Dentistry Uncensored with Howard Farran
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725 Tongue-Ties and Missions with Richard Baxter, DMD, MS : Dentistry Uncensored with Howard Farran

725 Tongue-Ties and Missions with Richard Baxter, DMD, MS : Dentistry Uncensored with Howard Farran

5/31/2017 11:49:46 AM   |   Comments: 0   |   Views: 372

725 Tongue-Ties and Missions with Richard Baxter, DMD, MS : Dentistry Uncensored with Howard Farran

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AUDIO - DUwHF #725 - Richard Baxter


Dr. Baxter attended Vanderbilt University for his undergraduate studies and the University of Alabama at Birmingham School of Dentistry where he graduated at the top of his class and was inducted into OKU, the national dental honor society. He attended the residency program at Nationwide Children’s Hospital / The Ohio State University, one of the nation’s top-ranked pediatric hospitals and busiest pediatric dentistry clinics. Dr. Baxter is a Board Certified pediatric dentist and Diplomate of the American Board of Pediatric Dentistry. After graduating from residency, he opened his own practice in Birmingham, AL, Shelby Pediatric Dentistry. His practice has grown quickly, and he was recently named the Small Business of the Year in his county in addition to Healthcare Professional of the Year. Dr. Baxter enjoys spending time with his wife, who is a nurse practitioner but is currently home with their twin 2-year-old girls, Hannah and Noelle. They both have a passion for using medical and dental skills for local and global missions.

www.ShelbyPediatricDentistry.com

www.mPowerApproach.org



Howard Faran: It is just a huge honor for me today to be podcast interviewing Richard Baxter, DMD MS. A pediatric dentist. Board certified all the way from Birmingham, Alabama. Doctor Baxter attended Vanderbilt University for his undergraduate studies and the University of Alabama at Birmingham School of Dentistry where he graduated at the top of his class and was inducted into OKU, the National Dental Honor Society. He attended the residency program at Nationwide Children's Hospital, The Ohio State University. Remember you've gotta say The Ohio State University. You can't just say, "Ohio State University," or they think you're a fraud. 

One of the nation's top-ranked pediatric hospitals and busiest pediatric dentistry clinics. Doctor Baxter is a board-certified pediatric dentist and diplomat of the American Board of Pediatric Dentistry. After graduating from residency, he opened his own practice at Birmingham, Alabama, Shelby Pediatric Dentistry. His practice has grown quickly, and he was recently named The Small Business of the Year in his county in addition to Health Care Professional of the Year. Doctor Baxter enjoys spending time with his wife, who's a nurse practitioner, but is currently home with her two twin two year olds, Hannah and Noel. They both have a passion for using medical and dental skills for local and global missions. 

Congratulations on being in the National Dental Society, OKU. My class ranking was so low they won't even let me lecture to them. 

Richard Baxter: That's funny.

Howard Faran: They said, "Dude, no. No." But you know I've got to start with something that's very interesting. A lot of things you think are just not supported by data, and who would have guessed? No one on our team guessed, would have ever guessed that, the online CE courses ... You know we have 50 different categories of online CE courses, and the pediatric dentistry courses are the most viewed. And you had an amazing course on Dentaltown. It's called Tongue and Lip Ties: Assessment, Diagnosis, and Evidence for Treatment. But my question to you is out of root canals, fillings, crowns, bleaching, bonding, veneers, why do you think Dentaltown has the most views in the category of pediatric dentists? I mean you and Josh Ran are just the kings of online CE, and why is that?

Richard Baxter: Yeah I think that what you hit on it before in a previous episode about the Affordable Care Act and pediatric dentistry, the essential benefits included with that. We think also, there's not a lot of information in dental school about pediatric dentistry. We show folks on worrying about requirements, new crowns and dentures, the focus on root canals, focus on that kind of stuff, and then you don't get to the pediatric dentistry part as much, so that might be one reason. 

Howard Faran: Another thing, do you think pediatric dentistry is well-shared? I mean at the conventions, like when you go to the big meetings there's so many courses on implants and root canals but this doesn't seem like you-

Richard Baxter: Yeah.

Howard Faran: Get a lot of ... So as far as supply and demand, I just don't see a lot of courses on pediatric dentistry. 

Richard Baxter: Yeah, there's not many courses. There's maybe one or two at these bigger meetings like the Hinman dental meeting in Atlanta. It's pretty close to us. Maybe one or two courses. But there's nothing on tongue ties especially ... It's so common. Some people say 10%, 20% of the population has a tongue tie of some kind. Now not all those are causing problems, but a lot of people have them. No one knows about them really so. And you've had some other guests on there, Joy Moeller, and some other people about tongue ties and myofunctional therapy, and sleep, and it really kind of connects a lot of those areas together.

Howard Faran: You sit in the middle of myofunctional therapists and orthodontists. Why do you think so many orthodontists don't buy into myofunctional therapy, or any of this? Do you agree that that's their common attitude and belief?

Richard Baxter: I think on the East coast and West coast-

Howard Faran: I asked one of the kingpins of orthodontists on a podcast what do you think of them, and I said, "What percent of orthodontists think myofunctional therapists are nuts?" He said, quote, "99%."

Richard Baxter: Probably. Yeah.

Howard Faran: This is Dentistry Uncensored, I don't want to talk about anything everybody agrees on. Why do you think that's the norm?

Richard Baxter: I don't know. I was just at course. I was with Joy Moeller [inaudible 00:04:28] dentistry meeting, and a lot of them makes sense. It works well. Teeth and bone versus muscle, the muscle always wins. [inaudible 00:04:43] I think she said in Europe more, and there's no really good reason why, but I'm not a myofunctional therapist. I don't know too much about it like they do, but there's no good reason, except it's not taught in dental schools probably.

Howard Faran: Yeah, and another thing that's funny is when people dismiss they always say I hear this, "That's some weird thing out of Europe." I'm like, "Okay, Europe. Yeah, that's where they make Audi, Lamborghini, Mercedes, Porsche-

Richard Baxter: I know.

Howard Faran: And you're from the country that makes, what do you guys make, Chevy? Pontiac? Oh, okay. I get it. I get it, yeah. Them Europeans."

Richard Baxter: You don't trust anything from Europe.

Howard Faran: I think Americans are the least trusting people on the planet. Maybe that's why they've been so successful. They don't trust government. They're the most cynical people I've ever met. When you go around the world lecturing, Americans, their gut reflect is, "I don't believe you." 

Richard Baxter: Yeah.

Howard Faran: That's where they start.

Richard Baxter: Yeah, that's how it is with the tongue ties. It's controversial. They don't exist or they don't cause problems. "Don't worry, he'll fall down and rip his lip tie eventually." A lot of misinformation out there about them so just trying to spread some truths. So the Dentaltown CE course is a good way-

Howard Faran: There's a lot of, you know, a lot of kids graduate ... This is the 24th of May. A lot of kids are getting ready to graduate, and one of the biggest questions they ask is, "Should I go into specialized?" What would you say to a kid who's thinking about being a pediatric dentist like you?

Richard Baxter: Yeah, so pediatric dentistry is a lot of fun. I wasn't sure what I wanted to do at first. I was thinking about orthodontics, oral surgery, pediatric dentistry, maybe just general dentistry. I really liked it all. I went and shadowed different offices. Really during dental school, go to visit different offices, see what real world pediatric dentistry is like versus in the clinic at the dental school, because it's a lot different typically. Same thing for any of the specialties. Real world oral surgery versus in the clinics. Real world oral surgery you're taking out third molars, and doing implants and stuff like that versus these massive traumatic cases you see at dental school. Just like real world pediatry dentistry you're seeing a bunch of patients and it's about volume typically. Quicker procedures instead of at the dental school where you see maybe one or two patients a day.

Howard Faran: How is the business dynamics? Because the way I read the stats is there's 325 million Americans and they only graduate 325 pediatric dentists a year. They only graduate one per million.

Richard Baxter: Yeah.

Howard Faran: That has to be pretty sexy on the supply demand curve. Is it, or is not right?

Richard Baxter: Yeah, orthodontics there's one on every corner pretty much, but we're in an area where there's not many pediatric dentists so people drive for routinely an hour to come see us.

Howard Faran: Yeah, and the other thing is I totally believe that out of the nine specialties, the one general dentists enjoy the least, is pediatric. Even though I raised four kids, have two grandchildren, I always feel like I'm a hospital, if you walk in I want to be there for you, but God dang, I always try to refer them to a pediatric dentist if I can or I can't get them in, whatever. You got to do what you got to do. 

Richard Baxter: Yeah. We have fun, we have extra training, we have TVs in the ceilings, they can watch whatever movie they want to watch.

Howard Faran: I bet you have one Disney movie that they almost always all watch.

Richard Baxter: Well, yeah. For the first six months we were open, all we watched was Frozen. That's it. Six times a day, all day everyday. Frozen. I know all the words. Not just the songs. All the words. The dialogue to Frozen too.

Howard Faran: It's funny because those kids, even my grandkids and when my kids were little, they never watch a movie once. Even when they're home. When they got a movie, they wanted to watch it 20 times in a year.

