Dentistry Uncensored with Howard Farran
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286 Dental Sleep Solutions with Gy Yatros and Richard Drake : Dentistry Uncensored with Howard Farran

286 Dental Sleep Solutions with Gy Yatros and Richard Drake : Dentistry Uncensored with Howard Farran

1/12/2016 7:24:50 AM   |   Comments: 0   |   Views: 1053




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AUDIO - DUwHF # 286 - Gy Yatros and Richard Drake




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VIDEO - DUwHF #286 - Gy Yatros and Richard Drake




 - Why dentists should care about dental sleep medicine (DSM)

 - The opportunity for dentists

 - Obstacles dentists face incorporating DSM

 - The four pillars of a successful DSM practice: Screening, Testing, Treatment, & Billing

 - What the DS3 system entails and how it provides proven solutions to ensure DSM success.


Dr. Gy Yatros has been practicing dental sleep medicine for over a dozen years and is a well-respected international lecturer in the field of sleep-disordered breathing and dental sleep medicine.  He has offices in Bradenton, Sarasota and Tampa, Florida devoted exclusively to the treatment of sleep disordered breathing.  He is a Diplomate of the American Board of Dental Sleep Medicine (ABDSM), past president of the Manatee Dental Society and is an Affiliate Assistant Professor of the Department of Internal Medicine with the University of South Florida, College of Medicine.  He is a Co-Founder of the Dental Sleep Solutions system for the successful implementation of dental sleep medicine in dental practices around the U.S.


Dr. Richard Drake is co-founder of Dental Sleep Solutions and has been practicing dental sleep medicine exclusively for over 12 years.  He has delivered thousands of dental devices and is a sought after and respected educator/lecturer in the dental sleep medicine community.  He is a Diplomate of the American Board of Dental Sleep Medicine, and has previously served as President-Elect, Secretary/Treasurer, and BOD for the AADSM. He is a part time faculty member at the University of Texas Health Science Center Dental School in San Antonio.



Howard Farran: It is a huge honor today. I just love technology. I'm sitting here with Dr. Gy Yatros, and he's in Bradenton, Florida, which is south of Tampa, Florida, north of Sarasota, right?

Gy Yatros: Correct. 

Howard Farran: And Richard Drake, who's in ... Where are you at in Texas?

Richard Drake: San Antonio, right in the center of Texas. It's that state in the middle of the country. 

Howard Farran: I love the River Walk there. 

Richard Drake: Yeah, exactly.

Howard Farran: The River Walk is the neatest thing. I've lectured there a few times and man, that is amazing. You guys are at the front of probably the next big thing in dentistry. I got out in '87 and it seems like every 5 years there's something and it seems like right now you're at the forefront of dental sleep medicine, and it's just exploding. Let me read your bios. Dr. Gy Yatros has been practicing dental sleep medicine for over a dozen years and is a well respected international lecturer in the field of sleep disorder breathing and dental sleep medicine. He has offices in Bradenton, Sarasota, and Tampa, Florida devoted exclusively to the treatment of sleep disorder breathing.

He is a diplomat of the American Board of Dental Sleep Medicine, past president of the Manatee Dental Society, and is an affiliate assistant professor of the Department of Internal Medicine with the University of South Florida College of Medicine. He is a co-founder of the Dental Sleep Solutions system for the successful implementation of dental sleep medicine in dental practices around the US. Then Dr. Richard Drake is co-founder of Dental Sleep Solutions and has been practicing dental sleep medicine exclusively for over 12 years. He has delivered thousands of dental devices, and is a sought after and respected educator, lecturer in the dental sleep medicine community.

He's a diplomat of the American Board of Dental Sleep Medicine, and has previously served as President-elect, Secretary-Treasurer, and Board of Director for the AADSM. He is a part-time faculty member of the University of Texas Health Science Center Dental School in San Antonio. Gentlemen, thank you so much for spending an hour with me today. I think it's very amusing when people say well they don't know if this is something they should get interested in or if there's enough patients that need this, when there's guys like you who do this ... That's all you do. You guys don't do root canals and crowns and pull wisdom teeth, do you?

Gy Yatros: Not anymore we don't. Rich hasn't done it for quite a long time. What, 14 years, Rich? Since you've done anything like that?

Richard Drake: 14 years now. Yeah, my wife chipped a tooth the other day. I said, "Are you sure you want me to fix that?" 

Howard Farran: Did you?

Richard Drake: No, I didn't. I'm a smart guy. 

Gy Yatros: To address the need, the need is huge, and that's one of the reasons Rich and I got involved in this, because we started doing it in our practices and we realized that a lot of patients have sleep disorder breathing and even furthermore, the ones that have it don't have a treatment. As many as 1 in 5 adults has at least mild apnea, and the majority of those people don't know they have it. Once they know they have it, they're not successfully treated because oftentimes they're maybe given a CPAP and they're not wearing it effectively and maybe they haven't been given the other option, which is a dental device that works quite well for a lot of the patients. 

Howard Farran: Take us back in time. How did you go from pulling wisdom teeth and doing fillings and crowns to doing this exclusively?

Richard Drake: Yeah, I want to tell my story real quick, Gy, if that's all right.

Gy Yatros: Sure.

Richard Drake: I'm a big fisherman, Howard, and I went to the Amazon jungle to fish for Peacock Bass, trip of a lifetime, right? I get stuck in a tent with a guy, snored so loud he scared the monkeys away at night, and I thought, "My God, how does your wife sleep with you?" He said, "Oh, we haven't slept in the same bedroom for a decade." I didn't even know what sleep apnea was. I was your typical dentist out there. I had a couple of patients that had it, and so I started taking a couple of courses. Back then, Gy, there wasn't anybody to call. Who do you take a course from or who do you call if you have a question like that? That's kind of how I started to get into it, and it grabbed ahold of me pretty good, and the next thing you know, I came home and told my wife I'm selling my practice. For 14 years now all I've done is dental sleep medicine. That's how I got into it.

Howard Farran: One more reason to go fishing. My classmate from UNPC, Craig Syke and I, we always go to Cabo and we've caught every fish imaginable. I love fishing. How'd you get into it, Gy?

Gy Yatros: My story's different, but some similarities. I always run into ... I had a dental practice on Anna Maria Island, just west of here, the nice beach, an office I had for 22 years almost. As I was treating my patients and developing my practice, I developed what we called Island Dental Spa. I became really a fee-for-service practice, did a lot of prosthetic dentistry. One day one of my patients came in and she said, "I've been diagnosed with apnea. I've tried a CPAP, and my physician says there's something you can do as a dentist to help this." This was about 14 years ago. I said, "Really? I guess maybe I can." 

