Dentistry Uncensored with Howard Farran
Dentistry Uncensored with Howard Farran
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209 Stress-Free Dentistry with Louis Kaufman : Dentistry Uncensored with Howard Farran

209 Stress-Free Dentistry with Louis Kaufman : Dentistry Uncensored with Howard Farran

10/27/2015 10:51:03 AM   |   Comments: 0   |   Views: 579

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AUDIO - HSP #209 - Louis Kaufman

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VIDEO - HSP #209 - Louis Kaufman

Learn how to perform better, minimally invasive dentistry with NuCalm, CBCT, and by living a healthy life.

Dr. Louis Kaufman is a nationally recognized educator, author and practicing clinician.  He is a graduate of the University Of Illinois School Of Dentistry.  Being highly experienced with LUMINEERS®, he has successfully completed over 1,000 patient cases in the Chicago area and continues to tour the country to train and educate other dental professionals about LUMINEERS® and other major dental procedures.  In 1995, he joined his father Richard’s well-established 60-year-old General Dentistry practice treating 3rd and 4th generation patients.  Dr. Kaufman serves on the advisory board of numerous dental manufacturers, consults on product development and educates clinicians around the globe.  He lectures at approximately 20 continuing education programs annually and has published numerous articles focused on restorative and cosmetic dentistry. Dr. Kaufman holds professional memberships in The American Dental Association, The Academy of General Dentistry, The American Academy of Cosmetic Dentistry, and The Chicago Dental Society, The American Academy of Dental Sleep Medicine, The Academy of Laser Dentistry and Illinois State Dental Society.  Areas Of Special Interest: LUMINEERS, IMPLANTS, Cosmetic Smile Design and Three Dimensional Imaging.

Howard Farran: It is a huge honor for me today to be interviewing who I consider a legend in dentistry, Louis Kaufman. Louis, thank you so much for spending an hour with me. You're a nationally recognized educator, author, practicing clinician. You're from the University Illinois School of Dentistry, you're highly experienced with Lumineers and have successfully cleaned over a thousand patient cases in the Chicago area. That is just amazing. You must know and be friends with Bob Ibsen.

Louis Kaufman: I am.

Howard Farran: You are.

Louis Kaufman: What a great guy. What a mentor he was for us.

Howard Farran: He was the one who bankrolled Dentaltown. In the beginning, the first year of Dentaltown, it lost one million dollars and he was the only guy buying ads on my magazine.

In 1995 you joined your father's well established 60 year old general dentistry practice treating third and fourth generation patients. Your dad and grandfather and great-grandfather were all dentists?

Louis Kaufman: Nope. No, just my dad.

Howard Farran: Just your dad.

Louis Kaufman: Yeah. Dad had been practicing 45 years at that point.

Howard Farran: Do you think dentistry is a genetic disease, a recessive gene?

Louis Kaufman: I think it could be somewhere in there. That's a good possibility.

Howard Farran: You're a consultant with all kinds of companies, you're published, you're just the man. There are so many things, I don't even know where to start with you. I want to start with something .... Let's start with Bob Ibsen's deal. He's 83 years old and he's been saying from day one that you don't have to cut off a millimeter and a half of- you don't have to strip off all the enamel to do veneers. I've always agreed with him. 

You see other segments in dentistry coming out calling themselves minimally invasive dentistry. One, I'll never forget the oldest dentist that ever went to my lecture. He was like, I think he was 96 or 98. He told me, he said, whenever you see a 95 year old lady, the only tooth left in her mouth is the one a dentist never drilled on. He goes, it's always going to be a canine and two bicuspids on the lower left and a canine and one [bicuspid 00:02:11]. He goes, don't touch the tooth. First do no harm. Now you see the [inaudible 00:02:16]

Let's talk about veneers because they're going to say, Louis if you don't cut off a millimeter and a half they're going to look bulky. I think that's crazy because the woman's already bleached her hair blond, no one thinks that's natural. She's got all this clown red lipstick on, no one thinks that's blood flow in her vermilion border. No one looks at her and says wow you have massive circulation in your lips. Boob jobs are usually anti-gravity. They're on four inch pump heels and they got these foot long fingernails on. No one looks at their fingernails and say, wow you must eat a lot of milk and cheese. Your nails are amazing.

Why is this dentist not see this person dressed like a clown and then say, oh but when it comes to your teeth, I need to strip off all the enamel on your teeth because that'd be a really good idea for the teeth.

Louis Kaufman: I think, you know what it is? It's so easy to cut down the tooth as we know. How long's it take to cut a crown down? Five minutes maybe, or a minute if you're Omer Reed. You can move quickly cutting crowns. Takes more time than planning going into a minimal prep veneer. You got to plan the case out well in advance, you got to look at the models, look to where you need to reduce. 

Some cases should go into ortho first. Some should be going to Invisalign first. Some cases can be really jacked up, rotations, crowding, crossbite. You're not just going to go ahead and put veneers on that. You're going to do the Invisalign first, get that arch formed where you want it, and then you go ahead and recontour the soft tissue if needed, and then go in and gently modify those enamel surfaces and get rid of those sharp line angles. I think dentists say, that takes more time because you got to think. 

When you cut a crown, you've been doing this how many years?

Howard Farran: God I hate thinking. 

Louis Kaufman: Okay, a lot.

Howard Farran: I graduated in '87 so I've been out there 28 years.

Louis Kaufman: Okay so you got eight years on me. I changed careers later in life. That's a whole 'nother story.

Howard Farran: I got eight years and 50 pounds. Don't forget the 50 pounds. I'm committed to obesity. I have to snack several times in between meals to keep this weight up.

Louis Kaufman: I snack in between patients too. Where were we? Centered centered.

The veneers, they take time. Cutting a crown, five minutes, boom you're done. If it takes you ten minutes, you're actually refining more. At this point I can do it with my eyes closed. Don't recommend that. Veneer preparations you have to take your time thinking about it, minimal prep. Do I have the room? Today's day and age, we're not doing feldspathics as much, but the e.maxes and the synthetics we're able to build in with the glasses now and the printing. We're in a whole different age than we were 20 years ago. That's what I'm saying.

Bob Ibsen was straight on in doing minimal prep. I have veneers. These are minimal prep veneers. Tetracycline staining.

Howard Farran: Really you had tetracycline stain?

Louis Kaufman: Yes sir.

Howard Farran: Basically when you were- when your teeth were still developing as a baby that a physician gave your mother tetracycline for her or you had a cold or-

Louis Kaufman: I had it as a kid probably was what one year old, two year old. [crosstalk 00:05:29]

Howard Farran: Does your mom remember why you needed it? Was it an ear infection or did she remember?

Louis Kaufman: No. You know what? I haven't asked. I don't know if she'd remember now. My mom's 91.

Howard Farran: Wow. Your mother's 91?

Louis Kaufman: Isn't that amazing?

Howard Farran: How old are you?

Louis Kaufman: 53.

Howard Farran: Oh we're the same age. That's right. I forgot that. You know you're old when you can't even remember your own age.

Louis Kaufman: And you're writing everything down.

Howard Farran: You're 53 and your mom's 91. I wish I took geometry so I'd know the ...

Louis Kaufman: She was 37 when she had me. 1962 was when I was born. Same as you.

Howard Farran: Your mom was 37. My mom was 39 when she got pregnant with my brother and she delivered him at 40.

