Dentistry Uncensored with Howard Farran
Dentistry Uncensored with Howard Farran
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213 Leadership And Endo with Pei Kang : Dentistry Uncensored with Howard Farran

213 Leadership And Endo with Pei Kang : Dentistry Uncensored with Howard Farran

10/31/2015 2:00:00 AM   |   Comments: 0   |   Views: 558

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AUDIO - HSP #213 - Pei Kang

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VIDEO - HSP #213 - Pei Kang

Dr. Pei Kang shares her observations regarding endodontics, why to control your spending, and how she has explored passions outside dentistry.



Dr. Pei has experience in running both brick and mortar and online businesses. Her expertise is developing business and marketing systems to increase visibility, audience growth, and productivity. 


Dr. Pei practices part time in the DFW area, She is the co-founder of "PR Podcasting", a done-for-you podcasting and PR agency, and co-hosts the ReLaunch and Become Known in Your Niche. During its iTunes debut, the show ranked #1 repeatedly in its New and Noteworthy categories - business, education, and health.

Howard: It is a huge, huge honor today to be interviewing, podcasting Dr. Pei Kang who goes by Dr. K. You have an unbelievable story. You're a dentist, you're a PhD, you starting finding your voice on radio. I'm going to start off with ... Now you live in Dallas, Texas. I want you to start off with your whole story, your story is amazing. Start with where you were born, when you became a dentist, where do you practice, what's your PhD all about, and then we'll get into finding your voice radio. Tell us your story, it's an amazing story.

Pei: Thank you so much for inviting me. We had a very short pre chat right before this recording and I can just tell you have been riding this technology. I'm very impressed that you ... This podcasting thing that you just took on and you grew your listener ship, you're serving your audience. Thank you for what you do.

Howard: Well thank you.

Pei: I was born in China-

Howard: Whereabouts?

Pei: Not far from Beijing.

Howard: Okay, northern China. Where they have winters and snow.

Pei: Oh my goodness, if you look at a climate that's similar to Boston ... I'm in Texas now and the summer is real tough for me. The winter is very nice. I actually originally studied dentistry back there. I practice a little bit where I was mainly in emergency room and taking care of root canal after root canals. At the time it was very very intensive. It was government owned hospital setting. That's where basically after graduation from medical school, that where you go to. That's actually considered a good job. Partly because it was somewhat boring and not very well paid, but the other side is my mom went and did some fellowship in Japan and she always thought "you know why don't you try to go to another country to study something else?" 

Many of you possibly know being any Asian parents they pay attention to your academic work a lot, or they get you to study music and play violin. That wasn't me but academics-

Howard: It reminds me of the funniest scene ... Have you ever heard of the cartoon 'Family Guy?'

Pei: Oh yeah.

Howard: The little Chinese family guy is only 10 years old and the dad runs in there and says "How come you're not doctor yet?" He goes, "Dad, I'm only 9" and then he slams the door and leaves. I thought it was so funny.

Pei: Yeah, that sums it up doesn't it. My mom and dad both went to college, and my dad thought if he can get his PHD from America wouldn't that be great. I had no concept what any of that meant, even when I was in my 20's. You would think after you got some college education you know you're life direction. Not really, I just was like "okay I'll try it." Long story short it wasn't that easy. I got accepted by the school but I didn't get my visa until the third try and I almost went to Japan, and the last try they said "hey, you get to go." I packed up and came over to Texas when I was 25.

Howard: Looking back now what would have been the advantage or disadvantage of your mother going to school in Japan versus you going to school in Texas, United States and getting your PHD? Looking back do you wish you would have gone to Japan or does your mother wish she would have came to America? What's the pros and cons of the decision of going to Japan or United States out of China?

Pei: That is such a good question. My mom is [inaudible 00:04:46] so she went to Japan to study nutrition. She went to Japan to do the fellowship and find out the root cause of loss of heart disease. Its actually in a nutrition, a diet. She was very intrigued by how in Japan ... How sophisticated the programs run, so she studied that. Actually to be honest with you her going to Japan didn't really have a whole lot to do with me coming to America, however I grew up extremely poor. I still remember the days we shared the apartment we had, it was just one room. Bedroom, the kitchen was outside but not outside, but outside our little room. The bedroom, dining room, everything. You just got one room of 4 people. 

When China was changing that's when my mom went to Japan and she got some scholarships and she actually saved up the for me to be able to buy the plane ticket and pay some money to come here. If I didn't come to the U.S I would have gone to Japan for sure, because I already had everything set up for that direction. I guess it's destiny. Honestly life would have been great either way but wherever I land, I do the best I can.

Howard: If you would have gone to Japan you would have learned Japanese. In Beijing do more Chinese people know English, Japanese, or Korean?

Pei: Definitely English.

Howard: Definitely English?

Pei: Definitely.

Howard: How many dentists do you think are in China, and of those what percent can read English? What percent can listen and understand English, and what percent could speak English.

Pei: Super good question. 100% can read. Speaking, obviously with any language, is possibly the hardest because ever since ... I think we start studying English when we are about 12 years old. By the time you take the college exam English is apart of it so reading English and English literature is not very difficult, but speaking to really communicate ... If they listen to us speaking I'm not sure they can understand very well. My speaking obviously is just next layer even more difficult.

Howard: I always found interesting of my friends, America is a huge immigration country. A lot of times you go to Poland, they're all Polish. Go to Korea they're all Korean. You go to Japan they're all Japanese. If you go to United States or Canada or England it's-

Pei: It's a melting pot.

