Dentistry Uncensored with Howard Farran
Dentistry Uncensored with Howard Farran
How to perform dentistry faster, easier, higher in quality and lower in cost.
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1090 Digital Scanning and Being Profitable with Steven Roth: Dentistry Uncensored with Howard Farran

1090 Digital Scanning and Being Profitable with Steven Roth: Dentistry Uncensored with Howard Farran

9/26/2018 2:21:46 PM   |   Comments: 0   |   Views: 426
Dr Steven Roth grew up as a first generation American in New Haven CT watching his Hungarian holocaust survivor family build businesses and become successful because of opportunity and hard work. He Graduated Columbia University with a BS in Psychology and The University of Penn-sylvania School of Dental Medicine in 1985.  After a one year residency Dr Roth jumped around working as an associate with several dentists before becoming an associate and then a partner on the upper east side of Manhattan. He has 3 children, loves golf, work-ing out and yoga, and listening to all kinds of podcasts Dr Roth learned how to do high quality operative and prosthetic dentistry by co-treating patients for 2 years with his senior dentist which allowed him to become a confident practitioner that was not afraid to treat most dental problems.  Dr Roth is proud to say he has restored the mouths of 2 Oscar Winners, several famous pro athletes, and many other wonderful and interesting people!. Dr Steve as his friends call him went through all of the Dawson Center, Frank Spear curriculum multiple times. He also studied with the Esthetic Advantage , Larry Rosenthal Esthetics courses, Dr. Bill Strupp,  and numerous other courses. He tries to do at least 100 hours of CE every year and became a Faculty member at Spear Education. Dr Roth has worked to bring Myntsmile toothpaste to market and is currently helping build Bridge Solutions/Greensky Patient Financing as the best possible solution for all patients.

VIDEO-DUwHF #1090 Steven Roth

AUDIO-DUwHF #1090 Steven Roth

Howard: It's just a huge honor for me today to be podcaster interviewing Dr. Steven Roth who grew up as a first generation American in New Haven Connecticut watching his Hungarian Holocaust survival family build businesses and become successful because of opportunity and hard work. He graduated Columbia University with a BS in psychology and the University of Pennsylvania School of Dental Medicine in 1985. After a one-year residency Dr. Roth jumped around working as an associate with several dentist before becoming an associate and then a partner on the Upper East Side of Manhattan. He has three children loves golf working out in yoga and listening to all kinds of podcasts. Dr. Roth learned how to do high quality operative and prosthetic dentistry by co- treating patients for two years with a senior dentist which allowed him to become a confident practitioner that was not afraid to treat most dental problems. Dr. Roth is proud to say he has restored the mouths of two Oscar winners several famous pro athletes and many other wonderful and interesting people. Sr. Steve as his friends call him went through all of the Dawson Center Frank Spear curriculum multiple times, he also studied with the aesthetic advantage Larry Rosenthal courses Dr. Bill Strupp and numerous other courses. He tries to do at least a hundred hours of CE every year and became a faculty member at Spear education. Dr. Roth has worked to bring Mitt smile toothpaste to market and is currently helping build bridge solutions green sky patient financing as the best possible solution for all patients. Man thank you so much Steve for coming on the show today.

Steven: Great to be here great to be I'm a big fan of your podcast.

Howard: Is that right, well my podcasts are only a success because I'm able to get guys like you to come on the show.

Steven: Yeah and I think what's really cool is you always talk about how I love all the young guys that go on the podcast the old dentist don't go I can tell you about five of my friends over all over 50 who love podcasts because we commute and we sit in the car and we listen.

Howard: Oh yeah and it's gonna be more fun when they get driverless cars I'm down here in Phoenix and Google which is owned by alphabet owns Waymo and they did their two year pilot study and Phoenix so I've been seeing these driverless cars for two years and they finished the study and it was so positive that Google ordered 60,000 more of those cars. So I mean my grandchildren probably won't even know what it's like to sit behind a steering wheel they'll just be in the backseat on their smartphone surfing listening to podcasts and doing their email and all that kind of stuff. So my first question to you is I hear this all the time New York has now what six dental schools?

Steven: Yeah six dental schools.

Howard: Can some kid coming out of dental school grow up to be just like you someday or is it a whole new world?

Steven: You know that's a great question and the answer I think lies in what do you really want to do if you're passionate about what you want to do you'll find the right road. I know you love to talk about dentistry go to cities and towns outside of the beaten path and it's and it's an easier road and it probably is but you know the generation of dentists that's in New York City now are going to retire at some point and there's 8 million people that need a dentist. So you know I don't think it's it's hard to do what I'm doing I think you have to withstand the you know the DSOs and you know you try to buy your practice there's so many practices for sale in New York right now it's unbelievable and a lot of those practices are great fee for service practices and if that's what you want to do you can do it.

Howard: Yeah and when you look at when I talk to all the big banking people they have a point four percent default rate yet these kids come out of school and you'll see them five years out of school they've had six different dentists associate jobs and it's like why don't they just buy and then they always tell me well it's different now it's like yeah I got a school may 11 and a hundred and thirty three days later September 21st which was just like three days ago it was my 31 year anniversary I mean I had my own shop opened up in 133 days why do they why do they just keep going from associate job to associate job to associate job in search of the the unicorn Dental practice?

Steven: So I think what one of the great things about you and your podcasts is you give great advice and I think most young dentists really need to find somebody who give some great advice and I think that you know they're Millennials obviously they're a different generation but when you talk to the really successful dentists and you said this a million times find the most successful dentists in your town and talk to them about how they did it you'll get the right advice. I think if you get all your advice from your colleagues who are the same age as you yes you may end up running around and being an associate forever but at the end of the day one of the greatest things about being a dentist is owning your own practice and living the American dream.

