Dentistry Uncensored with Howard Farran
Dentistry Uncensored with Howard Farran
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Why I CBCT Everyone with Dr. Neal Patel : Howard Speaks Podcast #67

Why I CBCT Everyone with Dr. Neal Patel : Howard Speaks Podcast #67

4/23/2015 12:00:00 AM   |   Comments: 2   |   Views: 1300

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"I scan ALL MY PATIENTS" --Dr. Neal Patel. Listen as he explains exactly what is so great about 3D Cone Beam. 




Howard Farran: I am at the 2015 Townie meeting in Las Vegas and I just pulled this gentleman off the stage from speaking, Dr. Neal Patel.

Neal Patel: How are you?

Howard Farran: And thank you for giving me an hour because when we are done here you’ve got to jump back on stage and do it again.

Neal Patel: That’s quite all right. I’ll send you a bill.

Howard Farran: Oh you will send me a bill? So tell our viewers about you and why you’re speaking at the Townie meeting and what’s got you fired up?

Neal Patel: That’s a great question. You know if I had to reflect on my own bio, I’d say I’m a wet fingered general dentist out of Ohio, basically running a digital practice if you will and I started my practice in 2008, right out of school.

Howard Farran: So you graduated in 2008?

Neal Patel: I graduated…

Howard Farran: So you’re a puppy.

Neal Patel: Yeah from Ohio state university and I guess I am considered a puppy, but what I did is I took a leap of faith. I knew that I wanted dentistry to be a hobby of mine and I wanted to be successful right out of the gate and I was trying to figure out how I was going to be able to compete with guys like you. You’ve got the experience, you’ve got patients that are absolutely loyal to you and you are you doing procedures through repetition and through systems, have a fantastic staff. I am trying to figure out how this young guy out of college, right out of dental school is supposed to start a practice and somehow do well, you know with all these other dentists around you and so I had to figure out a way to think outside the box. And so my strategy in 2008, despite what everyone was advising me against, was to build a reputation on technology and so I decided to go full bore. I bought CAD CAM, I bought cone beam, I bought digital sensors, I bought all the bells, all the whistles and I took a big leap of faith against everyone’s recommendation.

Howard Farran: And you did it in the worst economic contraction since the great depression in 1929. 

Neal Patel: That’s right and I figured that out after the fact right so.

Howard Farran: So what dental school was it in Ohio?

Neal Patel: So I went to Ohio State University for nine years, did general dentistry education there and I did an implant fellowship. 

Howard Farran: And when you graduated, was it September 15th 2008? So you graduated May of 2008? 

Neal Patel: Yeah, May/June area. 

Howard Farran: And then three months later the economy literally collapsed.

Neal Patel: That’s right.

Howard Farran: So how did it work out? So now it’s 2015 so it’s seven years later, looking back seven years later, do you wish you would have left dental school and got a job at Taco Bell for a year? Or move to another country? 

Neal Patel: I might be blessed, I might be very fortunate and lucky as some would say, but I think the reason I kept my head above water was because I took that huge leap of faith. You know I bought the technology knowing it was going to be a big risk, but I made a decision and that decision was to implement and integrate those technologies at the highest level. Not just to wait for the dentistry to catch up so that I could use those technologies in some way or form like some doctors do, but to make an effort to say I need to use this all the time and I need to figure out how to use it well and be consistent in my message to my patients and that my patients be the ones who grow my practice.

Howard Farran: Okay walk us through specifically. You graduated in 2008, what city did you set up in?

Neal Patel: Powell, Ohio which is a suburb of Columbus Ohio.

Howard Farran: Okay and name the pieces of digital equipment you bought.

Neal Patel: Okay. 

Howard Farran: And explain how, like what did it cost and how did you make a return on investment out of that?

Neal Patel: You know absolutely. I bought CEREC, CAD CAM at that time in 2008, it had the CEREC 3D which was a red camera and the MCXL which is a current mill that they have. So I bought that system. 

Howard Farran: And what did that approximately cost?

Neal Patel: At that time I think it was about $140 000.

Howard Farran: Okay.

Neal Patel: Okay so it’s a significant investment and to integrate technology like CEREC and CAD CAM for chairside restoration you have to make an investment in education, so obviously that was an additional outlay of cash to make sure that I’m educating myself to use the technology the way it was designed. 

Howard Farran: And where did you go to educate yourself?

Neal Patel: All over, there are so many great...

Howard Farran: Name great teachers that taught you CEREC. 

Neal Patel: You know Dr. Tarun Argawal, Dr. Sam Puri, Dr. James Clinton, Dr. Todd Ehrlich, all phenomenal clinicians who are using this technology.

Howard Farran: I love all those guys dearly.

Neal Patel: Uniquely, they’re not all the same so you’re going to learn something from each one of them and apply it, adopt it and use it for your patients, because not every patient is the same so you know, I made an investment in my education early on, but what I really hang my hat on and I guess what I’m really known for is cone beam. I adopted cone beam technology at the very early stages when it was still released in US market.

Howard Farran: When was it released in the US market?

Neal Patel: It was released in 2007 and so I had made the purchase 2007 but it wasn’t installed until 2008 because it took 18 months to build my practice and so by the time it was actually installed in my practice I had already been trained on it, I flew to Germany, trained directly under the engineers who developed the technology.

Howard Farran: Of which system?

Neal Patel: The GALILEOS. 

Howard Farran: So you went to Bensheim?  

Neal Patel: I went to Bensheim, sat with the engineers, sat with the software developers and literally trained directly from them.

Howard Farran: Do you think everybody calling it cone beam technology, do you think for the public it’s easier to explain probably going from a 2D film to a 3D film? Do you think CBCT can just be called 3D X-rays for the public? 

Neal Patel: I think from a consumer standpoint it should be explained clearly. Unfortunately I think a lot of doctors assimilate and assume that cone beam is a CT and there’s a difference in when you define what a CT is. There’s two kinds of machines. There’s fan beam rays which is what most medical imaging devices use, what they use in the hospitals and imaging centers.

Howard Farran: Like CAT Scans and MRI’s?

Neal Patel: CAT scans, you got it. What dentists use are cone beams, completely different set of physics that are included in that kind of technology where the benefit of the cone beam is much less radiation. So I would actually prefer that as a profession we wouldn’t call it a CT machine, we should call it cone beam volumetric tomography or cone beam CT but not just the word CT because it often has a connotation in the consumers eyes of high radiation for just a 3D X-ray, but I honestly feel that cone beams are coming, I can’t say it’s ever going to be but it’s becoming the standard of care that relates to multiple procedures such as implantology and any surgeries for that matter.

