Dentistry Uncensored with Howard Farran
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Doing Braces Right with Dr. Rick DePaul, Jr. : Howard Speaks Podcast #88

Doing Braces Right with Dr. Rick DePaul, Jr. : Howard Speaks Podcast #88

6/23/2015 12:00:00 AM   |   Comments: 0   |   Views: 906






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Listen to Howard and Rick talk about how Six Months Braces work, why patients prefer it, and how you can implement it into your practice.

Dr. Richard J DePaul, Jr. is the developer of Powerprox Six Month Braces® and a practitioner with over 20 years of orthodontic experience & over a decade of experience teaching doctors orthodontics. Dr DePaul is a recognized pioneer in the field and the most renowned cosmetic orthodontic educator training doctors today.




His profound international success is rooted in his ability to de-mystify orthodontic treatment, making it easy to learn and implement. A 1994 graduate of Case Western Reserve University, he has authored several books, articles, and DVDs on the topic and lectures extensively to sold-out audiences all over the world.





Howard: It is an absolute honor today to be with, the Man, Rick DePaul, Jr., who comes from a long line of dentistry. Your dad was a dentist, and it's funny … love you to death, dude, you are one of the few general dentists who, basically, only does ortho fulltime.

Rick: Yes. That’s right.

Howard: I mean, that’s just unheard of, and I want to get into that. First, tell me, what was it in dental school that made you … there were nine specialties, what was it in dental school that just made you dive into ortho? I know you said, what, your dad's brother was an orthodontist?

Rick: I have a lot of dentists in the family. My dad is a dentist, my sister, her husband, my uncle is an orthodontist, whose son is an orthodontist, whose wife is an orthodontist, and his other son is a general dentist. We have a lot of people in dentistry in my family.

Howard: Not to be rude, but is there a lot in-breeding going on in your [inaudible 00:01:42]? Has this been looked into?

Rick: I'll invite you to the family reunion and let you decide for yourself. How about that? I always kind of just liked that topic when I was in dental school, more so than restorative, or perio, or anything else. I also liked cosmetic dentistry as well, because that was really up and coming to becoming a really big thing when I was in dental school in the '90s, there was a lot of whitening and veneers, but I also didn’t really like how … that’s like some of the bigger institutes came in, and you'd have near virgin teeth, that were basically prepared for three-quarter crowns and I thought that was a little too aggressive, which is kind of how Powerprox Six Month Braces came to be actually.

I had two patients who were class 2, division 2s, with those incisors tipped way back and the laterals popped way out, and one guy wanted me to do braces, and the other girl she wanted me to do veneers on her. What was funny was I had no problem at the time, really preparing the teeth heavily to get a new [couple intentional 00:02:01], endos, and things like that, to do the veneers. Whereas, the ortho guy, at the time I was doing traditional braces, because that’s how I was originally trained, and I told them it's going to take two years to treat you, we have to correct this molar classification, and all these other things. He said the same thing that the girl said, "I don’t like the way this one tooth is sticking out, the lateral incisor. Can't we just pull it back?"

I had no problem preparing it on the girl, cut not moving it on the guy. Then when I seated her veneers, I was looking at her occlusion, and I actually saw, you know what, her occlusion it's exactly the same as the guy I told I had to change that occlusion, orthodontically. That's when the light bulb went off, and I was like, why can't I just move the teeth to the most aesthetic position instead of preparing them, so that’s how the whole Powerprox Six Month Braces thing came to be, coming up on 18, 20 years ago now. I just tell the doctors to think of it as orthodontic veneers. Not to say we are not moving the posterior teeth at all, but our focus is anterior cosmetic correction.

We still open bites, fix cross bites, rotate molars and pre-molars all the time, but our focus is on anterior cosmetic correction, again, think orthodontic veneers, and you really get your head around the concept, around what we are trying to accomplish with this style of treatment.

Howard: A lot of dentist … I believe the human mind is hard-wired to believe what you want to believe. I mean you start with what you want to believe, and you work backwards. I remember when the cosmetic revolution took off from '90 to 2000, and all the guys in the field were saying they were having sensitivity issues, and all the lecturers and companies were saying, "Oh, it's just you. You didn’t use rubber dam, you did something wrong. You didn’t mix it right, you blew it too thin, you blew it too dry." It was all us.

Rick: Yes.

Howard: It was only the Japanese that actually listened to the market, and the Japanese introduced self-etching Clerfeuille SE, and they just took like two-thirds of the bonding agent, because they were only ones who thought, "Well maybe it is us." They killed it. Another thing about these veneers, with dentists, I want to talk about is that there's not a lot of research, but when you peel off the enamel for upper 10 veneers, I'm going to ask you. In 10, 20 years what do those teeth look like? How many of those teeth have died and needed a [crosstalk 00:04:20]?

Rick: Yeah. [Crosstalk 00:04:19].

Howard: I mean what would you guess? What would you guess?

Rick: Oh. I would say as far as endo, of course it depends on how much you had to prepare and get them into alignment, you might be looking at 30, 40 percent on some cases.

Howard: I know. I know, and when …

Rick: It's ton, yeah, a ton.

Howard: You tell that to these cosmetic legend gurus out there, they are all, "You did it wrong." It's always us, they never have any of issues, and it's us, and I just don't believe them. I don’t believe there's transparency. If it was my granddaughter, I wouldn’t let anybody file down her 10 teeth, and put veneers on.

Rick: Right.

Howard: She would have to get braces, and cleaning and bleaching and tooth whitening. I'm not going to let someone peel her front 10 teeth like a banana, I just think it's extreme, and it's an extreme makeover. If you are cool with an extreme makeover, I mean it's your life, it's your body, that’s cool, but it's not very conservative, and what you are doing is incredibly conservative.

Rick: No, not … Yeah. That's funny because when I first started kind of bringing this to the dental community and teaching it, everyone thought it was aggressive, you are moving teeth fast, and all of this other thing, we are not really moving them fast, we just have a shorter race to run. Once we get our anterior cosmetic correction and have our posterior bite set to where that allows for stable results, all that’s left to do is whiten, do incisor ledge bonding if needed, and that’s it.

We are not having to go ahead and prepare teeth for 10 veneers and thing like that. Now, obviously if their teeth are really chipped more modeled, you can still do them, but now instead of preparing to just get the teeth into arch form, into alignment it is very like preparing, if you even veneers, and it's 90-odd percent of the time you don’t need them. It's whitening and bonding after the tooth alignment, but it's a very conservative, conservative treatment as opposed to aggressive treatment.

Howard: Can I just start with the 4,000-pound gorilla in the room that everybody else will dance around, but I will go right to it. What do the 10,000 orthodontists think about Rick DePaul, the general dentist going around teaching general dentists how to do six-month braces?

Rick: The really smart ones will realize that if their general dentists already knows how to do things like Powerprox Six Month Braces, even things like clear liner treatment, that their eyes will be opened up to all the orthodontic problems in their existing patient base, and there is going to be people that, as a general dentist, you don’t want to treat orthodontically. So many of my doctors tell me that if they don’t go on to learn comprehensive, traditional braces themselves, they are referring more and more and more to the orthodontist, so the ones that are really kind of smart about it will actually help their general dentists in the area, answer some questions and things like that, because they are going to get more and more.

