Dentistry Uncensored with Howard Farran
Dentistry Uncensored with Howard Farran
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1078 The Future of Teledentistry with Dr. Maria Kunstadter : Dentistry Uncensored with Howard Farran

1078 The Future of Teledentistry with Dr. Maria Kunstadter : Dentistry Uncensored with Howard Farran

7/7/2018 9:52:47 AM   |   Comments: 2   |   Views: 672

1078 The Future of Teledentistry with Dr. Maria Kunstadter : Dentistry Uncensored with Howard Farran

Dr. Kunstadter graduated from U.M.K.C Dental School. While there, she co-founded the U.M.K.C Dental Outreach Program.  The program has taken students, facility and alumni to third world countries to provide dental care for 25 years. Dr. Kunstadter has led and participated in over 24 medical mission trips worldwide since 1982.

Dr. Kunstadter has been in private practice of dentistry for over 30 years. In 2001, she co-founded The Smile Salon, the Midwest’s first Dental Spa. In 2004, she was designated an “Innovator “ by the Invisalign Corporation. In 2008, she achieved the designation of Elite Preferred Provider with Invisalign, which is awarded to only 1% of Invisalign providers in the world. Dr. Kunstadter was the first woman dentist to be awarded this honor. She is an international speaker with Invisalign and continued to receive Elite Status during her tenure at the Smile Salon.

In 2013, Dr. Kunstadter was appointed the Dental Director of The PAINS Alliance of Kansas City, an organization developed to address chronic pain nationwide. 

She is the co-founder of The TeleDentists, the first Teledental platform to provide dental consultation services to the healthcare industry.  Dr. Kunstadter has been a guest speaker at telehealth conferences about teledentistry and is passionate about being able to provide a virtual dentist wherever, whenever a dentist is needed.


VIDEO - DUwHF #1078 - Maria Kunstadter

AUDIO - DUwHF #1078 - Maria Kunstadter

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1078 The Future of Teledentistry with Dr. Maria Kunstadter : Dentistry Uncensored with Howard Farran

Howard: It is just a huge honor for me today to be podcast interviewing Maria Kunstadter, DDS, UMKC Class of ‘81. While she was at UMKC, she co-founded the UMKC Dental Outreach Program. The program has taken students, faculty, and alumni to third-world countries to provide dental care for twenty-five years. She has led and participated in over twenty-four medical mission trips worldwide since 1982. She's been in private practice in dentistry for over thirty years. In 2001, she co-founded The Smile Salon, the Midwest’s first dental spa. In 2004, she was designated an innovator by the Invisalign Corporation. In 2008, she achieved the designation of Elite Preferred Provider with Invisalign, which is awarded to only 1% of Invisalign providers in the world. She was the first woman dentist to be awarded this honor. She is an international speaker with Invisalign and continues to receive Elite Status during tenure at The Smiles Salon. In 2013, she was appointed the Dental Director of The PAINS Alliance of Kansas City, an organization developed to address chronic pain nationwide. She is the co-founder of The TeleDentists, the first Teledental platform to provide dental consultation services to the healthcare industry. She has been a guest speaker at telehealth conferences about teledentistry and is passionate about being able to provide a virtual dentist wherever, whenever a dentist is needed. Thank you so much, Maria, for coming on the show today. How are you doing? 

Maria: I'm great. Thanks for inviting me. Exciting. 

Howard: How cool is it that you're the first woman dentist to be awarded the top 1% of Invisalign providers?

Maria: Well, when I started dental school – before you Howard – only 3% of practicing dentists were women, so I'm kind of used to being on that edge and the first and starting female dentists. So it's very exciting and I love what I do.

Howard: Well when you graduated from UMKC in 1981, how big was the class size and how many women were in there?

Maria: There were a hundred and sixty in our class. Big classes, and there were ten women in our class.

Howard: So ten out of a hundred and sixty?

Maria: Yup.

Howard: Wow. So did you feel like you were a woman in a man's world or not really? 

Maria: Oh yes. I've been in a woman in a man's world. I was one of the guys since 1977. Which is fine with me – I enjoy everybody – but definitely a woman in a man's world and still, in telehealth now when I talk to the top executives, still a woman in a man's world. So it's a place I'm used to being. 

Howard: So what did you think about Saudi Arabia just legalizing- I mean, we look at the world as a marathon and there's some people at the front of the race and some at the back. What do you think of the fact that they just now legally can drive a car? 

Maria: Mind-boggling. Although they're so pulling them over; they haven't fulfilled it yet, but you know, when the United States went in to write the constitution for Iraq, they mandated 25% women representation in their government, but we don't have that representation at our government, and we could go on and on about the lack of female representation at the top levels of corporations. But that's another platform I get on occasionally, but probably not today. 

Howard: Well no, it's a great platform, because I'm real sensitive because I grew up with five sisters. And you know, where I saw the most sexism in the world? Was my own mom and dad. We lived right next to a river, and I could swim in the river everyday, I could fish in the river, and I was putting blue jeans with patches ironed on the outside of the knee. My sisters were putting dresses and they couldn't go within ten feet of the edge of the river, they got harassed that they left the lawn, and my only rule was I had to be back home when the streetlights came on. So I could walk eight blocks all the way to my friend Mark (unclear 00:04:11) and David Hoff and all these guys. If my sister would to ask my mom, “Can I walk eight blocks down the street to my friend Jordan's house?” it just would have been a resounding no, because she was a girl. And I remember swimming in the river thinking, what is my advantage of being a boy? I can remember that when I was ten years old. So I have lost a lot of friends for this, but every single election I've ever voted on my entire life, if there was a woman candidate instead of a man, I voted for the woman, and the reason I did is because I had all these dental assistants, they'd get divorced, their husband would have to pay child support so he would move over to New Mexico or California, so he wouldn't have to pay child support. And I'm sitting here thinking, my God, if I moved, do you think the IRS would find me for my money? Absolutely. But the government can't find their husband when he lives in Albuquerque and he owes child support. So I have always voted. And so on that last election, Hillary versus Trump, the Trumpers are fanatical. And I, saying in a dental lecture in Florida that I was voting for Hillary, and an entire dental office got up and left. I just thought, whatever, you're an idiot.

Maria: I have voted like that myself, Howard. Every election, just like you. That's amazing. We have that in common. So every election I vote for a female if there's a choice between male and female. So we still have a ways to go. I can tell you in dentistry it's been an advantage. With patients especially, that were back in eighty one, and still today. Seventeen percent of dentists are women now. That's all. My patients loved being treated by a female and instead of their preconceived idea of what males are going to act like when they're being treated by males in dental offices. I really had a huge practice advantage and a very successful practice because I was a female. They felt I was more gentle, my hands were smaller than those big guys. I used it to my advantage, I loved my patients and I love being able to practice dentistry and I think I was fortunate enough to be able to parlay that into a big advantage for my practice. 

