Dentistry Uncensored with Howard Farran
Dentistry Uncensored with Howard Farran
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221 Hit The Ground Running with Jarod Johnson : Dentistry Uncensored with Howard Farran

221 Hit The Ground Running with Jarod Johnson : Dentistry Uncensored with Howard Farran

11/8/2015 2:00:00 AM   |   Comments: 0   |   Views: 447



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AUDIO - HSP #221 - Jarod Johnson



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VIDEO - HSP #221 - Jarod Johnson



Jarod Johnson, DDS shows us the right way to dive into a successful, satisfying career after graduation.

 

 

Dr. Jarod Johnson earned his Bachelor of Science in Biomedical Engineering from The University of Iowa in 2009, and his Doctor of Dental Surgery from The University of Iowa in 2013. He recently completed the Advanced Education Program in Pediatric Dentistry at The University of Nevada, Las Vegas, School of Dental Medicine in June of 2015. During his time in Nevada he served as a Delegate in the Southern Nevada Dental Society to the Nevada Dental Association. He recently opened a private practice in Muscatine, IA.

 

 

smile@arcticdental.com

www.arcticdental.com




Howard Farran: It is a huge honor today to be doing a podcast interview with a pediatric dentist, Jarod Johnson who just put up a course a few months ago on Dentaltown, "The Blunderbuss Apex: A Search for the Smoking Gun." What's all that about? Tell us about your course and what made you want to do a course on that?

Jarod Johnson: Well, it's actually interesting. When I was interviewing for my residency program, I went out to Las Vegas and I met Dr. [Ram Lemon 00:00:34] and he's an endodontist. We are sitting there in the interview and he goes, "Well, you know what, we're growing new pulps in teeth." I just said, "Well, I'm a fourth year dental student, I'm sitting here and you got so much going on at that point in your life and you can't possibly know everything about every areas." I think we had maybe one hour lecture in dental school on teeth with immature apices, and I just didn't know if he was trying to pimp me or what was going on. I was quiet about it and then we got out to the program and we just kept seeing these problems whether it be a trauma or caries with these immature teeth and where you get them sent from everyone.

It seemed like there's just a mass confusion on how to treat this teeth. In our residency program, Dr. Lemon would come down to our clinic and be the endodontist to work with us and he's really changing the way that pediatric dentists in our training program were looking at this teeth and I thought that'd be something that we can expand on and help share and he's been great. We've had a ton of cases that I treated there, some of the other cases from the CA or from a few fellow pediatric dentists that trained with me. It's just an exciting topic and I think there's a lot of confusion that goes with that topic.

Howard Farran: Do you mind giving away the low-hanging fruit on your course? I mean I think make people learn from it and when they go back and watch it?

Jarod Johnson: Yeah. The biggest thing I think the dentist whether it'd be general or pediatric dentist that we miss as a diagnosis. With the immature permanent teeth, there's a different way and diagnose them. We have kids for one and there not a reliable reporter. How many kids are going to come to you and give you a truth about their toothache when they're going to have to have worked on and you don't know their experience in the past, so it can really be a challenge sometimes getting the key information that you need onto that kid. Parents …

Howard Farran: Do you sometimes feel like a veterinarian?

Jarod Johnson: With the kids that have these immature teeth, we typically can talk to them, get a lot more information compared to the primary dentist and where there may be three or four, but typically someone at six or has a little better ability to talk to you and tell you what's going on. Parents, they're not always with the kids. If they have two different parents and they're living in separate households, one may say one thing, the other may say the other thing and your diagnosis based on their subjective findings can often be a little confusing. The way we do our objective findings too, the way we tests or do vitality testing on the teeth or sensibility testing is what the endodontist who like to call it. Now, that could be tricky because the EPT doesn't work as well, so we may be relying on things such as cold a little bit more than the EPT just because the last thing to grow onto the tooth is actually the A-delta nerve fibers which makes the EPT works.

Some of these things can get confusing and overlapping and you may be testing an adjacent tooth and that tooth is not is well-developed so that may not respond because the nerve hasn't grown in. You really got to look when you're making your diagnosis to all these things since it's just confusing because it's not always presented that way in dental school and that you look at the teeth next to it in the quadrant. Sometimes you may be doing the opposing tooth, there in adjacent tooth or a tooth that developed at the same time is your control rather than the tooth that's right next to it. I think the biggest thing we had some cases that would be sent to us from Reno, Nevada and the patient would fly down and see us. They said they needed a root canal with their dentist and we go ahead and do our test and do our diagnostic sign to just needed a filling.

I think there's still confusion with this teeth and it's not always easy to do either. Sometimes I was presenting with challenges and the only thing we could do to get a diagnosis was to remove all the decay or work on the tooth without anesthesia and that you don't want to be wrong with that with the kid. Those are some challenges that I see in the diagnosis. We really covered a lot in the CA. It's a very well evidence-based to see, and so lots of evidence to back up what I'm talking about and just different tools to help you diagnose. We also talked about the management and we go through vital pulp therapy, non-vital pulp therapy, regenerative endodontics, apexification, pulp caps, pulpotomies, just all these things that are available to you to help you decide which way you want to practice with these teeth. We're trying to make it more clear so that you can manage this in your office and it can really be a practice builder for you if you have a kid that comes in in pain and you can take care of that and you know what to do with it.

Howard Farran: Jarod Johnson, you're now, you open up your practice in Muscatine, Iowa?

Jarod Johnson: Yup, that's correct. "Pearl of the Mississippi." A beautiful town here on the river …

Howard Farran: It's on the Mississippi River?

Jarod Johnson: Yup. A beautiful town on the river here and we got a beautiful downtown. We got a lot of cool things that are coming in to the community. It's got some large industry. We've got Heinz. We've got Haan Corporation, furniture manufacturing here, Monsanto is here, [Canton GPC 00:05:52]. There's a lot of good industry here.

Howard Farran: Where were you born and raised?

Jarod Johnson: I was born in Lincoln, Nebraska, and then I've lived in Iowa City, Iowa which is University of Iowa. I lived there through high school and then did all my college education at Iowa. Two years out in Las Vegas which is fun for residency and the specialty training to learn how to work with kids.

Howard Farran: Did you spend more money in your pediatric residency in Vegas or in gambling?

Jarod Johnson: Probably in the residency program. Tuition isn't cheap for students these days. I think the average dental student graduates with around $240,000 of debt and that's average so you're going to have some more. The private schools they may be looking a little higher education cost than some of the public schools, so it just depends on where you go.

Howard Farran: Iowa is the most special states to me because I went to a college in a great university where the drinking age was 21, and if we wanted to buy a beer we had to drive across the river and to Council Bluffs, Iowa where it's only 18. I thought it was so silly that Iowa … that Omaha and Council Bluffs couldn't agree on this because they have a policy in Nebraska 21 but just across the bridge and it's 18. What's the point to having a policy? All it did was inconvenience to everyone to have to drive across the bridge.