Also, we are going after a different market, most orthodontic practices are looking for adolescent patients. We are actually looking more for adult patients, people who didn’t have a chance to get their braces when they were younger, or maybe weren’t so good about wearing the retainers and had relapse. It's a totally different market that we are each going for. They want the younger kids, we predominantly want the adults, in the 18 and up, so to speak.

Howard: That is so true, because I'm in Ahwatukee , and it's about 80,000 people, it's actually Phoenix, but everybody calls it Ahwatukee, and there was a couple orthodontists around, and they were near the high school, and this Canadian orthodontist came down and set right across the street from the high school, and I mean his practice went crazy. He'll tell you that was his target market, high school kids.

Rick: Sure. Yeah.

Howard: They were high school kids. Then the other thing, explain where the name Powerprox comes from, that’s kind f a strange word, I mean we didn’t learn that word in dental school.

Rick: Originally, when I was trying to come up with the name for it, I thought at the time all the elements that we used to treat up these cases, and it was primarily, a mixture of the PowerNick titanium, and it has that beautiful shape memory power that automatically moves the teeth to the desired position, so the power of shape memory Nickel-Titanium [arch wires 00:08:22], plus Reprox, which is just another name for IPR. We do some IPR, Nickel-Titanium [crosstalk 00:09:03]…

Howard: Explain IPR.

Rick: IPR, Interproximal Reduction, when you have really wide teeth with bulbous anatomy, what I call interproximal mamelons, they’ve never in alignment, so they didn’t even a chance to wear during normal function, they are more bulbous, you see it all the time. You have one center that has a contact, the other doesn’t it's got a huge distal shaft of enamel, so doing that Interproximal Reduction you get more balance to that final tooth size in the smile, and to allow the teeth to fit into that beautiful [ideal 00:08:58] arch form that the shape memory Nickel-Titanium arch wire sets into, so that’s kind of where the word came from ; from the Power Nickel-Titanium, plus Reprox.

Howard: All right. I like to try to play the guess stuff, there's going to be like about 2,500 people will only be seeing this on sound, on iTunes, they’ve got it on their smart phone, they are listed in the car, our commute, and I'm trying to guess what theirs questions are to what you are saying. We are both older so we understand when NASA invented wire memory wire. Explain what memory wire is to these kinds who didn’t live through the invention of it.

Rick: Memory wire is quite simply, what happens is, you have this wire, and when you look down at an occlusal view of an upper or lower arch, you want to see that beautiful horseshoe shape. These wires are actually pre-made in this beautiful ideal horseshoe arch-form shape, and when you tie that wire, which is very flexible, into all the crowded and rotated teeth, you go ahead and put those into the braces on the teeth, that wire [inaudible 00:09:55] that beautiful horseshoe shape, and brings the teeth along for the ride. It helps to automatically reset the teeth to the beautiful ideal arch form.

In a crowded case, that’s going to gain space for you, in a spacing case, that can help close spaces, and also, plain and simple, it looks better, because you have that beautiful horseshoe shape, that beautiful wide smile. The wire does a lot of the work, and you get a lot of the credit, so we'll take that every time we can get it.

Howard: That was brought to us by NASA, NASA.

Rick: Correct.

Howard: It was NASA scientists who noticed that they, if they bend the copper or wire it's bent, but if they added nickel to the copper, and bent it, it went back, and that’s memory wire.

Rick: Absolutely.

Howard: Is that only a property of … something nickel, is nickel only …?

Rick: There's various combinations, but nickel titanium is the combination that you use in orthodontics to do that.

Howard: It's the most …

Rick: To get that shape [crosstalk 00:11:26].

Howard: Also on that Interproximal … what do you call that IPR interproximal …?

Rick: Interproximal Reduction.

Howard: Don’t you also think that when you are done with ortho, if those teeth touch each other, those contacts are very rounded, that’s a lot easier to relapse than if you bump two squarer blocks together. I mean, don’t you think …

Rick: Right.

Howard: … the flatter the surface, that you finish then, the better chance of retention.

Rick: That’s one of the tricks, especially on the lower anterior teeth, where you have that rounded contact, the contacts are very small, those teeth can slip off of each other. You can sort of keystone those contacts together to help lock them into position. We still get beautiful anatomy on those teeth. When you are done doing Reprox IPR, you should not be able to tell that it was done at all, but you can, especially on the lower anterior, again, keystone those together to help a little bit with longer-term stability, less likely to slip off of each other.

Howard: You picked … You explained Powerprox, but now let's talk about, where did you get the name Six Month Braces, because when I see six month braces, I'm always thinking … Did you see that movie, Something About Mary?

Rick: Yes.

Howard: Where that guy is in the car, the [inaudible 00:11:54] talking about 8-minute abs, and the guy says, "Well, what if someone comes out with 7-minute abs?" He was like, "You can't do your abs in seven minutes." Do you remember that scene?

Rick: I sure do. Yeah. Yeah. Yeah.

Howard: What's stopping me from starting five-month braces. Where did you get the six months, is what I'm saying?

Rick: I got it because that was the average treatment time of my cases. Most cases ranged from four months to nine months, so it's not a deadline, it's just an average of treatment times, so once you reach your goals, you are done. Sometimes you reach that in three, four months, sometimes it might take seven, eight, nine months. It's just an average of time, it's not a deadline which a lot people think. "Oh, six months, take them off." If you are done, you are done before that, if you are not, you might go a month or so longer, so just an average of times.

Howard: Okay. You are wildly popular on the Electro [scene 00:12:46], wildly popular in Dentaltown; my, God, working up 15,000  posts on Dentaltown. Thank you for all the sharing that you’ve done. I mean, I think you’ve answered every ortho question for 20 years on that thing. Thank you so much for that. This dentist, she's driving to work right now, she's got an hour commute, and she's driving to work, and she's listening to you, and she didn’t learn any ortho in dental school. I mean she didn’t do one case, and she's been out five years and … Talk to that girl. Why should she go listen to you? Why should she get into ortho? Why does she need to do this, especially when she's being pulled to learn like CAD/CAM or CBCT or do you know, this bone wrapping? There are so many things, you only got so much time in the day. Why should I learn this?

Rick: There's a lot of reasons. One of the key reasons you'll want to learn this, it's because patients actually want this done. They want straight teeth, they want a great smile, and when they want it, they are going to find a way to pay you to get it done. They want this, they are going to find you, it's a great to differentiate your practice from a lot of the other practices out there. Also it's a fantastic, general dentistry practice builder, because a lot of these patients will come in, they haven't been to the dentist in 5, 10 years, they have tons of periodontal, restorative needs that you to take care of, prior to moving the teeth.

