How did Dr. John Nosti, director of Clinical Mastery Series, get to where he is now? In this episode he tells new grads that if they want to accelerate their learning curve they need to become "CE junkies." Should a new grad buy a CAD/CAM, CBCT, and laser? What is Clinical Mastery Series and where should a dentist start? Should they bring their staff, and if so, to which course? Dr. Nosti answers these questions and more in today's episode.
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Dr. John Nosti's Bio:
Dr. John Nosti practices full time with an emphasis on functional cosmetics, full mouth rehabilitation, and TMJ dysfunction. His down-to-earth approach and ability to demystify occlusion and all ceramic dentistry has earned him distinction among his peers. He has lectured nationally on occlusion, rehabilitation, and technology (JVA/JT and T-scan).
As Clinical Director for Clinical Mastery Series he has authored and teaches the two-day “Ultimate Occlusion: Mastering Functional Dentistry ” ,“Ultimate Occlusion 2: Mastering Full Mouth Rehab”, and Ultimate Occlusion 3: Mastering Complex Cases" courses, as well as the “Over the Shoulder Full Mouth Rehabilitation” live patient program.
Dr. Nosti has consistently been a featured speakers at the BioResearch Annual Conference and “Townie Meeting” in Las Vegas, NV. He has lectured for numerous national conferences, including the annual sessions for the American Academy of Cosmetic Dentistry and Academy of General Dentistry. He has also spoken for many dental societies, and study clubs, including divisions of the Seattle Study Club.
Furthermore, he holds fellowships in the Academy of General Dentistry, International Congress of Oral Implantology and Academy of Comprehensive Esthetics. He is currently in the process of attaining the award of Master in the Academy of General Dentistry, as well as accreditation in the American Academy of Cosmetic Dentistry.
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Howard Farran: I am so excited today to be interviewing literally the most famous guy on Dentaltown. I mean seriously John, you’ve been on Dentaltown- you’ve got 7,000 posts. Your cosmetic work is just unbelievable. I shouldn’t even be doing this on video because you’re the whole deal you’re the cosmetic dentist, you’re beautiful, I have never felt so bald in my life as looking at your hair.
You have got enough hair for three Justin Biebers and a smile to match. I just want to tell you first of all, dude just congratulations to all your success. I mean unbelievable and I want to say that a few of us townies like Howard Goldstein and me and Pete Janicki who is a great friend of both of ours we saw- how many years ago did you join Dentaltown, what year did you join?
John Nosti: I think it has been like four or five years now.
Howard Farran: Yeah which sounds like a long time to you but I got on that thing in 1998 and so you got on in what 2010?
John Nosti: Well you know what I actually got on in 2002 but I lurked forever and I think it was about 2009 or 2010 that I started actually posting.
Howard Farran: Man and right when you started posting everybody’s like dude this guy is going to sky rocket all the way to the top and you are at the top you’re at the very top of the game in the richest biggest country in the world, United States of America, and your work- I mean really you’re like Picasso in dentistry, you’re just amazing
So I want to start, I want to back up, so what year did you graduate?
John Nosti: I graduated dental school in 1998.
Howard Farran: Ok 1998, that is when we started Dentaltown, so my first question to you John is, you know a lot of dentists- I am talking about the dentists that have just graduated let’s talk to these people, these 5000 kids who just walked out of school last May and another 5000 that are walking around and a lot of times kids start whining about you know there is corporate dentistry and when I got out of school it was managed care and HMO’s and you know it was always something but I look at the whole country.
God in 1862 America lost 800 000 people in the Civil War. Then they went into world war one which was the same time as the Spanish influenza which was when 5% of the planet died of the flu during World War one.
Then we go into the great depression then we go into world war two and what are you whining about? Corporate dentistry. I mean give me a break, and then I see guys like you who have just made their own luck and just is crushing it on so many levels, so what I want you to first my first question to you John is what do you say to the 5 000 kids that walk out of school go but John but I have student loans and there’s corporate dentistry and Obama Care is coming.
How do guys like you just like whatever and just rise to the top? What was your secret to your sauce that accounts for how you made it, was it pure attitude, was there something you were doing that you saw some of your class mates not working on enough?
John Nosti: First I want to thank you for everything you have done for me, that great introduction, I mean I am totally humbled sitting here in front of you on here. I am really honored to be here, so I thank you again for having me.
But you know going into what I felt was a big part of my successes you know I mean I was like everyone else out there. I graduated, I did a residency you know I finished up at Lehigh Valley Hospital in Downtown Pennsylvania in 1999 and you know right out of my residency two of my best friends from dental school, this guy Scott and Chalon we decided to open up a practice from scratch.
We had no money, kind a had no jobs and we had no patients so we opened up a practice opened up the doors and the three of us got together and said you know what we want to have our own practice and in order to do this we each need to get jobs in other offices.
So at the time you know who was hiring? I went out and I worked into a corporate office for a couple of months and I quickly realized that you know what? This isn’t for me, you know they want you to see more and more and more in such a short amount of time and it really wasn’t quality type dentistry so you know thank God I got a phone call from my now partners in South Jersey where I’m at and they said hey we are looking for a guy to come on as an associate who wants to then become a partner and so for three days a week I worked in my current practice and two days a week I worked with my best friends out of school and I sat there waiting for the phone to ring we had no patients, no staff and what was I going to do in the mean time? I mean I read.