I just so happened that day to have an advertisement from one of the labs making mandibular advancement devices, and not being afraid to try things, and not really knowing that much about it, I called the lab and they said, "Just take a couple of impressions and send it to us," and that's what I did. I handed it to the lady and she, a few days later, was just singing my praises, saying, "Wow. I feel better. My husband's happy." I think she said I was a genius, which what I did was took a couple of impressions and sent it to the lab. I said, "Well, this is kind of fun. The patients like me," and before long the physician who was her primary care started sending me some patients, as well as a sleep physician because they thought that I knew a little bit about this.

The truth of the matter is I really didn't know what I was doing at the time. I was just kind of winging it. That's when I met my mentor, who's here on the call with us, Rich Drake. I was trying to find a place to learn how to do this, and 12 years ago, a dozen years ago or so, there were no courses. There was no guideline of how to do this. There was no, "Here's what you do, steps A to Z." I met Rich through the AADSM as a mentor. They assigned him to me, and I think that's the day that he went from fishing a lot to working a whole lot more. Because he and I started trying to figure out, you know, "This is fun to do, but how do we make it profitable? What systems do we need in place?" 

It was frustrating back then and I started doing more and more and learning that I didn't know what I didn't know, and over time we started making this a more enjoyable thing to do in our practice, and started learning how to deal with all the obstacles and hurdles that come together. Rich and I worked on this together and I just became passionate about it. That part of the business grew and grew and grew as a whole separate business to the point where it was overrunning my restorative practice. 

Actually it was doing better than my pretty decent restorative practice. I had to make a decision at one point, and after going through an associate and deciding that my love and passion now was to do this, it was just very enjoyable, I decided a little over 2 years ago to sell my restorative practice to do just this. Then of course our other business where we  help dentists doing just this, helping dentists in dental sleep medicine. That's how our paths kind of mingled and here we are today.

Howard Farran: What is your other business? It's www.dentalsleepsolutions.com. Is that where you're teaching dentists how to do this?

Gy Yatros: Yeah. That website is more patient-centric, and you can get to our implementation system from that site. A better website would be www.ds3, D-S and the number 3, software.com. That's basically, we help dentists become successful in dental sleep. Having done thousands and thousands of these devices, we basically have systems for the hurdles in dental sleep, which, as a matter of fact, I think I'm co-authoring an article next month in your publication about those 4 pillars and how the challenges are ... If we can meet those in our practices, that we can be successful.

Howard Farran: What are those 4 pillars?

Richard Drake: You got to have a way to screen somebody when you got this practice, because one of the ways you started this, Howard was, "Well, look, these dentists are out there. Should we get into this? Should we do this? Where do the patients come from?" Last time I checked, they're actually sitting in your dental chairs in your office. That's where they come from, like Gy said. We got 40 million people that have this disease and only 10% know it, so that lowest hanging fruit out there are those patients walking through your office every day. But you've got to have a way to screen them. Then you got to have a way to get them tested, right? You got to have a way to treat them. 

That's what we do with the dental devices. Of course, you got to have a way to get paid. Those are the 4 pillars that that article Gy wrote is going to be in there next week. But, in between those things you got a couple of hurdles and things like that. The typical dentist, how do you screen somebody? Well, you know, I think back to when I started and I'm giving somebody a shot to do a filling, and they fall asleep. I thought that was because I was such a good dentist. I didn't know it was because they were half dead from sleep apnea, right? These people are right under our noses all the time. 

Guy and I got into this and we started doing this, and the whole challenge, there's all these hurdles. One of the analogies I use is you go to the local high school and you go around the football track. There's 10 hurdles out there. The typical dentist, he might get over one and then he might fall down on the second one, the third one. Those 4 big hurdles are the pillars that we talk about. That's what we decided to do, was how can we help dentists help these people? That's what literally changed our lives as we started to get into this, and we started to put systems together where you do that.

In our individual practices, we've grown this to be very successful. I've done that completely independently of Gy. Our software system, we have the Dental Sleep Solutions software. That's where the DS3 came from, but really we are a system that does this. You're going to have a thousand questions about which device do you use, or how do you screen a patient, or how do you get them sleep tested? That's kind of what we've been doing for what, Guy? Maybe 7 or 8 years now, is distilling that system down to something that's very efficient.

Howard Farran: What are questions we should be asking and the hygienists should be asking patients to see ... What are the red flags that they have sleep disorders? Are you sending them home with a device to test them while they sleep, where they take something home and apply electronic leads to them to measure themselves, or do you recommend that they go to a sleep center?

Gy Yatros: The answer to that is yes. All those above we do, but we'll break down the first two, screening and then testing. You're exactly right, Howard. They need to be asking questions. Again, a huge number, as much as 20% of the adults in these patients practices have untreated, undiagnosed for the most part obstructive sleep apnea. If we have a good screening process that we can identify these patients that need to be tested, that's the first step. Every office, whether you want to treat these patients or not, really needs to become involved in this. I think, as we talk about it in our courses, the obstruction, the problem, has to do with the tongue, has to do with the throat. It has to do with the things that are in our wheelhouse. 

We have a screening system that we digitized that makes that easier. There's other ones out there on the internet. Basically a questionnaire does a pretty good job of identifying the people at high risk. Things like the Epworth Sleepiness Scale is one that new people out there can Google, and it tells whether people are subjectively sleepy or not. STOPBang is another questionnaire we can use, and the questions that are on those typically have to do with sleepiness, snoring are the big ones, and then a couple of morbidities are huge. 

There is such a strong relationship that there's independently associated with untreated sleep apnea or certain health issues, such as high blood pressure, diabetes. If we start realizing that, if you realize that half of the people who have AFib have obstructive sleep apnea. Over a third of the hypertensive patients, so as we start learning this information, that's the kind of questions we need to ask and it can take less time than doing an oral cancer screening, 5 minutes or so to do the screening. Then as far as the testing, we can talk about that in a second. Does that cover the screening, do you think, well enough?

Howard Farran: Well, one thing on the screening. Do you believe that when dentists are making a grinding, a night-guard, that without a sleep study, that they could be missing the sleep disorder, that there's a co-morbidity between grinding and that? Do you believe that if a dentist is going to make you an upper, a guard for grinding your teeth at night, that they should be screened for sleep medicine?

Richard Drake: Well, if they don't, Howard, they're missing it 75% of the time. That's where the studies are coming out. You got to use your brain, though, right? That guy teases me all the time because I say that a lot. If you got a 14-year-old girl that's all stressed out and her TMJ's killing her, the likelihood that she has sleep disorder breathing is probably very low, but you got to use your brain and think about it. 