Richard Baxter: Yeah. We were watching Trolls yesterday with a patient, like, "Oh, yeah, I already watched it once this morning. I want to watch it again." Anyway.

Howard Faran: Ha. I want to give these kids some ... Is there anything you want to say about tongue tie and lip tie diagnosis? Assessment-

Richard Baxter: Yeah sure.

Howard Faran: and treatment of the [inaudible 00:08:39], because that's a neat thing. What I found interesting is I had a patient just a few weeks ago, and she was asking me about it, and I was really impressed that her physician, when she was in the hospital and having problems, they brought in a lactation specialist, and she'd already had a couple meetings with her, and I was just really amazed at how much information this consumer patient America has already gotten about ... Because they're trying to really promote breastfeeding.

Richard Baxter: Part of it is the breastfeeding push recently and getting off formula and doing the breast is best kind of thing, and then we got to the Facebook groups and the mommy groups, and now if anyone has a problem with nursing or any problem at all you can post on Facebook and some of those groups are called Dairy Queens or Milky Mamas. They have all these kind of names for these groups. What they can do is they'll post and then say, "I've had painful nursing, a poor latch, my baby's not gaining weight, they're fussy and gassy all the time, what's going on?" These other people answer and say, "Oh. Get him checked for a tongue tie." Then they'll come to our office, or there's a bunch of different providers all over the country, all over the world for that matter, and we'll assess the baby, see what's going on. Often there is a visible tongue tie, an anterior tongue tie, sometimes it's hidden, it's called a posterior tongue tie. There's often a lip tie associated with that, probably 90% of the time if there's a posterior tongue or a tongue tie there's a lip tie with it for the babies. We use a CO2 laser, it's actually here behind me.

Howard Faran: What's the brand of it?

Richard Baxter: It's a LightScalpel. They're from the Seattle area. It's a LightScalpel CO2 laser. It works really well. We used to have a diode, we used a Biolase iLase diode. In the second followup course on Dentaltown that comes out June 7th, that one has actually how to perform the procedure, all those other things. It has videos of the diode, has videos of the CO2 laser and how it works. The CO2 laser is way faster. It takes me about 10, 15 seconds to do a lip tie, about 10, 15 seconds to do a tongue tie, versus a minute, minute and a half for each of those sites with the diode.

Howard Faran: What's the name of that LightScalpel, that CO2 laser LightScalpel? Is there a model number on it or anything?

Richard Baxter: The LS 1005 or something.

Howard Faran: What did it cost you? LS 1005?

Richard Baxter: Yeah, this is Dentistry Uncensored, it's about $30,000.

Howard Faran: $30,000. I would have to know, do they have any association with the Seattle Seahawks?

Richard Baxter: I don't know. I don't think so.

Howard Faran: You said they're from Seattle.

Richard Baxter: Yeah, in the area. Not a suburb.

Howard Faran: That is my arch evil enemy, the Seattle Seahawks. If you're a true Cardinals fan, that is the devil. The other, you said the Biolase diode?

Richard Baxter: Yeah, just the iLase, the pen one, had that one first. Those are about $3,000. But where they get you is on the tips. The tips are around $8 or $9 a piece and typically I would do six babies a day maybe on average.

Howard Faran: Really? You're doing six babies a day?

Richard Baxter: Yeah, five or six, sometimes eight.

Howard Faran: Then the question is, from an epidemiological point of view, for every 100 babies born, how many of them are lip tied, tongue tied?

Richard Baxter: Dr. Kotlow who is in New York, he may be a good guest to have on, he estimates probably 25 out of 100.

Howard Faran: Is he a pediatric dentist?

Richard Baxter: He's a pediatric dentist. He kind of pioneered the procedure about 20 years ago.

Howard Faran: What's his name?

Richard Baxter: Larry Kotlow. K-O-T-L-O-W.

Howard Faran: Can you email him and email me? I'm Howard@Dentaltown.com. [crosstalk 00:12:22] because the one thing that's very noticeable in economics is you only have three functions, you're supposed to eat, drink, and reproduce. When you look at spending, mom will spend the most on her kids, the least on her grandfather, and the whole goal of a species is to reproduce them offspring, so I think that the kids are the most important to me. I would do anything for my two grandchildren. I'd give me kidney, my liver.

Richard Baxter: Yeah, and if they can't eat, they're not sleeping well, it really affects tons of issues. If there's airway issues later on, you have some specialist in there talking about airway ... It's sleep. Sleep disorder, breathing, sleep apnea. Often those who have tongue ties or a high arch palette. The tongue isn't pushing the palette out and smoothing it out so it goes from a U-shaped palette normally to a V shaped palette. So that can also be a sign of a tongue tie. [inaudible 00:13:18] orthodontics that connects with medicine, reflux issues, obviously all the airway issues leads to a whole nother host of medical conditions like ADHD and that sort of thing-

Howard Faran: I think the really big story, and this is a lot to do with it, is it doesn't seem like the news or the media that no one's talking about is that America has this 10,000 orthodontist machine putting all these kids through orthodontist while the archeologists are saying, "Man, there weren't even malocclusions 300 years ago."

Richard Baxter: Yeah, yeah.

Howard Faran: When you look at the fact, you said these websites, Breast is Best, Dairy Queens, Milky Mamas, the fact that it was nursing for years that those forces spread the palette, made room for the ... and then if they ate some they were probably chewing cartilage off a wooly mammoth's leg and now you're feeding them applesauce out of a jar, and the minute the kid has any difficulty nursing, which if they're having difficulty, well that's stress equals force divided by area, I imagine struggling, if you're hungry enough you're going to struggle, those are forces. So then they switch them to a sippy cup, or some bottle that's just a guzzler,

Richard Baxter: Yeah.

Howard Faran: and then these kids, they don't develop jaws. In fact, if I was a pediatric dentist, I would have a monthly Saturday morning about how to naturally prevent orthodontics, and then I'd give a whole course on how all these skulls that we find going back from 300 years to a million and a half, you don't see malocclusions. Do you agree with that or not?

Richard Baxter: Yeah. For sure. Who knows why tongue ties are increasing. Some people think it's folic acid, some people think it's all the environmental toxins. We don't really know exactly for sure. It's not just genetic drifts. It's not just the genes. It has definitely become more common. It's almost like autism where it's becoming more common, but it's also being picked up more, so not really sure why the prevalence is increasing but it's definitely something to look at. Like you said, in a previous podcast, this was probably your quote, but, "Money is the answer, what's the question?" You know?

Howard Faran: With autism, I have several friends that have an autistic child, but the economists say that when the federal government started giving extra money to schools if they had an autistic child, all these schools were saying, "Hey, this kid's not quite right. Let's get a diagnosis," and then we'll get more money, then we can have more teachers with that child-

Richard Baxter: Interesting.

Howard Faran: If you want more of something, subsidize it, if you want less of something, tax it or regulate it. 

Richard Baxter: Yeah.

Howard Faran: But I have read papers by epidemiologists who do not see evidence that autism is increasing, but they do see a massive increase in reporting.

Richard Baxter: Yeah, so who knows, but sometimes there are pretty common, we have people drive from four or five hours away to our office to have us release the tongue.

Howard Faran: I think it will be proven eventually that tongue tie is caused by something the parents do wrong, because I've noticed raising four kids that at the end of the day it's always the parent's fault. You don't understand this, you just have two twins. Every time Ryan messes up, he says, "Well, it's your fault!"

Richard Baxter: Yeah, I'm going to say they both have tongue tie, my girls did. I had a tongue tie. It's often is genetic too. We'll ask the parents, "Hey, did you ever have any difficulty speaking?" Or adults sometimes they have neck pain. Sometimes they'll have migraines. Speech is the main one that's obvious to pick up in adults.

Howard Faran: I believe that genetics is so important. I mean, I just found out yesterday that my grandfather was short, fat, bald, and dumb too. So I think I inherited all this stuff. So you got it where it's ... Next week six thousand kids are gonna graduate in dental school and they're all gonna go take jobs. Majority will take jobs as an associate in the private sector, which is like 85% of the associate jobs. And then some will go to corporate and every parent comes in, and says the same damn thing, "Well why am I gonna fix up a baby tooth, it's just gonna fall out anyway. I mean-

Richard Baxter: Sure.

Howard Faran: Let's just pull it." How would you coach a young 25 year old dentist who's gonna hear that question-

Richard Baxter: Yeah.

Howard Faran: Nine times a month next year?

Richard Baxter: Yeah, so often the miss conception from the parents is that the tooth will fall out next year or something. Typically, the back teeth don't fall out 'til 10 to 12 years old. So if it's a four, "Hey Mom he's gonna have this tooth for another eight years. And we don't want it to hurt him. Causes lost school days from tooth ache, can't concentrate in school." Cause actually pain is one major motivating factor. Aesthetics is another, so if they're missing their front two teeth or their back teeth cause you had to pull it, cause they didn't get it fixed right away, that's another factor too. Speech can be affected. They hold space for the permanent teeth ... Chewing, so there's lots of functions that we need baby teeth for. Sometimes the parents kinda overlooks and just see the dollar signs and the money. It's gonna cost X amount to fix it, but honestly most pediatric procedures are covered at 80% or something like that. So it's not like a huge out-of-pocket expense, unless they just don't have insurance. 