Howard: It's a melting pot. Would you say those are the only 3 great melting pots? The United Kingdom, United States, Canada? I mean to this level.

Pei: To my understanding America is the biggest because the whole country ... The concept is built on immigration.

Howard: I have so many friends whose parents came from another country. I find it interesting how they can understand their grandmother totally, but they can't speak it back to her. It tells me that that's got to be two different parts of the brain. I'm thinking ... An American only knows one language. You always know you're American if you only know one language. To be able to understand, to me it seems like if you can understand her, why can't you say it back? They say "I can't."

Pei: Right.

Howard: It's got to be to separate areas of the brain. You came to Texas at 25 and what school did you go to and what was your PhD in?

Pei: Originally I applied for the academic side of dentistry. Studied molecular biology related to the cause of cleft palate, it's not really dentistry but we can name it oral biology. That's in Baylor College of Dentistry, now is part of Texas A&M. 

Howard: Is Texas A&M in College City?

Pei: It is in College Station.

Howard: College Station, I'm sorry Texas College Station, okay.

Pei: It's all the same right.

Howard: I was close I had the college in there. College Station. How long did it take to get your PhD?

Pei: Total 4 years.

Howard: Wow.

Pei: At the end of the second year, my mentor who's - have to give her credit for a lot of things, where I am today. She really pushed me to make a decision, what do you want to do? Do you want to stay academic become a professor or do you want gain some clinical experience. I was possibly 26-27, I really don't know what I'm going to do with my life. Then one day I thought I didn't enjoy doing all those root canal work but I was good at it, so I thought "hey." Obviously I was attracted to the financial, potential ownership of business in the future so I thought "let me try to see if I can study endodontics."

My last year in my PhD was combined with my first year in the endodontic program, which that totaled 3 years. At total I did my 6 year combine in PhD and my specialty training.

Howard: You're an endodontist with a PhD in oral biology?

Pei: Right, that's correct.

Howard: You're probably the smartest person I've ever met.

Pei: See those letters make you think I have more brain cells right?

Howard: I think you do, I think you do for two reasons. You probably have more brain cells than and I probably killed a lot of them over the years drinking to many beers. If your mother was a cardiologist who got a PhD in Japan on nutrition, you probably ate healthy. I wish your mother was here because I wanted to ask her "with a PhD in nutrition, what type of potato chips does she recommend the most?" 

Pei: None.

Howard: Lays, Doritos, what would be her expert opinion on picking you perfect potato chip.

Pei: She's possibly going to look at your overall ... Evaluate your blood and see where you are, your health. I'm kidding to you, she-

Howard: I got to tell you my side, tell your mother this "I was 50 years old and for 4 years my doctor kept telling me "Look your blood pressure is 140/90, I got to put you on blood pressure pills. You're cholesterol's off the cliffs, I need to put you on a statin" and I kept saying "No I know it's a real bad because I don't exercise and I eat bad." Finally when I turned 50 and I realized my dad and both grandfathers all died at 60, I've signed up for Ironman a triathlon. Every morning you bike, swim or run. You bike, the next day you swim, the next day ride. At the end of the year I went back to my physical and my doctor said "If I would have put you on a statin I couldn't have lowered your cholesterol this much, and if I were to put you on high blood pressure I couldn't have lowered it this much. If all I saw was your numbers, your blood pressure, all the tests I ran, and if all I saw was your numbers I would think you were a 20 year old marathon runner."

Pei: Wow. 

Howard: I'm still short, fat, dumb, and bald but at least my blood pressure, and cholesterol and all my numbers look good. Nutrition is key, and Americans ... When I go to China, I've been there several times and Chinese in general probably have the healthiest diet in the world and Americans probably have the worst. Would you agree with that?

Pei: Yes, I do have a concern these days. China is becoming a very wealthy country these days, and when I go back I do unfortunately have seen people start to increase their portion significantly compared to before. The level of poverty we were in compared to what is now, I wish people could realized just because we have so much more resources doesn't mean we ought to indulge in those.

Howard: Absolutely. I also met the first Pediatric Dentist in Hong Kong, and I met the first Pediatric Dentist in Kathmandu, Nepal. I met the first Pediatric Dentist in New Delhi, India and they were all telling me the same thing. As the diet became more western ... I had this dentist in Nepal telling me that when he practiced from age 25-50 he never saw a child under 6 have a cavity. Then Coca Cola and Pepsi rolled in along with Snickers, McDonald's, Wendy's, KFC and all this stuff like that. He said "Now it's pretty much a general that you tell me the age of the child that's how many cavities they have."

Pei: Oh wow. Well here's a funny story ... You were talking about what my mom recommend about potato chips but one of her favorite cheap food is McDonald's french fries.

Howard: Oh yeah, they don't serve food better than that in heaven. That's got to be the ultimate, but unbelievable. You know what's interesting though? When you're studying stocks a lot of these stocks are growing in sales, but when it's a franchise you got to look at same store sales. Their sales might be increasing because they're opening a lot of new stores, like in China. They're opening up McDonald's and KFC's as fast as they can, but same store sales in McDonald's has peaked and is going down. Now highly educated mothers aren't taking there kids to McDonald's, so McDonald's for the first time ever is going to have to sit there and say "Look you're not going to get a college graduate mom to take her two kids to McDonald's." I think they're going to finally have to ... What was the response, "We're going to offer breakfast all day." They still don't get it. They still don't get it that people like you, and people like me ... I've got a 3 year old granddaughter, I'm not taking her to McDonald's. I go there myself after I put her to bed.

