Dr. Lance Timmerman is a Throwback (DHD233)
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They have a bunch of different opaque offers tints that sort of thing, but the one that I use the most in the one that I think every general dentist improvident restorative dentists should have in their tool. Kids pinko pig. Pinko pick has this. Magic ability take any gray coloration in block it out. So so much stuff. We do has to locking out gray whenever we're dealing with any kind of metal that we don't wanna show we need something that works on this pinko pages. And it's like a flow. But it opaque out. Great. It's amazing. So here's what I did. Screw mandible. I put a little bit of Teflon down. I put a decent layer taking kind of drag it up the site bitsy. Couldn't see that. Great. And then I placed Cosma Dan, Brennan off which match the colors and crown into virtually disappeared. It's all about the pinko bake. If you're not using it to get it, though, check it out a dental hacks dot com slash pink. Once you start using it you will find new uses for it every single day. This is a great bit of kit as they say cross upon everyone needs us in there to a box. They're doing some amazing things over there in Chicago. Thanks a lot for supporting the show cost. Hello dental hacks nation. Welcome to I guess, I'd call it. A greatest hits episode long story short. I am currently on spring break with my family. So I thought that we would have a throwback episode. If you will. So what I thought was. Man back in June twenty fourteen Jason I put out very first episode. I to episodes actually featured a brain trust. But it also featured an interview with the guy that's been on the show a whole bunch of times actually guy that we mentioned almost every week usually were joking about him. But bottom line, he was very first interview. And he was he did a good job. That'd be Dr Lance Tiernan, the one and only who has also showed up on lots of other podcasts, including working interferences with Dr Joshua Austin. He's he's all over the place. And he's been legendary voice dentistry for lots of reasons as well. So we thought we would go back to the very first episode. And so I include with you, the first intro that Jason I ever did together, which is a little rougher. I think than we normally are now is well as the entire interview that we did with land. So the first half he talks a bit about. Bowtie folks in the second half of the interview he talks about sleep apnea, which is quite because honestly, he might be the first time this inter-, you might be the first time I ever really took a look at sleep apnea, very seriously. So I feel like we've kind of come a long way. But also it's kind of fun to listen to the very first episode what we did. So I'm going to present that to you in its entirety for fun in the next week. We we back with a regular episode. So I hope you enjoy this. You have any questions or comments for us the Email, which we give about thirty times in. This interview is info dental hacks dot com, you can find us at the dental hacks nation Facebook page, just go on Facebook and search for dental hacks nation, if you're interested in doing a little more clinical stuff seeing cases and talking about clinical stuff. You can also check out the clinical hacks Facebook page, which were trying to grow a little bit. That's also on Facebook answer the questions when you ask her an invite, and we'll get you. In those groups and thanks for listening. We really appreciate we don't say it enough, but we pretty much don't have anything unless you guys are listened to shows. So we really appreciate it have any questions or comments suggestions anything all again in philadel-, hacks dot com, leave serve you at itunes. If you would we love that. And we will catch you next week. Welcome to the dental hacks podcast a podcast for dentists by dentists now, sit back relax your about to hacked. Welcome to episode one of the dental hacks podcast. We're your hosts Allen Mead. And I'm Jason Lipscomb. You can find us on Twitter at dental hacks, Email us at info at dental dot com. Or find us on Facebook at dental hats or something the phone book dental have. Hey, works to whatever works. Whatever works. So how are you doing tonight ups? I'm good. I'm good. How you doing? I am fantastic. I'd done with a full day of dentistry, and I'm ready to Kassim pods. That's right. That's 'cause what else. Do you wanna do after full day of dentistry, but podcast and sit around and talk about dentistry. That's right. What else is there? Right. What else is there? So this is our first episode of dental hacks. Why are we calling dental heck's? And we wanna take take the shine off other other dental podcasts and down the nitty gritty, we want to be the the people that you go to get the real story. Dennis for both wet finger dentists at sounds kinda gross. But we mean that in the nicest way possible, but now we wanna we wanna make a make dental podcasting fun and formative and talk about the things that that that we wanna hear. Let's be honest. What I really want to do is when that dentist gets in his car for like twenty minute. The twenty minute ride to work on Monday morning. I really. Want him to put us on? So we can have a laugh, and we put them in a good mood before he goes into work or she for that matter. This is not a sexist podcast. We want we want the other people out there to know that we commiserate with them. And we're all exactly trudging in there to pull out some amalgams when when they get to work. Exactly, we call it dental hacks based on the term life hack, which is kind of an internet me if you will. And it's basically how live your life a little bit more efficiently. And that's what we like to be. We'd like to be a go to source for information in laughs when it comes to dentistry, and we like to find some interesting people to interview and people in the dental world and really get down to the base of it. And and figure out how we can make our lives easier and have a little fun at the same time. I think exactly that's how we're going to do it each week. We're going to bring you an interview with someone interesting with some good information that you can probably take the office that day in better than that. Once we're done with our interview, we're going to go to our illustrious brain trust, the brain. Trust is a rotating panel of dentists that have. Really interesting. Opinions funny opinions most of them are on the panel because they're funny. We think they're funny, and I think you're doing and they've paid us large amounts of cash at too that the ones that are on a lot. You can just know they've paid us more. That's how so. Yeah. So we have a lot to bring you for our first episode here. So without too much further ado, we're going to get into our first interview. All right. So our