So it's typically not too expensive to fix the baby teeth, and it depends if you wanna do all zirconia crowns, which we do a lot of zirconia anterior, zirconia posterior. Those can get expensive if they're not covered by insurance. But-

Howard Faran: Are those pre-made zirconias or are they lab made?

Richard Baxter: They're prefabricated. We used EZ-Pedo, which just rebranded itself to sprig now, S-P-R-I-G. But EZ-Pedo I think they've advertised on your website before, but they work well. But they're prefabricated, they come in six different sizes per tooth, and you just put that size on. 

Howard Faran: I'll never forget the funniest, the saddest, bizzarest, weirdest pediatric case I've ever had. This woman came in, she's crying, I sent her to a pediatric dentist, this was way back in the eighties, and she came in and needed a chromosome crown and she said, "I just don't like the looks of it, it ... and why does it have to say L4 on the side of it?" I thought, "Oh my God-

Richard Baxter: Just brush it!

Howard Faran: I can at least get the L4 off, and I thought it was just hilarious that they couldn't even remove the number 

Richard Baxter: Yeah.

Howard Faran: on the side of the tooth. Another-

Richard Baxter: Yeah I take them off now.

Howard Faran: What's that?

Richard Baxter: I take the numbers off afterward, but it is a good test to see if they're brushing them. Cause if they're brushing them well they should come off on their own. 

Howard Faran: By the way, are you personally ... Is Shelby Pediatric Dentistry on Twitter?

Richard Baxter: I think so. @shelbypediatric maybe, or something. We don't tweet a lot, though. 

Howard Faran: Well I do it so my guests can ... they're driving, they're not taking notes.

Richard Baxter: Oh yeah.

Howard Faran: So at what?

Richard Baxter: Shelbypediatric. 

Howard Faran: Shelbypediatric?

Richard Baxter: [crosstalk 00:20:00] pediatric. Yeah. 

Howard Faran: Okay, Shelbypediatric. Let's see if that's you. @shelbypediatric in Pelham, Alabama?

Richard Baxter: That's us. Yup.

Howard Faran: Okay so I just retweeted your tweets on [inaudible 00:20:14], I retweeted your online CE course.

Richard Baxter: Okay. Thank you.

Howard Faran: And I retweeted the laser that you bought, which was LightScalpel.

Richard Baxter: [crosstalk 00:20:22] LightScalpel. 

Howard Faran: And but I wanna explain something for these purchases. So you said the LightScalpel is $30,000. Some people say a CAD Cam is $145,000.

Richard Baxter: Yeah.

Howard Faran: But those are debit sheet numbers. And what a debit sheet means ... and by the way I don't do any commercials, no one from LightSpeed or anybody, and no one gives me money. I make my own money. So I don't do any commercials, no one pays to get on this show. I don't get paid to sponsor anybody, or anything. But when someone says a laser is $30,000, or CERAC machine or an E40 is $145,000. That's a balance sheet number where you're asset equals, or balances to the liability of the EO versus the equity that you have into it by your down payment, or how much you paid off or whatever. But that ... you don't really see that, because when I talk to these companies, it's like cars and houses, only 10% of cars and houses are bought in cash.

Richard Baxter: Yeah.

Howard Faran: Everyone else finances. So if you buy a $30,000 laser, most everyone is gonna lease to own, over what five years? Did you lease yours?

Richard Baxter: [crosstalk 00:21:30] I'm not sure. I paid cash for it. 

Howard Faran: Damn dude. You are ... I just wanna ... Oh my gosh. That is so awesome.

Richard Baxter: Yeah.

Howard Faran: But let's say they did lease it. A $30,000 laser over five years, what do you think the lease pay would be?

Richard Baxter: It's not that much. Probably $500 a month or something.

Howard Faran: Okay, so $500 and how much do you charge to laser a tongue tie?

Richard Baxter: If it's cash, like if they don't have any insurance at all, it's around $670. So you do one a month and it pays for itself.

Howard Faran: Exactly. So if you ... Your balance sheet only matters if you're trying to get other people's money, a loan, or go public, or you're trying to get a divorce and have to split everything up in half. You don't look at the ... And that was the one thing I ... I cringe at giving Donald Trump any kudos, and you're never supposed to talk about religion, politics, sex or violence but-

Richard Baxter: Yeah.

Howard Faran: When I was young, I did read his "Art of the Deal" and the one thing that's blindsided me, he says, "The price never matters, it's the terms." He said, "I'll buy your house for a billion dollars if I can pay you a dollar a month for a billion months, because I can rent it for a thousand a month, so I'll make $999 a month for a billion months." So the price doesn't matter. So on these equipment purchases, what matters is the payment, and then you gotta look in your practice supply and demand. If you're seeing six or eight a day, you're a pediatric dentist. So if you're a general dentist you need to look at the supply of patients that you're serving, and that you're committed to, and how often you're seeing this. 

Richard Baxter: Yeah, we use it for gingivectomies. I'm gonna do my niece's gingivectomy tomorrow. And they can use it for operculectomies, you can use it to remove a mucus seal. I've done that several times, so you can use it for lots of other procedures other than a phrenectomy. But if people really start looking in there, looking under the tongue, one quick and dirty way to see if someone's a tongue tie ... it's not sticking it out, it's not protrusion, it's elevation. So if you can open as wide as you can, and lift your tongue up and touch the roof of your mouth, or almost touch it? Yeah so you're good Howard. 

Howard Faran: Am I good?

Richard Baxter: Yeah, try to touch the roof of your mouth. And you can see if it's held down, you can't elevate, or you can barely touch, or you can't touch at all. There maybe something worth considering. It doesn't mean you absolutely need one, but it's worth looking into, and see if there's any other speech issues, like R's, L's, S's, Sh sounds, T, Z, D. Those are the tongue tie sounds, but neck pain, migraines-

Howard Faran: Say the tongue tie sounds again?

Richard Baxter: R, L, S, T, D, Z, and Sh. And then ng like orange. So 66. 33. Those would be hard for people with tongue tie to say. Girl is really hard, cause there's an R and an L. They say gaul instead of girl. And it's often in kids, but it kids you really have to wait 'til they're four to six years old to really test their speech.

Howard Faran: And the other thing that's so upsetting to me is how many of my patients when you talk about the importance of breast feeding and not switching to applesauce, and bottles and sippy cups, actually make the kid chew something-

Richard Baxter: Yeah.

Howard Faran: Is they say that they get dirty looks if they're breast feeding. Like it's you go to a movie in America and Silvester Stallone or Arnold Schwarzenegger has a man made AK-47 and kills 100 people, it's a family show.

Richard Baxter: Yeah, that's okay.

Howard Faran: But if someone whips out a mammary gland and starts nursing a baby, it's rated R and they run for the door. How messed up is that?

Richard Baxter: Yeah, it is. It's a shame. 

Howard Faran: Yeah, I mean family values is about getting married and having babies and all natural, not buying a Ak-47 go to a shooting ranch-

Richard Baxter: No.

Howard Faran: You know? Crazy, crazy. I want you to give some more experience talking. They're always gonna get the question, "Can I come back with my baby in the treatment room?"

Richard Baxter: Sure!

Howard Faran: And you hear, you hear some people saying, "Well if you bring the parent back, they're not gonna listen to the dentist, they're just gonna be watching the mom." And they know-

Richard Baxter: Yeah.

Howard Faran: That if they start to cry, Momma will pick it up and pet it. 

Richard Baxter: Yeah, we actually have a sign. So we allow all the parents back, even for sedations, so we'll do an oral sedation in our office we'll allow the parent back. That's one of the reasons why I think our practice has grown so fast. We on average have about 200 new patients a month. 

Howard Faran: But okay, are you in Birmingham or are you in-

Richard Baxter: Pelham. It's a suburb or Birmingham. We're just South of the city.

Howard Faran: What's it called?

Richard Baxter: Pelham. P-E-L-H-A-M.

Howard Faran: P-E-L-H-A-M?

Richard Baxter: Yeah. 

Howard Faran: Pelham? So-

Richard Baxter: Yeah. So we have a lot of new patients. And typically that's because they wanna come back with their kids, and some other offices don't allow them back with their kids. 

Howard Faran: So how old is your practice?

Richard Baxter: We're two and a half years old.

Howard Faran: See? That's the one thing you and I have in common, I mean, I graduated May 11, thirty years ago this month, and I had my office open September 21. And now, so many of these kids are brainwashed that they can't just walk out of swimming school and go dive in the deep end. They have to walk around the pool, and they gotta do a residency, and they gotta go work at corporate, and they gotta do all this stuff. And I always-

Richard Baxter: Yeah.

Howard Faran: Feel like there's never a good time or start a business. 

Richard Baxter: No.