Howard Farran: Okay, so for the dentists listening out there. I mean basically you would only invest…how much did your GALILEOS CBCT cost? 

Neal Patel: At the time it was $185 000, it has come down significantly.

Howard Farran: Like what do they cost in 2015?

Neal Patel: You know street price it can go anywhere from $90 000 upwards of $200 000 depending on which unit you buy.

Howard Farran: Okay so for a $90 000 to $200 000 investments, this is only go to work if you get into implants.

Neal Patel: Absolutely not.

Howard Farran: Absolutely not?

Neal Patel: That’s what I thought when I got it, see I got it because I thought I wanted to plan my implants so that when I send patients to my surgeons they would make sure that the implants end up exactly where I needed them, because at then end of the day I have got to put a tooth on that implant and the patient’s ability to judge if the implant was successful or not doesn’t come from the surgery, it comes from what the tooth looks like and I think you and I both know we have plenty of phenomenal surgeons out there, but on the occasion were an implant doesn’t end up were it exactly should go, you can see it because a tooth doesn’t look like a tooth and so I thought I was getting cone beam so that I can help make sure that my surgeons place implants exactly were they needed it and when I learned more about the technology and as I was scanning patients I realized actually this is my primary diagnostic tool. It is my go-to imaging device for patients who need endo, for patients who have sinus discomfort, patients who have an abscess, pain, TMD, patients who are looking at orthodontic evaluation, looking at periodontal disease, even looking at patients airways. So if a patient says you know, I’m finding that I’m waking up with headaches or my wife is telling me I’m grinding my teeth, you know I’m actually comfortable discussing their airway, because I can show them their airway in 3D and talk to them about the possibilities of maybe getting a sleep study. Whereas before if I asked some dude, hey how are you sleeping at night, he would look at me really weird. You know, why is my dentist asking me how I’m sleeping? But when I can show them a visual aid of their actual airway in 3D, you know it really helps to facilitate treatment.

Howard Farran: Are you sending them to a sleep study lab?

Neal Patel: Yeah.

Howard Farran: Or do you send them home with a machine? 

Neal Patel: Both, it kind of depends on the situation. We have a lot of professionals as patients who don’t have the ability to just take a couple of days off and sleep at a sleep study center. So we’ve arranged an affiliation with a sleep physician and this is a great thing about cone beam because it allows me to broaden my referral resources. You know as a general dentist I don’t have the luxury of having referrals from other specialists. You know specialists have it great because as a general dentist, I’m feeding my specialists patients. Well because of cone beam, I can actually now reach out to physicians, primarily sleep physicians and ENT’s and say look, I’m a specialist of general dentistry because I can see things in 3D and we speak the same language because those guys are already seeing things in 3D. They have access to CT machines in the hospital, so they are sending me patients when they suspect that the sinus issue is really tooth born. There’s an endodontic abscess or and abscessed tooth that is causing the sinus issues. These ENT’s are specifically sending those patients to me because I have a similar understanding of how to evaluate 3D images.

Howard Farran: Okay, go into specifics for dentists out there because when you say a machine is $90 000 to $200 000? 

Neal Patel: That’s correct yeah.

Howard Farran: That’s a big range.

Neal Patel: Yeah that is a big range.

Howard Farran: It’s a house. So they want to know specifically, how much are you billing a CBCT? Is Delta paying, is Blue Cross paying, do you have to bill it as medical insurance? How much are you getting for a CBCT? How many would they have to do a month, and nobody gives $90 000 to $190 000 for a CBCT. Everyone would lease it, so what would the lease payment be and how many of these would they have to do and who is paying for these? Can you get into all that?

Neal Patel: Oh, absolutely. Not to bore everybody but if it interests you I assume it will interest everybody else. So generally speaking, looking at the return of investment for a cone beam, there’s two ways to look at it. You’ve got your direct return on investment and then indirect return. The direct return on investment would be, well how much do I have to charge the patient to justify the number of scans and so forth for the monthly that I’m going to have to pay for the lease payment. On average, you’re looking at anywhere from $1500 to $2500 a month for a payment, depending on the size of the machine and the manufacturer and the deal that you work out with them but generally, if you’re spending $2000 a month, let’s just say, how many scans do you have to take to cover that? Well the range for UCR, for a cone beam in dentistry is huge. Unfortunately we have doctors who are only charging as little as nothing, to some clinicians who are charging upwards of $800, $900 for a cone beam scan and we’re not consistent as clinicians, so we need to get on the same page regarding that, but most insurances are honoring a UCR fee anywhere from $300 to $400 based on my experience. 

Howard Farran: Most insurances like Delta, Blue Cross? Dental insurance or are you talking abut medical insurance?

Neal Patel: Dental insurance.

Howard Farran: Most dental insurances are paying around $300? 

Neal Patel: They’re not paying. They’re saying this is what we would consider as a UCR but it’s not a covered benefit, or they would actually downgrade it to a pan or a FMX. 

Howard Farran: A pan or a FMX, or a pan and a FMX? 

Neal Patel: Pan or FMX. 

Howard Farran: Just a pano, and what do you think the usual customary fee is for a pano in Ohio? 

Neal Patel: That’s a great question. I think it is somewhere around $89.

Howard Farran: So if the lease payment was $1500 to $2500. 

Neal Patel: You’re looking at 20 scans easily.

Howard Farran: You have to do 15 to 20 scans.

Neal Patel: Yeah.

Howard Farran: So you’d have to have 20 new patients…what percent of new patients do you recommend getting a, if they only have 2D getting a pano and FMX, versus a 3D? 