I subscribed to AGD to JADA to all these companies and you know I read as many journals and even went back and looked at text books that I didn’t bother to read when I was in dental school and one of the things that really stood out to me when my residency was continued education. I mean I didn’t know anything about continued education when I was in dental school and you know even though we saw some of the things you know when we get out of school what continued education is really thrown at us? Well it is thrown at us by Delta Dental and it is thrown at us by our local reps and come an hour and hear about this, have a lunch and learn and hear about that.
I was in my residency in a year I saw guys like Dennis Tarnow, Gordon Christiansen, John Kanca, you know all these guys that in 1999 they were it and they came to our continued education group at Lehigh Valley and I mean this really blew me away and I really said to myself you know what? It’s time to set the standards higher and I saw examples of what these guys were doing and I said to myself this is what I want to do and you know I just became a CE junky, literally.
I mean again I came out of school, I wasn’t making a lot of money, I borrowed my way through dental school above and beyond so I graduated in a huge amount of debt. I understand now guys comparingly and girls have more debt than I had but still I was over $150 000 in debt, I wasn’t making a whole lot of money because two days a week I wasn’t earning any income so you can figure how much money can I make as an associate working three days a week and I still took you know a seminar in a weekend that cost $2 000 or $3 000 from some great guys and you know what I just made a commitment to myself saying if I am going to invest in this weekend long seminar I am going to get something out of it, I am going to learn, I am going to dedicate myself and I am going to come back a better dentist, and I will say that you know ask my partners, month after month after month I would take a new course I would come back I would build on it.
I wasn’t a yahoo that would come back and do like I wouldn’t go and do an endo course and come back and start placing implants, I mean it wasn’t like that you know but I would come back and I would just be realistic, I would start introducing new procedures, I would start doing better in the procedures that I was already doing and that steadily started to steam roll.
Howard Farran: Let’s go back to this 5 000 dental students and lets address the two most common questions that dental students ask on Dentaltown and when I go and lecture in dental schools.
Number one: should I do a residency. I want you to talk about- that’s a big decision. The second one I am going to follow up with that is a lot of them see nine specialties and say should I specialize? Address those two questions for the 5 000 kids that are senior in dental school wondering if they should do a residency or specialize.
John Nosti: You know what I thought to myself that there is a point that, believe it or not I had the idea of becoming a pediatric dentist and luckily I was fortunate enough to run into a dentist and really talked to him about what I was thinking and he kind of turned me around he said are you crazy? Why would you want to become a pediatric dentist? You’re going to get everyone else’s headaches and you know you can open up and become a family practice and see all the children that you want and you know what that really kind of hit home to me because you know what maybe I was a little naive but I didn’t realize that once you specialize that is all you do is specialize.
So for those people contemplating being in a specialty -pediatric dentistry can be great. You kind of have geographic success and that teeth are going to fall out after a period of time and you don’t have to worry about long term but then you also do see kids go off and leave your practice so there is somewhat a constant changeover, if that is interesting to you I would say go at it.
You know as far as being a periodontist, if that is something that interests you placing implants and doing perioplastic surgery how bout it that’s fantastic.
But I would look at it that you need to have to have a great personality you have to go out on top of having great skills and you really have to be able to wine, dine and make friends with a lot of area general dentists in order to rely on the referrals. Now even when your dentistry speaks for yourself, if your personality doesn’t match and you don’t have great chair side skills, no one is going to refer you so you kind a have to have both of those sides.
Now going into the residency aspect of it: you know to me I have known a couple of people who are gung-ho to leave dental school, go out and start making money and I would say I think that that’s a bad thing to do and here’s why.
When you come out of dental school, I mean a lot of dental schools they try to really beat you up I mean it is all about learning how to be the big boy network and it’s this and it’s that and unfortunately a lot of professors shouldn’t be teaching, and they kind of beat you up when you’re in school and you get out and you kind of have this bad taste in your mouth regarding being a consummate student for the rest of your life and the last thing you want to do is continue to be a student. You want to go out and you just want to practice and show what you can do.
You know residencies, as I have seen it, they are a little bit different. You’re dealing with a lot of people who are involved with residencies like myself who want to teach one or two days a week, they don’t make a living doing it, they do it because they love to teach and you get out and you get involved into a different aspect of dentistry, you learn really how to practice dentistry, you learn how to really become a better student over a long period of time. So I would say from my experience I would highly recommend looking at a good residency and getting involved because it could really change your whole scope of dentistry.
Howard Farran: Yeah one of my best friends Dr. Tim Taylor in Chandler who practices in Maricopa, he just goes in Friday he does his 4-10’s Monday to Thursday and he literally goes into dental school all day Friday and he’d probably paid them to do it.
I mean he gets this little amount of money that he could go into his own office and do one filling and make more and he goes in and spends the whole day just because he’s passionate about the students and giving back and all that kind of stuff.
I want to ask now I am going to go back and talk to these dental students that are about five years out of school.
This is what I am hearing, their questions loud and clear they say: Dr. Nosti, I graduated with $300 000 student loans- blah, blah- if I were to be a good dentist like you do I need to pay six figures for a CBCT?
Do I need to pay six figures for a CAD/CAM? Do I need to buy a $50 000 laser? Can you address those three big things that could be as expensive as you know your student loans, in fact if you had a CBCT, CAD/CAM and a laser that could be your student loan indebtedness so should they double down on all those three things? So talk go through CBCT, CAD/CAM and laser any order you want because those are big high dollar ticket items.
John Nosti: This might be a shock to a lot of people but I don’t have a CBCT in my office and don’t have CAD/CAM in my office.
