Dentistry Uncensored with Howard Farran
Dentistry Uncensored with Howard Farran
How to perform dentistry faster, easier, higher in quality and lower in cost.
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1064 The Golden Proportion with Neal C. Nealis, DDS : Dentistry Uncensored with Howard Farran

1064 The Golden Proportion with Neal C. Nealis, DDS : Dentistry Uncensored with Howard Farran

6/14/2018 7:03:28 PM   |   Comments: 0   |   Views: 296

1064 The Golden Proportion with Neal C. Nealis, DDS : Dentistry Uncensored with Howard Farran

Dr. Neal Nealis graduated from the University of Illinois - Urbana engineering school in 1974. He pursued a brief career for two years as a petrochemical engineer building chemical plants for Amoco Chemical Corporation. Upon graduation from the University of Illinois College of Dentistry he entered into private practice in general dentistry. Additionally he has served on faculty at the University of Illinois and Loyola Colleges of Dentistry. He lectures to dentists and dental students on occlusion, aesthetics and practice management. He is past president of the University of Illinois Dental School Alumni Association. He is an active member of the Chicago Dental Society, the Illinois State Dental Society and the American Dental Association. He currently practices general dentistry full time in downtown Chicago.

VIDEO - DUwHF #1064 - Neal Nealis

AUDIO - DUwHF #1064 - Neal Nealis

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1064 The Golden Proportion with Neal C. Nealis, DDS : Dentistry Uncensored with Howard Farran

Howard: It is just a huge honor for me today to be podcast interviewing Neal Nealis, DDS, who you're not going to believe this. His office is next door to the American Dental Association on my favorite mile. It's a magnificent mile. That's probably got the nicest shops of a mile long on Michigan Avenue. So his bio: Dr. Neal Nealis graduated from the University of Illinois Urbana Engineering School in 1974. He pursued a brief career for two years as a petrochemical engineer building chemical plants for Amoco Chemical Corp. Upon graduating from University of Illinois, College of Dentistry, he entered into private practice in general dentistry. Additionally, he has served on the faculty at the University of Illinois and Loyola Colleges of Dentistry. He lectures to dentists and dental students on occlusion, aesthetics and practice management. He is past president of the University of Illinois Dental School Alumni Association. He is an active member of the Chicago Dental Society, the Illinois State Dental Society and the American Dental Association. He currently practices general dentistry full-time in downtown Chicago. My first question to you is, old guys, like baby boomers like us, we read books and the millennials, they're all on podcasting and YouTube and all that stuff, so our audience is massively skewed towards millennials, not baby boomers, but give them a picture, how you've been practicing dentistry. How many years have you been practicing it? What year did you get out of dental school?

Neal: So '79.

Howard: ‘79. So what's 2018 minus 1979? Come on. How many years is that?

Neal: Thirty nine.

Howard: Thirty nine years. Has the practice of dentistry changed in thirty nine years?

Neal: It changes every year. You've been in practice. Technology has just redefined dentistry and I think my classmates who haven't kept up with the innovations have been left in the dust. I think these innovations make us faster, better. I think it makes it more comfortable for our patients. I think technology… When I started dentistry, I had one of the first computers that had no hard drive. It had two five and a quarter inch floppy disks and even the operating system is no longer used, but it was even that writing letters was such an improvement over a typewriter and it's just evolving. The power on your cell phone is a million times stronger than that first computer.

Howard: Oh, this is more powerful than what landed on the moon in '69.

Neal: Yeah, it's incredible.

Howard: You know, it's funny because some dentists our age will send me a letter and it's so embarrassing because it's in cursive and I can't read half of it. So usually I'm showing it to someone else and saying, can you make that out? Can you make that out? And cursive isn't a form of, "oh, he took the time". Dude you can't read it! You hear other grandpeople bitch, “They don't even teach kids in cursive anymore!” Well, no one can read in cursive. So Northwestern and Loyola were dental schools in Chicago that closed down.

Neal: Correct.

Howard: And there was always Southern Illinois across from St. Louis and now you've got a new dental school there, Midwestern. And then there's always been UIC, University of Illinois, Chicago. Right now this is graduation season. So you're having six thousand dental students graduate this month. They're going through commencements all weekend. What advice would you give these new graduates who are twenty-five years old and $400,000 in student loan debt?

Neal: Yeah, I’m sure they're scared to death with that debt load. I would think the key to my success and the success of every million dollar practitioner that I've met is never stop learning. I think if you have a quarter million dollars in debt or more, half million dollars in debt, you're intimidated to pay for a course but you can buy their book for $100 — like a Dawson Book — and read that book for $100. And you can read it twice. You can take that course again for no extra cost.

Howard: Yeah, I love them, love them to death. But my God, it seems like every time they have an idea it's to spend several thousand dollars. They'll say, “I want to go to Spear or [inaudible 00:04:40] or The Pankey Institute and so I'm flying down and I'm dropping $3,000 for a week,” and I'm like, exactly, Peter Dawson's book is one hundred bucks. I remember when I went to the Misch Institute, before I even decided to go to the Misch Institute I read his book like a novel twice. And then I'm sitting there in this course and people are taking vicious notes and they're asking questions and you're sitting there thinking dude that was in the first chapter. And then I have a genius friend, Jared Pope, town next over from me. Every night he came home from work, he would just pull up Youtube and would type in dental implant surgery and he just watched an hour of Youtube implants. He taught himself how to do implants. I mean there's a million hours of Youtube videos showing every surgery known to man, but they have to fly down, stay in a resort and spend a thousand dollars to look at a fraction of those videos. So they're always spending money. Every solution is to spend money.

Neal: Well, I took my first Dawson course, I bought the book, I read it cover to cover, which is a long book, and then I got through half of it before the course started and I got there. I was so excited about this book. I asked the first ten dentists what they thought of the book. Eight of them said they were thinking about buying it. One said he bought it but hadn't started reading it and the other, the tenth person said he was on the thirtieth page. And I just read this book. I got so much information from the book.

Howard: Ryan you got my last two textbooks on there. Ryan, how many textbooks would you say is in my office?

Ryan: A whole bunch.

Howard: I'd say it's a thousand.

Neal: I think I learned so much from reading. I learned a lot from taking a course, but if I read the textbook first and then take the course and then read again. I'm reading a book now on how we learn and the big deal in this book is that we learn through repetition.

