Dentistry Uncensored with Howard Farran
Dentistry Uncensored with Howard Farran
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968 Energizing, Lucrative, & Fun Dentistry with Dr. Michael Gagaoudakis : Dentistry Uncensored with Howard Farran

968 Energizing, Lucrative, & Fun Dentistry with Dr. Michael Gagaoudakis : Dentistry Uncensored with Howard Farran

3/16/2018 5:05:20 PM   |   Comments: 0   |   Views: 240
968 Energizing, Lucrative, & Fun Dentistry with Dr. Michael Gagaoudakis : Dentistry Uncensored with Howard Farran

“Dr. Mike” is a General Dentist with practice limited to full arch implant dentistry.  His journey began in 2006 when after graduating dental school he started his first general dental practice from scratch where he provided all aspects of care in an insurance based managed care practice.  

In 2012 Dr. Mike had life changing surgery on his back that set him on a journey that transformed the way he thought about life and about dentistry and caused him to make some drastic changes in his practice life that included selling his practice so he could focus on providing transformational dentistry for his patients.

After selling his practice he went to work for corporate dentistry for 5 years where he gained the extensive full arch surgical and restorative experience and mentorships that led him to start a highly selective 100% fee for service practice in Winter Park, FL (a suburb of Orlando) that focuses solely on full-arch dental implant rehabilitation and provides both surgical, restorative, and lab phases of implant care under one roof.  Dr. Mike’s unique talent is to inspire his patients to make changes that transform the way they look at life starting with a change in their dental conditions.

His professional goal is to inspire young dentists to find their unique talent then use that unique talent to transform their practice into a place where they can then motivate their team, their patients, and impact the dental industry in a positive & encouraging manner.

His message of encouraging patients and professionals to focus on their higher purpose to propel themselves through their times of struggle is an essential part of his success and in the shared success of his inner circle of colleagues and patients that get the chance to work with him through his consulting business.

For more information about Dr. Mike go to his practice website: and click on the “for dentists” link at the bottom of the page.

VIDEO - DUwHF #968 - Michael Gagaoudakis

AUDIO - DUwHF #968 - Michael Gagaoudakis

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968 Energizing, Lucrative, & Fun Dentistry with Dr. Michael Gagaoudakis : Dentistry Uncensored with Howard Farran

HOWARD: It is just a huge honor for me today to be podcast interviewing Michael Gagaoudakis all the way from Winter Park, Florida, which is a suburb of Orlando, Florida, which is where we're going to have our townie meeting, April 11 to 14th at the Wyndham Bonnet Creek. Have you been to that place before?              

MICHAEL: Absolutely, it's beautiful. Beautiful Hotel. You couldn't have picked a better place to have your townie meeting at. Your guests are going to love it.          

HOWARD: Nice and there's golfing and it’s close to Orlando.              

MICHAEL: And you're right next to Disney and you can see some fireworks outside. Enjoy some beautiful pool. It's a beautiful place.      

HOWARD: I just read the other day that Disney is the second largest buyer of munitions buying the Pentagon because they have fireworks every day.

MICHAEL: That's crazy. And you can tell because their fireworks shows are absolutely amazing and they make some of the best fireworks shows and they're long. It's great. Nothing better than going out and sitting and watching and soaking that in. Especially with the family.          

HOWARD: Well, you know, it's funny, we had it in the first fifteen years in Vegas because back in the day, Vegas was all the hot thing, but now millennials don't want to go drink and smoke and gamble in Vegas. They want to do more fresh outdoor golfing, kids, you know?      

MICHAEL: Yeah, absolutely.      

HOWARD: So, Dr Mike is a general dentist with Practice Limited to full arch implant dentistry. His journey began in 2006 when after graduating from dental school, he started his first general dental practice from scratch, where he provided all aspects of care in the insurance base managed care practice. In 2012, Dr Mike had life changing surgery on his back that set him on a journey that transformed the way he thought about life and about dentistry and caused him to make some drastic changes in his practice life that included selling his practice so he could focus on providing transformational dentistry for his patients. After selling his practice, he went to work for corporate dentistry for five years, where he gained the extensive full art, surgical, and restorative experiences and mentorship that led him to start a highly selective 100% fee for service practice in Winter Park, Florida, a suburb of Orlando that focus solely on full arch dental implant rehabilitation and provides both surgical and restorative, and lab phases of implant care under one roof.          

HOWARD: Dr Mike's unique talent inspires patients to make changes that transform the way they look at life, starting with a change in their dental conditions. His professional goal is to inspire young dentists to find their unique talent, then use that unique talent to transform their practice into a place where they can motivate their team, their patients, and impact the dental industry in a positive and encouraging manner. His message of encouraging patients and professionals, to focus on their higher purpose, to propel themselves through their times of struggle, is an essential part of his success and in the shared success of his inner circle of colleagues and patients that get the chance to work with him through his consulting business. For more information about Dr Mike, go to his practice website, Orlando lifestyle dentistry, and click on the 'For Dentists' link at the bottom of the page. My God, that's an amazing journey. So, you went to work for corporate that actually had a lot of continuing education?

MICHAEL: No, it was actually a lot of in the field, actually experience. When I first got into the corporate world, I was actually coming out of dental school and you go straight into your own practice, you're kind of like the owner of your own little domain and you say so many times, you're on this little island and you just got your own little place. And a lot of the times that can be very, very comforting because you control the whole situation. But at the same time also, you're pretty much alone. You don't see what's coming in, when you get out of dental school, like so many dentists, you don't know anything about dentistry. You don't know anything about the business of dentistry actually. So, that's one of the things that when I got out of my practice, I was completely scared to go work for corporate dentistry, but it ended up being one of the best things I ever did.          

HOWARD: Now, can you tell us which corporate one you worked for?  

MICHAEL: It was a very economical denture place that did lots and lots of dentures.      

HOWARD: Affordable Dentures?          

MICHAEL: Similar. Economy Dentures actually, in Jacksonville, Florida.    

HOWARD: Was it just a local, regional place?        

MICHAEL: Local, regional place. He had a few different offices and the office that I went to go work at in Jacksonville is something that I have never seen before. He had, you know, 24 operatories. We basically did the entire denture process from start to finish in one day. So, we would go in, in the morning and it wasn't uncommon for us by the end of the day to have done five, six immediate denture arches?            

HOWARD: How many?              

MICHAEL: Five to six a day.      

HOWARD: When people say corporate dentistry, well first of all, I think it's silly because most dental offices are a corporation. When it has one-layer management, like when you have one office, you got to wear so many hats. But I've seen so many places, like it'll be, say a town of a hundred thousand or two hundred thousand, and they'll decide to do one in north, south, east, west. Now you have a scale for one-layer management where someone can really concentrate on HR, or legal, or accounting, or marketing, or website, staff training, all that stuff. That is very efficient, but when you go to the second layer of management, where there you have a headquarter that to manage the local corporate dentistry in say a dozen different states. And that second layer is trying to skim, 15, 16, 18% off the top. I don't really see how that works, the added value and I don't get that. But, like a denture place, like you're talking about, how many offices do they have?        

