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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It is just a huge honor today to be sitting in the podcast studio with everyone's mentor, Dr. Abdi Sameni DDS FACD, your ears are burning on the last episode on 12/90 with Dr. Kim Wright; she just thanks the world of you and she's doing a lot what you're doing building a continue education center and I'm, I really am all for the CE. I think it's the biggest variable to success: watching dentists for 32 years, the ones who took a hundred hours a year, they solved all their problems, and the ones who took 10 or 15, they were; they didn't seem happy. So Dr. Abdi Sameni, DDS, FACD, is a clinical associate professor of dentistry and a 1991 graduate of Herman Ostro School of Dentistry at USC.

He has been a member of the USC clinical faculty since 98. He is a former faculty for the aesthetic selective which emphasizes a biometric approach to restorative aesthetic care. He was the original director of the USC advanced aesthetic dentistry continuum for the portion relating to indirect porcelain veneers. He is the former chairman and developer of the USC international restorative dental dentistry symposium for the Ostro School of Dentistry at USC. In 2019, he founded the Los Angeles Dental Symposium. Dr. Sameni lectures nationally and internationally on topics related to interplanetary dentistry, digital photography and its applications for dentistry, and various aspects of biometric and aesthetic dentistry. Dr. Sameni is the past president of the USC Dental Alumni Association, past president of the USC Century Club, former member of the board of directors of the Pan Pacific Center for Continuing Oral Health Professional Education, and a member of the board of counselors for the USC School of Dentistry.

He served for six years on the board of directors of the Pan Pacific Center for Continuing Oral Health Professional Education. Dr. Sameni is the former chairman and developer of the Ostro School of Dentistry scholarship selection committee. He's a member of numerous professional organization societies which include the American College of Dentists, the American College of Aesthetic Dentistry, OKU National Dental Honor Society and the Pierre Fauchard Academy. He maintains a private practice in West Los Angeles, California. Now I get a bunch of websites for you. Is your private practice, West Los Angeles, California? Is that the LA WLA Dental Center? Yes, it is. So that's in for West LA. That's in West LA. And thank you for having me, Howard. And thank you, Kim, for like getting me here.

I don't know how things happen, but this is probably one of those spontaneous moments. You could have never planned it this good. And here we are. So thrilled to be on your show. You just made me tired listening to that. I got to stop working. Well, tell them why you were also coming down here. This is Friday and this weekend is the Dental Influencer's Day. So if you're interested, this is the Dental Influencer's Alliance. So if you go to InfluenceDental.com, you're going to that? I'm absolutely coming in for that. That's Instagram, yes. OK, now I thought that once you hit 50, you're kicked off Instagram and had to go back to Facebook. Well, you know, I actually am going to start Instagram because there's so much coming out of that.

But what I have the privilege of is I'm around a lot of young people. I have graduates that work with me and I've been around students for a long time. So this is where they're looking. And as a program director, it is I feel my job to scout people really well before I bring them onto programs. So this started a year ago in Los Angeles, and it's just very different. And I had to come see it for myself. There's a few people I have my eye on that I'd like to scout and see if I can find a way at some future date to bring them to L.A. And, you know, your email came literally the moment I pressed buy on my ticket. So, that kind of worked out. Well, L.A.

Dental Symposium, I mean, you call that the International Restorative Dentistry Symposium or what is it? Let me give you a little history because it's a little unclear how the whole thing is. It's a legendary program. It was a USC for, you said, 12 years. And now it's they now you're taking it over. So in 2008, at the time, our program director, a gentleman and a good friend by the name of Dr. Elon Rothstein, who was in charge of CE, approached me and said, 'Look, can we put something together that would be restoratively oriented? And it could be a two-day program that you could sort of find the speakers for.' And I gladly accepted. And it sort of started on his first year. We had about 80 people that attended the first one.

It sort of became the annual meeting for a lot of our part-time faculty to go. And we allowed access to a lot of students. One year led to the next and so on. And then when our dean, Avishai Sadan, joined, somebody who was just so popular on the CE circuit, he, who is this? Avishai Sadan, our current dean at USC. Oh, okay. So Avishai introduced me at different times to different people because he was running the ceramic symposium. And Jerry Sheesh was running it, and Avishai was working with Jerry, and I got exposed to just unbelievably good dentistry. And I kind of wanted to bring those people so that our group who would not necessarily go to all these, these meetings can experience that. That went on for about 12 years.

And, you know, as the times are changing, and I think you kind of see that CE is changing quite a bit. There are even hands-on courses that are online, and the resources change and your outreach changes. You and I are sitting here talking on a podcast. A lot more people will be able to hear and see this as opposed to if we were just sitting and we had 30 people watching. So I think they have big dreams to restructure and make their programs more accessible. And I think that's a big part of it. And I think that's a big part of it. And I think that's a big part of it. And I think that's a big part of it. And I think more available, more online, more streamlined, which I'm very supportive of.

But I had invited all these people and some of them like Luis Baratieri is not an easy person to bring to lecture for you. And the date was set. I had an option of canceling or taking it over. I kind of went to our school and I said, look, if you guys don't want to do this, I don't want to lose the opportunity. And, and they supported me in decision and said, you know, you can privately do whatever you like. And I said, well, I'm going to do it. And they said, well, I'm going to do it. And I discussed it with my team and the LA Dental Symposium was born. Now, because this had the name International Restorative Symposium of Dentistry of USC, we had to sort of take a year, let those people know that this is not changing.

And as of the coming year, it is just going to be known as the LA Dental Symposium. Being that this will no longer be a university-affiliated program, it allows me to bring business into this. It allows me to have, you know, side programs that may go on. So it's unwritten, but it's very promising as to what we can hopefully bring. So where do you, again, I, I figured out in '87 that every time you went to a CE course, it was always the same people. They're in this big city and it's the same people and over and over. And all the old ones who were my age back then, they all had their F-A-G-D, their M-A-G-D. And I put together very quickly that, that when you go to a course, it's, it's the materials going to change you.

It's the people you meet. You know, if you're five, you know, you're a summary of your five best friends. And if you kept your five buddies from college, you hate dentistry and don't do anything that that can take you down. And I thought the neatest thing about A-G-D and C-E was the people I met, like even on the things like the, the six weeks of the painting suit or seven weekends with Carl Mesh. My, my biggest memory was still, my buddy that I met there. And, and how, and, and so funny how so many times I went to a course on ortho with Brock Rondeau, but picked up something about adhesive dentistry. And, you know, it just, so it's, it's just the secret for me.

That's why I'm a big fan of this podcast because they got an hour commute to work. A lot of these speakers aren't ever going to go to Salina, Kansas, and they get it, they get to listen for an hour. And I was open, you know, if they listen to politics. On the radio for an hour, by the time we get to work, they'll probably just, you know, go shoot themselves. But they always get one good idea. But when you, you've, what year did you graduate from dental school? 91. 91. And I was 87. Where do you think they need the most C-E now? Is it placing implants? Is it clear aligners? Is it still adhesive dentistry veneers? Okay. So now you're hitting on a topic that's just changed.

