Dentistry Uncensored with Howard Farran
Dentistry Uncensored with Howard Farran
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191 Emergency Preparedness with Andy Mancini : Dentistry Uncensored with Howard Farran

191 Emergency Preparedness with Andy Mancini : Dentistry Uncensored with Howard Farran

10/14/2015 12:00:00 PM   |   Comments: 0   |   Views: 840

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AUDIO - HSP #191 - Andy Mancini

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VIDEO - HSP #191 - Andy Mancini

Andy Mancini, DMD, Julie Wilcox, and the team at Sedation Ready, Inc. teach exactly how and why a team should always be ready for immediately responding to an emergency in the office.



Sedation Ready, Inc. was formed by dentists for dentists. Plenty of offices use sedation techniques. With hands-on, intimate instruction, Sedation Ready helps prepare office teams for the worst of emergencies. There are lots of myths about emergencies and deaths at dental offices. Sedation Ready bravely addresses these taboos by simulating all kinds of emergency scenarios. Your team can be cool and collected during emergencies, and save lives in the process.



Howard Farran: It is a huge honor today to be interviewing this fine group of people on probably one of the most important topics there is in dentistry. I know Dr. Andy Mancini, you're a pediatric dentist but people don't die from a filling or a crown or root canal. It seems like if anyone ever dies in the office, they have an IV in their arm, they're under sedation and you guys are talking about the most serious aspect of dentistry.

Andy Mancini: You'd be surprised Howard that it's not just with IV or sedation, actually we have a lot of statistics, a lot of studies that people die and they have fatalities even just on their own, without any sedation so we have patients here, even pediatrics, that they had a cold and one child one time, choked on a lugey and was starting to have some issues. We see how the research, we have a lot of patients out there that they have ADHD, they have anxiety, depression, you name it. They're taking a lot of medications and add some sort of issues about anxiety in the office, in the dental office and the heart keeps pumping, beating so fast that it does trigger a lot of the issues that you've seen, a lot of 911 calls of their being summoned. It's unfortunately not just under sedation so that's what we're trying to change the mindset there, it can be happening to anyone, anywhere.

Howard Farran: I really applaud your mission statement, anxiety is one of the biggest issues in dentistry. I think the two things that keep people away from the dentist are fear and money and you guys are trying to address fear and I really applaud your mission. How did this mission come about? How did you get into this?

Andy Mancini: I've been doing a lot of pediatrics work, sedation, for a few years now and the mindset we have in the office, we take the whole team when you're going to be doing some of those courses because some state requirements, you are required to have some CE's, the continuing education, and unlike most of the offices, we have the staff coming along. If I'm learning something I want the staff to learn the same thing that I'm learning, we just have different roles here in this office but we're all part of a big wheel that comes together and with those courses, I've noticed that they are doing very exclusive, very segregated so assistants, they don't have access to every course or when they do they stay in a different room than the doctors and it's a different sort of a lecture. 

The lectures they have for the doctors, they shuffle the doctors together, like 4, 5, 6 doctors, some lectures even 10 doctors together for the simulation and what happens is, it's just nature, people ... One is going to be an alpha dog and the others are going to be watching. Sometimes they don't want to say anything to not sound stupid in front of a colleague and they go, they do their network, which is great, they learn some new things, which is wonderful but once it comes to reach that full potential in the course that they have out there, it's not happening. They are having that limitation because peer pressure in one way or they don't have that nature to be the alpha dog, to be hands-on, to be taking the lead. 

They are doing work in their office, then they are the alpha dogs in their office and when the emergency happens, they're not going to call Dr. Smith, Dr. Joe, Dr. John, that were their best friends who were in the course with them, they're going to be looking to their assistants, they're going to be looking to the front office and they're going to be looking back to the doctor and that's when the problem arises. In our course, we just decided we should be doing it differently. It was so interesting because one course that was being provided by a very strong group, I was begging them, I even paid the fee's for the assistants as doctors so we can do the simulation just our office, no can do, they have to be doctors. 

Apparently being a doctor is a big deal, I'm even going to get a bigger, 5-gallon hat because it's getting bigger for that ... What keeps everybody humble is, when I have an emergency then we have to get a very cohesive team to be coming together and we had one time an emergency here but we were prepared. Was not under sedation, was actually that kid that I mentioned, about the lugey and he had a [inaudible 00:04:43] spasm, he just couldn't breath. Just like that the child became purple and just like that, we got the child back to the natural color that he had. 

Howard Farran: Isn't that how Joan Rivers went? With the [inaudible 00:04:56] spasm? The famous Joan Rivers.

