Dentistry Uncensored with Howard Farran
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1301 Dr. Lynn Hurst on the Teledentistry Impact on Orthodontics : Dentistry Uncensored

1301 Dr. Lynn Hurst on the Teledentistry Impact on Orthodontics : Dentistry Uncensored

11/27/2019 6:00:00 AM   |   Comments: 0   |   Views: 125
Dr. Lynn Hurst was born in Corpus Christi, Texas (1957), the middle of 3 children, to Reverend Chester Clive Hurst, Jr. and Dorothy Mae Owens Hurst. Dr. Hurst graduated from A.C. Jones High School (Beeville, Texas), in 1975 and Southwestern University (Georgetown, Texas), in 1979, with a Bachelor of Arts (BA) major degree in Biology and minor degree in Chemistry and was a research assistant for 1 year at The University of Texas Southwestern Medical Center in Dallas. In 1984, Dr. Hurst received his Doctor of Dental Surgery (DDS) with Honors (Omicron Kappa Upsilon) from the University of Texas Health Science Center at San Antonio, Dental School. In 1986, Dr. Hurst simultaneously earned his Specialty Certificate in Orthodontics and Dentofacial Orthopedics from the University of Oklahoma Health Sciences Center, College of Dentistry and Master of Science (MS) degree in Orthodontics from the University of Oklahoma Health Sciences Center, Graduate College. In 2017, Dr. Hurst co-founded Candid, as Chief Dental Officer, to help usher in the first orthodontist directed teledentistry/teleorthodontics healthcare dental service organization, with a mission to provide accessible, affordable, quality and safe oral healthcare to everyone who desires a beautiful and healthy smile.


VIDEO - DUwHF #1301 - Lynn Hurst



AUDIO - DUwHF #1301 - Lynn Hurst


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Howard: It's just a huge honor for me today to be podcast interviewing orthodontist Lynn Hurst, who was born in Corpus Christi in 1957 the middle of three children to Reverend Chester Clive Hurst and Dorothy Mae Hurst. He graduated from A.C. Jones high school in Beeville Texas where four out of five of my grandchildren live and 1975 and Southwestern a university Georgetown Texas and 79 with a BA in biology minor in chemistry. In 1984 he received his doctorate dental surgery with honors on I'm on the Kron Kappa Absalon you can know I didn't get it because I can't even pronounce it from the University of Texas Health Science Center San Antonio in 86 he received a specialty certificate in orthodontics and dental facial peaks from the University of Oklahoma Health Science Center. So I wonder if he's a Texas football fan or Oklahoma upon completion of his education in 86 he entered private practice in San Antonio where Scott Lune practices right. So where he practice orthodontics out for 20 years after one year in practice he joined the faculty of the University of Texas HealthScience Center in San Antonio and has involved in orthodontic education and research ever since. Dr. Hurst completed phase 3 a board certification in orthodontics and achieving the status of a diplomat of the American Board of orthodontics in 2003 was one of only 30 orthodontist to be recertified as a diplomat. I mean his resume goes on forever and ever and ever and on 2007 he accepted the position as professor and founding dean for the College of Dental Medicine at Roseman University that's in Salt Lake City right?

Lynn: Salt Lake City and a campus in Henderson Nevada.

Howard: In 2008 the College of Dental Medicine began the inaugural postdoctoral dental program advanced education orthodontics and dental facial orthopedics Masters of Business Administration residency program an innovative and first doctoral level program to combine dental specialty training with an MBA degree in 2011 the College of Dental Medicine launched the predoctoral dental program initiated under dr. Hurst leadership. In 2010 dr. Hurst returned to Texas to be closer to he says his family that I'm sure it's my grandchildren and founded Texas orthodontics in January 2016 Dr. Hurst and Texas orthodontics implemented its proprietary innovative integrative clear aligner system ranging from digital orthodontic records to comprehensive diagnosis and treatment planning to by engineering Dental digital treatment to monitoring treatment compliance and progress to measuring treatment outcomes and into into post treatment retention positioning Texas orthodontics as the first exclusively clear aligner orthodontic practice transitioning from analog orthodontic braces to digital orthodontics clear aligners. Teledentistry tele orthodontics is the next frontier in dental medicine and 2017 Dr. Hurst co-founded candid candid you know like being straightforward straight teeth candid as chief dental officer to help usher in the first orthodontist directed tella dentistry teller orthodontics health care dental services organization with the mission to provide accessible affordable quality and safe oral healthcare to everyone who desires a beautiful healthy smile. Dr. Hurst's early research interest was in biomaterials currently his interest is in practice-based research networks and clinical trials and he has several peer-reviewed publications. Dr. Hurst is a member of numerous professional organizations the list is too long to read. In his spare time he enjoys automobiles footballs movies off-road motorcycle on and on I wanted to get you on the show so bad I'm the biggest anything new is the most controversy I mean you know how humans want everything the same how they'd be driving Fred Flintstone car if they could still have it but my gosh orthodontics is it's it's one of the most changing professions you saw smiles direct Club do an IPO and that went over like a lead balloon in church there's lawsuits everywhere let's just start there, what did you and in my lifetime I gotta start there when I let you around the world my gosh once you tell someone you're a dentist the first question on their mouth is Invisalign and it's like when I started lecturing around the world in my in the early 90s the big brands were Colgate crass and Listerine and all that stuff and then Invisalign comes out of nowhere takes complete mindshare if you go to Vietnam or you go anywhere on earth and say you're a dentist that the waitress says you do invisalign and then the smiles direct Club the teledentistry thing I don't know where to start but let's start with the smiles direct Club IPO because you're a founder of candid that very well may likely could do an IPO someday I mean I don't know I'm but what did you think of smiles direct Club?