Neal Patel: So I think the listeners have to understand that I have been through this rollercoaster ride. When I first opened up my shop I was setting my fee at $400 and I was honestly shooting myself in the foot because when I told a patient hey it’s $400 for a scan so I can tell you what your needs are, it was hurdle so high that unfortunately some patients didn’t move forward because they didn’t justify paying $400 just to take an image, because insurance at that point in time was not covering these fees on a normal basis so when I started doing that I realized that I set the hurdle too high. Then, year two came along and I made a second mistake. My second mistake was I said you know what, let’s just do it for free, here’s why I said let’s give it away for free, which is also a mistake and I’ll get into that in just a moment. I gave it away for free because what I’d noticed, and those patients the year previous to that, when I was charging $400, those patients that actually paid for the scan, I had almost 100% case acceptance regardless of what I presented, whether it was endodontic treatment all the way up to a full mouth rehab. I had close to a 100% case acceptance and I was not able to decipher, it was because I had qualified the patient as someone who had the means to do the treatment that I was recommending by setting that $400 fee or if there was something really related to having an opportunity to discuss their treatment in 3D and the patient can actually see what I was doing, that caused their increase in case acceptance. So the second year I decided to give it away for free in hopes that every patient would say yes to treatment and that was a great mistake but a bad mistake. I literally went from 30 to 40 new patients a month to 300 patients a month because I was providing free consultation with 3D and patients were actually doing the marketing. I wasn’t doing any flyers, radio, TV or anything like that. I was literally scanning patients and they were going home because I provided them a copy of their 3D scan and you know for example if an engineer came in with a toothache I would scan him, talk to him about his needs in 3D, and he just ate it up and I would burn it to a CD, gave him the software and he would take it back to work, wherever his engineering firm was, sit down in his cubicle, pop it in his computer the next day and all of his buddies in his work environment would hover around his computer looking at his scan and lo and behold, that week I get three or four phone calls from that one patient and that’s how I grew my practice. The problem was I couldn’t manage the growth. I was scanning every Joe left and right and I didn’t have the time to spend evaluating each patient, providing a comprehensive treatment plan and not knowing whether they were actually going to move forward with treatment or not. Okay, so I decided in year three, instead of shooting high and then giving it away for free, let’s figure out a price point where most patients are willing to accept it and what I said is let’s set it at the pan fee. Because in their eyes, it’s a pan and in the insurance eyes, they might consider to downgrade it to a pan, so I said let’s just give it away at a pan fee. Well what I noticed was, patients were accepting when I recommended they needed a scan they would take it without question and the second thing was, I started to control and calibrate my practice to make sure that the patients were of the mind set of doing comprehensive treatment. So I realized quickly that yeah, I could probably pay for machine by just taking scans and by charging an appropriate fee for it, but the reality was that patients were saying yes to treatment at 95% case acceptance rate. So the patients that we were seeing at first I was scanning them with the intent for planning implants or evaluating some trauma or on abscess and I realized what I was learning in scanning patients, I could use this for everybody so this is where it’s going to raise a few eyebrows. I scan all my patients. It is my primary…

Howard Farran: All your new patients?

Neal Patel: All my new patients. 

Howard Farran: Of any age? 

Neal Patel: No I draw the line for pediatric patients because unless I have something to gain from a cone beam, they have a growth anomaly or deficiency in growth pattern or something like that, then I won’t scan a pediatric patient and also patients who are pregnant. I won’t scan women who are pregnant just to make sure that I’m following suit with what we traditionally do in dentistry. But all other patients, I take a cone beam and four bite wings and that’s my comprehensive imaging.

Howard Farran: And how much to whom?

Neal Patel: So my bite wings might run about 30 bucks a piece and then I bill the insurance $150 for my cone beam and I usually get that as my UCR.

Howard Farran: And what is the billing number for that?

Neal Patel: That’s a great question. They’ve recently changed that but I believe it 0397 is for a cone beam.

Howard Farran: So I think it’s interesting how I had a lady, one of my first cone beam scans was a lady who always had a night splint, wanted to have her night splint redone and I thought well we should just get a picture of that. Get a CBCT and by God, if she didn’t have like a piece of sand rock right in her deal, which leads me to my question, I didn’t actually diagnose that because I send all of mine to Dale Miles to read them, because I’m going to be honest with you, when I take a CBCT, and it can’t be just me because I have two associates and it’s kind of like you’re looking out of the GALILEOS, what’s the telescope in outer space, is that called Galileo too? I mean it’s like you’re looking into deep space. I mean my God, I’m a dentist but I look at those CBCT’s and I don’t know how anybody reads those. How do you learn to even read one of those things? 

Neal Patel: Just like anything in dentistry. You have to take the time to educate yourself but the real benefit of cone beam is that if you take the educational programs, and there’s multiple ones available…

Howard Farran: Name programs that teach you how to actually ready a CBCT?

Neal Patel: Absolutely. So Dr. Don Tyndall out of UNC in Chapel Hill, Charlotte, North Carolina, he actually has a radiology program and it’s a one day program and he also offers two day programs.

Howard Farran: Is he a dentist? 

Neal Patel: He’s an Oral-Maxillofacial board certified radiologist.  

Howard Farran: And does he have a website?

Neal Patel: You know what he’s obviously faculty at UNC, so he can be easily accessed through their website. So he’s at the dental school there. 

Howard Farran: Okay. So he has an all day program? 

Neal Patel: An all day program and he really teaches doctors how to read, interpret, at least come up with a differential diagnosis list of potential pathologies that they’re seeing in scans. 

Howard Farran: Yeah. Now do you recommend that dentists, am I being a brat by setting all? 

Neal Patel: No not at all

Howard Farran: I put them in what is it…Dropbox? 

Neal Patel: Yeah.

Howard Farran: I put it in Dropbox to Dale Miles and he reads it and then he emails me a report. 

Neal Patel: Absolutely. There are some clinicians who…

Howard Farran: Do you think that’s overkill? Or until you learn how to read them? 

Neal Patel: I don’t think it’s overkill. I think it’s appropriate until you’re comfortable with evaluating your images. Every single cone beam must be evaluated. That’s due diligence. So you can’t just take a scan and then assume that everything is okay. You’re required to evaluate all scans entirely. Now you’re not going to be held liable for understanding what you see, but if you see something that looks normal and you compare it to some other scan that looks abnormal, in the instance you see something abnormal, it’s your responsibility to then either come up with a list of potential pathologies that that finding could be, or refer to a radiologist for further evaluation and for a radiologic report on that scan. 

Howard Farran: Now, and I also want to say that I have never, ever met a dentist that went to 3D that would want to go back to 2D. 

Neal Patel: That is so true.

Howard Farran: Just like I’ve never met anybody who said they wish they had the vision of Stevie Wonder or Ray Charles. I’ve never met somebody who could see that wanted to be blind, and I’ve never met any dentist, I haven’t met my first dentist who after reading, I mean after you see 3D, who would want to go back to 2D? 

Neal Patel: It’s very difficult. The number one regret that I know regardless of manufacturer for all of the dentists that get onboard with cone beam is that they regret not getting it sooner. Yeah it’s going to be the biggest purchase decision you’re ever going to have to make. It’s one of the most expensive pieces of technologies that we have access to in dentistry.

Howard Farran: I would disagree. I think that’s your wife.

Neal Patel: That’s true

Howard Farran: Your ex wife will cost you five times more than your student loans. 

Neal Patel: That’s too funny.

Howard Farran: So then are you doing surgical guides? Are you placing implants?

