1123 Richard G. Stevenson III, DDS, FAGD, ABOD, Founder of Stevenson Dental Solutions : Dentistry Uncensored with Howard Farran
Milo by I have a treat for you. Today. We are gonna podcast Richard grey. Stevenson, the third dias. He has his bachelor's degree in chemistry from UCLA in nineteen eighty-two is Dr surgery from UCLA Eighty-six after practicing general dentistry for seven years in Laguna gal, California, he accepted a fulltime teaching position at the UCLA school of dentistry as an assistant professor in the section of operative dentistry for four years. He served as chair of the preclinical operative, dentistry course, reoffered a comprehensive illustrated syllabus of operative dentistry. Dr Stevenson has been recognized by students on five occasions as teacher the year and has received numerous additional teaching words from twenty different classes students. He also receives the UCLA academic Senate distinguished lecturer award for non Senate faculty thousand three in two thousand ninety receive the ADA distinguish golden apple teaching award at both the pre doctoral and post. Octo categories in two thousand five received a fellowship in medical education from UCLA school of medicine. He has over PS polish over thirty articles on dental materials in the principles of evidence based dentistry and restorative techniques. Impure reviewed journals including operative dentistry evidence based at ustry the journal of studies and restorative dentistry. Here's the co author of a book chapter on castle. Dress rations in some its fourth edition of foot of opera dentistry. The chapter on implant inclusion in the new book implants in the aesthetic zone and the chapter on complications restorative dentistry. Best practices. He has authored numerous syllable guide. Instructional guides all aspects restored those three for UCLA another schools. He is the inventor of the RG instruments a series of four calibration a- junks to assist students and Dennis with evaluating preparation parameters. He is a reviewer for the journal of operative dentistry in the ABA professional product review. He's. Member of numerous dental organizations since two thousand eighty has been the secretary of the kademi of operative dentistry where he previously won and executive councillor. Then president and a sector assistant secretary. He is a fellow the kademi general dentistry and the American college Dennis his many charter member and past president of the Orange County RV Tucker Kaskel study club since ninety two and has demonstrated cast and drug goal techniques. Internationally of both the academy of RV Tucker study clubs, the American Academy of gold foil operators in two thousand three he was appointed. As a mentor of the Los Angeles cast study club additionally, doctors evenings as been mentoring four other castes gold study clubs to Peru. One to the pre doctoral UCLA students and one in Tokyo Japan. Dr Stevenson was the secretary of the kademi of RV Tucker cast gold study club for six years until twenty eleven he is both a lecture instructor in the UCLA. Continuum the surgical and restorative implant continuum and has led numerous hands on aesthetic sessions for visiting academics. Study clubs that UCLA in abroad. Dr Stevenson is given over five hundred continuing education presentations table clinics in restorative dentistry. International, including the Philippines, Peru Japan. China Korea Canada in two thousand seventy became the fifty eighth board-certified operative Dennis of the American board of operative dentistry in two thousand six he was inducted as a member in the American Academy restore dentistry, the only other UCLA faculty to achieve this honor was the late professor Robert Woolcott in twenty eleven he was named the UCLA school dentistry alumnus of the year in recognition of his outstanding contributions to organize dentistry the school the community on the UCLA dental of nice O'Shea ocean. He is currently professor emeritus of clinical dentistry and served as chair of the section of restorative dentistry. With over one hundred faculty members for seventeen years. He has made numerous instructional videos and restorative dentistry techniques, including ceramic inlays on lays digital materials, impressions dental Thakur v. These videos have been viewed by thousands of Dennis at internationally in two thousand nine he created the two year. Postdoctoral advance restored of clinical training program. He practises dentistry in west, Los Angeles. They focus on microscope dentistry implant restoration aesthetics. He started a YouTube channel, which I love in June of two thousand eighteen and six months over seven thousand subscribers in twenty fifteen started Stevenson dental solutions a teaching into and master billing center, a dental laboratory in twenty four teen. He lives in Los Angeles with his wife savvy that I that right and savvy perfect Mike seriously. I am so honored. You Email me back and said you come on the show. I literally yelled thank you so much for coming on the show today. It's a pleasure. Our so restorative dentistry. Gosh darn. Graduated in eighty seven and hot new thing was the PFM, and we did mostly Malcolm's composites. And I when I tell you this. I don't know if you're old enough to believe this or not, but our operative dentistry instructor made a sign of ethical pledge that amalgams and gold were superior. These new fabled composites were unproven garbage. And he told us we left if you are an ethical Dutta, she'll stay away from these new composite plastic things and stick with the goal, and and my all seven of my restorations or golden lays and all lanes. I don't have a composite. So man things have changed in our careers haven't. They sure have and for the better, I think. So is gold you're out there in Los Angeles. And Hollywood Bill I've always weren't is gold. This anybody like gold restorations or that just. Dying ours. I think it's both because there's a group of people out there that are seeking longest lasting restorations than they find people like me, they can do gold's rations. In Los Angeles. Where you would think that everything is focused on the aesthetics of those max Leary into your teeth looking absolutely beautiful. And that be one shade. You'd be surprised how many of those very same patients will say okay to gold on on second molar are inlay on a first molar. So I think it has its place in dentistry, and unfortunately, it's pretty much lost its traction in dental schools at this time, very very few schools are teaching the kind of gold work United routinely when we were in dental school. Well, one of the things I go to sun dental town is that when anybody publishes a study that says poster composites last six or seven years in Magas last thirty or thirty eight years every single Dennis owner says while not Mike composites, maybe maybe everyone else's composites last six or seven years, but mine last as long as a mouth of gold. Do you? Think the average Emo de composite is last thing as long as the average MODEM album R ammo de golden layer on lay. Well, it's not what I think is what the what the literature shows us. And that simply not the case the amalgams ju- outlast, the those routine average restorations, but I think deport of your your members, and is is well taken that if they're done exquisitely. Well, I think composite restorations have very long durability and very long lifetime. But during really well means doing things like placing rubber dam means using high magnification, it means making sure that you're carrying lights are calibrated tin and properly carrying the composite the means layering techniques that means understand the clues in polishing Kloesel surface. Really? Well, I means a lot of things, and I think that. That may not be the case in the average composite. I think that the average amount of money other hand boy, it's a. It's a very user friendly material, you know, you can place it under water, even it still works. And I I have seen very average operators play some albums that last many many many years, but have a lot of trouble with composites. But after they get some education and composites they