Howard: I still can't believe it hasn't even been a century that you've even had the right to vote. The nineteenth amendment was August 18th, 1920. So women haven't even had the right to vote for a century. 

Maria: Exactly.

Howard: But I want to ask you another politically incorrect question. I believe,

Maria: I love that. This is great.

Howard: I always say that in dentistry we sell the invisible. When I buy bottled water, everyone knows what bottled water is. When I go buy my iPhone, everybody knows an iPhone. But when I tell you, you have four cavities, how do you know? Tell me this, if a hundred women in Phoenix had their air conditioner break down and called George Brazil to come out to fix their air conditioner and the repair man said, I can't fix your air conditioner, you need a whole new air conditioner for a thousand dollars. What percent of women would just simply think twice and say, I don't know if that's true because you're a man and I think you're lying to me and trying to sell me something. What percent of Phoenix women would think that?

Maria: Depends on how hot it is. If it was a hundred and thirteen like it is in Phoenix sometimes, there may be a higher percentage of people that say go do whatever you need to do. But I do think with, well look at Angie's list. She was a female that started a referral system online based on having people that are reliable. So I think that with technology, again, going into the TeleDentists, but with technology, developed for those kinds of reasons, those kinds of questions. Do I believe what you're telling me, again, with dentists, um, the advantage of having a monitor with pictures up on the screen when, the offices and technology advanced in dentistry. We could show them their cavities. And then there wasn't a, are you sure? You're telling me the truth, but to be able to show a female in Phoenix that their air conditioner's broken down. I had that when I took my car in to get repaired and they're always like, you need to do all these things. It's like, well, wait a minute. And yes, there's huge depth. Like say if it's a hundred and thirteen in Phoenix, they probably more would agree to have that new air conditioning put in. 

Howard: And you know, the mechanics called when the engine light comes on, they call that the idiot light, because the engine light comes on and then somebody drives in like me, who grew up with five sisters and played Barbie doll size twelve, and has never looked under the hood. And they say you need all this stuff. And the first thing I'm thinking, well, how come when the idiot light comes on, you know all this stuff? Why doesn't my car tell me this? Why can't I plug in my IPhone and it tell me? Why is it relying on you? Why is it not even transparent? The fact that it's not transparent, I don't even trust you. I think women dentists. So when you graduated in 1981, only three percent of the dentists were women and now in 2018 it's seventeen percent. And I think it's a huge advantage, because even myself, I would trust a woman over a man any day of the week. I would always think the man is trying to sell me something for money and I would think the woman is trying to help me. Is that just 

Maria: Don't you think that in practices that when the doctor, a male doctor walks out of the room and the patient is turned to the assistants to say, is this true? Do I really need this? So many times with hygienists and they do talk to females and that may be the reason of the gender gap there validate not just the position of professionalism, and that may be a gender issue of them saying, do I really need this or that? And that happens all the time in practices that they asked the assistant and the hygienist to validate what the doctor said. 

Howard: And the reason, and the male has always messed that up because they're control freaks. So I always tell the hygienist, well you can't do that because you're diagnosing and that's against the law. And that's illegal and he's like shut up doctor. Not one hygienist is in jail today for reading and x ray. I flipped it on the head, when you come in for emergency patient, I'm going to take an FMX and when they're taking an FMX, every time they take that digital x ray and show it on the screen, I want the dental assistant to diagnose it on the deal. I think you ruined trust by having high staff turnover. You have a bunch of women in there that no one's, no one's even worked here for two years. Versus I get all these people that have worked for me ten, twenty, thirty years.  And as they take each x-ray, I want the assistant, I want (unclear 00:11:01) to say, see that black hole, that's a cavity. And then take the next x-ray and say, you see the root canal, that's because that cavity got all the way to the nerve. So when you free up your staff to communicate, you build trust. So to build trust, when you're selling the invisible, stop the staff turnover. Stop being a control freak, telling people that they can't diagnose. What are you a lawyer now? Are you a dentist or a lawyer? And it just means everything. 

Maria: I agree completely. Are you still wet fingered?

Howard: I am, my hand is dry right now. I still work.


Maria: Well, good for you. I actually retired fully in January. One to work on this project full time, but I've also been at it longer than you have. So good for you for (unclear 00:11:48)

Howard: (unclear 00:11:50) Retire, make grandkids. You're looking at me and you're thinking there's a fifty five year old short, fat, bald, ugly man. You're eighty five?  I am actually hot. I am a very sexy man if you're thirty years older than me. So I got all these older women who have to see me and I love them to death. But so where in your journey, how did you become the leader in TeleDentistry? What was going on in your journey where this even went off on a light bulb? 

