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VIDEO - DUwHF #913 - Greg Tuttle
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AUDIO - DUwHF #913 - Greg Tuttle
TuttleNumbNow is founded by Gregory K. Tuttle, a general dentist who practices in Sacramento, California and Orem, Utah. Since graduating from UNMC Nebraska in 1990, Dr. Tuttle has valued high efficiency and quality for more than 25 years. In 2003, Dr. Tuttle encountered a tough-to-numb tooth and X-tips were on backorder, so Dr. Tuttle figured a way to penetrate the mandibular buccal plate without drills, ports or sleeves, using just a 30 ga needle. His discovery led to a complete change in the way he approached local anesthesia and patients raved about not having a numb lip or tongue.
Now after 13 years of clinical success, Dr. Tuttle has revealed his findings in TuttleNumbNow. This protocol dispels myths about bending needles, penetrating the buccal plate, the use of Articaine in the mandible and epinephrine in intra-osseous delivery.
Howard: It is just a huge honor today to be sitting in my house with Dr. Gregory Tuttle. Thank you so much for coming by. He has over a thousand posts on Dentaltown. I'm sure you already know who he is, but his website is tuttlenumbnow.com. Tuttle, his name. Now, are you Delia Tuttle’s husband?
Gregory: No. No, no. I know she's popular in Dentaltown.
Howard: How come you're not wearing pink?
Howard: I'm confused talking to a Tuttle who’s not in pink. Delia Tuttle was—I think she lectured here last Saturday.
Gregory: She's a great Townie. Everybody loves her.
Howard: She is amazing. So tuttlenumbnow.com, I think—let me read your bio.
“TuttleNumbNow is founded by Dr. Gregory K. Tuttle, a general dentist who practices in Sacramento, California and Orem, Utah. Since graduating from the University of Medical College in Nebraska—in Lincoln—in 1990, Dr. Tuttle has valued high efficiency and quality for more than twenty-five years. In 2003, Dr. Tuttle encountered a tough-to-numb tooth and X-tips were on backorder, so Dr. Tuttle figured a way to penetrate the mandibular buccal plate without drills, ports or sleeves using just a 30 gauge needle. His discovery led to a complete change in the way he approached local anesthetic and patients raved about not having a numb lip or tongue. Now, after thirteen years of clinical success, Dr. Tuttle has revealed his findings tuttlenumbnow.com. This protocol dispels myths about bending needles, penetrating the buccal plate, the use of Articaine in the mandible and epinephrine in intraosseous delivery.”
I think what you're doing—I am a big fan of your thousand posts but, in a nutshell, I would back up before you… When I got out of school thirty years ago, when I did a crown I billed Delta of Arizona for a thousand bucks and they paid half. Thirty years later, they pay six hundred. And the bottom line at the end of the day, if you take a PPO that's 40% less, you got to go 40% faster. And these guys and gals, I know what they do. I mean, I've been a dentist for years. They numb up, they get up, they take off their gloves, they go back to their office and get on Facebook for ten or fifteen minutes, and they don't have ten or fifteen minutes because the faster you can numb and get going the shorter the appointment. And if you went from a $1000 crown thirty years ago to now doing one for 650 on a PPO, you can't schedule an hour and a half for that. And that's why general dentists can't do ortho because the orthodontist is flipping those chairs every fifteen minutes, and then you start doing ortho and you schedule those appointments in a half hour. Well, if the orthodontists have 50% overhead at fifteen minutes and you're scheduled in a half hour, you're doing it for free. Do you think—before you talk about your technique—do you think it makes you go faster so you could be more profitable?
Howard: I do.
Gregory: Yes. One of the slogans is, “Set down the syringe and pick up the drill.” So if you can set down the syringe and pick up the drill with instant numbness, then you eliminate all the guesswork and the waiting because the average dentist, he— my son’s graduating in 2015 and I said, “He can't do this dab-and-squirt, numb-and-wait technique. He's got to get in there. He's going to be $500,000 in debt. He can't just do dab and squirt. And so he needs to have protocol that eliminates the guesswork. Because when you do the first shot and you go to drill and they jump, the dentist doesn't know what to do. Do I wait longer? Do I give them more anesthetic? Do I use a different kind of anesthetic, Howard? Do I do a PDL injection, “Die, toothie! Die, toothie! Die, toothie,” jamming in the PDL, which there's a space which causes post op sensitivity, tooth distention? Do I refer him? Do I make another appointment? Do I sedate him? Do I say, “Hey, just hang in there, buddy. This is a ‘live like you were dying,’ Tim McGraw. Get to two-point-seven seconds on Fu Manchu here. Just hang on. We're going to do this?” And they don't know what to do.
And so I said, “He's graduating. I need to make some videos that I discovered this technique on how to begin with intra-osseous instead of using it as a secondary injection.”