first interview on the dental hacks podcast is Dr Lance Timmerman both Alan I are very excited to be speaking with him today. And I think you're gonna find that all his information is great and candid and berry informative. Doctor. Lance Timmerman is a cosmetic dentist since Seattle. Washington. A nineteen ninety eight grab that we're health sciences University School dental medicine doctor Timmerman found that he's name was learning about new procedures becoming self proclaimed. See junkie sounds dangerous while expanding his practice. Dr Timmerman began to treat both sleep apnea. Patients and those desiring talk services in our interview today. Doctorates shares his experiences with both Boeta cts intriguing. Sleep apnea in the Dylan Bamut, his share thoughts about candid and extremely formative sit back and enjoy a real life dental story from your new favourite dental bog cast dental hacks. And now it's time for the gentle packs interview. Allan, this is Lance Lance. What's happening? I don't mean to put you on the spot, but you are first interview. So if the interview sock from totally blaming you I won't have anything to do with Jason. I totally gonna reflect on you. I mean, no pressure, but don't suck bicycle. Yeah. That's my motto. Just about anything. Just don't suck. You should. I think we should have that on T shirt. Don't suck. I think we. And that could go so many different ways to. I mean, it really could. I mean, especially being dentists. Yeah, I'm serious like there's like five different entendre. So you can go with that. I love it. Don't suck. Okay. Yeah. I knew it entendre. Yeah. Look that up. It's cool. Okay. And now you at a lot of stuff on Facebook that you were that you were doing teaching as well. And and getting by toxin your office, so figured out places. Starting you might couple sleep apnea questions and things like that. Sure. If you're up for it. And but we'll see I mean, I don't know if I passed that stupid exam the other day. So maybe we should that way. What exam is that for the ADM trying to get a diplomat with okay American Academy dental sleep medicine? Yeah. Yeah. And. Was it? Well, I thought it'd be more practical questions person presents this way showing this into that. What does this indicate and it wasn't? It was random stuff. I didn't know what the hell Calgary ges so coming to find out about the tongue retaining device. And so I got that one wrong. Interesting. I would I would like if I were gonna take a test like that I would want more practical thing I would actually want to sleep for them. I want to go in. And I'd wanna like I'd wanna snort for them. Actually would be what I was going to have a full on event. That's right. Let me show you what you really is. That'd be good. I get your Appier right here. But yeah, that's right. You look real close at this apnea, pal. Great skin. That's important. Yes. I'm turning blue. Yes. That's an ethnic moment. All right. So actually, let me I'm gonna start with this. Tell us a little bit. But just tell us a little bit about your practice. Well, like. Thanks. Go ahead. I like to my practices is just a regular mom-and-pop family dental practice, but we do offer a lot of specialized services, and it's not until you have attempt come in for a couple of hours or no what I'm doing. So then you realize that you're just offering a lot of things that are than maybe while we do offer cleanings, and fillings, and crowns and root canals the regular stuff we do other services, like smile makeovers seniors bowtie external fillers sleep apnea dental implant, both surgery and restorative. So kind of hodgepodge just about everything. Sure. Are you the only dentist I am? Okay. Mostly because I can't get along with people so alone. That's that's strange in the dental community. The go figure from rather human being most of us get along. So well, I don't understand. You offer all that stuff yourself. It's very cool. Yeah. Mostly because I do see just to get away and do some travel in picking up a few nuggets along the way next thing. You know, you've got a whole bunch of different skill sets. I was telling I was telling Alan that you'd like to do a lot of traveling and and getting didn't license in different countries and things like that and gets pretty asking stories and. It's one of the things, you know, it seemed like a good idea at the time. Don't they always? That's pretty impressive. I'll get out to do as much as you. Do. That's kind of awesome. As a matter of fact, I kind of don't believe it. I think you're kind of lying. Well. Facebook allows you I'm much cooler online. You meet me in person. That's exactly exactly outs for that. Yeah. You've met me. You didn't like me. I keep seeking you out online though. That's what book the whole reason to do Facebook at all is to paint a picture of what you aren't. I mean, clearly exactly exactly I speak seven languages and many passports. It's just a. Yeah. He's he's kind of JAMES BOND of dentistry. Really? That's right. I'm working on it wasn't international hand model as well. Very nice all rights. Okay. So so we're going to focus a little bit on bowtie two because that's one of the things that. Jason. And I were talking about I think there's a lot of dentists out there and a lot of dental team members that are pretty interested in that. When did you get started in in? How did you get started with talks how long you've been doing it? I got started. We were trying to do the math today. I think we started in two thousand eight or two thousand nine like any good reason to add a service. My wife wanted Bota cts instead go go learn it and give it to me for free. So I went out and took a course. And it was it was good. I was happy with the the level of education immediately implemented in the practice. Did that for awhile? And in fact, it turned down other opportunities to take more classes because you you kinda think, you know, at all you don't know what you don't know. And it wasn't until my wife then wanted fillers that I realized okay, I only know the Boateng's part. I don't know the filler spark. Okay. So I went to another course to learn the fillers, but it was offered both talks and fillers together. So I had I tried to convince them to give me a discount because already know the Votaw part and the wise businessperson. They were they refused. And so I did the bow talks with and my eyes were kind of opened of so many other things that I was never taught with bowtie box. So I learned a little bit more with that. And then it was able to add filler to the protocol. And then again, my wife wanted fillers place somewhere else and. Needed. I that was the advance level course. So I went and took an advanced level course with the fillers to be able to augment lips better, and do some oral Commodores and just do things just different. And so. In