MICHAEL: About eight, I believe.        

HOWARD: Yeah, so when you have eight offices, you just have one layer of management and you can really focus and target and really get productive. So, you worked there for five years, learned a lot about the business and the implants and the removable and then you decided to do it yourself.        

MICHAEL: Yeah, absolutely. I also worked at a great provider, where I learned how to do All-on Four hands on. Took a lot of coursework, of course, and put that stuff to use. That was the type of dentistry that I really, when I first sold the practice, my existing practice, I decided, hey, you know, I want to go and do something that I love. I realized that I was in a situation where I was probably very, very burnt out. I know I was very burnt out and I decided that hey, I want to do some implants. I ended up learning how to do implants through CE courses and then also through doing actual hands on, putting it to use. And I didn't even realize how much experience I was getting as I was going and doing the denture cases. What I was doing is the first few steps of doing an All-on Four procedure.        

MICHAEL: So, what we did was we were just basically making our prosthetics or conversion dentures. We were extracting all the teeth and then placing immediate prosthetics that day. So, I really wanted to focus in and when I got out of the corporate world, I had a couple of really good mentors that were really good to steer me in the right direction and just kind of say, hey, look, you can do this type of stuff, this is not something that you don't have experience doing. So, that's how I ended up doing it.        

HOWARD: You talk about All-on Four, does your practice also do All-on None?        

MICHAEL: We do. In my practice, what I try to focus on is how can I get the patient into a healthy position that's as functional as possible, for that particular patient's situation and also help them build value and feel better about themselves at the same time. So, cosmetics is another big portion of our practice. We offer in our practice, our practice model is basically we do full arch dentistry. We offer full dentures, over dentures, All-on Four, and we offer like the old school round house type restorations, where we're using cemented bridgework, crown bridge work. We do that too.          

HOWARD: That is amazing. And you're not taking any insurance right now?

MICHAEL: No and we just, we grind it.          

HOWARD: So, you don't participate with anyone, not even Delta?              

MICHAEL: No.        

HOWARD: And what percent of the practices would you say in your Orlando Metropolitan area, including Winter Park, do not take any insurance?          

MICHAEL: I would say probably 1 to 2%.  We will file for the patient and we'll try and get the money back from the insurance company. And with Delta it's pretty difficult, just because of the way everything is set up. But the kind of the way that I wanted to do this was, when we started this practice and we worked part-time jobs, we came in at night. We worked every night, my wife and I. It was just a two-person team and my mother-in-law. We worked from six to nine every night, saw new patients. Fridays I had off from my regular job. We did surgeries on Fridays, we did surgeries on Saturdays. And you know, what built it, was word of mouth.        

HOWARD: I want to go back to Delta though. How does Delta make it more difficult?              

MICHAEL: I'm not very well versed in how insurance does all the billing. My wife does all that stuff for me. I'm really blessed to have her. She does all that stuff and it's nice to have a family business and that helps a whole lot. But basically, one of the biggest challenges I think that we have with Delta is, predeterminations in certain cases and also finding patient information, coverage and benefits, because if you're not a network provider, that can be a little bit difficult.          

HOWARD: Well you know, we're at a fork in the road that dentists have to insurance companies, like Medicaid and Medicare and Delta, they say they want to help the poor, but they don't. They want to control the poor. They don't realize that. OK, so let's say Medicaid or Delta will pay $100 towards a filling, but that's not what they do. They say no, but you can only charge a hundred. You can't charge a hundred and one, or a hundred and two. So, you're saying, in a car they have a Chevy, a Pontiac, an Olds, a Buick, a Cadillac. So, you're not telling your people that, well, we’ll for a Chevy, but if you want to pay out of pocket and upgrade it to a Pontiac, or an Olds, or a Cadillac, it's about power and control, which has been a problem with monkeys for millions of years. 

HOWARD: And they don't get it. I mean, it's just, like Medicare is always whining in Arizona and California that, well, they don't have enough participants. Well, why don't you say, hey, poor people, we'll subsidize, we'll pay up to $100 for a pulpotomy. But if your pediatric dentist says, well, we actually charge two hundred. Well, now you have a choice. Do I want to go to a pure play Medicaid practice or do I want to go to that really nice office that was referred to me by a friend and I really trust this place and they'll pay a hundred and I'll get another hundred. It's not about that. It's about an abusive relationship that doctors need to draw a line in the sand. If you want to subsidize poor people, government, Medicare, federal, Medicaid, state or private insurance, Delta, if you want to pay for it all, then you should have a list of all the dentists that will take that as full fee. But they don't take it for full fee. There should be other offers, because poor people upgrade.

HOWARD: I mean, they could buy a pack of Lucky smokes for $5, but how many of them upgrade it to ten for Marlboro. They could buy a Samsung. How many poor people upgrade it to an iPhone? I mean, telling poor people that they can only smoke Lucky smokes. What’s the poor man’s beer? In Kansas City, the poor man's beer was Wiedeman. I mean we could buy an entire case of beer at UMK Dental School for like two-fifty, at the time, but if you wanted a case of Bud back in the day, it was ten bucks, but we were poor dental students. So, what'd we buy? We bought the poor man's beer, but right now they'll pay for the poor man's beer, but they won't let you upgrade it to Fat Tire.            

HOWARD: And it just the abuse of the way they think and the way they think, while they're CEOs are making gazillions of dollars and not going to any Medicaid clinics or Medicare clinics. And they got the millions of bucks and they're driving the German and Japanese luxury cars and they're going to people like you, but none of their clients can be subsidized to go to someone like you. So, that's a fork in the road that needs to be passed. So, when you're on the podcast, you know, I'm fifty-five, I got four grandkids. That's not who listens to podcasts. Who listens to podcasts are younger people. A quarter, I always say, shoot me an email, Tell me how old you are, where you at in life, where you're from. And a quarter of them are in dental school and the rest are under thirty, so they all graduated and they never placed an implant. How would you coach a kid to go from zero to one? I mean, right now, how many implants you think you've placed?    

MICHAEL: Quite a bit. I don't keep track of those numbers, but over three thousand.              

HOWARD: Okay, so you going from three thousand to three thousand and one is nothing, but to go from zero to one, is everything. What advice would you give a kid? And especially in this country, most implant trainee is manufacturer sponsored. So, a lot of them are emailing me, are asking on Dentaltown, they're saying, “I feel like I need to pick the implant first because all the training is that company.” What would you tell a kid who says, I want to be like you in a decade. I've never placed one implant. Advise my journey.              