X-tips were on backorder. I had a tooth that I could not get numb. I'm sweating. The patient’s sweating. We've all been there. And I tried to just ram down—I knew where it needed to go but I didn't have an X-tip. If the needle bent and I tried to get it in… And then all of a sudden, it went in. That was a eureka moment of like I got him instantly numb with minimal anesthetic, a fourth of a cartridge. I set down the syringe and went. The patient was relieved, I was relieved, and we got it done. So from that moment on, around 2003-2005, I started to eliminate the (inaudible 05:24) eye block. Instead of only using the X-tip once a month or once every three months…
Howard: You're using X-tip but a lot of people won't. Don't know what that means.
Gregory: Okay. Yes, because 55% of those that become TNN dentists, they…
Howard: That become what?
Gregory: TNN-certified dentists. We can talk about that.
Howard: Oh, TNN?
Gregory: Okay. 50% of them have never done an intraosseous injection and their choices usually are Stabident and X-tip, all of which you have to drill a hole in the bone…
Howard: (inaudible 05:54) X-tip, Stabident? Explain what those are first, just in case they're driving to work and they don't know what either of those are.
Gregory: Okay. So you can go on our website, figure it, but basically you're drilling a hole in the bone, it's a secondary anesthesia. It's not considered a primary anesthesia, according to the American Association of Endodontists, because they said that because of the cost of armamentarium—an X-tip is about $5 per port, Stabident is about $2.50 last I checked—the cost of the armamentarium, the risk of penetrator separation, the temporary tachycardia – making the heart rate elevate, and the risk of root damage on drilling into the bone – the risk of root damage, that it should not be considered as a primary injection technique. That's the American Association of Endodontists. 50% of general dentists don't know how to do intraosseous, and then those that do, 90% percent of them only do it once a month. We took a survey of those that have joined the TNN-certified team, basically, and 50% of them use intraosseous daily. We did some market research, and so 50% of them are using intra-osseous daily. Some are still using it only on tough-to-numb teeth, but the main advantage is to the patient. No numb lip, no numb tongue. You're the college student, you're coming in, you can only be seen a certain day or whatever and then go back to school – we can work in all four quadrants the same day.
Howard: Okay. You talk about X-tip and Stabident. The other two would be the PDL and The Wand. Talk about those two.
Gregory: Okay. In my information on my website, I compare the difference between those. But The Wand, everyone can learn a lot from The Wand on it's pain-free delivery. The American Association of Endodontists, they studied these. They're called CCLADs, computer-aided delivery and local anesthetic delivery. Computer local anesthetic delivery, CCLAD. And they found that they were 37% effective, maybe 21 out of 74 irreversible pulpitis teeth or a super-hot tooth was remedied by the CCLAD. So therefore, they said that CCLAD wasn't adequate on a super-hot tooth and the very best for a super-hot tooth was intraosseous injection either with Stabident or X-tip and using Septocaine and Carbocaine if needed.
Howard: Okay. So you brought TuttleNumbNow. Why don’t you explain what that is? Because I'm sure they don't know what a PDL is. You know what the bizarrest research I ever read on a PDL is?
Howard: That it didn't matter what anesthetic you had even if it was distilled water. That if you put in a (inaudible 09:06)—it’s pressure.
Gregory: Yeah, it's pressure.
Howard: You're putting pressure in the PDL, which contracts the nerve, and it stops working because of the pressure. Did you ever see that study?
Howard: Do you believe study?
Gregory: You're trying to force liquid into a space that doesn't exist. Especially, some like to do it in a buccal furcation. But once the buccal furcation is compromised, we know that that's not good for a tooth. So we stay outside of that zone of the PDL unless we're extracting a tooth. There are a lot of handbooks on dental anesthesia, but there's not a cookbook. This is a cookbook. The main thing is for hard-to-numb teeth, and so dentists know exactly what to do. If I can write in my chart TNN four, for I know that I went through the protocol. I did TNN one, two, three, and four. So they know exactly what to do and when to do it without waiting.
Howard: So will you show us what TNN one, two, three, four is now or…? Do you want to go through the protocol? How did you want to explain this film?
Gregory: Well, I know that Dentaltown is to help dentists and it's not to sell products, and so I have to be careful. I haven't even started a thread on Dentaltown even though I have a thousand posts, but I've tried to defend what people would say about it and also offer suggestions…
Howard: Well, first of all, here's (inaudible 10:44) on Dentaltown. Let's say you lecture every weekend on something. Everybody's allowed to start one thread on what they do sell – lecture, consulting and all that stuff. So everybody gets their one thread.
Howard: And on the other threads you just have to answer, like you would be sitting at Starbucks, but in your signature you could have your name (inaudible 11:05)
Gregory: I do have a signature.
Howard: But I don't buy into the selling is a four-letter word. When I started Dentaltown, I owned Dentisttown, and I went with Dentaltown because if you took away all these amazing companies I'd be sitting out on a rug with a bunch of stuff from Home Depot and I've been to many countries where that's how they do dentistry. And if it wasn't these amazing companies making digital x-rays and intraoral cameras and, hell, I even use my iPhone, I mean, if I took away all these companies I'm not a doctor. I'm a horrible doctor. And I want to say one thing about the injection, that all the people, the big companies that be, they want to sell you a $100,000 CBCT when the greatest implantologists of all time did all their implants with a pano. But you have to have a $100,000 CBCT. Same thing with chairside milling. The greatest dentists I know all use an amazing lab guy.
