Doctor Chiappetti is a native of Scottsdale and received his B.A. degree from the University of Arizona in 1980.
VIDEO - DUwHF #1180 - Don Chiappetti
AUDIO - DUwHF #1180 - Don Chiappetti
He received his Doctorate of Dental Surgery from the prestigious University of Southern California in 1988 and has been committed to continuing education ever since. Dr. Chiappetti has concentrated his time and skills in learning advanced procedures and techniques in general and cosmetic dentistry. He has lectured and presented seminars on Smile Design and dental aesthetics.
Howard: It's just a huge honor of mine today to be podcast interviewing Don Chiappetti, we've been out here in the Valley of the Sun for the same three decades and I've been a big fan of his and we know so many common people. Dr. Don Chiappetti is a Scottsdale Arizona native he graduated from it with a DDS from USC in 1988 and has been in private practice sense. Don has been committed to continued education has studied and worked in many of the world's finest clinicians. He holds physicians and several professional associations he received his BA from the U of A in 1980, received as DDS from the prestigious University of Southern Cal in 1988 and now your son goes there.
Don: That's correct
Howard: and has been committed to continued education ever since he has concentrate his time and skills and learning advanced dental procedures and techniques and general and cosmetic dentistry. He has lectured and presented seminars on smile design at dental esthetics to remain leading-edge in patient care he is active members at AGD, ADA, Central Arizona Dental Society. The Scottsdale Paradise Valley study club which he just lectured at last month. Give back a smile for victims of domestic violence, Christina smiled care for Boys and Girls Club, certified in CEREC one restoration, certified Invisalign, teeth whitening. Dr. Chiappetti has successfully helped thousands of discriminating patients with their dental health including general complex restorative and a set of dental concerns. So I gotta tell you so when I got out of UMKC in 87 I did the whole demographics Arizona and I found this rocking hot place in North Scottsdale but I didn't go there because like you're a good-looking guy you could be a cosmetic dentist in Scottsdale and Paradise Valley and I thought man Kansas bumpkin and I wanted Phoenix I didn't want any of that. I remember one of the first times I went to a dental party up north Scottsdale and I asked this other guy I said which one is he he goes he's the one with this such-and-such shoes oh I am in the wrong crowd. I you know I knew Nike and Adidas I didn't know that people could recognize the name of your shoe but you've crushed it up there.
Don: Yeah I've been very blessed very grateful you know back in 30 years ago Scottsdale wasn't quite what it was is today I should say. You know back then you'd have a you go to a local watering hole there'd be a doctor and a farmer and a banker and an artist and a cowboy and a you know a native guy and everybody and now it's not like that at all. Now it's becoming a lot more discerning and discriminating as it were and I don't know if it's changed for the better but you know it's it was a really good place to live and make a living back then now it's a good place to make a living.
Howard: Well you're you're over in Scottsdale I'm in south Phoenix and it's really changed over the last 30 years.
Don: Yeah it really has where you practice I used to go dove hunting and where where I practice I'm ashamed to say but I my parents still live two blocks from where I practice you know so I haven't evolved very far in my lifetime but no I've been lucky to do real well there. My dad was a dentist there in Scottsdale he started in 1960 and at that time there was one medical and dental office in Scottsdale one and that where was a pharmacy enough a couple of physicians pediatricians and then he was the first one of the first dentists there and so now of course now there's one on every corner but so he sold that dental practice to me in 1988 I kind of thought it'd be...
Howard: Thats the year you graduated.
Don: Yeah I kind of thought it'd be father and son you know forever and he threw the keys on the desk and said send the checks here I'll see you later boy and that was the end of that.
Howard: He retired at that point?
Don: He did and about three months we practiced together was all and I asked him later so why did you do that you know I wanted to work early and he said I'll help you with cases you come over and I'll tell you about the patients I'll get I'll teach you who the patients are then I'll help you with the dentistry said but if I stick around too long we're gonna end up butting heads and so he sold it to me and then I sold it to Jonathan Coombs who I think you might know.
Don: I sold it to him in 15 I think no I'm sorry I sold to him in 2009 but I kind of stuck around and much like you I just can't let it go all the way so I'm still there treating some of the great patients that we have and some of the people that I've known for 40 and 50 years.
Howard: So how old was your dad when he sold it to you?
Howard: and so he retired at 54 and he's still a few blocks away with your mom?
Don: Yeah they both live there.
Don: He comes down in the office and steals my stamps and uses a copy machine and marvels at the Technology.
Howard: and why did you want to have an exit strategy in 2009 so I was on ten years ago?
Don: Okay that's a good question at that time I really did not like the the management aspect of it and I thought I would kind of taper off and ride into the sunset I was very blessed for have a great career so I thought now I'll be okay financially and but then when it came time to do it I said no man I don't know if I want to cut the life line all the way so I ended up selling to Jonathan and yet I stayed on as in the show at that point we kind of swapped roles.
Howard: So how many how many dentists are there then right now?
Don: There's three, Brandon Riff who now has bought the practice in 2015 I think he's gonna be on your podcast.
Howard: Yeah, he sold it he sold it to him?
Don: Yes and so both of us are still very in an associate capacity.
Howard: So why did Combs want to sell?
Don: He had some he had a lot of irons in the fire he had a couple of other businesses that were extremely time consuming and lucrative and so he decided that he was he couldn't devote all the time he needed to the Scottsdale Smile Center and so he sold but he's much like me he doesn't want to completely cut ties because he loves doing certain things. You know how you love doing certain cases you just it's exciting it's fun it's great you know if you can do one or two of those a day go home that's the way to go.
Howard: When I'm ever I thought about selling my dental office I thought okay now I'm gonna have to take a room in my house and make an oppatory.
Howard: You don't think you need a compressor or back and when you start thinking everything your going to need just like just leave it there.
Don: and that's kind of where we've what we've done and we've been blessed to be able to have a really great facility but like I said we've got patients that have been that I've known for all my entire life we've got patients that are third generation there and I'm not going to just turn my back on those people and
Howard: So what about your son do you see him entering this practice?
Don: You know I'm going to leave that up to him but the opportunity is available for him he'd be the third generation coming into that practice in Scottsdale and we'll see what he wants to do if he doesn't specialize he may come there you know and he at one point he said something about oh I'll do a GPR and I'm like no no you get out you go to every course Frank Spear ever took you're gonna study with John quois you go study with Bill Strump in Florida or some of these guys that are my mentors Ghalib Gorrell go study with these guys that'll be better than any GPR you can ever possibly do so.
