Dentistry Uncensored with Howard Farran
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914 Making Sense of Dental Practice Purchases with Thomas Larkin, DDS : Dentistry Uncensored with Howard Farran

914 Making Sense of Dental Practice Purchases with Thomas Larkin, DDS : Dentistry Uncensored with Howard Farran

1/6/2018 3:33:02 PM   |   Comments: 0   |   Views: 243

914 Making Sense of Dental Practice Purchases with Thomas Larkin, DDS : Dentistry Uncensored with Howard Farran

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914 Making Sense of Dental Practice Purchases with Thomas Larkin, DDS : Dentistry Uncensored with Howard Farran

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VIDEO - DUwHF #914 - Thomas Larkin



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AUDIO - DUwHF #914 - Thomas Larkin



Dr Thomas Larkin is a dentist, author, professor, lecturer, and entrepreneur. He has written two books on dental practice management and two books on oral wellness. With a background in clinical preventive dentistry, he brings a unique perspective to the emerging field of “oral systemic practice’”


Most recently he worked as an assistant professor at the University of Kentucky College of Dentistry from 2009 to 2013. For 2 years he was co-course director of the practice management class and developed the curriculum entitle "The Business of Dentistry, A Mini MBA".

 

In 2016 his MBA course became a part of the pre-launch curriculum for Jayme Amos’s Idealpractices.com, a dental start-up company. He also made several presentations on entrepreneurship nationally for Idealpractices.

 

In 2017, He is the newly appointed clinical director  at the Productive Dentist Academy and he first project has been the creation of an oral wellness division to help educate and most importantly implement advanced prevention strategies into everyday practice. 


www.tomlarkin.com




Howard: It is just a huge honor for me today to be podcast interviewing Thomas Larkin, all the way from Lexington, Kentucky. He's a dentist, author, professor, lecturer, and entrepreneur. He has written two books on dental practice management and two books on oral wellness. With a background in clinical preventative dentistry, he brings a unique perspective to the emerging field of oral systemic practice, and he just got back from the oral systemic health meeting in Salt Lake City. Most recently, he worked as an assistant professor at the University of Kentucky College of Dentistry from 2009 to 2013. For two years he was co-course director of the practice management class and developed a curriculum entitled "The Business of Dentistry, a Mini-MBA". In 2016 his MBA course became a part of the pre-launch curriculum for Jamie Amos's IdealPractices.com, a dental startup company. He also made several presentations on entrepreneurship nationally for IdealPractices. In 2017, he's a newly appointed clinical director at the Productive Dentist Academy and the first project has been the creation of an oral wellness division to help educate, and most importantly, implement advance prevention strategies into everyday practice. But when I think about you the most, and why I want you to be on the show, is you've always been a huge defender for the solo practice. You think these kids should come out and have their own office and you don't really advise that they go work for Corporate America. Is that a fair assessment?


Thomas: Absolutely. And that's since mid-90s I've been talking about entrepreneurship, but most recently now with the birth of the podcast and these guys getting really solid information outside of the university. Because it's not going to work within the system. I tried. You're probably familiar with the "Life and Dentistry." podcast.


Howard: Yes.


Thomas: It's in your pocket. That was a group that I kind of mentored. And there's a couple of guys in there that bought a practice when they were juniors in dental school and that was kind of my story. When I was with Jamie Amos that was a story that he picked up on, that I did my start-up my third year of Creighton.


Howard: On Dentaltown. My gosh. So Cool. The reason I started a podcast was I needed to start a genre on Dentaltown for podcasts. And it was 850 days ago and now we have mine on there, The Dentistry Uncensored, we got Dental Success blog, the Dentist Freedom Blueprint. Jamie Amos has "How to Open a Dental Office". He has 680,000 views on Dentaltown, on that podcast. Then there's [00:02:53] Dennis (inaudible) [1.0] "Dental Implant Practices", "Navigating Dental Insurance" podcast, Dr. Jesse Greene, "Delivering Wow" with Dr. Anissa Holmes, "Dental Up" by Keating, "The 8E8 Show" by Joshua Scott, "The Dental Marketer", the "Life and Dentistry" podcast, that's the one you're talking about.


Thomas: Yeah.


Howard: With Matthew Woodson. Nice, he's on there too. I'm telling you, this Dentaltown app--podcast is killing radio. The reason they are exploding is because these kids have an hour commute to work each day and they can't listen to Trump and Russia and Putin and North Korea and ISIS. By time you get to work you don't even want to live. They listen to quilting, cooking, dentistry, you know all the MMA fights with--what's that MMA fight guy?--Joe Rogan. So why would you want to just listen to your local radio station which is half obnoxious commercials for car dealerships? Now you watch news on television, 20 minutes an hour is commercial and the commercials are cut in half. The first half commercials are all these prescription pills that you should be taking and then they list all the side effects, and then the last half hour of the show is all these class action lawsuit lawyers against all these prescriptions that they are advertising on the first half of the show. You can listen to a podcast commercial-free. It's just amazing. So what are you passionate about now? You're with the Productive Dentist Academy, is that what your big deal is now?


Thomas: So kind of a Cliff Notes deal: I'm teaching at Kentucky and I'm writing a book on the dental entrepreneur, and I get to my chapter on the business of dental hygiene. And I saw an advertisement for the one of the first AAOSH meetings. [1.6] And one of the things that made me get stuck in writing this chapter is that I had a very unusual hygiene department in my private practice. Now this goes back to the late-80s. My dental hygienist used a microscope with a video monitor. And I was doing Keyes technique under the direction of Dr. Paul Keyes and Dan Locke. So I didn't know whether I wanted to put that in my book. Fast forward, I meet Dr. Bale and I said, "Man, this is a game changer." And you've had him on very recently. This is a major, major game changer what he's bringing to dentistry. So I decided to create an operations manual. It's called "Dental Diagnostics in Support of the Bale-Doneen Method." It took me two years to create it. And as of last month it's the first approved CE Dr. Bale and Dr. Doneen have both approved and endorsed it. And this is where we pushed it out at AAOSH to a very, very interested crowd.