If you got a 54-year-old bald-headed fat guy like me, who's tired and he's grinding and he's stressed out, well what else? Yeah, he's got high blood pressure. You talked about the red flags. He's pre-diabetic, he's got this, he's got that, and all that other stuff. Yeah, you've got to use your brain, though. I think the days are gone where somebody's stressed out and you make them a night-guard. That just doesn't make sense anymore. But again, you got to use your brain. Not everybody that you make a night-guard for has sleep apnea, but a lot of them do. 

Howard Farran: So you would guess that on average, 3 out of 4 times a dentist makes a night-guard for a patient, they probably have underlying sleep disorder?

Richard Drake: Yes.

Howard Farran: That's huge. 

Gy Yatros: Yeah. When was the last time, Rich, you made a flat plain splint without first testing the patient? Would you recommend doing that with your patients?

Richard Drake: I haven't done it for 14 years, but do we make night-guards for patients? Yes we do. Sometimes you got to treat TM dysfunction just to get their patient's mouth open far enough to take an impression, right? But you got to use your brain. Again, young females that need a lot of night-guard and TMJ stuff, not a lot of them have sleep disorder breathing. Again, you got to use your brain.

Gy Yatros: One fact that I'll throw out there, too, is there's a book called The Principles and Practice of Sleep Medicine, and that's kind of the sleep bible. The sleep physicians use it. It's a big 1700 page book that I read when I took my diplomate board and in there they quote that patients who have OSA, Obstructive Sleep Apnea, brush their teeth 3 times more often. The prevalence of bruxism is 3 times higher in OSA patients than non-OSA patients. There's also studies to show that on OSA patients that even a CPAP can decrease bruxism incidents pretty notably. There is a relationship undoubtedly, in a lot of the patients, but we don't want to go off to the extreme where we say everybody who bruxes has this problem. 

Richard Drake: Good point.

Gy Yatros: But sure, whether it's 75%, 50%, 80%, the numbers are maybe somewhat questionable. But to ignore the airway in your bruxing patients is a big mistake. Once you realize the airway has something to do with it, I wish I'd have known now what I knew then. I say that about a lot of stuff, but especially when the big rehab cases I used to do that failed or had problems with occlusion and breakage. I think back now, and if I'd have known what I know now, a lot of those cases may have turned out a little bit differently or not had the challenges that I was faced with when I was restoring those cases. 

Howard Farran: Okay, so let's move to testing, then. Now, you've been talking to this patient chair side. They snore, they're tired a lot, sometimes they fall asleep in the day, and you've got some red flags. What would you do next?

Gy Yatros: [Want to 00:17:36] get this, Rich?

Richard Drake: Yeah, well, there's a couple of different ways to get a patient tested. I think we sit them down, have a little bit of a talking to in a very short way. Again, a lot of this is where the rubber meets the road, Howard. You've been in a few dental offices in your days, right? You go in there and you look at the hygienist and there's got this bombed-out tooth and you go, "Well, did you take a PA? Did you talk to them about a root canal and a crown?" It's the same kind of thing. The hygienist is in there. They're cleaning teeth, they're doing that. They can be talking to them about getting a sleep test. We have national home sleep testing companies that in DS3 you just click a button and when you click a button, a home sleep test shows up at their home. They can do it at home.

Howard Farran: That's for all 50 states?

Richard Drake: The only state that a dentist can't order that is New Jersey, I believe, right now. 

Gy Yatros: That we're aware of.

Richard Drake: 49 out of the 50 states, you can do that. That's certainly one way that you can do that.

Howard Farran: What about Canada?

Richard Drake: A part of this uncharted area that we're looking at a little bit, Howard, is who takes the bull by the horns here? As a dentist, we're looking at these people every day. We're seeing their crowded airways. We're asking questions. We're seeing the red flags. Now we got to get this guy tested. You can implement a home sleep testing solution through your dental practice in 49 of the 50 states right now, where you order that. But dentists cannot diagnose this, so you still need a physician to look at that sleep test results and make the diagnosis, and then to write the prescription and a lot of times to get paid for this ... 

I'm putting the cart before the horse here a little bit, but you need a letter of medical necessity saying, "Hey, not only does this guy have sleep disorder breathing, which I've diagnosed, but it's medically necessary to treat." That option, home sleep test, or in-lab sleep test, most of the time is made by the insurance carrier themselves, because they'll only pay for one or the other. What do patients ask? "Hey, you need a sleep test." "Okay, well, where can I get one? What will they pay for?" We can start that process through the home sleep testing where we send it home with them. We work with several companies that do that around the country. You can work with their primary care physicians. 

You have local sleep labs that are run by mostly board certified sleep pulmonologists. Do you have a relationship with that person in your community? A lot of dentists practice in communities where they only have one sleep lab. They might only have one option aside from a mail order. That is one of the pillars, because it is very much a challenge, and we go back and we look at the big picture here. We go, "Okay, wow. 40 million people have sleep apnea. How come we can't get them tested?" Because most people don't want to go to a sleep lab. 

"You're going to video me while I sleep? I'm not really sure what I do while I sleep. I'm not sure I want a video of me while I'm sleeping." These are all things that go through people's heads. How come they don't want a sleep study? Well, "I don't want to wear that CPAP." Some people won't even go get a sleep test because they do that, so there's a couple of barriers here, and part of them is the system itself. But part of them is inside that patient's head, he already has preconceived ideas. "I'm not going to get a sleep test because I'm not going to wear a CPAP." We've got a lot of hurdles out there, and we've got a lot of barriers that we have to try to break down. 

Howard Farran: If you called it Hot Nurses Sleep Testing Lab do you think we would get more people to go get tested?

Gy Yatros: Possibly so. Just to be clear, we're not experts on state dental laws, and currently most states don't prohibit dentists from ordering that state, and you should check with your state dental laws as to whether you can or can't do that, and Medicare has its own set of rules that we have to go by. I think just to summarize what Rich said, which I think he said real well, is there's 2 ways of getting our patients tested. When we started this, the only way of doing it was sending the patient to the sleep lab. A lot of the hurdles, these pillars are actually lower. The hurdles, as Rich called them, have lowered, so now there's home sleep testing, and that's for sure. 

Insurance companies approve them, it's an approved way to be tested, and in my opinion, a preferred way to be tested. We can help implement that by referring. We can help in most states by maybe ordering it with one of the companies we work with, and we can help by maybe having our own equipment even that we can dispense. That's part of what we help, is we help set up those systems and someone in the office has to be accountable for that. There's a gap between, "Yeah, you're at high risk for this," and getting the patient tested.