Maria: Okay, good, great question. So in my practice, maybe it's because I'm a female, I instructed my front office people from the beginning of practice that, if someone calls in pain, you don't ask them what insurance they have. You don't ask them if they can pay for their visit. The first question you say is how soon can you get in today? So, because you and I both know it takes very little time and very little money and very little office expense to get somebody from pain to comfortable or at least reassured and reappointed for the treatment. So that's always been my practice philosophy. Pain is something that needs to be addressed no matter whether you have money or not. With antibiotics and expensive as they were then, you could get somebody, palliated and comfortable very quickly. I've been in dentistry a long time and when I was appointed as the Dental Director of the PAINS Alliance, which was a consortium that got together because of the chronic pain and the opioid crisis. The chronic pain patients needed their opioids and so this organization was organized actually to try and make chronic pain a public health initiative. The forward thought thinker that appointed me as the Dental Director knew about TMJ because I treated her for TMJ actually. So she knew that dentistry was involved in chronic pain and I was in Washington DC probably in 2013 with all the Wong’s. And of course I was the only dentist. Again, I'm used to being the only, but there were all the medical people and they kept saying over and over again, the top ten reasons people go to the emergency room for pain, one of them was toothaches. Like that's just crazy. You and I both know that's crazy. And so I'm sitting with all these, I call them the alphabet soup groups, because I can't even tell you which initials their groups were, and talking with all these really smart people from all over the country, and starting to learn more about telehealth. And the light bulb went on. Why anybody goes to the emergency room for a tooth ache, I don't know. In 2014, the American Dental Association came out with the huge research that, two point two million people went to the emergency room for tooth aches because the ACA had started and people thought they had insurance and somehow thought the emergency room was going to take care of this toothache. And then it was one point seven to two point two billion dollars spent in emergency rooms in the United States on oral codes alone. And I'm thinking this is crazy. Now you and I again know that dentists have been doing telehealth since the beginning, since 1848 when the telephone was invented. Telehealth, I remember when they first came onto the market, people go, how can you do a doctor visit on the telephone? I'm sure since you're still wet fingered, you've had those two o'clock in the morning call saying, Doc, you know that tooth that you said was going to hurt me, it's killing me. It's like, who is this trying to find? Who am I talking to? Well, this is Joe and you told me a couple months ago this tooth was going to start hurting me. It's killing me right now Doc, can you come in and do something? It's like, it's two in the morning. Well, I know I just got off work Doc. No, you need to take two aspirin, and I'll see you at my office tomorrow morning at nine o'clock. So dentists have really been doing TeleDentistry since the phone's been around. And so has telehealth been doing telehealth since the phone's been around. So I call it a perfect storm. Telehealth is growing massively. People are going to the wrong place to see a dentist. So we could virtually put a dentist in all the places people go seeking help. We could put a virtual dentist, there's not enough dentists to have every emergency room staffed with dentists. My patients that are pharmacists, say people come into the pharmacy all the time going, oh my god, my tooth's killing me, what should I do? And the pharmacists are like, you should go to a dentist. People are going to the wrong place, the wrong time with tooth aches, and if we had a virtual dentist at those locations, they can have the right specialist take care of their condition and talk to them. And then our program gets them into a dental office, to be treated for the condition within twenty-four hours. We know that standard emergency room procedure is, if a person goes to an emergency room for a toothache, they're a level one emergency, which is the low acuity need, and they may sit there for four hours because the heart attack, the stroke, all the higher acuity need patients are going in ahead of them. Then when they finally get to see the emergency room doctor, they're given a prescription of narcotics and are told go see a dentist. And so if they're legitimately trying to get this taken care of the next morning, they'll call an office and one of the front desk people will say, I have a new patient exam available in three weeks, will that work for you? And if you have a toothache, you're not going to be able to make three weeks. So they hang up the phone, they try the next office and go, oh, I could squeeze you in next week, Friday afternoon at two o'clock. And again, you're dying of a toothache, click you hang up and if you legitimately are trying to get an appointment, you can't get an appointment because you're not a patient on record anywhere. So, statistically they chew through their narcotics and twenty percent of the time they end up back in the emergency room for the same tooth, the same complaint twenty percent of the time. Between nine and $1,200 a visit, for someone to be seen in an emergency room for a toothache. And that kind of cost is really wrong. So we're disrupting that cycle. We're trying to put it, we're putting a dentist so they can talk to a dentist, get on a palliative kind of treatment. Many times as you and I know, the pain is, it's cutting my tongue. I broke my tooth and it's cutting my tongue. A dentist can tell them to go get that filling material at Walgreens and pack it in there so it doesn't cut their tongue. And then we get them into a dental office in their area based on their insurance, based on their convenience and location and their schedule the next day, knowing that pain is a pretty motivating factor. So the cycle is broken. They don't have to go back to the emergency room for care. They're in the right facility. They're at a dental office, they're seeing the right professional. And hopefully our goal is dentists is they end up with a dental home and they stay there so that that cycle for them, is broken and they now have the right place to be. And that that's how it all. So then, you know, going with telehealth where we have an app for teledentistry and that's how we got started.

Howard: That is amazing story. I call this dentistry uncensored because I just tell the truth and a lot of dentists they want it all sugar coated. But I want to punch our profession in the gut. Man went eight and a half percent of emergency room visits, are orodontogenic in origin, we're not doing our job. I always tell people out here in Phoenix, Arizona, if you come down here, the people that always get injured, are always tourists. They are never the locals. Only the tourists goes, it's hundred and fifteen degrees and decide they're going to climb a mountain, you know Camelback mountain, with eight ounces of water. But you know what, if you fall off that mountain and break your leg on a Sunday, the ambulance will be there, they'll carry you off the cliff, and they’ll take you to a hospital.  It's fully staffed twenty-four hours day, seven days a week. But if you fell down on that hike and busted off your front tooth, you couldn't find a dentist in Phoenix, Arizona to treat you. And then the dentist get all mad because they keep opening up new dental schools and it's like you and I know there are, there has never been a dentist in the White House, or the Senate, or the Supreme Court, but we have four dentists today who served in the Congress. Every one of those dentists, will tell you that dentists get zero sympathy because they average income of $175,000 a year and you can't find a dentist after five o'clock or on weekends, when you knock your front tooth out, and they are eight and a half percent of emergency room visits. I mean, we're clearly not doing our job. Do you agree?

Maria: Well, I am the answer, we're the answer to that and we're clearly not doing our job when a hundred-and-twenty-five million people did not see a dentist in 2015. Forty percent of our population did not see a dentist.

Howard: A hundred-and-twenty-five million in 2015?


Maria: Yup.


Howard: Why not? What's your source on that?

Maria: I have, I can send you sources. I have stacks of research.


Howard: I wish you would post some of these stats on Dental Town because the dentists need to see that, because they're like, why did Phoenix Arizona open up a new dental school? Hey dude. Maybe because there's no dentist open on Saturday, Sunday or after five o'clock. Have you ever thought of that? 

Maria: Absolutely. So not only are we there for people in town, but it's a perfect opportunity for people that travel, because if you're not a dentist or patient of record in a town, you're not going to get in or get seen either. But we can palliate. And we based on our reputation, get people into an office within 24 hours. If it's a Saturday night,  maybe Monday morning, but we at least have the opportunity to have the have them cross that barrier not being seen. So it's not only the emergency room tower, but it's also one of my biggest stands is since the year 2000, the Surgeon General called that primary care providers must integrate oral health into their practice because people see their primary care provider more than they see their dentist. That was in the year 2000. Then the Academy of Pediatrics said Primary Care Pediatricians must incorporate oral health into their primary care practice. The Academy of Family Practitioners, and it was Christmas eve of 2015, came out with a mandate recommending that all primary care practices have an oral health component in their practice, because of the statistics of people seeing their primary care provider more frequently than they see a dentist. It's supposed to be a program of prevention, discussion and referral. Do you know how many primary care practices are doing that now? None. Because doctors don't want to do dentistry. We have a primary care app that can be on a tablet in an exam room. And here's how I describe it for the primary care doctor, the assistant seats them in the room, they're sitting there with the tissue paper wrapped around them with nothing to do while they wait for the doctor. The discussion is, have you seen a dentist in this past year? And the answer is no. They get handed a tablet and we have a whole oral health program that does a risk assessment, a discussion with the patient on risk benefits in the way that improving their risks for oral health disease. We can refer them to a dentist if they don't have a dentist. And then we train the staff to do oral varnish on the patient before the doctor even gets into the room. And that there are codes, medical codes  that can all be billed out to their medical insurance, not their dental insurance. And then again, our goal is to get them into a dental office in their area so they have a dental home. That's another component of what we're doing, is we're providing that care in primary care offices around the country and there's two-hundred-and-seventy primary care offices around the country. And statistically people see their primary care provider once or twice a year. Statistically, we're still talking about the hundred and twenty five million that don't even go to the dentist.

