you know there's got to be if you googled around the world there's probably 20 companies that are getting involved in the clear aligners space you just mentioned 3M's aligner or they're really substitutes to Invisalign or Invisalign such a high quality with the materials and the plastics or do you think there really are clear competitive substitutes in the marketplace for clear aligner therapy if you're an Invisalign fan?

Todd: You know I don't know the answer told you that all we use here is Invisalign and we have we have a 3d printer so we have our own software 3shape that we use it's not a running software but we use to reshape and let's say ID band this morning and number 23 was just said in a little lingually and I look at the assistant and I say hey I want to move number 23 measly out. So she makes a note in our easy rx software then our lab technician comes and gets the doctor and says hey you have a reset on patient X we go in the lab remove number 23 we click on number 23 we can move number 23 however we want then we can 3d print that patients model and move it with our with our own clear aligners. Now that is very tough and there's some people in a space they do a lot of their own 3d printing in the office. What Dr. Baker and I do we do it most one-two-three aligners so if we can't capture the movement in three retainers it's just not predictable enough for us so then we tell that patient hey your treatment is way too substantial for what we can handle in our lab with our own clear aligners you need to go to Invisalign and you know because it's tried and true and you know a big line I remember I did it on my mother back in it seems like it was 2002 2001 2002 and that was 18 years ago I did Invisalign on my mom and I can remember you know how it was then and it has come such a long way with the attachments and the research and development is going in there so for us in our hands you know it works well you know I don't know where these other aligners I don't know where it's gonna fit in like you said patients are coming off you can Henry Schein, I know I didn't mention them over here but they've got their own they're coming into the aligners space so I think it just depends on you know what kind of technology is behind the plastic you know what kind of virtual set up to these companies using and I think we're gonna continue to see a lot of competitiveness in the marketplace in the clear aligners.

Howard: Yeah Henry Schein is huge Stan Bergman I think he's made 60 mergers and acquisitions in his tenure as the president and CEO of Henry Schein. So what he does with his what is it the SLXTM clear aligner system but yes but you but you that sounds like you're saying what I'm hearing from so many orthodontists is that the Invisalign technology of the tray is still superior to the competition.

Todd: You know again without using it I haven't used any of the other aligners out there I wouldn't be able to comment on that but you know I I do know what they put into it and I do know what it used to be I mean I can remember back in oh six when I first set up I was doing you know one to two Invisalign cases a year and then it just slowly got more and more because I got more and more comfortable on the types of my occasions that I can treat with invisalign.

Howard: Yeah, these you know podcasters tend to be young they're all under 30 send me an email tell me who you are where you live or make a comment on the YouTube channel on YouTube we're Come out of school with about two hundred ninety thousand dollars of student loans so when they go to buy something a piece of technology that they're really looking at it and you said something very interesting where you use the 3Shape scanner yet you love Align Technology Invisalign and line technology owns Invisalign iTero scanner and there's been some disputes between iTero and 3Shape but why do you use the 3Shape scanner and not the iTero scanner if your Invisalign provider?

Todd: Well I use 3Shape software now I do use the iTero scanner. So I have the elements you have two elements we have two elements from iTero that we use to scan but our software in our lab is actually 3Shape software that we use to manipulate the teeth. Let's say we need to close the space between we left a space between number two and three so what we'll do is we use our three shape software to mesial is number two to virtually close that space that way when we deliver that retainer it's a little tight to the patient but it closes the space but we use the only scanner I've ever had his iTero I've never tried any other scanners.

Howard: So do you print out that tray after you do use the iTero scanner with the three shaped software. What's the name of the three shape software for clear aligners?

Todd: It's just our software that we use digitally in the lab. So we print that model on our 3d printer.

Howard: Oh you print the model?

Todd: Yes sir but then we take and we make it clear retainer on top of that or two or three.

Howard: You make the retainer?

Todd: Yes sir

Howard: With 3d printing?

Todd: Yes sir

Howard: What machine?

Todd: No the 3d model is printed so we have did the mold of the teeth and then we take our bio star our mini star from Great Lakes and we vacuum form the retainer on top of the 3d model. Yeah we don't use a suck down machine we use a compete in a vacuum model from Great Lakes it's called a bio star and I love those things.

Howard: and where's Great Lakes at?

Todd: The company?

Howard: Yeah

Todd: Not totally sure I'm guessing up there near one of the lakes in the Midwest.

Howard: So what percent of your ortho are you doing today is old-school bracket versus new-school clear aligner are you about 80/20 80 percent bracket 20 percent clear aligner?

Todd: Well the interesting thing is, is we track what we're doing with software we look it up stats every night and how many new patients are calling our office how many exams we're doing that our little kids how many exams that we're doing that or adults and the adult part of a fact this is definitely growing and what we're seeing is the fixed appliances part of our practice is saying about steady. So it means you know which takes somebody out of britches in 18, 20 months we're replenishing that pool pretty well but the adult part of our practice people in their 40s 50s 60s it is growing astronomically and so I would say that the percentage of our practice is fixed, fixed treatment is about 75% and aligners is about 25%.