Lynn: Well candid in many ways is really an offshoot of the small direct club a concept in my own practice in 2015 late 2015-2016 I moved completely to clear aligners and the reason was I needed to find out how far can we go with this tool as an orthodontist so when you take the crutch of braces away you find out really quick what kind of training wheels you need and what it's going to take for you to be able to treat every case with clear aligners. So when I started that journey it was bumpy I was actually doing it with Invisalign what I learned during that time is that I learned what the weaknesses were of align technology or the Invisalign product in my opinion they we you know they push a lot of things that make that are proprietary to them attachments they ask dentists and orthodontists to do a lot of IPR I'm not a big fan of either one of those. So anyway I through that journey then you know smile direct club came along and in I was interested in having an orthodontist only version of that because as a specialist I and as an academic individual I think that there are certain people who have the proper training to do certain procedures. You know in school there were two things I didn't like well I didn't like blood for one that's the reason I went into dental medicine and turned out that there was blood in dental medicine so that created a problem for me endodontic treatment was was not something that got my attention extraction of third molars didn't get my attention I did a hated periodontal surgery it was way too bloody and when you know when it came to growth and development that seemed to be something that stimulated my mind so going you know again going back to smile direct Club candid is really and is intended to be let the specialist deal with a challenging space of tella  telemedicine teledentistry and we've got a great a great core of orthodontist that that work with with with our patients and you know and it's in it's been it's been a fun journey I always like stepping out and doing things a little bit different than had been done in the past. What I have found out is that in order to really address and I learned this in academics to address the access issue access to care you can't keep doing things the same way and expect access to care to follow it's not gonna happen so you have to change models about how you provide care well you know what we were what we were looking at doing it all of the universities have been involved in is creating opportunities back into the community so that we can build networks of professional colleagues to help us brainstorm and figure out ways to do this. Candid is just one of those things where we use it you're using modern technology to to really open up this access to care issue in and we know in the brick-and-mortar stores what all the fixed costs are and if you maintain that model you're at some point you're limited as to where you can bring your price point down so you have to change you have to kind of turn that upside down and that's what that's what we're doing.

Howard: So what year did you get out of ortho school?

Lynn: I got out I completed my residency in 1986.

Howard: Okay so 1986 you're an orthodontist and it was not even about ten years it was 97 when Zia Christi started Align technology and now isn't all those patents kind of expiring isn't that?

Lynn: Yes

Howard: The majority of his patents are expiring if that's what's opening up this because you see a plethora of all these clear liner companies is that because was Zia the the guy that actually invented it was he?

Lynn: Zia was a graduate student at Stanford not had nothing to do with dentistry and and he he and you know one of his colleagues they started thinking about you know some innovations and they you know they came up with this idea of getting impressions and getting these models and you know we we as dentists were kind of doing it you know old school way I remember my students and even when I was in my residency we'd get a model and then we'd have to we'd have to section all the teeth out like what we were doing you know we were gonna do a dye for a crown or something and then we would move them around and use wax to fill up man he he just took he just took the technology there was a veil at that time and built it into it kind of a digital format and you know it's it's it's sad but a lot of times some of the innovations in our profession come from people who do have a different lens on and they just see things that we kind of get buried in in the weeds because we as oral healthcare providers we're very detail oriented people and sometimes we have to you know we have to force ourselves to back up a little bit and look at the big picture you know and I find myself having to do that often.

Howard: Wow and and it's also not only do people make all these innovations from that weren't even from orthodontics or dentists but then they're also immigrants he was from Pakistan and it's just amazing when you look at all these IEPOS in Silicon Valley it's gonna like when the Boston when Boston one day the the Stanley Cup it was so interesting that not one of their players was even born in the United States it's always like when everybody Americans always tell you that America which the moon yeah with a bunch of stolen scientists from Germany after World War two I'm pretty sure that the people who got us to the moon not one of them spoke English they were all german-speaking physicists but yeah American went to the band Boston won the Stanley Cup but so would you say Zia started the genre of clear aligners for starting clear aligners?

Lynn: He's the original founder of align technology which is the company behind Invisalign so yeah he's that he's you know our history books are going to show that not Edward Hartley angle or Pierre Phil shard what you know were the great innovators of clear liners it was it was someone that wasn't even a dentist that will go down in the history books now since since that particular time you know in my profession of dental medicine is a whole really kind of rejected this upfront myself I mean I started treating patients with it and it was horrible and it was horrible because I was horrible the technology was horrible and we were you know we were still trying to implement the exact same you know movement techniques that we used with bands and brackets when because when you take a bracket it's away from the tooth and then you put a wire in it you have to apply couples and in a bunch of other different forces in order to move the root the way you want to that's the way we were trained. Well it actually you have to kind of unwind that and when you put clear plastic over a tooth you your tooth now becomes the bracket and so you got to think of the tooth is the bracket and you now apply forces to that tooth that you need to do in order to move it around so in some ways it's easier but it's you just have to kind of rethink the process and clear aligners quite frankly I don't think were of a significant penetration in the market or to general dentist or to orthodontists up until the intraoral scanner came along in about ten to twenty eleven twelve in that area when we got to where we could get a digital scan of the teeth we then started getting aligners that fit much better and that's kind of where things have taken off. Going back to your previous question the eleven of the foundational patents for align technology expired and these were kind of again they were they were the building block from all of their other patents that has opened up a floodgate of opportunities and you know there's a good reason our country has this kind of a 17-year head start window for someone to develop some technology because there's a lot of research and development that goes into that but what you know align technology took this very aggressive or pro in me and they just went after anyone who came into their territory and you know and I my my personal opinion there's gonna be a price to pay for that and not just in the market but from the from the dentist who were kind of under that thumb in creativity was kind of sign me there for that window of time. So right now there's a plethora of things going on that are just you know all over the place every major company in dentistry is coming up with their version of this Candid is like in summary is is really a tell identity DSO and we're we're doing the exact same things that I did in my office we're just doing them in a telemedicine teledensity manner or they can come into one of our studios in the studio is very similar to an office experience.

