Mark Frias, RDH, works at a busy office. When he first saw the Isolite system, he realized how valuable it would be to have hands-free suction as a hygienist. He bought an Isolite system himself in hopes that his employer would buy one for every operatory. When the owner refused, Mark took matters into his own hands and created a low cost, portable tubing system that connects to Isolite mouthpieces. Now he is looking to scale production and monetize his design. Listen to his journey in today's episode.
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HSP #54 with Mark Frias Audio
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HSP #54 with Mark Frias Video
Links and References from the Show:
KonaAdapter.wordpress.com - Mark's website for Kona adapter's here!
MarkRDH.com - Mark's blog for product reviews, expert interviews, how-to videos and general thoughts
Contact Mark at email@example.com
or via his Dentaltown.com profile: konarocky
Mark Frias's Bio:
Mark Frias, RDH is the designer and owner of the Kona Adapter, a full-time hygienist since 2007, and a blogger at http://MarkRDH.com. His blog focuses on product reviews, how-to videos, interviews, and his general thoughts on dental topics. Before his dental life, Mark served in the U.S. Air Force from 1992-2003 as an Air Cargo Specialist and then as a Manpower Analyst.
Websites, Emails, Phone Numbers and Products Mentioned:
It is an honor today to be podcast interviewing Mark Frias who is a go-getter mover and shaker dental hygienist. You have been doing this since 2007, you have over 1000 posts on our Hygienetown, Dentaltown, I want to thank you so much for that. Tell me, for every dentist in the United States, most people are always saying we have over 150 000 dentists, but there’s like 250 000 hygienists.
And every dentist has got one or two, I have three, tell me what’s hot and what’s not in dental hygiene, because I know you’re totally on top of it, you’re on top of products, you’re on top of everything. What would you tell us what’s hot and what’s not in dental hygiene?
Mark Frias: I would say probably the biggest thing Howard is I think hygienists want to be more independent, I think they want to- quite a few states have public health hygienists, my state does, they passed it in 2009.
Howard Farran: Tell them what State, you’re in Massachusetts, about 15 miles outside of Boston?
Mark Frias: That’s right, and you know that allows hygienists to have their own business basically and they can go out into public health areas and do hygiene basically.
Howard Farran: Okay just, explain that, you say public health, you mean just for screenings or can you set up your own dental hygiene office and do cleanings and recalls?
Mark Frias: Yeah not an office, usually it’s mobile, like maybe going to a nursing home or a school or pre-schools or something like that, and they go and do screenings, do fluoride education, stuff like that basically.
Howard Farran: Are you doing that?
Mark Frias: No, I did take the course though actually, but I decided to not do it.
Howard Farran: Okay so what states have where hygienists can independently practice- Colorado that was the first?
Mark Frias: Yeah I think Colorado is basically the only one that allows you to see any patient, which is I think what hygienists want to do, they want to see, be able to see any patient.
In my state when they did pass that in 2009, there was a battle between hygienists and dentists of course, and they wanted to be able to see commercial patients and see anybody, and then the dentists wanted the assistants to be able to scale teeth, so that was a battle between those two. And so what happened was they both backed off and dentists backed off on the scaling thing and hygienists said okay we can always see Medicaid patients or cash patients, but not commercial insurance.
Howard Farran: I just read a great book on the Google way, and their CEO that took it from 2004 to 2014 from basically you know, 500 employees to 50 000 employees and they said at Google that whenever they had debates like the one you just described, Google said well what is best for the Google user.
Let’s forget about all of our little departments and all this, and they gave the analogy of a remote control, and he said the reason nobody can use a remote control is because you have all these little, this is the DVD department, this is the VCR department, this is the HBO cable and then we get a screwed up remote control that’s just crazy.
And I always look at it and think what’s best for the consumer, you know when I look at the fact that there’s 117 towns where half America lives, and there’s 19 022 towns where the other half live, and probably 20% of those towns don’t have a dentist or a hygienist and in Colorado where they legalized hygienists to be independent practices, they’re all in towns of about 1000 and most of them have their dental chair inside their house and don’t have any overhead of rent and mortgage, equipment, all that kind of stuff. I just think these debates are beyond silly. I think everybody should just get together and say what would be the best for seven billion earthlings or 330 million that live in this country and you can’t be doctor focused or hygiene focused, we’ve got to be patient focused and access to care is huge.
I wish every town of 1000 for sure had a dentist or a hygienist but you go into a big city like Phoenix and there’ll be 20 dentists in one building, you drive an hour out of town and there’s no-one.
Mark Frias: Exactly.
Howard Farran: So it’s crazy. So Mark as a hygienist, you know we say we manage people, time and money and technology, what technology have you seen in your career that you think makes it easier for you to do hygiene better, faster, easier, at lower cost and see some hygienists not using that and thinking they should do this or that. Talk about that.
Mark Frias: Yeah the one thing I would say and it’s not really a new technology, it’s just the use of power scaling, you know Cavitron, PIEZO scale or whatever and to me, there’s so many hygienists out there that hand scale so much, that’s one thing I don’t understand. Because to me I basically 90% I power scale and 10% hand scale maybe, to finish up and it’s so much quicker and more efficient I think, and I just find it confusing why some hygienists don’t utilize it more. So I’m kind of confused by that. Some of the other products I use, I see a lot of Medicaid patients Howard, about 70% Medicaid.
Howard Farran: And explain about, let me explain what Medicaid is for international viewers, so in the United States, they have national insurance for the poor and the elderly called Medicare and then at the 50 state levels they have Medicaid, so when someone like Mark says Medicaid, it would be different in all 50 states, you know, the reimbursement and what, so explain when you say you do a lot of Medicaid, explain what that’s like in the great state of Massachusetts.
Mark Frias: It’s well, Medicaid, it’s called MassHealth in my state, they all have a different name, but it’s really a state program that’s Federally subsidized, it’s kind of a partnership, whereas Medicare for seniors is a federal program pretty much.
So we see the lower income patients a lot one of the big problems with seeing Medicaid, and that’s probably the primary reason why most dentists don’t take it, is because of the no-show rate that we have. It’s about a 50% no-show rate and it’s very tough to manage that.
Howard Farran: So why do you think the poor have more no-show rates than the middle class or the rich?
Mark Frias: I think one is maybe you don’t value it as much, I know with commercial insurance they have to pay some kind of co-pay or something like that, whereas Medicaid they don’t pay anything at all.