Neal Patel: I am, yeah. I am doing all of those things. I’m not going to name any manufacturers, you can look it up yourself but I picked a system that worked for me. You know I’ve tried to figure out what it is I wanted to use cone beam for and then I found a system where all of the features were already integrated and streamlined so it became turnkey for me. I didn’t want to go and figure out whose software is going to be compatible with my machine and then how I was going to print the guides and which third party company was going to handle my guides and then if it would even work with some of the implants I wanted to place. It’s a cluster…

Howard Farran: A cluster what?

Neal Patel: You say the other word, I’ll say cluster.

Howard Farran: It’s a cluster fuck, it really is.

Neal Patel: My mom is going to probably listen to this podcast.

Howard Farran: It’s the difference between Microsoft and Apple. When Microsoft came out, an entire industry of CD ROMS came out to teach you how to use their shitty software, and then the Apple came out and said we should hire guys so smart that a six year old little girl and her sixty year old grandmother should figure out an iPod without an instruction manual. 


Neal Patel: You got it and then they will teach us.

Howard Farran: Yeah, and so the advantage of, I know where you’re headed with this, is that with Sirona, by having the CAD CAM and the 3D X-ray machine made by one company, it’s seamlessly connected. 

Neal Patel: Yeah. 

Howard Farran: Its easy to learn, use and implement.

Neal Patel: One of the biggest misconceptions of having a closed system is that it’s not compatible with other workflows and that’s not true. I think the reason why they keep it a closed system is so that they can control the quality and make sure that the system actually works. So that when I take a cone beam, I can evaluate the cone beam for what it is, but if I have CEREC, I can take a CEREC scan and I can be rest assured that the scan from CEREC is going to stitch to my cone beam and then with that data, all I have to do is plan an implant in the software that comes with all of these features, I can plan an implant, upload the scan to Germany and they can mill a guide for me for any implant system. It’s open from that perspective. But the workflow, here’s what the kicker is. You know traditionally when the patient comes in for an implant consult, what is that workflow in your practice? What do you do? A patient calls and says I want an implant, what do you do? Take me through what you do in your practice? Assuming you don’t have cone beam. You would evaluate them clinically intraorally, you take a 2D X-ray, you talk to them about the theory of putting an implant in and not knowing if they need bone or not until they get in there to do the surgery, or maybe you order a surgical guide so two to three visits later you’re ready for the surgery, right? With this system, literally an implant consult, the first visit in a 30 minute appointment, I can have the surgical guide already ordered. The very next visit, granted that they don’t need hard tissue or soft tissue augmentation, I am ready to go ahead and jump right in to implantology and that’s the real benefit, that today patients I think are really willing to do high end dentistry if you make it worth it from a time standpoint. Because time is the issue, it’s not the money. At least from my observation, yeah money is always going to be an important factor when it comes to paying for ideal dentistry, but if you can show them how it can save them time and instead of a three hour visit, it can be a hour and half total, that’s where patients really appreciate the technology, let’s put it that way.

Howard Farran: So when you started that you got committed to technology, you started off with a lot about 3D X-rays. What other digital technologies? 

Neal Patel: So I definitely use digital sensors. I graduated from having Schick CDR Sensors. I most recently upgraded this to Schick 33, which is a phenomenal 2D image. I honestly thought 2D was a dead end, I wasn’t going to see much improvement in digital radiography from a 2D standpoint but they just unveiled a new sensor called Schick 33, S33 line pairs, the clarity is just mind boggling. So that’s been a great God sent because I am actually able to see much better in my 2D intraoral images. I’ve always been an advocate of lasers and I’m still training to learn how to use them appropriately, but lasers have really opened up opportunities to do soft tissue and hard tissue procedures and patients are really drawn to these things.

Howard Farran: What lasers did you get?

Neal Patel: So I’ve got several of the Sirona lasers. I’ve got the Sirona laser advanced. I also have the BioLase iPlus. 

Howard Farran: Okay go through those lasers. The first one is Sirona, hard and soft tissue? 

Neal Patel: So the Sirona lasers are diode lasers. They’re primarily soft tissue lasers and I use them everything from periodontal treatment to aesthetic crown lengthening, soft tissue crown lengthening, treatment of aphthous ulcers to uncover of restorative margins, prior to CAD CAM or even traditional impressions. So the soft tissue applications with the Sirona laser have been phenomenal. The iPlus on the other hand is a combination hard tissue and soft tissue laser and I found that to be invaluable and one of the most unique things that I use my iPlus for routinely is removal of bonded restorations, ceramic restorations. You know one of the most frustrating things in having to deal with aesthetically bonded restorations, glass ceramics today is in the event that you have to remove them, it’s not an easy thing to do, especially if it’s e-max and this iPlus laser, even if it didn’t cut hard tissue or soft tissue, even if it only removed my ceramics, it’s well worth it. I literally fire that machine on, you know apply it to the restoration that I am trying to remove from a tooth and it pops off in matter of 30-40 seconds without me having to take a hand piece to it at all.

Howard Farran: So where do you think hard tissue laser is going? What applications, are you using one? 

Neal Patel: So I’m using the hard tissue laser from BioLase. You know I primarily use it for osseous recontouring for aesthetic crown lengthening but also hard tissue crown lenghtening for proper restorative treatment, but you know there’s a newer laser that just came out, but I don’t have access to it it’s called the Solea Laser which I’m hearing, it’s a CO2 soft tissue and hard tissue laser that’s making pretty big waves in the industry so I’m looking forward to seeing that product develop as it has a little bit more longevity in the industry but it’s showing some promising results clinically.

Howard Farran: So you are one of those rare birds who came out of dental school and hit the ground running.

Neal Patel: But the reason I did that is because I love what I do and I think my message to everybody is you need to find something you really enjoy doing so that dentistry can be a hobby. If you can make dentistry a hobby, you’re golden. Otherwise it’s a chore. I had that lecture this morning and you know it’s funny because as dentists we have to be clinicians, we have to be engineers, we have to be artists, we have to be psychologists and we have to combine all those fields in order to just to treat one patient. You know it’s ridiculous the amount of stress that’s on us, so I understand dentistry is not an easy career. It’s very rewarding, but if you can make dentistry a hobby so that when you walk into your practice on Monday morning you actually look forward to going into your practice, regardless of what happens then that is were you can really do good things.

Howard Farran: How many times a day do you wish you would have become a vet instead?

Neal Patel: Absolutely never. I mean, mind you vets are also doing very well but…they’re doing phenomenal. In fact they’re using our instruments to do half their work. I mean they have Schick Sensors in the vet field too. I don’t know if you knew that?

Howard Farran: My new medical insurance plan I got sick and they referred me to a vet to be put down.

Neal Patel: They have the right amount of tranquilizers to do that.

Howard Farran: Yeah. So a couple of things, so you’ve been out of school since 2008?

Neal Patel: That’s correct.

