Dentistry Uncensored with Howard Farran
Dentistry Uncensored with Howard Farran
How to perform dentistry faster, easier, higher in quality and lower in cost.
Blog By:
howard
howard

1213 All things SDF, GI, FV, with Pediatric Dentist John Frachella DMD : Dentistry Uncensored with Howard Farran

1213 All things SDF, GI, FV, with Pediatric Dentist John Frachella DMD : Dentistry Uncensored with Howard Farran

6/24/2019 8:15:33 PM   |   Comments: 1   |   Views: 137

John Frachella, DMD is a pediatric dentist in Oregon and Maine with 45 years experience in the delivery of dental services in public and private settings. For the first 32 years of his career he was the dental director of a free clinic for indigent children in Bangor, Maine and for ten years served as the director of federal clinics in Wheeler County, Oregon.  He also works in private practices across the country, is on staff at OHSU Dental School and lectures for NYU Lutheran Medical College dental residency programs. Dr. John Frachella is a national leader in the use of SDF and how SDF impacts dental schools and clinical practice.


VIDEO - DUwHF #1213 - John Frachella



AUDIO - DUwHF #1213 - John Frachella



He presents new options in the management of caries lesions, especially in certain instances and populations. Over the past decade, Dr. Frachella has been using silver solutions in combination with glass ionomer technology to arrest caries while simultaneously addressing destructive dental cavitation (called Silver Modified Atraumatic Restorative Technique - SMART). He sees the minimally invasive medical management of caries as a new, historically proven, highly preventive standard of care for the treatment of worldwide populations of children and special needs adults who desperately need dental services the most.



Howard: it was just a huge honor for me today to be podcast interviewing Dr. John Frachella DMD he's a pediatric dentist in Oregon in Maine with 45 years experience in the delivery of dental services in public and private settings for the first 32 years of his career he was a dental director of a free clinic for indigent children in Bangor Maine and for 10 years served as a director of federal clinics in wheeler County Oregon he also works in private practices across the country is on staff at Ohio State University dental school lectures for NYU Lutheran Medical College dental residency programs dr. John for shell is a national leader in the use of SDF silver diamond fluoride and how SDF impacts dental schools and clonal practices he presents new options the management of caries legions especially in certain cells and populations over the past decade dr. Furr chela has been using silver solutions in combination with glass ionomer technology to arrest caries while simultaneously addressing destructive dental cavitation called silver modified ultramatic restoration techniques smart he sees the minimally invasive medical management caries is a new historically proven highly preventive standard to care for the treatment of worldwide populations of children and special needs adult who desperately need dental services the most my gosh I've been a huge fan of yours I've had so many people ask me to interview you jeanette mcclain jeremy horror steve Duffin you know I mean you're just this is just an honor to be talk to you today so there's a new as you call it a paradigm shift and it's very emotional because a two-year-old has eight cavities needs eight pulpotomy x' chrome stole crowns they take him to the o.r and it seems like every couple of months somebody doesn't recover from OR it's all over social media the dentists are destroyed the parents are destroyed the patient's gone so now silver diamond fluoride it's like with that two-year-old little girl bit alive if they just painted SPF on eight this is very emotional are you feeling the pushback from this debate

Dr. John Frachella: oh absolutely yeah  we're getting pushback all over the place but I think there's an equal amount of acceptance so there's a balance you know we have push back we've got acceptance I just got a notification from colleagues in Maine where I work four months out of the year who said that SDF has taken off like crazy and smart is taking off like crazy and two years ago they didn't want to hear about it so there was pushback two years and now there's two years ago now there's acceptance and I think that we're reaching a pretty good balance now and I want to thank you for  interviewing Jeannette and Steve Duffin and  others on this subject because I think the more we can bring this to the public's eye and to to organize dentistry's attention the more will we'll reach that balance and get less pushback 

Howard: well this is dentistry uncensored and every animal in the animal kingdom is very tribal so why does some of the dental tribe love it and why do some of the dental tribe push back well what is a the foundation of this resistance 

Dr. John Frachella: well you know essentially you know we don't know we can't do we won't change and you know we've got to combat the  willful ignorance and the fear you know the big fear of course is you know that Dennis think they're going to lose income and  we've proven over and over again and practice after practice that indeed it's exactly the opposite you can increase your income and be much more happy doing dentistry on phobics if indeed you have a practice that where you're treating children or phobic adults because less needles less fear less  of all the things that cause stress and you know we just have to get used to the fact that we're treating more teeth in one appointment then we used to because you know I guess we have to ask ourselves is it even ethical arm at disjunction Junction to ever treat a single lesion or a single quadrant of lesions when we can arrest all lesions immediately without needles or drills and simultaneously fill food traps prevent recurrent decay prevent future decay and sound teeth by providing mineral ion reservoirs of glass ionomer that really mineralized and kill bacteria in a way that makes mouths healthier regardless of income behavior lack of insurance or limited access to care and that's a hard pill for them to swallow but it's one that's I think is gonna be inevitable 

Howard: well I'm gonna I want to start at the very beginning it's on it's only June 24th we just had 6,000 kids walk out of dental schools in the United States and Canada decay is still the number one disease and sapiens around the world they still debate the basics what causes decay is an entirely nutrition is a contagious I I have noticed in 32 years that when a two-year-old comes in with and needs pulpotomy x' and chrome still crowns dad's got bombed out molars and is always holding this little kid on his lap and kissing it and sharing food with this so review what causes this decay on a worldwide level and what could prevent it and let's start there 

Dr. John Frachella: well it's you know we have to we have to honor the disease for what it is it's a bacterial disease and we have to ask ourselves what other bacterial diseases of the human body are treated with invasive surgery as a fer measure as we do in dentistry you know I work with a colleague in Maine and he's an internist he's a physician an internist and then he does he's also a dentist and he does dentistry you know on the side and does internal medicine when he's not doing dentistry and I asked him when he comes to the dental office I said you know what when you put on your dentist hat what makes it different than  the hat that you wear as an internist do you treat anything in internal medicine that is a bacterial disease do you treat it with surgery first and and what makes what makes it so special that you can treat this bacterial disease that dental disease caries dental caries with with  surgical invasion as a first measure that's where we have to really separate the wheat from the chaff here you know that's  the deal so I think that that we need to first honor it as a as a bacterial disease the bacterial disease that it is and you know we have to ask this when you've got that scenario that you just that you just identified of the dad with the decay and the kids on his lap and he's got decay and they're kissing you know if the house is on fire what do you do  you call a carpenter do you call the fireman Howard fireman exactly so let's be firemen first and then let's do that the countertop and the cabinetry after we put the fire out

Howard:  it kind of reminds me of the mhm pleura where everybody in America was seeing these ulcers and had to treat him with the surgery and then it was the Australians wasn't it who said this list this is a bacteria and  it weakens the protective mucus coating of the stomach and duodenum thus allowing acid to get through to the sense of lining beneath both asses bacteria irritate the lining and cause a sore all sir it's the same thing this bacterias is weakening the protective mucus coating of the tooth and the biofilm and so it's kind of a great analogy did you see parallels between h-bar bacteria and caries 