Howard Faran: It's a-

Richard Baxter: 2014 I graduated residency, I finished my Master's these, graduated residency, and had the girls all within one month. The next month we moved back to Birmingham, or Pelham, and then the month after that we opened our office. So I was building it while I was in Ohio at the time. And I was using FaceTime, and Skype to see how ... My father-in-law was here and he was lookin' at the building, and he'd walk me around virtually. And then I only came down and visited two times. And we built it from the ground up, so it's a free standing building, it was just a field. But we're next door to an elementary school. And we're also on a main road with a big lit sign, 10' by 7'. Now we have an LED sign, below that like one of those message boards. But we have about 40,000 cars drive by every day. So we try to do Facebook marketing, Google marketing, all the local newspapers, local magazines, stuff like that. Still the number one way people hear about us is, "Oh I was just driving by and saw the sign." 

Howard Faran: Alright I know it's location, location, location-

Richard Baxter: It is for sure. You have to be on a main road. And then I read your book, and I think you have a carousel in front of your office maybe.

Howard Faran: Yeah.

Richard Baxter: And I thought, "that's a good idea!" So I was looking into a carousel, and then I got a playground. So we have a playground outside now in the front, and it's more marketing. Cause people walk out and they see it, and it's also for the kids. They can enjoy it while their sibling is waiting for their treatment. So we have restaurant paging system so they can page and buzz the parents whenever their other kid's ready. So we try to do some fun stuff. 

Howard Faran: One of the biggest problems dentists have is why ... We always, for 15 years had the biggest problem having the Townie meeting in Vegas, cause Vegas knows who's gonna throw all their money on the Blackjack table, and it's not highly educated dentist, engineers, lawyers, and we always had to take whatever was left over. We were never a priority. That's why I started next year we're doing the next two in Orlando-

Richard Baxter: Okay. 

Howard Faran: We're gonna do all of them in Orlando. Plus I wanna take my grandkids-

Richard Baxter: Love Orlando. Love Disney.

Howard Faran: Yeah. 

Richard Baxter: My wife grew up at Disney World actually.

Howard Faran: You what?

Richard Baxter: My wife grew up at Disney World in Celebration, Florida, the Disney town. It's where she grew up. 

Howard Faran: There's a Disney town?

Richard Baxter: Yeah. It's called Celebration Florida. 

Howard Faran: Really? So-

Richard Baxter: Yes.

Howard Faran: So Disney World is not in Orlando?

Richard Baxter: No, Disney World is in Orlando, it's in Kissimmee, or just South of Orlando, but there's a Disney town called Celebration that Disney built. And then they sold it in the 90's or early 2000's, but it's like a Utopian, perfect town, basically is what they've designed it as. And-

Howard Faran: And-

Richard Baxter: They've just like perfect city planning ... like they put in ... Instead of putting in those little small trees like twigs that you see in most subdivisions. They put in massive oak trees, you know like only Disney could do. So it looks old from the beginning. White picket fences, and it's called Celebration. It's a nice town. 

Howard Faran: Wow. Well I'm gonna go see it, and what town is Disney World in?

Richard Baxter: It's Kissimmee, or right there-

Howard Faran: Spell Kissimmee.

Richard Baxter: K-I-S-S-I-M-M-E-E. 

Howard Faran: K-I-S-S, like kiss?

Richard Baxter: Yeah. I-M-M-E-E. Yeah, Kissimmee. I think, it's kinda hard to spell. 

Howard Faran: Well you know the problem with these young dentists is business ... You have to be comfortable with risk. People don't like to have uncomfortable conversations, they don't like to take risks. So if you're a young kid it just speaks volumes about how smart you are that you're scared. Only a moron-

Richard Baxter: Yeah-

Howard Faran: Would jump out of an airplane and say, "Yeah I wanna go parachuting," and be the first one to jump out of the plane without a chute. 

Richard Baxter: Yeah.

Howard Faran: You're smart. You've got eight years of college, you got A's in chemistry and physics and you know the Krebs Cycle, and I mean of course you're scared. But you have to ... 

Richard Baxter: Just take risks.

Howard Faran: [crosstalk 00:30:35] When you're young-

Richard Baxter: Yeah.

Howard Faran: When you're young it's the best time to take risks because you're young, you're dumb, you don't know all the risk, it's going to be scarier than you thought it was, but you're gonna survive and be twice the better man for it.

Richard Baxter: Yeah it's more work than I ever thought it would be, but it's definitely more rewarding than I thought it would be too. 

Howard Faran: Okay, but how old were you when you got out of dental school in 2013. You're 31 now, so.

Richard Baxter: Yeah, I finished in 2012, I graduated dental school, and then I did a two year residency with a Master's at Nationwide Children's Hospital. So I finished in June of 2014. And I started the practice in August of 2014. 

Howard Faran: And how old were you in 2014?

Richard Baxter: I don't know, 28?

Howard Faran: Yeah but think about it, who has more energy to do that? A 28 year old or a 38 year old?

Richard Baxter: Oh way, for sure, a 28 year old. 

Howard Faran: And then after you work for corporate a couple a years, then you start using all your debt for a house, a car, start a family. And then you go home and tell your spouse, "Well everything's all great and groovy, I'm gonna risk it all now in going in on a deal-

Richard Baxter: And then your salary goes down.

Howard Faran: [crosstalk 00:31:38] You know, risk it when you have nothing to lose.

Richard Baxter: I said, "Then your salary goes down." You're used to having an associate dentist's salary. But what most people do is they start up, and they'll work in their office two days a week, and then work at a corporate place two days a week. So I started doing that a little bit, worked some hospital cases for people, but we honestly took off. We were in the black from day one. So as a pediatric can do that, orthodontist's is a little bit harder, oral surgeon you can do that too. But really, honestly without Dentaltown, I would not have started up on my own. So I have to say thank you to you, Howard, cause 100%, without Dentaltown, without reading other people's mistakes, and people that have done before me saying, "Don't do this," or "Do this." I mean Jawbreaker, Jaws, Tom Janecek he did our dental office floor plan, we used YAPI, Open Dental, LumaDent lights, obviously Practice Café. I did Breakaway. We used Doctor Demographics. We used CEDR for office handbooks, so I really tried to do a Dentaltown office. 

Howard Faran: Gosh, slow down! So you did Jawbreaker, what's Jawbreaker's website?

Richard Baxter: It's officeplans.com.

Howard Faran: And how come he's one of my best friends ever on Dentaltown, and he still won't come on and do a podcast? 

Richard Baxter: I don't know.

Howard Faran: Do you know him?

Richard Baxter: But he's a really nice guy though.

Howard Faran: But will you send him an email and say that Howard's talking shit about him-

Richard Baxter: Sure.

Howard Faran: On Dentaltown, because I love that guy. So his website is officeplans.com?

Richard Baxter: Yeah, and he does a good job, and he's real reasonable. 

Howard Faran: What's he out of?

Richard Baxter: He's in Georgia, but the supply company like Shine or Patterson, they'll give you a floor plan, but that floor plan often is not the best use of time. It's built around selling you equipment-

Howard Faran: Absolutely, cabinets.

Richard Baxter: It's not built around efficiency. So I get sad at the end of the day, I look at my watch and I've only walked like 1,000 steps, cause it's that efficient. And I'm running around all day, but anyway it works well. So he did a great job. But we have headlights, we have no ceiling lights at all, so no operatory lights. It's all just our headlights. So the assistants, the hygienists, and me. 

Howard Faran: Richard Baxter, okay you're in Alabama, you said he's in Georgia?

Richard Baxter: Yeah, he's in Georgia. He just does it all via online. He'll send you the plans and stuff.

Howard Faran: So he designed the plumbing, so he did the whole plan?

Richard Baxter: He did the floor plan.

Howard Faran: Did you rent a retail space, or build from the ground up?

Richard Baxter: No, we built from the ground up. It was just a field, and we built from the ground up.

Howard Faran: And he did all the architectural for the whole building?

Richard Baxter: Just the floor plan. And then our architect, the contractor did the outside part, around that floor plan, though. So it all revolves around the floor plan. 

Howard Faran: Wow. I think that is so smart, I did the same thing. I found a guy that just does dental offices, and he told me that if you get a supply company to do your floor plan, they're just gonna try to fit the most shit in your office, the most cabinets, the most everything. 

Richard Baxter: Yeah.

Howard Faran: But they-

Richard Baxter: We don't have any side cabinets. We count on breakaway design, also. You had Scott Leune on the program I know. So we did breakaway, that was really helpful. Without Dentaltown and without Breakaway we couldn't of opened up.

Howard Faran: Well Dentaltown would be nothing if it wasn't for all you guys. All I am is the Verizon phone line, it's all you guys that make Dentaltown.

Richard Baxter: [inaudible 00:34:59]

Howard Faran: So you said office plans with Jawbreaker. What is his real name? Tom Janecek?

Richard Baxter: Tom Janecek.J-A-N-I-K?

Howard Faran: I think it's E-C-K. I'm not sure exactly. I love his professional work, what he does, cause he's a dentist too.

Richard Baxter: Yeah, I think he's retired now.

Howard Faran: Yeah. Oh yeah, but I love his jokes.

Richard Baxter: Yeah.

Howard Faran: That guy, he has posted more jokes under ... We have two jokes "Jokes Clean" and "Jokes Not so Clean". And Jawbreaker owns the "Jokes Not so Clean" he is so hilarious. So then you said Open Dental and there's-

Richard Baxter: I love Open Dental.