Howard: So it was a lecture you gave?


Thomas: No no no. This is a course. It's an actual course that I created.


Howard: But did you give the course at the meeting?


Thomas: No, we just had a booth there.


Howard: Okay.


Thomas: Yeah. Dr. Bale was speaking at meeting, and Dr. Doneen.


Howard: So explain the course. How long is it? Is it online, is it like a lecture--?


Thomas: Yeah. It's online at Productive Dentist Academy. It's eleven hours.


Howard: Oh my gosh.


Thomas: Thirty videos. It just takes you through the entire protocol. When you were interviewing Dr. Bale, you got the impression that he has to practice with a dentist. I call him dentistry's best friend. He's promoting dentistry like crazy. But what I knew that was unique about my past experience with the Keyes Method was that the dentists were going to get stuck on the bacterial testing. They don't understand the testing. And I thought I would bring an entire protocol. Bruce Beyer calls me out of the blue last December. He saw my program and he said this is the direction--He had met Dr. Bale--he said, "I want to take a productive dentist and create a division on this wellness because I believe in this." And then he said, "Would you be interested in coming to work for me and bringing your stuff?" And I said, "Absolutely, man." He's unbelievable. He and Vickie? They're crazy.


Howard: Yeah they're amazing people. So I'm afraid you're saying "the Keyes Method" and there's a lot of young millennials on here that aren't even old enough to remember that. I mean, that was something thirty years ago. Explain the Keyes Method.


Thomas: It was just massively controversial. But basically he said periodontal disease is a bacterial infection. You know the periodontists couldn't even decide that. They just wanted to cut the gums, and get the calculus off of there, and they never addressed the bacteria. And Keyes was very controversial. I mean, I wish there would have been social media because all the people were behind him but organized dentistry just absolutely torched him for twenty years. So it starts with a microscope and you look at the biofilm on every patient that comes in. It's a 25 cent test; that's why I loved it. And you start to educate the people that that stuff in your teeth is alive. They immediately connect with the visual. You know it's like the intra oral camera for perio. Now, I was using a microscope and a monitor before intra oral cameras were even around. This is a long time ago. Once you've diagnosed somebody's risk (your low, medium, high, however you want to call it), then you move into anti-infective treatment. That means anti-microbials. Back then it may mean antibiotics. Today we could use an antibiotic rinse and a laser. But the concept is you don't use water in a cavitron and just spread all that crap around. You have to do something anti-infective, which is essentially wound care. So that's the ship that it took twenty-five years of dentistry to make, especially because the periodontal community was very reluctant to put down the knife and stop cutting these gums. And that was my personal motivation because I was losing referrals. I was sending people to a local periodontist and they would come back pissed at me because they got these horrible results, painful results, and they were mad at me. And that's how I started my journey.


Howard: I really liked Dr. Paul Keyes and his technique mainly because you would take a toothpick and you would just barely wipe down in a five, six millimeter pocket and you'd smear it on the glass slide and the patient would get up and look down at it. I could only sell the gum disease because if it was really healthy mouth, the bacteria looked like they were all sleeping, and by the time it was really bad, they were all jumping around like they were all hopped up on caffeine and it was a big wow factor. I told myself for thirty years I should bring that back just for that. Just for that aspect of it.


Thomas: That's what I'm doing. I put it Bruce's office in February and I'm going to let Bruce speak--because I was just in his office a month ago. And of course Bruce is production on steroids. What an office to consult in. And I can't even tell you where his hygiene department has gone since February.


Howard: So did you bring back the [00:10:01] (inaudible) microscope? [0.6]


Thomas: Yes.


Howard: Oh my God.


Howard: Bruce had never seen one. Bruce has a microscope. I went to Wisconsin I put one in Vickie's office. Vickie had never seen one. She's like, "This is the new thing." But here's the good news: The good news is that technology has improved. I'm talking about the scope itself. We're in the process now of getting the latest and greatest with an iPad. You can watch the bacteria on the iPad and pass it around. We're packaging this entire thing with the microscope being the cornerstone of the therapy. The therapy is pretty straightforward. Bruce has got a couple of twists that we're putting into the risk assessment because, I don't know if you're very familiar, but the reason why Bruce and I align so readily is that Bruce's whole thing is risk assessment, like John Croix is doing. You know they start with the diagnosis and you want to look at periodontal risk, caries risk and then you get into a functional and aesthetic. So no, I'm just resurrecting old stuff.


Howard: Did you talk to Paul Keyes before he died?


Thomas: Yes I have. I have a new book. I got it autographed in September. Yeah I talked to him about 90 days before he died.


Howard: Because he died at 99 and his wife was like 101.


Thomas: 101. If you don't think baking soda and hydrogen peroxide an oral systemic, how about that for longevity? And he was sharp as a tack until the very end.


Howard: Wow, my gosh. I tried to podcast him but I couldn't get anybody--you know at 99 he didn't have Skype, and an internet connection.


Thomas: Yeah. He autographed my book and it's a prized possession.


Howard: Wow. So I hope you come out to my office and set it up there.


Thomas: Absolutely.


Howard: Now your online module. You said it's eleven hours long?


Thomas: Yes.


Howard: The best free marketing you could do is put the first hour up on Dentaltown on the online CE. We put up 450 one-hour courses. They're coming up on a million views and so many of these people put out a one-hour course and it's like they get to meet you, they fall in love with the subject, you motivate and inspire them, and then say, "If you want to take the other 10 hours, click here." That might be an approach.