Dr. John Frachella: absolutely I see analogy there it's exactly identical to that you know it's you know we have to we have to reach out and look at the at the origins of the disease and honor that from the beginning and we have to realize that we've  gone astray in dentistry we we started with  G V black-eyed N and W D Miller identifying it as a bacterial disease and treating it as such and then we got involved with the jewelry of dentistry and we got enamored by it and we got rich from it and then all the sudden it you know the disease God got away from us because we got away from it and we need to go back to the origins of the disease and we need to look at the disease today differently than we ever have because you know we were we're in a situation where we're eating more sugars and different kinds of sugars you know we've gone from mono Sakura from disaccharides to monosaccharides we've gone to the corn syrups and it isn't the same disease Howard this isn't the disease that we were facing when you and I graduated dental school it's worse it's more virulent it's more virulent because of the substrate changing and it's more virulent because of the habits that we have and we have to get back to treating the disease for what it is especially for those populations that need it the most and we have to realize that 50 percent of all children would paid for medical and or private health insurance don't utilize the death the benefits that they already have and we have data on that from 2013 to 2018 and what are the reasons to expense too invasive bad previous dental experiences so half of your potential market share won't even come to see you I mean we're in a career where a few people want to see us and we're the last place they want to come back to

Howard:  so in review you do believe that caries is a contagious inside the  primary home where this child lived yeah absolutely if we're gonna swap food back and so I mean it's so obvious you know the parents come in that's not it's not obvious to the dentist's though so make it obvious the I still get massive push back that pareo or caries is not contagious and it's like well if you walk out in your backyard and you see a giraffe there I mean it came from somewhere didn't just that's not how evolution works you just can't walk out your backyard and find a giraffe it came from a mom and dad giraffe somewhere yeah 

Dr. John Frachella: so I treat a lot of Mexican patients I love my Mexican population of patients because they bring me tamales for $2 a piece and they're like a vitamin pill and I love them but I've watched them cook and you know mom's got a mouthful of cavities and she's swapping food with the kid here taste this taste that you know you're not you know how are we gonna change that you know we've got to go back ten thousand years into a Sutekh culture and tell them well quit doing this well how did we get here is what they're saying to us they said well we got here by swapping food we're not going to stop it because you say it's a contagious disease we have to recognize that it is and realize that some things we can't change some cultural phenomenon within certain populations many of whom are high-risk populations high risk of caries populations we're not going to be able to change their  social dietary habits but thing that we can change through the use of antimicrobial medicines liquids we can actually change the flora by balancing it we can't totally prevent we can't totally stop the disease but we can control it with antibacterials and remineralize errs and that's the important thing so I think if we can recognize that we need to be firemen first and carpenters second that we will have more fun practicing for one basic reason we're gonna have less emergencies tomorrow if you treat a patient today who's got a mouthful of caries no matter where it came from whether it was contagious or not forget about it they got a mouthful of caries and you're gonna treat one quadrant today well tomorrow's emergency that's gonna screw up your whole day it's the teeth that you left untreated that you could have controlled the caries in those teeth right then and there on the spot for pennies on the dollar and in just a few minutes painlessly and effectively so why let it go out the door in fact I'll say this Howard is it ethical to let it walk I don't think so anymore not with the knowledge that we now have then we can arrest caries that partial or incomplete decay excavation is the new higher standard and that glass ionomer remineralize --is demineralized tooth structure that should not be removed by the way

Howard:  I think it was so hilarious that you're mentioning your Mexican friends your Italian and most Americans think Italians I started tomatoes in their sauces and it was actually the first tomatoes to make it to Europe were brought back from the Spanish conquistadors of South Africa Peru specifically in the 16th century the first mention of its 1548 in Tuscany yeah it's amazing so you believe decay is diet-related you believe it's contagious well then who what exactly defines the high-risk populations what is the difference in a high-risk and a low-risk population is a diet culture home care what  would define this

Dr. John Frachella: it used to be diet culture and home care but now the disease has become so virulent that it absolutely knows no socio-economic boundary so you can have the very very rich parents of who are going out into the workforce and  leaving their children to play with their iPhones and computers and having no supervision who are sipping on perfectly healthy organic apple juice all day long with a frequency rate that exceeds what would be healthy and are dropping their pH their salivary pH their the pH in their mouths to four point four when we know that carries occurs optimally at six point six and their mouths are at 4.4 for the whole day as they're slipping on apple juice very affluent mom and dad come home and look in the kids Massa oh my god he's got all this decay it does a high risk doesn't indicate doesn't mean a public health and a low socioeconomic status it transcends all of that because the virulence of the disease itself has altered it's changed again it's not the same zees as when you and I graduated dental school in the 70s 

Howard: and again why has it changed because of the different types of sugars on

Dr. John Frachella: because the substrate we've gone from a polysaccharide or a lot our disaccharide to a monosaccharide we change to corn syrup since you and I graduated dental school Howard that makes a massive change the bacteria can um can metabolize the monosaccharides much more quickly than it can a disaccharide and and just the sheer amount of that sugar of that substrate in the diet it pervades everything it's everywhere it's  oh it's in all foods and yes should we go back and change so we go back to Weston Price yes Weston Price was right go to those cultures back in time that didn't have refined foods that we're eating natural foods there was no caries of course but can we go back there I I'd like to think that we could I'd like to think that you know that I can as much as possible in my yurt in the middle of the ocean so national forests yeah but when I go out into the world and have to do dentistry and I've got to go to Jimmy John's to get a get a sub you know I know it's gonna something I'm eating is gonna whatever I'm eating is gonna be laced with  corn syrup and so it's ubiquitous so I don't think we can control that in an immediate sense in the long run I hope we can I hope we can fight the sugar lobby the way that we fought the tobacco lobby okay I hope we can do that I don't think we should give up the fight but in the meantime we gotta be firemen and we should concentrate on putting the fire out in all patients all socio-economic groups I work in practices that that are private practices private practice facades that our public health practices there's cost shifting we're working on people that are affluent so that we can turn around and treat those  children that are on Medicaid around the Oregon Health Plan or on main care and  so we're cost shifting in all of those populations we should be firemen first and carpenters later when time behavior and money allow cuz those are the three things right oh I don't have time to go to the dentist oh I don't have the money to go to the neck oh the kids behavior is bad well in that case being a fireman and paint the teeth

Howard:  the European countries like the UK don't have this problem because they do not authorize the use of high fructose corn syrup or are you aware of that and what do you think of that 

