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The highs and lows of being literally married with your career.
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AUDIO - Matthew Bickel - HSP #133
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VIDEO - Matthew Bickel - HSP #133
Kathleen and Matthew Bickel have been married for over 20 years. They're definitely still in love with each other and with the amazing practice that they share. Listen to their optimistic views about everything dentistry.
Kathleen Bickel, DMD:
•BA Albright College, 1988
•DMD UMDNJ, NJ Dental School, 1992 (now Rutgers School of Dental Medicine).
•AEGD UMDNJ 1993
Matthew Bickel, DMD:
•BA Rutgers Univ, 1988
•DMD UMDNJ, NJ Dental School, 1992 (now Rutgers School of Dental Medicine)
•AEGD UMDNJ 1993
•Married to Kathy Bickel, DMD since 1993, 2 daughters 20 and 15.
Co-owners of The Dayspring Center for Laser Dentistry since 1998.
Waterlase doc since 2004.
Howard: It is a huge honor today to be interviewing my online buddy, flyfishingdoc, who's been on Dental Town for a long time with over 1,000 votes, and when we started this interview, his wife walked by, Kathy, and so I told Kathy to sit down because I would love to just start with this amazing piece of data and see what you guys run with it. Dentists have had the highest suicide rates several times in the last 30 years, but if you look at the numbers, it's male dentists.
It's almost never female dentists, and they always talk about in divorce that a third of it is from financial, a third of it is from infidelity and a third of it is substance abuse. Women dentists, 30 percent of women dentists marry a dentist in their class, which is what you two did, which is why I told you to stop and pull up a chair for the intro question. The other 70 percent of the female dentists, if they don't marry a male dentist in their class, they marry someone kind of like a dentist, maybe a lawyer, physician, a banker, but the bottom line is they have a job.
Kathy: They make choices these women dentists.
Howard: Yeah, and a lot of male dentists they go out and marry the cutest thing they can find at the bar, and they'll never have a job, and they'll destroy $10,000 a month for the whole relationship. They talk about graduating with $250,000 in student loans, and I'm like, dude, you just married someone who's going to destroy four million dollars before you die. That's a big part of pain and suffering, which is an environment that leads to dysfunctional behavior, burnout, disease, depression. So, I want to ask you Kathy, when did you guys meet in dental school? When did you start dating? Did any of your other classmates marry a female dentist? You guys work together, what is it like working together and then going home and being husband and wives?
Kathy: That's a lot of questions there. I'll start at the beginning. We did meet in dental school the first year. I was a Brown; he was a Bickel. We're alphabetically arranged, so we were near each other. We were dating other people at the time. I sat next to another Brown. Come to find out, he was quite the jokester in our class. Started a rumor about a month into school that we were engaged. Everyone in our class was coming around, "Oh, congratulations. What an amazing love story. You just met and already you're engaged. What is that like?" We're both wondering what are you talking about?
Matt: What are you talking about?
Kathy: So, it came around that this guy sitting next to me started this whole rumor. Little did we know, three and a half years later, we would be dating and getting engaged.
Howard: Well, congratulations. How long you been married now?
Matt: It'll be 23 years, I'm sorry, 22 years. I'm in trouble now. It'll be 22 years on August 21st.
Howard: You dated all through dental school and married after graduation?
Matt: We started dating junior year of dental school, and we got married at the end of our residency.
Howard: Okay. That'll be another question, but later. You guys, did you immediately start practicing together?
Kathy: No. That was our goal from the start to get a practice together, but we went our own ways at first as associates and got some experience till w were ready to purchase our own practice.
Matt: Yeah, we worked as associates for about six years before we purchased our practice.
Howard: Do you guys work in the dental office at the same time or do you like do different times to have more hours covered for the consumer or do you overlap the whole time?
Kathy: We overlap the whole time.
Howard: So, you drive to work with each other, you drive home with each other, you live with each other, you work with each other, and you've been doing it for ... How long you been working together?
Matt: Seventeen years.
Howard: I think the dentists' personal relationship is why it's far more important than his practice. You've been doing this for 17 years, then there's two kids out there, two little love bunnies that are just starting it out, what advice, 17 years of a man and wife dentists working and living together, would you give the young kids who just walked out of dental school and are opening up day one? You've made it 17 years. What advice would you give this young couple so they can still be married 17 years because, you know, a lot of times the wife dentist, when she's [inaudible 00:04:27] her husband, she's thinking well, I've had no prior convictions. I've had no legal history. If I shoot him right now, I'll be out on seven years and good behavior. They'll sentence me for 20, and I'll be out in seven. What advice would you give these couples about working together since you've done it successfully?
Matt: I would say we didn't always do it successfully. There were some bumps in the road at the beginning because I've very much into technology and doing new things, and so I work four days a week full time. Kathy's two days a week, and so would happen is we would start doing something, and she'd just be getting used to the new way that I was doing something, and I would jump on to something new, and say, "Oh, I just bought this material for the office and this and this, and we're going to do it this way now. It was kind of annoying for her."
Kathy: [crosstalk 00:05:18] frustrating.
Matt: Yeah, so I had to kind of scale that back a little bit and understand that she wasn't working as much as I was, and so the things that I was getting quicker because I was doing it twice as much that I had to kind of slow things down and not buy so much new stuff to drive my wife crazy.
Howard: What was your perspective? What advice would you give the young couple on that specific?
Kathy: One thing that we did that really helped us out lot I think, we separated our interests somewhat. We're in the same dental office. I'm more interested in some aspects of dentistry and Matt-
Howard: Which ones?
Kathy: I'm interested more in kids orthodontics. I treat some babies for tongue and lip tie, and that interests me. Matt's more the big restorative, endo implants, that aspect of it.
Howard: I want a question to a female dentist that I can't really ask or answer cause I'd be written off as a sexist, but do you think since women have maternal instincts they're more geared for pedo and children because in all honesty, there's nine specialties? If you told me I had to be a pediatric dentist, I'd hand you my license. If they said, "Oh, no, you have to or we're going to take away your citizenship and you're going to have to find another country, glad, I'm going to Sydney or Toronto first plane out." I mean I just can't do it. I mean, when a kid is crying, my resting pulse is 140, my head starts sweating, and there's no money in China to do a pulpotomy. I mean, I still have to do it, but do you think it's sexist for a man like me to say, "Well, you're a woman, you have maternal instincts, so you're probably better with children?" Should I just not say that or is it just me?