Howard Faran: There's a very obvious thing that our research shows that 91% of dentists only want to know what their colleagues think, they don't want to know what the manufacturer thinks.

Richard Baxter: Yeah. 

Howard Faran: And on Dentaltown, if you Google any practice manual software, all it is is bitching, moaning, crying, complaining, and then you go to Open Dental forum out of Oregon.

Richard Baxter: Oregon.

Howard Faran: And they're all just raving fans. Remember that book-

Richard Baxter: Yeah. I have it. 

Howard Faran: They're "Raving Fans."

Richard Baxter: Yeah. You gotta read books, Howard. 

Howard Faran: Yeah. "Raving Fans: A Revolutionary Approach To Customer Service" by Ken Blanchard, Sheldon Bowles, forward by Harvey Mackay who wrote a review for my book.

Richard Baxter: Yeah you gotta have good books.

Howard Faran: Did you know Harvey did my book too?

Richard Baxter: I did not know that. But here's another book, "The E-Myth Revisited," this is another good one. There's lots of books to read.

Howard Faran: Now is he a Townie, Michael E. Gerber?

Richard Baxter: I don't think so no, this is just a small business book, but it's "The E-Myth Revisited." I have lots of other ones over there, but yeah it's important to read business books. Without my books, Dentaltown, and Breakaway I'd be lost in the sauce.

Howard Faran: So you said Open Dental and that's ... what's his name, the dentist that's started it-

Richard Baxter: Johnathan- 

Howard Faran: Nathan Sparks? Is the brother, and Dr. Johnathan Sparks started it.

Richard Baxter: Okay.

Howard Faran: And that is just amazing. And then you said, YAPI.

Richard Baxter: YAPI, Gina Dorfman.

Howard Faran: Yet another practice management information system. 

Richard Baxter: Yeah.

Howard Faran: By Gina Dorfman. 

Richard Baxter: Yup.

Howard Faran: Who guys by, what's her nickname?

Richard Baxter: Mopsy, I think on Dentaltown.

Howard Faran: Mopsy, cause that's the name of her cat. 

Richard Baxter: Okay I didn't know that.

Howard Faran: So tell them why you like Open Dental. Why you went with Open Dental.

Richard Baxter: So I was reading on the forums, and everyone seemed to be switching from Eaglesoft or switching from Dentrix, or PracticeWorks, any of those to Open Dental. I couldn't find a single person that's ever switched from Open Dental back to Dentrix, or back to Patterson Eaglesoft. That kind of sold me on it, and then I tried it out. They have really good customer support, and even if you don't want ... Sorry, Dentrix is like $10,000 I think if you buy a bunch of equipment they'll give it to you for free. But then they charge you for upgrades and it's $150 - $200 a month support. Open Dental is free. There's no charge to install it, and then it's $99 a month for service, and even if you don't want service, you don't even have to pay anything. So I could get it for totally free, I just wouldn't have any updates or support, which you want the support. I have it, but-

Howard Faran: I'll give you another tip on any business. When Sergey Brin and Larry Page started Google they never ever advertised one time for the first decade. Everybody was telling their friends, "Well Google it!" You know, get off all those other ones.

Richard Baxter: Yeah. 

Howard Faran: And Open Dental is the only practice management system that doesn't advertise anywhere. 

Richard Baxter: Word of mouth.

Howard Faran: They can't handle their growth. Last thing they need is spending more money for people trying to get it. We are switching from SoftDent, which we've been on for 30 years to Open Dental.

Richard Baxter: Cool.

Howard Faran: Yeah, Open Dental, it's the bomb. I'm gonna fly up there and see that guy. I've been trying to get him on a podcast, Ryan email him again, cause Jonathan, Nathan are ... The dentist is too shy to come on, but Nathan said he might. I'm trying to get them to do a bridge with QuickBooks online, and I think that-

Richard Baxter: [inaudible 00:39:09] It's such crazy that the accounting software doesn't bridge in with the ... I know.

Howard Faran: Oh my God it's the most insane thing in dentistry that they don't know their cost, and then they sell it with 12 different PPO's. They don't know the cost to make their bottled water, and they sell it for 12 different prices. And oftentimes the prices will vary all the way from 50%, like $100 to $200. I'm like, "Okay well dude, do you think you have 50% overhead?" "No." "Okay well how can you be selling this for $100 and $50, I mean that doesn't ...

Richard Baxter: Yeah.

Howard Faran: Yeah don't get me started on that or I'll have a heart attack.

Richard Baxter: I know. 

Howard Faran: Explain what YAPI is. YAPI.

Richard Baxter: YAPI is really important because that does our iPad forms, our online forms, and then more importantly than that, it's a communication system inside the office. So if I need something, I can just click a button that say, "Needs assistance," and then one of my assistants will run in and bring us something if we drop an instrument. It times, so as soon as a patient checks in, it times all those things. So I can make sure, I try not to leave any hygiene checks waiting more than ten minutes. Once you put the jelly in, that numbing jelly, we'll have a timer they click, and I'll know how long that patient's been waiting with the jelly in. When they're ready for treatment, so it really helps us run more efficiently. Has an instareview feature, so we have I think 300 Facebook reviews, and like 70 Google reviews maybe. A lot of those are because YAPI sends all of our patients an email or a text message saying, "Hey if you had a good time, review us." 

Howard Faran: Okay you said Facebook and Google reviews. I noticed you did not say Yelp reviews. Is that important or not important?

Richard Baxter: I might have like five, I don't think many people use it, but maybe they do. It seems like it's mostly Facebook, people trust their friends, and then Google.

Howard Faran: I'm afraid of Yelp. If they ever send me an email I just delete it. Because if you go to Dentaltown, and search-

Richard Baxter: [crosstalk 00:40:59]I read on Dentaltown-

Howard Faran: Every thread is a nightmare. There's not one good thread about Yelp. 

Richard Baxter: Yup they try to hold you hostage and they'll delete your reviews if you stop paying them or something. I try-

Howard Faran: I just figure I don't want them to know I exist.

Richard Baxter: Yup.

Howard Faran: I don't want ... But on the other hand, I'm classically trained by Warren Buffet and these guys who said they didn't want to go to Wall Street and read all these 10k's and 401's. Warren Buffet said, "If I wanna know about Boston Market, I'll go and have dinner there. I wanna see if people like the food. I want to talk to the manager. I wanna see if it's busy."

Richard Baxter: Yup.

Howard Faran: "Beat the Street" by Peter Lynch, same thing. 

Richard Baxter: Yeah.

Howard Faran: And when I'm on the street, I never in my life have seen anybody use Yelp. I'm 54-

Richard Baxter: I haven't either.

Howard Faran: I've never been at a bar-

Richard Baxter: [crosstalk 00:41:43] I'm sure they're out there.

Howard Faran: Or restaurant. I've never seen it.

Richard Baxter: But all those things they put money towards, Google, Facebook, but still the number one way they heard about us is the sign, just cause of the location.

Howard Faran: Yeah I think Google review's the most for me. I mean, my mom is the most religious Catholic person you'd ever meet, she thinks the Pope is a liberal, and even my mom says when you ask her a question, she says, "Well that's why God made Google." I mean it's completely vernacular. 

Richard Baxter: Yeah, yeah.

Howard Faran: So I would think a Google review. I've never heard anybody say, "Well check Yelp." I've never seen that.

Richard Baxter: Yeah.

Howard Faran: So you mentioned Jawbreaker's office plans, Open Dental, YAPI-

Richard Baxter: Yeah.

Howard Faran: Any other who else-

Richard Baxter: There's too many to list. I mean-

Howard Faran: Keep going.

Richard Baxter: Well everything on Practice Café. They did a good job. They did our logo and our website. They advertise on Dentaltown.

Howard Faran: Yeah Practice Café, now talk about them. Where they out of?

Richard Baxter: They're in Austin, Texas. But they have like a startup special. Basically if you ... And I heard about them from Breakaway, and from Dentaltown, but they do really high quality work. They're on the pricier side, but they do a good job. 

Howard Faran: A good job doing what?

Richard Baxter: With the logo, with your branding, with the website, they did a direct mail piece for us, which our direct mail didn't work that well, but I know direct mail has a 1% return rate, but with our sign, it being on a busy road, it trumped that pretty well. But I like Practice Café, they do a good job. 

Howard Faran: But you know, I still think direct mail at 1% is a gold mine. It depends on what your patient acquisition cost is, and what your new patient value is. You know?

Richard Baxter: Yeah.

Howard Faran: I'm in Phoenix, Arizona when I mail 100 homes, and one home comes in, that's always a cash cow. 

Richard Baxter: Yeah. 

Howard Faran: But so are you saying your direct mail wasn't a return on investment, or just that you had better opportunities with your money for higher returns.

Richard Baxter: Yeah, compared to the sign. I mean we'll try like the local parent newspaper, or parent magazine kinda thing, and that doesn't work. We'll get one or two patients for maybe a couple thousand dollars whereas the sign, the sign cost $15,000 maybe, and we get 120 patients a month from that. It just keeps growing every year, or every month. So the sign-

Howard Faran: And what's the latest thing about Practice Café.

