Dentistry Uncensored with Howard Farran
Dentistry Uncensored with Howard Farran
How to perform dentistry faster, easier, higher in quality and lower in cost.
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892 Creating Beautiful Smiles with Stuart Frost : Dentistry Uncensored with Howard Farran

892 Creating Beautiful Smiles with Stuart Frost : Dentistry Uncensored with Howard Farran

12/2/2017 1:11:17 PM   |   Comments: 0   |   Views: 382

892 Creating Beautiful Smiles with Stuart Frost : Dentistry Uncensored with Howard Farran

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892 Creating Beautiful Smiles with Stuart Frost : Dentistry Uncensored with Howard Farran

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VIDEO - DUwHF #892 - Stuart Frost



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AUDIO - DUwHF #892 - Stuart Frost



Dr. Stuart Frost is an orthodontist and comes from a family of dentists.  His father was a dentist and pioneer in implant dentistry for 40 years and his twin brother Steve is an endodontist /and has been on my podcast within the last year. He graduated with honors from UOP in 1992 and practiced general dentistry for 5 years with his father before going back to do a year fellowship in TMJD followed by his orthodontic residency from University of Rochester in 2000. He has been practicing orthodontics in mesa Arizona. He is currently on faculty as an Associate Clinical Professor at UOP orthodontic department for the past decade.  He is a KOL for Ormco, Propel Orthodontics, Spectrum lasers and iCAT. He has lectured extensively around the world for the past 11 years on Damon braces and mechanics helping practitioners work smarter not harder. He has created an “Airway Aware orthodontic practice and considers himself to be an artist orthodontist and has a private practice in Mesa Arizona. 


Howard: It is just a huge honor today to be podcast interviewing Stuart Frost, an orthodontist up the street from me right here. I'm in Phoenix, Arizona. He's in Mesa. He's an orthodontist and comes from a family of dentists. His father was a dentist and pioneer in implant dentistry for 40 years and his twin brother Steve, who we had on the show, is an endodontist, and has been on my podcast. I think it was like a year ago. He graduated with honors from the University of Pacific in 1992 and practiced general dentistry for five years with his father before going back to do a year fellowship in TMJD, followed by his orthodontic residency from the University of Rochester in 2000. He's been practicing orthodontics in Mesa, Arizona. He's currently on faculty as an associate clinical professor at UOP Orthodontic Department for the last decade. He is a key opinion leader for Ormco, Propel Orthodontics, Spectrum Lasers and iCAD. He has lectured extensively around the world for the past 11 years on Damon Braces and mechanics helping practitioners work smarter, not harder. He has created an Airway Aware orthodontic practice and considers himself to be an orthodontist in a private practice in Mesa, Arizona. And I can assure you he is a legend in my backyard and on OrthoTown and every orthodontist that has been on this podcast. Thanks so much for coming over.

Stuart: Pleasure to be here. Thank you.

Howard: My gosh. When I knew you were coming over I almost got verklempt thinking about when your brother was on the show telling me about the life you saved. Was it San Diego beach?

Stuart: We were in Newport Beach.

Howard: Newport Beach, so halfway between San Diego and LA?

Stuart: Yeah.

Howard: Mostly LA.

Stuart: Yeah, right between.

Howard: Right between? Tell them that story, that was crazy.

Stuart: Oh, you know what? Our family's been going to Newport Beach for the past 30, 40 years. And my twin brother and I have taken our families there and enjoyed the beach and carried that tradition on. About three, four years ago I was at the beach with my stepchildren and we were digging a big hole. And we got down about three and a half feet and the lifeguard came over and said, "Hey, you've got to fill that in. We had somebody pass away last month from a collapse." So I filled it in and thought nothing of it. Well, fast forward to last year in July we were at the beach with our family. We must have had 30, 40 people there of our family members. Steve and I were playing a game of spike ball and our nephew shows up and he said, "Hey, this lady over there, she's lost her two-year-old." And I'm looking around trying to find this lady and she's standing on the beach with her hands on her head, despondent. And we all look at each other like, "Wow." We know what that's like to lose a child or to think for a minute you've lost your child. So we went over to help and I said to my nephew, "Hey, let's get our family and go over there."

Now this lady had passed probably 75 people to get to the lifeguard station and ask for help and the lifeguard just raised his hands up like, "Well, we've had eight other people that have lost children already today." And this was around noon. So we got our family over and went and helped this this poor lady. And we get over and we ask her, "What did your son look like? What was his name? What was he wearing?" And she said his name and that he was wearing a blue swimsuit. And then we said, "Well, what was he doing?" And she said, "Well he was digging in this hole right here." You know, you've been at the beach where people have filled in a hole, and the sand was ruffled and there were two holes, and so immediately in my mind I was triggered, what happened three or four years earlier, by this incident where the lifeguard said, "Fill that hole in." So my nephew, I said, "Dig in that one, I'll dig in this one." And I started digging and I didn't find anything and I went over and here's my nephew and he's digging, taking big chunks of sand away, and he exposes that blue swimsuit. And I think I can safely say all hell broke loose. We pulled him out of the sand and then you can imagine the mom's horror and the dad came over and we laid him on a towel and he was ash gray. I've never been put in that situation where, what do you do? What do you do first? We've been all these years -- 30 years, 25 years of dentistry and every other couple of years we're getting CPR re-certified and it just came natural.

My brother Steve came up, he went and was at the feet. I was at the head holding his head. I tried to clear the airway and turn him a little bit. And Steve said, "We've got to start CPR." And so Steve began to give compressions. And with the new CPR protocols we pretty much just chest compressions, no airway. So I just watched. And as Steve gave the compressions I watched this little boy's face, and it's a tender moment and everything got quiet. I watched, and Steve, I don't know how long he was giving chest compressions, but this little boy's lip moved. And I told Steve, "Hey you're doing great, keep going. This is working." And then Steve kept giving compressions and then he flinched: this little boy, his face flinched. And I said, "Steve you got him, keep going." And then all of a sudden, he took a little breath of air. And then the lifeguards came over and they cleaned his mouth out and gave him some Ambu bags and he came up screaming. Truly a spectacular moment. Truly amazing. Thank you. Crazy.

Howard: Makes me verklempt. Damn. That would just be amazing. Wow, that is a hell of a story. My gosh. So, there's so many things we could talk about. Do you think being a general dentist for five years gives you a different perspective of being an orthodontist?

Stuart: So many times, when you want to specialize -- and you know this because you were in dental school and we went through that -- so many times we think that we have to get into dental school, get the best grades we can, be at the top of our class so we can specialize. And we get so short sighted or narrow focused because we think that that's the path we have to go. And for me, I wasn't in the top five of my class. You know, 29 out of 138 is good, but not good enough to get you into school. So, just by the natural path, I went to work with my father, knowing that I wanted to go back. I didn't realize the depth of education that I would receive by practicing for five years: working with patients; looking at veneers and tooth structure; looking at the shapes of the teeth; designing cases in my general dentistry; seeing what the other orthodontists in town were sending me with their cases. But seeing the good and the bad, it was a huge education for me. And so, when I went back to school, all of a sudden I brought with me all of this education, experience, patient experience, how to talk to patients. I think it's invaluable in my success today having those five years as a general dentist.