I just tell them, I can only move healthy teeth. In fact, we actually tripled our general dentistry in two years, once I started marketing for Powerprox Six Month Braces, so it's a great way to differentiate your practice, create a great general dentistry practice. Also, once you’ve done the tooth alignment, these patients that re cosmetically oriented, they want whitening. They are going to notice their incisor ledges are chipped or worn, they are going to ask you to bond their teeth, so you are going to the tooth alignment, you are going to get the general dentistry patient and you are going to get the cosmetic dentistry patient.

Also, these patients have a tendency to stay with you long-term, because you get to know the patient over the 7 to 10 visits that it takes over the 6 months, give or take treatment, and you build this fantastic relationships with them, they are going to listen to your other treatment recommendations. They are going to stay with you after you are done. We have patients that drive 3, 4, 5, up to 9 hours away, to get their teeth cleaned. It's amazing how dedicated these Powerprox Six Month Braces patients are to your practice, so it's another fantastic way to build your general dentistry practice, build your cosmetic dentistry practice, create a marketing niche for you, and get these patients to stay with you long term, and you get all the perks, all the benefits of a very controllable tooth alignment system.

You have fantastic control when you are using fixed braces, clear braces or lingual braces behind the teeth. With your coded wires, I mean, you get those teeth straight, patients love you, they actually bring you gifts constantly. I get so much food from patients, it is amazing. True story, the only thing I ever got  a patient who I did a root canal on, he gave me the finger. He said, it costs how much, and he flipped me off. That’s the only thing I ever got from an  endo patients, but I get tons and tons of awesome stuff, from Powerprox Six Month Braces patients. It is amazing. It's a fantastic thing to add to your practice.

Howard: I think that also, humans … If I've learned anything from 53 years on this planet is how complex the human mind is. I mean, it's just literally off the charts complex, and I think that when you look at people, it's a phenomenon like, they don’t … they haven't been bowling for 10 years, and there is no middle ground, or they own a bowling ball, and they have their bag, and they polish, and they go every week. They don’t own a … it's all or none, and with so many people, that they don’t like their teeth, mental health, they don’t care of their teeth.

Rick: Yeah. Right.

Howard: They don’t brush, they don’t floss. Once a human's body image says, "I don’t like my teeth." I think you’ve get their mental health first, and they hate their smile, they hate their teeth. Once they fall in love with their teeth, then they take care of it.

Rick: Exactly.

Howard: They shine that bowling every single day, and they go to the bowling leagues and they are in … humans are either all in or they are all out, there is just middle with a crazy human.

Rick: I've seen that so many times where they came in, they are an absolute train wreck. They haven't been to a dentist in 10, 15 years, and now you are giving them hope.

Howard: Right.

Rick: Okay. We can get you looking better, and we can do it in a timeframe that you are willing to accept, because a lot of patients, especially adult patients, just won't accept treatment time that’s 18 to 24 months. Of course we offer it, but not so many will take it, as you know, around 6, 7 months. Then what? We've got to get you healthy, now they are actually so motivated to that general dentistry that they’ve been putting off to get it done, they don’t say, "How much is my insurance going to pay for that crown." They say, "When can I get in?"

Then they get to take of themselves, and then you see such an improvement, not only in their dental health, but their self-confidence and self esteem, you'll see these people just come out of their shell. I mean it's really, it's actually one of the really cool parts of doing stuff like this.

Howard: I want to frame another question. I'd like to say, it's hard for me to ask these questions, because we've got everything from … these podcasts are rocking hot in dental schools. Versus us, you’ve been out for 20 years but … I want to ask you about another 4,000-pound controversy off in the room, which is four [bicuspids 00:18:49] extraction. [Dr. Woods 00:18:20] said … He was from Europe, what, or trained in Europe?

Rick: Used European techniques. Yeah.

Howard: Yeah. Back in the day when Rick and I were kids, there was this guy, back then most of orthodontists will pull four bicuspids to make it easy to make space. On the other extreme was this [Dr. Woods 00:18:40] said he would never pull four bicuspids. I mean I don’t think I ever saw him do a case pulling four bicuspids, and with most things in life, the truth is in the middle.

Rick: Right.

Howard: You know there's a place for everything. The thing that I'm frustrated the most about, the four bicuspids extractions that I used to see, which made get into work though, it's that a lot of times these orthodontists will just pull the four bi-s when the teethe that has all kinds of MOD amalgams, and crowns that had to be replaced, and when they told me they needed 6, 7 [inaudible 00:19:07], the ones that work with me, I can just take all the crap and recurrent the decaying amalgams, and just make them with open contacts.

Do you know what I mean? I could easily get their space just like taking everything out of their arch, you know, usually if you’ve got 4 MODs on … Eight MOD's and amenable, and half of them got [recurring decay 00:19:30], okay, and you take all that stuff out, but when you get to your top matrix, just don’t make a bulbous contact, you can get a lot of space just from redoing the restorations.

Rick: Oh, absolutely. In regards to, once you are taking out teeth like that, you are definitely into a traditional orthodontic case, one that’s typically going to take you 18 to 24 months on average. We don't take out premolars with Powerprox Six Month Braces because more anterior, cosmetic alignment. There are indications for taking out premolars. Like you said, the truth is in the middle. The cases where the patients what's called biometric protrude, it just means their teeth and their jaws are so far forward, they can't even close their lips over their teeth without showing this mass of strain in their face or their profile, they are so bulbous.

Those are the situations where it's often, even the non-extraction guys will tell you, these are cases for 4 bicuspids extraction, because you are trying to fit the teeth in while you are simultaneously improving the facial profile and the ability for them to close their lips over the teeth. Now, in those cases that are kind of borderline, you can definitely do that IPR in between all the teeth. Now in Powerprox Six Month Braces we are primarily canine-to-canine with our IPR, sometimes we'll go back to the molars in the more complex cases, but if you were to do your IPR from molar to molar, you can gain, in a lot of cases, 7 or 8 millimeters of space, which is basically kind of like taking out a half of bicuspid on the side and the other.

You can find a nice middle ground in a lot of those borderline cases. When you have wider teeth, or big MOD amalgams, like you’ve said, bulbous anatomy, so it's a little tricky when you only have small teeth, but when you have wider teeth with lots of enamel, you can do that. I mean, that’s what Jeff Sheridan used to do it all the time. His was called  Air-Rotor Slenderinzing or ARS, which was just more aggressive style of IPR. He did it primarily on the [bicus 00:21:27], but it took the bicus, but that was that wide, he made it about that wide, left a little bit of enamel on there. His cases turned out beautifully, okay, but at the time it was more controversial, because enamel was so sacred. Actually his nickname was Jeff the stripper, that’s what they called him, but his …

Howard: Is he still alive?

Rick: That I don’t know. I don’t know.

Howard: One thing you said, [Inaudible 00:21:45], he was the first ortho course you took with [inaudible 00:21:48].

Rick: Correct.

Howard: Yeah. He was so controversial among the orthodontists, I guess …

Rick: Oh, yeah; second-molar extractions, and yeah, a lot of stuff, predominantly functional removable appliances, just some finishing with brackets and wires, yeah.