Kathy: No, I think that's true much of the time. Not all the time. There's exceptions to everything, but I think much of the time that is true.
Howard: You know what, the future of pediatric dentists is going to really change because pediatric dentists used to make bank when all the dentists were males, but now that 45 percent of the graduating class is females, almost every female dental student dentist I know, almost every one of them, likes working on kids, and over every man that I know that's my age, that's the last thing they ever want to do.
Kathy: It takes a special amount of patience.
Matt: Yes it does.
Kathy: You're not expecting to do great amounts of dentistry at one time.
Howard: So, then I have another question for a couple because there's young kids out there who are starting this, now do you guys both defer to an office manager or is one of the you the office manager and one of you kind of acts more like an associate? How do you handle staff, and also how is it confusing staff? If Matt tells me no, and I just turn around and say, "I'm waiting for Kathy. I'll just go ask Kathy. Kathy will say yeah." Or if Kathy is being all, "No, we're not going to do that." Well, she's only two days a week. I'll wait until she's gone, then I'm running to Matt. How do you handle that or do you not see that issue?
Kathy: We handle that like parents.
Kathy: We have to be on the same team.
Matt: Exactly. That's how we've always been with our daughters is that if one of us says no, then the answer's no unless the two of us get together and talk about it and change our mind, but never go against the other one when it comes to dealing with your staff or dealing with your kids if you're talking about family.
Howard: How many kids do you have?
Matt: Two. Two daughters.
Howard: They're both girls?
Howard: What are their ages?
Matt: One is about to turn 15, and the other one just turned 20.
Howard: Yeah, see the difference in me and you, I have four boys, so I only have to worry about four boys. You have to worry about every boy in the entire state of New Jersey.
Matt: I'm well armed.
Howard: You're well armed? What other issues, and I don't even know what the questions would be because I'm not married to a woman dentist, I don't work with a woman dentist. What other issues that I might not even be smart enough to ask that you've conquered in 17 years that you could be giving advice to a young couple, man and wife dentists, that are now going to work together?
Kathy: Uh-huh. You want to be on the same page financially.
Kathy: That's very important. You have to have the same goals, the same ideas about what to do with your money, how responsible with your money you want to be, where you want to put it. That's important.
Kathy: A lot of fights come over what to do with your money.
Howard: Okay. Be more specific. You're talking about investing savings or not spending or not buying $150,000 CAD/CAM or $150,000 CBCT or-
Howard: $75,000 laser? Are you talking about those issues or are you talking about we have $5,000 this month to put away, is it going to be in a 401K or an index fund? Talk about more specifics because finance, bottom line finance is one third of divorce.
Howard: One third of divorce is over money and one third is over sex, and if you start paying money for sex, it's even worse, if you mix those. So, be more specific.
Matt: Pretty much I would say I don't know if we can be more specific because it's pretty much anything that we want to do with our money, but a lot of it has boiled down to expenditures in the office. One of the things that I would say to a guy married to another dentist where they have a practice is that oftentimes your wife picks up on things that you don't when it comes to financial issues or equipment purchases or advertising. I've learned in 17 years that if Kathy has a bad vibe about something and says, "Don't do it," that it's probably not a good idea.
Howard: Kathy, would you say that one of the big problems with boys is boys measure themselves by their toys, and they're always the first to run out and buy some big old gadget?
Howard: Do you think that's a problem with boys and toys more than women?
Kathy: That's been my experience anyway.
Howard: That's what I see, too.
Kathy: Matt [crosstalk 00:11:19] probably going to buy some big toy than I am.
Howard: I'll give you more specifics. If I go into a woman's dentist office, she places implants, she has one system. I go into a boy office that places implants, he has five systems and he bought $150,000 CBCT. The woman has one system, and she sends her patient over to the periodontist to get a CBCT for free. I mean boys just like toys. Do you agree with that?
Kathy: Yes, women, at least for myself, I like to find a way to do it, keep consistent, do it the same way. It feels comfortable. I'm not ready for the next and the next and the next all the time. Matt, what's newest on the horizon? What's coming out? What's the newest version of that?
Kathy: What's the newest toy? Let's get it in. Let's buy something else.
Howard: Now every woman listener on this podcast wants to know how do you train a male dentist? Do you use shock therapy? Do you use violence? Do you hit him? Kick him? Drug his food? What do you do?
Kathy: Hmm. To point out how it didn't work well in the past.
Howard: You have one of those steel trap memories where you can point out every damn example he's ever made wrong in 17 years?
Howard: Right on. Matt is that why you're called flyfishingdoc on Dental Town because she takes all your money and prudently puts it away and you're only left with a fishing pole and a worm?
Matt: No, no.
Kathy: Hey, fishing can be very expensive.
Matt: Yeah, my fishing stuff can be quite expensive, yes, but it's funny when I'm out fishing, I oftentimes not only forget what I do for a living but oftentimes forget my name. I'm so engrossed in it. It's a very good mental break from all the things that we do in the office which can-
Howard: Does she go fishing with you or is that your man time solo hobby?
Matt: A little bit of both. A little bit of both.
Howard: A little bit of both?
Matt: She does go fishing with me sometimes, but a lot of times I'm doing it by myself. One of my favorite things to do is to go stripe bass fishing in the middle of the night, and Kathy's not up with kayaking-
Kathy: I'm not up with things crawling on my feet in the middle of the night.
Howard: Is that ocean or freshwater? Is that rivers or lakes?
Matt: That's ocean in the bay. I usually take my kayak out at about midnight until three o'clock in the morning, and so it's a nice diversion. There's usually no other anything out there but me.
Howard: What bay? What city are you talking about?
Matt: I'm talking about near Ocean City or Longport.
Kathy: Oh, you're not going to give details?
Matt: Oh, I'm not going to give-
Kathy: His secret spot.
Matt: That spot is classified.
Howard: I have to tell you I have the fishing disease, too. I grew up actually, not kidding, you could almost throw a rock from my front door into the Arkansas River, so I went channel catfshing just nonstop my whole childhood and now I've got into ocean fishing. We go to Cabo, and I just love it.
Matt: Oh, nice.
