Dentistry Uncensored with Howard Farran

How to perform dentistry faster, easier, higher in quality and lower in cost. Subscribe to the podcast: https://podcasts.apple.com/us/podcast/dentistry-uncensored-with-howard-farran/id916907356

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Howard: It was just a huge honor to be podcast interviewing James W Gabhart ii DMD

James: Thank you Howard.

Howard: Here at the Kentucky Dental Association he is proud to provide superior dental services and a pleasant atmosphere to families throughout Hardin County an undergraduate of University of Kentucky and a graduate of the University of Louisville School of Dentistry. Dr. Gabhart has lived in Elizabethtown for more than 20 years he and his wife Kimber have three children Kyle, Kaylie, Garrett and Jessica. He is a leader in his profession and community serving professional organizations teaching dental dental hygiene Dental Assisting to students and area colleges and volunteering his time to a number of community organizations. He is also a part-time farmer and in his spare time he enjoys cooking, gardening and spending time with his family. My gosh so how's dentistry doing for you?

James: It's great

Howard: and what year did you graduate?

James: 94 this is our 25th anniversary this weekend.

Howard: Nice 25th you said?

James: Yes we're having our reunion tomorrow night.

Howard: Where at your dental office?

James: No we're doing it here at the downtown angels Indy, they do the different reunion classes.

Howard: Oh you mean the reunion for your dental school class.

James: Yes, 25 years.

Howard: This is awesome because most the people listen to podcasts are Millennials a quarter of them are still in school they love hearing from people who have done this you know 25 years how is dentistry changed in the 25 years?

James: Well I guess the big thing is corporate coming in and more businesses combining and then more specialization I would say as far as you know general dentists coming out don't do everything like I guess we had we had more we did more full service that we the biggest differences.

Howard: and what advice would you give to the young kids coming out of school, do you think they'll you do you think that when you and I got an 87 what year did you get out?

James: 94

Howard: Okay do you think we were in the golden years

James: Yeah

Howard: That was easier yes those coming out today?

James: Yeah but I still think it's I still think it's one of the best professions to be in we're still the most trusted income-wise we're one of the best out there still in the top three so I mean it's a great profession I think that they just get scared you know they just need a little more experience confidence and I would say get with good people in your area older dentists to mentor you and if you're not getting that for somebody find somebody can do it for you and if you get with those people they'll share and that's what you need.

Howard: but there they seem to be afraid to walk across a street and knock on the door because they think you're gonna think well I'm competing with you because I'm in the same town you are in a small town?

James: Small town yeah

Howard: How far are you?

James: 45 miles from here

Howard: 45 miles, are you on the river?

James: No central part state just directly down.

Howard: So what's the population?

James: Population the county's about 90,000, city's about close to 30 for the joining cities around us we draw from about a ninety thousand.

Howard: So what would you see her she's just afraid to go meet the dentist?

James: I think a lot of young people do yeah they come out and you know they think they got to go it alone and you can actually go to different offices and sometimes you'll get feedback sometimes you want but a lot of the older dentists really want you know to have young ones come in and meet them go to lunch talk about practice and help them out I've seen a lot earlier that have retired and basically they just walk away from their practice too because there was not anybody coming out that wanted to get a small single person practice they were afraid or...

Howard: Yeah and they're walking away from all the time on dentaltown, they put their practice up for sale they're in a town of 2000 they were doing a million dollars a year taking home bank and after two years just close the doors and walk away happens all the time so a small town is an illiquid as a liquid especially since the Millennials want to live in Nashville not smaller cities.

James: So what do you think's gonna let me ask you this, what do you think is gonna happen in the next ten years as far as the you know private practice in the younger group coming out the new graduating classes what's gonna happen with them what do you see happening ten years from now?

Howard: Well the one thing I see is I'm you know the young you know my first big move was to uh you know become a dentist you know right right the sovereign wave of Dentistry and then the next big thing I saw was the the internet moving 94 to 2000 and we started dentaltown and now I think the next big thing is absolutely artificial intelligence with cloud computing the Internet of Things America just had its first driverless semi truck picked up a load on i-10 in Los Angeles and driving i-10 goes all the way to San Francisco yeah the alternative is the sale two weeks south pay a hundred thousand across the Panama Canal and come back up and those that driverless car autonomy is gonna do probably get rid of twenty five thousand truck drivers a month for years and I see dentistry as it's all hands on, like Amazon's destroyed everything that you can sell in a box like all the stores retail stores if you're just selling a dress or shoes or something gonna box there they're gone and what's left well you need a human to cook the food cut your hair. Dentistry is all surgery, medicine 90% of Medicine and can even be threatened by AI your pills your tasks in fact AI in medicine does a much better job than a physician they're they're error-free and I think dentistry is hands-on surgery artificial intelligence isn't gonna replace you, you will have a high income job I mean dentistry I think has some of the greatest future prospects.

