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Howard Farran:
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Hey, it's a huge honor to be here today. We're at [Towny 00:00:09] meeting 2016. This is our 14th annual Towny meeting. Thank you so much for coming.
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Lewis Meyers:
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Of course.
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Karen Siebert:
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Thanks.
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Howard Farran:
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I wanted to podcast interview you guys because you guys have an interesting story. You work with American Eagle Instruments out of Missoula, Montana. You're a hygienist. You are Karen Siebert out of Chicago?
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Karen Siebert:
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Yes.
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Howard Farran:
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Chicago, the windy city.
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Karen Siebert:
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Yes, windy because we're loud mouths there, not because it's windy.
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Howard Farran:
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The reason I wanted to podcast interview is on Dental Town there's a huge thread. Have you seen that thread? You posted on it.
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Lewis Meyers:
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I have.
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Howard Farran:
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I want you to cover a couple of things. Talk about the company story, because I think the American Eagle Missoula, Montana is an interesting story. Talk about why did that thread explode, and you're a hygienist so tell everybody what's going on.
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Lewis Meyers:
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Okay, just a quick history on how American Eagle Instruments was born, the company, once upon a time there was a nice instrument manufacturer in Missoula, Montana by the name of American Dental Manufacturing Corp. You might have heard of this company, had nice instruments. They were prevalent in all the dental hygiene schools. About 25 years ago Hu-Friedy came in and bought that company. At the time the employees of the company, about 60 of them in the thriving metropolis of Missoula, Montana were told, "Your jobs are safe." It was less than a year later that they shuttered the factory and they moved that operation to Chicago. American Eagle Instruments was born from 17 refugees of the old American Dental Manufacturing Corp along with the investor, Brad Heckerman was the 18th person, and it was with his dollars that the company was born. Of those 17 refugees that started the company four actually still work with the company today. It's been 25 years.
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Howard Farran:
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They saved the town by saving a company, they saved the jobs.
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Lewis Meyers:
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Yeah, it was the President of the Chamber of Commerce is the one that approached Brad Heckerman, who had recently sold a business he was involved in a shooting sports industry. He was maybe looking to get into something new. He didn't have a dental background but decided to put his money behind these 17 passionate people and a company was born.
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Howard Farran:
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I discovered you on that thread on Dental Town. What was the name of that thread on Dental Town?
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Lewis Meyers:
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Karen, was it something like, "My hygienist refuses to sharpen anymore"?
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Howard Farran:
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That's right, so on the Dental Town app there's a search button. I'll just keyword, "sharpen," and yeah, "My hygienist tells me that no hygienist sharpens their instruments." This will be funny because here's what I can do on my iPhone, I can take a selfie and then on that thread hit, "comment." I'll put, "Are your ears burning?"
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Karen Siebert:
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Yeah perfect.
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Howard Farran:
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Burning, and then hit the camera icon, use existing picture. That, bing. There we go. Tell us about that thread because you can see at the bottom of that, it's a six page thread. What are they talking about, first thing? Someone who is sitting out there who's never seen the thread, "A hygienist tells me that no hygienist sharpens their instruments anymore. Is that true?" You're a hygienist.
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Karen Siebert:
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Right, so my first thought when I read that thread was, "The hygienist maybe didn't phrase it quite the way we would want to," as hygienists, to explain that there are new ways to approach efficiency with our instruments, and that sharpening is an exact science. That's really what she probably meant. It just probably didn't quite come out that way. It started this thread that was exploding and many dentists were not happy to hear that people were not sharpening. The problem is there's really not a whole lot of time in practice to sharpen anymore. We are pressed for time, there's so much more to assess during an appointment, that really we can do much more with our time than sharpen instruments. We can find more dentistry to be done, for example, sell a whitening procedure.
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Howard Farran:
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The truth is they weren't sharpening their instruments. At the time, in all practicality it just wasn't happening.
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Karen Siebert:
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Right, so not happening, so then you've got these dull instruments.
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Howard Farran:
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How many years have you been doing hygiene in the windy city of Chicago?
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Karen Siebert:
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31 this year.
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Howard Farran:
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31, okay, so [inaudible 00:05:03] dentistry 28. How many years did you ...
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Karen Siebert:
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I'm a year younger, just for the record.
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Howard Farran:
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Oh you're a year younger than me? Right on.
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Karen Siebert:
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I thought I'd throw that in there.
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Howard Farran:
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How many years did you use instruments that you had to sharpen, and in all reality and honesty how often do you sharpen your instruments, and then what change with these instruments?