Howard: You know I want to get you on the show because I'm you're in a very competitive market you've been crushing it for three decades and your dad was a dentist, your a dentist, your son's a dentist. So you know when we got here there were no dental schools.
Howard: and when you were born there is no dental schools, there's no fluoride in the water till 1989 and then the adjacent states Utah didn't have any dental schools now it's got two, Vegas Nevada didn't have any now it;s got one and now today or yesterday our governor Doug Ducey signed a bill that if you have a license in another state you don't need any red tape to come here. So how many dentists so the landscapes really changed I mean we're down here I've read reports has said that 10% of the homes sold in some years were just a Canadians. How many Canadian dentist are North and South Dakota, Iowa, Minnesota, what do you think that what do you think of the competitive environments what I'm trying to say that big long rant was you've seen it go from almost no competition to just drowning in competition.
Don: You know III think that's a good question but that I believe that the biggest threat to the individual dentist is not another dentist I believe it is a corporate mentality or these DSO's that's gonna buy up these big venture capital guys that are gonna buy up these conglomerates and then just run those dentists the mill I think that's what we need to fight against personally. I'm not afraid of competition I never went there's always room for cream always the cream at the top you know if that's what you want to do I think as a young guy you need to make up your mind this is the kind of practice that I want to have this is the kind of life I want to have. If I want to have a life that I go home at five o'clock and I travel on three trips a year and I make a $175,000 a year and if that's the kind of life you want then I think that maybe you could work for a corporation or a DSO and work for somebody else but I think that if you want to be your own boss you better position yourself early to do that in various ways. So the threat to me or the competition is not between dentists the competition is between non dentist owned corporations, that's what scares me more than the guy moving in from Iowa and I think for a dentist that's mid-career late career I think those guys moving in could be a very good adjunct to your practice because some of them that have established a practice in Iowa or Minnesota or North Dakota as you mentioned if they come to town they're not going to want to bust their hump too much they may want to they may be able to add to an existing practice a couple of days give the guys some relief. So I don't really think that I don't see that as a huge detriment to too young dentist the competition personally.
Howard: Now this is one of the dumbest mistakes ever made so and I got out of school you know I wouldn't have expended hours so I got an associate you know day one and I wasn't smart enough to get some guy who practiced 30 years and was retiring can come teach me everything I was so young and dumb at 24 I wanted homies my age life that wanted to do the same beer and drink and have fun. I just did it for the social needs and but yeah.
Don: but I'll bet it turned out that they wanted to be you after a while.
Howard: The average one say about seven years then opened up their own practice and live happily ever after but that's the next question I was gonna ask you is we each have children, does it seem like when you were USC everybody wanted to own their own dental office own their own business and today are the Millennials or there is a significant chunk of them to say I don't want to wear all those hats I just want to come in and be a doctor has that changed?
Don: You know I'm talking to my some of the students at the local schools here and talking to some of my friends are my son's friends I think that they would the majority would love to own their own practice the thing that's the variable that's changed since the time you and I were there was the huge cost you know. My son told me the other day he goes dad look at it this way, I'm getting a million dollar education for only half the cost from, oh great. So he's gonna be a basically an indentured servant for a while I mean how does this supposed to pencil out a guy coming out of schools 500 grand in debt he doesn't have a job.
Howard: You think your son will be five hundred thousand in debt?
Don: Four hundred fifty
Howard: Four hundred fifty thousand dollars in student loans?
Don: because daddy ain't payin.
Howard: Plus how much did you have to pay to bribe him into USC.
Don: That's a low hanging fruit Howard, that's a cheap shot right there yeah. No I might have been cheaper had I bribed somebody I don't know but no.
Howard: Is that school...
Don: Oh man they've taken their lumps you know.
Howard: What's your son think about all that?
Don: Oh he just shakes his head and walks the other way he's so busy in the lab working till midnight trying to make a poly acrylic resin fit of model but he doesn't doesn't know what's going on.
Howard: Humans are quite funny little creatures...
Don: That is the truth.
Howard: So but when he comes out of school though, so your dad still lives by your office and you're second generation, do demographics matter I mean could your son go into your practice despite all the increased competition or would you tell him you need to move?
Don: I believe you can I'm thinking I do and I think that if there's if the competition is a given and I don't feel it that much but I'm sure that a young guy would then I think you need to position yourself to set yourself apart some way somehow and this would be my recommendation to young guys's is determine how you want to live and how you want to practice if you want to be that $175,000 a year quit at five no responsibility guy that's one thing but if you want to be your own boss and have a fancy boutique practice and do all bonded ceramics and high-end comprehensive dentistry then I think you better set yourself apart someway somehow whether and and to me that starts with continuing education you know that's got to be the foundation the competency, you don't get there overnight. So and I think you better do something else marketing wise to set yourself apart and I'm not talking about advertising I'm talking about marketing someway somehow to set yourself apart from everybody else. I've got some mentors in dentistry I've also got some mentors in business and in business yeah I know you're a business guy got an MBA etc in business
Howard: but I went to ASu he went to U of A, I just want to say that.
Don: but we're in the same round and round where we we haven't done there's been no violence we agree to disagree on certain things but the point being that I have several mentors business mentors most of them are my patients and I asked him I said what is your you know I've got guys Bruce Holly from discount tire you know Bob Parsons from GoDaddy these are my buddies so I listen to these guys I don't listen to the guys that that advertise in the back of the dental journal say how to run your business you know I listen to the guys that have done it right. So I'm asking them what what am I gonna do to position myself or how am I gonna make myself a better business person you know and they say give people what they want get the money make it easy for people to give you money do something somebody else can't or won't think outside the given paradigm of delivery from here's the patient here's the dentistry and I see that as being the digital workflow you know I see that if I was a young guy and I wanted to position myself to be a quote high in fee-for-service only call your own shots guy, I would master the digital workflow you know from scanning to delivery and I think that that's going to be the future.
Hward: and so when you say the digital workflow is it too succinct to just say it's all digital that's what you want to do everything is digital?