Howard: So in summary of smiles direct club they tried to bypass a doctor there do you think that was their biggest mistake is that they like because when you look at Invisalign I mean they they court or sit on us I mean the big relationship with orthodontist, would you say that with smiles drugs biggest problem was that they tried to bypass the orthodontist and go around them?

Lynn: You know I I can't get into their mind and I don't know enough about them to be very intellectually critical but you know they have taken a little bit of an adversarial approach to the dental profession and I can tell you Candid is a hundred and eighty degrees away from that.

Howard: It's so insane I mean health care is 17 percent of the u.s. economy that means seventeen cents of every dollar it's the most health care is the biggest most entrench its regulated from 50 states 50 different state boards and that guy strategy was to start attacking and suing dentists and dental boards I mean you'd have to be dilute I mean you're not gonna see me go to the Phoenix Zoo and say let me in the cage with those lions I'll show them who's boss around here I mean to go I mean it was just crazy I don't know how or maybe have me wrong but I just wouldn't have attacked seventeen percent of the u.s. economy unless I really had to but so what if someone said well what's the difference in candid and smiles direct clubbed or Invisalign what would be if I was mr. wonderful on Shark Tank isn't that filmed in Dallas?

Lynn: Yes

Howard: So pretend were in Dallas and I'm gonna be the beautiful mr. bald wonderful from Canada he would say what is unique about first thing he's gonna want is do you have any IPO protection you just said that all izya stuff so mr. wonderful is gonna want, so make me make mr. wonderful happy right now.

Lynn: Well one thing you're better-looking than he is but I will still do my best to try to make that happen Candid initially was again a orthodontists rebuttal to what we feel in my specialty is we you know we've kind of so sometimes we feel like maybe a stepchild in that we've we've kind of been pushed out of you know pretty much all that we do and in history is gonna say that there's some probably some good reasons with why we have we've done that however as an orthodontist who is used to working with my colleagues because that's what we do, we work hand in hand with our general dental colleagues we work with other specialists everyday all day long in our practice. So you know for us to come into this face and want to punch everybody in the face that's just not that's not in our DNA, our DNA is to be part of the team and back when you and I were in dental school it was we were always taught that the general dentist is the quarterback of the team and you know the endodontist and the periodontist and the orthodontist and the oral surgeon and the pediatric dentist and the prosthodontist, everyone has a role to play in providing great care so the first thing I would say is that I wanted to choose my colleagues who are specialists and let's let's approach tella dentistry and do just what we do in our practices using the tools and the technology of teledentistry back that's really what we did. For example when whether it's a patient at home or a patient who comes into our studio the first thing we do is a notice of privacy practices we develop that doctor-patient relationship and we get a thorough medical dental history and a beginning of the informed consent that so that they understand what relationship they're getting into we all agree that that's the standard of care. The next thing we'll do is that we will get a an eight series photo individual photos that end up in a collage and it's what we as orthodontists call the American Board of orthodontics so when we go show cases or we go and sit before the board for certification it's a it's a standardized format three extra oral photos in five intraoral photos that we will present that we present to our orthodontists so that for them to be able to diagnose and treatment plan if they're at home they'll get a PBS and press and in what what one of the things I'm very proud of we now can get photos from patients through the technologies that we have that will rival what you can get in your private practice and I'm going to tell you it wasn't easy but with a lot of hard work and a lot of smart people we figured out how to get those photos and I'll put our records up against anyone. The next step is at home is the PBS impression okay now getting a PBS a good PV full-mouth PBS impression in an office is a challenge another thing I'm proud of is the ability through our training tools in you know through a lot of hard work by a lot of people in not me just a bunch of people and through trials and tests and studies we figured out how to get a really good PBS impression from our patients who don't have access to an office or to a studio. Okay in the studio it's simple but you know we get the photos by trained people we get the intraoral scans and that you know those come great the next thing we're rolling out right now is getting digital x-rays in the studio here in Austin where I live we have an x-ray machine so we're operationalizing that we think that that while there are some cases that it may not require having an x-ray we want our patients to always have that option in treatment and but it's so anyway so we go through and we we do all those things that information is put together it's sent to the orthodontist and the orthodontist at that point can make a decision of go or no-go basically in treatment, is the patient someone that we can treat in our space or is it someone who has to be referred back to a general dentist and second has to be maybe might need to be referred to an orthodontist because of the severity of the malocclusion doesn't fit in our model and I said when I say model would be very careful here our current pricing model it's not that we can't treat them it's that we can't treat them at the price point that because we only have one price point right now. So that's what we do.

Howard: What do you mean there's a lot of kids listening in dental school what do you mean you have one price point?