can usually play some quite well, but I think the proviso is and on the manufacturer say this and all the studies that look at composite longevity are looking out the last as long as how for example are looking at the ideal placement of these restorations. So I think that's the important for for people to realize so podcasters tend to be young about a quarter of audience is still in dental school. It seems like almost all the rest of them are under thirty. In fact, please league comment and watches YouTube leave a comment tell me how old you are what country live in or Email me. Howard dental town dot com. Tom. But what advice would you give to a youngster them? There's a big throttled dental town this weekend. And this Dennis said, he's he just graduating afraid to get a job as an associate at any of these big national chains because it just takes them so long to do an Emo de composite. So I I know what he's thinking listening to your nice thinking will you will you walk me through the raise the way, I'm asking the question is when I look at insurance claims filed of the thirty two teeth or just these four big spikes on the first molars. I mean, what's the most likely be root canal crowned extractive replace? So will you just walk through an M OD composite on a first year Muller? So you're asking me to walk through the process of how you'd actually technically do that. Yeah. Because they wanna know like name brands, they wanna know. Now, you got a lot of YouTube videos. How many how many YouTube videos, you have on your channel? I think I have about forty five right now. And and how do they what's the name of your you too, WWW dot YouTube? It's Lionel solutions. You also YouTube dot com forward slash Stevenson dental solutions. So that's the same as your website. Stevenson. Yup. By the way. That's why I called you to be able to show. I am so impressed by your YouTube channel. I mean, you just you can tell you really really put a lot of time and effort and work on those. That's amazing. So so is there a particular video in in? But you got a lot of videos on the YouTube channel. But, but but go into the deal like is there, you just go to your unique generally. Sure. Okay. So I, you know, first of all I I totally relate to the student that is concerned about working in a major chain like this because he's going to be pushed beyond his capabilities by by the system that exists in those types of practices, and I share his concern. I actually start out and dentistry the same way. I graduated in nineteen eighty six couldn't get a good associate job, the only place that was hiring was more of these corporate large dental practices. They've been around a long time. And while I was building my private practice. I had to work to pay the bills. So I almost got sick my stomach walking these prices and seeing that I had three or. Four opera Tories with patients all in them already. And they're saying okay getting done. And then soon as I finish a patient room and other patiently plopped in the chair. And it was it was hard to do. I mean, you're used to doing a restoration and three hours. Now, you have to get done and in how short of time it just you could never be fast enough, you're always being pushed and I had a hard time with that. I really did. I was thought to myself. I'm not going to be the fastest person this clinic, but I'm going to be the best. So at least I had that. And that was my approach for those first few years when I was doing that night. I advise my students the same thing. I mean, the reality is you graduate from dental school today. Many of them have five hundred thousand dollars in debt. I mean, that's that's a mortgage payment. I mean back when we were in school, we graduate with maybe thirty or forty thousand in debt, we paid it off in five years. Now, they're paying off these loans and thirty years, and that's this. It's a huge huge burden for them. So I think that they reality is going to have to find jobs wherever they can and Mike. My recommendations always been this be the best don't be the fastest be on the verge of being fired at all times. And then you're probably doing the job right because you're just a little too slow. I think that that's probably what we should be doing. Don't get pushed the on your abilities. Now for the MD composite. The procedure doesn't have to take an hour. You can do this procedure quicker. You can is late fewer teeth the rubber dam, and I think it actually will save you time once dams in place, and then once you you've done that you just need to follow a systematic approach. So we start with our Burs we remove the old restoration restart the procedure. And then we obtain the extensions as we would in in all of our board exams stuff. We know how to do quite well, but once that's all been established. I think that we ought to use the manufacturers. Bonding agents exactly as intended. So whether you're using a fourth generation fifth generation six to seven ten ration- universal. I think that what's really important is that use it properly. I personally prefer using total etch or self edge system with multiple bottles. I like that I was raised on that. I think that that's probably the the king of the bonding agents, but whatever system the you're provided it one of these clinics or that you choose to go for would can be used quite well, if you follow the manufacturer's recommendations, okay? So the tooth is isolated the carries have been removed. You've got your prep done. You feeling pretty good about it. And that shouldn't take more than about five or ten minutes even for dental student. If you really pushed without anyone having to check every little step, you do you can get it done. Pretty quick we've done this experiment at UCLA years ago. We gave students we said you have five minutes to do a class two and. The entire class after five minutes had to get up and leave the room. And we saw some amazing preparations. It's almost a no dinking. You just get right out of business in any event. What I like to use are one of the sexual matrix systems. And there are many out there. I think that they all have different nuances. They're very expensive. So I recommend that you probably just invest in a couple of them ones that you like I like garrisons product, the fusion system is amazing. But it's quite expensive the system by ultra dent called the veering system is very very good also quite expensive. There are others that you can shop around for that are significantly cheaper than I think are quite a so once this may chills sections matrixes placed I would recommend utilizing centripetal wall technique. So the composite could be placed in the box. Then pushed over towards the band light yard, and then that band and matrix assembly can be removed, and then you have the opportunity to do the same thing on the digital side. And then you turn your class to into class one. And I have at least two or three videos showing this particular technique on my YouTube channel, and I go through each and every step this relief. You of the need to use a bulk Phil product or a tough Meyer system. You don't need to use a global composite for this particular technique, even use good micro, hybrids, nanna hybrids or hybrid resins. And this this is so predictable. Now, you've turned this class to class one. And at this point, you build up the lobes rather than thinking about pushing it in like you at a on a mouth, I'm think about building the morphology the tooth back incrementally. And usually can accomplish in about four steps. And then you've got your beautiful anatomy completed if you follow this year. Can save a lot of time in the closer jesmyn aspects of things so people say well why that's so tedious. You have all these little steps. But I'm thinking, no, it's not tedious ultimately because you're a clues is going to be closer to ideal. You're not gonna have flash to clean up. You're not gonna have blood in the way because of the rubber Dan protecting you. So I think that that this can work really really quite well, it's a system and the key is don't shortcut the system. Think about the system is being a step one through ten and we can't