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AUDIO - HSP #176 - Eric Jackson
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VIDEO - HSP #176 - Eric Jackson
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Eric G. Jackson, DDS shares a few ways that a multidisciplinary approach to general dentistry can help you and your patients in ways you might not think.
Dr. Jackson received his DDS degree in 2005 from the University of Illinois College of Dentistry. Since 2009 he has owned and operated his private practice, Oral Health Care Professionals LLC, in Downers Grove, Illinois. Dr. Jackson holds Fellowship status in the International Congress of Oral Implantologists, the International College of Dentistry, and the Academy of Dentistry International. Additionally, he holds a Mastership in the Academy of General Dentistry. Dr. Jackson has served on the Chicago Component of the Illinois Academy of General Dentistry since 2010 and is presently serving as President of the organization for 2015-2016. He has served as the official team dentist of the Chicago Bandits women’s professional fastpitch softball team since 2013. Dr. Jackson is actively committed to providing quality dental care to patients of all income levels and medical conditions and regularly volunteers his time and dental skills to a variety of organizations. Two of the largest are The CDS Foundation Dental Clinic and The DuPage County Health Department.
www.OralHealthCareProfessionals.com
Oral Health Care Professionals, LLC
2033 Ogden Avenue
Downers Grove, Illinois 60515
(630) 963-6750
Email: Mail@OralHealthCareProfessionals.com
Howard: It is a huge honor today to be interviewing a real role model of mine, Eric Jackson. I feel like we have so much in common. We're both DDS. We're both Masters in the Academy of General Dentistry. We both have our fellowship International Congress of Oral Implantology and on and on and on and on. I have really gone to school following you on social media, too. You were the first person I know who just did it all right. Your social media posts are educating and informative. I always want to read them, and I can just imagine how your patients want to read them. How are you doing today?
Eric: I'm doing fantastic. Thank you. Thank you for the kind words. That's fantastic. Coming from someone like yourself with admittedly some of the top posts around means a lot to me. Thank you.
Howard: Oh, hey. I want to start off, there's so many things I can talk to you about. You're a master clinician. You're an Implantologist. You're a successful businessman. You're the top .01 percent social media marketing that I've ever seen, and I've been on social media pretty big time since 1998. First of all, I think where I want to start was you've got so many initials by your name. Talk to the young kids, was it important, looking back, was joining the Academy of General Dentistry and earning your fellowship and then going onto earn your mastership. Looking back was that a good idea for you?
Eric: It was immensely important. I've been very fortunate to meet some of the best people in dentistry through the AGD. I was very blessed. I went to the University of Illinois Chicago for Dental School. In the end, I'm sure you could attest, that only starts you out. That's your basic building blocks. Then you've got to start kind of expanding. What really interests you? What's the real world way of doing things? I've found all that through a variety ways through the AGD mentorship and all the different classes. All of a sudden you start stringing a few class together and you say Oh, well, what's that fellowship about? Maybe I can set a nice goal for myself. That becomes mastership and so on and so forth. Continuing education and the people that you meet get you through it. It's been a fantastic fantastic thing for me and my career.
Howard: I look back and I think of it as the single game changer I did in dentistry. I tell a funny story because when I was getting my fellowship in the Academy of General Dentistry back in the day you had to have 500 hours and pass an all day exam and practice 5 years, so it was about 100 hours a year for 5 years. They kept wanting me to take these classes in subjects that I didn't do. I didn't do Orthodontics. I didn't do implants. I complained and to my local, and they said no, and I went all the way up to the very top and this older guy just said "Howard, you've got to be cross trained". Carl Misch says that he didn't become a great Implantologist if he wouldn't have had his foundation in removable. He said that got him interested in Implantology was that these people putting dentures over implants and the implants were breaking and they were blaming it on the implants. He said no. You don't understand how to make a denture. You've got to get the bite first.
Eric: That's right.
Howard: If you put in a bunch of implants and the bite's horrendous and they don't function properly, then everything is going to go whack. He credits mastering dentures as his groundwork to mastering Implantology.
Eric: I've always said it's all about reverse, especially with implants. It's reverse engineering the case. You've got to figure out your destination and then you bring it back to where you are now. It really helps to set the path for the patient. The treatment path just kinds of flows out of you. You know I need to have implants here here and here if possible. How are we going to do that? And we can kind of figure it out that way.
Howard: I don't want piss off a bunch of people but I will. Some of these things that these DMD experts say, you can tell that they haven't done one case of orthodontics. At least 20% of everything they say just goes out the window if they just did a few orthodontics classes and treatments.
Eric: Well, and that's the benefit of having the fellowships and masterships of the AGD behind you. You're able to sit in a lecture or listen to a presentation and really kind of decide what works for you. After you've heard hours and hours and hours of this, you're able to kind of figure out what jives with your own philosophy. I'm a son of an orthodontist, and ...
Howard: Oh! I shouldn't have made that comment!
Eric: No, but you're 100% correct. You have to be multi-disciplined, because if you don't appreciate what the orthodontist can do in their wide scope, then how can you apply even some of that as a general dentist and the concepts of just tooth movement for example, whether you're doing Invisalign or you're doing the veneering cases that instantly straighten people's teeth. That's really important. The foundation that's just no longer are you blocked into one avenue of dentistry. It's absolutely melded more than it ever has been before.
Howard: The MAGD has also set the groundwork for my mind for Dentaltown. As I was joining the MAGD back in '87 and I was realizing, that I was thinking, when I would get back from these courses, that the most I learned was from the people I meet. Whether having lunch with them or going to the bar afterwards, having cheeseburgers and watch the football game, and I'd go back and have 6 pages from the bar of notes, and 4 pages [inaudible 00:05:51]. That's what I saw on the internet. We could just all get together and start talking, we would all win.
Eric: Absolutely. Dentaltown in itself is essentially the exact mode of what you want. You want to be able to rub elbows with people who are better than you and different than you, and that in turn, once you get better then you can rub elbows with someone who needs your assistance. That's, I'm sure, one of the main reasons why you've founded it. It's why it's such a fantastic resource to the profession, because whether you're God's gift to dentistry or you just graduated yesterday, there's something on there for everybody. It's no different than rubbing elbows with your local organizations or your regional, or in this situation, you could be rubbing elbows with someone in Malaysia on Dentaltown and really learn how they're doing it and vice versa also.
