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

Dr. Dennis Hartlieb completed his undergraduate and dental school studies at the University of Michigan (University of Michigan School of Dentistry 1988).  He maintains a fulltime practice in the Chicago suburb of Glenview, Illinois, focusing on esthetic and restorative treatment.  Dr. Hartlieb is an instructor at the Center for Esthetic Excellence in Chicago and is an Adjunct Associate Professor at the Marquette University School of Dentistry in Milwaukee, Wisconsin.

Dr. Hartlieb is a member of the American Academy of Restorative Dentistry, the American Dental Association, the American College of Dentists, the American Academy of Dental Sleep Medicine, and is an Accredited member of the American Academy of Cosmetic Dentistry.  Dr. Hartlieb is also Accreditation Examiner for the American Academy of Cosmetic Dentistry.

http://www.DOThandson.com

Howard: It is just a huge honor today for me to have Dennis Hartlieb in my home. My Gosh. He completed his undergraduate and dental school studies at the University of Michigan. Is that a wolverine?

Dennis: Go Blue!

Howard: Go Blue. University of Michigan School of Dentistry in 1988. He maintains a full time practice in the Chicago suburb of Glenview, Illinois, focusing on aesthetic and restorative treatment. He's an instructor at the center for Aesthetic Excellence in Chicago as an adjunct associate professor at the Marquette University School of Dentistry in Milwaukee, Wisconsin. He's a member of the American Academy of Restorative Dentistry, the American Dental Association, the American College of Dentists, the American Academy of Dental sleep medicine and is an accredited member of the American Academy of cosmetic dentistry. He's also a accreditation examiner for the American Academy of Cosmetic dentistry. 

Howard: But I want to thank you. You've been teaching courses, lecturing hands on for how many years?

Dennis: Twenty-five.

Howard: And I've been a dentist 30 years. You graduated in '88.

Dennis: Me too!  So I started teaching before I knew anything.

Howard: Yeah, and when I was getting my FAGD I needed lectures…

Dennis: Right.

Howard: And [inaudible: 00:01:11] I took so many of your courses, but then after the 500 hours of lecture for your FAGD, the MAGD was 600 hours, but 400 hours were hands on.

Dennis: Hands on, yip.

Howard: Well, you can't even find 25 hours of hands on denture [inaudible: 00:01.24]. So I took some of your courses like in Chicago, then I'd take it at Yankee, but you're an amazing instructor, you personally taught me a lot over the years.

Dennis: Thank you.

Howard: And I hope someday you raise the credibility of Dentaltown by building us an online CE course because just having your name on the masthead would be amazing.

Dennis: Thanks very much. That's very nice.

Howard: So thank you for all that you've done for dentistry. So, what are you passionate about today? What's got you excited?

Dennis: So, like I said, I've been teaching dentistry 25 years doing hands-on programs for 20 years. What I've come to really understand is that when we're learning hands on, when I'm teaching hands on, there's a huge bell curve and how people learn and when people come in and take these courses and they're spending thousands and thousands of dollars, what really was hurting my heart was I'd see people who are not getting their value out of taking these courses. They're away from their home. They've shut down their practice, they're losing money and they're spending money wanting to learn these techniques and they're not getting it. They're too far behind the eight ball and they're not understanding the information. I wanted to find a way to slow it down for them and make it affordable.

Howard: Now, are these he guys that during dental school were sitting in the back half of the class? [inaudible: 00:02:35]

Dennis: No, that was me. I was in the back.

Howard: Or were these the gunners in the front three rows?

Dennis: Well, you, I think it's interesting. No, I think it's so interesting is that people have developed certain skills and they learn at a different pace. Right? Some people get it right away. I'm someone, I got to hear it over and over and over and one of the frustrating things for me is when I'm learning and someone's racing to the next topic and I haven't really sort of gotten that thing, I'm like writing down notes, it's like, "What the hell did he just say because I'm still writing down something". So, I wanted to create a system where people could learn at their pace because I'm not the fastest learner and I know people learn all across the spectrum. So I decided I wanted to create a system where I could send people, not only video on how to do technique, but actually the same hands on courses that I'm teaching live, they can do in the privacy of their own practice, at the pace that they want to do, at a fraction of the price of going to an online course.

Howard: So how do you teach a hands on online?

Dennis: Yeah, so, I have it broken down into two segments…

Howard: Because that's what you're saying you've accomplished, right?

Dennis: Yip. So what I do is, the first portion of the program will be a lecture. So if we're going to talk about class four composite, I'll have a PowerPoint presentation, breaking it down step by step. If you're using cell factors it's how to use them better. If you're using a total left technique, what does that mean? If you want to do [inaudible 00:03:52] I'll sort of explain all that type of stuff. How to make your [inaudible 00:03:57] work better and then go through the concepts of layering techniques. If you're only doing Nanofills, this is how you do it. If you're going to be using a Microfill, this is how you layer that. So there's a huge lecture portion. Then there's a sort of a self assessment test. Make sure that you got the information, make sure you understand it, and what's great about this is they're broken down in a short little modules, two to three minutes, right?

Dennis: So you're working on your patient, you got time, anesthetic time, come down, you crank out a couple of these little modules, right? Or let's say you can't remember like, "All right, what did he say about Self-Etch?" You can go to the module on Self-Etch, and you don't have to go all the way through an hour long video to find that point. You just click right on that module and that will refresh your memory for you. After you go through that - I've done the same technique that you're going to do in the privacy of your own home through a microscope. So I send you the tooth model, the materials…

Howard: Oh, you're sending them a package that goes with the course?

Dennis: With the course. The same thing that I'm doing…

Howard: I don't think I've ever heard anyone, I've never heard anyone say that in my life. This is the first I've thought, "Duh!"

Dennis: Everyone we've brought this to, so Brasseler is one of our partners, BioHorizons implants, one of our partners, [inaudible: 00:05:11] is going to partner with us. So, everyone I've spoken to about this, it's been a brand new concept for all of them.

Howard: Damn, that's amazing.

Dennis: Thank you.

Howard: I never even thought of that. And the minute you said it, I'm like, oh my God, that is so obvious.

Dennis: It makes so much sense, right? 

Howard: That is so obvious.

Dennis: Because people want to get their experience, they want to be hands on.

Howard: Can I steal your idea? Can I do this on Dental...?

Dennis: Well, I know people are going to, so we want to do this with everybody.  We know, I know this is how to train dentists. I know this about my heart. This is how you have to train dentists.

Howard: Is it hard working with Brasseler, because every time you work with Brasseler you have sad thoughts of missing Peter Brasseler who passed away?

Dennis: Well…

Howard: There was no wilder guy you could go to dinner with after a convention than Peter Brasseler, Savannah, Georgia. That guy, is this disrespectful to say he could he drink you under the table and still have... I mean, he was so fun, I miss that guy so much.

Dennis: You know, I think…

Howard: Is that a fair assessment or is that bad?

Dennis: I've only heard stories, so I can only…

Howard: They're all true and they all gave you the [inaudible: 00:06:10]. He was so fun.

Dennis: I think one of other thing that I've really enjoyed in..., things that I never expected from dentistry, and I bet you'll say the same thing, is the people you've got to meet and the times, the experiences you've gotten to share, they're invaluable. I mean, I never anticipated being able to have so much fun with people. I was just with Jeff Rouse. Jeff Rouse is all the sleep stuff, right? And he was talking that if he wants to go have a drink with a buddy in San Antonio or in Seattle, there's one or two people he can call, but in Chicago, he's got like a whole bunch of people, because we've met all of these people around the world that you can just pick up a phone and say, "Hey, I'm in town, let's go and have a drink." And I've made all these connections that I just never imagined it.

Howard: You said you [Inaudible: 00:06:51] Horizons out of Alabama? Birmingham, Alabama. That was another mind blowing thing. If I remember the first time I went there, my God, you think Alabama - deep south, cotton fields, my God, that's where they built the space shuttle. Solid rocket fuel. Blasters. I mean, it was like…

Dennis: Right, right. Yip. There's some brilliant people.

Howard: It was like the Silicon Valley of the south. I mean some of the most intense engineers I've ever met in my life are down in that region.

Dennis: Yeah. I got a patient down there working for Mercedes and there's some really, there's a real brain cluster down there.

Howard: And you mentioned Cosmedent.  You have a deep history with Cosmedent.  Didn't you and Buddy Mopper... weren't you partners for a couple decades?

7.34 Dennis: So I joined Buddy twenty years ago in his practice, I was doing my dentistry in Chicago and I wanted to move out into the suburbs where my family was and I wanted to reduce my commute, and I needed to change the practice. The practice I was in was in a very blue collar neighbourhood. And I had gone through Frank Spear stuff and Dawson stuff and...wonderful patients, but they really could not afford to do the dentistry that I wanted to do. And nothing against that. I came from a very blue collar background. So, nothing against that, but I wanted to do a type of dentistry that they could afford. So Mopper was looking to bring somebody in to do that type of dentistry that I wanted to be doing. So I joined his practice.