Lynn: We only have we it's 1900 bucks okay it's and so nineteen hundred bucks when you look at it are in our business model when you take the cost of the aligners the cost of marketing all those things and you put everything together just like you would in your office there's only so many sets of aligners that we can use right now in that price in that model of nineteen hundred dollars. Now I from the beginning just like I did in practice I always had different price points for my patients I would have kind of the basic care and then I would have kind of the middle package because you call it the bronze silver and gold package for treatment I think that that's always important to give the patient those options at this point we only have the bronze package again I don't run the company I encourage as an orthodontist and its chief dental officer that we provide more robust choices for our patients but that's not what we're at right now okay. So when that information is sent to the orthodontist they make a decision about can we treat them or not treat them right now I can tell you that our numbers that are right at the 25% one of them every for people who come to us we have to send them back for dental care or we have to send them refer them to an orthodontist because it's something that we're we're not at the point that we can treat them. So that's I mean that's what we do and then after that we go through the process of getting the the 3d STL file converted into segmented and we then design the treatment and that treatment then is reviewed by our orthodontist again with the other diagnostic records and then we make a decision about you know do we need to revise that treatment plan or is that treatment plan good. Once we've approved the treatment plan it goes back to the patient and the patient has a chance to review that and make a decision is is it going to give them the outcome that they are looking for and as we know we know being dentist that the first thing what question we always ask is what's the chief complaint so if the patient comes in and they say I have TMD problems or whether they always call it TMJ I have TMJ ok well that's probably not going to be a patient that I'm gonna want to step into because we know that that is such a multifactorial area you know the diagnosis and the treatment plan it's all over the place it may not have anything to do with orthodontics so as an orthodontist I'm not comfortable treating those patients just because I may open up a can of worms that there's something else going on that I that I may not want to get into. Okay in my practice I had no problems dealing with that because those patients require a lot of one-on-one communication. So anyway we use that and we if the patient approach treatment we manufacture the aligners and we sit you know and then we send them to them we have a day one check in with them we're now moving into technologies where I can actually get a visual scan of my patients teeth and how they're tracking in the aligners every 10 days so I actually can see my patients more in teledentistry than I did in my own private practice. So it's there's there's there's just so many opportunities out there for us to provide affordable accessible high quality in safe care to to patients that are just a little bit out of the traditional model.

Howard: So basically they do so would you say that like smiles direct Club and crystal braces or more Do It Yourself DIY do-it-yourself dental offices that really you're trying to loop in the orthodontist I mean is that would that be the clear differentiator?

Lynn: Yeah again I have to be cautious about speaking for other companies because I don't know really where that is I'm not internal with them all I know is that for us yes it is orthodontist doctor directed its orthodontist directed personalized care throughout the journey of treatment many of our patients will get you know is is I don't know if you practice with if you do any clear line of treatment but if you do oftentimes you don't get it in the first set of a liner so you have to go back for a refinement and do additional treatment we as orthodontists know that that's going to happen and we provide that care to our patients. Now we do ask them to be just like I did in practice if I give a patient a simple case clamp your aligners and they don't wear them as prescribed I'm probably not going to get the outcome that either one of us want.

Howard: and they're any more or less compliance between boys and girls I mean I I just can't understand I I can't imagine that the average boy in high school in Texas would wear his clear aligners when he's been wearing the same Texas A&M; shirt for three days in a row, do you have any more combines for all the boys or girls or not really?

Lynn: The only compliance problem I have with teenage boys is not that they don't wear them it's that they don't take them out to clean them because once they put it in there like so thankful that they don't have braces on their like if they ever take them out that this you know this gift from up above or wherever is going to disappear and it's there's a big there's a big chasm between parents in the understanding of their children particularly the males if the males want it for some reason they will do anything if they don't want it, it just happens that most of my male adolescent patients they actually want the clear aligners if they don't want them what you said is a hundred percent true it's going to be it's going to be a train wreck.

Howard: So how do you, it's so tough on the one hand you want innovation you want everything to go faster easier higher-quality smart I mean there's this whole country's miss America there's something there's something in the secret sauce about American entrepreneurism I mean really it's the largest economy well how do you draw the line with the orthodontist who like dentist they're not they don't like change how you're a board-certified orthodontist in Texas which isn't a liberal state I mean that is a very conservative State when I go down there to Beeville I mean shout out to Tim Rainey and all those guys in there but how did this go over with a bunch of redneck conservative orthodontist in Texas I mean are you all right do you have any wounds you can show me or?

Lynn: You know what I have I have a bodyguard and I wear a flak jacket so I'm in and I'm in a special witness protection program.

Howard: Are you in there with Scott Loon?