MICHAEL: I'd start by doing lots of extractions. And that's kind of how I started. In my private practice, I did tons of extractions just on a regular one-person office type situation. When we went to go work for corporate dentistry, I started doing extractions, a lot of extractions. And it wasn't uncommon by the end of the week to have two hundred extractions underneath your belt. So, do something, set your practice up in volume for you to start doing surgery right away.            

HOWARD: But here's what they tell me, Mike, they say, “well, I'm afraid to do that, remove that tooth because what if I can't get it out?” What would you tell a twenty-five year old? And she's thinking, “God, what happens Mike, if I can't get it out?” Did it ever happen to you?          

MICHAEL: You've got to be good friends with your surgical specialists down the road. Go meet them. They're going to call you. When you get out of practice, don't turn down those opportunities to go meet them because they're trying to get out and have meetings with young dentists right off the bat. Go meet them, go talk with them over a beer, Have a beer with them. Sit down and talk with them. Say, “hey, look, I want to start doing extractions in my practice. I want to start doing implants. I'll send you everything else. I just want to start learning how to do, let's say, the easy implants.” So, the green light implants, you start doing the first molar implants, maxillary premolar implants.          

MICHAEL: Start doing those from there and you'll be amazed to find out that some of your specialists, they'll be very supportive. Because a lot of the specialists out there, they're doing big things, they're doing little things. There's this misconception in dentistry, and I think it's propagated a lot in communities that there's a lack of dental work to do. And because of that there's major competition between all of the different providers and oh, your specialist is not going to like it if you do surgery. But I have found that that is the 100% opposite of what it is. And I have found, if your specialist is telling you, “hey, I don't feel comfortable with you referring me after you had a difficult case.” Okay, I can understand that.            

MICHAEL: Don't throw your specialist under the bus. It's a two-way relationship. So, get to be good friends, but learn, study as much because there's different ways that you can learn. You can learn by your experience, you can learn by experience of others. A smart person will learn from his mistakes, but a genius will learn from the mistakes of others. And a lot of times what happens is, these guys have gone and traded that water before you. So, if you can go and get to be friends with your specialist and your local specialists, or even take some CE courses that are hands on, that'd be a great, great idea.              

HOWARD: And I got to give a big shout out to my mentor and idol. Robert Sundberg. He practises [inaudible 19:03] now, but he was a general dentist. We were both on forty-eighth street. I was on 14th and Elliot and he was two miles up the road. You'll see, Fortieth, there was Guadalupe, then Baseline. And he was such a dream. I can't tell you how many times in 1987, 1988, probably ten times, I just finally was ready to cry and give up and had him by [inaudible 19:27) and my receptionist, or assistant would drive him two miles up the street. Robert would start laughing and the patient would always say, I don't know what the problem was because he got out like one second. I mean, he was in there for like a second. It's like, I know, and he wasn't much older than me. I mean, I graduated in 1987, I forgot. 

HOWARD: He was from a university in Nebraska in 1980, so he's only seven years older, but seven years is a lot of head start when you're right out of school. So, you need to find a buddy, because I could use my oral surgeon, Don Gass, if it was during banker's hours. But Bob was like me, he was doing evenings and weekends and Saturdays. So yeah, you need a buddy and a lot of these dentists don't want to be your buddy, because they see you as competition and they think in fear and scarcity and just you go out there and meet them and find out they live in fear and scarcity. It's very important because then you can cross their name off and never interact with them again. Find the guy who, when you send them a root tip, not only has he pulled it out, but afterwards he wants to go have a beer with you and watch the ball game. You need buddies in your back yard and you got to find them.          

MICHAEL: Those people are priceless. Absolutely.          

HOWARD: Yeah. So, the next question I'm going to ask you is, when I tell you this you're not going to believe it but, Italy has two hundred different implant companies alone. Right now, if you go to Bloomberg, and ask them how many dental implant companies are, Michael Bloomberg [inaudible 21:02]. But there's over six hundred implant companies, hell, there were, I think three hundred at the IDF meeting. So, she just got back from Chicago mid-Winter. How many different implant systems do you think had a booth at the Chicago Midwinter System?  

MICHAEL: Crazy. Hundreds.      

HOWARD: Hundreds. So, help her out. She doesn't want to go through all that. You've placed over three thousand. Does the implant system matter? I know what she's asking. What one do you use? And is it just one or do you use several different kinds?      

MICHAEL: Several different kinds. I do. Lately I can tell you, I've actually been using the Hahn Implant System.        

HOWARD: The which one?        

MICHAEL: We've been experimenting with the Hahn Dental Implant System.

HOWARD: Spell it.            

MICHAEL: H-A-H-N          

HOWARD: H-A-H-N. Oh, that's the one that Glidewell’s using. 

MICHAEL: It is.        

HOWARD: What is that guy's name? I need to get him on the show. Who?  

MICHAEL: Jack.      

HOWARD: Jack Hahn. Do you know Jack?            

MICHAEL: No, I don't. Actually, you know what, I've used Glidewell for years.          

HOWARD: He's out of Columbus, isn't he? Or Ohio?      

MICHAEL: I believe so. So, in Orlando here, there’s the mission institute is pretty big. So, when they started using the implant system, I said, you know what, it's time I should take a look at it, from standpoint of implant body design. I like the primary stability that it gave. I also liked the prosthetic options that were accompanying with the implant. So more and more I find myself gravitating towards there. The other biggies are Nobel, which I will tell you the Nobel Active Implant is just an awesome implant. And my other favorite is the Bio-Horizons tapered implant that they have and both of those implants systems are really good. I've also done a lot of Implant Direct, and also a great company to look at right now, especially for startup costs, is Blue Sky Bio. They're right on par with the Hahn.          

MICHAEL: And I really liked some of the stuff that's coming out of those camps. The advantage that I see with the Hahn dental implant, that I like a whole lot, is the ability to work with Glidewell. They do a lot of volume of implants and when you're doing an implant, I'm going to tell you, I've tried so many dental labs and even a single, if you're going to be doing a single, nothing beats a custom abutment or screw retained crown from Glidewell, one of those BruxZir grounds from Glidewell. They work great and they fit great and they just do really high-quality work. I actually liked the way they work.       

HOWARD: Wow. One of the greatest podcast I ever did was the late Carl Misch and he actually went for two and a half hours. When someone knows that their time is nearing an end, man, he went all out. There was talk about dentistry uncensored. I mean, there were so many, wow. It was like a boxing match for two and a half hours. But the one thing, I went through the missions here, I got a fellowship and the mission stewed. But the one thing that Carl, and I think a part of his journey that everybody needs to remember is that, he mastered removable first. And, the reason he got into implants because all these people were placing an implant supported fix and the implants are breaking and they were blaming it on the implants. And he says, well, hell, your bite was so bad, you can't compensate for everything being wrong with an implant.    