Howard: Yeah it's totally owning your own business I don't think the mindset of someone who goes there 8 to 10 years of college is the employee mindset. I mean I just think I think dentists physicians and lawyers are like herding cats I mean they they you know there's there's nothing you could do as a senior doctor to please some 25 year old bright-eyed bushy-tailed kid who sees the whole world differently and it just is what it is man they should be their own boss.

Steven: When I had when I was an associate with my partner who we practiced together for 25 years the first thing he did was he said look he's like you're not gonna feel great going in with a patient ago said here's what we're gonna do I'm gonna get the patient numb you're gonna prep the teeth I'll come in and pack the cord you'll take the impressions and make the temporaries and you're gonna learn how to do everything and get to know every patient and the patient won't be scared because they'll think that I'm doing everything even though I'm not and that's how I learned how to be a dentist and I think there's not enough of that these days. I think dentists will you know throw a young associate in a room and said here go do the molar endo and the dentist doesn't know how to do the molar endo that's one of the hardest things to learn. You have to find somebody who's willing to give you their time and teach you and I think you know I was very lucky that I had that and at the time I didn't really love it because I felt like I could do anything what do I need this guy for but it was the best thing that ever happened to me.

Howard: So what did your bread-and-butter dentistry what do you mostly like to do?

Steven: So today you know I've gone all digital which I love you know I don't don't make the crowns in the office I used trios and you know get my models 3d printed in the lab and the entire practice is pretty much all adult prosthetics and cosmetics. So I spend all of my time doing crown and bridge veneers implants I employ a periodontist in the office he does places all the implants and does all the perio surgery and I try to practice very much like I learned from Dawson, Strupp and Spear and I don't see children I don't really have anybody in the practice under the age of 18 and I like that's how I like spending my time I love being creative and doing smiles it's a lot of fun. I love how you talk about on your podcast how why is it that some dentists are always doing a big case on a Friday when some dentists are not and I learned a long time ago that if you don't present it you don't get to do it, so I try to present ideal dentistry to every single patient that walks in the door they don't all say yes but a lot of them do.

Howard: So why did what do you think you're afraid I mean I wouldn't want to go to a doctor who said you know I can't tell Howard he's got lung cancer pancreatic cancer and erectile dysfunction all at the same time so I'm just gonna I'm just gonna tell about his pancreas. I mean why are they afraid to just present it complete dentistry especially when these Americans you know they buy 13 new cars between ages 16 and 76 and every time they buy new cars they're so happy in ecstatic and they love it they love their community what why are they afraid to have someone just do the same thing and just redo their whole mouth all the once?

Steven: Well you know I think that they're not taught to be proud of what they do and they and they should be and I think that you have to hang around the dentists and the teachers that aren't afraid to tell patients what's going on. I think dental school education is very basic and once you get out that's when you learn how to do what you do and if you're not around the right people you're not going to learn how to do the right things and you know I love what Spear says he always talks about how if you go in a jiffy lube they give you a checklist and say every single thing that's wrong with your car and asked if they if you want to fix it, you go to the doctor like you said they don't tell you the results of your blood test but not your urinalysis they tell you everything they don't pick and choose and I tell patients right up front I ask permission is it okay if I tell you every single thing that I see I see wrong going on in your mouth and they all say yes I've never heard anybody say no and it's just the fear of rejection I believe that less people kind of let's dentists kind of go down the wrong road, you have to be proud of what you do you have to tell people what's wrong and don't be afraid people are going to say please fix it.

Howard: So what would you tell the dentists who I mean I got a dollar for every time a dentist told me this I mean well you know I just don't like to sell dentistry I'm not a I'm not a used car salesman I don't like selling dentistry but what do you say to that guy?

Steven: I say you need to rethink what you're doing and go into therapy is what I think I think I think it's it's fear and and we all know what does fear stand for false evidence appearing real okay two years what makes you say that it's fear of rejection you know I think the fear of rejection is what is behind a lot of the problems that dentists have the high divorce rates the addictions it's fear of being rejected and guess what the more you do it the less fearful you are and the best way to do it is to start from the very beginning doing comprehensive great exams, there's great places to learn how to do it you can go to the Pankey Institute you could take courses on dentaltown you can go to Spear you can go to Dawson you can go to a lot of places to learn how to do a detailed exam and once you do a detailed exam patients sit up in the chair and say nobody's ever done that oral cancer screening exam on me like that Wow and deep deep down they're thinking I trust this dentist I trust her I trust him and when they see the effort that you put into taking photos and presenting dentistry and explaining everything to them with all the technology we have today most people just you and say yes may not be today may be a little bit later but they trust you and they're gonna stay with you.

Howard: Okay well let's talk about technology because I know what she's I I get all the emails so I know it's gonna say I can't buy I can't buy all that stuff I graduated $450,000 with student loans and you're talking about technology and Panky and Spear and Dawson so let's start with technology what would what has a return on investment?

Steven: In my opinion the biggest ROI of any technology and dental office is the camera whether it's a still camera or an intraoral camera whatever whatever you could afford that is what's going to sell you dentistry. Okay when a patient sees a quadrant or they see an arch and you can explain it to them on a big giant screen which doesn't cost a lot of money these days that makes your life so much easier and that's what I do probably 10 to 20 times a day is go over photos I taught my staff how to do all the photos I don't even touch a camera myself except for an intraoral camera when I'm in the middle of a procedure and we talk about how we never walk in a treatment room without a photo being up on the screen that is the number one thing that any new dentist needs to learn because once you do that patients understand that's number one. The number two technology I would say for me is gotta be digital scanning I love it, it makes my life so much easier today if you could look at your prep on a giant TV screen and see that it's right I just finished a case five minutes or ten minutes before we got on the phone of ten veneers on somebody I looked I didn't even look at the screen my dental assistant did the scanning and she came to me and said I don't think number 10 and 11 look right can you come back and check the scan I go back and check the scan she's a hundred percent right irie prepped that little area we stitch it into the image it looks perfect we send it down for the lab and 30 seconds they call up and say it looks good let's go and there are they're off printing the model and they'll be making the veneers probably by tomorrow. That for me is a great way to practice dentistry nobody's choking nobody's gagging that scanning is just incredible, I love it.