just do from one to four two nine two ten is not gonna work consistently for your can have problems like post op sensitivity issues, you're gonna have other dentists in your same group having to replace your dentistry. You're going to get the the stink eye of the office managers for problems like this. So I think that it's really critical that you follow a system and the thing that's amazing. Is that the system gets? Shorter and shorter shorter. But you don't skip steps. And that's the thing that that happens with continued competency with his this quest towards mastery. It's not that. You're short cutting those steps is that you're able to do those steps. More seamlessly in shorter period of time and have the same quality output. Does the what brand of composite are they all which wouldn't what buddy agent and composite to you recommend? I am a big fan of hers product called Optima on f l it is a fourth generation total edge system, and I've been using that for many many years, and I was we researched all the products that we could use it UCLA. And this is the product that we chose for our own students to learn with. And so if problems were occurring based on, you know, this product not being user friendly or issues with the students we'd hear about it really quickly. So we have a hundred students operating the clinic and in any given day, and we would see that there would be issues. So the dental school environment was a great place to this to to any proof of concept, and I happen to find this to be amazing product. It's just one extra step in the bonding procedure compared to a single step procedure. In a dozen take. A lot of time and post op sensitivity is is quite minimal the composites that I use are various and I do like three M'S products. I like the Phil Tech's Supremes. I think that they tend to be a little bit translucent for interior work in their little fussy in that respect. So sometimes I fall back on tried and true products like Hercules, x RV one of the older hybrid composites, very versatile product, it doesn't polish while in the interior. But it does provide us with the passively we need for maybe a class for restoration. Sometimes it's even good to have a couple of different types of composites. So have nice hybrid composite for building that class for restoration on the lingual. And then adding a micro NFL for the facial aspect of it for the surface. So that we can have a nicer finish. And a better looking restoration down the road. Because it's it's true that the Mike. Grefell Zanetto fills hold a better polish than the old hybrid composite materials. Well, if I have been what what is the biggest stress about an Emo D poster composite. They always say contacts or sensitivity deal. You talked the beginning about how you like the garrison fusion system and the v ring. So again, you just go back over contacts and sensitivities and those of the two biggest complaints, right? With convers first of all, you agree. That's the two biggest complaints. I do think it's exactly what's happening. And then there's about ten reasons for sensitivity to occur. And sometimes we focus on Ma-maybe. Maybe it's just the bonding material. I didn't get a good seal. But there are many other reasons, for example, you could be etching the Jason tooth inadvertently which could cause sensitivity you can leave the collusion slightly high. You can have gaps you can have like your system, that's not curing the composite adequately which leads to all kinds of sensitivity. Perhaps. You're not incrementally building up the composite. So you're putting stresses on the composite. You're not considering the C factor the configuration factor. So all of these things can contribute to to sensitivity. And I just think it's just follow. This follow the steps, you know, one through whatever step you're doing. And do it the same way every time. And I think that if you follow the manufacturer's recommendations, and like I said on my videos, I've got the Technics very well explained. I think you're gonna void sensitivity when it comes to contacts. I think that we've pretty much solve that problem with the sexual matrices and is long as you are using a good spring on these sexual matrices not a used one that's old and not doesn't have capable of providing adequate tension. I believe that these are very predictable ways of ensuring proper context is what's really key. Here is you cannot rely on a traditional Tuffah Meyer matrix system. His not going to provide you consistent contacts that we were able to achieve for example with our mountain restoration. So that was easy because you're able to compact the amalgam against the band, you're able to burnish the man it works very differently composite is much as we think it's pack -able is a very passive material. It. It goes where the walls tell it to go. You can't have composite push the band into position. The band is gonna push the composite. So whatever you set up before you start restoring his Scott to be forming a potential tight contact before you even place the composite, and I think that those are just, you know, little tips to help us with those two issues, and I completely agree those are killers. And if we finish a composite we have an open contact game over that's a failing restoration day want patients gonna complain. They're gonna get food packed in there. And then it's a barrister for us. We have to do another restoration. We have to do it for free and the patients losing confidence in us. And what's ensure that we're gonna get right? The second time. Right. I mean, so this is this is a big issue. And I think that just takes a little bit of time to make sure we manage the sexual matrices and the jeering or v rings properly and we can accomplish. Predictable inner proximal context. You know, there seems to be two strategies in dentistry, either their low cost high volume dentists are their high cost low volume, and man, I just don't think dental surgery opera, Tori is a game volume. And when I when I started hearing Dennis talking about why I don't wanna use this bonding agent because to step I wanna use only one step. It's like, can you imagine me being a fifty six year old grandpa going in for prostate surgery or a bypass then guy saying, well, I don't wanna do this better prostate surgery. I wanna I wanna use this one because it's one step slower. And so that's my trend. That's that's my. Minded guy, like us got up microscope. So which leads me into my question about bulk fill these guys say, I don't wanna I don't wanna use it to step body agent. I eat a one stop. And why would I wanna put an increment of us filled with bulk, Phil? So what what is your words of wisdom to somebody's using a one step bonding agent? Wanna do bulk fill is that is that good enough for your children, grandchildren, or no, I it Howard it isn't. And I I I laugh because the amount of time you're saving in the opera, Tori. I don't think any study has shown that has provided the patient with better service or even an equal service. It hasn't allowed you to make a better income. I don't think it allows you to sleep better night either. I think that the joy of dentistry is in our quest for mastery and our quest for excellence, and I think that's one of the beautiful things about our professionals were like that we wanna be that way. We were like that way in school. We were hungry. We wanted to learn. Learn I think that students today are very very potentially amazing dentists, I think that I'd were putting out the best potential masters right now dental schools, the educational system is incredibly good at doing what they do. The problem is once they get out of school the pressures are on in. It's very difficult to create this consistency that I think you and I experienced when I got a dental school in eighteen eighty six about same time. You did if I spent an hour on album that was the way was that was fine. I made a living. I made a good living and things were working quite well in that particular practice model today, m I slow maybe a little bit slow compared to some of the fastest operators in those clinics. But I don't think that the speed is Richard