Howard: I said for 25 years -- I've been out of school 30 years -- I said for 25 years that orthodontics was just like a Boeing. I mean, every year they come out with a 727 to 37, to 47 and 57. It's always newer and improved but it still just flies 550 miles an hour. And we fly around the world all the time, so do you. It's five hours from here to New York. It's 15 hours from New York to India, New Delhi. And I always said, "Who cares about a new and improved plane? Why don't you go faster?" And I said, "Orthodontics is the same. They just come out with all these new brackets, they always come out with all this new stuff. But at the end of the day, it's still two years." When is Boeing going to go 1500 miles an hour? And when is two year ortho going to go down to a year? And it looks like we're starting to have some breakouts where all these dentists out there say, "We know braces is two years." You really can't see that anymore.

Stuart: Treatment times have been steadily coming down for the past 17 to -- well, for me, almost 18 years. Treatment times --

Howard: Yeah, but you're ahead of the time. I'm talking about the average orthodontist.

Stuart: You know what's interesting? Thanks, but you know what's interesting is that orthodontists are funny: they have this idea that they already know how to straighten teeth. They've had bracket technology now for 100 years. They know how to put a bracket on a tooth, how to put a wire to it. They're not that excited about embracing change.

Howard: All humans.

Stuart: It's crazy to me to think about: here we are in dentistry, and you think back to where you were 30 years ago and the idea of using a laser or when the first DentCam came out --

Howard: Digital camera? Fujicam.

Stuart: Yeah Fujicam. My dad bought it, it was $45,000 in 1992.

Howard: I bought it that same time from Patterson. And it was the size of a refrigerator. Did he regret buying it?

Stuart: Never.

Howard: I know.

Stuart: Never. Because it made a difference in his patient's lives.

Howard: And everybody that waited five years until it came down to ten grand missed about a million dollars worth of dentistry.

Stuart: Completely. So here we are in our profession and there's so many new technologies that are benefiting people's lives and bringing the treatment times down. So one is the Damon bracket. We have a bracket system that uses less forces --

Howard: Now Damon: isn't there a scary movie that had a Damon?

Stuart: You mean demon?

Howard: No I thought there was a scary movie with Damon. I just got done seeing "It" the other day. Did you go see "It"?

Stuart: Haven't seen it yet.

Howard: That was a riot. But anyway, so the Damon brace. Tell us about the Damon brace. Is there an orthodontist named Damon?

Stuart: Yeah, Doctor Damon from Spokane, Washington.

Howard: Well you tell him that he's got to get his butt on this show.

Stuart: He needs to. Because you'll be very impressed with who this person is. He comes from a family of orthodontists. I think he has six brothers that are orthodontists.

Howard: Okay, so he has to be Catholic or Mormon.

Stuart: He must be Catholic then.

Howard: So his name is David?

Stuart: His name is Dwight Damon.

Howard: Dwight Damon, Spokane, Washington, and he's got six siblings.

Stuart: Six brothers -- five or six brothers that were all orthodontists.

Howard: Oh my god. Okay, I know. I know who is now. So you think it's a genetic component or a cultural?

Stuart: I think it's genetic.

Howard: So how old would Dwight be?

Stuart: Dwight is 75 years old now.

Howard: Is he still practicing?

Stuart: He is not, but he's still inventing.

Howard: Is he involved with Damon?

Stuart: He is. He is still involved. In fact, we're on, I think the sixth-generation bracket. He's about to break out the newest bracket.

Howard: Does he ever come down here to teach or does he ever come down here often?

Stuart: You know what? He does. From time to time he's come into my in-office course.

Howard: He's come to what?

Stuart: I have an in-office course I teach with orthodontists from around the world and --

Howard: But you only teach Orthodontists

Stuart: That's right.

Howard: I tried to get in and you said, "Kill yourself." So tell us about Dwight Damon's journey. He was an orthodontist; he had six siblings that are orthodontists?

Stuart: Yeah. He had at one time the largest practice in the nation in Spokane, Washington, if you can imagine.

Howard: Wow. Which is the west side of Washington, over the Cascades. You have Seattle on the east with the evil Seahawks, and then you got the Cascades and then you got the good side, Spokane.

Stuart: That's right. So Dr. Damon has a large practice. He's realizing the limitations with the technology that he has 30 years ago. He's extracting way too many teeth and seeing the negative impact on profiles and periodontium and he has this feeling there's got to be a better way. So, as many innovators, he starts thinking about and pondering how to make a difference and make it better. He comes up with this idea that he would cut up really small, little tubing like 0200 by 0282, being a little round; cut up little pieces like brackets and glue them on the tooth. And we're talking closed tubes that you could sling a wire through. And he convinces one of his best friends to let him put these tubes on each of his teeth and see what happens with a very light nickel titanium wire and these tubes. And he put these on, he threaded the wire through the back and all the way around the arch and all of a sudden he said -- in a four week’s time period he said he couldn't believe how the teeth moved and how quickly they moved, and he was astonished at what creating a tube did to tooth movement.

So his thought process was, "Well if I can create a tube, maybe I could create a bracket that has a door on it instead of tying the wire into the bracket and creating all that binding and friction or putting little colored rubber bands on there. If you could shut a door over the slot where the wire is, now you've got a tube." And reducing the friction in the binding allowed these teeth to move more efficiently with less pressure, less force, and the teeth move faster.

Howard: So it just seems intuitive that the harder the force, the faster the tooth would move. But you're saying the lighter the force?

Stuart: Think about this: if you took and put a force on a tooth, and you think about the microscopic level of the capillaries and the blood vessels. If you put a heavy force on a tooth it shuts down the blood flow, and necrosis of the bone and teeth actually start moving, and then you put a heavy force on it, it stops them. Completely stops the tooth movement. So it goes through this start stop, start stop with the amount of pressures you put on the teeth. That's not very efficient.

Howard: On his website. That's where I can see his Twitter.

Stuart: Account suspended?

Howard: So he is 75, he might not be aware of his social media. What I like to do is re-tweet my guests. Because they're driving right now, they're driving to work right now. But so he did something on Twitter -- We do the same thing on Dental Town: when you register on Dental Town it's a private property account. We ding your e-mail each month. And we ding your e-mail and you're not there, you can't get onto your account. We've got to know who you are. On Dental Town and Ortho Town you can say I'm a smiley tooth. Because if we do that, it's very controversial, because they say, "Well when someone criticizes me on Facebook I know who it is." We say, "Yeah, but if you don't like what he says, you delete his account." And Dental Town -- what's best for Dental Town doesn't matter what's best for dentistry is there has to be a place to ask a stupid question. And everyone knows who lectures: "Now are there any questions? No, okay, go to break." And then then people come up and say, "Well if you asked that in front of the class, everybody would learn from it." But they're embarrassed. There's got to be a place. So the website is And how long has been out?

Stuart: I think since early 2000s. Dr. Damon -- when I was made aware of the bracket and the system, was 1997. So I think 2000, 2002 they started putting the website up.

Howard: So it's a private company out of Spokane?

Stuart: Actually, he sold the rights to the bracket to Ormco. Ormco is the sister company of Kavo Kerr and the parent company is Danaher.

Howard: Which is the largest dental conglomerate in the world.

Stuart: Correct.

Howard: Do you know what percent of Danaher is actually dental?

Stuart: If I'm not mistaken it's about a third. But I could be wrong on that.