Howard: The last two books I read was Misch's Avoiding Complications and Oral Implantology by Randolph Resnik who we just had on the show. And [inaudible 00:06:57] we had both on the show. Eight hundred and fifty pages. I don't know what else you could learn about implants that wasn't in this book. And then Pathways of the Pulp, Stephen Cohen, I think when I was in dental school, I read the first edition of this book. I don't know what, this is the eleventh edition, I think when we were in school, what was it thirty years ago? The first edition, but we've had him on the show. I mean, so you could learn every single thing on earth from two books for four hundred dollars. So why are you dropping $4,000 for some week long four day course?  I mean, I don't get it.

Neal: Well, I think if you learn a computer application, you sit down and read the manual which would be like reading the textbook and it doesn't quite make sense until you actually either see it applied or try to do it yourself and then the book starts to make sense and then if you go back and reread the book, then it makes perfect clarity.

Howard: So when they come out of school, they've had the same complaints on some Fred Flintstone, they always come out of school and they say, well, they didn't teach us how to do this, they didn't teach how to do that. And I would say slow down spanky they took one hundred kids off the street and four years later they're legally able to do root canals, fillings, and crowns. That's a huge achievement. But they said they didn't learn anything. They didn't place an implant. They didn't do an invisalign course. They didn't do sleep apnea. There's all these things they didn't do, but they've got $400,000 of student loans. In the real world, what is selling? What has a return on investment? Can you pay back your student loans? They can't learn everything at once. Would you have them learn implants first, invisalign, sleep apnea, cosmetic dentistry,  occlusion, TMJ, there's so much to learn and it's going to take you thirty years to learn all that.

Neal: That's a good question. I think in four years of school can only teach much and there's been such a plethora of cosmetic materials and everyone has to be handled differently. So to add that to the curriculum, they have to take something out. So what I think what they take out his occlusion because they don't understand it anyway. I think most of the professors don't understand. Until you really, really understand it, it's complicated. Once you figure it out it's really pretty simple, but not many people take the time to get to that point, so since the students don't really understand it anyway, they drop it and they add these aesthetics. I think dentistry is becoming very aesthetics driven, orthodontics is certainly aesthetics driven and now we've got lithium disilicate and zirconia...

Howard: What I love about aesthetic dentistry now is invisalign because when we were little, the general dentist would take all these mangled teeth and they'd file them all down and do crowns or to do veneers sometimes they'd have to shave them down so far, the [inaudible 00:09:54] and had to have endo and now they can unravel all that with invisalign. And a lot of people after they get done doing invisalign and bleachings, a lot of cases, just a little bit of direct bonding and it's a great case, but you have two daughters. I have four boys. I wouldn't want them with crowded teeth to walk out with ten all ceramic crowns because their teeth are...that's how it was thirty years ago.

Neal: Well now I think we have...

Howard: So, I'm just saying cosmetic dentistry has become a lot more conservative, especially with clear aligners unraveling.

Neal: Yeah, I think clear aligners, I think they've been used for aesthetics. I use them mostly for function. If you have...

Howard: You're using invisalign?

Neal: To improve function. 

Howard: What clear aligners are you using?

Neal: Mostly invisalign.

Howard: Okay, so using clear aligners, invisalign.

Neal: To improve occlusion.

Howard: Well, let's talk about occlusion. Because you already said that they don't teach it in dental school because it's not understood. Obviously it's the most difficult complicated part of dentistry because it seems to be where all the controversy is. I mean, all the controversy lately...take pediatric dentistry. The only thing they even argue about is the use of silver diamine fluoride. Endodontists, you could read this entire book, there's not one controversy. You couldn't read anything in this book and go to any endodontist and he'd get all up in arms. But man, when you start talking occlusion, there's the neuromuscular, there's the CR, Pankey, Dawson. So talk about it. You mostly use invisalign not for cosmetic, but for occlusion?

Neal: Yes, I sell it to my patients for occlusion and they get a cosmetic benefit as a byproduct. If a patient comes into the practice and if you look at the - I take full mouth photographs on everyone -  I had a young dentist once he was graduating and said, is there any one piece of equipment that you couldn't do without? I think the one piece of equipment that I couldn't do without is my intraoral camera because I think of all of the things that we try to share with our patients. Communication is just the core of everything that we do and that's not taught, that's not even mentioned in dental school, but it's at the core of our existence in our practice, in our home and our family and our friends. Everything is communication. Your podcasts are just enormous source of communication. And I used to try and have my patients paint a mental picture of the cavity that I saw in their mouth. Them having never seen one, they had no idea what I was talking about, but if I show them a photograph, they know exactly what it is and what I'm talking about, but when it comes to occlusion, if I look at someone's teeth and they're incisal edges are breaking down, but the rest of the teeth are healthy, then those lower incisor, the incisal edges that have been tipped usually orthodontically into that envelope of function that we studied in occlusion, which made absolutely no sense. But if you think about it, every time you come up and just tap those teeth, after twenty, thirty years they wear down and when you get into the dentin, dentin wears eight times faster so the attrition of the anterior teeth accelerates eightfold once you get into the dentin. If you can just take those maxillary incisors, procline them and take them and dig their incisors and incline them, you'll get them out of the envelope of function. They'll stop destroying those teeth. It's enormous benefit because I think there's nothing I can put on people's teeth that's better than what they're born with, right enamel is calcium and between meals you're absorbing calcium and you're healing damage that happened during the meal. My porcelains, my lithium disilicates, my zirconias don't do that. They look like teeth, but their physical properties are completely different. Gold has the right physical properties, but it's the wrong color. We don't have any material that both has the same physical properties and the right color properties. So I think if for my patient, if I can help them avoid a dental problem in the first place and preserve that tooth structure, not just the tooth but the little parts of the teeth, I think that's the best dentistry.  I think nature is the best dentist and us as dentists are just, our best dentistry is just a poor simulation of what we're born with. So I think invisalign, to get back to your question,  invisalign just tipping those teeth which is an easy thing to do, we stop the damage of the incisal edges. I've done an enormous amount of thought and research on incisal edge position to the point where I think I'm beyond obsessive, but I've combined what I learned in engineering. My engineering class at University, [inaudible 00:14:44] was a number one program in the country the year I graduated. I have enormous amount of physics I've applied at the function because I've seen over my career these anterior restorations that have just totally collapsed. Six unit bridge snaps off at the cervical. I've seen anterior teeth on partial dentures that break off.  I see individual restorations breaking anterior teeth and we just think it's one of these black swans, one of these acts of gods, but there's something that's causing that. There's something about that occlusion that nature doesn't like. And Dawson has a great quote in his book. He says, if there's ever a battle between muscles and teeth, the muscles always win. If there were a major league baseball team, they'd finished every season one hundred sixty two wins, no losses. They would never lose. They would get kicked out of the league for being too good. So if there's something in occlusion that the brain doesn't like, it instructs the muscles, get rid of it, and you'll chew it and you'll wear it down and it doesn't work fast enough, the tooth will break. If the tooth doesn't break, then those forces get transferred into the roots and you get to see periodontal breakdown. But the muscles always win. They always win one way or another, they get rid of that interference.

