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255 Control Your Costs with Richard Offutt and Mustafa Shah-Khan : Dentistry Uncensored

255 Control Your Costs with Richard Offutt and Mustafa Shah-Khan : Dentistry Uncensored

12/12/2015 2:00:00 AM   |   Comments: 0   |   Views: 669




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AUDIO - HSP #255 - Richard Offutt



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VIDEO - HSP #255 - Richard Offutt


• What is the current state of dentistry for the independent practitioner

• Forces facing dental practices

• Dental supply industry

• Cost control and management of overhead

• How do we work to preserve the independent dental practitioner

 

 

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Dr. Richard Offutt:

Dr. Richard Offutt is co-founder and Chief Development Officer of The Synergy Dental Partners.

Dr. Richard Offutt attended Davidson College in Davidson, North Carolina. He was elected Phi Beta Kappa while at Davidson. He earned his DDS from the University of North Carolina at Chapel Hill. At UNC he was elected to Omicron Kappa Upsilon and Who’s Who in American Colleges and Universities. Dr. Offutt attended the University of Pennsylvania in Philadelphia where he received specialty degrees in periodontics and endodontics. Dr. Offutt was a professor at the University of Pennsylvania upon the completion of his specialty training.

 

Dr. Offutt has practiced periodontics and implantology in Charlotte since 1982. He has devoted an extensive number of days to continuing education in the areas of dental implants and periodontology. Dr. Offutt is married to his wife Becky and they have four grown children.

Dr. Offutt is a member of the American Dental Association, American Academy of Periodontology, The Academy of Osseointegration, and North Carolina Dental Society.

www.thesynergydentalpartners.com

roffutt@thesynergydentalpartners.com

***

 

 

Dr. Mustafa Shah-Khan:

 

Dr. Mustafa Shah-Khan is founder and Chief Executive Officer of the Synergy Dental Partners.

Dr. Mustafa Shah-Khan is a practicing General Dentist in Charlotte, NC. He graduated from the University of North Carolina at Chapel Hill with a BS in Chemistry and received his DDS from UNC’s School of Dentistry.

 

Dr. Shah-Khan is an active member of the ADA, NCDS and Charlotte Dental Society. He has served as a member of the Board of Directors of the UNC School of Dentistry’s Dental Alumni Association and the Charlotte dental Society as well as being a member of the nationally recognized Spear Education’s Faculty Club and the cerecdoctors.com Academy.

Dr. Shah-Khan is a contributing writer for Dental Economics magazine.

Dr. Shah-Khan and his wife reside in Charlotte, NC with their two young children.

 

www.thesynergydentalpartners.com

mshah-khan@thesynergydentalpartners.com 704-905-1885

 

 


Howard: It is a huge honor today to be interviewing two extremely amazing people. Thank you so much, gentlemen, for spending an hour with me today. I'll just read your bio. Dr. Richard Offutt, did I pronounce your name right ...

Dr. Offutt: Yes. 

Howard: Richard Offutt is co-founder and Chief Development Officer of the Synergy Dental Partners. Dr. Offutt attended Davidson College in Davidson, North Carolina. He was elected Phi Beta Kappa while at Davidson. He earned his DDS degree from University of North Carolina at Chapel Hill. Isn't that where Michael Jordan went?

Dr. Offutt: Yes, not to dental school though. 

Howard: At UNC, he was elected to Omicron Kappa Epsilon and Who's Who in American Colleges and Universities. Dr. Offutt attended the University of Pennsylvania in Philadelphia where he received special degrees in Perio- and Endo-, is that right. You're...

Dr. Offutt: Yes, that's correct. 

Howard: A Periodontist and an Endodontist? I think you're the first one I've ever met who's a periodontist and endodontist. 

Dr. Offutt: You stay in school long enough, they give you everything.

Howard: Dr. Offutt was a professor at the University of Pennsylvania upon the completion of his specialty degree. Dr. Offutt has practiced Perio and implantology in Charlotte since 1982. He has devoted an extensive number of days to continued education in the areas of dental implants and perio. Dr. Offutt is married to his wife, Becky, and like me, we're both crazy enough to have four grown children. Did you survive your four children?

Dr. Offutt: I did. Unscathed. 

Howard: Unscathed? I'm so lucky. Brian, my third son, helps with my podcast. 

Dr. Offutt is a member of the ADA, American Academy of Perio, Academy of Osteointegration and North Carolina Dental Society. His partner, Dr. Mustafa Shah-Khan. Did I say that right? 

Dr. Shah-Khan: Yes.

Howard: Dr. Mustafa Shah-Khan is a practicing General Dentist in Charlotte too. It seems like everybody new and hot and amazing is out of Charlotte. I mean, it's just ...

Dr. Offutt: Really. 

Howard: One of dentistry's hot beds. It really, really is. He graduated from the University of North Carolina-Chapel Hill with a B.S. in Chemistry and received his DDS from UNC School of Dentistry. Dr. Shah-Khan is an active member of the ADA, the NCDS, the Charlotte Dental Society. He has served as a member of the board of directors of the UNC School of Dentistry's Dental Alumni Association and Charlotte Dental Society, as well as being a member of the nationally recognized Speer Education Faculty Club and the [Syrac 00:02:26] Doctors.com which I take credit for because that was originally started on Dental Town with Samir Perry. Then those guys all migrated to [Syrac 00:02:35] section of doctors, and I applaud them for that. Dr. Shah-Khan is a contributing writer for Dental Economics, which was my favorite magazine going all the way back to dental school. I thought Joe Blaze was amazing. Dr. Shah-Khan and his wife reside in Charlotte with their two young children. If the younger dentists learned anything it was not to have four children. Is that your biggest take away from me and Richard?

Dr. Shah-Khan: That is correct. 

Howard: Cut your losses.

Dr. Shah-Khan: It's the first thing he told me.

Howard: Are you gonna stop at two or are you gonna go crazy and go for four?

Dr. Shah-Khan: We're done. We're done. 

Howard: Okay, so where do you guys want to start? Did you want to start with Synergy Dental Partners? I liked what you were talking about. What is the current state of dentistry for the independent practitioner? When you go talk to a room full of dentists, you don't talk for 10 minutes and they're afraid of corporate dentistry. They're seeing dental offices open up that are part of chains that go from sea to shining sea. They see the dental companies just getting bigger and bigger and bigger. They see dental labs getting bigger. I think they feel smaller and less powerful and less control over their destiny. It looks like you're addressing that and what are the forces facing dental practices, the dental supply industry, cost control, management overhead. More importantly, I want to start with how do we individual dentists preserve the status of an independent practitioner or do you think in 20 years we're all gonna be working in McDonald's anyway?