It's a really interesting story. When I joined Buddy, I told him, I said, "Look, I don't believe in composites. They don't work in my hands. I have very little faith in composites." He was great, very gracious. He said, "You know what, why don't you come in and spend a day with our practice and see what we're about, see what you think." It was an event that changed my life because it was truly the first time in my life where I realized that I didn't know shit. I thought I knew so much and I watched him do his bonding and I said, "You know what, Dennis, you've got to recalibrate. And now I look at the world completely different. When people offer opportunities and think about things, I'll say, “You know what, I don't know, so let's be open to it.” I watched Buddy sit down to do his direct resin bonding stuff and it has changed my dentistry and it's changed me professionally and personally. And so it was really something.

Howard: And he started out as a pediatric dentist.

Dennis: Right, Yeah.

Howard: So how do you go from being a pediatric dentist to a Rock Star Academy of Cosmetic Dentistry?

Dennis: Cosmetic dentist, right?

Howard:  How do you go from being a pediatric dentist to one of the top rock stars in cosmetic dentistry?

Dennis: Well, Buddy was a phenomenally talented dentist and so he was doing all these fracture repairs on kids and bonding back in the seventies, he was doing diastema closures on these kids. And the moms of these kids would come in and say, "You know, Dr Chopra, my dentist wants to do a PFM crown on my front tooth because it's broken." And you know, you think back to the seventies, what the PFM crowns look like... holy shit, right? So they're begging Buddy, "Would you please bond my tooth?" So Buddy's a Masters in pediatrics, and I think reluctantly over time he finally succumbed to the pressure, and he started bonding…

Howard: Because legally, technically the boards don't even want you to do that.

Dennis: Exactly right.

Howard: I remember that huge lawsuit that went all the way to the supreme court, in the south somewhere. Was it Arkansas? Because the orthodontist wanted to have a hygienist.

Dennis: Right, right.

Howard: And he's like, "Why can't I have hygienists?" And the board said, "Because you can't, that's in state board." So anyway.

Dennis: So Buddy started treating the parents of these kids, and started closing spaces and started fixing fractures and all of a sudden he starts veneering teeth and bonding. This is sort of the same time when porcelain veneers was first coming out, and Buddy really designed a system with composites that gave you excellent aesthetics, great function, and it was immediate. It was immediate. Anyone who's done porcelain veneers, everyone's got the same story, right? Take someone from ugly teeth, you put on provisionals that make them look better. And also you've got to start delivering the porcelain veneers and all of a sudden, they're going, "I like my temporaries better." The temporaries weren't better. It's just that you got used to the temporaries. And what's great about bonding is it's immediate. And so, you know, I may not be able to do resin veneers that are as great as some of these wonderful ceramists in the world. But you know what? Ugly teeth that are looking pretty decent in one visit and they're thrilled.

Howard: Now how many children do you have? 

Dennis: I've got one daughter

Howard: You got one daughter. Here's my deal is when your actions don't match your words. If I had a daughter and I had to pick between filing down the enamel on all of her front teeth and doing ten veneers versus sitting down and not touching her enamel and doing direct bonding, what would I do?

Dennis: Oh no doubt, right? Hands down.

Howard: And these young millennials, does that on Saturday, they get out and they think, oh, shave it down and do veneers. But tell them the truth. You've been doing this for thirty years.

Dennis: Yup

Howard: If you take someone on just the average mean, median, middle bell curve, do a case of veneers where you reduce enamel and then bond on...twenty years later, how many of those veneers had to be retreated? What does that look like twenty years later

Dennis: For resin or for porcelain?

Howard: Porcelain. Indirect porcelain veneers where you've reduced some enamel.

Dennis: Yeah, so the biggest problem is when you're dealing with people who have exposed roots, when you're dealing with loss of enamel and you're bonding to dentin. I mean, the failure rate is significant.

Howard: What is that? Try to quanitfy at ten or twenty.

Dennis: You know what, I just had a woman in…

Howard: In ten years, how many of those ten teeth, that got veneers now needed a crown?

Dennis: Now they need crowns, now they need crowns.

Howard: How many of those needed a root canal?

Dennis: I think a significant portion.

Howard: I mean, the bottom line is, you know, first do no harm.

Dennis: First, do no harm.

Howard: So instead of reducing all this stuff, unravel that stuff with clear aligners.

Dennis: There's no doubt.

Howard: Because here's what I see with dentists that makes me mad. The daughter comes in and says, "Daddy, do that to me." He's like, "no. You're going to have Invisalign and direct bonding." And then when it's not my daughter, let's numb up your teeth, file everything down, take an impression, send it to a lab. That should be your first red flag of an ethics concern. I mean, my sister, my oldest sister's been a cloistered Carmelite monk for thirty-five years. And she's read every major religion and the oldest ones are Hinduism, then it's Confucianism, Buddhism, Judaism, Christianity, Islam...and she says, there's not a name of a person, place, city, thing, there's nothing that shows up on all major religions except for one line, which is deep plagiarism. The golden rule: treat other people like you want to be treated. In fact, some of them say, this is the - I think it was Judaism - this is the only law that matters. Nothing else matters. And my sister says, when you read that, if you were at the university, they'd say, "dude, you plagiarized. You stole that from Howard. Look, Howard wrote that, and that's Hinduism and you wrote that and that's Buddhism and that's why she thinks there is a divine player of all the main religions.

Dennis: One super player.

Howard: When you're a dentist, it's just so easy. I mean a lot of people say, "well, would you redo the root canal and the crown or would you extract the tooth and do an implant?" Well, stop!  What would you do if it was your mouth? It's so easy! Just what would you do if it was you? What would you do if it was your daughter?

Dennis: I think the other thing, why I like being able to do direct resin is that I can give the patient the option. Because I'm not in their shoes and I tell patients this all the time. It's like, "here are your two options. I'm going to tell you the advantages and disadvantages. I'm not going to give you a million of them and just going to tell you a few of them. You need to know. If I do it in porcelain, I've got to drill more of your tooth structure away." Some patients are totally fine with that. Some patients are like, "fine, if it will last longer, the drill more tooth away. I've got other patients that say, "if you don't have to drill my tooth, that's what I want. I don't have to go any further than that." So if I can go through, here's option A, here's option B, advantages, disadvantages, advantages, disadvantages, what's right for you?  I'll do what's right for you as long as it's morally OK for me. I'm cool with that. I want them to decide, I don't want to be the person who has to decide for them. You know, I'm not Marcus Welby. I'm not the guy who's going to sit there and tell them what they've got to do.

Howard: You're giving away your age, you just lost our audience.

Dennis: Yeah, right? Okay, so anyone…

Howard: Marcus Welby. They're like "Marcus Welby, what the Hell's that?" It came on after Gilligan's island.

Dennis: I think it relates to...what's the medical show that all these millennials watch now? Grey's Anatomy. This is the Grey's Anatomy for my generation.

Howard: So I always ask my homies. Shoot me an email, howard@dentaltown.com. Tell me who you are, how old you are, who you'd like me to see, what country you're from. They're all under 30.

Dennis: Yeah, for sure.

Howard: 25% are in dental school, the rest are under 30. I get like one old guy a week. By the way, when he was talking about Buddy Mopper, that was podcast 135, if you want to go back there. So, how do they find out about getting a package and taking an online [inaudible 00:15:41]? Do they go to your website?

Dennis: dothandson.com

Howard: So what is "DOT"?

Dennis: Dental Online Training.

Howard: Dental Online Training, that's the dot.

Dennis: Or Department of Transportation.

Howard: And then hands on. Yeah, I'm so mad [inaudible 00:15:57]....

Dennis: Go ahead, tell.

Howard: Well, so in Yuma, Arizona, we just lost a child and a pediatric dentist case.

Dennis: Ok.

Howard: And the news is all over it.

Dennis: Ok.

Howard: And I know these homies. The best. Board certified, standard of care, everyone's still stumped what the hell happened and probably if there was an autopsy from hell done, there's probably something unknown about this child's health history. Just a class act.  But let's look at the government -  department of transportation. So when they build a four lane intersection, it eats and kills a human every month when they. When they develop all four [inaudible 00:16:36], so when they put a Walmart, a Target,  and a Cole's on all four centers, once a month, your daughter, my kid driving through the intersection, say, "which one is it?" Boom. Right up from my office, they kill a person every month. So who is the Phd, mechanical, civil engineer that designed that intersection right there? Does someone have to die every month for eternity? And if that pediatric dental office or my dental office started killing a kid every month, how long would it be before the government shut me down? I want the Department of Transportation to come stand at the corner and tell me how many people have to die per month. It's one a month since I opened my frickin practice. No one cares. No one talks about it. But that same government... when one of the best pediatric dentists in state who does everything right and loses one human and RIP, rest her soul, that would be so bad. Oh my God, they're ready to just beat him up. I'd like to put on trial all the civil engineers who designed all around Phoenix because they know if they put a twenty acre center on just one side of the street and then the other side of the street is like apartments and condos or whatever. No one dies.

Dennis: How interesting.

Howard: And you can't have a visual monkey come to an intersection with four ways to live because when you have an intersection with forty thousand cars a day, it only takes thirty days before someone missed something.

Dennis: For sure.

Howard: But anyway, I won't rant on that. But that's a good way to remember. Remember that story? I just ran out the Department of Transportation. So that's his website, DOT, which stands for dental online training. Hands on. Love it. So how many courses do you have?