Howard: Yeah. That’s what I love about Dentaltown, is these people are coming in from around the world, and you get to see things, because that’s what he was doing he was introducing European techniques.

Rick: Right. Yeah.

Howard: Yeah, and Jeff Sheridan, I loved his course too, he was amazing, an amazing man.

Rick: Since then I've taken … I've taken just about everybody, I've got a lot of training from Jay Geber, Harry Green, you know, I take a lot of his stuff, I've read everything there is to read from [Harry Green 00:22:26], Rando , and all the other guys, Lingle from Mariopause, I mean, it's always continuous learning you are never going to learn everything, in a two-day seminar, so it's just a matter of diving into that topic, finding resources that help you do that, and just working your way up the ladder, so you can be an expert in that; whether it's ortho or implants or restorative, whatever you want to do.

Howard: I've got to … Since you’ve mentioned Harry Green, I don’t know if you are aware of this. Did you know he lives in Phoenix too?

Rick: I sure do. Yeah.

Howard: Yeah. He's my buddy up the street, and we just had lunch a while back, in his favorite steakhouse with Dr. Belsomra . Anyway did I ever tell you my Harry Green story?

Rick: I don’t think so.

Howard: I have never done ortho, my aunt Sue comes in, and it was '87, I was 24 years old, and she hated her teeth, and she always talked about … she was 65 and she was always  talking about how sad she was she didn’t have braces when she was a kid, her parents couldn’t afford them, and [inaudible 00:23:19], blah-blah-blah. I said, "Well, let's do it for free, but I don’t know how, I can't refer you to anywhere free." I met this guy, this buddy of mine, and I called him, and I said, "Would you come in here and teach me how to do brace on my Aunt Sue?"

Harry agreed, he's such a lovely guy, he said, "Absolutely." He comes in, a long story short, so we do braces on Aunt Sue, but what blew my mind is her husband, Pat, and her three kids, she always was a horrible migraine sufferer, and she had this incredibly huge overbite, and they disappeared, and that was 28 years ago, and she's still alive. Every time I see her, she still rants and raves, and ask me how Harry is doing, and he cured her headache. Here is a woman that suffered migraine for 28 … for her whole life, and now from 65 to 85 she hasn’t had any. Talk about that, is that real, is that in her head? What percent of headaches you think are occlusal related, bit related?

Rick: It was obviously real for her, a lot of people will have that situation, and what I tell patients that come in pain or any kind of TM issues, what I actually do, I usually put them in NTI first. I want to make sure that they have something that’s caused by para-function, clenching, or binding, what have you, because I know if that’s the case, I put them in an NTI, I can get them comfortable within a few months. That’s kind of how I put my toe in the water so to speak, when treating these patients orthodontically. Get them comfortable first, if I can, great, I'll go ahead and do ortho on you. If I can't, then may have something like an internal derangement or some other structural problem, and it's just something that I don't want to, kind of, deal with anymore at this stage of my career.

Those ones are referred on out to the orthodontist to do, but a lot of times, once you are opening up those deep bites, removing a lot of those incisal interferences, and things like that, you get a better path of motion for the jaws to move around. A lot of times, a lot of those headaches will go away. Now having said that, what I typically do, once we are done with ortho in those patients, I'll typically have their nighttime retainer be a full arch NTI style retainer, against like opposing Essix something like that. They are still getting a combination of retention, and clenching suppression, so you can really make sure that they are going to be comfortable long term.

Howard: Okay. You used two words, I know a viewer didn’t understand. Go back and thoroughly explain NTI. You threw term loosely around a lot.

Rick: NTI, it's an applying … anterior midline stop appliance that just contacts … it usually goes on either the upper or the lower teeth, there's a little ramp on it, so the patient just bites onto their incisors. What this will do, is keep your muscles of mastication from clenching as hard. They clench at about 10 percent of the intensity when your back teeth don’t touch. It allows the muscles to rest not clenches tightly, and it can relieve a lot of muscular pain.

Howard: Okay. You threw out the word Essix?

Rick: Oh, Essix is just a lower clear retainer, kind of like a clear overlay retainer, it looks similar to an Invisalign tray.

Howard: Okay. Now, the other … I'd like to go right for the most … I always try to figure, what's the question a proper person wouldn’t ask? The next one would have to be, how much do you charge for this? How much do they charge, does insurance pay? Talk about money.

Rick: What I tell doctors to do is, because these vary across geographic areas, widely. What I tell doctors to do, is charge about 75 percent of whatever the going rate is for a traditional comprehensive braces in your area for Powerprox Six Month Braces. That gets you in the ballpark pretty done well. You can actually charge less if you want, I've actually done some trials in charging less and we did get a little bit increase in volume, but about 75 percent of what typical, comprehensive braces are going for in your area, is a good place to set our fee. Now I also offer Lingual braces, they go behind the teeth, so no one can see them, what I do, is actually double that fee to do Lingual braces.

Howard: Because it's that much harder?

Rick: (A) it's not that much harder when you select appropriate cases, but it does take a little bit more chair time by one or two hours per case, there is a little bit lab bill to do it, and also, patients will pay because they want it more, because not only is it fast, it's invisible. They’ll pay for what they want, they want invisible too.

Howard: Basically you just can't have an overbite with that, right, or they knock off the …?

Rick: No. Actually, you can have an overbite because there's a built-in bite plane right onto the front six upper brackets that they close onto and that allows you to correct things like deep bites, and overbites, and things like that.

Howard: Wow. Interesting. Do you know, I always … When I was in school in the first couple of years out when that was first, like, introduced, people were saying that you couldn’t do them because their tongue would get raw in the end. That there tongue will be playing with the Lingual braces and would get raw, and they couldn’t stop it. Has that been an issue for you?

Rick: Here is what I tell patients, the first weeks whether you have outside braces on the outside of the teeth, or inside braces, Lingual braces on the inside of the teeth, the first couple of weeks your teeth are going to be sore. With the outside braces your lips and cheeks are going to be sore, with the inside braces your tongue is going to be sore. Pick which side you want to be sore. After that first initial, getting-used-to-it period, they get used to it just fine; just like they do with Labial braces.

Howard: that’s a great analogy.

Rick: That has not been a problem … hasn’t been a problem at all.

Howard: Back to fees, what is the average ortho in your area, 5,500, 6,000, so you are probably at …

Rick: Probably in that ballpark.

Howard: You are probably at 4,000.

Rick: I charge 4,2,00 for upper and lower, clear Powerprox Six Month Braces, if I'm doing Lingual races, both upper and lower, I charge $8,500.

Howard: That’s just canine-to-canine?

Rick: Molar-to-molar, we talk from first molar to first molar. Even though our goal [crosstalk 00:29:30] advance here, cosmetic production …

Howard: [Crosstalk 00:30:05]. Oh, okay.