Howard: So, how do my homies getting involved? Your website is How do they download that app?

Maria: Absolutely. So here's what we're looking for. I do speak to telehealth organizations and speaking, and I say telehealth has broken down barriers. We're about twenty years behind telemedicine right now, in teledentistry. Only six states have telehealth laws. And in those states they've done the, I call them with a one off where a dentist will buy a camera and send their hygienist out somewhere on a satellite. The camera or the x-ray or the Nomad takes x-rays, and that can be sent back to the dentist’s office. So it's really a practice builder. And if you Google teledentistry, that's what you're going to find the most of. But only six states so far have laws that allow a hygienist or practice off sites.

Howard: What six states are those?

Maria: Oh California. I again, I will have to send you these.


Howard: I wish you would start a post on Dental town. There's a quarter million people. Just start a post is called Notes from Teledentist or something.


Maria: I will do that. So how can people get involved? We have to have dentists licensed in every state, because we are doing the practice of dentistry just like you're talking on the telephone, but we have a health history review that they'll get on the video. So it's a video conference with the patient. They'll get their health history, their dental, their chief complaint. They're little demographics of where they're living and then they can have a consult with the patient, but it's a patient in the state that the dentist is in. So we need more dentists that want to be involved and can actually, Arizona is perfect. There's a lot of retired people out there that want to still earn some money and they can work from their retirement home and talk to patients in their home state. So if a patient's calling from Mississippi, a Mississippi dentist will talk to that patient. So we're looking for dentists to participate with us. A new grads can earn a lot of extra money. You can earn over $800 a shift basically working with us. So on the contact at the back of our website, you know, have everybody contact us and be interested in more patients for themselves. Being a teledentist, we'd love to have that, we're looking for investors, and we’re looking for all kinds of things to take this to the level of teladoc. Do you know anything about telehealth, Howard? 

Howard: No.

Maria: Teladoc started in 2004 and is now the biggest telehealth company in the world and they have over thirty million members that talk to a doctor through teladoc. Their CEO, co-founder Gary Wall, is working with us as our CEO. So he's taking teledentistry. I told him if he can do for the teledentist, what he did for teladoc, I'll be happy with thirty million members. We're also talking with them and our goal is to be the dental provider for all telehealth companies and it is stated in telehealth that one out of five visits next year will be done through telehealth visits, not going to doctor's offices. Now, we will not be taking patients away from practices. Teladoc had a lot of fights because the doctors thought they were taking patients away from them by treating them on telehealth. Our goal is to put patients in doctors and dentist offices. We believe that we'll never run out of a population of hundred-and-twenty-five million. We'll never run out of people to work with even if we start getting them into homes. So our goal is to get people into the dentist offices around the country and be part of the team. 

Howard: That was just amazing. So how is it taking off in medicine?


Maria: Well, we are in negotiations with, there's three top telehealth companies right now. We're in negotiation with one of the top companies to be their dental provider. We are the first, so we want to land grab and actually we have a foot in the door with the second, American-well is a huge company. We're talking with them and we're trying to again say integration of oral health has been mandated since the year 2000 by the Surgeon General and we are the tool that medicine can use to integrate oral health into primary care. And Aetna, I will put this on your site too, Aetna and Columbia University, did a study in 2006 that showed integrating oral health and to prior, into their chronic disease patients, reduced medical cost by 12%, which is dramatic. Reduced risk factors for chronic disease patients by 27%, reduced premature and low birth weight babies by 35%, by integrating oral health in these patients' care. Do you know the cost savings of not having a premature baby born in taking that baby to full term? The medical cost in the long term, not just the immediate but the long-term medical cost savings of getting that baby to go full term and when you have grandkids, but statistically that baby will be at medical risk for the rest of their lives if they're born early in low birth weight so that, this is the things that drive me crazy. That study was done in 2006. Have insurances mandated they integrate oral health into their medical care? No. These are the kinds of statistics. If you look at the statistics, it is staggering the improvements in health by  integrating oral health into primary into care. But we're still not mandating it. We're still sort of the, it's a big soap box for me to say this needs to be done. I talk to hospitals all the time and, nursing homes, so the skilled nursing facilities are required. They have dental services that are required by Medicare in order to be in compliance. Do you know that Aspiration Pneumonia, is higher with people with teeth than it is with edentulous patients. If you think about a bolus of food, you would think an edentulous patient can't eat, chew their food as well, so they'd get more bolus of food down their lungs. However, that bolus doesn't carry the flora and the bacteria that’s on the teeth. So that the edentulous patient has less risk of Aspiration Pneumonia, which is a huge reason nursing home patients are taken to the emergency room, and die, and are hospitalized. And it's just a matter of oral hygiene in nursing home facilities as well. So there are so many avenues as you and I both know, that dentists need to be present. Oral health needs to be a primary important part and I'm pushing it as hard as I can. 

Howard: That is amazing. Who was our American Dental Association Executive Director, of like ten years back in the day? Was it Brenner or what? What was that guy's name? It's not the one now. Good old Irish girl, Kathleen. O'Laughlin, and being a 100% Irish and 100% dentist, I'm so proud of that. The ADA has an Irish Kathleen O'Laughlin. I just hope she's an alcoholic to just make us look good. 

Maria: Well I hope she's not.

Howard: They have fears that maybe she's a teetotaler but who was that guy? it was for like ten years and he was like Brenner. But anyway, he works now, he's a Dental Director, and I was lecturing in Florida to like three hundred insurance executives. And he was up there talking about the oral health continuum. He said, you know, the money's the answer. What's the question? He said when teenage girls have gum disease and drop a premi, it's a million dollars. They said where the money's going to hit the road right now is all these insurance companies like Aetna and all these big companies, they can't afford to have your periodontal disease kick this baby out early, and they are desperately with algorithms, and everything they can, trying to figure out this in all the continuum. Because they have rock solid data that gingivitis and gum disease is one of the leading causes of premature delivery. And what have you heard on that subject?