Dr. John Frachella: well I think that that you know that they're ahead of the curve and that we could we could they serve as a good example to us I think that's a that's great I don't know that they're carries rate is less than ours I don't have the data on that there  are others that can that can tell us more about that but you know my end of the deal is the firemen end Howard I know what I see in the populations that I serve in what I call the third world in yours in my backyard okay we can go to Bolivia like dr. Duffin does we can go to Africa like dr. duffin and doesn't we can see these populations of that have you know huge amounts of carries because they don't have access to care well all I have to do is walk into my backyard of Redmond Oregon and I can see as much or more decay or in Maine where I see more decay than I then I see even in Oregon that you know in the communities surrounding Bangor where  I have a have a place that I stay in a few months out of the year where the decay is so out of control including in in the capital city of Maine and Augusta where I work in a community dental clinic where the kids come in one after another after another and I paint their teeth and I put in glass ionomer and what do you think the parents say Howard the parents say Oh dr. John you're a children's dentist but will you treat my teeth and then you know what else happens Howard the dentist's come and watch me and I've invited you and I will continue to invite you and your team to come and watch me work in settings like Augusta Maine and you know what dentists like you who Job Shadow me say they go like this Howard they go hey hey do you have time dr. John would you would you do that in my mouth you know I lost this amalgam that I've had for 40 years and it's way up here and my dentist wants to do a crown but I know it's gonna be a root canal I don't have the time I don't want to spend the money even though I can get professional courtesy and have it done and here are these dentists who come in as doubting Thomases at the beginning of the day asking me at the end of the day if I have another 10 minutes because that's all it takes to treat their mouths with smart I mean that's the highest honor and the greatest endorsement of all they want me to be a fireman in their mouths and their dentists 

Howard: um one more thing I want to say about that high fructose corn syrup is a lot of people say well it's not banned in Europe because of health issue it's  banned because of a production quota look they always say politics you and sausage you don't want to see how it's made you just want to see you just want to eat it so with the government management team of your tribe has to put this through under a production quota but one thing that they're always talking about is that countries that use high fructose corn syrup and their food supply have a significantly higher prevalence of type 2 diabetes and countries that do not use a sweetener and it's a fact that Canada Slovakia Bulgaria Belgium we're all so high relative consumers of this so this is changing from a simple sugar  cane - high-fructose corn syrup it is a new variable that that you think might be changing the back to the dental decay disease right

Dr. John Frachella: I don't think it's changing it has already changed it the changes here were past it worth there were at were a total destruction we're at a level of total destruction I have children come in from again all socio-economic levels - whose mouths are totally destroyed I mean they come in with 20 decayed primary teeth I look at my job being that of trying to rescue them from the hospital or despite their dietary habits despite there's the cultural differences and despite what it is that's going on in their home because you know Howard I can't go home with them and be a disciplinarian in their lives I see them for a few moments and I see a patient about every 10 minutes and what I have to do within that 10 minutes is try to convince them that it's a matter of frequency so if you're going to talk about this high-fructose corn syrup and get carried away with it we got to look at the frequency of it so I say to the kid I go well what's the poison right Howard at what is your poison what's causing this don't lie to me I'm not gonna criticize you just tell me what it is well many times its organic apple juice sipping on it instead of guzzling it so number one you know we have to do we have to make a neon sign and put it over the top of their house and over the  mirror in the bathroom and the neon sign says chug don't sip because if they chug monster or Red Bull or organic apple juice or coca-cola or anything that is going to cause decay if you drink it sip it and have high frequency if they chug it instead then they're going to have less decay because they're chugging it it's not staying in the mouth and then I try to convince them rinse your mouth out with water after you've had your Coke episode or your monster episode and so they come in and they say well dr. John I you know really I'll tell you told me not to lie I'll tell you the truth I drink four monsters a day okay so or four Red Bulls a day and  they're 14 years old I go juggle well I don't think I can chug them well you're gonna have to chug them if you want me to work on your teeth because I'm not gonna work on your teeth if you're going to destroy them by sipping on this stuff so start chugging and I want to tell you something you may die from chugging four monsters a day but you're going to be an exquisite corpse because your teeth are going to be good so come on let's think about this for real okay yeah what causes decay gummy bears why because of the frequency well you know I try to get them to replace the gummy bear with chocolate why because chocolate melts milk chocolate melts at 98.6 which is what your mouth is just if you put milk chocolate on a - your car it's gonna melt you put no chalk on your mouth it goes in your stomach where you want it where we want it not on your teeth that doesn't have duration and then take a drink of water and limit the frequency we're frequency freaks we got to have this thing in our mouth this sour ball this this starburst candy that has maleic acid in it and we keep it in our mouth for hours at a time pop another one pop another one pop another one drop the pH in the mouth to 4.4 all day long and then wonder why we have two K we need to educate our patients about frequency because we're not going to be able to eliminate they're already at it and you know what we're now diction counselors were Dennis

Howard:  I want to remind the young kids who just got out of school you know I'm I I walked out in 87 and this is 2019 so you do the math three decades ago I thought restorative dentistry was better because we are replacing this bacterial infection with a strong metal that was very antibacterial I mean it was half amalgam it was the other half was silver zinc copper tin it's all antibacterial and then we did this aesthetic Health compromise and went with inner plastic composites and the recurrent decay just exploded and they usually had returned decay in six and a half years the amount were 28 years do you miss amalgam do you think that aesthetic health compromise of the whiter brighter teeth that we really paid a high price for because I know that now you people like you or and John kingka and all these people are looking at fillings with an active ingredients are going towards glass ionomer cements are going for fluoride varnish they're going for a silver diamine fluoride I mean everything you guys talk about is an active ingredient against the other 5500 species of animals 400 to 600 - which live in our mouths I'm eating this stuff I mean is that words go in it are we gonna go away from inert plastic composite resins to active ingredient fillings so that we have the biological weapon as opposed to just a mechanical replacement for physics of chewing 

Dr. John Frachella: well let's you know let me answer your first question do I miss amalgam I don't miss amalgam odd however it was wonderfully on bioactive it corroded and then it released silver that killed the bacteria and anybody who's removed and old amalgam a broken older amalgam knows what arrested caries looks like right you see it it's under there it's under the amalgam its arrested that's wonderful but what ended up happening was it didn't it wasn't remineralizing it was ant Tyrael but not remineralizing then we got into the plastics and the beauty of Dentistry the jewelry of dentistry but you know I heard Gordon Christensen say on your podcast last year that composites are cariogenic that cause cavities I also heard him say that in 1978 so why have we continued to use posterior composites now look I'm number one take nothing out of your tool kit don't take a mathematic don't get composites out of your tool kit we're gonna need them you know I snap off my central incisor by going over the handlebars of my mountain bike I want you to replace it with the newest latest greatest composite that's aesthetically pleasing plates okay so don't take that out of your tool kit please however you know why would I want such a thing in my mouth on posterior teeth that aren't in my smile line I want something that is as biologically active as possible and you know Howard I'll tell you something you can't out glass glass new manufacturers are coming out with this bioactive stuff I mean active is a great example it's 80 to 90 percent resin there is nothing bioactive about resin there is nothing biologically interactive because that's a better term biologically interactive about any part of resin so what can we combine resins with glass okay because you're not going to out glass glass there is nothing on planet earth that is more tooth like than glass why because all of the mineral ions that are in a tooth are in glass why because glass comes from sand what since and you break down sand you break down a tooth and they've got all the same mineral ions okay phosphorus calcium fluoride even aluminum even structure is in glass and so when you put glass when you powder glass reconstitute it put it into a tooth in a putty form it becomes the tooth and the tooth becomes it it forms a zone that is a permanent zone of acid resistant zone of chemical fusion you can't do that with amalgam you can't do that with composite resin tags our resin tags they're not molecular cross-linking you don't get molecular cross-linking with composite you don't get molecular cross-linking of the material with the tooth and the two through the material like you do with glass so are there new formulations of glass coming out you bet there are I've been testing new glasses for different companies now for the last couple years and they get better and better because we're asking for more aesthetics we're asking for more translucency we're asking for more of the things that composites give us that amalgams gave us that silicates gave us but silicates were bioactive Howard you remember silicates but what did they do they caused to sensitivity what does glass ionomer do it is so desensitizing as is silver diamine fluoride and when we use desensitizing materials that work with our biological systems well suddenly we're winning so yeah I think that's where we're going that's where we should be going you know if I if I if one of my gold crowns comes out which happened to me a couple of years ago you don't what are you gonna cement that on with Howard in my mouth are you gonna cement that on with the latest greatest resin you know mister I'll tell you what if I'm sitting in your chair and you grab the latest greatest resin and tell me you're gonna put that in there I'm gonna stop you and I'm going to say first put silver diamine fluoride on it on my tooth because it's under my gold crown and then put a glass ionomer cement or resin-modified glass ionomer cement so that raises the question how much resin can we put in the glass and still get the biological effect and I would say that 20% resin is the limit in other words 80% pure glass 20% resin and we'll get that biological activity that we're looking for plus we'll have the aesthetics okay so we can have the aesthetics of the resin along with the medicinal properties of the pure glass and blend them together how they do that how the chemists do that at the bench I don't know because it seems to me like they're dissimilar chemistry's but I know this it works and we put it doesn't matter in smart whether we use resin-modified glass ionomer with 80% glass and 20% resin or pure glass ionomer we seem to get the same results I think we can combine the Worlds and get the best from both 

