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AUDIO - HP #188 - John Heimke
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VIDEO - HSP #188 - John Heimke
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John Heimke, DMD shares details about full arch implants, and why he loves Digital Smile Design.
John Heimke DMD General Dentistry is an accomplished Cosmetic/Implant Dentist with over 26 years of experience. Dr. Heimke is known for his exceptional talents and unique skill sets in creating, amazing - Natural Rejuvenated Smiles.
Dr. John Heimke is a 1989 graduate of Case Western Reserve University School of Dental Medicine, earning his degree of Doctor of Dental Medicine (DMD). He also earned a graduate degree, Masters in Public Health (MPH) from Emory University. His Residency: Advanced Education Program in General Dentistry was completed at Ft. Benning, Ga., while serving in the U.S. Army Medical Department. He later completed his service with the U.S. Army at the 2nd Field Hospital, 576th Dental Detachment, Bremerhaven, Germany. Dr. Heimke is a Fellow of the Academy of General Dentistry, and Fellow of The Pierre Fauchard Academy. Dr. Heimke is a graduate of the Misch Implant Institute, Dental Implant Prosthetic Residency . He has attained Mastership level training with the renowned Aesthetic Advantage Advanced Aesthetic Continuum NYU College of Dentistry. Dr. Heimke has completed The Dental XP Online Dental Implant Externship 1yr Certificate Program, Stony Brook University School of Dental Medicine. Dr. Heimke is a member of The American Academy of Cosmetic Dentistry, American Association , Academy of General Dentistry, The Pierre Fauchard Academy, American Dental Association, Ohio Dental Association, and The Greater Cleveland Dental Society.
Dr. Heimke is in private solo practice concentrating on Aesthetic Restorative and Implant Dentistry, in Cleveland OH. He is a visionary, teacher, lecturer, and humanitarian He is married and has two beautiful daughters.
www.EveryoneLovesMySmile.com
jheimkedmd@gmail.com
216-496-8132 Cell
Howard: It is a huge honor for me today to be interviewing really a cosmetic dentistry legend in so many people's mind, my mind. You're always voted best cosmetic dentist in your area in Ohio. John Heimke, thank you for joining me today.
John: Thanks Howard, it's a pleasure.
Howard: You're talking to a lot of kids, there's probably about 7000 people listening to this. How does one go, how did your journey take you from leaving dental school like everyone else in your class to being a cosmetic guru and legend in your area?
John: I finished dental school at Case and then I went into the military. I did a general practice residency with the Army. Went to Bremerhaven, Germany after Fort Benning. Then after I did my tour of duty over there from 90 to 93, I came over to Cleveland, Ohio back here where my wife is from. We settled down and we started some associateships and then we bought a practice. I ended up in a 3 doctor group, and now I'm by myself. It's doing great.
Howard: What did you like more? Did you like group having camaraderie of peers, or do you like being just solo?
John: I think in the cosmetic implant restorative phase, I think that part of the practice really is conducive to the solo efforts that I'm doing right now. I do team with the surgeon and with a lab technician here in Cleveland, then I have additional labs too in Manhattan. That type of teamwork I feel works out better than actually in the same location, at least for me.
Howard: I got you for an hour today, lucky me and lucky to our listeners. What low hanging fruit tips can you share on what you've learned over the years? How many years you been doing dentistry?
John: Since 1989. What's that, 26?
Howard: 26, so 2 years less than me, that's why you have so much more hair than me. 2 years from now, you'll be just as bald as me. No, I'm just kidding.
John: Oh, really? I don't know if I'll still have my wife then.
Howard: What have you learned on your cosmetic journey? What do you think is the major takeaways that you've learned on how you can do exquisite cosmetic work versus some kid's starting out and doing his first anterior veneer case?
John: I think the big thing is number one you need to talk to the patient and then just listen and see what they are looking for. Then I want you to look at the patient's face and study the face, and then correlate that to what the smile is going to be. I think too many of us focus on the teeth as the first item as far as dentists are concerned, then we go to the face. That I believe is backwards. My mentor Dr. Larry Rosenthal, he taught me go from the face, then to the teeth. It seems to have worked out very well.
Howard: Larry Rosenthal told me I had a face for radio.
John: Really?
Howard: No, I'm just kidding. That's a good joke. I love Larry. When I did LVI, I was I think one of the first intro classes back when I was taught by Bill Dickerson in his dental office with Larry Rosenthal and David Hornbrook. My God, that was so fun. I think it was 4 3 day weekends in Las Vegas with those 3 guys. Could you have much more fun than that hanging out with Larry Dickerson and Hornbrook in Vegas?
John: That's a lot of egos.
Howard: Yeah. A lot of those egos, you almost have to have an ego in order to be confident. These young kids always get sold by the patient, I don't have money. Then they leave the office and drive away in a $30,000 car to their $100,000 home and they've already taken 3 cruises in their life. I think you need a big personality to be able to say, John, we can do that and it's going to look great and it's going to cost thousands of dollars. Don't you think the egos helps them? You don't meet very many humble cosmetic dentists for the movie stars.
John: No, I agree with you. I agree with you 100%. That's one of the things that those guys espouse, and are totally right in that respect. That was one of the things that I didn't have all that confidence years and years ago. I developed a lot of it basically because as you get better in your skills, you are able to demonstrate to the patient. The patient is looking for someone that is going to solve their problem, but they want to have that confidence that you can solve it. They don't want you hemming and hawing and giving them 5 different treatment plans. They want you to come up with a plan and say look, this is my plan, this is how long it's going to take, and this is what it's going to cost, because it is going to cost money. It's going to cost a lot of money. Then we figure out how to get that done, and then we do it. Just today before I talked with you, we just finished up with 2 consultations and we ended up, we have 2 patients each doing 20 teeth.
Howard: Is that 10 upper and 10 lower veneers?
John: It's a combination. I have one patient it's going to be a potpourri of bridges, veneers, crowns, all ceramic. Then on the lowers there's going to be some implant crowns and then some veneers. The other patient is all veneers. I couldn't have proceeded with them or they wouldn't have proceeded with me unless I came across as someone knowledgeable and confident in what my skills are. That's what those mentors taught myself and others how to do this. You can't do this by just being willy-nilly and talking about teeth and showing them little pictures and stuff like that. They don't care about that.