Louis Kaufman: Whoa.

Howard Farran: Huh. That is amazing. Unbelievable. Does your dad, how old's your dad?

Louis Kaufman: 91.

Howard Farran: How old was he when he retired the drill?

Louis Kaufman: Dad hung it up six years ago so he was 85.

Howard Farran: Oh my gosh. Are you [kidding 00:06:31]? That is so romantic. I love it on Shark Tank when if you're presenting an idea and then you talk about how then you're going to sell it in three years, and Mark Cuban always says if you got an exit strategy you're not in this and for that reason I'm out. All these people always come to me all the time and say, you got to develop an exit strategy. I always tell them my exit strategy was I'll be found dead in the operatory.

They asked Mother Teresa, they asked her before she died, she got the Nobel Peace Prize when she was 69 years old. They said what would you do if you found out you were going to die in a day? What would you do your last day? She goes I wouldn't change a thing. I would just keep on plowing my garden. I live each day as if it's my last day. I'm in my routine and this is what I do.

Louis Kaufman: Amen.

Howard Farran: I have my routine, I have my little Iron Man exercises in the morning and I have my podcast and I see my patients and I write my- I just have a routine.

Louis Kaufman: Becomes a routine, right?

Howard Farran: Yeah. I love it, I love my life and I wouldn't change anything if they told me I had six months to live.

Louis Kaufman: No. You love it, you create it, you have to create it. You have to want it, you got to do it, and you got to live it. I'm a guy of routine. I'm up 5:00 every day, I'm sure you are up early. You got your routine in the morning, boom you're at the office 7:00 reviewing your day. Done anywhere from 3 to 5 depending on the schedule and you got your time for working out and your time for doing everything. I love it. [crosstalk 00:08:00]

Howard Farran: I think it's interesting that you got veneers. I think that's so interesting. I'll never forget. I don't want to say his name because he passed away. There was this guy and say ... I'll just say his name, his name was Jim Pride. He was sitting there telling his lecture, it's like 1987, he was telling about how anybody in the world can sell [inaudible 00:08:20]. By the way this happened two different times and the other one was Walter Haley.

They would be sitting there saying, if you can't sell cosmetic cases you're not even trying. Blah, blah, blah. I raised my hand and I said, your teeth are brown, dark, gnarly. I said you have the worst teeth in the room so why didn't you get veneer?. He got all upset. Walter Haley was like five, ten years later, Walter Haley's giving the same spiel. I'm like Walter, your teeth could chew corn on the cob through a chain link fence so if everybody will accept cosmetic dentistry why haven't you? I love the fact that you walk the talk. You've done a thousand cases of veneers and you wear them. 

That's why male obstetricians and gynecologists kind of died. In the fifties and sixties they were telling all these women it was all in their head. All these women were like, you're a man, you don't know what you're talking about. You don't find many women who will go to a male OB/GYN.

Louis Kaufman: Can't relate, man.

Howard Farran: Yeah. They want someone who's had a period and had a child.

Louis Kaufman: Yeah. I call myself a dental cripple. I've had so many dental procedures in my lifetime, not because I wanted them, I needed them.

Howard Farran: Isn't that interesting to talk about? You would think if your dad is a dentist that you had the home care, you had the fluoride treatment.

Louis Kaufman: You would've hoped. I was a snacker. I didn't listen. I was a rebel.

Howard Farran: You think it was diet or you think it was genetics?

Louis Kaufman: I think it was genetics. Absolutely genetics. I am a firm believer. You see it every day, familial, you've generations of patients now. A husband and wife share spit if you will. We know the bacteria's shared, we see the breakdown. 

Howard Farran: I cannot tell you, this is anecdotal evidence and you're not supposed to do it, but I love it when someone says that's anecdotal evidence. I just point to them out, there are no double blind random clinical trials on that a parachute works. No one has ever thrown 100 people out where every other one did not have a parachute and definitively prove that a parachute saves lives. It's anecdotal evidence to say that that big parachute slowed you down. 

I have seen so many parents, say they look different. Say the mom is more dark skinned and black hair and the dad's more fair skinned and blond hair and they got four kids. Two of them have dark hair and two of them have light hair and you see it. The mother said when I was a little kid I was always at the pediatric dentist, I was always getting [inaudible 00:10:43] crowns. The two dark kids are like that. Then the dad, he doesn't brush, doesn't floss, he's only had a few fillings and his kids come in with Butterfingers stuck in between their teeth and they've never had a [cavity 00:10:56].

I've seen 28 years I've seen so much evidence that there is a genetic factor in obesity, in dental decay, in all these things-

Louis Kaufman: I agree with you 100 percent.

Howard Farran: We only know what we know. I bet a thousand years from now, everything we believe is going to look just as silly as what we think of when we go back a thousand years ago and look at the Vikings sailing around in their little wooden boats.

Louis Kaufman: True, true. The advances that will be coming down the road are amazing.

Howard Farran: There was probably genetics in play with you. You probably had more of a susceptible immune system to gram negative faculative anaerobic bacteria in your mouth.

Louis Kaufman: Absolutely. Hands down. I've had the root canals, I've had the extractions, I've had three implants right now. I've had periodontal issues where I had flap surgery back 15, 20 years ago. You live through it, you follow the hygiene that we prescribe to our patients.

Howard Farran: My most sad patient that I always felt the most pain with, especially in the eighties when I was young at this, was a hygienist who did everything proper all day long every day and she couldn't, she had root planing and gum surgeries and losing teeth. She would cry and tell me that she does everything perfect, she doesn't do anything wrong, and it's still- I'm like, it's not you. Just relax it's not you. Just like my male pattern baldness wasn't because I used the wrong conditioner.

Louis Kaufman: Right exactly. It's just that we're programmed a certain way. Those genes were handed down. That's the cards you were dealt, we were all dealt.

Howard Farran: What do you want to tell these kids about minimally prepped veneers? We've got about 7,000 listeners per show and anytime someone emails me I always reply tell me your demographics. They're always under 30, every email I got today was from a fourth year dental student. They said they listen to podcasts in the back of the room while their boring teacher is jabbering on about other stuff. 

What do you want to tell these kids about minimally prepped veneers? All they're going to hear is peel off all the enamel like bananas. Talk to 7,000 kids under 30 about minimally prepped veneers.

Louis Kaufman: My advice is get the right arch form to do your minimal prep, make sure we got a really good bite, no crossbites involved, and take your time studying the case, look to where you have to reduce .5, .7 of a millimeter of enamel. You're still creating some room for the laboratory. They're easy to do, they take more time. It's easy to cut teeth down. That's what you have to remember. It's easy to cut a tooth down, you can't put the enamel back once you take it away. 

It's rewarding not to damage a tooth. If we look at our Hippocratic oath, do no harm, I think they need to remember that. Don't do any harm. You're going to still give the patient the best result that they want. You're at a time in dentistry where all the software technology is available to make use of. You can properly plan the case out doing it that way.

Take your time, don't be in a hurry to cut a tooth down so fast. Conservative dentistry goes a long way.

Howard Farran: Speaking of Shark Tank, did you see the dental case, the dental company on Shark Tank the other day?

Louis Kaufman: No I didn't. I didn't.