Lynn: Yeah we have the same bodyguard but no it's not my colleagues when I first started approaching them about this they're like Dr. Hurst we thought you were crazy and you're officially crazy so but again as you talk through the taboos and the norms and they understand really what we're gonna do okay we're not do we're not doing quackery in and we're not we're not about trying to do something that's not already proven that it can work I mean there's there's still 80% of my orthodontic colleagues who don't even think clear aligners work so for them it's a very tough conversation for the orthodontist who have treated a lot of patients with clear liners and understand the pitfalls and the child and the workarounds in how you design the case then it starts to make sense but you know as we in the world of dentistry particularly in orthodontics I'll take my last 10 cases that I've treated in anybody who's listening you bring your last ten cases and you know what and let's just put it on the table and let's see who can do it I don't care if you do it with braces or do it with clear aligners. So it's a comparison I always look at is Michael Jordan and I can both be handed the same basketball the things that he can do with that basketball are intimidating to what I could do with that basketball it's the same basketball, so what I like to think of it's not the basketball it's not the clear aligner it's the doctor it's the knowledge it's the wisdom it's the experience behind the scenes that makes someone an expert or excellent what they do doesn't necessarily make them any smarter it just makes them the expert. I in 2019 can do pretty much anything with clear aligners that I could ever do with brackets and bands in traditional orthodontic ok and that's I'm not saying that to brag I'm just saying I put in the energy in the effort to figure it out and it's not easy but it's possible and if you tell me it's not possible and you've never done it or you've only done a hundred or a thousand of them then that doesn't really have much weight to me because it takes a lot of mistakes to get it right and we as dentists know that because that's why my mom god bless her I got rest her soul up until she passed away she kept asking me in Beeville Texas every time I would visit her, son you've been in this profession for a long time what they say you're still practicing? It was a good question okay because that's what we do all the time we practice every day we learn something that we didn't know the day before so that we can get a little bit better the next day so I think we all just need to keep practicing and every day we're gonna get a little bit better.

Howard: You know we started off talking and about Zia who started this clear aligner deal and you've been saying that you the patients that are so glad they're not all branded up there was another organist back in the 50s Dr. Crabencure invented invisible braces in Beverly Hills by going with lingual braces is lingual braces still a thing or is that really not a thing? I mean the few times I run into it the issue was their tongue would play with it until their tongue was hamburger is lingual you know they don't want people to see they're there they're there their braces is lingual braces still thing?

Lynn: There is still there are still several societies most of the lingual orthodontics is going on in Europe or in outside of the United States quite frankly and maybe that's because clear aligners have not penetrated the market in the same way as it has here in the US but my experience you know I'm a young orthodontist I get out Vince Kelly who was one of the first 3M guys who was involved in the in the lingual orthodontics was one of my instructors at Oklahoma and I was like okay well you know what I'm gonna do this well first of all I wasn't a very good orthodontist with brackets on the facial of the teeth so I'm not so sure what I thought I was going to be great about putting them on the inside of the mouth and then I realized why I had become an orthodontist because you're upside down working upside down in their mouth trying to put these brackets and put a wire in there it was very difficult I abandoned it in favor of clear brackets which was problematic in and of itself and the reason was though the patient complained if you put lingual on the upper and lower many patients can tolerate the lingual on the upper but when you consume tongues face on the lower it got really ugly and so I would have patients ever just like you know what you got to take these off so for a season I did lingual on the upper in in in facial brackets or buccal brackets on the traditional brackets on the lower but then there's a small segment of the population who is still doing that but I mean it's even it's in the hundreds it's just not very many people particularly with clear aligners around.

Howard: Yeah so there's so many if someone asked you well what is the unique selling proposition I mean I don't know how many there are but I mean there's a there's Candid, smiles direct clubs, stamp, cracked, smile of crystal braces from home dental easy smile dental lab directs in Texas they're in Dallas or earthly what do you say what would you say that mr. wonderful who said what is your unique selling proposition then this other long list?

Lynn: Well it's a it's a commitment to a quality outcome in whatever that takes so in in my private practice in San Antonio something that my parents always taught me my dad in particular he was like son whatever you choose to do just do one thing and be the best at it okay well I don't know if I'm the best at it but I've always tried to follow that that mo in so in whatever I've done in private practice I always wanted to have the nicest office I always wanted to have the best team around me because we in practice know that that's ultimately our success in and and or our failures can come from there and then I want it to be high-tech so I wanted to use I wanted to use technology I remember when I started my practice in San Antonio I had an IBM XT and it had 64 K RAM, 64 K Ram. I mean there are there's nothing that I even know of anymore that runs on that little Ram so I was like okay I need to network this so I put slave cards in the and that's probably not an appropriate term these days but they call them slave cards at that time they were they were PCI boards that you would snap in and you could make a connection and make a network. I loaded an Excel spreadsheet one time that was so big it consumed all of the RAM and it just froze up the computer that was running my home office so that you know there's if you do that in any space that you go into you're committed to take care of your patients you're committed to take care of your team that's really the Candid model we have great support we want to make sure that our patients we're not perfect but we're in and we but we are certainly in search of not perfection but excellence in in the care of the patients from how their teeth are aligned how they fit together to how they are addressed in communications and I think that those are the things that are currently differentiating us and that ultimately will be what brands us as Candid.

Howard: So when you're learning braces well first of all it orthodontics is different because I mean endodontists do majority a mole I mean do molar endo but dentists do some you know dentists general dentists do some and specialist do anywhere from you know the most difficult to a lot would what is the general thoughts of orthodontists there's ten thousand eight hundred of them in America, what do they think of when it they see a dentist doing a clear aligner case?