Jarod Johnson: Yeah, it's like fireworks. We're next to Missouri and Wisconsin they both sell them, so.

Howard Farran: What was that river, the bridge from Omaha to Council Bluffs? Was that the Mississippi River?

Jarod Johnson: That's the Missouri River.

Howard Farran: That's the Missouri River?

Jarod Johnson: Yeah.

Howard Farran: You're on the Mississippi River?

Jarod Johnson: Yeah, other side of the state.

Howard Farran: Okay. You're almost touching Wisconsin then?

Jarod Johnson: Well, Illinois. Yes.

Howard Farran: Illinois.

Jarod Johnson: Wisconsin also is a border state but it's on further north.

Howard Farran: How did you find that? Did you go there because there's the Iowa fine project where they give you $100,000 loan repayment if you go to an underserved community? Is that what you did?

Jarod Johnson: Well, there's a few different reasons to picking the town. One was that both my parents and my wife's parents are in the Iowa City which is about 30 to 40 minutes away. Also a pediatric dentist used to be here, [Mike Canales 00:07:58] he went to the University of Iowa and now he works there. Do we know that would work? There's a huge need here for a pediatric dentist. There's a lot of underserved people and they would come here and be busy right away. One of the neat things I thought also that Iowa has done and I think it could be a great model for around the nation is they partnered with Delta Dental in the State of Iowa and then communities around Iowa and they are placing dentist in the rural Iowa where there is a huge need for dentist.

Through the university, the university actually has someone that they hired to work and go out and help find communities that are searching for a dentist and then work with students on the other side to help them either open an office, join an office and be in that community and serve. Through that program, I've applied for it. I haven't received the funding yet, but the community go to also has to contribute a portion. You have to serve either elderly, children, underserved 35% in your office. You're helping out the community, serving the underserved and then over a period of three to five years they'll pay back some of your student loan.

It's really a great program to get dentist to where they need to go. Because I think the way dentistry is heading if we aren't able to take care of these people that are in the small communities or underserved, it's just going to be more difficult looking at reimbursements from whether it be state insurance or private insurance companies coming in and running the state in chances. That's really going to shrink and we're going to end up with a two-tier system like many other countries have. I think it's a really good program. It helps with the debt that students are graduating with and I know that's a big concern, and then it also really helps our health of our state.

I've been really pleased in working with Delta Dental who's actually contributing a portion to it and then the representatives from my community and the University of Iowa in helping make this program possible because they have … it's just a great program and they have placed so many dentists in to small communities in our state and I think it's a great partnership for everyone.

Howard Farran: I think that is so cool. I mean, I'm from Kansas and 11% in the towns don't even have a dentist. You know what, it's funny because you'd never go to driving on a corner and see 20 McDonald's stacked up on top each other, but you go and find a medical dental building with 20 dentists in one building and then you drive an hour outside of town and there's a town with no one. I think what Delta is doing with that is genius. Can you email me how the Dentaltown and see the Delta guy? Who's the Delta contact?

Jarod Johnson: Yeah. The Delta contact they have two different people working with it. One is [Beth Jones 00:10:47] and then the other one is [Susan 00:10:49]. I don't know how to say her last name but it's Susan and they both are through the Delta Dental Foundation of Iowa. This program, it's been around for a while.

Howard Farran: They only do it in Iowa or is there …

Jarod Johnson: Yeah. The state will give 25,000 and then Delta Dental will give 50,000, and then the community will give 25. The minimum you have to get is 5,000 from the community but then that cuts back on the total amount that you get. The community really has to have an initiative to bring someone in, and there's tons of benefits for the communities. If you'd think about it what you're just talking about, if someone leaves in that small town and they have to go to that big town to see, it goes down the center like the McDonald's, they're going to spend their money there, they're going to go to lunch there, they're going to shop by their groceries there, all this travel in our town is going to take money out of these smaller communities.

It really hurts other businesses when that money that could have been spent in the community that that you lived goes out of town for specialty care whether it be medical or dental. I think the plan can work for other professions as well just to help business in the communities. The dentists are obviously going to be good and players, it's going to be stable for a lot of families in there and it just really helps having that dental provider in the community too for oral health.

Howard Farran: I can't tell you how many dentists. I can tell you had the story. They wake up in their house, so there's a dentist for 1 of 2,000, they came the hour into work where there's another dentist for every 500 and they're in hour in traffic every day listening to my podcast and they do that, where if they would've gotten up in the morning and drove an hour the other way, they would have driven to a town of 1,200 people without a dentist. If you drive to that town, I can't tell you how many dentists found that town, went to the mayor of that town and they go to the corner of first street avenue and there's half the buildings are boarded up. They say, "Well, see that red building right there? It's 100 years old and boarded up. If you give me that for free, I'll put a dental office in there," and then they're like, "Hell yeah." Now they got a free land and building, and then they'll sit there and say say, "I have too much student loan that I can't afford the loan," and then they walk you to the only bunker in town.

He's like, "You're going to live here. You're going to work here. I'll give you a signature loan." You got a free land and building, you got a signature loan and they own their own practice then they find out this, that they're doing $1 million in that small town with very low cost and overhead and adding like 400, instead of driving into downtown. It's a demographic nightmare in the United States. This young dentist go out and he make this one little wrong decision and that is to go to right downtown, big city, nobody need you, nobody want you, you're not unique, and then they suffer there for 20, 30 years and just that one little decision was such as game changer. That's why I send Beth Jones and that Susan, I bet you anything her last name is [Q 00:13:55]. Is her name [Susie Q 00:13:56]?

Jarod Johnson: No, I don't think so.

Howard Farran: Is she singing a song Susie Q when she started? Yeah, I want a podcast and I wonder how many states Delta does this when?

Jarod Johnson: I am not aware. If you go through the ADEA, the American Dental Education Association, you can actually get on their website. If you're a young grad right now and you're looking for some opportunity to help pay on your debt, they have state by state breakdown of the loan repayment programs that are offered in the state you may be wanting to participate in. It could be something anywhere from Indian Health Services. It just depends on your state. I just been really impressed with what Iowa has done and it's working. Every year there's money appropriate. There are four spots this year available for four people to get this and …

Howard Farran: How many took it? How many took it?

Jarod Johnson: I don't know what the final numbers are but I'm just waiting on my community to match from, so …

Howard Farran: That website is ada.com or .org?

Jarod Johnson: That's ADEA, so it's American Dental Educators Association, and they have a list of …

Howard Farran: Is that ada.com or .org?

Jarod Johnson: Let me check here. I can see if I can pull it up. I think it's adea.org maybe, let's check. Yeah, adea.org. That's American Dental Educators Association. That's different than the ADA but it's an organization …

Howard Farran: Is it part of the ADA? Is that at 211 North Chicago Avenue in Chicago? Where they at?