Howard Farran: I got four boys and three of them still live with me and that's their favorite show. We only watch  television twice. It's during an Arizona Cardinals football game on the NFL or it's Shark Tank. That's pretty much the whole menu right there. 

Anyway, everybody knows that when an older lady gets ortho and she's got the brackets on, all those little wrinkles around her lip go away and there's a response to it. This guy had a product where just one hour a day you put on this thing that snaps onto the front of your teeth and pushes out your lips two millimeters. He has all these before and after pictures, it actually causes a response of the lips swelling connected to whatever and the wrinkles go away. It's just obvious.

Another thing about no prep veneers or even when you're building a denture, a little fullness- women are already doing Botox, they're already doing dermafills, there's no reason to shave off all their millimeter and a half enamel and jeopardize the tooth, which 10 years later, probably 10, 20 percent of these need root canals, or crowns or whatever.

Louis Kaufman: Absolutely. [crosstalk 00:15:26]

Howard Farran: If she says they're a little fuller, say yeah, we want your lips a little fuller and a little more vibrant.

Louis Kaufman: What a genius idea.

Howard Farran: Again, I don't see any American woman- I just went to the Arizona Dental Association Fundraiser Ball for their clinic. When women get all dolled up, the word natural never crosses anyone's mind. 

Louis Kaufman: Uh uh. Uh uh.

Howard Farran: From their head to their toes there's nothing natural going on.

Louis Kaufman: It's all painted on.

Howard Farran: Yeah.

Louis Kaufman: It's nothing natural. [crosstalk 00:16:00]

Howard Farran: Another thing that you do that's very rare is you're kind of a dental unicorn, you're jumping on that NuCalm. Tell us about NuCalm.

Louis Kaufman: [crosstalk 00:16:09] I got involved with NuCalm six years ago. When I first heard about it-

Howard Farran: Jim Poole? Was that his name?

Louis Kaufman: That's Jim Poole, Solace Solutions. What an incredible company in terms of transparency and communicating with you as a provider.

Six years ago when I first saw it, I was very- I'll be honest, I was skeptical, Howard. I was thinking, how is this going to work? You're hooking up some headphones, some block out sunglasses, you're chewing some pills, and you're hooked on a CES device.

Howard Farran: Hooked up to a what device?

Louis Kaufman: CES, Cranial Electrical Stimulation. Goes right behind the ears. I was in Las Vegas with Mike Miyasaki. We were, I think it was a [Deadmat 00:16:52] lecture. We had had a great time the night before and Jim approaches me, like, yeah check this out you got to try this. I said what is it? He said come on up to my room. I said Jim I don't swing that way.

Howard Farran: You thought it was Bill Cosby trying to give you a sleeping pill.

Louis Kaufman: Mike and myself we went up to Jim's room. We listened to this short spiel if you will on NuCalm. I said okay I'll try it. I ate the supplements, which is GABA, gamma-Aminobutyric Acid, which is a natural substance that occurs in your body. It helps stimulate sleep. L-Theanine helps the GABA uptake.

The CES device that you use is used for anxiety and stress, it'sbeen around 45 years, very natural, it helps that uptake in the GABA. You put on a set of headphones and what's playing, you're hearing, is classical music but in the background what's playing is a binaural beat. You're not even aware of it. Brings the brain waves down to a alpha wave length, like a pre-sleep state.

You put on these block out glasses or a block out mask, your visual stimulation is now brought down. That's shown to reduce your sympathetic response almost by 35 percent so increasing parasympathetic response by 35 percent. What does that mean in English? We're all hyper, we have a lot coming at us all the time in our lives. From stresses of being a business man, working, kids, patients. Now all of a sudden, you're going to the dentist, you're in the dental chair, right? That's not a great place to be. Nobody likes sitting your dental chair and looking forward to that shot. 

If I can make every day, that's one of the things I do is try to make every day an exceptional experience for my patients so I can get the best clinical outcomes, I'm looking to do that. What NuCalm does is it helps relax this patient down, very simply and easily, it helps bring in this parasympathetic response. The sympathetic nervous system is calming down, parasympathetic is building up, and you get to this meditative state.

You do yoga I believe, Howard, don't you?

Howard Farran: Yes.

Louis Kaufman: Okay. I can't remember the name of the Yoga gurus who get to that trance like state, that meditative state. What's interesting is some of the studies that have been done with NuCalm brings down your variable heart rate really low and it shows your brain activity decreasing. You're getting to this restful state. Imagine working on a patient that's completely calm, not moving, their gag reflex is now reduced, their muscle tension in the masseters are reduced, temporalis is reduced, their jaws are able to open up more. What does it allow you to do? You become more focused. You don't have to play that always that clinical psychologist. 

Getting back to Las Vegas. I tried it I was like wow this is really cool, I want you to bring it out to the office. First patient I did NuCalm on, it was a big man. He was probably about 280, about 6'4" had to do four root tip extractions. Guy was very fearful of sitting in my dental chair. Got him on the NuCalm, put topical on, anesthetized, this guy was not moving for the world. He was one of the most relaxed patients I had. I never forget looking down the hall looking at Jim and saying wow this is incredible. What an amazing response.

We have four systems in the office now. From that point moving forward, because I was one of the first dentists in the country to use it, it's now been approved by the US Military. It's being used by professional athletes, cancer patients, post traumatic stress disorder patients are using it as well. It's being used in more industries, we're not just finding a dental benefit from it. For dentists, it's making that whole experience in the office better.

When a patient, you take off these headphones that have relaxed the patient, they're like wow, this is great. I have patients now asking for NuCalm when they come into the dental office. They don't want a hygiene appointment without it.

Howard Farran: I was looking up NuCalm on the Google. It's

Louis Kaufman: Yes sir.

Howard Farran: The CEO of that is Jim Poole.

Louis Kaufman: Correct.

Howard Farran: I've always thought since when people say fear is the biggest inhibitor to dental deal, I call baloney and say it's cost. I have more people worried about the money or not getting it done for money and finance. I'd say finance is definitely number one, but I think number two is cost- I mean number two is fear. 

Louis Kaufman: I'm with you. I'm with you. Fear and cost sometimes go hand in hand depending on the patient.

Howard Farran: Yeah. You should do an online CE course on Dentaltown. You should just do one in general. You lecture-

Louis Kaufman: I'll do it on Dentaltown. I would love to do it on Dentaltown.

Howard Farran: I would love it. We put up 350 courses and they've been viewed over half a million times. I think it's like 562,000 times.

Louis Kaufman: It is so awesome what you- this is not to rub your butt. What you have done for our education, give you a big hug man. It's just [awesome 00:22:28]. I would love to do it. I'd be flattered, honored to do it.

Howard Farran: We would love to have it. Jim Poole, I remember, he's telling me about this several times. I just think that fear is just so huge. There's a lady up the street from me and she learned IV sedation. She told all the dentists in the neighborhood. She goes look I don't want your recall, I don't want anything. I'm only going to do IV sedation patients. She has one operatory and she does a couple million dollars a year from all these general dentists just sending them people that aren't going to have anything done. She puts them to sleep and she does the whole case and then sends them back.

When I see how booked out she is, all the time, fear's just huge. The other thing is with those fear people is if you can get them relaxed, they usually say dude if you're going to do this, I want you to do it all. 

Louis Kaufman: Right.