Howard Farran: And it’s 2015, what advice would you give to the 5000 graduates…this is April the 16th, so next month 5000 kids are going to come out of school and I don’t know if you remember that day but they’re always scared.

Neal Patel: They’re always scared, and understandable.

Howard Farran: Humans hate change, you know the night before you start dental school or finish dental school those are two nights you don’t sleep.

Neal Patel: That’s true.

Howard Farran: So next month 5000 kids will be laying in bed like this thinking oh my God, tomorrow I graduate, what’s next? Where do I go from here? What advice would you tell those kids? 

Neal Patel: Yeah. My advice for them is to realize that dentistry is going to be a phenomenal career for them and for them to realize why they wanted to get into it in the first place and not be daunted by what’s ahead of them. Coming out of dental school, I understand that they come out with a significant debt these days and that’s a challenge but I don’t foresee that as an obstacle for success. So I think what students need to do is realize and envision, write down what their goals are, so that they can at least join a track that will allow them to reach their goals. If you don’t have a written plan you might as well go blindly and join someone’s practice you know, be put to work. But the reality is that you have to have a vision for what you want to do in five years and ten years and 15 years and then you have to figure out what it’s going to take to result in that goal, to get that and achieve that goal, and if you don’t have it written down, you don’t have a plan.

Howard Farran: My advice though, on a slightly little different than yours, is that you’ll complain about the $250 000 student loans, but your divorce will cost you a million and something most interesting is the, when a dentist marries a dentist or a doctor, doctor, dentist, lawyer- when someone with seven to nine years college marries a partner with seven to nine years, they have the lowest divorce rate in United States of America. It’s under 10%. 

Neal Patel: Wow.

Howard Farran: And the women dentists, three out of ten women dentists will marry a guy in the class, so know you’ve got two couples making $10 000 a month. 

Neal Patel: Yeah.

Howard Farran: But the men…the other seven out of ten women dentists will marry a man with a good job, but the other seven out of ten dentists will marry a woman who will never work for 40 years. 

Neal Patel: There you go.

Howard Farran: So my advice would be, if you’re single in dental school and you graduate tomorrow, marry one of those chicks before you leave. Just pick one, because if you can just marry someone who makes $10 000 a month for 40 years, that’s going to be an awesome marriage. Trust me. 

Neal Patel: I understand you’re starting some marriage counselling services?

Howard Farran: I’m going to start that, Howard Farran Marriage Counselling Services but, we’re in Vegas right now where I’m zero for two, but no…seriously that is true because a lot of the finance stuff, they’re scared about getting out of school with $250 000 debt. They’re scared to buy a 3D X-ray that costs big money. 

Neal Patel: Absolutely. 

Howard Farran: Or a CAD CAM or a laser. I mean a lot of the fear these dentists have are because of money. I want to ask you another generational question since I’m old enough to be your dad. How come when I got out of school and 5000 dentists worked in the military and they said well I’m going to go to the navy for four years to get some experience, pay off some debt, I don’t really know what I’m doing, get a GPR or whatever, and everybody’s like dude, the navy, good for you. Go get some training and get your feet wet. But today if you say well I’m going to go and get a job in corporate dentistry like with Hartland or Pacific they’re like what? You know, like it’s some dark evil force or something. What do you think about getting your feet wet at Hartland or Pacific or something like that? 

Neal Patel: I think it’s a great pathway, I honestly do. I think if people really understood the people behind Hartland and Aspen and Pacific Dental you know their intentions are great and I think that sometimes…

Howard Farran: Solid guys.

Neal Patel: Dentists who are in private practice, on their own give these larger corporations a bad name because they’re fearful of the competition that they bring to the table. The reality is that they’re doing something right otherwise they wouldn’t be growing at the rate that they’re growing right, and so I think that, I encourage recent graduates to consider those opportunities because they have proper systems in place and protocols in place and stability. It may not be a long term solution for them, but it kind of depends on what the end point is. What are the goals for that student that’s coming out of school? Often a lot of students have a vision to have their own practice someday. You know what better place to learn the systems and the protocols than some corporate dental environment because they’ve actually got things down in place that are pretty sophisticated despite what people hear.

Howard Farran: They also do far better demographics. I mean one thing people never talk about Walmart, there is…you say well where does Walmart buy everything so cheap? Well they buy in such huge quantity. How did they buy in huge quantity with their first store? I’m pretty sure their first store is in Bentonville, Arkansas and where people miss the Walmart store is that they had no volume originally but in their first 32 states they were never in a big town. Now you said you were in a town I never heard of. 

Neal Patel: Well I was raised in a small town in Chillicothe.

Howard Farran: But where do you practice?

Neal Patel: In Powell, Ohio. It’s a suburb of Columbus, 10 000 people.

Howard Farran: But when I leave your town, would I be in the country before I went to Columbus or would I not know that left your town and I am in Columbus? 

Neal Patel: You know, it’s very closely associated with Columbus. 

Howard Farran: Is it where a demographic need is I guess what I’m trying to say? Was it an oversaturated area? 

Neal Patel: No it was right in the middle of The Row, an area that had potential and it wasn’t oversaturated and so I picked an area demographically speaking, from a good business standpoint. I knew that I had the right ratio. At the time in 2008 when I set up shop, I had a 1:1800 ratio which was fantastic right? You know so I did it the right way, which is to do my homework, to figure out what community could support a dentist and then also to pick a community where I wanted to participate and be involved, so that was another thing. So you always have to first ask yourself where you do want to live. That’s the place where you should practice. The other way around is often I think dentists pick a great opportunity in a community that’s not where they want to raise a family and that will bring conflict at some point although the business will be doing great, the wife might not be happy because they live in a community that the wife doesn’t want to live in. So you know, there’s a lot of things that have to go into making these decisions and I think a demographic search, as you had mentioned earlier is absolutely critical to the success of any business. Outside of dentistry that’s a fundamental, it’s a known thing. You have to do a demographic study before you start a business to see what the community could support and understand what your competition is. Dentists somehow, some of them do, some of them don’t but I think we need to encourage each other to do that. Especially these recent graduates, it’s appropriate to do a demographic study.

Howard Farran: So what would you say to the, I want you to address this guy because you’re a young, hot whipper snapper and you’ve got all this energy and you’re going for it and I’m so proud of you. So talk right now to this 40-50 year old dentist out here watching you and he’s out there in Parson’s, Kansas and his practice has been flat for 10 years. He’s done $400 a month for 10 years, kind of burned out. It’s a job now. He wishes he could win the lottery. How could he get fired back up? What would you tell that guy out in rural America, flat for a decade? How could he get fired back up in dentistry? 