Howard: So the largest dental company in the world is Dentsply Sirona. All dental. But Danaher's dental portfolio: do you think Danaher's dental portfolio is bigger than Dentsply Sirona?

Stuart: I do. Because it incorporates so many different areas. It's huge.

Howard: Yeah. Amazing: Kavo, Ormco. So how long ago did he sell to Ormco?

Stuart: So he had the royalties for the bracket up till about 2010. Then he sold those royalties to Ormco for a sum. But then has been hired on as a consultant and helping with new technology and that's why his new bracket that's come out is even better. But yet Ormco is the one that's going to be selling it.

Howard: So this is dentistry uncensored, so I don't want to talk about anything anybody agrees on. Obviously the four-hundred-pound gorilla in the room is that endodontists go to dental school and they teach you how to do root canals, because they know you're not going to do some molars and retreats. Oral surgeons go to dental school and teach you all the extractions, because they know you're not going to do all your impactions. Pediatric dentists teach you crumpsall crowns, because they know you don't want a screaming two-year-old child, which is tough for me because I'm across the street from Guadalupe. It's one thing to have a screaming two-year-old, but when it's screaming a different, language -- it's talking to its mom and I don't know what's going on. But orthodontists really -- it's a separate club. I mean, these kids come out of dental school and whatever they had to learn in ortho, it's always some theoretical cranial facial development and everything. But they didn't do an Invisalign case, they didn't do a simple space maintainer. Agree or disagree?

Stuart: Yeah. It's interesting. When I came out --

Howard: And I don't want to get you in trouble with Ormco.

Stuart: No, no. It's all good. When I came out, I decided that I wasn't going to do ortho in my general dentistry days because I didn't feel like I had all the tools and the skills necessary. And I decided to wait and do it by getting my specialty. I think there's a place for general dentists to do some ortho and to do some cases. And I want to be the one that can help facilitate those cases that they want to do, or the Invisalign cases. So I'm for it. I think that the more we support, the better off that we are as a specialty, because the general dentists that don't want to do all the cases, send them to me.

Howard: The best hygienist I've ever had in my entire life, or dental assistants first. And the prima donna you get straight out of hygiene school where you say, "Well you just got a cancellation. We got in a walk-in emergency." Once you put them in your intake, take a pee and a bite wing and get it all worked up for -- it might be an extraction or whatever. "No, I'm a hygienist." I mean it's like, “Whoa.”

And I think that one of the greatest implantologists the world ever had, Carl Misch, started off as a prosthodontist making dentures. And then he was seeing all these people snapping, overdenture the implants to the gum line and blaming it on the cheap implant. He's like, "Dude, your denture wasn't even in the ballpark. If you would have had a correct denture and then augmented it with implants."

So that cross training: what I've seen the pattern now for 30 years is that every dentist that learns ortho and starts doing some ortho cases, almost 80 percent of them stopped doing it within five years -- of a career that's going to go from 25 to 65. So in a 40-year career they only do it for about five years. But gosh do they become better diagnosticians. See you cross-train the whole picture. I see kids that love extractions but don't think they can do implants. It's like, pretty sure an implant's just an extraction in reverse. And I'm pretty sure those wisdom teeth you pulled is going to be harder than any implant you place in a bicuspid molar region. So I'm all for the cross-training, just for the knowledge, the diagnostic skills.

Stuart: I totally agree with you. When you start -- if you did an ortho case and you see what traps you can get into, what mistakes you can make, it teaches you quite a bit. And not only that, just occlusion. I mean, we profess that we get this great education in our dental school about occlusion, when I think we don't really understand occlusion until we're ten years into our private practice and we really finally start to get that. And so I agree with you: cross training and understanding ortho only benefits you as a general dentist.

Howard: And the cases that you get in trouble, well you need to know that because that child, don't you think should have been early interception more?

Stuart: I think so.

Howard: When they were younger.

Stuart: I think there's a place to be intercepted on these cases and if you've done some ortho, you know when those are.

Howard: And the other difference between not understanding ortho is saying, "You know you might -- here's a referral slip, you might want to go see Stu and have it looked at." That's a very different conversation as, "You know what? We have a serious issue here. If you don't get this fixed right now -- if you don't get some early interception" -- I mean, there's one thing when you know and I can passionately convince moms like, "Wow, I'm going to go today." Versus, "You know, there might be some orthodontic issues. I think maybe you should go get evaluated by an orthodontist. Here's Stuart Frost up the street." I mean, that's a totally different conversation.

Stuart: You know what? I love it when I get a referral from a general dentist telling the patient they need to be seen and this is why, because the patient comes prepped ready to go. They're already committed because their general dentist has told them: this is what's happening and I need you to go see the specialist. I love it when that happens.

Howard: And we reverse that door too with our specialists. Because if I'm going to send this guy to Greg Evans up the street to pull wisdom teeth, I'm going to e-mail the treatment plan, because I want the orthodontist, the endodontist, the pediatric -- I want my oral surgeon to say, "By the way, we're getting these four wisdom teeth done today. But are you aware you still have eight cavities." And I've been the oral surgeon out here since 1995, and each one of those little cavities can turn into a $2000 root canal bill, open crown. And then if you don't have that $2000 because you don't have insurance, or you say you maxed out your insurance, well then it will be a toothache and you'll be right back in this office getting another tooth pulled. So don't stop at four wisdom -- and when you have another doctor confirming your diagnosis and treatment plan -- And then sometimes the diagnostic and treatment plan, especially with periodontists, they'll disagree with the treatment plan. And they'll say, "Have you thought of this? Have you thought of that?" So now you got two doctors looking at some x-rays and a patient and co-diagnosing between the hygienist, your specialist, your general dentist. I mean, you can raise your practice 20 percent; easily raise your practice 20 percent just by sending the treatment plan and the x-rays -- especially now that they're digital -- to all your referrals.

And then what's also cool: say I refer someone to the periodontist, or the oral surgeon or the endodontist, whatever, and now that they have the records, say that person doesn't call them in the next week. Well now they got a hot lead. I mean, there seven point four billion people on earth. And now that periodontist's office, now that's in their tickler file. And they can call and say, "Stu, Doctor Farran called me a week ago and said that you had gum disease and you need to come down here. Did you lose the number?" And in small business, that's the highest paid position -- that's called outbound sales. All the people that -- their leads -- they pay top dollar for leads and the guy on the phone with a suit and tie is making six figures and then the guy back there in the factory is making $25, $30 an hour. And in dentistry it's reversed: the guy back in the factory fixing the teeth, he makes the six figures and then the girl doing outbound sales, her career is named after a piece of furniture: the front desk. And she's making $15 an hour and had no training.

Stuart: That's right.

Howard: It's just completely upside down. So, you're passionate about Damon.

Stuart: I am. And I got to tell you, one of the main reasons I am is I was watching all the cases that were coming in for those five years as a general dentist, and I saw a lot of root resorption from the orthodontist. The patients that were coming in. This is 1992, ‘93.

Howard: I wasn't even born.

Stuart: I was seeing root resorption, some stripping of tissues, unfavorable bone afterwards, occlusions. And I witnessed what was happening in our profession. And then when I saw Dr. Damon present his cases and watched, that I didn't see as much root resorption in his cases. I didn't see the gingival stripping like I had witnessed. I didn't see the extractions like I was witnessing as a general dentist. That was attractive to me. And then bringing treatment times down: less treatment times, less pain for the patients with greater outcomes or more beautiful results. That was attractive to me and that's what attracted me to the Damon system.