Maria: No, absolutely. That's the Aetna study that from '06 that showed that 35% reduction in low birth weight and premature babies. Aetna itself did that study. But nobody's still doing anything to impact that and change the dynamics of where our insurance money should go. It should be in prevention. And it's absolutely, I brag about Cuba, only because my daughter was and all the public health people say that Cuba has the best public health program for prevention in the world. And do you know why? Because that's the cheapest form of care delivery is prevention. There's statistics on children entering school with decay, and decay and missing teeth are better than ours. And there, they mandate that the people go and they make them go. So that's a whole different story. But the reason they have such a huge preventative program is they have no money to treat them if something happens. I mean they don't have the technology to treat somebody if something happens. So prevention, they realized is the cheapest and most effective care. We need to switch the dynamics of care, to the prevention, to the primary care docs practicing the prevention to getting people into dental homes for cleanings and hygiene. And that is our goal, to get people away from the urgent concept of dentistry into a home where they can be taken care of for all of those factors. So it's the statistics speak for themselves. Now we need to act. And I did talk with someone that was a researcher who, he was actually presenting on diabetes. Do you know, you just can't get your, A one C's under control if you have, gingivitis is an infection. So diabetics themselves need to have a dentist and an oral health program to keep their, A one C's under control, which would again reduce their diabetic retinopathy and all the things that go wrong with diabetes because they're out of control. 

Maria: So the teledentist and I'll just keep on that, keeps people informed. We have a prevention program, we have an acute care type of program. We put dentists where patients go inappropriately to seek help and they get the right specialist. One of my true stories is while we were developing this, Howard, again, I was at the office and a young man came into the chair and he said, "I just woke up in the middle of night and the roof of my mouth was burning and I thought I was going to die so I went to urgent care and urgent care nurse said, I don't know what's wrong with you. You should go to the emergency rooms." So $125 urgent care visit. Then he got to the emergency room, the ER doc went, "I don't know what's wrong with you. Let's do a cat scan." And so cat scan isn't going to show anything, so $2,400 later he shows up in my chair going through all these myriads, four days out and he had a primary herpetic lesion, primary herpetic infection. If a dentist had said, tell me what's going on, tell me how you feel, what's going on with you and started him on antiviral day one, the sequelae of the disease would have been three or four days. Day four, it's not effective anymore. So this guy had to suffer for ten days, but we finally said this is just a viral infection and he's $2,400 out and suffered with the disease for ten days where the right specialist could have gotten him on antivirals and he would have been better very quickly.

Howard: In Phoenix that CAT scan would be six thousand.

Maria: Uhmm, yeah, exactly.

Howard: Not to mention the radiation dose. Do you have an app that you can download right now in the app store? 

Maria: No, right now we are wholesaling right now to telehealth companies. So right now if somebody wants to get through the tele dentists, we are talking actually this afternoon about going direct to consumer. So it will be on our website, direct consumer that people can go to that website, click on and talk to a dentist. But currently we're wholesaling to telehealth companies and businesses and then they implement our care. 

Howard: Are you getting much help from any of the four dentists that are serving in the United States Congress from Arizona, Paul Gosar. There's one from I believe Idaho, Georgia and Texas, any of these guys helping you?

Maria: I haven't contacted them being a pretty independent person I haven't found dentists are the most open-minded, broad thinking kind of people. (inaudible 37:59) No, again I retired from my practice January 1 to make this full core press to get this going this year and really find, and we'll call it the lowest hanging fruit or telehealth companies, because I don't have to explain to somebody what telehealth is, they know what telehealth is. They have all sorts of specialists working with them and we will be there other specialist working with them. So we're trying to hit the low hanging fruits right now so we can get some real energy and synergy going with the company and then it's onward and upward. I know legal wise and all that we have barriers, but what I tell telemedicine people is they've knocked down the barriers, we're not going to be twenty years behind them in care we're riding the top of the wave of what they have done and we're going to get there at the same time because they've done a lot of the legwork of making telehealth a national agenda.

Howard: That is so amazing. How does it feel to be a pioneer in this?

Maria: Yeah, it's a lot of work. I thought opening a dental office was a lot of work, Howard, and I guess back then my inexperience with opening a dental office and business I do remember the challenges. Of course, it was a long time ago of how hard I thought that that was, but this is a lot of work as dentists talking to health care professionals, we still have that barrier to cross that we're dentists. But it's a lot of work. I have really good people with me like I said have the co-founder of Teladoc is our CEO, so he already has done this once and he's helping us do it again. 

Howard: So what's the name of that company? 

Maria: Teladoc.

Howard: So tell us about Teladoc. W-W-W dot T-E-L-E-D-O-C?

Maria: T-E-L-A-D-O-C.

Howard: Okay. Well, tell us about that. 

Maria: Well, actually, I'll tell you more about the telehealth industry that has been around since 2004. They are growing, as I say, almost one out of five visits will be by telehealth industry this year, but because employers, if they offer health insurance, they're offering insurance that has huge deductibles, maybe $1,000 to $5,000 deductible, they are adding telehealth as a benefit to cover those costs. In fact, you might need a Teladoc consult for that cough. But they're adding telehealth as a benefit for people and it's also a benefit for people that don't have health insurance, but there are a myriad of things that they cover. It's mind-boggling how many things you can talk to a person about, understand what's wrong with them and get them the prescriptions that they need and get them back to being healthy. 

And again, the goal with telehealth is to keep people at work. They may be talking to their Teladoc on their computer at work, but instead of taking time to take off, go to the doctor, wait, get an appointment, et cetera, et cetera, they can click into their Teladoc and have a video conference with the doctor of many specialties and now dentistry as well. So that really is a benefit and I tell healthcare providers that there's a lot of things people take off work for. How many times have you had a mom or dad take off a half a day of work, drags the kid in from school, takes the kid out of school to find out, is this tooth supposed to be loose because it's a ten-year-old and they thought they'd lost all their baby teeth. I mean, things that don't need to actually have a doctor visit, it's, “Yes, that's a normal tooth to be loose and the child will be fine,” and educate the patient and the parent on simple things like that. (inaudible 41:54) lesions, it's killing me, I have an ulcer and my lymph node hurts on this side. Does that really need to take a day off to go to try and find a dentist that will see them? And the answer is, not really. So there's many, many things you can talk a patient, not having to go into an office, just by getting the consultation with a dentist. 

Now again, I tell people in medicine, people are afraid of two things at the dentist, how much it's going to hurt and how much it's going to cost and being able to have a video conversation with a dentist is not threatening. People won't start sweating because they have anxiety about talking to somebody like you and I are talking. And then our dentists are trained to be very patient-centric. We're taught at UMKC to save the tooth and make sure that you get the root canal and crown and all the ideal dentistry. That might not be what's best for the patient and that's where our patient-centric conversations go. “What can you do? I haven't been to a dentist in X years and no, I don't need to save this. I just want this yanked out,” and that may be the best option for that patient. We also provide a discount dental card if they don't have insurance. They do have some money, but they can sign up for the discount dental card and if we're in areas that have a high population of people that would be calling that really have no money at all, we try and channel them to safety net clinics where they can actually- Our goal is patients take this pain moment and follow through and get the care that they need to eliminate the infection in their mouth, feel better, and then hopefully they'll move on to taking care of their mouths. 