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Karen Siebert:
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Well, probably until three years ago, when I discovered XP technology I was using and actually I still do teach with regular stainless steel instruments in my teaching job, at a dental hygiene school. I'm very familiar with sharpening, I teach sharpening, it's never going to go away. Of course we need it. The issue is being able to be an exact sharpener. When I was practicing I never liked it, I never felt confident with it. I don't really feel like I learned how to do it til I started teaching myself and another instructor showed me some new ways to approach it. For years, I was re-contouring and making sickles out of gracies and things like that. The problem there is we're not doing a good job for our patients because we're burnishing calculus. It is tough, even if we're taking the time. Sometimes we're doing it wrong. Then that leads to incomplete cleans.
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Howard Farran:
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Then what's new then? You said, "XP technology." What's new? There's instruments that need a whole lot less sharpening, is that what you're saying?
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Karen Siebert:
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No actually, no sharpening.
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Howard Farran:
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Because I thought you said she said it wrong, by saying, "no sharpening."
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Karen Siebert:
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Well, not exactly. The way she said it was that, "No one sharpens anymore." It sounds sassy. What she meant to say is, "I just don't have time to sharpen," because not a lot of people know about XP technology, and if she did she didn't explain what that was at the time.
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Howard Farran:
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What is XP? I assume it's from P90X.
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Karen Siebert:
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Yeah, I wish it worked the same way. That would be nice. Can we make it work so that it gives me a workout too? No, it is a completely different metal alloy than stainless steel is, so your comparing apples to oranges when you compare a stainless steel hand scalar to an XP technology hand scalar. It's made a completely different way, it's plasma ion engineering, and it creates a harder metal through the process. There's more to explain about it if you want to get into the geeky science part, but physics makes me sweat so I don't like to get into it too much. You're better at that actually.
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Howard Farran:
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These XP instruments are made out of a new, harder technology, you basically don't have to sharpen them?
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Karen Siebert:
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Exactly.
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Howard Farran:
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How long will they last?
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Karen Siebert:
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That's always the big question, and they do wear over time. Every instrument starts out sharp. There's no difference there, but it's how fast they start to wear and how fast they start to dull that matters. These are so hard that they dull much slower than our stainless steel, and to the point that for every practitioner it's going to be different because we all use them a little differently, we process them differently, we have cassettes or we don't have cassettes, it all matters in wear for both stainless steel and XP. We all like to say, I like to say, "Mine are lasting me about as long as my stainless steel instruments would have lasted me when I knew I should have replaced them." Even if you're keeping them much longer than that there is a point we all know our instruments need to be replaced. A lot of times we keep them a little bit longer. There's some kind of emotional attachment to them actually, so by the time they get to that point.
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They're thinner. We like them a little thinner because we can get into things by that point. The problem is the angle might not be right anymore.
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Howard Farran:
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You're in private practice and you teach hygiene?
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Karen Siebert:
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I don't do much private practice anymore. I'll fill in once in awhile but I did for years.
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Howard Farran:
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Now you're a full-time hygiene instructor.
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Karen Siebert:
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Part-time, and then I work wit American Eagle a little bit as an opinion leader consultant.
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Howard Farran:
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Not to get sidetracked on this but is it still a good job to go to hygiene school and come out and become a hygienist? Are they still getting employed? It's 2016, is that still a return on investment when dad sends his son? I've got two sons that are thinking about going to hygiene school.
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Karen Siebert:
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Really?
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Howard Farran:
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Yeah, is that still a good return?
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Karen Siebert:
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It's interesting. It's very different than it was in the day. Although I don't know, when I graduated jobs weren't everywhere. I had to look a little bit for mine, so I feel like there have been a couple of times in our careers that we haven't had jobs a plenty like we had through the '90's especially. If you love it and you have passion about it I think you should do it. It's such a great career. Our issues come from the legislation and not being able to have the full access to people that need preventive care like we could. We could make a bigger dent if we had access to some people. Some states do. I think Arizona just passed some new laws that allow hygienists to practice a little bit more under health maybe ...
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Howard Farran:
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Are they finding jobs when they get out of school.
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Karen Siebert:
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Yes, not always full-time, that's for sure. A lot of part-time, so you can't count on a full-time with benefits I would say, much more part-time, at least in my area and Chicago area. If you're looking for something that's full-time with benefits it's going to be a little bit more challenging, but I think when people persist they find them. I just ran into a past student at Chicago mid-winter who is now lead hygienist of a large group and is mentoring the hygienist underneath her. She looked and worked at it and it took her awhile to get there but she found it.
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Howard Farran:
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Are you teaching these instruments in your school?
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Karen Siebert:
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No, not in my school.
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Howard Farran:
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Why is that?
