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AUDIO - HSP #180 - Scott Perkins
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VIDEO - HSP #180 - Scott Perkins
We can spend years perfecting our systems to maximize clinical efficiency. But we don't know what we don't know. Listen in and let Scott Perkins explain a little about efficiency.
General Dentist with an emphasis on efficiency in clinical productivity. Author of the 15 Minute Crown Procedure and 15 Minute Molar Endo published in Dentaltown. Inventor of "The Impression GunRack" and the Samurai Precision Bur. Speaker, primarily on the subject of Clinical Efficiency and also teaches hands-on clinical workshops on molar endo.
Howard: It is beyond the hugest honor to be interviewing my buddy, Scott Perkins, a legend in Dental Town. You know who you remind me the most of, is Omar Reid. Do you remember Omar Reid?
Scott: Sure I remember Omar Reid.
Howard: He was at the top of the game when I got out of school in '87. I don't know how old he is. I think him and Gordon are about the same age, about 80. I'm not for sure on that. He wrote an article before the internet and texting and instant feedback, when you just got a magazine [inaudible 00:00:37] at your radio of billboard, and basically he said the 90 second crown prep. What he meant was that most dentists drill, rinse, look, drill, rinse, look, drill, rinse, look.
What he noticed that, if you just knew what you were doing and committed to the crown prep, the bur is only touching the tooth 90 seconds, so you can prep that thing in 90 seconds or you can take all day. Then everybody twist it around now, "Oh my God, how can he be a quality dentist if he's only spending 90 seconds on a crown prep."
You actually wrote the most controversial article of all time in dentistry, and it was called The 15 Minute Root Canal. You had every endodontist ready to get a 12 gauge shotgun and come down there and tell us [inaudible 00:01:25]. You were the same thing. You had a meeting in your office, and I went there, Jerome Smith went there. Who else showed up at that meeting in your office?
Scott: First of all, I've got to back up and remind you of how that started. I was on dental town, and everybody was attacking me over this 15 minutes endo, and Barry [Moosacant 00:01:46] was on there, and he said-
Howard: I just podcasted with him couple days ago.
Scott: Is that right? Barry said, "Well Scott, why don't you invite some townies to Houston and show them? Instead of me telling everybody about it, why don't you let them see what you're doing and then let them come back and tell all of us?" Because he was obviously skeptical. I said, "Okay. I invite Barry Moosacant. I invite you and of course I invited [inaudible 00:02:18] Jerome Smith and Richard [Ritchesky 00:02:19], and Chris Griffin I think.
Howard: Who else? There was a lot of them.
Scott: I'm trying to remember.
Howard: You know what year it was?
Scott: I'm going to think it's 2001 maybe.
Howard: I know it was between '98 and 2001.
Scott: That's when you and everybody came. It was great, but Barry Moosacant didn't come that time, but he came later on.
Howard: Let me just tell the views what my take was on it. I'll tell you my [inaudible 00:02:57]. Basically what Scott was saying is like, and so many dentists do it to this day, they are using an engine driven [night eye file 00:03:09] I would say. Say they start top-down, they're doing a 45. When they are done with the 45, then they take it down to file, then they are looking for the next file, then they are putting in the other file.
You had like 3 hand-pieces loaded. Your assistance, while you were doing the 45, they already had the 40 loaded, the 35 loaded. You basically didn't waste a single moment of doing anything. You basically had your eye on the tooth and just ding ding ding ding ding. You had 2 assistants with you. It was 6 hands just doing an orchestra, the root canal was far great. You can do a root canal on any of my tooth any day of the week buddy, and I can name 20 endodontists that are great friends. You were just amazing. You were a master of operations and logistics, and I swear every endodontist I know, doesn't even have 2 because they are trying to save money. They don't want to buy and extra $300 PM, so they are going to spend the rest of their lives manually changing it, and wasting 2, 3 minutes between each files for the rest of their lives, because they think their labor bill is smaller than their $300 PM bill.
Scott: Basically, root canal procedure for most dentists, is a spectator sports for a dentassist. They are watching you while you are going crazy trying to switch files out and do everything all by yourself. A lot of it has to do with the choreography between the dentassist, that's part of it. Part of it has to do with knowing what to do. It's a little decision-making tree or an algorithm. Let me backup and pay homage to Omar Reid. I listen to Omar Reid's tapes every day on the way to work when I first graduated from dentistry, because-
Howard: Is it called an Napilli?
Howard: Was the tape called Napilli, N-A-P-I-L-L-I? That was his retreat in Hawaii name them.
Scott: I'm trying to remember. There was several tapes that I had and I listen it. Omar Reid would speak real fast and he would speak cryptically, and so I had to listen to him over and over, and over, in order to catch what he was saying. I basically picked up where Omar Reid left off, so I owe a lot to Omar Reid. He influence my thinking.
Basically when it comes down to 15 minute root canal or 15 minute crown procedure, it's not that you can really do all these in 15 minutes, you really can't. The case I selected was real easy. It was a younger person. The canals were real wide. I put it on video and I put the final ... In fact, it's on YouTube, you can go watch. If you type in Scott Perkins DDS, you can see the 15 minute crown and the 15 minute endo, and you can see what I was doing.
The choreography was smoother with the 15 minuted crown, because I had my [crack assistant 00:06:12], but then her husband got transferred to another city, and so I when I did a 15 minute molar endo, I had to use a dental assistant that I'd only worked with 3 times before, and then I had to make this tape, this videotape, so that one was a little rougher, but we got through it.