We recommend that someone in the office really be kind of the sleep champion, or at least a knowledgeable person so that they can discuss why the person was at high risk, and go, "By the way, you're at high risk. We need to get you a test. Here's your options out there. Let's look at your insurance, what they're going to pay for, and let's go get this test." Most of them are a couple hundred dollars or less. "Let's just get you tested. We'll have you back in about 3 weeks to discuss it." That's the kind of conversations that we have with our people we work with, because you've just got to make it routine. This isn't something new or different. 

It shouldn't feel that way. It should be in the offices just like anything else, and we need to become comfortable with this in our dental practices. It's important. We started this because we truly saw a need. If the offices care about their patients, they need to at least get to the first 2 hurdles. They need to get their patients screened and they need to help them get tested. Whether they want to treat the patients or not, there's other dentists who can do it if they don't want to get involved with that aspect of it.

Howard Farran: You're talking to the patient, you think they have sleep. You can go to ds3software.com and there's a place there where you can click to have your patient get a home sleep ... What is it? Delivered to their house? Is it mailed to them? Does someone show up?

Gy Yatros: There's different companies that do that. No, to be clear, ds3software.com just explains our services. It explains how we help with all these pillars. We either have a specific solution that we deliver for these pillars, or we help implement those. Once you sign up for our service, and by the way our service is only a few hundred dollars a month, and we help the dentists implement this in their practices. With that service then, then they have a specific ... Part of what we have is a really robust web-based, Cloud-based software that's an EMR, that helps these dentists implement dental sleep. 

Once they have access to that, the patients can input their data through a web portal, and then once they're screened and identified at being high risk, then basically yes, we have a way that we can order the test with some of our home sleep testing partners that will deliver it to their door with instructions. The patient wears the test for 1 to maybe up to 3 nights. They send it back, so they would do it in the comfort of their home. The test is interpreted by a board certified sleep physician and the results are delivered back to that dentist's office. Then we recommend that the dentist sets up an appointment at about 3 weeks to review that. 

Now again, Rich mentioned that that doesn't necessarily preclude us from working with, nor do we encourage not working with the medical community, but now we have some information to share with the medical community and then start involving the primary care at this point. "Hey, look, we've identified this patient to be, that appears to have some airway problems. Can we get your input on it? Let's get this patient treated, either with the CPAP or a dental device, which by the way, are the 2 first-line therapy recommended treatments by the American Academy of Dental Sleep Medicine. 

Howard Farran: You have the complete program. How much is it? You said a couple hundred. What is that? $199? $299?

Gy Yatros: Currently it's $399 a month is our fee. If you look at what we do for that, we want these dentists to stick with us for a long time, and so I think the difference between us and a lot of the other companies out there that say that they help with everything, most of the other companies have one aspect of it. Maybe they have software, maybe they have sleep testing. Maybe they do insurance billing. 

We do many of those aspects ourselves, but our service is helping you do this. If we don't help you, Howard, if you signed up for our service for a few hundred dollars a month, whatever it is, and after 6 months if you're not doing dental devices or after a year, what are you going to do? If you're not watching your cable, what do you do? You turn it off. You discontinue our services. We, in a sense, have skin in the game, because our goal is to make dental offices successful, and we want long-term partners and relationships with our members.

Howard Farran: So there's no contract? They could stop any time?

Gy Yatros: Depends on the ... Just like any other contract, you pay more if you want to go by the month and there's activation fees for short-term contracts, but in general most contracts are about a year.

Howard Farran: On this $399 a month at ds3software.com, do you have all the educational videos? Is it online courses?

Richard Drake: Embedded inside the software we have ways that they can actually go through an edX platform or other things, so you log in to the software and then from the software we have ... I think we have what now? 12 hours of CE that everybody, the dentists and all their staff can get. We have something called Snoozle, which we've trademarked, kind of like the snooze and the Google part. We've got about 250 articles in there, so from your software you can type in, "What does AHI stand for?" "What's moderate sleep apnea?" "How do I bill for Medicare?" 

You can do all of these types of things. It's kind of like a dedicated search engine for dental sleep medicine. Those are just all of those things that it's hard to get ... For a typical dentist to get his arms around. How do you screen somebody? How do you get them tested? How do you treat them now? What kind of device do you want to make? We have, I don't know, Guy, what? 30 different educational programs in there about how to choose the correct device and then of course, the billing part.

Howard Farran: You guys should do a 1, 2, 3, 4 hour overview of all this for an online CE course on Dentaltown. We put up 350 courses on Dentaltown and they've been viewed over a half a million times. Today we just released Nuts and Bolts Treatment Planning by Dr. Michael Melkers. I think ... I get so many questions about this. Maybe you guys should do an intro on the screening, testing, treatment, billing, and put it up there. I think it might turn out to be one of the best marketing things you did. I think you'd probably get a lot of followers.

Gy Yatros: Well, great. We're very interested in it, and when we finish with this, we'll talk to you more about how to make that happen. That sounds like a great idea. To be clear, all that information that Rich just went over is available after you become a member. If you go to our website now it just tells about those services that are available, all the education and so forth's not available to non-members. The website you will see just highlights what you get if you decide to help us implement this.

I can tell you, having gone through this with Rich as my mentor, and us trying to figure this out, I think about all the time we spent trying to make this a viable part of our practice. To have basically a consulting group to help you do this along the way. If you want to do this, now you still have to put some effort into it. It's not plug and play and we do it all for you. You have to have staff meetings, but we've found that they've spent about, at most offices, around 20 hours of time, and this is highly, highly staff-driven. 

You've got good staff members who want to take this bull by the horns, that the offices could be up and running and you could basically build, as the sky's the limit, you could build a whole 'nother practice within your practice. Yeah, you could make a lot of money, but that's not really our motivation. You could really help a lot of people. Compared to the things I used to do in dentistry, the stress is so much less and the rewards are so high that you get patients who just love you and just think you've hung the moon. It has a lot of less stress in a lot of areas than general dentistry does. It's just [much better 00:30:11].

Howard Farran: A lot of dentists have emailed me saying things like they've heard to get into this, some programs cost 100 grand. Other lectures they go to, they need to buy a $5000 take-home testing device. Are there big economic barriers entering? Because some of these programs are 100 grand, literally 6 figures. Have you heard of some of these?

Richard Drake: Yeah, we have, and we're not here to put anybody down. Some of those programs out there, they provide quite a bit of service for that, and you would think, if you're going to pay that much, they'd certainly hold your hand along the way, right? I think that the most of those do. But you don't have to do that. We're still in a little bit, Howard, of this wild, wild west. We're still trying to figure out a lot of this stuff. Think back when I started 14 years ago, my office burned down 3 years ago. Kind of a weird story. 