Howard: To the young kids that just got out of school, I want to remind you that we all know what we know, but we don't know what we don't know, and I'm sure a thousand years from now, everything we believe will look crazy.
Eric: Oh absolutely. I've always joked, my grandkids are going to laugh and say "Grandpa, you screwed titanium screws into somebody's head? Why didn't you just grow the tooth in a petrie dish like everybody else does these days?" We're cutting edge right now. It all changes, especially these days, so rapidly, with the dissemination of information and the overall knowledge pool just doubling, what is it, annually or every six months. It just really makes it all the more important to stay on top of your stuff as a dentist.
Howard: There's a lot of people talking about the oral systemic link, that the mouth is connected to the rest of the body. Do you think that importance is growing in our lifetime right now?
Eric: Absolutely. Between the classic topics of diabetes and cardiac issues, now it's ... The link between dentistry and medicine, I'm sorry, the gap between dentistry and medicine is blurring more than ever before. In my office, I'm proud, we've branched out and we do things from genetic testing and salivary genetic testing when applicable. What else? Brush biopsies. I mean simple little things that really benefit patients. Why not offer a multidisciplinary approach, that encompasses not just the multi-disciplines of dentistry but also that of some of medicine. A biopsy brush is not that technical, especially if you have a fantastic team behind the actual histopathological report, you're in business and you're able to really help a lot of people. It happened last week. A woman didn't know what this bump was, and right there you can help and start getting some information in a couple of hours, a couple of days later rather.
Howard: Do you want to go into more details about that because I'm sure 99% of the listeners have never done any salivary genetic testing.
Eric: Sure. It's fantastic. It's literally, our big 3 things in dentistry, I always preach, dentistry is such a philosophical type field now. If I could do something that's high impact or high results with low cost and low invasiveness, if you could get those 3 things, you've hit your trifecta, right? Salivary testing, literally, you swish with a solution, you spit in a cup, and you send it to a laboratory and they're able to decipher a million different things from, is there HPV present? What types of strains of HPV is present? That's wonderful for throat cancer. You can also do it for periodontal type issues. That stubborn scaling root planing case that doesn't respond. THere's a couple reasons why it could and one of them could be some really nasty bacteria of certain strains that are kind of resistant more or less to traditional SRP methods, so you have to use a combination of methods. Perhaps, some antibiotics or laser or a combination of both. It's giving you an extra step because if you know what the name of the bug is, you can go after it a little bit more focused.
Howard: It's interesting to me, when I got out of school in '87, AIDS was just coming out big time and now there is 28 years later and the world is just barely waking up to the fact that babies are not born with these bugs and we transmit them from their caregivers mainly their mother and some of these people have untreatable periodontal disease are going home and kissing and trading saliva every night with some husband who hasn't been seen by a dentist for 20 years and it's not even dawning on the dentist or the patient to say we need to get your husband in here. I mean it's kind of silly. If you're treating her every 3 months for chlamydia, you eventually say, who are you sleeping with? She says well just my husband. Well, we think he has the bug too.
Eric: Yeah. You've got to watch home.
Howard: Salivary testing, what company are you using?
Eric: I use Orarisk.
Howard: Orarisk?
Eric: Yes. O-R-A risk. Yeah, it's a fantastic company that do quite a few different things via the saliva. Like I mentioned, HPV, periodontal type testing. Real nice.
Howard: The interesting thing about those bugs, Gordon Christian is saying every 3 months they discover a new species of bug in the mouth. Every 3 months.
Eric: Well, the nice part is you've got trained professionals who can help you identify that. Then they figure out what targets it, and you don't have to do it for every case but instead of seeing someone limp along in somewhat healthy [inaudible 00:11:29] for years, eventually leads to a slow decline, you can nail down those toughest percents of cases.
Howard: Did you dad ever forgive you for not being an orthodontist?
Eric: Yeah, my father is fantastic. He still teaches down at the orthodontic department at UIC, and never once did he ever push me towards it. In school, I was always drawn to exercises where we basically had a treatment plan. That's kind of what convinced me that I belong in more general dentistry. Then it was a genesis towards all the multidisciplinary approach, and the AGD fellowship classes and things like that.
I enjoy sitting down with somebody fresh and deciphering what they need. Maybe it's one filling or maybe it's 100 different things. Because there's so many sort of let's say, bullets in my gun, in my office we can do 80% of all dental procedures. We still refer out plenty. The nice part is we have deep intimate knowledge of everything, all the different disciplines, and that really transfers into the initial treatment plan. As always, the old cliché, general dentists, whether he or she is doing the actual treatment or not, is always the quarterback of the case. You're able to then direct where I'm needed, and more importantly advocate for the patient. You're their home dentist. You need to be able to translate the "dentalese" into layman, and it works out really nicely that way.
Howard: Well, maybe this would be a great time to ask you, one of the biggest controversies among practice management consultants is the patient calls up, and the number one reason they call a dental office is they want a cleaning. If a new patient calls up you, and you're multidisciplinary person, I want a new patient cleaning, how do you handle that?
Eric: The answer is essentially I've got our certain ways. I always like sitting down for a comprehensive exam first. We can do if necessary obviously a limited quick exam, but that won't get you into the cleaning department. That won't get you into the hygiene department. Just simple patient education, the fact that you're blowing people's mind when you tell them, well we need to figure out what kind of cleaning you need. Well, what do you mean there are multiple types of cleaning? I didn't know there were multiple types of cleaning? We got through the different types of cleanings. Different levels of invasiveness, etc. Just that alone, being able to sit down and explain that one fact to them, let alone the rest of it. My comprehensive exams are about 90 minutes long.
Howard: Can you go over that? The specifics of it? I bet a lot of people would want to hear that. What is the new patient exam? If I called up your office and said I want to see Eric, because he has the same name as my first son, Eric Farran, so I chose you just on your name Eric. What happens? Walk us through that. You schedule me for 90 minutes ...
Eric: Absolutely.
Howard: How does that actually work? What happens first, in order?
Eric: They come in the office, we sit down actually in this room where I'm at, my consultation room, and myself, the patient, and typically my assistant. We just sit down and we get to know each other a little bit. I need to know where you want me to take you. What your major goals are. You're past experiences. The pros and cons of those. Your likes and dislikes about the past experiences, so that way we can hopefully get a glimpse of you and a snapshot in time. We have to be able to build.