Andy Mancini: You are correct so she had an issue and was in a prestigious center and they just decided to be using a different set of anesthesia and tickling with her vocal cords, she's no longer here with us. It happens. That's what I'm saying, people are prepared in a way that once it needs to be coming, that conclusion of an emergency they are not. Our goal should be just like the air pilots, it's like that deja vu where you have a lot of simulation. Our simulation is not just those dummies for CPR, it is the hands-on, the mannequin ... I refuse to call our simulator a dummy because one, that thing is probably smarter than I am. It can interact in a way that just blows your mind away. You can have that sense of reality and then it can understand how important to have those courses on a frequent basis. Other studies mentioned that within 4 months, you lose 60% of any data acquired from anything. From CPR, ACLS, you name it. 

Again, back to the main principal of the office that created that course was to have the whole team learning the emergency because again, when they all have a simplified plan no one gets in each others way, no one panics and everybody can just get the best outcome for the patients. If not, you know how to recognize and have the appropriate care, like the paramedics, coming and doing the best they can do. Notice that most of the fatalities happens for lack of recognition of the emergencies. The last one we had, that was a fatality that led to death, they took over 26 minutes to recognize the patient was having some distress. 26 minutes, it's a lot of time. We talk about here that within 60 seconds, it already makes a difference, imagine 26 minutes. 

Again, we try to take the alpha dog, got the whole team, all interacted, all have that hands-on simulation, who have Q&A after the simulation just for that one office, which is just not done by any other course. The reason they can't do it? Logistics. They cannot put their 500 doctors to be done one-on-one, they have to shuffle everybody together. We're here to learn a different area, we're going one-on-one with each office. Our main goal is to save lives.

Howard Farran: Do you go to the office or do they go see you in Minnesota?

Andy Mancini: No, we travel all over the country just like a rock band. We go Seattle, San Francisco, Vegas, Dallas, we go to major cities and then we have the offices of those cities meeting us in a ballroom of a hotel. That has an advantage because they don't have to shut down production, they don't have to be far away, 4 hours in an airplane, 3 hours in an airplane, they drive 30 minutes, 40 minutes. Maybe some drive maybe an hour and a half and they have the course, they go back to their hometown or to their places and that's it, business as usual. 

Howard Farran: How long is this course?

Andy Mancini: The course is divided in 2 days. We have also the IV sedation portion of it. We remind some of the folks how to watch for the IV sedation, the tricks, all the hiccups, all the pitfalls and that's done on a Saturday. The main simulation and lecture happens on a Friday. It's an all-day course.

Howard Farran: You do it for one office at a time?

Andy Mancini: Correct. When you do the simulation, it's one office at a time. When you're having the lectures, we have a minimized group of offices, we can have them in the whole group but we still have that one-on-one feel.

Howard Farran: How much is that course?

Andy Mancini: It's $2500 and that includes one doctor and 2 assistants. It's almost like 27 CE's for 800 or 900 bucks, if you divide it for 3. You also have to think you're not having travel expenses, you're not having hotel to be sleeping in. You're not having any parking, all of that stuff that you have in the airport and whatnot. 

Howard Farran: I think you should put a teaser, one hour of your seminar on Dental Town, we put up 350 courses on Dental Town, they've been viewed over half a million times. I think you could just intermediate this by putting up the lecture part on Dental Town so they would all be turned on to you guys, your systems, your techniques, I think that'd be almost like a marketing program for you. You would be educating while simultaneously marketing.

Andy Mancini: Well, that's something to consider. Definitely put it together to have something that, the teaser, as you were calling. We definitely have the know-how to be doing that. I think even something even better now, if someone call us and they mentioned that they listened to your podcast, we can grant them a couple things; we can have the IV portion at no charge, and that's 1000 dollars cost or we can grant them a 20% off the ticket. Instead of it being 2500 hundred, they can have that for 2000 dollars and includes one doctor and 2 assistants.

Howard Farran: What do you exactly try to teach them in 2 days? What would they be going back to do? What should they be able to learn and go back and implement on their office on Monday?

Andy Mancini: They're going to be surprised, even of the offices we have taught around the country so far, how they lack a plan of emergency. They believe they have something in action but they don't. Once you have their hands on ... Place them on the fire, you see how they don't have that deliberated. You want to make it as simple as it could be. Two, we just review the whole medical protocol, they have to be selecting a case, during the case and after. Three, for emergencies, not even during sedation, and you'll see the most common outcome of emergencies, they'll be prepared to handling that. Then you have specific 2 to 3 simulations that is done and changes year after year. Some MD that went for 2015, or went back in 2016, they're going to be different simulations so unless you repeat one or so by popular demand but we always rotate and keep it fresh. 

They're going to be learning also about the changes in the guidelines that happens across the country, we have a big vote now that is going to be putting in November that is going to be affecting a lot of folks that they do sedation and a lot of them don't know that. We have a full time staff dedicated to look at changes in protocols and requirements. It's a lot of things that is just more than pumping CPR in a dummy so they learn, again, how to be thinking as a team, how to communicate well. If you make, an analogies is like Hell's Kitchen, when they have to communicate but without the cursing and all that drama but get you to interact in a team basis. That's what they're going to be learning or enhancing their skills.