Howard Farran: We're not going to do one tooth a year dentistry for the insurance maximum. If you can get her done, I want to come in here one time and never see you again.

Louis Kaufman: Exactly. I want to get it done because it's time and time is money. Time is cost. You can have so much more comfortable.

Howard Farran: Okay. Realizing Louis that you're talking to so many young people, I want you to [inaudible 00:23:44]. Before you go into- you talked about learning veneers, you talked about NuCalm. The other things you talk about, like CBCT and surgically guided implants. This kid's coming out of school at 250 to $400,000 in debt. They can't become you over night, and you didn't become you over night. You've been doing it for almost three decades. Where do you think is the best return on investment? 

When you're talking about minimally prepped veneers you were saying Invisalign or unrolling these, they only got so much CE time and budget. When you're coming out of school give them a plan- what would you learn [forst 00:24:22] that business is supply and demand. What are consumers demanding that they would have the best return on investment? Would you want them to learn short term Orthoforce like Powerprox Six Month Smiles. Would you want Invisalign? Would you want them to start hands on surgical courses and get a CBCT? You can't throw a cat without reading an article on Sirona Cad Cam.

Louis Kaufman: Right. Right. Exactly.

Howard Farran: That's $150,000. The CBCT's $100,000. If you add up $400,000 in student loans, they buy a practice for 400, and then you add $150,000 CEREC, $100,000 CBT, and a $75,000 Biolase that combined-

Louis Kaufman: Over a million.

Howard Farran: That combined will almost equal the amount of their first divorce.

Louis Kaufman: Yes.

Howard Farran: Walk these kids through. What should they learn first?

Louis Kaufman: Bang for your buck.

Howard Farran: Yeah. Give them an order of bang for their buck. What would you learn first to build a practice? To build your unique selling proposition prac- you're in Chicago dude. There's a dentist on every corner in Chicago. Hell the American Dental Association-

Louis Kaufman: I'm in a unique area of Chicago. I'm in the Hyde Park neighborhood. I'm by the University of Chicago, widespread demographics.

Back to the kids. Kid graduating today, you got to know Invisalign. Bottom line. You got to get that [arc 00:25:45] straight. We're creating room. Let's say we got maybe 19 and 30 is missing and we're doing Invisalign. That brings you right to place implants, guided surgery implants. You can't afford getting a cone beam, I just saw an ad yesterday the mobile vans with the cone beam machines in it where you can have them come to your office, schedule a bunch of cone beams for that day and ...

Howard Farran: Nice.

Louis Kaufman: Get them in and out. I bought a Planmeca ProMax three and a half years ago, 3D. Love it. Best investment I've ever made.

Howard Farran: Planmeca what?

Louis Kaufman: The ProMax 3D.

Howard Farran: ProMax 3D. That's out of Helsinki Finland. Why did you pick that one? There's Carestream that used to be owned by Kodak, there's GALILEOS owned by Sirona. What made you go with the Planmeca? The reason I ask you is because whenever those decisions get six figures, it's not a easy decision. My whole motto with Dentaltown is that no dentist should ever have to practice solo again. You're a sharp guy, a smart guy, why did you pick Planmeca as opposed to -

Louis Kaufman: Kodak.

Howard Farran: Carestream or Kodak or ITI?

Louis Kaufman: [crosstalk 00:26:52]

Howard Farran: Yeah.

Louis Kaufman: They're all great machines, bottom line. They're all fantastic machines. What it boiled down to is, I liked the Romexis software, but before that, the footprint of the Planmeca unit is small. It doesn't take up a lot of space. 

I'm in a old bank building built in the twenties, so space is a commodity. If I could buy a piece of property at Hyde Park if I had an extra five million dollars I would. Can't. Out of the equation. The Planmeca fits perfectly where I needed it, has a software that was very user friendly, I like the customer service. That's why I went to the Planmeca route. I like the fact that it also had disability- people in wheelchairs, I have an older population as well. Easier for them to get into versus the other bulkier units that are out there on the market.

Getting back to the kids-

Howard Farran: That's interesting. I've never heard anyone say that size mattered when they bought their CBCT, but when I've lectured in 50 countries and when you go to some of these countries, like if you go to Tokyo, everything is being done in 1/4 the size of an American dental office. Planmeca, Helsinki Finland, that's a high density, metropolitan where everybody's on a bicycle anyway. That's very interesting.

Louis Kaufman: Cool stuff. Planmeca's awesome. I like what they're doing.

Howard Farran: You're in a 1920 old building with Jimmy Hoffa buried in the basement.

Louis Kaufman: And a few others.

Howard Farran: Size was a- size mattered. That's the first time ever even crossed my mind. In America, these dental offices are just so much wasted space compared to Seoul Korea, Japan, Moscow. You can find an eight operatory office in a 800 square foot building in Moscow.

Louis Kaufman: I couldn't even imagine what that stress level is working in a place like that. 

Howard Farran: Yeah.

Louis Kaufman: It's part of what we do. I've been working with Hanh Tran.

Howard Farran: I love him. 

Louis Kaufman: Yeah. We've been working together now in discussions for the last eight months on office space, about what we're going to do with my space or maybe move to another floor. That's a whole 'nother podcast issue.

Space was a consideration with the Planmeca.

Howard Farran: Seriously, if you ever want to come back with Hanh and you guys do a podcast just on all those considerations and everything you thought about, that would be a very interesting one.

Louis Kaufman: That'd be cool.

Howard Farran: Yeah.

Louis Kaufman: Absolutely. Absolutely.

Howard Farran: Yeah.

Louis Kaufman: Get the arc straight, learn how to do implants. Some of these kids are graduating with some knowledge on placing them surgically and for sure they're learning how to restore them. Implants are a slam dunk when you're dealing with lower first molars if you have the proper planning and the proper tools. Some cases need to go to the specialist, you need to work as a group planning those cases out, but the simple 19 and 30s or the 20s and the 29s or the upper firsts where you got plenty of room between the sinus, we got great anatomy to work with. With guided surgery today and the proper planning and a good lab, hate to say it again, doing it with your eyes closed, you're taking all this guess work out of the equation.

You want a good mentor to work with. I worked with a great periodontist in Chicago that he spent some time over the shoulder with me. I attended a course down in the islands, in Jamaica. There was four of us, we placed over 50 implants in four days.

Howard Farran: What course was this?

Louis Kaufman: It was given by a Doctor Mike Schulman. I don't think it was part of the AAID. I'd have to look it up. It's that memory thing as you get over 50. You know what I'm talking about. It was a wonderful course. We reviewed gross anatomy in an anatomy lab and then we went over the drilling sequences, et cetera. Then we saw patients the next day. We were in that facility 12 hours a day working on patients getting implants. We weren't using guided surgery either. We were free handing it.

Howard Farran: In Kingston?

Louis Kaufman: Yes. Yes.

Howard Farran: Do you recommend that they commit to a type of implant system and first find out who's going to train you? Did you find out what this- what is his name? Mike what?

Louis Kaufman: Schulman.

Howard Farran: Spell it.

Louis Kaufman: S-C-H-U-L-M-A-N.

Howard Farran: Mike Schulman. Where's he out of?

Louis Kaufman: I think it's Island Implants. He's out of New Jersey.

Howard Farran: Island Implants. Did you first call Mike and say, what system are we going to be trained on?