Anyway, Omar Reid basically said he would put a video camera down, and if any of us took the time to do this, you put a video camera on what you're doing, and then go back and watch it. What you're going to see is, everybody does a 15 minutes crown procedure. It's just that if you time the amount of time that you're actually working on a tooth, the rest is chasing instruments around. You're missing something every time. You have to find packing cord, you have to pull it out, contaminated. You have to find the scissors. You usually have these crown and bridge scissors, they aren't even designed for cutting packing cord, which is like string. Then you have to find a dappen dish, and then an eye dropper. All these things you have to find.
What we did was we would pre-cut the cords. We put 4 cords in a little mini ziplock bag, and then have the Hemadent drawn up already in a syringe, so you're not hunting for all these things. We made what I called speed packs, so that you're prepared every time. That way, say your assistant isn't there, you're going to try to set up for your own procedure. What dentist can set up for his own procedure? That's stressful, right? If you have a speed pack anybody can do it. Even a trainee can do it, because everything is prepackaged and ready to go. You just pull the pack, instead of the crown or pull the pack instead of for endo, and drop it down, and you're ready to go.
That was a big part of doing these procedures quick, was just a setup time, making sure everything was there. Then it has to do with the choreography between the dentassist and the dentist. You are going to have to sit on a Friday or a day off and work with the dentassist to get your choreography down, instead of-
Howard: You said YouTube videos that was Scott Perkins 15 minute root canal part 1 and 2?
Howard: Was there any other YouTube videos or is that your-
Scott: Yeah, it's a crown procedure video.
Howard: What it's called?
Scott: Fifteen Minute Crown Procedure, and it's on YouTube too, that part of it. Of course, the rest of the video tape breaks down everything step-by-step, but now I'm back in dentistry after 8 years being off. I'll tell you something that's interesting how things have changed. I'm a little bit like Rip Van Winkle that's been asleep for a long time, and then he wakes up, and he steps into the new world of dentistry.
Howard: I'm 53, you're 58, you're going to have explain to all the kids out there under 30, who Rip Van Winkle was. That flew right over their head.
Scott: Rip Van Winkle was a character that fell asleep for 100 years, and so that when he woke up, the world had changed, and so he's really stepping from a 100 years back into a new modern world. Now, things haven't changed all that much, I don't think, in 8 years, but somethings have, and the progression ... I'll tell you what was interesting was that, one of the things I discovered, because I did most of my research on endo, what I did was I got extracted teeth from the Harris County Jail in Houston, and I got every endo files that I can find and purchase, and I put every motion that I could put on a file, and put these files into teeth.
I used rotation reciprocation and I use a linear reciprocation, I use rotary motion, and sonic motions. Ultrasonic as well as sonic motions, and I retrofitted these files and these different machines that would turn the files, and then tried them out in teeth, to try to determine what the most efficient motions and what the most efficient file sets were.
What I found out oddly enough was, the most efficient fastest cutting combination was a K file in a rotational reciprocating hand-piece. When Barry Moosacant came down, remember when you and all the [townies 00:10:50] came to the workshop, Barry Moosacant came a couple of weeks later and he had his [inaudible 00:10:57] files.
One of the first things I did was ... He was showing me his file set and I was showing him my technique. One of the things I did was, I picked up his ... He had a [night eye 00:11:09] file with a flat side, I think was a 35. I picked it up and I put it into a rotational reciprocating hand-piece that had a hand grip, a hand file gripper on it. That 35 file went right down the canal fast. It made my eyes popped out.
Barry's eyes were popping out. He looked at it and he said, "It doesn't do that every time." I said, "Barry, I don't think you ever really did put one of your files in a rotational reciprocating hand-piece. Have you?" He went back and he broadcast that everywhere, because it worked with his file set. Before that he just used his files by hand, and then he wind up on front page of Dentistry Today with rotational reciprocation. Then the manufacturer since then, one of the first things I discovered, was the weight one file, which they redesigned a night eye file, to go in a rotational reciprocating hand-piece. You have to change the geometry of the file, because nighttime files, they have to make them purposely dull if you're going to use it rotationally, because it just screws into the canal wall and snaps, but if you use rotational reciprocation, it doesn't do that, but if you use standard geometry night eye files, they're not aggressive enough, because they've have to make them purposely dull.
What they've done now is, they've like the Wave One file, they've switched the geometry to sharpen the edges of the file. They don't have as many turns in the file. Now it can work and cut rapidly, and it is the most efficient cutting type of geometries, the motion rotational reciprocation, and they've made it ...
It's way safer now to use a nickel titanium file. It's really changed my procedure. I still use a lot of steel in the beginning, because in the beginning, steel files are more flexible than nickel titanium and the smaller diameters, and they are sharper and they cut faster, so I use those in a hand gripper hand-piece, like an NSK [inaudible 00:13:21] TC. Whereas the nickel titanium file, like the Wave One, I used an Endomaxx which is a different manufacturer than NSK. It's got a different type of rotational reciprocation, but it's extremely efficient.
Then I discover the edge files. This is a company, and it's endodontist, I can't remember his name right now, but they are about half the cost, maybe even a third of the cost of Wave One file, and they cut just as well, and they are even more flexible than the Wave Ones. I use those and the Endomaxx, and now my endo is even faster than it was before.
A lot of my discovery was just in refining a very fast access technique that's safe and easy and reveals the quality result, because Barry Moosacant what he tells me, he says, "Hey Scott ..." When he came to visit me years ago, he said, "I don't have a problem being efficient [inaudible 00:14:36] because I always do that pretty quickly." He says, "I can spend 20 minutes on Access." I said, "Barry, show me how you do Access."
