Dentistry Uncensored with Howard Farran

How to perform dentistry faster, easier, higher in quality and lower in cost. Subscribe to the podcast: https://podcasts.apple.com/us/podcast/dentistry-uncensored-with-howard-farran/id916907356

Blog By:
howard

Crossing over from clinical to manufacturing and tech, and now to selling implants.

What successful dental offices have in common.

What the least successful dental offices have in common.

Advice to hygienists.

Working in the dental industry for 16 years, Stephanie’s extensive dental experience combines with her current professional focus on implantology providing the best solutions for dentists and staff. She served as presidents of the New Mexico Dental Hygienists’ Association in 2013 and continues to serve on the board. After graduating from the University of New Mexico with a degree in dental hygiene, she practiced clinical dental hygiene for 7 years. Prior to that, she was a dental assistant. Currently, Stephanie works with dentists, specialists and dental labs throughout Colorado, New Mexico and west Texas as the technical sales representative for OCO Biomedical dental implants.

sdominguez@ocobiomedical.com

505.350.9994

www.ocobiomedical.com

Howard: It is a huge, huge honor for me to be interviewing today, my favorite hygienist Stephanie Dominguez from New Mexico. Stephanie so many dentists I know just think you're a rock star. My best friend from dental school, no doubt was Craig Steichen, who's in your backyard. You know Craig.

Stephanie: Yeah.

Howard: Craig and I both agree that you are probably the most energetic, knowledgeable hygienist in the world. The reason it is is because you were a dental assistant ... You started off as a dental assistant, and then you were a hygienist for 6 or 7 years. Then you decided to go into corporate and you worked for Patterson, which is a really unique experience, because the reps ... The reason the reps are never going to go away, and people aren't going to buy all their supplies online is because, you get to see a variety of offices. 

You get to see what are the ones that are more successful. By success I don't mean just money, I mean they're happy, they're not getting beat up by insurance, their staff's happy, they're making money, they're feeding their families, they're living a nice life. As opposed to the ones that are depressed, burned out, want to quit, commit suicide. You know best practices and worst practices. 

Then now, you went into dental implants, which is probably the fastest growing ... The hot spot of dentistry is switching from a 3 in a bridge to an implant. You're with OCO Biomedical Dental Implants, which is my buddy Chuck Schlesinger. They're right out of Albuquerque right?

Stephanie: Absolutely. Actually I'm sitting in his office right now.

Howard: The reason I hate Albuquerque is because when I went to Catholic school, I never got that one right on a spelling test. If they put Albuquerque on there. I eventually learned Connecticut, because I just remembered you spell connect I cut, but there were no tricks to spell Albuquerque. I'm 53 and I still can't spell it. I'm not even going to try to spell it.

Stephanie: You're one of the masses, it's okay.

Howard: It's what.

Stephanie: I said, you're one of the masses.

Howard: Yeah. I don't think anybody can spell Albuquerque. Do people in Albuquerque even know how to spell Albuquerque?

Stephanie: Not all.

Howard: I want to start with, why did you even start in dentistry? Why did you become a dental assistant?

Stephanie: Oh, goodness. I've basically been in dentistry my whole life. My father's a dentist.

Howard: Oh, I never knew that.

Stephanie: I grew up in a small town in New Mexico, and the first job, technically, that I ever had in dentistry was pulling weeds in front of his office. He realized I really sucked at landscaping, so he finally decided to let me in.

Howard: Oh, my god. That's amazing. Does he still practice?

Stephanie: He does. Here in Rio Rancho, New Mexico.

Howard: Say the name of the city.

Stephanie: In Rio Rancho, it's a suburb of Albuquerque. 

Howard: That's where you were born and raised?

Stephanie: Actually I was born in Grants, New Mexico. Which is about 75 miles west of Albuquerque. He moved as soon as I graduated high school. Actually went from private practice to corporate dentistry in 1999.

Howard: One of the big corporate Janes?

Stephanie: Yeah. Here it's Perfect Teeth here in Colorado, Arizona, New Mexico.

Howard: Did he do that just because he got tired of running a business, and just wanted to go in there and do his dentistry to 5?

Stephanie: Yeah, exactly. He wanted to golf.

Howard: Yeah. I love golf. I think it's the greatest thing ever for like 3 holes, but after you've had 3 beers, 3 hot dogs, 3 holes I'm done.

Stephanie: I just drive that's it.

Howard: You just drive the golf cart?

Stephanie: Yeah.

Howard: My dad, who passed away 16 years ago, his best friend never forgave him for turning a corner to sharp in a golf cart, and his best friend fell out. The beer bottle, I think, broke one of his teeth and it was a huge disaster when my dad was drinking and driving a golf cart. I want to start off with ... There's so many things we could start with. 

You grew up in dentistry, you started off pulling weeds, dental assisting, hygiene. What i really want to capture today is, what do you think of all the offices that you've called on, from when you were working at Patterson to now implant rep. What do you think the guys like me and Steichen are doing more often than the guys that just never get it going do less? Have you ever thought of it like that? 

Did you ever walk in the practices and just think, if this dentist was doing what these other 3 ... The dentists that aren't getting it done, they always blame it on Obama, and the economy, and China, and all these things like that. Then people like you think, there's a dentist across the street kicking it out of the ballpark, it's not Obama, maybe it's the man in the mirror.

Stephanie: Yeah. There's several different things. This is a huge issue, it's not just any one thing that somebody is doing. I think, some of the least successful practices I've seen, where the doctor is miserable. One, I see them doing their own hygiene, which to me now a days, just seems very crazy to see a dentist still not having a hygiene department.

Howard: What percent of the dentists do you think still do their own hygiene?

Stephanie: Probably from what I've seen, at least like 10%.

Howard: They're saving money, of course. You know they're saving money. They tell me, I'm saving money. 

Stephanie: Yeah, exactly.

Howard: Yeah. You don't want to be doing a $1,000 crown when you could be saving money doing your own hygiene.

Stephanie: I think there are several things. One is the staff. They have no control over their staff. I think staff is everything when it comes to a successful dental office. What I've seen in the most successful offices, are staff that have been there for over 5 to 10 to 15 to 20 years with that doctor. That says a lot about the office, the culture, the relationship, and everybody is just happy. You see these staffs that have high turn over, nobody's happy, the staff rules the dentist, it doesn't make for a good working environment.