Pei: I see you looking around making sure nobody's hearing you.

Howard: No, Ryan's right here next to me. How long did you practice endo and what can you share about ... I want the capitalize on your degree in oral biology and microbiology because dentists are always trying to obtrate this root canal tooth so it looks beautiful on a X-ray. When you talk to smart people like you, root canals is about what you take the infection out of the tooth, not what you fill it up with. All the dentists want to say "Do you use lateral condensation, do you use vertical condensation, do you use a hot gun [inaudible 00:17:06] a glue gun, do you use Thermofill, what sealer do you use?" Every question you ask has nothing to do with endo. Endo is about getting rid of the infection, so you're a PhD in molecular biology, oral biology and you're an endodontist. What tips could you give us on root canal therapy, root canal success?

Pei: You're so right about what you said. What's more important is taking it out. There's so many tips I can share, I can just start with a couple.

Howard: No, give us all you got. You're the only thing I got. After you I have nothing so you just go. I'll sit here and listen to you until midnight if you got that many things to say. Endo seriously ... When I talk to my homies and say "What stresses you out in dentistry?" They say "Molar endo, gosh I got to do it because they're in pain, suffering it's $1,000. You make a lot of money but it's just hard, it just beats the crap out of me.

Pei: Let's start there, let's start with somebody with pain coming to you. One of the very first important thing is, when they are in severe pain occasionally you can tell exactly what is going on. It's very obvious, the patient knows you know. Sometimes it's not and no matter how much pain a patient is in I always take my time because sometimes when they are in so severe pain, it's hard to distinguish sometimes even if it's upper or lower. Sometimes taking an X-ray could be misleading, because when we see a big lesion that's got to be it. Always listen to patients. For example if somebody say "Oh my gosh this tooth been extremely sensitive to cold, I can't have anything even cool air makes it hurt." If that's the case and then you see a lesion on the X-ray or if you see an old root canal gone bad that's not the answer. There is a tooth that senses the cold that you have to find out, that's the tooth. 

The first step the diagnosis is very key, and the second thing is we're here to fix problems and patients expect us to do that. To get them out of pain is obviously awesome for them and good for you as a dentist. However, not every tooth is best for us to start drilling and you think draining it out is going to get them out of pain. After you clearly identify which tooth it is, the tooth that has loss of temperature sensitivity, those are the teeth that if you're able to get it open to the pulp they get the most relief. The necrotic nerve where the old root canal gone bad, those teeth sometimes if you open up on that same day you can actually cause more pain. Obviously if you communicate that, then that's good. If a tooth that doesn't feel any cold at all, then you can say "I can definitely open this tooth but I need to put you on antibiotics, but I do want you to know after I open it tonight and tomorrow is going to be very sore and you might actually have a little bit of swelling. You will also get some antibiotics. Manage the expectation is very important. 

If it's a tooth that's very cold sensitive that's the classic irreversible pulpits. Those teeth, the very important number 1 thing is you got to be sure the patient is numb. After numbing especially lower jaw, even upper I do this but especially lower, I gave them at least 10 minutes. I gave them even an Advil to take before I numb them to help reduce the inflammation and then after 10-15 minutes I use very extremely cold ice to test and say "Hey [inaudible 00:22:03]" and say "Hey do you feel anything" and if they say "no" I test it again. I don't want any of my patients to say "I felt where you drilled." Any of those little steps will lead to a favorable result, and I'm not even talking about operation yet.

Howard: Help out this kid, they're 25 years old they just walked out of dental school and one of the big stressful things they have is not knowing which tooth it is.

Pei: Yeah.

Howard: What do you do when you're not sure which tooth it is.

Pei: Obviously I'm not going to say refer to an endodontist, because that would be an easy answer. To start with, there's a whole list that you filter through. Some questions, asking their history is very key, and most of the time you can ask them "what did it start with?" And most of the time they say, "Oh it was down here, but then later on it felt like everywhere." So more than likely, that's where it started with. So you can start with there. Obviously X-ray's will aid with the diagnosis. 

The sequence of story and the thermotest, percussion test... here's something interesting, the percussion test, sometimes we can have a tooth that definitely needs endo, but the tooth next to it feels more percussion sensitive. So you've got to be careful with that. When the patient comes back, if you did drill on the wrong tooth, obviously that's something that is very hard to explain afterwords. 

Howard: No it's easy. You just say, "Wow, that infection was so big it spread to the other tooth. Unbelievable." Not that I've ever said that once. 

Pei: Another tough diagnosis is the molar, especially second molar, fractures. Their symptoms can be very minor, or can make you think it's the first molar but it's actually the second molar. 

Howard: A lot of these kids get stressed out, they post pictures all the time, they say, "What do I do?" A tooth died, they took off the MOD emalgun, they found the canals, they're cleaning it out, and then they see a black crack along the bottom. 

Pei: Yes. 

Howard: What should a dentist be thinking when they see a black crack on the bottom? Do you treat? Is that when you say, "this is just going to be a temporary thing, I should really be extracting this and doing an implant." Talk about cracks and what they mean to you. 