HOWARD: And he said that it was like peanut butter in your chocolate. It's like Reese’s Peanut Butter Cup. He said you got to cross train. If you don't know removable, you're not going to learn fixed. And removable and fixed is the Ying Yang. Just like some of these TMJ people. You listen to their lectures and you're just sitting there thinking, OK, if you did one ortho case, you would know everything you just said is insane. But I wouldn't even want to go to a TMJ specialist who didn't understand orthodontics. I wouldn't want to go to a fixed implant place, to a guy who couldn't make a denture. You know what I mean? Cross training. 

MICHAEL: You know, I love dentures to this day. One of the greatest things about dentures is that a lot of the patients that are opting for that kind of care, they can't find a dentist that will do a good denture for them. So, if you can do a good denture in your practice, so many people get out of dental school and they say, I'm never going to do dentures in my practice. I don't want anything to do with that. I would say, give me a denture, man. I would love to do dentures because you know, that is actually kind of, it's a full mouth rehabilitation basically on a piece of plastic that's easy for you to adjust the bite on.            

HOWARD: Another thing that's really, really amazing is when you go around the world, you realize like, if in the United States, you think, well the bomb is salt and pepper while you go to India, it's curry. I mean, when you go around the world, you see all these nuances. It's amazing how in Australia, they'll just do one implant up the middle. They'll do one right in the symphasis, an over denture, they love it. In America they always go to two, which creates a lever and a rotating plane. What do you think of one down the middle? Do you do many twos? With the twos, is it bone or rings? Or is it always a bar and a clip? Talk this through your Chevy, Pontiac, Olds, Buick, Cadillac, from All-on None to All-on Four. Is there anything in between?            

MICHAEL: Cool, yeah. Absolutely. I can show you. You want to see?          

HOWARD: Absolutely. Ryan told me you could pull up a slide presentation if you were to pull up a slide show and just lecture, I will just shut up and not interrupt or you got models?            

MICHAEL: So, you see that? I got models. I like using models actually, you know what, patients I feel if they can hold it in their hands, I think that there's a different level of understanding that they get. If you guys can see this, this is kind of the Chevy, this is the traditional denture. So basically, the standard way of making a denture, we don't have any kind of retention at all. We use the tissue for retention. Lots of times patients will use the denture glue, the adhesive that places over here. And this is the traditional way that for years, and years and years this was done. And one of the advantages of this, of doing this type of dentistry, is that you can take a patient that has maybe a lot of infection in their mouth.              

MICHAEL: Maybe they have a ton of cavities and you can get them to a healthy position where they're not having that active infection. Where they can actually have something that's very cosmetic, a lot of people knock dentures, but dentures are actually one of the most cosmetic restorations that we can do in dentistry. So, we can give them something that looks good. So, from that standpoint, there's a very large percentage of people out there that can be greatly benefited in terms of health and in terms of cosmetics from something like this. So that's our Chevy. Kind of like the next step up from that would be a removable over denture, where you actually will go and place your implants. At my practice, I actually use the removable locator system. So, I'm going to zoom this up if you guys can see it. So basically, those are little attachments that go on the implants. And on the other side of the denture, there are these little vinyl fittings, and those little vinyl fittings plug in to the denture to offer some nice stability and I can make those vinyl fittings pretty tight.            

MICHAEL: So, the nice thing about something like this is, I don't have to have as much acrylic, especially on an upper denture. I can actually relieve the pallet from inside of there, which is a nice thing because about half of the taste buds are located on the roof of the mouth. So, from this perspective of eating and what-not, this is actually a little bit more comfortable for a lot of patients. It's tissue born. So, basically what that means is that when you bite down and chew with this, some of the tissue maintains some of the pressure. So, where this goes from here is, we can actually create something that's not tissue born. We can actually create something that's implant more and that is actually one of the, that's kind of like the top of the line. That's the Cadillac. When we go to something like that...        

HOWARD: What system was removable? Locator system. What brand?

MICHAEL: A locator. Locator brand.  Zest Anchors.        

HOWARD: Oh Zest.          

MICHAEL: Zest Anchors, yeah.            

HOWARD: OK. So, Zest Anchors Locator Systems.        

MICHAEL: You got it.        

HOWARD: And one of the things I like about that is, a lot of people that had a serious hygiene problem or given All-on Four, and every time they come in, there's three ham sandwiches underneath their deal, but with a removable they can take it off and brush and clean better.      

MICHAEL: That's one of the greatest things about it. Because of that, one of the things you start to see is when you start doing these fixed restorations, years later and you start to see the patients four, five, six years later afterwards and you start to see, hey, what are the complications? You've asked yourself, what are the complications are we having with these types of restorations and in our patients. And most of the time, it has to do with Peri implantitis type of complications when there's a complication. And a lot of that is because of the cleanse ability of the fixed prosthetic. So, the advantage of having a removable prosthetic is that it's very easy home care, at home. Basically, a patient takes it out for five minutes in the morning, five minutes at night, they clip it out, rush these little implant heads, and then they clean the denture and some denture solution, and they brush it with the denture brush. And that typically, it's because of that, it's a nice durable restoration. These are the types of restorations that I see patients that are, if they are a geriatric patient and a lot older patient, I see these types of patients with surviving types of restorations that are removables like this, far into their eighties, nineties, and beyond. My grandfather has one and he's going to be a hundred and one in about two to three weeks actually.          

HOWARD: Now, do you think that was genetic. Was he a yoga instructor? Did he ever drink or smoke or eat Greek food? I mean, what would you think the secret is?

MICHAEL: I have no clue what the secret is. We had a big event for his hundredth birthday and he ate some nice, he ate pasta, he's Italian, so he eats pasta every single night. So, he ate a huge bowl of pasta, ate three pieces of chocolate cake, he had two cannolis, a bloody Mary, a Scotch and a cigar. And then afterwards he said he had a good birthday.          

HOWARD: Wow.              

MICHAEL: Whatever the secret is, I'll tell you what.        

HOWARD: So, what do you charge for that denture? And then, what do you charge for when it's on four Zest Anchor Locators?

MICHAEL: $1,000,000 for this one and $2,000,000 for this one.        

HOWARD: Well that's probably true. Just depends on what country you're talking about that or are they Zimbabwe dollars.        

MICHAEL: Flat out. What I do is, I charge about 10 k for the removable, for an arch, and then I charge for the upper, a fully anchored about 16 k and we have different grades.              

HOWARD: So just an upper and lower full denture is 20 grand.          

MICHAEL: No, upper or lower full denture without implants, would be about 10 grand, plus 5 grand depending on how many extractions there are.        

HOWARD: So just for the denture, it's twenty-five hundred an arch?            

MICHAEL: Yeah, twenty-five hundred an arch.      

HOWARD: Five grand for a full.  And then for just a denture on four locators, approximately what would that be?      

MICHAEL: So, upper and lower arch around eighteen thousand.        