Howard: I completely agree that's the main thing, and that's exactly what no dentist wants to listen to. Whenever you start talking about staff or anything, they go that's the soft stuff, I don't want to hear about that. Which bird do you use when you prep a crown. They don't want to hear about it, and that's probably why it's a huge problem. You nailed it a couple of times. Staff turn over is a red flag, isn't it?

Stephanie: Absolutely. 

Howard: What do you think that stopping staff turn over and keeping people 10, 20, 30, 40 years. What do you thinks going on in that office, as opposed to the high staff turn over and everyone's miserable?

Stephanie: I think in the offices that have a high staff turn over, the doctor is strictly focused probably on dentistry. Which the dentistry part of it is a very minimal to the whole business. Training them, taking care of them, paying them well, making sure they're busy, there's so many things that can go into making your staff happy, and just being a leader. I think so many dentists who have these high staff turn overs have need to invest in their leadership skills, and learning how to be a good leader for their team. 

Howard: Do you think that's something a person is hardwired at birth, they're just not going to be a people person later? I guess the more pointed, have you ever seen anybody change? Have you ever seen anybody who had staff turn over, poor leadership and then focused on it and 2 or 3 or 5 years later changed?

Stephanie: Yes. I think that to an extent, there's inherent built in born in leadership ability that people have, but I don't think it's anything that you can't learn and fine tune for your business. There's a lot of people who do it and do it very successfully, but you also see ones who they just don't have it.

I think that's why corporate dentistry is so popular and booming now a days with these dentists, because it's a good place for people that don't have those leadership qualities or abilities to go and still have a successful practice, but not have to deal with all of those other issues.

Howard: Absolutely. I feel sorry for corporate dentistry because they get such a bad rap. Back in my day, if you said I'm just going to join the Navy I don't want to deal with rent, mortgage and staff. I don't want to deal with any of that crap, I'm going to join the Navy, and I'm going to make a career in the Navy. Everybody would salute them and say that is so respectful serving your country, working for the Navy. Now you take out the word Navy and say Heartland Dental Care, and they're like what are you a communist. 

Stephanie: Yeah.

Howard: I don't get it.

Stephanie: I'm not an anti corporate dentistry person. I think it definitely serves it's purpose and I think there's a lot of defensiveness about it from the general private practitioner. That's only because it's making it more competitive.

Howard: Exactly. When you look at Congress, the United States Congress is basically a house of bribery, and every company has been trying to get ... Look when we grew up. Foreign companies couldn't even sale cars in America. It took forever to let in Japan and Germany, which totally made American cars better. I have lectured in 50 countries, the worst airline service in the world, is United States America because they don't let any foreign carriers fly domestic. 

Stephanie: Yeah.

Howard: A first class flight in America ... Americans don't even know what first class is. A first class flight means your chair is slightly wider and leans back 3 degrees. Go fly Singapore, the chair flattens out to a bed, you have your own television.

Stephanie: I like [inaudible 00:10:14] that's a good airline.

Howard: Yeah. Why does Americans have shitty airlines, and doesn't even know what first class is, because the pilots have gone to the government and no foreign airlines can fly domestic. A thousand years from now, people won't want competition, and when they go to vote they're going to vote for whoever says you don't have to pay taxes and will give me everything for free.

Stephanie: Yeah.

Howard: That's just the human condition, so there's a place for corporate. Especially in a place for corporate where there's so many dentists who are married to a dentist, but want to have 2 or 3 kids and they want to be a professional doctor, but they only want to do it 32 hours a week. They don't want to eat, live, and breathe a dental office while they're trying to take care of 3 kids and a spouse.

Stephanie: Yeah. You see how many woman are now graduating from dental schools, are almost outnumbering the men. It's bound to happen.

Howard: I'm glad I got out when I did, because I could never compete with a dentist that looked like you. They would come and look at me and say, my god I'm going to go to that Stephanie across the street. Staff turnover. Have you seen any courses, any programs, anybody out there that if a dentist has got staff turn over ... Here's the deal. You've seen on Dentaltown, a lot of them hate their staff. They'll get on Dentaltown and say my hygienist just came into my office and said this. It's like, dude why are posting on it. 

Stephanie: Right.

Howard: It's like when you have a family problem do you go on the Jerry Springer show? Our family, we don't need to fly to the Jerry Springer show, we'll just talk about it in our front room. 

Stephanie: Yeah.

Howard: Have you seen anything help a dentist with staff turn over?

Stephanie: I think, what dentists don't do well enough when they're struggling is, one admit it and ask for help. I've listened to so many of your podcasts where the really successful dentist have turned their practices around because they've gone to consultants. Whomever that may be. Bring somebody in to help you evaluate. Evaluate staff issues, and try and get them motivated. That will weed out the ones who really aren't committed to your practice anyway, and keep the ones who are, and hopefully move them in a better direction. 

Howard: Have you see any ... Who's the best dental consultants that you see in your backyard in New Mexico? Any of them come to mind?

Stephanie: No not particular. There are so many consultants out there. There's really good ones. Who we work with with OCO Biomedical, who I like the way that they work, is Progressive Dental Marketing. They're more of a marketing company, but what they do is they focus on the growth of staff. They really, really focus on training the staff and evaluate what they're doing and getting them motivated. It's really effective.

Howard: Where are they headquartered out of?

Stephanie: They're in Clearwater Florida.

Howard: Clearwater Florida, that's where Bill Strupp is. 

Stephanie: Really?

Howard: Yeah. Who owns that? Is it a dentist, hygienist?

Stephanie: His name is Bart, I don't know how to pronounce his last name, but I know his father's a dentist and he started this business after sort of ...

Howard: Can you hook us up?

Stephanie: Yeah, absolutely.

Howard: Yeah. Email him and CC me Howard@dentaltown.com, tell him I want to get him on here.

Stephanie: Yeah. They'd be a great interview.

Howard: Yeah. Lets do that. Okay. You said staff turn over and we'll get this Bart guy from Progressive Dental, he's got to be a good guy if his dad's a dentist. I tell my 4 kids that every day.

Stephanie: That's what my dad tells me to.

Howard: The founder of Facebook Mark Zuckerberg, his dad's a dentist. The greatest people had a father that was a dentist. What other things do you see in the successful offices?