the process of acquiring the skill set to do that in for the longest time. Really, the only people we were doing botox fillers on was the staff, and we'd mix it up use it and we'd end up going stale. So we're giving it away for free or discounted. And it wasn't until we realized that it was kind of a wasted skill set that we decided let's let's try to promote it a little bit more initially. We were afraid of of gaining the attention of maybe a turf war of plastic surgeons and others and just try to fly another radar radar. You really just don't do much of it at all. So in your you're in Seattle. Correct. Just south of Seattle greater Seattle area. Okay. What's what what town again? I'm in Tukwila Tukwila, okay? In is would you say there's a pretty competitive market for this kind of service. Well, we're just south of the more fluent area. It's kind of a more middle road community. There are some plastic surgeons and some high high rise I flew in types nearby. Sure. So we're we are I would say we're competitive with Lista twenty mile radius. Okay. So and in that twenty mile radius is very competitive, so does become price sensitive, and yeah, I would say it is still competitive location. So what do you where do you think? The if a dentist was going to say, okay. I wanna learn about Bo talks where should he go where she go to to learn about botox. I think of all the institutes are places. I gone the probably the one I thought that was the most comprehensive and applicable immediately was dentist bus Menards. Okay. And so I think that's a good place to start gets the right? It's taught by people that are specifically teaching dentists, so we're not taking the class with any other medical professional. I've been in other classes that was a mix of dermatologists, nurses, and others and the the kind of questions were irrelevant half the time because I just didn't care about all just was doing. So having a class of of just dentist was great. The the mixing ratios was a nice nice way. Having a nice concentration gives you a lot more control. When I was I thought it was diluted more which tends to lead towards side effects that you don't want. Okay. They deluding based on safety reasons or just for cost reasons, or it was just the way that. It was originally formulated. That's just the way it was always done years and years, and so things just keep changing and improving, and they realize that at a higher concentration, we might have to place it in more locations, but it won't spread the way the other other way would spread unpredictably. So I think Dennis BAAs probably the most current of the mall, but the other place that I went to I don't think they were bad either. I just think that Dennis has more offer where whereas spa located and what's the headquartered headquartered out of Miami? Or even Toronto on their. You're usually looking depending on the corpse the if it's gonna be lip augmentation course or beginner bowtie. Of course, you probably looking at a good two thousand dollar investment for the weekend. You will walk away for Monday morning. You won't have you'll have to make your first order both talks you won't be able to implement it Monday. But maybe a week from Monday. So it's something that you're you're pretty comfortable jumping into soon after them. Yeah, you'll walk. You will do a hands on if you don't bring your own patient. They'll provide a patient, and so you will have already placed anywhere from twenty to fifty units about talks on right then. Okay. You think for Dennis take both of the courses are just start out with the single bow toxin move onto the dermal fillers or do you find that you use one more than the other in your office? Their course is just you can't take one or the other is it's kind of taught simultaneously. Okay. And so the option really isn't there. But I don't think I would want an option of just the one. I'm glad that I ended up having to redo the tax while trying to learn the fillers. Mostly because when people come in, and you're trying to treatment plan, you're showing them the pictures and options, and then they start pointing outlines and things creases that you don't care about it. And until then it's it's nice to be able to know what it would take to to satisfy him and make them happy. You're doing a full set of of cosmetic foot as the CD series of photos with these patients as well. Kind of. Yeah, we didn't used to. But then we started going towards okay, we need to have a full face picture to at least narrate with the the Broncos and such. So, but I would say we do more both talks than fillers and partly because it's nice thing about both talks doesn't take very much time to do. We're fillers takes a bit of time you need to place on massage it and kind of step back, and look, and it you're probably going to go to half hour on average to do that procedure as talks you can pretty much go on and be done in five minutes. The how does how does bowtie work into the workflow of dental practice? I mean, you sitting you know, he set up like an. Operative appointment, or is it do you have a specific day or time that you're treating these Hausa work we've done both ways. My goal was to get so many people hooked on tax that just at the end of their cleaning appointment, we would then touch them up with some bow talks at just two minutes of the procedures. You're taking a couple of hundred dollar hygiene appointment and make it more like a five hundred dollar hygiene appointment has flight will work out that way, yet we do have the the core group of people that that's what we do. We when we really wanted to to promote it and kind of get the word out. We did do a group on. And I I've on the Glenn for punishment. I've done the group on for just about every type of service and the prove that doesn't work. Glad someone did really. So and I can tell all the reasons why. But the won't actually wasn't bad because we were able to negotiate with with group on to the point where you break, even we're normally you're losing money. Sure. And you're losing money because it takes time if you're doing exam cleaning xrays or you're doing a white in procedure unless you're giving away kits of whitening you're chewing up chair time. And so all of those other discounted things. Just screw up your day will the botox, you know, they can get in you can delegate most of the intake and just show up in time to perform it. And so really we were scheduling them in. We're able to schedule. So I only did three per day between ten and two. And then it was only five minutes out of the the scheduled to pop in. So then we would start collecting names people that want to be in right away. And we would just collect names of short notice type people for talks, and if a day fell apart, which it never does in my practice that we would be able to just call