Howard: I think it's funny when people say, "Oh, yeah, I'm going to go catch a marlin." Dude, I've been on trips that I've got 18 on one week, you know what I mean? I love it. There's something about no cell phone, no internet, no computer, no nothing, just out in the middle of nowhere catching these fish, and I just love it.
Howard: So, Kathy, do you got that bug, too?
Kathy: I do not have the bug for the ocean fishing. Seasick. I like my feet on the land, so my favorite is the small trout streams like in north Jersey, that kind of thing and the mountains.
Howard: Do you guys utilize an office manager?
Kathy: We do not.
Matt: No, no.
Kathy: We like to keep it as small as we can.
Matt: Yeah, we're-
Howard: How many operatories, how many employees, what's it look like in there?
Matt: We have three operatories. We have a full time front desk. We have a full time dental assistant, a part time dental assistant, and a full time hygienist.
Howard: Okay, so this is what the receptionists tell me, and I've talked to a gazillion on this. They say, "You know, it's horrible because the wife comes in and says go right," the wife dentist, and then the man dentist comes in and says, "Left, and I just want to sit here and cry or pull my hair out." You're talking to younger dentists or you might be talking to a marriage that's in trouble, talk to an office manager right now, because you guys seem functional and happy and I can tell from your body language, just smiling and giggling, I can tell that you're in love and all that stuff. Talk to this office manager or these man and wife dentists, what is she supposed to do? I mean, you both are her boss.
Howard: You're telling her two opposing things on so many issues, and they do, they-
Howard: They tell me they don't know whether they should cry, pull their hair out, so what would you say to everyone? What would you say to the man and wife dentists and the office manager?
Kathy: They should absolutely talk to the office manager together.
Kathy: The three of them hear the same conversation.
Kathy: That's really important.
Matt: I'm sure you've seen on my posts that I'm taking the Dental Maverick course with Tuan Pham, and one of the most important things that we learned in that course is communication and consistency. Your staff is not going to function well unless you communicate with each other. You communicate with your staff and that you're consistent in what you're doing. A husband and wife dentist that's pulling there office staff in two different directions, their practice is going to suffer because the patients are not going to see consistency, and their staff is going to show that they're very stressed out because they're not experiencing consistency from the husband and the wife.
Howard: Okay, so Matt, you guys been doing this for nearly 20 years. You've almost been on this earth half a century, address the real-
Howard: What's that?
Kathy: Thanks for reminding me of that. Next year I'm the big 50. Thanks.
Howard: The bottom line that no one wants to talk about is the fact that we're a social animal.
Howard: And, social animals are programmed that if we all don't get along, we're not going to survive. If the group of humans or monkeys or apes or dogs or cats or horses go two different directions, the coyotes and the hyenas and the lions and tigers, so we're hard wired to not communicate. We're hard wired that when someone says okay, we just say okay and we're thinking all these thoughts, so how do you coach a dentist to communicate when their natural birth hard wiring as a social pack animal is not to tell you how I feel? How do you communicate? One of my favorite definitions of success is how many uncomfortable conversations you're willing to have because I swear to God if the house is on fire, they're going to say, "How was your weekend?" You know, "Like the house is on fire. Why do you care about my weekend?" How do you have uncomfortable conversations? What have you learned that you didn't really know 20 years ago to have happen with your assistant, your receptionist, yourselves, everyone? How do you address something that humans don't want to talk about?
Matt: It's funny that you should put it that way because one of the things that's in the Dental Maverick course is to retrain your brain and to think differently about those situations that instead of looking at it as being an uncomfortable conversation or something that is a confrontation, that you look at it as a way for people to better understand what you're trying to do and to resolve a problem. So, you turn that negative into a positive, and if you're having trouble say communicating with your spouse and you're constantly having arguments about things, then if you can address that and change it as uncomfortable as that conversation might be, it actually is going to make your life better because it gives you the opportunity to resolve that issue and not have that problem anymore.
It's the same thing with your staff. If you're constantly having an issue, then ignoring it or talking about something else or just sweeping it under the rug doesn't actually change your situation. That conflict is going to come up again and again and again. What you need to do is look at it from the other way around that if you can get through that uncomfortable conversation, change things for the better, then you'll stop having that issue and then it's actually a positive instead of a negative.
Howard: Kathy, I want you to answer this because you're the woman dentist. A lot times when I'm at a dinner party or whatever and there's a couple like you and there's three or four single guys or their wives don't work, some of them will sit there and say, "God, I wish my wife brought home ten grand a month." What would you, not wanting to have uncomfortable conversation, what advice would you give to a dentist who kind of resents that?
It started off, "You were a stay-at-home mom, and we had a couple kids. We had two daughters, but come on the girls are graduated from college and you still don't have a job, and I'm sitting there busting my butt doing a root canal for $1,000 and every time I come home, you bought $1,000 purse, and why did you buy a $1,000 Gucci purse when I have to do a molar root canal for that? I had to do it three times because I'd had to do it twice to pay the rent, mortgage, [inaudible 00:20:34], computer, insurance, malpractice and only the third one got your damn purse." How would you coach a male dentist to have a conversation with their nonworking spouse since one third of marriages will fail over money?
Kathy: Uh-huh. Well, that's a tough one. They have to be together on the finances. I think that again is important. I think the male dentist has to appreciate what his wife is doing. One of the most important things they're going to do in life is raise their children, take care of their home. That's so important. That's one of the reasons I work part time my whole career practically because I wanted to be able to do both of those things. I'm not the buy a big expensive Gucci purse kind of person, so I can't really relate to that. I kind of think it's irresponsible to spend a lot of money like that, but the finances are both of theirs.
Kathy: You have to look at it that way. You can't look at ... The guy can't look at it as this is all my money that I earned. It's not. That's a bad way to look at it. It's the family's money. It's the husband and wife's money together. Whoever actually earned it doesn't matter. It's theirs together, and if you split hairs like that, "I earned this money," you're looking for trouble. You're going to get resentment from your wife and vice a versa.
Howard: I'm getting resentment from you when you said split hairs when I don't have any hair. She's sitting there all with five pounds of hair telling me to split my hairs. So, I want to ask you another ... I'm just going to keep going because you're so damn good. A lot of dentists your age ... Now, you said your girls are 10 and 15? Or 10 and-
Matt: 15 and 20.