Thomas: Oh absolutely. I'd love to. Then we've had some talk about creating a topic on a threat. I think I've emailed your sons and maybe you have been involved in that. One of the things that I would ask is that you have a miscellaneous thread called "Help" and that was where it was suggested to put prevention. I'm listening to Geoff Knight a couple weeks ago, the guy with the Silver diamine stuff from Australia. Man, there's some stuff happening in prevention. What I would love to see you do is bump that up to a main category, make prevention a main category. I will convince you on this Bale-Doneen stuff. I would just love to see it was a main category.


Howard: Ok, I'll tell you what. If you make me an hour online CE course, I'll make it a main category.


Thomas: Perfect. You got a deal.


Howard: We're horse trading in Louisville right now.


Thomas: Yeah, there we go. So can I back up a little bit? Because I want to tell a really fun story. What I want these young guests--because I'm in circulation with a lot of young guests--what I want them to know about you is that way before the internet and probably in dental school, you were always paying it forward and helping people. So I don't know when this was but it was in the 80s. And I reached out to you. It was the first time--you were just out of school--the first time that you were in dental economics, or one of the magazines, and I can't tell you what the subject was. But I called you and obviously I asked you a question about office layout. This is pre-Internet. And you sent me this. And I don't know if you can see--


Thomas: Oh I can.


Thomas: These are your office plans, Health Co. Dr. Faran, and so my question is (this is mid-80s) was I supposed to send these back?


Howard: Man, you remember Health Co.?


Thomas: Yeah.


Howard: My God, they were the biggest dental supplier ever. They were out of Dallas. I mean they were just the bomb. And wow.


Thomas: This thing is brown. It's weathered. I've carries it all over the country in my office. I've moved three times and it looks like the Dead Sea Scrolls. I mean this thing's got to be worth something.


Howard: Oh my god, that is so cool. Yeah, that was thirty years ago today September 21st. That's why I'm in scrubs. I just got back from my office.


Thomas: So what were you doing with Health Co.? Was that Today's Dental, was it at that office?


Howard: Yeah. I got out of school May 11 and Health Co. got it plumbed and got it all up and opened by September 21, '87 and that was the opening, thirty years ago today.


Thomas: That is crazy.


Howard: And what's even crazier is my oldest boy, he's only twenty-eight. I mean, I can't believe I've been a dentist two years longer than my oldest son Eric. My God, the time flies. But yeah, it's amazing. Health Co. was the biggest guy and he's gone. So many of these Fortune 500 companies are so arrogant, like Verizon and so many of them are arrogant. And what they don't realize is that the Fortune 500 in 1950, by 2015 88% of those companies were gone. Only 12% made it from 1950 to 2015. So when you're dealing with these companies and you think, "Well why do they do that?", just remember they have a 88% mortality rate.


Thomas: Wow. That's amazing.


Howard: And the mortality rate is speeding up. I forgot off the top my head was the mortality rate was. From 1950 to 2015 it was 88%. Can you find that stat? How many S&P 500 companies are gone from 2000 to today? But the mortality rate's going up faster and higher in dentistry. So do you think this oral systemic link--do you think it's bleeding edge or leading edge right now? Do you think this is about to take off in dentistry?


Thomas: Here's the deal. If it wasn't for Bale and Doneen--and I'm going to talk to you a little bit about that--I don't think you would be positioned to do much more than it has. When you look back to Bob Barclay in the '60s and '70s, there was an organization called the American Academy of Prevention. Bob Barkley, next to Gordon Christensen, he was a rock star. He had the second-most viewed personal appearances of anybody in dentistry next to Gordon Christensen.


Howard: You mean Bob Barclay?


Thomas: Yeah. And he died in '78 in a plane crash.


Howard: Where was that, Wisconsin?


Thomas: He was in Iowa, I think.


Howard: Iowa when the plane crashed?


Thomas: Yeah. So he had 8,000 members. I think it was called the American Academy of Prevention and it folded up within a year. So when you ask me about this, there have been several attempts at this and I know I've seen you document stuff going back to Charles Mayo, Weston Price. There have been people who've been all over this. But here's the fundamental thing. I don't know if you're very familiar with the Concordia study, where they looked at health care costs for people under periodontal maintenance. That's a really, really important study. The insurance companies have the information on the tip of their hands right now, that if someone is periodontally healthy, their overall health care costs go down dramatically. I'm talking 20%-30% for heart disease and diabetes. The dentist is the only person that isn't aware of this yet. We're in the middle of a cluster with our healthcare system. This thing is going to have to be redefined and that's kind of what I'm betting on, that prevention now is going to be a financial incentive. It's not going to be something people are going to do just because.


Howard: So who's their dental director at United Concordia? It used to be the executive director of the American Dental Association, is it Brenner? Brennan? It starts with a B.


Thomas: I don't know.


Howard: He was the American Dental Association's executive director for probably over a decade and now he's their dental director. I was listening to him lecture and they said the lowest hanging fruit, the most expensive disease from periodontal disease, is that if a pregnant girl has gingivitis periodontal disease and drops a preemie, it's at least one million cash out of their actuarial savings account. It just makes so much sense that every girl on the United Concordia goes and gets her teeth clean every three months because they just don't want her to drop a one pound frog. That's just horrible. Not to mention they save those preemies. But have you ever seen them, the ten-year follow-ups on a lot of these preemies? They always talk about, "Oh we saved the baby" but it'd have been a lot better just to prevent the whole damn thing to start with.


Thomas: Right. So there's your driver right there.


Howard: And Ryan just gave me the data. From the year 2000 to today, 52% of the Fortune 500 is gone. It had a 50% mortality rate in the last seventeen years. So we are in the fast lane. And I got to tell you this too because you graduated from Creighton. I went to Creighton too. I was at Creighton from '80 to '83. You graduated from Creighton in '80 and remember when we got out of school, those little advances, it seemed like every five years something minor would change. Now thirty years later there's so many damn things changing. And my friend, who's a pharmacist across the street for Walgreens, Brad says he can't even keep up with all the new drugs that come out every year. He said he used to have all of them in his head and now he can't even learn all the new ones. He can't even stay up on just the new ones. So we are in an exponential growth.