them up and fill the day with group on redemption. So in a very short time. I think we sold like to. Hundred group of it. And so within through three or six months, we did the two hundred cases. So so that's why I say that the group probably the only way that's would I would recommend and to do with groupon. With both talk. Interesting. So group group on Boateng's work, particularly well together who knew. Well as long as you're not trying to make any money. So I ran into a nurse. Why would you do that? So we were trying to gain exposure and brand ourselves and get the experience. I mean two hundred cases in short time, you end up being pretty pretty proficient. And so. You so this nurse these meet this class, and she goes away recognize your name, and I'm like, oh crap. And she says. Tonight into making money. And I said, yeah, exactly. Yeah. We could never do that. Because that's how I make my living. And I told look I'm hoping to get them to come back. Do dentistry do cleanings and fillings and the regular stuff and or come back for more boat docks. I could make money the second time. And so she wasn't too pleased with she understood. And so it worked out good. I like the whole idea of giving them a little bit. And hoping they'll come back for more. It's very off. It's like it's like crack cocaine cocaine and heroin dealers. Do excellent. That's the whole the heroin market. That's been the whole argument with with groupon is is how it fits in the dental world and a lot of people have done cleanings banks like that in the hopes that these people are going to come back and be recurring patients, and they found that these people are just deals half the time. So I really think it it does get in this case where it's it's it's a commodity where you got a one set price where it's not insurance base that you can that you can be successful with it in hopes that come back for other stops. I'm it does. It does make sense about work. Let's be honest in the dental office, how many procedures do you have where people actually are coming to really wanting it like last time I've had a patience. I really want this root canal have very often. But but I mean, they're seeking out because it's both talks. Yeah. That's I mean, that's I'll be honest. Most people don't wanna see me at all. Anyway, the dentist. Well, I try to take that to personally when they say that it's hard. Okay. So. Yeah. Tell this. What are the complications? You might see or contraindications for talks dermal fillers. Well, the first thing you want you'll have a standard informed consent. People have allergies to eggs, the whole albumen. The the process of fabricating the botox protein itself is apparently they're using eg show teams. Yeah. So but for the most part, it's you almost universal. I still actually haven't met anybody with an allergy for X. So maybe they don't I've been able to apply the boats. Anybody that came through the door asking for it? The complications are if you don't know where to place it correctly. I mean, just because we have a license doesn't mean we really should place. The bow talks you really should seek the training. You know, there's very few complications that you can run into. But that's only from knowing in advance thirty medical conditions beyond the hypersensitivity to the eggs. I've never had anybody. Check off anything of all the country indications. And I honestly it's been so many years since I've even read my informed consent. I can't remember it's on it. So in conformance. Yeah. So we tell them don't. And you haven't killed anyone to that's good. I mean. Well, not that I know. Chill admit to it. The bodies yet. They train you on tax courses that how to hide the body. Of course. For the advance for the advanced tax user. Okay. So you're using it kind of unabashedly for cosmetic enhancement, tell me. This. Do you use it for any pain patients? Or are you base? Interesting. Okay. So you do use it for them actually the therapeutic. Use is the one you really get the people on a schedule. They're going to be in there repeatedly. You know, the soccer moms that are addicted to adult they'll come in. Maybe not on the schedule because going gonna last three to four months on average, the soccer mom might be more like six months to year, depending on and they're gonna tell you when they're going to tell you when they wanted again, because they're exactly the see the wrinkle again, or whatever. Yeah. That kind of thing will the therapeutic. I have this one lady she's eighty four. She's got the smoothest forehead of any eighty four. But we're doing it for therapeutic. She's her TMD is significant enough that we tried so many different world devices, and you name to the theory. We try it. So Finally, I thought you know, I was looking at refunding money and no one wants to do that. Because I thought well how about the therapeutic use abo- talks, and she used overall cost the front Alice and into the masters you pretty much use an entire vile. And you know, she comes in like clockwork every three months is when it starts wearing off. And then she's in the schedule and walks in and we're placing another vile honor. It's interesting that you say that I heard in a podcast like a week or two ago, a neurologist who treats pain, and he's sort of a headache specialists. Literally, grab it almost exactly the same way. You did. So that great cool. I mean, you are clearly using it in multiple ways. That's that's interesting. Yeah. And you know, if people are making breaks guard, your your your Nygaard, you're gonna work better. If you put a little talks in the. Masters in the Brexit. It will the the forces are going to be decreased the everything about those anger are going to be affected. And so you're you're Brooks's guard might last even longer because you've added some talks two. That's interesting. Okay. So what do you think about states like, for instance, my state Michigan in Jason state Virginia who have kind of come down with either really tight regulations are banned the use of it like in Michigan. You can use them therapeutics for pain. But, but they have like the language is very clear that they don't be dentists are not to use it for cosmetic enhance when you feel like that about that. Well, well, I think that sucks and you should move. All time. Yeah. So, you know, I do think the states are I believe it's right now, there's four states that just can't and the rest of them. There's either limited use or free rein. And I'm fortunate to be in a state where it's pretty much free rein recreational pot too though. So there's that exactly Colorado. Just we love our potting and botox exactly the brownies state. So I stand there trepidation with it. But I don't think there's anybody better qualified to place votes than dentists were better at the injection itself. We know our