Neal Patel: You know it’s funny that you ask that. I actually have observed that the most successful practices are the ones that you would never assume had that opportunity and I kid you not, and I’m obviously biased. I love cone beam so much, but I’ve seen what it does for practices. It transforms them. Not only does it transform the doctor, but more importantly the team that supports that doctor all of a sudden is reinvigorated because this new piece of technology really brings a lot to the table for the team that supports that dentist and so you know, I think at the end of the day we have to forget about what we’ve been told about cone beam because a lot of us fear cone beam. We’re afraid of scanning a patient and missing a brain tumor, when in reality it’s a hard tissue imaging device and a dentist has every capacity to learn how to interpret the images and it’s so easy. The learning curve is actually much shorter and smaller than CAD CAM for sure. And if we can realize that cone beam can be a primary diagnostic tool in dentistry for all facets, pediatric assessment, orthodontics, endodontics, oral surgery, periodontics, endo…I mean the applications are immense. Not just about implants but when you add implants it’s icing on the cake. Cone beam will transform just about any practice that chooses to integrate it. There’s a lot of clinicians who buy it just to keep up with the dentist down the road. That’s the wrong way to look at it. If you get into cone beam you have to make a decision to integrate it the way it was designed. What I mean by that is to utilize it on a consistent basis, to use it for your patients in the diagnostics and the treatment planning and realize its potential uses moving forward and have the team that supports you also adopt it and make recommendations for patients who are in need of any of those given procedures. So I think it’s one of those things that all of us as dentists, our primary objective, as a general dentist speaking, our primary objective for our patient is to supply them with the best diagnostic information and treatment plan for what their need might be and if we don’t even have the best diagnostic tools in our practice, how we can we actually provide the best level of dentistry? 

Howard Farran: Okay, I want to make one statement then I’m going to ask you another question. One thing that I can tell you as an older dog is that some dentists are coming to me and saying, Howard does laser stand for light amplification stimulation emission radiation or financially does it really stand for losing all savings equals reality? And this is what I’ll tell you, I raised four boys. My boys are now Eric, Greg, Ryan and Zack, it’s alphabetical order, E, G, R, Z they’re 25, 23, 21, 19 and I can tell you that when they were little, if you put them out in the sand box and there was nothing in that sand box they would just get out.

Neal Patel: Okay.

Howard Farran: But if you threw in some Tonka trucks and some yellow Caterpillar trucks, and shovels and pails and a garden hose, my God they’d be there until the sunset and I have seen so many dentists that…it’s kind of dunny because you’ll go poorest parts of Phoenix and you’ll say, well that’s silly, why does that person live in a $20 000 house with dirt floor, but has a $30 000 purple low rider out in front of it? They’ll say well that’s just silly. Why would your car be hotter than your house? And I say really, well look at you. You rent 1000 ft² office which just looks like depression but your home is 4000 ft² and I’ve seen so many dentists that were burned out and fried and they got some new toy, whether it be a CBCT, whether it be a laser or whether they went and started placing implants and or whatever, but they got fired up again, and it was the fired up part that was everything. Not the technology. Same thing about, like these dentists that were flat and now all of a sudden they’re all fired up and they say well it’s because I went to this implant course with Jay Reznick and this and that and implant guided, but if you look closer I don’t even think that’s true. I think it was because they went to that course and that course is where they met their new best friend Timmy and now him and Timmy are best friends and they’re going to all these courses together. So him and his new best friend are all fired up and motivated. They’re energized. 

Neal Patel: I agree with you because patients are a lot smarter than we take them to be. They recognize when a dentist cares, they recognize when a dentist is excited for a certain procedure and they very well recognize when a dentist doesn’t look forward to doing a root canal on a molar. We exude that through our expressions and our attitude.

Howard Farran: So you’re talking about CBCT and implants but the guys out there listening…there’s probably going to be ten molar root canals done for every guy placing an implant.

Neal Patel: Yeah. 

Howard Farran: So how does CBCT look at a molar endo? I mean I have heard things that they have to be a specific size before you can see a missing canal or a MB2 or a fracture? 

Neal Patel: Yeah there’s a lot of parameters that go into it but the reality is, is that I think it takes the fear of unknown out of evaluating our patients. Whether it’s for an endo treatment or evaluation of a wisdom tooth that’s related to the inferior alveolar nerve, having an opportunity to see everything in 3D takes that unknown out of the equation and that allows us to speak more confidently when we’re recommending a treatment for example. You come in and say hey, I have a wisdom tooth that’s bothering me. I’ll say well it’s really close to the nerve, I’m just going to send you to an oral surgeon versus when I show you your image and show you the relationship and then address it and say this is why I want to send you to an oral surgeon, or perhaps this is why I know I can do this because it’s not closely related to that inferior alveolar nerve, so it would be safe for us to do this. You know having that level or confidence speaks miles for patients and I think that when they see a confident dentist, you see the team confident, you see the dentist being confident. Patients are starting to say yes to treatment and I often say to a lot of clinicians who come to be and say well, in my area we don’t have these kinds of patients that just say yes to dentistry. I say no, you do. You just don’t communicate and exude the confidence that it takes for your patients to say yes. If you go in there unsure, questioning the treatment, not sure as to if they need a bone graft or they don’t need a bone graft, I mean would you drop $5000 and say we’ll figure it out when we flap you open? You know what I mean, that’s no way to build a relationship with the patient who’s going through this process and who’s really under the knife. But if you can go in there and tell them with great precision as to what’s going to happen, that level of confidence is best for a good relationship with the patient but watch what happens to the team. When the team sees your level of confidence having these kinds of technologies, they start to recommend the treatment to your patients because like you mentioned this morning in your lecture, when the doctor leaves the room what happens? You know the assistant and the patient have a communication that either lets the patient say yes, we’re going to move forward or you know this doctor has never done this procedure, get the hell out of here before he does something to you type of a relationship and you know what’s I’m talking about. But when the team embraces the technology along with the doctor, that’s when a practice can really sing. That’s where the best of the best comes out. 

Howard Farran: And motivation is everything because every consultant that will tell you that Monday and Tuesday and Wednesday they will maybe diagnose $10 000 a day of dentistry and you’ve got to diagnose a lot of dentistry to do…because you’re going to do less that you diagnose and then by Thursday it’s like well, we’ll just watch it and then by Friday you come in with an abscess and it’s like well here’s some antibiotics and Vicoden. 

Neal Patel: They lose their motivation.