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Karen Siebert:
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It's complicated to some extent. There's a slightly modified technique to using XP technology because of the hardness of the metal. We lighten up the grasp and actually shave through the calculus or plane through it, rather than getting underneath it using lateral pressure and popping. If we used a lot of lateral pressure, even stainless steel can do this, we could dent the root surface and we certainly wouldn't want to do that. Instead, these come thinner, like we like them after they're sharpened down but they still have the proper angle so we're able to get in there and just plane through that calculus real lightly and reach the tooth surface and then feel that we're at the tooth surface because they are thinner.
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Howard Farran:
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You can interrupt anytime.
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Lewis Meyers:
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One of the things I love to share, Howard, is the concept that hygienists and their bosses need to get their head around, and that is that an XP technology instrument, you will discard and replace it when it begins to dull as opposed to a stainless instrument after it's been sharpened down to nothing. That's something that a lot of people, it's a paradigm shift in instrument utilization.
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Howard Farran:
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For a full-time hygienist to work, Monday through Friday 40 hours a week how long do these instruments last?
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Karen Siebert:
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Again, that's going to vary a little bit depending on how their reprocessed and whether they use cassettes to store them or they bag them and send them through, whether they dry the cassettes enough. Are the instruments enough? There are some variables and it is really hard to put a number on it, but again, however long our stainless steel have lasted, these should last at least as long.
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Howard Farran:
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Why did that thread go six pages long?
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Lewis Meyers:
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I tell you why, Karen, I'll take a stab at that one, because there were a couple of hygienists that piped in on it and they started taking about XP technology, these instruments that don't require any sharpening for the life of the instrument and that generated this whole, "No way, that sounds way too good to be true. That's impossible."
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Howard Farran:
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That's what I thought the first time I heard it.
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Lewis Meyers:
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Right, and so that, it started a whole discussion of how can that be and help us understand it. That's when I decided to get involved and I rarely do that, but I felt like hearing from the horse's mouth would be something that would be valued on the thread. We talked a little bit about the manufacturing process, and not only that but the expectation. When you say, "You never sharpen this instrument," some people might take that to be, "When I'm 99 years old I'm still going to have this instrument, and it's still going to be perfect," and that's not the case. There was just a lot of information that was going back and forth on that. It's still going.
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Howard Farran:
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When I look at everything that everyone is talking about on hygiene because I'm on the Dental Town all day everyday since 1998 and I feel like I have a good pulse on the market, it seems like the number one question that the most dentists and hygienists have is, the implant manufacturers were telling everybody that theirs has a 4% failure rate but it looks like the reality for America is it's more closer to a 20% failure rate. Perry implantitis is the problem. It seems like the most questions I see about dental instruments is, "Can I use these on dental implants?" If you're old enough to go back in the day, remember, they started coming out with plastic instruments. Talk about that. One of the most common questions we get is, "How do you scale or clean or maintenance a dental implant and to try to fight peri-implantitis?"
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Karen Siebert:
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Perfect question because I just did a presentation at Mid-Winter on implant instruments and I had to do a lot of research to look and see what is the deal. That peri-implantitis number runs from 12% to 47% of the cases developed that, and that is horrible. We have to do better than that. The plastic instruments have been showing a little residual being left on the implants themselves, and of course not very effective. None of us have liked them all along. Have you ever liked them?
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Howard Farran:
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No, they're big and bulky.
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Karen Siebert:
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Right, and that, and they just don't take anything off. It's kind of a joke.
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Howard Farran:
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The other thing, they did that because they didn't want you to scratch the implant but you look at these implant surfaces and they've got all these different surfaces on there, it's like how does a scratch bother this surface?
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Karen Siebert:
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That was part of my research because I wanted to answer that question. I thought, "Okay, now we do have all these textured surfaces." They're specifically textured and they're specifically textured for integration. A deeper scratch, which a scratch that we put in is going to be deeper than that surfacing texture, so if we put that scratch in it is more likely to attract biofilm and then we've really got something to deal with, and can lead to more peri-implantitis. There are a lot of speakers and people out there running around saying, "Just use stainless steel instruments because they are textured." When I looked into it I really found that that was only the case in maintenance class type one implants, so really no exposure of the abutment. You're just instrumenting around the [crustesus 00:15:41] itself, nothing touching the implant. Anything case two or three and below, where you've got actual exposure of either the abutment or the threads, it's recommended not to scratch them.
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Every single article I came across, and my textbooks, I've got stacks of textbooks, they all do still say, "That's what we should do, we should avoid scratching the threads and the abutments."
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Howard Farran:
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Then the other problem is how many dental implants do you have?
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Karen Siebert:
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I don't have any fortunately.