He pulls out, I think it's the number 4 round bur and he starts to do Access. I said, "Barry, is that the way they taught you to Access in your endodontic residency?" He says, "Yeah." I said, "Is that the way they teach most endodontists and most endodontic residencies around United States?" He said, "Yes." I was stunned. I said, "That's a misapplication of instrumentation. That's like using a butter knife to try to cut down a redwood tree. When those little round burs cuts on the in only, laterally it doesn't have very much length to cut, so it's difficult to control. It requires a lot of focus and concentration. It's just not a good way to do it."
I was using, you remember the GW2 Bur from SSY, and there's another geometry. Remember the [inaudible 00:15:43] I came up with. That's sold these days under different names, like the Speedster, from Coltene Whaledent. Coltene Whaledent bought the company I worked with, Cutting Edge Instruments, and then that bur was sold under many different names. Speedster is the one that ... It's the 1158G bur. That's the most efficient bur for making access when you're cutting through dentin or enamel and dentin to remove the pulp chamber roof. Things like hot bleach, I still use hot bleach. It's the fastest way to go down a canal.
Howard: Back to Edge Endo out of Albuquerque, the endodontist [inaudible 00:16:33], how come his smiles are half the cost? How does he do that?
Scott: You got me. I'd like to know that myself. Not only that, but the metallurgy in his nickel titanium and it's like no metallurgy I've ever seen. A regular nickel titanium file, if you put your finger on it and you flex it, it bends back to where it came from. On one of [inaudible 00:16:57] Edge Endo files, if you touch the file, it will bend and it will deform and it will stay that way, but not like steel does. Steel is bent and kinked, whereas this is still very flexible. You just brush it with your finger and it will bend.
Howard: Do you think people paid twice as much for their file just because they don't know or they don't like it for some reason?
Scott: I absolutely guarantee you that no one knows about the Edge Endo files.
Howard: Is it because they sell direct and they don't have a salesforce?
Scott: Yes, just because these big monopolies, they have all the marketing and the opinion leaders, and they are able to project, they are able to market. There's all kinds of great products. You can't listen to a lot of the opinion leaders, because they are bought off, so you have to go test this stuff yourself in order to find what's good. I'll tell you one of the best sources. I'm trying to remember. It's been a while since I've looked at it, but there's a, I think it's the US Army and they've got ... These guys, see, they're not bought off by anybody. Read their stuff.
Howard: What's the name of that deal?
Scott: I don't remember.
Howard: I ask him every 5 years if I can put a call in by them on Dental Town or put on their website or whatever, but the government military ... I think the US military hires more dentists than anybody on earth. I think they have like ...
Scott: The incredible thing about it is, usually they are not very efficient, but on the other hand, when they test products, they are not bias, because no one's paying them an honorarium, so when they are testing these things, it's kind of like me. When I put a K file a rotational reciprocating [inaudible 00:18:42], I go, "Look at me, I'm a genius. I discovered this." I thought, "Wait a minute Scott, rotational reciprocation has been around forever, and so are these K files. Someone before you obviously knew how these things worked, yet no one is using it, because who is going to pay someone to talk about a K file that doesn't have a patent on it."
In the beginning of your endo instead of hand filing, you might get a length with the hand file by hand, but right after that, put it into rotation reciprocating hand-piece and watch what happens. Your endo will go blazingly fast, it's just incredible. It's incredible how fast you can machine out a canal with a K file with rotation reciprocation. Then right behind that, by the time you get up to a number 15 file, you can go to a number 20, either Wave One, or I believe the Edge is called the X One file. They knock off everybody's files, and I think it's the X One, knock-off of the Wave one.
I haven't had a chance to do it. By the way, their number 20 file is a .06 taper. The first thing I thought of was, wow, the taper is a little big for me, because I always like to keep things small. I never wanted to file the canals larger than they really needed to be filed, because I didn't think there's no reason to do that. As soon as you get them large enough to obturate, that's when you should obturate them, and as soon as your apical gauge is right. I thought a .04 would be better. I recently found out that Barry Moosacant has manufactured a file, this nickel titanium that's flat-sided, that's a .04, that goes in a rotational reciprocating hand-piece, which is what I ... I don't know if you remember this, but that's what I told them to do in my office, right after you came for the workshop, when you came the next 2 weeks.
At that point he had his money invested in that file set, and he had steel files that were flat-sides, and then he gets up to a number 35, which is a beautiful file that he has. I think he had 2 nickel titanium flat-sided files. Now he has a kit that's designed. I'm thinking, theoretically, this is going to be better than the Wave One or the Edge.
I've only been back in practice here for about 3 months, so very quickly I'm gathering up information. My endo, I do 3 times the amount of endo that I did before. The average dentist has about 9 endos a month, and I'm doing about 30 of them. I'm somewhere between an endodontist and a GP when I'm doing endo, and just love it. It's going better than it ever did, so I don't know. I'm loving being back in dentistry.
Howard: Well, that's awesome. You took off when you were 52 and you said 6 years? Eight years you took off or 6?
Scott: It's about 8 years.
Howard: That's good that you went out and did something else. Basically again, the takeaway lesson for Scott Perkins, and I've been a student of you for 20 years, you're lighting the world on fire, whether it's crown and bridge, endo, whatever, is what you brought to my mind and so many of my friends minds, and so many people on Dental Town. Eisenstein say you do the same thing every day, expecting a different result, you're crazy. What you do, is you spend a lot of time upfront, thinking out every little step. Your tray setups were like OCD. You thought out the whole tray setup.
A lot of times the assistant will go in the room and she'll have a tray and she'll throw a little this, little that, little that. You were just meticulous on every detail so that when you actually start working on the patient, it was like watching Beethoven played the piano. He knew where every key was, he knew where every note was. It was a symphony.