It's changed for me over time. Okay. I think if you look at the C-E, and as someone who seeks speakers, so in order to make fees reasonable for meetings, we need sponsors. The things that are most important are not emphasized now. You know, we talk about implant dentistry. We talk about major aesthetic dentistry. Yet you take a look at, say, University of Geneva. And I've had the privilege of working with some of these other people just through the companies I've worked with. And see what they're doing. There's a guy over there by the name of Ivo Krejci, who is essentially the director of their minimally invasive program. And what they do is they, in their program, teach their students how to seal interproximal caries and how to diagnose differently so that that beginning lesion never occurs.

We just implemented that icon process into our clinical programs, right? So the education is contemporary. Then people get out. And I've worked with quite a few dentists who graduated that are four or five, ten years out. Depending on the environment that they fall in, what they teach in dental school is unfortunately not what they're able to practice. And what that kind of comes down to is it's all about how do I do it faster? How do I do it faster? There are certain things that you just cannot do faster. Now, in a bigger scheme of things, and when you look and see how things have to be done, and why is it fast, is because of the influence of the third parties that dictate what an office can and cannot do.

And the paradigm shift, I think, is different. So when you ask me, where should CE be? I think CE should be educating the people that before the cycle of death of a tooth begins. There must be a process that you can prevent it. Now, granted, there's a whole group of people that have had restorations that needs to change all the time. But there's a whole bunch that are getting new ones every day. And there is really no consensus. The technologies that allow you to be specific are not utilized in this country. And that's a pity. I think that whole endeavor needs to get redesigned - how do you decide to enter a tooth for the first time? Do you? It's really come a long way.

So if you're young and in school, and you think it's bad, I remember when I got out of school, I mean, the cosmetic dentists were just people who would file down a bunch of crowded teeth and put PFM's. And I mean, when they got done prepping the lowers, they all look like rice kernels. You're like, how could that be good? So then eventually, it became more minimally invasive. I love the fact that nowadays, veneers, they unravel everything with Invisalign or clear aligners. It's getting much more conservative than it was. It used to be just a wholesale crazy. But do you think it's rapidly becoming more minimally invasive? I would love to say yes, but the reality is that no.

Because if you look at, at least in America, or in California, I should say, if you look at the direction that dentistry is going, more and more DSOs are being formed. And less and less sort of specialized offices tend to exist. And when DSOs put their business plans, they try to work within third-party paying, take all the PPOs they can, etc. So in order to, for example, do sealing of the proximal lesions, they are not going to encourage that because that's not something that's covered with the current payer system. So where I see dentistry going is, a group will continue to work within the paradigm that exists, and find ways to make it faster and have more centralized ways of dealing with it.

And then there's going to be the groups that are going to take a different direction. And a good analogy, potentially, at least what I hope I can contribute to, is if you take a look at the organic food industry, you know, I moved into, I immigrated into the United States in 1983. You couldn't find organic. How old were you in 83? 16. So was it was that stressful to change countries at 16? You know, it's when you're from Iran, and that's where I'm from, I left when I was 12. And that was a time that I had to go alone. And I lived in a boarding school until my folks could leave the country. So I lived in Europe for about four years, and then we all immigrated into the US.

So you lived from 12 to 16 with no parents in a different continent? Actually, two of the years without parents. That's where I learned how to speak English. And, you know, and drink and drive and, and all that kind of stuff. Not bad. I didn't drive until 18. So it was kind of fun. And it was hard at the time. But going through hard times makes you prepared for others. Being in an environment like that makes me be comfortable, like whether you're from Sri Lanka or America or, I don't think in those terms, because I'm just comfortable with like, whoever and I'd like to get to know you for who you are, etc. That was instrumental for me at a young age to just, you know, despite the discomfort, get to, you know, get to know who you are, etc.

It's just been a fun experience. You know, have you heard of the company Intel? Yes. um the two founders that are two brothers are from iowa and i was just asked them one time at dinner i said uh you know you're just two normal guys from iowa from kansas how how did you come up with this and i mean it's a massive company and he said and they attribute all to being army brats they said you know we grew up and every two years dad transferred to another country and we would just lay there in bed and think well why was the last country so rich and this one so poor and they look

at the different things they said same people same house same appetite same plumbing same everything's in so they started to understand the small little nuances of economics and they said yeah we couldn't have learned that going to asu and reading books they lived it so you know what doesn't um what doesn't challenge you doesn't change you so those challenges probably made you the person you are um so so what are you so again back to the question um what do you think the media major areas that need to be addressed with CE? I mean, so all of it, I mean, CE is when you finish, what I like to call somebody who finishes dental school is a qualified beginner, somebody who is just taught to be safe.

And if they've paid attention, then they know the basics and hopefully with some mentorship, they'll kind of grow and so on. So all of the areas you can get better at. The question is, if you sort of change the perspective of the public and what is offered to the public, and then you look at what we offer and the reasons of what we do and what we don't do, I think the reasonings that we sort of justify some of the things that we do is not appropriate. And I really think, and I think this 30 years into this, because if you ask me this, I don't know, 25 years ago, I genuinely believe that I'm doing somebody a big service by taking those teeth and crowning them and getting rid of an interference and occlusally making them fit what I was taught is the best way to go.

But I think adhesive dentistry is a game changer, right? Because adhesive dentistry allows you to sort of keep the tooth biologically for a lot longer. And as dentists, we're trained that if our restoration fails, that's embarrassing. But if the consequence of our restoration ends up having a patient lose a tooth, that's a consequence that we agree. And not that I am at the stage that some of the cases that are beautifully reconstructed are failing. It's disappointing. And the ones that have their natural teeth may have needed a little more care, a little more hygiene. Some of the composites may have been redone five, six times. They're better off. Is that minimally invasive? Yes. I posted that yesterday. You ever seen something like that? It was a, I posted that on, it just, I mean, it exploded on Dentaltown.

So, so all on four, you know, you know, everybody talks about preserving bone, growing bone, saving bone, but all on four, you know, they, you have to make a lot of space for the inner arch. So now some of these surgeons are just with the teeth in and everything, just doing a, what is a, a term not very used very often. Um, um, osteotomy and entire dentition removal for an all-on-four dental implant case. The maxillary mandibular alveolar ridges were removed to allow enough bone ability, but man, a lot of people posted, they did not like this picture at all. That was too aggressive. Think about it. If you are a dentist and your commitment is to preserving a dentition for a lifetime, right? Because you're a really good dentist.

And I can't remember who said this. I think it's Ricardo Mitrani who said this. You're, you're a really good dentist. If your patient gets worse at the slowest rate possible, slow down the rate of death. So if you trace all of that back, how many unrestored teeth does one lose unless it's severe perio? What are your implants coming from? Mostly teeth that have had a crown and a post and it's a root fracture. That's like the number one reason. The number two reason are traumas and accidents. So what would you say is number one teeth that were restored? Yeah, like a tooth that is unrestored rarely is lost. I can still remember dental school. I asked him, I said, which tooth lasts the longest? And he says the one that a dentist never touched.