Howard: Okay, 15, 20, so a lot of dentists are thinking this. A lot of them have resentment. They're saying, "Well I put myself through school. I graduated with $250,000 in student loans and now I'm a rich dentist," and the wife says, "Well, we're not doing that. We're paying for the kids' school and all that stuff," and they're going to graduate with no debt. That's a big finance issue, so my question to you first is did your mom and dads put you through dental school? Did you graduate with no student loans?
Howard: You're both-
Kathy: We both had student loans for a long time, very long time. We financed those loans, extended those loans.
Howard: Okay. Then the question is you've got a 20 year old ... I'm sorry to throw you under a bridge right now. You've got a 20 year old, so is she going to do that, too, just mom and dad did or are you paying for her college?
Kathy: Yes and yes.
Matt: We're paying for her college, but she's also working to pay for her rent and her spending money. She's a very independent and industrious girl. She works very hard. She's in culinary school, and she works as a waitress at a restaurant. She's always doing something, whether it's working, school. She's very-
Howard: You paid for tuition, but she pays for rent and spending money?
Matt: Yeah, pretty much. We pay for tuition. We give her a little bit more, but she's one of these kids where she's very proud of herself when she says, "Hey, I made enough this month that I'm paying the rest myself and I'm also paying this bill." I'm very impressed with her for that.
Howard: That's awesome. What other advice would you give a married couple working together? Now, when you're driving home from work, so when you work the two days ... Yeah, so you work two days by yourself?
Howard: And you work two days together?
Howard: In reality, when you're driving home is there a point where you just turn off dentistry and turn on your two daughters and family or does it really blend? Is it really amorphous or is it-
Matt: It blends like crazy. Our girls laugh when we talk at the dinner table about dentistry. They just kind of roll their eyes.
Kathy: Or one of them will randomly say, "Hey, how are you? Who was that mom? Who was that dad?" "One of our patients." "Really? Again?"
Matt: Yeah, and they used to go, "Oh, another one of your patients, huh?" I'd say, "Listen, those people are the reason why you have a roof over your head and, you know, that you have nice things, so be happy that we're running-
Matt: Into patients all over town."
Howard: Does any of them get the dental bug?
Matt: Our oldest daughter who's in culinary school, she cannot stomach anything blood, medical. That's not her thing. The younger one actually wants to be a sign language interpreter.
Howard: Wow. You tell your daughter in culinary school that I want to see the first recipe that includes four fresh wisdom teeth. I mean, come on, there's a ham bone in my ham and beans, why can't their be four molars in a chili or something?
Howard: We'll call it Kansas chili or something like that. Then, I want to ask you another question. A lot of couples come out of school and they're saying, "Oh, come on, Matt and Kathy, you know, you graduated like 20 years ago in '92. Those were easy days. You didn't have corporate dentistry. You came out when the getting was good, but me and my husband we're coming out and, oh, the sky is falling." What would you say to that? Do you believe that or do you think it's all in their head?
Matt: I don't believe that at all. I think that we are in-
Kathy: Because we heard the same thing.
Matt: Yeah, we heard the same thing when we were in school.
Kathy: All the docs said, "Oh, the golden age of dentistry when I first came out of school, and it's no longer that way."
Matt: And, "Oh, yeah, they're working on a decay vaccine. The caries vaccine is going to be out in five years, and we're all going to be out of a job. Yada, yada, yada." What I see as being one of the great things about dentistry now is that so many people are keeping their teeth for so much longer, that we've got adult orthodontics that Kathy's doing. We've got implants that I'm doing. We've got a lot of root canals. There's so many new things that we can do. There is virtually nothing except for a cleaning that we are doing identical to what we learned in school. We're doing laser cavity preparations. We're doing laser gum surgery. I'm placing implants which they were in their infancy when I was in school. Digital radiography, I mean, we take that for granted, and that wasn't even thought of when we were in school.
Kathy: The cleaning's not even the same.
Matt: Yeah, the cleaning's not even the same.
Kathy: We weren't allowed to use Cavitron.
Matt: Now we've got [P8 00:27:06] and all that kind of stuff. The other thing about dentistry is just that one of things I was thinking of when I was preparing for this is that as human beings we tend to want to ... We want to have more, more, more, more, more. Some people look at dentistry as, "Oh, I'm going to make $300,000 a year. I'm going to make all this money and everything." You probably won't make that much, but if you look at the statistics in our country, the median household, not median individual income, but the median household income in our country is about $51,000 a year. As a dentist, you can work four days a week, 30 hours a week, and you can easily double that, most of the time triple that, without even really working all that hard at it. You can be an associate working in somebody else's office and do more than double what the median household income is.
So, sometimes I think we as dentists need to stop, take a deep breath and say, "Wow. We have a really sweet gig," and not to complain so much about it. I mean there's so much technology coming out now and there's so many ways to do things that I see this as another golden age of dentistry because there's so many things that we as GPs can do.
Howard: You said golden age. I think it's kind of gone from the golden age to the titanium age because what I'm excited most about titanium dental implants-
Howard: Is that when someone loses their tooth and you file down the two adjacent teeth and do a bridge, you haven't changed any of their behavior. They're still eating 150 pounds of sugar. They still don't brush, floss, see the dentist-
Howard: And now six, seven years later, now we're missing three teeth.
Howard: So you decided to place titanium. What I love about titanium is I feel like dentistry for a hundred years goes out in the middle of the farm and builds a wooden barn and then tells you to brush it and floss it and use Listerine and a tongue scraper, and then seven years later the termites have eaten the whole barn and you always blame it on the farmer. Now we have a chance to go in and build an aluminum barn and without brushing or flossing or anything, you come back seven years later and termites can't eat it.
Howard: I'm going to ask you how did you get into implants? Did you take a hands on course? What implant system specifically did you buy? Did you have to go out and buy $150,000 CBCT and do surgical guides or do you freehand it like a real surgeon? Talk about that.
Matt: Okay. Well, I had been wanting to get into implants for quite some time and was looking for a way to do it. One of the reps from Hiossen stopped into my office and said they were offering a course and would I be interested in it. I was absolutely interested in it, so I took the hands on Hiossen course at their-
Howard: Spell Hiossen for our viewers.