While you were doing it, we were all staring around the [inaudible 00:23:13] like damn. There is not one movement you didn't think about for a really long time. I almost think of you as dentistry's operations and logistics, because it didn't matter if you were doing a root canal or a crown, or a filling, you just thought of this stuff.
Gordon used to talk about his 25 years ago that, if slow setup, they had lean composites were coming out. They had fast set, slow set, similar to fast set, sets up in a minute and the slow sets up in 3 minutes. Really are you going to waste 2 minutes on every damn time you use this product, from age 25 to 65 for 40 years, and dentists don't think like that. I can't even get them to get a [inaudible 00:23:59].
The front office, they got a toothache, emergency, something. They want to bring the body in. They want to say, "Well, just come on down." They want a conversion rate, because the average office for every 100 calls, maybe a third of them get converted to an appointment, but half the time the receptionist is like, "I don't have a chair to throw this person in." Then I'm looking at the overhead. It's like, how do you have 24-28% for labor? How do you have 35% for the doctor. We got 55 cents to the dollar is going to people. Maybe 8-10% lab, 4 to 6%, 7% supplies, and we don't have a chair. Are you kidding me. A chair, it's not even a percent. Then you say, well it doesn't matter that you diagnose 100 cavities.
If you only convert 38 people, people that are getting treatment, you need more time in trying to get more people to convert to treatment. They'll just sit there. They don't have a chair or they are doing the filling and their ... For the conversion rate, they'll need intraoral camera. Well, the hygienist is using the intraoral camera because I'm saving money on the intraoral camera. I got money for payroll on the 1st and the 15th. She is using it and I'll forget. I'll just mumble some Latin and Greek in your ear."
Then you do that, then they don't convert, they don't schedule, they're not getting it done, so you're not a good doctor. You're not a good doctor when you see disease and you can't get the decay out. They'll take 40 courses on bonding agents and have big long debate of what's better, amalgam and composite. I'm like, "Dude, what do you care what's better about amalgam deposit?"
Scott: [inaudible 00:25:37] bonding strength than the next one was. I had a couple [inaudible 00:25:42]. I won't tell you what group it was. I had them test a couple of materials. I'm trying to remember the name of the 2 materials. One was a bonding agent from Parkel [inaudible 00:25:53] and it was with a build-up from ... Gosh, I can't remember what it was. They said, "We got bad news." They said, "It's only got so many megapascals and something else had more megapascals." I said, "Let me ask you a question, how many megapascals does amalgam have?" He said, "Zero." I said, "Well, they us amalgam to build up material for 100 years. I'll take the 40 megapascals or whatever it happen to be. It's good enough for me."
Howard: The same dentist anally whining about how many megapascals, he doesn't even remove the decay, period, on 2 out of 3 cavities he diagnosis, because he won't think about the case presentation. He won't get a intraoral camera for every room. He won't get digital X-rays, so he can print out the X-ray on a 8 x 10 and draw on it. Then he'll get on Dental Town and argue with a John [inaudible 00:26:47] 3:00 in the morning about bonding techniques. I'm like, "Why do you even care? If you could only talk a third of the people into removing the decay ..." I'd rather all decay was removed by every dentist on every patient, and they packed it with IRM and temporized it. At least you got out all the infection. You got out all the infection. Yes, you're just one of those guys, and I assume you just think about it on the way to work at night [crosstalk 00:27:17].
Scott: Let me tell you how it happened. Here is how it happened. Do you remember when the Rider's Digest [crosstalk 00:27:22]?
Howard: Oh yeah, Eric.
Scott: That's how I got to know you. You remember this?
Howard: Yeah. Tell them the story.
Scott: What happened was when I came home one day my wife hands me this Reader's Digest magazine and she said, "You might want to look at this," so I look. It says, "How dentists rip us off," on the front cover of Reader's Digest, so I'm in the state of shock. This was back when the internet was brand new. Most people really weren't on it.
Howard: To the younger kids, there's a lot of people listening this under 30, they probably never heard of Reader's Digest, but Reader's Digest was on every grandmas end table in America. It was the magazine.
Scott: It was in the dental office. It was in the reception room of every dental office.
Howard: I think one of it's key favors is it was small. It was only like 4 inches by 6 inches.
Scott: It was small and it was the most widely distributed piece of print media in the world.
Howard: Yeah, it was awesome. I grew up reading it.
Scott: I did too and the conservative people did, and so it was known to be conservative. I wondered what was going on and I did my own personal investigative piece of journalism on it and found out it was fraudulent. I took my findings and I send it to all the dental societies in the country by email in the country, and I send it to you, I guess. You published it in your newsletters before you had the magazine, before you had the Dental Town magazine, you had the Dental Town newsletter.
Parts of it got published in dental economics and then I guess . Woody Oakes Publishing Department. Later on after that I was making lots of money in dentistry, but I had 6 kids, and I wasn't making as much. I decided I was going to sentence myself to work on Fridays, every Friday, thinking about how I was going to increase my income in my dental practice.
I got a statue, the thinker, like this, and set it down, and so I thought every Friday, for about a year. Nothing much happen. I pushed my dental practice as far as I could. I say, "I'm going to try to invent something." I invented the gun rack. You remember the gun rack?
Howard: Yes I do. I had it in my office.
Scott: The gun rack [inaudible 00:29:44] all these different guns that mix, the base [inaudible 00:29:51] materials. Like the bike train wash material and the [inaudible 00:29:56], even buildup material and even temporary cement. I was trying to sell it, and I didn't have very much success. You had started your website, [inaudible 00:30:12] started your website for selling items. I thought, well, I don't know if I will be able to get the catalog, but I have to talk to the friends. Maybe they will put it in their online catalog. I called up and [Judith 00:30:28] answered the phone and she said, "What do you have?" I said, "Well, it's an invention." She said, "What is it for?" I said, "It's for being more efficient in crowns." She said, "Why don't you write an article about the efficiency for doing crowns?" I said, "Okay."