Obviously at that appointment, we're not just taking one little look at you today, we're putting the very first brick of a 40 year wall. We're going to be building a big giant house and this is the corner stone appointment. We have to make sure that we're very thorough and all things come from today.
Afterward we sit down 10, 15, 20 mins or longer, whatever it takes. That's why we like to have that much time. We'll go to the operatory, of course radiographs, photographs, and a big thing for me, I'm very interactive with the patients I think. It's very important to be that way because I'm a visual learner so I've got my big screen TV, it's a 40 in TV up in front that's linked to my computer behind them. I have all the photos, all the x-rays. If I see something that's interesting, I put them right up there and it becomes almost a mini-lecture. I'll say I'm kind of deputizing the patients into almost a dental degree. They get to know not all dentistry, but their mouth dentistry, and it really helps with obviously appreciation of what we do as a dentist on a day to day basis, and also what's going on in their mouth. Maybe, they've got stuff to do and maybe it's totally pristine. There's always things to talk about in someone's mouth, whether it's a craze line here or a little recession over there. Maybe they're brushing too hard or maybe they're grinding, and the different links between obviously head and neck. We'll talk about tonsils and obstructive sleep apnea and pediatric dentistry.
There's no one set conversation which is why that's my favorite appointment. I love doing comprehensive exams because it's back and forth, just like we're doing here. There's no set script. There's no set, of course there's bullet points you have to hit, but really it's just very honest conversation with a patient, and that's what really, that's what makes 40 years of enjoyment between a doctor and a patient I think.
Howard: I think that separates that new patient meeting the dentist first.
Eric: Absolutely.
Howard: It just totally differentiates your practice as apposed to scheduling with a hygienist and getting their cleaning and their profie, and what's also funny, the number one reason new patients come into my office and left their last dentist, the number one reason in my office, and almost solid for 20 years, well I just wanted a regular cleaning and they said I needed a deep cleaning. So obviously they didn't earn the trust, the respect. They didn't show them the x-rays. They didn't understand it, they didn't believe it. I just passed on an attorney because I setting something up and he couldn't explain it to me or my president. We listened to him for one hour and then when he left, I was like okay, did you understand wills? I don't. I'm not dumb, but I should be after one hour I should understand a will for my 4 boys. You know what I mean? I just didn't understand it.
Eric: I've been very blessed. I've got a patient Rolodex full of what I call high dental IQ patients. They're very smart, but they're not dentists. They're not in the dental field. They can get it. They absolutely understand what we're talking about because in the end, dentistry, whether it's fancy implant dentistry like you said before, whether you're building like Carl Misch building backwards to front but it's still just building. It's construction. What's a post? It's like a piece of rebar. Lots of analogies. Intelligent patients can really get that because they want to. They want to be part of it. They don't want to just lay there and say "fix me Doc." That's not what the modern patient, I find, desire these days.
Howard: I think a lot of people have heard the saying that journalists say all of the time, explain it like you're explaining it to a 6th grader. A lot of people sit there and say, that it comes off that you mean explain it like they're dumb? It's not that they're dumb. I'm a dentist. I'm not a plumber. I'm not a mechanic. When I take my car to the shop, he has to explain it to me like a 6th grader understanding auto mechanics. I grew up playing barbie dolls with 5 sisters. I never changed an oil, transmission. I never learned any of that stuff. I played music a lot. I never heard the engine warning signs. If the light comes on I take it in there, I need them to explain it to me like a 6th grader.
A big fan of these podcasts, thousands of them listen to this, are pretty much juniors and seniors in dental school or they've just been out 5 years. Those are the podcast people. You've been out a long time and you've made great achievements, what multidisciplinary skill set should they learn? Would you just recommend they just join the MAGD and learn all 16 skills? I think of you as an Implantologist. I really do. Do you think these kids should start signing up for hands on surgical courses and learn how to place implants? Do you do molar endo? What type of * do you do?
Eric: You have to find out what you love. I love certain things, actually it's most things. That's why ends up being such a large basket to choose from. If I could pick one thing, I've talked to students, whenever I give lectures to students locally, even some study clubs, it's always if you're not socket grafting, if you're the general dentist that can pull a tooth, every dentist should be able to pull a tooth, if you're not actually placing and doing socket preservation at the same time, well then I feel that that's something that you, first of all should be doing. That skill is absolutely imperative I think. Anytime somebody comes into my office excluding wisdom teeth, they're always getting a talk about preservation of the bone, preservation of the socket, even if they're not implant candidates, because at some point they might choose to in the future. So now what? You've wasted the most precious time to place that and preserve that socket. So, coming out of school, these days especially, it's all about differentiation. If you can differentiate yourself from the guy or girl down the street. It doesn't change for you and me frankly. You need to be able to do something a little bit different. Being able to provide the service of pulling a tooth and placing the graft in there in a wonderful simple manner, makes a world of difference for future treatment.
Howard: Do you mind walking us through your socket grafting technique?
Eric: Sure.
Howard: They always like to hear specifics, like I wouldn't say bone grafting, like what material? What name brand? Where were they ordered? Can you walk us through your bone grafting technique?
Eric: Sure. I'm a big fan, I've tried a lot of different ones, but still comes back to the way I was trained on. It's a 1 to 1 mix of Periglass and demineralized freeze-dried bone. I know you can use your putties. I've tried a whole bunch, different sizes, not every socket graft is the same. Sometimes you'll break out your A versus your B, but in general I like a mixture of Periglass and demineralized freeze-dried. It works very very nicely. It's tried and true. I've done thousands and thousands and thousands of them, and I'm not a big fan of being the first on the block to experiment on people.
Howard: I know.
Eric: The Wheaton Eye Clinic, it's down the street from my office, one town over. I know they do some of the best work in that state, let alone the region, but they don't offer certain things until they've been out in the market for 7-10 years. It's just company policy. I don't have a hardcore company policy like that, but the rationale is very sound. We've got a great new product why don't you try it out? You mean product test on my patients? No! These are my patients. Why don't you tell me some studies and we'll go from there. Again, Dentaltown, some people are more apt to try new things and some are more conservative. I can learn from them just by going on there, and that's just a wonderful way of just being able to communicate.
Howard: Oh my God, when I got out in '87, I've gone through cement and dicourse with Durelon. When I started getting into implants, I got my fellowship admission student, we were placing HJ coded. I got burnt so many times. I think when I turned about 40, until other colleagues have done it for 5 years successfully, I'm not going to even listen. I've paid my dues.