Howard: I don't know any amazing dentist who chairside-mill their crown. They didn't go to dental school to be a lab tech.
Gregory: Yeah, I'm with you.
Howard: But I'll tell you this. After thirty years of practicing dentistry, I get asked for a same-day crown like once a decade and then I call my lab man, say, “This guy is going out of town tomorrow. Is there any way we can get (inaudible 12:25)?” And he'll say, “Yeah.” You don't abuse it. Yeah. But I tell people that half of America is afraid of the shot and half of America is afraid of the bill. So get down…
Gregory: Yeah. That's good. That's why I'm here.
Howard: I mean, I want you to have a chairside manner that's not condescending, doesn’t make you feel bad. And fear is completely irrational because my biggest babies have tattoos all over their arm, a thousand shots from an unsterile needle, and they have a bar through their tongue and a paperclip in their eyebrow, and I want to say, “What are you afraid of, that will be your first shot that’s sterile?” But it's just in your mind. It's like a scary movie. The whole family saw It.
Howard: Obviously, it's a silly goofy movie. But if you get into it, they're scared. They're just as scared of the shot. And I think the best word-of-mouth referral is when once a day a patient says, “Dang, you're good at that, doc. You didn't hurt me. That's what I was afraid of.”
Gregory: Yeah. Let me show you…
Howard: “And then I was afraid of the bill.” Here's the number one (inaudible 13:33) clincher. There's only three publicly traded dental companies in the world, two in Australia – 1300SMILES, the other one is—what is it, Ryan? Pacific Dental Smiles?
Ryan: Yeah, Pacific Smiles Group, 1300SMILES and Q & M.
Howard: Pacific Smiles Group, 1300SMILES and Q & M out of Singapore. You know what all three of those have in common on their websites?
Gregory: What’s that?
Howard: They tell everybody… “I don't care what you need, we can do it for $99 a week.” And if I said $400 a week, I mean a lot of Americans, $400 a month, that's a big bill. But psychologically, you say, “Don't worry about the bill. Whether it's CareCredit, financing, (inaudible 14:11), don't worry about it. We’ll fix anything you've got for $99 a week.” And that's the fear of the cost. And I brought you in here today because I'm a big fan of yours and I think if these guys come out of Midwestern with half a million dollars of student loans, if they have an awesome chairside manner and an awesome pain-free shot and can figure out a way to finance, no one—what percent of Americans will pay $30,000 for a new car versus finance it for five years? So, figure out your financing. So I want you to tell them what you're doing.
Gregory: So let me just show you what…
Howard: Yeah, just show them. And sell. I want you to sell it.
Howard: (inaudible 14:49) I want to go to this podcast that a hundred homies get every once in a while, something comes along that turns the professional field and completely transforms the industry.
Gregory: We're transforming the industry. I sat with a major manufacturer right here and one of the consultants came and said, “What are you trying to do?” And I said, “I'm trying to change the world.” And so here's what we're doing. I got a cover sheet on how to get a successful start. That's how to get right off to a successful start, when doing TuttleNumbNow.
When they order online, any time, night or day, they can go to tuttlenumbnow.com and order online, download all that's here, the notes. I follow it up two to five days later with a thumb drive, which has four videos. The longest one is fourteen minutes long. It will show you exactly step by step how to penetrate the buccal plate with a 30 gauge needle with no drilling.
Howard: Now, is that a video?
Gregory: There's four videos on here.
Howard: Why don't you start a thread and put those four videos in there?
Howard: Yeah, because we're going to but we have to do this the right way. I started in 2005. I thought, “All I need to do is write in a journal and tell about it and tell my friends and they're all going to want to do it.” Immediate numbness, all four quadrants. Patients love it. No numb lip, no numb tongue. I'm numbing people that have never been able to get numb before. I thought everyone would like that.
I got no responses, not one e-mail. I didn't change a thing. So I said, “If I'm going to make change, I need to go to these authoritative figures, these dental icons. I need to go straight to their office and I need to show it and I need to do this for them.” And that's exactly what I did. In 2015, I made videos for my son who was in college to teach him. I got an idea to go to the dean. “Hey, what do you think about this?” He said, “That's awesome for the handicapped and the disabled. You're getting in. They don't even have to open their mouth.” There are so many advantages. I can do a crown on 30 and 19 on the same appointment on a Down syndrome kid with a big tongue and cheek. I'm not even doing a block. I just numb. You're numbing down on one side. “Hey, how’d you do?” “Good.” “You want to do another one? Let's do another one.”
So I discovered a needle in 2011, the osteo central needle it was called in France, and that needle a double-bevelled scalpel tip. It's 29% less force to penetrate.
