1 Episode results for "Leeson California"
1546 Dr. Hamid Abedi & Thomas von Sydow of Cornerstone Dental Specialties on Endodontics Made Easy : Dentistry Uncensored with Howard Farran
"Thousands of texas and schick owners have added a jazz sensor to their practice using our unique subscription option preserve your capital while never having to worry about warranty and support again visit jazz. Imaging dot com. That's jazz imaging dot com. It's just a huge honor for me today to be podcast dr hamid abi diaz ms mba. He earned his dental degree from the royal london. Hospital in nineteen ninety-one his msn. The ended on especially at loma linda university in one thousand nine hundred five but his mba from uc irvine. Doctor is an assistant professor at loma linda university department of indo. He enjoys teaching Oh by the way. That's where i can't say his name but the guy who invented a mta method. Drexel on my. I i. I pay someone a thousand dollars if i could pronounce that saying again. After tora john you know every ended on his always says we get him on your show. You've done effort into. Will you tell him that. I mean i mean hell he invented. Mta and the legend is that he was watching his serenade swimming pool. Having gin and tonic. And then he watched the The soaring pool maintenance man put repair mortar on the wall. And he got the idea that this about works underwater. And i'm like okay. I don't know if any of that's true. But i want to get him on the show and find out but anyway loma linda university department at is he enjoys teaching and his lecture extensively in his specialty filled both in the us and abroad he served on the professional standards peer review and ethics committee for the american association and onyx. He still works ten to fifteen days among chair side and that man next zoom. You can't see the ponytail but it's right there by he's trying to hide he's trying to look straight at the camera so you can't tell sporting a buddy tau is tom. Von sido comes to cornerstone with over thirty six years in the healthcare industry. Most recently thomas. A senior leader of all specialties and hygiene at pacific dental services for ten years. We my buddy steve thorne. he's been on the show. He's also held senior executive positions that noble bio care. Thomas holds a bachelors degree in healthcare management from southern illinois university carbondale and advanced certificates from harvard in leadership and corporate strategy. He's a member elected. The american association of the ended on enthroned advisory board and board advisory for care crew. A dental software company My gosh i. He's got a wife thirty five years and spending time with his three grand. Three children and grandchildren in that the best feeling in the world Got i just loved it all day but gentleman. I'm so thankful that you come on this show because the big dilemma is. i mean. there's several things i wanna talk about. And one is the fact that eight and a half percent of emergency room visits or a dont'a genyk in order in origin. These kids come out of school. Four hundred thousand dollars in student loans and a person shows up in toothache. And you don't want the specialties. is public health dentistry. And if you can't extract the tooth or do root canal. They're going to end up in the emergency room. And and it's it's unacceptable that a doctor of dental surgery can't get you out of pain by extracting a tooth or dinner root canal and they come out of school four hundred thousand dollars in debt and i swear half of them have already given up on this at all. I did a molar indo and dental school. And i'm not doing that again and like well. Well you have to receive your world. If you're the only dennis in eli arizona and someone comes in with a toothache and you say well. I don't do extractions root canals. Well we got. We got to change at forum. So i'm hoping today that you have some new things in endo that'll make these young kids wanna get back on the indo gravy train How are you guys doing. As you rightly said how endo daughters who were kind of that er doctors of dentistry our group. We have forty clinicians. We will working all out. And i know some of my other colleagues are open. Working pretty busy. I agree with you. One hundred percent patient coming in with pain to any doctor whether it's an end anonymous or General dentists as health professionals. We should be able to reassure them. Minimally get them out of pain or extracted tooth as you said the i know You know by doing that. We can keep the emergency rooms often. Because i know the number of patients on had specially in the tough times i was pre scarier especially the beginning. What patients were terrified. When who can as-as a refuge. And i had south to all. The doctors offices opened at to jar of emergencies because desperate situations physically turned away from emergency. Rose we were the last hope. And you know i think it was definitely tough for all of us on. I'm hoping that You know we learned some lessons on. Come out of this stronger. Yeah i remember when you know when they closed down for two months and it was confusing timings back then because you know you go back all the way to march i. Have you started wearing a mask. People like don't wear masks. Save those for the emergency room. Doctor so they you know a lot of mixed signaling. I shamed you for wearing a mask and then they shamed you later for not wearing a mask but i remember talking to steve to warn and trying to support him. Just like if you're gonna shut down all the dental offices they're all gonna show up at the emergency room and it was just crazy and it's like oh my gosh. After dentistry went through hiv aids. From seventy nine. On i mean we took infection control extremely serious and and prepared so much for this pandemic that it was kind of a crazy That the dental offices had to close down because exactly oral surgery us and by the way. I want to tell you something. I don't want you to ever forget this when you look at Pay for My gosh we're is there. It is right here when you look at the The specialty pay my gosh. What is it for those Those guys Right here average net income for dentist is a dental specialist three twenty general dentists one ninety seven dennis who are owner operators Own their own business. They make to forty four. Dennis employs make one forty seven but oral surgeons make four forty eight and ended on three. Oh seven i mean dude. It's blood and guts. And you come out of school. And you say. I don't like blood and guts and root canals. And i just wanted you. Bleaching bonding veneers and invis- line you know someone s to be a doctor and a rural doctor can pull a tooth and get you out of pain or start root now. And by the way oral surgeons arizona's arizona's the only state where any licensed dentists can come here and practice It's ground zero for. Dso's eighteen percent of all dentists worked for dso. But i know a guy that hires orel surgeons and ended on us in arizona and their base pay day one out of school for an oral surgeon is four fifty and versus their Commission based on production a lot of do seven fifty their first year. Holy moly and you tell me you don't wanna pull a tooth. So so how do you. How do you talk these kids back in endo well you know what we i one hundred percent. I think you know on the faculty of part time but you know. I'm graduating almost thirty years ago when i graduated. I did about twenty five root canals. We talk to people come to our training seminars that have left dental school with massive debt. What having done two or three can we had the first thing. I asked him what we are seminars. Outside done in school. And i'm always shocked. We had we had one a doctor. Who don one route. So i think it's you know it starts at the schools after that though. I think the. Kobe is given opportunity for a lot of doctors myself. Included to polish off and take continuing education courses. We have training. We have our own training institute that we can talk about now a little later but our our goal in this is to be able to allow any doctor to get a patient comfortable in five minutes by doing an open bed so we have a program for opening and then we have of course for the smart thirty minute roots at al smart signing for safe measure affordable reliable untested and. We're doing these courses. Want to help our doctor station during covid but to fill this massive that exists. It's not acceptable for a patient to arrive at a at a dental with out of dental office and to be told take these medications. Leave my office. I don't think that's acceptable. We gotta be able to take care of them. We have specific courses. That doctors can take. They can put into practice the following day monday leave our courses virtual universe so we had a grenade Which is what is behind us right now. In fourteen civilization stations in three stories we have lied gazes light beige. It's we partner. With a charitable organization called lesson that clinic we do free dentistry for them. Surgical ministry and patients coming to get you charity as for them but then of course you can actually access those patients and demonstrate like aces. We have a virtual version. Now we can send the dentist everything. They need including extracted teeth to do the course remotely in their in their office. If they're at home we can send them. An obama no added a sensor and we can walk curricula. And then we can we can have we can have ended novice argon stronger debrief their case their post op results. How how long did they don. What were the challenges. And we haven't no pulse as it's even. There's a couple times. Virtual hands on experience while a mannequin head includes all the instrumentation. Am visas files. It comes in a little kid by that action. Put it back into axa back because of coping virtual version. Now they also have a training center and what is the web's nobody websites for you guys. I which website is your training centers. Cbs dental www sees. Charlie tease and tom is in ivy dental dot com. Ct identical dot com. If they go on their a list of all of our horses and and and we'll be they see when the survey and also virtual orces immorality a obviously seat peseta in twenty twenty so royal between twenty one we can add additional or so it see ti workplace dot com dental also dot or dot org c. c. t. I dot or your ponytails too tight you need to let loose. How're you can show there. It is yeah there. It is seeking to judge it's boxes. This is very proud of businesses. This is what gets sent to you for our virtual hands on courses