Dennis: So we're going to be introducing with four courses, but we're going to be introducing new courses every couple of weeks. We're going to launch at midwinter meeting.

Howard: Chicago midwinter what is that, February?

Dennis: February.

Howard: And you live in Chicago?

Dennis: I live in Chicago.

Howard: In February...wouldn't you agree that February is the best time to go to Chicago?

Dennis: Oh, well the weather's perfect.

Howard: Oh my God. Chicago in April and May and October and November is the coolest city on earth.

Dennis: Well, you know why it's in February.

Howard: Why?

Dennis: I don't know for sure, but I'm guessing that it was the cheapest rates to get hotel rooms and conventions space. So dentists being dentists back a hundred years ago, they said, well, let's do it now because now we can get it for the cheap. And so I'm sure that's where it is.

Howard: I mean, when you come there from Phoenix. That's a shocking experience.

Dennis: Well listen, I'm going down to the southwest dental conference down in Dallas, and you know when they hold theirs? In August. And I'm like, I mean, what's wrong with this? Let's say we switch this with the midwinter meeting we'll take August and you guys take February.

Howard: And then the same [inaudibe 00:19:34] will say "Howard, what should we do because we've been having dwindling attendance the last ten or fifteen years because idiots like you are making online [inaudible 00:19:42] courses and they're taking courses online." And I say, "well for starters, what's this weekend?" Yankee. Really? Really? You want to go to Boston in February?

Dennis: I was so lucky.

Howard: You just got back from there?

Dennis: I was there. I flew in last night. I got in at midnight last night.

Howard: And how was the weather?

Dennis: Well, I came from Chicago, which was complete crap. So compared to that it was beautiful because it was only cold without the rain, snow mixed [inaudible 00:20:07].

Howard: Yeah, I think their number one competitor right now is Youtube and online CE. I mean I've got friends that learned how to place implants because they came home every night, got on Youtube…

Dennis: Youtube U, Youtube U

Howard: ...and just searched "dental implant surgery", and they said they just came home, made themselves watch an hour at night. A lot of them did it while they're on a treadmill or stair master, and you just can't watch an hour of free youtube videos every day for a year and not learn something about implants.

Dennis: And I think - look, I don't learn that way. I think it's a great way to learn, I don't learn that way, but I think that DOT comes in as a supplement to that. All right, so you've been watching these videos on implants. Now, how about a hands on program to go with that? So that the first time you sit down, you have the feel of what it feels like to go into bone on a model instead of going right to the mouth.

Howard: You know, most dentists come home at five o'clock and turn on ESPN and pop a beer. The guys that are getting on Dentaltown and reading this stuff and taking online CE courses...they're are a cut above the grade and a lot of them are the 30,000 AGD members and they're trying to get their fellowship in AGD, and their, Master in AGD. Will your online hands on course count as a participation credit?

Dennis: We believe so we're trying, we're working on that. Part of getting the ADA cert is you've got to be in business for a year and a continuing education format to be able to apply. So we believe we are satisfying all the requirements that it will take to be able to get credit for that. Because we have feedback, we have the ability to upload photos of treatment that you've done on these models and I can give feedback. And my team of other dentists that are going to be working with me will be able to say, "hey, consider your line angles. This is what we talked about. Go back to module two, this is where we talk about line angles. We want you to go back and look at that." Also with a self assessment test and there's a discussion panel so we can answer questions, make sure people are getting out of it what they need. Where I think this is going to be super helpful - for people who have associates and they have group practices - I believe this is going to be a way for them to be able to calibrate their dentists and makes sure that the dentistry that's been done under their name, under their logo, is good quality dentist. Because how do you know how good of a dentistry your associates doing? How do you know what's going on there? If you're busy working and someone else is working, how do you know what they're doing? This is a good way [inaudible 00:22:27]

Howard: So you said you're working with Brasseler, Cosmedent…

Dennis: BioHorizons

Howard: BioHorizons. Give us an idea. I want to go through... and you have four courses up? Are those the Brasseler, Cosmedent, BioHorizons? Which one has two?

Dennis: So let's see. Well Brasseler's involved in all of them because we're using their burs for....so we have an anterior contour course. I think if you're wanting to get into doing cosmetic dentistry, the first thing you have to learn is what's a central incisor look like? This is the key, the most salient part of a smile is the shape and contour of a central incisor. So essentially it's a contour exercise where you have a veneer prepped tooth that we send to you, you put it on the composite that we send to you…

Howard: Which is the name of this course again?

Dennis: The central incisor course I think it's called,

Howard: Man, this is so cool.  We know they say the bottom line is you want everything faster, easier, higher quality, lower in cost. And these millennials have $250,000 in student loans.

Dennis: At least.

Howard: And every time they want to take a course, they've got to get in a jet, fly across the country, stay in a hotel and your course, like this course here...posterior colusar restorations, one hundred and thirty nine bucks. Hell, the hotel they stay in is going to cost more a hundred thirty nine bucks.

Dennis: Right, exactly.

Howard: And the airline ticket's going to be, on Southwest Airlines, is still going to be a couple hundred bucks.

Dennis: Yup.

Howard: And then the course they're going to might be a thousand dollars a day.

Dennis: Yup.

Howard: And what you're doing is you're making it faster, easier, higher in quality, lower in cost. And then, you have this one course, the maxillary central incisor tooth shape and contour. It's ninety five bucks! Shit you spend $95 at dinner last night, drinking margaritas. And whenever you make it faster, easier, higher quality, cheaper, faster, better, you're onto something. Do you ever watch shark tank?

Dennis: Sure, yeah.

Howard: What does Lori Grenier always say? What's her quote she always says? If I see it...she's just got to get it right then.  What's her catch phrase?

Dennis: I don't know, I mean I watch it, but I don't…

Howard: She's got a catch phrase. Something about instant recognition of, "Oh, that's a hot idea." "A hero or a zero." Lori Grenier always says "I can tell instantly if this product is a hero or a zero." The minute you said, "I'm mailing you a package of stuff to go with the course." I'm like, "that's a hero." God Dang. That was so flipping obvious. Fifty five years. Thirty years in dentistry. First time I heard it. Hats off to you buddy.

Dennis: Thank you, thank you.

Howard: Notify our team, we will steal that idea [inaudible 00:25:02]

Dennis: I want to be part of it. Look, I think there's a…

Howard: You can be part of it, man. I'd love to have you involved in our [inaudible 00:25:07] any way you can.

Dennis: That'd be great. Look, I know this is the way to learn. Here's the other thing, besides the time, the money, all that. I think the biggest issue is at your pace. So you can stop the video, you can rewind it, you can watch it again and again. "OK, now I get the idea." When we're doing our techniques and we're working with a microscope and we have mirrors so you can make it as three dimensional as possible. I'm showing from all angles. Look, this is how I'm holding my instrument. This is how I want you to spread the composite. Look at it from this angle. Does it look like this? Go back. So I'm teaching in the way that I teach when I do my hands on programs, but they can stop it, they can rewind it and they can watch as many times as they need to do. They really feel confident and so they go into their office and they can literally start doing the dentistry that they want to be doing for their patients.

Howard: And what you said that's so genius is there's a lot of new research in education and the more you read about this, the more sad it is for America. When they started the department of Education, that was the best we ever measured and it goes down every year and the politicians can't fix it because if you said, "the first thing we need to do is shut down the department of Education." Then you'd be against education. Oh my God! But some of the research is mind blowing. Like even in middle school, a child cannot take in information, learn for longer than fifteen minutes.

Dennis: I even had a hard problem with that.

Howard: I can remember in grammar school, I mean I grew up next to the Arkansas River. I just daydreamed. I mean I put all these lines in the river with crawfish and worms, and I'm sitting all day wondering if I got a bite, and if I got a fish while she's teaching me who knows what, I'm daydreaming about frogs and catfish. And then the scariest part of the whole deal is that kids all the way up to eighteen years old basically don't code long-term memory until after 10 because they're tired and they're sleepy and they didn't want to get up and go to school.

Dennis: For sure.

Howard: And you woke them up, because you've got to get all of these classes in. And the research is saying if you would've let him sleep in and come here fresh... and then when they eat, if they have caffeine, their attention span is cut in half. So here's some poor kid, his mom gave him cocoa cherry pops and a mountain dew.

Dennis: And they're already ADD to start with

Howard: And he's got to compete with someone who had a toast and a scrambled egg and milk. So what you're saying about your online CE is that they get to go at their own pace.

Dennis: They get to go at their own pace.

Howard: Now what if they take the course, but wanting to go back and miss something. How many times can they take the course for $95?

Dennis: Well, they get the kit once, but they can take off the dentistry they've done and they can re-do that. Right? So let's say…

Howard: I'm in the didactic lecture.

Dennis: Oh the didactic, over and over and over and over. Unlimited. Unlimited time.

Howard: So you buy the course, it's unlimited. So you wouldn't ever have to take notes.

Dennis: Nope, you can go back.

Howard: What I do an online CE is I just take screenshots.