Eric: Totally agree because in the end, even if you're correct, there's always that one that's ah, that's just not as great a result as I would like. That's not what you want to say. That's not the kind of office I want to run. From the get go, from the time I started the office, I decided I'm not going to do that. It's going to end up tried and true.
Howard: Is it Periglass.com?
Eric: I believe so, yes.
Howard: Where do you buy that from?
Eric: We get our Periglass from, we just recently switched, the Periglass and the bone, for a while I was getting through Straumann. I use Straumann implants actually exclusively. I really like their product. Again that's a whole other podcast for you, I'm sure, but I've always enjoyed how the Straumann [inaudible 00:24:26] As a restorative dentist, that's obviously imperative. It's not just the surgical portion of putting it in there. It's how did they look? Are you able to make some beautiful custom abutments. How well did they stand the test of time? So for me, there's a lot of different places where you can get your bone and your Periglass for that matter, but it comes down to, I've always gone through my rep. It's one more reason why you really have to have a big strong rep. Reps these days are sometimes are being replaced by PDF files. That's okay to some extent, it's technology, but it sure is nice to have a living breathing human being who really knows his or her stuff.
Howard: You're talking about the Straumann rep.
Eric: Yeah, Straumann rep.
Howard: I would say, that I'm kind of confused by dentists because they should be really really smart, but they're not really classically trained in business and economics, and that's why I went back and got my MBA. Implants direct says we're going to go lower cost by selling them online. Everybody starts buying them because they're lower in cost, then they all start complaining about not having a rep. Are you not right in the head?
Now, they're putting reps in and their parent company Danaher [inaudible 00:25:38]. I'll say this, you can buy the cheapest implant from countries all around the world from Russia to Israel to whatever, but when I meet a dentist like you, like [inaudible 00:25:47], like so many people that are actually implementing it and placing a lot of implants, they all paid higher dollars for their implants because they value that relationship with their reps. So I call it just gettin' her done. It's kind of why I have a personal trainer knock on my door at 5:00. Because for the first 50 years, it didn't happen. If it didn't happen for the first 50 years, it's probably not going to happen in the second half either. I don't really care what we do at 5:00, what I'm paying for is gettin' her done. The people that are gettin' her done, placing ... How many implants would you place in a month or a year?
Eric: Oh I don't know for that, but in general it's been, I guess in the last decade it's been over 2000 implants, easily.
Howard: Every time I meet someone like that, they pay a higher quality implants for the rep. Is Straumann from Sweden or Switzerland?
Eric: Switzerland.
Howard: Switzerland. Are you liking Straumann because you like the local rep, or you like Straumann for technical reasons?
Eric: Earlier in my career I was at an implant center exclusively, so all we were doing was implants, big cases, things like that. Upon the realization, after I was there for a couple of years, I realized I missed a lot of general dentistry. My true calling was to really integrate things. Integrate implants into the day to day cosmetic dentistry we're all kind of familiar with, the family dentist. So in the end, I chose the Straumann company because, yeah, they had a fantastic rep, but I was also looking at Nobel, but the big thing for me was it just felt right in my hands.
I know that sounds a little wishy washy but, you're picking up the Nike or the Reebok, well these are both great, but I kind of like this one more. I don't know why. It just looks nicer. It just feels nicer in my hand or on my foot. I think that's exactly what happened. You were kind of drawn to it. Fortunately you were choosing between apples and apples, the 2 largest implant companies in the nation or in the world, so you can't go wrong, it's just a matter or what works well in your hand. Like so many things we do. Do you prefer A material or B material? Do you like 3M or do you like Sysco? They're all wonderful, it's just a matter of what you prefer. A little more viscious here, a little bit less there.
I really think that's the hardest part of coming out after the first 5 years. The young dentists, you've got to try a bunch of stuff in a responsible manner, without testing on people, you also have to be able to know what works well in your hands. The best way to do that is hook up with some really good experienced dentists. See what they use. Try out, so you're not necessarily, randomly picking through the [inaudible 00:28:49]
Howard: About 10 years ago, I was having dinner with Gordon Christian and the CEO of [inaudible 00:28:55] at the Chicago Airport on John Miles, and he said something very profound. He said dentists are very brand loyal because they have so many procedures they have to do that if there's something that works in their hands, they're not going to change because of an ad or a flyer or discount, because they have so many things that they're trying to improve in another area. If they're taking an impression and it works, they'll use the same impression material for 10 20 30 40 years. He used to always believe dentists were more brand loyal that any group of people out there because you're always working on weakest link in the chain. You're sure as hell not going to start changing what's been working for you for 5 10 20 years just because they've got a new color or flavor.
Eric: Exactly. I think dentistry and dentists in general have certain reputations and what not. Dentists are really good people. We're not trying to get 5 seconds faster. I don't care about 5 seconds faster. I literally couldn't care less. Is your new product just as good as the one you're replacing. If not, then you can keep your 5 seconds. I don't need that.
Howard: I love dentists. I really do. Whenever you stay at a dentist's home, they always have 100 non-fiction books. Whenever you stay in somebody's home who's not a dentist [inaudible 00:30:21] or a lawyer, they have people magazine and 50 Shades of Gray. Dentists are just smart. They're well read. Since they're classically trained in all the basics of science whether its math, physics, chemistry or biology, they're actually really spot on in areas of science outside their expertise, whether it'd be global warming or mercury.
I want to ask you about that. First of all, I need to go back to talking about bone grafting. Do you put a membrane over that and suture that in?
Eric: Sometimes yes and sometimes no.
Howard: What makes you do it, what makes you not?
Eric: Most of the time I'll do a PTFE type membrane. I'm pretty traditional. I don't really use that many of the titanium mesh. Sometimes I'll just place the traditional Periglass, I'm sorry, not Periglass, the traditional gel foam over the top of it, if it's a real small little fella, it works out really well. There's pros and cons to each one, and you have to pick the right scenario of course, just like everything we do. You get great results in the end, as long as your graft, especially the particulates I use, as long as it stays in there, you're going to be getting great results.
Howard: Some listeners might not have understood what PTFE means.