Stephanie: I see the more successful offices making their offices a dental home. Offering more services. Patients don't necessarily like going somewhere else for things. They don't care if you're not as qualified as the oral surgeon down the road, they would rather have you do it and they trust you more. Expanded services, I think, is huge.

Howard: What I would to expand them is if I sale a bottle water for a dollar, and this lid is the 10% profit, the hardest way to make another dime is to make a whole other bottle of water and then to sale it and collect the money. The easiest way to make another dime is to raise the price of this dollar bottle of water to a dollar ten. I've raised my price 10%, I've doubled my profit, and the insurance companies are just held the price increases on cleaning exams and fillings.

Stephanie: Right.

Howard: Where they have no control and they're not doing anything is implants. That's where you are. Some dentists will sit there and they'll buy an implant for a couple hundred, and they'll sale it for a thousand. Then after a while they're like, I think I'll just charge $1,500. 

Stephanie: Right.

Howard: That extra $500 they where already making 2 or 300. Some of these implant margins are 50-60%. 

Stephanie: Right. It gives the doctor so much more flexibility. What I've seen is because with the implants on a hundred dollars, what doctors are doing now, instead having trouble selling these huge price tag cases, they have the flexibility to reduce their costs to the patients and they're getting a lot more treatment accepted. They're still making a huge margin on it.

Howard: I'm in Phoenix, I'm not in Scottsdale, I'm not in Paradise Valley, I'm down here in Wal ...

Stephanie: I've been to your office.

Howard: Yeah. You've been to my home even. 

Stephanie: I have.

Howard: You met my boys. The thing about how we do full mouth treatment, is you got a lower partial. Why don't we place one implant lower right and we'll just leave it on your partial. Then maybe next year, we'll put another one back there.

Stephanie: Right.

Howard: Then the next year we could either put a 3 and a bridge on those 2 implants, or start ... We can stage them out. 

Stephanie: Right.

Howard: A lot of times when someone needs 6 implants we can do it one at a time. We'll do it over 6 years. I've been doing this 28 years and there's patients that took 5, 6, 10 years to do their whole treatment plan.

Stephanie: Right. I think another thing, that kind of goes along with that, is financing. Offering options to your patients to be able to finance these types of procedures. You see it in orthodontics all the time. I use my daughters orthodontist as an example, because I think they have the tightest ship I've ever seen in dentistry. They have the whole picture and they do a lot of in house financing, and it works out great.

Howard: What I don't understand, I don't know if you're old enough to remember orthodontic centers of America. Did you ever remember that when you were a kid?

Stephanie: I don't. 

Howard: That was in '87. How old were you in '87?

Stephanie: I was 6 years old.

Howard: You were 6 years old in '87?

Stephanie: I was.

Howard: Okay. Just making me feel like your grandpa now.

Stephanie: Pulling weeds out in front of dental offices.

Howard: What's that?

Stephanie: I said, pulling weeds out in front of dental offices.

Howard: My gosh. Basically the lesson of orthodontic centers of America, they didn't even learn to lessen it that day. Here it is, I still can't believe they haven't figured a lesson. Basically just in a nut shell, if I say to you what's the most famous sewing machine in the world?

Stephanie: Gosh. I'm the worst woman on the planet because I wouldn't know.

Howard: Name any sewing machine in the world. You can't name a single sewing machine?

Stephanie: I can't name a single sewing machine. 

Howard: Singer. 

Stephanie: Singer. 

Howard: Have you ever heard of that?

Stephanie: I have.

Howard: Why is Singer the most popular sewing machine in the world? There were a gazillion sewing machines because everybody worked in textiles, but Singer was the first one who realized, he thought these Irish people washing up on the shore they can't get a job in textile unless they have a sewing machine. A sewing machine is $100 they don't have $100, but if they get a job it's $1 a week. He was the first one to finance his sewing machine. He said, you come give me $1 a week or whatever, and I'll give you a sewing machine. You pay me $1 a week for 2 years or whatever. Every Irish immigrant would run and get a Singer sewing machine. He just took over the entire market because he had installment credit.

Stephanie: Right.

Howard: The other one was Henry Ford. Henry Ford had the model T and everybody remembers that. It was $668, but no one remembers the story of why he had to close that plant down and General Motors took over. General Motors took over with installment credit. Orthodontic Center of America was the only company ever in dentistry to make the New York stock exchange with a billion dollar evaluation, because this is what was always figured out. 

When you buy a car, you need to give GM the money, because they had to buy 30,000 parts and assemble it at their cost, but when you do orthodontics the cost is incurred when you come in every month for 24 months, so why the hell do you need $1,500 down and why are you financing these appointments. Imagine you went to get your nails done, and the little Vietnamese girl said, I'll sale you a 2 year package, it'll be $2,000. I need $500 down, I'll finance the remaining $1,500 at 9%, you're like what. You incurred any costs yet.

Stephanie: Right.

Howard: What he did is he said, 0% interest, 0% financing, $249 a month, everyone's approved for 30 months. You come in give them $249, they take the record. You come back next month give them $249, they put on the spacers. He financed the whole thing, because he said I'm not financing anything. That's why it's 0% interest, that's why it's 0% down. Orthodontists, they put up economic barriers and say your daughter needs ortho, but we're going to need $1,800 down, and then we're going to finance this 2 year thing, which we have no costs until you come in and we pay the rent, mortgage, equipment bill, all that stuff. Yeah, financing is huge. Who's your favorite financier?

Stephanie: I've actually always really liked Care Credit for patient financing. It seems that it was a very very simplified process, but of course around 2008 it was getting harder and harder for people to be approved. I like seeing different options. I'm not opposed to in house, maybe not call it financing, but payment installment, something like that.

Howard: 2008 that was a 1929, that was a full blown depression. In '29 when the same thing happened, the newly formed fad which was like formed in 1917, so they were young they didn't know much about economics. They tried to save the dollar.

Stephanie: Right.

Howard: They lost a quarter of the banks and we had a third unemployment from '32-'36. 2008 was a full blown depression, but at that time our fed chairman who got a PhD from MIT in the great depression said, screw the install we're going to do the opposite, and he printed 6 trillion dollars and recapitalized the banks. Yeah. 2008 it was a depression with liquidity. 

Stephanie: Right.

