Dentistry Uncensored with Howard Farran
Dentistry Uncensored with Howard Farran
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987 Total Health Dentistry with Dr. Susan Maples : Dentistry Uncensored with Howard Farran

987 Total Health Dentistry with Dr. Susan Maples : Dentistry Uncensored with Howard Farran

4/11/2018 7:37:23 AM   |   Comments: 0   |   Views: 349

987 Total Health Dentistry with Dr. Susan Maples : Dentistry Uncensored with Howard Farran

Dr. Susan Maples leads a successful, insurance independent Total Health Dental practice in Holt, Michigan.

She brings preventive and restorative dental expertise, a passion for mouth-body total health, a master’s degree in business/marketing, and 30+ years of experience in private practice.

 In 2012 Susan was named one of the Top 25 Women in Dentistry and one of the Top 8 Innovators (otherwise known as “disruptors”) in Dentistry.

In 2016 Susan received the Lucy Hobbs Mentor Award.

She is the author of BlabberMouth! 77 Secrets Only Your Mouth Can Tell You To Live a Healthier, Happier, Sexier Life.

She is the developer of the Hands-On Learning Lab™ kit , an interactional science-based learning program for dental patients and, an educational screening tool for patients and clinicians to uncover signs of illness such as Pre-Diabetes/Diabetes, Obstructive Sleep Airway Disorders, Acid Reflux, and Chronic Systemic Inflammation.

Susan is also co-investigator in an award-winning diabetes research study entitled Diabetes Detection in the Dental Office.

Her latest development is for YOU and it’s called Total Health University.  It’s a complete online learning curriculum for dental teams to develop a Total Health Dental Practice of your own, exclusively distributed through Henry Schein.

VIDEO - DUwHF #987 - Susan Maples

AUDIO - DUwHF #987 - Susan Maples

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987 Total Health Dentistry with Dr. Susan Maples : Dentistry Uncensored with Howard Farran

Howard: It is just a huge honor for me today to be podcast interviewing Dr. Susan Maples. She leads a successful insurance independent total health dental practice in Holt Michigan, which I assume is the richest part... is that the richest city in the world or just the richest city in America? 

Susan: We’re at the poorest.

Howard: I meant poorest. She brings preventive and restorative dental expertise, a passion for mouth body total health, a master's degree in business marketing, and thirty-plus years of experience in private practice. In 2012 Susan was named one of the top twenty-five women in dentistry and one of the top eight innovators, otherwise known as Disruptors in Dentistry. In 2016 she received the Lucy Hobbs Mentor Award. Lucy Hobbs was the first dentist in America, correct?

Susan: Woman dentist, yes.

Howard: Was she the first woman dentist in the world or just in America? 

Susan: I think in the world.

Howard: Yeah, and Ohio had the first dental college and then twenty years ago Baltimore had the first dental university. She is the author of this book right here ‘Blabber Mouth: 77 secrets only your mouth can tell you to live a healthier, happier, sexier life.’ She is a developer of the hands-on learning lab kit, an interactional science-based learning program for dental patients and, an educational screening tool for patients and clinicians to uncover signs of illness, such as pre-diabetes, diabetes, obstructive sleep airway disorders, acid reflux, and chronic systemic inflammation. Susan is also co-investigator in an award-winning diabetes research study entitled ‘Diabetes Detection in the Dental Office.’ Her latest development is for you and it's called ‘Total Health University.’ It's a complete online learning curriculum for dental teams to develop a total health dental practice of your own, exclusively distributed through Henry Schein. Susan, it is just an honor that you came on the show today. Thank you so much for taking an hour out of your valuable life to come talk to my homies.

Susan: Love it.

Howard: You know the one thing I like about you, not only have you been crushing it for... since 1985... you know, you're not doing it in Beverly Hills or Key Biscayne, Florida. I mean you're out there doing this in Holt, Michigan. Can a dental practice still be thriving when your state is contracting? I mean, you know?

Susan: Well, not only thriving but thriving as an insurance independent dental practice. I don't know another insurance independent dental practice in maybe a hundred mile radius of us, so that's kind of crazy, right out in the middle of nowhere. It gives hope to my audiences, I speak on this throughout the country almost every Friday of my life and it gives hope to people that they can create a total health practice. The real cool part about this Howard is that we actually attract people who want to spend money on health. Imagine. Right? I mean those are the patients we all want. So we can attract people who value health enough to pull out their own money to spend and they trust you because they know you're looking beyond their mouth. That is an amazing combination that sets us apart and creates a lot of buzz in the community. I would say our... probably our three top sources of new patients are one, medical providers, medical professionals that refer to us because we've really bridged that gap and I can talk more about that if you're interested? Two, I would say the hands-on learning lab where we do science experiments on every child on every visit, so we're teaching kids to be in charge of their own health by age 18; and number three, I would say the infant oral health exam. I just got off the phone with Delta Dental Foundation. They have $85,000,000 to spend, and they're looking for ways to try to help people do more infant oral health exams and they don't know why dentists won't do it and I'm like, I don't know why either because it is a huge influx of new patients for us. For new patient adults and grandparents, so that's kind of cool. 

Howard: One of the passionate things I have about infants is, it's so bizarre how the anthropologists have been pointing out to us a lot in the last couple years, that these malocclusions that all these American children have, didn't exist a couple centuries ago…

Susan: Right.

Howard: I'm right up the street from ASU which has the oldest hominid fossil. Lucy. a 1.6 million-year-old girl who didn't have her wisdom teeth in all the way, she was thirty-six inches tall, but the anthropologists are saying the malocclusions a new deal and what is it? Because children used to nurse for a couple years.

Susan: Oh yeah.

Howard: And they used to struggle and those struggling nursing spread the face of the development, then you would have fed the kid, you know here's a mastodon leg, chew on that for an hour, and now as soon as that kid has difficulty you switch to a bottle, which is just a guzzle machine, a sippy cup and then you feed it applesauce and then you want to know why your child... why the maxilla and mandible can't have room for all the teeth.