Howard: From France? France is Septocaine?
Howard: So Septodont makes that needle?
Howard: And their American division is in French Quebec, Canada.
Howard: Right? Montreal.
Gregory: So I went and I told them about it, and I said, “This needle goes in the bone.” And they said, “You know what? You're not authorized to use it in bone. It's only for infiltration. In fact, we don’t even make it in long because we don't want you doing blocks with it. This is a lance. It cuts stuff.” And they said, “You really shouldn't be touching the needle.”
So what I had to come up with was a way to do my technique which would satisfy the rest of the world that are a little hesitant with touching the needle. So you get this needle that was designed to go into bone. Then, this patented hub, it's a needle guide and that goes right in like that and it goes right like that. Retract and then you can go—you can go right in. I've had people watch me do the procedure and then they go try it and they can't get in bone. And someone said, “You just need four steps to the technique.” And I said, “Well, (inaudible 19:00) waterskiing. I have twenty steps to the technique and I take a very detailed explanation, just like dance moves. Once you get them down, you've got it and you're rolling with it.”
Howard: You must be a dancer to say that.
Gregory: My wife is.
Howard: Are you a dancer?
Gregory: My wife is.
Howard: What does she dance?
Gregory: She was on a dance team, drill team, Cougarettes at BYU.
Gregory: Yeah, precision dance team. So anyways, we came up with that, and then they said, “Well, what about recapping?” And I said, “Well, what about recapping? The bent needle, it's safer than any other. You're not doing a scoop technique. You're going right over and the tip is away from the force. Bam.”
So the recap’s there. Now, what about bending the needle? Stanley Malamed said, “I've always been opposed, bending the needle, but I saw your video and it's very compelling.” And I was like, “Wow. Awesome. He‘s watching my video.”
So take a look. I bend it over and I bend it back and it's done. It breaks off. That's why you never use that 30 gauge needle on a clock and you don't bury it to the hub.
Howard: Now, go back to—what is different about this Septodont made-in-France needle?
Gregory: It has a double bevel scalpel tip. It has 29% less force to penetrate. So if I'm doing an infiltration with it…
Howard: Say it again?
Gregory: It has a double bevel right here. It's in the booklet. It has almost a hatchet cut to it and it will penetrate the buccal plate easier than other needles. But you still need the steps, you still need the training, so that you don't cause problems.
Howard: So that's the use of the 30 gauge Septoject Evolution needle?
Howard: Is that the needle you recommend for all infiltrations?
Gregory: Yeah. Yeah, totally…
Howard: Because this technique is only for the mandible?
Gregory: No, you can do it on every tooth. For example, Monday I did eight, nine crowns. Instead of doing an injection here – topical, an injection – topical, an injection – topical, an injection there—all three hurt, even with topical sometimes, you got to go easy—one injection the way I train, five-millimeter penetration right through the front. Low-pressure, low-volume over-time technique is what it discusses, similar to—The Wand will give you four-minute distribution, about a 90-second. So 90-second distribution and infusion, not so much an injection, okay? You barely—I like a really nice syringe, this is also made by Septodont, but where you can have precision where the plunger glides smoothly instead of skipping and it also can deliver a drop at a time like you need to, okay? So with that one injection, complete and profound pulpal anesthesia on the eight, nine, and no numb lip for your cosmetic pictures, your follow up.
So if I'm pushing fluid through that needle, I showed you that I bent it over and bent it back and it broke. How many times do you think I can bend that over and bend it back with the needle guide on there?
Howard: You mean bend it straight up…
Gregory: Right here, at a ninety. Kink it at a ninety, kink it straight up, squirt.
Gregory: Kink it and squirt. How many times?
Gregory: Okay, I just did one, two, three, okay? Squirt. Do you want to do it? Or I could do it.
Howard: No, you do it.
Gregory: Four, five—I'm getting your table messy—six—nice phone by the way— seven, eight—you know, really kink it—nine, ten, eleven, twelve, thirteen. Okay, you get the point, right?
Gregory: Fifteen, sixteen, seventeen. I've gone up to a hundred. That's eighteen right there. That was some serious kinks just for…
So my point that I had to prove was you can bend a needle safely. Now, with that bend, you've got greater versatility, range of motion. You've got root proximity problems, you can get right in and you're not drilling. So now, all of a sudden, I'm staying away from a PDL. I'm penetrating the buccal plate. I am delivering anesthetic almost eight millimeters all the way to the lingual plate and with one injection, sometimes two, everything blanches, and I'm getting that infusion and I can go right in and poke that tooth. I can extract that tooth. I can do my…
Howard: So when you went from the buccal, the lingual is blanching?
Gregory: Because that needle was advancing eight millimeters. I'm penetrating the buccal bone. That's the secret of it.
Howard: So your eureka moment was that when you just happened to be using a Septodont Septoject Evolution needle, you realized it went through the bone?
Gregory: No, those didn't come out until 2011. My eureka moment was in 2005. I looked at the order of my X-tips and that's the last time I ordered an X-tip because now I could get in with my technique. It's counterintuitive.