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Howard Farran:
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I don't have any. The other problem with these implant cells is the people you're putting in, they lost these teeth for some reasons, and the reason usually has to do with a lot of Mountain Dew and no brushing or flossing or cleaning. It's hard to do an implant say when people, there's reasons you lost all your teeth. I didn't do anything to lose all my hair. That was just the card I was dealt but the people who are losing their teeth, most of them, there's a lot of behavioral reasons why they're losing their teeth. We can replace a tooth but we're not changing their behavior. If I owned a dental implant company, the not sharpening, that's cool. I put together how to maintenance a peri-implantitis because I think that is ...
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Karen Siebert:
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We have that coming out. We actually have a little pamphlet coming.
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Lewis Meyers:
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Yeah, we built a booklet. It's in production.
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Karen Siebert:
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I asked if it was here today. I'm so sorry it's not.
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Howard Farran:
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That's the fastest growing dilemma in [crosstalk 00:17:05]
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Karen Siebert:
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Yeah, I helped write that and we looked into some research.
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Howard Farran:
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Tell us about this program. What is it called?
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Karen Siebert:
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One of the reasons that we wrote this is because the implant instruments that American Eagle had just been formulated out of titanium nitrate.
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Lewis Meyers:
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The implant instruments, titanium.
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Karen Siebert:
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Yeah, I'm sorry, titanium implant instruments.
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Howard Farran:
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Oh so you did special instruments?
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Lewis Meyers:
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Just for implants, yeah.
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Howard Farran:
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Are these no sharpening too?
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Lewis Meyers:
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They're not. Titanium is a fairly soft alloy.
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Howard Farran:
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You figured a titanium instrument would be best ...
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Lewis Meyers:
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On a titanium implant, no doubt.
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Karen Siebert:
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Then they did research on the hardness, the rock well hardness of the various implants out there is and realized, "Darn, our instrument is actually harder than the softest implant." They actually scrapped all of our implant instruments and went back to the drawing board and created a titanium instrument that is softer than the softest implant so it won't scratch.
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Lewis Meyers:
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Titanium is a fascinating alloy. You can soften it down, you can harden it up through heat and deep freeze processes, you can manipulate the metal and so we settled in on a grade of medical grade titanium that's significantly softer than the softest implant that we evaluated.
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Howard Farran:
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When does this come out?
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Lewis Meyers:
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It's out, it's available. The instrument, yeah we have them on our thing.
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Howard Farran:
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What's it called?
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Lewis Meyers:
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American Eagle medical grade titanium implant instruments.
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Karen Siebert:
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Really catchy.
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Howard Farran:
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I do, I get 300 emails a day. I'm looking at all those threads a day and everyone is asking about how you maintenance for implantitis and the implant market has exploded. 2015 last year was the first year that the 150,000 general dentists placed more implants than the 30,000 dental specialists. Most of that's by 5,000 oral surgeons and 5,000 periodontists. Those 10,000 oral surgeons and periodontists now place less dental implants than the 150,000 general dentists. If that's 125,000 or 32 weeks or more. That's just the United States. When you leave and you go to Brazil, you go to the whole rest of the world, Brazil, India, China, the general dentists place 95% of all the implants. In America, that was the one that really got the specialist thing going. Now peri-implantitis, now you've got all these general dentists. They thought it was just that they got the implant in, it fused, they got the crown on, we're all good. Then they realized, "oh."
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One of my first full mouth implant rehab cases, that was in '87, she's still alive. She's 89 years old. Just because the implant worked, that's only half the problem. It's like a car. Eventually your car is going to go to the dump. As these implants get five to ten years down the road, peri-implantitis is going to be a ... They're not going to get a cavity. That's cool. People who lost all their teeth from streptococcus mutans, because they had full mouth decay, titanium is immune to that, but the peri-implantitis ...
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Karen Siebert:
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The p gingivalis.
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Howard Farran:
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Yeah the p gingivalis is still a major problem, and it's not even the p gingivalis. They're finding out, I was reading the other day that by the time you get four millimeters down into a cavity or four millimeters down into a gum pocket, four millimeters down into a cavity, they don't even find streptococcus mutans anymore, so the streptococcus mutans, the entry level first millimeters. Same thing with peri-o, by the time you get deeper and deeper it's not even p gingivalis anymore. It's all kinds of stuff. I've also been reading that they discover a new species of bacteria in the mouth every quarter.
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Karen Siebert:
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It's amazing how many have come along.
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Howard Farran:
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I am sure 300 years, 400 years from now everything that we're talking about we're going to look like Fred Flintstone.
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Karen Siebert:
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Right yeah, just go get our little wagon and pull it with our stone cart.