so let me open it up for you. If you're on i tunes listen to the audio switchover to youtube. Our channels youtube dental magazine. And thank you for the one million views. We passed one million views on youtube. That is so great things but switchover youtube. He's gonna open up. What does this say cornerstone group for first before you injuries. That tells us what the cornerstone group is says right on the package cornerstone his corners juliette group. And let me show you the bog. It comprises are different Groups cornerstone dental specialties. Which are service company. We have the ti dental that we talked about which is a training center and we go to slim specialty products. What we develop products at the end on than general. Dentists makes the whole process easier. You know don't forget as a group we've done probably over a million canals so we know a thing or two about root canals. Wow that is amazing. Let me just quickly show you. It's up to be very proud of this. I know during colbert's a lot of doctors we are fourteen workstations here at the center. But a lotta times doctors. They don't wanna travel so we run life courses. We have the whole madison. We have the mannequin head in the box. We have the titled on with real extracted teeth. Set in this. This gets melted for the doctor in their home or their office. We have a have trees. We achieved send you a little camera that gets connected your laptop so we can actually critique the cases that you're doing right from the comfort of your home and then obviously you know hand piece. We really is this kind of disposable endo chat developed everything in house for this allows you to do the root canal process. He's got great. Thank you is august of a kit. Has everything you need including An asean injury al-siyassa anaesthesia. Which you know about a patent for the product for that but anytime the patient has to be comfortable doing covert we gotta make sure patients are completely nom. We have device. We've created called a vacuum cloud especially with covert is a disposable clamp. That goes around the truth and is connected to suction your suctions reduces free. Which i think is very top it and we have everything you need for the root canal. A own dodig files at have peace got Of obviously irrigation. Everything you need to take care of either. The patient or in this chase are giving them. We have demonstrated up. Goes over the procedure the root canal procedure but the great thing is once a month. We have a live stream course so the doctors can be interactive. I'm they can partake in. Do improve their skills in any way from opening meditating to doing it thirty minutes. Small group cannot from the comfort of their home or their office. You you just do a root canal in thirty minutes you mean on. The course are thirty minutes on a live patient. More root canal. Well you know we do a delight. I think of. We have a live demonstration without senior doctors doing bala root canal and thirty minutes four canals. So so that. So you're saying it's possible to do a high-quality for canal. Molar endo start to finish in thirty minutes. Yes holy moly. I must be slower. Have a head injury. Hey i got to tell you something about that indo. When i go to school and eighty-seven ended honest. We're making as much money as world surgeons because they were doing eight to nine hours a day and they fell in love with a microscope and that's slowed them down so much. They dropped to forty five hours a day. And that's why you see the you know the surgeons Up at four forty eight and ended honest down to three zero seven. A lot of people think that That microscope actually cost a general are ended on about one hundred and fifty grand a year. What are your thoughts on that. And then you're saying that you muller in thirty minutes. I mean that that's that's nineteen eighty speed endo it will i think you know. In terms of innovation and end the microscope and enhance magnification was critical. Know the nineties. Ninety five ninety four. I think we introduced the microscope up at the local university. So i think it's critical to you. Some form of enhanced interrogation now. Most of the issues like scopes. We have loops not go up to eight to ten times negative occasion. But if you're going to do any type of molar You know what is opera lower as a high probability of an mba to meet me. Zealander lowers to this canals. So you have to be. You know you have to have the right to armament -tarian if the if the case selection is critical if i get a tough to on wisdom tooth with a separated instrument it's still takes me probably three four hours. Maybe a couple of visits daycare up. What if we have an average molar. That's open may the jaded by referring doctors so the patient is comfortable diagnosis as being done and assisi's made easier. It's possible to do that. I think you know now the new innovation or the. I don't think it's new. You know really for us is kind of discount convergence and digital dentistry and the past image Whether it's Comb being with software to really demonstrate to the patient. You know live case where. There is a problem or not and tom's lorca and a lot of dentists this kind of a convergence of the oral systemic health. You know. I went to dental school in england in the eighties. So nice lesion was cold out everything elision and the mouth was called a beauty spot or a artifact. Those things don't exist. That's an active infection in your job on is causing systemic effects. I'm you need to take care of it and the only way to take care of it as either extracting to is what you said or doing route genera our dude onyx surgery so love. I think that nextwave for all of dentistry in this kind of digital imaging and as a profession. You know there's been a lot of studies. Dentists can go to. Three patients can go two to three different dennis and get four different treatment. Plans saw to build up Spatially there's nothing better than live picture or a three d. image of the tooth with problems on the artificial intelligence and big data. You know we're gonna get to a point where it's going to be definitive. You either have a infection and elision or you don't and i think that's going to show that in reality and dynamics may be underdiagnosed not over diagnose and kids what he's talking about is long before you were even a dream in your parents is back in nineteen ninety seven. I know most dental school graduates weren't even born but anyway the reader's digest came out with the article said how honest or dentists and it was a blow up and dentistry Pulitzer prize winning. William atkin berg. Reader's digest how dentists rip us off. This guy was a legend and basically he. He took study models and fm. Axe went to thirty different dentists and got thirty different dream of plans. And everybody's like what the hell and then the national dental research sought. Okay we know that a pulitzer prize winning journalist reader's digest is a huge footprint in american history and he got his pulitzer prize on the three mile island right up so they said. Maybe there's something to this so they said we're going to redo this today but we're going to do it on two hundred dentists and only two treatment plans for the same and that was the two guys said you don't need anything and their dream of plan. Three toed ninety one hundred Went from like a hundred dollars to thirty thousand dollars. And so. And i see that i mean when you're at a continuing education class someone will hold up an x ray and and i mean it's amazing I i don't even know how. Dso's do a tom. You're with steve. Torn and pacific dental for ten years. How similar do you think they're onion now like locations thousand dollars. How consistent are their treatment plans and do you think will help them. Treatment plan more succinctly and evidence based and beijing. Big data shows that coastal. But it's certainly you know there's a lot of There's a lot of internal review of view hospital hospital so i work in healthcare for a long time sauce. Have ever you more. They have a group of doctors that a look at different things. Different transparent different items. It's not it's not punitive type of situation it's more a collaborative and a a communicated. A style is look you know about this. Way are one inch. It'd be too. Why should decide this versus that and coaching education crane. That goes around. Try to make sure that the diagnosis. That's made his accurate number. One number two to three plan is appropriate for the job that adheres to the standards of the community at large and the data and the research accent out. So that's how we did it. I can't speak dsl. But it is one of the advantages. Be there is. There is some Does exist and somebody got a helping younger dennis. Dennis experience so different way. But you were. You were talking about Just the same. You know you're talking about new technology and indo and the new technology. Of course i know my. Because i i can see their surfing behaviour on dental town and when something starts costing a lot of money though you know the people who go to downtown. Every day they go to today's actor topics and read a newspaper. Like what's everybody talking about but when someone does a specific search and then stays on for three hours. They're going to buy one hundred thousand dollars. Cbc t a cad cam and endo at nissan endo. And everybody's like how much is on indo going for these days we Bijon bergheim referring to gentle wave. Yeah made by made by sun endo yes yes correct. Well you know. I think A great attributed to answer your questions about eighty five thousand dollars. I believe between seventy to eighty thousand. And i believe the disposable costs are among you know more than fifty dollars for a case. But you know the principles. That's what i like to comment a little bit for your views. I think it's a great a lot of ended on. This are using it. But there's nothing the technology we call it. Activated allegation is nothing. New about activated irrigation. And there's different forms of it. You know you can Get back which is a negative pressure or a you know. irrigation as sonic forms of irrigation. Endo activator one made by densely hundred and fifty dollars a visa makes a product of hand held the ultra sonic device. So there's no doubt that Especially for cases that involving faction infected cases and re treatments. You should have some form of activation with sodium hydrochloride or irrigation. That you're using so if you don't have any dogs you can fill the hole out chamber with saudi michael chlorides or some of the new