Susan: Room to grow. You know, it's crazy, we've been doing what rapid palatal expansion at age six for a long time. If we could get the tongue working sixty times harder by breastfeeding, it would take its rightful place at the top of the palate, spread the mid-palatal suture and change the entire airway forever, which is crazy to think, but infant oral health exams really developed as a need to try to affront the number one disease among children which is caries. Caries is like, one in three three-year-olds have tooth decay. 20% of two-year-olds. That's nuts and when I was in dental school, Howard, way, way back they told us caries would be a thing of the past. It is a 100% preventable, but it's a transmissible biofilm disease, and we can actually work with parents to stop swapping spit and reduce the caries rate forever, which is crazy to think about, along with the airway, of course, that's a big deal.

Howard: Tell us about your journey to write ‘Blabber Mouth.’

Susan: Well, interestingly, I wanted to… I’ve talked to... do you know who Dr. Oz's best friend Rosen is? Michael Roizen. He wrote…

Susan: Pardon me?

Howard: Dr. Roizen?

Susan: Yeah. He wrote the book, I can't remember what his book is now, but anyway, he said if you really want to change your profession, because I said my profession’s really tough to change, we are Boy Scouts and rule followers and I … No disrespect to Girl Scouts and my generation was mostly Boy Scouts, and when I say that, we are very slow to change our practice. We can learn stuff but integrating it into practice is tough. So he said the way to do it, is the way Oz did it, to talk to the public and ask them to expect more from their dentists. Now I'm speaking to a bunch of dentists who might be mad at me for saying this right now but there are some ways, that if we don't become pertinent in this six-month preventive exam we will lose that. The diseases that we're trying to prevent caries, occlusal disease, periodontal disease and oral cancer are all getting worse, so if we don't make that preventative appointment about something that really matters, the evidence is clear that was based on a 1929 commercial for Pepsodent. So there isn't any good evidence that that appointment works and I'm trying to make it so that we don't lose this, in fact, we could see people every six weeks or every twelve weeks, not every six months. So anyway, Roizen said you need to reach the public and the way to reach the public is to write a book and then start being able to reach out and do podcasts and television and stuff for the public. So I wrote the book for the public, interestingly I've sold thousands and thousands of copies to dental teams because 85% of what's in there most dental offices don't know. It's on Amazon, today we probably sent out thirty copies to individuals so it does catch on to the public. We've never had it in bookstores. But this was really to help educate the public about all the mouth-body connections and everything we could see in the mouth, including early signs of metabolic disease.

Howard: So tell us about your online University.

Susan: We actually had to change the name to Total Health Academy because apparently ‘university’ is something that is a kind of protected name, thanks to Donald Trump. Total Health Academy - it's an online learning platform where people can… dental teams can purchase it. You can either buy the adult, the pediatric version, or the combo of those and it's basically about thirty-eight modules of online learning that comes with… It's on Lightspeed, so I don't know if you're familiar with the platform? It's fabulous. It has all the bells and whistles, all the forums, all the health histories, the screening forums, it comes with the hands-on learning lab kit, it comes with lots and lots of ways that dental office managers can monitor performance of team members, so that you can basically open it up like a menu... like you're going to eat at Applebee's, and decide where you want to start. Let's say this year you want to do a pediatric… the infant oral health exams, or a smoking cessation, or diabetes detection in the dental office, or reflux, or you know the list goes on and on. So you get or (inaudible: 9.55) practice. You get to choose what you want to learn as a team, you learn it together, you implement, you own it forever, so if you get new team members they basically pick this all up on their own time and catch up to the rest of the team and it's probably, if you were really hardy and wanted to do the entire curriculum, probably eighteen to twenty-four months of hardcore learning as a team. By the end of that, you're really positioning yourself to be bulletproof in today's economy against corporate... sinking reimbursements and corporate competition and you're attracting the best and brightest patients and building a network with physicians and really differentiating yourself in the market.

Howard: That is amazing. So her email for this is Is that still the email with the name change?

Susan: You can get to us that way - we just changed it to my…


Susan: There you go.  


Susan: You can see the sample of the platform on there too.

Howard: Yeah. So, you are having success with dentists doing this? I mean if you're doing it in Holt, Michigan, are you finding success with this in the flyover states? 

Susan: Yes and no. I'd speak mostly to average dental audiences, although like last week I was in front of six hundred people at the American Equilibration Society. We did a total health presentation in front of like twenty-six countries and so very sophisticated high-end dentists. I think that most people when I speak in an audience, they find all of this fascinating and sometimes they're hearing it for the first time. Sometimes they're doing zero Salivary Diagnostics, they're doing zero of every bit of this, so when they're not used to looking in the mouth for and helping people may... even airway - most dental practices aren't doing that. So when they're not used to doing any of this. it's pretty overwhelming. which is why Henry Schein asked me to create this platform. This Total Health Academy is as my business - I have a partner Jarod (inaudible: 12.19) we own it, but it is distributed through Schein and also now teaching at the Dawson Academy, doing four programs for them over the next year. Dawson Academy which is an advanced restorative academy is moving into total health, Kois is moving into total health. I don't know what Spear’s doing with that, but every major organization recognizes this is the future of dentistry and so we are moving Total Health Academy, mostly from me speaking at the front of the room. Mostly from people going out going, “Okay, I know what I want to do now and the hygienists are totally on fire, the entire team's excited,” and then they buy it from there.

Howard: The world is definitely changing. I graduated thirty years ago, my practice turned thirty years old September 21st and one of the things that always really upset me being a libertarian is that I could not go down to… what does that blood testing place on every corner out here? But if I walked in there, I couldn't order my own test for diabetes or anything. I had to go through the legal, regulatory, doctor's appointment, make an appointment and then he had to special signature, and Arizona finally just took that away and now anybody can walk off the street and go get any blood test they want. And another thing that really annoys me is oral cancer. You know, the HIV vaccine, as a doctor I’ve done...

Susan: HPV.