Dennis: And you can share with your team, right? One of the most, and we were talking about this, one of the biggest challenges...alright, you bring on a new product or new technique. You've got to share it with your team. So if you are sitting down with your team, with your assistants and the front desk. "Well this one is going to take me a little longer because this is how I want to do it. So it functions better, it looks better, the patient's happier. All right, we're going to do this as a team together." And then you can watch it over and over. You bring in a new staff person, new assistant, "go watch this video. This is how we're doing this technique." Right? So I'm going to pay you for an hour to sit down and take notes on this is how we do our technique.

Howard: So you're in tight with Brasseler.

Dennis: Yes.

Howard: Who's the president and CEO?

Dennis: Larry Rose.

Howard: Can you fix me up with him?

Dennis: Haha, I'll make a call.

Howard: I want him to come on the show. You know why I want him on the show?

Dennis: Why is that?

Howard: Well, whenever you say "group practice", people immediately start thinking of Heartland [inaudible 00:28:59] with DSO's [inaudible , but really 80% of all group practices and associates are in private practice. I mean there's a cottage industry has any industry where one person doesn't have 1% of the marketplace. There's a hundred and twenty five thousand dental offices. And the largest dog, Heartland only has eight hundred. So Heartland would have to go to twelve hundred and fifty offices. 50%more growth before he could have 1% of the practice. So when we talk about group practice, it's guys like when you Buddy [inaudible 00:29:29]. And the number one logistics nightmare there is, is they try to set up a standard kit to do a poster filling

Dennis: For sure.

Howard: And they can get doctors to agree on the gloves. They can get them to agree on the composite, the bonding agent. But when it comes to burs, all hell breaks loose.

Dennis: Yeah, Right?

Howard: And when you are at Heartland, you have eight hundred associates and say, you know, at Southwest airlines, every plane is a Boeing seven thirty seven.

Dennis: Same plane.

Howard: And everything's exact. Can we just get you to reduce, for a posterior MOD composite, can we just get this down to like five burs? And associates will walk.

Dennis: Oh interesting.

Howard: Like, dude, if I can't have my, this and my browser that...So my question is how many different burs do you need before you're board certified neurotic. At this point you need to see a doctor. I mean to prove my point, how many different burs does Brasseler have?

Dennis: Oh, there's a million of them. There's tons of them. 

Howard: I know. And then also if you say, "OK, I don't care, we're going to increase that. We're going to agree in our practice, ten different burs for a crown prep." Well if you only use four of them and you don't use the other six, but we autoclave them all together. I mean every time you autoclave it you're breaking it down. I mean it's just, it's crazy. I think another great answer might be, you know, a lot of times the innovation of the product didn't change. It was the packaging. Like milk, nobody would buy milk because your car container was round and when they started taking milk from square boxes to round holes, since every car has round and known as the square, the package milk industry exploded. I think for me it comes down to sterilization, it comes down to the dispensary. I think the solution that Brasselers should do is in a group practice, you're going to walk in a room to do a posterior crown [inaudible 00:31:32] and heres this matrix of a hundred different burs and you can just sit there and say, I need this one, this one, and this one. And then you doc, crazy psycho that can only do it with these three, and here you are the most talented dentist on the earth, but you can't do a posterior crown with these three burs, you need these three. You know what I mean? So I think it's going to come down to packaging. I think the way they package burrs needs to be systematic, that way a group practice can say "OK, for a filling a crown prep, a veneer..." all three associates got together and said, "OK, you know what our practice is going to use? We use fifty seven different burs. So let's give us a dispensing system because it drives the assistants bat shit crazy.

Dennis: Oh, can you imagine that?

Howard: And then when you're in the middle of the procedure, and you say, I need a [inaudible 00:32:22] So what am I going to do? Do I take out my gloves. Do I have to open the drawer, reach in there? You know, it's just crazy. So you're the crazy man.

Dennis: I am, ya a bit.

Howard: So you're the one that has to have these five burs. So as you're walking in the room to go do a crown prep, you walk through sterilization and you just say [noises]. And everyone's happy.

Dennis: And you make it so you have to pay for them so as the associate then they're already feeling the pain, right? So a little vending machine for your burs.

Howard: That's great. Because a lot of dentists, they pay their associate like 25 or 30% of adjusted production, but the dentist pays the lab bill. And those doctors all have lab bills, 9, 10, 11%. But the doctors say, you know, instead of paying you 25%, I'll pay you 30%. You pay half the lab bill, I'll split the lab bill with you. Oh now all of a sudden. And it's the same thing with health care costs. When you look at these countries that brag that they have no co-payments for healthcare, their health care costs are high and their lines are very long. And then when you just come in and say, "you know what, you just have to have a 5% co-payment.  I don't care what it is." Utilization plummets for 5%. And at 5%, you know, when I have no co-payment, I don't care that a knee costs fifty grand. 5% of fifty grand is how much?

Dennis: Now you got a little, now you got a little... [inaudible 00:33:42]

Howard: So now I'm calling Kansas City, Kansas, and I just found a lady does knees for forty five. And if I drive two hours into Jefferson city, there's a boy down there doing them for thirty thousand. Just any [inaudible 00:33:52]. And then you go into all the dental office in Arizona with the dentistry if free. Because it's poor. They're poor, poor, poor. They have a 50% no show for the appointment.

Dennis: Oh for sure. Oh, for sure.

Howard: But if you sat there and said, no, no, your appointment, you got to give us a $10 bill to get that done. They clean up their cancellations and then if you say you miss your appointment, to make another appointment we still want that ten bucks. It's not about right and wrong. It's about managing people. And when people have no skin in the game, then they don't show up their appointment. They don't care what the lab's charging for a crown.

Dennis: Yup, oh I agree.

Howard: You need to have associates have skin in the game.

Dennis: Look I think…

Howard: That would be interesting to have them pay. That would be so cool. How many burs would they need? How would that number be reduced if they have to pay pay for 50% of the burs? It would cut them in half.

Dennis: I think a bur vending machine I think would be a…

Howard: That's what we need.

Dennis: Right? They have to put in a credit card.

Howard: Would you get the CEO of Brasseler to email me? Howard@dentaltown.com. CC: Ryan Dentaltown. And I'm going to tell him Howard's wish is a bur vending machine.

Dennis: Haha, I'll let him know. I think we're on to something.

Howard: Yeah, and you can make it really easy. It could be electronic. You could just tell the doc.. what does average reservoir cost?

Dennis: Oh I don't even know. Quite honestly.

Howard: What would you guess?

Dennis: A few bucks. It's got to be a few bucks, right?

Howard: OK. So you just tell the associate, every bur costs, take any bur you want, use how many you want, but each one costs you a quarter. Or, we'll split the cost, you get the price on the deal. You can come in there, you can punch in, I'm doctor Howie and I use these three burs and I'm looking at where it's like, "oh my God, that big old [inaudible 00:35:29]. What if this bur was three ninety nine and this one was one ninety nine and I have to pay half that bur. It's solves the problem.  You need the doc to have skin in the game.

Dennis: I think for sure. I think at all levels. I mean education, right? You know, my daughter's down at Tulane, she's got some skin in the game. I think that's all really, really important for people to appreciate.

Howard: Now Tulane, is she in Med school?

Dennis: No, no undergrad. She's a fourth year in undergrad.

Howard: You know what Tulane is the most famous for?

Dennis: Well they're, number one party school this year, which as a paying parent does not really make me super happy. But [inaudible 00:36:02]

Howard: If you come back from central South America with some weird parasite fungus, infections, disease, you go to any hospital in the world and they'll say you need to go to New Orleans.

Dennis: Oh no kidding, really?

Howard: And if you google on Youtube, do this. Google "weird shit from Tulane." I mean  someone will come in and they got this big sore and they'll put hot wax on it and all of sudden a worm this long starts coming out of the cranium and ears and nose and...I mean there's shit in the Amazon that you couldn't even imagine how weird it is.

Dennis: I have a friend who's headed Derm, down in Tulane, I'll have to ask her.

Howard: And this is way too much information for a podcast…

Dennis: Well at least it's not visual. We don't have to see that worm coming out.

Howard: So we all went snorkeling. I took all four of my boys snorkeling and we came back and everybody was just sick and not right.  And they went to doctors and no one knew. And they finally said, you know, what you need to do is go to Safeway and order a bunch of whipped cream, cool whip and wash it all out. And then everybody poop in there and package it up separately with your name on it and mail it to Tulane.

Dennis: No way.

Howard: And then a week later they said, yeah, you all have a parasite that can only be killed with these mixture of antibiotics.

Dennis: No kidding, no kidding.

Howard: And they said that they would have never died.

Dennis: Oh no kidding.

Howard: They said they would have lived in your insides…

Dennis: Invasion of the [inaudible 00:37:24] half coming out of your skin.

Howard: So if she's interested in healthcare, man, God, if I went to Tulane, I'd get into.

Dennis: She's not, she's not doing anything with healthcare. She's going to work for the devil. She's going to go into marketing.

Howard: Well how'd she get from Chicago to New Orleans?