saudi michael chlorides with added surfactants adhere to the nineteen tino oils better and use your ultrasonic unit for for for scaling that'll create some acoustic waves and the tooth. Okay but just to be clear. I'm gonna hold your feet to the fire. It's eighty five grand dude by it. Shoulda shoulda dennis doing seven. Molars a month spent eighty-five thousand on on endo's general wave multi. Sonic ultra cleaning technology. Or would you pass. I think five we don't use it. You know so. I want to get on the side because i know that technologies. There's there's to do things i mean. Number one. the sun son and of gentle wave. You not really gonna use it till you've already worked at least twenty five or more right and so it's gonna clean out more but the most of the debris left in the tooth is amiss canal. My my my homeys myself included have a hard time finding the nba to if i found all the canals and got them all worked up to twenty the last thing. I'm looking thinking is all i need. Eighty five thousand dollar extra ultrasonic cleaner i i need to eighty five thousand dollar thing to show me where the damn canals are to say coupla busy no i think it's a very point this concept of a vital tool versus the chronic and how some endo ghana's if in doubt so right now i've become a little more aggressive if doubt i do general because all the research shows that if the tooth is vital in the state of irreversible alpine's and the american association the dodgers has classification for a symptomatic irresolvable pirates. When there's no lesion on the two and the tooth is vital. The body is much more forgiving. you know. I'm not a suggesting any shortcuts but if the root canals a little shorter or maybe irrigation is not ideal the body. May he'll because you working in sarah environment. When you have a lesion on the tools or the to disney chronic than all the research is compelling success rate is anywhere from five to ten percent less attitude with a lesion on it and you have to be much much more a two hundred six precise now. You can't feel a little short. You can't miss any canal adamy because the whole truth is infected but coming back to your question i agree with you. One hundred percents a large investment to making unless you're doing a certain number of root canals and to be honest with you the data's not compelling there's no large studied at shows using gentle wave is you're gonna get better clinical results and outcomes in using some other form of activated activation when it comes to irrigation and another problem where we we have is the fact that sense sad dentist. Don't get along with their value. Chain like all the other industries the whole value chain works together but You have the the dentist and the insurance people there. They just live on planets and they don't talk I talked to the chief economist. The ada he's on the same city as the have delta. He doesn't have access to neither data when i drink with them at a bar. I spoke in florida to the All the The dental insurance dentists and evaluators and all that stuff and they they were showing me amazing stuff but they wouldn't let me post any of it on dental. They but they were. They convinced me this that when a ended on does a molar indo in five years. Five percent senator extracted debate. If it healed and the goal that just is to still they're not in an honest to molars in in five years. Five percent are gone. And when general dentists do the molars five years ten percent or gone so the question is back on endo is why is that why you ended on his doom roller root canal and extracted. Five years. Later is it because they didn't get it all cleaned in shape. I would venture to guess that it's probably a fracture probably wouldn't restored first place what you're smarter than me on on all things into what would you say. I agree one hundred percent. I think that was the marcha. Saudi delta loopholes five hundred thousand teeth and they found out exactly as you said you know a delta did that yet marquette university of that study five hundred thousand t- ever see that. Can you send that to me of course of different times and as you said after ten years after one yet if my memory right about ninety six percent of teacher good after ten years as you said it was about ninety percent with five percent delta which was significantly statistic -nificant on five percent coming. Joe point there's a lot of different factors named planetologist and tommy is going to kill this. You know because we have this discussions about end. Don sources implants. The madonna figured decide very easily a lot of their studies. they eliminate smokers. They eliminate sars eliminate people with diabetes eliminate people with type four ball and they showed her result they eliminate a large Donald disease and then they look at survival versus success as i don did we shaw serving the fort in the sixties size out of scandinavia. We have very high criteria reestablishment of laminated. You're on a to consider its success. So there are a lot about the facts as well including inclusion colonel leakage restoration. That can impact a success as well. I would ask same plot colleges because they're masters at a new sexual studies a lot of criteria. And i think we're coming back to a happy medium. now. I to be honest with you. I've been a dentist story ours looking back. Twenty five years ended honors. Probably looking back in my own history. There are certain teams. That didn't i didn't need to retrieve two times and then do surgery on. I should have just extracted from bone implants and at the same time. There's teeth now. Healthy teeth being pulled to place an implant any implant snows. There's a lot of complications that are associated with dole as well. So i think it's coming back to a happy medium now. Hopefully we put the patient's interest i. I placed myself as the patient sitting. Now what would get in my own mouth. And i think the success with you know with among is pretty good. He's over ninety percent of five years. Which i think is a good success rate for something for you to. That's in a dynamic environment going through and beauce constantly. Wow that was profound but you know one of the things that i still concerned about with the kids. It's not the fact that the The you know supposedly cova that they didn't get much clinical experience. But you are on town. And they're asking about a Clinical diagnosis of the on the indo history. I mean You know medical dental history. Recent treatment drugs chief complaint. How long symptoms duration pain located blah blah blah. But on just clinical. Oh yeah i do pulp test. No we don't have any at our clinic How would you test. It were heat. Percussion i mean. Some of them don't even have to sleuth. And you're sitting there thinking you work. In a clinic and they don't have a pulp tester electric tester. You don't have to sleuth. i mean i. It concerns me that. They're not doing what i consider to be the basics back in the day do you see any of that or not. Really i agree. I agree you know what extreme we have. You know clone beams. You know gentle way on the other. Extreme howard are tests are prehistoric. We need a little hammer or percussion tube sleuth maybe four cuss coverage when you use ice and heat which is a simple endo ice and though is is probably ten dollars for the model and then if you electric politics for about one hundred bucks so what. We're not advocating spending hundreds of thousands of dollars on a cone beam and gentle wave. And you know. We have microscopes and other things but to give the preliminary tools that can help you determine to get to to take you from a dental mechanic to a dental doctor. Dentist switches strong diagnostics. Still to come up with a a pickle diagnosis at a pulp. All diagnosis is probably a hundred dollars worth of tools. It's not that much what we have to. Because you know when when i served the and peer review you know it doesn't matter how good the root canal looks many. What do you find. Four channels five canals. We have to have a clear diagnosis. We have to have a palpable diagnosis. Which really as you correctly said involves hope testing basically endo ice on the electric motors. And then the perrier pickled diagnosis which basically nose looking at radiographs carefully looking durra and using the back of that mirror basically to hit the tools for percussion during your pal patients your finger and then if you suspect cracks or other things using tubes luke or a q tip those are simple tests and you know they hit you know for about one hundred dollars so i can blame you if you don't send one hundred thousand dollars to buy the latest Cone beam but at a hundred dollars. I think john most finish should be doing these routinely because we have to get to paul and eneko diagnose says before we pick up the bar and we cause reversible damage shoot with are basically and what what was the website of your clinical dentists mobile. Dentist i believe are especially group. Cds dental dot com cd dental dot com. Yes cornerstone dental specialty. Cds off so that. That's the so talk about that. So what is that. Of course dental spicy set out over twenty two years ago to answer these questions but Tell tell us what you do. So cornerstone is probably the largest dotson north america. We have forty honest at service thirteenth states and roughly four hundred locations. We do about four hundred fifty to five hundred days event a month or about thirty five hundred cases of And you know we primarily service saadia so space in that model and we. Don't we set up. A patient referred to another brick and mortar location. We conquer the location take care of dental needs in that location so asian diagnosed on wednesday next wednesday. Their own medicated. Rayvey go we take care of their root canal they have jerry signed me to actually brown that too many times that same day so Everybody we're visits with a patient with more convenient for the patient but they should know that we're gonna take the insurance. That's there at the office because we're contract with that so there's a lot of a lot of city mess. People allowed bad. Things can happen when you end up. Patient business started referral slip and this this allows us more control and make sure that the that continued and finalized. And it's all the same route of general bachchan as the strongest relationship with an guar so model were starting to open up a model white bat in in the in the non the associates. That's the sds sixty and that is exactly se model with two exceptions to major except one in the model of