Howard: Now we're back to 2015. I noticed Care Credit, first they were Care Credit, then they got sold to GE. Now GE didn't they spin off and doesn't someone else own them?

Stephanie: I don't know. I kind of try and stay out of all that.

Howard: Yeah. I think Care Credit back, there's some other ones.

Stephanie: Keep Care Credit around.

Howard: Reduce staff turn over, a dental home with more expanded procedures, patient financing so you can be General Motors in stead of Ford, and Singer and everyone else, and Orthodontics Centers of America instead of asking for $1,500 down. What else?

Stephanie: I think patient engagement and referrals. There's so much marketing that you can do, even internally without having to go to a marketing company to help. Make referral incentives for your patients. Everybody has, close to everybody hopefully, now has electronic software that they run all this information through. There's so much information in let's say in Dentrix or Eaglesoft, that can be extracted from that to do internal marketing to your patients, referral incentives. I think referrals are huge. I do that in my business now. I get the majority of my business off of referrals. I don't think people capitalize on their happy patients enough.

Howard: That is directly tied to long term staff. I have patients calling the office wanting to talk to Jan, and they talk to Jan. Why are you talking to Jan? My mom and dad went to you for 15 years, and I remember going in there when I was 8 and I wanted to ask you about this or that. They're calling the office to talk to Jan.

Stephanie: Right.

Howard: I'm the dentist, and they don't care they remember Jan. In fact, during 2008 when about 75 dental offices in Phoenix went bankrupt and we just kept having all these new patients. People saying where are you getting all your new patients? I said, most of them are the kids from my older patients. 

Stephanie: Right.

Howard: They're moving out of Phoenix, they're moving back in, moving back home. Yeah, long term staff. The other thing Steph, when you talk to every dental consultant, when they come into an office they're going to be in there like for a week. They want to see what's going on.

Stephanie: Right.

Howard: A 100% of all my dental consultants friends say 100% of all the offices during that first day, they never saw anyone ask a patient for a referral.

Stephanie: No. Yeah, it's amazing how much that doesn't happen and how easy it is to forget about it. Then the dentist isn't able to monitor, nothings confronted. You have to be asking for referrals and engaging your patients. Honestly, this is with the staff retention, you want to have a good staff because, like you said, you are the dentist and the patients would rather talk to Jan. The minute you leave the room, they're asking assistant, they're asking your hygienist, everybody else what they should do. Staff is just so critical.

Howard: Stephanie, I know women ... There's two things you never ask a woman, that's her age or weight. Do you care if I ask your age?

Stephanie: I'm 34.

Howard: What I want to ask you, I'm 53. What I wanted to ask you is asking patients for referrals, the same goes with asking them to write a Yelp review or a Google Plus review. I want to talk about that because when I'm sitting at a bar with a bunch of dentists 50-60, we've never looked at Yelp, we've never read a review, we just don't get it. It seems like people that are 34 and under look at that more. Do you personally ever look at Yelp reviews when you go to a restaurant, or you're going somewhere, or Google Plus review? Is that a generation gap?

Stephanie: I believe so. I think I'm kind of in the middle of the two generations. I'm getting on to it, I travel so much that I do rely on those to lead me in the right direction when I'm going to places that I've never been.

Howard: Like what? Is it mostly restaurants, or is it doctors to?

Stephanie: Yeah, any type of business. Mostly restaurants. Doctors not so much, because I don't really have to deal with that. I think it's huge and I think the hardest part is asking. If you have script of something it can be uncomfortable for people to ask for somebody to give them a referral or a review. I think you kind of need to make a little script, or give them something to say that way it takes out the awkwardness of it all.

Howard: My belief on that, what you just described, was that since the natural selection of a dentist, physician, or lawyer around the world, is they only accepted the people that made straight A's. You got all the library geeks. When you went to college and you're walking around college, whenever you saw a loser, just someone had a book bag and was in the library, now they're called doctor.

Stephanie: Right.

Howard: All the people who are having fun, fraternities, dating, all that kind of stuff. This scientist engineer mathematician, gets out of school and he hires a bunch of people that would've worked in the library.

Stephanie: Right.

Howard: I personally think, that you should hire a staff that compensates your weakness. It's great if I'm good in this and I suck in that, I need to hire someone good in that who doesn't need to do what I ... Same when you hire an associate dentist. If I love doing ortho and TMJ, but I don't do root canals and implants, I need to get an associate that has those skills. When you get to the point where you have to write a script to your staff to ask for referrals, do you think maybe it's time where should trade that player out so that someday you can go to the super bowl and win the damn game?

Stephanie: Absolutely. I think that's a huge thing that's hard for dentists, is to be able to realize when to let somebody go. There's a lot of fear for doctors for letting staff members go. Whether they're horrible or not. That's a hard thing for them to do. Like you said, they do come out as scientists, engineers, mathematicians and they have the burden of running a business. Being HR, being accounting, doing everything. That's out of their comfort zone as well, and that's being able to let go staff members.

Howard: We're a social pack animal. We're not like a shark that doesn't have any skill sets to get along with another shark, because they don't need anybody else. Snakes and sharks aren't hard wired for that, but dogs, cats, monkeys, and apes we're hard wired that we want to please other people and get along.

Stephanie: Right.

Howard: To have an uncomfortable conversation or to do something unpleasing like fire you, it's against a couple million years of evolution in their brain. Their brain is saying, we just got to get along, because the real enemy is the hyenas, lions, and tigers.

Stephanie: Right.

Howard: I can't ever imagine seeing a hyena in Albuquerque, but one time Craig and I did so many shots of Tequila, I think I saw one. Maybe it was a coyote. Anyway. Patient engagement. Any other things come to mind?

Stephanie: Social media is huge now, obviously, you're very successful in that. Just since we are towards the generation of Yelp, Google reviews, Facebook, Twitter, all that good stuff, I think that you need to be involved in that. The best thing is that it's super easy. One of those young girls on your team would love to take that over and accept that as a responsibility, and do that and be very successful with it. That also gives them added responsibility, in the sense of importance. 

Howard: That's why I can't legally say this, so I can't say it, but one of the reasons I am so prolific on posting so many stuff is because I'm hoping ... Let me just say it legally. I'm hoping it gives people the ideas of things to put on their page. You don't really need to have a lot of thoughts. All you got to do is go to someone else's page who's crushing it.