Matt: It's H-I-O-S-S-E-N. It is a Korean company and their US headquarters are very close to here in King of Prussia, Pennsylvania. So, I took the hands on course there and placed my first implant with them. I find that the system is very easy to use. Their-
Howard: You did the hands on course in King of Prussia, New Jersey?
Matt: King of Prussia, Pennsylvania.
Howard: King of Prussia, Pennsylvania. Was that on humans or cadavers or mannequins or-
Matt: It was a progression of mannequins to pig jaws then to people.
Howard: Was the first live patient your mother in law or-
Kathy: That would not have been wise.
Matt: No, actually the first-
Howard: Isn't that the main benefit of getting married is you have your mother in law to do all your experimental dentistry on? I thought I read that on Wikipedia somewhere.
Howard: I might need a citation source for that.
Matt: Yeah. No, actually my first implant was placed on a woman who's been a long term patient of the practice, and she had been wanting to get an implant done but just didn't have the money for it, so I basically did almost the entire thing for free so that I could get some experience with my first one, and then it has just been progressing from there. I'm still not doing as many as I'd like to, but I'm doing a fair amount. I would say that the vast majority of the ones that I do are free handed. I do sometimes make surgical stents here in the office with just some aluminum tubing that I get from Home Depot and just center it on there and use a suck-down and then it gives you a guide for your initial osteotomy. I have done one guided surgery that I did with CAD-Ray and-
Howard: Did you take Arman's course?
Matt: No, I did not. I did not, but I practically got Arman's course with all the Facebook messages we had going back and forth.
Howard: The problem with Arman's course, it's amazing information, but he's much more funnier online, but in real person, he's just a quiet, shy guy. I was expecting a stand up comedian.
Howard: I thought I was going to meet Louis C.K. or something, and he was just this shy normal guy, and I'm like, "My God" because he is so hilarious online.
Howard: His comments. It's like British dry humor or something.
Kathy: He works the camera, huh?
Matt: I have really been enjoying placing the implants, and I have to say just thank you to you for Dental Town because that's one of the other things that my daughters laugh about is that this is how you usually see me. Yeah.
Howard: On the Dental Town app?
Kathy: Put that down.
Matt: Actually, I had the app for a while and I was running out of room on my phone, so I got rid of the app and I just go onto the mobile site. I have learned so much through Dental Town. I just finished a really difficult implant case that it was ... I think it was the second extraction that I did in preparation for doing implants. It was a college girl who had an over retained primary tooth that she lost, and I put Bioplant in, which I shortly after putting it in, you know, doing the research and everything online, oh, it looks like great stuff, I find out on Dental Town it's not great stuff.
Through the research that I was able to do on Dental Town I learned what I needed to do to get rid of it. I was private messaging with Holden several times about it, and was able to get that out of there, get a proper bone graft in, rebuild the whole ridge, and I just placed her screwmentation crown this week and the case is all finished. If it wasn't for Dental Town, that would've been sent to the periodontist with my tail between my legs. "Hey, I put the wrong stuff in. Please bail me out."
Howard: We can all thank Al Gore for Dental Town. More specifics, how much did the Hiossen kit cost? How much was the training course? How much was Arman's course? Do you recommend Arman's course? The most important question, did you end up buying $150,000 CBCT?
Matt: Oh, those are all good questions. Let's see.
Howard: I don't see Kathy holding a knife over your head, so I think you didn't have to buy the-
Kathy: That's no CBT.
Matt: The Hiossen course in and off itself was about $3,500, but they credit it back to you if you buy an instrument kit and a credit with them for implants, so I spent about $30,000, maybe $35,000 on the course, the equipment, the instruments, and then a credit of implants that I still have credit on. Then, I did not take Arman's course, but I would love to just from the experience I had working with him on that one guy new case that we planned out. As far as what we were talking about earlier about guys being gadget oriented, we have a small office like we said, three operatories. We do not have room for a CBCT, but I did have some guys come in giving me a presentation on one, and I was looking for where I could knock down a wall to be able to fit one in.
Howard: Do you have access to a CBCT if you need one?
Howard: I mean, is there a ... How big is your town? Is your town Turnersville? Is that a suburb?
Matt: Yes, it's a-
Howard: Or is that just a town
Matt: It's a suburb. It's part of Washington township, which is also the township we live in. We live in a different section of town.
Howard: Do you have access to a radiology center that has a CBCT or do you just not need them?
Matt: Actually, we have access to two places where we can get them. The orthodontist who's a couple doors down in our complex has one, and he does them for free for us if we need them, and there's also a mobile service called Mobile Facial Imaging that is local around here where they will bring a truck to your house, your place of business, wherever, and they'll do a mobile cone beam.
Howard: Which one do you use mostly?
Matt: I'd say about 50/50. I've done a couple with the orthodontist, and I've done maybe three with the-
Howard: What makes you pick the orthodontist or the mobile? Is it the type of machine? Is it you that you just don't want to bother the orthodontist since it's free? What makes you decide which one?
Matt: What usually makes me decide which one is I try not to bother the orthodontist because I don't like feeling like I'm imposing on people, but sometimes we have, you know, something comes up where I look at a case, and go, you know what, I really think I need a cone beam on this one, and if I have to send them to the mobile, then we're going to need to reschedule them, so usually they go to the orthodontist when it's a-
Howard: Do you think if the orthodontist charged you 50 bucks and had some skin in the game that you'd feel less guilt and more likely to do it?
Howard: Is this your religious upbringing that's making you feel guilty?
Matt: Right. You know what, what he told is that when the patient comes in if he can get paid by their medical insurance, he'll get paid by their medical insurance. If not, he just eats the cost to be nice, so I don't know. He also has a very busy office and sometimes he just can't fit them in, so I try not to impose on his [crosstalk 00:38:16].
Howard: Now, Kathy, did you not get into implants because you're just not really ever into blood and guts or did you not get into implants because you see this mechanically and say, well, if he's going to get into that, I'm not going to duplicate all the training and all that because I'll just let him do that? You said you were doing what Six Month Smiles or what did you say you were doing?
Kathy: Yeah, Powerprox six month braces, yeah.
Matt: Kathy also does comprehensive stuff as well.
Howard: Comprehensive what?