Howard: I didn't prove that TMJ is the most complicated because I remember when I got out of school and the first time I saw Dawson, at the end of the two day seminar, it was a two day seminar and I saw it in phoenix. At the end of the day's seminar, I went out to Pete and I said, so what's your schedule for this seminar? And he showed me, but he's given us today's seminar. The next month it was in Vegas, the next month it was in St Pete or whatever, so he was giving it four more times that year. I saw the exact same lecture four times that year because I was twenty five and it was all just... I've got to tell you, you're an engineer. Two most engineering shocking things I've learned this year, Arizona as the Boulevard in Scottsdale, Frank Lloyd Wright. So they're big Frank Lloyd Wright friends. So there's a town in Japan, I think it was in Osaka. Anyway, they had commissioned him to build a building and he saw these earthquakes films. So what he did is he laid a slab and then he put these big four or five foot cmap balls and then he laid another slab. Then he build this six story building after the earthquake came and destroyed the entire city guess who’s was the only building standing.

Neal: Yeah, Frank  probably called said did my building make it? 

Howard: Yeah. And his made it. And then I just saw one, did you see about the big heavy weight ball and the Taiwan building. Ryan, did you see that? The big heavyweight ball and the Taiwan building. So Taiwan built this huge building and it's swaying and then there's earthquake movement, so what they did is in the very top of the building they hung this, I think it's a four hundred tonne ball on four chains, so as the building sways, it's a ballast and so it's almost not moving because it has this four hundred tonne ball at the top and between the anchor and this is amazing. What percent of dentistry, what percent of occlusion and TMD is engineering, mechanical engineering?

Neal: All of it.

Howard: Do you think it should be an undergraduate prerequisite course, mechanical engineering one-o-one.

Neal: You wouldn't have anyone in dental school.

Howard: Why is that?

Neal: Well most dentists go through a biology program. It's a different way of thinking. You get an A on your biology test, you read a chapter, memorize as many facts as you can and then regurgitate it onto a test it's all memorization. I have a horrible memory. I have to write everything down and I've always been that way, but math just makes sense. They didn't care if I read my books or not. I graduated from one of the best engineering programs in the world and I never read my books. I would look at example problems, figure out the logic, do the homework, and then when it came to a test, you would never get the exact same problem that you had on homework. They'd always change something which would change the formula, so you had to understand how these formulas were created because they would never be the same. I tried for my first calculus test, I tried to memorize all the formulas in the book. I was up all night and I realized that was just not going to work, they weren't going to give me this exact same problem, so I had to spend the last four hours actually reading those chapters.

Howard: You talk about the difference between a clinician and a practitioner. What is the difference between a clinician and a practitioner?

Neal: Yeah, that's a good point. I think we come out of dental school, we have the have the foundation of aesthetics and occlusion function, but they don't have time to mention practice management, so I call that a clinician. You can work in a clinic and you can fix teeth, but if you want to operate your own practice, I think you need to understand management and that's a whole different ball game. I used to criticize the dental schools for not offering a course but I heard it explained that it's not the responsibility of the dental schools that teach practice management. They have four years to make our current doctors not dangerous to get them to where they can pass a board exam and if they already have one student pass a board exam because they had spent time learning practice management the university would feel that they have failed. I think what they should do is teach their students that there's a need to learn practice management and to get those skills and I think that when a young dentist gets those skills in management, then that makes them a practitioner. That they're capable of running a small business. You don't have that coming out of dental school. There's a couple of good books that are sort of along that line. One is by Michael Gerber called The E myth revisited. Outstanding book. And he talked about the woman making cupcakes. Said she's a technician because she contacted me make a cupcake, but it can apply to dentists or truck drivers or anyone, but he says you need to spend 10% of your time as the manager looking at the numbers and 5% of your time as the entrepreneur. That's why I like your book so much because you start by talking about how you have to identify your core values and your philosophies and then summarize it into a mission statement. And then once you have that mission statement, it drives all of your decisions. And coming up dental school, it took me ten years to figure that one out because I took some course where some businessperson told me that and I said, this makes perfect sense. I think most business ideas are pretty common sense. Like most dental ideas are pretty common sense, but it takes someone to think them through and if you let someone to take it through and teach you what they've concluded it saves you a lot of time. I think that's true in most business books.

Howard: So if you're a young millennial and you just got out of dental kindergarten, the E-Myth was a revolution back when you and I were little because what it was trying to explain, what no one could understand was these franchises. So you were in this small little town in Lyons, Kansas and you had a hamburger restaurant there, hamburger fries and coke. Think of Fonzie and The Happy Days. And you had it for forty years. It was all good. And then this McDonald’s opened up across the street and within ninety days the restaurants would fold and they were all like, well, this lady owned a restaurant. She was born in that town. She was raised in that town. They went to one church, one high school, one, everything. What's going on? Well, the problem is when you own a family restaurant, the mom spent all the time taking orders and taking money and making change. Dad was in the restaurant. He spent all his time making hamburgers, fries and coke, but they spend all their time in the business. They never ever worked on the business. And then here's the franchisee, where headquarters, they don't serve customers. All they do is work on the business and then their franchisees benefit of all that development. And so what dentists always say, they say, well, I'm going to work Monday through Thursday, eight to five, and then Fridays I'm going to go in and I'm going to do the business. And then Friday morning you wake up, you're exhausted. The alarm clock goes off, you say to hell with it, you roll over and go back to bed and then you get up at noon and decide you're going to go play golf and business is always the last priority and you just can't own your own business if you don't focus on the business of whatever your craft is. Cooking in a restaurant...

Neal: We go to school in our case for dentistry because we have a passion for dentistry where you learn this incredibly complicated, all these incredibly complicated techniques and we get pretty good at it by the time we finish school and we're very proud of these skills that we have developed and we think that we are capable of practicing dentistry. And then when it comes to the business side, it's not what we went to school for. We find it boring. I think that's true of everyone in healthcare. And think how insurance companies have made these inroads, I think they've gone a little too far with these networks in reducing fees. I think eventually we'll see those fees coming back because the quality is going to demand it.