Eric: Essentially, it's plumbers tape, right? That's the whole idea. Nice little plumber's tape over the top but a whole lot more expensive medical grade. It's going to able to keep that material in place because, unless you're getting primary closure and actually getting the gums, the gingiva, etc. to close over and hold it in, it's a particulate, it's going to be like sand falling out. I compare it to sand falling out of a coffee cup. You don't want that. You want to keep the coffee in the coffee cup. So you have to, fork it off. So that way you're [inaudible 00:32:02]
Howard: How do you charge for that? Does insurance pay anything?
Eric: Oh yeah. My staff here is fantastic. We can bill out to medical sometimes, not always but sometimes. Yeah, more dental insurances are covering implant placement and socket grafting, probably more the implants I guess right now, than the socket grafting but in the end, I price both my implants and my socket grafting, especially my socket grafting, probably quite a bit lower than I should just because I want them to be done. I want the socket graft to be placed in there. I don't want it to be, well I don't want it to be well maybe maybe not. It comes down to everything's better with more bone. You know what? Let's put it in there. Let's make sure it's done right.
Howard: If your extraction fee was a dollar, what would your bone grafting fee be in relation to it? Is 1 to 1? Is it 1/2 to 1? 2 to 1?
Eric: It's about, a little under 2 to 1.
Howard: So it's twice as much money for the bone grafting as it is for the extraction.
Eric: Yeah, the bone grafting, yeah, that's about right.
Howard: Anything else you want to say about Straumann or the rep or anything about that?
Eric: They're fantastic. For the younger people watching, the actual brand, if it works well in your hands, you can use a cheap one, you can use an expensive one, but just know what you're using. You can use multiple ones for that matter. There's nothing wrong with multiple different systems in your office. By as a young dentist, you may not have that availability to you, whether it's your own office or you're funding. They're very expensive. So it comes down to I like the one that does a little bit of everything.
Howard: Next time you see your rep, tell them the thing that still blows my mind the most is that Nobel Biocare, Straumann, ITI, Straumann. None of these major companies or even [inaudible 00:34:05] None of them but a 25 to 50 hour from A to Z had to place implants on Dentaltown and it has 202,000 members and they put those 250 some courses half a million times. You would think if you owned an implant company and you know they have all the courses.
Eric: Sure they do.
Howard: You know they have them. That's been crazy.
Eric: They've got the research, they've got the development. They've got everything at their disposal.
Howard: You should tell your rep that. That's still the most overlooked deal and if I owned the company, I'd put up tomorrow. Then the big thing is what about a CBCT. Did you actually buy one or do you just have access to one, because that's a big chunk of change.
Eric: It's a big chunk of change. I've got access to one. We've done everything from ... I'm in the western suburbs of Chicago. There's actually quite a few around. Specialists, friends of mine. There's even mobile units, that can come by. Actually the mobile units are some of the best and most convenient because the patient is already here. You walk outside to the mobile unit.
Howard: You use that? You use the mobile unit?
Eric: Yeah. It's been wonderful. It's not exclusively, sometimes it's nice to be able to have the different technologies. Everyone's got different systems. Truly, the mobile units should not be overlooked. Put it that way.
Howard: What percent of the time, when you place an implant, do you use the CBC tape?
Eric: My office and my implants consist of predominantly 1 2 3 at a time. Occasionally we're crossing the arch, but really a lot of patients have all of their teeth. We're not doing super large, full rehab hybrid type cases like I did in the past. So it's much more of converting a bridge to individuals. For that, it varies. The vast majority I still don't use a good solid [inaudible 00:35:58] is really the mainstay I'd say. Then of course you'd have it at your disposal if you need it. The CBCT could be ordered left and right.
Howard: What percent of these ... Well first of all explain, you said you use to do a lot of complex cases, and now you're doing more [inaudible 00:36:16] than a 3 unit bridge. Why did you migrate from a lot of complex cases to more not doing a 3 unit bridge?
Eric: Back, before when I was an associate, I was working at an implant center, and that was the genesis to all of my real world surgical skills we'll call it. We didn't see children. We didn't see anybody under 18. It was only implants, all day long, everyday of the year. A lot of crown, lot of bridge, lot of the [inaudible 00:36:42] part of it too.
At some point, I missed the variety of general dentistry. I was able to take that and incorporate that more into the family dentist modality. The downside though, there's always the pros and cons. You can't necessarily have the same focus and experience for the patient but also the dentist. As a surgical center, you have to do several hygiene checks. There's a child down the hallway that's a little bit upset about getting his teeth cleaned. It doesn't jive that way, so I've kind of cut back on the larger cases because in my neck of the woods, that's not the bulk of the cases for me. For every one giant case that comes through, which is not terribly often, there's dozens of the 1's 2's and 3's that we just put it.
Howard: I always thought that was the strangest thing about dental continuing education is that, you go to a convention and they have these TMJ courses. TMJ is not 1% of the average dentist's revenue. They have all of these courses, upper 10 veneers, and that's not even 1% of a dentist's revenue. Then you go to an implant case and they're showing all of these full mouth reconstructions and most people in the room, at least 1/2 have never done one case ever and the other 1/2 have only done, they can count those cases on one hand. Then you sit there and say well, what do you dentists do all day long. Well 96% of crowns are done one tooth at a time. 96% of implants are placed one at a time, and nobody wants to talk about that because it's just not super sexy.
Eric: It's not glamorous. It's not sexy. You're right. It doesn't sell tickets. It's the main stay of it. Especially in a well controlled hygiene population, our patients brush their teeth. Initially they come in off the street fresh to the office and we've got to do some work but you know what, through patient education and the actually value that you place not only on the doctor-patient relationship but also their teeth in general. Your teeth are not disposable. They're very important. Your quality of life will suffer unless you start changing things a little bit. Just by basic tenants like that, which we all try to do, things get pretty stable pretty quickly, and especially with effective communication.
Howard: When 96% of implants get placed one and a time, and you have a tooth in front and tooth behind, what percent of the time do you use the surgical guide, versus just eyeballing it?
Eric: I'm a big surgical guide guy. I think it's important. It's how I was trained. I really like it quite a bit. I guess you can always freehand it I suppose. There's plenty of people out there. I a big surgical guide kind of guy especially when you're doing multiple types. When you've one in front and one behind, you know the angulation needs to match. It goes back to the reverse engineering. I want to know where the crown's going to be. Just being to visualize it in that small piece of plastic or acrylic, it means a lot to me.
Howard: Walk us through your surgical guide. There's so many that people talk about.