Matt: She also does comprehensive work, though, you know, full two or three year bands and brackets, the whole-
Howard: Did you split that up over interests like braces is clean and cosmetic and you're just not a blood and guts person, or did you do it like business? Well, it'd be more efficient just to invest money in you to do this, and then I'll invest money to do this so we don't have to duplicate the cost of all the training?
Kathy: More like that. Yeah. It's not that I'm avoiding blood or guts or anything like that. I really enjoy orthodontics, which surprised me, and the big restorative is not as much my interest, so it made sense for us to split that way. You get the training. You take this part of the practice. I take the training, and I take this part of the practice.
Howard: What else do you guys separate? You do ortho; he does implants. What else do you separate?
Kathy: Not much else.
Matt: I do basically all the root canals.
Matt: Also, I do retreats of root canals as well, which kind of flows in nicely with the implants-
Matt: Because if I'm managing a retreat and I notice that there's a fracture or it doesn't seem like it's something I'm going to get a good result out of, then we talk about doing an implant. Orthodontics, when we first bought the practice, we bought the practice from a dentist who was ... He was starting to mainly specialize in orthodontics and TMJ. He was getting out of the regular restorative, and he was moving out of state. So, he had a lot of orthodontic cases that were going here and he was a former faculty for, which group was it?
Kathy: American Orthodontics Society,
Matt: American Orthodontics Society, so he came in and did basically a private in-office course for us so that we could take over his patients. As we progressed with this, it was something that I just really ... It really didn't interest me all that much, and I found myself, every time I saw an orthodontic patient on the schedule, I thought, oh, it's a waste of my time. I'd really rather be doing such and such. We started to get to the point with us both doing the same thing that it seemed like that it was unnecessary that we were doing the same treatment, and it would be better if we branched out, and I could be expert in one area, and she could be expert in another area. I think it lends itself to a better relationship with patients.
They view it a little bit differently when I'm doing a new patient exam and the patient tells me that they're interested in doing some orthodontics, and I tell them, "Well, my wife does all the orthodontics in the office because she has all the training in that." She does the same thing with implants when somebody wants to replace a missing tooth. "Well, let me have my husband come in and take a look at ya," and it has more of an air of expertise and extra training when I can't do it, but she can or she can't do it, but I can. I think the patients look at it a little bit differently then.
Kathy: It's better for us, too. Less competition.
Howard: What other high price or did you go CAD/CAM?
Matt: No, we have not gone CAD/CAM. Our main office expenditure for technology is two WaterLase machines. We actually just-
Howard: Wow. Two of them?
Matt: Two of them, and we just had our new iPlus 2.0 installed today, and we also we have another iPlus, the regular one, and that's being upgraded to the 2.0 system.
Howard: The 2.0 WaterLase.
Howard: How much did that cost you?
Matt: We got a very good deal.
Kathy: We should probably not disclose [crosstalk 00:42:39] good deal.
Matt: Yeah, they probably don't want us to disclose the good deal because we've been customers of Biolase since 2004, and so when their-
Howard: But, for a listener, I mean, there's AMD lasers for $2,000. There's some lasers for $50,000. What would it retail at?
Matt: Yeah, you're talking around $50,000 to $60,000 mark.
Howard: Why would you need two of them instead of one?
Kathy: Because I want one, too.
Kathy: We have a his and hers.
Howard: You have a his and hers WaterLase laser?
Matt: Hold on. The new one is right here. It was just installed today, and this is what our tech put on it.
Howard: You know what? Seriously, you have to send me a picture of you two with his and hers WaterLase because I think you might be the only ... There's two million dentists on earth; you might be the only married couple dentists with a his and her WaterLase on the entire earth. You might be two out of two million. Will you send me that?
Matt: Sure, I'll be happy to.
Kathy: And, I missed my opportunity to get the pink one.
Kathy: Our tech did not show me the pink one until today.
Matt: Oh, my God.
Kathy: Because I would've been sure that it was a hers.
Howard: Oh, I'd send it back. I would send it back just for the photo. No, I think that would be absolutely hilarious to send out. You know you have a rocking hot dental office and a rocking hot marriage when you buy his and her lasers.
Matt: What was happening was when we first got into laser dentistry, what was happening was we had trouble scheduling people on the days that we were both here because we basically went all in with them, and we use them for restorative, we use them for crown troughing, I use them to lay flaps for implants, I use them for root canals. About the only thing we don't use them for is cleanings and ortho, and even sometimes ortho you need them to get extra tissue out of the way or to do a little gingivectomy.
Howard: In all honesty, someone that's going to spend fifty thousand bucks on a laser, let alone a hundred for his and her, slow down a little bit why you bought that. Slow down a little procedure,
Howard: Because this person's ... 85 percent of my listeners are an hour commute to work, and so they're driving to work and that's why we always get a transcript of our podcast because you log onto Dental Town, so they don't have to pull over and do notes, but slow down and spend a little more time because $50,000, that's a huge purchase.
Matt: It is.
Howard: I mean, $50,000. That's a lot of money, so you could buy a car for that. Why did you buy a $50,000 laser? What procedures and why? What are you doing with it?
Matt: The main reason why we got involved with it was because we wanted to do no anesthesia restorative, which I would say for, I'm going to say for virgin teeth or replacement composite, probably 70 percent of the time you can do it with no anesthesia.
Kathy: And, for the kids, almost 100 percent. No primary teeth-
Kathy: That I've encountered need anesthesia with the WaterLase.
Howard: Okay, how does that work?
Kathy: I wish I knew. I don't the Biolase people know it has an anesthetic effect.
Howard: Explain how you numb up a primary tooth with a WaterLase.
Matt: You just start cutting, and the kid feels nothing.
Howard: You're not holding it onto the tooth and making a numbing deal?
Matt: No, you're-
Howard: You're just cutting with it and they're not feeling it?
Matt: Right, you're using-
Howard: Is it numbing the tooth or is it just cutting it without them feeling it?
Kathy: Just cutting it without them feeling it, so they don't get that numb feeling, which is fantastic for the kids-
Kathy: Because a lot of times even if they get past the needle stage, the fact that they're numb really wigs them out.
Kathy: And, they don't like that, and they get upset, so if we can do it without a needle, without the numb feeling-
Howard: Are these mostly occlusals, preventatives and restorations or are these DOs and MOs?