Howard: So, where you're at now is Phoenix, Arizona, but south of that mountain there. So when you fly into the sky harbor, you see this big mountain range. It's a big park and it goes from like [inaudible 00:24:14] avenue. So everything north of that nine hundred thousand people is Phoenix. Behind that it's still phoenix, but everybody in this behind the mountain calls it Ahwatukee. So Ahwatukee probably has twenty churches and I've met and I've talked to every single priest, minister or whatever. They all say the same thing. They all went to seminary school for six, eight years.  And then when they come out they realized in about an hour that even running a church is a business. So when you say to me, well, I'm a dentist, I don't like to sell, I went to eight years, I'm not going to be a salesman. Dude, if you're a Lutheran pastor, you need to be a businessman. If you're a Lutheran pastor, you better have a flair for marketing. If you're a Lutheran pastor, you better get an A in HR attracting and retaining great quality people and dealing with... you're talking about, you know, doesn't matter if it's your practice, your family, your lover. Communication is everything. You also talk about knowledge equals income and income equals knowledge. What does that mean to you?

Neal: Well to me, that means that, I came with the idea about twenty years ago. My practice was struggling, I had two small children at home. I had this great engineering degree. I had a good dental degree. I had a great opportunity coming out of dental school, practicing, my former professor who was also the director of postgraduate prosthodontics, asked me to join his practice. And I was having trouble paying my bills. It just didn't make sense. I was frustrated, I was unhappy and I sat back and I thought about when was the last time I really felt good about myself and it was probably back in college in engineering school actually. And also in high school. And the main difference between then and where I was at was that I was actively learning, so I started buying books and reading them because I couldn't afford to take these expensive courses and the more I learned, the more my income increased, and that's true today. As soon as I learned a new technique, that's another problem that I can resolve instead of referring out or even not even recognizing it in the first place as a problem like the damage in incisal edges. I just thought that was a normal condition of wear until I really sat down and thought about what's different between those four teeth and all of the rest. Every time I learn something it increases my income so the more I learn, the more I'm worth.

Howard: Is there an order to learning first? I mean you just can't get out of school and master placing implants, sleep apnea, invisalign, occlusion, business management. Is there any order that you would learn?

Neal: Well you do a lot of reading. I mean there's some books that are just more full of practical ideas than other books. I think for practice management, the book that I used to always first recommend was Bill Blatchford's book called Blueprints, but after reading your book, I think I would start with your book.

Howard: You're just saying that because you're with me. If Bill Blatchford was here, now we've had Bill on the show and his daughter.

Neal: Yeah, who's also a dentist. He referenced her often, but I think your book has all of the ideas a young dentist needs in order to develop the business portion of a successful practice. I think a young dentist needs to know occlusion, it needs to know aesthetics and I really liked the Dawson book for occlusion. I don't agree with everything in the book, but it's six hundred and two pages. I've read it cover to cover six times over the course of almost forty years. I still learn things every time I read it. There's things that I've read so much that I see things that are sort of on the edge of what's been...

Howard: Well why is that field so controversial? Why do you have people who are...well, when you said you don't agree with everything in there, it reminds me of religion. I don't care if you had six catholic nuns all from the same immaculate heart of Mary. They don't even agree. And they're all from the same tribe of the, you know what I mean? So I don't think you could ever get two occlusion guys to agree 100%, but why do you think there's more disagreement than say amongst then say endodontics.

Neal: It is so complicated. I really liked the cover of his book Functional Occlusion because he's got anterior teeth, posterior teeth, muscle and the joint.

Howard: Okay, say it again.

Neal: Anterior teeth, posterior teeth, muscles and the joint. And he says they're all interrelated, but I think you can also tie in the periodontium, the bone, not just the joint, but the condyle, the disc, the articular eminence, you can tie in the brain, I think tie in hormones and emotions and you can tie in the airway to this whole system and when you change something in that system, it affects everything else.  And that's why I'm very careful and what I was getting at, and it's is probably a discussion in itself, is the incisal edge position. The nathologists back in the sixties and seventies looked at function, said, we've got to come up with some rules that make sense. So they took this area of occlusion that really hadn't been given any thought and they came up with some ideas that actually work. They thought you could simulate people's jaws on articulators. Those are the first articulators. And they thought you simulate that. And they built these very meticulous restorations and then they could transfer them to the mouth and they were just shocked that they didn't always always fit like they did on the articulators. And that's because something in the system was changing. One thing that they said, and this goes back to Niles Guichet, who I think was a brilliant a nathologist or occlusion specialist, he said that anterior guides and posterior guides are independent. Because you calculate them in different ways and they're unrelated. I think that can't be true. I think the incisal edge, the anterior guidance and the articular eminence, are integrally related, they're tied together by the bones and the muscles and if you change either one of those, either damaging the joint or moving the incisal edge, you're going to affect everything else in that system.

Howard: I think what you just said was so profound. [inaudible 00:31:05] posterior and anterior teeth, muscles and joints, but you're adding periodontium,  the bone, the brain, the hormones, the airway. What was the other thing you said? Periodontium, bone, hormones, airway...

Neal: The condyle, the discs...

Howard: Condyle, disc, but I want to go back to, you said the brain. What did you mean by the brain? Because if you ever want to take two occlusion guys and send them both to the nuthouse, tell them that part of TMD, temporomandibular disorder, disease, joint disease is stress. I mean some people will say grinding the teeth is purely a mechanical engineering deal, can all be fixed with interferences, occlusion, etc. etc. Invisalign. Now other people say, “Dude, look at that guy grinding his teeth. He just lost his job. He's going through a divorce, his kid's sick, he hates his boss. His mom's got cancer.” Do you think all those psychos- What would you call those? You know, life's tough. When you said brain, were you referring to that or do you think that is not the case and it's more a purely mechanical engineering issue?