Howard: Well I always said that when Jobs came out with the smartphone, when they merged the iPhone or the phone with the computer, I said it's going to be the world's greatest century. I think from 2007 to 2107 will be human's greatest century. And the first thing it's killing is nationalism because the internet doesn't know borders. So when you're doing teledentistry, does it matter if the doctor’s from Canada or England or Australia? Do you see teledentistry and Teladoc and all that stuff kind of being international?

Maria: Absolutely, in fact, Teladoc just bought a telehealth system in Spain. Now as we've talked to people in different countries, of course, I believe that they'll have dentists and doctors in their own country that will be answering the calls because the cultural significance of healthcare is different for everybody. Now every culture has a different demand for healthcare. Look at the British people and their emphasis on oral health, so we know when we go, not if, when we go to different countries, we will have it staffed with people in their own country that are trained because it's a different magnitude of culturalism and healthcare. Here, you go anywhere in the world, they’ll say you're an American because you have white teeth and straight teeth and perfect teeth. It's either your tennis shoes or your teeth that will show that you're an American, right? So it's different in different parts of the world and yes, telehealth is happening around the world, and yes, we are talking with other countries about incorporating this; there'll be a British dentist for the British telehealth system. 

Howard: Well, the dentistry is very different in Ireland because the Irish, when they swish with Listerine, which is 27% alcohol, they don't spit it out. They just swish and swallow. Only the Americans waste all that alcohol. I want to switch gears, Invisalign, because I mean you're the top 1% Invisalign provider. You're talking to a bunch of dentists who probably have never even done a single Invisalign case. What are your thoughts on Invisalign? 

Maria: Well, I love Invisalign. I was an early adapter for Invisalign. I did GP ortho, I've done a lot of, in case you haven't figured this out, innovation so I love incorporating orthodontics in my practice. I loved it when I had another tool that was Invisalign, so I'd still continue to do fix and functional appliances and Invisalign. But to me it is again, your patients love coming in. They love the results. They love what's happening. They're happy when they leave, they're happy to pay for it because they're very excited. Technology is, this is what I teach when I do Invisalign instructing, is how you move teeth basically, and I'll use my hands because I talk with my hands a lot in case you hadn't noticed that, but you move teeth by pressing on them, pushing on them and it's the pressure that moves the tooth. 

So it's the osteoclastic activity on the side of the pressure and the osteoblastic activity on the side of it being moved so that you can move a tooth by pressure with a wire, by pressure with plastic. As long as you know how to move it, how much to push it and where to move it that's the professional side of it. But you can move a tooth using any of those tools and Invisalign's another tool or doing orthodontics and it's one that people really love. The patients love and I love it. I've done it since 2002 and I’m still actually finishing cases, even though I retired, I want to see all my cases to the end, so I still see patients once a week to finish their Ortho. 

Howard: So you know Invisalign's doing teledentistry really because they bought 17% of Smiles Direct Club and they're opening up spa's where somebody will scan, send the scan to Costa Rica and then mail the aligner straight to the patient. What do you think of that type of teledentistry where now they'll be doing orthodontics without even a doctor involved?

Maria: Well, I would love to incorporate teledentistry into that because unsupervised and I've again done Invisalign where you were taking impressions and professionally trained assistant's impressions didn't always turn out correctly. So having a patient take an impression in their home with their putty and then sending it off to me it harbors risks factors that I would not want to integrate. Aligners not fitting patients, not wearing them, I would love to and probably will talk to them about making sure that they have at least a teledental consult with the patient every six weeks so they can visualize that something's going along correctly, but yeah, I hesitate sending a patient out. I wouldn't send a patient out to drill their own tooth either, but I think that's fraught with a lot of risk to not have professional supervision. 

Howard: Have you talked to the CEO of Align Technology, Joe Hogan? Have you told him these thoughts? 

Maria: No, I haven't, but I'd love to.

Howard: I'm trying to get him on the show. I have a bunch of homies in San Fran, I even know who his dentist is. He's my patient. I've been trying to get him on the show. I think a lot of people are afraid to come on the show. I know I got turned down for a podcast yesterday because they go, "Well, we're in the middle of a legal suit and you know about that it's on Dentaltown and my lawyers say I can't come on your show because they don't know what I'm going to ask you." But Joe Hogan, if you're listening to this, it just is what it is. It's like dental insurance a lot of dentists think that dental insurance companies are evil. It's like, dude, you pay the American Dental Association a $1000 a year and they've never sold a dollar of dental insurance. And then these dental insurance companies go to employers and sell some $19,000,000,000 of insurance a year, just Delta only nineteen billion a year and you call them bad names. Why don't you get the ADA to go sell $19 billion dollars of dental insurance to you? 

So I want to have a gentleman conversation about this, but it's interesting because I think that if you're international listening to this, saying the United States of America is as irrational as saying the EU because you can't compare Germany to Greece. You can't compare Spain to Portugal, to Denmark. The United States is really fifty different state countries flying under the same flag and I am predicting that some of these states, attorney generals are going to go crazy on this Smiles Direct Club because you know the orthodontist are talking to their local representatives and they're saying, "Are you telling me that my nineteen-year-old daughter could go to a mall, get scanned, that x-ray sent to Costa Rica ... invisalign." What if she's long face, a wide angle, I think an attorney general is going to go ballistic on this. Do you think so?

Maria: They already are. There are multiple state lawsuits because really they're providing dentistry without supervision so there already are multiple lawsuits against Smile Direct. 

Howard: Yeah, so Joe's got a distinguished career, man. He was the president of GE Healthcare for a long time so from what, president and CEO of GE Healthcare from 2000 to 2008, he's got to be a sharp guy. Ryan, any luck getting him on the show?

Ryan: No.

Howard: No, no luck. Come on he went on Kramer. Kramer's a short fat bald guy. How could he go on Kramer? I mean, my gosh, what does Kramer got that I don't have? He's got a belly, he's the same age, he's bald, he's insane. Yeah, Ryan said he just went to the mall and there was a Smile Studio, which mall? The Chandler?

Ryan: The Chandler Fashion Mall. 

Howard: The Chandler Fashion Mall and Brooke Fulham, is that the ...?

Ryan: Brooke ...

Howard: Yeah, so she's not even a dental assistant, she gave Ryan a card, Brooke Fulham, Smile Associate So it's going to be interesting because we're talking about teledentistry and what is it going to be in teledentistry when the people do it all from India, which I've lectured in India several times and their dentists are vastly superior to our dentist. Dentists don't want to hear that in America, but the bottom line is when you apply to dental school today, how many total dentists are applying for how many total seats? What do you think it is? What do you think the ratio is?


Maria: Well, I don't know.