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Howard Farran:
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You're going to be Fred Flintstone, I'm going to be Barney Rubble. You'll be Wilma.
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Lewis Meyers:
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It's interesting how that Segways back to the XP technology. Again, getting back to this thread on how people were just like, "How can that be?" I was trying to think of the example I used, like we put men on the moon. An instrument that doesn't require sharpening isn't really that far-fetched. It just so happens that the engineers that developed this particular way of surface engineering metal happen to work for American Eagle. Hu-Friedy could have come out with this, their engineers just didn't. The things we do with our iPhones, what you just did on the Dental Town site, who would have envisioned that 20 years ago? Completely impossible. An instrument, a sharpened freak curette or scalar should not seem so outlandish with the technologies that are available to us today.
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Howard Farran:
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See that's when I've got to take exception to what he just said because all four of my grandparents, my two grandmas and my two grandpas all went to the grave knowing that the landing on the moon was filmed in Hollywood. They're from Kansas. I swear to God, they all thought it was a conspiracy, and at least 10% of my living cousins still believe it to this day. You know what I wish you guys would do, you just gave a deal, Dental Town has 350 courses, they've been viewed half a million times. If you got peri-implantitis instruments, you need to find, we need a course. I want a course.
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Karen Siebert:
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Yeah, I'd love to put that together.
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Howard Farran:
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I wish you would and then you could talk about the XP, you could talk about other things. I know my homies and I know the number one question they have with scalars and with hygiene in general right now, the 4,000 pound elephant in the room right now has shit, why is the bone dying around this implant? They're buying $78,000 lasers to go around it. They're getting desperate. We do believe that Peridex is a better mouthwash than Listerine because the Peridex is a sticky oil and might stick to the implant, whereas an alcohol Listerine ... Talk about peri-implantitis for a little bit.
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Karen Siebert:
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There's been so many things that have come out lately about Peridex and about different ways to approach it that I feel like I'm a little bit in flex at the moment on what I choose. I don't really have a strong opinion. One of the products I love for peri-implantitis is Perio Protect. They're trays. Have you ever heard of those?
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Howard Farran:
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Yes.
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Karen Siebert:
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Yeah, so they're trays.
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Howard Farran:
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Is that St Louis?
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Karen Siebert:
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Yeah, Tanya Dunlap is the person you probably would have met before from Perio Protect.
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Howard Farran:
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Is she your friend?
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Karen Siebert:
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I do know her yeah, we actually both do.
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Howard Farran:
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Set up a podcast.
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Karen Siebert:
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She would be fabulous.
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Lewis Meyers:
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Yeah, she's terrific. She's a PhD, she's great.
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Howard Farran:
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A PhD out of St Louis.
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Karen Siebert:
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Yeah she is, and their product is so interesting because as you said, we're discovering a different bacteria every quarter. It adds oxygen down to the non-aerobic area. I'm screwing that up big time, but into that pocket.
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Howard Farran:
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We basically only fight gram negative facult of the anaerobic bacteria that can't live in oxygen so all these therapies that can get oxygen into those areas, that's how floss works. You carry air in between the teeth and 29% of the oxygen in the air kills anaerobes and you carry out the food and disrupt the biofilm. Yeah, Perio protection is a big deal. What's her name again?
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Karen Siebert:
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Tanya Dunlap.
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Howard Farran:
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What's her website? Perio Protect.com?
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Karen Siebert:
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Yes, Perio Protect.com?
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Howard Farran:
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You'll introduce us?
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Karen Siebert:
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Yeah.
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Howard Farran:
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Send me an email, I'm Howard@DentalTown.com, and CC her into that. Anything else you guys want to talk about?
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Lewis Meyers:
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What about your educational opportunities that we offer with our clinical educator team? Karen's our lead clinical educator. We have a very small team of four hygienists that bring in webinars into the office.
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Karen Siebert:
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Yeah, we're A2D Pace certified now, so we offer a free CE for a one hour webinar. We also have hands on courses that we can bring to groups, study groups components, we've done a lot with dental hygiene components, and actually bring [inaudible 00:25:03] and the XP technology to them and teach them the modified technique, because it is a little different. It's definitely different than what we learned in school. Not hard to change but you need to learn it because of that paradigm shift, so we've got the hands on classes. We've got webinars to go into your office.
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Howard Farran:
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Where's the webinars at?
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Karen Siebert:
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We set them up individually actually so far. It's a live meeting.
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Howard Farran:
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How do my homies get a webinar into their office?
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Karen Siebert:
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You can contact AmericanEagle@marketing ...
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Lewis Meyers:
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Marketing@AM-Eagle.com to set up a webinar.