Thomas: It's a very disruptive period. And so that's why these these alternative health care models-- For instance, Bruce Baer. He has a nurse practitioner in his office now practicing the Bale-Doneen method. You can go into the dental office, get a carotid ultrasound, get your labs drawn. That was one of the things I was going to show you because I just had mine done at his office a month ago. I've been in the program about three years. So for your audience who's not familiar with the Bale-Doneen Method, I'm going to make it greatly simplified. Their concept is arterial health and inflammation. And if you haven't noticed, inflammation is now the subject. It's not cholesterol anymore. It's inflammation. They are of the belief that the mouth is about a 50% contributor. Now it's not just all perio. To be perfectly honest with you, there's an endodontic lesion that's a huge component of this inflammation deal but that's a whole other conversation. So let's say that the mouth is a combined contributor of 50% of inflammation. That makes the dentist a keystone player in the solution. So let's make it super simplistic. I go in, get the carotid ultrasound. They look at the plaque. They draw the HeartLab panel, Cleveland HeartLab panel, and then they look at the periodontal pathogens. This is my current test. I just had it done, the Cleveland HeartLab. This is the advanced biomarkers for inflammation. And you see that everything is green. All the boxes are green, so I'm within normal limits on these advanced inflammatory biomarkers. So within the Bale-Doneen method, I have no periodontal pathogens and my carotid IMT, I have moderate heart disease. I have moderate heart disease, but the plaque is beginning to transform from soft to heterogeneous to calcified, which is the reversal of heart disease. Once again, before I was going to go save the world, I was pretty much interested in saving my ass first. I've got to be transparent.


Howard: What percent of your perfect score card is because you're in Lexington, Kentucky and you've been washing Jim Beam through your arteries your whole life? Or was it Wild Turkey?


Thomas: No, it's Woodford Reserve, man. Those are Walmart brands. We've got a lot better than that. So that's the Bale-Doneen Method in a nutshell. What I'm doing is training the dentists. We're matching dentists and Bale-Doneen physicians together. They have to practice together. Because the physician is going to say, "I've got to know your oral biofilm DNA. I need to know if you've got pathogens. I need to see preferably a cone beam, I need to find the endodontic lesions." So those are a couple of the main components that the dentist is going to evaluate. Sleep apnea is a part of the Bale-Doneen Method. It's a very cool deal. And so when I met him in 2013 I kind of made a bet and I said, "Listen. This may go nowhere and it may go somewhere. And if it goes somewhere it's going to be a big deal." And I think Bruce became a patient. Everybody that really gets convinced of this becomes a patient, because what he explained to me is you see these outliers, these people that are perfectly fit and have heart attacks. You know, the runners and cross fitters and they have a heart attack? Well there has to be an explanation for the outlier. Most of the time it's going to be something oral.


Howard: Inflammation is all the rage. It seems like so much of what I read is that, no matter what disease process is going on, it starts out with inflammation and the C1 reactor and I have the C1 super sensitive. It's like if the doctor does a physical and he finds nothing wrong but your inflammation is elevated. There's still a concern and keep looking.


Thomas: [00:24:50] (Inaudible) [0.1] With Dr. Bale, when he began this fifteen years ago, I think he backed into this dental component. He's looking at this inflammation and he's kind of a detective and he has a theory. And he says, "I can't find it, I can't find it, I can't find it." And then by happenstance, somebody has an abscess tooth, and they have a tooth out and the inflammation goes dramatically down in the blood test. He says, "Hey, we need to start looking in the mouth a little closer." And then what has happened over a period of time is that he's created these theories as to why the dentist is a franchise player in this whole process. So what I've done is I've created this as kind of a bedrock for a prevention program. This is a really good rationale. You can do prevention for prevention's sake which was what I did back in the '80s. But now you're a mainstream player in this whole thing.


Howard: You came out with a book last year on Amazon, "I'm Free: A Consumer's Guide to Saving Thousands on Dental Care with Simple Preventative Measures." It's the only book I've seen in dentistry where you have 100% five-star ratings. I also find it interesting on Amazon that people who bought your book also bought "Beat the Heart Attack Gene: The Revolutionary Plan to Prevent Heart Disease and Stroke", which you've been talking about and we had on the author on the show. They also bought "Brain Maker: The Power of Gut Microbes to Heal and Protect Your Brain-for Life". And the third one was "Your Mouth, Your Life: Your Connection of Oral Health to Whole Body." And I was listening to someone the other day. I said, "Well, what's around the corner?" And they said that when you look in the mirror, you see a homo sapien with about a trillion cells that you got from your mom and dad. But from your mouth to your anus is 10 trillion cells where none of that DNA came from your mom and dad, and that has more to do with your health than the one trillion you got from her mom and dad. They think that, in the future, to get control of [00:26:59] (inaudible) and [1.3] periodontal, all these bugs in your mouth will be more about changing the gut microbiome in your body. How long have you been practicing dentistry?


Thomas: Clinically, I've practiced for 17 years.


Howard: OK. Did you see patients that basically had no home care and never had cavities or periodontal disease? And then I had a hygienist who I saw every three months and she had perio surgeries and continue to lose teeth and she'd always cry and she was traumatized. I was always trying to be an armchair psychologist saying obviously it's not your fault, there's something else going on. But you can tell by being a dentist. Sometimes you touch people's saliva and it's just water. Other times you touch people's saliva and you can pull it up three or four inches. I'm talking about that book. People who bought your book also bought "The Power of Gut Microbes to Heal and Protect Your Brain-For Life." I think we're going to be preventing decay and gum disease by controlling the gut microbiome in another decade. Do you see that coming?


Thomas: Oh yeah, that's the emerging science. I'm seeing that everywhere. In fact, there's one of the Cleveland HeartLab casts now that goes into the gut thing too. There's no question that that's emerging.