the general guts working all day. Care the credentialing everything. And we're gonna we're gonna bought us is is a visit to the general dennis but more importantly we're going to show up in that brackets with a digital design studio. That's going to have a cone. Beam scanner jer siberia machine. Aural stander three d. printer racial standard at all the tools arterial microscope. Every need to complete the cases that day. We're going to bring that into the office. Used opera pretorius treat their patients and then and then we leave and come back on Basis so what we learn seventeen years in the diaz mace doing million root canals this way and starting to approach. Now the private as you brought up earlier which is we decided purposely Part of this in the more rural or outer suburbia markets where acid care to enhance it on his is limited is elite eighty seven hundred hundred dot. Luckily in the us and servicemen are fifty million. Took freelance seventy five or a million people and in the in the areas where imply overstays in the non by also communities are massively undeserving. Look at the kaiser permanente thing data. They're massively under served in the mid western states. So it'll be our digital focus increase access to care and try to try to bring this bottle pulled over seventeen years to a much broader audience. So the general dental is going to be the Your website surgical ds three sixty. That's the name of the company correct so surgical deal is going to do what. You're doing with cornerstone. Dental specialties for dso's Surgical three sixty is going to be doing that. For a general dental office to be Obviously the more convenient etc. So what states You doing this right now. In cornerstone dental specialties. Ferdie esso's it's thirteen. It's probably eleventh thirteenth status. It's we're we're mostly south west. So if you think california arizona. Oregon washington colorado Each state different levels of penetration. You know we're in tennessee or in virginia. We are in a soda. Try to try to rigoberta going through those days of my mind right now. But you know. I've got a sunbelt states. Had brought up the west coast and then starting to encroach on the east coast. Southeast he starts. The new model were focused on initially on a tennessee in missouri That's where the we think. Many great it's is so we're we're starting our our new platform in and the net platform revolting. Should stand down the road as you imagine if we're gonna show up into endo potential show up and do a larger cases with oral surgeon or or implants we can show up and do or surgery for wisdom tv arium surgery. We're not gonna get involved with some of the other specially pedo. Ortho this at work but the surgical specialties words one visits. We think we can extend this flat. Future to other specialties. Well pediatric dentistry and orthodontics is doing best together. Those that one plus one is three. You know you take your kid in jeopardy dennis. Every mom says does billy need ortho and every and those two are coming together. No doubt i'm clear choice. Showed us that. When you take the implant surgeon the prostate honest to restored and the lab tack. That's one plus one plus one eight how that equals five because at companies have been sold five times They're doing you know i mean you know. They're they're making money. They're making so much they can never resist selling it to the next highest bidder but i think oral surgery and endo go together you said at the beginning oral surgeons and ended on us. Are the emergency room doctors for dentistry. And and that's where the money is. Because you know if i went in you know you got to convince me to get bleaching bonding veneers if i went in your offices had howard you look so much hansen with the nears. I'd probably laugh. So hard my molars of fallout. But when you're in pain you're begging the doctor do but kids. Here's the other thing you've got to figure out you know You're a cynical bastard like me. Money's the answer what's the question You know the insurance companies are driving this schism because you know they're at the value chain to they're paying for the staff and they know when they pay ended on us to do it. It's more likely be done once instead of twice the state boards. You know anytime. A general dentist has a root canal. Fail they always go so to the ended honest and then they start asking these vague questions like what this done to the standard of care which there's really no definition to. What is the standard of care. That's as vegas is too. But here's the deal. When i do a mole rando and they'd give me seven fifty and i pay my associates. Twenty five percent. Well they might pay an ended on us. Thirteen hundred dollars to do it. And then they ended on us comes in and around here in arizona. They're asking for forty to fifty percent of the fee. So then you're looking at the math. Well what's fifty percent of thirteen hundred versus twenty five percent of seven hundred and you start looking at it and it's like my gosh. I actually will make more money if the ended on. Does it and you guys are saying you're gonna do the insurance billing and collection for those fees is that just because you don't have faith in the general dentist for more control. And what software are you using were we. Dds as our platform and it really is partially because it's a pretty complicated process to get everybody credential at locations and making sure that the insurance bill out properly and everything. So we'd like. I said we still enter herself. Control to be transparent by I think it's more or less than these. These moral markets where. They're not used to working this way We found that when we did our research stress level of brain a specialist in went down a little bit or the front desk from the front office. You know the staff a team you know. Kyra you'll turnkey solution for a day or two. We literally like a virtual brick and mortar practice inside iraq is so it becomes very hassle-free referral standpoint area hassle staff astle free for the dentist and they still get the monetize it Unlike academy to set it up to a rookie mortar. So you chose Planet dds for your software. Yes and that's the that's the leading top rated cloud based practice banjul solution. I come back to that in one second. But i want to know the The other one is that My gosh didn't Didn't sawn endo Gary car is a really famous ended on us. Out there. in san diego's only person ever kicked me out of a c course me and mike tola 'cause he was limited to end on us only yeah and he owned a video. The digital software were so many of my friends and john leeson california. He loves the te'o but they sold that tucson indo if they sell that tucson indo. Would you have considered using te'o software since you're ended on us and you would present of your businesses. Endo versus the other specialties. We door surgery by but but basically one hundred percent right now endo. The decision for planet was predicated on. We didn't we didn't do a ton. Investigation into but the factor was slough based the fact that had very large market share strong support team and again assistance with the back end for the house. Stuff like the building the credentialing the you know the benefits coordinating the automation built into the system. Because obviously we're we're mobile so we need a lot of. We need a lot of you know. High in technical support is not just about the record chart and how you know manage radio brass the nuances. That are some of these other softwares. It's warm Complete continuum of care. And as i mentioned we'll Purposeful tag is to eventually layer in other services door platform because once built trust with these clients. Were pretty confident that we bring it a competent Role surgeon and they do have a need for more extreme cases in implants that they will choose us as artery so it was a combination of things. That landed is unplanted. Dds era guy seki is. He's as gary site eric. Co planet diaz. guess sorry. I he i had him on the show Number seven fifty eight amazing man but as a sounds like the cloud was the big feature for you. Would that be safe to say. Yeah i would say. Probably a good decision Actor so so. So the general dennis. The number one new go-to is open dental. So i'm sure eric would love it. If you gave them a plug for a planet the yes but why. Why did you like planet. Dds and i'm i was with software for thirty years. That was the biggest piece in the in the room. owned by kodak. And they you know back in the day but why do you like What would your plug be for planet. Dds over like open dental. Did you consider open dental We did not. I don't believe that was not one of the ones that are hugh said. It was what we felt was the comfort of their support. You know we got a lot of time with their senior leadership team including their technical team so understanding a lot of people there for a long time and the energy really understood got history in their support. And then i think they're getting back to the grave offer us is really important someone that we could outsource a lot of this stuff you know. Maybe dennis still need to outsource got really great staff. They've been with. We're all time. You're finding certain aspects of that front office work You know we could off our plate to focus on our core competency. Which is our our service delivery. That was that was probably the biggest factor. But you know they were in their little ad in her in the back of your there will rebound street from us. Use it as well extensively. You know we've provided under donald services that facebook so We worked very well in our hand. I'm sure there's other softwares that the great job as well. I just want to say one thing. Though as you know at this kind of continue my career. I i the brick and mortar. End the practice floor up coming up to fourteen years. I think one of the advantages are grouped especially with the training that we provide. We try to build a deep relationship with a general dentist. Go to so whether it's access to our courses. We specifically work with our dentists. We actually give them one of our opening med kids so any patient that comes to the office can be taken care of by the dentist that includes hands-on courses. We offer over sixty nine hours of see what i which site is the sixty hours of see if you. Cgi dental dot org. You guys did one website just to have all your websites listed. Just say go to. This website will so which one is at. Sds three sixty ce or which one would probably makes them that we will link all of them to the. That's