Howard Farran: Are you really treating an abscess with antibiotics, really? So motivation and inspiration is huge. So I want to go back to molar endo because again I feel like we were talking too much about implants when, those guys out there listening I know, they all do molar endo but not all of them do implants. When I look at molar endo, I look on Dentaltown and everybody wants to talk about, if someone said tell me about molar endo, they’d say what file do you use? It’s like dude the number one reason root canals fail is not what file or what you obturate with, it’s missed anatomy. The number one failed root canal in America is a maxillary first molar because they miss the MB2. Number two most failed root canal is a mandibular second molar because they miss, there’s two canals and not one. Number three is the mandibular incisors which everything is a no brainer. They have a lingual and so are you, so tell these people, does CBCT help you find missed canals? 

Neal Patel: Yeah. It’s my cheat sheet. Monday morning it is my cheat sheet, my staff actually call it that because I have an edge in my practice, not because I’m smarter than everybody, but I have a cheat sheet in my practice.  So when I take a scan, I know exactly what the clinical situation is. If a patient has a mesiobuccal tooth and I look at the canal system and I’m like look, this is not worth my time, it’s not worth the pain and the effort. I’m going to send you to a specialist. I’ve just saved myself a lot of hassle and the patient a lot of hassle too, but often if I have a road map to the patient’s mouth I know how to get from A-Z if I have that road map.

Howard Farran: And you’re so right, it has increased my referrals to the endodontist because, I just…one Monday and it was a no brainer, one canal so I thought CBCT, one canal 80% of the way down the tooth and turns into two.

Neal Patel: It bifurcates.

Howard Farran: It bifurcates and I just said, there’s not enough money in China to pay me to sit here all afternoon and try to do this thing and I swear to God, if that had been a 2D PA, I would have thought it was one canal, you know I would have found one of those and I would have done it and I wouldn’t have done it properly. 

Neal Patel: The reality is that a lot of the specialists who adopted cone beam early were really nervous about general dentists getting into cone beam because they were fearful that the general dentist were going to take away their implants and some of the other things that they were routinely getting referrals from and the reality is that, what cone beam have done is its reinforced the relationships because now the dentists are looking for those specific things and they’re recommending specific treatments because they have access to this kind of imaging and you know the average dentist is referring more implants, also doing them as well, but referring even more implant to the specialists because now the whole team is looking for implants because they know they can do them.

Howard Farran: I want to make one comment about endodontists. Desperate men do desperate things and if you’ve got $300 000 in student loans, a stay home wife and four kids or whatever and you know, I would not send molar endo to an endodontist without a CBCT that does not do surgical guided implants. Because if your only tool is a hammer, everything look like a nail and I see all these re-treats that have been done in dentistry and a year later they need it extracted and you call that endo and say well, what do you think about that? Well I did the best I could, well dude it didn’t last a year. You have any remorse, any guilt? Are you going to give them their money back? Well I mean I told them, I mean I’ll do the best I can, but then the endodontists who can make the money other ways, who take a CBCT and say I’m not going to re-treat that, I mean it’s got fracture, it looks like crap I’m going to pull it out and do an immediate implant because they can make $1500 doing a re-treat or $1500 placing an implant and they can make $1500 either way. Isn’t it interesting how many of those molars they would have retreated they’re now pulling in a minute?

Neal Patel: Yeah.

Howard Farran: And how many endodontists you know, in my 20 years, that when they do a molar root canal, a re-treat or an endo it has to be extracted and you get given your money back, but now with CBCT, so desperate people do desperate things. You know I would want an endodontist that can also make that decision. 

Neal Patel: Make that decision, I agree. I think unfortunately it’s a big war out there right. Every specialist is vying for the implantology market and the general dentist is also doing the same thing. When the reality is, it’s a tooth replacement option that any clinician with proper education has the ability to place an implant. I firmly believe that. I feel that as a specialist, periodontist, oral surgeon and even some endodontic surgical programs out there have the education through their residencies, but that doesn’t mean that a general dentist is not educated enough or doesn’t have the ability to educate themselves enough to be able to also place implants at the same clinical level, clinical skill set that a specialist could, and I firmly believe that. 

Howard Farran: So what do you think of Gordon Christensen’s comments about, a couple of months ago on a podcast with me he said okay, we have nine specialties and he said he thinks the specialty of periodontics is dead.

Neal Patel: I think, I’m not sure his perspective, my perspective is I think that the periodontics specialist is actually, there’s going to be a bigger demand. We see more and more gum recession these days than we’ve ever seen before and gum recession is something that needs to be managed and so I think the perio field is booming, so he may see it from a different light but from my perspective I think the periodontal market is huge. Not as it relates to periodontal disease. I see less and less people with periodontal disease these days, but what I do see as an alternative to that is gum recession.

Howard Farran: And what do you think is causing this gum recession?

Neal Patel: You know I think that it’s just the nature of how you know, you tell patients to brush but you also have to teach them how to brush properly you know I think a combination of poor technique, abrasive toothpastes and a combination of patients who are aging you know, these days patients are living longer and they’re keeping more of their teeth.

Howard Farran: What about occlusion?

Neal Patel: Occlusion is, all of those things weigh heavily onto the causative factors of recession so I think that with people living longer, people working later in their lives and their careers than they’ve ever worked before. Higher stress levels and people’s abilities to keep teeth these days as a recourse of that we’re seeing gum recession so.

Howard Farran: Okay, so I’ve only got you for nine more minutes, so I want to tighten you up a little bit. You’re young, you’re energetic and you’re crushing it on so many levels. Thank you so much for coming down here and lecturing for me twice, but there’s a burned out dentist out there in rural America. He’s 40 to 50, he’s been flat for a decade, if he could buy one piece of equipment what would you recommend he buy that could motivate him, inspiration and make him want to get in the sandbox and play dentistry and put a sparkle in his eye again?

Neal Patel: Without question its cone beam.

Howard Farran: Cone beam, over CAD CAM, laser? 

Neal Patel: Yeah so here’s the deal. I can do restorative dentistry without CAD CAM. I might not enjoy it. I love my CAD CAM system, but I can still do dentistry. I can do dentistry the traditional way. I can take an impression, send it to lab of my choice and really get a phenomenal result, but if you take my cone beam away from me I will walk. I will walk from dentistry because what I can see in cone beam is simply mind boggling. I mean literally I have a road map to my patient’s dental needs. I see things that I wasn’t anticipating in one in four patients. Let’s take for example, if I take a patient and I have a FMX and a pan and I do a treatment plan on that patient without cone beam and then I take a cone bean on the patient and re-evaluate my treatment plan, it’s going to change and in fact, one in four patients has an incidental finding in their cone beam that actually has a significant impact on the treatment plan. The long term treatment plan and that’s significant and I think that dentistry as hard as it is, we want to eliminate our failures and that starts with having the best diagnostic tool. You know for any one condition there’s three different treatment plans and you know that, but with more objective data we can actually get closer to agreeing upon a common treatment plan and making dentistry less of an art form but more of an objective science.