Howard Farran: So they have no skin in the game.
Mark Frias: Exactly. Because what happened, for us in 2009 we had adult benefits and we saw adults. And they cut the benefits for the adults, and they cut it 100% so we’re just seeing, I mean we saw adults still but either had to pay cash or whatever. They since brought the benefits back, but to me instead of cutting it 100% I think they should have just cut it by maybe 90%, sorry I mean by maybe 10%, and have the patients pay something.
Because they were cutting, they were cutting the benefits to save money in the budget, in the state budget, so to me if you just make them pay like maybe 5% or 10%, that’s going to automatically cut their spending, because some people are just not going to pay 5% or whatever it is, so to me that would have been a better idea to do that instead of just cutting the benefits totally.
Howard Farran: And that is one thing, you know you think about liberals, or a lot of time it’s associated with the poor and conservatives are more the rich, but that is one economic lesson that I wish everybody would realize is that if a person isn’t paying something and has no skin in the game, free, it distorts the incentive.
Like if you hand out government cheese and you know a brick that should be $10, if you charge free- people will just get it and use it as a doorstop or dog food or go home and get in cheese fights. But if you just say, you are going to pay $1 dollar for something worth $10, now they start treating it like, they start making better decisions. But free is almost never a good idea.
Mark Frias: Yeah.
Howard Farran: And I think a lot of countries around the world with socialized universal health care, just not having any co-payment at all, it just really distorts utilization, no-shows etc.
So what is the low hanging fruit for someone who is as highly intelligent, and motivated and on top of your game like you- what is the low hanging fruit advice you would give to dentists who have a hygiene department, to hygienists, what are the things, what are the easy things that you think they’re not doing that they should be doing?
Mark Frias: I would say in some cases dentists maybe though let their hygienists pretty much manage perio like in a sense. I know some dentists micro manage their hygienists and I understand the legal aspects of it, I know that we can’t technically diagnose and all that kind of stuff.
Howard Farran: Yeah but you know any hygienist in jail today for diagnosing or reading an x-ray?
Mark Frias: I think it’s zero.
Howard Farran: Yes, so I think that goes back to the old, ancient, we’re a social animal, and if we all didn’t nod to the four hundred pound gorilla and we all work together, lions couldn’t pull down a cheetah, monkeys and apes wouldn’t have survived, and it’s just counter intuitive to our biology to delegate and release and quit trying to control everybody around us, and my gosh there is nothing that I- the biggest low hanging fruit I see for hygienists, I mean I see, I’ve been in 1000 dental offices where the hygienist just doesn’t say anything, and then the dentist goes in there for a five minute check and puts a mirror in and there’s a bombed out tooth, and he has to start out from scratch.
And in the most successful practices hygienists would have taken a bitewing, would have diagnosed it and said now you know this tooth, you know needs a root canal and a crown, and if you extract it, you will need an implant but we’re not going to place the implant right away, we need to do a bone graft, and it has a whole hour to explain all this stuff, and in the super successful offices, they look at their hygienists like you and say oh my God, you can do so much for me, and let you go.
Kind of like the most rocking hot bands of the ‘70’s were the ones who got backup singers and let ‘em rip. And then all the other bands said well no I’m not going to do that, she’s competing with me, and then they would go to tape, in fact there was a movie about it called Ten Feet from Stardom. And they’d say you’re singing too loud, and you didn’t follow the sheet music, and these bands went nowhere. And having your hygienist be like the backup singer for Mick Jagger the Rolling Stones or David Bowie or any of the great ones who just let ‘em rip, my hygienist when I walk into the room, I don’t have to explain anything.
Mark Frias: Yeah I mean what I do personally Howard, because I work out of eight chairs, because I see a lot of pedo and adults, so I hop around quite a bit, because of no show rate we overbook and sometimes it gets crazy and so I’m not there all the time when a dentist comes for the exam, I’m just all over the place, so what I do is I just write down stuff.
Like I write down occlusal on three, whatever, just because you know they’re trying to go faster because it’s a pretty high paced situation so you know they’re in the mouth whatever, three minutes, five minutes, and I’m in there for a while so I see stuff, you know I wear loupes, I wear 4.5 loupes so I can see.
Howard Farran: 4.5?
Mark Frias: I do.
Howard Farran: I don’t want to embarrass you Mark, but I want to ask you, how old are you? I’m 52, how old are you?
Mark Frias: 42.
Howard Farran: Okay 42, so I see, when I go and do practices it looks like the hygienists and dentists under 30, they never have loupes on. And their comeback is well Mark you’re 42, Howard he’s got one foot in the grave, he’s 52, of course you guys in your 40’s, 50’s wear loupes. But do you think they should be wearing loupes in hygiene school? Do you think if I just graduated from hygiene school and I’m 25 years old, do you think I should be wearing magnification?
Mark Frias: Absolutely. I think some hygiene schools actually mandate it now, and some dental schools I think do too. They started us off with 2.5, which to me was okay, I didn’t have a headlight at the time, to me, having a headlight makes a huge difference.
Howard Farran: Name brands, what are you using, what names?
Mark Frias: I have a cheap pair of MedLite loupes, they’re very cheap but they work very well, they flip up.
Howard Farran: Okay, MedLite.
Mark Frias: And I use LumaDent light. I used to have the Sheer Vision light, the Infiniti, which is a nice bright light but had the flickering problem with the wire and all that, so I switched over to LumaDent, I have two of those.
I have back up loupes, just in case because I want my loops.
Yeah so we started with 2.5 in school, when I had the overhead light it was kind of difficult to use, and then after hygiene school I put it away and I used an overhead light and no loupes, and then one day I bought a cheap headlight and it was pretty good, so I pulled out my old Sheer Vision 2.5’s, I bought the Infiniti light, put it together, and to me it was like I could see for the first time it was nice having it.
Then I just jumped to 4.5, I was thinking of 3.5 but I thought I’d jump to 4.5 and go for it, and I got used to it pretty quick so that’s max for hygienists. I mean for hygienists it would probably be 3.5 for most people, but I mean I like seeing, so it’s really cool.
Howard Farran: Yeah, I jumped to 4.5 too and I make everybody in my office, the assistants and hygienists, everybody has to wear magnification, because you know you wouldn’t do dentistry blind, and you know telescopes, you know, you can see those planets a lot better- so tell your background with Isolite.