Then after I hang up the phone I said, "Man, I'm going to look stupid. What do I know about efficiency?" To tell you the truth, I wasn't efficient at that point like I became. I ran a very high-end practice that had high production and so forth, and I've always been efficient, but not like I came to be when I was asked to write that article. I sat down and I thought it out on paper theoretically. I calculated up all the set time of the materials. I switched things, and the assistant would do some things, I would do some others.
I said, theoretically a crown could be done in 15 minutes, and I thought, that can't be true, there's no way. Let me rethink this. I rethought, I said, no, no, theoretically it could be done. I talked to my assistant, [Meg 00:31:34]. I said, Meg, you know theoretically a crown could be done in 15 minutes." She said, "You're crazy." I said, "Well, maybe. Let's try it." We got the timers out, and the second time we tried it, it was 15 minutes.
I said, "No one is going to believe this." I said, "I'm going to have to make a videotape," so then I made the videotape. The article came out in your magazine, Dental Town. I went to a photographer. You at that time, you would dress up in like an astronaut costume, you'd do stuff like that. I said, well, I'm going to do it too because Howard does it. I got the cowboy outfit, and so I did that.
Since I was the editor and the publisher of my little city's newspaper, to use in the city of Southside Place, which is a small incorporated city. This was in Houston city limits. I knew how difficult it is to publish things and how stressful it is. I say, "I'll lay out the front cover and maybe there will be stress and they will put it on the front cover," which is exactly what happened. That was the first real controversial article that I wrote.
I thought things too, that's the first time I thought things too, like you're saying. That worked so well. Later on I thought, what will I do next, and I thought, I know, I hate endo. I said, endo gives me nightmares. When I see an endo on the schedule, especially before lunch or before the end of the day, it's just a feeling in your stomach that's not good. I thought out endo, and then I wrote the next article. That's how I became efficient, actually, because of you and your magazine.
Howard: It's funny about how so much of success is counterintuitive, like a controlling, social animal, top-down 400 pound gorilla down, is why we make organizations like Pope, Cardinal [Prees 00:33:39], General Colonel, whatever. What are the counterintuitive things is to avoid controversy. You are a social animal and you all got to get along. Whenever you do something controversial, I think there's about 10 people are quoting for originating, "I don't care what you say about me, just get my name right."
It's so funny how you write a magical piece and they don't talk about it, but you say controversial and it goes viral. You were the first gone viral for Dental Town ever on that 15 minute recording. I had hate mail from endodontists. There were endodontists that wanted to run me up a flagpole. I started learning that you could go talk for 8 hours, but you just say 1 colorful off the cuff joke that offends at least 20% of the people, and it'll be the buzz of the entire convention.
I just started collecting every off color dental jokes you could imagine, throwing it out there, knowing that the more you cringe, the more you would write letters and tell everyone, because back then everyone was like, "What was the name of that guy?" You were like [Miley Cypress 00:34:51]. Remember that girl that swung on balls and chains?
Scott: Oh, hopefully I am not like Miley Cypress.
Howard: No, but I'm saying, when Miley Cypress swung on that ball and licked the chain or twerked or whatever the heck, I was thinking about all those spots on all those newspapers and CNN and all those deals, and if that would have been a 30 second commercial, a 60 second commercial, a 2 minute commercial. The woman literally got, I would say at a minimum, 100 million dollars of free advertising, because she shook her butt and twerked her something.
You've seen rock stars do it all the time. Remember when we were little, Alice Cooper, you knew he was just trying to out-crazy his act from the year before. He lives up the street. I'm in Phoenix. I learned right out of the gate that if you can throw an article that 20% of the dentist violently disagree with, publish that every time you can.
Scott: I knew when I wrote it that it was ... I tried to put a disclaimer in the article. I said, "Now, I'm not suggesting that you do this in 15 minutes. I'm not saying that you can do it every time. I'm just saying if you're very organized, it is possible and put it on videotape." In fact, I got invited to speak to Creighton University. The reason I did, [Higginbotham 00:36:20], Dr Higginbotham was the head of continuing education at Creighton. In the Reader's Digest article, Mr [inaudible 00:36:31] that did the pulitzer prized winning author that wrote that fraudulent article, he went to Creighton. Then he then clandate, the Creighton people [inaudible 00:36:44], he twisted what they said, in order to support his article, which was damaging to dentist.
Howard: Okay, but go back, because I'm 53, you are 58, half of the people listening this have no idea what you're talking about. Tell them the gist of the article.
Scott: Here is how it went, a pulitzer prized winning author, William [Heckenbarger 00:37:10] was commissioned to write this or to test how honest dentists were. He went and presenting himself to 50 different dental offices around North America, to give him an opinion of his mouth. In the article there were these 5 good guy dentists. One of them was a former dean of The University of Kentucky.
One of them were Mr. Heckenbarger's own dentist, up in Hershey, Pennsylvania. I don't remember all their names. They deemed that his mouth was health and needed very little dental work, if any.
Howard: I think the dean said zero.
Scott: Yeah, that's right. He was an [inaudible 00:38:03] character. Anyway, then he went to all these other dentists and what the article found was that all these articles want to do 2 crowns or 3 crowns, and even a full mouth reconstruction, and basically painted them as a bunch of quacks that just wanted to make money.
The conclusion of the article is, it doesn't do any good. They called the American Dental Association, and the American Dental Association says, "We recommend you get different opinions." The Reader's Digest William Heckenbarger said, "I got different opinions, and that didn't help. I was getting ripped off. Dentists were trying to rip me off everywhere I went."