Dr. Shah-Khan: I hope that that's not the case. We think that there are lots of things dentists can do to help control their destiny and preserve the independent dental practitioner. I do think we have to recognize what the forces are that we're seeing. Dentistry forever, from 1981 to 2005 had a steady increase in practitioner salary. Basically it was a 79% increase. Once we hit 2008, GP income dropped $190,000 from a peak in 1981 of $215,000. Then what we've always seen is as GDP rises, so does dentist's income because spending increases. Since 2012 is the first time that we have seen GDP rise but dental incomes drop. In fact, in 2013, we saw average dental incomes drop to $181,000, which is the first time that we've seen numbers like that since 1996-97. There are definitely forces working against us.

Howard: Could I be ... that was so profound what you just said. Will you repeat those numbers again? I just want everybody to hear those. You said from 1981 to what? The numbers went up 79%. Would you just repeat those numbers again?

Dr. Shah-Khan: From 1981 to 2005, dental incomes rose 79% to a peak of $215,876. When we hit 2008 recession, everything kind of went out the window. By 2009, average GP income dropped to $191,000. Then it even got worse. Typically as GDP rises, so does dental spending and so does practitioner salary. In 2010 to 2013 was the first time that we've seen a rise in GDP, but we've seen a decrease in average practitioner's salary to $181,000. That's the first time we've seen those numbers since 1996-97.

Howard: That is amazing. In fact I was ... the American Dental Association has an economist and he wrote an article called Attorneys, Dentists and lattes. Did you get to see that on the ADA website? 

Dr. Shah-Khan: I did not.

Howard: He was basically saying that from the 2008 meltdown every industry sector has recovered except attorneys, dentists and coffee shops. We haven't recovered. Do you think from 2013 to now, do you think we're still sliding down or do you think it's stabilized or ...

Dr. Shah-Khan: I think, from what we've seen, and you don't see very many statistics that have come out since 2013. Obviously, it takes them a little while to digest the numbers and come out with the studies. From what I'm seeing, it seems like we've plateaued in dental spending, which would sound fine except for the fact that we're continuing to see an increasing the cost of delivering care. 

Another crazy statistic if you look at since 1985 to 2013, the cost of delivering care rose 297%, but the cost of inflation costs of goods and services across the board only rose 114%. I think that's one of our biggest problems that we're facing is cost of delivering dental care is rising. Even if spending stays flat or spending increases at a small percentage, our problem is how much it costs us to place an implant, to place a crown, to do [inaudible 00:07:40]. The cost of that is increasing too much. I think if you continue in the normal path that we've always continued on and don't pay attention to your numbers and don't pay attention to how your practice is set up, I do think we are probably gonna see a steady slide in dental incomes. 

Dr. Offutt: I talk to dentists every day all over the country for our company and ...

Howard: And that company is Synergy?

Dr. Offutt: Synergy. Yes.

Howard: Which is Thesynergydentalpartners.com. The Synergy Dental Partners.com. Okay. Will you explain to our viewers what that company is and then say what you were gonna say?

Dr. Shah-Khan: Yes, absolutely. Synergy Dental Partners is a national group purchasing organization. Essentially what we have done is we ban independent practitioners together all across the country in hopes of being able to leverage their buying power together to negotiate price savings on consumables. Our core competency is saving on consumable dental supplies. What we're looking at is ...

Howard: Explain consumable dental supplies. That doesn't include lab, that's not labs. That's supplies, impression materials.

Dr. Shah-Khan: Correct. That's the core competency, which is basically anything that you use and throw away in a dental office; impression materials, composite, bonding agent, cotton rolls- you name it. But we also have partnerships in other things that help impact dental overhead like lab companies. We have a few partnerships in there. We have a partnership with an implant company. We have a partnership with Rotary Diamond provider, Komet USA, Buyer Horizons, Prudental Dental Lab, DDS Lab. Our major supply provider is Darby Dental Supply. What we do is we take the buying power of our thousand members across the country, negotiate price savings agreements with our distributors and try to help control overhead.

Howard: You have 1000 dentists?

Dr. Offutt: Just north of 1000 dentist offices. offices that have asked us to help them since we started the company. 

Howard, what I was getting to say is I talk with dentists all over the country every day. I'm a full-time practitioner, but we run Synergy Dental as a bolt on operation. I talk with them everyday and I talk with their receptionists while I'm waiting for the doctors. They ask me, what's your company do? I go we're a group purchasing organization that helps dentists save money on dental supplies. Every single office says boy, oh boy, we really need help there. It's one of these things ... that's right in our sweet spot. That's our core competency is helping offices save money. 

It's always interesting because it doesn't matter where you call around the country. The things that Dr. Shah-Khan has said is so true that the spending on dentistry is fairly level. The cost of delivering the care is increasing, which would include your 2 x 2's, your cotton rolls as well as your dental hygienists, your assistants and business office people. All those costs are increasing, and we're having fairly flat revenue growth. As those two lines converge, the dentist finds himself in between. 

I think that part of our whole proposition is for dentistry, both for ourselves and for the Synergy Dental Company is how do we preserve the practice, the individual practitioner? How do we help keep it so that those lines don't converge to the point that the dentist can't be in business? Part of that is is dentists have to learn excellence in every aspect of their business. Whatever they choose to do in their practice, whether it's bonding or whether it's implants, whatever, they've got to become excellent in those services, but they also have to gain competency in dealing with all of the different aspects of running a business. Very few dentists have office managers that can handle it like our medical colleagues where they have a whole staff of people that handles HR, handles their retirement plans, handles their outsourcing of their lab work. Dentists have to gain competency in all those areas and they have to be excellent in what they're doing because that's the only chance they have or we have. Dr. Shah-Khan and I are both in private practice, that we have of being able to have a sustainable business model. It becomes very important.

A lot of what we talk about all day long with dentists all over the country is how do you do that? The one aspect of that that we bring to the table is in saving money on consumable supplies. That's what Dr. Shah-Khan has been writing about in Dental Economics and posting on their websites and what have you. It becomes that's the dialogue, Howard. That's the dialogue we have to have with dentists is how do you do that? What does it take for you to be competent to be able to survive in the private practice?

Howard: Okay, you say you have north of 1000 members and I don't know how many of our listeners are your clients, but you're talking to several thousand dentists right now. They are all individuals multi-tasking on a commute to work. Try to paint a picture how does this dentist driving to work, how does she know her supplies are not in line? She doesn't know what the other eight dentists supplies are in the medical/dental building. When I ask them at dinner, I'll go to dinner and I'll talk to a guy and I'll say well, what is your sundry supply? They'll say I think it's somewhere between 4 or 6 or 7%. I'm like, God, the difference between 4 and 7, that's a huge variance, especially in a million dollar practice.