Don: No I think that I think that technology is wonderful if it helps you achieve the goal. My goal and what I would recommend my son for example is how are you gonna give people what they want faster better easier not necessarily cheaper but faster better and easier. If people want something as you know there's very little that's gonna separate them from getting it. You know once people yeah how many you know 50-year old ladies want to get their smile improved a lot how many that really really want it find that the economics to be a barrier not many in my experience.
Howard: You know I'm I cringe when I say this because my dad always held up his fingers does it meet the fight for your role is a faster easier better cheaper and smaller more succinct you know the for the first steam engines were so big all could do is pump water out of flooded coal mines in England but as they got faster easier better and more smaller the shipping industry all the way down to railroads but dentists hate it when you say cheaper but I always say faster easier better cheaper and succinct that is what would technology well first of all first of all when these kids come out of school you said name of Kois who would you go to in descending order?
Don: Frank Spear
Howard: You go Speer first
Howard: and you got to do him really quick as any didn't his exit strategy any retiring next year?
Don: Probably I've heard that, we'll see.
Howard: Yeah yeah right right. Spear, Kois
Don: I like Bruce Crispin actually esthetic professionals he was one of my early mentors I love the guy helped me a lot you know Corky Wilhite and then a lot of a lot of the Europeans you know
Howard: Corky Wilhite he's in Chicago?
Don: No he's in while he was in Louisiana at LSU
Howard: but he always teaches with that cosmetic dentist in Chicago.
Don: Yeah he does he teaches up there with Direct Ressins, well Buddy Moper
Howard: Buddy Moper, yeah
Don: Yeah and then a lot of the Europeans you know Newton Fall in Curitiba and
Howard: Jason Christian yeah
Don: Christian Coachman who's a stud among studs you know all these guys Ghalib girl Turkey Barnard Tuaty in France. These guys are masters you know and when you get to be that level you can call your shots man.
Howard: Okay but this is dentistry Uncensored okay so I got a call bullshit on I'm not cuz it's not on me I know how was she's thinking she's commuting to work on and she's like dude I live in Parsons Kansas you live in Scott's now can that girl in Parsons is that I mean can she do what everything you just said in Parsons Kansas?
Don: I don't think
Howard: or if she moved us Beverly Hills or Scottsdale.
Don: No I don't think so I think that, again if someone wants something if she is available or she is able to create that value I don't think there's anything that would stand in our way.
Howard: and I actually agree because I am every time I go to Wichita Kansas where I got my mom a couple sisters cousins all stuff you know you'll I was at this small town it was so funny and we were in a town of like 2000 and he was telling me how you know you just can't do that out here and we're looking at this mexican restaurant there was a circle-k out there or a quick stop they call him out there and I said how many cars in that parking lot and there were seven trucks and 4 a more than f-150 that's 50 grand one two was a 250 and when was a Ford 3 F350 which is a hundred grand right and I said why do these guys all have money for those f-150s and you know how much a combine costs these days.
Don: Oh yeah
Howard: It's a half a million dollars and yet and yet they don't have any money to save their teeth.
Don: and I'm not talking about just about smile design either I'm talking about somebody who's you know had removable dentures for years and they can't eat right you know and you now you're able to quickly easily give them something better you know implants support in something or other I see that as a huge demand and I don't think that is that particular thing is going to be determinate just on your demographic I really don't because if people are edentualus you know you got a couple of choices you got a denture or nothing and as you know you know a lower denture with four implants works great or two implants sometimes with an over denture. Is not a great service yeah can you make that back to my digital workflow thing I think that guy that's starting out in Kansas or wherever you said if he masters the idea of explaining to people what's available without tooting his horn but just saying hey this is what we can do and make it easy scan em once implant and denture once all digital I think that's a good service for people and I think he can charge more than the guy down the street that's gonna make a conventional nineteen appointment denture.
Howard: and where do you draw the line cuz a lot of a lot of our friends in the valley start off with CEREC and now a lot of them only used that for the scanning part, we're where do you draw the line between oral scanning and chairside milling are you pro both or?
Don: I'm Pro both and I think it's like anything case selection I think that I was a doubting Thomas on the CEREC but I've been also using it for over ten years. So I've been through the learning curve I said we Mark Morin up and Michigan you know and oh my god.
Howard: but Rella Christensen went and spent a day with him in his office.
Don: I wonder how those two got along.
Howard: but anyway
Don: So the point being that I think that Sarek is great in certain situations but I think that there again and this is the bigger stroke that I'm trying to paint is that if you can use technology to meet a need for a person that is a great service I think it's wonderful but sometimes we get a little reliant on that for example someone comes in and they've broken the cusp on an upper first molar, well I can do one single visit milled ceramic restoration it's gonna fit great it's gonna be pure perfect gonna be an hour and a half it's a single visit one shot no temporary you know the whole spiel great you do it. Well have you looked at the opposing teeth now have you looked at the adjacent teeth now you know back in the in the mid late 80s 90s we were looking at quadrant dentistry full mouth dentistry at least explaining to the patient whether they want it or not you know hey you got this amalgam this crack maybe it needs to be upgraded makes some sense to do it at the same time you do the other one we were doing a lot more quadrants now I think we're doing a lot more back to single tooth dentistry and that's being forced by CEREC. Yes you can do multiple restorations and in one visit but to me that sort of defeats the purpose, to me the beauty of it is efficiency for the time. It's certainly not a time saver for the dentist at least in my opinion I've been tended a long time a pretty fast there's no way I can do a single unit faster an hour and a half I just can't I just can't now I've tried everything.
Don: If I was gonna prep it temp it and have them come back total tear time would be about 4550 minutes maybe so it's not a time saver maybe it's a little bit of a lab fee saver maybe but the real issue there I think is that are we ignoring the full-mouth are we ignoring the big picture by just going to single tooth dentistry because it's efficient.
Howard: Well you know what's funny is a role model mine in England he published a paper day says research shows dentists under diagnosed when faced with time pressure says doctor Anastacio Plazas deputies got like fifteen initials after his name academic clinical fellow in England but anyway he did this really nice study because I'm England's get a lot of DSOs and he said that the rush dentist isn't doing a complete exam and and I really credit when I came out here in 87 them Omar Reid was given this big ol course on complete dentistry and all this stuff like that and I literally did not have the money and I thought myself he seems like a nice guy I bet if I show up there and tell him I don't have the money for the class but one day I'm gonna have enough money to come back that he's gonna en oh he left I told him that he gave me the whole to I was like his son yeah the whole weekend and he was the first guy that really drilled in my head complete dentistry complete exam, how do you how do you when they get out of school they're overwhelmed at this broken tooth. How do you come out of 80 still in these dental schools and you're like looking at this broken tooth like it's gonna take everything I got to figure this out numb but I do the whole thing and then you're sitting there saying oh forget the tooth go up to 30,000 feet and look at all the whole mouth. How do you get from A to B?