Howard: HPV vaccine. I can't give the vaccine, neither can my hygienist who in the hospital has the same years of training as a registered nurse. I can't even give them a flu shot. Tennessee was the first state that finally passed law that said a dentist can give a flu shot. I mean right now the pharm tech at Walgreens and CVC with nine months training can give both of those vaccines, but dr. Farran can't. Because I think it sends a mixed message to these kids coming out at dental kindergarten that, “Dude, you can't even give a flu shot, you can't even give an HPV vaccine, you're not a real doctor, just go drill, fill and bill.” 

Susan: That’s interesting.

Howard: What’s that?

Susan: It's interesting because you know HPV oral cancer’s spreading at 30% a year. By next year we're gonna have more men with oral cancer from HPV than women with cervical cancer, and we can test for HPV in the mouth and identify it but we can't give a vaccine. It's funny. I send them adults who are over the age of twenty-one for men and twenty-six for females that can't get it paid for by insurance anyway, so I send them right down the road to the pharmacist who can give it. But you know the dentist of the future Howard, is all about the patient of the future and the patient of the future is sick and sicker. We’re now one in eleven diabetes, we’ll be one in three diabetes by 2050. We're now at, well Michigan's at 37% obesity, but I think it's around thirty-three to 35% for average for the country, we’ll be at 42% by 2050. So, one in two heart disease by then, we're one in two cancer by then. We are getting sicker and it will be absolutely crippling economically. I think it was. which president said way back that American... that our best asset is healthy citizens. It was Winston Churchill, not a president, and you know what? We have taken our eye off the mark on that. When we spend two hundred and forty-five billion dollars on diabetes in 2012 for only sixteen million diabetics and we're already up to thirty point three million in five years, do you have any idea how much it's going to cost us when we have a hundred and five million diabetics by 2050? And that's that's not our number one disease. So we have some skin in this game. We can absolutely predict and preamp some of this disease if we can catch the seventy-seven million pre-diabetics and help them turn the ship around before their pancreas is toast. Now we're talking about being powerful, right? You go to your doctor and get pre-diabetes and they say, “Oh, we don't have to prescribe anything yet, so what else do you have for me?” They don't talk about prevention at all, so we're the last bastions of prevention on the planet and we could use that and that's a powerful tool. Plus seven million undiagnosed diabetics think we have no business picking up a sharp instrument in a perio packet on a diabetic who doesn't know they're diabetic. That's nuts on our part, so we have to help them and we can do point-of-care diabetes testing. In fact, there's a code for that now and we can do it right in our office so that's pretty cool.

Howard: Well you know when you and I got out of school thirty years ago, did you ever think we'd be sitting here today where U.S. life expectancy went down for the second year in a row - right there on the USA Today?

Susan: Not at all surprising.

Howard: We thought it would just keep going and going and going and going and now two years in a row, back to back, it's going down... 

Susan: Was it down to where Czechoslovakia is? You know that? And they spend about one-sixth of what we spend. We are twice the per-capita expense and we're seventeenth out of seventeenth out of industrialized countries for health. We ought to be appalled by that.

Howard: What advice would you give? She's a little girl, she's twenty-five, she’s just graduated from dental school, she's got two hundred and fifty to $350,000 in debt, she wants to be like you when she grows up, but Rome wasn't built overnight. How would you start her out on her journey?

Susan: Well, for one thing, I think that they don't teach enough business in dental school and you get out with that kind of debt load and the banks don't want to loan you money, so where do you go to work? You go to work for somebody else. If these corporations are smart, they keep you from learning about the business of dentistry so they don't lose you. Where do you go? I think you go figure out how to run a business and you get some business savvy, and really, it's not just about numbers, it's about leadership, it's about hiring and communicating, and I think you get really good at people skills, Howard, and then I think you get some dentists to give you a land contract and mentor you and I think you figure out how to jump into private practice, because you're not going to hired and pay your bills in corporate dentistry, at least that’s said to me.

Howard: But they don't hear you in dental schools. Do you know what they hear in dental schools? All these DSOs, the thirty-five biggest DSOs, they’re in all the dental schools with Domino's pizzas providing lunch, saying the sky is falling, private practice is dying, when we were little all the pharmacists owned their own place, now they all work for Walgreens and CVS and that ten years from now half of all the dentists will be working at a DSO, which is a joke because not one DSO could even go public. They're just rollouts and what a rollout is, is I go get a million dollar loan from Wall Street and I buy a dental office that does a million a year and I say, “Look we went from zero to a million, so now what? Well now give us ten million and we'll go by ten million dollar offices, then we say, “Look we've grown from one million to ten million,” and by the time they get to a hundred million dollars in sales, they have a hundred million dollars in debt. Now you couldn't even do that on Shark Tank. If you went to Shark Tank and told them that business plan, they would laugh. They'd want to say, “I’ll loan you a million dollars, you start a dental office and two years from now I want the debt gone, and your office grew from one million to two million. So that's why there's no publicly traded dental offices in America. There's only three in the world, two are in Australia 1300SMILES and Pacific Smiles, then there's one in Singapore called Q&M. But in America they're just debt-laden roll outs, so to you millennials, if you think, well working as an associate is such a great idea, well then it then riddle me this. Riddle me why do you all quit your associate job in a year? And then if you talk to them five years out of school they've worked for five different dentists, for a year each for five years, so this is…

Susan: Why?

Howard: Because they're humans. They don't want to live under someone's thumb. They want to open up their own place. So I'm telling you, you're only gonna be happy when you're the boss.