Dr. Offutt: You take that to the bottom line and you can educate your kids.

Howard: What should supplies be? What should lab be? What should labor be? How does this ... she's listening to you right now. How is she supposed to know her supplies are out of line and you could help her?

Dr. Shah-Khan: Ideally we want your supplies ... we would, nationally, I think you look at the average, supplies are about 6%. If you can keep supplies at 6%, you're at a good spot. I think you see supplies getting closer to 7 and 8%. Like you said, some guys will say, well, yeah, it's 1%, 2%, that's a not a big deal. The crazy answer we hear from several dental supply company reps is you're talking about 2% on your overhead. What you need to do is you just need to increase how much dentistry you do and then it'll all take care of itself and I'll show you how to do that. I've never seen a dental supply rep show me how to increase my production by 2 or 3%. If I could increase my production at will, I think it'd be a great thing. 

What we're seeing is guys do have these percentages that are getting north of that 5, 6%. What our proposition is let us give you an opportunity to get the lowest possible pricing that you can. The original thing that you were asking about is how does Dr. Jones in Anywhere America know what his supplies are and that his supplies are higher than anybody. The biggest thing that's going on in dentistry is dentistry is tremendously fragmented. The fragmented nature of dentistry, even gets mentioned on a lot of the K1 statements of a lot of the bigger companies as being a key to their profitability. 

A big reason why we started Synergy is I have an office right beside another general dentist. I was ordering from one of the bigger companies; he was ordering from one of the bigger companies. We were ordering almost the exact same stuff. He had an invoice laying on his table one day and I brought my invoice in and let's say we're ordering Imprint 3. I was paying $40 less on Imprint 3 than he was. 

Dr. Offutt: That's because Shah-Khan's a meaner man. 

Dr. Shah-Khan: That's right. I was paying more on bonding agent than he was. The statement that it told us is that the fragmentation across dentistry shows us that you can have five dentists within a block of each other all ordering from the same company or even very similar companies all doing the same volume of ordering, and they're all paying different prices. We're like that is the one key piece that we have ...

Howard: In MBA school, I got my MBA from Arizona State University is because this fragmented market does not have transparency in its prices, so everybody's paying a different rate. 

Dr. Offutt: Howard, Howard ...

Howard: The american culture is in America, they don't like to haggle and argue over price. You go to some countries, it's culture. If I drive 100 miles south of my house and go into Mexico, they're born and raised to argue over prices. A lot of americans, they don't like that. They say it with women car dealers. Women don't like to go on a car lot and argue and debate about price, but your cousin Earl might love it. If one dentist is really on top of his Patterson's rep, they'll get lower prices than someone who's just a nice guy and says hey, how are you dong? How's your new baby? Is that, do you agree with that.?

Dr. Shah-Khan: Absolutely. I definitely agree with that. That's kind of what we do is we present guys the opportunity. We're gonna negotiate these pricing points for you. We're gonna get you a lower overall situation than you can get yourself unless, you know what I mean, there are some very, very aggressive guys who will go in there and they will beat this rep up and beat that rep up and maybe they are able to negotiate good pricing. We're looking to protect the guys who aren't necessarily doing that. These are the guys who want to practice dentistry and want to practice a high level of dentistry and don't have time to necessarily pay somebody to go through six different catalogs and call six different companies and order products from six different places to get the lowest possible price. What we try to do is present you an easy opportunity to get the lowest possible price.

Dr. Offutt: Howard, let's flip the paradigm around a little bit. Let's look at the story from the side of corporate dentistry where that is what they do for their corporations. They negotiate price point. They take it out of the doctors' hands. The doctor doesn't have to do any of this business transaction thing. What happens as a result of that? As a result of that leverage that they have, the operating costs of the corporate dental office are so vastly lower than our private practice doctor that our doctors are starting at a disadvantage from the get go because their cost structure is vastly different. That's one of the things that we have to look at and address in private practices. How do we work on the cost basis for everything we do? We have to lower the cost of doing business because as we talked about earlier, the lines are converging. They're converging. The overhead is converging with the ...

Howard: When I talk about corporate dentistry, I always talk about Heartland and Pacific ...

Dr. Offutt: Me as well. 

Howard: Because I think those are the two best ran corporates. A lot of people say corporate dentistry and I feel sorry for corporate dentistry because there are some chains that are just embarrassing. I think Rick Workman of Heartland and Steve Thorne of Pacific do a damn, I think they do the best job.

Dr. Offutt: Yes.

Howard: What do you think they're paying for supplies? What do you think their percent of revenue goes to?

Dr. Shah-Khan: I think they're probably right at about 3.5, 4% probably. 

Howard: 3.5, 4%? And that's about what when I with an MBA and looking in dental offices, that's about the dentist variance.

Dr. Shah-Khan: Yes. 

Dr. Offutt: Yes.

Dr. Shah-Khan: 3.5 to 4%. One month they'll be five, next month they'll be 8.5. God, your variance from month to month is their total supply bill. I'm gonna play devil's advocate 'cause I know these guys are listening. First thing they're gonna ask you is how do you get paid? How are you making money? How do I join this? If I go to thesynergydentalpartners.com, what do I do? I sign up? Is it a membership? Is it $1000 a year? How does it work?

Dr. Offutt: Here's the deal, Howard. Our basic premise that we started ... This is the Dr. Shah-Khan came to me five, more than five years ago with this idea for Synergy Dental. Our premise is that we, that Synergy is a free service. It is free to the doctor. It costs them nothing to save the money. I talk with doctors every day and I tell them, I say look, check us out. Check us out and see what's up. If we can't save you money, don't use us, right? It's a pretty simple proposition. If we can't save you money, don't use us. 

Now in the five years we've been running Synergy, or four and a half years we've been running Synergy, I've not found that situation yet, but I tell doctors that that's the key to it. Synergy is a free service to the dentist. We do get paid an administrative fee by the vendor. 

Howard: And that's Darby? That's Darby for supplies ...

Dr. Offutt: Our vendor partner. 

Howard: Then you said BioHorizon for implants?

Dr. Offutt: Komet USA for rotary instruments through ...

Howard: When you say rotary instruments, you mean burs?

Dr. Offutt: Diamonds and burs. That's right. 

Dr. Shah-Khan: Yep. 

Dr. Offutt: He's using fancy words.

Howard: Rotary instruments. Komet for diamonds and burs. I don't know why when I heard rotary instruments, that tricked my brain, but you're right. 

Dr. Shah-Khan: It took me forever to finally process that. Komet used to throw that word at me all the time and I was like don't you mean burs?