Rick: … we move the posterior teeth to facilitate that, that not only help us make space for alignment, so that we can reduce the amount of IPR that we need, a lot of people think we do like tons and tons and tons of IPR, most of our cases are from 1 to 3 millimeters, if that, because we make space by de-rotating premolars, doing other things. Also we are opening up deep bites to give you that wall of teeth look better aesthetics, also reducing incisal interferences, heavy hits, that can lead to relapse, so we bracket usually from molar to molar, even our focus is on anterior cosmetic practice, so we can get a better-looking and a more stable final result.

Howard: You are bracketing the first molars? I always … I still put bands on first molars, just because I still seem to have a lot of brackets on first molars come off. That’s not an issue for you or … but you bracket mostly first molars?

Rick: We go ahead and bracket or tube the first molars all the time, the only time we use a band is if we happen to be using an appliance that’s going to help us with some other things, which is pretty rare, only about 5 percent of the cases use an additional appliance. We haven't had too many issues. One of the reasons we don’t have too many issues is because we usually place, if you have a deep bite, then they have a tendency to bite on their lower, and use the lower molar too. Okay. We use a lot of buildups, bite-raising buildups to help set our final vertical dimension, our vertical dental overbite, and that will also prevent those molar tubes from popping off as much. I'm not saying they never pop off, because they will occasionally, but we have far fewer de-bonds doing it that way than if you just have that deep bite pounding on those lower molar tubes.

Howard: Now, so you are charging 4,200 for Six Month Braces?

Rick: Correct. Correct.

Howard: How much is your course?

Rick: The course is 1,997 for a live two-day hands-on course, and that also includes access to our Case Support, and Online Seminar website. There's an additional 17 hours of video training on there, and you can post questions on our forum post cases, the doctors that actually do the best, have the most cases and finish them the best, of the doctors that spend a lot of time on the site; because it's set up for continuous learning.

Howard: Yeah.

Rick: You take the course, you go ahead and you start some cases, you post some cases on the forum and getting some feedback, you are already learning. Then once you’ve done a handful, or you are halfway through a handful of cases, you watch the first level of videos again. You are going to hear things that you just weren’t ready to hear the first time.

Howard: Oh, absolutely.

Rick: You are always going to hear something different the second, third, fourth time you go through. We have three different levels, so you just keep working your way up the courses, putting cases on there, getting feedback, re-watching the videos, it's set up so that you become an expert as quickly as humanly possible, it's a really fantastic massive resource that’s available for our doctors, and that’s just included with the live seminar.

Howard: Yeah. Basically what you just heard kids, that for … if you do this, your first case doubles your return on investment.

Rick: Absolutely, yeah.

Howard: If you do this for 2 grand, your first case you make 4 grand. I mean, it's literally, it's literally, if there's anything in dentistry, it's a no-brainer. I've always challenged your site for your members because I always thought, and I'll say this in public, I always thought that was a strange business decision, because your website where everybody is talking to each other, they are all preaching to the choir. They are all members and all that. I always thought, if you put all that on Dentaltown, with 198,000 people around the world, as those guys were all discussing, that that would be the best marketing you could get.

Rick: Well, I've done plenty of that.

Howard: Right. I know, I know, yeah.

Rick: Yeah, I've done …

Howard: You have 15,000 posts on Dentaltown, but I always thought, like you are 17 hours of CE Courses on your site.

Rick: Yeah. Yeah. I've done plenty of that on Dental Town, I had a CE Course, years ago on there, and obviously I posted a whole bunch of cases, you kind of get the best of both worlds. On Dentaltown you get people that don’t really know about it, a lot of people who are opposed to it for whatever reason, and that kind of brings a whole bunch of different opinions. What's nice about Case Support Forum, it's yeah, we are preaching to the choir, we all know what the goals of the treatment are, everyone is on board so we can all help each other, treating cases, getting the best results for our patients. It's kind of the best of both worlds, in a way, by having some posts on Dentaltown, and having posts on our Case Support Forum, because we can help the people that are dedicated to Powerprox on the one side, and people that are still learning about it on the other.

Howard: What is that, that website is SixMonthBraces.Com, right?

Rick: Yeah. You go to SixMonthBraces.Com and just enter the doctor [crosstalk 00:34:23] …

Howard: It's not the number, it's S-I-X Month Braces-dot-Com.

Rick: Correct.

Howard: Rick, this kid is driving to work and he's thinking this, "What if I get halfway through a case, and I don’t know what to do, and I don't know who to refer to? Who is going to bail me out if five months into thing I realize I'm stuck, I'm lost, I don’t know what to do?"

Rick: Well first off, I do help a lot of doctors who have learned from other systems and don’t know what to do. I'm always available to help, I don't care you started, who you learned from, whatever, I help people all the time, from all over the world, I'm there to help you. Taking my class, you are probably not going to get in that situation as frequently, because we are heavily, heavily, heavily based on diagnosis and treatment planning.

You are going to actually know which cases to treat, versus which cases to refer right off the bat, okay, so it's probably not going to be as much of a problem. I teach you how to do orthodontic thinking, so you are going to know what to do and why you are doing it, so you can think your way through all those clinical scenarios really easily, so chances you are not going to be in that situation, but if you are, all you’ve got to do is post the case up on the forum, and we are all there to help you, and we we'll kind of dial it back and get you back into a situation. More likely than not I'm going to be the one to help you, and we'll be able to get you back on track.

Howard: Okay. Basically, I want the dentist to … The average dentist get about 20 new patients a month. I want the dentist to think back on the last month, the last month's 20 new patients. What type of patient would he be looking for, and since this is braces and cosmetic and all that, is it more girls than guys? Is there a certain age range? Is there a typical patient, or is all over the board.?

Rick: It can't be all over the board, but we do have a tendency to get people in roughly the 25 to 45-year-old range, a little bit higher female, but a really surprising number of men. More than I thought, I thought it was going to be 75 percent female, but it's probably 60/40, or 65/35 in favor of female. That’s kind of who we are really going for. We are not wanting to treat, necessarily, young kids with this style of treatment, we are looking for more adult patients who either missed their window for braces or have relapse, because those are the people that typically aren’t going to want to necessarily wear braces that long.

Howard: Again, this dentist is thinking about the last month's 20 new patients. How do you approach this? Because if I came to you, and you said to me, "Hey, Howard, look at my gorgeous hair, I'm Rick DePaul, I've got [inaudible 00:37:00], you should wear a wig.;" I would … You can't go up to a girl and say, "You know, you would look a lot better with straight teeth. Do you realize how much prettier you'd look like if you straightened your teeth." I mean so you can't say something like that.

Rick: Right. Right.

Howard: How do you … Of this doctor's 20 last patients, you are saying key on the 25 to 45, and that it's really boys and girls. How do you approach this?

Rick: Okay. I got you.

Howard: Do you say, "Hey, are you tired of looking short, fat and bald, and do you want to letter?" By the way, for all our viewers on air, I've known Rick for 25 years, and he is wearing a wig. That’s common …

Rick: Absolutely! I'm finally busted.

Howard: I'm [inaudible 00:37:40] him right now. How do you approach this subject?