our head neck anatomy as well as anybody alleged. Illeg you sleep to that class. Yeah. So, but I mean, if we're going to be doing TM J the appliances, then we should be able to place it, they're politically if we're doing cosmetic period Donald surgery lip tack procedures and things like that. That's that's pretty invasive. I think we should be allowed to maybe put a little bow talks in the lip to. Get rid of the vertical smoker lines, lateral, sinus window, we can go in there. Do that all day long? Exactly. You find what do you how do you market it? Again. Do you have any particular? I mean, you say you did a group on. But are you? I mean is it are you are you working? Your search engine stuff? Is it, you know, newspapers radio what what what's your marketing campaign for this? And you market it separately from other dental services. Yeah. I I have kind of list if I do a direct mail piece, and we're pretty consistent with direct mail. I it's kinda listed there. It's a little more subtle when it's listed amongst all the bullet points of things that you do I do have looks like a little magazine that we created. It's probably I don't know twelve or sixteen page brochure and one page talks about Bo talks, another page talks about implants, another page talks about teeth whitening. So there's before and after about veneer, cases and stuff. So that's there as well. Those are probably the more classic ways that were promoting. And then we decided that the group on actually worked pretty good. But we didn't wanna do it too often. So we have kind of an eighteen month two year when as far as regularity. We don't want people to just say, I'm gonna wait. You're next coupon comes out because they'll never pay full fee. So if we do that infrequently, and if they're gonna wait that long, okay, fine. You're just never going to take advantage of the frequent use of it. But most people it's more of a branding opportunity here. Easing for your direct mailings. And you're in you magazine, if you if you don't wanna say, it's fine. I understand. No, I I I use since incorporated and Chris add almost alternatively. Ultimately, we will do I think the the brochure itself starts to look stale. Yeah. Record there too familiar with it. And so then switching to the other company very similar database, very similar approach kind of freshens it up. And then when we start seeing diminished returns with that. We'll go back to the other. Okay. All right. Are you finding are you finding a lot of new patients seeking you out specifically because of the botox or is typically a a regular dental patient that decides that it's a benefit to be in the office and duboe talks. I would say it's more. It's coming straight from the the groupon type of promotion, and then they they see that from it. Even the search engine the stuff the stuff on the internet. I still think those people are seeking dermatologists and others more traditional providers. So it's the existing patients or or the the groupon. We recently we featured on the evening news recently. And so that kind of got some good exposure. But that's going to become a flash in the pan. We don't really expect long-term exposure that way have you had any negative feedback from some of the. The real doctors are heard any patients anything about it, or well, the only I was I did take I'll a little courses where these Matala just put him on and the same place where that nurse said. Wait. I know who you are. Well, I was just there to observe. I didn't want to just wasn't sure how I was going to be received. And as wonder Matala Jesse. She said, oh, you didn't bring any fillers doing fillers in tier trough underneath the eyes. And I have some if you want to inject me I thought. Oh, okay. And then someone said something let her know that I was at dentists, and she looked at me. And she went, oh what your dentist? Yeah. She'll know never mind. Let's see. Okay. You suck. Then five minutes later, the guy teaching a class was talking about placing it in the masters for trying to slim the face. He says be careful don't inject too deeply into the masters because then you'll hit the terabytes. Wait a minute. No. You won't know underneath. I said. Yeah. But there's a big old bone there. You might need a little before we get. Yeah. So you've got bigger problems. If you're getting the territories. So then the the one that she she looked at me. And she goes, oh, you you clearly know you're out of it. You can go ahead and do my troughs and his crew, Hugh. Nice. So you get little things like that. I do it. You do have a point. I mean, what what physician any physician uses a needle as much as we do. I mean, that's sort of dick heroin tear. When users would probably be good to they should training dentists at the time 'cause we're all need. And you're going to end at this. When I had my vasectomy. The guy told me he says, oh, your dentist, man. You know, your nerves and said, well, I hope you know, yours we just kind of go for an area and just hope it works. But you actually know your facial anatomy. And there goes this way. Now when and that that's done on me that. Yeah, I'm I'm kind of bad ass. Okay. So here's here's the here's the question. Do you have any needle phobic patients who really want talks have people who bitch about the the injections, even though it's pretty much all injections? Yeah. Yeah. And so we don't normally place topical anesthetic on the forehead before we we do it. But on those people we wait an extra ten minutes to let it just get numb as a possibly could. But I've been surprised at the people that have bitch Dimona, give me hassle to give a dental injection and was only doing it because the tooth was swollen. And everything was you know, about losing a tooth because of they were needle, folks. But yet they were easier to do have have the bow tie kinda like the person's all tattooed, and they say, well, I hate needles. I can't stand this. Well, they're your lobes are big enough that you could put your thumb through exact. So then the nice thing is using a three one gauging needle. And that's that's the insulin level so small barely feel. If any okay. So do you do you have our talks patients more high maintenance than than a non Boateng's patient? Yeah. To be honest. Yeah. There's so many people providers out there that are doing it so differently. They're deluding four to one two and after one one to one all over the place that some people will I'll purposely now ask them how many units they had previously. What was their their concentration previously enough to confuse them enough to let them know that? Well, you're you really want to learn this because you need to know where it goes because I just one we we did the glow Bella. That's those the frown lines between house and the the person she's a seasoned veteran with talk. She does it