Howard: And what's really bad, the saddest thing, is that the fastest way to ruin your gut microbiome is eat a whole bunch of sugar. Because the bacteria that feed on the sugar kill so much of the great bacteria. I was watching this one documentary where this researcher went to the most primitive tribe in Africa that still was nomadic and living off the land and he only stayed with them ten days. They ate nuts, berries, whatever they ate. He only ate that stuff for ten days and they took a stool sample before he left and did the analysis, and after ten days he had a completely different gut microbiome.


Thomas: That's amazing. And that also makes me think of something that we need to talk about, antibiotics and antibiotic resistance. You know that is a tremendous problem right now. One of the resources that I'm kind of bringing to the table--I'm bringing a lot of relationships to the table--is somebody I met three or four years ago, who you interviewed, is Jim Hyland from Toronto [00:29:27] (inaudible) that [1.5] has the patented antibiotic rinse. We're making this a part of a recommended protocol too, because systemic antibiotics for periodontal disease, if you believe in the whole gut thing, that's not a good thing. But you can take them orally, gargle, spit out and you don't have a systemic effect. And you had a great interview with Jim Hyland.


Howard: Did you grow up in a very agricultural area?


Thomas: I was in Omaha.


Howard: You were in Omaha. Well, growing up in Omaha, there were a lot of cattle. But 80% of all the antibiotics used in the United States are fed to farm animals. A third of all my friends were wheat farmers, corn, milo, cattle. I can remember being ten years old asking those guys, "Why do you give them antibiotics?" and he goes, "Because it makes them fat. And when you give antibiotics they get obesity." When you look at identical twins where one had an ear infection and got antibiotics one time and the other identical twin didn't get the antibiotics, by age ten years old one is already headed towards obesity. What's bizarre is 80% of all the antibiotics are given to animals because they know it kills gut microbiome and makes them obese. I've been reading where the most common transplant in the world is a fecal matter transplant. They're taking obese mice and doing fecal transplants from skinny mice and the obese mice start losing weight.


Thomas: I'm having problems that visual. I don't know whose I want.


Howard: But isn't that amazing? When you give people antibiotics and everything they eat is out of a box (cereals, prepared foods, packaged foods) they're not getting any natural vegetables and all that stuff like they have been for the last 2 million years. This is really exciting new science.


Thomas: Oh no question about it.


Howard: And you know who invented the fecal matter transplant?


Thomas: No.


Howard: Same place--Australia--where they were watching the Americans doing all these stomach ulcers surgeries. This woman doctor down there was saying, "How is this infection? It's like an ulcerated area." She's the one who figured out it was H Pylori bacteria and started treating with antibiotics. There was another woman physician down under in Australia who saw this kid after he had done chemo, laying there lifeless, and he'd cry when he would poop. In his anus his the skin was shedding and she's looking at him and she's saying, "I think the chemo killed everything in his intestine". So the mother was there and she said, "Go to the bathroom and this stool, I'm going to put it in a enema." So she gave this little six year old kid who just got through chemo a complete enema of his mother's bowel movement. And she said in twenty-four hours he snapped back to life.


Thomas: Wow.


Howard: And now, post-chemo, they're starting to do this all over the place. America usually isn't in first place. It's usually going to be Australia, Scandinavia, these people. But yeah, it's amazing.


Thomas: It is.


Howard: So if you quit drinking Jim Beam for a week--That's what we should do. We should have you poop, do your analysis of your sample, stop drinking Jim Beam for one week, and see what happens to your gut microbiome. So you talk about six degrees of separation. What do you mean by that in dentistry?


Thomas: When I was talking about you in particular?


Howard: Yeah.


Thomas: What I meant, I think, in the thing you had me fill out was the times where our paths have crossed, but you didn't know it. I want to ask you a question about this in particular. This is in heavy circulation on the Internet and I remember this. This was a period of time--I don't know who's been putting this out, but I saw it yesterday--where this was an attempted coup of the ADA by you and Woody--what was that about? You were very militant if I remember correctly.


Howard: Yeah, when I was young I was filled with piss and vinegar. Now I'm very mature. But I [00:33:59] (inaudible) my podcast (inaudible). [1.7] No, but basically "Capitation" was coming out and the ADA had a full-time legal department they weren't doing anything. Their dues are north of 200 million a year. And I wanted a million dollar ad during the Super Bowl. I wanted this ad where's the glass of water and this slow motion upper denture was falling into the glass of water with James Earl Jones' voice saying, "In the United States by age sixty-four, 10% of Americans have zero teeth." Then here comes a lower denture splashing into the water. "By age seventy-four, 20% of Americans have zero teeth. Call your dentist today and get your teeth cleaned." I thought that would have been, for 1 million--So they wouldn't do national, they wouldn't do television advertising, they wouldn't sue the insurance companies for all this misrepresentation and all this stuff like that. Rich Maddow had the the "Profitable Dentists Newsletter", Woody Oakes had--No, Woody Oaks had the "Profitable Dentists Newsletter". The Maddows had "The Maddow's Report". I had "The Farran Report" that turned, later when I added the Internet, into a thing called Dentaltown. Gordon Christensen was the most famous speaker on Earth. Still is to this day. We went down there and I was very proud that the president, the president elect, the executive director--they all sat and they let us all rant for hours. And by God if they didn't sharpen their pencil. [00:35:31] Spitkis was [0.8] the attorney back then and he started subpoenaing and all these insurance companies and they started going after him. And as far as advertising, I'd say the ADA on Facebook, Twitter, LinkedIn, Pinterest, they're a social media maverick. I mean the "brush twice a day, two minutes" philosophy at that time. So I thought they listened very, very well and I think what got their attention is at that time the American Medical Association just went under 49% members. Dentistry is about 67%. They saw people quitting the American Medical Association, which I last heard is like around 25% now. The doctors are so disillusioned with the AMA. American Dental Association is listening. I've had a couple of their presidents come on the show, the executive director. They've got two out of three dentists and they want the other one third and I think they're extremely responsive. A lot of dentists bitch about the ADA, but it's kind of like your parents. There's a lot of things you can whine and complain about your mom, your dad, your grandma, your grandpa, your sisters, but they're still your family. They're the only people that represent dentistry in Washington D.C. They're the only ones. So if you don't like them--you graduated from school with a $350,000 investment to become a dentist. You ought to support your only trade association that's going to go there and fight for you. There's dental therapists, there's all kinds of issues. And the other thing that the ADA wasn't good at is they don't tell everybody what they're doing. They got 300 people at 211 Chicago Avenue who are working all day, five days a week, but they don't tell you all their legislative accomplishments, all these bills, all these things they took out of fifty different states. They do a lot of work but they don't toot their own horn.