Susan: I agree with that and I have to say, not to brag, I have six businesses, but one of them is my dental practice, it's my mouth lucrative. Aside from everything I will say to be (inaudible: 20.57) to have thirty hours of clinic time a week and gross a couple of million bucks and you have no insurance contracts in a little tiny town, and we do it and honestly I could not do it without having this differentiation of total health, because we're attracting people that drive for miles to look for optimal health solutions. So it's a niche for sure and I think that private practice, I don't know where you feel Howard will end up, the mix of private versus corporate versus public, but I do know that if you're going to be successful in private practice you're gonna have to have some sort of niche. You can't just blend in. You're gonna have to have some sort of niche or you're competing with corporate dentistry, which…

Howard: Yeah and I love that niche because I got my MBA from Arizona State University and they used to always look at every business and say, “What is your unique selling proposition?” Warren Buffett, the richest investor, he was in Omaha, I went to Creighton, Omaha, he came and spoke to our business class, that was in 1980, and he said look, “You take out a five by seven index card and a number two pencil. If you can't explain to me or what you do, what is your unique selling proposition, how do you make money, I'm not gonna invest in you.” And your consumer and that marketing piece, you said nitch, I call it unique selling proposition, you got to be different, what is different about than the other hundred and fifty thousand dentists in America or the ten dentists in your town?

Susan: And think about this. If you can differentiate yourself in a way that attracts the best kinds of patients, now you're really talking, not just a little tiny segment but a segment... so if you look at like cosmetics and where the cosmetic era went, the early-out, the early adapters got the big cosmetic cases. The laggers got the occasional veneer case. They never did that well with it. Same thing with implants and same thing with sleep, when I look at total health, I think it's such a prime opportunity for young people to say, “Look I'm going to focus my entire practice around this,” especially people who are health focused, to begin with, on themselves and their own young families. So I think it's an awesome opportunity but it's still not reached the tipping point, which is a beautiful opportunity for people that want to jump in, but I think it will and I know it's getting a big global buzz (inaudible: 23.19) speaking at Tokyo and Nova Scotia and Toronto and Calgary and Hawaii. I think it's starting to really catch on. Septodont just hired me to do their big global forum and happens to be in DC, but there is a buzz about the world that dentistry will take a differentiating role, just like the pharmacists have done when they hired PAs and nurse practitioners to do their minute clinic. Just like the doctor of nurse practitioners are doing. The hygienists, dental hygienists, not just as periodontal therapists but as preventionists in general, their role is quickly changing, if we can stop making them be tooth cleaners that step aside so we can check for holes in teeth. We have to let go of our old paradigm and start seeing, even periodontal disease is a very different paradigm shift in optimal treatment to include diabetes detection, tobacco cessation, identification of pathogens, identification of genetic risk factors that also parallel with heart disease risk factors. We have to look at the causative factor of periodontal disease. We have to change our entire way of looking at perio-therapy, which is hard for people to do when they're immersed in … That's why I love your podcast because you're speaking to young people. They're much more open-minded.

Howard: When you say young people, are you talking about me? 

Susan: Yeah, you and me.

Howard: You and me. So I've podcasted…

Susan:  I'm older than you are, by the way, three years.

Howard: Are you? Three years? Well, why do you have a face for YouTube and I have a face for iTunes? That does not make sense. But you know what? When you talk to every single dental consultant who's done it for ten, twenty, thirty years, they say that first day they observe the practice. no one has ever observed day one in an office and heard one person ask for a referral. And then here's people like me and you, where you talk about networking with the medical community for a physician referrals. To me it's so shocking, like I've had dinner with every damn pharmacist from Walgreens at my house, the physicians lunch, my favorite ones go watch a football game with you on a Sunday, and these dentists that you're talking to right now, they only got accepted to dental school because they got A's in physics and chemistry and geometry and they sat in the library, and they actually think a rock party is the library on a Friday night. They've never asked a patient for a referral and the thought of them calling up a physician and saying, “Let's have a beer after work.” You might as well just ask him to sell drugs.

Susan: I did something more interesting and you can hear more about this on the podcast I did for American Academy for Oral Systemic Health on co-referral relationships and networking, but I started a Wellness and Prevention Study Club. I ask all my patients if they feel well served by their medical community because I know that the people we surround ourselves with will absolutely change the direction of our lives and our outcomes in health. So I always ask and we try to play ‘matchmaker, matchmaker, make me a match’ when we're looking for new… how to how to fix people up with medical team members that are perfect for them. But I reached out to a dozen physicians in my area of all different variety and I asked them to come together to see if they wanted to study together and we formed this Wellness and Prevention Study Club. Now it's very popular, I only have twelve seats at my dining room table. We meet once a month, so I've got twenty-five people and they … We sent the email out today for April 3rd and I already got seven people ‘yes’ today, because they know they want a seat at that table. We're starting a cardiology unit, we just finished a whole unit on functional medicine, before that sleep. We're doing amazing things. So around the table, we have a rheumatologist, a cardiologist, a sleep doctor, two functional medicine doc’s, a naturopath. We have all these docs and what I've learned in… and I think this is fascinating, is you know dentists, general dentists sort of know the same kind of stuff. When they start talking they might do it differently. These doctors, depending on what journals they read and how they practice and their belief systems and their anecdotal evidence, they're all over the map on stuff. We talk about... heated debates take up, like vaccination schedules or proton pump inhibitors for reflux, I mean they're all over the map on how they feel about prescribing these drugs and where we are with it, the opioid crisis, all that. I’ve learned a ton from them and by learning to speak their language and to write letters on behalf of my patients for what we notice, it's created this enormous network for us. So you're absolutely right, you meet them face to face, you have a beer with them or a glass of wine, it's a game-changer. Now we're friends, now we text each other, now we refer to each other, now we get the more complicated patients and here's what I know - complicated health patients, complicated dentistry. I dig train-wreck dentistry. I like it all. I like placing implants, I like doing surgery, I like reconstruction, I like prosthetics. If I want to do those big cases I need some train-wreck patients coming in here, not just people that want to get their vitamin D levels where they want it. So that's been a huge boost for our practices. getting those the (inaudible: 29.05)

Howard: Ryan, how many doctors, chiropractors, naturopaths, have been at my dining room table in the last, I don't know, six months? 

Ryan: Ah man, fifty.