all the time. And so we went ahead, and we did the globe. Ella? She calls a couple of weeks later saying it didn't take and I'm thinking, oh my gosh. How what do you mean? It didn't take. Well, she drives an hour into office to to show and the she couldn't move to go Bella at all. But above the global the other worry lines on the forehead. They were still there and moving. And she says look my four they're still lines. I said, I know, but I didn't treat the forehead. I said, we do the globe Bella. And she goes, no. But usually when I get my Nikola the forehead is affected too. So that tells me that they were using diluted version of the tax. So it spread more, but doesn't last as long, and so you know, she was bastards. She. She knew what she knew. And she was mad at me. She wanted me to give a free Bo talks to to finish it off. And I said, no, you got your discount with the group on. So you can pay full price for the touchup. So I lost her in that one. And I don't think I'll see her again. But the lot of them they think they know how both talks done, and he asked him a few questions about dilution and number of units than they quickly realized that they might not know everything. So yeah, I would say probably the more high maintenance people. But once you've got them, an understanding trusting that, you know, what you're doing that you might actually be better than that plastic surgeon industry, unless be honest, it's not the plastic surgeon doing it. It's his nurse. Sure. That's doing or is this system. You don't even know if she's a nurse or not. So you you're competing with that person as far as skill level as soon as they they trust, you know, that you might actually no more than them. That's where you're probably going to get them to come back for repeat business. All right. I'm I'm I'm cashed out on the boat docks. Dermal filler tasty got anymore. I think I'm pretty good. Pretty good. Okay. You doing okay, Lance? We'd beaten up to bed. Yeah. All right. Let's talk about sleep apnea because that's jazz. Sounds like you you just took the test on all that stuff. So so how how long you've been doing sleep apnea treatment? Well, I say started dabbling about eight years ago. Okay. You know, we started doing sedation dentistry about twelve years ago. And it's at that time. I started noticing when she put someone's sedated, and they relaxed a lot, you know, they looked like they were going to die in my chair and started freaking me out. And so that's when I kind of learned what sleep apnea was right around that time. My father was diagnosed with sleep apnea started wearing a C Pap machine. And he was one of the people that that actually tolerates he loves it because he feels the benefits from it. And so started looking into it and went to one of the DSM meeting their convention. It's every end of may early June. They have their annual meeting went down to to see what it was all about. So I started taking a couple classes to kind of get certified. But really to be honest. I was just dabbling every once in a while we would make an appliance and all omitted it. Now, I was doing it wrong because I really wasn't screening appropriately. And I wasn't doing the proper follow-up. It was pretty much just. Kinda like giving a Brexit guard. Here you go, I hope it works. And so as I started, you know, sometimes the less, you know, the more success you have to work coming back planing. They there I didn't have any problems until I finally did and an I needed to do a home sleep test. At least find out how good I had done. And if I needed to make any adjustments, and so started taking even more courses to make sure I wasn't going to kill anybody. Because to be honest. This is one thing that we do that is life or death. If we don't treat them in their sleep apnea, they could die in their sleep. They're probably not gonna die if I don't clean their teeth. Well, forgiven those ears but with sleep apnea, it's saving lives. And so about I would say three years ago is when I decided to be a little more serious about it and started pursuing my diplomat with a DSM and had to do a certain level of of see credits and collect a whole bunch of before. And after cases and to submit those. So as long way of saying about it years, right? Sure. Let's even do it for eight years or so. So tell me about what kind of let's be honest isn't sleep apnea just a way to persecute fat people. I'm sorry. A little bit diagnose leap apnea from across through me. That guy is really fat. He's got sleep apnea. Yeah. Yeah. You know, it's interesting that that is a common misconception that it's a fat person disease. The weight of the person is only one of the variables. But as a society we are getting fatter, and that's why sleep apnea is becoming more and more common. But I've been shocked at some of the people that have come back with their HI index number that tells you the severity of the condition. Some of our most severe cases have been fairly lean people and are are lower number average numbers were the more morbidly obese people. So I just looking at a person it's kinda hard to predict how they're going to have the condition. She probably right. They're going to have a some level of it. We I took I took a course from a Toco sleep. And of course, it was just a six hours a day course. And I was surprised honest. I was I was surprised to hear how much how much different the diagnostic criteria are than I thought. I mean, the, and they the classics leap apnea patient is though, you know, forty plus year old overweight male. But he the the instructor was talking Fairmont about middle aged women that are fitness freaks that still have it in children lots of children. And of course, it presents differently. Each one of these types of of of patient. So I I just I just like to laugh because someone was someone diagnose me from across the room. Right because I'm fat. And it bothers me too that they did that to me and I don't even snore. Sorry. Because he was asleep and snoring. That's right. It was because the class sucked. It's not because I'm asking. Come on people. Thing if you're giving a course and someone to sleeping you can just accuse them of being having sleep apnea occurs. That's right. That's a good approach. Okay. So you're treating a lot of patients for this. Then how are you are you screening mostly from during your exams, or you ask is a questionnaire, or is it what do you? I mean, what happens is my understanding is everyone's regular patient base has probably a decent percent of people that may be suffering from this. And so the questions how do you bring it? How do you bring it up to them on a regular basis because most people don't know that they have these problems? Most people think they're tired. Most people are one of the things where it's not typically a patient doesn't come in