Rick: Actually you can just, right in the hygiene department, have your hygienist just ask the patient, if they see any bit of like … Let's say they see some lower [inaudible 00:37:51], which you see every single day in your hygiene chair. If you just say something like, "Hey, Suzie, if there's a way we could straighten these teeth to give you a great smile, by the time your next cleaning visit rolls around, is that something you want to talk about?" Right there they are either going to say, "Yeah. This one tooth here has been driving me nuts for 30 years, I've always wanted it straight;" in which case you can now open the conversation to talking about things like Powerprox Six Month Braces.

Whereas, they might say, "Ah, it's been that way for 30 years and I don't care about it;" then you know not to barrage that patient with a sales pitch. People love to be told their options, but they hate to be sold stuff. This allows you determine which patient that is, so that’s how I would approach it in a new patient who didn’t come to you specifically Powerprox Six Month Braces.

Howard: The only time I am suggesting it, and I suggest a lot peridontally-based, where I set them up, and I show them the panel and I say, "In dentistry we have our own BMW, and it's a biological minimum width and bone, and the bone in between each one of these lower anterior teeth, it's got to be a millimeter-and-a-half thick, or there's not enough interstate carrying in white blood cells, red blood cells, food, nutrients, and on yours, where they are all crowded with this paper thin bone, you are 35, I can fast-forward you to 65." That’s going to be a perio nightmare, 30 million Americans don’t have one tooth in their head, one-fourth of seniors have zero teeth, one-fourth have less than half.

I don't like the fact that you don’t have a BMW between these lower anterior teeth, and that is true, and it would bother me, I wouldn’t let any of my four boys, have paper-thin bone in between their incisors, and I fight that stuff all day long. The BMWs is a serious opening.

Rick: Oh, absolutely, because a lot of these cases …

Howard: Do you know if they still call that BMW, biological minimum width?

Rick: Probably.

Howard: Yeah. Okay.

Rick: I'll have to check the Perio Forum on Dentaltown to make sure.

Howard: Yeah.

Rick: Yeah. No, you definitely get periodontal benefits as well, when you’ve had situations like that, and actually a lot of people that are doing, you know, PerioLase [lenaxa 00:39:59] treatment, a lot of those patients really need ortho when they are done with that, so it's a good combination for people offering that, once you are done with your fourth quadrant of [Lanap 00:40:11], you pop into some type of orthodontics, the line of the teeth, to help equalize the bone levels and all of that. Yeah, that hurts, definitely, it's not just cosmetic, that’s what it's most-commonly used for, but you definitely get ancillary benefits from periodontal condition as well. There's no doubt about that.

Howard: Are you doing any metal brackets, or is it all clear?

Rick: I do primarily, clear. The only reason I offer any type of metal all anymore, is years ago my sister found out that if you buy like 20,000 metal brackets they are a nickel cheaper, and I couldn’t return them, so I have them on the menu for people who are on a really tight budget, but primarily we are using clear brackets.

Howard: Which is kind of silly because then they put a crazy color rubber band on. I mean it's like they want clear …

Rick: Oh, yeah.

Howard: … so you don't notice, and then they put a purple, red and pink band on there.

Rick: It happens all the time.

Howard: I think the metal in the mouth thing is so weird, the thing that bothers me the most is, you want to treat other people like you want to be treated. All my restorations I have like seven, and they are all gold, and they’ll all be permanent, and you just see woman after woman come into your office with gold earrings, gold bar through her nose, golden bracelet, watches, wedding ring, gold everywhere. I say, "Can I put a gold on-lay on your back molar?" They just freak, and then they want these clear brackets, which makes no sense, because they’ve got silver jewelry all over their body, and then you give them the clear brackets, and then they choose bright orange, and pink and purple, and it's like, beauty makes zero sense.

Rick: Yeah. Especially the kids will do that, more so than the adults, but yeah, it happens all the time. I mean all the time. I think my oldest patient I ever treated was 75 years old, and she would match the color, the O-rings on the braces to whatever her church choir was wearing, for her upcoming concert that month. She had some fun with it to match her dress and the rest of choir. Yeah, it's kind of funny if the kid begs his parent for them, and then, yeah, they go ahead and do the colored O-rings on them.

Howard: Rick, explain this phenomenon that I don’t understand. I'll give you an analogy on implants, you'll find dental, placing a single root form implant first molar to first molar, is twice as easy as removing a wisdom teeth, yet 80 percent of the doctors who remove wisdom teeth just think that an implant is just too much for him, exactly opposite. Doing a root canal is hard, no offense to you, but a second molar root canal is harder than what you are doing. Agree or disagree?

Rick: I agree. I agree 100 percent.

Howard: Yeah. Why do so many dentists who pull wisdom teeth and place implants and do endo not do … not go to your course? I just don't get it.

Rick: A lot of it I think is fear of the unknown. Unfortunately a lot of people don't learn a whole bunch of ortho in dental school, and it's kind of this big mysterious kind of treatment modality that you just don’t understand. I think that’s a big part of it, and also they are often worried about it, if I don’t know how to plan out this case, what does happen if I get in trouble in the middle of the case. It's a lot of plain and simple fear of not know what to do, and how to deal with any kind of complications that occur in the middle of treatment. We've solve all of that for you, and I'm going to show you how to plan all the cases out, and you have immediate on the Case Support Forum on the east site, so you don’t have to worry about those things, we guide you through things, any time that you are having any kind or questions or issues, all you’ve got to do is post the question.

I mean we have guys that went from zero ortho, never took one ortho course, never did an ortho case, who went from zero to over 75 percent Powerprox Six Month Braces in their practice in just a couple of years, because they hang out on the site and use that continuous learning, so it's a really easy, available entity for you to learn, and you just have to take advantage of what's there for you. You'll be able to learn it, you just have to be a little bit dedicated, and spend some time, just like modality, you’ve got to spend time, take some course and follow up with reading, and the fact that we offer excellent support, just is another massive, massive benefit.

Howard: Have you tried making this a mandatory part of the curriculum in the 56 dental schools? Because a problem with the dental schools out there, they are all in big cities.

Rick: Yeah.

Howard: They have all these specialty departments and they don't realize that a third of their class is going to go to rural America with zero specialist. What's sad about these dentists in these small towns that don’t do what you are teaching them how to do, Six Month Braces, is that you'll tell them,  oh, you need ortho, and then she's like, it's going to be 24 visits over two years, and the orthodontist is an-hour-and-a-half down that road, and she's like, "Why you ain't doing it?"

Now this little kid is not going to get ideal treatment because you didn’t make it an easier, faster, better, it's easy. When I hear these philosophers about what we all should be doing or not doing, they are never thinking of rural America, they are never thinking of rural America, they are never thinking of Eloy, they are thinking of Phoenix. They are never thinking of Arizona City, they are thinking about Tucson. Do you know what I mean?

Rick: Mm-hmm (affirmative).

Howard: We live in a country with two worlds, the urban and the rural, and the rural dentist is the jack of all trades, and these rural dentists they could … I just really think they should do your course.