Lynn: Orthodontist generally don't think general dentists should be doing any orthodontic treatment okay now I will differ a little bit there because I have worked with in known some general dentist who have made the commitment and the dedication to really figure this stuff out in in lieu of having the formal training they've spent the time and in in in some cases I've had some general dentist who were better at orthodontics it's some of my own colleagues now that's not the case if you look at the if you look at everyone that's not the case because it's very difficult in a general dental practice to jump from endo to extractions to a class one carius prep and restoration over to a pediatric patient jumping over to a patient in braces and the reason that that is challenging is that as you build your orthodontic patient population within your own practice the chair time in traditional braces is very is very loaded in the return on dollars isn't there so it's better for the general dentist from an economic standpoint to do that unless they're really going to focus on it and it's a very big part of their practice so just to blend it in that those chair dollars are very low compared to almost every other procedure that they do. So I'm not against it I just want if your general dentist and you're gonna do it invest the energy and the time to figure it out and provide excellent care in that means that you need to you need to monitor your treatments in the beginning through treatment and at the end. The only way that we learn is to look at what we did at the end and then we assess ourselves and that's the definition of a professional you don't need somebody looking over your shoulder to tell you that you need to get better your education and your perseverance and your continual desire to understand your trade your profession is really what makes you an expert in anyone in our profession who chooses that path can be very successful in whatever they choose to do but you're just not gonna be great at everything.

Howard: Okay the next six questions I'm going to ask are gonna be clinical nature let's all write you know records diagnosis dream planning the treatment monitoring treatment measuring treatment outcomes and then post treatment retention but let's start with digital works on a collector record this is Dentistry Uncensored we like to talk about what's the most controversial some people are saying that CBCT is the standard of care other people are saying no it's not some people are saying well you should do it if you can we've had two oral radiologists on the show saying she doesn't like the amount of radiation compared to a pano and she's also she's seen way too much of people getting CBCT's without thyroid collars on so my first question is is CBCT standard of care and ortho in 2019?

Lynn: No absolutely not the challenge the the the radiologists that you spoke with because when I was in academics I was a big proponent of pushing CBCT in dental medicine not just orthodontics but in dental medicine however as we started to look at the amount of radiation to get a volume image to get a high-quality voluminous because what you're doing is you're getting three-dimensional images in being extracting in looking at two-dimensional images most of the time so if you can get a panoramic x-ray and/or a supplementary x-ray or you can get periapical in byte wings and you can do it at a lower dose of radiation and you're not using the three-dimensional features of the cone beam CT it's come to me it's contraindicated because of the amount of radiation versus the what you're looking at if you're taking a 3d image and you're only reviewing 2d images that makes no sense to me for the patient so I would when I talk about digital radiography or digital records I'm talking about digital photos to to primarily two-dimensional x-rays and then you can you can then take the scan of the teeth and get a three-dimensional model out of that so you know you can you can actually articulate them you can make them look like you know the what orthodontists you know look like plaster models you can put them on an articulator if you want to you can do all that. It's basically putting everything in ones and zeros so that you can review all this stuff in front of a nice monitor in computer and so that you have instant access to all of your patient's records that's what I'm talking about in digital radiography but I'm backed off of my I'm a little bit more skeptical. What we did in academics we would take the three-dimensional model and then and then we would send that to a radiologist for them to review it because at that point there was some concerns about the dentist was going to be liable for things that we weren't looking at and and so you add all of those things to it you're just increasing the cost of care and if you're not looking at anything that's three-dimensional I just don't think that that's the that's the right tool.

Howard: If someone it seems like podcast a couple of hundred or thought seems like almost everybody says they're at the 80/20 rule or 80% fix wire 20% clear aligner you there's another guy in Canada or a hundred percent wait why do you think the majority of orthodontists are still 80/20 clear aligner and why their wires are a couple of people like you that are more all clear aligner?

Lynn: The only rationale I've come to is they they don't want to they don't want to take the training wheels off and figure out some of these nuanced tooth movements that are a little bit more of a challenge now if you subscribe to everything that align technology or Invisalign tells you there are a number of limitations particularly relative to extrusive movements in the indian excessive need for attachments and that's because part of that's in part because they have a scalloped cut in that scalloped cut does not grab the tooth remember and removable partial dentures what we learned is the only way you're going to get this partial denture to stay in the mouth is what undercuts we in fact we would even go in and we would remove some of the tooth either on the patient or on the plaster so that we can get those little clasps to fit in under there and lock in so you know when you're moving teeth it's the same thing you got to grab it I don't have a bracket now so I have to use my tooth is the bracket in that's it's just comfort level they you know they fall back on the comfort of what they know to do with bands and brackets.

Howard: So what percent of your practice I mean you you're the clinical director of Candid and you own Texas orthodontics right?

Lynn: No I'm no longer in private practice.

Howard: Okay so you no longer with Texas orthodontics?

Lynn: I'm no longer with I sold the assets of Texas orthodontics back in 2017.

Howard: Okay my bad I'm sorry for given that innocent misinformation but I'm glad I know I'm but by the way a lot of people when you say we want to write that for article dentaltown or you got a post out on social media they're so afraid that say yeah you know I'm afraid I might be wrong you know I got a monthly column since 1994 and of course I've served my own magazine because no one else had published me well but it's funny what everybody is afraid of I always enjoyed the most I mean you could be wrong in something and all these people for free volunteers editing your incorrect thought and sending you a letter or a phone call I remember one time I was in doing a working on a patient this is back in like 94 95 and some they come back and they said there's some dentists on the phone in your office he says it's urgent I went back there and he and I said hello this Howard he goes he goes What did he say it was uh Oh who was the I not Eisenhower in World War two who was the big General Patton he was Patton was not a five-star general you idiot he was a four-star general eisenhower was a five-star and I'm just like okay you know who's about dentistry but it was so funny because like I'll never ever forget that Patton was only a four-star general. So when you're wrong people it's just so nice to say all your thoughts so if you're thinking something incorrectly someone's gonna tell you about but I'm gonna go to a severed a list seems like I've been doing this 32 years I'm 57 years old seems like whenever I talked to a patient about orthodontic and you know under 25 they're like joy knee braces am I gonna get braces but man whenever you're talking to anybody my old my age they've already had ortho a couple of times they're only thought is retention it seems like seems like everybody thinks orthodontics is this really neat thing but it seems like I've seen a lot of people who've had ortho two or three times and in high school and when they first come in because then they go back the big surge and Invisalign all that is when you're back on the market and you go post your picture on tinder or plenty of fish did I put my picture up on plenty of fish and they took it down they said dude you're a whale you're not a fish and they said lose 50 pounds and resubmit it but the bottom line is when these ladies and men are coming back on in there they're on the market that they had braces in grammar school they had braces in their 20 and these young dentists that are getting an ortho I tell them all the time I said straightening the tooth is the easy part retaining as much harder do you think what do you think harder straightening or retaining?