Neal: No, I think it's a good point. I think it's something that needs to be researched at universities, but I think when people are under stress, it affects the musculature and I think the elevator muscles shorten — I think that's been proven — and then when the teeth start contacting, there's a very specific way that our brain wants our teeth to function, specifically it wants the anterior teeth to guide the jaw side to side. They're ideally engineered for withstanding horizontal forces with these long roots, but they're small teeth so they don't withstand vertical forces very well. The posterior teeth you get the exact opposite. They got the big white chewing table that will crush food, but they have relatively short roots, so designed for vertical forces. When you slide side to side, if you have a posterior interference, particularly a contralateral interference, it creates enormous leverage, a different type of leverage than what the brain wants. It goes from a class three lever to a class one lever. I'm getting a lot of engineering, but what that means is that turns into a seesaw, so if the brain wants the cuspids to contact and the musculature pulls the jaw together, it pivots around that contact and stretches at the joint, and we've been programmed to know that that's dangerous to our survival because we evolved when we were chasing our food and if we couldn't eat, if our jaws couldn't function, we would die. So the brain, I think it's very protective. Now when people move into an urban area with all of the stresses, it ramps up the stress. Those muscles become shorter and we feel those contacts more and the brain instructs the muscles to chew them away. It's a way of doing our own dentistry. Now we as dentists see these teeth break and we put on lithium disilicate, it looks like teeth, everyone wants things to look great, but then when that breaks, then we go to zirconia because zirconia is even stronger and then the opposing tooth breaks, so we put zirconia there also. Those forces don't disappear. Those forces go up into the roots. When you do a periodontal exam, if you go around the arch and everything, two's and three's very healthy, and then you get to a molar that has some four or five millimeter pockets, there's something different than that tooth and ninety nine out of a hundred times, if you check the occlusion, there's a lateral interference. All the time. So if you get rid of the interference, that's part of the cause for that tooth losing bone. We've built restoration so that the teeth don't break but those forces have now been transferred into the roots and now the muscles are always going to win. The muscles are damaging the bone. They will chew that tooth right out of the head to get rid of that interference because it's jeopardizing the joint and with stress, I tell people you have certain amount of interference, you need a certain amount of stress, so interference are up here, but if we reduce the interferences, we need more stress to trigger bruxy, so if you have a person who has enough stress, they'll start bruxying again. Peter Dawson finally agreed after decades of insisting that you could adjust away people's occlusion and get rid of all the interference, they'll stop bruxing. He finally agreed that some people just start going to brux. It's like, you know when you bite down on your posterior teeth, you feel masseter flex, slide up on your anterior teeth, my masseter shut off 80%. That's not true on everyone. I think these people who have chewed their teeth flat, I think those masseters don't shut off when it comes on their anterior teeth. So all the forces of these powerful muscles are transferred to the front teeth, these delicate front teeth that aren't designed for it. They chew them down. Muscles always win.

Howard: You and I both know that, okay, so there's two hundred and eleven thousand Americans who are alive, who have an active license to practice dentistry. Probably a hundred and fifty thousand of them are thirty-two hour week or more general dentists, thirty thousand thirty-two hour week or more specialists, but back to general dentists. If anybody comes in and they complain about TMJ, 80% of the dentists treat it with just have the assistant take upper and lower impression. They send it to a lab, they make a night guard. Patient comes back a week later, the assistant tries in the night guard, the dentist comes in and makes a couple of adjustments. That's it. Do you agree? That's how 80% of TMJ is treated, TMD is treated with a night guard?

Neal: Yeah, I think the reason is that coming out of dental school, we haven't gotten much of an education on the joint.

Howard: But do you agree that's how 80% of temporomandibular joint disorders are… Do you call it TMJD or do you call it TMD?

Neal: TMD.

Howard: You call it TMD? I noticed some people are calling it TMJD, temporomandibular joint disorder. What would you say to some young dentist or any dentists and that's how he's been treating TMJD for thirty years. What would you tell them about that?

Neal: I would suggest that they get a better understanding of TMD and the two places that I have found that makes sense. I like things that make sense. First was Jeffrey Okeson's book, Temporary Diagnosis and Treatment of Temporary Jordan.

Howard: Can you send me that, Ryan. Jeffrey Okeson? How do you spell Okeson.

Neal: O-k-e-s-o-n. He runs the maxilla facial pain clinic at the University of Kentucky. At least he used to.

Howard: Yeah, we've had him on the show. Right Ryan? So what's his first name?

Neal: Jeffrey

Howard: J-e-f-f-r-e-y. O-k-e-s-o-n

Neal: And the other person is Mark Piper. Who came out of the Dawson Institute and I think he makes a lot of sense too. I think he really understands stands the joint. He's broken it down into nine different, they both have, and explains what the difference between each of those, capsular and muscular, how to treat each one and why each one happens and what the [inaudible 00:38:40] if you don't treat these is going to be, some are more urgent than others. He makes a lot of sense. I really liked his courses.

Howard: Another huge controversy, so there's ten thousand six hundred thirty hour a week or more orthodontist. Some orthodontists just say, you know, we're keeping it real. This is how we roll. Other TMD experts are saying, man, you take all these American kids and you throw them through this ortho factor. You're blowing out the curves failure blowing out the curve of Wilson and they're not finishing the case and they're just making them straight and pretty. And a lot of TMD people really have problems with the way 80% of orthodontics are done. Do you agree with that or is that an extremist position?

Neal: You were mentioning earlier that dentistry is very aesthetics driven and it's becoming more so. I think with orthodontics, it's really difficult to move. I look at some of the cases that the orthodontist that I worked with treats. And I do simple orthodontics, but the complicated things I send to him and it's like he's gotten a job from one person and I had a upper jaw from someone else and put those together and they're total mismatches. It's very difficult. I think when someone goes in to have their teeth straightened, when they look good, mom pays the bill and they're finished. And to get the occlusion you can't get the occlusion to where nature really wants it. I think inclusion has to be within a tenth of a millimeter and they nature will perceive that. And I think with orthodontics you're at best going to get it with a half a millimeter

Howard: I see Jeffrey Okeson DMD. He has a book management of temporomandibular disorders of occlusion, seventh edition. You know, I mean the book is new. It's one hundred twenty five to buy it used it's ninety six fifty. You can rent it for $49, but that's what I don't understand. Like you can buy that used book for under a hundred bucks and you won't do that, but every time I go to Kois, Pankey, Spear or Nash, I mean there's just people that have no money dropping $5,000 on a weekend course. I mean there's so many guys. We have four hundred courses on dental town and each one of them is $18. They spend more than eighteen on the cab fare when they fly into Phoenix, they spend more money just on the cab to the resort. Have we just lost a generation of readers?

Neal: I think so. I think, so. I don't understand why because you get through dental school, you have to be a strong reader. I think part of it is psychological. I think when I graduated from dental school and read these textbooks because someone was forcing me to read them, I was to be tested on it, it was sort of intimidating. And I had this rebellious side of me that did not want to read. So I didn't read for ten years and then I was surrounded by all of these ideas that I didn't understand. So now I've gotten myself to the point where I'm going to read, not because someone's making me read, but because I choose to do so. In fact, I've got my whole team in my office as a book club. We all read a minimum six books a year, which isn't a lot.