Dennis: So she knew she wanted to do business. So she was down to my Alma Mater, Michigan and Tulane. Those were the two schools that she liked most. And then as it turned out, Tulane's a smaller school, and she had interaction with her professors. When she was applying she could reach out to professors, they would actually respond. Whereas at Michigan they weren't responding. And then what really attracted her as a young millennial is sort of the social interaction that Tulane has with the city of New Orleans post Katrina. So as a business student, they work with local businesses and their business plans. So she's in marketing, so she works with local businesses every year and works on marketing strategies for local businesses. So she gets real world experience on local businesses and that really attracted her to go into Tulane. So it's been a really good experience.

Howard: It sounds like the apple did not fall far from the tree with that little girl. 

Dennis: Yeah, I think she's a bit of an entrepreneur and she enjoys seeing businesses [inaudible 00:38:31].

Howard: So right now you have four courses. Do you want us to wait to release this?

Dennis: If you could, that'd be great.

Howard: Yeah sure. Yeah. Just tell Ryan when you want to release and...would you like it released how long a month? Two months?

Dennis: Yeah, about a month. Right about when we're getting read to…

Howard: How many courses you think can be on there then?

Dennis: Well, we're going to keep it to four. We want to keep it to four because we're learning, right? We're learning what do people want to learn? And so that's going to help us sort of gauge which other courses we want to get into. But teaching dental students and young dentists has helped me understand what they don't know getting out of school. So we have a porcelain veneer preparation course that's going to be ready to roll because I get that question all the time for my young dentists, how to appropriately cement an emax crown. You wouldn't believe that's one of the biggest struggles, because dentists don't want to read instructions. So we were going to have a technique. They'll actually have a crown and they can cement, they'll have the model, they'll have the crown so we can walk them through step by step what they need to do.

Howard: So you know Rick Workman?

Dennis: Oh sure yeah, well I don't know Rick Workman, I've met Rick Workman and I know certainly who he is from Heartland and stuff.

Howard: Because I think one of the best marketing things you could do is you put one on Dentaltown and then say, you know, we got many more of these on this site so it'd be like a content marketing. And then I go to Workman who’s got eight-hundred offices and Steve Thorne at Pacific Dental's got five hundred and Rick Kirshner, Comfort dental's got three fifty because this is so affordable and that's what they're supposed to be doing is finding their doctors…

Dennis: We beta tested with two. We've beta tested with one DSO group in Chicago that has thirty practices.

Howard: Which one's that?

Dennis: DecisionOne.

Howard: Yeah we’ve podcasted the CEO.

Dennis: AJ is awesome. Yeah, so AJ Acierno has been a friend of mine for gosh, fifteen years or so.

Howard: What a great guy.

Dennis: Great Guy. Great concept on his practices. What's great about our website is the administrator. We can make one of their head of education an administrator so they can go onto the backscene and they can see who's actually taking the courses. They can see if they've actually skipped ahead on the videos. They can actually ask them to upload images, so as a DSO head, they can make sure, they can calibrate their dentists to make sure that they're doing the procedures that they want to do. So for instance, a lot of their dentists may want to go out and do a Spears or Kois or Dawson or whatever. They can say, "look, that's great, but let's make sure that you're ready to take those courses." Let's get them to make sure we have some basic building blocks. Tthey can use it for interviewing. This is one of the biggest problems I understand is that once these dentists are into these groups, how do they know what they're doing? So they can use this as an interviewing technique. Do these two techniques through DOT. We want to see what your results look like. Because if the dentist can't follow a video step by step by step and come out with a decent result, maybe this is not the dentist they want to be hiring.

Howard: So Brasseler is in all four of these courses in the package because you need a bur to do this. So the one with Biohorizon. That's an implant company. So there's an implant course.

Dennis: Yeah, so we're doing the first course is a provisional of an anterior implant. So we have a six tooth implant model, a Biohorizon implant, a fixture analogs already in the [inaudible 00:41:54].

Howard: A provisional what?

Dennis: A provisional crown for tooth number eight, I think it is.

Howard: Provisional Crown on an implant.

Dennis: On an implant. So we send the six tooth model, we send the temporary cylinder, we send the vacuform, we send the visacryl so they have their temporary material, and then they just follow along with me. This is how you do it. You're trying your vacuform, you drill your hole through your vacuform, you put in your little stick. This is what you need to do. This is how you take it out. This is how you add to get the contour. This is how you support the soft tissue. And we go through all of that. Then they screw it back in. We've had great success....so I Beta tested all these courses with the...I'm up at Marquette, so I'm working with a lot of Marquette students, but I also do it with dentists themselves. Great feedback on all these courses, and in that course in particular, the young dentists have done a lot of it.

Howard: And who saved Marquette dental school?

Dennis: Well I don’t know. I have my though…, why do you say that?

Howard: No, tell me what your thoughts are.

Dennis: Well Zachariasen came in and I thought... there was an interesting time.

Howard: Cause you remember they were going to close down the school. 

Dennis: They were going to shut it down, sure. 

Howard: What year about, was that?

Dennis: That was...that's going to be about twelve, thirteen years ago. Because the old structure was a hundred years old and it didn't allow them to do the things they needed to do to [inaudible 00:43:12].

Howard: But who saved it?

Dennis: I don't know. Tell me.  

Howard: Do you remember Lord’s Dental studio?

Dennis: Oh sure. Yeah, yeah.

Howard: And the owner was Renny Challoner.

Dennis: I know the name. I don't know him.

Howard: He knew it was going to close, and he was hitting all the deals. The government, that Jesuits, all this things like that. And he was the man who found out what the problem was, who needed to be there, got them all in one room, shut the door and he said, "you're not leaving until we save this damn dental school." And when you talk to anybody say, “well, I got a call from Renny Challoner, well, I got a call from Renny Challoner.” He got everybody that could make a decision to solve the damn problem and one dental lab save that damn dental school.

Dennis: Oh, that's fantastic.

Howard: And if you don't think it was a verge of shutting down, how many dental schools have you and I witnessed shut down in our years. Georgetown.

Dennis: Farley Dickinson

Howard: Northwestern.

Dennis: Northwestern, Loyola in Chicago. [inaudible 00:44:04]

Howard: What's the one in Atlanta?

Dennis: Emory.

Howard: Emory. I mean, dude if you say "ah, they would've never closed it down." We, we've seen seven, eight…

Dennis: Ten, I think was ten dental schools.

Howard: Yeah we've seen ten dental schools close down and there's only one dog saved that school. Shout out to Renny. Which I personally don't like Renny because he's one of those cheese head Brett Favre fans and I've tried to convert him to the Arizona cardinals for almost thirty years.

Dennis: Yeah that's not going to happen. It's in their blood, that cheese is in their blood. They've got cheese curds in their blood.

Howard: Cheese curds in their blood. So this is dentistry uncensored. I want to ask you some tough questions.

Dennis: Please do.

Howard: What do you think your number one expertise is? And I always thought of  a composite that was where you're the Rolex, Mercedes elite, would you say it's composite?

Dennis: Well, I think my expertise is a communicating with dentists. I think that I teach really, really well and I think I help dentists get better.

Howard: You do, I've seen you, I'm guessing four to six times.

Dennis: There's much better clinical dentists. I mean go on instagram or facebook.

Howard: But as far as the knowledge of composites and bonding I mean, you're pretty elite.

Dennis: Well, I got a good knowledge. I have a great foundation.

Howard: So let me just ask you some of the dentistry uncensored politically incorrect questions.

Dennis: Alright, please do.

Howard: Thirty years ago - Delta - you just would submit your fee and they'd pay 80% of it for composite. So you could raise high fees, do all this layering stuff, you could spend all day and all night because you can set your own fee.

Dennis: Yup.

Howard: Now, Delta when dentists, I mean, 1% of dentists say Delta. According to Delta's website, 95%.

Dennis: Yeah, which is not true.

Howard: Okay, but there's a lot of dentists on a PPO.

Dennis: There are, there are.

Howard: And so if you're going to give me less money, I've got to go faster. So these bulk fill, instead of layering and bonding and layering, these bulk fills, it's like you want them to be good. You want to believe it.

Dennis: Yes.

Howard: Because it's so much easier just to [inaudible 00:46:03] at one time and curate and done. So what's your thoughts on these bulk fills? Will you have any courses coming up on bulk fills?

Dennis: Yes. We will have courses on bulk fills. Bulk fills are helpful, for sure. You know, the limitation of the traditional composite, you can cure through two millimeters. With bulk tools you can cure through four millimeters. They do that by changing chemistry and they also do it by making the material more translucent. So the advantage of it is you can put in a big amount of composite, curate all at once and then typically what I will do, is then I will layer over top of that with my traditional nanofill. So instead of having to…

Howard: So when you say nanofill, what is a nanofill, what is the brand names of [inaudible 00:46:44]?

Dennis: There's a bunch of nanofills…

Howard: And by the way, I always ask that because the number one complaint is always when somebody says " well, I use a composite."They don't want to hear you're using composite, they want to know the name of the damn composite.

Dennis: There's three composites in our marketplace. There's micro fills, [inaudible 00:46:57] makes the leading, the industry leading, material, their renamel microfill is the best microfill out there. Microfills give you the advantage of polish ability, stain resistance, most enamel-like material. Microfills are meant for anterior composites. Class fours, veneering, class fives. I use them nonstop for that. The downside with microfills, they chip more because they have poor fluctual strength. So you need to have your microfill supported either by tooth structure or a stronger composite like the micro hybrids that you and I grew up with. And then more recently introduced the nanofills, which are a replacement for the micro hybrids.