Lynn: Retaining for sure

Howard: and how many ladies have you met in your life that by 60 had braces three times?

Lynn: Yeah it's it's you know I had again it's a good thing I'm not in private practice anymore because it's probably politically incorrect but I would always tell my patients children adolescents adults okay here's the dirty little secret of orthodontics retention is forever so here's our agreement you're gonna have to wear your retainer until I die or you die because one of us has to exit because that's the only way that we're gonna get closure on this thing because the teeth are always moving and you know in you know I went through a phase about ten years where I put permanent retainers on my patients because I got tired of them coming back and they didn't wear their retainers. I stopped that because then the general dentist and hygienist were saying you know what these patients aren't taking care of these permanent retainers in there getting some gingival recession in there there hygiene isn't great there's some periodontal concerns and I was like oh my lord and then you know fortunately what came along because I was talking about the old plastic ones and I still have mine with the wire that came around the little loops and stuff like that when we got to wear clear aligners and I saw the patients when we would use the retainers for you know for look like a clear aligner for retention they didn't really didn't complain about those the problem was they were so rigid that if they didn't wear them like their wire and plastic ones there they put it in after about two or three days in their eyes would cross. So now we have some little softer materials I don't you you you still remember the tooth positioners orthodontists went through this you would just give him this big mouth guard at the end and they had to chew in it for hours a day and and that was for the orthodontist who didn't know how to get the teeth there and they would just cross their fingers and pray that that was gonna chew him into occlusion. So anyway but yeah it's a retention is forever it's forever and ever.

Howard: So do you think Candid we'll try to do an IPO I mean Invisalign this stock has been crazy smiles drug clubs having a bunch of problem it's got venture capital backing what is the what is the next move for Candid?

Lynn: You know Candid is we're very comfortable where we're at continuing to innovate in this space of tele-dentistry tell orthodontics creating you know our arm systems so that we have control over the things that we're doing in the you know in as well as we walk down this road I don't see that on the horizon for us anytime soon particularly in light of happen with smile direct club so you know what we're wanting to do now is separate ourselves out as the choice if you're interested in getting affordable accessible quality safe clear aligners and you want to do it in the tele-dentistry model or in this you know our studio model by orthodontists that that's who we are and we want to just keep beating that drum so that as many people in the United States will understand that that's who we are and again being very candid being very straightforward about you know what what the reality is of treatment because you would be surprised then our number one reason for negative comments on social media aren't it's for patients that we that we tell them we can't treat them that are those are the people that are most upset and that's never I mean I've never experienced that in private practice before so it's a different it's a different world it's a different space.

Howard: but where I was going when I mentioned where you used to I have Texas Orthodontics so I was gonna ask you if you did a hundred clear aligner cases how many would be tella dentistry tele orthodontics versus seeing the patient physically in person?

Lynn: When I was at Texas Orthodontics for the last for the last year and a half to two years I was treating my patients like it was a Tele dentistry practice I would gather the records I would do the diagnosis and treatment planning I I would have an in-office consultation with them I would deliver their aligners and then I would put them on dental monitoring and I would view their and here's a good part I went from twenty five team members down to five because the amount of support that you need when you don't have people you know patients coming back into your office every week it changes the whole and I had a 19 chair orthodontic practice so I needed about three of those when I moved into clear aligners in the kind of atella dentistry model so I was doing that before we were doing at a candid.

Howard: So for Candid one of the VCs is Bobby Ghosh all right isn't it Bobby goes are you friends with him do you know him?

Lynn: Yeah

Howard: My god he's he's got some he's with we work live handed so what's he what's he all excited about these days?

Lynn: He's if you if you kind of look at our brand in our look he's responsible for that because he's the the he's thinking he's the chief design officer he kind of gives us the look that we have the colors you know the just the whole feel of what that looks like you know I'd like to think in in in I tell my close friends then I'm a really good orthodontist so but don't get me into the marketing and into the design because that's not that's not what we do you know it sometimes we as healthcare providers we sometimes think because we're good and one thing we're good at everything again I'm really good at like one single thing in this whole world and I know how to slalom water ski so there's two things oh my claim to fame is I hold the university record at southwestern for 100-yard dash which I will always hold.

Howard: Is your name Earl Campbell?

Lynn: No no no no okay I was actually probably faster than a real Campbell but he was a lot tougher than I was.

Howard: Are you how are you serious you're that fast?

Lynn: I ran a nine seven five hundred yards not meters in 1979 now I'll always hold the hundred-yard dash record because they do 100 meters now so nobody will ever beat me yeah and but you know when you're going to a college that has a student body of less than 2,500 so nobody really cares.

Howard: Well you know what my only claim to fame is?

Lynn: What's that?