I read his article and I was in a state of shock. I go to the internet, which was new, and it was dial-up. There was no such thing as cable broadband internet. I looked at the article, which is almost identical. Except for one thing, Mr. Heckenbarger's X-rays were on the internet, and I saw these crowns with these big overhanging margins.
I was able to find ... They listed the name of the so-called good guy dentists, and what cities they were from, so I just looked them up and called them up. I called one of them, he say he name was Dr. Jones. Dr Jones, this Dr. Perkins from Houston. I just read your article how dentists rip us off and I am very shocked." The doctor say, "Oh yes, shocking, very shocking." I said, "Well, I'm just really curious about Mr. Heckenbarger, about the condition of his mouth." He said, "Mr. Heckenbarger was a great patient, great oral hygiene, just the kind of patient you want in your practice."
I'm thinking, actually I want the kind of patient that need some dentistry, not someone that has perfect health, but it's nice to see those with perfect health. In any case I said, "Well, Mr. Heckenbarger understand he had a lot of crowns in his mouth. Did he have a lot of crowns?" The doctor would say, "Well, yeah, he did." I'd say, "What conditions were those crowns in?" The doctor would say, "Excellent." I'd say, "Really, excellent?" He goes, "Yes."
"Are you sure excellent?" "Oh yes." I'd say, "Come on now, excellent, good, above average, average?" He would repeat, "Excellent." Then I would say, "You know Dr. Smith, did you know that Mr. Heckenbarger's X-rays are posted on the internet?" He would say, "No." I say, "Well they are, and I'm looking at then right now from my office in Houston and those crowns look like they fit like boots on a rooster."
The doctor got real quiet, and he said, "Well, the margins were kind of thick." I said, "Wait a minuted, I just go through asking you over and over again, and you repeated multiple times they were excellent. What's going on?" I did this to all 5 doctors, and they all tripped up the same way as the first one did. When I researched their backgrounds, they all had ties in managed care. The former dean of the University of Kentucky Dental College, his only current form of employment was MetLife's National Managed Care, a chairman of MetLife's National Managed Care Program. He hadn't practice dentistry in a long time. He was affiliated with MetLife.
I asked some of my patients who worked with and investment firm upstairs, I said, "Check that [inaudible 00:41:55] sitting on the Reader's Digest board of directors." There were like 4 MetLife executives on the Reader's Digest board of directors. The article was obviously highly inaccurate. When I talked to his own dentist, his own dentist had told him, if memory serves, that he was a candidate for full mouth reconstruction.
They were blasting the dentist. He had the kind of mouth, you could have said, "Look, these crowns need to be replaced" or "You could use a full mouth reconstruction." His X-rays showed that. They took the X-rays down, but not before I downloaded them.
Howard: Do you still have them?
Scott: I probably do on an old hard drive. I got to look for them, but I could probably-
Howard: Oh my God, if you do, upload them on Dental Town on that article, because we [inaudible 00:42:46] we talked about that.
Scott: They published it, Reader's Digest and put I out there. I'm assuming there's no legal problem with republishing that.
Howard: It's probably before HIPAA anyway.
Scott: [inaudible 00:43:01].
Howard: Back to the 15 endos and you did the 15 minute crown. Now I don't know, I'm thinking there's probably-
Scott: The right anesthesia.
Howard: Yeah. There's probably 15,000 CAD/CAM I imagine, in the 125,00 dental offices, 125,000, 10% would be 12,500. We pass that unit. It's probably 50,000. Do you think CAD/CAM is making people go faster and more efficient or not? Because a lot of dentists wonder about that, because it's pricey. It's a buck and a half to buy those things. Do you think it leads to faster, easier, higher quality, lower cost dentistry?
Scott: Are you talking about Serac machine? Are you talking about-
Howard: Yeah, Serac or E14.
Scott: Dental impressions. When I went out of dentistry, I taught workshops, I still teach workshops, dentists would come with a Serac machine, and they say, "How do I make this more efficient?" I would tell them, "You need to sell the Serac machine." I had dentists that sell their Serac back then, and their production went up. The reason why is because the dentist is bogged down be a lab tech, and you can't really be a lab tech and make money. It can't be done.
I also said this, "I'm not bashing Serac. Some day we'll all own Serac machines, when the technology is improved where it works very efficiently." CAD/CAM is some good stuff. It's really accurate. It's some quality, from everything I can tell and what I've heard these days. Digital impressions, to take a digital impression now, there's a lot of advantages to having one, but it is time consuming to take one, compared to snapping an impression. Remember, I'm just back, I've just been back maybe 3 months, and I'm in a practice with-
Howard: Yeah, but you did more dentistry ... You graduate in '84?
Howard: I was '87, but from '84 from till when you were ... You're 58. You take off 6 years or 8 years?
Scott: Excuse me?
Howard: How many years did you take off?
Howard: Basically you practiced 30 years.
Scott: I think it was maybe 24 years. I'm not sure exactly.
Howard: Twenty-four years and you probably did twice as much dentistry as the average dentist did in 24 years.
Scott: I did a lot of dentistry. When it comes to endo, these teeth were extracted teeth that I worked on, but I would literally work on extracted teeth from the time the sun came up till well after the sun went down. In fact, my wife Mary-Jane said, "Scott, you're worrying me. You look a little bit like Jack Nicholson, the shiny," because I'm bent over the stereo microscope.
Howard: Was she in that picture you sent me just a little bit ago?
Scott: No. That's my staff, my new staff here in El Paso.
Howard: Okay, I wondered who it was. There's no family, non of your 6 kids in that picture?