James: Yeah I do too, let me ask you something else I saw you speak in Vegas it's been years ago at TDSC and you were talking about GPs placing implants and the analogy you gave was taking the square peg and putting the square hole the round peg put the round hole come on guys you got to do this I started in implants and in abundant bone it's not that difficult just like you said so I learned early on doing it that way now the kids come out of school I feel like they're a little bit of a disadvantage because they're told you have to have so much technology you have to have a cone beam you have to have a guided delivery system you have to do surgical you know what I mean placement in it so somebody brand-new if they've never done it if they have this expectation heck I spend how much money to be able to do the implants well I'm not going to do it.

Howard: Well the good and a couple of things like that be when you go around the world you know dentistry is a very homogenous organization around the world they have the same issues in Tokyo Paris London in Louisville and the only fees not touched by insurance the interest on fees is orthodontics and implants, so when you go to Tokyo and Paris and London where the government only pays you 100 dollars for a molar root canal they don't do molar endo they just pull them and do an implant and so a lot of user their insurance base population if they can convert one person a week to clear aligners ortho or one implant a week they're making Bank and if you look at all the legends in implant dentistry Carl Misch all of them their first five to ten thousand implants are placed on a pano and if you're a great if you're a surgeon now and if you don't want to get into blood and guts and you want to place the implant without any blood and you think you're gonna take a CBCT make a surgical guide and have a robot come in and and all that kind of stuff that it's not gonna work then they either need to be a surgeon you're going to need to lay a flap and yeah you can you can place an implant without all of this super fancy sophisticated stuff it's the people selling the machines that are gonna make you believe that it's standard of care when I guarantee you there's not a lawyer that can even come on this show never really didn't explain what standard of care is it's such a subjective thing but are you placing implants?

James: Yeah

Howard: and are you liking it?

James: You led me to it.

Howard: Oh awesome

James: I love it

Howard: So share your journey what implant are you placing?

James: Right now BioHorizons is what I'm using the most.

Howard: Out of Alabama?

James: yep I went to the AIE Institute the investment and did their part of their survey

Howard: The AIE? Where is it at?

James: Alabama it's in Bessemer Alabama it's the one that's there associated bio horizons I should know this I'm drawing a blank.

Howard: So it's called the bio horizon or what is it would you say BAE BA implant?

James: Let me look it up here, Bessemer Alabama I'm drawing a blank right now you got me under pressure man.

Howard: Let's see how good google is Alabama implant Sergey Brin Larry Page you guys are still doing Oh McCracken implant oh absolutely I should have known that one. So you went to his Institute?

James: Yep

Howard: and how did that go?

James: Wonderful they put you in do the training treatment planning and then you get into the surgeries and you get the surgical experience unbelievable.

Howard: and he's got a DDS and a PhD the guy's an intense dude.

James: Yeah I mean you should have him on your show.

Howard: Well I have asked him to be on the show Michael you're here you hear your own students yeah tell him well he's I'm sure he's busier than a one-armed paper hanger but I'm so you went down there and and tell us about it's the Alabama implant education and when did you go down there I mean weekend's was it?

James: Well we did the we do didactic course first ended up three days I think was in Cincinnati and they went down there for a three days surgical and when your doing the surgical basically let you say I'd had most of them are brand new and hadn't placing the implants I have been placing implants before that and I've gotten with Toni Thick at a Lexington who does osteo ready which now is I think a little implant company and that's how I got started.

Howard: Yeah

Howard: and that was a weekend course that gave me experience and got me to actually starting to placing to begin with and then when I got down there basically I said I want to do you know sinus lifts immediate posterior implants.

Howard: Wow so you want to be so you can tell them what you want to do.

Howard: So are you using a CBCT now?

James: No I'm certain I'm shopping now.

Howard: Yeah so what did doctor McCracken say about...

James: They all said the same thing is basically you know you can practice without them but boy it's nice to have them so.

Howard: So their saying it's a luxury item.

James: No I think it helps you clinically for sure.

Howard: I mean for a simpler time I mean the end of the day you have to make Carl Misch place 5000 implants.

James: Right and if you got a bone to bone you know it's like putting a nail in a 2x4.

Howard: Right right so are you so what are you trying to do them all are you...

James: Just try to take care of my patients, we got more into some full arch stuff we're replacing you know in extractions PRP prf grafts on top of that multiple implants immediate denture then have them come back and once the implants are healed doing a implant retained but I'm doing removable not fixed.

Howard: but you're probably old enough to remember the subperiosteal the Ramos frames I mean my gosh they've come a long way are you doing, who is the most likely to get an implant is today someone has all their teeth that lost a first molar is it someone edenturlous, someone who gets dentures on two?