That's right. You know, one of our clinical professors, a guy by the name of Winston Chee, actually wrote an editorial once in the Academy of American Academy of Aesthetic Dentistry. And he called it 'an enamel preservation fee' that a dentist should actually be paid an enamel preservation fee as opposed to procedures that you do. Because once you take it away, you can never replace it. Now, talking in 2000 and you know, 20 years later, this is a viable conversation because adhesion prior to adhesion, you couldn't do these things. When you needed mechanical retention, you needed to do the thing that you needed to do to satisfy that requirement. But, you know, you look at a Boeing airplane today and you look outside the wing. How many screws do you see holding the pieces together?

It's primarily adhesively bonded together. Adhesion works great when the environment is controlled. And as dentists, we sort of take the posture of, yes, laboratories get great results, but really, in the mouth, you can control that. You just have to make the commitment to a rubber dam. So adhesion is not complicated. Rubber dam can be difficult. Now, when you work in an environment that you've got to do something, that you have 20 minutes to do something, and the rubber dam maybe takes 40 minutes to place on and isolate in multiple different ways, then that's the first thing that you give up. And I think that the awakening needs to come from the fact that it's not that the technology that's lacking is creating that environment that then allows you to do it.

Yeah, I mean, it's come a long way. I remember when I was in dental school, I was so amazed that the ADA held the patents for, I mean, that bonding benefits of Dr. Michael Bonacore was back in 1955 that all these patents on it and Erwin Smegal ran out with it with the American Society of Dentalists. So when I look around the globe, so America's only, I hear things all the time saying, you're big in USC. They say, well, America only has only 4.5% of the PhD students. Well, America's only 4.5% of the population. What's your point? They say, well, most of them come from Asia. Well, there's a hell of a lot more people in Asia than the whole United States of America.

But when I look at the dental industry, there's 211,000 Americans licensed, 150,000 general dentists, 32 hours a week or more, 30,000 specialists, 32 hours a week or more. They're billing out about 119 billion. But the planet's got 2 million dentists and they're billing out half a trillion dollars. But most of all, the growth is pretty just like the advanced economies. You know, it grows one and a half to two and a half percent. The only thing double digit with oomph is implants and clear aligners. And they're in double-digit growth. Will that affect a lot of your programming decisions for your Let's analyze that for a second. LA Dental Symposium. I always confuse LA Dental Symposium with WLA Dental Center, West LA Dental Center. So, is West LA that's a tougher part of town, isn't it?

No, actually, West LA Dental Center is very close to UCLA. It's somewhere between Santa Monica and Beverly Hills. I would say it's an upper-middle-class community. I've been there for over 20 years. Yeah, and I thought it was more like Hollywood. No, Hollywood would be more north. But you know, LA is just so spread out. But you raised a really good point. You said the double digits are implants and clear aligners. Why do you think that is? Well, I mean, at the end of the day, the, you know, there's what life, the biosphere popped up about what? Three and a half billion years. I mean, your only goal is to reproduce that offspring. So anything to make you look more attractive.

I mean, if you're missing your front tooth, they're always gaming, trying to look better because in their unconscious, they want to attract a mate, reproduce that offspring. So that's what the patient wants, right? I think at the unconscious level. And I agree with you. If you feel better, you look better. There are studies that show that you'll succeed more. You'll work longer. You'll be more efficient. Yeah. All of that. What I'd like you to sort of think about is the average person today knows about implants, right? Someone from TVs, billboards. Clear choice. Clear choice. So those people have gone to the public, right? I think one of the people who really, maybe 10, 15 years ago, brought cosmetic dentistry to the mainstream, and he deserves a lot of credit for that, is Bill Dorfman.

Bill Dorfman. Okay. Is that what you're going to say? Yeah. Yeah, that's what I was going to say. That extreme makeover show, right? Mm-hmm. What it did is it allowed the universe to be aware that there is such a thing that I can have. And then people started asking for it, right? And then education started about that because it became a demand. Now, I can sit and argue and say some of the methods and methodologies may not be what I would agree with, but this is not about that. He deserves the credit for bringing it to the public. How come the majority of the dentists in the United States are unaware that you can seal proximal lesions? For the world, for that matter. Well, I'll go really brutal because I like to go back in history.

I think when you're in the present, you get so confused and tribal and you miss the point. But when you go back to America, they started dental insurance about, what was it, about 1950? 1948 in California, Seattle, Oregon. It was the Longshoremen's. So there was a union that solidified anything coming in and out of the country had to go through the Longshoremen's Union. It was the perfect choke point of the labor deal. And one of the first things they started was dental insurance. And those dental companies in Seattle, Washington, and Portland, Oregon, and California eventually turned into Delta Dental. Yep. And then, when did, when was the radiograph invented? When did Renkin, or rather, Röntgen invent, when, when did Röntgen invent the radiograph? I don't recall. It's probably sometime in the 1920s or 1930s now.

Invent radiograph. So X-rays were discovered 1895. So here it was, 15, or here it was 1958, and nobody had an X-ray machine. And then Delta started covering X-rays at 100%. And it was a domino effect across the country. Okay. And, and the hallmark of economics is that people chase incentives. Like when I was getting my MBA program, it was really sad to hear the, the people from hospitals. They say, 'you know,' they, we only, you know, we spend an hour with grandma and we get a $20 an exam. We get this. And we lose money on every everything. So we have to do a biggie and a biggie is anything 50 to a hundred grand, like a hip, a knee, a bypass.

And if we do four biggies a day, we can run everything at a loss and cover everything. And I'm just like, how sad. If you don't filet grandpa open and redo a knee, or if you don't do a 50, 70, a hundred thousand dollar procedure, you run everything at a loss, but incentives matter. And if there's no code for it, it's dead on. It's dead on arrival to what? 80% of the planet. But you know, I kind of feel that the public doesn't understand insurance. Medical insurance has no cap, right? If you get sick, you go to a hospital, no matter the cost, you're covered. You have a deductible that, that you sort of truly pay as an insurance, right? Dental insurance is a discount club that you pay a premium.

Yeah. And you allow decision-making on some other person that then influences your doctor as to what to offer you or not. $2,000 is what they pay. And to get that $2,000, if you're going to do it legally for the major stuff, you have to pay $2,000 to get $2,000. How can you ever be comprehensive? Now take that a step further. You are somebody who is like a young person and you've got these interproximal areas that you could potentially seal. But you would never really get that initial MO filling that you would get today, is mostly composite. And if there's a way to sort of protect you against that, what is that worth? What is keeping that marginal?

And you know, to get cosmetic work and redo your whole mouth or implants on Ford, that's $20,000, $30,000, a hundred thousand dollars, depending on who does it. If you took a healthy hourly profit after your expenses and you started doing some of those things, whatever these, these works like other professionals do, like if you're a lawyer, if you're an accountant, you basically have your fee and whatever else is on top. Don't you think that most people would opt for it because they don't have to pay, you know, tens of thousands of dollars, they would pay a thousand dollars, $2,000, get it protected. Because what happens to that class two cavity that you get the first time, the first time that you get it, if you get it in an in, first of all, let's just even go back.

How do you decide which lesion you enter? Think about that. You look at an X-ray, right? And you take a look at that X-ray and, and it's generally accepted that if you see it hit the DJ, you enter. How do you enter? Buckle? Mesial? Most people, you kind of go in and you start looking, right? Well, you can trans-luminate. And if you trans-luminate, you know where that is. And if you trans-luminate and you capture that image, you can trans-luminate later and see, did it grow? How come some of the people that never did it from the time they were 20, they still have that interproximal lesion the same. You've experienced that, or you offer a patient to do something and they don't year after year, they come and you're really trying to fight to see, Oh, maybe you should, because it's a little more 20 years ago, you didn't have trans-lumination today.

