Dentistry Uncensored with Howard Farran
Dentistry Uncensored with Howard Farran
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1497 Prosthodontist Cherilyn G. Sheets, DDS, on Microscope-Enhanced Restorative Dentistry : Dentistry Uncensored with Howard Farran

1497 Prosthodontist Cherilyn G. Sheets, DDS, on Microscope-Enhanced Restorative Dentistry : Dentistry Uncensored with Howard Farran

11/10/2020 3:00:00 AM   |   Comments: 1   |   Views: 96
Dr. Cherilyn Sheets maintains a full-time private practice in Newport Beach, California for esthetic rehabilitative dentistry. She is an international educator, clinician, author and researcher and received numerous awards. Dr. Sheets is Founder and Co-Executive Director of a non-profit teaching and research center, the Newport Coast Oral Facial Institute. She and James C. Earthman, PhD, Professor of Material Science and Bioengineering, University of California Irvine (UCI) School of Engineering, are leading research on energy dissipation in teeth and implants. They hold numerous US and International patents on the technology for quantitative percussion diagnostics.

VIDEO - DUwHF #1497 - Cherilyn Sheets

AUDIO - DUwHF #1497 - Cherilyn Sheets

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*Please excuse any typos as this was digitally transcribed.

it is just a huge honor for me today to be podcast interviewing Dr Cherilyn Sheets DDS my gosh she maintains a full-time private practice in Newport beach California for aesthetic rehabilitative dentistry she's an international educator clinician author and researcher and received numerous awards dr sheets is founder and co-executive director of a non-profit tt research center the Newport coast oral facial institute she and James c earthman PhD professor of materials science engineering are leading research on energy dissipation in teeth and implants they hold numerous u.s and international patents on technology for quantitative percussion diagnostics she is also a fellow in the academy of general dentistry American college of dentist international college of dentists academy of dentistry international the Pierre for charity academy of dentistry she received the 2002 Gordon Christian award for excellence in lecturing thanks for not giving it to me Gordon uh the 2004 usc school of dentistry alumnus of the year award and the 2006 section of honor award distinguished dennis award from the California section of the Pierre furchard international honor dental academy i mean my gosh this this dr sheesh has been a legend uh since i can ever remember i mean i when i was getting my fagd and magdd uh i was going to all your classes and she's also um big in the microscope uh what did she the uh she got the excellence in clinical research award from the academy of microscope enhanced dentistry the honorary membership and the American college of prosthodontics to say you have a legendary practice is uh is uh just an understatement of the year so how are you doing today i'm doing great my gosh i wish my mom could have heard that she would have been so happy well i was worried about you because um when gene was on um i guess she had the uh the fire she had to evacuate jean was in the evacuation area and she had to leave but luckily we were not so uh but it was really smoky here and air quality was bad and a lot of our staff and other colleagues had to move out but California’s been um having a pretty bad problem this summer so um we've been affected kind of the entire state well the whole pacific coast actually yeah and it's a really big state a few international lectures i mean my god if you drive from the California Mexico border to the California Oregon border at 80 miles an hour on the interstate it's a 12-hour drive my gosh it's uh it's like the ninth largest economy in the world it's just uh all by itself um but i um i wanted to get you on the show so bad because uh when when you go into dental schools there's actually more women than men and i um i cringe uh when i do uh 10 podcasts in a row and they're all you know short fat white bald guys it's like you know the dental school the last thing half the class needs to hear is an old uh man like me uh when they got role models for you did you feel when you got out of dental school that dentistry was a man's profession and now 2020 it's not or or how how did how did you perceive it going in it oh absolutely when i went into dentistry um my dad who was a dentist and i had two uncles who were dentists um he walked with me on the beach and he said this is uh going to be different you know you're really breaking new ground here and i just said oh dad you know it's it's silly but um you know you it's always hard to think of yourself as a pioneer and really i think of the women that went ahead of me in dentistry as really being the pioneers but the reality is that when i came out when i graduated i became part of one percent of the profession because the profession was statistically 99 male so for most of my career um particularly during the maybe first three quarters every time i did anything it was the first time a woman had done anything so to see um to see all the women now that have come into the profession and the um academic credentials they have going into dental school and what they're doing is is really very exciting and i'm so glad to see it so it's kind of equalized out that's what i had hoped was that at some point you would see an equal number of men and women being attracted to our profession because it's such a wonderful profession for both of us you know uh for both sexes well i want to get right to the the only the only male female there's only like a couple issues i can think about one of them when you go to dental school they're so sweet because the biology inside them saying that you know biology says you got to be the best parent in the world and uh and then the women know that you know all men are pigs and that she'll even though she's a dentist married to a dentist she'll probably end up having to do more homework and and whatever and she's just wondering if she if she really wanted to be the best mom would it be better as an employee for say uh pacific dental or you're out there in a California with western dental or owning your own business because a lot of them think well if i own my own business i'm going to be there evenings and weekends and burning the midnight oil and maybe if i just got a job at uh western dental i leave at five o'clock and i go be miss mom what would you advise her on that well i think that it's an individual choice you know that every woman has to make um i i was started off as an associate to my father but by year three i knew i didn't want to be an associate you know i wanted to be an owner and i went to him and i said dad you know i'd really like to buy into the practice and he said why in the world would you do that you know you're gonna probably earn more as an associate and i said because i want a piece of the rock so i think you're kind of geared one way or the other maybe and um and both can work out fine for a woman with you know a family life we ended up having just one daughter but um by the time i had had her i was in two practices i was practicing with my dad and i was also practicing with carl reader i was lecturing i was very over committed and i found out i was pregnant and so that was like you know a shock we hadn't expected that but we were obviously quite thrilled to find out so i just started getting rid of things that i knew i could get off my plate or that i didn't want to do and i focused on the practices but i didn't build my own practice uh until i was 40. and that's one thing i think that women have is you know this incredible ability to have a long career and you can reinvent yourself at different places so for me my two is uh you know my association with carl was a wonderful learning experience my practicing with my dad as an associate as a co-owner you know had a tremendous amount of learning that went there and you know i i just knew that i wanted to set my own agenda and have my own stamp if you will you know on a final practice and and that's what i've been able to have so uh as far as the young woman that you're asking about that says you know i want to be a good parent i mean i wanted to be a good parent and i think that every working mom does and you have to um you know have to have i think a really supportive spouse uh in order to be able to pull this off so particularly if you're a dentist and you're in your own practice and you've got appointments and then all of a sudden your child isn't feeling well and you need to get to the doctor luckily my husband who is a financial advisor a little more flexibility with his appointments and so he was able to um you know to step in and then and then the other thing is if you're working full-time and you can afford it particularly if you have two incomes you know you need to have help and i think oftentimes um you know women don't necessarily have that support system but you know i've always thought of the home as kind of a mini office if you will and i needed to have somebody there that could be there when i wasn't there but as soon as i was free then i wanted to take over you know as mom and you know do all those kinds of motherly things so anyway it's uh it's kind of unique for everybody but all three of us in in our office you know i have the one daughter melissa who now is married and has children justine had three three sons two of which were twins who just turned 30 and uh and gene has two daughters so we all kind of combined the you know private practice with family life so Justine had twins she had her son andrew and then she had twin boys right before she came into practice with me because when they did that new York times article that there's no research for floss i would imagine that she would have known that if she had twins they should have been separated at birth and raised totally differently and then we'd have found out if the floss worked before they died um you know you um you're big in the microscopes uh any anybody well no i want to ask one family question where i go into that um you said your husband is a financial advisor and uh your daughter Melissa or her husband are heads funds managers um is this the craziest stock market they've ever seen and the million dollar question or billion dollar question dentistry is that dentists all want to know are any of the dsos over legend oh over leveraged and if there's much contraction are they going to be all right and uh um i'm sure you get asked that question all the time with your whole husband and uh daughter and all that in hedge fund but what do you think do you think and this market is insane and do you think there's any highly leveraged dsos that are going to have to contract if there's a financial contraction well um it is a crazy market i wake up every morning and my husband has on the stock channel to see what the futures are doing so i've kind of gotten a little bit of an education just by curiously like he's gotten an education in dentistry vicariously by being married to me uh so um yes it's crazy October is always nuts uh traditionally so that was kind of expected but then we've got so many other factors this year uh it's definitely volatile so that's that's the stock market as far as the leverage aspect of the dsos honestly i i just don't know that answer so i would be really i i can tell i mean you don't to be a poker player to know but when you talk to the uh ceos i mean you got all the way from rick work but he looks like you know he just he's at a birthday party he's all happy and all that kind of stuff because you know he's uh he's all liquid and then you talk to some of these other uh dso ceos and i mean my god they look like they just saw you know a murder scene or something i mean they are freaked out of their mind i mean you could just read the body language on on the podcast and in fact after i podcasted one of them i had about three or four dso guys saying no howie could you tell he was massively over leveraged and he's he was crapping his pants during the whole show um so um yes sir you have your finger on the pulse of that question much more than i do um yeah and i'll give you i'll give you one advice on that is in dentistry there's a lot of different silos and the business of dentistry if you're a dentist and