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Howard Farran:
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Another thing we could do is Dental Town, there's a casino by Dental Town and we put the Towny Meeting on. This is our 14th annual Towny meeting, but that department really doesn't have anything to do until the next Towny meeting. We've been putting on little bitty meetings in Phoenix at the casino. We've had Josh Ren, pediatric dentist had 100 dentists come and learn about pediatric dentistry. [inaudible 00:26:09] want to do that hands on course because the thing that people don't realize is the city of Phoenix, Phoenix is only a million but the metro of Scottsdale, Mesa, all those cities is almost four million and there's 3,800 dentists in a town. Maybe if you ever talk to [Hargo St Arbor 00:26:28] maybe you want to put on that hands on course in Phoenix and then we might be able to film it and make an online CD course out of it. I'm just thinking outside the box.
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Lewis Meyers:
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I love the idea.
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Karen Siebert:
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That would be really great because yeah, it's fun, and we've done a course together that's really nice because like I said, the physics makes me sweat a little bit, so it's really great to hear that part from Louis and Louis has a lot of background on the manufacturing of it, but the hands on part and the education of how to use it, that's my bag.
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Howard Farran:
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[crosstalk 00:26:55] and how to deal with the fastest growing nightmare in dentistry is peri-implantitis, and if you've got a softer, I think that's neat. If you can explain the physics of why a softer titanium scalar on a harder titanium implant and whatever, and anything that helps treat peri-implantitis, because there's a lot of confusion in the market. Some people are saying you've got to buy a $68,000 laser to do it and some perios are saying the $2,500 American Dental ADP Allen Miller AM Allen Miller design, so AMD laser, the $2,500 EMD laser does the same thing. Some people are throwing mouthwashes in there and then think the Peridex is better because it sticks. Some people are putting those tetracycline chips down there, and then dentists, they've always got one eye on the patient and one on cost. Some dentists are just buying a tube of tetracycline tablets and then dumping one of them out in a petri dish, and taking a brush with water and brushing the tetracycline down.
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You hear everything. I'm sure 80% of it is voodoo but we do have to maintain these until you make a judgement call that you're going to extract them and it's a hard judgement call to make because if it's still [ankylostin 00:28:11] bone and it's still holding the tooth, and you're not spreading Perio on natural teeth, it's a hard judgement call when you decide when am I going to sacrifice and remove this implant? Peri-implantitis is going to be a bigger problem until ...
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Karen Siebert:
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There's a new magazine called Evidence-Based Practice for the Dental Hygienist that is just been out under a year. The last issue had an article that was a meta analysis of the information out there about implant maintenance.
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Howard Farran:
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I have not heard of this.
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Karen Siebert:
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It's really new.
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Howard Farran:
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Who's doing that?
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Karen Siebert:
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Her name is Julie France of Holly, she's the one who put together the EBD site for the ADA, and she's based in Chicago too. There's another person that you would probably love.
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Howard Farran:
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Will you introduce us?
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Karen Siebert:
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Yes definitely, because she would be really great. I loved getting that magazine because you hear so much. You hear, "Just throw old scalars on the implants, it doesn't matter. Do this." Having these meta analysis in a actual ...
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Howard Farran:
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What is her website, evidence-based what?
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Karen Siebert:
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I don't know what her website is. I just have a hard copy magazine. It's Quintessence Publishing.
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Howard Farran:
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I've been going to the Ouija board of dentistry websites and she's saying, "Go to the evidence-based." I knew.
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Karen Siebert:
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That Ouija board wouldn't work for me for a long time but this one seems a little nicer.
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Howard Farran:
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Evidence-based dental hygiene?
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Karen Siebert:
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Evidence-Based Practice for the Dental Hygienist, it's a nice long title.
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Howard Farran:
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Evidence-Based Practice for the Dental Hygienist. Huh.
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Karen Siebert:
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It's Quintessence Publishing if that helps.
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Howard Farran:
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Right now, the international journal.
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Karen Siebert:
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Oh yes, it is international.
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Howard Farran:
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It is Quintessence Publishing, and you know the woman behind that?
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Karen Siebert:
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Yes, yeah. I have met her. I don't know her super well.
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Howard Farran:
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You're going to introduce us?
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Karen Siebert:
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Yeah, I'd love to. I'm going to take a two day course from her in May, about learning how to put more evidence-base into what we write, because that's just something that's so hard, to make sure that you're getting good studies into what you're writing.