Stevenson. Go ahead. Sorry. Okay. Sorry. Videos. I'm one of you two gentlemen. Yes. But I I agree with you. I think that if you treat every patient is though where they were your spouse mother father or kid, I think if you're going to perform the best possible data street, and you're gonna see time as being irrelevant because we have to provide quality dental care for patients. So we just were rebound by that that that's an oath. We've basically taken. By the way, I'm not not the you don't need any marketing at all. I mean, you got seven you have over seven thousand scribes on each gel. But on town when you make a post, you don't you the YouTube channel share versus usual link and the next by overs in bad metric owed on dental town. You can you can click that embed and drop that embed video in opposed. So your YouTube channel is in the post in every dentist who starts posting their YouTube channels on YouTube. I mean on dental town there YouTube channel double because there's a quarter million Dennis on dental town, and my job is to point them into drug tion of great content. And I think your videos are just amazing. And I think I think you should. And if you're shy to say our told me to do this. I'm not kidding face us, Dennis guy told me to do this. But I I wish people look at your. Your YouTube channel videos because the the attention to detail is amazing. I'm going to switch gears completely talk about your journey to start. Your Stevenson dental solutions continue education center, those your journey by the way on Instagram. He's Stevenson dental solutions. And thank you so much to the twenty five thousand follow me on Twitter at Howard for an I just re tweeted, he's at Dr underscore RG S. I so that's that's his name Richard grace. He was in the third and I just retreat. I just said I added a YouTube video and by the way, it's a class to amalgam preparation. So so is a Malcolm I mean, you'd use video at amalgam preparation you're out there in LA is a mountain still alive is still a restoration out there in LA barely. Barely alive barely alive. But you know, one of the things about amalgams is that teaches us how to use our instruments and our hands. Really? Well, it's a great skills. Trading exercise, so dental schools that aren't even teaching amalgams formerly in the in the clinic are still holding their students to this to the standards of trying to achieve that ideal. Malcolm preparation. I just have one one thing. I want to remind. People when it comes. I've had the honor to lecture in fifty countries, and I'll never forget being in some developing nations. One one time it was in Tanzania and this dentist one to show me his office. And the he wanted to do you to be caused by Dennis? And he did the preparation and the patient would sit up rants and spit and a pickle ball hit. And then he would put on the asset. And during every step this this little girl leaning forward and swishing and sitting no rubber dam. No assistant, no high-speed suction. And I was looking at this. And I mean, it was at amalgam on this poor little girl probably would lasted thirty forty years. Yes. Or no suction no rubber dam, and I watched the whole procedure. It just couldn't have been anything johnke, and this poor little girl paid all this money. But what's this guy doing he's on the internet? He's on YouTube. He's hearing people in rich countries like United States and Canada and Australia. New Zealand trash talk amount. Ogm? And it's like, dude, there's all they're seven and a half billion people on earth. There's two million Bennis and over one million of practice without high-speed suction a dental assistant. And so, you know, I just I really makes the cringe when people trash talking album when and then when countries say that they should ban amalgam. It's like, well, if you've if you forced a hundred poor developing countries and got rid of their amalgam. And then those dentists are doing direct composites without high-speed suction dental chairs remember dams. What do you think would happen to the quality of that country's ministry? So so, but anyway, so white what possessed you to make the the amalgam preparation just for just good skills to no good skills. To know. I think it is a viable restorative technique that should stay alive in some way, you know, the pressures politically here in Los Angeles. Extreme not to do amalgam. Sweet. We have waterline management. We have disposal management. It is. So tricky nowadays. I don't I don't know how I think that that your feelings of my feelings are very similar about this. But what's going to change? I mean, how is it going to change? You know, you mentioned. Developing countries not having adequate technology to perform composites properly. I totally agree with that. I think that an amalgam in in those particular situations is the best procedure possible for that that little girl. It's it's sad to see this happen. I I won't say that I've completely given up. You can see that in my own subtle way. Putting out videos on him outcomes and amalgam finishing and polishing I have three part series on the large amounts, including how to finish in polish it, and that has been extremely popular video. So I think that there is perhaps some hope that it's going to stay around. But the the political culture environment is sold so very strong and social media has has really helped to. Basically put the amalgam as the least likely procedure to be done by pit that patients are going to ask for. So I I don't know what the answer is. I think that having amalgam out there and just say, hey, look, this is a possible procedure for you. This is how they look when they're done properly, and they can last patient many many years on the cover of the ADA journal. I think it was probably about fifteen years ago. There is a picture of premolar with a class to amalgam in it. And it was a close up, and it the the amalgam was done by Dr miles Markley, Dr miles Mark Lee was master clinician used to teach at university, Colorado. And he was a big fan of amalgam. And you look at the amalgam said, yeah, that's an old amount. But gosh is pretty good man is a nice contact the margin sealed it has really nice anatomy, and you can tell. It it had been polished at one point. Now, it's a little bit worse for the wear, but there's no need to replace it. And the caption at the bottom of the page said this is a this Malcolm is fifty eight years old, and I don't believe that we're going to. And I think that it's sad that that's happened. But what can we do other than try to get people to do composite better, and maybe consider albums and patients that are looking for some kind of different solution? We'll talk about your journey that led to the Stevenson dental solutions on education center, and wealth. LA I gotta tell you. I love teaching at UCLA UCLA was very good good for me and good to me. And I love the students. I in all dental education environments, there's a changing political regime. There's administrative branch that. You know, the one year it's very conservative one year. It's very liberal, and you just have to sort of navigate through that process. And I think after doing that for twenty six years, I was I was pretty much ready to branch out on my own because I felt like in the academic world your little bit held back from really doing the teaching and creating new things the way you really want to because the reality is of the dental school environment. You mean, you have to teach you have courses you have faculty. You have a lot of administrative responsibilities. So I just have to ask myself. What do I love doing the most? Well, I love dentistry, and I love teaching and when I looked at my job walking every day as chairman of restorative dentistry. I said, wow, I'm not able to teach very much, and I'm not able to do that much dentistry. I'm Elise seeing patients a day a week. I'm only able to teach maybe day week in the clinic the rest of the time. I'm doing administrative work. So I said what can I do to change this? And the only solution I could come up with side just had to retire. So actually retired early after twenty six years. But actually in