Howard: So you started off at the beginning saying that treatment times have been coming down for, you said 18 years. I've really only noticed it the last five, but I've always said you were ahead of your time. What do you think -- give us months: like 17 years ago, what was the median, mean, mode, average month treatment plan? Where is it in 2017?

Stuart: I think the AAO has done some articles on this and really looked at what that average time is for a child doing orthodontics, and they said between 24 and 30 months was the average time a child would be in orthodontics.

Howard: Right now?

Stuart: That was before.

Howard: Okay, that was what year?

Stuart: That was say '92, '94.

Howard: 24 to 30 months in 1990. And where would you put it at 2017, which would be a quarter century later?

Stuart: Six months less: 18 to 24 months.

Howard: 18 to 24. And that's for a child, that's for children.

Stuart: That's for children and adults.

Howard: Oh, that's teenager and adults.

Stuart: Yeah, I think the misconception is that adult teeth don't move like kid’s teeth, but they do. I think if we use the right forces, we have adult teeth move like kid’s teeth. Still bone biology.

Howard: Yeah, I was absolutely blown away. I remember when I opened up in '87, this patient came in named Sue. And new patient exam, I was telling her -- she said her biggest regret in life is when she was a child that she didn't have braces. And now she'd moved here because she'd retired. Her husband worked for Mobil oil, and just a big old regret. And I said, "Well why don't you see -- you're 65," now this was 30 years ago. I said, "Well why don't you go see --" Oh my god he banded her up completely and she was ecstatic. And of course she always laughed like this and it was a big deal to her. She's still alive today. I've seen her this year.

Stuart: That's really cool.

Howard: So a lot of these paradigms are just not true. Another paradigm that I learned the hard way is if you had a baby tooth with no permanent tooth underneath it, well that ain't going to work because we've got to pull that baby tooth and do a bridge or an implant or whatever. Everybody that didn't accept my treatment plan, them were the smart ones and that baby tooth is still there. True or false?

Stuart: I think it's true. I try to retain those baby teeth as long as possible, because patients in their 40s, late 40s, still have them. As long as they have good roots to them and there's no cavities then they're going to stay there a long time. I try to keep them.

Howard: It's the eruption cyst developing underneath it that mechanisms the resorption. It just doesn't run out of time. So you said the forbidden word: occlusion. There's no two ways about it. If I sat down ten pediatric dentists there's almost nothing they would disagree on. Maybe sodium, what is that? Diamine fluoride. 100 endodontists, your brother, they wouldn't even get into an argument, there wouldn't even be a heated discussion. Boy, you sit down ten guys from occlusion, it's like ten different world religions.

Stuart: It's so true.

Howard: Why is that?

Stuart: I think that we're all passionate about thinking that we pay attention to occlusion, we pay attention to roots, we pay attention to everything. But there's so many different thought processes in what's important, what's not. Group function, canine rise, does it make a difference? CR, CO slides. What are we really trying to do here?

Howard: Neuromuscular.

Stuart: Yeah, neuromuscular. Think about that today. Here we have all these patients that are stressed out and their masseters are on fire, the temporalizes are triggered and on fire and so we throw all kinds of issues --

Howard: You know how I treat those?

Stuart: I know how I treat them.

Howard: You know how I treat them?

Stuart: How do you treat them?

Howard: I give them a referral for a divorce attorney and tell them to give their kids up for foster care. And all the stress is gone.

Stuart: As somebody who has gone through a divorce I understand that.

Howard: Same here.

Stuart: Yeah absolutely.

Howard: So if it was math, we'd all come to say two plus two equals four. So why is the occlusion -- why are so many really smart people who are getting great results with their patients not agreeing on so much?

Stuart: I think every person is so different. Their muscles are different, the temporalis, as all the different structures and that stress that they're having, it plays out in different ways and different people. I've been around: I've watched the Pankey  guys, I've seen the others. When I was in my TMJ residency, I had a -- I call him a [00:30:21] Genathologist [0.3] --

Howard: A genath? I've never heard that.

Stuart: Absolutely. He called himself that.

Howard: A Genath-nologist?

Stuart: Because his idea was -- he was a dentist, he went to prosthodontic school and then he taught in the ortho department at Eastman Dental Center. His name is Ross Tallents. He did TMJ. And his idea is CR, CO whatever. Because who can really find it? Who does a point on the chin and finds it or by manual manipulation and finds it? And his thought process was that we could argue until we're blue in the face.

Howard: You just gave me a flashback. When I tell you this story you won't believe it. I was lecturing one time and I met a dentist who got an ink dot tattoo on the three places. I mean, he was one of the most intense people I ever met.

Stuart: Yeah. So everybody is passionate about it and I love it because we really are trying to do what's best for the patient. But there's different ways to get there. So I don't think there's really a corner in the market. I just try to get as good a functional occlusion as I can with canine rise and anterior guidance and do the best --

Howard: But canine rise: some people are going to shout out there -- some of the older boomers are going to say, "What are you talking about? I send every one of my patients to you and they're in canine guidance, and you send every one of them back in group function."

Stuart: Yeah. Well our goals as orthodontists, and I would say that the majority would be aligned, is we try for canine rise. That's our goal.

Howard: But go back to 1990, when 324 to 30 -- what percent came in canine guidance and left group function?

Stuart: Yeah.

Howard: What percent would you say?

Stuart: That's a good question.

Howard: Versus today.

Stuart: I would say that there probably is less today because we have more information. And orthodontists are really trying to take their cases to another level. So the orthodontists that really care, and are working and motivating their patients to wear the elastics and get to that canine rise, I think the majority are going to get there. So I would say it's better now than it ever has been. But we still struggle.

Howard: This is dentistry uncensored so there's no softball questions here. This one is going to hurt, I'm going to throw you under a bus.

Stuart: Okay good.

Howard: We've had some oral radiologists on here that say orthodontists should not be using CBCT. It's too much information and the CBCT, the oral radiologist says, "Show me a case where the CBCT changed your treatment plan." And does that justify all those extra radiation?

Stuart: This is such a great debate today in orthodontics, as well as dentistry, because I know a lot of general dentists in town that now have iCATs in the practice. Basically, what it comes down to, you have a company, Imaging Sciences, who is known as iCAT.

Howard: Now I'm going to get you in trouble with all of the companies you work with.

Stuart: No. You've got a company that's committed to bringing the radiation doses down by a single scan. Right now my iCAT FLX has 11 microsieverts of radiation when I take one scan. Eleven microsieverts. I'll do the math for you, that's about the size of a digital pan.

Howard: Nice.

Stuart: So if we're talking 11 microsieverts on a patient, that's basically walking outside in 90-degree weather for a day or two.

Howard: God I wish it was 90. We're in Phoenix. It was 118 a few weeks ago.

Stuart: Yeah. And you say does it really change my diagnosis and outcomes? And I've got to tell you, from a standpoint of orthodontics, there's so much to this C.T. scan that we haven't even scratched the surface on. For the longest time we were just looking, "Okay, where is that impacted canine? Can I get to it?" Well in CBCT you can find out and pinpoint where that is. There are so many different factors that are excellent. I've got to tell you: for me, I couldn't practice without it today.