Howard: And what is the genre of these books? Does it usual have something to do with your office though? Communication, HR, dentistry.

Neal: Yes. We've read some good, very useful books. I just bought everyone a copy of your book.

Howard: Oh, thank you.

Neal: I bought everybody a copy of Spark. Have you read Spark?

Howard: Spark.

Neal: It's written by Lynch and Lynch...two ladies from the marines and one's married to a man who had been in the air force and it's on leadership. But I bought each one a copy of Spark. In fact, I bought ten copies of your book. I've given five to my team and five to young dentists who asks where they should start.

Howard: You also talk about golden proportion and then follow that up with average...

Neal: Averagism.

Howard: So talk about golden proportion to averagism.

Neal: Well that's getting over into the aesthetics portion that I think young dentists need to know. When I first heard a golden proportion. And for people who don't know what that means, it goes back, I've traced it back to 450 B.C. But what it is, is if you have two line segments, one line segment and split it into parts A and B. The small part divided by the big part equals a big part divided by the whole length.

Howard: Okay say that again, say that again.

Neal: The small part divided by the long part. So A divided by B equals B, the long part, divided by the whole length, which we call C.  And it comes down to a very specific number. And the ancient greeks thought that was a magical number in that it would define the width, the height of a butterfly wing, the width, the height of a leaf that, it defined the width, the height of everything in nature. And then there was Eddie Leven who were the prosthodontist in England, got an article published in the 1970's in the journal of prosthetic dentistry. And then he wrote a whole article on the gold proportion a few years later, also in the same journal. And when I first heard this probably about 2008, it stirred something inside of me. I think that's inside of all us in it. And in my lecture I start with this image of mickey mouse is a sorcerer's apprentice. I mean, everyone's just endeared with that cartoon. I was doing a six unit anterior bridge shortly after I heard about it. I said, let's use the golden proportion. And he's Japanese. He's very polite and I had him on the phone and said I want to use the golden proportion. And there was silence and it's like, I'm married to [inaudible 00:44:52], so I can read his silences? It's just a process sometimes louder than his words. I said, what's wrong? Still silence. I go, you don't like the golden proportion? He said, no. I said, no, why not? He said, well, and it stopped there. He just, he just didn't say anything and then I go because you think it leads to ugly teeth. He goes, yes. His whole conversation, we had a whole conversation. He said no. And yes, it was this whole contribution beside his silences. So I set out to prove him wrong. I googled golden proportion dentistry  in 2008 and I got four hundred and fifty hits and I google it every two years since then I googled last year I got three hundred fifty thousand hits. So there are people using the golden proportion in dentistry and it's going viral. So I was going to prove him wrong. So first I took some orthodontic corrected teeth and I measured the angle of lateral incisor to the central incisor. And if you twist it at a certain angle, it equals the golden proportion, and I conclude it's only about 18% of these orthodontically corrected at teeth that fit the golden proportion and 82%, the central incisors just became enormously big. I thought that was not helping my cause to proving my technician wrong. So when he went next door to the American Dental Association, back then, they had this open policy on their library and I found six articles conducted universities from six different countries and everyone concluded the any recurring proportion including golden proportion led to inferior aesthetics. And then there was JD Preston had an article published in the journal of prosthetic dentistry where he measured the angle of lateral incisors and concluded that 17% were aesthetic. So my technician was absolutely right. So when you get down to what I'm actually studying, I'm assuming that what we see most often in nature is considered the most aesthetic. That's averagism. So that the average lateral incisor, and you get this from any orthodontic textbook is 78% the width of the central and a cuspid is about 80%, so no one, not even god can tell two hundredth of a millimeter difference between lateral and central. So if you make a lateral incisor, 80% of the width of the central and the cuspid 90%, and when you had that opportunity like doing all on four or anterior bridge, that's what people most often see in nature and whenever I've used that width proportion, people love the appearance of their teeth. That's averagism

Howard: Wow, now are you lecturing on average? Have you written articles on it?

Neal: I've done all this mostly for my own benefit. I think Einstein said something about if you can't explain an idea, then you don't understand it well enough. So in order to get these ideas clear in my mind is I've created these PowerPoint presentations just for myself and just in the last eight years I started sharing those with other people, some local dental societies in and around Chicago.

Howard: Well, you need to put those up on dental town. If you put them on Dentaltown people will be able to watch him in Kathmandu

Neal: Yeah, and we'll do that. I've scheduled two lectures on occlusion, two lectures on aesthetics. I want to do two lectures on management for dental students and young dentists.

Howard: Well, I'd love to have him on dentaltown. Ryan, can you send him an email and Hogo? So I'm Howard at Dentaltown and we got the guy in charge of the online CE is also Howard. He's Howard Goldstein, so we call him Hogo because I was first. So I got Howard and so he's But what I tell everybody about millennials is so many of my friends are all worried that their kids don't read. Well, a Youtube video is a million times more stimulating then some black and white book. I mean, you'd have to be really old to think that a black and white book with no photos could compete with video. And they love online CE, they just love it. It's video so they get to see you. But make it digital and you'll really hit it off huge. You talk about a neat story where dentists should be given a guide on how to develop their careers that in the Cheshire cat observing Alice at the crossroads. The cat asks Alice, where is she going Alice replies she doesn't know. So the cat concludes that it doesn't matter what path she takes because if you don't know where you're going it doesn't matter what path you're on. It was a great movie.

Neal: It gets back to what we were talking about earlier, having young dentists having even older dentists that haven't done those, identified their philosophy and values. And summarize that into a mission statement. If you want to get from here to there, you need to understand where there it going to be. And if you just work day to day without having any vision in twenty years you're going to be somewhere. But it might not necessarily be where you want it to be. I try to balance my life. I know it's in your book you've got the four b's. I do something similar. I have myself, where I exercise. I was in the gym this morning. In fact, I exercise so much, I live in a condo downtown Chicago, the old ladies in my building use it as a meeting because we don't have a meeting room in our building. They took up a petition that I sweat too much. I was just indignant. I said, I went down to the building manager, I said, you know, they put rubber floors down because it's a gym, you're supposed to sweat. And I said, this is not a fight I need to fight. So I bring an extra towel. I put it underneath the bike. But myself, I like to take care of my body and my mind. I think they're inseparable. My family, there's nothing more important than my daughters now my grandchildren and my career because that supports everything else and then I call it my religion. And if you don't subscribe to organized religion, you still stand for something and that's your religion. People should write down what their values are and that's your philosophy and values, and just summarize it and then all of your decisions in life should be based on those philosophies and values. They don't need to be popular with other people. But if they're important to you. I grew up in a middle class neighborhood; integrity and honesty we wore on our sleeves and if someone called you a liar they should be ready to fight on the playground. And that's...