The other thing I found out with patients is in the job of dentistry, especially doing smiles, complete smiles, half of the work is mental. These patients are in pain. They're not maybe in physical pain, but they're in a mental pain. Once we can help them get through that mental pain, because they're coming to you with that problem. You can see it in their eyes. Look at the photographs before and after. Whenever you look at the photographs you always see that pain in their eyes. Wen they're done though, then all of a sudden it changes.
Howard: Nice. How did you learn that? Just years of trial and error? Did you take some training? Did you read a book?
John: I train wherever I can. Obviously I did the continuum with Larry, and I'd recommend anybody to do it. I also am a big reader and I got the book on Nordstrom, I got the book on Starbucks.
Howard: Nordstrom, do you remember the title, Nordstrom, Starbucks, do you remember any of those titles?
John: I can get it for you. I think it's The Nordstrom Way. Then there was a book on Starbucks, similar kind of book. It was written by somebody that used to work there and did a biography of the owner or the CEO and how they do their system. As you know, and you've probably talked about it, Starbucks, they don't sell coffee. In fact, they sell more milk than they do coffee believe it or not because of all the stuff they put in. Actually, their main product is the Starbucks environment itself. It's that feeling you get when you walk in there. That's really what they're selling. They're not selling coffee.
Howard: I got to tell you Larry Rosenthal's story, because it's just so Larry. It just sums up Larry Rosenthal who is a bigger than life person. By the way, do you still stay in contact with Larry?
John: Every so often.
Howard: Tell him I want to podcast interview him. I think that would be amazing. Larry has me come down and speak at one of his New York cosmetic events or whatever, this is way back in the day. I think it might have been 1989, 90, 91, something like that. I lectured his group, he's got a cosmetic deal and he's got a bunch of speakers over 2 days. After the day was over we went back to his office he had some emergency patients he had to check, and he wanted to give me a tour of his office. After we leave, if you guys don't know who Larry Rosenthal is, he's a good-looking guy, long black hair, ponytail, drives a black Porsche, has a million dollar condo overlooking the park.
When we left his office to go to the restaurant where we're going to meet his wife for dinner, he made 6 stops on the way home. He'd run into these various clubs. He would just go up to 80-year-old women who have all the money. He'd go, Margaret, and he give her a big hug and kiss her right on the lips. He'd say, "Margaret, I swear if you got your front teeth done, you'd look 60 years old. It would take 20 years off your smile." They're just gooing and gooing and cawing. He'd probably lined up 10 little old ladies, probably every one had 10 times more money than you and I combined, lining them up for $50,000 veneer cases. He's just always in sales mode and he's good-looking in a Porsche, he's always on. He just make old ladies in Manhattan feel good about themselves. He does his supermodels and whatever, but that's what he's doing. He's making people believe that if they give him a lot of cash, they're just going to look better and feel better and be happier. Wouldn't you say that, how would you sum up Larry Rosenthal?
John: I would say that's a perfect description. Not only with that, it's not just the talk, but he walks the walk. He has the skills. I use them every day in what I do. Every so often I will text him and tell him, Larry, I thank you for opening my eyes to the world of dentistry and cosmetic dentistry and major restorative. It's built my practice and I'm always in debt to him.
Howard: Yeah, an amazing guy. Dentistry has adverse natural selection. They only let you in dental school, med school or law school if you sat in a library and made straight A's in calculus, in physics, in geometry, in trig and all that. The natural selection is you got all these scientists, engineers, mathematicians show up. How do you take those people out of school, because the dental schools aren't going to accept you. If you're Larry Rosenthal and you had a personality and you had a girlfriend in college and you joined a frat and you just made a handful of A's, B's and C's, they're not going to accept you. You have to be a geek sitting in a library for all of undergrad. You naturally selected out all those Larry Rosenthal type personalities. That's why they're so rare in dentistry. You're talking to a bunch of kids right now driving a car, they're afraid of their own shadow, they can't ask their patients for referral. They're afraid of their own shadow. How do they sell veneers to people who want to trade money to look better and feel better?
John: First off, you have to develop your own brand of who you are. You have to consciously think, this is exactly what I did years and years ago. I said, how am I going to do this? I was that kind of nerd. I wouldn't talk to anybody openly. I would always sit in the corner of a room and things like that. What I did was I said all right, I've got to develop my brand. If I want to do this type of high end dentistry, how am I going to do it? First thing I did is I went to an Italian men's suit shop and I said, "Dress me." They dressed me. They showed me how to dress. Then from there I made sure the office was commensurate with the level of care that I wanted to do. As you can see, this is our reception room. My office by the way here has 3 operatories and has 900 square feet. I have one major treatment room, I have an overflow room, and I have a hygiene room. We're doing these major cases all the time weekly.
The other thing that I did is again I started reading business books all over the place. Whenever I could get one, I would get it and read it from page to page and start taking little tips out of there. I also took coaching from Dr. Bill Blatchford. Excellent, excellent resource. He taught me to concentrate on asking questions of the patient, that big question of asking them, why are you here? How can I help you? What's your budget? Try to get to that in the beginning. You want to know where they're at. If somebody buys a house, the real estate agent doesn't say, takes you to a neighborhood for $2 million houses but you can only afford $200,000 houses, that's ridiculous. You got to find out where they're at. You've got to also let them know, hey, it's going to cost this much money. Are you prepared to do that? If they say no, then it makes no sense to spend another half hour talking with them about doing this type of work. You have to find an alternative then. Maybe there's an alternative practice.
Howard: Back to consultants, you said you had Bill Blatchford come out. Bill is a chunk of change. Every consultant tells me the same thing. Everybody that desperately needs them won't pay a dollar for it, and then all the successful guys like you and me and Jerome Smith, all these big practices, we always buy consultants. Consulting is just so bizarre. The people who would benefit the most ...
John: Don't do it.
Howard: They won't do it. Then people like you, you're investing big money in Bill Blatchford just to be a little better, a little better, a little better. The guys who could invest the same money and be twice as better overnight, they won't even think about it.
John: No. Dentists as you know are notoriously cheap. They'll squeeze the crap out of a Buffalo nickel as they get a chance.
Howard: Oh, that's a good one. That's a good one. I like to joke, did you know dentists invented copper wire? They were fighting over a penny.