Thomas: So let me ask you your opinion on something. We've got a mesothelioma settlement, a tobacco settlement. Why has there not been a mountain dew settlement? I mean I just can't see that those don't line up accordingly to have resources for all the damage that has been done by refined sugar.


Howard: And the cigarette settlement is the the dumbest thing if you study smoking. When World War II broke out, Americans didn't smoke. Then they drafted six million boys and sent them overseas for four years and they issued them a pack of cigarettes every single day for the whole four years because they thought it was good for their nerves. So six million boys came back addicted to smoking and that's when smoking exploded. And then what does the government do? Turns around and sues the tobacco companies. And then the tobacco companies where you live in Kentucky for years have been trying to study, "What can we do to make a safer cigarette? What is actually causing lung cancer?" And who has shut them down? The government. Because they're all like, "You can't make a safe cigarette. You can't even call Marlboro Light 'light' because they'll think it's safer." So the government, the Pentagon started the smoking craze. The government's the one that wouldn't let Philip Morris study safer cigarettes. And then they end up suing them. It kind of reminds me of General Electric. During World War II, General Electric kept going to the Pentagon when they're making all these ordnance and bombs and they said, "What do we do with all this toxic byproduct waste?" And the Pentagon said, "Pour it in the Baltimore River." So they did all during World War II and then thirty years later, who wants to sue GE for the cleanup?


Thomas: The government.


Howard: And they're like, "Dude, you were detonating nuclear bombs. We could have dumped that shit right there when you were detonating Trinity. We asked you where we should dump it. You're the one who told us, no you're not trucking out there." It's kind of like at these nuclear reactors. They're always afraid that it's going to let out some radiation. Japan, when it had that big earthquake and it got hit by tidal wave, it let out some radiation and everybody's all freaked out about it. Are they insane? The United States and Russia detonated 1800 nuclear bombs above ground. Those little reactors? That'd be like a chipmunk pissing in the ocean. When they detonated those bombs there was radioactive material 5000 miles away instantaneously. Anyway, don't even get me started. The government is so--well actually, I just think people are crazy in general. They're just sapiens with clothes on.


Thomas: The human condition. So let me ask you: are you going to be at Voices of Dentistry, or are you familiar with that?


Howard: They're having it in my backyard. They're having it in Scottsdale. When is it going to be?


Thomas: I think it's the last weekend in January.


Howard: And who's the organizer?


Thomas: That would be Justin Moody, Alan Mead, Mark Costas.


Howard: I haven't heard from any of them. Justin Moody is my good buddy. Alan Mead has been on the show. Mark Costas--I haven't heard anything from him. Are you going to be on the show?


Thomas: No. Basically what we're doing--Because that was actually where I met Vicki. The first time I met Vicki was at Voices in January. And so we're going to be a sponsor. I've got a private Facebook group called The Pathogen Lounge, where we're kind of creating a group to share information on the oral systemic and we're going to have a physical entity at Voices where we're going to have workstations with a microscope, with the biofilm DNA, with lasers, showing people all these protocols of advanced prevention. That will be a part. That's what we're talking to them about doing.


Howard: Who are you talking to about that?


Thomas: See, I don't know.


Howard: That's like I have a townie meeting. That's their meeting. I don't want to go barge in their meeting or whatever. If they invite me I'll go, if they don't invite me, I get it. Townie meeting is tough when you have a meeting because several hundred of your buddies are emailing me, "I want to speak, I want to speak, I want to speak." But you can only just have a few speakers everyday for three days. So yeah, I won't barge on the show but what's the date on that?


Thomas: January 28 pops in my head, but you'd have to go to VoicesofDentistry.com.


Howard: Well that's a beautiful time of the year in Scottsdale, January 28th. My God, that is crazy good. One of the reasons I called you the most was the fact that you've always been a champion for the solo practicing dentist. You also talk about building and selling a dental practice while in school. You think that's possible?


Thomas: No that's not possible, that was just some of my insanity as a twenty-seven year old. You know how you get risk averse as you get older? Now when I had some students two years ago in Kentucky come to me as juniors and say, "We want to buy a practice," I was like, "Dude, you're a junior" and they said, "Yeah, but you did it too." And they are three months out of dental school and they have three practices now. Now, I've mentored them through the process and these weren't start-ups. I would call them a hybrid start-up. These were distressed practices on a real bad trajectory with some sick doctors or whatever. These weren't your typical acquisitions. They had no web presence, no website, so I was able to kind of make all of those things happen. It's an interesting little niche. It's been a great story we're documenting really closely with the "Life and Dentistry" podcast.


Howard: Yeah. Are these the guys you're talking about?


Thomas: Yeah, [00:43:37] Matt Wittson and [0.8] Daniel De la Cruz are the two practice owners.


Howard: Well tell them to come on the show and talk about their podcast.


Thomas: Yeah absolutely.