Eric: Mine aren't anything very complicated. You can make a very quick version of it. There's lots of different kinds. Some of my favorites for the simpler cases, you've got a box of old denture teeth. Take your model, pour it all up, place your denture teeth of appropriate sizes in there. That's a pretty good approximation of about where the tooth is going to be. Get your set down, get your [inaudible 00:40:22] on there, and you've got yourself a wonderful surgical guide that's going to keep your nose pretty clean.
Howard: You take upper [inaudible 00:40:33], you pour up the models, you put a denture tooth there, then you do a set down over that?
Eric: Yeah. Yeah.
Howard: Then do you drill a hole in the model?
Eric: I'll drill a hole in the model where I want it, which is nice, then you can just extend that hole up into the plastic. You're surgery becomes, for a lack of a better term, it's semi-guided I guess. You've already got the desired hole there. You've just got to match A to B.
Howard: Very good. Do you have any favorite implant software, from CBT, if you've got a CBT, is there designing software, or is that not a really big passion of yours.
Eric: I don't have any solid allegiance to just one software. Plus, it's changing so often. It's not my norm to use it every single time. I don't have a particular allegiance at this point.
Howard: A lot of people don't want to get a CBCT because they think the half life of the technology is only 5 years.
Eric: Well I agree. Plus it comes down to be truly effect, you're taking a lot of CBCT's on people. I have children in the office, and that whole debate where I'm still again, I'm waiting a little bit more, let me see a little more research on it, whether you're going to extrapolate on it. How wonderful that you can take a CBCT of somebody and extrapolate out the pan and the bite wings, and the full mouth, and everything. With that said, it's how necessary, and more importantly when will you have to buy a new one to stay up with the Jones'.
Howard: A lot of dentists come out of school $250,000 in debt. They're wondering, do I need a $150,000 CAD/CAM. What would you say to a kid like that? Do you have one?
Eric: I don't CAD/CAM, no. I still think the laboratory is a vital vital importance as far as making high end restorations. I've got several friends that do wonderful work with CAD/CAM, but you just can't, at least in my opinion, at this point replace the human element of it all. They can mill it, but what it comes down to when you need custom shading, you need somebody there that's truly an artist in it, especially for the anterior cases.
I know that's not necessarily for every office because you can do very well and succeed with the speed and efficiency. A friend of mine is able to do it half the amount of time I am and that's wonderful, because the patients truly value that. There's no second appointment. You wait there, and you mill it, and there's no temporary. That's really really nice in some respects. For me, right now I'm looking at the scanners technology as they're coming through. I like the idea of being able to ditch at some point the impression material. I think that will be a really fun day when we no longer have to take semi-gelatinous goop and gag people, just to make a nice crown or a bridge, be able to do that remotely without any powder or dust. I know it's right around the corner to be really really predictable.
Howard: Do you mainly use one lab or do you use 1/2 dozen different labs?
Eric: Nah, somewhere in between. I use a lab that's for my posterior restorations, I've got one for my anteriors and my implants, and I've got one that's removable. So I've got actually 3.
Howard: Are they all in Chicago?
Eric: Yeah, they're all local. I think that's really important too. The benefit is, I'm in Chicago. I'm not in the middle of nowhere. There's the density of it all. I'm very blessed to have them literally in my backyard. Some of them are just a couple of towns over. Being able to send a patient over, all right Mrs. Jones, you're going to go down to the laboratory, the actual clinician who's going to make your appliance, who's going to actually draw you and shade you and get everything out, it's a very nice way to do it. The patient, they love it, because they can literally say I want it to look more like this or like that. They bring them back for a little shade check. It's a wonderful service. It's a lot of the load off my end. When you're dealing with anterior teeth, hey, [inaudible 00:44:36] but the cosmetics is just as important.
Howard: Our podcast is usually downloaded in 206 countries on every episode, so for the viewers around the world, Eric actually lives in the city of Chicago where the American Dental Association is, on 211 Chicago Ave. Is that it?
Eric: Yeah, I think that's right, yeah.
Howard: I learned that from my check to them every month. I think all of the American dentists want to ask you, why does the Chicago Mid-winter hold their ... I mean I love Chicago. I think it's one of the coolest cities in the world. I've been to so many countries, Chicago, New York, San Fran, San Diego, San Antonio maybe. Why didn't they have the Chicago mid-winter in April? Why isn't in like rocking awesome May or October or around Halloween. Why is it in February when it's ... To our viewers around the world, Chicago almost touches Canada. It's way up North and it's on the tip of a lake, so you always have a wind chill factor coming off and they have it in February. That would be the exact month I would not have it. Why do you think they do that?
Eric: They like the [inaudible 00:45:46] Maybe it's an ego thing. Chiberia is what they were calling it last year. It's about as cold as it gets, but historically February and September are always a little bit slower months because people are just getting back into things especially with school in September. That's probably the genesis, but that's just pure speculation on my part.
Howard: Whenever I ask the old guys, I always get the same answer. "We've had it that same weekend since 1850 something"
Eric: That's probably more accurate than my explanation.
Howard: I think they were having that meeting before the civil war at that time there because no one seems to know. It's always been the same day.
So, then everyone is wondering, do you screw your crowns to implants or not? We keep hearing a lot, one of the biggest causes of peri-implantitis is excess cement and some Implantologists say they're not seeing them anymore. What are you doing?
Eric: Obviously with the screw, you're going to have the visible access screw, you can use opaquers and things like that, but I don't screw, but I do always make a custom abutment. I really want that cement line up as high as possible away from that implant, just like a natural tooth. Whether it's a CAD/CAM brand name like Atlantis, or something along those lines, just being able to have a beautiful wide platform that mimics a perfect ideal crown prep, and then you simply just have to clean around the 1/2 millimeter around the gum line, you're in great shape. Very predictable, obviously a nice opaque cement so you can see what's going on inside the x-rays, and you're in business. CAD/CAM custom abutments and I go along very well with my implants. I don't use stock abutments.
Howard: Eric, how would answer this? I'm in Phoenix and there's 2 dental schools in my backyard, one's in Glendale and one's in Mesa. When they're in my office the most common question I get is, the problem they have with implants is the person that usually lost the tooth had decay and gum disease. They're just thinking, what's going to last longer on that missing tooth. The person already has a mouth full of viralant perio-pathogens [inaudible 00:47:56] and what would you say to a kid that said "Eric, the person who lost his tooth had a huge cavity and bleeding 5 millimeter pocket, so mouth's filled with bugs. What would last longer? An implant and a crown there or 3 unit bridge?" Please explain that.