the academic world that's still kind of early. But I I found the solution in teaching outside the school teaching the way I wanna teach teaching in a. I think in a way that probably challenges students more provide students with more of gut check when things aren't going. Well, at other words, photographing their work midway through a project, and then showing that work on the screen for all the other students to see and critiquing. What's right? And what's wrong about the procedure and giving helpful hints? You think you can do that in dental school no way that never can happen. But in my center, I can do that. I can show them live demonstrations, I've got multiple video cameras. I have different types of magnification systems. I've got you know, HDTV's, so we're showing the procedures live. I'm doing them. The students are watching me make mistakes there watching me struggle through certain aspects. They're seeing that I have to change strategies. They're seeing an honest approach to the fact that dentistry is not eat. Easy. And they love it. The absolute love it because they're liking here. This guy with all this experience. He's struggling, and he's showing me ways to to to you know, conquer over these these shortfalls and errors that he's making. And this is really cool. And so there's a certain approachability. With that. There's a there's a friendship that can occur in a small environment. And I only take twelve people my courses are always limited to twelve. So I get to know everybody. Really, well, and we spend most of our time doing the work. It's not about talking about it. You know, you go to a dental conference today, and you're gonna see highly Photoshop beautiful European style gorgeous dentistry, and I gotta tell you. That's not the real world that that probably took that clinician three days to prep that tooth and make that final restoration with the laboratory technician standing by the entire time and. And to present that as this is what's the Chiba -able? I think it's inspiring. But at the same time, it's is sorta doing disservice to us because it makes us feel like, gee, I'm not that good. And so what I try to do is tell everybody. Hey, look, you you probably can't be that good in a real world situation. But let's strive for that. And let me show you the ways that we can get a little closer to that. In a real world way, you know in our private practices. It doesn't have to be expensive. It doesn't have to involve these unreachable levels of ceramic, you know, mastery. We can do this in our own practices. If we understand the techniques. So that's our approach, and I I do courses for general dentists that have many years of experience they love getting new techniques. For example, we do post your ceramics courses where maybe a dentist is a little bit unsure about a certain immediate dense. Ceiling or how to handle covering cuss? Just exactly the right way. So they'll come to the course, and they'll be sitting next to a student. It's his graduated six months before. And the two of them are learning simultaneously new techniques. And this is, hey, we're all in this together type of feeling and the like I said the first thing I do is all prepa tooth, and I'll make a mistake, and everyone goes cool mistakes be made. How does he overcome the mistake? Yeah. Oh, I get it in. So this this this process is really really fun. It's hard to do that a dental school environment. It's really hard to do that in a c course, for that matter as well mostly courses in, you know, I'm speaking of the ones that I've taught all over the place typically try to fill the classroom with a lot of people. And so you'll get twenty five thirty five people in a hands. On course instructor doesn't get to know anybody's name. They don't really get to push people. They don't have the opportunity to take for to make videos live or photographs in show the work. That's. Being done by the participants, and they have to it's a different model. So that's that's been my approach. So I think that my niche is definitely one that has not been filled previously. It's gaining allow traction. I'm absolutely shocked at the growth of my YouTube videos. I cannot believe it that just six months I went from zero subscribers to over seven thousand and it doesn't seem to be letting up I'm picking up about fifty subs. Every day. I have about fifty videos that I already have in the queue, and I'm going to be putting out I'm digging. This is a super fund the comments. I get are awesome. And in when I'm wrong, and I get a comment that someone has a different opinion. I'm always happy to entertain it and say, hey, that's a really good piece of information. And it's all include that in the future video. And I think that that's how we all learn so that's the inspiration. Howard. I wanted to take the the. Gilles that I learned from my mentors the methodologies in teaching that I learned from my dental educator mentors at UCLA. And my my passion, my passion for continuous hard work and improvement has those three things have really formed my motivation to start my own center. For teaching your courses are at sand. Demons California, these fifteen miles west of Antero international airport is that Toronto Ontario Canada. Sandy is famous for two things Bill and Ted's Bill and Ted's adventure and the water slide. It was the first big water slide in the United States. So and it's a sleepy little town of about thirty five thousand housing grown or shrunk in the last thirty years, and it's a very nice non LA type environment. And we have a great center there with a very large hands on stations. And my wife makes lunch for everybody. We get to know everybody, quite well, we go out to lunch together when she's not cooking. And it's it's worked out really well for us is untrue international airport because that the one that's also called John Wayne. No, that's that's an Orange County. So on -tario international airport is about forty miles. Maybe about thirty five forty miles east of downtown LA, and it's an airport where you you you land. And you can walk to your car, and there's no traffic and so that airport. There's no traffic. It's the only problem with Antero international airport is we don't have flights from every city yet. So it's. You know that airport. So another thing I wouldn't ask him, by the way. This is not a commercial. I asked you to come on the show. You didn't ask me, I'm a big fan of your YouTube channel? And I hope he posts a lot of YouTube videos in a threat because you said, you got seven thousand thinking up several thousand more by this podcasts and posting these on some of these on dental town, but earth is already order. I'm looking at your twenty nine thousand courses March one post your ceramics, April anterior ceramic veneers, April cast gold restorations. And then you have anterior composites have diagnostic diamonds post your composites implant, restorative poster ceramics anterior ceramics, enter composites diagnosed is there any order like do you recommend the after take the diagnostic diamond or they started joing filling in other all why I remember I'm gonna go through these courses and just tell me some. So you're saying there's no order you have. Take a bin. It's nice to take the diagnostic diamond. I, but is not absolutely necessary. Okay. Well, let's talk about these posters. Ceramics? Adam does that Ceram whatever you say ceramics, an indirect? Are you a big fan of CAD Cam oral scanning talk about posters ceramics? I'm a fan of all of it. I scam. The been scanning since the early early days I've been a trained in Ceyrac twenty six or twenty seven years ago and have gone through all the evolution. I was the one that brought the cat Cam technology to UCLA in the restored a department years ago. Pardon me from France. No, no, I brought I brought the this Serono syrup technology to UCLA as a teaching and clinical treatment option years ago. So we basically went from impressions with traditional materials to scanning as an option that students do both. I personally am going to be teaching the course with scanning as an option to conventional impressions. So both can be done. I think