Howard: so you mentioned pulp dense activity Activa bioactive products for proactive dentist so you're not a fan of pulp dense Activa bioactive restoratives restorations

Dr. John Frachella: my friend that was the biggest marketing blitz scam of dentistry ever they put this stuff out they've got the they've got these individuals that promote this that aren't dentists claim to be scientist but don't have any degrees I can see that tell us all their bioactive does that and the other thing when we use them in combination with silver day I mean fluoride when we use Activa in combination with silver diamine fluoride we get failures and then people come back to us and say smart doesn't work why is that because when I write an article for dr. bicuspid for instance okay I write the article about silver diamine fluoride and glass ionomer and they put a banner for Activa on the top I didn't put that banner there they did why because dr. bicuspid is owned by shine and shine wants to sell Activa for pulp debt so they put the banner up dentist who's reading my article he actually or she actually is reading this saying oh because they're reading it very quickly because they're very busy I'll use Activa former technique that dr. Fraschilla is recommending and then they fail and then they say smart fails look we got to stop with the advertising and the BS this is you know this is dentistry uncensored right Howard right look let's talk about it this is wrong this is not science resin is inert dammit you need to ask what is in the material you need as a dentist as a new dentist graduating from dental school you mentioned the numbers you need as a new dentist to do your due diligence what is in the material now if the manufacturer and let's use pulp that in this instance says to you know we can't tell you what the formulation of Activa is we aren't allowed to tell you how much glasses in Activa because it's proprietary walk away you need to know you need to know what is in this this material this is not about ad copy this is about science are you a dealer or are you a snake oil salesman what are you as a dentist use your own intelligence use your own scientific intuition and your scientific knowledge to analyze the products you're using and if it's resin know that it's in earth I'm not saying don't use it I want it on my front tooth I don't want it on my back tooth what is it doing on my back tooth nothing it's cariogenic even Gordon says that 

Howard: even Gordon the GaN dentistry oh you mentioned dr. bicuspid I had lunch last week with the the new owner Craig overpack he's a CEO so it's not a owned by but I want to go back to amalgam back to amalgam you know the average dentist has 2,000 patients and you said you don't want anybody to remove anything from their toolbox I mean half the dentists in America and the 20 richest countries have entirely removed amalgam from their toolbox and so if  the average dentist has 2,000 patients can a dentist actually say there could never be a use for amalgam for any of my 2,000 patients or would you think say that's just not correct

Dr. John Frachella: I haven't used amalgams and since probably 19 Oh I'd say 1980 I quit using amalgam in 1980 when I began studying with Ron Jordan and then I studied with Bayer talati and then I studied with tanka and then I studied with Gordon Christiansen and I quit using amalgam in those days when I was doing my mentoring with them and I haven't used it since so I have taken amalgam out of my toolkit okay what I find interesting is that I have amalgam restorations in in my mouth that my dad who was a dentist put in when I was a teenager and they're still in my mouth but you know my teeth are fracturing around some of those amalgams and what do I do I mean I think you'll find us pretty  hilarious but I put glass ionomer in my own mouth over those amalgams what's very interesting to me is glass ionomer sticks marvelously to amalgam so those dentists that want to still use amalgam and there is a small percentage of them that still do I tell them don't take it out of your toolkit because it'll be much more comfortable for them if it's in their toolkit and I tell them hey when a Malcom's fracture and you don't want to do any more destruction who want to be minimally invasive and there isn't any decay under it put glass ionomer on top of it and it'll stick to the amalgam as well as to the tooth and test it out yourself doctor do it yourself I just emailed dr. Doug Young yo P and he told me hey I put one of these in my mouth and then he told me Brian dovey did one in his mouth it's really funny here we got dr. young dr. Brian dovey and me putting glass ionomer crowns on our own teeth our selves not going to a dentist to have it done doing it on ourselves and seeing tremendous outcomes on our own teeth that we're doing with glass ionomer in my case over an amalgam that my dad did when I was a teenager but no I haven't used almalcolm and it's not really in my toolkit whatsoever but I haven't taken composites out um

Howard:  I'm gonna go back to the you know the  biggest issues I'm again going with the emerge disease you've been doing this for decades how do you treat a child behavior management I mean how can you stay out of the o.r I mean forty years ago the  papoose board was the most common I I think that was more common though or when I was a how was it change in managing child behavior from Pappu's boards Oh ours too now

Dr. John Frachella: I burned my Papoose boy come on you say use it as a snowboard you're out there and already gonna Maine could you're snowboarding with that it doesn't have enough rocker on it it's too flat here's the deal I call knee to knee lap to lap with a parent so I'm going need to need just like we are right here Howard look at me the two of us need a knee right put your kid in your lap I want you to turn the kid around so your kid is facing you put his legs around your waist and put his head in my lap right here just like this in my lap now you hold his hand and he cries perfect his mouth is open now I treat him you hold him lovingly I treat him lovingly I call that the act of dental love and I can do it from birth to about age I've done it on eight-year-olds nine year olds who are big and strong but they feel the love mom's holding the hands mom's showing the kid that she trusts dr. John she trusts dr. Howard dr. Howard is treating and she trusts and there's love and no matter how the kid acts no matter how much he Christ what do we say you're the best patient I ever saw thank you for letting me paint Keith with the medicine thank you for letting me smear this glass ionomer medicine on your teeth we'll have you back in a couple of weeks and we'll do it again and if you want to cry that spine because you let us do it that's what does it we need to learn to be healers this is hands-on healing in the classical sense where we have energy coming from our hands from a higher source because we are taught to be healers first or are we are we now being taught in dental school you can answer this better than me Howard are we taught to be technicians or are we taught to be hands-on healers