Pei: Oh my gosh, that's my favorite topic. I see this so often. Just about every week, or sometimes every day I see one. Every week at least two or three, and mostly it's associated with lower second molars. Mostly it's associated with people with a little bit of proxism, older than 40, or people with a little bit of chronic stress. The reason why it's sometimes not obvious, in the beginning stage they always complain and say, "Hey doc, when I chew on certain things it hurts, but not everything." That's the beginning stage, if you can catch that symptom, identify that it's a very bad tooth, even if there's no filling on that lower molar. A good test is called Tooth [inaudible 00:26:18] test. If you have that pain on release, when they bite down they feel okay, but when they release on that particular cusp and they feel a jolt, it may or may not be severe. 

Those teeth, in the beginning, they don't even feel much severe lingering to cold at all. But at that stage, some of the teeth can do very well with a crown, especially a gold crown. That's my observation not clinical data. Overall, I've seen people do better with gold crowns. 

Howard: Why do you think that is? I agree with you, I'm 53, I have 7 restorations and they're all gold on-lay crowns. In Phoenix, Arizona there's a lot of retired people. I have a lot of patients that are 80, 90, sometimes 100 years old, and the only dentistry I've ever seen that lasted 50, 60, 70 years was gold. I never saw any other material last like that. So that's the only thing in my mouth, but why do you think the gold works better?

Pei: You possibly have more insights or intuition on that than me. My suspicion is less tooth preparation. What's your thought?

Howard: Yeah, I agree. A lot of these people are reducing two, three millimeters. It's kind of weird when you have to reduce and drill down a lot of teeth to restore. That doesn't even make sense. "What are you doing?" "Oh, I'm drilling down your tooth to restore it." Whereas, an inlay and on-lay you take out all the defect and cover the cusp and go for the gold. 

Pei: Yeah. One tip I do recommend, even in the early stage, if you can catch it, I think that's a blessing for your patient. Because over the years the crack increases, then they eventually end up losing their teeth. But if you do do crowns on those teeth, even if it's a gold crown, again manage the expecations. Always tell them, "This way you don't have any decay this tooth is fairly sound, however, any cracked teeth, after a crown, has a chance that it needs a root canal. So let's wait and see, hopefully we found it early." So you always communicate, and hopefully that's the end of that. 

But when I see a patient with a lower second molar with very minimal restoration and they need endo, I always say, "You know what, I think this tooth is cracked. I'm just 95% sure about this. We're going to have to find out once we get in there if it's worth your time and money to try and do a root canal or not. And if the tooth still has vital nerves, most of the time that means the crack hasn't gone deep. But if the tooth is already necrotic, you see the lesion wrap around the root, I would say the survival chance is very low. 

Howard: So at that point you would extract? 

Pei: To that point, I do communicate one more time with the patient. I say, "I don't think this has got a good chance, do you want me to open it to take a look, or do you just want to take my word for it?" I do give them that choice, and most people understand that it's probably time to cut their loss. 

Howard: I think that's so amazing for you, because most people would think, "Well, you just want to do the root canal because you're going to get paid $1,000." And I think dentistry is so noble in the fact that, here you are turning down $1,000 and saying, "No, it's not worth your $1,000 don't give me your money." 

I mean, I look at all the gazillions of hours me and my friends spent trying to get fluoridation into Phoenix water and being called communists and crazies and I spent more than 1,000 hours trying to get fluoride into the water in 89. I didn't work Fridays for two years just answering all the crap from the eight city councilmen, the mayor, and getting hate mail. There's 25% of Americans that absolutely hate any form of government. They don't want the government touching their water, they don't want the government putting fluoride in, it's just an anti-government thing. This country has the most anti-government I've ever met compared to other countries. You go to Scandinavia or Australia, everybody wants to work together. You come to America and it's like 25% of the people want to overthrow the government. 

Well, you're in Texas. There's more guns than people in Texas. So I just think it's neat that dentists are trying to prevent decay with water fluoridation. They're always trying to prevent decay by putting you in the hygiene department. They're always telling you to brush and floss, and here you are saying, "No, I don't want your $1,000 it's not worth your time or money, cut your losses." Dentistry is a very noble profession. 

Pei: I believe so. I think it's all about... I think what I see these days is if a dentist gets so much student loans to finish dental school, and then build up another couple hundred thousand to get a brand new building. That dollar sign is going to star to cloud your judgement. To me, it doesn't matter what profession, if this is my tooth, or this is my mom's tooth, there is just no chance that you would want anybody else to do that kind of...Honestly, let's put it this way, if the goal is to make money, honestly don't select dentistry or being a doctor at all. There's so many ways of making great money that's much more than being a doctor. 

Howard: And what ways would that be?

Pei: Owning a franchise, Supercut. Those are franchise ideas, and honestly in Texas, especially the town I practice in, I had the opportunity to meet so many private business owners. They either have a business of five people or ten people or up to fifty, and they have more time, freedom and money to dispense than a doctor. It's not an easy profession. We're there a lot, we only make money when we work on patients, and honestly you say we have a business, we really don't. We own our job. Other business owners, they actually leverage other people's time to make additional income, and they do have more time freedom. 

Howard: So you say Dentists own their job whereas a businessman owns other peoples time?

Pei: Well, I wouldn't say own, but they can leverage other people time. 