HOWARD: Just for the dentures and the four implants and the locators. So, it'd be nine thousand an arch.      

MICHAEL: Yeah.      

HOWARD: And then, All-on Four would be for upper and lower?      

MICHAEL: About 16 k an arch.            

HOWARD: 16 k an arch. And what is it, Clear Choice, the big chain?          

MICHAEL: Clear Choice is a big chain, yeah.          

HOWARD: Aren't they about twenty-five an arch?            

MICHAEL: They are and the only way they do, and Clear Choice is a great option for a lot of different patients. The only reason why I can actually do what I do is, I do most of the work myself. I want to be really good at one thing and take that thing as far as I possibly can. So, from the planning aspect, I'm doing most of the planning of the case. I have an in-house lab guy that helps me with it, these types of cases. So, to do a basic acrylic to [00:35:16 sounds like vitaleum] substructure, or All-on Four, that's our fee. Now, if we're going to compare apples to apples doing a zirconia. So, the zirconia bridge is the new kind of latest, greatest. And I'm going to give a shout out to Michael Tischler because Tischler Dental Lab does great work for these.

HOWARD: Where’s his lab at?            

MICHAEL: It's up in New York. Just outside of New York. I believe it's just outside of Rochester, New York.        

HOWARD: And how long have you been using Tischler Dental Lab?            

MICHAEL: Actually, we just started using these. We just started doing the zirconias and I'm very impressed with the cosmetics. I'll show you a traditional zirconia that I would get at my normal in-house lab, my in-town lab. It's kind of like opaque. We have different grades by the way, so this like a traditional, full Zirconia monolithic restoration. And Glidewell makes great ones of these. They're called the BruxZir. So, this would be about twenty-two an arch and then this would be about twenty-five an arch. And the difference is in the detail of the gingiva, you'll see that Tischler Dental Lab have just really does a good job in the setups as well.      

HOWARD: Well, you know what, I would just kill for it if you and Tischler made an online CE course.      

MICHAEL: Man, I would love that.      

HOWARD: To show how you guys do that but I feel bad saying that. You know why I feel bad saying that, because there's two hundred and twenty countries and when I said that, that's because all the dentists in the twenty richest countries would want to know that. But you know, every time I'm in India and Africa and Asia, you start off with that dentures is the most common full mouth cosmetic deal. And whenever I'm in like Tanzania or South Africa, they say, well I want an online course. I wish you'll make a flipper, because here we're not going to give her a three-unit bridge and we're not going to give her an implant and a crown, but I really wished I could make a better single flipper. Now, I'm always coming back here, but no one in America wants to be that guy who was famous for making a flipper. Their ego wants them to do before-and-after on a supermodel, Raquel Welch or something.        

MICHAEL: But, because it's fun.          

HOWARD: But the majority of the planet cosmetic dentistry is a flipper.

MICHAEL: That's a great point. And I think that's a part of the process. So often, you know, the more and more I learn, the more and more humbled I become. Doing these types of restorations is fun. It's kind of when I sold my practice and I said, well, you know, what type of dentistry? I had an opportunity to kind of figure out what kind of dentistry I wanted to do, and this was the type of dentistry that really appealed to me and kind of got me going and motivated and created a little bit of momentum in my life. But you know what, that could be a flipper in another country, that could be doing the best class II composite that you could possibly do, that could be doing Endo.      

MICHAEL: Endo is one of the most challenging types of procedures that we do in dentistry. And it's going to be different for everybody out there and there's nothing wrong with that. My best recommendation is for somebody, do the type of dentistry that gets you motivated to wake up in the morning, and get you going. Because you know what, at the end of the day, if you could give a little old lady, a ninety-two year old lady that comes in here and chipped her front tooth and you could bond her front tooth, and she's happy and smiling on the way out. You know how much joy you're going to give to that person. That person is going to be extremely appreciative, for somebody that you can do that. You don't have to do a full set of veneers on everybody that walks through the door.              

HOWARD: You know, Ryan just sent me, according to the University of Toronto, there are three hundred and fifty-seven implant companies. Wow. And that list is probably, I mean there's so many, but anyway, so you were using Zest Anchors for one, but you're also using the Jack Hahn system. Glidewell. Do you use any other systems?          

MICHAEL: I do. I use a lot of different systems and I actually started out placing Zimmer implants.          

HOWARD: The Zimmer biomet?          

MICHAEL: Yeah, now they've joined kind of forces right now.            

HOWARD: Now that you see back in the day, but I got an eighty-seven. That was three-i.              

MICHAEL: Yeah.      

HOWARD: Implant Innovations Incorporated, is that what it was?              

MICHAEL: Yeah.      

HOWARD: Then they got swallowed by Zimmer, they got swallowed by the Biomet, but aren't they near you, Zimmer, aren't they in Florida?          

MICHAEL: Yeah, they are in south Florida. They're probably about a three-hour drive from me. So, it's big here in Florida because they're centered here. So, we see a lot of those implants that come in. I would say that the implants that I see the most of, because we got a lot of patients that will come in that maybe have complications with their All-on Four and we have to go in there, fix them up, decontaminate implants or replace implants. I will tell you that a lot of the most common implant companies out there, and some of the best ones I would tell, you, Nobel Active, I would tell you is a great implant. I like it because of the primary stability. When you place it, it's easy to get nice primary stability. Bio-Horizons in terms of primary stability is excellent and even Implant Direct has an interactive implant.            

MICHAEL: They have a lot of different lines of implants through Implant Direct. But I liked the interactive implant. It gives really good primary stability. And because of that, you have some options when you're placing the implant, so that you can get a better outcome on the case. So, those are the three major ones. A couple of the companies out there that are doing some, you would call them knock-off implants, that are doing excellent, excellent work. We've used an implant company called Blue Sky Bio. And then more and more I'm seeing Hi-Tech Dental Implants.          

HOWARD: That's the name of the company, Hi-Tech Dental Implants? Can you find me that, Ryan?      

MICHAEL: Hi-Tech Implants USA dot com.            

HOWARD: I mean, my gosh, there's so many great [inaudible 42:23] like, Nobel, you use Nobel Bioactive. I mean that company was started by the inventor of implants, 1965 Brandmark places first titanium and dental implant to a volunteer and Paulo Malo out of Lisbon, Portugal invented the All-on Four and he went with no biocare. Implant Direct was Gerry Niznick. You should see the podcast I did with him. I think he started Core-Vent.

MICHAEL: Core-Vent implants. Yeah, which I believe, was that bought by Zimmer?      