i don't care if you're a billionaire rick workman uh or a land pes a landless squatter peasant like me that whole spectrum all the big corporations are on LinkedIn so a lot of times you know when you spend your whole social media deal on Instagram and snapchat uh you're probably talking to other kids in dental kindergarten school but if you want to know how what the big movers and friars that are doing um and what's neat is a lot of times I’ll make a post and then some uh some wall street banker guy will private message me and oh my gosh and and they they always ask the same question and i always want to see if they're gonna ask it differently because you and i are old enough to remember the first one uh was orthodontic centers of America we lived through that uh lazarus realized that just like in real estate you can sell a three-bedroom two-bath house but you can't sell a nine-bedroom house that's why the nfl is always going bankrupt they don't have liquid and dental offices if your office is for 750 in a metro you can sell it today but if it's three million um dso's about the only person writing a check and lazarus saw all these big two three four five million dollar ortho practices got a big line of credit took them all public the only guy who made the new york stock exchange with autonomic centers of America the whole thing internally collapsed wall street will not touch these guys again and they all all the um financial guys say well it seems like like they'll buy it they'll dump some money into it but it's like a hot potato they just want to see if they can fix it up and sell it to another private equity guy and then he tries to sell it to another private equity no one will hold this i mean look at uh clear choice i mean what if they had five owners by now i mean and and the real exit strategy is i'm going to go to nasdaq and i'm doing going to do an ipo uh but wall street won't have it because they they were burned so bad with the first one but but specifically on prosthodontics if if there was a kid in high school right now saying i could see following your husband and your daughter and being a wall street uh person or i could see being a prosthodontist now that you with with all this uh illustrious career how would you answer that question oh i love what i do i love what i do and i do it all over again and it's interesting um i mean but my husband loves what he does and he's absolutely not oriented at all towards medical so a lot of it depends upon the person but one of the things that i've always treasured you know about dentistry is the fact that you can kind of create your own canvas you can and you can change it constantly so when i started off you know i was in a family dentistry practice and then i just kept gearing more towards the more complex cases my dad started referring me all of that you know and then you start getting more and more education and then you start taking on more and more complexity and and and as i look back i've been able to have interests you know that you could follow and then all of a sudden that leads you down a whole nother road or a whole nother direction and um it's it's a little you know not to sound too country but like making a quilt you know you keep putting different pieces of education information together um and dentistry allows you to do that as a small business person where you can basically uh to whatever extent anybody can uh just just set sail in the direction you want to go so going back to your first question about the young woman you know that's trying to decide which way to go i mean maybe she starts off in a in a dso or in an associate position but then ultimately wants to be her own boss and she can do that and then you know wants to bring in partners and you know there's there's just so many ways or maybe they want to go into education and i i just have loved you know the way that i've been able to do it and i i'm so blessed to have this incredible team around me of people both dentists and support people uh you know within our laboratory our hygiene programs and you know our other um aspects of the office and i've gotten to get involved in areas that i never thought i was going to be involved in so you know i call it dentistry and censor because i don't want to talk about anything anyone everyone agrees on uh even though it's hard to get two dentists to agree that today is Friday um but i want to go to mike's shop you're a legend in microscope dentistry you're a legend in prosthodontics you're you're really i mean you were a legend uh when when i got out of school in 87 you already you were like born a legend um but the microscope so i'm gonna i'm gonna play um everybody knows the fastest way to increase your quality is just magnification i mean loops you know you start off at 2.5 then you go to 3.5 whatever and then you look at microscopes the endodontist all have them um you know all that kind of stuff um um if you can see it it's going to be a lot higher quality just imagine the opposite imagine if your dentist wasn't um sherlin sheets but it was uh stevie wonder uh you know that would be uh a very very uh difficult challenging restoration but microscopes also um when people ask me how much does a microscope cost i say well who cares what it costs i don't care if they give you one when i got out of school in 87 i came to this town matloff liebow all the legendary endodontists were doing eight to nine molars a day and then and then the years went by and they decided to i want to see better well that's seeing better slowed them down to four to five so when you look at their income i mean um i would have to say the the the microscope is uh as the um my gosh it's probably worse than sargeni to these uh these endodontists because uh well look at their income um dental specialists um in general uh dental specialists are make 320 and general dentists make 197. general dentists who own their own practice make 244 dentists or employees make 147. so you make a hundred thousand dollars a year more on average to specialize instead of not and you make a hundred thousand dollars a year more if you own um and that's what the word socialism actually means uh if you ever um read more than the first page of a political science book socialism means i own it's it's a workers right to own their means of production they wanted to own their land and they'll pay the king in taxes but they didn't want to be an indentured servant orlando squatter peasant and that's why in these downfalls i cringe historically when dentists are selling their means of production to go be an employee i mean you in history you always want to own your own place but oral maxis surges are the top dogs 448 periodontist number two 330. endodontists are number three at 307 and before the microscope they were neck to neck with oral surgeons and now they let them damn gum gardeners pass them so do you think the um the the microscope is one of those things where it clearly increases the quality but you're gonna have to increase your cost because it's gonna increase your time or what is your your thoughts on that what's my opinion on that okay so um there's this really a a good question um i i can give you a long answer i can give you a real short answer so oh um my opinion is just based upon not only my experience but you know probably 2 000 more dentists that we've taught through the years and there's a couple of ways to look at this one is the quality of the work the other is the quality for the dentist so let's look at the quality of work first i had two companies global and gen med that came to me uh and said we know that the microscope has totally revolutionized endodontics but we don't know if anybody can do this for restorative dentistry so we would like to have you evaluate it and see if you think this could be helpful so um i'm always willing to look at something i'm always curious and so i said sure you know we'll do it so they brought two microscopes into the office one for me and one for um for justine and we um started to look in it and i had just finished some porcelain veneer preps and so i pulled the microscope over to look at them i thought they were pretty nice preparations and when i looked at i thought oh gosh what's this little blip here so i went in and i slowly you know started to smooth it out and so then you'd find something else and you kind of dinked around and then you moved the microscope away and i looked at it and i said this is the best work i've ever done so i was hooked i mean that said okay we need to know how to do this and then Dennis Sanilac and cliff rattle said no we can't teach you you know we just know for our fields but you're going to have to figure out how you are going to learn and then you're going to have to figure out a faster way to teach people so that's that's what we did we made the commitment because we started seeing things and seen ourselves capable of doing things that we couldn't do without that magnification and illumination that the microscope brings so i think what happens is with the increased quality of work uh your reputation starts to be spread because your patients are telling people about the fact that their dentist do the microscope and uh you get a better quality result and it builds the reputation of the practice so that's one aspect the other aspect which i didn't expect at all was me you know how it affected me and i had um like most dentists you know neck issues and you know headache problems i just thought was normal i just thought that that's what everybody had and uh what i realized was it was because of the posture you know the insane postures that we have to uh have as dentists when we're doing uh long appointments and a lot of our days because we're doing a tremendous amount of full month reconstruction you know I’ll sit down and start prepping at eight and i won't even get out of the chair until about one o'clock or two o'clock uh to take my first break so um if i wasn't sitting up ergonomically straight looking through the microscope which is like looking through binoculars where i have no pressure on my neck or head and no oculars pulling down even though i do use oculars with a light on it for you know at times but taking a lot of that off of my body has kept me much younger and healthier so um you know i do work out i do take massage you know i try and treat my body like i'm an athlete because i'm not near done practicing and i want to continue on so if you think in terms of speed and income level you know my income level is actually increased since i've been using the microscope and i think for two reasons one because of this quality thing and the fact that i'm healthy and i know a lot of my colleagues have already had to stop practicing dentistry because of disability problems so um longevity counts for overall income for your um you know for your lifetime but even as i look at myself you know right now on a day-to-day basis but it's definitely been a positive for me what i decided to do with the exercise and eating healthy and all that stuff i decided to just be the control group i mean someone someone needs to be the control group well and you're still going strong so i'm glad we've got you in a control group um those um microscopes i mean i mean it really is amazing um one of my dentist friends is a um really into uh outdoorsy stuff and everything and he did a this great thing for me and i didn't know what to get him but i bought him a pair of zeiss binoculars because you get you just get a pair of binoculars and you're not really sure it's a little bigger you get zeiss binoculars and you're outside like a half hour before sunrise and a half hour after sunset you think you have night vision goggles um so when i think of microscopes there's global microscopes out of st louis you mentioned another one what did you say you said um genmed dead men but i don't believe they're uh making microscopes for dentistry any longer okay but there are a number of companies you know that um zeiss is another one that you mentioned and then there's a number of um asian microscope builders and uh you know uh leica was in for a while making microscopes and they came out of the pro out of the um making it for dentistry and then they've come back in so um there's many choices you know the nice thing about the microscope uh Howard is that when you invest in a microscope it lasts