Scott: Right, a great staff.
Howard: You know what, I say it all the time, but Warren Buffett, the only person who became one of the richest people in the world, a billionaire, he says when he studies companies to look at them, he says that he almost thinks that 95% of CEOs spend half their time, trying to figure out how to raise their overhead. Dentists are all thinking, "I'll be successful if I just spend a lot of money, and I'll buy some silver bullet." Then they'll talk about, "Well, if you buy this laser, I can do a frenectomy in like 30 seconds." It's like, a frenectomy? Is a frenectomy even .01% of your revenue? You're going to spend $75,000, so you can save a dollar on a 15 scalpel?
Yeah, I see dentists buying CAD/CAM, and they used to take a rubber and brush and send it to a lab, and now they are in the [inaudible 00:47:07] for 3 hours making a crown. It's like, so you spend $150,000 to be a glorified lab tech? Why did you go to 8 years of college to be a dentist? Why didn't you go to [inaudible 00:47:17] lab school for 2 years?
Scott: I think you can do it, but I think what you have to have is a well trained assistant, who becomes your in-house lab tech, and then it makes a lot of sense.
Howard: They're control freaks. They won't delegate. I do that. I do that with mine. I numb, I prep, I leave. When I come back, it's all done. I already cement. [inaudible 00:47:35] They are too controlling. They get mad when their hygienist talk to the patient. They wouldn't even let their hygienist have an intraoral camera because she said this tooth over her is completely broken and it needs a crown. Then he tells her if she talks again he's going to fire her, and she's not a doctor. It's just crazy.
Scott: I rely on those hygienists to do a lot of the communication or most of the communication. I think that's invaluable. I agree. Here is one thing, Howard, as far as spending a lot of money, it depends. What I found was, when I started testing products, I would find some products, like the K file. I'm talking about the fastest thing.
Most nickel titanium doesn't start till [inaudible 00:48:19] anyway. The hard part of the root canal is not when you go to finish the canal out. It's in the beginning stages, after you get access and you're trying to negotiate the canal. That's the hard part, and you're going to use steel to do that. Every root canal starts with steel.
I'm just using it in a rotational reciprocating hand-piece, and making sure that I've got a well that holds a lot of [inaudible 00:48:48], in order to do the root canal. There's a lot more detail. I could talk about all the aspects [inaudible 00:48:57], if you'd like to speak about more aspects of it, but there's more-
Howard: You should write a updated version of the 15 minute root canal and the 15 minute crown for dental town.
Scott: Yeah, I would love to.
Howard: That would be classic. That would be epic.
Scott: Doing just that. This is funny, I had an invention a new invention, but I thought this one was really going to catapult me. I spend a lot of time, trying time to find out how to manufacture this invention. It fits in a latched, tied, hand-piece, and it's made by a Swiss crew machine, rather than a CNC machine. I found out, when I get back into dentistry, they were already been produced and even patented before I even thought of it, and is distributed by Ultradent.
I want to write an article on how ... They manufacture for a different purpose. I'd love to do that. I'd love to introduce this new product. It really helped in endo. I don't have any financial interest in it at all, because the product that I had, that I developed and thought I'd invented first, someone else has already invented. I'd love to do that.
Howard: If you ever want to have a hands-on course, I got the whole setup facility in Phoenix and Vegas.
Scott: That would be wonderful. I love it.
Howard: If you ever want to do a hands-on course, in fact maybe you should do that during the next towning meeting. During the next towning meeting, we should have a hands-on course. Would you want to do it on endo or crown and bridge? You know how many people would show up, just because they've been your raging fan on Dental Town since 1998. They would just want to show up and just hug you and talk to you. It would just be like a family reunion.
Scott: I miss everybody. Talking to you is fantastic for me. You just can't even imagine.
Howard: You should do a hands-on during the towning.
Scott: Oh yeah, I would love to. Just tell me when and I'm on it. It would be great. I've got an updated endo. This endo course is updated. It's less complex by far than it was before. It's way simplified.
Howard: Email me email@example.com and we'll set it up. Hey Scott, I want you to go ... One advantage you have and I have at our age is attitude is everything. Attitude determine your aptitude and your altitude. It all starts with an attitude. I hear these young kids talking and they self-talk so many negative things, "I hate endo. I suck at endo. I don't like endo. I don't want to do endo."
I tell people, "I don't care if I am sitting at a table and I got 3 enemies across the table, they just freaking want to kill me. I don't care about that. What I fear is when the enemies live in your head, between your ears. What would you tell these kids who are sitting there and telling themselves, "I hate endo, I don't like endo"? In fact, some of them say, "I don't like surgery. I don't even like blood." It's like, "Dude, you became a doctor. What do you think you were going to work on, an Intel machine, an iPhone? Obviously, you started off knowing that humans were filled with blood and guts, and now you got out and you're telling that you want to work on iPhones." What would you tell these younger kids who are self-talking they hate endo?
Scott: I would tell them the same thing that the Wizard of Oz told the scarecrow, and the tin man who's lying, that you already have a heart. You already have courage. You already have a brain, and you can do it. You just need to learn how. Everything is hard when you don't know how to do it. Once you know how to do it, it's easy.
Howard: Oh my God, I can't believe you staid the Wizard of Oz, because 2 nights ago, on my birthday, August 29th, I treated myself to the play, Wicked. Have you heard of that play?
Scott: Oh yeah.
Howard: Did you go see it?
Scott: I missed it. I just got here and I saw it, I was going through downtown.
Howard: I've lectured in New York so many times, I've gone to so many Broadway plays, I can't even count them. Truthfully at least half the time you kind of leave at intermission because you're yawing, you're bored, you got a lecture tomorrow.