Rick: Yeah. I think it will be a great way to help a lot their patients, because a lot of people tell me that, you know, the same kind of thing, you have to drive a100 miles to go to any specialist. When my dad graduated, he went up to work in Red Lake, Minnesota, [Convenience 00:45:57] Health Service, and the closest oral surgeon was something like 200 miles away.

If you had someone come in with a broken jaw, and you just tell them, okay I'll give you some pain meds for the night, you come home … or you come back to the office tomorrow, and he will go back to his house, and read in his oral surgery book, how to fix broken jaw, and he had to be the one to fix because they wouldn’t drive. Absolutely you know, if you learn these things, you are going to be able to help tons and tons of your patients that you wouldn’t normally be able to help.

Howard: You would not believe that so I had a car issue, and it was kind of an emergency issue, and I had to go to the garage that was right next to the 7/11, there's a garage right there, and I pull in there, and this kid was fixing it, and I said, "Where did you learn this, did you go to car maintenance school? He goes, "Man, you don’t have to, if you have a smart phone, because every single part … " and he just typed in, and he goes, "Lexus 450 Statoil, where is the boom?" Then a YouTube video pops up.

Rick: Yeah, wow.

Howard: He says, "I've learned how to fix all cars, just from watching YouTube." Then about three months ago I was at one of those restaurants where they … What is that when they cook at the table?

Rick: Oh, like the Japanese, like that?

Howard: Yeah. The Japanese. Yeah.

Rick: Yeah. Yeah. Yeah.

Howard: This kid was just crushing it. He was a little White kid, and he looked like he was about 18, 19 years old, and I said, "Where did you learn all these moves?" "I've seen this done 100 times." I said, "You are amazing." "All YouTube, I learned every  one of these moves on YouTube." Then I want to ask you another question, how much did this will the dental assistant get to do?

Rick: Depending on your state regulations of course, your doctor time on a case can be as little as 30 to 60 minutes. They can do tons and tons and tons of stuff, depending on your regulations. In my state, they are allowed to do a whole bunch, plus I have an  [inaudible 00:47:46] who helps me, so it's even more that they can do, but most doctors, what they could do, they could place the brackets, and just do IPR, and that’s it, and the rest could all be assistant time, but most doctors, what they could do is, they could place the brackets and just do IPR, and that’s it, and the rest could all be assistant time more or less.

Your per-appointment adjustment time, doctor time, could be 5 minutes, 10 minutes, depending on how much you want to talk to the patient, so it can be very assistant-driven, and it's not difficult to teach the assistants how to do it, it's actually very straightforward, so a lot of it is assistant-driven.

Howard: Are you recommending this two-day course, you bring your assistant?

Rick: Yeah. In fact, we allow you to bring an assistant for free, and then you should bring as many as you feel would help you in your practice, absolutely.

Howard: Right. Anyway to quantify what percentage your assistants in Ohio versus you, I mean is that half and half 80/20, 90/10?

Rick: No. It's probably … Nowadays my assistant probably does 80 percent, if not more of the actual chair time work.

Howard: Right on. Then, diagnosing treatment planning; so this dentists right now I'm told he can figure the last 20 new patients, and you talk about 25 to 45, and you misted the ortho window in high school. They don't like a certain tooth. I guess what I want you to do is, what would be the lowest-hanging fruit case to start? What would be a case to start to where, "Come on, dude, you’ve got to at least do that, you are a doctor. How could you not do this case?" Describe the low-hanging fruit ortho Six Month Braces case?

Rick: It's actually going to be a class 1 or a class 2 case, with mild to moderate crowding, or mild to moderate spacing, and about 50 percent deep bite, 50 percent vertical dental overlap. Those are your pretty much … the most straightforward cases you are going to get. You are going to be able to treat them very safely, those cases are very predictable, to treat. You just follow the sequences that we've set up for you, and those are as bad as the low-hanging fruit.

Howard: Okay. Then you are going to do an ortho workup, you are going to do a panel and the SEF and then tracing?

Rick: That’s recommended, a lot of people teaching this style of treatment don’t recommend SEFs. I think they are better for medial legal protection as well as diagnosis. I'll show you which cases are safer without, and which cases absolutely not treat without them, but it's always best to have them. We take photos, models, and our films as well.

Howard: You are doing a full ortho workup then?

Rick: I do. Yes.

Howard: What percent of the SEFs do you trace personally, versus you send them out to be traced?

Rick: Now I send them out to be traced. I'll trace one here and there. In the beginning sometimes it's nice to trace your first one, but really the important thing is interpreting the data you get back. What we used, we only look at four items. Okay. When I'm doing a traditional orthodontist case I look at about 16 items, but for Powerprox Six Month Braces since our goals are a bit different, our goal anti-cosmetic correction, we only look at four factors, and it's basically just to rule out what I call danger cases. Cases that can end up being an open bite, or an under bite, inadvertently, that are kind of hidden beneath the surface.

It's really to help spot those cases. Now, those cases aren’t necessarily hard to treat if you know they are coming, but they help especially at the beginning, a doctor learning orthodontics to help avoid those kinds of cases.

Howard: What are the four things you are looking?

Rick: I look at the [scaler 00:51:22] class, the maxillary to the mandibular bone, I look at the skeletal vertical dimension, the upper face site, to the lower face site, and I look at the upper and lower incisor angles.

Howard: Okay. This dentist listening in his car, he's thinking, I don’t have a pen … I have a pen, I don’t have a  [inaudible 00:51:42]. What would you tell that person?

Rick: I would tell them, I would absolutely not treat any case that does not have at least three, and preferably four to five millimeters of vertical dental overbite, because those are the cases that tend to be more about the hidden class 3s, or hidden open bites that can pop open, or go into anterior cross bite for you.

Howard: Say this dentist says, "Okay, I have pen, and I don’t have a SEF, I'm thinking about getting a CBCT."

Rick: Mm-hmm (affirmative).

Howard: Are you doing your own [pan and SEF? Is it a CBCT? If you are going to get a CBCT to start doing some surgical guides for implants, is there a CBCT that you use? Or, what are you using for your pan and SEF?

Rick: I use just a digital pan and SEF, CBCTs weren’t as big when I got, so it's not an upgradable one, but my oral surgeon has one, and the periodontist has one, so I can still refer out if I have to look at, and impact the canine or something like that. Even if you have an oral surgeon or a periodontist in your town, and you absolutely need to get a [SEF 00:52:47] slice out of one, most of them will let you do one, so that if you are not read yet to buy your own do anything, you can get it done.

Howard: Who do you say you get it … your CBCT, or periodontist, and who is the other one you said, oral surgeon?

Rick: An oral surgeon, if I need one, yeah.

Howard: How many times a month do you send someone to your periodontist or an oral surgeon for a CBTC?

Rick: Rarely.

Howard: Rarely?

Rick: It's rare.

Howard: Then when you do, do they … they charge you for that?

Rick: They just charge the patient directly.

Howard: Okay.

Rick: Whatever it is, a couple of few hundred dollars. I don’t get them for Powerprox Six Month Braces, I only use them for more involved, comprehensive cases, where we have multiple impacted teeth, or something funky.