Jarod Johnson: This one, I'm going to check here. It should be on their website here I guess. This is in Washington DC.

Howard Farran: Washington DC?

Jarod Johnson: This is like, if you're a dental educator, this is their association for the …

Howard Farran: Who's the executive director of that?

Jarod Johnson: I'm not aware but they just put the list on it. It helps the students with anywhere from getting to dental school to place and after dental school. It's for dental educators. It's their big organization. If you're a professor and adjunct at one of the schools, you can be a member there and help partake in that organization.

Howard Farran: That is amazing. Also, and dentist just … dentist can just start driving to these small towns and these cities and see what's available. I also think a reverse engineer, this is what the founder of Heartland Dental Care, Rick Workman, did, is he was so counter-intuitive. He just start calling the insurance companies saying, "Where are you selling insurance across the whole state but people are calling him and complaints they have your insurance but there's no dentist," and they literally gave him a list. These are the towns where your complaints that I have insurance for the state shares, police, teachers, firemen, whatever, and there's no dentist that takes my insurance because there isn't [inaudible 00:16:45], and he started going there and open up dental offices. He worked with the insurance companies backwards to find the location. I mean that just genius.

Jarod Johnson: When I was doing my training in Las Vegas I had the opportunity to join the Southern Nevada Dental Society. I love being on Dentaltown. I check it probably every day and it's great, and I got a lot of ideas from my office on it. You pick up little things. In dental school they don't teach you how to fill out an ADA claim form as silly as that may sound. You don't know how to file insurance, what do you do with primary and secondary insurance. All these questions, a lot of those topics are covered on Dentaltown or covered in the magazine, and as a young professional it's great to have that community online to be able to see what other people are doing. Maybe you don't comment on every post, maybe you're just browsing to look at something to search if something you've really need to answer on.

One of the things it doesn't do, it doesn't bring a lot of policy together on the state level. That's why I got involved in the Southern Nevada Dental Society, and you would be surprised to some of the things that are just going on in different states and in Nevada alone, things that we're fighting as dentist. One of the things I think that's interesting is most dentists go in and either join a practice or join a corporate practice. These corporations whether … I'm not saying they're bad or good but they're not coming at the table at the state or at your dental meeting as a delegate and talking about these issues. We really need to stand up for ourselves as a group whether it be code-bundling. I'm sure you see that everyday in your practice and it's okay for the insurance company to bundle all these codes together but it's not okay for a dentist to do it.

Howard Farran: What do you mean? Explain that, that went over a lot of people's head. What do you mean code-bundling …

Jarod Johnson: Code-bundling is let's say, I have a patient that comes in for a new patient exam and I do it for bitewings and then I see a few teeth with large cavities. I want to make a few PAs and then I don't want to do PAs of all the mouth, I want to get a pano on this young kid to see how their teeth are developing and their jaw. What they'll do is instead of paying for the pano, paying for the bitewings and paying for the PAs you made, go bundle that and say "No, our FMX or full mouth series, complete mouth series code is more cost effective for us to pay that than to pay for what you actually did, whereas if I were a dentist and I submitted things that I didn't do, that's fraud, but when they bundle it for something I didn't do, that's okay.

It's just not fair for us not to get paid for what we do. We talked about the debt levels, average graduate over $240,000 and you got to be able to produce that money to pay that back. There's going to be a point where we're not getting paid enough to take the insurance plan, you're going to have the problem we just talked about where nobody in town is taking my insurance because these things are happening and we spent a lot of time and without the x-ray we can't really diagnose and there's other things when you do a crown or look at direct pulp caps for example.

If you're doing a direct pulp cap, looking at some of the recent studies with MTA and 80% success. If you could avoid a root canal, 80% of the time in these cases shouldn't you get paid for that? MTA is not a cheap product to have in your office. It's a lot of cost associated with it. It's difficult to handle. It's going to take you more time than putting calcium hydroxide on there, but it's better and if you can avoid $1,000 root canal on a molar I think you should get paid for it. There's a lot of things that they bundle in and that there are services and we do have override cost and we do have to provide for that. If they're bundling these codes and we're not getting reimburse to what we should, it's going to be difficult for us in the future to go forward and offer quality care to our patients that have insurance.

Howard Farran: Well, speaking of overhead, we heard to the website physicians for a national health program, www.pnhp.org, pn.hp.org. It said, the health insurance company CEO's total compensation in 2014. The head guy of Cigna made 27 million last year, that's 104, 000 a day. The head guy of UnitedHealthcare made 66 million, that's 254,000 a day. The average dentist who walks out a dental school, student loans at about 250 and this guy makes 250 a day. The head guy Humana made 13.1 million last year. The head guy of Anthem made 8 million last year, that's 31,000 a day. 

It's tough because everything intelligent is about checks and balances and if you didn't check the dentist they would want to do come in to work on Monday morning and do one crown for $1 million and then go home. The insurance companies they had it their way, we'd all be indentured servants, you know what I mean? It's always that checks and balance. Can the lion really lay down with the lamb? They have to be checking and balancing. It's complicated. You got the government, you got the dentist, you got the interns companies, you got the patients, and if they're always edging back and forth.

Jarod Johnson: I mean, it's definitely something that … but that's some of the things that in Nevada that they're working on to have some simple things like someone that reads the claim should be a dentist from insurance company. You shouldn't have someone that's not a dentist saying whether or not this crown is justified or not. That should be a dentist. There's some little things that they're fighting for for dentist but we also need as young dentist to be at the table and be invested in these things or we're not going to … we need to go for it and take it our level as we're advocating for the patient, because that's the only way that we're going to ever get anything done as if we're out there and we're on the patient side and I don't think anyone went in to the field to dentistry to not take care of people. You never hear anyone say that when they talk about why they became a dentist. We're in a unique profession where we get to be our own boss right now and I like to keep it that way.

Howard Farran: You got to what?

Jarod Johnson: We get to be our own boss if you choose to.

Howard Farran: Oh, be your own boss.

Jarod Johnson: Yeah, and I think that's appealing for the field. We're also in the field where if someone comes through us in pain, we can make a difference in their life right away. There's a lot of things that are attractive about dentistry and if we're not at the table and leading on the forefront in our organized dentistry I don't think we're probably be a lot of corporations. We'll probably like the pharmacies where we used to have a CVS, or I mean, at local pharmacy now I have a CVS on Walgreens taking over. We definitely need to be involved and I agree there's give and take but if we're not out there trying to work with them and advocate for our patients I think it's going to be more difficult in the future as we are on our own boss and we do what we're told.

Howard Farran: I think specific to your CVS still the problem with those, the pharmacies that 70% of their cost was buying the pills, and so, that's a perfect economic model to roll them all up so they can all have leverage against Merck and Pfizer and Johnson & Johnson, whereas in dentistry only 7% of our cost is supplies. The pharmacies were 70% and we're only 7% for supply. Number two, is that a pharmacist just hands you a bottle of pills.