Howard: Komet is a German bur company, right?

Dr. Shah-Khan: Correct. Komet is ...

Howard: When Peter Brasseler started Brasseler Burs, wasn't Komet the original supplier for Brasseler?

Dr. Offutt: Right. No, you're exactly right. Komet made every Brasseler Bur every made and then Komet and Brasseler split when Komet was able to finally start selling burs directly in the United States. Every Komet bur is still made in the same factory in Germany. Brasseler, you know, right or wrong, if you order Brasseler burs, they're gonna come in five different packets 'cause they're made by five different companies now. 

Howard: Not to throw my fellow Americans under a bridge, but I have been in 100 dental manufacturing companies in six continents, and I'm telling you the dental manufacturing companies in Germany and Japan are a civilization ahead of the ones in America. I'm sorry, America, but it's just true. I mean, think of their cars. Think of Mercedes Benz and Audi and Porsche and Lexus and then think of Chevy and Chrysler. I mean, those German manufacturing plants, I mean, holy moly. You feel like you're in Star Wars. 

Dr. Offutt: Komet's the largest bur and diamond manufacturer in the world. 

Howard: So what are the other partners? Darby, Darby's out of New York. Isn't that Manhattan?

Dr. Shah-Khan: Darby is based out of Jericho, New York. 

Howard: Jericho, New York? 

Dr. Shah-Khan: Yes. 

Howard: Who's the guy that runs that?

Dr. Shah-Khan: Jeff Daly.

Howard: Jeff Bailey? There's another guy. 

Dr. Shah-Khan: Daly, I think is the ...

Howard: Jefy Daly. Daly. 

Dr. Shah-Khan: Is the overall ...

Howard: Who's the other guy married to the blond?

Dr. Shah-Khan: I'm not sure.

Howard: But anyway, so BioHorizons, that's in ...

Dr. Offutt: Birmingham.

Howard: Birmingham, Atlanta.

Dr. Offutt: Alabama. 

Howard: Alabama.

Dr. Offutt: Birmingham, Alabama. 

Howard: Birmingham, Alabama. Who are your other partners? Darby, BioHorizon, Komet, who else?

Dr. Shah-Khan: We have two labs on board- PruDental out of California.

Howard: PruDental?

Dr. Shah-Khan: Prudental. DDS Lab out of Florida. 

Howard: Are those shipping centers for China or are those ...

Dr. Shah-Khan: Prudental is 100% made and operated in the United States. DDS Lab does have some operations in China. The opportunity that we present people is obviously the lowest cost that we can if you want only your stuff made out of the United States, then Prudental is the way to go. If cost is the number one piece that you're looking for while still getting good control and FDA regulation, DDS Lab is a good opportunity. 

Howard: Yes, I was at a modern dental lab in Shenzhen, China where they have 4000 employees and these UPS trucks would pull up a couple times a day and I was looking at the incoming boxes. It was like almost all the labs I'd ever heard of in my life. They're collecting them in your city and then they're sending them to China and then they get them back in like four days and they re-package them and send them to you. 

Anyway, so go on. I go to the synergydentalpartners.com and basically what you're doing is you're doing a volume discount. You're buying stuff and saying, obviously if I buy one Barbie doll, it's $10, but if I buy 1000 Barbie dolls, I'm gonna get them for $7 a piece. That's basically what you're doing.

Dr. Shah-Khan: Two things I wanted to mention. One, there are a couple other partners. We use Garrison is one of our partners with Matrix Bands and composite products. Kettenbach USA, which is a great producer of impression material, bite registrations, things like that is another one of our partners that we definitely wanted to list. We also use a company that we formed a partnership, Dental Card Services. We launched Synergy Card Services through them. 

Howard: Dental what? What was the last one?

Dr. Shah-Khan: Dental Card Services.

Howard: Dental Card Services? 

Dr. Shah-Khan: Yes. With Dental Card Services is a credit card processor that focuses on the dental industry. Then we have some consulting partners, Dr. Stan Michalski with Michalski Coaching as one of our consulting partners.

Howard: He's an in-office, dental office consultant?

Dr. Shah-Khan: Yes.

Dr. Offutt: Yes.

Howard: Tell him I want to podcast him. 

Dr. Shah-Khan: We would love to. 

Dr. Offutt: We will. 

Howard: Yes, I would love it. 

Dr. Offutt: He's quite good. We've known the man for years and what he is very good at is taking a doctor from X to X plus 10% in growth of his production. 

Howard: His name's Stan what? 

Dr. Offutt: Michalski. 

Howard: Spell it. 

Dr. Offutt: He has an added ... Michalski.

Howard: Mich ...

Dr. Offutt: Alski. 

Howard: Alski?

Dr. Offutt: Yes. 

Howard: Is he Polish or Polish?

Dr. Offutt: I think he's polish. He's got the statistical data to back up his efforts across his clientele, so he's interesting. One of his key areas is controlling cost and that's the interface that we have with Michalski Consulting is he consults with the doctors and a big thrust of it is yes, increasing your production, but controlling your costs.

Howard: And he's a dentist too?

Dr. Offutt: Yes. 

Howard: Yes. Does he still practice or just consult?

Dr. Shah-Khan: He still practices a little bit.

Dr. Offutt: Little bit now. 

Howard: Find his consulting company. 

Dr. Shah-Khan: Kind of back to where we were talking about what is the model? What does it cost? A dentist pays us nothing and we also have no contracts with the dentist. We don't force you to commit to volume. You can buy one cotton roll or you can buy every product that you use in your office from us. It never costs you anything. Some companies will ask for a monthly fee. Group purchasing organizations are plentiful- nothing happens in a vacuum in this country. If anybody sees something that they think is an opportunity they'll do it. There are other companies that are asking for annual fees, monthly fees. There's even a company that's asking for 2% of gross revenue to be a part of the GPO, which I think is kinda crazy.

Dr. Offutt: Howard, think about that. You're gonna give up 2% of your gross revenue. I just can't understand that. The goal is to save money and that just seems like such a give away that you're behind before you start, but that's their model.

Howard: Okay, I want to take this in a different direction. It's easy for a bunch of dentists to all get around a campfire and say the distributors are charging us too much money. When I go to talk to the distributors, when I talk to a Patterson rep or a Benco rep or a Burco rep, they tell me their side of the story too. Let's talk about, because this is dentistry uncensored and when I go into lecture, I've never gone in there trying to sugarcoat. I've never gone in there trying to make a friend. I've always thought to myself, if I love and respect you, I'm gonna tell you that this is what you're doing wrong. They said they go into a group practice and three dentists, they all have to have three different kinds of gloves. They use three different kind of bonding agents. When they go in there and say, I could lower your supply bill if you just were kind of reasonable. They just tell me ... can you talk about the horrible stuff that the dentists do, how they are their own worst enemy? They're not just getting the best price 'cause they're not the type of person that likes to haggle. When I meet someone, the last thing I want to do is haggle or argue with them. Life is just too short to do that. 