Mark Frias: Yeah so basically I started 2008, I worked for Cool Smiles Howard, I mean there’s a lot of stories about Cool Smiles, but the first place I worked in Boston in Roxbury, that was the first Cool Smiles I worked in. We had ten chairs in that office, so I was really hopping around in there.
I found the Isolite on Dentaltown on the forums and of course they were talking good things about it, but that was at hygiene school and there was no way I could afford it and there was no way the school would let me install it because it was a big deal to do anything in school, so in 2008 I decided to buy my own which cost me- well I had the Dentaltown discount at the time, and it was like $1400 and they give you like four boxes of mouthpieces which is a good deal, and I installed it.
My hope at the time was like, they’re going to love this thing and they are going to buy it themselves, you know, so I was just kind of trying to prove it to them, like yeah, I showed the dentist of course they were like yeah this is great, but they’re not going to pay for it, the corporation, you know, which they didn’t.
I was kind of naïve about it. So I had it in the one room, I really couldn’t use it because I was you know, nine out of ten chairs I couldn’t use the Isolite, I couldn’t move it around, it wasn’t feasible. So I kind of put it away for a while and didn’t use it and maybe six months later I sold it to my wife’s boss who’s a dentist, he used it because he does a lot of observation patients, and 2010 I just decided, I pulled out a mouthpiece and I started tinkering around with it, to see if I could figure out a way to hook it up to the HP valve.
Howard Farran: Explain HP valve to a listener who doesn’t understand that.
Mark Frias: Yeah, it’s a high volume evacuation, you have two different valves, in a typical dental office you get the saliva ejector valve, some people call it slow speed, and some people call it high speed with an HVE suction. So the Isolite hooks up to that system, that high volume system.
With Isolite you have to disconnect that and install it. So I was just sort of tinkering around with a mouthpiece, with a saliva ejector, actually they posted something on Dentaltown about it and I showed people how to use a saliva ejector as a cheap way to do it, and then I just figured out this design.
I couldn’t make it myself, I went to Home Depot many times in the plumbing section, trying to kind of, with elbows, and just playing around with stuff, and so I just thought I’d find someone like a machinist or something, somebody that could do something.
And I just kind of started the journey for me just Googling for months and months and learning manufacturing and all this, and it was kind of a pain but I got answers from people, I emailed a lot of people and then at some point I figured like I was making it for myself personally, something I could just do portably, have a portable connecter, I can go from room, from chair to chair, and then I just thought like hey, maybe I can sell this thing, and then I just decided to do that basically.
Howard Farran: What did you name it, Kona Adaptor?
Mark Frias: Kona Adaptor yeah.
Howard Farran: And where did the name Kona come from, is that coffee from Hawaii?
Mark Frias: I guess there were emails from dentists there you know, is that like a Hawaiian thing or something, I said very indirectly, because at the time, I named it after my dog that had already passed away, a Rottweiler, her name was Kona, but I wanted to name her after something bicycle really, because I’m into bikes.
Howard Farran: I see the bicycle pump behind you.
Mark Frias: Yeah, there you go and so Kona is a Canadian bike manufacturer.
Howard Farran: Really?
Mark Frias: And they have a whole Hawaiian theme with all their bike names and stuff, so very indirectly yes, named after the Hawaiian you know, Kona, but that’s really my dog basically.
Howard Farran: I’m sorry to hear your dog passed, that’s tough.
Mark Frias: Six years ago yeah.
Howard Farran: And so are you an Iron Man or do you just do triathletes or do you only do cycling or?
Mark Frias: I used to race a lot Howard, bikes, I did bike 10 k’s and 5 k’s. I raced last year a little bit mountain biking but no swimming though. I’ve thought about triathlons so many times but I don’t know, I love cycling.
Howard Farran: Are you a big Lance Armstrong fan?
Mark Frias: Absolutely.
Howard Farran: Are you?
Mark Frias: Yeah.
Howard Farran: That was a weird ending to that legend, wasn’t it?
Mark Frias: Yeah well I see it as, yeah he cheated but you know, it’s all relative I guess at the time.
Howard Farran: Yeah. So are you still a big fan of Lance?
Mark Frias: Yeah. Yeah.
Howard Farran: Yeah, that’s what he claims, he claims he was in a race in a sport where everyone did it.
Mark Frias: Yeah, yeah.
Howard Farran: That’s what he says.
Mark Frias: Yeah, I don’t think it’s just cycling too, I think it’s a lot of sports, Barry Barnes and you know, everybody else.
Howard Farran: Yeah, so everybody thinks I’m cheating but this body is all natural.
Mark Frias: Okay.
Howard Farran: And I’m not wearing a wig.
So I want to ask you a question that- I want to address the large variances I see.
I see some offices just big into fluoride treatments and fluoride varnishes, but let’s just talk fluoride treatments and fluoride varnishes, explain to our listeners what you see as the difference and why do some offices- haven’t done a fluoride varnish in ten years, other offices do them ten times a day, and fluoride treatments, they vary so much, they vary from a swish to trays to all that stuff, can you talk about those two issues and what value you see in those, in those techniques and or products you know?
Mark Frias: Yeah we, when I started off with Cool Smiles we only had the foam, the trays, and they only used the fluoride varnish for like, very little kids that really couldn’t tolerate the tray. And so when I started there I was like why don’t we use the varnish for everybody, because to me I think it’s a better product, it sticks on your teeth for hours and hours you know, and it’s a lot easier for anybody to tolerate, you just brush it on, it’s quick, and price wise there’s not much difference, it’s pretty much the same. I think we pay like a dollar per varnish and we charge I don’t know, 26 bucks I think.
Howard Farran: So you - you use a pop vial or what product do you use for the fluoride?
Mark Frias: Well we use Benco because Benco is our biggest supplier so they have their own brands. So that brand is not the best but there’s other ones that are, you know, go on very thin supposedly, I haven’t tried those yet, there’s quite a few out there that claim that.
Howard Farran: And how is that applied, it’s in a canister?
Mark Frias: Yeah, individual use, it’s got a little brush in there, you just mix the fluoride varnish and just dry the teeth, apply it to the teeth.
Howard Farran: And you like that better than a foam or a tray?
Mark Frias: Yes way better, I think. The only negative about it is you know, kids or anybody really, their teeth don’t feel clean after that, so that’s why I think I try to find then the best brand is important.