Stephanie: Absolutely. You just share. How many shares do you get on posts, right? 

Howard: Yeah.

Stephanie: You have the content there.

Howard: I also think that when you pay someone a lot of money to do your social media in another state, you don't get it, because if your assistant has an iPhone and she walks up to her hygienist on the first day of hygiene month and whips out her video camera and says, Stephanie it's dental hygiene month give me 10 seconds, what's your best advice to all of our patients in Albuquerque about dental hygiene month. Then you say, brush 2 minutes every morning and every night, floss before you go to bed, and you won't lose all your teeth when you're a grandma. Then she can upload that in a second.

Stephanie: Yeah.

Howard: It's their own staff. Every dental office I go into, I always find one staff who checks Facebook before she gets out of bed, and before she rolls over and goes to sleep she looks at it one more time. Then plugs it into the charger. Why are you paying someone 5 states away to do it, when that girl's working for you? 

Stephanie: She would love to be able to do that. Gives her an excuse to be on Facebook at work and not get in trouble.

Howard: Yeah. Lets switch over to implants. When I got out of school ... Stephanie this is amazing, your dad will know this story. Do you realize when I was in dental school from '84-'87 the oral surgeon placing implants were called butchers, hacks, crazies, nut jobs, and they would do like 50 cases and their patients loved it. Then they'd have like one case go bad, and the local board would take their license away. 

Stephanie: Right.

Howard: Then when I started placing implants, when I got my diplomat in the national congress of implantology [inaudible 00:31:54] we had these implants that where covered with all this white stuff. Then the next thing you know the white stuffs coming off and showing up in their kneecap. Now, 28 years later, I lived long enough to see that all the kinks are worked out, and it's a very predictable restoration. My question to you is, it started off when doctor Branemark came to America. He would only train oral surgeons.

Stephanie: Right.

Howard: Nobody but an oral surgeon could go to the course. Then the periodontist got involved. Now the periodontist are thinking about changing their name from the American Academy of Periodontology to the American Academy of Implantology and Periodontology. I want to ask you this. You mostly know New Mexico? Would you say that or what do you mostly know?

Stephanie: I mostly know New Mexico, I also cover Texas and Arizona, well West Texas, and Colorado.

Howard: You cover Arizona?

Stephanie: I do.

Howard: You mean you've been coming out here and not calling grandpa Howard?

Stephanie: I just recently picked it up as of January.

Howard: Okay.

Stephanie: I told you I would call you next time I was out there.

Howard: Okay. Is still mostly being done by oral surgeons and periodontists? What penetration does it have with general dentists? What percent would you say are being placed by the specialist? What percent do you see are placed by general dentists?

Stephanie: I believe it's about 10% of general dentists placing implants now. For me, I work majority with general dentists. That's who I work with 99% of the time. 

Howard: Is that because the oral surgeons won't let you in their office, because you've never had your wisdom teeth pulled?

Stephanie: I have had my wisdom teeth pulled. No. I just see that it's a huge advantage for these general practitioners into their office, into their business, to be able to incorporate implants. Like you've said, what is the percentage of general dentists oversees placing implants?

Howard: Yeah. In Korea and Germany, 3 out of 4 place one every month. 

Stephanie: Right. I don't know why we're so far behind here, and that's changing. If I have anything to do with it.

Howard: Is Chuck Schlesinger the dentist, he's not the founder of OCO. What is he the president?

Stephanie: No. He's the chief operating officer. 

Howard: Chief operating officer. If Arizona is your territory, he ought to do some of his hands on training courses in my dental office. We could close that thing down on a Friday, Saturday, Sunday and do a 1, 2, 3 day. I've CBCT from Care Stream. I could fill that course up just from my buddies that I drink with. We could have an alcoholic implant course all in one day.

Stephanie: Those are the best ones.

Howard: Is Craig placing implants?

Stephanie: He is.

Howard: He is now?

Stephanie: He is placing implants. It's been a 1 1/2-2 years since he's been placing. He was one of my first customers when I started with OCO. 

Howard: I was his first customer. Did you know that? 

Stephanie: No.

Howard: Do you know how I was his first customer?

Stephanie: Do I want to know?

Howard: Probably not. Here's a podcast confession. I'm making an illegal confession to 7,000 dentists right now. I would make my dentures in lab class, I think sophomore year. Craig would just look at it and goes, dude that looks horrible. I'd say what should I do? Then he'd take it, and he'd just knock everything off, he'd start from scratch. In like 10 minutes, he'd knock all the teeth off, put them all back on fastened and everything. He looked like Beethoven and I'm like wow. Then I take it to the instructor and the instructor would give me an A on it. Then when I walked away he'd say tell Craig he did a great job. The instructor could actually tell Craig Steichen's work. It was so artistic.

Stephanie: He's great. He's a great story to, because I've worked with him with Patterson. Then I moved over, but incorporating implants into his practice has just given him a new light. He's very very excited.

Howard: Do you know what the first thing that lit him up like a Christmas tree, was the CEREC machine.

Stephanie: Yes.

Howard: He's the only guy who when he bought his CEREC machine took it home at night and slept with it in bed. He loves that thing.

Stephanie: Yeah.

Howard: Talk about that. You worked for Patterson, they were the sole distributor of ... By the way, now that Dentsply merged with Sirona. Do you think Patterson will still have an exclusive on that machine?

Stephanie: I'm pretty sure they will for the short term future at least. I'm not sure what the long term future looks like, as they don't oversees. They sale through Shine and multiple distributors. It'll be interesting to see how that unfolds, but I'm pretty sure for the next 3-5 years they'll still.

Howard: That would be an uncomfortable relationship if you're selling through Shine and like 56 different countries, but then they say that little country called America. That would be weird.

Stephanie: Right.

Howard: I'm sure that's ...

Stephanie: That's the way it's been though.

Howard: Yeah. What do you think about ... What percent of the dentists right now have a CAD/CAM?

Stephanie: Probably 10-15%, somewhere around there.

Howard: About the same ones doing implants?

Stephanie: Yeah, probably a little more than our implants, but I think the implants are definitely catching up. It's a much smaller investment to get started.