What are dental offices doing to themselves that's raising their supply bill, even with their high cost Patterson dealer?

Dr. Shah-Khan: I think you're totally dead on right that you can lower your cost if you would standardize, if you would all use the same materials and then you can buy things in bulk, that definitely works. If you look at the medical model, GPO's have been very prevalent in medicine for a long time. That's the model. They go to the manufacturer. Everybody uses cotton rolls from Johnson and Johnson. Everybody uses tongue depressors from Johnson and Johnson- that's what the deal is. We look at it and we look at it in a different way. We're a business as usual kind of company. We want you to be able to use the different products that you want to use. If there's five guys in your practice and you want to use five different impression materials, go for it, you know. 

Howard: But no, you should tell them to do both. You should tell them to buy group practice from you, but be smart about it too. I've seen, in my 20 years, I've seen a dental assistant break down and cry three times because she can't keep straight ... you know, she's in a group practice and they keep throwing her in different rooms and you're using this bonding agent and he's using this bonding agent. She sets up your tray forgetting that you're the one dentist who ... I think the assistants are tortured in group practices, especially by the time they get to three docs. I'm surprised they're not drinking Listerine by noon. If they standardize it, the assistants' lives would be easier and their costs would come down. I think you should advise ... I think when these guys send in for three different bonding agents, you should forward their call to Dr. Phil.

Dr. Shah-Khan: You know, the interesting thing about that, what you're talking about is kind of an internal management dynamic. What we are offering the doctors is you can have anything you want and you can have it at the Synergy price. If you want five impression materials based on different applications, perfect, but save money on all five. What they have their internal operation do, that's totally up to them. We had some discussions with the company, very prominent company, a virtual company that sells things online. They looked at us and told us that they feel that they could force dentists to buy particular products based on just price point alone and that they could more or less mandate that.

We tried to explain to them over a cup of coffee that dentists are unique individual. If six of us sat down and prepared the same tooth, we probably would do it differently. If we all prepared a first molar, we'd use different stuff, right? That's the beauty of dentistry is that one size doesn't fit all. As long as you're in an independent practice, you can prepare that tooth any way you want and use any materials you want ... what we're asking doctors to do is be efficient so that you can survive in that model. Be efficient. What part of that is is what I started out on is excellence across a wide number of disciplines.

Howard: You know, what I used to do is I used to refer to a higher authority, someone who's not in our group practice like Gordon Christen of CRA, something like that. I'd say look, we are all gonna use one impression material and we're not gonna beat the chest of I'm older; you're younger, you're an employee, blah, blah, blah. We have to agree on certain things. I noticed every corporate dental ... when I talk about corporate, 90% of the corporate dental practices I know of are like four to five or six or ten locations, you know. Just a handful are in different states. When I go lecture to a corporate dental office that's got 15 locations in Louisville or something, I've noticed that all those corporate offices they have gotten everybody to agree on a type of glove, a type of impression material. The one that everybody gives up on is burs. I get that because I'm a dentist and I use more burs on a stupid little crown prep than I need to. If someone came in and took half my burs away, I'd pout.

Dr. Offutt: That is true. What you're saying I think is exactly true is that in those models, they do try to standardize what everybody uses. Our contention is is that most all of our clients, well over 1000 offices, most of these guys and ladies are ones and twos and three doctor practices. In one location, sometimes they'll have two locations with three doctors, so they're not in the world of where they are having to standardize their supplies. That's the beauty of it. Our point is if we can help you do that more efficiently with more cost control and not have to change your products, how you work it out in the office logistically is kind of an internal issues. 

Dr. Shah-Khan: We're trying to level the playing field. We're trying to level the playing field for the independent practitioner with the Heartlands and Aspen Dentals in the world. We want to get you very similar pricing to what these guys are getting. The other aspect what you're talking about I think is very valid. If you do have multiple doctors and you can standardize things, I think you can definitely save more. We feel that's kind of on the consulting side of it. We're not trying to really- and probably should do more of it- but we're not trying to necessarily advise you on how to operate your practice. We're trying to present to you an avenue to save while you're operating your practice in the manner that you are. Through Michalski and other guys that we work with, those are the guys that will advise you on how to even ramp up your savings.

Howard: Let's talk about specifics like polyvinyl siloxane impression material. I mean, isn't polyvinyl siloxane, polyvinyl siloxane, polyvinyl siloxane? Can you really have a Nike and an Adidas polivinyl siloxane?

Dr. Shah-Khan: I'm probably the worst person in the world to ask this question to because I've used 3M's imprint since I got out of school. Imprint has gone Imprint 1, Imprint 2, Imprint 3, Imprint 4. They all behave a little differently. Some's a little more viscous, some's a little less viscous, so those things operate differently in doctors' hands. You know that as well as I do. I like, we're on Imprint 4. I use Imprint 2 Light Body and Imprint 4 Heavy Body because Imprint 2 Light Body has a different viscosity, so it operates differently in my hands. Maybe that's just in my head but that's what works. That's what I put in somebody's mouth and it comes out and the impression's right. I get Imprint 3, I don't like how it is, I get a tear in here. From a chemical perspective, PVS is PVS. From the nuance perspective, it is not. 

Howard: Yes, I'm kind of different that way. I've used polyether imprint gum for 28 years. That was because my next door neighbor, when I was in the 6th grade, Kitty Henderson, when I was in the 6th grade, he was already using emper gum, you know what I mean?? I've already been on it. But let's go to titanium, same question. You have a deal with Bar Horizon. Titanium's, titanium's, is titanium. Does an osteoblast, and an osteocyte really know if that titanium is made by Noble Biocare or Megagen or Biohorizon. 

Dr. Offutt: I'll turn that to my surgical partner. 

Howard: You're gonna default on that?

Dr. Offutt: Yes, I think if you have four blocks of titanium, all cut from the same source, you're right. Titanium's titanium's, titanium, but I think what makes the difference in titanium are the surface characteristics of the particular implant. Doctors are going to still opt for an implant system that they day one can get predictable high quality results with. Hopefully, that's the goal. I don't know, it takes a lot to shake a surgeon from one implant company to another. It takes a lot. It has to have had a lot of issues because the loyalty of being able to deliver a predictable outcome day in and day out surgically is very, very important. 