Howard: Three to one, four to one, five to one?

Maria: Yeah, probably maybe five to eight, a lot, that are accepted versus being accepted a lot.

Howard: And I went to India in New Delhi and this one dental school accepts fifty students a year and every year they get fifty thousand applications. So in India when you're trying to be a dentist if you had one blemish on your life, you wouldn't have a chance so when those dentists and physicians and cardiovascular surgeons when they get accepted into Indian school, they are a cut above the cloth. I mean hell, it's just pure math and so I imagine teledentistry and telemedicine, especially on hours after 5:00 and on weekends it's all going to be run by dentists and physicians in India and they're going to be amazing. So having dentists and physicians doing teledentistry licensed in India versus the United States, Invisalign, doing Invisalign without a doctor or an orthodontist. We're in fun, strange times. These are all new boundaries, aren't they? 

Maria: Yes, yeah absolutely. I know Invisalign owns part of Smile Direct and I was not very happy as a provider when I heard that. It's basically, and again I'm so old, Howard, I remember when one of my reps came in with Crest white strips and they told us, "Oh," this is when whitening came around and they said, "oh this is never going to go direct to consumer. This is only going to be sold in the professional offices where it's under control." And I laughed because it was such a great product and it was direct consumer probably in three years. So direct to consumer has a lot bigger market, so people that are selling them want direct to consumer, but I think that we need to make sure that we understand what is being done and tooth movement is dentistry and that needs to be done by a professional. 

Howard: Yeah, well I asked my orthodontist friends about 20% of their cases, every Orthodontist I talked to you, it's about 20%. So in the Orthodontists mind, they still need fixed four out five times and so that one thing that I have concern about these molds doing Invisalign. How could all of your cases be Invisalign when all of my Orthodontist friends only use it 20% of the time? So it's going to be strange and also there's a lot of pushback against state boards like Ted Cruz, one of the most powerful Republicans in Texas, he always says that state boards are just Cartels ran by their members to eliminate competition and the courts in, was it North Carolina or South Carolina, where the bleaching case when all the way to the state supreme court and they told the dental board, well, you're just trying to protect your income. There's no reason you need to be a dentist to do bleaching and all that stuff. So we're in strange times and it'll be really interesting to see all this stuff plays out, but this is America so at the end of the day money's the answer, what's the question? 

And I got to say one shout out to the millennials when you graduate $300,000 in student loans and say, well that's why I'm not going to be a member of the American Dental Association. Well, if the millennials unfund their only representative at the table then they're taking their $300,000 investment in becoming a dentist and flushing it down the toilet because, in America, America has more lawyers than physicians. So when you're in a country that has over one million attorneys, and the only reason I have paid the ADA dues forever is because I see their legal battles here at the state level at Arizona. When I talked to the Arizona executor director, Kevin Earl, I mean, basically he's a full-time lobbyist. That's all they do is work for the state government and if you've seen the laws that other people are trying to push down to you, so this is America. It's not about truth, liberty, justice, the American way, it's about money's the answer, what's the question? And if you're not going to sit down and battle it out with the attorneys in Washington DC and at your local fifty state level then the profession of dentistry will be sold out to DSO's, publicly traded align technologies', the whole nine yards. And it's just the way it is. 

Maria: Absolutely it is and actually since you said millennials it's kind of interesting statistically, which takes me back to the teledentist, but most people think the only people that go to the emergency room with toothaches are poor people. I mean every time I come to discussing this with anybody, it's like, "Oh yeah, those poor people." It's like, "No, no, no." The statistics are millennials are 60% of the population that goes to emergency rooms for any condition and it's because they're in the, I want it here and now immediately mindset, and so they've got a problem they want it solved and they're going to go get it fixed. And that's their mindset and the millennials, again, it's statistically a third of them have private insurance, they just never had mom or dad say go to see the dentist. So they've had this insurance all along and then suddenly they have a crisis so they head to the emergency room thinking it's going to be fixed and they're the perfect client too because everything's on the computer and everything's hands on. So, yeah, millennials are definitely the vision of what the ADA does, is hard for them to see because they are so in debt at this point. Bless their hearts.

Howard: By the way, not only are there are more millennials than baby boomers because last I heard ten thousand baby boomers die every single day. We're just old. My oldest son had his fourth baby last night. Actually, his wife had it, but my son was somehow involved, but the bottom line is LinkedIn I see all these dentists they're always working social media. They're always working, Facebook, Facebook, Facebook, hell half the people on Facebook probably didn't see a dentist last year. But on LinkedIn, which Microsoft owns LinkedIn, they own Skype. You and I are skyping today, they own Skype, LinkedIn, every one of those millennials has a job and has dental insurance and I can't believe people are putting all this noise on Facebook. I mean, gosh darn there's no one on LinkedIn who doesn't have an iPhone, a job, dental insurance. 

It's the most Invisalignish market there is and also when you said you went to dental school only 3% of dentists were women. Well, when you and I went to dental school all those big families, only the biggest malocclusion on a daughter where they started thinking, well, maybe no one will marry this girl because her bites off so bad, got ortho. But you fast forward fifty years now they're getting Ortho for the miniest little tooth movement. In fact, when, Ryan and I, we couldn't believe it, we were in Cambodia and we thought we were in a poor country and when the waitress found out I was a dentist, she had like twenty questions on Invisalign and her sister had already got it. And I'm sitting here in Cambodia, in Malaysia, in Indonesia and poor girls in developing nations have high heels and Invisalign and lipstick.

Maria: And a cell phone. Everybody has a cell phone.

Howard: I think Invisalign is a billion dollar stock and it's still a buy and it's going places because I don't think orthodontics isn't even about malocclusion anymore. It's about the smallest, minorest, tooth movement. It's more to do with hair, nails and lipstick and eyeliner than anything to do with occlusion.


Maria: Absolutely and that's where it goes back to. When I started doing fixed braces, children would cry if they needed to have braces and then fast forward to where we had colored O rings and et cetera and children would cry if I said they didn't need braces because it has become a status symbol and Invisalign's the same way. They might not be able to have a nice house, they might not be able to have a nice apartment, but they can show they're wearing Invisalign and with their lipstick, it'll enhance that and it's a status symbol and having white teeth, like I said, you know you're an American. They know you're American around the world because of your white teeth and your straight teeth. It's a status symbol as well. 

Howard: Well, you know the status symbol I was reading about by Professor Scott Galloway, from NYU Stern School of Business, is the iPhone. It's a huge status symbol to go into a bar, single, with an iPhone than Android. They put their iPhone in the same category as like a Gucci purse and Invisalign and all that stuff. You're far more likely to get a date at a bar with an iPhone than Android.

Maria: If you have Tinder on the iPhone though.