Howard: Let me ask you this. If 15% of the dentists are doing same day crowns with CEREC and probably, you think, 10% of the general dentists are placing implants. Is that like a Howard and Craig office where the offices that have CEREC are also placing implants, or do you see where a dentists is just I need a new thing and 15% went CEREC and 10% went another way with implants? What's the overlap? 

Stephanie: I see a lot of integration between the two, because the technology with CEREC has come so far with the implant being able to build custom abutments and make crowns whatever the technology it's there. The people who are utilizing it to it's fullest extent are joining. I have a ton of CEREC doctors who also place our implants.

Howard: What I've also noticed is the ones who get the CEREC Sirona, is CBCT.

Stephanie: Right.

Howard: It doesn't matter what CBCT you get. Technically it doesn't matter, you can export anything on a dicom file, but when it's all integrated together it's just a lot easier. It's just an easier experience. It seems like the ones who have the CEREC and the Galileo CBCT and it's integrated, it's just easier to do, easier to get use to, and those dental offices just get it going.

Stephanie: Fully integrated system. 

Howard: I know. 

Stephanie: It's nice, it makes life a little bit easier. 

Howard: If you're a tech freak, where you just love that kind of stuff, and they're using all these different parts and pieces and they just love it, that's great, but if you're not a tech freak it's probably a lot easier to get a seamless integration. Would you agree?

Stephanie: Absolutely.

Howard: Why did you go to OCO? What does ... OCO, that use to be O ring company or what was it?

Stephanie: Yeah, the O ball company and then it evolved to the O Company, and then it evolved to OCO.

Howard: Start with the O Ball company. They were the first ones what, putting balls and locators under dentures?

Stephanie: Right. Doctor Dalise, patented the first O Ball for upper denture attachment.

Howard: What was his name?

Stephanie: That was in the 70s. Doctor David Dalise.

Howard: David Dalise, I met him.

Stephanie: Yes, you have met him.

Howard: That would be an awesome podcast. That would be an awesome podcast. He invented that.

Stephanie: Yeah.

Howard: He patented that. Can you set that up?

Stephanie: Absolutely.

Howard: The more things change, the more they stay the same. I still think the simplest deal for a lower denture with low income money, someone who wants a used car or a Chevy, is just to put 2 implants down there with balls and O ring locators. Grandma goes from this slipping sliding miserable thing, to really ... She literally doubles her pound per square inch bite, and you're placing them in mand anterior, there's no anatomy down there. It's the hardest bone of the two jaws, and the fact that 9 out of 10 dentists can't even do that it's really insane. You can even use the existing denture. You don't even have to make a new denture.

Stephanie: It's the most life changing procedure that I've seen in dentistry and my 16 years in the field. I've seen patients cry, just out of pure joy of having a few implants that hold in their dentures. It changes patients lives and it's really cool to see and it's so simple. It's a simple fix.

Howard: It's high profit margins.

Stephanie: Absolutely.

Howard: That one procedure would probably be more profit dollars than you made off your hygiene department all week.

Stephanie: Right. If you're doing 4 many implants with ball attachments on the lower that's less then $200 for the implants.

Howard: We both agree this is one of the most special treatments in dentistry.

Stephanie: Absolutely.

Howard: We both know that David invented this and patented it in 1970. We both know that Dentaltown put up 350 online courses that have been viewed over half a million times. How come David has done an online CE course on this?

Stephanie: When you talk to Chuck about this last time on your podcast, it's definitely something that we're working on.

Howard: It give a deeper, meaningful relationship. There's a bunch of implant companies and it'd be a deeper meaningful relationship if they met the founder of the company, and that he invented this when he was 70. You kind of feel ... Here's where I get mad at Dennis. The other day I was talking to Dennis and he was telling how he does a denture appointment in 3 days, in 3 appointments.

Stephanie: Right.

Howard: He says, I do this in 3 appointments, but then of course you're going to have to adjust it 25 times. Dentists are always complaining about denture patients coming back needing adjustments. Maybe they are coming back in adjusting it 25 times because you nail that baby down with a couple 2 or 4 implants.

Stephanie: It's such unproductive chair time for the doctors, and just a pain in the butt. When I assisted that was ... It's hard.

Howard: Technically wasn't it a pain in the mouth? You said pain in the butt, but isn't that only when they swallow their denture?

Stephanie: Yeah. 

Howard: I'm going to throw David Dalise under a bus. He's got to get on there and make that. That would be so classic and timeless, talk about a throw back Thursday. I can push that course out to 300,000 dentists digitally.

Stephanie: Yeah.

Howard: If we could just get 300,000, if we could just get 1% of 300,000 ... I don't know what that number is because I only took Geometry. I forgot to take Trig. That would be game changers. I also believe this, some people don't believe me in this but a lot of women with dentures, their whole life they're afraid to smile, they're afraid to laugh, they're always covering their mouth, things like that. It was Dan Fisher ... Do you know what Dan Fisher told me '87? He said the key to a rocking hot dental office isn't about dental health, it's about mental health. You're suppose to be doing dentistry to increase their mental health.

If you look at every dental procedure you do, and realize that tooth is attached to a human with a brain, and that's why you want to do whiting and tooth colored fillings, and nail her denture down with 2 or 4 locators. Forget her damn teeth. I got uncles, some of my dad's uncles they're all from [inaudible 00:44:29] they all lost their teeth. They got their first set of dentures and threw them in a farm field. They were still morbidly obese. They could eat their way to 300 pounds with 0 teeth over 30, 40 years. 

When I was a dentist, newly dentist from '87. I was back there in Parson [inaudible 00:44:46] and some of my 80 year old uncles, you want me to make you a denture? Hell no, I had a pair of them in 1950, those were the worse things ever. You don't even need teeth for chewing and eating.

Stephanie: I have an uncle in Oklahoma, who I've seen gum a steak like nobody else's business. 

Howard: Yeah. Oklahoma, Kansas, my entire pedigree was born in a barn and none of them uncles need one tooth to eat anything, even corn on the cob or almonds, they can gum it. Grandma's not going to go to the buffet and sit there with her grandchildren with no teeth.

Stephanie: My grandmother wouldn't even let me clean her teeth that were holding her partial and dentures. She would never take them off in front of me, somebody else had to do it because she didn't want me to see her like that.

Howard: I get that. I never leave the home without my wig on. No ones ever seen me. You're the first person that's ever seen me without my wig on. Why did you pick OCO? You told me, because you lost all your teeth from doing meth in high school, and you had a denture.