going. You know, doc, I think I've sleep at just like they don't think they grind their teeth. Either. Exactly, we're doing it in two ways. The probably the more difficult way is to screen your own patients. Because if they haven't been diagnosed ready you need to that. Now, do some sort of screening to then find out if you need to make a referral to the because we can't diagnose. So we need to have sleep physician make that determination. So they'll do a sleep study a polysaccharide and. Then once they've got that diagnosis we can move forward and the mild to moderate cases, really the the first thing to do really should be an oral appliance severe ones, you should try c-pap. And if they refuse just doesn't work, they're intolerant. Then look into oral appliances as plan b sure we go for the low hanging fruit. So we do market externally. I do have a a deal on TV and radio talk about hating c-pap. So we are going straight for the people that hate their c-pap. There are some pulmonologist and sleep physicians that don't like to be having a negative word connotated with the c-pap because it is saving lives, and is the gold standard. And it does a great job. But only for those people that will wear it. Sure. So we're going for the people that hey, eight it. So these people are already diagnosed they already know that they have condition and and want to do something. So when they're calling it's really easy for us. Then find out their doctors information and have them fax over their sleep study a prescription for an oral appliance the the patients come. Inside the the affidavit saying, they're intolerant. And then we can use their medical insurance to pay for it. I mean, that's that's pretty cool. That's so are do you work. Do you find that the relationship you have with physicians who are treating this sleep sleep doctors, essentially is it are you working with them? Or is there more adversarial relationship? We're definitely working with them. But it was it was adversary. I mostly because they've been burned before I think the other dentists they take the weekend course, and they were like me years ago today bling and would would present to the office saying, hey, sh semi your patients will now talk into the sleep techs. And I now go hang out sleep techs couple times once a month or so just to hang out at pizza and watch the Polycom grams most because I want them to give me referrals because sometimes they can give my name out should have people that failed eight c-pap. Do you know how to party? So what we do is the initially to the doctors were skeptical of me and my approach I would go to their office trying to introduce myself to develop that relationship of and and they're just like me at my office. The the sales rep shows up my off my staff knows not to let them talk to me at all saying there. So it was getting the same thing. But as soon as I started having request of their own patients, and then they were eventually seeing their pay shins successfully treated with appliance, and then they're getting letters from me and the communication the biggest beef that most the sleep. Doctors have is they hate sending a patient to a dentist and then never hearing from the dentist or the patient ever again. And so by our protocol includes a lot of communication via letter fax or Email or all three back to the sleep doctors. So that they're aware of the of the entire process. So it's it's a slow go took a long time to develop these relationships. But as time goes on the relationships grow. That's when the referrals become more. The goal is to not have to re- to market externally at all. And just have a referral based flow. We're not quite there yet. Thank sleep apnea treatments. Become very popular in the past several years. I think a lot of people are getting into it. And then finding that it is a slow go, and it does a lot of work, and and maybe dropping off a little bit myself included. I think the insurance portion was the biggest drawback for us. How have you ever come that insurance? And and can incorporate that into your office and ever come those roadblocks? Yeah, you know, we think dental insurance is the big evil empire trying to learn medical. It's just a different ballgame. I mean, you have diagnostic codes as well as treatment codes every insurance has their own accepted. You know, we were all used to different PPO type plans. So we never really know what to expect is far as the cost is I'm used to being well, this is my fee, my fees my fee. And pay this or that, it's it's a little bit more of a crapshoot with each one. The insurance game is so difficult that we do actually use an outside billing service to to manage a lot of it. So for a percentage of the revenue they'll take away a lot of the headache. We just have to collect all the right paperwork to to give them. So that they can do their part. And as long as they've got the right information. They can streamline it. And we usually get we'll always have to do it predetermination. Whereas in dentistry, we try to get people to void predetermination because it's just a delay tactic with medicine. It's almost mandatory. You're you're you're foolish not to. So at least them we know we're now dealing with deductibles that we don't really have to deal with much in dentistry. And it is worse now with the change in healthcare, whereas before people had at one to two thousand dollars deductible now we're getting five to ten thousand dollars deductibles, change healthcare. What I know. She'll write this down. Now, plenty about this. We're we we have a fair amount of treatment in my family. We my son is a tick, we do Fairmont of speech therapy and stuff like that. And and you know, we have for two years. We haven't hit our our our deductible. So I'm like, I'm, you know, taking bigger risks. Maybe hoping to break my leg or something like that because you know deductible. I'll hit the actual I'll start cashing in. Then see what I'm saying? Yeah. You gotta make sure you have all of the year major surgeries and trauma all in one year. That's right. That's right. Okay. Gonna get the hemorrhoids surgery in the same time. Two for one deal. Right. Exactly the same needle deductible. And I'm perfect. It's like I buy the Secta me. I get the hemorrhoids for free. I see no problem with any of that. If out a nickle every time I heard that. I believe the the idea of dealing with medical insurance. Like, clearly I've written in bitched about dental insurance for a long time. But the medical insurance is here's here's a little. Here's a little thing for you. Try and go to your doctor's office and pay with cash give that a try see. Yeah. My daughter, actually, she broke her arm a few years ago and took her to the hospital, and everything was we were insured guy came in and didn't have insurance, and they send I walked up