Howard Farran: Andy, do you teach oral sedation or conscious sedation or twilight sleep or deep sedation? Talk about all those different terms on here.

Andy Mancini: Oral sedation became now conscious sedation because it's done just by mouth or it you can have it by nose when it is sprayed in for some of the nose. We also mention to each about IV sedation. Some offices they have that [inaudible 00:12:37] capability and we have our full time staff that talks about that. The IV is addressed mostly in our Saturday day. Again, we talk about the pitfalls, what you look after, what you look up to and how to maybe enhance some of the shortcuts and you'd be surprised how they leave the course saying, "Oh, I was never aware I could have done that." They always do in a way that takes longer instead of having maybe a faster and better way, without shortcuts. We don't cut corners and no shortcuts but just have more efficient ways to be doing the procedures.

Howard Farran: What is your favorite oral sedation's?

Andy Mancini: We use here a cocktail of those, we go from [Versaid 00:13:16], Demerol, [inaudible 00:13:18], chloralhydrates and a lot of folks are going to be thinking, "Oh chloralhydrates have been discontinued," and actually it has a way that you can have your hands-on chloralhydrates still and you teach that in the course. It has a lot of things that we really help them to make the selection of the drugs so it doesn't have one size fits all. Goes again, what procedure they're doing, the age, weight and the length. It's a lot of moving parts that we just get the provider to be thinking much quicker how to make that selection.

Howard Farran: What about IV sedation?

Andy Mancini: IV I can have Julie have a taste into it because she's our expert that talk about IV. Julie, if you want to jump in?

Julie Wilcox: Okay. I teach the Saturday course on the IV skills and training and this portion of the course is a compliment to the emergency portion. Its really beneficial because it takes a person looking at all the different things that you have to address with IV's. The course is really inclusive for a beginner or an advanced practitioner. It really can cover anyone and that's what really unique about working with really small groups is that you can find out how they practice, you can cater the course to their needs and give them that ability to learn new content, ask questions while you're teaching and then, lastly, have that hands-on time. That one-on-one time is so valuable. 

Andy Mancini: Our course, they have the hands-on, not just slide there and talking. They have the hands-on as well.

Howard Farran: Your website is sedation ready dot com?

Andy Mancini: Correct.

Howard Farran: Julie Wilcox, do you do the sedation's for Andy in his pediatric dental office? 

Julie Wilcox: I'm a CRNA but he has not done IV sedation in the office as of yet.

Andy Mancini: We chose not to go in that route and just our choice, other offices they do. We don't get her just for pediatric dentist, we have periodontists, a general dentist, they place implants. Obviously an adult population so it's just a preference of how each office responds. What I want to make clear because again, the course is not about just sedation, it's a course about emergencies so how to recognize, how to be prepared and how to summon any help or your team, that's the main thing.

Howard Farran: Some of these cases that have been all over social media this year, you're reading the stories and they're just crazy, they left him sitting up in the chair with their head forward while the dentist went down the hall for 10 minutes, looking for other physicians in the building. Just batshit crazy ... Not even maintaining an airway, there's a huge need for this, this is why I was super excited to get you guys to come on today. The simple things like something's going wrong, just making sure they're maintaining airway. 

Julie Wilcox: Absolutely and that's just the basic, being able to handle an airway is where some of my expertise comes into. I've been in anesthesia for over 20 years so it's really wonderful to have someone build that confidence that they can actually take care of someone's airway and manage it. [crosstalk 00:16:58].

Andy Mancini: In the studies mentioned that even some folks, again, having cleanings in their office, cleanings, but when they see the medical history they're having a lot of medications they take. I'm not talking about just sedatives or anything and they end up having issues that obviously the hygienist or the assistant may not be able to identify at first because you're not going to the right course and when you have the doctor to jump in, you have to get everybody so quickly ready so again, that only doesn't happen with sedation, it happens anytime, anywhere. It can happen in your hallway, it can happen when you leave your office. 

They just collapse outside, so who's going to be responsible for that? Something on top of that, that's going to be released very soon, that we're going to be talking in our course is how to be dealing with the HIPA, how to get be protected there. Their systems, when you have to be sharing notes with paramedics or hospital, which no course addresses that, not a single one. I know because I've been to those courses, I've attend those courses and they don't talk about that either. [inaudible 00:18:01] should be thinking several things that we thought and we're just making simplified for all the [inaudible 00:18:08]. 