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Howard Farran:
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I have to throw myself under a bus here because it's going to offend a lot of people. Humans are always extremist, and some of the evidence-based purists, it reminds me of growing up where everyone was quoting the Bible, "The Bible said this, the Bible said that." The problem with the evidence-based deal, that's no greater point to start, but then when you stand back and realize that 100 years from now everything we believe is going to be wrong. I'll give you two examples of my lifetime, I got out of college, and I went and took physics. When I was 18 they told us that the atom was 99.99999% empty space, you had this nucleus proton and the electron flying around the edge at the speed of light. Then 25 years later, "Oh did we say it was 99.99999% empty space? We meant that it was filled with dark matter, that it was 1,000 times more dense than all the energy, it's like standing in the bottom of the ocean." I was like, "How did you go from 99.99% empty space?" There's just so many things.
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The other thing I didn't understand in oral pathologies, they'd always say, "Smoking, cancer you get from smoking and drinking and toxins," and I said to myself, "If you put all those toxins in a room full of rabbits they'd all die." That is the opposite of cancer. Cancer, these rabbits are dividing every 20 minutes. You keep saying, "toxins," but it looks like powerful fertilizer because the cancer shit is growing out of control. Now it is 25 years later and they're like, "Oh, maybe that oral cancer was the Human papillomavirus that got in the nucleus and told it to turn on and start dividing every 20 minutes." It seems like maybe I'm being too much of a skeptic but it seems that 25 years ago when they said, "This is caused by stress and toxins," everything that the religious people get mad at you for, and then anything they solved, it turned out it was virus. It's almost like stress causes everything that they haven't found out what it causes yet.
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The evidence-based journals are like, "Here's the evidence." Okay, here's the evidence but 1,000 years from now we're going to look like the Flintstones. You've got to be a moderate, the evidence is the best place to start but then you've got to be realistic and just say, "Does this work? Is this working for you," because that's what dentists, at the end of the day, they go on and they'll say, "I know you say that everything I'm doing is wrong but it's been working in my hands on my patients for 25 years, so how do you argue with that?"
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Karen Siebert:
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That's what I find with lasers. Everyone in practice out there is saying, "It's working for me," and yet if you saw the latest evidence-based meta analysis of that, they're saying they really don't have good evidence on it. What are we to say to that? We've got all these people saying it's working.
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Howard Farran:
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Then you've got the human psychology of the patient, that comes in and pays a bunch of money and gets treatment with a laser, how does that change your behavior? Now they've invested this money, so now they're going to brush and now they're going to floss. Our patients' mind, our patients' mental health is ten times more important than their oral health, and I've just seen people in my own office that when you tell them you're going to put a laser on them their eyes get real big ...
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Lewis Meyers:
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Oh it's a sexy word.
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Howard Farran:
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Then they feel confident and, "Will you treat it with a laser?" If I just think that no matter what my mama had bad teeth, my daddy had bad teeth, my mama had a denture, my daddy had a denture, my grandma had a denture, and all this bullshit, but they didn't get treated with a laser. Now there's lasers and now they're like, "Now I see hope, so now I am going to brush, now I am going to floss, now I am going to do all these things that you and I always do." How does that figure into your meta analysis study?
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Karen Siebert:
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Right, yeah. It is a good place to start, and there's so much stuff and [crosstalk 00:33:57] and I bet you'd like her, yeah. I saw a course given by her.
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Howard Farran:
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So many things we could do. We might want to do that hands on course in Phoenix.
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Lewis Meyers:
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I'll tell you something else about hands on. One of the things I loved to do is put our composite placement instruments into dentists' hands as far as hands on opportunities because these instruments are surface engineered just like sharpen-free XP technology instruments are, but obviously it's not a sharpen-free thing, it's a defect-free surface thing, because at its very core XP, the manufacturing process is a filtering process, so no impurities, no macro-micro particles ever make its way to the instrument's surface. Even under intense magnification it's as smooth as a mirror. Put those instruments into dentist hands and play with some composites. Yeah.
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Karen Siebert:
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The composite just slides off.
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Howard Farran:
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Do you live in Missoula, Montana?
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Lewis Meyers:
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I live in Dallas. I'm in our home office.
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Howard Farran:
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How many people live in Missoula?
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Lewis Meyers:
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Missoula is about 75,000 people. It's big enough to have a Costco. They've got a Costco.
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Howard Farran:
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I tell you what, everybody in Phoenix, in the winter it's 10% Canadians. A lot of those Canadians are up in Winnipeg, and to drive down there for the winter, they drive down Winnipeg, through Montana, Idaho, Utah.
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Karen Siebert:
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Wow, what a drive.
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Howard Farran:
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It's about a 20 hour drive and everybody that's ever driven it has said, "That is the prettiest, coolest." You go through the Grand Canyon, Brice Canyon, Utah, Montana. That's some of the prettiest territory on earth.