Howard Farran: Are you serious?
John Nosti: Could you imagine?
Howard Farran: Is that because you do a lot of anterior work and you don’t want a monolithic block and you’d rather have feldspathic stacked porcelain from a rocking hot lab? I know you’re a big fan of the lab right here in my back yard.
John Nosti: Absolutely.
Howard Farran: Gold Dust.
John Nosti: Yes.
Howard Farran: That does phenomenal work, Gold Dust Dental Lab, what’s their www?
John Nosti: Gold Dust Dental.com
Howard Farran: Gold Dust Dental.com?
John Nosti: Yeah Gold Dust Dental Lab.com is their website.
Howard Farran: Now this will be in the notes so make sure if you follow up on the email because for my listeners they might be in an hour commute home from work on some interstate so my viewers don’t have to write anything down, we always offer a transcript with links, so will you make sure that link is in there? Is that why, John, because you want hand crafted aesthetic feldspathic porcelain or? Why did you not buy a CAD/CAM?
John Nosti: You know I think there is a couple of things. I mean first of all it’s not only just because I do a lot of anterior aesthetics because I think in order to be successful you have to be able to do a lot of still single tooth dentistry so I still do a lot of bread and butter inlays, onlays and posterior crowns and you know just looking at it, the numbers weren’t right for my practice. I mean if you have multiple doctors in your office and each doctor likes to do a certain thing and you can hire in our opinion an assistant or an restorative hygienist who can then work the system and be the stain and glaze and do everything else, then I think it works well.
I have talked to a couple of great people on Dentaltown who are trying to push me into the CAM/CAM realm and you know just right now the numbers just don’t make sense and I think you have to look at it: how much are you paying from your lab, how much are you still paying with blocks and burs and how much time is it going to take in order for you to get the ceramic that you want coming out of the machine in order for that to be worthwhile for your practice. And just looking at it, it hasn’t been something we really entertained in my office yet.
Howard Farran: Now have you entertained optical scanning of teeth for impressions as opposed to an impression material? Have you thought, what has your amazing mind thought of that technology?
John Nosti: So we have looked at that and we have looked at a couple of different companies and a couple of different scans and I’ve had some in my office to try out and you know we have had issues with uploading some of the scans. We have had issues how some people you know sell you a scanner but then you have to pay a usage fee per scan, that is as much money as the impression material.
It doesn’t really make sense unless you’re just trying to get rid of impression material in your office and someone like myself I still do a lot of splints and I still do a lot of study model analysis.
Howard Farran: Splints for implant guided surgery or for TMD?
John Nosti: Everything, implant guided surgery…
Howard Farran: Are you placing implants?
John Nosti: I do not place implants.
Howard Farran: Okay. But do you have a CBCT?
John Nosti: We do not have a CBCT and mainly because we don’t place implants in my office. We have a new associate and he’s interested in it and one of the things that we haven’t even gone that realm of allowing him to place a lot of implants is because my partner and I we do refer to specialists who do use CBCT.
Howard Farran: Okay, what about laser, the last one?
John Nosti: I actually have several lasers in my office.
Howard Farran: In the price range of what?
John Nosti: In the price range of the cheapest one would be AMD’s Picasso.
Howard Farran: By the infamous, great Alan Miller.
John Nosti: Absolutely.
Howard Farran: God I love that guy.
John Nosti: It is a fantastic laser, I love it. That’s probably my cheapest laser my go to diode and the most expensive laser I have it’s still running, so knock on wood, is a VersaWave by the defunct Hoya ConBio.
Howard Farran: Was that a diode or carbon dioxide?
John Nosti: It’s an erbium. It is hard and soft tissue. I would be lost without it but right now it is still running strong. So do I think people need to have a laser in their practice: I think you need to have a way to change soft tissue, I wouldn’t use an electrosurge and with such great lasers like an AMD Picasso Lite that is so inexpensive I do think that is a technology worthwhile investing in.
Howard Farran: So who is more fun and handsome to go to dinner with, you or Alan Miller?
John Nosti: I’ve got to give it to Alan.
Howard Farran: He is so fun to go to dinner with. So John I am going to ask you a personal question: why do guys like you like to share so much on Dentaltown?
I mean you have spent a gazillion hours sharing cases on Dentaltown. Why do you like to leave a very busy successful cosmetic practice, I know you were touring the country with some great people. Lee Ann Brady who is in my backyard here in Phoenix who is an amazing clinician, Jason who is probably the top photograph guy, wouldn’t you say, in dentistry?
John Nosti: I would say Jason is on a whole other level. Jason, he’s down in Ponte Vedra, Florida. He’s phenomenal.
Howard Farran: Yeah his photos are almost as good looking as his wife.
And Mike Smith who is also in the backyard so I am going to ask a question: why did you for 7,000 posts I mean you literally put a gazillion hours on Dentaltown and you leave a very successful practice and I look at you guys out there and I know you can’t be making what you would make if your just doing an anterior veneer case in your office.
What makes you do that, what drives you to do that and talk about your clinical mastery and how did you hook up with Lee Ann Brady and Mike and Jason, how did the four of you, I mean is it like the three musketeers or how did this even happen? Will you go into the birth of that?
Were you all four serving at the Betty Ford Centre at the same time and you figured this out in rehab, how did this all come about?