James: Ours in a general our practices generally somebody comes in breaks a tooth off that's maybe endodontically restored for years there's no tooth structure left do an immediate or molar tooth that fails same situation for whatever reason large restoration caries fractured root take it out let it heal place it so mine are more single.

Howard: It's more single tooth.

James: It seems to be

Howard: and those are those are easier cases than subperiosteal or Ramos frame or any of those deals. One thing I've noticed in the insurance data is the number of aplecollectomies has just gone just plummeted almost nothing so it looks like the market of restoring a failed endo has massively gone towards implants. What would you say to a young kid who's kind of scared they're like yeah they got $284,000 two loans they wish they could do that I've broken to place the implant but they're just scared.

James: Do it like you said tell show do, go watch one get done.

Howard: Yeah

James: See it happen ask questions treatment plan one and do it.

Howard: Yeah that's why I think Carl Misch was so helpful for me I was I was squirmish and afraid and and then I'd walk down to him and the weirdest thing I remember Carl Misch is I mean he'd lay a flap from you know corner to corner and half the time he was looking at me like one of those drivers like stairs the road y-you know I remember telling so many people over the years you know I'm not gonna talk to you if you have to look at me while you're driving and Carl be sit their talk was like I felt like I went to Vietnam and then came back home and now I have a BB gun you know go target practice and so you get so exposed that it numbs your fear away. So how are you doing to implant a week I mean how about...

James: When we need them I mean I don't its holes or anything it's like somebody walks in and needs a full arch case we talked about it and we got a price set from bundling that includes everything and then if they're with it they do it if they're not we can make a traditional denture, its all in what the patient wants.

Howard: and what are you most passionate about today what's get you exciting about dentistry today?

James: New stuff I just started Invisalign that I've never done so that's been new for me so I'm learning you know looking at my clenched X and stuff how to actually do ortho well that's kind of new and so it's basically try to do something new every couple of years we brought in the implants were brought in sedation we brought in Invisalign I got doing more complicated I'll say root canal posterior so that was kind of away from for a while so it's just getting interesting.

Howard: So where did you go for the root canal training?

James: I went to a course that was with the pro taper diamond gold or something.

Howard: Tulsa Dental?

James: Tulsa dental of course somewhere and got the new one of their new systems not the reciprocating the one before that is the one I use.

Howard: So you know who started Tulsa Dental, was Ben Johnson and Tulsa Oklahoma and he sent us some the oldest video of a root canal ever done it's over a hundred years old have you seen that?

James: No

Howard: Oh my god and it is just go to dentaltown and type in oldest or even YouTube just going to YouTube on the dentaltown but it's amazing how things really haven't changed a hundred years I mean we're still about rubber dam cleaning shaping. So you're doing sedation?

James: Yeah

Howard: Where did you get training for that?

James: The docs the docs course and that's a also Toby Feck is big into that Lexington and they do it I guess nationally we're state to state it's different regulation wise and they teach you I think what is going to be an efficient but more importantly a safe way to do it a safe way to do it. I've seen you know numbers on some of the kids who have issues and I don't treat any children at all sedation wise but a lot of times it's you know toxicity from anesthesia these cases and it's just simple it's like you got to know baby weight three-year-old light five-year-old weight and how much can they have and don't go past it and I think sometimes what will happen as a kid gets in there to get sedated unfortunately and they're giving too much and they're trying to do too much at once.

Howard: Yeah Arizona a dentist just lost a child because they were doing four quads, the hygienist went in and numb the patient he did not know that so he went in and numb four quadrants again but the other thing that stood out in that case is that you know every time you go to a physician the first thing they do is they weigh you take your height your blood pressure and in dentistry what percent of dentists do you think weigh their patients are or get their height and take your blood pressure for sedation?

James: It's not very high for sure.

Howard: I now and that's that or even we gotta think that would be a practice builder I mean that you're going to is if someone's talking to their wife and they said yeah I thought I saw a floatie alright don't feel right well you're getting a cleaning next week that I always take your blood pressure when you go in there good and did you think it'd be a practice builder if you do what they always do?

James: Sure

Howard: and it's always just the assistant I mean they sit down they put an automatic cuff they put up I mean it doesn't take them very long but then that but so you're not afraid of the IV sedation?

James: We're doing oral IV and I'm probably trying to decide if I want to get into that at all so that oral know I mean I got the reversal drugs I had a background in respiratory so I'm familiar with Airways and we've got all the emergency equipment AEDs that's another thing when we got our AED it's like thinking how many practices don't have an AED and you look at the risk factors of like cardiac issues and things when you're getting some of these drugs to patients and there's a normal person as the population out there that's at risk and then it really increases that some of the procedures we do like simple as an AED how hard is it to get your team to use it, a lot of practices still don't have them in their office.

Howard: Yeah and do you have one in yours?

James: Yeah and it's great.