Howard: Now who owns iCAT?

Stuart: Imaging Sciences. But Danaher has iCAT.

Howard: Truth be known, it seems like they're there the leader among all the specialists.

Stuart: They are the leader. They are. And they're innovating all the time.

Howard: If you meet anyone who's placed 10,000 implants, they're on iCAT. Why do you think that is?

Stuart: Again, this is a company that has committed to being the industry leader, they're innovating all the time. So this 11 microsieverts that they just came out with a couple of years ago, it was double that for the first five years before that and so people were so up in arms about the fact that we had 30 some microsieverts. They've spent all the time trying to reduce that radiation.

Howard: And where are they? On the East Coast?

Stuart: They're in Pennsylvania.

Howard: Have you ever gone down to their facility?

Stuart: I haven't.

Howard: I love visiting dental factories. I just do.

Stuart: Go to Ormco in Orange County. It's fascinating.

Howard: Yeah, I've been there. Like most families go to Disneyland. I'll go to Disneyland if there's a Futuredontics, Ormco.

Stuart: That's awesome.

Howard: Well you just learn so much.

Stuart: You do. Can I just make one more point about iCAT? I think that you say, “Well it's just a CT scan.” Well no, it's not. Because they're constantly figuring out ways to use that information to bless the lives of our patients. So about four years ago iCAT went in and figured an algorithm out to map the airway of our patients. So now they've gone in and every scan I have, I have a complete picture of the 3D volume of their airway: from the nasal pharynx down past the epiglottis. And now we're using those numbers and finding the minimal constricted areas and seeing if we can use those to impact our patients for good and create better airways. So you're talking about information that's there that we need to innovate to use that information to directly impact our patients for are good. And they're doing that.

Howard: Now do you have your tonsils?

Stuart: I have my tonsils.

Howard: See I don't. And neither do any of my sisters. You know, 55 years ago, first time you got a sore throat they'd just take out your tonsils. And then the pendulum swung the whole other way, so it was: they're in there for a reason. All this airway trip, when I got out of school in '87 it was not even mentioned one time. It didn't bubble up till about a decade ago. And a lot of dentists are calling -- some are saying bullshit, fad. They joke like, "Oh yeah, I got a C pap machine and my hair grew back and my erectile dysfunction went away. How much is all this airway breathing hype and real?

Stuart: Let's put it this way. A colleague of mine -- a friend, not a colleague -- a friend of mine passed away on Christmas morning four years ago from obstructive sleep apnea. Had a massive heart attack. Now Howard, can you imagine what his children found on Christmas morning when they found him passed away? It was devastating for this family. Something that could have been treatable and could have saved his life.

And so four years ago, all of a sudden I said to myself, "Wait a minute, do I have obstructive sleep apnea? What does that mean?" And I went on a journey of education and trying to find out what this all was about and realized that there's a lot of people walking around that have airway issues. And are we going to send every patient through to jaw surgery and bring them forward and do this? No. However, what I'm going to do now as an orthodontist is approach each patient as a potential patient that could have obstructive sleep apnea, either now or in the future. And what can I do to increase that airway and make a huge airway for them to impact them so they don't have to have that problem of wearing a C pap or having a dental device to bring their jaw forward so they don't snore, or they don't stop breathing during the middle of the night.

Howard: We lost a Supreme Court justice over it.

Stuart: Yeah. It's a big deal. And so I've come to a realization, through using iCAT and using their airway scan button: it's the easiest thing to look on the C.T. scan is to create an airway and see what it is. Now we're taking our patients that are seven years old, six years old, they come in and we ask questions, using our scan as a baseline to help us. Another tool on our belt to help these patients have better airways. We ask parents questions and what we're finding is that many of these kids that have bruxing problems -- You know those kids that came in, the canines are worn down completely and you're like, "What is this kid doing?" The ones that have problems bedwetting, ADD, all of these kids fall into a little pattern of their airways are decreased. We can see that on our iCAT scan and we can use that information to help bless the parents, bless these kids’ lives. Many of them have large tonsils. The adenoid tissue is large, they have very minimal volumetric airway and we're impacting them for good.

Howard: Now sometimes are you taking out tonsils and adenoids?

Stuart: Absolutely. I think the pendulum is trying to get back to where it was before we were taking these out. You'll notice, and many of you out there, that you see these patients that come in and they're seven years old and they have dark circles under their eyes. If you just ask a question to the mom, "Hey, does your child snore?" And the moms will say, "Yeah, yeah they snore." And I'm here to tell you no child should snore

Howard: I went over to a friend's house, like a month ago, out by you in Mesa, and little Jamie was 5 years old. He was in kindergarten and he was sleeping there just "arrrrrgnnnnnn." And as soon as he woke up, it looked like a power sander on his teeth. That's not normal.

Stuart: It's not normal.

Howard: What would you do if she brought you in a five-year-old to you with flattened teeth and says he sounds like he's chewing a box of marbles when he sleeps on the couch.

Stuart: That's a great question. So I'm going to take a C.T. scan and I'm going look at the airway. And if the airway is decreased -- now we have numbers that will say, okay on an airway scan if the minimal constricted airway is 50 or below, that's potential for a severe obstructive sleep apnea in a child. 50 to 80 is moderate.

Howard: Which can stunt his growth.

Stuart: Well it can, yeah, stunt his growth. Stunt his brain function. And so the reason these kids are gnashing and grinding is they are trying to move that jaw to get the tongue forward so they can breathe. So they're mashing their teeth or grinding. These are the kids that are at school, they can't focus during the day. They're the ones that have to be on ADD medicine. Many of the times the doctors get that mixed up with a true ADD and they just put them on medication. They don't know what else to do. In fact, I've had mothers that have written me letters afterwards saying, "Thank you. I didn't know what to do with my daughter. They were going to hold her back a year. I know my daughter is smart but she's doesn't focus in school."

So if a patient comes in, they're five years old, if a mother comes in and is concerned about this, I'm going to do an expander appliance on her primary molar, I'm going to try to get the sutures to open up in the face and then I'm going to send the patient for adenoids and tonsils to be removed if they need it.

Howard: Who do you refer that to in town?

Stuart: The EMTs in our town, Scottsdale, Phoenix. I haven't found one that is excited to work with me. They say, "You orthodontists think you are trying to diagnose here." Which we're not, we're only trying to help bless the patients’ lives, plus our own. You ever notice these patients, they're are the ones that have the open bites? They're the ones that their jaws are open, they have the long faces, those are all the patients that need their tonsils and adenoids out when they were eight or nine years old.

Howard: Have you found anyone?

Stuart: I haven't found anyone that's that excited.

Howard: What percent, if you say, "Take out adenoids, tonsils," will they do it?

Stuart: Maybe ten percent.

Howard: Ten percent of the time?

Stuart: They'll take my referral to them serious.

Howard: You know, speaking of long face, this is dentistry uncensored, talk about everything. But talking about long face, this and that, but I always thought that gay people looked slightly different. Did you see that study that was published? They took a hundred facial photographs of gay -- anyway, long story short -- a computer now, on a facial scan, can predict that you’re a homosexual 78 percent of the time.

Stuart: Pardon me for chuckling a little.

Howard: I posted this on Dental Town because I always thought that. And so, yeah you can tell a lot just by the initial patient consultation.

Stuart: Completely.