Howard Farran: So Mark do you pay attention to age? I mean does age determine who gets a fluoride varnish or not? Is it CAMBRA? In California CAMBRA is the big thing, the caries assessment profile risk, I mean if some guy as old as me, 52, came in and had eight cavities and just got those filled and just came in for the cleaning?
Mark Frias: Well in my office Howard, you know because we see Medicaid, it’s tough to sell that to the patients, even though I try sometimes, but only kids get it because it’s covered by insurance of course. But yeah some people you know if they have recession, root caries is a problem, sensitivity, so fluoride varnish is good for that kind of stuff. We don’t really try to sell fluoride to adults but we should, in some cases at least.
Howard Farran: Yeah and when the corporate chains do it successfully, a lot of people grumble, you know because they don’t do that, and they accuse them of up-selling, but take reimbursement out of it, I mean, if you have a high caries index you should have a fluoride treatment.
Mark Frias: Exactly, and maybe even prescription, PreviDent or something like that to take home.
Howard Farran: PreviDent to our viewers, regular toothpaste is 1000 part per million and PreviDent is 5000 per million.
Mark Frias: I would use MI Paste, that’s one of the things that people also recommend.
Howard Farran: MI Paste?
Mark Frias: Yeah.
Howard Farran: Explain that.
Mark Frias: I’m not sure what the ingredient is, maybe something like NovaMin, something like that, something mineralized, basically like fluoride.
Howard Farran: Oh by the way you never told our viewers and listeners where they can get the Kona Adaptor.
Mark Frias: Oh they can Google it and it will come right up. I use a Word Press blog page where all the information is: konaadaptor.wordpress.com.
Howard Farran: And that is mainly so you can carry your Isolite easily and quickly from room to room?
Mark Frias: Basically yeah.
Howard Farran: So I would think Isolite would want to buy that technology patent from you?
Mark Frias: I would say, yeah.
Howard Farran: Are you trying to get them to do it, are you in touch with them?
Mark Frias: Well actually it’s funny you ask, because I never heard from them ever over the last four years, you know people ask me, oh you should work with Isolite and I got an email a couple of days ago from the CEO and because we have the Yankee Dental coming up.
Howard Farran: Yes, in Boston.
Mark Frias: And on the 31st I’ll be going, I’m talking to the CEO Sandy Hirsch and she wrote me a very nice email and said they want to work together in some capacity, so we’ll see.
Howard Farran: She’s an outstanding lady, I love that whole team. And Yankee has moved from- it used to be in the downtown Convention Centre and now it’s moved out towards the ocean.
Mark Frias: Yes towards the water, they have a new Convention Centre there.
Howard Farran: What do you think of that move?
Mark Frias: I went there, it was good, I went there, it’s very easy to get to, it’s a lot easier to get to, I went there for the ADHA Convention, their annual meeting, but that was 2012 maybe, something like that. So I went there for that, not as crowded as the Yankee.
Howard Farran: Yeah and then they got the- for tourists out there, what is that, an Independence Walk or Independence Avenue, the walk, or what is it?
Mark Frias: Yeah there’s a historic trail.
Howard Farran: What’s that called?
Mark Frias: I don’t know, I forgot.
Howard Farran: It’s phenomenal.
Mark Frias: Yeah I haven’t done it Howard, Freedom Trail maybe, something like that, I don’t know.
Howard Farran: Yeah, amazing, you have to go, and it’s just like Arizona, when you go to the Grand Canyon, there’s no one there from Arizona, everybody there is from Japan and Germany, and half my friends that I know here that are born and raised in Arizona have never gone to the Grand Canyon but it’s a must.
Plymouth Rock is not as big as you’d think it was, or describe to the viewers how big Plymouth Rock is.
Mark Frias: It’s not eventful, it’s about-
Howard Farran: How big is it?
Mark Frias: I don’t know, it’s probably about half the size of a Fiat, maybe if that, not even.
Howard Farran: Yeah.
Mark Frias: It’s very small.
Howard Farran: Yeah, I was thinking it would be something that you’d set a lighthouse on top of, and it was something that you could fit in the back of a truck.
So what else would you like to talk about? Talk about selling, you say selling is not a dirty word. Why does everyone in dentistry say I didn’t go to dental school eight years to be a salesman, so why is selling not a dirty word to you?
Mark Frias: I wrote a post about that, Howard, about why hygienists should embrace selling, and I tried to explain very clearly in the beginning that there’s a big difference between ethical and unethical selling.
You know, selling is not inherently bad. Selling is just persuading or convincing people to do things, to make a choice basically. So that choice could be a good thing like in the case of a hygienist, you are trying to convince somebody to go through perio treatment, right, or it can be a negative thing you know, you can try and rip somebody off like whatever, I don’t know.
I’m not a big fan of ARESTIN, you know, if there are some places out there that place ARESTIN you know fifty sites, it’s very expensive and maybe that’s a little too much, you know, or something like that.
Howard Farran: So that’s ARESTIN and what was the other one, Periochip?
Mark Frias: Periochip, Atridox I think is the other one, something like that.
Howard Farran: Do you use any of those regularly?
Mark Frias: No, I did in my first office that I worked in, in general practice, a small office, one dentist, we had ARESTIN and we used it very, very locally and you know, not too much just here and there. I’m not sure how good it is, you know if it works well, I hear pros and cons.
Howard Farran: But back to selling, what do you think, what do you think a hygienist should be doing?
I mean my advice being a dentist is, dentists please quit trying to be a control freak and free up your back up singer, your hygienists who’s in there for an hour, and don’t give her a script, let her run and fly, this is his or her career, let them go.
Mark Frias: Yeah well the three things the hygienists do, right, is we do perio, we do prevention, we do education, that’s drilled in our head in hygiene school.
So we should be the ones that kind of maybe manage those things and since the hygienist sees the patient the most for the longest time, the hygienist should be, you know, first of all looking for things that help the dentist find things, the decay or whatever, they should also be setting up the dentist if the patient maybe was say you talked about getting implants or something six months ago.
Just talk about that again and maybe convince the person to do it. But they should also be able to educate their patient on things that the dentist does or the office manager does if it’s care credit or something like that. You’re kind of setting up the office manager to help process that- their application. So for me the hygienist is in a perfect place to kind of launch for everybody, to get it started I guess.