Don: I think that number one you concentrate on treatment planning and I think that the philosophy behind that is treat the person not the tooth treat this is a person this is a tooth how am I gonna treat this person. Now this person may need to have this single tooth restored okay but would you agree that occlusal disease is under diagnosed would you say, I would too. So have we examined this person's bite how's that effect is it working right is it not working right are we gonna be in the other interferences that are caused fractured teeth or jaw problems or fremitus or pareo problems down the road you know I don't know I'm like oh my god I get you to do a crown I'm gonna make 1,500 bucks or am I gonna get to know this person tell me about yourself let me what's your dental experience what do you want you know are you happy with your smile do you chew comfortably what's your goals you want to keep your teeth forever fine treat the patient give them what they want. That's why I think to answer your question in a long way treatment planning is critical know the person and new pen that starts with a new patient exam to me and this goes along lines of what Omer was talking about and Pankey's talked about for years and Dawson's talked about for years is treating the big picture and that to me in my office can only happen with a real thorough extensive new patient exam. So I am the opposite of I got a coupon in the mail I get a checkup and bitewing x-rays and a cleaning four hundred bucks I'm the opposite of that I personally I spend an hour and a half with every new patient because I want to get to know that patient and I think that's benefited me because when it's time to present ideal treatment people care. People are pretty smart if they if they feel like they're getting a rush job and a sell job they're they're not gonna like that you know and if they know that you care truly and that you're not out for the buck only I think they're gonna do it you tell them after you establish this trust. So I think the new patient exam to answer your question of how is this new kid gonna treat this to spend enough time to know the person do a real comprehensive new patient exam and then prioritize you know say hey yeah you got this broken tooth I understand it needs to be treated and we're happy to do that for you I also want to look at the big picture so that we can you know save you money later save your time later save your comfort later you know however you're gonna present that in a way that the stresses the benefits of what you're going to do.
Howard: Do you remember Perry Radcliffe?
Don: Of course he practice right next door to me I'll tell you some stories about Perry.
Howard: I want to hear because as the competition change our colleagues into being perceived as adversaries because when you talk about learning full mouth dentistry your talking about spear ace all these great Institute's that cost money and you have to fly to go back when I was a baby when you get over your head you'd call Perry not only would he tell you to come over then he'd take you out to dinner and buy you dinner and drinks till midnight and you could just call up your periodontist, I mean the way the fastest easiest way to learn treatment planning is to have a buddy whos a periodontist up the street or someone. Do you see that changing that atmosphere of collegial relationship is changing?
Don: Yeah I have to say I think that's an excellent point there's two issues in there, one is the idea of this collegial relationship and like we were talking about earlier you know back in the old days we'd have an open house at somebody's office and you know sit around have a have a beer a sandwich and talk about hey I'm not the only one you wouldn't believe what I saw today this patient and how do you do that and this staff and all the challenges that we face as dentists and business owners it's nice to know you're not in it alone it's nice to be able to commiserate with your buddies and we used to have more of a collegial atmosphere and now it's become into this oo I don't want to talk to that guy because he might steal my patient. I think that's wrong I think we need to embrace our profession it shouldn't be me against Dr. so-and-so two blocks down it should be me and Dr. so-and-so against them. You know whatever it is that interferes with the the doctor-patient relationship insurance companies come to mind, it should be us against them not us against us. So that's the one part of the question and then the other part you were asking me about was Perry yeah I agree with you the comprehensive care when I first came to town like my first or second day practicing you know wide-eyed and terrified Perry calls me over at whoa he calls me over his office and he says come over here I want you to look at this dark dark field phase-contrast microscope, so I go over there and he said you know here we see you know some heinous inner fills some base fills these are these are periodontal pathogens you know he was treatment periodontal disease like an infection 30 years ago and he was branded a heretic in this town you know he was like all that that's Perry he's crazy he doesn't you know do gum surgery you know he treats it like it and of course now that's that's the science that we that we know to be true but anyway so I'm young guy and I'm looking at this microscope going I got a patient over there that I'm trying to get numb I got to do an MOD onlay on this tooth and I and Perry said do you want to be a dentist or doctor do you want to be a tooth carpenter if you want to be a tooth carpenter go back and fix that tooth if you want to be a doctor stick here and learn about immunology and he gave me a book on immunology I'm like holy crap I'm trying to find out what kind of composite resins gonna stick to a tooth and he wants me to learn about immunology but as time has gone on the point and he sent me a ton of patients because I spent the time to learn about immunology, periodontal disease as a disease and not necessarily a you know surgery template so.
Howard: and now his son is running their mouth wash company.
Don: Yeah and and I don't know him very well I still use that that product by the way is it is a disinfectant. Remember back in the day we used to use tubulicid and Glen with some of the disinfectants I use that client dioxide I think it's great yeah as a disinfectant cavity preparation disinfectant.
Howard: So what percent you know if you just graduating dental school and your son's gonna have 400 and that's what they have at AT Still and Midwestern all this stuff and if he came out and say he wanted to do some Invisalign, what percent of the orthodontist in town here we'd say yeah come on by bring you know I'll help you work these out I'll help you with your Invisalign cases or what half would think in fear and scarcity and saying you shouldn't be doing should be sending it to me?
Don: Probably half I'd say
Don: I'd say so yeah I think that I think the ones that are confident in their abilities and and understand the team approach to dentistry would would benefit if they knew if he was in my practice and he knew my practice they would bend over backwards to teach me Invisalign because they want me to refer all the other ortho cases you know and we have got some phenomenal specialists in this town in this country it's dumb not to use it I mean I work with some great oral surgeons I know you do to some great periodontist Easy Perio down there at Randy Fitzgerald's down there in Ahwatukee great periodontist. You know why would I mess around with a difficult implant when these guys can do it with their eyes closed and patient benefits. So same thing with the Invisalign yeah I might be able to do a tough case but I'm gonna I'm gonna defer that to the orthodontist every time just because I'm not the best at it. Remember I said whatever comes between me and the patient I get kind of resentful and that maybe my own limitations so whatever's best for that patient that's where they're gonna go if it's oral surgery then they're gonna go to the top oral surgeon and I know we differ a little bit on this I know you do a lot of surgeries and stuff yourself but for me and it's just my level of ability I'm not as skilled at putting in a maxillary implant on an immediate extraction, so I'm gonna send them to a periodontist. So back to your question of how many orthodontists are gonna help but young kid I think that if there again if we have a collegial approach and the dentist says to the orthodontist help you with the Invisalign and I will send you my ortho cases it would be dumb of that orthodontist not to help them.