a good thing if you go to any of. These are trading the cornerstone training institute. We're sitting in right now. See dental dot org. But i the sign. It's kind of confusing. We go to the offices. We offer hands on courses. We work with our general dentist partners to make sure because don't forget howard wearing the office. Maybe one time or two times a month the patient when the patient arrives on the tuesday the general dentist has to be comfortable to do the diagnosis. So we have the tools for diagnosis. They got to be able to do a case difficulty assessment. To make sure there's something that they would do or something they would refer out if it's a case that they would refer to one of our daughters so providers then got open medicate the tooth so we have special kids for up had pieces. Kids whatever's whatever we can do to impart information knowledge and develop a deep relationship. That's based on a collaboration between specialists or the super dennis and also the the owner doctor of the also so the sixty the continuing education is on. Cbs dental dot org c. As in charlie ivy dental okay. There it is. I'm well you know what you might wanna do. You got sixteen courses. We put four hundred courses on dental town been viewed over a million times and you ought to put one of those courses on dental town continuing ed where you could introduce yourselves and then tell them for twelve more courses go to your website. Sixteen hours is roots out kuntsler. I'd be happy to share. Core cited from covid at a lot of reviews will be glad to share content. Smart thirty minute root canal. And donna course fourteen ce cra. So that's one course. It's a fourteen hour course. Okay and and that's free. No one i can. As i said we have a covid chorus that i'll make available at no cost for the doctors that we affiliate twins and we worked with. That's a free. that's all included. Because we work our on you know clinicians. A lot of them are instructors. We walk one on one. So they'll get those courses at free one day. Join what for individual doctors want to hands on course outside of our group. It's a paid course. But how much does that paid course. A two day course need runs out to one thousand nine hundred ninety nine but it's a hands on course and includes patient component as well and you get a probably three four hundred dollars worth of supplies and kids to take with you. Nice man that is the main so you just opened up. A huge kenner warms covid nineteen. I don't know if you guys heard about that yet. But there's this virus thing going around and I got vaccinated january fifth my first shot and then twenty. One days later will be january. Twenty six my second shot and the number one thing people are emailing me. Say they want me to ask my guess. Would you take the vaccine today. Right now is by. Oh my gosh he did it. He got jabbed job. I your first one or second one. I won i won. Yeah i had more hair than you and a longer ponytail. Before i got the vaccine. So good luck with that thomas. I hope you I hope you saw that point until we so what so. How did cho vid change what you do. How cova change ended onyx the year. Two thousand twenty and is having an impact in twenty twenty. One i think you hit on the head with a lot of the things You know that you mentioned. I think as i said the for the for oral surgeons and you know it didn't have much of an impact. There were several months. Id overall. We're down what it didn't have the impact that it had on some other industries that are that are devastated with With with that. Said i think because we went through the hiv Crisis while cook so dennis are. We're well prepared. We are already taking universal precautions when we sink patients so i think the doctors that opened and took care of emergency patients. You know you know. They managed to build deeper relationships. I do think it have some impact. I've seen with my own patients Patients wanna come. They don't wanna keep going to different locations that want to just come to one location and get the work done and leave that. That takes the pressure of p masks gloves and other things so having the patient is one of the things that led to us developing some of the some For sds three sixty we go to the location that reduces the visits for the patients. Statistics are clear patients. Don't like leaving offices. They don't like leaving the general dentist. They've got a great relationship. So i think general dennis doing more courses taking care of their patients or affiliating deeper. Would their specialty network is probably one of the things that i see Come out of this crisis. Hopefully we're going to be getting out of well. I mean let. Let's talk you know when people lightly when canadians Brag and they say you know i went in. I had a cancer treatment and a bypass. It didn't cost me a nickel. Okay so what are you saying that we should take everything we learned in economics from from Gosh darn the wealth of nations. By adam smith in seventeen seventy six to today and just throw it away because the canadian says it didn't cost me anything so so so now people don't show up on price. They're not they're not you. Don't have the customer in anything in economics all healthcare. She just have a straight ten percent coping. If you're going to get a fifty thousand dollar knee replacement you're not willing to pay five will. Why should everybody down the street. Pick up the whole fifty thousand if you're not willing to pay five thousand there's got to be an incentive if there's no incentive it doesn't work and my boss in in in dentistry It's kind of a reverse incentive. Every dentist is a tribal monkey so he wants to own his own house so he builds out a whole dental office. There's one hundred sixty eight hours in a week. And he's open thirty two hours and so it's closed eighty one percent of the week and two hundred years of of adam smith to now we know in retail The bigger shop one everything. Two hundred years ago yet. A shop house where you lived up stairs you had a little something about the size of your garage and the next generation pull you out of business by putting two garages together. And then three then four. And then. They maxed out in america when walmart and costco. and and all the big players Said that two hundred and fifty thousand was too big. They started seeing people like me. I won't go to a walmart that big. I'd rather go buy a gallon of milk safeway where it's reasonable. I don't want to go to you. Know the the cardinals football stadium to buy my groceries so their size matters. at least. That's what all my girlfriends told me. So the bottom line is if i take my childhood pediatric dentists and i asked disney braces will the orthodontist should be right. There If i go in there to the ended on us and they say no to crack tooth we. We shouldn't do that well. Then he should be able to pull the tooth and place at implant or they want one stop shop. I was shocked the first time i lectured in australia. I go down there about every five years since one thousand nine hundred and do the big idea. I fly into auckland new zealand into sydney melbourne. Brisbane gold coast. I've done that every five years for thirty years. I was shocked. The first time. I went down there. It was so cool. It's like going back to one thousand nine hundred fifty at that time the grocery store yet the bread store and then you had to go to the butcher and then you had to go. I mean it was. Like i had to go to places and i thought it was really cool because they don't even have losing america. It's all thrown under one roof clear choice. Another example put the oral surgeon the prostate honest lab tech all in one room and and then the other thing when you look at dentistry so there's one hundred and fifty thousand locations and they're all closed eighty percent of the time then. History doesn't need to build another dental office for a decade there. If you're a dentist coming out of school you should get a damn app and your calls up and says hey can you clean my teeth. And he pulls up the evanston says. Yeah oh howard. Dental office is available. I you an hour. And then they're just be straight feed and we have a fifty dollar an hour room. Fear something and you come in there and do their. If i was an ended on his coming out of school the first thing they do is they complain at four hundred dollars in dental school and then went to endo school three years and Now seven hundred thousand dollars i say. Okay okay stop. The madness. don't want them by land building and by another and build another dental office. Are you out of your mind. You're going to build a dental office when eighty percent of opera are closed. It's kind of like freeways when you look at a freeway. A car needs ten car. space ten. an hour goes so say. The average car is going sixty miles. An hour needs. Six cars faces freeways. Don't even they're not even use ten percent of the time they're empty all night long in the middle of the night all the salah but no one needs to build another damn dental office for twenty years especially if you come out of school. Forty thousand dollars in loans You know Seven to seven seven days a week. Is the business model that the only three publicly traded dental companies on planet earth That is their hours. That's one three hundred smiles and pacific smiles group in australia and q an asset. Which rick workman was the first billionaire. Denison in america. But that guy and kyun am i mean that guy. I mean raymond amin. He's rolling thing across china about as fast as gingas. Kahn went through it. and they love it. Because you know it's quality first world dentistry. And he has a billion three hundred million people to roll through. That's why america's economy is bigger than england. Just because even today they only have seventy million we have three hundred twenty million size again matters but if i was an ended on his coming out of school and all that dead for land building by practice or yadda you're mine. I would pick the five largest practices in phoenix arizona. And just go up to them and say. I'll do your endo. Monday tuesday wednesday thursday friday and everybody wins. The the patient wins your treatment. Plan case acceptance wins dentist or even track their true implant acceptance rate the same day. Dentistry is the number one driver entering plant acceptance rate. When you say yeah you need a root canal. But here's a piece of paper. You gotta call another number. Go down the street. All hell breaks loose When you say well we can't do it today because see our staff see. We had a no