forever it's not like investing in a computer and then 18 months later they say oh yeah that's out of date and you have to go and replace it so you're buying a piece of equipment that's going to be able to be utilized probably throughout your entire practice career and the other thing is I’ve got a you know video camera hooked up with a digital and you can document things and you can show the patient what you're seeing and it's it's magical i mean they look at that and all of a sudden they don't have to just quote trust you uh what you're telling them they can see it at the same time and they're extremely appreciative and you can document you know the destruction that you're seeing under a restoration that maybe doesn't seal well or something like that and they can understand why you felt you needed to take that off so there's so many side benefits besides just the um disability and magnification when you're working yeah i had an associate that um i mean he was young i'm 58 i think he wasn't even i mean he wasn't even 40 and he um he had to get a microscope because if you think about like a submarine guy he he could only look straight ahead and uh so he's doing a microscope and then he also did something where he went to costco and got a big big screen uh so um he could even see it on the tv and uh that was uh um amazing uh but I’ve seen all kinds I’ve seen a friend of mine in Woodstock he actually uh was in the wrong place during time and a police got robbed he got shot and was paralyzed he was fine but i have I’ve and he was fine and uh but I’ve had so many people that i know um they couldn't practice anymore because they physically couldn't do it um so do you um they're always gonna um ask you're a prosthodontist what what are you using it um what magnification is that four six eight ten how how big are you magnifying it well first of all i'm across the bonus because i'm grandmothered into it you know i didn't go to specialty program because i just want to make that clear and by the time i was out of school for nine years that's when the programs actually started um but i have definitely done prosthodontics my entire life and that's where my lecturing and research and everything it's been so now going back into that um because you've said it a couple times i just want to clarify it for any uh people that are really concerned about that um what was the question now tell me again uh my gosh uh well i i i want to talk about that first because i think that specialty thing just got thrown away uh you were um you go to the greatest endodontist um uh my god john McSpadden and the McFadden condenser well he never Nintendo’s school they didn't even have them back then it was just practice loomband and then we saw a couple of years ago in Texas uh where someone was advertising that they're an implant specialist and of course you know the boards weren't going to have that because the ada doesn't list them and it went to court and the Texas judge said dude the ada is a membership program what does that have to it's not a state regulator and furthermore he does have a practice learning implants but what i have seen on this business model is you're right when we were little and you just wanted to be an endodontist you just practice limited endo and then the dental school said well how can we steal more of this young child's future earnings um let's make it a one-year program and then within like an hour it was a two-year program and now they're like well let's make it a three-year program and what they need to do is just go for it they need to make specialty school an indentured servant program where if you get accepted you're chained to the chair and you just you just work for dental school deans the rest your life but but the bottom line is i have seen this with my own eyes one was a small town in Albuquerque where this guy was on Donald town not Albuquerque small town new Mexico and he says he was thinking about going into school because he's in the town of ate Dennis they all hate morendo he hated everything but into and and everybody was like why the hell would you go to indo school you you've already been doing this for 20 years you've gone to all the courses cliff ruddell he took every rental course known to man uh which they're all written by phyllis um cliff's just the uh pretty boy that gives a lecture with that wiggy wears and uh and so the bottom line is um just practice limited like kids are telling me they're saying well i want to be a pediatric dentist i say well first of all um nobody wants to work on a crying screaming children i mean i'm wondering what went wrong in your childhood uh i would tell a doctor first that you're having this uh these thoughts of becoming a pediatric dentist but my gosh if i was in the middle of a pandemic and i wanted to be an endodontist and i looked at the cost of that for three years i mean just one half of one year you could go to every postgraduate program in endodontics from here to europe to istanbul so um you don't have to go to specialty school that is an American dental association thing it's kind of like if you become an eagle scout i'm so old when i was little they didn't have eagle scouts it was a pterodactyl scout and uh my gosh um i don't know do you think if someone wanted to be a prosthodontist um you have uh you're the co-executive director of the Newport coast oral facial institute if someone was just came out of school four hundred thousand dollars in debt in the middle of a pandemic and said well should i just go to prosta school for one two three years or just take half that money and take every um postgraduate coercer is in prosto what would you advise in this day and age honestly is economically um unattractive as it is i'd say go to a specialty program because in a concentrated time they're going to give you an in-depth education that takes years and years and years to accumulate uh and so often the um weekend courses you know even though when any of us give them we try to give as much to meet as possible but it's oftentimes uh lecture it's not hands-on and you know you really need to be mentored by somebody you know i had the incredible opportunity to be mentored you know shoulder to shoulder for nine years you know which really taught me how to read the literature how to give lectures how to uh you know understand uh what to look for how to be more definitive you know in my analysis and and most importantly i think the absolute one of the best things he did that totally changed my life was taught me how to do a comprehensive examination and that depth of that comprehensive examination changed everything for me because i started you know with the kind of just typical dental practice that you know my dad was doing and and and practicing uh in a in a very traditional way and when carl had me start doing two hour you know examinations on patients my ted thought oh my gosh between all the ce you're doing and all of these long examinations you know we're going to go bankrupt but in fact what it did was it gave me a much better concept of what those patients needs were and instead of just seeing a fractured tooth and saying oh we need to put an only on that or we need to put a crown on it i started realizing that by the time i looked at the occlusion and what was happening is the patient moved into balancing interferences that this tooth on the opposite side in the same area was setting itself up for an additional fracture and you start putting pieces together with the period the occlusal tmj you know the dental examination the oral cancer examination you've got all of this data at one time and by the time you go to make your dental diagnosis it it's just just so easy you know you know what needs to be done in phase one to take care of problems for the patient you know the dental iq of the patient you know how receptive they're going to be to care you know whether you need to put them through a preventative program in order to change habit patterns so when you go in to do the dentistry they don't destroy it right away and it just it changes the way you approach things and when i started working with carl i saw that instead of going in and when every time you diagnosed a patient you had to do more and more work on them just throughout their lifetimes these patients you know would have a reconstruction they'd invested in their mouths they'd gone through preventative education they knew how to take care of themselves and from that point on they were just getting their teeth cleaned and every three years getting an examination so it's it's a whole different philosophy of how to really approach uh dentistry and dental care but it's more of a systems analysis way of diagnosing and treatment planning and treating when you're saying carl are you saying are you talking doctor carl ryder yes carl reader car it's reader it's reader yeah and he was one of your strong mentors in the beginning i actually met crow when i was 21 years old i was in dental school uh and uh or 20 maybe yeah 20. and um it wasn't until after i was out practicing with dad and i was on the California dental association scientific sessions committee that you know we were brought back together and um when i was thinking about maybe uh seeing some of our patients from inglewood down in orange county uh he had said well i think you should see them in my office and you know long story six months of discussing back and forth finally i thought why am i fighting this this is such an incredible opportunity to get a prosthodontic education and so that's how it all started so um that was so he didn't go to process school either did he no he would i mean none of those guys did uh they were all grandfathered you know into pros when it became a specialty i mean guys he was born in uh um 1945 uh so it's kind of a new thing and it's uh it's interesting how people um you look at the history of why something was started and it looks it looks uh very different uh to you you know what i mean yeah than it does now um so um did you was there anything else you wanted to say on uh microscopes i mean a lot of people just want to say you know if if like in it I’ll say well you know i only want to look look at four or six eight x and then they see these cheap ones on ebay but you bought this one on global there's a high-end zeiss global's out of st louis it's more a value price uh zeiss is out of germany so you got the transport again but but the dentists always want brand names so how would you answer that would you go with the brand um well i think it's two things uh one um you should look through them and see the optical qualities on both and um and then also look at the service you know what are the companies going to do to support you once you have the microscope because you do need to be trained on it i mean i justine and i and dr picat and i learned uh on the job training and that's the most stressful the hardest and the longest way to do it so to be able to have some people i know there's multiple sites where you can get training in it a really good program that's on the weekend cuts about six months off your learning curve so um i think that that's important um i feel that the learning curve for using the microscope is one of the best times that i ever devoted to my personal education it's it's that impactful upon my my career and me personally so that's um that's it i think that really what needs to happen Howard is they need to teach this in the dental schools because we all kind of gravitate towards what you know we learned in dental school unless you really are constantly looking for new and different things but uh technically i think that that's a really valuable time to get uh habit patterns that you're to carry with you throughout your lifetime so certainly um striving for excellence you know is something that we all were taught in dental school and that's something you want to carry with you your whole life but to be able to learn how to use this very simple tech technology that has such a powerful impact upon your entire life in dentistry is worthwhile to be taught in schools i want to i want to go to prosto and i have a bias for the kids i mean these are podcasts i mean all my friends and feedings that are my age if i put a gun to their head and told them to find my podcast on their iphone i'd have to shoot all of them um when they when they uh sounds like