Howard: And CC me on it: Howard@Dentaltown. And then the other Howard is in charge of the online CE. His name's Howard Goldstein. So he's HoGo@Dentaltown. Invite those guys come on the show and CC Howard Goldstein because if you've got eleven hours of modulizing, the best marketing would put the first hour up and then we'll move that to a main category. But you just said something extremely profound that is worth repeating. And that is when I ask them, I always ask them, "Email me at Howard@Dentaltown.com and tell me who you are." Because I don't know who's downloading this on iTunes and all that stuff. I was surprised that about 25% of all the emails, they're still in dental school. They're d1, d2, d3, d4, and all the rest are pretty much under thirty. They're all millennials born after 1980. But what he just said that's so profound is, when you get older, you get risk averse. So what you do is you get out of school and you go work for corporate and they're paying you a buck and a half a year, a hundred and fifty, a hundred and seventy. So then you go get in a house and you get married and as you get older and you're like, "Well, I kind of got a nice gig going. Do you really want to risk all this stuff?" I walked out of dental school May 11, had my office open September 21. So I got out of school May 11 at twenty-four, turned twenty-five August 29th, got my office opened September 11, and had four boys in 60 months. And there is never a good time to start a business or have a kid. If you're thinking about having a kid, you'd better have one right now. They're even doing it in high school where they're making these dolls that mimic a child crying, waking up, and all that, and they get sent a home with these twelve, thirteen year old girls. A third of them come back to school after a week and say, "I'm never having a kid." And there's another phenomenon you see in big Catholic and big Mormon families where the oldest daughter of a family of like six, eight, or ten kids, she was changing diapers and babysitting the babies her whole life. And when those girls get out of the house and get married, they don't have any romantic notion of a kid. They say, "Hell, I raised my five younger siblings." So they're most likely to never have a child. If you're the oldest girl in a family of six, seven, eight, nine, ten, kids, they don't have the kids either. My four boys are the single best decision I ever made but I couldn't do it at 55.


Thomas: Right.


Howard: I mean shit, I can't even adopt a puppy at 55. It's just too exhausting. So when do you open up a dental office? Before you even think about it. Just go buy one or build one tomorrow. You're not going to die. But the last part of this rant: same thing in the military. The military has several thousand years of data. The only people that they can charge and order into gun battle and gunfire and cannons is young males. By the time they started getting desperate and recruiting thirty year old males, they'd say, "Hey Thomas, take that gun and charge that hill!" And you're like, "Are you shitting me? There's frickin' cannonballs flying over the top." And women, at every age, say, "I don't think that's a good idea. I think you're going to get killed doing that." And look what the military does with risk. All these Purple Hearts and ribbons. They're trying to encourage all this insane risk taking with your own life and limbs and health. So, best time to open up a dental office is in dental school. The next best time is the day you graduate and the worst time is after you get fat, lazy, older, and sedentary and start to analyze how much work it's going to take and then you make a rational decision. And what does corporate dentistry do? They pay you enough money so they can kill all your dreams.


Thomas: Yeah, you got it. That's it in a nutshell. I'm riding with those guys right now and enjoying the hell out of it. I mean, if I can't do it, the next best thing is to mentor somebody with that kind of energy and that kind of fearlessness. I got a group doing it right now, it's great.


Howard: So when you were in dental school for two years teaching, from 2009 to 2013, co-course director of the practice management class on "The Business of Dentistry, a Mini-MBA", did you think--You know we keep hearing, "The millennials are different, they're different, they're different" and the class is half women. Do you think when you were in dental schools that those class people psychic mind as  far as entrepreneurship, owning my own practice was different than thirty years ago when you and I were at Creighton?


Thomas: When I graduated from Creighton, they were two girls in a class of, I don't know, my class 60 or something. But there was an expectation that every one of us was going into private practice. You had a handful of smart guys, the geeks, that were going to be specialists, but everybody was going into private practice. But here's when I'm unhappy about today. I take a freshman class, first week, and I say, "How many people here wanted to become a dentist because you have a role model, a mentor, a neighbor, whatever who's independent and has kind of a cool lifestyle?" All the hands go up. You come back second semester, senior year. "How many people here are on a path of freedom, independence, entrepreneurship?" And it's like two or three. So somewhere between freshman and senior year that just got beat out of them. It's actually the marketplace is beaten out of them. I don't think there's full disclosure as to what this is all about, this whole dental school process. And I think corporate dentistry is kind of letting dental schools off the hook. They've never wanted to train people on debts, on business. They never wanted to. There's some exceptions and I'm generalizing. Now that everybody can get a job, they don't give a rip about business training. That's kind of the state of that. As far the millennials, I hate characterizing. I try not to do that because I look at this group of people I'm working with right now and they're as sharp and as hard working as anybody in our classes. So you can't do that. That's not fair.


Howard: Yeah, I hate it when people--I'm 100% Irish--I hate it when people say that all Irish people are crazy like  Conor McGregor  and alcoholics, when only when only 38% of Irish are alcoholics. 62% of us are not. Tell us about your connection with Jamie Amos, who has 680,000 podcast views on the Dentaltown app. Crazy. He has more views and dental podcasting than anyone.


Thomas: So he kind of started this process. I had started on this Bale-Doneen kick where I'm writing the manual and I get a random email from Jamie. I'm leaving the university, I'm working in a practice, and I'm writing this manual. And he said, "I read in your bio that you started to practice during dental school. I need a chat with you." He was just starting the business. It was just him and his manager. He said, "That's a great story. Would you like to do a podcast?" So I started doing some of the original initial podcasts with IdealPractices and he just got a great response because not only was I talking about start-ups, I was talking about wellness. I was talking about where I saw opportunity. I'm very optimistic about where dentists can position themselves. He took my book. My book was basically a gift to the senior students. I never even was going to sell it. He created his MBA training for his start-up. I was involved in that until Bruce called me. So I was a part of that. I saw that podcast thing that you're talking about, the penetration of the message, and it's amazing.


Howard: So that's why his podcast went off so well. It was because you were his secret sauce guest.