You can trans-luminate and look at that way. There is a lady who has her PhD. Her name is Marwa Abdulaziz. She went to the University of Geneva. She spoke for us at the symposium. She's now working at UCSF on a sabbatical. She has a PhD and part of that PhD was to start analyzing what you see in an x-ray and what you see once trans-luminated. And then once you open the teeth, how accurate are you? And many times you enter and you're like, okay, where is the decay? And sometimes you enter and the decay is rampant. So our, our, our diagnostics for initiation are not being used properly because it's expensive, right? You have to pay $7,000 to have a care review unit, but you could get an Advent light, which is what I use currently.

And that Advent light will sort of show you where it is. And that light is, I don't know, $300. And that gives you some sort of an idea. Next is photography, right? So if you have a photograph of a tooth and that person comes back five years later, three years later, you compare the photographs, half of the things that you think were going to happen doesn't happen in some. And in others, things get worse where you didn't suspect it. Now it's not perfect, but when you read your notes and you sort of say this was under observation, what do you do with that? I mean, I know you've had Kyle Stanley here talking about AI. Let's look into the future a little bit.

How cool is it if, if the judgment doesn't have to come from you because the technology can tell you something changed. And, you know, as a dentist, we kind of feel like unless we took something away and we built something and we inserted, we haven't worked and we don't deserve to get compensated well. Whereas maybe the thinking should be the opposite. Look at dermatology, right? For a second, get out of dentistry. Dermatology is one of the most popular, popular areas of medicine because they rarely have emergencies. Most of what they do is elective. Patients want it because they understand it's good for them. And the media and the, they have invested in letting the people know, letting the public know. Look at the drug companies. There was a time that the doctor would give you whatever.

Today, you will know what Lunesta is and you'll ask for it and your doctor will have to learn. So back to what started this sort of tangent, that we went on. Implant companies have double-digit profits because they've taken it to the public. They're investing in educating the dentist and teaching them how to do it well. The cosmetic stuff started because of Bill Dorfman and the likes that sort of put it out there. And frankly, it's rewarding when you do it well because it's like something you see right away. It's art. It brings the artistic part of dentistry out, et cetera. And that's kind of fun to do. So it's, it's pleasant for the people that like it. Why doesn't anybody show cases 10, 15 years later of these big makeovers?

Have you seen one? Absolutely. But, but all humans don't like facts. Like I'm, I mean, I, I've been on dental town since 1998 every single day. Almost the smartest dentist, you know, you say, well, how long do you think your posterior composites last compared to amalgam? Like, oh, I, I can count on, on one hand, how many of my fillings have failed? I'm like, well, you know, when I talk to insurance people and they have hundreds of millions of claims that they're, they're seeing like six and a half years. And then they say, then they say, well, well, my, my, well, those are yours. I mean, obviously my hands, look at my hands. Obviously I'm, I'm gifted. I mean, I, I don't think they like facts.

And I, I think AI, I think AI is going to blow their mind because the insurance companies are using it first. And right now they just arrested a girl out by you who had submitted the same x-ray 60 times for a molar root canal. And she's going to go to jail for a long time. And so they're, they're fraud Glidewell next to you. They're using it to read impressions better than human. But I think, I think the next phase is they're going to sit there and say, wow, I'm going to give you a thousand dollar benefit to a molar root canal. And if you do it at five years, 5% are extracted. He does it. 10% are extracted. Howard does it 20% extracted. We're not going to subsidize Howard anymore.

And I, I think, I think, and I can tell dentists are not going to like this because they, they, they can't even, they can't even tell you their, their feelings fail today. But you know, let's talk about standard of care. We, we sort of agree that there's a certain level or evidence-based dentistry, even better, right? How would you define evidence-based dentistry? That means if the average person sort of follows the general guidelines of something, and you look at it in multiple different ways and you look and see what worked and what didn't, you draw conclusions that this approach, this procedure, this material is good or bad. Then you pass that gospel to others. Agreed? Right.

What about the person who took extra care, reduced less, isolated immaculately and did something and took three times as long, unless just for argument's sake, charged three times as much, which is still less than the cost of a crown and a root canal. Okay. And, and would that patient be better off? Or worse off? That, that's really the part that's like, so I used to do aesthetics and reconstructive, you know, one of my heroes is Frank Spear because he had a very; he probably wouldn't even know me by name, but he showed me that you look comprehensively. I got involved in implant dentistry because. You're old enough to remember when it was Quace and Spear were partners. Yes, actually that just recently separated. And they ended on the two big ones, Ruttle and Buchanan is.

Right? But you know, but not to sidetrack, but the whole concept of endo; I mean, we should leave decay that's deep alone and seal it and wait for symptoms before we take the pulp out. We don't think that way. An X-ray goes to an adjuster and the insurance and gets preauthorized. The Endo is approved prior to care is removal. So, so, the paradigms of what we think I think can change. You know there's a guy who's a Harvard MBA, his name is Michael Porter. I don't know if you've read anything absolutely so. One of the things I've taken out of that he says: There's basically two ways to succeed. One is if you're the cheapest whatever, if you can be the cheapest and your focus is to be the cheapest, you will always be busy.

The other is, you have to be different. Now I see dentistry going in a couple of different directions. I understand that if I'm a young grad today and I owe a half a million dollars, someone's going to come give me a 401(k) give me all of my CE and create an environment that I'm not committed possibly pay some of my loan off; it's attractive financially and for my life. The other way they're not going to make as much money, those places don't really exist. Then you take a look at the practice and like you know you've met my two sort of associates here with me, like y'all, who who is one of the most brilliant people I've ever met that that really started just like this for for for training purposes and she just finished her master's in HR; she's just that kind of a girl.

And we've tried to redesign our system, that's the taller one, and the shorter one is Rachel, who really in many ways in adhesive dentistry knows a lot of the things that we're doing and we're trying to do a lot of the things that we're doing a lot more than many other people because she actually just follows all the protocols. And you know when you start teaching something, you start sort of understanding it a little bit better. Why I'm sort of going there is: You look at our office and our office about 30 percent of what you pay goes towards managing your appointments, managing the schedule, having somebody to answer your phone calls, pre-authorizing for insurance. Right so I could be 30 percent cheaper and Make the same money if I could control the front desk costs.

Add to that today's average person who is in their mid-20s have read that they will not stay at the same job more than four years; they constantly move around, right? Oh yeah! So if that's the reality and I just have a lady who's been with me more than I have been with this practice her name is Nancy Rosenblum; she's retiring at the end of this year. She's given more than 40 years to this practice, that's just not going to happen and I'm not going to be able to do that because I'm not going to be able to do that in the future. So, so the process of this, this dental approach is is A bit hindering, you know. I make tea times for golf; I don't talk to anybody.