Howard: So if you're 75 percent fixed and 25% clear aligner what's the difference between someone getting fixed what are the most correlating variables on why to fix versus removal is that age is it what is it?

Todd: We're still I still look at adults and I try to get them into clear aligners so when I'm looking at an adult and they've got gold crowns they've got zirconia crowns they got implants they have bridges they have heavy restorative work I'm automatically looking at them I'm thinking I would love to have this patient if I can in clear aligners and I look at the patient I say well if I can treat you with them with a clear line or work fixed appliances and at the end I don't know the difference between what I've treated you were then I'm willing to take that chance but if I know there's gonna be a difference between one option or the other I'll try to steer that patient into that option. You know with adults Howard you know with a deep bite I say they have a deep bite and you put fixed appliances on their mandibular arch their calling you've every other week with the bracket off and things like that with with with clear aligners you don't have to worry about repairs you you delivered that mandibular clear aligner and no biting plastic on plastic and you don't have to worry about that, that's the nice thing about about treating it don't sit there with the clear aligner.

Howard: I think that is you know my book which has nothing to identity just business uncomplicate business you only manage three things people time and money. I love the fact that you just said you look at your numbers every night I mean dentist they love their art but gosh so many I'm just hate the whole business side of it. Tell them again what numbers you said you look at you said how many new patients calling how many new patient child exams how many new patient adult exams or what are your basic numbers that you're monitoring on people time and money, money being the number.

Todd: Absolutely you know what what I use is a product called gauge and I'm not affiliated with gauge whatsoever but I've been using gauge when it was all with the metric so when when it first came out it was a company called what their metrics and now it's called gauge and I log in to gauge what it does is it pulls information from my server every night and every night at 9 o'clock p.m. Eastern time for me gauge populates all my data and what I do is I go to the summary tab and I look at I look at production. So I look at in that production I don't look at gross I look at net production for the day and it gives me a relative index of how I'm doing for the month so on April 1st when I look tonight I'll look at my net production and it's comparing to what I did last year meaning April of 2018. So it's giving me you know I may be down 20% and that just means April 1st I so I had a really good April 1st so it's giving me a relative number so I look at net production I look at net collection and then I look at patients 30 60 90 I look at insurance 30 60 90 then I look at new patient phone calls I look at my new patient exams that I did that day adults kids and I look at I look at my observation my week or kids because we don't do a lot of phase one in our office we do a lot of week off so if we see there's 7 8 9 10 year olds we're putting them on recall we don't do a lot of phase when our phase one rates about 5%. So I look at my we call pool you know how many I've got on there what we're doing with the recall pool and then finally one of the most important statistics that I look at is what I would call over estimated completion date. That's people Howard that I said would be out of races in 18 months and they're not for whatever reason so I've told you 12 months and you an adult and your 14 months in treatment I want to know why I want to flag those people. So I want to look at my percentage of my overall practice how many you overestimate a completion date. So that's really what I'm looking at everything I told you right there I logged in at nine o'clock 9:15 that right there takes me about two to three minutes to look at. So Howard I mean look at my numbers every night it's it's a quick snapshot of what of what the office did that day it's not like it's taking me 10 15 minutes two to three minutes tops.

Howard: Well you know I'm you and I have something so much in common besides good looks in hair you got that one covered you beat me on that one but I got out of school May 11 I had my office out in September 21st you were building on your office while you were finishing dental school walk into it. These what do you think makes an entrepreneur like you who just happened to be a doctor of orthodontics what why do you think you just did it well so many of the Millennials they come out of school and they job hop all these associates and they have to have five jobs in five years before they're so miserable the only reason they open up their own practice is just because they're sick of the alternative. It's kind of like democracy it's the worst system in the world except for the alternative a dictatorship. I mean you know why do you think you just did it and while everybody else walks around the pool dipping their toe in the water for five years?

Todd: That's a good question I get that question a lot Howard, you know when I there was no other option for me. You know in Cary North Carolina it's an extremely competitive area it was competitive back in 2005 so my family had relocated down here and I knew that's where I wanted to be I was just married at the time and we had one daughter of our three. So I was looking in other areas but I kind of knew Cary was where I was going to end up and I talked to every orthodontists and people of course said you know it's competitive you know you may want to consider other places and you know I listen to all that and at the end of the day I just decided to go ahead and you know set up my own shop it's what I wanted to do since I was in orthodontic school and I think it really if I could boil it down it boils down to my father's business he was a family independent pharmacy it's still a family in Spain apart pharmacy in West Virginia. So I grew up with Virginia there was one stoplight for my dad to get a work in West Virginia it's about a ten minute commute and he still has his pharmacy there's it's still running it's still successful but me and my two sisters and my mom and dad we worked in that pharmacy year-round. So we got quite a bit of snow in Virginia and when school was called off my dad was going into pharmacy and guess who was going with him the kids. You know we were in there throwing up the pop machine I was doing inventory I was sweeping the floors I would take all the deodorants off of the shelf dust that shelf put all the deodorants back on there same thing with the shampoo toothpaste. I mean we've all all been in these drug stores I mean that was all done by our family and it was just that worth that my dad and mom instilled in me and that came down from there no parents I mean my dad went to Wake Forest and his dad made him work in the coal mines to help pay for Wake Forest and you know so it's that and it's just it's humility. I try to look through everything to do a biblical lens on my approach to life and one of the things that I really try to come to work with is just the sense of humility there's no job beneath me in the office with our 21, 22 team members you know I will clean the bathroom I'll do whatever it needs to take and I'm not a I'm not a dictator and I like to just show people that I'm willing to do any task and even the day I'm just I'm a student and I'm learning and I tell people even though they're they may be trying to learn for me I'm trying to learn from them I'm trying to learn as much as I can and I think we need more humility and just those kind of features and in today's in today's world and if you're able to come to the table with those kinds of qualities I think the people can be more successful so that's just some of the things that's helped me.