Louis Kaufman: This is interesting. I was giving one of my lectures, I don't know if it was cone beam or whatever. I'm talking to some doctors, I'm like, I want to get in implants this year. It's on my bucket list of what I want to learn. This is like three years ago. They said here's a course.

His name came up twice. Twice somebody's name's coming up saying how much they enjoyed it, I'm going to check him out. I called him up, got myself signed up for the course, and I went down to Jamaica and took the course.

Howard Farran: Wow. I love Jamaica. I lectured at the AACD meeting in Jamaica. I swear to God it's one of those islands where you thought, now why am I going home? Why don't I just get a job here at the resort I'm staying at, never come back?

Louis Kaufman: It was so rewarding.

Howard Farran: How long have you been placing implants?

Louis Kaufman: I've been placing them two years, two years this week. Happy anniversary.

Howard Farran: Two years this week?

Louis Kaufman: Yeah.

Howard Farran: How's it going?

Louis Kaufman: I am restoring at least one or two cases a week now, I'm placing four to six a month versus two years ago, I wasn't placing any a month. That's added to my bottom line, top line, let's go to the top line, about $150,000.

Howard Farran: A year.

Louis Kaufman: A year.

Howard Farran: Wow. That is nice. What a service to your patients. I still look at dentistry of the last century as we spent a century going out there in the farm, I'm from Kansas, building this wooden barn and then whining to grandpa and grandma that they got to brush it and floss it and use Listerine and tongue scraper and six and a half years later the termites come back and eat the whole barn. Now we're out there building aluminum barns. Now gram negative faculative anaerobic bacteria, just at this point, are not eating titanium.

Louis Kaufman: Exactly. How can you go wrong not doing it? That student coming out, get the [arch 00:33:31] aligned, get the space, learn how to place implants. The systems are getting simpler and simpler to place these implants.

Howard Farran: Okay. I want to ask you a question. You're a dentist, you have this patients had at 12:00, you're talking about a lower first molar, you've got a second premolar in front of it, you got a second molar behind it. You lay a flap, you see both sides of the buckle wall, why would you go through all the trouble of a surgical guide? Is that to avoid hitting the inferior alveolar nerve? Then explain how do you get a surgical guide?

Louis Kaufman: That's a great question. I love the question.

Howard Farran: You know why you love the question? My motto is I'll throw 20 of them out there and you'll grab one. You notice everyone of my questions is at least 10 so one of them had to be good.

Louis Kaufman: I'm a firm believer in the KISS rule, Keep It Simple Stupid. We all know that, that's Business 101. I can see the whole case, pre-plan the case in advance. Why flap the tissue when I can punch through the tissue? I know where the nerve is going to be, I know how much acrylic I have or I know my drilling sequence. It's all been pre-planned versus flapping open, drilling. I'm still checking with my pilot drill, my planning drill if you will, to see if my guide pin to make sure everything is right before I go step it up. To me that just makes sense. I'm placing implants now 10 or 15 minutes, one unit. Boom done. Start to finish.

Howard Farran: How long start to finish?

Louis Kaufman: 10 to 15 minutes.

Howard Farran: That's after the anesthetic.

Louis Kaufman: That's after the anesthetic. Guided surgery.

Howard Farran: It's funny because-

Louis Kaufman: That's cool.

Howard Farran: A lot of times we say something or we listen to something, we don't know what they've been hearing. In my right ear I got my good buddy Jay Resnick, oral surgeon in Southern Cal who does everything with a surgical guide. His rationale's if I get it right free handed 95 percent of the time, but 5 percent I send it back to the referral and the [inaudible 00:35:39] angle is wrong, he goes I can't do that. I'm a referrals based practice. I have to have a bulls-eye every single time.

Then I have other 60, 70, 80 year old periodontists and oral surgeons say I've placed 30,000 and I've never seen a surgical guide. What is this surgical guide you talk about? It's training wheels. You don't need it. Hogwash. Like all knowledge, the truth is in the middle, but you basically, what percent of your implants do you do a surgical guide with?

Louis Kaufman: Right now 100 percent. I stopped doing free hand.

Howard Farran: How do you get a surgical guide? Do you do this lab work?

Louis Kaufman: I send it to a lab, I have a couple different labs I work with.

Howard Farran: My viewers always want to know the names of labs.

Louis Kaufman: One is-

Howard Farran: I get in trouble.

Louis Kaufman: You get in trouble okay. I've done Implant Concierge, I've done 3DDX.

Howard Farran: Implant Concierge.

Louis Kaufman: Implant Concierge.

Howard Farran: What's the other one?

Louis Kaufman: 3DX.

Howard Farran: 3DX. 

Louis Kaufman: Then I have my guy Kevin out of Missouri. I think it's Dental Implant Solutions. I can get all these for you. I can actually-

Howard Farran: Yeah. We'll put that in the notes. Ryan, so he'll email that to my son Ryan. We always get a transcript of these because almost everyone that I've ever talked to is commuting to work for an hour. That's why they're an hour long. Almost everyone's got an hour commute that are listen to this. 

Louis Kaufman: Sure.

Howard Farran: My listeners don't have to take notes. We'll always upload the transcript on Dentaltown. We'll put that in the transcript notes. Implant concierge, do you know what city that was in?

Louis Kaufman: Implant concierge it's in the south.

Howard Farran: In the south?

Louis Kaufman: South. 3DX, Jersey.

Howard Farran: Jersey.

Louis Kaufman: Then Missouri is, I love this guy in Missouri, he does only BioHorizons right now. He's looking to get into another company.

Howard Farran: Dental, it's dental-

Louis Kaufman: I think it's Dental Implant Solutions.

Howard Farran: Implant Solutions?

Louis Kaufman: Yeah. I'll get you all the correct information and that way they can have it.

Howard Farran: They make your surgical guides too?

Louis Kaufman: You know what?

Howard Farran: All three labs make your surgical guides too?

Louis Kaufman: All three do. I do BioHorizon implants. That's the company I've started with and I like their customer service. [crosstalk 00:37:55] in Chicago is phenomenal.

Howard Farran: That's out of Alabama. That was a Carl Misch origination company.

Louis Kaufman: Yes.

Howard Farran: He was involved in the ground floor on that.

Louis Kaufman: Yes. [inaudible 00:38:03] picked them up.

Howard Farran: Did you ever go to any Carl Misch training?

Louis Kaufman: No I never did. I wish I had.

Howard Farran: You're using his system.

Louis Kaufman: I've gone to his lectures. I have not done his hands on. Some of the best lectures I've ever attended were form Carl Misch.

Howard Farran: I think it was the first time I ever saw an implant placed was Carl Misch. While he's staring at my face talking to me the whole time, he reaches in with a 15 blade and cuts from retromolar pad to retromolar pad, reflects it, sewing the lingual to the other lingual, the lingual in the back. The whole time I just wanted to yell at him, quit looking at me. Kind of like when someone's driving. It's kind of when you're in the back seat of a car and the driver keeps looking back at you while they're talking. You're like, dude just look at the street.

I couldn't believe it. He's talking to me the whole time while he sunk like eight implants on a lower jaw in what couldn't have been 10 minutes. My first implant case was like watching Mozart play the piano.

Louis Kaufman: It's like, please look at the road. Okay I got the name completely wrong. The BioHorizons lab is 3D Solutions and the guy's name is Kevin. Phone number 866-760-8821. He-

Howard Farran: Go ahead.