Eric: I would tell a young dentist, what we've talked about earlier, a really good comprehensive exam. Has it been 30 years since they've been at the dentist? If they don't have a true value for things, if they don't understand that implants aren't necessarily forever. You hear it on the radio all the time, with the implants, oh these are forever, well they're not, not unless you take care of them, and even then they haven't been around that long with their single rooted form to really be able to make that kind of claim.
So that patient better be well educated, certainly as clean as possible going into it, and then it comes down to a lot of patient responsibility. I'll have people coming to me for implants and I'll joke with them, I'm going to talk you out of this implant Mrs. Jones because you need a bridge on that tooth. They're looking at the space, and I'm looking at the space and the neighbor's. The 2 neighbors have 15 lbs of amalgam in them from 1922. It's not going to be very long before those need some help too. Why don't you go with the bridge, Mrs. Jones, and kill 2 birds with one stone? Again it's full circle. True comprehensive dentistry is multidisciplinary, being able to choose between implant and crown, being able to look at the entire mouth. Evaluate the gums, evaluate the flora of the mouth, their past histories. It's a very complex time consuming appointment that all happens in 0150 comprehensive exam.
Howard: On of my very good friends, they're ear, nose, and throat. You don't want to get them started on sinus lifts. It's going to be a wreck forever.
Eric: Yeah, yeah.
Howard: It's funny how dentists say I don't want to do a bridge because I don't want to file the enamel off of the tooth and put 1/2 a bucket of sand in a person's sinus. My ENT buddy Gordon saying, no. It's funny how a dentist, the enamel's sacred, but they'll destroy the sinus, so an ENT is like, leave the sinus alone, it's sacred. File down the teeth, and it's funny how everybody has their own perspective. As you get older and older and older you just realize that binomial thinking is a red flag. When someone says always yes or always no, up, down, right not left, whenever you hear an extremist, you know the truth is in the middle somewhere. As you get older older and older, you get more and more moderate and realize that every question is complex. In fact, when I'm asking you questions I'm half the time thinking did I ask that question right? How you ask the question is everything.
Eric: Nothing is absolute, right? That's the old saying. It all comes down to patient care. Each patient is different, each treatment plan is different. You have to know both the physical and the emotional backgrounds. You've got to know a little bit about everything to truly get that patient what they want because in the end, and even then, I may have even misspoke there, it's what they want and what they need and what you can achieve. All these things come together at the end of that appointment. It's a very interesting thing because, like your ENT friend, there's no one way to do things, and I'm sure there's some definite validity to that opinion, and I'm sure there's some definite validity to the dental aspect of it as well. It comes down to, you're absolutely right, being able to do it with multiple different ways is imperative.
Howard: [00:51:37]One of the things that you're a role model and idol to me is you always have one eye on your patients needs but you also have an eye on cost. You've factored that in in a big way. You're a big part of the CDS Foundation Dental Clinic and the DuPage County Health Department. Thank you for that.
I want to ask you this. You can't even go a month or 2 and there's something in the news about mercury. A lot of these young kids are saying what about amalgams for poor. It's so confusing. It's extremely complex. We know amalgams last at least twice as long as composites. They're bacteriostatic. Mercury, silver, zinc, copper, tin. Every one of those is antibacterial to some degree. They're cheaper, but right now in San Diego the scientists are finding a lot of mercury in sea lions, in their hair. It's showing up in mollusks, whatever that is.
I read that the main mercury contamination for the ocean is burning coal. Coal goes up in the air, it goes over the ocean and settles, and that's the mercury deal, but some people are pointing out clearly to me that somewhere around 5 or 6% of atmospheric mercury is coming from cremating 3 million humans a year and their amalgams are actually are going into the vapor. My question to you is, you work for the poor, you volunteer for the poor, what do you say to the young kid that says is being amalgam free that extremist? What do you think about amalgam? Do you use it in your office? Do you use it in your clinics? Do you use it at the CDS Foundation Dental Clinic, or the DuPage County Health Department?
Eric: I can only speak for what I believe. I don't introduce any new amalgam to the party. Am I the one that's harping about, you got to get all of that out of your mouth right away? No, but when I have to remove any, no new amalgam is going in. I haven't placed an amalgam personally in 6-10 years, quite a long time.
I've been blessed also, you've touched on the economics of it all, the beautiful part is the Chicago Dental Society free clinic is such a great organization. The give a lot of carte blanche to the providers. If you wish to place amalgam, go right ahead. They've got it there. If you wish to place only a resin, like I would do, you've got it there. You've also got time. There's no expectations that you have to put 37 fillings in an hour. It's not a race. You're treating good working class people who are either the working poor or under the poverty line. It's nice because you're able to do it exactly the same as I would for my paying patients in my office.
Long winded answer to your question, but I don't introduce any new to the party, for the same reasons you've said. There's a lot of question marks out there. Yeah, there are some positives to it, but there are quite a few negatives, and every year that goes by, you've got to wonder. Again, no sense in experimenting on people. In the end, the cosmetics of it all, people don't mind having the nice white matching fillings. It quite nice.
Howard: At least once a month, a dentist will say I don't pull teeth or place implants because I don't blood and guts. I always think, then how the hell did you end up in dental school?
Eric: I agree.
Howard: You should be working at Intel. My Iphone doesn't have any blood. I always tell them, you know what? You should then do extractions at crematories. They really need to pass laws that someone needs to go in there and extract those teeth, before they cremate them. So, if you don't like blood and guts, maybe you could be a cremation amalgam extractionist.
Eric: You wouldn't need to use a whole lot of Novocaine either. That'd be great.
Howard: Yeah. You wouldn't have to worry about bleeding.
So Eric, I seriously can't think of a single dentist or a single company that does social media better than you.
Eric: Thank you.
Howard: Even the people that have the big companies, and I look at their stuff. It's good and everything, but in all seriousness, yours is the best. My question to you is, are you the one doing all that? Do you outsource that to a company, and has it been a return on investment? Is it worth it? Do you get new patients from it?