Howard: Well I never understood, you know people badmouth corporate dentistry like Heartland, Rick [inaudible 00:34:17], or Steve Thorne with Pacific Dental Services and hiring up all these kids and opening up all these franchises. But I look at 5,000 graduating dentists ever year. I look at 150,000 physical dentist office buildings, I know because I mail a magazine to them all each month. And out of 168 hours a week, that building is open 32 hours. So 32 hours into 168 is 19% utilization of the land, building, equipment, everything. So that facility is sitting there empty four out of five hours, and they have no idea how many incoming calls are coming. If some nice lady Dr. Pei saying, "Help I have a toothache I need a root canal, I'll give you $1,000 to fix it." They don't even track the incoming calls. All they have is an answering machine where 13 incoming calls come before one leaves a message, and I think that dentists aren't good business people. 

The only good business people I see in dentistry is if they weren't born in the United States. I've got to talk to you about that since you weren't born in the United States. When you talk to the consultants, there's some things you can't say because they're just politically incorrect, and I never learned what those were. That's why my seminar is called Dentistry and Such...I've actually been...We won't even go there. The bottom line is, every consultant will tell you, that if the dentist was born outside the United States, especially from anywhere in Asia, they live frugal during school. When they come out they'll buy a practice, they'll usually live in the practice. The hours will be seven to seven, seven days a week for the first five years, and you come back four years later and they're out of debt and they have a ton of cash. 

But if it's an American, born in America, they come out of school, they'll buy a house that's the same size as their practice. They'll go buy a $30,000 car. They'll go out to eat dinner almost ever single night. They'll take vacations and cruises and you come back to those people at 50 years old and they're still in debt paying interest on other peoples money. But they go, "Not the Asians, the Asians will work twice as hard and will live frugally and will be debt free five years out of graduation." Agree with that or disagree?

Pei: I can only speak for myself, but I didn't know that... Is it really true?

Howard: It's very true. In fact, when I go into dental schools... In fact I even lectured to a dental school this morning. I did a podcast lecture to Nova Dental School, and my standard speech to every dental school is I tell those guys, "The smartest decision you could make is before you graduate from dental school, you've got to marry one of the Asian chicks in the class. She's going to make $150,000 to $200,000 a year, you won't even have to work. You'll just be her little pretty boy. She'll just work, work, work, work." And you know what they're going to do? They're going to be a dentist and then they're going to build a building, and they're going to buy all this equipment, but they're also going to marry a woman who has no intention of working. And she's going to spend $10,000 a month, which is basically $100,000 a year and over a 40 year marriage will destroy, $4 million of revenue. And that's the bigger source of stress in their life than getting dental student loans. 

They always, seven out of ten of them marry a woman who will never earn a dollar. And not only will never earn a dollar, she's not going to stay home and cook dinner. She's not going to have two kids, she'll have four. She's not going to buy a 2,000 square foot home, it'll be a 5,000 square foot home. She's not going to buy a Chevy, she'll buy a BMW. She's not going to pain her own nails, she's going to get a mani/pedi. It's just crazy. 

And then, by the time they finally pull the plug on this cash-destroying machine. Then the divorce will cost them a million dollars. I think you can get rid of all your stress by marrying a Chinese dentist like you. Do you have an identical twin that I can marry? A twin sister, a Siamese? Anything?

Pei: We'll I have a sister. She's a breast cancer surgeon. But part of it, you know, my mom, she's actually quite a spender. 

Howard: Your mom is a spender? A cardiologist?

Pei: Yeah, even when we didn't have money. 

Howard: The key to reducing stress is quit spending so damn much money.

Pei: Yes. 

Howard: I mean, you've got a week off, why can't you go camping and fishing at the lake? Why do you have to take a cruise? You know, you've got a week off, why did you have to go to Paris, France, why couldn't you have gone to Baylor? Why do they have to spend money? 

You meet dentists and you look at their lifestyle, and my first question is, "Dude are you like a famous rock star? Did you sell a million albums of something I didn't hear about?" It's just crazy. And if you marry a crazy-spending person, you're going to have a life of stress. 

Pei: Yeah, I think when you look at a lot of dentists, they feel like, "Oh, I'm going to make so much money," and they spend on potential future money. And that's just not the way to do it. When I took over, when I bought the practice, that's after two years of working in an associate position. I actually bought a very small practice. The equipment, everything's very old. I did not spend any money on replacing the furnishings. I hate looking at them, but I didn't spend any until I had very positive cash flow. And honestly, I actually repainted the walls myself. The loan was for seven years, I paid it off in four. 

Howard: But most of the people listening to us right now, 95% are listening to us sound-only on iTunes. Only 5% are seeing the video on Dental Town or YouTube. But to you guys listening on iTunes. If you could be seeing this, when she looked at me she made me put a paper bag over my head. She said, "You look worse than my old dental equipment." So I'm talking through a bag right now. I just think the anti-spending advice is so point on. I look at all the dentist problems I know, a lot of them even got into substance abuse. One of the reasons they got into substance abuse is because they were in a marriage where the problem that was causing all the problem was their spending. The overhead at the office, the spending going on at home, and finally they just drove themselves to drink or eat Vicodin or do drugs or whatever. So they've just got to slow down the spending and work more hours. 

And I personally think, if you own your own home and you rent your own office. You kind of were born in a barn. You're not much smarter than a cow or a sheep. You probably go home and say, "Daaaaad, Daaaad." Because only a sheep would live in a building bigger than their business. It just makes no sense to me. So you own your land and your building of your dental office while you live under a bridge in a cardboard box, and you learn how to cook at home. And you don't spend money until you have it. And then what you're going to find out, is when you have more money than you'd ever know what to do with, then you're not going to want to spend it. Then you've never developed a life of habits where you've always got to spend money to be happy. 