Howard: and you went with the 3Shape from, you went with the Trios from 3Shape out of Copenhagen Denmark, help her make that decision because I mean 3m sells one the true def scanner why did you go with 3Shape trios?

Steven: At the time my dental lab recommended it they said we're working with all the different scanners this one's the best get it and I've never been one to say no to buying buying technology at the time I think it was $40,000 I think now they're under 30 and you can lease something like that for you know keep your cash flow right for less than thousand dollars a month. I mean that to me it's just a great bargain I know you can't do Invisalign with it okay but you can send the image I could I send my images to the dental lab and they print it out and send that from there 's to Invisalign if that's what you really want to do or you can use smart moves or you can do you know other companies but since most of my practice is crown and bridge and veneers and diagnostic wax ups I use the trios well I have three machines now you know they're all over the office the color they're amazing.

Howard: Now the three shape of the business line thing that's all tied up in court though so that's kind of yet to be determined in it?

Steven: Yeah it's it could be determined but they stopped allowing you to send trio's images I think back in April or May I think it upset a lot of dentists it seems silly that you would want you know take to take the instruments away that allowed dentists to send you cases but I guess Invisalign must own their their imaging software or their or their scanner that they want you to buy the iTero.

Howard: Right

Steven: You know my from the speed and many image quality that we get from the TRIOS seems a lot better to me so I'm not switching.

Howard: So Align Technology owns iTero, Invisalign they also own I think 17% of Smiles Direct Club.

Steven: Yes

Howard: What do you think about that whole issue?

Steven: So I don't know enough about it but here's what I would say what happens if you do orthodontics on somebody with active periodontal disease their teeth come out of their head I don't know how they get past that in other words if somebody if some patience just goes online and says okay I'll get my models and I'll start doing Invisalign by myself and they have advanced gum disease I think they're going down a really wrong road that would be like trusting people to take their own blood pressure and get to the hospital before they have a stroke it doesn't make a lot of sense to me. You know I kind of leaned towards referring to an orthodontic specialist it but if it's at all confusing or difficult I don't understand how you trust the patient to make those decisions.

Howard: You know you said you have a periodontist come in the office, you know I there's one thing that I just can't get out of my mind and that is you know 1,900 there's no specialist Healthcare's 1% of GDP a century later its 14% of GDP there's 58 specialists with the MD's there's nine wood dentist and now I see you know these dentists just trying to be everything like their practices of the dump so they say okay I'm gonna go learn Invisalign and then a year later they say well I'm gonna go learn how to place implants whereas you have a periodontist come in your office. I mean can they can you be Superman and do all nine specialties in your office is that the goal or do you think you you think it's a better decision to narrow your focus?

Steven: You know look I I believe in narrowing your focus and I'll tell you why I think that all the people that say they're not busy enough they have to learn all their specialties are leaving out one big thing what they're lacking is the ability to sell dentistry. Okay once you have the ability to sell dentistry then you can pick and choose what you want to do here's why I love the periodontist he did my crown lengthening surgery years ago I was never so scared in my life okay it took them 20 minutes okay I had no pain I took two advils an hour after he was done I was prepping teeth okay there is no chance that I could have ever done the surgery like he did that's all he does that's his wheelhouse. Okay I have two other dentists that are in my office with me we all use the same periodontist he's amazing he's changed his practice to a point where he just goes into several general dentists office he does even have an office anymore, okay he places all the implants he's done thousands without a failure hey I'm not gonna be able to do that but I could prep a tooth or I could prep ten veneers with my eyes closed at this point. So I'm pretty sure he would not want another periodontist prepping his veneers I don't want a general dentist doing my periodontal surgery they might be great at it okay That's not me I would rather focus on what I do which is prepping teeth making temporaries selling dentistry that's the number one thing sell the dentistry and then you can do whatever you want.

Howard: Does he bring his own dental assistant?

Steven: He does not we trained one of our assistants to work with him we don't really have that good of a relationship he's only been with me 29 years.

Howard: Can you explain the business relationship is it an even 50/50 split?

Steven: Pretty much what we do is close to 50% split we provide all the patients he does all the surgery we bought all the equipment so something ever happened and he left we would still have it and leave it behind. You know there are some weeks where you know he could do five implants two crown lengthening surgeries two grafts he's out of here by 2:00 or 3:00 o'clock on a Tuesday he makes a nice living, our patients get a great service and we have a nice little income tacked on to that for us. Okay and that there is nothing more convenient for a patient then they come in at 8 o'clock in the morning I prep three teeth on the upper right while I'm making the temporaries he goes in and does the crown lengthening surgery he's in and out probably start to finish in 40 to 45 minutes the temporaries ready I go back in and cement the temporaries do the bite right patients done they only had to get numb one time they come back in 6 to 8 weeks when they're ready I re-prep and we make the crowns it's pretty nice I'd rather not go through that twice.

Howard: You know in my own zip code I got one friend who when they just big implant cases you know he anesthesiologist meets the patient he puts them under a periodontist comes in does all the implants all that kind of stuff and the whole time he's just surfing on dentaltown and then I got another dentist who's every other once a month he's in some implant course and all that kind of stuff like that but man you can do it profitably both ways and it's probably a lot more higher return on asset on the to just have someone come in and do it and split the fee than learning all that yourself I mean from the business point of view.