I basically go there's a scheduler, I kind of schedule it. And I think if we can take some of the things that we get from other industries, maintain costs of things that don't create better patient care, emphasizing the technology and the education of the patient as a profession. I think the DDA and the ADA they should take the lead of informing the public that you know implants are great if you need it, but hey, if you seal your teeth, you may not even need the cavity. How come that's not popular? And why can't why is it the same fee whether somebody uses a rubber? dam or not wouldn't that encourage you not to use a rubber dam if the build-up is included in a restoration or not wouldn't that make you like be like why should i put a build-up i've heard that the most profitable restoration is the one that's going to be used for the rest of your life and i think

that's what's going to be used for the rest of your life and i think that's what's going to be used for the rest of your life and i think for a restorative dentist is a single tooth implant in terms of the money that you make as a dentist right when you're doing a single tooth implant isn't that kind of where you fail that saving a tooth and That is your most profitable thing, what if the smallest class two was the most profitable thing in dentistry would more dentists want to learn that, well it goes back to what I started in the beginning um what two things what are the only two things growing double digit implant and

and they're the most profitable because the insurance companies whether it be private or government don't set the fees for those so when they when um in the United States for example when um Johnson signed into law Medicare and um when Medicare you know first it was a relationship but for years it was like well what what codes are using then they Started group coding, but after 10, 20, 30, 40 years, they finally figured out your business and then they lowered their reimbursement um to so there's almost no profit. So when the insurance company gives you say $180 for a filling that's probably your cost. So when people um, so people gravitate to something where they can just set the fee in the profit zone. And that's an implant and clear liners.

I mean, a dentist will go do like, I think the hardest thing I do in my office is uh yeah, when I see on the schedule, I got to go in there and I got to do a quadrant mod composites on two, three, I mean that's just an hour down, it's intense. Oh my god, there's no shortcuts, it's just you're gonna be in there for an hour, um, but um, you know that that um, that you're probably just breaking even, depends how you charge, well I mean if you're participating with the insurance, but 95% of U.S. dentists take Delta, according to Delta, Delta says great for Delta, terrible for 95% of the dentists, because it it forces you

to do things that you know is not better to make diagnoses that is not the most conservative, how do you think your patients would feel if they knew that when you're giving them their options, that's even in your radar, but you know I could do a filling here and if I put it Over them, it'd probably work pretty good. It's a little hard to do, and I'm basically going to break even, but well, that's some of the emotional um pushback we've had on this show with silver diamine fluoride. Some of the young pediatric dentists are going to be going to be going to be going to be going to be going to be going to have a lot of fun; they like to just paint on the silver diamond fluoride and kill the decay, and do that every six months.

And some of them feel like some of the pushback from the older guys is, 'Well, my god, I'm Bill Papadomies and Chrome Steel Crowns - eight of them! And you want me to paint this stuff on there?' For you know, $15 and/or there might not even be an insurance code, so, yeah, incentives matter. I mean, if you went over to the MBA program at USC and told them incentives don't matter, they'd laugh you out of the building. I mean, but going back to cheapest or different a movement is necessary here right, a movement of people who are going to get out of what's normal and accepted and easy that are willing, and I am part of that.

I've started this a long time ago; I gave up Delta then all the day that they would allow me to do a Crown but not an Only Wow, what year is that? I can't remember the year, but basically we sent something to your principles. Buddy, and it's okay, but let me get, let me give you the devil's advocate because I know my homies and they're gonna say, 'Come on, dude, I'm in Salina Kansas, you're out there in Hollywood, you big money, I wish I was in Salina Kansas being able to do this, the overheads is probably less, they pay less rent to get in and out of their offices is easier. Okay, the concept that insurance enables people to get the best thing.

Take a family and I'm surprised nobody has done this or maybe somebody has done this or you go find the person who's done this and bring it on the show. Take a family and look at a 20-year projection of family of four: how much? Did their employer or their company contribute to dental insurance? How much out-of-pocket did they pay to subsidize what they received, and what procedures were done for them in a 20-year span? Then, see how many of those things got to be redone because they were restored restorative failures that are inevitable. Well, tell the kids because the kids might not see this, but you, you asked me a question earlier like like

we got out of school in the 80s, uh, there are all these legends out there doing all these full mouth veneer cases and I, I was a little uneasy with it because I knew a lot of them, and when their daughter was 16 and Asked for that she had to go get braces and bleaching, but when someone came in with a debit card, they built out. But if someone comes in and got the traditional upper 10 veneers done, the typical LVI way, what would those look like in 10 years or 20 years? The tissues would be always inflamed, you know. You can't bond subgingivally if... If you accept that as a principle, you can't bond subgingivally if you don't see your margins.

You shouldn't bond the worst restoration on the planet is an unbonded bonded restoration; an amalgam is better a glass ionomer. On a lot of my older patients, right where if they don't have the temperament To really get it isolated, it's better for me not to do bonding. It's better for me to do a full crown. It's better for me to do a gold crown. That's not the discussion. The discussion is for the tooth that has not been invaded at some point. The arithmetic of this is that there is somebody who dentists have not touched, why is it touched for the first time? And are there alternatives? And how do you make those decisions? I look at our charts; my patients are extremely unique because they grow gum and they lose gum, and that's because I look at them, and they look at my own probings.

Oh, okay! And it's like a three millimeter of recession. I look At that and I look back, and it was two millimeters; then it becomes three millimeters before I had photographs and everything. And we make decisions, and when you're off a millimeter in three, you're 33 percent in error based on that, you may make a recommendation, you just emotionally decide where I see the future, and I'm in the building process of this. I do not have the workflow to tell you, but if there's one thing I want to contribute, I want to contribute a way that you come into an office, you get scanned at your first visit, 3D, where you really see where everything is; that can get saved, and if you're young. and you have your own enamel and etc you you see in radiographs and you look with trans illumination and you capture that data and don't be in a rush to get in there which proximal carries became a root canal in a year and and you know i have friends that spend ten thousand dollars a month to try to be on top of that google page for patients to come in what is wrong with you re repairing and redoing some

patients very recently i don't think that's a big story we need to talk about but when will i be able to continue to try and Smart Accenture and read the Ego Uhh I as I continue to explore

third-party?h and also to the point of using The Microsoft distancing model I built is size 8. Well, how much effort do you put on your first patient? And how much effort do you put on a recall? You know, 10 years ago, I stopped doing exams right after a prophy because I missed things. I posted this yesterday. My phone was ringing and dinging after I posted this. Which one was it? Oh, check out this. I posted this yesterday. It's a three-year trial by Professor Nicola Ines, I-N-N-E-S, shows no evidence to suggest fillings are more successful in treating tooth decay. Three-year trial. I mean, 43% of those participating in the study experienced toothache or dental infection regardless of the treatment they did. And it's funny because this is on the pediatric forms.

And, I mean, could you imagine being a pediatric dentist saying, don't do that, just paint silver diamine fluoride? And then people saying that, you know, this is a pediatric study, that these fillings, there's no evidence to suggest they're more successful. So if you think of tooth decay, right? She's a pediatric dentist, teacher, and researcher. Her work is focused on improving the way we manage the disease dental caries. So let's look at dental caries. It is an infectious, communicable, untreatable disease. Agreed. It's a bacterial infection. That can go from tooth to tooth, person to person. We do not have a vaccine and we do not have a medication for it, right? So if you look at it in that perspective, while you're doing your restoration and leaving a margin, you're always vulnerable to that.