Howard:  I hope healers so I want to go back to SDF and everything you're saying because you guys have the American Academy of pediatric dentistry and it's it's a huge organization they have 6,000 591 members so what does the AAPD what  is your leader what is the Pope saying about pediatric dentistry today that is different than four decades ago are they on board with SDF or they wishing it would go away what how does what do they think 

Dr. John Frachella: AAPD is all politics Joe Joe Franken yo Franken not Joe I was going Joe but it's yo he's from the Netherlands invented a RT in 1998 the World Health Organization declared that a traumatic restorative treatment as per yo Franken was the standard of care should be the first go-to for all carries in all children worldwide a APD wouldn't accept it oh no they had to invent their own AR T and they called it ITR interim therapeutic restoration let me tell you something Howard every restoration is interim and therapeutic there is no such thing as a permanent restoration no matter what material no matter whose mouth a AAPD is politics they're gonna be group within APD we have wonderful people that are promoting SDF lightson at McLean god bless her and she's changing the face of a AAPD but we've got diehards in a AAPD who are resistant you know the bottom line is in organized dentistry a AAPD AAA AGD all of them we gotta emphasize the fact that SDF is just another topical fluoride only newer and better and that anyone with a license that allows them to apply topical fluoride should automatically be allowed to apply SDF SDF is a potent tooth desensitizer so is fluoride varnish but SDF is way more effective caries is a bacterial disease and bacterial diseases of the human body should not be treated by invasive surgery first whether you're a APD AGD or a DEA and if your house is on fire call the firemen for gosh sake not a carpenter 

Howard: so to hold your feet to the fire the the president of the a PD Kevin Donnelly he's down there and conservative good ol boy Texas is he 

Dr. John Frachella: yup Kevin Donnelly is using SDF but he's got one foot on the conservative side of the naysayers and the other foot with Jeanette McLean and myself and Jeremy Horst and the others with the SDF and he's trying to play both both fields I guess that's probably again politically correct because like I said this is about politics he doesn't want to lose his old-school consistency but he wants to stay friends with the new school constituency so you'll see him talking out of both sides of his mouth like any president of such an organization will have to these days right any 

Howard: leader of a tribe it doesn't matter if it's your own household family your city your country the world I mean the animals all have to get along on the surface and the surface sapiens always arrange themselves that way or there's other controversies from the past I still want to get your for decade perspective do you think I'm you know water fluoridation is still controversial I mean one-fourth of Americans think it's a bad idea and I can't believe that now anti vaccinators are as strong as the anti floor it is I mean one-fourth of Americans don't want vaccines or water are fried in the water do you think fluoride in the water is as important today is when they started doing Grand Rapids Michigan in 1945 or has the whole bio active film change and it's less of a necessary what would your view on water fluoridation after four decades

Dr. John Frachella: well you know Howard when I first started doing dentistry in Bangor Maine in 1974 that was my first year as a dentist I having graduated dental school from the University of Pittsburgh and I went to Bangor Maine and I became a public health dentist and they stayed in that position for 32 years while in Maine I hope to fluoridate more New England communities than probably any person still alive today I worked with Myron Alou Kia and I worked you know many of the late greats of the day to flirt eight I was what was called a fluoride evangelist well then what happened was the substrate changed as we talked earlier we went to corn syrup and the decay became caries became so virulent that all of the water fluoridation that we were doing was helping a little bit but it wasn't really meeting the  need alone without something more and then we got the anti fluoridation us in there and we were screaming back and forth across the table with each other and there came a point when I finally threw my arms up and I said you know I don't want to do this kind of politicking anymore because I can apply those fluorides locally in the mouth and have a greater effect yes there's a combined effect yes water fluoridation is very positive fluoridated toothpaste absolutely 5,000 parts per million fluoridated toothpaste for those you know high-risk cases those high-risk kids that can spit you know we don't want to use that in kids to swallow because well you know we'll have we want it to be topical fluoride not systemic fluoride when we're using it in toothpaste and when we're using it as SDF and when we're using and glass ionomer it's topical but you got to remember something Howard I mean this is really important we get 35,000 parts per million of fluoride after immediately placing a glass ionomer and 20 parts per million locally into that tooth for the first month after placement my gosh man balance that against one part per million are you kidding me I mean even seven to eight years later Ella Christensen is telling us we're getting as much as you know seven parts per million from glass ionomer fillings and balance that against one part four million from the water yes it's additive but I think we can be more effective and do less politicking more dentistry on more people and be more effective if we use glass ionomer x' in combination with silver diamine fluoride and fluoride varnish at the chair side and try to keep our communities that are flirted fluoridated but I don't think that that that our efforts to fluoridate more communities are going to be as effective as what I just said

Howard:  you know there's an interesting threat on dental town right now about a direct pulp caps and everybody of course is a surgeon and wants to know you know how do you how do you do it do you do MTA pulp resin you know the MTA pulp resident thread on dental town has about 200 pediatric dentists posting how they you know how they recommend do this surgery and it kind of but they don't address the fact that complete caries removal is no longer recommended by a lot of leaders in our profession what why do you think it's emotional that I mean obviously if you came in this room and buried me and see man I'd be dead but they just don't want a dead corpse down there they just want to clean it all out is that an emotional thing or is there biological reasons not to leave dead bacteria and there if 

Dr. John Frachella: it's emotional and it's political and it's and it's economic you spend how many you spend four years going to dental school four years going to college four years going to dental school you're you know you're five hundred thousand dollars in debt before you even open a practice you open your practice you're a you're a million dollars in debt before you see your first patient and you learned how to do Pol Pot amis so you're gonna do pulpotomy x' regardless of the scientific literature we need to stop this we need to look at the science we need to be scientists first the science points to the fact we should be going nowhere near the damn Pope get the mushy stuff out stay the hell away from that stuff when you get into leathery Denton leave it I don't even put a bird mouths anymore I use a spoon excavator and I scoop out the soft stuff the mushy stuff I put the silver diamine fluoride on top I put the glass ionomer on top and that lasts till exfoliation indirect PopCap's ridiculous direct pop caps ridiculous don't go there okay I'm not saying take that out of your toolkit there will be the occasional case where a direct or indirect poke cap is absolutely indicated where it will work but it will become rarer and rarer the more you use the medical management of caries in minimally invasive dentistry period 

Howard:okay these kids want to know exact brand names you said you use SPF and glass ionomer they want to know what what what brand wear 

Dr. John Frachella: okay well in the United States the only silver diamond fluoride that we can get is advantage arrest which comes from elevate oral care and that's what you have to buy if you're in Australia you can use a silver fluoride product that's a different brand or you could use Riva I think in the United States we can get Revis star also but you don't want to use the potassium iodine part just the silver part but it's more expensive than the advantage arrest from elevate so what we advocate is advantage to rest that's what you're buying then the glass ionomer that you put on top just make sure that it's got either pure glass ionomer or if you're using a resin-modified glass ionomer why would you use a resin modified glass ionomer howard because you're married to the light why are you married to the light because you learn using the light in dental school and you've got better patient management because it's quicker you can set the thing up they can walk out in it's hard so you can use resin-modified glass ionomer Zhaan you know I'm partial to the GC America products because they aren't resistant to divulging what's in them in other words it's not proprietary they say yes it's this percent glass ionomer this much percent resin that's important to me but there's but there's other glass ionomer products on the market that will work with silver diamine fluoride and you use the two of them together 