Howard: and how much money was it?

James: The AED probably $300 or something not much.

Howard: Not much

James: They save one person's life how much is it worth

Howard: Yeah

James: Right

Howard: Well depends what if it was your father-in-law

James: He is someone I would save he's a good man, he is a good man.

Howard: Alright so what advice would you have for these are Millennials coming out of school they got $284,000 in loans?

James: Don't worry don't worry so much you're gonna be fine.

Howard: Yeah

James: If they got good worth work ethic meaning they're willing to work a week two days or three days and don't get too financially unstable right off they're gonna pay their loans off they'll be fine.

Howard: The neatest thread I've read on dentaltown in a long time was uh if you know what you know now when you graduated dental school what would you do differently if you if you knew what you knew now when you walked out of dental school what would you have done differently?

James: In my timeframe or now?

Howard: In your in your time frame so when you graduated dental school knowing what you know now and looking back at what you did what would you have done differently?

James: I would have done a lot of stuff the same I think I think the only thing different I went into a group practice and I stayed in it for 13 years I maybe would have gone on my own sooner but then again I got a lot of experience from them so I mean I would it maybe I would have done in AGD or some surgical training right after school of course you know that would be something else get more training after we got out immediately you know.

Howard: So you were 13 years in a group practice and now what?

James: Solo for 12

Howard: So yeah Wow 13 in group with four people 4

James: 3 people

Howard: Okay so for half of your career with three group and now half solo what are the pros and cons in which one do you like better?

James: I like the solo better now but I'm really my daughter actually graduates this year she's a senior so I'm gonna become a group practice next year again.

Howard: She's going to come join dad?

James: Yeah

Howard: What an honor.

James: That was one of the cool things about my graduation year 1994 my daughter was born that's gonna end up coming back and practicing the same year I graduated.

Howard: Wow I mentored my four boys now they're all successful drug dealers all around the world. So thats going to be a great feeling so what do you think about that?

James: I love it I mean cuz I'm at a point that you know it's really the volumes there but my body doesn't need as much the pace that the pace that I'm running.

Howard: Yeah

James: So I'm looking forward to having you know, it all has its pros and cons.

Howard: So little this is Dentistry Uncensored so we'll ask the tough questions, lawyers always recommend when you get married ever prenup and then dentists don't do it, they recommended thinking of a partnership you need to have in writing and but when it's family members a little girls never gonna go say dad I need a prenup I'm daddy's girl, Are you gonna have a written contract?

Howard: Yeah I love my children and I've told them all said here's what happens you all will get 1/3 of whatever this is there's three of you so when she comes in because we had the Thanksgiving talk and we're all Thanksgiving that's not like hey you're coming in you're getting the practice it's she has to buy into the practice and I try to do it structure to where it will be good for her, it'll be good for me but especially be good for her but in another five or ten years when she's ready to bring somebody else in and I'm going to slow down a little more hopefully the same contract will still work so it'll be good for her.

Howard: and who did you get to write this contract?

James: I'm doing it right now.

Howard: but did you get someone who only does dental contracts?

James: I'm in the process its she's coming in next May or June you know in the summer so that's what I'm doing right now I'm going to different companies and seeing what they offer.

Howard: Because I've noticed that there's so many nuances in dentistry that when people get someone that only do dentistry that really good advice but if they should then say well my neighbor is the best lawyer in town and lawyer so it's someone..

James: They will be with dental

Howard: I'm so proud of you that you got a lawyer in between you and your daughter to get this right now because I can't think of that most Prince died without a will Lisa Franklin died without a will.

James: Right

Howard: Some of the smartest most successful people out there they there everything ends up in probated and so if when you're going in with family it's especially important to have a contract with an exit strategy because you don't want to walk away from something over business and then lose your mom and dad relationship. Does it scare you or your wife having a child working for you?

James: She was the one kid that growing up though she was always at the office if I had to go up for an emergency on the weekend come on let's go she would come up there at 5 or 8 10 up through middle school high school take her you know come up and do suction in and clean the room up and we're done I take her and get her McDonald's Happy Meal or something

Howard: Wow

James: She's been around it for a long time.

Howard: Well thanks so much for coming by and being on the show.

James: Thank you

Howard: How's the Kentucky Dental meeting going for you?

James: It good it looks like it's a little bit bigger this year so I like to see that thing hey and keep doing what you're doing, I appreciate it because things that you said to me when was that in TDSC you've got a good memory?

Howard: That was the Maddow brothers.

James: Yep

Howard: I spoke I'm the number one speaker yeah I think I spoke at nine or 10 of their meetings basically every year which is a fun cuz I live in Phoenix, it's a fun little drive I always took my four boys I just I love the Maddow brothers that's a great show but...

James: I remember a lot of stuff you said from back the it still rings true thank you very much.