Stephanie: Absolutely.

Howard: You needed balls and O rings.

Stephanie: Yep. 

Howard: That is the most beautiful denture I've ever seen.

Stephanie: I can blow out candles like no man's business.

Howard: Why did you pick ... There's 275 implant companies. Why did you pick OCO?

Stephanie: I really like the story of OCO. It's a great company, it's been around long. It's not to corporate it's a nice private company, and we have so much room to grow. I just saw it as a great opportunity to get in down here, and help propel this company to where I think it deserves to be. There's a lot of growth in it, it's a great product, it's a great company, and I just couldn't be happier to be representing it. 

Howard: That is awesome. Chuck is a good guy and so is David.

Stephanie: He's great. He is so smart and such a great resource. He's available to all the doctors.

Howard: Was he born in New Mexico, Albuquerque?

Stephanie: No, he's from San Diego. 

Howard: San Diego, a little surfer boy. Surfer boy goes inland. How long have you been with them now?

Stephanie: It's been almost 2 1/2 years.

Howard: Okay. I want you to talk about this. Here's where I want you to switch. Podcasting is a multitasking behavior. The reason they've exploded is because most all my listeners have an hour commute to work, and if they have a half hour commute they listen to a half to work and half hour back home. We both agree 9 out of 10 dentists have never placed an implant. Your talking to about 7,000 dentists right now, so about 6,300 of them have never done an implant.

Tell them how they can ... They're driving their car. Tell them how they go for it. Stephanie, I ain't ever placed an implant. I don't even know if I'm a good surgeon. How do I go from I've never placed an implant, how can I get ahold of Stephanie and OCO, and a year from now be like Craig Steichen and placing an implant?

Stephanie: It's education, and our company is focused around education. We have CE courses every month all around the United States that are hands on, we have cadaver courses. Chuck also does a great thing, is he mentors doctors. He'll actually go to your office on the day of surgery, see 4 or 5 or 6 patients and be there mentoring you. Our company is education focused. There's no way you can place an implant without being properly educated. 

There's tons of ways to be educated about implants on Dentaltown. There's a lot of dental implant ... I know August has some great courses on there. Start learning, give me a call I'll hook you up in your area with some CE courses. 

Howard: How often do you get out to Phoenix?

Stephanie: I get out there maybe once a month, maybe every other month. 

Howard: You tell Chuck, let's do that in my office. I can name so many of my friends have never placed one. I'll get all my friends that know they should and never have, and we should do this in Phoenix. 

Stephanie: Absolutely. The education is so huge, because the biggest barrier for general dentists is this fear that's been instilled in them since dental school. The more that they learn about implants, and we can sort of disseminate those fears one at a time, really will give a doctor confidence to know that they do have the skills set to be able to place straight forward implants.

Howard: I want to go back to your days of a hygienist, because you were a hygienist for 6 or 7 years and you've seen a lot of hygiene departments. What advice would you tell a doc listening to you right now about how they could have a better relationship with their hygienist and a better hygiene department? Also Stephanie, how would they even know if they have a good hygiene department or not? Is there any barometers or any statistics you could tell them? What are red flags to look for? Production?

Stephanie: I think we all know, what is it, about 60% of the population have some form of periodontal disease. Going through your reports and looking at the periodontal maintenance codes and seeing what percentage of your practice is that. If it's 10-15% you know there's a big gap and that somethings going on in your hygiene department that you need to reevaluate. I think hygienist and dentists need to be partners more so, than that control over one or the other. They're a team. 

The hygienist can make or break you, because like I said earlier, the minute you walk out of the room they look at the hygienist sadly, what should I do. Is he telling me the truth, what do you think, what do you know about implants. If they're not onboard and they don't share your vision with you, they can destroy your office.

Howard: It's again, they're hard wired at birth. We're all hard wired as a social animal to obey the 400 pound gorilla. The 400 pound gorilla is hard wired to control and make everyone else submissive. That's why you see in every organization, take religion. The pope, the cardinals, the bishops, the priests, the alter boy. Take the military you've got the general, it just goes down the line. A lot of success is being counter intuitive to your hard wiring. 

Stephanie: Right.

Howard: I know you're hard wired as a 400 pound gorilla, but the successful people undo all of that and delegate out and make a flat organization. I have told everybody, and nobody believe it, but I've been in business 28 years and I've got a lot of these people from day one. We run a democracy. Just because I own the joint, if we have 7 people vote on it and I vote we're going left and 5 other people vote we're going right, we're going right. I get vetoed about 95% of the time. I'm not even kidding.

Stephanie: Right. I don't doubt that.

Howard: When I get vetoed I'm thinking, either I'm wrong or I need to go back and get more data or maybe more education or whatever. If I can't convince them, I'm going to bully it through because we've been very successful, and I think the best dentists are humble. They're humble to their patients, they're humble to their staff, they're humble to their suppliers.

Stephanie: Absolutely.

Howard: That was another thing I did with my reps. I didn't want any rep coming in there and standing at the counter and sitting in my waiting room. I told every rep when they ever came in here, if you ever come back make a damn appointment. Make an appointment, I want to see you like I would any patient and I would treat them as an emergency patient. That's what we do, we throw them in the emergency room.

Stephanie: Yeah.

Howard: Someone just called in our office, because I want to be respectful. The 28 years they've all helped. When you treat them like gold, they'll help you.

Stephanie: Right, absolutely. I think that's one of the things that with all of the online ordering and sort of dentists going away from utilizing their reps and distributors. We have so many resources for you guys, and ways to be able to help and grow your businesses and practices, beyond just selling you something. I completely think we're under utilized, but I do also agree that I don't agree with just walking into an office, because your time is extremely valuable.

Howard: We were talking about what successful people do. Better patient engagements, social media, reduced staff turn over, expanded procedures for a dental home, et cetera. I can absolutely tell you that all the dentists I know, who got an implant program going in their office, you say why do you use that system. Like [inaudible 00:53:55] why do use no bottle care. Oh I love the rep. They all have a human and the ones that are trying to save a nickel by buying them online from Russia, or Israel or whatever, because they got it ten cents cheaper. They got it cheaper, but they didn't get it going. 

Stephanie: Right.