show at tan and showed eleven. And you probably don't we do it now but now it's lunchtime and we're like government. Employees were entitled to a lunch. So we're all gonna leave at twelve Why we give you bike. It in antibiotics. And it's like men work hard and hustle. And if you're slow on endo. I always scheduled it at eleven o'clock before noon lunch break. And if the four o'clock before we close at five so that if a one hour root canal went to two hours i didn't care i was ready to do it so yeah. Don't go buying another dental office. That's a crazy and if you get out of school and your mom and dad are still alive. I'm reading studies. Thirty eight percent of senior citizens in america are lonely. And that's because if you weren't subsidizing with them with social security with money didn't have they'd be living with you and then your complaints. You can't find daycare. Why grandma's being subsidized and another house. My gosh come out of dental school. Go move back in with your mom and dad. I met adilson the other day. Who has his grandma. He says grandma. She threw her arms up. You know she's going to have a roommate and her grandson and he's getting home cooked meals free room and board so incentives matter economics matter all this stuff matters and i think the business model you have winter you going to do it for me in my dental office in phoenix arizona. We'd be glad to take care of. You treated overwhelmed with ended on. It's so you got plenty of didata software. But i can't find. I cannot find one to come into my office one or two days a week to commune. Talk to tom bucks. He's almost almost read. Our business slant about space and utilization. We'll follow up with you. we can serve you are. You'll be our pleasure a to to work together. Well yeah so let's go back to arizona arizona's number one crowded because our governor ducey. Who sounds like he can't find any friends. but He he says if your license anywhere in the united states you can come. Come there so you know. It's really hard to go. Get a dentist to sell their practice and take boards and moved to another state. And i'm totally against that. In fact i think all the boards. I think they're horrible because see the large hispanic populations in guadeloupe. That doesn't have one american dental office. And every time a mexican trained dentists comes to waterloo. Pain starts treating the bore. The board calls their mobster friends. The police arrested and kidnapped and put in a cage and deported. Why 'cause they were doing because they didn't have an arizona license. I mean we talk about evil racket. Healthcare wouldn't even healthcare never had an affordability issue until fifty states rolled out fifty state boards and didn't let any foreign trained doctors in here and what the board do is telling me. Hey is this guy An enormous i mean. He says he's done us. But i don't think tom vaughn. Sido is a dennis. I think his friend hamid of is. But i mean i'm the consumer Same thing with chemotherapy agents. Okay this drug is an approval. The fda then takes us at furnaces. So we can't we will not sell it to you. So then again. The person i bought my house or had to move to scandanavia to get a drug invented by an american made by an american pharmaceutical. The fda wouldn't let her bias so she had to move to scandinavia. I ju just makes me so mad if the fda says hey how we you got a brain tumor and we have not approved this drug and it's like well. My only other option is death. Why don't you move me ahead of the mice and rats and cockroaches and let me try it. I mean what what what ruined history is when a bunch of rich people that have lots of options. They spend all their time taking away. The one option for the poor guy. If i want to go to a dentist in guadeloupe who got his dental degree in mexico city. I have the right. Who the hell was the state board telling me. I don't have the right to see. And then furthermore i go to these i say. So you're saying no health care is better than non are you out of your mind. They go. Well what if what did they do. Something really bad in and it looks like he's he's trained dentist. Gb black didn't go to dental school. I mean they were apprentices. Back then So you know. Don't pull my string you you probably pull my string on purpose. Didn't you just wanted to see me. Kobe hoping you're not a positive impact. Because forget about dentistry medicine. We had the crisis in new york. It was difficult doctors. Were volunteering this whole thing about the state boards a lotta. the barriers. Should come down if you go to an ada accredited program. I agree with you one hundred percent. You shouldn't have to go through five of the loops especially when it comes to taking care of patients and the ada just got I mean they got marginalized in texas when that implant all just was advertised these specialists and and the state board of texas Right corns that's not a special day. The ada does not recognize it and the judge said the as a membership organization. What the hell does that have to do with this guy. First and foremost is he lying and they go no he has. Diplomatic international congress are online policy. And all those implants and the judge like well. What's the problem own. Our membership organization doesn't want him to seize specialist. Well they don't care you know and now you can. In fact a lot of the ended on us some of the greats i. i don't want to butcher the names wrong. I i think. I ben johnson. It was either ben johnson or john expanding who just passed away. What a great loss. And i loved that guy so much he was just a great man But back then they didn't go to into. I don't think mcfadden winter endo program. Did he father. Yeah he was grand vote in. So what do they do they were. He was brexit chattanooga and all his friends he sell all about. This exciting is friends. Told him like they tell them today. I hate into. I'm not going to do and he said well. I'll tell you what i'll have my practice limited to endo and when you send the patient i'm not going to do the crown and cleaning steal your patient I'm not gonna do that. So just let them practice limited. If i was graduating cove nineteen and i and i didn't get accepted into school. That's another thing that's funny when people don't accept an indo school they just throw in the towel you know how many people i know. Go to dominican republic. Believe somewhere down. In central south america gets their indo training. Come back up here and filed the board. And it's all good. But i would sit there and i would go find. The urban are very competitive. Everywhere and the rural is fly over. I mean the i mean. I just did a webinar with the My gosh rear admiral timothy rix and posted on dental town and he was talking about Oh my gosh. It was amazing. Those podcasts are released a couple of days ago but he calls a dental desserts. Sixty million people six thousand four hundred and eighty seven dental health professional shortage areas by the hp essay. That's a health for health resources and services administration twenty twenty nine point. Two eight percent of their need dental needs or matt. Ten thousand seven hundred and sixteen practitioners needed to remove the eighth. Psa designation will fill all those just for mexico in india tomorrow morning at eight o'clock but it's the state boards keeping those people. So that's what the government always does for five thousand years the take a baseball bat and break your legs and then they offer to help you buy a wheelchair and it's like you know when when when you when you go to the government for help you just you just are have never read a history book. I don't know that they the first break it. And then you ask the person that breaks it for help Yeah so. This is the state boards. I would like everybody. There is on a state boards dental examiners to go spend the night in guadeloupe every night and listen to the crying children with tooth aches While they Say well no. We're not letting any mexican dentists in here. So you know i please. Don't ever bring up the government when you're talking to me on my podcast. Because they kind of ruins the the whole show for me and but anyway. So so i to go back. Gosh we went over an hour. Do you guys gotta go. Can i go to any overtime. Or how are you guys looking for your own mind. Oh my gosh well goop go back. I want you to go back. Cbc t that's that's a great one. It's another one hundred. Forty thousand dollar piece of equipment is standard of care. I mean the number one cause of root canal failure is. You didn't get it all cleaned out and you didn't get it all cleaned out because you missed an entire canal. So do you think a cbc t hope you find that fourth canal and is that standard of care. I think it definitely helps in certain situations. I personally don't think it's a sign of care who don't need a cbc t if you're doing a number eight anterior tooth. You got the concept. I laura as laws reasonably achievable reno. Radiation. don't forget especially on children. You know depending on the type of Field of view. You have if you have a full field of you. You may get up to three hundred. Micro-sieverts of radiation. So you gotta way down. So i think it's a delicate discussion. The out of position paper in two thousand fifteen about sold you gotta weightings off. I think if you're doing uh re-treatment a surgical case with anna nicole features that are close by. I would definitely recommend a cone mall for a standard Carries a radio. regular perrier. kgoradio has two to four mike. Micro-sieverts of radiation. You got a couple of angled. Radio grabs solo. I an average two. And you know your dental anatomy. And you're using some form of magnification. I think that should be in my opinion. That should be fine. Complicated cases retreatment surgeries. I definitely think it's You know You know it's very useful. So i wanna say one thing kids and again. I'm not an ended honest. I never. I never lectured on clinical dentistry. Because i think we be by ended world surges. Earl surgery by oral surgeons. I think the twelve specialty should talk about You know if you wanna learn something about oral surgery endo perio pediatric dentistry orthodontics processed atlanta. Caesar oral facial pain. Oral med oral path oral radiology dental public health. Why are you talking to me. I mean there are specialist that stuff. But here's what. I learned after thirty two years ago. And this is my common-sense approach. I can't do endo Through a pfm. Or an m odiham album. I i take off to die. There's bacteria getting in there from somewhere and it's not