Howard: So on Tinder, Ryan, what is it, swipe left is you’re bad and swipe right-

Ryan: Yeah, right is right.

Howard: Right is right so I should join Tinder and my name will be Dr. Swipe Left. That's a good joke. I'm Dr. Swipe Left on Tinder. But so last question, I can't believe we went over an hour by ten minutes. You and I are both UMKC alumni; are they helping you in any way on all this? 

Maria: Do you really have to ask that? As a UMKC grad, do you really have to ask that?

Howard: I do.

Maria: No, they're not. Not at all. Actually, they had done a study at Truman Medical Center where they had a system set up for dental emergencies. They had a card that they could give patients and they had openings in their schedules at the UMKC in the mornings for those patients and they found statistically, by getting patients in, they had a pretty good, maybe 60% would show up for the appointment and so the groundwork was laid, but then UMKC ran out of money to upgrade their software and I said, "I've got the software you need, Truman, here we are." And they went, "Doo, doo, doo, doo, doo-"  So no, no, not getting help from UMKC at this point, but I'm always hopeful. 

Howard: So who was the Oral Surgery Department Chairman when you were in school? Who were the oral surgery instructors when you were there?


Maria: Dr. Andrews. Was he there when you were there, Andrews?

Howard: No, I don't remember him. Did you have a Matt Horgen? 

Maria: I know the name, but I don't think he was there when I was there. In fact, speaking of women- So I love surgery. I was in the surgery all the time and I wanted to be an oral surgeon because I actually love surgery. So I went over to Truman to talk to Dr. Hyatt back then and he said, "We go hunting and fishing and the residents and blah blah blah, blah blah." And I'm like, "Oh no." This was a battle I chose not to fight. At that time in '81, there were zero women oral surgeons in the United States.

Howard: Wow.

Maria: So I just went, "No, I'm tired. I'm not going to do this."

Howard: And then you remember Brett Ferguson?

Maria: Oh yeah, he was in my class.

Howard: He was in your class and now he's president of the American Association of Oral and Maxillofacial Surgeons. 

Maria: Yeah, he's a good guy. I still see him socially and he's a good guy. He and Rita, his wife, we see them occasionally and yeah, he was in my class, aha.

Howard: Well, tell him I'm trying to get him on the show. 

Maria: Well, I will. You know he's a busy man. 

Howard: I know, I'm sure he's not going to come on the year that he's the president of the American Association of Oral Maxillofacial Surgeons. But man, I love that guy. Talk about a walking encyclopedia, you could ask him any question under the sun and he would just look you right in the eyes and tell you the answer and I just remember standing there when I was a kid thinking, how does that guy do that? And Charlie White, remember Charlie White?

Maria: Yes.

Howard: What I love the most about the UMKC oral surgery is these kids come out of school from these private dental schools three/$400,000 in debt and they tell me they've pulled like one molar and did one molar and crown. What I loved about UMKC oral surgery is that you could there and pull all the teeth you wanted all day, every day because they had a pain clinic and there was always a waiting room full of people and whenever you couldn't get the tooth out, you go ask the oral surgeon. (Mithias? 01:06:24) always says, "How long you been working on it?" I said, "Like fifteen minutes? He says, "Well, come back after you've worked on it for half an hour." And then after a half hour, you'd come back and he'd looked at it, but it was so cool because by the time you got out of UMKC I mean I had pulled hundreds of teeth. When I graduated, I literally thought I was fearless. I thought I could get anything out just because the oral surgery department was so good and now all these dental schools are sending all their endo to their Endo grad school and they're sending all their extractions to their oral surgery post grad deal. And I tell these students that if I was picking a dental school, I'd pick a dental school that didn't have any graduate programs because you want to do the molar endos. You want to do the extraction. You don't want to have everything taken away from you because they're trying to keep the grad students busy. But we went well over. Hey, the only reason the shows a success is because I'm able to get people like you to come on. 

Maria: Well, thank you.

Howard: Maria, thank you so much for coming on the show today and talking all things teledentistry and Invisalign. And if you see Brett and Rita tell them to come on the show.

Maria: I will.

Howard: And next time I'm in Kansas City we'll have to go get an Irish shot of Jameson somewhere. And good luck to you on all your teledentistry endeavors. 

Maria: Oki Joe's Barbecue I market that and bless his heart, Anthony Bourdain said it's one of the top thirteen places in the world you have to eat before you die.

Howard: Is that right? What's ...

Maria: RIP. Oklahoma's Joe's.

Howard: And where is that out in Kansas City?

Maria: It's in a gas station on 45th Street and they've now opened one in Johnson County that's a real restaurant, but it's in a gas station on 45th Street, right close to KU. So next time you come into town let me know and I'll take you there.

Howard: Alright. What did you make of that Anthony Bourdain deal? Wasn't that bizarre, that a super successful guy on top of his game because when you and I were at UMKC dentists used to say they had one of the highest suicide rates. Even though now it's by far the military, I mean these guys going back so dentistry isn't even  ... but remember back when they used to always say that dentistry always had a high suicide rate?

Maria: Yeah, absolutely and I used to tell my patients when they'd complain, I said, "You know dentists have one of the highest suicide rate and you're one of the reasons why." That was one of my lines.

Howard: Well, do you see any parallels between Anthony Bourdain and dentists because in Phoenix, every year one or two or three dentists offs themselves and they're always rich and successful and a nice house and a spouse and it seems like everything's perfect. And then he offs himself. Do you see any parallels between Anthony Bourdain and dentistry, suicide rate?

Maria: I think that perfectionism is a sickness really and I think probably he was the same. He was just trying to attain something unattainable as unfortunately they drill literally into our heads as dentists to try and attain an ideal anything with a tongue and saliva in the mouth is ridiculous. So I, I think it's a mental illness that's pre-set for people that are either OCD for dentists and looking for the ideal in life that's not attainable and not being able to sit back and appreciate what's around you. It's really sad.

Howard: I know and I always tell dentists when you go in and find that dentist who's always running late, it's because he does this MOD filling and the contacts not quite snappy, perfect. And it's like, dude, this person hasn't even flossed their teeth in five years. You're running late because you care more about this filling than the patient does. And I always said don't care more about your dentistry than the patient does. Like if you came into me I would do a world class perfect filling, but when you're in Phoenix, Arizona, and people have been coming in for five years and you're trying to do a filling with bleeding gums and all this stuff, you're just getting it done.

Maria: On a tooth that needs a crown anyway.

Howard: So yeah, so why are you running fifteen minutes late redoing a filling on a person who doesn't even care about their own health? But, yeah, interesting.

Maria: We think a lot alike.

Howard: But on that note, thank you so much, Maria for coming on the show. 

Maria: Thank you.

Howard: And remember her website is Have a rocking hot day.

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