Jarod Johnson: Yeah.

Howard Farran: You don't care if Obi-Wan Kenobi or R2-D2 or a droid or an ATM machine hands you pills. In dentistry, the reason I think it has the most safety is I don't see any dentist holding on to even half of their patients. I mean, they get 25 new patients a month their whole life, and if you got 25 new patients a month every three year, 25 times 30 you'll have a full time hygienist working 40 hours a week, 50 weeks a hour servicing 1,000 people for six month [cleanings 00:25:05]. They'll get 25 new patients a month for 40 years and still have one hygienist.

It seems to me that for every person that walks in the dental office front door, one works out the backdoor and at 2015 nobody can keep their customers for life. Who cares if it's a corporate dental office across the street or private practice? The practice across the street, it didn't matter if they have no hygienist, one hygienist or two hygienist or three hygienist. Come back 10, 20, 30, 40 years later their capacity number changes. Some will just like build $1 million practice and they'll do 1 million year while getting 50, 60 new patients a month. If they'll get 50, 60 new patients a month for four decades which means 50 to 60 patients a month we're going to out the backdoor.

I feel at 2015, when you lay a person back and you have to work with your hands, in their mouth and you got to explain this to Latin and Greek to your patient who don't know Latin and then pay money, it's so stressful and it's so complicated that nobody has figured it out how to keep even half of their customers for life. Corporate dentistry, I don't see any advantages they have other than a group practice where if two people shared a pano machine that be lower cost and then one person out. Other than just the raw skills of efficiency of a group practice, like I always had two or three dentists in my office to share that so we can expand [inaudible 00:26:33], but I don't see any advantage, corporate dentistry has over just my practice that has a couple doctors. You know what I mean?

Jarod Johnson: Yeah. I definitely see … My point is more along lines of we want to be involved in organized industry to go ahead and make sure that we're really addressing the issues that are concerns toward to the dentist and to our patients. I just want to encourage people that it's great. You're going to meet people and you got to talk to them, that work them with them similar to like you do on Dentaltown, but you also doing something a different way than what we do on Dentaltown. Dentaltown is a more talking about issues that come up on our everyday practice talking about techniques that people are using that are great ideas out there. I've learned so much from just been on there but I'm just trying to be an advocate for things at the state level, things that are going on each our states.

Howard Farran: Absolutely. Absolutely.

Jarod Johnson: That was more my points, not the point that …

Howard Farran: What …

Jarod Johnson: I don't think corporate is bad. I think it is what it is and it's going to be what … it's a great stepping stone for some people and there's corporations out there where you can own two portion of it, so I think it's …

Howard Farran: What percent of the dentist are members of the American Dental Association?

Jarod Johnson: I believe the last number I heard, I don't know if this is true, but I think it was over 90%.

Howard Farran: For your State of Nevada or Iowa?

Jarod Johnson: I'm not 100% sure. I know Nevada, we've … When I was in Nevada that was always a struggle trying to get people and I think people don't see necessarily see the benefit but there's a lot that is being done and I honestly didn't see the benefit until I was a delegate. I was sitting on the meetings where we're talking about the issues that our lobbyist is going to town for us on. Some of these issues were big deals and our dental association we were taking steps ahead of the game so that when legislation came through we already had, we're proactive. One of the things was with opioid abuse and having the system to look up opioids on your patients and do a self-report on that and you can look at that once. The medical profession they were ahead of the game doing that. When that both came up for the law, we were already saying we're already doing this and the medical profession wasn't and it was a big deal to have …

Howard Farran: Talking about specifically, you wanted to be … Explain opioid abuse website, you want to look at … what do you mean?

Jarod Johnson: What the Nevada Dental Association is they actually works with the Nevada Dental board to go ahead and make it. Dentist had to log in at the system and it's a system where you could check if you wanted to how many times the patients receiving the narcotics. You could say just differentiate between …

Howard Farran: It would tie into Walgreens and CVS' data banks so you could see this patient …

Jarod Johnson: You could look something up and then it also would provide information so that you can look for things that might come up if there's a red flag. There was already legislation coming down the pipeline that was going to regulate this and it was going to be way more regulation than what dental association had and it was enough. They were proactive about it and when they came time to go to the lobbyist went up there and said, "Hey, we're already doing this. Look at all the positive steps we're doing to help reduce opioid prescription that be used in Nevada from dentist." Everyone thinks dentist are this huge prescribers of opioid and this one way to combat that and just say, "Hey, this is what we're doing to make sure we're proactive about the patients that we're treating and looking them up, and having a resource for dentist to do that." Those are things that I … You don't see that if you're not sitting at the table talking about …

Howard Farran: Interesting thing about hydrocodone. It's been the number one most prescribed prescription ever since they started recording prescriptions. Every year I've ever seen, here's the top 10 prescribed medication in the United States. Hydrocodone, 0.5 milligrams, 500 milligrams of acetaminophen is the number one every year. You know what I used to do is when I got in school in '87, back before computers and all that stuff and we had prescription pads, I always wrote the prescription to the pharmacist.

I went to Walgreens and CVS and invited every single pharmacist to my house for dinner and got to know them all because so many people go to the pharmacist. They say, "What's good for toothache? Is it this Orajel or this pill, whatever," and they would peel off the prescription and they'd hand it to him, and then later they told me that their general managers found out and they're not supposed to do that but they all did it anyway. When I would ever call my pharmacist friends in Ahwatukee that I had for dinner in my house and I could just say, "Hey, patient, Jim Jones, is he pulling my leg?" and they'd say, "Dude, he's got a prescription for Vicodin from 16 different doctors in the last 90 days." I think all that's illegal, isn't it? I mean, for him to tell me that, is that illegal?

Jarod Johnson: As far as the pharmacist or …

Howard Farran: Yeah. Yeah, pharmacist I mean. When I [crosstalk 00:31:36] …

Jarod Johnson: I mean …

Howard Farran: … pharmacist and he tells me "No, this guy is working in the system. He's abusing …

Jarod Johnson: I mean, they're involved in your patient's healthcare. If you with your HIPAA protocol in your office, if you're allowed to, I can … my policy is written that if we need to get information that share with another medical provider, we can get permission to do that. Iowa has a database as well that I'm aware and I haven't …

Howard Farran: When you basically signs the HIPAA deal, that just be permission to call the pharmacist?

Jarod Johnson: Well, it depend how your policy is written if …

Howard Farran: You should start a thread on Deltatown and get everybody posting their HIPAA deal so we can all read through them.

Jarod Johnson: It's a huge one but it's through the ADAs. It's interesting with the HIPAA stuff. I went over to urgent care here because I had wax to my ear, and their HIPAA thing was like two sentences and I just said, "How are they getting away with this when I got to have four pages of stuff?" I think it also depend on your state and then the way your forms are written if you have it written so that you state that you can share information with these providers and they sign that form and agreed to it obviously then they have given you permission to share information if your policy is not written so that you can share that information with them maybe and to get some more permission depending on the provider.