Howard: And a lot of the most elite cosmetic dentists, you call is cosmedents, is that yours?

Dennis: No, Cosmedent is all Buddy Mopper.

Howard: Who's that famous British cosmetic dentist?

Dennis: Jason Smithson.

Howard: He loves renamel.

Dennis: Yeah. Well, the microfill…

Howard: Do you ever talk to him?

Dennis: Yeah, yeah. Jason's a very good guy.

Howard: I have been wanting to podcast him for one thousand days.

Dennis: He's a fun, interesting guy. It would be a riot.

Howard: If I got a hands on course from him. Another one from you. I think I got one from him, but it was like ten year. Do a search for online CE, for Jason

Dennis: Smithson.

Howard: Smithson.

Dennis: Big [inaudible 00:48:08] Jason Smithson I think made his career by going through dental town. He's an electric personality, he's a phenomenal dentist. And he really works well in that…

Howard: Last time I saw him lecture was in Belize.

Dennis: Oh is that right?

Howard: It was at the Michael Melkers Belize deal and I took the boys there. That was a blast. It was unbelizable.

Dennis: Is that where you got your parasites?

Howard: No, that was Cozumel, scuba diving. I have a dentist friends in New Orleans and every once in while they'll text me a video that they got from one of their physician buddies and you would think it was literally like Black Magic Voodoo. I mean, they're pouring wax over stuff. So this thing under his skin starts to suffocate so finally shows its head and you got to grapple with the tweezers right when it sticks its head out and it's some of the craziest stuff…

Dennis: I don't like that stuff.

Howard: ...you'd ever see in your life. Okay, so you're talking about microfill renamel, Jason Smithson loves his anterior stub, direct composites, which is far better than indirect veneers. 

Dennis: Then you have two other groups. You got your micro hybrids which came out like the late eighties. This is all the materials that you and I used to use. That would have been like herculite. Remember herculite?

Howard: Herculite was…

Dennis: [inaudible 00:49:26] right?

Howard: Was it Holzer? Kerr? or Holzer?

Dennis: Herculite I think was Kerr.

Howard: OK. You're right, you're right.

Dennis: And then, I mean, all of them had it, they all had it. Renamel had, Renamel still has an excellent, Cosmedent has their hybrid, which is a great material. The advantages of the micro hybrids before those came out, they had what were called true hybrids, which were large particles that are greater than one micron. They stained really poorly. They wore down. They were a good start, but they weren't great materials. So the micro hybrids replaced those. What you find with micro hybrids is they didn't maintain the polish very well. So they came out, and they told us this is a universal material. It's as strong as a hybrid and it polishes like a microfill. Neither were true. They were strong enough, but they didn't maintain their polish.  These are the materials people would come in and they do a class four, they'd do a class five, and the patient would come and say, "why is it staining?" Or it would feel rough. So they just lost their polish right away. Then about ten years ago, nano composites came into the marketplace. Nanos essentially replaced micro hybrids. They're almost as strong as micro hybrids, but they polish much better than micro hybrids.

Howard: And you call them nano…

Dennis: Nanofills composites.

Howard: Nanofill. Which really replaced micro hybrid, not microfills.

Dennis: Right, they told us they are universal that they would polish as well as the micro fills and as strong as the micro hybrids. Neither are true. They're not as strong as micro hybrids.

Howard: Okay, she's driving to work, she wants to know: what do you use? When we're talking about dentistry uncensored, 25% of them are still in dental school and the other 75% are all thirty and under. How old's your daughter?

Dennis: Twenty one.

Howard: I don't have a fifty five year old dentist friend in Phoenix that even knows if I put a gun to my friend's head and said, download my podcast. I'd have to shoot every one. So it's a millennial deal. So they go to lecture and everybody's talking about all one four and they're like, "damn it. I want to do [inaudible 00:51:42].

Dennis: One, I want to do just one. 

Howard: And when you look at hundreds of millions of insurance claims on the thirty two teeth are just like nothing. Then the six year molars just boom! You know, three, fourteen, nineteen, thirty. What's the tooth most likely to get a restoration? First molar. Most likely be root canal? First molar. Most likely to be crowned? First molar. Extracted, replaced... so it's eighty, twenty. Like all the dentists, they're struggling. They got out of school. They're trying to get down their filling their crown, their this. So I'm going to beat you up right now.

Dennis: Yeah, no do it.

Howard: See an MOD composite on any first molar.

Dennis: Yes.

Howard: How do you do it?

Dennis: What I do. So I believe in the bulk fill. Here's the thing with bulk fill though, is that the challenge is making sure that your adhesive is properly light-cured. If you have a poorly light-cured adhesive, then you've got a crap bond and you've got a failed restoration. So what I do is I use a core material, I use CosmeCore. I'm a Cosmedent guy, but that's…

Howard: CosemeCore, now is that a microfill or…

Dennis: No, it's a micro hybrid.

Howard: It's called Cosmo…

Dennis: CosmeCore.  C-o-s-m-e-c-o-r-e.

Howard: And it's a micro hybrid?

Dennis: Yeah. So it's a core build up material. It's a dual cure material.

Howard: Nice.

Dennis: I like that because I don't have to light-cure my adhesive. I have a dual cure acubator...I etch the tooth, rinse off my etch. I go through my…

Howard: Total etch the tooth?

Dennis: Total etch the tooth.

Howard: Okay, total etch. 

Dennis: Rinse off the etchant, take off the excess moisture. So suction off the tooth, use a multi brush to dab off the actual water because you don't want to have pools of water there because that will dilute your adhesive. So I'm going to dab off the extra moisture. Now there's a two-part adhesive because you have to have a catalyst. I don't want to light-cure it. Because I don't know, I can get my lights seven millimeters down to that box and have a great cure. So I do a dual cure activator, put it in, several coats, air thin it. I inject my Cosmecore. I fill it until it's about a millimeter to two millimeters from the occlusal surface, light-cure it at all at once. So I got my MOD, except for the final surface. I light-cure it, then after I light-cure it I'll take a nano composite. I use the nano composite from Cosmedent, Renamel NANO Plus. And I will do…

Howard: It's Renamel Plus?

Dennis: Yeah. They call it NANO plus,  Renamel NANO Plus. 

Howard: Okay, so that's your top layer?

Dennis: That's my top layer. That gives me the best…

Howard: Top for a posterior, not for an anterior.

Dennis: Exactly. We'll talk about that for the anterior, but for the posterior, then I built up this MOD except for the last little bit and I can literally do a [inaudible 00:54:28] inject, takes me ten seconds to make it look like a cusp. I just take my instrument and I just blend it over the cusp, light-cure that for a few seconds. Do the next cusp, light-cure for a couple seconds.

Howard: So is one of your courses a posterior MOD composite?

Dennis: It will be, absolutely. Yeah. Not yet, but it's going to be coming down the road.

Howard: OK, now on this implant. When we switched to the BioHorizon course on the [inaudible 00:54:54]. On the implant, here's what she's telling me. She's saying in America, all the implant training is tied to a manufacturer.

Dennis: Sure is.

Howard: So I have to pick what implant I do first. So what implant do I pick?

Dennis: Yup, for sure.

Howard: Number two. All the implant people say implants have a 98% success rate and any basic literature search on medscape says that in five years, 20% have peri implantitis and in nine years like 30% have peri implantitis and at fourteen years, 40% have peri implantitis. So she's like, well am I going to really extract this tooth because it has gum disease or to put in an implant that has a 98% success rate, whatever the shit that means, but have peri implantitis in [inaudible 00:55:42].

Dennis: Right, so you've got to define success. What is success? If the tooth is still in the mouth, then is the [inaudible 00:56:01] successful, even if it isn't a nine millimeter pocket. So if an implant is in the mouth and it has peri implantitis, but it has pocketing, if it's still in the mouth, it's still successful. It's still in the mouth, that's it. 98% success. Managing implants is far different than managing teeth. Teeth die a slow slow, awful death. I mean [inaudible 56:05] for a long, long, long, you manage it.  [inaudible 00:56:05] is a nasty death. And it can go much more aggressively, much more difficult to treat. So yeah, that's a big issue, for sure. How are you going to manage that, and what you know... I think those numbers are real, sort of…

Howard: Well you know is one thing I've noticed, that it's always dependent on. I remember when I got out of school, you were doing quarter and perio surgery and root amputation.

Dennis: Anything you can do to save those little teeth.

Howard: Then all of a sudden everyone said screw this, we're going to treat, this with an extraction and titanium. We're just going to pull it. Now I'm seeing the pendulum coming back, the old school periodontal procedures because I think this panacea that I can just wave a magic wand, throw the tooth away and stick in titanium didn't turn out as fairy tale as everybody thought it did. Did you agree with that?