Richard Baxter: I'm not sure exactly, the guy we worked with his name was Josh, but I'm not sure of many people there. But you can call any of them.

Howard Faran: Okay Practice Café, who else? 

Richard Baxter: LumaDent? So Don Ton, yeah he was on Dentaltown. He created a website ... A headlight. I was in dental school actually at the time, and he did a good job on those. It was way cheaper than the Orascoptic or Designs for Vision headlights. So we got a bunch of headlights from him, and they work really well. So all my assistants have one, my hygienists have one. For the price of one of those Pelton crane overhead lights you can outfit your whole office with ten LumaDent lights. 

Howard Faran: So you don't have overhead lights? 

Richard Baxter: None. Yeah. 

Howard Faran: I've never seen that in a office.

Richard Baxter: Never sterilize. I can show you if you want. But anyway it's easy. 

Howard Faran: And I'm retweeting these as you talk about them.

Richard Baxter: Yeah. 

Howard Faran: Yeah, "@practicecafe we now offer flexible direct mail campaigns. Find a campaign that fits your budget. Target specific audience," Which would matter to a pediatric dentist. 

Richard Baxter: Yeah you try to just get into households with kids and stuff like that. Practice Café did a good job. LumaDent they're great. I have loupes and the light from LumaDent. Let's see what else we use. We have the DryShield is great. So it's like IsoLight, but you don't have to throw it away every time. So IsoLight is about $2.50 maybe a piece, whereas the DryShield, each mouthpiece is $25, but you can autoclave it and use it about 50 times, so it's about 50 cents per use, instead of $2.50 per use.

Howard Faran: That is amazing. 

Richard Baxter: But you can do quadrant dentistry. You can do half mouth at a time. You can do full mouth if you need to pretty easily with the DryShield. 

Howard Faran: Is the DryShield a substitute for-

Richard Baxter: It's like IsoLight.

Howard Faran: IsoLight. 

Richard Baxter: Yeah it's like IsoLight, but it's silicone, whereas IsoLight's made out of plastic. And if you accidentally autoclave a plastic one, thinking it's a silicone one, the IsoLight one will shrink in the autoclave.

Howard Faran: What's the website? DryShield?

Richard Baxter: .com I think, something like that. Yeah the DryShield works really well. 

Howard Faran: DryShield Dental, okay I'm on there. And what does a IsoLight cost, and what would a DryShield cost?

Richard Baxter: So IsoLight's around $1,500 maybe for a kit. The DryShield I think is less, but the real thing is the mouthpieces, is the consumables.

Howard Faran: Right.

Richard Baxter: So the IsoLight mouthpieces are $2.50 a piece, whereas the DryShield it's about 50 cents per use, because it's $25 for a mouthpiece, but you can reuse it 50 times. Sometimes 100, it just depends. 

Howard Faran: Well you're a really smart man, because you brought up the same example when it came to the Biolase diode versus the other one, because it was ... With the LightScalpel you didn't have the disposables, and the Biolase you're saying each tip is eight bucks, and you're using six to eight of them again. 

Richard Baxter: Yup.

Howard Faran: And that's the one thing that the United States' government has not figured out. The entire country was built by the lowest builder, but they never factored in the cost that maybe someone who is 30% more expensive, that road would have still been good 10 years-

Richard Baxter: Less maintenance. Yeah.

Howard Faran: So they go with the cheapest damn highway, I mean that was what John Glenn said when he circled the Earth. They asked him, "What were you thinking when you were up there during the first American to orbit the Earth in satellite," and he's thinking, he said, "I think I'm sitting up here in a capsule that was built by the lowest bidder." 

Richard Baxter: That's scary thought. 

Howard Faran: I know. It's just crazy that our government still believes that, because every time they say, "When you save money in the short term, that's the fix cost," but what are the variable costs? What is the total cost?

Richard Baxter: Yeah, yeah.

Howard Faran: Just like a home.

Richard Baxter: Yeah.

Howard Faran: It's amazing with a home, you buy this expensive home, but if you go with tile instead of carpet on the 30 years or 40 years that you might live there, how often does carpet gotta be replaced? 

Richard Baxter: Yeah.

Howard Faran: If you wanna know architectural designing, just go to Europe and look at every 1,000 year old castle. What is it made out of?

Richard Baxter: Yeah. Stone. 

Howard Faran: It's all stone.

Richard Baxter: Yeah.

Howard Faran: There's no wood and dry wall, sheet rock, and carpet and wallpaper and all this crap. I mean these people buy a home on a 30 year mortgage that won't even last 20 years. 

Richard Baxter: Yeah, that's the thing.

Howard Faran: Literally regut everything.

Richard Baxter: Yeah.

Howard Faran: But you see it, and I think Chipotle is the best. Have you ever eaten at Chipotle?

Richard Baxter: They have the best guacamole anywhere for sure. 

Howard Faran: But the design of it.

Richard Baxter: Yeah it's cool, it's just industrial. 

Howard Faran: You can't hurt anything. You can't hurt the floor, the wall, the chair, the table-

Richard Baxter: The chair-

Howard Faran: You could walk in there with a hammer and go crazy, insane and no one would know it.

Richard Baxter: Making me hungry, I gotta go there for lunch

Howard Faran: Yeah, and you lose weight there too, cause the food's so filled with bacteria and what was there big scare? What was the thing they had in their food?

Richard Baxter: I don't know, probably listeria or something. E. Coli. 

Howard Faran: Yeah. Anybody else you want to mention on Dentaltown?

Richard Baxter: I was gonna mention about EmPower too, it was on the sheet there.

Howard Faran: Yeah, yeah that's your website. What's that deal? You and your wife are ... That's unbelievable.

Richard Baxter: It's neat. We go where there's like no dentists at all, like I was just in Northern Ghana, there's 3 million people there, and there's one dentist. And he's a government dentist like we've been talking about, so if he sees five patients, or 50 patients he gets paid the same thing. So he probably sees 10 a day. But one extraction is a month's salary there. So even if they can get to the dentist, they can't afford it. SO what we do is we go in and train pastors to extract teeth. So on a typical dental mission trip, you would go for a week or so and take out teeth as fast as you can, get tennis elbow, maybe take out 200 teeth. And then at the end of the day on the last day there, there's still a line of people that haven't been seen. And then you leave and there's complication later, and people need antibiotics later and then they get mad at you, cause you came in and helped them, but what you ended up doing is hurting the ministry you wanted to help. 

And so, with EmPower we go and we train local people that know the language and know the culture, they know all the rules, and so we leave it up to them to work out the government stuff. Now this is Dentistry Uncensored, so it's a little bit controversial, but I figured you'd appreciate it. But you go in there, and these people are taking out their teeth with pliers, with no anesthetic. So I mean if we can train them how to do it safely, no I'm not teaching them all the dental school stuff, but in a week training they take out the same amount of teeth as the average dental student. They take out about 20, 25 teeth in order to get a certificate. And so, it's pretty cool. We'll go with three or four dentists. We went to Ghana, we trained about 20 pastors to extract teeth. They all trained them in dental hygiene, they train them in vision, how to get people glasses, they teach them sewing. So they're trying to empower these people with skills so they can go on and provide that to their community and then surrounding communities where there's literally no dentists. 

Howard Faran: And I retweeted your @M-Power approach on Twitter.

Richard Baxter: Thank you.

Howard Faran: So what I like the most about mission ... I mean this is a selfish thing to say ... it's @empower_approach. What I like the most about missionary dentistry, is I know so many dentists over the years that are burnt out, fried, caught up in the rat race, thought their house wasn't big enough,

Richard Baxter: Yeah.

Howard Faran: They needed a new car, they weren't making the money they thought they would, and then they go do a trip to Haiti, and they come back and say, "Oh my God." It just totally, every time I do it I take three, four of my boys and it just totally resets your clock-

Richard Baxter: It does.

Howard Faran: From psycho, crazy American, Korean, Japanese, German hyper, spastic crazy man to-

Richard Baxter: Yeah.

Howard Faran: Wow shut up, slow down, smell the roses.

Richard Baxter: Yeah, I mean I think a billion people in the world live on less than a dollar a day. Another-

Howard Faran: And the average ... So the bottom billion live on a dollar a day and the bottom three billion lives on three dollars a day. 

Richard Baxter: Yeah I was gonna say the next billion was two ... It's unbelievable. I mean like think about what your car insurance is, for example, that's more than a dollar a day. It's crazy. 

Howard Faran: Yeah it is. 

Richard Baxter: I'm going to Haiti in the fall, went to Myanmar Burma back in 2013, my wife went with me on that one. So yeah, it's real enjoyable ... I think I have a picture behind me on the wall from that one, so you can see that we trained the pastors-

Howard Faran: Well yeah but if you go to your website mpowerapproach.com, you've got lots of pictures, some really cool videos now did you post ... we have 50 categories on Dentaltown, and one of them is humanitarian.

Richard Baxter: Yeah.

Howard Faran: Have you posted these YouTube videos in the humanitarian section?

Richard Baxter: It's actually not my organization, but I do represent them sometimes.