Steven: Absolutely and you know what it's great when they can come while you're prepping the case you didn't even plan to do the work okay and they come in and they say hey you know what this decays a lot deeper that I thought what do you think I could do the crown lengthening right now great do it and again the patient gets a much better result. Nobody gets results like they do when they do regular pareo with their crown and bridge or their operative or their veneer cases. Now I have a patient come in for you know a smile design visit and I had the periodontist come take a look and say what do you think that's been a crown lengthening here and make this look better the periodontist comes it said yeah but if you don't do the osseous it's gonna look like that one six months and we both know there's a lot of dentists out there just using a laser and doing the cosmetic crown lengthening whether the bones in the way or not. I'd rather have a periodontist they're telling me hey this is how we have to do so it's it also creates a fun environment we have a great time.

Howard: So I want to focus on crown lengthening for a second every single I mean a hundred percent of all the very nuts that are met said that all of their crown lengthening cases come from like fighting they're referring dentist and the other ten twenty thirty occasional of the you know thirty five forty have never set one ever why is it first of all do you agree that eighty percent of all the crown lengthening are done by about five percent of all the general dentists and why do you think eighty percent of the general dentists did not do a crown lengthening procedure last year?

Steven: So I think that's a great question and I agree with you and I would say the answer is once again fear rejection or fear of losing the patient. There's a lot of dentists who are afraid that if their patient goes to the periodontist they're not coming back they're going to be referred somewhere else because it's a periodontist may not like the prep or maybe the periodontist is going to keep them in their recare system there's fear of losing the patient which is the same as fear of rejection but if the patient trusts you and and thinks that you're doing a great job they'll do it but you know what look at the cases that you've done where you did the crown lengthening and five years later what does the tissue look like it looks as good as the day that it was done it doesn't have the crown lengthening and maybe it's borderline and it is a three or four millimeter pocket and you have to shove five pieces of cord down there to get a reading you're not going to be able to get a nice case and if you try to scan somebody who needs crown lengthening surgery you're definitely not getting the scan right. So I think the skidder makes you do better dentistry because of that not only faster but better.

Howard: Yeah and if I could sum up better dentistry or higher dentistry in just one word it would only be magnification. I mean you're a human you go from naked-eye two loops you're a better dentist if you get everybody in the office for their hands and someone's mouth add your assistants and hygienist two loops even better if you're an endodontist and can go from loops to pull it in a scope even better and when you scan i'm not forget when I bought my first CEREC machine first time I asked and one of my perhaps I saw my prep the size of the basketball I mean you just can't I mean magnification is everything.

Steven: Absolutely I mean I'm up to six mag on my loops now because I'm 58 but I remember starting it even two-and-a-half and it changed my life and that's what the scanner does. I think it's I think the first time I ever saw you lecture was in the Bronx Big Apple dental meeting it has like the 89 or 90 or maybe 91 I don't know when you started lecturing it had to be one of those first years you were out there you were talking about you know the $40,000 intraoral camera that blows your tooth up to look 25 times what it was if you want to show a patient what's wrong with them that's what you do okay magnification is the same concept it's those digital scanning. If you're afraid to look at your prep on a digital scan it's cuz you're probably not doing a very good job and I also remember the first time I ever saw Frank Spear he said something that stuck with me for the last thirty years and he said the reason why dentists always want to know what other dentists are using to prep their teeth and how they're doing it is because they don't know what the prep is supposed to look like if you know what something's supposed to look like you can do it okay and that's stuck with me forever because at the time I didn't really know what the prep was supposed to look like myself okay but if you get it and you understand what things are supposed to look like then you can do it and when you're looking at that on a digital scanner with a with a foot-and-a-half prep in front of you it's kind of hard to do a bad job.

Howard: Now you're a faculty at the spear Center how much if some young kids listen to this right now how much longer do you think Frank will be there retires to Hawaii?

Steven: That's a good question I don't really know but I do think that people that have been stepping in and getting really involved they're a terrific and just like anything else he's an amazing communicator and you can listen to the guy forever but the reality is it's the concepts that are the most important part of the whole process and people that understand the concepts can teach them and you know I don't think Thomas Edison isn't around to teach everybody about electricity anymore nobody lasts forever unfortunately and I think people will take that over and I that there's a couple of guys I saw there recently who were tremendous lecturers there's a guy from Mexico City Ricardo Mitrano I think his name was and Gary Dewood is wonderful. So I think it becomes more of the ideas and the personality after a while.

Howard: Yeah I'd still buy into the whole his whole retirement thing because I just so see it I mean name any of the greats and the legends who just walked away from I don't care if it's Hollywood I mean yeah I mean who just came out of the movie who's that guy Robert Redford just came out of the movie my mom's joke for her entire marriage is whenever I say what's the secret to be married all those years she'd always say cuz Robert Redford never called me and he's in another movie now obviously I mean I had dinner with him taking up Provo Utah you know those two day courses he has dinner up at Sundance and I think it would have been up there a dozen times and he's walked in twice and I just I just everybody who retires after about a year of watching the wheel of fortune and Oprah you know they realize it's not all that it's cracked up to be you really think you really think he can walk away from that and just go watch wheel of fortune and fish?

Steven: No are you a fan of Billy Joel?

Howard: Yes

Steven: Okay so he has...

Howard: Anybody who marries Christie Brinkley is my friend.

Steven: So he has an in residence concert performance at Madison Square Garden once a month this has been going on for at least five years and I saw him interviewed and he said I told that the garden that when we stop selling out I'll stop doing it he makes over a million dollars a month one show a month it sells out every month and every the next month they go okay if we don't sell that we won't do it and it sells out again and they just keep going and going and going and the more they do it the more people want to see it and I agree with you how do you stay retired. Have you ever heard of bite FX?