front, and I said, well, wait a minute. So this guy was coming in needed help. And would if if I came in, and I just had one hundred thousand dollars in cash just sitting right here. She's we can't take you. There's the system is built not to take cash. Yeah. Tony has to have insurance. They they they could not do a cash pain person. And it blew my mind that it was kind of an ER urgent care thing for kids and. I I might man. That's that's foreign it's foreign but on top of that. It's like you ask them to try to predict. Okay. So I hate to use the term, but a co payment, right? You're gonna have to pay us around where you try to ask him to predict every insurance is different. It's like they throw up these ridiculously high numbers in see what the writer. It's the insurance company it sends back, and then you get a Bill in three months in it. It's a it's a roll the dice. It could be seven bucks or could be twenty five hundred bucks. It's it's not sane in. I think to myself if I even came close to trying that my patients, I would never hear the end of it. Like, if I haven't told them if I haven't told them to the sent what they're what they're exactly what they're they're part of the you know, they're half or their quarter. They're furious with me. And honestly, we do pretty good job. I think you don't we do a really good now with with that. And I just blown away by how no one was last time a physician talk to you about money. It's it isn't their fault system is. But it's like, wow. It's a hard way to live. So in a sense. The sleep apnea thing is kind of you get to dip your toes in that poll. I'm not sure. Yeah. A little bit that the good thing though is insurance is actually do want to help with the sleep apnea because they know so many diseases are related to sleep apnea that if they can prevent it. They will save billions of dollars in the future. So they've been pretty good about pain for oral appliance therapy or the home sleep test, and all that kind of stuff that that they may have been more reluctant to previous years, but as more data's coming out and showing the relationship he's other really expensive treatments. They're more for the prevention. Is that Bill services is that a local or is that a national debt other than its Nash that from? Yeah. So we're currently we're using gogo billing there. They don't dance on a pole. They're just a man for a second. Yeah. He had me interested almost. We do have a couple of companies that we work with there, probably are predominant one that we work with. So they really do streamline it make it easy. The before tried to my I was really reluctant to spend more money. And so we were trying to do it all in house, and you know, my staff, which is going crazy, and so fine when we started farming it out it just freed up all this stress for everybody. So we were still able to crack the code or dipping our toes into the medical world, and without too much, gray hair. All right. So you were you alluded to this a second ago, and the one thing the speaker, I heard I'm not gonna say who was speaker. I heard was very good. He was very compelling, but towards the end of his lecture, he got he I felt a little black helicopter thing going on there. It was like you kind of tell in his mind sleep apnea was sort of the one to cause disease, and it was a little bit. I I felt like to me he was reaching a little bit. What are your thoughts on that as far as the relationship disease and sleep apnea? He was thrown out just yet. Everything you could you could imagine. Yeah. I was skeptical when I heard it, and especially the one guy said most diseases have a relationship and till until recently, we used to say most, and now we can say all and there was some linked to cancer, and I'm gone, no way. So then I started doing some research on my own. And you know, there's definitely credibility to to say that every disease has a relationship to it. And at least at the very least the big ones. It's I have a hard time with that relationship with thing that always gets under my skin, that's a whole other conversation have, but but clearly there's some importance there some I mean, I think. I can disagree with some of the some of what he had to say because I don't I don't know that the research that's been done is good enough research to make claims that that some people are making in listen to me like I'm some kind of economic, but I will say that it's definitely up and coming. I mean, this is this is essentially ten years ago. You didn't hear physicians talking about this stuff? And now, it's kind of everywhere. So I think it's not going anywhere. Right. I think you will become a believer. The more you're exposed to the data. I think you're just start seeing more and more correlation that you thought was company be hokey and out there. And then you're you're you will eventually believe it's sound like some guy trying to believe it's what the evidence says that the. All right. And there's enough evidence to show that interesting interesting. All right. We are. We're like at fifty two minutes of this recording right now. So I ten minutes was good. So. We're actually I I would say we've probably got about forty five minutes. Solid stuff. Actually. So we'll have to. All right. So I I this very good actually, your an excellent interview Lance have you practice where you're practicing in front of the mirror last night. Be honest. A little bit. I'm actually wearing a suit because I thought we were video Skyping. And because Jason lied to me, which is funny because I'm not wearing anything. No it wasn't. Ok Jason gave anything that. We missed any any good stuff. Now. I think everything is was really great. I'm really impressed with the way. Everything went. So I haven't done good. Yeah. I this. This was this was a blast. So maybe we'll just we'll just interview you every week. You have a problem with that? Well, we can always do that time. Who doesn't right? I mean seriously. Well, great, man. Thanks a lot Lance. I appreciate it was it was great to talk to you. This was really really informative. Okay. Thank you. It was fun. Wow. That was that was a really great interview with Dr Ramin. He's got some really great suggestions for the sleep apnea dental practice in it sounds like he's kinda got it down to a science that you really enjoyed what he had to say. If you need to get in touch with Dr temperament or or if you just want to find out more about him. He is in Seattle. You can find him on his website, which is the r Timmerman t I m m E R M A N dot com. Yup. Dr Timmerman dot com. Check it out. He's got a great website. Yeah. We'll have all that. We'll have all that on our. We'll make sure we have his information on the in the show notes. Do you have any questions or comments on his interview or anything you need to Email info at dental hacks?