Howard: I just have a thing with them wisdom teeth is it's a weird love affair my assistant with me 30 years a wisdom tooth can't hang on for 60 seconds with me last Friday I pulled three sets of wisdom teeth in and I'm not talking with the numbing time I'm talking about after their numb...
Don: Just with local are you sedate them?
Howard: They're all local I think two had nitrous but when I actually go in there to remove them I always had a timer but it I haven't got over five minutes and years and years years they're just there's nothing that little wisdom tooth can do so that's a different love affair but...
Don: Hey if you like it that's another story.
Howard: and my staff actually doesn't even like wisdom teeth because I'm across the street from Guadalupe and when they fail the finance deal I still dod it and their like their going to tell everyone else or they need four out but they can only pay for one I do all four. It's like I can't pass up.
Don: You know what let me talk about that for a second you know Matt Porter he's a
Don: Yeah Matt Porter talked to our study club about a year ago and he said that the and he values a lot of practices I think it's safe to say he's pretty much an expert in evaluation of practices and he said that the practices that he evaluates that consistently have the highest value do the most charitable, think there's a correlation I do.
Howard: because you're not thinking in fear and scarcity you're thinking I hope growth abundance.
Don: and abundance
Howard: Yeah so when you're when you see that periodontist up the street and you know the first periodontist I fell in love with he probably doesn't want me to say this on this deal that I fell in love with him, Ralph Wilson.
Don: Love Ralph yeah
Howard: That guy wasn't afraid to tell anybody what he thought you know and he was I just loved his intellectual annihilation of researcher but he was my go-to guy for decades every time I got a perio question or a thought he just sends him and five minutes later he give you.
Don: It's a little disconcerting that Ralph knows the literature off the top of his head about that question cuz I've done the same thing Ralph what are the studies there statistics show about this and he'll quote you chapter inverse and it'll be correct and it's like oh man.
Howard: Yeah I mean he just he just yeah I mean and that's what you're saying he started earlier that when you're when you're a guy that's just totally into it you're totally intense and you want to be the best there's always room for the crane to float to the top no matter where you are. Now if you're gonna be average or burned-out or not like it or have a bad attitude or you don't you know like people you might have your work cut out for you. What I also liked about them about your presentation and your talk is your you have so much self-esteem that you talk about mistakes you've made in your career what talking podcasters are mostly Millennials what mistakes did you make in your dental career that she could learn from listening to you instead of having to stick their tongue in the same light socket?
Don: Yeah that's a question that there's there's no there's no doubt that it's nice to look at your beautiful successful cases and gloat and say isn't this great but the times that I've learned the most are the ones that were failures or certainly less than than ideal. Towards that end I'll preface it with with photography to me is critical in dentistry I think it's essential I think it's imperative I think it's an absolute necessity for two reasons, certainly to document what you're doing and then towards that end to educate people the patience but from a personal perspective how are you gonna know quantitatively if your works better now than it was 20 years ago how do you know this well maybe it lasts longer maybe you don't see stuff coming back but if you photograph everything and you compare over all your cases whether it's a single tooth or a quadrant or a a pareo surge or an Invisalign or something compare it to the results that you got 20 years ago to today am I getting better if I'm not I'm not gonna wallow in mediocrity I'm not gonna you know I don't want to do that I want to continue to improve till the day I die. So that's the first thing is photography and measure it but going back to the mistakes I've learned a lot from failures and when you start putting your work up on the wall blowing it up and looking at every little thing you go without that's just not gonna cut it you know that margins not great or or that I lost that papilla because I didn't plan for you know two implants together or whatever but in broad strokes the mistakes I've made have probably been case selection you know if I if you get red flags and stomach lining gets a little turned up when you're about to treat this case and something doesn't seem right listen to that and I haven't a few times when I've gotten burned as a result. So that's one it's probably case selection the other one is probably I have been a little too quick to try to make people happy repeatedly I've made a few mistakes in that regard I think that sometimes you got to remember the patient is the one with the disease and if there's a problem that I can't make right saying somebody has a crown it hurts you know and so you say well or it's got an open contact of course I'm gonna replace it so replace it and still hurts this isn't right. I've probably been a little too quick to bend over backwards too long I've held on to too long rather than saying you know what here's your money back or you know what it's perfect go down the road, so that's a mistake that I've made a few times is trying to think that well this patient had a problem with dr. XYZ but I can fix it you know I that's been a mistake. So red flags pay attention you know patients with hyphenated last names those kind of things no I'm just kidding.
Howard: I'm not kidding
Don: You know what I mean.
Don: Yes so that's been a mistake, probably listening a little too much to manufacturers and not enough to dentists.
Howard: How many times have we got burned from manufacturers.
Don: Artglass, Target Vectorious
Howard: He's saying it not me, Dicore.
Don: Yeah Dicor
Howard: My first cosmetic dentistry course was Dicore and cementing with Durelon.
Howard: Guess how many of them fractures and I had to replace...
Don: Me too
Howard: Do you think the manufacturers have gotten any better or is it the same as at worse?
Don: No I think they've gotten a little more sophisticated at hiding it I mean they're out to sell product.
Howard: It's like Facebook you know when you get on Facebook or Twitter or whatever and you're and you don't pay any money you're the product and these dental manufacturers they said they're anything I don't want to pay twenty dental schools from here to Sweden to do this long-term study we're just gonna market the hell out of it and the people who jump on the bleeding edge will know within a year or two if it works and man when you're fit I'll be 57 this year my god I'm I want to see what all the young kids do and then I want to hear about it on dentaltown two three years later yeah with the bleeding edge I oh my god.