I want to focus one more thing on endo, because I can't let you go with a PhD and a molecular biology. Dentists always ask me, "Well, after a root canal what antibiotics do you give them?" And then a long discussion, "Do you give them Penicillin or Augmentin? Or do you give them Penicillin and Metronidizol?" They're always talking about antibiotics. Do you think antibiotics is a big part of endo success, or do you think they're overpersribed? 

Pei: Honestly, a lot of times I don't think antibiotics really play a part in the success. However, and honestly this might be very controversial and the textbook is probably not going to agree with it. But in my practice, and in the doctors I work with, we have seen a significant less pain with patients that took antibiotics. So I normally look at, if the patient doesn't have much legion, and the tooth is still very sensitive to cold and hot... Especially cold. If it's sensitive to heat there are two reasons they could be sensitive to heat. One is the infection is getting worse. Two is the tooth actually possibly has a crack. So if the tooth is just sensitive to cold, I possibly wouldn't even worry about getting them the antibiotics. 

There has also been, in the past, when I did... For example, the patient calls on Friday and I'm not there. So the general dentist ends up prescribing some mild Amoxicilin to them, and they're pain starts to reduce. So by the time I see them on Monday they say, "I've started to feel better after the antibiotics." So, in a way, I know it's controversial, and we don't want to overperscribe anything, however, if there is a chance that patient could actually get a hold of something and they have a chance to actually start feeling better. I'm not opposed to it. But on the other hand, if there is a tooth... Sometimes on the phone, I have never met the patient, but the doctor wants to kind of get an idea if they should perscribe antibiotics. And I said, "does the patient still feel hot and cold?" And they said, "No, hot and cold doesn't matter, but if I touch it, it's like sends me off the roof." When that happens, please give them some antibiotics. They're going to start getting significant relief. 

And if I do re-treatment, no exception, I always put them on antibiotics even prior to getting the work started. Because I just tell them, "I'm going to stir up some old, resistant bacteria here." And the other thing is, especially I guess in the endo practice, I deal with a lot of older patients. They may not be healthy in other ways. They may have some heart problems or hip and joint problems, or diabetes, blood pressure. Their immune system may not be as strong as we think it can be. 

Howard: And of course the other question is, pain medication. What is your standard protocol for after a molar root canal pain medication? 

Pei: Okay, most of the time I just prefer for them to take Advil or Motrin prior to the numbness wearing off. Once that wears off, the pain sets off, our neurons have pain memory. So it's going to be hard to stop that pain, why not prevent that pain. So I always recommend, and sometimes if it's upper root canal and I have a feeling the patient already... Oh, another thing is, the pain they had prior had to do with their pain afterwards. So if I have a feeling the patient is going to have quite a bit of pain afterwards, I even give them Advil, Motrin before they leave the chair. 

Howard: Okay. It's what you take out, its what you clean out, it's what you kill with the bleach. Is there anything, as far as obteration that's better? Is it obtration, obturation? Here's some common complaints from endotonitists, that general dentists use too much sealer. You hear general dentists and endodontists... One of my best friends who was an endodontists who died, Joey D, Joe Duffkin. He liked warm [inaudible 00:47:35] pluggers to get that three-dimensional. Some people are big into single cone, some are big into lateral condensation. Some of these obtraters, single carriers like a Thermofil. Does any sealer, do you think, work better? Any obteration system work better? Any thoughts on that?

Pei: Good question. I know there [inaudible 00:48:00] and then I sometimes use AH+, but overall my biggest concern about obtration is I have a very gentle hand, and I hope when you obtrate, no matter what technique, don't think pushing on the side or pushing down so you can get that perfect look or [inaudible 00:48:37] place, is the best thing. Especially these days, a lot of teeth, by the time they need root canals, there's a chance, especially people older than 30, especially 40, their teeth have got micro-fractures here and there, crack lines there. I have seen so many root canals fail because of a root fracture. [inaudible 00:49:04] area, especially the lower molars. If you look at it's root after the preparation, you have a very short distance from the [inaudible 00:49:23]. 

Howard: So that sounds like you're a pulp lover. You like to keep the sealer and the [inaudible 00:49:30] away from the exit. As opposed to [inaudible 00:49:33] who always likes to see a puff of sealer cleaned out the apex. 

Pei: You know, I...

Howard: Are you a pulp lover or an apical barbarian. 

Pei: A pulp lover. 

Howard: Pulp lover? 

Pei: Here's the thing, if it's vital pulp, a lot of times you are not going to see that puff. Necrotic pulp you are going to see that puff because, by the time you work on it, there is some level of root resorption. So it's easier to see that puff. But I never cared for the look. Of course we get to the end, but no. To me over-instrumentation, especially if you go over that PDL, violate that natural area, it's actually worse. 

Howard: Okay, you're so amazing. You start in Beijing, you end up in Texas in Baylor, dentist [inaudible 00:50:33]. You also jumped on a new technology, podcasting. You have a website called Relonshow. Your husband that you married was in radio, and then you guys started -

Pei: Yes. 

Howard: Tell us that story, and how's that part of your life? Tell us what you're doing there. What made you get into that? Tell us all about it. 

Pei: That's a very interesting story. We married for fourteen years, he was a banker and obviously I was a dental student. So later on-

Howard: You've been married 14 years? 

Pei: 14 years. 

Howard: Good for you. 

Pei: Thank you. So he left corporate maybe about eight years ago, and he started developing his own coaching, speaking business, became an author, had a number one book on Amazon. And I started-

Howard: By the way, my book just hit number one on Amazon two days ago. 