Howard Farran: And you know the funniest thing is a lot of people talk about whether this treatment was the best treatment or whatever, but anybody will tell you, and research said, the number one thing you’ve got to get right is the diagnosis. 

Neal Patel: The diagnosis is key.

Howard Farran: Because if you have the wrong diagnosis the treatment goes well…

Neal Patel: And that happens so often in dentistry. I’m not saying that the treatment didn’t go successfully, I think as a dentist we have the art of being able to just about to do anything for a given condition and improving the situation and in the eyes of the patient and in they eyes of the clinician, it’s an improvement but if we can all agree on one treatment plan for a given condition, that might shift our reality as dentists and I think we need to be more objective and less subjective in how we treat our patients.

Howard Farran: So in oral radiology, what do you think was a bigger breakthrough, cone beam technology 3D, or the person on the pano that figured out to put the L and the R on there? I mean that was huge dude.

Neal Patel: That was huge right.

Howard Farran: Because seriously, because one thing it’s really huge is when you show people a FMX they were always looking like a deer in headlights. 

Neal Patel: Yeah.

Howard Farran: No one can, in their mind put 16, 18 films back together. 

Neal Patel: No, I mean look, it took us four years to get a degree in dentistry so we’re licensed to interpret that FMX. How is it possible for us to spend two to three minutes with a patient who’s never seen an FMX and help them understand what you and I see?

Howard Farran: But the pano thing was more realistic.  

Neal Patel: Somewhat yeah.

Howard Farran: It had the one picture, L and R, they immediately see L and they go is that the left? And you’re like right on, but you have to admit, when you show them that 3D, they realize they’re in NASA outer space GALILEOS. I mean you’re going over it with them? 

Neal Patel: Absolutely, I review all of my cone beams chairside. That’s were the magic happens.

Howard Farran: And are you doing that on a laptop or are you doing that on a mounted…? 

Neal Patel: So when I said it’s important to be integrated, it’s one thing to have the technology, but to be integrated means you have to utilize it in a fashion where it touches the patient before they leave. Where if you take a cone beam, you don’t wait until the end of the day to review it and then give the patient a call and say hey, you have a sinus infection. No that’s not how it works. To capitalize on your investment, you not only have to use it but you have to show the patients how you used it. So the moment of interest, the peak moment of interest is when the patient is actually there for the scan so you owe them, and it’s an obligation from my perspective, that you owe the patient the opportunity to evaluate the scan with you. So what I do in my practice is I have a monitor that’s at the foot of the chair, the moment that cone beam is taken, I seat them back in the chair, I do an intraoral evaluation, head neck examination, traditional work up and then the staff will have the cone beam pulled up at the foot of the chair and I go through it for the very first time. I don’t rehearse anything, I don’t plan my implants ahead of time so I can magically show them look how easy it is to do implants. I do it chairside with the intent of doing this co-diagnosis opportunity where we’re evaluating the patient with the cone beam for the first time and honestly the images, being an owner of cone beam, you can vouch for this, what you see is what you get. I mean when you see a large abscess, it looks like an abscess on the cone beam. There’s no misinterpretation of no bone. There’s just a black space.

Howard Farran: If you did this to 100 patients, how many of them would have a little oh or ah in there sometimes? 

Neal Patel: They all do, they’re al very impressed but the reality is that a lot of patients have already seen this right, so they’ve already been to the hospital for either their family member or something like that, so they’ve seen these technologies. So what it does is…for the patient’s mind it feels like, what I’m seeing is that it solidifies that yes, you’re the dentist of choice because most other dentist, if in the event they get a second or third opinion, are not going to show them the same thing you know. So I tell my team, we’re not trying to push treatment on our patients. We’re just planting the seed and educating them on their first visit and what we’ve observed is in the event that, that patient gets a second or a third opinion, those second or third opinion dentists don’t even come close to the way we present the treatment with cone beam and so that patient calls back saying you know what, I went to a second and a third opinion and really liked Dr. Patel, you know it’s a little bit out of my range financially, is there anything we can work out, is there payment options? So they’re calling us back even after a second and third consult, asking us to do the treatment but to work on their terms. That’s powerful.

Howard Farran: And so the last close. This guy is driving to work, he’s been listening to you on his Bluetooth in his car. She wants to learn more. What would be her next step? What would be a first step for her? 

Neal Patel: You know a first step, there’s so many good courses out there on cone beam. They mostly revolve around guided implantology and that’s a good place to start but just know that that’s not the focus necessarily. You can use cone beam for all facets of dentistry, but the manufacturers right now are running these different educational programs. One of them that I speak at is the 3D Summit. So if you go to Sirona, you can learn about these educational programs just to see if it’s a good fit for you for. Have an opportunity to evaluate and actually play around in the software and see other clinicians who are using these things successfully before you plunge into it. So that’s an initial stage that I think is appropriate given the price point of this technology.

Howard Farran: And I will just say one thing on the close and that is, there’s 125 000 general dentists in America and there’s 30 000 specialists and those specialists are always calling you out trying you to get you to go to lunch or they’re sending you cookies on your birthday or 4th of July or whatever the heck, I have never met a specialist in Phoenix, Arizona where if some general dentist said I’m thinking about 3D, you have one, can I send a patient over for a scan? 100% will say yes and if you say well can I come over with the patient and look at it and talk to you? Every specialist in America is dying to have lunch with you, dying to meet you, this specialist, they’re shy, introvert geeks just like you. The only reason you became a dentist is because you didn’t have enough personality to become an accountant, so if you call up that specialist, he’s like an engineer too, and you just say hey, I’m a geek. I only talk to my own shadow, can I be your friend? Can I come over with a patient and take a CBCT and when you show me we can talk about it. Every dentist wants a friend and if you just call your specialist, like if some dentist up the street called you up and said can I come over and look at your CBCT, what would you say? 

Neal Patel: Absolutely. You know listen, there is so much dentistry that has to be done out there and I think dentists need to put their guard down and just realize we’re all in the same swimming pool and I think we all need to help each other.

Howard Farran: Yeah and in America, when you have the three fastest growing diseases on earth, number one on planet earth for seven billion people is dental caries, followed by obesity and followed by diabetes. So there’s room for everyone. Thank you so much for giving me an hour of your time and I feel so bad because you have to leave here and go jump straight on stage on Townie meeting.

Neal Patel: It’s what I do. I appreciate you Howard. Thank you for everything you’ve done.

Howard Farran: Alright. Thank you. Thank you so much. 

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