And the bigger that margin, the more vulnerability. And the closer to the tissues or below the tissue, the higher that vulnerability. So if there is a way to get the tooth to sort of heal itself, that would be a better solution. Unfortunately, it's not easy to do because we have patients that have to comply and that's where we fail most of the time. Because when you finish a restoration, it's in good shape. Some patients take great care and some don't. But my issue with just excessive restorative care is that initially it seems really good, but almost invariably when you look at it two, three decades later, the ones that are not good, the ones that are not good, the ones that have been more aggressively restored have the bigger problems.

So have you been following that fiction dental trial? No. It's pretty cool. It's called the Fiction Dental Trial. And it's basically researchers just, you know, you said, oh, the cavity's through, we need to do a filling. And they're all sitting there looking at the data. And like I say, a lot of these professors who are pediatric dentists, dentists, researchers, whatever, they're saying, man, you don't have an argument for the filling. It's the surgical model. Yeah, it is the surgical model. And, you know, the surgical model becomes extremely important when it's about replacement of other things. You know, I learned, I have a resource for you. Go check out, maybe you already know about this, a place called Style Italiano. Yeah, he's been on the show. Look at the work that gets done there, right?

And that's in Italy and that's like, you're telling me a guy in Kansas is going to hear and say, 'Well, this guy's in Hollywood.' There are people in Morocco and Iraq doing dentistry like that, right? It's not like nicer offices. It's not better equipment. It's not better materials. They sort of bought into the philosophy of let's keep things super gingival. Right. And I think that that adhesion has brought that to the game. And, you know, one of the hardest things, I think, is to unlearn. Learn something. It's easier to learn for the first time than to unlearn and go a different direction. And I think that once we get comfortable, we're just comfortable. Right. Yeah, this is a very interesting deal. I was very excited about Tufts the other day.

Tufts had a Dr. Nikhil Udner, MS, PhD, developed bacteria. That would make low-calorie sugar called Tagetose that will not cause cavities. He actually made a sugar that tastes like sugar. It has 38% fewer cavities, but the bacteria can't cause decay from it. Yeah, I mean, xylitol kind of had the same concept, right? That this is sugar that they can't metabolize. But, you know, looking at all of these things is a great thing. Because it's like thinking maybe the first approach should not be surgery. You know, think of the medical world, right? If they would sort of do your blood pressure and they would sort of get a plaque index and there's a whole series of things that you could do.

And the first thing that they would tell you is, let's just do a bypass because it may get clogged up later. Right. It's just, you know, for me, 30 years into this, and look at the stress. Stress to the dental world. When you do a case that somebody spent $50,000, $60,000 with you and that case is failing, that's not a good day at the office. And the management of that case is difficult. When you have a case that you did a class two that failed, are you that stressed out that you have to do it again? Probably not as much. And I know you probably know who Dan Fisher is, right? Yes. South Jordan, Utah. Dan the Man Fisher. There you go.

He used to invite two people from each school once a year before the Sunshine Act kind of complicated that. And I had the privilege of going there. And one of the things that I kind of wondered is, here's this guy who's got this amazing material and he doesn't make anything for porcelain. He doesn't do indirect materials except impression materials. So I asked him and he says, you know, the majority of the world can't afford indirect dentistry. So his focus is to sort of help those people. And then what he said is, if every office learned to charge by their time, then you make the right decisions because it makes no difference what you're doing. And if you look at other industries, the law industry, if you look at the accountants, if you look at the contractors, most of the world, that hires professionals, hires them that way.

And as your skill gets more, your hourly rate goes more. And this sounds weird, but we've implemented in our office successfully. You know, if I take Delta and somebody wants a front tooth that looks really pretty, without lying and cheating about it, I can't have them pay for a better lab. Right. If a patient knows that, is that good for them? And I'm not trying to bash the dental insurance companies, because their intent is not to be bad, but it's an agreement between the patient and that company. And if they understood more, maybe then they'll choose to use the insurance for things that make sense and go outside it. So have you set the date for your next year? Yes. Okay. Okay. And also I'm a little confused.

So I know the LA Dental Supply, LA Dental Symposium, just LA Dental Symposium. Yes. The West LA Dental Center, that's your dental office. You have another website, ePoint Inc., ePoint Inc. So that's a whole interesting story. We had a couple of people that sort of moved out of the area and we wanted a front desk person to help us and we just couldn't find it. So I went to recruiters and through the recruiters, we found somebody. Actually I found Ya that way. And we started making all these training manuals so that as we bring people in, we can sort of show them what we want them to do for us because we're a little different as far as insurance goes and all that kind of stuff and somebody needs to explain that well to a patient.

Then, we thought we had a business opportunity, and ePoint was meant to become a recruiting agency specifically for fee-for-service dental offices, because a lot of my friends are suffering from not having that opportunity. the good front desk help that they need what we quickly front desk or assistant the purpose was front desk when we formed it but then we discovered that that's not an easy thing to actually feel there's not a lot of people out there who are willing to work for the salaries that's paid for that that would have that level of skill and that level of customer service because a person like that could work in the hospitality industry can work in

the food industry they would basically have easier lives and make more money so we've kind of failed at creating the talent the demand for us to find it is there but we can't equip it so now we're sort of rethinking it and we're thinking maybe we should have some training that we do for other people so that they can go in this direction and when the USC continuing education program stopped I needed an umbrella of a different company than my private practice to sort of run the LA dental symposium so it went under there and and you know where Kim was so helpful to us and AGD sort of became a partner to sort

of help us with the CE part of it and and these things were not pre-planned they were just ends to a mean if you will so have you set the dates for uh next year I believe it's November I want a six and seven the the weekend after the election the weekend oh my gosh I love how on e-point you spelled it out e-p-o exclamation mark n-t I've never actually you start you you do it twice in one area you do it with a small e then p-o exclamation mark n-t but I love the way I've never seen that before where you threw in a um yeah and it's been so difficult to actually get the right registrations for that so I know you know we were sort of creative and then many times You're creative and then you get roadblocks that definitely was one of those situations.

Oh, I was telling you before, you know? I fly out of the country tomorrow and uh, just have a little bit of time to do that! The Roman numeral two after my name my dad named me the second, I mean half the countries; it just stops the whole system! I'm I'm still going to the cemetery yelling at my dad because uh names... But yeah, you put an exclamation mark in there, yes! Just lost uh, the whole Microsoft backbone of the internet, yep, um, so, so the LA Dental Symposium; you um, it's not on your website when this when the dates. Is it not on your website when the dates is are six and seven? No, we haven't really discussed it.