I had 20 home sleep testing units in my office when it happened. I don't have any now. There's different ways of doing that. If you want to buy one, you can do it. What we try to teach dentists how to do is how to do this at the bare minimum and be efficient at it. If you want to go out there and spend money, I would certainly ask for referrals for those people, and are they delivering on the product and what they do? We're certainly happy. We've got several hundred people using our software and our systems, and they're ... I would say 90% of them are very happy. 

The 10% that aren't, I don't think they're unhappy with us as much as like Gy said, they're just not doing it. If we get back to the kind of the screening part, when we were talking about after that, how do you get them tested? The typical dentist would say, "Hey, you know what, Jim? Man, you really need to get that sleep study done. I'll see you in 6 months." What's the sense of urgency? You might have this disease that's killing you. What do you say, Gy? You use the analogy about the cancer, right?

Gy Yatros: Yeah. If you had someone that came in, and here in Florida, if it was a commercial fisherman let's say, and their vermilion border was all gone because of sun damage, and there was really nasty looking, something not normal on his lower lip, how many of you could get this patient to go get that looked at? We would say you've got to go get this looked at. We wouldn't say the word cancer. We'd say, "We're worried about it," like we would say we're worried about your airway. It's going to cost more than a sleep test and it's going to be a whole lot more painful. But we'd get them to do it. 

The difference is that ... Not cancer, but the lesion ... That's the word I was looking for, sorry. The lesion that we're looking at, it's just right in front of us. I think it's just glowing at us is the difference. Untreated Obstructive Sleep Apnea, undiagnosed Obstructive Sleep Apnea, is more subtle. It's just not something you can just see like that. That's why it's harder to get these patients tested, because it's not as obvious as something we can see. But if we believe in it to the same extent, we can certainly make our patients understand that and they'll get tested. It just comes down to that with it. 

Howard Farran: Richard, what did you do to your girlfriend that made her burn your dental office down?

Richard Drake: That's none of your business.

Howard Farran: This is Dentistry Uncensored. To be clear, you guys, you're saying you can learn more about dental sleep medicine and start doing this without buying a take-home kit, a take-home testing device for 5, 6, $7000?

Richard Drake: Sure you can.

Gy Yatros: As of now with the companies that test, and working with your local physicians, absolutely. As Rich said, we don't want to disparage anybody spending more money, but we also encourage you to look at anybody who's trying to help you implement dental sleep. See what they're selling. Take a look at it, see how much it costs. See what they're really going to help you with, and then look at our service. We are the best value by a long shot for what we do. You can go to our website, call any of our members, and Rich said the 90%. We have huge customer service high marks, and what Rich said is even the people who ... We're pro-active. We're like a personal trainer. 

We call them up, "Hey are you doing this? How many patients have you screened? Why aren't you screening your patients?" Even the people who maybe haven't taken the time, that's maybe that 10%, they're still going to tell you, "You know what? Those guys, that company ..." We have a whole team of customer service reps that their job is to make you successful doing this. The customer satisfaction's great because for what we're charging, we're delivering a huge amount of value. I don't think anybody's even close to it when it comes to that. And yes, you can do it without making those purchases. It's not like it was in the past. We don't have to have home sleep testing equipment. There are things that we want to purchase, that's fine.

Richard Drake: I want to add, too, though Gy, that, Howard, if a guy has a home sleep testing device that he's bought, we're going to teach him how to use it in his practice. 

Gy Yatros: Right.

Richard Drake: Absolutely. We're not going to tell him, "Hey, you shouldn't have done that." You heard me say I had 20 of them at one point, right? Anybody out there listening to this wants to send me one, I'll take it. Because we've got plenty of ways to use them. But we're a little bit in that wild, wild west still, and we're still trying to figure out how some of this stuff works. That's part of what you're paying us for, is that's what we do all day every day, right? That's what we try to get [crosstalk 00:35:45]

Howard Farran: Okay, let's go next. We talked about screening, we talked about testing, but let's say it all comes back and we need to treat this patient. What is the full distribution if you treat 100 patients? We've heard some will need CPAP, some will need dental appliances. We've even heard orthognathic surgeons saying that a lot of these people could be instantly fixed with orthognathic surgery. Talk about treatment now.

Richard Drake: Go ahead, Gy, you can start.

Gy Yatros: All right, I'll start with that. The American Academy of Sleep Medicine and the American Academy of Dental Sleep Medicine recently came out with an update to their practice parameters as far as it pertains to treating patients who are diagnosed with Obstructive Sleep Apnea, and what their treatment options are. I kind of summarize that, and you can read all 50 something pages, and we even have a webinar that we did on those practice parameters. 

But essentially it comes down to, there are really 2 first line of therapy treatments, CPAP and dental devices. CPAP works better more predictably, so in other words if you hook a CPAP up to someone, it's going to more predictably open up their airway. No one's going to argue that. The negative is a lot of people won't wear the CPAP. It doesn't work if you don't wear it. Now, dental devices have a little less ...

Howard Farran: Explain what CPAP stands for.

Gy Yatros: Sorry, thank you. It stands for Continuous Positive Air Pressure, so basically it's a pump that blows air into the airway and it blows open the obstruction with positive pressure. It works by having a mask or a nose cannula, something attached to the patient with a hose, hooked to basically a blower that blows the airway open. It efficiently blows open the airway in most cases, not all cases. But the problem is compliance. 

Howard Farran: Do you have to sleep on your back with that? Could you sleep on your ... I sleep face down. How would that work if you sleep on your belly?

Gy Yatros: Well, it would be much more difficult, if not impossible. The mask can get moved to the side, and it can get air leaks. You're going to have this mask in your face that's going to have to be attached to the hose. Yeah, it works much better when the patients lay on the supine or back position. They have to carry this with them when they travel. They've got to find a plug to plug it in. It causes some patients to get dried out, so they have humidifiers. They've come a long way, but the bottom line is you're tethered to a hose that's attached to a pump, that has to hook on the nose or mouth. The worse your apnea is, the higher the pressure and so the mask has got to fit well enough to not have leaks.

For the patients who can't tolerate it, which is significant numbers, dental devices are recommended. But that being said, it's not just people who can't wear CPAP. Because CPAP, again to review, higher chance of opening the airway, but less chance of compliance. Dental devices have a little less chance of predictably opening the airway, but we have a far higher compliance, and so when you look at them together, they work equally as well for most symptom relief, and many times as far as health benefits is what the health practice parameters stated. Basically, when we look at treating apnea, those are the 2 choices, and that's what we help educate our members on.