Howard: Bite FX?

Steven: F as in Frank X is an X ray it's a company that makes a software that is all related to occlusion and you can use it to demonstrate all kinds of occlusal information to patients it's a great great company was on the iPad so when I just I'm a member I pay a monthly subscription to be part of them they're great and I could show patients things about TMJ and I could show them what anterior guidance is and I can show them it's a great educational tool. They're having Pete Dawson on this week interviewing him on a webinar and now how old is he?

Howard: He's got to be 80.

Steven: He's got to be more than 80 okay and I think that's great, he still he's still sane and he's still talking dentistry why can't Frank do it he's got 20 years on him.

Howard: Right right right. You said magnification we both agree you can just see it's better I already looked at that right now that's a use it on iPad?

Steven: I use it on all I have you know large screens in the opatory and it's on the same computer as my Dentrix my Dexes and we could just go in and each room we have a license for each room and we can demo it on the same TV screen but I have it on an iPad in my in my waiting room it's pretty cool.

Howard: Well they're gonna love you because I just found them on Twitter @biteFX and by the course of BI te FX they have 15 followers and I just retweeted their tweet to my 25,000 wonderful followers thanks for following me @Howardfarran hey I want to go back to preio because a lot of these kids that come out of school they're very confused they go back and they work with their hero you know their moms a dentists or dad's a dentist...

Steven: Yeah

Howard: and they they say things like well you know the best way to be perio is with four shafts you know show that reef some sunshine let's get some titanium in there and you don't to deal with it and then these kids are telling me that their parents implants you know whether they did or a periodontist or oral surgeon you know five years later you know twenty percent of them have peri-implantitis and you know, so I think when you and I got out of school periodontist was a huge profession and then it's kind of got wandering and lost with people saying while I'm not going to do pareo surgery on a molar when I'll just extract and do an implant but now that we've been doing this implant thing for a couple of decades there's a lot of peri-implantitis. So how do you how do you they have questions how do you rationalize I'm gonna do a periodontal surgery on this molar but I'm going to extract it and treat it with titanium.

Steven: So how long have dental implants been placed in the United States it was about what 1989 or 1987 something like that they've been around for about 30 years I would say so 30 years is great but we don't know what happens at 40 and 50 and if it's my mouth and then I love it I think I learned this from Pete Dawson he taught something called widiom "would i do it on me".

Howard: Nice nice

Steven: I've always loved that and you know what what would you rather have crown lengthening and three new crowns and you brush and floss it and keep it healthy for the rest of your life or just take them out put bone grafts it and hope the bone grafts work hope I don't blow out my sinus with a hole and get three implants and maybe I have peri-implantitis and maybe I don't. Personally I want my teeth they have they have nerves around them to let you have a tactile sensation and you know let's be honest an implant is a compromise it's great that we have them you know when I first started practicing and you first started practicing so distal extension partial denture was something that kept me up at night and luckily today you have an option that you don't have to have it but there's a guy who I followed on your forum for years on Dan Melchor out of...

Howard: Absolutely

Steven: Clearwater Florida and he carries the baton for perio and you know treating things the right way so you can maintain teeth and I think like anything else that gets lost in the shuffle you know now all of a sudden after dentist in New York City or sleep dentists and they were the same guys that were cosmetic dentists and they were the same guys that were implant dentist. You can't focus on one field like that and expect you know to do right by patients and it always goes back to Widiom, do I want that okay are you gonna do veneers on a 16 year old who has beautiful teeth and just needs a little whitening or maybe just a little crown lengthening is it about the money or is it about the patient is would you do it on me okay I'm not giving up my teeth for implants if I don't have to.

Howard: Why don't you make a meme, put your faces our Dr. Roth says Widiom, would I do it on me.

Steven: That's a great Ideo, I'm gonna do that.

Howard: Yeah make the meme email it to me Howard@dentaltown I'll make sure a half million people see it. I mean it's that is just everything and and and also I can say that you know just whenever you're almost conservative I mean first do no harm I mean I'd rather I'd rather try every single last thing to save my tooth even if it's to redo the root canal I don't care any you know whatever I just I just want to save the natural body parts I think most of the markets like that too.

Steven: Absolutely and you know what we have a periodontist and somebody asked me the other day how many times have you done a full mouth implant case and I'm like if I do one arch in a year that's a full arch that's a lot and we have we have a pretty advanced adult practice and the reality is if you're in an area where people actually take care of themselves that doesn't come up that much you know the whatever you call that company that does the all-on-four okay I don't see that very often because most of my patients are healthy because they're on three months recare instead of six months recare and we have a periodontist who treats the perio as it comes up so they don't lose all their teeth at the same time okay most of the implants I'm doing is because an endo failed for the third time or the cone scan picked up a fracture or the cone scan you know told you that the bone is just you know there's a there's a post you know preparation those are the kinds of implants we do it's usually single units or sometimes two or three minutes where they lost on one side of an arch but that's I would guess that's probably ninety percent of the implants done you know in the United States are the one and two here and there and you know I don't like the idea of pulling out teeth for no reason that's crazy.

Howard: Yeah and it's very bizarre when you go to these dental conventions because the the people who get all the lecture space or they all on fours but the guys that's doing all on nuns they they don't get me you know no one wants to go to the lecture on all on none but for every all-on-four case in America for 50 grand how many dentures are done at $1,000 an arch. I mean you know what is it a hundred what would you think a hundred to one I mean this couldn't that this country has 320 for ninety one place only did 18,000 arches last year mean 18,000 isn't even a rounding error in fact I would I could prove you that the United States government couldn't even tell you the exact population plus or minus 18,000. I mean when I was in China I was having breakfast with the president of the the Chinese Dental Association and I said well how many dentists are there and he goes he goes you don't understand China in India he said when we tell you we have a billion three hundred million people that's plus or minus a hundred million he goes I go he goes you know how same thing with India what we do population estimates are plus or minus 100 million people and and how would Jesus there would be no way to know how many benicar China suddenly reduced to being more like he estimated it was the same number of United States general dentists at one hundred thousand which shows you if they have five times as many people the same number of dentists it shows you that diet has to be a huge factor in this whole dental decay business would you agree?