coming from their kidney up to the apex of the rue. It's coming from their mouth down. So the first thing i do is i take everything out. And you say oh. We just put that crown on their. We'll see if you put it on the ground you can take off the ground throw it away. Its debt the to died. It's done because when you're going through cost and you're you're working. Lincoln ones measure on a up and ones on a valley in one for you got four files. You're trying to remember a twenty one nine thousand nine hundred seventeen. No take out the whole restoration take off the crown and pack your cord. And i determined that this is restored will then when you go to access the pulp. You need a right angle berry. Needs something like five fifty seven no round burst stuff because when you go to right angle geometry when you fall through the roof you feel that you fell in there and rule number one. Don't touch the floor. I'm never going to find that. Mb to if you scott screwing up the whole damn floor so now. I got the to prep for my final restoration. I opened up. I don't care how big the access hole is. Because i'm going to stick at crown on this thing when i'm done and then i didn't touch the floor. That's that's how i do more indo. I mean when. I see these guys more through a pfm and they put a final amalgam filling in there. It looks like the size of bb is like what is going on. So that's what i do. So you're i mean i feel free. You're an amazing. And donna's feel free to tell me that was the worst endo lecture you ever in your life was my five minute ran on endo no. I think you're dead on. I got to remove the concert. Leisure access Who advocate because that really reduces that. Don't forget inside. The instrumentation is great. You really need irrigation. Gatien is cleaning and shaping a cleaning gets stung by iridescence. So you need the minimum allowed to get your ego gets in make sure your activating in some ways we set this point is doing a root canal a to that's not going to be a restore will so i agree with you on percent of what we're doing canals we know a lot of time the to be crowned afterwards. We're not going to sacrifice the crown in terms of missing anatomy or determining restore ability or cracks or other things too. So i'm with you getting damn on taking to about collusion removing chronic. That's going to impede the great fan of these ninja accesses. You know you'd reach tank out as much as you. Can you know to not to allow you to see the restorative aspects of the tool and help you with anything. That's going to make sure that you're looking for the nba to your troughing for pistol canals canals. And you need some space for that and you know why i love l. stephen buchanan so much if not the most you i love that guy because it was his lecture who I i. I was mad. Said he said you know this irrigation and you can activate and all this stuff he says but what i do is i just let it soak in there. After i'm all done i let it soak in there for an hour and i'm like an hour or you are. Are you serious and i thought well you know you just doubled. The cost of a of a root canal. It's it's too long. And all that kind of stuff like that. And then i realize oh my god that was the practice management holy paradise because all be doing roof now. And my time's up. I need more time. But i'm outta time. And then i just tell the patient and say look. Here's the deal. It's an infection. It's not the tooth. And this dr. Steve and al buchanan. And he's this great teacher in california. And he he says that do increase the success rate you need to let s bleat sit here and soak for an hour. Are you good with that. And they're like. Oh yeah. I mean one thousand dollars so now i got you know the assistant in there sitting with them for an hour. Why can stay on schedule and get another stuff done and then come back and finish and and that's what he likes so How how's that for letting plane. I think the cleaning is critical. The will your warming the saudi microflora using full strength horses. Abstract is actually We find out a lot of new. Saudi michael surfactants and one of them is i think smear off is one where it kind of increases let ability or what. I do know what i've heard. Is you know we had a bola. And the cdc goes into clear up an area. They put attend around the area. This with saudi michael cole. Right so michael chloride is still probably the that we have. And then we can augment that went additional whether it's something like mta biopure with up as doxycycline or like Has a mixture of a accident. But i'm a firm advocate of irrigating if you're going to irrigate us twenty to forty. Cc's be very liberal with your Irrigation use a safe needle twenty-seven gauge sometimes at thirty one gauge really tight canals. But you can't over irrigating canal and sodium hyper chlorides left in a to a a you know i have no issues. I think it's great especially in cases chronic or re treatments. You got active infection going on. I don't think there's any harm. I don't think i've ever left so for our who's in that situation. If i have to get done. I'd probably feel they can out something like calcium drug side and maybe bring it back another time but i don't think there's any old moore is not going to be solved. Your our so irrigation is good. Okay but you just walk into a great question that they they still ask dental town. When can you do the roller canal. And one appointment and win doesn't need to be done into great question. You know i think if the truth is vital. That's you know it's like any time insurgent when you get your goal bladder. People don't going four times to look at it a go in there in any type of surgical intervention including antibiotics and oral serve bureau surgeon. Quick take out your wisdom to the less trauma it causes so if you can go in and out. So that's the best surgical issue little protocols you can go in and out in my opinion is solid evidence without to his vital whether it's a reversible irreversible ballplayers or you're doing an elective route jal. All those can be done in one visit if you follow the power if you find the canals if you get paid cincy what's more important in ended on. Exciting is the concept of patents city. You gotta be able to get to the end of the canal zone you find and remove the causative issues which is you know either. Inflamed or an aquatic helped issue in cases of a swelling or. You can dry canals. Those those are always associated with chronic cases on re treatments in situations. Like that. I think it's okay to go. Two steps of what most of the time for fresh food canals reversible irreversible. Bite us if you could get it. Dominant timely manner. Those those should be in one visit. I can argue that. It should be done because every time you go in there. You're going to introduce bacteria in the to even using a robert not gonna over instrument is going more time. You don't spend two hours cutting a crown. Prep because by the time you're done you're going to get a pyramid. You go into cut the crown pregnant seven if you know what you're doing and you're going to be in and out so i can. The same concept applies in the box. Okay the other question is what what advice would you give. What tool can i buy to help me find that. Mb to that. You know the I'll say i. I'd i'd pay the eighty five thousand dollars for a son endo gentle wave of i just find machine that have find the damn mb to So what what. What advice would you give on someone trying to find an nba. Two excellent one. I would follow your recommendation. I make sure your access is large enough removed. The restoration be accents. Large enough know the. The literature is clear. The nba two is usually two to three meters. So you got a trough. Somehow you gotta be able to trough now you can use an ultrasonic unit trough or you can use a long round very good friend of mine. John months we've lectured together. These days is the inventor of the discovery bar. I think those are great burst long next stainless steel bars That you can what you have to trough and to be able to off affectively. You need either a microscope. Or you need head lights and magnification usually about minimally i would say three and a half but if you have some formal magnification at a hassle lighting and you can schoff. That's what you should do and you would trough you draw straight line from from the md. Want to the palatal and you would off. We do our courses because our courses are specifically focused on locating n. b. twos. You should be able to trough two millimeters dial and three and three millimeters straight line from b. One two palatal and you should cut dry. If the tooth is vital. You're going to get a little bleeding. You should never cross wet because if you trough dry you're going to get the piled then tino powder is gonna go onto the nba to area now. What we've found because every now we do you're going to get to canals filled in the nba. Even if we don't find because a lot of times it's the related to enigma's so you need to have some form of you have some forego reciprocating advocacy's that you can draw from nbc one to the nba to location. You can clean out a lot of the than tino triangle there because more than half the time these don't have separate portal exits peel easily. Call them so to trough good magnification learn ultra sonic around bird soft trough dry and lots the good access okay. I'm sorry for keeping along and so much overtime but these are just routine questions that just keep coming out of dental school. I the tuesday. She knows his dad that needs a canal. She takes out the modise malcolm and there's a crack on the floor and she's like okay. Is it hopeless. Howdy how what is a black crack on the floor. I can just tell you. Know the last You know we. American associated around the dodgers. The last meeting we probably had maybe twenty percent of the lectures were around this kind of crack tube syndrome of crack teeth. In my opinion and again you can argue both sides of this. So i'm saying if you have a crack team the most common in the lower second molars so lower second. Molar is going to be your most problematic to about one because the canal is very close to the end and this highly. So you know if you're gonna talk to a patient drivers save the tools. Please please under promise and over deliver. Let your patient make the choice. You tell your patient. Mrs jones is a crackle students like a wins ivan. 'cause the crack i can promise you. I didn't 'cause kids. 