Howard Farran: You know what, I'm a big fan. That was the reason I contacted you. You have 400 posts in Dentaltown, you got to see. Of course, I'm a big fan of your post. Did you think you should start to thread on that or post to ADA HIPAA form?

Jarod Johnson: I paid for it. Obviously, you don't want to be using copy written material, but if you go to ADA's website you can actually purchase the OSHA compliance manual on the HIPAA compliance manual. I did both those as I open my office here …

Howard Farran: ada.org, the forward slash, www.ada.org [crosstalk 00:33:33] be forward slash …

Jarod Johnson: It'll be on their catalogue. Make sure you look, if you're an ADA member they're always sending you something in the mail, make sure you get the coupon code because you'll save 10% off of that. Don't pay the full price, I mean it's going to be reduced anyways but then make sure you find the coupon code because they're sending out all the time whether it's through the ADA Morning Huddle or if you're getting it they'll send out brochures to you sometimes in your office to try to get to buy those. Usually there's a promo code so make sure you get the additional percent off. I use that as I started my office and …

Howard Farran: You said the HIPAA manual and the OSHA manual?

Jarod Johnson: Yup. I actually bought a bundle, it came with the HIPAA manual, the OSHA manual and then dental letters, so press releases, stuff to your website, dental letters when you got patients aren't showing up, dental letters when you got patients who have care they need to get completed.

Howard Farran: How much was all that?

Jarod Johnson: I think it ran me around $800 to $900.

Howard Farran: Wow. Do you know the person in charge to that?

Jarod Johnson: I do not, but it's through the American Dental Associations.

Howard Farran: Yeah. Talk about their Morning Huddle.

Jarod Johnson: That's …

Howard Farran: The Morning Huddle, the email …

Jarod Johnson: Yup, the email …

Howard Farran: Yeah.

Jarod Johnson: … something as I'd been impressed with.

Howard Farran: Yeah, so am I.

Jarod Johnson: What they do is they take days. I think they have a system where they can scour press releases and newspapers around the nation and I think it's really good because I've actually used some of the articles they put there in my social media. You're always looking for something to an article or something to put out and it's about probably 10 to 15 articles everyday that they send out and usually it's something about a public health measure that's going through, someone is doing dentistry from the heart, things like that that they open their office for free dental care.

An article with the world leader in dental care in their fields, so like a specialist they have the AAPD present on there, the ADA spokes people around there and it's been really good because you can pick out a topic probably everyday and share that on your social media if you wanted to to help educate your patients and really have a presence. I always like the stuff that you post on your stuff and some of that stuff I share to on my social media, but this is something that it gives me an idea what's going on the dental field, what are some issues other states are dealing with, what are some things that are coming up as far as patient concerns.

There may be article in the Wall Street Journal that you can take a look and see maybe one of your patients reads that and maybe you need to do a little more information about that. I think there's just one I think two or three weeks ago that was great on sedation. If you do sedation in your office and you had a patient who read that, they may be coming to you with some questions about your monitors and what medications you're using and what are some side effects. Reading that, you can really be prepared when the patient walks on the door and they tell you, "Oh, I read this article" and you'll know exactly what they're talking about just by reading that little short paragraph for probably a minute of your day, and after something interesting you click on it and read it.

Howard Farran: I love your passion. I love you enthusiasm. I love everything about you. Why would you come out in dental school $200,000, 300,000, 400,000 in debt and now invest $1,000 a year in memberships to the American Dental Association which is your organized body for representing dentist. I've been a doping member every single year since graduation in 1987 and I just … it irks me when you hear dentist bitching about the ADA so they don't pay their dues. It's like you're bitching about your country.

Jarod Johnson: They do so much for us. If you're not involved in your local dental association, if you're not in these committees, you don't what they're doing, they're distant to you.

Howard Farran: I know.

Jarod Johnson: My eyes are opened in Nevada. I'm lucky they asked me to be a delegate for the two years that I was there. I made great friends, great, mentors I met that were in my state and they do so much for us and I think at sometimes we … if you're not involved you don't really appreciate it, but what other body can go to their nationally and say we've got 90% dentist in our organization? People listen to that. If we ever lose that and we have … I think the American Medical Association and I just saw how… they don't even … I don't think it's even half from what I thought. It's …

Howard Farran: They fell under half a decade ago.

Jarod Johnson: We as dentist, we have this ability and people are listening when you say you're walking to that Senator or congressman's office and you say I represent 90% of the dentist in America. That's powerful.

Howard Farran: I had dinner last week with the executive director of the Arizona State Dental Association Kevin Earle and his number two guy [Terry Zalowski 00:38:11] and it's mind-numbing to hear all the things are working. Yeah, I have no idea. I mean, you're in your office and you're trying to get number 19 numb to do a root canal and yeah, you're just worried about your rubber dam clamping. They're talking all these legislators, all these issues, all these things and you don't know the half of the details. Dentist might hear of like a low-hanging fruit big macro question but it says 80% said they're working and you'd never even know and it's so important and we have to have a collective body voice.

Jarod Johnson: Yeah. If you're young and one of hardest things for me when I went to the meeting was, I am new dentist, I'm a nobody. You have all these dentists in the room that their body is for 20 years and you're trying to getting in and talk to them but don't be intimidated for that. Go to a few meetings if you can, talk to people. People are going to start to realize you when you show up. That's how I was asked to be on this committee. I showed up to things and that's what people want. Once you start showing up you're going to make great relationships with the people in your community. We're all similar but we don't all go there and we talk about dentist but we talk about our families and they're great friends. It's just relationships that you build are incredible.

Howard Farran: I love the president we just had in the one next year. Did you see a podcast for those who's a … what was her name, Maxine? That's the president of the ADA who just finished and then the next year is from Southern … I mean, just great people. Just great, honorable, good people just trying really hard to do the right thing …

Jarod Johnson: Yeah. I can imagine that'll be a tough job to, all the speaking obligations that they get to have and you're the head of talking for 90% of the people would be pretty stressful. There's topics that keep come up. I remember the infection control one where we get the dentist in Oklahoma that had infected some people from reusing the same needles, the fluoride stuff that's going on amalgam, all these things are just things that they constantly have the talking points right on for us as an organization or we could be in a world [inaudible 00:40:21].

Howard Farran: Yeah. Yeah. The sterilization thing, I have a feeling that's going to go down really, really ugly because the dentist I have noticed in terms of disease and drove last 28 years and getting information about water fluoridation all that stuff, they already have had epidemiological models where they had traced back outbreaks of let's say hepatitis or something just and all pointed to a dental office. I know the Cecil the Lion, how do you connect Cecil the Lion to this but …

Jarod Johnson: Yeah.