HOWARD: By Dentsply and then he started Implant Direct and then Bio-Horizon, that was actually Carl Misch was the leader of that.  And that's made in the same time or in Alabama where they make the solid rocket boosters for the space shuttle. It's like a high-tech mecca city. My gosh, these are just amazing. And Zimmer is making the news because the biggest problem with, well they're the only implant dental implant company that does everything. I mean they do spine implants, and hips and knees, and they do every implant. And their number one problem with a hip implant is a staph infection and they think they've got a coding now that bacteria and they're not going to like. And so, Wall Street's very excited, I'm hearing that. But back to mistakes. My biggest mistake going back to 1987 is, I'd have these really old people come in and they were like eighty-five to ninety-five and you knew they needed all this work, but you sat there and thought, well hell, he's not going to live for another year or two.  Ten years later, they're still there. They're still golfing and showing up. When you're a little kid, I know when you're twenty-five and get out of school, them eighty-year olds look like they already are dead, but my god, you have to treatment plan that they're not going to die.      

HOWARD: Because number one, on my warranties, I always tell dentists, if you get a warranty at 5 years, I mean if you live to be a hundred and your dental work only lasted five years, well you'd have to replace it 20 times and now you're telling me, because a lot when they don't have warranties, like you see dentists in town where someone will snap a tooth at the gum line, they don’t know how to place an implant. So, they'll do a root canal post build up and a crown and a year later they walk in and it's in your hand. And I tell that dentist you have to warranty everything five years because if it does last five years, you don't know what you're doing and a human can't have their dental work replaced 20 times, if they live to be a hundred. And when you have to start warrantying, let's say when you get associates, because I'm going to warranty it.      

HOWARD: So then I will dock the associate their production and they will get mad and I'll say, well, a three-unit bridge would have lasted longer than what you did. And they say, well, I didn't want to file down to adjacent teeth. Well the customer didn't want to pay $2,500 for a root canal and a crown that will last them a year. And then maybe learn how to do implants. And another thing, a big mistake is that back to this human behavior, only 1% of people who smoke a pack a day quit within any given year. Only 1% of people who go to AA will quit drinking for the rest of their life. So, what made them lose all their damn teeth. So, if what made them lose all their teeth, their behavior, because they like Mountain Dew or they don't like to brush or floss or do any of that and their wife doesn't do it, and their mama doesn't do it and their whole neighborhood doesn't do it, then look at removable, look at fixed removable.            

HOWARD: I see way too many fixed implant cases that they come in and you're like, my god, did they not know that, I mean they're packing a whole bunch up there. And where I've got burned the most in the last 10 years is, you'd be surprised who's on meth and when they're on meth they have no saliva. And I don't want to throw communities under a bridge, but like out here, I don't know why, but my police officer patients tell me it's true, but for some reason it's a plague in Apache Junction. My friends in California, they say it just took Bakersfield by storm. And so, you start doing a bunch of dentistry and crowns and root canals on bridges on someone who has no saliva. Two years later, it's all mush. And I look at the money that I charge that person and it should have been a denture and a lot of the experts of meth say that they have to have never touched it for at least six months, before you'd ever consider saving a tooth. You see the meth out there in Orlando?          

MICHAEL: We see meth, we see everything. The truth of the matter is that these patients wouldn't need this type of work unless they had some kind of contributing factor a lot of the times. So, that's the nitty gritty of something like this and that's the reason why we offer all of the different options to our patients. It takes us actually sitting down with a patient, in a judgment free zone as we possibly can. And saying to a patient, hey, you know, no judgement here. It's ok if you do, but are you doing any recreational drugs? You know, because it's going to severely affect the outcome of your treatment if we don't know about that. So, that's one of the biggest challenges and nowadays, you hear about it on the news, the opioid epidemic that is hitting Florida majorly right now especially, but the whole United States, this is one of the biggest challenges that we're dealing with in patients.          

MICHAEL: And seeing you have to actually find out from these patients, this is a question on our questionnaire, are you using any recreational drugs? And sometimes patients are not going to be honest and they're not going to answer that in the best possible way that they can. Well, it does, it comes to light because down the line you start to realize, okay, there's something going on here with these implants. So, the glamour of doing full arch restorations and what-not, is wonderful because you get to change people's lives. On the other side, there's a lot of hard, hard work that goes on in there and I can tell you that there's been patients that have walked into my office and we didn't see it coming in and then all of a sudden, you start to realize that that work is breaking down far faster than it should have.      

MICHAEL: And then you ask them, “hey, what's going on here?” And a lot of times they’ll be truthful or you know, even sometimes they'll say, “oh yeah,” they'll come in with a two liter of Mountain Dew after they've gone and done their teeth and today we've gone and extracted an entire arch of teeth and placed our implants. So now they've got Mountain Dew, their Mountain Dew habit has not changed at all. And guess what, that stuff's acid. It eats up, it'll eat around implants.        

HOWARD: Actually, it's a big debate on Dentaltown. I agree with this one side of the deal, but other people don't agree with it. But anyway, the bottom line is all the soda pops use, I think, phosphoric acid. And, I think Mountain Dew uses phosphoric and citric acid. But there's this guy on there that did a video talking about titratable acidity and some dentist with a chemistry degree says he doesn't believe it, but, everybody in the street knows that people who drink two liters of Mountain Dew a day, they have an entirely different level of decay than people who drink Dr. Pepper. When people tell me that a dentist isn’t really a doctor, I say, well either it was Dr. Pepper, or Dr. Seuss or Dr. Dre. But yeah, there is a cool video, Just Google on YouTube, Mountain Dew decay. But by the way, I love having guys like you on the show. These companies you mention, Blue Sky Bio with Sheldon Learner was podcast eighty-nine. Carl Misch was two eighty-two, Gerald Niznick was six seventeen, Paulo Malo was five seventy-one. I love you guys for coming on and sharing so much. And also, when I'm in like Africa and Asia, it is so romantic to be in like Kathmandu, Nepal, and then people telling me, “my God, I can't believe I'm in Kathmandu, Nepal, on my Samsung listening to all these podcasts for free. It would take me literally three months wages, as a dentist to fly to America to see one course for one day and turn around and go back home.” And they just say, “I get to listen to the greatest people in dentistry for free on my Samsung. Because guys like you come on for free and share your story. So was there anything between a denture, four locators and All-on Four. Was there anything in between that?

MICHAEL: Sometimes we'll do a bar retained over denture. And basically what that restoration is, is where we, I don't have a model of that on hand, but, basically what we do is, we make a bar that attaches to our implants and then on that we place locator attachments or locator abutments onto, so that much like the removable prosthetic here, that clips in without having to use the denture adhesive, it will clip in just like that. Now, the advantage to that type of restoration is that it offers the best of both worlds. You have a restoration that's easily cleansable because you can pop it off and you can clean around the bar very easily. You can clean the teeth very easily. The other nice benefit to it is that instead of being a tissue-based restoration, that every time you bite down on food, you feel the pressure on the gum, the bar keeps that from happening. So, the bar will actually allow you to have a fully implant supported restoration. From a standpoint of a patient, that's more comfortable.            