Howard: Well it's interesting as your dad's industry was completely taken over by dsos I mean Walgreens and CVS it was a slaughter and your industry when I was in school you probably you don't remember to this I don't know how old you are but orthodontic centers of America made an attempt at this with a big line of credit and tried to roll up all the orthodontists and it failed it was the only one that made it to the New York Stock Exchange and it failed miserably. Why do you think orthodontic centers of america failed miserably yet your dad's industry a pharmacy it did not?

Todd: Well that's a great question and I can remember when Walmart came to blue field of Virginia so there's not a Walmart in booth of West Virginia Walmart came and built right on the state line it was halfway between my home and our family drugstore and my dad was so stressed out when Walmart came because he was saying hey this is this is gonna be yes you know the family business that he got from his parents. His mom and his father and his uncle will all pharmacist so it had been a family business for a while but you know Walmart came and what happened to my dad he grew and you know people wanted that customer service you know people were able to come to my dad and a lot of people in our area were on multiple medications and my dad would potentially find a an interference between one drug to another and my dad would call up the doctor and just add that extra layer or that extra customer service. So he actually came out of out of the Walmart air blowing in his pharmacy and you're right when I when I just got out of residency orthodontics OCA orthodontist Centers of America they were they were a hot topic and it was kind of at the end a lot of people had jumped on and sold their practices to orthodontic Centers of America during that time but obviously it was something that came and went but at the end of the day whether dentistry or endodontics, oral surgery, orthodontics we have to be customer-facing we have to be what customer service oriented you know yes we provide a product but if we're not going to create your raving fans and raving patients and and do everything we can to meet not only meet the patient's expectations that exceed them we're not gonna be successful.

Howard: Well you know Orthodontic Centers of America it went public in 1994 how old are you in 1994?

Todd: I was 20

Howard: Oh so were you well I don't know if you're 20 if your paying attention to that but you know they had 2,000 employees in cells of 226 million dollars on the New York Stock Exchange as OCA for Orthodontic Centers of America, Gasper Lazar was amazing but why do you think it failed why do you think you're an orthodontist, why do you think they failed?

Todd: I don't really know, you know 1994 I was at Virginia Tech not even I didn't even know I wanted to be an orthodontist I was at Virginia Tech totally oblivious to to OCA. So I don't I don't really know why I don't know what their business model was you know we've got a lot of that going on now we've got a bunch of bigger groups in America that are coming together and that are doing you know some of those similar type things and they're doing it they're doing it you know differently. So you know it's it's not something that's been a one-and-done I mean it's a it's a repetitive cycle in our profession where you know even these corporate dental practices you know North Carolina is one state where we don't have a lot of corporate dentistry but you know you got these corporate dental offices that are now bringing in orthodontists their bringing in oral surgeons are bringing in periodontist, endodontist. Their bringing everything in-house so I think everything's cyclical and well certainly we're dealing with with these types of things again even though orthodontic centers of america and there may even be a couple of those practices still remaining I'm not sure.

Howard: So going to fixed I noticed you're a big huge Damon fan why talk about why you're Damon orthodontics fan.

Todd: Yeah that's a great question when I was trained from Peter Non at West Virginia we were heavily Larry Andrews and Larry Andrews was a great pioneer the straight wire appliance back in the 70s and when I was trained I was trained from Dr. Non and Dr. Tim Tremont and Tim treatments now on the program director MUSC the Medical University of South Carolina and we were trained with the six elements of optimal occlusion. So k9 guidance anterior coupling so the way I was trained was like a twin bracket and when I came out I was twin traditional orthodontics and Damon was around in we just couldn't we did not do Damon when I was a residency so when the one code folks would come into the office they didn't even try to sell me on Damon passive self ligation and I developed a great relationship with one of our earlier reps here he's now at Huy his name's Dale Herman. Dale Herman came into my office for literally three years and he didn't try to sell me and he developed a relationship with me and he knew I was an avid reader and and things like that and eventually he got me to try Damon brackets and I couldn't believe that I was putting those on teeth because all I knew was twin and you know Andrew Dawson and Larry Andrews and you know canine dysplasia and all that but lo and behold I put those on and I started with you know one case ten cases fifty and I would document them with photographs and I was using a lot of expanders at the time in conjunction with fixed appliances and I just saw some differences with passive self ligation that I really really loved and you know Howard now I practice 13 years in the private practice I'm not counting my residency of 3 years but in 13 years of private practice I'm practicing orthodontics totally different than when I was training and I always tell people 13 years from now I tell my patients this, 13 years from now on practice in the same way that I do today shame on me. So if I'm not learning and getting better and learning better techniques for example we put early like elastics on every single patient so we put 2 ounce rubber bands the day they get braces and the way I was trained was to wait until you're leveled and aligned and start elastics like 12 months into treatment and we use big old 6 ounce rubber bands 6 ounces and there were three sixteenths inch I mean these things were very tough rubber bands very tight and now what we're doing is we're trying to achieve class 1 on 2 ounce rubber bands it's like feather weights.