Howard Farran: … it's the same thing. It's a perfect storm. There are already these big groups forming that did not want big game and they were forming and getting bigger and louder and louder and then a dentist walks in, a rich dentist from a rich country and [inaudible 00:41:04] and they were just ready to destroy this guy. The truth be known that a lot of people in that country didn't know who Cecil the Lion was. It wasn't made out.

Jarod Johnson: Yeah.

Howard Farran: It wasn't like they [inaudible 00:41:15]. The next, so he was in part of a perfect storm that the world had enough of shooting lions and rhinos …

Jarod Johnson: Yeah.

Howard Farran: The same thing is about to happen with sterilization. I mean, for years … did you see that peanut butter guy who just got sentenced like 28 years because of a food poisoning outbreak and they would always … the groups always say, "Well, how come if an individual goes and shoots the guy, you press charges, but when a company isn't doing the right thing and they kill 10 people in a food outbreak, you don't even press charges." All these groups have been raising for years and years and years and finally they had the peanut butter contamination and the feds went in and they investigated and they tried him like it was a murder and the guy got 28 years and that's going to happen to a dentist.

A dentist, a good old boy who just wasn't [inaudible 00:42:08] just thought bought a nice deal from their dealer and thought everything was great and thought this was a good but really didn't do the details, and then there was going to be some type of little like a hepatitis outbreak and someone's livers going to shut down and they're going to die and the media and social media is going to pounce him and they're going to put him in front of jury and they're going to show do you not dotting the I's and crossing your T's while being a rich dentist spending 150,000 a years. Little poor Amy is dead and the trial is probably going to send that dentist to jail, and that's probably what it'll take before everybody sits there and says, "You know what, in this world of instant information and social media, it's game over. You got to dot the I's and cross the T's or go home or go work for corporate or the navy or someone else."

Jarod Johnson: Yeah, and I agree with you, and that's one of the things … how many of us in our dental school training got in front of our Midmark M11s were taught how to load it and do all this stuff. That was never taught to us. All the instruments used in dental school, you put on the tray, you send off back to the big central sterilization and you never learned that process. There's tons of things that we don't learn in dental school that if we're going to be a business owner and we're going to be taking this risk where we do need to sterilize instruments, we make sure that they're clean and know all the protocols to make sure that we keep our patients healthy.

We definitely need to be able to get that information from somewhere and this is great. When I opened my office, you're going to have the reps come in and you're going to get your training and then you run your spore test and you make sure things are going right, but that's something that's not taught that we have to be aware of. If you're not savvy enough to pick up on these issues and make sure you dot in the I's and cross the T's it could be a lot of trouble.

Howard Farran: What's weird about my autoclave was whenever it gets loaded it starts using profanity and repeating the same stories over and over. Upon on the word "loaded," horrible joke. Okay. What's the difference between the dental society that you're involved with in Nevada versus Iowa? Is it the same different issues, different …

Jarod Johnson: Some of the issues I think are the same, it's just that there are different points within the states. I've been to one meeting here in Iowa, Las Vegas is a big community. Their dental meetings they have them every month from August all the way through the end of the year through March, and just a lot more meetings. As far as the downsizers, different issues. Iowa is currently undergoing Medicaid reforms so it's going to go from state run to private run. That's one of the issues that dentists are facing. We've had a lot of companies come to us and say, "I've got the deal. There's no deal that's been made" and they're trying to sign you up. When they go to the state, they can say, we always going to sign up, take us.

There's different issues that we're battling in different states but it's been … I've been impressed with the people and my district meeting and I've been to a few of the Iowa dental meeting, so it seems like our delegates and trustees are trying to work on the issues that are really pressing to dentist center patients in the state. If we have some of these private companies come in, take a scheme of the dollar. Some of our fees that we're charging doesn't even cover our lab fee and then you're going to take more away, how are we going to be able to see some of these patients that have the greatest need. It's going to be a little more difficult. We need to advocate for patients and make sure we're getting reimbursed properly for [inaudible 00:45:44], cover fee, then we got to pay our staff and so that's going to happen otherwise we're not going to be able to continue to see these patients. It's going to be an unfortunate circumstance for a lot of people including the dentist.

Howard Farran: When you were in Nevada to dental society and now on Iowa, did you guys have like a Dentaltown message board to talk all the time in between going to the physical meetings where you see each other?

Jarod Johnson: Not quite. That's one things I like about Dentaltown, I can log on everyday …

Howard Farran: Do you realize on Dentaltown we spend a year programming private forum? The complete Dentaltown, if you go to private forums you have a complete Dentaltown where a guy can start a group and they can add or not accept or kick out members just their own Dentaltown.

Jarod Johnson: Yeah.

Howard Farran: You could go to all the dentists in Iowa and say, "I set up a private group on Dentaltown and we can all talk and no one can go in there and read what we're saying unless the site, the person who started the group accepts them or denies them." I set that up so that all 50 states they could go in there and talk about these political issues without having to worry about other people …

Jarod Johnson: yeah.

Howard Farran: … reading what they're saying. Were you were at the private group section?

Jarod Johnson: No, I wasn't. Nevada had one as a Facebook group but obviously different generational things, some … a dentist that's been practicing for 50 years and may not be computer savvy, one that just came out school maybe. Obviously, it's a great way to communicate and I think there are a lot of things that were right up on there about trying to get people to come meetings too, different topics. If someone is doing in after hours at their office where they wanted people to come over and just talk, that was advertised on there. Yeah. I think it's definitely got a good place. I love that idea, just have another private place, because sometimes the Dentaltown, I'll read something and I'll say, "I don't know If I would agree on that, if I could read that.

Howard Farran: Right. Right.

Jarod Johnson: Because obviously there's issues and no one is mentioning names and we're all be in very compliance for us HIPAA. If one of my patients got on there and read something that I wrote, I wanted to look at me in a positive way and I know we get frustrated sometimes but definitely we want to always have a positive spin on my name and the things that I say and it's nice to be able to have that private way so that way or if an insurance company were to get on there, someone that was against the of agenda of advocating for the patient, you'd definitely would want to give away all your tips and secrets if you're going to work with the lobbyist and try to pass legislation.

Howard Farran: Let's go to pediatric dentistry. A lot of kids have listened to this podcast, the juniors and seniors in medical school. One of the most biggest question they ask when they graduate is should I do a residency or should I specialized. How would you answer that question and specifically towards pediatric dentistry? Why did you picked to go on to pediatric dentistry instead of being a general dentist? It was [crosstalk 00:48:36] decision or would you do it again?

Jarod Johnson: I wholeheartedly do it again. When I was in dental school and in my college training I was able to work with the few organizations, I was actually junior high football and basketball coach. I had worked to the few organizations, I worked with kids in town and I realized I could deal with the older kid or junior high kid and then also through dental school, it's just fun working with the kids. Every day I come to work and it's going to be different. Nowadays it's going to be the same. You never know which personality of the kid's going to show up. Really to treat kids, I felt like I needed to have specialty training to be able to offer either sedation or go to the hospital to try to make that kid have positive of a dental experience that I can. One of the big things, if you're looking at pediatric residency programs, I would definitely look at what their school philosophy is, are they a hug them, are they a drug them, are they a [slug them 00:49:29] school.