John Nosti: So you know I looked at it first going back to Dentaltown, why do I do that, well I really looked at it where a lot of great people have shared time with me and shared their procedures and how they got to where they got to and are able to be successful in doing that and why do I go on Dentaltown? Why do I post, and you’re right we don’t make any money I surely can make more money being in my practice and doing it but one of the greatest things about Dentaltown and being able to share information is getting an email once in a while, and having people tell me you know what I did what you told me to do and it made the procedure unbelievable, or thank you so much for sharing, it’s about the camaraderie.
We are here in the whole dental world together and it is not all about competition, it’s about how we can make each other better dentists and how in return we can make our patients lives a whole lot better and that is why really I love teaching and I love the avenue of Dentaltown I mean just to go out there and post and hit so many people, we thank you for starting that it’s a fantastic forum.
Howard Farran: Well you have to thank Al Gore, he invented the internet.
John Nosti: Oh yes it’s true. I forgot of course don’t forget Al Gore. So how did the four musketeers get together? So Jason, Mike and I we met teaching with the Hornbrook Group.
Howard Farran: Oh really, that’s your roots, in Chicago or Illinois was it?
John Nosti: Yeah well we were all over we were based out of Chicago for a number of years and when the Hornbrook Group ceased to exist we all formed, including David, we formed the Clinical Mastery Series.
Howard Farran: Oh David Hornbrook is in the Clinical Mastery Series?
John Nosti: He was originally.
Howard Farran: Who’s the founder?
John Nosti: He was part of the founder members, like me, Mike and Jason but unfortunately with David’s schedule and what he was doing he no longer became part of the group after a couple of years.
Howard Farran: You can feel free to say that when he lost his thumb you fired him. He had a disability and you just fired him with a disability. You mean, rude guy you.
John Nosti: Absolutely, following that you know Mike, Jason and I were doing it together for a couple of years and Lee a couple of years ago decided that she no longer wanted to be part of Spear Education as much, she doesn’t burn any bridges, everybody knows she was a clinical education director for Pankey for a long time and then from Pankey she went to the Spear Education and when she felt like she had done everything she could do with Spear Education, she kind of went her own way and was doing her own thing for a year or so and she came upon Clinical Mastery and the opportunity came for her to join the group and we are very, very, very happy to have her.
She is unbelievable, such a great individual and kind of shares the same things that Mike, Jason and I share and that is just the love of teaching and trying to again make dentistry just a better place for everyone.
Howard Farran: What I love most about you four teachers is, in dental school some people teach you and they make you feel bad or feel dumb, and other people like you and Lee Ann where you can make the most complex so simple and you make everyone feel better and they feel motivated to go out and push their limits a little further.
John Nosti: Absolutely, that’s what it’s all about, you know.
Howard Farran: I mean it seems like when you had your last course in Phoenix some of your students were driving to the airport like Gigi from San Francisco calling me saying that was the greatest I mean they just feel so empowered and motivated, no one leaves your course and feels like, I’m dumb and I could never do what you guys do. They leave that place and say man I can’t wait to get back to my practice and try that too.
John Nosti: That’s our goal, I mean completely because how many times have you taken a continued education seminar and you felt that you left there feeling like you are dumber than the person who was speaking up on stage. That is not what we are about, we are here to try to help everyone else elevate their practices.
Howard Farran: So I want to say one thing that you kind of lightly said and maybe you knew you said it powerfully, but when I look at the greats, and I have met them all, I mean I’ve met really all the greats I mean in their office seen them practice things, I don’t care if it’s Omer Reed, to you when you walk into an operatory it’s just karma and energy and fun and smiles and they just want to do it and fix it up and then when I go into that dental office that’s can’t get over 300 000 a year or 400 000 a year and they walk in there and it’s just low energy and they walk in there and they sit down and they point to the x-ray and they start talking about an interproximal cavity on the distal side causing irreversible pulpitis needing endodontic therapy and a post build up and a full restoration…
John can you teach charisma? Can you teach a personality? You have actors and movie stars, obviously some of these famous movie stars play, they cry when someone really didn’t die, can you teach that karma and energy?
John Nosti: You know what I think you can because this is kind of going to go back to my high school wrestling days. Two big sayings stand out to me from high school and the first one which was written on our wall in paint, painted on our wrestling wall was: victory is reserved for those who are willing to pay the price.
So that was number one. Number two was actually was a quote given to me by Jim Jorden who was like a four time NCAA wrestling champion and then has gone on to become something in government, quote me wrong, he might be a governor but he plays something in government, but Jim’s quote was: the amount of confidence you have is directly proportionate to how hard you have worked, and I kind of look at that and translate it to being you know what if you walk into a room and you just look at the patient and you look in their eye and you know this- their treatment plan you’re going to give them is whole heartedly the treatment plan for the patient. I think you can be very confident in yourself and look the patient in the eye and tell them what they need.
I think we start looking away and getting down on ourselves when we are either questioning what we think needs to be done, or if we are not confident in our skills.
So there’s two things you have to look at, number one: get confident in your skills, practice, work on that, do anything you have to do in order to get confident in your skills and then to get confident in your treatment planning, read a little bit more and believe in whatever you are telling the patient there might not be a right or wrong but it is sometimes it’s a right now.
I had a patient in today just as an example if I could just go on about it, he is 80 years old and he has a cavity on the distal of number 31 that is probably within a millimeter to two millimeters away from the alveolar crest.