that you need to know how to do both. And the the key is that the tissue management. For scanning and the tissue management for taking conventional pressure. Exactly the same. And that is the hardest part about impressions. So whether you scan it, and you get this incredibly accurate scan that you work from or whether you take a conventional impression you need to manage the tissues properly. And that's a big part of what we talk about. We talk about indications for on lease in partial coverage ceramic materials when can you do something less than full crown when is it? Okay. To keep things super Jinja Gingele. What about bonding do we have to bond? Every crown we do or can we use conventional cements on some bond. Others. What are the indications for those? How did we policies materials how do you polish their Konia? I mean, this this hard hard product, how do you polish that compared to Email ex how do you deal with fells Pathak materials? So there's a lot of confusion. There are a lot of materials. There's a lot of things involving a lot. It's significantly. You know, evolving science. So we stay on top of it. I'm constantly going to conferences. I'm educating myself bringing new information to our courses, but the course is is pretty robust because it's many many hours of hands on training where they actually get to prepare the teeth and fabricate restorations abs- Ramic and cement them as so they get go to go through the entire process. And if you are somebody that's never done an indirect host earier ceramic restoration, and you read an article or watch YouTube video you're not gonna have the confidence or the abilities to really do that predictably in your practice. You've got to be taken to the next level. You need a mentor. You need to be able to prove that you can do it you need to sit down and go through the steps and not just listen to somebody talk about it. And try it on a patient. I think it needs to be taught at a higher level. And that's that's where courses are coming from. I start the day with a very short lecture probably forty five minutes to an hour. That's it. And then we get right into the hands on. And then we stopped people at times when we bring up little five minute, lectures or little demos, or such such as and this is how the the courses generally go. They're not filled with six hours of lecture in two hour time slot to throw in a little little practice on on extracted tooth. I think that that's typically what most hands on courses do in the community. And I think that that's a much less effective than than what we're doing. So am by the way. Would you? Get your FA GDF's five hundred hours contagious -cation five years old as them. But when you get your master ship AD, it's another six hundred dollars four hundred hours of those have to be hands on you've got you could get a lot of hands on hours. Go these courses, I'm gonna go back to. This is Dennis uncensored. I don't wanna talk about anything. Everyone agrees on. It's really stressful. When these kids have four five hundred thousand dollars student loans, and then they're looking at one hundred forty five thousand dollar CAD Cam and is due. But is that they're already half a million dollars in dead? Would you say just go forward and spent another hundred forty five which is another year dental school? No, no, I wouldn't. I don't think. That's I don't think that's a smart move at all. I think that the that. If you're going to first of all you have to understand when you have a CAD Cam in a cheer side knowing machine, you are the laboratory, and if you really want to be the laboratory, and that is your passion than find go for it and get yourself in more debt. It's gonna take you a long long time to see the return on investment, my recommendation is this go into the digital world a little bit more carefully go into the digital world. Slowly, you can purchase. Scanners with open plateau. Forms that can be purchased for a fraction of the cost of the milling machines. And then you can start scanning outsourcing, those laboratories who will then take the -til files, and advocate, the restorations and see how that goes I, and if that is something that you're just loving, but you wanna be able to provide the patients with faster turnaround time, okay, by the million sheen. But once you bought that milling machine, you have just committed yourself to a big expensive piece of equipment is gonna break down. It is going to have the need to replace the milling ends. The tips is gonna is it's they're fussy. I've got four million machines. And I know what how these work, and they are a pain in the butt. So I say that and it UCLA we had many more than that. And we were constantly having up up keep these things and to the point where we almost needed a full-time person just to keep machines running so new doctors. I know it looks really appealing to get into. Cad Cam world. I know it looks really great to get a CBC t in your office. I know that sounds like what you've gotta do. But I would recommend against it. I think that you can outsource your cone beam Brady graphs, you can save a lot of money and don't buy a milling machine. I'm sorry Serono. But I just don't think it's the right move for new practitioner. Yeah. Word word to your mother. I mean, yeah. All the same question. Three. I've been using Imprezza which originally was SVN Germany than three embodied. But I mean, I I do an import government Prussian for seventeen bucks and three wants to sell me seventeen thousand dollar tree scanner were just the just the software. Support is two hundred dollars a month. I mean, so two hundred dollars a month. If you're averaging a seventeen dollar impression two hundred divided by seventeen that's another twelve impr-. Russians. So my question to you is how do I justify going from a seventeen dollar impo gum impression to seventeen thousand dollar true depth scanner. And when you said scanning you recommended open platforms, but that might washed over someone's head, and you didn't give a name brand. So so there's there what I do is throw like five questions. I hope that maybe one of them's get enough read by answer. But. Well, I think that I like the trio scanner I think it's an amazing piece of equipment. We get scans at my laboratory from different scanning platforms and were able to mill with whatever we get. It's not a problem, but design in mill, but I said, if if you absolutely believe that you must get into this. This impression capturing technology. Great. Let's start slow, but I completely agree with you. Right. You know for a guy that has four milling machines. And I mille every material the dentistry remakes from titanium gold chromium cobalt in all the ceramic materials from guy that is a twenty seven year user of Sirak technology. How'd why perform dentistry my practice, impressions conventional impressions? Why do I do it that way because I it's predictable. I don't have an extra piece of equipment sitting in the opera, Tori. It's very very simple for me to do. And I believe that it's quite cost effective. And I'm not doing it this way because I'm an old school guy. I'm doing it this way because I'm a new school guy. I actually believe that I'm able to capture consistently better impressions when I'm using polyvinyl materials are either materials than I can when I'm scanning because her said the dimension, this sort of fourth dimension of impression taking is this not talked about is that you've got an open soul Casse. And now you've got to grab the scanner. And you've gotta scan that soult hasn't totally develop a scanner that can scan through soft tissue and blood man, you are in a hurry. And now you've got the patient holding their mouth open rather than inserting material into the soul Cus with pressure and a volume metric change. Occurring in that Saugus with the trading inserted now, you're in this passive mode. So now, you can't do anything with tissue anymore. The tissue has to be completely retracted. And now you've got a scan that area with usually quite large scanning want to, you know, even the small ones are large compared to the simple procedure of injecting around tooth