John: Yeah, same thing. Dentists are cheap. They're just cheap people. We have to change that. I really think if you want to be a success, especially now in the type of economy that we have after 2008, it's not a gimme anymore. You really have to work at it to do it. I prefer to work on 2 patients a day and crack my nut versus having to work on 10 or 20 patients a day and crack my nut. It's whatever you'd like to do as a dentist and how you want to run your practice. For me, I think economy of scale, it's much easier to work on 1 or 2 people, do an arch, and then change the room around twice than to do it 8 or 10 times. I don't know how you feel about that.
Howard: Absolutely. You're right about the 2008 economy. I like the chief economist at the American Dental Association, every once in a while, about every 6 months he'll put up about a 2 minute YouTube video. His last one was lattes, lawyers, and dentists, what do they have in common? It was that after 2008, now that the economy is back full swing, what are the only 3 areas that didn't recover? Money paid to the dentist, money paid to lawyers and money paid for lattes, coffees, Starbucks. They're not back to 2008 levels. Do I assume you don't take dental insurance, or do you?
John: No, we do. We're a fee-for-service practice but we'll fill out the forms.
Howard: You'll fill out the forms and they submit them, or you submit them?
John: No, we'll submit them.
Howard: You'll submit them? I'm going to call, everybody listening this is going to say, dude, where do you get these big cases? How do you get these big cases? Just years and years of reputation? Is it mostly word of mouth referral or are you a big advertiser in high-end women's magazines? Then the other question I wanted to ask, sorry, I throw so many questions out at one time, I don't know if it's just me because I was born in a barn from Kansas. I always think of cosmetic work is for woman. What percent of these cosmetic cases are for women versus guys?
John: In my practice, 85% females, 15% males. As far as full-arch implants like [pretel 00:15:56] bridge, 50-50. As far as cosmetic veneers, things like that, it really is about 85-15 females to males.
Howard: The reason I'm trying to pin this down, because I don't want dentists spending a lot of time trying to get a case out of some guy that's not going to do it, can you say anything about these guys that might make them easier to spot? Are they people trying to look good because they are in sales or are they models? Do they have anything in common?
John: Yeah, as far as the males are concerned, I think you've got the male that might have had a life change where he got divorced or he might be older and he's starting to look to settle down. Something must have happened. Somebody must have told him and he wants to get his teeth done, so he comes in for the consult. Females are a little bit different. They are usually, something is gnawing at them, again, there's something that they're just not happy with that look. It bothers them so much that eventually something triggers.
I learned something from you years and years ago. When you started doing Dental Town, you were talking about the Internet and everything like that. I was thinking about the Internet, and then finally I came to the conclusion, I said, this Internet thing is actually pretty good. I started cutting back my print advertising and going into Internet. Basically we built a website that's all video driven. I don't know if you've seen our website, but 90% of it is all video driven. The patient gets to visit me ...
Howard: Are you talking about Everyone Loves My Smile?
John: Everyonelovesmysmile.com.
Howard: Yeah, it's an amazing website. In fact, I just cut and pasted it and changed your name to Howard Farran, and changed the address to Phoenix, Arizona.
John: That'll be a million dollars.
Howard: I'm just kidding. Yeah, I love your website.
John: I trademarked the practice name, the facial aesthetic designers, I did that. Found a trademark attorney in Columbus, Ohio via the Internet. We trademarked it, didn't cost that much, under $2000. I own that name. Then I also decided to brand it. We do certain things in the practice. I look a certain way, I have my brand right here, I have my logo on my jacket, all my team members have the logo. I want everyone to look like they're working at the clinique counter, because I deal mostly with females. My assistance wear black underneath, and then they wear a lab coat. I wear a lab coat and a tie. That's what I do.
Howard: I love the color of that tie. What is that, fuchsia?
John: Yeah, it's something like that.
Howard: Fuchsia, pink, yeah. Rocking hot tie.
John: That's my trump tie. I have the blue suit to go with it. That's what we did, we branded the practice, and then I started to do, we had the website. From that point on, then all of a sudden Facebook came in, Twitter came in, Blogger came in, and YouTube. The one thing that I do a lot of is video blogs. I will take my iPhone and I will put it here in my reception area and I'll do a 1 minute, 1 1/2 minute video about a topic in dentistry. Obviously what I do is cosmetic so I'll talk about cosmetics, implants, how I design a smile, things like that, then immediately I'll load it up to YouTube. Because YouTube is owned by Google, it gets ranked very quickly. If you go on to Cleveland and type in cosmetic dentist Cleveland, go on the video page and see where I am.
Howard: How long are these videos?
John: They can range from 30 seconds to a minute and a half. You don't want to go over 2 minutes because people in this day and age, they're video driven, they want to see everything visually. They don't want to read a lot of stuff. They're not going to stay on it very long. They're not going to stay on it very long. You want to keep it under a couple minutes. I do local TV shows. They have a chat show at NBC here in Cleveland. I'll do that periodically.
That's how you get the confidence also, because you start to do these little videos, and you might be a little rough at first, but people don't mind that. They understand you're doing it. Actually, they like it better than a very slick thing that's done where it's edited by a professional and all that. The other thing is you're going to get confidence when you go on these shows, because then you can, you're speaking to thousands of people and you just get that feeling, hey, it's not so bad. Then you can sit back, and then when you're chatting with patients you can have a better rapport with them because you feel more comfortable doing an interaction.
Howard: Let's talk about, you say you basically went from old-style print, yellow page newspaper printed physical stuff to digital.
John: Right, we don't do any Yellow Pages anymore.
Howard: No yellow pages. You mostly do digital. It's a great website, everyonelovesmysmile.com, and that's getting good Google search because you feel you're placing a lot of 1 to 2 minute YouTube videos.
John: Right. You can edit it yourself. I would try it, just use your iPhone. I bought a little thing off Amazon, those little tripod for $15. I do it myself. You don't have to hire some guy that's going to charge you $1000. That's another thing, dentists hire sometimes people to do all this stuff, the website was expensive but doing your own video blogs is virtually free.
Howard: Did you have a dental company build your website or was it a non-dental company?
John: No, I had Jamie Lynch out of San Diego from veneervideo.com. He does not only dentists, but he does regular businesses other than dental. He cut his teeth on dental and he really knows video marketing and how all that works.
Howard: Jamie, J-A-M-I-E L-Y-N-C-H, Jamie Lynch?
John: Veneervideo.com.
Howard: Is veneer the dental veneers, or is that used in another way?
John: Like I said, he cut his teeth so to speak on doing these websites for dentists in the beginning, that's what he called it, veneervideo.com.