Howard: Fifty. Fifty. And these kids listening, they don't realize... do they realize... where do Americans go when they got a toothache? They go to Walgreens, they go to the pharmacist and they say, “What's best for a toothache? There's Anbesol, there's this of that” and they go, “No, you need to go call Howard, hell I have him in my number in my cell phone. Go across the street to Today's Dental, his email’s, just go over there.” He calls it Today’s Dental, he says you don't need an appointment when you go to the emergency room if you're standing at the counter asking me about what's her pain, just go across the street.

Susan: I think it's brilliant because I haven't actually included a pharmacist in that table. We have everything, we have a chiropractor, a naturopath, an osteopathic manipulation medicine doctor, but I haven't included a chiropractor, I mean a pharmacist, so I absolutely need to do that.

Howard: What's genius about the pharmacist is their first line offense for questions, I mean most people ask the pharmacist. They’re at Walgreens and they go ask that pharmacist and you wouldn't believe their genius read of the demand in your community. They know what everybody's asking, they know what all the questions are. 

I want to ask you a very controversial question. I always call bullshit when your words and actions don't match up. The dentist on Dentaltown, if you say your natural or are all natural, or what do they call them?

Ryan: Holistic.

Howard: Holistic or anything like that, you're a quack, but when they get sick and they go to their MD and polypharmacy, they say “Oh, you got high blood pressure, here’s a prescription. Oh, you got high cholesterol here's Simvastatin. Oh, you can't sleep, here's a pill.” Funny how all the dentists immediately turn all holistic and don't take any of those pills and say, “Okay, if it's at the point where I need to take three pills, I'm gonna start exercising, join a gym, start training for a marathon, you know? They turn all natural and all holistic when it's them, but anybody who says natural, holistic in dentistry is a quack, yet the people that I know that put on their website natural alternatives or holistic dentistry or things like that, man they’re getting millennials to drive to their practice an hour away because they just smell, “Well, maybe this person isn't just your standard doctor who’s just gonna set there and write  prescriptions, and drill, fill and bill. Maybe this person's gonna be different.” So how do you how do you reconcile your own profession... well what do you think dentistry's own professional views are on holistic alternative medicine?

Susan: I don't use the word holistic in my own acumen only because I don't want to turn people off. If you're a holistic dentist, good for you, what does that mean to you? But there are people that do associate that with quackery and lack of evidence-based practice. I will say that I believe that every cell in our body wants to heal except those that are cancerous, and I believe that every person wants to be healthier and if we can help people figure out how to identify the root cause and turn the ship around, we can get them off a lot of medications, a patient’s got to want to do that. In terms of integrity, I think you have to walk the talk and I think it's important, not that everybody that works in my practice, my Total Health Practice be the spitting image of a model and working out twenty times a day and eating clean every day, but I do think that we all need to be on the journey, and if I can get my audiences 100% of hands in the air, the entire team, everybody in the audience saying at the end of the day you picked up some key pieces for your own health and the health of your family and everybody can raise their hand, now I've got them on the journey, and this is a big problem because we in medicine and dentistry are just as unhealthy as the rest. You see a lot of people practicing some very, very unhealthy behaviors and so I think we need to figure out what everyone says they know what they needed to be healthy, they just lacked discipline, I don't believe that at all. Now you’ve got this whole ketogenic thing going on and everybody's like thinking it's okay to walk around eating fat bombs of cream cheese with salami in it because that's how you lose weight. I want to go, “What?” It's like we have to help people get there. Interestingly, Howard, you might find this intriguing, but you know about the commercial Pepsodent put out in 1929 that said brush your teeth twice a day, visit your dentist twice a year, right? That's what we still recommend today, but do you remember what the third part of that advertisement is? Eat correctly. 

Howard: Really?

Susan: And that's the one part where there's… I'll show it to you. I can show it to you.

Howard:  Amos and Andy, Pepsodent, brush... How did it go? Amos and Andy... 

Susan: It’s Pepsodent and it's 1929 and it says: do these three things to have strong, healthy teeth. Number one was eat correctly, number two was visit your dentist twice a year, and number three was use Pepsodent twice a day. And it was a ploy to use more toothpaste. Interestingly as we look at evidence-based dentistry, the one piece that we threw out of there, which people don't even remember was eat correctly. That's the only piece we have lots of evidence for. We don't have any evidence to say going into your dentist every six months creates better dental health, unfortunately. We also don't have any evidence to say brushing your teeth twice a day does it? We do know that obviously, people who take better care of their teeth do take better care of their body, and there's a host immune response there as well, but it's amazing how we forget about that piece that is all about how to feed your body so that it comes forward in a healing position and an ability to heal from pathogens, from viruses, from fungus, from stress. So we have a long way to go in dentistry to help people understand what is optimal health. We don't even really have parameters of optimal health, just parameters of disease. We don't even have parameters of optimal health, and so if you think we should be testing for anything in the dental office, think about this: blood levels for vitamin D, certainly A1C for diabetes, and pathogens and all that, but what about vitamin D? You can't really recommend a certain amount of vitamin D if you don't know what the blood levels are, because that's a fat-soluble vitamin. So all of this I think is coming to us and I think all of it will help patients keep their teeth longer and be in better health, and I don't know about you, I do not want to do this slow, slippery American decline in my health. I want to live like this and have one bad day, and sorry to my friends, right? It's not about how many years you get to live, it's about the quality of her life. So I'm all about helping people do that. I was born of two parents who smoked two packs a day and I spent lots of time in the hospital. Hospitalized seven times over the age of twelve. Spent the first three months in an oxygen tent. I fought for my own health, I know what's possible and I know what's possible for kids, to put them in the driver's seat for their own health, and I absolutely know we can inspire people to become younger and more excited about their life, even in a year, and give all the credit to their dental office and blab you up in the community, I love the whole aspect of that. 

Howard: Did your parents die from smoking? How old were they?