So I don’t do molar root canals, it’s the second molar, I send them to the endodontist and I tell the guy ahead of time: honestly this tooth is totally borderline. I think if you talk to half the doctors out there they are going to tell you to get it out and get an implant, and if you talk to the other half of the doctors they might say we can save it but-
I just talk to the patient and I say what is it you want to do, the guy is like I am 80 years old, I am not looking for forever, I am looking for right now, and I said if you want to get out of pain, let’s go get the root canal done let’s at least start excavating the decay and let’s see how far it goes.
Then the endodontist calls me and he is like a little nervous and says but John I don’t know this tooth is borderline, I am worried about him and this and that and I said well did you talk with the patient? Did you just express your concerns with the patient?
And it’s talked again with the patient and said what do you think? Here are your two options, it’s either A or it’s B and don’t necessarily be so concerned about choosing the right one for the patient. It’s A, or B, and whatever the patients decides is going to be good for that patient.
I think a lot of times when we get that fear off of ourselves, tell the patient whole heartedly what you would do if it was your tooth, I think that goes a long way.
A lot of times again, be educated, be confident in your skills and when I sit down with patients- granted there are times that I am high energy and people are coming in and like I want a smile and it is so great to be like oh I am going to give you a great smile it’s going to be wonderful- but then there is people who come in and are very logistic thinkers and they are analysts and they want to sit there and fold their hands and they are not going to get very excited about 10 units of smile design, they want to know that what they are doing is going to be structurally sound and is going to work well for them, and I will just sit there I’ll talk to them very calmly and I will say you know what, this is the problem you have when you are in my office this is what I am going to recommend you do in order to correct that and there are a lot of times when I would finish off by saying if you were my brother, if you were my sister, if you were my father, this is whole heartedly the treatment that I would do on you.
And I think doing things like that and just having the patients understand that you’re concerned for them I think that sells your treatment all day every day.
Howard Farran: I had no idea we had that in common, I was a high school wrestler, I had four boys I started them off at five, do you know in my garage I literally have a professional wrestling mat made in Pennsylvania for 25 years.
My boys and I have spent probably more time wrestling than probably any other thing we have ever done it was just a wrestling family, in fact the only reason I really am a dentist is because my dad was begging me to drop out of high school to go work with him in a Sonic Drive-In Restaurant, he thought high school was nuts and dumb and a waste of time and the only reason I went to high school and made good grades, because if you didn’t make if you made a D you couldn’t be on the wrestling team, and I literally only went to high school for the wrestling team. So if it wasn’t for wrestling I would be a Sonic Drive-In Manager.
Now I want to ask you some more questions: for a cosmetic legend like you are if you were doing anterior work- well I can’t say anterior work because I have never shown my smile just to my listeners. I never show my smile in any of my photos and I went to John and asked him what he would do for me and he referred me to a vet to be put down and I thought wow, and I said are you sure John, there is nothing? And he said no dude there is nothing you need to be put down, you’re an old dog, you just need a shot like a race horse.
But John to these young cosmetic dentists I want you to talk about this, go into- everybody I have heard that’s seen you live in your Clinical Mastery deal literally dude you’re like their number one fan- 100% of the people I have met that went to your course -I am serious- is a raving fan.
I have never heard anyone say oh it was good, it’s not like oh yeah I learned some pearls or- it’s like oh my God! You’re just like that magnetic teacher.
I want you to talk about, what is the curriculum at Clinical Mastery and then answer the most common question on Dentaltown about cosmetic dentistry: if it’s an anterior case you know, corner mouth to corner mouth, would you be doing E.max, would you be doing BruxZir is a new big word or are you old fashioned and like the feldspathic porcelain?
So would you be looking for some of those labs on Dentaltown that do a lot of feldspathic porcelain like the way they did it 25 years ago or do you like some of these modern, fancy materials from like Ivoclar or BruxZir and also being a cosmetic dentist, do you ever do gold? I have seven restorations in my mouth and all seven are gold because I figured if you’re short, fat and bald it doesn’t matter what your teeth look like I just want to go total longevity. Answer all those questions.
John Nosti: You’re going for the bling, it is so funny I was on vacation-
Howard Farran: I am going for the grill, I will go to you and you can do a gold grill on me that says Dentaltown.
John Nosti: There are times that I talk to patients about doing gold and I will be honest with you, there’s people that still choose to have tooth colored restorations.
I find that more patients allow me to do gold if they already have gold but saying that, I still do think that and lot of the new ceramics out and you can call E.max new when it’s really been around for six or seven or even eight years now, so it’s been around for a long period of time now even ten years.
Howard Farran: Now is E.max just kind of an evolution of Empress back from when I got out of school? Or is that an over simplification?
John Nosti: I think that is an over simplification.
Empress is leucite-reinforced where E.max is Lithium Disilicate so some people try to say that it is Empress Two reformulated but that is still not as correct as it is new material. It started out with a brain child of Empress Two but it’s totally has evolved into something completely different.
So Empress is leucite-reinforced, E.max is Lithium Disilicate.
So if you ask me as far as cosmetics go, you know if I have someone who comes in and it could be minimal prep, light prep shades, no occlusal breakdown, really occlusion I don’t really have to worry about redesigning anterior guidance and I am looking for some gorgeous dentistry, I still have a tendency to lean back towards Empress.
Part of that could be the fact that you know what, I started doing it in 2000 and I still love how Empress looks. I think there is part of that and I still think it’s a part of E.max as good as E.max looks, there are some times where I think in situations it could look a little bit grayer, not gray in terms of black and white, but it is just a little bit different, saying that when I have a patient who comes in who has wear and they have breakdown and they are looking for something that they want longevity and rehab where even their teeth have failed them, I am not even thinking twice. I am going to E.max because it still gets me a great look and the strength of it is absolutely unbelievable, I mean it is the strongest bondable ceramic out there.