Pei: Yay! 

Howard: Under the category, Dental Consultant it is number one.

Pei: What's the title?

Howard: 'Uncomplicate Business: You Only Manage Three Things, People, Time and Money." And under dental business it's number one. Sorry to interrupt you. 

Your husband is a coach or speaker on Amazon, but who does he consult with? What vertical? Any small business or is he-

Pei: Mainly actually, direct customers. So it's not business owners, it's people who actually want to reinvent their lives, who want to find out what's true for them. So his customer, mainly is actually 40-50 years old female who wants to release their creativity in a different way than they've been trained. And he has a counseling and psychology background. So that's-

Howard: Is he a psychologist? 

Pei: Nope, not a psychologist. So, what's interesting is, as he was developing his business, I found out there's certain things I'm really good at. Like internet marketing, social media, I'm real quick at learning lots of internet tricks. Not just tricks, it's something, SEO, all these things you have to do when you have your presence online. I was just doing it a couple hours a week, for fun, and then I helped him launch his book on Amazon and the more I'm involved, the more I'm intrigued with what he does. And then, after a while, I was like, "Gosh, my practice is great but it's starting to get boring. I wonder what else I can do?" And especially after hearing him coaching his clients, finding what they can do. So he kind of guided me, and long story short, we started working together and we actually helped other people become number one authors, and to build a platform with their book or podcasts. So that's the-

Howard: Well then help me! Help me, you know-

Pei: You're doing an awesome job. You're very entertaining. You're a great interviewer, you already got your book. 

Howard: Oh you're just saying that because I look like Brad Pitt. You know, here's my mission. There's two million dentists on earth, and Dental Town only has 200,000. I still haven't found 90% of the dentists, and when I go to Tanzania, Ethiopia, Nepal, India, when these people discover Dental Town that's been out since 1998, has 4 million posts from 200,000 dentists with 350 online courses. They tell me it was like they died and went to heaven and figured out how to do root canals, crowns, implants. They're stress went down, and they stared doing dentistry better, faster, easier, lower cost. 

Pei: Awesome. 

Howard: I've walked in to a dozen dental school that when the dean sees me literally busts out bawling telling me that before Dental Town it was all these 10-20 year old books. And then they discovered Dental Town, and now they don't need any of these foreign books that weren't native to their language anyway, and the cases on dental town were posted yesterday, whereas the books they used to have were 10 year old books that took 5 years to make. 

My mission is to connect all the worlds dentists so they all practice better, faster, easier, lower cost, and I am shocked that 90% of the dentists on earth have never found or stumbled across dental town on a Google search. 

Pei: Okay. 

Howard: I mean when you tell me we only have 200,000 dentists, I think we must be doing something on purpose to prevent our growth. How many dentists are in China? Because you said earlier that they all could read, which means they could all go to dental town and read. How many dentists do you think are in China? 

Pei: Oh gosh, I honestly don't know. Back when I was studying there were only 30 or so dental schools. Now there are about 80, and that is by no means can meet the demands in the future. But here, internet marketing, when you look at the platforms it's interesting because for them to access an American site, it might be a lot slower. So there is a thing, I think called a CD. What is that called? There is a certain license your host server might provide so other people from different parts of the world can access your site a lot faster. 

Howard: Can you email me the information on that? 

Pei: Yeah, if-


Pei: I'm pretty sure, I'm pretty sure I can. Go ahead, go ahead. We have that because if it loads slow, people give up. 

Howard: Right, that's why, yeah. So do any of my listeners, could any of them benefit from what you and your husband are doing? Has your husband ever consulted with dentists that are trying to, that are... You said mostly females between 40 and 50 that are trying to explore their gifts outside of dentistry. Has he targeted any dentists for this?

Pei: Not particularly, a lot of professionals. But no, he didn't really narrow it down to just that one profession. 

Howard: Do you think it would be an interesting podcast for an hour? Or do you think he would want to make an online course on Dental Town? 

Pei: I'm pretty sure he would. I mean, he helped me. 

Howard: Because we put up 350 course on Dental Town, and they've been viewed over 550,000 times. 

Pei: Wow. 

Howard: Because it's so... And that's another thing I wanted to ask you specifically, you're in Baylor, right? Baylor, Texas? Is that the city you're in? 

Pei: Dallas. 

Howard: You're in Dallas, Fort Worth? 

Pei: Mm-hmm (affirmative) 

Howard: Which is interesting because you live in Dallas, but you're an Arizona Cardinals football fan and you hate the Dallas Cowboys. Is that correct? 

Pei: Whatever you say. I'm-

Howard: That is correct, because if she says anything else I'm going to cut her mic. If some young woman is 25 years old and she's getting beat up by endo and she said, "can I come watch you for a day?" Would you let her? 

Pei: Yes. 

Howard: And see, that's the difference between street smart and dumb. I'm always meeting these dentists and they have all this student loan debt, housing debt, stay at home wife, three kids, and they want to learn something. And they always feel like they have to fly across the United States, pay $5,000 for a weekend course, and go listen to some Nike, Adidas, Puma course. And I think the street smart people are the ones that get on YouTube, go on Dental Town, or just walk across the street to their endodonist. 