Susan: Yeah. Well, my mom quit and she just died two years ago from lymphoma, but my dad died from smoking-related illness. He had six strokes in seven years. He died at seventy-three. Interestingly, he had advanced periodontal disease, which in those days we didn't understand, was an absolutely causative effect on heart disease. He also had sleep apnea, that I could hear him from the bedroom above me, but I obviously I didn't know back then what I know now. I had dentures waiting in the pan for him when he had his first stroke and I was super happy we hadn't taken his teeth out and tried to give him new dentures while he was dysphagic from a stroke, but now I realize had we extracted his teeth, he may never have had the second, third, fourth, fifth, or sixth stroke. So it was a very sad way to lose the man I loved, just one stroke at a time. But I actually was very fortunate, my mom was a psychologist and the (inaudible: 38.38) and sex therapist, hence the sex section in the book - she would have been disappointed if I didn't put the whole sex section in the book, but she got a job at the College of Osteopathic Medicine when I was twelve and she somehow found a doctor, an adult factor, a doctor for adult sick people, an internist who took me under her wing and saw me once a week for six weeks and once a month for six months and helped me get off all my medications, get rid of all my allergies, but she helped me figure out how to exercise my lungs. She gave me a little piece of bubble plastic, she said this is your lungs, your lungs under a microscope should be clear with air like this and all these bubbles and in the little walls are the vessels that pick up oxygen and take it to every cell in your body and without it you're sick and tired. And she said, “and you are ready for this, I will help you get all the moisture out of your lungs without medicine, but it's going to be work on your part,” and so she worked with me. I know what a health professional is capable of. This is why I'm doing this because I absolutely believe in the power that we have to help America upright this downward health trend, but dentistry has to take its rightful place at the table. In the meantime, we get to capitalize from it as well.

Howard: Your mom was a sex therapist?

Susan: I know. You love that don’t you? 

Howard: My mom, I found her driver's license one day. Not only did I find out how old she was, but it said that she had an F on sex, maybe that's why…

Susan: My mom did not. She had an A+ there. 

Howard: I think the sexual health is a… I think it's the biggest example of the failure of the American healthcare system when a man can't get an erection he goes to the physician and she writes him a prescription for a pill. It’s like, “Are you out of your mind?”

Susan: (inaudible: 40.02) a third of those drugs are for men under the age of thirty. How is that happening?

Howard: But the thing is, I mean the only goal of a species is is to survive long enough to spiral out the DNA. When it comes down to your ding-dong doesn't work, I mean your whole mission as a species is over and if they look deeper they'd find out oh he's diabetic, he has high blood pressure, he's obese, he doesn’t exercise…

Susan: Periodontal disease -  three point three times more likely for periodontal disease. Hence the chapter: “Floss or be flaccid.” 

Howard: Ryan, how come when she talks about sexual dysfunction, she raises her voice and looks at me? She leans forward, raising her voice. Did you tell her Ryan? But no, the bottom line is you shouldn't give a guy Viagra when he's so ill he can't get an erection. I mean you got to start backing this guy up but giving him... I keep reading all of these studies on polyphagia, that by the time you're on five prescriptions, your mortality rate is going off the charts and I want to ask you this - the number one cause of death in America is heart disease, number two is cancer, we all know that. But number three never gets mentioned on TV, number three is two hundred thousand Americans die in the healthcare system every year from an iatrogenic cause, not from a disease they walked in here. And the Centers for Disease Control screams about this, and we all know with heart disease - quit smoking, we all know with cancer - quit smoking and quit eating bacon, but what no-one ever talks about, that the one million MDs kill two hundred thousand Americans each year in their screwed up system, and it's all so confusing because I think one of the reasons - Regina Hertzler talked about this in my podcast, a medical economist from Harvard University, that … look at all the names of hospitals - St. Joseph, St. Mary, St. Sister Aloysia, I mean how do you make the bad guy St. Mary's? I was born at St. Francis of Assisi, that's probably why I'm bald. It's hard to throw these lies under a bus because they're nonprofits named after saints.

Susan: And they're not collaborating and here's the tricky part. we're complicated as human beings and the diseases are complicated that we're talking about and they all intersect, and we're going to people that know a little bit about each one, I know from my Wellness and Prevention Study Club. And here's the rub, every one of us statistically will be misdiagnosed at least once in our life and if you're a complicated medical patient, a lot more than once. And where are we talking to each other? It's funny, I was speaking to a group of osteopaths, a large group of us who passed last summer, and I was giving them hell about proton pump inhibitors, I go, “You guys know that these PPIs have a broad-based warning not for more than two weeks, okay? 60% of the America has reflux, let's talk about the root cause of this instead of just getting them on the pill and then they can just put them in a passive position then go eat whatever they want.” So I said, ‘Did you know it blocks dietary absorption of calcium, magnesium, iron, and B12.” So you got osteoporosis because you're taking calcium from your bones, you pee it out through your kidneys, you got kidney stones. I go, “Stop it.” So afterwards one of the doc's came up to me and he said, “I wish I'd heard you ten years ago.” I said, “Well, I wasn't even speaking ten years ago.” And he said, “I am a plastic surgeon for twenty years,” he said “My doctor had me on proton pump inhibitors for eight years. I trusted him. I'm not a GI doc. I don't know anything about reflux.” He says, “I'm on proton pump inhibitors and now I have pernicious anemia, I could spit.” He said, “He used to be a friend of mine, now I won't even talk to him.” I said, “Well, you know, he probably didn't know.” He said, “He knew, what am I gonna do, you have reflux. We have to worry about Barrett's Esophagus and esophageal cancer.”

And you talk about an awful combo with HPV increasing and acid up on the posterior pharynx, the combination of damaging cells and now the Pernicious HPV, twenty-five of these HPV viruses have caused cancer in the mouth, not just the one sixteen and eighteen we worry about. So we in an epidemic of oral and oropharyngeal cancer. And talk about pancreatic cancer, inflammation of the pancreas linked to cancer, where do you think the inflation is coming from? The twenty-two to forty teaspoons of sugar we're eating every day? We have got to help people figure out the cause of their disease, not just... anyway you got me going... you got me going! 