Howard Farran: So you talk about the hygienist should do perio, they should do prevention, you talk about fluoride treatments, education- do you use any aids, do you use some of these like KickerApps.com has a great– they’re the number one selling app or KC or do you use an intraoral camera? Do you sell with a blown up digital radiography? Talk about sell education aids.
Mark Frias: Personally I use that- a DBS app. I don’t have it any more, I had it on my iPad One that blew up on me.
Howard Farran: So you can’t download it again?
Howard Farran: Probably, I probably can but I don’t use it any more.
I did it on my own, Howard, like I said with the corporation environment and we see Medicaid they try and keep things very simple and standardized so I do a lot of things on my own.
You know I had an iPad for a while, I used that app.
Right now what I use a lot is I have this typodont- it’s like a perio one and I think it helps a lot. It’s pretty expensive, like 200 bucks but it’s pretty realistic and what I do is, I just take a clean probe and I just probe in this thing in front of the patient so they can see it.
So that I can explain what I’m doing with the probing and to me - like it helps a lot because it is very realistic typodont and you can like pull the teeth out and it’s got calculus on it and all that.
So, I say when people actually see it – because I don’t actually have a camera to show like calculus or bleeding or whatever, to make up a show, you know? You know a show like calculus or bleeding or whatever. Just having that for me I think helps and I see the patient’s face kind of get it. O boy! And then I like pull the tooth out and then I say that if this goes on and on your tooth will fall out eventually at some point.
Howard Farran: I just found that out on my iPhone it’s DDS GP.
Mark Frias: Yeah, that’s it.
Howard Farran: DDS GP.
Mark Frias:It’s a good app. It’s a good app.
Howard Farran: So what else do you use to sell or educate?
Mark Frias: Those are the main things I use. I used the app for a while. I used that. I use to have – I just like print out pictures sometimes and use that. We have some models of other stuff. We do a lot of – not a lot of, but we do you know stainless steel crowns and I try to explain that. There is even models for that. I just took the CE course on Dentaltown, Howard, Dr. Ren?
Howard Farran: Yes! Josh Ren. Pediatric dentist.
Mark Frias: And I am a hygienist, I am not placing crowns, but to me it’s – I get a better understanding of it because I am explaining it to the parents a lot, so even for a hygienist it is a good course.
Howard Farran: And speaking of that. So, we have Dentaltown and Hygienetown and Orthotown.
What is the difference, for you being a hygienist, the difference between Hygienetown and Dentaltown and do you spend more time on Hygienetown or Dentaltown or what is your thoughts on this? Should there even be two separate communities? Do you think Hygienetown should be rolled in to Dentaltown? Tell me what you think.
Mark Frias: Yeah. I think it is nice having us separate. I just wish it was a little more active in Hygienetown it’s pretty active, but not like Dentaltown. Dentaltown is pretty active, so I am probably on that side like 70% of the time. I would probably be more in Hygienetown if it was a little more active, but I do my part and I try to post a lot of stuff.
Howard Farran: Well, maybe your podcast will help get that motivated and I encourage hygienists. The hygienists wanted their own site so we started Hygienetown. Of the nine specialties only orthodontists asked for their own separate site and so we delivered and you have been a huge – so who are your fans, who are you talking to on Hygienetown? Who are your other hygienist role models or who do you like to?
Mark Frias: To debate?
Howard Farran: Yeah. To debate.
Mark Frias: Daniel Lopez, he is good and I like him. He is kind off relatively new I think he has joined us now for maybe two years ago or something. Andrew Johnson, you interviewed. He is on there a lot now to. I am forgetting names now. Trish Wolferen if I am pronouncing it alright. She has helped me a lot. Linda Douglas
Howard Farran: From Canada?
Mark Frias: Yeah. She is good. She is on there a lot to. So those are probably the main hygienists that-
Howard Farran: So review what is controversial on Hygienetown? Where is there debate? Where you see to hygienists – Well like on Dentaltown you see people that are pro-amalgam and others say they will not place amalgam so that is a debate. Taking insurance is a big debate. What are controversies on Hygienetown, where people actually, passionately agree to disagree?
Mark Frias: I am trying to think. I am not sure if there is any big disagreements. I am not sure, because what comes to mind for me is the mid-level on the Dentaltown side. That is the big one. I know like every time they post about mid-levels, you know it is always a long thread.
Howard Farran: It is always a long thread and it’s always talking about, I don’t know, I just – I just always want to ask the dentists – you know, the patient comes first and when you are talking about quality dentistry, define the quality of a filling or cleaning that is never done. Like Alaska has areas larger than your state that don’t have a single dentist or hygienist and then when someone starts talking about putting someone on a snowmobile and sending them out there across the arctic, the first people that say no are the dentists.
That is just selfish and what I like -reviewing 15 000 years of history, I think all problems in humanity fall under two deals: humans don’t like to be transparent. They like to be secretive and not tell anybody what they are doing or lie about what they are doing and then number two they don’t want any competition and they just go to the government and try and get trade embargoes and you know unions try and get laws that they can just get raises.
Nobody wants any competition and no one wants to tell anybody what they are doing and if you just correct the transparency and competition or you might call it checks and balances like a lot of people call America’s democracy the first checks and balance in a senate in a judicial executive and what it is, that is just check and balance. It is just competition. I think there would be nothing better for any industry for all their practices to be transparent and for it to be more competitive. Like cars! I am 52 so when I was little and they banned imports from Germany and Japan, American cars were horrible!
Mark Frias: Horrible.
Howard Farran: And then when America – when Japanese and German cars started coming in, the Americans had to start getting their act together and look at the airline industry.
Our airline industry does not allow domestic carriers to come in and do domestic flying. I have been to 50 countries and we have one of the worst airline industries that there are and if you would get rid of that law and let all of these fantastic airlines from Australia and Europe you let all those players come here – O my God – the prices would come down, the quality would sky rocket, but America had just one merger and union strike after another and this is why I think the dentists – that is another reason why the dentists needs to let their backup singer hygienists go and take away the sheet music and take away their hand cuffs and let them fly.
So, let me tell you this, so you are saying on Hygienetown there is not a lot of great big passionate debates there is about hygienists on mid-level write up Dentaltown. I’ve seen a lot of threads on Hygienetown about what their biggest complaints are working in a dental office. Review those. What are the most common gripes that hygienist have working in a practice that has a dentist owner, dental assistants, office managers, front desk, treatment coordinators.