Howard Faran: But do you post some stuff-

Richard Baxter: I will now. I'll post something. It's hard, cause on the forums it's kinda like the wild west a little bit. People'll say, "Ah that's ridiculous, and you're doing things you shouldn't be doing," but I mean really these people are out there, they have nothing, they have no other hope other than these people. And they do a really good job too. They did a study where they had the American dentists taking out teeth, and then they had these EmPower trained dentists, I think it was in India, taking out teeth, and they had less complications actually than the Americans dentists taking out teeth, cause they went slow and they prayed with all the patients beforehand, and if it gets difficult they'll stop and pray with them. It's really cool.

Howard Faran: Well I have this ... It's so frustrating, even in my backyard, you have in Phoenix a lot of people from Central and South America, and I'm across the street from a Guadalupean reservation, and they'll always go in there and they'll find somebody who has an apartment that's doing $1 extractions and they want to arrest them, and make their life miserable and all that stuff. And I say, "Well Guadalupe doesn't have a dentist."

Richard Baxter: Yeah.

Howard Faran: And there's 5,000 illegal citizens, aliens, living in there, and these dentists at the board who are always Christian, holding a Bible, basically believe that no care is better than some healthcare.

Richard Baxter: Yeah.

Howard Faran: And I just sit there and I think the board should say, "Okay these are the licensed dentists in Arizona, and these are the non-licensed dentists in Arizona."

Richard Baxter: Yeah I know any backed out

Howard Faran: And if you want to go to a dentist in mexico, in Guadalupe, in his house, which could have a dirt floor, and get their extraction, knock yourself out because I believe that some healthcare is better than no healthcare.

Richard Baxter: Yeah and it's hard, cause in America we don't want to play like a two-tier system, I know they-

Howard Faran: Why? The do in cars, when is there not a two-tier system?

Richard Baxter: I know. I know. I'm-

Howard Faran: I mean GM, Chevy, Pontiac, Olds, Buick, Chrysler-

Richard Baxter: Yeah.

Howard Faran: Education, I mean there's you know-

Richard Baxter: Yeah. 

Howard Faran: I mean.

Richard Baxter: So they go to India or other places, they don't even go to Central America too much, cause there's a lot of dentists there, and they have more access there, but they try to pick out really remote places. In Myanmar, they have the second lowest GDP spending on healthcare out of any country other than North Korea. So, they really have no spending at all, almost on health-

Howard Faran: But you said something more profound at the beginning about forget about teaching Ministers to pull teeth, it's the sustainability, well I think the number one issue that people need to focus on when they do missionary dentistry is that everybody lives in a hut that someone has a Samsung. The deal is when you're gonna go into a town, you know having Star Wars show up, and Chewbacca come out-

Richard Baxter: Yeah. 

Howard Faran: R2-D2 and pull 200 teeth and fly away, that ain't right.

Richard Baxter: What's the longterm impact?

Howard Faran: So what you do is when you get to the bush you find who is the dentist in the bush. And you get that guy in there, and you say, "Hey my name is Howard Farran, you can email me at Howard@dentaltown.com, here's my phone number," and then they would text or email and say, "It would be nice if we had some lidocaine." Then you Patterson saying, "Give me all your expired lidocaine I'm out, and whatever the lawyers won't let you sell." Then you ship it back to them, and so you have a sustainability.

Richard Baxter: And often what we'll do is we'll encourage them to charge a little bit, so whereas the Government dentist might charge $30 for an extraction, a month's salary, they'll charge maybe $2 or $3 and that covers their gloves they can find locally, their gauze they can find locally, the needles they can find locally, they typically use disposable syringes. They can buy multi dose vials of lidocaine, and so they actually can get lidocaine from the pharmacy in a lot of those developing countries, like in Ghana or Myanmar. And so they have to be able to source all of those locally, so they can actually, without any intervention from us as Americans anymore, they can sustain their model, and keep going and keep providing that care for people.

Howard Faran: Well here's what I want you to do. First of all, I gotta remind everybody on dental town that you know on Facebook if someone's mean to ya, you just unfriend them. But when you go to Dentaltown ... The reason Dentaltown's better than Facebook is because Facebook you're preaching to the choir. If anybody comes on there and says, "Actually that root canal is not very good and I'll tell you why," well you'll just unfriend them. So on Dentaltown you're forced, and you got what three, four, 500 friends on Facebook, you got a quarter million on Dentaltown, so someone's gonna point out some stuff, but the deal is this, you have to do it in a nice, respectful, friendly, fun way. 

Richard Baxter: Yeah.

Howard Faran: And we have a "report abuse" button that people don't realize. If you're reading a post ... even if you didn't post it or it's not about you, and you just read that and thought, "We'll that's mean." Hit the report abuse, it's instantly emailed to a bunch of volunteers and we play baseball, three strikes and you're out. And then if you post that under the humanitarian on that post, I think a lot of people, they want to do this.

Richard Baxter: Yeah.

Howard Faran: I always meet dentists who say, "That's on my bucket list! Someday I want to go."

Richard Baxter: It could generate a good discussion, if nothing else. And then often the most harsh critics, once they actually go on a trip with EmPower, they say, "Oh my gosh, I had no clue." Like there's some oral surgeons I know, they're like, "This is ridiculous, you can't teach people how to take out teeth in one week safely," and all these things. So we say, "Well come on a trip with us!" And they go and then they become a believer in the system and the model that it really does work, and it really does empower people to do it themselves.

Howard Faran: And I remember one time, I was on a missionary dental trip, and I noticed that everyone, that all these people wanting you to look at a tooth, but everybody was scratching their head, digging, scratching their butt. And so we drove into town and you know, one Benjamin you can buy the best doctor in town. Went to a pharmacist bought ... they said, "Yeah they all scabies and worms."

Richard Baxter: Yeah.

Howard Faran: And so we went to the pharmacy, bought 100% of all their scabies and worms, and then went back to the village and dewormed and descabied everyone, and I went back home as a dentist thinking, "Forget the teeth, man. Could you imagine having worms and scabies?"

Richard Baxter: I know, I know. Yeah so EmPower has a medical module too where they teach stuff like that, or basic hygiene, just washing your hands. And often the dental is good, but vision has actually been the most popular. So the people that can't see anything at all, and they have a special thing that has like 5 different pairs of glasses on them, they can see what their prescription is, more or less, it's not exact, but it's close enough, and they can get them a pair of glasses. And now they realize that there's actually leaves on trees-

Howard Faran: Oh that is so ... Yeah, and then to think that of all these countries that spend 5% of their GDP on military, and there's somebody that just wants dewormed and a pair of glasses. 

Richard Baxter: Yeah. Yeah.

Howard Faran: Yeah. And it's also very interesting, you have so many bleeding heart liberal in the United States that just believe about all this poverty, and poverty, and poverty, and poverty, an poverty and you're like, "Dude have you been to Somalia? Have you been to Ethiopia?"

Richard Baxter: Yeah.

Howard Faran: "Have you been to Haiti? Really?" So you mean that lady over there who's 75 pounds overweight, smoking a cigarette, eating at Taco Bell, that she's below the poverty line? Really? Because, I bet everybody in Haiti would trade places with her in a minute.

Richard Baxter: Yes our poor make us look rich in other places.

Howard Faran: Our are poor smoke a pack a day, have a dime bag of weed, you know are living in a car, a house, have electricity, refrigerator, iPhone, microwave. I mean, I understand that there's inequality in America, there's poor-

Richard Baxter: Sure, sure.

Howard Faran: But my God, there are 7 and a half billion people out there and the bottom one billion would trade places with our bottom, I think they're saying now 13.5% are below the poverty line, it's about 40 million people. Well I gotta a billion people that'll trade places with those 40 million. 

Richard Baxter: I know. Yeah.

Howard Faran: So where should they go? Should they go to that website? 

Richard Baxter: Yeah! mpowerapproach.org dot O-R-G

Howard Faran: And what does the M stand for? 

Richard Baxter: M its just empower without the E. 

Howard Faran: Mpower without the e?

Richard Baxter: Yeah they're empowering, it's-

Howard Faran: Empowering people. Okay I get it. I thought the M ... My old brain went to medical-

Richard Baxter: It's okay try to be sustainable rather than creating dependency, there's a good book called, "When Helping Hurts." You can tell from the title though, you can go with the best of intentions trying to help, like we said trying to take out teeth as fast as you can, and then you leave, and then what lasting impact did you really have? Whereas these people go in, and they're winning mission awards now. It's really innovative what they're doing. 

Howard Faran: Where are they out of?

Richard Baxter: They're out of Louisville, Kentucky. It's real small, it's just three people that kinda run it, but they have a bunch of trips, and they're always looking for more dentists.

Howard Faran: You know what the Nike brand of my childhood was, and I'm 54, in '63 you know what the biggest brand name, Gucci purse thing in the world was when I grew up?

Richard Baxter: No.

Howard Faran: A Louisville slugger baseball bat.

Richard Baxter: There you go. Yup.

Howard Faran: I mean every little kid on my block wanted a baseball bat, that was a Louisville slugger. 

Richard Baxter: Yeah.