It's kind of like Dr. Shah-Khan said with the impression material. Listening to him describe the different, I haven't taken an impression in 30 years, right. We use it for our crown- more than that. The deal is is that no way are you gonna force him into a box- either of you guys. Both of you are, you use what you use. I think that that flexibility is important. Titanium isn't just titanium. I think the surface characteristics are very important. 

Howard: Let me rephrase the question. Why did you pick Biohorizon?. That's the one that actually Carl Misch was involved with in the beginning. 

Dr. Offutt: Yes, correct. Yes. 

Howard: I got my fellowship as I mentioned I think Carl Misch and Dr. Branmarker are just legends. Why did you go with Carl Misch's Biohorizons?

Dr. Offutt: We had a relationship with the people at Biohorizons and we talked to them. They were interested in this as a possibility. They offer outstanding products. I use their products every day. I think how some of this started for us as we approached vendors that sold the things that we liked, that we use, that we're comfortable with. I talk to doctors every day about bone grafting sockets and barrier membranes, both for Synergy and for my private practice in Charlotte. I think that, I'm very comfortable offering that product line. I've used all of their products. It's a solid company based in Birmingham. It's a great story. Their corporate culture is good. I'm not saying it's exclusively or that it's exclusive to them, but we like the company. I had a relationship there. We like the people that run it. They were willing to take a chance with us when we had a lot of good ideas but not a lot on the table. We appreciate that relationship very much with that company. 

Howard: Can you give an example of how much someone would save if they're buying five implants from Bar Horizon by themselves versus if they were buying them through you? 

Dr. Offutt: First it's, you have to understand the paradigm here a little bit. We don't touch the doctor's product, nor do we touch their money. What we do is we negotiate contracts for pricing. The doctor still buys his implants from Biohorizons. He doesn't buy them from Synergy. The typical discount for a Biohorizon implant is about 30%. That's what we offer.

Howard: If they're going through you, they save 30%?

Dr. Offutt: Yes, that's about the number.

Howard: That's huge. That's just amazing. 

Dr. Shah-Khan: Think about it, it's $120 off a $400 implant, you know what I mean?? That's a, you can start giving people implants if you want to. 

Dr. Offutt: Here we go, Howard as I told you, I talk to doctors a lot and I ask them, they're minimizing the effect of savings. Lots of doctors will minimize that effect on their lives and their practice. I ask, I go if you were walking down the street and you saw a five dollar bill laying there all by itself, nobody's around you; nobody's there. You're by yourself. Would you pick the five dollar bill up or would you walk on by? 

Howard: I was born in a barn in Kansas. I'd pick up a penny.

Dr. Offutt: I've not met a doctor who said he'd walk on by the five dollar bill. Then I tell them why don't you by your diamonds through Komet USA. You save five dollars a diamond. It's that simple. This isn't a sophisticated business. We just save you money. 

Dr. Shah-Khan: Well, let's look at it. Like you were saying, let's look at the Komet deal. Just to throw percentages out there, you can save 60% on your diamonds, you know what I mean?? That is a crazy amount of money on something that you use every single day. 

Howard: And you can save 15% on your car insurance if every time you wreck your car, you throw it in reverse an get the hell out of that scene. 

Dr. Shah-Khan: That's right. 

Dr. Offutt: That's right. 

Howard: That's my advice. Just drive away from every accident. You'll save a lot of money ...

Dr. Offutt: Hit and runs. That's the way to live.

Howard: Hit and runs. Yes. Do you have any interface? Is there something like if I go to, Brian, pull up the Synergy Dental Partners.com. I mean, can I order my supplies on your website?

Dr. Shah-Khan: You can not. What we essentially do is you interface with us initially. You sign on to our membership forms. Dr. Offutt deals a lot with all of the day to day singing up of members and he enrolls you with all of our vendor partners, and you're coded as a Synergy member. When you're coded as a Synergy member, you automatically get the pricing. We have specific inside reps that are assigned to Synergy clients that we try to get you with so you can contact our Synergy reps. You call them, you order your supplies from them. You get the Synergy pricing. They invoice you; you pay them. 

Howard: Okay. 

Dr. Offutt: If you fill out the form, Howard, like you're looking at, if you fill that out and you submit it, it comes to me. 

Howard: Well, I'm sending it to you right now. 

Dr. Offutt: And then you ...

Howard: I'm a multi-tasker. 

Dr. Offutt: And you have to say you'll accept my phone call tomorrow because I'll call you tomorrow. 

Howard: Okay. 

Dr. Offutt: And I'll offer to help you. 

Howard: Brian, email that to Richard, it's Richard Offutt, right?

Dr. Offutt: Right. 

Howard: Musta Shah-Khan?

Dr. Shah-Khan: Mustafa Shah-Khan. 

Howard: Mustafa Shah-Khan. So were you always teased when you were in high school and Shaka Khan had the number one hit album out?

Dr. Shah-Khan: I've got albums in my locker- vinyl. There would be vinyl sitting in my locker. 

Howard: From Shaka Khan?

Dr. Shah-Khan: Absolutely. 

Howard: Oh my God. What was her big sign? She was with Rufus, wasn't it? Her big one with Rufus.

Dr. Shah-Khan: Yeah, I think so. 

Howard: Oh my God. She was the ... uh, send it to both, either to Robert and [inaudible 00:45:04] 

Dr. Offutt: We're gonna get your information. I'm gonna get your information tomorrow. I'll look at it tomorrow, and what I'll do is I'll send you then a couple of emails that give you all of our vendors, all of the vendor contacts and all of the reps at each of the vendors, okay? Then later in the day or the next day, I'll call you. I'll say hey, this is Richard Offutt. I'm calling to see if I can help you answer any questions, anything about Synergy. If the doctor will come to the phone, which sometimes they do, sometimes they don't, I will have a conversation with them. I tell them I'm the interface with all the new doctors that call us. Then we have a conversation and I get their offices established with their vendors and then you start saving money. It's not that hard. 

Howard: What percent of the dentists are like me? I mean, okay, so I got out of school in '87. I hired my dental assistant, Jan, and she's still there 28 years later. The only difference between me and her is she looks 10 years younger. I've never ordered any supplies in 28 years. I mean, I have, what percent of the dentists are like me that has an assistant do all of that versus what percent of the dentists are actually involved with ordering their supplies themselves? When you said that you're gonna call me and have a conversation, well, I would just hand the phone to Jan. I wouldn't even know what, I couldn't answer one question.

Dr. Offutt: That's perfect because you've empowered her to make decisions on your behalf, in your best interest. 

Howard: What percentage of dentists do that? 