I'll let them continue Howard, I know it's been a long process you should be mentioning, I have a patient I'm going to be seeing, not a sedation, and I just want to stress then because you mentioned about your teaser and I'll follow up with you on that but for all your viewers that they mention that they saw on the podcast, because you only for 2015, four dates available left, everything else has been sold out. One is in Dallas, one is Phoenix, one is Miami and the other one, it's in Atlanta. These are the last four for 2015 and if they mention your podcast and they call the office, we grant them 2 ways, 20% off, it would be a 2000 dollar deal instead of 2500 or they have the IV course portion that can be waived, that's a 1000 dollars value on that. They can make a choice but they have to mention you.

Howard Farran: Before you leave, I have to ask you, I've lectured in Italy before, how did you leave Italy and go to Minnesota? What went wrong in your decision making?

Andy Mancini: You know ... 

Howard Farran: It had to be love, did a woman attract you to make that decision?

Andy Mancini: I can tell you, making the move to Minnesota, I found joy in my life and that was the best thing ever.

Howard Farran: Oh is it the one behind her, which one? The one behind her, okay, okay. That explains it because if I wasn't seeing her right now, nothing else would explain moving from Italy to Minnesota. I know that because my sister is a cloistered [Carmite 00:19:35] monk in Lake Elmo, Minnesota so I go up there all the time. What's funny is sometimes when I go visit her, I drop 100 degrees. I've left here when it's 88 and got there and it's like minus 12 and it's unbelievable. She likes it. I would take Italy or Phoenix any day over minus 12.

Andy Mancini: That's okay, I always go back to visit so Italy's always going to be there.

Howard Farran: What's your favorite city in Italy?

Andy Mancini: I'm biased because I was born in Florence so then Florence is the favorite city though.

Howard Farran: Yeah, I like Rome and Venice are amazing.

Andy Mancini: My mom, she's from Rome and Venice ... I was going to propose to her Venice but change of plans, proposed here in Minnesota anyway.

Howard Farran: Do you cook her lasagna and Italian food and all these fancy Italian dishes everyday?

Andy Mancini: You name it, you have to come and try our dishes here.

Howard Farran: All right, so now Julie, you're going to take over now?

Julie Wilcox: I guess so.

Andy Mancini: Let me just comment, there's a whole team effort here.

Howard Farran: All right, thank you for your time and congratulations on your mission.

Andy Mancini: Prego. Ciao. Ciao.

Howard Farran: Ciao. Ciao. 

Julie Wilcox: I really, really enjoy teaching the course. You're surprised all the time at the various levels of knowledge. It can be as simple as someone laying a stethoscope on the chest and listening to the heart sound for the first time. To be able to recognize a murmur or to be able to put in an oral airway and to be able to actually not only visually be a part of it, but to have that tactile part too. The sim models are really neat. They do everything, they even talk back at you so you've got to be careful with what you say. No they're really unique and the IV portion of it, there's actually a sim model arm off our pediatric sim model which is really nice because it doesn't give away all the [vena 00:21:46] puncture areas but it actually allows the person to be able to actually have that hands-on time. It's really fun. 

You're able to set up, prepare, plan ahead and that's really where the safety comes in because once you're able to go through a scenario, hang the IV solution, people don't even think about IV solution too much and what actually it's made out of. It's actually a medication so if you're hanging with D5W, it has actually sugar in it or if you're hanging a bag that's a [colloid 00:22:25], it might be changing the makeup within the vascular system and pulling fluids towards it to increase blood pressure. There's a lot of different things to discuss to broaden peoples alertness to what they're doing with the IV and then actually being able to handle it, puncturing the bag, spiking it, priming the tubing, and most importantly, being able to actually start an IV, isn't as easy as it sounds. Just like Dr. Mancini said, our average patient population now is adult population and kids too, are a little bit more overweight, they have more medications on board and they have more going on and people are living longer. Having that chance to ask questions while you're actually trying to attempt a brand new skill is pretty unique. 

Howard Farran: I have a lot of friends that have always done IV sedation, obviously you either do it or you don't, it seems like the ones that do it and have been doing it forever, they always have much larger practices because I think that fear is the major issue. I think dentists always think about price, they always think about insurance, should I take this PPO or whatever but there's a lot of people where fear is a ... Fear is hugely irrational, they might come in with 20 body piercings and 10 tattoo's but can't have a shot. You're like, "Dude, your sleeve, how many shots was on your sleeving? You've got your ear pierced 9 times and a bone through your nose but you're not going to let me give you a shot." Fear is hugely irrational and it seems to be a big game changer in the practices that do it so sedation ready, you feel you can go in there and get them up to speed on a weekend? 

Julie Wilcox: No, we're not all about covering everything in a weekend, it takes a lot more time than just one course to be an expert at something. It's life-long learning so what we, what I do in my portion of the course is just get the foundation established. Getting people the ability to anticipate something coming. Being able to actually assist the doctor at the time of an emergency, instead of actually just for the very first time handling a bottle of medication and not knowing the dose and not having injected air and drawn out medicine or where the IV supplies are, what size you should grab, all of those things, being prepared ahead of time is huge. I definitely don't feel that anyone is ready to give IV sedation in a weekend. That's just my opinion.