about a quarter of them are still in dental kindergarten school and the rest are under 30 and you're uh you're too overqualified uh to speak to them but they're coming out of school and and for the first couple years they need to learn the basics i mean when you start playing football you know let's learn how to pass catch uh you know let's learn the basics of a block a tackle a pass a catch and they're in fixed prosthodontics and when i sit down with my insurance guys um you know there's 32 teeth and you look at all the claims made and there's just four big spikes on the six-year molar i mean you know 80 percent of the dentistry what toots most likely to have a mod a crown extracted replace an implant a bridge whatever so she's sitting down we're just gonna do baby steps we're gonna do one tooth dentistry on a six-year molar and um um the question she's asking is uh is is she gonna think i'm a bad dentist if i use a quadrant bite um when should she use a full mouth impression when should she use a quadrant tray and i'm sitting here wondering do you even use vinyl polyester polyester anymore are you all digital scanning now or are you still using goop oh well we still use goop we take a lot of polymyosaloxane impressions we have two different digital scanners we have the um three shape and we have the itero uh we invest a lot in technology in our office and but the truth of the matter is as much as we are embracing technology uh on all levels which includes digital um impressions and digital scanning and all of that um when you get to large uh arches there still is some problems you know with that with the discrepancy so we're taking our polyvinyl selection impressions too and we've got a way to kind of cross check things but um as as the technology improves and expands you know everything just keeps getting better and better so i'm sure that some of the problems that um are still there will get solved um the interesting thing you act about a quadrantino tray or full arch what we do is we take quadrant trays for dice but we always take full arch trays for master caps even if we're just doing a single crown can we repeat that say that one more time yeah i said even if we're doing a single crown we always do a full arch impression for the master cast and then we'll use quadrant uh impression trays for to get the dyes and the reason we do that is because it gives the technician then the entire arch for all of the occlusal movements and you end up with less adjustments when the restoration goes back to the mouth which saves the dentist chairs time huh that is a dream um i i want to go back to the digital oral scanner because i i can tell you know um i can tell what they're doing on downtown i mean there's many different behaviors on downtown there's the the a real popular one is they just go to today's active topic what is everybody talking about today and it could be all over the board um but a lot of times um you can tell by the dollar amount like when they're gonna go spend a lot of money they'll do a search and they'll stay on there for like an hour and a half or two hours three hours and they come out of dental school four hundred thousand dollars in student loans because obviously um you know i got out of high school in 80 80 to 20 20 40 years just a solid one and a half to 3 gdp growth for the 20 richest countries including America whereas education they've been disconnected from reality there's no gravity their their costs are going up they've had no eye on cost um you know what what dental schools have done is just it's just sick i mean to strap this little kid with four hundred thousand dollars in debt um and he thinks it's a bad deal because he hasn't got divorced yet so when you're when you're 25 you think 400 a lot of money but after he gets a divorce he'll say man that was chump change um but when they're um when when they're sitting there coming out of school they're like oh my gosh well everybody says i need a cad cam cerac machine that's 140. um everybody says for peri-implantitis i need that uh lenap um um millennium laser that's another 140 000. um you're saying to get a microscope um and you know all this stuff is a big money and when we talked about oral scanner you said three shape and itero and i want you to go into that because you're different you're a process itero is owned by a line which owns invisalign so all the orthodontist or any general dentist or a cosmetic dentist can do a bunch of invisalign they always get the eye tarot but i noticed if you have no ambitions of um ever doing clear aligners and you're just looking at the scanner they go with three shape at a copenhagen so why did you have both are you doing ortho clear aligners with itero and crown and bridge with three shape or why do you have both that's exactly right that's exactly why we have both uh we had purchased three shape because at the time that we did it it was better for you know the pros that we were doing but it also allowed us to do clear aligners because invisalign also took the scans from three shape but then when invisalign bought a tarot they made it um mandatory that you used itero so i mean you could fight it but the fact of the matter is uh we wanted to keep working with invisalign so we just fit the bullet and bought it but really what you started with i think is really important and i want to go back to one of the statements you made and that is you know here's this new young graduate of school and you know people are telling they need to have you know digital x-rays well that makes sense okay but then they need to have you know lynnette that doesn't make sense to me you know and then they need to have you know a scanner well maybe that doesn't make sense you know do they you've got all of these fabulous you know things in the candy store if you will you know to buy but you don't need and you in fact don't want to buy all of them at once because it goes back to what you also said about you need to learn how to block you need to know how to throw you need to know on how to do all the basics in the football game before you start you know doing these razzle dazzle different things so one thing that we discovered even ourselves being very mature you know um dentists when we did one of our expansions in the practice and we turned into all these digital things um as far as new technologies we realized we had overbought for our ability to learn and master each of the different technologies so one of the things that i would recommend is that if you're a new dentist and you're setting up your practice is to not feel like you have to have everything at once you know you want to be able to make sound economic decisions you want to be moving in the technologies that are going to be the best for you and also help increase and stabilize your revenue stream and then you can add on you know different technologies and also be sure that that technology has been out there probably for at least five years if you're a young you know person who's investing in these so that you know that it's not just a flash in the pan that that fizzles out so anyway that's something that when you made those comments it triggered those thoughts in my mind so i circled back well that those are great thoughts um but i i'm gonna pin you down on this i'm gonna hold your feet to the fire because i they're big purchases like uh i mean i mean i mean i i just see the the baloney like uh like the people selling um the the cerak machine on dense fly sirona they have all these people out there saying well i do all my interior veneers with that well i I’ve never met a cosmetic dentist in beverly hills that uses a chairside milling machine for that i mean it's just some of it's crazy but yesterday the european federation of peridol periodontology um came out with their efp guidelines and efp publishes first evidence-based treatment guidelines for periodontics and they indeed set off a controversy on dental town uh because it says uh suggest not to use lasers as a adjunct to sub-gingival instrumentation uh for peri-implantitis um you're a prosthodontist you get referrals from all kinds of periodontists oral surgeons you get to see this industry very unique do you think what did you think of those uh guidelines uh the european federation and periodontists saying that lasers aren't part of the picture in treating uh uh are treating on perio failures well actually that's the first time I’ve heard about it so you know i'm hearing it for the first time um we have a peri-implantitis protocol in the office which is really pretty inexpensive that any uh young dentist could utilize uh without having to invest and that just uh concentrates on using antibacterials and home care and so we'll go in and if we have someone who is really showing signs of either periodontitis or implantitis we place them on jorgen slots one of his techniques which is using the water pick with a small amount of clorox in it you know a few drops of that helps kill off the bacteria and then when they come in for their hygiene we actually infiltrate you know around the uh implant so that it's given a deeper soaking if you will of that and it is been between the biofilm control maybe measuring we use like an oral dna and we can measure the bacteria that are perhaps causing the greatest problems we can do targeted antibiotics therapy and try and change the patient's habit patterns uh in lifestyle and that's been extremely effective for us so anyway it's certainly we can add on other things you know such as lasers but if you aren't doing the basics of um bacterial control and uh and using antibacterials in frequent hygiene visits you know i i don't know that the laser is going to be a solution anyway all righty well i just emailed you uh the link to that article okay yeah and um there it is uh I’ll send you that okay what's that i said i won't read it right now is that okay well actually i want to go back to that protocol because it's very confusing when you're a kid and you're in dental kindergarten you're um you know you're learning oh don't place implants if they're a smoker they have high blood pressure they all these things then they get out in the real world uh newsflash your vegan yoga instructor isn't gonna need all on four you know so the only people that show up are just human disasters i mean you know the um you know they smoke they drink and i'm not just talking about the irish even even other groups will do that um so she's comes out of dental school brainwash oh well you smoke you have high blood pressure you don't take your medication uh you do everything wrong and then they're like well i just got rid of all my patients because everybody that needs an all on four uh doesn't own a water pick so so how do you um how do you teach a kid and then i want to circle around all the way back to the beginning is this um here's the here's the third 20-year journey for a dentist um the reason we started online c in 2004 and the reason i started this podcast four years ago is because it's obvious that if i had to pick one variable that correlates with success and i don't mean success money it means they love dentistry they like going to work they buy toys they buy things the number one thing i see it correlated to is a number of hours of ce because if you take 100 hours of ce a year you're getting exposed to cheryl and sheets you're getting exposed to all these ideas and you're unique but after a hundred hours of stuff you're gonna find something that gets you motivated and and my gosh um you know they got an hour commute and they get a listen i'm bringing them sherilyn sheets for free uh while they're driving down the deal so you got to do your your ce um but the um um but the other thing is um um you know you got to do your ce where was i going the other thing where did i oh is um you do enough c you start with one two dentistry and then it takes you about five years to figure out well golly if i'm gonna numb the whole quadrant i might as well do the other tooth in that quadrant okay now we know you're five years out of school and then about another decade you'll say well if it's gone if i'm gonna be on the right side i might as well do the whole right side but then they stop there because they can't do both sides at once because i mean you've never seen an oral surgeon numb up all four wisdom teeth and pull them eight times a day from