Do I go to BruxZir? I don’t because I look at it at the anterior aesthetics portion of it, if they are going to layer BruxZir to make it look good, well then it is going to be weaker than E.max and I can’t bond to it, so then why would I choose that? To me it is going to be a weaker than a less aesthetic restoration, so E.max has it over BruxZir.
You know when you look in the posterior arch, let’s say second molars, will I do a monolithic zirconia on a second molar severe BruxZir? You know I have done it but to me it has to be in a situation where I am doing a full mouth reconstruction and I am doing monolithic zirconia over monolithic zirconia.
Especially in situations where I can’t bond. If I can bond I am still choosing E.max over E.max, studies have shown it wears very similar to enamel, it’s kinder to apposing enamel so and I can adjust it and I can polish it back up to its original form coming from a lab where you know there are still questionable out there whether or not you can achieve that with a monolithic zirconia restoration.
When monolithic zirconia came out, let’s say five years ago at the time, they said the restoration you want to have it should be polished and then it should be glazed and they no longer recommend that.
Now they are recommending only a polish restoration because they’ve shown in about a year’s period of time the glaze wear’s off, so what are they going to tell us in another year or two? Are they going to tell us don’t do polished or you know after a year or two or three years the polish breaks down and now you have a lot of apposing enamel breakdown, so I am not so hung up on the monolithic zirconia yet.
Now saying that would a zirconia have its place in-
Howard Farran: If you could cement monolithic zirconia. You can’t just cement an E.max correct?
John Nosti: No you can cement E.max as long as it is over 1.5 millimeters thick you can cement it.
Howard Farran: As long as it is over 1.5 millimeters thick?
John Nosti: Thick, as long as the occlusal-
Howard Farran: Oh as long as the E.max is 1.5 millimeters?
John Nosti: Yes, so as long as you have more than 1.5 millimeters of occlusal clearance you can cement it with anything.
It is as strong as if you have bonded it. I have a tendency to bond a lot of mine in but as long as it is that thickness you are good to go in FujiCEM, like a RelyX Unicem, Multilink, SpeedCEM, take any CEM you want and you can put it in pretty much.
Howard Farran: Okay well I am still using Elmer’s glue.
John Nosti: Well there you go, that works well too.
Howard Farran: Because of the horse hooves in there, I’m sold on the horse hooves.
Go into Clinical Mastery: tell us about your curriculum because you have got four different teachers, it’s four of you so do you teach four different subjects? Is there overlap? Is it a curriculum like, is Clinical Mastery like you sign up for this and take session one, two, three, four then you did Clinical Mastery, talk about that.
It’s Clinical Mastery.com, correct?
John Nosti: Yes it is Clinical Mastery.com.
Howard Farran: Okay talk about that, is it lectures? Is it over the shoulder? Is it all the above?
John Nosti: It is all the above. We looked at it where we have a couple of different tracks that you can follow depending on what you are trying to get out of you know like going through like a continuum.
Jason teaches photography, so if you sign up for photography Jason is going to be the guy that will lecture to you.
Howard Farran: Jason Olitsky?
John Nosti: Jason Olitsky correct. But if you come and you take any one of our occlusion series, and that is going to be mastering functional dentistry, mastering complex cases and mastering full mouth reconstruction, through those three courses you are going to get a heavy dose of myself, Mike Smith and Lee Ann Brady. So three of us are involved in teaching that core group.
Now we also offer a treatment planning seminar now that seminar is kind of interchangeable anywhere in the group, you can come and take that course after you have been through a couple of courses you can come and take that course the first to start and that is going to be taught be all four of us. It’s Jason Olitsky, Lee Ann Brady, Mike Smith and myself.
Howard Farran: Is treatment planning diagnosing treatment planning or do you also talk about presenting the case?
John Nosti: All of it.
Howard Farran: Explaining to the patient trying to say the dirty word -sell.
John Nosti: Absolutely.
Howard Farran: Will we have to rate this podcast R since we said sell?
John Nosti: So what we basically do is we start out and we give you a forum and a decision tree to follow, to go back to examine your patient and then we each present different patients who present to our offices for different things.
Like an extreme cosmetic case, implant cases, broke down wear cases, full mouth reconstructions involving patients with TMD and each one of us will take you through cases from our practice and present to you, this is what we did in our diagnosis, this is what we did for our case presentation and this is how we executed the case.
So you’re basically going to get four different speakers talking about different cases from their practice and giving you different nuances and how we do what we do on our practice.
Again that could be a standalone, it could be in the beginning, the middle or at the end of the series.
Howard Farran: I want to make one observation I have had and I want to know if you have seen the same observation.
I’ve lectured 1500 times in 50 countries and I always learned that the right half of the room is one doctor who brought his wife and two assistants and two receptionists and hygienists so it’s like the right half of the room is like almost all staff, and the left half of the room is all solo dentists and all the dentists on the right half of the room they all make twice as much money as the dentists on the left half of the room, and all the left half the room comes by themselves to save money and I was wondering do you recommend bringing- I mean like when I hear the treatment plan deal, it’s almost like I would send my staff and I wouldn’t go.
Do you see that common denominator that the dentists who get their staff fired up and educated in CE just do financially so much better than the ones who come alone?