Don: So that's been a mistake that I made and you know what's worse than then the manufacturers that are doing that is the dentists that are prostituting themselves for that product and then the next year they're doing it for something else and the next year they're doing it for something else and the next year you know what I mean oh the Flexi post is the greatest thing in the world I'm the spokesperson...
Howard: and then their lecturing at the Arizona Dental Society and oh I have no conflicts of interest really go a Google search ha ha freakin Google oh yeah what do you know they should be dressed up as NASCAR players.
Don: Basically wear a sponsorship jacket and call it like it is I agree with you on that you know so that's why...
Howard: What percent of the lecture circuit should be wearing a NASCAR jacket?
Don: Oh Lord I don't know
Howard: Just to piss off everyone
Don: Probably 15 percent maybe
Howard: 15 thats all you'd say?
Don: Yeah that's all you you think it's more I don't know I'm to leary to say but...
Howard: but one of the easy tips you can do in the lecture is okay he's mentioned nine products and they're all from the same company if that if that isn't a red flag I mean you know
Don: That's one of the things I did like about...
Howard: but it is funny about how this guy was for all these products then I guess switch sponsor now he's all these products.
Don: and you're like if you've been around a while ago wait a minute five years ago weren't you touting XYZ well yeah but that was you know you don't ever hear about that anymore.
Howard: Yeah and that's a difference in dental town and Facebook because in Facebook if I follow you and I call your you just delete it and block me dentaltown isn't isn't Facebook.
Don: and that's why the only thing we had before dentaltown was CRA was Gordon and Rella you know and to his credit he was tried really hard to be impartial and that was a long time ago and I and I used to listen to his stuff and believe it because it was the only thing I knew that was relatively unbiased you know.
Don: I don't know if it still is I haven't looked at it but I don't even know if he's still.
Howard: He's amazing god he's amazing, we lecture together in Pennsylvania was on his 80th birthday.
Don: Unbelievable, he's got a lot of energy.
Howard: and I think that was like five years ago and his older brother still crushed in the banking industry oh my god the good clean Mormon Utah living.
Don: Yeah oh that clean living and pure thinking paid off for him I guess.
Howard: So you you said something very profound that gets missed over all the time is how important photography is you always hear these kids saying should they buy a CBCT or should they buy a CAD CAM or a CEREC machine it's like my gosh humans look with their eyes and these dentists that was Steve Hays who turned me on to digital photography back in 88 in Scottsdale near you and and today I noticed you know when people talk about marketing and talking about direct mail or social media or Google AdWords but that guy who doesn't do any of that but his website is just filled with photo documented cases of how a patient would want to see it not how you'd want to say and and those are the ones where patients are getting on airplanes and flying in two three four hours. Imagine if you are a self-conscious older woman with dentures and you want to get implants you want to get very very emotional and you think your dentist up the streets little dokey hokey-pokey good old boy whatever but you're looking for that amazing work and then they find out well I live in Wichita, Kansas this guy's in Dallas well that's a it's a one-hour flight on Southwest Airlines I'm going there. So dental photography is just it's just a must.
Don: It is and you know we have different series for different reasons but a new patient examination in my opinion is not complete without extra oral and intramural photography and a lot of times when you take pictures of quadrants of amalgams composites whatever natural teeth and you put it up on a big screen you don't have to say a word you know I don't know what who told me I think Jim pride if you remember Pride in Jim Pride he was one of my mentors originally but easy he was big on that and he said just put a picture up there and then don't say a word it's hard for you guys like you and me but sit on your hands for 30 seconds and the patient will go what's that, what's that, what's that.
Howard: and you know what him why I use so is listen Jim Pride I think I saw that so many times he made a team five times as much money from his vineyard in California.
Don: Oh yeah beautiful place.
Howard: It's like that that guy was the last dentist in California.
Don: Just like you Howard.
Howard: No no not true but he was a man and but then that was the most fun of his lecture when you're done going to the vineyard and drinking the grapes all night.
Don: I remember I was like five years in practice maybe so early 90s mid nineties and I saw him lecture and I said I'm gonna go take his workshop and I'm gonna take my entire team and at the time I think it cost me like $20,000 which was just huge I mean it's still a lot of money but back then it was like oh this is just crazy that would have been like a house I would had to wait buying a house and I took my whole team up there and my dad said you're insane that's crazy this is the dumbest thing you've ever done I recommend against it you're gonna spend $20,000 to go to a dumb management course then everybody's gonna forget in a week but I will tell you that that next year my practice revenues increased by over $100,000 and some of the systems that we learned then we are still in place to this very day.
Howard: and they just the Pride Institute just got rolled in it was just purchased by wasn't it just purchased by Spear?
Don: Oh I don't know maybe the and but there again that's another thing you know a lot of that pride Institute was Jim Pride and when he tried to bring in the younger guys or the younger people I think it lost a little bit of its Flair same with Omar's practice same with God let's see Gordon Christensen you know when the younger guys come and they it's a tough act to follow.
Don: It's hard to replace that dynamic seaman leadership so.
Howard: Yeah Spear Education buys the Pride Institute that was that was September of 2018 this is April so you know about eight months ago.
Don: Wonder what they paid for it.
Howard: Did you go to the Spear Institute?
Don: Oh yeah
Howard: Some distance near you?
Don: Absolutely yeah
Howard: Frank spear empty is manji practice management oh my gosh
Don: Yeah smart guys
Howard: Tarun Agarwal and
Don: Samir Pari
Howard: Samir Pari oh my god
Don: Smart guys yeah
Howard: You know what Samir taught me the most not so much the chair sight milling but what I would I fell in love with cuz well it's kind of funny I have a love-hate relationship with CEREC because I bought the CEREC 1 oh my god I mean my temporaries were better and then when they came out here I 2 I tried that again so then the CEREC 3 came out you know so I had been on the whole time well it wasn't till CEREC 3 had an update um what was it Bluetooth or whatever.
Don: The red cam.
Howard: Yeah I already had 20 years of sticking my tongue in this CEREC light because I wanted it to work but the thing that really got me with it it was not using it for the chair side milling but wood first time I saw my prep 40 times bigger on the screen I wanted to just turn in my dental license and was hoping oh my gosh and I always think the fastest way to increase quality is magnification and the alot dentists oh oh tell me something I don't know okay well your hygienist isn't wearing your assistants not wearing them and then you want to know why your hygienist is missing tartar and your assistant didn't clean the temporary so everybody with wet hands magnification all my favorite endodontist in town all have a microscope and they're only using it a 8X.