Howard: What was your eureka moment?
Gregory: My eureka moment…
Howard: You were out of X-tips.
Gregory: I was out of X-tips.
Howard: They were on backorder.
Gregory: I went to try to—I knew where it had to go and I knew how to get there and it went in without drilling, and then I had a good self-seal around the gingiva instead of wondering how much is getting in there. You've got the X-tip, you've got the port, and it limits how deep that needle can go. And so I could advance it. I had versatility, range of motion. I got it in there and immediately the patient was comfortable, and I said, “I'm doing this every time.” And so I tried all these different needles, all different variations, different locations, and over fourteen years I've figured out how to do this one tooth.
Howard: And so what percent has this replaced your inferior alveolar nerve blocks?
Gregory: Okay, inferior alveolar nerve block is my—and I use Gow-Gates, by the way—that's my seventh injection, if I have to get to it. See, there's not one injection that's going to be universal. I mean, the new guys, the young guys, they want that, and it does a lot of times. The lower first molar’s my easiest tooth to numb.
Howard: But it's their hardest tooth to numb.
Gregory: Well, lower second molars are usually, yeah, the hardest tooth to numb.
Howard: Why is the second molar harder than the first molar?
Gregory: The bone is thicker on the buccal, so it's harder to penetrate. And so that's why I have a whole video that's on troubleshooting lower second molars.
Howard: And don’t some of them have a little branch of a nerve up the lingual…?
Gregory: There can be mylohyoid. Also, you could have the perfect injection technique and they don't get numb. You have (inaudible 26:39) toxin or resistant receptors and some call it redheads or gingers have a hard time getting numb, and sometimes it's just a matter of chemistry and not performance with the needle.
Howard: Redheads are hard to get numb and they also are more likely to have gingivitis.
Gregory: Ah, gingivitis. Nice one. That's what I came up with and obviously I found that if you want to get change in dentistry, number one, you've got to go to these ultimate authority figures in dentistry…
Howard: So who have you gone to? Who are your ultimate authorities? You went to the dean in Midwestern.
Howard: And did they just get a new dean? They just had a changing of the deans.
Gregory: Sure, Dr. Smith is who I talk to.
Howard: How long ago was that?
Gregory: That was in 2015.
Howard: Dr. Smith, what’s the first name?
Gregory: Bradford Smith. You probably don't remember this but in, let's see, 2015, I went to Greg Stanley. He helped…
Howard: Of course I remember that. He's my buddy.
Gregory: So he taught me how to get out of debt and how to accumulate, and I felt like he was on my side as a new dentist. And I went in and talked to him and his periodontist on staff, and I showed him…
Howard: Who’s his periodontist on staff?
Gregory: Well, his consultant. We met on Saturday. He goes, “You've got fifteen minutes,” and two hours later I walked out of there. And he's like, “Come teach my masterminds. These guys, they're going to love it.”
I showed him this graph. Basically, it's the lifecycle of a practice – production, collections, and my day’s work. And I looked and your production and collection raises each year, and then that's paid off. You kind of get comfortable and you start working less and your production kind of plateaus out. But then all of a sudden, right here, something dramatic happened. I didn't get a new office manager. I didn't raise my fees. I didn't get a new consultant. I didn't get a new machine. All I did was change my needle technique and I started doing instant numbness—set down the syringe, pick up the drill dentistry—and my production and collections went off the chart and my day's work went down.
I could also go in for a hygiene check: Instead of just doing the exam, I could say, “Hey, let's numb 30 and do that occlusal right there,” or “that buccal,” and turn my hygiene room into a treatment room. Back when I started out as an associate, I had one chair and the other dentist had one chair.
Gregory: Dentists that had seven chairs can numb and wait and they don't lose a step. They're always busy. They're always doing something. But when you're down in Dominican Republic and you have one chair and you numb the way they do third-world-dentistry, “Numb. Put them in this chair. Hold the tray. Numb. Put them in this chair. Hold the tray. Numb. Okay, let's get the first one back. Let's numb. Now let's go to drill. Oh, he still feels it. Oh, numb again. Put them over here,” it's a circus. It's a circus of instruments. It's a circus only working on one tooth, not helping the people. I went down Dominican Republic and I had…
Howard: With Greg Stanley?
Gregory: No, no. I got off-track, sorry.
Howard: Yeah, Greg (inaudible 29:57) Haiti. So you went down Dominican Republic with Eric Harris or…?
Gregory: No, it was a humanitarian trip and I would numb, drill, fill, done. “How’d you do?” “Good.” “You want to do another one?” And so we could do every single tooth that needed to be worked on and not have to wait and not have to contaminate instruments and trade out. We’d just go.
And so I got this moment at my son's graduation as I hooded him, I was like, “I've got to get this to the whole world.” Some people criticize me for charging for the kit or getting out. I've spent the last two years literally answering e-mails from Malta, Macedonia…
Howard: Well, who would complain about you charging for the kit?