Howard: Okay, I think I just found him, and now I think his name is San Diego production company, is that right?
John: He might have changed it, yeah. Run Star Media or something like that. Jamie is phenomenal. He's an innovator and he was telling us to get into video before any of that ever came into being.
Howard: What about Facebook and Twitter?
John: I have my private Facebook page, I have the business Facebook page and all that. I constantly add content to that. Twitter, I link it, one key thing with social media is you want to link one to another. Twitter to Facebook, Instagram to Facebook, things like that. You also want to do a blog. I do a blog. Blogger is what I do. Blogger is owned by Google. It's very good when you put a blog on there.
Howard: Bloggers is owned by Google?
John: Blogger is owned by Google. B-L-O-G-G-E-R.
Howard: B-L-O-G-G-E-R, is there an S?
John: No, it's just Blogger.
Howard: Blogger.com?
John: Yeah.
Howard: I like to know all the Google properties, because 85% of the searches minimum are done on Google, and a lot of people believe that if you are creating content on YouTube or their properties like Google plus or YouTube or you're saying Blogger.com, that that helps your SEO.
John: Yeah, all that stuff, all those little things feed him. It's like multiple paths to my website. Everything goes to my website. Any advertising I do or marketing that I do, I want it to go to everyonelovesmysmile.com. I don't want it to go to John Heimke, nobody will remember that name. I want them to go to everyonelovesmysmile.com. Why did I pick everyonelovesmysmile.com? It's natural. The patient says it, mentally they're going automatically now, everyonelovesmysmile.com. Maybe if I go to that place, everyone will love my smile. You got to think a little bit, and that's where the business aspect comes in where you learn how other businesses do things, how they figure it out. They're spending millions to do that.
These businesses don't sit on their laurels. IBM, Google, Microsoft, all these places constantly send their managers and employees to training, like you were saying about Bill Blatchford. They're constantly training their people. When they're doing that, those are potential dollars that may go to that company but not come to us. It's not all about dollars, obviously it's what we do with the smiles. We have to get paid. If you want to attract these people, you're going to have to work at it a bit.
Howard: What percent would you say that people coming in and getting a full smile makeover are fixing themselves up because they just got divorced? It seems like I always notice that a lot. Do you notice that a lot?
John: There's a fair amount. I can tell you what happened since 2008 too. A lot of people, companies downsize. When it comes down to firing this person or this person, they've done psychological testing, and they found out that HR people are saying, I'm picking the better looking person and the one with the better smile. It's just a fact of life.
Howard: That's why I chose to own my own company.
John: There you go, me too.
Howard: Did you find it?
Speaker 1: That's the one on YouTube, he's got his name all over but I can't find one site that has a bunch of videos.
Howard: Okay. Yeah, we're not finding that site for Jamie Lynch.
John: Yeah, veneervideo.com. You can try, I don't know, maybe change the name of it. I'll get that information to you. I'll contact you.
Howard: We'll put it in the notes. We always get the transcript of these and put them on Dental Town so that, most of our listeners are actually commuting to work. The reason we go an hour long is because that is the average community of my listeners. What's surprising is it doesn't matter if it's in a big city like Cleveland or rural, most dentist have an hour commute. That's why we do an hour long. We get a transcription of all these and put them in the notes so that these dentists aren't trying to take notes while driving or have to pull their car over on the side, you'll get that to me. I was also wondering when I was reading your background, you have a very interesting background. You started our military. Why did you get a Masters in public health?
John: One of the things at that time I was interested in doing some teaching when I was going to be older. They had a good program at Emory that dealt with business administration. I said I think I'll take that route, because it was like a major track. You could take 5 tracks, epidemiology, health administration, I don't know, epidemiological intelligence service, and something else. I said all right, I'm a general dentist, I'm probably not going to specialize. I said I want to have a Masters degree for some credentials. It went along with it, so I got it.
Howard: I want you to talk about, you're a developer and you're associated with the pink hybrid implant restoration, the digital smile design, the virtual lab contents. Will you talk about some of those?
John: Sure. Digital smile design, that has been something that I've gotten into in the last year. Christian Coachman, Dr. Christian Coachman, one of the foremost ceramists and cosmetic dentists in the world developed this concept of digital smile design. Actually I'm going tomorrow for 3 more days of Dan's training in Manhattan with my lab manager.
Howard: From Christian? Christian is going to be in Manhattan?
John: Yeah. Christian Coachman is going to be there. They're going to be doing their presentation on digital dentistry and how to do these digital smile designs. I've incorporated, since I took my initial training from one of his instructors, Andrea Ricci in April in Toledo, I've now incorporated digital smile design in every smile case that I do. I'll tell you basically what it is. It is a way that you can communicate to your laboratory as if the laboratory technician was in your office. It's basically a Keynote or PowerPoint presentation that has photographs. It has video, it has a video narration from me talking to the lab person saying, I'm Dr. John Heimke, this patient is patient X and we're going to be doing this on this patient. I would like the teeth this long, I would like to achieve this goal, blah blah blah.
Then I go into a design phase with a PowerPoint that shows the face, and then it shows intraorally. I'm able to use a calibrated ruler that the full face and the intraoral photograph are all calibrated. The technician can take that digital ruler, put it on the teeth, and know exactly how long they are. I can design how much gum I want to alter or change. I can show that I want to take a tooth out or I want to put an implant here. To me it's the ultimate in communication. The real big thing about it is the video. Christian has talked about taking video of your patient, having them say count from 69 to 60 for phonetics. Take a side view and have them smile and relax. Do a facial view, smile and relax. Have them read a few sentences. You want to look at that face and you want to see the facial dynamics, the muscle dynamics, and how that relates to their pre-op smile. Then you can do it later when they're getting their temporaries and confirm where they're at. That's really the revolution.
Howard: Okay. What would someone who wanted to get this Christian Coachman who's an extremely famous cosmetic dentist out of Sao Paulo, Brazil, correct?
John: Yes.
Howard: How would they get this digital smile design? How much does it cost? How would they learn how to use it?
John: The beauty of his system is you're using PowerPoint or Keynote. If you have a Mac and you have Keynote, then he's going to teach you to take photographs, he'll tell you what photographs to take with your digital camera. Then you can take your video, I do it with my iPhone. Then you incorporate it into this PowerPoint presentation. Then I use Dropbox or one of those kinds of systems to send it to my laboratory. You can also ...