with impressment journal. So I think that you know, you you you find yourself in that situation with Crandon bridge in lays on lays and things like that. Where I do think scanning has a great places for the clear liner technology, and whenever we're doing any any non braces versions, he's clear liners invis- lying things like that. I think that scanning has a tremendous benefit for the practice. If that's the direction, you wanna go, and they wanted to go to clear liners scanning his doing clear liners a line technology owns invis-, align. And I- terro is where you would go with the dude is it is it is. It's it's where I would go, and it's also where I'd buy stock too. Because if you've looked a line technologies has just been an incredibly successful company. And I think that that is I, you know, go with the winners. Yes. And also you've lectured around the world, and I was blown away at how little girls talked about invis- line in Cambodia Malaysia, South Africa. I made women and men wanna be more beautiful. And when I am when I read when I read the fact that only fight percent of Americans have had orthodontics, man. That's a lot of upside to that market dominant. Okay. And. I would also so you would go that way. I want to talk about a couple more of your courses. Because I I've heard nothing on dental town everybody rents raise about you. I want to go to switch over again to diagnostic diamond. Because what I see? I mean, who cares? If you did the perfect molar root canal, but they did need a root canal. They had a faction or you. You did the most alternate retrieve root canal. You didn't understand that the tooth was fractured. I mean, I mean, I would rather my doctor are especially a surgeon get at a on the diagnosis at a c on the treatment that at eight on the treatment and the wrong diagnosis. I'm talking about diagnostic designed think that's why you're a doctor and got the diagnosis. Right. You're right in it said that there are many different treatment options. But there's only one correct diagnosis one of the things that. I do in the diagnostic diamond is I take people through four part approach to looking at every case we look at the we look at the gums. We look at the teeth. We look at the clues. And that we also look at the aesthetics and these four areas make four corners of a diamond. So like, a baseball diamond, and that's been my my approach John choice. Frank spear two of my amazing mentors whom I have learned so much from us, very similar protests. So I think that so what will be home? What would be home plate first base? Second base third for this now. Yeah. Home Homebase would be Berio. And then your first base would be your structure, your bio mechanics, that's all all things about teeth. Second base is is going to be the function. And then third base would be the. Attics? And you know, we we have to start when we when we hit the ball. We gotta start on Perreault, and then we can work our way around the bases to aesthetics, and unfortunately, what happens in diagnosis his people are are kind of thinking about maybe that Perry was absolutely the most important thing to to treat. I and yet they don't understand how aesthetic than aesthetics is what needs to be actually planned, I so it's kind of interesting reverse process every case should be planned based on the aesthetics but implemented based on the payroll in starting with the radical apparent disease or the control of that and then moving into structure understanding function and finally be able to deliver the aesthetics with all of those previous basis having been been covered. So what we teach in. The course is to look at the patient as a person. In their smile position and make some determinations about what is okay, and what needs to be changed with their smile from there. You can then go into function what is between functioning to make this work. And then what is chain structurally? And then when you speak changed paragon only. But in terms of the implementation of the implementation of that particular plan we start with the payroll I like to can give you a different analogy. Let's imagine that you are going to build your dream house. You found a piece of property that is exactly what you want. And so you're just you're standing out from the property, and you're envisioning what when you're looking at this piece of property while you're looking at the house you looking at the final house sitting on that piece of property. You know, exactly where the front door is going to be where the garage is going to be where the master bedroom's going to be. He imagine that. I do you look at that piece of property and imagine the plumbing. Do you look at that property? Imagine the framing and the the hinges in the working parts of the house. Of course, not. So when we look at a patient. Let's look at them as the finished house. But then let's go back and engineer how do we achieve that? We've got to start with a pair of we've got understand the teeth. We've got understand what restored at procedures are best with patient and how to make it work. Who cares if you have a house, but the the garage door doesn't open it gets stuck every time you push open. Who cares the windows? Don't the windows don't slide open and closed or this light switches don't work that's all function so function is incredibly important. And then finally the aesthetics can be predictable. If all of those things are done, just right? So the diagnostic diamond is a its philosophical approach it, but it's also practical approach where we can achieve a diagnosis for every aspect around the basis of of that baseball diamond, and we know what treatment off. Options are going to be possible to achieve the solution to that diagnostic diagnostic issue, and what we teach in this court courses blows people's mind in in three days their their head is spinning because they have they have found out things that they believed in that were completely wrong. They have learned more about inclusion in three days than they usually learned in the entire time. They were in dental school, and we bring in so many incredible concepts in such a simple way understand them that you can implement your practice right away that this diagnostic diamond course, is is a real important one. I would love it. If it went took. That course, I, but sometimes people have to ease into ease into these courses and decide let me try them out. And we'll see how this composite courses. I and if I like him, maybe I'll come back, and you know, that's the way it works. And I'm okay with that. Because I know that once they come we've got. Them because we were the real deal, and we show people how to turn this new knowledge into better results right away. I still have questions for you. And I've gone over the hour. Can I keep you a little bit for overtime? I want to ask you you look at the nine specialties in dentistry, and there's hardly any debate debates among likely pediatric dentist debate really about silver, dining, fluoride, the end donnas, you go to dinner with eight ended honest, don't really argue about anything. But one is the clues urine. So controversial why are there so many camps? And I want you I'm gonna hold your feet to the fire because they asked Pacific questions will should I go. Learn painting ACLU's or neuro muscular, there's LV there's neuro muscular some people say to learn inclusion you got to have fifteen thousand dollars of of equipment and T scans. And and they they they just wanna know where do they go? I know they wanna learn more about inclusion, but they feel like it's almost like you to be you wanna learn about religion. I say we got a pig religion. Which are you going to be Indu of Buddha's, a Catholic? So so why is it do? Agree that it's confusing. I do I do. And there are least six different philosophies of inclusion and the the at least six, and I have learned from many of those the masters of the six and have taken courses in many different philosophies, but it wasn't until I. Started getting mentored by John case in Seattle and Frank spear who's now in Scottsdale, many many years ago that they were able to look past all of the the