Matt: These are class twos, DOs, MOs, occlusals, and the laser not only can you cut the cavity prep without them feeling it, but it also does have an analgesic effect to it where if there's a spot that you're having trouble reaching with the laser, you can go in with a slow speed round bur and they don't feel anything. What amazes me the most with the kids is you'll do this whole prep and think, they say they're comfortable, I hope they are, and then you go to put the matrix band on it, and that's the only time that they wiggle is when that matrix band goes around the tooth. When that happens, you know for sure that you've had a kid that's been comfortable throughout the whole procedure.
Howard: Because that's because the matrix band's hitting the tissue?
Matt: Yeah, because they're feeling a little tightness from the matrix band.
Howard: How long would it take you say on a first molar? How long would a cut take you to prep an MOD with a high speed versus a MOD with a WaterLase laser from Biolase?
Matt: I would say it might take, I don't know, as far as cutting time, I'm going to say-
Kathy: It's a little bit longer.
Matt: It's a little bit longer. Maybe between checking the prep and depending on how big it is, maybe ten minutes of prep time where it might be five minutes with-
Howard: Okay, so you basically bought his and her lasers because you're doing no anesthetic restorative operative?
Matt: That's how it started out, but what happened was once we got them in our hands, we realized there was so much more that could be done with it.
Howard: Now, these are carbon dioxide lasers?
Matt: No, these are-
Howard: Erbium YAGS?
Matt: These are erbium YSGG.
Howard: Is that a erbium YAG or just erbium?
Matt: It's erbium. It's erbium YSGG. I think it's [epsilum 00:48:35], selenium, garnet. I don't remember all the letters, but it's erbium YSGG.
Howard: Okay. You started out investing fifty thous ... Because I would think that would be a huge marketing word-of-mouth referral thing-
Matt: It was.
Howard: If people are leaving your office and Kathy just did a filling and I didn't get a shot.
Howard: That'd be huge. Are you using it on your marketing or do you do much marketing? Do you market yourself as a laser dentist or-
Matt: Yes, the name of our practice is the Dayspring Center for Laser Dentistry.
Howard: Right on, and you think that's a unique selling proposition? That's a good-
Matt: It is and even for things we don't use the laser for, it has kind of a halo effect that people ... People look at the equipment that we have, and they say, "Okay, you guys are on top of the latest things." We hear a lot of times from people when they come in, "Oh, my old dentist wasn't like this. He's back in the stone ages."
Howard: Unless they're in Colorado, then they're just stoned.
Howard: You started off with doing no anesthesia restorative dentistry. What percent of your restorative dentistry is done with a erbium YAG or an erbium YSGG laser from Biolase and not giving anesthetic?
Matt: And, not giving anesthetic? I would say maybe 40 percent, because we do do a lot of amalgam replacements. Most of the time with an amalgam replacement because the laser can't cut the silver, you do have to numb and remove it with the high speed, although if somebody has a smaller amalgam with a lot of decay around it, oftentimes what I can do is I can go around the amalgam very carefully with the laser so I don't hit it at all. Then, you basically take the high speed and it's got the analgesia effect, and you can cut the amalgam in half with the high speed, and then pop both halves out and then go straight to the laser. I don't do that very often, but you do have some patients that are very, very needle phobic. They say, "Hey, I'm okay if I feel a little bit, because I'd rather do it that way than get-
Howard: You would say 40 percent is needle free.
Matt: I would say so.
Howard: Do you use amalgam? Do you place amalgam or are you amalgam-
Matt: No, we've been amalgam free for 16 years now.
Howard: Okay. What other procedures do you do with that laser?
Matt: Pretty much everything.
Matt: We do perio therapy with it. We do frenectomies with it. I use it for extractions like a periotome. I'll trough around the tooth and start cutting the ligament attachment with the laser. I lay flats for my implants with it. I do implant recovery with it. We've also done some treatment of failing implants with it with some good results. One of my favorite uses for it is root canals because what the laser will do is it will set up a ... It's kind of like an ultrasonic in the sodium hypo and gets it circulating, and you get a lot more debris coming out with the sodium hypochloride than you do with just squirting it down the canal.
Howard: You put the bleach, the sodium hypochloride, in there and then activate it with a laser?
Matt: Right. You put the sodium hypo in the chamber, put the laser tip in the chamber and activate it, and it's almost like putting stone on a model trimmer. It starts bubbling and you see it kind of circulating around, and then you'll see little pieces of debris coming out.
Kathy: It penetrates the walls.
Howard: Is the laser used for LANAP?
Matt: No, it is not. No it is not.
Howard: By the way, when I'm asking these questions, remember I'm trying to guesstimate
Howard: With 7,000 dentists, so don't-
Howard: I don't want you to go home tonight and say, "Did Howard have a head injury?"
Matt: Yeah, so that's the-
Howard: I'm just trying to sit there and think, there's 7,000 people. My whole motto at Dental Town is that we could use the internet so that nobody would have to be alone. Do you know what I mean?
Matt: And, that's the great thing-
Howard: So many dentists go home and all their loved ones don't know if this laser's used for LANAP. You know what I mean? So, I try to form a community. Is this laser used for LANAP?
Matt: No, it is not. That's the PerioLase that's used for LANAP, but-
Howard: Who sells PerioLase because that kind of sounds like Biolase?
Matt: I believe that's Millennium Technologies, if I remember correctly.
Howard: Did you think about getting a PerioLase by Millennium for LANAP or do you use the erbium YSGG for perio?
Matt: We use the erbium for perio and we get pretty good results with it.
Howard: You think it's kind of similar or do you think it's like a knockoff or they both ... Is one the name and one generic?
Matt: I think PerioLase they have a patent on the procedure, and their wavelength is specifically for doing the LANAP. Basically, what we do with the WaterLase is very similar to LANAP. You're cleaning out the diseased tissue in the pocket, you're sterilizing the pocket, and then you are treating the root surface of the tooth to give a better surface for the attachment to reattach to. Basically, anything that you're doing to clean off that root surface, get the bacteria out of the pocket and give the patient a clear shot to keep everything clean is going to provide you a good benefit. One of the-
Howard: If someone came in they had a bleeding 6 mm pocket, when you went in, you would take the laser in there?
Howard: Would you try to also try to just like physically remove 2 or 3 mm of that tissue so it has access, or are you talking about you would take the laser in there to use it kill bugs and aerobic bacteria?