Howard: okay well my friend Jeffrey Knight who's a big in a downunder and so so I want you to go back and say why did you not like Riva stars two step procedure where they're applying potassium iodide solution over the silver fluoride solution a silver iodide precipitate is formed why do you not like that

Dr. John Frachella: because we took extracted teeth and we with caries and we did a study using the potassium iodide and the and their silver diamine fluoride and then just silver diamine fluoride and at first for the first week of putting the teeth in solution the potassium iodide teeth were white and the silver diamond fluoride teeth were black and then after a month they all turned black so we found that there was no difference and to do the Jeff Knight Patel you know a silver reeva star potassium iodide technique is not non-invasive he is recommending needles and drills it's an invasive procedure okay that's fine we're not about invasiveness I'm sure it works dr. Jeff Knight is a wonderful scientist he worked with dr. Graham Craig who helped him develop the product dr. Graham Craig is now not advocating or using the Riva star product nor are we because it's an invasive procedure you know dr. Craig was doing smart in 1978 on Aborigines children who had bad dental experiences previous bad dental experience from well-intentioned missionaries who came in and did invasive dentistry and then they were combative when dr. Craig went into the outback he couldn't treat these kids you know necessity became the mother of invention and he started applying a silver ion solutions with glass ionomer x' in 1978 collected data and he's the great granddaddy of smart as far as we're concerned and he helped to develop Riva star and isn't using it he's advocating the non-invasive no needle no drill technique of silver diamond fluoride in glass ionomer you can't do that with Rivas star you've got a you've got a got to give needles and use drills

Howard:  so he's the I'm your tournament I'm Graham Craig right the director of Riedel Health Foundation of Australia and yes and he's not using SDI when it's right out of Melbourne in his own backyard not only that he helped develop develop the product and still works for as far as I know still works for SDI or worked for SDI but no he's not using RIBA star because again he is has dedicated the rest of his career but both as an academic he teaches in the dental school there and as a clinician to non-invasive work so again not using not using needles or drills how 

Howard: is he your buddy I've met him once in person and we email each other quite often and he's my hero as well as my friend wow that is so cool so I'm I gently we Louie or Dion went over an hour I gotta switch gears and going to overtime you got can I keep you on overtime a little bit longer

Dr. John Frachella: yeah let me tell you another Grand Prix story you ready yeah so we did us a public smarting we did street-smart in San Francisco we've received a lot of criticism for that IAD our was in San Francisco a couple years ago the International Association dental research and we decided that outside of the Marriott at the Moscone Center that we would actually conduct a smarting on the streets of San Francisco on homeless people so we announced with a megaphone walking up and down the street that we would provide free dentistry and we had a lawn chair and I created a bicycle trader I made a traitor out of a bicycle so you turn a bicycle upside down and you can actually trigger eight a capsule of silver diamine fluoride if you have a credit card I used an old credit card with a hole in it and you hold the credit card to the spokes of the bicycle and it goes put it up and it actually trigger ate the material and we were using a bicycle trader if you want to see this go to youtube bicycle trader and you'll see the bicycle trader and we did this on the street with lawn chairs applying silver diamine fluoride doing a little bit of scooping of material applying silver diamond fluoride and put glass ionomer in patients teeth sitting in the dental chair in the Moscone Center on the street in San Francisco and people from iadr are we're coming out of the building wondering what the heck was going on and watching us and we got a lot of criticism for that because you know it was kind of over the top but one thing that struck me was this voice behind me as I was doing a smart as saying that's amazing that's simply amazing and he I said well that's an odd voice and I kept doing the work and I heard it again that's amazing and somebody tapped me on the shoulder and said that's dr. Craig and I turned around and I said oh my gosh you're Graham Craig he said well you must be john and I said well I am and that's where we met each other and he thought it was amazing because I was using my finger this one right here Howard because it's the instrument I always have with me on the end of my wrist and I was using my finger to apply the glass ionomer on the street and I literally do that same technique in the dental office because I have to because I see a patient every 10 minutes as many as 20 30 40 patients a day and I'm able to do that because again I'm a fireman and it is my obligation my job my mission to put out fires first I am given up doing the jewellery of Dentistry I will hold my composites anterior and posterior up to any in the world because I've studied with the best but I put the fire out first because I feel that is what we are ethically bound to and I don't know if they take the Hippocratic oath like I did when I was in dental school these days they probably don't but I took it to heart Howard and that's what I do 

Howard: well my brother Paul lives in um Sydney Australia and I've gone down there about every five years and lecture to a half dozen cities every five years probably since 1990 but this I'm Graham Craig you're talking about he's not only a dentist he has a PhD and he got his PhD he uses chemistry background to investigate various metal fluorides and a study of iron fluorides became the base for his PhD this this is not some guy with just some minor opinion this guy has been published thirty times and I mean hangs given over 200 postgraduate courses he's just an amazing man so so back to the kids you've done this for decades as a pediatric dentist they just walked out of pediatric dental kindergarten what advice would you give them moving forward where should they go for the harris-perry gifted kids yeah they just graduated from pediatric dental school I mean to you but what would you tell them to do would you tell them too that they should do some public health for a while to get more education do you recommend these what are they the the F H Q's is that FQHCs what advice would you give a new graduate from you're Dentists

Dr. John Frachella: well the biggest problem that we have is with these new graduates is that you know they're in debt up to their ears and they need to make money quick and I would say don't be put off by those who will tell you that you can't make money doing smart dentistry you can make more money doing smart dentistry because moms get it Howard moms get it the moms come in they don't want their babies hurt they don't want their babies to have needles and drills when you don't use needles and drills and put the fire out first you're  get more referrals from more moms of more moms and more referrals and your practice is going to build very  quickly you're going to get out on time you're going to have less emergencies you're gonna see more patients in any given unit of time you're gonna charge less per patient because you're not being as invasive but cumulatively you're going to make more money because you're going to see more patients and you're gonna be busier then you could ever imagine being then when you fought at one time that you were going to become an invasive dentist you know I'll never forget when I lectured at UCSF here in San Francisco with dr. Jeremy Horst and Steve Duffin and um we lectured and there were many prominent lecture dentists that have given lectures and I've been in their lectures that were sitting in in my lectures and I was honored to be there dr. Joel white was there dr. danke Lucy many other great visionaries in dentistry were there and they were listening to me talk with my colleagues dr. horriston dr. dolphin and at the end they had many questions and we were holding a question-and-answer session but one of the dentists of faculty members interrupted us and said would you please come downstairs we have third-year dental school applying silver diamine fluoride for the very first time John Featherstone was Dean and he had initiated it at UCSF and it was historic and they wanted me and dr. dolphin and dr. horse to come downstairs to take a picture with fourth year third and fourth year dental students applying silver diamond fluoride and we took these pictures and my arm around this this one dental student as she was sobbing as the pictures were being taken and I thought boy there's something wrong and the pictures we were done taking the pictures and I I said to her I said are you okay and she goes all I'm fine and she was just sobbing and I said are you sure and she said I'm crying dr. John because I so happy that I don't have to do dentistry the way I was taught invasively that I can do it this way non-invasively medically and with the kindest and best possible way that it's preventive of future decay thank you for bringing this into my life well I hope that through this podcast Howard and through other media that we can spread this word to these new dentists and that they can feel the same as that dental student felt that day when she first applied silver diamine fluoride in the UCSF dental school clinic