Mark Frias: Yeah, I think that well- I think that some of the things hygienists feel- like in cases where the dentist might be micro managing and hygienists want to have some responsibility with perio especially.
Howard Farran: Explain that.
Mark Frias: Yeah. I mean obviously you want an office protocol and everybody be on the same page, but I mean hygienists is capable of looking at the patient, you know doing the perio charting and talking to the patient and diagnosing and treatment planning what that patient needs, then having the dentists come in and basically, yeah I agree, you know?
I mean even if you slightly disagree it is not going to be a huge gap, you know what I am saying? Like if you say this patient needs two quads of SRP and a dentist thinks like probably four, I think maybe four. I think there is a couple of slight pockets on the upper right or something like that.
It’s not a big – you know it is not a big difference enough to say: Ok, I’ve got to take over this, I can. You know? Because even dentists are going to disagree. I mean if you got two dentists, you know, diagnosing, I mean, whatever it is they don’t disagree on what to do and what it is and so on.
Howard Farran: Well you couldn’t get all the dentists to agree that this is January, let alone Friday, so that is the human condition.
Everyone sees everything differently. I have three amazing hygienists. The new one has been with me eight years and all the other ones longer than that and we agree on everything. I mean it is kind of like when you watch a basketball game and that player passes the ball right up by the hoop and the other guy knows it’s coming, it’s already in the air and it’s a slam dunk. I think in America we diagnose 100 cavities and then we drill, fill and bill 38 and all they talk about is how to do these 38 fillings and nobody talks about the 62 that weren’t done and then you tell me you are a quality dentist when two out of three cavities, you didn’t even remove the decay and if you want to increase the close rate it’s pretty nice when the hygienist can spend all that appointment talking about it and then instead of the patient hearing confusion, the dentist comes in and says: O absolutely!
It’s kind of like - my joke is like - the dentist will come in and sit down and the hygienist says, I have got a stick on number three, so the dentist say, well pick up a sharp- and the patient is like Ah! And the hygienist says don’t blow air on the canine it is very sensitive so he’s like really, blows air on the patient Ah! The hygienist says don’t tap on this canine it’s very sensitive percussion- really?
I see dentists go in and re-probe their entire hygienist’s probing. I mean do you think your hygienist is a sociopath, so she could stick on three? I mean if your hygienist says you’ve got to stick on three you should be able to take a mirror and look at it and confirm it or not. If you literally have to pick up an explorer and start digging around in the occlusal again you’re crazy or your hygienist is a lying sociopath and you should find one that doesn’t lie, I mean it is just patient centered and I – Google solves all their programmers debates. They just say: OK. We have got all these different departments arguing about this. What does the person searching on Google, what’s best for that person?
If we just keep focusing on that person we are going to do great. If dentistry just kept focusing on patient centered instead of dentist centered and hygienist centered and mid-level practice and you can set up shop and blah, blah, blah and just kept focusing on the customer- the patient, it would be so much better. So they gripe about controlling. What else do they gripe about?
Mark Frias: Well a lot of it is about pay, I guess. Pay raises and that kind of thing. And that is another pet peeve of mine, hygienist that say: I haven’t had a raise in three years, four years, five years, but to me why should you get a raise for being alive?
You know you should have a reason for getting a raise and make a case for a raise and I think a lot of hygienist too they – and I want to pick on hygienists for a while. I think they don’t realize the stress that dentists have. You know dentist owners especially, there are so many things, like to me – I just think a dentist – you go through dental school and you have so much responsibility, plus you have to run a business at the same time and that is just so much to do and I think a lot of hygienists don’t appreciate it especially if the practice is not doing so well because of the recession or whatever it is and they still want a raise every year.
Howard Farran: Well the raise is based on the science that if the earth travels around the sun one complete revolution they should get a raise.
I mean the basic raise in dentistry are all the humanity is based on astrology. You know what I mean- around the sun when it should be based on production, collection, overhead etc. but my- I’ll defend the hygienists- that most offices the dentists isn’t transparent with the numbers, again I think all human history, the problem is transparency and no competition, so when I go in and ask the average hygienist what does this office have to do to break even? Nine times out of ten I have no idea. Really? You don’t know your break even point? I mean really? I mean my dad had a restaurant when I was ten years old and he used to call it the bam number, BAM, bare ass minimum.
This is what we got to do just to survive and everybody knew it and everybody was going on that number. Nine times out of ten a dentist is not transparent with their numbers and then I think the reason why Dentaltown has so much more activity than Hygienetown is if a dentist just gets on there and spends an ordinary amount of time and becomes a much better dentist they are always going to make more money and a hygienist could go to Hygienetown and spend a thousand hours and be the best hygienist in the world and not even get a dollar raise and I think that’s the – and you always see two out of three dentist go to continued education courses without their hygienists and actually, more important than the hygienist – you know who answers the most questions in the dental office?
Mark Frias: No.
Howard Farran: Who is answering the phone? And that person nine times out of ten doesn’t know - knows the least about dentistry in the entire office and they answer the most questions and then you say to your dentists why aren’t all your receptionists, your only link to the outside, answering the far majority of questions, why do you not take them to any of the dental courses?
They’ll go: This is about root canals. Oh like patients don’t call and ask about root canals all day, every day? You know what I mean?
So, the online CE is amazing. I want to ask you another question. A lot of - you know I thought a lot for a long time and a lot of my consultant friends see it too. Some of these dentists, everything is a watch. I mean, it’s either- what I don’t understand about watches – I grew up in Kansas. No farmer went out to a barn and saw an area the size of a fist of termites and said I will just watch it.
Mark Frias: We’ll see how it goes.
Howard Farran: I mean I can put my fist through it but I’ll just watch it.
I’ll wait until I can drive a car through it or a tractor. I mean it is an occlusal pit and fissure and if I look the DMFT rate, the diseased, missing and filled teeth by age 65 in America it is like 95, 96% percent of all of them are diseased, missing, filled teeth.
What are you watching? And the hygienists and the dentists, do both say they are going to watch? I mean if the hygienist say I have got to stick and the dentist says it is a watch, and it is the same dentist who says his production is flat and he is not making any money and I’m sitting here thinking about gram negative anaerobes in that pit and fissure that can’t be brushed out, flossed out, that should be physically drilled out. Removed. What is the deal with watches? What’s with that?