Louis Kaufman: What?

Howard Farran: You're sending them the models and they're making the surgical guide. Are they also using the CBCT data?

Louis Kaufman: Correct. I'm sending them a DICOM file.

Howard Farran: Over the internet?

Louis Kaufman: No I don't do it over the internet. I send the models and the disc together boxed up, send it out. I don't have a digital scanner yet for the office. I've been kind of waiting until we get a little smaller head on that sucker. Polyvinyls I'm quick with, I'm fast, and those work.

Howard Farran: One of those labs could do a very good free marketing deal if they showed the dentist on the other end how they reconstruct- how they make a surgical guide.

Louis Kaufman: We'll be printing them in our offices eventually.

Howard Farran: Yeah. Oh yeah. Greed and fear are the deals. With the dentist, the greed is I want to be able to do this, charge for it, this is fun, won't get a cavity. The fear is I'm going to hit the that inferior alveolar nerve, I'm going to get a parasthesia, I'm going to be sitting in a trial, I'm going to get spanked. I think if they saw how they can make these surgical guides and they were explained how that pilot won't hit the inferior alveolar nerve. Do you think with a surgical guide you could hit the inferior alveolar nerve and cause parasthesia?

Louis Kaufman: No way. If you properly plan it out, you've done guided surgery, you can see the course of that mandibular nerve as it's running through that canal. It's taking all that out of the equation. You've pre-planned it out. Unless you went in there blatantly and just jammed that pilot drill down, that's the only way it's going to happen and the guide prevents that from happening.

Howard Farran: If I was a lab I would build an online hour long CE course showing how the mechanic- dentists work with their hands.

Louis Kaufman: How's it done? How's it done?

Howard Farran: When you say export a DICOM file, they don't want to hear that. They want to see it. What is a DICOM file? Show me how you do it. How do you burn it to a disc, what button did you hit? Did anyone see the lab man? How do you get a disc and know where the damn nerve is. They want to see the details. Dentists are scientists. 

Louis Kaufman: [crosstalk 00:41:28]

Howard Farran: If you show them the whole sauce, they'll taste it. If I was a lab I would show the whole receiving end and I bet they get a lot of new clients and customers [inaudible 00:41:38]. 

Let's back up a little bit because Invisalign. Someone driving to work, she's 25 years old, she's never done Invisalign. How does she go from I've never done Invisalign case to doing an Invisalign case? What would be- talk her through the stairs. What would she do first?

Louis Kaufman: Google it. Get on there, find out where a local course is. You don't have one in your city, look for a city that's close and you go sign up for a one day course. I don't know if they're two day now. That's what I did when I got involved in Invisalign when they first came out. I was out in California. I was visiting friends so I made double trip out of it. I went for a two day down in Beverly Hills. Took the course and came home and I started doing sip- I'll never forget the instructor said pick the simple cases. The difficult ones, send them to the orthodontist. You can't do everything. That's why there are specialists.

Howard Farran: I'm too embarrassed to tell you how I did my first ortho cases. You want to hear?

Louis Kaufman: Sure.

Howard Farran: I signed up, I decided that I wanted to be taught by a board certified orthodontist, not a Holiday Inn course by a general dentist. The only one I could find was Richard [Lids 00:42:47] course called FORCE, Faculty Orthodontic Research Centers of America. He taught ortho at, I think, in San Francisco, I think UCSF, and then he went to Detroit. 

Then I said after that course I'm going to take Brock Rondeau, then Jack Sheridan. I signed up for four ortho courses for four years. I thought to myself I need a buddy to go with and all that stuff. I put an ad out for an orthodontic dental assistant and I hired an orthodontic assistant who'd been in a orthodontist for 15 years who was telling me at 24 years old, she goes, Howard, I don't need you for anything. I can trace the [inaudible 00:43:22], I've been doing this 15 years. I do my [inaudible 00:43:24] you don't know anything. I just need your license. 

I had her to start with and I was like 24 and she was like 45. She went with me to these courses and I actually learned 80 percent from her. She was real world tire hit the pavement, showing me every single case whereas a lecture was only like, I think Lit was a four day course-

Louis Kaufman: Three or four day course, yeah.

Howard Farran: Yeah. Brock Rondeau was like four times for a weekend. That wasn't nearly as much [edumacation 00:43:59] as this 45 year old woman who'd been a ortho- she loved it because her orthodontist never listened to her ever and I was this humble young guy saying yeah. You're the sensei-

Louis Kaufman: Thank you, thank you very much.

Howard Farran: I'm the young Padawan. You just tell me. It was so amazing and it was so great.

Louis Kaufman: [crosstalk 00:44:18] fun.

Howard Farran: Yeah. I'll tell you what, you pay a hygienist $40 an hour and she's in there doing $100 an hour cleaning stuff. Okay. You take a $5,000 ortho case, knock that out by 24 appointments and then the fact that you're paying an orthodontic assistant 20 and she's billing out about $300 an hour. One orthodontic assistant, that's more money than your whole hygiene department.

Louis Kaufman: I love that. That's fantastic.

Howard Farran: It's a triple, triple- plus the other thing I always thought is sometimes you get a little nervous when you go in there and you got a tough case to do and everything, but a hygiene check or an ortho check? By a hygienist that knows what's going on and a orthodontic assistant that knows what's going? Basically you're just going in there having fun like hey Louie how are you doing? What's new with you? How's your dad? How's your mom?

Louis Kaufman: Exactly.

Howard Farran: Yeah. They know what's going on.

Louis Kaufman: They make life easy on you. Team training, getting your help to be just the best they can be. That was lucky you had an orthodontic assistant like that. You found her. What a plus.

Howard Farran: I was looking for her. I specifically went looking for her.

Louis Kaufman: That's huge.

Howard Farran: When I opened up my office, I want to tell these young kids another thing, I felt bad because you're not supposed to discriminate and it's illegal and all this stuff. I put ads out for a hygienist and all these young hygienists would come out of school and everything. I thought okay I'm 24 I don't know what the hell I'm doing. The last thing I'm doing is hiring a 24 year old hygienist that just got out of school. The one I hired was the oldest one that applied. She was 56. I told her, I said, look I'm not hiring any young kids. I have no idea what I'm doing. She said you are so smart because I know exactly what to do and blah, blah, blah, blah, blah. 

Louis Kaufman: [crosstalk 00:46:02]

Howard Farran: She would read the X-rays before and she'd write down the fillings. I'd come in, I'd read them. I never got it right for at least six months. She was always like are you sure about the distal number three? I'm looking again. I was just young and humble. 

Again, she loved her job because the dentist she worked for was arrogant and got mad at her when she was telling the patient they needed to have treatment, or need to have a root canal. He would tell her she was diagnosing and breaking the law and going to get him sued. Here's this young humble guy saying just tell me what's going on. I basically learned so much from a 50 year old hygienist and a 40 year old ortho assistant.

Louis Kaufman: That's a great story man. That's so cool. You do. One of our staff members been with me 50 years, Howard.

Howard Farran: Are you kidding me?

Louis Kaufman: She has known me-

Howard Farran: Wow.

Louis Kaufman: Jackie's been with me 50 years. She's known me since I was three years old. 

Howard Farran: What position? Assistant, hygienist, front office? 