Howard: well you know when you started this answer you talked about economic incentives they have a lot of debt and when  two or more people get together it was the first economist Adam Smith from Scotland who said that they're conspiring against the masses the biggest controversial thing is dental therapists because that's invading on dentists economic production or even after I'm expanded duty dental function system so if you answer this question you're I'm I'm actually throwing you off the bridge right now off of a cliff do you think dental therapists are important part of silver diamine fluoride and preventing a dental decay especially on children of high risk so

Dr. John Frachella: Howard this question keeps being raised with  let's split just let's go to dental hygienist so let's go to ask this first and then we'll go to D hats okay with the therapist you know Montana a couple months ago decided that dental hygienists weren't allowed to apply silver diamine fluoride because that would indicate the dental hygienists were diagnosing decay and that wasn't allowed by their state Dental Board let me tell you something dentists don't diagnose carries silver diamine fluoride does it's the greatest caries detector known to dentistry period and I don't care whether my dog applies it or whether a dentist applies it damn it if it turns the tooth black it was curious because it won't stain non-affected dent dentin won't a stain non-affected dental tooth structure so saying that a dental hygienist ur and after can't apply it is silly it's stupid it's turf fighting its turf wars I'm sick of these turf wars damn it are we real doctors Howard real doctors have physicians assistants when I go to my doctor I'm first seen by PA and by Gauri she's good and I trust her I love her she does a wonderful job she always has she always will are we not that kind of doctor or are we afraid of art of losing turf of losing market share to our afters look let me tell you something when we teach this when I go out and lecture SDF and smart and I at the doctor to Dennis it's hard when I lecture it to F does it's easy because they have a lot less to unlearn and because most of them are moms and moms get it okay now let's go to dental therapists dental therapists are just another in the many line of auxiliaries that we have that I feel personally are necessary in certain areas for instance in Alaska where you know the the American Dental Association fought against the the dental therapists movement there and they lost in a lawsuit will those dentists that won the lawsuit against the American Dental Association in favor of the dental therapists actually hired me to go up to remote villages a remote village in Alaska on a barrier island 50 miles from Russia in the Bering Sea now Howard how are you going to get new dental grads to go to a barrier island in the Bering Sea where they eat you crook as their major protein source bugarach is bearded seal they were killing bearded seal on the ice when I arrived and they were eating raw blubber on the ice when I flew into this place where we had onboard to Dennis that had hired me to come there and teach them how to do smart and how to use silver diamine fluoride and I was hired specifically to train dental therapists because they couldn't get Dennis to go to this island now you know I think there's areas in our country where we need dental therapists and afters and that we should quit being so damned paranoid because you know if we're real doctors have confidence in who and what we are and we need to learn how to delegate damn it because there's too much decay for us to be able to drill our fill our way out of we're never gonna drill and fill our way out of the decay that we have today we need help so delegate that help 

Howard: nice I'll tell you what the most romantic thing about Alaska is when we bought that from Russia in 1867 and they still have Russian communities that don't speak a word of English and when you walk in there you're just getting stared down like you're not of our tribe and whenever I was down there driving around and going halibut fishing and salmon fishing and eyes telling the dentist my lectured where I'd gone and talked to they're like dude that's not your place you should not have gone there and you know why America actually bought it because if they didn't buy it from Russia Denmark was gonna buy it so they just wanted it because Denmark wanted it they didn't even have a reason for getting it but back to these there's forty four hundred and fifty three pediatric dentists the United States they just got out of school they have tons of debt money's the answer what's the question insurance really drives so much of health care in the United States it's a fee-for-service eken i's incentive plan to drill fill and bill and do surgeries do you think the SDF economic reimbursements are too low for the high economic reimbursements of the pulpotomy Crum cell crown do you think that the major player in that space in America is Delta Dental do you think Delta dentals got this right economically or do you think they have it wrong economically 

Dr. John Frachella: well first of all we got to go back to what I said earlier that 50 percent of all children with paid for private health insurance benefits do not utilize the dental benefits they already have because dentistry is too expensive too invasive and because they've had bad previous dental experiences so let's start with that 50% of these people that have dental insurance aren't even getting treated because they don't want to go to the dentist okay so let's start there let's look at the paradigm shift because you know we use that term Steve Duff and used it when in your podcast and others have used that paradigm so when you have two paradigms Howard what do you have in between the paradigms you got chaos that's where we are right now we've got chaos economic chaos with the insurance companies especially so here's the deal with smart you know was a couple of years ago I called up the a da and I said hey you guys um you know you better call glass ionomer a composite so that when we do glass ionomer z-- we can bill for composites per surface and they said oh no no and I said wait a minute glass ionomer z-- are a composition of dental materials by definition and many glass ionomer have resin in them so they have composite in them now if you don't want my lawyers to be talking to your lawyers about this I think you better settle this now I'm not gonna wait I want it settled now in the CDT guidelines I want this in the book otherwise I will throw I literally threatened a class-action lawsuit they heard me loud and clear and within weeks they changed it and the new CDT guidelines is a few years ago came out saying that glass ionomer Zoar composites now what that's opened up for you and me is this and for our new graduates when we do a smart we can charge that two ways all right if you're new to smart and you're not confident that it will retain okay now retention is a weird metric Howard retention is no longer a good metric when you've got glass ionomer x' it doesn't matter whether the glass anamur is regained or not because that doesn't identify failure or success because of the 35,000 parts per million and that permanent zone of acid resistant chemical fusion that occurs between the glass anamur and the tooth even if the glass ionomer lost you still got that layer in there that is acid resistant so you can also add more glass ionomer without giving any needles and without giving any drills and that can therefore be thought of the outer layer of the glass ionomer can be thought of as a Karev as a sacrificial layer right so if you are going to Reno if you think you're gonna have to replace that glass anamur don't charge it as a composite because insurance companies will only allow you to charge the composite once if you have to do it again it's on your dime don't charge it as a composite charge it as a sedative filling which gives which brings in less money then a composite but allows you to do it multiple times until you've learned the technique well enough to know ah this one is going to retain then when you've got the skill and knowledge and confidence that your smart is going to retain start charging it as a composite per surface and make just as much money as you would be doing  drill and fill composite dentistry and not lose a dime

Howard:  okay I might need to let you go but I can't let the man go without hearing your views on dental sealants I mean you they're all over the board dental town that has 50 categories one for each of the ten spies under pediatric dentist I mean you got people saying god sealants half up until the first year half fail to sing here there's a big joke if the sealant falls off and the tooth doesn't have a cavity that it didn't need a seal it anyway I think that's a very funny joke but um what's your thoughts on dental sealants 