Eric: Oh absolutely. It's been a tremendous asset. Yeah, I do everything myself, and it's the old adage, it's write about what you want to read about. If I'm feeling a little bit more surgical, I have an office newsletter that I started, and it's all about patient education. One more way I don't have to a long diatribe with patients while they're here in the office. They've got places to go and people to see, but they really want to learn about how and why I do the Invisalign the way I do it. The Invisalign Experience with Dr. Jackson.
It's all on the website. A fun little video, a fun little this. You pepper the actual things in there that reflect directly back to my office but also the internet is a wonderful thing. Put a funny Pinterest quote up there that you like on Fridays. It's Friday fun day. All the different little things you want. It's kind of just a reflection of what's in my head I suppose, and I guess that's a lot of different directions. If it resonates with someone like yourself, I'm a very happy man. It's been wonderful. It's just a really great way to disseminate information, deputize like I said, the patients into being a deputy dentist.
Howard: I really feel like I know you. From following your social media, how long have you been doing that? Since about, what would you say, like 2009?
Eric: Yeah, about '09.
Howard: I've been following you since 2009. I feel like you're my neighbor. I feel like I really know you.
Eric: That right there is the reason why. What's the real way to know your dentist. You could spend a lot of time with him but that's when you're getting work done, and that's fine, but you can absolutely do it from the comfort of your own phone and just kind of know what goes on in his or her head.
Social media costs effort. I've got people calling all of the time, they want to take over this or they want to ghost write for that. That's not me. I want to make sure that the words coming out of my mouth are actually the words on the page and vice versa.
Howard: How could someone listening to this right now follow you on social media?
Eric: We just recently passed 3000 twitter followers and I'm really pleased. A local Downers Grove, outside of Chicago dentist, I'm remarkably proud of that.
Howard: What's your twitter? At what?
Eric: @EJacksonDDS
Howard: @EJacksonDDS
Eric: Yeah. There's a little bit of everything, from the Youtube channel, to Facebook, and Twitter, to even the more obscure things like LinkIn. You'd be surprised. I'm able to get ahold a rep like that because sometimes I have their card, sometimes I have their LinkIn account. They're the business people. We're dentists. We don't really deal with business in the same way, but you know what? I don't need an actual business card. I've got your information right there, and it's wonderful. You'd be surprised how often I get that weird look. They said "Wow. No one ever follows me on LinkIn." Yeah, that's important. We're doing business here.
Howard: Yeah, and your posts are amazing. When I follow your posts, you're very likeable ...
Eric: Well Thank you.
Howard: You're cases and implants, you feel like you're going to an authority.
Eric: Thanks you.
Howard: You don't feel like you're going to some kid. You don't feel like you're wishy washy, or someone whose focused on insurance. You feel like I'm going to go there and this guy totally knows what's going on and he's going to get it done.
Eric: That's the beauty and the curse of social media. You put yourself out there, and for better or for worse, it's very transparent. You can put generic premade posts from your provider up there, but truly it's one of those things where I prefer the real thing. I want to make sure that it's all correct, that a true representation of me.
Howard: I'm out of time. We're right at 60 minutes and I have one overtime question for you.
Eric: Fire away.
Howard: You mentioned Invisalign. What are your thought on Invisalign and what would you say to someone who says, there's a couple of companies out there doing it. Do you like Invisalign? Have you tried other ones? Do you think that it's a significant part of your practice?
Eric: Like everything else, I never have one part of my practice that's more significant. It's funny. It comes in cycles. You'll get a bunch of implant cases all of a sudden and then you'll get a bunch of Invisalign cases all of a sudden. Then you get a bunch of crown and bridge type cases. It just kinds of ebbs and flows like that. That's what really makes me a very happy general dentist. I like variety. I like being able to dabble in a little bit of everything.
How I do Invisalign is a little bit different. There's a lot of different ways to do it. I don't charge for work ups at all. I think it's a really nice service. It's because I'm not doing a tremendous amount of it. I'll just enjoy sitting down after work and then just work up a case. Then, I'll have a patient come on back. It's a rare treat to be able to sit down with somebody and say "Here's what I think visually you can look and here's what I think your case is going to end up like. What do you think?" Usually, with an orthodontist, and not Invisalign type cases. it's all between the ears. I can do that in 9 months, or in 2 years. The nice part is to be able to really visualize or show the patient, it means the world. It also gives them ownership. They know what's happening. It's no different than a blueprint for your new house that you're going to build or the office building you're going to construct.
Howard: Some orthodontists are not shy at all about the fact that dentists shouldn't be doing ortho. Has your dad ever told you [inaudible 01:01:43] "Son. You should not be doing Invisalign!"
Eric: No, because he instilled in my a long time ago, and it's very apparent, Inivisilign can't do everything. I'm very against the Invisalign can just replace braces, and there's plenty of people out there that more or less either say it or treat like that. You can't do certain movements predictably. That one case that you were able to move that molar over here to the other side of their face, that's a one in a billion shot. I'm not going to do one in a billion type procedures on my patients. I want to know nice traditional tiping, twisting, a little bit of extrusion. That kind of thing. I'm very traditional. I'm an old soul when it comes to Invisalign, but the nice part is their technology gets better and better. When I don't think they can be accomplished with Invisalign, well I've got some beautiful specialists lined up right there down the street.
Howard: Well Eric, you said you lecture sometimes at your study clubs and stuff.
Eric: Yeah, I have.
Howard: If you've got an hour lecture, I'd give anything to have you put it up on Dentaltown.
Eric: I'd love to.
Howard: I would actually love that. I just think you're a hell of a guy, you're a hell of a clinician, you're a hell of a social media, I just think you're a hell of a guy and I just want to tell you, we're 2 minutes over time, but thank you so much for spending an hour with me today.
Eric: Thank you.
Howard: Thank you for all you do for dentistry, and the CDS foundation, the DuPage county Health, everything. You're just a hell of a guy. Thank you so much for spending an hour with me today.
Eric: That means a lot coming from a guy like you. You're somebody that I've sat in your lectures, your MBA and your different dentistry courses. You're just fantastic. Being able to sit here. This is exactly what I wanted to have when I was young. First year out, second year out, being able to rub elbows with the likes of Howard Farran, or the likes of anybody else in that league. I mean really, we're talking A-list people here, and here I am sitting skyping with you and it's fantastic.
Howard: Aw, thanks buddy. Well, thanks and I hope you have a rocking hot rest of the day.
Eric: You too. Thank you very much.