Steven: Absolutely 100 percent I mean I see a lot of kids who just moved to New York City and they're out of college having their first job and now I find the toughest patient to deal with is the patient that comes in they've been seeing their family dentist in Kansas or wherever they moved to New York City to come in we take out all the technology we do dexas we do photos we do everything and we find oh my god this kid has you know 15 interproximal lesions what the heck is going on and what always happens with the patient they called her they call their parents they tell their parents and they go oh that New York City dentist is trying to rip you off the papers rants come back home and let you know Dr. Kevorkian are a little bit dentist you know fix you up. How come Dr. Kevorkian didn't know you had to decay in the first place. So yeah I think it's still a problem what happens when you're in college I have a kid in college now in Wisconsin they you know they have sports strings they have if they have sodas they have vodka they have you know they smoke weed and go out on the town and eat and don't brush their teeth and what happens at the end of college they have they have decay everywhere okay it isn't from a virus it's from their dietary habits and their lack of oral hygiene.

Howard: Right when you know when you look at um I think there's only 25 million homes the United States that are paid off the rust all have a 30-year mortgage when you look at cars all the data I see only 10% of cars are bottom cash 90% are financed and the dentist still goes in there and say ok to do there's everything we talked about there'll be $2,500 can I have your credit card or it'll be 49, 50 can I have your credit card you are involved with bridge financial solutions green sky patient financing, talk about that talk about the importance I mean like the people that I see selling all the cases they don't go in there and say oh yeah that on one for is 25 thousand dollars an arch I need $50,000 preferably in unmarked bills they go in there and they say this will be three hundred and sixty dollars a month for 60 months you know they're always using installment credit. So talk about bridge financial solutions green sky patient financing and could you do your big cases without that?

Steven: Okay so the first time I ever saw you lecture I'll never forget you said you go in the airport and the lady that's mopping the floor is on a cell phone and the cell phone is on her shoulder and she's talking while she's mopping and the minimum cell phone bill at the time had to be 50 bucks or 100 bucks and you said somebody could forward 50 to $100 a month for their cell phone they could afford fifty to a hundred dollars to finance their dentistry okay and I got sick and tired of certain companies what doing what i felt was dishonest things to my patients when I came to financing, so for the last five years I have been trying to build a patient finance company that had much better terms that lets you borrow a lot more money than a usual suspects I have cases in my office that are 40,000 50,000 60,000 and how many people can write a check for that that meant it happens once in a blue moon the Oscar winner might be able to do it but the reality is most people cannot do it and if it's better to treat the full arch and open the bike than it is to do a crown year I'm gonna recommend that and we got together with green sky who's now a public company I think they have a four billion dollar market cap and said okay you know this is how the kind of Dentistry that I do I know you're really new in dentistry let us help you build this platform for dentists and what I got from them and just I can give you the exact terms and I'll show you where you can find out how to sign up it's free.

Howard: It's called green sky or bridge financial?

Steven: Green sky financial is a parent company and bridge solutions is basically my partner and I getting together and working with green sky to make their product even better green sky does everything they do medicine they do construction you know they do autos they do everything but we are trying to perfect it for specifically for dentists and I'll give you a story of what I did with one of their loans this weekend I used I'm working on this because this is what I do in my office. I had a patient come to me last week or owed me $28,000 been paying me 500 to $1,000 a month for the last god knows how many years the patient now needs $20,000 more what dental work I was able to have the patient apply for a loan pay off what they owed me the twenty eight thousand and get the additional twenty thousand. So they now had a 48 thousand dollar loan they're getting seven years to pay it off the interest rate is under 10% I don't remember the exact number the application and the approval was done in less than ten minutes on an iPad okay that patient is now going to have a healthy mouth they're not owing me money no there's no bad feelings okay and it's the soft application so if they decided not to do it doesn't go against their credit the application is does not go under on their credit report. So we basically said we need more money better terms so you could get two years interest-free on the loan so there are patients who could actually afford to maybe write the check well so you know what I could use the extra money right now no interest. The more dentists we get the better terms we're getting so it's actually a lot of fun but I am doing two to three loans a week myself okay and I actually have a dentist that I that I'm friends with who's out on Long Island which you've probably heard of who literally does over two hundred thousand dollars a month in loans for patients but that can't change your practice I don't know what else can and once again you still gotta sell the dentistry but it's a lot easier to sell when you have a tool like this.

Howard: So who's John is that your friend John Russo?

Steven: No my friend is guy by the name of Darren Anderson.

Howard: I was on that bridge that website.

Steven: Yeah so go out to the green sky website the bridges is part of green sky not to confuse the issue.

Howard: So you know you don't want them to go to bridge financial org is that does that you?

Steven: No no go to green sky.

Howard: but is bridge financial solutions you?

Steven: No bridge the one that you're looking at right now is not okay we just we are still in part of green sky the reason we set up that bridge name is so you know we can delineate ourselves from there other businesses.

Howard: So that is did you name it that because it's green as Irish?

Steven: I know you're Irish and I know you have a green screen behind you but no.

Howard: and what we're talking about I mean what is the irish lesson from the Irish diaspora what is the greatest living machine if you ask any American what's the greatest sewing machine what would they say?

Steven: Singer?