Howard Farran: I never heard that, hug them, drug them or slag them.

Jarod Johnson: Yeah. In every schools got a different philosophy. The hug them schools you're going to praise and work with them. The drug them, sedation every school so you're going to get a little bit more work with oral sedation and maybe some IV sedations and then anesthetics. The slag them school you're going to get more behavior management.

Howard Farran: Okay. Hug them is more …

Jarod Johnson: Praises and you're happy and friendly and then slag them you're going to get a lot more behavior management with them as far as getting things done and maybe a little stressful on you but at least you know what it's like. I think you should experience all of them in your residency, take the most difficult cases you can, because once you leave you're on your own. You're the top person there. There's no one behind you to step in and say, "What are you doing or to take over." You really going to be confident once you leave your program. I think anyone that goes into specialty program will be. Definitely it take that as the most difficult cases you can take and ask about the philosophy.

If you really want a sedation experience because you think you can do a lot with sedations, don't go to a slag them school where you're not going to be able to get that. Also you're going to want to make sure you go to school that ask them what drugs they use. If you're going to be doing a lot of sedations, you want to be versed in a wide variety of medications and feel comfortable doing that. You don't want to get out of practice and say, "Oh shoot, I didn't train with this drug, and then think "Well, should I use it or not?" My answer to that question would be I'm not going to use that I haven't trained on because, if you don't train with it that you might not get all the things that you didn't know about to be comfortable with it. Those are definitely things. You obviously want to look at what's your call schedule like, definitely you want to be able to deal with trauma.

You want to be on-call and be able to deal with those things. When you see that in private practice, I know it sucks to be on call but when you got to go on to the hospital and take care of someone and you were the only person there to do it you learn pretty quick on how to manage these cases with trauma. Trauma is difficult because it's not always going to be successful what you do but at least you can know that you're able to develop the best treatment plan at that time and given the course the patients follow-up you'd be able to see them or that follow-up with their regular dentist. You can make a big difference in someone's life and if you can be able to deal with trauma.

Howard Farran: If you saw 100 patients, what percent of your tactics, should be hug them versus drug them, versus slag them?

Jarod Johnson: I mean, it just really depends on the patient. Obviously parents too these days, parents are becoming more and more, they don't want their kid held down. Parents are very affluent. They don't want their kids to have drugs. They think they should be able to do it. Depending on the parent and how much work they have, the amount of time, if the kid comes to me in pain versus if they're not in pain, I think there's a lot of talk that's been going on about this. The silver nitrate and silver diamine fluoride as alternatives, the Hall technique in pediatric dentistry. There's a lot of different things that we don't a whole lot about but are definitely alternatives to doing things. Maybe if we can kick something off a little bit further the kid can grow and we can get it done in six months. I don't know, it just depends on every kid.

I tried to look at every kid as an individual and see what's going to work best for this parent. Is this parent going to want to have their kids sedated or they're going to want to just get put to sleep the whole time. Sedations, it could be multiple visits and maybe they'd rather have it done at once. There's risks to both, there's benefits to both. That's probably the thing I struggle at the most being on private practice is trying to come up with what's going to be the best behavior management technique because one technique doesn't fit every patient and it doesn't fit every parent. At the end of the day, you got to have the parent and happy and the patient treated successfully or that patient could be gone somewhere else.  It might be … go ahead.

Howard Farran: I'm sorry. No, go ahead.

Jarod Johnson: One of the big things I learned in residency and [inaudible 00:53:43] that's been great is when the patient comes in to you in pain or the kid comes to you in pain and the parents taking the time off work. It's in a great benefit if you can get that kid, get that treatment done, so when they go home they're not in pain because when they go home and their dad is sitting there and the mom brought them in and that kid is still in pain, they're going to say, "You went here. You took this much time, you didn't go to work and you spent this much money and they didn't take care of your problem," it's going to create some problems at home and the household. There's different ways we can do things. Sometimes you can't always do treatment and sometimes it's difficult for the parent but where the patient I should say, but definitely those are things that I like to take into consideration. Sometimes it's challenging and sometimes they don't want to do it and you can't really force anyone to do and you can just educate them on what is going to be the best for their kid.

Howard Farran: Is there's still a use for a papoose board in your opinion?

Jarod Johnson: I believe so. There's different uses for it, a variety of reasons. Maybe to help you get the procedure done where you've got a kid that maybe going to the hospital if you don't do this. That could be something the infection or the pain is that bad that it has to be done. Maybe you need to be done on a sedated patient, someone that if sedated they can't keep, they're flopping around a little bit, that you need something to hold them down a little bit so that they're not interfering with your staff or the procedure. Obviously we're using sharp tools instruments that can get in the way.

Some special health care needs actually do benefit from utilizing it, so things like autism if that's something where the patients going to feel more comfortable when they're in a blanket wrapped up, that may be something work can be done. There's sometimes really kids … anesthesiologist here in my town they don't want to take a kid under a tooth a general anesthesia. If there's a kid that has D, E, F, and G and they're not looking so good and I'm not comfortable [inaudible 00:55:49] then maybe our only option to get those teeth out, they'll be numb but sometimes it has to be done and that's something to talk to the parents about.

There's risks to go on to sleep and on a two-year-old we're finding out more and more about general anesthetics and there's been some post here on Dentaltown, even discussing it about general anesthetics in young kids and neurotoxicity. I don't think we know the answer. I don't think we have enough information to say one way or the other, but like you said, there's the world of social media. If someone can pinpoint something on some procedure where there's something a risk or something, that can be a big deal.

Howard Farran: By the way, do you spell papoose board with a P-A-P hyphen P-O-S-E or did you just go P-A-P-P-O-S-E?

Jarod Johnson: P-A-P-O-O-S-E. No hyphen so …

Howard Farran: P-A-P …

Jarod Johnson: O-O-S-E

Howard Farran: It's P-A-P-O-O-S-E.

Jarod Johnson: I think, that's how it been.

Howard Farran: You're incredibly intelligent because that did give away red flag of a highly intelligent person is there's no black and white, yes/no answers anything. Everybody wants a yes/no, left, right, just a … and life is 50 shades of gray. When someone comes in and says, "Oh amalgam should be illegal, and there should never be a papoose words. I mean, they're just not critical thinkers, because like you just said, if you don't get it done and you have to get it done, the next step might be an emergency …

Jarod Johnson: The hospital …

Howard Farran: The hospital …

Jarod Johnson: … that looked at the … I don't know if you've heard of Deamonte Driver story. Deamonte Driver went in to the hospital with a toothache, his mom left, she came back the next day and he was dead. He had bacteria from abscess tooth …

Howard Farran: How old is he?