Howard: Nice, I love it. I love your passion and enthusiasm.

But she's listening to you right now, twenty-five years old, she's got a quarter million dollars in debt, if she goes to, tell her more about it, what does it cost, what kind of courses…

Susan: If you're just wanting the pediatric portion, infant oral health, pedo and pedo airway and all of the hands-on learning lab that comes with that, it's four grand, thirty-nine ninety-five. If it's adults you want, just adult practice it's seventy-nine ninety-five, and if you get both it's ninety-nine ninety-five, so it’s ten grand and you own it forever. And I'm constantly redoing it. What's cool about it is using a platform like this rather than the old way with DVDs and things like that is, whenever we're adding new evidence and redoing these, they're they're basically right and you get a notification and they're right in there you own it forever, so you can literally sit down and let's say, three years from now you want to do a smoking cessation program and you want your whole team involved and everybody goes home and you know in fifty minutes they watch this and they get the download of the forms that they need and they sit down as a team and integrate it into the practice and put it out on Twitter and Facebook and you know reach out to their patients and let them know they're doing this and now they have a new revenue source, and they're helping people keep their teeth. This is like an example, but it's A-Z on total health. And can see it on on the website, you'll see all the modules and you'll get a sample of what that looks like.

Howard: How many courses are there, how many hours is it?

Susan: Oh my gosh, I think we have thirty-eight modules. They range from about twenty minutes to fifty-five minutes, but again, it's not just learn it and go and implement it. If you're looking at diabetes testing, you have to get a CLIA waiver and you got to get the machine, get trained on the machine and teach people how to do a finger stick. It's not just “Oh boy, if I watch this for twenty-five minutes I'm going to get everything there is on diabetes and prediabetes, but the modules kind of give you all the steps you need to do it and there's a self-test step for each one so you can test the proficiency of your team. And it has, for instance, even the health history that we created for this, has boxes so, sleep, brain health, bone health, joint health. It's a two pager, but the low-hanging fruit of the questions we want to ask will help you identify food sensitivities and when you get into chronic systemic inflammation from food sensitivities we talk to you about how to do a food cleanse and how to help identify food sensitivities in the mouth and help the patient learn them. So there's just a whole bunch there. It's really cool, really fun.

Howard: You know, you got to buy the book. My favorite chapter in your book was “Floss or be flaccid.” You got to buy her book ‘Blabber Mouth’ just to read “Floss or be flaccid.” My doctor told me my flaccidness was caused because the last check... I had to write a check for three point eight million. Just the thought of that, that's why it died.

Susan: I have to laugh, my nephew said the college drink of choice at Michigan State University a couple years ago was Viagra, Jagermeister... or Jagermeister, Red Bull and Viagra. There’s a party waiting to happen. Why is it that these eighteen-year-olds and twenty-year-olds are taking Viagra at the end of the night? Don't ask me, I think I know, but you know it's alcohol and pickup dates and kind of interesting.

Howard: Yeah, and I also tell those young kids in school that condoms prevent minivans, you know. If you don't want to drive around in a minivan, wear a condom. I think what you're doing is amazing, but I'm want to hold your feet to one fire, because I know my homies, I mean I've been a for dentist thirty years, I've watched them come out of schools, graduating class for thirty years, they’re afraid of their own shadow, they're introverts, they would rather go home and do geometry or trig, and here's me, where I've had fifty naturopaths, chiropractors, everyone in my own house, and you have them one night a week. These people, if you walked up to him and said “boo” they'd crap their pants and run and jump in a bush. How do you get them to actually really call the naturopath across the street, the chiropractor, the cardiologist, the dermatologist, how do you get them to actually muster up … I mean how do they do that when it's not them? 

Susan: I'm figuring that out. First of all, we're insecure enough about... Here's what I can get them to do. I can get them to learn to write letters to their docs and for everything they see, and in the Total Health Academy all of the letter templates are there, so they basically can... if they see signs of erosion, red tissue, they're looking at the post nasal drip, and the clearing of the throat, at the patient that can't lie back and they fill out and they've got seven factors for reflux, they can write a letter to the doctor knowing what they're talking about and every time they do, they differentiate themselves in the community. They're writing a letter to all the medical professionals that go with that patient and that is something they can do. That's what the introverts can do.

Howard: Here’s what I noticed straight out of school. I would go to a lecture and I would notice that half the people left at lunch didn't come back, the only people that stayed till the end say were bored, had nothing else to do, and then that night you go sit in the bar with that guy and after he had three shots of Jagermeister or the next day you went fishing in Abasambo with your five or ten of these dentists, that's when they just take off the gloves, have a blast, it's completely uncensored and I always sit there and say, “Why don't you talk like this during your lecture? Why are you standing there in a seat going over these powerpoints, I mean you'd make a librarian kill herself,” and the same thing with your local physician, your local physician, you know when you go in his office, or you send him a letter all this, they’re all trying to be the doctor, but God, then you get them at Brad's place or you get them at Zips, or you get them in your house and you get a couple beers down, it's so damn fun and then…

Susan: I know. I'm uncensored every time I talk and guess why? Because I never quit my day job. All I can do is fire me, right? 

Howard: Yeah.

Susan: I have nothing to risk and I'm gonna tell it the way it is and I think people like that. Everybody wants to pay attention and have fun learning, and when you're talking about body parts and you're talking about how people digest food and how they're pooping and whether they're urping food up and whether they're having erectile dysfunction, I mean we don't have any chair side screening for erectile dysfunction, unfortunately, and we’ve thought about the blood pressure cuffs, but those were too big for most guys, so we left that alone. We're not doing any of that, but we certainly talk about it in front of the room and when you're talking about it, ears perk up and we get more and more comfortable talking about how to be physicians of not only the musculatory system but how to help our medical providers learn this. So I think it's important for us to lighten up a little bit, relax, stop being so formal all the time. I think it's important with our patients too, be real people.