Howard: Yeah and singer wasn't that good of a sewing machine every like 20 different sewing machine companies and everybody wanted 50 bucks and they wanted a 50 bucks now and it was gosh-darn Mr. Singer who came over from London knowing these guys could only get textile jobs if they had a sewing machine and none of them had $50 only the shirt off your back so he said c'mere Irish boys I'll give you a $50 sewing machine but when you get paid your $3 on Friday you come back and give me one of those dollars and after a year you own it well everyone else went under it was the same thing with Ford and General Motors. I mean Henry Ford wanted all of his money down and then General Motors came along and offered GMAC financing and that's why they shut down the Model T assembly line after 10 million cars because Henry insisted of getting his money up front and if you want to be a great dentist that serves kings and queens that's not really what America is about I mean what America is about is the middle class and installment credit is everything. So if they go to green sky I can't believe I'm gonna retweet green sky when they're not even following me my gosh but I'm gonna I'm gonna do it anyway though so it's @greenskypay.

Steven: Actually here go to this go

Howard: That's my sausage fingers make a lot of typos /sponsor

Steven: Yeah backslash bridge that's the link that will take you now to sign up.

Howard: Nice

Steven: Okay and if all townies want to go there okay we are going to get them special deal okay and  that's the way to do it and it says credit limits as high as 55,000 it's gone up to 65,000 in my office if you do a full mouth reconstruction with cord buildups pareo surgery etc etc etc it's close to $100,000 okay that's New York City prices I'm not saying that everybody should go out and do that what I am saying is if you want to do great work and pay a great lab and have a periodontist do great beautiful work it's going to cost you a lot of money and getting it financed is the way to go.

Howard: Yeah I mean it's just it's just the it's really the only way to go I mean for every person that can just pay in cash how many are there that just need a payment and that that's how these sales that's how they sell the average American thirteen cards of their lifetime and and and I don't even know why is it more to be General Motors making cars if GMAC it's made $3 a net income for every dollar if the book that I love the most on that its called the profit zone and it working every industry and it just added up the net income dollars and you took like automotive and all the car companies that made all the cars did they didnt make 10% of the profit how GMAC financing was like and you know the financing the car was like 30% and the number two was insuring the car like progressive and State Farm those guys were like another 30% and what was just mind-blowing until I started telling dealers that this couldn't be true was that car parts and care maintenance was more pompadours than selling the damn car and every person I know in the valley here that owns the car a lot says oh man 80% of my money on the maintenance and the all that not selling the car he goes he goes you know you pretty much hardly make a dime it just like every restaurant I go to they just want alcoholics feed there they they make 80 percent of their money on the wine and that's how they bring out a wine menu they don't make any money off lasagna and breadsticks and salad there's so much labor and cost and materials 30 percent food cost they just want to pour your drink for 10 bucks and just nothing but net.

Steven: You know what we'll do sometimes if a patient is going to do ten veneers and the cost is I don't know somewhere between 25 and 30 thousand dollars let's say we'll add in the first four hygiene visits so to get them on a great maintenance schedule and make that part of the application for the loan. So they get their veneers and the first four hygiene's that basically guarantees that they come back and you can do follow-up on their caces and they become great patients, maybe it's costing them $500 a month but with a great loan. So this is I couldn't practice without it I really couldn't and and I know you say this a lot why are some dentists doing big cases and some dentists or not, yes part of it as sales part of it is patients liking you part of it and you talked about this all the time is being passionate and having fun and patience picking up on that okay. If the patient's not under stress about the money it's a lot easier to get them to do it okay and you're doing it for their own good and that's what sales is it's making people happy with the decisions they make and that's why I love doing this and you know what like you always say I'd rather play golf and you know we'd rather do dentistry than play golf sometimes I'd rather play golf however okay there isn't a data I don't come in the office where I don't say to myself who am I gonna get to a complete case of dentistry today that is the first thing I think about every single day, we have a morning huddle we go through the hygiene schedule and I say you know what Mrs. Smith would really benefit from having her mouth redone she'll look great she'll have teeth when she's retired we won't have to worry about all these problems let's talk to her about it and what we'll do is say Mrs. Smith you mind staying an extra 15 minutes to get a bunch of photos done and some digital scans of your mouth and she'll say sure we'll do it come back I won't charge you it will sit and we'll talk about what we can do for you and then it's only a matter of time. So I bring up a patient financing or doing the case the right way and that's how you that's how you build a big practice become your patients friends and was there can't do it if you don't present it.

Howard: Yeah I know my homies and I want to make one thing clear I called you several times to come on this product I think I've been calling you for about three years to come in the show this is not a commercial I don't get any money from anyone no one's ever given me money to come on my show but I still want to go back to  I know my homies and I know what they're already yelling as their driving to work commuting, their saying dude he doesn't get it I'm in Cleveland and I've had these patients fiancee and no one gets approved. What would you say the guy who's saying now I'm tired of spending all this time running an application and all I get is denials because you know I'm out in the middle of the Indiana I'm in Hoosierville.

Steven: That's a great question and here's what I would say sign up it takes ten minutes to sign up and try it if it doesn't work on your patience you wasted 10 minutes 15 minutes we're getting approvals that the other big companies are not giving on a regular basis okay. Sure if somebody has a 200 credit rating and they're on the FBI's most wanted list there's a pretty good chance they won't get approved however most people will.

Howard: You know you remind me of one of my heroes Bob Gibson who I was an optician in Southern Cal everybody wanted these tooth colored fillings and he wrote a book on and he said dentistry who don't realize there would have never been cosmetic dentistry until they had the technology of adhesion and it's a technology of adhesion that's spun up all this not cosmetic stuff and he realized like you that toothpaste or the average tooth was dulling his composite so he came out with Rembrandt a harder harder toothpaste for polishing and you've done the same thing on the other coast he was Pacific your Atlantic with Mynt Smile, Mynt Smile talk about your journey with Mynt Smile and what made you swing your time on that?