Gregory: Well, I mean, over-promoting it. Promoting it, I guess.
Howard: Well, humans are just bizarre.
Howard: I mean, they're just bizarre.
Gregory: So in Malta, Macedonia…
Howard: Always stay true to yourself.
Gregory: I get these orders and they're saying, “Wow, thank you. I can finally do what I need to do, not running out of anaesthetic.” They're able to get it numb. They don't have the luxury of referring to a specialist. They don't have nitrous or sedation. There's just one chair and they're gone. So this is what needs to happen…
Howard: So talk about your kit. How much is the kit and where do they buy it?
Gregory: Okay. Tuttlenumbnow.com is where you buy it and the cost is $490. I don't charge any tax. I don't charge any shipping. I ship them to all fifty states and sixteen countries just off of your Dentaltown.
Howard: Just off Dentaltown?
Gregory: 60% of the sales have been off of Dentaltown.
Howard: And you know what's so funny, is the craziest thing I see on Facebook is these people, these consultants, and they're always posting to their four hundred friends on Facebook. It's like, I'm pretty sure your other four hundred friends on Facebook already know what the hell you do. Why are you spending your time posting on Facebook when you get to have that same post with a quarter million people on Dentaltown?
Gregory: Yeah. Yeah.
Howard: I mean, it just blows. I mean, I don't care what they teach, lecture, consult, they’re always inbreeding to a couple hundred people on Facebook and 60% of your sales are on Dentaltown. The busiest in-office dental consult I know of is Sandy Pardue and she posts every day on Dentaltown. She said that's where she gets all her leads.
Gregory: There's so much good advice on there. And at first I had some people that were, you bend it at the hub, you bend it over and you bend it back, and it snaps off.
Howard: But why does that happen at the hub and not mid-needle?
Gregory: That's what I discovered. The needle is made…
Howard: Just physics?
Gregory: Yeah. It's just like a pipe bender. If you kink that pipe off at the weld, at the bottom, it’ll snap off where the glue is. But if you use a pipe bender and you can bend it and bend it and bend it and bend it and bend it, quite a long time.
So it's not even about bending needles. That's not the big issue. The big issue for dentists is what the patients are saying. When they can leave like, “What? Don't you have to wait for me to get numb?” “No, we're going now. We numb now,” the slogan, the test is right on it. And then I can say, “If you feel it, let me know, and then we can go to TNN number two, TNN number three, four, switch up.”
Patient satisfaction is number one. Number two is tough-to-numb teeth. This is getting people numb that have never been numb before. They come in and they say, “I've never been numb. My lip’s been numb, my tongue’s been numb, but it hurts every time.”
And what that leads to is what I call the chain reaction of failure in dentistry. The number one question to CR that comes in is, “Why are crowns falling off?” But I came up with this chain reaction of failure—it's in my booklet too—and basically it says the reason crowns are falling off is not the bonding agent that you choose. My theory is inadequate anesthesia, because what happens…
Howard: For the crown segmentation?
Gregory: Inadequate anesthesia period on that lower second molar is the hardest tooth to numb, is the hardest tooth to dry. And why don't we drill more? We're going to leave decay because we start drilling, they jump like, “Okay, I'm going to finish where it is.” We don't have the occlusal reduction that we need. We're not going under the gum enough because maybe that's not numb.
And so we have inadequate tooth reduction, inadequate clearance. We leave decay. Cord packing hurts. The impression is inadequate because we didn't get that dry. Bad margins, bad temporaries, pain, and the permanent crown fails. It fractured. Why? It's not because it's a CEREC, it's not because it's bad glue, and it's not because it debonded. It’s because they never got numb in the first place to reduce the tooth adequately and restore it adequately and dry it properly.
So a patient comes in, “I'm going to cement a crown on number 30 on you.” I go right back in, I can find pretty much the exact same hole that I made with the needle the first time in, pressurize the tooth, low-pressure/low-volume/over-time technique, penetrate, set it down, air, water, dry it right now, adjust it, cement it, and done.
Howard: Now, do you think most people think the biggest—I think the biggest test of anesthetic is actually not a root canal. I think it's an extraction.
Gregory: Well, there's pulpal anesthesia and then all of the surrounding structures but…
Howard: So do you use this for extractions?
Howard: So if you were going to pull that second molar, would it be the same technique as if you were going to numb it for a crown?
Gregory: Absolutely. I treat every single tooth, I start with the one that works best. If intraosseous works 96 and 98% of the time, why start with (inaudible 36:06) block that only works 74% of the time and numbs everything but what you're trying to get numb?
Howard: I want to see another—this is Dentistry Uncensored. There still is this big taboo about articaine versus lidocaine. A lot of people say, “Well, the only reason articaine is better than lidocaine is because it’s 4% versus 2%.” Some people will say, “I'd rather give two carps 2% than one carp of 4%,” because there is this paresthesia mythology that's perpetuated. Well, what are your thoughts on Septocaine, which is articaine in Canada, Septocaine in America?