HOWARD: A lot of people, they're always afraid when they do these locators that when they go to pick them up, that it's going to get the impressions going to lock in. Do you have any tips or tricks on the locators?        

MICHAEL: Locators. We actually buy the impression copings. So, there's a couple of different ways you can do it. You can actually do a chairside conversion, where you go and take the denture, hollow it out around the locator and pick it up with acrylic. But our process is a little bit different. We take our final impression with impression copings that go directly on the locator, so that when you pull that final impression out, part of the impression coping is located inside the denture itself or inside the impression itself.      

HOWARD: This is dentistry uncensored. So, if I were to ask you to stop, what did Gandhi say, they first of all disagree, then they will violently disagree, and then they finally agree. But some of the biggest controversies, are when people have to realize that All-on Four got so popular, is because then you didn't have to do sinus lifts, and is that one of the reasons that you think you like them, and people are grabbing towards All-on Four so you can avoid the whole sinus lift issue?              

MICHAEL: I think from a standpoint of yes, I agree. I think yes, avoiding the sinus lift is nice. From a practicality perspective, I think the person that really enunciated this the most, was probably Milo. When he started teaching this, and he has a great YouTube video that talks about the history of the All-on Four restoration that I would recommend. If anybody's getting into All-on Four, watch that YouTube, it's just called the history of the All-on Four restoration. And I would definitely take a look at that. The advantages that you're going to get from the All-on Four, when you're doing the sinus lift, you actually add time to the sequence of treatment. So, you're taking a restoration that with the traditional approach to a sinus augmentation might take twenty months. Also, there's added expense for the extra materials.            

MICHAEL: Our whole thing and our practice is we're trying to make this accessible to as many patients as possible. So, this type of restoration, or a fixed restoration in particular especially, we want to create a place where we can actually service more patients with this. So, from a standpoint of practicality, from a standpoint of speed that it takes to get to a permanently anchored restoration. For a qualified patient, I think the nice advantage of not doing the sinus augmentation, is you cut the treatment time down. So, a typical treatment time for an All-on four case can be around four months from start to finish, whereas the sinus augmentation might be about twenty months or so.          

HOWARD: I want to ask you more controversial stuff. Drawing blood. Some people, including the late Carl Misch said, voodoo, other people have said, hell no, it works. Before you get mad at me and start yelling podcast listeners, The New York Times was the one that brought it to our attention, there is no research on flossing. And as mad and upset as dentists got, the epidemiologist said, well, Howard, Mike, I don't care what you believe, there's no studies done on flossing that proves flossing works. Now, there's an art and a science, you and I know that flossing is a great idea, and that people who do it, it's better, but there's no research. That's what Carl Misch was saying about drawing blood and centrifusion and all this kind of stuff. Some people, like some of my best friends say, well, I guarantee it works. Is it art? Is it science? Do you draw blood? Do you do all that or do you think that's overkill?      

MICHAEL: We're just getting into using PRF.          

HOWARD: Tell them what PRF stands for.              

MICHAEL: Platelet rich fibrin, which is basically where you draw blood, centrifuse it down, and create a portion of the blood that has a lot more platelets in it, and healing factors in it, and then you place that in the surgical site. The advantages of that are that it’s supposed to be better healing for the patient. I can tell you that just from doing the few cases that I have done with it, I've noticed the difference in the post-operative sequella, after doing these types of cases, where we won't get as much discomfort from the patient. The patient won't be complaining as much about the discomfort after the surgery, which is nice. And a little bit less swelling in certain cases. In other cases, you're always going to, you know, when you lay a flap on a surgery, you're going to have to expect, you're going to get some swelling. So, that's just part of the process. 

HOWARD: Another controversial is, we like to talk about All-on Fours, but I love it when I look at the insurance data and they show the thirty-two teeth and then like a hundred million claims and it's just four spikes on the first molars. The four first molars, I mean, the ones that get the most restorations, the most root canals, the most crowns, the most extractions. I mean Glidewell. Jim Glidewell can show you reams of data. I mean, most dentistry is done on four teeth. So, when these people get out of dental kindergarten and they're twenty-five and they want to be like you when they grow up, and they place their first implant and you said the green light is on the first molars or maxillary second byes. When she does that implant, is she going to cement it or screw it?        

MICHAEL: I would screw it now. I think of the future of dentistry and the future of dentistry is screw retained restorations. And the reason for that is, I just love the way that on recall these screw-retained restorations, the tissue looks around them. And that's one of the reasons why in specific, I use Glidewell. I feel that they are the best lab out there at creating that restoration right there, that BruxZir screw retained prosthetic. I have yet to see a lab that can actually rival that. From emergence profile, I think those cases are just beautiful on re-care. The management of the tissue is just very, very nice. So, I would recommend and suggest for a beginning dentist, you're going to place your first implant and you're going to restore your first implant, put an closed tray impression coping on there, take an impression of the implant. Send it out to Glidewell, they've got a great deal on making a screw retained BruxZir crown. And when you get that puppy back, go ahead and screw it into place. Check the occlusion, check the interproximal contacts and I think you'll be pleasantly surprised.      

HOWARD: What if she wants hands-on training. Where would you recommend she go?              

MICHAEL: There's a lot of great courses out there. I would not hesitate to make recommendations. I know some of the nice courses here in Florida, I can definitely tell you the Misch institute is world renown.        

HOWARD: Is Craig [inaudible 1:1:25     ] teaching there now? 

MICHAEL: I believe he is, I'm not sure of that though. I have seen their students and talked with their students about taking those courses. When I first got involved with implant dentistry, I started taking the courses that were offered by the people that made the implants, which was nice. I took a few courses from Erin Gard. So, he's one of the guys down in Miami. And I think those were some influential courses for me. Another guy that really taught me a lot about implant dentistry, a guy in Jacksonville, Florida, who is one of my mentors, Joel David. I think his practice is one of the practices that has one of the most volume of dental implants in the country.          

HOWARD: What's his name?      

MICHAEL: Joel David and he is pretty amazing at what he does. And he's got a surgeon there named Dan Norfolk, they do a nice volume.              

HOWARD: In Florida?      

MICHAEL: In Florida. Yeah.      

HOWARD: Now you're coaching dentists. How are you coaching dentists?  

MICHAEL: I do it on a personal level. I basically started because I had a few friends that just asked me. They said, hey, I'm having a problem with this case and I'm having a problem with that case. Can you kind of help me out with this, and it started from there and a couple of my friends said, you know what, you should charge for this because I go into their practice and I help hold their hand as much as they possibly, you know.       

HOWARD: So, you go to their practice?        

MICHAEL: Go to their practice. Yeah, absolutely. So, it's a nice thing that we can actually do those green light cases together, which is really nice. I don't know about you Howard, but a lot of times, the way I learn is by actually seeing it step-by-step, actually being in the room as opposed to like a PowerPoint presentation. They're great, but there's something that you can actually learn by being in that room during the surgery. Some things you can pick up, so because of that, I think it's a valuable resource.              