age 25 to 65 nobody wants to come back so they do this journey from one to dentistry to quadrant dentistry to right side they never make it to full mouth like the oral surgeons but the the skill set you need the most is diagnosing and treatment planning and prosthodontist are the best and the second best would be a periodontist and in fact when i did my referrals um i would never refer to a specialist since they only did one thing i had one thing i valued him on and that is you know you send you send this kid to an oral surgeon because he needs four wisdom teeth he didn't look at anything else pulls the four wisdom teeth max out the insurance and trash for air i would only refer to a specialist if we can email them the x-rays in the treatment plan so that i could have another authority father figure go in there and say uh like an indiana saying you know we're going to do this root canal day it's a thousand dollars but you have four fillings over here that are like 250 each and if you don't go back there and fill those every one of them is going to be a thousand dollar canal in fact i'd rather pull this tooth and take that thousand and do four 250 dollar filling so i don't want to take all your money and sink it in one tooth so i mean in the united states at age 65 10 of no teeth has 75 20 percent of no teeth so let's not spend your whole dental budget on one tooth but just having that another doctor go over and give his presentation just was miracles for the treatment plan presentation i mean it just uh they'd come back and say yeah you know i was gonna get that fix but he was right man he said what you said he said you gotta go back and get those fillings on so if i was a young kid i would i would be looking for someone that can teach you diagnosis and treatment planning and that's only going to be a prosthodontist or a periodontist and it's a hardest skill set and if you could learn that in five years instead of 25 years i mean life's gonna be a lot easier would you agree with that yeah well i i agree with uh with a number of things you've said and on and it kind of spurts you know some thoughts in my mind um let's go back um and i want to try and touch on a number of the things you said but when you talked about the patient that comes in that it's an absolute disaster they're smoking they've got diabetes it's out of control you know they've got plaque everywhere in their mouths you know and and it's it's it's a disaster you know it's a dental disaster that's the kind of patients that we see a lot of and so the way we approach it is we don't go in and start diagnosing that we're going to do a quadrant you know or to we take it in mostly like a triage you know the first thing we're going to do is as we are determining you know where we've got to go in to intervene you know they do need a root canal or we we're going to have to clean up the decay because we don't want to go into a root canal we're going to put a provisional crown on and we're going to stabilize it and while we're doing that and the patient wants to move forward ultimately into permanent treatment we are going to have them with an oral educator oral health educator in our office who is going to be showing them the bacteria in their mouths disclosing it teaching them how to brush getting them on a water flosser or fusion or something like that and and the amazing thing is Howard is these patients who have been absolute dental disasters start to feel better i mean they start to feel physically better they start to see that they're taking more control of their mouth and they're starting to get the picture that this is the way to really control their costs because if you can get someone who goes in and really cleans up their mouth cleans up their life style cleans up their uh diet they're going to start feeling better and you are building longevity for that patient for your practice and also for long-term dentistry oftentimes i i mean i practiced in Inglewood California which i don't know if you're familiar with ingowood at all but it's right by ellie international airport it's right by the forum it's a community that i watched drop down the economic ladder lower and lower financially and i took that same philosophy you know that i was doing with a very affluent uh community into my care for my patients you know in the inglewood community and they appreciated the fact that we weren't just there to put a crown in or put a filling in but that we were really trying to help them get healthier and get a better lifestyle and a healthier body and you know they were extremely loyal and beneficial and some of those cases took much longer i mean there would be patients that you know the treatments founded over seven years but ultimately we just kept building the pieces that we needed until we got them there we did some very sophisticated dentistry on these patients that needed it but could afford it over a long time period so anyway i don't know if that answers you know some of your question but um i just can't over emphasize how important i think it is to have a systematic plan to help your patient be better so that when you do your dentistry and you're trying to do it to the highest level that you can that it's going to last for that patient and they're going to be able to really take care of it and and feel good about making the investment whatever level it is so i got to tell you something funny when you're talking about do i know inglewood this this is how straight out of kansas i am so i was born in wichita kansas went to creighton undergrad and omaha and then um went to dental school in kansas city a lot of people said why didn't you go to creighton school uh because my parents were catholic they had seven kids in like three days and my brother paul was born after i left home and omaha was an eight-hour drive phoenix in uh can't say was uh four uh but then when i got a senior dental school i wrote the uh department of economic security and i said um you know this before computers laptops any of this stuff and i said what are your economic growth projections and they sent me this big report it all came true that um it was an 85 to 2000 they thought the united states created 30 million new jobs and a half them being five towns it was orange county silicon valley phoenix boston and tampa and i was so straight out of kansas i mean i wasn't gonna go to florida because i the insects are insane everybody has nets around their deal and boston's frozen i'd already lived in that and um but i was afraid of California i mean i just thought well i'm not going to raise a family in California they're all hippies on drugs out there and i was literally scared of California and that's been one of the most interesting things because now that 32 years out of school oh my god some of the most conservative dentists i ever met in my life are from California and here i went into that thinking they were all just wild hippies same same same experience i had with india you know when i grew up you know in catholic school mother teresa calcutta was like you know she was like higher up than the pope and jesus and all that stuff and and they told us how they're all vegans and they only planned and they're so healthy and they're just the healthiest vegan dieters in the world then i go lecture over there the first time every dentist house i walk into offers me a platter of sugar cookies and it turns out that i think i think indians eat more sugar than any uh and anybody uh on earth uh so uh crazy uh crazy misconceptions i got but um all i want to say on this is that um you know when you buy a big purchase that makes you feel good i mean you feel like it's like a congressman like our senator when they get elected to go into office i mean they're only gonna be none for like well what's the big billion dollar deal that you sign i mean humans just don't feel like they did anything unless they spend a bunch of money so i really want to grow my practice so if i just go buy a hundred and thirty-five thousand dollar cereal machine well doesn't that just by itself make me a better dentist no um i i don't even get the serra machine and that's what i'm going to hold you to on this when i talk to prosthodontists they seem to be the least likely to have a cerec machine and i mean and so so you're doing uh the best crowd and bridge margins of the general dentist um why do you not have this uh cerak machine or do you have it or not no we don't and i understand it's extremely helpful you know for a lot of people and they have made tremendous improvements from the original uh models which didn't have good marginal adaptation all kinds of other problems and i think once again like we talked about technology the longer it's there the more refined and the better it gets but the reason that we don't have it is we don't do a lot of one-tooth dentistry so we're oftentimes looking more towards what that patient you know is going to need and we have our own in-house laboratory with eight technicians that just work for us so um we've searched over the world you know to try and find people that were really highly technically trained that could do the more sophisticated work that so many of our patients need so one of the limitations of the cerec is that you basically have a monochromatic restoration and that oftentimes the occlusal anatomy you know is either chosen from a replication of what the tooth was to begin with which often times is worn uh or now you have uh chances you know to pick something out of a directory you know where you can get something that's more uh current and looks like a a not worn too so they've keep modifying things getting them better um but you know just it's not applicable to what we do and and the other thing is i mean you know um i mean none of it makes sense i mean so you know here it is um um okay so i um i prep the tooth i take an ember gum i send it about eight blocks down from my office and there's a guy there as old as me in fact we're on the same diabetes medication and and erectile dysfunction medication and we just have the oh we're taking all the same pills and he's made like 30 000 crowns and then your idea is like well hell with that i got an idea let's spend 135 000 of other people's money and then I’ll train my assistant who's never made a crown to start making my crown i'm like dude you just went from no capital intensive and and this is why i was scared to go into dentistry because uh i was in omaha at creighton and freshman year class um warren buffett came and talked to that in our business 101 class he was in with the dean and he heartbroke me because he said you know number one when you pick a career do not get one that's um capital intensive and don't ever go into a business where someone else sets their price i'm like oh jesus medicaid medicare delta dental they set all the prices and it's capital intensive so it was a really bad idea and my dad tried to talk me out of it the whole time because my dad um had sonic drive-in franchises he had like nine of those and roger carpenter had like a hundred and jim williams had like a thousand and then um and i i told him i want to be a dentist because our next neighbor kenny anderson not only is he a dentist he's still a dentist and and back then you know no technology i go into kenny's and he had this x-ray machine it looked through the tooth and then when he did the impression he had his own lab because back then all the all the dentists had their own in-house lab that that went away and my dad was saying eight years at college he goes after eight years you could only be a multi-millionaire with four restaurants and i said yeah yeah i get it but i don't want to make cheeseburgers my whole life and and his parting shots was well okay but if you're gonna go to college for eight years you at least ought to be a real doctor uh and he kept hound of that in me so he made me apply to creighton med school and creighton dent school and the proudest thing was showing my dad okay i'm accepted to med school dumbass but i'm going to dental school like my neighbor kenny anderson uh who i thought was a real dentist but here's the deal anybody if your best idea is how to make something more expensive uh you're not smart i mean i tell you hold your fingers is your idea better faster easier cheaper smaller and you say uh well i need a hundred and forty five thousand dollars of