Dennis: Oh, for sure. But interestingly, I took an Uber in from the airport last night. It's like midnight and had a real nice, Uber driver. I'm chit chatting with him. He asked me what I'm in for, you know, I'm talking about, the dental podcast stuff. He goes, "oh, I just went through some dental surgery myself." This is a young guy, forty years old maybe, and he just had [inaudible 00:57:11] upper and lower. Because his teeth have been a misery his whole life. He's always had problems, so he said, I saved for three years to be able to afford it, and over Christmas break he had all his teeth, slipped out. He had all on four upper and lower in in his provisionals and now he's getting ready for the finals and I said to him, I said, "you've got to be careful. If you're teeth failed like that, the same thing can happen with your implants. We won't get decay, but you have to be worried about", here he's a smoker. I said, "man, you got to take the better care of these than you do your car." And so I don't think that they understand the disease that can happen to implants and the destruction to the bone when disease happens to the implants.

Howard: But the thing that upsets me about that whole, I love that story. It's a beautiful story. But what upsets me [inaudible 00:58:04] is they'll go to Chicago, midwinter [inaudible 00:58:07], and they'll have all these lectures on All-on-4's. And none of them will do one. They'll go back home and they work in Aspen and they do all, all on none. And when they go to online CE courses, I can get a hundred dentists to build Dentaltown an online CE course on placing a dental implant. I can't find anyone to make me one to make a denture. And so when you're in a real world America, like I'm in Phoenix, I'm across from the Guadalupe Indian reservation. Here's how many All-on-4's they had last year. None. Guess how many all-on-nones, they had last year. And then she's sitting there, she's twenty five years old and she did one denture in dental school. That's what she got for $300,000 in student loan debt.  And that's the challenge that I was trying to get amazing online CE producers and lecturers like yourself, but bring it back to the hood for the people that just walked out of dental kindergarten. They need a course on a damn denture. They want courses on how do you go from zero implants to one. It's pretty easy to teach someone to go from one hundred to a hundred and one or a thousand, to one thousand and one. But you know how hard it is to be twenty five and go zero to one. And then I go watch this all-on-4 course and then the next ten patients I present that $25,000 an arch to and in Phoenix Arizona the say "OK, that's great. But, I don't know if you noticed, but I'm not Tom Hanks. I just want to [inaudible 00:59:37] denture.

Dennis: That's reality.

Howard: And she's like, wow, I need one denture. Now, how did we do that again?

Dennis: Yeah, for sure. I mean Biohorizons from our conversation, one of the first courses they want is a locator course. Because they realize that...when I'm talking to manufacturers. I asked them, what is your biggest problem? What problem can we solve? Because I believe dental only training should be the intermediary for corporations and dentists. How do we get dentists to use your products better so the patient can have better care? I'm not here to tell manufacturers how they should be teaching the dentists. I want to be the conduit to get the information from the manufacturer to the dentist so they can do better treatment for their patients, have more confidence when they're going in to do their treatment.

Howard: And you know, it's funny, when we started dental town, I owned [inaudible 01:00:31] and these dentists would get all mad and they say, well this guy came on and he owns a company and he's trying to sell stuff. Like, oh, so what are you a volunteer? So you sit in your dental office doing free dentistry all day. Do you think I think I could be an amazing dentist if I didn't have five hundred dental companies like Brasseler and Biohorizon and CAD/CAMs. I mean if you took away all the dental manufacturers, we'd be sitting on a rug outside with shit we bought from Home Depot and they still...it's our number one complaint on Dentaltown. When you hit a report abuse [inaudible 01:01:03]. It's always because, "well, I actually work at X, Y, Z company and our top selling product is this because of the problem you just said", oh my God, you're trying to sell something. It's Lucifer's brother or you know, it's not Lucifer's brother. He has passion. Dentaltown is for anybody who spends their whole life in dentistry and some of the most passionate people in dentistry are a lot of manufacturers.

Dennis: Yeah.

Howard: They've spent their whole life trying to put a better, faster, higher quality, lower priced product in your hand. We all treat the same patient.

Dennis: Look, if we didn't have all that, then you're right, we'd still be using rocks and chisels to fix teeth. You know, it is that competition of manufacturers trying to do it faster, better improve the access to care and improve the care that we do. You know, you brought up for, with people who are stuck, are doing a lot of medical insurance programs for dental insurance programs. How do we make the dentistry that we're doing better? And that's what one of our courses is like. All right, how do you do a class for composite if you're not going to be using opaque or is it you're not going to be using [inaudible 01:02:05]? How do you make it look good? If you're just using the nanofoil system only. How do you make it look like a good restoration? This is what you need to know. This is how you create your bevel. This is how you layer it and can use these two composites and it's not going to take you any more time than if you just use one composite, but you're going to get a much better restoration. But this is what you need to know how to do it. If you want to be able to do layering where you [inaudible 01:02:30], microfills, all that. We'll have those courses too, but if you need to know how to do the basic courses because you can't charge as much but you still want to do good dentistry and still want to have a happy patient. This is how you do it.

Howard: But back to that implant kit system. Chicago midwinter's coming up.

Dennis: Yep.

Howard: She's going to drive in from Green bay or Milwaukee. How many different implant companies are going to be down on that floor?

Dennis: Dozens.

Howard: So she's twenty five. We're in our fifties. Give her a break. How does she pick an implant?

Dennis: Yeah, so I think that the challenge is, and what I found is, that typically when dentist, restorative dentists, general dentists are doing the implants, it's based on what the surgeon wants to use. This is what they like and I've always, I always felt like it was directed by the surgeon, my goal and teaching these restorative courses. First of all, I like Biohorizons, I like the people I get to work with, but I want the dentists to be able to understand the techniques. Alright, this is how I make a provisional. Alright now that I know how to make a provisional and I have this implant specialist who's using Biohorizons. I have this implant specialist that's using Straumann, Astra or whatever. They do the same technique. Now that they know the technique, they can figure out which system fits best for them. So when the implant surgeon says, "what implant system do you like", it's the same way to do it, but now they've worked with all the parts and they say "this is the one that I'm most comfortable with. These are what I have. I have the driver for this system..."

Howard: You said astek? 

Dennis: Astra. 

Howard: Astra, that's a [inaudible 01:04:05]  

Dennis: Astra. So Nobal, you know, all the big players... 

Howard: But name all the big players. Because the one thing that older guys can tell you is you don't want some small company, because then five years later they're gone.

Dennis: Yeah, I think that's the truth.

Howard: And you don't want a company with no research because then if you do a big case, and I'm saying a big case is, ten to fifty thousand and it fails and she goes and talks to a malpractice attorney and then he saying, "you use ABC implant, can you show me the literature?" So you want a major that you know is going to be there in ten years and does their own research. That'd be Straumann and Nobel Biocare, Biohorizon, Megagen, Astra, who else? Just shorten the list.

Dennis: Boy, you got me. I mean, Zimmer, did you say Straumann..

Howard: Yup, Straumann.

Dennis: Three eye.

Howard: Well Three Eye was bought by Zimmer. 

Dennis: Right, alright.

Howard: So Three Eye is Zimmer.

Dennis: I mean, I think those are the big guys, right?

Howard: So it's pretty much just Straumann, Nobel Biocare, Biohorizon, Megagen, Astra, Zimmer...am I missing anybody?

Dennis: I think that's the big players.

Howard: Yeah. So, you got it down to six. And then my advice after that is why are you flying across the country to learn how to do implants when your periodontist is across the street? And half of the periodontist think in fear [inaudible 01:05:29] and say, "well no, I'm not going to teach you implants. You don't know how to do implants. That's how I make a living and feed my family. You refer me the implants." Okay that's an idiot. The next periodontist will say, "well, hell yeah", because they know you're in dental in kindergarten and you're going to try to do some singles and this and that, and you're going to give him the ones that you don't feel comfortable doing. It's the same thing with orthodontists, the biggest orthodontic practice I know, half of them thinking in fear and say "oh my God, you're doing invisalign. That's my department." Shit, dude. Invisalign has already dumped the orthodontist and bought smiles direct club, a big chunk of that, and they're now you can go into a kiosk and have no one in dentistry. do the scan. They send it to Costa Rica where they make the clear aligners. Invisalign is telling the orthodontists, "we don't even need you", and now you're the orthodontist saying, I don't need this young twenty five year old girl dentist across the street. The only orthodontists I know that are doing five million a year or more, they tell every dentist within a twenty mile direction, "hey, I got a free invisalign study club last Thursday of every month. Bring your cases. I'll teach you." Because what do they all learn? Within a year or two, you're bored of the invisalign because when you do a crown, you're done an hour. When you do an invisalign case, you're married to it for two years.

Dennis: Right, and you're married to that patient after that [inaudible 01:06:52].

Howard: And number two, there's going to be all these other Ortho cases that you don't want to do. So the people who always think in hope, growth and abundancy grow. Same thing with that dentist across the street. The dentists that walk across the street and press the flesh of the dentist across the street...you're not competing with that dentist, you're competing with thousand dollar iphones and Disneyland…

Dennis: That's the truth.

Howard: ...and cars and clothes and it's not the dentist across the street.

Dennis: Right, I agree.

Howard: And it also gets heard in a lot of lawsuits. I can't tell you in thirty years how many times someone will walk in and say, "I'm going to sue this guy. Look what happened, what happened, what happened." And then immediately you just say, well, "OK, I'll put out the fire if you just leave the last guy alone because he's a really great guy and let's find out what's wrong." Then they do that to me. And you got each other's back and they're getting [inaudible 01:07:38]. They don't realize they're getting [inaudible 01:07:39] payments from your alcoholic drinking friend who you've eaten four million cheeseburgers with.