Howard: We're social animals. We're monkey's without tails, and monkeys need other monkeys to figure out how to peel open the banana. If you're standing there all by yourself, you may be looking at that banana for 20 years. To get it going on you need human relationships.

Stephanie: Yeah. That's the biggest factor that you should look at when deciding what to go with is, what's the support, who's the human that's going to be helping you, are they valuable, will they be there for you when you need them. There's so many implant companies that you have to look at the value of the people and the service.

Howard: Yeah, and some of these big suppliers reps ask me if I would change, because I started with Patterson, then I went to Shine, then I went to Benco, then I went back to Shine. They're asking why did you switch that? Why do you think I changed?

Stephanie: The rep. 

Howard: The rep was changing.

Stephanie: Yeah.

Howard: Jan has a relationship with Valerie. Nobody cares who Valerie works for.

Stephanie: Right.

Howard: That's Jan's relationship buddy, problem solver. That's her girl.

Stephanie: Takes care of business, that's what it's about.

Howard: Yeah. Jan could care less who's back filling the order. I always tell other companies, if you want my business, what I'd do is I'd get Val, because Val's got Jan.

Stephanie: Right.

Howard: At the end of the day, it's all relationship driven with your patients, with your staff, with your kids. I still think one of the greatest feelings of being blessed that I know, the reason I pinch myself everyday is because I get to talk to all 4 of my boys everyday. There's nothing that means more to me than that. Then your staff would be next, not your patients.

Stephanie: Right.

Howard: If you're killing it with your 4 boys, and then you're going in there and your connecting with your team, the patients all take care of themselves. When you're not connecting at home and family, and you're going to work and you're not connecting with your staff, then you want to know why none of patients come back, and you don't have a hygienist or whatever. It's all the foundation. I want to go back to hygiene. 

Stephanie: Okay.

Howard: You said 10% have no hygienist. I'm trying to let this ...

Stephanie: Some living experiences and market setup.

Howard: What percent would have one, what percent would have two, what percent would have three. The question I'm going for is, what do you think is the ideal dentist to hygiene ratio?

Stephanie: I think at least 2 hygienists per dentists. It kind of depends on your active patient base, but I think with 2 full time hygienists, I think that's the ticket per dentist. 

Howard: What's really exciting going back to 2008 is America has lost 50 million manufacturing jobs ever since Ronald Reagan said free trade. Then immediately Asian government started subsidizing television manufacturers so they could sell them at a lose until we closed all of ours down. With 50 million lost manufacturing jobs from free trade, there's a bunch of men pouring into healthcare, because healthcare is 17 cents of every dollar of our GEP, and I'm starting to see a lot of male hygienists, male dental assistance, male office managers.

We always talk about how the dental school class is gone from all men to half women. I'm starting to see the labor force in dentistry, and when you go into the hospital. I had a kidney stone a couple months ago, that's about as nice as getting ran over by a car. That place was a third male.

Stephanie: Yeah. I've seen that to. I work a lot in the hygiene association and your slowly seeing the male population growing as far as hygienists and assistance, and I love that because I don't know. I was raised with boys. Being in an office with all females can be a little crazy. I think it's a nice healthy mix to have some more males other than maybe just one dentist in there.

Howard: Absolutely. Especially since half your patients are men, half are women. A mix would be better. Would you call yourself tomboy or a girly girl?

Stephanie: I'm more of a tomboy. I have 2 older brothers, I'm barely learning about girls through my daughters and they really really scare me to death.

Howard: That's why I fear. I only have one grandchild and it's little Taylor, she's 3 and she's a girl. All she's got is her dad, her 3 uncles, and grandpa. 

Stephanie: Good for her though.

Howard: She hasn't done one girly thing in the first 3 years, and we're like scratching our head like should we buy her a Barbie doll or a pink truck.

Stephanie: It's less expensive that way.

Howard: I wonder if she even knows she's a girl. She probably thinks she's a boy. I want to tell you something about Hygienetown. Hygienetown has like 58,000 registered hygienists on there and we just decided to have a yearly issue. Once a year, we're going to take the greatest hits out of Hygienetown and mail a Hygienetown physical magazine to, I think, like 80,000 hygienists. You're the most amazing hygienists that I know and I wish you'd be a part of that issue.

Stephanie: Yeah, absolutely.

Howard: Email my team and said, hey the bald one said you're going to do a yearly magazine. I'd love to have a blog or an editorial or something from you in there.

Stephanie: I would love to do that.

Howard: You've done it all. Dad's a dentist, dental assistant, dental hygienist, Patterson, implants, OCO Biomedical Dental Implants. You're an amazing woman, it's an honor for me to call you a friend. I don't know who admires you more, me or Craig Steichen. Craig and I should start the mutual Stephanie Dominguez.

Stephanie: Dominguez.

Howard: Admiration club. Thanks for spending an hour with me. Tell David Dalise that Howard is going to drive out there to Albuquerque and pull out all of his hair. If the guy who started this revolution doesn't make me an over denture course, that would service so many ...

Stephanie: Any excuse to get you out here again will use, okay.

Howard: You already got an excuse. If you ever want to get me to Albuquerque all you have to do is have Craig text me.

Stephanie: Steichen, we're waiting.

Howard: Yeah. All you've got to do is get Steichen, because the most fun we ever had ... We've been kicked out of Cabo 4 times. 

Stephanie: I can see that.

Howard: 4 times we've gone deep sea fishing, and the manager of the resorts like they were glad to see us leave. We have so much fun. Steichen and I have this rare behavior where we love deep sea fishing. We'll get up at like 4:00 in the morning and catch fish until our arms are so tired we can't drag them in. Then they come back and they clean them all and everything, but there's all kinds of poor people by the docks wanting to ... We just give it all to them and then we go do Tequila shots till 3:00 in the morning. Then get up at 4:00 and fish the next day.

Stephanie: Do it again.

Howard: We do that until our liver shuts down. Yeah, you ever want me out there just have Craig call me, and if you ever want to do a hands on course, I'm dead serious, I can fill that course up.

Stephanie: I promise I've been working on that small diameter mini implant denture retention course for Dentaltown.

Howard: That would be a great service. All right Stephanie thank you for all that you do for dentistry.

Stephanie: You're welcome. Thank you Howard. Take care.

Howard: Bye bye.

Stephanie: Bye.