Howard: Well that's because you're Irish.

Neal: That's Irish, yeah.

Howard: My favorite Irish joke is a guy, he's walking home from work and he sees two men fighting. He stops, he says, hey, is this an open fight? Can I join? A lot of dentists are very, very stressed and, last year, the average dentist only made one hundred and seventy four thousand. Dude, one hundred and seventy four thousand is a lot of money. What percentage of Americans would kill to go get a job tomorrow that paid out a hundred seventy four. And then a lot of people talk about that the politics are so bad right now. I'm pretty sure that politics during the civil war were a lot worse than they are today. I mean the civil war, one in every thirty americans got killed and then the turn of the century you had world war one, which happened also during the Spanish influenza which killed 5% of society. You know, Philadelphia bought its first steam engine during that period because they couldn't dig the graves fast enough. And then after that, at the end of world war one, what did we get? We got the great depression, lost a third of the banks, 25% unemployment from thirty eight, thirty six. And then when that was over, we got world war two, so a lot of times when people are crying about how bad everything is now, I always wonder, have you ever read a history book? Because I'm pretty sure the worst of the worst today would have been the best of the best of the best during all those previous times. And one thing people don't talk about the civil war, everything was made out of wood and they fought with fire. I mean, entire towns would burn down. I mean, how would you like to wake up one out of every thirty people is dead and your entire town's burned down and really, really your student loan crisis is that bad?  But we know for dentists aren't anymore addicts than the general public. 14% of dentists will have inpatient treatment during their career. It's the same as the American population, but when they're listening to and they're burned out and they're fried hear that a lot on dentaltown. There's mile long threads about burnout, [inaudible 00:54:06], depression. What would you say to a dentist who says, Neil, I'm just burned out. I'm getting beat up by the staff, the insurance companies, the patients. I'm just fried. What do you think that comes down to?

Neal: Well, I think they need to take control of their lives. You have a choice as to how you feel, whether you realize it or not. Most of them really haven't given it any thought. So they haven't come up with any philosophies. When I think of being burned out, I think of an old musical, Camelot. Where King Arthur, young King Arthur is frustrated and depressed and [inaudible 00:54:46] comes in and says what's problem? He says I'm just feeling depressed. And it leads into a song. But the whole point is when you're feeling depressed, learn something new. So I would recommend to a young dentist to learn something new. I mean, first learn your aesthetics, function and practice management, but once you feel you have that mastered, then branch out and add something else to that. And when you master that, then maybe add something else, but I think learning something new. And the other thing I think that leads to depression is that we make money, we spend money and make more money, we spend more money and we don't get control of our finances. And I think that's a huge problem. And there's a number of books. Your book mentions it, Gary Katie has a book, Michael Schuster has a book about controlling your finances. Just because you have this bigger income, don't increase your expenses. Don't go buy that Lexis and that new house. Put some of that money into a bank and have some forced savings. My younger brother, who has a masters in tax law.

Howard: Your older brother?

Neal: My younger brother. When I was in my thirties, I think that year I qualified for food stamps. He insisted I fund my IRA even though I was only in my early thirties. I said, man I've got young children at home. I need to bring this money home. He said, sixty five is going to be here before you realize it, so save that money, and I argued with him several times and finally he convinced me to do that, but I think living within a budget is enormously important. I've heard it said that what Asians and Europeans don't understand about Americans is why we need such excesses. I had this patient once and we were bartering, he had bad teeth, he still has bad teeth, but he worked for Sony in Chicago and we would trade electronics to fix his teeth because he never had money to pay for these crowns and bridges and implants. And I wound up accumulating eight televisions, nine televisions, and they were those big boxes and when the flat screen TVs came out, they became obsolete. There were televisions I threw away that I'd used twice. And in the midst of that, I heard that comment why do Americans need such excess? And we don't. We are manipulated by advertising and think we need these excesses when we really don't. There's that old paradox. Need a certain amount of money to be happy, but extra money doesn't bring extra happiness. The friends of mine that have made the most money are the ones that are sometimes the most miserable. They'd been through therapy because they're just unhappy. They expected all this extra money would make them that much happier and it just didn't happen. And they were frustrated that I didn't. I think they'd never gotten down to their core values of defining what was important to themselves. To me, it's my career, my patients, my staff, my family, myself, and I'm living within my values that I've defined for my own life.

Howard: Yeah. I mean my car is a 2004 with one hundred sixty thousand miles and every time I go in to get an oil change they're like, well you give us your car and one hundred grand, you could drive home with a new one. Like why would I give someone one hundred grand? I mean everybody...they don't have the money. So they finance and they lease, all that stuff. And they don't realize that when you go finance a five-year fancy new car, it makes you feel good today. You feel good, you bought a new car, but you don't realize how much of your life, sweat, blood and tears you're going to have to give for that deal. And so many people, just  just lowered their standard of living. They'd have so much less stress and many dentists can't even pass...I'll say them, I'll say, okay, name me one area of your life where you just live below average. You don't go camping to the lake, you went and flew to Maui. You don't have a Toyota, you'd have a Lexus, BMW. You don't have a three bedroom, two bath house. You have a five bedroom, three car garage. You sent your kids to private school. I mean really? On top of that private school. When you look at the greatest hundred people that ever lived in the United States, between 1700 and 1900, none of them went to college. And back when Harvard started, Harvard was nine months. College back then was one year. But what did Abraham Lincoln do? He lived in a library. He just read books. He read books; all leaders are readers. And, my gosh, you just quit spending and read more and you started off this whole deal that the secret to success was learning more.  This is why I started this podcast because in my thirty years, the people that I watched, I always say, well, what did they have the most in common that rose to the top, master of the universe, pay off their student loans, live happy ever after. I would say it was the people who took the most continuing education. I saw that all the time. But so many people live in a small town of Lyons, Kansas, they don't really have a lot of access to study clubs and this and that. When I saw this smartphone come out, I mean we started online CE on dental town and got four hundred courses. I hope you put some up there, but what I thought, the biggest advantage I can contribute is I can get a lot of amazing people to come on the show and what I love is if they commute an hour to and from work each day they tell me they want ten hours, but one hundred hours...shoot, they work two hundred days a year and we're just talking about one way. So I think these podcasts, I think online CE, audio books, if you don't want to read these books, I tell every older dentist I know who's got a book. Almost every single dentist that has a book on amazon, they just have a book. So you're just going to sell the baby boomers, but just sit down, you read the book. One time, my book took me five and a half hours to read it, the audio books is the only thing the millennials will buy. They're on a treadmill. You said you bike. How often are you on the bike?