Howard: So Damon is a product which is owned by Orm Co which is owned by Kay broker which is owned by Danaher my am i following this correctly?

Todd: You got it right I think there's a lot of it yes.

Howard: So does does Orm Co have a clear aligner too?

Todd: Yes

Howard: and what's that called then?

Todd: Spark

Howard: They called spark and are you a big fan of spark do you think that's not going somewhere?

Todd: Well they just come out of the clinical trials with that and we were not on the clinical trials with that product but we will be trying that product out for sure and I don't know yet because we haven't we haven't actually used it yet.

Howard:  I says ah it said ok so they're aligners on Oracle website or insignia clear guide Express simplify 5 is that what you're talking about?

Todd: I think that's more the Insignia product insignia is more of a indirect bonding. So insignia is where the custom-fabricated fixed appliances.

Howard: Okay for the seating?

Todd: Yes

Howard: but I don't see their clear aligner on the Orm Co website that'll be that'll be interesting to see how that's going. I want this is dentistry uncensored so I want to hit you with some hard questions I hope this one doesn't a hack you off it there's a lot of Dawson orthodontists people that are really big into occlusion and I know occlusion is the most controversial part of all a dentistry. I mean you get you get five occlusion experts in the room and none of them are gonna agree on anything but a lot of them always throw orthodontist under a bridge and I say well you know they're orthodontist blows out the curve of speed that curve oh well sudden they don't you know when I get these faces back their occlusion is blah is that a fair is that a fair complaint by occlusion and again a lot of the occlusion people are fanatics I agree with that so but which would your thoughts on orthodontics and occlusion and all the Dawson CR versus new or lingual and all that set because when I'm talking to the kids in school occlusion is a they're more troubled and under not understanding occlusion more than they are in you know basic bonding fillings x-rays. So talk all things occlusion and ortho. See what I do is like rant so long there's got to be one good question in there somewhere that you'll take them run with.

Todd: That's a great question and you know occlusion in our office is extremely important, now I would put it up there with facial driven treatment planning. So what we try to do is treat to the face and make sure that the smile aesthetics are going to be great but we cannot compromise the occlusion and that's the patient is aware of it. So a lot of what you just talked about earlier where you know you're blowing out the curve of you know curve speed and the curve of Wilson and things like that I think the biggest disconnect is between between dentists and orthodontists is the communication. So if I've got a skeletal class two because that's what we deal with in orthodontics and in dentistry is class two patients you know mandibular deficient they've got over jet we're not doing with class three's now that's a very smaller part of my practice so we're done with class three's and those class two's can come in where we can do nice camouflage treatment what I would call camouflage and camouflage can be by leveling the lower curve SP and gaining a great great occlusion but for what I'm treating an adolescent what we do is Dr. Baker and I have a patient care coordinator and what we try to do is we have an iPad with an eye pencil and we're on Google suite here in the office so we don't do any of these types of your pieces where we're talking into these ear pieces will use Google suite and you know we have we of shows in our office and we have 21 people working in this office but we will Google suite the patient care coordinator and I'll say hey we need to send a progress report to patient X so and that's four months into treatment Howard. So we're doctor Baker and I will get a share of our report and that's HIPAA compliant and we go in there with the ipencil and we actually write the dentist a note with our ipencil four months into treatment hey we're struggling here you know your patient's not keeping their teeth clean they're not wearing elastics that way the communication is very upfront in the beginning. I always tell parents I don't want to tell you about a problem 16 months in you know what's been going on for months zero to 16 why are we not achieving an optimal result. So I like to let our dentist in on that situation the earlier the better and I like to hear them 1 or 2 times during treatment that we may be finishing with a compromise result because I always tell people and we do photos the day of deband because I want people to see what kind of job we did and you know Dr. Baker and I talked about Dawson we we do central occlusion so centric relations central oclusion for us is first tooth contact so we're doing central occlusion and we measure any slide to MI in our exams and every patient we seat which a central occlusion on what what's coming together when we do by manual manipulation and what do you some enamel opacity equations but I think if we're not getting canine guidance we report whether or not we're getting canine guidance and anterior disclusion on our post treatments reports. So for us right up there with facial driven treatment planning occlusions key. I mean if I can't interdigitate the tea and always caught this zipper effect you know what I'm doing a new patient consult and it's on our big screen in the new patient room and I talk about their teeth being able to zipper together that's where you know number number six has to go right here between number 27 and 28 now point on the screen where is that tooth has to go and so for us yeah I can't comment on the on the rest but for us we're trying to we're trying our best to do the best we can with occlusion and when we can't get there that you know because everybody's gonna have that certain percentage of patients that either has just a such a severe skeletal class too that you you have to finish them end on class too because you didn't want to extract premolars just to gain a good occlusion because sometimes I'm against extracting number five and twelve just to retract everything when there's no crowding just to get them in a in a more quote-unquote appropriate occlusion I'll educate that patient hey I'm gonna finish you class two and here's the reasons why but a class two canine let's face it Howard that's great canine disclusion if you've got a class two canine and on and you have them go into excursive movements you you have absolutely hardly any you know non-working interferences.