Howard: “How are you doing?” And just talking and meeting. I mean, now when your gaydar is going off, there's something to that. When their breathing is going off, when they're grinding, when they're stressed, circles under the eyes. It's not all bite wings and study models

Stuart: And it's interesting that you started off asking me about rescuing this little boy in the sand that was buried alive and wasn't breathing. One of the things that my brother and I and our family did is we acted. To save somebody's life or to be a hero, you can't sit back. You have to be engaged with that person or engaged to do something to make a difference. And that's the same thing in these kids’ lives. You're going to see it. You're going to see these kids with the dark circles under their eyes or their canines that are worn down: their baby canines. That should be your clue as to: I need to act and make a difference in this kid's life.

Howard: Another controversial question. Some people on Dental Town think TMJ, grinding bruxism, is completely 100 percent mechanical and has no brain function to it. Other people think if you lost your job, your husband's cheating on you, your daughter's a stripper in Apache Junction, that that can lead to "ngrrrrrr." Do you think it's purely mechanical? Do you think it's purely brain or a combination?

Stuart: I think it's a combination. When you have patients that are grinding and bruxing, I think that's in the brain. And I don't think we can turn that off. Sometimes when we align the teeth and we widen and we get a cross bite out or we fix the occlusion, sometimes that'll shut off but it's not routine. And there's so much variable in that. I could spend a whole podcast just talking about my experience with TMJ and what I learned in that one year fellowship with this --

Howard: It sounds like an online CE course you should be making for Dental Town. Wink, wink, wink

Stuart: I know. We have to talk about that. But I think that there's two components to what we call TMJ and one is obviously myo-facial and that's the ones that the patients are stressed out. They're the ones that are going through divorces, they're the ones that are worried about their children: they're grinding, their masseters are on fire, that temporalis -- I can find trigger points every centimeter throughout their temporalis muscle and they're the ones that are benefiting from the Botox and helping them calm those muscles down. But I don't think they're true TMJ patients, I think it’s more myo-facial.

Howard: So, throwing my homies under a bridge, because I know them good. Ninety five percent of dentists -- and this is reality, you don't want to believe it or not -- when someone's coming in and they're grinding and they say I'm TMJ: their teeth are broken, cracked, they're worn down, everything. It's just 95 percent of the time take an upper [00:46:29] neuralgenis [0.0] and we're going to send it to the lab, we're going to make an upper night guard and we aren't sorry and just fix your TMJ. What do you think of that standard routine operating procedure? First of all, what percent of the time in America do you believe that's how the general dentists treat it?

Stuart: I think that's all they know. That's what we're taught.

Howard: What do you think of that treatment plan?

Stuart: I think it's good, in a way. We want to protect the occlusion, we want to protect the teeth. The problem is this: is when you give a splint to somebody and you say, “Wear this for eight or nine hours.” And they do, you have to say, "Hey, there's a potential here that you could end up with an open bite. You're going to wear this night guard and if you haven't equilibrated that" -- I mean, we take the impression, or we do a scan now, we take a bite and we send it off and we get back this splint and we just put it in.

I think it's great, but there's more to it. We need to make sure to have one tooth contact throughout, otherwise we're going to get bite changes. So I see people coming in all the time, "Hey, my dentist gave me this night guard. It helps. I'm bruxing on that. But now I have an open bite. What am I going to do with that?" So I don't think it's just a question of should we or shouldn't, it's which ones should we give a night guard to and which ones shouldn't we? And telling them and informing them that you may have bite changes and if you do you're going to see an orthodontist.

Howard: So most of the joints in the body: my elbow determines where my hand is going to be, my knee determines where my foot is going to be. Here we have a joint that when it closes, the teeth come together, the joint is leftover. It's very controversial on Dental Town. Some people say, "When I see grinding and bruxing, what I want to do is I want to put them in ortho and let their joint relax, go where it needs to be seated and pull the teeth.” So it's balance between -- so that my hand is in the right place when my elbow is extended. Other people say, "That's crazy." Where do you weigh in on that? I know it's tough, because it comes down to the individual. But in general, what do you think of that?

Stuart: Here's my philosophy. I feel like that after doing orthodontics for 18 years I've realized something about my TMJ patients. The ones that feel better are the ones that go through ortho and get the transverse, that arch width. When they get that corrected with ortho those patients feel better from their TMJ. That's one correlation I can tell you right now.

Howard: Now does that usually have to have implants component?

Stuart: Yes. So that's braces and wires or Invisalign, getting that arch width.

Howard: So you can do it without a retainer?

Stuart: That's right. You can't do it with a retainer. So it's with active treatment. By getting the transverse it seems to solve a lot of issues, especially occlusion and some TMJ issues.

Howard: What percent of your TMJ patients that you see on referral end up getting ortho?

Stuart: I would say almost 100 percent.

Howard: We started out this conversation saying that Boeing, their planes still fly at the same rate. But dentistry times are coming down and there's some other technologies out there. One of them is Propel orthodontics.

Stuart: Yes. I love Propel.

Howard: Who owns Propel?

Stuart: Propel is their own company.

Howard: Is it stand alone? First, explain if she doesn't know what you're talking about

Stuart: So, in orthodontics, like you said, we're always trying to reduce the treatment times. And about seven, eight years ago we had OrthoAccel, a company that would make a vibrating device. OrthoAccel, or Acceledent, and they claimed that we would bring treatment times down, teeth would move faster. And so it kind of started off this whole idea of accelerated treatment in orthodontics, again. We see this every 25 to 30 years, people start trying to go back and accelerate treatment. I found my aligner cases or my Invisalign went faster but not my --

Howard: With Acceledent? And what was their product name?

Stuart: Acceledent is the product name

Howard: And what was the company name?

Stuart: OrthoAccel.

Howard: Okay so you noticed it went faster with Invisalign, but not your Damon brackets.

Stuart: Correct.

Howard: So do you think it was basically just seating the tray better?

Stuart: I think it's seating the tray better.

Howard: So the vibration mechanism wasn't stimulating osteoclasts and osteoblasts and the PDO and doing all that, it was just getting the dam tray seated

Stuart: That's my thought process. They had evidence base that the vibration was causing the inflammatory response to happen, which was signaling the bone to soften and teeth move faster. It wasn't my experience with brackets and wires.

Howard: But what about Propel?

Stuart: Propel is just micro-ostia perforations. Taking a mini, if you will, a mini wood screw, if you will, numbing the gums, perforating the bone a couple times between each root, creating that inflammatory response as well. Which brings in the cytokines and the cytokines activate that inflammation and turn the bone over faster. To me, I've seen that works. That's saving my patients four to six months in treatment.

Howard: So what percent of your cases do you use Propel in?

Stuart: It's still very low because it is a minimally invasive procedure and once you explain it to patients, sometimes they get, "Hey, I don't want my body being punctured." And so I would say that we're still less than one or two percent of my patients that will pick to accelerate --

Howard: And it's basically someone getting ready for the 25-year class reunion or the wedding where they have a nailed down date.

Stuart: And believe it or not, it's the female patient that's ages 40 to 60 who want to be done in less than a year treatment time. So they'll pick --

Howard: And why do you think they want it done in less than a year?

Stuart: Well most of them are turning 50 and they want to be done for the 50th birthday. They don't want the wires and brackets on for an extended period of time. They want to be done as quick as possible.