We got to have real conversations. Sometimes a CPAP's better for patients. The more severe the disease, the more likely we might want to do CPAP. The less severe we might want to do dental devices. But anybody who can't wear a CPAP really should consider a mandibular advancement device before they do something more invasive like MMA surgery. MMA surgery, Maxillo Mandibular Advancement surgery is very successful, maybe over 90% by a lot of studies, but it's a whole lot more involved than wearing a piece of acrylic in the jaw every night. 

Howard Farran: So you would say the MMA, Maxillary Mandibular Advancement, that would probably would have the lowest compliance and the highest cost, correct? I mean, I've done this 28 years. When you tell orthodontic people about orthognathic surgery, men don't seem to be very interested in that. Women, if they think it's going to make them a lot better looking will do it.

Gy Yatros: The lowest acceptance I think you meant, not compliance. Yes. We're doing more and more of that. I'm recommending it the more on patients who are younger, who are not obese, and so we do have patients that do that, but yeah, to get the patients to agree to this, to get insurance to pay for it, it's quite expensive. There are risks associated with it.

Howard Farran: My bias, from MBA school, is that price is king. What would MMA surgery cost? What would a CPAP cost? What would dental devices cost? On average. 

Richard Drake: It depends on if you're in network or [inaudible 00:40:25]. We're having fewer and fewer maxillary, oral and maxillo-facial guys doing MMAs, because they can make more money taking wisdom teeth out in 22 minutes than being tied to this patient for 6 months. Typical, I've had 3 patients in the last 3 months undergo MMAs through the UT Health Science Center, and the total cost with hospital stay, anesthesiologist, and the surgeon's fee, was in the high 20s. 27, 28, $29,000. That's going to be a little bit different depending on what part of the country you're from. Probably cost you more in Manhattan than it would here in South Texas.

CPAP and dental devices, average CPAP is about $2000, and you've got ongoing costs with CPAP. The masks wear out, the straps that hold the mask on, the hoses have to be cleaned and replaced and things like that. You got a couple thousand dollars for the compressor, which like Gy said, they're getting better and they're getting quieter, and they're getting smaller, but those things can go out too. You've got ongoing costs with that. The average dentist across the country is charging between 2 and $3000 probably for a mandibular repositioning device, roughly. 

Howard Farran: So it would be the same price then? A dental device is 2 to 3000.

Richard Drake: Yeah. It's about the same price. 

Howard Farran: Okay, so there's no cost difference? Okay. What percent, when you do the 4 pillars, when you do the screening, when you do the testing, when you get to the treatment, what percent go for MMA versus CPAP versus dental devices?

Richard Drake: MMA, I've been doing this 14 years, Howard, I've made maybe 6000 mandibular repositioning devices, and I think I've had 5 or 6 patients undergo MMAs. 

Howard Farran: Okay, so then what percent would go CPAP over dental devices?

Richard Drake: Well, part of that depends on who diagnosed and where the patient came from. One of the challenges we have ... If we screen that patient and we say, "Hey, you need to get a sleep study done," and there's only one sleep lab in town and we send them to the sleep lab, that physician, all he learned was CPAP. I promise you that. Right, Gy?

Gy Yatros: Right.

Richard Drake: That's all he knows. He doesn't know that you exist in town. He doesn't know that he has a dentist he can refer to for a dental device. One of the barriers as dentists we fight, is this medical model that's in place that everybody gets CPAP. Everybody gets CPAP. Our members, we kick them in the rear end and we say, "Hey, get out there and visit 2 doctors a week, 2 doctors a week. I want you to walk in their office, hand them your practice brochure and your business card.

Talk to the receptionist and say, 'Hey, you probably don't snore, but your fat husband probably does, right? Come on over to my office and I'll treat him at cost, so that we can get in with this doctor and we can do that.'" I'm not blaming the physicians, but most physicians don't know we exist. Most physicians don't know that this is a treatment option. In the big scheme of things, pretty much everybody gets CPAP. 

Gy Yatros: 95% was the latest study I saw in the United States. 

Richard Drake: Per market share.

Gy Yatros: Today. Now other countries are closer to 50/50, and that's why we started Dental Sleep Solutions and DS3, because that's just out of whack. The patients we screen and bring in through our practices, the mild to moderate cases, we present CPAP and dental devices, which one do you want? Most patients choose a dental device, for the ones who are good candidates. Patients who are mild to moderate, what is it, Rich? Maybe 3 out of 4 that we diagnose are in the mild to moderate category?

Howard Farran: Let's try to ... At least 9 out of 10 people are listening to this on iTunes, so there's thousands of them out there that won't see you. Explain what this dental device is. Is it something you take [alginates 00:44:24] for? Polyvinyl siloxanes? Is it attached to the upper and the lower? What lab is making this? Do you guys have the lab or is there a list of labs? Talk about the dental device. Is there several different types depending on the treatment plan?

Richard Drake: There are, and that's one of the questions that most dentists have, is which device do I make for which patient? There's 100 devices out there, Howard, that have FDA approval for the treatment of snoring and sleep apnea, 100. We use mostly about 10 devices. The TAP device, T-A-P. If you're listening to this on iTunes, as soon as you get home, get on your computer, look up TAP. Look up the EMA. Look up SomnoDent, look up the Suad, look up the EMA. Did I already say that one? The Narval. 

There's several devices that ... Probably 10 devices have 95% of the market share. But basically what it looks like is good impressions, polyvinyl impressions. Take a bite, a protrusive bite because we're going to take this device and we've got to fit it together in space. We need a protrusive bite with your maxillary mandibular teeth separated. Then we're going to do some kind of acrylic or plastic. Take 2.0 BIOCRYL and do a suck-down. This is how the typical dentist, driving down the road and listening to iTunes can think about this. 

You're going to put a button on the upper canine. You're going to put a button on the lower molar, and then you put a rubber band between them. The shorter you make that rubber band, the more you pull the jaw forward. We're good, dentists, we're good at making things fit. We take a good impression, we get this thing back, so now we have a rubber band mechanism to move that. We have others that have little hooks and screws. We have others that have male-female type Herbst devices, where you put shims on, but they're all made from an upper and a lower. Then they have some kind of mechanism to help titrate or move the jaw forward. 

Gy Yatros: I want to add that we call these a lot of different things. They are mandibular advancement devices, or MAD's, so they keep the jaw from falling back, and we actually move the jaw forward. Another word is, that we use, are dental orthotics. We call them dental devices. There's also ... What's the other? There's several words that people use, and basically they're pieces of acrylic held together somehow that keep the jaw in a forward position and keep it from retruding. You may hear different terms that are out there, and they're most likely meaning the same type of device. 

Howard Farran: But more specifically in the lab, so you guys don't have a lab yourself? You don't make these?

Gy Yatros: No. We have partnerships.