Howard: Do you think it's way too much of an oversimplification to say that dentistry three diseases occlusal caries and perio?

Todd: Did i think it's too simplified?

Howard: Yes some people always say that you know in their lecture you know these are the three diseases that dentistry treats occlusion, caries and perio and I was wondering do you think that's true False oversimplify I mean Einstein said make it simple enough. perio

Todd: I think that I get where you're coming up now I think it's I think that's how it was simplified I think the dentist has a very tough job. It's kind of like my my general physician he's got to know everything head to toe and you know I think the dentist they've got to deal with acute and chronic problems you know they have to deal with pathology. You know what about that little irritation fiber mom they on the lip what about that little leukoplakia spot you know up there near the second molar you know is it you know the parotid you know that they so I think carries occlusion in perio it goes well beyond that for for a general practitioner. I think they're the runway is so broad and I mean my hat's off to them I always tell people on to ADD, I had to go in and turn on my vision to orthodontics because I can only deal with one thing you know what I did dentistry for four years and I would be reading about root canals I'd be reading about you know atradoc's you know all these different supplements that I could do and my head was spinning and cuz I wanted to do it all well and I was like well you know orthodontics is where I need to be.

Howard: Yeah and I think that you know 1900 there were no specialties and by 2000 there was 58 with the MD's and nine for general dentist and I think when these kids come out and want to be a super dentist and they want to do implants and ortho and everything I just I keep telling them we're not gonna go back 120 years to 1900 where the doctor delivered your baby and fix your eyes ears nose and throat I mean it's I think guys like you are luckier because you can go really really deep on one thing and when I see successful dental offices doing any type of specialty work it's like their main thing they don't do they're not really into specialty work in ten you know in all ten specialties but you cannot go deep in everything in fact this will blow your mind. I own a magazine dental town magazine ortho town magazine there's 40,000 magazines that go to doctors now are you gonna read 40,000 magazines each month to stay on top of and look at implants okay you learn implants do you understand bone grafting what about sinus lifts what about all on fours I mean it's never never ending but I want to ask one more question on the occlusion because it's dentistry uncensored and it's controversial her succinct decision is I'm out of school I've been practicing couple years I want to learn more on occlusion but it seems like there's that Dawson CR camp and that Bill Dickerson lvi neuromuscular occlusion and she just doesn't want to she just wants she can't take everything I say take them all over your 40-year career but would you guide her right towards Dawson CR or left towards neuromuscular?

Todd: For me I'm going I'm going more the Spear Dawson Pankey route. I'm not familiar too much with the LVI route and you know we have some people in our area that subscribe to the LVI route but I would say here in Cary North Carolina you know most of our pediatric dentist and general dentists and prosthodontist we all speak the same language of Dawson Pankey spear. You know I mean look at Spear look at that study club that is just grown leaps and bounds and when you go in there you know you've got multidisciplinary ortho when I can go in there we can all talk the same language now I wouldn't be able to go in there and talk the lvi language because I don't know it so I would if I was if I was training a dental student and somebody was coming to me I'd say hey Dawson Pankey Spear these are tried and true and this is where you should start with the occlusion but now remember what I said before you know sometimes I think orthodontists can you know if we're doing a treatment plan just to get the occlusion what are we doing to the joints. So let's say I'm taking out premolars on the maxillary arch and I'm retracting 6 to 11 you know what am i doing to the mandibular arch am i over impinging it on the to the disc and things like that. So I think we've got to know where occlusion is we've not we need to know where our baseline is but we've got to be able to know what's best for each individual patient.

Howard: Yeah you were talking about Spear, Dawson, Pankey you forgot my favorite two ones right next to you Ross Nash and then Kois in Seattle. You're pretty close to Ross Nash aren't you he's in Huntersville?

Todd: He's right outside of Charlotte North Carolina yeah that's about two it's about two and a half hours away from me.

Howard: So do you like his occlusion training?

Todd: I've never done the Rosh Nash, I've done more of the Pankey, Dawson.

Howard: I like to have mostly support the bald beauties in dentistry and Ross Nash has a gorgeous bald head so I'm gonna say and I love Kois is God what a great guy Kois is so amazing. My favorite Kois joke is he's 100% Greek, remember that Big Fat Greek Wedding I always tell him that Kois's secret is he sprays all of his crowns with Windex before you see some remember that Windex scene?

Todd: Oh yeah the Greek Wedding movie yeah and I love Kois you know course is relatively you know that's a little bit new on the scene and you know the material that come out of there I loved reading about that.