Howard: You know the difference between a 25-year-old dentist listening to this and a 55-year-old dentist? The 25-year-olds think all the cosmetic surgery cases are on the young, hot beautiful girls with less than ideal, perfect teeth. First of all, they're already beautiful and they don't have a dime. And the guy who taught me -- the godfather of cosmetic dentists, where I've been in his practice. Well, number one you got to be in a big city. He's in Manhattan. Larry Rosenthal. So he's got a pool to pick from. Unlike him if he lived in Parsons, Kansas. And it's the 80-year-old ladies that have all the money.

If I said to you, "Okay describe an American worth a hundred -- if I said describe an American who makes 25 million dollars a year," almost all of them live in Manhattan in insurance, banking, financing. But if I said, “If you had no debt and you had a hundred million dollars cash in a savings account.” Now you're almost entirely 80-year-old widowed women and your hard-working man died a long time ago. You sold the company, you put it in the stock market. And when that 80-year-old woman comes in, she's paid off her house: they are the ten percent of Americans who buy their cars in cash, their houses in cash. They're all over 65.

And Larry Rosenthal, these little old New York ladies would walk in and he'd say, "Oh my god, Irma. If you got veneers, everyone would think you were 65." And she's got a liver spot, less hair than I do. And there's 50 grand. He would do it. They'd join them the mirror, she'd see those beautiful teeth and she'd cry. And she felt younger. And in my practice, for 30 years, we've done a lot of that. But it's that divorced woman getting ready to go back on the market and she's like, "Okay, I got to put my picture up on and eHarmony, Plenty of Fish."

I put my profile on Plenty of Fish and they took it down. They said, "Dude you're a whale. Lose 50 pounds and reapply." But the fixer uppers, to go back on the market, those are the those are the ones I would see have the cash; big income and don't want to wait two years to get on Tinder.

Stuart: You're exactly right. And the ones that are using Propel are the female patients. They're the ones and they're doing it.

Howard: And women just value beauty more. I think when I was little very few men valued beauty. I think a lot more value it today. Seems like back in the day they were worried about getting the farm, getting the business, the Marine Corps. But now it seems like -- So you are a fan of Propel orthodontics.

Stuart: I am.

Howard: Okay, now let's add another very controversial question. You like Spectrum lasers. Some people say that lasers stand for light amplification stimulation emission radiation. Others say laser stands for losing all savings equals reality. They are expensive toys. I know boys like their toys. Is Spectrum laser a return on investment or is it a boy toy?

Stuart: Personally, I think if you use it, it's a return on investment. And it's just like that dent cam from 1990. You know, if you're going to use that $45,000 dent cam, you're going to get a return on your investment. And we have to use the product in our practices.

Howard: Why Spectrum, and what do you do with it in your practice?

Stuart: So I'm not your typical orthodontist that: take the braces off, the patient goes on the way, you slap them on the rear end, "Hey, congratulations you did a great job." I'm looking at the shapes of the teeth. I'm looking at the embrasures between the central incisors and the centrals; central lateral; lateral cuspid. If the embrasures aren't right we're reshaping, we're reshaping cuspids. And at the end of treatment I polish the enamel.

Howard: You talking about Spectrum as a hard tissue agent?

Stuart: No. I'm making a point, sorry. I'll get to it. By paying attention to all those little details, the other part of the finishing of braces and taking the braces off is: what do the gum tissues look like? And many of these kids, even adults, have hammered tissue and you might get some variation in gingival architecture that doesn't look right. And so part of the finishing product is taking in and talking to parents about how the gingival architecture looks and if it's not right, numbing the tissues up and using the laser. Spectrum laser is just a laser that I found that is one of the most efficient and has the most consistent power and cutting. Many of these lasers today --

Howard: For soft tissue only?

Stuart: Soft tissue only. Correct. Many of the lasers today, a lot of the orthodontists anyways, they like these changeable tip lasers. Where it has a fiber on one end and then the fiber in the hand piece, in the hand model. And that loses power when you transfer from tip to tip. The Spectrum laser is a continuous fiber and we have very consistent cutting and power with the Spectrum laser. Are all lasers created equally? No. And I didn't want all the bells and whistles, all the flashes, I just wanted something that was consistent, worked and was made here in the U.S.

Howard: Manufactured in San Francisco. And you went to UOP?

Stuart: I did.

Howard: Did you ever go behind the scene when you were at the UOP or did they come after --

Stuart: They came after I was there.

Howard: They came after that?

Stuart: That's right.

Howard: That is my favorite city in the United States.

Stuart: Yeah, I love going there. About every ten weeks I get to go back, teach at the school.

Howard: Oh my God. So why do you teach at UOP and not University of California, San Francisco up the street?

Stuart: Well, one of my mentors in orthodontics was teaching at the school, and back in about 2005, 2006 I'd said to them -- Hey look at that.

Howard: Can we add this video of junior year? So, he's talking about Spectrum lasers. So why just UOP and not University of California, San Francisco?

Stuart: So UOP: my mentor was there. I asked if I could go teach with him at the school because one, I had an amazing humanistic approach to my dental career, my dental learning at UOP. It was very humanistic, a very pleasant experience. So I wanted to go back there and give back. And at the same time my mentor was there so I was going to learn orthodontics while I'm helping teach the residents at the same time.

Howard: Well there's more to that -- okay, so I know you're driving to work. So what I do is I like to retweet my guest's last tweet. So I went to Spectrum Lasers on Twitter and it's @bcobley1

Stuart: Yes.

Howard: What's B Cobley?

Stuart: So Bob Cobley is the owner of the company and he is the one that -- he sells lasers, it's not a big sales force, it's him. It's like a mom and pop show.

Howard: Well get him on the show.

Stuart: I would love it.

Howard: Get him on the show. You know, the one thing that Dental Town is, and dentistry uncensored, is it's a great equalizer. Because the big companies like Danaher can afford to buy all these full-page ads in this Dental Town magazine, but the little guy -- I mean, I'm just as a little guy. In fact, I get a lot of flak from my team because they say, "Oh, yeah we sold an ad in the magazine and then you threw them under a bus on your podcast for an hour." How many times have I got that? "Oh yeah, the owner, they're really glad they bought an ad 12 times in Dental Town because they just heard what you said about them at the townie meeting and they've got a booth there." But I just keep it real.

Stuart: That's awesome.

Howard: I just keep it real

Stuart: The cool thing about this Bob is he's developed a laser for implants. Where any implants that are failing, you can take one of his lasers and go get rid of whatever the bacteria is that's causing the failure. And he's just experimenting with a new laser that will help with tooth movement as well. Speed up tooth movement.

Howard: How will a laser speed up tooth movement?

Stuart: I think it's the same process as Propel, where you put a laser on the tissues, it causes the inflammatory response and the teeth move faster.

Howard: So, gosh darn you. You promised me an hour, you gave me an hour ten. Is there anything I missed? Anything you want to talk about? You're going to get me the guy from -- the owner of -- do you know the guy who owns Propel.

Stuart: Yes, I knew him as well.

Howard: Well if you want to get me the owner of Propel, owner of Spectrum. You know the owner, the CEO of iCAT?

Stuart: I do.