Neal: Every morning.

Howard: For how long?

Neal: Half hour to an hour.

Howard: Yeah, so are you watching tv on the wall or you listen to audio books or you do while you're on the bike?

Neal: Just sweating, irritating my neighbors.

Howard: But they go to the gym, they go on these deals and they put in their headphones and you know, sometimes you're in the mood for music, sometimes it's an  audio book. Ryan, did you see that new radio station app that ...they just came out with the app. What is it? One o Four point three. I noticed that lifetime, a lot of people are listening to one o four point three on the radio. But just put a lot of good ideas into your head and I also believe in parting shot is that if I gave everybody in the world a gun and told him to shoot the person that's causing all the pain and suffering in their life, it would just be mass suicide. Yeah, it's all you buddy. It's all you. Times are good, the American dream alive. Just make better decisions for yourself.

Neal: I think balance of life is huge. I find when I'm getting stressed, if I'm out of balance, it was about six years ago, I heard Bill Blatchford speak and he advocated reducing your hours from two hundred forty days, which is two weeks vacation to one hundred eighty. You'll increase your income. I heard him speak thirty years before, he was saying the same thing. So I thought if it really didn't work he wouldn't be still saying to reduce my hours, so I went back to my office. I said, listen, we're going to cut back. We're going to try this. We're going to do seven weeks paid vacation, but if our income doesn't go up, we're going back to two weeks paid vacation. And our income went up, so every six weeks we'd take a week off and in that week we do some reading. We take some classes, but most of the time we spend with our friends and family. I think that makes it so that we lead lives. We're working to live rather than living to work.

Howard: I've also seen this where you take a dentist who goes in there and works  

Monday through Thursday, eight to five and they'll just crush it, they'll refill Friday, Saturday, Sunday, then you look at the other dentist who works Monday through Friday, eight to five and a half day on Saturday and they're pacing themselves as if they're doing a marathon. And then when you look at some of the dentists that just crushed it, some of the biggest producers I know, they do six to noon, Monday through Thursday, but when they go in there, they're full blown sprinting mode. I mean they're just high energy and one I like for the older people, this is a good one for the older people. Older people don't have this stamina that you did when you were twenty five. I mean that just is what it is. They'll work Monday and Tuesday, take off Wednesday, then do Thursday, Friday, then take off Saturday, Sunday. And so what you were saying is the energy level, you know, work-life balance, well if you're just going to… I mean, imagine when you look at hospitals where a lot of the doctors do a twenty four hour shift on Monday and Thursday. Well, they show up to work and oh my God, I'm going to be here for twenty four hours. They're just in rest mode the whole time. Because they've got to pace. So one last question- We went over an hour. I can't believe we've been talking for over an hour. You talking about Donald Enlow and his book “Facial Growth”. What do you think of that book?

Neal: If you ever have trouble sleeping, I'll loan you my copy. It’s got so much information in this book that if I get through four pages, they would just hurt my brain. I'd have to stop, put it down and think about what I just read. I was in the midst of a case. I had taken a course in Invisalign where they said I could expand without limits and it wasn't sure I could believe him, but it really, really lent itself to this particular situation. So I was expanding this person's arch and I was getting nervous and before I hurt the person what I did was I bought that book and I also bought the book by Bishara who was the Head of Ortho at the University of Iowa and read his book. I read them both cover to cover, but it explains how our jaws develop and our teeth develop. It talks about adaptation. The one idea that he mentions in his book that really resonated was that our facial bones continue to grow a millimeter a year. I don't think they grow a millimeter a year, but I think the point is they do grow and the upper and lower bones don't necessarily grow at the same rate and I think there's poor communication between the upper and lower jaws. Kind of like a husband and wife, but the point is that in order for the teeth to fit together- Because the brain wants to teeth fit together very precisely. It tells the muscles to chew away what's in the way and that's why we brux. It's nature's way of fine-tuning a better bite, and if we interfere with nature's ability to adapt, then we cause other problems somewhere else in that system. They might lose bone, we might fracture teeth, we might damage-

Howard: You know what the weirdest thing about his book is? I kid you not on Amazon, people who bought “Essentials of Facial Growth” by Donald H. Enlow MS PhD also bought “The Dangerous Case of Donald Trump: Twenty-seven Psychiatrists and Mental Health Experts Assess a President”. So what does it tell you about people studying “Facial Growth” by a guy with an MS and PhD also bought “The Dangerous Case of Donald Trump”. That is hilarious. Oh my God. That is hilarious. That's the funniest also bought link to a dental book I've ever… So he has the “Essentials of Facial Growth, Second Edition” and then he's got “The Human Face: An Account of the Postnatal Growth and Development of the Craniofacial Skeleton”. Any one of those books you recommend more than the others? If they were going to start off with one, would you go with “Essentials of Facial Growth” or “The Human Face: An Account of the Postnatal Growth and Development of the Craniofacial Skeleton”? Which one of those two would you start with?

Neal: I think the one I read is the “Essentials of Facial Growth”.

Howard: And you liked that one.

Neal: Yes, but it didn't teach me as much as some of these other books have. That's not the place where I would have young dentists start.

Howard: So what about the first book? Where would they start?

Neal: Well, I think they need to focus on those three areas that we discussed. I think with occlusion, I would start with Dawson's book and read it and practice and then five years later I'd read it again. With aesthetics there's a good book by Terry and Geller, Douglas Terry and Willi Geller out of Switzerland. Very good book.

Howard: Okay say it again. Terry...

Neal: Douglas Terry and Willi Geller who's a famous ceramist. They're in Switzerland.

Howard: G-i-l-l-e-r?

Neal: G-e-l-l-a-r, I believe.

Howard: Terry Geller?

Neal: Douglas Terry and Willi Geller. And speaking of [inaudible 01:08:26] every three years they do a symposium on ceramics. Have you attended them? Twenty-eight speakers over three days, prosthodontist, dentists, professors, ceramists talk about different parts of cosmetic dentistry, ceramics.

Howard: So Douglas A. Terry, “Esthetic and Restorative Dentistry: Material Selection and Technique, Third Edition”. Man, I can't believe we went over an hour. That was a fast hour. Seriously, thank you so much, Neal, for coming by the show today. Giving us an hour of your life to share what you know with my homies. That was a truly amazing hour. And I thank you so much for coming by the house today.

Neal: Thank you very much for having me.

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