Joy: I guess the important thing to know about with our course is it isn't about ... It is definitely about the emergency and how to handle the emergency, but 90% of emergencies actually should have never happened. If the person would have realized the steps that are happening to actually calling 911, the EMT's or paramedic's arriving. It's how do you mitigate those risks that you have when you're doing a procedure or you're having people walk into your office with high anxiety. Dr. Mancini starts his lecture with the statistics of the number 1 fear is public speaking the 2nd fear is going to the dentist and then I think the 3rd is death. People actually are scared of speaking in public and a dentist than they are of death. 

It's being aware as a provider and your assistants being aware that the minute someone walks into your practice, you're evaluating them, you're evaluating their level of anxiety, you're evaluating their physical appearance, you're making sure that your protocols include understanding what other factors may cause issues such as diabetes or medications that they're on or whatever. Obviously with our population of kids there's not quite as much medications that may cause risk factors but it's really that whole process of, all the way from the person walking into the door, through the procedure, avoiding that medical emergency and then having appropriate care after they leave your practice. It's really being able to identify that, even while ... For us, we use a pulse ox and Dr. Mancini has a stethoscope that he has ... I think he puts it ... Where does he put it? 

Julie Wilcox: It's a pre-cordial stethoscope. 

Joy: Yeah, throughout sedation-

Julie Wilcox: It can be put right here, where you can listen to lung sounds and heart sounds at the same time while you have your hands free. It's attached to a little earpiece that you have molded from an ear company so you can listen to your patient the whole time you're working and be in-tune to their hemo-dynamics, their blood pressure, you can tell all that by that. Anesthesia uses that all the time.

Joy: Yeah, it's knowing your instruments but also knowing the shortfalls of your instruments because of the travel time for oxen-oxen-

Julie Wilcox: Oxygenation.

Joy: Oxygenation.

Julie Wilcox: Oxygenation, that's a mouthful in itself. 

Joy: Of the blood and so, all that kind of stuff. It's talking through that whole process and what's great with both Dr. Mancini and Julie is the level of experience that they've had. Julie's had 20 plus years of experience from being on crash teams and actually having medical emergencies in the hospital to running her own anesthesiology practice. The people that are providing the information are highly educated, highly skilled, hands-on experience and then imparting that knowledge not just by speaking it but also guiding them through the process. We have the 2 days of both lecture and hands-on and then in addition to that, we have the practices evaluate their office protocols from patient intake through patient procedures and then also their medical emergencies. Julie then, or the team evaluates it, and then after the seminar we do a call to really go through in detail what they've done, so they get that practical take-away to really get to the point where their office is not going to be in the news. 

Their office is going to be, instead of being the, "Let's cross our fingers nothing happens," they feel completely comfortable that they're covered and really, what we're hoping that this will become as we continue to grow, is it'll be an annual thing that people come back to because, like Dr. Mancini was saying, that knowledge attrition. 60% of knowledge is gone after 4 months so coming back and re-evaluating and learning new things, I think they've changed the CPR courses every year they have some new change in CPR and so it's really making it a repetition so that you just ... It happens, you get that rush of adrenaline but it doesn't wipe away all of your knowledge.

Julie Wilcox: We actually include a full year of follow up with everyone who attends the course. They can reach out by phone or email and we get back to them. We actually answer their questions and if they've got something coming up, they have a concern, they can reach out and give us a call and we'll be there for them. That's really unique, is that follow up portion that you were talking about Joy. We also keep it really fun and light and so that as a team, people are able to communicate freely and they're not intimidated. Keeping it simple, the simple principle or that type of thing, is really important with medical things because that communication may not be there, it may not exist because there might be that hierarchy so when you have the assistants and the hygienist and the dentist all coming together and doing this workshop together, this course, and this hands-on portion, that's where you really get to see those unique dynamics within the team.

Howard Farran: You live in Hudson, Wisconsin and the other 2, Mrs. Mancini and you live in ... Where in Minnesota?

Jaden: I live in Cottage Grove.

Howard Farran: Is that a suburb of Minneapolis?

Jaden: St. Paul.

Howard Farran: Okay, St. Paul.

Jaden: Yeah.

Julie Wilcox: Joy is in Hudson and I'm in [Baraboo 00:31:57]. 

Howard Farran: Is your last Mancini now?

Joy: Not yet.

Howard Farran: Oh not yet, I'm sorry, I jumped the gun there.

Julie Wilcox: Very soon.

Joy: Yeah, right around the corner.

Howard Farran: Delay it as long as you can because the minute he gets the legal contract he'll stop cooking for you. You're in Wisconsin and that is close to Minneapolis, right?

Joy: Actually we're in a suburb, our home is in a suburb of Minneapolis too. We live in Woodbury. The office is in Hudson so everybody practices out of Hudson, Wisconsin but it's literally 30 minutes outside of St. Paul. 