Howard: Yeah yeah just amazing man. So let's switch subjects completely different let's go to business would you you're a very successful businessman, talk about what makes it you know establishing your purpose your brand your differentiation you're top of the mind awareness brand strategy talk about the business of orthodontics.

Todd: Absolutely and you know one must consider any field of Dentistry as a business. I always tell people you've got to be the CEO of your organization you know nobody's going to run a practice like you are so if people aren't willing to dive in and deal with the hard decisions you know that they may pay for it along run. So what about one of my big things when I set up in over six was to really put a put money back into the community so I started sponsoring all these swim teams these swim team became in I would sponsor them and then the schools came in and I guess what I was thinking how would is that everybody was doing the same thing I was but they weren't. So here I was in my little hole and I just assumed everybody else was doing this and you know come to come to think about it they weren't and you know that's what really got the ball rolling for us and I love to talk about TOMA my top of mind awareness. You know whether or not a parent is at a swim meet or maybe their at a school where we're giving away a set of braces or maybe two sets of braces to the school sound auction and people are actually bidding on our brackets on our braces to win free orthodontic treatments and maybe they're there or maybe they're on the closed Facebook group you know we've got Facebook groups here that are closed with moms and maybe they're mentioning about orthodontics and you know I want to get an opinion on orthodontics. So top of mind awareness just means for us when somebody mentions teeth or braces or straightening or Invisalign we want them to think of our practice first or at least think of our practice. So that's that's been huge for us to go into the community and really support our community and then that the community come to us and we've actually taken it a step further in the last two years not only give money into the community but were actually active in the community so we're participating in events most most every weekend you know I would say two weekends a month we're participating in some community event while staff actually goes to those events.

Howard: Now my homies I know that I know my own ways the first thing they're gonna say is well do you have to pay him to do to go to these events?


Howard: Its so obvious but that's the most common question.

Todd: Oh yeah you know we pay, you know we do a staff trip every year this year we 're going to Nashville. So we're taking our whole team to Nashville you know we'll pay for them to obviously go there but while they're on the plane they get paid because it's a working hours so if we're gonna fly Wednesday afternoon they're on the clock so not only we pay them for their plane ticket to go to Nashville but we're paying for them to sit on the plane and it's all spelled out in our leadership documents and our employee handbooks and employee manuals. I mean everyone knows where we are because we have team meetings every quarter and we spell this stuff out to our team so they know what to expect.

Howard: Marketing is everything according to Fred joil and when you talk about top of mind awareness or TOMA top of mind awareness is that mostly social media means that something you're doing on Facebook YouTube Twitter and LinkedIn or is it direct mail or is an Instagram. Is that a marketing concept more and and how would you break up your marketing between social media plan you know events?

Todd: You know Dr. Baker and I we're not huge on social media. So social media is got such a small small presence in our practice and those guys out there the growing their practices guys and girls that have grown their practices on social media and that's not where Dr. Baker's and I are and we're not into direct mail either we don't mail things to people's homes we don't give money off for braces, what we do is we focus on the patient in here so not only are we going out to the schools and all the events in town but we focus on our branding and our vision and our strategy once the new patients here so we focus on the new patient experience and we don't we don't we do a terrible job of asking for google reviews you can tell the people that ask for Google reviews and they start at zero and they get a 200 been open for a couple of months you know so we've been open for thirteen years and I don't even know how many Google reviews we have it's I think it's you know one hundred and hundred and some I don't know I don't even know the number but we do it we do a bad job of asking for google reviews but people come into our practice and I think one thing that sets us apart is we could be a second or third opinion and we're not offering treatment for that for that patient. They may be a 12 year old boy and they may have most of their teeth in but you know 18 and 31 still aren't all the way in and we're looking at the parent more like you know your son's 12 years old you know why don't you wait another year what's the hurry why get braces on right now you know and that's that's done really well I mean and that's just our ethical honest opinion you know and that's the way you know I'm fortunate to have a partner that thinks the same way I do and that's generally done really well for us. There's some people want the braces on now and they'll get another was it honest and they'll get braces on at that point there is a lot of business that goes into everything and other than Dr. Baker and I do not do is we don't do what they call same day starts. So you know when a patient comes in here and they want braces we appoint them so we want them to go home and think it over and make sure that this is this is where they want to be and they actually have to come back into our office and at a later time after records have gathered and get braces on.

Howard: You know Sam Walton obviously built the largest distribution center in the world it's the largest employer in America and one of his key things that he said in his autobiography was that everybody was doing games with like a Labor Day Sale and a fourth of July sale you buy one today get another one free he said you know that it's all noise and he pioneered everyday savings at Walmart and he wasn't gonna play the games because the promotions cost money and the more games that you played like that actually makes your cost go up and the secret to lower price is lower cost and I see that same thing in dentistry where everybody's talking about the new patient experience well that's got to be a gimmick compared to everyday customer experience. So are you do you find yourself focusing your internal culture with staff and team building on the new patient experience or the everyday every customer experience?