Dr. John Frachella: I think dental sealants should all be glass ionomer surest modified glass ionomer x' because those dental sealants if they were glass ionomer x' would then serve as mineral ion reservoirs for the rest of the teeth there was a study done in 1994 by a guy by the name of Sogeti in italy on 1,000 700 five-year-olds that proves it's a wonderful study you should look it up see eg eg TI it's a wonderful study that proves that glass ionomer sealants on the occlusal surfaces of teeth prevent caries interproximally so as a preventive measure not just on the occlusal surface but for all surfaces smear glass ionomer on all teeth of all children in all schools in america damn it and do it with f does and dental therapists because dentists are too busy in their offices back to the dental therapist put him in the damn schools and have them smear glass ionomer on all the posterior primary and permanent teeth of all children in america and forget about this silly inert composite resin sealant crap use glass ionomer x' uncensor dentistry flat-out howard that's the deal glass ionomer why not you're doing smarts anyway what are you gonna do with the rest of the capsule Howard you're gonna throw it away put it on the tooth behind oh whoa wait a minute the tooth behind doesn't have any carries on it I don't care smear it on the occlusal surface put it into occlusion there's your glass ionomer sealant acting as a mineral reservoir of ions mineral ions for the rest of the teeth to help combat the virulence of today's dental disease

Howard:  and last but not least I mean that the biggest issue is I mean obviously I have four children that made me gosh five grandchildren I the biggest nightmare would be if one of them didn't wake up from sedation and the AAP pediatric dental group update says that they just recommended they just published this not too long ago that there needs to be at least two individuals with specific training credentials should be present with a pediatric and undergoing deep sedation general anesthesia for dental treatment and identity or a hospital surgical center and what this last last question what is your view and what are your thoughts after four decades on dental sedation and what would your guidance 

Dr. John Frachella: be you know what you just said about having two other individuals there in anesthesia is absolutely no insurance whatsoever against your grandchild dying from sedation or hospital dentistry 

Dr. John Frachella: I gave a lecture in Hawaii to the pediatric dental Association of Hawaii and Honolulu two years ago and the whole front row was a group of Chinese dentist living in Honolulu working in Honolulu that were pediatric dentists and they were young except for one he was an elder and they were listening intently to everything I said and asking the most questions and they made sure they placed themselves in the front row and at the end of my lecture the elder came up to me at the lectern and he said could we have a word and I said certainly and we walked out in the hall and he said that's my family I said excuse me he said that's my daughter and my son-in-law and that's our staff and I am the dentist who tried to help save Sidney Boyles life she was the first girl little girl I think she was three years old that died from a sedation in a dental office and he said I want you to know the dentist that was doing the sedation was down the hall from me in the building across the street in Honolulu and she was doing sedation dentistry with an anesthesiologist present three to four days a week and I tried to stop her from doing it I told her quit doing this and she said I can't stop doing it I've got a million-dollar debt from dental school and opening new office this brings in a ton of money to me and he said please stop doing it I'll help you any way I can you're gonna hurt someone and sure enough she had this incident and who did she go - she going running down the hall to him do you know - person CPR will you help save this little girl and this Chinese man with a tear in his eye said to me I breathed in her mouth but I couldn't bring her back alive so thank you for lecturing today and teaching me and my staff that we don't need to go there anymore let's stop doing this Howard

Howard: wow that is a sad story you said your time out the case of Lily Geyer no Sidney Boyle Sidney boy how do you spell City Boyle BR y le sy d NE y huh that is uh Oh Finley Boyle I I thought you say I'm sorry Finley Boyle yeah sorry yeah and these are just the nightmares you know she was a three year old girl who's left brain dead following a procedure at a local dentists in Hawaii that's uh that's just that's got to be rock bottom and just rock bottom and imagine imagine 

Dr. John Frachella: Howard if you were lecturing and the very dentist who advised against the dentist doing that the other dentist doing that and who was called in to save that little girl's life ended up in the front row of my lecture 

Howard: what are the chances man but she was eventually found not guilty of manslaughter in that in that case there was a trial and she was found not guilty 

Dr. John Frachella: well whatever you know what I'm saying is look what happens when we do this I'm not saying that she should be guilty be held guilty or accountable I'm sure she's paid her dues in terms of brief and and I I feel as sorry for the dentist as I do for the family and for the little girl that isn't the point the point is let's try to rescue patience from having those that's rescue dentists from feeling and young dentists that are graduating dental school from feeling that they need to go to resort to that to pay their debts that's wrong man that's wrong yeah 

Howard: and it's not about innocent or guilty it's about the end of the day that little girl is gone and that just it just ruins it for the dentist the family the little girl is just a colossal a disaster that that's why I love this podcast so we can talk about the stuff that's completely dentistry uncensored I mean we just talk about stuff that everyone would cringe at unless you're with them at dinner and you're having dinner and drinks that they want to talk like we talk but when you go to a dental meeting you lose that completely I've said it so many times over the years I you listen to so many lectures where half the people left at lunch never came back it was so boring you thought you're gonna die and then later that night at the bar for beers later you're getting the best damn dental lecture in the world that I'm sitting there saying why didn't you talk like this in your lecture and so that is the difference that the media makes the  format but seriously John you're a legend in my mind you're in the legend in Jenelle's mind I mean you've done so much for dentistry and most people do not want to go on the record they don't want to post in social media across all platforms Facebook Twitter or Instagram less than one percent make all the original content and only nine percent reply whereas 90% of all surface sapiens on earth just just they just uh they just read they they're lurkers and it's so refreshing to get a guy like you that has just no filters no holds barred you don't really care what anybody thinks this is what you patently believe in and you're you're willing to share it and regardless of if that causes an error on your back so I love you for it and thank you so much for giving me in my home he's an hour and a half of your life day I had so much fun podcast in her video 

Dr. John Frachella: Thank You Howard I really appreciate it it was an honor and we have to go on the record who loved Jeannette McLain more me or you I obviously me but are you gonna try to claim that it's you she's she's just one of my favorite people in the whole world because what she brings to the table because of the loves it for the children the chiyan parts because you know Howard and Jeanette is a great example of this it's not about us man it's about the kids and we got to remember that yeah and 

Howard: she's got some great online CE courses if you don't want to have to fly to Hawaii to see John lecture I mean it's right on dental town I mean they're there less than the they cost less than the uber ride to the airport to fly to the course she's got one of the biggest course on that one ounce silver is a new black improving your practice with silver diamine fluoride you just have to watch it John thank you so much for coming on the show thank you hard 

More Like This

Total Blog Activity

135
Total Bloggers
2,691
Total Blog Posts
1,548
Total Podcasts
1,265
Total Videos

Sponsors

Site Help

Sally Gross, Member Services
Phone: +1-480-445-9710
Email: sally@farranmedia.com

Follow Hygienetown

Mobile App

WITH HYGEINETOWN . . . NO HYGIENIST WILL EVER HAVE TO PRACTICE SOLO AGAIN

WWW.HYGIENETOWN.COM - WHERE THE HYGIENE COMMUNITY LIVES

9633 S. 48th Street Suite 200 • Phoenix, AZ 85044 · Phone: +1-480-598-0001 · Fax: +1-480-598-3450
©1999-2019 Hygienetown, L.L.C., a division of Farran Media, L.L.C. · All Rights Reserved