Howard: Damn! But you know what? The reason I like to do owners is because when I was little, on all the family vacations, dad would pick up me and my five sisters, we'd all get in the station wagon. By the way, the first time we went to Disneyland, put all that back down, me and my sisters played Monopoly sitting around the board table. No seatbelts. From Wichita Kansas to Disneyland. But Dad always wanted to stop at Six Flags over Texas. He always liked amusement parks and go visit factories. And when I started lecturing I always stopped by -- I think I've seen half the dental factories in America. Just always -- like my oldest sister is a cloistered [01:02:41] carnley [0.2] nun in Lake Elmo, Missouri. So every time I flew down there I would either go visit Patterson [01:02:47] indecipherable [0.1] for four hours. Even though it's his white house, he'd tell me what products were hot, what's not, what's selling, what's not, everything: the average rep sees 100 offices. What are the 10 offices doing a million doing, that the bottom three have never tried once? Or I'd go to 3M and they had like, I don't know, 50, 60, 70 [01:03:11] peaches [0.5] and there's this little five-foot-tall Indian girl, I think her name was Sumitra. She retired a few years ago. She'd take me to a grease board and started talking about Vitrabond and [01:03:23] Vitramare [0.2] and all -- It was an organic chemistry class I never had a grade in. I mean, just mind-blowing.

Working with your value chain, working with your manufacturer, and so many dentists are jaded and say, "Well I'm not going to talk to Propel because they're trying to sell me something." And then they turn around try to sell their patient a crown. Well how come you can sell dentistry but when someone comes in and sells you a Damon bracket -- and I used to do a cover story on the front of Dental Town every month and it was my favorite part. But my editorial team made me take it down because when you look over your complaints it was like, "Well this is a tabloid, it's got a picture of the company selling stuff for profit." And it's like, "What are you, a volunteer? What, are you working on homeless people for free?"

A dental company who sell -- and furthermore, if they sell stuff but they have sustainability for 10, 20, 30, 40 years. They're selling something to your homies, so you might not like it but other people with eight to 12 years of college are gobbling this shit up. So why do you have such a jaded -- and you only find it in America, you don't find that culture in Europe. They have the bi-annual Cologne meeting. The IDS meeting. It's the biggest meeting in dentistry, it's every other year. 110,000, 140,000 dentists show up. Nobody wants to hear you speaking about Propel. They're like, "Well is the owner here? Well, why the hell would I want to talk to an orthodontist who's been using Propel for ten years if I can meet the owner?" And he probably isn't a dentist and this and that. Well, who are you and your journey? It's a very jaded -- It's the same thing the Americans have with the government. You go to Scandinavia, the government and the free enterprise and the people are all trying to work a problem, whether it's get off -- I remember when Iran had the first oil embargo against us, and that's the first time I ever saw gas lines. Gas went from like one to two bucks overnight.

Well Scandinavia, I think it was in Denmark -- it was one of the Scandinavian countries said, "Well, we're not ever going to have this again." So they banned -- they said, "You're not going to sell us, we're going to take it one step further. We're going to pass a law that we'll never import oil from your country again." Now they're like a third wind, a third solar, completely diversified. And then the government work with the manufacturers so all those jobs are 40, 50 dollar an hour jobs. When people talk about global warming: like, who cares about global warming? Who cares what causes it? Would you rather have a dirty coal job? If we move the whole country to solar and wind, that would be like 100,000 jobs, probably like 40 dollars an hour. And that's what Scandinavia did.

So when me and Ryan get to lecture on five continents a year, you see all these other people, and the old school “run a dental school like a Marine Corps and that's what's best,” that's dead and gone. And I don't even think it works well for the Marine Corps. And if you want to run a dental school, do it like our Art Dugoni. Do it like Jack Ellenburg and the next time a sales rep comes in your office, don't make them wait for 30 minutes in the office, shake his hand. Where's he from? He’s making a living selling this stuff.

Stuart: What can he do to help you in your practice?

Howard: Yeah. I mean, just amazing. Even with the government, like every time there's an Easter parade they sell a little parking stall for like 15 bucks at the end of the parade. So we put up a cardboard table, we get the staff there. Everybody is at the damn parade. We make a float. I unicycle down the parade route, it's only one mile. It shocks people that my fat ass can unicycle for a mile. But you know what we do? We go down to the government, the offices of dental health, we tell them it's the Easter Parade. It's right here. Do you have any brochures? Dude, I couldn't fit all the brochures they give me in my SUV. And they're great brochures and didn't even cost them a dime. And I'm like, "Why are you giving me all these?" And he says, "Because we see a practicing free enterprise dentist about maybe every three or four months around here." And so, work your value chain. Fix your attitude. Your attitude determines your altitude. Thank you so much for coming by and talking to my homies here.

Stuart: My pleasure. Thank you.

Stuart: My name is Dr. Stewart Frost. I'm from Mesa Arizona. I'm an orthodontist and I love my job. Fun fact a lot of people don't know about me is I'm a twin. And my twin brother and I would go to our father's office and watch him work on patients and we loved how he treated patients and how he was a great dentist and we wanted to be like him. So we went into the field of dentistry.

I went to Arizona State University for my undergraduate and then got into school in 1989 into University of Pacific School of Dentistry in San Francisco. After I graduated from there I practiced for five years with my father here in Mesa, Arizona, and then went back to specializing in orthodontics. While I was a general dentist I was watching the patients that were coming in from local orthodontists and I was seeing some things that intrigued me. Straightening teeth was more exciting than drilling teeth and then putting crowns or veneers over them to make them straight.

I went into orthodontics thinking that I was just going to line up the teeth, just create smiles with the teeth all aligned. And I realized that orthodontics is more than just straight teeth. It's about creating beautiful smiles.

My process, or evolution, if you will, as being in practice, has gone from just lining up the teeth to creating beautiful, spectacular smiles. When I first started in orthodontics, again, all I was trying to do is learn how to straighten teeth. And then, as I became more aware of what I really was doing and the lives that I was changing, I realized that I'm impacting people's lives for good. In fact, changing lives.

I'll never forget, I put braces on a patient, she was an adult that had four teeth extracted as a teenager and she was coming back in to be retreated. And I treated her and made this beautiful smile for her. It impacted her face and made a difference. And when I took the braces off I handed her a mirror. She held the mirror up and looked and she started to touch her upper lip and her face and she said, "I have my smile back." That alone was huge for me, because I realize that I'm making a difference on every single patient who walks through this door.

I realize there is more to our faces, there's more to our breathing and our airway. Hence my practice has evolved that encompasses the head, the neck, the face, breathing, airway. And then of course lining up teeth for a beautiful smile.

I took my family to have a family photograph. I introduced myself to the photographer and she said, "I know who you are." And I said, "You do?" I was surprised. And she said, "Yes, you're known in the community as the artist orthodontist." "Why do you say that?" And she said, "Well, your smiles are different than the others in the community." And she said, "I've been taking photographs of all the patients in the community, yours are different."

The emotional side of what I do is really probably the greatest part of my job because you see the change in a person when they start and then when they finish. Their personalities come alive, they have more self-confidence and their smiles are gorgeous, they love it. To be a part of changing somebody's life means a great deal to me. We all go through processes and journeys in our lives. And to be an intrical part in somebody’s change in their life is a joy that I get to experience every day. I didn't go into orthodontics thinking that that would be part of my job, would be to change somebody's life. But to see that smile transformation, see that change, is really what does it for me inside. It's pretty spectacular.

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