Howard: My only record I'm the only person on earth who's listened to all 1294 shows of Dentistry uncensored nobody nobody has done that.

Lynn: You are incredible

Howard: Are you a hunter?

Lynn: You know what you know not not much of one, no I don't, I don't like things dying in front of me.

Howard: Okay it was like every time I go down in Texas seems like every dentist I meet down there wants to go pig hunting deer hunting.

Lynn: Yeah I son my son is looking for another dad because he thinks I failed him in that particular arena.

Howard: Oh my gosh it was so great so I'm so honored for you to come on the show today I love your entrepreneurialism I love it and in dentistry I can only imagine what all the colleagues saying I've seen a Scott Loon where you know he tries to do something new and on cutting edge and all that stuff and oh my gosh the best way to the best way to not ruffle any feathers just do nothing say nothing hide in the basement and my gosh you're anything but that I remember next door to you my gosh you're in Texas wasn't it in Arkansas were a dentist we're north autonomous just wanted to have a hygienist because the patients were coming in and they and he said why not just have a cleaning I mean my gosh he should have just climbed up on the top of the tree and shot himself. I mean that I mean that was like like he was trying to sell drugs or something.

Lynn: Yeah it's you know what our profession can get a little stodgy sometimes and yeah entrepreneurs forward thinkers are not always right okay but we've got to have people who step out of kind of the way things are always being done and give it a try and you can you know you may you take the you know the death penalty for doing it but you know what we get one chance to go around this life you've taken a lot of you've taken a lot of risk going out and doing what you do I applaud you for that you you kind of keep the conversation in dental medicine germane and active and alive and if you weren't doing this who else would be doing it nobody.

Howard: and I just and I can't believe we're ten minutes and overtime I just want to finish one last thing um if you have those entrepreneur things there's two million dentists in the world and they all no matter where you go in the world they got four five six seven eight nine ten eleven twelve years of college and Europe has this you know America every state has their own meeting I mean 50 states fifty meetings national meetings, Europe does one massive meeting every other year in Cologne Germany have you ever gone to that one?

Lynn: I have not but some of my colleagues did this year I need to go next year they said it was incredible.

Howard: See it's a Korean dental company and they're starting to crush and create well they don't have time to go to Russia and Canada and yeah so there's just people all the time saying I'll take the US distribution and use the other contract you say okay but within you know a couple of years you got to be selling so many dollars a month or we're not gonna do but what I love the most about that show is it's the same way reason I love architecture it's not like I love a bathroom our windows seal or a door or church what I love the the deal is that okay you have to have a bathroom you have to have a place to go shower and all that kind of psyche that and just how they slightly made it different in Germany versus Ukraine versus Poland versus Russia and it's the same thing about dentistry you got eight billion people and only basically you know two million so many dentists and they are all trying to do the same exact thing but they all do it slightly different and I remember I was laughing in last sunrise there was wood I saw Dan Fischer from Ultradent and I mean we were just like couldn't believe how all these dentists from Lebanon and Iran and Korea and Brazil all trying to just like extract a tooth I mean they all just want to extract too but they do it a hundred different ways they do or tell a hundred different ways bonding bleaching veneers it is just amazing. I would love I can't wait until maybe tella dentistry starts taking off at the next clone it's the last clone meeting it Whirley wasn't about teledensity but that is the next frontier I mean we all got an iPhone. I mean I remember with them when the Motorola flip phone in the night Kia phone were everything and then in 2007 all the sudden you could see the person you were talking to and what I can't imagine is I'm all the pharmacists in my area I tell them when someone comes up mashes it what's differencing ibuprofen or I got a toothache should I take Ambusal or should I take Bufferin or this or that I say well pull out your damn iPhone and FaceTime me and what's amazing is they'll do my buddy Brad will say aid this guy just asked me he should say Ambasal I'll say I'm busy can you talk to him for a second and he pulls his cheek back and I'm looking at it's like I feel like I'm sitting on his lower incisor I I can see and so tella dentistry is gonna be just big it's gonna be the next big thing and congratulations for you to being an entrepreneur and climbing the flagpole and letting everyone have a target to shoot at you while you try to pioneer this tella dentistry because I think the meaning of life is very simple I mean we live in the present and who built this present the 108 billion humans who have lived and died before us represented in your local cemetery and when I was born I never built an interstate or or a bridge or anything and those are all presents left by the hundred and ten eight hundred eight billion that left the die before us and the only meaning to your life is that when you die the people that what you leave as a present to the next generation and I think you mentioned GV Black and you mentioned Piar Furshard and we're gonna leave a lot of really nice presence to our replacement sapiens and tell a dentistry telemedicine telework that onyx is going to be one of those big huge gifts so thanks Lynn for all that you do thanks so much for coming on this show today and if you're ever want to go get some real barbecue and Beeville you just come down to the next time I'm there cooking.

Lynn: Hey when you when you come to be you'll see your grandkids you have to come I'll meet you in Beeville and we'll have that barbecue or I'll take you to Franklin's here in Austin.

Howard: Well if you take me to Franklin you're gonna have to take four grandkids

Lynn: Yeah you know what let's go alright it's a deal.

Howard: Alright well I'll be there two weeks over Christmas or anything that opens up let's do it.

Lynn: Send me an email I would love to do that and thank you for your time and I appreciate the platform and your codifying a lot of things in video and audio that our children and grandchildren great grandchildren are going to get to be able to to review so thank you.

Howard: Alright buddy have a great day 

 
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