Mark Frias: Yeah. I think if the groove has a stain, I can see they’re using air abrasion to clean it out or Fissurotomy Bur, something really, really thin to clean that out and if it’s shallow then just place a sealant, if it’s worse then you thought it was then it’s a composite restoration, but it’s pretty minimal to go in there I think with air abrasion and or a small bur to do that.
Howard Farran: Now, are you placing sealants?
Mark Frias: I do place sealants.
Howard Farran: And do you use a Fissurotomy bur or air abrasion when you place sealants?
Mark Frias: I wish I could legally, but I can’t. What I do is I have a very thin, sharp navy sickle scaler, if I need to- because sometimes the tooth is very, very clean, you know there is no stain at all. The other thing I use too is - I use like a MicroEtcher basically and that is the latest one.
Howard Farran: The Danville Engineering MicroEtcher or which MicroEtcher are you using?
Mark Frias: Yeah I used the Danville before, but what I did I kind of made my own. I use air polisher, but I put the more abrasive – the same powder they use in air abrasion but-
Howard Farran: Aluminum oxide?
Mark Frias: Yeah, and I use it at a low pressure so I am not prepping the tooth but it’s a – it cleans much better than sodium bicarbonate or calcium carbonate which is the air polishing type powder.
Howard Farran: Because diamond is the hardest material on earth and second is aluminum oxide, but isn’t that just bizarre what you just said? You place sealants on patients. Do you use a Fissurotomy bur- I wish I could?
Mark Frias: I wish I could.
Howard Farran: But, some lawyer in state board and a bunch of dentists has taken that away from you. Does that make any sense to you? And what I also don’t understand is how many years of college did it take you to become a hygienist?
Mark Frias: Well I went through a two year program but almost nobody finishes in two years. I went to school and I took classes for four years basically.
Howard Farran: But did you take any pre-requisites before you went to the hygiene school?
Mark Frias: I did.
Howard Farran: So that was two years, right?
Mark Frias: Yeah. X-ray. At least a year before that.
Howard Farran: So, how many years of college did you go to?
Mark Frias: I have a two year degree technically, but the way the hygiene program works in these two year programs is they basically squeeze a four year degree into a two year program. Same with nursing too, so it’s like full throttle through hygiene school with a lot of information.
Howard Farran: Now here is my pet peeve about that. You said the same as nursing and if you were to become a nurse instead of a hygienist, in a hospital you would be giving shots, you could be giving vaccines, you are not allowed to give a flu shot even though Americans see their dentists twice as often as their physician.
You are not allowed to give a HPV vaccine even though nurses can for HPV for cervical cancer, yet it is the leading fastest growing cause of oropharyngeal cancer. I mean it just- that it is crazy stuff. This is something you would expect in a crazy banana republic and it is happening in the United States of America.
Mark Frias: Yeah. To me just to take a small bur or air abrasion just to open up the grooves a little bit. It’s not like all of us are just going to go crazy and prep the tooth to the pulp, you know. We can go slow until- if it’s getting deeper and deeper we can say okay- have a dentist-
Howard Farran: Yeah but in other states dental assistants are allowed to do fillings. I mean expand the duty of the assistant and then there’s you, a registered dental licensed hygienist that can’t do it. Crazy.
Mark Frias: Well same thing with hygienists too, they have- I know Kansas is the only state that I know of where they can scale coronally if they have training but in my state and other states, hygienists do the same thing. I don’t want assistants to scale because that’s what we do. I don’t see a problem with them doing very minor scaling on maybe kids in a pedo environment.
So we have the same thing as dentists have, same reaction to mid level.
Howard Farran: I have to say that Kansas is the greatest state in the Union because that’s where my mom and dad were born, that’s where I was born and my five sisters and brother, I love Kansas. I just lectured there last week. So I want to ask you another question, I’ve only got you for 10 more minutes. A lot of dentists want to rev up their hygiene department and get it modernized and take it to another level and so they’re always looking at hygiene consultants to come in.
Consultants that are just focused on hygiene. Is there any you like or is there any low hanging fruit that you’ve learned? Do they do similar things? What’s your thought on hygiene consulting?
Mark Frias: I haven’t experienced any personally.
Howard Farran: But you’ve probably read about a lot of it on Dentaltown.
Mark Frias: Yes, to me what I think the common denominator is for all of them is basically taking perio seriously. I think that’s the main thing. I thing there’s a lot of situations out there where either the dentists are not taking perio seriously and the hygienist maybe too and they just don’t- if you go through they’re codes, they’re not doing scaling root planing, perio maintenance, that kind of thing. So I think that alone- because the cost difference between as you know, between that and the scaling root planing is huge.
If the patient had a couple of 5 mm pockets with sub and you’re not doing scaling root planing then you’re throwing money out the window basically.
Howard Farran: I’ll tell you my biggest worry or pet peeve about perio is if you have a bacterial infection below the belt, a STD, gonorrhea, syphilis, chlamydia or whatever you could never go to your family physician every six months and just still have gonorrhea and just take another shot of penicillin. The physician would say can you bring in the person you’re sleeping with? I think you’re giving it back and forth.
Yet perio, so many people I see are on a three month recall for five years and I say well let me see the husband’s chart- oh we’ve never seen the husband. Especially on new patients. I would say, so you’ve been getting your teeth cleaned every three months and you have perio and your husband hasn’t been to the dentist in five months, well do you kiss him? Every day. Every night. It’s like really?
And how many times have I seen in my 28 year’s career where some kid has come in every six months for a decade, never had a cavity, never had gingivitis, goes off to college and comes home with gingivitis and three cavities.
I’m like Johnny, are you making out with a little girl or a boy somewhere because I think you’re trading bacteria with someone- and then I’ve seen it with older patients where- I mean I’ve had this conversation a dozen times where you see them every six months for a decade and everything’s fine and all of a sudden they’ve got three cavities and gum disease, and I say are you making out with a new partner?
And they go well yes I am. I go well I’m pretty sure this person has a lot of cavities and gum disease and then you get that guy in and he’s got three bummed out wisdom teeth, a lingual bar calculus and ten cavities and the planet doesn’t realize that- what is the difference between below the navel and above the navel?