Thomas: Initially.


Howard: Now isn't he down in Florida and has some place in the Caribbean?


Thomas: Right.


Howard: I wonder if Irma messed him up. Did he get hit by Irma? I was looking at the pictures this morning of Puerto Rico. How sad.


Thomas: Oh terrible.


Oh my God. And the Florida Keys? I took all four of my boys for a wedding down there for their cousin. I love The Keys. That place looks like a lawnmower hit it.


Thomas: Wow.


Howard: Crazy, crazy, crazy. So my God, that was the fastest hour. But I just want to keep you for a few more minutes. What's the cold action? Should they go to your website? What do my homies do next? What's their homework for today? Your website is TomLarkin.com L.A. R.K.I.N.


Thomas: That's my personal site. So if you go to ProductiveDentist.com and you want some more information about the whole Bale-Doneen and this thing kind of interests you, go to a ProductiveDentist.com forward slash AAOSH. So what we did is we created a splash page for last weekend's--.


Howard: Tell them what AAOSH stands for.


Thomas: The American Academy of Oral Systemic Health. So we've got a splash page there where it has all the information about my course. I want to jump on making your course for you. I think that's a great opportunity for us because I really want to bring all of these resources into one place and really help propel this forward because I'm kind of a believer.


Howard: And where is [00:54:11] Bruce Baird in [1.3] Texas? What city is he in?


Thomas: He's in Granbury. I think it's an hour south of Dallas/Fort Worth.


Howard: Yeah. And I just want to say a couple of things. We have so many self-limiting beliefs between our ears. Dentists are their own worst enemy. They get up every morning and they say it's the economy, it's the insurance, it's my stupid patients. [00:54:35] Bruce Baird, [1.3] the whole time I've known him, does about 4 million a year. I've got to tell you a couple of things about that. Number one, I'm always telling you--supply and demand--that people who are 1 to 2 hours away from a major airport usually are practicing an area where there's one dentist for every 3000 or 3500 people. By the time they get to downtown Dallas or North Scottsdale or out there in East Mesa there's a dentist for every 500 people. So he's out in the middle of Granbury doing four million a year, and then you're sitting there in Salina, Kansas saying, "Well the only people that do that are in Manhattan and Miami and San Fran." [00:55:18] Bruce Baird's [0.9] doing it in Granbury, Texas. Would you say that's an uppity yuppie community?


Thomas: I've been there twice. It doesn't look like it to me.


Howard: Oh my God. That's a city where the people get excited when they build a new Wal-Mart. And he's crushing 4 million a year. He's a people person. You know, it's funny on this global warming thing how so many people are so confused why so many people don't believe it. Look at when the theories of evolution came out. There was violent opposition to evolution and all these great science theories. But when they come out these theories, they don't try to understand that there's always violent opposition to any new theory. But they talk down to them and they're condescending: "Well all the PhDs know it. You're from Granbury, Texas, you moron idiot." That's why they all flipped them off and didn't believe in it. And then with Americans, they all believe if it's too good to be true it's not going to be true. I thought it was funny in The New York Times yesterday they had an article on global warming and then they had another article about how this numerologist has predicted the end of the world and it's of course November 13 or something like that. So you're running a newspaper that's saying global warming and the end of the world in the same New York Times. Everybody says if it's too good to be true, it's not, and if it's too bad to be true, it's not. The truth's somewhere in the middle. I think so many dentists talk down to their patients. So many are condescending. Every meme I've seen by a consumer on the hygienist: "What's the difference between your parents and your dentist? Your parents talk down to you about cleaning your room and your dentist talks down to you about cleaning your teeth." And I think [00:57:11] Bruce Baird's [1.2] and Vicki's secret sauce is how they emotionally connect with their patients. Now not only could he sell 4 million dollars a year in dentistry in Granbury, but now he's selling total wellness, carotid stethoscopes, taking bloodwork because they trust him. Because he's a good old boy from Texas. There's nothing pretentious about him, there's nothing condescending about it. He's a dentist that everyone would want to go to the bar with.


Thomas: No question. I'm going to be with him all next week and he's everything and more. It's been a real honor to work with him.


Howard: Yeah and you know what? You ran fifteen minutes late. And the lady up front all pissed off and she's taking it out on the front desk and then after that procedure you go back in your office and close the door. Or my staff will tell me, "The next lady's really upset." I'll walk the patient out there that I got done and then I'll turn to the lady, "Hey Betty. You know why I'm fifteen minutes late?" Then I'll start punching Tom Larkin on the shoulder, saying, "I haven't seen this guy for three years. He shows up unannounced, needs a gosh darn root canal, and I'm sorry. I didn't run fifteen minutes late, this bozo right here made me run fifteen minutes late." And they're all laughing and she's like, "Oh it's OK." And then the receptionist stand there like, "What do you mean she's saying it's OK?" It blows their minds because you can really get mad at the receptionist, the assistant, the hygienist, but when the doctor walks in the room, whether it's [00:58:39] Bruce Baird [0.8] or myself, it's all behind. I'll even tease some patients: "You should give her five bucks to buy her a Starbucks coffee for making her wait fifteen minutes for you. You know last time I gave you a floss you thought it was a broken yoyo. You only brush your teeth twice a year and my hygienist does it for you both times." And they're all laughing and giggling. It's the human side. If you go down the Productive Academy, listen to how Vickie talks to people and patients. Listen to how Bruce talks to people and patients. That's the secret sauce. Not the alphabet soup stuff behind your name, that you got your diplomat in the academy of "who gives a shit". Talk to people on their level.


Thomas: Yeah, that's the secret sauce.


Howard: So you're going to be in Scottsdale at the Voices of Dentistry. I'll see you when you're in town.


Thomas: That would be an honor. And we're going to put a system in your office too.


Howard: I would love that. I can't wait to see whose bacteria are jumping around faster, mine are yours. Thank you so much for coming on the show.




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