other people's money okay it should have been killed at that i mean it should have been killed at that but you needed a reason to keep going and um you know i look at those lasers for a hundred thousand dollars i still don't know what they do that i can't do with a one dollar uh scalpel you know what i mean and uh you know just um if you don't have to be smart to spend money where you have to be smart is to do something better faster easier cheaper and higher quality without spending money and when i got out of school average dental office overhead was about 50 and now it's 65 and it's going higher and higher and higher so just go easy on the spending man just really really cozy and she said what she said is if you're just doing crown and bridge and implants i think the market has spoken it's three shape uh but if you're gonna do clear aligners um you gotta go itero because uh invisalign owns that space and they did the incredibly um aggressive i mean i i i can't even believe the fcc let it fly i mean i just think that should have been stopped yeah so and um you know you can you can have a wonderful dental practice without having a scanner you know for chronobridge i mean you don't need that you've got polyvinyl siloxane with a tremendous history and a tremendous accuracy and the important thing this is something that we've really learned the important thing for either is to get the impression of the margins and it is harder to get a good impression of the margins with a digital scan than it is with polyvinyl siloxane uh because you can pack it has to be clean it has to be dry and you've got to take it and we examine all of our um impressions in fact we don't even do it chair site i mean we can look at it chair side but i let the final decision be made in the laboratory by the technicians looking at it under a microscope at 21x that's way better than i'm going to be able to see but honestly if you don't get that impression right like you know Howard the technician can't get a good model and if they don't have a good model they're not going to have a closed margin when it comes back to you and so you've basically built in your short longevity at the time you took your impression so the problem with the digital scanning is that there's a shadow in approximately particularly in a deep margin so if you've got a super gingival margin the digital is really great and it's very effective if it's sub-gingival you have to really do a lot of tricks to try and get it and if it's really deep you're going to be better off taking an impression so that's my additional input for you well that was uh that was very very good uh import um i want to go back to um i slightly mentioned about you know um you know when we talk about dentistry what's really cool about dentistry is you go from kansas to kathmandu to a dentist that practices in a canoe and they all use the same terminology it's very very scientific and then when you go into political science oh my god the every country has a different meaning for the left the right conservative stuff but again the the idea the word first used for socialism was that individuals realize that they needed to own their own land they needed to own their means of production and you and i lived through where when we were little every pharmacist owned the land and building uh just like the dentist did the ophthalmologist did the dermatologist did and and now um they're all going to work for um you know some big company and what i don't like about that is my four boys i'm so glad i never shot them all because they they turned into six grandchildren and the grandchildren i mean if you just looked at the four boys yeah i should have drowned them in the bathtub uh but you look at the six grandkids i'm so glad i didn't do that and and when my grandkids need a dentist if they go to the the dentist and it's owned by um you know delta um or it's owned by wall street well where are my grandchildren gonna go when they need a damn dentist i i don't want him going to a dentist where some office manager is calling every mod a crown opportunity um one of them said the other day that um 40 35 of new patients uh should should have gum disease and need root plain keratin i said well i i hope you go to a physician that thinks 40 of his new patients have chlamydia and just assumes that you do you know uh real doctors think that you should have chlamydia before you're diagnosed with clinician but um but so the the long rant is um you know we've seen this profession for three decades when you look at these babies coming out of school um who don't even look old enough to drive let alone uh be a dentist um do you think that their um chance to go into private practice um is the same chance you and i had or do you think um that it's going to consolidate and they're all going to be working at mcdental's in 20 years i don't think it's going to consolidate and they're all going to be working in mcdonald's you know for gentles mcdental sorry mcdentals um i mean i think that things go through phases and cycles and i think that right now particularly with the extreme um indebtedness that students have when they come out that there is a tremendous tendency you know towards going there i think that the schools are kind of uh planting the seed that that's their only option you know is to go into uh some sort of corporate dentistry and even if they do um you know when we went to dental school Howard um most of the guys because he was all guys at that time went into the service you know and they had two years working for uncle sam in one of the branches and that's how they got their speed up and that's how they became more proficient dentists so i mean going to corporate dentistry for a couple years you know whatever it is to build up their speed get more learning under their belt if if you have a plan and you know that you want to ultimately be independent and you're set up personality wise to be able to handle that to want to be independent want to be able to have the business controls want to be able to control your own financial destiny then if those are things that are important to you then it's a matter of having a plan working the plan and ultimately getting there and it's maybe not going to happen overnight but you can have a long career and demonstrate um so it's a matter of choosing what you want and i certainly would feel terrible for our profession if it just went so that everything just became um a employee type situation i think one of the things personality wise about people that choose dentistry is that oftentimes they want to be their own boss and uh if that's the case for the young students that you know you're dealing with and talking with and the young dentists that have come out i think they still have that opportunity in dentistry well what i want to do is you know i have a um you know i just put on a [ __ ] monitor i mean you tell me uh that you don't want to do all this stuff and you want to pay down your debt and all this kind of stuff you're just going to work for someone else and i say okay well you just graduated from 80 still it's 2020. let's do an easy number five let's go back to 2015 let's get the names of all the graduates and I’m sure they just win got a job for dso and they all lived happily ever after and that is clearly what we do not see we see they've had a different job every year and only when they're so broken and they're thinking okay I’m just going to jump off the uh the you know a building or I’ll finally start my own practice so they just have to get a all new rock bottom and i i don't get it i don't i I’m one of those old grouchy farts that doesn't like anything new because when we got out of school um we didn't have skank of America doing the dental transition bank loans uh the dentist carried the paper so so if i think you're a disaster and you're going to fell in beverly hills you're just you know your your trailer trash from Kansas uh this will never work but if you're approved by bank of America then hell let's do it and I’ve seen so many rotten deals but when we were little the dentist made his money three times so let's add a practice he's gonna sell for a dollar well he owned the land and building uh that was another dollar and uh and then he financed it that was a dollar so he'd say okay um young dental student you want to buy my practice it's a buck and um I’ll be gonna finance it to you for 10 years and at 10 and that interest he ends up selling it for a buck but the financing he makes another buck and then when the 10 years is loaned the only variable in real estate is not having a tenant now you've been in this building for 10 years you have all this brand and then since you're an animal you'll say well i have to own my own land and then you'll buy the land and building because you can't shop it around because you have to you have to factor in how much it cost you to move so those dentists would really screen the person because they're carrying the paper they would make an additional purchase price by financing the paper and then what was really cool is if you got in over your head or you had an upset patient and you said hey man this bill i mean he's threatening he's going to come down here and shoot me he's like i know bill well I’ll talk to bill or they'd come in and it was just a much better system and then when i got out of school it was a very sexist time back then uh the other side of it was um my gosh um old men would never help their boys like my sisters got their college paid for because they were a girl and uh my my dad uh my guy he wouldn't go sign anything uh for boys that was very common back then um so what i do i came down to phoenix and i saw the center and i said how much you want for it and he said 15 and he said 15 square foot for three years and i said okay I’ll go 20 square foot for five and Dave Chatham said okay what am i doing with that extra money i said well you built this 16 acre center I’m a dentist i i don't know how to do you build up my thousand fine then we went down to healthco which was out of Dallas i got rolled into shine or whatever and um they just came in and they loaded the whole thing up with equipment and then they broke it over a 60-month uh um lease to own so i had a free build out i had free equipment i just had to make the payment for 60 months so you would get into a dental office with no money down if you wanted your own and if you wanted to buy one the owner would carry and i just think those were much better i i do not think um it's better than this now but here's what you got to do is you're always asking me about um should i own my own practice or should i be scared here's dentist's problems you know you're the only person in your town that knows right now the difference between a cosign and a tangent you're you're too smart and free enterprise you need to be risk adverse and there's no better way to be risk converse than just being dumb and not knowing what you're getting into so i always say when you get out of dental school it's while you're that young hell you're 25 you could run into a window every day for a year and be fine i had i made my four boys in 60 months I’m most proud of that i mean she was 60 months four kids opened up my practice um i graduated may 11 got open September uh 21st made my four kids and by the time i realized what two horrible ideas these were hell it was too late i already had a practice i had employees i had kids and then and then the next thing you know you blink in that decade is just like a whirlwind and then you're so glad you did it you're so glad it's over but what do young dentists do they think about it for five years and then they get used to a higher income because what dsos do they're gonna pay you just enough money to kill all your dreams and ambitions and they want you to get your spouse a couple babies stay home mother and a nice salary of like 150 and the wife say well well you're making 150 my dad lived in a trailer are you sure you want to take on all this risk so they pay you just enough to keep your heart broken so uh if you're coming out of school and you want to have two kids and start your own practice uh just do it right now don't even think about it because dentistry has about a one percent failure rate whereas you start a new restaurant 20 to 40 percent go bankrupt in the first year dennis it's less than one percent