Howard: You didn't have to buy anything from Christian Coachman?
John: No, just the training.
Howard: The training shows you how to use existing technology. It sounds like you're a Mac person. You're using Keynote on Mac and you're using an iPhone. Christian, you give him money learning how to use the system, but you didn't have to buy a package from him.
John: No. Now they're coming up with ways of communicating to different lavatories all electronically through digital. There's some costs there, but I haven't gotten into the point. I don't know if I will at this point. It's more the digital smile design, which is phenomenal. When I've sent it to my laboratory to Peter Kouvaris in Manhattan, my oral design ceramist, he called me on the phone when he got the first one. He said, "I can't believe the information that you're giving me here. I actually have video of this patient doing their phonetic sounds. I'm seeing the side of their face, I'm seeing them move versus just a picture of their face." He can do so much more with that when we're designing the wax up and the smile.
Howard: Who's the lab man, what's his name?
John: Peter Kouvaris.
Howard: Have you spoke of ours?
John: K-O-U-V-A-R-I-S.
Howard: Where is he out of?
John: He's in Manhattan.
Howard: You're using a lab in Manhattan, New York?
John: Yeah, for 14 years.
Howard: Wow.
John: He's an oral design ceramist I don't know if you're familiar with Willie Geller. He's one of the foremost ceramists in the world.
Howard: Willie Geller, do they work together?
John: No, Willie is the mentor for this group of 60 master ceramists.
Howard: What's his name, Willie what?
John: Geller, G-E-L-L-E-R.
Howard: Where's he at?
John: He's in Switzerland, either Zurich or Geneva. I forget which, I think it's Zürich.
Howard: Are they big Kevin Coachman fans too on this digital smile design?
John: Peter is going to be taking the course with me tomorrow over the weekend.
Howard: If you did this, you would need your lab man involved with that obviously.
John: They don't necessarily have to take the training. He wanted to take the training so he could have even more information on it. He got it right away. As long as you have a computer, for example, he's not Mac, he's PC. I just convert my PowerPoint into a, my Keynote into a PowerPoint presentation. I sent that over Dropbox to him. He got it right away.
Howard: That leads me to another question. You're talking about your lab man. In our lifetime CBCT, I mean CAD/CAM is getting big and huge. There are a lot of cosmetic dentists saying they're doing veneers with CAD/CAM. What do you think about that? Are you doing any anterior cosmetic work with CAD/CAM or are you sending it out to man-made labs for that level of aesthetics?
John: For that level of aesthetics, we're doing man-made. I really think no matter what, digital, I love it. I really love it. I think it's great. However, that 20% or 25% to really take it over the top from an average to an unbelievable veneer, you need that master ceramist to do it. You need somebody that's literally a master in doing that so they can take, they can blend the shades, they can then bring out the life in the tooth. It's a team effort though. The dentist can't be a slouch. He just can't say here's my impression, here, you take care of it. It's literally we're on the phone talking about each case, but now we're using digital smile design to do that little bit more so he's not on the phone as much. Then we're getting that superior result. We've even come up with a concept, I'm sorry, we've even come up with a concept, like we're doing Skype right now. We've done a few Skype consultations from my office in Cleveland directly to Peter in the lab while I have the patient in for consultation.
Howard: Are you Skypeing right now on an Apple Computer?
John: Yes.
Howard: Okay, because Skype is owned by Microsoft, interesting. Back to America, in our lifetimes, when I got out of school in 1987 there were 10 times as many programs teaching you how to be a lab tech. When you're talking about a master ceramist, it pretty much closed all those programs down. Seems like whenever I meet a master ceramist, they're always from Europe, Germany, you said Switzerland, Sweden. Do you see the master ceramist pool of master ceramists shrinking and shrinking and shrinking? Is it almost a dying lost art, or do you think it's going to rebound? What do you think about that situation?
John: I think there's some young guys out there, the DTG guys that are like the young bucks, the hipsters of high-end cosmetic dentistry. I see them coming up. That's going to be a small part, I think it's going to be about 30% of the market. The big worry that we all have to worry about as dentists, I assume you know the average age of lab owners in this country right now. Do you know what that is?
Howard: What is it?
John: 54.
Howard: 54. That's young, because I'm 53.
John: We're in trouble.
Howard: What are you saying, I'm getting old and getting ready to die?
John: I'm going to work to until 70, you probably are too. Listen, these guys that are lab owners, 54 is the average age of that owner. He's going to work maybe another 10 years. That's the majority of them. Imagine when they start retiring in bulk. Who's going to take over from that? What are we going to do?
Howard: Yeah. You know what, when you've lived half a century, you start losing things to right and wrong and you start understanding, you see patterns. I always see the cycle. From 93 to 2000 when the stock market's going to go up every day forever, and then it comes right back down. Right now people think, they're taking the last 10 years of the growth of corporate dentistry and they just keep saying it'll do that every same unit of time. You just know that's never going to work. Everything ebbs and flows, ups and downs. I'm almost smelling a rebirth of the small lab. I really am.
John: I would think so. It's going to be a 1 or 2 person laboratory.
Howard: Yeah. Niche markets to where you if want the wham bam thank you ma'am, the big mass-produced digital stuff, that's all good. When you start having, I get nervous when some guy comes in like me, looks like me, some older guy, whatever. It's all good and we can do CEREC, CAD/CAM, same day, front tooth, stain, glaze, whatever. If they start coming in and they start looking hot and they start pointing and talking and you just realize it's another level, I switch to man-made every single time without even blinking. I'm not even going to go there. My listeners, you've got 7000 dental homies listening to this thinking, man, this is a lot. Going from setting up this digital smile design, how would you recommend someone listening to start learning more about that?
John: The one thing with digital smile design, you have to take the course. You have to take the training.
Howard: How would they find that course?
John: Either Christian Coachman, DSD.com, DSD.com. Digitalsmiledesign.com. You should get to the website. I know after New York they go to Las Vegas. After Las Vegas, it might be Mexico or something like that. I know he's completing a world tour. I think he's going all the way to December. I think there's 3 or 4 more dates coming along.
Howard: Boy, you know what I wish? I wish you and your lab man, I wish you and Peter Kouvaris would make a 1 hour online course on Dental Town to go into more detail about that, both ends of the same stick where you guys are talking about that. I think that would be amazingly cool. Have you ever thought about doing something like that?