Gregory: Yes. Mm-hmm.
Howard: What are your thoughts on Septocaine versus articaine and what are you using there?
Gregory: I think you have to go with research on those types of studies, and you can talk to the main gurus, the Stanley Malameds, Al Reader, these guys that dedicated their entire lives to this topic. And I think he's made it crystal clear…there is actually a book that I really enjoy that has all the studies comparing, and it just came out in 2017 by Al Reader —it has tons and tons of studies.
Howard: Al Reader.
Gregory: Al Reader.
Howard: How do you spell Reader?
Gregory: I have the book in my car. I think I can get it.
Howard: Well, let's see if I can find them on Google.
Gregory: John Nusstein, Al Reader…
Howard: Successful Local Anesthesia for Restorative Dentistry by Al Reader, John Nusstein and Melissa Drum.
Gregory: It's Awesome.
Gregory: Published in 2017, so everything that I'm doing is current, up-to-date, and if you really want to know about…
Howard: So you talked to Al Reader about…
Gregory: No, I haven't. Yeah, I've talked to Al Reader on the phone. And Stanley Malamed of course, he's been talking—it's interesting that his topics used to be “there's nothing new in local anesthesia.” Magnus invented the needle that goes directly in bone in 1968, Bourke injected into cancellous bone, X-tip came about in 1999, but his topic was always “there’s nothing new in local anesthesia.” Then he came out with a lecture that said, “Is the mandibular block passé?” and there was a CD that they put out and there was a video you can watch on that. And now his current discussion has been the renaissance in local anesthesia. And so he's been in contact with me a little bit and we're really excited about the future.
Howard: But go back. What percent of the time are you using Septocaine versus lidocaine?
Gregory: All the time. I don't even have lidocaine in my office. It expires if I have it in there. I don't use it. There's no need.
Howard: I want to talk about another subject. We still have deaths in dentistry. Most of them always involve an I.V., and I've always told these guys that in every hospital in America you cannot do the cardiovascular bypass surgery and the anesthesia. You can't be an orthopedic surgeon and fix a broken leg and do this and this. Every hospital mandates a board-certified anesthesiologist. My oral surgeon up the street from me did it ten years ago. You know what he said? He said that even if it wasn't just because that's really the legal statute, it's faster for him. I mean, we have a hygienist clean the teeth.
Howard: He has an anesthesiologist do the anesthesia. He actually makes money off having a board-certified anesthesiologist.
But the other one here locally in Arizona, it was a child that he gave too much lidocaine. He wasn’t using Septocaine. He used lidocaine and he gave so much lidocaine to a two-year-old that it died. The baby died and it was a tragedy beyond tragedies. But do you use this in pedo and do you think it means that the child gets less anesthesia, less lidocaine or Septocaine?
Gregory: Yes, I use it in children. The toxic threshold for children with articaine is one carpule per twenty-five pounds, so you can use two carpules. But basically, I'm using more needles and less carpules. So in my technique, point four CCs is all I'm delivering per needle stick. So I can go around and I can restore teeth in all four quadrants with one carpule most often.
Howard: And when you go into any physician or emergency room in the United States, what's the first thing they do to you? What's the first thing they do when you go to the doctor?
Gregory: Make you sign papers.
Howard: They take your weight, your temperature, your height.
Gregory: Yeah, your height, your weight.
Howard: Do you know anybody who works on children who is not a pediatric dentist who doesn't weigh the children? I mean, you go to any pediatric dentist in Ahwatukee, first thing they do is like any M.D., like any emergency room, “Stand on the scale, Johnny,” take your height and weight. You just said one carpule per twenty-five pounds. These people haven't ever weighed a child.
Howard: You have to weigh your child and you got to pretend that you're a doctor. The doctors use board-certified anesthesiologists and they weigh their patient before they give them drugs. They take their height, weight, temperature.
Gregory: Yeah. That's a good point.
Howard: And he just said one carpule per twenty-five pounds, and what do you do? You just turn to mom. “How much does Johnny weigh?” Oh, that works really well in court.
Gregory: With children a lot of times, since I'm going intraosseous direct, I'm barely using the stopper width of the anesthetic.
Howard: Yeah. And another thing, that's a differentiating factor…
Gregory: And I'm doing this for the dentist in the trenches, the guys that can deliver a lot less anesthetic, they can get teeth numb that have never been numb before, and they can go throughout the world. This is not done until it's in every operatory, in the hand of every dentist, and every patient can benefit from having their tooth numb when they get it worked on.
Howard: So right now I think we've covered A to Z. We're at fifty-five minutes. Do you have any video that you could give me and Ryan to play now or is that something that's part of the kit?
Gregory: I have given you the entire kit. You can take it to your office, play with it, and watch and learn and try it out. Like I said, some dentists use it as a secondary technique on a tough-to-numb tooth, and others realize, “Wow, the patients really like it,” and they use it on every tooth. It'll walk you through the entire protocol. There's a promo video online but there's a lot of information at the website, tuttlenumbnow.com, comparing PDLs, comparing Stabident, X-tip, and patient testimonials. I have doctor and patient testimonials. I collected them in two weeks.