Howard Farran: What made you guys get into this?

Joy: The sedation course?

Howard Farran: Sedation ready, yes.

Joy: It goes back to Dr. Mancini's frustration of how the courses were provided by other CE courses. He has the philosophy of the team and really saying, "Who's going to be by my side when I experience a medical emergency? Or when I experience something where I need my team to step in," it's not going to be Dr. Jones or Dr. Smith or Dr. whomever, it's going to be my team and I need them to feel just as comfortable and just as experienced going through this. He reached out to a course and said, "I want my team to experience this with me. I want them in the room hands-on with their ... " 

They had more of a CPR dummy, they didn't have the simulator that we have and he said, "I want them to have the same experience I did," and they said, "No," they said, "There's going to be other doctor's in the room, we don't want to take away from the doctor's experience," so Dr. Mancini said, "Well then I'll buy the room. I want them to come." They said, "No, we won't do it." He's like, "What course will let me do this?" They said, "No course will let you do it." He said, "Well then, I'm making my own course," because-

Howard Farran: I got thrown out of a endo course in San Diego. I won't say his name, he's one of the most famous [inaudible 00:34:11] but it's for endo-dontists only so I think I was 27 so I checked out the box that I was an endo-dontists, I just didn't say anything and he figured it out at 3:30, only an hour and a half to go and he made me leave.

Joy: Wow.

Julie Wilcox: Oh that's just, that's just silly. I don't understand that exclusivity.

Howard Farran: Tell me, what do you recommend because we do have dental anesthesiologists in dentistry and they've been trying to get specialty status for a long time, do you think it's better that a company like yours, Sedation Ready, prepares the team for everything but for the actual IV, bring in a dental anesthesiologist or do you think that should be a core competency specialty focus or do you think dentists can do the sedation and the procedure?

Joy: Are you talking ... Do you understand the question?

Julie Wilcox: Yeah, I do. Really even though there's ... Anytime you're doing ... Let's put it this way, the dentist has to be totally competent in what he's doing with that patient and actually some people can do 2 things at once, but most people can't, very well anyway. I sure wouldn't want someone leaving the room while I was deeply sedated. You need somebody watching you and monitoring you very closely and I feel that training's really important. For most people, and dentists, we're all in our specialty so it's important that once you reach that moderate to deep sedation, or even general of course, I think it's important to have a nurse anesthetist or an anesthesiologist or somebody that's specialized. 

Whether that be the dentists in anesthesia, when they've actually had that course work and it's appropriate for them to be in that role. What you find is everybody scrambling, you've got one person doing the procedure, but who's really watching the patient? That's my feel on it. Safety is key. A lot of people aren't very good at multi-tasking and it's a lot of liability. When you're running the show, you're responsible for everyone that's caring for that patient and you're supposed to be directly supervising those people. You're taking on a lot of risk and liability so it's not a good idea to be all about the money and be taking people that are anxious, because people pay anything, they're frightened. Everyone's scared of the dentist, even me. There's a fine line, you have to really be a patient advocate in that-

Howard Farran: I always here people say that public speaking is the biggest fear but I've never been at a funeral and heard anyone say, "Well at least he's not up there giving a speech." 

Joy: Very true.

Howard Farran: We're glad he's in a box, as they're lowering him down into the ground. Would you say that you're more about getting the office ready for this whole thing but if you're going to put them lights out, bringing in a dental anesthesiologist?

Julie Wilcox: Yeah, you need a professional for that. There's always exceptions to the rule. You might have someone very highly skilled dentist that's gone on to anesthesia training-

Howard Farran: I knew this-

Julie Wilcox: -I think it's rare, I really think it's very rare.

Howard Farran: I know this debate's been going on a lot around the world. I've heard this debate in the United States, I've heard it in the United Kingdom, where if you go into hospitals, they're not allowed to give the anesthesia and do the surgery. You can't do the bypass and run the IV, they break that out. Then when you go into dentistry, all day long, oral surgeons are doing the IV and doing the surgery and the ... That's a red flag there. Some countries are saying, "No more. No more."

Julie Wilcox: It's very, very dangerous. Look at all those people that went to plastic surgeons and remember the liposuction and how many people had died because of the tremendous fluid shifts within the body. It's a real scary situation.

Howard Farran: For the record, a lot of people think I've had liposuction and I have not. I have not. I'm also not pregnant. I want to dispel those 2 myths. It's a red flag to me that in the physician world you can't go in a hospital and run the IV and do the surgery but then in the dental world you do that. I think dental anesthesiologists, I got out of school in '87 and it seems to be a rising trend, getting more and more popular and I've also noticed some of the dental offices here in Phoenix, where all they do on the SEO marketing and Google and their Facebook and their Twitter, that they will put you to sleep and they do it with a dental anesthesiologist. They have huge practices because they're always getting that patient that hasn't been to the dentist in 10-20 years and they always need multiple big treatment plans or root canals, fillings, crowns, they're just huge cases.