HOWARD: Basically, they go to Orlando Lifestyle Dentistry dot com, and then there's a link there Contact for dentists and they email you? Or fill out a contact form?        

MICHAEL: Email me or they can actually call our office. Cindy, my mother-in-law, she will answer the phone.        

HOWARD: What's that phone number?          

MICHAEL: Four, zero, seven, fifty-four, SMILE (six, four, five, three). They can call. She'll ask them a few questions for our contact form and then I'll call them back and say, hey, let's talk about this. Let's see what we can do to get you trained up, get you feeling confident in placing dental implants.      

HOWARD: So, you go to their office, that's mainly what you're doing? And is it to help them over the shoulder surgery or is that practice management or lab work or what is it?              

MICHAEL: Mostly, over the shoulder surgery. So, we're offering that to doctors here in Florida. We hope to actually expand that.      

HOWARD: So, can they come watch you?              

MICHAEL: They can come and watch us. We actually offer a class where they can actually watch the entire process of teeth in a day from, start to finish. We do a surgical, a live surgery in the office and they can actually see that.

HOWARD: You know what the holy grail is now, an implant continuing to age can hands on surgery. People like Aaron Gard made a great business out of it. You can't do hands on surgery in Florida if you don't have a license in Florida, or if you're from California or Texas. So, they go to Dominican Republic where the license don't matter. I'm here in Arizona and there's amazing institutes if you drive into Mexico, into Yuma or San Diego and into Tijuana. But a lot of the women dentists, they don't feel safe. A lot of people don't like to go there. I quit going to Cabo because the last time I went to Cabo, I was robbed by the police officers. A police car pulled up behind me, two policemen got out, took my wallet and left. And I'm like, dude, when the police are robbing you, you know there's a problem, but you know what the holy grail is, you know what they're doing?              

HOWARD: They're going to homeless shelters and they're going to their state board and they're saying if a licensed dentist in good standing comes to the state, can they do volunteer free dentistry on the homeless? Well, who the hell would say no to that? And so, the first guy that did it was right here. What was his name? And it was my buddy at the homeless shelter. Chris Wolcheck. I love Ryan. He is, since I don't have a memory or a brain anymore, Ryan's my substitute brain. Chris Wolcheck who went to the state board and he found a homeless shelter just for vets. Well, how can you tell a homeless shelter for vets that Mike can't come down from Florida and do free implants on them. So, then another dentist heard that and he was in New Jersey. He went to his homeless shelter and had the homeless shelter call them.          

HOWARD: So that is the holy grail. You should find a homeless shelter in Orlando, and it's probably going to be like Mickey Mouse's cousin, Minnie Mouse's drunk niece and a bunch of ducks. But it's really cool because they're homeless, it's a dental clinic for the poor and you're getting a licensed dentist who love continuing education. You can really kill with this in so many ways. The dentists don't have to go to a third world country. Women, single dentists in America feel safe going to Orlando, but not really into Mexico, which has about ten thousand murders a year just in the drug trade. And it's cheaper. I mean, it just flat out cheaper to go to Orlando than it is to the Dominican Republic. So that's something you should think about. And really, I would love it if you made some online CE, because old people like me go to dental conventions, because we have to sit in a brick building and watch a guy do a PowerPoint slide, but the millennials are all on to this online CE and they say, before I go to a course, I want to see the instructor first.      

HOWARD: We’ve put up four hundred and eleven courses on Dentaltown, the views are coming up on a million, the podcast views past five million. They want to see you, to see you have the chemistry. They like what you're saying all that and like the [inaudible: 1:08:44] what they did is they have five different weeks. So, they did a one hour of greatest hits album of each one of their one weeks for online CE and that was really a great marketing thing for them because they'll give away a lot of greatest hits, a lot of kids watch that. So that was really interesting. I really liked that. Now, I want to go spend a week at the Pink [inaudible 1:08:58]. But Mike, it'd be amazing if you'd make an online CE course and it'd be also amazing if you could just throw something on the end of that course for Asia, Africa, and Latin America and show how many tips on a flipper because that ten-year old little girl in Tanzania who lost her front tooth is mortified and it changed her life when you can teach a Tanzanian dentist to give her number eight back. And that's just cosmetic. Hero stuff for six billion people on the planet.

MICHAEL: And that's huge, Howard and I'll tell you why. Because the more you can open that door to helping more people, being more impactful, that's where the real change is made in the industry. I really believe that. And I think what you do is, you connect to all those people together in one place. There's nowhere that you can go for that in one place that's so focused other than Dentaltown. So, I love what you guys are doing over there and I'd be happy to make a CE course. And I also open the door, if you're in Africa right now listening to this, one my goals in life is to meet a hundred thousand people. I would like to meet a hundred thousand people. So, if I could do that, that'd be great. You be doing me a favor. Email me. It's              

HOWARD: I love that, Mike does dentistry and your townie name is Influential Dentist. You're a cool dude, man. Seriously. I love your energy, I love your karma. I mean I just, I just love what you're doing. But, the internet, like Dentaltown or YouTube, it's really great at transferring information from all the old or highly experienced to the young within a country. But where it's revolutionary is transferring information from the twenty richest countries to the two hundred poorest countries. I was reading this detail in the Economist where these kids are barefoot, they got their Samsung, reading Wikipedia, they're looking at global images of their farm in Africa, and Asia, and South America. And they're sitting there realizing their overwatering the north part, they're underwatering in the south part. They need to rotate their crops and crop yields are growing faster now in Africa and Asia than ever before.      

HOWARD: And it's all because that kid has a smartphone and he's on Wikipedia. I just want to remind you one thing. I was born in 1962 when I was ten in 1972, mom found some encyclopedias that were twenty years old, printed in 1952 at a garage sale. And me and my five sisters thought we just got all the knowledge. Now, that kid gets a smartphone and Wikipedia is fifty-two million pages updated today. I think Homosapien is good. I think the smartphone in 2007, the next hundred years after that, 2107 will make the last century going to the moon, look silly. I think this is going to be our finest century.            

MICHAEL: Who knows? One day somebody is going to be doing dentistry on the moon and that would be really cool.      

HOWARD: Yeah, they're going to call it the smartphone century and 2007 to 2107 is going to be our finest leap.            

MICHAEL: That's really cool.      

HOWARD: Seriously man, we went over fifteen minutes. We've been here an hour and fifteen minutes. Love what you're doing. Love your energy. I love everything about you. It was an honor to podcast interview you today. Thank you so much for coming on this show and talking to my homies. I hope you have a rocking hot day and I hope to see you at the townie meeting.        

MICHAEL: You'll definitely see me there, sir. I love it, thank you very much.        

HOWARD: All right, thank you. And come and see both of us at townie meeting. It's April 11 to 14th.        

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