Todd: We do we do both so we focus on on the on the patients every day so we do things every day in this practice where we will pick our patients and will like them handwritten notes will engage with those patients with our reward hub our practice genius or will reward them for hygiene you know wearing elastics. So we're focusing not only on the new patient but those patients and treatment I mean those those are just as important if not more you know just to satisfy the people that are in treatment because you know if you've got somebody that's unhappy with your services once they you know know orthodontist is a it's a funny place to be because of seeing us every couple of months for a couple of years so they come in here you know twelve times or so even more and if you make them mad at any one of those visits don't tell 10 people but if they're extremely happy they may tell one maybe but you know I do think you do need to look at all those things you just mentioned because we have a coffee bar we do make cookies we've got a flavored water machine and people come in here and they may think wow you know Dr. Bo, Dr. Baker has a lot of bells and whistles my money is going to pay for this but we actually keep our overhead very well in check. So we do have those things now we're not doing those positives you talked about every single month but we do have that little extra umph when you come in here it doesn't feel like a regular orthodontic practice but yeah I would say we're focusing on the new patient experience and their overall patient experience in general.

Howard: So you said you dropped a couple names you said reward hub is that which is owned by practice genius?

Todd: Yes we use that system it's worked out really well for us we actually we track what our team members do so we track the percentage. So if we have a team member that's just not doing it at all then they're not engaging with their patients let's say we have a team member that just wants to get Howard out of the chair and he wants to get somebody else in there and he may want to you know he or she may want to finish Howard appointment five minutes early so they can go into the break room and get on Facebook. You know so we're looking at those things we're looking at how engaged they are with our patients so we're looking at those reports Dr. Baker and I look at those every month what percentage of our assistants are using practice genius you know because that goes into what you just said you know goes into the patient experience.

Howard: So practice genius powers the patient rewards hub an engagement marketing suite that features reward kids club social media reviews and contest engagement all rolled into one easy application. How long have you been on that?

Todd: Oh gosh probably eight years.

Howard: and you like that?

Todd: I love it let me just have to use it right. I mean nothing's you know people are in this profession Howard you know people buy things and it sits on the shelf you know we buy that new tool.  I mean dentists, orthodontist I mean orthodontist especially we love new things and we love new products but a lot of times we go into it we dive off the deep end and we don't really understand that product or that tool and how we're gonna implement it in our practice so it's like anything else you have to work on it you know we work in our practice but we work on our practice so you can't just work in your office 8:00 to 5:00 every day and go home you have to work on your practice as well.

Howard: and who's the CEO who's the head dog in charge of that place?

Todd: I have no idea.

Howard: No idea, I love your business side of it. A lot of dentist start playing with Invisalign and then they go to their local small town study club and they're like oh I don't want I don't want to send my Dr. Bo he might find out I'm doing Invisalign and he won't love me anymore. What do you think of other people in Cary North Carolina general dentist doing clear aligner therapy, are they friend or foe?

Todd: They're friend you know and Dr. Baker and I mean if you have anybody that's listening I mean anybody that's closely associated with us knows when we're going out to lunch we're encouraging people to do those Invisalign expresses. You know that the number 23 and number 26 that are that are rotated in and you know that patient wants to get clear aligner treatment we're absolutely fine with the dentist and what will help the dentist out if they need any help we're not we're not here to shut and turn anybody away if somebody wants our help whether or not that be another colleague orthodontist or a colleague that's a dentist. So we certainly encourage it and what we like to do is we like to just teach people what may be what they can handle and what they can do and people have different skill sets so we have dentists that tackle you know complex in base on cases and we have other people that stay more in that express just simple alignment. You know I think as long as we're doing proper communication and proper informed consent and record taking I think it's absolutely fine.

Howard: You were the past president of the North Carolina Association of orthodontists and we had another guest that was too david paquette you say peck at oh yeah david paquette who was his bald head would you say he's the most handsome orthodontist and all of America?

Todd: Well you know you know with bald-headed he's one of the most handsome yeah orthodontist for sure he does his head oh very well I know I know you like Dave.

Howard: He has a cool dude man he is just so darn cool, I podcast presidents of founders and CEOs of large DSOs they've all said on my show transparently well we go to certain states but we avoid other states because of legislation or laws or whatever. Do you the North Carolina Dental orthodontic Association that you and David were past presidents of do you guys think that the future needs more reining in some of these orthodontic DSOs like say smiles direct Club?

Todd: That's a tough question you know when I rolled off the orthodontic board that was three years ago and smiled Direct Club was not even I mean as far as I can tell wasn't even around. So I think it's it's to each individual state and you know I can't really comment on you know those states where there's large DSO's because I know people that are involved with individual DSO's that do great work and you know their model was actually really well so I think it just depends on the state and how that states run. For North Carolina we had  our own Dental board for a long time back in oh five when I took the Dental Board we had to take the North Carolina Dental Board since then the Dental Board which I think networked with Sita and so you can take multiple boards and become licensed in North Carolina. When I came to if you did not take the North Carolina Dental Board it was like Florida if you did not take their dental boy you couldn't take Serta or nerve or anything like that in practice and North Carolina but now it is a little bit more friendly and they do have that reciprocity rule now where if you practice I think five years in another state you can come in at North Carolina so we're definitely seen a lot more influx of people coming into the large cities like Raleigh you know where was associated with and Charlotte.