Louis Kaufman: Front office. She can do a little bit of assisting still, handles insurance claims, reviewing things, resubmitting. She's a jack of all trades. No pun intended. I learned a lot from this woman because she was smart, she was insightful, she knew how to read people, she understood relationships with people. Our business is relationships. You used to talk about in your book, time, money, people right? And some other things.

She taught me about people, but she was also aware of money and how you spent it and how were you using your time. She was a mentor to me. Now today- it was like family. We go back- you know what it's like when you're with somebody for so long, you spend more time there than you do with your kids. It's built a very good harmonious relationship. 

I have other people been with me 30 years. My head assistant for me she's been with me 10 years. My other assistants five and a few after that. We got a lot of longevity and it's about relationships.

Howard Farran: I couldn't agree more. I've always felt- I grew up with five sisters and played Barbie dolls until I was 12.

Louis Kaufman: I had three older ones yeah.

Howard Farran: I always felt that after a woman has worked with you for 10 years, you love her like a sister. You become family.

Louis Kaufman: Yeah. You do.

Howard Farran: I worry about them like I do my five sisters, I protect them like I do my five sisters. They've become family.

Louis Kaufman: They're family. You're darn right you worry about them.

Howard Farran: They absolutely drive me as crazy as my five sisters, but luckily I have one sister that's so crazy she makes everyone else look good. Also you were saying staying fit. This was a part of- this is a part of your secret recipe sauce.

Louis Kaufman: Absolutely. I dropped about 25 pounds since dental school. I always had worked out but I wanted to change my eating habits and get healthier. I have a sister who's a nutritionist. I went to see her. I said look sis, I said cholesterol's going up, this is going up, I want to stay off of medications. What do I need to do?

I'd always been exercising, so diet. She talked to me about diet, eating healthy, less snacking. I think we are in such a high stress profession, and I'm sure you can speak to this more than even I can Howard, you feel better. When you started training for the Iron Man. Your whole life changes, the way you feel, your energy level changes. You embrace the day, you can deal with stress better, you feel better. 

We as dentists we're in a high impact environment. We're dealing with a lot of personalities, we're diagnosing, we're doing intense focused work. You need a release. My release is I got into cycling. I actually had contacted you right before I bought my first bike. You gave me some suggestions. Since then I now have three different cycles for road and Cyclocross and mountain biking. I try to do maybe 50, 60 miles a week. I get out two or three times a week. Biking, that's become my passion, a habit. Or hit the gym.

I see many of our colleagues, I don't know about the younger ones, but many people our age that you need to get rid of that stress, you need to get rid of that release. You need to eat better. I abused my body a little bit earlier in life. I was that generation. I live a healthier, clean life now and I think that's critical that we have to eat well, make sure you're getting that eight hours of sleep at night. NuCalm, bringing NuCalm into the picture. I have my own home system. I NuCalm two or three times-

Howard Farran: Wait a minute. What do you mean home system? Talk about that.

Louis Kaufman: Okay. My home system is the actual NuCalm that I use at the office. I have a set of headphones, plays the music for me. I have the supplements. There's also a cream we can also put on the carotid arteries as well. I hook myself up. I put the CES on, I eat the supplements or use the cream, put the mask on. I go chill out on my bed for 30 minutes to an hour and I feel like I've been reset, recharged.

I mentioned it's being used in sports right now. Even my workouts have become better. You feel stronger. The Chicago Blackhawks actually been using it for three years. Four years. Four years now.

Howard Farran: I think this is so important. Would you do a course on this?

Louis Kaufman: Absolutely.

Howard Farran: Right now they're listening to a podcast in a car. They want to see the machine. Would you do-

Louis Kaufman: So easy. I'll do it. I'll do it. [crosstalk 00:51:46]

Howard Farran: Fear is so huge.

Louis Kaufman: We'll figure it out. Have somebody from the company call me.

Howard Farran: It's Howard Goldstein on the message board so it's

Louis Kaufman: Okay HoGo.

Howard Farran: I was so when he joined the team-

Louis Kaufman: He's HoGo.

Howard Farran: Yeah. He had to be HoGo. The H-O's for Howard and G-O's for Goldstein. Fear is the biggest thing. That's another underutilized thing. I have dentists who are anesthesiologists and for those people who just come in and say I have to be knocked out. Most dentists just say no. That's not available. We don't do that. You'll be fine. Blah, blah, blah. We'll sit there and say we have a dentist anesthesiologist you will pay him, you'll talk to him, he'll do a consultation with you. He'll show up here. 

Louis Kaufman: Sure.

Howard Farran: He brings in all of his narcotics, drugs, equipment, all that kind of stuff, and he'll put them completely out while you do the dentistry. I think it comes back to a dental office has to track every time they say no. Someone will call your office. Are you open evenings? No. Are you open before eight? No. Are you open Saturdays? No. Can you put me to sleep? No. Do you do Invisalign? No. 

The dentist is in the back unaware of all these nos. Then he's sitting there calling me saying Howard, how do you get more new patients? Number one, you're saying no 40 times a week. Maybe if you said yes 40- in fact I always had- when we used to-

Louis Kaufman: Amazes me.

Howard Farran: Back in the day how we used to have prescriptions made for the prescriptions. Now they're all digital.

Louis Kaufman: Right. Right.

Howard Farran: When I used to make the prescription pad I used to make one getting the yes. I had them by every phone. Every staff if there was a no they had to say okay his name was Louis Kaufman, here's his phone number, here's what he asked for. That's how I got into teeth whitening in 1987 because I was having a person call me about once a month saying do you bleach teeth? We didn't know what that was in '87. It was Omni out of, what was it? Louisiana. Arkansas.

Louis Kaufman: The two solutions you mix together?

Howard Farran: Yeah. It was back in- it was some crazy company called Omni Care in Arkansas. I never heard of it. I kept looking at these we're saying nos so then I'd investigate. Next thing I know I called the Arizona rep. I think his name was Dave [Cheetam 00:53:57] or Dave something and got that. 

I've been tracking nos. That's how you learn supply and demand.

Louis Kaufman: Brilliant.

Howard Farran: People are calling you up saying can he put me to sleep? They're not even entering that in the chart. By the time you see them, you don't even have the date of the first thing this person asked for was can I be put to sleep. You got to track what they're asking for.

Then they're coming in with the health history and they say, have you had gonorrhea, syphilis or herpes. Those are three questions you ask in a bar. I want to know what are you expecting to have done, what do you want to have done.

Louis Kaufman: What are you here for?

Howard Farran: Yeah. I want to know your mind.

Louis Kaufman: What brought you in today? Yeah. What made you call the office?

Howard Farran: Fear and money is huge. Let's talk about money. Do you do any patient finance? 

Louis Kaufman: CareCredit, Lending Club are the two that I use. If you're going to pay your bill in full, cash or check, 10 percent off whatever the cost is of the procedure if you're paying in full that day.

Howard Farran: Okay. You give a 10 percent cash discount. You use CareCredit, which you'd have to be living in a cave not to have heard of that. What's the third one you said?

Louis Kaufman: Lending Club.

Howard Farran: Lending Club. Talk about Lending Club and why if you have CareCredit you also have Lending Club.