Julie Wilcox: They're huge cases but you have to remember that nurse anesthetists or anesthesiologists, they both can do that. [crosstalk 00:39:44] Just like in the hospital.

Howard Farran: Explain to our viewers the difference between a nurse anesthetist, an anesthesiologist, a dental anesthesiologist.

Julie Wilcox: A nurse anesthetist first goes to nursing school and then specializes in anesthesia practice. Which is usually 3 years of study. I went to school a long time ago so for me it was 2 years and then a masters degree. Now the education is increasing. For an anesthesiologist, they are an actual medical doctor and then has gone into a specialty focus, which can be another 4 years in anesthesia, so they are a doctor of anesthesia. However, in the anesthesia world, both people perform the same exact jobs. Except one is a nurse anesthetist and one is an anesthesiologist.

Howard Farran: You think they're both equal substitutes in the marketplace? Do you think if a dentist has access to either one that you're good?

Julie Wilcox: Absolutely. Yep. The main key is that the dentist has to make sure that they have a qualified, credentialed, anesthesia provider that has privileges at the hospital that they utilize. If there is a crash, a person who goes down in the dental office, that dentist or the nurse anesthetist or dental anesthesiologist, has to be able to have privileges at that hospital too. You've already got that pre-setup and that's part of the course too, teaching people what the requirements are and what's needed. A lot of dental practices are way out in the rural area and it might, they might be up steps, maybe the paramedics wouldn't be able to get up with a stretcher or maybe they don't have access or it takes an extended period of time to get there. 

It broadens the mind to all of the considerations, just like joy was saying, from the minute the person comes in the door, you should be doing an airway assessment. Thinking about wow ... Look at the person and use every minute that you have to make that plan safer. To be able to anticipate because anesthesia, like they say in school, is 99% boredom, not really true but, 99% boredom, 1% sheer terror.

Howard Farran: You could say the same about pilots and marriage. 

Joy: Thanks for that.

Julie Wilcox: Thank you.

Howard Farran: Who's this person on the left here? We haven't heard from her yet. You have beautiful teeth by the way.

Jaden: Thank you.

Howard Farran: They're perfect, are those au-natural? Or is that braces and bleaching?

Jaden: I did have braces but no bleaching.

Howard Farran: Wow. Wow. Those are incredibly straight and white teeth. What do you do?

Jaden: I do a lot of the marketing, advertising, sending out email blasts, stuff on the website-

Joy: She's the master of INS. Basically taken Dr. Mancini's dream and made it a reality.

Howard Farran: I still thing the best marketing you can do ... It's what I call deconstructing the marketing deal, I tell this to people all the time. I the days of ... I think going to these dentists and giving them an hour of him so that they get to see him, they get to hear him, they get to form a relationship, I think going from an email to, "I'm going to fly him down to my city," is kind of a big jump but I think when they sit there and see him and hear an hour of the lecture, then they've heard an hour and they say, "Okay, I've listened for an hour, now I want to hear 2 days." 

You can deconstruct the deal. It's a lot easier to get them to go from nothing to an hour and then the same effort to go from an hour to 2 days. Instead of just going from, "I just heard of this guy and now let's do 2 days." I think, and a lot of those consultants that put up a ... I know an endo-dontist who put up an endo course on Dental Town and he got booked for 76 speaking engagements ... 

Julie Wilcox: We want to be able to reach out to everybody. It's really important, even all the anesthesia conferences that I've ever attended, they're all huge lecture halls with 3 to 500 people so there isn't that quality time for questions and answers and that's what's really, really unique about us with Sedation Ready.

Howard Farran: The reason I try to get you guys on, and by the way, I have no connection with companies to my podcast listeners, you're talking about 7000 of us. They don't pay me to be on here, I don't pay them to be on here, there's no money changing hands but the reason I wanted you guys on here is because it's been a bad year in social media for dentists and anesthesia, they only thing that took the anesthesia deaths off the front lines was some dentist shooting a lion and another pediatric dentist and a hygienist hiring a hit-man to kill her pediatric dentist, did you hear that one? 

Julie Wilcox: No!

Jaden: No!

Joy: No!

Howard Farran: Yeah, a hygienist was jealous her boyfriend was dating a pediatric dentist so she hired a guy to shoot him. Before those 2 events, dentistry was in the news usually because someone died in there and it usually had something to do with sedation. That's still a huge issue and all people only know what the know, they don't know what they don't know and I agree completely with Andy 1000%, I've seen what are the common traits of successful people? When you go to a seminar and there's 300 people, it's always the left side of the room is 200 individual, dentists, that come by themselves and then the right side of the room, is the same size room but it's one dentist who brought, the whole row is their staff. Whenever you see the dentist who always takes the entire staff with him to the seminar, both assistants, the hygienist, both receptionists and even their spouse, oh my God, those offices are twice as happy and healthy and functional and profitable and money and then the guys on the left, they just don't get it. Dentistry is not a dental event. 