If I wanted to learn the greatest endo in the world, I would just call an endodontist down the street, Brad Gettleman, and say, "Brad can I just sit and watch you?" And he's always like, "Sure, absolutely." These street smart people can learn all the secrets of dentistry free on a Howard podcast. $18 for a one-hour course online. For free walking across the street to an endodontist, periodontist, pedodontist, good luck with the orthodontist. I don't think any of them want to share their secrets, but I just don't think you need to spend $4,000 to go to a weekend course to learn endo, do you? 

Pei: Well, I do think a lot of dentist schools, the number of root canals you've done by the time you graduate is not even close to getting you sufficiently educated for that. But, the continued education is important, but if there's any way you can actually get ahold of some extracted teeth and practice. You know, practice makes perfect. 

Howard: How many of your husbands teeth did he let you practice a root canal on while you were trying to learn how to do endo? 

Pei: Oh he has perfect teeth. I, myself have five root canals. 

Howard: So do you think that's diet or genetics? 

Pei: It's my poor dental hygiene when I was a teenager. I just ignored and got away from doing the things I was supposed to do, and I'm paying the price now. 

Howard: And do you think that was from you, or do you think that was the culture of the time and place of where you lived at the time? Is that how everybody did it, or is that just you? 

Pei: I have a sweet tooth, my sister has perfect teeth so I can't blame it on the culture. Not yet at least. 

Howard: My last question, because we're out of time... By the way, when I had breakfast with the president of the Chinese Dental Association last year, he told me that he said there were 150,000 dentists in China, which is amazing because they have 1,300,000,000 people. The United States just has 330,000,000 people and we have 150,000 dentists. 120,000 general dentists, 30,000 specialists. So it's interesting how China and the United States had the same number of dentists at 150,000, yet we were 300,000,000 they were 1,300,000,000. What is that four to one population for China to the United States? Is it four to one or five to one? 

Pei: Depends on I guess what the population is now. I would say somewhere around that. 

Howard: Yeah, so I thought that was very interesting. But I've got to ask you one question before I go. How come every time I go to China I can't find any Chinese food?

Pei: Because they call them food. 

Howard: That's so funny. Everything an American thinks is Chinese food, you pretty much can't find in China. Would you say that's true? 

Pei: Very Americanized, yes. 

Howard: Okay, well hey, I'm your biggest fan. Is there anything, should my viewers go to your Your website is Do you think a lot of these dentists would be interested in that? Do you think any of my listeners would want to log on to you and start a podcast? Or talk about that. Is that...

Pei: You know, exploring your gift, your creativity, to me is very important. If you feel like there's something else out there, that there's something more you want to explore, sure. Tune into our free podcast and hear how other people have made some life transitions, either dramatic or not dramatic. For me personally, I'm actually, hopefully soon, going to start a dentist podcast called 'The Dentist Happy Hour.' 

Howard: Awesome. 

Pei: Yeah. 

Howard: Well let me tell you, if you've got a podcast. When I started Dental Town it wasn't, it was Dental Town. It was about a community, and one of the reasons I started my podcasts was, Dental Town has a podcasting site. So we have an app, and the other podcasters didn't want to put on my deal because they thought I wouldn't want that. 

I was like, "Are you kidding me?" Dental Town has 4 million posts. I've only posted 20,000. I'm not even 0.001% of the posts. And when those dental podcasters put their podcasts on Dental Town, and it was on the app, that was the best free marketing they ever did. Even though most people just listen to it on Dental Town like once and then download it on iTunes because that's how they listen to their podcasts. But when you come out with 'Dental Happy Hour' upload it on Dental Town. We've got 205,000 members on the website. About 40,000 of them have downloaded the app. And truthfully it's your best marketing. They all see it. I can't believe dentists put their podcasts for free on iTunes, and they don't put it for free on Dental Town. It's the best target marketing you can do. It's free. There's a dozen podcasts now. If you download the Dental Town App and go to the podcast section, there's a dozen podcasts on there. Every one of those guys who put their podcast on Dental Town said their downloads and views exploded. 

So when you come out with 'Dental Happy Hour' please put it on there. Dental Town is about the dentist. It's not about me or my column or my post. 

Pei: I feel the same way about mine. 

Howard: Yeah, and you know the founder of McDonald's, Ray Crock is dead, and 40,000 McDonald's get up every day. Sam Walton's dead, they open up 40 new Walmart's a day. Hell, I'm 53 years old, I'm not going to be podcasting for the next 10 years, or 20 years, or 30 years, so basically... And plus, you should start a dental podcast show, because if you can't create a dental podcast show better than mine, you're not even trying. Because I know I'm not even trying. Okay? So hey, Dr. Pei, you're just a Hell of a person, love you to death. And if you want to see what she's doing on her Relaunchshow, because you can help them start a podcast, right? 

Pei: Definitely. 

Howard: So if you go to, and tell her that Howard sent you, she'll actually do everything for free. Is that right?

Pei: Yes. 

Howard: Is that what you said? 

Pei: Howard [inaudible 01:05:33], yes the ticket. 

Howard: Okay, well hey, tell your husband if what he does in his consulting, and what he does, if he wants to come on the show for an hour I'd love to have him. Or if you or him think it's better to build a structural, more professional hour online CE course on Dental Town, you can do that. Do whatever you want. 

Dr. Pei, I'm your biggest fan, and thank you so much for sharing an hour with me today. 

Pei: It has been an honor, and I cannot believe how easy it is to talk to you, and I hope we continue to keep in touch and work for the dentists. For their happiness, for their profitability, and you know? Yeah. 

Howard: Okay. On that note, thank you so much. 

Pei: Thank you, take care. 

Category: Endodontics

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