Dr. Offutt: I've talked to many offices where the doctors have actually had to take back over their ordering because they were spending so much money in their offices on dental supplies that it was out of control. They will take it back over, get control of it and then give it to, empower someone that works for them to do it. Many, many times the doctors are totally unaware of their cost structure. 

In my world, we take out a tooth and we do bone graphing. If we take the tooth out and we do bone, grafting, we'll put the bone in the socket. We'll put xenograft on the facial and we'll cover it with a membrane. Well, you need to know that each one of those little packets you open is a $150 worth of dental supply expense. You need to know those things. Many dentists don't have any idea of the cost structure of their procedures, and so they end up being a little disappointed then when the financial aspect of their practice doesn't work out.

What we try to do is just offer the opportunity. I'll have a conversation with the doctor and I'll tell them we're hear for you. I'll answer any question you send me by email or telephone. I tell them I see patients all day, so you may have to leave me a message and then I'll get back with them. I do emails all day long and most doctors are very appreciative of what we're trying to do for the private practitioner. Every now and then we'll come across someone who is a little more combative with us on it and I tell them, I go look, only use us if we can save you money. If we can't save you money, don't use us. It's that simple. If you can get the deal at home, get it at home. 

Dr. Shah-Khan: Howard, what you were saying back to you not having any idea of what the supplies are and placing supply orders, basically what the dentist has to do is the dentist as the decision maker has to say okay, we're going to try these guys out. So Jen, you're my assistant, I want you to try these guys out. Dr Offutt, we'll talk with you and we'll get everything sorted out as far as how we're gonna use their products.

Howard: I want to switch gears because the bottom line is supplies. You said supplies should be, what was the range you said dental supplies should be? 

Dr. Shah-Khan: About 5%. 

Howard: Okay, 5% but what's the range of labs? What's the range of labs? Double. 

Dr. Shah-Khan: Absolutely. Labs, I mean, if you can save on labs, you can save ...

Howard: I don't want to talk anymore about supplies, which is only five. Let's switch to labs, which is 10. Would you agree that supplies are about 5% for the average dental office and labs are about 10? I see the range of labs if they're massively into [syrac 00:49:27], Cadcam, it's down closer to 7. If they do a lot of crown and bridge, it can be as high as 12.

Dr. Shah-Khan: Correct.

Howard: Also the other thing I want to point out is that a lot of dentists think their supply bills are too high when they're actually not 'cause they move into Syrac and they start buying all these e-max blocks, and that's on their supply bill, but when they were taking polyvinyl and sending to a lab, that was all in their lab bill. In my Today's Dental, we put all of our e-max blocks in our lab category. We don't put that in the supply category 'cause it's crown and bridge.

Anyway, so the range of labs is twice as much as supplies, so switch gears and start talking about labs. How can a dentist call the Synergy Dental Partners.com and what's, how can they start saving money on labs?

Dr. Shah-Khan: Well, we're gonna, just like Dr. Offutt was saying, the same as we're gonna enroll you with Darby and everybody else, we're gonna enroll you with our two lab partners. Our two lab partners are gonna save you about 37% on lab costs. If we can save you those kind of percentages there on something that is probably closer to 12%, then you're gonna achieve greater savings than if you just get your supplies under control. 

Dr. Offutt: The whole pool of money is so much bigger. It really is quite substantial to the bottom line. We lose track sometimes of what you're trying to do is take this to below the line. You want to take this down to your bottom line- your savings. If you can save 25% up top, all of a sudden that extrapolates quite nicely to the bottom line for your personal income or funding your pension plan or educating your children in college. There's numerous things you can do with the money, but doctors have to realize that you've gotta save the money above the line to get it down below the line on your balance sheet. That's a huge concept that we don't stress enough.

Howard: I want to know on Prudental or the other lab which was DDS Lab. Some of the labs I'm hearing about are if you orally scan your impression and they receive a digital oral scan, they don't have to pay a human being to pour up a model, trim a die, blah, blah, blah. Do these labs do any of that? Are they into that or what are your thoughts on that?

Dr. Shah-Khan: Yes, everybody we work with has the ability to accept digital scans 'cause let's face it, digital scans are the future. Prudental Lab.com

Howard: Oh, Prudental Lab. 

Dr. Shah-Khan: Prudentallab.com

Howard: Okay, there we go. Okay, so ...

Dr. Offutt: This is actually a very exciting company. Its our newest vendor partner. We launched them two weeks ago and folks have been very happy. They're actually offering doctors a kind of a try us out type of opportunity that will save them a significant amount of money. Doctors should check it out and see and always be skeptical, you know. You have to always be skeptical. Make sure it's delivering the quality you want and make sure that it's in a timely fashion you want and have the opportunity . 

Howard: And then the DDS Lab. Which one, if someone's gonna try either, which one would you recommend?

Dr. Offutt: They're both great. They're both great. They bring different products to the table in terms of one is all domestic. The other has partially domestic and partially offshore, so yeah, I think you have to look at it and see what company gives you the product and the service that you want for your patient. We like both of the companies and so we wouldn't say oh this is better than that or that's better than this. The doctor has to look at it, evaluate it, which one is the company they would feel comfortable with, which is the company they like their products and their service. I mean, it's like anything else, which works best in your model.

Howard: And the other one is DDS Lab? Did you find that?

Dr. Offutt: Yes. 

Howard: DDS Lab. Yeah. 

Dr. Offutt: And Howard, actually right now ...

Howard: DDS Lab. That's in China. 

Dr. Offutt: But right now what we have found is that some of the national labs doctors are more comfortable with labs that they're more familiar with and so we're actually branching out a little bit in the laboratory area to add some partners that we should be announcing sometime in the near future to give them more regional names that doctors recognize. 

Howard: I want to go back, I want to end, we really only have five more minutes. I want to go back to Richard and the fact that the ADA recognizes nine specialties and you went into perio. That one changed the most. I mean, from '87 to 2015, when I got out of school, it was scaling and root plating and hemi-section lower molars in half and all this. Seems like most of those periodontal surgeries and the endodontics, you're and endodontist, apicoectomies. It's kind of like periosurgery on three rooted T's and apicoectomies on failed root canals is kind of gone now. Now you just pretty much go straight to titanium. Is that an oversimplification or true?

Dr. Offutt: I think you have to strike a balance in it. I think you're exactly right. I've had this conversation with a doctor today at lunchtime where I was saying that the percentage of the things that I learned in my specialty program. At the university of Pennsylvania, phenomenal, wonderful place, awesome teachers. It was great. State of the art. What I learned there, what I do in a given day, what I learned there is about a third of it, 25% of it. Everything other than that, the other 75% of what I do all day long I've learned since then. I think your point is straight on. We have to be able to evolve, and I think periodontics has evolved tremendously. There still is the fundamental need to keep people's teeth in their heads. People still get gum disease, guys. They just have a little periodontal disease. You still need a tooth crown lengthened. You still need some attached gingiva added too. Those fundamental skill sets, those things are still there. Yes, maybe the technique's changes a little bit, but ...