'cause it is the location of the to lower the lower second molar. You taking a lot of masticate forces your massa temporarily muscle the best if you have thermal sensitivity with that can take one hundred percent with a root canal. A root canal. Give you take care of that knife. You have a crack. We doubt thermal sensitivity. What would discomfort. You may always upset because the crab probably goes towards the perry donald ligament so you want to every time you just say you each iraq charity you have sensitivity of that too so if you can live with that we'll take care of the root canal the chrome if you'd want one hundred percent order feel anything mrs jones we gotta take that to dial ball graft implanted four to five thousand dollars. You choose what you want done. Because i think the autocratic tooth for madonna's is like a full denture or general dentists. You don't want a patient coming back every week. And i think when i lecture To my group my general dentist partners is you know if if you have a crack on the floor. There's no perry donald ligament there's no perry associated with it if it was my own to get a root gironde crown to and would live with the fact that if i'm gonna stay Heart charite. I'm gonna fear them a little bit and i'm happy to live with that and then we follow up with radio graphs. In the absence of pathology you know lotta of patients live with to get used to it now if you get. The patient wants one hundred percent. They don't wanna feel anything on that. Greg tune you know then is their choice. Take the to place an implant the okay you know my sister my oldest sister mary as a non she. Sister anne alway for thirty forty years. Zoe tells me that you know that. The golden rule treat other people that you want to be treated as found in every major religion. Hinduism islam every religion. There's it's the you can't find the name of a person place or thing and all the major religions from hinduism today as the on except for the golden rule and one of the problems i have with the golden rule is i would only lead ended on us do a molar root canal me i would never. I would never go to a general dentist. I i've ran ironman with dentists that the would probably be the best show ever. But i'd still go over to jason heller brad cattleman or an ended on so i really liked to specialty thing coming in because it doesn't violate the golden rule. I like it monetarily. Money's answer the question because the insurance companies are going to pay me more money. I like it legally because america has one million attorneys. And they're not they're not gonna go after a specialist because that that's that's hard to do they're going to get the general dennis to get hung by us spy shows so i like all that stuff the only thing i'm trying to and retail has proven for two centuries that put it all under one roof. That's that's the retail formula. And when i go to asia. When i'm lecturing in miramar and and all those places over there they have dental hospitals and when you're in pain you go to the dental hospital and a lot of these towns. I did a podcast for i think it was. I think it was cambodia. And he had the tallest building in his town and the first floors were general dentistry paediatric when all the way up and there's not a single dental hospital in the united states america. Ds don't even own a dental hospital But when you are doing your special guy. I understand love everything about it but when you say it's a mobile platform the mobile part is the ended on his going to your office. You're not doing anything. A mobile clinic are you are only one hundred percent. There's too much dental space. There's no me there's so many there's so much dental spaces you almost as i said you read our business flat. No we take the technology we take your cone beam jase for difficult cases. We have a better. Are you doing it inside. Someone else's brick and mortar dental off doing it mobile. No the denture. She's old deliver in the general dental office. Okay when you say the doing when you say mobile platform i'm thinking of an rv. I'm thinking of a driving around dental chair. But you don't do that no dentistry. We have a small unit that has all the technology essary to do complicated cases the microscope. be we can't can to partner with dr so in times of covy when the doctor can place his restoration or her restoration at the same visit which honor respect the patients time and look at it economically. There's no need to build more dental offices when we have so much space in dentistry right. Yeah that's so. My final question is so. How's how's the business plan working how how's demand. Ben how how is it. Everybody we've talked to has loved the concept With you know it's been a little difficult to go to office to office because we kind of launched a project middle of covid but every doctor we've talked to a you know has the concept of being able to have a specialist. Come to their office for them to be able to monetize space and to be able to take a cone beam if necessary and in times when the patient as you said yourself to get dentistry at the same time same day dentistry for them to be able to get the regional. Darn and to cad cam. Delivered crowd on the same day. Those all be very positive and final question. I swear i'll let you go someday. Your course on the this smart thirty minute. Root canal ended. Encores is tall by ahmad on the tour. He's he's ended on sending tucson. Is he still down in tucson to move out willing tucson. Actually i helped build. He wasn't a great on the daughters out of harvard. Board-certified he's up in the bay area now but he's one of our one of our senior donnas and he lectures the course Once a month so he flies down from the bay area. Wow well you tell that. Little fancy harvard boy. These come on the show tucson. And i'm going to show my two boys live in sanford now they When you go to on that cellphone tower. My boys started a cellphone. Welding tower visit oldest ones and because they were rock climbers and when they were going to college flagstaff. These people will come by and bribes. I remember. Eric says this man's offering me like five hundred dollars. If he takes out a two hour drive. And i climbed to the top of the tower. And pull off this for eisenbach. And i said well can you kick his ass in. You know they are. They all rustles. Yeah i'm not worried about that. He goes. I go do it. Turns out no one can climb a cell phone tower and so to be a welder and a cell phone tower. so he he said well. Let's learn welding. we have cell. Phones are but that that san francisco cell phone. They'd kept him busy for two years and they've they're making more money than dennis out of dental school and they're having the time of their life. Try to kill their dad. They'll be hanging upside down taking a selfie in their truck. Looks like a little little little matchbox car but And talk about a vital business during the whole covert thing they were telling the cell phone towers were keep cell phones going one hundred percent. We're not gonna do that. Yeah i'd love to get out on there and talk All things because again. They're in pain and their unity treatment. As opposed to you. Go into some cosmetic course and trying to convince someone to get bleaching mean if i told the woman you know you really. You really should bleach your teeth. She's probably looking at me saying well. Why don't you lose thirty pounds and then get back to me. you know. i mean. I'm not gonna tell some woman. She's a bleacher. Either bonding or veneers. But my gosh kids if you can pull a tooth and do a mole root canal. You're a real doctor and they'll always be a need for you. And i wanna thank you guys for coming on the show today and you're supposed to get our your life and i stole to. You gave me one. I stole the other one and anything. You can do to spread your message on dental of your article dental time magazine or put up a online course or you said put that cova one on there so howard at dental town the other. Howard is howard goldstein. He's in charge all online c. And all that stuff. So he's ho-gau h. o. g. o. at dental town but the indo courses always do well because they they're just hard. There's there's no doubt about it. They're hard so thank you guys for all that you do. Thanks for coming on the show. And my gosh. If you can get an ended on come into my office in phoenix. I love you for life. That would be great and again the reason as we do oliver and we don't have a problem with that. Well we refer and but again it's not about me. It's about the damn patient. My patience don't want to come in to find out. They gotta go somewhere else. I wanna come and get it done and it'd be really nice to know that we could just say these two days a month come in. And they'll do the end of swedish pleasure. Thank you so much for and get that. Mta carton that perfect. that's all call. Dr t sensors one last thing to stories. Irs dr t and perry radcliffe the legend. Has it that perry radcliffe and he told me this dinner in right here in Scott slow paradise valley that he was sitting there looking at his phone. I live in a desert. One hundred and fifteen degrees. And i can see the bottom of the swimming pool if i go to any lake in the whole country. You can't see three inches down there. It's just chlorine and acid and when you an acid when you lower the peach by one. It doubles the free release. A hydrogen and boom. That was the invention of Perry radcliffe and omar reads Retardant mouthwash that was corey dioxide. And i love it but i don't buy it because as swimming pool water when i went to rinse my mouth was swimming pool. I pour my beer out. Stick it in the swimming pool. And then i I switched with it. And but i'm a classy guy so i don't put it back in place but onside and other deals dr t same thing parag looks that it was a gin and tonic and i think it was him. You told me the same dougherty. He was also sitting by all drinking. Gin and tonic. And the swimming pool repairman guy using the swimming pool repairman. Putty oh my god. That's cement works underwater in a swimming pool. And that was the birth of mta. He's telling to either. Come on the show and tell me if that story is true or false or he's not sure what class my guy but perry's is true so at least you got one at too but the story is not true but i think the story goes because i was involved with the development You're the pool boy. The boy fixing doctor okay. Got all changes his story to where you were the poor boy. Do you have a picture of your cleaning the swimming pool. While he's sitting of all right guys have a great day. Thanks for coming on the show. 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