John Nosti: 100% you know we can build on and come back to that question because we do offer over the shoulder courses, one is given by Jason and you get to go in and you get to see Jason prep and see an anterior cosmetic case or anterior aesthetic case and then so you get to see him prep, diagnose, prep, temporize and then he also seats a ten unit case and then myself, I give the over the shoulder full mouth rehab course over two weekends so it is one patient, you see me diagnose and prep a full mouth rehab and then you see me seat the full mouth rehab.
Now I do think there are courses that are advantageous for doctors to bring their staff to. The over the shoulder course I think that is imperative you know if you’re not brining one of your assistants you should definitely bring both of them or just bring the assistant that you work with the most who is at least going to be able to go back and teach the other assistants.
I think that’s huge because to go back and see how my assistant and I work together you can’t communicate that and you can’t give that expectation back to your assistant unless your assistant sees it happen and it is the same thing with Jason’s assistant and how they work together.
And it’s this is the thing that happens where, and I am sure you know this, you know we’ve inserted so many units together so many times that my assistant can even tell when something goes wrong and then what plan B to start following after that.
And then of course we talk about it in the course, but when an assistant sees another assistant work at that level, that is going to push her to work at that level for you. And honestly that can’t come from you. It’s not going to come from the dentist, that is one thing.
The other thing too is bringing me back to our lecture courses. Our occlusion one course that is an unbelievable course not only to bring you assistants to but a lot of times even to bring your hygienist to because you know you might have told you hygienist 1001 times about this is attrition, this is abrasion, this is erosion, these are the things that we have to deal with at least talk to the patients about it and give them an A plan, B plan, C plan and a contingency plan in order for things not to get worse in their mouth.
And as many times as you had gone over that with them, a lot of times if they are then not taking the realm or the reins and then going with it and then helping you talk about it with patients, it’s not sinking though and a lot of times it doesn’t sink through so well coming from the doctor who owns the practice and the best way I can explain to that is my own hygienist. One of my hygienists, phenomenal been with my practice the longest out of all the employees, been here longer than I have been here she has been here 20 plus years. You know I have sat there went over with her on lunch hours after lunch hours this and that, when did she feel confident enough in herself and now going back in talking to the patient about it? When she took and came to my occlusion course.
Again she heard me, she heard Mike, but it was coming out of the office sitting in a learning environment and actually being able to absorb the information where it is not you talking to them about that in between patients, or it’s not you trying to teach them that after hours when everyone is trying to run home and get home to their family.
When you’re not sitting there doing it over your lunch hour where you’re worried about is the food going to get here or where did we order it and who is my two o’clock patient you know, it comes out of the office just like we learn in our best environment that way and it helps your staff learn too so I think that’s really imperative you have hit the nail on the head. I am definitely more successful in training their staff as well.
Howard Farran: Everybody needs fuel up and everybody needs a Vince Lombardi coach fuelled up, I have had the same assistant Jan for 28 years and she quotes you guys like some preacher quoting the bible, it’s like John Nosti said this and Sameer Puri said that and Gordon Christensen said that. I sent her down to David Hornbrook’s office 25 years ago.
I want to ask you something about occlusion because I thought it was very obvious that in our lifetimes one of the we just lost the man who invented implants, Dr. Branemark and in America that Doctor Branemark would have been Carl Misch and Carl Misch started off with removable and he mastered removable and then he got into implants and at the time you were seeing all these people who were saying implants would break and they weren’t strong.
I am going back 20 years to 1987 when I left school so many people said until they can make a stronger titanium and Carl Misch was saying dude, the implants snap because you don’t know anything about occlusion, and I thought it was very interesting that the people who mastered occlusion they never had any problem with implant supported dentures and their implant supported bridges were fine and a lot of these people who keep saying these crowns they are always coming off the implant and they are always coming loose and you’ve got to screw them down better and it’s like, so I am going to ask you two things when you talk about cosmetic dentistry.
I think two big areas on cosmetic dentistry is, if I go up to an American and say describe a person worth a hundred million dollars they always describe a man in a factory and all that kind of stuff, but it is not true. If you’re worth a hundred million dollars, you’re an older woman widow.
I have sold more cosmetic dentistry cases to older women in cash because when you’re 70 you don’t blink at trying to looking 60. When you’re 80 you’ll pay three times the rate to try and look 70.
I think a lot of young dentists try to sell cosmetic dentistry to young good looking people when they don’t have a dime. And I will never forget this John, my great grandmother died at 99 and seven months, she missed 100 by four months, and when you walked in her bathroom at 99 she still had the powder puff, she put on the lipstick, she spritzed the perfume, I mean a 99 year old lady wants to look good and I want you to comment on that, not diagnosing who need cosmetic dentistry based on weather you’d date them or not.
Number two: a lot of the cosmetic dentists don’t even realize they are cosmetic dentists because it is removable and the United States have 30 million people that are denturists and a lot of people- a smile makes- if I said to a dentist describe a smile makeover he’d say upper ten veneers and you should see Nosti or Hornbrook, and I am like, you didn’t mention the lady who finally got sick of it and pulled all of her teeth and that denture is the cosmetic smile makeover, there’s 30 million of them. Can you be a cosmetic dentist doing removable?
John Nosti: I absolutely think you can be a cosmetic dentist and do dentures because I think more and more now with the baby boomer ageing increasing and these people coming in you know they have dentures and they want to look the way you’re cosmetic albums look like on your website and in your office.