Howard Farran: But is this something they can send to their existing crown and bridge lab? What's the chance their crown and bridge life makes a MAD device, a Mandibular Advancement device? 

Gy Yatros: Maybe the crown and bridge is not real high. This is more often done by removable labs. But maybe the crown and bridge lab may do it. They can certainly ask. A lot of the removable ones do. There's a lot of different labs across the country. We use quite a few of them. We even have partnerships with some that give our members discounts, so yeah, if you've got a lab you like then ask them. 

Howard Farran: What labs do you like? Because I always try to guess questions ... Most everyone's listening to this alone in their car. Almost everyone tells me it's probably 95% that commute to work, and they're screaming out, "Well, what lab do you use?"

Gy Yatros: We have used many over the years. I would say the ones that we use the most are Keller Labs. We've done a lot of lectures and so forth with them.

Howard Farran: Is that St. Louis?

Gy Yatros: Yeah, but they have more than one branch than just the St. Louis, and you get that nationally. We use SomnoMed. They do quite a few of our devices. S-O-M-N-O-M-E-D.

Howard Farran: Where are they out of?

Gy Yatros: Texas, I guess. Right, Rich? Still?

Richard Drake: Yeah. Yeah, they're out of Texas.

Gy Yatros: And we use DynaFlex Lab, which is an orthodontic lab, so sometimes the orthodontic labs are the ones that are getting involved in this.

Howard Farran: Where's DynaFlex?

Gy Yatros: It's out of St. Louis as well. 

Howard Farran: I thought that, so Keller and DynaFlex are both out of St. Louis?

Gy Yatros: Right.

Richard Drake: Yeah. Space Maintainers Labs. 

Howard Farran: That's out of St. Louis, too, isn't it?

Gy Yatros: No. That's more California if I'm not mistaken. Rich and I are more East Coast people, but I think that's a really popular lab out on the West Coast.

Richard Drake: You've got one there in Phoenix, Gergen Ortho Lab. Gergen makes a whole lot of sleep devices as well. Great Lakes Ortho is another one that makes them, so [crosstalk 00:49:09]. 

Gy Yatros: Dental Services Group, DSG, we work with. I guess you kind of put us on the spot here and we don't want to forget somebody, like we're giving people we work with here, and if we forgot somebody ... 

Howard Farran: What is the lab bill for this, for a mandibular advancement device, and how much are you charging the patient for it? A lot of dentists have in their head that if the ... 5 times lab bill's what they charge, so is there anything like that? What is the typical lab bill and what is the typical charge to the patient?

Gy Yatros: The lab bill will be 200 on the lower end, to the high 6's on the higher end, depending on which devices that you're going to do. Really, the answer to your question's difficult because it kind of comes down to billing and what we bill, and the systems you have in place. What do you need in a practice to make this profitable? If you have good systems and a lot of your staff does this, we find a lot of offices can receive $1500, and when I say charge and receive, we're talking about medical billing. There may be a discrepancy there, because insurance is paying some. 

But the total amount collected, a lot of offices can be quite profitable, even more profitable than they are on other procedures when they collect 1500. Does that mean that we have offices that collect twice that? Sure. There's offices that collect $3000 a case. I think somewhere in between there is what most offices collect. There's outlanders where people get 1000, there's people that get 5000, but we really haven't talked about that last pillar of the billing. That's where really probably the biggest can of worms with this whole system is. Medical billing, if you've ever gone to the doctor ... 

I've just been to the doctor recently, and you get a bill that says it was $5000, but then they have insurance and write-off and the next thing you know, they allow 3000 and you're paying 700. Medical billing's complicated. We could talk about that for 4 hours in and of itself. What we bill and what we accept and what the office actually puts in their pocket is kind of a complex formula that really is one thing that if dentist's offices do this, if they get help with nothing else, they should get help with that aspect of it as well.

Howard Farran: On the ds3software.com, do you teach them medical billing and/or do you do the billing service for them? Is that a service that you or someone provides?

Gy Yatros: The answer is yes. We help, if the offices want to do self-billing, we can help them do that, and our software allows you to do electronic billing. We have a direct connection with 4500 billers and we can get instant verifications and so forth. We recommend as dentists first get involved in this, they let a third party biller do this, and we have our own in-house third party billing. We have hundreds of dentists throughout the country we do the billing for.

We also connect with other third party billers that want to use our portal and our system because it makes their billing better. At any time that a dentist is using a third party biller and they start doing a half dozen cases a month, and they decide they want to move it in-house, then it's seamless. They can go ahead and start doing that. All of the above I guess is the answer to that. We recommend starting out with some help and hand-holding for this aspect of dental sleep medicine. 

Howard Farran: When someone goes down this path, is this something they will have to do this the rest of their life? Are they ever treated and cured from sleep disorders, Obstructive Sleep Apnea? For instance, what if they were 250 pounds and they went down to 185? Would that go away? When you talk about ... Is it a chronic or sometimes is it acute? What are the other co-morbidities that could be treated side by side? Is that too many questions for one question?

Richard Drake: Yeah, that's too many, Howard. You're going to have to distill that down a little bit. No, but weight loss, 20% weight loss usually equates to about a 15 to 20% reduction in the AHI, or the RDI, the Respiratory Disturbance Index. That's kind of the ways that we measure sleep apnea. We haven't got into that, but you have a sleep test and how many events do you have? "Well, I had 22 per hour." Okay, well 22 is moderate sleep apnea, so that guy weighs 220 pounds, 20% weight loss, he's got to get down to ... 

What's that, 44 pounds? He's got to get down in the 170's, that kind of thing. That's only a 20% reduction in that number. Most of the time weight loss helps and we always counsel people about weight loss, but usually sleep apnea, we have to remember, it's a progressive disease. Once you have this, it's getting worse with time, and it's getting worse with alcohol. We are in a sense kind of married to these people when we start treating them. But that's part of the beauty of it, too. A lot of insurance companies pay to remake the device at 2 1/2, 3 years. 

Howard Farran: A lot of experts say that TMJ disorders, TMD disorders are 90% female. Do you see any male/female ... First of all, do you agree with that TMD, is the majority female patients, and is sleep disorders more male/female, or evenly spread?

Richard Drake: I agree that most TMD issues are female, just as an aside. Again, we could talk about that for 4 hours, but men have twice the prevalence of sleep disordered breathing until women quit menstruating. Within a year of a woman's last period, there's a whole lot jokes in there. [crosstalk 00:54:38]

Howard Farran: I thought you were setting me up for a joke. I thought, "Okay, I know this is a joke," but it wasn't a joke. 

Richard Drake: Within a year they catch up with men. It's a men dominated thing until the 45, 50, 55, somewhere in there, and then the women catch up quickly. 