Howard: Okay, so go to tuttlenumbnow.com. And you said you do have a promo video on your website?
Howard: But did you want to put that on this podcast or just have them go to the website?
Gregory: No, they can just go to the website.
Howard: Go to the website?
Gregory: Yeah, yeah.
Howard: Well—how many children did you have?
Gregory: I have five children.
Howard: And one became a dentist or…?
Gregory: One became a dentist.
Howard: Now, is that oldest, youngest, middle?
Howard: He's the oldest.
Howard: He's the oldest?
Howard: So you’ve got four more in the batter's box?
Gregory: No, these are all married and career people, and I have one son on a mission in Thailand and that's our youngest.
Howard: Well, I feel sorry for your son in Thailand because I love Thai food but you never relax when you eat Thai food because you're always afraid you're going to bite into that one thing that just makes your entire head start sweating. So you're always eating Thai food, all nervous, like what is that thing that does that? Do you like Thai food?
Gregory: I love Thai food.
Howard: Even the thing that when you buy your head starts sweating?
Gregory: Yeah, yeah.
Howard: You like that too?
Gregory: Yeah, I like it. I like it hot.
Howard: Do you?
Gregory: I like to feel the heat.
Howard: Oh my God. Thai food is the only food where if you bite into the wrong thing, there's not enough saltine crackers and water to stop your nose from running for—oh my God. So how does he like Thailand?
Gregory: He loves it. All those Townies that have been very supportive, I want to appreciate. Thank you. Guys like Jerome Smith (inaudible 44:55) Tuttle, I think you're really on to something. Guys like (inaudible 44:58) aka Fart Face.
As a closing statement almost, he is one that was kind of critical, “Why would I pay this?” And then he said, “Guys, listen,” and he (inaudible 45:12). He said, “Guys, listen.” He said, “The day I got my loupes and my light, I went in my office after working on three patients, I shut the door, and I sobbed.” He said, “TuttleNumbNow has had the exact same impact on my practice.”
Howard: Fart Face said that?
Gregory: Fart Face said that.
Howard: That when he got his loupes and his headlamps…
Gregory: “I got thirty-seven orders from that day.” He said that. And then we did a market research on, “Have people been happy with this or (inaudible 45:49) mad?” I sent out to four hundred people, I got a hundred and six responses. For an online survey, that's pretty good.
Mind you, all they're getting is the kit and then they have access to me. I personally respond to every e-mail someone has a question or a complaint. They can send me a— video your technique, and I'll say, “Look, you weren't using the right needle. You weren't on the right location. Hey there, you're not doing anything I taught you how to do. Go back and look at the notes.” It'll all come to me.
Howard: But how cool is Dentaltown that you get thirty-seven referrals from a doctor named Fart Face?
Gregory: Yeah, exactly. But Dentaltown, just the support, like they're saying, “Hey, I saw them going at you on a thread. I want to thank you for what you're doing for dentistry,” it's really been rewarding at this stage in my career to have that feedback and that impact on the profession.
Howard: Well, I've been a big fan of your posts. And what I want to tell the dentists on the closing thoughts, because we went way past an hour, is when you've done this for thirty years you eat a lot of crow. I mean, I remember when I got out of school the smartest cosmetic dentist said that on a beautiful woman do Dicor crowns and cement it with Durelon, okay? Everyone I did broke and had to be replaced for free. Artglass came apart, Heraeus Kulzer, Targis-Vectris, (inaudible 47:16), and the guys are replacing implants (inaudible 47:19) in the beginning. I can give you names of oral surgeons who had their licenses taken away because they were doing subperiosteals, Ramus Frames, they were doing miracles, but the first one that failed, the board looked at them and said, “What are these yahoos doing?” and took your license away. But now, when Dr. (inaudible 47:37) dies, he makes the cover of The New York Times as this genius. Dude, they weren't a genius when they started, and just because you've been doing something some way ten, twenty, thirty years, doesn't mean that it's the best, fastest, easiest, highest quality, lowest-cost way.
And so when somebody comes out with something new, before you start throwing bricks at them because you just don't know, just concentrate on your own journey and just try to have a little open mind. And I know you think you're an open mind, but do you think anybody could change your religious views? No. Your political views? No. Your favorite foods to eat, your health your nutrition? No. So then why do you think you have an open mind in dentistry?
And what I admire about the people in dentistry the most, my idols in dentistry are the guys that no matter how many bricks you throw at them they just build a house out of them.
Gregory: That's awesome.
Howard: And I just think what you're doing is amazing. And I also I think it's amazing that on a Saturday, instead of sitting home watching college ball, you're at my house talking to my homies for free about what you've done. And I want to thank you so much for all that you've done for dentistry and Dentaltown, I mean a thousand posts, and on your day off coming by my house.
Gregory: Thank you, Howard. It's been a pleasure.