Howard: You've been doing this for several decades and a lot of these listeners haven't done it for five years. I mean, when fans send me an email, they're usually five years out of school or less. I mean, really that's about 90% of what I get. Help her out. Apicoectomy or extract and do an implant?

Dr. Offutt: I think you have to look at the case, and there's so many variables on it. I've done a lot of apicoectomies. I haven't practiced endo in many, many years. I would probably do an apico if I thought I had a good prognosis with the rest of the tooth. I don't think, just like I crown lengthen teeth. I do a lot of crown lengthening every day. I don't go to the forcep right away. Those things are important for a practice. What the dentist needs to be able to do is decide if we can do a successful apico, does that extend the usefulness of the tooth for the future? If that's the case, then you do it. Something live on there, Howard. I'm not sure what that is 

Howard: That's my apicoectomy that's gone bad. 

Dr. Offutt: It looks like some ...

Howard: That's my canine tooth sticking out. It's gone bad. 

Dr. Offutt: That has some kind of mustache or something. In any case, I think it's case selection on both peridontics and endodontics.

Howard: I've only got you for two more minutes. Sorry, Mustafa. I get this all the time.  It doesn't make sense. This lady's losing all of her teeth from gum disease, so the periodontist is saying we're gonna pull this tooth and put in an implant, well, then she's just gonna get peri-implantitis. I mean, she's got p. gingivalis in her mouth and you pull the tooth, all you're gonna do is take it from periodontal disease to peri-implantitis. What is my periodontist trying to do to me? How would you answer that?

Dr. Shah-Khan: Well, I don't necessarily think that that is always the case. I think once we get you in the hands of a good periodontist, the periodontist's job is also to help maintain the rest of your existing dentition and to improve your oral healthcare to get you to the situation where your periodontal disease is stable and you're not going to get peri-implantitis. You know, obviously we're not gonna just throw an implant into a situation and the surgeon walk away and not have any contact and just hope for the best. We want you in the hands of a surgeon who's going to provide the adequate level of care for you to improve your oral health. 

Dr. Offutt: The walk away, Howard, this is a little bit of an editorial on my part. The walk away surgeon for implant dentistry is a real challenge because implants have the same problems that teeth have- they crack, they fracture, they get periodontal disease, implantitis, bone loss. It's a very much of a challenge when I see people every day that are in my practice that are there with peri-implantitis. I tell them I go my best suggestion is to go back to the surgeon. They go, well, he doesn't treat that. All of a sudden, the peri-implantitis cases are all in the periodontal offices and there's a lot of them done by good surgeons, good restorative people. There's a lot of peri-implantitis. That's something that on a whole other podcast we could talk about in terms of how do you manage that in the dental practice. 

Dr. Shah-Khan: But it is a team concept. 

Howard: I would love to have an entire podcast on peri-implantitis. But let me ask you this, I'm trying to pin you down like an attorney on a trial. Would implants replacing a mouth lost from dental decay last longer than implants placed in a mouth lost from gum disease? 

Dr. Shah-Khan: Yes. 

Dr. Offutt: Yes. 

Howard: Yes. 

Dr. Offutt: Statistically, you're right. 

Howard: And I also believe that all ...

Dr. Offutt: One of the limiting things was a history of advanced periodontal disease. That's one of the limitations to ongoing implant success. 

Howard: I also am very cynical about all the implant success rate that everybody's talking about 'cause when you dig deeper into those studies, it's always dental implants placed in people who lost their teeth from decay and the implants are always in the anterior mandible. It's never implants replaced with people who had gum disease in the maxilla. Would you agree or disagree with that?

Dr. Offutt: Oh, no, I think you're right. I think you have to be very careful. Read articles from referee journals. Make sure that there's not a hidden agenda by the person espousing the data because implant dentistry's wonderful. It's maybe the most innovative thing in my entire career, and I finished dental school in 1979. It's definitely a wonderful thing, but it needs to be an eyes wide open approach for the restorative dentist that's placing his own implants because guys and ladies that are very good surgeons that have been doing it for career are having problems. Having problems with peri-implantitis. It's there. The practitioner in private practice, especially the restorative doctor that's placing his own implants, needs to really gear into how to manage that. How do I maintain and manage my dental implant patients? It doesn't have to be with a periodontist. They can learn those skills themselves, but it does take quite a bit of focus. 

Dr. Shah-Khan: I think we'll learn a lot more in ten years. Right now, the en vogue thing is all on fours or all on four plus. We'll see what happens in ten years with these people who are losing all their teeth and then having implants placed and immediately loading these things. It'll be very telling.

Howard: Well, you know what, we put up 350 online C-course on Dental Town and they've been viewed over, last time I saw it was like 575,000 times because the old model when we got out of school was you close down your office. You travel to a convention, you sit in a convention all day. The new model is you just sit there and watch it on your iPad on your couch. Also I think the dentists like it in hour segments, not all day lectures. 

Think of all the all day lectures you went to where after the afternoon break, half the class doesn't even come back. How many times have you seen that in your life? I mean, you're fried. If you ever can know anybody that can put together an online C-course on how to manage peri-implantitis, that would be a rocking hot video because we're just placing more and more and more implants so these peri-implantitis cases are starting to stack up.

Dr. Offutt: I'll follow up wit you on that because we're actually doing a presentation in January. We're having a doctor come in from Mayo Clinic who has quite a significant academic record. We are gonna have a two hour evening for dental hygienists with the practitioners that we work with where we're bringing a speaker. It's for their hygienists. They're the interface with these implant cases. We want them to be geared so that they can identify the issues and advise their doctor when they see them. We're focused on that. I can follow up with you on that and if we wanted to video it for you we could probably do that. 

Howard: Yes, you could video it and have it sponsored by the Synergy Dental Partners. 

Dr. Offutt: That would be something but I gotta talk to Dr. Shah-Khan about that. He's not all agreeable on that kind of stuff. 

Howard: All right. Hey, gentlemen, thank you so much for spending an hour with me and all our listeners. I think you guys are amazing. You guys are great. Thank you for all that you do for dentistry. 

Dr. Offutt: Thank you. 

Dr. Shah-Khan: Thank you, Howard. 

Howard: Sorry my cat had to make a cameo.

Dr. Offutt: Not a problem. 

Dr. Shah-Khan: We appreciate it. 

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