Howard: Yeah. A lot of kids tell me, they really want a CBCT, but they just don’t have the money, and a lot of them had doubled the student [inaudible 00:53:38], and it's funny.

Rick: Oh, yeah.

Howard: I tell them all, you don’t need one, you need access to one.

Rick: Right, yeah.

Howard: You’ve got to be street smart, not book smart, and if you really want a CBCT every once in a while, I bet there's nine of them, within 20 miles of your office, and it's …

Rick: A lot of big cities … a lot of big cities have radiology centers too, so you can send out for all types of different films and views.

Howard: Do you know what? If you listen to the public, if you listen to the public, like, you will always hear them say, "Well he needed to do this dye scan of my kidney, or this or that, and then I had to drive 40 miles over to Glendale to have it done. If you need that one CBCT, I mean you can talk your consumer to drive 40 minutes if it's a one-time deal.

Rick: Right.

Howard: Now they are going to go there every week for the rest of their life, but driving a-half-an-hour for a medical test is just nothing for a consumer.

Rick: Right. No.

Howard: I've only got you for five more minutes, and so I want you to address this. It's just human … they are afraid, and I didn’t tell you my ortho story, and the best thing that happened to me, was for some reason I noticed when I went to the CE courses, that everyone had their FAGD and their MAGD, they were just better dentist. I mean this is obvious, they were CE junkies, like you said your dad was a CE junkie and was driving you to go to course in middle school. I signed up for my FAGD, because I want to be like them. I did not want to learn ortho, and I did not want to learn implants, and I wanted to take all my course on fillings and crowns and root canals, and it forced me to … In order to get my FAGD I had to take classes like yours, and my God, it was just love first sight. I don’t think I've ever, ever felt … taking some in a specialty.

It's also interesting. Like, I was at a convention not very long ago, and this guy was complaining the night before, that tomorrow he had to take one on antibiotics, and all this stuff, for his FAGD, and it was just going to be on prescription, he was dreading it. That night he was just lit up on fire, because these structural programs force you …

Rick: Yeah. Yeah.

Howard: … to do things that you weren’t going to do. I wish I could force my listeners to go spend two days with you, I wish I could force them, because I've known you for 20 years on boards, and your 15,000 posts, do you know how are saying, "Oh, yeah, that was good." You have raving fans. I mean, you have life-changing fans, I mean you do. You are rock star in dentistry, and so many of these … and the other thing is, back to dental health. Your patients aren’t going to take care of their teeth if they have bad self-image of their teeth. If they think teeth are ugly and crowding and dark, and they hate their teeth, they are not going to take care of them.

You need that, but the thing with the dentist, if you are going into the office everyday and all you are doing is fillings and crowns, and filling and crowns, and you say, "No, it's a job, and I'm just trading time for money and I'm burned out and fried." God! Learn something new. Go learn how to place an implant, go learn how to do some ortho. I think ortho is fun, and I'll tell you another thing, sometimes when you are tired, and you are walking in and you see your next patient, and it's like retreating a failed second molar root canal, and you are like, "Arrrggh," because it's a Pandora's box, you have no idea what you are going to get into.

Rick: Yeah. Yeah.

Howard: It is so refreshing to just say, "Oh, I have three ortho checks." I mean that’s like you are on recess. That’s just like, "Hey, go get a cup of coffee. You can text back your four boys, you just got three ortho checks in a row. It's just fun, it's low key, as I say, I wish I could reach through iTunes right now, and make you go to Rick DePaul, and you are a life changer, you are a role model for them.

Dude, I've only got you for two-and-a-half minutes, so I want you to give your best two-and-a-half minute close, to get … if you keep doing the same thing every day and expecting a different result, your insane. They are burned out, they are fried, their practice has been flat for 10 years, they need something, they need to add something, they need to spice something up. I know adding Six Month Braces is going to do it. Give them two minutes of close as to why they should come see you.

Rick: As you said, it's just much fun, and it's so low stress, it's like a different environment when someone actually wants you to see them. They are excited to come into the office, they are not dreading it. They don't say, "We never hear, "I hate the dentist." We never hear, "How much is my insurance going to pay, I want to get this over with." It just doesn’t happen. They are very excited, "Look how much my teeth moved this month. They look great, they are feeling so much better." Not only are they bringing you gifts, you see the smile on their face light up, and it really makes you and your staff, your whole team gets excited to see these patients, so it brings up the morale of the entire office.

It goes way beyond you know, increasing your profitability, you are having fun again, okay, and this is how dentistry should have been, but unfortunately insurance dictated a lot of that drag down. The patients are excited to see you, you are helping them a lot, you are changing their lives, you are just making them so happy, so exited, and it's so easy to implement this into your practice, and so many people want it. They are just going to come to your office in droves, and it's just going to create that fantastic working environment, you are going to love going to work.

You are not going to have worry about dreading that root canal retreat where the guy is going to flip you off, "It costs how much?" No. This patient is like, "Oh, my god, my teeth are so straight I love them. I told 10 people about you this week. That’s what you hear with this kind of treatment. We hear it every single day.

Howard: On the last note. I hope I'll get her name right. How is your adorable wife? Is it Marci?

Rick: Margie?

Howard: Margie, oh, I'm sorry.

Rick: Margie.

Howard: I'm sorry. She is adorable, I don’t know who I like more, you or her. She's just a … I think word-of-mouth is … Behind every successful man is a successful woman. Dude, I think she's more successful than you.

Rick: There would be no Powerprox Six Month Braces if it wasn’t for Margie. She does all of the hard work. I get to have fun talking to people, teaching doctors, she's the one that does all the hard work behind the scenes. She runs the whole show, she runs the practice, she does everything, so without Margie, I would not be sitting here talking to you. There's absolutely no way I could ever do this on my own. She actually deserves a ton, if not like 99 percent of the credit for…

Howard: Please don't tell her I called her Marci. Please lie, and said, "Howard, said hi." You just have to say what I say, ugh.

Rick: That’s not a problem.

Howard: Then my last questions, we are over time, is Dude, every time I see you on … post a picture of yourself you are eating like a 5,000 calorie dish. How do you stay looking so good, when you are always eating gourmet foods at fancy restaurants? How does that happen?

Rick: You may notice that I only post pictures of me when I'm away teaching classes. When I'm home I don’t eat like that, and I tend to exercise like a mad man. If I didn’t do those things I would weigh about 600 pounds, no doubt about it.

Howard: Okay.

Rick: That’s how …

Howard: On that note we are out of time, all I'm going to say is, run don’t walk, to go see Rick DePaul Jr., with Six Month Braces. Dude, you are a life changer. Thank you for all that do for dentistry, thank you for all that you do for Dentaltown, and thank you for all that you do for making so many dentists get back into it again.

Rick: Thank you so much, Howard, for Dentaltown and everything you’ve done as well. A life-changer for you, my life would be totally different without you.

Howard: All right, buddy. I can't wait to see you again, sometime.

Rick: See you , take care.

Howard: Bye.

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