Howard Farran: Interesting. Interesting. Well, if you had a 4 hour course on TMD, on why women have it more, I would love to get more online courses, any online course from you guys, because I think you guys are both really far out there in the lead on this new direction. So many dentists when they go to ... I just went to greater New York and it seems like every one of my friends that went there, they're just trying to knock out fillings, bonding, root canals, and to go into these other things like TMD. They're just not as common on the CE circuit. You know what I mean?

Richard Drake: I do. 

Gy Yatros: We do.

Howard Farran: What's next ... What would your close be? I only got you for 4 more minutes. Do you think you might do some online CE?

Gy Yatros: Absolutely. We'll touch base after this and figure out how to get that going.

Howard Farran: Yeah, I'm howard@dentaltown, and then we hired Howard Goldstein, we had 2 Howards, so he's hogo@dentaltown.com, but mail hogo@dentaltown and cc me, howard@dentaltown. 

Gy Yatros: We'll do it.

Howard Farran: I know ... I get questions on this every day.

Gy Yatros: Yeah, and we'll make that happen. I promise. That sounds exciting. We're glad to be involved in doing that. I would close, at least from my closing here, to say if you're a dentist and you want to learn more about this, we're the resource for you. We do courses all throughout the country, and I can honestly say no one does courses like we do. I think, Howard, you've heard me talk before in the past, and we've evolved a lot since you heard me years ago. What we do is teach you how to do this in your office. 

We have no other agenda other than this is the systems in place, and even if you've done, you're doing a dozen appliances a month, or dental devices, whatever we're calling them today, we're going to make you more efficient at doing that, and that's what we teach. Look, here's the systems you need in place, here's how you do it, and no one teaches it like us. You can check out our website about that. We have courses all throughout the country. We have our member meetings, too, that you can attend. As a non-member, you pay for them. Our members, we didn't even talk about the benefits. We do online study club every other week for our members, where you talk to Rich or myself. We have 4 member meetings a year that are hands-on, free for our members, a small fee for non-members to come to those. 

Staff members are encouraged to come to all these. Look at our website. If you don't know much about it, come to one of our courses. If you know you want to get more involved, we can give you a free trial of our software and our services, and you can go online and start looking at all that online CE, and just use it for a few weeks. No commitment. We're very proud of what we've done and we know that if you see what we have to offer, then you're going to see that if you really want to do dental sleep, you're in the right place. Again, it's ds3, 3 as in the number 3, software.com, or you can get to it from dentalsleepsolutions.com as well. But to go right into where our services for dentists are, it's ds and the number 3, software.com. 

Howard Farran: Gy, I just can't help but ask, but how come you didn't shave your head for this interview?

Gy Yatros: Well, you know, Howard, strangely enough my hair started growing back after I quit doing dentistry. I'm serious. You met me a few years ago. Look. Look at the difference here. That's what the lack of stress in dental sleep has done for me. Maybe if you'll get involved, you'll be looking like a hippie in no time. 

Howard Farran: Hey, Gy, I got to ask about your name. That's an uncommon ... G-Y. I've never met anyone with that 2-letter G-Y, and Yatros. I've lectured around. That sounds so Greek. Is that Greek?

Gy Yatros: Yeah, it's Greek for doctor as a matter of fact, and there's only about a half dozen or so Yatroses in the country.

Howard Farran: Yatros is Greek for doctor?

Gy Yatros: Absolutely. Yes, yes it is. 

Howard Farran: And [dosur 00:58:35] is Latin, correct? I thought doctor was [dosur 00:58:40] meaning teacher, but Yatros, or is that Latin?

Gy Yatros: I didn't know we were going to have a Latin quiz, so I don't know. I know what Yatros means and that's about the only Greek word I speak. 

Howard Farran: G-Y, is that a family name or did your mom just ...

Gy Yatros: The truth be known, my legal name is George. My grandmother nicknamed me that, because that's my initials, and just because we're not good spellers, originally from Kentucky, it made it real easy and we would have misspelled Guy anyway. That's why we have it there, so yeah. 

Howard Farran: Oh my God. Well, hey, I got to commend you, I can't tell you, Gy, how many times I've dropped your name when people have ... Every time they say, "Well, do you think there's a market for this? Am I wasting my time learning this? Do you think I'll have patients for this?" I'm like, "Gy does this full-time. That's all he does. How can you say you don't have a market for this when this guy doesn't even do root canals and fillings and crowns anymore?" There's a huge market.

Richard Drake: Howard, I want to tell you, there are 4 members that we have with DS3, who have come out of school, they haven't done a filling yet. 

Howard Farran: Who just graduated from school?

Gy Yatros: Yeah, started with us. 

Richard Drake: In the last couple of years, they haven't done a filling. In other words, they got out of school, this is all they're doing and they're making a good living at it, and their hair is growing.

Howard Farran: The thing I can't help but remember, in MBA school, they just kept saying, "Your business, you got to have something unique. You got to have a unique selling proposition. When everybody's the same, like a gallon of gas, a barrel of oil, a bushel of corn, you're just a commodity and you all compete on price. What is your unique selling differentiation? What makes you different?" This is one of those ways that where you can be really different than the dentist across the street. 

Gy Yatros: We're different, us, is we really help dentists be successful. I don't want to say this disparagingly, but there are services and companies that promise a lot out there in dental sleep, and it's almost given a bad taste in some people's mouths. For what we charge, it's just an incredible value, and we help dentists do this. To not get involved in this is to not get involved in something that can be very life-changing for your practices, both in helping your patients and enjoyment. 

Howard Farran: Well, [inaudible 01:00:53] because I want to do is sometimes the dentist just wants to learn something with no strings attached, low-cost first to see if they feel comfortable, and so to fly all the way to another city or buy a $5000 device, or whatever, to learn more, they're kind of cynics. Dentists are cynical bastards, no doubt about it. To sit there and have you guys spend an hour on a podcast, so they're on their iPhone, they're commuting to work, and no strings attached, no money, and just low-cost listening app.

That's I wish you'd do an online CE course on this, because it'd be another low-stress, low-cost way for them to learn more, and then when I'm sure they see this bald beauty, Richard, and this hairy guy, Gy, they'll probably fall in love with you and learn more from you, and then want to learn more. Then at the end of the day, that's what our patients need. 

Gy Yatros: Absolutely. We're excited to get involved. 

Howard Farran: All right. Well, hey, thank you gentlemen so much for spending an hour with me today, and I hope you have a rocking hot day. 

Gy Yatros: You, too. 

Richard Drake: Thanks guys. 

Howard Farran: All right. Bye-bye. 

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