It's a dentist, it's a receptionist, it's a hygienist, it's your spouse. It's a team culture and the culture starts from the head down. The Italians say, "A fish rots from the head down," and if the head's not in the right place, the rest of it is all rotten. I totally applaud this entire team approach, everybody has to be on board, I think from a ... There's 9 specialties in the American Dental Association, one of them is public health and the dental anesthesiologists are trying to get on there and I almost think dental anesthesiologists is a form of public health because so many people don't get access to dental care because of fear. 

Dentists are always the first to blame everything on money but these American's, they all have a car, they all have a cellphone, they all have a computer, they all have trips to Disneyland, they all eat out at fast-food, they buy $300 worth of ... They buy $300 worth of fast food. Even happy hour, one drink, you could have bought a 12 pack. American's waste all their money but there's a lot of people with really bad teeth and a lot of oral systemic health issues because they're afraid of the dentist and it doesn't have to be that way. 

Julie Wilcox: I lost a friend who had a tooth abscess that did not get it treated, didn't tell anyone that he was sick. He became septic and actually passed away.

Howard Farran: I lost one patient from that too and her name was Charity and she was 5 and it was the saddest thing ever and she had a toothache and she needed to come in and she didn't and it went down into her throat and she suffocated in the middle of the night and I swear to God, her mother aged 10 years in a year. She just looked ... I almost think it would have been better if it had killed the mom and left the baby. It just killed her. Killed her.

Julie Wilcox: Oh absolutely, yeah, and that's what we don't want to have happen. Kids, everyone is so precious and each individual is truly unique.

Howard Farran: I want to thank you for all your time and I want to thank you for coming on here today, I applaud your mission. I applaud the importance of what you're addressing. It's far more important than what bonding agent you should be using. This is the most critical stuff. Like you said, in some of those narratives that we've read from these fatalities, they didn't do anything right. They left them sitting up in a chair, the ambulance people are saying, "The chair was erect, the head was forward," and it's like my God. The doctor's running down the hall, the assistant doesn't know what to do. It's just crazy.

Julie Wilcox: Disaster. Disaster.

Howard Farran: I do, I hope, if you're the marketing guru, I think you should be a course on Dental Town. It's very counter intuitive because ... Consultants make this mistake all the time, they say, "If I get on Dental Town and I tell them what I know, then they're not gong to hire me," it's exactly the opposite. The dentist doesn't want to hire a consultant if he doesn't know how she thinks. He wants to know how does this person think? Then when she says what she's going to do the dentist says, "That's a great idea. I know I'm never going to get it implemented so I'm going to write a check and give it to you because I would love for you get this implemented." 

When the dentists watches that and says, "Wow, I like that," and "I need my office on board," then they're going to call you and say, "Come on down and get my whole team involved," and then plus, every dentist knows the most important thing you learn on continuing education is that your staff doesn't believe you because you're just ... I'm from Kansas, I was born in a barn, I'm not the classiest, most cultural guy, I don't use enough deodorant or cologne but when somebody comes in 100 miles away from home with a power point deal, that person is God. That's why I take all of my staff with me because if that person up there lecturing says it, they're all taking notes and if I say it, they're all like, "Oh that's just Howard. Someone throw him a cheeseburger and he'll shut up." Deconstruct the sales process, the more information you put out there, the more of that course you give away, the more they're going to come and write a check and ... Thank you ladies for your time.

Julie Wilcox: Thank you so much!

Howard Farran: I'm here in sunny Phoenix, Arizona so if it ever gets too frozen cold up there and you think you're going to die, just come on down and visit me in Phoenix.

Julie Wilcox: Sounds good, thanks Howard.

Joy: Thank you Howard!

Howard Farran: Good luck on your courtship and your dating and your marriage and ... What's his favorite Italian dish that he cooks?

Joy: Lasagna.

Howard Farran: Lasagna. Yeah. My son Eric, I was lecturing in Venice and I took my oldest boy, Eric, with me and you just think, this is America, there's lots of Italian's that live here so there's good Italian restaurants all over America and you think, we have the best Italian food in America too and we just don't.

Joy: We don't. 

Howard Farran: It's just not like Italy.

Joy: It's completely different.

Howard Farran: Yeah, it's completely different and even when you go to an Italian restaurant and you know the whole family's Italian, I don't know if they're doing American Italian or whatever but it's not as good as Italy. Thank you for your time ladies.

Joy: Thank you!

Julie Wilcox: Thank you!

Jaden: Thank you!

Howard Farran: Bye-bye.

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