And I know nowadays with the materials we have, we can give them an awesome looking denture that will rival what your all ceramics are looking like and we have teeth like PhysioSet and Phonares from Ivoclar, PhysioSet from Candulor you know these teeth look unbelievable, they’re nanohybrid composite and they look great.
I think you have to get with a great lab technician who can custom-characterize the denture base for you so it doesn’t just look like a piece of plastic in someone’s mouth, I think that too is imperative.
Howard Farran: Name some names, name a lab that can make a rocking hot denture.
John Nosti: Brian Carson for Signature Smiles out of Fayetteville, North Carolina, I mean that is my guy. That is my go-to guy. Brian does an unbelievable job in dentures. I mean really this is what this guy does.
Howard Farran: What is his www?
John Nosti: It’s www.signaturesmilelab.com
Howard Farran: What is his name to google?
John Nosti: Brian Carson.
Howard Farran: Send that in your email notes, we will put that in the transcript.
John Nosti: Absolutely, will do. Brian is unbelievable.
I think you know a lot of people hate removable because you do it the way you’re taught in dental school and then people come in and you don’t really know how to get the occlusion right, no one really uses gothic arch tracers and if you don’t use gothic arch tracer, go back and look at one of my most recent articles on Dentaltown on how to use one, because really when you’re dealing with full dentures occlusion is everything.
If someone is coming in repetitively for adjustments and they continue no matter what you do to the intaglio surface of the denture and they are still having problems, I guarantee occlusion is the problem on that person.
You know there is a reason why guys were successful on doing implants and why people are not successful in doing all ceramic dentistry or implants or even dentures and I really think it boils down to occlusion.
People want to have better looking smiles and we have talked about it before you know how many people in their 90’s are still putting on makeup they still want to look great and your patients are willing to pay for top notch cosmetic functional prosthesis.
I had someone run a survey for them an independent survey on people on the internet that are denture wearers and the numbers were staggering, 85% of people surveyed says their dentist never gave them a choice for a better looking or better fitting prosthetic and that alone you know- start talking to your patients about it.
They are willing to pay a little bit more money for better teeth for better processing like Ivocap or IvoBase which hands down I think it is better than traditional processing like Lucitone 199, the denture is going to fit better.
It is not going to have issues where you take an impression, your impression rocks and then you go to insert a denture and it falls out of the patient’s mouth. Now that is a problem of processing, so I really think that guys and gals need to go back and revisit removable because if you think you want to do full mouth reconstruction’s in your practice with all ceramics, I would challenge you if you can’t get it done in removable I would reconsider your vision of wanting to get it done in all ceramics.
Howard Farran: Well this has been the fastest hour I have done on a podcast. This has just been amazing. I have done two of your four guys I have done you and Jason, tell Lee Ann Brady and Mike Smith I’d like to follow up with them so that our viewers could get a full spectrum of your whole faculty with Clinical Mastery.
And I want you to end this, wrap up to the dentists out there, I want your closure to be aimed at the dentists out there that are always telling me times are tough the economy is not good- blah, blah, blah- I’m talking about the civil war and world war one with the Spanish influenza and the great depression, word war two- close with how there is this dentist out there for probably ten years has practice is the same and he is telling me my town is going nowhere, it’s been flat for ever, I don’t see anything great on the horizon. What do you say to that guy? Close talking to that guy who has been flat for a decade and thinks the sky is falling and America’s glory days are behind us and nothing good to say.
John Nosti: Listen I don’t know an area hit harder from the economy that Atlantic County New Jersey, where Atlantic City is closing casinos left and right, tens of thousands of people have lost their jobs and this is my backyard, this is where I practice Mays Landing in Somers Point New Jersey.
I can tell you, if you look at my numbers last year to this year, I was down a little bit but if you look at my numbers from the year before things go up and things go down especially in a cosmetic and functional practice.
The average income in my area is probably less than what it is in yours, Google Mays Landing and find that out, and you know I am no different than you, get on Dentaltown, read what you can read for free, look up everything you can about how to become a better dentist how to do things a certain way if you need areas and strengthen procedures.
Look it up, invest in the number one person and that is yourself and I can guarantee if you are listening to Howard, he gave me a lot of accolades, a lot that I don’t deserve but I’m very much appreciative, if you think that I am something special and I have built something special don’t think that I am anything different because you can go and you can do it yourself.
Howard Farran: Everyone wants to know, you’re from New Jersey, do you listen to Bon Jovi or Bruce Springsteen all day long, which one of those two is the greatest?
John Nosti: You know what my partners love Bruce but I have to say I am a product of the 80’s and I love 80’s metal so I am a Bon Jovi guy.
Howard Farran: I love Bon Jovi, I love Bruce too.
Hey John thank you so much for an hour of you, this has just been amazing. Go to Clinical Mastery, get fired up and everybody I know that goes to a course with like you they come back and they just like start doing a bunch of bigger cases they are more excited more animated there all into it and motivation is like deodorant: you need it every day.
Go get some more skills in your toolbox, go get a dose of John Nosti, thank you so much for what you have done for your patients, thank you so much for what you have done for Dentaltown, thank you so much for your over the shoulder Clinical Mastery.
John you are, I am going to start calling you Dr. Bon Jovi Nosti the Third.
John Nosti: Howard thank you so much I am humbled and honored to be here today, thank you again I greatly appreciate it.
Howard Farran: All right go Bon Jovi.
John Nosti: Take care.
Howard Farran: Bye-bye.
John Nosti: Bye-bye.