Why do dentists, hygienists and patients have a different understanding of gonorrhea to AIDS below the belt, but not anything kissing when we have two very famous people now with oropharyngeal cancer that went public- One was a famous movie star, what was his name, Michael Douglas and then we had the other one, the New York Buffalo Bills? Jim Kelly who said guys, I got oral cancer and it wasn’t from smoking and drinking and all that. It was from kissing other humans and yet this isn’t even absorbed amongst the dentists and hygienists let alone the public and my hands are tied. I can’t have a conversation with a mom saying well you would give a girl a HPV vaccine because you wouldn’t want her to get cervical or uterine cancer and I don’t want her to get oral cancer, has your daughter been vaccinated? If not, can we vaccinate her or your son today?
That’s not happening, so I hate to say, it’s just crude to say, if anything good came out of AIDS, because how could something good come out of that large of a human tragedy and to see more, that’s my favorite HBO special, How The Band Played On, the story of the discovery of AIDS, but if one thing good did come out of AIDS it’s that the whole planet knows that below the belt, you can kill each other with a virus and now they’ve got to take that knowledge upstairs and say, yeah you can die from kissing someone and I can’t treat you for periodontal disease and cavities if you’re making out every night with someone who’s got periodontal disease and cavities.
Talk about that. What do you think about what I just said there?
Mark Frias: Yeah it’s a good point Howard. For some reason, I don’t know what it is, that people see the mouth as some kind of special spot on the body that they don’t treat the same.
Howard Farran: And that might be from our religious roots of civilization where below the belt was bad and naughty, you shall not commit adultery, shall not covet the neighbor’s wife and kissing is more just not that bad. I think it might be the religious taboos or whatever.
Mark Frias: My experience, dentists do it and hygienists do it, the patient gets an exam, say it’s a kid, they’ll say stuff like oh, you only have one cavity. As if one cavity is not a bad thing. Like no big deal.
Howard Farran: And the other thing the public doesn’t realize, people will come in and the first thing, another pet peeve of mine is that there’s toothpaste that’s red. How could they sell red toothpaste to mask the blood showing up in the white toothpaste they’re spitting in the white sink? They’ve got to see that they’re spitting out blood. And then they come in and you say when you brush your tooth, is it a white toothpaste or is it a red toothpaste? When you spit out, do you see blood? Yeah. How long have you seen blood?
If your hand was bleeding every day, would you not realize, and your gum areas, when you have gingivitis or periodontal disease, all that gingival tissue is about the same surface area as the palm. If your palm was bleeding every time you looked at it, every day you put it down there’s blood, would you have not seen someone? Would you have not thought a bacterial infection and would you have not got treatment?
This is the biggest thing in dentistry. This is what we have to educate all these people on. If you’re going to meet somebody and you feel the need to put a condom on below your belt, well don’t start trading spit with them. Don’t start kissing them and if any part of your body is just chronically bleeding, you need to see someone! You need to get treatment. I’m down to three minutes with you. I want your close to be this Mark, I just met two hygienists yesterday that came in to visit Hygienetown here in Phoenix, Arizona.
What would you say, I want your close to be two minutes on, what would you say to the next graduating class of dental hygienists around the world? What advice would you give them?
Mark Frias: I would say this Howard, for most of them, well the vast majority, are going to be part of a team in an office and they shouldn’t see themselves as just followers and that’s one of the notes I had on here to talk about. Being a follower. Followership is not a bad thing. It’s one thing that I learned about in basic training in the air force. That’s the first thing I learned about and it’s not just taking direct orders, that’s not what it is. It’s basically just being a good team member and to see yourself as a professional with a dentist and to be the best hygienist you can be in the office. To always be learning, to be honest with the dentists, open communication, don’t be afraid of dentists because in hygiene school, people that didn’t come from a dental world, they see a dentists as this God basically and just being a good team member and following is not something that just a hygienist do or the assistants do, everybody is a follower and a leader.
There’s a saying: be a leader, not a follower. I think that’s bad advice. I think you should do both. Dentists will follow hygienists sometimes if the hygienist is good at something and they’re not good at something. Maybe they’re a shy person and they’re not good at communicating or whatever. So to me I see it as a team effort. Its not one person is above the other person. It’s, we’re all working together to meet collective goals basically. So that’s what I would say, be a co-professional with the dentist and don’t be afraid to talk with them.
Howard Farran: Very well, and Harvard Business Review has an article on humility at least once a year where they look at the greatest CEO’s that ever lived and they’re trying to identify what traits do these great CEO’s and leaders have and usually the top one is not a knack in marketing or finance or any of that stuff, usually the top trait is humility, because humility makes you listen, humility makes you think that you don’t know it all and listen to other people. Listen to your customers, listen to your team members, listen to your employers and what I want to say is, to the hygienists coming out, is if you get a job and it’s a toxic environment, you don’t take money to go into a toxic environment.
That leads to depression, burnout, disease, drinking, escaping, drugs, overeating whatever and I would find an office, here’s our core values: we have twelve. The core values of my office are create a fun, positive and professional environment. Be passionate, enthusiastic and determined to make a difference. Be humble. Embrace and drive innovation, you’ve mastered that. Follow the golden rule, treat others like you would want to be treated. Mistakes will be made, be accepting or accountable and move forward. Never stop learning. Be honest and respectful, integrity is everything. Balance life and work and be fully present in both. Strive to make everyone feel safe and valued important. Be remarkably helpful. Create opportunities to make our customers feel special and if I could give any advice to the new graduating class and to all the hygienists out there, is if you’re not in a fun environment where you feel safe and the dentist is helping you grow professionally and listens to you and I mean, it’s kind of like a lover.
If your lover is toxic and you’re afraid of that person and you don’t feel safe and you’re walking on eggshells and you’re just doing your time, that’s a bad idea. Go find a place where you want to go to work and work with people that you want to work with. The people where you can share a crazy idea and someone can say I don’t know about that, but you feel safe to share and just go and have fun because if you’re driving to work and you realize that dentists are like a fireman, firemen put out fires, police catch bad guys and we have donated our entire career to killing gram negative anaerobes. Finding them, killing them, exterminating them and if that’s not fun for you to do, then you’re probably not working at the right place.
Go find a better place because I know a ton of dentists who just go in every day and have a blast. I know you’re a busy man Mark Frias, thank you so much for spending an hour with me and my podcast. I’m going to push this out to every dentist and hygienist I know around the world.
Mark Frias: Thank you for having me Howard, it was great. It was fun.
Howard Farran: Alright buddy have a good day.
Mark Frias: You too. Bye.
Howard Farran: Bye-bye.