and dennis all go bankrupt for the same thing they have their license taken away why do they have their license taken away eighty percent of time it's alcohol fifteen percent it's opioids five percent it's cocaine um so if you can just not be a junkie or stay clean or get help or go to the betty ford center as long as you can piss in a cup you're not gonna go bankrupt so you know you're over analyzing this uh you know way too much and and i i can tell you this I’ve been in this long enough to know but you couldn't get two you couldn't even get too prostate honest to agree with anything you said today on the show i mean Dennis uh it's like herding cats and i could get my two partners to agree with me we've all seen this thing you know you you really exemplify something that's important for your um viewers to see cures to see depending upon whether they're watching or listening and that is you have a command of economics you understand business and you understand you know the way that a deal is made and i think that most people when they come out of a health education uh such as dental school don't have any business background so one of the most important things they can do you know is to start to understand and get financial literacy um it was my husband who came to me i was practicing with my dad which i was still buying in to the practice which he never thought that i would ever get over buying into the practice with him so i was making a pittance up there even though i was out producing everybody i was carl reader's associate and he was controlling you know my income there too and mark said to me they are building the final building in the four building complex and uh if you're ever going to have your own practice this is the time you need to do it and i remember thinking i can't I’m trapped and this is kind of goes to what you were saying about them giving you just enough money where you can't you know move uh because you can't give up what you are getting but you aren't anywhere near what you feel your potential is and so i remember thinking i i can't i can't do that and he looked at me and he said you have no idea what you can do or what your borrowing capabilities are and so um i i took the leap uh he started his own business at the same time i started mine that was not planned but that's actually what happened and um neither one of us ever ever have regretted you know what we did and i wanted to just have a small practice i had five operatories it was just gonna be me in the office i had five employees i started with and everybody said oh you're gonna grow with this like your dad did because up there we had a 10 operatory practice with 25 employees and i said i will never do that well here i am we have 6 000 square feet we have 25 employees I’ve got three and a half dentists and um but this size if you build it from a small beginning and what you said about the economics I’m doing it i sat my five people down that first day and we didn't even have any furniture in my private office and we just sat around you know the walls and i had supplies set around there too too because we hadn't even set up inventory yet and i said well here's the deal guys i have no money in the bank to pay you so whatever we produce and collect this month that's what we've got to work with to pay everybody and they all just went okay let's go to work and we never missed a payroll and never we had pressure you know on anybody to feel like we were just there for the money it was just doing what you do the best you can and caring for your patients to make a good experience for them and people like that and they send in more people and within uh a year the practice doubled in size so that's that's my personal experience and you know if you have um the desire to have your own practice every time is different but i had to have my parents co-sign for me on the loan because they were still nervous about women but at this point in time we went in and we got a significant loan to go in and change all of our equipment all of our cabinetry and basically remodeled the whole office which is now eight operatories the lab and um we finished all of that the first of march and the 16th of march we had to close for cobid but we knew that we had to then get everything together right away we couldn't sit around passively and wait until someone told us what to do so we just dug in our heels immediately started looking and seeing what we needed to do to move from a universal standard of care to a transmittable disease standard of care set our plans wrote an article which they published in dentistry today and then had everyone back mid-march mid-may sorry and opened up business as usual in june and we have been practicing as pretty much full speed ever since then so whatever your challenges are um like i said if you kind of know what you want to do and um are willing to put in the hard work for it and just set a plan and like Howard is trying to educate you you know have some sort of financial literacy about what you're doing you can make good choices and end up where you want to be so i wish you all good luck um yeah um do you need to go or can you can you stay on a little i mean i know we've gone over an hour but do you need to uh you need to get off yes i thought you might be tired of talking with me oh hell no i i still got some of my uh questions i gotta ask um a couple things uh I’m going um you know i always said you know that the best education get um is in your center i i don't understand why when people want to learn implants their first idea is let's fly to the Dominican republic i mean i never got a in geometry or geography but I’m pretty sure that's a different country why would you go to the airport drive past five periodontists office to go fly to a foreign country because when you have an implant complication you're gonna want one of your best alcoholic drinking buddy periodontists to be able to bail yeah you're not gonna be flying the patient back to mental health so i think the best ce is is your specialist in your backyard and um and a lot of these dentists are asking these questions on dental town and I’m going to ask you one because you're an expert in cracks but they're always young dentistry saying well i took out this mod amalgam and there's a crack underneath it and so the first thing so they they just they freak so they're always going to take a picture they're always going to post on dental town and it's always like you know would you restore it would you do a root canal it's asymptomatic so again i look at that stuff and i understand that you're a baby uh but um you really need to get that part down the best and the best way you're gonna do it is when you write up your best treatment plan is to walk it across the street to the periodontist and prosthodontist and just uh hopefully they won't laugh so hard that they fall out of their chair uh but what do you what do you do when you take out an mod amalgam and there's a crack there because you you've you've you're always been talking about diagnosing cracks and all that stuff yeah well i what i do is i take a picture of it so we can document it because you are now right in the sweet spot of what my research has been with uh professor jim earthman for the last 30 years almost it's like 25 years something like that but um cracks are really important uh it's the third most common cause for the loss of teeth behind carries and and periodontal disease and this whole structural stability of teeth uh and implants is critically important so what we've been working on is uh you know as a diagnostic to make it easier for the dentist to know where their structural problems and where they're gonna find that but let's use your example you know they just took out an mod alloy and because of the alloy and the staining of that you can see that there's a crack running from the mesial to the distal if there's a crack that's that significant and it's a vertical crack that's going down which is what those mesial to distal cracks are then you want to put a crown on the tooth if you've got an oblique crack that's running under one of the cusps then you know maybe you can do an only on that tooth but you're going to need to do some sort of protective covering so that when the person bites down and clenches and bruxes that they're not you know spreading the crack more because just like in a crystal base you know every time it's hit that sharp crack point just keeps propagating until uh you know you run into a catastrophic event so that's um one of the things that we're hoping that we can help dentistry with uh in the future uh with a product that will make it easier to diagnose cracks and fractures and structural instability um you know um dentistry has um you know when my dad was in sonic the whole value chain was family i mean my dad ordered a million dollars of meat from one guy a year so when we went skiing in Breckenridge his family did too i mean you all work together like an orchestra and then i came out of dentistry and oh my god the uh um you know the um you know delta will give them a hundred thousand dollars a year for 20 years they only they only get one letter from you because you didn't cover something you evil bastard blah blah i mean i i remember one time um lecturing at a cda and uh drinking at the bar with uh the the delta CEO and a delta California and um he said uh last year we did 1 billion dollars of cells to these bass ungrateful bastards and he says uh not only they never invited me to speak but they got look at the name of this title it was bill Dickerson and the name of his lecture was delta or the devil he goes can you believe these ungrateful bastards all we do is go out there and sell stuff so that they get a subsidy and and we get treated like crap and um so the um they'll they'll show me data but they'll show me data like that if the endodontists do millions of root canals on a six-year-old just pick one to keep it standard number three and to get rid of old judgment we're not like well is it failed is it short is rpa no is it is it gone has it been extracted when general dentists do a mole root canal on three in five years ten percent of them are no longer found on the radiograph when endodontists do it it's five percent but the endodontists say it's probably a diagnosing error on on a crack i mean they go right to the crack they always think i probably yeah it probably got pulled because i didn't get an a on the diagnosis but what i do with that stuff i don't even care because we warranty everything five years because when you get young kids out of school some too they'll snap at a gum line and whenever you're playing with other people's money the entire government uh no one even cares so you're like uh oh well I’ll do a root canal a post build up and I’ll put on a crown and I’ll just be a hero and then a year later they come in it's in their hand and then they say well do i get my money back and you're like well no it's not my fault what am i gonna do and it's like no you're gonna warranty it five years because if the average person loses me 80 uh you know i mean they're gonna have to if you're demonstrating the last five years and everybody's gonna live to be a hundred they can't afford to have all their fillings fixed uh 20 times do you like the way i could take 100 divided by 20 and arrive at five uh yeah I’m using a calculator over here uh so so the bottom line is um just get your diagnosing and treatment plan skills it's the most uh important thing you're ever going to do absolutely i just can't say that enough um so prosthodontist um they start their website is um what do they do it's um go to a pro and i gotta tell you the funniest prosthodontics deal i remember when i started my uh uh media company I’m a dentist i got an MBA but i i started the Ferrari report in 1994 so i consider myself a dental journalist I’ve had a monthly column ever since and my sister i mailed it to my two sisters in the nunnery and uh my sister Mary kay uh sister Anne of Yahweh she used to be married she read it and it was about process and she called me she goes what is a prosthodontist and i say um well why why why do you ask and she goes well i know you know Mary Magdalene is a prostitute i know presto is artificial and tutas love so it's is it love of dentists and i said now it's odonto greek uh but it's an artificial uh tooth