fervor that may exist in any one of these religious beliefs of the about inclusion, and and get to the practical aspect of things and that really worked for me. And I was able to see how well it worked to my practice to. And so I think that. You know, we need to be open minded about change. We need to be open minded about changing our philosophies. How do you change somebody's philosophy about inclusion? That's written three textbooks on the subject has their entire institute based on one philosophy. If that person is being exposed to a new philosophy that makes sense. They're going to reject it. Because it undermines everything they've built in the last thirty or forty years. So I wanted to find mentors that were willing to say what I knew in the past is wrong. And this is the direction we're headed, and that's what I've subscribed to. And so what I teach in. My centers is a an approach that actually works with works. Well, within any of these other philosophies because it really at the at the foundation is the patients got to be comfortable chewing. When's the last time you went to dentists and you sat in the chair, and they said, hey, Howard house you choosing going. Zero r dentist asking patients. How well do you chew? It's not happening and that's function. That's really what is all about. So I think that the the approach we take is. Based on the philosophies. These amazing philosophies incredible science has been done all of these different positions about inclusion, but perhaps in a way made it more clear, not simple, but clear and reproducible on your private practice. And that's I think what what really stuck with me. It wasn't so much philosophy is it was a practical approach which worked time and time again. So you got to go to is YouTube channel, I mean, it's it's YouTube dot com forward slash Stevenson dental solutions. You also have. So you have your lecture class in LA or nearly Rhonda. But you also have online continued -cation talk about your online courses, we have several the online courses are basically, you watch video, and we send you a quiz, you answer the quiz, and you grab a C unit and the we really fortunate to get ADA, sir. Prove last year, that's a very difficult process. That also is transferable to pace for anyone in the academy general dentistry going for masters ship or fellowship. And that's just how it works. And we plan on on releasing many many many more of these online versions simply watch video watch a lecture and then answer little quiz. And you're good to go. You know, again, I. No, you don't need any marketing advertising. But if I was you from a business point of view, I would put one of those courses on dental town, we have online courses, and then it would it would mass market your name, and brand and online courses. Howard gold seen ho-gau at dental town dot com HBO GO for Howard gold, Saint Hobo Dotan combat you go to get the courses. I put one of them on dental town, and then safe you wanna watch the other gazillion. But I what I see. What are your core? Almost makes me wanna cry. You have our PD design. Right. And and so the I don't know if people know this, but a lot of labs they don't want to cast the partial framework. So right. The so you think you're using your lab in Iowa, but they're mailing it down to new Gallas air Zona. And then they drive him across the street in the Mexico, and I drive down there. And I see this lab this lab down there. I love the lab they get over one thousand. Impressions a day and ninety percent of all the impression. It's just the impression. And it says lower parcel. I'm like, dude, you're a doctor, and you just said it impression instead lower parcel. First of all, what do you think of the end? That's real. I've saved this with my own eyes. I'm in Phoenix, Arizona. It's a three and I love going down to Mexico. What would you say to the doctors who take an impression and just put lower partial and send it to the lab? I'm like come on guys. Please. You're not doing the patient and favor there. I mean, you learn how to do partial dentures and dental school by the by your prostate on us. And maybe thought that they were making it more complicated needed to be. But I there is no easy way to make a partial denture proper. You've got a design it you have to have cast you have to serve it. And that's what we teach in this design course in it, it it's very sad to learn that that's that that happens and you're right. I mean, I think it probably happens more than ninety percent of time that just lower impressions are taken. They're sent off. Make lower partial. We've gotta do better. We've gotta do better as a profession we were were smarter than that where capable and we have the skills. Let's not let the quest for the easy buck in practice be more important than what we know. Is right. Let's always remember that we have taken an oath to do our patients the best service, we possibly can. And I, you know, I I don't think anybody in the right mind would argue with what I just said it is the approach that anyone of us would wanna have our doctors take when they were taking care of us. Well said and I just one final question. The one four thousand pound elephant the room Minoan talks about four and a half percent of Americans will end will finish their life out in a nursing home. It's it's a little it's just a tad under five percent and geriatric dentistry doesn't get any headlines. But there's telling us that in the nursing home. They're getting one root surface cavity per month. And I see dentists getting these patients, and it's a big expensive pain to go. Pick up lady. Lot of dementia Alzheimer's take him to the dental office, and he'll put in twelve classified composites. And and do you think when you have Alzheimer's dementia arthritis camp brush camp floss? Do you think a composite was the best restoration for his cavity? No, sir. I do not that we would not do that. I don't think I've ever treated a patient with those similar similar conditions in that way. I would place when amalgam if I could get some isolation, I might play a glass Heimer restoration. But I would never play. A composite there. I think that's a scientist shown is what percent of the dentist will say. Well, I don't even have Malcolm in my office. I'm like, how do you have two thousand patients be a doctor of dental surgery? And you don't even have an amalgam tool in your toolbox. I mean is that is that a well rounded doctor? I don't think it is. I don't think it is. I. You know Howard. I know how to do amalgams composites glass. I on gold work, we need to know what to do at all. And we were taught all of this. And if we weren't taught learn, and then you can off your patients were options more appropriate options. And the the one that gets the most that I I don't know will Africa as well. My entire offices metal free. I'm like, what are you flying or plastic airplane on with? I mean, what is metal? How was metal the new bad guy? Really? Why is it that where we would from Stonehenge to Atlantic our civilization? We learned to work with medals. Apparently that person doesn't do implants. Yeah. What will their desert Konia? Mm-hmm. Yeah. Konia is is is a new the new ceramic. But if you if you look at Coney Coney, m the element on the periodic table, it looks like aluminum, it'd medal is a metal outside. So metal oxides are part of all of our ceramics who it's interesting that people say they're metal free. The I don't know how they can avoid the. The elements of the periodic table that are every comp- if every single one of our ceramic systems that we use so go to Steven son Esa Len dental solutions dot com again, I was so excited when you agreed to come on the show. I'm a big fan of yours and my gosh on my homies enjoyed this so much. Thank you so much for coming on the show today. It's been a pleasure. All right happening. And by the way, if you if you went ever wonder why to article on anything we talked about for dental magazine. Please send Senate end because I like I like these kids listen to the old guys. I I am so old you realize when I got out of dental school the Dead Sea was only sick. All right. Have a great day.