Howard: Yeah and they always say you're a summation of the five people you spend the most time with. If you're in Parsons, Kansas and all five of your friends are weed farmers, that's one guy, but if you decided that of your five friends, one was gonna be the local physician, dermatologist, cardiologist, you get twenty four-hour-a-day continual education because they're always talking the same human. I mean we're all mechanics, working under the same hood and maybe we only do teeth or transmissions, but if your buddy does wheels and tires and batteries and electrical and all that kind of stuff like that…

Susan: I couldn’t agree with you more. And I'll tell you what the shortage of health care coming our way, it's going to be nice for us to have a cadre of friends who are helping us resource for our own health and our own families, so I love the fact that I could text message you know twenty-four of my local docs and say, “Hey, what do you think about… who should this person see or how can I get my patient into this quickly?” and you know when you're able to do that for your patient... I had a patient the other day, she's really had some problems with endocrinology and I got her in with the head of endocrinology at Michigan State University he next day and said, “I’ll work her in, no worries.” She said, “How did you do that? They told me I had to wait two months.” I said, “They’re my friends,” and you know you are now that person's best friend, you have advocated for your patient, you've helped him along, I tell you there's nothing better than to champion their health with the medical care in the community, so, love it.”  

Howard: By the way, I did start a local study club for men with erectile dysfunction in my neighborhood, but it was a total flop.” 

Susan: What was it?

Howard: It was a total flop. Last question, I have to ask because you're a girl, I'm a boy, when you were in dental school, would you say it was a man's profession when you were in dental school and would you say today... when we're in dental schools, I mean half the class was women. When you were in dental school, how many women were in your class when you graduated?

Susan: We had thirty-three out of a hundred and thirty-three and it was the largest class of women we'd ever had. And it was unbelievably difficult sometimes. I remember one time I went to get a clinical instructor and I said, “You know doctor,” I won't say his name, “can I see you for a minute?” and he looked right at me he said, “Well Susan, you're looking right at me, what more of me would you like to see?” And I was so embarrassed and I just kind of turned around, I don't get embarrassed easily but he was just like this, and I turned around he said, “You need to learn to choose your words more carefully.” They did some amazing things that these days they wouldn't get away with, but they really... you know I remember an occlusion class the guy saying, “The guys are going to be really good at these articulators and the girls could probably mix the plaster for the guys, because they would be a lot better at mixing.” You know just stuff like that. They would say whatever they wanted, it was pretty interesting” But you know what? At the end of the day, it's wonderful that our profession is mixed. I wish that women had more opportunity or took more opportunity for leadership positions and also in private practice and I realize you get out and it's time to have babies and there's only one mama, and I think it's a really great thing to be a parent but it's also great for kids to see moms engaged in business and a leadership position. So I'm all for it, I'd love to see more not just more women practicing, but more women stepping into leadership positions. Most of the boards of the organizations and academies that I'm member of are mostly still male-dominated and that'll take a while, so I'm looking forward to that. I don't love separating the profession to women and men, I think we're all in it together and I think we have an enormous opportunity for helping the world become a healthier place. I just hope we take our rightful place at the table before we lose that opportunity.

Howard: How many children... did you get married and have children? Were you in school, out of school? How many kids do you have?

Susan: I only have one in he’s twenty-four, and he's amazing, and I've been single for I don't know how many years now. 

Howard: My Ryan's twenty-four. Do you want two kids? 

Susan: He's really a great kid, by the way. 

Howard: He is perfect. 

Susan: Yeah, he’s awesome.

Howard: You’ve been single for how long?

Susan:  Since Hunter was eight, so it's been a long time.

Howard: So see kids you learned something very smart: number one, don't get married; number two, never sign a contract. But I want to remind them of something. They're always whining about their $250,000 student loan and I always tell them their divorce will cost five times more. My divorce was three point eight million. I graduated $87,000 in student loans, so my divorce was like forty times more expensive than my student loans. But the average cost to raise a child in America, from birth to seventeen, is two hundred and thirty-three thousand. So when you graduate $250,000 in student loans, that's just one kid. So maybe you just come out and you have one kid or two kids. I grew up in all Catholic school. I had five sisters and a brother, I went to Budd Sacrament, then St. Pat's, then Bishop Hill high school, then Creighton, I mean you know how huge those families were back then? I had a friend... when I tell people this, they don’t even believe me. Brian Hesse, his mom, and dad had twenty-one kids. I didn't find out for a couple years... I thought his who his dad was, it turned out that was his older brother. His oldest brother I thought was his dad.

Susan: I have a family in my practice who has seventeen kids. We treat them at 50%. About 10% of what we do is for people in need and so we just cut, reduced the fee. 

Howard: Are they Catholic or Catholic?

Susan: They're neither. Believe it or not, these kids were homeschooled and they had a church in their basement. They're very, very conservative. This is an unusual kind of family but they're lovely people. And now the kids are all going off to get jobs and they're working (inaudible: 58.42) are uneducated because the parents aren't able to help, but it's a different kind of situation, right? Anyway, I think your advice is good. I think you have to be very, very careful who you surround yourself with in general, friends and marriage, and don't be so quick to jump in.

Howard: Ryan, will you please send an invoice to Eric, Greg, Ryan, and Zach, all four of my sons for $233,610, two thirty-three six ten. Just round it to two thirty-five, and I’ll take that on … No, I'm just teasing, Ryan's... I can't tease Ryan anymore, he's already dead inside and I'm just working with me. But hey, seriously, thanks for all you do for dentistry, thanks for being a role model, thanks for coming on and talking to the kids.

Susan: It’s such an honor to be with you too. I mean, you’re kind of funny sitting sexy, and I think you're hilarious and I think it's an honor to be with you. I've been a big fan for a long time and I'll be back I hope.

Howard: Oh, any time you want to come back on, and I am funny. I'm funny, I'm funny looking, I'm funny smelling, I like anything funny, but it was really, really fun to have you on the show. I hope the kids go to your website and thank you so much, Susan. I hope you have a rocking hot day.

Susan: Thank you, you too.

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