John: Yeah, we can do that, no problem. We can get something together. I can get Peter on, he's a very dynamic personality. He's a true artist. In fact, if you look at my YouTube page, there's a video with Peter and I at his studio in Manhattan. He literally is a block from the flatiron building down there in Manhattan on 18th Street, 18th and 7th I believe. It's a fantastic facility. I have patients from Cleveland, not a lot but a few, that really want that specialized care. They didn't want to do a Skype. I said, "I'll tell you what, do you ever go to Manhattan, do you want to go see a show over the weekend?" They said, "Yeah. That wouldn't be bad, I could go up there."
He sets up an appointment with them and he'll do a personalized consultation with them. I just had a patient do that. She went up there, gave them a call 2 weeks or 3 weeks ahead of time. She was going to be there for some business and then do some personal stuff. She made the appointment and she did a personal consultation. Now he's completing the wax up, then we're going to go ahead and move forward with the case.
Howard: If you're going to get a play, I still think of all the, I've seen so many plays. I still think Wicked was the best play I've ever seen. Did you ever see that one?
John: Yeah, it is good.
Howard: Did you like it?
John: Yeah.
Howard: Was that one of your top faves of all time?
John: I'd say it was probably in the top 10.
Howard: Name some other top tenners that you liked.
John: I liked the Rodgers and Hammerstein plays, South Pacific, Sound of Music, all that classic stuff. Carousel, all that kind of stuff.
Howard: Did you see the Book of Mormon?
John: No, I haven't seen that.
Howard: Everybody loves that. They say you either walk out in the first 5 minutes or you laugh your head off and stay for the whole play, no in between. Talk about the pink hybrid implant restoration.
John: The pretel bridge, which is basically a full arch implant supported bridge. It's made of milled zirconia. I like to have monolithic milled zirconia. You can also layer it. The problem with that is if you're ever going to have a potential area of fracture or chipping, it's going to occur where the porcelain, even though it's the pretel porcelain, where it's layered to that substructure. Where I hang my hat on this restoration is that zirconia will not break. It can, but it's going to break in fabrication or if you didn't design it right. It will not chip. You know zirconia, how strong it is, it just does well. When you make it out of monolithic, everything but gums and the teeth are all made out of one puck.
Howard: History has burned us before. Remember back in the day when the targets came off the [vectors 00:41:00] the art glass. Whenever you put two Oreo cookies together held by a cream, the juncture is the weak spot. It's just simple physics. That's what you're saying to avoid. You just like one material, you just like the cookie, you don't like it juncturing and attaching to another one because that's the area where it can go wrong.
John: Right. These patients that are opting to have their teeth extracted, because most of them, they have failing teeth. We're going to remove the remaining failing teeth, we're going to then place 4 to 6 implants. At the same day we're going to create conversion bridge. They go from crappy teeth to a beautiful conversion bridge that's screwed on that doesn't come in and out in about 4 hours. Then about 3 months later, we start the process of making the monolithic zirconia bridge. I like it better, and I'll tell you why.
What converted me was I had a patient that had a titanium hybrid wrapped in acrylic and with denture teeth. It's done very, very well. He's had it for almost almost 10 years. He comes in and he says, "John, my teeth are wearing and I broke this tooth off. What do I do?" I look at it and I said, "It's a success, you've been using it." He goes, "I love it, I love it. I don't like this that it's wearing." I said, "Because it's acrylic. It's like a tire on a car. If you put 50,000 miles on a 45,000 mile tire, eventually you got to get a new tire."
Howard: I want to ask you a very specific question based on someone as beautiful as that woman behind you. The woman behind you with all the nice teeth, she has a very high smile line. You can see all of her gum tissues. This is going to be a nightmare case because she's gorgeous, she has a high lip line. When a woman like that walks in your office and she's missing a single anterior tooth, and you're an elite cosmetic dentist, would you rather meet that challenge with a 3 unit bridge or an implant and a crown?
John: I usually opt in this case for a 3 unit bridge. I'll also probably not just do a 3 and a bridge, if it's number 8, I'm going to probably go and do more teeth onto the other side. Otherwise it might look awkward. We can get very close, but it's like I had a patient come in the other day, fractured number 9, some kind of sports injury. We didn't just do number 9, we're doing 8 and 9.
Howard: You agree, we both agree that if aesthetics is your number one priority, you can probably nail it better with a bridge then an implant and a crown. You just don't know how the implant's going to heal, you don't know whether the tissue is going to end up. There's just so many unknown variables, which if you do that to me, we're all good. If you did it to the woman behind you, she's not going to be a happy camper if that implant is showing or metal, correct?
John: I'm in agreement with you on that, yeah. I know there's guys that say they do wonders and all this, but still, in the interior, being the kind of practices that we have, we have to produce for these patients. They're not exactly patient all the time. Like you said, you get the little bit of a recession and you show a little black, you're sunk.
Howard: I'm going to ask you another question specifically. Obviously gravity is pulling every one of our body parts down to the ground. When you see young girls, high lip lines when they smile, it looks like their upper liver is showing. Every 10 years that lip's just coming down and down and down, and they want teeth to show. What do you do when some lady's in there and she's 60 years old and her lips are hanging so low she's not showing teeth, she wants these big [inaudible 00:44:41] How far do you go lengthening teeth for a smile? Another thing on the age, when you're looking on TV, these guys that are 80 years old, they don't show any upper teeth. In fact by the time they're 80, they're showing lower gum tissue. On top of that, as they're using their teeth for 6, 7, 8 decades, they're wearing their teeth down. They're wearing their teeth down from erosion and abrasion. Their teeth are getting shorter and their lips are coming down. How much do you lengthen anterior teeth so that they can show some teeth when they smile?
John: Obviously there's some limits in there. Personally my ratio that I go by is I go by is I like teeth to be somewhere between 10 and 12 millimeters in length. That's my ideals.
Howard: For central incisors?
John: Yeah. I really don't go that much further, maybe a millimeter in some cases. I really don't vary that too much. Now, a lot of times when we're building a smile, the buccal corridor is deficient. A lot of things go south on the side, and that brings everything down. One of the things that we do is we build out that buccal cord or right and left. I also have Peter build a height of contour in the gingival third. That'll cause the muscles on the inside of the mouth to cause that lip to evert a bit. You're going to get a millimeter or so from that. It's an internal face lift kind of look there.