but i I’ll still always laugh about that the rest of my life uh she uh the first thing she saw when she saw prostitutes was prostitute Mary Magdalene that is just hilarious uh but um you say go to a pro and um you know uh orthodontists are under assault because um they were mad at general dennis when they started doing Invisalign and now it's like now they're like forget the dentist i mean now they're they're skipping the doctors and smiles club direct um but do you but what i want to go to is do you think the go to pro go to a the message go to a pro process on us because i see it with the Florida orange juice they're trying to build their brand drink flour oranges do you think the concept go to a pro do you think it's working um i think that i think it is in some uh manner i mean I’m in a I’m in one community you know that's um a little bit more um well i don't know if i call Newport beach urban but but it is when you compare it to many other uh cities throughout the country um so the people that we see have either been referred in by a dentist or they've been uh referred in because they've got complexities and so uh other people have told them to come see us and then we also get patients who have absolutely no idea of our capabilities they just would heard that we were a good dental office and so they come so we kind of have this mix but if you've got a problem i mean if you've really got a problem i think that most patients are starting to be a little bit more sophisticated in their choice of who's going to help them with the problem particularly if they've been treated and they've had failed treatment uh that's oftentimes you know we feel like we're the caboose on someone who's been treated numerous times and then you know they end up in our office which um creates some problems of its own because they're emotionally exhausted financially exhausted and they don't trust much anymore so it's a kind of a unique group to care for I’m glad the whole practice isn't that way but we do have some of those so anyway go to a pro uh is it effective um i guess it is limited they also now what is the new um the new motto is um your smile are what is it your smile are something or else it was it kind of changed the the approach a little bit your smile are commitment they're just not bad it's it rhymes better anyway so we'll have to ask them if it was effective or if they just changed it because they wanted to this is dentistry uncensored uh we've gone over an hour i can't believe uh my gosh kyle how much time are we on how long have i oh my god i got Cherilyn sheets for an hour and a half I’m gonna ask this question the last because if if it's entirely inappropriate we'll just cut it off right here but uh um i know you're a usc legend and you are and that school is amazing and they've gotten some black guys over at the usc med school the dean was uh having some wild and crazy parties and then uh the usc the um the whole uh scandal where kids were uh parents were trying to uh bribe their way to get in schools there um did you look at that as an adult and say you know if you have 100 apples when I’m drawing or [ __ ] happens or was that a black eye on usc and did it hurt you because i know you're a big usc fan oh well i think anytime uh your university has problems you know that they run into like that the goal is to hope that the current administration and the people are in charge been corrected but the dental school uh has not had any direct connection you know with those uh problems that have been on the main university and the main medical health science campus so i think that they've been working really hard avishai saddam is a great dean he's been really trying to increase the significance of all of the programs the teaching programs are going on there and they tend to be very innovative so certainly uh they've got some great people that are there they've got pascal monye who's just incredibly talented uh there's just so many people that are luminaries that i think they feel wonderfully blessed to have on their faculty so i i wasn't too concerned about the dental school but certainly when you hear that uh your school's name is blast all over the place is doing some things that were inappropriate that's not the best news of the night i was just sad that when the med school dean was caught with drugs and prostitutes um i i was embarrassed it wasn't the dental school dean because dennis are so boring that if we actually got caught with drugs and women it actually they're like damn i didn't know that my dentist could do that it would have actually helped uh our brand uh they would know maybe the dean of kansas city is gonna have that happen to him then you can feel that way for real oh my gosh um but um was there any um one uh well i don't want to ask that one um i was going to ask you about uh saw endo because there's another example where these dentists are doing a great job and um and then someone comes along and says uh well let's just add a hundred dollars of uh variable cost uh stuff to it i mean i mean again my bias comes from this you know everybody remembers henry ford but you don't remember why there were 86 other car companies the car was invented in Germany but the model was always five or six guys build a one really expensive car for a king or queen and henry was the guy who came out and said no we're gonna build a working man's car and and who's going to make a 5 daily wage and so if your idea if your best idea is to make something twice as much money um you know i grew up poor and uh you know and we had we had seven kids my dad delivered bread at rainbow bread but he saved his money and bought him a bought a sonic franchise when i was 10 and that peeled my eyes out i couldn't believe the lifestyle uh that it changed but uh um sawnindo i mean it's another 100 000 machines a bunch of stuff uh cost i mean if if all if your only idea is to do something better by spending a lot of money then you're cut out for kings and queens and uh i had um what was my last question that i wanted to uh ask um oh what last final question one final question the final question sorry the final the final final final is this if you're in dental school um you might have missed this infinite wisdom on the difference between women and men there's only i mean it's if women go up in something men have to go down and women always marry up you could be the valedictorian of a dental school and marry the waitress from the waffle house if she had just the right butt in a pair of levi's and every woman dentist you'll ever meet in the rest your life they're always married to bankers and lawyers and prosthodontists and this and then every time i meet the dentist and his wife it's like she couldn't get a job at the waffle house she'll never get a job she does she spends ten thousand dollars a month so you get married at 10 at 25 to 65. you marry the stay home destroy ten thousand dollars a capital a month for 40 years versus you you're i want you to look around your dental school class right now i don't i don't care what they look like you're going to find one in that room and you're going to marry it because she's going to make 10 000 a month from age 25 to 65 so destroying 10 000 a month to making 10 000 a month is not only a 10 million dollar difference but here's something really neat if you have a postgraduate degree if both spouses have a postgraduate degree in the same thing it's the lowest divorce rate in America it's under 10 percent when two dentists two lawyers two whatever get together because you have something to talk about you have something in common so if you marry that girl in the class you just got rid of ninety percent of divorces instead of having someone that spends ten thousand dollars a month you have some that makes ten thousand months but if you always wonder why women dentists are so damn happy it's because they know their husbands at work right now and if i look at you and you want to know why you're so stressed your wife is so clueless that she's like this my husband's really really stressed so I’m gonna surprise him i just bought first first class plane tickets to Hawaii and i rented a a suite and we're gonna go there and and get lying things on our eyes and we're gonna rejuvenate yeah when it's over you're gonna get your visa bill and you just destroyed another 10 20 30 000 and and if you say to that person well let's not go to Hawaii let's just go camp to the lake she's like why do you think i married you i mean look how good looking i am look how you're not uh it's because you're a dentist a doctor a lawyer and this homie uh don't go camping most dentist wives if you want to hide something from them you put it in the oven and their idea of camping is going to a hotel that doesn't put a chocolate mint on the pillow so Mary smart Mary smart i can't drive that message home enough Mary smart when you're in dental school marry like a girl find someone who's smart talented ethics hard work do not fall for that optical illusion that your eyes are playing on you so is that the same uh advice that you'd give the women students i just hardly ever see any example i mean i almost never ever meet a woman dentist who married some nut job okay i mean i mean even like a low job for a woman dennis would be like an accountant unfortunately unfortunately and I’ve probably been around more women dennis than you have um i have seen a number that have married people that definitely didn't share their same work ethic and actually saw the woman dentist as being the bread and butter for the family and those marriages didn't survive either so i think really maybe the crux to the message that you're trying to say is to choose carefully make sure that you're not just letting your hormones you know make those decisions but that you're making sure that you have a common value structure a common um way that you can carry you know your lifetime together as a partner and that uh that that's something that is going to be critical for myself my mother-in-law thought that i was way above my husband's family i i was raised to have no concept of um hierarchy amongst you know uh different levels of society my parents just raised me to think that everyone had value and I’m just very grateful to them for that but that wasn't the case with him so i she was concerned that i was going to dump my husband but actually he was my best friend we met when we were 17 we went through college together i saw him always being supportive of me and i had guys in my class who wanted to marry me and you know what their reason was Howard because they thought that we were a two-income family and therefore you know it was going to be a good business arrangement but that wasn't what i was looking for i wanted that soulmate that partner that i knew i could go through life with where i would be supportive of him and he would be supportive of me so you know i think that those are all good things you know for everybody to think in terms of because choosing your mate is probably the most important thing that you're the most important decision you're going to make in your life and you want to have someone that is going to be there for you and you're going to be there for them i got out of school with 87 000 of student loans my divorce was 3.8 million cash so my my my uh student loans are my divorce was um 43 times more expensive than dental school so again it's a huge decision and here's my decisions um marry like a woman marry with your brain not your gosh darn uh retina uh number number two uh own your means of production and every time um every time uh something goes uh south uh the employees are all let off but the owners are fine and then if inflation ever takes off uh owners can raise their prices but not people who are renters of their time so uh I’m gonna let you go uh you're uh there's fires thank you so much for coming on the show thank you for being my role model as i was getting my fagd at matd i saw everything he did and uh if you ever want to um if you ever want to put an online sea course on downtown we put up 400 one-hour courses and they've been viewed over a million times so if that's something you want to ever do with your uh uh Newport coast oral facial suit sherilyn sheets thank you so much for coming on the show thank you Howard it's fun being with you
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