Matt: You would use it to remove some of the excess tissue and also basically to make a large trough in the gums and then with ... I have 6x loops and with the 6x loops and the light, once I make that trough, I can actually see down the root surface and kind of the same visibility you would get doing a flap surgery without having to lay the actual flap.
Howard: Okay, but on that bleeding 6 mm pocket if you're going to reduce that to like a 3 and clean it out, would you numb it up for that?
Matt: Oh, yes.
Matt: Yes, that you would have to be numb for. Most of the soft tissue procedures, unless they're minor things like I did a treated an aphthous ulcer on Kathy today, and something like that you don't need to be numb for. Crown troughing you don't need to be numb for, but anything more involved than that like a frenectomy or any kind of perio treatment, you would need to be numb for because there's a lot more tissue that's removed.
Howard: Does she usually get a canker sore after her day off where she's just day drinking all day long? Would you say that's what it is, you know?
Matt: No, you know-
Howard: She's just day drinking. Does the day after day drinking usually get her a canker sore?
Matt: Every since I've known in the pressure of dental school, that was ... Dental school was like an aphthous factoring for her.
Kathy: [inaudible 00:56:05]
Howard: Kathy, you think your sores are related to stress?
Howard: Or, do you think it's food and pH?
Kathy: I think they're related to stress.
Howard: You think it's a stress response?
Howard: Because some people think it's acidic foods. They'll say, "I always get it after tomato sauce or grapefruit juice or oranges." Some people relate it to citrus, but you think it's more an autoimmune response to stress?
Kathy: For me it is. I don't get bothered by the acidic things, but the stress? I had two really large ones in dental school, the biggest of my life, that they came in and said, "Oh, can we photograph that?" And, that was the most stressful time of my life.
Howard: Was it around finals or boards or you don't want to say?
Matt: Yeah, it was near the end. I think it was when we were trying to get the requirements done.
Howard: Talk to our listeners about what happens with a canker sore. It's sensitive? It burns when you eat or drink? Then, he does what with the laser and what's it afterwards. Do you need anesthetic for that?
Kathy: I did not need anesthetic for that. It's on very low power, .25 watts, so it's very low power and no water.
Howard: Is he cauterizing it or-
Kathy: Yeah. Essentially cauterizing it.
Matt: Yeah, that's basically-
Kathy: Yeah, so that it heals faster.
Matt: Yeah, you're basically I want to say, the laser term would be ablating but kind of frying or cauterizing that top layer where all the virus particles are living, and you get rid of that. What usually happens because I've had it done to me as well, is it will get a little bit hard and almost scab up within the first couple of days. I'd say it reduces the amount of healing time by about half, but it's also much more comfortable for that time that it's healing because it's more like you jump to the last three days of the aphthous instead of having to go through the whole thing.
Howard: What would you say to a dentist who's out there thinking, "You know, I've been looking at that WaterLase for years, but $50,000? That's huge." What would you say to that person? Do you think it's a return on investment or is this part of Matt's boy toys?
Kathy: It is. I think it is if you're committed to it.
Kathy: We've heard many people get the WaterLase, it doesn't ... There's a learning curve involved. If you're not willing to put the time in to the learning curve-
Kathy: Then, you're going to put it in the corner-
Kathy: And, you're going to be upset with yourself for spending $50,000 on this ornament-
Kathy: In the corner.
Matt: It would be kind of akin to somebody getting a CEREC machine, and they do a couple of crown preps. They get an open margin and go, "Ah, I'm just going to take impressions and send it to the lab." It's something that you have to work at to perfect it to get it to work well for you.
Kathy: But, it's worth it.
Matt: It's well worth the-
Howard: Would you say that's the most common toy that you guys have in common that was an expensive piece of equipment that you guys both agreed on and play with evenly? I mean, obviously, if you bought his and hers?
Kathy: Yes, I would say that.
Matt: I would say the two things that we spent the most money on and that we enjoy the most together would be the two WaterLases and the two Jeeps.
Howard: The two Jeeps. What kind of Jeeps did you get?
Matt: She has a Grand Cherokee and I have a Wrangler.
Howard: Do you guys like Jeeps because you're camping, fishing, kayaking? Or, why-
Matt: Yeah. Yeah, we like to play outside.
Howard: Are you both outdoor people?
Howard: That is awesome. We're out of time. Do you think you guys would ever do a online CE course on the his and hers WaterLase? I still think you're probably the only two man and wife married dentists on earth that have his and hers WaterLase. This has got to be the rarest story I've heard in at least a year. I don't think it exists.
Matt: Yeah, we're special. What can I say?
Howard: You are special. I really think you are special.
Matt: Yeah, I'd be interested in doing something like that. We actually joked around with the WaterLase techs a few years ago because the older machines were much more temperamental and I developed a whole protocol for how to care for the machine and the tips so that we wouldn't have problems with it. I always joked with our tech that I should teach a course on how to, on how to-
Howard: Well, you know, you should because the bottom line is I know dentists as well as anything. The only thing I might know better than dentists is my four boys. Dentists believe dentists. It doesn't matter what a dental manufacturer says. The dentist is always thinking well, you're just trying to sell me your bonding agent or your glue or whatever.
Howard: But, they would ... You guys are honest, have integrity, married 17 years, two kids. You bought your own money his and her deal. They would listen to you a hundred times more than a dental company.
Howard: I think if you did one because really why did a man and wife dentist each buy a his and hers specific laser? That's a huge story.
Howard: You guys should share that story. We are completely out of time. I just want to sit here and say that huge fan of your posts, love your website. I just think you're a great guy. I'm a huge fan of your posts.
Howard: I actually did this podcast such out of selfishness. I wanted to meet you online. I wanted to go to lunch with you, and I'm in Phoenix and you're a five hour plane flight away, and this was just so rocking hot cool for me. Then, to the viewers, Kathy just happened to be walking by one split second before we started, and I'm like, "Hey, grab her. Grab her" because I wanted to meet you, too. Thank you so much for spending an hour with me.
Matt: Thank you.
Howard: Good luck on those two girls, and we'll see you later.
Matt: Thanks, Howard.
Kathy: Thanks. It was fun.
Matt: Take care. It was a blast.
Howard: All right. Bye bye. Thanks again.