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Karen Siebert:
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Yeah, and I've gotten to go to Missoula a couple of times to see the company and what a gorgeous area.
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Lewis Meyers:
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Things shut down. They shut down the factory completely at noon on Friday during the warm spring and summer months because it's a long winter and they want to get out and enjoy the beauty that is Montana.
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Howard Farran:
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I practice in Phoenix and I've been telling Ryan for 30 years, if I was smart I'd figure out a way to practice in Phoenix in the winter and Montana, Idaho, or Alaska in the summer. I'm still trying to figure it out.
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Lewis Meyers:
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You need to come visit us this summer. I typically set up a summertime visit for hygienists and dentists to come and just spend a couple of days and see what we do, and love to have you.
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Howard Farran:
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I would do it. That would be fun. That would be very fun. Hey, thanks for stopping by and telling us about all this stuff. Like I said, none of these companies, no one gives them money. There's no money trans-hand, none of this stuff. I wanted Lewis on because of that thread. That thread exploded and I thought it was onto something. By the way, I want to say one more thing about that thread. When we started Dental Town a lot of people would email me and say, "Oh my God, there's a manufacturer on here. You've got to ban him." I'm like, "What?" I called it Dental Town.
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I own Dentist Town, I didn't call it Dentist Town because I always felt a lot of dentists would say when a dental manufacturer was on there and say, "Why do you have a new one? He's trying to make money." Dude, aren't you trying to make money? Do you do free crowns and root canals? In my office, if you took away 500 dental companies, now I don't have any implants, now I don't have any lasers, now I don't have any cav-cam, I don't have any digital radio, I don't have any instruments you can't scale. I figure, my office, if you closed down 500 dental manufacturers I would be sitting outside on a rug with a bunch of shit from Home Depot doing the worst dentistry in the world.
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The reason I want dental manufacturers on the site, if you're listening to this and you are dental manufacturers, is that if all the dentists on Dental Town are saying, "They make it red. It would be so nice if they made it blue," well dude, your manufacturers need to know. I can tell you, I know Lewis, if you had a problem with his product or you had a dream or you said, "God Lewis, if you just did this," if he don't know it ain't ever going to happen and that's why it's Dental Town not Dentist Town because you guys make us look good. The minute we lose the dental manufacturers we're horrible.
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Lewis Meyers:
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Let me tell you, I take very seriously the threads and the site and the last thing I ever want to be called is Joe Sales guy, even though I know I am, that's my title. However, if I'm ever going to post anything on the site I just want to be able to put accurate information out there that hopefully helps somebody.
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Howard Farran:
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I love it because you have the passion, you like to sell. A lot of dentists say, "I don't like to sell." It's like dude, I've had women that when I pulled all their teeth and place a denture, they told me they thought of killing themselves for a long time, for the first 90-60 days the thought crossed their mind several times, they're just done. They lose their self-esteem, they lose their mental health. They're older, their husband left them, they've got stretch marks, now they don't have any teeth, and then when you say that you don't want to sell dentistry I think you need to get out of dentistry. If you're a dentist and you say, "I don't like to sell dentistry," get the freak out. Dentistry doesn't need a bunch of dentists who don't have enough self-esteem to say, "No, spending your money on dentistry is a thousand times better than spending your money at Wally-world or buying red widgets or buying your four millionth toy for your granddaughter." Dentistry is serious stuff.
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When a dentist tells me he doesn't like to sell dentistry I always think, "Do you not understand what you do? Do you not understand how important this is?" I'll say you to, last question to you, how much money would I have to give you to pull your front tooth and you could never replace it for the rest of your life?
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Karen Siebert:
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There's not enough money in the universe.
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Howard Farran:
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What if it was a million dollars cash?
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Karen Siebert:
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No, no way. I would lose my self-esteem, I would be done, just like you talked about those women. I would never smile and I can't imagine that.
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Howard Farran:
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Yeah, but you'd still be the hottest woman in Missoula, Montana.
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Karen Siebert:
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I don't think so. You should see, there's quite a few. It's a college town too.
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Howard Farran:
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If she won't take a million bucks to lose her front tooth, it's that important to her self-esteem and then you tell me that you don't like to sell dentistry. Dude, you're messed up in the head. You should be proud that this is the service you provide because half the shit at my house no one ever needed. Half the stuff my boys buy they don't ever need, but dentistry you need. You need health. The only true wealth is health, and when women lose their teeth, when men lose their health, when you fall apart it's over. Thanks for all you do for dentistry, and I hope we do a lot more stuff in the future.
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Lewis Meyers:
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Absolutely, love to.
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