Howard Faran: It says on their deal, equipping indigenous pastors and Christians in developing countries to provide sustainable dental and medical care in their communities in the name Christ. So since it mentions Christ that's the difference between charity dentistry, and missionary dentistry? So you would call ... because we have two subs under the humanitarian-

Richard Baxter: [crosstalk 01:02:50] Yeah it's a Christian organization. 

Howard Faran: Say it again?

Richard Baxter: Yeah it's a Christian organization.

Howard Faran: So the technical term is missionary dentistry, right?

Richard Baxter: Yeah I think so rather than just humanitarian. Humanitarian's like for the good of humanity, whereas missionary is for the sake of Jesus, so.

Howard Faran: Well I don't know the ... So how I list on Dentaltown is the forum is called humanitarian dentistry, then we separate it between charitable and missionary dentistry.

Richard Baxter: Yeah. Some people use the terms interchangeably, but-

Howard Faran: Yeah.

Richard Baxter: It's a really cool organization, and they do a lot of good work around the world so happy to be a part of it. 

Howard Faran: Well my oldest sister's a cloistered Carmelite monk nun-

Richard Baxter: Yeah.

Howard Faran: I've been a dentist for 30 years, she's been a nun for 35 years, she tells me ... She's probably the smartest person I know, and she can read all the other major religions in their own language.

Richard Baxter: Wow.

Howard Faran: Like the Bible wasn't-

Richard Baxter: Yeah.

Howard Faran: Written in English or German, hell it was written-

Richard Baxter: In Hebrew or Greek.

Howard Faran: Yeah, Hebrew or Greek. Well she's fluent in Hebrew and Greek and she's read all the major religions, and she says there's not a person, place, city, thing, there's nothing in common that's show up in all the major religions, except for one line, which she says is so exact you'd call it plagiarism, and it says, "Treat other people like you would want to be treated."

Richard Baxter: The golden rule. Yeah.

Howard Faran: The golden rule. She said that's the only line in every major religion, no matter what you're studying, Hinduism, Buddhism, Judaism, Islam. And she says that that is her proof that we're all praying to the same God, and that all God really is, even if you're not religious, is it just means there's something out there bigger than you. And I don't know if you can call it Jesus, Ali, Yahweh, Abraham, or the big bang or whatever, you just gotta stay humble, my friend, because you know what you know, but you don't know what you don't know. And nothing is better therapy on a burned out dentist than getting out of the rat race of Korea, Japan, Germany, United States, Toronto, and going back to our roots of people and helping them.

Richard Baxter: Yeah.

Howard Faran: And in fact I do it for selfish reasons, I do it for me. How selfish is that? How selfish is it-

Richard Baxter: No, that's the way it's designed. It's designed you know when you help other people, God designed it so you feel better.

Howard Faran: Now I gotta tell you my funniest story from a missionary dental trip. Took all four of my boys down to Mexico. I think the boys were, they were probably like two, three, four, and five, and after about five hours, my oldest boy Eric who must have been five or six at the time says," Dad? How come they don't have trampolines?" I thought, "Well they also don't have running water, electricity, sewage." But it's so funny, the mind of a five year old, it never dawned on Eric that there are kids on Earth who don't have a trampoline in their backyard. 

Richard Baxter: Yeah it-

Howard Faran: And Greg and Zack and Eric were counting the minutes until they could get back home and jump on their trampoline, and they were profoundly sad that these kids didn't have a trampoline.

Richard Baxter: I know, my girls, they're twins, they'll be three next week, and my daughter Hannah says ... we'll be talking about the kids in Africa that don't have any food or don't have any toys like this, and she just this morning said, "I want to send my Legos to the kids in Africa." And Noels said, "I want to send our train set to the kids in Africa that don't have any trains sets." So we're tryna teach them early that there's lots of kids out there that are not blessed to have toys that they do. To have food that's nutritious and tastes good, so I think there's several famines going right now in East Africa, West Africa-

Howard Faran: Oh yeah. Lot's of famines.

Richard Baxter: So no clue how much we're blessed, and we take it for granted with these first world problems. 

Howard Faran: And then as soon as a famine breaks out, right behind it's gonna be the disease and the Cholera, and it's just absolutely ... it's crimes against humanity, and it's just so sad. But I would just say this, there's two million dentists on Earth, and half of them practice like us in the 20 richest countries like the United States, Germany, Japan and all that stuff. And you just gotta ... I think the best thing for your ... Especially raising kinds in America, you gotta get them out of this country, and you can do a lot of tourism. Like when you go to Tanzania and Ethiopia-

Richard Baxter: [crosstalk 01:07:12] It's a great education.

Howard Faran: You can take them to ... What's the big park in-

Richard Baxter: In Ethiopia?

Howard Faran: What's the Lion King ... The Serengeti.

Richard Baxter: In Kenya.

Howard Faran: I mean you can go see the Serengeti and I mean it's so gosh darn beautiful-

Richard Baxter: Yeah.

Howard Faran: But while you're looking at the Serengeti you see the natives living in huts.

Richard Baxter: Yeah, that's a better education than you can give them in a classroom. 

Howard Faran: And another thing I notice is that when I'd walk up to the huts and my friends would always say, "Don't do that, don't do that! They'll freak out." I said people are nice. So I would just walk out there and do like a namaste thing, and try to give them a gift or something, and next thing you know they bring you into their hut, and you'd be sitting down where they were burning-

Richard Baxter: [crosstalk 01:07:52] Yeah that happened in Myanmar.

Howard Faran: Where they're burning poop inside their hut because there's no firewood. They burn the poop, because when smoke's coming out of hut, the mosquitoes aren't coming in, because Malaria kills one million people a year in Africa.

Richard Baxter: Oh yeah. Yeah, I think it's like 26,000 children die every day from starvation or preventable disease like diarrhea, I mean it's shocking.

Howard Faran: And when you're sitting in a hut with no running water, electricity, or sewage, and they're burning collected animal poop-

Richard Baxter: Yeah.

Howard Faran: To keep the mosquitoes out, and then while you're sitting there thinking, "Well should I remodel my home? Should I redo that? You know my cars gotta 100,000 miles."

Richard Baxter: [crosstalk 01:08:32] I know, and there's nothing wrong with my cabinets, I just don't like the way they look. 

Howard Faran: Oh my God I love it. Well hey I love-

Richard Baxter: [crosstalk 01:08:40] We try to live mission to mission.

Howard Faran: I love you, I love everything you do, I'm a big fan of you on Dentaltown. I do, I loved your CE course, I just think you're ... You should be the All-American poster boy of dentistry, I mean really, you really are.

Richard Baxter: Thank you, Howard. We just try live missionally, we give back a lot, we don't [inaudible 01:09:01] live in bigger, fancier cars, houses. We really try to ... We've done a bunch of wells with Never Thirst, a local organization, they do wells in Cambodia and India. We really try to give back to M-Power, other organizations, so we try to do the right thing, and not just spend more on us.

Howard Faran: Yeah I just lectured in Cambodia a few months ago, and it was like a six hour drive to their biggest temple. And leaving the capital, and driving six hours to that temple, and driving through that country side it's like, "Wow. Wow."

Richard Baxter: Yeah.

Howard Faran: I mean you just couldn't one mile without seeing something and thinking, "Wow." And then one last thing to take away for these kids, cause we got 6,000 kids graduating next week, is ... I my car is 2004. And it's 2,000 something ... I could upgrade my car brand new, and I look at these kids coming out of dental school, and they'll buy their first house, and I'll say, "Why is your house bigger than your parents who worked for 40 years?"

Richard Baxter: Yeah.

Howard Faran: "Why are you driving a brand new Honda Accord, and your mom is driving a 10 year old car? And then let's go look at your grandparents. Their house is half the size of your parent, and their car is 32 years old. Why is your grandma driving a Dodge Dart in a 1,000 square foot house. Your parents in an 18 ... and your first house was 3,500 square feet, and you eat out 19 in 30 meals," and what they don't realize is that is the source of their stress. A minimalist lifestyle it just plummets.

Richard Baxter: [crosstalk 01:10:34] Yup there's a good Netflix documentary on minimalism. And I can't remember what it's called right now, but it's ... My father-in-law always says, "It's not what you make, it's how you spend it."

Howard Faran: Yeah and the one pair of research that no one would believe that wrote that book, "American the Millionaire Next Door" written by two Ph D's who only looked at data. And the number one occupation for millionaires was teachers, and it's because physicians, dentists, and lawyers think they need to live in a mansion, and eat out, and fancy vacations, and teachers just accept, "Well we're poor." And what do they do? They save three or four or five percent every month, so when they were 65 they had the highest percentage of millionaires-

Richard Baxter: Interesting. 

Howard Faran: So you're not a doctor. You've got a half a million dollars in student loans, you're not all that and a bag of chips. Go move back in with your parents, minimalism, and I just wanna tell you thank you so much for all that you do for dentistry and Dentaltown, and Haiti and Ghana and your missions, and thank you so much.

Richard Baxter: Well right back at you, Howard. Like I said, I couldn't of done the office that we do, and we couldn't do the mission trips and support the people that we do without Dentaltown for sure. So I very much thank you. 

Howard Faran: Awe thanks buddy, you're too kind. Talk to you later!

Richard Baxter: See you buddy, bye bye. 


Category: dental, Podcast
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