Scott: Yeah, I'll fall asleep.
Howard: Wicked, I mean, at the very end, you jump out of your chair for a standing ovation.
Scott: That's killing me.
Howard: It's the single greatest play I ever saw in my life. It was just classic all the way from the beginning to the end. What else would you tell all these kids? They are self-talking, they are not going pull a tooth, they're not going to [inaudible 00:53:41], they are not going to place an implant. I'm going, "Well, you're not going to do it if you keep telling yourself that all day." Is Sarah your oldest? Are you a grandpa yet?
Scott: You wouldn't believe this, about 3 days ago, her boyfriend flew to El Paso and read me this letter, asking for permission to marry my daughter. You ought to see this letter. You wouldn't believe it. He's an army ranger. He's got a degree from West Point, toured Iraq, and then he got a degree from Northwestern, so I'm thrilled, and he's the nicest kid.
Howard: Let's say Sarah just got out of dental school, she's getting married to classed [inaudible 00:54:22] guy, and you hear her not going to fight an enemy in Iraq or something like that, but the enemy is in between her head and she says, "Dad, I hate endo. I don't like endo" how would you try to get her to change that around in her head?
Scott: Right now, the guy I work for is like 2 years older than my eldest daughter Sarah, and he's an ambitious young man. He's got 5 offices, and I'm the oldest guy in any of these offices. The rest of them are young, and some of them have just been out a year or 2. He's trying to pick some real quality kids, but like anyone else, they don't have a lot of experience in this endo. That's one of the things I do. I go to an office where someone's having trouble, and I've already given a workshop to this group.
As far as dentistry, who taught us anything in dental school? Did the dental instructor ever teach you anything where you went or did you just show them what you did after you did it? It's kind of like in medicine, watch one, do one, teach one. You didn't get a lot of instructions. I think as far as we as dentists, you have to get out there. You're not going learn unless you try, at least try. Don't [root 00:56:00] for it, try. You can also root for it if you can't tackle it. Right? Try.
Howard: You could say, "Well, I think the endodontist would do it better than me?" It's like, "When did the endodontist, when did he did his first root canal? So what, the endodontist was born an endodontist? Didn't the endodontist had to do his first root canal?"
Scott: You got to start somewhere.
Howard: I was so lucky, in the oral surgery it had 3 legends, [Man Organ 00:56:23], Charley White and Bret Ferguson, and you would come back to them and you'd say, "I can't get it out," and he would look at the clock and say, "How long you've been on it?" You'd say, "Five minutes? Come back and tell me what's going on in 25 minutes." Then you go back 45 minutes, and it [rolerize 00:56:45]. They come back, they just take a Popsicle stick. They'd say, "I like the [inaudible 00:56:50], that flap is so small. I couldn't pull it. It takes just the same amount of time for a flap twice as long."
He goes, "Peel that baby back like a banana until you can see some white mandible. Then spend another 25 minutes trying to get it out." It was just so amazing. I loved the oral surgery department the most. Those 3 oral surgeons, I swear to God they're like uncles to me.
Scott: You've just reminded me, Ben Taub is a hospital in Houston, and that's where we did rotation to take teeth out. The resident oral surgeon, I'm trying to get these teeth out, and they are just a bunch of roots. It looked like trees sticking up from a man-made lake. It was Dr. Chin. Dr. Chin is sitting back like this with his feet kicked back.
I said, "Dr. Chin, can you help me? I'm having a little trouble here." He says, "Layer flap." I'm thinking, flap, I think I saw that in one of those dental books somewhere. Next thing I knew I had a scalpel into my hand, and I got the teeth out. He wasn't going to help me get this teeth out. I wound up taking out a lot of teeth, just because I dove in and did it.
To be fair, there are some incredible dental instructors. We had one name [Clide Co 00:58:11] and Clide Co, he wouldn't do exactly that. He would sit down and he would show you actually how to do something in the clinic, which everybody love Clide Co. He was always voted the students favorite instructor because of just that. He would take you under his wing and show you how to do stuff. Then he would pat you on the back too after you did it.
Howard: I had a couple students from [inaudible 00:58:37] School last week, and they were in there pulling wisdom. That's still my favorite procedure. I have to be honest. If I owned you one procedure, it would just be wisdom tooth, I have to admit that, and number 2, probably molar endo. They said to me, "How did you pull it? You didn't even look in the mouth." I say, "We'll, how would Steve Wonder ..." I said, "I feel the elevator in between those teeth and I say, it's by feel. I look back and feel it. I don't have to stare at the moving tooth. You're just feeling it, and you are feeling it and you just pop that baby out.
Scott: It's just like endo, these guys have a $30,000 stereo microscope, but what can you do with it? You can get access and you can locate a canal, but after that, it's a blind procedure. You put the file in the canal, it's blind from there on. There's stereo microscope for that. There is nothing but feel when you're doing endo. You're right about ... I'm doing a lot of these. I really didn't do them when I was in Houston, 2 Houston centers. I was in a high-rose building and I didn't have kids or teenage kids or college aged kids when I was there, but where I am now I've got a lot of them, so I find myself doing exactly what you're talking about. I'm taking out a lot of third molars and these impacted third molars and the maxilla. You don't even see them half the time. You're finding them with your elevator by feel.
Howard: Yeah, you've got a lot of senses and feel is the huge one in dentistry.
Scott: Tactile sense.
Howard: Yeah, tactile sense. Well hey, dude, we are out of time, and I just want to tell you that you were so much of a legend in my early formative years. Thank you so much for spending an hour with me today. I just thank you. Thank you for all you do for dentistry, and thank you so much for spending an hour with me today.
Scott: Okay, great.