You know I'm scouting for it currently and we'll probably are going to continue after the election some of the highlights of last year's so if you're um, so I cannot believe six and seven of November is the date, 2020 November yes, so when is the election next year? Isn't the election always the first Tuesday of is it every year and that would yeah it is, yeah. And 2020 will finally see clearly hopefully um, I can't wait, you know. It's funny I can't believe we're doing that election, that means a lot to me because um, the last election is what made this podcast really yeah I mean um I um the last election you know

um talk radio and social media and these dentists had our commute to work they said dude I can't listen to this crap an hour each way you know um even like me I kind of like my news summaries on like Friday night you know you can watch a couple of news programs and you can watch a couple of news programs and you can watch a couple of news programs you know that kind of sums up the week right but some people you know they're watching that breakfast lunch and dinner I mean it sounds like tonight the NFL game that's perfect you know I had a game Monday night I have one game Thursday But I can't watch it three times a day, and but anyway, they were all emailing me saying, 'Dude, I gotta well, you started dental podcasts, and now um what I'm most proud of is not the um not the this podcast, the fact that now there's 60 people in dentistry uploading a dental podcast on Dental

Town, and the views are crazy. People do a podcast; they upload it to iTunes, you can upload it for free on Dental Town. There's one guy on there who has 600,000 views just on Dental Town, and um and then my advice to any podcasters because I know there's a lot of people out there um, you know I, I own a media company; dentistry so I've been a dentist but I've owned A media company since 94, and media is only the medium. A lot of people they do too much of one medium; a lot of people they do there, there's print, there's Instagram, there's iTunes audio, YouTube, visual. But all the podcasters, like we're doing this on video, even though um I have a face for radio, you look like you were made for a video, hardly but thank you, you have that Dorfman look, um.

But my gosh, they're there, they want to watch it; I can't believe all the people that do these audio podcasts have nothing on YouTube and I would rather go video on that, but um. So yeah, that election means so the next election is on November. um, third yeah, and you're, you'll be, the weekend before or after, six and seven, we just signed seven, and where are you going to be, same place, the Biltmore Hotel in downtown, downtown Los Angeles, and what, what, and that means something to you because that that's where you're having every year, you just have relationships, it's a great room, people are familiar, it's centrally located so that local people can come and you know we're getting more and more people that are coming from outside of Los Angeles,

and frankly my goal with that symposium is to let the audience see some of these people that ordinarily they would never cross paths unless they join these big academies where they have a lot to offer and and uh hopefully I can leverage that and then bring them back on for more like a detailed one or two day course that we're going to do and what do you think um okay so I was trying to get the address so the address here is right here um so the address of that is the 506 South Grand Avenue Los Angeles California so where where is that at that is right in the heart of downtown Los Angeles it's like literally a mile away from the Staples Center in California I mean it's 10 percent of America I mean it's um it's what the ninth largest economy In the world, I think you could um totally fill that thing out without ever even leaving Southern Cal, you know.

You're getting international people, it's what I would love is to get somebody who's in Chicago, somebody who's in the suburb of someplace, you know. You went somewhere and we didn't quite finish there if I worked in an area that I had a little more time and I wanted to have a little better time and I would sort of see the ease of doing that type of dentistry that's not as stressful, my life would be better, my patients would be better, and they're not exposed; they don't see some of the things that you see and I see and then. You know, I'm not saying transforming your entire practice to one case or two cases; some of the best dentistry I see is from some of the most uncommon places.

And uh, because people who typically go to become a dentist want to do really well. You know, another thing I've noticed um over the years like, say it's tomorrow, Saturday. I'm flying you know, you know. It's international when your flight time's 13 and a half hours on one leg but um, what one thing I noticed, you know? So much has changed like when I started lecturing internationally in 1990. You always had a translator, yeah. Now there's no translators. I mean, because 30 years ago, parents Realize, I told their little kid, you know the international language of science is is math and the international language of um, business and and everything else is English, and um, so now there's no translators uh, it's just amazing now that doesn't mean they can all talk to you because you know in LA, you have a uh Hispanic friend who can understand his her

grandmother but can't speak it right which always blew my mind that how can you understand grandma and not just parrot it back but it's obviously it's obviously a separate issue um, but I have noticed going around the world especially places like um, like Singapore, Tokyo. France, a lot of people say yeah, you know back in the 70s, I did it that American way, running back and forth for operatories, I felt like I was born just to provide jobs for assistance and receptions, all that stuff. And um, I got rid of it all and went down to one operatory, my iPhone and my overhead dropped down to a hundred thousand a year, and now I do three hundred thousand, take home two hundred.

I used to do a million and take home 180, now I do 300, take home 200, and I'm not stressed. Then, I also coach them that um, you know, so much of our stress is just by design, and in dentistry there's so many threads on dental time about stress, stress. Stress, you know what? Just slow down. And the way I was justified is because you're supposed to treat other people like you want to be treated in a lot. In dentistry, when you're really stressed, it's because you only got seven more minutes to finish this well, throw the clocks away. Um, I mean, who decides that for you? Who decides what your fee should be? Who decides how long you should schedule? You do. And you know, I don't know.

Like there's a movement in Europe right now it's called slow dentistry, and they have a very specific protocol that they're trying to create. That the first thing they do is they're going to Do they're going to do a lot of the basic minimum of that's McGwell right is is that his movement McGwell, you know I know Marco Gresnick and I know that he was featured in there, I don't know the name of the person that actually started it but I kind of joined their social media and I watched some of the things that they do and say, and it's an interesting concept. It says like no dental visits should really be less than an hour, and I mean you know that that that's just not that complicated to understand.

Yet when we put three or four things and you know I don't know, I don't know, I don't know, I don't know, I don't know. have done that when I finished school, for about four years, I worked in a really busy clinic and and I felt exhausted every day, and it's just really hard to finish something without doing your best. I want um, I can't believe we went over an hour but um, I want you to explain something because um, there are some old people, whenever I say 'you know', most a quarter of my list, a quarter of my emails, are still in dental school and the rest of them, they're all under 30, but I get a one from a 50, 60, 70 year old every once in a while.

And for those older guys out there, a lot of them tell me, um, I don't even know what you're huge on Instagram, they don't. get what's the difference between Facebook and Instagram what why do you think Instagram what do you think Mark Zuckerberg son of the dentist Ed Zuckerberg why do you think his son paid a billion dollars for Instagram and why it's a big thing in your um in your world so explain to the old guys let me tell you I am more with the old guy than the young guy what I have is a team who understands Instagram and I'm trying to get better at it my social media personal social media

stuff is not that good it's mixed of students family friends etc but what Instagram does is it allows you to broadcast something and show what you have done Or what you can do, people can pass it around so quickly, and, and that's the good part; the bad part is you see a lot of stuff that could be misleading as well. You see it before and after, you don't see a prep, you don't see anything like that right. So I think in our area Instagram has a lot of teaching opportunities that you could do if you standardize it. That's something that we're talking about; we think we're sort of toying with the idea of starting something called iPreserver, which basically becomes a group of dentists that dedicate themselves to a particular practice and and don't let the the million reasons why.

You shouldn't don't think that way, think of why you should and find the ways to do it so we have a five-year goal on that and and in that concept what we think is; you should make available to people in detail how you did something I think Instagram can be huge that way with the Instagram TVs and so on and I think the younger population gets that a lot, and the meeting that I'm here for that that I'm excited to see what they're doing yeah it's just born that way, you know we didn't send a single flyer, influence dental.com, the di founders are Blake McClellan, founder of implant compare app, Dr. Nareef Sanada, prosthodontist, Dr. Payman. Payray Raisi, general dentist. Dr. Benjamin Johnson, oral maxillofacial surgeon. Dr.