Louis Kaufman: My office manager, I had her do the research on the Lending Club. It seemed there was more ease of use, if you will, for patients to get approval. I think we're paying a little higher of a rate than CareCredit, but as you know everything's about cash flow and keeping that cash flow going. We just had a couple approvals this last week. We just got started with Lending Club. She's telling me it's very simple to implement, the funds are transferred quickly. The team likes using it as well. 

They had a couple more financing options I believe than CareCredit. CareCredit has been wonderful. I'm not denying that. Integrated with SoftDent on your iPads as well. Easy to use.

Howard Farran: Lending Club, that name sounds so familiar to Lending Tree, wasn't that the big S&P500. Lending Tree?

Louis Kaufman: Lending Tree sure, sure.

Howard Farran: Is that a division of Lending Tree?

Louis Kaufman: No clue. 

Howard Farran: No clue.

Louis Kaufman: No clue on that.

Howard Farran: Okay. I got to remind the listeners and United States of America only 10 percent of cars and 10 percent of houses are bought in cash. 90 percent of everything over the price of $1,000 is financed. $1,000 to $100,000 house to a $50,000 car, only one in ten times does someone say here's a check, here's the cash.

Nine out of ten times it's financed, yet a dentist will take 1,000 bone grafting courses and never address the financial side of the equation.

Louis Kaufman: They're not open on Saturdays.

Howard Farran: What I like most about CareCredit though is the staff always sits there and says you don't understand. In our world it's different. Our patients, we're in Phoenix, the economy, Obama, blah, blah, blah, blah, blah. Then CareCredit can come in, I don't know if Lending Tree does this, they show you all the financing they're doing in your zip code. It doesn't take much of a genius to figure out who's office is what. They'll say okay this office across the street, last month they financed six cases between 4 and 12,000. This office financed zero and he's in the same building. 

Here's a building with eight dentists. They'll be like three guys in there financing four or five big cases a month or a quarter or whatever. Then there's five that don't have any. You go talk to the five who don't do any, they think it can't be done. It's like, it's being done in your own building.

I love that comparative data so the staff- a lot of the times I think staff-

Louis Kaufman: Absolutely.

Howard Farran: I think a lot of times staff just think Louis doesn't have $5,000 to have four implants and a denture. Howard's crazy, he doesn't have that kind of money. It's like, quit judging the pocket book. Maybe she would give-

Louis Kaufman: Never assume.

Howard Farran: Anything to have a fitting denture on implants and bite into a T-bone steak. You don't know what she wants.

Louis Kaufman: You don't know if a patient can afford ... I hate it when people assume. Don't assume- I don't know anything about what you have. You can look like a bum, but you could have $10,000 in your pocket or 20 or a ton in the bank. I've had ladies come into my office, I say okay I'll do that 10,000 case for immediate dentures and extractions. If you looked at her and you had assumed, you would assume maybe she didn't have any money, but she had it. I can name numerous cases.

My motto is, my team is don't assume anything about anybody. If somebody's in a bad mood or they're upset, there's a reason why and it's our job to find out why that is. It's all about the patient. It's so important. It's not about us, it's about our patients.

Howard Farran: I want to end on this, I've only got you for one minute. I want to end on this one question, a macroeconomic question. Your dad's 91 year old dentist who just hung up the drill when he was 85, you said. You and I are both 53, been doing this for three decades. These kids are coming out of school and they're hearing things like the golden years are over, the glory days are over, corporate dentistry's taken over. What does your old man and what do you think about the state of the condition today? Do you think dentistry will be as good for the 25 year olds rolling out of school today as it was for you and me 30 years ago or your dad 50 years ago? How would you answer that question?

Louis Kaufman: I think absolutely it can be. I think you have to resist the temptation of corporate. If you're going to do corporate dentistry you're going to find yourself in compromising situations to produce dentistry that might not be needed in some cases, from what I'm seeing going on. I think you're still in one of the best careers there is. You can be a solo practitioner, you can go into a group practice, you're a business owner. I think you have to stick with it and have a plan. You don't want to be living the high life right out of dental school. Get your debt paid off, live frivolously, take the smart Continuing Education courses that are going to allow you to thrive in that dental practice. Get out in your community. 

If you can purchase your own real estate in the market do that. I would love to have 20 years, 60 grand a year, do the math on that. I'd love to have that money in my pocket towards the real estate. There's so much potential out there. There's golden times. Don't get sucked into the corporate lifestyle. I hate it.

Howard Farran: My office is across the street from Guadalupe. It's an Indian reservation. You'll routinely see a $10,000 house and parked out in front is the $30,000 purple lowrider. Dentists will say to me why do they have a $30,000 car? They have too much car. I always say to them, dude you live in a 3500 square foot $400,000 home and you rent 1,000 square foot office. What's the difference? 

I had bought the land and built a 4,000 square foot building while I was still living in an apartment.

Louis Kaufman: Yeah.

Howard Farran: I didn't have a car in undergrad or the first three years of dental school. When I look at dentists that are stressed out of their mind, a lot of it comes back to a crazy lifestyle. A lot of these people-

Louis Kaufman: Absolutely.

Howard Farran: In fact I said to this one dentist, this one dentist had five cars. I said wow, I had no idea you were a rock star. What's the name of your album? Are you filling up stadiums? I had no idea. Who are you? You must be a movie star. Five cars? Are you completely out of your mind? My car is 2004 and it has 115,000 miles on it and this guy's got 1/5 the size of my practice and he has five cars.

Louis Kaufman: It's lunacy. Those times will come. You can get those five cars down the road if you need them. Get your debt paid off. That's my biggest [inaudible 01:02:20] get the debt paid off. I went back to dental school when I was 27 years old. I left corporate America. That's a whole 'nother story. I went back to dental school I worked full time on the weekends for a catering company so I could afford to live and go to dental school during the week.

I gave up life, basically for six years. Gave up my social life, all of that. I would not change that for the world. You have to live frugally, you got to live smart. Get the debt paid off, advance your education, you'll make the money. Build the relationships in your community and with the people around you.

Howard Farran: It's all about the community, it's all about the relationship and stress is all about money. Quit spending money. They say the three causes of divorce are a third over money, a third over sex, and a third over substance abuse. I think the substance abuse is usually related to the money.

Louis Kaufman: Yes.

Howard Farran: I think they're so in debt and they're so stressed out and their lifestyle's so crazy that they come home and put their misery out with a six pack of Bud Light.

Louis Kaufman: Well said.

Howard Farran: Hey we are completely out of time. Louis I do hope you build us an online CE course.

Louis Kaufman: Would love to Howard.

Howard Farran: A lot of these kids, they can't afford to fly across the country, go to Key Biscayne, Pankey or the [inaudible 01:03:35] or whatever. This online CE stuff is so low cost, they do it at their house. It's the Walmart, Ikea, Southwest Airlines way to learn something. If you could put these kids up a course for low cost that would be amazing. 

Louis Kaufman: I would love to. I would love to. Absolutely. 

Howard Farran: Thank you for spending an hour and give-

Louis Kaufman: Thank you Howard.

Howard Farran: Give your dad a big kiss and a hug from Howard. Tell him that's just amazing that he practiced until 85. He's my new idol.

Louis Kaufman: Your welcome. Thank you. I will. 

Howard Farran: All right.

Louis Kaufman: Take care.

Howard Farran: Bye bye.

Louis Kaufman: Bye bye.

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