Steven: Okay so there is a wonderful dental hygienist named Lisa Marie Kayap it was her idea and I'm just showing you what a bottle looks like right there okay and I don't know how many years ago maybe 10 12 years ago she was doing her hygiene in Nice New York City practice, you can go to and spelled


Steven: So Lisa came up with the idea she had an event that I take no credit for inventing this toothpaste it's all her but she came to me a couple of years ago and said you know sales are kind of slow things aren't going great I could use a little help. So I said the sample this looks like a fun project and I think this lady's passion is in the right place let's try to help her do this so I got involved with this product and I love it I recommend it to all my patients they go on the website and they sign up and get subscription orders and the research shows that it's the only product that polishes porcelain and composite available on the market today it actually got a patent about six months ago as the only product that can do this in the US and the reality is it doesn't scratch your veneers it actually makes them look better it polishes them up it's got a very low abrasiveness to it similar or even better than Sensodyne and if you look at what goes on with tooth paste these days Sensodyne is one of the top selling toothpaste in the United States why do you think that is?

Howard: Well it'll block drug they sold to GlaxoSmithKline but why is... ask the question again.

Steven: Why do you think it's one of the top-selling toothpaste in the United States?

Howard: because people have somewhat sensitive teeth.

Steven: All right what do they not want to do go to the dentist I want to avoid the dentist the reality is a lot a lot of the garden variety the popular toothpaste is very abrasive and nobody really knows 100% what causes all recession but certainly having a highly abrasive toothpaste isn't helping when it comes to sensitive teeth because it's taking off the really thin enamel at the cej this toothpaste not only does polish your porcelain in your composite but it actually is great for sensitive teeth as well because it has such a low abrasiveness and it does not contribute to add fractions and and recession it actually is as gentle as can be and that's why I love the product because most much of what I do is crown and bridge in veneers and dental implants they all have porcelain and Emax and zirconia and they need a product that will polish them so I thought I just thought it was a great idea and I'm just trying to help her move this product along week yet we actually just started working with the American Academy of cosmetic dentistry.

Howard: You know I know that because the reason I retweeted on Twitter, she's at @myntsmile or not .com @myntsmile is because their commuting so their not taking notes so what I do when im podcasting I forward their tweets and I just retweeted an excellent article on tooth whitening so I just retweeted that article so you continue.

Steven: So what we decided to do because we love the cause of get back a smile as which is AACDs big charity is...

Howard: Okay I'll retweet that one, you got two retweets about giving back a smile.

Steven: We are donating a portion of the sales of Mynt smile for a year to give back a smile because we think it's such a great charity and they're helping us promote the product.

Howard: Nice

Steven: We hope to continue that relationship for a long time and you know I just think it's great when somebody who's an active you know wet finger dentists or dental hygienist as they say which means that they just actively practice I still practice full-time I think it's great when people come up with inventions and products that's based on what they do every day and it's based on helping patients lives get better and this is what one this is one of those products okay and guess what if you want to do more cosmetic dentistry and getting your patient on a product like this actually gets them looking at their teeth more and wanting more cosmetic dentistry. So we have plenty of spouses and partners and family members who use Mynt smile because somebody in their family has some cosmetic dentistry and guess what they love the product it tastes great. So I am trying to help her work this product because I believe in it and I put every single patient I have who gets any kind of Dentistry on it because I think it does a better job.

Howard: Well I just went on my Dentaltown app, I still can't believe that there's a quarter million dentists and hygienists on dental town and 60,000 of them download the app and the app keeps getting downloaded over a thousand times a month I just did a search for Mynt Smile there's a thread on it I just forward it to you and hopefully you guys can both post on there and if you're shy if you don't want to feel spammy just say that you just did a podcast with Howard and he told you to come on here and talk more about it.

Steven: Awesome

Howard: Would you do that?

Steven: A hundred percent.

Howard: Hundred percent, I can't believe we blew through an hour I could watch you for forty days and fourty nights. I just gotta tell you my New York City's story though my first lecture was April no August I forgot the date August of 1990 and I was born and raised in Wichita Kansas you know all things a grain silo I went to creighton of Omaha the same Kansas City and so here I am in a window seat and I'm flying along we're descending and I'm just looking out the window and it was the first time I ever saw New York City it looked like the Grand Canyon in bursts and I remember just gasping and I was scared to go by myself so I asked my classmate best friend at Steichen from dental school he's in Albuquerque to go with me and he was looking after the huge from Albuquerque we were just like what and we wish this how hillbilly dumb we were, we go to the airport get the cab and he says where you going I said to Sheraton and he says which one and that was the first time it dawned on me there was more than one Sheraton. He goes dude there's like 60 in Manhattan and so we had to run back in the airport wait line at a payphone call my crew back in Phoenix ask them if there was an address on that Sheraton anyway so we go to Sheradan we unload our stuff and we ran downstairs to go to explore and then next thing you know I mean we probably landed by like six o'clock or something next thing you know looks at me and says dude it's 3:30 in the morning and he's like your lecture we've lost all concept a time and I still go to Manhattan it's the cool of damn city on the planet so good at ya say I know you're a busy man thank you so much for giving me in my townies your time and coming on the show I really really I hope you have a rockin hot day.

Steven: Thank you thank you very much thanks for the opportunity I think that people like you make dentistry a lot more fun you've probably changed an entire generation of dentist and not just with dentaltown with your lectures I still remember going with my staff members and we would laugh and so hard our facial muscles for killing us. You know we had a great time coming to see you and I hope we can all come see you again soon.

Howard: All right well on that not have a rockin hot day buddy.

Steven: All right thanks a lot 


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