Dennis: Right, right.

Howard: You know, and they're like, "Howard, he messed everything up" and this guy is thinking, yeah, we're going to be doing shots and about two hours at Brad's place. So one last thing about your [inaudible 01:07:52]. A lot of people think that it's actually the cement that's causing peri implantitis.

Dennis: Right, so cementosis, as the cement gets leaked down onto the implant. So with the provisionals especially, I think you need to be able to contour the tissue and the only way to do that is through a screwed down technique. And so that's a technique that we teach, is how to contour the provisional. So it will support the tissue, we go through in the lecture portion. Alright, if you're adding here, this is what you should suspect from the soft tissue. So if you're trying to raise a soft tissue, this is how you want to contour it, if you're trying to drop down the soft tissue this time we want you to subdigital contour, but it's all screwed down so we can avoid having cement, especially at that stage.

Howard: Okay, and we still haven't answered one question, which was how many Brasseler burs you need on that cart before you're neurotic and psychotic and need mental help.

Dennis: I think the person who needs the therapy is my assistant for trying to get my burs organized. That's just part of the artistic aspect of it, right? [inaudible 01:09:04]

Howard: I've been a huge fan of you and Buddy Mopper and Jason Smithson. Who's the other guy? Is it…

Dennis: Corky Willhite, who I taught my first hands on course with at Cosmedent four years ago.

Howard: My two podcast wishes are Corky and Jason.

Dennis: Oh, Corky's great.

Howard: Can you help me line them up?

Dennis: Oh yeah, for sure.

Howard: We can do it over Skype, whatever. I've seen those guys all lectures so many times.

Dennis: Done, yeah that's no problem. They're great.

Howard: You know, a lot of people say - this is my last thought -  that corporate dentistry is going to take over dentistry and you know, when we were little, every pharmacist owned their own building, now they all work for CVS and Walgreens. And then I go in there and I look at dental associates. The average one only stays one or two years. They hate it.

Dennis: Right, they hate it.

Howard: I never heard anyone say, "oh my God",and when I way that, I'm not talking about Heartland and [inaudible 01:10:03]. 80% of associates work in the private sector, not even 20% work in these big DSO's. And it's not just in dentistry. When you go to the stock market bubble think, Facebook, Apple, Amazon, Netflix, Microsoft, Google, their average millennial only stays one to two years, right?

Dennis: Right, and then they're off.

Howard: And you hear all these stories about Google banking, the work environment, with bean bag chairs and foosballs and free healthy snacks and yogurt and all this bullshit. They still can't keep anyone.

Dennis: They can't keep anyone, yeah.

Howard: Because at the end of the day, the human doesn't want to take orders. Why do kids leave home? Because they want to do stuff that...dad was actually not letting his daughter get drunk at home every night.

Dennis: We try to avoid that.

Howard: So she left him, and went all the way to New Orleans. That's human nature. Human nature is: I wasn't born to be told what to do by you. And as you get higher educated, I asked every three star general that had been in my practice last thirty years. I've had a three star general in the air force, couple two stars in the army, a one star in the marines because we're in a retirement center. And I said the deal with managing military is, you know, you want a bunch of very young boys because of all the boys were thirty or forty. They wouldn't follow the orders and when you have highly educated people with eight, nine years of college, it's like herding cats. So you're working at corporate, if you think the bur issue is a problem, just go to private practice. Just go to private practice and you're going to be fine. What advice would you give her? She's driving to work. She freakin hates her job, but she's just scared. It's fear.

Dennis: It's fear, absolutely. 

Howard:Of pulling the trigger, opening up my own shop. That will be your final thought.

Dennis: My final thought is I do believe there are people who are entrepreneurial in spirit and I think you have to be entrepreneurial if you're going to open up your practice or are going to be solo practice. You've got to make tough decisions. How are you going to lead your practice? How are you going to manage? How you going to train your team and how are you going to continue to get educated? If you're not entrepreneurial, I don't think there's a problem at all with working for a group, but for people who are entrepreneurial, you got to be brave. You got to be able to look past the fear and have courage and that was a message to my team at our end of the year meeting, was have courage, have the courage to tell the patient this is what you need to do, have the courage to tell your teammate, "hey, when you said this, this is how I felt." Be courageous and that's what I would tell young dentists. Be courageous. We've all gone through this. We've set the path. Continue the path. You can do that. You just need to have courage.

Howard: And address this mental block she has, she's twenty-five and she's a human. And a functional human has empathy and sympathy and if you don't have empathy and sympathy, you're actually a sociopath. She just wants to do one tooth dentistry because she doesn't have the heart to tell you you have eleven cavities. And she's like, well I can't go tell Dennis he has twelve cavities. Maybe we should just do the one he was pointing to. So they go through one tooth dentistry, then they evolve up to quadrant dentistry and then they eventually move up to full mouth dentistry, because a lot of times we'll say "why [inaudible 01:13:29] all four quadrants?" Really, the guy next door to you is an oral surgeon and numbed up all four quadrants and you asked me "do you want to come in four different times to have four different quadrants done?"

Dennis: Just get it done, just get it done.

Howard: Hell no. My next surgical procedure is a colonoscopy. What if he came in and said, "well, how about we'll go up halfway the first visit then next Thursday you can come back and..." No, so how do you coach, as a father with a daughter to be able to look a man in the eye and say, “Dude, you have twelve cavities?”

Dennis: Right? I think you have to ask the patient for permission. 

Howard:  I mean, do you agree that this is an emotional problem?

Dennis: I 100% agree, and I think you have to ask the patient for permission. “I need to talk to you about what I see. Can I have your permission? Is it okay if I show you?” Cause you've talked about this, about the value of intraoral cameras, right? It's one thing to tell patients. You have to show them, and if you don't have an intraoral camera and you can't get an intraoral camera, pick up your damn iPhone, get a mirror and take a photograph and blow it up on the screen. You don't have to get so complicated. Show them what the problem is. And holding a mirror is 1970s dentistry. I say, get your camera out. I teach the dental students, use your iPhone. Take a photograph, show them this is the problem, help them understand and then let them make the decision that's right for them. “This is what I see. How would you like me to take care of it? This is my recommendations.” And I've told patients over the years, “look, you've got twenty more years till I retire. You've got ten more years from now until I retire.” And I tell patients, “you don't have to decide today, this is your mouth, your teeth, your money. You tell me when you want me to do it. I'm showing you the problem. You let me know when you want to do and I'm here until whatever year.”

Howard: The number one fear they have is rejection. So if I tell you you have fourteen cavities and you reject me and don't do it and walk out, I feel horrible.

Dennis: Well I think that's because they're putting themselves in the position of making the decision for the patient. What they have to do with the patient, I think, is to share with them what their findings are. Then it's the patient's decision. Here's what I see. Here's how I would fix it. What would you like to do? That's it. And if the patient says, "I don't want to do anything right now", that's alright. If they have a car that the engine light comes on and they decided not to do anything because the engine light came on are they a bad person? No, they just decide to ignore the fact the check engine light came on. They can wait until the check engine light goes from yellow to red and then deal with it. It's their car, their money, that's their problem, right? That's how their teeth are. We're there to educate and tell them, inform and support them with their decision and I think to do otherwise, to judge them for making a decision that you may not make. I think that's immoral. I think that's wrong. It's their decision, their money, their mouth, their teeth. I'm there to guide them through the process. You do what you want to do. You know what? Don't call me though on Friday at midnight because the tooth is hurting that we talked about. There's got to be that agreement, but it's their money, their mouth, you know, their tooth.

Howard: You know why I quit flossing?

Dennis: Because?

Howard: Because at my favorite bar, they never make it medium rare, they always make it well done.

Dennis: Alright.

Howard: So when they make it well done, that's when I floss, and my mouth fills up with  blood and it seems like I'm eating a medium rare. Is that smart? Is that a good idea?

Dennis: I like it. That's a good idea.

Howard: So stop flossing if they're over cooking your steaks. Thank you for all that you've personally done for me in the last thirty years. Thank you for all you've done for dentistry. Dennis, you're a rock star. Thank you so much for coming by the house.

Dennis: Thank you for having me. What a great time to be able to sit here with you and talk about what I've done for dentistry, what you've done for dentistry, that can't be measured. And so I'm grateful to be here. It's been a great time.

Howard: Well, actually everything I did for dentistry was invented by Al Gore, so we just have Al Gore to thank for inventing the Internet. 

Dennis: Take care of that global warming too.

Howard: And by the way that's a bad joke. I hate saying that joke because the truth of the matter is if you go in and look it up, he did a lot of massive infrastructure deals for the backbone behind the internet.

Dennis: Oh, I didn't know that.

Howard: So when he said that he shouldn't have said it the way he said it, but if you historically look at what he did, it's the worst joke in the world because he of everybody in the government at that time, he did the most to spin the internet down the street faster.

Dennis: Oh how interesting, that's so funny.

Howard: I feel bad for saying that joke.