Brian Balawaz, general dentist, and you know, you look at how from year one to year two, this changed it's dramatic. John Coy is the keynote speaker. This has to mean something for John to agree to do this, and I'm thrilled to see it because that's the population that needs to sort of learn how to diagnose better, how to be conservative if that's what they choose, find the things they like to do and not do the things they don't want to do. Because we live in an interdisciplinary world, and I think Coy's is what he does better than anything, I mean sure. he's a great world-class prosthodontist second to none all that kind of stuff but for young kids he's such

a mentor because he's not gonna make you feel bad there's no stupid questions and he's gonna he's gonna he just has a great is that the Greek personality he's just a I always tease him that his secret to all his crown and bridges he sprays Windex on him before he submits a member of Greek fat wedding yeah remember that Windex thing but he's just he's just such a mentor and and he's with Picos Michael Picos same thing these are just guys where I mean you can just you know I say there's no stupid questions that take you under The thumb, and they're just so uh, they're just so world-class, and Joe um Marnifar, he uh, he teaches right here in uh, in town, he's the oral surgeon, right?

Yeah, Midwestern, and uh, my gosh, Brian Harris, um, he's local, yeah, he's uh. Talk about genetics, his dad's a dentist, and he dad had four sons, like I had four sons, so I I um, when I found out, um, there's a dentist in town who had four boys, and they were 10 years older than my boys, four boys, I called them and said, can I uh? I gotta be your friend, I said, can I spend the night with you, can I, and he said, well, I'm going to LVI, and I said, well, can I share a hotel with you, and uh, he said, uh, sure. I figured since he knew I had four boys he hoped I wasn't hitting on him and uh but yeah it was great we went to LVI in the day then at night we go in the hotel room and he would just tell me all the advice of raising four

boys what an entrepreneurial family yeah Brian is just a great guy so what's so what's the takeaway from that influence dental well you're asking me about three days too early oh so you haven't been to it I've never been to one now okay my main purpose like I told you is I want to see what it's like and and I'm really excited to go see Amanda say I've heard so many good things I've never heard her speak so I'm you know gonna go watch her speak and Some of the other speakers, and see who I can work to bring to our symposium and expose their good work. All those all the speakers all those

many more all those are speaking yes and and who were you looking forward to go see Amanda say Amanda say yes she she she actually has joined John Coyce, I believe, and they're doing a big hands-on on direct resin which I think is so needed and um you know the country is big so the more people that get to get exposed the more we'll become interested. And at a symposium, you're not going to leave it and go do it and be an expert but it gives you the resource to maybe go take Coy's class and and learn that. and become better huh and Amanda say she's a um from Mount Pleasant South Carolina yes I've met her at a number of different meetings we sort of both belong to the aed and and I'm really excited to go see what she's presenting and then some of the other younger people that that I know like this guy Adamo I've never met never really seen much of his work he's very good in photography

and uh you know it's going to be exciting to see these younger people who nobody knows about presents and let me tell you about photography it's it's the your pay oh Danny Dominguez is um Danny Dominique is he he's there too um but I mean it's it's amazing How um, um patients go to your website and you, you tell me that you're a member of the American Academy of Cosmetic Dentistry or Implant Dentistry or Koi Spear, whatever you tell me. All this stuff. I go to your website and you just look like some Joe Harry. And my gosh! Patients are so visual. We were talking about that's why we do the podcast on YouTube too. My gosh! The people who get a digital camera and commit to it.

Now, some I know can't commit to it but they got an assistant that committed to it. And that was the last I wanted to tell you about your ePoint, and then we'll wrap this up is the fact that um on the ePoint deal um I was lecturing To like, 100 DSO guys in Scottsdale the other day and you know the big dilemma with anyone with associates is employee turnover of course how do you keep your employees? Um, and it's like well I hear the other end um what was the tipping point of course people don't like their job of course people like to stay in bed and eat donuts all day but you know um but what was the tipping point?

They had a really big day they didn't sleep well last night they were doing that big molar endo and they walked in there and their their Joe Friday dental assistant she's gone now and then here's some temp that he couldn't pick out of a police office. I got off the phone and I'm like oh my gosh they're all those DSO guys there man you can't have you the reason you have dentist turnover is because you have employee turnover and stop the employee turnover and once that dentist like I have a rule of my assistants you know once they've been with me 15 20 30 years I always say you know if you're going to call in sick at least have the courtesy of texting me first so I can call in sick and because I I don't want to go work with a temp and uh I mean my gosh when I have to go in and it's going to be a temp you should see

text i get you know that i mean because they know i i just can't stand doing it So, you want the uncensored answer to why we have a problem and remember, we try to build e-point, and we can't staff it. You don't take care of them. You do a parallel of a 25-year-old person that gets a job at Nordstrom's - good employee, responsible person, smart, picks things up, follow that career for 10 years, see the growth pattern, and what they get and the benefits and everything that they get in that world; like the stress that they would have to go through compared to if they make a mistake in dentistry it's much more dramatic right, and any good person would feel bad if you make something what what when we make a mistake someone.

Gets hurt, right? That's stressful for someone who cares. So, if you look at it in that paradigm and I mean, I'm just going to say stuff that probably is going to create a lot of issues with a lot of dentists and they may not like what I'm about to say. But why should a hygienist be paid more than a dental assistant? Your profit on a hygiene appointment is about 20 to 30 dollars when you take everything away: the time that you put to schedule the patient, that part of the office that's rented for them, and what they get paid. And I'm not saying they don't deserve what they get paid; but a chair-side dental assistant is what enables you to do your Business best and really, when you look the plateau, it's like by the time you hit 25-30 dollars an hour, right there's nowhere to go.

Practice consultants advise you to get rid of them and get new ones so that whole dynamic is is unfortunately flawed. And how I try to keep mine interested is maybe I can't pay them the same as like you know some of the other things. But you saw me come here with two of them, right? I know how many of them I've been paying for, and I've been paying for them for need dental assistance. Go see what you see that could get inspired to be like 'Wow, look at that rubber dam and how much easier it is to work for them.' Take the initiative to actually go and and support what you learned, so just in case you switched you and I mean, so many people come on the show and said that they, for 30 years, you go to CE, and this side of the room every row is an office, it's a dentist reception, the whole team's there, and it just, you know, every row is a dentist.

And then over here, it's all the dentists coming alone to save money, and you look at you, you go pull the tax returns on this group, this group makes twice as much as this group. I mean, they don't come to your office because they have a problem with some person in there, well, you're only one of five, six, or seven. People in your office and um, my gosh, the the the um, um people who take all their like tomorrow be interesting on this influence still you I would imagine majority yeah so it's like okay well you came to Phoenix you got all fired up you're all charged up then you walk back in there Monday morning and your staff's like, 'You know they're just not feeling it.' So um, well I want to thank you for um all that you do for dentistry and it's a um, I mean you have some big fundamental lofty goals and I, I'm sure you're more aware than anyone how difficult they are.

I mean it's so hard to turn around uh a train that's been going in the same direction. For 70 years, but if anybody can do it, it was you. Thank you so much for so much, I really appreciate being on the show. I know I can't turn the train around; I'm just looking for a car to go a different direction.