Howard: Since you opened that Pandora's box, what do you think about Botox and Dermafill? Are you using that, are you doing that yourself for some of these cases or are you sending that out to a cosmetic dermatologist?
John: Yeah, I was trained by Louis Malcmacher on Botox and fillers. I do it very conservatively. Botox, I love Botox. All my staff has Botox. Botox is an excellent product. I just can't say enough about it, and it's a self recall kind of thing. Dentists, if that's in your state and it's allowed, take the training. It's an excellent adjunct for the patient. Especially, look, when they get their teeth done, then they do want to look a little bit younger. The Botox will cause these wrinkles to soften a bit. I only do the forehead, I do the brow and a little bit the crows feet. That's the only areas I do. Then I do a little filler on the nasolabial areas and I'll do the lips a bit. Most of it is Botox though. I think it's an excellent, excellent adjunct. Considering that people come in on a 6 month recall anyway for cleanings and that, that's a good recall for that product.
Howard: You would recommend training by Louis Malcmacher? God, that's a hard name. Is it Malcmacher?
John: Malcmacher, yeah, something like that.
Howard: Malcmacher, I love that guy. I love him. He's just an adorable man and I love his wife. He's just great. You'd recommend him to train you up for Botox?
John: Yeah. It was excellent training. Like I said, I haven't looked back on that. I think patients, they'll come to me and I'll do it. If they want really weird spots for the Botox, I say, "Look, go to your dermatologist, go to your plastic surgeon." Now the plastic surgeon in my area loves me because a lot of times the patients will want their eyes, they have big baggy eyes. I'm like, "Look, go to this guy. He's very good, he'll do a nice eye tuck there, and your Botox is doing what he needs to do." Now it's time for a little eye job. I'd much rather have an eye job and a little Botox than getting my whole face tightened up.
Howard: How much do you charge for these Botox tucks, how much time does it take you? How much does it cost for you to buy this stuff?
John: Botox is sold by the unit. I think a bottle of 100 units is about 550, $600. Let's say the average patient takes about 37 units, 38 units. The price range in Cleveland I know ranges from about 9 dollars to maybe $20 a unit.
Howard: How much do you charge?
John: I'm right in the middle, I'm at 15.
Howard: If you bought that 100 units and you're at 15, you'd buy 100 units for $600. If you use that all up, how much would that be?
John: Whatever 15 times, $1500, yeah.
Howard: $1500, and how much time would that take you?
John: The average Botox patient, let's say they're coming for a recall. Recall takes 5 minutes.
Howard: Takes you 5 minutes?
John: Yeah. Injecting it takes about 2 minutes maybe.
Howard: What percent of the patients like it?
John: I would say 99%.
Howard: 99% look in the mirror and say thanks Doc, that was worth it?
John: Yeah. We do not call them back. Right now we're getting into the holidays are going to be coming up. I told my staff, we better order Botox. The other thing is, it's one of those things you get it in a day. You don't have to keep, unless you know you're going to have a tremendous volume, you don't have to keep a lot in your stock. You call them and you say, look, I need 2 bottles. You get it tomorrow.
Howard: Where are you buying this from? Does your dental supplier, does Patterson Shine [Benco 00:49:59] sell this or do you buy it somewhere else?
John: No, I buy it directly from Allergan, the people who make Botox.
Howard: Okay, spell that. A-L-L-E-R-G-E-N?
John: Yeah, Allergan.
Howard: Allergan, A-L-L-E-R-G-E-N?
John: Yeah.
Howard: Interesting. How long have you been doing that?
John: 5 years.
Howard: How long do you think it usually lasts?
John: It lasts anywhere from 4 months to 6 months. The nice thing about Botox is it has a cumulative effect. Once you start doing it, let's say you're on your third round. It has the staying effect. It looks better and better as you keep doing it. If you're one of these people that tries it and doesn't do it again for a year or two and then you try it again, it doesn't look as good. You got to keep doing it.
Howard: What about dermal fillers? Did you get into that or you don't like that?
John: I do fillers, I do the Allergan product, the Juvederm. It'll fill the little nasal labial crease. Or you can do the lips and poof the lips a bit. I'm very conservative though, I don't like a tight look and I don't like a lip that looks like a duck lip. I don't like that. I do a very conservative fill.
Howard: When those girls are walking around with the puffy lips, those have been pumped up with Allergan's Juvederm?
John: Juvederm, yeah, or one of the other company's fillers.
Howard: Yeah. Is that a cultural thing? Is it more younger kids wanting that puffed up lip look? Are all ages, baby boomers, seniors, they all like that?
John: No. Most people that come to me, they're looking for a nice subtle fill. They're not looking for a big lip like that. If somebody does want that, again, I tell them go to the dermatologist or the plastic surgeon, because that's not something that I do.
Howard: What do you do if you get the lady who looks like she's been a smoker, she's got all the lines, I just assume since so many of them are smokers sucking on a cigarette. Sometimes I've had patients that had those, they claim they had no history of smoking. I'm a little confused. Do you take those cases on? Is that more heroics?
John: I think it's more heroics. I tell them, I say, look, you've developed these lines here. You can try filling in those areas, but a lot of times you may need more of a plastic surgeon to help you in that respect. Especially if they're really, really pronounced. A lot of times I'll start looking at their smile and I'll see really they have not very much lip support in there. Then we can start talking about a smile. Maybe if we build out the smile with veneers and we can help support the lip from underneath, you're going to get some stretching. We can maybe make those really deep lines more subtle.
Howard: Talking to these podcasters, they're awfully young. They really are. If you lined up 100 dentists and they say oh yeah, I listen to podcasts every day or week, they're young. They're under 30. Looking back at your career, do you think joining the AACD was a big part of your journey? Would you recommend that? You're a member of just about everything. If someone wanted to be a cosmetic guru legend in their community, do you think that's a big part of the journey, or not really?
John: I think it's an adjunct. I don't know how big of a part. It depends how much you want to take part in it. One of the things we did do that was very gratifying and I still would do it is the Give Back A Smile program. That's a situation where you help battered women primarily rejuvenate their smiles. We've done that a few times here in the Cleveland area. We get laboratories that are willing to donate their efforts, we're willing to donate our efforts. It's very gratifying to do that. Plus they have excellent training meanings and things like that where you can meet all these gurus and go from there. I would definitely recommend it.
Howard: That's called the Give Back A Smile program?
John: Yeah, Give Back A Smile.