Howard: and when and I really like oral scanning just because um you're a monkey and you have limitations you can only see 50 microns right so to get that prep 20 30 40 times larger on a screen I have never looked at the initial scan and didn't have to go in there and do something.
Don: I agree.
Howard: You know I mean just like you're doing it out of embarrassment. So what oral scanner do you like?
Don: You know I have to say but I'm not super well-versed on the intraoral scanners I have used several including Trios and that's probably the one I've used the most the I have not used the new CEREC scanner that's brand new that's out there it's only been out a couple of months I think. So I'm not real well-versed in that so I don't really have an opinion yet, I've tried two or three and we don't own one right now.
Howard: Well are you doing clear aligners?
Don: Yes yes
Howard: and so Invisalign is owned by Align technology they own Itero they're trying to get everyone to use the iTero.
Don: Of course so they'll accept all of them except for the 3Shape
Don: 3Shape yeah
Howard: and that's a wild thing but
Don: Wouldn't it be nice if people could somehow scan their mouths at home and then send you this file.
Howard: And then send it to you the file.
Don: My partners working on some of that stuff right now.
Howard: Seriously a home scanner.
Don: Who knows.
Howard:That would be interesting. So I'm gonna tell you why I wouldn't want to be you.
Don: Why you wouldn't want to be me?
Howard: Yeah it's a fair deal and that is you know my patients in Phoenix there I mean you know almost every root canal that I ever did that failed and had to be extracted back in the day the old man say you know I told you to pull it the first time you're the one who wanted to save it then I give his money back whatever but it seems like those Scottsdale people patient selection those are some more intensive I would not want to practice where you are and so what advice do you give I mean you've got to know that the expectations of a Scottsdale clientele are 10x of what you'd find in Chandler Phoenix or Glendale or Peoria, does it you know what would you tell your son stay away from these crazies or you like them or how do you deal with them?
Don: Boy that's a good one I don't know any different first of all because I've always been in that environment but like I said there's no doubt that the procedures are getting more difficult and certainly the patients are getting more difficult there's no doubt about that. So I would just say that that no I don't treat them any different than I treat anyone else you know no matter where they're from or what their socio-economic level is but I would just say to manage the expectations you know make sure my competency is there manage people's expectations spend a lot of time talking to them in advance documentation informed consent those kind of things but at the end of the day you know if someone is if someone is demanding but reasonable I'm good with that if someone is demanding and unreasonable that's where I got problems you know. I've had patients that had a 3x5 card that put them under their under their incisal edges and trace the it size little edges with a pencil and fold it in half and said look it doesn't match perfectly you know that kind of a thing then I think it's just a matter of managing expectations and then and having the confidence to say look this is perfect you don't think so here's the name of three other cosmetic guys in town or three other great dentists and in the state and I've sent patients out of state for evaluation that weren't thrilled with whatever it was and saying it's great it's perfect you know that's what it is. So now the problem there is that I've never done a case that I was a hundred percent over the moon about I could always find something that I would pick apart this and that you know and so then that's where the little doubt creeps in like could I have done it better is this peak is this reasonable to remake this case. So it's a tough call it's a tough call but as far as the demanding patients if you don't keep them waiting you charge full fee you've managed expectations you're honest and you do good work I don't think it's I have not really had that much of a problem any more than I my other colleagues that don't have that kind of practice.
Howard: You know I'm the United States is a big country you and I when we got a school we watched the first round of these DSO start in America I got a New York Stock Exchange dozen on the NASDAQ they all emploaded now you got a second round coming in Wall Street won't touch him with a ten-foot pole I mean it's it's what it's society what does this say when snapchat and Pinterest can go public and Lift but not a place that does dentistry I mean you know the country needs dentists it doesn't need snapchat or Instagram or any things like that. So Wall Street knows you can't manage dentist I mean they they totally know that but where I think DSOs are learning is a lot of dentists they find out when they own their own place they gotta wear a lot of hats to me I think the first ten years of my career just getting my FAGD, MAGD, diplomat just trying to learn I was a cook in the kitchen I was just trying to learn how to cook but these DSOs come and they provide HR advertising accounting Vance you're a very suave businessman how did it how did you learn business and how does this kid coming out of school learn business so that they can where I had an HR, finance, accounting, advertising, all these things that have nothing to do with whether you're a cook or a cosmetic dentist?
Don: Yeah that like I told you before that's a that's a tough one because I you're your business training in dental schools probably about the same as mine which was basically none. I was lucky that that my dad was a good businessman and he retired at age 54 made some good investments so and so that was my first mentor then I have asked successful business people that are patients and friends you know how what do you do how do you do it and it's fairly simple. You know I know you talk about money people in time and and Parsons for example talks to me about giving people what you want monitor it measure it you know he's got some business principles Bruce Holly's got some business principles that he's taught me and it's all pretty simple it's all like do good work treat people well be honest pay it forward do those kind of things you know greed will take you down fear will take you down fraud will take you down sex will take you down drugs will take you down you could have a divorce we'll take you down right, am I liying? Those are the things that are gonna whack you in that you know yeah so avoid those things don't take stock tips you know.
Howard: Actually I got a really great advice on stock tips because we I mean you know when you get my age it's like you don't really know why something might work you might not know everything about it but you recognize patterns. I think I've done anything in my life just very nice patterns and in the 31 years or 32 years I've been a dentist whenever brokers started calling me and trying to get me to buy specific stocks it always crashed after that I mean. So basically what it meant is all the smart money won't touch this so this guy has been told by his broker to unload a hundred thousand shares and so they just start dialing dentists and physicians and that was that's probably one of the biggest market top calls I've seen in the for crashes.
Don: Let me tell you this story about that I had this fancy three-piece suit stockbroker you know when I had two nickels finally after about ten years yes well I gotta have stocks you know you gotta have stocks and bonds I didn't know anything about it but I knew that yet so I get this fancy guy down on 24th and Camelback you know the big high-rise building he's got the three-piece suit drives Ferrari you know he's got everything. So I got this guy's must be wicked smart so he sells me Nortel industries Don I got this heart hot thing Nortel industries it's the greatest thing you're gonna make a ton of money so I scrape up my nickels and I give him ten grand or something and one day I was going down to his office to ask him why Nortel Industries was trickling down to nothing and I got off on the wrong floor and the whole floor I see a sign it said Nortel industries and there was nothing there but desks and wires saying you know the thing they vanished in the middle of the night and that guy had done just what he said they told him unload these shares in there that's what he did.