Jarod Johnson: I'm not sure his age but this was a while ago and this was …

Howard Farran: Right. It's all over social media.

Jarod Johnson: That if someone … If he would had that done, he would have … he'd be here today. There's times where maybe yes I would use it. It's not every time but …

Howard Farran: What about nitrous oxide? Is that falling to your drug them category?

Jarod Johnson: Yeah.

Howard Farran: Is that under the hug them or drug them or slag them …

Jarod Johnson: That'd be a drug them, so that's just like, nitrous oxide has been shown to be safe and effective. It doesn't work for …

Howard Farran: Do you use it much?

Jarod Johnson: Yeah, quite a bit.

Howard Farran: You don't like to give percentages, like what percent we get nitrous versus what percent we get sedation, versus what percent we get to papoose just in general? Is that guys like me [crosstalk 00:58:15].

Jarod Johnson: Sometimes the nitrous is more on the parents, I don't think the kids need it but it does help relax them. It hits the brain in three different receptor areas, one of those being the opioids. It can help with things like the injection, smaller fillings on certain kids I might not have to use an injection. It just depends on the kid. I can't say it's a blank, I know you want yes or no. it just depends. I mean, I probably would use it on probably 60% of patients.

Howard Farran: 60%.

Jarod Johnson: I also use it when I do my sedation.

Howard Farran: When you do your sedations, so you do it in your office or do you think them to the hospital?

Jarod Johnson: Yeah. Sedation is in office and then general anesthesia is done in the hospital setting. Sedation, we're doing moderate sedation and modern sedation permit here in Iowa. It means a purpose response for two of our book commander awake the whole time. If I ask them how they're doing, they'd be able to say yes. Sometimes decisions don't go well and they're just screaming, but that time we discuss with the parent if they want to go to hospital or they want to finish what we're doing at that point in time and that is …

Howard Farran: What terminology … You said sedation, you do in the office and what do you do …

Jarod Johnson: Moderate sedation.

Howard Farran: Moderate sedation doing in the office, and what did you call when you take them to the hospital?

Jarod Johnson: That's general anesthesia.

Howard Farran: You called it general anesthesia.

Jarod Johnson: Yup.

Howard Farran: Moderate sedation, the consumer that's what they're calling twilight sleep?

Jarod Johnson: Yeah. I think there's a big confusion [crosstalk 00:59:45]. I think there's a big confusion among dentists and people. They think sedation means to sleep. I think some dentists here have said, "Oh, do you do sedation?" I say, "Yeah." I say, "Ask them where they do it," and they say, "Oh, we go to a surgery center." There's still some confusion with the terminology and I think it's unfortunate because in our specialty training this is a way you're trained to talk about it. That creates a lot of confusion I think for people when … Yes, I offer sedation but I also can go to hospital and offer general anesthesia. They are two different things, one is sleep and one is not.

Howard Farran: Would it be smart to say mild sedation is nitrous oxide, moderate sedation is done in the dental office and general sedation is done in the hospital?

Jarod Johnson: Correct. Yeah. There's different levels and the problem is there's overlap between the levels.

Howard Farran: Right.

Jarod Johnson: As a general rule, you obviously want to look at to what your state will allow you to do as your dental board and what you're trained to do, but you always want to be able to rescue someone from one stage deeper than you're able to take them. That's what is taught in my anesthesia rotation, [inaudible 01:00:54]. If someone's going deeper than you're trained to do, that's not something that you need to have a corrective action. That's not something that you want to be doing. The biggest thing I think from a sedation aspect is staying within what you're trained to do and if you're not trained to do it, don't do it. You don't want to be getting into trouble.

Howard Farran: When you do the general sedation in the hospital, do you do the sedation or do you bring in a board-certified anesthesiologist?

Jarod Johnson: Nope. All of the stuff at the hospital is done by either an anesthesiologist or a certified nurse anesthetist. I don't do anything as far as putting them to sleep. They manage the airway. They put a breathing tube in, all that stuff. If they need me to stop, reposition, do anything, I get out of the way and they do that. Number one priority at that point is the patient's airway and obviously heart rate and things like that.

Howard Farran: I'm going to ask you a very politically incorrect question. You don't have to answer. Is there any advantage or disadvantage of having an MD board certified anesthesiologist or a nurse anesthetist when you're in the hospital?

Jarod Johnson: One of the things that I've noticed is the comfort level of the training. There's certain kids with special healthcare needs that my hospital would not feel comfortable working with. That's something where that may have to go to a university setting just because the kids' metabolism they have metabolic disorder, things like that that require a little more training, maybe something that they're not comfortable with but at the same time if they're comfortable with the case, the only person I can clear a person for general anesthesia is the person doing it. If that person feels that within their training that they're qualified to manage this case then that's their choice.

Howard Farran: Do you use both? Do you use MDs and nurse anesthetist?

Jarod Johnson: I've used MDs before and then here at the hospital we have certified nurse anesthetist and they do a wonderful job, they do manage the kids pretty well.

Howard Farran: Well hey, we are out of time. My format is an hour and we're at hour and three minutes. I just want to say, I think you're so cool. I'm a big fan of your course. You got to see the Blunderbuss Apex: A Search for the Smoking Gun. I'm a big fan of your 400 posts. I can't believe you're just a kid. You've already got a CE course, you got all these posts, you’re an organized dentistry. Seriously, thank you so much for your passion, your enthusiasm for all that you've done for dentistry in such a short, short time.

Jarod Johnson: Well, I hope I can only grow. I want to … if we're not involved in it somewhere else will be and I want to be here at the forefront and of the issues. I want to be involved in our communities. I really appreciate you reaching out to me and having me on here. It was a heck of a fun time, putting together the CA course and it's just a wonderful thing to help educate people and to help. If you take it, I hope you learn something and I hope you can take something into your practice every day that really can help you build and grow your practice and feel more comfortable managing some of the cases that I learned in my residency training to treat.

Howard Farran: I think I'm looking at a future president of the American Dental Association.

Jarod Johnson: I don't think so. I think it would be …

Howard Farran: I don't know.

Jarod Johnson: … too much work.

Howard Farran: You might think different when you're in my age. If you can send me an email and introduce me to those two Delta ladies, I'd love to do a podcast or an article or something on a Delta line …

Jarod Johnson: Yeah, I'd be happy to. I'll send you them and also my contact at the University of Iowa that would love to talk to you about the program. I think it'd be a great way to maybe get it started in another state. It's a great way for dentists that are coming out of school to take a huge trunk of their debt load if they're able to work with it. I think it's a great thing that we can share, get information out and hopefully get start in a few more states.

Howard Farran: All right, buddy. Well, thanks again for spending an hour with me.

Jarod Johnson: All right. Thanks for having me and …

Howard Farran: Thanks Jarod Johnson. Bye-bye.

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