Howard: My final question I know you're a very busy man and it was such an honor that you came on the show and I know you got patients scheduled last question. She's a general dentist she's working as she wants to learn more ortho where would you advise her to learn ortho as a general dentist where can she go?

Todd: I would go on you know there's there's two different ways, so most people that are general dentist wanted to go into the clear aligner space has a lot of resources that are online tutorials. So I would I would start there because anytime you can loan in your own home it's free mainly and it's fantastic it's very convenient. The other thing I would do is tell her to get in touch with a local orthodontist in her area and just express her desire hey I want to learn an occlusion better I want to learn...

Howard: I gotta stop you remember in dental school and I remember at Creighton I had four of the greatest friends we all became dentists they were just world class personal human beings but when you go to a dance on Friday night they just sit there and they wouldn't ask anybody to dance because there are so fear of rejection and she's so afraid she's gonna drive over to your office and you're gonna say hey you wanna learn ortho so go to ortho school and slam the door in her face she's too scared to ask, talk to her.

Todd: So Invisalign I think for the fixed I would be I'd be a little cautious about these you mentioned direct mail earlier I mean I'm an orthodontist I get all these direct mailers about hey you know come to this weekend course you can learn about braces and everything like that oh by the way it's $29.99 it's $3,000 I'd be a little I'd tell her to you know proceed with caution there that's just my opinion. So I would I would search online and and just do as much as I could online I would I mean there's a wealth of knowledge out there online with these Facebook groups and just you know podcasts like these I mean there's tons of information you can learn for orthodontics it's free it's online and you know I know so that's the way I would go.

Howard: and you'd recommend going to Invisalign.comand taken their online courses?

Todd: Absolutely yeah they've got tons of tutorials and webinars and all that and all that stuff they do that for orthodontist. So they do that for orthodontists and general dentist.

Howard: Was there any question you wish I asked and I was too stupid to ask it? Did I forget any question that you're thinking I wish Howard would have asked?

Todd: I think everybody needs to have you know you know we talked about how we you know develop our practice, I think everybody out there needs to have core values I think they need to know why they're in existence. You know so what's their core values I think everybody out there should have a mission statement. I think they need to have a brand vision you know brand vision is where do they want to go you know their mission statement is the reason for existence but the brand vision is potentially where do they want their brand to go and then I think people need to have brand promise. So I just really encourage people to look into those things and then just value positions and differentiators I mean you touched on that. So I'd really encourage people to really do research on you know what makes up their internal being and really express that either practice you know people in our office they know what makes up Todd Bovenizer they know what makes up Chris Baker because we wear it outward every single day. I mean and that's how we try to operate a minute and I go back to our early treatment philosophy early treatment is great I'm not saying anything against early treatment those unilateral cross bites those under bites we treat knows every time but we're real careful with how many people are wearing braces and it's nine ten eleven years old I mean they've really got to need it that's why our phase one orthodontic rates you know five percent last year.

Howard: Do you think your purpose brand mission brand promise do you think all that all those core values come from your childhood as colonial Baptist is that where you picked that up?

Todd: No, well you know my childhood was in Virginia with my parents and very similar you know you know colonial Baptist I've been going there for thirteen years that's what meg and I landed when we came here that certainly helps shape Who I am you know today and just you know how I'm growing you know how am i growing as a father how am I growing as a husband how am i growing as a business owner. You know we can't stay stagnant but a lot of the a lot of the core values, mission statement, brand promise, it comes from my father's family independent drugstore Goodykoontz. Goodykoontz is still there.

Howard: Wow well hey I know you got patients I know you got to go I cannot tell you what an honor it was to have you on the show thank you so much and also thank you for that article you wrote for Orthotown magazine passive ligation actor results by Todd Bovenizer Orthotown magazine December 18 Thank you so much for all that you've done for dentistry for orthodontics for the North Carolina Association for Orthotown Magazine I just think you're one hell of a guy it was an honor to interview you today.

Todd: Thank you Howard, I'm a big fan and you know you mentioned earlier about the the phone I'm still I'm 44 and I'm still a computer guy so anytime I pull up orthotown I do it on the computer. So there's certain things I do on the phone but there's other things I do in a computer but I will tell you something I learned you're not trying to learn everything that I can that orthotown I've already learned something about that I should have had pre and post-treatment selfs on there. You know supplementary x-rays and after I published that and I even went through a little a person that proof read it I'm like oh my gosh you know if I ever write one of those again I learned so I'm like I'm gonna put that pre and post-treatment self a metric xray on there but you know what it was a good article could have been better absolutely next one all right will it be different absolutely.

Howard: Yeah and you know I just read a deal that reddit is like one of the fastest growing social media sites and the interesting thing about it is 98% of redditors never post and people are always afraid to post because they're a fear of public speaking they're gonna be wrong no one will love them anymore and I always thought it was the opposite every I've had a monthly column since April of 1994 and every time I say something wrong I love it because that's what I thought and then all my homies run to me and say no no and so it's when you're transparent and post you get a new editing clean up your own information act that so many people can think wrong thoughts the rest their life and never have them edited by their friends and loved ones but I know you gotta go thank you so much for coming on the show today I hope you have a rocking hot day.

Todd: Have a great day okay.

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