Howard: Oh man.
Don: So don't take a stop cap the other thing about business it's not very complicated debt is the enemy, the previous generations they didn't have any debt.
Howard: Yeah I think I think that
Don: Now it's almost the norm it's almost accepted that you have debt who says you have to have a mortgage you know who says you have to have a car payment.
Howard: and then they're there and seen as soon as their car is paid off they go get a five-year loan on a bigger newer one.
Don: Yeah it turns out that if you do that you're not paying more over the long run do you know that.
Howard: Yeah so when you are with them you will really give back a smile for victims of domestic violence Christina Smile care for boys and girls clubs and talk about this because when you mention Bob Parsons and everybody knows him as the founder of Go Daddy I see him as the major funder for Chris Volchok's homeless shelter for dental homeless shelter for...
Howard: Bright Way and I go down there...
Don: and you know he's got a HIV clinic too you know he's got a victims of domestic violence clinic you know he's got a free-standing health clinic you know he's got a children's dental clinic.
Howard: You talking about Bob Parsons?
Don: Yeah he don't talk about that.
Howard: Yeah he's an amazing so what's so weird is why are you involved in Bob Parsons where does that come from?
Don: We're just friends.
Howard: No I mean where does it come from in your journey to want to give money to an HIV homeless swelter dental.
Don: I want to give money time or everything I can because I have learned like if you start dentistry is one thing but life is something else and if you I have some personal philosophies that I have strayed away from and found to be the truth one of which is like I have a purpose. You know I asked my son what is your purpose what why are you here what are you doing what you do you know it took me till I was 25 28 years old to learn what my purpose was and everybody has a different purpose but for me one of the highest purposes is to be a maximum service period. So every day if I set out and say what can I do to be of service abundance will happen if I set out and say am i meeting my monthly numbers and am I gonna do X amount of crowns today am I gonna make this much money then I might get there but that victory is gonna be hollow or it's gonna get taken away or it's gonna get lost or something bad's gonna happen and I just know this. So that intention of being of service I have to focus because my natural reaction is to be selfish you know my natural natural reaction is to be greedy my natural reaction is to be fearful but if I can set out everyday to be of service in some way shape or form good things happen and that's just that's a fact like gravity in my life.
Howard: You know I'm in some things you can measure like Bob Ibsen was a dentist in California he started Denmat.
Don: Oh yeah great guy.
Howard: California wanted dental materials but was interesting.
Don: USC guy by the way.
Howard: USC guy and you know he came out with Rembrandt he made them anyway long story short he sold like two hundred and fifty million dollars to Procter and Gamble and then out of nowhere that was swallowed up by Gillette probably have 40% you know he had more money than anything and I'm sitting out there at his house with my four kids he has his own 18 hole golf course and talking to him guess what he did when he finally sold everything and had you know hundreds of millions of dollars after taxes he his lawyers told him he can't do dentistry so he built a dental office and he said what my purpose is and I'm his cosmetic dentistry and so he loved domestic violence and he thought that was a good purpose and so here's the guy with two hundred and fifty million dollars he's 80 years old what does he do Monday through Friday 8:00 to 5:00 rebuilds cosmetic cases on women whose lover knocked their damn teeth out.
Howard: and I told Bob I said you know you got a 18 old golf course and I said when's the last time you played on it and Marcy says he never played on it. So you think you want to be a billionaire and have a yacht in a golf course and here's the Bob...
Don: Then what...
Howard: and here's Bob with an 18 hole golf course Marcy said he's never played on it and he's doing volunteer dentistry because after the purpose.
Don: Yeah here's the thing so you know AZ mom yeah mission of mercy there's on a mission of mercy this is such a great thing the Christina smile thing through the Boys and Girls Club which was a mobile dental clinic that came around associated with the Senior PGA Tour I have a soft spot for Boys and Girls Clubs but and so we did that but now that is no more and so we kind of transfer our efforts to this AZ mom which is just awesome where they convert the Colosseum to big huge dental clinic and there's you know I think we served over 2,000 patients in three days this year it's just phenomenal thing no money doctor, patient. People are lined up for in the morning around the Coliseum to come in and get their dental care don't tell me that people don't want to get their teeth fixed people want to get their teeth fixed if you can separate the money or the other bullshit that stands in the way from that that's a greater good. So anyway so I go down there Arizona mission of mercy man your blood and guts combat dentistry doing it doing it doing it yeah and I'm driving home and I talked to my wife on the phone she goes man you sound like you're in a great mood she says how come you go down there once a year and you do free dentistry for three days and you're happier now and you come home from your fancy Paradise Valley practice and you're like kicking the dog and throwing shit. You know it's like I think there's a lesson there somewhere. So you know Ibsen he's doing some good stuff now he's sleeping itself sheets too ain't nothing wrong with that but I don't think that this I bet you his intent and his purpose was there before the silk sheets I'll bet ya.
Don: because I know several several guys of that caliber wealth and almost always they've got something a little bit deeper in their heart and there's a point where peace of mind serenity family love those kind of things are more important than money there's a point you know.
Howard: So I can't believe we went well over an hour over is an hour and we're five minutes past that. Graduation advice to dental student says we're at April next month six thousand kids are gonna get their doctor degree in dentistry and they're gonna join our profession what advice would you give them?
Don: Be proud be honest do good work stand behind your work you know didn't stand behind their work they might as well be a lawyer and pay it forward you know be charitable that's my advice you know keep your nose to the grindstone don't think that anybody owes you something but if you're willing to work hard study hard and improve yourself I think the sky's the limit. I think dentistry is a phenomenal profession and talk to the physicians you're not gonna hear that you know I asked all your buddies I'm sure you have that all your buddies that are physicians would you send your kid to medical school and they're always like I don't know you know it's a tough gig, I got a friend he's a cardiac cardiac surgeon he does a heart valve replacement he gets 2,500 bucks after it's all said and done that's ridiculous that's obscene. So advice dentistry is a great profession be proud you know the collegial compliment other good dentistry continuing education, there's some world-class phenomenal educators out there who are not just in it to toot their own horn seek him out study with him and then yeah like I said be charitable.