Howard: Is that through the AACD?
John: Yes, they do that.
Howard: What I liked about that is in my career of dentistry, back when I got in in 87, almost all employees in the dental office were women. Since the 2008 crash and we lost so many manufacturing jobs and so many construction jobs, men are pouring into healthcare, because healthcare is 17% of the GDP. Now men are starting to wake up and realize, my God, my wife's a dental assistant and she's making at 19 an hour and I lost my 12 dollar an hour construction job, hello. Right now I have 2 dental assistants that are males. My office manager is male. Males are pouring in there right and left.
Back in the day when we would work with my sister's place or whatever and it was all women staff and they would bring in some woman whose husband knocked out her front 4 teeth, 5 teeth, and we'd fix her up. I always thought it was real bonding for the women. They just felt good coming in and they felt more good about their office. No matter how tough the month was, at least we took Amy and gave her self-esteem and confidence back after her husband had knocked her teeth out.
John: Yeah. That's something to do. I can also say that you don't necessarily always have to go through an organized program. We'll take patients that we see that we really want to help, and either we'll reduce the fee or we just may do the case too. We did a scenario about 7 years ago, because I was in the military, we took Cleveland area veterans that were injured in Iraq primarily, somewhere, Afghanistan. I got a group of dentists, I think there was 8 dentists around the city. We got laboratories and we gave them back smiles, we did their smiles basically for free.
Howard: That is so dang cool.
John: It was very very gratifying. I talked to a dentist 2 weeks ago on the east side of Cleveland. He said, "John, I still see this patient, comes to my practice, he still thanks me everyday." He says it was one of the most gratifying things I ever did.
Howard: Yeah, a smile can change a life, especially if it's just killing their self-esteem. When a woman, when someone gets disfigured in the military or someone, the number one reason people call, if you ask anybody what's the number one reason people call 911, they'd probably say I don't know, a heart attack, a car wreck. It's always domestic violence. It's always two lovers trying to kill each other. I want to ask you another specific question. When you have a case and you're just like, man, I really want to use this on my digital marketing, I want to put this woman on my website, blah, blah, blah, blah. How do you arrange that? Do you offer them a discount? Do you at the beginning say I'll tell you what, you'd be the perfect before and after model picture I'm looking for, I'll give you this discount, or do you not? They just volunteer it because they're proud of it? How does that usually work?
John: I guess you could do that. In the beginning we did that. We would ask people and say, "Look, we want to do this. We've trained in this, we're working our way through this." Yeah, we did things like that. The other thing is say for example with some of our full arch implant cases, a patient is very, very happy, they're ecstatic. I'll ask them, I'll say, "A lot of people don't know what this procedure is all about. Would you mind giving me a short little YouTube on how you feel about this? Again, you look at my YouTube channel, you can see a few patients that we've done there. They're expressing how they feel. One of them was literally when we put the chair up after doing the conversion, he was in the chair for 4 hours. You can see his reaction right there.
Howard: What percent of women particularly do you think would give you a testimonial? What percent of women?
John: Most of mine are male, so I would say a small percentage. It's mostly male.
Howard: Yeah, they don't like to tell you their age and they don't like to admit to any cosmetic procedures, especially not one that's going to be splashed out on Facebook, YouTube and Twitter and all that stuff.
John: You definitely have to chat with them. Don't take that willy-nilly. Make sure that all these parameters are laid out.
Howard: I'll tell you what, how I've picked up a couple over the years, I remember one time watching 4 of us dentists were at a Phoenix Suns game watching Charles Barkley. Our server was just gorgeous. She just had horrendous teeth. I told her, I said, "I will do it for free." Because I needed before and after models, and nobody would consent. Even telling her for free, she had to think about it for 3 months because just the psychological trauma of, she lived in an hour, 30 minutes west of the stadium and I lived 30 miles south of the Stadium. It still took her 3 months. It was just a rocking hot before and after picture. I only got you for 1 more minute. My last question is, you're also a member of the Pierre Fauchard Academy. Pierre Fauchard is known as the first dentist really in France.
John: [crosstalk 00:59:10]
Howard: A lot of Americans say the father of dentistry is G.V. Black, but that's an American toward 1898, whatever. Pierre Fauchard was a century before that. Why did you join the Pierre Fauchard Academy and what has that done for you?
John: Basically it's an honorary Fellowship. I was nominated and I read about what it was all about in a number of dentists in Cleveland, it was a big honor. I said, this sounds pretty good. Again, it's one of those additional honors that you get when you do things. I guess people recognize you, it makes you want to come to work every day as far as continuing your work and continuing always to learn, even though I'm 53. Again, training is a big thing. I tried to do at least almost 100 hours a year. You always learn something.
Howard: That's why, yeah, go ahead.
John: It makes you better. I'm sorry, it makes you better and it's also going to generate more business for you, because face it, we run a business. This isn't for free. Also, we're very, very talented as dental practitioners. I don't think a lot of people appreciate the skills that we have can impact people tremendously. There's so many people that want to do it. I can tell you another thing. The vast majority of my patients are middle-class patients. They're not rich people. There's some, but most are middle-class people that are just fed up with having a crappy smile.
Howard: I heard Cleveland was all millionaires.
John: You did?
Howard: Are you a big Cleveland Browns fan?
John: I'm a Browns fan, but I think it's going to take a few more years.
Howard: Yeah. Hey, I'll tell you what, you're a rock star, you're an idol in so many minds, you're an idol in my mind. Thank you. I really hope you have Peter call me to do a podcast, that would be great to have you followed by him. If you guys can make an online scene course, we put up 350 courses and they've been viewed over half a million times. Like you say, all your digital went from print to online. Dental continuing education is just massively going from a bricks and mortar building to online digital, because they don't have to shut down their practice. They can go back and watch it 10 times.
If I'm listening to your lecture and you say something and I miss it, I miss it. Digitally I can rewind it, I can listen again. They don't even have to take notes. They can play it 10 times if they need to. If they watch it and say oh my God, my assistant needs to see this, they can play it again for her. If you can make an online scene course for this digital smile design, that would be amazing. Hey, thank you so much for an hour of your time. Thank you for all you've done for dentistry. I hope you have the rest of your days as a rocking hot day.
John: Great, thank you Howard. It was a pleasure. We'll get that together for you.
Howard: All right, have a great day. Bye-bye.
John: Thank you, you too. Bye-bye.